Who needs a Gluten-Free Diet?
A gluten-free diet is the only treatment for those who have celiac disease, an autoimmune condition that is triggered by the ingestion of wheat, rye or barley, which causes damage to the villi (fingerlike projections) of the small intestine. In individuals with celiac disease, removing these specific grains causes the damage to heal, returning to a fully functional absorptive surface. Symptoms of active celiac disease may include weight loss,growth problems (in children), bloating, diarrhea or constipation, gas, abdominal cramps, and/or vitamin and mineral deficiencies. Symptoms are not just gastrointestinal, but there are some extra-intestinal symptoms including neurologic disorders, migranes, and behavioral problems. Additionally, a skin condition called Dermatitis Herpetiformis (DH) occurs in some individuals with celiac disease, which results an intense itchy skin eruption. It is important to recognize there are approximately 300 symptoms linked to celaic disease, and the gastrointestinal symptoms are more commonly found in children.
What is Gluten?
Gluten is a protein found in wheat, rye, and barley. It is the substance in flour that forms the structure of dough. It is the “glue” that holds the product together.
Where is Gluten Found?
Gluten Containing Grains to Avoid
Barley Faro Spelt
Barley malt/malt extract Graham Flour Triticale
Bran Kamut Udon
Bulgar Matzo Flour/Meal Wheat
Couscous Orzo Wheat Bran
Durum Panko Wheat Germ
Einkorn Rye Wheat Starch
Overlooked Gluten Sources*
Ales Broth Soy Sauce (may contain wheat)
Beer and Lagers Pasta Marinades/Thickeners
Breading Roux Herbal Supplements
Brown Rice Syrup Sauces Prescription Medications
Coating Mix Soup Base Over-the-counter Medications
Communion Wafers Stuffing Vitamin and Mineral Supplements
Croutons Self-basting Poultry Lipstick
Candy Imitation Bacon/Seafood Gloss and Balms
Luncheon Meat Modified Food Starch (may contain)
*These ingredients don’t always contain gluten, however the foods with these ingredients should be carefully reviewed to ensure they are not gluten-containing. Be sure to read all labels carefully. If a product has questionable ingredients, avoid it until the manufacturer confirms that the product is gluten-free. Labels must be read every time you purchase food because ingredients in a product can change at any time.
What foods can I eat on a Gluten-Free Diet?
Gluten-Free Grains and Starches
Amaranth Millet Rice Bran
Arrowroot Montina Saga
Buckwheat Potato Starch Sorghum
Corn Potato Flour Soy (soya)
Flax Quinoa Tapioca
Flours made from Rice Teff
Nuts, Beans, and Seeds Gluten Free Oats*
*Historically, oats were not recommended because it was thought that avenin (the storage protein found in oats) was also toxic to gluten-intolerant individuals. However, recent research in Europe and the US has described that oats are well-tolerated by most children and adults when consumed in moderation and do not contribute to abdominal symptoms, nor prevent intestinal healing. PLEASE NOTE: regular, commercially available oats are frequently contaminated with wheat or barley. However, “pure, uncontaminated” oats have recently become available from several companies in the US and Canada. These companies’ process oats in dedicated facilities and their oats are tested for purity. Pure, uncontaminated oats can be consumed safely in quantities < 1 cup per day. It is important that you talk to your physician and your registered dietitian prior to starting oats.
How do I start my new Gluten-Free Lifestyle?
Your first thought might be to stop at the grocery store on your way home from the hospital or doctor’s office to stock up on gluten-free labeled foods. However, pre-packaged gluten-free foods can be very expensive and high in calories, like many other packaged and processed foods. First, go home and check the labels of the food that you already have in your kitchen. Many of your favorite brands may already be gluten-free. This keeps you from having to read all the labels on your next shopping trip.
When shopping for a gluten-free diet, stay on the perimeter of the store. This is where you will find naturally gluten-free foods for balanced meals and snacks following the balanced plate principle of the 50-25-25 plate at meals and protein and fiber at snacks. Start your shopping trip with the fresh produce section. There are no worries in this section! Stock up on nutrient rich, low fat, low sodium fresh fruits and vegetables, for meals and snacks. Then, head into the fresh meat, poultry, and seafood section. All of these are naturally gluten-free, as long as, they do not have any breading or marinade added to them. Use caution when choosing luncheon meat and other processed meat. They may contain gluten as fillers or flavor enhancers, so read the labels carefully. After the meat section, it’s time to visit the egg and dairy sections of the grocery store. Keep in mind that eggs are a protein and therefore on the protein section of the balanced plate; and dairy in the carb section of the plate, as dairy is both a protein and carbohydrate source. Most of these products are gluten-free, so once again, check the labels. Calcium-rich desserts and snacks, like yogurt and cheese, are excellent choices for a gluten-free diet. Within the inner isles of the grocery store, look for these healthy options to increase your variety of balanced plate options:
- Corn Tortillas
- Plain Rice (Brown or Wild for more fiber!)
- Dried or canned Beans and Legumes
- Spices and Herbs
- Nuts and Nut Butters
- Cooking oils (except Canola oil, it may have traces of gluten)
- Canned vegetables and fruit
- Cereals: General Mills Chex Cereal (Cinnamon, Honey Nut, Rice, Corn, and Chocolate Only), Kellogg’s Gluten Free Rice Krispies, Nature’s Path, Glutino’s, Bob’s Red Mill, Arrowhead, and Udi’s Granola, just to name a few brands.
- Other options, as well, just remember to READ THE FOOD LABELS
Many grocery stores now stock more grainy, carb options that are specifically gluten-free. Look in the Asian section for rice noodles and rice crackers. Check out the “organic” or “health food” section for Gluten-Free pastas, flours, and baking products. Specialty health food stores typically have Gluten-Free foods in the frozen food section. One can select Gluten-Free bagels, breads, or brown rice pizza crusts to defrost and warm at home. Some frozen food sections have Gluten-Free frozen meals as a convenient option.
Preparing Foods at Home…
When sharing a house with others who are not on a Gluten-Free diet, cross-contamination can be an issue. To prevent cross-contamination, here are some suggestions:
- Purchase separate jam, jelly, mayonnaise, and peanut butter to avoid wheat/bread crumbs in the shared jars.
- Purchase a separate toaster for gluten-free breads, or use a toaster oven that can be cleaned between uses, or place tinfoil on the rack to avoid contamination.
- Clean counter tops and cutting boards often to remove gluten-containing crumbs.
- Cooking utensils, colanders, and pans need to be cleaned carefully after each use and before cooking gluten-free products.
Can I enjoy eating a restaurants?
Being on a Gluten-Free diet does not mean that you will never be able to eat at a restaurant again. Dining out is a big part of our way of life and with a little effort and planning, it can continue to be enjoyed. Before leaving home, do your homework. Most restaurants have a website, so you can review the menu online to see if there are gluten free options available. Some restaurants have a Gluten-Free menu to order from: Outback, Uno’s Chicago Grill, Carrabba’s Italian Grill, PF Chang’s, Chili’s, Famous Dave’s, and many others. When you are ordering, first identify yourself as someone who is allergic to gluten and cannot eat wheat, barley, rye, or oats. Food items that you would never guess have flour in them, often do. Always make sure everyone is aware of your needs. Do not be afraid to ask how the food is prepared. Meats may be marinated in soy sauce. Hamburgers and hamburger buns may be grilled in the same area. A salad may not have croutons in it, but may arrive at your table with a breadstick across the top. All these methods can lead to gluten contamination. Most restaurants are aware of gluten-free needs, but never assume. Be pleasant and informative, if questions arise.
Are all Gluten-Free foods Healthy?
There are many specialty companies that produce excellent gluten-free products. Although they taste wonderful, the ingredients used may not be a healthy alternative. A gluten free cookie is still a cookie! Also, additional ingredients will need to be added to baked goods to replace the gluten, leading to a higher sugar and fat content. Therefore, good nutrition and eating a balanced diet is important in maintaining a healthy weight while eating gluten free. A balanced diet includes fruits, vegetables, lean proteins, dairy, and gluten free whole grains. Keep in mind, all carbs, which includes whole grains, starchy veggies, fruit and dairy, should just be ¼ of your plate for any meal.
Use these guiding principles for creating healthy meals and snacks:
- 50-25-25 Approach to Meals: 50% non-starchy vegetables, 25% lean protein, and 25% gluten free whole grain, starchy veggies, dairy, or fruit.
- Protein and Fiber at Snacks:
- Protein foods include, lean meats, legumes, nuts & nut butters, and dairy.
- Fiber foods include, fruits, vegetables, and gluten free whole grains.
- If you have diabetes, be sure to account for all carb choices as well.
GLUTEN FREE SAMPLE DAY
Gluten Free Oatmeal with ½ cup blueberries and 2 Tbsp Sliced Almonds
Greek Yogurt and 2 Tbsp Gluten Free Granola
Southwest Grilled Chicken Salad
(Salad vegetables, 3 oz chicken, ¼ cup black beans, ¼ cup corn, ¼ cup salsa, and 2 Tbsp Guacamole)
100 calorie pack of Almonds and Apple
Salmon with Steamed Vegetables and Herbed Quinoa
½ cup Frozen Kefir topped with ½ cup fresh berries
www.cureceliacdisease.org (University of Chicago Celiac Disease Center)