Celiac Disease

Gluten-Free Diet for Celiac Disease

An Overview of the Gluten-Free Diet

If you've just been handed a diagnosis of celiac disease or non-celiac gluten sensitivity, you probably were told to "go gluten free" (in some cases, with no more information than just that). If you've been researching the gluten-free diet on your own—perhaps because you believe it may help with a health challenge you're facing—you may know more about it.

In both instances, though, you may not realize that starting a gluten-free diet is a major dietary step to take, and one that comes with a steep learning curve.

So what exactly is involved in starting and following the gluten-free diet? Just eliminate gluten, right? Well, yes. But for many people, the starting point isn't jumping right into the diet. Instead, it's figuring out exactly what gluten is so that you can begin to understand what to eliminate.

Gluten is in many foods (including many in which you wouldn't expect to find it) and it's extremely difficult to avoid.

In fact, the learning curve on a gluten-free diet is equal to or greater than the learning curves on almost any other type of diet. You will get the hang of it eventually, but you'll learn more about food labeling and ingredient names than you ever thought you would need to know in the process.

You'll also make mistakes as you learn how to eat gluten-free. They're inevitable, so don't beat yourself up over them—even if your body beats you up because of them. Even when you've been eating gluten-free for a decade or more, you'll probably still make mistakes, although they likely won't be too severe.

What Is Gluten?

The gluten you need to avoid is a protein found in grains like wheat, barley, and rye. So, any food that contains wheat, barley, and rye thus contains gluten, such as bread, pasta, cakes, cookies, and most cereal. Gluten-containing grains are commonly used in foods because they have characteristics that are prized by food manufacturers. For example, wheat bread gets its distinctive, pleasing elasticity and texture from gluten, while cakes and pasta stick together instead of crumbling because of the gluten protein.

However, bread, cereal, and pasta represent only the tip of the gluten iceberg—gluten is an ingredient in many, possibly even the majority of, processed food products. In certain soups, gluten grains act as thickeners, allowing manufacturers and cooks at home to use less of expensive ingredients such as cream. Barley malt, meanwhile, is frequently used as a sweetener in candy and cookies. And in beer and some forms of liquor, gluten grains are fermented to make alcoholic brews.

There are some foods that always contain gluten, such as conventional bread products and pasta. But avoiding these just isn't enough if you're following a gluten-free diet. You need to eliminate every scrap of gluten—even the ingredients that are hidden.

Why Eat Gluten-Free?

Most people who follow a gluten-free diet do so because they're using it to treat a specific health condition. The best-known health condition that responds to a gluten-free diet is celiac disease. In fact, the diet was first developed to treat celiac, which is caused by an autoimmune reaction to the gluten protein.

Specifically, when those with celiac disease consume wheat, barley, or rye, the gluten in the grain triggers the immune system to attack the lining of the small intestine. This triggers celiac disease symptoms and can lead to malnutrition, anemia, osteoporosis, and many other potentially serious health consequences.

People with celiac disease must be gluten-free for life in order to alleviate symptoms and significantly reduce the risk for related conditions.

Even tiny amounts of gluten can keep immune systems in overdrive and prevent intestines from healing.  People with what's called non-celiac gluten sensitivity (also known as non-celiac wheat sensitivity) also follow a gluten-free diet. This condition was only recently recognized and isn't as well understood as celiac disease.

It's thought that those with gluten/wheat sensitivity are reacting to a compound in the grains (although not necessarily gluten) with symptoms that include digestive upset, headaches, and fatigue. Researchers haven't yet identified why some people experience these symptoms. However, they're considering various culprits, including gluten/wheat-induced leaky gut, in which a permeable intestinal lining allows proteins and microbes to escape into the bloodstream.

In those with gluten/wheat sensitivity, a gluten-free diet prevents symptoms just as it does in celiac disease.  Additionally, there are other conditions in which some people may benefit from going gluten-free, including thyroid disease, rheumatoid arthritis, and even type 1 diabetes.

Research into all of these conditions—and why the gluten-free diet appears to help alleviate symptoms in some cases—is ongoing.

Doctors recommend that people not start eating gluten-free before being tested for celiac disease. That's because you need to be consuming gluten for celiac disease testing to be accurate.  It can be important to know for sure whether you have celiac so that you can watch for related health conditions that might occur.

What Foods Contain Gluten?

To eat gluten-free, you'll need to avoid everything that contains wheat, barley, and rye. Getting rid of the obvious items—bread, pasta, crackers, and cookies—should be pretty easy (although it can be rough emotionally to let go of your favorite foods, even if you're replacing them with gluten-free substitutes).

The problem is that gluten can hide under various ingredients on a food label. Do you have a can of soup in your cupboard that contains "starch"? That starch might contain gluten. What about that candy with "natural flavors"? Potential gluten there, too. It's seemingly everywhere and you'll need to figure out where it hides in order to avoid it.

The U.S. Food and Drug Administration (FDA) does not require disclosure of gluten on food labels, although manufacturers can disclose it voluntarily under the FDA's gluten-free labeling rules. Legally, manufacturers must disclose wheat (one of the top eight allergens), but they don't need to disclose barley and rye.

Many companies do choose to make it easy for people to identify their gluten-free products without looking at the ingredients. They'll use bold labeling that states "gluten-free" or a symbol that means "gluten-free." Although gluten-free packaged products once were relegated to health food stores, the growing popularity of the diet has ensured that all kinds of gluten-free products can be found in many mainstream grocery stores. You can also purchase foods specifically certified gluten-free by an independent organization.

Other manufacturers, like Kraft Foods and Con Agra Foods, have policies of always disclosing ingredients that contain gluten in their food labels. In those cases, a gluten-containing starch would be labeled in the ingredients list as "starch (wheat)," while a gluten-containing natural flavor might read "flavoring (barley)." However, foods with no gluten ingredients aren't necessarily gluten-free since they could be subject to gluten cross-contamination in processing. 

How to Start a Gluten-Free Diet

Given all of this, you might think eating gluten-free seems a bit intimidating. But you can actually eat gluten-free without reading a single food label, just stick entirely to naturally gluten-free whole foods such as fresh fruits, vegetables, meats, poultry, and fish.

This, in fact, is the best way to start a gluten-free diet because it prevents you from making rookie mistakes while your body adjusts. This approach will also help you isolate any symptoms later on when you've added in more foods. Furthermore, it may help you consume more needed nutrients since packaged goods have less of those all-important vitamins and minerals than fresh, whole foods.

There's actually quite a long list of reliably and safely gluten-free foods. If you're shopping in the produce section, for example, all the fresh fruits and vegetables are safe to consume on a gluten-free diet (although anything that comes pre-packaged might not be). In the meat section, stick to beef, poultry, pork, and seafood that doesn't contain marinades or other added ingredients. Basically, as long as it's plain, it's safe.

Rice and quinoa are both good choices as a starch to add to your diet—just be certain to buy plain varieties with no added ingredients. Potatoes can also be a good choice, although you'll need to watch how they're prepared. Dessert can be a bit tricky since many of the classic go-to's contain gluten (think pie, cookies, and cakes). Ice cream may be a good choice—unless you're lactose intolerant, a common problem in those with celiac disease.  Be especially careful to stick to an ice cream brand and flavor that's considered gluten-free (yes, ice cream can contain gluten).

Avoid Trace Amounts

You may be surprised to find that once you've started eating gluten-free, your body will react to even tiny amounts of gluten with a replay of old symptoms or even new ones you weren't expecting. Such symptoms may include digestive upset and fatigue. Unfortunately, this is pretty common after a gluten exposure and can take several days, or more, to feel like yourself again.

Also, some people are just more sensitive to gluten cross-contamination than others. Unfortunately, this means they have to be extra careful.  Regardless of where you wind up falling on the sensitivity scale, you'll need to do some homework when you first go gluten-free to minimize the chance of an accidental glutening. Specifically, you'll need to:

There are ways to make the process of going gluten-free easier. You can, for example, download a smartphone app to help you identify products and restaurants that cater to those who are gluten-free. You can also check in with your favorite grocery store to see if it maintains lists of gluten-free products or labels the products on their shelves. And, you can bring your own food to gatherings where you don't think the food provided will be gluten-free enough for you. 

Overall, starting a gluten-free diet and consistently eating gluten-free will force you to become far more aware of what goes into your food and how it's made. But the benefit of better health should make all that extra study worthwhile.


National Institute of Digestive and Diabetes and Kidney Disease. Celiac Disease.

U.S. Food and Drug Administration. Gluten-Free Labeling of Food.

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