by J. Haas, L. Bellows, and J. Li* (3/14)
- Gluten is a storage protein found in wheat, barley, and rye.
- Celiac disease is a genetic disease where gluten in the diet causes the immune system to attack the cells in your own body.
- The only treatment for celiac disease is a lifelong, gluten-free diet.
What is Gluten?
Gluten is the general name for one of the proteins found in wheat, barley and rye. Gluten containing foods can be part of a healthful, balanced diet; however, some people may suffer from conditions, which may require elimination of gluten from the diet.
There are three common medical conditions associated with gluten that susceptible individuals may encounter— celiac disease, gluten sensitivity, and gluten intolerance. These conditions are all commonly used to describe individuals with adverse physiological conditions related to gluten. It is harmful for someone with celiac disease to eat foods that contain gluten. It is not recommended, however, that individuals who do not suffer from one of these conditions follow a gluten-free diet.
What is Celiac Disease?
In people with a genetic susceptibility, celiac disease results from eating gluten, which triggers an immune response to attack the lining of the small intestine. The process may also damage other areas of the body. Damage to the small intestine interferes with absorption of nutrients and increases the risk for diseases like bone disease, anemia and intestinal cancer. Right now, the only effective treatment for celiac disease is a lifelong, gluten-free diet.
What is Gluten Sensitivity?
Non-celiac gluten sensitivity is used to describe people with non-specific symptoms such as nausea, abdominal cramps, or diarrhea after eating gluten. Gluten sensitivity involves an immune reaction to gluten. However, unlike celiac disease, that reaction does not involve the production of damaging antibodies that cause intestinal damage.
What is Gluten Intolerance?
Gluten intolerance is commonly used to describe individuals who have symptoms after eating gluten, and who may or may not have celiac disease. Similar to gluten sensitivity, these symptoms may include nausea, abdominal cramps, or diarrhea.
Diagnosing Gluten Intolerance, Gluten Sensitivity or Celiac Disease
If you experience these symptoms when consuming gluten, you should consult a doctor before eliminating gluten from your diet. There may be an underlying medical condition, for which a gluten-free diet is not the treatment.
If you have just been diagnosed with celiac disease, gluten sensitivity, or gluten intolerance, you may be feeling confused, stressed and concerned about diet changes. This is normal, but this step-bystep guide can help you through the first days of your gluten-free life. The damage caused by celiac disease is reversible, and you will often feel better within a few weeks. The day-to-day reality of following a gluten-free diet is challenging in the beginning, but it can be done and will get easier with practice. Even if you don’t feel sick after eating gluten-containing foods, you can still damage your body. While avoiding gluten-containing foods may seem difficult at first, it is easy to identify them once you are familiar with their names. To get started, see the list of gluten-containing foods and ingredients provided at the end of this fact sheet (List 1). Take the list with you when you shop or eat out.
10 Steps to the Gluten-Free Diet
Switching to a gluten-free diet can be difficult in the beginning. Following these 10 steps can make the changes easier.
Step 1. Identify Naturally Gluten-Free Foods at Home
Many foods are naturally gluten-free. Before you buy expensive store-bought gluten-free breads and cereals, look in your kitchen cupboards and refrigerator for the following items. Note that ‘Plain’ refers to no additives.
- Fresh fruits
- Fresh beef, pork, chicken, turkey, fish, and seafood
- Fresh eggs
- Fresh, plain milk, butter, margarine, cream
- Plain beans
- Plain corn
- Plain white rice, brown rice, wild rice
- Plain nuts and seeds
- Sugar, honey, molasses
- Spices and herbs
Step 2. Identify Gluten-Free Packaged Foods at Home
Next, take out all of the packaged foods with food labels and put them on your kitchen table. Some packaged foods have gluten hidden in the ingredients. A list of Common Sources of Hidden Gluten is provided for you at the end of this fact sheet (List 2). Read the ingredient lists. If you find any sources of gluten in the ingredients, do not eat that food. You can either get rid of the gluten-containing foods or place them in a separate part of the cabinet so others in the household can eat them. Labeling laws now require wheat ingredients to be clearly labeled, however this does not necessarily mean the food is gluten-free. A gluten-free label, on the other hand, identifies a food that is safe to eat.
Step 3. Plan One Week’s Menu Around Naturally Gluten-Free Foods
Looking for a place to start? Try these suggestions:
- Cream of rice cereal with fresh fruit or nuts
- Cottage cheese or yogurt with fresh fruit
- Scrambled eggs, bacon and fresh fruit
- Egg, cheese, and vegetable omelet with potatoes and fresh fruit
Lunches and Dinners
- Baked potato with cheese and vegetables
- Corn tortillas with stir-fried meat and vegetables
- Stir-fried meat and vegetables with rice and wheat-free tamari
- Bean-and-cheese burritos made with corn tortillas
- Grilled meat or fish, baked potato and vegetables
- Plain rice cakes with cheese or peanut butter
- Nachos made with plain corn chips, cheese and salsa
- Celery sticks with cream cheese or peanut butter
- String cheese
- Plain popcorn with oil and salt
- Fresh or canned fruit with yogurt or ice cream
Step 4. Make a Gluten-Free Shopping List
After you have planned your one week’s menu, make a gluten-free shopping list for foods you wish to buy. See sample Gluten-Free Shopping List (List 3) at the end of this fact sheet.
Step 5. Read Food Labels Every Time You Buy
Some, but not all products will be labeled as gluten-free. Ingredients may change over time for the same brand product. For foods that are not labeled as gluten-free, be sure to check the ingredients for hidden gluten every time you buy a packaged product. Take the Shopping Guide: Sources of Gluten (List 4) provided at the end of this fact sheet with you when you go food shopping. However, when purchasing items with a gluten-free label, you can be sure that it is gluten-free. In August 2013, the U.S. Food and Drug Administration (FDA) published a new regulation defining the term “gluten-free” for food labeling. The regulation provides a uniform standard definition. So, if a manufacturer labels a product “gluten-free,” the food must meet all of the requirements of the definition, including that the food must contain less than 20 parts per million of gluten. The rule also requires foods with the claims “no gluten,” “free of gluten,” and “without gluten” to meet the definition for “gluten-free.”
Step 6. Avoid Cross-Contact
If you also shop and prepare food for people who do eat gluten-containing foods, it is important to protect your gluten-free foods from contact with gluten.
- Buy two jars of jam, mayonnaise, and peanut butter. One is for you, and the other is for everyone else. A knife with bread crumbs will leave gluten behind in a shared jar. Be sure to label which jar is gluten-free. You can also buy squeeze bottles so nobody needs to use a knife.
- Buy a separate toaster for gluten-free breads, or put clean aluminum foil on the rack of your toaster oven when you use it for gluten-free products. Buy a separate colander/strainer for gluten-free pasta. Colanders are too hard to clean to completely remove gluten. Color coding with a permanent marker can help keep all kitchen utensils separate.
- Clean counter tops and cutting boards often to remove gluten containing crumbs.
- Clean cooking utensils, knives, pans, grills, thermometers, cloths, and sponges carefully after each use and before cooking gluten-free foods.
- Store gluten-free foods above gluten-containing foods in your refrigerator and cupboards. By doing this you prevent the risk of gluten-containing food particles falling below onto gluten-free foods, causing contamination.
- Use pure spices rather than blends.
- If you bake with gluten-containing flours, put away or cover your gluten-free foods when you bake. Flour dust can float in the air for several hours and contaminate your gluten-free products.
- Avoid purchasing staples from bulk bins to minimize cross contamination.
Step 7. Eat Out and Travel Gluten-Free with Ease
You can eat out at restaurants. Although there is concern for cross-contact when you eat out, you can reduce the risk by planning ahead.
- Before you leave home, do a little homework. Many restaurants have a website where they post their menus. Write down all the choices that are gluten-free. Often a menu with gluten-free options is available on request.
- Avoid bakery-type restaurants or pizza places where the gluten-containing flour can stay in the air and come in contact with other foods.
- Call ahead and talk to the manager or chef about items that are prepared gluten-free.
- Make your first visit to a restaurant before or after peak dining hours so the staff has enough time to answer your questions.
- Always identify yourself as someone who is allergic to wheat, rye and barley. Though many people may be familiar with the term “gluten-free,” they may not know what foods contain gluten. Bring your own gluten-free food when traveling. This way, you will always have something you can eat. Apples, raisins, fruit leather, rice cakes, and nuts are good travel snacks.
- Always ask how the
food is prepared. Talk to the manager or chef if your server doesn’t know. Some
specific questions to ask include:
- Is the meat marinated in soy sauce, teriyaki sauce, or Worcestershire sauce?
- Is the chicken dusted with flour before pan-frying?
- Is the oil used for French fries also used for frying onion rings (or other breaded foods)?
- Are there croutons or bacon bits on the salad?
- Do you use wheat flour to make the gravy (or thicken the soup)?
- If your meals will be prepared for you (hospital, college dining hall), ask to speak with the dietary manager.
Step 8. Eat a Balanced Diet
People on a gluten-free diet may not get enough calcium, vitamin D, iron, B vitamins, or fiber. For example, many gluten-free breads, cereals, and pasta are not fortified with vitamins and may be low in fiber. Are you getting enough nutrients from your diet? If not, be sure to include some nutrient dense gluten-free foods listed below and/or take a multivitamin and mineral supplement. Additionally, look for “whole grain” versions that contain the bran layer (rice bran, brown rice, brown rice flour). Variety is key to maximize protein, fiber, and nutrients.
Table 1. Nutrient Dense, Gluten-Free Foods
Milk, yogurt, cheese, sardines and
salmon with bone, broccoli, collard greens,|
almonds, calcium-fortified juice, amaranth, teff, quinoa
|Iron||Meat, fish, chicken, beans, nuts, seeds, eggs, amaranth, quinoa, teff|
|B Vitamins||Eggs, milk, meat, fish, orange juice, beans, nuts, seeds, gluten-free whole grains|
|Vitamin D||Vitamin D-fortified milk and yogurt, egg yolks, salmon, sardines, tuna|
Vegetables, fruits, beans,
amaranth, quinoa, millet, buckwheat, sorghum, teff,|
Step 9. Identify Any Additional Food Intolerances
If you are not feeling better on a gluten-free diet, you may have other food intolerances such as lactose (milk sugar), cow’s milk, soy, corn, eggs, nuts, yeast, and acidic foods. Talk to your doctor and registered dietitian if you are not feeling better on a gluten-free diet.
Step 10. Get Support
For a successful transition to the gluten-free lifestyle, you need support from your doctor, dietitian, family, friends, and others.
If you have celiac disease, joining a local support group can be very helpful. Individuals in this group understand what you are going through better than anyone else. They will be able to offer you emotional support and answer all many of the questions you have. For a list of support groups, see the Resources section.
List 1. Gluten-Containing Foods and Ingredients (This is not a complete list.)
|Autolyzed yeast||Emmer||Malt extract, malt syrup, malt flavoring, malt vinegar||Soy sauce|
|Barley (pearl, flakes, flour)||Farina||Malted milk||Spelt|
|Beer (gluten-free beer is available)||Faro/Farro||Matzoh||Triticale|
|Brewer’s yeast||Fu||Modified food starch||Wheat|
|Bulgur||Gluten, gluten flour||Oats*||Wheat bran|
|Chapatti||Graham flour||Orzo||Wheat flour|
|Couscous||Hydrolyzed vegetable/plant protein||Rye||Wheat germ|
|*Those labeled gluten-free are fine. Oats do not contain gluten, but have the risk of cross-contact during harvesting or processing.|
List 2. Common Sources of Hidden Gluten (This is not a complete list.)
|Blue cheese crumbles||French fries||Meat loaf||Self-basting poultry|
|Breading||Gravy||Nuts||Soups, soup bases|
|Broth, bouillon||Herbal Teas||Processed meat||Soy sauce|
|Cereal binding||Icing/frosting||Rice mixes||Thickeners|
|Chocolates||Imitation seafood||Roux||Vegetarian “burgers”|
|Color (artificial, caramel)||Imitation bacon||Salad dressings|
|Dry roasted nuts||Maltodextrin||Sausage|
List 3. Sample Gluten-Free Shopping List
|Milk*||Cheddar cheese||Cream cheese*||Butter|
|Yogurt*||Cottage cheese*||Sour cream|
|Binders (for baking)|
|Xanthan gum||Guar gum||Tapioca|
|Canned and Packaged Foods|
|Peaches||Pears||Green beans||Dried beans|
|Rice* (all forms, even glutinous)||Amaranth||Buckwheat||Soy|
|Quinoa||Arrowroot||Potato flour, starch||Teff|
|Millet||Bean flours (garbanzo, fava)||Sorghum||Tapioca (manioc, cassava)|
|Popcorn*||Corn chips*||Nuts and seeds*||Jello|
|Rice cakes, rice crackers*||Potato chips*|
|Honey||Jams, jellies, marmalade||Herbs||Pickles|
|Ketchup||Corn and maple syrup||Salt||Vinegars|
|Mustard||Sugar||Pepper||Regular mayonnaise and salad dressings*|
|Peanut butter||Spices||Olives||Vegetable oils|
|*With no gluten-containing additives.|
List 4. Shopping Guide: Sources of Gulten (This is not a complete list. If in doubt, choose another brand.) Read labels every time you buy! Ingredients can change at any time.
|Foods to Avoid|
|Atta||Dry roasted nuts||Licorice||Seitan|
|Autolyzed yeast||Durum||Malt||Self-basting poultry|
|Baked beans||Einkorn||Malt extract, malt syrup, malt flavoring||Semolina|
|Barley (pearl, flakes, flour)||Emmer||Malted milk||Soups, soup bases|
|Beer (gluten-free beer is available)||Farina||Marinades||Soy sauce|
|Brewer’s yeast||Flavoring||Meat loaf||Stuffing|
|Broth, bouillon||Fu||Modified food starch||Textured vegetable protein (TVP)|
|Brown rice syrup||Gelantized starch||
|Bulgur||Graham flour||Oats (not labeled gluten-free)||Triticale|
|Cereal binding||Gravy||Processed meat||Wheat|
|Chocolate bars||Hydrolyzed vegetable/plant protein||Roux||Wheat bran|
|Color (artificial, caramel)||Icing/frosting||Rye||Wheat flour|
|Communion wafers||Imitation seafood||Salad dressings||Wheat germ|
|Couscous||Imitation bacon||Sauces||Wheat starch|
Major National Celiac Support Groups (they will give you information on local groups)
Gluten Intolerance Group; www.gluten.net
Celiac Disease Foundation; www.celiac.org
Celiac Sprue Association-USA; www.csaceliacs.org
Canadian Celiac Association; www.celiac.ca
Professional and Government Websites
American Dietetic Association; www.eatright.org
Celiac Center at Columbia University; www.celiacdiseasecenter.columbia.edu
Celiac Disease and Gluten-free Resource; www.celiac.com
Center for Celiac Research & Treatment at MassGeneral Hospital for Children; www.celiaccenter.org
National Institutes of Health; digestive.niddk.nih.gov/ddiseases/pubs/celiac/
University of Chicago Celiac Disease Program; www.uchospitals.edu/specialties/celiac/index.php
Guides for Gluten-Free Dining Out and Travel
Bob and Ruth’s Gluten-Free Dining & Travel Club; www.bobandruths.com
Gluten Free on the Go; www.gluten-free-onthego.com
Gluten-free Restaurant Awareness Program; www.glutenfreerestaurants.org
The Essential Gluten-Free Restaurant Guide
Triumph Dining Cards; www.triumphdining.com
Waiter, is There Wheat in my Soup? The Offiicial Guide to Dining Out, Shopping, and Traveling Gluten-Free and Allergen-Free by LynnRae Ries; www.whatnowheat.com
100 Best Gluten-Free Recipes by Carol Fenster http://savorypalate.com/index.php/100-best-gluten-free-recipes/
Easy Everyday Gluten-Free Cooking by Donna Washburn and Heather Butt www.csaceliacs.info/shop.jsp
Gluten-Free Living; www.glutenfreeliving.com
Sully’s Living Without Magazine; www.livingwithout.com
Resources & References
Case, S., Heap, J., Raymond, N. (2006). The Gluten-Free Diet: An Update for Health Professionals. Practical Gastroenterology. 67-92.
Children’s Digestive Health and Nutrition Foundation. (2005). Gluten-Free Diet Guide for Families. Retrieved from: http://www.naspghan.org/user-assets/documents/pdf/diseaseinfo/glutenfreedietguide-e.pdf
Cranney, A. et al. (2007) The Canadian Celiac Health Survey. Dig Dis Sci. 52(4) 1087-95.
Cureton, P. (2006) Gluten-Free Dining Out: Is It Safe? Practical Gastroenterology. 61-68.
Mahan, L., Escott-Stump, S., and Raymond, J. (2012). Food and the Nutrition Care Process. St. Louise, Missouri: Elsevier Saunders.
Niewinski, M. (2008). Advances in Celiac Disease and Gluten-Free Diet. Journal of the American Dietetic Association. 108 (4), 661–672.
Pagano, A. E. (2006). Whole Grains and the Gluten-Free Diet. Practical Gastroenterology. 66-78.
Thompson, T. et al. (2005). Gluten-free Diet Survey: Are Americans with Celiac Disease Consuming Recommended Amounts of Fiber, Iron, Calcium and Grain Foods? J Hum Nutr Diet. 18(3), 163-9.
U.S. Food and Drug Administration. (2013). FDA defines “gluten-free” for food labeling. Retrieved from: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm363474.html
*J. Haas, Colorado State University Extension specialist, and research associate; L. Bellows, Extension food and nutrition specialist, and assistant professor; and J. Li, former graduate student.3/09. Revised 3/14.
Colorado State University, U.S. Department of Agriculture, and Colorado counties cooperating. CSU Extension programs are available to all without discrimination. No endorsement of products mentioned is intended nor is criticism implied of products not mentioned.