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Table of Contents

• Quick Facts…
• What is Celiac Disease?
• What is Gluten?
• 10 Steps to the Gluten-Free Diet
• List 1. Gluten-containing Foods and Ingredients
• List 2. Common Sources of Hidden Gluten
• List 3. Sample Gluten-free Shopping List
• List 4. Shopping Guide: Sources of Gluten
• Resources

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Quick Facts…

• Celiac disease is a genetic disease where gluten in the diet causes the immune system to attack the cells in your own body.
• Gluten is a storage protein found in wheat, barley, and rye.
• The only treatment for celiac disease is a lifelong, gluten-free diet.

If you have just been diagnosed with celiac disease, you may be feeling confused, stressed and concerned about diet changes. This is normal, but this step-by-step 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.

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?

Gluten is the general name for one of the proteins found in wheat, barley and rye. It is harmful for someone with celiac disease to eat foods that contain gluten. 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 will 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.

• Fresh, frozen or canned fruits
• Fresh beef, pork, chicken, turkey, fish, and seafood
• Fresh eggs
• Fresh, plain (unflavored) milk, butter, margarine
• Fresh or low sodium canned vegetables
• Plain beans
• Plain corn
• Plain white rice, brown rice, wild rice
• Plain nuts and seeds
• Potatoes
• Oils
• Sugar, honey, molasses
• Spices and herbs

* Plain = no additives

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

Don’t know where to start? Try these suggestions:

Breakfasts

• 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 low-fat cheese and vegetables
• Corn tortillas with stir-fried meat and vegetables
• Stir-fried meat and vegetables with rice and wheat-free low sodium sauce
• Bean-and-cheese burritos made with corn tortillas
• Grilled meat or fish, baked potato and vegetables

Snacks

• Plain rice cakes with cheese or nut butter
• Nachos made with plain corn chips, cheese and salsa
• Celery sticks with cream cheese or nut 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

Occasionally, ingredients change for the same brand product. So, you must check the ingredients for hidden gluten every time you buy a packaged product. Always take the Shopping Guide: Sources of Gluten (List 4) provided at the end of this fact sheet with you when you go food shopping.

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.
• 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.

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. The staff may not understand the word “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 with celiac disease may not get enough calcium, vitamin D, iron, B vitamins, or fiber on a gluten-free diet. 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.

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, or nuts. Talk to your doctor and 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 other people living with celiac disease.

Joining a local celiac disease support group can be very helpful. These people understand what you are going through better than anyone else. They will be able to offer you emotional support and answer all the questions you have. For a list of support groups, see the Resources section.

Remember, you are fortunate that celiac disease has a known treatment and that the damage is reversible. With practice, you can manage this condition with ease. Good luck!

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List 1. Gluten-containing Foods and Ingredients

List 2. Common Sources of Hidden Gluten

This is not a complete list. Ale Atta Autolyzed yeast Barley (pearl, flakes, flour) Beer (gluten-free beer is available) Brewer’s yeast Bulgur Chapatti Couscous Dinkel Durum Einkorn Emmer Farina Faro/Farro Fu Gluten, gluten flour Graham flour Hydrolyzed vegetable/plant protein Kamut Lager Malt Malt extract, malt syrup, malt flavoring, malt vinegar Malted milk Matzoh Modified food starch Oats* Orzo Rye Seasoning Seitan Semolina Soy sauce Spelt Triticale Wheat Wheat bran Wheat flour Wheat germ Wheat starch *Those labeled gluten-free are fine. Oats do not contain gluten, but have the risk of cross-contact during harvesting or processing.

This is not a complete list. Baked beans Blue cheese crumbles Breading Broth, bouillon Candy Cereal binding Chocolates Color (artificial, caramel) Communion wafers Dry roasted nuts Flavoring French fries Gravy Herbal Teas Ice cream Icing/frosting Imitation seafood Imitation bacon Licorice Maltodextrin Marinades Meat Loaf Nuts Processed meat Puddings Rice mixes Roux Salad dressings Sauces Sausage Seasonings Self-basting poultry Soups, soup bases Soy sauce Stuffing Thickeners Vegetarian “burgers”

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List 3. Sample Gluten-free Shopping List

List 4. Shopping Guide: Sources of Gluten

Vegetables Broccoli Cabbage Carrots Celery Lettuce Potatoes Tomatoes Fruits Apples Bananas Grapes Oranges Meat, Proteins Beef Chicken Eggs Fish Pork Turkey Shrimp Dairy Butter Cheddar cheese Cottage cheese* Cream cheese* Milk* Sour cream Yogurt* Binders (for baking) Guar gum Tapioca Xanthan gum Frozen Foods Berries Corn Gluten-free waffles Mangoes Peas Sorbet Canned and Packaged Foods Dried beans Green beans Peaches Pears Gluten-free Grains Amaranth Arrowroot Bean flours (garbanzo, fava) Buckwheat Corn Millet Potato flour, starch Quinoa Rice* (all forms, even glutinous or “sticky” rice) Sorghum Soy Tapioca (manioc, cassava) Snacks Corn chips* Jello Nuts and seeds* Popcorn* Potato chips* Rice cakes, rice crackers* Condiments Corn and maple syrup Herbs Honey Jams, jellies, marmalade Ketchup Mustard Olives Peanut butter Pepper Pickles Regular mayonnaise and salad dressings* Salt Spices Sugar Vegetable oils Vinegars Drinks Coffee Fruit juice Tea *With no gluten-containing additives.

Foods to Avoid This is not a complete list. If in doubt, choose another brand. Read labels every time you buy! Ingredients can change at any time. Ale Atta Autolyzed yeast Baked beans Barley (pearl, flakes, flour) Beer (gluten-free beer is available) Breading Brewer’s yeast Broth, bouillon Brown rice syrup Bulgur Cereal binding Chocolate bars Color (artificial, caramel) Communion wafers Couscous Dextrin Dinkel Dry roasted nuts Durum Einkorn Emmer Farina Faro Flavoring Fu Gelantized starch Graham flour Gravy Hydrolyzed vegetable/plant protein Icing/frosting Imitation seafood Imitation bacon Kamut Lagar Licorice Malt Malt extract, malt syrup, malt flavoring Malted milk Marinades Matzoh Meatloaf Modified food starch Mono- and di-glycerides Oats (not labeled gluten-free) Processed meat Roux Rye Salad dressings Sauces Sausage Seasonings Seitan Self-basting poultry Semolina Soups, soup bases Soy sauce Spelt Stuffing Textured vegetable protein (TVP) Thickeners Triticale Wheat Wheat bran Wheat flour Wheat germ Wheat starch

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Resources

Major National Celiac Support Groups (they will give you information on local groups)

• Gluten Intolerance Group; 206.246.6652
• Celiac Disease Foundation; 818.990.2354
• National Celiac Association; 1.888.4.CELIAC
• Canadian Celiac Association; 905.507.6208

Professional and Government Websites

• Academy of Nutrition and Dietetics
• Celiac Center at Columbia University
• Celiac Disease and Gluten-free Resource
• Center for Celiac Research and Treatment, MassGeneral Hospital for Children
• National Institutes of Health
• University of Chicago Celiac Disease Program

Resources and References

• Cureton, P., Gluten-Free Dining Out: Is It Safe? Practical Gastroenterology, 2006: p. 61-68.
• Gluten-Free Diet Guide for Families. 2005, Children’s Digestive Health and Nutrition Foundation
• Thompson, T., et al., Gluten-free diet survey: are Americans with celiac disease consuming recommended amounts of fiber, iron, calcium and grain foods? J Hum Nutr Diet, 2005. 18(3): p. 163-9.
• Cranney, A., et al., The Canadian Celiac Health Survey. Dig Dis Sci, 2007. 52(4): p. 1087-95.
• Case, S., Heap, J., Raymond, N. (2006). “The Gluten-Free Diet: An Update for Health Professionals.” Practical Gastroenterology: 67-92.
• Pagano, A. E. (2006). “Whole Grains and the Gluten-Free Diet.” Practical Gastroenterology: 66-78.

Original fact sheet by J. Li, J. Anderson, J. Roach, Extension specialist and professor; former graduate student; Colorado State University food science and human nutrition. 3/09.

Adapted with permission from Colorado State University Extension.

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Information in this publication is provided purely for educational purposes. No responsibility is assumed for any problems associated with the use of products or services mentioned. No endorsement of products or companies is intended, nor is criticism of unnamed products or companies implied.

© 2013

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