Your Essential Guide to Gluten-Free Nutrition and Celiac Disease

In the U.S., around 3 million people are affected by celiac disease (1,2). This condition triggers a reaction in the digestive system when gluten, a common protein, is consumed.

The empowering news is that celiac disease—and the discomfort it brings—can be effectively managed through mindful nutrition. The key is to steer clear of gluten-containing foods and beverages. However, gluten often lurks in popular foods and can be tricky to spot on ingredient lists and product labels.

This article is your essential guide to understanding celiac disease and managing it through nutrition. Discover how to identify if you have celiac disease, navigate the hidden sources of gluten, and explore the abundant, naturally gluten-free foods that support your well-being.

What is Celiac Disease?

Celiac disease is a gastrointestinal autoimmune condition where the body cannot tolerate gluten, a protein found in wheat, rye, barley, spelt, and triticale. It is also known by other names such as celiac sprue, gluten intolerance (though this can also refer to non-celiac gluten sensitivity), and gluten-sensitive enteropathy (3).

This condition often runs in families and is more commonly seen in individuals with a Northern European background (3,4). Those with celiac disease are at a higher risk of developing other autoimmune conditions like thyroid disease, type 1 diabetes, rheumatic diseases, and liver diseases (3,4).

The immune system, particularly in the small intestine, reacts to ingested gluten by producing antibodies against gluten and the intestinal lining (3). This reaction causes inflammation, damaging the intestinal lining and impairing the absorption of essential nutrients such as iron, zinc, copper, B6, B12, Vitamins A, D, E, K, and amino acids (3). Consequently, malabsorption can lead to malnutrition, even with adequate nutrient intake (3,5). Long-term health issues related to malnutrition include slow growth, anemia, miscarriages and infertility, osteoporosis, intestinal cancers, nerve damage, and seizures (1,3).

The combination of digestive inflammation and malnutrition often results in a range of common symptoms (3).

How Do I Know If I Have Celiac Disease?

Recognizing celiac disease can be challenging due to its wide range of symptoms. Common signs include abdominal pain, bloating, gas, nausea, vomiting, diarrhea, constipation, canker sores, and tooth discoloration (3,6,7). Symptoms may extend beyond the digestive system to include headaches, seizures, itchy or scaly skin, bone or joint pain, menstrual changes, miscarriages, infertility, fatigue, and weight loss (3,6). Additionally, mental health symptoms such as irritability, mood changes, and depression are also possible (3).

It’s essential to distinguish celiac disease from gluten sensitivity or wheat intolerance, as only celiac disease causes damage to the small intestine (4).

Due to symptom overlap with other digestive conditions, diagnosing celiac disease based solely on symptoms can be tricky (7). Diagnosis typically involves blood tests and small intestine biopsies (7). For the most accurate results, these tests should be conducted before starting a gluten-free diet (7). Therefore, consult your healthcare professional as soon as celiac disease is suspected.

The encouraging news is that celiac disease symptoms can be managed by avoiding gluten (3). According to the American Gastroenterological Association, “A strict gluten-free diet is the only treatment available for celiac disease” (8).

After eliminating gluten from your diet, symptoms may improve within a few weeks, and the intestinal lining can heal within a few months (3).

What Do I Eat If I Have Celiac Disease?

Living with celiac disease means committing to a lifelong gluten-free diet, as even tiny amounts of gluten can trigger symptoms and cause intestinal damage (3,5).

Gluten is prevalent in many everyday foods and ingredients, making it challenging to avoid. Common grains like wheat, rye, barley, spelt, triticale, and even oats (unless labeled gluten-free) are significant sources of gluten (2,3). This means gluten is often found in cereals, flours, breads, baked goods, and pastas, where it helps give these foods their texture and shape (2). For those with celiac disease, it’s crucial to choose products labeled “gluten-free” or “without gluten.”

The U.S. FDA allows a “gluten-free” label on foods if they meet specific criteria, containing no more than 20 parts per million of gluten (1,2).

Beyond the obvious, gluten can also hide in unexpected places:

• Dairy products with fillers

• Prepared soups, sauces, dressings, and gravies

• Processed or cured meats

• Creamed vegetables

• Flavored coffee

• Frozen meals

• Meal replacements and bars

• Seasonings for french fries and potato chips

• Soy sauce

• Many cereals, granolas, and bars using non-gluten-free oats or malt extract

• Beer, flavored liquors, and malt beverages

Additionally, gluten can be found in non-food items like lip balms, lipsticks, shampoos, conditioners, toothpaste, dietary supplements, and some medications (4,5,9).

[Always read your labels!]

Nutrition Pro Tips If You Have Celiac Disease

When managing celiac disease, it’s crucial to go beyond just looking for gluten-free labels. Avoiding common gluten-containing grains like white or whole wheat, rye, barley, spelt, and triticale is essential. Here are some specific ingredients to steer clear of and naturally gluten-free foods to embrace.

Avoid Cross-Contamination

Cross-contamination can occur when gluten-containing foods come into contact with gluten-free foods through shared utensils, cutting boards, containers, and even toasters (9,10). When dining out, seek restaurants with gluten-free menus and inform the server about your celiac disease (10). This vigilance also applies to social gatherings and eating at others’ homes (10).

Ingredients to Avoid

Be cautious with packaged and prepared foods, as they may contain gluten:

• Flours (durum, emmer, kamut, semolina, spelt)

• Food starches, thickeners, gravies

• Hydrolyzed vegetable protein

• Malt flavoring, extract, or vinegar

• Brewer’s yeast

• Breaded foods

• Matzo

• Malt products

• Couscous

• Farina

• Bulgar

• Farro

• Oats not labeled gluten-free

• Preservatives and stabilizers

Always check ingredient lists or contact the company to ensure products are gluten-free.

Naturally Gluten-Free Foods

Enjoy these foods in abundance:

• Fresh, frozen, or canned fruits and vegetables (without sauce)

• Fresh fish, poultry, or meat

• Eggs

• Plain, natural dairy products

• Plain nuts and seeds

• Rice and rice flour

• Gluten-free grains (amaranth, buckwheat, quinoa, teff, millet)

• Flours made from gluten-free foods (cassava, coconut, corn, potatoes, tapioca)

• Oats labeled gluten-free**

• Soybeans and edamame (but not soy sauce)

Ingredients That May Contain Gluten

Be mindful of these:

• Vegetable Protein/Hydrolyzed Vegetable Protein

• Modified Starch

• Natural and Artificial Flavorings

• Caramel Color

• Modified Food Starch

• Hydrolyzed Plant/Vegetable Protein

• Seasonings

• Dextrin

• Maltodextrin

**Oats may be cross-contaminated during processing or packaging, so always look for a gluten-free label (10,11).

Your grocery store may have a dedicated gluten-free section. Look for gluten-free baked goods (made with alternative flours) in the freezer section (11). Avoid bulk sections where cross-contamination is possible (11).

Favorite Gluten-Free Cookbooks/Blogs

• Daniell Walker’s “Against All Grain” and related cookbooks

• Michelle Rosen’s “Paleo Running Mama” blog and cookbook “Paleo Baking at Home”

• Cassy Joy Garcia’s “Cook Once Eat All Week” and “Cook Once Dinner Fix” (add more veggies to her recipes)

• Ronny Joseph Lvovski’s “The Primal Gourmet”

• The Whole 30 Cookbooks

Favorite Gluten-Free Products

• Super Bloom Bakery small batch fresh baked bread: Super Bloom Bakery

• Various chickpea and lentil pastas

• Cappello’s pizzas, cookie dough, pastas

• Pacha bread

• Simple Mills crackers and baking mixes

• Bob’s Red Mill flours

• Otto’s Cassava flour and baking mixes

• Bedrock Bakers English muffins and bagels: Bedrock Bakers

• Simple Kneads bread

• Siete chickpea tortillas

Final Thoughts

The encouraging news about celiac disease is that it can be effectively managed by avoiding gluten. While gluten is prevalent in many pre-made, processed, and packaged foods, there is a rapidly expanding variety of gluten-free alternatives available. Additionally, knowing the extensive list of naturally gluten-free foods empowers you to control your gluten intake and prevent the distressing symptoms associated with celiac disease.

Do you need assistance with selecting or preparing gluten-free foods? As a Functional Medical Registered Dietitian, I’m here to help.

Looking for support to eliminate the digestive symptoms of celiac disease? Need personalized recommendations for recipes, meal plans, and strategies to ensure you’re getting all the necessary nutrients? Ready to start working with a professional dedicated to helping you thrive despite celiac disease? Book an appointment with me today to explore how my programs and services can support you. Schedule a complimentary consultation here: Book a consultation.

References

(1) U.S. Food and Drug Administration (2022, March 7). Gluten-Free Labeling of Foods. https://www.fda.gov/food/food-labeling-nutrition/gluten-free-labeling-foods

(2) U.S. Food and Drug Administration. (2018, July 16). Gluten and Food Labeling. https://www.fda.gov/food/nutrition-education-resources-materials/gluten-and-food-labeling

(3) Harvard Health Publishing. (2023, April 7). Celiac disease (non-tropical sprue). https://www.health.harvard.edu/a_to_z/celiac-disease-non-tropical-sprue-a-to-z

(4) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Definition & Facts for Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/definition-facts

(5) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Treatment for Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/treatment

(6) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Symptoms & Causes of Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/symptoms-causes

(7) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Diagnosis of Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/diagnosis

(8) Adelsberg, R. (2021, March). Gluten-free diet: nutritional value. American Gastroenterological Association, AGA GI Patient Center.  https://patient.gastro.org/gluten-free-nutritious-diet/

(9) Celiac Disease Foundation. (n.d.). Sources of gluten. https://celiac.org/gluten-free-living/what-is-gluten/sources-of-gluten/

(10) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Eating, Diet, & Nutrition for Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/eating-diet-nutrition

(11) Celiac Disease Foundation. (n.d.). Gluten-Free Foods. https://celiac.org/gluten-free-living/gluten-free-foods/