Celiac Disease and Gluten-Free Diet

A lifelong, gluten-free diet is the only treatment for celiac disease. Fortunately, it is extremely effective. Symptoms often go away within days of starting the diet. (Some symptoms, such as certain dental problems, may be permanent). Complete healing, however, of damaged villi lining the intestines may take months or years.

Additional intake of gluten can damage the intestine, even if you have no symptoms. Nutritional supplements, given intravenously, may be needed if the intestinal damage is significant and does not heal.

Since gluten is present in many foods (eg, bread and pasta) and it is often an additive to many foods, the diet can be complicated and frustrating. Many people seek the help of a dietitian in meal planning. Some patients find support groups helpful.

A gluten-free diet is a necessary and effective treatment for celiac disease. By eliminating gluten, the offending substance, you can halt the damage and many of the symptoms caused by the body's reaction to gluten. Abstaining from gluten allows the villi lining the intestines to heal. This may take months or years. Eventually, the intestines will be more capable of performing their essential role of absorbing nutrients from the diet.

Read more details about Gluten-Free Diet.

Following a gluten-free diet can be challenging in our gluten-filled world. Fortunately, an increasing number of gluten-free products are available to help. Also, due to rising awareness about celiac disease and gluten sensitivity, more people are coming together online and in person to support each other and share resources.

Foods to Avoid

To follow a gluten-free diet, you must avoid all foods containing:

• Wheat
• Rye
• Barley
• Oats (in most cases)
• Note: This list includes most bread, pasta, cereal, and processed foods. Special gluten-free breads and pastas are available. They are made with potato, rice, soy, or bean flour.

Doctors are still uncertain as to whether people with celiac disease must avoid all foods containing oats. Research is currently underway to answer this question. Until these studies are completed, ask your doctor for advice about eating oats. Many people with celiac disease also become lactose intolerant. If you are lactose intolerant, you may also need to avoid milk products. In some people, lactose intolerance resolves after following a gluten-free diet.

Managing the Diet

Maintaining a gluten-free diet requires a lot of vigilance since gluten is included in many unexpected foods and beverages. When buying processed and packaged foods, carefully read all labels. If you are unsure if a food contains gluten, don’t eat it until you find out definitively. Calling the manufacturer of the food can sometimes be helpful in this regard.

A short (but by no means exhaustive) list of other foods that contain gluten include:

• Flavored coffee
• Beer
• Tuna in vegetable broth
• Packaged rice mixes
• Some frozen potatoes
• Creamed vegetables
• Commercially prepared vegetables, salads, and salad dressings
• Pudding
• Some ice cream

Ordering at restaurants can also be challenging since many foods on the menu may contain gluten. Rather than shying away from eating at restaurants, however, call ahead and see if you can get details on what ingredients they use in their foods. Many restaurants will be cooperative in this regard.

Since gluten is present in many foods and it is often an additive to many foods, following a gluten-free diet can be complicated and frustrating. Many people seek the help of a nutritionist in meal planning. Some patients find support groups helpful. Due to an increasing awareness about celiac disease and gluten sensitivity, online and in-person support resources are on the rise.

If, despite maintaining a gluten-free diet, your symptoms worsen or do not improve, contact your doctor.

Following a gluten-free diet can be difficult to adjust to, especially if you have been recently diagnosed with celiac disease. The United States Department of Agriculture (USDA) developed MyPyramid, which provides guidelines for healthy eating and focuses on six food groups. While MyPyramid is intended for the general population, below are some suggestions for eating gluten-free while following the USDA’s food guidelines.

Grains

Out of all of the food groups, the grain group poses the most problems for people with celiac disease. This is because many of these products contain gluten. But there are gluten-free choices, including:

• Amaranth
• Bean flour
• Corn flour and corn meal
• Potato flour
• Rice flour and rice
• Soy flour
• Flax
• Millet
• Quinoa
• Oats—These are naturally gluten-free, but are often processed with wheat products. Some companies sell “uncontaminated” oats.

When shopping, check the food label to see if the product is labeled as “gluten-free.” Regular grocery stores may offer some of these products, but natural food stores will have a larger selection—like gluten-free breads, cereals, pasta, and tortillas. You can also order these products online.

How Much Per Day? 5-8 ounces, depending on your age, gender, and level of physical activity

Vegetables

You can eat nearly all types of fresh, frozen, and canned veggies. You should avoid vegetables in sauce since sauces could contain gluten. Also avoid any veggies that are breaded, as well as French fries. Other than that, you can enjoy a variety of veggies during your day, like broccoli, lettuce, spinach, carrots, corn, peas, and eggplant.

How Much Per Day? 2-3 cups, depending on your age, gender, and level of physical activity

Fruits

As with the veggie group, you will be able to enjoy a range of fresh and frozen fruits. Most canned fruits are also safe to eat, especially those that are packed in natural juices. But double-check the label for any gluten additives. If you like dried fruit, remember to look at the list of ingredients. Some dried fruits have been dusted with flour to prevent the pieces from sticking together. You will need to avoid fruits in sauce and fruit pie fillings since these, too, may have additives.

A Note About Additives: Many additives contain gluten. To follow a gluten-free diet, familiarize yourself with these additives so that you will be able to spot them on food labels. There are some additives that are safe for you to eat. A few examples include gelatin, maltodextrin, sorbitol, and xanthan gum.

How Much Per Day? 1½ to 2 cups, depending on your age, gender, and level of physical activity

Dairy

All types of products made from milk fall into this category. Many people with celiac disease also develop a sensitivity to dairy. If dairy isn't a problem for you, good gluten-free options include aged cheeses, plain yogurt, and cream. Fresh, dried, and evaporated milk are all okay for you to consume. Avoid malted milk since it has barley and wheat. Also, keep in mind that chocolate milk and other flavored milk drinks may have gluten.

Be sure to read the labels of cheese sauces and spreads, which may contain additives. In addition, flavored yogurt, frozen yogurt, and ice cream may have either additives or ingredients (like cookie dough or granola) that include gluten.

How Much Per Day? 3 cups

Meats and Beans

You have a lot of options with this food group. Fresh fish, poultry, and meat are all safe to eat. You can also have eggs, tuna canned in oil or water, plain nuts, and legumes (beans, peas, and lentils). Try to avoid processed meats, like cold cuts, hot dogs, and sausages, which may have wheat fillers. Meat marinades, flavorings, and seasonings should also be on the “do not eat” list. Also keep in mind that imitation seafood and meat (eg, veggie burgers), as well as anything breaded, contain gluten.

How Much Per Day? 5 to 6½ ounces, depending on your age, gender, and level of physical activity

Fats and Oils

Many people get fat in their diet by eating common oils like olive, canola, and corn oil. Other sources of fat include nuts, olives, oily fish (eg, salmon), avocados, mayonnaise, salad dressings, and butter. Mayonnaise and some salad dressings and margarines may contain gluten, but gluten-free varieties are available in stores and online.

How Much Per Day? 6-7 teaspoons, depending on your age, gender, and level of physical activity