What is a gluten-free diet? Gluten is a general name for storage proteins found in wheat, rye, barley, and oats. Gluten may cause health problems for some people. A gluten-free diet is a diet including foods and drinks that do not contain gluten. A diet without gluten should be followed if you have celiac (SE-le-ak) disease, or dermatitis herpetiformis (her-pet-i-FORM-is). Dermatitis herpetiformis is a skin condition that is also called DH. A gluten-free diet should also be followed if you are allergic (al-ER-jik) to wheat. People who need this diet to treat a medical condition usually need to follow it for their whole lives. With celiac disease, eating too much gluten may cause you to have diarrhea and stomach pain. You may also be very sad most of time, or become angry easily. It is possible for you to have celiac disease but have no symptoms. Even so, you are still at risk for medical problems. With DH, you may have very itchy rashes which may blister. These symptoms may come and go, but you should still follow a gluten-free diet all of the time. Following this diet may decrease the amount of medicine that you need to take for DH. What can I do to make a gluten-free diet part of my lifestyle? Changing what you eat and drink may be hard at first. Think of these changes as “lifestyle” changes, not just “diet” changes. You may need to make these changes part of your daily routine. Following a gluten-free diet may help you feel better. Choose a variety of items on this diet so that you do not get tired of having the same items every day. Keep a list of items allowed on this diet in your kitchen to remind you about the diet. Carry a list of items allowed on this diet with you to remind you about the diet when you are away from home. Tell your family or friends about this diet so that they can remind you about the diet. Ask your caregiver, a dietitian (di-e-TISH-an), or a nutritionist (noo-TRI-shun-ist) any questions you may have about your diet plan. A dietitian or nutritionist works with you to find the right diet plan for you. Dietitians and nutritionists can also help to make your new diet a regular part of your life. Always read the ingredient labels on products before buying any packaged food. Gluten is found in many foods and drinks. It may not be clear which foods contain gluten. As a general rule, avoid all foods that contain wheat or the wheat-related grains. This includes spelt, triticale, and kamut. You will also need to avoid foods and drinks with rye, barley, and possibly oats. You will need to avoid eating many grain, pasta, and cereal products, and many processed foods. Even while following these guidelines, a gluten-free diet can still be well-balanced, and contain a variety of foods. At first, it may take more time to shop for groceries, and plan and prepare meals. Over time, you will learn what products to buy for a gluten-free diet. For more information about a gluten-free diet, you may want to contact the following: Celiac Disease Foundation13251 Ventura Boulevard, Suite 1Studio City, CA 91604Phone: 1-818-990-2354Web Address: http://www.celiac.org Canadian Celiac Foundation190 Brittania Rd. EastMississauga, ON L4Z 1W6Phone: 1-905-507-6203Web Address: www.celiac.ca What should I avoid eating and drinking while on a gluten-free diet? Breads and starches:
- Bread crumbs.
- Cereals, including muesli, oatmeal, farina, and other hot cereals.
- Crackers, and trail mixes with small crackers.
- Packaged rice and noodle mixes.
- Some rice cakes, rice crackers, and popcorn cakes.
- Wheat or flour tortillas.
- Avoid all breads, cereals, pastas, baked items, and mixes that contain these grains or ingredients:
- Barley, bulgar.
- Cereals with added malt extract and malt flavoring, such as Cheerios™.
- Wheat flours, including white flour, gluten flour, graham flour, high protein flour, and pastry flour.
- Gluten, vital gluten.
- Oats, oat bran.
- Wheat bran or flour, wheatgerm, or unnamed starch.
- Wheat flours, including white flour, durum flour, gluten flour, graham flour, high protein flour, and pastry flour.
- Chocolate drinks, hot cocoa mixes, and chocolate milk.
- Malted milk drinks.
- Processed cheeses.
- Some puddings, ice creams, frozen and flavored yogurts.
Fruits and vegetables: Baby food fruits with starch added.
- Breaded vegetables.
- Cream soups or vegetables with flour.
- Fruit jams, jellies, sauces, spreads, or syrups with thickeners.
- Fruit pies, pastries, and cobblers made with any of the grains listed in the breads and starches section.
- Some French fried potatoes (especially those in restaurants), and flavored potato chips.
Meat and other protein sources:
- Breaded meat, fish, or poultry.
- Canned baked beans.
- Casseroles made with flour or pasta.
- Chicken, turkey, or other deli meats and roasts made with processed vegetable protein.
- Corned beef.
- Foods with macaroni, noodles, or pastas made from types of flour listed in the breads and starches section.
- Imitation seafood, imitation bacon.
- Meat dishes that include flours listed in the breads and starches section, such as meatloaf, Swiss steak, or meatballs.
- Meats or meat dishes containing soup base or bouillon made with certain ingredients (in the Checklist for the Patient section).
- Packaged meats made with flour (such as cold cuts, lunch meats, hot dogs, sandwich spreads, pates, sausages, canned or imitation meats).
Fats, soups, sauces, and seasonings:
- Any soup made with noodles.
- Certain salad dressings, such as malt vinegar. Read the label before buying the product.
- Chip dips.
- Gravies and sauces made with flour.
- Most canned and dry soup mixes, as well as soup bases or bouillon mixes with yeast or vegetable protein.
- Rice syrup.
- Seasoning mixes.
- Some brands of chili sauce and steak sauce.
- Soy sauce made with meat.
- All cookies, pies, pastries, and cakes made with any type of flour listed in the breads and starches section.
- Fruit pies thickened with flour.
- Ice cream and ice cream cones.
- Licorice and jelly beans.
- Additives, preservatives, and stabilizers found in processed foods, medicines and mouthwash.
- Beer, ale, and malt liquor.
- Cereal beverages (Postum™, Ovaltine™).
- Certain imported foods. Imported foods labeled “gluten-free” may still contain wheat starch.
- Flavored coffees.
- Instant coffee made with wheat.
- Medicines that contain gluten. Ask your caregiver if any medicine that you are taking contains gluten before taking it. Vitamins may also contain gluten.
- Non-dairy creamers.
- Pickled foods.
- Prepared mustard.
- Some instant natural beverages.
- Some spice blends such as curry powder, ground pepper mixes, and herb seasonings.
- Sweets and candies made with certain ingredients (in the Checklist for the Patient).
Checklist for the Patient: Take this list with you when you shop. Look for products with “gluten-free” written on the label. It may not be clear what products contain gluten. This list contains items to look for when reading food and drink labels. Avoid buying products that have one or more of these ingredients: __ Caramel flavoring, or non-United States manufactured caramel coloring. __ Cereal extract or additive. __ Cereal protein. __ Edible starch or wheat starch. __ Emulsifiers. __ Flour. __ Fillers. __ Hydrolyzed, hydrogenated, or texturized vegetable or plant protein (HVP or HPP). __ Dextrin. __ Malt, malt flavoring, or malt extract. __ Mono-glycerides or di-glycerides. __ Stabilizers, such as gluten stabilizers. __ Thickeners, such as modified food starch. __ Vegetable gum or protein, such as oat gum. What can I eat and drink while on a gluten-free diet? On a gluten-free diet, it is very important to read the ingredient label on packaged foods before buying the product. Less-processed foods or things you make yourself should be safer to eat than packaged foods. While oats were not included in a gluten-free diet in the past, newer research finds that oats may be safe on this diet. Ask your caregiver about adding oats to your diet. Breads, cereals, pasta, and baked items made with potato, rice, soy and bean flour may be eaten on a gluten-free diet. Some gluten-free cereals include Arrowhead Mills Corn Flakes™, and Health Valley Rice Crunch-Ems™. Products with garbanzo, potato, rice, soy, and tapioca flour may be eaten. Foods made with nut flour and millet may also be eaten. Brown, white, and wild rice without sauces may be included in a gluten-free diet. Rice products, such as rice cakes, rice crackers, and puffed rice may also be eaten. Rice cereals, cream of rice cereal, and rice polish may be eaten. Corn products, such as cornmeal, corn flour, corn tortillas, or corn cereals may be included in a gluten-free diet. Popcorn and popcorn cakes may also be eaten if they do not contain any gluten ingredients. Ingredients such as corn starch and potato starch are also OK when selecting foods. Gluten-free flours, baking mixes, and baked foods may be selected and included in this diet. Arrowroot powder, amaranth, buckwheat, hominy, quinoa, and tapioca are also allowed on a gluten-free diet. Plain meat, fish, fruits and vegetables are safe to eat while following this diet. Choose fresh, frozen, or canned meat, fish, fruits and vegetables. For packaged items, choose foods that do not have ingredients listed on the Checklist of ingredients to avoid. Ketchup, distilled vinegar, and some mustards are safe to include with meals. Ingredients such as maltodextrin and soy sauce that is labeled “gluten-free” may also be included. Caramel coloring made in the United States, and most syrups and jellies may be included in a gluten-free diet. Some chocolate drinks may also be enjoyed. Read labels on these items to make sure they can be included in your diet. Over time, you may learn how to prepare a variety of enjoyable and healthy meals and snacks. To learn more about recipes for a gluten-free diet and order gluten-free products, you may contact the following: Celiac Sprue AssociationP.O. Box 31700 Omaha, NE 68131Phone: 1-402-558-0600Web Address: http://www.csaceliacs.org What other diet guidelines should I follow? When you eat away from home, ask the waiter, chef or host how the foods and drinks that you are about to eat are prepared. Take a list of the ingredients, foods, and drinks not allowed on a gluten-free diet. Ask if any of these ingredients, foods or drinks are in the meal. If they are, ask for other foods and drinks that are OK to have while on a gluten-free diet. Call your caregiver if you have questions or concerns about your illness, medicine, or a gluten-free diet. Sample diet for one day: Early morning snack: Banana. Breakfast: Soft boiled eggs, gluten-free toast with butter, milk. Morning snack: Gluten-free rice cakes. Mid-day meal: Tuna salad with tomato and lettuce. Apple. Afternoon snack: Carrot sticks. Evening meal: Broiled chicken, baked potato, green beans. Baked apple. Evening snack: Gluten-free rice crackers and sliced Swiss cheese. Risks: With celiac disease, eating too much gluten may cause you to have bloating, diarrhea and stomach pain. You may also be very sad most of time, or become angry easily. Your teeth may lose their white color. Eating gluten will cause problems in your small intestine (bowel). This may make you unable to get the nutrition your body needs, even while following a healthy diet. There may be weight loss, and children may not grow or develop correctly. Following a gluten-free diet when you have celiac disease may stop your symptoms. It may also heal bowel problems, and stop more bowel problems from developing. You may feel better, and healing may start within days of starting the diet. Some people with celiac disease will not improve even if a gluten-free diet is carefully followed. This is because their intestines are too damaged and are unable to heal. You may need to have other treatments, and take medicines to help treat celiac disease. People with DH often have the same intestine damage as those with celiac disease, but not the same symptoms. People with DH who do not follow a gluten-free diet may have a very itchy, blistering skin condition. If you are allergic (al-ER-jik) to wheat and do not follow a gluten-free diet, you may have an allergic reaction. This may include a rash, sneezing, watery eyes and nose, itching, swelling and hives. This may lead to trouble breathing and unconsciousness (unable to be awakened from sleep). The symptoms may begin minutes or hours after eating wheat products, and they may lead to death.