In the U.S., approximately 3 million people are believed to have celiac disease (1,2). This condition primarily affects the digestive system and is triggered by a common protein found in many foods.
The good news is that treating celiac disease, with all its associated discomforts, can largely be achieved through dietary adjustments. The primary approach involves steering clear of foods and drinks that contain gluten. Unfortunately, gluten is present in numerous popular foods and can be disguised in ingredient lists and labels.
This article provides essential information to help you identify if you may have celiac disease and offers guidance on effectively treating it through nutrition. You'll discover which foods commonly contain hidden gluten, which ingredients to avoid, and a variety of nutritious options that are naturally free from gluten.
As always, if you want to benefit from personalized nutrition counseling for your celiac disease, contact Catalyst Nutrition and Training! You can book an appointment with us today!
What is celiac disease?
Celiac disease is an autoimmune disorder affecting the gastrointestinal tract, characterized by an inability to tolerate the protein “gluten”. Also known as celiac sprue, gluten intolerance, or gluten-sensitive enteropathy (3), gluten is naturally found in wheat, rye, barley, and triticale.
The condition often runs in families and is more prevalent among individuals of Northern European descent (3,4). Those with celiac disease have an increased likelihood of developing other autoimmune disorders like thyroid disease, type 1 diabetes, rheumatic diseases, and liver diseases (3,4).
When gluten is consumed, particularly in individuals predisposed to celiac disease, the body's immune system, primarily in the small intestine, mounts an inflammatory response (3). This immune reaction can lead to inflammation and damage to the intestinal lining, impairing its ability to absorb nutrients effectively (3). Despite adequate nutrient intake, this malabsorption can result in malnutrition, contributing to long-term health concerns such as slow growth, anemia, miscarriages, infertility, osteoporosis, intestinal cancers, nerve damage, and seizures (1,3).
The combination of gut inflammation and nutrient deficiency often manifests in a variety of common symptoms (3).
How do I know if I have celiac disease?
Common symptoms of celiac disease include:
abdominal pain
bloating
gas
nausea
vomiting
diarrhea
constipation
canker sores
tooth discoloration (3,6,7)
In some cases, symptoms extend beyond digestive issues to include:
headaches
seizures
itchy or scaly skin
bone or joint pain
menstrual irregularities
miscarriages
infertility
fatigue
weight loss (3,6)
Mental health symptoms such as irritability, mood changes, or depression may also occur (3).
It's important to note that celiac disease differs from gluten sensitivity or wheat intolerance because it specifically damages the small intestine (4).
Diagnosing celiac disease can be challenging based solely on symptoms, as they overlap with many other gastrointestinal conditions (7). Diagnosis typically involves blood tests and biopsies of the small intestine (7), which are most accurate if conducted before starting a gluten-free diet (7). If you suspect celiac disease, it's crucial to consult a healthcare provider immediately.
The good news? Symptoms of celiac disease can be effectively managed by eliminating gluten from the diet (3). According to the American Gastroenterological Association, "A strict gluten-free diet is the only treatment available for celiac disease" (8).
Upon removing gluten from the diet, symptoms of celiac disease often show improvement within a few weeks, and healing of the intestinal lining can begin within a few months (3).
What do I eat if I have celiac disease?
Celiac disease triggers an immune response, meaning even a tiny bit of gluten can set off symptoms and harm your health, so steering clear of gluten in foods and other items is crucial for the long haul (3,5).
The tricky part is that gluten lurks in many everyday foods and ingredients used in lots of prepared dishes (3). Grains like wheat, rye, barley, and triticale are major sources of gluten (2,3), found in staples like cereals, white and whole wheat flours, most breads, pastas, and baked goods (2,3). Gluten is the protein that gives baked treats their texture and shape (2). For folks with celiac disease, it’s smart to opt for products labeled “gluten-free” or “without gluten.”
The FDA says a “gluten-free” label is voluntary for food makers who meet all the rules (1), which mandate that foods contain less than 20 parts per million of gluten (2).
Aside from the obvious grain-based foods, gluten can sneak into unexpected spots:
Dairy items with added fillers
Ready-made soups, sauces, dressings, and gravies
Processed or cured meats
Creamed veggies
Flavored coffees
Some seasonings on fries and chips
Soy sauce
Many cereals, granolas, and bars might include regular oats or malt extract, not gluten-free ones
Alcoholic drinks like beer, flavored liquors, and malt beverages
Watch out for gluten in everyday items like lip balm, lipstick, toothpaste, dietary supplements, and certain medications (4,5,9). Always read labels carefully!
Nutrition Tips for Celiac Disease
In addition to seeking out foods labeled gluten-free and steering clear of wheat, rye, barley, and triticale, below are some specific examples of ingredients to avoid and naturally gluten-free options to enjoy.
It's important to be aware of the potential for cross-contamination. If gluten-containing foods come into contact with gluten-free items during the packaging, storage, preparation, or serving process, there's a risk of gluten transferring and contaminating the gluten-free food (10). This can occur through shared utensils, cutting boards, containers, and even toasters used for regular bread (9). When dining out, opt for restaurants that offer gluten-free menus and inform the server about your celiac disease to minimize risks (10). The same idea applies when attending social gatherings or eating at someone's home (10).
Here are examples of ingredients commonly found in packaged and prepared foods that should be avoided because they may contain wheat, rye, barley, or triticale:
Various flours (durum, emmer, kamut, semolina, spelt)
Food starches and thickeners
Hydrolyzed vegetable protein
Malt flavoring, extract, or vinegar
Brewer’s yeast
Preservatives and stabilizers
To ensure a food is free of these gluten-containing ingredients, carefully review the ingredient list on the label or contact the manufacturer directly.
Here are examples of naturally gluten-free foods that you can enjoy at your leisure:
Fresh, frozen, or canned fruits and vegetables (without added sauces)
Fresh fish, poultry, or meat
Eggs
Plain dairy products
Nuts and seeds without added flavors
Rice and rice flour
Gluten-free grains like amaranth, buckwheat, quinoa, and teff*
Flours made from gluten-free sources such as cassava, coconut, corn, potatoes, and tapioca
Oats that are certified gluten-free**
Soybeans and edamame (excluding soy sauce)
*Opt for gluten-free grains fortified with essential vitamins and minerals [K].
**Look for oats that are specifically labeled as gluten-free due to potential cross-contact during processing or packaging (10,11).
Many grocery stores have dedicated gluten-free sections, and you can also find gluten-free baked goods made with alternative flours in the freezer aisle (11). When selecting gluten-free foods, it's advisable to avoid bulk sections where cross-contamination may occur (11).
The Bottom Line
Here's the positive side of dealing with celiac disease: you can effectively manage it by steering clear of gluten. While gluten is prevalent in many pre-made, processed, and packaged foods, there's an increasing variety of gluten-free alternatives out there. Understanding which foods are naturally free of gluten gives you the power to control your gluten consumption and avoid the bothersome symptoms of celiac disease.
Do you need help choosing or preparing gluten-free foods? Catalyst would love to help!
Need support in eliminating digestive symptoms of celiac disease? Want personalized recommendations for recipes and other ways to ensure that you are getting all the essential nutrients? Ready to start working with professionals who are invested in seeing you thrive, despite celiac disease?
Book an appointment with us today to see if we can help you!
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/
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