Treatment Handbook of celiac disease

Gluten free diet

December 14, 2021

Treatment:

Avoid gluten

The good news is that the only treatment for celiac disease -- a gluten-free diet -- starts to work within days, and the small intestine usually heals completely within three to six months. Although giving up favorite foods such as wheat breads and pizza can be tough at first, many people who have adapted to a gluten-free diet comment that while it can be inconvenient, it does not prevent them from socializing or traveling. Many gluten-free foods are available by mail order and on the Internet, and gluten-free items are becoming more common in supermarkets and restaurants.

Recent developments are making shopping a bit easier, too. As of January 2006, new FDA rules require that all foods containing any of the eight major food allergens (milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soybeans) must list that information on their labels. This doesn't mean that people with celiac disease are home free, because even wheat-free products can still cause trouble. For example, while oats don't contain the gluten that harms people with celiac disease, there is the possibility of cross-contamination with wheat in the growing and milling process. Also, some products labeled *wheat-free* contain barley, usually in the form of malt or malt syrup. The FDA is working on a rule for gluten-free labeling with action expected sometime after 2007.

There are general guidelines you can follow (see table below), but you'll need to check labels carefully for hidden gluten in commercially prepared foods, such as cured pork products, self-basting turkeys, imitation meats and seafood, and the thickeners found in gravy and some spaghetti sauces. Another source of hidden gluten is dates and candies that are dusted with flour to prevent sticking.

General guidelines for gluten-free eating*
Food type	Do not eat	Okay to eat
Grains, potatoes, flours, and cereals	wheat, rye, or barley (breads, bread crumbs, pasta, noodles) spelt, semolina, kamut, triticale, couscous, bulgur, farina rice mixes, some converted rice unidentified starches or fillers most commercial cereals	gluten-free pastas and breads (made from soy, rice, corn, potato, and bean flours) plain rice, corn, popcorn, potatoes, sweet potatoes, soybeans, other beans, nuts, millet, amaranth, quinoa oats (consult doctor first), buckwheat cornstarch, tapioca, and arrowroot starch gluten-free cereals (e.g., corn and rice)
Fruits and vegetables	canned soups, soup mixes, bouillon cubes creamed vegetables most salad dressings	fresh, frozen, or canned fruits or vegetables, unprocessed and without sauces homemade soups with allowed ingredients
Meat, fish, poultry, main dishes	commercially prepared fresh or frozen meat and main dishes, lunch meats, and sausages	fresh meat, fish, poultry
Dairy products	processed cheese, cheese mixes, blue (veined) cheese yogurt or ice cream that's unlabeled or that contains fillers or additives low-fat or fat-free cottage cheese, sour cream, or cheese spreads	plain natural cheese gluten-free plain yogurt and ice cream whole, low-fat, and fat-free milk full-fat cottage cheese and sour cream
Alcohol	beer, whiskey, bourbon, grain alcohol	wine, light rum, potato vodka distilled alcohol
Miscellaneous	grain vinegar malt vinegar beer commercial pudding mixes malt from barley soy sauce made from wheat	distilled rice, wine, or apple cider vinegar homemade puddings from tapioca, cornstarch, rice sugar, honey, jam, jelly, plain syrup, plain hard candy, marshmallows gluten-free soy sauce
* Not an exhaustive list. More complete information is available through the various celiac disease organizations listed under Selected resources

Foods and beverages aren't the whole story. If you have celiac disease, anything that goes in, on, or near your mouth must be gluten-free, says Melinda Dennis, nutrition coordinator of the Celiac Center at BIDMC. Medications (both prescription and over-the-counter) as well as vitamins, minerals, and other supplements are often packed in a starch base that may contain gluten. Make sure yours is derived from corn or tapioca. Gluten is also found in some personal care products, such as lipstick, toothpaste

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Gluten free diet

December 14, 2021

Treatment: