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Celiac Disease and The Gluten Free Diet

Gluten-Free Diet

 

Who needs a Gluten-Free Diet?

A gluten-free diet is the only treatment for those who have celiac disease, an autoimmune condition that is triggered by the ingestion of wheat, rye or barley, which causes damage to the villi (fingerlike projections) of the small intestine.  In individuals with celiac disease, removing these specific grains causes the damage to heal, returning to a fully functional absorptive surface. Symptoms of active celiac disease may include weight loss,growth problems (in children), bloating, diarrhea or constipation, gas, abdominal cramps, and/or vitamin and mineral deficiencies.  Symptoms are not just gastrointestinal, but there are some extra-intestinal symptoms including neurologic disorders, migranes, and behavioral problems. Additionally, a skin condition called Dermatitis Herpetiformis (DH) occurs in some individuals with celiac disease, which results an intense itchy skin eruption. It is important to recognize there are approximately 300 symptoms linked to celaic disease, and the gastrointestinal symptoms are more commonly found in children.

What is Gluten?

Gluten is a protein found in wheat, rye, and barley.  It is the substance in flour that forms the structure of dough.  It is the “glue” that holds the product together.

Where is Gluten Found?

Gluten Containing Grains to Avoid
Barley
Barley malt/malt extract
Bran
Bulgar
Couscous
Durum
Einkorn
Emmer
Farina
Faro
Graham Flour
Kamut
Matzo Flour/Meal
Orzo
Panko
Rye
Seitan
Semolina
Spelt
Triticale
Udon
Wheat
Wheat Bran
Wheat Germ
Wheat Starch
Overlooked Gluten Sources*
Ales
Beer and Lagers
Breading
Brown Rice Syrup
Coating Mix
Communion Wafers
Croutons
Candy
Luncheon Meat
Malted Products
Broth
Pasta
Roux
Sauces
Soup Base
Stuffing
Self-basting Poultry
Imitation Bacon/Seafood
Modified Food Starch (may contain)
Soy Sauce (may contain wheat)
Marinades/Thickeners
Herbal Supplements
Prescription Medications
Over-the-counter Medications
Vitamin and Mineral Supplements
Lipstick
Gloss and Balms

*These ingredients don’t always contain gluten, however the foods with these ingredients should be carefully reviewed to ensure they are not gluten-containing. Be sure to read all labels carefully.  If a product has ques­tionable ingredients, avoid it until the manufacturer con­firms that the product is gluten-free.  Labels must be read every time you purchase food because ingredients in a product can change at any time.

What foods can I eat on a Gluten-Free Diet?

Gluten-Free Grains and Starches
Amaranth
Arrowroot
Buckwheat
Corn
Flax
Flours made from
Nuts, Beans, and Seeds
Millet
Montina
Potato Starch
Potato Flour
Quinoa
Rice
Gluten Free Oats*
Rice Bran
Saga
Sorghum
Soy (soya)
Tapioca
Teff

*Historically, oats were not recommended because it was thought that avenin (the storage protein found in oats) was also toxic to gluten-intolerant individuals. However, recent research in Europe and the US has described that oats are well-tolerated by most children and adults when consumed in moderation and do not contribute to abdominal symptoms, nor prevent intestinal healing. PLEASE NOTE: regular, commercially available oats are frequently contaminated with wheat or barley. However, “pure, uncontaminated” oats have recently become available from several companies in the US and Canada. These companies’ process oats in dedicated facilities and their oats are tested for purity. Pure, uncontaminated oats can be consumed safely in quantities < 1 cup per day.  It is important that you talk to your physician and your registered dietitian prior to starting oats.

 

How do I start my new Gluten-Free Lifestyle?

Your first thought might be to stop at the grocery store on your way home from the hospital or doctor’s office to stock up on gluten-free labeled foods.  However, pre-packaged gluten-free foods can be very expensive and high in calories, like many other packaged and processed foods.  First, go home and check the labels of the food that you already have in your kitchen.  Many of your favorite brands may already be gluten-free.  This keeps you from having to read all the labels on your next shopping trip.

Grocery Shopping…

When shopping for a gluten-free diet, stay on the perimeter of the store.  This is where you will find naturally gluten-free foods for balanced meals and snacks following Retrofit’s guiding principles of the 50-25-25 plate at meals and protein and fiber at snacks.  Start your shopping trip with the fresh produce section.  There are no worries in this section!  Stock up on nutrient rich, low fat, low sodium fresh fruits and vegetables.  Then, head into the fresh meat, poultry, and seafood section.  All of these are naturally gluten-free, as long as, they do not have any breading or marinade added to them.  Use caution when choosing luncheon meat and other processed meat.  They may contain gluten as fillers or flavor enhancers, so read the labels carefully.  After the meat section, it’s time to visit the egg and dairy sections of the grocery store.  Most of these products are gluten-free, so once again, check the labels.  Calcium-rich desserts and snacks, like yogurt and cheese, are excellent choices for a gluten-free diet.  Within the inner isles of the grocery store, look for:

  • Corn Tortillas
  • Plain Rice (Brown or Wild for more fiber!)
  • Dried or canned Beans and Legumes
  • Spices and Herbs
  • Nuts and Nut Butters
  • Cooking oils (except Canola oil, it may have traces of gluten)
  • Canned vegetables and fruit
  • Cereals:  General Mills Chex Cereal (Cinnamon, Honey Nut, Rice, Corn, and Chocolate Only), Kellogg’s Gluten Free Rice Krispies, Nature’s Path, Glutino’s, Bob’s Red Mill, Arrowhead, and Udi’s Granola, just to name a few brands.
  • Other options, as well, just remember to READ THE FOOD LABELS

Many grocery stores have begun to stock more products that are specifi­cally gluten-free. Look in the Asian section for rice noodles and rice crackers. Check out the “organic” or “health food” section for Gluten-Free pastas, flours, and baking products.  Specialty health food stores typically have Gluten-Free foods in the frozen food section.  One can select Gluten-Free bagels, breads, or brown rice pizza crusts to defrost and warm at home.  Some frozen food sections have Gluten-Free frozen meals as a con­venient option.

Preparing Foods at Home…

When sharing a house with others who are not on a Gluten-Free diet, cross-contamination can be an issue.  To prevent cross-contamination, here are some suggestions:

  • Purchase separate jam, jelly, mayonnaise, and pea­nut butter to avoid wheat/bread crumbs in the shared jars.
  • Purchase a separate toaster for gluten-free breads, or use a toaster oven that can be cleaned between uses, or place tinfoil on the rack to avoid contamination.
  • Clean counter tops and cutting boards often to remove gluten-containing crumbs.
  • Cooking utensils, colanders, and pans need to be cleaned carefully after each use and before cooking gluten-free products.
Can I enjoy eating a restaurants?

Being on a Gluten-Free diet does not mean that you will never be able to eat at a restaurant again.  Dining out is a big part of our way of life and with a little effort and planning, it can continue to be enjoyed.  Before leaving home, do your homework.  Most restaurants have a website, so you can review the menu online to see if there are gluten free options available.  Some restaurants have a Gluten-Free menu to order from:  Outback, Uno’s Chicago Grill, Carrabba’s Italian Grill, PF Chang’s, Chili’s, Famous Dave’s, and many others.  When you are ordering, first identify yourself as someone who is allergic to gluten and cannot eat wheat, barley, rye, or oats.  Food items that you would never guess have flour in them, often do.  Always make sure everyone is aware of your needs.  Do not be afraid to ask how the food is prepared.  Meats may be marinated in soy sauce.  Hamburgers and hamburger buns may be grilled in the same area.  A salad may not have croutons in it, but may arrive at your table with a breadstick across the top.  All these methods can lead to gluten contamination.  Most restaurants are aware of gluten-free needs, but never assume.  Be pleasant and informative, if questions arise.

 

Are all Gluten-Free foods Healthy?

There are many specialty companies that produce excellent gluten-free products.  Although they taste wonder­ful, the ingredients used may not be a healthy alternative.  A gluten free cookie is still a cookie!  Also, additional ingredients will need to be added to baked goods to replace the gluten, leading to a higher sugar and fat content.  Therefore, good nutrition and eating a balanced diet is important in maintaining a healthy weight while eating gluten free.  A balanced diet includes fruits, vegetables, lean proteins, dairy, and gluten free whole grains.

Use Retrofit’s guiding principles for creating healthy meals and snacks:
  • 50-25-25 Approach to Meals:  50% fruit/vegetables, 25% lean protein, and 25% gluten free whole grain or starch
  • Protein and Fiber at Snacks:
    • Protein foods include, lean meats, legumes, nuts & nut butters, and dairy.
    • Fiber foods include, fruits, vegetables, and gluten free whole grains.

 

GLUTEN FREE SAMPLE DAY

 

Breakfast: Gluten Free Oatmeal with ½ cup blueberries and 2 Tbsp Sliced Almonds
Morning Snack: Greek Yogurt and 2 Tbsp Gluten Free Granola
Lunch: Southwest   Grilled Chicken Salad(Salad vegetables, 3 oz chicken, ¼ cup black beans, ¼   cup corn, ¼ cup salsa, and 2 Tbsp Guacamole)
Afternoon Snack: 100 calorie pack of Almonds and Apple
Dinner: Salmon with Steamed Vegetables and Herbed Quinoa
Dessert (optional): ½ cup Frozen Kefir topped with ½ cup fresh berries

Helpful Resources:

www.cureceliacdisease.org  (University of Chicago Celiac Disease Center)

www.celiac.org

www.celiac.com

www.glutenfree.com

www.glutenfreemall.com