The Gluten-Free Diet simply means not eating food that is made from the grains of wheat, barley, rye, and oats. These grains contain a plant protein called gluten, and it is this gluten that must be strictly excluded from the “gluten-free diet.”
Gluten in wheat, barley, rye, and oats is made up of specific arrangements of amino acids that can harm the body. While some other grains have “gluten” in them, like corn, they are not harmful because their amino acids are differently arranged.
Even small quantities of gluten from wheat, barley, rye, and oats are harmful, preventing remission or inducing relapse.
The strict definition of a gluten-free diet remains controversial due to the lack of an accurate method to detect gluten in food products and the lack of scientific evidence for what constitutes a safe amount of gluten ingestion. Therefore, a zero tolerance approach to gluten ingestion is prudent.1
Food that is not made with gluten from wheat, barley, rye, and oats as an ingredient may be safely eaten. Foods that are ordinarily made with gluten, such as pasta and bread, are replaced with those that are gluten-free. Read more…GF Food Substitutes.
Q. Who should follow this diet?
A. People who need to restrict gluten due to a self- or medically diagnosed condition.
The Gluten Free Diet is the essential and only treatment for people with any form of Gluten Sensitivity Reaction, particularly Celiac Disease (CD), Non-Celiac Gluten Sensitivity, Gluten Allergy and Dermatitis Herpetiformis (DH). Autism, autoimmune disorders, and many other disorders may improve.
Read more…Health Conditions.
Q. What must I do?
A. This diet is simple and rewarding, but can be challenging. Removing gluten from the diet involves more than simply not eating bread, pasta, baked goods, pizza, and cereal. It requires us to learn how to recognize all foods with gluten, called “unsafe” foods, in order to strictly avoid eating them. Gluten-free food is called “safe” food. There can be no cheating. Only 1/8th of a teaspoon of flour can cause new intestinal damage in people with Celiac Disease and Dermatitis Herpetiformis.
Q. Is there anything I should avoid at first in addition to gluten?
A. Yes. Cane sugar, which is sucrose, should be used with caution because it is poorly digested by a damaged small intestine, causing digestive disturbances, such as bloating, pain, and bowel changes. This situation may produce loss of normal bacteria populations needed for bowel health and encourage overgrowth of pathogenic bacteria and yeast (Candida Albicans). What’s more, sucrose (undigested sugar) can abnormally enter the bloodstream through a “leaky gut.” Leakiness can happen to anyone given the right circumstances, and always happens to celiacs with or without intestinal damage. Studies have not yet been done to determine the effect of sucrose in the blood.
In addition, Lactose Intolerance is common in Celiac Disease. Undigested lactose (milk sugar) in milk causes bloating, pain, and diarrhea in affected people. Only milk and milk products that have been lactose-reduced should be used until normal lactase production in the small intestines resumes.
The following three sections can lay the foundation that will enable you to protect your health and enjoy your life:
- Learning Safe Versus Unsafe Food.
- Buying Safe Food.
- Preparing Safe Food.
1. Learning About Safe Vs. Unsafe Food
The chart below lists the unsafe grains that contain gluten.
|Wheat and these wheat strains: Durum, Kamut, Spelt (also called dinkel), Einkorn, Emmer, Farro.
Triticale (wheat / rye hybrid).
To use the above information for constructing a gluten-free diet, we need to understand how the unsafe grains are actually used in making food. Then we can avoid them and replace them with safe foods.
Q. How are unsafe grains used in food?
A. The chart below shows various ways that unsafe grains may be used as ingredients in foods. Whether making our own food, buying it at a store or restaurant, or eating food made by someone else, we must learn how to look for and recognize suspect food in order to avoid eating gluten.
Unsafe Grains as Ingredients in Food
Wheat berries, rye, oat groats, rolled oats, barley, pearl barley
Starch from wheat, rye, barley, oat.Modified food starch from wheat.Oat gum.
|Soy sauce or tamari made from fermented wheat and soy.Malt vinegar fermented from barley.Distilled white vinegar.|
|Cracked grain –
Wheat (couscous), oats, rye, and barley.
|Meals/ coarsely gound grain –
Wheat meal, matzo, oat meal, rye meal, barley meal.
Hydrolized vegetable protein (HVP) and
texturized vegetable protein (TVP) from wheat
Beer, ale, porter made using barley.
|Flours/ finely milled grains –
Whole wheat flour, graham flour, all-purpose flour, bread flour, cake flour, pastry flour, semolina flour, durum flour and gluten (high protein or vital wheat gluten) flour.Other strains of wheat:
Emmer flour, kamut flour, spelt flour (also called dinkel), farro flour, and einkorn flour.Rye flour
Triticale flour (wheat /rye hybrid).
|Cooked products Seitan (100% gluten)
Regular pasta (all types)
Regular noodles( all types)
Bulgar (parboiled wheat)Couscous
|Germ – Wheat germ and wheat germ oil.||Flavoring –
Barley malt, malt extract, and malt flavoring.
|Bran – Wheat bran, oat bran.||Syrups –
Barley malt syrup and oat syrup.
Q. What foods can I eat on a gluten-free diet?
A. There is a vast world of safe food out there waiting to be discovered. Meat, poultry, seafood, fish, eggs, dairy, fruits, vegetables, nuts, beans and other grains such as rice or corn are allowed, as well as all foods made from them – as long as the food does not contain gluten grains. Most of us who have a problem with gluten, developed it because we have been eating a great amount of it every day. If you find your diet loaded with bread, pizza, pasta, and doughnuts, overhaul your diet with fruits, vegetables, safe grains, and legumes. Read more…GF Food Substitutes.
The comparison chart below shows examples of foods that can be safely eaten and those that must be strictly avoided. For more detailed information, discuss gluten-free choices with a health care specialist or dietitian skilled in this diet.
Foods Allowed/Not Allowed
*Plain means no gluten ingredients are added to the food.
**Commercially prepared means the product is made by a company for the purpose of selling it.
|FOOD GROUP||ALLOWED||NOT ALLOWED|
|Fruit||All plain* fresh, frozen, or dried fruit; canned fruit in natural juice.
Pie fillings thickened with cornstarch, tapioca, or arrowroot.
|Commercially prepared** canned or prepared fruits/ pie fillings thickened with flour.|
|Vegetables||All plain* fresh, frozen, or canned vegetables.
GF sauced vegetables;
vegetables thickened with cornstarch, tapioca, or arrowroot such as Harvard red beets.
|Commercially prepared **creamed vegetables and vegetables in sauce thickened with flour.
Vegetables with regular bread crumbs or battered and fried such as deep fried onions.
Salads with croutons or with dressing thickened using flour or oat gum.
|Meat, fish, seafood, fowl||Plain* fresh, canned, or frozen beef, pork, ham, lamb, rabbit, or other eat, seafood, fish, poultry, turkey, or other birds.
Bacon; hotdogs, cold cuts; scrapple and sausage made with safe fillers and binders.
Canned fish, poultry, seafood,
meat in brine or plain water.
GF breaded, battered or otherwise prepared.
|Commercially prepared** meat, fish, seafood, and fowl or other bird, such as are breaded/ battered (fried), blended, or injected with solution (as in turkeys/chickens/hams).
Any of the following that use gluten-containing fillers: cold cuts, hotdogs, scrapple, meat loaf, sausage, meatballs, meat patties; canned meat, fish, poultry, or seafood using hydrolyzed vegetable protein.
Imitation crab, other meat using wheat gluten or seitan.
|Eggs||Fresh eggs boiled, poached, fried, or plain* scrambled.||Commercially prepared** dried or frozen egg products using flour or wheat starch. Souffle, omelet or scrambled eggs thickened with flour or pancake batter.|
|Milk and milk products||Plain* fresh or evaporated milk including goat and sheep milk. Plain sour cream, light/heavy cream; plain yogurt.||Malted milk, commercially prepared** chocolate and flavored milk.
Yogurt thickened with wheat starch, hydrolized protein added, or with granola added.
|Cheese||Plain* aged, chunk cheese, such as cheddar, Swiss, edam, Parmesan, Romano, and manchego; cottage cheese, cream cheese, and specially prepared GF spreads/ mixes.||Cheese product thickened or stabilized with oat gum or wheat starch, such as spread/ sauce for nachos or macaroni. Some veined cheeses aged with moldy bread, such as bleu cheese, stilton, Roquefort, and gorgonzola.|
|Pasta and Noodles||Specially prepared GF pasta and noodles made with rice, corn, potato, or other safe flour.
Bean thread, rice, and wheat-free buckwheat noodles.
|Regular pasta such as penne, spaghetti, lasagna, and macaroni.
Regular noodles using wheat flour.
|Naturally GF starch dishes||Plain* rice, wild rice, sweet potatoes, potatoes, yams, buckwheat or kasha, millet, and hominy or polenta.||Commercially prepared** flavored or seasoned rice, wild rice, kasha, or other GF food using wheat starch/ flour, oat gum, or hydrolized or texturized wheat protein.
Frozen French fries and potato products dusted with flour at the plant and/or coated with seasoned flour at the restaurant. Potatoes stuffed with a flour thickened filling.
|Breads and yeast raised buns, pizza, and doughnuts||Specially prepared GF.||Regular.|
|Flatbreads and tortillas||Specially prepared GF flatbreads. Plain* corn tortillas.||Regular flatbreads/ flour tortillas.
Corn tortillas with flour or barley added.
|Quickbreads||Plain* corn muffins and corn bread. GF muffins, GF English muffins, GF scones, GF biscuits, GF breads like Irish soda bread, banana, apple, and date/nut bread.||Regular quickbreads.|
|Baked goods||GF cakes, pies, cookies, brownies, pastries, tarts, croissants, and Danish.||Regular baked goods.|
|Doughnuts and fried dough||Specially prepared GF doughnuts and fried bread dough.||Regular doughnuts and fried bread dough.|
|Pancakes, waffles, and crepes||Plain* buckwheat pancakes.
GF pancakes, waffles, and crepes.
|Buckwheat pancakes made with flour. Regular pancakes, waffles, and crepes.|
|Cereals||All plain* cereals made from safe foods, such as rice, corn, buckwheat, millet, and amaranth, and are not coated with malt or malt flavoring.||Regular cereal made from wheat, rye, barley, and oats such as wheat flakes, wheat puffs, shredded wheat, wheat germ, cream of wheat, and oatmeal.
Any cold cereals coated with malt syrup or malt flavoring to keep them crisp, including safe grains such as crispy rice or corn flakes.
Granolas, muesli, and kashi.
|Soups||Homemade broth and soup, and stew using safe ingredients and thickened with cornstarch.||Most canned and dry mix soups and stews. Boullion and boullion cubes using hydrolyzed wheat protein.|
|Legumes||Plain* beans, peas, lentils, chickpeas, peanuts, and soybeans.||Any made with unsafe ingredients such as baked beans thickened with flour or oat gum, coated or blended with breadcrumbs, or flavored with soy sauce or malt syrup/ flavoring.|
|Snacks||Plain* corn, potato, soy, and vegetable chips.
Specially made GF breadsticks, pretzels, and crackers.
Trail mix made with GF ingredients. Plain nuts and seeds.
Plain fruit bars.
|Regular wheat, rye, barley, and oat-based crackers, crisps, and pretzels. Trail mix with wheat nuggets or oat granola. Seasoned roasted nuts. Seeds with unsafe flavoring.|
|Beverages||Plain*coffee, tea, cocoa, and fruit juices.
Wine made in USA, vodka distilled from grapes or potatoes, sake, vermouth, cognac, and tequilla.
|Coca-cola, malted milk, commercially made drinks with unsafe grains such as Ovaltine, Postum, and Tang. Herbal teas flavored with barley malt; root beer; some flavored coffees. Some instant decaffeinated coffee.
Regular beer, ale, and porter.
|Cold Desserts||GF ice cream, frozen yogurt, sherbet, and sorbet.
Gelatin, junket, and custard.
Puddings, such as rice and tapioca, thickened with cornstarch or arrowroot.
|Ice cream and sherbets made with gluten stabilizers, cookie dough, cookies, or other cereal additives. Ice cream cones. Pudding mixes and puddings thickened with flour, wheat starch, or oat gum.|
|Sweeteners||Crystalline fructose, honey, maltitol, sorbitol, rice syrup, pure maple syrup, and pure fruit spreads.||Rice syrup with flour and some corn and pancake syrups using wheat, barley malt or oat gum.|
|Condiments||Apple cider vinegar, white vinegar distilled from corn, rice vinegar, balsamic vinegar, wine vinegar, and fruit vinegar like plum and raspberry.
Mayonnaise, mustard, catsup, sauces, pickles, and olives made with safe vinegar.
Tamari made from soy only. Soy sauce made from soy only.
|Soy sauce and hoisin sauce made from soy and wheat.Malt vinegar and products made using it.|
|Fats||Butter and any oil other than wheat germ oil.||Wheat germ oil. Non-dairy cream substitutes; some commercial salad dressings using wheat germ oil.|
|Sweets||GF candy and fruit bars.||Commercially prepared** candies dusted with flour to keep from sticking, fillings thickened with flour, wafers and other cereal parts made from unsafe grains, and addition of oats or oat gum or malt flavoring/ syrup. Twizzler’s red licorice and Goetz’s Cow Tales are examples using wheat flour.
Some gum drops, and some chewing gum.
|Deli or salad bar foods||Plain* salads/ vegetables without croutons or breadcrumbs.
Caution: may be contaminated by use of utensils used for unsafe foods or by spillage onto them.
|Regular tuna, egg, chicken, seafood, fish, and ham salad. Pasta salads. Breaded foods/ battered foods.
|Nutritional bars||Specially prepared GF.||Regular bars containing gluten.|
|Thickeners||Cornstarch, arrowroot, potato starch, and tapioca starch.
Xanthan gum, guar gum, carob bean gum, locust bean gum, gum Arabic, cellulose, and carrageenan.
|Wheat starch/ flour, hydrolized wheat protein, oat gum.|
|Flavorings||Maltodextrin (in the USA it’s derived from corn, potato or rice), most spices and herbs.||Barley malt, malt, malt extract, and malt syrup, oat syrup. Some spice blends. Dry curry powder.
Maltodextrin is usually derived from barley or wheat outside of USA.
|Miscellaneous||Active dry yeast, bicarbonate of soda, GF baking powder, cream of tartar. Specially prepared communion wafers||Instant dry yeast. Some baking powders.
Standard communion wafers.
Chart 1.3 Safe and Unsafe Foods. Adapted from chart provided in “Celiac Disease.” National Digestive Diseases Information Clearinghouse.
Q. Is distilled white vinegar gluten-free?
A. Distilled white vinegar is made from wheat. Traditionally, vinegar derived from wheat, barley or rye was not allowed in the gluten-free diet. Concern about this continues because on one side sensitive celiacs continue to report abdominal symptoms when they ingest this vinegar or products made from them.
On the other side, the distillation process is said to make the inclusion of gluten (peptides) in vinegar not physically likely. Research we are able to locate to date is limited to a Flemish study and a Dutch study that appear inconclusive because, admittedly, the methodology for testing was not designed to detect “small (but still toxic) peptides” that have recently been discovered.
White vinegar (not distilled white vinegar) by law refers to vinegar made from apples. However, it can be manufactured from corn, potato, rice, or barley but should include the source on the ingedient list. Corn derived vinegar is the most widely used vinegar in manufacture of food in the USA. For those of us who react to white vinegar derived from wheat, barley or rye, the FDA advised us that if the vinegar is derived from wheat, it must declare this on the label according to the Allergen Labeling Act effective 1/2006. This would not apply to barley or rye, so the only way to be sure is to contact the manufacturer of the product.
Q. Are there other sources of gluten I should know about?
A. Yes. There are “hidden sources” because you wouldn’t ordinarily suspect them. Gluten, usually as starch, modified food starch, or hydrolized vegetable protein (HVP), may be used in the following:
- Lip balm.
- Shampoo and other hair care products like hairspray and mousse. (Yes! People with dermatitis herpetiformis tell us they break out in this specific rash from such products.)
- Body care products.
- Vitamin and mineral supplements.
- Glue on stamps and envelopes (do not lick to seal but rather use water.)
- Playdough (toy product for children).
2. Buying Safe Food
Q. What do I need to do?
A. Take an inventory of the food you already have, make a food list to take shopping, read every package label on the items you pick at the store, and develop a routine for shopping.
- Inventory. Before shopping, check the pantry and refrigerator first to see what safe food you already have. Remove all items that are unsafe and clean the surfaces. Flour is like dust. It can get into everything. The objective is to prevent contaminating restocked safe food in your own house. If you must share space with someone not on the GF Diet, put your safe foods in a separate cupboard. In the fridge, put your food in containers or on separate shelves above unsafe foods to avoid contamination.
- Make a Shopping List. This depends on your food preferences and cooking style. Read more…GF Food Substitutes.
- Read the Ingredient List on Every Food Package Label Every Time. There is no better way to find out what’s in the package before buying. Look for the word “gluten” or anything derived from wheat, rye, barley, and oats shown in Chart 1.2 “UNSAFE GRAINS AS INGREDIENTS” above.
- Note: foods that say “wheat-free” may, in fact, contain one of the other gluten-containing grains. If in doubt, call or e-mail the manufacturer to confirm product is gluten-free. Some people use their cell phones to call the manufacturer while in the store. Don’t be shy.
- Manufacturers are required under the U.S. Food and Drug Administration (FDA) regulations to provide consumers the advantage of knowing what is in commercially prepared food by means of an ingredient list on the food label. Here’s their information:
The ingredient list on a food label is the listing of each ingredient in descending order of predominance by weight. That is, the ingredient that weighs the most is listed first and the ingredient that weighs least is listed last. The list is found on the same panel as the name and address of the manufacturer, packer, or distributor.
For example, Ingredients: Pinto beans, Water, and Salt.
A trace ingredient is only required to be listed if it is present in significant amounts and has a function in the finished product. If a substance is an incidental additive and has no function or technical effect in the finished product, then it need not be declared on the label. An incidental additive is usually present because it is an ingredient of another ingredient. Sulphites are considered to be incidental only if present at less than 10 parts per million. ((“A Food Labeling Guide.” Chapter IV–Ingredient List. U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition September, 1994 -Editorial revisions June, 1999.))
As of January 2006, the “Food Allergen Labeling and Consumer Act of 2003” requires food manufacturers of food sold in the United States to clearly state in “plain English” on the packaging if the product contains wheat (and eggs, fish, shellfish, peanuts, soybeans, and tree nuts). Small amounts of such ingredients as colorings, flavorings, and seasonings are included. It does not require declaring of gluten, barley, rye, or oats; however, a separate gluten-free rule has since been established. Only foods containing less than 20 parts per million can be labeled gluten-free in the United States.
- Develop a Grocery Store Routine. First, buy all the whole foods you normally choose that do not have gluten, then read package labels on prepared foods you might want. Unless marked on the package as “gluten-free,” contact the manufacturer. Question buckwheat, amaranth, millet, quinoa, and teff. These are naturally safe foods that can be contaminated at the farm, at the mill, and at the packaging plant.
To avoid unsafe hidden ingredients, watch for malt and malt flavoring/ syrup, distilled white vinegar, unsafe or unknown polymers and additives listed in chart 1.2, “UNSAFE GRAINS AS INGREDIENTS” on this page top. Use chart 1.3, “FOODS ALLOWED/ NOT ALLOWED” as a guide on this page top.
- 12 Helpful Tips When Buying Food:
3. Preparing Safe Food
Here are some helpful guidelines.
1. Keep your pantry and fridge well stocked so you won’t fall short and be tempted by hunger.
2. Protect your safe food from contamination by gluten.
- Do not use the same utensils to make safe and unsafe foods.
- Do not use the same utensils to serve safe food either at home or away, such as at work or school, a party or restaurant salad bar.
- Do not place safe foods close to unsafe foods when serving. For example, if you place your cake next to an unsafe cake, someone is sure to cut both cakes with the same knife.
- Always wash shared counters or other surfaces thoroughly before making GF food.
- Always wash shared equipment such as mixers, skillets, or blenders before using.
- Keep safe food stored in separate containers or cupboards if sharing space.
- Do not use a toaster or toaster oven that is also used for unsafe breads.
- Cover your food and place it on a napkin when using a shared microwave, especially at work or school where the oven may not get cleaned properly.
3. Make your own food from scratch whenever possible.
- Build your meals around plain meat, eggs, milk, cheese, vegetables and fruits that you season yourself. Read more… GF Food Substitutes.
- Buy some GF cookbooks or use our online recipes for ideas…go to Recipes.
- Double or triple the recipe then freeze for other meals or use for lunches to save time and money.
4. Don’t make an issue of being different and make safe food for the whole family. After all, rice pasta tastes and looks like regular pasta. Your family will feel better, too.
5. A child’s school lunch is safest when packed at home and when the child fully understands why only safe food may be eaten. Nevertheless, you have a right to expect availability of safe food at the cafeteria.
6. When traveling, always pack some safe food. It’s a good idea to keep some nutritional bars and snacks in the glove compartment for emergencies.
4. Eating Out
- Always ask to speak to the manager to tell him you need GF food.
- Get to know restaurants with a GF menu or that understand “gluten-free”.
- Call ahead whenever possible to ascertain the likelihood of food safety.
- If the restaurant uses prepared sauces or dishes they do not make from scratch, try another place.
- Avoid deep fried foods – even if they have a safe coating (unlikely), they are certain to be cooked in the same deep fat cooker as unsafe breaded/ battered food, unless the fryer is used only for safe foods. [Deep fried foods are usually very unhealthy due to trans fats and high calories.]
- A dedicated fryer used only for French fries, for example, would be safe provided the fries were cut at the restaurant. Commercial frozen fries and potatoes cannot be trusted.
- The same goes for grilled. Always ask if anything other than safe foods like steak is cooked on the grill to ascertain if the grill surface is safe.
- Soups, stews, and casserole dishes cannot be trusted unless the cook guarantees all ingredients are safe.
- Rather, choose plain cooked or sauteed foods made to order.
- Ask for seasonings like olive oil, butter, or apple cider, rice, or wine vinegar if you like.
5. Menu Ideas
Here are some options to help get started:
- Fresh fruit and juices without sugar.
- Eggs any style, using safe ingredients.
- Gluten Free toast with fruit preserves/ butter.
- Gluten Free muffins, scones, coffeecakes, cornbread GF pancakes, waffles – use fresh fruit or fruit preserves for added nutrition.
- Gluten Free cereal, hot or cold – add fresh fruit, raisins, nuts, or cinnamon for flavor.
- Gluten Free yogurt with fresh fruit, nut or cinnamon.
- Fresh fruit/ vegetables cut into bite size pieces.
- Gluten Free cheese.
- Hard boiled eggs.
- Gluten Free trail mix.
- Gluten Free nutritional bar.
- Gluten Free crackers, chips, pretzels.
- Freshly popped corn.
- Leftovers from dinner.
- Big salad – using gluten-free dressing with apple cider, rice, or wine vinegar – no sugar, Top with chicken, ham, turkey, egg, cheese, tofu, beans…other protein source.
- Organic corn tortilla with choice of filling – use gluten-free salsa.
- Sandwich with gluten-free roll/ bread and gluten-free condiments.
- Gluten-free soup, chili, chowder.
- Cottage cheese and fruit.
- Gluten-free yogurt with add ins.
- Center around any fresh, frozen, or canned meat, seafood, fish, poultry, or legume you like that is not mixed with, covered, or injected with unsafe ingredients.
- Make sides with any fresh, frozen or canned vegetable that is not mixed with or covered with unsafe ingredients.
- Big salad – using variety of greens, gluten-free dressing with apple cider, rice, or wine vinegar – no sugar (yes, honey). Top with chicken, ham, turkey, egg, cheese, tofu, or legumes…other protein source.
- Starch dish – use potato, sweet potato, rice (such as plain, gluten-free flavored, risotto, pilaf), sweet corn or cooked GF polenta/ mush, gluten-free kasha (made from plain buckwheat seeds), plain amaranth seeds, and cooked plain millet.
- Gluten-free corn tortilla with choice of filling.
- Gluten-free pizza/ calzones.
- Hamburger/ Sloppy Joe/ steak sandwich with gluten-free bun and gluten-free condiments.
- Chili con carne made gluten-free.
- Gluten-free soup, stew, casserole.
- National Institutes of Health, “National Institutes of Health Consesus Development Conference Statement, Celiac Disease,” August 9, 2004;1-14.