Celiac Disease Diet: What You Can and Can’t Eat
If you have not noticed, the supermarket shelves and the restaurant's menu offer more and more gluten-free products, from chickpea paste to cauliflower pizza crust. And while a gluten-free diet for celiac sufferers is undeniably trendy, it's not a lifestyle choice but a necessity.
The cause of celiac disease is unknown and can develop at any age. According to The Celiac Disease Foundation (CDF) today, an estimated 1 in 10 people around the world are affected. The effects can be very different. In fact, there are 200 known symptoms of celiac disease that can occur in the digestive system or in other parts of the body.
Dealing with celiac disease requires a lifetime commitment to avoiding gluten in all its forms. Unfortunately, this group of proteins is found in many popular foods, making it difficult to identify what is safe to eat. Wondering how to spot gluten on a nutritional label? You are not sure which grains you should stay away from? Are you looking for celiac-friendly alternatives to some of your favorite foods? Whether you or a loved one in your household is following a celiac diagnosis on this diet, or just curious about the difference between celiac disease and gluten intolerance, read on and find answers to all your burning questions about this common condition disorder.
What is celiac disease?
According to CDF, celiac disease is an autoimmune disease that adversely affects the lining of the small intestine when gluten – a protein found in wheat, barley and rye – is ingested.
When someone with celiac disease consumes gluten, his or her body immediately triggers an immune response that attacks the small intestine, thereby impeding nutrient intake.
Amanda A. Kostro Miller, RD and LDN, member of the Advisory Council on Smart Healthy Living, notes that symptoms of celiac disease are common:
- stomach pain
However, the CDF reports that adults with celiac disease may or may not have digestive symptoms, and other symptoms may also appear. These can be:
- Bone or joint pain
- Cancerous ulcers in the mouth
- Deafness or pain in hands and feet
- Dermatitis herpetiformis (an itchy rash)
According to Miller, your doctor may test for celiac disease by analyzing antibodies and / or biopsy of the small intestine.
What is the difference between celiac disease and gluten intolerance?
Both celiac disease and gluten intolerance are associated with an adverse reaction to gluten. However, it is important to distinguish between the two. The former leads to an autoimmune reaction to gluten, the latter being a condition due to the inability to properly metabolize and absorb the protein.
It has long been believed that people with gluten sensitivity do not suffer the same intestinal damage as people with celiac disease. However, a 2016 Columbia University Medical Center study has shown that people with gluten sensitivity (who were never tested positive for celiac disease) were on a diet that included wheat, some of which had some damage to the gut cells.
"People's reactions to gluten can be mild to severe," says Miller. "If you have gluten intolerance, you may be able to tolerate a certain amount of gluten and / or wheat / barley / rye as ingredients in certain foods. Celiac sufferers should, however, avoid all gluten-containing foods and / or gluten-containing ingredients. "
For this reason, the state-certified endocrinologist Dr. Anis Rehman Anyone who has been newly diagnosed with celiac disease or non-celiac gluten sensitivity, detailed medical advice from a nutritionist.
Unlike celiac disease, Miller says there is no test for gluten intolerance. That's why she advises you to visit a registered nutritionist if you suspect you have this condition. An elimination diet may be recommended to confirm that gluten is the culprit of your symptoms.
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Foods that you can eat gluten-free
Although gluten must be avoided, there are many foods that you can enjoy if you have been diagnosed with celiac disease. In fact, some foods, such as fresh and frozen products, legumes and dairy products are naturally gluten-free.
According to Andres Ayesta, RD, LD and founder of Vive Nutrition, as well as Monica Auslander Moreno, RD, LD / N and Nutritionist for RSP Nutrition, here are some of the staple foods that are safe to eat with a gluten diet:
- Fresh, frozen, preserved or dried fruit (excluding gluten-containing additives)
- Fresh, canned or frozen vegetables (excluding gluten-containing additives)
- Meat, poultry and seafood (unless breaded or dipped in flour)
- Dairy products (with the exception of some flavored dairy products and yogurts)
- Beans and legumes
- Nuts and seeds
- Certain grains (quinoa, millet, rice, amaranth and teff)
- Oils and vinegars
It should not be a problem to find on the supermarket shelves a variety of gluten-free crackers, pasta, breads, muesli varieties and much more. However, for processed foods, care must be taken to ensure that the products are gluten-free and not cross-contaminated.
Food that you can not eat gluten-free
If you suffer from celiac disease, you need to keep away from gluten-containing foods – not only to prevent possible discomfort, but also to prevent damage to your gastrointestinal tract.
It goes without saying that a piece from a traditional pizzeria or an Italian sub is off the table. However, you must also skip bread, pasta, bakery or other wheat, barley, rye or triticale products. That means croutons, breadcrumbs and even seitan are a no-go. While fresh fruit and vegetables are okay, Miller warns that frozen and preserved versions sometimes contain sauces or flavors with gluten.
According to Dr. Sashini Seeni, a general practitioner at DoctorOnCall, should avoid some other foods during the celiac diet:
- Products containing wheat, barley, rye or triticale
- Processed meat (salami, sausage, hot dogs, etc.)
- cheese spread
- Flavored yogurt with gluten preservatives or other additives
- Semolina flour / couscous
- spelled flour
- Wheat meal
There are many other sneaky foods with gluten to watch out for, such as soy sauce (which contains fermented wheat), gherkins (which contain malted wine) and pudding (which contains wheat-based thickener). According to Ayesta, spices and seasonings often contain gluten. Even some canned soups and bottled salad dressings have wheat thickeners to give them a creamy texture.
It is important to remember that some foods that do not contain gluten are still at risk of cross-contamination. For example, oats are naturally gluten-free – but some are processed in facilities that also process wheat, barley and rye. For this reason, it is advisable to check the label to make sure that the product has been processed in a gluten-free facility.
"The list of possible gluten ingredients is complete," says Moreno. "Celiac sufferers need to talk with their doctors about their particular sensitivity and needs."
When eating out, it is important to communicate clearly with your server about your need to avoid gluten. Make sure that this need is due to celiac disease, not gluten sensitivity or a dietary change. While certain dishes appear safe, the sauces or spices may contain gluten-containing additives that you do not know. For example, some restaurants add pancake batter (which is full of gluten) to omelets to make them fluffier.
"At a restaurant, you may need to worry about gluten cross-contamination on cooking surfaces," adds Miller. "Most catering establishments can not guarantee that they are gluten-free. Some people with severe gluten sensitivities may develop symptoms when foods touch a surface containing flour or other gluten products. Although I do not recommend celiac disease being scared of our food system, it is important to be vigilant and to communicate your nutritional needs to those who cook for you so that they become aware of it. "
Fortunately, Ayesta notes that many kitchens now have gluten-free certifications indicating that they use practices to avoid cross-contamination with gluten.
How to read food labels
Determining whether a product contains gluten requires some practice. Although some products are specifically labeled as "gluten-free," the US Food and Drug Administration does not require manufacturers to provide gluten on food labels (gluten-only ingredients such as wheat).
If the package contains a "gluten-free" label, you know that under FDA regulations, there are less than 20 ppm (parts per million) of gluten. However, since not every gluten-free product carries this label, you may need to do further research to determine if it is safe to eat or not. Miller recommends that you check the allergen warning section, which is usually near the ingredient list, for wheat. Keep in mind, however, that a "wheat-free" label does not necessarily mean that a food is gluten-free, as it may still contain rye and barley. For this reason, it is advisable to search the ingredient list for all types of wheat, rye, barley / malt and their derivatives. Cornflakes and rice balls are considered gluten-free cereals, but often contain malt extract / flavor.
Look for hydrolyzed wheat protein, hydrolyzed wheat starch, wheat flour, bleached flour, bulgur, wheat germ oil or extract, and wheat or barley grass that either contain gluten or may be cross-contaminated. Many of the thickeners added to soups, salad dressings and sauces contain wheat, but guar gum, xanthan gum and locust bean gum are all celiac-friendly alternatives.
"Understand which products are at the highest risk for cross-gluten contact," says Miller. "Flours and cereals, for example, have a high contact with gluten, so consumers should buy flours and cereals that are specifically labeled as gluten-free."
Other ingredients that may possibly contain gluten include modified (food) starch, (hydrolyzed) vegetable protein, (hydrolyzed) vegetable protein, plant starch, dextrin and maltodextrin. You should be careful when you find terms like "natural flavor" or "artificial flavor" in the ingredients, as they can sometimes be made from barley.
If in doubt, always ask the manufacturer if a product containing any of these ingredients contains gluten or could be cross-contaminated.
Gluten-free substitutions of popular foods
Just because you have celiac disease does not mean you have to give up your beloved pastry or your pizza. Fortunately for those with celiac disease it is easier than ever to find safe substitutions for popular gluten-containing foods such as baking mixes, breads, crackers, biscuits and more.
Fancy a hearty plate of pasta? Look for gluten-free products made from quinoa, rice, chickpeas or cornmeal instead of wheat flour. Rice noodles and mung bean noodles are of course also gluten-free.
Cakes, biscuits and muesli that use almond flour or coconut flour instead of wheat, rye or barley are also permitted. Other gluten-free options include potato flour, pea flour, soy flour, arrowroot flour, tapioca flour, hemp flour, rice flour, sorghum flour and buckwheat flour.
When it's time for a taco night, use corn tortillas or brown rice tortillas instead of flour.
While there are many gluten-free crackers on the market, rice cakes are also a phenomenal option if you are looking for a crunchy side dish with cheese, gluten-free hummus or salsa.
Many pizzerias make gluten-free versions of their pies. However, if you also use wheat flour in the same kitchen, you should ask yourself if there is a possibility of cross-contamination. You can also make your own pizza with a cauliflower or spaghetti squash crust.
And if a good portion of pancakes is needed on a lazy weekend, all you have to do is replace the wheat flour or the all-purpose flour with cornmeal. As an added bonus, cornmeal contains more saturating protein than regular flour.
Of course, the celiac diet requires some strict restrictions and special considerations, but fortunately, more and more restaurants and food manufacturers are ensuring that there are delicious alternatives for those who do not need gluten. The more you learn about gluten-containing ingredients, the easier and more effective you can read nutritional labels to make a smarter and safer buying decision.