Adherence to a strict gluten free diet remains the only treatment for celiac disease.  While options are increasing it can still be very challenging to find gluten free prepared foods.  When struggling to decipher what is or isn't gluten free, remember that five of the six fresh food groups are gluten free!

Anything made from or with wheat, barley or rye, contains gluten and must be avoided.  This includes everything from the obvious like breads and pastas to the not so apparent, like lip balms and lotions.  Ingestion of gluten in any form can trigger celiac disease to become active. As little as 1/8 of a teaspoon of flour is enough to set off this abnormal response.

HEALING THE GUT

Step one in managing the gluten-free diet is to understand which foods contains wheat, rye, and barley so they can be eliminated from the diet, and intestinal healing can begin.   It may seem overwhelming at first as wheat, rye and barley are common food ingredients, however there are variety of foods that are naturally gluten-free. Fresh foods, without any processing or additives, from the fruit, vegetables, dairy products, and meat/meat alternatives food groups are all NATURALLY GLUTEN-FREE. That is five out of the six food groups.

Below you will find a list of ingredients to avoid as they contain wheat, rye, barley, or derivatives of these grains. It is important to look for words such as these on all food ingredient labels. Check for words like these every time you shop.

Ingredients to AVOID (CONTAIN GLUTEN)

• Abyssinian Hard (Wheat Triticum duran)
• Avena (wild oat)
• Barley (Hordeum Vulgare)
• Barley malt, barley extract
• Beer, ale, porter, stout, other fermented beverages
• Blue Cheese**
• Bran
• Bread flour
• Broth**
• Bulgur (bulgur wheat, bulgur nuts)
• Bouillon
• Cereal (cereal extract, cereal binding)
• Cracker meal
• Croutons
• Couscous
• Dinkle***
• Durum***
• Einkorn, wild einkorn***
• Emmer, wild emmer***
• Edible starch
• Farina
• Farro***
• Filler
• Fu
• Flour (Including but not limited to: all-purpose, barley, bleached, , bread, brown, durum, enriched, gluten, graham, granary, high protein, high gluten, oat, wheat, white)
• Germ
• Gluten, Glutenin
• Graham Flour
• Hordeum, Horderum vulgare
• Hydrolyzed oat starch, hydrolyzed wheat gluten, hydrolyzed wheat protein
• Kamut ***
• Malt, malt beverages, malt extract, malted milk, malt flavoring, malt syrup, malt vinegar
• Matzo (Matzah)
• MIR (wheat, rye)
• Miso (may contain barley)
• Mustard powder**
• Oats, oat bran, oat fiber, oat gum, oat syrup*
• Oriental wheat
• Rice malt, rice syrup, brown rice syrup**
• Rye
• Soy Sauce**
• Seitan
• Semolina
• Spelt***
• Sprouted wheat
• Tabbuleah
• Triticale
• Udon
• Vital gluten
• Wheat, wheat berry, wheat bran, wheat germ, wheat germ oil, wheat grass, wheat gluten, wheat starch, whole wheat berries

* 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.

** May be made with wheat   *** Types of wheat

Creating a "safe" cooking environment

In order to become completely gluten-free, it is important to "de-gluten" your kitchen. 

1) If you plan to have both gluten containing and gluten-free food in your household, it is important to determine which foods are "SAFE" for the family members who have celiac disease. Use a laundry marker and label "GF" (gluten-free) on all safe foods and condiments.

2) Start by taking out everything in the pantry, refrigerator, and freezer (not all at once!) and reading labels.

3) In addition to the previous gluten containing grains, there are also many ingredients to question. These ingredients MAY contain of wheat, rye, or barley. If you have any questions about an ingredient, then contact the manufacturing company to learn about where these products are derived. (Does this product contain: wheat, rye, barley?)

• Seasonings and spice mixes - pure spices do not contain wheat, rye or barley. Spice mixes, when two or more spices are blended together, do not commonly use wheat. Alternatively, seasonings are a blend of spices, herbs or proteins that are combined with a carrier including: salt, sugar, milk powder, cereal flours (wheat) and starches
• Dextrin - May be derived from corn, waxy maize, waxy milo, potato, arrowroot, WHEAT, rice, tapioca, or sago; however two large U.S. manufacturers use cornstarch in their production
• Flavorings - Gluten containing grains are rarely used. Flavorings are mostly derived from corn; exceptions include barley malt flavoring, or flavorings in meat products. However, natural flavor may be made from a variety of plant materials and should be confirmed with the manufacturer
• Modified Food Starch - The FDA requires manufacturers to state if starch comes from wheat using parenthetical statement, IE: (wheat) or will state: "Contains wheat" or "made on equipment that processes wheat"
• Starch - The FDA regulations state "starch" implies cornstarch, and if alternative starch is used it will be identified as such (ie: wheat starch)
• Mono and diglycerides - An emulsifier made from specific fats or oils heated at high temperatures. Previously in question because wheat can be added as a carrier with this food ingredient; the label will state if wheat is present

GLUTEN-FREE IngredientS (SAFE TO CONSUME)

• Acorn
• Almond
• Amaranth
• Arborio rice
• Aromatic rice
• Arrowroot
• Basmati rice
• Brown rice, Brown rice flour
• Buckwheat
• Calrose
• Canola
• Cassava
• Channa
• Chestnut
• Chickpea
• Corn, corn flour, corn gluten, corn malt, cornmeal, cornstarch
• Cottonseed
• Dal
• Dasheen flour
• Enriched rice
• Fava bean
• Flax, flax seeds
• Garbanzo
• Glutinous rice
• Hominy
• Instant rice
• Job's tears
• Millet
• Modified corn starch
• Modified tapioca starch
• Montina^TM
• Peanut flour
• Potato flour, potato starch
• Quinoa
• Red rice
• Rice, rice bran, rice flour
• Risotto
• Sago
• Sesame
• Sorghum
• Soy, soybean, tofu (soya)
• Starch (made from safe grains)
• Sunflower Seed
• Sweet rice flour
• Tapioca
• Taro flour
• Teff
• Wild rice

Gluten-free Additives (SAFE TO CONSUME)

• Acacia Gum (gum Arabic)
• Adipic Acid
• Algin
• Annatto
• Aspartame
• Baking Yeast
• Benzoic Acid
• Beta Carotene
• BHA
• BHT
• Brewers Yeast
• Brown Sugar
• Calcium Disodium EDTA
• Carrageenan
• Caramel Color¹
• Carboxymethyl
• Cellulose
• Carob Bean Gum
• Cellulose
• Corn Syrup
• Corn Syrup Solids
• Cream of Tartar
• Dextrose
• Ethyl Maltol
• Fructose
• Fumaric Acid
• Gelatin
• Glucose
• Guar Gum
• Invert Sugar
• Karaya Gum
• Lactic Acid
• Lactose
• Lecithin
• Malic Acid
• Maltodextrin²
• Maltol
• Mannitol
• Methylcellulose
• MSG - monosodium glutamate
• Papain
• Pectin
• Polysorbate 60; 80
• Propylene Glycol
• Psyllium
• Sodium Benzoate
• Sodium Metabisulphite
• Sodium Nitrate; Nitrite
• Sodium Sulphite
• Sorbitol
• Stearic Acid
• Sucralose
• Sucrose
• Sugar
• Tartaric Acid
• Tartrazine
• Titanium Dioxide
• Tragacanth
• Vanilla Extract
• Vanillan
• White Vinegar³
• Xanthan Gum
• Xylitol
• Yam
• Yeast

¹Caramel color is manufactured by heating carbohydrates and is produced from sweeteners.  Although gluten-containing ingredients can be used, they are not used in North America; corn is most often used, however it is important to check with food manufacturers. 

² Maltodextrin is made from cornstarch, potato starch, or rice starch.

³ Distilled white vinegar is safe to consume on the gluten-free diet.  Vinegar is a solution made of acetic acid and flavoring materials such as apples, grapes, grain, and molasses.  For example, cider vinegar is made from apple juice; malt vinegar is made from barley malt, Balsamic vinegar is made from grapes.  Distilled vinegars are gluten-free because the distillation process filters out the large gluten proteins so that they do not pass through to the end product.  Therefore, the finished liquid is gluten-free. Patients with celiac disease should not be concerned about distilled white vinegar or foods such as pickles, which may contain it.  The exception to this rule is MALT VINEGAR, which is not distilled, and therefore is not safe to consume.

A note about oats:  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.

It is recommended that people with celiac disease meet with a registered dietitian who is educated in the disease and the gluten free diet.  Long-term, it is critical to monitor the diet not only to ensure that gluten is completely out of the diet, but also to ensure that critical nutrients are being absorbed.