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Celiac Disease Diet

What Is It, Foods are Eat, Foods to Avoid, and More

Author:Lily Guo

Editors:Alyssa Haag,Stefan Stoisavljevic, MD,Kelsey LaFayette, DNP, RN, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:Stacy Johnson, LMSW


What is celiac disease?

Celiac disease, also known as gluten-sensitive enteropathy or celiac sprue, is a chronic disease of the small intestine in individuals who develop an immune response to gluten. Gluten is a protein in wheat, barley, rye, and some oats. When an individual with celiac disease ingests gluten, their immune system reacts abnormally, causing inflammation in the small intestine. Due to inflammation, the small intestine's villi (i.e., the tiny, fingerlike tubules lining the small intestine that absorb nutrients from food into the bloodstream) may become destroyed. Destruction of intestinal villi results in symptoms of nutritional malabsorption, bloating, nausea, vomiting, diarrhea, constipation, and weight loss. Over time, systemic signs of celiac disease can occur, such as fatigue, anemia, osteoporosis, and damage to the nervous system, causing neuropathy and seizures

In children, celiac disease leads to similar gastrointestinal symptoms but may further impair growth and development due to the malabsorption of essential vitamins and minerals. For children with celiac disease, consuming gluten may lead to delayed puberty and increase the risk of learning disabilities. In adults and children, celiac disease can present with itchy, blistering skin rashes in a dermatological condition known as dermatitis herpetiformis

There is currently no cure for celiac disease; however, following a strict diet that avoids gluten can help manage symptoms and decrease intestinal inflammation. 

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What is a celiac disease diet?

A celiac disease diet refers to a diet that eliminates foods and drinks that contain gluten to relieve celiac disease symptoms and reduce intestinal inflammation. A gluten-free diet avoids grains, pasta, cereals, and processed foods. Those with celiac disease are typically recommended to follow this diet for life to prevent the recurrence of intestinal damage. Even the slightest amount of gluten can trigger an immune system reaction that may cause damage. Individuals with celiac disease and gluten intolerance often become experts at reading the ingredient list at the back of a food package to ensure the foods they are eating don’t contain gluten. The Food and Drug Administration (FDA) has set a standard of fewer than 20 parts per million of gluten as the criteria for using the claim “gluten-free” in packaged foods and beverages. A clinician or registered dietician can guide individuals on what to eat and drink to maintain a well-balanced diet. 

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How does a celiac disease diet help?

Celiac disease diets can help reduce the inflammation and destruction of intestinal villi that occurs with gluten consumption. Once ingested, gluten is broken down into gluten peptides. Typically, these peptides pass through the small intestine. In the small intestine, local immune cells called macrophages activate the immune system if they detect pathogens. In individuals with celiac disease, gluten peptides get recognized by macrophages as foreign proteins, and  T-cells are activated. T-cells may then start producing inflammatory cytokines like interleukin 15 (IL-15) that attract other immune cells and induce inflammation, which ultimately causes symptoms ranging from asymptomatic to severe malabsorption.  Avoiding gluten through a celiac disease diet minimizes the autoimmune attack on the gastrointestinal system. 

What foods are best on a celiac disease diet?

The foods that are best on a celiac disease diet include naturally gluten-free food groups such as fruits; vegetables, including potatoes; meats, including poultry, fish, and seafood; beans; legumes; nuts; and dairy. Specific grains like rice, millet, corn, chia, quinoa, chickpea, pure wheat grass, and barley grass are gluten-free and acceptable within a celiac disease diet. Other grains, including amaranth, arrowroot, buckwheat groats, cassava, flax, soy, and tapioca, are likewise gluten-free. Oats are sometimes considered gluten-free if they are not cross-contaminated with sources of gluten. Oats, rice, and corn are often processed in the same facility as wheat gluten products. One can check product labels to ensure that it is marked as gluten-free, or for a warning label, before consumption. Most beverages are gluten-free, including juices, sodas, and sports drinks. Alcoholic beverages, including hard liquor, wine, distilled liquors, and hard ciders, are also gluten-free. 

A celiac disease diet is a well-balanced diet with many different food groups and can also include pre-packaged bread, pasta, and other processed foods marked as gluten-free. These products can commonly be found in grocery stores as well as restaurants. Finally, gluten-free does not equate to fewer calories, and dietitians may recommend not exceeding the daily caloric intake. 

What foods should be avoided on a celiac disease diet?

Foods that should be avoided on a celiac disease diet include products containing wheat, rye, triticale (i.e., a cross between wheat and rye), and barley. Other grain products that have gluten include farina, graham flour, semolina, and any other kind of flour not labeled gluten-free. Wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein, einkorn, emmer, spelt, and kamult all contain gluten.  

As a general rule, traditional wheat products such as pasta, bread, crackers, and other baked goods often contain sources of gluten and are not recommended in a celiac disease diet. While fresh and frozen fruits and vegetables are naturally gluten-free, it may still be important to read the food labels on processed fruits and vegetables, dried fruit, and pre-made smoothies, as these products may contain hidden sources of gluten. Examples of ‘hidden’ sources of gluten include emulsifiers, dextrin, mono- and di-glycerides, seasonings, and caramel colors, which can be found in candy; potato chips; processed meats (e.g., cold cuts, hot dogs, salami, and sausage); french fries; bouillon cubes; and rice mixes. Additionally, canned soups, sauces (e.g., gravy, soy sauce), and salad dressings that may otherwise be gluten-free often contain additives such as modified food starch, preservatives, and stabilizers that contain wheat. 

Beverages, including beers, ales, lagers, malt beverages, and malt vinegar, are made from gluten-containing grains and are not gluten-free. Some wines with added color or flavoring and those made from barley malt, such as bottled wine coolers, are likewise not gluten-free. Some medicines may contain gluten, including herbals, vitamins, supplements, and probiotics. While the risk is minimal, tablets and capsules can be sources of gluten contamination. If an individual with celiac disease is concerned about their medicines, they should discuss this with their healthcare provider.

Naturally, gluten-free products and grains may be contaminated during cross-contact harvesting, processing, storage, and preparation with foods containing gluten. This frequently occurs with oats as they are often harvested and processed with the same equipment used for wheat. Therefore individuals with celiac disease may need to look for gluten-free labels on oat products, such as granola and granola bars. All kitchen items used for preparing gluten and gluten-free foods should be separated to avoid cross-contamination during at-home food preparation. These include cooking utensils, cutting boards, knives, and spoons. When eating at a restaurant, one can inquire about how the food was prepared or ask whether a gluten-free menu is available.

What are the most important facts to know about a Celiac disease diet?

Celiac disease diets are recommended for people with celiac disease. This chronic autoimmune condition results in damage to the villi of the small intestine after the consumption of gluten-containing foods. Foods containing gluten include wheat, barley, rye, and processed foods such as bread, crackers, and pasta. The celiac disease diet consists of gluten-free foods, mainly natural food groups including fruits, vegetables, meats including poultry, fish and seafood, beans, legumes, nuts, and dairy. Certain grains are acceptable in a celiac disease diet, including rice, millet, corn, chia quinoa, and chickpea. While celiac disease is a chronic condition with no cure, individuals can manage symptoms by adhering to a celiac disease diet. 

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Resources for research and reference

Crowe, S.E. Putting celiac disease in perspective: Pathogenesis, comorbidity, and transition of care. United European Gastroenterol J. 2020;8(2):129-130. doi:10.1177/2050640620908460

Dietary changes for celiac disease. Johns Hopkins Medicine. (2019, November 19). Retrieved September 19, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/celiac-disease/dietary-changes-for-celiac-disease#:~:text=You%20can%20still%20eat%20a,and%20other%20specialty%20food%20shops. 

Dunne, M.R., Byrne, G., Chirdo, F.G., Feighery, C. Coeliac disease pathogenesis: The uncertainties of a well-known immune-mediated disorder. Front Immunol. 2020;11:1374. Published 2020 Jul 8. doi:10.3389/fimmu.2020.01374

Gluten-free foods. Celiac Disease Foundation. (n.d.). Retrieved September 19, 2022, from https://celiac.org/gluten-free-living/gluten-free-foods/ 

Kagnoff, Martin F. “Overview and pathogenesis of celiac disease.” Gastroenterology, vol. 128, no. 4, Apr. 2005, pp. S10–18. www.gastrojournal.org, https://doi.org/10.1053/j.gastro.2005.02.008.

Parzanese, I., Qehajaj, D., Patrinicola, F., Aralica, M., Chiriva-Internati, M., Stifter, S., Elli, L., Grizzi, F.. Celiac disease: From pathophysiology to treatment. World J Gastrointest Pathophysiol. 2017 May 15;8(2):27-38. doi: 10.4291/wjgp.v8.i2.27. PMID: 28573065; PMCID: PMC5437500.

U.S. Department of Health and Human Services. (n.d.). Eating, diet, and nutrition for celiac disease. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved September 19, 2022, from https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/eating-diet-nutrition