Celiac Disease Diet

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. 

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. 

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.