Ok, so you or a loved one has been diagnosed with celiac disease. Now what?

It’s no secret that living with a diagnosis of celiac disease changes your life. Certain foods no longer become a choice - but a necessity, as the first rule you have to adhere to is to avoid gluten.

But how can you live with a disease that eliminates an ingredient found in the vast majority of foods?

Read on to discover how to get started on a gluten-free diet and live healthfully after a celiac diagnosis in Part 2 of my mini-series on celiac disease.

Getting Started on a Gluten-Free Diet

Yes, a celiac diagnosis changes everything. 

This section is designed to help you navigate through all the hype and educate you about gluten, where it’s often hidden, and how to avoid cross-contamination to help get you started you on your journey to better health. 

The first step is recognizing that if you have celiac disease, you must adopt a gluten-free diet for life - and “cheating” on this kind of diet when you have celiac disease spells disaster.

The second step is to educate yourself. You need to be aware of what gluten is, which foods contain it, and how to avoid cross-contamination so you don’t get sick.

Gluten-Containing Foods

What exactly is gluten?

Gluten is the name given to specific proteins called prolamins that are present in certain grains like wheat, rye, barley, and oats. Gliadin is the prolamin found in wheat, secalin is found in rye, hordein is present in barley, and avenin is present in oats. 

When ingested, these prolamins become toxic to someone with celiac disease. They cause a reaction which prevents the absorption of nutrients and causes any number of potentially debilitating symptoms. If you missed last week’s post, be sure to check it out - Celiac Disease: Signs and Symptoms that May Surprise You!

 The following foods and ingredients contain gluten:

• Matzo

• Oat Bran

• Oat Flour

• Oatmeal

• Oats

• Rye

• Seitan (a meat substitute used in many vegetarian dishes with ingredients derived from wheat gluten)

• Semolina

• Soy Sauce

• Spelt

• Triticale

• Wheat 

• Wheat  Bran

• Wheat Germ

• Wheat Starch

• Whole Oats

• Barley

• Brewer’s Yeast

• Bulgar

• Couscous

• Durum

• Einkorn

• Emmer

• Farro/Faro

• Graham flour

• Kamut

• Malt

• Malt Extract

• Malt Flavouring

• Maltose

• Malt Syrup

• Malt Vinegar

NOTE:

In the case of oats, oatmeal, whole oats, oat bran and oat flour, if any of these ingredients are listed on a food label and the product is certified gluten-free, then it is typically safe for those with celiac disease. Even though oats themselves are gluten-free, it’s important to know that commercially available oats are often contaminated with wheat and/or barley. This means buying certified gluten-free oats is a must for anyone with celiac disease.

How to read Food Labels

The best way to avoid gluten is to choose whole foods - those in their most natural state, and cook all meals at home. This is truly the best way to avoid all sources of gluten and know exactly what you ingesting.

However, we all live in the real word. I know that this is not always possible every day.

So when buying food that is pre-packaged, it’s important that you make the best decisions possible - for you and your health.

Part of that involves learning how to read food labels properly. When reading labels, you should always check two things. 

First, check the “Warnings” section on a food label. Look for the phrases “Contains” or “May contain” that would appear below the ingredients list on a nutritional label.

If these words are followed by “Gluten,” “Wheat,” “Rye,” “Barley,” or “Oats,” put the product back on the shelf and walk away. It it not safe. If none of these words appear in the warning section, or the product does not have a warning section, then move on to checking the actual ingredient list. 

This is the second thing you must learn how to do. If you read the list of ingredients and it includes ANY of the words in the “Gluten-Containing Food” list above, then the product is not safe for you. 

So please familiarize yourself with this list. Take a screen shot of it, or add it to a note on your phone so you will always have the list with you. Then refer to it when shopping. Over time, these words will become second-nature and should be pretty easy to spot. But when you are fist getting started on a strict gluten-free diet, it’s a good idea to refer to the list to ensure you don’t end up consuming gluten by mistake.

Special Notes about Gluten

Please note the following regarding rules for food labels:

• The top eight allergens including milk, eggs, fish, shellfish, tree nuts, peanuts, wheat and soybeans. Currently in the United States, companies are required to note if their product contains any of these top allergens. Because of this, such allergens cannot be hidden in other ingredients like seasonings or natural flavourings.

• Though wheat must be included in the list of top allergens, gluten does not. Gluten is not technically considered an allergen. So remember that “wheat free” does not necessarily mean “gluten free.” You must do your due diligence and search the ingredient list to ensure the food's safety.

• If a warning like “Made in a plant that also processes wheat” is listed on a label, its meaning can only be understood by contacting the company. It may or may not be safe for a celiac. So if you aren’t willing or able to find out exactly what the manufacturer means by these words, then you best avoid the food.

• Manufacturers may change the ingredients in their products from time to time. So, a certain product that doesn’t contain gluten today, may contain gluten in the future. 

• Look for a Gluten-Free certification or declaration. In August 2014, the Food and Drug Administration stated that manufacturers can use the term “gluten-free” if the product contains less than 20 ppm gluten. Third-party certifications can help provide reassurance. Since making a gluten-free claim is voluntary, foods not labeled gluten-free don’t necessarily mean that they contain gluten.

• Look for hidden sources of gluten, and learn which ingredients are code for gluten. Semolina, spelt, and durum are all forms of wheat, and malt is commonly derived from barely. FDA regulations require packaged foods to clearly label if it contains wheat, however rye and barley do not have to appear in plain language on the label. Plus, USDA-regulated products, including medications, do not have to identify wheat derivatives on ingredient lists. As medications often contain gluten as a filler ingredient, please ask your pharmacist to carefully check the ingredient lists of all medications you are taking.

• Avoid products with confusing labels. It’s possible to create a gluten-free product that contains wheat starch - the starch from the wheat plant after its been isolated from the grain. If it has been processed to remove the gluten protein, it can be safe.  It’s also possible to produce a safe gluten-free product in a plant that also processes gluten-containing products, if proper manufacturing and testing processes are employed. However, you must be your own advocate. If you don’t trust a manufacture’s label or find it too confusing, your best bet is to leave the product be.

• When in doubt, leave it out. About 70% of people with celiac disease continue experiencing symptoms from inadvertent gluten exposure, even at low levels. If you are unsure about an ingredient or product label, it’s best to find a better alternative.

These are all good reasons to continually check ingredient lists and food labels to ensure you stay safe at all times. [quote]

How to Avoid Cross-Contamination

Even though you may be diligent reading labels and sticking to a strict gluten-free diet, mistakes can still happen.

Should you find yourself “glutened” by mistake, cross-contamination may be to blame. 

Cross-contamination with gluten-containing ingredients might happen when food is being manufactured, packaged or prepared for eating. 

To avoid it as much as possible, you must realize that crumbs matter! Look around your kitchen to see if there are crumbs on the counter, on the cutting board, in the microwave, or lurking in the knife drawer. Anywhere you see crumbs means the potential for cross-contamination exists.

At-home practices to avoid cross-contamination if you are celiac:

• You should have your own butter dish and cutting board that is used only for gluten-free foods.

• You should consider getting your own separate toaster. Alternatively, a toaster oven with a removable rack that can be washed if others use it may be a good option. If this isn’t possible, try a toaster bag - a silicon bag that holds bread while it is being toasted. The bread toasts through the bag.

• Try to set aside a section of the counter for preparing gluten free food only. If this is not practical, make sure the counter space you use is freshly washed to ensure it is free from crumbs or flour dust.

• When baking, do gluten-free baking first. Wrap and store your baking before working with regular flours, as flour dust in the air can settle on your gluten-free products and contaminate them.

• Try to avoid breathing in regular flour dust - it can settle in the nasal passages and may eventually get swallowed, then end up being digested.

• Use clean utensils and avoid “double dipping” into jars of nut-butter, mustard, mayo, and the like. Once knives or spoons have touched food with gluten, if they are reused, they will contaminate the food in the container. If it is too difficult to train family members not to double-dip, it might be wise for you to have your own jar of jam, nut-butter, mustard, etc.

• Be cautious when using shared pots, pans and utensils. Make sure they are thoroughly cleaned before using them for gluten-free foods. In the case of muffin tins, paper liners may be a wise investment.

• Anything with a porous surface like a wooden spoon or wooden cutting board can retain gluten particles after cleaning if used for baking. So it’s best you have your own dedicated set, or avoid using wooden utensils altogether.

Away-from home practices to limit cross-contamination as much as possible:

• Avoid shopping from bulk bins. They can easily become contaminated if scoops have been used in more than one bin. 

• Avoid shopping at the grocery store deli counter if gluten-free meats are being cut with the same utensils or meat slicers used for regular meats. Ensure they have been cleaned between uses, or shop where the butcher can accommodate your needs.

• Avoid buffets unless you can be assured of their safety. It’s common for chefs to test internal temperatures of foods using the same thermometer or for customers to use spoons for more than one dish.

• When eating out, talk to your server or, better yet, the restaurant manager to ensure your safety. Let them know you are celiac and only order food if they can ensure all necessary precautions can be taken, including cooking your food on a clean grill and using dedicated gluten-free utensils.

• Avoid fried foods at restaurants that use the same friers and oil to cook all foods. Though fries themselves may be gluten-free they can become contaminated when fried in the same deep frier as battered chicken or fish.

• Avoid meat cooked on a grill which hasn’t been cleaned after cooking regular food with gluten. Similarly, gluten-free pasta may be cooked in the same water that was used for regular pasta.

In celebration of Celiac Awareness Month, and to all those struggling with celiac, I hope you find this information helpful. 

As always, I welcome your thoughts and value your feedback. Let me know what you think by dropping me a line or commenting below and sharing this content.

If you haven’t already done so, please sign up to receive my newsletters for more information about brain health, neuronutrition, lifestyle tips, and nutritional advice. Of course, if I can help you or a loved one who may be suffering from celiac disease or any of the mystery symptoms associate with it, make an appointment to see me today!