Gluten Free 101: Here’s Where You Begin
Who should be gluten-free? A gluten-free diet is the only treatment currently available for individuals diagnosed with Celiac disease (CD). Even for individuals with “silent celiac” – those who lack outward symptoms of CD – it is crucial they maintain a strict gluten-free diet because the internal damage caused by CD to the small intestine lining occurs as long as gluten is eaten. A gluten-free diet is also the recommended treatment for individuals with Non-Celiac Gluten Sensitivity (NCGS), dermatitis herpetiformis (DH, the skin manifestation of CD), wheat allergy and other gluten-related health issues, as well as many autoimmune diseases like Type 1 diabetes and autoimmune thyroid disease. While going gluten-free may feel overwhelming at first, and you may wonder exactly what you will be able to eat, with a little time, careful planning, reliable resources and no-fail recipes, you’ll be on your way to renewed health enjoying your gluten-free lifestyle in no time!
Keep this in mind when you first go gluten-free:
1. There are more foods you can eat on your gluten-free diet than those you cannot. A positive attitude is in order! Check out this No Thought Required Gluten Free Foods List to help you get started!
2. Going gluten-free is an opportunity to explore all the nutritious, gluten-free foods nature has to offer. Embrace fresh, in-season fruits and vegetables, gluten-free whole grains, all-natural lean meats, poultry, fish, eggs and plant-based proteins, as well as healthy fats as part of your balanced gluten-free diet. Enjoy sweet and indulgent treats in moderation.
3. While you will likely see improvements in your negative health symptoms soon after beginning your gluten-free diet, the small intestine (damaged in those with CD) takes anywhere from 6 months to 2 years to fully heal, with most healing within 18 months, according to the University of Chicago Celiac Disease Center. To encourage healing, a diet made up primarily of natural, whole foods is best. Keep processed foods to a minimum.
Grocery Shopping: While our reasons for going gluten-free may differ, one thing we all have in common is the need to eat in order to sustain our health and provide our bodies with fuel. That means, we all must go to the market to purchase food. For some, the simple task of buying groceries becomes a dreaded (and lengthy) endeavor. Fortunately, it does not have to be!
Naturally Gluten-Free Foods & “Shopping the Perimeter” As stated earlier, all-natural fresh produce, meats (with no added seasonings or sauces) and eggs are gluten-free. In addition to these foods, most dairy products are gluten-free – milk, cheese, yogurt, etc. – but watch out for products like yogurt where gluten may be added (usually for thickening and texture). You may have heard it wise to “shop the perimeter” of the store for healthier, more natural offerings. In most cases this is a great way to shop for healthier foods, as well as for foods that happen to be naturally gluten-free. That’s because the perimeter of most grocery stores are where produce, meat, seafood, the deli department, dairy case and eggs are located. In each of these areas, you will find healthy, naturally gluten-free foods you can enjoy. Of course, this doesn’t mean you must avoid the center aisles of your supermarket. Consider all-natural canned and frozen vegetables and fruits (with no gluten-containing sauces added), dry beans, nuts, seeds and dried fruits in sealed packaging (i.e., not from bulk bins where there is a risk of cross-contamination), as well as cooking oils, most condiments and even some cereals like Chex from General Mills, which are gluten-free. With so many choices available in the market these days, shoppers can opt for certified gluten-free (learn about gluten-free certification organizations) products, foods labeled “gluten-free”, non-GMO products, as well as organic varieties of most of these foods (and remember, organic products are GMO-free).
Gluten-Free Food Labeling: Before you jaunt off to the market, take a look at Label Reading 101 for a Gluten-Free Diet. The United States FDA passed labeling laws for gluten-free foods on August 2, 2013. All food labels bearing the gluten-free claim must be in compliance with the < 20 parts per million requirement before August 2, 2014. Learn more about the labeling of gluten-free foods here. Before you pick up a bag of certified gluten-free oats, you may want to read “Gluten Free Oats Not an Option for Everyone on a Gluten Free Diet” to learn why some of us with CD can tolerate oats and others cannot.
Gluten by Any Other Name… Is Still Gluten Gluten can lurk behind a variety of aliases. In fact, you may not see the word “gluten” on a food item that contains it. Here are some other terms that should signal a “gluten alert” when you see them.
- All forms of barley (including malt extracts, syrup, flavoring or malt vinegar)
- All forms of wheat (flour, bran, germ, starch, hydrolyzed wheat protein, bulgur, durum, semolina, graham flour, kamut, spelt, einkorn, emmer, farina)
- Fu, Japanese wheat gluten
- Seitain, also called “gluten meat”, often used in vegetarian cooking
- Triticale (a cross between wheat and rye)
- All forms of rye
- Matzo (traditional matzo contains gluten; however, gluten-free matzo is available)
- All oat products that are not certified gluten-free (including oatmeal, oat bran, oat flour, whole oats, rolled oats and quick oats)
Some Questionable Foods & Ingredients
- Brewer’s Yeast is considered unsafe because it is traditionally a by-product of beer making.
- Nutritional Yeast is cultivated on molasses from sugar cane or beets and is considered gluten-free.
- Yeast used in bread baking – quick, rapid, or fast rise and instant dry yeast – are gluten-free.
- Vinegars such as Balsamic, rice, rice wine, wine and apple cider vinegars are naturally gluten-free. The only exception would be if “other” ingredients (like flavorings) are added. Check the label. And remember, malt vinegar is derived from barley and is NOT gluten-free.
- Modified food starch – is added as a thickener and stabilizer and can be made from corn, tapioca, potato, wheat, or other base ingredient. Corn is nearly always the source in North America. Potato and rice are occasionally used. Wheat-based food starch, as we said earlier, must be listed per FALCPA law. In the US, “starch” on a food label means cornstarch, which is gluten-free.
- Maltodextrin is made from corn or potatoes in the US and Canada; however, maltodextrin from other countries could be made using wheat starch, so beware of foreign-made foods with this ingredient.
- Hydrolyzed vegetable protein, also called hydrolyzed plant protein, textured vegetable protein or HVP, this ingredient could contain protein obtained from wheat. While most is made from soy, corn or peanuts, wheat ingredients are sometimes used. Look for the allergen statement before consuming products containing this ingredient.
- Dextrin – Dextrin is a starch, typically derived from corn, potato, arrowroot, rice or tapioca here in the US; however, it can be made from wheat. Remember, if wheat-based ingredients are used, those should be listed in a “Contains” or “Allergen” statement per FALCPA law.
- Caramel color – Commonly added to foods and beverages, caramel color can be made from barley or other gluten grain products; HOWEVER, gluten-containing ingredients are no longer used to make caramel coloring in North America. Companies use glucose from corn and sometimes sucrose to make caramel color.
For an extensive listing of gluten-free (and other allergen-free) products, visit the Gluten Free Resource Directory.
Be Aware of Hidden Gluten and Cross-Contamination You will become very familiar (and diligent about) hidden sources of gluten – places you wouldn’t normally expect to find gluten, but there it is – and cross-contamination – when gluten comes into contact with otherwise gluten-free food, thus making it unsafe for those who must live gluten-free.
Hidden Gluten: Gluten can hide in many, many places, or may show up in surprising foods where we least expect it.
Note: this does not mean ALL of the following foods ALWAYS contain gluten, just that these are some of the more common foods/drinks where gluten is known to hide. Always be sure to carefully read labels before consuming any food you think may contain gluten, and when in doubt… don’t eat it!
- Soy sauce (traditional soy sauce contains wheat; however there are several brands of gluten-free soy sauce available; for those who must also avoid soy, try coconut aminos as a soy sauce alternative)
- Beer (there are many gluten-free and gluten-removed beers available on the market – click here for brands)
- Salad dressings (many gluten-free salad dressings are available)
- Processed cold cuts (a variety of gluten-free deli meats are available)
- Processed cheese spreads
- Communion wafers (gluten-free varieties are available)
- Licorice candy (Candy Tree makes gluten-free licorice)
- Flavored coffees – Learn more about gluten in some flavored coffees here.
- Medication – Learn more about gluten in medicines here. Here is a list of Common Over the Counter Medicines that are gluten-free.
- Herbal supplements (a variety of vitamins and supplements are gluten-free)
- Play Dough (Aroma Dough is gluten-free, or you can make your own gluten-free play dough)
Learn more about hidden gluten in these articles:
4 Places to Look for Hidden Gluten in Your Salad – discusses gluten in salad toppings and ingredients
Are You Waking Up to Gluten in Your Cup? – discusses gluten in some coffees
Cross-contamination: Gluten cross-contamination occurs when gluten comes in contact with your gluten-free food, rendering it unsafe for consumption for those of us who must be on a gluten-free diet.
For an individual with celiac disease, even the smallest amount of gluten can lead to intestinal damage, so it is extremely important for the individual, as well as their family – to be aware of the risk of cross-contamination and ways to prevent it.
Common places cross-contamination occurs:
- In food manufacturing and packaging facilities.
- In restaurants (or any establishment serving both gluten and gluten-free foods, i.e., food trucks, concession stands, etc.)
- In the home (either your own, or in the homes of friends or relatives you visit)
In Food Manufacturing:
Problem: Manufacturers sometimes use wheat or oat flour to dust foods like dried fruits to prevent them from sticking together before packaging. This should be listed on the ingredients label in an “Allergen Statement” or a “Contains” statement.
Solution for avoiding this issue: Read labels diligently every time, even if you have safely eaten a product in the past. When in doubt, always phone the manufacturer before consuming a questionable food to ask about their processing practices and gluten.
Problem: A single facility processes multiple products. Depending on those products, that could mean airborne gluten-containing wheat or other gluten grains.
For example, a company that processes a naturally gluten free food (like popcorn) may also produce a gluten-filled food (like wheat crackers).
Solution for avoiding the issue: Select products manufactured in a dedicated gluten-free facility. Most packaging will indicate if the facility is dedicated; alternatively, you may call the manufacturer for more information.
Problem: Shared equipment is used to process various food items in a manufacturing facility. Naturally gluten-free foods (like potato chips) may come in contact with the same equipment used to package gluten-containing foods (like pretzels).
Solution for avoiding the issue: Again, a dedicated facility is the best bet. It is also helpful to phone the manufacturer and inquire about how processing lines are used and cleaned (and sanitized) in their facility. Most are willing to share this information. (Note: Gluten-free certification does not require a dedicated facility.)
While more and more gluten-free restaurants and bakeries are opening across the country, their numbers are still few, meaning most individuals do not have access to a fully gluten-free dining out experience.
There are; however, many restaurants offering gluten-free menus and options for diners. The major issue gluten-free diners face is knowing which establishments take gluten-free seriously and understand what it means to prepare a true gluten-free meal.
For those where kitchen staff do not, cross-contamination can occur in a number of ways. For example, a gluten-free burger patty may be placed on the same grill where buns are warmed or toasted; gluten-free foods may be fried in the same deep fryer where gluten-containing breaded or battered items are fried; salads may be mixed in the same bowl where gluten-containing salads (i.e., with croutons) are mixed; gluten-free pasta may be cooked in the same pot as gluten pasta; gluten-free pizza may be sliced with the same pizza knife as regular pizza, and the list of possibilities goes on. It’s easy to see, when dining out gluten-free, it is not only important to address the foods you order, but also to discuss with your server (and perhaps the chef or kitchen staff) exactly how your food will be handled from start to finish.
When dining out, use these tips to help reduce the chance of gluten contamination.
1. Call ahead to discuss your special diet with the restaurant staff and determine whether or not they will be able to safely accommodate you.
2. Once at the restaurant, share your dietary needs with your server and request to speak to the chef or someone from the kitchen who will be involved in preparing and overseeing your meal.
3. Carrying a Gluten Free Diners Card is also a great idea. Search online for “gluten free dining cards” for options to create custom cards to print and take with you when dining out.
4. Be specific and explain in detail how you need your meal prepared: separate cook surface, mixing bowl, pots, pans, surfaces, utensils, etc. from gluten foods. Also let the server know to leave off any bread, croutons, etc. from your plate – simply removing it at the table is not enough to keep safe and free from gluten.
5. Be clear that you must be gluten-free for medical reasons and stress (in a pleasant manner, of course) to the wait and kitchen staff that you will become ill if you ingest even a small amount of gluten.
6. For condiments like salad dressings, soy sauce, etc., you may wish to take along a small container of gluten-free alternatives. Most restaurants don’t mind when you explain it is due to a health condition or food allergy.
7. Inspect your food when it arrives. If there is any doubt, discuss it with your server or kitchen staff. Never consume foods you are unsure about.
Use online resources like Allergy Eats to locate gluten-free (and other allergen-free) restaurants where you are.
Find gluten-free bakeries near you with the Gluten Free Resource Directory search tool.
In the home kitchen:
In a shared kitchen (which most are) there are obvious sources of gluten contamination, such as crumbs of gluten-containing bread left on the counter after a family member prepares a sandwich, but there are some less-than-obvious places gluten can hide, too, such as wooden utensils, small appliances, and even on the knobs and handles in our kitchen. Use these tips for preventing cross-contamination in the home.
1. Store it smart. From the time food enters the fridge or pantry, it makes sense to keep gluten-free and gluten-filled foods separate. You may designate a shelf in the pantry and one in the fridge for gluten-free foods. For example, gluten-free cookies, crackers and pastas live on one shelf while their gluten-full counterparts resides elsewhere. It’s a great idea to have gluten-free foods on a higher shelf, just in case a crumb escapes to items below. If that happens, there is no worry that gluten-free foods are contaminated by a microscopic morsel of gluten. For some, color coding is a great way to keep gluten-free foods segregated. For example, purchase plastic bins (green for gluten-free, perhaps) in fridge and pantry friendly sizes for storing gluten-free foods. This is especially helpful when young children must be gluten-free.
2. Be a counter top cop. Crumbs, the ultimate offender when it comes to gluten contamination in a shared kitchen, can spill, bounce and hide all over seemingly clean counters and dining tables. Minimize the risk of contamination by keeping disposable kitchen-safe wipes handy. Before preparing meals and snacks, simply give the counter tops a thorough once-over in case stray crumbs linger. It’s also a good idea to wipe down appliances, refrigerator door handles and sink faucets, just in case the gluten eaters forgot to wash their hands after preparing and eating their food.
3. Use utensils wisely. Wooden spoons and other porous utensils/containers (like cast iron cookware) can harbor minuscule amounts of gluten. Another place gluten can linger is inside the holes on sieves and colanders (think about draining gluten-filled pasta). The best bet is to purchase a new, dedicated colander or sieve for all gluten-free pastas and grains. This is where the color-coding comes in handy, too. A nice bright green colander gives us the green light to use with our gluten free foods. A red one will stop us in our tracks so we don’t mistakenly use the gluten-friendly strainer and risk cross-contamination. Also beware of non-stick cookware if you’re still using it. Scratches and nicks in the surface can be prime areas bits of gluten can hide.
4. Put gluten free diners first. Prepare gluten-free foods/meals first, then move them securely out of harm’s way before beginning the gluten portion of the meal. For example, if everyone’s having a sandwich, join in with your own gluten-free version, just be sure to make your sandwich first. Set it aside, then carefully prepare the gluten-filled foods. For some of us who are extremely gluten sensitive, investing in a box of food-safe disposable gloves is well worth the price. This is especially true when preparing foods for others who are not able (small children, physically challenged individuals or elderly parents). This way, no gluten comes in contact with the skin. It is not only when preparing human foods that we may come into contact with gluten. Another source of gluten contamination exists for pet owners who feed their pets gluten-containing pet food. Gluten-free pet foods are available.
The Contaminated Kiss: That’s right, gluten from your partner could make its way to you via kissing. Even if those other lips avoid gluten-containing foods, gluten contamination can also occur if your partner recently:
- Drank regular beer
- Applied lip products (lip balm, lip-gloss or lipstick) that contain gluten (There are many options for gluten-free lip products, as well as other gluten-free cosmetics.)
- Applied other gluten-containing cosmetics or skin care products near the mouth
- Brushed with a gluten-containing toothpaste
- Swished with a gluten-containing mouthwash
You can find manufacturers of gluten-free toothpaste, mouthwash and other personal care items here.
Keep in mind:
- Toothpaste does not fully get rid of gluten.
- Even after brushing, gluten-containing food particles can be left behind in the teeth.
- Gluten on hands can be transferred to the face and mouth.
To help keep the contaminated kiss at bay, use these tips.
- Tell your partner about your need to avoid gluten, including how ill you become if you ingest it.
- Have your gluten-eating partner follow this routine (when possible) after eating: Floss, rinse, brush and rinse again.
- If flossing and brushing are not possible after eating, try a thorough rinse and wait several hours before a kiss.
- Ladies, help keep your gluten-free man safe by wearing gluten free lip-gloss or lipstick.
- Gentlemen, be sure you don’t have any crumbs lingering in facial hair after eating. Tiny crumbs of bread (or other gluten-filled food) can get trapped in your mustache (or other facial hair).
Now, that’s a lot of information, but it is all necessary to manage your new gluten-free life, and manage it well. When it comes to gluten, leave no stone unturned, never accept a product at “face value” without careful inspection of the label (or even a call to the manufacturer), and by all means, if there is any shred of doubt about whether a food contains gluten or not, pass it by. In time, recognizing sources of gluten – even the tricky ones – will feel like second nature to you, your confidence will increase and you will enjoy renewed health on your gluten-free diet. Allow it to be liberating and exciting, and always keep it simple, affordable, nutritious and fun!