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Gluten-free diet: What's allowed, what's not

A gluten-free diet is a diet that excludes the wheat protein gluten or Gliadin. Gluten is found in grains such as wheat, barley, rye and triticale (a cross between wheat and rye).  A gluten-free diet is used to treat celiac disease and gluten sensitivity.  Initially, following a gluten-free diet may be frustrating. But with time, patience and creativity, you'll find there are many foods that you already eat that are gluten-free and you will find substitutes for gluten-containing foods that you can enjoy.

 Details

Eating gluten free is a zero-tolerance diet.  That means that a small amount is NOT acceptable.  Even the smallest amount can continue to cause damage internally.  Switching to a gluten-free diet is a big change but it just takes getting used to. You may initially feel frustrated by the restrictions but when you notice how much better you feel you won’t mind that changes need to be made.  Stay positive - focus on all the foods you can eat. Be prepared when you go to restaurants or to dinner parties.  You may also be pleasantly surprised to realize how many gluten-free products, such as bread and pasta, are now available. Many specialty grocery stores sell gluten-free foods and many restaurant menus now offer gluten free options. (A note of caution about restaurant dining- Most servers, cooks and managers of restaurants do not understand wheat sensitivity.  They think if they accidently bring you a salad with croutons or place your burger on a bun that it is ok to just remove the wheat source and bring it back to you.  They don’t understand that the item is already contaminated with the wheat and is not safe for you to eat.  Ask that they bring you a new one.  It is best to tell them when you get to the restaurant that you have a wheat allergy and that the food needs special handling.  Better yet, call before you go and ask if they have a gluten free menu or if they are familiar with food preparation for wheat/gluten allergies.)  If you can't find restaurants or gluten free items in your area, check with a celiac support group or go online.  If you're just starting with a gluten-free diet, it's a good idea to find a support group either locally or online.

Allowed foods

Many healthy and delicious foods are naturally gluten-free:

  • ·         Beans, seeds, nuts

  • ·         Eggs

  • ·         Fresh meats, fish and poultry (not breaded or batter-coated and check on marinating ingredients)

NOTE - Many restaurants put gluten in their burgers and in steak marinades.  It is difficult to know unless they tell you definitively that it does or does not contain gluten/wheat.

  • ·         Fruits and vegetables       

Many grains and starches can be part of a gluten-free diet:

  • ·         Amaranth

  • ·         Arrowroot

  • ·         Buckwheat

  • ·         Corn and cornmeal

  • ·         Flax

  • ·         Gluten-free flours (rice, soy, corn, potato, bean)

  • ·         Hominy (corn)

  • ·         Millet

  • ·         Quinoa

  • ·         Rice

  • ·         Sorghum

  • ·         Soy

  • ·         Tapioca

  • ·         Teff

Always avoid

Avoid all food and drinks containing:

  • ·         Barley (malt, malt flavoring and malt vinegar are usually made from barley)

  • ·         Rye

  • ·         Triticale (a cross between wheat and rye)

  • ·         Bulgur

  • ·         Durum flour

  • ·         Farina

  • ·         Graham flour

  • ·         Kamut

  • ·         Semolina

  • ·         Spelt

Avoid unless labeled 'gluten-free'

In general, avoid the following foods unless they're labeled as gluten-free or made with corn, rice, soy or other gluten-free grain:

  • ·         Beer

  • ·         Breads

  • ·         Cakes and pies

  • ·         Candies

  • ·         Cereals

  • ·         Cookies and crackers

  • ·         Croutons

  • ·         French fries

  • ·         Gravies

  • ·         Imitation meat or seafood

  • ·         Matzo

  • ·         Pastas

  • ·         Processed luncheon meats

  • ·         Salad dressings

  • ·         Sauces

  • ·         Seasoned rice mixes

  • ·         Seasoned snack foods, such as potato and tortilla chips

  • ·         Self-basting poultry

  • ·         Soups and soup bases, bouillon

  • ·         Soy Sauce

  • ·         Vegetables in sauce

Certain grains, such as oats, can be contaminated with wheat during growing and processing stages of production. For this reason, doctors and dietitians generally recommend avoiding oats unless they are specifically labeled gluten-free.

You should also be alert for other products that you eat or that could come in contact with your mouth that may contain gluten. These include:    

  • ·         Medications and vitamins that use gluten as a binding agent

  • ·         Make-up, mascara, lip stick

  • ·         Play dough

Watch for cross-contamination

Cross-contamination occurs when gluten-free foods come into contact with foods that contain gluten. It can happen during the manufacturing process, for example, if the same equipment is used to make a variety of products. Some food labels include a "may contain" or “manufactured on equipment that also contains” statement if this is the case. But be aware that this type of statement is voluntary. You still need to check the actual ingredient list. If you're not sure whether a food contains gluten, don't buy it or check with the manufacturer first to ask what it contains.  Much of this information is available online but it can be frustrating.  Cross-contamination can also occur at home if foods are prepared on common surfaces or with utensils that weren't thoroughly cleaned after being used to prepare gluten-containing foods. Using a common toaster for gluten-free bread and regular bread can be a source of contamination or others dipping into the same dips and spreads using gluten containing foods. Butter and mayonnaise that others use knives that are used on gluten containing foods.  Consider what steps you need to take to prevent cross-contamination at home, school or work.

Results

People with gluten sensitivity who eat a gluten-free diet experience fewer symptoms and complications.   In some severe cases, a gluten-free diet alone can't stop the symptoms and complications.   This may indicate there is another yet discovered sensitivity.  In these cases, doctors might prescribe medications to suppress the immune system. 

Risks

Not getting enough vitamins

People who follow a gluten-free diet may have low levels of certain vitamins and nutrients in their diets. Many grains are enriched with vitamins. Avoiding grains with a gluten-free diet may mean eating fewer of these enriched products. Proper lab testing will determine if there is need for supplementation of these vitamins.

  • ·         Iron

  • ·         Calcium

  • ·         Fiber

  • ·         Thiamin

  • ·         Riboflavin

  • ·         Niacin

  • ·         Folate

Not sticking to the gluten-free diet

If you accidentally eat a product that contains gluten, you may experience abdominal pain, gas, swelling, indigestion or diarrhea. Some people experience no signs or symptoms after eating gluten, but this doesn't mean it's not damaging their small intestines. Even trace amounts of gluten in your diet may be damaging, whether or not they cause signs or symptoms.

Just a reminder that we offer GlutenFlam at our clinic to keep on hand for unexpected exposure to reduce symptoms and offer relief.

Written by Ryan Frusti — August 14, 2012