Celiac Disease – Gluten Free Diet Guide
If your child has been diagnosed with Celiac Disease, the challenges of a gluten-free diet can seem overwhelming at first. But there’s still plenty to eat and more options are available all the time. Download the GI Kids Gluten Free Diet Guide to learn more about starting a managing a gluten free diet for your child.
What is Gluten?
Gluten is the general name for one of the proteins found in wheat, rye, and barley. It is the substance in flour that forms the structure of dough, the “glue” that holds the product together and is also the leavening ingredient. When these proteins are present in the diet of someone with CD, they become toxic and cause damage to the intestine. This damage leads to decreased absorption of essential nutrients and, if left untreated, can lead to nutrient deficiency and subsequent disease (i.e. iron deficiency anemia, decreased bone density, unintentional weight loss, folate and vitamin B12 deficiency).
Where is Gluten Found?
The grains containing gluten include wheat, rye, barley, and all their derivatives (see Table 1 for a listing of grains to be avoided). These grains are used in such items as breads, cereals, pasta, pizza, cakes, pies, and cookies and as added ingredients to many processed food items.
What About Oats?
Many recent studies indicate that the protein found in oats may not be harmful to most people with celiac disease. However, there is concern that the oats may be contaminated with wheat during the milling and processing. Please consult your physician or dietitian before adding oats to your child’s diet.
Life Goes On!
Eating Away From Home
A diagnosis of CD does not mean never eating at a restaurant again. Do not stay home for fear of making a mistake on the gluten-free diet. Dining out is a big part of our way of life and, with a little effort and planning, can continue to be enjoyed.
- Before leaving home, do some homework. Most restaurants have a website that can easily be found through an Internet search engine. Review the menu online to see if there is enough selection for you. Some restaurants have GF menus or a list of common food allergens utilized in making their foods.
- Call ahead and talk to the manager or the chef and ask about specially prepared items that are GF.
- Try to make your first visit to a restaurant before peak dining times.
- Always identify yourself as someone who cannot eat wheat, rye or barley. Food items that you would never guess have flour in them, often do. (One large popular pancake house adds pancake batter to their omelets.) Salads may not have croutons, but may arrive at your table with a bread stick across the top.
- Don’t be afraid to ask how the food is prepared. Meats may be marinated in soy sauce. French fries may be made in the same fryer as other breaded products. Hamburgers and hamburger buns may be grilled in the same area. All these methods can lead to gluten contamination.
- Be pleasant and informative, but not demanding.
- Bring your own GF bread or crackers.
Don't Blame the Gluten!
On a strict GF diet, gastrointestinal symptoms will begin to improve in a few weeks and will completely resolve after 6 to 12 months. After healing has occurred and antibody levels have returned to normal, symptoms may not be a reliable way to determine whether or not you have taken in gluten.
You can eat gluten-containing foods and may not have symptoms and, conversely, you can have symptoms without ingesting gluten. The following items may cause GI problems that are not gluten related.
- Acidic foods. Vinegars, tomato products, and citrus juices can cause reflux symptoms.
- Sorbitol. It is found in medication and dietetic candy. As a non-digestible sugar, sorbitol can cause bloating, gas, cramping, and diarrhea.
- Guar gums. These gums are used in gluten-free products and may cause gas, bloating, and abdominal pain.
- Lactose. Before the intestine has healed completely, the lactase enzyme may be deficient. Lactase is needed to break down the sugar in milk called lactose.
- Undigested lactose can lead to increased gas, bloating, abdominal pain, and diarrhea.
- Food allergens. In a recent survey of the Celiac Sprue Association, over half of the members reported having additional food intolerances to foods such as milk, soy, nuts, yeast, eggs, corn, and fructose.
- Flax. Flax can increase the number of bowel movements.
Gluten-Free Doesn't Mean It's Good For You
Today there are many specialty companies that produce good gluten-free products. Although they taste wonderful, the ingredients used may not be a healthy alternative. Good nutrition is also important as you select foods in your diet.
Pamela Cureton, RDN, LDN