Celiac disease is an autoimmune disorder that affects around 1% of the population worldwide. It causes damage to the small intestine when a person with celiac consumes gluten, a protein found in wheat, barley, and rye. When a person with celiac disease eats gluten, their immune system attacks and damages the small intestine, leading to an inability to absorb nutrients properly. The only treatment for celiac disease is strictly following a gluten-free diet by avoiding foods containing gluten. This article provides a detailed overview of the foods to avoid celiac disease in 2024.
What is Celiac Disease?
Celiac disease is a serious genetic autoimmune disorder where the ingestion of gluten triggers an immune response in the small intestine. This causes damage to the villi, the small finger-like projections that line the small intestine and promote nutrient absorption. When the villi get damaged, nutrient absorption is impaired leading to malnutrition and other problems. The condition is also known as celiac sprue or gluten-sensitive enteropathy.
Celiac disease is estimated to affect around 1 in 100 people worldwide, however, many cases go undiagnosed. It can develop at any age after gluten is introduced into the diet. The rate of celiac disease is increasing, likely due to better detection methods and awareness of the condition. People with a first-degree relative with celiac disease have a higher risk.
Symptoms of Celiac Disease
The symptoms of celiac disease can vary greatly between individuals. Some of the common symptoms include:
- Chronic diarrhea or constipation
- Abdominal pain and bloating
- Fatigue
- Unexplained weight loss
- Failure to thrive (in children)
- Bone loss
- Skin rash (dermatitis herpetiformis)
- Mouth ulcers
- Joint pain
- Headache
- Depression or anxiety
- Tingling numbness in hands and feet (peripheral neuropathy)
However, some people with celiac disease do not have any digestive symptoms and may experience issues like anemia, osteoporosis, infertility, or miscarriage. Since the symptoms can overlap with other conditions, celiac disease is commonly underdiagnosed or misdiagnosed.
Diagnosis of Celiac Disease
Celiac disease is diagnosed through blood tests and a biopsy of the small intestine. To test for it, doctors will check blood for high levels of antibodies including:
- Tissue transglutaminase (tTGA): Elevated levels confirm celiac disease.
- Endomysial antibody (EMA): If positive indicates celiac disease.
- Deamidated gliadin peptide (DGP): High levels suggest celiac.
If blood tests and symptoms suggest celiac disease, the doctor does a biopsy of the small intestine to confirm damage to the villi. This involves taking a small sample of the tissue and examining it under a microscope.
Genetic testing can also be done to look for the HLA-DQ2 and HLA-DQ8 genes associated with celiac disease. About 40% of the population carries these genes, but only around 3% develop celiac disease. So genetic testing alone cannot diagnose celiac disease but it can rule it out if the genes are not present.
Treatment for Celiac Disease
The only treatment for celiac disease is following a strict 100% gluten-free diet for life. This involves avoiding all foods and products containing wheat, barley rye, or any type of derivative. Some people need to avoid oats also as they may be cross-contaminated.
When gluten is completely removed from the diet, the small intestine starts healing and the villi regain their ability to absorb nutrients. Symptoms improve and antibody levels normalize over time. People with celiac disease need to be meticulous about reading ingredient labels to avoid accidental gluten exposure.
In addition to the gluten-free diet, doctors may prescribe vitamin and mineral supplements to correct nutritional deficiencies commonly seen in celiac disease. Regular follow-up is important to monitor adherence and check for any complications.
Foods to Avoid with Celiac Disease
A gluten-free diet requires excluding all foods and ingredients that contain gluten. Here are the main foods and ingredients that need to be avoided with celiac disease:
- Wheat
Wheat contains gluten and must be completely avoided. This includes:
- Bread, baked goods, and pasta made with wheat flour
- Wheat bran and wheat germ
- Wheat starch
- Durum wheat
- Einkorn, farro and spelt (forms of wheat)
- Semolina
- Couscous
- Wheat-based cereals like bran flakes
- Malt and malt flavoring
- Brewer’s yeast
Check labels for ingredients like “wheat flour” or “wheat protein”. Oats are naturally gluten-free but are often contaminated with wheat so should be avoided unless labeled “gluten-free”.
- Barley
Like wheat, barley contains gluten and must be avoided. Watch for:
- Pearl barley
- Barley flour or malt
- Barley malt syrup
- Barley malt extract
- Beer and lagers (contain barley malt)
- Rye
Rye is a grain closely related to wheat and contains gluten. Avoid:
- Rye bread
- Rye flour
- Rye cereals
- Crackers with rye
- Rye malt
- Cross-contaminated foods
Some naturally gluten-free grains and flours can get cross-contaminated with gluten grains during growing, harvesting, processing, or transportation. Common culprits include:
- Oats and oat products
- Rice flour
- Corn flour
- Soy sauce
- Legumes and beans
- Seeds like chia and flaxseeds
Ensure any grains are labeled “gluten-free” to avoid cross-contamination.
- Beer
Most beers contain gluten from the barley or wheat used in the brewing process. Only those labeled “gluten-free” are safe.
- Wheat substitutes
Avoid wheat substitutes like:
- Seitan – made from wheat gluten
- Einkorn
- Farro
- Spelt
- Kamut
- Durum flour
- Soy sauce
Regular soy sauce is made from fermented wheat so it contains gluten. Only use tamari or gluten-free soy sauce.
- Other avenues of gluten
Gluten can sneak into foods from additives and flavoring agents such as:
- Hydrolyzed wheat protein
- Textured vegetable protein (TVP)
- Natural flavoring
- Stabilizers and thickeners
- Soy sauce or teriyaki sauce
- Malt vinegar
- Salad dressings and sauces
- Soup bases and bouillon cubes
- Dessert toppings
- Beer batter
- Croutons
Carefully read ingredient labels of all packaged, canned, and processed foods to watch for sources of hidden gluten. When eating out, ask about preparation methods and ingredients used.
Naturally Gluten-Free Foods
Many basic whole foods are naturally gluten-free and can be enjoyed freely on a gluten-free diet. These include:
Fruits and Vegetables:
All fresh fruits and vegetables are gluten-free. Frozen and canned varieties are okay to eat as long as no wheat additives are added. Pickles and olives are also fine to eat.
Meats, Fish, Eggs and Legumes:
- Beef, pork, poultry, seafood
- Eggs
- Legumes like beans, lentils, chickpeas
- Nuts and seeds
- Natural nut butter like peanut butter
Dairy:
- Milk
- Cheese
- Yogurt
- Butter
Plain dairy products are gluten-free, but flavored varieties may have gluten additives.
Grains and Flours:
- Rice in all forms
- Corn
- Quinoa
- Buckwheat
- Certified gluten-free oats
- Amaranth
- Millet
- Sorghum
- Teff
- Arrowroot
- Cassava
- Almond flour
- Coconut flour
Look for gluten-free labeled packaging to avoid cross-contamination.
Fats and Oils:
- Olive oil
- Coconut oil
- Vegetable oils
- Shortening
Beverages:
- Water
- Coffee
- Tea
- Wine
- Hard cider
- Distilled alcohols like rum, vodka, gin
- Gluten-free beer
Herbs, Spices and Condiments:
All fresh and ground herbs, spices, salt, pepper, mustard, vinegar without additives, pure maple syrup, honey and jam are gluten-free. Stock up on these to flavor gluten-free cooking.
Sweets:
- Honey
- Maple syrup
- Jam
- Jelly beans
- Licorice
- Smarties
Look for gluten-free labeled candy, chocolate, and desserts made without wheat, barley, or rye.
Reading Food Labels for Gluten
Reading ingredient labels is a must to avoid accidental gluten exposure. Here’s what to look for:
- Contains statement: Food labels in some countries clearly state contain wheat, rye, or barley. This indicates the presence of gluten.
- May contain the statement: Indicates a risk of cross-contamination. Best to avoid.
- Gluten-free label: Products certified gluten-free are considered safe. May say “gluten-free” or have an official GF logo.
- No gluten ingredients: Scan for wheat, rye, barley, or any derivatives like malt. Oats also need to be avoided unless specified gluten-free.
- Allergen warnings: Wheat, rye, and barley will be highlighted after the ingredients if present.
- Unsafe terms: Words like malt, textured vegetable protein, and natural flavors could signal hidden gluten.
When in doubt, contact the manufacturer to inquire about gluten content or the presence of cross-contamination risk.
Eating Out Gluten-Free
Eating out on a gluten-free diet takes extra care. Here are some tips:
- Research the menu in advance and look for gluten-free options
- Ask about ingredients and preparation methods
- Request for gluten-free soy sauce
- Ask if fried items use separate fryers
- Avoid breaded or thickened items
- Check if sauces, dressings, and marinades are gluten-free
- Specify no croutons on salads or garnish with breadcrumbs
- Ask for plain rice or baked potato instead of pasta
- Look for a gluten-free label or logo on menus
- Check if the restaurant has a dedicated gluten-free menu
Being clear with your needs and asking questions is key for safe gluten-free dining.
Cross-Contamination Risks
Cross-contamination is the inadvertent introduction of gluten into gluten-free foods through shared kitchen tools, surfaces, fryers, and processing equipment. This poses a serious risk for people with celiac disease.
To avoid cross-contamination:
- Have separate toasters and spreads for gluten-free breads
- Use separate pots, pans, utensils and cooking surfaces
- Wash hands before preparing gluten-free foods
- Avoid deep fryers that fry breaded items
- Request restaurants to change gloves before gluten-free prep
- Opt for salads and fruits to avoid cross-contamination
- Check labeled packages for “may contain wheat” warnings
- Look for “gluten-free” labels for oats, beans and grains
Being vigilant can help identify and reduce the chances of gluten exposure through cross-contamination.
Traveling Gluten-Free
Traveling with celiac disease requires extra preparation and research. Here are some tips:
- Pack gluten-free snacks like trail mix, nuts, dried fruit, and protein bars.
- Carry a translated gluten-free food card to communicate with local restaurants
- Book accommodations with kitchen access to prepare your meals
- Research gluten-free restaurants at your destination in advance
- Learn key phrases to communicate gluten-free in the local language
- Visit grocery stores to buy safe gluten-free foods
- Bring gluten-free packaged meals for long flights, road trips or cruises
- Wash hands frequently and use sanitizing wipes
- Check the ingredients of toiletries like lip balm as wheat is sometimes added
Planning helps reduce stress and prevent accidental gluten exposure while traveling.
Dermatitis Herpetiformis Skin Rash
Some people with celiac disease develop an itchy, blistering skin rash known as dermatitis herpetiformis. It occurs in around 10-20% of people with celiac disease. The rash is caused by IgA deposits in the skin when gluten is consumed. It most commonly occurs on the elbows, knees, and buttocks.
Strict adherence to a gluten-free diet helps resolve the rash and prevents it from recurring. Doctors may prescribe medications like dapsone to provide additional relief from intense itching. However, avoiding gluten is the key to managing dermatitis herpetiformis.
Oats in the Gluten-Free Diet
Oats are naturally gluten-free but are often contaminated with wheat during growing or processing. Some individuals with celiac disease can tolerate uncontaminated oats, while others need to avoid it.
Introduce oats cautiously under medical supervision. Only consume oats labeled “gluten-free” with purity protocols to avoid cross-contamination. Limit to 1⁄2 – 1 cup cooked oats daily and monitor symptoms. Discontinue if any intolerance develops.
Communion Wafers
The communion wafers used in Christian churches are made of unleavened wheat bread. They contain gluten and are not safe for people with celiac disease.
Many churches now offer gluten-free alternatives made of rice or potato starch. Check with your church ahead of time to see if they have an accommodation in place. Some accommodate by serving a separate chalice of wine.
Medications and Vitamins
Many medications and vitamin supplements contain gluten as fillers or binders. Always check the label or call the manufacturer to verify gluten-free status, especially for:
- Prescription drugs
- Over-the-counter medicines
- Herbal supplements
- Vitamins and mineral supplements
Do not make any assumptions as gluten fillers can show up unexpectedly. Probiotic supplements also need verification as some derive strains from wheat sources.
Celiac Disease Checkups
After being diagnosed with celiac disease, regular follow-up is important. Your doctor will want to see you for periodic checks. This may include:
- Bloodwork to monitor antibody levels
- Repeat endoscopy/biopsy after 1-2 years of eating gluten-free
- Nutrient testing to check for deficiencies
- Bone density scan for osteoporosis screening
- Growth monitoring in children
- Symptom review to ensure gluten-free diet is working
Annual monitoring helps assess recovery and identify any persisting issues like anemia or osteopenia for early intervention.
Gluten-Related Disorders
Some individuals experience gluten reactions despite not having full-blown celiac disease. This includes:
Non-Celiac Gluten Sensitivity:
Symptoms are similar to celiac disease but there is no damage to the small intestine. May benefit from a gluten-free diet.
Wheat Allergy:
Immune reaction to wheat proteins that trigger symptoms like hives, difficulty breathing, and anaphylaxis. Requires wheat avoidance.
Gluten Ataxia:
Damage to the cerebellum affects balance and coordination when gluten is consumed. Requires a strict lifelong gluten-free diet.
Dermatitis Herpetiformis:
Gluten-induced skin rash with itchy blisters. Resolves with a gluten-free diet and medication.
While testing can help differentiate, adopting a gluten-free diet may provide relief.
Support Groups and Resources
Living with celiac disease requires diligent label reading, meal planning, and advocacy. Connecting with resources and support groups can help:
- Celiac Disease Foundation– Offers local support group finder
- Beyond Celiac– Provides counseling, webinars, and conferences
- Gluten Intolerance Group (GIG)– Leading source for gluten-related disorder support
- American Celiac Society– Volunteer-based support organization
- Local celiac support groups through hospitals and community centers
Connecting with others living a gluten-free lifestyle provides helpful tips and shared experiences.
Coping Emotionally with Celiac Disease
Being diagnosed with celiac disease and transitioning to a strict gluten-free diet can be challenging both physically and emotionally. Some helpful tips include:
- Allow yourself time to grieve – it’s normal to feel upset about all the changes
- Find new favorite gluten-free foods – expand your diet horizons
- Make self-care a priority – take breaks from meal planning and treat yourself
- Share with close friends and family – build your gluten-free support system
- Connect with other “celiacs” – you are not alone in this journey
- Focus on what you CAN eat – the gluten-free world is expanding
- Be kind to yourself – perfection is impossible; you’re only human
- Celebrate milestones – mark progress in adapting to your new normal
Teaching Family and Friends About Your Gluten-Free Needs
Having celiac disease requires being a self-advocate when eating meals prepared by others. Teaching family and friends how they can support you is essential.
- Explain that even crumbs or traces of gluten can make you sick. Emphasize that it’s not an allergy or preference.
- Ask loved ones to keep gluten out of shared spaces like the butter or condiments.
- Offer to bring a dish you can eat to group meals.
- Suggest easy swaps like corn tortillas instead of flour.
- Provide links to help educate them further about safe gluten-free eating.
- Show appreciation for accommodations and don’t scold occasional mistakes.
- Provide snacks you can safely eat if worried a host hasn’t prepared adequately.
- Offer gentle reminders ahead of group meals on what you can eat.
With open communication and by providing helpful resources, your loved ones will better understand your needs.
Raising Gluten-Free Kids
Parents of children diagnosed with celiac disease face added challenges. Here are some tips:
- Consult with a pediatric gastroenterologist and registered dietician
- Join online parent support groups to connect with others’ experiences
- Educate caregivers, teachers, coaches, and other parents about your child’s gluten-free needs
- Pack safe snacks, treats, and lunches for school and activities
- Teach them how to read labels, order at restaurants, and advocate for themselves
- Keep gluten out of your home and have dedicated sections in the kitchen
- Make dishes the whole family can enjoy like pizza with a gluten-free crust
- Find gluten-free substitutes for favorite treats like cupcakes and pasta
- Emphasize the inclusion of dietary differences to prevent bullying
- Make sure they carry medical alert identification
With diligence and proper education, kids with celiac disease can thrive and safely navigate the gluten-free lifestyle.
Gluten-Free Kids and Parties
Birthday parties and holidays pose added challenges for gluten-free kids. Here are some party tips:
- Provide a gluten-free treat option the hosts can serve
- Offer to bring a special dessert they can safely eat
- Have them eat beforehand if unsure of safe options
- Remind hosts of their dietary needs ahead of time
- Help educate friends’ parents on reading labels
- Empower kids to ask questions and speak up
- Limit food exposure risks like shared utensils
- Focus on fun activities vs food-centric parties
With some accommodations, kids with celiac disease can still fully enjoy parties and celebrate special occasions.
Dating and Relationships with Celiac Disease
Having celiac disease can impact dating and relationships. Here’s how to navigate it:
- Share you have celiac disease early on so it’s not a surprise
- Educate potential partners on how gluten affects you and what you can’t eat
- Suggest safe restaurant options for dates like steakhouses
- Offer to cook a gluten-free meal at home together
- Explain cross-contamination risks and how you avoid gluten
- Assure your date you can dine out safely with some adaptations
- Find fun activities beyond just eating out
- Be patient providing ongoing education as needed
- Don’t tolerate partners who aren’t respectful of your needs
With good communication, those who care about you will understand and thoughtfully accommodate your gluten-free lifestyle.
Celiac Disease and Pregnancy
Maintaining a gluten-free diet before and during pregnancy is important for women with celiac disease. Reasons include:
- Prevents malnutrition which is dangerous during pregnancy
- Lowers risk of miscarriage and complications
- Optimizes nutrient absorption critical for fetal development
- Avoids passing celiac disease onto the baby
- Manages pregnancy issues like anemia, preeclampsia, and low birth weight
Consuming even small amounts of gluten during pregnancy increases the chances of the child developing celiac disease later. After birth, introduce gluten gradually between 4-12 months as per pediatric guidance.
Gluten Intolerance Symptoms in Babies
Celiac disease is rare in infants under 12 months old as they are not consuming much gluten yet. However, some babies experience reactions when gluten is introduced through cereals, teething biscuits, or mom’s breastmilk if she eats gluten. Potential symptoms include:
- Colic
- Chronic diarrhea
- Constipation
- Failure to thrive
- Excessive spitting up
- Abdominal distension
- Irritability
- Skin rash
Consult your pediatrician if such symptoms arise when introducing gluten. Blood testing around 12 months can check for celiac disease if concerns arise earlier. Strict gluten avoidance is advised if confirmed.
Seniors and Celiac Disease
Celiac disease can develop at any age, even in seniors. Typical symptoms like diarrhea and weight loss are often chalked up to normal aging. This leads to underdiagnosis in the elderly.
Unexplained anemia, osteoporosis, neuropathy, or Vitamin B12 deficiency may warrant testing seniors for celiac disease. A gluten-free diet may alleviate nagging health issues and improve quality of life.
Seniors on a gluten-free diet need to ensure adequate fiber and nutrients as appetite declines with age. Work with a dietitian to develop a nutritious and balanced gluten-free meal plan.
Non-Celiac Gluten Sensitivity
Non-celiac gluten sensitivity involves symptoms with gluten ingestion without the intestinal damage seen in full celiac disease. People may experience:
- Bloating and abdominal discomfort
- Diarrhea or constipation
- Headaches
- Fatigue
- Joint pain
- Skin issues
- Anxiety or brain fog
It’s not an autoimmune reaction but rather an intolerance. About 6-10% of people may have NCGS. The treatment is following a gluten-free diet which improves symptoms.
Gluten Sensitivity Testing
Since non-celiac gluten sensitivity lacks blood markers or intestinal changes, identifying it involves an elimination diet:
- Remove all gluten for 6 weeks
- Notice if symptoms resolve
- Slowly reintroduce gluten and monitor for the return of symptoms
- Get tested for celiac disease if no clear symptoms upon gluten reintroduction
Keep a food and symptom log to track reactions. Work with a registered dietitian to ensure nutritional adequacy while trialing a gluten-free diet.
** Wheat Allergy vs. Celiac Disease **
While celiac disease and wheat allergy both require avoiding gluten, they differ in important ways:
- Wheat allergy: Immune reaction to wheat proteins. Usually appears suddenly with exposure.
- Celiac disease: Autoimmune reaction to gluten. Causes gradual intestinal damage over time.
- Symptoms: Wheat allergy can cause hives, throat swelling, and anaphylaxis. Celiac causes mainly digestive issues.
- Diagnosis: Wheat allergy identified by skin prick test. Celiac by blood test and biopsy.
- Treatment: Wheat avoidance for allergy. Requires gluten-free diet for celiac disease.
Those with a wheat allergy can typically tolerate barley, rye, and oats that people with celiac disease cannot. Consult an allergist and gastroenterologist to differentiate between the two conditions.
** Mushroom Risotto Recipe (Gluten-Free) **
Risotto is naturally gluten-free and this mushroom version makes for a delicious and healthy meal.
Ingredients:
- 4 cups gluten-free chicken or vegetable broth
- 2 tbsp olive oil
- 1 small onion, diced
- 8 oz assorted mushrooms like cremini, shiitake, oyster, sliced
- 1 1⁄2 cups arborio rice
- 1⁄4 cup dry white wine or broth
- 2 cloves garlic, minced
- 1⁄4 cup parmesan cheese, grated
- 2 tbsp butter
- Salt and pepper to taste
Instructions:
- In a small pot, warm the broth over low heat and keep it at a simmer.
- Heat olive oil in a skillet over medium heat. Sauté onions for 2-3 minutes until translucent.
- Add mushrooms and continue cooking for 3-4 minutes until softened.
- Add rice and stir to coat with oil and mushroom mixture. Cook for 2 minutes.
- Stir in wine and cook until absorbed.
- Add 1⁄2 cup simmering broth and cook, stirring frequently until absorbed.
- Continue adding broth 1⁄2 cup at a time allowing it to absorb before adding more. Stir frequently.
- After 15-20 minutes, the rice should be al dente. Remove from heat.
- Mix in garlic, parmesan, butter, and season with salt and pepper.
Enjoy this gluten-free risotto topped with extra Parmesan cheese and a salad!
Gluten-Free Chocolate Cake Recipe
This easy one-bowl chocolate cake recipe is naturally gluten-free.
Ingredients:
- 1 1⁄4 cups almond flour
- 1⁄4 cup coconut flour
- 1⁄2 cup cocoa powder
- 1 tsp baking soda
- 1⁄4 tsp salt
- 1⁄2 cup maple syrup
- 1⁄3 cup coconut oil, melted
- 1 tbsp apple cider vinegar
- 1 tsp vanilla extract
- 1⁄2 cup dairy-free milk
- 1⁄2 cup dairy-free chocolate chips
Instructions:
- Preheat oven to 350°F. Grease an 8×8 baking pan.
- In a large bowl, mix the almond flour, coconut flour, cocoa powder, baking soda, and salt.
- Add the maple syrup, coconut oil, vinegar, vanilla and non-dairy milk. Stir until fully combined.
- Fold in chocolate chips.
- Pour batter into prepared pan and bake for 25-28 minutes.
- Let cool before slicing. Top with powdered sugar or whipped coconut cream.
This fudgy chocolate cake is a crowd-pleasing gluten-free dessert!
Conclusion
Following a strict gluten-free diet is the only treatment option available for managing celiac disease and relieving symptoms. This requires diligence in eliminating even traces of gluten that can be hidden in many foods and products. Sticking closely to naturally gluten-free whole foods like produce, lean proteins, dairy, and certified gluten-free grains is imperative.
Carefully reading labels, asking questions at restaurants, and avoiding cross-contamination allows those with celiac disease or gluten sensitivity to thrive. Seeking out support groups, connecting with others on a similar journey, and working closely with knowledgeable physicians and dietitians make living gluten-free much more achievable. With proper education and planning, it is possible to manage celiac disease or gluten intolerance both physically and emotionally.
Mustafa Al Mahmud is a passionate medical writer and health enthusiast. He is excited to share his knowledge and make reliable health information more accessible through Quick Medico. Mustafa aims to write about common diseases, medications, wellness topics, and the latest health research in easy-to-understand language. He believes clear and accurate health communication empowers readers to take charge of their well-being. In his free time, Mustafa enjoys hiking, cooking, and spending time with his family.