Nutrition for Celiac Disease
Someone who has celiac disease is unable to properly digest gluten, the sticky protein found primarily in wheat, rye, and barley. Also called celiac sprue and gluten intolerance, celiac disease affects each person differently. Some people have no symptoms. Others might experience difficulties with their digestive system or other parts of the body. One person might be irritable or depressed, while another might experience diarrhea and abdominal pain. Celiac disease is hereditary and can be diagnosed through blood tests or even by examining a small piece of tissue from the small intestine.
The only treatment for celiac disease is a diet free of gluten. To recover from the damage caused by gluten, prevent further damage, and eat enough of the proper nutrients, a carefully monitored diet is required, usually with the assistance of a dietitian skilled in assisting those who have celiac disease.
Essential Nutrition for Celiac Disease
Celiac disease can be the cause of a variety of health conditions. When celiac disease damage is done to the intestines through the consumption of gluten, the body absorbs fewer nutrients. This leads to deficiencies in iron, calcium, folate, and other B-vitamins, which are necessary for optimum health. Adjusting your diet for celiac disease can make replenishing these nutrients difficult, since the elimination all sources of gluten from the diet includes removing all wheat, barley and rye—sources rich in iron, folate and other B-vitamins.
Nutritional counseling for suffers of celiac disease is vital, not only for identifying and eliminating sources of gluten, but for ensuring adequate intake of all essential nutrients. Supplementing your nutrition with vitamins can be effective; however, it is important to select supplements that are gluten-free and meet 100 percent of the daily-recommended intake (DRI).
Recommended Foods for Celiac Disease
A well-balanced diet can usually provide adequate amounts of most nutrients. This involves eating nutrient-dense foods so the body can absorb essential vitamins and minerals.
Recommended foods include:
- For calcium, select milk, yogurt, cheese, ice cream, sardines, salmon, broccoli, spinach, almonds, figs, calcium-fortified soymilk, and orange juice.
- For iron, choose meat, fish, poultry, nuts, seeds, legumes, dried fruit, eggs, amaranth, and quinoa.
- For folate, select leafy green vegetables, broccoli, asparagus, orange juice, liver, legumes, cantaloupe, bananas, peanuts, walnuts, and sesame and sunflower seeds.
- For Vitamin B12, choose liver, eggs, milk, meat, poultry, fish, and seafood.
The Importance of Gluten
Gluten forms the structure of dough that holds the food together. For people with celiac disease, exposure to this protein causes damage to the intestine. If left untreated, the the digestive system will absorb fewer and fewer nutrients. This can lead to malnutrition and finally to diseases, such as folate and vitamin B12 deficiencies, iron-deficiency anemia, and decreased bone density.
Which Grains Contain Gluten?
The following grains contain gluten and should be strictly avoided:
- Barley and barley products
- Flours such as bromated, enriched, graham, phosphated, self-rising, white
- Matzo flour/meal
- Wheat and wheat products
What Other Foods Contain Gluten?
- Ales, beer and lagers
- Broth, bouillon cubes
- Brown rice syrup
- Coating mixes
- Cold cuts, salami
- French fries
- Gloss, balms
- Herbal supplements
- Hot dogs
- Imitation bacon/seafood
- Luncheon meats
- Medications, both prescription and over-the-counter
- Rice mixes
- Sauces, marinades
- Self-basting poultry
- Soup, soup bases
- Vitamin, mineral supplements
What are Some Gluten-free Grains and Starches?
- Flours made from nuts, beans and seeds
- Indian rice grass
- Job’s tears
- Malt vinegar
- Potato starch and flour
- Rice, rice bran, wild rice
- Soy (soya)
Many recent studies indicate that the protein found in oats may not be harmful to most people with celiac disease. However, the oats might have been contaminated by wheat while being milled and processed. Consult a physician or dietitian before adding oats to your diet.
Starting a Gluten-free Diet
Begin a gluten-free diet by basing meals around naturally gluten-free foods. Focus on shopping around the perimeter of the grocery store. Fresh fruits and vegetables are naturally gluten-free, rich in nutrients, and low in fat and sodium. Select fresh meat, poultry, and seafood. Use caution when purchasing processed meats, as they might contain gluten as fillers or flavor enhancers. Read labels carefully.
Most egg and dairy products are gluten-free. Calcium-rich gluten-free desserts and snacks commonly include ice cream, yogurt, and pudding.
Once done shopping around the perimeter, go to the store’s inner aisles and consider these foods:
- corn tortillas
- plain rice
- dried beans and legumes
- spices and herbs
- peanut butter
- cooking oils (olive canola and oils contain healthy monounsaturated fat)
Many grocery stores now are stocking gluten-free products. Health-food sections usually have gluten-free baking products, flours, and pastas for people with celiac disease.
Avoid Contaminating Food with Gluten
When some individuals in a household are on a gluten-free diet while others are not, precautions need to be taken to avoid accidentally ingesting gluten.
- Cooking pans, utensils, and colanders that have been used to cook foods containing gluten must be cleaned thoroughly after each use and before cooking gluten-free products.
- Purchase separate peanut butter, jelly, jam, and mayonnaise jars to avoid gluten-containing bread crumbs in shared containers.
- Use a toaster oven that can be cleaned between uses, or place foil on the rack to avoid contamination. Consider purchasing a separate toaster for gluten-free breads.
- Clean counter tops and cutting boards often to remove gluten-containing crumbs.
Find a Nutritional Consultant
It is important to select a dietitian with expertise in celiac disease. Registered Dietitians (RDs) have completed academic and experience requirements established by the Commission on Dietetic Registration, American Dietetic Association's credentialing agency. RDs must successfully complete a rigorous professional level exam and maintain ongoing continuing education to maintain their credentials.
It might take several consultations with a dietitian to gain confidence in sticking to a gluten-free diet. Occasional repeat visits with a dietitian might be necessary, especially if tests show evidence of more gluten in the body.
Information from the Celiac Sprue Association on the gluten content in various foods.
A Gluten Free Diet Guide from the Children's Digestive Health & Nutrition Foundation website on Celiac Disease.
Gluten-Free Friends: An Activity Book for Kids, by Nancy Patin Falini, MA, RD, LDN.
Gluten-Free Diet: A Comprehensive Resource Guide, by Shelley Case, B.Sc. RD.
Kids with Celiac Disease: A Family Guide to Raising Happy, Healthy, Gluten-free Children, by Danna Korn.
The Gluten-Free Gourmet—Living Well Without Wheat, series by Bette Hagman
Wheat-Free, Gluten-Free Cookbook for Kids and Busy Adults, by Connie Sarros