Tips for Following a Gluten-Free Diet, According to an RD

The gluten-free diet is a pattern of eating which excludes foods and beverages which contain the protein gluten. Foods with gluten include wheat, barley, and rye. In this article, we will discuss when the gluten-free diet is necessary for health, sources of gluten, what to look for on a food label, and 5 tips for shopping gluten-free.

When Gluten Should Be Excluded from Your Diet

If you are a healthy individual without a medical diagnosis that requires you to avoid gluten, you do not need to follow a gluten-free diet. Foods that contain gluten include wheat products which provide health-promoting nutrients such as fiber, B-vitamins, magnesium, and iron. Also, many studies have shown health benefits from consuming whole-grain foods containing wheat.

Various studies have linked the consumption of whole grains to improved health. For example, one study found that groups with the highest intakes of whole grains including wheat (2-3 servings daily) compared with groups eating the lowest amounts (less than 2 servings daily) were found to have significantly lower rates of heart disease and stroke, development of type 2 diabetes, and deaths from all causes. This is important to note because it shows that gluten-containing foods can be part of a nutritious diet. (1,2,3,4)

Although some gluten-containing foods provide essential nutrients and health benefits, there are a few medical reasons why some individuals need to exclude gluten from their diet.

Celiac Disease

Individuals with celiac disease should completely avoid gluten. Celiac disease is an autoimmune disorder where the immune system attacks itself. With celiac disease, gluten causes the immune system to react in a way that causes intestinal inflammation and long-term damage. If unmanaged, celiac disease will cause damage to the intestinal villi which affects proper nutrient absorption into the bloodstream. Without healthy villi, the individual can become malnourished, even when eating enough calories and nutrients. In addition, over time celiac disease increases many health risks including anemia, arthritis, diabetes, and gastrointestinal cancers. Additional health risks that are increased by celiac disease are growth retardation in children, infertility, miscarriage and birth defects, delayed puberty, early osteoporosis, and thyroid conditions. Symptoms of celiac disease include malabsorption, abdominal bloating, cramps, gas, chronic constipation, diarrhea, stomach pain, appetite loss, fatigue, vomiting, and weight loss. A painful rash, eczema, joint pain, and muscle cramps can also occur. Due to these symptoms, it is crucial for people with celiac disease to exclude gluten from their diet.

Non-Celiac Gluten Sensitivity

Non-celiac gluten sensitivity (NCGS) is different from celiac disease. This is an innate immune-system response to gluten, not an auto-immune condition. This condition does not damage the intestine in the way that celiac disease does. NCGS causes uncomfortable symptoms when a person consumes gluten. Symptoms are similar to celiac disease and include fatigue, headaches, a “foggy mind”, stomach pain, bloating, and changes in bowel movements. Following a gluten-free diet helps to relieve these symptoms. Talk to your doctor or a Registered Dietitian if you think you may have NCGS and before making changes to your diet.

Foods with Gluten to Avoid

Since many foods contain gluten, following a gluten-free diet can be difficult.

The following are the main sources of foods that contain gluten:

• Wheat and wheat ingredients- wheat flour, white flour, bulgur, durum, emmer, farina, farro, semolina, wheat bran, wheat starch, and triticale
• Barley- beer, ale, porter, stout, other fermented beverages, malt, malt flavoring, malt syrup or malt extract, malted beverages, and malted milk
• Rye
• Processed foods that may contain wheat, barley, or rye- brewer’s yeast, bouillon cubes, brown rice syrup, candy, cold cuts, hot dogs, salami, sausage, French fries, gravy, salad dressing, pasta, rice mixes, sauces, seasoned tortilla and potato chips, soups, soy sauce, and fried foods
• Any milk and milk products with added wheat ingredients
• Grains that usually contain wheat- bread and rolls (white, whole wheat, multigrain, potato, rye), other baked goods (brownies, cakes, muffins), breadcrumbs, cereals, couscous, pancakes, waffles, flour tortillas
• All fresh, frozen, and canned fruits and vegetables prepared with wheat ingredients
• Oats- oats do not always contain gluten but are usually cross-contaminated with gluten from other products during processing. If you would like to eat gluten-free oats, you should talk to your physician and registered dietitian. (5,6)

Foods to Eat While on a Gluten-Free Diet

Following a gluten-free diet does not mean you cannot enjoy nutritious and delicious foods. The foods listed below will help promote a well-balanced diet full of flavor while following a gluten-free diet:

• Safe grains, bread or pasta made with gluten-free flour, and plant foods- amaranth, arrowroot, buckwheat, cassava, corn, flax, legumes, millet, potatoes, quinoa, rice, seeds, sorghum, tapioca, teff, wild rice, chickpea flour, almond flour, and yucca
• Fruits and vegetables- all fruits and vegetables are naturally gluten-free and provide antioxidants, essential nutrients, vitamins, and minerals
• Eggs
• All meats and fish unless battered or coated in gluten-containing ingredients
• All nuts and seeds
• Dairy products such as plain milk, plain yogurt, and plain cheeses. Be aware of ingredients in flavored dairy products because these may contain gluten
• All vegetable oils and butter
• Herbs and spices
• Most beverages excluding beer, unless the beer is labeled as gluten-free (5,6)

For more information on foods to eat and avoid while living gluten-free, speak to a registered dietitian.

Reading the Food Label for Gluten-Containing Ingredients

It is important to carefully read food labels if you have celiac disease, non-celiac gluten sensitivity, or a wheat allergy. Ingredients can be hidden sources of wheat, barley, and rye, so knowing the following terms will help you identify which foods to avoid and which to safely eat.

Other Words That Mean Wheat

• Bromated flour
• Durum flour
• Enriched flour
• Farina
• Flour
• Graham flour
• Phosphate flour
• Plain flour
• Self-rising flour
• Semolina
• White flour

Under the Food Allergen Labeling and Consumer Protection Act of 2004, if a food or an ingredient contains wheat or protein from wheat, the word “wheat” must be clearly stated on the food label. This means that the label must clearly state that it “contains wheat” or the ingredient “wheat” must be listed on the food label.

In addition to the above foods listed to avoid, carefully read food labels and the ingredients list for ingredients made from barley and rye. Processed foods commonly contain wheat, barley, and rye, so always be sure to check the ingredients on the food label.

Some medications and supplements also contain ingredients made from wheat or barley, so talk to your physician and pharmacist if you are taking medications and on a gluten-free diet. The Food Allergen Labeling and Consumer Protection Act of 2004 also covers dietary supplements, infant formulas, and medical foods, so if a product contains wheat or wheat protein, including in the flavoring, coloring, or incidental ingredients, the word “wheat” must be clearly stated on the label.

Labeling for Gluten-Free Foods

The Food and Drug Administration (FDA) created standards for the labeling of “gluten-free” foods. If a product contains less than 20 parts per million of gluten or contains no barley, wheat, or other crossbred hybrids, a food can be labeled as “gluten-free”. Foods can also be labeled as “gluten-free” if the food is naturally gluten-free.

Although there are defined “gluten-free” claims, it is still important to read the ingredients list on labels. Gluten is not required to appear on the ingredients list or Nutrition Facts, so knowing the ingredient sources of gluten is critical.

5 Tips to Successfully Shop Gluten-Free

Here are a few shopping tips to guide you when shopping gluten-free:

• Choose plain foods that are naturally gluten-free. These include vegetables, fruits, meats, poultry, fish, cheese, yogurt, milk, eggs, nuts, seeds, and beans. Since gluten-free labeling is not required for naturally gluten-free foods, keep this in mind when shopping for foods as well.
• Keep an eye out for foods labeled as “gluten-free”. There is a variety of gluten-free baking items, flours, pasta, pizza, and more available in grocery stores. Also, search for the “gluten-free” section in your local grocery store. With more people following a gluten-free diet, most grocery stores have a gluten-free section.
• Remember that the word gluten-free is not the same as grain-free. Following the allowed list of foods above, choose grain products that do not contain gluten.
• If you would like to eat oats, ask your physician or registered dietitian about oats. If allowed, only buy oats labeled as “gluten-free” to reduce the risk of consuming oats contaminated with wheat, barley, or rye during processing.
• Always read the ingredients list and the “Contains” statement on food labels for ingredients that are sources of gluten.

Outlook

If you have been diagnosed with celiac disease or non-celiac gluten sensitivity, being gluten-free is essential for your health. It can be challenging, but with careful planning, label reading, and the help from your doctor and a registered dietitian, living gluten-free can become part of your everyday life and enjoyable.

Always include whole foods in your diet such as fruits, vegetables, nuts and seeds, and protein from lean sources. With the restriction from the gluten-free diet, you still can enjoy a variety of flavorful foods and eat a nutritious, well-balanced diet.

References:

• Liu S, Stampfer MJ, Hu FB, et al. Whole-grain consumption and risk of coronary heart disease: results from the Nurses’ Health Study. Am J Clin Nutr. 1999;70:412-9.
• Mellen PB, Walsh TF, Herrington DM. Whole-grain intake and cardiovascular disease: a meta-analysis. Nutr Metab Cardiovasc Dis. 2008;18:283-90.
• De Munter JS, Hu FB, Spiegelman D, Franz M, van Dam RM. Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review. PLoS Med. 2007;4:e261.
• Johnsen, N.F., et al. Whole-grain products and whole-grain types are associated with lower all-cause and cause-specific mortality in the Scandinavian HELGA cohort. British Journal of Nutrition, 114(4), 608-23.
• Nutritioncaremanual.org. 2020. - Nutrition Care Manual. [online] Available at: [Accessed 16 December 2020].
• Nutritioncaremanual.org. 2020. - Nutrition Care Manual. [online] Available at: [Accessed 16 December 2020].