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Living Healthy with Celiac Disease
A guide to managing a gluten-free diet in the real world
For Celiacs, Dietitians & other Health Profesionals

What is Celiac Disease?
Gluten is a protein found in all forms of wheat (including durum, semolina, and spelt), rye, oats, barley and related grain hybrids such as triticale and kamut.

When people with celiac disease consume gluten, the absorptive villi in the small intestine are damaged, preventing the absorption of many important nutrients. The long-term effect of untreated celiac disease can be life threatening. However, with a completely gluten-free diet, the intestinal lining will heal completely allowing most patients to live a normal, healthy life as long as they remain free of gluten in their diet. Even a small amount of gluten can cause symptoms to reoccur.

Although the gluten-free diet should be taken seriously, living and eating in the real world requires a sense of humor and a knowledge of both the diet and ingredients.

Stocking A Gluten-Free Pantry
Gluten is hidden in many unsuspecting foods such as licorice, soy sauce, malt vinegar, some flavorings, most processed foods, self-basting turkeys, some cold cuts, and many prepared stocks and soups. Vinegars and alcohols that are properly distilled should not contain any harmful gluten. However, if additives have been added after the distillation process, they may contain gluten. Gluten is also used as a binder in some pharmaceutical products and can be the starch in unidentified food starch, modified food starch, caramel coloring, hydrolyzed plant or vegetable protein. It's also important to avoid products where the ingredients are of questionable origin or are listed as simply "natural flavorings, flavor extracts, or spice extracts" as gluten may be used in processing them.

Most food manufacturers have toll-free customer service numbers and will gladly check on the source of these questionable ingredients. Until the patient is sure a product is gluten-free, it's best not to use it. Plain rice of all types (including wild rice), tapioca, potatoes, corn, and legumes are safe for a gluten-free diet. Most celiac patients can also tolerate soy products, except soy sauce which is usually fermented with wheat.

Gluten-Free Baking
Thanks to new recipes, mixes and ingredients, it's not difficult to make tasty gluten-free breads, pastries, pizza, and even bagels at home. Although such baking defies traditional food science, an alchemy of gluten-free flours (such as rice, tapioca starch, potato starch, cornstarch) and guar or xanthan gum (a pinch is an excellent binder in gluten-free baking) helps create baking mixes that work well. Numerous resources are available to celiac patients including cookbooks, support groups, mail order companies (offering recipes, ingredients and baking mixes) and the Internet which contains a comprehensive list of resources.

Eating Out
Entrusting your gluten-free diet to a "stranger" is a risk that all celiacs must face at one time or another. A few simple guidelines can help minimize that risk.

Attending Parties

  • Suggest that the host put a portion of salad aside before adding croutons and salad dressing.
  • Ask that a plain piece of meat, fish or chicken be set aside before marinade, sauce or barbecue sauce is added.
  • Offer to bring a dish. (That's a tactful way to find out what's on the menu, too.)
  • Bring rice crackers, gluten-free rolls or bread. A gluten-free roll, a plate of salad, and a piece of fruit can make a reasonable meal when all else fails.

Cocktail Parties: the chafing dish maze

  • Bring a gluten-free dish so there will be something safe to eat.
  • Seek out the vegetable, fruit and cheese platters (usually safe and there's always at least one.)
  • Eat something at home so you won't be tempted by questionable foods.

Eating in Restaurants

  • Don't expect a chef to scrutinize ingredients as carefully as you would. Make it easy by providing essential information, but not more information than is necessary.
  • Make it clear to the chef and the server that this is a serious food allergy and that their help to make a meal that is safe is greatly appreciated.
  • Be pleasant and informative, not demanding or accusative.
  • Select restaurants where food is made to order and menu choices are simple (e.g., grilled or broiled items).
  • Avoid chains where much of the food is pre-packaged and made off-site.
  • Call restaurant chef or manager ahead of time (not during meal times) to ask if they can accommodate a gluten-free diet.
  • Fax or mail a list of prohibited foods such as the card below.
  • Begin with something basic and safe rather than asking the chef to remove forbidden ingredients from a dish in hopes of making it safe.
  • Ask for a piece of grilled or broiled meat or fish with olive oil and lemon juice, or butter and herbs.
  • Opt for a baked potato and avoid rice (often prepared in chicken stock), intricate potato dishes and fried potatoes (the same oil may be used for batter-fried foods, too.)
  • Ask for a plain salad with oil and wine or balsamic vinegar - no croutons, please.

Restaurant Card

Use this card as a tool to help explain the gluten-free diet to your server and chef upon arrival at a restaurant in advance of your visit.

Guidelines for Preparing a Gluten-Free Restaurant Meal

I have a severe reaction to gluten and thank you for preparing a meal that I can safely eat. I appreciate your effort-- plain and simple food is just fine.

I cannot digest the gluten in wheat, rye, oats or barley. Even a crumb or speck of flour made from those grains will make me ill. Please be careful not to make my food in pans that have flour or crumbs on them from other food preparation. Please do not use oil that was previously used for frying breaded foods.

I cannot have bread, breadcrumbs, flour, whole wheat flour, semolina, soy sauce, rye breadcrumbs and flour, barley malt, pearl barley, orzo, oats, oat flour or oatmeal, starch (unless it's from corn, tapioca, or potato), modified food starch, hydrolyzed vegetable or plant protein, cakes, cookies, buns or rolls, and sauces made from canned or powdered stocks.

Please do not put croutons on or near my salad or breadcrumbs or toast on my food. Please do not put cookies in or near my dessert. I must also avoid low fat mayonnaise, yogurt, marinated foods and foods covered in barbecue sauce (unless the ingredients are known). I cannot eat foods covered in most sauces and gravies.

Thank you for your help!

The Gluten-Free Pantry would like to thank the following for their help in providing segments of this information:

Celiac Disease Foundation
13251 Ventura Blvd., Suite 1
Studio City, CA 91604-1838
Phone: (818) 990-2354
Fax: (818) 990-2379

Chef Jane Davis, Evanston, Ill.

Joel J. Reich, M.D., Manchester, CT

For more information, please visit our Celiac Resources & Links Section