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
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.
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.
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
- 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
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
- Select restaurants where food is made to order
and menu choices are simple (e.g., grilled or
- 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
- 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.
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
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:
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