If you have been medically diagnosed with coeliac disease then your immune system has been reacting to gluten and damaging your gut. To get better, you must remove gluten from your diet, which is the only treatment for coeliac disease. Gluten is found in the grains wheat, barley and rye.
There’s currently no cure for celiac disease. A strict gluten-free diet — also known as the celiac disease diet — must be followed to allow your body to heal.
For people with celiac disease, an autoimmune disease that’s triggered by eating gluten (a protein found in wheat, barley, and rye), news of a diagnosis can at once be a relief — and a huge burden. It may be a relief because it can take up to a decade to get the accurate diagnosis, and a burden because now it’s up to you to change your lifestyle to control the disease.
You may have heard the term ‘gluten free diet’ before. This can be a bit confusing to some people because it isn’t a diet in the way that most people understand it – it’s not designed to help people lose weight. It’s just a way of eating that helps you heal your gut so you can start absorbing all the nutrients you need from your diet.
If you have celiac disease and consume even small amounts of gluten, damage to your intestines will continue, regardless of the absence of symptoms (1Trusted Source).
For those with celiac disease, avoiding gluten is essential but can be harder than it seems.
This article reviews the benefits of the celiac disease diet and provides lists of foods to eat and avoid, as well as a sample menu and helpful tips.
That doesn’t mean it’s easy. Going gluten-free means rethinking how you shop, cook, and order in restaurants. With education and effort, you can make confident choices about foods that taste good and are good for you.
What is Gluten?
Gluten is a protein in wheat, barley, and rye. When those grains and the ingredients made from them (flour) are used to make foods — like pasta, cereals, and bread — gluten is the “glue” that holds them together.
How Does Gluten Affect People with Celiac?
Celiac is a genetic autoimmune disease. When you eat a food with gluten, the protein attacks the villi, or little fingers that line your small intestine. Without the help of healthy villi, your body can’t absorb nutrients into the bloodstream.
This causes digestive issues and malnourishment, especially when iron, calcium, and vitamin D aren’t being absorbed. If it’s not dealt with, celiac can cause other long-term conditions, such as neurological disorders and osteoporosis. It could also trigger the start of thyroid disease.
How Will I Need To Change My Celiac Disease Diet?
If you have celiac disease, you will need to remove foods and drinks that contain gluten from your diet. Following a gluten-free diet can relieve celiac disease symptoms and heal damage to the small intestine. People with celiac disease need to follow a gluten-free diet for life to prevent symptoms and intestinal damage from coming back. Your doctor or a registered dietitian can guide you on what to eat and drink to maintain a balanced diet.
If you or your child has been diagnosed with celiac disease, you may find support groups helpful as you learn about and adjust to a gluten-free lifestyle. Your doctor or a registered dietitian may be able to recommend support groups and other reliable sources of information.
What Is the Celiac Disease Diet?
Anyone diagnosed with celiac disease must follow the celiac disease diet.
It requires avoiding gluten, a naturally occurring protein found in several grains, including wheat, barley, and rye.
When someone with celiac disease eats gluten, it causes an autoimmune response in their body that damages the lining of the small intestine.
As a result, the small intestine cannot properly absorb nutrients from food, creating symptoms like diarrhea, unexplained weight loss, and malnutrition.
The only way to prevent this damage is to strictly follow the gluten-free celiac disease diet.
A gluten-free diet is essential for managing signs and symptoms of celiac disease and other medical conditions associated with gluten.
A gluten-free diet is also popular among people who haven’t been diagnosed with a gluten-related medical condition. The claimed benefits of the diet are improved health, weight loss and increased energy, but more research is needed.
- Celiac disease is a condition in which gluten triggers immune system activity that damages the lining of the small intestine. Over time this damage prevents the absorption of nutrients from food. Celiac disease is an autoimmune disorder.
- Non-celiac gluten sensitivity causes some signs and symptoms associated with celiac disease — including abdominal pain, bloating, diarrhea, constipation, “foggy brain,” rash or headache — even though there is no damage to the tissues of the small intestine. Studies show that the immune system plays a role, but the process isn’t well understood.
- Gluten ataxia, an autoimmune disorder, affects certain nerve tissues and causes problems with muscle control and voluntary muscle movement.
- Wheat allergy, like other food allergies, is the result of the immune system mistaking gluten or some other protein found in wheat as a disease-causing agent, such as a virus or bacterium. The immune system creates an antibody to the protein, prompting an immune system response that may result in congestion, breathing difficulties and other symptoms.
Potential Benefits of Celiac Disease Diet
The celiac disease diet is required for anyone diagnosed with celiac disease and has many benefits.
Reduces the Symptoms of Celiac Disease
Many people with celiac disease experience uncomfortable symptoms, such as diarrhea, indigestion, abdominal pain, fatigue, and headaches.
Following a gluten-free diet for at least one year has been shown to improve these symptoms in more than 90% of people with celiac disease, significantly improving quality of life.
Intestinal symptoms like diarrhea tend to be the quickest to resolve — with some people experiencing relief after just two days on a gluten-free diet.
Overall, it takes an average of one month to see significant improvements in bowel movements, bloating, and abdominal pain.
Prevents Small Intestinal Damage
For people with celiac disease, eating gluten triggers an autoimmune response that damages the small intestine, where nutrients are absorbed.
Avoiding gluten prevents this autoimmune process, and the small intestine can heal and return to normal function.
This process takes time — so the earlier a gluten-free diet is started, the better.
In one study, up to 95% of children with celiac disease who followed a gluten-free diet for two years no longer showed signs of intestinal damage).
Recovery tends to be slower in adults — with 34–65% achieving gut healing in two years.
However, this number jumps to at least 66% — and up to 90% — after five or more years on a gluten-free diet.
Being vigilant about avoiding gluten is crucial. Exposure to even tiny amounts can hinder the healing of your intestines.
Improves Nutrient Absorption
Nutrient deficiencies are prevalent in people with celiac disease due to poor absorption in the damaged small intestine.
Deficiencies in iron, calcium, magnesium, zinc, vitamin B12, niacin, riboflavin, and folate, as well as vitamins A, D, E, and K, are the most common.
In fact, unexplained iron deficiency anemia is one of the most recognized signs of celiac disease in adults.
Yet, supplementing will not always correct deficiencies in people with celiac disease if their intestines are still damaged and unable to absorb nutrients.
Following a gluten-free diet has been shown to repair the intestines enough to correct iron deficiency anemia within six to twelve months, even without taking a supplement.
Women with celiac disease have higher rates of infertility and may be at a greater risk of miscarriage than women without this condition.
Research suggests that the autoimmune response that gluten triggers in people with celiac disease may be to blame.
However, following a strict gluten-free diet has been found to improve fertility and reduce miscarriage rates.
May Reduce Cancer Risk
Celiac disease is associated with a three-times greater risk of non-Hodgkin’s lymphoma — an aggressive form of cancer that occurs in the lymph system.
Several studies have found that diagnosing celiac disease early and following a gluten-free diet can reduce this risk — but more research is needed.
Lowers the Risk of Osteoporosis
Up to 75% of people with untreated celiac disease have lower bone density and a higher risk of osteoporosis.
This may be due to poor calcium and vitamin D absorption, as well as increased inflammation that interferes with the bone-building process.
Research shows that diagnosing celiac disease early and starting a gluten-free diet can help stop bone loss and reduce the risk of developing osteoporosis.
Following a gluten-free diet requires paying careful attention to food selections, the ingredients found in foods, and their nutritional content.
Allowed Fresh Foods
Many naturally gluten-free foods can be a part of a healthy diet:
- Fruits and vegetables
- Beans, seeds, legumes and nuts in their natural, unprocessed forms
- Lean, nonprocessed meats, fish and poultry
- Most low-fat dairy products
Grains, starches or flours that can be part of a gluten-free diet include:
- Corn — cornmeal, grits and polenta labeled gluten-free
- Gluten-free flours — rice, soy, corn, potato and bean flours
- Hominy (corn)
- Rice, including wild rice
- Tapioca (cassava root)
Grains not Allowed
Avoid all foods and drinks containing the following:
- Triticale — a cross between wheat and rye
- Oats, in some cases
- While oats are naturally gluten-free, they may be contaminated during production with wheat, barley or rye. Oats and oat products labeled gluten-free have not been cross-contaminated. Some people with celiac disease, however, cannot tolerate the gluten-free-labeled oats.
Wheat Terms to Know
There are different varieties of wheat, all of which contain wheat gluten:
Wheat flours have different names based on how the wheat is milled or the flour is processed. All of the following flours have gluten:
- Enriched flour with added vitamins and minerals
- Farina, milled wheat usually used in hot cereals
- Graham flour, a course whole-wheat flour
- Self-rising flour, also called phosphate flour
- Semolina, the part of milled wheat used in pasta and couscous
Gluten-Free Food Labels
When you are buying processed foods, you need to read labels to determine if they contain gluten. Foods that contain wheat, barley, rye or triticale — or an ingredient derived from them — must be labeled with the name of the grain in the label’s content list.
Foods that are labeled gluten-free, according to the U.S. Food and Drug Administration rules, must have fewer than 20 parts per million of gluten. Foods with these labels may include:
- Naturally gluten-free food
- A prepared food that doesn’t have a gluten-containing ingredient
- Food that has not been cross-contaminated with gluten-containing ingredients during production
- Food with a gluten-containing ingredient that has been processed to remove gluten
Alcoholic beverages made from naturally gluten-free ingredients, such as grapes or juniper berries, can be labeled gluten-free.
An alcoholic beverage made from a gluten-containing grain (wheat, barley, rye and hybrid grains such as triticale) can carry a label stating the beverage was “processed,” “treated” or “crafted” to remove gluten. However, the label must state that gluten content cannot be determined and the beverage may contain some gluten. These beverages may not be labeled gluten-free.
Processed Foods That Often Contain Gluten
In addition to foods in which wheat, barley and rye are likely ingredients, these grains are standard ingredients in a number of other products. Also, wheat or wheat gluten is added as a thickening or binding agent, flavoring, or coloring. It’s important to read labels of processed foods to determine if they contain wheat, as well as barley and rye.
In general, avoid the following foods unless they’re labeled as gluten-free or made with corn, rice, soy or other gluten-free grain:
- Beer, ale, porter, stout (usually contain barley)
- Bulgur wheat
- Cakes and pies
- Communion wafers
- Cookies and crackers
- French fries
- Imitation meat or seafood
- Malt, malt flavoring and other malt products (barley)
- Hot dogs and processed lunchmeats
- Salad dressings
- Sauces, including soy sauce (wheat)
- Seasoned rice mixes
- Seasoned snack foods, such as potato and tortilla chips
- Self-basting poultry
- Soups, bouillon or soup mixes
- Vegetables in sauce
How to Avoid Nutritional Deficiencies if You’re Managing Celiac Disease
One complication that often arises from celiac disease is nutrient deficiencies. “The severity of the inflammatory reaction in the intestine, and how much of the intestine is affected, influences how someone absorbs nutrients,” says Bertiger.
Bertiger points out that while people with celiac can be deficient in a range of vitamins, most commonly he sees B12, calcium, iron, and vitamin D. (Though so many people, especially in Northern climates, are vitamin D deficient that this is often seen across the board in people with celiac and healthy folks.) Along with those, Mukherjee often sees deficiencies of zinc, folic acid, and carnitine, a nutrient that helps the body produce energy.
Problems with macronutrients can pop up as well. “In worse cases of celiac disease, patients cannot absorb and digest fats very well, so they may have diarrhea filled with fat,” he says. In that case, someone won’t absorb calories very well, so weight loss and malnourishment becomes a legitimate concern.
Iron deficiency is especially telling. “Many people become iron deficient as the first sign of celiac disease,” says Bertiger. “When patients are mildly anemic, one of the first tests we give them is for celiac,” he adds.
The first course of action is to treat celiac with a gluten-free diet. It’s best to meet with a registered dietitian who specializes in celiac who can assess your diet, provide guidance on what to eat, and help you meet your nutrient recommendations to correct deficiencies. “He or she can also identify all the nooks and crannies in the world that gluten hides,” says Bertiger.