Celiac Disease/Gluten Intolerance
Gluten Free Quick Start Guide
What is the cause of Celiac Disease?
The exact cause of celiac disease is unknown. Some people live their lives symptom-free, and sometimes the disease is triggered, or becomes active, for the first time after surgery, pregnancy, viral infection, or severe emotional stress. Celiace disease is considered an automimmune disorder because the body’s own immune system causes the damage. It is also classified as a disease of mal-absorption because nutritients are not absorbed into the body.
How is Celiac Disease diagnosed?
It can be identified by a blood test that detects antibodies. A sample from the intestine is then studied under a microscope.
How is Celiac Disease Treated?
It is managed completely by removing gluten from the diet. To manage the disease you must avoid foods that contain gluten for the rest of your life.
What is Gluten?
Gluten is a protein found in what and other flours. Grains that contain gluten include wheat, barley, and rye. Other foods made from these grains that contain gluten include: triticale, spelt, graham flour, durum wheat, semolina, bulgur, kamut, farina and matzo meal. Examples of gluten containing foods include: flour tortillas, pita bread, many cereals, pasta, sauces, gravies, crackers, and white or whole wheat bread.
What is gluten intolerance?
It is a digestive condition triggered by eating gluten. An immune reaction occurs in the small intestine resulting in damage to the villi on the surface of the small intestine. This causes an inability to absorb nutrients from food.
What are the signs of gluten intolerance?
Most people have general complaints of bloating, abdominal pain or diarrhea. The symptoms are very similar to anemia, gastric ulcers, irritable bowel syndrome, or Crohn's disease.
What should I avoid if I have Celiac Disease?
Cakes, pies, cookies, crackers, cereals, breads, pasta, gravies and sauces can all contain gluten. Read labels well to make sure you are not eating any gluten. There is controversy as to whether or not oats should be omitted because some people can eat them without having symptoms.
- Avoid: wheat, rye, or barley. Also kamut, triticale, durum, farina, enriched flour, spelt, self-rising flour, semolina, graham flour, pastry flour, cake flour and wheat starch.
- Wheat-free does not mean gluten-free. It may still contain barley or rye.
- Malt and malt flavoring are made from barley and are not gluten free.
What can I eat if I have Celiac Disease?
Enjoy fresh meats, fish, and poultry, vegetables, fruits, potatoes, rice and gluten-free flours such as potato, soy, rice and corn flour.
- Safe grains and flours: Rice, corn, soy, tapioca, cornstarch, teff, quinoa, amaranth, arrowroot, buckwheat, flax, potato, millet. Also any flour made from beans, legumes, nuts, or tubers.
Where can I buy gluten-free foods?
Check with your local grocery store to see what gluten free foods they carry. What you cannot find in the grocery story, try going to a health food store or buy online via the Internet.
Cross Contamination: What is it?
A food will become "contaminated" when a gluten free food comes in contact with a gluten-containing product. To prevent this, follow these simple steps:
- Designate certain appliances, such as a toaster, for use with gluten free products only.
- Separate all your gluten free foods from other foods in the home.
- Always use clean utensils for serving, mixing, cooking and cutting.
- Have separate containers of condiments, butter, peanut butter, etc.
- Institute a "no double-dipping rule".
- Do not purchase flour or cereal from open bins.
Naturally Gluten Free Products
- Amaranth*
- Beans, Peas, Legumes, Garbanzo
- Buckwheat - Whole Grain Flour - beware if combined with other flours
- Butter - watch for additives
- Cheese - real unprocessed - not Roquefort
- Chickpeas
- Corn - Cornmeal, Polenta, Flour, Hasa Marina, Masa, Grits and Pasta
- Flax
- Fruits and vegetables - plain-canned, fresh frozen
- Juice
- Meats and Fish - plain
- Milk, Eggs
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- Millet*
- Montina
- Oils - Vegetable, Canola
- Plain nuts, Nut flour
- Potato - flour, starch
- Quinoa - whole grain, flour
- Rice - all forms - whole grain, flour, rice pasta
- Seeds
- Sesame
- Sorghum
- Soy Milk, Cheese, Tofu
- Tamari
- Tapioca - whole pearl, flour
- Teff - grain, flour*
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Naturally Gluten Free Ingredients
- Annatto
- Arrowroot - flour
- Baking soda
- Caramel color
- Carob
- Cellulose gum
- Citric, lactic, malic acids
- Corn gluten
- Cream of tarter
- Dextrin*
- Dextrose
- Gelatin
- Glucose syrup
- Glutinous rice
- Guar gum
- Herbs
- Hydrolyzed Plant Protein (HPP) - usually okay in US*
- Hydrolyzed Vegetable Protein (HVP) - usually okay in US*
- Lactose
- Lecithin
- Locust Bean Gum
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- Maltitol
- Manioc (tapioca flour) Modified food starch - if made in US*
- Mono - and Diglycerides (dry) - usually okay in US*
- MSG - monosodium glutamate*
- Nut flour
- Oat Gum
- Sago Seasonings - pure spices okay, seasonings may contain additives*
- Silicon dioxide
- Spices - plain
- Starch - in food - potato, tapioca, corn
- Sucrose
- Tamari
- Tapioca starch, flour
- Vanilla and vanilla extract
- Vegetable broth
- Vinegar - distilled not malt
- Xanthan gum
- Yeast (except Brewers Yeast)
- Yogurts - flavored - could contain fillers*
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Grocery Shopping Guide For Gluten Intolerant Customers
Produce:
- Fruits and vegetables are gluten free.
- Eat 5-9 servings of fruits and vegetables per day.
Cereal:
- Many rice cereals contain malt. These are not suitable to eat.
- Gluten Free Oats are available. Regular oats may be contaminated in the field where they are grown or in the manufacturing facility.
- Call the cereal manufacturers to ask about cross-contamination.
- There are a wide variety of gluten free cereals available.
Baking Aisle:
- Single ingredient spices that contain nothing but the spice itself do not contain gluten. Seasoning blends are blends of spices that should be checked by the manufacturer for any processing agents.
- All varieties of sugar are gluten free.
- Cooking oil that just contains the oil is gluten free.
- Beware of baking sprays that contain flour. Most cooking and baking sprays do not contain gluten.
- Distilled Vinegar is allowed because the distilling process removes any trace of gluten. Avoid Malt Vinegar.
Pasta:
- Couscous should be avoided because it is wheat.
- Most pasta is not allowed. Look for the gluten free varieties.
Dairy:
- Eggs, butter, margarine and most sour creams and cottage cheese do not contain gluten.
- Milk made with malt, malted milk or non-dairy creamers should be avoided. Regular milk is okay.
- Beware of Roquefort and blue cheese.
Meat:
- Choose fresh poultry, fish, pork, and meat that are sold plain. Frozen varieties with nothing added are okay as well.
- Processed meats such as hot dogs, bologna, sausages, and lunchmeats may have gluten-containing ingredients. Check with the manufacturer.
- Be careful when broth is added to a meat item.
General:
- Always read the ingredient statement.
- Most canned vegetable, canned fruits, dried and canned beans do not contain gluten.
- Most soups contain wheat and/or barley.
- Rice is naturally gluten free but avoid flavored rice products.
- Soy sauce may contain gluten so be sure to check the ingredients.
Frozen Foods:
- Frozen fruits and vegetables sold without added ingredients are gluten free.
- Avoid frozen foods with sauces.
- Ice cream with added cake or cookie pieces should be avoided.
- Fruit Popsicles are generally safe. Check the ingredients.
Beverages:
- Coffee, tea, most carbonated beverages, Soy and Rice beverages are naturally gluten free.
- Avoid drink mixes with malt.
- Most liquors contain gluten
Over-The-Counter Supplements, Vitamins, Medications and Personal Hygiene
- Many personal care and supplement companies are starting to label their products gluten free.
- Burt's Bees, Kiss My Face, Dr. Bronners and Tom's of Maine are gluten free.
- Call the manufacturer, as these type items can be sources of gluten.
Gluten-Free Companies and Resources
Additional Celiac Resources and Information
Our practice sponsors a support group, which was established by Dr. Al-Tawil, for those with Celiac Disease. Families with children who have this disease benefit greatly from the support and information provided through this group, and travel from the entire state of Tennessee as well as the surrounding states. The group meets the 3rd Monday every other month at 6:00 PM. All meetings are held at Children's Hospital in the Meschendorf Conference Room. For more information, contact one of our Registered Dieticians at (865) 546-3998 and review the information on the support group's website: www.celi-ACT.com.
In addition to this support group, a counseling session with a Registered Dietitian for newly diagnosed Celiac patients or those patients who are gluten intolerant is offered. A Registered Dietician will provide individual counseling for those patients and their families to help them learn the basics of living a gluten-free lifestyle. Please schedule an appointment with one of our dietitians, you can contact our office at (865) 546-3998.
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