10 General Nutrition Recommendations for Celiac Disease
Celiac disease affects about 1% of Canadians, and onset can occur at any age. Individuals with celiac disease experience an unusual immune response whenever they eat foods that contain gluten. This means that following a strict gluten-free diet is necessary to avoid symptoms. However, the benefit is that people with celiac disease usually do not need any medications and can fully control their condition through dietary changes. Yet, some might find it difficult to follow the diet. Read on for some tips to make it easier to stick to a gluten-free diet.
1. Follow a lifelong gluten-free diet
Gluten is the protein found in wheat, rye, barley, and triticale, which triggers an inflammatory response in people with celiac disease that flattens the villi lining the inner wall of the small intestine. These microscopic finger-like projections are responsible for absorbing nutrients from the food we eat, so damage to villi often leads to malabsorption, malnutrition, and a variety of symptoms, including diarrhea, abdominal pain, skin rashes, brain fog, headaches, and decreased energy levels. A 100% gluten-free diet is currently the only treatment for celiac disease and avoiding gluten over time allows the lining of the small intestine to heal so it can properly absorb nutrients again.
2. Read food labels meticulously
Practice reading food labels for sources of gluten. In Canada, the food label must say that it contains wheat, rye, barley, triticale, or regular oats in the “contains” statement or ingredient list. These gluten-containing grains will not be hidden in a general and/or vague statement such as “natural flavours”.
3. Learn about potential sources of cross-contamination
It can take just a single crumb from a piece of gluten-containing food to trigger an inflammatory response in someone with celiac disease. Common sources of cross contamination include using a toaster or toaster oven that is also used to toast gluten-containing bread, condiment jars (e.g., jam, peanut butter), butter dishes, bulk bins at the grocery store, oil that is used to deep fry both gluten and gluten-free foods (e.g., French fries at a restaurant), and water that is used to cook both gluten and gluten-free foods (e.g., pasta at a restaurant). A registered dietitian with expertise in celiac disease can help you identify possible areas of cross contamination and how to prevent and manage this. Ask your gastroenterologist for a referral or contact Dietitians of Canada.
4. Look for a gluten-free logo or claim on high-risk foods
High-risk foods are foods that tend to be highly contaminated with gluten, such as regular oats grown in the same fields as wheat, rye, and/or barley. Other high-risk foods include gluten-free flours, gluten-free grains (except rice), flaxseeds, and hemp hearts.
5. Eat gluten-free oats
While oats are naturally gluten-free, regular oats are consistently contaminated with gluten. Gluten-free oats are oats that have been carefully sifted through to ensure that there is no cross-contamination with gluten. It is best to wait until you have stabilized on the gluten-free diet and have normal celiac antibody levels before introducing gluten-free oats into your diet. Most people with celiac disease tolerate gluten-free oats, but there are some people who will react to a protein in the oats called avenin.
6. Learn how to cook gluten-free carbohydrates
There are so many gluten-free whole grains to discover. Instead of eating only white rice, experiment with cooking a variety of gluten-free whole grains, such as buckwheat groats, millet, sorghum, quinoa, and teff. Replacing grains with starchy root vegetables – such as potatoes, sweet potatoes, parsnips, and turnips – is another option. Mixing up your carbohydrate choices can help increase the variety, flavour, fibre, and nutrient intake of your meals.
7. Learn new recipes
While you might have to change the way you’ve been eating for most of your life, it can be an exciting opportunity to explore foods you don’t normally eat. There are many gluten-free cookbooks, blogs, and cooking videos available to help you find something new.
8. Practice eating out on a gluten-free diet
This takes courage, confidence, and time spent mourning the loss of spontaneity that comes with being able to eat anything on the menu. Reduce fear and anxiety by contacting the restaurant in advance, researching online, and/or getting to the restaurant early to speak with the waiter in advance. It’s important to make sure that staff understand you have celiac disease specifically, as some people who are gluten-free by choice require less strict protocols.
9. Correct and prevent nutrient deficiencies
Nutrients of concern include iron, folate, vitamin B12, vitamin D, calcium, protein, total calories, and fibre. Your healthcare team might order blood tests to check for deficiencies, particularly for iron and vitamin B12. If you are deficient in a vitamin or mineral, you might require regular monitoring as you make dietary changes or begin using supplements to get your levels where they should be. A registered dietitian with expertise in celiac disease can regularly assess diet quality, nutrient intake, and recommend appropriate supplementation as needed.
10. Advocate for regular follow-ups with your healthcare team
It is important to see your doctor, gastroenterologist, and registered dietitian with expertise in celiac disease regularly, especially initially after diagnosis, and annually after that if you are still struggling with the gluten-free diet, to monitor celiac antibody levels and mitigate the risk of nutrient deficiencies and potential complications.
Gluten-Free Diet
The following chart shows which foods are safe to eat, which foods might contain gluten, and which definitely contain gluten. In general, make sure you always read the packages of foods that you aren’t sure are gluten-free, especially when you are starting out.
| Food Type | Gluten-Free | Might Contain Gluten | Contains Gluten |
| Breads & Cereals | flour/bread made from rice, corn flour, cornstarch, cornmeal, arrowroot, pea flour, soy, potato, tapioca, sago, buckwheat, millet, quinoa, whole-bean flour, and baked goods made with the flours listed above
cereals such as puffed rice, puffed corn, puffed millet, rice flakes, hominy, quinoa flakes
pastas made with the above ingredients
corn tortillas, corn tacos, rice cakes |
oats are naturally gluten-free but are often contaminated
flavourings added to cereals and rice cakes
|
flour/bread made from wheat, rye, barley, triticale, gluten flour, graham flour, durum flour, bulgur, farina, semolina, spelt, kamut, and baked goods made with the flours listed above
cereals made from the above ingredients or with malt flavouring
pastas/tortillas/tacos made with wheat or any of the above ingredients |
| Fruits & Vegetables | fresh, frozen, and canned fruits and juices
fresh, frozen, canned, and dried vegetables |
fruit pie fillings, some dried fruits
batter-fried vegetables usually contain gluten but can be made with gluten-free grains |
|
| Milk & Dairy Products | milk, plain yogurt, cheese, cottage cheese, buttermilk, cream, cream cheese | flavoured milk and yogurt products
custard powders |
ice cream that contains wheat ingredients (e.g., brownies, cookie dough)
malted milk |
| Meat & Alternatives | fresh, frozen, canned, and smoked meats, poultry, fish and eggs
lentils, dried beans and peas, tofu, nuts, and seeds |
luncheon and prepared meats (ham, bacon, sausages, pate, bologna, wieners, etc.),
baked beans |
seitan (plant-based protein made from gluten)
plant-based meat substitutes (e.g., deli slices, veggie dogs, veggie burgers) |
| Other | soups: gluten-free broths, soups made with foods allowed
beverages: tea, coffee, soft drinks, distilled alcoholic beverages (e.g., rum, gin, etc.), wines, cider
condiments: relish, ketchup, mustard, pure herbs and spices, vinegar, gluten-free soy sauce, most pickles
fats: butter, margarine, vegetable oils, shortening, lard, salad dressings from allowed ingredients |
some canned soups and bouillon cubes
beverages: some coffee substitutes, some chocolate drink mixes
condiments: some mixed spices (e.g., curry powder, chilli powder)
fats: suet is coated in flour, typically wheat, but there are some that use gluten-free flour |
beverages: beer, malted beverages
condiments: soy sauce and msg
fats: wheat germ oil |