A Nutrition Guide to Celiac Disease

Celiac disease is an autoimmune disease in which foods that contain gluten cause the immune system to attack the lining of the small intestines. Over time, this erodes the intestinal lining and causes a wide range of symptoms, including digestive issues, abdominal pain, and headaches.

It's important for people with celiac disease to avoid foods that contain the protein gluten—found in wheat, rye, and barley, as well as a variety of packaged foods—to prevent damage to the intestines from occurring and to manage their symptoms. The only effective treatment option for celiac disease is a lifelong gluten-free diet.

This article will explain what can be eaten on a gluten-free diet, what foods to avoid, and how to navigate dining out with celiac disease.

What Is Celiac Disease?

Celiac disease is an autoimmune disease that impacts approximately 1 in every 100 people.

The condition can develop at any age. Some children exhibit celiac symptoms as soon as gluten-containing grains are introduced into their diets, while many women begin to experience celiac symptoms following pregnancy and birth. Genetics and stress are also thought to play a role in the development of the condition.

When people who have celiac disease consume even a small amount of gluten (a protein found in wheat, rye, and barley), their body's immune system reacts by attacking the small intestine. This attack can cause damage to the small fingerlike structures within the small intestine called the villi.

Your villi play an important role in nutrient absorption. If the villi become damaged, you are unable to absorb essential vitamins, minerals, and other nutrients from food. This can lead to malnourishment regardless of how much you eat.

Benefits of a Gluten-Free Diet for Those With Celiac Disease

The only effective treatment option for those with celiac disease is to follow a strict gluten-free diet. Those who have celiac disease must stay on a gluten-free diet for life.

When people with celiac disease adopt a gluten-free diet, they typically experience a significant improvement in symptoms within days or weeks. If they stay the course on a gluten-free diet, symptoms often disappear entirely.

Those with celiac disease who follow a gluten-free diet may see improvement in the following symptoms:

• Recurring stomach pain
• Recurring bloating
• Rash that may be painful or itchy
• Muscle cramps
• Pain in the bones
• Weight loss
• Constipation
• Gas
• Diarrhea
• Numbness in the legs
• Pale, foul-smelling stools
• Infertility
• Early-onset osteoporosis (weak and brittle bones)
• Low blood count
• Change of teeth color

Eliminating gluten usually helps to heal the damage done to the small intestine, as well as prevent further damage from occurring.

In most cases, the small intestine should be completely healed within three to six months of beginning a gluten-free diet. When this happens, the villi will be able to work again as normal.

In people who are older, it may take up to two years for the small intestine to heal completely.

List of Foods to Avoid

On a gluten-free diet, those with celiac disease must not ingest anything containing gluten. This includes foods, beverages, some medications, and even products like cosmetics.

Gluten is a protein that acts like glue to help foods hold their shape. It is mostly found in products containing the grains wheat, barley, rye, and triticale, but it can be used as a thickening agent or filler in certain packaged food products, like salad dressing, sauces, and soups.

As such, if you have celiac disease, it's important to read the labels of any packaged products to ensure they don't list gluten in the ingredients. Look for products that are third-party tested and certified gluten-free.

Wheat

Those on a gluten-free diet for celiac disease should avoid foods that contain wheat. Wheat can be found in foods like:

• Cereals
• Pasta
• Bread
• Baked goods
• Sauces
• Salad dressing
• Soup

Barley

Barley is another grain that contains gluten. Those following a gluten-free diet for celiac disease should avoid foods and drinks that contain barley. These include:

• Beer
• Brewer's yeast
• Soup
• Food coloring
• Malted milk
• Milkshakes made with malted milk
• Malt syrup
• Malt extract
• Malted barley flour
• Malt flavoring
• Malt vinegar

Rye

Rye is another grain that contains gluten. Those on a gluten-free diet should avoid foods containing rye, including:

• Cereals
• Rye bread
• Rye beer

Triticale

Triticale is a newer grain that is a cross between rye and wheat. It also contains gluten, so those with celiac disease should avoid it.

Triticale can be found in:

• Cereal
• Breads
• Pasta
  

List of Foods to Eat

While cutting out gluten can take some effort, there are several foods those on a gluten-free diet can safely eat, including foods that are naturally gluten free.

There are also many gluten-free packaged products available, but it's important to look for ones that are made in gluten-free facilities and are certified gluten free, ideally by a third party.

Naturally Gluten-Free Foods

Healthy whole foods that are naturally gluten free include:

• Vegetables
• Fruits
• Meat
• Poultry
• Dairy
• Fish
• Seafood
• Bean
• Nuts
• Legumes

There are also naturally gluten-free grains, starchy foods, and legumes that can be eaten on a gluten-free diet. These include:

• Amaranth
• Beans
• Buckwheat
• Chia
• Corn
• Flax
• Millet
• Potato
• Quinoa
• Rice
• Soy

Oats are also naturally gluten-free, but be sure to look for brands that are labeled as gluten-free. There's a high risk of cross-contamination with gluten if the oats are grown next to rye, barley, or wheat.

Tips for Dining Out

Eating out while following a strict gluten-free diet for celiac disease requires some effort, but it has become much easier in recent years.

As awareness of celiac disease (and other gluten sensitivities and intolerances) has grown, many restaurants, including major national chains, have implanted designated gluten-free cooking areas to avoid cross-contamination and many have dedicated gluten-free menus. There are even 100% gluten-free restaurants in some areas.

Other tips for safely dining out from the Celiac Disease Foundation include:

Choose a Restaurant Wisely

If you have celiac disease, you will have the best experience dining out if you do a little research ahead of time to find a restaurant that has a designated gluten-free cooking area and a menu of gluten-free options available. Consider looking at the menu online or calling the restaurant to discuss your options before making a reservation.

Most restaurants also have items on the menu that are naturally gluten free, such as salads, some soups, burgers served without a bun, or entrees like meat or fish that are served with rice and vegetables.

However, if you're dining at a restaurant without a special gluten-free menu, be sure to confirm that your meal isn't served with a sauce that may contain gluten or is breaded with ingredients that may contain gluten.

Tell the Waitstaff

When you arrive at the restaurant, advise the servers that you have celiac disease. Make sure they understand what this means. If they don't, explain clearly the foods you can't eat.

Make sure to emphasize that gluten can even be found in ingredients like soy sauce. If you are unsure if the server has understood you, ask to speak to the chef or manager of the restaurant.

Don't Make Assumptions

When ordering, never assume that an item on the menu is gluten free. It is always best to ask.

For instance, an egg omelet may seem like a good gluten-free choice, but some restaurants may use a batter with gluten that makes the eggs fluffier. A baked potato should be naturally gluten free, but it may have a coating containing gluten that makes it extra crispy.

If in doubt, ask. Most restaurants are happy to make accommodations to meet your needs.

Have a Backup Plan

Sometimes, friends or family may choose a place that is not gluten-free friendly. Or maybe your first choice on a menu isn't available or there may not be enough gluten-free options that sound good to you.

To avoid disappointment (or going hungry), consider eating at home before going out if you know you're going to be dining at a place without a gluten-free menu. And consider bringing backup gluten-free foods with you in case there aren't gluten-free menu options available.

Summary

Celiac disease is an autoimmune condition that causes the body's immune system to overreact to gluten and attack the lining of the small intestine. People with celiac disease must follow a strict gluten-free diet to manage their symptoms and prevent damaging their intestinal lining.

Gluten is found in the grains wheat, barley, rye, and triticale. It's important to avoid foods that contain these grains, as well as products that use gluten as a thickening or bulking agent.

Fortunately, there are a number of naturally gluten-free foods (such as fruits, vegetables, meat, fish, and most dairy products), as well as packaged gluten-free foods available for those with celiac disease to enjoy.

A Word From Verywell

Starting a gluten-free diet for celiac disease can seem overwhelming, but help is available.

Consider consulting your healthcare provider, a nutritionist, or a registered dietitian, who will be able to give you tips on navigating these dietary changes, and direct you to other resources such as blogs, cookbooks, and cooking seminars to help you as you make adjustments.

Your healthcare provider can also point you toward helpful meal plans, tips on how to read food labels, and advice on what foods and drinks to choose. If you have any questions about adopting a gluten-free diet, don't hesitate to ask for help.