Celiac disease diet: Avoiding foods that contain gluten

Celiac disease (also known as gluten-sensitive enteropathy) is a chronic digestive and immune disorder in which consuming foods containing gluten triggers an immune reaction that causes gastrointestinal discomfort and, over time, damages the small intestine. If enough damage is done, the intestine may no longer be able to properly absorb nutrients, leading an individual with celiac disease to become nutrient-deficient. This could affect other systems throughout the body.

For this reason, it’s important for people with celiac disease to follow a strict diet that excludes gluten.

What is the connection between gluten and celiac disease?

Gluten is a protein found in wheat, rye, and barley. In someone with celiac disease, the immune system mistakenly recognizes gluten as "foreign."

When people with celiac disease eat foods containing gluten, the immune system attacks the gluten when it reaches the small intestine. The attacks damage villi, which are small, fingerlike projections in the small intestine that help the body absorb nutrients from food. As villi become eroded and flattened, they have trouble absorbing nutrients. In the short term, this can lead to diarrhea and other digestive symptoms.

Left unchecked, the inability of the small intestine to absorb nutrients can lead to malnutrition, weight loss, anemia, osteoporosis, infertility, liver disease, nerve problems, and, rarely, seizures.

In contrast to celiac disease, non-celiac gluten sensitivity is a condition in which people experience physical symptoms after eating gluten, even though they do not have celiac disease or a true wheat allergy.

Diet and treatment of celiac disease

While there is no “cure” for celiac disease, avoiding gluten can prevent recurring symptoms. A gluten-free diet can also relieve celiac disease symptoms and even allow damage to the small intestine to heal.

Because avoiding gluten is currently the only way to prevent symptoms and intestinal damage from celiac disease from returning, people with celiac disease must follow a gluten-free diet for life.

Foods to avoid with celiac disease

Many foods can contain gluten — including many you wouldn’t expect, like canned soups, sour cream, and cold cuts. That’s why a person with celiac disease must be vigilant about reading labels and asking questions about food ingredients.

In general, avoid the following foods if you have celiac disease:

• Cereals, breads, or other grain products that include wheat, rye, or barley. This includes white or whole-wheat flour (including cookies, crackers, cakes, and most other baked goods), semolina, couscous, breadcrumbs, most pastas, and malt.
• Processed cheese, cheese mixes, low-fat or fat-free cottage cheese, or sour cream.
• Dairy products such as yogurt or ice cream that contain fillers or additives.
• Canned soups or soup mixes.
• Creamed vegetables.
• Products that contain modified food starch, food starch, hydrolyzed vegetable protein, stabilizers, or fat replacers or substitutes. (Examples of fat replacers include cellulose, gelatin, dextrins, gums, modified dietary fibers, whey protein, microparticulated egg white, and milk protein.) Check the label for these ingredients.
• Prepared or processed meats.
• Avoid beer, including ales and lagers, and malt vinegars, which are made from gluten-containing grains. Wine and most distilled alcoholic beverages are gluten-free.
• Flavored coffee, malted milk, or herbal tea with malted barley.

If you have celiac disease, work with your doctor and a registered dietitian who is knowledgeable about celiac disease. They can help you maintain a balanced diet while avoiding gluten.

Because damage to the small intestine can interfere with nutrient absorption, your doctor may recommend testing for deficiencies in nutrients such as iron, folate, vitamin B₁₂, and vitamins D and K, particularly when you are first diagnosed or if symptoms persist.

What happens if you have celiac disease and keep eating gluten?

Avoiding gluten is not easy. Gluten is common in foods such as bread, pasta, cookies, and cake.

Consuming anything containing wheat, barley, or rye, even in small amounts, can trigger a celiac flare-up. Research has shown that the maximum daily gluten consumption that seems to be safe for most people with celiac disease ranges from just 10 to 50 milligrams (mg) of gluten; a slice of wheat bread contains 2,000 mg of gluten.

Individuals with celiac disease should be aware of the risk of cross-contact. Cross-contact is when a gluten-free food or food product is exposed to a gluten-containing ingredient or food — making it unsafe for people with celiac disease to eat. Cross-contact can happen at home, in restaurants, and in other food service locations. Cross-contact can occur when the same appliances or cleaning supplies are used for both gluten-containing and gluten-free foods.

Cross-contact can also occur during the growing, processing, and manufacturing processes. You can contact a manufacturer to ask if they batch-test their product for gluten, if they know how their raw materials were sourced and produced, and what procedures they go through to prevent cross-contact in the factory.

What are good foods to eat if you have celiac disease?

If you have celiac disease, focus on foods you can enjoy that do not contain gluten. These include:

• fruits
• vegetables
• meat and poultry
• fish and seafood
• dairy products without fillers or additives
• beans
• legumes
• nuts
• chia
• corn
• flax
• millet
• potato
• quinoa
• rice
• soy
• tapioca
• wine.

Oats are naturally gluten-free but are often contaminated with gluten-containing grains during growing and processing. Choose oats labeled gluten-free. Most people with celiac disease tolerate gluten-free oats well, although a small number may react to the oat protein avenin.

What happens if celiac disease is left untreated?

It is important to adhere to a gluten-free diet if you have celiac disease. If left untreated, celiac disease can lead to severe malnutrition and can put you at risk of serious consequences, including osteoporosis, anemia, infertility, liver disease, neuropathy (damaged nerves), and, rarely, seizures.