Celiac Disease: Gluten-Free Diet

What Is The Difference Between Celiac Disease and A Wheat Allergy?

When you have celiac disease and you eat food with gluten in it, the gluten triggers an immune response that damages your small intestine.

A wheat allergy means your immune system reacts to the proteins in wheat (and not necessarily gluten). However, unlike celiac disease, a wheat allergy does not lead to damage of the intestine but it can cause other uncomfortable and harmful reactions.

Important Nutrients and Foods For A Gluten-Free Diet

Gluten is a type of protein that is found in certain grains. When following a gluten-free diet, avoid grains containing gluten such as:

Barley
Rye
Triticale
Wheat (including coucous, bulgur, spelt and kamut)

Foods that contain these grains must also be avoided such as breads and other baked products, crackers, cereals, pastas, soups, sauces (e.g. soy sauce), seasonings, malt vinegar, salad dressings, cookies, cakes, prepared meats (e.g. deli meats, hot dogs, hamburger patties, imitation seafood), beer (derived from barley), flavoured coffees and teas, some candies (e.g. licorice) and chocolate bars, as well as some nutrition supplements and medications.

Eat a diet rich in:

Iron

Consume iron-rich gluten-free foods to prevent iron deficiency
Good sources of iron include meat, fish, poultry, many gluten-free flours, cereals and starches (e.g. amaranth, millet, quinoa, rice bran and teff), nuts, seeds, dried peas, chickpeas, lentils and kidney beans, dried fruits and blackstrap molasses

Calcium and Vitamin D

Consume adequate amounts of calcium and vitamin D to prevent osteopenia and osteoporosis, which are common in people with celiac disease
Good sources of calcium include dairy products such as milk, cheese and yogurt
Good sources of vitamin D include vitamin D-fortified products, egg yolks and fatty fish like salmon, mackerel, tuna, and sardines

Fibre

Consume fibre-rich gluten-free products
Good sources of fibre include fruits, vegetables, nuts, seeds, pulses (dried peas, chickpeas, lentils and kidney beans) and their flours, amaranth, flax seed, mesquite flour, oats (pure, uncontaminated), quinoa, rice bran, rice (brown and wild) and teff
Gradually increase fibre and increase the consumption of fluids, especially water, as you increase fibre intake

Food Choices for Gluten-Free Eating

Examples of foods that can be safely included in a gluten-free diet:

All fresh vegetables and fruit
Milk, cheese and yogurt
Fresh meat, poultry and fish (avoid any that have been breaded or marinated)
Legumes such as chickpeas, lentils and kidney beans, dried peas
Eggs
Soy beverages, tofu
Nuts and seeds
Oil, butter and margarine
Distilled alcoholic beverages

Starches and cereals that can be safely included in a gluten-free diet:

Buckwheat
Corn
Flax
Pulse flours (soy, chickpea, lentil, fava, etc.)
Millet
Potato
Pure oats
Quinoa
Rice
Sorghum

These foods can be made into pasta, bread and a variety of baked goods, which are available at many grocery stores. Foods that can safely be part of a gluten-free diet may contain gluten once they are used to make other food items. For example, beans are no longer gluten free when wheat is used in a baked beans recipe.

It is safe for most adults with celiac disease to have up to 3/4 cup (175 mL) a day of pure oats (measured dry). However, it is important to only use pure, uncontaminated oats. Since most oats sold in North America are processed near or with grains that contain gluten, oats are not considered gluten-free unless it is specified.

Watch out for hidden sources of gluten found in:

Beer
Broth, soup, soup bases
Candies (e.g. licorice), chocolates, chocolate bars (especially ones with wafers)
Flavoured coffee and tea
Hydrolyzed plant protein and/or hydrolyzed vegetable protein – if the source is not mentioned or from a wheat source
Imitation seafoods
Modified food starch – if the source is not identified
Deli meats, sausages, hot dogs
Seasonings
Sauces (like soy or teriyaki), gravy, marinades
Some medications (check with your pharmacist)

Understanding Nutrition Labelling

Canadian guidelines require that gluten-containing products are clearly labelled. Regulations require that gluten sources be identified using plain language either in the ingredient list or in a ‘contains’ statement (e.g. “contains: wheat/gluten”) that appears immediately after the ingredient list. If you are unsure about an ingredient, call the company and ask questions.

When reading a food label, consider the following:

% Daily Value (% DV): classifies nutrients on a scale from 0% to 100% and tells you if there is a little (5% DV or less) or a lot of a nutrient (15% DV or more) in one serving of a packaged food. You can also use this percentage to compare the nutrient content of different foods.

Choose products with higher % DV of fibre, iron, calcium and vitamin D.

Start with reading the warnings.

If wheat, rye, barley, oats or gluten appear in either the ‘contains’ or ‘may contain list’, avoid the product.
If there is a ‘contains’ statement, and it does not include wheat or a gluten grain, the ingredients are acceptable.
If there is no ‘contains’ statement, check the ingredient list. If you see wheat, rye, barley, or oats, avoid the product. If you do not see any gluten source listed, the ingredients are acceptable.
If one allergen is listed in a ‘contains’ statement, then all the allergens including gluten must be listed.
If the ingredient list just says oats, assume they are contaminated with gluten, unless they are specifically identified as pure uncontaminated oats.

The only warnings that have official meanings are ‘contains’ and ‘may contain’. All other warnings (e.g. “made in a plant that also processes wheat”) can only be understood by contacting the company.

Grocery Shopping Tips

Read food labels every time you shop. Ingredients can change without notice, even on foods that you have bought before.
Look for gluten-free products that are enriched with vitamins, minerals and dietary fibre.
Choose nutritious ingredients such as amaranth, brown rice flour, buckwheat, flax, nut flours, quinoa, pulse flours (chick pea, yellow or green pea, bean) and teff.
Since gluten-free packaged products tend to be higher in sugar and fat, compare products and select ones with lower contents of each of these nutrients.
Buy chickpeas, kidney beans and lentils for soups, salads and casseroles to increase fibre.

Gluten-Free Substitutions

Make your own gluten-free versions of your favourite foods using well-tested recipes. Try using the following mixtures in recipes to replace wheat flour.

Gluten-free flour recipe options:

Use this mixture to replace 1 cup of wheat flour:

½ cup (125 mL) sorghum flour
½ cup (125 mL) bean flour
2 tbsp (30 mL) tapioca starch

1 cup of this mixture can replace 1 cup of wheat flour:

4 cups (1000 mL) white rice flour
1 1/3 cup (325 mL) potato starch
1 cup (250 mL) tapioca flour

The information in this resource is for general information purposes only and is not intended to replace informed medical advice. Consume foods according to any dietary guidelines you have been provided from a health care professional. Metro Ontario Pharmacies Limited assumes no legal liability for the accuracy, completeness or usefulness of the information.