Diagnosed With Celiac Disease? How (and Why) to Follow a Gluten-Free Diet

Help for sticking to a healthy gluten-free lifestyle
couple shopping for a glutten free product

If you’ve been diagnosed with celiac disease, your doctor likely informed you that you’ll need to follow a strict and life-long gluten-free diet. This means avoiding all foods that contain or have come in contact with wheat, barley or rye ingredients.

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Don’t panic! A gluten-free diet will definitely take some adjusting to, but it isn’t a sentence to a life without bread, pasta or other foods you love. Thanks to the many gluten-free products and recipes readily available today, it’s possible to follow a gluten-free diet and still enjoy many of your favorite foods. It just requires some extra effort and care.

You should be very careful to avoid gluten because, when you have celiac disease, ingesting even small amounts can trigger an autoimmune response in your body that can damage your intestinal lining. The damage can lead to a variety of symptoms that can affect your overall health, so it’s important that you understand how to follow a gluten-free diet.

Ready to get started? Registered dietitian Anna Taylor, MS, RDN, LD, serves up some tips on eating a celiac disease diet.

What to eat

First, know that all fruits, vegetables, legumes, nut and seeds, oils, meat, seafood, eggs, poultry and dairy products are free of gluten in their natural forms.

But, if these foods have been processed — and have had additives, flavors or other ingredients added to them — they may not be safe to eat. We’ll get into that in a bit.

Gluten-free grains

Most grains (except for wheat, barley and rye) are actually gluten-free. Grains and starches that are green-lighted on a celiac disease diet include:

  • Amaranth.
  • Arrowroot.
  • Buckwheat.
  • Corn.
  • Millet.
  • Potatoes (including sweet potatoes).
  • Quinoa.
  • Rice.
  • Sago flour.
  • Sorghum.
  • Tapioca.
  • Teff.
  • Wild rice.

A quick word about oats: They’re naturally gluten-free and are also a great source of vitamins, minerals and fiber that might otherwise be lacking in a gluten-free diet. However, they’re often grown, processed or stored near wheat or products that contain wheat. If you do purchase oats, look for a certified gluten-free label.

What to avoid

Gluten-containing grains

On a celiac disease diet, you’ll need to avoid these gluten-containing ingredients:

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  • Barley.
  • Barley malt/extract.
  • Bulgur.
  • Couscous.
  • Durum.
  • Einkorn.
  • Emmer.
  • Farina.
  • Faro.
  • Graham flour.
  • Kamut.
  • Matzo flour/meal.
  • Orzo.
  • Panko.
  • Rye.
  • Seitan.
  • Semolina.
  • Spelt.
  • Triticale.
  • Udon.
  • Wheat.
  • Wheat bran.
  • Wheat germ.
  • Wheat starch.

Questionable ingredients

When it comes to gluten, not all foods are so straight-forward. Some ingredients and foods may or may not contain gluten, depending on how they’ve been made. It’s best to avoid these products unless you can verify that they don’t contain gluten or aren’t derived from gluten-containing grains:

  • Brown rice syrup (can be made from barley).
  • Flour or cereal products.
  • Hydrolyzed vegetable protein (HVP), hydrolyzed plant protein (HPP), or textured vegetable protein (TVP).
  • Malt vinegar (distilled vinegar is OK).
  • Modified food starch.
  • Rice malt.
  • Seasonings or “natural flavors.”
  • Soy sauce or teriyaki sauce.

Gluten where you might not expect it

While many products advertise their gluten-free status on their packaging, you won’t see products that aren’t gluten free with labels that say, “Full of gluten!” You’ll have to get good at checking food labels carefully and scrutinizing every ingredient.

Be especially careful with products that might contain unexpected gluten, such as:

  • Breading.
  • Brewer’s yeast.
  • Broth/bouillon.
  • Brown rice syrup.
  • Communion wafers.
  • Croutons.
  • Salad dressings.
  • Drugs or over-the-counter medications.
  • Energy bars.
  • Herbal or nutritional supplements.
  • Ice cream or gelato.
  • Imitation bacon and seafood.
  • Licorice.
  • Marinades.
  • Medication or supplements (rarely; look for words like starch, pregelatinized starch or flour).
  • Playdough (wash your hands after using).
  • Processed meats (deli meats, salami, bologna, hot dogs, lunch meats).
  • Roux.
  • Sauces and gravies.
  • Thickeners.
  • Veggie burgers.

Shopping for (healthy) gluten-free foods

Most national and regional grocery chains stock gluten-free packaged and convenience foods. Sometimes they’re located in a special aisle or section, but often they’re on the shelf alongside other foods. If you have access to health food stores, these typically have a good variety of gluten-free items.

Any packaged product marketed as “gluten free,” “without gluten,” “free of gluten,” or “no gluten” must contain less than 20 parts per million of gluten — the lowest detectable level in foods — according to the Food and Drug Administration’s safety standards. However, it’s a good idea to get in the habit of checking every product’s ingredient list, regardless of the claims made on its packaging. (Beware of products marketed as “wheat free” – that’s not the same as gluten free!) And don’t be afraid to ask store managers or staff if a particular item is gluten free.

An important caveat when grocery shopping: Gluten free does not equal healthy.

Processed gluten-free foods like breads and sweets can still be high in fat, sugar and sodium, and low in fiber.

Follow these tips to make the healthiest choices at the grocery store:

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  • Shop mostly in the perimeter of the store for nutritious foods like fruits, vegetables, meat, fish, poultry and dairy products.
  • Choose packaged gluten-free foods that are made from whole grains like brown rice or quinoa instead of white rice or cornflour.
  • The first ingredient on the label will be the most abundant in the food, so make sure that it is a gluten-free whole grain.
  • If you make a gluten-free pizza or pasta dish, load it up with vegetables and lean protein.
  • Watch out for gluten-free frozen meals — like all frozen meals, they can be loaded with sodium.
  • Save the gluten-free snacks and desserts for special occasions.

Tips for dining out

The best way to avoid gluten when you’re eating out is to prepare ahead of time. Start by calling the restaurant you plan to visit to see if they are able to safely prepare your food without gluten and without risk of cross-contamination.

Then, check out the menu online and make a mental note of dishes that sound good to you.

When you get to the restaurant, tell your server that you can’t be exposed to gluten. It’s important to be firm. You might say: “I have celiac disease, so I can’t eat foods that contain or that have come in contact with wheat, barley, rye or oats (unless oats are certified gluten-free) or else I will get very sick.”

They may offer you a gluten-free menu, or suggest items that can be prepared gluten free. Don’t be afraid to ask questions. Even a little bit of gluten contamination could make you sick, so it’s best to be safe rather than sorry.

Here are some things to note when you’re selecting items from the menu:

  • Salads: Make sure your server knows that croutons cannot come in contact with your salad. Some salad dressings contain flour as a thickener, so ask your server about the ingredients.
  • Soups: They are often thickened with flour. Ask your server.
  • Meat: Opt for grilled meats instead of fried, and ask what the meat has been marinated in.
  • Meat substitutes: Veggie burgers and other meat substitutes are often made with fillers that contain gluten. Check with your server.
  • Fried foods: Avoid anything fried (such as French fries, onion rings or tortilla chips) unless the restaurant has a separate fryer dedicated to gluten-free foods.
  • Alcohol: Distilled alcoholic beverages (i.e. gin, rum, vodka) and wine are safe on a gluten-free diet. Most wine coolers, beers, ales and lagers — unless they’re specified as gluten-free — do contain gluten because they were fermented from gluten-containing grains.

Avoid dishes that have these words in their name or description, which suggest they contain wheat:

  • Au gratin.
  • Bechamel.
  • Cordon bleu.
  • Encrusted.
  • Farfel.
  • Fricassee.
  • Fritter.
  • Gnocchi.
  • Meuniere.
  • Pan gravy.
  • Raspings.
  • Roux.
  • Scallopini.
  • Soy or teriyaki sauce.
  • Tempura.
  • Veloute.

If you’re having trouble navigating a gluten-free diet, seek out a dietitian in your area who can help you identify healthy gluten-free foods, develop meal plans and make sure all your nutritional needs are being met.

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