Ideally, the home of a person with celiac disease should be 100% gluten free and a safe space to eat food but this is not always feasible if there are other people in the house. Pots, pans, dishes, and utensils have to be thoroughly cleaned with soap and water to eliminate all traces of gluten. Gluten can be removed with just soap and water but the cleaning has to be done well. Tables, counters, and any area where food may be placed should also be cleaned thoroughly. Some kitchen appliances will be impossible to clean such as a toaster or bread maker and will need to be replaced completely. Also, any food in the pantry that contains gluten should be discarded. If you cannot have a 100% gluten free home, then the compromise is to have separate gluten free pots and pans, appliances, food storage, plates, and utensils. This arrangement is possible but it definitely requires more work and diligence. Your family and roommates need to commit to help keep the person with celiac disease healthy.

At first, eating gluten free seems like there are very limited options, but in reality, there are numerous naturally gluten free foods that can be eaten and enjoyed. Naturally gluten free foods include all fresh fruits and vegetables, meat, cheese, dairy, eggs, nuts, seeds, corn, rice, and potatoes. A gluten free diet does NOT mean one has to only buy food in the gluten free aisle of the store. If you prepare your own food with fresh, healthy ingredients, there is no limit to the types of food that can be made gluten free.

Most grocery stores have an aisle called “gluten free foods.” These foods are alternatives or substitutes to common foods that normally contain wheat flour. Some of these substitute options taste great and one cannot easily distinguish the difference between the gluten free food and the original food that contained gluten. For example, gluten free pasta that is covered in gluten free sauce (spaghetti or lasagna) tastes great. However, some of the substitutes do not taste quite the same, such as bread, and may take time to adjust to their taste.

For the newly diagnosed celiac patient, we strongly recommend you create a list of naturally gluten foods that you already like and prepare your own gluten free food when you start this journey instead of purchasing a large number of substitute foods from the gluten free aisle. This will make the transition easier. Remember, naturally gluten-free foods include all fresh fruits and vegetables, seafood, all types of meat, milk, butter, yogurt, most cheeses, eggs, nuts, seeds, beans, corn, rice, quinoa, potatoes, other flours (buckwheat, coconut, millet, gluten free oats, tapioca, teff), vinegar, wine, and distilled alcoholic beverages. For a more specific list of gluten free foods, click here.

At this point, you might be thinking ‘What about my junk food?!’.

As a physician, I would strongly encourage you to start your gluten free journey with a strong commitment to eating healthy and clean, BUT, we are only human and sometimes we crave junk food. If you have a craving for your favorite chips, just read the label. Most corn and potato chips are safe to eat. Most chip dips or salsa are safe. Most candy is safe, but read the labels to be sure or search the internet if the label is not helpful.

Fortunately, most beverages are naturally gluten free. Some examples of safe, gluten drinks include water (tap water, bottled, and sparkling), juice (orange, apple, grape), milk, coffee, tea, soft drinks, lemonade, sports drinks, energy drinks, and some alcoholic beverages (wine, liquors)

Beverages to avoid on a gluten free diet include beer, ales, lagers, and malt beverages including wine coolers.

The first time you go to the grocery store to buy gluten food will be the hardest. Every trip after that gets easier and easier because you learn what is safe and what is not safe to eat.

In many grocery stores, the food is separated into sections. Interestingly, the healthier food like fruits, vegetables, meat, and dairy are usually on the periphery lining the walls. The less healthy, processed food such as junk food is in the middle part of the store and creates the bulk of the store aisles. So, once you have bought naturally, healthy gluten free food from the periphery of the store, then it is time to explore the aisles of processed and prepared food in the middle of the store. This requires careful reading of the labels to find out if the food is safe It is crucial to carefully read the nutritional information on pre-packaged foods because it often has hidden gluten. Some food will be labeled “gluten free” or certified GF (gluten free). In the United States, the Food and Drug Administration (FDA), requires that food labeled gluten free adhere to strict guidelines so that it is truly gluten free. For processed foods that are not labeled gluten free, one needs carefully read the list of ingredients to determine if the food is gluten free or not. Foods that contain hidden gluten will list ingredients such as rye, wheat, barley, malt, soy sauce, brewer’s yeast, oats, yeast extract, and autolyzed yeast extract.

Oats should be ok to eat, but they have to state they are prepared in a gluten free facility. It turns out that most oats or oatmeal are harvested and processed with the same equipment that harvests and processes wheat. Also, many fields of oats sometimes will have a stray wheat plant mixed in. So, if you like oatmeal, choose a ‘gluten free’ oatmeal like Bob’s Red Mill that processes the oats in a safe manner. I personally think they taste better anyway! If you have questions about an ingredient, a quick internet search on your phone for that food or ingredient can usually answer whether it is gluten free or not. Some examples of foods that hide gluten in their ingredients include soy sauce, sausage or processed meats, oatmeal, candies (licorice, some chewing gums, Twizzlers), canned soups, some oats, packaged seasonings, gravy, soup stock cubes, veggie burgers, instant coffee, some alcoholic beverages such as beer, meatballs, and meatloaf.

This is not a complete list of foods that could contain gluten. It is very important that you read all labels and search the internet if in doubt. Also, in many of the above examples, it is possible to find gluten free versions (GF soy sauce, GF canned soup, etc) but you have to carefully read labels.

The hardest part of following a strict gluten free diet for a celiac patient is not selecting gluten free food, but it is avoiding cross-contamination. Cross-contamination occurs when a food that should be gluten free has a small exposure to gluten. For example, some fast-food restaurants offer gluten free bread as an option for sandwiches. However, if the restaurant worker uses the same gloves that prepared a sandwich with normal gluten containing bread and then prepares a sandwich with gluten free bread, then the gluten free bread picks up small crumbs of gluten which can cause symptoms. This is cross-contamination. It can easily occur at restaurants where both gluten and gluten free food are served. Additional examples of cross-contamination include:

• Use of a common toaster in a restaurant

• Use of a common utensil such as a spoon that stirs gluten free soup with soup that contains gluten such as noodles

• Use of a common fryer in which gluten free corn tortilla chips and gluten-containing fried foods are found

• Use a common pot of boiling water for gluten free pasta and regular pasta

• Use of a common kitchen prep area where gluten and gluten free items are prepared.

• Use of a common pan, such as a Wok, that prepares both gluten free and gluten containing food

For a celiac patient, eating at a restaurant can be a daunting task and requires careful but polite questions with the server, or manager to ensure there are no cross-contamination issues. It is helpful if one can call ahead when the kitchen is not busy. It is equally important to always be polite with your questions.

Ideally, a celiac-friendly restaurant will have a dedicated kitchen space for the preparation of gluten free food and food prep protocols in place such as changing gloves to prevent cross-contamination. Unfortunately, most restaurants are not aware of cross-contamination and are unable to comply with the needs of celiac patients. With time, we are hopeful that with education and market forces, restaurants will develop these protocols to prevent cross-contamination. In the meantime, even though it is uncomfortable, ask the waiter or manager how the food is prepared to prevent inadvertent gluten exposure.

One difficult situation for the celiac patient is eating at someone else’s house. The same issues of cross-contamination can occur with food preparation. Even with the best intentions, food can easily get cross-contaminated with inadvertent gluten exposure. Careful but polite questioning of the host is the best approach to avoid cross-contamination. People with celiac disease are often pressured into eating food at a party with the naïve promise that they promise there is no gluten in the food. It is still helpful in this circumstance to ask careful questions. Because cross-contamination can be subtle and difficult for people to understand, I recommend you be prepared by bringing your own food or having a backup for food in case the food is contaminated. In some circumstances, eating ahead of time will allow the person with celiac disease to enjoy social visits without getting sick.

Worship services can also be difficult circumstances since communion in the Christian tradition uses wheat flour bread for the Host. I recommend you speak with your minister or priest about your circumstances with celiac disease. For Protestant Christians, the substitution of a rice cracker can be used. For Catholic celiac patients, I recommend you discuss this issue with your priest about the best options.

Another tricky situation is when the labels state that the food was processed in a facility that processes wheat and may contain trace amounts of wheat. In general, I recommend you avoid foods with that warning because eating them will be like grocery Russian roulette. Sometimes you eat it with no reaction and at other random times, it causes a flare.

Some folks with celiac disease have relatively mild symptoms and may choose to ignore the dietary restrictions. I don’t recommend this approach! A gluten free diet is still recommended in people who have celiac disease with mild symptoms because they can develop vitamin deficiencies such as vitamin D and mineral deficiencies such as iron. People with celiac disease have an increased overall risk of death and increased risk of cancer.