MS, RD, LDN, CSSD, CBS
Rachel holds a Master’s in Nutrition Communication from Tufts University and is also a Board Certified Specialist in Sports Dietetics. She works as a nutrition and wellness coach with focuses on infant and maternal nutrition, and mindful eating.
One of the biggest food trends of the moment is a gluten-free diet. For most people, eating the gluten found in minimally processed grain-based foods can be part of a healthful diet. The emphasis here is on “minimally processed”: some people feel better avoiding grain-based products not because they are no longer ingesting gluten but because they’ve stopped eating refined grains. For those with Celiac Disease, eliminating gluten is essential to health, and for those who have a non-Celiac gluten sensitivity, avoiding gluten can be important for maximizing health. It is important to discover your needs rather than to simply go with the trend!
What is gluten anyway?
Gluten is a protein found in rye, barley, malt, some oats and the many forms of wheat including bulgur, couscous, durum, einkorn, farina, faro, graham, kamut, semolina, spelt, tabouli and triticale. Unless specifically marked gluten-free (and therefore made from gluten-free grains), foods that typically contain gluten include breads (loaves, pita, rolls, bagels, matzah, etc.), baked goods (cake, muffins, cookies, cupcakes, doughnuts, scones, etc.), pasta, crackers and beer.
In addition to the “obvious” sources of gluten like baked goods and bread-like products, gluten can also hide in processed foods as an additive to improve texture, taste and extend shelf life (think chicken broth, salad dressings, veggie burgers, soy sauce, seasonings, spices) and even in some medications.
While oats do not inherently contain gluten, they are often contaminated with wheat during processing. Certified gluten-free oats are well tolerated by most people with Celiac Disease and gluten-sensitivity, though they are problematic for a small portion of the population.
Celiac is an autoimmune disease where the ingestion of gluten can prevent the small intestine from properly absorbing key nutrients such as iron, calcium, and vitamin D. Roughly 1 out of every 133 Americans has Celiac Disease.
Symptoms among those with Celiac Disease vary greatly. Some people report no adverse reactions from eating gluten at all while others complain of bloating, abdominal pain, gas, diarrhea, fatigue, rashes, joint pain and general malaise. It’s important to know that with or without symptoms, gluten ingestion with a confirmed Celiac Disease diagnosis can result in long-term complications such as certain cancers, anemia, osteoporosis, infertility and short stature in children. Therefore, it is imperative that anyone with Celiac adhere strictly to a lifelong gluten-free diet.
A Celiac Disease diagnosis first requires a blood test and then confirmation from a biopsy of the small intestine. In order to be properly diagnosed, you must be eating gluten regularly in your diet at the time of the testing. For this reason, it’s never recommended to eliminate gluten (or other food substances) without first speaking with your healthcare provider.
Typically, once those with Celiac Disease are on a gluten-free diet, most are able to properly absorb nutrients again, but a multivitamin is often still recommended.
Gluten sensitivity or gluten intolerance
Some people who do not have Celiac Disease may still report adverse symptoms after eating gluten (like bloating, abdominal pain, gas, diarrhea, fatigue, rashes, joint pain, general malaise) due to non-Celiac gluten sensitivity or gluten intolerance.
Unlike Celiac, a blood test or biopsy cannot diagnose gluten sensitivity and it is important to rule out (or in) Celiac before participating in a gluten elimination test (because you need to be eating gluten to be tested). After results of Celiac testing are negative, a gluten elimination test would help determine if your symptoms are in fact in response to gluten exposure. The test involves eliminating and then reintroducing gluten to your diet. If your symptoms go away with gluten elimination and return with ingestion, then gluten sensitivity is suspected.
Because you will need to rule out Celiac Disease first, you and your healthcare provider can make a plan for the timing of an elimination test and a Happy Family Mama Mentor can then help you prepare for it.
When gluten-free food shopping
It is important to understand the difference between naturally gluten-free foods and gluten-free processed foods.
Whole foods like vegetables, fruit, nuts, seeds, beans, fish and certain whole grains like quinoa and brown rice are naturally gluten-free and are the best dietary staples for most people. For those with Celiac Disease or gluten sensitivity, it’s important to purchase such naturally gluten-free items like quinoa, brown rice and oats from gluten-free facilities (indicated on the label) to avoid contamination.
Gluten-free pastas (usually made from beans or rice) are available, as are gluten-free breads and baked goods. Keep in mind that many of these gluten-free processed foods are often higher in fat, sugar, and calories (in order to make up for changes in texture, shape and flavor), lower in B vitamins, iron (fewer gluten-free products are fortified than their gluten-containing counterparts), and much lower in fiber.
You may also notice that gluten-free processed foods are frequently more expensive. But you can find many well-tested recipes for homemade gluten-free crackers and breads online.
If you suspect Celiac Disease or gluten sensitivity, speak with your healthcare provider BEFORE eliminating gluten from your diet
Remember, Celiac can only be properly diagnosed when you’re regularly eating gluten. If you’re anxious to get started, speak with a Happy Family Mama Mentor about keeping a food and symptom journal. Don’t change your diet yet, rather write down what and when you eat and when you experience any bothersome symptoms. It helps to be as specific as possible.
A Happy Family Mama Mentor can also help you anticipate what to expect in the diagnostic and determination process.
If you’ve been diagnosed with Celiac Disease or gluten sensitivity, speak with a Happy Family Mama Mentor
A Happy Family Mama Mentor can help you identify acceptable and unacceptable foods, avoid cross-contact, read labels, and make sure that you are getting all of the nutrients you need despite a restricted diet.
While following a gluten-free diet, know which foods to avoid
You’re better off skipping the following:
And be aware that foods can become contaminated with gluten through cooking or handling, which can happen with shared pots, deep fryers, cutting boards and utensils.
Be your own detective, speak up and play it safe
Read food labels and look for the various forms of gluten-containing foods. When choosing gluten-free processed alternatives, make sure to check fat, sugar and calories to ensure that you’re making the healthiest choices.
Inform servers and hosts of your dietary restrictions. Don’t be shy to inquire about the various ingredients, cooking techniquesand steps taken to avoid gluten cross-contact. Many restaurants now have gluten-free menus so be sure to ask.
If you can’t get a clear answer or are unsure whether a food contains gluten, play it safe and opt for something else. It helps to always have a handy stash of nuts or other gluten-free food in your car, desk or bag to tide you over.
Emphasize naturally gluten free foods
Make fruits, vegetables, nuts, seeds, beans and whole grains like brown rice and quinoa, lean meats and poultry, low-mercury fish, and lower-fat unsweetened dairy or unsweetened dairy alternatives the focus of your diet.
Fill one quarter of your plate with gluten-free whole grains.
Gluten-free whole grains include amaranth, buckwheat, corn (flour/meal), millet, oats (certified gluten-free only), quinoa, brown and wild rice, teff, and sorghum.
Sweet potatoes, squash, corn and peas, are naturally gluten-free, starchy vegetables so enjoy them but be sure to eat plenty of non-starchy vegetables as well.
Speak with your pharmacist to ensure that your medications and supplements do not contain gluten
If you are pregnant, trying to get pregnant, or breastfeeding, make sure you are taking your prenatal or postnatal supplements daily.
Celiac Disease. National Institute of Diabetes and Digestive and Kidney Diseases. Date accessed 16 July 2018.
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