By Felicia Newell

May is National Celiac Awareness Month! Before we dive into the specifics a gluten-free diet, it’s important to cover some stats on celiac disease and why it is so important for those with the disease to follow a gluten-free diet.

Did you know celiac disease is now recognized as one of the most common chronic diseases in the world? It is estimated that it affects as many as 1 in every 100 – 200 people in North America. As many as 300,000 Canadians⁽¹⁾ and at least 3 million Americans⁽²⁾ are affected by the disease; however, many remain undiagnosed. In fact, as many as 99% of people with Celiac disease are undiagnosed!⁽³⁾. If you’re unsure if you have Celiac… listen to your gut (pun intended). It is important to advocate for yourself and get tested.

Celiac disease is a genetic autoimmune disease. Symptoms are triggered by ‘gluten’, which is a protein found in wheat (including spelt and kamut), barley, rye, and triticale (a cross between wheat and rye). For those with celiac disease, the body’s immune system responds to gluten in a different way than those who do not have the disease. Consuming gluten results in inflammation and damage to the lining of the small intestine, which reduces the ability to absorb iron, calcium, vitamins A, D, E, K, and folate⁽¹⁾.

For those with Celiac, delays in getting diagnosed and not following a strict gluten-free diet can result in chronic poor health, anemia (when the amount of healthy red blood cells in the body is too low), a higher risk of infertility in both males and females, miscarriages, osteoporosis, and certain cancers of the gastrointestinal tract⁽¹⁾. For these reasons, early diagnosis and again sticking to a strict gluten-free diet is extremely important. Sometimes individuals with Celiac can consume small amounts of gluten without any symptoms (known as ‘silent symptoms’), but damage can still be occurring to the intestinal tract that can lead to negative health consequences.

Those with Celiac really used to struggle finding products they could consume. However, now that there are more and more people emerging who have a sensitivity or intolerance to gluten (Nonspecific Celiac Sensitivity; a different reaction to gluten and not as serious), and some even avoiding it for ‘trendy’ reasons (weight loss, perceived health benefits), the good thing is that it’s becoming easier to follow a gluten-free diet (due to increasing demand for affordable gluten-free products). There are also more and more resources out there for those with Celiac disease. Be mindful of the source of information though, as we all know misinformation and alternative facts can be shared easily online. Some of the top sources to get information on for Celiac disease are celiac related not-for-profit organizations such as the Canadian Celiac Association, the Celiac Support Association, and the Celiac Disease Foundation.

Now that the informative yet important stuff is out of the way, we can get on to the good stuff – what is a gluten-free diet?!

Below are examples of gluten-containing items that should be avoided⁽⁴⁾:
• Bulgur
• Couscous
• Freekeh
• Wheat Bran
• Wheat Flour (wheat breads, pastas, crackers, etc.)
• Wheat Germ
• Wheat Gluten
• Wheat-Based Semolina
• Seitan
• Orzo
• Udon
• Barley Malt
• Barley Malt Extract/Barley Malt Syrup
• Barley Malt Flavoring
• Malt Vinegar
• Brewer’s Yeast
• Beer made from barley, wheat or rye

The tricky thing is that many times the above gluten-containing foods could be added to other common foods, such as:
• Broths, Bouillons, Soups
• Sauces
• Soy Sauce
• Marinades
• Salad Dressings
• Gravy
• Prepared Meats (e.g., burgers, hot dogs, sausages)
• Meat Substitutes (e.g., vegetarian burgers, sausages)
• Imitation Crab or Lobster
• Snack Foods
• Candy (e.g., licorice, chocolates, chocolate bars)
• Flavored Coffees and Teas

This is why label-reading is very important, for information on checking the ingredients list Visit Here.

What about oats?

Way back yonder, it was thought that oats also caused intestinal damage to those with Celiac disease. However the main reason that some people react to oats is that they are commonly contaminated with gluten-containing grains during processing and production. Therefore, consumption of regular oats is not safe for individuals with Celiac. There are a few companies that produce pure, uncontaminated gluten-free oats, but it varies (even oats that state ‘gluten-free’ unfortunately may not be truly gluten-free). Only oats manufactured with the ‘Purity Protocol’ are recommended, which are grown and processed completely separate and there’s no risk for cross-contamination. For oats in US and Canada that follow the Purity Protocol, Visit Here. For more information on the safety of gluten-free oats, Visit Here.

So… what the heck can I eat on a gluten-free diet?

Gluten-free Food Choices Include:

Milk and Alternatives
• Cheese
• Milk or milk alternative (almond, soy, rice, etc.)
• Plain yogurt (read labels for flavoured)
• Frozen yogurt (check label)

Grains
• Almond, buckwheat (check label, sometimes buckwheat is mixed with wheat), corn, coconut, brown rice, or almond flours and pastas
• Corn, buckwheat or brown rice tortillas
• Rice and corn cereals
• Rice or rice mixes (check label for seasoned packaged mixes)
• Quinoa
• Millet
• Popcorn
• Plain corn tortilla chips
• Plain rice or corn cakes or crackers (check label)
• ‘Purity Protocol’ gluten-free oats (see link above)

Meat and Alternatives
• Fresh unseasoned beef, chicken, turkey, fish
• Unseasoned canned tuna
• Plain pulses (beans, chickpeas, lentils, legumes) (check label, sometimes dried beans and lentils have wheat grains in them)
• Dry roasted nuts or seeds
• Gluten-free deli meats (check label)
• Nutritional yeast
• Unseasoned tofu
• Meat substitutes such as veggie burgers and TVP (read labels)

Any unseasoned fresh or frozen fruits and vegetables

Others
• Any certified gluten-free food item
• Applesauce
• Vinegar (red, white, apple cider, balsamic)
• Plain herbs and spices, and gluten-free spice mixtures
• Sweeteners: sugar, honey, maple syrup, etc.
• Baking soda/baking powder
• Xanthan gum/arrowroot starch
(be sure to check the ingredients list on packaged foods so that they don’t include the above gluten-containing items)

When in doubt, go for naturally gluten-free foods, choose foods that are ‘certified gluten-free’, and reach out to the resources mentioned above if you need further guidance. If you have been diagnosed with Celiac disease, it is also important to get a referral to see a dietitian who specializes in the disease. To find dietitian in your area, you can visit www.dietitians.ca/find in Canada, and for those in the US, http://www.eatright.org/find-an-expert.

(1) Health Canada. Celiac Disease – The Gluten Connection (2008). Available from: http://www.hc-sc.gc.ca/fn-an/pubs/securit/gluten_conn-lien_gluten-eng.php
(2) University of Chicago Celiac Disease Center. Celiac Disease Facts and Figures (2005). Available from: http://www.uchospitals.edu/pdf/uch_007937.pdf
(3) Canadian Celiac Association (Homepage). Available at: www.celiac.ca
(4) Shelley Case RD, North America’s Gluten Free Expert – What Items Contain Gluten? Available from: https://shelleycase.com/items-contain-gluten/