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Girls' VersionThe Gluten-Free Diet
 Children's Hospital Boston Celiac Disease Support Group
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You may have heard about the gluten free diet on TV or read about it in a magazine or newspaper. Unlike fad diets, the gluten–free is not another weight loss plan. The gluten–free diet is a diet recommended by a health care provider for people who have been diagnosed with celiac disease, an autoimmune disorder that’s triggered by gluten. To heal the body, a gluten–free diet must be followed. Following a gluten–free diet can seem overwhelming at first, but it's really not as hard as it might seem. Once you lean which foods to avoid and which foods you can eat comfortably, you'll feel much better.
What is Gluten?
Gluten is a protein complex found in the grains wheat, barley, rye, spelt, and triticale. Flours made from these grains are commonly used to make foods such as breads, cereals, pasta, pizza, and baked goods. The gluten in these foods gives them the elastic texture and it helps provides the structure of the food.
Why would someone need to follow a gluten–free diet?
Anyone with celiac disease should follow a gluten–free diet.
What is Celiac Disease?
Celiac disease is an autoimmune disorder that is triggered when gluten–containing foods are eaten. An autoimmune disorder is one in which the body’s immune system attacks an organ. When a person with celiac disease eats a food with gluten in it, the immune system launches an attack against the small intestine which damages the lining of the intestine. Noticeable symptoms of celiac disease are diarrhea, abdominal (stomach) pain, weight loss, nutritional deficiencies, anemia, poor appetite, irregular periods, delayed growth, and delayed onset of puberty. Some teens will have almost no noticeable symptoms, but their health care provider may detect low bone density.
Gluten is toxic for someone with celiac disease. Following a gluten–free diet heals your small intestine, and usually stops your symptoms of celiac disease.
What foods do I avoid on the gluten–free diet?
Foods that contain gluten are “red–light foods” for anyone with celiac disease. Following a gluten–free diet means you should:
- Remove grains that contain gluten from your diet. You shouldn't eat any food that contains wheat, barley, rye, or oats. Keep in mind that wheat has many forms. Avoid products that include bulgur, durum, graham, kumut, spelt, and semolina. These are all forms of wheat!
- Avoid all obvious sources of gluten such as bagels, breads, beer, cakes, candy, cereals, crackers, cookies, dressing, flour tortillas, gravy, ice cream cones, licorice, malts, rolls, pretzels, pasta, pizza, pancakes, sauces, stuffing, soy sauce, veggie burgers, vegetarian bacon/vegetarian chicken patties (many vegetarian meat substitute products contain gluten) and waffles. Please note this is NOT a complete list.
- Look for “hidden” sources of gluten. Avoid foods that have gluten–containing ingredients listed such as ale, barley, beer, bleached flour, bran, bread flour, brewer's yeast, brown flour, brown rice syrup, bulgur, couscous, dextrin (unless the source gluten-free), durum, farina, farro, hydrolyzed vegetable (wheat) protein, gluten flour, graham flour, granary flour, groats, harina, kumut, malt, malt extract, malt syrup, malt vinegar, matzo, modified starch (unless the source is gluten-free), rye, orzo, semolina, self–rising flour, spelt, smoke flavoring, soy sauce, wheat germ, wheat and white flour, whole meal flour, and vegetable gum.
What’s up with barley?
Barley contains gluten and frequently is used to make malt. This is often used as a sweetener flavoring. As a general rule you should avoid natural or malt flavorings. If a food has “natural” or “malt” flavorings listed on the ingredient list, contact the company because it’s possible these flavorings came from a non–gluten source.
Do I need to avoid oats?
Oats may contain gluten. It's best to check with your health care provider to see if you can eat oats. While you are new to the gluten-free diet and still healing, it's best to avoid oats. Oats are often processed in the same factories as wheat, and therefore not always gluten–free. To find out if your favorite brand of oatmeal is gluten–free, call the company or check their website. When eating out or when in doubt, avoid oats.
What foods are safe to enjoy on the gluten–free diet?
Many foods are naturally gluten–free, including milk, butter, cheese, fruits and vegetables, fresh meats, fish, poultry, eggs, beans, nuts, seeds, corn and rice. While most breads, pastas, cereals and baked goods contain gluten, there are many grains and flours that are also naturally gluten–free which can be used to make breads, cereals, pastas, snacks and baked goods. Think of these grains and their products as “green–light foods” which are safe to eat on the gluten–free diet.
“Green–light foods” include:
Amaranth |
Ragi Potato |
Arrowroot |
Rape |
Bean Flours (romano) |
Pea/lentil Flour |
Brown Rice Flour |
Potato Flour |
Buckwheat |
Potato Starch |
Carob Flour |
Quinoa, Quinoa Flakes |
Corn (Maize), Corn Flour |
Rice bran |
Corn Meal |
Rice (brown, white, wild) |
Cornstarch |
Sago Flour |
Kasha |
Sorghum, (Casava Flour) |
Kudzu Root Starch |
Tapioca Flour |
Millet Masa Flour |
Tarrow Root |
Montina Flour Millet |
Teff Flour |
Nut Flour (almond, pecan) |
Teff, Teff Flour |
Potato, Potato Flour |
Yam/Sweet Potato Flour |
How can I tell if a food is gluten–free?
A product stamped with the Certified GF Gluten–Free label is the fastest and easiest way to spot a gluten–free product. Manufactures can add this label if they comply with the FDA rule of “gluten–free”.
Another way to tell if the product contains gluten is to read the allergen statement on packaged foods. The FDA food allergen labeling law requires food companies to label all foods that have wheat or contain wheat products. The allergen statement is found at the end of the ingredient list on packaged goods. Read the allergen statement, if it says “contains wheat”, it's a “red-light food”.
The food labeling law does NOT cover barley, rye, or oats. This means if the allergy statement does not include wheat, you should then read through the ingredient list for all of the other sources of gluten described above. If you don't see any of those words in the ingredient list, then the food is most likely a “green-light food”.
Reading food labels is very important because ingredients can change without notice, and often without a noticeable difference in the packaging. If you want to make sure the food is gluten-free, call the company or look on their website.
In the sample ingredient label below, the ingredients are circled in red and the allergy statement is circled in blue. The food, which contains whole grain wheat, is a “red-light food”.
What are other possible sources of gluten?
Gluten is added to more than just food. Remember to check products such as toothpaste, mouthwash, lipstick/gloss, stamps/envelope glues supplements, vitamins, and both prescription and over the counter medications. These are frequently overlooked sources of gluten.
How can I still eat my favorite foods?
Eating and baking gluten–free has become so much easier as more companies now make gluten–free foods. You can now buy gluten–free breads, rolls, pizza–crusts, buns, bagels, donuts, cookies, muffins, pretzels, cereals, and desserts. You and your family can also substitute gluten-free grains and flours in your favorite recipes. The following brands have a great selection of gluten–free foods which you can buy directly from their websites from many grocery stores:
| Glutino® | |
| LaraBar® | |
| Bumble Bar® | Lundberg Farms® |
| Pamela’s Products® | |
How do I shop for gluten–free foods at the grocery store?
Many grocery chains carry the gluten-free brands mentioned above. These products are commonly found in the aisles that contain natural and organic foods. It's also important to remember that most of the fresh foods found along the perimeter of the store (outside aisles) including fruits, vegetables, meat, poultry, fish, and dairy are naturally gluten-free. Rice, beans, peanut butter, nuts, cooking oils, and corn and rice cereals are also typically gluten-free.
Watch for possible gluten cross-contamination. This means foods that have gluten in them come in contact with gluten-free foods. Be aware of gluten cross-contamination at deli's, buffets, and salad bars.
What does a Gluten–Free Grocery List look like?
| Dairy |
 Milk |
| Cheese |
| Plain Yogurt |
| Fruit |
| Apples |
| Bananas |
| Mangoes |
| Oranges |
| Strawberries |
| Vegetables |
| Plain fresh or frozen vegetables (without any added sauces or breaded toppings) |
| Grains: Cereals, Flours, and Grains |
| Brown Rice |
| Mesa Sunrise® Cereal |
| Rice Chex® Cereal |
| Quinoa flakes (very similar to oatmeal) |
| Kinnikinnick® Bread |
| Vans® GF Waffles |
| Proteins: Meats, Poultry, Fish, and More |
| Amy’s Kitchen® (frozen entrees, soups/chili) |
| Bell and Evans® GF Chicken Nuggets |
| Beans: black beans, chickpeas, northern beans |
| Boar’s Head® Luncheon Meats |
| Canned Tuna |
| Ground 100% Beef |
| Fresh or frozen poultry |
| Plain tofu |
| Whole fresh Eggs |
| Snacks and Desserts |
| Bumble® Bars |
| Corn Tortilla Chips |
| Crunchmaster® crackers |
| Envirokidz® Rice Bars |
| Fritos® Original |
| Lays® Classic Potato Chips |
| Mary’s Gone Crackers® |
| Nuts: Plain almonds, walnuts, soy nuts |
| Popcorn |
| Condiments and Seasonings |
| Salsa |
| Peanut Butter (Note: reduced–fat may contain gluten) |
| Jelly |
| Ketchup |
| Pancake Syrup |
| Hummus |
How can I stay gluten–free while eating away from home?
The best way to stay gluten-free when away from home is by planning meals and snacks ahead of time. That may sound hard, but following these tips can make it easier:
- Eat breakfast at home or pack a gluten-free breakfast to eat at school or on-the-go.
- Work with your parents, nutritionist, or school nurse to find gluten-free foods on the school breakfast and lunch menus.
- Pack your lunch in an insulated bag to eat at school or on-the-go.
- Keep gluten-free snacks such as trail mix, snack bars, popcorn or nuts in your backpack for times when you need a quick snack.
- Check out the The Gluten Intolerance Group's (GIG) list of 50 fast GF foods AND easy gluten-free snacks.
Eating at a restaurant
If you're planning on eating at a restaurant, go to one that has a gluten-free menu or talk with the restaurant manager to find gluten-free menu items before ordering. Remember to tell the manager or chef that both the meal AND its preparation must be gluten-free. More and more restaurants are becoming gluten-free friendly and making it known with this label. The GF plate label seen at restaurants shows you that they are registered to use safe practices to prepare your food.
The following restaurants offer a variety of gluten–free choices. There are many privately owned restaurants that also offer gluten–free menu choices. Don’t be limited to this short list; there are always to modify and work with restaurants to make many meals gluten–free.
| Applebee’s | Go Healthy Cafè |
| Bertucci’s | L’annam Vietnamese Cuisine |
| Big Fish Grill | Legal Sea Foods |
| Burtons Grill | Maggiano’s Little Italy |
| Boulder Creek Dining Company | Mama Fu’s Asian House |
| Burger King (hamburger patty 100% beef) | McDonalds (hamburger patty 100% beef) |
| Carrabba’s Italian Grill | The Melting Pot |
| Charbonas | Nizza |
| Cheeseburger in Paradise | Outback Steakhouse |
| Dairy Queen | PF Chang’s China Bistro |
| Garlic Jim’s Famous Gourmet Pizza | Pizzeria Uno (certain locations) |
| The Grill on the Alley | Posana Cafè; |
| Gold Wok Cafè | Soul Dog |
| Goode Co. Texas Bar BQ | Wendy’s |
What does a typical day on the gluten–free diet look like?
| Breakfast |
| Scrambled eggs |
| Gluten-free toast with butter or margarine |
| 1 piece of fresh fruit |
| Apple or orange juice |
| Lunch |
| 100% beef hamburger without a bun |
| Plain yogurt with added nuts and driet fruit or GF granola |
| Grapes |
| 1% or skim milk |
| After-school Snack |
| String cheese |
| Microwave popcorn |
| Water |
| Dinner |
| 100% beef tacos with shredded cheese, lettuce, and salsa on GF corn tortillas |
| Corn nibblets |
| 1% or skim milk |
| Dessert |
| Sorbet or GF cookie |
If you have family members who don't follow a gluten-free diet, take the following steps to prevent gluten cross-contamination:
- Clean all cooking and eating utensils (silverware, cutting boards, and anything that touches food) before using them.
- Keep separate containers of jelly, butter/margarine, peanut butter and all other spreads and label them as “gluten-free”.
- Use a separate toaster for gluten-free foods (if possible).
Where can I find gluten–free recipes?
The best resources for gluten-free recipes are the internet and gluten–free cookbooks. The GI department at Children’s Hospital Boston is a wonderful resource for families, and has great recipes as well as cookbook suggestions.
Should I take a vitamin or supplement?
Talk with your health care provider or nutritionist about vitamin and mineral supplements. Some people who follow a gluten-free diet may not get enough of certain nutrients, vitamins, and minerals in their diet such as fiber, iron, and calcium. It's important to meet with a nutritionist to develop a healthy, balanced diet and to find out if you need to take any vitamin or mineral supplements.
The following gluten–free recipes are from the Center for Young Women’s Health “Quick and Easy Recipes for Teens” cookbook:
Banana Nut Smoothie
Ingredients:
- 2 ripe bananas, peeled
- 2 cups pineapple juice
- 2 tablespoons creamy peanut butter
- 2 tablespoons low-fat plain yogurt
- 2 teaspoons vanilla extract
- 6 ice cubes
- Nutmeg
Preparation:
- Combine all ingredients except nutmeg in blender
- Cover and mix on high until smooth
- Sprinkle with nutmeg
- Serve Immediately
-Makes 4 Servings
Chicken Stir Fry
Ingredients:
- 6 boneless, skinless chicken breasts, cut into bite-sized pieces
- 2 medium onions, chopped
- 2 large green peppers, diced
- Salt and pepper
- 1 tablespoon canola oil
- 3 cups brown rice
Preparation:
- Cook rice according to package directions
- While rice is cooking, heat the oil in a large skillet and carefully place the chicken in the oil
- Pan fry the chicken until it is no longer pink in the middle and set aside
- Add onions and green pepper to skillet and heat until soft
- Add chicken back to the skillet, season with salt and pepper to taste
- Serve on a bed of warm rice
-Makes 6 Servings
Remember, no amount of gluten is “safe”. If your health care provider or nutritionist has told you to follow a gluten-free diet to treat celiac disease or gluten intolerance, it's important to keep completely gluten-free. This will prevent the immune reaction that gluten causes, and will allow your small intestine to heal and stay healthy. Even a little bit of gluten can harm your intestine and cause an upset stomach.
Updated: 7/20/2011
