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Girls' VersionThe Gluten-Free Diet:
A Guide for Parents
 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. If your teen has been diagnosed with celiac disease, he must follow a gluten–free diet to heal his body. This guide was created for you and your family to help navigate the gluten–free diet including how to avoid gluten, how to identify gluten–free foods, and how to adapt to a gluten–free lifestyle.
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 and decreases nutrient absorption. Noticeable symptoms of celiac disease include diarrhea, abdominal pain, weight loss, nutritional deficiencies, anemia, poor appetite, 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 prevents harm to the small intestine and allows it to heal. The gluten–free diet should stop your teen’s symptoms of both celiac disease and gluten intolerance.
What foods should my teen avoid?
Following a gluten–free diet means your teen should remove all foods that have gluten from his diet. Foods that contain gluten are “red–light foods” for anyone with celiac disease. To eliminate “red–light foods”, your teen should:
- Remove grains that contain gluten. He should not eat any food that contains wheat, barley, rye, or oats. Keep in mind that wheat has many aliases. He should avoid products that include bulgur, durum, graham, kumut, spelt, and semolina. These are all forms of wheat!
If you ever see this label on package, it tells you that the product contains wheat and isn’t gluten free.
- Look for “hidden” sources of gluten. He should 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 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 source 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.
- 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.
What’s important to know about 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 there are foods your teen likes to eat that contain “natural” or “malt” flavorings on the ingredient list, contact the company. It’s possible these flavorings came from a non–gluten source.
What should we do about oats?
- Oats may contain gluten. Oats are often processed in the same factories as wheat, therefore not always gluten–free. It's best to confirm with your teen’s health care provider if it’s appropriate to include oats in diet. Just after your teen’s diagnosis of celiac disease and while you and your teen are learning about the gluten–free diet it is best to stay away from oats. This helps allow for gut healing.
- 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 eat 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 several 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.
These “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 identify a gluten–free product. Manufactures voluntarily test their products obtain this label. When their products comply with the Food and Drug Administration (FDA) rule of “gluten–free”, then a product can be certified. Be on the lookout for upcoming labeling laws which will not only define the term “gluten–free”.
- The FDA’s Food Allergen Labeling and Consumer Protection Act (FALCPA) is another way to identify products containing wheat. The FALCPA requires all FDA–regulated packaged foods to clearly state on the label of all foods or ingredients in a food that contain the one of the eight most common allergens. The top 8 allergens include: milk, egg, peanuts, tree nuts, fish, shellfish, soy and WHEAT.
The FALCPA 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. If the statement reads “contains wheat”, then it is a “red–light food.”
- The FDA does NOT regulate labeling for barley, brewer’s yeast, malt, rye, and oats. This means if the allergen statement does not say “contains wheat” you need to examine ingredient list for all of the other sources of gluten described above. Then, if you don’t see any of these words in the ingredient list, then the food is most likely a “green–light food”.
- USDA (United States Department of Agriculture) regulates different foods than the FDA. The USDA is responsible for meat, poultry, and egg products. Look for the ingredients barely, brewer’s yeast, dextrin, malt, modified food starch, and oats on the label of these foods to find out if the product contains gluten.
- Remember, there is no harm in contacting the company if the label is unclear and you want to make sure that the food is gluten–free. In fact, the best way to determine if a particular product is gluten–free is to call the food manufacturer or look on their website. By law, food manufacturers must list their contact information on the back of all packaged foods.
Reading food labels is very important. Products ingredients can change without warning and often without a noticeable difference in the packaging. To help you identify gluten–free foods, please see the sample ingredient label below. The ingredients are circled in red, and the allergy statement is circled in blue. This food, which contains whole grain wheat, is a “red–light food”.
How can I make my kitchen gluten–free?
There are two general ways to approach your kitchen after your child has been told to follow a gluten–free diet. Both approaches present different challenges, but both allow for your teen to safely eat gluten–free.
One way that some families choose is to make their kitchen completely gluten–free requires you to throw out all gluten containing foods and sanitize all cupboards, cooking equipment, and utensils.
Other families choose to keep gluten containing products in their kitchen while adhering to safe food storage, preparation, and cooking practices for their gluten–free teen. If you’re planning on keeping foods with gluten in your kitchen check make sure you minimize the risk of gluten cross–contamination.
Here are some great tips to decrease the chances of gluten cross–contamination:
- Keep gluten–free products in a separate cabinet
- Store gluten–free foods in airtight containers
- Store gluten–free flours and baking mixes in airtight containers in the freezer
- Purchase separate butter, condiments in squeeze bottles, peanut butter, spreads (to prevent contamination with wheat bread crumbs)
- Use separate colanders, sponges, strainers, toaster ovens, bread machines, towels, dish rags, and wooden utensils for gluten–free cooking
- Clean counter tops, cutting boards, measuring cups and spoons, the microwave, pot holders, and baking pans well and often
- Wash all shared utensils before and after each use
Regardless of your kitchen approach, here are a few tips for meal planning for the whole family, including ways to save money!
- Rinse all gluten–free grains well before cooking.
- Use a gluten–free cookbook when preparing foods with gluten–free flours. This way the quantity and mixture is accurate.
- Use a skillet or crock pot to make 1 dish meals with naturally gluten free ingredients like meats and fresh vegetables.
- Use a rice steamer to cook amaranth, buckwheat, brown or white rice, quinoa, and sorghum. Gluten–free whole grains do require a bit more water than white rice.
- Prepare a larger quantity and store in the freezer. Cook gluten–free whole grains, chili, stew, or homemade soup.
- Gather coupons for gluten–free foods. Call the companies of interest and request coupons.
- Check out Costco, BJ’s, Sam’s Club and other major chains for gluten–free foods and less expensive prices.
Where can I buy gluten–free foods?
Eating and cooking gluten–free has become so much easier as more companies now make gluten–free foods. You can purchase gluten–free breads, rolls, pizza–crusts, buns, bagels, donuts, cookies, muffins, pretzels, cereals, and desserts online or in most major grocery stores.
The following brands have a great selection of gluten–free foods which can be purchased directly from their websites or at many grocery stores in the organic food aisles:
| Glutino® | |
| LaraBar® | |
| Bumble Bar® | Lundberg Farms® |
| Pamela’s Products® | |
How do I shop for gluten–free foods?
When shopping at your local grocery store, it’s 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. Even though these foods are naturally gluten–free it’s always important to be a smart shopper and look out for possible sources of gluten cross–contamination. Gluten cross–contamination occurs most frequently at deli’s, buffets, and salad bars.
Gluten–Free Grocery List
| 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 my child stay gluten–free while eating away from home?
The best way to help your child stay gluten-free when away from home is by planning meals and snacks ahead of time. That may sound challenging, but these tips can make it easier:
- Encourage your teen eat breakfast at home or pack him a gluten-free breakfast to eat at school or on-the-go.
- Work with your teen, his nutritionist and/or school nurse to find gluten-free foods on the school breakfast and lunch menus.
- Help your teen pack a gluten-free lunch or snack.
- Select gluten-free portable snacks that your teen can keep in his backpack, such as trail mix, snack bars, popcorn or nuts that he can eat away from home. The Gluten Intolerance Group (GIG) has a list of 50 easy gluten-free snack as well as 50 easily found gluten-free foods.
- If you are planning to go out to eat at a restaurant, either choose one that has a gluten-free menu or speak with the restaurant manager to identify 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 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, everything from entire menus to just a few options. 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 |
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.
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
- 1 1/2 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
What else do I need to know about the gluten-free diet?
No amount of gluten is “safe”. If your teen’s health care provider has told him to follow a gluten-free diet, it is important to keep his diet completely gluten-free. Even a little bit of gluten can cause symptoms and damage the small intestine.
A gluten-free diet is not always a healthy diet. 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. Additionally, some of the gluten-free foods can be high in calories and sugar. If your teen must follow a gluten-free diet, it's best to meet with a nutritionist to develop a healthy, balanced diet and to identify if any vitamin or mineral supplements are necessary.
There are many hidden sources of gluten. 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.
- Medications: Both prescription and over-the-counter medications may contain gluten. For over-the-counter medications, check with your pharmacist. With prescription medications, ask your child’s health care provider to specifically state, “Medication must be gluten-free” on any prescriptions.
- Envelopes and Stamps: Envelopes and stamps may have a gluten-containing adhesive. Your teen use self-adhesive versions or use a sponge to wet the adhesive.
- Soaps, Shampoos, and Lotions: Many of these products contain wheat or oat. While gluten cannot be absorbed through the skin, it is important to be aware of this, especially if your teen has a habit of biting his finger nails.
Updated: 7/20/2011
