Gluten-Free Diet Guide for Celiac Disease & Non-Celiac Gluten Sensitivity
The Quick Start Guide is designed to provide a basic understanding of the gluten-free diet. Not all areas of the diet are as clear-cut as portrayed by this Guide.
This is intended to be used as a basic reference tool for people newly diagnosed with celiac disease, dermatitis herpetiformis and non-celiac gluten sensitivity. For more detailed information consult with a dietitian who is knowledgeable in the gluten-free diet and go to the websites listed.
Choose Naturally Gluten-Free Grains and Flours, including rice, cassava, corn (maize), soy, potato, tapioca, beans, sorghum, quinoa, millet, buckwheat, arrowroot, amaranth, teff, flax, chia, yucca, and nut flours.
Research indicates that pure, uncontaminated oats consumed in moderation (up to 1⁄2 cup dry rolled oats daily) are tolerated by most people with celiac disease. Look for uncontaminated oats that are specifically labeled gluten-free.
Consult your physician or dietitian before including gluten-
free oats in your diet and for regular follow-ups to monitor your response to the gluten-free diet.
The following grains and ingredients derived from these gluten-containing grains must be removed from the diet:
» Includes varieties such as: durum, emmer, spelt, farina, farro, KAMUT® khorasan wheat and einkorn.
• Barley • Rye • Triticale, a cross-breed of wheat and rye
The key to successfully following the gluten-free diet is to become a careful and thorough reader of labels on packaged foods. This includes both ingredient labels and “gluten-free” claims. Manufacturers can change ingredients at any time so you should read labels every time you purchase foods.
The Food Allergen Labeling and Consumer Protection Act (FALCPA) applies to the majority of packaged food products, those regulated by the U.S. Food and Drug Administration (FDA). The law requires that packaged food products which include an ingredient that contains protein from any of the top eight allergens (milk, eggs, peanuts, tree nuts, fish, soy, wheat and Crustacean shellfish) be labeled in one of two ways: the allergen must be named in either the ingredient list or a separate ‘Contains’ statement immediately following or next to the ingredient list.
FALCPA also required a federal standard to be set defining the term “gluten-free” and rules for using the term on product labels. The FDA announced on August 2, 2013 that if a product bears the label “gluten-free,” the food must contain less than 20 ppm gluten, as well as meet other criteria.* The rule also applies to products labeled “no gluten,” “free of gluten,” and “without gluten.”
The labeling of food products as “gluten- free” is a voluntary action for manufacturers.
• The use of a “gluten-free” label does not replace or eliminate the need to comply with the mandatory allergen labeling which requires wheat to be listed as described above.
• Note that a product whose label indicates the presence of wheat may be gluten-free if the wheat-containing ingredient (e.g. wheat starch) has been processed to remove gluten and results in a gluten content of less than 20 ppm. In such situations the labeling must indicate that “The wheat has been processed to allow this food to meet FDA requirements for gluten-free foods.”
• The regulation also applies to dietary supplements, but not to over-the-counter or prescription medications.
• Manufacturers choosing to label products “gluten-free” will be required to comply with this regulation by August 5, 2014.
• Consumers need to be aware that the use of a gluten-free label is optional, and non-labeled products may still be gluten-free. Reading the label to check ingredients remains an essential part of successfully managing the gluten-free diet.
* For more information: www.fda.gov. Search “Questions and Answers: Gluten-Free Food Labeling Final Rule”
If a product bears a “gluten-free” claim after August 5, 2014, it is considered to have met the FDA regulations of less than 20 ppm gluten and should be safe to eat.
Since manufacturers have until that date to comply with the gluten-free food labeling rule, it is essential to read the ingredient label in its entirety, whether or not the product bears a “gluten-free” claim. Look for the following ingredients and these words in the ingredient list or ‘Contains’ statement: Wheat, Barley, Rye, Malt, Brewer’s yeast, Oats (unless specifically labeled gluten-free).
Are all food products covered under the FALCPA labeling rules? No.
The labeling requirements in FALCPA only apply to food products regulated by the FDA.
Those products regulated by the U.S. Department of Agriculture (USDA) are not required to comply with FALCPA. The USDA regulates egg products, poultry products, meat products, and mixed food products that generally contain more than three percent raw meat or two percent or more cooked meat or poultry (e.g. soups, chilis, frozen entrees).
Even though USDA products are not required to comply with FALCPA, it’s estimated that 80 to 90% of these products voluntarily comply.
If there is any doubt about whether a USDA-regulated product is complying with FALCPA labeling, the following ingredients may be derived from wheat and need to be avoided or investigated: Starch, food starch, modified food starch and dextrin.
It is important to note that in USDA-regulated products the single word starch can mean either “corn starch” or “wheat starch.”
If you contact a food manufacturer to verify the source of an ingredient, specify the ingredients and the lot number of the food in question. State your needs clearly - be patient, persistent and polite.
When unable to verify ingredients for a food item or if the ingredient list is unavailable DO NOT EAT IT.
Adopting a strict gluten-free diet is the only known treatment for those with gluten-related disorders.
Distilled alcoholic beverages, distilled vinegars, and wine may be safely included in the gluten-free diet. Most beers, ales, lagers, malted beverages, and other fermented beverages are made from gluten-containing grains and are NOT gluten- free. Beers made from gluten-free grains, such as sorghum, are gluten-free.
Wheat-Free May Not be Gluten-Free
Products labeled “wheat-free” are NOT necessarily gluten- free. They may still contain rye, oat or barley-based ingredients that are not gluten-free.
Contamination in Food Preparation
It is imperative when preparing gluten-free foods to prevent cross-contamination with foods containing gluten. Contamination can occur if foods are prepared on common surfaces, or with utensils that are not thoroughly cleaned after preparing gluten-containing foods. Using hard to clean equipment for both gluten-free and gluten-containing foods is a major source of contamination. Toasters, strainers and flour sifters should not be shared. Deep-fried foods cooked in oil also used to cook breaded products should be avoided. Spreadable condiments in shared containers may also be a source of contamination. When a person dips into a condiment such as mustard, mayonnaise, jam, peanut butter or margarine a second time with the knife used for spreading, the condiment becomes contaminated with crumbs and is not safe for consumption by individuals who cannot tolerate gluten. Consider using condiments in squeeze containers to prevent cross-contamination.
Wheat flour can stay airborne for many hours in a bakery or at home and contaminate exposed preparation surfaces and utensils or uncovered gluten-free products.
Not All Adverse Reactions are Due to Gluten Consumption
Other food intolerances, food sensitivities or food allergies, and even the stomach flu are common causes of symptoms similar to those experienced by gluten-free consumers who have been exposed to gluten. People newly diagnosed with gluten-related disorders may have trouble digesting certain foods, especially fatty ones, until the small intestine has healed and starts to absorb nutrients normally. It may be helpful to keep a diary of foods eaten. Read labels and listen to your body. Consult a registered dietitian knowledgeable in the gluten-free diet and adverse food reactions.
Attitude is Everything
Like anything new, it takes time to adjust to the gluten- free diet. It is natural to mourn old food habits. Instead, stay focused on the foods you can eat! Fresh fruits and vegetables are delicious and healthy. Fresh poultry, fish, meat and legumes provide protein and are inherently gluten- free. Most dairy foods can also still be enjoyed. Gluten-free substitutes for foods commonly made with wheat are widely available at health food and mainstream stores, direct from gluten-free food manufacturers and from Internet sites.
Over the past few years, the gluten-free product market has grown exponentially, with hundreds of products now
available from major manufacturers and the choices are seemingly endless. Try gluten-free waffles or gluten-free cereal for breakfast; a sandwich on gluten-free bread for lunch; and rice, corn or quinoa pasta for dinner. Include lean meats and proteins, fresh vegetables and fruits too! Your new way of eating can be very satisfying and nutritious!
Undergo Proper Testing Before Starting the Diet
The gluten-free diet is a life-long commitment and should not be started before being properly and professionally diagnosed. Starting the diet without complete testing is not recommended and makes diagnosis difficult. Tests to confirm celiac disease could be inaccurate if a person is on a gluten-free diet. For a valid diagnosis gluten will need to be reintroduced. This should be done under medical supervision. Celiac disease is an inherited autoimmune disease and screening of family members is recommended. Consult your doctor for your specific celiac disease blood testing needs.
This brochure was developed collaboratively by:
Information in this publication is in agreement with the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guidelines. This Guide was developed to assist people newly diagnosed with celiac disease, dermatitis herpetiformis or non-celiac gluten sensitivity with preliminary gluten-free choices while learning the basics of the gluten-free lifestyle.
Common sources of gluten: (Note: gluten-free versions of these foods are widely available)
• Breads • Cereal Products • Cookies, Cakes and other Baked Goods • Crackers • Croutons • Flour • Pastas • Stuffings and Dressings
Foods that may contain gluten and need to be verified:
• Brown Rice Syrup • Breading and Coating Mixes • Candy • Energy Bars • Imitation Meats • Imitation Seafood • Licorice • Marinades • Panko (Japanese bread crumbs) • Processed Lunch Meats • Salad Dressings • Sauces and Gravies • Seasoned Rice Mixes • Self-basting Poultry • Soy Sauce or Soy Sauce Solids • Soup Bases, Broth and Bouillon • Teriyaki Sauce • Thickeners (Roux)
The following items also need to be verified:
• Communion Wafers • Drugs and Over-The-Counter Medications • Herbal and Nutritional Supplements • Vitamin and Mineral Supplements
Celiac resources include books, doctors, websites, blogs...
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