Accurate Education – Elimination Diet: Gluten

Elimination Diet: Gluten

Definitions:

 

Food Sensitivity:

A catch-all term for conditions which result in symptoms due to ingestion of a food or nutrient, regardless of the mechanism by which the symptoms occur.

 

Food Intolerance:

Symptoms resulting from the inability to digest/metabolize a food or nutrient – symptoms that are usually limited to the gastrointestinal (GI) tract.

 

Food Hypersensitivity:

An immune/allergic response to a food or nutrient that causes gastrointestinal (GI) symptoms and/or systemic symptoms.

 

 

See:

Food Intolerance & Sensitivity: An Overview

Food Intolerance & Sensitivity: Gluten

Elimination Diet – FODMAPs

 

See also:

Diet & Diets

Diet & Pain – An Overview

Diet & Fibromyalgia

 

Wellness/Anti-Inflammatory Diets (coming soon):

Mediterranean Diet

Paleo Diet

Okinowan Diet

Elimination Diets

Fasting

 

Diet Supplements:

Supplements – An Overview

Minerals

Vitamins

Key to Links:

Grey text – handout

Red text – another page on this website

Blue text – Journal publication

 

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Elimination Diet – Gluten

For those with gluten sensitivity, ingestion of gluten, a protein found in wheat, rye, and barley. may give rise to a wide range of systemic, behavioral and GI symptoms. Eliminating gluten from the diet is both diagnostic and therapeutic.

 

Gluten Elimination Diet: Celiac Disaease (CeD)

In order to verify the diagnosis of gluten hypersensitivity (Celiac disease) when blood testing and/or intestinal biopsy identify high risk for this condition,  a trial diet eliminating gluten is warranted to both confirm the diagnosis and treat the condition. While an improvement in symptoms should be evident in weeks to months, it may take up to a year for the full benefits to be evident.

 

Gluten Elimination Diet: Non-celiac gluten sensitivity (NCGS)

In order to verify the diagnosis of gluten sensitivity (non-celiac gluten sensitivity) when blood testing and/or intestinal biopsy identify low risk for Celiac disease (CeD0,  a trial diet eliminating gluten is warranted to both confirm the diagnosis of NCGS and treat the condition. Improvement in symptoms should be evident in 3-4 weeks after completely eliminating gluten in the diet. Upon resolution of symptoms, reintroduction of gluten into the diet followed by return of symptoms is the final determination establishing the diagnosis.

Gluten-Free Diet

While it is difficult to maintain a gluten-free diet (GFD), careful attention to the process can be successful and rewarding. The following is a list of foods described as safe, to be ingested with caution only and those known to contain gluten and not be safe. This list is of course not all-inclusive. Care with reading food ingredients labels is mandatory and there are a number of resources available on the internet to help.

 

Grains, flours, breads and starches

Grains & Flours

Safe:

Amaranth, Arrowroot, Bean Flour (Lentil, Romano, Garbanzo, etc.), Buckwheat, Carob Flour, Chickpea Flour, Corn Flour, Corn Meal, Cornstarch, Job’s Tears Kasha (Roasted -Buckwheat), Kudzu Root Starch, Maize, Maize Waxy, Masa Flour, Millet, Montina Flour (Indian Rice Grass), Nut Flour (Almond, Chestnut etc.), Pea Flour (Chickpea, Besan, Cowpea etc.), Potato Flour, Potato Starch, Quinoa, Ragi, Rape, Rice Flour (White, Brown, Sweet, Bran), Sago Flour, Sorghum, Soy Flour, Tapioca, Flour, Tarrow Root, Teff Flour, Yam Flour

 

Cautions:

“Safe” flours in bulk bins in stores.

Groats can be from either safe or unsafe grains.

Soba Flour is usually buckwheat but may contain wheat as an ingredient

 

Not Safe:

Barley (Malt, Pearl, Grass etc.), Bleached Flour, Bran, Bread Flour, Brown Flour, Farina Graham, Fu (dried wheat gluten), Gluten Flour, Graham Flour, Granary Flour, Groats (Barley, Wheat), Harina, Malt, Matzo Semolina, Oats, Rye, Semolina, Spelt, Wheat (Semolina, Sprouted, Durum, Starch, Bulgar, Kamut, Grass, etc.), Whole-Meal Flour Wheat Germ

 

Breads

Safe:

Breads and mixes using only allowed flours, (100% corn, rice, soy etc).

 

Cautions:

Gluten-free breads and mixes made in a non-dedicated facility.

 

Not Safe:

All breads and bread products made with flours and grains not allowed.

 

Cereals

Safe:

Hot and cold cereals made from the allowed grains, Cream of Rice, Cream of Buckwheat, Grits Corn, Hominy Grits

 

Cautions:

Commercial cereals made in a non-dedicated facility

 

Not Safe:

Hot and cold cereals containing a grain not allowed. Cereals made with malt or malt extract.

 

Pastas, Potatoes & Other starches

Safe:

Pastas made from allowed grains, Rice including white brown and wild, Corn tacos and corn tortillas, Potatoes, Saifun (bean threads), rice noodles

 

Caution:

Commercial rice and pasta mixes, French Fries, Fried restaurant foods (gluten contaminated grease), Polenta

 

Not Safe:

All pastas made from grains not allowed, Couscous, Tabbouleh, Soba Noodles

 

Cra
ckers & Snack foods

 Safe:

Corn Tortillas (plain), Potato Chips (plain), Popcorn (plain), Nuts (plain), Crackers made with grains are allowed.

 

Cautions:

Flavored tortillas and chips, Flavored rice cakes, Rice Crackers, Roasted Nuts, Rice Cakes, Microwave popcorn

 

Not Safe:

All containing grains not allowed, Pretzels, Flour Tortillas

 

Dairy 

Dairy Products

Safe:

Milk dry, evaporated and condensed milk, Cream, Yogurt (plain), Aged Cheeses

 

Cautions:

Whipping Cream, Flavored Yogurts, Milkshakes, Flavored milk, Ice-cream, Frozen Yogurt, Soy and Rice milks, Cottage Cheese, American Cheese, Cheese Spreads, Cream Cheese, Low Fat and Fat Free Cheese, Ricotta Cheese, Imitation Cheeses, Sour cream, Veined Cheese (Blue, Gorgonzola).

 

Not Safe:

Dairy products containing ingredients not allowed, Malted Milk, Chocolate milk with malt.

 

Meat

Meat & Other Proteins

Safe:

Fresh 100% meat, beef, pork, and poultry, Eggs, Tuna Fish canned in oil or water, Tofu-Soya Curd, Nuts (plain), Legumes (beans, peas and lentils)

 

Cautions:

Soybean and other meat substitutes, Sausages, Meat Imitations, Seafood Imitations, Egg Substitutes, Tuna canned in broth or brine, Meats and fish containing HVP or HPP, Deli Meats, Peanut Butter, Products that contain broth.

 

Not Safe:

Processed meat products containing ingredients not allowed, Seitan

Fruits, Vegetables and Soups

 Fruits & Fruit Products

Fresh Fruit, Pure Fruit Juices

 

Cautions:

Thickened or prepared fruits and pie fillings, Dried fruit mixes, Jelly and Jam

 

Not Safe:

N/A

 

Vegetables

Safe:

Fresh, frozen and canned plain vegetables without additives, Legumes, Peas Beans and Lentils.

 

Cautions:

Tomato paste, sauce, and puree, Vegetables in sauces or contain additives, Baked Beans

 

Not Safe:

Battered dipped vegetables

 

Soups

Safe:

Commercially prepared gluten-free soups and stocks.

 

Cautions:

Commercially prepared soups and stocks, Beware “home made” statements. Bouillon cubes and Powder.

 

Not Safe:

Any soup containing ingredients not allowed.

 

Nuts and Seeds

Nuts & Seeds

Safe:

Nuts (plain), Seeds (plain), Soybeans, Coconut

 

Cautions:

Dry roasted nuts, Flavored or sweetened nuts, Nuts in bins, Flavored or sweetened coconut

 

Not Safe:

Wheat Nuts

 

Fats

Safe:

Butter, Oils (vegetable, canola, olive etc), Shortening, Crisco

 

Cautions:

Margarine, Low fat butter spreads, Salad Dressing, Mayonnaise

 

Not Safe:

Packaged Suet Wheat Germ Oil

 

Desserts

Safe:

Gluten-free cakes, cookies and baking mixes, Pure Cocoa, Gluten-free ice cream
cones

 

Cautions:

Ice Cream, Frozen Yogurt, Sherbet, Pudding/Custard, mixes, Candy, Frozen Desserts, Icing, Ices, Meringues

 

Not Safe:

Cakes, cookies and other baked goods made with unsafe grains, Ice Cream Cones, Licorice

 

Beverages

Beverages

Safe:

Tea (black, green and white), Coffee (plain), Pure Fruit Juices, Cider

 

Cautions:

Soy & rice beverages, Instant tea and coffee, Flavored tea and coffee, Hot Cocoa, Hot Chocolate, Soda, Sports Drinks, Nutritional Supplements

 

Not Safe:

Malted Beverages, Ground coffee with added grains

 

Alcohol

Safe:

Hard Cider, Wine, Sake, Sherry, Champagne, Tequila, Cognac, Brandy, Rum, Kaluha, Gluten-free Beer

 

Cautions:

Alcohol distilled from grains, Vodka, Whiskey, Bourbon

 

Not Safe:

Beer, Ale, and Lager

 

Condiments

Condiments

Safe:

Salt, Pepper (black, white and red), Pure Herbs, Pure Spices, Pure Flavoring Extracts, Wheat Free Soy Sauce, Cream of Tartar, Pickles, Honey

 

Cautions:

Ground Spices, Seasoning and Spice mixes, Gravy Cubes and Mixes, Bouillon Cubes and Powder, Ketchup, Mustard, Mustard Powder, Worcestershire Sauce, Salad Dressings, Soy Sauce, Teriyaki Sauce, Relish

 

Not Safe:

Most Soy Sauces contain wheat

 

Other

Misc.

Safe:

Seaweed (algin, algae, alginate), Alfalfa, Aspic

 

Cautions:

Yeast, Yeast Flakes, Bicarbonate of Soda, Baking Soda, Baking Powder, Powdered Sugar, Molasses, Rice Paper, Confectioner Sugar

 

Not Safe:

Communion Wafers, Brewer’s Yeast

 

Non-Foods

Cautions:

Lotions, Creams, Cosmetics, Lip Gloss, Lip Balm, Sunscreen, Toothpaste, Mouthwash, Products used in Dental Offices, Medications: Prescription and over the counter (many contain gluten), Laxatives, Vitamins, Stamps, Envelopes, and Gummed Labels, Play Doh, Paper Mache

 

Resources:

1.  www.wheat-free.org
2. Celiac Disease – National Institute of Diabetic, Digestive and Kidney Diseases (NIDDK)
3. What should I avoid eating if I have celiac disease? – NIDDK

 

References:

Gluten: Celiac Disease

1. Update on Celiac Disease – New Standards and New Tests – Algorithm
2. ACG CLINICAL GUIDELINE – DIAGNOSIS AND MANAGEMENT OF CELIAC DISEASE – 2013
3. Benefits of a gluten-free diet for asymptomatic patients with serologic markers of celiac disease. – PubMed – NCBI
4. Coeliac disease -2008-Leeds
5. Diagnosis and management of adult coeliac disease – guidelines from the British Society of Gastroenterology

Gluten: FM and Celiac Disease

1. Clinical impact of a gluten-free diet on health-related quality of life in seven fibromyalgia syndrome patients with associated celiac disease

Gluten: Non-Celiac Gluten Sensitivity (NCGS)

1. Nonceliac gluten sensitivity. – PubMed – NCBI
2. Non-celiac gluten sensitivity – Time for sifting the grain – 2015
3. Non-celiac gluten hypersensitivity. – PubMed – NCBI
4. The Overlap between Irritable Bowel Syndrome and Non-Celiac Gluten Sensitivity – A Clinical Dilemma – 2015
5. Non-celiac Gluten Sensitivity. Is it in the Gluten or the Grain? – 2013
6. Fibromyalgia and non-celiac gluten sensitivity – a description with remission of fibromyalgia – 2014
7. The Effects of a Gluten-free Diet Versus a Hypocaloric Diet Among Patients With Fibromyalgia Experiencing Gluten Sensitivity-like Symptoms: A Pilot… – PubMed – NCBI
8. Gluten-free diet in the management of patients with irritable bowel syndrome, fibromyalgia and lymphocytic enteritis – 2014
9. Non-coeliac-gluten-sensitivity – A-new-disease-with-gluten-intolerance-2015

 

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