Celiac disease is an autoimmune condition that causes severe damage to the lining of the small intestine. Gluten — a protein found in wheat, barley, and rye — triggers its symptoms.
There’s currently no cure for celiac disease. A strict gluten-free diet — also known as the celiac disease diet — must be followed to allow your body to heal.
If you have celiac disease and consume even small amounts of gluten, damage to your intestines will continue, regardless of the absence of symptoms (1).
For those with celiac disease, avoiding gluten is essential but can be harder than it seems.
This article reviews the benefits of the celiac disease diet and provides lists of foods to eat and avoid, as well as a sample menu and helpful tips.
Anyone diagnosed with celiac disease must follow the celiac disease diet.
It requires avoiding gluten, a naturally occurring protein found in several grains, including wheat, barley, and rye (2).
When someone with celiac disease eats gluten, it causes an autoimmune response in their body that damages the lining of the small intestine.
As a result, the small intestine cannot properly absorb nutrients from food, creating symptoms like diarrhea, unexplained weight loss, and malnutrition (3).
The only way to prevent this damage is to strictly follow the gluten-free celiac disease diet.
Summary The celiac disease diet avoids gluten-containing foods to prevent autoimmune intestinal damage in people with celiac disease.
The celiac disease diet is required for anyone diagnosed with celiac disease and has many benefits.
Reduces the Symptoms of Celiac Disease
Many people with celiac disease experience uncomfortable symptoms, such as diarrhea, indigestion, abdominal pain, fatigue, and headaches (4).
Following a gluten-free diet for at least one year has been shown to improve these symptoms in more than 90% of people with celiac disease, significantly improving quality of life (5, 6, 7).
Intestinal symptoms like diarrhea tend to be the quickest to resolve — with some people experiencing relief after just two days on a gluten-free diet.
Overall, it takes an average of one month to see significant improvements in bowel movements, bloating, and abdominal pain (8).
Prevents Small Intestinal Damage
For people with celiac disease, eating gluten triggers an autoimmune response that damages the small intestine, where nutrients are absorbed.
Avoiding gluten prevents this autoimmune process, and the small intestine can heal and return to normal function.
This process takes time — so the earlier a gluten-free diet is started, the better.
In one study, up to 95% of children with celiac disease who followed a gluten-free diet for two years no longer showed signs of intestinal damage (9).
Recovery tends to be slower in adults — with 34–65% achieving gut healing in two years.
However, this number jumps to at least 66% — and up to 90% — after five or more years on a gluten-free diet (9, 10).
Being vigilant about avoiding gluten is crucial. Exposure to even tiny amounts can hinder the healing of your intestines (11).
Improves Nutrient Absorption
Nutrient deficiencies are prevalent in people with celiac disease due to poor absorption in the damaged small intestine.
Deficiencies in iron, calcium, magnesium, zinc, vitamin B12, niacin, riboflavin, and folate, as well as vitamins A, D, E, and K, are the most common (12, 13).
In fact, unexplained iron deficiency anemia is one of the most recognized signs of celiac disease in adults (14).
Yet, supplementing will not always correct deficiencies in people with celiac disease if their intestines are still damaged and unable to absorb nutrients (15).
Following a gluten-free diet has been shown to repair the intestines enough to correct iron deficiency anemia within six to twelve months, even without taking a supplement (16).
Women with celiac disease have higher rates of infertility and may be at a greater risk of miscarriage than women without this condition (17, 18).
Research suggests that the autoimmune response that gluten triggers in people with celiac disease may be to blame (19).
However, following a strict gluten-free diet has been found to improve fertility and reduce miscarriage rates (19, 20).
May Reduce Cancer Risk
Celiac disease is associated with a three-times greater risk of non-Hodgkin’s lymphoma — an aggressive form of cancer that occurs in the lymph system (21).
Several studies have found that diagnosing celiac disease early and following a gluten-free diet can reduce this risk — but more research is needed (22, 23, 24).
Lowers the Risk of Osteoporosis
Up to 75% of people with untreated celiac disease have lower bone density and a higher risk of osteoporosis (25).
This may be due to poor calcium and vitamin D absorption, as well as increased inflammation that interferes with the bone-building process (26).
Research shows that diagnosing celiac disease early and starting a gluten-free diet can help stop bone loss and reduce the risk of developing osteoporosis (26, 27).
Summary Following a gluten-free diet has many benefits for people with celiac disease, including reducing symptoms, allowing the small intestine to heal and properly absorb nutrients, and decreasing the risk of infertility, cancer, and osteoporosis.
There are many naturally gluten-free foods to enjoy on the celiac disease diet, including (13):
- Animal proteins: Beef, chicken, dairy products, eggs, game meat, lamb, pork, seafood, and turkey.
- Fats and oils: Avocado, coconut oil, olives, oils, solid fats, and butter.
- Fruits and vegetables: In any form, including fresh, frozen, dried, or canned.
- Gluten-free cereals and pseudocereals: Amaranth, buckwheat, corn, millet, quinoa, rice, sorghum, teff, and wild rice.
- Herbs and spices: All fresh and dried herbs and spices are naturally gluten-free and can be enjoyed liberally.
- Legumes: Beans, lentils, peanuts, peas, and soy.
- Nuts and seeds: Any type, including almonds, cashews, chia, flax, pecans, pepitas, pine nuts, and walnuts.
There’s also a wide variety of specialty products, including gluten-free bread, cereals, flours, crackers, pastas, and baked goods.
Summary All animal proteins, fruits, vegetables, nuts, seeds, legumes, herbs, and spices are naturally gluten-free. There are many naturally gluten-free grains and specialty products, too.
The only foods that should be avoided on the celiac disease diet are those that contain gluten.
Foods that naturally contain gluten include the following grains (13):
- Khorasan (KAMUT®)
- Wheat berries
- Wheat germ
- Wheat bran
- Triticale (a cross between wheat and rye)
Products made with these ingredients include:
- Breakfast and baked goods: Bagels, biscuits, bread, cornbread, crepes, croissants, donuts, flatbread, flour tortillas, French toast, muffins, naan bread, pancakes, pita bread, potato bread, rolls, and waffles.
- Desserts: Brownies, cake, cookies, pastries, pie crust, and some candy.
- Pasta: Chow mein, couscous, dumplings, egg noodles, gnocchi, ramen noodles, ravioli, soba noodles, udon noodles, and wheat pasta.
- Snacks: Crackers, graham crackers, and pretzels.
- Some beverages: Beer and other malted beverages.
- Other: Breadcrumbs, croutons, wheat flour, barley flour, rye flour, gravy, malt flavoring/extract, panko, sauces thickened with flour, soy sauce, stuffing, and anything with a flour coating, such as chicken tenders or tempura.
Foods that are often cross-contaminated by gluten include:
- Commercially fried foods: Many restaurants fry all of their foods in the same fryer, which can contaminate gluten-free items like French fries.
- Improperly handled gluten-free items at restaurants: Gluten-free items should be prepared with designated gluten-free equipment and a clean pair of gloves.
- Oats: Oats are often processed on the same equipment as gluten-containing grains and may be contaminated unless specifically labeled gluten-free.
Foods that frequently contain hidden gluten include:
- Brown rice syrup: Brown rice is naturally gluten-free, but the syrup is often made with barley malt, which contains gluten. Look for gluten-free varieties.
- Chips: Can be dusted with flour or contain malt vinegar, so check ingredients.
- Ice creams and frozen yogurts: Watch for cookie, cake, or brownie mix-ins.
- Lunch meats: Some brands add starches that contain gluten.
- Marinades and salad dressings: May contain malt vinegar, soy sauce, or flour.
- Meat substitutes: Seitan, veggie burgers, veggie sausages, imitation bacon, and imitation seafood can contain gluten.
- Meats: Some commercially prepared meat mixtures contain gluten or are marinated with gluten-containing ingredients.
- Seasoning packets: May contain gluten-containing starch or flour.
- Soup: Watch for flour thickeners (often used in creamy soups) or barley.
- Stock, broth, and bouillon: Some varieties contain flour.
Summary Wheat, barley, and rye should be avoided on the celiac disease diet, as well as anything made with these grains or cross-contaminated with gluten.
- Breakfast: Hard-boiled eggs with fresh fruit and almonds.
- Lunch: Lettuce wrap with gluten-free deli meat, potato chips, and guacamole.
- Dinner: Shrimp and vegetable stir-fry with tamari (gluten-free soy sauce) over rice.
- Breakfast: Plain Greek yogurt with sliced fruit, nuts, and honey.
- Lunch: Leftover stir-fry.
- Dinner: Chicken tacos with sautéed peppers and onions served in corn tortillas with refried beans and salsa.
- Breakfast: Gluten-free toast with avocado and a fried egg.
- Lunch: Tuna stuffed avocados with a side of sugar snap peas and trail mix.
- Dinner: Baked chicken with lentil pasta, marinara sauce, and roasted vegetables.
- Breakfast: Fruit smoothie made with plain Greek yogurt.
- Lunch: Leftover chicken and lentil pasta.
- Dinner: Dinner bowl made with quinoa, sauteed kale, avocado, and sweet potatoes with herbed tofu dressing.
- Breakfast: Overnight oats made with gluten-free oats, milk of choice, nuts, coconut, and blueberries.
- Lunch: Spinach salad with quinoa, chickpeas, vegetables, and olive oil dressing.
- Dinner: Pizza made with gluten-free crust.
- Breakfast: Bacon and eggs with breakfast potatoes and berries.
- Lunch: Leftover pizza and a side salad.
- Dinner: Baked salmon with steamed vegetables and brown rice.
- Breakfast: Omelet with mushrooms, peppers, and onions, along with a piece of fruit.
- Lunch: Vegetarian chili topped with cheddar cheese, green onion, and avocado.
- Dinner: Roast beef with potatoes, carrots, and onions.
Summary Meals do not have to change too much on a gluten-free diet. There are many gluten-free substitutes for items like bread, pasta, and soy sauce.
Following a gluten-free diet is relatively simple, but there are a few common pitfalls to avoid.
In the US, products made with refined flour like bread, crackers, and pasta are required to be fortified with the B vitamins niacin, thiamine, riboflavin, and folic acid (28).
However, gluten-free versions of these foods are not required to be fortified. This may increase your risk of nutrient deficiencies if you eat a lot of these products (29, 30).
Additionally, whole-grain wheat, barley, and rye are good sources of fiber, so it’s important to consume other fiber-rich foods, like oats, beans, and legumes when you have to avoid gluten (31).
Gluten-free products like bread, baked goods, crackers, and pasta can cost more than double the price of traditional wheat-based items (32).
However, these specialty items aren’t required on the celiac disease diet. You can easily meet your nutrient needs by eating less expensive, naturally gluten-free foods.
If you lack inspiration for what to cook on the celiac disease diet, browse the web for gluten-free recipes or look for a gluten-free cookbook online or at your local library or bookstore.
While gluten-free items are becoming more widely available in stores and restaurants, the celiac disease diet can sometimes feel limiting and isolating (33).
This is especially true in social situations that involve food, such as weddings, parties, or dining out with friends (34, 35).
However, following a gluten-free diet gets easier with time and experience. Research shows that most people are accustomed to the diet after five years (36).
Some tips to make eating out a better experience include reading menus online beforehand, calling restaurants to verify gluten-free options, or bringing at least one gluten-free item to a party.
Staying positive and focusing on the foods you can eat, rather than those you can’t, helps make the celiac disease diet more enjoyable.
Summary Potential pitfalls of the celiac disease diet include nutrient deficiencies, higher costs, and less flexibility when dining out. Eating a balanced diet of naturally gluten-free foods and planning ahead can help you avoid these drawbacks.
The celiac disease diet is a gluten-free diet that reduces symptoms of the condition, allows your gut to heal, improves nutrient absorption, and decreases your risk of infertility, cancer, and osteoporosis.
Avoid wheat, barley, rye, and anything made with these grains, and focus on naturally gluten-free foods and grains.
While the celiac disease diet can seem expensive and limiting at first, planning ahead and learning to enjoy new foods can make the transition easier.
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