Strict Gluten-Free Diet for Celiac Disease

Celiac disease is an autoimmune disorder that causes damage to the small intestine when gluten is consumed. To test for celiac disease, your physician will order a blood test. If the test is positive, a diagnosis of celiac disease will need to be confirmed through a biopsy of your small intestine. If you have been diagnosed with celiac disease, it is vitally important that you follow a strict gluten-free diet to avoid further damage to your intestines.

What Foods Have Gluten and Should be Avoided?

Gluten is found in the following grains:

  • Wheat (includes spelt, kamut, farro, durum, etc.)
  • Barley
  • Rye
  • Triticale – a hybrid of wheat and rye

These grains are found in flour-based foods, such as crackers, bread, cereals, pasta, pastries, baked goods, etc. They may also be used in the production of certain ingredients, such as malt vinegar or beer made from barley or wheat.

Food to Focus on

Wheat, barley and rye are good sources of complex carbohydrates, fiber, B-vitamins, magnesium, zinc, etc. Here is a list of naturally gluten-free foods to replace these nutrients:

  • Legumes (beans, lentils, peas)
  • Rice
  • Quinoa
  • Millet
  • Corn
  • Buckwheat
  • Amaranth
  • Sorghum
  • Teff
  • Certified gluten-free oats

Other foods that are naturally gluten-free and provide a good source of fiber, vitamins and minerals include fruits, vegetables, nuts and seeds.

Eating a variety of foods from all food groups, including proteins (meat, poultry, fish, eggs, legumes, nuts and seeds), dairy, fruits, vegetables and starches (potatoes, rice, oats, quinoa, etc.), helps prevent nutritional deficiencies.

Reading Food Labels

All packaged foods must list the ingredients on the package. Food laws require that any of the top 8 allergens, including wheat, be clearly stated on the package. An example of what this looks like – Contains: Wheat. Barley and rye are not included in the top 8 allergens and therefore do not need to be clearly stated. It is important to read through the ingredients for possible ingredients containing gluten.

Ingredients/Foods That May Contain Gluten

  • Bouillon cubes, broth or stock
  • Brewer’s yeast
  • Brown rice syrup
  • Candy
  • Chapstick/lipstick
  • Fried foods
  • Malt, malt extract, malt vinegar, malt syrup, malt flavoring
  • Meat substitutes
  • Oats
  • Pre-seasoned meats
  • Salad dressings and marinades
  • Sauces, such as soy sauce and gravies
  • Spices
  • Starch or dextrin
  • Plus, many more…  

Gluten-Free Labeling

Food labeled gluten-free must contain less than 20 ppm as required by the FDA and deemed safe for people with celiac disease. Gluten-free labeling is voluntary so there may be foods not labeled gluten-free but in fact are. Keep in mind gluten-free labels can be placed anywhere on a package. Check out the FAQ section on the company’s website or call the manufacturing number on the package if you are unsure whether a product is gluten-free or not.

Avoiding Cross-Contamination

Foods that are naturally gluten-free can be contaminated with gluten during the growing, harvesting, storage, preparation and cooking phases. It is important to choose certified gluten-free oats because even though they are naturally gluten-free they are commonly contaminated. Here are some other common sources of cross-contamination:

  • Bulk bins
  • Buffet tables
  • Cast iron skillets
  • Fryers
  • Grills
  • Shared condiment jars, non-stick pans, strainers, wooden utensils, cutting boards, etc.
  • Shared counter space, particularly when baking with flour at home, bakeries, pizzerias, etc.
  • Shared kitchen sponges and dish rags
  • Toasters
  • Waffle irons  

One-Day Sample Menu

Breakfast – 2 scrambled eggs on corn tortillas, spinach, cheese, salsa, piece of fruit

Lunch – Greek salad (leafy greens, cucumber, tomatoes, kalamata olives, feta cheese, kidney beans, salmon, red wine vinegar, olive oil), piece of fruit

Snack – Greek yogurt and handful of berries

Dinner – Lentil vegetable soup

Following a strict gluten-free diet can be difficult. Consider meeting with a trained healthcare provider, such as a registered dietitian, to help navigate a gluten-free diet. 


Learn more about Gastroenterology at The Oregon Clinic