Celiac Disease

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What is Celiac Disease?

Celiac disease (CD) is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food.  When people with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine.  The tiny, fingerlike protrusions lining the small intestine are damaged or destroyed.  Because the body’s own immune system causes the damage, celiac disease is considered an autoimmune disorder and can also be classified as a disease of malabsorption because nutrients are not absorbed.

What is Gluten Intolerance?

It is a non-allergic and non-autoimmune digestive condition in which the consumption of gluten can lead to symptoms similar to those experienced in Celiac Disease or a wheat allergy. Most people have general complains of bloating, abdominal pain or diarrhea, as well as headaches, fatigue, and/or bone or joint pain.

What is Gluten?

Gluten is a protein found in wheat, barley, and rye.  It is the substance in flour that forms the “glue” that holds the product together.  In someone with Celiac Disease damage can be done to the intestine, which can then lead to decreased absorption of essential nutrients.  If left untreated, possible conditions can develop such as decreased bone density, iron deficiency anemia, unintentional weight loss, vitamin B12 and folate deficiency, and other autoimmune diseases.

Where is Gluten Found?

The grains containing gluten include wheat, rye, barley and all their derivatives.  These grains are used in items such as:  pies, pasta, cereals, pizza, cakes, cookies, and breads.

Avoid the following grains:

Barley maltGraham flourTriticale
BulgurMatzo flour/mealWheat
CouscousOrzoWheat bran
DurumPankoWheat germ
EinkornRyeWheat starch

Food Labeling Laws

Companies must identify in “plain English” the eight most prevalent food allergens including, fish, milk, peanuts, eggs, soybeans, tree nuts, shellfish, and wheat.  If wheat protein or a protein derived from wheat is used as an ingredient it must be declared in the allergy statement.  The law does NOT declare oats, rye, barley (malt) or gluten.  If the label does not indicate in the allergy statement that wheat has been used, you must still read the list of ingredients for other gluten containing grains.

Be sure to read all labels carefully.  Avoid all questionable products until the manufacturer confirms that the product is gluten-free (GF).  All food-manufacturing companies have a 1-800 phone number to call with questions about gluten.  Ingredients in a product can change at any time.  The following questions may be helpful in determining if a specific product contains gluten:

  • What is the source of starch in your modified food starch?
  • What natural flavorings are used?
  • What is the source of the vegetable gum?
  • Ask for a supervisor if necessary

Some companies cannot guarantee if the product is gluten-free if other gluten-containing foods are processed in the same manufacturing plant.  This is due to cross-contamination within the plant.

What about Oats?

The protein found in oats may not be harmful to most people with CD but there is a concern as the oats may be contaminated with wheat during the milling and processing.  Please consult your physician or dietitian before adding oats to your child’s diet.

What Can the Patient with Celiac Disease or Gluten Intolerance Eat?

There are many foods that will fit into your child’s diet that are naturally gluten-free and taste good.

Recipe for Peanut Butter Cookies

1 cup sugar

1 large egg, slightly beaten

1 teaspoons baking soda

1 cup peanut butter

Combine and shape into 1-inch balls, place on ungreased cookie sheet and crisscross top with fork.  Bake at 350 degrees for about 10 minutes.

Celiac Sprue Association

Gluten-free grains and starches

AmaranthPotato flour
CornRice bran
Flours made from nuts,beans and seedsSorghum
MilletSoy (soya)
Montina ™Tapioca
Potato starchTeff

NOTE:  Distilled vinegars are gluten-free, as all distilled products do not contain any harmful gluten proteins.  Malt vinegar is not distilled and does contain gluten.

How do I start a Gluten Free Diet?

At Home

Start the new diet by looking at the foods you already have in your home.  Many of your favorite brands may already be gluten-free.  Begin to plan your meals to include naturally gluten-free foods.  Make a grocery list to help you stay on track at the store.   Try the following meal suggestions:


  • Cottage cheese with apples and cinnamon
  • Fruit and yogurt smoothies
  • Cream of rice cereal with nuts, seeds, or dried fruit
  • Eggs, cheese and veggie omelet with fresh fruit

Lunch and Dinner

  • Loaded baked potatoes with cheese and veggies
  • Meat/veggie fajitas or quesadillas made from corn tortillas
  • Tuna fish on mixed greens with fresh fruit
  • Stir-fry meats, poultry, seafood and chopped vegetables served over brown rice.
  • Beef or chicken kabobs on rice and ice cream.


  • Rice cakes or rice crackers with cheese or peanut butter.
  • Baked apple
  • Pudding, ice cream or yogurt topped with berries and whipped topping.
  • Popcorn
  • String cheese
  • Nachos made from corn chips with melted cheese and salsa.
  • Celery sticks with cream cheese, peanut butter or cheese spread.

At the Grocery Store

Shop the perimeter of the store.  This is where you will find most foods that are naturally gluten-free.  Stock up on nutrient rich, low, fat, low-sodium fruits and vegetables.  Fresh meats are normally gluten-free so buy fresh, seafood, poultry and meat.  Luncheon meat and other processed meats may contain gluten as filler or  flavor enhancers.  Be sure to read labels carefully.   The dairy section contains many gluten-free items such as yogurt, pudding, and milk.

Within the inner aisles of the grocery store, look for:

  • Spices and herbs
  • Dried beans and legumes
  • Corn tortillas
  • Plain rice
  • Cooking oils (canola and olive oil)
  • Peanut butter


Check out the “health food” or “organic” section of your grocery store for items such as GF baking products, flours and pasta.  Specialty health food stores also offer larger varieties of GF foods.  Look in the Asian section for rice noodles and crackers.

At School

Meet with key school employees, such as the teacher and the school nurse.  Provide them with written material about CD and GFD.  Let them know the symptoms your child has when he/she eats gluten.

Provide a list of GF foods/snacks to the school and other caretakers.  Remind them not to change from the list unless they check with you first.

  • Write a letter to the room mothers. Ask to be notified of any activities involving food.
  • Keep a tin of GF treats at school
  • Check on craft projects that may involve flour. Gluten is not absorbed through the skin, but children frequently put their hands and other objects into their mouths.

Eating Away From Home

With a little effort, you can continue to enjoy dining out in restaurants.  Here are a few tips to avoid getting sick.

  • Most restaurants have a website with a menu online. Some restaurants have GF menus or a list of common food allergens utilized in making their foods.
  • Always identify yourself as someone that cannot eat wheat, rye or barley.
  • Visit the restaurant before peak dining times.
  • Call ahead and talk to the manager or chef to inquire about specially prepared items that are GF.
  • Do not be afraid to ask how the food is prepared. Meats may be marinated in soy sauce.  French fries may be made in the same fryer as other breaded products.  Hamburgers and hamburger buns may be grilled in the same area.
  • Be pleasant and informative, but not demanding.

Bring your own GF bread or crackers.

Food Preparation and Cross-Contamination

To avoid contaminating your food at home with gluten, follow these suggestions:

  • Purchase a separate toaster for gluten-free breads or place aluminum foil on the rack to avoid contamination.
  • Purchase separate jam, jelly, peanut butter, and mayonnaise to avoid breadcrumbs in the shared jars.
  • Carefully clean all cooking utensils, pots/pans, and colanders before and after each use.
  • Clean counter tops and cutting boards often to remove gluten-containing crumbs.

Overlooked gluten sources:

AlesBeer and lagers


Brown rice syrup

Coating mix

Communion wafers



Luncheon meats





Soup base

Envelope glue

StuffingSelf-basting poultry

Imitation bacon/seafood

Soy sauce

Marinades, Thickeners

Herbal Supplements

Prescription Medications



Vitamin and Mineral



Gloss and Balms

Play Dough


Medications    www.glutenfreedrugs.com

Possible sources of gluten in medications include:

  • Starch, pre-gelatinized starch
  • Sodium starch glycolate
  • Dextri-maltose
  • Dextrin
  • Maltodextrin

Vitamin Supplements

Damage done to the intestinal lining can lead to decreased absorption of B-vitamins, iron, folate, and calcium.  A vitamin/mineral supplement may be necessary.  Many gluten-free foods are not fortified with B-vitamins and iron like their gluten-containing counterparts.  Be sure to select a vitamin/mineral supplement that is gluten-free and meets 100% of the recommended daily allowance (RDA).  Most nutrients can be obtained through a well-balanced diet.

Gluten Free Does NOT Mean it’s Good for You!

There are many specialty companies that produce good gluten-free foods.  Although they taste good, the ingredients may not be a healthy alternative.  Good nutrition includes foods that are:

  • Low in fat and calories
  • Rich in calcium and fiber

Family Support

Family support is very important.  All family members should be aware of GF dietary requirements and become involved in both grocery shopping and meal preparation.  For younger children, have only their gluten-free foods accessible.  Encourage non-CD children to not share their food.  Parents must set a good example and be very supportive of their CD child.

Should Other Family Members Be Tested?

First-degree relatives of patients with CD should undergo serological testing and a gastroenterologist should further evaluate family members with positive blood test results.

Celi-ACT Support Group

The sudden dietary and lifestyle change may induce certain feelings of fear and confusion.  Our practice sponsors a support group, which was established by Dr. Al-Tawil, for those with Celiac Disease. Families with children who have this disease benefit greatly from the support and information provided through this group.  For more information contact Celiactgiforkids@gmail.com and review the information on the support group’s website: www.Celi-Act.com. 

Sample one-day menu:


Orange Juice

Cream of rice cereal


Gluten-free toast with jelly or margarine



Tomato juice

Hamburger on gluten-free bread with pure mayonnaise, tomato and lettuce

Fresh fruit salad




Tossed salad with pure oil and vinegar dressing

Broiled chicken breast

Herbed brown rice

(not from a mix)

Steamed broccoli

Gluten-free bread with margarine

Orange sherbet



Rice cakes


Fruit juice


Mosaic and scalloping