Gluten-Free Diet: A Guide for Parents

Young women's version of this guide
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Gluten FreeYou may have heard about the gluten free diet on TV or read about it in a magazine or online. Despite what some people may think, the gluten–free is not a weight loss diet. The gluten–free diet is a diet recommended by a health care provider for people who have been diagnosed with celiac disease, an autoimmune disorder that’s triggered by gluten, or with non-celiac gluten sensitivity. If your teen has been diagnosed with celiac disease, he must follow a gluten–free diet to heal his body. This guide was created for you and your family to help navigate the gluten–free diet including how to avoid gluten, how to identify gluten–free foods, and how to adapt to a gluten–free lifestyle.

What is Gluten?

Gluten is a protein complex found in the grains wheat, barley, and rye. Flours made from these grains are commonly used to make foods such as breads, cereals, pasta, pizza, and baked goods. The gluten in these foods gives them the elastic texture and it helps provides the structure of the food.

Why would someone need to follow a gluten–free diet?

Anyone with celiac disease should follow a gluten–free diet. If your teen’s health care provider tells him that he has gluten sensitivity he should also follow a gluten-free diet.

What is Celiac Disease?

Celiac disease is an autoimmune disorder that is triggered when gluten–containing foods are eaten. An autoimmune disorder is one in which the body’s immune system attacks an organ. When a person with celiac disease eats a food with gluten in it, the immune system launches an attack against the small intestine which damages the lining of the intestine and decreases nutrient absorption. Noticeable symptoms of celiac disease include diarrhea, abdominal pain, weight loss, nutritional deficiencies, anemia, poor appetite, delayed growth, and delayed onset of puberty. Some teens will have almost no noticeable symptoms, but their health care provider may detect low bone density.

Image of A. In a healthy person, nutrients get absorbed by villi in the small intestine and go into the bloodstream., B. In a person with Celiac Disease, the villi have been damaged by inflammation, so fewer nutrients pass into the bloodstream.

Gluten is harmful for someone with celiac disease. Following a gluten–free diet prevents harm to the small intestine and allows it to heal. The gluten–free diet should stop your teen’s symptoms of both celiac disease and gluten intolerance.

What is gluten sensitivity?

Gluten sensitivity, also called non-celiac gluten sensitivity or gluten intolerance, can be diagnosed if a person does not have celiac disease or a wheat allergy (both of these tests are negative) but they have some similar symptoms and they feel better when they are on a gluten-free diet. While someone with gluten sensitivity will have similar symptoms as a person with celiac disease, they do not have the same intestinal damage. It is unclear whether people with gluten sensitivity need to be as strict about adhering to a gluten-free diet. There is no definitive test for gluten intolerance. If you think that your teen might have celiac disease (or an allergy to wheat or gluten sensitivity), he should consult with a medical professional rather than simply avoiding gluten. A health care provider will want to have testing done while he is still eating gluten in order to give him the best medical care.

What foods should my teen avoid?

Following a gluten–free diet means your teen should completely avoid all foods that contain gluten. Foods that contain gluten are “red–light foods” for anyone with celiac disease. To eliminate “red–light foods”, your teen should:

  • Remove grains that contain gluten from his diet. He should not eat any food that contains wheat, barley, or rye. Keep in mind that wheat has many forms. He should avoid products that include bulgur, durum, graham, kumut, spelt, and semolina. These are all forms of wheat!
Whole Grain

If you ever see this label on package, it tells you that the product contains wheat and isn’t gluten free.

  • Look for “hidden” sources of gluten. Your teen should NOT eat foods that have gluten–containing ingredients listed in certain products such as: ale, barley, beer, bleached flour, bran, bread flour, brewer’s yeast, brown flour, brown rice syrup, bulgur, couscous, dextrin (unless source gluten-free), durum, farina, farro, hydrolyzed vegetable (wheat) protein, gluten flour, graham flour, granary flour, groats, harina, kumut, malt, malt extract, malt syrup, malt vinegar, matzo, modified starch (unless source gluten-free), rye, orzo, semolina, self–rising flour, spelt, smoke flavoring, soy sauce, triticale, wheat germ, wheat and white flour, whole meal flour, and vegetable gum.
  • Your teen should not eat any obvious gluten containing foods such as: bagels, breads, beer, cakes, candy, cereals, crackers, cookies, dressing, flour tortillas, gravy, ice cream cones, licorice, malts, rolls, pretzels, pasta, pizza, pancakes, sauces, stuffing, soy sauce, veggie burgers, vegetarian bacon/vegetarian chicken patties (many vegetarian meat substitute products contain gluten) and waffles. Please note this is NOT a complete list.

Why should my teen omit barley from his diet?

Barley contains gluten and is frequently used to make malt. This is often used as a sweetener flavoring. As a general rule you should avoid natural or malt flavorings. If there are foods your teen likes to eat that contain “natural” or “malt” flavorings on the ingredient list, contact the company to see if these flavorings came from a non–gluten source.

Does my teen need to avoid oats?

Oats may contain gluten because they are often processed in the same factories as wheat. It’s best to check with your teen’s health care provider to see if he can eat traditional oats or if you need to look for certified gluten-free oats. To find out if your teen’s favorite brand of oatmeal is gluten-free, call the company of check their website. Some brands, such as Bob’s Redmill, Glutenfreeda, and GF Harvest make oatmeal that is certified gluten-free. When eating out or when in doubt, avoid oats.

What foods are safe to eat on the gluten–free diet?

Many foods are naturally gluten–free, including milk, butter, cheese, fruits and vegetables, fresh meats, fish, poultry, eggs, beans, nuts, seeds, corn, quinoa and rice. While most breads, pastas, cereals and baked goods contain gluten, there are several grains and flours that are also naturally gluten–free which can be used to make breads, cereals, pastas, snacks and baked goods – and many pre-made products on the market are made from these grains and flours. Think of these grains and their products as “green–light foods” which are safe to eat on the gluten–free diet.

These “green–light grains” include:

  • Amaranth
  • Arrowroot
  • Bean Flours (such as garbanzo or romano)
  • Brown Rice Flour
  • Buckwheat
  • Casava Flour
  • Carob Flour
  • Corn (Maize), Corn Flour
  • Corn Meal
  • Cornstarch
  • Kasha (roasted buckwheat kernels)
  • Kuzu Root Starch
  • Masa Flour
  • Millet
  • Montina Flour
  • Nut Flour (almond, pecan)
  • Potato, Potato Flour
  • Pea/lentil Flour
  • Potato Starch
  • Quinoa, Quinoa Flakes
  • Rice bran
  • Rice (brown, white, wild)
  • Sago Flour
  • Sorghum flour
  • Tapioca Flour
  • Taro Root
  • Teff, Teff Flour
  • Yam/Sweet Potato Flour

How can I tell if a food is gluten–free?

  • A product labeled “gluten-free,” “no gluten” or “without gluten” is the fastest and easiest way to identify a gluten–free product. Manufactures can use these terms if they comply with the FDA rule “gluten-free.”
  • Another way to tell if the product contains gluten is to read the allergen statement on packaged foods.The FDA’s food allergen labeling law requires food companies to label all foods that have wheat or contain wheat products. The allergen statement is found at the end of the ingredient list on packaged goods. Read the allergen statement, if it says “contains wheat,” this means it has gluten and it is a “red–light food.”
  • The food labeling law does NOT cover barley, rye, or oats. This means if the allergy statement does not include wheat, you need to then read through the ingredient list for all of the other possible sources of gluten. If you don’t see any of those words in the ingredient list, then the food is most likely a “green–light food.”

In the sample ingredient label below, the ingredients are circled in red, and the allergy statement is circled in blue. The food, which contains whole grain wheat, is a “red–light food”.

image of an ingredients label, highlighting the ingredients list and allergy statement

gluten-freeThere is also a symbol that may appear on packaging of gluten free foods, which the Gluten Intolerance Group has deemed “Certified Gluten Free.” This symbol represents that the food manufacturer has applied for and been granted certification of the product’s status of gluten-free, by submitting test results showing that there is no gluten contained in the product.

You might notice that some food labels have the following statements and are unsure whether or not your son should eat them. When in doubt, ask your child’s dietitian or medical provider, but in general:

  • “May contain traces of wheat” – AVOID
  • “Made on shared equipment with wheat ingredients” – AVOID
  • “Manufactured in a facility that also processes wheat ingredients” – OK

How can I make my kitchen gluten–free?

There are two basic approaches to preparing gluten-free food in your kitchen when your teen must follow a gluten-free diet. Both approaches present different challenges, but both allow for your teen to safely eat gluten–free.

Some families choose is to make their kitchen completely gluten–free. This approach requires you to throw out all gluten containing foods and sanitize or purchase new cupboards, cooking equipment, and utensils.

Other families choose to keep gluten containing products in their kitchen while adhering to safe food storage, preparation, and cooking practices for their gluten–free teen. If you’re planning on keeping foods with gluten in your kitchen make sure you minimize the risk of gluten cross–contamination.

Here are some great tips to decrease the chances of gluten cross–contamination in your home kitchen:

  • Keep gluten–free products in a separate cabinet
  • Store gluten–free foods in airtight containers
  • Store gluten–free flours and baking mixes in airtight containers in the freezer
  • Buy separate butter, peanut butter, cream cheese, and other spreads (to prevent contamination with wheat bread crumbs)
  • Use separate colanders, sponges, strainers, toaster ovens, bread machines, towels, dish rags, and wooden utensils for gluten–free cooking
  • Clean counter tops, cutting boards, measuring cups and spoons, the microwave, pot holders, and baking pans well and often
  • Wash all shared utensils before and after each use

Where can I buy gluten–free foods?

Eating and cooking gluten–free has become much easier than in the past as more companies now make gluten–free foods. You can purchase gluten–free breads, rolls, pizza–crusts, buns, bagels, donuts, cookies, muffins, pretzels, cereals, and desserts online or in most major grocery stores.

Here are some brands that carry gluten-free products:

 

How do I shop for gluten–free foods?

Many grocery chains carry the gluten-free brands mentioned above. The products are commonly found in the aisles that contain natural and organic foods or they may even have their own section, labeled “gluten free foods.” It’s also important to remember that most of the fresh foods found along the perimeter of the store (outside aisles) including fruits, vegetables, meat, poultry, fish, and dairy are naturally gluten–free. Rice, beans, peanut butter, nuts, cooking oils, and corn and rice cereals are also typically gluten–free.

Watch for possible gluten cross–contamination. This means foods that have gluten in them that have come in contact with gluten-free foods. Be aware of gluten cross–contamination at deli’s, buffets, and salad bars.

Gluten–Free Grocery List

How can my child stay gluten–free while eating away from home?

The best way to help your child stay gluten-free when away from home is by planning meals and snacks ahead of time. That may sound challenging, but these tips can make it easier:

  • Encourage your teen to eat breakfast at home or pack him a gluten-free breakfast to eat at school or on-the-go.
  • Work with your teen, his nutritionist and/or school nurse to find gluten-free foods on the school breakfast and lunch menus.
  • Help your teen pack a gluten-free lunch in an insulated bag to eat at school or on-the-go.
  • Buy gluten-free snacks such as fruit, cheese sticks, trail mix, snack bars, popcorn or nuts that he can eat away from home.

If you are planning to go out to eat at a restaurant with your teen, either choose one that has a gluten-free menu or speak with the restaurant manager to identify gluten-free menu items before ordering. Remember to tell the manager or chef that both the meal and its preparation must be gluten-free. More and more restaurants are gluten-free friendly and making it known on the menu. However, because “gluten-free” in some instances is seen as a trend rather than a medical necessity, it is important to tell the server or manager your level of sensitivity rather than just ordering something labeled gluten-free.

Some restaurants are easily able to make modifications to meals even if they do not have a separate gluten-free menu. When in doubt, always ask, even if the meal appears to be gluten free on the menu; usually not all ingredients are listed on a menu.

Hidden sources of cross-contamination at restaurants include using the same pans and utensils to bake gluten-free bread, using the water from boiling pasta to steam vegetables, and adding bread or flour to thicken soups.

 

Where can I find gluten–free recipes?

The best resources for gluten-free recipes are the internet and gluten–free cookbooks. The GI department at Boston Children’s Hospital is a wonderful resource for families, and has great recipes as well as cookbook suggestions.

The following gluten–free recipe is from the Center for Young Women’s Health “Quick and Easy Recipes for Teens” cookbook:

Banana Nut Smoothie

 

What else do I need to know about the gluten-free diet?

A gluten-free diet is not always a healthy diet. Some people who follow a gluten-free diet may not get enough of certain nutrients, vitamins and minerals in their diet such as fiber, iron and calcium. Also, some gluten-free products can be high in calories and sugar. If your teen must follow a gluten-free diet, it’s best to meet with a nutritionist to develop a healthy, balanced diet and to identify if any vitamin or mineral supplements are necessary. It is not suggested that people follow a gluten-free diet if not medically necessary.

There are many hidden sources of gluten both in food and non-food products. Gluten is also found in foods such as candy, sauces, soups, and marinades. Remember to check products such as toothpaste, mouthwash, lipstick/gloss, stamps/envelopes, glues, supplements, vitamins, and both prescription and over the counter medications. These are frequently overlooked sources of gluten.

  • Medications: Both prescription and over-the-counter medications may contain gluten. For over-the-counter medications, check with your pharmacist. With prescription medications, ask your child’s health care provider to specifically state, “Medication must be gluten-free” on any prescriptions.
  • Envelopes: Envelopes may have a gluten-containing adhesive. Your teen use self-adhesive versions or use a sponge to wet the adhesive.
  • Soaps, Shampoos, and Lotions: Many of these products contain wheat or oat. While gluten cannot be absorbed through the skin, it is important to be aware of this, especially if your teen has a habit of biting his finger nails or touching food after putting on lotion.
Boston Children’s Hospital Celiac Disease Support Group: More information here