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A Guide for Parents
 Children's Hospital BostonCeliac Disease Support Group |
If your teen has celiac disease or gluten intolerance and has been told by a health care provider to follow a gluten-free diet, you may feel overwhelmed. However, you will be relieved to know that in recent years, as more people have been diagnosed with celiac disease, following a gluten-free diet has become easier. Gluten-free foods are now carried in most major grocery stores and on-line. This guide was created to help you and your family better understand the restrictions of a gluten-free diet, 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. It is the gluten in these foods that make them chewy and gives them the elastic texture.
Why would someone need to follow a gluten-free diet?
Anyone with celiac disease should 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, irregular periods, delayed growth, and delayed onset of puberty. Some teens will have almost no noticeable symptoms, but their doctor may detect low bone density.
Following a gluten-free diet will prevent harm to the small intestine and decrease the symptoms of both celiac disease and gluten intolerance.
What foods should my teen avoid?
If your teen’s health care provider has told her to follow a gluten-free diet, she should avoid all foods containing wheat, barley, rye, and sometimes oats as well as foods that contain any of the following grains:
Oats may contain gluten. Oats are often processed in the same factories as wheat, so, they are not always gluten-free. To find out if a certain brand of oatmeal is gluten-free, call the company or check their website.
Foods that contain any of these ingredients are considered “red light foods”, because they contain gluten and should be avoided by teens following a gluten-free diet. Foods that commonly contain these ingredients include breads, bagels, rolls, crackers, pretzels, pasta, pizza, flour tortillas, cereals, pancakes, waffles, cookies, cake, ice cream cones, licorice, beer, soy sauce and malts (unless the food is clearly labeled “gluten-free”).
What foods are safe to eat on the gluten-free diet?
While most breads, pastas, cereals and baked goods contain gluten, many foods are naturally gluten-free, including milk, butter, cheese, fruits and vegetables, fresh meats, fish, poultry, eggs, beans, nuts, seeds, corn and rice. Additionally, there are many grains and flours that are also naturally gluten-free which can be used to make breads, cereals, pastas, snacks and baked goods. These grains and their products are considered “green-light foods”, as they are safe to eat on the gluten-free diet and generally will not cause symptoms. They include:
Amaranth |
Pea Flour |
Arrowroot |
Potato Flour |
Bean Flours |
Potato Starch |
Buckwheat |
Quinoa |
Carob Flour |
Ragi |
Corn Flour |
Rape |
Corn Meal |
Rice Flours |
Cornstarch |
Sago Flour |
Kasha |
Sorghum |
Kudzu Root Starch |
Soy Flour |
Maize |
Tapioca Flour |
Masa Flour |
Tarrow Root |
Millet |
Teff Flour |
Montina Flour |
Yam Flour |
Nut Flour |
How can I tell if a food is gluten-free?
In 2006, a new food allergen labeling law came into effect that requires food companies to label all foods that have wheat or wheat products in them. This is great news for people who must follow a gluten-free diet, because it makes identifying “red-light foods” much easier. To figure out if a food is gluten free, you need to read the allergy statement found at the end of the ingredient list on all packaged foods. If an allergy statement reads “contains wheat ingredients”, it is a “red-light food”. The food labeling law does not cover barley, rye, or oats, so if the allergy statement does not include wheat, you should next read through the ingredient list to look for the words rye, ale, barley, beer, bran, brewers yeast, brown rice syrup, malt, malt flavoring, malt vinegar, or dextrin. If you don’t see any of these words in the ingredient list, then the food is most likely a “green-light food”. If you want to make sure the food is gluten-free, call the food company or look on their website.
To help you identify gluten-free foods, please see the sample ingredient label below, in which the ingredients are circled in red, and the allergy statement is circled in blue. This food, which contains whole grain wheat, is a “red-light food”.
Reading food labels is very important, because ingredients can change without notice, and often without a noticeable difference in the packaging. Remember to check products such as toothpaste, lipstick, vitamins, and medications.
How can we identify foods that contain gluten?
In 2006, the Food Allergen Labeling and Consumer Protection Act came into effect, which requires food companies to label all foods that contain the eight most common allergens, including wheat. This is great news for people who must follow a gluten-free diet, because it makes identifying “red-light foods” much easier. Now, in order to determine if a food contains gluten, you should first read the allergy statement found at the end of the ingredient list on the back of all packaged foods. If the food contains any wheat-based ingredients, the allergy statement will read “contains wheat ingredients”. If the allergy statement does not include wheat, you should read the ingredient list. Look for other gluten-containing grains and products including rye, barley, bran, malt, malt flavoring, malt vinegar, or dextrin. If none of these words appear in the ingredient list, the food is most likely gluten-free. However, the best way to determine if a particular product is gluten-free is to call the food manufacturer or look on their website. By law, food manufacturers must list their contact information on the back of all packaged foods.
How can I make my kitchen gluten-free?
There are two ways to approach your kitchen after your child has been told to follow a gluten-free diet. Some families choose to make their kitchen completely gluten-free. Others choose to keep gluten in their kitchen while making it safe for their gluten-free teen. Both approaches are challenging but necessary, as foods and their preparation must be gluten-free in order to prevent cross-contamination with gluten-containing grains. If you choose to make your kitchen gluten-free, you must throw out all gluten containing foods and sanitize all cupboards, cooking equipment and utensils. If you choose to make your kitchen partially gluten-free, try some of the following tips:
Where can I buy gluten-free foods?
Eating and cooking gluten-free has become so much easier 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.
The following brands have a great selection of gluten-free foods which can be purchased directly from their websites:
Shopping for gluten-free foods at the grocery store: When shopping at your local grocery store, it is important to remember that most of the fresh foods found along the perimeter of the store including fruits, vegetables, meat, poultry, fish, and dairy are naturally gluten-free. Additionally, rice, beans, peanut butter, nuts, cooking oils, and corn and rice cereals are also typically gluten-free. Many grocery chains also carry the gluten-free brands mentioned above. These products are commonly found in the aisles that contain natural and organic foods.
Gluten-free Grocery List
Dairy
Milk
Cheese
Yogurt
Fruit
Apples
Bananas
Orange Juice
Vegetables
All vegetables
Cereals & Grains
Corn Tortillas
Rice Chex® Cereal
Brown Rice
Tortilla Chips
Envirokidz® Rice Bars
Van’s® GF Waffles
Meats, Poultry, & Fish
Bell & Evans® GF Chicken Nuggets
Canned Tuna
Ground Beef
Boar’s Head® Luncheon Meats
Eggs
Snacks & Desserts
Lays® Classic Potato Chips
Fritos® Original
Fruit Snacks
Ice Cream
Popcorn
Condiments & Seasonings
Salsa
Peanut Butter
Jelly
Ketchup
Pancake Syrup
Hummus
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:
| Applebee’s | Legal Sea Foods |
| Burger King | Outback Steakhouse |
| McDonalds | PF Chang’s China Bistro |
| Taco Bell | Pizzeria Uno |
| Wendy’s | Maggiano’s Little Italy |
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 Children’s Hospital Boston is a wonderful resource for families, and has great recipes as well as cookbook suggestions.
Click here for gluten-free recipes
Click here for gluten-free cookbooks
The following gluten-free recipes are from the Center for Young Women’s Health "Quick and Easy Recipes for Teens" cookbook:
Banana Nut Smoothie
Ingredients:
Preparation:
Makes 4 Servings
Chicken Stir Fry
Ingredients:
Preparation:
Makes 6 Servings
What else do I need to know about the gluten-free diet?
No amount of gluten is “safe”. If your teen’s health care provider has told her to follow a gluten-free diet, it is important to keep her diet completely gluten-free. Even a little bit of gluten can cause symptoms and damage the small intestine.
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. Additionally, some of the gluten-free foods can be high in calories and sugar. If your teen must follow a gluten-free diet, it is best to meet with a nutritionist to develop a healthy, balanced diet and to identify if any vitamin or mineral supplements are necessary.
There are many hidden sources of gluten.
Updated 2/6/2008
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