A Patient Guide to Gluten-free Living

Gluten-free diets have become popular in the last few years, even for those are are not gluten intolerant. Whether your patient truly has a gluten intolerance or celiac disease or they are simply cutting it out, there are many ways to easily substitute popular food items containing wheat and other gluten-containing grains. Helping patients find healthy and safe alternatives is key to supporting them to live a healthy lifestyle and decrease gastrointestinal symptoms, fatigue and inflammation associated with celiac disease.

About 1 to 2 percent of the population has celiac disease¹, which is an autoimmune form of gluten-intolerance. Those who have celiac disease cannot consume gluten or any food that has been cross-contaminated with gluten. About 6 percent of the population falls into the gluten intolerant category.

Gluten is a protein found in wheat, rye and barley. For those who are intolerant or have celiac disease, consuming gluten can cause inflammation in the gut leading to gas, bloating and diarrhea. You may hear patients ask about gluten, as wheat or rye may also be present in some oral medications. Most drug products contain 'no gluten' or 'virtually no gluten' and the starch flour used is potato or corn starch. The FDA released a document² for manufacturers to provide recommendations on how certain oral drug products should be labeled regarding gluten, a matter of interest to individuals with celiac disease.

The FDA website states that, "Based on information available to the Agency, we are aware of no oral drug products currently marketed in the United States that contain wheat gluten or wheat flour intentionally added as an inactive ingredient. We would expect any such product, if it existed, to include wheat gluten or wheat flour in the list of ingredients in its labeling."³

Gluten is found in many bread products, such as cereals, and pasta, as well as salad dressings, condiments and deli meats. Knowing which foods to avoid is paramount for reducing symptoms and improving quality of life.

Some foods to avoid:

• Wheat
• Rye
• Barley
• Malt
• Salad dressings containing gluten
• Puddings
• Condiments, like mustard or soy sauce
• Beer and malt beverages

Foods patients can eat:

• Quinoa
• Buckwheat
• Brown rice
• Corn grits
• Gluten-free oats
• Nuts and seeds
• Fruits
• Vegetables
• Beans and legumes
• Millet
• Dairy products

What should patients look for on food labels? Items will not necessarily say ‘gluten’ on the label. Look for anything that says wheat, rye, barley, malt, yeast or oats (unless gluten-free). Also look for the gluten-free label on the package. Since gluten-containing grains contain nutrients, make sure that your patient is speaking with a nutritionist, doctor or healthcare professional about creating a well-rounded diet.

How can one incorporate gluten-free grains?

• Add quinoa to soups or sprinkle over salads.
• Cook gluten-free grains for a breakfast cereal. Add fruit, nuts or cinnamon for some extra flavor and nutrients.
• Amaranth flour can be added to gravy or used to boost nutritional quality of baked goods.
• Teff can be used to make veggie burgers by combining cooked teff with beans or tofu, garlic, herbs and onions.
• Use gluten-free oatmeal to make muffins or cupcakes.

There are plenty of ways to live a gluten-free lifestyle without compromising on taste or missing out on your favorite foods. Being aware of what to look for on nutrition labels as well as what to avoid will help your patients decrease symptoms and enjoy eating!

References

• What is gluten? Celiac Foundation. https://celiac.org/live-gluten-free/glutenfreediet/what-is-gluten/. Accessed February 27, 2018.
• Gluten in Drug Products and Associated Labeling Recommendations. U.S. Food and Drug Administration. www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM588216.pdf. Accessed February 27, 2018.
• Medications and Gluten. U.S. Food and Drug Administration. www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/ucm410373.htm. Accessed February 27, 2018.