People with celiac disease need to avoid foods that contain gluten. Other people may do so because they have sensitivities or intolerances to this group of proteins.
People understandably associate gluten with grains, but a range of other foods, drinks, and products such as supplements can contain it.
Grains that contain gluten
- triticale, a hybrid of wheat and rye
- seitan, which is often used as a meat substitute
- wheat varieties and derivatives, such as: spelt, durum, couscous, semolina, farina, farro, kamut, einkorn, wheat berries, bulgur, wheat bran, wheat starch, wheat germ, emmer, and graham flour
Foods that usually contain gluten
- breads, including bagels, flatbreads, and pita
- pastas and some other noodles
- cakes, crackers, and biscuits
- pies and pastries
- some breakfast cereals
- breadcrumbs and coatings
- many meat substitutes
- malts, such as malt extract, syrup, flavoring, or vinegar
- brewer’s yeast
Food that may contain gluten
Check the list of ingredients or ask at a restaurant before consuming:
- french fries
- gravies and sauces
- salad dressings, marinades, and vinegars
- processed meats
- soy sauce
- potato or tortilla chips
- bars and similar snacks
- cereals and granolas
- egg dishes in restaurants
Alcoholic drinks that contain gluten include:
- malt beverages
- dessert wines
- wine coolers
However, gluten-free varieties of many of these drinks are available. Also, most distilled alcoholic beverages are gluten-free.
It is important to note that the following products can also contain gluten:
- medications, vitamins, and herbal supplements
- lipsticks and lip balms, which a person can easily ingest
- playdough, the toy
- communion wafers
Some otherwise gluten-free foods come into contact with gluten during preparation or processing — potentially making them unsuitable for people with celiac disease.
Common areas of cross-contamination include:
- cutting boards, toasters, and utensils
- shared food containers, which may hold butter, mayonnaise, or peanut butter, for example
- restaurants, such as pizzerias
- anywhere that foods are deep-fried
- oat production facilities
For people with celiac disease, research suggests that the usual threshold for gluten consumption 10 milligrams (mg) per day.
Having a diet with a gluten content of 20 parts per million (ppm) should put most people below the 10 mg threshold.
The amount of gluten in foods varies widely. “Gluten-free” products must contain fewer than 20 ppm of gluten, according to a Food and Drug Administration (FDA) ruling.
This means that to hit the 10 mg daily threshold, a person would have to eat 17 slices of gluten-free bread, if each slice contains 20 ppm. Or, for context, they could eat an amount of regular flour the size of a pen’s tip.
While the FDA have set guidelines about how much gluten many so-called gluten-free products can contain, there are no such rulings for alcoholic beverages or meat, poultry, or certain egg products, which are regulated differently.
As a result, anyone looking to limit their gluten intake needs to check labels carefully and consult staff at restaurants.
The following are some alternatives to products containing gluten:
- buckwheat, as groats or flour
- quinoa, as a grain or flour
- rice, as a grain or flour
- potato flour
- soy flour
- chickpea flour, which is sometimes called gram flour or besan
- corn, from cornflour to taco shells
- oats, but only those labeled gluten-free
- pastas made from lentils, peas, corn, rice, or buckwheat
- gluten-free breads, pastries, wraps, and sweet treats
- cauliflower, as a pizza base, for example
- zucchini, carrot, or squash noodles
People on gluten-free diets may also enjoy dishes that do not resemble those containing gluten and are rich in vegetables, fruits, and beans, and pulses.
Celiac disease is a serious health issue. It causes the immune system to attack the gut, and the resulting damage to the intestinal lining can prevent the body from absorbing enough nutrients.
For a person with this condition, it is crucial to avoid all gluten and take precautions against cross-contamination.
Other people experience health issues caused by eating gluten but do not fit the diagnostic criteria for celiac disease. In this case, a doctor may diagnose gluten intolerance or non-celiac gluten sensitivity.
If someone is unsure whether they have an allergy or intolerance to gluten, they can try eliminating foods containing gluten from their diet, to test whether their symptoms improve.
If after reintroducing gluten to the diet, the symptoms return, this is a good indication of a gluten sensitivity.
The symptoms of a sensitivity may include:
- abdominal pain
- joint and muscle pain
- chronic fatigue
- a headache
- brain fog
Anyone with these symptoms or other concerns should receive professional care.
A 2018 review suggests that a person’s tolerance to gluten may, in part, be determined by the composition of their gut bacteria and genetic factors.
The authors also noted that consuming processed gluten-free products may lead to a nutrient deficiency and a diet too high in trans fats and salt.
Avoiding gluten may seem daunting at first. However, many shops and restaurants now offer gluten-free options.
Also, many whole foods are naturally gluten-free, which may encourage a person to cook from scratch more often.
Planning meals and checking ahead when eating out can help prevent mishaps and limited choices.
Overall, it is important to be aware of cross-contamination and gluten in unexpected food and nonfood products. Anyone with symptoms of gluten intolerance should see a registered dietician or a doctor.