Gluten-free diet

Alternative names
Celiac disease - nutritional considerations; Gluten sensitive enteropathy - diet; Celiac sprue - diet


Celiac disease is an inherited autoimmune disease that usually affects several organs in the body before diagnosis and treatment. When a person with celiac disease consumes any food, beverage, or medication containing wheat, barley, rye, and possibly oats, their immune system is “triggered” and responds by damaging the lining of the intestinal tract.

As a result, the absorption of nutrients is altered and the risk of developing other autoimmune disorders, infertility, miscarriage, neurological conditions, osteoporosis, and certain types of cancer is increased.

The symptoms of untreated celiac disease can be intestinal in nature (such as constipation, recurrent abdominal pain, bloating, diarrhea, weight loss, lactose intolerance, malnutrition) or seemingly non-intestinal (anemia, fatigue, muscle cramps, bone and joint pain, mouth ulcers, irritability, seizures, depression). Some people have no symptoms whatsoever. Lactose intolerance is common upon diagnosis and typically resolves after treatment.

Blood work screening is usually the first step in making a diagnosis. The diagnosis can be confirmed by conducting an endoscopy (EGD) with biopsy samples. The disease can first develop at any point in life from infancy to late adulthood. The cause for the disease is unknown.

There is no known cure at this time but there is an effective treatment - the gluten-free diet. This diet, when followed stringently, is effective because it eliminates the “triggers,” thereby preventing symptoms and manifestations of the disease.

Food Sources

Staples of the gluten-free diet include:

  • fruits and vegetables  
  • meat  
  • milk-based items  
  • potatoes, rice, corn, beans  
  • cereals made without wheat or barley malt  
  • a wide variety of specialty foods (such as pasta, bread, pancakes, and pastries) made with alternative grains (rice, tapioca, potato, or corn flours and starches)

Such products can be purchased through local and national food companies, or can be made from scratch using numerous alternative flours and grains.

The gluten-free diet involves eliminating all foods, beverages, and medications made from the offending grains. This means all items made with flour (all-purpose, white, wheat) are prohibited - including pasta, bread, buns, pancakes, bagels, waffles, pizza, cakes, cookies, pie, most cereals, breaded foods, stuffing, gravies, crackers, most soups, and most convenience foods.

These are the obvious sources. Far less obvious foods that must be eliminated include communion host, many sauces such as teriyaki and soy, some salad dressings, beer, marinades, croutons, and some candy. Further complicating the diet is risk of cross-contamination. Items that are naturally gluten-free may share transportation, a production line, a fryer, or a grill with a grain such as wheat, thereby contaminating a product which would have been safe otherwise.

Restaurant eating and social gatherings pose an additional but manageable challenge. Calling ahead and special planning become important measures. Label reading becomes a frequent, essential task due to the widespread use of wheat and barley in foods.

Despite its challenges, maintaining a healthy, balanced diet is achievable with education and planning.


Upon diagnosis, it is very important for a person with celiac disease to seek consultation from a registered dietitian with a specialty in celiac disease and the gluten-free diet.

Joining a local support group is also recommended. (See celiac disease support group.) Given the challenging nature of the gluten-free diet, people with celiac disease can share practical advice on ingredients, baking, and mechanisms for coping with this life-altering, life-long disease.

A multiple vitamin and mineral, or individual supplemental nutrient, may be prescribed to correct or prevent deficiency.

Johns Hopkins patient information

Last revised: December 4, 2012
by Janet G. Derge, M.D.

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