Pediatric Celiac Center (847) 723-7176 www.advocatechildrenshospital.com Thank you to the Men's and Women's Association of Advocate Lutheran General Hospital for the donation of this printing. Quick Start Gluten-Free Diet The Gluten-Free diet is the only medical Gluten-Free treatment for Celiac Disease. • Potatoes • Rice Celiac disease is an autoimmune disease, • Corn which is triggered by gluten. The • Corn tortillas autoimmune response causes damage to • Corn chips the small intestine and food is not properly • Plain potato chips absorbed. Some people have symptoms • Quinoa such as stomach aches and diarrhea. Other • Nuts people have no symptoms at all. • Beans Labels must be read carefully. • Fruits Avoid these words on food labels: • Vegetables Wheat • Plain fresh or frozen meats, fish and Barley poultry Rye • Milk Malt (malt flavoring, malt extract, • Most yogurt malt vinegar) • Most lunch meats Oats (unless labeled gluten free) • Cheese • Juice Contains Gluten • Most soft drinks • Most ice cream Regular: breads, pasta, pretzels, crackers, • Popcorn cookies, brownies, pies • Lemonade White or wheat tortillas • Ketchup Breaded meats such as chicken nuggets • Most mustard Soy sauce • Most spices Most meat loaf, meatballs (contain • Soy breadcrumbs) • Peanut butter Malt vinegar • Corn meal Most veggie burgers • Coffee Ice cream cones • Tea Most restaurant French fries (cooked in • Tapioca same fryer with breaded items) • Millet Licorice • Arrowroot • Plain chocolate Gluten-free foods must be prepared separately from gluten containing foods. A separate toaster for gluten-free bread is needed as well as separate butter, peanut butter, and jelly containers. Gluten-Free Diet 1 What is Celiac Disease? Celiac disease is an autoimmune, digestive disease that damages the small intestine and interferes with the absorption of nutrients. It is one of the most common inherited autoimmune diseases. It is estimated that 1% or 1: 133 people have celiac disease. All first and second degree relatives should also be tested. The gluten-free diet is designed to decrease symptoms such as: abdominal distension, diarrhea, steatorrhea and weight loss often associated with ingestion of foods containing gluten, a protein found in wheat, rye and, barley. Also, to interrupt the autoimmune process triggered by gluten. There are many, many different symptoms for celiac disease. Many people have “silent celiac disease”, with no obvious symptoms; however, there is still damage to the small intestine. A strict gluten-free diet is a very effective treatment for celiac disease. It helps to relieve symptoms and prevent future complications. The Gluten-Free Diet The gluten-free diet is the only treatment for celiac disease and dermatitis herpetiformis (DH). There are no medicines or other medical treatments for celiac disease available at this point in time, though some possible treatments are being researched. The consequences of continuing to eat gluten containing foods include increased risk of lymphoma, infertility, nutrition deficiencies, osteoporosis and triggering other autoimmune diseases. Nutrition management includes the gluten-free diet along with a gluten-free multivitamin and iron supplement, if needed. Life-long elimination of gluten-containing products is required, even when symptoms have subsided. Medications Some use gluten as the filler for tablets and capsules. Ask your pharmacist and/or contact manufacturers. This includes over the counter as well as prescription medicines and vitamins. The website www.glutenfreedrugs.com is a helpful resource. Food labeling laws do NOT apply to medicines. 2 August 2014: Gluten-Free Food Labeling Final Rule: Food may be labeled gluten-free if it is 1) inherently gluten-free or does not contain any of the prohibited grains : wheat, rye or barley 2) The final food product meets the standard of <20ppm of gluten. This is considered a safe threshold of unavoidable gluten through cross contact. 3) Ingredients derived from a gluten-containing grain that has been processed to remove gluten and final product contains <20ppm The gluten-free food label regulation applies to FDA regulated foods only and is VOLUNTARY. Allowed legal terms: gluten-free No gluten Free of gluten Without gluten (other terms such as “made without gluten containing ingredients” are not regulated.) *processed to allow this food to meet FDA gluten-free requirements” (This is for hydrolyzed, fermented or distilled foods) This symbol is helpful to look for on packages. This represents certificatoin by the Gluten Intolerance Group of North America. These items are tested at < 10ppm of gluten. Food Allergen Labeling and Consumer Protection Act (FAL CPA) January 1, 2006. Per this law wheat (not barley or rye) must be labeled in plain terms, such as “contains WHEAT”. Wheat can be listed in ingredient list OR lower on package as “contains wheat” Foods under USDA regulation are not required to list allergens. This includes meats, broth, poultry and eggs. However, unprocessed all are gluten free. Processed meats, such as deli meats, hot dogs, sausage may contain gluten. However, most companies choose to label allergens. These symbols identify USDA foods: 3 This is a general list for your information and does not replace the need to read food labels. Always remember to read the full ingredient list when purchasing any product. If in doubt, contact the manufacturer about ingredients used in packaging or processing. 4 LABEL READING GUIDELINES Avoid: Wheat Barley Malt (malt vinegar, malt extract, malt flavor) Rye Oats (unless labeled gluten free) Contains Gluten Gluten-free Barley Ascorbic acid Barley malt Carmel color Bran Corn starch Brewer’s yeast Dextrin Couscous Dextrose Durum Fructose Graham Guar gum Malt Hydrolyzed soy protein Malt extract Lactic acid Malt flavoring Lactose Malt syrup Mannitol Malt vinegar Maltose Miso Maltodextrin Oats, unless labeled gluten-free (due to cross Mono and diglycerides contact) Monosodium glutamate (MSG) (made in Rice malt USA) Rye Natural color and flavor Semolina Sodium benzoate Soy sauce (wheat fermented) Starch (always from corn in USA) Wheat Stearic acid Wheat Flour, white and wheat Vinegar (NOT malt vinegar) Brewer’s yeast Vegetable oil Whey Many foods are naturally gluten-free even if they are not labeled “gluten-free” 5 GRAINS GLUTEN-FREE FOODS TO QUESTION CONTAINS GLUTEN Amaranth Rice or Potato mixes Atta Arrowroot Barley Bean Bulgar Buckwheat (pure) Cake flour Carob Couscous Corn(bran, meal, starch) Einkorn Corn tortillas Emmer Chick pea (garbanzo) Farina Flax Farro Garfava Graham Hominy Kamut Job’s tears Gluten Mesquite Low gluten flour Millett Matzo/matzah Montina (indian rice Pumpernickel grass) Rye Nuts Semolina Pea flour Spelt Potato Triticale Quinoa Wheat Ragi Wheat starch Rice Wheat bran Rice bran Wheat germ Sago Wheat tortillas Sorghum (milo) White tortillas Soy Most oats (most contain Sweet potato wheat from cross- Tapioca (cassava, contamination) manioc) Taro Teff Wild rice Oats (only if labeled gluten-free and after stabilized on a GF diet) 6 CEREALS GLUTEN-FREE FOODS TO QUESTION GLUTEN CONTAINING Cornmeal Corn flakes All cereals containing Cream of rice (brown Rice crispies Wheat, rye, barley or malt or white) Hominy grits Quinoa flakes Polenta Puffed Amaranth Puffed corn Puffed rice Rice flakes Chex® select flavors; rice, corn, honey nut, chocolate, cinnamon, vanilla, apple cinnamon Cream of buckwheat Specialty gluten-free cereals GF Rice Krispies® 7 PROTEIN FOODS GLUTEN-FREE FOODS TO QUESTION GLUTEN CONTAINING Beans and legumes Dried meats Breaded meats Eggs Baked beans Gravy Packets Nuts Canned pork and beans Turkey with stuffing Most peanut butter Marinated meats Fu Plain tofu Processed meats; Seitan Plain fresh or frozen deli meats, ham, Most veggie burgers meats, fish and poultry hot dogs, sausage, pate Imitation meat or fish Many vegetarian meat Meat loaf substitutes (most contain Meat balls soy sauce) Basted turkey/meats Tempeh Miso Sushi Glazed ham Surimi (imitation crab) 8 DAIRY FOODS GLUTEN-FREE FOODS TO QUESTION GLUTEN CONTAINING Milk; fresh, dry, Flavored yogurt Malted milk evaporated, condensed Flavored milk drinks Yogurt toppings Buttermilk Frozen yogurt Ice cream containing Lactaid milk® Cheese sauce cookies or malt Butter Cheese spread Cheese Cream cheese Cream Sour cream Most ice cream Most yogurts BEVERAGES GLUTEN-FREE FOODS TO QUESTION GLUTEN CONTAINING Most soft drinks Flavored coffee Malted beverages Most root beer Hot chocolate mixes Ovaltine® Juice Postum® Most Tea Oat milk Coffee Barley Tea Milk Most non-dairy Beverages (such as rice, soy, nut milks) 9 SOUPS GLUTEN-FREE FOODS TO QUESTION GLUTEN CONTAINING Homemade broth or Bouillon cubes Most canned soups stocks Dried soup mixes Ramen noodle soups Stocks/soups made with Canned soups Soups made with wheat, rye gluten-free ingredients Restaurant soups or barley Udon noodle soup Gluten-free bouillon cubes Gluten-free broth FRUITS GLUTEN-FREE FOODS TO QUESTION GLUTEN CONTAINING All fruits; fresh, frozen or Dried fruits Fruits topped with streusel or canned Fruit pie fillings granola VEGETABLES GLUTEN-FREE FOODS TO QUESTION GLUTEN CONTAINING All vegetables; fresh, Au gratin/scalloped Vegetables; breaded or batter frozen and canned potatoes dipped Dried vegetables Creamed vegetables French fries cooked in a French fries dedicated gluten-free fryer Most restaurant/fast food French fries (cooked in same fryer as gluten containing foods) 10 SWEETS AND DESSERTS GLUTEN-FREE FOODS TO QUESTION GLUTEN CONTAINING Fruit ice Candy Regular