I Know I Have Celiac Disease, What’s Next?

Adjusting to a New Normal

Give yourself permission to not know everything about celiac disease right away. Be kind to yourself and treat every day as a learning experience. The good news is, living with celiac disease today is easier than ever due to increased awareness of the disease, a large selection of gluten-free foods on the market, and restaurants becoming increasingly accommodating.

Why Gluten-Free?

• A strict, gluten-free diet is the lifelong treatment for celiac disease. There are currently no medications or surgeries to treat or cure this disease.
• Gluten is a broad term for protein found in wheat, rye, barley and their derivatives which causes an autoimmune response in people with celiac disease. A gluten-free diet excludes these food ingredients.
• Everyone is different and recovers at different rates! After a few days following a strict gluten-free diet, your symptoms should subside, however, your gut can take months or sometimes years to heal.
• The faster you transition to a strict gluten-free diet, the better your health may be in the long-term. Fear not - start simple and follow the tips below to follow a gluten-free diet.

Following a Gluten-Free Diet

• As soon as you’re diagnosed, ask your doctor for a referral to a Registered Dietitian or find a Registered Dietitian here to help support you as you start your transition to a gluten-free lifestyle.
• Learn which foods contain gluten and which ones don’t:

Here is a list of SAFE gluten-free grains and ingredients:

• Amaranth
  • Buckwheat
  • Corn
  • Millet
  • Oats *see below
  • Quinoa
  • Rice - white, brown and wild
  • Sorghum
  • Teff
• *Take extra caution with oats. They’re naturally gluten-free BUT many factories that process oats also work with other grains that do contain gluten. Therefore, most oats are contaminated with gluten. It’s recommended to eat oats that have been certified as gluten-free. This means that they have been grown and processed in gluten-free facilities. Look for a gluten-free label on the package.

Here is a list of gluten-containing grains and ingredients:

• Barley
  • Brewer’s yeast
  • Bulgar
  • Couscous
  • Durum
  • Farro
  • Kamut
  • Malt (extract, vinegar, flavouring)
  • Rye
  • Semolina
  • Triticale
  • Wheat (bran, germ, starch, flour),
• Though this is a long list, there are still many delicious and nutritious foods that naturally do NOT have gluten – hooray! Embrace a healthful diet filled with fruits, vegetables, nuts and seeds, legumes, gluten-free grains, lean meats, poultry, eggs and/or fish.
• Click here for a sample meal plan for gluten-free living and for recipes: here and here.

Reading Food Labels

Check out this full guide on how to read food labels for celiac disease.

On the food label, keep your eye out for these two sections:

1. The “contains” or “may contain” statement:
   1. Check for sources of gluten (refer to the above list) – if any gluten-containing item is listed, the food is NOT safe to consume.
   1. If oats are listed, assume they are contaminated with gluten unless specified otherwise.

• The “Ingredients List”:
  • If there is no “contains” statement, refer to the full ingredients list.
  • Check for sources of gluten (refer to the above list) – if none are listed, it is acceptable to eat!

Ensure you read the ingredients list every time, as manufactures may change their ingredients. Review the ingredients carefully for hidden sources of gluten, such as malt vinegar or triticale.

Gluten-free claims are not interchangeable with wheat-free claims. A product can still contain gluten even through its wheat-free.

Preventing Cross-Contact

Believe it or not, crumbs matter when you are diagnosed with celiac disease. All it takes is a crumb to trigger symptoms and cause damage to your gut.

Here are our tips on eating safely whether you’re staying in or going out:

At Home:

• Have a designated gluten-free:
  • Butter dish
  • Cutting board
  • Wooden utensils or other porous utensils that may retain gluten
  • Toaster, or toaster oven with removable racks that can be washed
  • Counter top section – alternatively, thoroughly wash to ensure there are no crumbs or flour dust on the surface.
• Ensure shared pots are thoroughly scrubbed before using for gluten-free foods.
• For muffin tins, consider using paper liners to avoid cross-contact.
• No double-dipping. Once clean utensils have touched gluten, wash them before using them again.
• Label your spreads and condiments to avoid confusion.
• Make your gluten-free food FIRST. Otherwise, thoroughly wash your hands after touching gluten-containing foods.

Dining Out:

• Check out these tips
• Ask your server if they have a gluten-free menu or if gluten-free precautions are taken.
• Ask about marinades, dressings and sauces – things like soy sauce may have gluten-containing ingredients. 
• Potatoes are gluten-free but don’t assume french fries are.
  • McDonald’s fries have a gluten-containing beef flavouring.
  • Many restaurants’ fries are contaminated with gluten. They don’t contain gluten but are fried in the same oil as battered foods.
  • Ask your server if they have a designated gluten-free fryer that is celiac-friendly.
• Specify if the gluten-free pasta is cooked in clean water separate from gluten-containing pasta.
• Ask if the rice is cooked with gluten-free broth as some broths contain gluten.
• At buffets, be aware of cross-contact of utensils and thermometers poked into gluten-free and gluten-containing foods. Ask your server what gluten-free precautions are taken.
• Call ahead during non-peak hours and speak with the manager or chef about safe gluten-free options for celiac disease.

Celiac Disease is a life-long journey and will take time to settle into. Remember to be kind to yourself and advocate – ask politely, but still ask when you’re dining out. Educate your friends and family on what you need from them to feel supported in your journey. As much as this is an educational journey, make it fun by connecting with Registered Dietitians and other people with celiac disease.

FAQs

Is the damage to my gut reversible?

• Yes, the damage will heal as long as you’re on gluten-free diet! Prevent and heal the existing intestinal damage by sticking to a strict gluten-free diet. 

Can gluten be absorbed through my skin?

• No, it cannot. Simply touching gluten-containing foods is safe.
• However, inhaling flour or other airborne gluten sources can potentially cause harm if it is swallowed and enters the gut.

Is it okay to have a “cheat day”?

• People with celiac disease should never intentionally “cheat” and ingest gluten even if it’s once in a while. Not following a strict gluten-free diet can lead to poor health outcomes (e.g. poor nutrient absorption, anemia and intestinal cancers) in the long run.

Do I need to take a multivitamin to increase my nutrient level?

• Upon diagnosis, some micronutrient levels (e.g. iron, folate) may be lower than normal due to the poor absorption of these nutrients when the intestines are damaged.
• Eventually, in most cases, on a strict gluten-free diet you will be able to properly absorb nutrients again.
• On a gluten-free diet, it’s important to continue eating a variety of nutrient-dense foods to increase your nutrient intake and promote good health.
• If you are still concerned about your nutrient intake, talk to your doctor or dietitian about supplementation options.

Resource Alert! Want more information?

Living a healthy gluten-free life

How to talk to your family members about celiac disease

Questions to ask when you’re dining out

Learn about alcohol and beer consumption with celiac disease

Canadian Celiac Association Food Labeling guidelines & webinar

Registered Dietitians advocating for celiac disease Social Media:

Check out Feriha, Selena Shelley, and Taylor (a Dietetic Intern) on Instagram.