An estimated 3 million Americans are living with celiac disease (1,2). This autoimmune condition primarily affects the gut and is triggered by the ingestion of gluten—a protein found in some of the most widely consumed grains.
The encouraging news? Nutrition plays a powerful role in managing celiac disease. The foundation of treatment is removing gluten from your diet entirely. This can be more challenging than it sounds because gluten hides in many processed and packaged foods. But with the right knowledge and tools, managing celiac disease through diet is absolutely achievable.
This guide will help you understand what celiac disease is, how it’s diagnosed, which foods to avoid, and how to build a nourishing, gluten-free diet.
What is Celiac Disease?
Celiac disease is an autoimmune disorder where the body’s immune system attacks the small intestine when gluten is eaten. Gluten is the protein found in wheat, rye, barley, and triticale (3). This condition is also referred to as celiac sprue, gluten intolerance, or gluten-sensitive enteropathy.
It tends to run in families and is more common in people of Northern European descent (3,4). People with celiac disease are also at greater risk for developing other autoimmune disorders, such as type 1 diabetes or autoimmune thyroid disease.
When gluten is ingested, it causes an immune reaction in the lining of the small intestine. This leads to inflammation and damage that interferes with nutrient absorption, which can result in malnutrition even when a person is eating well (3,5). Over time, this can lead to anemia, fertility issues, osteoporosis, and other complications (1,3).
Signs and Symptoms
Celiac disease presents in a variety of ways. Some people experience classic digestive symptoms like bloating, nausea, vomiting, diarrhea, or constipation (3,6,7). Others may develop mouth sores, discolored teeth, joint pain, skin rashes, or fatigue. Mental health symptoms—such as irritability, mood swings, or depression—are also not uncommon (3).
Unlike gluten sensitivity or wheat intolerance, celiac disease causes actual damage to the small intestine (4).
Because symptoms can resemble those of other digestive disorders, diagnosis typically involves blood work and, in some cases, an intestinal biopsy (7). It’s important to stay on a gluten-containing diet during the testing process to ensure accurate results.
Managing Celiac Disease with Nutrition
The only proven treatment for celiac disease is strict, lifelong avoidance of gluten (8). Even small amounts can trigger symptoms and intestinal damage (3,5).
Gluten is most often found in wheat, rye, barley, and triticale, which means it shows up in everyday staples like bread, pasta, cereal, and baked goods (2,3). It’s also used as a thickener or stabilizer in processed foods—and can even show up in unexpected places like soy sauce, beer, and salad dressings.
To help consumers identify safe products, the FDA allows manufacturers to label items “gluten-free” if they contain less than 20 parts per million of gluten (1).
Hidden Sources of Gluten
While it’s relatively easy to spot gluten in breads or pasta, it may also be hiding in:
- Soups, sauces, and gravies
- Creamed vegetables or flavored dairy products
- Cured or processed meats
- Flavored chips or fries
- Granola, protein bars, or cereals made with malt or regular oats
- Beer, malt beverages, and flavored liqueurs
- Non-food items like supplements, lip balms, and some medications (4,5,9)
Reading labels carefully is essential.
Tips for Safe Gluten-Free Eating
Cross-contact (when gluten-free foods come into contact with gluten-containing items) is another concern. This can happen in kitchens, during manufacturing, or even when foods are stored or served using shared utensils, cutting boards, or toasters (9,10).
When dining out or eating at social events, let others know you have celiac disease and ask about dedicated gluten-free preparation methods (10).
Here are a few ingredients to watch for in packaged products:
- Flours: spelt, semolina, emmer, kamut, durum
- Modified food starches
- Hydrolyzed vegetable protein
- Malt extract, malt vinegar, or flavoring
- Brewer’s yeast
- Stabilizers and preservatives
When in doubt, check the manufacturer’s website or call the company directly.
Naturally Gluten-Free Foods
Fortunately, there are many nutrient-dense, naturally gluten-free foods:
- Fresh fruits and vegetables (plain or frozen/canned without sauces)
- Meat, poultry, fish, and eggs
- Plain dairy products
- Gluten-free grains: rice, quinoa, buckwheat, amaranth, teff*
- Flours from corn, cassava, coconut, potato, or tapioca
- Gluten-free oats** (look for labeled brands)
- Nuts, seeds, soybeans, and edamame
*Choose gluten-free grains that are fortified when possible.
**Regular oats may be cross-contaminated during processing, so choose oats labeled gluten-free (10,11).
You’ll often find a dedicated gluten-free section in most grocery stores. Frozen gluten-free bread, muffins, and other baked goods are increasingly available (11). When shopping, skip the bulk bins, as cross-contact is more likely in those areas.
Final Thoughts
While living with celiac disease requires a lifetime of dietary vigilance, the upside is that the condition is entirely manageable through nutrition. With greater awareness and an ever-expanding market of gluten-free options, it’s easier than ever to take control of your health and reduce the risk of long-term complications.
Need help reading labels, finding gluten-free products, or building a personalized meal plan? I’d love to support you.
Book a session today and let’s get started on your path to vibrant health.
References
(1) U.S. Food and Drug Administration (2022, March 7). Gluten-Free Labeling of Foods. https://www.fda.gov/food/food-labeling-nutrition/gluten-free-labeling-foods
(2) U.S. Food and Drug Administration. (2018, July 16). Gluten and Food Labeling. https://www.fda.gov/food/nutrition-education-resources-materials/gluten-and-food-labeling
(3) Harvard Health Publishing. (2023, April 7). Celiac disease (non-tropical sprue). https://www.health.harvard.edu/a_to_z/celiac-disease-non-tropical-sprue-a-to-z
(4) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Definition & Facts for Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/definition-facts
(5) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Treatment for Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/treatment
(6) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Symptoms & Causes of Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/symptoms-causes
(7) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Diagnosis of Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/diagnosis
(8) Adelsberg, R. (2021, March). Gluten-free diet: nutritional value. American Gastroenterological Association, AGA GI Patient Center. https://patient.gastro.org/gluten-free-nutritious-diet/
(9) Celiac Disease Foundation. (n.d.). Sources of gluten. https://celiac.org/gluten-free-living/what-is-gluten/sources-of-gluten/
(10) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Eating, Diet, & Nutrition for Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/eating-diet-nutrition
(11) Celiac Disease Foundation. (n.d.). Gluten-Free Foods. https://celiac.org/gluten-free-living/gluten-free-foods/
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