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What Should (or Shouldn't) I Eat If I Have Celiac Disease?

Medically Reviewed by Minesh Khatri, MD on October 27, 2021

Celiac disease has just one clear treatment: Say goodbye to gluten. It sounds simple, but can feel overwhelming. Isn't gluten in everything?

It may feel that way at first. Because celiac affects almost 3 million Americans, gluten-free labeling is now the norm. You can find gluten-free foods on menus, grocery store shelves, and right in your own refrigerator.

That doesn't mean it's easy. Going gluten-free means rethinking how you shop, cook, and order in restaurants. With education and effort, you can make confident choices about foods that taste good and are good for you.

What Is Gluten?

Gluten is a protein in wheat, barley, and rye. When those grains and the ingredients made from them (flour) are used to make foods -- like pasta, cereals, and bread -- gluten is the “glue” that holds them together.

How Does Gluten Affect People With Celiac?

Celiac is a genetic autoimmune disease. When you eat a food with gluten, your immune system attacks the protein. This causes damage to the villi, or little fingers that line your small intestine. Without the help of healthy villi, your body can't absorb nutrients into the bloodstream.

This causes digestive issues and malnourishment, especially when iron, calcium, and vitamin D aren’t being absorbed. If it’s not dealt with, celiac can cause other long-term conditions, such as neurological disorders and osteoporosis. It could also trigger the start of thyroid disease.

Should I Get Expert Help?

Support is essential. Ask your doctor to refer you to a registered dietitian who specializes in celiac. A dietitian can show you how to:

  • Understand food and product labels
  • Customize gluten-free meal plans and recipes
  • Stay on top of nutritional deficiencies
  • Be aware of conditions associated with celiac

What Can I Eat?

A gluten-free diet isn’t as limited as you might think. In addition to prepared foods with gluten-free labels, the following foods are naturally gluten-free and the can be the foundation of healthy celiac diets:

  • Beef
  • Poultry and eggs
  • Fish and seafood
  • Beans, legumes, and nuts
  • Fruits
  • Vegetables

Though you have to avoid wheat, barley, and rye, naturally gluten-free grains do exist. Use these to replace the big three:

  • Amaranth
  • Arrowroot
  • Buckwheat groats (also called kasha)
  • Cassava
  • Chia
  • Corn
  • Flax
  • Millet
  • Potato
  • Quinoa
  • Rice
  • Soy
  • Sorghum
  • Tapioca
  • Teff
  • Yucca

What Should I Avoid?

Take a deep breath. Though the list below may contain some of your favorite foods, many have gluten-free counterparts:

  • Beer
  • Bread and pastries (cakes, cookies, croutons, flour tortillas, pies, stuffing)
  • Some breakfast foods (pancakes, waffles, biscuits, French toast)
  • Cereal and granola
  • Crackers (pretzels, graham crackers)
  • Food coloring
  • Noodles (ramen, soba, udon)
  • Pasta
  • Salad dressings
  • Sauces and gravies
  • Soups

Wheat, barley, and rye can appear in various forms and varieties, all of which contain gluten as well. Be sure to look out for these on food product labels:

Wheat

  • Wheatberries
  • Durum
  • Einkorn wheat
  • Emmer (or farro)
  • Farina
  • Graham
  • Kamut khorasan wheat
  • Semolina
  • Spelt

Rye

Barley

Triticale (a hybrid of wheat and rye)

Malt

  • Malted barley flour
  • Malted milk / malted milkshakes
  • Malt extract
  • Malt syrup
  • Malt flavoring
  • Malt vinegar

Brewer's yeast

Wheat starch

Are Oats Safe?

Oats are tricky territory. Despite their nutritional benefits, and the variety they offer celiac diets, oats are often grown near wheat, barley, and rye. This opens the door to cross-contamination.

Check with your doctor or dietitian about oats labeled gluten-free.

Can I Eat Casein?

If you have celiac disease, you might also wonder if you need to avoid casein, which is a protein in milk, butter, and cheese. If you’re allergic to casein, definitely keep it out of your diet. But if you don’t have a casein allergy, you might not need to worry about it.

There hasn’t been a lot of research on whether casein has the same effects as gluten. The theory got its start decades ago, when some people thought that casein, gluten, and autism might be linked. That theory isn’t proven.

One thing to keep in mind is that if milk upsets your stomach, it could be due to lactose, which is the natural sugar in milk. Casein and lactose aren’t the same, and your sensitivity may have nothing to do with casein. Anyone can have lactose intolerance, including people who have celiac disease and people who don’t.

You can ask your doctor to test and see if you’re allergic to casein. If you remove casein from your diet, you’ll want to focus on getting enough vitamin D and calcium.

Reading Food Labels

Knowing how to read food labels is the most important part of a successful gluten-free diet. Grocery store aisles are the battleground in the fight against gluten. Take these tips with you:

  • Manufacturers can label food gluten-free if it has less than 20 ppm (parts per million) gluten. This means it's safe, but double-check the ingredient list.
  • Gluten goes by many names. Wheat, barley, and rye are sure to stand out in an ingredient list, but look for lesser-known derivatives like malt flavoring or graham.
  • Wheat-free doesn't mean gluten-free.
  • When in doubt, leave it out. This is a well-worn phrase in the world of gluten-free foods. No cracker is more important than your health.
  • Labels won't replace common sense. Remember that naturally gluten-free foods like bottled water or green beans won't always be labeled gluten-free.
  • Still not sure? Call the company that produced the food or check their website. Have the SKU number from the scanner pattern on hand for easy reference.

Kitchen Smarts

When gluten-free food comes into contact with a food that has gluten, cross-contact occurs. Make sure these home hot spots are used only for gluten-free foods:

  • Toasters
  • Colanders
  • Convection ovens
  • Flour sifters
  • Sponges, dishcloths
  • Containers
  • Utensils
  • Pots, pans, skillets
  • Grills, griddles, presses, irons
  • Fryers
  • Cutting boards
  • Shelves in your refrigerator and pantry

Show Sources

SOURCES:

Beyond Celiac: "Gluten-free Diet."

Celiac Disease Foundation: "Live Gluten-Free," “What Is Celiac Disease?”

National Institute of Diabetes and Digestive and Kidney Diseases: "Celiac Disease."

Academy of Nutrition and Dietetics: "Celiac Disease."

University of Chicago Medicine, Celiac Disease Center: "Celiac Answer Bank."

American Academy of Pediatrics: “Gluten-Free/Casein-Free Diets.”

Food Allergy Research & Education: “Milk Allergy.”

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