The Gluten-Free Diet: A Guide for Teens

The Gluten-Free Diet:

A Guide for Teens

sds Children's Hospital Boston
Celiac Disease Support Group

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You may have heard about the gluten-free diet on TV or read about it in a magazine. But, unlike popular fad diets, the gluten-free diet is not another weight loss plan. The gluten-free diet is a diet recommended by a health care provider for people who have been diagnosed with celiac disease, an autoimmune disorder that is triggered by gluten. To heal the body, a gluten-free diet must be followed. Following a gluten-free diet can seem overwhelming at first, but it is really not as hard as it might seem. Once you learn which foods to avoid and which foods you can eat comfortably, you will feel much better. Read on and learn more!

What is Gluten?

Gluten is a protein complex found in the grains wheat, barley and rye. Flours made from these grains are commonly used to make foods such as breads, cereals, pasta, pizza and baked goods. It is the gluten in these foods that make them chewy and gives them the elastic texture.

Why would someone need to follow a gluten-free diet?

Anyone with celiac disease should follow a gluten-free diet.

What is Celiac Disease?

Celiac disease is an autoimmune disorder that is triggered when gluten-containing foods are eaten. An autoimmune disorder is one in which the body’s immune system attacks an organ rather than fighting infection. When a person with celiac disease eats a food with gluten in it, the immune system launches an attack against the small intestine which damages the lining of the intestine. Noticeable symptoms of celiac disease include diarrhea, abdominal pain, weight loss, nutritional deficiencies, anemia, poor appetite, irregular periods, delayed growth, and delayed onset of puberty. Some teens will have almost no noticeable symptoms, but their doctor may detect low bone density.

Image of A. In a healthy person, nutrients get absorbed by villi in the small intestine and go into the bloodstream., B. In a person with Celiac Disease, the villi have been damaged by inflammation, so fewer nutrients pass into the bloodstream.

Following a gluten-free diet will help the small intestine heal and decrease the symptoms of celiac disease.

What foods should I avoid on the gluten-free diet?

If your health care provider has told you to follow a gluten-free diet, you should not eat any foods that contain wheat, barley, rye, and contaminated oats, as well as foods that contain any of the following ingredients:

Ale, beer, bleached flour, bran, bread flour, brewer's yeast, brown flour, brown rice syrup, farina, graham flour, fu, gluten flour, graham flour, granary flour, groats, harina, malt, matzo, rye, semolina, spelt, wheat, whole meal flour and wheat germ.

Oats may contain gluten. Oats are often processed in the same factories as wheat, so, they are not always gluten-free. To find out if your favorite brand of oatmeal is gluten-free, call the company or check their website. When eating out or when in doubt, avoid oats.

Foods that contain any of these ingredients are thought of as “red light foods”. People following a gluten-free diet should stop eating them. Foods that commonly contain these ingredients include breads, bagels, rolls, crackers, pretzels, pasta, pizza, flour tortillas, cereals, pancakes, waffles, cookies, cake, ice cream cones, licorice, beer, soy sauce, and malts unless they are labeled gluten-free.

What foods are safe to eat on the gluten-free diet?

While most breads, pastas, cereals and baked goods contain gluten, many foods are naturally gluten-free, including milk, butter, cheese, fruits, vegetables, fresh meats, fish, poultry, eggs, beans, nuts, seeds, corn and rice. Additionally, there are many grains and flours that are also naturally gluten-free which can be used to make breads, cereals, pastas, snacks, and baked goods. These grains and their products are thought of as “green-light foods”, as they are safe to eat on the gluten-free diet. They include:

Amaranth	Pea Flour
Arrowroot	Potato Flour
Bean Flours	Potato Starch
Buckwheat	Quinoa
Carob Flour	Ragi
Corn Flour	Rape
Corn Meal	Rice Flours
Cornstarch	Sago Flour
Kasha	Sorghum
Kudzu Root Starch	Soy Flour
Maize	Tapioca Flour
Masa Flour	Tarrow Root
Millet	Teff Flour
Montina Flour	Yam Flour
Nut Flour

How can I tell if a food is gluten-free?

In 2006, a new food allergen labeling law came into effect that requires food companies to label all foods that have wheat or wheat products in them. This is great news for people who must follow a gluten-free diet, because it makes identifying “red-light foods” much easier. To figure out if a food is gluten free, you need to read the allergy statement found at the end of the ingredient list on all packaged foods. If an allergy statement reads “contains wheat ingredients”, it is a “red-light food”. The food labeling law does not cover barley, rye, or oats, so if the allergy statement does not include wheat, you should next read through the ingredient list to look for the words rye, ale, barley, beer, bran, brewers yeast, brown rice syrup, malt, malt flavoring, malt vinegar, or dextrin. If you don’t see any of these words in the ingredient list, then the food is most likely a “green-light food”. If you want to make sure the food is gluten-free, call the food company or look on their website.

In the sample ingredient label below, the ingredients are circled in red and the allergy statement is circled in blue. This food, which contains whole grain wheat, is a “red-light food”.

image of an ingredients label, highlighting the ingredients list and allergy statement

Reading food labels is very important, because ingredients can change without notice, and often without a noticeable difference in the packaging. Remember to check products such as toothpaste, lipstick, vitamins, and medications.

How can I still eat my favorite foods?

Eating and baking gluten-free has become so much easier as more companies now make gluten-free foods. You can now buy gluten-free breads, rolls, pizza-crusts, buns, bagels, donuts, cookies, muffins, pretzels, cereals, and desserts. Additionally, you and your family can substitute gluten-free grains and flours in your favorite recipes. The following brands have a great selection of gluten-free foods, which you can buy directly from their websites:

Shopping for gluten-free foods at the grocery store: When shopping at your local grocery store, it is important to remember that most of the fresh foods found along the perimeter of the store including fruits, vegetables, meat, poultry, fish, and dairy are naturally gluten-free. Additionally, rice, beans, peanut butter, nuts, cooking oils, and corn and rice cereals are also typically gluten-free. Many grocery chains also carry the gluten-free brands mentioned above. These products are commonly found in the aisles that contain natural and organic foods.

Gluten-free Grocery List

Dairy

Milk

Cheese

Yogurt

Fruit

Apples

Bananas

Orange Juice

Vegetables

All vegetables

Cereals & Grains

Corn Tortillas

Rice Chex® Cereal

Brown Rice

Tortilla Chips

Envirokidz® Rice Bars

Van’s® GF Waffles

Meats, Poultry, & Fish

Bell & Evans® GF Chicken Nuggets

Canned Tuna

Ground Beef

Boar’s Head® Luncheon Meats

Eggs

Snacks & Desserts

Lays® Classic Potato Chips

Fritos® Original

Fruit Snacks

Ice Cream

Popcorn

Condiments & Seasonings

Salsa

Peanut Butter

Jelly

Ketchup

Pancake Syrup

Hummus

Where can I find gluten-free recipes?

The best resources for gluten-free recipes are the internet and gluten-free cookbooks. The GI department at Children’s Hospital Boston is a wonderful resource, and has great recipes as well as cookbook suggestions.

Click here for gluten-free recipes

Click here for gluten-free cookbooks

The following gluten-free recipes are from the Center for Young Women’s Health "Quick and Easy Recipes for Teens" cookbook:

Banana Nut Smoothie

Ingredients:

2 ripe bananas, peeled
2 cups pineapple juice
2 tablespoons creamy peanut butter
2 tablespoons low-fat plain yogurt
1½ teaspoons vanilla extract
6 ice cubes
Nutmeg

Preparation:

Combine all ingredients except nutmeg in blender
Cover and mix on high until smooth
Sprinkle with nutmeg
Serve Immediately
Makes 4 Servings

Chicken Stir Fry

Ingredients:

6 boneless, skinless chicken breasts, cut into bite-sized pieces
2 medium onions, chopped
2 large green peppers, diced
Salt and pepper
1 tablespoon canola oil

3 cups brown rice

Preparation:

Cook rice according to package directions
While rice is cooking, heat the oil in a large skillet and carefully place the chicken in the oil
Pan fry the chicken until it is no longer pink in the middle and set aside
Add onions and green pepper to skillet and heat until soft
Add chicken back to the skillet, season with salt and pepper to taste
Serve on a bed of warm rice
Makes 6 Servings

How can I stay gluten-free while eating away from home?

The best way to stay gluten-free when you are away from home is by planning meals and snacks ahead of time. That may sound hard, but following these tips can make it easier:

Eat breakfast at home, or pack a gluten-free breakfast to eat at school or on-the-go.
Work with your parents, nutritionist, or school nurse to find gluten-free foods on the school breakfast and lunch menus.
Pack your lunch in an insulated bag to eat at school or on-the-go.
If you are going to eat at a restaurant, either go to one that has a gluten-free menu or talk with the restaurant manager to find gluten-free menu items before ordering. Remember to tell the manager or chef that both the meal and its preparation must be gluten-free. The following restaurant chains have gluten-free menus:

Applebee’s	Legal Sea Foods
Burger King	Outback Steakhouse
McDonalds	PF Chang’s China Bistro
Taco Bell	Pizzeria Uno
Wendy’s	Maggiano’s Little Italy

Keep gluten-free snacks such as trail mix, snack bars, popcorn, or nuts in your backpack for times when you need a snack and are away from home.

What does a typical day on the gluten-free diet look like?

Breakfast:

Scrambled eggs

Gluten-free toast with butter or margarine
1 piece of fresh fruit

Apple or orange juice

Lunch:

100% beef hamburger without a bun

Fruited yogurt
Grapes

1% or skim milk

After-school Snack:

String cheese

Microwave popcorn

Water

Dinner:

Beef tacos with shredded cheese, lettuce and salsa on gluten-free corn tortillas

Corn nibblets

1% or skim milk

Dessert:

Sorbet

What else do I need to know about the gluten-free diet?

No amount of gluten is “safe”. If your doctor or nutritionist has told you to follow a gluten-free diet to treat celiac disease or gluten intolerance, it is important to keep completely gluten-free. This will prevent the immune reaction that gluten causes, and will allow your small intestines to heal and stay healthy. Even a little bit of gluten can harm your intestine and cause an upset stomach.

If you have family members who do not follow a gluten-free diet, take the following steps to prevent gluten contamination:

Clean all cooking and eating utensils (silverware and anything that touches food) before using them.
Keep separate containers of jelly, butter/margarine, peanut butter and all other spreads and label them as “gluten-free”.
If possible, have a separate toaster for gluten-free foods.

Talk with your doctor or nutritionist about vitamin & mineral supplements. Some people who follow a gluten-free diet may not get enough of certain nutrients, vitamins and minerals in their diet such as fiber, iron, and calcium. If you must follow a gluten-free diet, meet with a nutritionist to develop a healthy, balanced diet and to find out if you need to take any vitamin or mineral supplements.

Written by the Center for Young Women's Health Staff

Updated: 2/6/2009

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