You may have heard about the gluten free diet on TV or read about it in a magazine or online. Despite what some people may think, the gluten–free diet is not a weight loss diet. The gluten–free diet is a  recommended by a health care provider for people who have either been diagnosed with celiac disease, an autoimmune disorder that’s triggered by gluten, or with non-celiac gluten sensitivity. If your teen has been diagnosed with celiac disease, she must follow a gluten–free diet to heal her body and reduce signs and symptoms of celiac disease. This guide was created for you and your family to help navigate the gluten–free diet including how to avoid gluten, how to identify gluten–free foods, and how to adapt to a gluten–free lifestyle.

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. The gluten gives these foods an elastic texture and  helps provide the structure.

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

Anyone with celiac disease should follow a strict gluten–free diet to avoid causing long term damage to the small intestine (see image) as well as symptoms. If your teen’s health care provider tells her that she has gluten sensitivity she should also follow a gluten-free diet in order to avoid any symptoms she may have.

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. 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 and decreases nutrient absorption. 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 health care provider may detect low bone density.
Gluten is harmful for someone with celiac disease. Following a gluten–free diet prevents harm to the small intestine and allows it to heal. The gluten–free diet should eventually stop your teen’s symptoms of celiac disease or gluten intolerance.

What is gluten sensitivity?

Gluten sensitivity, also called non-celiac gluten sensitivity or gluten intolerance can be diagnosed if a person does not have celiac disease or a wheat allergy (both of these tests are negative) but they have some similar symptoms and they feel better when they are on a gluten-free diet. While someone with gluten sensitivity will have similar symptoms as a person with celiac disease, they do not have the same intestinal damage. It is unclear whether people with gluten sensitivity need to be as strict about adhering to a gluten-free diet. There is no definitive test for gluten intolerance. If you think that your teen might have celiac disease (or an allergy to wheat or gluten sensitivity), she should consult with a medical professional rather than simply avoiding gluten. A health care provider will want to have testing done while she is still eating gluten in order to give her the best medical care.

Things to keep in mind…

A gluten-free diet isn’t always a healthy diet. 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. Also, some gluten–free products can be high in calories and sugar. If your teen must follow a gluten–free diet, it’s best to meet with a dietician to develop a healthy, balanced meal plan and to identify if any vitamin or mineral supplements are necessary. It is not suggested that people follow a gluten-free diet if not medically necessary.

There are many hidden sources of gluten both in food and non-food products. Gluten is also found in foods such as candy, sauces, soups, and marinades. Remember to check products such as toothpaste, mouthwash, lipstick/gloss, stamps/envelope, glues, supplements, vitamins, and both prescription and over the counter medications. These are frequently overlooked sources of gluten. Check with your pharmacist and ask your teen’s health care provider to write, “Medication must be gluten–free” on any prescriptions. Many soaps, shampoos, and lotions contain wheat or oats. While gluten cannot be absorbed through the skin, it is important to be aware of this – especially if your teen has a habit of biting her finger nails or touching food after putting on lotion.

What foods should my teen avoid on the gluten–free diet?

Following a gluten–free diet means your teen should completely avoid all foods that contain gluten. Foods that contain gluten should never be eaten by anyone with celiac disease. To eliminate gluten-containing food your teen should:

• Remove grains that contain gluten from her diet. She should not eat any food that contains wheat, barley, or rye. Keep in mind that wheat has many forms. She should avoid products that include bulgur, durum, graham, kumut, spelt, and semolina. These are all wheat!
• Your teen should not eat any obvious gluten containing foods such as: bagels, breads, cakes, candy, cereals, crackers, cookies, dressing, flour tortillas, gravy, ice cream cones, licorice, malts, rolls, pretzels, pasta, pizza, pancakes, sauces, stuffing, soy sauce, veggie burgers, vegetarian bacon/vegetarian chicken patties (many vegetarian meat substitute products contain gluten), and waffles. Please note this is NOT a complete list.
• Look for “hidden” sources of gluten. Your teen should NOT eat foods that have gluten–containing ingredients listed in certain products such as ale, barley, beer, bleached flour, bran, bread flour, brewer’s yeast, brown flour, brown rice syrup (unless the food is labeled gluten free), bulgur, couscous, dextrin (unless source gluten–free), durum, farina, farro, hydrolyzed vegetable (wheat) protein, gluten flour, graham flour, granary flour, groats, harina, kumut, malt, malt extract, malt syrup, malt vinegar, matzo, modified starch (unless the source is gluten–free), rye, orzo, seitan semolina, self–rising flour, spelt, smoke flavoring, soy sauce, triticale, wheat germ, wheat and white flour, whole meal flour, and vegetable gum.

Why should my teen omit barley from her diet?

Barley contains gluten and is frequently used to make malt. This is often used as a sweetener flavoring. As a general rule your teen should avoid natural or malt flavorings. If there are foods your teen likes to eat that contain “natural” or “malt” flavorings on the ingredient list, contact the company to see if these flavorings came from a non–gluten source.

Does my teen need to avoid oats?

Oats may contain gluten because they are often processed in the same factories as wheat. It’s best to check with your teen’s health care provider to see if she can eat traditional oats or if you need to look for certified gluten-free oats. To find out if your teen’s favorite brand of oatmeal is gluten–free, call the company or check their website. Some brands, such as Bob’s Red Mill, Glutenfreeda, and GF Harvest make oatmeal that is certified gluten-free. When eating out or when in doubt, avoid oats and oat-containing cereals and breads.

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

Many foods are naturally gluten–free, including milk, butter, cheese, fruits and vegetables, fresh meats, fish, poultry, eggs, beans, nuts, seeds, corn, quinoa, and rice. While most breads, pastas, cereals and baked goods contain gluten, there are several grains and flours that are also naturally gluten–free which can be used to make breads, cereals, pastas, snacks and baked goods – and many pre-made products on the market are made from these grains and flours. Think of these grains and their products as safe which are safe to eat on the gluten–free diet.

Gluten-Free grains

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

A product labeled “gluten-free”, “no gluten” or “without gluten” is the fastest and easiest way to identify a gluten–free product. Manufactures can use these terms if they comply with the FDA rule “gluten–free”.

Another way to tell if the product contains gluten is to read the allergen statement on packaged foods. The FDA food allergen labeling law requires food companies to label all foods that have wheat or contain wheat products. The allergen statement is found at the end of the ingredient list on packaged goods. Read the allergen statement, if it says “contains wheat”, this means it has gluten and it is a unsafe.

The food labeling law does NOT cover barley, rye, or oats. This means if the allergy statement does not include wheat, you need to then read through the ingredient list for all of the other possible sources of gluten. If you don’t see any of those words in the ingredient list, then the food is most likely safe.

In the sample ingredient label below, the ingredients are circled in red and the allergy statement is circled in blue. The food, which contains whole grain wheat, is not safe.

There is also a symbol that may appear on packaging of gluten-free foods, which the Gluten Intolerance Group has deemed “Certified Gluten Free.” This symbol represents that the food manufacturer has applied for and been granted certification of the product’s status of gluten-free, by submitting test results showing that there is no gluten contained in the product.

You might notice that some food labels have the following statements and are unsure whether or not you should eat them. When in doubt, ask your dietitian or medical provider, but in general:

• “May contain traces of wheat” – AVOID
• “Made on shared equipment with wheat ingredients” – AVOID
• “Manufactured in a facility that also processes wheat ingredients” – OK

Where can I buy gluten–free foods?

Eating and cooking gluten–free has become much easier than in the past as more companies now make gluten–free foods. You can purchase gluten–free breads, rolls, pizza–crusts, buns, bagels, donuts, cookies, muffins, pretzels, cereals, and desserts online or in most major grocery stores.

Here are some brands that carry gluten-free products

How do I shop for gluten–free foods?

Many grocery chains carry the gluten–free brands mentioned above. These products are commonly found in the aisles that contain natural and organic foods or they may even have their own section, labeled “gluten free foods.” Often gluten-free bread, bagels, and prepared food is found in the freezer. It’s also important to remember that most of the fresh foods found along the perimeter of the store (outside aisles) including fruits, vegetables, meat, poultry, fish, and dairy are naturally gluten–free. Rice, beans, peanut butter, nuts, cooking oils, and corn and rice cereals are also typically gluten–free.

Watch for possible gluten cross–contamination. This means foods that have gluten in them that have come in contact with gluten–free foods. Be aware of gluten cross–contamination at deli’s, buffets, and salad bars.

Gluten-Free Shopping List:

Dairy

Fruits

Vegetables

Grains

Proteins

Snacks and Desserts

Condiments and Seasonings

There are two basic approaches to preparing gluten–free food in your kitchen when your teen must follow a gluten–free diet. Both approaches present different challenges, but allow for your teen to safely eat gluten–free.

Some families choose to make their kitchen completely gluten–free. This approach requires you to throw out all gluten containing foods and sanitize or purchase new cupboards, cooking equipment, and utensils.

Other families choose to keep gluten containing products in their kitchen while adhering to safe food storage, preparation, and cooking practices for their gluten–free teen. If you’re planning on keeping foods with gluten in your kitchen make sure you minimize the risk of gluten cross–contamination.

Here are some great tips to lower the chances of gluten cross–contamination in your home kitchen:

• Keep gluten–free products in a separate cabinet
• Store gluten–free foods in airtight containers
• Store gluten–free flours and baking mixes in airtight containers in the freezer
• Buy separate butter, peanut butter, cream cheese, mayonnaise, and other spreads (to prevent contamination with wheat bread crumbs)
• Use separate colanders, sponges, strainers, toaster, toaster ovens, bread machines, towels, dish rags, and wooden cutting boards and utensils for gluten–free cooking
• Clean counter tops, cutting boards, measuring cups and spoons, the microwave, pot holders, and baking pans well and often
• Wash all shared utensils before and after each use

Eating Gluten-Free Away From Home

The best way to help your child stay gluten-free when away from home is by planning meals and snacks ahead of time. That may sound challenging, but the following tips can make it easier.

Eating at school or on–the–go:

• Encourage your teen to eat breakfast at home, or pack a gluten–free breakfast to eat at school or on–the–go.
• Work with your teen, her nutritionist, or school nurse to find gluten–free foods on the school breakfast and lunch menus.
• Help your teen pack a lunch in an insulated bag to eat at school or on–the–go.
• Buy gluten–free snacks such as fruit, cheese sticks, trail mix, snack bars, crackers, or nuts that she can eat away from home.

Eating at a restaurant:

If you’re planning to go out to eat at a restaurant with your teen, either choose one that has a gluten–free menu or speak with the restaurant manager to identify gluten–free menu items before ordering. Remember to tell the manager or chef that both the meal and its preparation must be gluten–free. More and more restaurants are gluten–free friendly and making it known on the menu. However, because “gluten-free” in some instances is seen as a trend rather than a medical necessity, it is important to tell the server or manager your level of sensitivity rather than just ordering something labeled gluten-free.

Some restaurants are easily able to make modifications to meals even if they do not have a separate gluten-free menu. When in doubt, always ask, even if the meal appears to be gluten free on the menu; usually not all ingredients are listed on the menu.

Hidden sources of cross-contamination at restaurants include using the same pans and utensils to bake gluten-free bread, using the water from boiling pasta to steam vegetables, and adding bread or flour to thicken soups.

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

Gluten-Free Sample Menu

Gluten-Free Recipes

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

The following gluten–free recipes are from our “Quick and Easy Recipes for Teens” cookbook:

Banana Nut Smoothie

Eggplant Marinara

Avocado Salad

Frozen Fruit Squares