Celiac disease is a serious autoimmune condition that affects approximately two million people in the U.S. A celiac flare-up can cause debilitating symptoms such as:
- Chronic diarrhea
- Abdominal pain and bloating
- Skin rashes
- Neurologic symptoms (seizures, numbness in extremities, or tingling hands, feet, and legs)
Long-term, celiac disease flare-ups can cause osteoporosis, miscarriage, and malnutrition. It can also be a contributing factor to the development of other diseases such as multiple sclerosis and diabetes.
Although researchers have not been able to pinpoint the cause of celiac disease, they do agree on the one trigger that must be completely eliminated from the diet in order to control flare-ups: gluten.
Gluten is a protein composite that gives bread and other baked goods elasticity and shape. Gluten is present in wheat but can also be found in other grains such as wheat, spelt, rye, barley, farro, kamut, and semolina. For many people with gluten sensitivity, avoiding gluten is not difficult, and if a small amount sneaks into their diet, the consequences, although not comfortable, are short-lived and minor. For those with celiac disease, even the tiniest amount of gluten can cause excruciating pain and other side effects.
Here are some common hidden sources of gluten.
1. Soy sauce
Soy sauce is made from fermented wheat (among other things). There are gluten-free versions available, but they need to be clearly labeled. Don’t assume that tamari and nama shoyu are gluten-free.
2. Salad dressing
Salad dressing can contain malt, another source of hidden gluten, or it may use flour as a thickener.
Gluten can be hiding in the flour used as a thickener or in grains that are included in the soup itself.
It is one thing to have gluten pop up in foods you can avoid, but what happens if medications you have to take are hiding gluten? Many doctors are not even aware that some prescription medications contain gluten and may be unwittingly prescribing them for their celiac patients. Gluten Free Drugs is a website that follows the push for labeling of all ingredients in medications and also lists drugs that are gluten-free. If you or a loved one have celiac disease, take a moment to check the medication list.
Beer (and some other alcohols) are made with wheat, barley, and malt. There are gluten-free beers on the market to substitute, or you can stick with clear alcohols based on corn or potatoes (like vodka).
Candy often has malt as a flavoring and can also use wheat in cookie-based candy bits. Even something like licorice and some hard candies contain gluten. Avoid this hidden gluten by avoiding candy altogether (best for your health!), or looking for specific gluten-free labeling.
From barbeque sauce to ketchup, gluten is used as a stabilizer and a thickener in many condiments. Gluten-free substitutes are becoming more widely available, or you can take advantage of late summer’s bounty and make your own.
8. Meat substitutes
From seitan to vegetarian burgers, watch out for hidden gluten. It may be right on the label (textured wheat protein) or it may come in the form of grains that contain gluten. Gluten gives these products their meat-like texture. Look for veggie burgers that contain only veggies with no gluten-based binders or thickeners.
9. Products labeled “wheat-free”
Wheat-free does not mean gluten-free. Other grains and food contain gluten and can still cause a flare-up. Only products manufactured in a strict, dedicated environment can be labeled gluten-free.
Cereals often contain malt as a sweetener or flavoring, and oats, although naturally gluten-free, are one of the most cross-contaminated foods out there.
11. Flavored potato chips
Potatoes contain no gluten, but flavored potato chips are usually manufactured in a non-dedicated industrial kitchen, meaning they can be cross-contaminated. Additionally, many flavored chips use malt and barley as flavorings or sweeteners. Some even have wheat gluten listed as an ingredient. Look for brands like Kettle chips or popchips, both of which are gluten-free.
12. Chewing gum
Some chewing gums use a gluten-based powder to prevent the gum from sticking to the wrapper. Try gluten-free gums like Trident or Glee.
13. Restaurant food
It can be very difficult for those with celiac disease to eat out. Although many restaurants have increased their gluten-free offerings, some use gluten in unexpected ways. IHOP, a popular chain restaurant in the U.S., uses pancake batter in their omelets to make them fluffier, and pancake batter contains gluten. Other concerns might be for gluten-free pasta that is cooked in the same pasta water as regular pasta. Celiac patients should ask questions and alert servers before ordering anything. Some restaurants may be unable to accommodate a strict, gluten-free diet.
14. Baking powder
Baking powder is baking soda, cream of tartar, and a thickener. This thickener can be flour, so it’s best to read the label carefully. Better yet, make your own baking powder by combining one part of baking soda to two parts cream of tartar.
If you want gluten-free cornbread, you may have to make it yourself. Many prepackaged mixes contain cornmeal combined with flour, and most cornbread in restaurants also use flour.
16. Blended and flavored coffee
If you like your coffee light and sweet or flavored and frozen, you may be in trouble. Many coffee flavorings contain malt and barley, and some instant coffee contains flour as a bulking agent. Even the sprinkles and java chips on your Frappucino contain gluten.
17. Communion wafers
While this is not a daily problem for most people, those with celiac disease may need to skip taking communion, as communion wafers are made with wheat. Even the sacramental wine may have bits of crumbs. If this is an important part of your worship, talk with your religious leader to see what he or she suggests.
18. Cooking utensils
Cutting boards, wooden spoons, side towels: all of these daily cooking utensils can contain trace amounts of gluten that can be dangerous for those with celiac disease. Keep cooking utensils for gluten-free cooking separate from all others.
For an even more extensive list of sources of hidden gluten, visit the Celiac Disease Foundation’s website.