What foods have gluten?
A quick guide to gluten-free diet for patients and nutritionists
What foods have gluten? This question is more and more commonly asked by anyone experiencing celiac disease-like symptoms and indeed, 1% of the worldwide population is affected by celiac disease. This disease affects individuals who are genetically predisposed to this condition and is an autoimmune disease caused by an abnormal immune reaction to gluten. Multiple organs can be affected and patients can present a varied list of clinical symptoms so that physicians of all specialties should consider celiac disease as a possible diagnosis when evaluating their patients.
Since celiac disease can manifest with widely varying symptoms, we can classify this disease in three categories:
- classic, with symptoms including diarrhea, weight loss, malabsorption, and vitamin deficiency;
- atypical with minimal GI symptoms but possible anemia, neurologic symptoms, arthritis, or infertility;
- asymptomatic with no symptoms but which is generally identified on incidental screening.
Non-celiac gluten sensitivity is a distinct condition characterized by an adverse reaction to gluten that cannot be classified as an autoimmune disease and in the absence of an inflammatory response.
Both adults and children affected by one of the following conditions should consider doing serologic testing for celiac disease: autoimmune hepatitis, type 1 diabetes, Down syndrome, Turner syndrome, Williams syndrome, iron-deficient anemia, primary biliary cirrhosis and all subjects having at least one first-degree relative affected by celiac disease.
Also unexplained elevation of liver transaminases can be a sign of celiac disease.
Once diagnosed of celiac disease (and/or dermatitis herpetiformis), the only thing to do is to avoid gluten for life since there is not alternative treatment for the condition to the gluten-free diet.
What foods have gluten?
Gluten is found in wheat, rye, barley and any foods made with these grains. Let’s see some of them more in detail:
- Cereal grains containing gluten: wheat, kamut, spelt and barley
Wheat, barley, kamut and spelt are contained in all foods made by wheat (white, durum and wholegrain), kamut and spelt flour such as: bread, pasta, ravioli, tortellini, crackers, baked foods (cakes, pastries, muffins, cookies, etc.), croutons, packet snacks, rusks, waffles, pancakes, crepes, pizzas, pretzels, flour tortilla, breadsticks and communion wafers.
Semolina, bulgur and cous cous contain wheat too and also pudding can be made with some flour. Although based on potatoes, gnocchi (a typical Italian dish) are traditionally prepared with some wheat flour. Beer, lager and ales are other forbidden products, because they can be both wheat-based and barley-based.
One has to be careful because it is common practice to use white flour in the preparation of meat, fish and some dressings as well as sauces. When eating out, asking the details about the preparation of the dishes on the menu before ordering them is a must for all celiac people.
Other products that must be checked on the label of the purchased products are: wheat germ, wheat bran, triticale, starch, modified starch, hydrolised starch, food starch, edible starch.
- Gluten Surprises
Many do not know it, but also the following foods can contain gluten:
- Broth in soups and bouillon cubes;
- Breadcrumbs and croutons;
- Some candies;
- Fried foods;
- Imitation fish;
- Some lunch meats and hot dogs;
- Seasoned chips and other seasoned snack foods;
- Salad dressings;
- Self-basting turkey;
- Soy sauce;
- Seasoned rice and pasta mixes;
Some packaged foods can include both additives and ingredients that contain gluten. It is therefore fundamental to always check labels and ingredient lists for these products. For instance, some processed dairy products such as cheese, yogurt, whipped cream and other may contain gluten from food additives.
Ingredients in food products change frequently; therefore it is a good rule to check the label of packaged and processed foods before purchasing them.
Finally, “wheat-free” does not automatically mean “gluten-free” since gluten can be contained in barley, spelt and kamut too. Any questions about the possibility that a product can contain gluten can be asked at the producers, many of them include contact information on the labels or on their websites.
And what foods do NOT have gluten?
Many foods are naturally gluten-free. These include:
- Meat (check if meat has been floured before cooking);
- Fish (check if fish has been floured before cooking);
- Fruit and vegetables;
- Pulses (beans, peas, chickpeas, etc.) and pulse flours;
- Almond meal flour;
- Brown, white and wild rice;
- Coconut flour;
- Corn starch;
- Guar gum;
- Potato flour;
- Soy flour;
- Vegetable oils.
There are also many alcoholic and soft drinks that do not contain gluten, such as:
- Fruit juice;
- Flavoured water;
- Fizzy drinks;
Gluten-free beers and lagers are also available.
A gluten-free diet can be challenging for those who do not have an education in nutrition. I hope that this article will be of help both to celiac and gluten-sensitive people, but also to other fellow nutritionists, nurses or physicians who have to deal with this type of patients. If you have any further doubts about gluten-free diet or celiac disease, feel free to use the contact form on my website and do not forget to share this article on social media!
 Mavrinac MA, Ohannessian A, Dowling EP, Dowling PT. Why celiac disease is so easy to miss. J Fam Pract. 2014 Sep;63(9):508-13.
 What foods hage gluten – The American Diabetics Association http://www.diabetes.org/food-and-fitness/food/planning-meals/gluten-free-diets/what-foods-have-gluten.html