The Gluten Free Diet For Beginners + Food List
Gluten free diets are getting crazy popular these days. And by last count, they were nearly as popular as the grandaddy of trend diets...the low carb diet. But what does a gluten free diet actually look like? Can it really help your health? And are there any potential downsides. Let's take a look at what the research says.
Table of Contents
1. What is the gluten free diet?
Gluten is made up of a combination of proteins that are found in the cereal grains wheat, barley, and rye.1, 2A gluten free diet is an eating pattern which excludes all foods that are either made with or contaminated by gluten during preparation and/or production.
A 2017 market research study revealed gluten free diets were second only to low-carbohydrate diets in popularity, with 11% of Americans having tried a gluten free diet in the prior year.3
While the popularity of the gluten free diet has reshaped the landscape of modern grocery store shelves, the diet originated way back in 1941 as a therapeutic diet for the treatment of a gluten-stimulated autoimmune disorder called celiac disease.2
Today, gluten free diets continue to be used as the primary treatment for celiac disease, as well as for related autoimmune conditions of the skin (Dermatitis Herpetiformis) and the rare neurological autoimmune condition called gluten ataxia. Other non-autoimmune uses of the diet include the treatment of non-celiac wheat sensitivity and wheat allergies.2
In spite of the popularity of the diet, research is ongoing to determine if gluten free diets have any benefits beyond these specific gluten and wheat related diseases.
Current areas of research for gluten free diets include autoimmune disorders not typically associated with gluten, autism spectrum disorders, and psychological illness, just to name a few.3
It’s not uncommon for gluten free diets to be promoted as beneficial for people without a medical diagnosis requiring gluten exclusion.3 To date, evidence of benefits from following a gluten free diet have not been observed in healthy individuals without underlying medical conditions.2
2. What foods & drinks can you eat on gluten free diet?
What You Can’t Eat
The grains to avoid on a gluten free diet are wheat, barley and rye. It’s important to know that wheat (and related grains) are called other names too, including emmer, farro, hulled wheat, semolina, triticale, durum, bulgar, einkorn, khorasan, spelt, durum, and kamut.
Derivatives of gluten-containing grains are sometimes used by food manufacturers in non-grain based foods. For instance, barley malt is used commonly for foods such as corn or rice based cereals, syrups, and candies.
Wheat is the basis of most grain-based foods such as breads, pasta, cereals, cookies, cakes, pastries and several snack foods, though gluten free alternatives may also be available for these foods.
Additionally, wheat is often used as a thickener for sauces and gravies, as a food additive, and as a coating for meat or fish.4 Other foods and beverages that contain wheat include seitan, worcestershire sauce, soy sauce, beer, and kvass.
Incorporation of oats into a gluten free diet has been an area of controversy. Rarely, people with celiac disease can react to oat’s protein, too. Commercial oats may also become contaminated during processing by gluten-containing grains; however, this can also happen to other gluten free grains and is not specific to oats. Generally, even large quantities of gluten-free oats eaten by people with celiac disease have not been found to compromise intestinal health.4 Choosing certified gluten free oats is important to avoid gluten contamination.
The gluten-free diet includes all food groups that are naturally gluten free such as fresh fruit, vegetables, seafood, meat, poultry, legumes, nuts, and most dairy products. Gluten free grains and pseudocereals include: amaranth, buckwheat, sorghum, quinoa, millet, rice, and corn. Even though these ingredients are traditionally gluten free, product labels have to be reviewed to avoid ‘hidden’ gluten.2
Hidden Sources of Gluten
Just as we avoid cross contamination by not preparing raw meats using the same cutting board where we prepare fresh produce, the same level of mindfulness is needed to avoid gluten cross contamination.
- In the field: contamination from adjacent fields, harvesting on shared equipment, or grains shipped together.
- At the factory: shared storage or processing equipment, open bins.
- Home: cutting boards, shared toaster, counter tops, shared spreads (butter, peanut butter, jam, etc.) shared utensils and kitchen equipment.
- Restaurants: Grill, deep fryers, salad bars, improper food handling by employees, serving utensils.4
Non-food Sources of Gluten Exposure
- Workplace exposure to airborne flour (e.g. bakeries)
- Wheat-based playdough
- Wheat-based communion wafers
- Dietary supplements
- Prescription and over the counter medications
- Toothpaste or dental adhesive4
A Note on Prescription Medications
Starches are sometimes used when making pharmaceutical medications. Most often these starches come from potato, rice, or tapioca, which are gluten-free. However, traces of gluten can sometimes be found in pharmaceuticals that use dextrans, dextrates, dextri-maltose, maltodextrin, modified starch, pregelatinized starch and sodium starch glycolate. It’s recommended that all long term medications be reviewed with a pharmacist to assess for gluten exposure if you have a medical condition which requires you to avoid gluten.4
3. Example of gluten free diet meals
1 cup, cooked certified gluten free oatmeal or other gluten free hot cereal (amaranth, buckwheat porridge, etc.)
1 medium apple
3 oz chickpea pasta
2 rice cakes
1 cup roasted potatoes
1 cup unsweetened almond milk
2 tbsp peanut butter
1/2 cup zucchini
1 tbsp fresh rosemary
1 tbsp pumpkin seeds
2 cup spinach (cooks down)
6 oz salmon
1 tsp flax seeds
1 tbsp olive oil
1 tbsp butter
1 tbsp dried cranberries
1 tbsp fresh basil
1 sliced garlic clove
1 tbsp raisins
1 oz pine nuts
1 tbsp lemon juice
1 sliced garlic clove
1 cup broccoli
1 tbsp parmesan cheese
4. How easy is it to do?
If you are considering following a gluten-free diet, the main things to consider are the inconvenience, the cost, and the palatability of gluten-free substitutes of conventionally eaten foods.
The inconvenience of following a gluten-free diet is largely a problem of the past. The gluten-free industry grew 136% from 2013 to 2015;5 the variety and availability of gluten-free foods continue to grow. However, dining out can still be a struggle for those following a strict gluten-free diet due to limited menu options or the risk of cross-contamination. Following a gluten-free diet requires diligent label reading to avoid gluten, which may be inconvenient at grocery stores or when dining in social settings or traveling to regions where limited gluten-free options are available.
Gluten-free products tend to be expensive. In a recent study,2 the most dissatisfying part of following a gluten-free diet was the cost. Gluten-free products can be 200-500% more expensive than their standard gluten-containing counterparts, potentially causing a financial strain on those wanting to avoid gluten.3
Recent data suggest that more than $15.5 billion were spent on retail sales of gluten-free foods in 2016, twice the amount spent in 2011.6 That number continues to grow due to the demand for gluten-free foods and rising food costs. A great way to lower the price of a gluten-free diet while enhancing nutritional quality is to minimize packaged foods and go for naturally gluten-free whole foods.
The last potential obstacle to following a gluten-free diet may be replacing gluten-containing foods with their gluten-free substitutes. The food industry has tried hard to replicate our favorite gluten-containing carbs such as pizza crust, bread, and pasta, to name a few. Test out several brands at the start to find your new gluten-free favorites.
It is easier to follow a gluten-free diet now than 10-15 years ago in terms of availability and variety of foods on the market. However, with that increased variability in products comes a new consideration: are gluten-free products healthy?
The desire for gluten-free dining has increased the variety of "ultra-processed" foods such as bread, salty snacks, breakfast cereals, ready-to-eat pizzas/hamburgers/sandwiches, frozen meals, sweet snacks, and desserts. Processed foods, regardless of gluten content, tend to be higher in calories and lower in fiber and other nutrients. If you are starting a gluten-free diet, consider how to do so healthfully.
5. Benefits of gluten free diet
Gluten-related Autoimmune Disorders
Celiac disease, dermatitis herpetiformis, and gluten ataxia are gluten-related autoimmune conditions.2
Celiac disease is an autoimmune disorder where the genetics ‘load the gun’ and the environment and diet pulls the trigger. When someone with celiac disease eats gluten, special immune cells called T-cells (AKA killer cells) wreak havoc on the intestinal lining. The result is inflammation, a battered intestinal wall, and the breaking down of important tissues for absorbing nutrients, which can all result in pain and several nutrient deficiencies. Gluten avoidance for someone with celiac disease is critical for managing the disease, which if left unchecked, may lead to more discomfort, esophageal, skin, and bowel cancers,7 and continued nutrient deficiencies.8
Dermatitis herpetiformis (DH) is an autoimmune disorder that commonly occurs along with celiac disease. It’s often called “celiac disease of the skin” and involves an itchy and blistering rash. A strict gluten free diet can lead to significant improvements for people with DH, but this can require following the diet for months or even years to see the results.2
Gluten ataxia is a rare autoimmune condition that causes brain damage due to antibodies made by the body after eating gluten in susceptible people.2 Possible symptoms of ataxia might include poor coordination, gait changes, tremors, slurred speech, eye movement changes, or vertigo.9 Specific symptoms are related to the parts of the brain being impacted. At Least one year of a strict gluten free diet may be needed for clear signs of improvement in people with gluten ataxia.2
Gluten Free Diets and Other Autoimmune Disorders
The use of gluten free diets has been explored for a number of autoimmune disorders including rheumatoid arthritis, type 1 diabetes, autoimmune thyroid disorders, autoimmune liver disease (hepatitis), multiple sclerosis, psoriasis, inflammatory bowel disease, and vitiligo.2 At this point in time, there are more questions than answers as to how a gluten free diet might impact certain autoimmune diseases, and which patients (if any) with these diseases might benefit from a gluten free diet.
Differences in study design, as well as other dietary changes along with gluten removal (for example, a gluten-free AND vegan diet trial for rheumatoid arthritis 3 can make it challenging to disentangle benefits and know for certain that going gluten free is what prompted a health benefit. Adding to the complexity is the fact that several other autoimmune disorders can also commonly occur along with celiac disease, which may be especially true for autoimmune thyroiditis, autoimmune hepatitis, type 1 diabetes, Sjogren’s syndrome, and psoriasis.10
Until more well controlled studies are done, the jury is still out on how gluten free diets might impact other autoimmune disorders not traditionally associated with gluten.
Wheat Sensitivities and Allergies
Non-celiac wheat sensitivity (NCWS) (also commonly referred to as non-celiac gluten sensitivity) is a condition where gut or body-wide symptoms are experienced after eating gluten-containing foods. Commonly, NCWS results in IBS-like symptoms in sensitive individuals.11 NCWS is a diagnosis of exclusion, meaning that it’s only diagnosed after celiac disease and wheat allergy have been ruled out.
Other components in wheat besides gluten may also cause NCWS including compounds called α-amylase/protease inhibitors, and short chain carbohydrates that aren’t well absorbed in the small intestine, such as fructan.11 At this time, researchers are looking for easier ways to diagnose NCWS, but for now a highly controlled food trial that minimizes the risk of experiencing a placebo effect is the only way to diagnose NCWS.
How often NCWS occurs is not yet known, but it’s estimated to affect 0.6-6% of the population. NCWS occurs most often in women and in the 3rd and 4th decades of life. NCWS may be prompted by multiple factors including the immune system, issues with intestinal barrier function, and the microbiome.11
Wheat food allergies can be started by an immune system overreaction caused by IgE antibodies. Other wheat food allergies can be prompted by a type of disease fighting white blood cell called an eosinophil. This type of allergy is commonly found in people with a disease called eosinophilic esophagitis. Food allergies to wheat are most common in children. If wheat is inhaled such as from airborne flour in a bakery, then problems such as baker’s asthma can also be triggered for people with respiratory allergies to wheat.12 A gluten free diet naturally restricts all wheat, which can also prevent the allergic reaction along with avoidance of airborne wheat.
Gluten Free Diets for Cognitive Disorders and Psychological Illness
Small studies of gluten free or gluten and casein free diets have been done in people with autism spectrum disorder (ASD). To date, there is currently poor evidence for the use of gluten free or gluten free casein free diets in ASD.3
Several studies have evaluated the effects of a GFD on patients with schizophrenia, a brain disorder characterized by hallucinations, delusions, and disorganized speech and behavior. While results have been mixed, some studies have found beneficial impacts from a gluten-free diet in Schizophrenia. More research is needed to draw firm conclusions.3
Gluten Free Diets for Healthy Individuals
To date, no beneficial effects from a gluten-free diet have been shown in healthy individuals.2 A lack of studies on gluten free diets in healthy people without any inflammatory or autoimmune conditions makes it challenging to substantiate using gluten free diets in healthy people.13
6. Risk of gluten free diet
While all diets require some thought and consideration to keep things balanced, this sadly may be even more of a challenge on a gluten free diet. Unlike wheat based products, gluten-free items are typically not fortified or enriched with additional nutrients.
Generally, gluten free products are lower in fiber, protein, and key micronutrients such as folate, iron, niacin, thiamin, and riboflavin.2 Gluten free items are also typically higher in calories, fat, sugar, and sodium compared to regular products. Studies have shown that the total fat content of gluten-free breads is at least twice the amount found in their gluten-containing counterparts.
Moreover, many gluten-free pasta products appear to have significantly higher carbohydrates and sodium contents than traditional products.2
One study evaluated three gluten free foods and noted a higher level of fermentable carbohydrates called FODMAPs (potential gut irritants for sensitive individuals)14 in the gluten free products compared against the gluten containing products. This is notable as avoiding gluten may not be enough to resolve gut discomfort for those with FODMAP sensitivities if high FODMAP gluten free alternatives are eaten.
A survey of a group of children following a gluten-free diet assessed how often they were eating "ultra-processed" foods. These energy-dense foods included bread, salty snacks, breakfast cereals, ready-to-eat pizzas/hamburgers/sandwiches, frozen meals, sweet snacks, and desserts.
The results showed that 77% consumed processed gluten-free foods multiple times per day and 20% ate exclusively processed gluten-free foods. Processed foods, regardless of gluten content, are still processed foods and should never be the cornerstone of any diet, including a gluten free diet. Several healthy and nutrient dense foods are naturally gluten free including fruits, vegetables, legumes, nuts, and more.
Taking advantage of these healthful non-processed options is a great way to construct a balanced gluten free diet, while minimizing the risks of nutrient deficiencies. Another point of concern is that gluten free diets may enhance the exposure to heavy metals.
A National Health and Nutrition Examination Survey (NHANES) found significantly higher urine levels of arsenic and blood levels of mercury, lead, and cadmium in people following gluten free diets.3 This may be a consequence of gluten free diets being high in rice or rice based products and fish, both of which can contain high concentrations of these heavy metals.3 A 2013 consumer report suggests eating no more than two ¼ cup uncooked (roughly ½ cup cooked) servings of rice per week to avoid excessive arsenic exposure.15
It’s a good idea to diversify gluten free grains and pseudograins as much as possible to reduce heavy metal exposure on a gluten free diet.
7. Our conclusion
- Gluten is made up of a combination of proteins that are found in the cereal grains wheat, barley, and rye.
- A gluten free diet is an eating pattern which excludes all foods that are either made with or contaminated by gluten during preparation and/or production.
- Being mindful of the risks of cross contamination and hidden sources of gluten is essential. To properly follow a gluten free diet, you will need to know which foods contain gluten and how to spot those foods on ingredient labels.
- Going out to eat can be hard for people following a strict gluten-free diet due to limited menu options, the risk of cross-contamination, and inadequate education/training on gluten-free foods for the kitchen staff.
- Inconveniences might include social settings or traveling to regions where limited gluten free options are available.
- Gluten free products are much more expensive, and may also be less nutritious due to lower fiber, protein, and vitamin content, along with higher fat, sodium, sugar, and calories.
- A great way to lower the cost of a gluten free diet while enhancing nutritional quality is to minimize packaged foods, and go for whole foods that are naturally gluten free and not marked up in price.
- While many gluten free food options are available, some may feel closer to the real-deal, while other products feel like a miss. It may take some exploration to find your new favorite gluten free substitutes.
- Gluten free diets are used to treat celiac disease, dermatitis herpetiformis, gluten ataxia, non-celiac wheat sensitivity, and wheat allergies.
- The use of gluten free diets has also been explored for non-celiac autoimmune disorders, cognitive disorders, and for psychological illness, amongst others, but more evidence is needed to determine if gluten free diets are beneficial for these conditions.
- No benefit of gluten free diets in healthy individuals has been detected, though few studies exist in healthy individuals.
- The gluten free diet, while necessary for some, has several pitfalls that should be considered before trying the diet without a good reason. Major areas of concern would be to limit highly processed gluten free foods, as these foods often are not as nutritious as whole food options or their gluten-free counterparts. Also, be especially mindful of the risks of heavy metal exposures, and work to diversify your gluten free grain selections outside of just rice.
An evidence hierarchy is followed to ensure conclusions are formed off of the most up-to-date and well-designed studies available. We aim to reference studies conducted within the past five years when possible.
- Systematic review or meta-analysis of randomized controlled trials
- Randomized controlled trials
- Controlled trials without randomization
- Case-control (retrospective) and cohort (prospective) studies
- A systematic review of descriptive, qualitative, or mixed-method studies
- A single descriptive, qualitative, or mixed-method study
- Studies without controls, case reports, and case series
- Animal research
- In vitro research
- Volta U, De Giorgio R, Caio G, Uhde M, Manfredini R, Alaedini A. Nonceliac wheat sensitivity. Gastroenterol Clin North Am. 2019;48(1):165-182
- El Khoury D, Balfour-Ducharme S, Joye I. A review on the gluten-free diet: technological and nutritional challenges. Nutrients. 2018;10(10):1410
- Lerner B, Green P, Lebwohl B. Going against the grains: Gluten-free diets in patients without celiac disease—worthwhile or not?. Dig Dis Sci. 2019;64(7):1740-1747
- See J, Kaukinen K, Makharia G, Gibson P, Murray J. Practical insights into gluten-free diets. Nature Reviews Gastroenterology & Hepatology. 2015;12(10):580-591
- Reilly N. The gluten-gree diet: Recognizing fact, fiction, and fad. J Pediatr. 2016;175:206-210
- Diez-Sampedro A, Olenick M, Maltseva T, Flowers M. A Gluten-free diet, not an appropriate choice without a medical diagnosis. J Nutr Metab. 2019;2019:1-5
- Catassi C, Bearzi I, Holmes G. Association of celiac disease and intestinal lymphomas and other cancers. Gastroenterology. 2005;128(4):S79-S86
- Caruso R, Pallone F, Stasi E, Romeo S, Monteleone G. Appropriate nutrient supplementation in celiac disease. Ann Med. 2013;45(8):522-531
- Ashizawa T, Xia G. Ataxia. CONTINUUM: Lifelong Learning in Neurology. 2016;22(4):1208-1226
- Denham J, Hill I. Celiac disease and autoimmunity: review and controversies. Curr Allergy Asthma Rep. 2013;13(4):347-353
- Volta U, De Giorgio R, Caio G, Uhde M, Manfredini R, Alaedini A. Nonceliac wheat sensitivity. Gastroenterol Clin North Am. 2019;48(1):165-182.
- Cianferoni A. Wheat allergy: diagnosis and management. J Asthma Allergy. 2016:13
- Lerner A, Shoenfeld Y, Matthias T. Adverse effects of gluten ingestion and advantages of gluten withdrawal in nonceliac autoimmune disease. Nutr Rev. 2017;75(12):1046-105814
- Melini V, Melini F. Gluten-free diet: Gaps and needs for a healthier diet. Nutrients. 2019;11(1):170
- Arsenic in Rice | FDA Recommends Diversifying Grains - Consumer Reports. Consumerreports.org. https://www.consumerreports.org/cro/news/2013/09/arsenic-in-rice-test-data-prompt-fda-to-recommend-diversifying-grains-in-diet/index.htm. Published 2021. Accessed May 17, 2021.