Adult Gastroenterology Associates
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Gluten-Free Diet Purpose Gluten is the protein part of wheat, rye, barley, oats, and other related grains. Some people cannot tolerate gluten when it comes in contact with the small intestine. This condition is known as celiac disease (sometimes called non-tropical sprue or gluten sensitive enteropathy). There is also evidence that a skin disorder called dermatitis herpetiformis is associated with gluten intolerance. In patients with celiac disease, gluten injures the lining of the small intestine. This injury results in weight loss, bloating, diarrhea, gas, abdominal cramps, or vitamin and mineral deficiencies. When patients totally eliminate gluten from the diet, the lining of the intestine has a chance to heal. Removing gluten from the diet is not easy. Grains are used in the preparation of many foods. It is often hard to tell by an ingredient's name what may be in it, so it is easy to eat gluten without even knowing it. However, staying on a strict gluten-free diet can dramatically improve the patient's condition. Since it is necessary to remain on the gluten-free diet throughout life, it will be helpful to review it with a registered dietitian. Nutrition Facts Depending on the foods selected, the gluten-free diet can meet the Recommended Dietary Allowances (RDA) of the National Research Council. Special Considerations The person who prepares the patient's food must fully understand the gluten-free diet. Read food labels carefully and do not use anything that contains the following grains: wheat, rye, barley, oats, buckwheat, millet, amaranth, and quinoa. The following do not contain gluten and can be eaten in any amount: corn, potato, rice, soybeans, tapioca, arrowroot, and carob. Grains are used in the processing of many ingredients, so it will be necessary to seek out hidden gluten. The following terms found in food labels may mean that there is gluten in the product. Hydrolyzed Vegetable Protein (HVP), unless made from soy or corn Flour or Cereal products, unless made with pure rice flour, corn flour, potato flour, or soy flour Vegetable Protein unless made from soy or corn Malt or Malt Flavoring unless derived from corn Modified Starch or Modified Food Starch unless arrowroot, corn, potato, tapioca, waxy maize, or maize is used Vegetable Gum unless vegetable gums are carob bean gum, locust bean gum, cellulose gum, guar gum, gum arabic, gum aracia, gum tragacanth, xanthan gum, or vegetable starch Soy Sauce or Soy Sauce Solids unless you know they do not contain wheat Distilled White Vinegar is made from grains and may contain gluten. Many commercially prepared condiments are prepared with distilled white vinegar and may contain very small amounts of gluten. Any of the following words on food labels usually means that a grain containing gluten has been used: stabilizer starch flavoring emulsifier hydrolyzed plant protein There are now several companies that produce gluten-free products, and several support groups to provide delicious recipes and help patients adapt to the gluten-free diet. Food Group Do Not Contain Gluten May Contain Gluten Contain Gluten Milk & milk products (2 or more cups daily) whole, low fat, skim, dry, evaporated, or condensed milk; buttermilk; cream; whipping cream; Velveeta cheese food; American cheese; all aged cheeses, such as Cheddar, Swiss, Edam, and Parmesan sour cream commercial chocolate milk and drinks, non-dairy creamers, all other cheese products, yogurt malted drinks Meat or meat substitutes (5 to 6 oz daily) 100% meat (no grain additives); seafood; poultry (breaded with pure cornmeal, potato flour, or rice flour); peanut butter; eggs; dried beans or peas meat patties; canned meat; sausages; cold cuts; bologna; hot dogs; stew; hamburger; chili; commercial omelets, soufflés, fondue; soy protein meat substitutes croquettes, fish, chicken loaves made with bread or bread crumbs, breaded or floured meats, meatloaf, meatballs, pizza, ravioli, any meat or meat substitute, rye, barley, oats, buckwheat, gluten stabilizers Breads & grains (4 or more servings daily) cream of rice; cornmeal; hominy; rice; wild rice; gluten-free noodles; rice wafers; pure corn tortillas; specially prepared breads made with rice, potato, soybean, or arrowroot flour, Kellogg's Sugar Pops; puffed rice; Post's Fruity and Chocolate Pebbles cornbread, packaged rice mixes, ready-to-eat cereals containing malt flavoring breads, buns, rolls, biscuits, muffins, crackers, and cereals containing wheat, wheat germ, oats, barley, rye, buckwheat, bran, graham flour, malt; kasha; bulgur; millet; Melba toast; matzo; bread crumbs; pastry; pizza dough; regular noodles, spaghetti, macaroni, and other pasta; rusks; dumplings; zwieback; pretzels; prepared mixes for waffles and pancakes; bread stuffing or filling Fats & oils (servings depend on caloric needs) butter,margarine, vegetable oil shortening, lard, salad dressings, non-dairy creamers, mayonnaise gravy and cream sauces thickened with flour Fruits (2 or more servings daily) plain, fresh, frozen, canned, or dried fruit; all fruit juices pie fillings, thickened or prepared fruit, fruit fillings none Vegetables (3 or more servings daily) fresh, frozen, or canned vegetables; white and sweet potatoes; yams vegetables with sauces, commercially prepared vegetables and salads, canned baked beans, pickles, marinated vegetables, commercially seasoned vegetables creamed or breaded vegetables; those prepared with wheat, rye, oats, barley, buckwheat, or gluten stabilizers Snacks & desserts (servings depend on caloric needs) brown and white sugar, rennet, fruit whips, gelatin, jelly, jam, honey, molasses, pure cocoa, fruit ice, popcorn, carob custards, puddings, ice cream, ices, sherbet, pie fillings, candies, chocolate, chewing gum, cocoa, potato chips cakes, cookies, doughnuts, pastries, dumplings, ice cream cones, pies, prepared cake and cookie mixes, pretzels, bread pudding Beverages (4 to 6 cups or more daily) tea, carbonated beverages (except root beer), fruit juices, mineral and carbonated waters, wines coffee, decaffeinated coffee, cocoa mixes, root beer, vodka, chocolate drinks, nutritional supplements, beverage mixes Postum™, Ovaltine™, malt-containing drinks, cocomalt, beer, ale, gin, whiskey, rye Soups those made with allowed ingredients commercially prepared soups, broths, soup mixes, bouillon cubes soups thickened with wheat flour or gluten-containing grains; soup containing barley, pasta, or noodles Thickening agents gelatin, arrowroot starch; corn flour, germ, or bran; potato flour; potato starch flour; rice bran and flour; rice polish; soy flour; tapioca, sago   wheat starch; all flours containing wheat, oats, rye, malt, barley, or graham flour; all-purpose flour; white flour; wheat flour; buckwheat; bran; cracker meal; durham flour; wheat germ Condiments wheat-free soy sauce flavoring syrups (for pancakes or ice cream), olives, pickles, relish, ketchup, mayonnaise, horseradish, salad dressings, tomato sauces, meat sauce, mustard, taco sauce, soy sauce, chip dips distilled white vinegar Seasonings salt, pepper, herbs, flavored extracts, food coloring, cloves, ginger, nutmeg, cinnamon, bicarbonate of soda, baking powder, cream of tartar, monosodium glutamate curry powder, seasoning mixes, meat extracts synthetic pepper, brewer's yeast (unless prepared with a sugar molasses base), yeast extract (contains barley) Prescription products   all medicines: check with pharmacist or pharmaceutical company   Sample Menu Breakfast Lunch Dinner cream of rice 1/2 cup skim milk 1 cup banana 1 med orange juice 1/2 cup sugar 1 tsp baked chicken 3 oz rice 1/2 cup green beans 1/2 cup apple juice 1/2 cup ice cream (made with-out wheat stabilizers ) 1/2 cup sirloin steak 3 oz baked potato 1 med peas 1/2 cup fruited gelatin 1/2 cup butter 1 Tbsp tea 1 cup sugar 1 tsp This Sample Diet Provides the Following Calories 1748 Fat 62 gm Protein 77 gm Sodium 1577 mg Carbohydrates 225 gm Potassium 2934 mg