GLUTEN: A yellowish-gray, powdery mixture of plant proteins occurring in cereal grains such as wheat, rye, barley…. The gluten in flour makes it ideal for baking because the chainlike protein molecules of the gluten trap carbon dioxide and expand with it as it is heated. Gluten is also used as an adhesive and in making seasonings, especially monosodium glutamate (MSG).
—The American Heritage Science Dictionary
Gluten is a protein found in wheat, barley, rye, contaminated oats (meaning they were grown, harvested, or processed in a gluten-containing facility), and a multitude of other products—as its word origin suggests, it acts as the “glue” that holds these foods together. Gluten is that sticky, binding substance that gives breads and pastas their elasticity and texture.
As you might expect, breads and other everyday foods like pizza, cookies, muffins, and bagels contain gluten, but so do a number of other items that may really surprise you. Because gluten is an all-purpose stabilizer and thickener, manufacturers add it to a wide range of consumer products. Medications, marinades, condiments, coffees, packaged spices, postage stamp adhesive, envelope seals, lipsticks, hairsprays, and even your daily multivitamin can all contain gluten as well.
If you cannot tolerate gluten, you should right away start familiarizing yourself with what exactly gluten is, and where it’s found. Once you are armed with the correct knowledge, you can take the necessary steps to get the gluten out of your life. If you don’t have a health issue related to gluten but still want to clean up your diet, you might take a more moderate approach to deglutening your diet. In that case, you might want to start by simply reducing, not all-out eliminating, gluten. Replacing your breakfast cereal with a G-free version and having your sandwich on G-free instead of white bread are simple ways to make those changes. Still, whether you go G-free in some or all aspects of your life, you should first understand what exactly gluten is, and where it’s found.
Before I get into what you can’t eat, let’s focus on everything you can feast on and enjoy whenever you want. All of the following in their pure form contain no gluten whatsoever:
Gluten is an incredibly sneaky substance, hidden in the unlikeliest places. Let’s start, though, with the most obvious sources of gluten: grain-based products made from wheat, barley, rye, and contaminated oats. All these common grains, especially wheat, have numerous derivatives and aliases. If you are new to the G-free lifestyle, keep the names of these wheat and barley derivatives with you on your next trip to the grocery store.
Wheat is an ancient food, a staple of much of the world’s food supply for almost 10,000 years. It is the second-most popular cereal in the world, more common even than rice. Only maize (corn) is produced and consumed in greater quantities worldwide. Different cultures have processed wheat in an endless variety of ways—leavened it into breads, powdered it into flours, fermented it into alcohols. All of the following foods contain wheat (and therefore gluten) and should be avoided on the G-free diet:
Rye—the key ingredient in rye flours, rye breads (like pumpernickel), rye beers, and some whiskies and vodkas—is closely related to wheat. Rye has a lower gluten content and a higher fiber content than wheat.
Half of the barley produced in this country is used as animal feed. When fermented, barley is used to make malt, a key component in the production of many beers and distilled alcohols. Coffee substitutes and instant coffees also frequently contain barley. If you see any of these words on a label, the food is likely to contain barley:
Triticale is a hybrid of wheat (Latin name: Triticum) and rye (Latin: Secale) developed in the late nineteenth century. Grown in areas where wheat is difficult to cultivate, this synthetic grain is mostly used in animal feed.
Oats remain a subject of great debate in the G-free community. While oats don’t contain gluten, they are often grown or processed alongside wheat, so the risk of cross-contamination (see here) is fairly large. “By far the majority of people with celiac disease tolerate oats,” says Dr. Green. “There are some very well-described cases of people who got the same intestinal lesion with oats, but that’s an exceptional case.” But, he adds, “Most oats are in fact contaminated and there are some gluten-free oats that can be used. But we advise people to eat gluten-free oats if they can get them. If people experience symptoms from eating contaminated oats, it’s probably just because they’re eating more fiber.” Before consuming any oat product, investigate the brand and speak with your physician.
Dextrin refers to a category of polysaccharides made from starch. Dextrin can be produced from corn, potato, arrowroot, rice, tapioca, or wheat. While most U.S. manufacturers of dextrin use corn, imported dextrin is often made from wheat, so you shouldn’t buy a dextrin-containing product until you’ve double-checked its source. Dextrimaltose is made from barley.
When you swear off gluten, you will quickly learn that a standard loaf of bread is off-limits, but unfortunately, the distinction between G-free and G-full foods is not always this clear-cut. The G-free diet requires you to examine just about every food before putting it in your mouth.
The following list of products might contain hidden sources of gluten:
Bacon bits and other imitation bacon products: Unless the package indicates otherwise, many imitation bacon products contain gluten. Hormel’s Real Bacon Bits are gluten-free.
Beer: While you can find plenty of delicious G-free beers these days (see here), most traditional beers are made from barley, rye, and other gluten-containing grains.
Blue cheese: The mold that gives blue cheese its characteristic color usually originates on old bread, so I would stay away.
Brown rice syrup: Rice on its own is safe, but brown rice syrup is made from a combination of rice and barley malt.
Cereals: Most traditional cereals have a high gluten content. Unless a cereal is made exclusively from the G-free grains listed on here, you should avoid it.
Coffees, flavored and instant: Avoid flavored and instant coffees unless you’re assured they’re G-free, and avoid sharing your coffeemaker with them as well. Decaf coffee can also contain gluten, so check that one, too.
Communion wafers: Many Catholic communities have already worked out G-free communion solutions for their celiac members. Ener-G Foods sells G-free communion wafers (www.ener-g.com).
Croutons: Croutons are made from dried, toasted bread. If you see any on your salad, send the whole plate back.
Dairy substitutes: Avoid dairy substitutes unless you are certain they’re gluten-free. Vance’s Dari Free (www.vancesfoods.com) is a potato-based milk substitute.
Deli meats: I only buy deli meats that say “gluten-free” on the label, as many have added gluten. Sausages, hot dogs, salami, and self-basting turkeys are even more likely to contain gluten. For more information, please see here and here.
Fried foods: French fries, chicken nuggets, and other deep-fried foods might all be contaminated with gluten. Make sure that there is no gluten in the batter of any fried food that you order, and also that your food has not shared a deep fryer with any glutenous food, as cross-contamination can occur.
Gravies: Gravies are often thickened with gluten-containing products, so always eat your food dry unless you’re assured that the gravy is 100 percent G-free.
Hydrolyzed vegetable protein (HVP) and hydrolyzed plant protein (HPP): HVP and HPP are used in many fake meats. If these are made from wheat, they are unsafe. If made from soy, they are safe. “Under the FDA, if they come from wheat, the source must be put in parentheses on the label,” said Dr. Green. But he still recommends caution, since barley as a source would not necessarily be indicated on the label.
Imitation seafood: The imitation crab in California rolls might contain fillers made from wheat starch. Always check.
Licorice: Pure licorice is G-free, but most commercial licorice candies have added gluten. It depends on the brand, so be sure to read the label carefully.
Marinades: Stay away from all premade marinades such as teriyaki sauce. Almost all restaurant marinades have some gluten content.
Salad dressings: Many restaurants and food manufacturers add gluten to thicken salad dressings.
Seasonings and spices: In their pure form, seasonings and spices are gluten-free. But watch out for spices that contain added declumping agents, as these often contain gluten. If you don’t see an ingredient list on the bottle, call the company and inquire about gluten and fillers. The term “ground spices” might indicate the presence of gluten, so be on guard against that one as well.
Soy sauce: Some soy sauces are gluten-free, but you can’t bet on it. I recommend bringing your own G-free soy sauce along to Asian restaurants.
Soup bases: Commercial bouillon cubes and chicken, beef, and vegetable stocks often have added gluten. Do not buy any of these without reading the label, and do not order soup in restaurants without asking about the soup base.
Beauty products: I will be exploring this subject in more detail in Chapter 14, but in the meantime, you should know that many lipsticks, lip glosses, skin moisturizers, hairsprays, and other everyday beauty products might contain gluten, often in the form of wheat germ oil or hydrolyzed wheat protein.
Stamp and envelope adhesive: The adhesive used in stamp and envelope adhesive is likely to contain gluten, so play it safe by using sticker stamps and moistening envelope flaps with a sponge.
Play-Doh: While experts don’t yet know if gluten can be absorbed in the skin, the gluten content of Play-Doh is a problem because children often place their hands—and their toys—directly into their mouths.
Prescription drugs and over-the-counter medications: Some prescription drugs contain gluten-based filler ingredients, also known as excipients or inert ingredients, added to the active drug. You have to be really careful because most pharmaceutical companies don’t list which excipients they’ve used either on the bottle or in the package insert. You might just see the word “starch,” with no information about where the starch comes from.
While some starch-based excipients are made from corn, potato, and tapioca, others are wheat-based. Therefore, proceed with caution. Talk to your doctor and your pharmacist about the gluten content of the medications—both prescription and OTC—that you take. If you still have questions, call the manufacturer.
Unfortunately, you have to go through this process every time you get a refill, for several reasons: Pharmaceutical companies frequently change the inactive ingredients without warning, and generic drugs often have different excipients than the brand-name version of the same drug. For more information, check out www.glutenfreedrugs.com. You will find lists of medications (Advil, Aleve, Visine A, Pepto-Bismol, Nyquil, and many more) that manufacturers list as gluten-free.
Vitamins and supplements: Decoding the additives in vitamins and nutritional supplements has gotten a lot easier over the last few years. Under the Food Allergen Labeling and Consumer Protection Act of 2004, nutritional supplements must be labeled if they contain wheat (barley and rye are not used). Still, you should always talk to your pharmacist about the gluten content of different vitamin brands, or ask your doctor to recommend a safe, G-free supplement. If you are still not convinced that the vitamins you are taking are safe, get on the phone with the manufacturer right away. (For tips on making these calls, see here.)
As you start to navigate the world without gluten, you will need to become an expert label reader—and I am here to teach you this essential skill. You will soon have all the tools you need to read (and even better, to understand!) the labels of a wide range of consumer products, all in a matter of seconds. You will also get in the useful habit of keeping tabs on your favorite items to make sure their ingredients haven’t changed when you were not looking.
The good news is that deciphering labels gets easier every day. Under the Food Allergen Labeling and Consumer Protection Act of 2004, food manufacturers must clearly label all products that contain any of the eight most common food allergens: wheat, milk, eggs, fish, shellfish, tree nuts, peanuts, and soybeans. But while this new labeling protocol is a huge improvement—and a boon to celiacs everywhere—you should still be on your guard, because as we know, a food could be wheat-free and still contain gluten. (Corn flakes, for example, contain no wheat, but they often do contain barley malt.) The FDA is in the process of developing universal glutenfree labeling for foods and medications.
Another warning: Foods under the supervision of the U.S. Department of Agriculture instead of the FDA—meats, coffee, dairy products—are held to a different set of rules altogether. “If it’s USDA,” said Dr. Green, “they don’t have to declare what it’s from, or whether or not it contains wheat, so it can be confusing. If the food is from the USDA, you have to get that information directly from the manufacturers.”
In Chapter 7, I will walk you through the step-by-step process that I rely on to determine the gluten content of a product. For now, I just want to familiarize you with the red flags that may signal the potential presence of gluten in a product.
If you’re just trying to clean up your diet and cut back on gluten, then you are probably safe steering clear of the most obvious G-full foods like pasta and bread. On the other hand, if you have celiac disease, a wheat allergy, or any other health problem associated with gluten consumption, even the smallest amount of gluten can hurt you. Going gluten-free means going gluten-free all the way. So not only must you avoid bagels and pizza and other obvious suspects, you must also turn away any foods that have even come into contact with these substances. This is the phenomenon known as cross-contamination.
This is where things can get really tricky. Cross-contamination occurs when a food that does not itself contain any allergens touches a food that does contain allergens. Cross-contamination can take place at any stage: If a G-free corn chip is processed on the same conveyor belt with a wheat- or flour-containing substance, then that chip has been cross-contaminated. If oats are grown, milled, processed, or stored alongside wheat, then those oats are cross-contaminated. If you drain G-free pasta in a mesh colander that has recently been used for G-full pasta, then that pasta has been cross-contaminated. If you slice carrots with the same knife that you used to slice bread, then those carrots have been cross-contaminated. It’s these small, seemingly harmless exposures that will get you every time.
When you go G-free, you have to start asking endless questions, not just about the content of your food, but about a million little details surrounding its preparation. Were your eggs flipped with a gluten-contaminated spatula? Did that ice cream scoop touch a sugar cone? Did someone dust that cake pan with flour before filling it with G-free batter? Did that chicken share a grill with a glutenous marinade?
If you are as sensitive to gluten as I am, your stomach will soon answer those questions for you, though the actual source of the contamination will not always be clear. You will be left wondering what made you feel so awful. It won’t be the wheat crackers because you no longer eat them. But could it be that the same knife that you used to spread dip on your G-free cracker was also used on the wheat-containing ones? You knew not to have the ice cream cone, but could your dessert have been scooped with the same scooper that went into the cookie dough ice cream? You become like a detective on CSI: You are always tracing your steps back.
Cross-contamination is a subtle, often invisible process, and it’s 99 percent of the difficulty of remaining G-free. Which is not to say that it’s impossible! There are lots of simple measures you can take to reduce your risk of eating cross-contaminated food.
These long lists of G-full products and warnings about cross-contamination can be intimidating at first glance, and I am sure you are wondering right now if you will ever eat again. The answer is a resounding yes. There is a world of G-free foods out there just waiting for you, and you might be surprised by how delicious they are!