Perhaps you want to start a gluten-free diet plan because of a chronic medical condition such as celiac disease…or because you’ve heard it will help reduce your headaches…or just make you feel better overall. No matter the reason, there’s more to it than simply making food substitutions—you will have to find new ways to still enjoy food.
Bottom Line Personal spoke with Jennifer Dalton, DCN, RDN, LD, program director of dietetics and nutrition at University of Dayton, about going gluten-free (GF) the right way.
Get a diagnosis first. If you’re going GF because you suspect a medical problem, it’s important to get checked out by your health-care provider before you eliminate gluten from your diet. Reason: To properly diagnose conditions such as celiac disease, gluten needs to be in your system in advance of a blood test. If you’ve already gone off gluten on your own, you’ll first have to add it back to your diet for three to five weeks, and that can cause discomfort.
A doctor also can distinguish between a wheat allergy and irritable bowel syndrome (IBS). All can cause similar symptoms, such as abdominal pain and bloating, but IBS is not caused by gluten. It may stem from your gut’s inability to absorb certain carbohydrate foods. In this case, what may help is a FODMAP diet that removes offending carbohydrates, such as some types of vegetables, fruit, dairy and/or wheat. For information on the FODMAP diet, go to UniversityHealthNews.com and enter “IBS trigger foods” into the search box…then choose “IBS Trigger Foods: FODMAPs Diet Identified as the Primary Culprit.”
In other cases, individuals may have symptoms that are similar to those of celiac disease or a wheat allergy yet test negative for these conditions. But even in these cases, removing gluten or wheat from their diets may resolve their symptoms. These individuals may have what we refer to as non-celiac gluten sensitivity (NCGS).
A Degree of Commitment
There are differences between celiac disease, a wheat allergy and gluten sensitivity, mostly the degree to which you have to avoid wheat and gluten. If you have celiac disease or a wheat allergy, even just a gluten-containing crumb could be all it takes to elicit an allergic or inflammatory response that damages your intestines.
Every person’s adjustment will be different, but a common challenge for beginners is crafting meals that still deliver nutritional quality. Work with a registered dietitian (RD) to find out how to enjoy a varied diet and avoid nutritional deficiencies. He/she will help you make up for a shortfall of the vitamins and minerals you were getting from fortified cereals and other wheat-based foods. An RD also will help you take a progressive approach, first finding food substitutes for what you’ve been eating and then making further swaps for a higher-quality diet if your previous diet was lacking—small achievable changes that will become permanent habits.
Making Food Substitutions
Start by keying in on your foundational foods—the 50 to 100 foods you eat most often in a given month. Make a list, and identify the ones that have gluten. One by one, search for substitutions that offer the taste and texture you’re looking for. It likely will take trial and error to find what suits you. Examples…
If you like crusty artisanal bread for your avocado toast at breakfast, look for GF bread made with amaranth, millet and/or quinoa.
If pasta salad is a favorite, select a GF pasta—pasta from black beans has the toothy appeal of whole-wheat pasta, while pea protein pasta is closer to egg noodles.
If you love breaded chicken cutlets, replace the breadcrumbs with finely ground nuts for a nice crunch and added nutrients.
Hidden Concern: Food Safety
Many people don’t realize that a GF diet plan isn’t just about avoiding foods with gluten. You also have to set up your kitchen to avoid cross-contamination. For people with celiac disease or wheat allergy, the food-safety component is a top priority because any exposure to a gluten food can prompt symptoms.
What this means: Buying dedicated tools and equipment for your use only, starting with knives, a cutting board, a colander and a toaster. Label or color-code them so that everyone in your household knows which items cannot come into contact with gluten. I found out the importance of this after I was diagnosed with celiac disease—I was still using my grandmother’s rolling pin when I realized that, even though it looked clean, the wood had picked up enough gluten over time to cross-contaminate the GF dough I was making. Cast-iron skillets and stoneware can harbor gluten, too (glass and metal are safer).
Managing Your Emotions
Because a GF diet plan involves so much more than “eat this, not that,” it can feel very restrictive at first. Surprisingly, many people go through a grieving process. After an initial feeling of joy because you feel better physically, reality sets in. You can’t make in-the-moment decisions about eating out because you have to consider food safety…you may lose some ability to engage with family and friends…the foods you eat will be different.
Whenever you have to change the way you eat, you’re also changing part of who you are. Many people who have to give up gluten experience a loss of identity and develop feelings of isolation. Depression, anxiety and grief are common reactions to significant dietary changes. That’s because food helps us connect with others. Food often is a big part of your culture and traditions and your sense of belonging—even the exact taste of certain foods can be highly symbolic. Thanksgiving for you might be synonymous with making pies with your family…but now you have to find ways to recraft beloved recipes.
How to cope: Identify what traditions and social activities are most important to you, and create workarounds to maintain them. Some suggestions…
Investigate safe havens for eating out. Dining out is an important social experience for most people—but just as you can’t have safe GF foods without using GF cooking equipment, you can’t safely order GF menu items at a restaurant unless they were made in a GF prep space. The only way to know that is to ask. Take the time to vet a restaurant before you eat there—call ahead, ask to speak to the manager, explain that you are GF because of an allergy or celiac disease, and ask for details about the restaurant’s GF cooking practices. Some will tell you that they can’t guarantee there’s no cross-contamination, while others might say that when anyone with an allergy or other dietary need comes in, they prep in a dedicated space.
Many communities have GF restaurants where you can trust the safety. Where I live, there’s a local pizza chain with a dedicated prep room. While the wood-fired oven is shared with gluten pizza, there’s a dedicated tray used for GF pizzas. PF Chang’s is an example of a national chain with a dedicated GF menu and prep space—the restaurant even uses a different shape of dish to distinguish GF foods.
For quality-of-life reasons, some people make the decision to take their chances with GF menu items in a restaurant without dedicated prep spaces and equipment. My suggestion then is to dine out only once a week to limit the potential for inflammatory damage.
Engage with local GF cooking experts. Adjusting to the taste differences in GF versions of favorite foods can be a stumbling block. This is where local resources, such as a baker at a GF bakery or a chef at a GF restaurant, can help. They know how to make GF versions taste as close as possible to traditional dishes and with the right texture. Ask if they’ll work with you to convert your favorite recipes. My husband was in the military, and whenever we moved to a new town, my way to build community was to bake cinnamon rolls for new neighbors. I tried to re-create our family recipe for the rolls without success, but then I met a baker who was willing to help. Once I was able to bake a tasty GF version, I felt more complete.
Find support within your family. Because celiac disease is hereditary, chances are some of your family members have it and have made the same changes you’re now making. But if not, it will be important for you and your family to find ways to maintain traditions in your new reality. Explain your diagnosis to your loved ones and that diet is the chief way to control your condition and feel your best. Help your family understand why eating away from your home is challenging, and explain about safe food preparation. Offer to bring the needed ingredients and tools when you visit so you can make dishes together.
Connect with friends and coworkers. It may feel like you’re burdening others with your dietary needs. So building a strong network of supportive friends is extremely helpful. These are the people who understand what you’re going through and will advocate for you because they care about your well-being. They are your champions.