Getting Started on a Gluten-Free Diet: A Step-By-Step Guide
Updated March 1, 2021
The following content is intended to be used as a preliminary guide for those who are newly diagnosed with celiac disease or gluten sensitivity. Not all aspects of the gluten-free diet are as clear cut as portrayed here. For specific guidance about the gluten-free diet for yourself or a loved one, consult with a knowledgeable dietitian or your healthcare provider. Visit the Resources section of the Gluten Intolerance Group website at www.gluten.org for more information.
Introduction to a Gluten-Free Diet
Individuals with gluten-related disorders must avoid gluten for health reasons. This includes anyone diagnosed with celiac disease, non-celiac gluten sensitivity (NCGS), or dermatitis herpetiformis (DH), the skin condition related to celiac disease. Gluten is the generic name for certain types of proteins found in wheat, barley, and rye and their derivatives.
When individuals with celiac disease ingest gluten, an immune response occurs which damages the lining of the small intestine and can lead to symptoms and health problems in virtually all body systems. Even very small amounts of gluten can cause problems, whether or not obvious symptoms are present. In the case of non-celiac gluten sensitivity (NCGS), damage to the small intestine may not occur, but gluten must still be avoided.
The gluten-free diet should not be started before being properly diagnosed with a gluten-related disorder. Starting the diet without complete testing makes later diagnosis difficult. Tests to confirm celiac disease could be falsely negative if a person were on a gluten-free diet for a period of time. For a valid diagnosis to be made, gluten would need to be reintroduced for at least several weeks before testing.
Following a gluten-free diet is a major lifestyle modification and can feel daunting, particularly for the newly diagnosed. There is a lot to know about foods, ingredients, and changes in lifestyle and cooking, and you may be wondering just where to start. Try taking things “one step at a time” to help make your gluten-free transition more manageable.
STEP 1: Learn What Foods to Include or Avoid
While the basis of a gluten-free diet is avoiding certain foods, you should also learn what foods are safe to eat. There are many naturally gluten-free foods you can still enjoy that happen to be delicious and healthy! Focus on shopping the perimeter of your grocery store: vegetables, fruits, fish, poultry, meats, and dairy products are good places to start. In their natural forms, without potentially gluten-containing flavorings or ingredients added, these foods are gluten-free and are staples of a gluten-free diet.
If you are going gluten-free, these gluten-containing grains should be eliminated from your diet:
- Wheat – Includes all varieties and forms such as: durum, spelt, semolina, couscous, bulgur, emmer, farina, farro, and einkorn.
Avoid varieties and derivatives of these three grains including:
- Triticale, a hybrid of wheat and rye
- Wheat starch that has not been processed to reduce gluten to the levels that meet the definition of gluten-free
- Malt extract – derived from barley
- Malt vinegar – derived from barley
- Brewer’s yeast – usually derived from beer that is brewed from wheat, barley, or rye (although can also be derived from sugar beets)
Choose naturally gluten-free grains and flours, including rice, corn, soy, potato, tapioca, sorghum, quinoa, millet, buckwheat, cassava, coconut, arrowroot, amaranth, teff, flax, chia, yucca, bean flours, and nut flours.
What about oats? Research indicates that conventional oats consumed in moderation (up to ½ cup dry rolled oats daily) are tolerated by most people with celiac disease. See our article: Are Oats and Oat Flour Gluten-Free? The safest oat products are those that have been certified gluten-free. While products labeled gluten-free should comply with the FDA definition of containing no more than 20 ppm of gluten, this is not third-party verified. GFCO’s standard for gluten-free is 10 ppm of gluten or less. Consult with your physician or dietitian before adding oats to your gluten-free diet.
While distilled alcoholic beverages are gluten-free, most beers, ales, lagers, and malted beverages are NOT gluten-free because they are made from gluten-containing grains. Beers made from gluten-free grains, such as sorghum, are gluten-free. Beers with “gluten-removed” on the label may not be gluten-free and should be avoided. Check out our article: Does Fermentation or Distillation Make a Product Gluten-Free?
STEP 2: Carefully Read Food Labels
An important part of successfully following a gluten-free diet is reading packaged food labels carefully. This includes “gluten-free” claims on packages, as well as product ingredient lists. Since ingredients can change at any time, it’s important to read labels every time you shop.
Look for a GFCO gluten-free Certification Mark
A product that carries a third-party gluten-free certification, such as Gluten-Free Certification Organization (GFCO)’s mark, is considered safe for gluten-free consumers. If a product is certified gluten-free, you can stop at this step.
Look for items labeled gluten-free
If a product is not certified gluten-free but bears a “gluten-free” claim and is regulated by the FDA, * it is considered safe to consume. The FDA gluten-free labeling regulation also applies to products labeled “no gluten,” “free of gluten,” or “without gluten”.
Check the list of ingredients
For products that are neither certified nor labeled gluten-free, it is essential to read the ingredient list. If any of the following are present on the ingredient list, the product is not gluten-free:
- Wheat ** (including all types of wheat such as spelt)
- Oats unless the oats or oat-containing products are certified gluten-free
- Brewer’s yeast
A product that is labeled gluten-free may include the term “wheat” in the ingredient list (e.g., wheat starch) or in a separate “Contains wheat” statement, but the label must also include the following statement: “The wheat has been processed to allow this food to meet the Food and Drug Administration (FDA) requirements for gluten-free foods.” Read our statement on “Contains: Wheat.”
*FDA and USDA
The FDA gluten-free labeling regulation is a part of FALCPA (the “Food Allergen Labeling and Consumer Protection Act”). FALCPA applies to FDA-regulated products only. The FDA regulates the vast majority of packaged foods. The USDA regulates meats, poultry, egg products, and mixed products which generally contain more than 3% raw or 2% cooked meat (e.g., some soups and frozen entrees). Products regulated by the USDA are not required to comply with FALCPA, but an estimated 80-90% do so voluntarily.
**Looking for wheat on ingredient labels
FALCPA requires that the top 8 allergens be clearly identified, wheat being one of them. Derivatives of wheat, such as “modified food starch,” must clearly indicate that “wheat” is the source when this is the case. If there is any doubt about whether a USDA regulated product is complying with FALCPA labeling, the following ingredients may be derived from wheat and need to be avoided or investigated: starch, food starch, modified food starch, and dextrin.
Read our article “3 Tips for Gluten-Free Label Reading.”
STEP 3: Explore Gluten-Free Goods
There are many gluten-free grains you may not have tried before, like sorghum, teff, and buckwheat (which is naturally gluten-free, despite its name). Often when some doors are closed, others are opened. Look at your gluten-free diet as an opportunity to discover new gluten-free foods and cuisines. Get inspired by Mexican and Indian spices and ingredients. Corn tortillas, salsas, guacamole, and beans are naturally gluten-free. Cook with traditional Indian ingredients like cumin, turmeric, and lentils.
Other naturally gluten-free foods are fruits and vegetables; fresh meats, poultry and fish; legumes, nuts and seeds, and plain dairy products. These foods in their pure forms are gluten-free. Processed or flavored versions may have gluten-containing ingredients.
Gluten-free substitutes for foods commonly made with wheat are widely available at mainstream, international, and specialty food stores, direct from gluten-free food manufacturers, and from websites.
Distilled alcoholic beverages, distilled vinegars, and wine may be safely included in the gluten-free diet. Read our article, “Does Fermentation or Distillation Make a Product Gluten-Free?”
Check out our meal plans:
STEP 4: Watch Out for Cross-Contact with Gluten
When preparing gluten-free foods, take care to prevent cross-contact with foods containing gluten. Cross-contact can occur if foods are prepared on common surfaces, or with utensils that are not thoroughly cleaned after preparing gluten-containing foods.
Using hard to clean equipment for both gluten-free and gluten-containing foods is one potential source of cross-contact. Toasters, strainers, and flour sifters should not be shared. Deep-fried foods cooked in oil that are also used to cook breaded products should be avoided.
Spreadable condiments in shared containers may also be a source of cross-contact. When a person dips into a condiment – such as mustard, mayonnaise, jam, peanut butter, or margarine – a second time with the knife used for spreading, the condiment becomes contaminated with crumbs and is not safe for consumption by individuals who cannot tolerate gluten. Consider using condiments in squeeze containers, when you can, to prevent cross-contact.
Wheat flour can stay airborne for many hours in a bakery or at home and land on exposed preparation surfaces, utensils, or uncovered gluten-free products, potentially causing a problem for anyone avoiding gluten.
See our articles “7 Tips for Avoiding Gluten Cross-Contact at Home” and “Gluten in Your Food: Cross-Contact or Cross-Contamination?”
STEP 5: Join a GIG Support Group
Living a gluten-free life comes with some challenges. Having a support network can be invaluable. Be a part of a caring and supportive gluten-free community in your area. We have over 90 adult and youth support groups. Connect with like-minded people, share tips, recommend places to eat, swap recipes, and know that you’re not alone in your quest to live a safe, gluten-free life. Find a GIG Support Group.
When it comes to living gluten-free, take one step at a time, learn as you go, seek help from others, and grow healthy!
Modified from The Quick Start Gluten-Free Diet Guide for Celiac Disease & Non-Celiac Gluten Sensitivity, developed collaboratively in 2013 by: American Celiac Disease Alliance, Celiac Disease Foundation, Celiac Sprue Association, Gluten Intolerance Group, National Foundation for Celiac Awareness.
This article has been assessed and approved by a Registered Dietitian Nutritionist.