Celiac disease is a genetic digestive disease that causes damage to the small intestine and interferes with the absorption of nutrients from food. A person with celiac disease cannot tolerate gluten, which is a protein in wheat, rye and barley. With this disease, the immune system responds to gluten by damaging the villi, which are tiny protrusions that line the small intestine. Normally, villi allow nutrients to be absorbed through the walls of the small intestine into the bloodstream. Damage to villi leads to malabsorption and malnutrition. Certain foods must be avoided with celiac disease.
It is important to read the ingredients on food labels and be on the alert for gluten in products that may not be labeled. A general rule of thumb is to avoid flour derived from barley, wheat and rye. The forbidden flour list includes durum flour, white flour, enriched flour, semolina, matzo flour and graham flour. Remember that a product labeled as wheat-free does not necessarily mean gluten-free.
The four main ingredients in beer are water, malted barley, hops and yeast. Barley is the most widely used malt. Depending on the brew, wheat, rice, oats and rye may be substituted for barley. Ale, porter and stout must be avoided.
Malt refers to a grain, usually barley, that has been allowed to sprout and is used in brewing or distilling. A person with celiac disease needs to avoid malted milk, malt extract, malt vinegar, malt flavoring and malt syrup.
Bran, farina, oat and oat bran, wheat germ, wheat, wheat brain, whole wheat berries and wheat grass must be avoided. The University of Chicago Celiac Disease Center warns that regular, commercially available oats are frequently contaminated with wheat and barley. Pure, uncontaminated oats may be tolerated in limited quantity. However, talk to your physician before adding oats to your diet.
Couscous is made from semolina flour. Semolina is the hard part of a grain of hard wheat. The endosperm or center of the grain of wheat contains gluten. Barley can be used to make some varieties of couscous. This tiny pasta must be avoided.
Flour, water and eggs are the three main ingredients in pasta. Pasta made with semolina, whole wheat and unbleached flour must be avoided. Noodles made from the flour of finely ground rice do not contain gluten.
Miso is a fermented soybean paste that originated in Japan. Usually made from soybeans, miso can be produced from rice, barley and wheat by adding a yeast mold. Ingestion of gluten in any form can trigger the immune system of a person with celiac disease to respond adversely.
Croutons are cubes of stale bread that have been buttered, baked and seasoned. They are a familiar salad topping that must be avoided if you have celiac disease.
Toasted cubes of bread are a main ingredient in most stuffing mixes and recipes. But anyone with celiac disease does not have to give up holiday stuffing completely. The Celiac Sprue Association website offers a recipe using homemade cornbread.
Soy sauce is a widely used condiment made from a fermented mixture of mashed soybeans, salt and enzymes. In many traditional brewed recipes, equal parts pulverized wheat and crushed soybeans make up the mash, which is allowed to ferment for up to six months. Soy sauce should be avoided.