Gluten and gluten-free diet

Gluten is a protein found in common cereal grains, especially wheat, barley and rye, and sometimes in oats. In people with coeliac disease, even small amounts of gluten in the diet set off an immune reaction that damages the small intestine. This damage interferes with the absorption of nutrients from food and can cause bowel symptoms and deficiencies of vitamins, minerals and other nutrients.

Coeliac disease is treated by following a gluten-free diet. This means avoiding all foods containing gluten. In Australia, food labelled ‘gluten free’ must not contain any detectable gluten and must not include oats or malt.

A gluten-free diet is something to be followed for life and should not be started before coeliac disease is diagnosed by your doctor or specialist. In fact, starting a gluten-free diet before coeliac disease is confirmed can make diagnosis difficult and is therefore not recommended.

By following a gluten-free diet, people with coeliac disease can avoid long-term health complications of coeliac disease, so it’s worth getting it right!

You will also be advised by your doctor to follow a gluten-free diet if you are diagnosed with a skin condition called dermatitis herpetiformis — like coeliac disease, dermatitis herpetiformis is linked to gluten sensitivity.

Gluten-free diet

The table below indicates foods to avoid and foods to include in a gluten-free diet. However, it is intended as a general guide only. People with coeliac disease or dermatitis herpetiformis may benefit from seeing a dietitian for an individualised dietary plan and advice on how to read food labels.

Gluten-free diet
�Foods to avoidFoods allowed
Flour
  • Flour or cornflour made from wheat, rye, barley or triticale
  • Flour made from oats∗
  • Flour made from rice, soy, potato, arrowroot, buckwheat, sorghum, sago, lentils, tapioca, amaranth, lupin or millet
  • Cornmeal or polenta
Bread and related foods
  • Bread containing wheat or rye
  • Sourdough bread
  • Normal pizza, wraps and tortillas
  • Rice cakes, corn cakes
  • Gluten-free bread, wraps, tortillas or pizza
Baked goods and desserts
  • Biscuits, pastries, pies, cakes, muffins, buns, pikelets, croissants, crumpets and breadcrumbs, unless labelled gluten free
  • 'Flourless' desserts or cakes containing breadcrumbs, biscuit crumbs, baking powder, semolina or soft icing sugar (also make sure the cooking tin was not dusted with flour)
  • Gluten-free biscuits, pastries, rolls, cakes or muffins (or mixes to make these foods)
  • Desserts or cakes made from allowed flours (see above) and other allowed ingredients (e.g. rice pudding made at home with rice and milk, cakes made with almond meal and gluten-free baking powder)
Breakfast cereals
  • Breakfast cereals containing wheat or wheatbran, barley, rye, semolina or malt extract
  • Breakfast cereals containing oats or oatbran∗
  • Breakfast cereals made from rice, corn or soy∗
  • Gluten-free muesli, muesli made at home using allowed ingredients
Pasta and noodles
  • Pasta, spaghetti, noodles, vermicelli, gnocchi and instant pasta meals containing wheat
  • Pasta made from rice, corn, cornmeal, tapioca or buckwheat
  • Gluten-free pasta
  • Rice noodles, rice vermicelli
Grains
  • Wheat, barley, rye, oats∗, triticale, couscous, bulgur, semolina
  • Rice, buckwheat, polenta
Fruit and fruit products
  • Commercially prepared fruit pies
  • Fresh, frozen, canned or dried fruit
  • Fruit juices
Vegetables and vegetable products
  • Canned or frozen vegetables in sauce
  • Commercially prepared vegetable or potato salads (unless dressing is gluten free)
  • Fresh, frozen, canned or dried vegetables without sauce
  • Vegetable juice
Animal products
  • Foods prepared or thickened with flour, batter or crumbs
  • Sausages
  • Most processed meats and fish
  • Corned beef, meat pies, frozen dinners
  • Meat, poultry or fish that is fresh or cured, or frozen without sauce, crumbs or batters
  • Canned meat or fish without sauce or grains
  • Ham off the bone∗, bacon, gluten-free sausages
Dairy foods
  • Malted milks, some soy drinks
  • Cheese spreads and pastes∗
  • Cheeses - block, cream, cottage or ricotta
  • Milk - fresh, UHT, powdered, evaporated or condensed
  • Yoghurt
  • Cream - fresh or canned
  • Ice cream with cone or cereal-based topping
  • Other ice cream∗
Legumes (beans, peas and lentils)
  • Legumes processed with thickeners (e.g. some brands of baked beans in tomato sauce)∗
  • Canned legumes∗
  • Dried or fresh legumes
  • Gluten-free baked beans
Take away food
  • Hamburgers
  • Pizza
  • Souvlaki
  • Battered or crumbed food
  • Steamed rice
  • Chicken with no stuffing
  • Asian dishes without flour or soy sauce
  • Baked potato
  • Chips/fries∗
Savoury snacks
  • Flavoured potato chips and packet savoury snacks
  • Dry roasted nuts∗
  • Plain potato chips∗
  • Plain rice crackers∗
  • Plain popcorn
  • Dried or fresh nuts
Chocolate, lollies and treats
  • Filled chocolates
  • Liquorice
  • Many lollies∗
  • Plain chocolate
Non-alcoholic drinks
  • Cereal-based coffee substitutes
  • Malted drinks
  • Barley water
  • Flavoured milks
  • Tea, coffee, cocoa, milk
  • Cordials
  • Water
  • Soft drinks, soda water
  • Fruit and vegetable juices
Alcoholic drinks
  • Beer, lager, ale, stout
  • Wine
  • Spirits
Other products
  • Malt, malt flavouring, malt vinegar
  • Soy sauce
  • Yeast extract spreads
  • Pickles, relish, chutney
  • Mayonnaise∗, salad dressing∗
  • Custard powder∗
  • Textured vegetable protein (often used as a meat substitute)
  • Sugar, honey, golden syrup
  • Jam, peanut butter
  • Tamari
  • Commercial bottled sauces
  • Herbs, spices, salt, pepper
∗ Some of these products may contain gluten; always check the label (or ask the restaurant) and avoid if there is any doubt.

Here are some other frequently overlooked items that may contain gluten — check before consuming:

  • croutons;
  • baking powders;
  • coating mixes for covering foods;
  • energy bars;
  • marinades, sauces and gravies;
  • soup bases; and
  • stuffing.

Medicines

Remember that some medicines (including herbal supplements and nutritional supplements) may contain gluten. Some prescribed or over-the-counter medicines come with a Consumer Medicine Information leaflet — you can look in the ingredients section to check whether the medicine contains gluten. If your medicine does not have a Consumer Medicine Information leaflet, check with your doctor or pharmacist or the product manufacturer.

Other potential sources of gluten

Other gluten-containing products that you don’t actually eat but could come into contact with your mouth include lipstick and postage stamps. Play dough can also contain gluten, so wash your hands after touching it.

Tips for living a gluten-free life

  • Become an expert at reading ingredient labels — a dietitian can teach you how. Look for ingredients in the ‘not allowed’ column above, and avoid these products.
  • Read the label every time you purchase a food — manufacturers may change ingredients at any time.
  • If you can’t verify that the food is gluten free, don’t risk it. If you have coeliac disease, your small intestine is affected every time you consume gluten, even if you don’t have symptoms.
  • Remember that ‘wheat free’ does not mean ‘gluten free’. Wheat-free products can still contain barley, rye or spelt (a form of wheat).
  • Make sure gluten-free foods don’t come into contact with foods that contain gluten. Contamination can happen through using a common toaster for gluten-free and regular bread or not thoroughly cleaning utensils and preparation surfaces that have been used for food containing gluten.
  • It takes time to adjust to a gluten-free diet. Although you may miss the foods you used to eat, try to stay positive and focus on the many things you can eat.
Last Reviewed: 27 June 2012
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References

1. Gastroenterological Society of Australia (GESA). Information about coeliac disease; Fifth Edition, 2011. http://www.gesa.org.au/files/editor_upload/File/GESA%20Coeliac%20Disease.pdf (accessed Aug 2012).
2. Coeliac Australia. The gluten free diet. http://coeliac.org.au/coeliac-disease/diet.html (accessed Aug 2012).
3. Mayo Clinic.com. Gluten-free diet: What’s allowed, what’s not (updated 20 Dec 2011). http://www.mayoclinic.com/health/gluten-free-diet/my01140/ (accessed Aug 2012).
4. Dermatitis herpetiformis (revised February 2009). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2012 Jul. http://online.tg.org.au/complete/ (accessed Aug 2012).
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