Celiac disease

Celiac disease (coeliac disease in the UK) is an autoimmune condition. When someone who has it eats gluten, a protein in wheat, rye and barley, their immune system damages the lining of the small intestine. It is not a food allergy and not an intolerance. The treatment is a strict gluten-free diet for life, and only a doctor can diagnose it.

If you think you might have celiac disease, talk to a doctor before you cut out gluten. The tests usually need you to still be eating gluten to give a clear answer.

Substitutes

These grains and starches contain no gluten:

• Rice, corn (maize), cornmeal and cornstarch
• Potatoes and potato starch
• Buckwheat, millet, sorghum, teff, quinoa and amaranth
• Gluten-free flour blends, which often include a little xanthan gum to help hold baked goods together

Oats are a special case. EU and UK law lists them as a cereal containing gluten. They contain avenin, a protein similar to gluten that a minority of people with celiac disease react to. Most regular oats are also grown and milled next to wheat and pick it up. Oats labeled gluten-free are kept apart from wheat, and most people with celiac disease tolerate them. Ask your doctor or dietitian before you add them.

Common mistakes

• Forgetting the other names for wheat: spelt, khorasan, durum, semolina, farro, bulgur, couscous, freekeh and seitan.
• Using regular soy sauce, which is usually brewed with wheat. Use a soy sauce or tamari labeled gluten-free.
• Missing barley in malt vinegar, malt extract, malted drinks and most beer.
• Sharing a toaster, colander, wooden board or deep-fryer oil with gluten-containing food. Tiny amounts matter, so cross-contamination is a real risk.
• Thickening sauces with a wheat-flour roux out of habit.

In recipes

A recipe tagged gluten-free should contain no wheat, rye or barley, no ingredient made from them, and no oats unless they are labeled gluten-free. On packaged food in the EU, the UK and the US, "gluten-free" means less than 20 parts per million of gluten, a level most people with celiac disease can tolerate. Restaurant food is not always held to the same standard, so ask how the dish is made. A dietitian can help you learn to read labels and plan meals.