Eating Out Safely with Celiac Disease
by Jessica Wilcox, RD, LDN

Celiac Disease (CD) is a permanent intolerance to certain proteins found in wheat, rye and barley. These proteins are collectively called “gluten.” In an individual with CD, when gluten is ingested, the tiny hair like projections lining the stomach and small intestine are damaged or destroyed. Nutrients are absorbed through this very delicate lining, and when destroyed, malabsorption of nutrients leading to deficiencies specifically in iron, calcium, folate (a B-vitamin) and the fat soluble vitamins A, D, E and K, can occur. This disease is most often found in genetically susceptible individuals and is associated with a higher risk of other autoimmune diseases such as type 1 diabetes, osteoporosis, gastro-intestinal lymphoma, and reproductive and neurological problems.  The most common side effects reported by people with CD are abdominal pain, diarrhea, weight loss, extreme weakness, anemia, mood swings/depression, joint pains, easy bruising, constipation, nausea and vomiting, and lactose intolerance.

The only known treatment for CD is a lifelong adherence to a gluten free diet. Derivatives of wheat, rye and barley include malt, grain starches, hydrolyzed vegetable and plant protein, texturized vegetable protein (TVP), triticale, einkorn, polish wheat and kamut.  These must be avoided in a gluten free diet. Food items that do not contain gluten are rice, corn, sorghum, millet, teff, ragi, Job’s tears, buckwheat, amaranth, quinoa, and flax. There is question as to whether oats are toxic to a person with CD. Oats may be contaminated with gluten where they are grown, processed or during transportation. It is a good idea to research whether your oats are processed in a facility that also produces wheat products. But in general, it is wise to avoid oats until the USDA initiates its plan to advise the public of the gluten content of foods.


How to Dine Out Gluten Free

For people with CD it can seem close to impossible to eat at a restaurant without risking gluten ingestion. The awareness of food allergies and intolerances are becoming more common. Thankfully, restaurants are working towards cooperating with their patrons to ensure a safe, healthy and enjoyable dining experience. Several restaurants offer wheat, dairy, egg and peanut free dishes, as well as vegetarian and vegan entrees.


Here are some helpful hints for dining gluten free:

• When choosing a restaurant, avoid buffets due to the potential for cross contamination from tongs or utensils, especially from baked goods.

• Always ask your server for advice on what to order. They should know the menu, or should be willing to speak with the chef for information on specific ingredients.

• Call a restaurant ahead of time and ask questions about the menu and whether they offer gluten free dishes.

• Order simple dishes avoiding sauces or gravies. Always ask for the sauce on the side, foods made with several ingredients may be more likely to contain a no-no.

• Ethnic restaurants often cook food from scratch and may actually be safer even with mixed dishes.

• Use a chef card. A chef card is a personalized card that instructs the chef and other restaurant personnel on simple ways to ensure your food doesn’t contain your allergen. Our favorite is the new Triumph Dining cards which are written in English and in a variety of other languages such as Thai or Japanese, so that the chef if fully aware of your need to avoid gluten. The Triumph Dining cards give an overview of Celiac Disease, what you cannot eat, what you can eat, cautions about cross-contamination and what ingredients should be checked. Visit www.triumphdining.com for more information and to order the dining cards. The cards are available for six common cuisines in the US: American, Chinese, Indian, Japanese, Mexican and Thai.

Jessica Wilcox, RD, LDN has been on the staff at Live Nutrition for the past two years. She is a native of Orleans, MA and completed her undergraduate degree at Colorado State University. She completed the first portion of her Dietetic Internship training at Live Nutrition. Jessica is now a full-time graduate nutrition student at Montana State University.