Celiac Disease

Celiac disease is a genetic autoimmune condition that causes damage to the small intestine when gluten is consumed. It is estimated that 1 in every 100 people worldwide has celiac disease. Despite being so common, it is known that only about 30% of patients are correctly diagnosed.

When people with celiac disease eat gluten (a type of protein), their bodies trigger an immune response that attacks the small intestine. These attacks damage the villi—tiny finger-like projections lining the small intestine that support nutrient absorption. When the villi are damaged, the nutrients we consume cannot be absorbed properly by the body. Therefore, nutrient deficiencies occur.

Celiac disease is hereditary, meaning it runs in families. It can develop at any age after a person starts consuming gluten. If left untreated, celiac disease can lead to additional health problems. For this reason, the only treatment—following a “gluten-free” diet—must be maintained for life. It is very important to ensure that a gluten-free diet is healthy and balanced.

What Is a Gluten-Free Diet?

Gluten is a protein that occurs naturally in some foods, but it is also used as a binding agent in the food industry. For this reason, it is possible to encounter gluten in unexpected foods. Gluten can be found not only in foods such as pizza, pasta, breakfast cereals, and baked goods, but also in everything from ice cream to sauces, and from cosmetic products to dietary supplements. Therefore, reading labels is very important.

SAFE–RISKY–FORBIDDEN FOOD GROUPS IN CELIAC DISEASE

Safe: Foods that do not contain gluten and are safe to consume.

Risky: Foods that carry a risk of cross-contamination with gluten and are not recommended.

Forbidden: Foods that contain gluten and should not be consumed.

MEAT, FISH, AND EGGS

Safe: All

Risky: Sliced deli meats and sausages; air-dried, salted beef; salami; canned meat; meat- or fish-based sauces; ready-made or pre-cooked foods

Forbidden: Meatballs with added bread; dishes with bulgur and minced meat; fish fried with flour; sausages

DAIRY PRODUCTS

Safe: All

Risky: Milk-based beverages; ready-made fruit yogurt; whipped cream; heavy cream and puddings; sliced cheese; spreadable processed cheese; blue-veined cheese and mold-ripened cheeses

Forbidden: Yogurts containing cereals and derivatives; milk desserts with added wheat flour; yogurt- and milk-based soups with added bulgur

GRAINS

Safe: Rice, rice flour, starch, buckwheat, corn bread, bread made with special gluten-free flour, soybeans, potato flour, chickpea flour, bean flour, quinoa, chia

Risky: Packaged potato chips; puffed rice and corn

Forbidden: Wheat, oats, einkorn bulgur and flour, whole wheat and flour, barley, rye, and all foods made with them; bulgur, pasta, vermicelli soup, noodles, couscous, biscuits/cookies, bagels, ice cream cones, bread, semolina, crackers, pastries, cakes, buns, bran, malt

LEGUMES

Safe: All

Risky: None

Forbidden: None

BEVERAGES

Safe: Tea, linden tea, milk, ayran, fruit juices, lemonade, soda, cola drinks, salep

Risky: None

Forbidden: None

VEGETABLES AND FRUITS

Safe: All

Risky: Ready-made meals containing thickeners, starch, etc.; sugar-coated fruits

Forbidden: Vegetable dishes containing flour and grains; dried and fresh fruits consumed with flour and derivatives

FATS AND SEASONINGS

Safe: Butter, margarine, and vegetable oils (in small amounts; 1 tablespoon per day), vinegar, lemon, pickled brine, spices, salt, tomato juice, homemade tomato paste

Risky: Ready-made sauces; bouillon cubes or broth mixes; herb or spice blends; flavor enhancers; baking powder

Forbidden: Foods with excessive added fat; clotted cream; cream; hazelnuts, peanuts, almonds, walnuts, etc.; ready-made tomato paste; ketchup; flour-based sauces and commercially sold seasoning products

Additional points to consider in celiac disease:

• Gluten-free foods should be placed on the top shelf of the refrigerator. Cabinets used to store gluten-free foods should be separate.

• Stainless steel cookware and glass containers are suitable for people with celiac disease and should be preferred when possible.

• Gluten-free menus should be prepared using separate kitchen equipment (grill, pan, pot, cutting board, knife, etc.). If this is not possible, equipment must be thoroughly cleaned before use.

• Frequently used appliances such as sandwich presses and toasters should be kept separate.

• All gluten-free products should be stored in closed containers such as jars, bottles, or cardboard boxes, and each should be labeled.

• Porous containers and wooden kitchen tools (cutting boards, spoons, ladles, rolling pins, etc.) should not be used in gluten-free areas, because they are difficult to clean due to grooves and joints.

• Bread and cake baking pans, cake trays, and oven trays should be colored or labeled.

• All ingredients used during food preparation must be questioned. In particular, it must be ensured that additives such as sauces, spices, tomato paste, mayonnaise, ketchup, and bouillon used in gluten-free foods are gluten-free.

• Cooking methods must be questioned. Especially foods described as “crispy, fried, coated” should be consumed with caution due to the risk of contact with gluten-containing foods.

• Gluten-free foods should not be fried in the same oil as other foods. For example, oil used to fry a food coated with breadcrumbs should not be used to fry a gluten-free food. To apply the diet safely, a kitchen scale should be used.

• Gluten-free ingredients such as baking supplies (baking powder, yeast, sesame, poppy seeds, etc.) should always be well packaged and stored separately from gluten-containing foods on upper shelves.

• Water used to cook gluten-containing pasta should not be reused. Even a very small amount of gluten can be a potential hazard for people following a gluten-free diet.

• Safe areas with no risk of gluten contamination should be created in food preparation areas, kitchen shelves, and the refrigerator.

• When eating out, be careful and learn the ingredients of the dishes.

• Products without label information should not be preferred.

• Attention should be paid to the gluten content of medicines, cosmetics, shampoo, cream, toothpaste, soap, paper cups, etc.

• If a gluten-free diet is not followed strictly, malabsorption can occur in many vitamins and minerals, especially B12, B9, and iron. Therefore, follow-up with a doctor and dietitian is necessary.

Considering all of this, celiac disease can be challenging for nutrition and social life. Therefore, after diagnosis, getting sufficient information about the disease from your doctor and following the most suitable nutrition plan created with dietitian support will help you manage the process safely. Especially for children, additional psychological support is recommended to improve adaptation to social life.

Dietitian Bengi Bayer