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Dear Dietitian – Tracking down hidden gluten in your diet

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PICT Leanne McCrate Dear Dietitian
Leanne McCrate, RDN, LD

Dear Dietitian,

My fourteen-year-old daughter was recently diagnosed with celiac disease. We made an appointment with a dietitian, and she is doing her best to follow a gluten-free diet. The problem is she still has stomach aches and diarrhea three to five times a week. What should we do?


Dear Mandy,

Today as many as 3 million Americans suffer from celiac disease. As you have learned, gluten is a protein found in wheat, barley, rye, and triticale (a hybrid of wheat and rye). Gluten intolerance, or celiac disease, is the body’s reaction to gliadin, a component of gluten. This reaction damages the small intestine, resulting in the malabsorption of nutrients. Symptoms of gluten intolerance include abdominal cramping, bloating, and diarrhea. The definitive diagnosis of celiac disease is a biopsy of the intestine performed by a gastroenterologist, a GI doctor.

Gluten-free diets have become a bit of a fad in the US, but it seems to be past its peak. Some claim that going gluten-free will help treat thyroid problems, but scientific evidence is lacking. Others eliminate gluten to cope with Irritable Bowel Syndrome (IBS), but little research has been conducted in this area. A gluten-free diet is effective in treating celiac disease.

Your daughter may be unknowingly consuming foods that contain gluten. For instance, some candy, malt flavoring, and soy sauce contain gluten, but food manufacturers are not required to put this on the label. It takes a thorough investigation into food products to learn what foods contain gluten. 

Label reading is an integral part of following a gluten-free diet. Of course, you must avoid any products containing wheat, barley, or rye. Look for foods with “gluten-free” on the label. To be labeled “gluten-free,” the Food and Drug Administration (FDA) requires that a product contain less than 20 parts per million of gluten. This type of labeling is voluntary.

Keeping a food log would help identify foods that cause problems. A small notepad can fit in your daughter’s purse or backpack and be a valuable aid in recording problem foods as she goes about her day.

Remember, it takes at least six weeks to adjust to a new way of eating. Try to be patient. You may consider making a follow-up appointment with the dietitian to gain more insight into the gluten-free diet. Education is a process that takes time.


Dear Dietitian

Leanne McCrate, RDN, LD, is an award-winning dietitian based in St. Louis, Missouri. Her mission is to educate consumers on sound, scientifically-based nutrition. Email her today at Dear Dietitian does not endorse any products, health programs, or meal plans.