Does Gluten Cause Migraine Headaches?

Almost everyone gets a tension headache from time to time, but migraine headaches are a different matter, and can be quite severe and seriously interfere with normal life. About 10% of people suffer from migraine, and despite a huge amount of research around the world, we still only have a limited picture of the overall cause or what triggers a single episode.
There have been many speculative articles and personal anecdotes in the popular media about a possible role of gluten in triggering migraine. So, I decided to explore this controversy by looking at some of the available research studies.

Gluten causes a wide range of symptoms in the nervous system

Gluten is the only known trigger for celiac disease, which typically involves inflammation of the intestine. It’s also becoming increasingly clear that celiac disease can also have a wide range of neurological effects in the brain and the rest of the body (Ref. 1, Ref. 2). This leads to three questions regarding a migraine-celiac link:
  1. Are celiacs more likely to have migraines than the general public?
  2. Are people with migraines more likely to have celiac disease?
  3. Does gluten cause migraines?
We are getting closer to answers, but some of the evidence is contradictory.

Are celiacs more likely to have migraines?

In a 2001 study of 86 Spanish children with celiac disease, 19% had migraine headaches (Ref. 3), which is substantially higher than the approximately 10% value found in the general public. Interestingly, all the patients were already on a gluten-free diet to treat their celiac disease.
A German study of older celiac patients (mean age of 51) found migraine in 28% of them (Ref. 4). Again, the patients were on a gluten-free diet. One possible complication was that all the patients were volunteers, so we can’t be certain that they represent the celiac population in general.
Finally, in an Israeli study of 111 pediatric celiac disease patients, 14 (12.6%) were found to have migraine, compared to 5.7% in a similar population of non-celiac control subjects (Ref. 2)

Are people with migraines more likely to have celiac disease?

In a 2003 Italian study of 90 migraine patients, 4 were found to also have celiac disease. This frequency (4.4%) was significantly higher than the frequency of celiac disease in a randomly-selected control group of people without migraine headache (0.4%) (Ref. 5). For comparison, the overall prevalence of celiac disease in the general population is thought to be approximately 1%.
In one Turkish study, 73 children with migraine were tested for anti-TG2 antibodies (a strong indicator of the presence of celiac disease) (Ref. 6). Four patients (5.5%) were antibody-positive, compared to 0.6% of a group of 147 control children. Surprisingly, no evidence for actual celiac disease was found after an intestinal biopsy. Perhaps the antibody test may have uncovered a mild or early stage of the disease?
In contrast, a 2011 study of 100 Iranian children found a prevalence of celiac disease of only 2%, which was no different from the prevalence found in 1,500 control children without migraine headache (Ref. 7).

Does gluten cause migraines?

Even if there might be a slight association between these two diseases, this does not mean that the trigger for celiac disease (gluten) is the same as the trigger for migraine. Many diseases show up in clusters: for example, many people have both diabetes and high blood pressure, but this does not mean that diabetes is caused by hypertension, or vice versa. Many patients with celiac disease also have other autoimmune diseases such as diabetes, but there is no clear evidence that one causes the other.
As mentioned previously, two studies in patients whose celiac disease was well-controlled by a gluten-free diet still had a relatively high frequency of migraine. This doesn’t support the idea that gluten is a trigger for migraine (Ref. 3, Ref. 4).
In contrast, in one small study (Ref. 5), four newly-diagnosed celiacs with migraine were followed for 6 months after moving to a gluten-free diet. In this case, one had complete relief from migraine, while the other three showed an improvement in their symptoms. This migraine relief was accompanied by an improvement in blood flow to the brain in a PET scan.
Likewise, in one preliminary study of 14 patients (Ref. 2), migraine was found to be completely or partially relieved after shifting to a gluten-free diet.
It should be stressed that none of these studies was designed to rigorously test the potential role of gluten, while ruling out other possible unrelated effects.

What about non-celiac gluten sensitivity?

“Non-celiac gluten sensitivity” is less well-defined than celiac disease, but we are gradually reaching a consensus on diagnosis of gluten sensitivity. This field is still in flux, but many researchers now believe that this is a distinct condition. Briefly, if wheat allergy has been ruled out, and celiac disease has been ruled out, and the individual has symptoms which appear to be relieved after moving to a gluten-free diet, then the person is considered to be “gluten sensitive”.  Very little is known about this condition, but it will be interesting to see how prevalent migraine is in this group, and whether gluten plays a role.

Scientific and ethical challenges in studying the health effects of gluten

Comparing a “gluten-free diet” with a “normal diet” is not really a rigorous test, because there are are many differences in food composition between these two diets, not just the presence or absence gluten. A preferred trial might be one in which everyone starts out on a gluten-free diet, and then testing the effect of adding back a known amount of gluten (or a placebo). Ideally, neither the patient nor clinician should be aware of who was receiving the trigger substance (a placebo-controlled, double-blind trial). No such trial has been performed yet, so any weak association with gluten is still very tentative.
Ethical problems arise when performing clinical trials on celiacs, because deliberately administering gluten to a patient with celiac disease will almost certainly cause intestinal damage, and healing can be slow. In contrast, trials studying the effect of diet on people with gluten sensitivity  or migraine should be easier to accomplish.

Conclusion: The current evidence suggesting that gluten causes migraine headache is very tentative

While the studies so far suggest that there may be an association between celiac disease and migraine, we still do not have enough data to draw a firm conclusion that one causes the other. In addition, the evidence for the benefits of an elimination diet are weak, at best.
Once they have been diagnosed, most celiacs, of course, go on a gluten-free diet (or should); so, if anything, if gluten were an important trigger for their migraine, then celiacs might actually have a lower incidence of migraine than the general public! There is certainly no evidence for this.
While there have been many speculative articles in newspapers and on the internet that gluten is a trigger for migraine, the actual research results so far are much more tentative, and it is too early to conclude that a gluten-free diet will be helpful. This field is still in its infancy, and much larger, well-controlled clinical trials will be required before we can draw firm conclusions.
Ref. 1:  Hadjivassiliou, et al.  Gluten sensitivity: from gut to brain. Lancet Neurol (2010) 9:318-330.
Ref. 2:  Zelnik, et al.  Range of neurological disorders in patients with celiac disease. Pediatrics (2004) 113:1672-1676.
Ref. 3:  Roche-Herrero, et al.  The prevalence of headache in a population of patients with coeliac disease.  Rev Neurol (2001) 32:301-309.
Ref. 4:  Burk, et al.  Neurological symptoms in patients with biopsy proven celiac disease. Mov Disord (2009) 16:2358-2362.
Ref. 5:  Gabrielli, et al.  Association between migraine and Celiac disease: results from a preliminary case-control and therapeutic study. Am J Gastroenterol (2003) 98:625-629.
Ref. 6: Alehan, et al.  Increased risk for coeliac disease in paediatric patients with migraine. Cephalagia (2008) 28:945-949.
Ref. 7:  Inaloo, et al.   A comparative study of celiac disease in children with migraine headache and a normal control group. Turk J Gastroenterol (2011) 22:32-35.

How Soon Will I Recover From Celiac Disease After Going on a Gluten-Free Diet?

A  large study of 381 celiac disease patients at the Mayo Clinic showed that the intestinal recovery is slow, with only about one third of patients recovering after 2 years. This fraction improves after 5 years, but while a gluten-free diet is very important, many people do not recover completely. As might be expected, people had a better chance of a partial or full recovery when sticking to their gluten-free diet more religiously.


Mucosal Recovery and Mortality in Adults with Celiac Disease After Treatment With a Gluten-Free Diet by  Rubio-Tapia, A., et al., Amer. J. Gastroenterology, 2010, 105, 1412-1420.

Is Sorghum Gluten-Free? Yes, Sorghum Flour is a Safe Food for People With Celiac Disease or Gluten Sensitivity

Celiacs often struggle to find gluten-free substitutes for wheat that are both pleasant to eat and nutritious. Sorghum flour is widely believed to be a good wheat-substitute for people with celiac disease or gluten sensitivity.

Forty percent of the world’s sorghum is produced for human consumption, mainly in Africa and India, and sorghum flour made from these grains is a staple food for 300 million people. Different cultures use sorghum in a bread form, as a porridge, as couscous, or as a beer. In the West, sorghum has been typically used as a feed for farm animals, but this is now changing, with the increasing interest in gluten-free alternatives to wheat.

What is the Evidence that Sorghum is Gluten-Free?

Gluten-Free Sorghum Flour -03Sorghum is in the grass family, and is more closely related to grains like rice or corn (maize) than wheat. “Kifirin” is the main storage protein in sorghum, and is only distantly related to the storage proteins in wheat (gluten). A small study (Ref. 1) tested the effect of digested protein fragments from sorghum on intestinal biopsy samples from 8 patients with active celiac disease. No evidence of inflammation was observed. In contrast, biopsy samples treated with protein fragments from wheat gluten gave a positive signal in four different assays for inflammation. Based on this result, the effect of consuming a large amount of sorghum flour (150g daily) on two people with well-controlled celiac disease patients was tested. Baked goods containing sorghum were eaten for 5 days (cookies, cakes or bread). No negative symptoms were observed.
The other way to test for the presence of proteins related to wheat gluten is the “Mendez R5 ELISA” assay. This assay detects proteins that are closely related to gluten (although it does not measure safety directly). A recent study (Ref. 2) tested 7 sorghum flours, and found that all sorghum samples had “gluten” levels of less than 5ppm—well below the proposed 20 ppm cutoff for a safe gluten-free food.
Gluten-free Sorghum Flour -01
Ref. 1: Celiac disease: In vitro and in vivo safety and palatability of wheat-free sorghum food products. Clinical Nutrition (2007) 26, 799–805 Ciacci C, et al.

Pros and Cons of Sorghum Flour as a Gluten-Free Alternative to Wheat

Modern varieties of sorghum have been bred to be paler in color and less bitter than traditional varieties, resulting in a flour that is highly versatile. Several manufacturers now offer reasonably-priced sorghum flour that can be be used alone or blended with other starches. Sorghum flour is a good source of protein, fiber and fats, but is lower in certain amino acids and vitamins than wheat (Ref. 3), so it needs to be combined with other foods to achieve balanced nutrition.Quinoa is another excellent gluten-free option for celiacs, and has a superior nutritional profile (Ref. 4).
Ref. 3: The gluten-free diet: safety and nutritional quality. Nutrients. 2010 Jan;2(1):16-34. doi: 10.3390/nu20100016. Epub 2010 Jan 14. Saturni L, et al.
What about Sorghum for Gluten-Free Beer?
As I discussed last year (Ref. 5), beer made from barley or wheat contains gluten, so many brewers have been experimenting with other seeds and grains, to create a beer that is suitable for people with celiac disease or gluten sensitivity. As I will discuss in a future blog, many brewers rely on malted gluten-free sorghum as a starting point for gluten-free beer. In African countries, sorghum is a common ingredient for making beer, and this often involves not only yeast fermentation, but bacterial fermentation, as is used in sourdough bread, for example.
Ref. 5:  Is “Gluten-Free” Beer Made From Barley Malt Safe for Celiacs?


The latest research provides further evidence suggesting that sorghum flour should be a safe alternative to wheat, and suitable for the gluten-free diet of people with celiac disease or gluten sensitivity.

25 Ways to Eat Well and Stay Healthy on the Gluten-Free Diet

It isn’t always easy to adjust to the gluten-free life. But there are commonsense ways to make it much simpler. These tips will help you love gluten-free living.
1. Be patient.
Almost everyone is overwhelmed by the challenge of eating gluten free. Initially it might seem like the diet eliminates all the food you love to eat. Or you might feel surrounded by gluten and unsure if it’s safe to eat anything. It could take up to six months to begin to feel comfortable with the diet and confident about your food choices. So don’t expect to get it all straight overnight.
You may experience grief over having to give up foods you have eaten all your life. Don’t worry, it’s normal. You will almost certainly make mistakes at first and eat food that contains gluten. This is also normal. And a few mistakes won’t kill you. Time is on your side and the lifestyle will get easier as you learn more and gain confidence in your choices.

2. Be positive.
Concentrate on what you can eat, not on what you can’t eat. Remember that most of the nutritious foods you are supposed to eat to stay healthy are gluten free. This includes plain meat, fish, poultry, beans, eggs, vegetables, fruits, rice, nuts and legumes, not to mention rice, corn and soy. Plain spices and herbs are also gluten free as are plain fruit juices, milk, coffee, tea, wine and distilled alcoholic beverages. Later, when the insecurity fades away, you can go beyond plain. On the other hand, just because something is gluten free, does not mean it is good for you. Cool Whip, for example, is gluten free. Junk food is still junk food whether it’s gluten free or not.
3. Don’t cheat.
Now is the time to decide you are not going to cheat. You will be tempted. At some point you might start thinking the diet just isn’t worth it, especially if you weren’t very sick when you were diagnosed. You might decide there is simply too much gluten around to avoid, so you might as well go ahead and eat it. You might not want to stand out or make a fuss when you are eating with others.
Let’s look at these excuses.
The diet is most certainly worth it. Now only will it make you feel better than you ever have before, it will also protect you from the risks you face if you continue to eat gluten – osteoporosis, for example.
There is a lot of gluten around. But once you develop some perspective on the diet and acquire knowledge about ingredients, you’ll discover that you can successfully avoid gluten and stay happy and healthy.
In terms of sticking out in a crowd, maybe the gluten-free diet is not quite as conspicuous to others as it is to you. These days people follow all kinds of diets – vegetarian or dairy-free, to take just two examples. Maybe they have diabetes and need to keep track of their carbohydrates. Or they are trying to lose weight or save money.  In a climate of raised food consciousness, those who follow a gluten-free diet may not be as special as they think.
Beyond a few moments of guilty pleasure, you have nothing to gain by cheating, and you have a lot to lose, including your good health. Stick to your vow not to cheat. Treat yourself to a favorite gluten-free comfort food when the going gets rough.
4. Make connections.
Get in touch with a support group. There are local support groups all over the country, all loosely connected. Most are wonderful sources of information, understanding and practical details. If your doctor or dietitian can’t put you in touch with a local group, you can check or write to us at
Once you’ve found a support group, go to meetings, get to know others who follow the gluten-free diet and volunteer to help. Most support groups need more help than they get. And most offer a great deal more to individuals than each person can possibly put back in.
If you’re not the support group “type,” you will still find it helpful to go to at least one meeting. You’ll find out where to shop and eat out. You’ll be able to talk to people who will understand exactly what you are going through.
5. Gather information.
Learn everything you can about the gluten-free diet. This will involve time and effort and eventually it will mean sifting through conflicting information to try to separate the accurate information from material that is inaccurate or unfounded. Naturally we recommend Gluten-Free Living. It is the best source of reliable information currently available. If you don’t find that to be true, we will gladly refund your subscription price. You can subscribe to our magazine here.
Be especially cautious online. Anyone who has a computer can become an instant expert. This is true in any area and you just need to be skeptical. That said, the Internet can be an excellent starting point for your information search. Our website is reliable and informative.
You might also want to purchase a basic book on celiac disease and gluten sensitivity. We recommend Celiac Disease: A Hidden Epidemic by Peter HR Green, MD and Rory Jones. This book clearly and comprehensively covers all the basic medical and other information you need to know to live a happy, healthy gluten-free life.
6. Buy a cookbook.
Buy at least one specifically gluten-free cookbook. It will offer recipes that are exclusively gluten free. But it will also provide basic details about the peculiarities of gluten-free cooking and baking.  There are no many to choose from. Anything by Carol Fenster, Bette Hagman or Connie Sarros is sure to be good. But there are plenty of other authors to choose from.
Meanwhile, do not throw out the cookbooks you now have. As you become more and more informed, you’ll be better able to tell if a given recipe is safe and even to know what substitutions you will need to make to convert a recipe to gluten free.
7. Shop around.
Check out all your local supermarkets, health food stores or other shops that sell food. Gluten-free foods are getting more shelf space in supermarkets every day. You’ll probably go through some trial and error before you figure out the best places to shop locally. At the same time, continue surfing the Internet to discover new sources of gluten-free products. At this point, you will probably be amazed by how many gluten-free products there are. These days you can find a gluten-free version of almost anything.
You’ll find many individual companies that sell a wide variety of gluten-free food or order though giants like Amazon can be very economical when you buy in bulk. So if you have storage space at home, check what’s available there.
8. Develop supermarket savvy.
Learn to navigate the supermarket. At first you’ll probably spend double or triple the time you used to spend on each shopping trip. That’s because you have to read every label every time you shop and at first, you won’t be familiar with many of the ingredients.
Don’t try to figure out everything at once. Select one or two items you would like to be able to eat and check them out. Almost all food processors have 800 numbers listed on their food labels. Bring your cell phone to the supermarket and gather detailed information on the spot. The next time you shop, you can select one or two more items to check up on. If you have a smart phone, there are a number of apps that enable you to check the gluten-free status of a product right on your screen while you are at the supermarket.
Don’t forget to shop the perimeter of the supermarket. That’s where you usually find the produce departments, where just about everything will be gluten free, or the meat and dairy departments, where most of the items will be gluten free. Look through the frozen food cases for gluten-free items.
Although aisles that contain bread, cake or cookies used to be barren of gluten-free items, you might find a few gluten-free choices depending on how your store stocks gluten-free foods. Some, like Wegmans, put all the gluten-free products together. Others, put gluten-free cookies in the general cookie section and gluten-free bread in the bakery department. Cereal, too, usually contains gluten. But recently a few companies have reformulated some popular products to be gluten free. You can find gluten-free Chex products as well as gluten-free Rice Krispies and Fruity and Coco Pebbles. Check the label carefully to make sure you pick up the right ones.
9. Become a label expert.
Labels are the key to finding safe gluten-free food.   First, look for a gluten-free label. It tells you a product is made with gluten-free ingredients and can be a short cut for finding foods that fit in your gluten-free diet. Be aware that current U.S. labeling laws don’t require gluten-free ingredients to be tested for cross contamination.  The Food and Drug Administration (FDA) is working on a definition for use of the gluten-free label on foods. Once approved, the FDA-approved label will set specific standards for foods labeled gluten free and take cross contamination into account.
Meanwhile, if you want more exacting standards for items labeled gluten-free, look for a certification seal from the Gluten Intolerance Group or the Celiac Sprue Association.  (See next tip for more details)
When a food has neither a gluten-free label nor a certification seal, you have to rely on the ingredients list to determine if it has gluten-containing ingredients. Look for any wheat, rye, barley, malt or oats.
Under the Food Allergen Labeling and Consumer Protection Act, wheat always has to appear on a label when it is used in any form in a food regulated by the FDA. So if an ingredient, modified food starch for example, is made with wheat it will clearly say so on the label. The word wheat can be in the ingredients list or in a Contains statement that follows the ingredient list. Foods that contain wheat are not gluten free unless the wheat is found in a highly processed ingredient from which the harmful protein has been removed. This includes maltodextrin, glucose syrup and citric acid.
Barley, rye and oats are not covered by the allergen labeling law.  Rye is mainly used in rye bread, where it is clearly labeled. Barley is also usually included in the ingredients list when used, though it may be called malt, malt flavoring or malt extract and should be avoided. Oats that are not specifically labeled as gluten-free are highly likely to be cross-contaminated and are not gluten free.
Some foods also have advisory statements, like “May contain wheat,” “Made in a facility that also processes wheat,” “Made on equipment that also processes wheat.” These statements are voluntary and have no official definition. Some companies use them broadly for legal protection and others use them to warn allergic consumers about a real risk in the processing of a food. On the flip side, you may see statements like “Made in a dedicated gluten-free facility,” or “Made on dedicated gluten-free equipment.” At first labeling reading can seem overwhelming, but you will learn the ins and outs faster than you might think.
10. Look for a GF certification seal.
When you are looking for gluten-free products, a seal of approval from one of the groups that certify gluten-free foods can give you an increased level of confidence in their safety.
The Gluten Intolerance Group and the Celiac Sprue Association both offer certification for products that meet their standards.  To use the GIG seal, a product must be tested and found to contain less than 10 parts per million of gluten. In addition, GIG auditors review ingredients and do an on-site inspection. CSA puts its recognition seal on products that test to less than 5 ppm of gluten. CSA also reviews the process, equipment and ingredients a company uses.
For the gluten-free consumer, these seals guarantee that gluten cross-contamination from all sources, including growing, harvesting, transportation and processing, is measured and limited.
11. Solve the bread challenge.
Bread should remain a staple in your daily diet. You can buy a variety of ready-made gluten-free breads. Some supermarkets and most health food stores carry them, as do chains like Whole Foods or Trader Joes. Or you can order on the Internet.
If you like to bake, you can bake your own bread. To make the job easier, consider buying a bread machine. With a bread machine and a ready-made bread mix or gluten-free baking supplies, you will always have fresh gluten-free bread available. The delightful aroma of baking bread will instantly make you feel better about going gluten free. Although bread machines may seem expensive, they can be especially helpful in the gluten-free kitchen and may save you money in the long run.
Initially the taste and consistence of gluten-free bread might seem odd, but don’t make any snap decisions. Try all gluten-free food at least twice. Or if you don’t like the initial taste, try toasting the bread. You’ll be amazed at how quickly you adapt.
12. Base your GF decisions on facts.
It’s easy to worry needlessly about a few gluten-free topics because of all the misinformation floating around about them. We include chewing gum, stamps and envelopes and toothpaste in this category.  Research into each of these topics has shown that finding gluten in any of them would be difficult if not outright impossible.
Likewise worry about gluten in lipstick, medications and cold cuts is out of proportion to the danger it poses for those who follow the gluten-free diet.  While you might occasionally find a brand of one of these products that is made with gluten, the vast majority are gluten free. It’s wise to verify the gluten-free status of each, but silly to spend a lot of time worrying about the risk they pose.
Overall, your gluten-free decisions should be based on facts, not broad generalizations that spring from a nugget of misinformation that keeps getting passed around.
13. Customize your kitchen.
Develop a plan for your kitchen that will protect gluten-free food from contamination. Although celiac disease does tend to run in families (see 23) most of those who follow a gluten-free diet live with gluten-eating relatives.
If you can, buy two containers of spreadable staples like butter, mayonnaise, peanut butter, jellies and cream cheese, and designate one of the two for gluten-free use. This will prevent gluten-containing crumbs from getting mixed in and then spread on gluten-free bread. Another way to prevent contamination is by using a clean spoon to remove spreads from a container and then spreading with a knife.
Some families buy bright tape or neon stickers and stick them on everything that is or should remain gluten free. You might also want to keep all the gluten-free foods in one place in the refrigerator or cupboard and even designate a portion of the kitchen counter for preparing gluten-free foods.
Buy a personal toaster and make sure on one else uses it to toast bread that contains gluten. You might even want to treat yourself to a deluxe model. Many gluten-free breads taste better toasted so it will get a lot of use.
You can also toast gluten-free bread in a toaster oven, but protect it with foil or one of the special bags that are available for just this purpose. Several brands are available at
There are as many simple and practical ways to prevent cross contamination as there are families coping with the needs of gluten-free family members. Whatever works for you is the right way to go.
14. Plan appropriately.
Modify the way you plan menus. When purchasing, storing and cooking food, think in terms of making the job as easy, adaptable and comfortable for everyone as possible. Keep a stock of gluten-free food on hand, including gluten-free snacks. You may need them for times when you are away from home and unsure of what you will be able to eat or where you might buy something. Store carefully. Cook in quantities. Freeze leftovers. You can also freeze many gluten-free baking items so you have them on hand.
In planning meals, don’t forget that some meals are naturally gluten free. For example, broiled fish or meat, plain vegetables and plain potatoes and rice are all gluten free. Keep a supply of gluten-free pasta on hand. Many of the pasta dishes you have been cooking are probably gluten free as long as you use gluten-free pasta. When cooking for your family, use separate pots to boil the pastas.  Make sure your pasta sauce is gluten free (it usually is), but be careful with your utensils. Be sure to use clean ones to serve the gluten-free pasta.
15. Vary your diet.
It’s very tempting, especially when first diagnosed, to start eating the same things over and over. This usually happens when early paranoia sets in and gluten begins to seem like it’s everywhere. Some people who follow a gluten-free diet never lose their fears and it’s at least open to debate as to whether this kind of paranoia is harmful or not. While new restrictions are a normal part of adjusting to gluten-free living, you still need to consume a variety of foods in order to get all the nutrients you need to stay healthy. You have to think gluten free. But you also need to think in terms of packing as many nutrients as possible into your nutrient-starved body.
16. Choose whole grains.
If you want to have a healthy gluten-free diet, you have to include whole grains. This includes brown rice, sorghum, buckwheat, quinoa, amaranth, millet and specialty gluten-free oats. They are rich in fiber, antioxidants and minerals such as calcium, magnesium and selenium and vitamins B6, E and niacin.
Some make great breakfasts in their original whole grain form. Others are ground into nutritious flours. And some make great side dishes at dinner, particularly brown rice and quinoa. In addition, many gluten-free food companies are now using whole grains in products as diverse as energy bars, pasta, bread and muffins.
The U.S. Department of Agriculture recommends that you eat at least three servings of whole grains each day. It’s easy to do if you eat brown rice instead of white rice, trade rice noodles for quinoa pasta and make your sandwich with whole-grain gluten free bread instead of bread made with white rice flour and potato and tapioca starch.
17. Emphasize calcium.
Be sure to eat plenty of calcium-rich food, especially if you are newly diagnosed and making the transition to a gluten-free diet. The rigors of learning the diet might make you forget how important this mineral is, especially to those who have been diagnosed with celiac disease. Calcium is one of the main nutrients robbed from the body by undetected celiac disease and inadequate calcium can lead to long-term problems, such as osteoporosis.
Dairy foods are the best sources of calcium (see next tip). In addition, the following foods are among the best non-dairy sources of calcium and they are all naturally gluten free (but be sure to read all labels): canned sardines and salmon with bones, canned shrimp, bok choy, collard greens, turnip greens and broccoli. You can also take advantage of products that sometimes include added calcium, like orange juice.
Consider taking a calcium supplement every day. Calcium carbonate is usually recommended as the best, most bioavailable form (meaning it dissolves so the body can absorb it). Dose recommendations vary, depending on age and gender. Ask your doctor or dietitian how much you should take.
Health care professionals suggest spreading your daily calcium supplement over two or three doses each day, with a partial amount taken at or near mealtimes.
18. Don’t skip dairy foods.
Dairy foods are important even if you are lactose intolerant. But they can be a problem (sometimes it’s a temporary problem) for those newly diagnosed with celiac disease. That’s because untreated celiac disease tends to destroy the tips of the villi where lactase is produced. Lactase helps digest lactose. Without sufficient lactase, you can develop problems like gas, bloating and diarrhea after consuming food that contains lactose.
Some people diagnosed with celiac disease find their lactose intolerance goes away as their small intestine heals. Others discover it doesn’t go away because they are genetically predisposed to be intolerant of lactose. If that’s the case and you continue to be lactose intolerant, use one of the products currently available that help people digest lactose. But remember to check that it is gluten free. The Calcium Information Center suggests that lactose intolerant individuals consume food with lactose-containing beverages to help delay gastric emptying and decrease symptoms.
19. Deal with DH.
Pay attention to all these tips if you have dermatitis herpetiformis (DH). DH has been called celiac disease of the skin. It is an extremely itchy, red rash that tends to appear on the elbows, knees, buttocks, scalp and back. The rash is caused by IgA deposits just under the skin that result because the individual is sensitive to gluten
Dermatologists often treat DH with dapsone, a drug that relieves the itch and slowly clears the rash. Affected individuals also should follow a gluten-free diet or the rash returns. The gluten-free diet gradually decreases the need for dapsone to the point where it can be discontinued. But DH patients must continue the diet for life.
20. Stock your pantry well.
When you have little or no time to make dinner, it’s great to have a few ready-made meals in the pantry or freezer. It used to be impossible to find any that were gluten free. Now, a growing number of companies make gluten-free frozen meals from pizza to pasta to breaded chicken and fish.  The gluten-free diet won’t seem like such a burden if you have a few meals you can count on for days when you or the kids have an evening activity or you just don’t feel like cooking. Everyone needs a break from the stove every once in a while.
Also be aware that during the spring Passover season, Jewish law forbids eating any food that contains “chametz,” which refers to wheat, rye, barley, oats or spelt, the exact grains forbidden on the gluten-free diet. So it’s a good time to stock up on foods labeled “Kosher for Passover.” They are certified to be gluten free with one very important exception – matzo. This is a special form of unleavened bread made with wheat flour and water. It is eaten as is in the large square crackers that substitute for bread during Passover. It is also ground into matzo meal or processed further into flour.
To assess Passover foods, first make sure the label clearly identifies the product as “Kosher for Passover” (must include all three words). Then read the ingredient list. If you don’t see matzo or any form of matzo (matzo meal, matzo flour, matzo anything or cake flour), the item is guaranteed to be gluten free.
21. Don’t stay home.
You can travel and eat out while following a gluten-free diet, but you do have to be cautious. When you travel, plan ahead. Try to bring as many food items as you can without making your trip uncomfortable. If you are traveling in this country, use the Internet to find a local support group at your destination. The group may have a website listing sources of gluten-free food or a phone number you can call.
If you are traveling abroad, make sure to bring a translation that explains your dietary needs. Go to or for translations and other travel aids.
Eating out takes on a new twist when you lead a gluten-free lifestyle. Think in terms of small, ethnic (many ethnic cuisines are corn-or rice-based), or standard American, which can be good choices. If you develop a relationship with a restaurant (tipping well doesn’t hurt), your confidence level will rise. When dining out, clearly explain your dietary needs. You can talk to the server, the manager, or, preferably, to the chef. When you are sure that you have been understood, relax and enjoy yourself. An increasing number of restaurants, both local and chains, now have gluten-free menus. While these are a great place to start, still make sure the chef understands your needs. A gluten-free menu is only as good as the staff that prepares and serves your food.
22. Don’t complain.
Try not to think of the added expense of gluten-free food as a burden. Remember it is the only “medicine” that will assure your good health. Compared to the cost of prescription drugs and their associated and sometimes negative side effects, you can even convince yourself that the gluten-free diet is quite a bargain. And try not to blame specialty food companies for the added expense. It comes from all the additional steps they have to take to make sure they are producing safe food.
Most importantly, consider how much it would cost you to deal with the health problems that can develop if you have undiagnosed celiac disease. If you look at the gluten-free diet as a critical preventive health measure, then it will seem cheap indeed.
23. Test the family.
Encourage your relatives to be tested, especially your first-degree relatives. The prevalence of celiac disease in first-degree relatives (parents, children and siblings) is much higher than it is in the general population. But be prepared for resistance from relatives, whether or not they have symptoms. Sometimes relatives refuse to be tested. Don’t feel guilty if they make that decision.
24. Teach your children well.
If you are the parent of a child who follows the gluten-free diet, you have a challenging and very important job.  You are in charge of your child’s gluten-free diet now, but you are also in charge of helping your child achieve and maintain a positive attitude since the gluten-free diet is for life.
Yes, you have to make sure you child’s food is gluten free so he or she will feel well and grow properly. But making your child feel as normal as possible within the confines of the diet is just as important. Generally that means never letting the diet stop him from participating in an activity, going to a party or hanging around with friends.
Plan for food in advance. Bag and freeze gluten-free cupcakes and pizza so you are always ready for a birthday or school celebration. Send gluten-free snacks your child can have when an unexpected treat turns up in the classroom. Offer to bring food, which happens to be gluten free, to scout meetings, soccer games and other activities so your child can enjoy it along with everyone else. Many of the foods children typically like are now available in gluten-free versions that you can keep stocked for your child.
You can police every food to make sure it does not contain gluten. But your child still won’t grow normally if she is made to feel that celiac disease limits or defines who he or she is. Gluten-free kids adjust amazingly well with the right kind of support from family and friends and a “can do” outlook on their diet from you.
25. Get on with life.
In the beginning, having to follow a gluten-free diet may seem like the worst thing that ever happened to you. But you will soon discover that it may be the best thing that ever happened to you. The diet is manageable. It prevents more serious health problems.
Most of all, the diet is doable and the lifestyle is rewarding. You can (and you will) get to a point where you follow a strict, unwavering gluten-free diet as if it were the most normal thing in the world.


5 Rules To Follow To Dine Out Safely When You Have Celiac Or Gluten Sensitivity

It's easier than ever to eat out on the gluten-free diet. Multiple national and regional restaurant chains offer gluten-free menusand seem to have taken the time to truly understand the needs of people with celiac disease and non-celiac gluten sensitivity. Even many fast food restaurants now offer gluten-free options.
But it's still possible to run into trouble at a restaurant, especially if you're fairly sensitive to trace gluten. In most cases, the problem isn't gluten ingredients in the food itself — it's gluten cross contamination.
In fact, I spent a long time basically refusing to eat out, since I almost always got glutened. It wasn't worth the pleasure of the meal to spend two days recovering from it.
Now, though, I've developed a series of rules I follow to ensure a safe restaurant meal. By implementing these, I've been able to resume going out (which I really enjoy), and mostly do it safely.
It's helped that awareness of gluten-free issues and needs has risen generally among the restaurant community as many more people ask for gluten-free options.
But it's honestly helped more for me to follow my own rules for gluten-free restaurant dining as methodically as possible.

Rule #1: Choose Your Restaurant Wisely. Restaurants with gluten-free menus are a good place to start, since in many cases (but not all), staff members at those restaurants receive training on how to keep food gluten-free and to avoid cross contamination.
But you still have options if you don't want to go to a chain restaurant. For example, ethnic restaurants offer gluten-free options. In addition, you can try a local restaurant, although you'll need to choose sensibly — the local bakery and cafĂ© may not offer good gluten-free options, and you may not even be able to enter the place due to the flour in the air. You'll have better luck with an upscale establishment where they make most of the food from scratch.
Rule #2: Talk Directly to the Chef or the Manager. Take it from me: Having your server relay questions back and forth to the chef or the manager just doesn't work. At all. Details get overlooked and ingredients get garbled, especially as your requests get more complicated (and avoiding cross contamination is pretty complicated!). Your server may say he knows how to ensure a gluten-free meal, but unless you take the time to quiz him extensively, you won't be sure if hereally knows his stuff. Also, he won't be in the kitchen actually preparing your food; the kitchen staff takes care of that.
Instead of trusting your server to get everything right, enlist the help of a manager or — preferably — ask to speak to the chef directly. In most cases, I've found chefs to be very knowledgeable and very willing to help. Once I started skipping the server and going straight to the chef, my restaurant-related glutenings declined dramatically.
Conversely, skipping this rule — even for part of your meal — can lead to big trouble. At one restaurant we trusted, we spoke to the chef at the beginning of the meal. At the end, the server recommended the gluten-free brownie with ice cream. Now, I didn't remember seeing a gluten-free brownie on the menu, but all seemed well, so I decided against bothering the chef again. That turned out to be a major mistake: the brownie was sugar-free, not gluten-free ... as I learned only after eating it.
Rule #3: Stress Cross-Contamination Issues with Your Chef and Server. As I said earlier, most of our problems in restaurants (the brownie incident excepted) have involved cross contamination, not actual gluten food served to us. Workers in busy restaurant kitchens need to share cooking surfaces, utensils and pans ... and it can be difficult to carve out a place to make an allergen meal in that chaos. Some restaurants that excel in gluten-free items actually keep separate kitchens for gluten and non-gluten food (Disney does this in some cases), but most do not.
  • To stay safe, make sure you ask the kitchen staff for the following:
  • Wash their hands and change their gloves before preparing your food
  • Mix any salad in a clean bowl (many restaurants reuse bowls, and they may contain crouton fragments or unsafe salad dressings)
  • Avoid using a grill surface that's shared with gluten-containing items (including hamburger buns, sauces and breaded items)
  • Use fresh water to cook gluten-free pasta or steam vegetables (some restaurants reuse pasta water for this purpose)
  • Place gluten-free pizzas or rolls on a pan instead of directly on an oven surface, and cover them with foil to avoid crumbs
Also, ask your server to keep your food away from the bread basket and other obvious gluten threats; it's possible to have cross contamination introduced between the kitchen and your table.
Rule #4: Question Everything. Many restaurants follow the practice of having someone who's not your server bring your food to the table. In some cases, that person will say reassuringly, "Here's your gluten-free meal." But when the person doesn't say that, I always ask "Is that gluten-free?" I've saved myself from several glutenings this way, as the person realized he had picked up the wrong plate. If something appears on your plate that you didn't order (such as a garnish or a sauce), don't touch it or try to push it aside; instead, find out what it is and whether it's safe. If there's any doubt, ask for another plate to be prepared.
In addition, if you're very sensitive you'll certainly need to ask more questions. For example, the restaurant may offer a dessert that doesn't include gluten ingredients, but it may be made right alongside the gluten-filled pastries on the menu.
Rule #5: When In Doubt, Don't Eat. In most cases, I'm able to eat out safely and enjoyably. But I've skipped meals entirely on occasion because the restaurant seemed clueless about gluten. I don't enjoy going hungry, but I prefer it to getting sick the next day. If the chef doesn't seem to get it — or worse, doesn't seem interested in trying — you're better off not taking a chance.

Is Celiac Disease Caused by a Change in Gluten Consumption?

The cause of celiac disease remains a puzzle. The prevalence of the disease has increased dramatically over the past few decades; but, contrary to some of the claims in the popular media, there is no clear evidence that changes in wheat or changes in wheat consumption can account for the major increase in prevalence of celiac disease.
In my previous article (Ref. 1), I discussed some of the current ideas for the huge increase in celiac disease that has been reported, including changes in childhood infection or breastfeeding. This blog focuses on the idea that the amount of gluten that we consume might be important.

Has the U.S. Consumption of Wheat Changed Significantly?

In the 1600′s and 1700′s, it was very expensive to produce wheat, so wheat bread was mainly consumed by the wealthy. In the 1800′s, improvements in machinery for agriculture and milling reduced wheat production costs, and expansion of the railroad system enabled transportation costs to be reduced dramatically, especially over long distances in the U.S. By 1900, U.S. wheat consumption had increased to 226 lbs/year for an average person (see the Figure and Ref. 2).
In the 20th century, there was a steady decline in consumption, with an all-time low of 110 lbs/year in 1975. More recently, dietary concerns about the health effects of dietary fats, plus an increase in fast-foods, led to a resurgence in wheat consumption. This may also have been influenced by dietary recommendations from the USDA. In 2011, U.S. per capita consumption of wheat was about 133 lbs.
The prevalence of celiac disease is estimated to have increased about 4-fold over the past half-century, but there is no obvious relationship between the dramatic rise of celiac disease and the fairly modest changes in wheat consumption over the same period.

Has the Gluten Content of Wheat Changed Significantly?

A recent paper by D. Kasarda (Ref. 3) discusses this idea, based on available information about U.S. wheat over the past century. Two main types of wheat are consumed: “hard” wheat has a higher gluten content, ideal for bread making, while “soft” wheat has lower gluten, and is more suited to cakes and pastry. Hard wheat contains about 12-14% total protein, while soft wheat has 7-11%. Durum wheat, used for pasta, has a high total protein content, but less gluten than bread wheat.
According to Dr. Kasarda, no major changes in wheat protein have occurred for the years where data is available. The only slight changes are for years in which there was a drought, but it is common practice to blend wheat produced in different years in order to achieve a consistent gluten content.

What About Changes in Agriculture?

Agricultural practices have changed over the years, with increased use of fertilizer, and changes in crop rotation patterns. However, these changes have focused on increasing the overall yield of wheat, rather than changing its gluten content.

What About Changes in Wheat Genetics?

There are literally hundreds of varieties of wheat grown around the world. Breeding efforts have focused on increased yield, and adaptation to different environments—not altered gluten content. Interestingly, wild varieties of wheat can have roughly twice the gluten content of modern versions (Ref. 3). So far, genetic improvements have involved traditional breeding approaches, and the use of modern “genetic engineering” technology to improve wheat has not been applied on a commercial scale. (In principle, genetic engineering technology might be used to reduce the immune-stimulating activity of wheat, without sacrificing its bread-making properties, but this approach has not been tried yet).

Worldwide Trends in Celiac Disease

Another way to examine the possible role of gluten consumption is to look at celiac disease prevalence in different countries. For example, the prevalence of celiac disease in Germany is roughly one tenth that in Finland, even though Germans eat plenty of bread. Of course, there are many other differences between these two countries, including their different ethnic backgrounds. However, genes can’t be the critical factor, since people in Karelia (who are ethnically Finnish, but live in Russia) have a much lower celiac disease prevalence than their Finnish relatives.


While there are some people who would like to blame modern wheat agriculture for the rise in celiac disease, the available evidence simply does not support this idea.
Personal comment:
Wheat currently provides about 20% of calories for the world’s food supply, and is a critical part of the world’s nutrition. From a social perspective, the 20th century “green revolution”, with its dramatic increase in wheat yields certainly saved the lives of millions across the world. In the future, changes in climate and population will put increasing stress on our ability to feed the world. The challenge will probably be to maintain current productivity, let alone address the increasing demand, so I personally hope that we haven’t exhausted ways of improving wheat strains and agricultural methods. What do you think?

Ref. 2:  Wheat’s Role in the U.S. Diet Has Changed Over the Decades.
Ref. 3:  Can an Increase in Celiac Disease Be Attributed to an Increase in the Gluten Content of Wheat as a Consequence of Wheat Breeding?  Kasarda, D.