Hidden sources of gluten

When your child is diagnosed with celiac disease, you suddenly become a food detective – scouting for gluten, sometimes hidden deep in the ingredient list of your family's foods or daily products.

"Parents of children with celiac disease must be very careful to keep gluten out of their child's diets," explains Michele Alkalay, M.D., Director of the Childhood Celiac Disease Program at Children's Health℠ and Assistant Professor at UT Southwestern. "When someone with celiac disease eats gluten, their body reacts in a way that damages the small intestine. Avoidance of gluten is the only treatment."

While certain sources of gluten are obvious, it's easy to be confused about other common foods, grains or ingredients. Dr. Alkalay explains how to tell if something is gluten-free and ways to keep children with celiac disease healthy.

What is gluten?

Gluten is a name for the proteins naturally found in wheat, rye, barley and foods made with these grains. Common sources of gluten include:

• Baked goods

• Breads

• Cereals

• Crackers

• Pasta

• Pastries

• Sauces, dressings and gravies

• Soups

When children have celiac disease, they should avoid foods containing gluten, or they may experience excessive gas, abdominal pain, vomiting, weight loss and other symptoms.

What does gluten-free mean?

A gluten-free food is a food made without the proteins found in wheat, barley and rye. Nutritious foods that are naturally gluten-free include:

• Fruits and vegetables

• Meat and poultry

• Fish and seafood

• Dairy

• Beans, legumes and nuts

You can also find naturally gluten-free grains such as quinoa, corn, rice, sorghum and amaranth in grocery stores and health food stores.

How can you tell if something is gluten-free?

Some products say "gluten-free" on the package – but not all. To be certain, check the ingredient list.

"If your child needs to be on a gluten-free diet, it's important to read food labels carefully," says Dr. Alkalay. "You're looking for foods that do not contain any type of wheat, barley or rye. Be aware that sometimes these ingredients have other names, and your child should not eat them."

Hidden names for gluten

When reviewing a food label, check for these gluten-containing ingredients that are forms of wheat, barley or rye:

• Brewer's yeast

• Bromated flour

• Durum

• Einkorn

• Emmer

• Enriched flour

• Farina

• Farro

• Flour

• Graham

• Kamut® brand khorasan wheat

• Malt (including malt syrup, malt extract, malt flavoring, malted beverages, malted milk and malt vinegar)

• Phosphated flour

• Semolina

• Spelt

• Triticale

• Wheat flour

• White flour

• White self-rising flour

Do prepared or processed foods contain gluten?

Yes, be aware that some prepared and processed foods may contain gluten, depending on how they are made. These include foods you order in a restaurant or ready-made and prepackaged items you buy in the grocery store. Commonly missed sources of gluten can include:

• Bouillon cubes

• Brown rice syrup

• Candy and candy bars

• Caramel color

• Cold cuts

• Hot dogs

• Imitation bacon

• Salami

• Sausage

• Potatoes with seasonings that contain gluten

• Gravy

• Marinades

• Modified food starch

• Roux (cooking base from which sauces are made)

• Sauces and sauce thickeners

• Stuffing

On packaged items, look for labels that say "certified gluten-free." In restaurants, certain menu items may be marked gluten-free, but beware of added seasonings, marinades and sauces that may contain hidden sources of gluten.

"When you go to a restaurant, ask questions about how the food is prepared," recommends Dr. Alkalay. "For example, chicken and potatoes are supposed to be gluten-free. But if you eat them in a restaurant that uses seasonings or batters that contain gluten, that's a problem. Ask the chef or research websites ahead of time."

Frequently asked foods: What is gluten-free?

See clarification if these commonly confused foods contain gluten or are gluten-free:

• Corn tortillas: Corn tortillas are gluten-free if they're made with pure corn. If they are prepared with seasonings or other types of ingredients that contain gluten, you cannot eat them on a gluten-free diet.

• Couscous: While couscous looks somewhat like rice, it is not gluten-free. It's made from semolina, a type of wheat. There are some alternative forms of couscous available, such as brown rice couscous, which do not contain gluten.

• Farro: Farro is a wheat grain and is not gluten-free.

• Oatmeal: If you get 100% pure oats, those are gluten-free. However, oats may be contaminated with wheat during milling and processing. Make sure to check labels.

• Popcorn: Corn is gluten-free. However, if you're buying popcorn in a bag, make sure it's gluten-free certified. Otherwise, seasonings and preparation techniques may include gluten.

• Potatoes: In their natural form, potatoes are gluten-free. However, gravy, sauces and seasonings may contain gluten. Be aware that French fries may be fried in a batter that contains gluten. Watch out for bagged potato chips, too.

• Rice: All types of rice, in their natural form, are gluten-free.

• Quinoa: Pure quinoa is a gluten-free grain. Be aware that cross-contamination can occur if the quinoa is harvested along with wheat, barley and rye. Buy quinoa that is labeled or certified gluten-free.

What nonfood items contain gluten?

Check nonfood product labels, too. Everyday health and skin care items may also contain gluten that can be harmful to children with celiac disease. These include:

• Creams

• Lip balm/lip gloss

• Makeup

• Play-Doh

• Prescription medicines

• Shampoo

• Vitamins, herbal supplements and gummies

More tips to avoid unexpected sources of gluten

If your child is on a strict, gluten-free diet, be aware of the possibility of cross-contamination. This can happen when a naturally gluten-free food comes in contact with other types of food that contain gluten.

To guard against cross-contamination:

• Do not buy bulk food stored in bins that may have once contained products with gluten. (Even naturally gluten-free grains sold in health food stores may be at risk for cross-contact with gluten.)

• In restaurants, ask whether the gluten-free meal was prepared with the same utensils as other foods containing gluten.

• At home, prepare your child's food with separate pots, pans and utensils (unless the whole family has transitioned to a gluten-free diet.) Separate toasters are a good idea, too. Even left-behind crumbs can cause a cross-contamination problem.

While detecting gluten may feel overwhelming, families should know there are resources to help. Consult with a dietitian about your child's celiac diet and consider joining a support group. You can also download free apps, such as:

• Gluten Free Scanner allows you to use your phone's camera to scan the barcodes on food packages and learn whether the food contains gluten.

• Find Me Gluten Free helps you find restaurants that serve gluten-free meals anywhere you go.

"Thankfully, there is a growing variety of gluten-free foods on the market – gluten-free pizza, pasta, bread and a slew of other alternatives," says Dr. Alkalay. "Just make sure to double-check labels and consult your child's doctor and nutritionist to help keep your child healthy."

Learn more

The Childhood Celiac Disease Program at Children's Health is the only medical pediatric celiac program in North Texas. Learn more about our multidisciplinary clinic dedicated to celiac disease care.

For additional, trusted gluten-free dietary tips, visit the Celiac Disease Foundation website.

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