Maintaining a Nutritious Gluten-Free Diet

While eating gluten-free is the number one priority for those with celiac disease (CD), it is also important not to forget about nutrition. A standard gluten-free diet (GFD) may fall short in certain nutrients, such as fiber, iron, calcium, vitamin D, and B vitamins. The good news is that many naturally gluten-free foods are healthy choices. Consuming more of these foods can go a long way in closing any nutritional gaps for those with CD.

Why Is a Healthy Diet Important?

A healthy diet is full of nutrients that are needed for many important functions, including sustaining life, maintaining your energy (calorie) needs, and reducing your risk of chronic conditions such as diabetes, heart disease, and certain cancers. Both the Mediterranean diet and vegetarian diets can also easily be adapted to be gluten-free. Access the Education Materials on CeliacNow to review both of these diets.

What Should You Include in Your Healthy GFD?

  • Fruits and vegetables
  • Legumes
  • Low-fat dairy, if tolerated (if not, include other sources of calcium and vitamin D)
  • Gluten-free whole grains (be sure to select only those specifically labeled gluten-free)
  • Lean protein
  • Nuts and seeds
  • Healthy fats

For detailed guidelines and recommendations, read our comprehensive guide to the gluten-free diet by food category.

Guidelines for a Healthy and Balanced GFD

It’s important to remember that no one food or food group is better than another. However, you can get more nutrition in each bite by choosing “nutrient-dense” foods most of the time. Here are some general ideas to remember.

  • Eat more foods rich in vitamins, minerals, and/or phytonutrients. Phytonutrients are natural chemicals or compounds produced by plants. They can help support a healthy body.

  • Eat fewer foods with higher amounts of sodium (salt), saturated fat, added sugars, and refined grains. Thankfully, the FDA’s ban on artificial trans fats took effect in 2018, so these harmful fats have effectively been removed from the US food supply.

  • Ease up on the processed gluten-free foods, such as muffins, cookies, and cakes. These may be higher in calories, fat, sodium, and sugar, but also lower in fiber, vitamins, and minerals.

  • Make your GFD heart-healthy by reducing fat and sodium, eating a variety of fruits and vegetables, including lean protein such as chicken, fish, beans, and legumes, eating less red meat, and choosing healthy fats such as olive oil.

  • Select labeled gluten-free whole grains such as amaranth, millet, quinoa, and brown rice (note: white and brown rice do not need to be labeled gluten-free).

  • The Mediterranean diet is based on many of these principles and is also easily adapted to be GF. For more information, read our guide about combining the Mediterranean diet and the gluten-free diet.

  • Balance your calorie intake with your physical activity to manage your weight. View activity guidelines for all age groups.

Nutrition Guidelines by Food Group

Water/Fluid Intake

Staying healthy also requires staying hydrated, so make sure you drink enough water. A general recommendation is 6 to 8 (8 oz) glasses of water or other beverage that is low in sugar, such as tea, coffee, milk, or lactose-free beverage such as gluten-free rice, soy or almond milk (labeled gluten-free).

Water needs vary for each person and are based on many factors, including the weather, activity levels, medical conditions, fiber intake, and certain medications or supplements. Check with your doctor or registered dietitian to determine the right amount of water/fluid intake for you.

Important Nutrients on the GFD

A healthy, balanced diet provides all of the nutrients needed for a healthy body. However, those with CD should pay special attention to specific nutrients that may be lacking, or to help correct deficiencies that may be occurring. The biggest nutrients of concern are fiber (discussed above), iron, calcium, vitamin D, and B vitamins.

Can’t I Just Take a Supplement?

Gluten-free multivitamin/multi-mineral supplements, as well as calcium, vitamin D, omega-3, and other supplements, are often an important part of the nutritional therapy for someone with celiac disease. These may be recommended by your doctor or registered dietitian based on your age, gender, lab values, current diet, and past medical history. Discuss what, if any, supplements are most appropriate for you with your doctor or registered dietitian.

Limit Your Intake of Sweets and Salt

There is no end to the variety of gluten-free candies, cookies, pies, sweets, sodas, and drinks with added sugar available. Try to fill most of your diet with healthy, nutrient-dense foods and keep calorie-dense sweets to a minimum. This can help avoid unwanted weight gain. Get some ideas here on how to build a healthy, gluten-free snack.

  • Keep your salt/sodium intake reasonable by flavoring home-cooking with herbs and spices that do not contain salt. Try to choose lower sodium items when dining out.

  • Keep your salt intake at about 2300 mg/day. If you are African American or have diabetes, high blood pressure, or chronic kidney disease, or if you are over the age of 50, try to lower your sodium intake further to 1500 mg/day. You can find the exact amounts of sodium in foods by looking at the Nutrition Facts panel.

Take-Home Messages

  • Avoiding gluten is the most important first step toward health for someone with celiac disease. A balanced heart-healthy gluten-free diet can improve overall health and reduce the risk for chronic disease.

  • Consult with a registered dietitian skilled in celiac disease to be sure that your new diet contains appropriate amounts of required vitamins, minerals, and nutrients, specifically iron, calcium, vitamin D, B vitamins, and fiber.

  • Extra gluten-free vitamin and mineral supplements may be needed. Follow your physician or registered dietitian’s advice.

BIDMC Celiac Center Revision Date: December 28, 2021
Editors: Melinda Dennis, MS, RD, LDN, Dan Leffler, MD, MS