Before reading this page, take this short quiz.

No one food or food group is superior to any other. Choose a variety of "nutrient-dense" foods, which are rich in vitamins, minerals, and/or phytonutrients. This variety includes fruits, vegetables, plain nuts, plain seeds, dried beans, legumes, labeled gluten-free whole grains, lean meats, fish and chicken, and low-fat or fat-free dairy products.

Minimize the foods containing "empty calories." Empty calories come in non-nutritious foods such as sodas, candy, "junk" food, many baked goods, desserts, and alcohol.

Following these basic nutrition guidelines can help you feel great as well as lower your risk for chronic diseases such as diabetes, cardiovascular diseases, and certain cancers. 1

It is important that your gluten-free diet is heart-healthy. In order to make it heart-healthy make sure that your diet:

  • Is low in fat and sodium.
  • Has a variety of fruits and vegetables.
  • Includes lean proteins, such as chicken, fish, beans, and legumes.
  • Has a limited amount of lean red meat.
  • Incorporates labeled gluten-free whole grains such as brown rice, amaranth, millet, and quinoa.

Consult with a 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.

Click here for information on cooking with beans, peas, lentils, and chickpeas which are all very high in nutrients and fiber. 
Please note this is a generic handout that includes some recipes with wheat and/or gluten. 

Healthy Eating Recommendations Specific to Celiac Disease:

  • Grains: Consume the recommended number of servings (6-11 servings) from the gluten-free grain food group each day. The number of servings will depend on your energy (calorie) needs. 2Visit www.choosemyplate.gov/supertracker-tools/supertracker.htmlto estimate your own individual calorie needs and track them. 

    Consume at least half of your gluten-free grain servings each day from whole grain sources. 3 

    Whenever possible, choose products made from labeled gluten-free whole grains and flours, such as teff, millet, brown rice, amaranth, buckwheat, and quinoa which are good sources of iron, fiber, and B-vitamins. 2 

    Choose enriched and/or fortified, gluten-free products over refined, unenriched products whenever possible. 2 Enriched products, such as bread, cereal and baking mixes have defined added amounts of the B vitamins thiamin, riboflavin, niacin, and folic acid, and iron. 

    HEALTH TIP: To find out if a product is enriched or fortified, look for the words "enriched" or "fortified" on the box or look for added vitamins and minerals, such as thaimin, riboflavin, niacin, folic acid, and iron in the ingredient list.
  • Fiber: Your fiber needs vary based on your gender, age and medical conditions. Speak to your dietitian or doctor to discuss your individual fiber needs. 

    FIBER RECOMMENDATIONS (DAILY REFERENCE INTAKE)
    Age (years) Gender Fiber (grams per day)
    14-50 Male 38
    19-50 Female 25
    >50 Male 30
    >50 Female 21
    All ages Pregnant female 28
    All ages Lactating female 29

    Reference: Reprinted with permission from “Dietary Reference Intakes: Recommended Dietary Allowances and Adequate Intakes, Total Water and Macronutrients,” 2011, by the National Academy of Sciences, Courtesy of the National Academies Press, Wash, DC. http://www.nap.edu/catalog.php?record_id=13050. 
    Accessed November 30, 2012.

    Glass waterSPECIAL NOTE: 
    If you are not used to eating a lot of fiber, slowly increase your intake of gluten-free whole grains (in 1/2 cup cooked portions) and other high fiber foods. Remember to drink plenty of water as you add fiber to your diet. 

  • B-Vitamins: (thiamin, riboflavin, niacin, B6, folic acid, B12) 
    Gluten-free whole grains, enriched bread, pasta, baking mixes, and fortified cereals, as well as non-grain sources, 2will help you meet your B vitamin requirements. 
    FOOD SOURCES OF B VITAMINS:
    PLEASE NOTE: ALL GRAINS AND FLOURS SHOULD BE LABELED "GLUTEN-FREE."
    B Vitamin Food Source
    Thiamin (B1) Millet, teff, brown rice, enriched or fortified gluten-free grains and flours, lean pork, legumes (garbanzo beans, lentils, pinto beans, soy beans, and black beans), nuts, cantaloupe, honey dew, orange juice
    Riboflavin (B2) Quinoa, millet, enriched or fortified gluten-free grains (such as enriched yellow corn grits), meat, eggs, low-fat dairy products, legumes, nuts, green leafy vegetables (spinach, kale, collard or mustard greens, asparagus, and cabbage), mushrooms
    Niacin (B3) Brown rice, buckwheat groats, millet, wild rice, enriched or fortified gluten-free grains and flours, lean pork, beef, poultry, fish, legumes, and seeds (sunflower, pumpkin, or sesame seeds)
    Pyridoxine Hydrochloride (B6) Meat, fish, poultry, bananas, avocado, potatoes, sunflower seeds
    Folate (B9) Amaranth, buckwheat groats, yellow/enriched corn grits, legumes, fruit juices, and green leafy vegetables
    B12(cobalamin) Fish, shellfish, meat, poultry, eggs, dairy products, fortified gluten-free cereals, fortified gluten-free soy milk

    Reference: Thompson T, et al. Gluten-free diet survey: are Americans with coeliac disease consuming the recommended amounts of fibre, iron, calcium and grain foods? J Hum Nutr Diet, 2005;18(3):163-69; Higgins L. Whole Grains = Nutritional Gold. In Real Life with Celiac Disease: Troubleshooting and Thriving Gluten-Free . Eds. Dennis M, Leffler D. AGA Press, Bethesda, MD, 2010; http://www.glutenfreediet.ca

  • Iron: Iron is needed to produce red blood cells, to protect against damage to our cell membranes and for many other functions in the body. It is important to have sufficient, but not excess, iron in your diet. 

    There are two kinds of dietary iron. Heme iron, the iron source from red meat, fish and chicken, is the most readily absorbed. Iron sources from some vegetables and fruit, dried beans, and gluten-free grains are called nonheme iron and are less well-absorbed. Incorporating vitamin-C rich foods, such as citrus fruit (oranges, lemons), strawberries, and green, red, and yellow bell peppers, into the same meal as your iron-rich foods will increase iron absorption. 1 

    This chart lists food sources of iron and the recommended iron intake per day for women and men.
    GLUTEN-FREE FOOD SOURCES OF IRON DIETARY REFERENCE INTAKE
    Beef, pork, lamb (choose meats that are lean)

    Green leafy vegetables: spinach, asparagus, broccoli, collard greens, mustard greens, kale, turnip greens, parsley, cabbage

    Fortified foods: rice, corn grits, uncontaminated/labeled gluten-free oatmeal and fortified cereals

    Salmon, shrimp, tuna, oysters, clams, most kinds of seafood

    Most kinds of legumes: lima beans, kidney beans, navy beans, soy beans, chick peas, pinto beans, black-eyed peas

    Grains: labeled gluten-free, such as teff, amaranth, quinoa

    Nuts/seeds: plain almonds, cashews, walnuts, sunflower seeds, sesame seeds or tahini, pumpkin seeds

    Dried fruits: apricots, raisins, dates (not rolled in flour), prunes, figs

    Turkey, chicken, egg yolks
    8mg/day (males >18 years old and females > 50 years old

    18mg/day (females 19-50 years old)

    Reference: Decher N, Parrish CR. Balanced and Delicious: A Healthy Gluten-Free Diet. In Real Life with Celiac Disease: Troubleshooting and Thriving Gluten-Free . Eds. Dennis M, Leffler D. AGA Press, Bethesda, MD, 2010.

  • Calcium and Vitamin D: Damage to the small intestine from celiac disease may interfere with calcium and vitamin D absorption. Although individual needs vary, you should consume about 1,200 mg (milligrams) of calcium and 1,000 IU (international units) of vitamin D per day 1from diet and supplements combined. 

    Calcium: Primary sources of calcium include fat-free or low-fat milk, yogurt, cheese, and cottage cheese. 
    Click here for a chart of calcium and vitamin D-rich food sources. 

    Gluten-free low lactose and lactose-free dairy products and/or nondairy sources of calcium and vitamin D are available for those who are lactose intolerant. 2 Visit the section on Lactose Intolerancefor lactose-free and low lactose food sources. 

    Basic Rule of Thumb for Calcium: Consume three servings of low-fat or non-fat gluten-free dairy foods or non-dairy alternatives each day. 2Three servings will provide ~900mg of calcium. The rest of your calcium intake can come from smaller amounts of calcium found in other common foods. Check the chart below for additional sources of calcium. Talk to your doctor about starting a gltuen-free calcium supplement with vitamin D if you are not meeting your needs. 

    HOW TO COUNT CALCIUM INTAKE FROM THE NUTRITION FACTS LABEL: 
    Read the nutrition facts for the percent daily value of calcium for the serving size. 
    Take off the percentage sign and add a zero to the number to find out how many milligrams (mg) per serving of calcium are in your food. 

    For example, if your nutrition facts label says it has 30% of the US daily value of calcium per serving then it has 300 mg per serving.
  • Vitamin D: Vitamin D is found most commonly in dairy products, particularly milk. However, few foods, other than fortified milk, contain vitamin D in significant amounts. It's usually hard for people to get their vitamin D needs from food sources alone. Use the chart below to check for additional sources of vitamin D. 

    Basic Rule of Thumb for Vitamin D: Count up your dietary sources of vitamin D and the vitamin D in your gluten-free multivitamin/mineral supplement or any other supplement that may contain vitamin D. If you are not meeting your vitamin D needs, talk to your doctor about starting a calcium supplement with vitamin D, or a separate vitamin D supplement. 

    Click to download these helpful PDFs:

  • Protein: Among many other important functions in the body, protein helps to heal the lining of the small intestine from the damage done by untreated celiac disease. Most healthy adults require 0.8 - 1.0 grams of protein per kilogram of their body weight daily. For example: 

    A 140# (63.6 kg) female should aim for~51 grams of protein each day. 
    140/2.2 (pounds to kilogram conversion) = 63.6 kg 
    63.6kg x 0.8 grams/kg = 50.9 grams protein 

    To give you an idea of what this looks like: 
    51 grams is equivalent to:
    • one-half cup of chopped, cooked skinless chicken breast (21 grams)
    • one-quarter cup of low-fat cottage cheese (7 grams)
    • 1 medium egg (6 grams)
    • one cup of non-fat milk (8 grams) and
    • one-half cup cooked lentils (9 grams).

    Since protein needs are based primarily on weight, gender, medical condition, and amount of exercise, it is recommended to ask a dietitian to help you determine your individual protein needs for the day. Special populations, such as endurance athletes, growing children and teenagers, pregnant women, people with malabsorption concerns, people on hemodialysis, or those with healing wounds, may have greater protein needs. 1 

    Make sure to include healthy protein sources in your diet, such as fish, lean poultry, lean pork, lean beef, eggs, and fat-free or low-fat dairy. The lean protein sources below are low in fat, and each provides 8-12 grams of protein per serving: 4 

    • 1 cup low-fat yogurt
    • 1/2 cup low-fat cottage cheese
    • 1 cup nonfat or low-fat milk or soy milk
    • 1.5 oz grilled or baked chicken, turkey, fish, pork, or lean beef

    There are also many vegetarian sources of protein. 

    HIGH PROTEIN GLUTEN-FREE VEGETARIAN FOODS
    Tofu
    Eggs
    Milk, gluten-free soy milk
    Yogurt, soy yogurt
    Cheese
    Quinoa, amaranth, buckwheat, teff, millet, sorghum (labeled gluten-free)
    Plain nuts, seeds
    Lentils, dried beans, chickpeas, soybeans, edamame (fresh soybeans)
    Tempeh*
    Vegetarian burgers*
    Vegetarian hot dogs*
    * Only a few of these products are gluten-free; check labels carefully.

    Reference: Decher N, Parrish CR. Balanced and Delicious: A Healthy Gluten-Free Diet. In Real Life with Celiac Disease: Troubleshooting and Thriving Gluten-Free . Eds. Dennis M, Leffler D. AGA Press, Bethesda, MD, 2010.

  • Fruits & Vegetables: Eat a variety of fruits and vegetables to get enough vitamins, minerals and antioxidants. 

    Eat at least 4 and 1/2 cups (9 servings) of a variety of fruits and vegetables (depending on your calorie needs) 3to ensure you are also getting enough vitamins A, C, and K, folate, fiber, magnesium and potassium. Choose whole fruits and vegetables, including fresh, frozen, canned (in its own juice) and in dried forms, rather than juice. When you drink juice, drink 100% juice and limit it to 1/2 cup per day. 

    NUTRIENT DENSE FRUITS AND VEGETABLES
    Safe and Nutrient Dense Safe but Less Nutrient Dense Questionable Avoid
    Vegetables:
    Carrots, tomatoes, broccoli, kale, spinach, bell peppers, asparagus, sweet potatoes*, yams*, winter squash*, summer squash, zucchini, low-sodium gluten-free vegetable juice
    Iceberg lettuce, cucumber, corn, potatoes Dried vegetables or vegetables in sauce or gravy; check labels for added ingredients Added ingredients, seasonings, or sauces containing gluten
    Fruits:
    Berries, apples, cherries, grapes, pomegranates, oranges, peaches, nectarines, plums, melons, bananas
    Dried fruit or fruit in sauce or pie fillings; check labels for added ingredients Dates rolled in oat flour

    * These vegetables are starchy and, thus, have more calories than the other vegetables listed. 

    Adapted from: Decher N, Parrish CR. Balanced and Delicious: A Healthy Gluten-Free Diet. In Real Life with Celiac Disease: Troubleshooting and Thriving Gluten-Free . Eds. Dennis M, Leffler D. AGA Press, Bethesda, MD, 2010.

    What's a serving size?

    • 1/2 cup fruit
    • Medium-sized piece of fruit (the size of a tennis ball)
    • 1/4 cup dried fruit
    • 3/4 cup (6 ounces) of 100% fruit or vegetable juice
    • 2 cups leafy vegetables (spinach, lettuce leaves, etc.)
    • 1 cup cooked or raw vegetables

  • Fats: Try to make healthy choices by: 

    • Reducing saturated fat intake

    Reduce saturated fat intake (fatty cuts of red meat, poultry with skin, and full-fat dairy such as whole milk, butter and cream) by choosing lean cuts of beef, pork, fish or poultry, and fat-free or low-fat dairy products. Consume less than 10% of your daily calories from saturated fats. 3 

    Keeping trans fatty acidintake as low as possible. Synthetic trans fats are found in oils that have been hydrogenated (chemically altered to a more solid form). They are called partially hydrogenated oils and can be found in some margarines, baked goods, and snack foods. 3 

    Getting enough of the heart-healthy omega-3 fats. 1
    Omega-3 polyunsaturated fatty acids are an important part of a "heart-healthy" diet. The three omega-3 fatty acids are eicosapentaenoic acid (EPA) , docosahexaenoic acid (DHA) , and alpha-linolenic acid (ALA). 

    The American Heart Association recommends eating a variety of oily fish at least twice per week to obtain the most heart-protective benefit from omega-3 fats and to reduce your risk for cardiovascular diseases. 5

    If you have been diagnosed with a cardiovascular disease or need to lower your triglyceride level, an increased intake of EPA and DHA (especially in the form of food) may be helpful. 

    The table below presents the best sources of EPA and DHA. Some farmed fish, such as farmed tilapia and catfish, may contain higher amounts of omega-6 (pro-inflammatory fatty acids) and lower omega-3 than wild-caught fish. 7, 8 However, in general, the differences in omega-3 content between farmed and wild-caught fish are negligible, and choosing any source of omega-3 rich fish, such as those listed in the table, is beneficial. 9


    TOP SOURCES OF EICOSAPENTAENOIC ACID (EPA) AND DOCOSAHEXAENOIC ACID (DHA)
    Fish EPA and DHA Content (g) per 3 oz. Serving Amount of Fish (oz.) Required to Provide 1g EPA and DHA
    Herring
    Pacific
    Atlantic

    1.81
    1.71

    1.5
    2.0
    Salmon
    Atlantic, farmed
    Atlantic, wild
    Chinook
    Sockeye

    1.09-1.83
    0.90-1.56
    1.48
    0.68

    1.5-2.5
    2.0-3.5
    2.0
    4.5
    Mackerel 0.34-1.57 2.0-8.5
    Sardines 0.98-1.70 2.0-3.0
    Tuna
    Fresh

    0.24-1.28

    2.5-12.0
    Halibut 0.40-1.00 3.0-7.5
    White (canned in water) 0.73 4.0
    Flounder/Sole 0.42 7.0
    Crab 0.35 8.5
    Shrimp 0.27 11.0

    Reference: Adapted from USDA Nutrient Data Laboratory. Available at http://www.nalusda.gov/fnic/foodcomp./.

    Be aware that certain types of fish (tilefish, swordfish, king mackerel, and shark) may contain significant levels of environmental toxins, such as mercury. The FDA recommends that children and women of childbearing age limit their consumption of these types of fish.

    For up-to-date information regarding the safety of fish and shellfish consumption, refer to the FDA and the Environmental Protection Agency Web sites ( www.fda.gov/Food/default.htm and www.epa.gov, respectively). 1

    Vegetarian Sources of Omega-3: Plant sources of omega-3 fats, in the form of ALA (Alpha-Linolenic Acid), are beneficial for heart health because your body has the ability to convert some ALA to EPA and DHA. EPA and DHA have the strongest effect on heart health. ALA is a good choice for vegetarians or others avoiding fish. 1

    TOP SOURCES OF ALPHA- LINOLENIC ACID (ALA)
    Food Serving Size ALA Content (g) per Serving
    Flaxseed Oil 1 TBSP. 8.5
    Walnuts, English 1 oz. 2.6
    Flaxseeds 1 TBSP. 2.2
    Walnut Oil 1 TBSP. 1.4
    Canola Oil 1 TBSP. 1.2
    Mustard Oil 1 TBSP. 0.9
    Soybean Oil 1 TBSP. 0.8
    Walnuts, black 1 TBSP. 0.6
    Olive Oil 1 TBSP. 0.1
    Broccoli, raw 1 TBSP. 0.1

    Reference: Adapted from USDA Nutrient Data Laboratory. Available at http://www.nalusda.gov/fnic/foodcomp./.

    Any fresh, plain, untreated fish or shellfish, nuts, seeds, or vegetable oils are safe choices for consuming omega-3 fatty acids. Commercially treated, preserved, or marinated fish or shellfish are questionable. Breaded or battered fish should be avoided, unless care was taken to ensure gluten-free preparation, such as using gluten-free breading. 1

    Alternatives and Supplements:

    • If eating fish is not for you, a gluten-free capsule containing 1 gram total of EPA and DHA is a reasonable substitute.
    • ALA-based supplements are available for vegetarians and vegans.
    • Consult with a dietitian or physician before using.
  • Sweets: Limit your intake of sweets and sugar-sweetened beverages. 

    There is no end to the varieties of gluten-free candies, cookies, pies, sweets, sodas and drinks with added sugar on the market. Loading up on healthy foods and keeping sweets to a minimum will greatly improve your overall health profile and help you avoid unwanted weight gain. Visit the Snacking Section for some healthy snack ideas. 

  • Salt: Monitor your salt/sodium intake. Crossed out salt shaker 

    Reduce sodium intake to less than 2,300 mg (milligrams) per day. If you are 51 years or older, or at any age if you are African American, or have hypertension, diabetes or chronic kidney disease, try to lower your sodium intake to 1,500mg/day. The 1,500mg recommendation applies to about half of the U.S. population. 

    Monitor salt/sodium intake by flavoring home-cooking with herbs and spices which do not contain salt or choosing low-sodium options when dining out. 

    For more ideas, visit: Dietary Guidelines for Americans: http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/Chapter3.pdf 

  • Water: Staying healthy also requires staying hydrated, so make sure that you drink enough water. 

    Glasses of watergeneral recommendation : Aim for 6-8 (8 ounce) glasses of water or other low sugar beverages, such as tea, milk or lactose-free beverages (gluten-free rice milk, almond, soy, hemp milk, etc.) per day. Water needs vary by person based on many factors such as fiber intake, exercise level, medical conditions, climate, certain medications and supplements, etc. Your doctor or dietitian can calculate the correct amount of water for you. 

  • Supplements: Gluten-free multivitamin/multi-mineral supplements, as well as calcium 3, vitamin D, omega-3, and other supplements, are very often an important part of the nutritional therapy for someone with celiac disease. They are recommended by clinicians based on your age, gender, lab values, current diet and past medical history. 

    Talk to your doctor or dietitian about a gluten-free multivitamin/multi-mineral supplement appropriate for your age and gender to supplement your diet.

Click here for a 15-page guide to the gluten-free diet by Food Category.

TAKE HOME MESSAGES:

  • A balanced gluten-free diet loaded with healthy foods can help you feel great, improve your overall health and reduce your risk for chronic diseases.
  • Consult with a 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.
  • A dietitian or physician can advise you about supplementing specific nutrients, as needed.
  • As you can see, having a balanced diet doesn't have to be complicated. Just follow these guidelines and you'll be on your way!

References:

  1. Decher N, Parrish CR. Balanced and Delicious: A Healthy Gluten-Free Diet. In Real Life with Celiac Disease: Troubleshooting and Thriving Gluten-Free . Eds. Dennis M, Leffler D. AGA Press, Bethesda, MD, 2010.
  2. Thompson T, et al. Gluten-free diet survey: are Americans with coeliac disease consuming the recommended amounts of fibre, iron, calcium and grain foods? J Hum Nutr Diet, 2005;18(3):163=69.
  3. USDHHS. USDA. (2010). Dietary Guidelines for Americans, 2010. http://www.cnpp.usda.gov/dietaryguidelines.htm. Accessed May 8, 2012.
  4. Health Canada. Nutrient Value of Some Common Foods. Tufts University School of Medicine, Harvard University, and USDA National Nutrient Data Bank, 1999.
  5. Kris-Etherton PM, Harris WS, Appel LJ, American Heart Association Nutrition Committee. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 2002;106:2747-57.
  6. Van Horn L, McCoin M, Kris-Etherton PM, et al. The evidence for dietary prevention and treatment of cardiovascular disease. J Am Diet Assoc 2008;108:287-331.
  7. Weaver KL, Ivester P, Chilton JA, et al. The content of favorable and unfavorable polyunsaturated fatty acids found in commonly eaten fish. J Am Diet Assoc 2008;108:1178-85.
  8. Hamilton MC, Hites PA, Schwager SJ, et al. Lipid composition and contaminants in farmed and wild salmon. Environ Sci Technol 2005;39:8622-29.
  9. He K, Song Y, Faviglus ML, et al. Accumulated evidence on fish consumption and coronary heart disease mortality: a meta-analysis of cohort studies. Circulation 2004;109:2705-11. 

    Revision Date: 11-6-12 
    Author: Melinda Dennis, MS, RD, LDN 
    Editors: Mary Kay Sharrett, MS, RD, LDN, CNSD and Daniel Leffler, MD, MS

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