Celiac Disease Living with a gluten-free diet
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Celiac Disease Living with a gluten-free diet englisch
What is celiac disease? Diagnosis
Celiac disease is a lifelong chronic disease of the small intestine caused by A reliable diagnosis is crucial due to the numerous changes that celiac disease
the body’s inability to properly digest gluten. Gluten is found primarily in grains, can mean for one’s lifestyle and health. A blood test for transglutaminase
such as wheat, spelt, rye, barley and oats. The food we eat is broken down antibodies, endomysial antibodies and gliadin antibodies provides the first
by in small intestine into its components and the nutrients are absorbed into significant indication of celiac disease. However, a final and definite diagnosis
the body through the mucous membrane in the small intestine. The intestine of celiac disease can only be made by the patient undergoing a biopsy of the
is lined with numerous folds, called “villi”, and these villi absorb the nutrients. small intestine.
In those affected by celiac disease, ingesting gluten leads to an auto-immune
reaction of the intestine’s mucous membrane, namely, villi degeneration. This Today’s endoscopic biopsies of the small intestine are usually safe and last no
causes the surface of the small intestine to become enflamed and increasingly longer than 10 – 15 minutes. During the procedure, a camera positioned on a probe
smaller and flatter preventing the mucous membrane from adequately absorb- is inserted through the mouth, esophagus and stomach into the small intestine.
ing sufficient nutrients. Malnutrition can develop as a result. Several tissue samples are taken and then microscopically analyzed. The blood test
alone cannot replace a small intestine biopsy. A stool test also does not provide a
reliable and definite diagnosis.
Symptoms Treatment
Only a strict, lifelong gluten-free diet can ensure the restoration of the flattened
The most frequent symptoms in children and adults are: and damaged villi to their normal state and maintain proper functioning of the
mucous membrane. Even the smallest amount of gluten causes damage to reoccur!
Bloated or bulging abdomen
Below normal body weight As a rule, as long as a gluten-free diet is strictly maintained, the person affected
Weak musculature by celiac disease can live a normal symptom-free life. Since this is the only treat-
Anemic paleness ment for celiac disease, the persons affected must fundamentally change their diet
Abnormal and/or frequent stools, diarrhea and likely also their lifestyle. The good news is that in most cases, a noticeable
Vomiting improvement occurs within only a few days of eliminating gluten: general well-
Irritability, tearfulness being increases and digestion problems decrease. However, the amount of time
Loss of appetite it takes to be completely symptom-free can vary greatly, depending on the degree
Delayed growth in children of damage to the intestine, the age of the individual involved and any initial (often
Burning tongue, feeling of fullness concealed) errors in nutrition.
Flatulence, nausea, diminished appetite
Muscle spasms (tetany) and bone pain (ostealgia)
Increased risk of bleeding
Subjective freedom from symptoms when the diet is not
Sallow or pasty skin maintained does not mean that a gluten-free diet should be
Nervousness, depression abandoned.
Deficiencies in tooth enamel
Often, definite symptoms of a gluten-containing diet will reappear after a very
long time, sometimes even years later. Long-term consequences of discontinuing a
gluten-free diet can lead to serious diseases which, by then, are usually incurable.Tips for beginning Fish/canned fish/fish products/frozen fish
Fried herring, fried rolled herring, breaded products, surimi
As a member of the DZG (German Celiac Society), you will receive comprehensive
informational material or you can view it online in our members’ area. Please read Meat products/German sausages
through the “List of Gluten-Free Foods” carefully along with the general information Breaded or floured pieces of meat, semmelwurst (sausage made
in Part 1 of the list. Go through the lists of products to determine whether your with bread crumbs), grützwurst (a type of sausage made with groats),
favorite products are gluten-free and what alternatives may be available. Check mehlwurst (sausage made with flour)
the contents of your kitchen cabinets and pantry: you should immediately get rid
of all foods that definitely contain gluten. Meat replacement
Seitan, Wheatys®, Vegarita®
Please check the food list beforehand for items that may contain gluten. An alter-
native from another company is often to be found in the food list for these rejected Drinks
products! Coffee substitute (surrogate), barley malt coffee, grain coffee from
Oats and products derived from oats which have not been contaminated with gluten-containing grain, commercially available beer, malt beer
gluten-containing cereals can be consumed in the framework of a gluten-free
diet providing that no complaints or symptoms arise as a result of consumption. Milk/dairy products/milk products
Yogurt with gluten-containing cereal additives
Good to know: Just 1/8 gram of wheat flour can damage the
small intestine and can lead to discomfort.
Remember this symbol as well; it indicates that the
product is gluten-free. 2. Gluten-free foods that are safe to consume
Grain products and food containing starch *
Specific notes on individual Amaranth, buckwheat (knotweed, it is not a wheat) , millet (teff/sorghum),
corn (popcorn), quinoa, rice (incl. wild rice), potatoes, chestnut flour,
food groups chickpea flour, mung bean starch, soy, tapioca (tapioca starch/manioc
flour/cassava), grape seed flour, sago from manioc – from the marrow of
the sago palm
In this section, we would like to provide you with an overview of lists of foods
containing gluten (1) and gluten-free foods (2) and make you aware of what foods * Please read the “Special notes on possible gluten additives”,
(3) may contain gluten additives. especially the potential contamination risk.
Baking/thickening/binding agents
1. Foods that always contains gluten and should be strictly Carrageen (E 407), carob seed flour (E 410), gelatin, guar flour (E 412),
avoided kuzu (kouzu), pectin (E 440), arrowroot starch / maranta starch),
tragacanth (E 413), xanthan (E 415)
Grain products/bread and baked goods/pasta
Wheat, rye, barley and oats in all forms (e.g., flour, groats, semolina, Spreads
flakes, farina, bran, germ, bulgur, couscous), also durum, unripe spelt Marmelades, jellies, confitures, pure syrups, honey, maple syrup
grain, spelt, einkorn, heirloom corn, emmer, kamut, triticale and other
wheat derivatives, tempura flour, sago from barley or wheat, udo noodles, Eggs
as well as somen noodles from wheat Eggs Vinegar Nuts/seeds
All types of vinegar without seasoning or herbal additives, fruit vinegar, All unprocessed almonds and types of nuts as well as peanuts, sunflower
vinegar essence, red wine vinegar, white wine vinegar, balsamic vinegar, seeds, pumpkin seeds, linseeds, poppy seeds, sesame seeds, pine nuts
Aceto Balsamico
Canned food (fruit/vegetables/pickled foods)
Fish/canned fish/fish products/seafood Canned foods in which only the fruits and/or vegetables, water and sugar,
Unbreaded fresh or frozen, unseasoned fish glucose syrup and/or salt are listed in the ingredients
Fish canned in its own juice and oil
Mussels, crabs, scampi, crabmeat, shrimp and oysters (fresh or frozen) Milk/dairy products/milk products
All plain dairy products, such as milk, yogurt, buttermilk, soured milk, whey,
Meat products/sausages clabber, kefir, cream (also canned whipped cream), condensed milk, coffee
Fresh or frozen, without breading, unseasoned pieces of pork, beef, veal, cream, milk froth, crème fraîche, sour cream (also German schmand), quark,
poultry (incl. oat-fed goose), lamb, venison, entrail meat cream cheese, mascarpone, cottage cheese, fruit yogurt, fruit buttermilk,
fruit soured milk, fruit whey, fruit clabber and fruit kefir without malt and/or
Meat replacement grain additives
Lupine protein and tofu (soy-based)
Fruit
Vegetables All types (fresh), frozen fruit without additives
All types (fresh), all green salads, all raw vegetables, frozen vegetables
without additives Cooking fats/oils
Oils, pure vegetable fats, butter, margarine, concentrated butter
Drinks
Coffee (also instant/freeze-dried coffee), all types of (mineral) water, Tomato puree/mayonnaise/mustard/horseradish
pure black, herbal, green and fruit teas (without vitamin and flavor Tomato puree from tomatoes and salt, mayonnaise, mustard from mustard
additives), pure cocoa powder, pure fruit juices (100 % pure juice), fruit seeds and salt, horseradish from radishes and salt
nectar, fruit syrup wine, champagne, Prosecco, unfermented fruit juice,
cider schnapps, clear spirits, brandy, fruit brandy, rum, arrack, gin, grain, Sugar
cognac, tequila, vodka All types of sugar (household, powdered, candied, brown sugar), gelling
sugars 1:1, 1:2 or 1:3, natural glucose, fructose, caramel
Seasoning/seasoning mixtures
All individual seasonings (salt, pepper, paprika, etc.) and herbs, as well as
mixtures of pure seasonings (seasoning mixtures), glutamate/monosodium
glutamate (E 620 – 625)
Legumes 3. Foods that can contain gluten as an additive, but might not
All types (peas, beans, lentils, chickpeas, kidney beans, peanuts, etc.)
Baking/thickening/binding agents
Cheese Baking powder, sal volatile/Harts horn/ammonium carbonate, fresh yeast,
Natural cheeses such as Emmental (Swiss), Gouda, Edam, Tilsit, Lindenberger dried yeast, organic yeast, couverture, glazes, icing, vanilla sugar, flavors,
Grünländer, Parmesan etc. (also in grated and / or diced form), plain cream cream stabilizer, colored gelatin
cheese, mozzarella in brine, sheep cheese, natural goat cheese, feta in brine Spreads Cheese/cheese preparations/cream cheese
Spreads, nut-nougat creams Cheese imitations, light cheeses, Roquefort, German hand cheeses,
cream cheese, herb cheese, cooking cheese, processed cheese, herb
Desserts cream cheese, mold cheeses (blue cheese, gorgonzola, etc.)
Pudding, mousse
Snacks/nuts/seeds
Ice cream/ice cream powder/ice cream ingredients Poppy seed and nut baking mixtures, trail mix, chips/crisps, puffs, sticks,
All types of ice cream candied products, products with coating (e.g., toasted almonds, glazed
apples)
Vinegar
Herb vinegars, vinegars with seasoning and herbal mixtures, malt vinegars Confectionery/chocolate/pralines
(barley malt) Chocolate bars, candy bars, chocolate products, filled chocolate, wafers,
bonbons, chewing gum, licorice
Fish/canned fish/fish products/seafood
Canned fish with sauces and seasonings, muscles, crabs, scampi, crab Canned food (fruit/vegetable/pickled food)
meat, shrimp and oysters in sauces or seasonings, sushi Canned food with information such as flavoring, preservatives,
flavor enhancers, seasonings, acidifiers and light/diet products
Meat products/sausages
Seasoned meat products, all sausages (also ham), kebab meat (Döner) Milk/dairy products/milk products
Light/diet products, yogurt products, cream cheese products,
Drinks quark products, reduced-fat products
Flavored coffee & coffee pads, as well as some flavored teas, cocoa drinks
and milk drinks, cappuccino drink powder, fruit or vegetable juices with Mustard/ketchup/mayonnaise/horseradish
fiber and / or malt additives, sodas, isotonic drinks, liqueurs, whisky, Ketchup, salad mayonnaise, remoulade, mayonnaise cream, horseradish
mulled wine, punch and mustard with seasoning and herbal additives
Cereal products/bread and baked goods/pasta Cooking fats/oils
Cornflakes, buckwheat bread, millet noodles, etc. Oils with seasoning and herbal additives, herb, garlic and seasoned butter,
reduced-fat products, diet products
Seasonings/seasoning mixtures/flavor enhancers/spices
Spice preparations, seasoned salt, herb flavoring, seasonings, Dried fruits
seasoning mixtures, seasoned sauces, curry powder (mixed spices), Contamination possible due to “floured” conveyor belts
French fry seasoning
Seasoned sauces
Legumes Soy sauces, fish sauces, chutneys
Dishes from (canned) legumes
Sugar/sweeteners
Potato products All artificial sweeteners (powder, tablets, liquid), flavored glucose,
Pommes frites/French fry products, dried potato products, mashed flavored gelling sugar, gelling agents, flavored sugar sticks, etc.
potato products, products from pre-formed potato dough (croquettes,
gnocchi, potato noodles...), fried potato products (potato pancakes,
hash browns), potato dumpling products (dumplings), potato snack
products (chips, crisps, sticks etc.)Special notes on possible
gluten additives
Yeast
Organic yeast (fresh yeast cubes, dried yeast) should be avoided for safety It is possible that ham is rubbed with a mixture of wheat and water to prevent or
reasons in gluten-free food, since wheat and/or wheat germ can serve as a delay it drying out ( cut off the rind).
medium here.
Regarding imported meat products or while on vacation, please note that there
Ice cream are often ingredients used that are not listed on the package, in stark contrast
The use of materials with stabilizing, thickening or emulsifying agents is typical to German standards. The countries of the European Community are required
in the production of ice cream and ice cream products. Therefore, it must be to indicate whether an imported or exported packaged product contains gluten
assumed that gluten-containing components and / or wheat starch is contained additives in the ingredient list.
in commercial ice cream. This applies to all types of ice cream (soft ice cream,
packed ice cream, ice cream parlors). The basic material data for the production With products produced abroad and then packaged in Germany, the country of
of ice cream are also available online this year at http://www.dzg-online.de or origin is not always evident.
upon written request for members.
When purchasing loose goods, it is often not possible to request the necessary
Fish information from sales personnel at the counter.
Be careful with sushi! It may have gluten-containing additives (e. g. surimi). The
risk of contamination can not be excluded due to the preparation of food on
a board. Sushi rice can be contaminated with gluten through seasoning with When you buy fresh sausage, specifically ask about:
gluten-containing soy sauces. The noodles offered in sushi bars / restaurants
are frequently fried; the same cautionary measures apply here as with all Gluten-containing additives and binding agents
commercial fried foods, i.e., from a restaurant. Gluten-containing seasoning mixtures
Gluten-containing pickling additives (brine)
In many sushi bars / restaurants, an appetizer soup is typically offered, which Cutter process aid (aid, which must be used when cutting
contains miso (fermented barley) and contains gluten. Many of the seafood meat into small pieces)
soups offered often also contain surimi (contains gluten). Color stabilizers
Flavor enhancers
Meat products/sausages
Ready to cook, prepared meat products or instant prepared meat products often
contain starch, bread crumbs, grain products and/or pasta as additives. Also, Mention the term ‘gluten’. Have the manufacturer name the additives used (sea-
some types of sausages, which are originally produced in accordance with soning vendor, etc.) and compare these with the companies named in the food
commercial and location usage, contain bread crumbs, groats and other grain list. Or send a product request to the branch office. We will be glad to contact
products, e. g. German grützwurst (contains groats), semmelwurst (contains your butcher.
bread), and mehlwurst (contains flour). German regulations regarding meat
processing allows starch and vegetable protein to be used in the production of
meat products. Grain, fruit, and vegetable additives are also permitted. The use of
these additives in packaged goods must be indicated on the package in connec-
tion with the trade name or evident in the list of ingredients.Grain/bread and baked goods/pasta Seasoned sauces
If you do not buy your grain as a dietetic gluten-free product, please think about The majority of commercially available soy sauces are industrially manufac-
possible contamination. For your own safety, only buy whole grains (rice, corn, tured, since traditional production is very time-consuming and cost-intensive.
millet, buckwheat, quinoa, etc.). Then please examine them for foreign sub- Depending on the type of soy sauces, up to 50 % or more contain a grain or
stances before processing, sort and clean carefully – see also “Contamination grain-based additive. The “Tamari” type is 100 % soy. Gluten-containing grain is
risk in the household”. added to the “Koikucki sho-yu” and “Shiro sho-yu” types.
Gluten can sometimes be found in the designation “Maize/corn, rice, buckwheat We recommend selecting fish sauce or chutney using the current “List of
bread”, if it is not marked as a dietetic gluten-free product. Non-dietetic soy gluten-free foods”, since different ingredients can be used with regard to the
bread often contains only about 10% soy. basic ingredients depending on the consistency.
Millet and buckwheat noodles for general consumption are also, as a rule,
not gluten-free. Somen (Asian noodles) are manufactured from buckwheat or
wheat flour. Fermented gluten-containing grain is not gluten-free. Gluten-con-
Contamination in the household
taining grain does not lose its celiac irritants through the germination process
(e.g., Essene bread/manna, living bread and bread drink). In addition to choosing gluten-free foods, the storage and preparation of this food
is of special importance in preventing contamination with gluten in the household,
Legumes in particular when cooking gluten-free foods at the same time as gluten-contain-
Contamination by other grains is possible; therefore carefully inspect the ing foods for unaffected family members.
legumes for foreign substances before use. Often, gluten-containing types of
grain (rye, barley) can be used as climbing aids in legume cultivation. Therefore, Work surfaces/working tools/cooking utensils
check the individual products based on the current list of gluten-free food and Before starting to work, the work surfaces, cookware, baking pans, baking sheets,
read the manufacturer’s information. egg beaters, cooking spoons, etc. must be carefully cleaned. Please be careful that
cleaning cloths, dish towels and hand cloths are free of gluten (flour dust, etc.).
Potato products
Many fast food chains and quick-service restaurants often use the same fryer Wooden work tools (cutting boards, rolling pins, cooking spoons, etc.) should
for preparing French fries / chips / pommes and other gluten-free fried foods that only be used for gluten-free preparation, since cleaning is difficult as flour can
are also used for frying gluten-containing foods. In our annual request, we have get stuck in the scratches and grooves. Furthermore, it is best to (hand) wash all
appealed to due diligence and indicated possible contamination sources in such utensils diligently and / or to use a dishwasher.
preparation. For your own safety, please ask the service personnel about the
preparation methods on your next visit to a fast food restaurant. Bread and cake baking pans, baking sheets, and bread machine inserts can be a
different color or marked with stickers to distinguish those used for gluten-free
Confectionery baked goods. Baking paper, wax paper, or aluminum foil is also ideal for covering
Malt is often used in the manufacture of confectionery (e. g., barley malt). baking sheets and baking pans.
Chocolate products, chocolate with fillings or wafers can also contain
gluten. Massive amounts of chocolates can be manufactured with the It is recommended that gluten-free products be stored above gluten-containing
addition of malt. products (on higher shelves) to avoid contamination through falling crumbs, etc.
Caramel coloring is gluten-free. It is a food coloring approved for human
consumption. It is produced from heating sucrose or other types of sugar Keep gluten-free ingredients such as flours and baking ingredients (baking
together with acid. powder, yeast, sesame, poppy seeds, etc.) well packaged (e.g., in plastic
containers, cans, jars with screw tops) and separate from gluten-containing
foods.Basic documents
Grains
If you do not buy your gluten-free grain specifically labeled as a dietetic, gluten- Upon joining the society, members receive a comprehensive information
free product, please be aware of possible contamination. For your own safety, you package that includes the current annual list of gluten-free foods and
should only buy whole grains (rice, maize/corn, millet, quinoa, amaranth, etc.). Be pharmaceuticals. These lists are updated quarterly. You also receive these
sure to spread it all out on a flat plate before processing to look for foreign objects, updates, together with our newsletter, “DZG Aktuell” (German Celiac Society
then sort and carefully clean. Today).
If you grind the grain yourself, take care that only gluten-free types are ground in
the grain mill and / or the attachment for the food processor in order to prevent con-
tamination. For the aforementioned reasons, it is not recommended that gluten-
Members magazine
free grain be processed in the mills of health food shops, whole food shops, etc.
Current information on celiac disease appears regularly in the members magazine,
Upon purchasing a grain mill (stone mill), it must be ensured that the mill is used DZG Aktuell. Medical articles and information on gluten-free nutrition, holiday tips,
for the processing only gluten-free grains, so that it is “ground in“ exclusively with innovations in gluten-free products, restaurant tips, invitations and reports on DZG
gluten-free types of grain. events, as well as reports and dates of discussion group meetings are published
here.
Bread and baked goods
Always keep gluten-free bread and baked goods separate from food contain-
ing gluten (cover with foil or pack in bags). Contamination by gluten-containing
products is excluded by purchasing extra bread baskets/an extra toaster used
exclusively for gluten-free rolls/baked goods. Alternatively, a so-called “Toasta-
Discussion groups/
Bag” can be used. This is a re-usable foil bag, in which gluten-free toast can be
prepared without risk of contamination. “ToastaBags” are also ideal for vaca-
contact persons
tion and other trips.
We have many members who volunteer as contact persons and are a first impor-
Cooking pasta tant contact point in for all newly diagnosed persons throughout Germany.
When cooking noodles containing gluten at the same time for unaffected family
members, you must use separate cooking pots and also different cooking spoons Baking courses
for stirring. It is recommended that the gluten-free noodles be drained and rinsed Many of our contact persons also organize baking courses, in which the handling
well with cold water (prevents them sticking together) and arranged in its own of gluten-free flour can be practiced. The baking courses also enjoy great popular-
bowl. ity with all members as a meeting place for those affected.
Leisure time activities for children, youths and adults
Membership DZG Volunteers regularly organize recreational activities, city tours or hiking
weekends to promote contact and exchange of experience between the mem-
bers.
The annual membership fee for the Deutsche Zöliakie Gesellschaft e.V. (German
Celiac Society) is EUR 45.00 per calendar year. New members are charged a
one-time administrative fee of EUR 15.00. Additional family members who are
also members of the DZG are charged a flat rate of EUR 3.00 per calendar year.
We will grant a reduction in the membership fees for those with especially low
income upon receiving submitted proof of income.What does the DZG offer?
Detailed informational material on celiac disease
The current “List of Gluten-Free Foods”
The current “List of Gluten-Free Pharmaceuticals”
The current version of the members magazine “DZG Aktuell”
A comprehensive recipe collection
The health resort and holiday director “Sorglos Reisen” (Carefree
Travel) with addresses of restaurants, hotels and health resorts that
offer a gluten-free menus
“Request to the cook” card in German and several other languages in
the practical credit card size for your wallet
The celiac passport
The “DZG Medizin” (German Celiac Society Medicine) journal
Members also receive the address of the contact person living in their region. In
addition, the DZG offers their members a medical consultation over the phone
and a phone consultation regarding nutrition.
For more information, please contact us.
Issued by:
Deutsche Zöliakie-Gesellschaft e.V.
Kupferstraße 36
70565 Stuttgart
Germany
Photos: iStockphoto/Ozoneimages/Photocase · 2014
Telefon: 0711 / 45 99 81-0
Fax: 0711 / 45 99 81-50
www.dzg-online.de
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