What foods should someone with celiac disease avoid?

Celiac disease is an immune-mediated condition in which ingestion of gluten damages the small intestine and interferes with nutrient absorption. Avoiding gluten completely is the primary treatment. Evidence-based guidance from Dr. Peter H.R. Green Columbia University and clinical resources from the National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health make clear that people with celiac disease must exclude wheat, barley, and rye from the diet and be vigilant about hidden gluten in processed foods.

Common gluten-containing grains
Wheat appears in many forms including spelt, kamut, durum, semolina, farro, bulgur, and einkorn; all should be avoided unless specifically labeled gluten-free. Barley is found in malt and malt flavoring used in candies, cereals, and some beers. Rye is present in many breads and some spirits. Triticale, a hybrid of wheat and rye, also contains gluten. Foods made from these grains — breads, pastas, pastries, many breakfast cereals, and baked goods — are the most obvious sources that must be eliminated.

Hidden sources and cross-contact
Gluten can appear where it is least expected. Soy sauce traditionally contains wheat; malt vinegar is derived from barley; broths, gravy mixes, ready-made soups, salad dressings, and processed deli meats can use gluten as a stabilizer or thickener. Beers brewed from barley and some flavored alcoholic beverages contain gluten. Oats themselves do not contain gluten but are often contaminated with wheat during growing, harvesting, or milling; many experts, including Dr. Joseph A. Murray Mayo Clinic, recommend certified gluten-free oats only after individual tolerance is established. Cross-contact in home and commercial kitchens — shared toasters, cutting boards, or fryers — can transfer traces of gluten and trigger symptoms and intestinal injury.

Relevance, causes, and consequences
For people with celiac disease, even small amounts of gluten can perpetuate villous atrophy in the small intestine, causing diarrhea, abdominal pain, weight loss, anemia, and long-term complications such as osteoporosis and increased risk of certain malignancies if untreated. The immune response to gluten is distinct from wheat allergy or non-celiac gluten sensitivity; specialists emphasize strict lifelong avoidance. Regular follow-up with healthcare providers and dietitians experienced in celiac disease, as recommended by Dr. Peter H.R. Green Columbia University, supports nutritional adequacy and monitoring for complications.

Human and cultural nuances
Dietary change intersects with culture, tradition, and food availability. In regions where wheat is a culinary staple, removing gluten affects communal meals, religious observances, and food economies. Access to certified gluten-free alternatives varies by territory; rural or low-resource areas may rely on naturally gluten-free staples such as rice, maize, cassava, millet, quinoa, and legumes. Environmental considerations include supply chains and shared agricultural or milling infrastructure that increase the risk of cross-contact. Clear food labeling, education, and culturally sensitive meal planning help people with celiac disease maintain health while preserving social and culinary traditions.