Living with Celiac Disease
Don’t let the gluten-free diet restrict your
cooking and baking; use it instead as an
opportunity to experiment with new ingredients
and flavors. Look for alternative ingredients
in your local ShopRite store or use the “Ask
the Dietitian” feature at
to submit a question or favorite recipe.
Visit the Live Right with ShopRite section
of for more information
and resources to help you manage a gluten-free
lifestyle or call our Customer Care Center:
1-800-ShopRite (1-800-746-7748)
July 2009
Choices for your Lifestyle
What is Celiac Disease?
Celiac disease (also referred to as celiac sprue, non-tropical sprue, and gluten-sensitive
enteropathy) is a digestive disease that is triggered by consuming a protein called
gluten, which is found in wheat, barley and rye. When people with celiac disease eat
foods containing gluten, their immune system
responds by damaging the fingerlike projections that
line the small intestine called “villi.” Damaged villi
make it nearly impossible for the body to absorb
essential nutrients into the bloodstream, which can
lead to malnourishment and a host of other problems
including cancer, osteoporosis, infertility, diabetes,
and the onset of other autoimmune diseases.
Managing a gluten-free diet doesn’t have to be a challenge.
If you are newly diagnosed, you may feel as though you have to give
up all the foods you love! But with a little education and effort, you
will learn that there are still many delicious foods you CAN eat.
There have been incredible improvements in gluten-free foods and
there are new products entering the marketplace everyday.
Nearly one out of every 133 Americans has celiac
A cross-section of the small intestine
disease, equivalent to nearly 1% of the U.S. population. showing the fingerlike villi lining
However, 97% of people with celiac disease remain
undiagnosed or misdiagnosed. Translated into numbers, this means that up to three million Americans have celiac disease and only about 100,000 know they have the condition.
Celiac disease is a genetic disorder, meaning that it
passes from parent to child via DNA. In some cases,
stressful events like pregnancy, surgery, infection,
or severe emotional distress can trigger the onset
of the disease.
In this guide you’ll find information about celiac disease,
symptoms, diagnosis, treatment with a gluten-free diet, safe and
unsafe grains, as well as tips and recipes for gluten-free living.
Symptoms of Celiac Disease
Celiac disease has a wide variety of symptoms that
often vary from person to person. Because there are
approximately 300 symptoms associated with the
disease, doctors often have difficulty diagnosing it
and, in some cases, misdiagnose people with other
digestive disorders such as irritable bowel syndrome.
Be sure to explore our aisles for all of the gluten-free
foods available to you at your local ShopRite. We can help
make your gluten-free diet easy and delicious.
Although the most commonly reported symptoms
are gastrointestinal, some people may experience
no intestinal issues and some people experience
no symptoms at all.
• Abdominal pain
• Bloating
• Gas
• Constipation
• Decreased appetite
(may also be increased
or unchanged)
• Diarrhea
• Nausea
• Bloody stools
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Living with Celiac Disease — A Guide to Managing a Gluten-Free Diet
• Anemia
• Fatigue
• Attention Deficit
Hyperactivity Disorder
• Infertility or pregnancy
• Bone and joint pain
• Itchy skin rash
(Dermatitis herpetiformis)
• Depression
• Enamel defects on teeth
• Fractures or thin bones
• Failure to thrive in childhood
(delayed growth)
• Migraine headaches
• Numbness in legs
• Osteoporosis or osteopenia
• Pale sore in mouth
Anyone who suffers from the above symptoms for several months should speak to
their doctor about the possibility of celiac disease being the cause. In all cases of celiac
disease, a delayed diagnosis can increase the risk of worsening symptoms, development
of new symptoms and other complications.
Diagnosis of Celiac Disease
To determine if a person has celiac disease, a physician can screen by using an antibody
test, genetic test or a small intestine biopsy. Although there are three options, the only
definitive test is the small intestine biopsy.
Treatment of Celiac Disease: A Gluten-Free Diet
To date, there are no medications or surgeries that can
cure celiac disease. The only treatment is a gluten-free
diet. People with celiac disease must avoid all foods
that contain wheat, rye and barley.
The gluten-free diet is a lifelong commitment for
people with celiac disease. Eating any amount of gluten,
no matter how tiny it is, can cause damage to the villi
of the small intestines and prevent the absorption of
essential nutrients.
A physician will typically recommend that a newly
diagnosed celiac disease patient consult with a registered dietitian. These professionals can help someone
with celiac learn how to plan a healthy and wellbalanced gluten-free diet. They can also help people
network with local celiac support groups.
Most people who strictly follow a gluten-free diet will
experience relief of symptoms within a few days, although it will take up to six months
for the small intestine to heal in children and up to two years to heal in adults.
A small number of people will continue to experience symptoms even when following a glutenfree diet. This is called unresponsive celiac disease and generally occurs when the small intestine
has been severely damaged by celiac disease. According to the National Institutes of Health,
researchers are currently working to develop a drug therapy to treat people with unresponsive
celiac disease.
How to Live with Celiac Disease
Eliminating all foods made with wheat,
rye and barley from the diet can seem overwhelming when a person is first diagnosed,
but with a little extra effort in the kitchen,
people with celiac disease can eat delicious
food that tastes just as good as their
glutinous counterparts.
1. Accept that you have celiac disease. The
first step towards managing a successful gluten-free diet is accepting the fact that your
health depends on it. Keep in mind that you are finally on the road to becoming healthy.
Having a positive attitude will make managing the diet a much easier task.
2. Schedule an appointment with a registered dietitian. As soon as you receive a celiac
disease diagnosis, you should ask your doctor for a referral to see a registered dietitian.
Studies show that repeated visits with a dietitian, who is experienced with a gluten-free
diet helps with diet compliance and positive outcomes.
3. Learn which foods contain gluten. Gluten is a protein found in all forms of wheat,
rye, and barley. You will also need to familiarize yourself with hidden sources of gluten.
4. Learn how to read food labels. It is important
to always read the labels of prepared, canned, and
packaged foods to be sure they are
gluten-free. Plain meat, poultry, fish, fruits and
vegetables are all naturally gluten-free, as are
rice, potatoes, corn, quinoa, sorghum, millet,
and teff.
5. Research gluten-free manufacturers. As
more people are diagnosed with celiac disease,
the gluten-free marketplace will continue to
expand with better tasting products on our shelves.
6. Prevent cross-contamination at home. Learning to prevent cross-contamination is
key to maintaining a gluten-free diet. This means separating gluten-free products from
other items in your pantry and washing all cooking surfaces and equipment before
preparing gluten-free foods.
7. Educate your family. You must educate your family about the gluten-free diet and
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Living with Celiac Disease — A Guide to Managing a Gluten-Free Diet
Living with Celiac Disease — A Guide to Managing a Gluten-Free Diet
how to prevent cross-contamination. Remind your family
not to share utensils, pots and pans, toasters and other
cooking items without thoroughly washing them. For
example, teach your family not to dip a knife in peanut
butter that has already touched a piece of bread.
8. Attend local celiac support group meetings. These
meetings can help you to learn more, plus they are a great
opportunity for sharing cooking tips as well as your
favorite gluten-free recipes.
9. Schedule annual follow-up appointments with your
doctor. To make sure you are adhering to the gluten-free
diet, schedule annual exams to receive the celiac antibody
test. If your blood test comes back normal, it will confirm
that you are maintaining a completely gluten-free diet!
Build the base of your diet around healthy
and naturally gluten-free foods such as
plain meat, fish, poultry, fruits and
vegetables, as well as rice, potatoes,
corn and quinoa.
A first and simple step is to look for dishes
that need very little customization, perhaps
just the substitution of one gluten-free
ingredient for one that is not gluten-free.
For example, make macaroni and cheese
Quinoa (pronounced “keen-wha”) is a delicious and
or baked ziti with rice, corn, or lentil pasta, nutritious whole grain!
or prepare enchiladas with corn tortillas
instead of the wheat flour variety.
The following grains and ingredients should not be consumed as they are derived from
wheat, barley or rye:
Matzo meal
Malt flavor
Gluten is often found in places you would never suspect. Below is a list of common
items that can contain gluten:
Lip balm
Dairy substitutes
Hydrolyzed protein
Imitation seafood
Lunch meats
Modified food starch
Play dough
Soy sauce
Bouillon cubes
Brown rice syrup
Rice mixes
Self-basting turkey
Vegetables in sauce
French Fries
Seasoned tortilla
chips/potato chips
Chicken, beef,
vegetable Broths
Over-the-counter and
prescription medications
Keeping a Gluten-free Kitchen
Malt vinegar
Oats in their natural form do not contain the gluten protein.
However, most mills that produce and store oats also
manufacture wheat, making the chances of cross contamination
inevitable. In addition, current research shows that approximately
1%–5% of celiac sufferers react to oats in their pure form.
Although the cause for this reaction is unknown, some literature
suggests that a protein in oats can trigger a similar response to
There is no way to determine if you will react, so the best advice
is to proceed with caution and consult with your doctor or a
registered dietitian. Oats in their natural, pure form that are
produced in a gluten-free facility can be enjoyed by most people with celiac disease.
Gluten-Free Safe Substitutes
If you don’t use the correct substitutes when replacing wheat flour in gluten-free recipes,
your cookies may come out of the oven flat and tasting like rubber.
Below is a list of the most useful gluten-free flours that can be substituted in recipes
that call for wheat flour. For best results, use these flours in combination with other
gluten-free flours — they are not intended to be used individually as a one-to-one
substitute for wheat flour. If you can’t find an item in your local ShopRite, stop by the
customer service desk or give us a call at 1-800-ShopRite (1-800-746-7748) and we’ll
do our best to help you locate it.
Almond Meal Flour is made from whole almonds that have been finely ground into a
powder. It is used in cookies, cakes and other desserts. Be sure to store almond meal
flour in the freezer.
Amaranth has a very high protein and fiber content and adds a nutty flavor to glutenfree baked goods. It is most commonly used in combination with other flours to make
breads, pasta, pancakes and other recipes.
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Living with Celiac Disease — A Guide to Managing a Gluten-Free Diet
Living with Celiac Disease — A Guide to Managing a Gluten-Free Diet
Buckwheat is a grain-like ingredient but it has no relation
to wheat and is therefore gluten-free. Buckwheat is used
throughout Europe to make pancakes and serves as a fantastic alternative for gluten-free cooking, especially when
used to make breakfast cereal and lower calorie gluten-free
breads. When being used as a replacement for wheat,
buckwheat is best used in combination with other glutenfree substitutes. It is only recommended for replacing up
to half of the wheat flour content in any recipe.
Coconut Flour is a delicious and healthy alternative flour
that has a high fiber content. It provides a natural sweetness and added moisture to baked goods. When being used
as a replacement for wheat, coconut flour is best used in
A delicious stack of buckwheat combination with other gluten-free substitutes. It is only
pancakes with fresh fruit
recommended for replacing up to one-quarter of the wheat
flour content in recipes.
Cornstarch is made by grinding up the starchy portion of a corn grain and turning it into
a very fine powder. Cornstarch is typically used as a thickening agent, such as for soups,
sauces and stews. It is also used in pre-made gluten-free flour blends because it creates
a smoother texture. When using cornstarch in place of wheat flour, use one-and-onehalf teaspoons cornstarch for every tablespoon of flour.
Garbanzo Bean (chickpea) Flour — All bean flours, are high in protein and fiber content.
As opposed to rice, tapioca, and potato flours, bean flours more closely mimic the
texture of white flour when used in baked products.
Guar Gum is made from guar beans and has eight times the thickening ability of corn
starch. It works well for thickening sauces and is often used to make gluten-free breads.
Guar gum is to be used as a binding agent only in combination with gluten-free flour
substitutes. Use one teaspoon of guar gum for each cup of flour called for in the recipe.
be refrigerated. As with white rice flour, it is best to combine brown rice flour with several
other flours to avoid the grainy texture. Ener-G Foods and Bob’s Red Mill produce a finer,
lighter brown rice flour that works well with dense cakes such as pound cake.
Xanthan Gum is used to add volume or fluffiness to gluten-free bread and other baked
goods. It is made from Xanthomonas and is a natural carbohydrate. Like Guar gum,
Xanthan gum is to be used as a binding agent only in combination with gluten-free flour
substitutes. Use one teaspoon of xanthan gum for each cup of flour called for in the
• For gravy: Use arrowroot starch or cornstarch as a thickener.
• For stuffing: Make your favorite recipe with gluten-free
cornbread or gluten-free white bread (homemade or
store-bought) or experiment with rice stuffing.
• For flouring or breading meat and fish: Try cornmeal, potato
flakes or mixtures of gluten-free flours, seasoned to taste.
To create a gluten-free coating, whirl some dry, gluten-free
bread or corn tortilla chips in a food processor until fine. Or,
some people enjoy crumbled gluten-free waffles or crisped
rice — these are not usually sweetened and, when seasoned,
create a tasty, crunchy coating.
• For pudding and pie filling: Try gluten-free starches such as
cornstarch, potato starch, tapioca or arrowroot.
Cornmeal is great for breading
meat or fish!
• Find a prepared gluten-free baking mix to keep handy in your refrigerator. These tried
and true mixtures of gluten-free flours, starches, and leavening agents can usually be
substituted with wheat flour on a one-for-one basis.
• Use rice flour for a roux or white sauce — you will find that bean and soy flours have
too strong a taste.
Potato Flour is made by grinding potato roots and subsequently removing the fibrous
material. Potato flour is most commonly used to thicken sauces and is generally
included in gluten-free flour blends because it adds moisture to baked goods.
Sorghum Flour is a millet-like grain and adds a strong flavor to gluten-free baked goods.
Add in about one-eighth cup to enhance the flavors of breads, cookies and cakes.
Tapioca Flour can add chewiness to baked goods, and is wonderful thickening agent.
Tapioca flour is known for being one of the more flavorless gluten-free flours, so it
won’t affect the taste of your dish.
Brown Rice Flour is milled from unpolished brown rice and has a higher nutrient value
than white rice flour. Since this flour contains bran it has a shorter shelf life and should
Living with Celiac Disease — A Guide to Managing a Gluten-Free Diet
Reprinted with permission from Carol Fenster, author of 1,000 Gluten-Free Recipes (Wiley,
2008) and Gluten-Free Quick & Easy (Avery, 2007).
Rice Flour Blend (#1)
3 cups brown rice flour
1-1/4 cups potato starch or cornstarch
3/4 cup tapioca flour
Brown rice flour blends should be
Bean Flour Blend (#2)
2 cups potato starch or
1-2/3 cups garbanzo/fava flour
2/3 cup tapioca flour
2/3 cup sorghum flour
Store your blend in an airtight
container in a dark, dry place.
These flour blends may be used cup for cup as a substitute for all-purpose wheat flour
in your favorite recipes.
Living with Celiac Disease — A Guide to Managing a Gluten-Free Diet
• When traveling, pack staple, nonperishable, gluten-free grain
foods, such as cereal, bread, rice cakes, and crackers.
low fat dairy
fruits & vegetables
• When eating at other people’s homes, offer to bring a
gluten-free dish everyone can enjoy.
• The safest choices will be foods without sauce, breading,
marinades, or gravies.
• Before going to a restaurant, call ahead to speak with the
manager. Explain your dietary restrictions and discuss the
restaurant’s menu options.
• Since cross-contamination is a concern ask how food is prepared and if it is prepared
with the same oil or on a the same surface as foods containing gluten. If so, ask that
a portion of the surface or grill be cleaned prior to your meal preparation.
The growing number of gluten-free products available in stores provide great alternatives to their gluten containing counterparts. However, some gluten-free products may
be more processed and lack much needed nutrients like fiber, calcium, and iron. These
gluten-free foods should be seen as “once-in-a-while” foods leaving room for the bulk
of your diet to come from naturally gluten-free foods. A healthy gluten-free diet should
focus on all food groups; including low fat dairy, fruits and vegetables, lean protein,
and of course gluten-free whole grains.
Gluten in Medications
Although people with celiac disease are generally focused
on the food they eat, it is important to remember that it is
possible to be exposed to gluten when taking medication.
Gluten is used in many medications as a binder to hold
the pills together. There are currently NO requirements for
labeling gluten or common allergens that may be found in
drug ingredients, so it is important to always check with the
manufacturer to make sure that the particular medication
you are taking is indeed gluten-free. To learn more about
the inactive ingredients in medications, you can download a short flyer from the
NFCA website (
• Choose pre-packaged deli meats and cheeses to avoid cross-contamination that may
occur from deli slicers.
gluten-free whole grains
Living with Celiac Disease — A Guide to Managing a Gluten-Free Diet
Gluten-free Recipe
lean protein
Prep time: 15 minutes
Cook time: 20 minutes
4 boneless, skinless chicken
breast halves
3 tbsp. chopped onion or shallot
2 tbsp. chopped celery
1 cup cooked wild or brown rice
1/4 cup chopped dried apricots
3 tbsp. chopped pecans
1/2 tsp. dried thyme leaves
1 tbsp. finely chopped pecans
1. Preheat oven to 375°F. Place chicken
on clean work surface. Cut pocket in side
of thick portion of meat, not cutting all
the way through.
2. Spray small nonstick skillet with
nonstick cooking spray and place over
medium-high heat. Add onion and celery.
Cook and stir until
onion is tender. Stir in
wild rice, dried apricots,
pecans, thyme and
pepper to taste. Cook
and stir until hot.
Stuff each chicken
breast with filling; fold
chicken to enclose filling. Place chicken
breasts in shallow baking pan.
3. Sprinkle evenly with finely chopped
pecans to coat. Bake 15 to 18 minutes or
until thermometer in stuffing registers
at least 165°F.
Serves 4
Per serving: 247 calories, 17g carbohydrate, 30g protein, 2g fiber, 7g fat,
1g saturated fat, 68mg cholesterol,
81mg sodium
Living with Celiac Disease — A Guide to Managing a Gluten-Free Diet
Gluten-free Meal Ideas
Here are a few ideas for preparing healthy,
gluten-free meals:
• Grilled London Broil with baked potato
and steamed green beans
• Grilled Portabella mushrooms, drizzled
with olive oil and balsamic vinegar,
served with a mixed green salad
Gluten-free Recipe
• Omelet prepared with chopped veggies,
gluten-free toast and fresh sliced fruit
such as melon
• Asian-style Chicken
and Broccoli over brown
rice (check marinades
to ensure they are
• Plain yogurt with fresh berries and
ground flax seeds
• Oatmeal (gluten-free) or another
gluten-free, whole grain cereal with
fresh sliced apples, cinnamon and
a touch of brown sugar
3 bananas
1 egg
1/2 cup of brown sugar
1/4 cup of white sugar
1/4 cup of oil
1/2 cup of skim milk
1/2 teaspoon of vanilla
1/2 cup of potato starch
1/2 cup of cornstarch
4 teaspoons of baking powder
1 teaspoon of guar gum
1/4 teaspoon of baking soda
1/4 teaspoon of salt
1/2 cup of dried flake coconut
(either sweetened or unsweetened)
Preheat oven to 350°F. In a large mixing
bowl mash bananas. Add egg, brown
sugar, oil, milk/yogurt, and vanilla. Beat
until no lumps appear. Add potato starch,
cornstarch, baking powder, guar gum,
baking soda and salt. Beat until no lumps
appear. By hand stir in coconut. Pour into
• Gluten-free toast topped with peanut
butter and banana
loaf pan or line muffin tins. Bake bread
for about 40 minutes and muffins for 30
minutes, until a toothpick inserted in the
middle tests clean. Allow to cool briefly
before removing from the pan.
Serves 12
Per Serving: 180 calories, 6g fat,
1.5g saturated fat, 0g trans fat, 15mg
cholesterol, 230mg sodium, 33g carbohydrates, 19g sugar, 1g fiber, 1g protein.
• Green leafy salad
topped with fresh
veggies, canned tuna
fish, sliced hardboiled
egg and low-fat dressing
• Quinoa salad, Mexican style, prepared
with frozen corn and black beans.
Top with grilled chicken strips
• Turkey or Roast Beef Sandwich —
prepare with gluten-free, whole grain
bread and pre-packaged Black Bear
gluten-free deli meats
• Gluten-free frozen meals
• Chili with whole grain, gluten-free
corn chips
• Hearty minestrone soup with chickpeas
or gluten-free pasta (be sure the broth
is gluten-free)
• Gluten-free tacos or wraps filled with
any of these: fish, beans, ground turkey
breast, low fat sour cream, salsa,
avocado, or lowfat cheese
• Lasagna or ziti using gluten-free pasta
and low fat cheeses
• Risotto: primavera or seafood (make
sure canned broth is gluten-free)
• Yogurt parfait — use
plain yogurt and mix
with fresh fruit and
gluten-free, whole
grain cereal
• Celery topped with peanut butter,
then sprinkle with raisins.
• Air-popped Popcorn
• Fresh vegetables such as carrots,
celery and broccoli with hummus
or gluten-free dip
• Low-fat chocolate milk
• Fresh or dried fruit
• Edamame
• Gluten-free trail mix
• Broiled salmon (or fish of choice) over
brown or wild rice with fresh or frozen
• Rice cake with melted lowfat cheese
and tomato
• Lowfat corn chips and salsa
Living with Celiac Disease — A Guide to Managing a Gluten-Free Diet
Living with Celiac Disease — A Guide to Managing a Gluten-Free Diet
Gluten-free Products at ShopRite
Listed below are a few of the gluten-free brands and product lines available at ShopRite.
For a complete listing, visit the Live Right with ShopRite section of
If you can’t find an item in your local ShopRite, give us a call at 1-800-ShopRite and
we’ll do our best to help you locate it.
Amy’s frozen entrees
Al Fresco sausages
Annie’s Naturals dressings
Applegate Farms deli meats
and cheeses
Arrowhead Mills baking
mixes and cereals
Nature’s Path cereals and
snack bars
Gefen cookies
Newman’s Own snacks
Genisoy snacks
Notta Pasta
Gillian’s Food cooking
and baking mixes
Nu World Foods
Glenny’s snacks
Bakery on Main granola
and snack bars
Glutano breads, cookies,
pasta, and sweets
Bionaturae pastas
Gluten-free Pantry
baking mixes
Bob’s Red Mill baking mixes
and cereals
Chebe baking mixes
Glutino pasta, entrees,
snack bars, and sweets
Ore-Ida Golden Crinkle fries
Pacific Natural Foods
beverages, soups
Pamela’s Products cookies
and baking mixes
Panderos Delights cookies
Perky’s cereal
Golden Valley beef jerky
Rice Dream beverages
Hodgson Mills
baking mixes
Roland crackers
Dr. Praeger’s frozen entrees
Hol-Grain crackers,
bread crumbs
Southern Homestyle
cooking mixes
Eat Smart Chips
Honest Kids beverages
Soy Joy snack bars
Eden canned beans
Ian’s frozen entrees
Ener-G cooking/baking
mixes and snacks
Kinnikinnick Foods breads,
cookies, baking mixes, and
Spectrum Naturals
Chex rice cereal
Conte’s frozen pasta
DeBoles pasta
Enjoy Life granola,
cookies, and snacks
Envirokidz cereals,
snack bars
Erewhon cereal
Fantastic Foods soup,
rice, and dip mix
Fearn Baking Mix
Foods Should Taste Good
Kozy Shack puddings
and desserts
Seeds of Change dressing
Tinkyada pasta
Lifestream waffles
Tribe of Two Sheiks
Flavorganics extracts
Food For Life breads
Mi-Del cookies
Foods by George pizza,
breads, muffins, and
Mrs. Leeper’s pasta
Nasoya tofu
Nature’s Highlights
pizza crust
The NFCA website offers free,
comprehensive information and support
materials for celiac patients, their families
and health care professionals.
Tabatchnick soups
Tribe hummus
Mary’s Gone Crackers
The National Foundation for Celiac Awareness
is a non-profit organization made up of medical
specialists, professionals, and industry leaders
— all dedicated to working with leading
researchers to better understand celiac and to
find a cure. NFCA is a leading resource for celiac
information and the only organization with a
nationally focused celiac awareness campaign.
Success rice
Larabar snack bars
Lundberg Family Farms
entrees, baking mixes,
About NFCA
Van’s waffles
Wholesoy & Co yogurt
Wholly Guacamole
Wolfgang Puck broth
Yoplait yogurts
Zensoy beverages
Zhena’s Gypsy Tea
assorted teas
Living with Celiac Disease — A Guide to Managing a Gluten-Free Diet
Contact Information
Main: 215-325-1306
Media/Press: 215-325-1306 x.103
Philadelphia Office:
P.O. Box 544, Ambler, PA 19002