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How to stay gluten-free during the holidays

The key to a gluten-free holiday is planning and clear communication, according to University of Minnesota Health Gastroenterologist Justin Howard, MD.
The key to a gluten-free holiday is planning and clear communication, according to University of Minnesota Health Gastroenterologist Justin Howard, MD.

For many families, the holiday food spread can be as important as seeing family, building community or observing religious traditions.

But that table full of gravy-laden meatballs, breaded casseroles and potatoes can be a minefield for people with celiac disease.

Celiac disease is a digestive disease that results from an immune reaction to gluten, which is a protein found in wheat, rye and barley. When someone with celiac disease eats gluten, it causes damage to their small intestine, which can lead to abdominal pain, nausea, chronic diarrhea, malnutrition and weight loss.

University of Minnesota Health Gastroenterologist Justin Howard, MD, who sees celiac disease patients at University of Minnesota Medical Center and Fairview Maple Grove Medical Center, is here to share his expertise and help make the holidays easier to digest.

What hidden sources of gluten should I watch out for during family gatherings?
Many celiac disease patients’ frustrations revolve around the foods they can or can’t eat during the holiday season. Obvious sources of gluten, such as pasta or bread rolls, are certainly no-nos. It’s easier to avoid those food items, but other foods—including casseroles, gravies, salad dressings and even soy sauces—may also contain gluten. You really have to do your homework and look at the ingredients, especially if you’re not hosting or cooking for the get-together. If you are cooking, you can find ways to be creative with your cooking ingredients. Use cornbread instead of wheat rolls or wheat-based stuffing. Or use gluten-free flour, beans, corn, nuts or potatoes. Some alcohols also contain gluten. Cocktails made with distilled alcohol are OK, but beer—unless it is gluten-free beer—should be avoided.

How can I communicate my dietary needs in a positive way to family members who may be skeptical?
You need to be politely assertive. Most of the misunderstandings regarding celiac disease come from a lack of knowledge about the condition. So you may have to provide a little education. Knowledge is power. If you are invited to a party, don't be afraid to reach out to the host ahead of time and inform them of the fact that you have celiac disease. Most hosts want everyone to enjoy the food they make. To make things easier, you can offer to bring a gluten-free dish. Focus on the positive things during the holidays, like the time you are able to spend with family and friends that you may not get to see the rest of the year; don’t just focus on the foods you can’t have.

Can I cheat on my gluten-free diet (just this once) for the holidays? What are the consequences?
People with celiac usually know from experience what happens to them if they cheat on their gluten-free diet. Will eating one cookie that contains gluten cause permanent damage? No. But it may make the next several hours uncomfortable. In the end, each person has to decide whether or not that cookie is worth it. A long-term solution may be ensuring that there are alternative options, such as desserts made with gluten-free flour. These may not taste as good as their gluten-containing counterparts, but they are getting better—as is the variety of options available for a gluten-free consumer.

What should I do if I have celiac disease and accidentally ingest gluten or am exposed to it?
If it does happen, you just have to take it easy and wait for the symptoms to resolve. The biggest factor for avoiding cross-contamination is to do your homework and plan ahead. Make sure that you have met with a dietitian to discuss a nutritionally balanced way to avoid gluten. The term “gluten-free diet” implies complete removal of gluten from the diet, but in reality this is not totally possible due to contamination of foods with trace amounts of gluten. “Gluten-free” therefore indicates a diet that contains gluten at such a low level as to be harmless. This exact level is not known for sure, but research suggests that ingesting less than 10 mg per day is unlikely to cause harm to most people with celiac disease. But again, this is why it is important to educate yourself as well as learn from personal experience.


What if I’m not sure if I have celiac disease? What are the symptoms? What are my next steps?
Symptoms of celiac disease can include nausea, abdominal pain after eating, bloating, diarrhea and weight loss. These symptoms are not specific to just celiac disease and can be due to other conditions. If you are worried that you may have celiac disease discuss this with your doctor who can discuss with you the appropriate evaluation. Your doctor may also decide to refer you to a gastroenterologist.

Our gastrointestinal team can meet with a patient, talk about all of their symptoms and then perform blood and endoscopic tests to help confirm the diagnosis. We work closely with the patients and dietitians to come up with a reasonable plan and diet regimen that is sustainable going forward, so that patients with celiac disease can live their lives symptom free.