Gluten-Free Quickstart#
Medical Disclaimer
This guide is for informational purposes only. It is not medical advice. Read the full disclaimer.
Going gluten-free for DH is different from going gluten-free for general health. For DH, strict means strict — even trace amounts of gluten can trigger flares. Here's how to get started.
What contains gluten#
Gluten is a protein found in:
- Wheat (including spelt, kamut, farro, durum, semolina, einkorn)
- Barley (including malt, malt extract, malt vinegar)
- Rye
- Triticale (wheat-rye hybrid)
Common foods that contain gluten#
- Bread, pasta, cereal, crackers, cookies, cakes, pastries
- Beer (barley-based)
- Soy sauce (most brands contain wheat)
- Many sauces, gravies, and soups (flour as thickener)
- Breaded or battered foods
- Many processed foods (check labels)
Foods that are naturally gluten-free#
- Rice, corn, potatoes, quinoa, buckwheat (despite the name), millet, sorghum
- All fresh fruits and vegetables
- All fresh meat, poultry, and fish (unprocessed)
- Eggs, dairy (plain)
- Beans, lentils, nuts, seeds
Hidden gluten sources#
These catch many people off guard:
| Source | Why |
|---|---|
| Soy sauce | Most contain wheat. Use tamari (wheat-free) or coconut aminos. |
| Oats | Often cross-contaminated with wheat during milling. Only use certified gluten-free oats. ~5% of DH patients react to even pure oats. |
| Malt flavoring | Derived from barley. Found in many cereals and snacks. |
| Communion wafers | Traditional wafers contain wheat. Low-gluten options exist. |
| Medications | Some use wheat starch as an excipient. Check with your pharmacist. |
| Supplements | May contain gluten as a filler. Look for "gluten-free" on the label. |
| Shared cooking equipment | Toasters, cutting boards, colanders, fryers used for both GF and regular food |
| Restaurant kitchens | Shared prep surfaces, fryer oil, pasta water steam |
| Lipstick and lip balm | Can be ingested. Check ingredients. |
| Play-Doh | Contains wheat. Relevant if you have children. |
Deep dive: GFD Implementation Science covers the 20ppm standard, cross-contamination science, and more
The 20ppm standard#
Foods labeled "gluten-free" must contain less than 20 parts per million (20ppm) of gluten. This threshold was set based on research showing that most celiac patients can tolerate this level without intestinal damage.
However, DH patients may be more sensitive than the 20ppm standard accounts for. Some research suggests that even "gluten-free" products at the upper end of this threshold could cause issues for sensitive individuals.
Practical implications#
- Look for certified gluten-free products (GFCO, CSA, or equivalent) — these are tested to stricter standards
- "Wheat-free" is not the same as "gluten-free" — a product can be wheat-free but still contain barley or rye
- When in doubt, choose naturally gluten-free whole foods over processed "gluten-free" products
First week action plan#
Day 1: Clear your kitchen#
- Remove all gluten-containing foods (or designate a separate shelf/area)
- Get a dedicated toaster for GF bread
- Get dedicated cutting boards, colanders, and wooden spoons (porous materials absorb gluten)
- Clean shared cooking surfaces thoroughly
Day 1-3: Stock up on basics#
- Rice, potatoes, certified GF oats (if tolerated)
- Fresh produce, meat, fish, eggs
- Certified GF bread, pasta, and snacks for convenience
- Tamari or coconut aminos (soy sauce replacement)
- Naturally GF grains: quinoa, buckwheat, millet, corn
Day 3-7: Establish routines#
- Read every label, every time — ingredients change
- Learn which restaurants have reliable GF options
- Download a GF scanning app (e.g., Yummly, Fig)
- Tell family and close friends — you'll need their cooperation
Eating out#
Restaurant meals are the highest risk for cross-contamination. Strategies:
- Call ahead and ask about GF preparation procedures
- Avoid deep-fried foods unless there's a dedicated GF fryer
- Simple is safer — grilled meat/fish + vegetables + rice is lower risk than complex dishes
- Ask about sauces — many use flour as a thickener
- Dedicated GF restaurants are the safest option when available
Cross-contamination at home#
If you share a kitchen with gluten-eaters:
- Dedicated GF toaster (non-negotiable)
- Separate butter/condiment jars or use squeeze bottles (no double-dipping knives)
- Clean surfaces before preparing GF food
- Separate sponges for GF and regular dishes
- Label GF items clearly in shared spaces
- Cook GF food first before making gluten-containing food
About oats#
Most DH patients can tolerate certified gluten-free oats. However:
- Conventional oats are frequently contaminated with wheat during growing and milling
- About 5-8% of celiac/DH patients react to the oat protein avenin itself, even in pure oats
- Introduce cautiously — try small amounts of certified GF oats and monitor for several weeks before making them a regular part of your diet
Oat safety data: Cross-Reactivity & Triggers
What about the US vs. European wheat?#
Some patients report tolerating bread in Europe but not in the US. This is a real phenomenon with several possible explanations — different wheat varieties, different processing methods, different gluten content. However, if you have DH, you need to avoid wheat everywhere. The immunogenic gluten proteins are present in all wheat varieties.
Full analysis: GFD Implementation Science
Nutritional considerations#
A strict GFD can lead to nutritional gaps. Work with your doctor to monitor:
- Iron — gluten-free diets can be lower in iron
- Fiber — many GF products are low in fiber
- B vitamins and folate — often reduced on GFD
- Vitamin D — DH patients are frequently deficient due to malabsorption
- Zinc — often low in DH patients
- Calcium — important if intestinal absorption is impaired
Next steps#
Learn about triggers beyond gluten that can affect your DH: