Beyond Gluten Free

Coping with multiple diet restrictions

The gluten-free diet alone presents daily dietary challenges. The picture is even more complicated when the gluten-free diet is coupled with other dietary restrictions due to allergies, intolerances or other medical conditions.

Other diet restrictions beyond gluten free include:

  • Dairy/Casein/Lactose
  • Soy
  • Tree Nuts
  • Peanuts
  • Corn
  • Sugar
  • Fish and shellfish
  • Eggs

When someone who is gluten free also has to avoid one or more of these foods, a number of gluten-free choices are no longer options. For example, ice cream can be included in the gluten-free diet, but not a gluten-free/dairy free diet. Soy is found in broths, cheese and gluten-free soy sauce, making these foods normally allowed on the gluten-free diet off limits if you also have to avoid soy.

In general, there is no direct link between having celiac disease and another food allergy or intolerance. Since food allergies are very common and on the rise, celiac disease or gluten intolerance and another allergy sometimes just co-exist.

There is, however, a direct link between having celiac disease and lactose intolerance when first diagnosed. This usually improves after the gluten-free diet is started because the damaged villi in the intestine where the lactase enzyme is made begin to recover. This allows the enzyme production to resume and lactose, a milk sugar, is again digested in the gastrointestinal tract.

There is also a genetic link between celiac disease and type 1 diabetes. Patients with both conditions have to follow a gluten-free and diabetic diet.


When someone is allergic to a food, they have an immune system response to the protein found in that food that can range from skin rashes to gastrointestinal upset to life-threatening respiratory distress, called an anaphylactic reaction. Tests can determine if someone is allergic to a particular food.

A food intolerance does not involve the immune system but can cause a variety of symptoms that can affect the skin, respiratory tract, and gastrointestinal system. There is no test for food intolerances, and they are often diagnosed through the use of a food diary that tracks foods consumed and reactions.

Parents of children with autism are using a gluten-free/casein free diet in an attempt to treat this developmental disorder. There are widespread anecdotal reports of success, though scientific studies have not yet found a direct link between diet and improvement in symptoms.


In recent years, a number of products that are both gluten and allergen free have become available. In addition there are numerous cookbooks and websites that address diets that go beyond being gluten free. Gluten-Free Living also features information about other dietary restrictions in every issue of the magazine.

(This material is not intended to provide medical advice, which should be obtained directly from a physician.)

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