Living Gluten-Free: Hidden Gluten and Daily Choices

Most hidden gluten is controlled by kitchen habits and label reading.

• Read the ingredients every time, even for products you have bought before, because recipes change. Look for wheat, barley (malt), rye, spelt, semolina, farina, couscous, bulgur and freekeh. In Saudi Arabia and the Gulf, allergen statements and “gluten-free” claims follow SFDA/GSO labelling rules; ask SFDA or the manufacturer if unsure, as not all products are tested.
• Prevent cross-contact at home: use a separate toaster or toaster bags, separate butter, jam and tahini jars (no double-dipping knives), clean boards and pans, cook gluten-free food first, and keep gluten-free flour away from wheat flour.
• Eating out: tell staff clearly that you have coeliac disease (not a preference), ask about shared fryers, grills and flour dusting, and choose simple grilled dishes. Avoid buffets where spoons are shared. If unsure, do not eat it.
• Do not rely on “wheat-free”, “no added gluten” or “natural” as meaning gluten-free. Look for “gluten-free” wording or a recognised certification.
• Travel and Hajj/Umrah: pack safe snacks, carry a short card in Arabic and English explaining your diet, and ask about meals in advance.

Naturally gluten-free foods are the foundation of a healthy gluten-free diet; the sections below focus on where gluten hides. Ask for a dietitian experienced in coeliac disease at diagnosis and then regularly.

• Naturally gluten-free: rice, corn, potatoes, sweet potatoes, quinoa, millet, sorghum, buckwheat, amaranth, legumes (foul, lentils, chickpeas, hummus), fresh vegetables and fruit, plain meat, fish, eggs, plain dairy (laban, yoghurt, cheese), nuts, dates, olive oil, tahini. Choose these for most meals.
• Saudi and Gulf dishes that contain gluten: bread of all kinds (tamees, saj, samoon, pita, mutabbaq), samboosa and sambousek pastry, harees, jareesh, freekeh, bulgur and tabbouleh, couscous, maamoul, kunafa, luqaimat, basbousa, qatayef, mehalabiya with added flour, sobia (a Ramadan drink often made from barley or wheat), Arabic sweets with semolina, pasta, and wheat-based vermicelli (shaʿriyya) added to rice. Check vermicelli rice, which looks like plain rice but is not gluten-free.
• Hidden in sauces and seasonings: soy sauce (usually contains wheat), teriyaki, gravy, ready sauces, salad dressings, ketchup or mayonnaise in some brands, marinades, stock cubes and bouillon powder, flavoured or seasoned rice, some baharat or spice mixes with fillers, seasoned salt, curry paste, and bottled harissa or tomato pastes with thickener. Single-ingredient pure spices are usually safe; use them for cooking, or check mixes.
• Hidden in processed foods: sausages, burgers, nuggets and kofta with breadcrumbs or fillers, battered or fried foods (and food fried in shared oil, such as falafel, fries and chicken), canned soups, instant noodles, flavoured crisps and nuts, breakfast cereals with malt, chocolate or biscuit-coated sweets, imitation crab, ice cream cones and some flavoured yoghurts and milkshakes, flavoured instant coffee or hot chocolate mixes, and beer, malt drinks and some energy bars. Plain unflavoured Arabic coffee and tea are gluten-free, but check flavoured or instant mixes.
• Hidden in medicines and supplements: some tablets and capsules use wheat starch as a filler. Ask your pharmacist to check, and never stop a prescribed medicine yourself. Also check toothpaste, lip balm and communal items you may swallow.
• Gluten-free substitutes are not automatically healthier: many are lower in fibre and higher in fat and sugar. Prefer whole foods and fortified or wholegrain gluten-free products, and keep an eye on weight.
• Nutrients to watch: iron, folate, B12, vitamin D, calcium, fibre, zinc and magnesium. Take supplements only according to tests and advice; many gluten-free products are not fortified like wheat flour.
• Oats: use only products labelled gluten-free and introduce slowly with your doctor’s agreement; stop and report if symptoms return.

There is currently no approved medicine that replaces the gluten-free diet. Medicines are used for complications or deficiency.

• Iron, vitamin D, B12, folate, calcium and other supplements are given according to blood tests.
• Dermatitis herpetiformis may need a skin-targeted medicine from your doctor, in addition to the diet.
• Refractory coeliac disease, which is rare, may need steroids or immune-suppressing treatment from a specialist.
• Avoid “gluten-digesting” enzyme products as a substitute for the diet; they are not proven to protect the gut.
• Vaccination (including pneumococcal) is sometimes advised in long-standing coeliac disease; ask your doctor.

Tests are used to confirm diagnosis and to review the gut if symptoms persist.

• Gastroscopy with small bowel biopsy confirms diagnosis in most adults and may be repeated if symptoms or antibodies persist despite the diet.
• Bone density scan (DEXA) may be advised at diagnosis or later for those at risk.
• Capsule endoscopy or imaging is used when complications are suspected.