



As a dietitian who both counsels patients with newly-diagnosed celiac disease and personally follows a strict gluten-free diet as the result of my own autoimmune shortcomings, I spend a lot of time scrutinizing diets for traces of unexpected gluten. My work involves scouring the margins of people's diets, from their medications and vitamins to favorite candies and protein powders, to root out even trace exposure to gluten. But until recently, I had skimmed cursorily over drinks as a potential source of gluten exposure in my celiac patients, doing a quick check to make sure they knew to avoid obvious sources such as beer and malt beverages.

But lately, the risk of gluten contamination from beverages has been on my radar screen to a much more prominent degree. I had one patient whose celiac antibodies remained positive -- and whose digestive distress persisted -- despite the most careful attention to her diet. We eventually realized that the digestive comfort tea she was using to calm her stomach was made with barley ... and was ironically the source of her ongoing distress! This was followed soon after by a patient who experienced severe diarrhea after consuming a seasonal pumpkin coffee beverage from a leading donut chain. And as a result, I've been spending more time delving into all of the other potential sources of drinkable gluten so that I can better prepare my patients for success at making sure they don't wash down their gluten-free diets with, well, gluten.

So, fellow celiacs and gluten-intolerant comrades: No matter how much you think you've mastered gluten-free living, it may pay to review the following list to make sure your beverages aren't acting as a Trojan Horse for gluten into your gut:

Beer. Beer is made from malted wheat or barley, both no-no's for folks with celiac disease. As far as beers making a gluten-free claim, these fall into two camps. The first includes beers made with naturally gluten-free grains, such as sorghum, millet and rice. These are all acceptable substitutes for people with celiac disease, and some actually even taste really good! The second includes beers made from gluten-containing grains that are processed in a manner intended to extract the gluten. Several marketers of these products test their beers and claim that the final products' gluten content remains under the necessary Food and Drug Administration threshold of 20 parts per million. Despite such test results, the safety of gluten-derived beers -- such as Daura or Omission -- has been a source of great controversy within the celiac community. One industry watchdog group has voiced concerns that there are limitations in currently available testing technology, which may result in potentially toxic fragments of barley-derived proteins escaping detection during analysis. Meanwhile, the regulatory body overseeing alcoholic beverage labeling, called the TTB, has issued a statement allowing marketers of such beverages to carry a label stating they were "crafted to remove gluten," with a fine-print qualifier that the product cannot be guaranteed to be gluten-free and may, in fact, contain gluten. Gee, thanks, TTB. That's just about as clear as mud. Personally, I play it safe by drinking champagne exclusively.

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Wine coolers. Since wine is gluten free and fruit juice is gluten free, one could be forgiven for thinking that wine coolers would, by extension, be gluten free. But alas, most "wine coolers" are no longer made from wine (too expensive) but rather malt liquor, which is not gluten-free. (Malt liquor is derived from barley.) Indeed, those fruity, bottled alcoholic drinks marketed by brands such as Seagram's Escapes, Bartles & Jaymes and Smirnoff Ice are all malt beverages, not wine or vodka-based beverages. Mike's Hard Lemonade is another malt beverage, albeit one that carries the TTB's cryptic "crafted to remove gluten" claim. Once again, I advise defaulting to bubbly when in doubt; a mimosa makes a fine stand-in for a wine cooler.

Flavored, specialty coffee drinks. Plain old, unadulterated drip coffee is naturally gluten-free, and so is the milk and real sugar one might use to adorn it. But once you introduce added flavorings into the mix, all bets are off. Sweetened syrups, flavored powder mixes, flavor and spice mixtures, or the decorative "chips" that top off your whip all have the potential to contain gluten, and you can never assume that a spiced seasonal coffee, a flavored latte or a frothy frappe is gluten-free unless you verify the ingredients first. This goes for café beverages as well as packaged products you brew at home, such as certain flavors of K-cups or seasonal flavors of packaged ground coffee. Of course, verification is easier said than done, since most major coffee chains do not disclose the ingredient lists used to make their specialty drinks, and not all flavored packaged coffee products specify whether the "natural and artificial" flavors they list on ingredient labels contain gluten or not. (Yes, I'm looking at you, Dunkin' Donuts Ground Pumpkin coffee. Please disclose.)

Torani brand syrups, which are used by many specialty coffee chains, has issued a statement regarding which of its products contain gluten, but it's up to you as a consumer to verify whether your barista is using them to flavor that skinny vanilla latte you ordered. The sprinkles and chips that adorn whipped toppings are often a potential source of gluten, and several sources have indicated that Starbucks' Java chips seem to fall into this category. Powdered drink bases -- like chai latte mixes -- all have gluten potential as well. On the bright side, most experts consider caramel color -- a common ingredient in coffee additives -- to be gluten-free regardless of whether it was derived from wheat, so that's one less ingredient you need to be concerned about from a gluten perspective.

Herbal teas. I've been as surprised as anyone to discover just how many varieties of herbal tea actually contain gluten -- typically in the form of barley. For example, four varieties of the popular Tazo teas sold at Starbucks contain gluten (Green Ginger, Honeybush, Lemon Ginger and Tea Lemonade), as well as several varieties of Yogi teas (Calming, Healthy Fasting, Kava Stress Relief and Stomach Ease). A handful of flavors from Republic of Tea (Coconut Cocoa) and Celestial Seasonings (Sugar Cookie Sleighride, Roastaroma) also contain barley. Barley also appears in certain K-cup teas as well, such as Timothy's Lemon Blueberry Tea. No matter how innocuous and calming the name may sound, even tea labels must be reviewed to verify gluten-freedom for folks with celiac disease following gluten-free diets.







Tamara Duker Freuman, MS, RD, CDN, is a registered dietitian whose NYC-based clinical practice specializes in digestive disorders, celiac Disease, and food intolerances. Her personal blog, www.tamaraduker.com, focuses on healthy eating and gluten-free living.