When my kids were learning math facts — addition, subtraction, multiplication tables — I used to tell them:
I know this stinks. But right now, you’re learning the rules of math.
Once you know the rules well enough, you get to use them to your advantage and have a little fun.
Yes. I think algebra is fun.
Yes, I’m dorky and I’m okay with it.
Anyway…
I’ve been thinking about celiac disease the same way.
There are some basic rules you need to learn first.
At the beginning, they can feel overwhelming. Suddenly food requires labels, questions, planning and a vocabulary you didn’t know you needed.
But once you know the rules, understand why they exist and get comfortable applying them, something changes.
You don’t necessarily become more restrictive.
You become more confident.
You begin to understand which things actually matter, where the meaningful risks are and when real life requires a little judgment.
The Rules of Celiac are not about making your life smaller.
They’re about giving you enough knowledge to become less afraid.
So, here are The Rules of Celiac, as I see them.
1. Never, ever purposefully eat gluten
This one really doesn’t need much explanation.
Celiac disease is an immune-mediated disease triggered by gluten. The treatment is a strict lifelong gluten-free diet.
So don’t intentionally eat gluten.
That doesn’t mean you will execute the gluten-free diet perfectly every day for the rest of your life.
Accidents happen.
Labels get misunderstood. Restaurants make mistakes. Someone uses the wrong spoon. You discover afterward that something wasn’t as safe as you thought it was.
The goal is not perfection.
The goal is to understand where the real risks are and reduce accidental exposure as much as reasonably possible.
There is an enormous difference between accidentally getting glutened and deciding, “Eh, it’s only one piece of pizza.”
Learn that distinction early.
2. Get a complete diagnosis
Before reorganizing your entire life around a gluten-free diet, make sure you actually know what you’re treating.
For most adults, diagnosis involves appropriate celiac blood testing followed by an upper endoscopy with biopsies of the small intestine while the person is still consuming gluten. Selected children can sometimes be diagnosed without biopsy when they meet specific criteria under pediatric guidelines.
That means:
“I feel better when I don’t eat bread” is not a complete celiac diagnosis.
Neither is:
“My aunt has celiac, so I probably do too.”
Neither is:
“Someone told me to try gluten free and my stomach stopped hurting.”
Those things may absolutely be reasons to investigate celiac disease.
They are not necessarily enough to establish the diagnosis.
If your blood work, biopsy, symptoms or other pieces don’t agree, keep asking questions.
Maybe celiac disease is ultimately where you land.
Maybe something else is going on.
The important part is figuring out why the information doesn’t line up instead of forcing everything into the diagnosis you expected.
And yes, testing can be expensive and cumbersome, particularly without good insurance coverage.
But so can unnecessarily following a restrictive gluten-free diet for the rest of your life because the diagnosis was inaccurate or incomplete.
3. Make naturally gluten-free whole foods the foundation of your diet
Gluten-free food does not have to mean expensive replacement food.
Start with the enormous amount of food that never contained gluten in the first place.
Fruits.
Vegetables.
Meat and other proteins.
Eggs.
Dairy, if you tolerate it.
Rice.
Quinoa.
Potatoes.
Beans.
Naturally gluten-free foods are your friends.
And before anybody comes after me:
I am not taking away your cookies.
Gluten-free bread, pizza, pasta, crackers, cookies and whatever other replacement food makes your life better absolutely have a place.
You have already lost regular bread.
You do not need me confiscating your gluten-free Oreos too.
But your entire diet doesn’t need to come out of a box screaming GLUTEN FREE across the front.
And eating more whole foods does not mean you now have to spend three hours every night producing artisanal meals from scratch.
Most nights, I can get a gluten-free dinner on the table in under 30 minutes with a protein, a vegetable and a starch.
It isn’t always sexy.
Sometimes dinner is simply chicken, broccoli and potatoes.
Nobody from the Food Network is knocking on my door.
But everyone gets fed.
That’s the point.
4. Not everything is celiac
Celiac disease can cause an impressive range of symptoms, and it is associated with a number of nutritional deficiencies and other health conditions.
But people with celiac disease also continue to be ordinary humans who get ordinary human ailments.
Sometimes we just have a headache.
Before my diagnosis, nobody would have automatically blamed today’s headache on celiac disease.
It probably isn’t caused by celiac disease now either.
I also once broke my toe.
Not because celiac disease had weakened my bones.
I dropped a very heavy serving dish on it.
That sucker would have broken whether I had celiac disease or not.
Sometimes a broken toe is just a broken toe.
This matters because once you’ve been diagnosed with a disease that can affect many different parts of the body, it becomes incredibly tempting to use it to explain everything.
Sometimes celiac really is involved.
Sometimes it isn’t.
New, persistent or worsening symptoms deserve appropriate medical evaluation rather than automatically being filed under CELIAC DID IT AGAIN.
Those are the foundational rules.
Now comes the more interesting part.
How do we actually live?
5. Be careful when you eat out — but don’t assume you can never eat out again
Eating outside your own kitchen adds uncertainty.
That is simply true.
A completely gluten-free restaurant eliminates many potential sources of cross-contact and is generally the easiest option.
But completely gluten-free restaurants are not available everywhere, and most of us occasionally want to participate in the restaurant world the rest of society seems to enjoy without conducting a doctoral dissertation first.
So learn how to evaluate restaurants.
Does the restaurant have gluten-free procedures?
Does the staff understand what cross-contact means?
Are gluten-free foods prepared separately?
Are fryers shared?
Are surfaces, utensils or cooking equipment shared?
How does the kitchen handle allergies and medically required diets?
Have other people with celiac disease had good experiences there?
Ask good questions.
Listen carefully to the answers.
Then make the best decision you can with the information available.
Eating out with celiac disease can be done.
It simply requires more work than looking at the menu and ordering whatever sounds delicious.
6. Don’t let the naysayers get to you
Not everybody will understand your medically required gluten-free diet.
Some people will forget.
Some will think you’re being overly cautious.
Some will insist that the crumb they dropped on your plate couldn’t possibly matter.
Some will tell you about their cousin who “just takes the bun off.”
Some people will make beautiful efforts to understand.
Others won’t.
You cannot build your entire sense of safety around whether everyone around you approves of what you need.
You are responsible for taking care of your health.
Explain when explanation is useful.
Educate people who genuinely want to understand.
Give people some grace when they’re learning.
And recognize that you don’t need unanimous approval to take care of yourself.
Which brings us naturally to Rule #7.
7. Invest in Teflon underwear
Yes.
Teflon underwear.
This is one of my favorite pieces of celiac equipment.
You cannot buy it at Target.
Teflon underwear protects you from the slings and arrows of:
“You’re making this up.”
“A little bit won’t hurt.”
“Can’t you just scrape it off?”
“But you used to eat bread.”
“You’re being dramatic.”
“I made this especially for you. Why won’t you eat it?”
Teflon underwear is the ability to hear those things without allowing them to knock you sideways.
It lets you say:
No, thank you.
I can’t eat that.
I appreciate the effort, but I’m not comfortable with it.
This is what I need.
And then move on.
At first, Teflon underwear is uncomfortable.
Standing up for yourself can feel awkward, particularly when food is wrapped up in hospitality, family traditions and other people’s feelings.
Eventually, it gets easier.
And someday you may wonder how you survived without it.
8. Keep up with your medical care
Diagnosis is not the finish line.
Celiac disease requires ongoing management.
Follow-up care can help evaluate healing, persistent symptoms, nutritional deficiencies, bone health and associated conditions.
Your individual follow-up schedule should be determined with the healthcare professional managing your celiac disease.
For many people, particularly after diagnosis, that means regular visits and repeat laboratory testing.
And if things change?
Don’t wait simply because your next routine appointment isn’t due yet.
If symptoms become significantly worse, new symptoms persist or something feels genuinely different, call your doctor.
The gluten-free diet is enormously important.
It is not a substitute for medical care.
9. Travel. Camp. Go places. Do things.
Celiac disease gets to change what you eat.
It does not automatically get to determine how big your life becomes.
Travel.
Camp.
Go to college.
Take the job.
Attend the wedding.
Visit another country.
Go hiking.
Get on the cruise ship.
Do whatever it was you wanted to do before celiac disease entered the conversation.
Will some of those things require more planning?
Absolutely.
You may research restaurants before leaving home.
You may call a hotel.
You may pack half your kitchen.
You may travel with enough snacks to survive the collapse of civilization.
Fine.
Planning is not the same thing as limitation.
Sometimes the logistics will be annoying.
But don’t let the disease convince you that staying home is automatically safer, easier or better.
Your life is still yours.
10. Read the label every time
You know that product you’ve purchased safely for five years?
Read the label.
Again.
Manufacturers change ingredients.
Suppliers change.
Production facilities change.
Gluten-free claims change.
Packaging changes.
The product that was labeled gluten free last year may not carry the same claim today.
That doesn’t automatically mean the product suddenly contains gluten.
It means something changed, and you need to evaluate the product based on the information available now, not on what you remember from three years ago.
Turn the package over.
Read.
Every time.
It takes seconds and eliminates a whole category of preventable mistakes.
11. Keep your head up
Celiac disease can be hard.
Not occasionally hard.
Sometimes three-meals-a-day, every-damn-day hard.
Food is woven into nearly everything we do.
Breakfast.
Lunch.
Dinner.
Snacks.
Birthdays.
Weddings.
Vacations.
Office parties.
School events.
Dates.
Holidays.
Tuesday afternoon when somebody walks into the office carrying doughnuts.
Some days, living gluten free feels incredibly ordinary.
Other days, you’re tired of thinking about food and wondering why everyone else gets to simply eat the cake.
Both days are normal.
Keep moving.
One meal.
One label.
One restaurant.
One trip.
One decision at a time.
Learn the Rules. Then Learn How to Live With Them.
This is where we come back to algebra.
When my kids were memorizing multiplication tables, there wasn’t much room for creativity.
Seven times eight was 56.
It didn’t care how they felt about it.
They simply had to learn it.
But once they understood the rules of math, they could do much more interesting things with those rules.
I think celiac disease works a little like that.
At first, you need the basics.
Gluten triggers celiac disease.
Don’t intentionally eat it.
Learn how to read a label.
Understand cross-contact.
Get appropriate medical care.
Know how to feed yourself safely.
Those are the rules.
But eventually, life presents situations that aren’t printed neatly on a worksheet.
A restaurant isn’t completely gluten free.
Your family wants to travel somewhere unfamiliar.
A research study challenges something you’ve always believed.
Someone cooks for you in a shared kitchen.
A label gives you incomplete information.
That is when knowing the reason behind the rule becomes more useful than simply memorizing the rule.
You can ask:
What risk is this rule trying to control?
What do I actually know about this situation?
What can I do to reduce the risk?
Where is the line I am comfortable drawing?
Sometimes the answer will be easy.
Sometimes you hold the line.
Sometimes you decide there is reasonable room for flexibility.
Sometimes you make a decision and later realize you would do it differently next time.
That’s living.
The Rules of Celiac aren’t meant to create a smaller, scarier world.
They’re meant to give you a framework for navigating a world that wasn’t designed around celiac disease.
Learn the rules.
Understand why they’re there.
Then use that knowledge to build the biggest, fullest life you can.
And maybe even have a little fun.
Yes.
Just like algebra.
Want More Science, Side-Eye and Practical Celiac Information?
Fat Celiac is about figuring out how to live gluten free in a very gluten-covered world — without ignoring the science and without being terrified of everything.
If that’s your kind of approach, follow Fat Celiac, share this with someone who needs it, and stick around.
We’re going to keep figuring it out.
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