Gluten Free Questionnaire 


by Melissa Barlow
Expert on gluten intolerance, and former proprietress of the Empress restaurant.


1. Bloated or distended abdomen (severe pressure and volume).
2. Indigestion, acid reflux or nausea.
3. Migraine headaches.
4. Overall physical fatigue regardless of usual sleep or rest.
5. Brain fog (trouble focusing or feeling overall hazy).
6. Experiencing long bathroom visits accompanied with pain, chills, abdominal cramping, constipation and diarrhea.
7. Feelings of extreme fullness with a normal meal OR feeling hungry regardless of the amount of food ingested.
8. Aching or dry joints.
9. Eczema or acne that seems untreatable.
10. Extreme weight loss or gain that does not adjust with exercise or usual dieting.


- Depression and Extreme Irritability or Mood Swings
- Chronic Sinusitis
- Infertility/Miscarriage
- Ovarian Cysts/Extreme Menstrual Cramps/Missed Cycles
- Poor dental health (example: multiple root canals/discolored and weak teeth)
- Anemia (and other nutritional deficiencies)
- Narcolepsy
- Brittle Bones - easily fractured or broken with little trauma
- Irritable Bowel Syndrome
- Crohn's Disease
- Delayed growth (in children)
- Autism/ADHD
- Incorrigible Allergies


Do you or any other family members have other auto-immune disorders such as:

- Crohn's
- Lupus
- MS
- Parkinson's
- Rheumatoid Arthritis
- Chronic Fatigue
- Fibromyalgia

Autoimmune disorders often live side-by-side and many have been linked to, or thought to have been triggered by, a gluten irritation. Maintaining a gluten free diet is recommended as treatment for many of these disorders even when the patient does not test positively for Celiac Disease.

Do not expect "usual" when dealing with an autoimmune disorder. Celiac Disease prevents the intestine from absorbing nutrients and causes the immune system to be compromised, resulting in a myriad of seemingly unrelated symptoms. ONLY when we look at the body as a whole can we start to see the connectivity of an immune system battling to survive.

Important to remember that gluten sensitivity is a spectrum, and is not as simple as a 'yes' versus 'no' diagnosis. Each individual needs to identify the particular symptoms they personally associate with gluten/wheat intake. Also, since many doctors are not well-versed in this area, it is important to educate yourself as well as your health care provider.

Seek a blood test from your doctor BEFORE making any changes to your diet. Since the test registers antibodies that your system creates in reaction to gluten, if you take away the gluten then you take away the antibodies and thus make the test inconclusive.


Self Evaluation: Two-Week Test

You must learn to trust and listen to your body in hopes of finding a pattern to illness when there seems to be none. The Two Week Test is, in my opinion the best way to evaluate if you have a dietary problem. I recommend this not only for gluten sensitivities but also for diary, casein, soy, nut, and other food allergies as well. For two weeks, aim to cut out as much of ONE suspected ingredient at a time. In this case, do your best EVERY DAY for 14 days to eliminate gluten from your diet. NO cheating, although there may be some accidental ingestion out of habit. On the 15th day stay home and binge on items that contain gluten. By binge, I do not mean overeat, but simply making sure to saturate every meal with gluten. Cereal and waffles for breakfast, sandwich or pasta for lunch, pizza and beer for dinner. Record, in a journal, every symptom that appears/reappears for the next 72 hours. Nothing is too small a symptom, even hiccups or lightheadedness can be a suggestion.

Although it is possible to have celiac disease without any external symptoms, the damage to the intestines is still being done. However, if you have no reactions to the two week test, then you may be suffering from another food allergy or other medical condition and should seek the opinion of your doctor.

Stage One (Two Months): Pastas, Desserts, Breads, Beer

This stage comes with a learning curve. You will spend plenty of time reading every label that you can, so we aren't going for perfection here. Let's shoot for eliminating as best as we know how without dying of starvation, roughly 90% - BUT NO CHEATING.

REMEMBER : Think Substitution not Elimination. It will be good for your meal planning as well as your psyche.

Eliminate wheat, rye, barley and malt.

Substitute the main culprits with gluten-free options.

Pasta becomes gluten-free pasta.

Cookies, cakes, pastries become gluten-free desserts.

Pizza and beer night is now gluten-free pizza and gluten-free beer or cider night.

Also... Soy sauce to gluten-free soy sauce. There is more wheat than soy in most soy sauce.

Stage Two (Months 3-6): Hidden sources

After becoming accustomed to reading labels on a regular basis, now we start to eliminate the last 5-10% of the hidden gluten most likely still making its way into your system.
Avoid the following, as a "small" amount can do major damage on a regular basis.

- Modified Food Starch (unless it specifies corn, tapioca, potato, rice)
- Vegetable Protein
- Hydrolyzed Protein or Starch
- Edible Starch
- Gliadin
- Binding or Filler
- Germ, Germ Extract or Germ Oil
- Artificial Flavoring
- Triticale
- Fu. Matzo, Udon, Durum, Semolina
- Dextrimaltose
- Maltodextrin
- Dextrin

Review all medications as many are packed with wheat. Some generics may offer a gluten free options, ask your pharmacists for a complete list of non-active ingredients and to mark your file as gluten free to help with future prescriptions. There are also a few pharmacies that can pack their own antibiotics free of fillers.

Some extremely sensitive people benefit from eliminating all wheat based substances, including grain alcohol and vinegar. There are many pure vinegars available such as apple cider, balsamic and rice wine. Instead of grain based spirits, there are some potato vodkas, clear rum, clear tequila and a few corn bourbons available. Brandy, sherry and sake are also gluten free.

Topical contaminations can become an issue at this stage, especially if there are any skin irritations associated with wheat allergy. Shampoos, lotions, toothpaste, shaving cream and soap may contain wheat based ingredients that can exasperate symptoms such as eczema, dry skin, itchiness, dandruff, acne, and cracked skin. Many products will identify as wheat-free since the rest of the wheat stalk and grass can cause symptoms.

Stage Three: Cleaning Your Environments

Now that you have a solid handle on everything you ingest and apply to your body, it is time to recognize environmental contaminants. This is also a good time to start educating the people around you that this is a severe allergy and, just as with nut allergies, you need a little help and respect when it comes to matters of food.

Ask the people at work to be considerate of eating their sandwich or cupcake over your desk, these small crumbs can affect you. Ask your significant other to be mindful to rinse their mouth, or refrain from eating or drinking after them if they have been eating wheat. In some cases, celiacs can react harshly to airborne wheat like that found in a bakery or commercial kitchen. You may find this to be true if someone is still doing gluten baking in your home kitchen. Start to create a safety barrier with specified muffin tins, shelves and serving utensils. Be polite, yet confident and assertive, to express your dietary needs EVERY TIME that you go out to eat. One bad meal can leave you sick for weeks.



I was once poisoned by less than a gram of flour and it caused my entire system to shut down and remain sick for over three weeks. This was from one piece of gluten free cake made with gluten free batter. The cook had accidentally floured the pan with regular flour before baking the batter. That minuscule and unseen dust on the bottom of my cake made me bedridden for 3 days, barely able to walk for another week and resulted in a breakdown from the stress on my system.

A little can be a lot! For some people one cookie may not cause severe reactions, but two may. For others, like myself, minuscule amounts -- mere crumbs -- can cripple me. Be aware for yourself and for those suffering in your home. Treat it as seriously as a peanut allergy.

Most people experience a gluten sensitivity diagnosis as a loss and often go through the grieving process. After a month or two of feeling healthy and being alleviated from symptoms, DENIAL may occur. Many people after feeling much better start to wonder if it might have been caused by something else (and they truly miss the comfort foods) and decide to start eating freely again. This is often followed by a return of symptoms, sometimes much more sever than before. Many people become ANGRY that their lives are now more complex, and must be planned and coordinated. Soon thereafter, BARGAINING begins and "I'll just eat a little here and there and the symptoms will not be so bad" become common place. Upon the return of symptoms or declining health, DEPRESSION sets in once a person feels the weight that their own health is completely controlled by the choices they make day to day. Accepting that you control your own sickness is a sad and liberating feeling. This is the final stage, ACCEPTANCE. We accept that time and time again the same test has proven with the same results, and it is clear to us that not only are we gluten intolerant, but we are from here-on-out responsible adults (or parents of affected children) who choose health over impulse.

If you are wheat and gluten sensitive you deserve to feel better and be healthy. You do not need to eat foods that harm you out of respect for the host. Once you say, "No thank you, I have an allergy" they will, and should, understand. Don't give in to pressure, others cannot understand the agony that you experience once you make it home.