Barley is a cereal grain grown in 27 states across the US and around the world, according to the National Barley Foods Council. Barley contains a plant protein known as hordein that’s rich in gluten. When people with celiac disease, or CD, ingest foods or drinks made with barley, their immune systems launch an attack against the protein.
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When someone with celiac disease eats or drinks foods laced with gluten from barley, her body identifies the protein as a foreign body and tries to destroy it. This autoimmune attack damages the villi, or small finger-like projections inside the small intestine that absorb vital nutrients from food passing through the gut. The villi become less effective at capturing nutrients, and the individual becomes malnourished no matter how much she eats or drinks. Over time, untreated celiac disease can cause osteoporosis, some cancers, diabetes and infertility, according to the National Foundation for Celiac Awareness, or NFCA.
According to the Celiac Sprue Association “The best and only known treatment for CD is simply this: a lifelong elimination of gluten.” This includes gluten from barley, as well as wheat and rye.
Grocery stores sell pearl barley for home cooking, as well as barley-based cereals, breads and other baked goods. Barley can be processed into malt, which is used to produce many commercial beers. It’s also a key component of many flavorings, colorings, flavor enhancers, hydrolyzed plant protein and hydrolyzed vegetable protein in commercial food products. Read labels to look for terms like barley malt or barley extract.
People with celiac disease know that barley can be found in many cooked dishes served at the homes of families and friends, or at restaurants. Some casseroles and stews use barley as a main ingredient or as a thickener, salads may incorporate barley for added protein and side dishes like risotto or pilafs may substitute barley for the traditional rice ingredient. Even breakfast foods like frittatas, pancakes or waffles may include significant amounts of gluten protein from barley. Read restaurant menus to rule out dishes that include "barley" in the title, but also ask your server if barley has been incorporated into a dish. For example, the miso used in soups and other Japanese dishes, is often made with barley.
The National Digestive Disease Information Clearinghouse publishes a listing of gluten-free alternatives to barley. These include corn, quinoa, tapioca, wild rice, millet and flax.