Nutritional Quality of the Gluten-Free Diet

Nutritional Quality of the Gluten-Free Diet

In Honor of Celiac Disease Awareness Month, Gluten Free Watchdog is writing a series of articles (the goal is one per day during the month of May) related to the gluten-free diet–currently the ONLY treatment for celiac disease. 

Post (#25)…

Yes, gluten-free diets are as varied as the people who follow them. Yes, gluten-free diets can be exceedingly healthy. And yes, gluten-free diets can be very unhealthy. All of this is true of “non gluten-free diets” as well. But our focus is on the gluten-free diet…

According to the Academy of Nutrition and Dietetics Evidence Analysis Library (I was part of the celiac disease workgroup), based on the scientific studies done on the nutritional adequacy of the gluten-free diet worldwide, this diet may be:

  • High in fat
  • Low in carbohydrates
  • Low in fiber
  • Low in iron
  • Low in folate
  • Low in niacin
  • Low in vitamin B12
  • Low in calcium
  • Low in phosphorous
  • Low in zinc

There are many possible reasons for these findings, including:

  • Low overall intake of carbohydrates
  • An overall decreased intake of grain foods
  • Low intake of gluten-free whole grains
  • Lack of enrichment and fortification of gluten-free grain foods
  • Decreased intake of milk-based products

Unfortunately, there are relatively few studies on the nutritional content of gluten-free foods available in the US, and on the nutritional quality of the gluten-free diet as “typically” followed in the US. Studies that have been done are dated. My published research is from 1999, 2000, and 2005 (see photo). What these studies found is that gluten-free grain foods in general do not contain the same levels of thiamin, riboflavin, niacin, folate (folic acid), and iron as their gluten-containing counterparts. And women with celiac disease consumed 46%, 44%, and 31% of recommended amounts of fiber, iron, and calcium, respectively. These findings taken as a whole may be due to both the lack of enrichment of most refined gluten-free foods as well as (at the time of these studies) very low to absolutely no use of gluten-free alternative grains other than refined rice and corn.

The good news…

Now more than ever gluten-free alternative grains are being used in bread, pasta, breakfast cereals, and baking mixes. Believe it or not, when we conducted our 2005 study on the nutritional adequacy of the gluten-free diet, only one person (not a typo) was eating a grain food based on a grain other than rice or corn.

If you are concerned about the nutritional quality of the grain foods you eat…

  • Take a look at the ingredients lists of your breads, breakfast cereals, pastas, and mixes.
    • Is a whole gluten-free grain listed as one of the first ingredients?
      • Look for amaranth, buckwheat, millet, oats, quinoa, sorghum, teff, whole corn, and wild rice.
    • If the first few ingredients are refined, such as white rice flour, rice starch, cornstarch, milled corn, or tapioca starch, is the product enriched or fortified with vitamins and minerals?
  • If you are eating primarily refined, unenriched/unfortified grain-based foods you may want to make some changes.

If you are a dietitian interested in research, we need updated studies on the nutritional quality of the gluten-free diet. It is a difficult task as most gluten-free packaged foods are not included in nutrient databases. Assessments must be done by hand to avoid numerous missing values. If you are up for it, I am more than happy to provide guidance.

Tomorrow’s post: Gluten-Free Grain Foods and the Lack of B-Vitamin Enrichment

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Comments (5)

  • Erogo Reply

    I found using enriched Nutritional Yeast by KAL or Braggs in 2 meals a day really helped to keep many of the normally low nutrients in check (I normally mix with egg whites, or make a dairy free cheese with it). I normally eat a grain free, dairy free diet high in fats with almost zero carbs (Ketogenic/Paleo). I also make sure to eat 4-6 servings of leafy greens a day. That with my standard intake of nuts, seeds, and egg whites, along with cooking almost everything with coconut oil seems to maintain a good calorie intake and nutrient profile. I do supplement a bit extra with b-vitamins, iron, and vitamin D.

    May 25, 2017 at 4:49 pm
  • Maria Newman Reply

    Everyone forgets about B1 Thiamine…very hard for a celiac patient to get that vitamin in their diet. It’s found in breads and cereals but not in Gf bread or cereals. Check out the symptoms of being deprived at that vitamin. I was completely depleted of B1 but because everyone talked about the B12 and other vitamins I had made the necessary adjustments. Both my doctor and I were surprised that I was completely depleted of that one vitamin. I now take 100mg tablet a day. And my latest test came back in the normal range.

    May 25, 2017 at 7:38 pm
    • Tricia Thompson Reply

      Thanks for posting this information, Maria. Riboflavin also may be an issue (for the same reasons as thiamin, including the lack of enrichment/fortification of gluten-free foods).

      May 25, 2017 at 7:45 pm
  • N Gordon Reply

    I do a lot of alternate grain baking since my son is highly allergic to many foods. I would like to enrich at home. Can I purchase a B-complex that can be added to recipes?

    November 6, 2017 at 6:32 pm

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