Which of these nutrients may be found in low amounts in gluten-free diets as typically followed worldwide?

In honor of Celiac Disease Awareness Month 2018,

A series of bites, barks, tail wags, face licks, and pant tugs from Gluten Free Watchdog

May 15, 2018

Gluten Free Watchdog Pant Tug, Post # 15

Question: Which of these nutrients may be found in low amounts in gluten-free diets as typically followed worldwide?

• Carbohydrates
• Fiber
• Iron
• Folate
• Niacin
• Vitamin B12
• Calcium
• Phosphorous
• Zinc

Answer: All of them

There are currently discussions on social media pertaining to the nutritional adequacy and general healthfulness of the gluten-free diet. These discussions prompted me to repost the blog below from last year’s CDAM campaign. A companion piece will post tomorrow. When reading, remember that this piece is not necessarily about your specific gluten-free diet but rather gluten-free diets as typically followed. While packaged gluten-free foods have changed since the time of my original research, there is still an overuse of refined rice flour and corn flour and various starches. The use of rice-based ingredients is so common in gluten-free grain foods that it has led to concerns about arsenic intake among folks with celiac disease. Yes, consumers can make the choice to make products from scratch using alternative flours but this is not always an option for many folks. What research should prompt folks to do is support manufacturers who use alternative grains in their products—as a major versus a minor ingredient.

…

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.

My research found 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.