Injecting Nutrition into the Gluten-Free Diet

in Celiac, The Celiac Expert

Gluten-free food choices are a great thing, but now we need nutrition along with taste.

The gluten-free market is exploding with a growing number of widely available specialty products. This is welcome news for those who need to follow a gluten-free diet. But while you rejoice over the many choices available at the supermarket and online, you also need to be aware that not all gluten-free items are created equal.

Perhaps you have a sharp eye for a gluten-free package claim and are a pro at scanning food labels to avoid wheat, rye or barley as ingredients. But your expertise in label reading should not stop there. How often do you read the nutrition facts table on a product?

As research (including my own) shows, this is emerging as an extremely important step if those with celiac disease are to get an adequate amount of vital nutrients in their diet. It is essential to look at the types of ingredients used in the product, then learn to compare the nutrition facts table with those of similar products.

History of Poor Nutrition

So just how nutritious are gluten-free products? Let’s look at recent history to find out. Back in 1999 in the Journal of the American Dietetic Association, dietitian Tricia Thompson reviewed the ingredient lists and nutritional composition of various gluten-free products. She assessed the thiamin (vitamin B1), riboflavin (vitamin B2) and niacin (Vitamin B3) content of gluten-free flours, breads, rice and corn flours, cornmeal and mixes.

Seventy-three percent of breads, cold cereals and pastas contained a refined grain or starch as the first ingredient and only 32 percent of the refined products were enriched. Fewer than 10 percent of the flours, breads and cereals and none of the pasta varieties were enriched.

Her comparison of the vitamin B1, B2 and B3 status of 64 gluten-free products and gluten-containing counterparts was an eye-opener. Ninety-two percent of the gluten-free products were lower in one, two or even all three of these vitamins.

In a follow-up study in 2000, Thompson turned to the folate, iron and fiber content of gluten-free products. None of the breads or pastas and only three cold cereals were enriched with folic acid. When it came to iron, none of the pastas and only 12 percent of the breads and 3 percent of cold cereals were enriched. And 31 percent of the breads, pastas and cereals had lower amounts of fiber than their gluten-containing counterparts.

Room for Improvement

You’re no doubt expecting things to have improved. Let’s start with the work of Canadian researchers Tasha Kulai and Moshin Rashid, who in 2013 compared 71 gluten-free and 60 gluten-containing products. Many of the gluten-free products were lower in vitamins and minerals and higher in fat, carbohydrates and calories. For example, the iron content of all the gluten-free products was about one-third of that in the gluten-containing items; an average of 8.6 milligrams (mg) of iron compared to 25 mg. Gluten-free pasta was higher in carbohydrate and lower in protein, iron, folate and fiber.

I’ve also examined the issue of nutritional value, recently completing an evaluation of the enrichment status of almost 1,000 gluten-free products from the United States, Canada, Europe and Australia, which are available in North America.

Nutrition Composition Study

What’s surprising is that in spite of a much larger number and variety of gluten-free products on the market today compared to 1999, the nutritional composition and enrichment status of many products is still clearly inadequate.

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The resulting impact on the gluten-free diet of the individual can be profound. Dietitian Anne Lee reviewed the diets of 50 patients of the Celiac Disease Center at Columbia University to find that rice cereal was the most common breakfast food. For lunch, most were having bread made of white rice or tapioca or rice cakes or crackers. Fifty-five percent of snacks were chips, pretzels, cookies, cakes or doughnuts. When patients did include a grain or starch, white rice was the most common.

Lee shifted the nutritional composition of the patients’ diets by substituting gluten-free oats at breakfast, a high-fiber brown rice bread at lunch and quinoa for dinner instead of the patient’s standard dietary pattern. Her study, published in the Journal of Human Nutrition and Dietetics in 2009, found that the alternative dietary pattern was significantly more nutritious.

It’s important to note that enriched-gluten-containing products (breads and other baked products, cereals, pastas and flours) contribute a large percentage of the daily folic acid and iron intake. Unfortunately, many gluten-free products are not enriched with iron, folic acid and other B vitamins.

Yet change can come. Let’s encourage gluten-free manufacturers to get on the healthy bandwagon with enriched foods and whole grains. And remember to check the nutrition facts table. Just like looking for words that warn of gluten’s presence, it’s not hard to do, once you make it a habit.

Also See:
Tips for Healthy Gluten-Free Eating

Shelley Case is a consulting dietitian and author of Gluten-Free: The Definitive Resource Guide. She is on the advisory boards of the Canadian Celiac Association, the Celiac Disease Foundation and Gluten Intolerance Group.