Avoiding Nutritional Pitfalls in a Gluten-Free Diet: All About Folate

The Gluten-Free Diet and Folate

With the proper food choices, a gluten-free diet can provide enough folate. However, it may be more difficult for a person following a gluten-free diet to consume recommended amounts of folic acid from enriched food than for a person following a more typical American diet. In the United States, most refined wheat-based flour, bread, pasta, and breakfast cereals are enriched or fortified with folic acid. However, because most refined gluten-free grain foods are not enriched, this source of folate is less readily available to people following a gluten-free diet.

Folate-Deficiency Anemia

Anemia can be defined as a decrease in the amount of hemoglobin in the blood. Hemoglobin is a protein found in red blood cells that carries oxygen to all the tissues of the body. Folate is required to make red blood cells, and without adequate amounts of folate because of poor dietary intake or poor absorption, red blood cells cannot develop properly. Folate-deficiency anemia is referred to as a macrocytic, megaloblastic anemia. This means there are low numbers of large, underdeveloped red blood cells that contain lower than normal amounts of hemoglobin. People with untreated celiac disease may not properly absorb folate or folic acid. When you are diagnosed with celiac disease, you should be assessed for both types of anemia: folate-deficiency anemia and iron-deficiency anemia.

Folate Deficiency and Cardiovascular Disease

According to the American Heart Association, high blood levels of the amino acid homocysteine are linked to an increased risk of coronary artery disease. There is some evidence to suggest that homocysteine traveling through the circulatory system may damage the walls of the arteries, leading to the development of fatty deposits. Folate is necessary to change the amino acid homocysteine into the amino acid methionine. If too little folate is available, blood levels of homocysteine will increase, so not getting enough folate in your gluten-free diet could put you at a greater risk for cardiovascular disease.

Adding Folate to Your Diet

You can increase your intake of folate by eating a variety of gluten-free foods. These include foods enriched with folic acid and foods that naturally contain folate.

Foods Enriched with Folic Acid. As previously discussed, eating foods that have been enriched with folic acid is very important if you are a female capable of becoming pregnant. Even if you do not fall into this category, folic acid from enriched foods or supplements is more easily absorbed than folate from food. While most manufacturers of gluten-free flours, breads, pastas, and breakfast cereals do not enrich their products, a few do. The following table gives the folic acid content of some enriched gluten-free foods available from several companies.

Foods with Folate

Food sources of folate include legumes, green leafy vegetables, and fruit juices.