Nutritional Quality of the Gluten-Free Diet

B Vitamins, Iron, and Dietary Fiber

Whole-grain and enriched or fortified varieties of grain food such as bread products, pasta, and breakfast cereals contribute a significant amount of B vitamins, iron, and dietary fiber to the diets of Americans. It may be difficult to get the nutrients you need on a gluten-free diet because the majority of specially manufactured gluten-free breads, pastas, and cereals are neither whole grain nor enriched. As a result, they contain very little thiamin, riboflavin, niacin, folate, iron, and dietary fiber, which are all crucial for leading a healthy lifestyle.

Specially manufactured gluten-free breads, pastas, and cereals often are made from starch such as rice starch, cornstarch, and potato starch, or refined flour such as milled rice and milled corn. During the milling process, when a whole grain such as brown rice is refined to make white rice, the bran and germ of the grain are removed. Much of the vitamins, minerals, and dietary fiber found in grains come from these portions.

In the United States, most refined wheat-based breads and pasta are voluntarily enriched with thiamin, riboflavin, niacin, folic acid (the synthetic form of folate), and iron. Enrichment means that the nutrients (with the exception of fiber) lost during the milling process are added back into the food. Also, most regular breakfast cereals are fortified with vitamins and minerals. Unfortunately, most refined, specially manufactured gluten-free breads, pastas, and breakfast cereals are neither enriched nor fortified. It is unclear why most manufacturers of gluten-free foods do not enrich their products. Perhaps the reason is simply that they are not required to. Because enrichment of refined wheat-based grain foods is voluntary in the United States, gluten-free substitutes for these products do not have to be enriched.

Historical Nuggets

• As recently as 2000, no manufacturers of specially formulated gluten-free foods available in the United States were enriching or fortifying pasta products or ready-to-eat breakfast cereal. But at present, Maple Grove Food and Beverage (Pastariso and Pastato brands) enriches a variety of pasta products, and Enjoy Life Natural Foods (Enjoy Life and Perky's brands) fortifies a variety of ready-to-eat breakfast cereals.
• In a survey of celiac disease support groups in the United States in 2000, there was no consensus on whether the grains millet and sorghum and the pseudocereals amaranth, buckwheat, and quinoa are gluten free (they are). Now these whole grains are used by several manufacturers of gluten-free foods, and you can find them in a wide variety of products.

Enriched Versus Fortified Foods

You will sometimes see the terms enriched and fortified used interchangeably when referring to food products, but they are not quite the same. In general, when the word enriched appears on a food label, it means that vitamins and minerals have been added back to a refined grain food that originally contained them until they were removed during the milling process. Under regulations of the Food and Drug Administration, only certain foods in the United States may be voluntarily enriched with specific vitamins and minerals. This is done in part to prevent overconsumption of a specific nutrient. Foods that may be enriched include bread, rolls, buns, flour, macaroni, noodle products, rice, cornmeal, and farina. To be labeled enriched, these products must contain certain amounts of thiamin, riboflavin, niacin, folic acid, and iron.

In addition, foods may be fortified with a wide variety of vitamins and minerals that may or may not have been found in the original food product. The amounts of specific nutrients that may be added to fortified food products may or may not be regulated, depending on the specific food and nutrient. Examples of foods that may be fortified include breakfast cereal, soy milk, orange juice, and energy bars.

Whole Grains Versus Refined Grains.

To give you an idea of the nutritional differences between a whole grain and a refined grain, consider the following comparison between white- and brown-rice flour:

Enriched Grains Versus Unenriched Grains

To get an idea of the nutritional differences between an unenriched and an enriched refined grain, consider the following comparison between unenriched and enriched cornmeal:

As the preceding examples illustrate, whole-grain and enriched foods are more nutrient dense than refined and unenriched foods. This means they provide higher levels of nutrients for the same calorie content. The recipes in this book will give you some great ideas for cooking with a variety of gluten-free whole grains.

Calcium

Some persons with celiac disease, especially those who are newly diagnosed, may have a secondary form of lactose intolerance. Lactose is a type of sugar found in milk. To be digested, it must be broken down in the small intestine by the enzyme lactase. Persons newly diagnosed with celiac disease may have low levels of lactase as a result of damage to the lining of the small intestine. As the small intestine heals in response to a gluten-free diet, the lactose intolerance will naturally resolve. Until it does, a lactose-reduced or lactose-free diet is generally recommended.

Because individuals with lactose intolerance may avoid milk products, and because milk products are a major source of calcium in the American diet, persons with celiac disease who also are lactose intolerant may not consume enough calcium.

Fat

There is nothing inherent in a gluten-free diet that makes it more (or less) likely to be high in fat. Nonetheless, many gluten-free diets are high in fat. For overall health and well-being, persons with celiac disease should pay attention to the fat content of their diet, especially as it concerns saturated and trans fats. Any diet that contains full-fat diary products, processed snack foods, and fatty meat products may be high in unhealthful fat.