By Jodi Bjurman, RD, CDE -- Outpatient Nutrition Expert
Gluten-free products are everywhere. Walk into any health-food store, or even a regular supermarket and you will see an abundance of gluten-free items to choose from, perhaps even a whole aisle of choices. More and more people are talking about this diet and deciding to follow its guidelines, but why? What exactly is the draw? What does it really mean and should they be concerned about any nutritional issues?
Gluten is a protein that is found in wheat, barley, rye, and crossbred varieties of these grains. When the flours of these grains are mixed with water to make baked goods, it's the gluten that becomes elastic during mixing and kneading, allowing bread products to develop their characteristic light, airy texture.
Wheat is among the top three field crops in the United States, and as such is a major source of grain, and therefore of gluten, in the American diet. When we search for whole-grain products to improve our diets, it's easy to reach for whole wheat breads, pastas and cereals as some potential sources. An avoidance of gluten necessitates that these foods be eliminated from our plate.
For individuals with Celiac disease, following a gluten-free diet is essential. This condition is characterized by an abnormal immune response to gluten. When a person with Celiac disease ingests gluten, absorptive surfaces of the small intestine become damaged as their immune system destroys intestinal villi, causing malabsorption and symptoms like diarrhea and abdominal pain or discomfort. In order for a diagnosis of Celiac disease to be made, you must still be consuming gluten and see your doctor for a series of screening blood tests and a biopsy of the intestine.
Many of us know people who have said that they are gluten-sensitive but who do not have Celiac disease. They have chosen to follow the gluten-free diet for personal health reasons; they simply feel better on this type of diet. Some believe that a gluten-free diet helps them to improve blood sugars, or it simply leads to avoiding calories from tempting, gluten-containing carbohydrates like cakes and cookies. Whatever the reason for going gluten-free, individuals should be clear about their rationale- this is not an easy diet to follow.
Reading labels becomes a critical component to adopting a gluten-free diet. As anyone who has gone grocery shopping can attest, there are a lot of types of wheat flour on the shelves - bromated, enriched, phosphated, plain and self-rising. All of them should be avoided, along with barley, rye, triticale (a cross between wheat and rye), bulgur, durum flour, farina, graham flour, kamut, semolina and smelt. Here is a list of grain and plant foods that are clear of gluten:
Today, many products from pastas to flours are made from these sources. Keep in mind that it is important to make sure that the approved grains are not processed or mixed with gluten-containing grains, additives or preservatives, as many of them often are. Wheat-free does not always mean gluten-free. To qualify as gluten-free, the final product must contain less than 20 ppm gluten. Many organic or health food stores can help you decipher the labels, and organizations like the Celiac Disease Foundation (www.celiac.org) can provide tools to make your journey easier, such as a list of ingredients to be aware of when purchasing your groceries.
There is always an accompanying risk that overall nutrition will suffer unless the person going gluten-free educates themselves about the best choices to make within the allowed foods. This is because eliminating a commonly eaten group of grains from your diet might create a significant nutritional hole. Gluten-free diets have been known to fall short in fiber, calcium, iron, and B vitamins. There are gluten-free products that are left un-enriched and are quite processed. That's why it is important to check gluten-free product labels for enrichment with nutrients like B vitamins and iron, then make sure that you are replacing naturally - or with supplements - the vitamins that might be missing. This is especially true for women who are pregnant or nursing.
If done right, a gluten-free diet has a potential benefit of shifting your diet to having a greater focus on plant foods that are naturally free from gluten and more “whole”, such as fruits, vegetables, beans, seeds, and nuts. If you are non-vegetarian, be sure to choose unprocessed protein foods like fresh eggs, lean meats, fish, and poultry to keep potential sources of gluten away. If lactose in foods is not a problem for you, most non-fat and low-fat dairy products can also be included. One last important consideration: cross-contamination can occur in your kitchen at home or in restaurants. All food preparation for those with celiac disease must be done in a dedicated area with pans only used for the gluten-free diet.
There are a number of delicious and nutritious gluten-free recipes that you can easily make at home, without paying a premium for special products. Consider spaghetti squash, for example, as a substitute for pasta. To prepare this gluten-free alternative, follow these few simple steps:
- Cut the squash in half length-wise
- Scoop out the seeds and rub the inside with salt and olive oil
- Cook face down in the oven at 400° for 45 minutes or until the flesh is completely tender
- Use the back of a fork to gently lift out the tasty strands of squash
- Serve with your favorite toppings like spaghetti sauce or fresh vegetables