The Gluten Free Diet: How to Eat Healthy Gluten-Free

    
Kiah Connolly, MD

It’s no surprise that people who are allergic to gluten need to avoid eating it. This includes people with celiac disease and other gluten intolerances. Many other people simply prefer to live their life glutenless. 

A gluten-free diet can absolutely be healthy and sustainable. But because gluten is found in so many food types, it’s easy to exclude important nutrients when eating strictly gluten-free. It’s also easy to accidentally eat gluten. 

Whatever your reason is for eating gluten-free, learn how to do it right: make sure you’re getting the nutrients you need and make sure you’re not accidentally eating unwanted gluten. 

What is Gluten?  

Although commonly referred to as a grain, gluten is made of two proteins found in wheat, rye and barley - as well as certain food additives. 

 

The two proteins in gluten are called gliadin and glutenin.

The word gluten literally translates in latin to “glue” -  which is a great description of how gluten works in food and why it is such a desirable ingredient in some processed foods. The classic example of this is dough - glutenin contributes to the chewy sensation of dough and gliadin helps it rise. 

Gluten Allergy

Some people are allergic to these proteins. If you do have an allergy to gluten it is certainly bad for your health. 

The most common form of this allergy is celiac disease. Celiac disease is an autoimmune disorder that is triggered by gluten.

If someone with celiac disease eats food with gluten, it leads to damage in their small intestines and can cause many problems including serious malnutrition.

A skin condition can also be caused by gluten allergy, called dermatitis herpetiformis.   

Some people also have concerns that being sensitive to gluten is a cause of a variety of other health conditions, such as autism. While there isn’t any evidence to date that shows gluten causes these conditions, some people choose to try going gluten-free to see if it helps them feel better.

If you’re like many people that are going gluten-free, more power to you!  But it’s important that you also make sure you’re not missing out on important nutrients in the process.

Exactly What is Gluten-Free & How to Avoid Gluten

In the strictest sense a gluten-free diet means not eating any products containing a significant amount of gluten. ‘Significant amount’ is stated because many products are often processed with other foods that do contain gluten - and this can lead to the contamination of otherwise gluten-free foods.

Facilities marketing gluten-free products often address this contamination issue by guaranteeing a certain threshold of gluten contamination by the term “parts per million” (ppm). This “ppm” is really just a fancy way of quantifying how much gluten (however tiny) may be allowed in a food product for it to still be considered gluten-free.

The Food and Drug Administration (FDA) requires products that are labeled as “gluten-free” to contain less than 20 ppm gluten. 

So where did they get this number?! The FDA came up with 20 ppm because there is scientific literature that supports this as a safe amount of gluten for even highly allergic individuals to consume. It's also so difficult to detect anything less than 20 ppm that the FDA did not feel reporting levels lower than this would be reliably accurate.

Of course some foods that are produced in an allergy friendly facility or have never come into contact with any gluten residue can contain zero ppm. These foods aren’t always labeled because they are naturally gluten free and include many fruits, vegetables, and proteins.

Is Gluten Good For You?

Unless you are allergic, a gluten-free diet will not in of itself promote weight loss or improve your health. 

Contrary to what popular diet trends would like you to think, many foods that contain gluten can absolutely be good for you!

In fact, if you don’t have an allergy to gluten, it’s not recommended that you avoid it in your diet. Research continues to show that gluten filled whole grains have many health benefits including reducing the risk of heart disease, diabetes, obesity,  and even some cancers (1,2,3,4,5,6).

Higher whole grain consumption has even been associated with a decreased risk of total mortality (7). These healthy grains are also loaded with important nutrients and may have antioxidant properties to help support the immune system in individuals not allergic to gluten (8,9).

 

It’s probably not the gluten per se that provides the health boost we know about from these whole grain foods. Some research does suggest that cutting out gluten when it’s not medically necessary might negatively affect your gut health (10). However, there is also certainly not enough science suggesting gluten in of itself provides you with any benefit - and much more research would be needed to make any such conclusions. 

Looking for a healthy diet and don’t have a gluten allergy? 

A suggestion would be to try starting with a balanced approach that includes lean proteins, heart healthy fats, fruits, vegetables, and whole grains while minimizing refined carbohydrates and sugar. These modifications alone can make a world of difference in getting you to just 'feel better' while still maintaining the health benefits whole grains offer.

Are all Gluten Foods Good for You? 

Definitely not.

Although many whole grain superfoods include gluten, it can also be found in many heavily processed less healthy foods - such as high sugar desserts and refined grains. Eliminating these unhealthy gluten options may be why many people can report feeling better off of gluten, even if they don’t have a gluten allergy.

How to Eat Healthy on a Gluten-Free Diet

You can absolutely have a robust and healthy lifestyle gluten-free, whatever your reasoning. 

However, eating gluten-free can make it harder for many people to get all of the nutrients they need due to so many food restrictions. It can be very challenging to find the right foods for a balanced diet that include all of the required nutrients and are certified gluten-free. In fact this can be the most difficult part of getting good nutrition without gluten. 

Bottom line: you can consume a healthy and balanced diet with or without gluten. What’s important is that you get all the necessary nutrients in a personalized diet that is right for you 


Are There Any Health Disadvantages of a Gluten-Free Diet?

 

People with true gluten allergies must commit to gluten-free eating. However, there can be disadvantages to strictly eating gluten-free in people without a confirmed gluten allergy. 

It’s important to remember that gluten-free and nutritious do not always go hand in hand. Just because something is free from gluten does not make it good for you.

 

There have been some studies linking gluten-free diets to an increased risk of health problems, such as type 2 diabetes and heart disease (11, 12). This could be due to a decreased intake of heart healthy grains. It also could be that eating healthy well balanced food can just be more difficult gluten-free, especially if you aren’t equipped with the right information.  

With the emergence of the gluten-free fad there is a tremendous amount of publicity and financial incentives for products to advertise and equate gluten-free to healthy. This absolutely isn’t true.

For example: french fries, potato chips, sugar filled treats, and many foods with high saturated fats may all be naturally 'gluten-free'. However, these are clearly not healthy options. So don’t be fooled by the massive marketing ploys by the food industry to get you to think otherwise. Always read labels and look at the nutritional content of what you consume.

If your intent is to be both healthy and gluten-free, make sure you’re checking the nutrient facts. Always read the ingredients to look at added sugar, saturated fats, calorie content and the serving sizes of products you're perusing along the isle.

Getting Good Nutrition Without Gluten

You don’t have to be a nutritionist to create your own great gluten-free diet. But you do need to know a few basics to make sure you’re not missing out on important nutrients. 

Healthy Gluten-Free Food

Strictly eating gluten-free products can feel overwhelmingly limiting at first. 

There are plenty of healthy foods that are naturally gluten-free including: 

  • Fruits and vegetables 
  • Meat (poultry, fish, red meat) 
  • Gluten-free whole grains 
  • Nuts
  • Cheese (except blue cheese) 
  • Seeds 
  • Legumes (beans)
  • Cottage Cheese 
  • Yogurt

Eating Whole Grains Gluten-Free

Eating unrefined whole grains has time and time again been shown to have massive positive benefits on our health (13). But just because you’re cutting out gluten doesn’t mean you have to leave behind the powerhouse of health gains that all whole grains have to offer. 

Instead of wheat, barley and rye you can choose to include alternative gluten-free grains as a regular part of your diet - such as quinoa, brown rice, corn, millet, buckwheat and oats.

Bottom Line: Quinoa, brown rice, corn, millet, buckwheat and oats all offer the health benefits of whole grains - gluten-free. 

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Nutrients Not to Miss on a Gluten Free Diet

To help us meet all of our nutrient needs, various common food products are infused with vitamins and minerals that can be otherwise easily missed from our diet. 

Fortified Foods

The term “fortified” is used to describe adding these nutrients to food products. Many gluten containing whole wheat products were chosen to be fortified with these vitamins and minerals, which is one of the reasons why nutrient deficiencies can occur on a gluten-free diet.

Common Nutrient Deficiencies in Gluten-Free Diets & How to Avoid Them

Important nutrients that are frequently low in a gluten-free diet include calcium, fiber, iron, vitamin D and various B vitamins. The good news is that you can still get all of these nutrients gluten-free - you just have to know where to find them. 



Nutrient

Deficiency

Gluten Free Source

Calcium

  • Osteopenia*
  • Dairy
  • Orange Juice (Fortified)
  • Tofu
  • Salmon

Vitamin D

  • Osteopenia/Rickets*
  • Sunshine
  • Fish
  • Eggs
  • Orange Juice
  • Dairy (Fortified)

Iron

  • Anemia*
  • Fatigue
  • Restless Legs
  • Skin Changes
  • Generalized Weakness
  • Meat
  • Spinach
  • Kale
  • Fish
  • Dried Fruit

Fiber

  • Constipation
  • Beans
  • Leafy
  • Greens
  • Brown Rice
  • Sweet Potatoes

Vitamin B1

(Thiamine)

  • Fatigue
  • Irritability
  • Generalized Weakness
  • Gluten Free Soybeans
  • Gluten Free Legumes
  • Macadamia Nuts
  • Asparagus

Vitamin B2

(Riboflavin)

  • Anemia
  • Rash
  • Glossitis*
  • Eggs
  • Green Vegetables
  • Mushrooms
  • Almonds
  • Dairy

Vitamin B3

(Niacin)

  • Fatigue
  • Irritability
  • Pellagra
  • Meat
  • Fish
  • Potatoes
  • Sunflower Seeds
  • Mushrooms

Vitamin B6 (Pyridoxine)

  • Rash
  • Swollen Tongue
  • Cracked Lips
  • Fatigue
  • Decreased Energy
  • Irritability
  • Anemia*
  • Garbanzo Beans
  • Bananas
  • Poultry
  • Fish
  • Potatoes
  • Pistachios

Vitamin B12

  • Anemia*
  • Fatigue
  • Glossitis
  • Sensation Changes
  • Mood Changes
  • Meat
  • Fish
  • Dairy

*Osteopenia / Rickets = Weak Bones; Anemia = Low Hemoglobin Blood Count, Glossitis = Enlarged Tongue

Vitamin supplements can also be helpful. But remember, it’s all about getting the right amounts of what you need; there is such a thing as too many vitamins! Vitamin toxicity can occur when taking too many of these supplements and this is also bad for your health. So always take vitamin supplements only as directed.

Calorie Counting 

The same basic concepts that apply to all diets also of course apply to gluten-free. Effectively managing weight will always involve balancing how many calories you consume with how many you burn. Keeping track of this balance to maintain a healthy weight is a cornerstone of everyone’s well-being. 

Bottom Line: A healthy gluten-free diet involves eating certified gluten-free foods at the right portion sizes to fit your calorie needs and nutrient dense foods that include key micronutrients our bodies need to thrive. 

 

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