Healthy Gluten-Free Eating
It can be challenging to find balance in a gluten-free diet, but it's a skill you can learn. Empower yourself first with knowledge: learn which nutrients you'll need to pay attention to, and familiarize yourself with the foods you love that contain them. Soon, you'll have the instincts to reach for the foods that keep you healthy and feeling great!
Tips for healthy gluten-free eating
What Everybody Needs
The MyPyramid guidelines give a good snapshot of what a balanced diet looks like, gluten free or not. Every one of us should be getting foods daily from all the food groups: grains, vegetables, fruits, milk and other dairy foods, meat and beans, and fats and oils (Visit www.mypyramid.gov for more guidance on serving sizes and a range of servings you can aim to eat daily).
For someone avoiding gluten, of course, the most challenging pyramid piece is the grains group-containing breads, cereals, pastas and starchy vegetables (not in the grain group of the food pyramid). But within each of those categories, there are plenty of gluten-free choices, from rice, potatoes and corn to the ever-growing selection of gluten-free breads, cereals and pastas now available.
Eating the right amount of calories to stay in a healthy weight range is important for just about everyone - and even more so if you have celiac disease. While the reasons aren't yet clear, studies show that people with celiac disease are more likely to be overweight.1 Your health care team can help you plan how to balance what you eat with regular physical activity.
What to Watch
Having celiac disease or gluten intolerance can raise your risk for being deficient in certain nutrients. That's because celiac disease can damage your intestinal tract, reducing its ability to absorb nutrients. (Sticking with a gluten-free diet can help, of course, by preventing further damage and allowing your system to heal.) Another factor: Simply eating a more limited diet increases the chances that you'll miss out on something your body needs. So you'll need to be aware of those vitamins, minerals and nutrients that you're more likely to lack,2, 3 and focus on getting more of the foods that contain them. Your doctor may also recommend you take supplements as extra insurance. Here are some of the key concerns - and foods4 - to keep on your radar screen.
Iron: This mineral is vital for making hemoglobin, which transports oxygen into your body's cells. Iron deficiency (anemia) is one of the more common problems found with celiac disease, so make an effort to eat iron-rich foods daily such as meats and poultry, fish, beans, raisins and iron-fortified gluten-free breads and cereals. Vitamin C can help your body absorb iron better, so include plenty of C-rich foods like citrus fruits and juices, peppers, kale, and tomatoes.
B vitamins: This family of vitamins plays many key roles in the body, including helping our cells use energy and in building new cells. Research has shown that people with celiac disease are at risk being deficient in some B vitamins.5 Especially important to watch is folate, needed for making red blood cells. It's found in vegetables (think foliage) and fruits (particularly citrus), beans, and nuts. Some foods are also fortified with folic acid, the synthetic form of folate - but unfortunately, eating gluten free means missing out on one of the most widely consumed fortified foods: wheat-based flour and the breads, cereals and other foods made from it.6 When buying gluten-free versions of these foods, read labels and choose fortified types whenever possible.
Another B vitamin of concern in celiac disease is vitamin B12 (cobalamin), which is vital in the development of red blood cells, and in maintaining a healthy nervous system. Having celiac disease can affect your ability to absorb B12; what's more, our ability to absorb the vitamin also naturally declines as we get older. B12 is found in animal-based foods like meat, poultry, eggs and dairy products, so you're vegan you'll need to be extra vigilant;7 look for B12-fortified foods and supplements that are also gluten-free.
Calcium: Getting enough of this bone-building mineral is especially important when you have celiac disease, since there's a greater risk of developing low bone mineral density (weak bones). The best sources are dairy products (see "Dairy Dilemmas," below, if you have trouble tolerating them) - but you'll also find calcium in dark leafy greens, broccoli, tofu (calcium-processed), and canned salmon and sardines.
Dairy Dilemmas: If you were recently diagnosed with celiac disease, you may also have trouble digesting lactose, the sugar naturally found in dairy foods. That's because celiac disease can damage the cells in the small intestine that produce lactase, the enzyme the body uses to break down lactose. Choosing lactose-free or lactose-reduced dairy products can help in the beginning. But chances are, as you follow a gluten-free diet and your intestinal tract heals, your lactase-producing cells will be able to function again. After a while, you may find that you can tolerate dairy products much better - and maybe even take them off your "avoid" list. You can also try these strategies to help make dairy foods easier to tolerate:
- Choose fermented dairy foods, such as yogurts with live and active cultures, and aged cheeses. Fermentation breaks down the proteins and sugars in milk and makes it easier to digest.
- Start with small amounts - say, a quarter-cup of yogurt - and see how you feel afterwards. You can gradually build up to more.
- Eat dairy foods with other foods, so that your body processes them more slowly, allowing more time for digestion.
- Be consistent. Don't skip dairy for a long time (say, more than a week). Consistent exposure to lactose may help you adapt to consuming dairy.
Whole Grains: Foods made with whole grains contain all the vitamins, minerals, fiber and other nutrients found in all parts of the grain kernel. These wholesome foods are so important to good health that the U.S. Dietary Guidelines recommend that everyone get at least three servings of whole grain foods daily.8 If you're avoiding gluten it can be harder to meet that goal, since several types of grains are off limits.9 So make an effort to seek out whole versions of gluten-free grains like brown rice and corn (including whole grain hominy, grits and cornmeal). Why not try some less common gluten-free whole grain alternatives? Amaranth, millet, quinoa, and sorghum are wholesome and delicious! Look for products labeled with a "whole grain" stamp,10 which helps you easily identify foods that contain whole grains.
Fiber: Fiber is the part of plant foods that our body doesn't digest, and it's vital to keeping your digestive tract running smoothly and in helping protect your heart. Fiber also helps you feel full without adding any calories, so it can help you manage your weight. But if you're eating gluten free, you're not getting fiber from the places most people do: wheat-based breads, pastas, and cereals. You don't have to miss out, however, if you get plenty of plant foods in your diet. Load up on vegetables and fruits, eat nuts regularly, and when you choose gluten-free grains and seeds, choose whole versions whenever possible. Look for gluten-free cereals, pastas, breads and other products with extra fiber added - they're getting easier to find.
In fact, digging into a healthy balanced diet is easier than you think. Best of all, you'll feel the results as you heal and find that positive energy that comes from taking good care of yourself. It's a win-win for your body and your soul.
Author Joyce Hendley, who holds a Master's in Nutrition, is a freelance health writer and contributing editor at EatingWell magazine.