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Can a gluten free diet cause malnutrition?
by Frann Leach
A gluten free diet is not something anyone will take up just for fun, as unless you have a sensitivity to gluten, it is of no benefit.
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Of course, sometimes the only way to find out if you are gluten intolerant is to exclude it from the diet for a period of time, and see if the symptoms you suspect it may be causing go away. [Gluten intolerance is also often linked to other intolerances, such as to dairy products. ed]
The foods which contain gluten are all grains of one kind or another, principally wheat, rye and barley, as well as products derived from them, such as malt, wheat germ, semolina, etc. If you eat these and you have celiac disease you don't absorb the nutrients; they cause damage to your intestine and sometimes other problems as well. The situation is similar in other forms of gluten intolerance. For this reason, gluten is of no nutritional value to people suffering from gluten intolerance, quite apart from the damage it may be causing. In fact, one of the signs used in the initial diagnosis of celiac disease is nutritional deficiency.
Obviously, if you can't get any nutritional benefit from gluten AND it's doing you damage, then a gluten free diet is a necessity, but there are important nutrients which in a normal diet would be obtained from wheat and the rest, which will need to be considered when deciding what to use as a substitute. Although you may be able to get similar bulk, taste and properties as an ingredient, the nutrients will be different, and you have to be aware of this, and make adjustments elsewhere.
In the UK, all wheat flour except wholemeal is fortified with iron, thiamin, niacin and (for most types) calcium by law. Whole wheat flour naturally contains useful quantities of magnesium, niacin and folate, as well as selenium in some cases (depending on where it is grown). White flour also contains around 10% protein. None of these nutrients are available to someone who is gluten intolerant, and deficiencies of vitamins D and K, folic acid, calcium, iron, magnesium, and zinc, as well as essential fatty acids, are common due to interference with the absorption of other food.
Even after following a gluten free diet for over a year, many people still suffer from various vitamin and/or mineral deficiencies. It's probably a good idea for anyone, but particularly someone on a gluten free diet, to eat some fish or take a fish oil supplement every day and supplement with a good one-a-day multivitamin and mineral supplement (making sure that it is labelled as gluten free). If you look for selenium on the label, that indicates that it is probably a good mix.
Anyone on a gluten free diet will have become aware of just how much the standard diet relies on flour and other wheat, rye and barley derivatives. It's quite difficult to fill a shopping trolley with gluten free food in the average supermarket, even though many do make an effort to provide a small selection of such products on a couple of shelves at the back of the store. Because in the main, the store's grocery buyers do not have this condition, the selection available is usually small, and may consist of items which are picked with little regard for quality, purely on grounds of easy availability.
Because wheat and its derivatives are so versatile, substitutes for wheat and its partners in crime are many and varied, depending on exactly what they are being used for. For example, gram or chickpea flour (besan or garbanzo flour in the US) makes a great batter for coating vegetables or small pieces of meat, rice flour can be used to make pancakes and for thickening gravy and sauces, buckwheat flour is often used in baking.
We don't have millennia of experience of this type of cooking, so we can't rely on recipes and methods handed down from one generation to the next to balance our diet, but by watching our bodies, and taking note of information we find on packets and elsewhere, it becomes easier.
A gluten free diet won't cause malnutrition in somebody who needs to be on it, rather the reverse. But nobody should eat gluten free if they don't need to either for diagnostic or health reasons.
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