Last spring, I wrote a blog post for Scientific American’s guest blog about gluten sensitivity, a condition in which patients without celiac disease exhibit symptoms, such as bloating or fatigue, that improve with a gluten-free diet.
Much controversy still exists in the media over whether non-celiacs should follow a gluten-free diet. Experts often note that people going gluten-free should work with a doctor or dietitian, as avoiding gluten-containing grain products can also mean missing out on important vitamins and minerals.
What are these vitamins and minerals, and what exactly are gluten-free connoisseurs risking? I decided to investigate. One of the first vitamins I came across was folate, a B vitamin found in many whole grains, vegetables, beans, fruits and fortified breakfast cereals .
Folate is most important for women who are or could become pregnant because having too little of the nutrient can cause serious birth defects to the brain and spine . It’s so important that, in 1998, the Food and Drug Administration began requiring folic acid, a synthetic form of the vitamin, to be added to all products made from enriched grains, which include many cereals, flours, pastas, and breads .
When whole grains are refined, the method used to make products such as white flour, the milling process removes many vitamins, including folate . The term “enriched grains” refers to grain products in which some of these vitamins have been added back . The FDA-mandated addition of folic acid actually actually adds more folate back into these grains than they originally contained, meaning the products are actually "fortified" . ("Enriched" refers to the addition of nutrients that were lost, while "fortified" refers to the addition of nutrients that weren't originally there). This fortification means enriched grains can have more folate than whole grains .
However, many gluten-free grain products are made of neither whole grains nor enriched grains . They often replace gluten-containing whole or enriched grains, with starches, such as potato starch or rice starch . These starches don’t contain the natural folate found in whole grains or the added folic acid in enriched flours .
One study took a look at the gluten-free flours, breads, pastas and cold cereals of 16 companies to see how they compared to their gluten-containing counterparts, in terms of folate. Of 37 gluten-free cereal products, 30 contained lower amounts of folate, compared to fortified, gluten-containing cereals. None of the gluten-free bread or pasta products in the study were enriched with folic acid.
The 2010 Dietary Guidelines recommend 400 mcg folate per day of folate for adults –both men and women. That equals nearly 7 cups of raw spinach or 4 cups of fortified breakfast cereal, though one’s folate should ideally come from a variety of foods . The amount is higher for women who are or could become pregnant – closer to 600 mcg.
Beyond protecting babies, adequate amounts of folate are associated with reduced risk for some forms of cancer . However, supplementing the natural folate one's diet with high doses of synthetic folic acid from fortified foods or supplements may actually put people at risk for colorectal cancer .
So what’s a gluten-free eater to do?
Consider how much folate you're getting. Some gluten-free products are enriched or fortified, so check the nutrition label to see if your favorite gluten-free bread has added folate . FDA requires enriched foods to list folate content on their nutrition labels, although foods with natural folate aren’t required to do so [5,4]. However, other sources of folate still might be a better option, if your gluten-free favorites are made mainly of refined flours (enriched or not) and starches, which provide minimal amounts of other important nutrients, such as fiber.
Naturally gluten-free whole grains can provide some folate. For example, the whole grain quinoa contains about 25 mcg of folate per serving . Veggies and beans can also be a good option – a ½ cup of black-eyed peas has and 4 spears of asparagus each contain around 100 mcg – about 25% of the folate the average person should be getting each day . A multivitamin with folic acid could be another option to consider, especially for gluten-free women who find they're not getting enough folate . Of course, talking with your doctor about these issues is always a good place to start to ensure your diet includes enough folate, but not too much added folic acid.
1. The American Cancer Society 2010 Nutrition and Physical Activity Guidelines Advisory Committee (2012). American Cancer Society guidelines on nutrition and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians, 62 (1). doi: 10.3322/caac.20140 Retrieved from http://onlinelibrary.wiley.com/doi/10.3322/caac.20140/full
2. U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2010). Dietary Guidelines for Americans, 2010. Washington, DC: U.S. Government Printing Office. Retrieved from http://health.gov/dietaryguidelines/dga2010/dietaryguidelines2010.pdf
3. Thompson, T. Folate, iron, and dietary fiber contents of the gluten-free diet. Journal of the American Dietetic Association. 100(11). Retrieved from www.ncbi.nlm.nih.gov/pubmed/11103663
4. Office of Dietary Supplments, National Institutes of Health. (2010). Dietary supplement fact sheet: Folate. Retrieved from http://ods.od.nih.gov/factsheets/Folate-HealthProfessional/
5. “Food Standards: Amendement of Standards of Identity for Enriched Grain Products to Require Addition of Folic Acid, 61 Fed. Reg. 8781-8797 (March 5, 1996) (to be codified at 21 C.F.R. pts. 136, 137, & 139). Retrieved from http://www.gpo.gov/fdsys/pkg/FR-1996-03-05/pdf/96-5014.pdf