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Gluten-Free Living

GOING AGAINST THE GRAIN

SHUTTERSTOCK

For most, going gluten free is an adjustment. Gone are wheat, rye and barley; in their place come rice, quinoa and millet. Gluten-free grains and products made with them can ease the transition to eating gluten free. But what happens when even gluten-free grains cause continued symptoms? Should those with celiac be not only gluten free but grain free as well?

THE WHOLE (GRAIN) STORY

While the grain-free Paleo diet is still trendy, research shows that ancient man most likely ate grains—in particular, oats, millet and sorghum. Today, grains such as corn, rice and wheat make up a little more than half of the calories consumed around the world.

Grains can be whole, refined or enriched. Whole grains—rich in fiber, B vitamins, iron, antioxidants, healthy fats and some protein—contain three distinct parts: the bran, germ and endosperm. Examples of gluten-free whole grains include brown rice, oats and quinoa. Refined grains, which became available with the advancement of milling techniques in the late 1800s, are stripped of their healthy germ and bran. While refining a grain improves the texture and shelf life, it also removes B vitamins, fiber and iron. Enrichment of grains, which began in the 1940s, returned many vitamins and minerals to refined grains, most notably folic acid, an important nutrient for women of childbearing age.

Whole grains have been shown to yield many health benefits, including a reduction in the incidence of type 2 diabetes, high cholesterol, cardiovascular disease and inflammation. A recent randomized controlled trial found that those who consumed whole grains in place of refined grains experienced more significant weight loss and reduction of inflammatory markers in the body.

REAPING THE BENEFITS

But some with celiac continue to experience symptoms despite their best efforts to eat gluten free. Could grains themselves be to blame?

“I worked with one client recently who had ongoing symptoms, both gastrointestinal and non-gastrointestinal related, despite having already excluded gluten, dairy and other problematic foods,” says E.A. Stewart, RD (eastewart.com). “I suggested she try a grain-free diet, and after a couple of weeks, she started feeling much better again—almost like her old self. I’ve had other clients report similar results, although it does not help everyone.”

Stewart states that she most frequently recommends grain-free diets for patients who have non-gastrointestinal-related symptoms. “I work with my celiac disease and gluten sensitive clients to help them follow a diet that is as liberalized as possible. But if they continue to have problems even after following a strict gluten-free diet, I might suggest modifying the diet even more.”

Jessica Beacom, RDN, and Stacie Hassing, RDN, LD, registered dietitians with The Real Food Dietitians (therealfoodrds.com), share similar stories: “In our experience, patients with celiac disease that aren’t responding to the gluten-free diet tend to do well and make greater progress when all grains are removed from the diet.” Beacom and Hassing cite concerns about contamination of naturally glutenfree grains as one reason to consider removing them from the diet. “Sometimes gluten-free grains can be cross-contaminated with gluten, as is the case frequently with oats and millet that aren’t produced or prepared in a dedicated facility and tested appropriately,” says Hassing.

Stewart echoes this concern. “Before moving onto a grain-free diet, I think it’s important to make sure all gluten-free grains are not cross-contaminated with gluten, “ she advises. “A lot of my clients know to buy labeled gluten-free oats, but other naturally gluten-free grains may be contaminated as well.”

Concerns about the purity of naturally gluten-free grains are not new. In 2009, dietitian and gluten-free expert Tricia Thompson (glutenfreewatchdog.com) tested flours that were not specifically labeled gluten free but made with naturally gluten-free grains, such as millet, soy and sorghum. She found significant levels of contamination in some of the samples, indicating that some of the naturally gluten-free grains were at risk for contamination with gluten, either in the fields, transport or manufacturing. (It is important to note that flours specifically labeled gluten free were not found to be contaminated with gluten.) Based on this research, Thompson and other experts recommend eating naturally gluten-free grains and products made with them only if they are explicitly labeled gluten free.

WEIGHING THE EVIDENCE

While some patients have found relief by omitting grains from their gluten-free diet, research to support this practice is still very preliminary. “There was one study recently on the Specific Carbohydrate Diet, which excludes grains, that found it may be beneficial for patients with inflammatory bowel disease,” says Stewart. “I expect we will see more research in the future.” Beacom and Hassing have found that despite the limited evidence, they have had success in advising patients to go grain free when other options fail. “Though there are more and more studies examining the potential benefits of a grain-free, Paleo-type diet, many still employ small sample sizes, and no one has yet to produce a long-term study,” advises Hassing. “That said, several studies are showing promising outcomes, and when combined with a large amount of anecdotal evidence from people who’ve benefited from grain-free diets, it does appear there is merit to the idea when celiac disease is severe and doesn’t respond to just removing gluten.”

FIBER-FULL IDEAS

Constipation is a common complaint for many who go gluten free; omitting grains entirely can potentially slow things even further. “Fiber is firmly associated with whole grain in many people’s minds. When people think about a grain-free diet, it seems impossible to get a sufficient amount of fiber,” says Hassing. “But vegetables, fruits, nuts and legumes have higher fiber content, in many cases, than whole grains.” See “Fiber up the grain-free diet,” above, for Beacom and Hassing’s tips to increase fiber intake without grains.

Stewart also recommends her patients look for other sources of dietary fiber, but if that doesn’t do the trick, she also may suggest a supplement. “I have found that when it comes to supplements, there is no one-size-fits-all solution, so I may recommend supplements made from psyllium husk fiber, acacia fiber, inulin or guar gum.” Stewart advises caution, however, when choosing to take fiber in supplement form, as too much too soon can cause increased digestive discomfort.

BAKING WITHOUT GRAINS

Going grain free doesn’t mean sacrificing taste or texture in baked items, says Stewart. “Almond flour is one of my favorite go-to grain-free flour substitutions. You can make incredibly moist and delicious baked goods with almond flour alone, plus I like that it provides additional fiber and protein.” She also recommends experimenting with other flours. “Other grain-free flours in my arsenal include tapioca flour—which provides a more bread-like texture—cassava flour and arrowroot. I also use coconut flour, but you should only swap a quarter of regular flour with coconut flour, or your baked goods will be like a brick!” Stewart expects to see more grain-free flours available soon. “I recently started experimenting with green banana flour, which provides a source of resistant starch, which has been found to benefit the gut microbiome.”

AWAY FROM HOME

Eating grain free away from home presents many of the same challenges as eating gluten free in restaurants. Beacom and Hassing suggest researching a restaurant’s offerings online or calling ahead: “We recommend choosing a restaurant where you can order a meal that consists of protein, such as chicken, steak or fish, and several veggie options. Entrée salads could also be a good grain-free option, too, but you’ll want to know exactly what the salad contains.” Stewart notes that a grain-free diet can become a challenge in restaurants if someone is also vegetarian or vegan, as options may be even more limited. “I always recommend that my clients keep something portable on hand, such as an energy bar or nuts, in cases where you are caught without any options,” she says. For those who are traveling, Beacom and Hassing recommend packing a cooler. “Keep it filled with grain-free snacks and lunch options, so you don’t have to eat out every meal,” they advise. “Pack veggies and hummus, berries, apples, nuts and seeds.”

MAKING THE TRANSITION

While omitting grains from your diet may improve symptoms for some patients, it’s not easy, notes Stewart. “Giving up grains can lead to a lack of variety, which can lead to boredom with eating, decreased overall food intake and unintentional weight loss.” Stewart also offers a word of caution about over-restricting the gluten-free diet: “I worry about patients who become fearful of everything they eat, which is not healthy and can lead to disordered eating.”

Beacom and Hassing encourage their clients to explore grain-free alternatives to bread, pasta and pancakes. “Finding these substitutes can help clients transition to a grain-free diet,” explains Hassing. “Our job is to help them find ways to incorporate these foods into their diet in a way that helps lessen the feelings of deprivation while not overdoing them to the point of crowding out other healthy foods.”

VEGGIE-LOADED TURKEY CHILI

Courtesy of The Real Food Dietitians, therealfoodrds.com

SERVES 6

Ingredients

1 tablespoon olive oil or avocado oil
1 pound lean ground turkey, beef or chicken
2 large garlic cloves, minced
½ medium onion, diced
1 small red bell pepper, diced
1 small zucchini or yellow squash, diced
1 medium carrot, diced
2 tablespoons chili powder
1 tablespoon cumin, ground
2 teaspoons coriander, ground
1 15-ounce can tomato sauce + ½ can water
1 15-ounce can crushed or petite diced tomatoes
1 15-ounce can black beans, rinsed and drained
1 cup corn, frozen Dash of cayenne, optional Salt to taste

Directions

In a large pot or soup kettle over medium heat, add the oil. Once the oil is hot, add ground meat, garlic, onion, bell pepper, zucchini and carrot. Saute for 7 to 9 minutes, or until meat is cooked and no longer pink.

Add seasonings, tomato sauce, water, tomatoes, beans and corn. Bring to a boil over medium-high heat. Reduce heat to low, cover and simmer for 15 minutes, or until carrots are tender. Serve with toppings of choice and salt to taste, if desired.

Nutrition information per serving: 283 cal, 8 g fat, 33 g carbs, 9 g sugar, 575 mg sodium, 9 g fiber, 22 g protein

STRAWBERRY CHICKEN POPPY SEED SALAD

Courtesy of The Real Food Dietitians, therealfoodrds.com

SERVES 4

Wrapped in a crisp lettuce leaf, this recipe makes for an easy lunch that’s tasty and fresh.

Ingredients

2 cups cubed organic chicken, cooked
½ cup diced strawberries
¼ cup diced red onion
¼ cup diced celery
⅓ cup sliced almonds, toasted*
1-2 tablespoons chopped fresh basil
¼-⅓ cup mayonnaise
2 tablespoons lemon juice
1 teaspoon poppy seeds
Salt and pepper to taste
Leaf lettuce or butter lettuce
Chopped green onion, for garnish, optional

*To toast almonds, place in a small pan over medium heat. Toast until slightly browned, tossing occasionally. This only takes a few minutes, so watch closely.

Directions

In a medium bowl, combine the chicken, strawberries, red onion, celery, almonds and basil.

In a small bowl, combine the mayonnaise, lemon juice and poppy seeds. Gently stir into the chicken mixture. Salt and pepper to taste.

Serving option: Scoop into a lettuce leaf or onto a bed of greens and top with green onions and a few toasted almonds.

Nutrition information per serving: 239 cal, 16 g fat, 4 g carbs, 2 g sugar, 180 mg sodium, 1 g fiber, 21 g protein

TERIYAKI CHICKEN AND PINEAPPLE KEBABS

Courtesy of The Real Food Dietitians, therealfoodrds.com

SERVES 4

Nothing says “summertime” like these grilled chicken and vegetable kebabs with sweet and savory teriyaki sauce.

Ingredients

CHICKEN

1¼ pounds boneless, skinless chicken breasts, cut into 1-inch chunks
2 cups fresh pineapple, cut into 1-inch chunks (about ½ of a small pineapple)
1 large bell pepper, any color, cut into 1-inch pieces
½ large red onion, cut into 1-inch pieces

TERIYAKI MARINADE

¼ cup coconut aminos (gluten-free tamari also works well)
1 tablespoon water
½ teaspoon garlic powder
¼ teaspoon dried ground ginger
1 tablespoon toasted sesame oil

ADDITIONAL EQUIPMENT

Wood or metal skewers

Directions

In a small bowl, whisk to combine all marinade ingredients. Add chicken pieces, toss and coat. Cover and refrigerate while you prep the vegetables and pineapple and the grill preheats.

Preheat grill to medium-high direct heat.

Thread meat, pineapple, peppers and onions onto skewers, alternating as you go.

Brush leftover marinade over the kebabs.

Grill over medium-high direct heat, turning every 5 minutes or so, until the chicken is cooked through and the vegetables are tender. Remove from grill and serve.

Nutrition information per serving: 260 cal, 7 g fat, 16 g carbs, 12 g sugar, 340 mg sodium, 2 g fiber, 31 g protein

CAULIFLOWER TABBOULEH SALAD

Courtesy of The Real Food Dietitians, therealfoodrds.com

SERVES 6

A fresh, grain-free take on a traditional Middle Eastern dish. We’ve replaced the bulgur wheat with lightly sauteed cauliflower “rice” for a gluten-free and Paleo-friendly side dish to serve with your favorite protein or share at your next potluck event.

Ingredients

SALAD

1 tablespoon avocado or olive oil
4 cups riced cauliflower (about a 15- to 16-ounce bag or 1 medium cauliflower, grated)
½ large cucumber, diced
2 stalks celery, diced
4 Roma tomatoes, seeded and diced
4 green onions, white and green parts thinly sliced
¼ cup mint leaves, minced
1 cup fresh parsley, minced

DRESSING

1 clove garlic (finely minced if not using a food processor)
3 tablespoons avocado or olive oil Juice of 1 lemon (about ¼ cup)
½ teaspoon salt, or to taste
¼-½ teaspoon pepper, or to taste

Directions

Place a large skillet over medium heat. Add 1 teaspoon avocado or olive oil. When oil starts to shimmer, add the riced cauliflower and stir. Continue heating and stirring until cauliflower starts to release some of its moisture and is crisp tender (don't overcook it—you want it a little al dente, or toothy). Remove from heat and continue to stir for a couple more minutes to help the moisture evaporate as the cauliflower cools. Spread onto a large plate or baking sheet and set in the freezer while you make the dressing and chop the veggies.

Add dressing ingredients to a blender and blend on high until well combined. (Alternatively, you can finely mince the garlic, then whisk dressing ingredients in a small bowl if you don’t have a blender.)

When cauliflower is cool, place in a large bowl with cucumber, celery, tomatoes, onions, mint and parsley.

Pour dressing over salad and stir to combine. Taste and adjust spices as needed. Serve immediately or refrigerate for 30 minutes to allow flavors to combine.

Store unused portion in a covered container in the fridge for up to 4 days.

Nutrition information per serving: 120 cal, 8 g fat, 11 g carbs, 4 g sugar, 265 mg sodium, 5 g fiber, 3 g protein

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