The Hidden Costs of Gluten-Free: How Ultra-Processed Gluten-Free Foods Outpace Their Gluten-Containing Counterparts
Dear Editor
The popularity of gluten-free diets has increased significantly, driven by the rising diagnoses of gluten-related disorders, such as celiac disease and gluten sensitivity, and the perception of associated health benefits. However, replicating gluten-containing foods' taste, texture, and nutritional value remains challenging. Gluten, found in wheat, barley, and rye, provides elasticity and structure to food. Removing it requires innovative techniques, such as fractionation, washing, or enzymatic hydrolysis, which often alter the nutritional composition of foods [1].
Foods labeled “gluten-free” are often made with naturally gluten-free ingredients such as rice, corn, or quinoa. However, these products frequently lack the nutrients found in gluten-containing grains, such as fiber, iron, and B vitamins [2, 3]. Studies have shown that children [2] and adults [3] following gluten-free diets may experience deficiencies in these essential nutrients. Furthermore, refined starches like rice or tapioca dominate many gluten-free products, increasing the risk of deficiencies that can negatively affect energy levels, cognitive function, and digestive health [4]. Prioritizing nutrient-dense gluten-free foods, such as quinoa, teff, and amaranth, or fortified products, can help mitigate these risks [1].
Research links ultra-processed foods to cardiometabolic disorders, mental health conditions, and increased mortality [5]. Gluten-free diets relying on ultra-processed options, such as packaged cookies and snacks, may pose similar risks. These products often include added sugars, fats, and stabilizers to mimic the properties of gluten, which undermines their nutritional value [6]. The high content of added sugars, fats, and other additives in ultra-processed foods contributes to their poor dietary profile [7]. To maintain health, minimally processed gluten-free foods, such as plain quinoa or roasted chickpeas, should be prioritized [7].
Children with celiac disease face emotional and social challenges due to dietary restrictions, impacting their quality of life and potentially leading to psychological distress [8]. The desire for normalcy often leads families to prioritize convenience, opting for ultra-processed gluten-free products. While these products may facilitate social inclusion, they can reinforce poor dietary habits and nutritional imbalances [4]. Supporting children with celiac disease requires a balance between enjoyable and nutritious food options while addressing their emotional well-being and providing resources to manage the psychosocial impact of the condition [9].
Education is crucial for families managing gluten-free diets. Healthcare professionals and dietitians can teach families to read ingredient labels, identify hidden gluten sources, and select minimally processed options. Tailored meal plans incorporating whole grains, fortified products, and fresh produce can improve nutritional balance [10]. Schools can ensure gluten-free options in cafeterias and educate staff about the needs of children with celiac disease [9]. Public health campaigns should raise awareness about the risks of ultra-processed gluten-free foods and promote healthier choices [6].
In conclusion, a healthy gluten-free diet requires more than simply avoiding gluten—it demands attention to nutritional adequacy, minimizing the intake of ultra-processed foods, and addressing psychological impacts. Families need clear and actionable guidance from healthcare professionals, schools, and public health initiatives. Encouraging minimally processed options, such as fresh fruits, vegetables, and whole grains, is essential for long-term health. By combining education, dietary planning, and public policy, the physical and emotional well-being of those adhering to a gluten-free lifestyle can be effectively supported.
References
1. Melini V, Melini F. Gluten-free diet: Critical review of current nutritional and food safety concerns. Nutrients. 2019;11(10):2670. doi:10.3390/nu11102670.
2. Penagini F, Dilillo D, Meneghin F, et al. Gluten-free diet in children: An approach to a clinical practice. Nutrients. 2013;5(10):4223-4231. doi:10.3390/nu5104223.
3. Kreutz J, Adriaanse M, Van Der Ploeg E, et al. Narrative Review: Nutrient Deficiencies in Adults and Children with Treated and Untreated Celiac Disease. Nutrients. 2020;12. doi:10.3390/nu12020500.
4. Saturni L, Ferretti G, Bacchetti T. The gluten-free diet: Safety and nutritional quality. Nutrients. 2010;2(1):16-34. doi:10.3390/nu2010016.
5. Pagliai G, Dinu M, Madarena MP, et al. Ultra-processed food exposure and adverse health outcomes: Umbrella review of epidemiological meta-analyses. BMJ. 2024;384:e077310. doi:10.1136/bmj-2023-077310.
6. Monteiro CA, Moubarac JC, Levy RB, Canella DS, da Costa Louzada ML, Cannon G. Ultra-processed foods and the need to determine their role in obesity and other chronic diseases. Public Health Nutr. 2018;21(1):1-6. doi:10.1017/S1368980017002419.
7. Fardet A. Minimally processed foods are more satiating and less hyperglycemic than ultra-processed foods: A preliminary study with matched meals. Food Funct. 2016;7(5):2338-2346. doi:10.1039/c6fo00107f.
8. Biagetti C, Naspi G, Catassi C. Health-Related Quality of Life in Children with Celiac Disease: A Study Based on the Critical Incident Technique. Nutrients. 2013;5:4476-4485. doi:10.3390/nu5114476.
9. Simón E, Molero-Luis M, Fueyo-Díaz R, et al. The gluten-free diet for celiac disease: Critical insights to better understand clinical outcomes. Nutrients. 2023;15(18):4013. doi:10.3390/nu15184013.
10. Perez-Junkera G, Simón E, Calvo AE, et al. Importance of an ongoing nutritional counseling intervention on eating habits of newly diagnosed children with celiac disease. Nutrients. 2024;16(15):2418. doi:10.3390/nu16152418.
Competing interests:
No competing interests
01 January 2025
Giovanni Ghirga
Pediatrician
Member of the Scientific Committee of the Italian Branch of the International Society of Doctors for the Environment, Basel, Switzerland
Rapid Response:
The Hidden Costs of Gluten-Free: How Ultra-Processed Gluten-Free Foods Outpace Their Gluten-Containing Counterparts
Dear Editor
The popularity of gluten-free diets has increased significantly, driven by the rising diagnoses of gluten-related disorders, such as celiac disease and gluten sensitivity, and the perception of associated health benefits. However, replicating gluten-containing foods' taste, texture, and nutritional value remains challenging. Gluten, found in wheat, barley, and rye, provides elasticity and structure to food. Removing it requires innovative techniques, such as fractionation, washing, or enzymatic hydrolysis, which often alter the nutritional composition of foods [1].
Foods labeled “gluten-free” are often made with naturally gluten-free ingredients such as rice, corn, or quinoa. However, these products frequently lack the nutrients found in gluten-containing grains, such as fiber, iron, and B vitamins [2, 3]. Studies have shown that children [2] and adults [3] following gluten-free diets may experience deficiencies in these essential nutrients. Furthermore, refined starches like rice or tapioca dominate many gluten-free products, increasing the risk of deficiencies that can negatively affect energy levels, cognitive function, and digestive health [4]. Prioritizing nutrient-dense gluten-free foods, such as quinoa, teff, and amaranth, or fortified products, can help mitigate these risks [1].
Research links ultra-processed foods to cardiometabolic disorders, mental health conditions, and increased mortality [5]. Gluten-free diets relying on ultra-processed options, such as packaged cookies and snacks, may pose similar risks. These products often include added sugars, fats, and stabilizers to mimic the properties of gluten, which undermines their nutritional value [6]. The high content of added sugars, fats, and other additives in ultra-processed foods contributes to their poor dietary profile [7]. To maintain health, minimally processed gluten-free foods, such as plain quinoa or roasted chickpeas, should be prioritized [7].
Children with celiac disease face emotional and social challenges due to dietary restrictions, impacting their quality of life and potentially leading to psychological distress [8]. The desire for normalcy often leads families to prioritize convenience, opting for ultra-processed gluten-free products. While these products may facilitate social inclusion, they can reinforce poor dietary habits and nutritional imbalances [4]. Supporting children with celiac disease requires a balance between enjoyable and nutritious food options while addressing their emotional well-being and providing resources to manage the psychosocial impact of the condition [9].
Education is crucial for families managing gluten-free diets. Healthcare professionals and dietitians can teach families to read ingredient labels, identify hidden gluten sources, and select minimally processed options. Tailored meal plans incorporating whole grains, fortified products, and fresh produce can improve nutritional balance [10]. Schools can ensure gluten-free options in cafeterias and educate staff about the needs of children with celiac disease [9]. Public health campaigns should raise awareness about the risks of ultra-processed gluten-free foods and promote healthier choices [6].
In conclusion, a healthy gluten-free diet requires more than simply avoiding gluten—it demands attention to nutritional adequacy, minimizing the intake of ultra-processed foods, and addressing psychological impacts. Families need clear and actionable guidance from healthcare professionals, schools, and public health initiatives. Encouraging minimally processed options, such as fresh fruits, vegetables, and whole grains, is essential for long-term health. By combining education, dietary planning, and public policy, the physical and emotional well-being of those adhering to a gluten-free lifestyle can be effectively supported.
References
1. Melini V, Melini F. Gluten-free diet: Critical review of current nutritional and food safety concerns. Nutrients. 2019;11(10):2670. doi:10.3390/nu11102670.
2. Penagini F, Dilillo D, Meneghin F, et al. Gluten-free diet in children: An approach to a clinical practice. Nutrients. 2013;5(10):4223-4231. doi:10.3390/nu5104223.
3. Kreutz J, Adriaanse M, Van Der Ploeg E, et al. Narrative Review: Nutrient Deficiencies in Adults and Children with Treated and Untreated Celiac Disease. Nutrients. 2020;12. doi:10.3390/nu12020500.
4. Saturni L, Ferretti G, Bacchetti T. The gluten-free diet: Safety and nutritional quality. Nutrients. 2010;2(1):16-34. doi:10.3390/nu2010016.
5. Pagliai G, Dinu M, Madarena MP, et al. Ultra-processed food exposure and adverse health outcomes: Umbrella review of epidemiological meta-analyses. BMJ. 2024;384:e077310. doi:10.1136/bmj-2023-077310.
6. Monteiro CA, Moubarac JC, Levy RB, Canella DS, da Costa Louzada ML, Cannon G. Ultra-processed foods and the need to determine their role in obesity and other chronic diseases. Public Health Nutr. 2018;21(1):1-6. doi:10.1017/S1368980017002419.
7. Fardet A. Minimally processed foods are more satiating and less hyperglycemic than ultra-processed foods: A preliminary study with matched meals. Food Funct. 2016;7(5):2338-2346. doi:10.1039/c6fo00107f.
8. Biagetti C, Naspi G, Catassi C. Health-Related Quality of Life in Children with Celiac Disease: A Study Based on the Critical Incident Technique. Nutrients. 2013;5:4476-4485. doi:10.3390/nu5114476.
9. Simón E, Molero-Luis M, Fueyo-Díaz R, et al. The gluten-free diet for celiac disease: Critical insights to better understand clinical outcomes. Nutrients. 2023;15(18):4013. doi:10.3390/nu15184013.
10. Perez-Junkera G, Simón E, Calvo AE, et al. Importance of an ongoing nutritional counseling intervention on eating habits of newly diagnosed children with celiac disease. Nutrients. 2024;16(15):2418. doi:10.3390/nu16152418.
Competing interests: No competing interests