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Whole Grains and the Gluten-Free Diet

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THE CELIAC DIET, SERIES #2 Carol Rees Parrish, R.D., M.S., Series Editor Whole Grains and the Gluten-Free Diet Amy E. Pagano Recent attention to whole grains has increased with the Dietary Guidelines for Ameri- cans 2005 recommendation to eat at least three servings of whole grains daily. This new emphasis follows research linking whole grains to reduction of chronic disease risk. The American population in general is not meeting this recommendation. For a person diagnosed with celiac disease, a gluten-free diet and the elimination of one of the most common grains in the U.S. makes meeting those recommendations even more chal- lenging. Many gluten-free whole grain options are available and several are exception- ally nutrient dense. Familiarity with these grains, however, is limited. Educating patients on gluten-free whole grains and helping them to incorporate these foods can improve the nutrient profile and add fiber to a gluten-free diet. INTRODUCTION of the grain, known as the bran, contains fiber and a rains, the edible portions of cereal grasses in the large percentage of the B vitamins. The germ is actu- Gramineae family, have been an indispensable ally the embryo of the seed and contains unsaturated Gsource of food for millennia (Table 1). Botani- fat, vitamin E, some protein, minerals and B vitamins. cally, grains are complete fruits, containing both the The endosperm is designed to function as the food sup- fruit and seed of the plant. The term whole grain is ply for the germ and therefore is made up mostly of generally used to refer to a grain or grain product that carbohydrate and protein with some B vitamins. Since contains all three of its main parts (endosperm, bran the bran and most of the germ are removed during the and germ), either intact, or in the same relative pro- refining and milling of grains, the majority of fiber, portion as the original grain. The outer protective layer mineral and vitamin content are lost. Other beneficial phytonutrients such as lignans, phytoestrogens and Amy E. Pagano, M.S., R.D., Outpatient Nutritionist, phenolic compounds are removed as well. University of Virginia Health System, Charlottesville, Historically, the invention of the roller mill allowed VA. for more efficient separation of the germ, bran and 66 PRACTICAL GASTROENTEROLOGY • OCTOBER 2006 Whole Grains and the Gluten-Free Diet THE CELIAC DIET, SERIES #2 endosperm and made refined grains more readily avail- Table 1 able. This refinement originally flourished because Gluten-Free and Gluten-Containing Grains removal of the lipid portion (in the germ) prevented the oxidation of unsaturated fats and spoilage of grains Gluten-free grains Gluten-containing grains when exposed to prolonged air and light. Prior to the days of refrigeration and rapid transportation, this Amaranth* Barley proved beneficial. Refined grains were also seen as Buckwheat* Rye symbols of purity and greater wealth. These distinc- Corn Wheat tions only added to the popularity of refined grains, a Millet popularity that unfortunately still lingers today. Oats** Data from the 1994–1996 United States Depart- Rice ment of Agriculture (USDA) Continuing Survey of Quinoa* Food Intakes by Individuals showed the average intake of whole grains in children, adolescents and adults to Sorghum be one serving or less per day (1,2). This falls short of Teff the recommended minimum of three servings as put Wild Rice forth in the Dietary Guidelines for Americans 2005 (3). This newest set of guidelines, published jointly by the *Not a true cereal grain; **High risk of gluten contamination. USDA and the Department of Health and Human Ser- vices, and its accompanying MyPyramid Food Guid- ciencies in the general population, they are nonetheless ance System (www.mypyramid.gov) make use of the important. Especially since many gluten-free whole catch phrase make half your grains whole. This recom- grains are packed with higher levels of fiber and min- mendation stems from an association between whole erals than the more familiar grains, and provide an grain intake and reduced risk of chronic disease includ- opportunity to further enrich the diet (Table 2). One ing cardiovascular disease and type 2 diabetes (4,5). will find the information below on gluten-free grains is also applicable to the general population and need not be limited to those with celiac disease. GLUTEN-FREE DIET A strict gluten-free diet is currently the only treatment for celiac disease and requires the complete removal of PREPARING GRAINS all wheat, rye and barley products. This quickly elimi- Cooking whole grains involves rinsing the grain in nates one of the most common sources of both refined cold water, adding it to an appropriate amount of and whole grain products in the U.S. Gluten-free water, bringing to a boil and simmering covered and replacements for cereals and baking mixes are often undisturbed for a specified amount of time. See Table made up of a combination of cornstarch, potato starch, 3 for specifics for each grain. While simmering on low tapioca starch and/or white rice flour. The nutrient heat, grains typically do not need to be stirred. Once all composition of these products pale in comparison to the water is absorbed, remove from heat and let sit for those made from whole grains. Even refined gluten- about five minutes before serving. The amount of containing products can be more nutrient dense grain will typically double or triple in size when because they are fortified with iron, thiamine, cooked (i.e. 1 cup of dry quinoa will produce approxi- 1 riboflavin, niacin and folate to replace the losses in the mately 2 ⁄2 –3 cups of cooked quinoa). Other liquids, refining process. Refined gluten-free products are typ- such as chicken or vegetable stock, juice or milk can ically not enriched. Although the research is limited, be used instead of water to add flavor. low intakes of fiber, calcium and iron (in women) have Since most whole grains require a longer cooking been found in the celiac population (6,7). While these time than refined grains, time saving methods are often findings are not necessarily any different from defi- necessary for busy lifestyles. Pressure cookers are pots PRACTICAL GASTROENTEROLOGY • OCTOBER 2006 67 Whole Grains and the Gluten-Free Diet THE CELIAC DIET, SERIES #2 Table 2 Nutrient Content of Gluten-Free Whole Grains Grain Fiber CalciumIron MagnesiumZinc Thiamine Riboflavin Niacin Folate (1 cup raw) (g) (mg) (mg) (mg) (mg) (mg) (mg) (mg) (mcg) Amaranth 18 298 14.8 519 6.2 0.16 0.41 2.5 96 Buckwheat 17 31 3.7 393 4.1 0.17 0.72 11.9 51 Millet 17 16 6.0 228 3.4 0.84 0.58 9.4 170 Oats 16.5 54 7.4 276 6.2 1.19 0.22 1.50 87 Rice, brown 6.5 63 3.4 272 3.8 0.79 0.08 8.19 38 Quinoa 10 102 15.7 357 5.6 0.34 0.67 5.0 83 Sorghum 12 54 8.5 n/a n/a 0.46 0.27 5.6 38 Teff* 11 331 12 342 8.8 0.70 0.20 2.7 135 Wild rice 9.9 34 3.1 283 9.5 0.18 0.42 10.8 152 Compare to Wheat: Wheat, durum n/a 65 6.7 276 8.0 0.80 0.23 12.9 83 All data, unless otherwise noted, obtained from USDA National Nutrient Database for Standard Reference at http://www.nal.usda.gov/fnic/foodcomp/search/ *Data obtained from Gluten-Free Diet: A Comprehensive Resource Guide by Shelley Case with lids that seal. With the steam trapped inside, pres- grains are best kept in airtight containers and stored in sure builds, temperatures rise and foods cook quicker. If a cool, dark and dry environment. Most intact grains using a pressure cooker to cook whole grains, use one- can be stored at room temperature for up to a year if the half cup less liquid than normal and shorten the cooking above conditions are met. Millet and oats, however, are time by half. Batch cooking is another time saver. Dou- best used within two to three months. It is recom- bling a recipe will create enough for leftovers for the mended that whole grain flours, unless used within one next day’s lunch or freeze and reheat later in the week. month, be kept in the refrigerator (up to six months) or It is also useful to cook a larger amount of plain grain the freezer (up to one year) as they are more suscepti- for use in two or more different recipes. For example, ble to oxidation. It is not necessary to bring the flour to cook a double batch of millet and use half immediately room temperature before using in a recipe; the flour can to make millet “polenta” or other dinner recipes and use be used directly from the refrigerator or freezer. the rest the following morning for a breakfast cereal mixed with fruit, nuts and/or seeds and milk. GLUTEN-FREE GRAINS There are a variety of gluten-free whole grains avail- STORAGE able, each with its own unique texture and flavor, Storage of whole grains also warrants mention. The including corn, millet, oats, brown rice, sorghum, teff unsaturated fat content of whole grains is small but sig- and wild rice. All of the above grains will be high- nificant for storage purposes and thus whole grains lighted below except for corn, which is already famil- have a shorter shelf life than refined grains. Whole (continued on page 70) 68 PRACTICAL GASTROENTEROLOGY • OCTOBER 2006 Whole Grains and the Gluten-Free Diet THE CELIAC DIET, SERIES #2 (continued from page 68) ranth flour to baked goods will Table 3 Cooking Gluten-Free Whole Grains boost the nutrient content as ama- ranth has a significantly higher Grain (1 cup dry) Water (or other fluid) Cooking Time content of minerals (especially calcium, iron, magnesium and Amaranth 2 cups 20–30 minutes zinc) and fiber than other whole 1 Buckwheat 2–2 ⁄2 cups 15–20 minutes grains.
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