Gluten-Free and Dairy-Free Diets

Suggested Citation: Garko, Michael (2018, August). Gluten-free and dairy-free diets.  Retrieved from www.letstaknutrition.com.

Gluten-Free and Dairy-Free Diets

Dr. Michael Garko, Ph.D.

Host & Producer Let’s Talk Nutrition – Health Talk Radio for the 21st Century

I grew up at a time in America when the health benefits of cow’s milk went unchallenged and milk was considered the next best thing to mother’s milk (keeping doors unlocked and windows open at night was also viewed as safe). Wheaties was (and still is based on the marketing) the Breakfast of Champions. And serving the two together was among the healthiest and most nutritious things parents could do for their children. As an aside, as a kid I always found Wheaties (Champions or not) to be too dry and requiring too much sugar, and, thus, preferred Cheerios with ice cold milk and fresh fruit.

Much has changed since then. Now grains and milk are under attack by those some would call food and dietary heretics, calling for grain-free, gluten-free and dairy-free diets. There is now Grain Brain and Wheat Belly that are treated as syndrome-like.

There are legitimate health and dietary reasons for gluten-free and dairy-free diets to be promoted and recommended, especially for those who have real sensitivities to gluten and dairy and suffer from celiac disease or are lactose intolerance. However, as with most well-meaning trends in the world of diet and nutrition, things can go haywire. The internet is replete with unsubstantiated claims about a gluten-free diet even though 98% of the general population is without wheat issues (see Greger & Stone, 2015). There are those who go on a gluten-free diet but do not suffer from celiac disease or do not have a non-celiac gluten sensitivity. They believe that such a diet is what the doctor ordered because they do not want to suffer from a Grain Brain, Wheat Belly or Sour Dough Derriere (I made the last one up).

In sum, although celiac disease is relatively rare afflicting less than one percent in the general population (Greger & Stone, 2015; Rubio-Tapia et al., 2012) and there is a paucity of double-blind clinical trials focusing on non-celiac gluten sensitivity, recommending gluten-free diets for those afflicted with celiac disease, a wheat allergy or a wheat sensitivity diagnosis is what the functional medicine health-care provider ordered.

In terms of dairy, there is a robust and sometimes acrimonious back and forth regarding the health benefits versus the deleterious effects of milk and dairy products that will not be resolved here. For example, Kongerslev et al. (2016) assessed the scientific evidence primarily from meta-analyses of observational studies and randomised controlled trials, on dairy intake and risk of obesity, type 2 diabetes, cardiovascular disease, osteoporosis, cancer and all-cause mortality. They concluded, “The totality of available scientific evidence supports that intake of milk and dairy products contribute to meet nutrient recommendations, and may protect against the most prevalent chronic diseases, whereas very few adverse effects have been reported” (Kongerslev et al., 2016, p. 11). On the other hand, other studies have found a relationship between consumption of dairy products and increased risk for prostate cancer (Lu et al., 2016), breast cancer (Galván-Salazara et al., 2015), ovarian cancer (Qin et al., 2016) and heart failure (Heli et al., 2018).  In sum, studies examining the connection between dairy products and different health outcomes have not produced clear and decisive findings unequivocally supporting the consumption of dairy products or their avoidance.

Even though there is not a robust body of research to confirm or disconfirm the theory of gluten-free and dairy-free diets, my recommendation to a person suffering from gluten or dairy sensitivities would be to follow the protocol for gluten-free and dairy-free diet under the supervision of a healthcare provider.

Gluten is not only found in grains. There is an increase in gluten-containing foods other than grain-based products.

The following is a verbatim list of products containing gluten (see Celiac Disease Foundation, 2018.)

 

Gluten-Containing Grains and Their Derivatives

 

  • Wheat
  • Varieties and derivatives of wheatsuch as:
    • wheat berries
    • durum
    • emmer
    • semolina
    • spelt
    • farina
    • farro
    • graham
    • KAMUT® khorasan wheat
    • einkorn wheat
  • Rye
  • Barley
  • Triticale
  • Maltin various forms including: malted barley flour, malted milk or milkshakes, malt extract, malt syrup, malt flavoring, malt vinegar
  • Brewer’s Yeast
  • Wheat Starchthat has not been processed to remove the presence of gluten to below 20ppm and adhere to the FDA Labeling Law

 

Common Foods That Contain Gluten

 

  • Pastas:
    • Faviolis, dumplings, couscous, and gnocchi
  • Noodles:
  • Ramen, udon, soba (those made with only a percentage of buckwheat flour) chow mein, and egg noodles. (Note: rice noodles and mung bean noodles are gluten free)
  • Breads and Pastries:
    • Croissants, pita, naan, bagels, flatbreads, cornbread, potato bread, muffins, donuts, rolls
  • Crackers:
    • Pretzels, goldfish, graham crackers
  • Baked Goods:
    • Cakes, cookies, pie crusts, brownies
  • Cereal & Granola:
    • Corn flakes and rice puffs often contain malt extract/flavoring, granola often made with regular oats, not gluten-free oats
  • Breakfast Foods:
    • Pancakes, waffles, french toast, crepes, and biscuits.
  • Breading & Coating Mixes:
    • Panko breadcrumbs
  • Croutons:
    • Stuffings, dressings
  • Sauces & Gravies (many use wheat flour as a thickener)
    • Traditional soy sauce, cream sauces made with a roux
  • Flour tortillas
  • Beer (unless explicitly gluten-free) and any malt beverages (see “Distilled Beverages and Vinegars” below for more information on alcoholic beverages)
  • Brewer’s Yeast
  • Anything else that uses “wheat flour” as an ingredient

 

Foods That May Contain Gluten

 

The following foods need to be verified by reading the label or checking with the manufacturer/kitchen staff.

  • Energy bars/granola bars – some bars may contain wheat as an ingredient, and most use oats that are not gluten-free
  • French fries – be careful of batter containing wheat flour or cross-contact from fryers
  • Potato chips – some potato chip seasonings may contain malt vinegar or wheat starch
  • Processed lunch meats
  • Candy and candy bars
  • Soup – pay special attention to cream-based soups, which have flour as a thickener. Many soups also contain barley
  • Multi-grain or “artisan” tortilla chips or tortillas that are not entirely corn-based may contain a wheat-based ingredient
  • Salad dressings and marinades – may contain malt vinegar, soy sauce, flour
  • Starch or dextrin if found on a meat or poultry product could be from any grain, including wheat
  • Brown rice syrup – may be made with barley enzymes
  • Meat substitutes made with seitan (wheat gluten) such as vegetarian burgers, vegetarian sausage, imitation bacon, imitation seafood (Note: tofu is gluten-free, but be cautious of soy sauce marinades and cross-contact when eating out, especially when the tofu is fried)
  • Soy sauce (though tamari made without wheat is gluten-free)
  • Self-basting poultry
  • Pre-seasoned meats
  • Cheesecake filling – some recipes include wheat flour
  • Eggs served at restaurants – some restaurants put pancake batter in their scrambled eggs and omelets, but on their own, eggs are naturally gluten-free

 

Distilled Beverages And Vinegars

 

Beers, ales, lagers, malt beverages and malt vinegars that are made from gluten-containing grains are not distilled and therefore are not gluten-free.

 

Other Items That Must Be Verified By Reading The Label Or Checking With The Manufacturer

  • Lipstick, lipgloss, and lip balm because they are unintentionally ingested
  • Communion wafers
  • Herbal or nutritional supplements
  • Drugs and over-the-counter medications
  • Vitamins and supplements
  • Play-dough: children may touch their mouths or eat after handling wheat-based play-dough. For a safer alternative, make homemade play-dough with gluten-free flour (Celiac Disease Foundation, 2018)

 

The Celiac Disease Foundation (2018) cautions against cross contamination and offers the following:

Cross-Contact

When preparing gluten-free foods, it is important to avoid cross-contact. Cross-contact occurs when foods or ingredients come into contact with gluten, generally through shared utensils or a shared cooking/storage environment. In order for food to be safe for someone with celiac disease, it must not come into contact with food containing gluten.

Places where cross-contact can occur:

  • Toasters used for both gluten-free and regular bread
  • Colanders
  • Cutting boards
  • Flour sifters
  • Deep fried foods cooked in oil shared with breaded products
  • Shared containers including improperly washed containers
  • Condiments such as butter, peanut butter, jam, mustard, and mayonnaise may become contaminated when utensils used on gluten-containing food are double-dipped
  • Wheat flour can stay airborne for many hours in a bakery (or at home) and contaminate exposed preparation surfaces and utensils or uncovered gluten-free products
  • Oats – cross-contact can occur in the field when oats are grown side-by-side with wheat, select only oats specifically labeled gluten-free
  • Pizza – pizzerias that offer gluten-free crusts sometimes do not control for cross-contact with their wheat-based doughs
  • French fries
  • Non-certified baked goods e.g., “gluten-free” goods from otherwise gluten-containing bakeries
  • Bulk bins at grocery stores or co-ops

 

Conclusion

 

Gluten-free and dairy-free diets can be health-promoting ways of eating. Those who suffer from gluten and dairy intolerances, sensitivities and allergies have legitimate health reasons to avoid both. That being said, adopting a gluten- and dairy-free way of eating is best achieved when following established evidence-based dietary and nutritional principles and regimens such as those promoted by Dr. Michael Greger, Dr. Neal Barnard, Dr. Caldwell Esselstyn, Dr. John McDougall and Dr. T. Colin Campbell, Dr. Michael Klapper and Dr. Joel Fuhrman are among the leading proponents of a whole-food plant based diet, no meat and no dairy and in some cases no oil. In a future article, I will focus on how such a way of eating can promote the health and wellness of those who should avoid gluten and dairy.

 

References

Celiac Disease Foundation (n.d.). Sources of gluten. Retrieved from https://celiac.org/gluten-free-living/what-is-gluten/sources-of-gluten/

Dehghan, M. et al.  Dairy consumption was associated with lower risk of mortality and major cardiovascular disease events in a diverse multinational cohort. Lancet, 18:)31812-9

Heli E.K. et al. (2018). Intake of Different Dietary Proteins and Risk of Heart Failure in Men. Circulation,11: 1-12.

Galván-Salazara, H.R. et al. (2016). Association of Milk and Meat Consumption with the Development of Breast Cancer in a Western Mexican Population. Br J Cancer, 115(9):1122-1130.

Greger, M. & Stone, G. (2015). How not to die. New York: Flatiron Books: New York.

Kongerslev, T. et al. (2016)  Milk and dairy products: good or bad for human health? An assessment of the totality of scientific evidence. Food & Nutrition Research 60: 1-11

Lu, W. et al. (2016). Dairy products intake and cancer mortality risk: a meta-analysis of 11 population-based cohort studies. Nutrition Journal, 15:91 1-11

Rubio-Tapia A., Ludvigsson, J.F., Brantner, T.L., Murray, J.A. & Everhart, J.E. (2012, October). The prevalence of celiac disease in the United States. Am J Gastroenterol.107(10):1538-44;