Is a Gluten-Free Diet Healthy? The Role of Fortified Foods

In a previous article on why gluten-free living isn’t just a fad, I described a few historic events that lead me to truly believe that it’s not just a fad. While I certainly don’t mean to flip sides on that opinion, whether or not a gluten-free diet is healthy is a totally different story.

While gluten was originally connected to several chronic diseases long ago, and it’s connected to many additional health issues today, that doesn’t necessarily mean maintaining any old gluten-free diet is healthy.

The key reason behind this is food fortification.

You know those breads and cereals in the grocery store that say “Fortified With Vitamins XYZ”? Have you ever wondered why gluten-free breads don’t say that?

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Why Do We Have Fortified Foods?

In the early 20th century, public health and nutrition merged as a set of food policies. This is when health problems directly associated with nutritional deficiencies were most prevalent. Conditions such as Goiter, Beriberi, Rickets, and Pellagra were extremely common, yet easily remedied through dietary amendment. So, the government mandated that key vitamins and minerals should be added to certain food staples, such as cereals and breads.

Food fortification was born.

The biggest question about food was and still is: Are the products on the market actually meeting or serving the true nutritional needs of the people?

Let’s look at Goiter as an example of why food fortification started. Goiter is a condition of the thyroid gland that causes swelling in the neck. In the 1920s, medical scientists in the United States indicated that iodine could remedy the high rate of Goiter throughout the country, and these scientists conducted studies that found up to a 90% reduction in the occurrence of Goiter as a result of healthy doses of iodine. We now know that Goiter happens as a result of iodine deficiency.

This success and others like it triggered food fortification programs that included adding Vitamin D to milk (to overcome the high rate of rickets), the addition of B Vitamins to flour and grains as a general approach to overcoming widespread vitamin deficiencies and Pellagra, and adding folate to all cereal based foods to reduce neural tube birth defects.

Most of these initiatives were a great success, and they quickly became models for other global food fortification initiatives. By 1942, 75% of all white bread sold was fortified.

These initial fortification programs were designed to specifically address public health problems, and the most frequently fortified nutrients were thiamin, niacin, riboflavin, folic acid, and iron. These were added to products such as enriched flour or bread, and calcium was sometimes fortified as well. Fortification began to be written into law in the 1930s and 40s.

The Role of Fortified Foods in the Gluten-Free Diet

Flour and white bread to this day are fortified with many important vitamins. While laws came into place to serve the general population long ago, what about the part of the general population that doesn’t eat things like wheat flour and white bread, i.e. people on a gluten-free diet?

People with celiac disease are already deficient in many of the nutrients above: B vitamin deficiency leads to less energy, iron deficiency increases the already ramped up odds of iron-deficiency anemia, and calcium deficiency leads to weaker bones (and people with celiac already have increased odds of bone conditions like osteoporosis and osteopenia). Then there are people with gluten intolerance, in which every case is very different. The big problem with “gluten intolerance” is that many people identify gluten as a problem, cut it from their diet, and never get tested for celiac.

But we’re really not even talking about nutrient deficiencies – the question is whether or not people with celiac or gluten intolerance can get the vitamins and minerals they need by simply cutting gluten from their diet? The answer is no.

In order to nip nutrient deficiencies in the bud while following a gluten-free diet, people with celiac and gluten intolerance need to pay very close attention to the actual foods they consume (and don’t consume), plan meals ahead of time, take nutrition seriously, and eat whole, natural foods throughout the day.