Diet Tips:Are gluten-free foods actually better for you?

Journal review by Shirley Webber (Research dietitian)

The gluten-free diet has been getting a lot of attention for a number of years now. However, there is still some confusion about whether or not this is actually a healthy diet.

A gluten-free diet restricts wheat, barley, rye and oats. Following this diet is essential for those who are diagnosed with coeliac disease. For this small portion of the population, gluten can be damaging to the gastrointestinal tract. 

There are many other people following a gluten-free diet, whether it be due to suspected sensitivity to gluten, or just because they think it is a healthier way to eat. Studies have shown that gluten intolerance without coeliac disease is rare, so for many people following a gluten-free diet for other reasons, what impact does choosing gluten-free products have on their nutritional status?

A study by researchers from the University of Sydney recently considered the nutrient differences of major gluten containing food groups which included: dry plain pasta, breads, and ready-to-eat cereals. Comparisons were made by analysing the nutrition information panel on gluten-free products (those stating on the packaging that it is gluten-free certified) and gluten containing foods in this category. Nutrients were also compared using the Health Star Rating - a nutrient profiling initiative implemented by the Australian Government. 

Analysis of the three food categories showed that there was, in fact, a very similar nutritional profile for both the gluten-free and gluten containing foods, however, with one notable difference in the protein levels: gluten-free foods contained consistently less protein than gluten containing foods, in particular in pasta and bread. There was also variation in the fibre content of gluten versus gluten-free foods.

This study also considered discretionary foods which cover: cereal bars, cake mixes/cakes, sweet biscuits, ice cream, corn and potato chips, cured meats, sausages and hot dogs, and sugar based confectioneries. For four of these discretionary foods (cereal bars, cake mixes/cakes, sweet biscuits, and cured meats, sausages and hot dogs), the Health Star Rating did not change for gluten versus gluten-free products. In three of the categories (ice cream, corn and potato chips, and sugar based confectioneries) the total energy density was lower in gluten-free products than in gluten containing products. Despite slightly better nutritional quality in gluten-free options, overall discretionary foods are all high in sodium, saturated fat, and sugar.

This study highlighted that gluten-free doesn't mean healthier, particularly when looking at some commonly used cereals, pastas, and bread, which make up a big component of the Australian and western diet. More research needs to be conducted to assess the vitamin and mineral differences of these gluten versus gluten-free products.

Wu, J. H. Y., et al. (2015). “Are gluten-free foods healthier than non-gluten-free foods? An evaluation of supermarket products in Australia.” British Journal of Nutrition 114: 448-454.
 

Diet Tips:Monash University Comprehensive Nutrition Assessment Questionnaire (CNAQ)

Dr Jaci Barrett (Accredited Practising Dietitian)

In 2009, we published a journal article detailing the production and validation of a food frequency questionnaire (FFQ). This FFQ was a component of my PhD. The aim was to develop a FFQ able to provide analysis of FODMAP intake, amongst other nutritional factors, so that we could use it in our research and avoid the need to have our patients complete lengthy food diaries for long periods of time.

The FFQ was validated and due to the broad range of nutritional factors that it was able to assess, we named it the Comprehensive Nutrition Assessment Questionnaire (CNAQ). The FFQ can adequately assess intake of the following:

Macronutrients	Vitamins	Sugars & fermentable carbohydrates	Minerals
Energy	Vitamin A	Total Sugars	Calcium
Carbohydrate	Thiamin	Glucose	Iron
Protein	Vitamin C	Fructose	Magnesium
Fat	Folate	Excess fructose	Phosphorus
Saturated fat	Niacin	Sucrose	Potassium
Polyunsaturated fat	Riboflavin	Lactose	Sodium
Monounsaturated fat	Thiamin	Total OS	Zinc
Cholesterol	b carotene equivalents	Fructans
Alcohol		Total GOS
Starch		Raffinose
Dietary fibre		Stachyose
Resistant starch		Sorbitol
Glycaemic index		Mannitol
Glycaemic load

This extensive list makes the CNAQ useful to a wide range of researchers and health professionals including those involved in gastroenterology, endocrinology, cardiac, renal and nutritional medicine.

Due to the broad appeal of the CNAQ, we then arranged for the CNAQ to be produced into an online tool, so that it could be easily accessed by researchers and other interested parties around the world. Organisations are provided with an account, participant email addresses are uploaded into the secure site, and participants are then sent a personal login to complete the online CNAQ. Completed responses can then be viewed by the organisation and the nutrient analysis can be automatically exported into excel.

This is a fantastic tool, particularly in the research setting. There is an extraordinary time saving by utilising this online tool compared with manual entry of daily food diaries.

For more information please see the original validation paper http://www.sciencedirect.com/science/article/pii/S0002822310011909. 

You can also read more about the online CNAQ or download an order form here www.cnaq.com.au.

 

Diet Tips:The low FODMAP diet in East and South East Asia

By Marina Iacovou (PhD Candidate and Accredited Practising Dietitian)

In October 2015, we published an article in the Journal of Neurogastroenterology and Motility, on how the low FODMAP diet can be applied to countries in East and South East Asia. There is growing interest in using food choice/dietary change to influence clinical outcomes in patients with irritable bowel syndrome across the globe, in particular the low FODMAP diet. This interest has also led us to testing international foods, sourced from other countries.
 

Major high FODMAP sources are frequently used in Asian cuisines, including: onion, garlic, shallots, legumes/pulses, and wheat-based products. Also many Asian countries are adopting some more Western dietary habits, such as the inclusion of lactose-containing milk and dairy products. Both of these factors are likely to be contributing the prevalence of IBS in Asia.

Traditional and commonly consumed dishes were considered in the article, for their FODMAP content - some of these include:

•         Korean dishes: Kimchiand Doenjang (fermented side dishes) and Mandu (Korean dumplings)
•         Japanese dishes: Gyozas(the equivalent to dumplings)
•         Thai dishes: Tom Yum Soup
•         Chinese and Hong Kong dishes: Man tou and Bao (wheat based buns), and red bean sweet soup and green (mung) bean soup, wontons and dim sum
•         Taiwanese dishes: street food called stinky tofu (yes that’s right, it’s not a typo) and youtiao (deep fried dough sticks made with wheat flour)
•         Vietnamese dishes: Hanh phu(fried shallots) and Nuoc mam cham(dipping fish sauce) and Pho bo tai nam(commonly known as Pho – a beef noodle soup)  

 

Although these dishes have not been tested for their FODMAP content as a complete meal, in their usual serving size, we have tested many of the ingredients found in the recipes. These ingredients are high in FODMAPS (onion, garlic, leek, shallots and mung beans), and therefore, the likely FODMAP content of these traditional dishes may be moderate-high FODMAP. For this reason, dietary approach, using the low FODMAP diet, holds great promise in treating IBS patients in East and Southeast Asia.

 

Common Asian ingredients that we have tested are also listed in the article with their corresponding FODMAP rating (low, moderate or high).There is no reason to miss out on these delicious Asian cuisines. Whether you are eating out, travelling, or cooking Asian dishes at home - there is always a low-moderate FODMAP option. 

You can find more tips on dining out Asian here.

Marina Iacovou, Victoria Tan, Jane G Muir, and Peter R Gibson – The Low FODMAP Diet and its Application in East and Southeast Asia; Journal of Neurogastroenterology and Motility, Volume 21 No. 4 October, 2015.