Special Considerations |
The person who prepares the patient's food must fully understand the gluten-free diet. Read food labels carefully.
- Do not eat anything that contains the following grains: wheat, rye, and barley.
- The following can be eaten in any amount: corn, potato, rice, soybeans, tapioca, arrowroot, carob, buckwheat, millet, amaranth and quinoa.
- Distilled white vinegar does not contain gluten.
- Malt vinegar does contain gluten.
Grains are used in the processing of many ingredients, so it will be necessary to seek out hidden gluten. The following terms found in food labels may mean that there is gluten in the product.
- Hydrolyzed Vegetable Protein (HVP), unless made from soy or corn
- Flour or Cereal products, unless made with pure rice flour, corn flour, potato flour, or soy flour
- Vegetable Protein unless made from soy or corn
- Malt or Malt Flavoring unless derived from corn
- Modified Starch or Modified Food Starch unless arrowroot, corn, potato, tapioca, waxy maize, or maize is used
- Vegetable Gum unless vegetable gums are carob bean gum, locust bean gum, cellulose gum, guar gum, gum arabic, gum aracia, gum tragacanth, xanthan gum, or vegetable starch
- Soy Sauce or Soy Sauce Solids unless you know they do not contain wheat
Any of the following words on food labels usually means that a grain containing gluten has been used
- stabilizer
- starch
- flavoring
- emulsifier
- hydrolyzed plant protein
|
Food Group |
Do Not Contain Gluten |
May Contain Gluten |
Contain Gluten |
Milk & milk products (2 or more cups daily) |
whole, low fat, skim, dry, evaporated, or condensed milk; buttermilk; cream; whipping cream; Velveeta cheese food; American cheese; all aged cheeses, such as Cheddar, Swiss, Edam, and Parmesan |
sour cream commercial chocolate milk and drinks, non-dairy creamers, all other cheese products, yogurt |
malted drinks |
Meat or meat substitutes (5 to 6 oz daily) |
100% meat (no grain additives); seafood; poultry (breaded with pure cornmeal, potato flour, or rice flour); peanut butter; eggs; dried beans or peas; pork |
meat patties; canned meat; sausages; cold cuts; bologna; hot dogs; stew; hamburger; chili; commercial omelets, soufflés, fondue; soy protein meat substitutes |
croquettes, fish, chicken loaves made with bread or bread crumbs, breaded or floured meats, meatloaf, meatballs, pizza, ravioli, any meat or meat substitute, rye, barley, oats, gluten stabilizers |
Breads & grains (4 or more servings daily) |
cream of rice; cornmeal; hominy; rice; wild rice; gluten-free noodles; rice wafers; pure corn tortillas; specially prepared breads made with corn, rice, potato, soybean, tapioca arrowroot ,carob, buckwheat, millet, amaranth and quinoa flour; puffed rice |
packaged rice mixes, cornbread, ready-to-eat cereals containing malt flavoring |
breads, buns, rolls, biscuits, muffins, crackers, and cereals containing wheat, wheat germ, oats, barley, rye, bran, graham flour, malt; kasha; bulgur; Melba toast; matzo; bread crumbs; pastry; pizza dough; regular noodles, spaghetti, macaroni, and other pasta; rusks; dumplings; zwieback; pretzels; prepared mixes for waffles and pancakes; bread stuffing or filling |
Fats & oils (servings depend on caloric needs) |
butter,margarine, vegetable oil, shortening, lard |
salad dressings, non-dairy creamers, mayonnaise |
gravy and cream sauces thickened with flour |
Fruits (2 or more servings daily) |
plain, fresh, frozen, canned, or dried fruit; all fruit juices |
pie fillings, thickened or prepared fruit, fruit fillings |
none |
Vegetables (3 or more servings daily) |
fresh, frozen, or canned vegetables; white and sweet potatoes; yams |
vegetables with sauces, commercially prepared vegetables and salads, canned baked beans, pickles, marinated vegetables, commercially seasoned vegetables |
creamed or breaded vegetables; those prepared with wheat, rye, oats, barley, or gluten stabilizers |
Snacks & desserts (servings depend on caloric needs) |
brown and white sugar, rennet, fruit whips, gelatin, jelly, jam, honey, molasses, pure cocoa, fruit ice, popcorn, carob |
custards, puddings, ice cream, ices, sherbet, pie fillings, candies, chocolate, chewing gum, cocoa, potato chips |
cakes, cookies, doughnuts, pastries, dumplings, ice cream cones, pies, prepared cake and cookie mixes, pretzels, bread pudding |
Beverages (4 to 6 cups or more daily) |
tea, carbonated beverages (except root beer), fruit juices, mineral and carbonated waters, wines, instant or ground coffee |
cocoa mixes, root beer, chocolate drinks, nutritional supplements, beverage mixes |
Postum™, Ovaltine™, malt-containing drinks, cocomalt, beer, ale, gin, whiskey, rye |
Soups |
those made with allowed ingredients |
commercially prepared soups, broths, soup mixes, bouillon cubes |
soups thickened with wheat flour or gluten-containing grains; soup containing barley, pasta, or noodles |
Thickening agents |
gelatin, arrowroot starch; corn flour, germ, or bran; potato flour; potato starch flour; rice bran and flour; rice polish; soy flour; tapioca, sago |
|
wheat starch; all flours containing wheat, oats, rye, malt, barley, or graham flour; all-purpose flour; white flour; wheat flour; bran; cracker meal; durham flour; wheat germ |
Condiments |
glutent-free soy sauce, distilled white vinegar, olives, pickles, relish, ketchup |
flavoring syrups (for pancakes or ice cream), mayonnaise, horseradish, salad dressings, tomato sauces, meat sauce, mustard, taco sauce, soy sauce, chip dips |
|
Seasonings |
salt, pepper, herbs, flavored extracts, food coloring, cloves, ginger, nutmeg, cinnamon, bicarbonate of soda, baking powder, cream of tartar, monosodium glutamate |
curry powder, seasoning mixes, meat extracts |
synthetic pepper, brewer's yeast (unless prepared with a sugar molasses base), yeast extract (contains barley) |
Prescription products |
|
all medicines: check with pharmacist or pharmaceutical company |
|
|
 |
Why Doesn't A Low-Fat Diet Reduce Cancer Risk? |
|
Author: Suzanne Dixon, MPH, MS, RD
For: Cancer Nutrition Info, LLC |
Summary: Review of JAMA. 2006;295(6):629-42. |
|
"I just read about a big research study that did not show any health benefits from eating a low-fat diet. I thought a low-fat diet could reduce cancer risk. Why didn't this study show any health benefits for women who are eating a low-fat diet?"
The study that you have heard so much about comes from a research project called the Women's Health Initiative (WHI). This project was set up to follow 48,835 women for 9 years. The women were 50 to 79 years old at the beginning of the WHI project. There are several different studies that are a part of the overall WHI project. The goal of the nutrition study that you've read about was to find out if a low-fat diet with plenty of vegetables and fruit could lower the risk of breast cancer, colon cancer, and heart disease in women. The first results from this low-fat diet study were released just last week. These results were big news for several reasons:
- A lot of time and money has been invested into this study.
- This is one of the first controlled diet trials looking at the possible health benefits of a low-fat diet. A controlled diet trial is when some of the people in the study are randomly assigned to follow a specific diet. The health of these people then is compared to other people who are not following the diet. This allows researchers to get a better idea of the health effects of certain diets. It is a better way to study the connection between nutrition and health than simply observing what people eat on their own and asking them about it.
- At first glance, the results of this study seem to be the exact opposite of what people would expect. This study seems to tell us that eating a low-fat diet that contains plenty of vegetables and fruit does not reduce the risk of breast cancer, colon cancer, or heart disease.
What Did The Researchers Study?
Sometimes, what researchers want to study and what they actually do study are two very different things.
The researchers wanted the women in the low-fat diet to do the following:
- Eat no more than 20% of their total calories as fat.
- Eat a minimum of 5 servings of vegetables and fruit every day.
- Eat a minimum of 6 servings of grains every day.
- Eat no more than 7% of their total calories as saturated fat.
What Did The Women Really Eat?
The women in the low-fat diet group actually ate the following:
Total Fat in the Diet
- By the end of the first year of the study, about 31% of the women in the low-fat group were eating 20% of their calories from fat. This means that two out of three (69%) of the women did NOT meet the low-fat diet goals.
- By the end of the sixth year of the study, about 14% of the women in the low-fat diet group were eating 20% of their calories from fat. This means that 86% of the women did NOT meet the low-fat diet goals of the study after 6 years.
- By the end of the first year of the study, the women in the low-fat diet group were eating an average of 24% of total calories as fat.
- By the end of the sixth year of the study, the women in the low-fat diet group were eating an average of 29% of total calories as fat.
In summary, only a very small number of the women assigned to eat the low-fat diet actually followed the diet guidelines. By the sixth year of the study, only 14% of the women in the low-fat diet group were eating the prescribed low-fat diet! This means 86% of the women did not follow the diet! On average, the women in the low-fat diet group were eating 29% of their calories from fat! This is NOT a low-fat diet. This barely meets the government recommendation for the general public to eat no more than 30% of total calories as fat.
Vegetables & Fruit
- By the end of both the first year and the sixth year of the study, the women in the low-fat diet group were eating an average of 5 servings of vegetables and fruit per day.
- By the end of the first year of the study, the women in the low-fat diet group were eating an average of 1.2 more servings per day of vegetables & fruit than the women in the normal diet group.
- By the end of the sixth year of the study, the women in the low-fat diet group were eating an average of 1.1 more servings per day of vegetables & fruit than the women in the normal diet group.
In summary, the women in the low-fat diet group ate about 5 servings of vegetables and fruit per day, as instructed. However, they only were eating about 1 more serving of vegetables and fruit per day than the women in the regular diet group. In other words, everyone in the study ate almost the same amount of vegetables and fruit.
Grains
- By the end of the first year of the study, the women in the low-fat diet group were eating an average of 5 servings of grains per day. By the end of the sixth year, they were eating an average of 4 servings of grains per day.
- By the end of the first year of the study, the women in the low-fat diet group were eating an average of about 0.9 more servings per day of grains than the women in the normal diet group.
- By the end of the sixth year of the study, the women in the low-fat diet group were eating an average of about 0.4 more servings per day of grains than the women in the normal diet group.
In summary, the women in the low-fat diet group did not meet the goal of eating 6 servings of grains per day. As well, they did not eat substantially more grains than the women in the regular diet group.
Nutrient Levels in the Body
The researchers took blood samples from a small group of women in the study. They wanted to measure the levels of carotenes in each woman's blood. Carotenes are a group of nutrients that are found in vegetables and fruit. Levels of carotenes in a person's blood are a good way to tell how many vegetables and fruit that person regularly eats. The more vegetables and fruit a person regularly eats, the higher her blood levels of carotenes will be.
After the first and the third years of the study, there were virtually NO differences in the blood levels of carotenes between the women in the low-fat diet group and the women in the regular diet group. In other words, based on blood levels of nutrients, the women in the low-fat group probably were eating about the same amount of vegetables and fruit as the women in the regular diet group.
Saturated Fat
After one year, the women in the low-fat diet group were eating an average of 8.1% of calories from saturated fat. This means that the majority of the women in the low-fat diet group did not meet the goal of eating less than 7% of calories as saturated fat.
New Information About Nutrition & Disease
The WHI project was designed over a decade ago. Since that time, research has found that type of fat in the diet may be more important than amount of fat in the diet. Health experts now believe that eating the right kinds of fat may play a bigger role in our health.
The Time Frame
This study followed the women for an average of 8.1 years. In terms of cancer and heart disease, this is not a long time. The damage in the body that can lead to cancer and heart disease can take several decades to occur. Even if the women in the low-fat diet group followed the diet exactly, 8 years may not be enough time to see a benefit.
Putting It All Together
The bottom line on this study is that women who do not follow a low-fat diet obviously will not get any health benefits from that low-fat diet! Adding 1 serving of vegetables and fruit per day to the diet may not make much of a difference in overall health either. As well, the WHI diet study does not provide enough information to answer the question "Does a low-fat diet lower the risk of cancer and heart disease?"
The women in the low-fat diet group ate an average of 29% of calories from fat. This is not a low-fat diet. They ate 1 more serving of vegetables and fruit per day compared to the regular diet group. They ate less than 1 more serving of grains per day compared to the regular diet group. These differences are too small to allow for meaningful comparisons. There just isn't enough difference in the way these two groups of women were eating to see much of an effect on health!
After learning more about this study, we may want to ask, "Why are the news headlines so misleading?" It is not surprising that eating a diet with 29% of calories from fat does not improve health. It is not surprising that simply adding one serving of vegetables or fruit per day does not significantly improve health either! The attention that this research has received provides a good example of why we all need to be more informed about nutrition and health. It is important to "read between the lines".
Moving Forward
The way to improve your health and reduce your cancer risk is to eat a plant-based diet, maintain a healthy bodyweight, exercise regularly, and avoid tobacco (smoking and chewing). Ideally, the whole diet needs to be based around vegetables, fruit, whole grains, and legumes (beans). For true health benefit, no more than one-quarter of the plate should be covered by meat or other animal foods. This means that three-quarters of the plate should contain vegetables, fruit, whole grains, and legumes (beans). This style of eating will help you to eat at least 9 servings of vegetables and fruit each day. This type of diet will be naturally low in fat too.
The recent low-fat diet study confirms that very small changes in diet probably will make very small changes in health. Furthermore, studies in cancer survivors do tell us that eating a true low-fat diet and eating plenty of vegetables and fruit can lower cancer risk!
If you are in cancer treatment, these diet changes may not be right for you. The information on this site is not a substitute for consultation with a
healthcare professional. Please discuss all medical and nutrition questions with
your healthcare provider.
|
|
|
