A DASH of nutrition: the gluten-free edition
--
As part of an assignment for my Medical Nutrition Therapy class I had to follow a therapeutic diet for five days and document energy, macronutrient and micronutrient intakes. I also had to eat at least one meal out at a restaurant. The diet I chose to follow was the DASH diet for celiac disease.
What is celiac disease?
Celiac disease is an immune reaction to eating gluten. The consumption of gluten affects the small intestine. If left untreated, over time it can result in damage to the small intestine’s lining and result in malabsorption of some nutrients.
What is gluten?
Gluten is a protein found in wheat, barley and rye.
What is the DASH diet?
The DASH diet stands for Dietary Approaches to Stop Hypertension. Pretty clever, right? The diet focuses on a balanced diet of fruits, vegetables, lean meat, whole grains and dairy products. For individuals suffering from celiac disease, gluten is removed but individuals are still able to fulfill the dietary guidelines for all the food groups.
The DASH diet is generally used for individuals with hypertension (high blood pressure); however, it has evolved in the treatment of metabolic diseases, celiac disease and also is promoted as an optimal lifestyle for the broader population. In order to make the DASH diet effective in the treatment of celiac disease, modifications need to be made to exclude gluten from the diet.
How do you follow the DASH diet?
The DASH diet doesn’t offer a list of constrained foods or specific macronutrient allocations, the following servings across the food groups are recommended for a 2000 calorie/day diet:
- Grains (focus on whole grains)- 6 to 8 servings/day
- Meats, Poultry, Fish- Less than 6 servings/day
- Vegetables- 4 to 5 servings/day
- Fruit- 4 to 5 servings/day-
- Low-fat/fat-free dairy- 2 to 3 servings/day
- Fats and oils- 2 to 3 servings/day
- Nuts, seeds, legumes- 4 to 5 servings/week
- Sweets- Less than 5 servings/week
Many foods in the grains food group include gluten, however there are gluten-free options for individuals with celiac disease to eat. Some examples of gluten-free grains include brown rice, pure oats (need to read the label), corn, tapioca, soybeans, potatoes.
Preparation before starting the eating regimen
In order to prepare to follow this diet:
- I made a meal plan for the five days I would be adhering to the diet. I also stocked my fridge and pantry with foods that aligned with the diet guidelines. This helps in avoiding unnecessary temptation.
- I also did research on celiac disease so I would understand how I need to shift my meal choices while adhering to the diet.
In choosing a restaurant, I specifically chose one I knew offered ample gluten-free choices on the menu. I perused the menu ahead of time so I would be familiar with the choices and have an idea in my head of what I would order. Preparing myself before eating out helped set my expectations and frame my mindset.
Challenges & Observations
The challenges I faced in following the gluten-free DASH diet included:
- Eating too much protein.
- Fat intake seemed high.
- Not meeting daily caloric intake on a consistent basis.
- Not eating enough carbohydrates on a daily basis.
I thought I would be more hungry in following this diet and I didn’t experience that. In order to ensure I was meeting the food group serving requirements (or at least coming close), I had to get creative in incorporating food groups in each meal. For example, I was adding vegetables to breakfast and a cup of fruit with my lunch. I felt I was more satiated as I increased my vegetable and fruit intake. I’m pretty active so I continued my workout regimen and didn’t feel deprived despite the more constrained diet.
In following the gluten-free DASH diet, I noticed I consistently consumed a lot of protein, more than what was required based on the USDA DRI calculator. In reviewing my food diary, I must subconsciously correlate satiety with protein. When I was preparing for the diet, I was concerned I would be hungry because of the gluten restriction. I was surprised to see I didn’t have a problem meeting the requirements for the protein food group (includes lean meats, poultry and seafood).
In reviewing my food diary, I was a bit concerned about my fat intake however quality matters and much of my fat consumption was olive oil, avocado, salmon. I also consumed more dairy than normal. Cheese is higher in saturated fat but I was able to balance that intake with other food choices. Fat-free cheese versions have less saturated fat but it is something to be mindful.
I do not normally count calories and macronutrients. In doing so for the purposes of this assignment, I noticed the only day I met my suggested daily energy intake was the day I ate at the restaurant. This doesn’t surprise me as I think it is common to eat more calories when out because the meal is prepared by someone else and you may not be as mindful of the ingredients in the meal. I think a reason for not meeting the energy intake was my focus on eating the appropriate servings for each food group. I wasn’t considering the caloric intake as much. However, sufficient energy intake is important because not eating enough calories can also result in inadequate consumption of micronutrients and macronutrients. In fact, most of the days I was following this diet, my carbohydrate intake came up short. I attribute this to my elimination of gluten from the diet. While there are other food sources that do not include gluten that provide carbohydrates, it was a bit of a mind shift in how to meet the carbohydrate requirement. Before logging my food for the day, I always went into it thinking I met the requirement and I didn’t meet it.
What I would do differently
Conclusion
For individuals suffering from a chronic disease, such as celiac disease, preventing the consumption of certain foods, it can be hard to not only navigate eating on a daily basis for sustenance but to participate in social events involving food. There are a lot of resources to help prepare meals aligning with the constraints of the eating regimen, such as the Celiac Disease Foundation and National Heart, Lung and Blood Institute (NHLBI). Overall, I think the DASH diet offers health benefits for individuals suffering from chronic diseases, such a hypertension and celiac disease, as well as it benefits the broader population as a roadmap for daily nutritional intake.
References
- DASH eating plan. National Heart, Lung, and Blood Institute Web site. https://www.nhlbi.nih.gov/health-topics/dash-eating-plan#:~:text=Description%20of%20the%20DASH%20Eating%20Plan&text=The%20DASH%20eating%20plan%20requires,beans%2C%20nuts%2C%20and%20vegetable%20oils. Updated 2020. Accessed September 12, 2020.
