gluten-free round -up · • check/recheck labels • check gum, mints, candy • modify religious...
TRANSCRIPT
Gluten-FreeRound-Up:Non- responsiveceliacdisease,oats,probiotics
&arsenic
MelindaDennis,MS,RDNNationalCeliacAssociationFallMeetingOctober29,2017
Disclosures• NutritionCoordinator,CeliacCenter,BethIsraelDeaconessMedicalCenter
• Founder/Owner:DeletetheWheat,LLCNutritionalConsulting
• SeniorNutritionConsultant,NationalCeliacAssociation• Co-investigator,arsenicstudy[pending]• Co-author,articleonprobiotics[JournalofAcademyofNutritionandDietetics,2017]
Non- ResponsiveCeliacDisease(NRCD)• NRCDistheblankettermfor
• persistentorrecurrentsymptoms• persistentsigns,orlaboratoryabnormalitiestypicalofceliacdisease(CD)despite6-12monthsofdietaryglutenavoidance
• NRCDiscommon,affectingfrom7-30%ofpatientstreatedwithagluten-freediet(GFD)forCD.
Others included: Peptic ulcer disease (2), Crohn’s disease (1), Duodenal adenoCA (1), Food allergy (1), Gastroparesis (1)
Non-Responsive” Celiac DiseasePersistent or recurrent signs/symptoms occur in
~30% of patients
Leffleretal,CGH2007;VeeraraghavanACG2015
InanFDA-regulatedFoodProductNotLabeledGluten-FreeAvoidtheFollowing:• WheatRye Barley• MaltOats Brewer’syeast• Yeastextract Autolyzedyeastextract
• IfanUSDA-regulatedfoodisnotlabeledgluten-free,alsoavoidmodifiedfoodstarch,dextrinandstarch.
• IfyoudonotseeanyofthesewordsonthelabelofanFDA- orUSDA-regulatedfood,theproductisunlikelytoincludeanygluten-containingingredients.
• Cross- contaminationisstillpossible(variesbyproduct).
ThompsonT.ADAPocketGuidetoGluten-FreeStrategiesforClientswithMultipleDietRestriction,2nded.Chicago,IL:AcademyofNutritionandDietetics;2016
Naturally gluten-free grains, flours, and products made from them
may be contaminated with wheat, barley, and/or rye.
Choose labeled gluten-free versions of these products.
Celiac Disease Celiac Disease Toolkit. American Dietetic Association. Chicago, IL, 2011; Thompson T, Lee AR, Grace T. J Am Diet Assoc. 2010;110:937-940.
Top13FrequentlyOverlookedSourcesofGluten: Doyou…..?
• Periodicallycheckmedicationsandsupplements
• Buygrainslabeledgluten-free• Understandfoodlabelinglaws• Check/rechecklabels• Checkgum,mints,candy• Modifyreligiouspractices• Educatefamily,friends,roommate,guests,schools,co-workers,camps,nursinghomes
• Strategizediningoutsidethehome
• Intentionallyeatgluten• Knowinglyeatfoodsthatmaybecontaminatedwithgluten
• Eatoats• Drinkglutenreducedorremovedbeer
• Thinkaboutsushi,pizza,tortillas,bakeries,hotchocolatemix…
• Others????
Thislistisnotcomprehensive.
FrequentlyOverlookedSourcesofGlutenorPotentialSourcesofGluten• Autolyzedyeastextract/Yeastextract
• Beer/Ale/Lager• Breading/batter• Brewer’syeast• Broth/BouillonCandy• Communionwafers• Croutons• Dressing
• Drinkmixes• Flour/grain/cerealproducts (notlabeledgluten-free)
• Frenchfries• Gravy• Herbaltea• Imitationbacon• Imitationseafood• Malt/maltextract• Marinades
Thislistisnotcomprehensive.
FrequentlyOverlookedSourcesofGlutenorPotentialSourcesofGluten• Matzoandmatzomeal• Medications/Supplements
• Oats(unlesslabeledglutenfree)
• Panko• Pasta• Play-Doh™• Preparedmeat,fish,poultry,meatalternatives
• Processedluncheon/delimeats
• Ricemixes• Saladdressing• Sauces• Seasonings• Soupbases• Soysauce• Stuffing• Thickeners(Roux)• Vegetablesinsauce• Winecoolers
Thislistisnotcomprehensive.
OatsandCeliacDiseaseOneofthemostimportantwholegrainfoods,highinfiber,Bvitamins,ironandprotein(2xthatofrice)
Manycontrolled,shortandlong-termstudiesofadultsandchildrenindicateoatsaresafeforconsumptionbythemajorityofpatientswithCDandDH1.
SubsetofCDpatientsexistswithanexaggeratedimmuneresponsetooats2.mmnCrosscontaminationwithglutencontaininggrainsisalargeconcern.
InclusionofoatsintheGFDremains adecades-longcontroversialtopicacrosstheglobe.3 Officialrecommendationsvaryamonggroups.
1. Janatuinen et al, Gut 2002; Peraaho et al, Scand J Gastroenterol 2004; Storsrud et al, Br J Nutr 2003; Storsrud et al, Eur J Clin Nutr 2003; Reunala et al, Gut 1998; Hoffenberg et al, J Pediatr 2000; Hoberg et al, Gut 2004: Kupper C, Gastroenterol 2005; Hardy et al J Autoimmunity 2014; 2. Lundin et al, Gut 2003; Peracho et al, Scand J Gastroenterol, 2004; Arentz-Hansen H. PLoS Med. 2004; 3. Fric et al, Nutr Clin Care, 2011
OATS
Swedishchildrenwithceliacdiseasecomplywellwithagluten-freediet,andmostincludeoatswithoutreportinganyadverseeffects:along-termfollow-upstudy
• Oatswereincludedinthedietof89.4%ofthechildrenforameanof3.4years.
• Most(81.9%)atepurifiedoats,and45.3%consumedoatslessthanonceaweek.
• Amongthosewhodidnotconsumeoats,only5.9%refrainedbecauseofsymptoms.
• GeneralcompliancewiththeGFDwasgood.
• Mostpatientsdidnotreportadverseeffectsafter long-termconsumptionofoats.
TapsasD,etal.NutrRes.2014May;34(5):436-41.
Oats- DidyouKnow?• Untilrecently,purityprotocolGFoatshavebeentheonlyoatslabeledgluten-freeandrecommendedfortheGFcommunity.
• CertainGFgrainmillershavebeenmechanicallysortingoatsandsellingthemtomanufacturers(bothlargeandsmallcompanies)ofGFoatsandoatbasedproductssince2012.
• SomeGFcompaniesareusingacombinationofboth.• Itisnearlyimpossibletodistinguishpurityprotocoloatsfrommechanicallysortedoats
GlutenFreeWatchdog.https://www.glutenfreewatchdog.org/news/the-gluten-free-oats-situation-why-it-is-such-a-sticky-wicket/.Accessed10/9/17.
seed field facility
Kernel-basedglutencontaminationofgluten-freeoatmealcomplicatesglutenassessmentasitcausesbinary-liketestoutcomes
InternationalJournalofFoodScience&TechnologyVolume52,Issue2,pages359-365,20OCT2016http://onlinelibrary.wiley.com/doi/10.1111/ijfs.13288/full#ijfs13288-fig-0001
1outof57servingswerenotincompliancewiththeFDAGFlabelingrule.
GlutenFreeWatchdog’s(GFWD)StanceonOats
• RemainssupportiveoftheuseofpurityprotocoloatsforpersonswithCDandgluten-relateddisorderswhotolerateoats.However,inlightofthestudyfindingsfromQuakerweaskallsuppliersofpurityprotocoloatstore-evaluatetheirtestingprocedures,includingsamplingmethodologyandtheamountoftestingdoneonoatgroatsandfinishedproduct.
• Supportiveoftheuseofgluten-freeQuakerOatsbypersonswithCDandgluten-relateddisorders.Atthistime,weareNOTsupportiveoftheuseofanyotherproductcontainingsortedoats,includinggluten-freeCheerios,gluten-freeLuckyCharms,andgluten-freeandcertifiedgluten-freeproductssourcingoatsfromGrainMillersorLaCrosseMilling.
• WhenoatsarepulledfromthemarketplacefortestingtheyshouldbetestedusingtheRidascreenGliadinR5ELISAMendezMethodusingthenewprotocolrecommendedbyR-Biopharm
https://www.glutenfreewatchdog.org/news/gluten-free-watchdog-updated-position-statement-on-oats/.AccessedOct2017
GFWD’sPurityProtocolList• A listofcompaniesfollowingthepurityprotocolandcommentsfromseveralcompaniesusingmechanicallysortedoats
https://www.glutenfreewatchdog.org/news/oats-produced-under-a-gluten-free-purity-protocol-listing-of-suppliers-and-manufacturers/
WhatGFWDRecommends• Thesituationwithoatscontinuestoevolve.GlutenFreeWatchdog’spositionstatementonoatswillbeupdatedinthenearfuture.Inthemeantime,ouradviceis:
• Chooseyouroatproductsbasedonyourcomfortlevelwithregardtothelevelofinformationprovidedtoyoubymanufacturers.Considerthefollowing:• Doesthemanufacturerdisclosewhethertheyusepurityprotocolorsortedoats?
• Dotheydisclosetheirtestingprotocols?• Dotheydisclosetheassay[test]theyusetotestoatsforglutencontamination?
• Ifamanufacturerrefusestoansweranyofthesequestionsorrespondsbysayingtheinformationisproprietary,moveontoanothercompany.
GlutenFreeWatchdog.https://www.glutenfreewatchdog.org/news/quaker-researchers-publish-a-second-study-highlighting-the-difficulties-associated-with-testing-oats-for-gluten-contamination/.Accessed10/9/17.
NationalOrganizations:GFOatsStances
• AcademyofNutritionandDietetics,2009• GraduallyincludeGFoatsuncontaminatedwithwheat,barleyorryeatintakelevelsof ~50gdryoats/day;generallysafeandimprovescompliancetotheGFD.
• NorthAmericanSocietyfortheStudyofCeliacDisease,2016• Encouragesconsistent,stringent,transparentandreliabletestingmethodstoensureendproduct<20ppm
• DiscussGFoatswithdoctoranddietitian;monitorIgA-tTGbeforeandafterintroduction.Persistentorrecurrentsymptomsshouldpromptanassessment,mayincludeanintestinalbiopsy.
ExecSummaryofRecommendations- CeliacDisease.InclusionofGlutenFreeOats.ANDEvidenceAnalysisLibrary,2009.https://www.andeal.org/topic.cfm?menu=5279&cat=3726;NASSCDSummaryStatementonOats.http://www.nasscd.org/files/Oats-Statement-NASSCD-April-2016(1).pdf.AccessedOct2017.
Canada’sStance onOats• HealthCanada'sMarketingAuthorization,2015
• Permitstheuseofgluten-freeclaimsforgluten-freeoats(thatdonotcontainmorethan20ppmofglutenfromwheat,rye,barley,ortheirhybridizedstrains)andforfoodscontainingtheseoatsasingredients,undercertainconditions.
• CanadianCeliacAssociationProfessionalAdvisoryCouncilrecommendsguidelinesforaddingpure,uncontaminatedoats:https://www.celiac.ca/oats-statement
• Gluten-freeclaimtoberemovedfromGeneralMillsCheeriossoldinCanadabyJan1,2018(CanadianFoodInspectionAgency)
https://www.canada.ca/en/health-canada/services/food-nutrition/food-safety/food-allergies-intolerances/celiac-disease/gluten-free-labelling-claims-products-containing-specially-produced-gluten-free-oats.html;https://www.celiac.ca/oats-statement;https://www.celiac.ca/gluten-free-claim-removed-general-mills-cheerios-sold-canada.AccessedOct2017
Meta-analysis:SafetyofAddingGFOats• Non-contaminatedoatstoleratedbygreatmajorityofadultsandchildrenwithCDinthestudies
• Datanotrobustenoughfordefinitive,evidence-basedrecommendationsonthesafetyofoatsforpatientswithCD
• Limitedconfidenceduetolowquality,smallsamplesize,limitedgeographicdistributionofdata
• Needmorewell-designedtrialsevaluatingtheeffectofpureoatsintheshort/longterm,inchildren/adultpatientswithCD
• Informationneededre:sourceofoats,includingcultivars,andamount/frequencyofoatsconsumedandcompliancetoGFD
PintoSanchezMI,etal.Gastroenterol,2017
Meta-analysis,cont’d• Purityleveldependsoncountryoforiginandlocalregulations
• Oatproductsneedtobesubjectedtoclinicalstudies.• OatsusedinGFfoodsshouldbeproduced/processedunderprotocolsthatensurepurityduringallphasesofproductionwithreliabletestingmeasuresthatconsistentlyguarantee<20ppmofgluten.
• WeendorsetherecommendationsbyNASSCDtosupporttheuseofpureoatsinCDandmonitorlevelsofIgA-tTGbeforeandaftertheirintroductionintothediet.
• Persistentorrecurrentsymptomsshouldpromptanassessmentthatmayincludeanintestinalbiopsy.
PintoSanchezMI,etal.Gastroenterol,2017
BIDMCCeliacCenterOatsStance2017
• Morecomfortablewithpurityprotocolprocessatthistime• SomecompaniesmaybedoingagoodjobatconsistentlyprovidingmechanicallysortedGFoats.
• InvestigatehowallGFoatsaregrown,processed,andtestedtoconfirmtheirGFstatus.
• ReadonGlutenfreewatchdog.orgaboutmechanicallysortedversuspurityprotocoloatstofindyourowncomfortlevel.
• Talktoyourceliachealthcareteamtohelpyoumakeaninformeddecision.
BIDMCCeliacCenterOatsStance,2017• Crosscontaminationisaconcernregardlessofthetypeofoatthatiseaten– purityprotocolormechanicallysorted.
• MoreNorthAmericandataneededonoatsafetyandcontamination
• WecallonALLsuppliersandmanufacturerstoofferconsistentlysafeoatsandoat-basedproductsthatareproventobegluten-freethroughrigorousandprecisetesting,betransparentabouttheirprocess,andprovideevidenceofconsistentfavorableresults<20ppm.
AddingGFOats:BIDMCCeliacCenter
• DiscussthedecisiontointroduceANYTYPEofGFoatsintoyourdietwithyourdoctor.
• Newlydiagnosedpatients:Avoidoatsuntil CDiswellcontrolled(completeresolutionofsymptomsandnormaltissuetransglutaminaselevel[IgA-tTG]).
• Underphysician/dietitianguidance,thegradualadditionofuncontaminatedlabeledgluten-freeoatsupto50grams/day(alittlemorethan½cupdryrolledoatsor¼cupsteelcutoats)maybeattempted.
• Drinkadequatewater:oatsarehighinfiber.
DennisM,etal.CeliacDiseaseToolkit.Chicago,IL:AcademyofNutritionandDietetics,2011
AddingGFOats:BIDMCCeliacCenter• Follow-upwithyourgastroenterologistwithin3-6monthsafterintroducingGFoats.
• Symptomsfromeatinggluten-freeoatsmaybedueto1 ormorefactors:• Intolerancetotheincreaseinfiber• Foodintolerances(oatsthemselvesorfructose,otherFODMAPs,etc.asingredientsinoat-basedproducts)
• Glutencontamination• Immuneresponse(rare)tooatproteinsimilartothatofgluten
• Diligentlymaintainroutinefollow-upswithyourmedicalteam.
KupperC.Gastroenterol,2005;Fricetal,NutrClinCare,2005
Whattodoif….• Youhavepersistentsymptomsand/oranelevatedanti-TTGantibodylevelAvoidallGFoats/oatproductsuntilthesesymptomsand/orlevelhavesubstantiallyimproved;followupwithyourdoctor.
• YoudevelopnewsymptomsthatseemtocorrelatewithGFoatingestion?Followupwithanexpertceliacphysiciantodeterminewhetherglutenexposureoranalternativediagnosiscanaccountforthesesymptoms.
• Youwanttoissueacomplaintrelatedtopotentialglutencontamination?ContactMedWatch,theFDA’sAdverseEventReportingSystembyphone:800-332-1088(chooseoption#4tospeaktoaperson)oronline:https://www.accessdata.fda.gov/scripts/medwatch/index.cfm?action=reporting.home.Keeptheproduct’sboxorpackagetoreportthebatch/lotnumbertotherepresentative.
NASSCDSummaryStatementonOats.http://www.nasscd.org/files/Oats-Statement-NASSCD-April-2016(1).pdf.AccessedOct2017.
Drawing:AbbyBradley,age11
Bacteria:Youarewhateatswhatyoueat• Microbiome– bacteriaonbodysurfaces• Mostliveinyourcolonoronyourskin• 50%ofstoolweightisbacteria• ~Samenumberofbacteriacellsashumancells• Bacteria:3.3milliongenes:Humans23,000genes1
Adaptedwithpermission:JocelynSilvesterMD,PhD1.Qin,J.Nature464,59-65(2010)
Drawing:AbbyBradley,age11
Diversityisthespiceofmicrobiallife• 20,000speciesofbacteria(atleast)• Morehealthypeoplehavemore“biodiversity”• Communitypopulationisnotstatic• Somebacteriamorecommoninhealthypeoplethanothers• Thereisno“healthy”microbiome
Bacteria’sRole:• MakeVitaminK• Fermentfibertoproduceshortchainfattyacids• Communicatewithimmuneandnervoussystem
Adaptedwithpermission:JocelynSilvesterMD,PhD
Drawing:AbbyBradley,age11
Probiotics• “Livemicroorganismsthat,whenadministeredinadequateamounts,conferahealthbenefitonthehost”1
• NoevidenceforspecificuseofprobioticsinCD• Enthusiasmexceedsresearch• Difficulttoguideuse,selection,lengthoftime• Clinicaldecision:casebycasebasisforsymptomrelief• Trial,astolerated,andmonitor• Encourageprebioticandprobiotic-richFOODsourcesonaregularbasis,astolerated
1.SandersME.Probiotics:definition,sources,selection,anduses.ClinicalInfectiousDiseases,2008
Gluteningrowthmedia?• AnabstractpresentedatDigestiveDiseaseWeekin2014raisedconcernsaboutgrowthmediainprobiotics.
• Thisstudyassessedtheglutencontentofprobiotics:
*FDA-regulatedfoods,includingsupplements,mustcontain<20ppmglutentobelabeledGF.
15werelabeledasglutenfree
2ofthe15productscontained>20ppm*ofgluten(liquidchromatographymassspectrometry)
Nazarethetal.Widespreadcontaminationofprobioticswithglutendetectedbyliquidchromatography-massspectrometry[abstr].ProceedingsofDigestiveDiseaseWeek2014.Presentation108.Gastroenterol.2015;148(4suppl 1):S-714.
ThomsonT,DennisM,EmersonL.JAcadNutrDiet.2017Sep1.
Probiotics,DigestiveEnzymes&Gluten• “Bacteria,mold,yeastandenzymesproducedbybacteriaareusedinavarietyofproducts,includingprobioticsanddigestiveenzymes.
• Thesemicroorganismsmaybegrownonmediathatmayincludeingredientsderivedfromwheat,barley,andrye.
• Althoughthebacterialormoldstrainspresentinprobioticsenzymes,supplementscontainingprobioticsorenzymes,andsomefermentedfoodsisdeclared,noinformationonthegrowthmediaistypicallyprovided”.
ThompsonT,etal.JAcadNutrDiet,2017
Probiotic
Probiotics,DigestiveEnzymes&Gluten• “Bacteria,mold,yeastandenzymesproducedbybacteriaareusedinavarietyofproducts,includingprobioticsanddigestiveenzymes.
• Thesemicroorganismsmaybegrownonmediathatmayincludeingredientsderivedfromwheat,barley,andrye.
• Althoughthebacterialormoldstrainspresentinprobioticsenzymes,supplementscontainingprobioticsorenzymes,andsomefermentedfoodsisdeclared,noinformationonthegrowthmediaistypicallyprovided”.
ThompsonT,etal.JAcadNutrDiet,2017
ThompsonT,etal.JAcadNutrDiet.2017
ToSuppliersandManufacturers
• Disclose thecomponentsofgrowthmediatomanufacturers.• Beawareofthepotentialforglutenproteinfragmentstoremaininbacteriagrownongluten-containingmedia
• Deactivate and testwithacompetitiveELISA.• Moreresearchneeded.
Thompsonetal.JANDSept2017
TotheFDA
• HowAREgrowthmediaforbacteria(andothermicroorganisms)definedinlabeling?
• Ifwheat,barley,orryeareusedasgrowthmedia,cantheybelabeledasglutenfree?
• Iftheuseofglutencontaininggrowthmediaisallowedinagluten-freeproduct,howshouldproductscontainingbacteriaandbacterialenzymesbetestedtoensuresafety?
Thompsonetal.JANDSept2017
ToConsumers
• Ifyouuseprobiotics,selectproductslabeledglutenfree.• Concerned?Contactmanufacturersandaskquestions,suchas:
• Areanyofthebacteriaorbacterialenzymesusedinyourproductgrownongluten-containinggrowthmedia?
• Ifso,doyoutestbacterialstrainsandfinalproductsforglutencontaminationusingacompetitiveELISA?
• Untilmoreisknownaboutresidualglutenfromgrowthmedia,erringonthesideofcautionandavoidingproductscontainingingredientsgrownongluten-containinggrowthmediamaybebestiftheproductisnottestedforresidualglutenusingacompetitiveELISA.
http://www.sciencedirect.com/science/article/pii/S2212267217310663
Thompsonetal.JANDSept2017
ArsenicandtheGFD• Anodorless,tastelesselementfoundinsoil,water,andair• OrganicandInorganic(carcinogenic)• Linkedtomanyhealthproblems• Noknownsafeamountofarsenic• HigherlevelsindifferentpartsofU.S.
• Riceisgrownunderfloodedconditionsandwillabsorbarsenicfromboththesoilandthewater.
• Potentiallyhigherriskforpeoplewhoregularlyeatalotofrice,especiallychildren
• Morestudiesneeded
http://www.dartmouth.edu/~arsenicandyou
TakeActionAgainstArsenic• Howmucharsenicisinyourtapwater?• Howmuchisinyourbottledwater?• Testyoursoil.• Stopsmoking.• Eatricewithlowerlevelsofarsenic.• Soakandrinserawrice(30%reductioninarsenic)• Cook6cupswater:1cuprice.• Discardsomeofthewaterduringcooking.• Besurethewateryouuseforcookingricedoesnotcontainhigharsenic,sincericeabsorbswaterasitcooks.Youshouldnotusewaterwithmorethan10partsperbillionofarsenicforcooking.
http://www.dartmouth.edu/~arsenicandyou/;https://www.glutenfreewatchdog.org/getreport?rid=452;https://www.glutenfreewatchdog.org/news/arsenic-and-rice-update-for-gluten-free-consumers/
There’smorethan1kindofrice
Sometypesofricehavelessarsenicthanothers.• Quick-cookingrice• Instantrice• SushiricegrownintheU.S.• WhiteBasmatiricefromIndia,Pakistan,orCalifornia(1/2inorganicarsenicofmostothertypesofrice)
• Whitericehas~80%lessinorganicarsenicthanbrownrice.
http://www.dartmouth.edu/~arsenicandyou/
PassmethealternativeGFgrains!• Reducetheamountofriceandriceproductsyoueat.
• SubstitutericebyROTATINGinothergluten-freepseudo-grains.
• Amaranth,millet,buckwheat,teff,sorghumandquinoaANDdrinkmorewater.
Thesepseudo-grainsarehighinfiberandwillofferyoumanyimportantnutrients:• Vitamins• Minerals• Morenutritiousthanrice
Besuretheyarelabeledgluten-freetoavoidcrosscontaminationwithglutencontaininggrainsduringharvest,transport,andproduction.
A
B
C
D
E
F
Amaranth
Buckwheat
Millet
Quinoa
Sorghum
Teff
LeslieCerier
LeslieCerier
KristineKiddKristineKiddKristineKidd
Nutrient Content of Whole GF
Flours Fiber (gm) Folate (mcg) Calcium (mg) Iron (mg)
Amaranth 12.9 158 307 14.69Buckwheat groats 16.9 69 28 4.05
Millet 17.0 170 16 6.02Quinoa 11.9 313 80 7.77Sorghum 12.1 38 54 8.45Teff 15.4 — 347 14.73Wheat flour, whole-grain 14.6 53 41 4.66
Wheat flour, white enriched
3.4 245 422 5.84
ml1 cup, uncooked
NutrientContentofWholeGFGrains:Fiber,Folate,Calcium(1cupuncooked)Iron
USDANationalNutrientDatabase,http://www.nal.usda.gov/fnic/foodcomp/search/index.html
NutrientContentofGFGrains- BVitamins
Flours Thiamine (B1) (mg)
Riboflavin (B2) (mg)
Niacin (B3) (mg)
B6(mg)
Amaranth 0.22 0.39 1.78 1.14Buckwheat groats 0.37 0.44 8.42 0.579
Millet 0.84 0.58 9.44 0.77Quinoa 0.62 0.54 2.58 0.88Sorghum 0.46 0.27 5.6 1.13Teff 0.75 0.52 6.49 0.93Wheat flour, whole-grain 0.54 0.26 7.6 0.41
Wheat flour, white enriched
0.84 0.52 7.3 0.06
USDA National Nutrient Database, http://www.nal.usda.gov/fnic/foodcomp/search/index.html
1 cup, uncooked
Thislistisnotcomprehensive.
Thislistisnotcomprehensive.
Thankyouto:• TracyPunshon,Ph.D.,Dartmouthresearcher
• JocelynSilvester,MD,PhD
• TriciaThompson,MS,RDNwww.glutenfreewatchdog.org