Amy Burkhart, MD, RD

Amy Burkhart, MD, RD

Amy Burkhart, MD, RD, is a board-certified emergency medicine physician and registered dietitian. She also trained in integrative medicine with Dr. Andrew Weil at the University of Arizona Center for Integrative Medicine. Her practice is located in Napa, CA.
1100 Lincoln Ave. Suite 200
Napa, CA 94558
(707) 927-5622 Office
In the past several months we have seen a media backlash of information regarding the gluten-free diet. The diet has been called a hoax, a fad and a litany of other less desirable names. It has become the national punch line in cartoons and late night comedy, while media outlets are trying to understand the topic and separate fact from fiction. As a result, people who have celiac disease or non-celiac gluten sensitivity are encountering skepticism about their need to follow a gluten free diet.

Facts are lost in the media hype

Many of the articles and TV segments do mention celiac disease and gluten sensitivity, but that information unfortunately, often gets lost in the drama (and comedy). A fad or a hoax is far better press than a medical condition. The public is confused, as are the journalists who write the stories.

A recent article in the Wall Street Journal discussed whether or not the gluten-free diet has real health benefits or is simply a fad that will run its course. I had the pleasure of being interviewed in the video segment. In my initial discussion with the journalist, I was surprised to find that she thought the rise in popularity of the gluten-free diet was due solely to celebrity influence and media hype. In fact, research by the Mayo Clinic reveals that the incidence of celiac disease has quadrulpled since the 1950s. The Wall Street Journal author was not aware of the rise in medical need for a gluten-free diet, and she is not alone.

Nutritional deficiencies in gluten-free diet

There is n24911311_so denying a fad component to the phenomenon, and that will pass. The diet is difficult to adhere to if you do not have the negative reinforcement of illness with gluten ingestion. It is also expensive and socially inconvenient. When the fad component fades, we will still be left with an increasing population of people with celiac disease and non-celiac gluten sensitivity who need the gluten-free diet to stay healthy. But is it nutritionally sound and balanced? If not, what can we do to ensure that it is?

Prior studies have found as many as 38% of patients with celiac disease have some nutrient deficiency with components such as protein, fiber or vitamins and minerals. A recent studypublished in the journal Plant Foods for Human Nutrition compared what would happen if you substituted gluten-free products for their gluten-containing counterparts. The study team compared over 200 foods and their gluten-free equivalents. The results reinforced the findings of previous studies, indicating that a gluten-free diet is not necessarily more nutritionally sound than a gluten-containing diet.

In fact, the study suggested that a gluten-free diet may have a negative impact on cardiovascular health as well as other key aspects of health. Undesired health outcomes may occur if there is a heavy reliance on packaged gluten-free products.  These products are often lower in protein and fiber, and higher in fat (especially saturated fat), cholesterol, sugar and calories. Gluten-free products are also generally known to be lower in B vitamins and iron, although this study did not evaluate for these nutrients.

Increasing the nutritional value of the gluten-free diet

For people who must follow a gluten-free diet for medical reasons, there are many ways to improve the nutritional profile of the diet. Consuming a predominantly plant-based diet of whole foods, which may also include lean meats and fish, is a great start. The following are a few suggestions to make your transition to a healthier gluten-free diet easier.


  1. Eat real food. Avoid processed gluten-free foods as much as possible. When you do eat packaged food, choose the items with the least number of ingredients.
  2. Increase fiber. Consume more beans, vegetables, fruit, and grains such as quinoa, amaranth, millet and chia.
  3. Increase protein. Eat plenty of nuts, seeds, beans, dairy and lean meats and fish.
  4. Improve your vitamin and mineral intake. One way is to drink your greens in juice or a smoothie. This will also help your fiber intake immensely. Find a favorite recipe and drink it daily.
  5. Decrease your sugar intake. Switch from soda, juice, and sugary coffee drinks to sparkling water with a splash of juice. If you drink coffee try stevia as a sweetener.
  6. Plan ahead. Forgetting to always have “back-up” foods is more likely to result in a nutritionally poor meal.
  7. Lower your fat intake. Bake and broil your foods whenever possible, rather than frying.
  8. Reassure yourself that you are not “deprived.”Availability of gluten-free options is increasing daily and feeling deprived leads to overeating and poor food choices. Planning ahead helps with this. Having a substitute at hand minimizes feelings of deprivation. Focus on the positive. You feel better if you don’t eat gluten!
  9. Decrease your cholesterol intake by using the “plate” method.  Assign one half of your plate to vegetables, ¼ to carbohydrate and ¼ to protein, preferably plant based. Plant foods do not contain cholesterol and do contain fiber, which is proven to help manage cholesterol levels.
  10. Enjoy your food. Enjoy it with others often. The pleasure of eating and socializing is a vital part of a healthy eating plan.

For those days when cooking from scratch is next to impossible, you don’t have to settle for potato chips for dinner. Food manufacturers are beginning to address the consumer demand for healthier versions of gluten-free foods, and more products are on the way. Manufacturers are starting to use alternative grains with more nutritional value than the typical blend of rice, potato and tapioca flours. Higher protein content is being achieved through the use of bean and nut flours. The future looks bright for more of these types of products as the demand for them increases, and they can be incorporated into a healthy gluten-free diet focused on fresh, whole foods.