The gluten-free diet is a lifesaver for those with celiac disease. That’s because excluding gluten-containing foods such as wheat, rye, and barley lets the small

intestine heal so a host of health problems will improve. But if you’re not careful, avoiding gluten can create new problems: nutrient deficiencies and fat overload. studies have shown that if you follow a gluten-free diet, you may end up eating too much fat and too little carbohydrate, fiber, iron, calcium, phosphorus, zinc, and the B vitamins folate, niacin, and B12. Here are four strategies to keep you gluten free and well nourished at the same time.

trim the fat: “Many gluten-free baked goods have more added fat, and sometimes sugars, too, than do their gluten-based counterparts to make them palat-able,” says shelley Case, Bsc, RD, a saskatch-ewan, Canada-based consultant dietitian specializing in celiac disease and author of Gluten-Free Diet: A Comprehensive Resource Guide.

steer clear of these hidden fats, says Case, by reading the Nutri-tion Facts panel on product labels. “Then buy the one that is lowest in fat yet still satisfying,” she explains.

Heart-stopping saturated fat can be a problem, too, adds Tricia Thompson, Ms, RD, a Manchester, Massachusetts-based nutrition consul-tant, speaker, and author of The Gluten-Free Nutrition Guide. “some people cut down on foods containing carbohydrates in an effort to eliminate gluten and end up eating more

high-fat meats and dairy. The solution is to focus on gluten-free whole grains, fruits, and vegetables. These are virtually fat free and nutrient dense.”

Fill up on fiber: Many gluten-free products are made from the big four: cornstarch, potato starch, tapioca starch, and white rice flour, says Case. “This means they’re high in starch and low in fiber,” she explains.

To get more fiber, says Marlisa Brown, Ms, RD, CDe, CDN, a Bay shore, New york-based chef, certi-fied diabetes educator, and author of Gluten-Free, Hassle Free, “Choose gluten-free whole grains such as amaranth, buckwheat, brown rice, legumes, millet, sorghum, soy, and teff. For example, look for a breakfast cereal made out of any of these grains

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and add flax and fresh or dried fruit to increase the fiber even more.”

Whole grains also add vital nutrients to the diet. According to a study published in the Journal of Human Nutrition and Dietetics in 2009, substituting oats, high-fiber gluten-free bread, and quinoa for white rice not only ups your intake of fiber but also of protein, iron, and calcium.

Fortify meals with B vitamins, folate, and iron: Gluten-free flours and starches traditionally have not been enriched with the B vitamins thiamin, ribo-flavin, and niacin; the mineral iron; or folate. But now several manufacturers such as enjoy Life Foods, ener-G Foods, and Kinnikinnick add these nutrients to their products.

“The B vitamins are not listed on the current Nutrition Facts panel,” says Thompson. “Therefore, the only way to know if a bread or baked item is a good source of these vitamins is to look for the whole grain form or for products that are ‘enriched’ or ‘fortified.’”

you can also get thiamin from eating pork, flax, sunflower seeds, potatoes, and eggs; riboflavin from dairy products; and niacin from peanuts, chicken, beef, and dried beans.

Iron is also a key nutrient that may be in short supply in gluten-free diets. Forty percent of people with celiac disease who participated in The Canadian Celiac Health survey in 2005 reported being anemic upon diagnosis.

Once the gut heals, iron from red meats is well absorbed, says Case. “so is iron from dried beans and peas, dried fruit, nuts, seeds, eggs, and black-strap molasses when taken with a source of vitamin C such as orange juice or tomatoes.”

Bone up on calcium: Thirty-five percent of those queried by The Canadian Celiac Health survey said they’d been evaluated for bone disorders such as

osteoporosis or osteopenia, which under-scores the need for calcium.

“Milk is loaded with calcium, but many people with celiac disease can’t drink it because they are lactose intolerant and it sends them straight to the bathroom,” says Case. “The lactase enzyme is located

in the tips of the intestinal villi, and these are damaged by celiac disease.

Getting on a gluten-free diet will heal these villi, and the lactase enzyme activity

will usually return.”Hard cheeses such as cheddar, provolone, and

swiss have less lactose than does milk and are better tolerated. In addition, calcium-processed tofu, calcium-fortified nondairy milks, and some leafy greens such as kale, collard greens, and bok choy are good sources of calcium.

— Carol M. Bareuther, RD