Is gluten-free bread healthier than regular bread?

At my grocery store, the bread selection stretches across an entire aisle. And among those amber waves of bread loaves, bagels and buns are a few gluten-free options, which can cost about twice as much as their wheat-based counterparts. Are they a more nutritious choice?

As is often the case with nutrition questions, the answer will depend on your individual circumstance, said Jerlyn Jones, a spokesperson for the Academy of Nutrition and Dietetics and a registered dietitian in Atlanta. But for most people, choosing a gluten-free bread instead of a wheat-based bread is not an inherently more nutritious option, she added. And, gluten-free breads can be harder on your wallet, she said, since they are often more expensive and have a shorter shelf life.

Gluten is a protein found in the grains of wheat, barley and rye. In traditional bread made from wheat flour, gluten forms a protein network that makes dough cohesive and stretchy and gives bread that quintessentially satisfying, chewy texture.

But gluten or other components of wheat can cause health problems in some. For the estimated 1% of people worldwide who have celiac disease, a serious autoimmune condition triggered by eating gluten, the protein causes intestinal damage that can impair nutrient absorption and lead to symptoms like diarrhea, weight loss, fatigue, anemia and a blistery, itchy rash. The only effective way to manage celiac disease is strict and lifelong gluten avoidance.

For others with milder wheat-related sensitivities, eating the grain doesn’t cause the intestinal damage found in celiac disease, but it can cause gastrointestinal discomfort and symptoms like fatigue and headache that usually go away when wheat is avoided. It’s not clear how many people have this condition, called non-celiac wheat sensitivity, but it may be more common than celiac disease.

A third, much less common wheat-related condition is a wheat allergy, which can cause allergic reactions like diarrhea, vomiting, facial swelling or difficulty breathing within minutes to hours after eating wheat.

If you have celiac disease, wheat sensitivity or a wheat allergy, going with a gluten-free bread is clearly the better choice. But in a 2017 survey of 1,000 people in the United States and Canada who purchased gluten-free groceries — conducted by food and beverage ingredient supplier Ingredion — 46% said they bought those products for reasons other than a medical condition. Among their top motivations: wanting to reduce inflammation or consume fewer artificial ingredients, believing that gluten-free products were healthier or more natural, and thinking that such products would help with weight loss.

However, none of these beliefs are true, said Anne R Lee, a registered dietitian and an assistant professor of nutritional medicine at the Celiac Disease Center at Columbia University Medical Center.

“Typically, the gluten-free products are higher in fat, higher in sugar, higher in salt and lower in fiber and your B vitamins and iron,” she said.

Making bread without gluten is a technological challenge, and manufacturers tend to rely on ingredients like refined rice, potato or tapioca flours, which contain much less protein and fiber than wheat flours, Lee said. Most of the refined wheat flours used in the United States are enriched with iron and the B vitamins folic acid, niacin, riboflavin and thiamin, while the flours used in gluten-free products generally don’t contain these added nutrients.

Gluten-free bread manufacturers also often add sugar, fat and salt to their products to make them taste better, Lee said. And in part because gluten-free breads tend to contain more water, fat and refined starch than wheat-based breads, they spoil and become stale more quickly.

For these reasons, going gluten-free is not always a better choice.

“If you think you have an intolerance to gluten, before you take it out of your diet, go see a gastroenterologist and really be tested appropriately,” Lee said. An added benefit: Celiac disease is more difficult to diagnose in people who have already eliminated gluten.

There’s also quality of life to consider. Restricting your diet can make you more anxious in social situations or make you more reluctant to try homemade foods at family meals, Jones said.

Food “is not only fuel for our bodies, but it also gives us enjoyment, too. You don’t want to miss out on enjoyment, especially nowadays,” she added, referring to those who avoid gluten without a medical reason.

For her patients who need to eliminate gluten, Lee advises focusing less on packaged gluten-free products and more on whole foods like fruits, vegetables, beans and gluten-free whole grains and seeds like amaranth, buckwheat, quinoa, teff and millet.

“If you do a gluten-free diet where you’re using foods that are naturally gluten-free, like all these wonderful grains, then your diet can be incredibly healthy,” she said.

But if you’re craving a sandwich, you’ll need bread. The good news is that gluten-free products have improved — “they’re better than they were even five years ago,” Lee said. Many manufacturers have started to include more gluten-free whole grains in their products, which can boost fiber, protein and some vitamins and minerals. Just as wheat-based breads can range widely in nutritional quality, from highly processed white bread to whole grain loaves, the same is now true of gluten-free options, Lee said.

To identify better gluten-free breads, Lee recommended comparing their nutrition labels with those from whole wheat breads. Check for similar levels of fiber and protein and minimal added sugar, and look for a bread with whole grains among the first few ingredients, which are listed in descending order by weight, so that the first ingredient is always present in the largest amount.

“If your first ingredients are water and tapioca starch, put the bread back on the shelf,” Lee said.

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