Tag: nutrition

Obtaining calcium on a dairy-free diet

I have been on a dairy-free diet since February and for me personally it has been helping with the brain fog issue, scalp eczema, and experiences of fear/panic attacks/existential anxiety. I have tried all sorts of dairy – fermented, non-fermented, lactose-free, goat milk, sheep milk, kefir, yogurt. In the end, I found that I feel better on the days when I do not consume dairy and that the negative effects of it make it not worth it for me to continue consuming it. Some dairy has significant levels of the vitamin B12 and iodine, but those nutrients are not difficult to find elsewhere. Chicken liver, eggs, and salmon contain enough vitamin B12. Eggs also contain iodine and I use iodized salt when cooking. The main element I was concerned about when I stopped eating dairy was calcium. I tried taking calcium supplements for a while but I experienced quite negative side-effects such as frequent urination, constipation, and abdominal bloating. I decided to therefore look for natural sources of calcium that are dairy-free.

It’s possible to obtain enough calcium from fortified plant milks, and that might be the easiest option, if that works for you. I’m not sure though that it would be any different from just taking a calcium supplement, because plant milks are fortified with the same calcium carbonate. I am also not a fan of fortified plant milks as there is some evidence that consuming a lot of extra vitamin B12 and folate, which are added to plant milks in high amounts, can increase the risk of some cancers.

Folic Acid and Vitamin B12 Supplementation and the Risk of Cancer: Long-term Follow-up of the B Vitamins for the Prevention of Osteoporotic Fractures (B-PROOF) Trial

Also I found that fortified plant milks increased my anxiety and occurrence of nightmares, I found the same effects when I was taking a B12 supplement on its own. I consume enough B12 through eggs, meat, and fish, and enough folate through legumes and fruits, therefore my assumption is that the extra vitamins from fortified plant milks had negative effects for me. If you have no problem with vegan substitute products, then you can easily obtain enough calcium without diary by eating fortified vegan plant milks, vegan yogurts, vegan cheese. Tofu also usually has calcium sulfate added to it. Unfortunately I experienced worsening of scalp eczema when eating soy frequently, but if soy is not a problem for you, fortified soy milk and tofu are good sources of calcium.

Since I am currently not consuming a lot of soy products and not consuming plant milks, I had to find other sources of calcium. After looking through nutritional info for various foods, I found that the best way to get enough calcium is to consume bones. Most of the calcium is stored in bones, and only small amounts are found in blood and tissues.
The easiest way to consume bones is by eating canned salmon and canned sardines. You can check the nutrition info on the cans, the salmon needs to be “with skin and bones”, not just the file. The can of salmon that I bought contains in total 363mg of calcium, which is about 30% of daily value (DV). A can of sardines can contain up to 40% of DV of calcium. You can eat the fish right out of the can or add to soup. Another source of calcium is chia seeds, two table spoons contain around 18% of DV. You can add chia seeds to oatmeal in the morning. Another way to eat some bones is by cooking bone broth. There is no evidence that calcium leaks into the actual broth, the amount is very minimal, so you would have to eat the softened bones themselves. I usually cook a broth with chicken or turkey bones for at least an hour, then they are soft enough to actually eat.

Best natural sources of calcium: canned sardines, canned salmon, chicken/turkey bones from bone broth, chia seeds

Why do humans need calcium?

Calcium is required for multiple processes in the human body. 99% of the calcium is stored in bones and only 1% is found in blood and tissues. When there is not enough calcium in the blood, the parathyroid hormone will signal the bones to release calcium. Therefore it’s important to consume enough calcium so that it doesn’t have to keep being released from bones, as you don’t want to weaken your bones. For women especially, it is important to receive enough calcium from diet. In all humans after the age of 30, bone destruction usually exceeds bone products. Women can experience greater bone loss after menopause as the levels of hormones that play a role in building bones become permanently lower.

Calcium is needed for nerves to carry signals between brain and other body parts, it’s also needed for muscles to move. Calcium is required for muscle contraction, blood clotting, regulating heart rate, and cell fluid balance. Not having enough calcium can lead to painful muscle spasms, twitching of muscles, numbness or tingling in feet, hands, and mouth. It can also lead to anxiety, depression, itchy skin, and tiredness.

Vitamins before antidepressants . Vitaminas antes de los antidepresivos.

Texto en español a continuación.

This post will not be against antidepressants. I only want to share my experiences, in case they might help someone. I found out the hard way that eating healthy and obtaining all the basic vitamins is necessary (but not sufficient) for mood stability and emotional regulation. Unfortunately not all doctors or psychiatrists check for vitamin and mineral deficiencies before prescribing antidepressants. There is a lot of research indicating that many vitamins and minerals are important for the functioning of neurotransmitters. So I am not stating ‘always vitamins instead of antidepressant’, but in my opinion as a patient, diet should always be reviewed first. Especially if you have any gastrointestinal problems, family history of gastrointestinal issues, or you live in a northern country. Also if you are vegan, vegetarian, or have any other food restrictions.

I have written in my previous posts about getting a diagnosis of autoimmune encephalitis, but let’s set that aside for now. I did end up being referred to a neurologist, but in this post I want to focus on my experience with psychiatrists. When I was referred to a psychiatrist by the emergency department, several blood tests were performed. Blood glucose level, iron level, thyroid stimulating hormone (TSH) test results were sent to the psychiatrist. Since these test results came back normal, right away the psychiatrist prescribed me mirtazapine.

Mirtazapine did not help my mood and I only gained weight on it and had trouble waking up in the morning. Therefore, my dissatisfaction with this approach is that several important blood tests were not prescribed. For example, I live in a northern country, therefore it is possible to be deficient in vitamin D. They also didn’t ask me about my diet, but a spicy diet can lead to deficiencies in B vitamins and omega 3 fatty acids. Additional point – my blood glucose was checked only once, it was not proven how I react to eating carbohydrates.

Later I discovered that I was deficient in vitamin D, that my blood sugar level would jump too high after eating refined carbohydrates, and I was not getting enough folic acid and calcium. By not performing the necessary laboratory tests, the doctor lost a lot of time and delayed my treatment. I was also taking unnecessary high doses of antidepressants, which were not helping.

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Esta publicación no será contra los antidepresivos. Solo quiero compartir mis experiencias, en caso de que puedan ayudar a alguien. Descubrí por las malas que comer sano y obtener todas las vitaminas básicas es necesario (pero no suficiente) para la estabilidad del estado de ánimo y la regulación emocional. Desafortunadamente, no todos los médicos o psiquiatras verifican las deficiencias de vitaminas y minerales antes de recetar antidepresivos. Hay mucha investigación que indica que muchas vitaminas y minerales son importantes para el funcionamiento de los neurotransmisores. Por lo tanto, no estoy diciendo “siempre vitaminas en lugar de antidepresivos”, pero en mi opinión como paciente, la dieta siempre debe revisarse primero. Especialmente si tiene problemas gastrointestinales, antecedentes familiares de problemas gastrointestinales o si vive en un país del norte. Además, si eres vegano, vegetariano o tienes otras restricciones alimenticias.

He escrito en mis publicaciones anteriores sobre el diagnóstico de encefalitis autoinmune, pero dejemos eso de lado por ahora. Terminé siendo referido a un neurólogo, pero en esta publicación quiero centrarme en mi experiencia con los psiquiatras. Cuando el departamento de emergencias me remitió a un psiquiatra, me realizaron varios análisis de sangre. Los resultados de las pruebas de nivel de glucosa en sangre, nivel de hierro y hormona estimulante de la tiroides (TSH) se enviaron al psiquiatra. Como los resultados de estas pruebas mostraron ser normales, de inmediato el psiquiatra me recetó mirtazapina.

Mirtazapine no ayudó mi humor y solo subí de peso, y tuve dificultad para despertar en las mañanas. Entonces, mi insatisfacción con este enfoque está que varios análisis de sangre importantes no fueron prescritas. Por example, vivo en un país del norte, por lo tanto está posible estar deficiente en vitamina D. También no me preguntaron sobre mi dieta, pero una dieta espicifica puede conducir a las deficiencias en vitaminas B y ácidos grasos omega 3.  Punto adicional – mi glucemia se comprobó solo una vez, no fue probado cómo reacciono al comer carbohidratos.

Mas tarde descubrí que era deficiente en vitamina D, que mi nivel de azúcar en la sangre saltaria demasiado alto después de comer carbohidratos refinados, además no estaba recibiendo suficiente ácido fólico y calcio. Al no realizar las pruebas de laboratorio necesarias, el doctor perdió mucho tiempo y retrasó mi tratamiento. Además estaba tomando dosis altas innecesarias de antidepresivos, que no estaban ayudando.

Any benefits to ‘ancient’ grains?

Ancient grains are whole grains that are considered more… ancient… than some modern grains. If you ever visit health stores, than you probably had seen this marketing label multiple times – Ancient Grains Pasta! Ancient Grains Cereal! Ancient Grains Bread. Also now I see everywhere sprouted breads, sprouted cereals, sprouted oatmeal. There is even a brand that sells Ezekiel 4:9 bread with a verse from the Holy Scripture on the package. I suppose they were trying to emphasize how ancient the recipe is. Or holy.

In general I think dietitians would say that whole ancient grain breads, wraps, cereals, pastries, etc., are definitely healthier than same items made out of white flour. I also think they are healthier than similar gluten-free items. In those the main ingredient is usually tapioca starch or white rice flour. Take for example Glutino sandwich bread. I just Googled it and right away saw this description of their product by the company: “Did you know? Gluten comes from the Latin word for “glue”. So think of yourself as eating glue-free.” Yes, because the word gluten originates from some Latin word meaning ‘glue’, you should drop everything and switch to eating slices of white matter made out of modified tapioca starch, corn starch, potato starch, and baking soda. One slice of the Glutino bread contains 0g fiber, 0g protein, and I don’t see any other nutrients listed on the label.

In this conversation  I will not refer to people who have celiac disease. I understand that with celiac even one crumb of gluten would cause an autoimmune reaction. I’m referring here to all of us who did not test positive for celiac disease, but were told by naturopaths and other pseudo ‘doctors’ that gluten is causing their autoimmune disease, or thyroid disease, or depression, anxiety, autism, you name it. I don’t see any convincing evidence that whole grain gluten grains cause any of these diseases. To provide good evidence, I think a study would have to follow two randomized groups of patients for a while and restrict the diet of the test group to be gluten-free, group assignment of course would have to be unknown to the patients. The diets would have to be the same in other aspects, otherwise it’s not a fair comparison. Also the diet should be healthy , so the patients are receiving all the necessary nutrients, since we are interested in whether or not gluten has negative effects on health with an otherwise healthy diet. You would also have to do separate studies for each condition. Randomized test-control study for patients with schizophrenia, with depression, with autism, hypothyroidism, etc. If gluten negatively affects schizophrenia symptoms, it does not necessarily mean that  it also negatively effects patients with thyroid disease. For example high soy consumption is not recommended for those taking levothyroxine as it may interfere with medication absorption. On the other hand some research suggests that soy has antidepressant effects and therefore could help individuals with depression.

Is there some research in regards to gluten and neuropsychiatric and autoimmune diseases (except celiac)? Yes, there is. I just really don’t like the claims by naturopaths on their websites that it’s known that gluten causes schizophrenia, depression, and everything else. We definitely can’t claim causation, we don’t have such information at this point, and it doesn’t make sense to bundle up a dozen of diseases together. Schizophrenia is very different from hypothyroidism, and both are different from ADHD.

For schizophrenia: there is some renewed interest in regards to gluten-free diet. “Going gluten free shows a benefit for a subset of schizophrenia patients,… Those on the gluten-free diet also showed improvement in gastrointestinal symptoms and improvement in certain cognitive traits, such as attention and verbal learning.”

Interest renewed in targeting gluten in schizophrenia

Autism: The one review of research that I found indicated that evidence was inconclusive. “Studies evaluating gluten/casein-free diets reported some parent-rated improvements in communication and challenging behaviors; however, data were inadequate to make conclusions about the body of evidence (insufficient SOE). Studies of gluten- or casein-containing challenge foods reported no effects on behavior or gastrointestinal symptoms with challenge foods (insufficient SOE);”

Nutritional and Dietary Interventions for Autism Spectrum Disorder: A Systematic Review

Hypothyroidism: I could not find an actual systematic review on relationship between hypothyroidism and gluten research, therefore I am not sure if there is any evidence that gluten consumption negatively impact thyroid function. Clinical websites state that there is no such evidence. “Generally, there’s no hypothyroidism diet. Although claims about hypothyroidism diets abound, there’s no evidence that eating or avoiding certain foods will improve thyroid function in people with hypothyroidism.”

Hypothyroidism diet

Personally I did not achieve remission in depression or autoimmune disease with a gluten-free diet. In fact at first going gluten-free probably led to a worse diet for me, as I would eat two or three gluten-free bread cheese sandwiches a day, and as we can see this type of bread has no proteins, nor fiber, no other nutrients. So basically I was eating tapioca starch. I was also consuming gluten-free cookies, which are probably mostly sugar and again, tapioca starch, corn tortilla chips, and gluten-free subs (gluten-free Subway buns are a lot of cornstarch). I doubt there are any B vitamins in the above foods, nor any other nutrients. What about a healthy diet with gluten-free grains vs. the same diet, but also including gluten whole grains? It has been over a month for me since I started eating gluten again. I have not noticed so far any changes in my health. My health did not improve nor did it worsen. I don’t want to limit myself and keep falling victim to these restrictive diets promising to cure all your mental health problems. Gluten-free diet, alkaline diet, keto diet, AIP diet.. there will be claims found for each of these that this specific diet cures depression, autism, and schizophrenia. Well I have not found a cure for depression, so I do not have that answer. It’s important to eat healthy, but it doesn’t seem to me that a very restrictive diet is an answer.

Again, for myself I did not observe worsening of mental issues after introducing gluten whole grains to my diet. Also not obsessing over whether something was contaminated with gluten lessened my anxiety related to eating. I am still trying to avoid A1 cow dairy and yeast (based on my testing of my symptoms). I want to restrict as few foods as possible. Naturopaths telling people that a bite of gluten or a piece of corn will cause panic attacks for the next few months are the ones actually contributing to anxiety of people like me. By starting eating gluten again I made my life much easier – I don’t have to pay extra for gluten-free oats, I buy rotis, wraps, and samosas, which I can easily eat at work in the morning or as a snack. I’m eating cereal and getting the B vitamins. I can purchase good tasting spelt pasta for cheap, instead of buying very expensive chickpea pasta.

In regards to whole wheat vs. more ancient wheat related grains, I don’t think there is strong evidence that ancient grains are better, but there are some studies related to this. I buy and mix both types of flour – spelt and whole wheat. I noticed that using only spelt flour, the muffins or cookies don’t rise as well (even though I do add sodium bicarbonate or potassium bicarbonate).

There is some evidence in support of ancient grains consumption, I will review it below.

Grain composition is affected by both the environment and agronomy, particularly the type and amount of nitrogen fertilisation. Increased nitrogen application leads to higher protein content (Shewry et al., 2013), but this is accompanied by effects on protein composition, with high protein grain containing higher proportions of gluten storage proteins and of gliadin proteins within this fraction (Godfrey et al., 2010).

 compared data for ancient wheats with modern durum and bread wheats. However, to minimise effects of the environment they only considered studies in which modern and ancient wheats were grown together in field experiments. They concluded that ancient wheats differ little from modern wheat species in their contents of most bioactive components and may be lower in some components such as dietary fibre. However, there is clear agreement in the literature that einkorn, emmer and Khorasan (Kamut) wheat all have higher high contents of the carotenoid lutein than bread wheat, which is selected for white colour. Modern durum wheat is also rich in lutein due to selection for yellow colour.

Six trials reported comparisons of Kamut or related forms of Khorasan wheat with modern durum and/or bread wheats, measuring effects on parameters related to cardiovascular disease, glycaemic index, type 2 diabetes and irritable bowel syndrome. However, none of these studies compared Kamut wheat grown in identical conditions to the control wheats, presumably because the growth of Kamut is strictly controlled. As stated on the Kamut® web site (http://www.kamut.com/en/discover/the-trademark): “The KAMUT® trademark is a guarantee that the khorasan wheat bearing it is always the original, unmodified, unhybridized and non-GMO variety. KAMUT® khorasan wheat is also always grown certified organic and meets high purity, nutrition and quality standards”.

Scazzina et al (2008) obtained wholemeal Kamut and bread wheat flours from a local (Italian) supermarket and hence nothing is known about the growth conditions of the crops or the identity of the control wheat (although it would be expected to be a blend of commercial cultivars). Tortillas prepared with 60% flour had significantly higher fibre (6.7% compared with 3.5%) and lower starch (44.3% compared with 48.6%) when made from Kamut than from bread wheat, but did not differ in glycaemic index in an intervention trial.

Pasta made from the semi-whole wheat semolina fractions of Kamut and durum wheat and bread and crackers made from the semi-whole wheat flours from Kamut and bread wheats were compared in a randomised single blinded cross-over trial with 22 patients. The Kamut diet resulted in significant reductions in metabolic risk factors (total cholesterol, LDL cholesterol, blood glucose), improved redox status, increased serum potassium and magnesium and significant reductions in circulating levels of pro-inflammatory cytokines.

Do ancient types of wheat have health benefits compared with modern bread wheat?

Gluten, scary titles, and science

Last Friday during lunch I bought some spelt crackers and ate them, and nothing happened. Spelt is a type of grain that is strongly related to wheat. Why did I decide to try it? Well I have been trying to eat gluten-free since May 2016 when I was diagnosed with Hashimoto’s thyroiditis (and later on with Hashimoto’s encephalitis). I had been seeing a psychiatrist since October 2015 but I wasn’t responding to any of the prescribed psych meds, so my mom ordered the family doctor to refer me for autoimmune testing and high levels of anti-Tg and anti-TPO antibodies were found. I also tested positive for deamidated gliadin IgG, but negative for transglutaminase IgA antibodies. Total IgA was within normal range. Clinical websites state that if total IgA is normal and tissue transglutaminase (tTG)-IgA is negative, there is a low probability of the patient having celiac disease and a biopsy may not be necessary. My doctor did order a biopsy because of the elevated deamidated gliadin antibodies and the results indicated that there were no atrophic features identified (celiac disease causes persistent villous atrophy).

So what happened next? I think a rational doctor at this point should have said that I could go on with my bread eating, since the biopsy is the main test for celiac disease detection, and my results came back normal. But psychiatrically I was not well and my mom was very scared, she didn’t know what to do, since the psychiatrist was also out of ideas. When conventional medicine fails, people turn to alternative. Soon here we were, with my mom at a naturopath’s office. Consultation price per hour was around $250. The man in a white coat, pretending to be a doctor, asked me about my symptoms. He stated that I had to stop consuming gluten, dairy, needed to do a food sensitivities test, hair analysis test, should stop taking my antidepressant medication, and should buy $100 worth of supplements from him. He also mentioned eating cooked kale. In total this one consultation, after my mom also paid for all the tests he ordered, cost my mom around $2000 – $2500. That’s how you make money, ladies and gentlemen.

It’s very easy to come across articles online with scary titles about gluten. “Is Gluten Causing Your Depression?”, “The Surprising Link Between Gluten and Depression”, “Is gluten messing with your mind? Find out how.” One articles states that it could be actually FODMAPs (fermentable oligo di mono-saccharides and polyols) causing bowel inflammation and in turn depression. Wheat is high in FODMAPs and it’s effects could be misinterpreted as caused by gluten. This theory has some research to support it. Personally since I started eating gluten already a month ago, I did not experience abdominal pain from wheat products. I did notice bloating and pain after eating yeast containing products, such as bread, but no problem with eating wheat rotis, flatbread, etc. I am also using helminthic therapy, as I mentioned in previous posts, so this also could have helped with abdominal inflammation.

Some other articles outright claim that gluten causes “hundreds of symptoms”, also causing depression, psychosis, schizophrenia, and autism. To make extraordinary claims you have to provide extraordinary evidence. I have not been able to find strong evidence that gluten consumption causes any of the above conditions. There do exist several studies finding negative symptoms from gluten consumption, but I would not call this strong evidence. There are also other studies indicating negative impact of a gluten-free diet. I will list some of the studies below, covering both sides of the argument:

  1. Mood Disorders and Gluten: It’s Not All in Your Mind! A Systematic Review with Meta-Analysis. Meta-analyses with random-effects were performed. Three randomised-controlled trials and 10 longitudinal studies comprising 1139 participants fit the inclusion criteria. A gluten-free diet (GFD) significantly improved pooled depressive symptom scores in GFD-treated patients (Standardised Mean Difference (SMD) −0.37, 95% confidence interval (CI) −0.55 to −0.20; p < 0.0001), with no difference in mean scores between patients and healthy controls after one year (SMD 0.01, 95% CI −0.18 to 0.20, p = 0.94). There was a tendency towards worsening symptoms for non-coeliac gluten sensitive patients during a blinded gluten challenge vs. placebo (SMD 0.21, 95% CI −0.58 to 0.15; p = 0.25). Our review supports the association between mood disorders and gluten intake in susceptible individuals. The effects of a GFD on mood in subjects without gluten-related disorders should be considered in future research.
  2. Effects of a gluten-free diet on gut microbiota and immune function in healthy adult humans. The trial included 10 healthy subjects (30.3 years-old), which were submitted to a GFD over one month. Analysis of fecal microbiota and dietary intake indicated that numbers of healthy gut bacteria decreased, while numbers of unhealthy bacteria increased parallel to reductions in the intake of polysaccharides after following the GFD. Fecal samples of subjects under a GFD, which represent an altered microbiota, also exerted lower immune stimulatory effects on peripheral blood mononuclear cells than those of subjects on a regular gluten-containing diet.
  3. The Gluten-Free Diet: Fad or Necessity?

    Some evidence indicates that there are significant drawbacks to following the gluten-free diet. For example, gluten-free processed grain products (e.g., breads, cereals, and crackers) are often lower in fiber, iron, zinc, and potassium (29). The gluten-free diet also may increase the risks for nutritional deficiencies, especially in B vitamins, iron, and trace minerals (30). In addition, gluten-free products continue to be significantly more expensive. A 2015 study found that gluten-free bread and bakery products were on average 267% more expensive than gluten-containing breads, and gluten-free cereals were found to be 205% more expensive than gluten-containing cereals (29).

    Individuals following the gluten-free diet also may fail to adhere to recommendations regarding daily servings of grain products. One study found that 38% of patients with celiac disease included no grain or starch choice at meals; when patients did choose a grain product, 44% most frequently chose rice (31). In another survey of people with celiac disease, 80% were eating less than half of the recommended daily amount of grains, and only 1.1% ate the six recommended servings each day. Of those who did eat grain products, 61% most frequently chose rice and corn (32).

Personally I don’t see any strong evidence that a gluten-free diet would reduce depressive symptoms in persons with no celiac disease. In the first study, the authors state “anti-gliadin IgG antibodies disappeared in NCGS patients [34] and markers of systemic inflammation were reduced in IBS patients [36], as well as healthy mice [37] following initiation of a GFD.” I don’t see this applicable to me because I tested and I do not experience any IBS symptoms from consuming wheat or spelt. I do find myself having strong abdominal pain after consumption of regular cow milk products or yeast containing products, such as leavened bread. I have no problem with muffins prepared with baking soda, rotis, tortillas, or breakfast cereals. I see no reason to not eat these foods as they are healthy whole grains and contain B vitamins. In general I don’t want to have specific constrains for myself and feel guilty after eating once piece of pie. I know some naturopaths will say that even one piece of a cookie with gluten can make you depressed, but I see that as non-scientific nonsense. I have been gluten free, dairy free, on the autoimmune protocol diet, and I am still depressed. Depression can be caused by genetics, female hormones (such as premenstrual dysphoric disorder), epigenetics. One piece of pie isn’t going to make it or break it for me, but it does make that moment sweeter. I’m not going to be eating pie often and I do limit my sugar intake, but once a week at a friend’s house is no big deal.

By law, in Canada white wheat flour has to be enriched, therefore by eating flour products you obtain several B vitamins.  “The mandatory enrichment of white flour with B vitamins, iron and folic acid is a cornerstone of Canada’s fortification program aimed at helping to prevent nutrient deficiencies and maintain or improve the nutritional quality of the food supply.

Section B.13.001 (Food and Drug Regulations):

[S] Flour, White Flour, Enriched Flour or Enriched White Flour

(d)shall contain in 100 grams of flour

  1. 0.64 milligrams of thiamine
  2. 0.40 milligrams of riboflavin
  3. 5.30 milligrams of niacin or niacinamide
  4. 0.15 milligrams of folic acid, and
  5. 4.4 milligrams of iron

(e) may contain

(xv) in 100 grams of flour

  1. 0.31 milligrams of vitamin B6
  2. 1.3 milligrams of d-pantothenic acid, and
  3. 190 milligrams of magnesium

(f) may contain calcium carbonate, edible bone meal, chalk (B.P.), ground limestone or calcium sulphate in an amount that will provide in 100 grams of flour 140 milligrams of calcium.

All white flour and foods containing white flour that are sold or intended for sale in Canada, both imported and domestically produced, are expected to be in compliance with the enrichment requirements for white flour.

White flour is processed and has high glycemic index, so it’s not advised to eat it often, but I am no longer trying to completely avoid it. Whole grain gluten flours such as whole wheat, splet, and kamut, also contain B vitamins. I am also glad to eat fortified cereal again, as they are cheap, convenient, and in one bowl you get a lot of B vitamins, plus magnesium, zinc, and iron. For example, I bought a giant box of bran flakes for $5 at Drug Mart and only 3/4 of a cup contains 30% DV iron, 45% DV thiamine, 10% DV B6, 8% DV folate, 10% DV zinc. It’s pretty hard to get that nutrition from consuming gluten-free corn cereal or puffed rice. Also it tastes better, so why not eat it? Unless someone provides strong and clear scientific evidence to do otherwise.