By Anil Kesavan, MD
Food and its impact on health is a common topic of conversation among people. There are television shows, books and countless websites dedicated to the subject. In recent years, one of the most common culprits of concern when it comes to food is gluten.
As a pediatric gastroenterologist at Rush, I often hear questions about gluten. Many of my patients’ parents ask me how a gluten-free diet can affect their child’s health or help improve different symptoms. The answers to their questions are not always simple.
What is gluten?
Let’s start with the basics. Gluten has been an integral part of the human diet for thousands of years. There is currently no scientific evidence that states gluten is intrinsically harmful to healthy children.
Here are some things you should know about gluten:
- Gluten is a protein found in wheat, rye and barley.
- Gluten provides viscosity and elasticity to dough, which gives bread its chewy texture.
- Gluten is found in salad dressings, marinades, sauces, processed meats, candy, beer and meat substitutes.
- Gluten is also found in non-food items including playdough, lipstick, medications and vitamin supplements.
Who should be gluten free?
While there is nothing fundamentally unhealthy about gluten, it can cause health problems for children who have certain medical conditions. It is important to establish a balanced, gluten-free diet for your child if they suffer from one of these conditions.
- Celiac disease: About 0.5 to 1 percent of the population has celiac disease, an autoimmune condition directly linked to gluten. For kids with celiac disease, gluten causes intestinal inflammation and a number of symptoms, such as abdominal pain, diarrhea and poor weight gain and growth. It is a life-long condition that currently does not have a cure. What is encouraging, however, is a gluten-free diet will alleviate all symptoms for people with the disease.
- Wheat allergy: About 0.4 percent of children in the United States are allergic to wheat. But most children outgrow this allergy by adulthood. Symptoms in children can range from mild (e.g., rash) to severe (e.g., anaphylaxis). Children with wheat allergy must only avoid wheat-containing products and can safely consume other gluten-containing grains (e.g., rye, barley).
- Non-celiac gluten sensitivity: In recent years, there have been an increasing number of kids who do not have celiac disease or wheat allergy but still have gluten-related symptoms. This is known as non-celiac gluten sensitivity. Children with gluten sensitivity have both GI and non-GI symptoms (e.g., bloating, abdominal pain, diarrhea, tiredness, joint pain, headaches, depression).
There has been a lot of interest in using a gluten-free diet to treat other health conditions, including thyroid disease, migraines, autism and various autoimmune conditions. Unfortunately, there is no scientific evidence that going gluten-free improves symptoms in any of these disorders. I work closely with my patients and their parents if they have one of these conditions and want to try a gluten-free diet.
Are gluten-free foods healthier?
The number of people eating gluten-free foods far exceeds the number of people who have gluten-related health conditions. Sales of gluten-free foods have increased from $100 million in 2003 to almost $1.8 billion in 2013 in the United States. Forecasts estimate an increase to $24 billion in the United States by 2020.
So are gluten-free products really healthier than non-gluten free products? There is no evidence that gluten-free products are healthier than their gluten-containing counterparts. In fact, here are some things to note about gluten-free packaged foods:
- Gluten-free packaged foods are frequently more calorie-dense with fewer nutrients.
- Gluten-free products require the addition of extra fats and sugars to achieve optimal taste and texture.
It is important to closely read nutritional labels when consuming gluten-free products to ensure a healthy diet. Pay particular attention to the total amount of sugar, saturated fat, cholesterol and fiber in these products.
Staying balanced with a gluten-free diet
A gluten-free diet can be lower in B vitamins (e.g., folic acid, niacin, riboflavin, thiamin). Gluten-free versions of pasta, bread and cereal are typically not fortified. That’s why I encourage my gluten-free patients and their families to eat foods high in B-complex vitamins, such as legumes, dark green leafy vegetables, nuts, dairy products, fish, eggs and chicken.
Gluten-free substitutes are also commonly made with grains like white rice and potato flour, which are lower in fiber than wheat. A low fiber diet can lead to constipation in kids. I suggest incorporating high fiber gluten-free grains — including quinoa, buckwheat, certified gluten-free oats and amaranth — into children’s diets.
Including these other gluten-free grains into your child’s diet also reduces the total amount of rice that your child eats. Rice is a very common grain used in gluten-free products. While safe in small amounts, rice has high concentrations of inorganic arsenic, which can affect childhood development with long-term exposure.
While a gluten-free diet can be a vital and necessary therapy for kids with a gluten-related diseases or allergies, it should always be carefully implemented and closely monitored with help from medical professionals.
Anil Kesavan, MD, is a pediatric gastroenterologist at Rush University Children’s Hospital. If you are worried that your child may have a gluten-related disease, call (888) 352-7874 to make an appointment at the Rush Pediatric Celiac and Food Sensitivity Clinic. This multidisciplinary clinic provides family-centered, comprehensive medical care to children who suffer from food-related symptoms. The team includes pediatric gastroenterologists, pediatric allergists and dietitians who will work closely with your family to create the best treatment plan for your child.