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In recent years, the gluten-free diet trend has been a cause of concern for both pediatricians and gastroenterologists because in most cases, this type of diet is not necessary or even advised. Although the primary treatment for celiac disease––a systemic, chronic autoimmune disorder caused by intolerance to gluten proteins––is a gluten-free diet in children who do not have dietary restrictions or are not directly advised to be by their health care professional. such a diet can lead to nutritional imbalances and deficiencies.1
Researchers have documented that gluten-free products have less nutritional value and are of lower quality than products containing gluten. With grocery store shelves lined with gluten-free products and a perceived health benefit to this type of diet, the gluten-free trend is on the rise.
“We know that a gluten-free diet is a critical treatment for individuals diagnosed with celiac disease or other health conditions that benefit from gluten avoidance,” said Kelly F. Thomsen, MD, MSCI, pediatric gastroenterologist, assistant professor of Pediatrics, director of education, and assistant director, Fellowship Program at Monroe Carell Jr. Children’s Hospital. at Vanderbilt in Nashville, Tennessee.
“We also know that gluten-free products are increasing on the market at a rate that is disproportionate to the number of patients. [receiving a diagnosis of] celiac disease. In fact, most people following a gluten-free diet do not have celiac disease or another medical diagnosis that requires them to avoid gluten. That includes children too. We definitely see some children following a gluten-free diet, because of the perceived health benefits or because they may have chronic symptoms or digestive difficulties for which parents are looking for solutions,” said Thomsen.
Apart from these perceived benefits, parents can be convinced of the trend itself, says Thomsen.
“They may see gluten-free products, which are marketed as healthier options, or they may see celebrities or have friends and family who follow a gluten-free diet and be influenced by it that.”
Some parents may notice that their child is “feeling better” (more energetic, less lethargic) on a gluten-free diet, despite normal medical tests and the absence of celiac disease. As a byproduct of being on the diet, however, the child has cut more carbohydrates, and there would be fewer types of sugars that are difficult to digest.2
In addition, any child may feel “better” with the sudden introduction of more fruits and vegetables, which are a staple of a gluten-free diet. However, that “feeling better” is likely to come from getting rid of excess carbohydrates, cookies, and cakes and certain types of sugars rather than eliminating gluten, and the placebo effect may also play a role.
The marketing of gluten-free products, along with the many products at the grocery store, can play a role in parents picking up an item for their children thinking it is a healthier product.
“Many people perceive these foods to be healthier, but especially when it comes to gluten-free packaged foods or gluten-free baked goods, these foods may contain more fat, sugar, [or] calories than the typical gluten-containing product,” said Thomsen.
Sugar aside, nutrients are important for children. They may lack gluten-free options, but are available in gluten-containing products.
“[Gluten-free products] they are often not fortified with nutrients in the same way that standard products might be, so there is an increased risk of iron deficiency, folate deficiency, [and] vitamin B deficiencies,” continued Thomsen.
Calories are also vital for developing babies. Cutting out foods made with wheat, which contain gluten, can present challenges when it comes to reaching the target number of calories that a particular child may need.2
For parents, other challenges also arise when their child is on a gluten-free diet.
“Comparing these products also has a significant cost [with]…the standard colleague. And sometimes inconvenience too. It’s hard to find gluten-free products or gluten-free menus.”
Testing for celiac disease or wheat allergy is available and should be the first step that could lead to a gluten-free diet. But it is vital for parents to understand that testing must be done before removing gluten from their child’s diet.
“As a gastroenterologist,” Thomsen said, “[I would suggest that] if a family is concerned about a gluten-related health condition, an evaluation with their health care provider should be necessary [and] consider testing for celiac disease before making any dietary changes. That’s probably the biggest take-home point.”
“What sometimes happens is families come in to see me, they’ve already started a gluten elimination diet, and then it’s very difficult at that point to determine if they have celiac disease or not , especially if they got relief from some symptom. to avoid gluten,” Thomsen continued.
This makes it much more difficult to get a result that could help the family and improve the child’s diet, while adding more testing time.
“Actually, to get those answers, they would have to reintroduce gluten into their diet for a period of time to be tested. That can be difficult for someone who is getting relief from symptoms from changing their diet,” said Thomsen.
It also looks at the impact the child’s diet may have in social settings and whether they need more help.
“Eating is part of our socialization, and children on specialized diets may need extra support to deal with dietary elimination,” Thomsen said.
Overall, it is important to have conversations with parents about these trends and changes in diet in general. It gives the parents an opportunity to explain why they want to change their child’s diet and automatically gives the health care professional a chance to step in.
“It’s important that parents and children who follow special diets work with their health care teams, so they can get support if they need it to deal with those dietary restrictions.”
Click here to read more from the January/February issue of Contemporary Pediatrics.
References:
1. Penagini F, Dilillo D, Meneghin F, Mameli C, Fabiano V, Zuccotti GV. Gluten-free diet in children: an approach to a nutritionally balanced diet. Nutrients. 2013; 5(11):4553-4565. doi:10.3390/nu5114553
2. McCarthy C. 3 reasons your child shouldn’t go gluten-free (unless your doctor says so). Harvard Health Publishing. June 15, 2020. Accessed January 11, 2024. https://www.health.harvard.edu/blog/3-reasons-not-put-child-gluten-free-diet-unless-doctor-says-201606079760
