Does My Child Need a Gluten-Free Diet?

Lately, gluten free diets are getting a lot of attention. Going gluten free has been rumored to increase energy and concentration, cure digestive ills, and even improve symptoms of autism and ADHD in children. With so much hype it’s hard not to wonder if your child might not benefit from a gluten free diet.

Gluten is a protein found in certain grains like wheat, barley and rye that gives baked goods their texture. Because gluten helps make foods taste better and improves their texture, it's also added to everything from deli meats to French fries. For most children gluten is completely harmless, with two exceptions. "Children should be following a gluten-free diet if they've been diagnosed with celiac disease or with non-celiac gluten sensitivity," says Tricia Thompson, MS, RD, co-author of Easy Gluten Free: Expert Nutrition Advice with More than 100 Recipes.

What exactly are celiac disease and non-celiac gluten sensitivity? Celiac disease, also known as celiac sprue, is an autoimmune condition that affects one in 133 people. For children with celiac, even the slightest morsel of gluten can mean trouble, triggering the release of antibodies which mount an assault on the intestines. These attacks damage the intestine, making it difficult to absorb many of the nutrients children need to grow and thrive. They also cause many unpleasant symptoms such as gas, bloating, diarrhea and weight loss or weight gain. Untreated, celiac can also lead to complications such as anemia, neurological disorders and osteoporosis. Non-celiac gluten sensitivity (or NCGS) is believed to be more widespread than celiac, affecting an estimated 18 million Americans. It's similar to celiac in that it also involves an immune reaction to gluten. But unlike celiac disease, that reaction doesn’t cause the body to produce damaging antibodies. So while a child with NCGS may have many celiac-like symptoms, he or she won’t experience the same intestinal damage, nutrient deficiencies or long term complications.

Currently, the only treatment for celiac disease or non-celiac gluten sensitivity is a gluten free diet. "A gluten free diet is extremely restrictive so it can be difficult for a child to follow," says Dee Sandquist, MS, RD, a spokesperson for the Academy of Nutrition and Dietetics. "It can also be psychologically and socially challenging." Birthday parties, sleepovers, eating out and even snack time at school can be difficult to navigate. But the good news is that when children with celiac disease do give up gluten their growth returns to normal and their symptoms quickly improve according to a 2008 article in the Journal of the American Dietetic Association (now known as Journal of the Academy of Nutrition and Dietetics).

If you suspect your child has celiac or NCGS, experts recommend having your child screened by your health-care provider before going gluten free. In fact, testing for these conditions only works if your child is eating a gluten containing diet. Because gluten is found in so many foods, unnecessarily restricting it can actually cause your child to miss out on important nutrients like iron and B vitamins children normally get from enriched and fortified foods like cereals, bread and pasta. If, after testing, you do find that your child needs to go gluten free, working with a registered dietitian nutritionist can help develop a plan that ensures he or she gets all the nutrients needed for optimal health.

Should people without Celiac Disease eat a gluten-free diet?

Many on Gluten-Free Diets Don't Have a Celiac Diagnosis
Lack of a doctor's diagnosis hasn't deterred people from trying gluten-free diets, which have gotten high-profile plugs from celebrities and talk show hosts. The market research firm Mintel estimates Americans will spend $7 billion on gluten-free foods this year. The market for gluten-free products has grown 27% between 2009 and 2011.

Among 55 people in the study who said they were on gluten-free diets, 53 tested negative for celiac disease. That led researchers to estimate that 96% of people on gluten-free diets may not need to be on them.

While experts say it's not necessarily dangerous to eat gluten-free -- many people who try it find they eat more fresh fruits and vegetables and less junk food, for example -- it's not recommended to self-test with a gluten-free diet. You should check with a health care provider first.

"If you suspect you have some intolerance to gluten, it's VERY important that you get tested for celiac disease to confirm or rule out a diagnosis," says Rachel Begun, RD, a dietitian who specializes in celiac disease and is also a spokeswoman for the Academy of Nutrition and Dietetics.

Begun says people who try gluten-free diets on their own may also miss out on key nutrients, like iron and B vitamins. And a new study suggests that going gluten free may actually raise your risk for type 2 diabetes. The gluten-free diet, meant for a small population of people who have celiac disease or a gluten intolerance, became popular despite lack of evidence that it was healthy for most people.

According to Dr. Geng Zong from the Harvard University Department of Nutrition T.H. Chan School of Public Health, gluten free foods are often less nutritious because they lack dietary fiber as well as vitamins and minerals. They also tend to be more expensive. His study looked at the health effects of a gluten free diet on subjects that did not medically need to follow one. In a long term longitudinal study scientists observed that most subjects consumed 12 grams of gluten or less per day. In those that consumed higher amounts of gluten the risk of type 2 diabetes over a 30 year span was lower. Cereal fiber intake was lower in subjects on a gluten free diet, which is important to note as it is a protective component for the development of type 2 diabetes. After accounting for the effect of cereal fiber those in the highest 20% of gluten ingestion experienced a 13% lower risk of diabetes development than those with the lowest intake of gluten.

The bottom line is that if you don’t need a gluten free diet don’t follow it. Include gluten-containing high fiber whole grains in your diet daily. The Dietary Guidelines for Americans advise 20-25 grams of dietary fiber daily for women and 35-38 grams of dietary fiber for men. Below is a list of whole grains and their fiber content:

  • Barley (1/2 cup cooked): 3.1 grams
  • Bran cereal (3/4 cup): 5.9 grams
  • Brown rice (1/2 cup cooked): 2 grams
  • Oatmeal (1/2 cup cooked): 4.1 grams
  • Rye bread (1 slice): 1.5 grams
  • Quinoa (1/2 cup cooked): 2.75 grams
  • Whole wheat bread (1 slice): 3 grams
  • Whole grain pasta (1/2 cup cooked): 5-6 grams

Sources:

Andrews, Lisa C. “Can a Lack of Gluten Raise Your Diabetes Risk?” UP4Nutrition, 20 July 2017, up4nutrition.com/2017/07/20/can-a-lack-of-gluten-raise-your-diabetes-risk/.

Ansel, Karen. “Does My Child Need a Gluten Free Diet?” Www.eatright.org, American Academy of Nutrition and Dietetics, 21 Jan. 2014, www.eatright.org/resource/food/nutrition/vegetarian-and-special-diets/does-my-child-need-a-gluten-free-diet.

Doheny, Kathleen. “What's Behind the Gluten-Free Trend?” WebMD, WebMD, www.webmd.com/digestive-disorders/celiac-disease/news/20160916/whats-behind-gluten-free-trend#1.

“Celiac Disease.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease.

“Going Gluten Free?” National Institutes of Health, U.S. Department of Health and Human Services, 19 July 2017, newsinhealth.nih.gov/2016/05/going-gluten-free.