Gluten-free products are increasingly popular, but they are not suitable for everyone. While a diet without gluten may work for adults, there are only a few reasons for children to avoid it, and many reasons not to. In a recent commentary published in the Journal of Pediatrics, I outline considerations for pediatricians who may be advising parents regarding the gluten-free diet. Before eliminating all the gluten from your kids’ meals, here’s what you should know:
1. Gluten is not naturally toxic
Foods are composed of three basic elements: fat, carbohydrate, and protein. Gluten is a protein contained in wheat, rye and barley—ingredients which are common, especially in processed foods. In roughly 1% of adults and children, genetics plus gluten combine in ways that we do not completely understand to trigger a condition called celiac disease, which can damage the intestinal lining and lead to serious nutritional and gastrointestinal problems among other issues. For people with celiac disease, gluten is toxic and should be completely avoided in the diet.
However, in almost all children, gluten travels through the intestine without causing disease and will never lead to problems. To date, science has not shown that there is a toxin in gluten that makes it bad for our bodies. A balanced diet containing fresh fruits and vegetables, lean proteins, and a variety of carbohydrate sources is the best way for healthy children to stay healthy.
2. A gluten-free diet may not provide balanced nutrition for children
Gluten-free food is not the same as healthy food. Fruits and vegetables are naturally gluten-free and should be incorporated liberally into every child’s diet. But a gluten-free cookie is still a cookie.
Many gluten-free substitutes for items such as breads and cookies are actually higher in fat and calories than gluten-containing varieties. Gluten-free items such as some cereals and breads may also not be nutrient fortified to the same degree as those with gluten. Folate and B-vitamins are often added to our usual starch staples, silently protecting people whose diets may not be very balanced from deficiency. Without these quiet sources of nutrition, vitamin deficiencies could develop.
A gluten-free diet is often fiber deficient. Fiber is important for gastrointestinal health, including maintaining regular bowel movements. Quite commonly, children who initiate a gluten-free diet become constipated. Increased consumption of rice, a common gluten substitute, may also expose children to more arsenic in their diets, as arsenic is frequently present in the earth where rice is grown.
Growing bodies and brains require balanced nutrition. For those children who need a gluten-free diet, can be implemented safely and healthfully with the guidance of an experienced registered dietitian to help avoid all of these and other nutritional pitfalls.
3. A gluten-free diet may actually make it harder for doctors to tell if your child has celiac disease
Parents are wonderful detectives and some will be the first to identify that their child has an issue with gluten. But symptoms alone are insufficient to diagnose celiac disease or wheat allergy, the two conditions related to gluten and wheat that have been scientifically linked to disease in children. But a blood test for celiac disease cannot distinguish between a child who has celiac disease but is on a gluten-free diet and a child who never had celiac disease to begin with.
If you are concerned that your child may have a problem with gluten, speak to your child’s doctor before banning it from your child’s diet. A child with celiac disease needs special monitoring over time and their family members may need to be tested. Even if you plan to give the diet a try regardless of the test result, it is extremely important for your child and family’s health to know why the diet is necessary.
4. A gluten-free diet is socially limiting and expensive
It’s not easy to be on a gluten-free diet as an adult, and it’s worse as a child. Most childhood activities revolve around food (think birthday parties, snack time and lunch in school, class trips, camp). For children who require this limited diet for long-term health, parents, schools, and the medical team work to make the child’s experience in school and at home as easy as possible. But it is never really easy and most of the children I have treated for celiac disease would trade in their gluten-free diet in an instant if they knew gluten would not make them sick. Gluten-free children frequently feel different from their peers, and some worry that the diet may limit their future choices, like college and career. In addition, gluten-free foods are incredibly expensive and for many families the diet can be challenging to financially sustain in the long run.
If parents need or want a diet free of gluten, that is their choice. But there are significant reasons to think twice before imposing it on kids.