In recent years, the trend toward gluten-free diets has raised concerns among pediatricians and gastroenterologists alike, as this type of diet is not necessary or even advised in most cases. Although a basic treatment for celiac disease – a systemic, chronic autoimmune disease caused by an intolerance to gluten proteins – is a gluten-free diet for children who do not have dietary restrictions or who are not directly advised to do so by their healthcare provider, such a diet could lead to nutrient imbalances and deficiencies.1
Researchers have documented that gluten-free products have less nutritional value and are of lower quality than products that do contain gluten. With supermarket shelves ready to be lined with gluten-free products and a perceived health benefit of these types of diets, 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 who benefit from avoiding gluten,” said Kelly F. Thomsen, MD, MSCI, pediatric gastroenterologist, assistant professor in Pediatrics, director of education and assistant director of the Fellowship Program at Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tennessee.
“We also know that the increase in gluten-free products on the market is not proportional to the number of patients. [receiving a diagnosis of] celiac disease. In fact, the majority of people who follow a gluten-free diet do not have celiac disease or any other medical diagnosis that requires them to avoid gluten. This also includes children. We certainly see some children following a gluten-free diet, either because of perceived health benefits or because they may have chronic symptoms or digestive issues that parents are seeking solutions for,” Thomsen said.
Beyond these perceived benefits, parents may also be won over by the trend itself, Thomsen says.
“They may see products that are gluten-free marketed as healthier choices, or they see celebrities or have friends and family who follow a gluten-free diet and are influenced by that.”
Some parents may notice that their child “feels better” (more energetic, less lethargic) on a gluten-free diet, despite normal medical tests and the absence of celiac disease. However, as a byproduct of the diet, the child has cut out more carbohydrates and ingested fewer types of sugars that are difficult to digest.2
Plus, any child might “feel better” if they suddenly eat more fruits and vegetables, a staple of a gluten-free diet. However, that “better feeling” likely comes from cutting out excessive carbohydrates, cookies and cakes, and certain types of sugars rather than from cutting out gluten, with the placebo effect possibly also playing a role.
The marketing of gluten-free products, along with the abundance of products in the supermarket, can play a role in parents purchasing an item for their children thinking it is a healthier product.
“Many people consider these foods to be healthier, but especially with gluten-free packaged foods or gluten-free baked goods, these foods can have higher levels of fat, sugar, [or] calories than the standard gluten-containing product,” Thomsen said.
Apart from sugar, nutrients are important for children. These may be missing from gluten-free options, but are available in products that do contain gluten.
“[Gluten-free products] are often not fortified with nutrients in the same way as standard products, so there is an increased risk of iron deficiency, folic acid deficiency, [and] B vitamin deficiencies,” Thomsen continued.
Calories are also crucial for children’s development. Excluding foods made with wheat and containing gluten can pose problems when it comes to achieving the target number of calories a given child needs.2
For parents, other challenges also arise when their child follows a gluten-free diet.
“There are also significant costs associated with these compared products [with]…the standard counterpart. And sometimes also discomfort. It can be difficult to find products that are gluten-free or menu items that are gluten-free.”
Testing for celiac disease or wheat allergy is available and should be the first step toward a gluten-free diet. But it’s critical that parents understand that testing is required before eliminating 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, it should really warrant an evaluation with their healthcare provider [and] considering testing for celiac disease before making any dietary changes. That’s probably the biggest take home point.”
“What happens sometimes is families come to me, they’ve already started a gluten elimination diet, and then it’s very difficult at that point to determine whether they actually have celiac disease or not, especially if they have some relief from symptoms experienced. with avoiding 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 also requiring more testing time.
“Really, to get to those answers, they would have to reintroduce gluten into their diet for a period of time in order to be tested. That can be difficult for someone who experiences symptom relief from a change in their diet,” Thomsen said.
Consideration is also given to how the diet may affect the child socially and whether he or she may need further help.
“Food is part of our socialization, and children who are on specialized diets may need some extra support to deal with dietary eliminations,” Thomsen said.
Overall, it’s important to have conversations with parents about these trends and dietary changes in general. It gives the parents the opportunity to explain why they want to change their child’s diet and automatically gives the healthcare provider the opportunity to intervene.
“It is important that parents and children on special diets work with their healthcare teams so they can receive support as they navigate those dietary restrictions.”
Click here to read more from the January/February issue of Contemporary Pediatrics.
1. Penagini F, Dilillo D, Meneghin F, Mameli C, Fabiano V, Zuccotti GV. Gluten-free diet in children: an approach to a nutritionally adequate and balanced diet. Nutrients. 2013;5(11):4553-4565. doi:10.3390/nu5114553
2. McCarthy C. 3 Reasons Why Your Child Shouldn’t Eat Gluten-Free (Unless Your Doctor Says So). Harvard Health Publishers. 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