Trendy gluten-free diets can lead to nutritional consequences

Trendy gluten-free diets can lead to nutritional consequences | | Image Credit: © Icons-Studio - © Icons-Studio - stock.adobe.com.

In recent years, the gluten-free diet trend has caused concerns for pediatricians and gastroenterologists alike because in most cases, this type of diet is not necessary or even advised. Though a staple treatment for celiac disease––a systemic, chronic autoimmune disorder caused by an intolerance to gluten proteins––a gluten-free diet in children who do not have dietary restrictions or who are not directly advised by their health care professional to be on such a diet could lead to nutrient imbalances and deficits.¹

Researchers have documented that gluten-free products have less nutritional value and are of lower quality than products that do contain gluten. With grocery store shelves that can be lined with gluten-free products and a perceived health benefit of this type of diet, the gluten-free trend has been on the rise.

“We know that a gluten-free diet is a critical treatment for individuals who’ve been 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, education director, and assistant director, Fellowship Program at Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tennessee.

“We also know that gluten-free products on the market have been increasing at a rate disproportionate to the number of patients [receiving a diagnosis of] celiac disease. In fact, the majority of people who are following a gluten-free diet do not have celiac disease or another medical diagnosis that requires them to avoid gluten. That does include children, too. We certainly see a number of children who are following a gluten-free diet, either because of perceived health benefits or because they may have chronic symptoms or digestive difficulties that parents are looking for solutions to,” added Thomsen.

Aside from these perceived benefits, parents can be persuaded by the trend itself, Thomsen says.

“They may see products that are gluten free, that are marketed as being healthier choices, or they may see celebrities or have friends and family who are following a gluten-free diet and be influenced by that.”

"As more foods are now labelled gluten free and available in supermarkets, individuals began prescribing a gluten free diet for themselves and their children without seeking medical advice or understanding the consequences of eliminating essential foods that prevent iron and vitamin deficiencies," said Donna Hallas, PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN.

Hallas is clinical professor, program director, Pediatrics NP, New York University Rory Meyers College of Nursing, New York, New York, and a Contemporary Pediatrics editorial advisory board member.

Some parents may notice their child “feeling better” (more energetic, less lethargic) on a gluten-free diet, despite normal medical tests and the lack of celiac disease. However, as a byproduct of being on the diet, the child has cut out more carbohydrates, and would include less types of sugars that are hard to digest.²

Plus, any child might “feel better” with the sudden implementation of more fruits and vegetables, a staple in a gluten-free diet. However, that “better feeling” is likely coming from the removal of excessive carbohydrates, cookies, and cakes and certain types of sugars rather than from the removal of gluten, with the placebo effect potentially playing a role as well.

The marketing of gluten-free products, along with the abundance of products at the grocery store, can play a role in parents picking up an item for their children with the notion of its being a healthier product.

“Many people do perceive these foods to be healthier, but particularly for gluten-free packaged foods or gluten-free baked goods, these foods may have higher contents of fat, sugar, [or] calories than the standard gluten-containing product,” Thomsen said.

Sugar aside, nutrients are important for children. These could be lacking in gluten-free options, but are available in products that do contain gluten.

“[Gluten-free products] often are 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] B vitamin deficiencies,” Thomsen continued.

Calories are also crucial for developing children. Cutting out foods that are made with wheat, which contains gluten, could result in challenges when it comes to hitting the target number of calories a particular child may need.²

For parents, other challenges also arise when their child is on a gluten-free diet.

“There’s also significant cost associated with these products compared [with]…the standard counterpart. And inconvenience sometimes too. It can be hard 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 that could lead to a gluten-free diet. But it is crucial for parents to understand that testing needs to come before they axe 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 really should warrant an evaluation with their health care provider [and] consideration of testing for celiac disease before any dietary changes are made. That’s probably the biggest take-home point.”

“What happens sometimes is that families come in to see me, they’ve already begun a gluten elimination diet, and then it’s very difficult at that point to determine whether they actually have celiac disease or not, particularly if they did experience some symptom relief with gluten avoidance,” Thomsen continued.

This makes getting a result that could help the family and improve the child’s diet that much more difficult, all while adding more testing time.

“Really, in order 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 is experiencing symptom relief from their diet change,” Thomsen said.

There is also the consideration on how the diet may affect the child in social settings and if they may need further help.

“Eating is a part of our socialization, and children who are on specialized diets may require some extra support to cope with dietary eliminations,” Thomsen said.

Overall, having conversations with parents on these trends and diet alterations in general is important. 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 are following special diets work with their health care teams, so that they can get support if they need for coping with those dietary limitations.”

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 adequate and balanced diet. Nutrients. 2013;5(11):4553-4565. doi:10.3390/nu5114553

2. McCarthy C. 3 reasons your child should not 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