ask the doctor
Ask the Doctor: Gluten-free Kids
You have questions about your gluten-free kids, and AllerMates has answers… from the best and brightest doctors, of course! See below for our most commonly received questions on gluten, as well as what our featured doctor has to say about each.
Dr. Joseph Kasper is board certified in internal medicine. He holds degrees in Computer Science and a Masters in Positive Psychology. He is a medical director of multiple sub acute rehabilitation facilities. He has particular interest in metabolic diseases such as diabetes and gluten sensitivity.
Q. How will I know if my child has celiac disease?
The clinical consequences of celiac disease, otherwise known as gluten enteropathy, can range from asymptomatic nutritional deficiencies to severe malabsorption. Celiac disease can vary in severity in both symptoms and clinical consequences. Symptoms can range from mild fatigue to severe abdominal disturbance while the consequences can vary from minor electrolyte imbalances to significant malabsorption and malnutrition. These signs and symptoms occur when the gluten cross-reacts in a pathologic fashion to certain areas in the small intestine. Initially, physicians were only diagnosing the most severe cases late in the disease process. However, given recent advancements in our understanding of celiac disease, physicians are now recognizing this condition earlier and hopefully before the presence of some of the more troublesome consequences. Fortunately, there are new and better commercially available blood tests to screen for celiac disease; however these tests are not yet sensitive enough to detect all patients that suffer from gluten sensitivity. Therefore, I believe that the best test for celiac disease is still a strict three to four week trial of a natural gluten-free diet (one that contains only foods that are naturally gluten-free like eggs, beef, poultry fruits, vegetables, nuts and cheese).
Young children may not recognize early signs or might hesitate to inject themselves at the onset. Even older, responsible kids can have difficulty using an injector during an allergic reaction, so why risk a last-second slip that misses the dose? A responsible adult can help make sure that the injection is administered properly and help the child remain calm until emergency personnel take over.
Q. Who should eat a gluten-free diet?
Anybody can choose to eat a diet that is free from gluten. There is no nutritional value to gluten and it is not a required nutrient in a healthy diet. It does however give food a desirable, chewy texture. This property has been successfully exploited by the food industry and is why gluten is so pervasive in the modern North American diet.
I am one of a growing number of physicians who believe that gluten has the ability to negativity cross react, not only with the small intestine as in gluten enteropathy, but with many other organs and structures within the human body. These may include tendons, blood vessels, skin, nerves, hair and the brain. This pathologic cross reaction can present as common symptoms such as migraine headache, eczema, psoriasis, neuropathy, hair loss, joint pain, chronic fatigue, ADD, ADHD, anxiety and depression.
Since a gluten-free diet is naturally low in carbohydrates, I commonly prescribe this diet for anybody who simply wants to lose weight or wishes to control their glucose. I also utilize this type of diet as a natural alternative for patients who suffer from chronic conditions such as the ones mentioned above. These conditions are quite frustrating for patients because as physicians we generally cannot cure these ailments but rather are relegated to ameliorating their symptoms. This is because the medical community and pharmaceutical industry has largely focused on the symptomatic relief of these conditions rather than their root cause. I find a significant proportion of these patients experience partial or complete resolution of their symptoms when they embark on a natural gluten-free diet. It is safe for any person who has failed to respond to or who is dissatisfied with the results of conventional therapies to try a gluten-free diet. However, when testing the diet, it is important to remember to adhere to a natural gluten-free diet and avoid commercially processed gluten-free products such as gluten-free pasta and bread.
Q. Is it okay for my kid to be on a gluten-free diet just to be safer or healthier, even if there is no underlying medical condition?
Yes, it is safe for anybody to eat a gluten-free diet even if a person does not have gluten sensitivity. Given the epidemic of type 2 diabetes mellitus (T2DM) and obesity in the United States today, especially amongst our youth, I believe it is a healthier alternative to the conventional diets espoused by the ADA and AHA. Much of these epidemics are a result of high carbohydrate content of our modern American diet. A gluten-free diet is naturally low in carbohydrates and is an excellent diet for both weight control and diabetic control.
Q. Are gluten-free foods safe for kids with wheat allergies?
Yes, no and maybe so. Let me explain. Gluten is a protein that is found naturally in most wheat products like bread and pasta. In general, wheat is about 85 % starch and 15 % protein, most of that protein being gluten. If a person is allergic to wheat they may be allergic to the starch component and or the protein component of the wheat product. If a person is allergic to the starch component of wheat, a gluten-free product will produce the same type allergic reaction as one that contains gluten. A gluten-free product will only benefit a person with gluten sensitivity. However, it is important to remember that there is no legal definition or standard for what constitutes “gluten-free”. Therefore it is buyer beware. Although it may be unethical, it is not illegal for a company to market a product as “gluten-free” that contains some gluten. Does a product need to be 100% gluten free, 99% gluten-free, 50% gluten-free or just 1% gluten-free to be labeled as gluten-free? We just don’t know yet. I do believe the FDA is presently working on developing a uniform standard but to date I do not believe there exists an established legal standard. Therefore, the advice I give to my patients is that if they have a true wheat allergy they should to avoid all wheat products, including gluten-free wheat products. However, if they have gluten sensitivity they should avoid all foods that naturally contain gluten even if they are marketed as “gluten-free”. They should eat only foods that are naturally gluten-free. If a person with gluten sensitivity must have bread and or pasta, they should carefully research the brands they purchase to ensure a high standard of “gluten free”.
Q. If my child is having an allergic reaction and I’m not sure whether to use Benadryl or epinephrine and decide to err on the side of caution and use epinephrine– can I cause any harm to my child?
When in doubt, always use the epinephrine and go to the emergency room. Epinephrine isn’t harmful at all and it could be a life-saving decision.