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Expert highlights dangers of ‘gluten-free fad’ in children
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Although the gluten-free diet is a critical treatment for celiac disease, consumers without celiac disease purchase the majority of gluten-free products, and many place their children on the diet without adequate knowledge of how it may impact them. According to a recent commentary published in the Journal of Pediatrics, health care providers should play a greater role in educating patients on how the current “gluten-free fad” may negatively impact their children.
“The increasing popularity of the [gluten-free diet] has important implications for children,” Norelle R. Reilly, MD, from the division of pediatric gastroenterology and the Celiac Disease Center at Columbia University Medical Center in New York City, wrote. “Parents sometimes place their children on a [gluten-free diet] in the belief that it relieves symptoms, can prevent [celiac disease], or is a healthy alternative without previous testing for [celiac disease] or consultation with a dietitian. ...The health and social consequences worthy of consideration in advance of starting a child on a [gluten-free diet] are not described adequately online or in books promoting an empiric [gluten-free diet] trial.”
Norelle R. Reilly
One of the most common inaccuracies regarding the gluten-free diet is that it is a healthy lifestyle choice with no disadvantages, Reilly wrote. The reality is that the diet provides no known health benefits to patients without celiac disease, wheat allergy or nonceliac gluten sensitivity.
“For children, the currently established indications for exclusion of dietary gluten or wheat are celiac disease and wheat allergy. It is not yet clear to what extent non-celiac gluten sensitivity affects children,” Reilly told Healio Gastroenterology.
Moreover, gluten-free products may have higher fat and sugar density, lack nutrient fortification, and contain higher amounts of certain toxins like arsenic and mercury, which can lead to a number of health problems in those following the diet without a physician’s or dietitian’s guidance. Gluten-free products may also cost more than their gluten-containing counterparts, and social isolation, inconvenience and reduced quality of life have been documented in children on a gluten-free diet.
Importantly, beginning a gluten-free diet could impact celiac disease diagnosis and detection rates at the population level.
“Celiac disease must be excluded in symptomatic children prior to reducing or eliminating dietary gluten, as testing for celiac disease depends on ongoing gluten consumption,” Reilly said.
Another common misconception is that gluten is intrinsically toxic to healthy individuals, but no data support this, and for most people, “gluten proteins pass through the gastrointestinal tract without leading to disease,” Reilly wrote.
Many also believe that a gluten-free diet is appropriate for first-degree relatives of someone with celiac disease, or for infants at risk for developing celiac disease. In reality, a gluten-free diet “is not advisable for at-risk individuals under any circumstance without first testing for [celiac disease] while the patient is consuming gluten in an unrestricted fashion,” and for infants, recent data show that neither delayed or early gluten introduction affects risk for developing celiac disease.
“Given the substantial nutritional and quality of life risks, a [gluten-free diet] driven by factors apart from the treatment of specific disease or symptoms may carry more risk than benefit for children,” Reilly wrote. The gluten-free diet “should be recommended judiciously and patients self-prescribing a [gluten-free diet] should be counseled as to the possible financial, social, and nutritional consequences of unnecessary implementation. Health care providers may not be able to end the [gluten-free diet] fad, but can certainly begin to play a larger role in educating patients, excluding [celiac disease], and preventing nutritional deficiencies in those choosing to stay gluten-free.” – by Adam Leitenberger
Disclosures: Reilly reports no relevant financial disclosures.
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