Parents often have questions about whether their child should avoid gluten, as many people have chosen this diet in the belief it has health benefits. For people with celiac disease, eating gluten free is not just a “fad” diet. Strict avoidance of products that contain gluten is mandatory for children diagnosed with celiac disease and a gluten free diet must be followed for life in these cases.
Celiac disease is an autoimmune disorder that has both a genetic component and a “trigger” component. The trigger is the ingestion of foods that contain wheat, barley or rye (often collectively referred to as gluten).
Celiac disease can be cured by following a gluten free diet. Most patients will have complete resolution of their symptoms and the damage to the lining of their intestines will improve. Completely avoiding gluten is easier said than done as it is found hidden in many readily available foods. Until recently, this meant that people with celiac disease had to carefully scrutinize food labels to look for clues that there might be gluten present. The good news for people with celiac disease is that new food labeling laws have improved the situation. For example, wheat is one of the allergens that must now be listed on all labels if present. Furthermore, the FDA has recently decreed that foods can be labeled “gluten free” if they contain less than 20 parts per million of gluten. This is a level below which the vast majority of celiac patients will not experience a bad reaction if they ingest such a product.
There are people with a variety of symptoms similar to those seen in celiac disease that have negative tests for celiac disease and have normal findings on small intestinal biopsy. Some such cases have never-the-less elected to try a gluten free diet and claim to feel better when they do so. This has spawned the new belief that there is an entity of non-celiac gluten sensitivity (NCGS). The symptoms of NCGS are indistinguishable from those of celiac disease, but there is no elevation in antibody levels and no evidence of inflammation or damage to the lining of the small intestine.
While it is believed that NCGS is a genuine condition, it is most likely much less common than currently claimed. A gluten free diet does not just eliminate the protein fractions of wheat, barley and rye that are the cause of celiac disease, but also removes a lot of other products that are found in the starch component of these products. Some people who feel better on a gluten free diet may do so because these “starch” products are highly fermentable and can cause abdominal complaints such as pain, gas and bloating, which improves when eliminated.
In these cases it may not be necessary to be strictly gluten free but simply limit the amount of “gluten” foods that are ingested each day. It is extremely important to distinguish between celiac disease and NCGS. People who have celiac disease and do not follow a strict gluten free diet are at risk for many other adverse health consequences. Conversely, people with NCGS may feel bad when they ingest gluten but are unlikely to have any other serious consequences.
Symptoms include abdominal pain and other gastrointestinal problems, weight loss and fatigue
It is an autoimmune disorder with both a genetic and trigger component
Can be cured by following a gluten free diet
Must avoid all products containing wheat, barley or rye for life
Non-Celiac Gluten Sensitivity (NCGS)
Symptoms include abdominal pain and other gastrointestinal problems such as bloating and diarrhea
After testing, found to not have celiac disease
May feel better on a gluten free diet
The gluten free diet does have potential deficiencies including fiber, calcium and other vitamins and minerals. If your child is having any symptoms that make you suspicious that he or she may have celiac disease, it is important to talk with your pediatrician. If your pediatrician has your child tested and it is it found that they have celiac disease, or if they think your child would benefit from a gluten free diet, work with him or her to find alternative sources of these nutrients to supplement their diets.
Ivor Hill, MD, MB, ChB, is director of the Celiac Disease Center, one of the signature programs within the Section of Pediatric Gastroenterology at Nationwide Children’s Hospital. He is also professor of Clinical Pediatrics at the Ohio State University College of Medicine.
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