Natalie W. Geary MD
The media has focused a lot of attention on gluten free diets and the role of gluten in inflammatory disease. The important thing to remember is that one should be “gluten aware,” not terrified of gluten. Only those with Celiac diesaese have to be strictly wheat free.
The difference between Celiac disease and gluten sensitivivity is the difference between allergy and intolerance.
An allergy is when your body generates antibodies against a substance, that never goes away and are measurable in the blood test.
An intolerance, on the other hand, is when your body can only process a moderate amount of a substance without feeling “flooded”. Intolerances are not measurable in a blood test and hence often go undiagnosed.
Many children with wheat intolerance go undiagnosed for years. Usually the onset of symptoms is subtle: as they get weaned off breast milk or formula they are usually transitioned to jar foods that do not contain a lot of wheat so it is not until they start eating regular table food with the family that one begins to notice signs. In other words, once they start eating what the rest of the family east: pasta, bagels, muffins, bread, pizza.
For most children this does not happen until they are over 2. The typical child is a complacent eater until this time.
Once they start to develop their own will, they become what I call “exclusive eaters” meaning that they will fixate on a few foods that they will eat, and refuse the rest. This usually takes place around 3 and the foods they tend to choose are chicken nuggets (breaded), pasta, hot dogs (with a bun) and other wheat-based products. There is not a sudden change in their behavior or health or wheat related symptoms because with wheat intolerance (as opposed to wheat allergy or celiac disease) it is all a matter of quantity. So the typical scenario is that as the child gets older, and more in control of her diet, the symptoms increase.
What are the symptoms of gluten sensitivity?
— Some symptoms of gluten sensitivity in children may include:
— Eczema
— Agitation and mood swings
— Extreme changes in weight
— Pain in joints
— Headaches
— Fatigue
— Depression
— Gastrointestinal issues like constipation or diarrhea
Gluten sensitivity is not something one outgrows — one adapts.
This is an important distinction: adults tend to adapt to unpleasant physical sensations unless they are so extreme as to compromise their ability to go to work.
So the bloating, abdominal discomfort, mild aches and pains, and headaches are written off to other issues: “I ate too much last night”, “I need a vacation,” “I am stressed about something.”
In children, they do not have the same adaptation capability so they complain that their stomach hurts but when taken to the pediatrician there is nothing pathologic on exam. They are irritable but it is written off as lack of sleep. They have a rash (excema) that is attributed to “allergy.” They have attentional issues and are prescribed Adderal. The truth is that many many children by the age of 5 (probably 40%) have a wheat intolerance, mild to moderate, that goes undiagnosed.
And it gets progressively worse as the child gets older because the child starts choosing his own food and the choices inevitably include a preponderance of wheat.
>Why do so many kids have chronic ear infections, asthma, multiple allergies, obesity not seen in earlier generations?
The role of food preservatives in chronic inflammation is not completely understood. However, the data suggests that there is a dramatic increase in not only food intolerances but food allergies in children.
And the universally highest food consumed by children is wheat. Think about the typical American diet: pizza, pasta, muffins, donuts, and fast food. And think about bread: if you are in France and buy a baguette from the local baker, it is hard and stale within 24 hours if not consumed.
If you buy a loaf of Wonder Bread at Walmart it has been sitting on some shelf for months and will last in your pantry for another few months and never get hard. Why? — Preservatives.
Preservatives are a cause of chronic inflammation, and inflammation is at the root of a huge host of symptoms. The “atopic triad” is a term that refers to the triad of symptoms in three areas: skin, respiratory, and gastrointestinal. In children this translates to eczema, chronic ear infections and asthma, and persistent abdominal pain, bloating and cyclical diarrhea alternating with constipation.
What are the benefits of gluten awareness for children?
Gluten awareness in children clearly reduces the inflammatory response. This means that they have less mucus production (and therefore less ear infections), less visceral discomfort (and therefore a better ability to focus and stay still), certainly less need to be constantly at the pediatric office, and a healthier appetite that doesn’t leave them uncomfortable after every meal.
How to “parent” a gluten sensitive child?
Teach them how to eat in real life situations. The critical message for parents to hear is this: unless your child has true celiac disease, wheat is not a poison, it’s just something to be mindful of.
In other words, if you know your child is headed to a birthday party ( ie pizza, cake, cookies) the message is not to tell her “no you can’t participate in the fun.” Just the opposite – It’s to plan ahead and recognize that she will get a wheat overload that day, so for breakfast and dinner best to have zero wheat.
The concept is that your intestinal tract is like of a series of test tubes: if you put a little of many different ingredients into the tubes, they don’t overflow and cause a mess. If you put a lot of one thing into one of the tubes, it overflows and is a hazard.
So if you know that you child is going to experience a wheat overload, prepare in advance for the hazardous and avoid wheat before and after. Certainly you do not want your child to feel socially isolated or “sick” at the party: and parents who send their children with special foods to social events do not always realize the psychological impact that has on a child. Better to plan for before and after and then let him enjoy the party.
The important point is to remind you that the time to impact on your child’s health is early, preferably from the day you stop breastfeeding; meaning that nutrition, like exercise and other healthy habits, is a learned skill.
Like learning a language, the earlier you start, the easier it is to learn. Children’s attitudes about nutrition and eating mimic their parents. It is, again like language, learning by exposure and example.
Just as a child learns to talk by hearing their parents talk, children learn to care for their bodies by seeing their parents do the same. And nutrition is at the crux of a healthy body. Becoming a gluten aware family is not complicated. And the whole family will feel more energetic, less irritable, and less uncomfortable.
Shopping for a gluten free household is easier than you think. Currently the food industry supports a 3 billion dollar a year business in gluten free products. There are many on-line resources, but even large food market chains are carrying products that are gluten free. Most have a section within the store, but some just have them alongside the wheat products.
For example, in the aisle that sells pasts, most stores now carry gluten free pasta or rice pasta. In the aisle selling cookies, there are hundreds of brands of gluten free cookies. Frozen foods like gluten free waffles, snacks like gluten free chips all exist and are no longer relegated only to natural food stores. You can even buy gluten free vitamins for children.
While it may feel daunting to start, remember that unless a family member has celiac disease (i.e. no wheat at all) this is an exercise in moderation not exclusion.
It does not have to become a full-time job to become a gluten aware family, but it will bring a “we all feel better” result.