Celiac disease and the gluten free diet: To wheat or not to eat

The gluten-free diet (GFD) is a choice for some. But for many, it’s necessary. Those with celiac disease have an immune-mediated reaction to gluten leading to inflammation of the intestine. Choosing to combat this with a GFD can initially seem daunting. 

Gluten is a protein found in wheat, rye and barley. It has obvious sources, such as pastas and breads, but is also hidden in foods like candy and sauces. A GFD can reverse the effects of celiac disease, but the need for a GFD will be lifelong. Although there are certain genes related to our body’s immune function that can predispose to celiac disease, although many people carry these genes and never develop celiac disease. Although celiac disease was thought to be more common in children 6 to 24 months, older children and adults are increasingly diagnosed. Some symptoms include abdominal pain, weight loss, diarrhea or vomiting. However, many are asymptomatic and identified because of an affected family member or other non-gastrointestinal complaints.

There are factors that can lead to an increased risk of celiac disease. Gluten introduction before four months may be harmful. Breastfeeding was thought to be protective although new research is conflicting. Overall, introduction of gluten around 5 to 6 months of age is likely appropriate, though it varies case-by-case. 

The process of applying the GFD to everyday life might seem overwhelming. Here are a few tips to help with this process:

  • Make a list of the child’s favorite gluten-free foods
  • Start investigating by reading labels and asking questions
  • Consult a dietitian 
  • Decide if the whole family will shift to a gluten-free diet or just the child
  • Partition off a section of the pantry for gluten-free food and label containers accordingly
  • Discuss the GFD with the child’s teacher
  • Pack lunches and check the school lunch calendar
  • Pack favorite non-perishable foods and check with local support groups for restaurant recommendations when traveling

Today, living gluten-free seems easier than ever. Gluten-free options can be found in restaurants and grocery stores. But is it more challenging too? There are so many options concerning when, where and how to introduce gluten to children. With that, it easily seems to pose more of a problem than a solution. But with the right knowledge and tools, it becomes easier to understand the relation between gluten and celiac disease. Gluten-free diets in children should remain limited to those with celiac disease, and the role of gluten-intolerance and related problems needs further research. Parents should contact their pediatrician if they are concerned about celiac disease and the role of a gluten-free diet, however we don’t recommend starting a gluten-free diet until celiac disease has been diagnosed (or excluded).

Post by:

Douglas S. Fishman, MD

Dr. Fishman is the Director of GI Endoscopy and Therapeutic Endoscopy and is active in the study of pancreaticobiliary disease in children. He is the medical director of the Pancreaticobilary Program (PBP). Current studies include evaluation...

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