3 reasons your child should not go gluten-free (unless your doctor says so)

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There is a puzzling and worrisome new phenomenon that I am seeing as a pediatrician: parents who are putting their children on gluten-free diets.

It’s puzzling because in the vast majority of cases it isn’t necessary — and it’s worrisome because, although parents are doing it because they think it’s healthy, a gluten-free diet can be very unhealthy for children.

Gluten is a protein found in wheat, rye, barley, and some other grains. It’s in bread and other baked goods, cereals, pastas — and in many other foods in small amounts. For people with celiac disease, even those small amounts can make them sick. People with allergies to wheat can’t eat it either. But the number of people with celiac disease or wheat allergy is actually pretty small. For both of these conditions, there are tests that can be done to make the diagnosis (which are best done when the person has been eating gluten, not when they’ve been gluten-free).

Some people "feel better" on a gluten-free diet, even though their medical tests are normal. However, this is unclear and controversial. Lots of us would feel better if our diet suddenly had more fruits and vegetables and less cake, cookies, and other carbohydrates. Also, a gluten-free diet may have less of certain sugars that are hard for some people to digest; it may be those sugars that are the culprit, not the gluten. Some studies suggest that there can be a strong placebo effect, too. The mind-body connection is very strong, and sometimes just believing something will help makes it help. And while some people without celiac disease or wheat allergy may indeed react to gluten in a way that isn’t healthy, those people are relatively few.

Yet "gluten-free" is all over products in the grocery store — as if gluten were evil. But gluten isn’t evil at all. Here are three ways that a gluten-free diet can be unhealthy for children:

• It can be missing important nutrients. Whole grains that contain gluten have lots of crucial nutrients — including B vitamins, antioxidants, iron, selenium, and magnesium. They have fiber, too, which is important for good digestion. While it’s possible to get these nutrients and fiber without eating gluten, it takes some work.
• It can be too low in calories for growing children. Kids need healthy calories to grow, and when you cut out foods made with wheat or that otherwise contain gluten, it can be harder to get those calories.
• It can be high in arsenic. A staple of a gluten-free diet is rice — and many rice products are high in arsenic. The rice plant is particularly good at pulling arsenic out of the soil, and there is a fair amount of it left from prior pesticide use. Arsenic in large amounts can be lethal, but even smaller amounts can lead over time to not only cancer and other health problems, but to learning problems when infants and children are exposed. The American Academy of Pediatrics and the Food and Drug Administration have been cautioning parents about limiting rice and rice products in their children’s diet.

Because gluten is in so many foods, being on a gluten-free diet can also make school lunches, play dates, and other aspects of a child’s daily life significantly more complicated — and it can be more expensive, too.

So before you cut gluten out of your child’s diet, talk to your doctor. Talk together about why you want to do it; find out if there are any tests that should be done, or if there are other ways to achieve what you are hoping to achieve by cutting out gluten. A child’s diet can have a big effect on not only her current health, but her future health; be sure you are making the very best choices.