Louis Bell, MD, Chief of the Division of General Pediatrics, shares the latest in medical thinking on an important topic: gluten-free diets.
It’s hard not to notice the “gluten-free” craze that has taken our society and our local grocery store shelves by storm. But what is gluten and who should avoid it? I asked Maria Mascarenhas, MBBS, a nutrition expert and Director of CHOP’s Integrative Health Program, to weigh in.
Gluten is a protein derived from wheat, barley and rye. It is ubiquitous, used as a stabilizing agent in many processed foods and even found in pharmaceuticals, cosmetics and toys, such as Play-Doh.
Gluten’s pervasiveness is cause for concern primarily among people with celiac disease, an autoimmune disorder in which the body reacts to gluten as if it were a poison. As gluten makes its way through the digestive system of someone with celiac disease, their immune system reacts by producing antibodies to attack it. These antibodies end up destroying the part of the small intestine that absorbs vital nutrients, which can lead to serious illness.
Celiac disease occurs in about 1 percent of the general population. Symptoms can include growth problems, chronic diarrhea, chronic constipation, vomiting, and abdominal bloating and pain. The chemicals in gluten can also enter the bloodstream, resulting in fatigue, irritability, trouble focusing and even seizures. Ingesting a portion of gluten as small as a crumb can trigger symptoms. A strict gluten-free diet is the only treatment for celiac disease. Once gluten is removed from the diet, the intestines heal and symptoms go away.
Traditionally, those with celiac were the only ones who adhered to a gluten-free diet. There is increasing recognition, however, of a new disorder called non-celiac gluten sensitivity. People with this condition have all the same symptoms of celiac but don’t test positive for it. Removing gluten from the diet or sometimes simply reducing it resolves symptoms in these individuals.
Seeing the benefits of a gluten-free diet has led an estimated 21 percent of Americans — both adults and children — to incorporate gluten-free foods into their diets. But Mascarenhas cautions otherwise healthy individuals against adopting a gluten-free diet without careful thought.
“Removing all gluten makes a diet low in fiber and B vitamins,” she says, “so it can be dangerous because you’re not getting some of the nutrients you need.”
She recommends speaking with your physician before making any dietary changes, and coming up with a plan to monitor the diet’s impact on your or your child’s health.