The gluten-free diet in children: Do the risks outweigh the benefits?
The prevalence of celiac disease (CD), an autoimmune disease, is increasing. The only treatment for CD is a gluten-free diet. However, the increasing prevalence of CD does not account for the disproportionate increase in growth of the gluten-free food industry (136% from 2013 to 2015). A Commentary scheduled for publication in The Journal of Pediatrics discusses several of the most common inaccuracies regarding the gluten-free diet.
Little is known about the motives of individuals who adopt a gluten-free lifestyle. In a study conducted in 2015 of 1,500 Americans, "no reason" was the most common explanation for choosing gluten-free foods. According to the author of this Commentary, Dr. Norelle R. Reilly, from New York-Presbyterian/Columbia University Medical Center, "Out of concern for their children's health, parents sometimes place their children on a gluten-free diet in the belief that it relieves symptoms, can prevent CD, or is a healthy alternative without prior testing for CD or consultation with a dietitian." Given the frequent misunderstanding about gluten, available data regarding the gluten-free diet warrant clarification.
One misconception is that the gluten-free diet is a healthy lifestyle choice with no disadvantages. In fact, in individuals without CD or wheat allergy, there are no proven health benefits. It could increase fat and calorie intake, contribute to nutritional deficiencies, and obscure an actual diagnosis of CD. Another misconception is that gluten is toxic; there are no data to support this theory. A gluten-free diet also is not necessary for healthy first-degree relatives of individuals with CD or for healthy infants at risk of developing CD.
For a small subset of patients who are guided by an experienced registered dietitian, a gluten-free diet can lead to better health and an improved quality of life. However, there is no scientific evidence that a gluten-free diet is beneficial for children without a verified diagnosis of CD or wheat allergy. Due to potential nutritional deficiencies and quality of life issues, it could actually pose more risk than benefit. Dr. Reilly notes that "parents should be counseled as to the possible financial, social, and nutritional consequences of unnecessary implementation of a gluten-free diet." Healthcare providers may not be able to stop the move to a gluten-free diet, but they can play a larger role in educating patients and parents.