A gluten-free diet makes diagnosing underlying conditions difficult and can leave potential, long-term consequences unaddressed.
The growing popularity of a gluten-free diet among adults appears to be spilling over to children, with help from the pediatrician’s office.
“An increasing number of primary care physicians, who are seeing children with symptoms possibly related to gluten intolerance, are advising them to try a gluten-free diet without any initial investigations or work-up to exclude celiac disease or other causes,” says Ivor Hill, MD, chief of the Section of Gastroenterology, Hepatology and Nutrition at Nationwide Children’s Hospital and director of Nationwide Children’s Celiac Disease Center. “It’s creating a bit of a problem.”
Changes caused by the diet mask the underlying condition, and each underlying condition has different long-term health consequences. Physicians need to know what is causing the symptoms in order to best treat and monitor a child, specialists say.
At the request of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Dr. Hill assembled and led a group of authorities who have written a report to help general pediatricians distinguish among conditions that benefit from a gluten-free diet and apply best practices. The paper is published in the Journal of Pediatric Gastroenterology and Nutrition.
“We wanted to specifically encourage pediatricians not to advise children to go on a gluten-free diet before they’ve done some testing,” says Dr. Hill, who is also a professor of Clinical Pediatrics at The Ohio State University College of Medicine.
Three conditions benefit from removal of gluten from the diet. In order to test for them, children must be on a diet containing gluten. If already on a gluten-free diet, patients must be returned to a regular diet. (Note that health risks and often-uncomfortable symptoms may come back when gluten is reintroduced).
The conditions are:
Reference:
Hill ID, Fasano A, Guandalani S, Hoffenberg E, Levy J, Reilly N, Verma R. NASPGHAN clinical report on the diagnosis and treatment of gluten-related disorders.. Journal of Pediatric Gastroenterology and Nutrition. 2016 Jul;63(1):156-65.
Photo credit: Nationwide Children’s