Gluten-free is a big part of my pediatric nutrition practice. It has also been my life since 1998, when we pulled gluten out of my son’s diet. He was 22 months old. Within two days, he had the first formed stool of his life. No more gold slimy lumpy stuff to burn his skin. Bloating, gone. Allergic shiners, gone. Anxiety, crying, sleep – all began to improve dramatically.
This was a big eye opener for me, after a very difficult start for my son. I’d been a nutrition professional for a decade, and had two degrees in nutrition; I was a registered dietitian who had worked in research, grant writing, and patient care. But I never knew gluten could wreak so much havoc without a celiac diagnosis. None of our pediatricians suggested this path; in fact, they opposed it. But this was a huge help to my son, who is still gluten free at age 20 today.
What our doctors didn’t realize is that you can have gluten sensitivity – an immune response to gluten – without celiac disease. Celiac disease is an end-stage symptom of gluten sensitivity. It can leave an intestinal wall atrophied and unable to function; it may trigger chronic diarrhea, unintended weight loss, meager growth, anemia, or skin changes (dermatitis herpetiformis).
Celiac disease, which is an autoimmune reaction to your own gut, is just one of many symptoms of gluten sensitivity, albeit an end-stage one. What is rapidly emerging in medical practice and academic press is that eating gluten can trigger autoimmune reactions in tissues besides the gut, such as your thyroid gland or your brain.
This isn’t a fad, or fiction. It’s fact. But the grey area is individual variation.
Whether or not someone will benefit from a gluten free diet takes thoughtful assessment with a knowledgeable practitioner. Ultimately, only actually trying a gluten free diet will answer this question for you – but, see below – it has to be uber strict, and long enough for the body to drop circulating levels of antibodies to gluten. Only then will those antibodies no longer be able to attack any of your own tissue in an autoimmune, cross-reactive fashion – and this can take four to six months at least. “I tried it for a month and it didn’t work” doesn’t mean much, unless you do actually have celiac disease. In that case, most people feel better pretty quickly, as soon as a three or four days going gluten free.
So, does your child or teen need a gluten free diet? Or is it just a fad? You can ask your pediatrician, but he may not be much more informed than mine were. Many docs still regard gluten sensitivity as benign, and don’t even check for it; others only advise avoiding gluten once it creates the full meltdown of celiac disease, confirmed with biopsy.
Luckily, you can find out exactly what is up for your child. Several resources are available now to look for gluten sensitivity. If your pediatrician isn’t helpful with tests below, you can work with DirectLabs.com to sort it out, or contact me for an appointment. I provide screening for gluten sensitivity, celiac serology, or gluten allergy if other resources in your insurance network can’t or don’t. And, I guide families on how to transition off gluten, what to eat, how to cook and bake gluten free, and more.
Gluten Reactions: Lab Test Basics
Wheat Allergy Test: This test checks for immunoglobulin E (IgE) reaction to wheat. A pediatrician, family practice doc, allergist, or GI MD is the usual in-network resources to order this blood test for your child. This can also be checked with a skin prick test, to see if a hive or wheal develops. It checks for a classic allergy reaction, which will usually create symptoms like hives, vomiting, headaches, stomach pain, constipation/diarrhea, eczema. Wheat allergy can be negative while gluten sensitivity is positive; the two don’t always happen together, so both should be ruled out.
Gluten Sensitivity Test: This test checks for a sensitivity or delayed reaction to wheat or gluten, mediated by immunoglobulin G. It can also check IgG to gliadin, which is part of gluten. If you need to reach beyond your pediatrician, allergist, or GI doc for this blood test, check with labs like Cyrex, Alletess, Great Plains Lab, or Genova Diagnostics. Common symptoms with sensitivity to a food protein include irritable stools, reflux, bloating, headache, mood changes or anxiety, fatigue, allergic shiners at eyes, mild eczema that comes and goes, difficulty with schoolwork or attention, and sensory irritability.
Gluten Sensitivity Test, Again:EnteroLab and Genova Diagnostics use a stool or saliva sample to check for other gluten-reactive immunoglobulins called IgA and IgM. No blood draw needed, but false negatives may be more common with this test, especially for people with chronic illness or weak overall nutrition status.
Genetic Testing: This checks your genetic odds for being gluten sensitive or acquiring celiac disease, but doesn’t measure reactions to gluten. This is often done as part of a celiac diagnostic process, because it’s unlikely you will develop celiac disease without the gene haplotype that helps make it happen. Click here to learn about HLA-DQA1 gene and here for HLA-DQB1 gene.
Tissue transglutaminase (TTG), Reticulin, and Endomysial Antibody Tests: These tests look for antibodies to your own gut tissue and enzymes. If positive, celiac disease is highly suspect. A gut biopsy may follow, to see if your gut wall is actually already damaged by the chronic autoimmune inflammation caused by these antibody reactions. In this case you are literally attacking yourself. These do not gauge reactions to gluten itself. The gluten sensitivity tests mentioned above can be positive, while these autoimmune reactions are negative, a scenario I’ve seen hundreds of times in my pediatric nutrition practice. Ding! You don’t have celiac disease (yet). You do have gluten sensitivity, and may benefit from a gluten free diet.
Elimination Diet: This means total avoidance of gluten for a while, to gauge improvement. Persons with celiac disease usually improve quickly when they first withdraw gluten, within a week or two or even faster. Persons with gluten intolerance may not notice dramatic shifts until a few weeks later. And, if there are other food proteins that bother your immune system, you may not notice any improvement on a gluten free diet at all. This could mean you’re not reactive to gluten, or, it could mean you react to gluten and some other foods you didn’t withdraw. Not sure? Do some blood work to sort it out. Especially for kids, elimination diets are cumbersome and time consuming. If your child is struggling, it’s expedient to do the lab testing. Talk to someone knowledgeable about gluten sensitivity who can review lab findings in the context of signs and symptoms, for a final decision on what to do.
Fad? Nope. We are in the midst of a scientific discovery process that many people may not tolerate gluten. And we haven’t even touched on the controversy around how the wheat we grow and eat today has changed dramatically in the last sixty years, possibly contributing to the problem, as has the heavy use of pesticides on it like glyphosate. Many conditions may have an inflammatory component that includes gluten sensitivity. Such as…
ADD or ADHD, autism, non-verbal learning disability, Asperger’s syndrome
In those scenarios, I regard gluten guilty until proven innocent. The fiction part? It’s definitely fiction that symptoms hobbling your child’s learning, growth, or behavior don’t matter. They do matter, and you can easily find out if gluten is part of the story. If it’s working against your child, a gluten free diet will be worth it. It’s so much easier than it was in 1998!
How was your child’s school physical, did you talk about upcoming flu season and how to use nutrition and food to stay healthy?
Probably not, but you likely were encouraged to get a flu shot for your child, even though they have a fairly poor record of success. Plenty of not so subtle efforts are afoot to pit parent against parent and doctor against parent, sadly. Increasingly, parents come to my office with anxiety over pressure felt socially, at school, and in the doctor’s office to “just do it” – vaccinate to the CDC’s specs – regardless of a family member’s medical needs, history, ethical or efficacy questions, or existing laws that protect choice.
School physicals are where the pressure may be at its worst. Many parents believe if they don’t vaccinate their children, school access is denied – a fallacy not upheld by existing laws nationwide. Most states have exemptions to permit individual needs around vaccination. Your child can go to school without following the CDC vaccine schedule, in most states. This may not be easy, but your child’s health and safety are too precious to risk, if any possibility exists that a vaccine may trigger a reaction – which I have witnessed many times, in my twenty odd years in pediatric nutrition practice.
There are many reasons to individualize vaccination schedules, like any other medical treatment. Some children have allergies to ingredients in shots (click here for vaccine ingredients, and here for information on traces of nuts in vaccines), or family history of adverse reaction. Every parent should know the eight questions to ask before giving any vaccine to a child.
Manage the pressure at your child’s next physical by presenting some of the information below. If your doctor won’t discuss it, consider finding a pediatrician who respects your concerns. A naturopathic doctor or osteopath are often informed on options beyond vaccines for preventing and treating infectious diseases, such as how to use food, nutrition, and herbal tools to support the immune system. Chapter 6 of this book explains how to find different types of providers; another chapter explains how to use nutrition to stay healthy and avoid infections. Here are points to discuss with your child’s health care provider:
(1) Vaccinations can spread disease. They are supposed to prevent disease, but disease transmission from vaccines has been repeatedly documented. If your child just started school and just got sick, proximity to newly vaccinated peers may be a factor. Here are examples:
– Flumist vaccination showed a 2.5% rate of transmission from recently vaccinated to unvaccinated persons. Meanwhile, getting no vaccine for flu at all showed only a 4% risk of flu – which means that getting this vaccine not only makes an arguably insignificant difference in protecting you from flu, it may actually spread the flu as well.
(2) Vaccines can fail. They can fail to protect entirely, or may create a weaker, false, or transient immunity – meaning that it may be easier, not harder, for diseases to spread in vaccinated populations. Flu, pertussis, pneumococcal infections, measles, mumps, and chickenpox have occurred in highly vaccinated populations. In spite of this, health officials still believe vaccines are successful, still insist unvaccinated persons in good health spread disease, and still urge us to get vaccinated! Examples:
– A study in Canada found measles outbreaks occurring in populations with over 90% vaccine compliance but sill blamed measles cases on unvaccinated persons.
– This study in the Marshall Islands decided MMR vaccine was a success even though, once again, an outbreak occurred with high vaccination compliance. Giving extra doses of vaccine was touted as the cure for the epidemic – it may have run its natural course anyway. Poor sanitation, poor nutrition, and crowding – all known factors in disease severity and transmission – may well have caused it in the first place.
– Chickenpox (Varicella) vaccine failures are noted above. Another pitfall introduced with chickenpox vaccination is the rise in shingles, a more severe and painful infection with Varicella virus that afflicts older persons. Without frequent boosting from naturally circulating chickenpox in children, older persons may suffer waning immunity to the virus, thus becoming more susceptible to shingles.
– Some argue that when data on infectious disease are juxtaposed with timelines for when vaccines were introduced, it’s noticeable: Vaccines may not have prevented much of anything. Infectious disease may have dropped mostly due to vast improvements for hygiene, nutrition, and advent of antibiotics in the twentieth century. Some infectious diseases indeed trended downward in a dramatic way, well ahead of widespread vaccination.
Flu shots are especially encouraged for anyone with a health condition that might make them more vulnerable to infection. But this may be more wishful thinking than reality, according to a prospective cohort study of 263 children that found that “children who received flu vaccine had three times the risk of hospitalization, compared to children who had not received the vaccine.” For children with asthma, the risk was worse.
(4) Vaccines contain highly toxic and highly allergenic ingredients. Read vaccine product inserts (available on line) before you go to the doctor’s office – these are lengthy documents that you might want some time to understand. The prevailing belief is that the small amounts of toxins and allergens in vaccines are safe to inject. But would you let your child lick even a tiny amount of formaldehyde? How about mercury? Many are concerned that industry interference has kept safety standards dangerously low for vaccines, and no review had been made of the cumulative effects of repeat injections.
Children who are allergic to egg or pork may need to skip flu shots, since several brands contain these. Nut oils are a controversial ingredient that manufacturers have not had to disclose to the public, under current laws protecting proprietary formulations. Mercury remains in about half of flu vaccines brands, and other shots given to kids. MSG (monosodium glutamate) is in some vaccines, so if this is an ingredient you avoid in food, you won’t want to inject it. Vaccines may also contain formaldehyde, aluminum, genetically modified viruses, yeasts, and bacteria, along with antibiotics, human tissue components (from aborted fetal tissue), and proteins or tissue components from monkeys, chickens, pigs, and cows.
(5) Deciding to defer shots? Then it’s important to keep your child’s immune system healthy. This is where nutrition can play a starring role. Children need varied diets. They should be amenable to accepting many fruits, vegetables, protein sources, and healthy fats and oils. All of these contain nutrients essential for good immune function. If your child is a picky eater who sticks to starchy processed stuff – like Goldfish crackers, sweetened yogurt, breakfast cereal, bread, and milk – you have your work cut out for you. You may need to supplement to add protective nutrients, though foods are the best sources.
– Vitamin A’s protective effect against measles and other infectious diseases is legend in public health nutrition circles, and was recently revisited in British Medical Journal. Cod liver oil at ½ to 1 teaspoon daily is an adequate amount for children in normal nutrition status. Vitamin A rich foods (or foods with lots of vitamin A precursors) are easy to get if you have a juicer or good blender. Try tomatoes, carrots, kiwi, papaya, spinach, kale, or peaches if you’re juicing. Cooked pumpkin, yams, beets, or butternut squash are good sources if you’re cooking. A pressure cooker makes this job fast and easy; baking is easy if you can plan ahead.
– Zinc and iron keep key detox and immune proteins functioning normally. Organic grass fed beef, pork, nuts, seeds, pumpkin seeds, lentils, and spinach are good sources. If your child’s diet is void of these, have your doctor check ferritin level to see if an iron supplement is needed. Iron supplements can be poisonous, so use them only with supervision. Zinc is safe to supplement, and can be purchased in kid-friendly chewables, liquids, or teas. For children eating poor diets that lack mineral-rich foods, give 15-30 mg of zinc daily.
– Underweight children may get sick more often. If your child’s body mass index is below 13 or 14, or below the tenth percentile for his or her age, s/he may be healthier with more weight. Allow liberal servings of healthy foods and fats/oils like avocado, organic eggs, ghee (clarified butter), organic butter, olive oil, flax oil, nuts and seeds, sesame tahini, or coconut milk curries. You can check your child’s body mass index here.
– Vitamin D has an excellent track record for preventing flu and reducing incidence of complications from upper respiratory infections. Give children 1000-3000 IU daily in drops, or allow time in the sun, to get healthy doses of vitamin D.
– Remove foods that trigger wheezing, runny/stuffy nose, itchy rashes, or other signs of inflammation. Your child’s immune system will be more organized to fight true infections if allergens are off the table.
– Add a high potency probiotic – at 15 billion colony forming units (CFUs) per dose or higher. In my practice, some children do best at very high doses – up to 250 billion CFUs/day. This varies widely, but don’t give up on probiotics until you’ve tried a high potency blend for at least 2-3 months for your child. These not only improve digestion and protect the intestine from invading pathogens, they can help fight colds, reduce eczema, prevent flu, and lessen respiratory infections too. One of my favorites is Klaire Labs’ Prodegin, a high potency, soft chewable for children.
Poor outcomes happen to children from vaccines on a daily basis. In fact, the government has been compensating families for vaccine-triggered injuries and deaths for over twenty years. So before you let your children join the millions of students getting vaccinated for school, talk through these issues with family and health care providers. Find solutions that gift your child with good health.