Nutritionist Kelly Dorfman Talks About Transitioning Kids to Gluten-Free Diets
By Mari-Jane Williams

Kelly Dorfman, nutritionist and author of “What’s Eating Your Child,” joined staff writer Mari-Jane Williams to talk about transitioning children to a gluten-free diet. Here is an edited excerpt.

Q: Why is it that some people are so resistant to not eating gluten?
A: I think it comes down to change being hard (especially long term), people being emotionally attached to certain foods (which has to do with their personal history) and the fact that nobody likes to be told they cannot do something!

Q: I have celiac disease, my son’s pediatrician doesn’t think my son should be tested because he has no symptoms. Should we put him on a gluten-free diet?

A: If your son does not have symptoms, I would not restrict him unnecessarily. True, he has a higher chance of having gluten issues because of your situation and so you should be watchful. Also, you can keep him ‘gluten light’ to keep his exposure down and possibly reduce the chances of him getting the full blown disease. Your household likely has less gluten foods anyway because of your situation so this can be a natural and easy thing to do without making restrictions.

Q: What tips can you offer parents of kids with celiac disease or food allergies to help teachers or day care providers avoid cross contamination at lunch or snack time?
A: I think it is tricky with daycare and school providers because we cannot expect them to know as much (or care as much) as the person with the sensitivity. I think the key is to develop a good relationship where they are not feeling criticized or controlled so they feel free to ask questions and communicate their concerns. I have seen situations where school employees develop a “don’t ask, don’t tell” policy and hope they do not get caught giving something wrong.

If the situation is very touchy, you need to bring all snacks/meals/treats and ask them not to give any other foods to the child (without asking first). A doctor’s note helps give this request gravity so they do not feel like the ‘poor child’ is ‘being deprived’ but that they are doing something supportive to help.

Q: My grandson has headaches off and on all the time. Could this be caused from gluten foods?
A: Short answer– yes. It is one of the neurological symptoms of gluten intolerance. However, there are many, many reasons for headaches (including low blood sugar, vision strain, tension/anxiety, etc.) so I do not want to give the impression that gluten-free living is the answer to all that ails you.

Q: My 11 year old son has been eating GF for the past 3 years. He handles it beautifully and I have grown into a better cook for the entire family because of it. Now, suddenly he is showing a new sensitivity to dairy. It has been dramatic in that any food with a trace of dairy disrupts his GI tract for 24-48 hours. Is this connected to his body changing hormonally and will puberty create further problems with his food allergies?
A: In my experience, most people who cannot handle gluten also cannot handle lactose (the sugar found in milk products). Most can handle yogurt or cheese but you are saying your son cannot handle even trace amounts of proteins. I would need to know more info but off the top of my head (so please take this with a grain of salt) my guess is that you have removed the irritant (gluten) but have not done well enough with healing the underlying issue.

The analogy I use for this is that if you take the nails out of your driveway, your tires stop getting new holes but you do not heal the old ones. In theory, a live biological system should heal but sometimes just removing the irritant is not enough . . . especially with the pressure of puberty (and increased growth) on the system.

You may want to find a medical professional familiar with these issues and consider digestive enzymes, probiotics and nutrients to heal the gut lining. I don’t like the idea of having to restrict more and more foods. In my view, that symptom is a call to do something else. I hope that helps and good luck. Your family is likely enjoying your improved cooking skills!

Q: What’s the deal with oats? Other than cross contamination issues, do some oats have gluten in them or not? Thanks.
A: Thank you for asking this question! I can’t believe more people don’t find it confusing. Oats have gluten. However, there are many families of gluten and the type of gluten in oats is not in the exact same family as wheat/rye/barley gluten. As a result, many people with celiac disease can handle pure oats.

So when you see a package that says ‘gluten free oats’ what it really means is wheat gluten free oats. Oats are full of gluten (and you might be able to handle them if you are gluten free anyway).

Q: My son tested positive for gluten sensitivity but he is so resistant to his diet and he hates that he’s not supposed to eat the things he used to. Even breads like Udi’s he probably should not eat because of the yeast but so many of the gluten free products are not tasty. It’s especially hard when we go to church because they offer snacks like bagels and pop tarts. He knows he’s not supposed to have them but I think he does anyway. How to get around this?
A: This is tricky because you do not say whether or not he is doing dramatically better not eating gluten. Many tests for gluten sensitivity are prone to false positives so you have to consider the clinical picture when interpreting them. There are not great tests for gluten sensitivity except to go off gluten and see if symptoms get better.

To follow-up with the last question, it is possible that he can handle a little gluten ( once or twice a week) even if he is sensitive or you could find his behavior or digestive symptoms get much worse when he does. Since you think he is cheating but are not sure, that suggests he can handle a little here and there. Being flexible , when you can (because it is not celiac disease) goes a long way in helping kids feel better about trying a diet. Though I am not a fan of pop tarts, I would consider letting church be a time when he can have one treat and just see how he does.

Q: Why do so many gluten free products, e.g. cereals, crackers, have so little nutritional value? Can you recommend some products or alternatives?
A: I love this question! The absolute best gluten free foods are the ones that are naturally gluten free anyway. Chicken and rice, steak and potatoes, quinoa, corn based tacos, even frozen yogurt are often better than the gluten free substitute baked goods and pasta. Rice, quinoa, millet, wild rice, potatoes, sweet potatoes and corn are all gluten free grains that are nutritious. Then there are all the nuts, seeds, beans, fruits, vegetables, meats and cheeses. They are all good.

Q: My son has been celiac for almost 10 years, and keeping his weight up is a constant challenge. Despite butter, whole milk, and avocados, there just doesn’t seem to be a route to success for him. He’s 19 now – 5’10.5” and weighs about 127, has never been above 130. Ideas for a worried mom?
A: I feel your pain. Yesterday, I dealt with a family with a 6 foot son who is also 130 pounds. It is so hard (for moms, in particular it seems). In nutrition, absorption is 9/10th of the law. So, you are avoiding the irritant but it sounds like he has not healed his gut lining enough to improve absorption. In theory (and if all the stars align) two years of gluten free living should heal the lining. In practice, I have seen people 10 years out who are not healed completely or absorbing optimally.

You might want to talk to someone about digestive enzymes (there was an old study done at Stanford, I believe, that found they could be useful in celiac disease), extra zinc (for helping the gut lining) and possibly probiotics. These are all substances thought to help with the process (and certainly should not hurt).

Good luck.