Gluten has been in the news a lot lately and often gets a bad rap. Some see a gluten-free diet as a cure all for a vast array of stomach problems, including pain, bloating, diarrhea, constipation, and even weight gain and behavior problems.

But gluten – a nutritious mixture of proteins found in wheat and other grains – isn’t necessarily the culprit, says Nancy Nelson, a nurse practitioner at Seattle Children’s in the Gastroenterology and Hepatology program who specializes in stomach problems and inflammatory bowel disease. Cutting it out of your diet may not magically make you feel better.

That doesn’t mean that gluten sensitivity isn’t real – just that it gets the blame more often than it should. And while the cause of stomach problems varies, the symptoms are often very similar making it difficult to figure out how to feel better.

Processed foods contribute to stomach symptoms

“Many people don’t realize that processed foods, like those containing large amounts of sugars, can cause symptoms similar to those commonly attributed to gluten or wheat,” says Nelson.

“Processed” describes foods have been altered from their natural state. Not all of them are bad for you. Milk, for example, is considered processed when it’s been pasteurized. But many foods that are processed for convenience lose their nutritional value and gain a lot of unwanted extras like sodium, sugar, trans-fats and preservatives.

Eliminating processed foods from your diet and eating more whole grains and fresh fruits and vegetables eases stomach problems for many, Nelson says.

What problems can gluten cause?

Gluten does cause problems for some people that can range from temporary discomfort to a severe impact on health.

Some people are allergic to wheat and experience symptoms like hives, rashes and closing of the throat.

Others are gluten sensitive – they experience stomach and intestinal discomfort when they eat food with gluten. Gluten sensitivity (also known as gluten intolerance) is a subjective judgment – there’s no way to medically test for it, but some people do feel better when they eat less – or no – food containing gluten, according to Nelson.

“Eliminating a food group may be fine for adults,” says Nelson, “but it makes it much harder for children to have a balanced diet. Foods with gluten are often a good source of fiber, iron and B vitamins.”

The key for anyone eliminating a broad food source is to understand what nutrients are in the foods you are avoiding and make sure to get them from other food sources. “We see this problem with teens who become vegetarians,” Nelson says. “They stop eating meat and poultry, but don’t replace them with another healthy protein source and don’t include enough fruits and vegetables.”

Those who are gluten sensitive may feel uncomfortable when they eat it, but it’s not actually harmful to their bodies and won’t hinder a child’s growth or development, notes Nelson. They may not need to be completely gluten free, and can tolerate small amounts, based on symptoms.

That’s not the case with celiac disease (CD).

Celiac disease

Celiac disease is an immune reaction to dietary gluten that interrupts the small intestine’s ability to absorb nutrients.

Typical symptoms of celiac disease include failure to grow, unexplained weight loss, signs of malabsorption of nutrients, unexplained fatigue and irritability, diarrhea/constipation, excess fat in feces (steatorrhea), bloating, farting (flatulence) and abdominal pain after eating.

“The actual incidence of the disease is quite low (about 1% of the general population),” says Nelson, “though it is significantly higher among those who have a close family member with celiac disease or have certain other conditions such as type 1 diabetes or Down’s syndrome.”

Unlike gluten sensitivity and gluten intolerance, celiac disease can be positively diagnosed using a blood test for celiac-specific antibodies, which is then confirmed by biopsy of the small intestine. The intestinal injury and symptoms resolve with a very strict gluten-free diet (GFD). People with celiac disease need to completely eliminate all gluten from their diets.

What to do if your child has stomach problems

While persistent stomach problems are common and can be caused by many things – nearly 30% of all children see a doctor for this reason before age 15 – only a small percentage of these kids have serious problems such as celiac disease.

Identifying the cause of a child’s ongoing stomach issues can be a challenge for parents. Before focusing on the role gluten may play, Nelson advises considering the role a child’s diet might play: is it well balanced? Does it include sugary drinks or processed food? Other factors to consider include whether a child is well hydrated, if they are having frequent and easy bowel movements, if there are emotional triggers (like social or academic stress) at play, and if they are getting enough exercise and sleep.

If small tweaks in these areas don’t lead to improvement, it may be time to talk to your child’s doctor. “There’s no need to self diagnosis,” says Nelson. “The tests for celiac disease are reliable. However, you do need to have had recent and daily exposure to foods with gluten for the test to be accurate.”

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