Gluten-Free Diet: What Patients and their Families Should Know

By Dr. Bassam Younes, pediatric gastroenterologist at CHOC Children’s

In recent years, gluten-free diets have risen in popularity and gluten-free products become more readily available—but not everyone who puts themselves or their children on a gluten-free diet has a medical reason for doing so. Here’s what your patients and families should know about this widespread diet:

Shouldn’t everyone just go gluten free?

Many people assume that since gluten can have such strong negative effects on some of us, that it would be safer if we all just avoided gluten. Wrong.

Gluten-free foods may be safe to eat, but they’re not calorie-free. Many gluten-free foods and snacks are higher in fat and calories. Also, very few gluten-free products are enriched with essential vitamins and minerals that most gluten-containing products contain. This means if you’re on a gluten-free diet not managed by a registered dietitian, you could be missing out on essential nutrients your body needs. At CHOC, our team of pediatric gastroenterologists work in tandem with registered dietitians to care for children who require a gluten-free diet.

Dr. Bassam Younes, pediatric gastroenterologist at CHOC

What is gluten?

Gluten is a general name for the proteins found in wheat, rye, and barley and triticale (a cross between wheat and rye). It can be found in many types of foods, but is primarily made up of two different types of proteins:

  • Gliadin– gives bread the ability to rise
  • Glutenin– responsible for dough’s elasticity, acting as a glue to hold the food together, affecting the chewiness and maintaining the shape of baked products

Here’s a few cases where I would recommend a gluten-free diet to my patients:

Celiac disease

If you are diagnosed with celiac disease, it means you have an autoimmune reaction to gluten. Whenever you eat something containing gluten, your small intestine is hyper sensitive to that gluten, which leads to difficulty digesting food. Some common symptoms of celiac disease are diarrhea, decreased appetite, stomachache and bloating, poor growth, and weight loss.

Many kids are diagnosed with celiac disease when they’re between 6 months and 2 years old, which is when most kids get their first taste of gluten in foods. Girls are twice as likely to have this disorder than boys.

For some people, the problems start slowly and the symptoms may be terrible one week and not as bad the next. Because of this, some people aren’t diagnosed with celiac disease until they’re older. The problem is chronic, which means that although symptoms may come and go, people who have celiac disease will always have it.

If celiac disease is not treated, patients will develop weight loss and malabsorption (a condition that prevents the absorption of nutrients through the small intestine).

No one is sure why celiac disease happens, but it appears to run in families. You have a 5 percent to 10 percent chance of getting celiac disease if someone in your family has it. Others at higher risk for celiac disease include those with Type I diabetes, an autoimmune thyroid or liver disease, Trisomy 21 (Down syndrome), Williams syndrome, Turner syndrome, IGA deficiency or juvenile chronic arthritis. If your child falls into this at-risk group, they should be tested for celiac disease even if they don’t currently show symptoms. Celiac disease can harm the digestive system if no obvious symptoms are present.

Some children with celiac disease do not respond to the Hepatitis B vaccine. They will respond to the vaccine once they are on a gluten free diet. If your child was vaccinated for Hepatitis B prior to their celiac disease diagnosis and starting their gluten-free diet, they may need to be revaccinated for Hepatitis B. Consult your pediatrician about your child’s vaccination history.

In addition to a complete medical history and physical examination, diagnostic procedures for celiac disease may include blood work or a biopsy.

The only treatment for celiac disease is a lifelong adherence to a strict gluten-free diet.

Wheat allergy

You might be hypersensitive to wheat proteins without having celiac disease. People living with a wheat allergy have an immune reaction to the proteins found in wheat. A type of white blood cell attacks the wheat, alerting the body that there is a problem. Reactions can occur within a few minutes to a few hours, and can include nausea, abdominal pain, itching, swelling of the lips and tongue, trouble breathing or anaphylaxis. People with wheat allergies cannot ingest wheat, but they have no trouble ingesting gluten from non-wheat sources.

Children with a wheat allergy may eventually outgrow it, but the only treatment is eating a wheat-free diet.

Non-celiac gluten sensitivity

Non-celiac gluten sensitivity is not well-defined, but it is not an autoimmune response (like Celiac disease) or immune response (like a wheat allergy). There are no tests to diagnose a gluten sensitivity, but your doctor can do a biopsy or allergy test to rule out Celiac disease and wheat allergy. If a child’s symptoms improve by following a gluten-free diet, then gluten sensitivity may be diagnosed.

The only treatment for non-celiac gluten sensitivity is adhering to a gluten-free diet.

Learn more about pediatric gastroenterology at CHOC.

Join Us for CHOC’s Inaugural Complex Feeding Disorders Conference, Jan. 19-20

Disordered feeding among children with food allergies and eosinophilic esophagitis; avoidant/restrictive food intake disorder; and motivational interviewing to improve parental learning are just some of the topics being covered at “Optimizing Feeding Outcomes – An Advanced Course in Managing Complex Pediatric Feeding Disorders,” hosted by CHOC Children’s on January 19-20, 2018, at the Newport Beach Marriott Resort.

The anticipated event, featuring CHOC’s multidisciplinary faculty and nationally recognized leaders, including Mitchell Katz, medical director, gastroenterology and CHOC’s Multidisciplinary Feeding Program, and keynote speaker Evan Kleiman, radio host of Good Food, is open to pediatricians, gastroenterologists, family practice physicians, nurse practitioners, nurses, occupational therapists, speech-language pathologists, clinical psychologists, licensed clinical social workers, registered dieticians, and others who care for children with feeding challenges.

CHOC Children's Multidisciplinary Feeding Program

“The conference is a great opportunity for us to share nationally and internationally our experience in assessing and treating children with complex feeding disorders,” Dr. Katz says. “We have a responsibility to our community to be educators, in addition to our roles as medical providers.”

CHOC’s Multidisciplinary Feeding Program — the only one of its kind on the West Coast — offers a positive, holistic approach to feeding disorders and receives referrals from throughout the country.

After the conference participants will be able to:

  • Follow suggested best practice model for treatment of pediatric feeding disorders and gastrostomy tube weaning.
  • Advocate for developing an effective multidisciplinary team to improve outcomes for children with feeding difficulties and gastrostomy tube dependence.
  • Apply specific behavioral feeding strategies to improve a child’s interaction with and intake of food.
  • Follow nutritional intervention strategies to improve nutrient balance, increase caloric intake and optimize growth and development of children with restrictive diets.
  • Coach parents on strategies and techniques to improve the parent‐child feeding relationship.

To register for Optimizing Feeding Outcomes – An Advanced Course in Managing Complex Pediatric Feeding Disorders visit CHOC’s website. Early bird fee registration deadline is Dec. 15.

This activity has been approved AMA PRA Category 1 Credit TM

What Providers Need to Know about CHOC’s IBD Program

When a child or teen is diagnosed with inflammatory bowel disease (IBD), the entire family is affected.  Patients with ulcerative colitis and Crohn’s disease often require ongoing medical management throughout their lifetimes.  CHOC Children’s IBD Program was recently established to provide these patients with access to pediatric gastroenterology experts and other key subspecialists, advanced diagnostics and the latest evidence-based research to diagnose and create personalized treatment plans.  The program’s team works closely with patients’ primary care providers to ensure care coordination and open communications.

“Primary care providers play a major role in managing the care of patients with IBD.  They are our partners in helping us reach our ultimate goal: securing bright futures for our patients,” says Dr. Kenneth Grant, pediatric gastroenterologist at CHOC Children’s.  He provides the following program highlights:

Dr. Kenneth Grant leads the IBD program and serves as the Chair of Gastroenterology at CHOC Children’s
  • Board-certified pediatric gastroenterologists who work with the latest advancements in IBD research and are engaged in continuous quality improvement
  • A support team that includes a registered nurse, nutritionist, social worker, and behavioral health expert
  • Coordination with primary care providers, medical and surgical subspecialists, and adult IBD providers and programs
  • Membership in the ImproveCareNow (ICN) network, whose purpose is to transform care provided to children and adolescents with IBD. CHOC is the only Orange County hospital that participates in ICN.
  • Outpatient care provided at multiple locations: Orange, Mission Viejo, Corona, Newport Beach and Fountain Valley
  • Emergency office visits with IBD medical providers for established patients, with same day or next day appointments usually available
  • IBD Parent Advisory Council whose members partner with providers to enhance the program
  • Outpatient infusion services
  • Ongoing research into the causes of IBD and development of better treatments

“Treating IBD in children and teens can be complex, requiring specialized expertise and a multidisciplinary approach to care.  We are proud to now offer additional support services to our IBD patients,” says Dr. Grant.

To speak with a CHOC gastroenterologist about the IBD program, call 714-509-4099.

Appointments can be made by calling 888-770-2462.

What CHOC Physicians are Grateful for this Thanksgiving

As Thanksgiving approaches, CHOC Children’s physicians explain what they’ll consider when giving thanks this holiday.

 

“CHOC has provided me with lifelDr. Neda Zadehong blessings. I am grateful to have grown up at and with this hospital, from the initial CHOC Tower to the current Bill Holmes Tower, through pediatric residency training and beyond.  To now be a member of such a remarkable team of providers — including our nurses and support staff — is both humbling and inspiring. Every day, I am especially thankful for the families who cross our threshold, and entrust the care of their most precious children to us. With continued commitment and dedication toward the health and well-being of our children, the future will be brighter than any of us can imagine.”
– Dr. Neda Zadeh, genetics

 

Dr. Kenneth Grant

 

 

“I am thankful to be working for an organization that creates an environment where our patients become our family. I am also grateful that CHOC Children’s has the foresight to invest in the innovative ideas we have to improve the health care we provide.”
 – Dr. Kenneth Grant, gastroenterology

 

 

 

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“I am thankful for the opportunity with be partnered with an excellent children’s hospital. I am also thankful for the pleasure of working with other positive people who provide outstanding care to the children of Orange County. Together, we work to improve the care and services we deliver to our most important resource — our children.”
– Dr. Daniel Mackey, pediatrics

 

 

 

 

Dr. Lilbeth Torno

“I am grateful for the incredible team we have in oncology, inlcuding   doctors, nurse practitioners, physician assistants, nurses, the research team, members of ancillary services, our inpatient, clinic and OPI staff, administrative support, and other subspecialists, who all have great minds and compassionate hearts, and walk the difficult cancer journey with our patients and their families. I am humbled to be with such great company here at CHOC, who care deeply for children.”
– Dr. Lilibeth Torno, oncology

 

 

 

goodman_tg“I am most grateful to the people behind the scenes at the hospital who do all the invisible jobs that are so important to keep CHOC Children’s running: the housekeepers, lab and x-ray technologists, bio-medical engineers, pharmacy technicians, scrub technicians, security guards and maintenance staff that work tirelessly, 24-hours a day.”
– Dr. Gary Goodman, critical care

 

 

 

 

 

Dr. William Loudon

“I am most thankful for the ability to practice alongside of the caring and professional staff and physicians at CHOC, who all share the common goal of caring for children. Working together, we are able to tackle incredibly complex and varied problems that present in the amazingly diverse population of children that we serve.”
Dr. William Loudon, neurosurgery

 

 

 

 

 

 

“I am thankDr. Amy Harrisonful for so many things here at CHOC. I feel truly blessed every day to have found a professional community of like-minded caregivers who share a passion and dedication for continued improvement in the care we provide. I am also so grateful for the opportunity to meet and care for such incredibly courageous patients and to become a part of their families. Finally, I am thankful to my teams within the pulmonary division, the Cystic Fibrosis Center and the muscular dystrophy clinics for their selfless care of our patients. I wish our entire community a healthy and happy holiday season.”
Dr. Amy Harrison, pulmonology

 

choc_zupanc

“I’m thankful for the opportunity to serve my patients and families, and to help them secure bright futures through CHOC’s world-class care. I am also so grateful to work among a team that is steadfastly committed to the health and well-being of children in our community and beyond. “
Dr. Mary Zupanc, neurology

 

 

 

 

 

 

 

aminian

“I am thankful for the platform CHOC has given us to provide service to a community that inspires me daily. I am humbled to just be part of it all.”
Dr. Afshin Aminian, orthopaedics

Drs. Nick Anas and Mitchell Katz Discuss Success of CHOC’s Clinical Leadership Council  

Dr. Nick Anas, CHOC’s pediatrician-in-chief, sat down with Dr. Mitchell Katz, director of CHOC’s Multidisciplinary Feeding Program and pediatric GI lab services, to talk about CHOC’s Clinical Leadership Council (CLC), and how it has benefited programs like the feeding program.

CHOC’s Multidisciplinary Feeding Program is one of a few specialty feeding programs in the country to offer comprehensive outpatient consultation and inpatient programs. With the support and success of CLC’s process, the feeding program has grown tremendously and increased the number of patients it can treat.

Watch this brief video to learn more about CLC and the feeding program.