Q: We suspect our son has a food allergy to wheat gluten. If this turns out to be the case, what will this mean for his type 1 diabetes management? What kinds of healthy allergen-free meals and snacks would make sense for a child with type 1?
A: On the surface, treating food allergies in kids with type 1 diabetes is really no different than helping any other child avoid foods and ingredients that trigger allergic responses. Eliminating wheat gluten from a child's diet can be tricky, but with the newfound popularity of gluten-free foods, it's easier than ever to find child-friendly choices that a gluten-intolerant child with diabetes can safely eat -- and actually like!
Because your child has diabetes, the extra step that is required of you will be to check the carbohydrate counts of any new allergen-free foods swapped in for old standbys. For example, compared to a serving of your usual brand of boxed macaroni and cheese, most brands of gluten-free mac-n-cheese have higher carbohydrate counts, due to the use of rice flour (versus wheat flour) and other alternative ingredients.
There is one other specific issue that should be addressed: Your child may simply be intolerant to gluten, but it's important to rule out the possibility of celiac disease, an autoimmune disorder that damages the lining of the small intestine as a reaction to eating gluten. The reason for the concern? While medical science continues to investigate the relationship between celiac disease and type 1 (which is also an autoimmune disease), varying sources report that between 5 and 8 percent of the type 1 diabetes population also has celiac.
To get to the bottom of what's going on with your child's health, the first step is to talk to your diabetes care team. At the children's hospital where I work, all children with type 1 are screened annually for celiac disease via a simple blood test. Many of the children who test positive for celiac antibodies previously displayed sensitivity to wheat-containing foods, but we also see children test positive for antibodies who showed no symptoms. In all cases, further GI testing is needed before an actual diagnosis of celiac disease can be made.
If it does turn out that your child has celiac disease, the solution is to avoid all foods containing gluten, which includes wheat gluten, but also gluten from barley, rye, and oats. You may notice some food products are labeled as "wheat-free." These might be okay foods for a child with a wheat gluten allergy, but celiac disease requires you to carefully check to make sure foods are indeed free of all types of gluten (wheat-free and gluten-free are not one and the same).
The dietitian on your care team will be able to help you make the transition -- and can also provide tips on what foods to avoid and include for your child's overall digestive health and nutrition. It may take some time to master how to spot foods that are hidden sources of gluten, but just like the learning curve you went through to care for your child's type 1, before you know it, you'll be the neighborhood gluten-free expert.
--Megan T. Robinson, M.S., R.D., C.D.E., L.D.N., is a registered dietitian and certified diabetes educator at The Children's Hospital of Philadelphia.
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