Gluten has been blamed for weight gain, irritability, irregular bowel movements, fatigue, and a host of other symptoms. The charges against gluten are exceeded only by the number of gluten-free products lining our supermarket shelves.
Many of these labels are appearing in the baby aisle as well, a reasonable consequence of the gluten-free movement given that the symptoms of gluten ingestion overlap nearly perfectly with the behavior of most infants and young children.
But does gluten deserve this reputation? What is it? How does it impact health? And should parents avoid feeding gluten to their children?
What is gluten?
"Gluten" is so often invoked as an enemy that it sounds scary, but it's definition is downright boring. "Gluten" has taken on all manner of nefarious meanings, but, most simply put, it is just a group of proteins that are found in wheat and other similar grains. Those proteins are in fact desirable, because the gluten formation in bread dough is what gives really good loaves their chewy texture. That's why many recipes call for bread flour, which has more protein and will lead to a chewier texture than other, lower-protein varieties.
What illnesses are related to gluten?
While gluten is completely harmless to most of the population, it does pose a genuine health risk to two populations. Celiac disease is an autoimmune condition in which the body reacts to gliadins, one of the two protein types found in gluten. In adults, celiac disease is associated with gastrointestinal symptoms like diarrhea, constipation, and abdominal pain. Many children with celiac disease don't show these symptoms. Instead, because celiac disease interferes with nutrient absorption, one of the most obvious symptoms of celiac disease in infants and young children is failure to thrive. In both children and adults, prolonged exposure to gluten can damage the small intestine, which is why patients with celiac disease are prescribed gluten-free diets.
Like celiac disease, a wheat allergy is also an immune response. In medical literature, an "allergy" refers specifically to the body's immune response to a protein that is usually considered harmless to humans. In patients who develop wheat allergies, the first exposure triggers the body to develop antibodies, so that upon subsequent exposures, the body will react. Anaphylaxis is the most serious symptom, which is why patients with wheat allergies also have gluten-free diets.
Patients who have gastrointestinal discomfort after consuming gluten but no other symptoms of celiac disease or wheat allergy are increasingly being diagnosed with non-celiac gluten sensitivity (NCGS). Unlike celiac disease and wheat allergy, which are related to the immune system, intolerances are related to digestion. Intolerances for certain types of foods can lead to discomfort, but they do not cause long-term organ damage like celiac disease or life-threatening anaphylaxis like wheat allergy.
Does gluten pass to the baby through breastmilk?
If you spend any time on gluten-free forums, you'll find the oft-repeated but rarely-sourced claim that gliadin, one of the proteins in gluten, passes into breastmilk.
Before considering this remarkable claim, let's step back from the question of gluten for a moment and think about the digestive system.
Let's say you, sleep-deprived parent, drink a latte. Some parts of that latte, including water, sugar, and caffeine, are immediately absorbed into your bloodstream. But the milk, which includes proteins, fats, and complex carbohydrates, aren't digested until later, when they reach the stomach and small intestine. Proteins are broken down into amino acids, while fats are broken down into fatty acids and glycerol. All of these molecules, as well as the sugars coming from carbohydrates, pass from the small intestine into the bloodstream. Once in the bloodstream, those molecules can travel anywhere in the body, including into breastmilk. But by the time those molecules appear in breastmilk, they look very different from how they started.
Now imagine that you're eating a piece of bread. You don't think of that bread as a protein source, but it is. The gluten proteins from that bread will be broken down by your stomach and small intestine into amino acids, which will then pass through your small intestine into the bloodstream. By the time your body recombines those amino acids into the proteins in your breast milk, they won't be gluten proteins anymore.
This has not stopped various gluten-free advocacy groups from claiming that gluten is present in breast milk. However, without a complete paradigm shift in our understanding of human digestion, this seems extraordinarily unlikely. What's more likely is that the proteins formed in breast milk are similar in structure to gluten proteins, such that when researchers study the proteins found in breast milk they find similar structures.
Can gluten-containing formula and foods cause celiac disease and wheat allergies?
Even if your child is considered high risk for celiac disease or wheat allergy, there's no indication that he should not have gluten. In the case of allergies, researchers have found that earlier introduction to potential allergens actually decreases the likelihood that children will develop allergies.
Early introduction of gluten does not appear to have an effect on the development of celiac disease. Researchers behind the TEDDY study, a large longitudinal study of children, found that the timing of gluten introduction to children does not impact the onset of celiac disease. Another study explored the introduction of gluten and breastfeeding and found that neither contributed to celiac disease.
My child is (irritable, inconsolable, contorted) after nursing or eating. Could it be gluten?
Here we get to a really tricky problem, trickier even than studying human digestion or immune responses. You breastfeed your baby. The baby starts screaming. The baby has strange-looking stools. You remember you ate that bread before nursing, and come to think of it, the baby cried the last time he ate cereal...
But here's the thing: Babies cry. A lot. And humans are generally good at seeing patterns where there are none. Parents who are looking for causes of pain in their babies' crying can develop impressively elaborate, but ultimately false, narratives to explain this behavior.
None of this is to say that you shouldn't raise concerns with your pediatrician. But if your child is gaining weight normally, there's not a lot of reason to suspect celiac disease. If your child is not breaking out in hives and is still breathing, there's not a lot of reason to suspect wheat allergy.
If your child seems uncomfortable after eating a food, see what happens the next time. And the next. And the time after that. With more data, you may notice that what looked like a pattern is just the haphazard nature of early parenting. And if you are in the lucky 96-99% of the population who doesn't suffer from celiac disease or wheat allergy, you may find a giant bowl of pasta makes that hard fact easier to swallow.
This piece originally appeared on Parent.co.