Anna Laura Orizondo has her own toaster. She is 5.
“I can’t put her bread in my toaster because it would get contaminated with the crumbs,” says her mother, Annakarina Orizondo, who lives in Miami’s Westchester area. She says with the exception of bread, she and her husband are trying to eat gluten-free, like their daughter, who was diagnosed with the digestive and autoimmune disorder, Celiac disease, three years ago.
Gluten, a protein found in wheat, barley and rye that makes products like bread and pizza chewy, was damaging Anna Laura’s small intestine. She suffered from constant stomachaches, bloating and diarrhea, an inability to gain weight and bouts of moodiness.
She’s been on a gluten-free diet since her diagnosis and drinks lactose-free milk and special shakes since she’s also lactose intolerant. But, dieticians say, she has a medical reason to do so. For others, eating gluten-free foods and drinking milk substitutes — like almond, soy and rice milks —are the trendy thing to do, with people often mistakenly believing they’ll lose weight if they do so.
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Anna Laura’s doctor, Dr. Alisa Muñiz Crim, medical director for Nicklaus Children's Hospital’s Center for Inflammatory Bowel Diseases, cautions that parents may have the mistaken belief that by switching to plant-based milks and gluten-free foods their child is eating healthier, when, in fact, some of those products can have much more added sugar.
Take chocolate almond milk. One cup has 17 grams of added sugar. To put that in perspective, the American Heart Association recommends the maximum amount of added sugar one should consume in an entire day is 25 grams for women, 37.5 grams for men. Thus, one cup of chocolate almond milk contains two-thirds of your daily allotment if you’re a woman, and slightly less than half if you’re a man. Regular milk does not have added sugar; the sugar comes naturally from lactose.
“I think there’s a lot of people who’ve bought into the idea of going gluten-free or going milk-free,” says Crim. “One of the big issues associated with gluten-free products is that since they’re less palatable, they have a higher sugar content, so it can cause weight gain even though you think you’re eating healthily.”
A cup of milk has upwards of eight grams of protein; almond milk has one gram, on average. Milk also contains calcium and other nutrients essential for kids’ bone development., nutritionists say. Almond, rice and soy milks, unless they’re fortified, are not a natural source of calcium. And nutritionists note that lactose, found in regular milk, absorbs calcium better than calcium-fortified, plant-based milks.
“Unless there’s a specific reason that your child can’t have milk because they have a milk allergy or intolerance,” Crim says, “you’re still better off drinking milk if there’s no medical necessity to avoid it, then to use one of these alternative milks.”
Meanwhile, gluten isn’t found just in food, it’s found in everyday products, too. Anna Laura can’t use the crayons at her school, since they contain gluten, so her mother supplies her with special color pencils. Her body creams and toothpastes also have to be gluten-free, or else she breaks out in rashes.
In the U.S., retail sales of gluten-free foods are projected to reach nearly $24 billion by 2020, according to Statista, an online source for statistics and studies.
Johanna Lopez is a specialist in gastrointestinal diseases and registered clinical dietician with UHealth-University of Miami Health System’s Crohn’s and Colitis Center. She often discusses gluten-free and dairy-free options with her patients, who range from age 15 and up.
I have all these pre-teens and teens that are drinking almond milk and they don’t get any calcium or dairy from any other sources – that’s a problem.
Sonia Angel, coordinator for Memorial Regional Hospital’s Diabetes and Nutrition Center
She says many patients suffering from Crohn’s and colitis, inflammatory bowel diseases, ulcers and bleeding report a rise in symptoms when they eat foods with gluten and dairy.
“For patients who have gastrointestinal diseases,” she says, “plant-based milk is a better option than cow’s milk. Almond, coconut, cashew or hemp milk is a good alternative.” She adds that some cheeses, yogurts and ice creams are also plant based.
However, she says she wouldn’t advise parents of kids or teens who don’t have any gastrointestinal issues to give up regular milk, citing, like Crim, scant levels of protein, calcium and vitamins in milk substitutes.
“Studies show that children who don’t drink cow or goat’s milk don’t meet the requirements for Vitamin D,” she says. “It’s an important nutrient for growth, bone strength and development.”
She says that parents concerned with cows treated with hormones and antibiotics should opt for organic milk.
In terms of gluten-free diets, one of the issues — besides added sugar — is the lack of vitamins in unfortified, gluten-free foods.
“It’s an issue for kids whose nutritional needs are not being met when they’re eating gluten-free unfortified food,” she says.
She also says that many gluten-free products are based on rice, which she says is exposed to higher levels of arsenic since the poisonous chemical dissolves easier in water, like paddies, where rice is grown.
“The gluten phenomenon is en vogue right now. People think it’s healthier,” says Sonia Angel, who’s been the coordinator for Memorial Regional Hospital’s Diabetes and Nutrition Center for 11 years.
A certified diabetes educator, she specializes in nutritional issues in patients from birth to teenagers and does one-to-one weight-management counseling with kids.
“When following a gluten-free diet, usually you will lose weight and you’ll have less gastric issues. However, studies have shown that truly only people who have a gluten sensitivity or allergy or have been diagnosed with Celiac disease really need to be gluten-free.”
She says she sees a lot of teenagers whose mothers have put them on a gluten-free diets to lose weight. “But they’re losing weight at the expense of missing out of nutrients like fiber and vitamins and minerals because it’s a very restrictive diet,” she says. “I have all these pre-teens and teens that are drinking almond milk and they don’t get any calcium or dairy from any other sources – that’s a problem.”
Added Carla Duenas, a registered dietitian at Baptist Health South Florida: “The only way children should be on a gluten-free diet is if they experience symptoms of gluten intolerance.”
She says one of the biggest misconceptions about gluten is that it makes you fat. “It’s a protein found in wheat. I think what makes us fat is overeating carbohydrates in general,” she says. “Gluten-free pasta can still make you fat if you eat a lot of it.”
And Duenas says parents who choose to give their kids milk substitutes should read the labels to make sure the food is fortified with calcium and Vitamin D. They should also look at the protein levels, she said.
“For growing children, protein is very important. If parents are giving their kids almond milk they have to make sure they’re getting their protein elsewhere, from beans, steak, chicken, fish and so forth,” she says. “Protein, calcium and Vitamin D deficiencies are concerning in children who are following a dairy-free diet.”
Almonds by themselves have protein, she says, as well as almond butter, but almond milk “is pretty much the water that comes out from the process” and doesn’t have much, if any protein, she says. She recommends soy milk over almond milk if regular milk isn’t an option, since soy milk contains more protein.
Soy, however, is one of the top genetically modified crops in the U.S. and federal regulators don’t require GMO products to be labeled. Duenas suggests buying organic soy milk.
For Anna Laura, she’s still able to enjoy her favorite foods – like macaroni and cheese, pizza, pasta and chicken nuggets, thanks to gluten-free products.
“I have to read the labels very carefully,” says her mother.
They still see Crim to monitor her gluten levels.
“She impresses people,” says Annakarina of her daughter. “When people offer her foods, like cookies, she says, ‘No, I can’t eat that. I have Celiac disease and I’m gluten-free.’’’