Gluten and milk linked with constipation in kids

The natural food for human babies is breastmilk. However, at some point, children need to be weaned onto ‘solid food’. In the long term there is good reason, I think, for aiming for a childhood diet that is essentially ‘primal’ in nature. That means a diet based on foods like meat, fish, eggs, nuts, seeds, fruits and vegetables. What it doesn’t mean is a diet rammed full of starchy carbs and dairy products.

Some would counter such a diet with the claim that dairy products are essential for bone health, and that carbs supply valuable ‘energy’ for active, growing children. Let’s take the first of these assertions first – is milk and specifically the calcium it supplies really important for bone health. Thinking about this from an evolutionary perspective, this hardly makes sense. We probably haven’t been consuming dairy products in any meaningful way until a few thousand years ago. The paleontological record shows we, as a species, had a good, solid bone health until about 10,000 years ago (around the time we introduced grain). Apparently, we did fine without milk for about 2 million years, but now apparently we must have it for healthy bones. Seems a little odd.

The idea that milk and/or calcium do not play a huge part in bone building is also supported by some science. For example, in a review published in the journal Pediatrics, researchers cast a critical eye over 37 relevant studies, of which 27 found no relationship between dietary calcium or dairy product intake and measures of bone health [1]. Of the remaining studies, any apparent benefit was small. This review clearly deflates the notion that dairy products are ‘necessary’ for the normal growth and development of children.

Further evidence for the limited role of dairy products in building bone has come from a study published in the British Medical Journal which amassed evidence from 19 studies in the effects of calcium supplementation in children ranging from 3-18 years in age [2]. This mass of evidence found that calcium supplementation had no effect on bone density in the hip or spine, and very marginal benefits for bone density in the arm.

This study was accompanied by an editorial which highlighted the lack of evidence for the ‘benefits’ of not only calcium, but also dairy products, for bone health [3]. The editorial called for policy makers to revise calcium recommendations for young people and for a change in our assumptions about the role of calcium, milk, and other dairy products in the bone health of children and adolescents.

As for the idea that starchy carbs provide vital ‘energy’ for active growing bodies. Well, first of all, the body’s cells can run on carbohydrate (glucose), but this can be formed from other ‘macronutrients’ including protein. The absolute requirement for carbohydrate is, strictly speaking, none at all. Plus, if we were concerned about children getting enough calories, surely it’s fat we should be looking to to help here (seeing as it contains about twice as many calories per gram as carbohydrate). And finally, growing bodies rely mainly on protein to provide the raw materials necessary for this. The idea that children somehow ‘need’ starchy carbs just does not stack up.

Not only are dairy and starchy carbs of limited nutritional and health value, they can be positively problematic. For example, starchy carbs can upset blood sugar and insulin in a way that predisposes to issues such as weight gain and type 2 diabetes. And then we have the issue of ‘food sensitivity’.

Unwanted reactions to food can manifest in many ways including abdominal discomfort and bloating, irritable bowel syndrome, asthma, eczema and ear, nose and throat issues including enlarged tonsils, sore throat, glue ear and ear infections. While any food can, in theory, trigger such symptoms, experience (and some science) reveals repeat offenders to be dairy products and wheat. Within wheat, ‘gluten’ is often what gives rise to problem, and this protein is found in other grains such as oats, rye and barley.

Another potential symptom of food sensitivity is constipation. There is some evidence, for example, that milk can cause constipation in children [4,5]. And a study published recently has implicated gluten too [6]. In this study, researchers looked to see if the timing of introduction of gluten into a child’s diet appeared to have any bearing on risk of constipation at the age of 24 months. Timing may be important because, generally speaking, the sooner a foodstuff is introduced into a child’s diet, the more likely it is to provoke food sensitivity issues. Constipation was defined as less than 3 bowel movement per week or the presence of mainly hard stools for two weeks or longer.

Constipation was more likely in children who had been introduced to gluten at 6 months or earlier, compared to those who had later introduction of gluten to their diets. Earlier introduction was associated with a 35 per cent increased risk of constipation.

The researchers assessed the relationship between timing of introduction of cow’s milk and risk of constipation and found no association. However, they did find that a history of cow’s milk sensitivity in the first year of life was associated with a 57 per cent increased risk of constipation, which is consistent with other work linking cow’s milk with constipation (see above).

This study is epidemiological in nature, and cannot be used to conclude that gluten (or milk) causes constipation. However, my experience in practice leads me to believe that these foodstuffs are indeed a common cause of constipation and other gut symptoms in childhood (and in older individuals too). It is perhaps not too much of a surprise that these relatively recent additions to the human diet are common provokers of unwanted symptoms. And as I pointed out above, despite dietary dictats to the contrary, such foods offer relatively limited nutritional value. The problems with such foods and their lack of necessity in the diet should cause us to reconsider, in my opinion, if ‘cereal and milk’ really is a healthy, nutritious way to start the day.

References:

1. Lanou AJ, et al. Calcium, dairy products, and bone health in children and young adults: a reevaluation of the evidence. Pediatrics. 2005;115(3):736-43

2. Winzenberg T, et al. Effects of calcium supplementation on bone density in healthy children: meta-analysis of randomised controlled trials. BMJ 2006;333:775-778

3. Lanou AJ. Bone health in children. BMJ 2006;333:763-764

4. Heine RG, et al. Cow’s milk allergy in infancy. Curr Opin Allergy Clin Immunol. 2002;2(3):217-25

5. Daher S, et al. Cow’s milk protein intolerance and chronic constipation in children. Pediatr Allergy Immunol. 2001;12(6):339-42

6. Kiefte-de Jong JC, et al. Infant nutritional factors and functional constipation in childhood: the Generation R study. Am J Gastroenterol. 2 March 2010 [Epub ahead of print]

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14 Responses to Gluten and milk linked with constipation in kids

  1. Marco 12 March 2010 at 4:10 pm #

    Hi Dr. Briffa,

    are the opioid peptides in gluten (gluten exorphin and gluteomorphin) and casein (casomorphin) which provoke constipation in children and adults?

    Do you think some intestinal permeability (leaky gut) would be necessarily required to have this effect?

    Thank you.

  2. simona 12 March 2010 at 10:08 pm #

    Thank you dr. Briffa.
    Could you give some suggestions for lunch boxes for small children?

  3. Everett 13 March 2010 at 11:01 pm #

    You mention in the lead up to this that oats have gluten. I have seen the opposite said on many occasions. Also, raw and pasteurized dairy are two vastly different things. It would have been nice for you to speak to this difference. Finally, soaked and fermented grains are also quite different than the usual fair. I’m sure you’ve heard of the Weston A. Price foundation.

  4. smilinggreenmom 14 March 2010 at 2:40 am #

    Wow! This is so interesting as a mom of a food allergic child. Our son had terrible food issues and Eczema and could only be helped with his chewable probiotic. We have tried to really look at foods and nutrients and I never thought of this way. Do you then think that they will have enough calcium from eating whole foods? We definitely do that and I wonder about supplements etc. We also eat Kamut Khorasan Wheat which is an ancient grain and many can tolerate it that have a gluten intolerance. Thanks for this info – I would love to hear your thoughts on how those that lived so long ago did not have calcium issues! TY!

  5. Jo Lonergan 18 March 2010 at 4:42 pm #

    Just wanted to say thanks again, Dr Briffa, we’ve followed your advice for more than two years now, and all my daughter’s digestive issues resolved long ago, her ferritin is good, she’s recently had a huge growth spurt and she’s just doing so well. Thank you. This thing you do is so important, this research is so important and so inaccessible.

    Simona, my eldest likes parma ham with corn crackers in her packed lunch (with fruit salad and a drink) and my youngest is very partial to mashed tinned salmon in a nice little pot with a plastic fork and some carrots or hoummus, a home-made gluten free muffin which you’ve packed with raisins, maybe – the school probably won’t want you to use chopped nuts or nut flour in it, but if no child in your school has a nut allergy (unlikely these days) then that might be an option too, perhaps with a smoothie. They both finish their packed lunches. You could also do a cold chicken salad, a spanish omelette (sometimes how cute the pot you put it in makes the difference to whether the kids’ll eat it).

  6. damaged justice 18 March 2010 at 9:54 pm #

    Most oatmeal is gluten-contaminated, although it is possible to find certified gluten-free oatmeal. I’ll pass given its effect on blood sugar alone:

    http://heartscanblog.blogspot.com/2010/03/oatmeal-good-or-bad.html

    As far as “soaked, sprouted and fermented” grains being better than untreated, true enough. Others can choose to make toxins less toxic, I choose not to eat them at all based on cost/benefit analysis.

    http://www.paleonu.com/panu-weblog/2010/3/12/the-argument-against-cereal-grains-ii.html

    Note that Dr. Harris linked above is more tolerant of dairy than many other paleo writers, keeping it as his final step of elimination. Like you, I would have preferred to have seen Dr. Briffa go into more detail (raw versus pasteurized, A1 casein versus A2), but this post is still an excellent introduction to the idea that certain things most people think are “essential” are entirely a matter of choice, rather than a requirement.

  7. simona 27 March 2010 at 7:24 pm #

    Thanks Jo.

  8. simona 27 March 2010 at 7:38 pm #

    There is a certain calcium requirement for children and it depends on the diet if they’re getting it or not.
    I don’t think they generally eat loads of greens or sardines so dairy products are a good source of calcium for those who don’t get it otherwise. Magnesium and vitamin D are important too as avoiding wheat or cereal fibre that interfere with vit D status or the absorption of minerals.

  9. Lauren 1 May 2010 at 2:10 am #

    Dr. Briffa.

    My 2 1/2-year-old son has had eczema and constipation issues since under a year. While finally weaned for good at 14 months, he was breastfed exclusively until 6 months when I introduced table foods starting with oatmeal, fruits and veggies, wheat products and soon after proteins.

    I have been desperate to “fix” both of these problems (constipation and eczema) and have tried everything. Lower salt, more fruit, fiber and fluids, and probiotics had little and no lasting effect. Excluding dairy helped his constipation for about a week and then he reverted back again. But about 4 weeks ago I started a gluten free diet – his eczema cleared up almost immediately. His constipation has ebbed noticeably.

    My questions to you:
    - is there medical testing available to determine food intolerance and sensitivities like these and to give me a clearer picture of how to adjust his diet? (The constipation still feels like a threat and I’m so afraid of missing something and slipping back into painful poops, especially now that we’re facing potty training)
    - is this something young children grow out of, or are those that are ?
    - do you believe that MY eating of gluten and dairy while breastfeeding had an effect on his current intolerance? (this is mainly for if we had another baby)

    Thank you so much for this article and for any further help.

  10. Susanne 14 September 2010 at 3:51 pm #

    personally do not really recommend drinking milk for kids. It will to certain extent cause allergy to most children. some researches said that drinking too much milk will lead to lack of calcium.

  11. harry morrow brown 22 September 2010 at 1:46 pm #

    My website allergiesexplained.com has a very large section on the adverse effects of milk allergy and milk intolerance including constipation.
    Cow Milk was meant for baby cows, not baby humans

    H Morrow Brown MD FRCP FAAAAI

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