The term “weight management” generally brings to mind the issue of how to lose weight, or at least how to prevent gain. But sometimes there are health-related reasons to gain weight, and one scenario where this may be the case is in celiac disease.

Weight loss (or, in the case of kids, slowed growth) is one of many possible consequences of undiagnosed celiac disease. The inflammatory response caused by gluten in people who have celiac disease undermines the body’s ability to absorb nutrients by damaging intestinal cells that are involved in nutrient absorption. When nutrients aren’t absorbed, they are not available to the body to support health and growth: malnutrition, weight loss, and/or slowed growth can result.

There are two main aspects to the recovery of nutritional status and health after beginning a gluten-free diet: 1) the healing of intestinal cells, which allows for normal nutrient absorption; 2) consumption of a healthy, gluten-free diet that provides the nutrients needed to help reverse nutrient deficiencies and that (when applicable) supports recovery of lost weight and/or resumption of normal growth in kids.

In the case of children who have celiac disease, weight loss – or a slowing of weight gain or overall growth – can be especially detrimental. While there are natural variations in children’s rates of growth and weight gain, most healthy kids generally follow the ranges defined on standard pediatric growth charts. Falling below these ranges may be associated with increased risk for various conditions, including decreased immune function, cognitive impairment, and higher risk of fractures due to decreased bone density.

It is important to work closely with your child’s or your own personal healthcare team and dietitian throughout the healing process so that follow-up, testing, and dietary advice and planning can be individually tailored. However, following is some general information to keep in mind.

An increase in calories consumed generally leads to a gain of weight, and vice-versa, reducing calorie intake generally leads to weight loss. However, re-gaining weight that was lost unintentionally (or reversing a trend of slowed growth) needs to take into account more than just increasing calories. It’s easy to add calories to the diet for example by increasing intake of common processed foods that often get caloric density from fats and sugars but which don’t provide significant amounts of vitamins, minerals, and other nutrients that are essential to health and rebuilding. When the body becomes starved of critical nutrients it begins a process of “autophagy,” which means that it starts breaking down its own tissues to provide ongoing energy and other components needed to maintain functioning. Muscle and other tissues that may have been broken down by the body need not only extra calories, but also protein sources for rebuilding. This is even more critical for children, who are not only rebuilding lost tissue, but supporting ongoing growth as well.

What does all this mean in terms of what foods to put on your gluten-free table? Let’s look at some details:

Healthy Gluten-Free Diet Guidelines

• A healthy gluten-free diet to support reversal of malnutrition, weight loss, or impaired growth should include plenty of vegetables, sufficient protein, gluten-free whole grains & healthy starches, healthy fats, nuts & seeds, and fruits.

See what a healthy gluten-free plate looks like, and find more detail here: https://gluten.org/wp-content/uploads/2018/12/EDU_Healthy-Gluten-Free-Eating-Guidlines-1.pdf

• Good sources of protein include meats, poultry and fish, beans, eggs, nuts and seeds, and dairy products.
• Each meal, aim to fill half the plate with vegetables. As a simple rule of thumb, think of the colors of each plant as an indicator of its nutrients. The more colors on the plate, the more different nutrients being provided. Favoring cooked vegetables rather than raw may be easier on the digestive system of those with significant intestinal damage. Consult with your dietitian/healthcare team.
• Kids generally have smaller appetites and need to eat more often than adults. This means that snacks play a more important role in their diet, so be sure to choose healthy, nutrient-dense snacks, too. Instead of thinking of snacks like treats, think of them as mini-meals: opportunities to provide important nutrients. In the early stages of recovery it may be necessary to provide full meals 5 or 6 times a day, so what you had thought of as a snack time actually becomes another meal. Consult with your dietitian/healthcare team.

Ideas for adding nutrient-dense foods to snacks and meals:

Start with favorite foods that are naturally gluten-free, and add to them:

• Nuts (chopped or sliced) and seeds (e.g. sunflower or pumpkin) work great on cereal (hot or cold), yogurt, salads, vegetables, and casseroles.
• Add sliced avocado to sandwiches and salads.
• Spread hummus on sandwiches
• Add grated cheese to baked potatoes
• Spread a split banana with peanut or almond butter and drizzle with honey (microwave if desired)

Good snack items:

• • Nut and dried fruit-based energy bars
  • Hard boiled and deviled eggs
  • Fruit and yogurt smoothie with nut butter and extra powdered milk added in
  • Your favorite nut butter (almond, peanut) on crackers, with apple slices
  • Gluten-free granola with fruit and milk
  • Hummus and whole grain GF crackers with carrot sticks
  • Cheese, fruit, and whole grain GF crackers
  • Avocado, smashed with a little lime juice and salt, with corn or bean-based chips
  • Bean dip with guacamole and corn or bean-based chips
  • Trail mix. Make your own from your favorite dried fruits and nuts

Contributions from Carolina Nunes, MS, Bastyr University Dietetic Intern (2019)

This article has been assessed and approved by a Registered Dietitian Nutritionist.