FeaturesOct/Nov 2013 Issue

Food Allergies and Teenagers

Food and Mood

As the fourth-generation owner of Chicago’s historic The Berghoff Restaurant and CEO of Berghoff Catering & Restaurant Group, Carlyn Berghoff knows food. When her daughter Sarah was diagnosed with celiac disease at age 13, Berghoff quickly sprang into action, purging her pantry of all gluten. She restocked her kitchen with gluten-free products but was frequently disappointed with the taste and texture. She wanted more for Sarah.

She set out to create gluten-free versions of foods that Sarah and other teens with celiac disease miss the most, co-authoring Cooking for Your Gluten-Free Teen: Everyday Foods the Whole Family Will Love with daughter Sarah, pediatric gastroenterologist Suzanne Nelson, MD, and food writer Nancy Ross Ryan. Teens told Berghoff and Nelson that they craved gluten-free doughnuts, macaroni and cheese, chicken nuggets, burgers, pizza and cake—these recipes and more went into the cookbook. (Many recipes offer dairy substitutions, as Sarah is also sensitive to dairy and chocolate.)

“The gluten-free diet can be particularly challenging for teens because they’re so often on-the-go after school, at sports events, at friends’ homes and at restaurants. And they want to eat the same food as their friends without appearing different,” Berghoff says. “I really want to speak to kids about peer pressure and also about learning how to cook for themselves. They have to survive college. If they can’t take care of themselves, they’re not going to be able to make it over the hump. They need to learn how to read labels, how to cook and how to grocery shop.”

Berghoff and Sarah want their cookbook to provide more than just gluten-free recipes. They hope it also offers emotional support to teens with celiac disease.

“Just because you have this small illness, it’s not going to make or break you,” Sarah says. “Our goal is to show people they’re going to be healthier on the gluten-free diet. They’re going to be living longer. And there is actually a lot of food out there other than gluten-filled stuff.”

Now 16 and a junior in high school, Sarah is increasingly peer-sensitive.

“When you’re a kid, you want to be able to eat the food that everyone else around you can eat. You don’t want to carry your lunch bag everywhere you go,” she says. “Once I got into high school and started to go out with my friends, it hit me. You’re out on a date and they pay for dinner and you have to lecture the waiter about gluten-free food—it’s embarrassing. It’s kind of like, I just want to be normal.”

Many teens with celiac disease are prone to depression. “In teenagers, psychiatric changes, including depression and suicidal ideations, are well described in the medical literature. These symptoms are more serious in celiac teens than in the general population of those with celiac disease,” says Guandalini.

Some 31 percent of celiac teens reported an episode of major depression at some point, compared to 7 percent of the non-celiac control subjects, according to a 2004 Finnish study published in the journal Psychosomatics. (The depression significantly decreased after three months on a gluten-free diet.)

A 2011 Italian study in the journal BMC Pediatrics revealed that girls with celiac disease showed more internalized symptoms, like anxiety, while boys showed higher externalized symptoms, like social withdrawal and attention problems—even after following a gluten-free diet.

Children with anxiety or depression from celiac can be broken into two groups, says Aaron Rakow, PhD, clinical psychologist and director of psychological services for the division of gastroenterology, hepatology and nutrition at Children’s National Medical Center in Washington, DC.

“Prior to diagnosis of celiac disease and the adoption of a gluten-free diet, many children experience mood and behavior disorders often directly correlated with the physical discomfort they experience. When these children adopt a gluten-free diet, many of their physical and psychological symptoms improve,” he says. “However, for a second group of children, even after diagnosis of celiac disease and adoption of the gluten-free diet, the depression and anxiety continue or even worsen because of the psychosocial stressors of living with celiac.”

Rakow works with Children’s National’s Celiac Disease Program, meeting with families upon diagnosis. He says some kids can develop depression and social alienation over feeling like they’re alone with celiac disease. Others can develop anxiety disorders after having to become hyper-vigilant about food and keeping themselves safe.

He instructs parents to keep communication lines open and to be available to their teens. “Tell your child again and again—‘Although you might not want to talk right now, I want you to know that we are here for you, no matter what.’”

“Often with parents, the urge is to attempt to immediately fix the problem at hand,” Rakow says. “I often recommend that parents try to simply be as present for their children as possible, to listen to and support them as needed, while seeking professional mental health support if more significant concerns arise.”

This approach, he says, can bring about positive change and strong parent-child relationships.

Next: Gaining Strength

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