Ask Tara McCarthy, MS, RD, LDN – June 2021

This month’s “Ask the Expert” features Tara McCarthy, MS, RD, LDN, Clinical Nutrition Specialist, Boston Children’s Hospital. Tara answers questions about multi vitamins and strawberries.

Question - My pediatrician thinks my daughter should be taking a multivitamin plus iron. Do you have a recommendation for a gluten-free children’s multivitamin?

Tara McCarthy - This is a very common question for dietitians. Celiac Disease can cause damage to intestinal villi which is where many vitamins and minerals are absorbed. Some patients are diagnosed with celiac disease after the diagnosis of iron deficiency anemia. We recommend a multivitamin for patients newly diagnosed with celiac disease. In the United States, wheat products are fortified with B vitamins, therefore when you avoid gluten you may be missing out on these extra vitamins. Of note, many gummy multivitamins do not have adequate B vitamins so be sure to check the label. The recommendation would be a chewable vitamin or one the child can swallow as these are usually more complete. We all know that children do not always eat the perfect diet especially in the early phases of celiac disease because the child may have symptoms that influences what they eat. As a rule of thumb, if a child eats 5 different fruits and vegetables daily, has a good variety of grains and whole natural foods which contain iron then, then they may not need a multivitamin. If your child struggles in any of these areas, consider the multivitamin as a safety net. The most important information is for any multivitamin or supplement to say GLUTEN-FREE on the label.

For these reasons, lack of diet variety, damaged villi and vitamins missing in the gluten-free diet, many children with celiac disease may benefit from a chewable multivitamin with iron. It is always important to meet with a registered dietitian who specializes in celiac to look at your child’s specific intake. My recommendation is always a chewable multivitamin that says gluten-free on the label and has close to 100% of all the vitamins and minerals. My current go to recommendation is Target brand Up and Up multivitamin.

(Note: Flintstones has changed its formulation and is no longer gluten-free).

Question - Strawberries are in season and my kids have always loved strawberry picking. Since my son’s diagnosis of celiac disease, I am concerned about strawberries and strawberry picking. I have read that strawberries are grown on straw and most often wheat straw. Is this true? And if yes, is this a problem for gluten cross-contact in eating strawberries?

Also, is it a concern being in the strawberry field picking the strawberries and coming into contact with the wheat straw?

Tara McCarthy - Just last week I noticed my strawberries were labelled gluten-free and thought this was hysterical, because of course strawberries are gluten-free. So, I looked more into this and the name is “strawberries” because these are berries that were originally grown on straw. Straw and hay are often used interchangeably. Straw is the stalk of the plant left over after the grain has been harvested, the gluten is in the grain. Hay is harvested before the seed (which contains gluten) is made. Today, not all strawberries are grown on straw. Plus, the wheat is in the grain kernel and not the straw part of the plant. Our recommendation would be to not worry about gluten contamination in fresh strawberries.  Always wash your berries before you eat them and always wash your hands before you eat anything. Strawberry picking is a great activity that we would encourage in the celiac community.

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