Jump to content
  • Sign Up
  • Join our community!

    Do you have questions about celiac disease or the gluten-free diet?

  • Latest Topics

  • 0

    Celiac Disease and Breastfeeding - The Missing Link

    Destiny Stone

    Celiac.com 04/19/2010 - Celiac disease is a vastly growing epidemic. 1 in 133 people have celiac disease, and only about 3% of those people are accurately diagnosed with celiac. Celiac can be a silent killer if left undiagnosed, and can present itself in the guise of irritable bowel syndrome, anemia, and  colon cancer to name a few. That's why it is of utmost importance to diagnose celiac disease early on. Current studies are being conducted to determine when and why the onset of celiac occurs. In recent years epidemiological studies are indicating that the timing of the introduction of gluten, combined with breastfeeding patterns, may play an important role in the onset and development of celiac disease.

    It is very difficult to determine the true prevalence of celiac disease, due to the fact that celiac symptoms can be entirely asymptomatic, or painfully symptomatic, and the reasons for the variations in symptoms are still unknown. Individuals who test positive for the DQ2/8 antibody are genetically predisposed for celiac. However, when exposed to gluten, only about 4% of those predisposed individuals  develop celiac. This finding has led researchers to recognize the importance of other genetic factors that must also be playing a role in the development of  celiac disease.

    In recent years, remarkable scientific advances have been made concerning celiac disease. Seven additional candidate genes have recently been discovered to be possible contributors to celiac disease developments. Additionally, new findings suggest that early introduction of solid foods may also lead to development of gluten intolerance. In England, the incidence of celiac disease showed considerable decline in the 1970's following doctor recommendations to avoid adding cereals to formula diets, and to avoid the introduction of gluten to children before 4 months of age.

    A new  ten-year study which evaluated the age at first introduction of gluten containing foods, highlighted stronger epidemiological evidence regarding the timing of introduction of gluten than previously documented.  The study assessed 1,560 children between the ages of 3 and 7 months who were at risk for  celiac disease or type 1 diabetes. The results of the study showed that out of 51 children who developed celiac disease autoimmunity (CDA), those who were exposed to gluten in the first 3 months of their lives had a 5-fold increased risk of CDA than those children who were exposed to gluten at 4 to 6 months of age. Moreover, children who ingested gluten for the first time at 7 months of age or after, showed an increased hazard ratio compared to children who were introduced to gluten at 4 to 6 months of age. The results of this study indicate a connection to gluten introduction and age introduced, thereby confirming the existence of a “window period” for gluten introduction.

    Celiac disease became a rising epidemic in Sweden in the mid 1980's. The influx of celiac patients under 2 years old was cause for concern, considering neighboring countries were seeing a decline in celiac patients during that same time period. The Swedish celiac epidemic pattern was eventually correlated to the  new dietary guidelines, which as a result of the study, were later changed. The initial dietary guidelines mandated that infants were to  be introduced to gluten only after they were weaned from breastfeeding, and larger amounts of gluten were given to the infants during this time. Further findings of the study showed that while the amount of gluten  introduced during weaning of the children may play a critical role in the development and onset of CDA in genetically predisposed children, although it did not protect the children from asymptomatic celiac disease. This and other consequent studies strongly support the theory that the amount of gluten ingested during the introduction of gluten in the diet, also plays an important role in the onset of celiac disease.

    The direct correlation between celiac disease and breastfeeding is a hot topic. While many people have varying opinions of whether or not breastfeeding can contribute to the onset of celiac,  new studies demonstrate some very important findings. In England, meta-analysis findings show strong evidence that  children who were still breastfeeding during the time when gluten was introduced to their diet, had a 52% reduction risk of developing celiac disease. These findings conclude that breastfeeding during the time when gluten is introduced into the diet, can prevent many, if not most cases of symptomatic celiac disease. Additionally, Swedish observations showed that  children that were breastfed at the first exposure to gluten, exhibited a lower risk of developing celiac disease than children that were formula fed. The amount of gluten introduced into the diet did not make a difference in these cases. Even if the amount of gluten was high, the risk of developing celiac disease was reduced. Furthermore, the risk was reduced even more if the child continued to breastfeed after gluten introduction. At Chicago University, students did a study that showed that children breastfed at the time gluten was introduced into their diet, were as likely to develop intestinal as extra-intestinal symptoms, and children who were not breastfeeding when gluten was introduced showed a higher chance of showing intestinal symptoms.

    These studies confirm the possibility of a “window” period for gluten introduction. This new evidence suggests that there is actually a “window” of time for gluten to be introduced into the diet, where there is a reduced risk of the subsequent development of celiac disease.  As a result of these findings, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) committee recommend avoidance of early and late introduction of gluten. The recommended age is older than 4 months of age, but younger than 7 months.  It is also recommended to introduce gluten gradually, in small amounts and while your child is still nursing.

    Source:

    • World J Gastroenterol 2010 April 28; 16(16): 1939-1942


    0


    User Feedback

    Recommended Comments



    Guest Kinga

    Posted

    I don't really understand why it is necessary to introduce gluten so early, if at all in the first year. If you extend breastfeeding past 12 months, then you can introduce gluten after 12 months, perhaps?

    Share this comment


    Link to comment
    Share on other sites
    Guest Destiny

    Posted

    Of course it is always important for you to decide what is best for your child with the help of your pediatrician, as every child is different and has different needs. However, as this article suggests, there is an evident "window period" where gluten seems to do the least overall damage to the celiac infant when introduced at that time.

    Share this comment


    Link to comment
    Share on other sites
    Guest R.E.

    Posted

    I have a child who was never introduced to gluten containing grains, her only exposure to gluten was in utero and through breast milk until 7 months of age when I was diagnosed with a gluten sensitivity. At age 2 approximately her pediatrician decided to test her for celiac since her growth was poor and she came out positive for the Anti-DGP test. So all these studies, based on my knowledge and experience, are extremely limited and fail to consider many other factors that can contribute to celiac disease such as maternal health, etc.

    Share this comment


    Link to comment
    Share on other sites
    Guest rachel

    Posted

    I don't really understand why it is necessary to introduce gluten so early, if at all in the first year. If you extend breastfeeding past 12 months, then you can introduce gluten after 12 months, perhaps?

    I agree. It seems bizarre to introduce gluten before 7 months wen your not suppose to wean until there abouts...after all, breast is best and is suppose to prevent these things, isn't it?

    Share this comment


    Link to comment
    Share on other sites
    Guest DoctorZ

    Posted

    This is a very difficult topic. Alessio Fasano, a celiac expert, is studying European children and introducing them to gluten only after one year of age. I could not find published data, but he presented preliminary data at one of his presentations that showed that holding off gluten exposure decreased immune reaction to it (and hence celiac). Again, early research.

    Share this comment


    Link to comment
    Share on other sites
    Guest Katrina

    Posted

    As I have a daughter soon leaving this critical window, I can't decide whether to give her barley cereal with her solids, or wait until she's a year old. I'd be interested in Fassano's research as he's a name I trust in the field.

    Share this comment


    Link to comment
    Share on other sites
    Guest Niamh

    Posted

    I wonder if the 7 month part is related to the fact that many children are weaned from the breast at six months, perhaps a child is more likely to develop celiac disease if gluten is introduced when they are not being breastfed, regardless of age?

    Share this comment


    Link to comment
    Share on other sites
    Guest MomToBe

    Posted

    What I don't understand is since I have celiac disease (very severely, for almost 4 years) and am 23 weeks pregnant with baby girl #1 and am almost 28 years old, how is continuing to breast feed my child GLUTEN-FREE breast milk going to prevent her from getting celiac disease? I understand the introduction of gluten being slow, and continuing to breast feed, but how is it supposed to "prevent" her from getting celiac disease? If she's supposed to have it (because of my wonderful, celiac disease-filled genes) she'll get it. Maybe I'm over-thinking this being a first-time mom, but I just don't think that anything is going to prevent my daughter from inheriting my disease... although, according to this study, it might just postpone the inevitable.

    Share this comment


    Link to comment
    Share on other sites
    Guest Gluten Intolerance Test

    Posted

    This is an interesting study referred to here but the data is for a rather small sample, too small to be meaningful in my opinion.

     

    Does any one know of any larger scale studies which validate the results of this one?

    Share this comment


    Link to comment
    Share on other sites



    Your content will need to be approved by a moderator

    Guest
    You are commenting as a guest. If you have an account, please sign in.
    Add a comment...

    ×   Pasted as rich text.   Paste as plain text instead

      Only 75 emoji are allowed.

    ×   Your link has been automatically embedded.   Display as a link instead

    ×   Your previous content has been restored.   Clear editor

    ×   You cannot paste images directly. Upload or insert images from URL.


  • About Me

    I diagnosed myself for gluten intolerance after a lifetime of bizarre, seemingly unrelated afflictions. If my doctors had their way, I would have already undergone neck surgery, still be on 3 different inhalers for asthma, be vomiting daily and having chronic panic attacks. However, since eliminating gluten from my diet in May 2009, I no longer suffer from any of those things. Even with the proof in the pudding (or gluten) my doctors now want me to ingest gluten to test for celiac-no can do.

×