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Celiac.com 05/25/2017 - No parent likes to see their child ill. This is most especially true of a newborn. The baby feels sick, perhaps has a fever, and often all they do is cry, look miserable and no one gets any sleep. So while we can all agree that it's no fun, could keeping your baby healthy actually prevent a lifetime of celiac disease? The answer is quite possibly 'yes' based on a recent study published in BioMed Central Pediatrics. The title of the study is: "Early infections are associated with increased risk for celiac disease: an incident case-referent study". [A case referent study is simply one where people with the disease to be studied are identified and compared to people in a control group who do not have that disease but are similar in other respects.] Specifically, the authors concentrated on the 'epidemic' of celiac disease present in Swedish children under two. Their goal was to discover any potential risk or protectant factors that could influence the expression of celiac disease. Nine hundred and forty five children participated in this study, 373 of whom had celiac disease, with the remainder making up the control group. All of those with the disease were diagnosed with it prior to their second birthday. The scientists discovered that if a child had 3 or more infections, regardless of type, during the first 6 months of life, their risk for contracting celiac disease was significantly increased. This risk remained stable after adjusting for variances in infants' feeding and socioeconomic status. Additionally, the risk of celiac disease was further increased if, in addition to the infections, the infants were introduced to gluten in large amounts, compared to small or medium amounts, after breastfeeding was discontinued. The authors concluded that there was actually a synergistic effect between early infections and daily gluten intake. That effect was more pronounced when the infants who were ingesting gluten, did so after breastfeeding was discontinued. So what is our take-away from this study? As a parent of a newborn, one certainly can control whether the infant is breastfed, and the benefits of doing so compared to any available formula seem irrefutable. Therefore, even if a mother is having some trouble nursing or with her milk production, it is well worth the effort to overcome whatever obstacles are present so her infant receives the benefits of nursing for at least 6 months. Personally I encourage a year, but 6 months would be the absolute minimum. Controlling whether or not your child becomes ill is certainly more difficult than ensuring he or she is breastfed, but I would like to share an interesting correlation that we see here at the clinic. Breastfed babies seem, on the whole, to be much healthier than formula fed babies. There is certainly considerable support in the research to support our clinical experience. You may have more control than you would imagine, simply by ensuring that your infant is nursed for as long as possible. The only further dietary recommendation I would suggest is that the infant's mother get checked for gluten intolerance during pregnancy or as soon as possible, and if she has any genetic markers for either celiac disease or gluten sensitivity, she should avoid all gluten (and dairy products) during the nursing months – both have been shown to lower the immune system. Finally, from a lifestyle viewpoint, it would perhaps be prudent to make the first 6 months or so of life as stress-free as possible. I know that some infants gain a passport and international travel experience well before their first birthday due to relatives in foreign lands or from out of state. While all families are excited to greet a new infant into the family, consider having the infant stay at home while others make the journey to meet him or her. This might very well prove to have long-term benefits for the child's health. I hope that you found this helpful. Unfortunately, celiac disease, much like so many other autoimmune diseases we are trying to avoid, continues to increase in frequency. Anything we can do to reduce the numbers of people suffering is well worth it. If you have any questions, comments, or would like to improve your health. Please contact me – call 408-733-0400. We are here to help! Reference: BioMed Central Pediatrics. 2012 Dec 19;12(1):194. Early infections are associated with increased risk for celiac disease: an incident case-referent study. Myléus A, et al.
Celiac.com 11/07/2012 - When it comes to whether or not mothers with celiac disease should breastfeed their children, there has been a fair amount of conflicting information in circulation. Some studies have found that breastfeeding renders a protective role when combined with a 'windowed' introduction of gluten, but others have shown no such protective effect. Furthermore, some researchers question the longevity of the protection offered. An international project called PREVENTCD seeks to boil down current information from a number of studies, in order to produce a primary prevention strategy for infants at risk of developing celiac disease. The PREVENTCD project aims to answer the following questions: Breastfeeding (BF) and celiac disease (Does any BF reduce the risk of developing celiac disease in early childhood? Is there a difference between any or exclusive BF in regard to risk reduction? Is the duration of BF related to the risk of developing celiac disease?). BF at the time of gluten introduction and celiac disease (Is gluten consumption while being breastfed important for risk reduction?). Timing of gluten introduction (Is age of gluten introduction important to the risk of developing celiac disease?). Amount of gluten at weaning (and later) and celiac disease (Is the amount of gluten ingested an independent risk factor for the development of celiac disease in early childhood? Is there a threshold level of gluten consumption for developing celiac disease in early childhood?). Does the administration of microbial supplements (probiotics) and/or substrates (prebiotics) has an effect on the risk of celiac disease? For this report, a collection of studies (preference given to randomized controlled trials) involving infants at risk of developing celiac disease and breastfeeding practices were examined independently by a number of researchers. Inclusion criteria were applied independently and quality of each study's data was examined using the Cochrane Collaboration's tool for assessing bias risk. Meta-analysis was planned, but outcomes and definitions were inconsistent. 29 studies were initially identified. Of those, 12 studies were included in the analysis. Collating the data from each, the questions were answered as follows: Effect of Breastfeeding on Celiac Disease: Some studies show a protective effect of breastfeeding children at risk of developing celiac disease, but some show no effect and no studies show a long-term preventative effect. Thus, the main controversy surrounding breastfeeding celiac children is whether it has a significant long-term effect. This should not be interpreted as evidence that suggests breastfeeding does not render long-term protection, but rather that no studies have adequately addressed the question yet (partially due to methodological challenges). Studies showing protective effect have postulated that the protection offered by breastfeeding is the result of introducing cytokines, as well as IgA antibodies, lactoferrin and other enzymes (as well as small amounts of gluten) that contribute to passive immunity by reducing the number of infections in the gut. Data from the studies also suggests that longer breastfeeding periods have a more pronounced effect on celiac disease risk. However, there was no evidence to suggest that 'pure' breastfed children were at any less risk than those both breastfed and formula fed. Effect of Breastfeeding at Time of Gluten Introduction on Celiac Disease: Data from five case-control studies suggests that breastfeeding at the time of gluten introduction is associated with lower risk of celiac disease compared to formula feeding. The quality of the data is questionable, as most feeding patterns were gathered retrospectively. Again, it is also unclear whether the protective effect merely 'postpones' celiac disease. One study also showed no effect of breastfeeding at the time of gluten introduction on celiac disease autoimmunity (effect on biopsy-proven celiac disease is unknown). Timing of Gluten Introduction: While the role of age at time of gluten introduction in determining celiac disease risk is unclear, data from observational studies suggests that early and late introduction of celiac disease may increase risk of celiac disease. Early is defined as before 3 months, while late is defined as later than 7 months. One randomized controlled trial showed that gluten introduction after 12 months might be beneficial, but sample size and unclear risk of bias make this finding inconclusive. Effect of Amount of Gluten at Weaning (and Later) on Celiac Disease: One study documented that introducing gluten in large amounts versus small or medium amounts increased celiac disease risk. This echoes old data collected during Sweden's 1980s celiac disease epidemic, but it is unclear whether this is a dose-response effect or a threshold effect. However, a recent study proposes a quantitative model for a HLA-DQ2 gene dose effect in the development of celiac disease. Administratioin of Probiotics and/or Prebiotics: There have been no studies examining the effect of probiotics and prebiotics on celiac disease risk in infants, but it is reasonable to assume that manipulating gut microbiotia in early stages of life could affect celiac disease risk. Future studies should investigate this possibility. In conclusion, there are still a lot of holes in the data, but what we know thus far tells us that: Breastfeeding seems to offer some form of protective effect (whether long or short term) on celiac disease risk in infants. Longer breastfeeding periods seem to offer more protection, but some formula feeding doesn't appear to affect celiac disease risk. Gluten should be introduced in small quantities between 4 and 7 months. Gluten should only be introduced while/if the infant is breastfeeding. The committee on Nutrition of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) believes that this strategy map will not only decrease rates of celiac disease, but type 1 diabetes, mellitus and wheat allergy as well. Most of these recommendations have been in place for a while and there is a lot of room for more data, but in the meantime, this is probably the safest strategy for feeding infants who are at risk of developing celiac disease. Source: http://www.medscape.com/viewarticle/771287?src=mp
Celiac.com 12/08/2010 - A team of researchers recently compiled an overview of prevention measures and exploratory pharmacological treatments of celiac disease. Maud Pinier, Gregor Fuhrmann, Elena Verdu and Jean-Christophe Leroux comprised the research team. First, a bit of background. Human leukocyte antigens (HLAs) is the name scientists give to the major histocompatibility complex (MHC) in humans. HLAs are host to a group of genes that influence human immune system function. The HLA group of genes on chromosome 6 encodes cell-surface antigen-presenting proteins, along with numerous other genes. The proteins encoded by certain genes are also known as antigens. The major HLA antigens are key components of immune function. HLA DP,DM, DOA,DOB,DQ, and DR present antigens from outside of the cell to T-lymphocytes. Celiac disease is common worldwide, and 90–95% of people with celiac disease exhibit HLA-DQ2 molecules and the rest exhibit HLA-DQ8. Celiac disease affects about 1 in 100 individuals in the general population, but recent studies show a substantial increase in American and Finnish populations in the recent years. This rise in celiac disease rates cannot be explained by better screening methods, and other factors have been suggested including environmental factors such as breast-feeding, time of gluten introduction, and infections. Celiac disease patients can present a wide variety of pathological and clinical symptoms, ranging from severe to subtle, and the clinical expression is not always indicated by the presence of intestinal atrophy. Classic celiac symptoms include diarrhea, abdominal bloating, and discomfort. However, numerous people with celiac disease go undiagnosed because their symptoms are not apparent, as in cases of silent celiac disease, or because their symptoms are atypical. Complications of celiac disease include refractory celiac disease, a rare, but complex disorder with severe and recurrent symptoms, in which patients remain unresponsive after at least 6 months on a strict gluten-free diet. It's rare for patients with non-responsive celiac disease to develop enteropathy-associated T-cell lymphoma, a complication of celiac disease that requires drug-based therapies. Only about 0.5–1/1.000.000 celiac patients develop this rare disorder. Other autoimmune disorders, such as autoimmune thyroiditis and type 1 diabetes, are also more common in people with celiac disease. Among siblings of children with type I diabetes, rates of celiac disease have been shown to correlate with the prevalence of celiac disease-associated HLA-DQB1 alleles. Moreover, the risk of celiac disease is significantly higher in children with type 1 diabetes who also carry the HLA-DQB1*02–DQA1*05 genotype. A recent genotyping study comparing 8,064 people with type 1 diabetes with 9,339 control subjects showed that patients with type 1 diabetes and celiac disease share seven common alleles that regulate autoimmune responses. Recent data also confirm an elevated risk of mortality in individuals with mild gluten-induced inflammation who show no villous atrophy. The team concludes by noting that, due to the high prevalence of celiac disease, and its rising numbers, early prevention may represent a cost-effective strategy. Source: The American Journal of Gastroenterology , (28 September 2010) | doi:10.1038/ajg.2010.372
(Celiac.com 08/13/2000) Because celiac disease has emerged as a public health problem, Swedish researchers conducted a study to analyze the trends in the occurrence of symptomatic celiac disease in Swedish children from 1973 to 1997, and to explore any temporal relationship to changes in infant dietary patterns. The researchers established a population-based prospective incidence register of celiac disease in 1991, and collected data retrospective date from 1973. A total of 2,151 cases met their diagnostic criteria, and were used in the study. In addition the researchers collected national data on an annual basis regarding the duration of breastfeeding and intake of gluten-containing cereals and recommendations on when and how to introduce gluten to the diets of infants. The incidence of celiac disease in children below 2 years of age increased fourfold (200-240 cases per 100,000 person years) between 1985 and 1987, followed in 1995 by a sharp decline to the previous level (50-60 cases per 100,000 person years). A pattern like this one is quite unique for a chronic disease of immunological pathogenesis, which suggests that prevention could be possible. This study demonstrates that the celiac disease epidemic is in part the result of a change in three factors within the area of infant feeding, including the amount of gluten given, the age of gluten introduction, and whether breastfeeding was ongoing or not when it was introduced. There may also be additional factors involved, and the search for them should be intensified. Ivarsson A, Persson LA, Nystrom L, et al Acta Paediatr. 2000 Feb;89(2):165-71