Because my daughter was diagnosed with celiac disease 3 weeks before I had my son, one of my first questions I had for the GI doctor was, “What can I do to reduce his chances of having celiac disease?” As does most scientific research, a lot of the studies lead to the conclusion that more studies need to be done. Great! But, what do we (think) we know now?
Here, I’ll try to summarize the latest recommendations available and give a little of the “why” behind the recommendations. Studies show that only about 4% of the people with the DQ2/DQ8 genes actually develop celiac disease. What, then, leads those 4% to develop the disease? One theory is the timing of introduction of gluten. The DAISY project found that those children exposed to gluten in the first 3 months had a 5-fold increased risk of developing celiac compared to those exposed initially between 4-6 months. Additionally, those exposed after 7 months had a slightly higher risk than those exposed between 4-6 months. Of note, this study was done with children at high risk for celiac disease (those who had a 1st-degree relative with type 1 diabetes or certain genetic markers). A meta-analysis (a statistical way to combine the related results of multiple studies) completed in 2006 found that children being breastfed at the time of gluten introduction had a 52% reduction in the risk of developing celiac disease compared to their peers who were not breastfed when initially introduced to gluten-containing foods.
The protective effect of breastfeeding is likely multi-faceted. Some proposed theories include: Breast milk has the ability to introduce small amounts of gluten through the breast milk (levels in parts per billion), and/or babies benefit from the microbiota (types and amounts of specific “good bacteria”) introduced into their GI tracts through breastfeeding. A 2011 study found a common increased level of B uniformisbacteria both in the breastfed group of infants and those with the genotype at low risk of developing celiac disease, possibly suggesting that higher levels of this bacteria are protective against the development of the disease. Much more research is needed in this area before any specific recommendations would be mainstream but I think as parents anything we can do to improve the health, or even the potential to improve our children’s health, is well worth it!
1. It appears there is a window between 4-6 months during which it’s best to expose children to gluten. Especially if they are “high risk” for developing celiac disease including those with 1st degree relatives with celiac or type1 diabetes.
2. Breastfeeding, of any duration, appears to have a positive effect on decreasing risk, or at least delaying onset of celiac disease.
3. Breastfeeding during the time period your child is initially exposed to gluten may also decrease risk of celiac disease.
4. Breastfeeding does not seem to affect the severity of disease.
Sanchez E, et al. Influence of Environmental and Genetic Factors Linked to Celiac Disease Risk on Infant Gut Colonization by Bacteroides Species. Applied and Environmental Microbiology. Aug. 2011. 5316-5323.
Silano M, et al. Effect of the timing of gluten introduction on the development of celiac disease. World J Gastroenterol April 2010. 1939-1942.
Radlovic N, et al. Influence of early feeding practices on celiac disease in infants. Clinical Sciences. Augutst 2010. 417-422.