Parents Protect Babies from Celiac Disease

Introducing gluten-containing foods into the diet between four and six months of age is protective for infants at risk for celiac disease, reports the Journal of the American Medical Association (2005;293:2343–51).

Celiac disease, sometimes called gluten-sensitive enteropathy, is an autoimmune condition affecting the small intestine. Gluten is found in a variety of grains, including wheat, barley, and rye. In susceptible individuals, gluten triggers the production of antibodies that attack the cells lining the intestine, causing inflammation and a decrease in the absorptive capacity of the bowel. The resulting malabsorption of protein, fats, vitamins, and minerals can lead to stunted growth in children, thinning of the bones, anemia, and weight loss. Celiac disease usually appears in childhood, manifesting as symptoms such as diarrhea, abdominal pain, and bloating. Untreated, it can increase the risk of developing certain types of cancer, including intestinal lymphoma and colon cancer.

Celiac disease is often inherited; most people with the disease have one of several genes that increase their susceptibility. These same genes also increase the chance of developing type 1 diabetes. Relatively few susceptible people actually develop celiac disease, however, suggesting that there may be other important contributing factors.

Successful celiac disease treatment relies on the complete avoidance of gluten-containing foods, though it may still take several years for the bowel to heal after this diet change. Pasta, breads, gravies, crackers, cakes, pies, modified food starch, and malt flavoring are all potential sources of gluten in the diet. Corn, rice, quinoa, amaranth, and buckwheat do not contain gluten and can be eaten freely by people with celiac disease. While oats contain some gluten, most people with celiac disease appear to tolerate oats.

The Diabetes Autoimmunity Study in the Young (DAISY) study recently found a connection between the timing of introduction of cereals in children’s diets and diabetes development. In an extension of this study, researchers investigated whether the timing of gluten introduction into the diet affects the risk for celiac disease. A total of 1,560 children identified as being at increased risk for celiac disease (those with a “susceptibility gene” or with a sibling or parent with diabetes) took part in the study. Parents answered questions regarding their children’s intake of cow’s milk, formula, and other foods during interviews that took place when the children were 3, 6, 9, 12, and 15 months old. The presence or absence of celiac disease was determined by blood tests.

Over the course of the study, 51 children were diagnosed with celiac disease. Children who were introduced to gluten during the first three months of life had a five-times greater risk of developing celiac disease than children who were first exposed between four and six months of age. In addition, children who ate their first gluten-containing foods after seven months of age also had a higher rate of celiac disease, although the risk was only marginally increased.

The results of this study suggest that gluten-containing foods should be introduced between four and six months of age to minimize the chance of at-risk children developing celiac disease. It should be noted, however, that these results cannot be generalized to the whole population. The American Academy of Pediatrics recommends that babies be exclusively breastfed until six months of age, at which point solids should be gradually introduced.

Kimberly Beauchamp, ND, received her bachelor’s degree from the University of Rhode Island and her Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. She is a co-founder and practicing physician at South County Naturopaths, Inc., in Wakefield, RI. Dr. Beauchamp teaches holistic medicine classes and provides consultations focusing on detoxification and whole-foods nutrition.

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