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Early Introduction Of Solids Lowers Celiac Risk

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by Amy Spangler
March 20, 2013

If childhood obesity rates aren’t evidence enough to convince parents of the importance of infant feeding, the results of a recent study may do the trick. A group of Swedish researchers found that early introduction of small amounts of gluten-containing foods (foods containing wheat, rye, or barley) in breastfeeding children reduces the incidence of celiac disease—not just a little, but by a lot!

Research
Celiac disease is among the more common genetic diseases. Also known as gluten-intolerance, celiac disease affects an estimated 1 percent of individuals worldwide. Individuals with a family history of celiac disease are at even greater risk with 1 in 22 affected. Symptoms of celiac disease include abdominal pain, diarrhea, vomiting, constipation, foul-smelling stools, and weight loss. The only treatment for celiac disease is the avoidance of gluten.

Sweden has one of the highest rates of celiac disease worldwide—exceeding that of Europe and the United States. Upwards of 150,000 Swedes are thought to have celiac disease. And an estimated two-thirds have yet to be diagnosed and treated. Between 1984 and 1996 there was a fourfold increase in the incidence of celiac disease in Swedish children under the age of 2 years. This increase was followed by a similar decrease 12 years later—a phenomenon never before seen.

Researchers, striving to explain the epidemic, analyzed data from ETICS (Exploring the Iceberg of Celiacs In Sweden), a screening study of 12-year-olds born during the epidemic (1993) and after (1997). More than 18,000 sixth graders from five locations in Sweden were invited to participate in ETICS, and more than two-thirds (69 percent) were tested (blood test) for the disease. Children who tested positive were given an intestinal biopsy to confirm the diagnosis.

Results
When researchers compared the two groups of children, those born earlier (1993) and those born later (1997), they found the following:

  • 2.9 percent of the children born earlier had celiac disease, compared to 2.2 percent of those born in later
  • Both groups of children received gluten-containing foods at 5 months of age
  • Children born earlier were breastfed an average of 7 months, while those born later were breastfed an average of 9 months
  • 77 percent and 63 percent of children born earlier were still breastfeeding at 4 and 6 months of age, compared to 83 percent and 74 percent of children born later

They concluded that it is the combination of early introduction of gluten and ongoing breastfeeding that reduces the risk of celiac disease in children up to age 12. A fact that is not surprising given how human milk affects bacterial growth in the intestinal tract.

These results lend further support to the “window of opportunity” theory. In other words, introducing potentially allergenic foods too early (prior to 4 months) or too late (after 6 months) may actually increase the likelihood of sensitivity and/or allergy. Celiac disease is unique in that it appears to be the combination of early introduction of gluten and continued breastfeeding that is critical.

Recommendations
The American Academy of Pediatrics (AAP) in its 2007 clinical report acknowledges that there is no evidence to support delaying the introduction of solid foods beyond 6 months of age. This includes foods known to cause allergies in young children such as eggs, fish, peanut butter—and gluten.

However, there is a growing body of evidence to suggest that earlier introduction (after 4 months but before 6) may actually reduce the risk of food allergy in high risk kids (those with a family history of food allergy). Studies show that late introduction of solid food and short duration of breastfeeding may actually increase the risk of food allergy. The onus is now on parents, especially those with a family history of food allergy, to talk with their child’s health care provider about when and how to introduce certain foods, and to breastfeed for at least the first year.

At the same time, be wary of the anti-glutenites—a growing number of individuals who advocate for gluten-free diets, claiming that it will help you lose weight and “cure” many conditions such as diabetes and even autism. The fact is there is no evidence that gluten is bad for you. Wheat has been a staple in our culture for centuries. So unless you have a confirmed food allergy, you will want to steer clear of any diet that advocates eliminating an entire food group.

Unfortunately, celiac disease has a strong genetic component, so there is no guarantee that introducing gluten-laden foods between 4 and 6 months of age and continuing to breastfeed will prevent the disease. But if these proven strategies don’t work, you can always blame it on the genes.

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