Who will actually get celiac disease? Celiac disease certainly has a genetic component, but something else has to happen for a person to actually have CD. That is why children who have a parent with celiac disease, or a sibling with CD, only have a 10% to 11% chance of developing it themselves.
Much research has focused on trying to find an event that triggers the disease. A viral infection affecting the gastrointestinal tract may very well be one of these events.
Others, however, have looked at when wheat is introduced into the diet of a young child, and whether or not timing could have anything to do with the development of CD. There is also a question about whether or not breastfeeding may have a protective effect against the development of CD.
Studies have been done all over the world, looking at the age that wheat is introduced into the diet of infants and the rate of celiac disease. They have also looked at breastfeeding and the risk of celiac disease.
Doctors recommend that infants breastfeed for the first six months unless there is an actual danger to mother or baby that makes it impossible. Breastfed infants have their mother’s antibodies, which protects them against infection, including the viral intestinal infections that are thought to be one possible trigger for CD.
Interestingly, gluten gets into breast milk of women who eat wheat. Studies have found gluten in breast milk consistently, with even higher amounts in colostrum, the fluid first made by the breast before complete milk comes in. So, many infants are exposed to gluten before they actually eat solid food.
A number of studies have documented that the risk of celiac disease in young children, those less than two years old, is less if the child is still breastfeeding when first introduced to gluten in the diet. The risk is even lower if breast feeding continues after children are eating foods with gluten.
Some of this information comes from an epidemic of celiac disease in young children that occurred in Sweden between 1984 and 1996. The diagnosis of CD in children under 2 years of age was 4 times the usual amount. As the children born during these years were followed, 3% of them developed celiac disease by the age of 12. Those children who were breastfeeding at the time of gluten exposure had a lower risk of CD, as did continuing to breastfeed after gluten was added to the diet.
In the United States, a prospective study in Denver followed 1560 children at risk for either celiac disease or type 1 diabetes, which are genetically related. Children at risk had a first degree relative with the diabetes, or an HLA genetic type associated with celiac disease and type 1 diabetes. All of these children are at higher risk for CD.
The children were followed from birth, for an average of 4.8 years. 51 out of the 1560 children developed celiac disease. Children exposed to any of the gluten-containing grains during the first 3 months of life had 5 times the risk of CD compared with children exposed between ages 4 and 6 months. Those who first ate gluten after the age of 7 months had a somewhat higher risk as those getting gluten between ages 4 and 6 months.
These researchers suggested that the increased “leakiness” of an infant’s intestinal lining might account for the higher risk when give gluten at an early age. The finding that the risk goes up again slightly after 7 months of age is harder to explain. This study did not find a protective effect of breastfeeding.
The researchers noted that The American Academy of Pediatrics had recently published a policy stating that breastfeeding is the best choice for the first six months of an infant’s life, with gradual introductions of food after this time.
At the current time there is an ongoing study called PREVENTCD in ten European locations. Babies with a family history of celiac disease were considered for the study if they had HLA-DQ, which was a total of 1345 children. The mothers have been told to breastfeed for six months if at all possible. When the children reach 4 months of age, half the children will be given gluten (in the form of gliadin, which is 50% of what is in gluten) on a daily basis, and the others will get placebo. By the time these children are 3 years old, results should start to be available.
Recommendations in the meanwhile included breastfeeding, with gluten introduced into the diet between 4 and 6 months of age, while breastfeeding continues, in order to decrease the risk of CD. These recommendations are not for all babies, but for babies at risk of developing celiac disease.