Breastfeeding and Celiac DiseaseThere’s no question that breastfeeding is good for babies. It’s the best source of nutrition for newborns and infants, and it contains immunologic properties that protect against infections. There is also substantial evidence that breast milk helps the baby’s immune system develop properly. Celiac disease – an autoimmune disorder in which patients can’t eat gluten – is directly related to immune system function. Therefore, scientists have been studying how a mother’s decision to breastfeed, and to continue breastfeeding, might help to protect her baby against celiac disease. Two particularly interesting topics of medical research and discussion are: (1) Does breastfeeding affect a baby’s risk for celiac disease, other autoimmune diseases (such as type 1 diabetes) and atopic allergies? and (2) Does it matter how old the baby is when he or she starts to eat gluten?
Accumulating evidence does suggest that breastfeeding helps protect babies against celiac disease. But what does that mean? Does it mean the baby is protected as long as the mother breastfeeds? Does the protection last throughout childhood? Into adulthood? Are some babies more at risk than others? Before we look at those questions, here is some background on breastfeeding.
Older Views On "Exclusive Breastfeeding"In 2001, the World Health Organization (WHO) advised that babies be breastfed exclusively – that is, not fed with anything except breastmilk – for their first 6 months. This was a change from WHO’s previous guideline, which was to breastfeed exclusively for the first 4 months. One goal of the 6-month rule was to reduce infant mortality in developing countries. In addition, although a baby’s kidneys and gastrointestinal tract are mature enough to process nutrients from food by the age of four months, there was a somewhat theoretical concern (without strong evidence) that young infants’ immune systems would be better off, and their risks of developing autoimmune diseases, allergies and asthma would be lower, if certain food proteins (including gluten) were not introduced until they were at least six months of age.
New Research on Exclusive BreastfeedingIn many countries, including the U.S., the U.K., and Australia, rates of food allergies and intolerances went up, rather than down, after adoption of the 6-month exclusive breastfeeding guidelines in 2001. In Sweden, for example, studies showed that rates of celiac disease rose sharply when the 6-month exclusive breastfeeding guidelines were adopted (and later dropped back down when the practice of earlier gluten introduction was resumed). Also, it turned out that babies who are breastfed exclusively for 6 months have a higher risk of anemia. Therefore, researchers have been re-examining this advice and attempting to improve it, by conducting studies to determine the best time to introduce critical food proteins to a baby’s diet. The research related to cereals (i.e., gluten) is particularly interesting. This research is showing that for all babies, the best time to introduce gluten is probably between the ages of four and six months.
While much of the research has involved babies in the general population, some studies have involved babies considered to have a higher risk for celiac disease. One study, published in 2005 in the Journal of the American Medical Association, was conducted in babies who had genes that are common in celiac disease patients. In this study, the babies who ate gluten before four months of age had a five-times-higher risk of developing celiac disease in childhood compared with babies who started on gluten between four and six months. Babies who first ate gluten at age seven months or older also had a higher risk compared with babies introduced to gluten between four and six months, but the increase in risk was small.
It is also worthwhile to note that in at least one large study in children at risk for insulin dependent diabetes mellitus, those who started eating gluten before 4 months of age or after 7 months of age were more likely to have autoimmune changes in the cells of the pancreas (called “islet cell autoimmunity”) that are a precursor to diabetes.
When Should Gluten Be Introduced to the Baby’s Diet?As a result of the research described above, and other evidence, many doctors now think that between the ages of four and six months is the best time to carefully start introducing gluten, in small amounts, to the baby’s diet, while the mother continues to breastfeed. In 2008, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition published a “position paper” that said, in part, “It is prudent to avoid both early (before 4 months) and late (7 months) introduction of gluten, and to introduce gluten gradually while the infant is still breast-fed, inasmuch as this may reduce the risk of celiac disease, type 1 diabetes mellitus, and wheat allergy.”
But remember: No one is saying that the timing of a baby’s first gluten exposure during some critical early window of development can eliminate that baby’s risk of ever developing celiac disease – just that it might be possible to lower the risk. Researchers are still not sure, however, whether a “favorable dietary pattern” would lower the risk of celiac disease for a baby’s full lifetime, or just through some period of childhood.