by Anne Eglash MD, IBCLC, FABM
Does breastfeeding protect from celiac disease, AKA gluten allergy? Celiac sprue is a disease affecting 1% of people worldwide, and stems from the formation of antibodies against gluten. These antibodies attack the small intestine, causing abdominal pain, diarrhea, and weight loss. In addition, many people with celiac disease have other symptoms such as body aches, vitamin deficiencies due to malabsorption, anemia, fatigue, and loss of bone density. Individuals with celiac disease are also at risk for other autoimmune illnesses including hypothyroidism and type 1 diabetes mellitus.
According to a 2017 article entitled ‘Recent Advances in Pediatric Celiac Disease’, people at greatest risk for celiac disease have certain genetic markers. The question is whether early dietary factors, such as breastfeeding and the infant’s gut microbiome, play a role as to whether a susceptible person will develop celiac disease.
According to the authors of this report, which statements below do you believe are accurate, regarding infant diet, microbiome, and celiac disease susceptibility?
- The longer infants are breastfed, the lower their risk of celiac disease.
- Children who develop celiac disease tend to have fewer healthy, protective bacteria, such as bifidobacterium and lactobacillus.
- Delaying gluten introduction until 12 months of age reduces the risk of celiac disease.
- Introducing gluten while still breastfeeding decreases the risk of celiac disease.
- Probiotic therapy is not considered standard treatment to prevent celiac disease in genetically susceptible infants.
See the Answer
The answers are B and E
Expert Rev Gastroenterol Hepatol. 2017 Mar 28:1-10. doi: 10.1080/17474124.2017.1309288. [Epub ahead of print]
Recent advances in pediatric celiac disease.
Lee GJ, Kao JY
The incidence of celiac disease (CD) has increased over the last half-century, resulting in rising interest in identifying risk factors for CD. The necessity of duodenal biopsies in the diagnosis of CD has recently been challenged. Areas covered: This review covers the recent literature regarding the role of infant feeding practices, including breastfeeding and timing of gluten introduction, and the microbiota in the development of CD. Additionally, the application of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for a non-biopsy approach to the diagnosis of CD is reviewed. Expert commentary: Recent investigations have not revealed any significant effect of breastfeeding or timing of gluten introduction on the risk of CD in at-risk populations. There are alterations in the microbiota of CD patients. However, the role of the microbiome and whether its manipulation has a clinical effect are unknown. Preliminary data suggests a non-biopsy approach to diagnosis of pediatric CD can be applied to several populations, although additional studies are needed. Prospective investigations are underway to examine the interplay of infant feeding practices and the microbiome and to identify particular CD-specific biomarkers that may aid in the diagnosis and ultimately prevention of CD.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
It seems clear that children with celiac disease have a more pathogenic microbiome, with fewer healthier, protective bacteria such as bifidobacteria and lactobacillus. The authors of this study state that it is unclear if the difference in microbiome is caused by the genetic susceptibility to celiac, or whether the difference in microbiome increases the risk of celiac. Trials are now in progress to determine whether supplementation of probiotics containing bifidobacterium alter the clinical course of celiac disease.
Early studies evaluating the relationship between breastfeeding and celiac disease indicated that breastfeeding appeared protective. It seemed that introducing gluten while still breastfeeding reduced the risk of celiac disease. Now that much larger studies have been done on this subject, it appears that the relationship may be much more complicated. Even though breastfeeding is associated with a healthier gut microbiome, with breastfed infants having higher proportions of bifidobacterium and lactobacillus, results of several studies do not consistently demonstrate protection from breastfeeding. Some confounders that also alter the infant microbiome may make the relationship between breastfeeding and celiac disease hard to evaluate. These include factors such as cesarean births, antibiotic exposure, and early gastrointestinal infections.
Stay tuned for more on the topic. Given the role of the infant microbiome in the expression of celiac disease, I have a hard time believing that early infant feeding has no association with the development of celiac disease.