In an effort to prevent Celiac disease in newborns with a family history, pediatricians have been advising mothers to introduce gluten-filled foods between four and seven months of age before the immune system fully developed. But that advice is likely to change based on two new studies that find this tactic doesn’t work to prevent the condition where gluten triggers immune cells to attack the intestine.
In the studies published Wednesday in the New England Journal of Medicine, babies under one year of age who were at high risk of Celiac disease were either randomly fed gluten or didn’t get the wheat protein until they were slightly older. Both studies reached similar conclusions: The timing of gluten introduction didn’t make a difference whether the children developed the condition a few years later. Breast-feeding also didn’t provide any protective benefits, the researchers found.
“The studies were very well conducted and demonstrate that giving a little bit of gluten while breastfeeding — something that we advise currently — does not protect kids from getting celiac disease,” said Dr. Peter Green, director of the Celiac Disease Center at Columbia University Medical Center, who wrote an editorial that accompanied the studies. “I think these findings will change practice and will provide relief to parents who couldn’t breast-feed and have children with celiac disease.”
In one study involving 832 newborns who had a parent or sibling with Celiac disease, researchers found that those given gluten at six months were more likely to have developed the condition by two years of age compared to those who weren’t fed any gluten until they were at least a year old. Those differences, however, disappeared by the time the children turned five years old with about 20 percent in each group getting a diagnosis of Celiac disease by that age.
Study coauthor Dr. Alessio Fasano, director of the Center for Celiac Research and Treatment at MassGeneral Hospital for Children, said “the most shocking finding” was that breast-feeding offered no protection. “What we found is that genes play a big role. If babies have two copies of genes associated with Celiac, their risk goes way up,” he said.
About 1 percent of Americans have Celiac disease, but the study found that children who inherited one of the celiac genes, DQ2 and DQ8, from either their mother or father had a 20 percent risk of testing positive for the condition by the time they were five compared to a nearly 40 percent risk in those who inherited genes from both parents. Nearly everyone who develops Celiac disease has one of these hereditary genes.
“The practical advice we can give to families is that if you have a close family member with celiac disease, the rest of the household needs to be screened,” Fasano said. Most of those with the condition go undiagnosed for years or even decades because the constellation of symptoms — including weight loss, diarrhea, headaches, abdominal pain, and fatigue — can mimic many other conditions. A routine blood test can screen for the disease, which is then confirmed with an intestinal biopsy to check for tissue damage.
A rapid rise in Celiac disease, as well as other autoimmune diseases like type 1 diabetes and lupus, has led researchers on a quest to determine lifestyle causes to explain the rise. “About one-third of the population has a DQ2 or DQ8 gene, but most never develop Celiac disease, and we want to know why that is,” Fasano said.
He and his colleagues recently launched a study that involves following 500 high-risk children to examine the role that environmental factors, such as intestinal infections or antibiotic use, play in celiac disease risk and to monitor changes in the gut microbiome that could occur before the onset of the disease.
Dietary habits instituted over the past few decades, like the addition of refined sugar, artificial colors and sweeteners, and wheat gluten to many processed foods, could have caused changes in the types of bacteria that colonize the intestinal tract. “Previous research suggests that certain changes occur in the microbiome months before children convert to Celiac disease,” Fasano said. “If we can determine what these good bacteria are and intervene with probiotics, maybe we can prevent the disease.”
But such treatments, if they do work, are likely years away. Green points out that several other explanations could be more likely to explain the rise in Celiac disease, including the so-called “hygiene hypothesis,” which blames our increased cleanliness and exposure to fewer germs for messing up our idle immune systems.
“The role of the microbiome is very trendy and a bad one has been incriminated with everything,” Green said. “Whether it plays a role or not in Celiac disease still needs to be determined with future research.”