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Friday, March 8, 2013

Is there hope for preventing celiac disease?

Celiac disease is an autoimmune disorder in which the introduction of gluten (a protein found in wheat and other grains) precipitates the truncation of the small intestinal villi. This results in a host of unpleasant symptoms, not least of which is the inability to properly absorb nutrients. Once diagnosed with this condition, the only remedy is to avoid all products containing gluten, an expensive, time consuming and sometimes unpalatable option. Because of this, Swedish researchers led by Anneli Ivarsson and Anna Myléus of Umeå University are seeking a way to prevent people from getting the disease in the first place.

The scientists compared two groups of children, each numbering several thousand. The first had been born in 1993, the middle of a ‘celiac epidemic’ in Sweden in which unusually large numbers of children had been diagnosed with the disorder. The second were born in 1997, after the epidemic had subsided. All the children were tested for celiac at age twelve. Sure enough, about 30% more kids had celiac in the first group than in the second.

So what was different about the two groups of children? From 1982 to 1996, parents were advised to postpone supplementing their infants’ diets with gluten-containing foods until the babies were six months old. In 1996, that recommendation was changed to four months of age. The celiac epidemic in Sweden lasted from 1984 to 1996. Could this be a coincidence? Certainly, and more investigation must be done in order to prove that this correlation is in fact a causation. However, the authors feel that early introduction of gluten in conjunction with continued breastfeeding may stave off the development of celiac disease. I’m sorry to say that I'm a bit more skeptical myself.

For one thing, there were minimal actual feeding differences, as remembered by the parents, between the two groups. The children in the 1993 cohort had been breastfed for an average of seven months versus nine months for the later group of children. Gluten was introduced to both groups at about five months of age. The authors contend that the parents might not remember exactly what they had done twelve years earlier, a valid point, but one that could work against them just as much as it could for them. As things stand, the surveys don’t highlight any great differences in infant feeding practices. 

Second, the prevalence of celiac disease did not go down to zero in the 1996 cohort. Just over two percent of those kids had the disorder, which is still a fairly high number. Even if the parents of the second group had followed the authors’ recommendations, it wasn’t a panacea. Then again, possibly reducing the risk of your child developing celiac disease by 30% is nothing to scoff at.

From personal experience, I know that it’s not always possible to convince an infant to follow the feeding plan you’ve designed. I’m not sure this data is worth battling with a child over, but I’m neither an expectant mother with a history of celiac disease, nor a doctor. As always with information gleaned from this blog, check with your medical professional before deciding on any health practices.

Ivarsson, A., Myleus, A., Norstrom, F., van der Pals, M., Rosen, A., Hogberg, L., Danielsson, L., Halvarsson, B., Hammarroth, S., Hernell, O., Karlsson, E., Stenhammar, L., Webb, C., Sandstrom, O., & Carlsson, A. (2013). Prevalence of Childhood Celiac Disease and Changes in Infant Feeding PEDIATRICS, 131 (3) DOI: 10.1542/peds.2012-1015.