Protecting Children from Celiac Disease and a Child's View the problem.

Protecting children from Celiac Disease:

I've written several articles about gluten, microbes and auto-immunity.   All those interactions are interesting to think about.  To me this has been like tinkering with puzzles.  Celiac disease is a problem of auto-immunity and exposure to the plant protein gluten.  It can be a rough road to follow, especially for children.  They can't eat the same things other kids eat, and other kids and even adults may not understand that something that seems so normal to them, like a cupcake or sandwich, can cause serious pain and discomfort for a celiac child.  This website, "Growing Up Gluten Free" is written and maintained by a child with celiac disease.  It helped me understand what life is like for kids like her. 

Two children enjoy a Box lunch at CrossFit Seven in Fort Worth, TX.

Celiac disease is more common in people of European descent and probably has a strong genetic component.  However, there are other factors involved as well.  An individual may be predisposed to developing Celiac disease but not get it unless a combination of other factors line up as well.  One thing I had written about in an earlier post was the possibility that gut flora (microbial species and ratios of species) might influence the development of Celiac disease.  Intestinal flora in infants will be dependent on whether the infant was born by C-section and on whether he or she was breast fed or bottle fed.  The infant digestive system is not completely developed at birth.  It is suited for breast milk.  New research published this month (October 2012) supports a role for bacterial ecology in Celiac Disease.  Delaying introduction of wheat until the infant reaches 12 months of age appears to reduce risk that a genetically at-risk child will develop the disease.  Children with a genetic predisposition to Celiacs may take longer to develop an intestinal ecology favorable for wheat (and possibly other foods) than other children.  The study was a joint project of the University of Maryland School of Medicine and the Universita` Politecnica delle Marche, in Ancona, Italy.

A Systematic Review of infant feeding practices and incidence of Celiac (Coelicac) disease has also been published very recently (Szajewska et al. 2012).  The authors suggest that the best time to introduce wheat into an infant's diet is between 4 and 7 months, and that it should be done while the child is still breastfeeding.   Introducing wheat before a child is under 4 months increases the likelihood that he or she will develop Celiac Disease.  Likewise, delaying introduction until a child is older than seven months may also increase risk of Celiac's.

There are lots of unknowns still.  The Szajewska paper does a great job of defining what they are.  

Sellitto M, Bai G, Serena G, Fricke WF, Sturgeon C, Gajer P, White JR, Koenig SS, Sakamoto J, Boothe D, Gicquelais R, Kryszak D, Puppa E, Catassi C, Ravel J, & Fasano A (2012). Proof of concept of microbiome-metabolome analysis and delayed gluten exposure on celiac disease autoimmunity in genetically at-risk infants. PloS one, 7 (3) PMID: 22432018  

Szajewska H, Chmielewska A, Pieścik-Lech M, Ivarsson A, Kolacek S, Koletzko S, Mearin ML, Shamir R, Auricchio R, Troncone R, & PREVENTCD Study Group (2012). Systematic review: early infant feeding and the prevention of coeliac disease. Alimentary pharmacology & therapeutics, 36 (7), 607-18 PMID: 22905651