Science You Can Use: Worried about celiac disease? New analysis says longer breastfeeding, especially at time of gluten introduction, reduces risk

For some time research has been drawing a link between breastfeeding and lowered risk of celiac disease, but a meta analysis published this month* is shedding more  light on this relationship.

Celiac disease is an auto-immune condition that damages the lining of the small intestine and prevents it from absorbing important nutrients.  It’s caused by a reaction to eating gluten.  Celiac disease runs in families, so infant feeding choices can take on particular importance for parents concerned about their kids’ risk.

The relationship between celiac disease and breastfeeding has been under investigation since the 1960′s, and the authors of a new meta analysis sought to update our understanding by examining literature from 2004 to 2011.  Three observational and one case control study were included in this analysis.

A prior analysis, published in 2006 established that:

  • Increasing duration of breast feeding is associated with a reduced risk of celiac disease
  • Breast feeding at the time of gluten introduction significantly reduces the risk of celiac disease
  • It is not clear from the primary studies whether breast feeding only delays the onset of symptoms or provides a permanent protection against the disease

The latest study, published this month, examined four newer studies, and found that two of three studies on duration of breastfeeding “reported significant associations between longer duration of breastfeeding and later onset of celiac disease.”

And as the prior analysis demonstrated, “breastfeeding during the introduction of gluten to the infant was reported to have a protective effect in two studies.”

The authors conclude:  “Our findings in combination with the previous findings from Akobeng et al‘s systematic review and the two recent published review articles make it safe to say that breastfeeding has an important role in delaying and/or preventing the development of celiac disease. ”

Duration of breastfeeding

The 2006 analysis found a widely varying degree of protection based on the duration of breastfeeding.  One study found that “children who were breast fed for less than 90 days were about five times more likely to develop celiac disease compared with children breast fed for more than 90 days.”  Another found that “the risk of developing celiac disease decreased significantly by 63% for children breast fed for more than 2 months compared with children breast fed for 2 months or less.”

The 2012 analysis confirms these findings.  While one study found no effect, one found that “longer duration of breastfeeding significantly reduced the risk to develop CD in the first year of life.”  Two studies found that exclusively breastfed children who did develop celiac disease exhibited symptoms and were diagnosed later, and one found that the symptoms of those diagnosed were less severe.

Breastfeeding at the time of gluten introduction

The 2006 analysis also found that “children being breast fed at the time of gluten introduction had a 52% reduction in risk of developing celiac disease compared with their peers who were not breast feeding at the time of gluten introduction.”

Similarly, the 2012 analysis reported on one study which found that “if gluten was introduced while the child was still breastfeeding the risk of developing celiac disease was reduced by 58–62%.”  Another found that of the children who did develop celiac disease, those who were breastfeeding at the time of gluten introduction exhibited symptoms significantly later.

Further questions

There remain a number of questions about the relationship between breastfeeding and celiac disease.  The authors of the 2006 analysis point out that 1) the case controls used in these studies were healthy children, but that celiac disease can be asymptomatic, and 2) since the studies didn’t follow the children into adulthood it’s possible that breastfeeding delayed but didn’t prevent celiac disease.

And the protective mechanism at work?  That’s not at all clear.  Could it be that children get a lower “dose” of gluten at the time of introduction because of a higher intake of breastmilk?  Could it be the breastfeeding-related reduction in gastrointestinal infections which might trigger celiac disease in predisposed children?  Is it something in the milk itself?

Whatever the reason, this study gives parents concerned about their children’s risk of celiac disease more reason to think carefully about their infant feeding choices.

Does celiac disease run in your family?  What do you make of this study’s findings?

*A previously published version of this post incorrectly linked to and described the 2006 analysis.  The post has been updated to clarify the findings of the 2006 the 2012 analyses.

 



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5 Responses to Science You Can Use: Worried about celiac disease? New analysis says longer breastfeeding, especially at time of gluten introduction, reduces risk

  1. MelissaT says:

    I have been determined to breastfeed because our children inherited a lot of genes with health issues. My husband has ulcerative colitis and there is cancer on my side of the family. Some family members also had celiac disease.

    My mother-in-law breastfeed my husband until he was 7 months and then switched to formula. However, he still got colitis when he was 18.

    I nursed our son until he was 2 and I’m still nursing our 9 month old daughter. We’ve drastically changed our nutrition. Which I think, in addition to breastfeeding, has been key to the fact that everyone’s healthy right now!

    Mercifully, our kids have never had ear infections, or needed antibiotics. In my opinion, breastfeeding makes a huge difference in a child’s health.

  2. Brooke Shaw says:

    Very interesting! I’m also thinking that the gluten expressed in the breast milk (from day one if mom doesn’t have CD) helps the nursling to develop an immunity.

  3. Shannon A. says:

    My husband and I have 5 children, 2 of which have been diagnosed w/Celiac Disease. They are our oldest children at ages 8.5 & 7. My husband and our oldest child both also have Type 1 Diabetes, our oldest girl also has another autoimmune disease that effects her soft tissue. My husband also suspects heavily that he has Celiac, but is undiagnosed as he’s been off gluten now since our oldest’s diagnoses last September (2011). We deal with asthma as well with 2 of our children.

    I breastfed all my children for at least a year. My oldest was 15months old when we weened. He was 18months old when he was diagnosed with Type 1, and 8yrs when Celiac was found. I have a hard time thinking that my breastfeeding staved off the Celiac, but who knows for sure. My husband and I both feel that the extended breastfeeding helped his pancreas last as long as it did, so maybe it did help his intestine that much more.

    More then anything we just have a rampant issue with autoimmune in our family. We watch the younger three like hawks for signs of Celiac, but considering our home is a gluten free zone it’s pretty safe here for them. We watch all 4 of the non-diabetics with even more diligence because we know it could be just around the corner.

    My point it this. This is no fail safe to keeping your children disease free. Knowing my husband’s disease I “did everything right” for our first born. But he still got Diabetes at 18months. And after that, we were even more aware of food and health concerns, yet Celiac still came. All you can do, as a parent, is make the best choices for your family at the time the choices are there to make. Everyday something new will happen and new choices will have to be made. As long as you do your best, and care for your little ones with every ounce of your being, it’ll turn out alright in the end. Even if you have diseases to account for.

  4. Jenn says:

    I’m currently still nursing my nine month old. I was dx with Celiac in 2007, but displayed symptoms starting around high school age – constant stomach upset and migraines/headaches, mysterious rashes and bad hives. I am thinking my husband has it too, but he won’t get diagnosed. I fear that my daughter has it because I do and pray that she doesn’t and has the freedom of choosing to eat what she wants. Either way she’ll be raised in a gluten free home because of my eating habits, so I hope that even if she doesn’t have it that she will take gain knowledge of healthy-eating regardless. She displays no other intolerances or allergies…yet. I don’t intend to willingly introduce gluten to her, which I know some parents do. I would never introduce gluten while breastfeeding because of the detrimental effects it has on the gut and would never in my life want my daughter to experience some of the effects that I have, especially being so small and fragile right now. She’s been sick-free this long and hope that we can keep her sick-free for a lot longer. Gluten damages the gut and I would prefer not to start that downward spiral. This research is definitely a good start to figuring out what the heck is up with Celiac. I wish it never existed. It’s awful and would never wish it on my worst enemy. I HATE it sometimes and other times I’m thankful. Love/hate. But you take what you get and you live with it and make the best out of what you do have :)

  5. Debb says:

    I am a 50yr old informally diagnosed Celiac patient – I had a severe rash (DH) that went away when I went on a gluten free diet, along with a multitude of other symptoms that I’ve experienced for as long as i can remember. I breast fed my daughter for one year, she is now an adult with her own child. She was diagnosed positively with a DNA test to have Celiac. I am sure that i was breastfeeding at the time she was introduced to gluten filled foods… she started experiencing gut cramping and diarrhea about middle school, thinking it to be a normal occurence since i lived with it all my life, I passed it off as a nervous stomach and didn’t ever seek medical help. I now look back and wish i had – she would have gone through less pain in her life and I would of course also been less affected. We live – learn – and try to help others.

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