Important news regarding a long term study of children with genetic markers for celiac disease and how gluten exposure in early childhood may affect onset of disease. It seems that higher gluten exposure in young children gave them a higher risk of developing celiac disease. Let’s break this down a bit.
This study was inspired by a spike in celiac disease in Sweden between 1984 to 1996. There is a 3-fold higher than expected rate of celiac disease in this population compared to normal populations. When these children were infants, the prevaling practice was to introduce gluten abruptly and often discontinuing breast feeding. According to the definitive study on the celiac epidemic in Sweden, the reason for the epidemic is, “Our findings suggest that infant feeding and early infections, but not early vaccinations, have a causal role in the celiac disease etiology and that the infant feeding practice – gradually introducing gluten-containing foods from 4 months of age, preferably during ongoing breastfeeding – is favorable.” This study concluded that a large number of antibiotics, large amounts of gluten in infancy, and stopping breastfeeding all contribute to the development of celiac disease in susceptible populations.
Two other important things – Zero patients without DQ2 or DQ8 were diagnosed with celiac disease and vaccinations did not impact the rate of celiac. I know lots of people are talking about “new” genetic markers for celiac. Fifty-seven alleles other than the HLA DQ2 or DQ8 markers were studied and unless the patient had either of the common HLA markers, they did not develop celiac. But the additional fifty seven alleles did confer some risk. Vaccination recommendations were not changed between the epidemic celiac population and the control celiac population.
Now that we have the background on the Swedish celiac epidemic, we have to talk about the new study. Lemme tell you that reading several articles on the study range from downright scary to more scientific. I don’t want to pay JAMA for the source article, so I am only reading second hand interpretations of the information.
This was a big, multi-national, multi-year study to understand the effects of early gluten exposure and the development of celiac disease. It seems that for susceptible children that between ages of 2 and 3 more than a daily slice of bread can increase their chances of developing celiac disease. Susceptible children are those that carry the HLA DQ 2 or HLA DQ8 markers. Specifically, the study authors say, “A daily gluten intake over 2 grams at the age of 2 was associated with a 75 per cent increase in risk of developing celiac disease. This is in comparison with children who ate less than 2 grams of gluten.” Pretty scary statistic.
As a counterpoint, Dr. Maureen M. Leonard, and Dr. Alessio Fasano wrote an editorial that was published alongside the study. They say that previous research has found no significant relationship between the amount of gluten ingested and the prevelance of celiac. They go on to say, “Furthermore, the prevalence of celiac disease in Finland is higher (1%-2.5%) than in Italy (0.7%-1.1%), yet wheat consumption in Italy is much higher than in Finland; this is also the case in Greece,” they wrote. Here is the study showing that celiac and gluten consumption are not related.
I’m not sure what the answer is on this. One group says celiac develops from too much gluten in infancy. Another says it is too many antibiotics, gluten, and stopping breast feeding. (Breastfeeding is a whole other sensitive subject in my book.) Another group says celiac and gluten consumption are unrelated. I’m not sure this issue is settled and that has to be hard for parents trying to make the best decisions they can for their children.
More studies need to be done in order to determine whether early gluten exposure in children is truly a cause for the development of the disease. This study only looks at children – what about the adults that have been diagnosed at a later age? Did they have it their entire lives and only recently found out? Did it get triggered by something else later in life?
Right now, prevailing wisdom believes celiac is triggered in adults and children by a bout of a rotavirus, stress, pregnancy, or other event. I really think they don’t know what causes people to go from a state of health to someone with celiac. A lot of research needs to be done on what is the trigger and how not to engage the trigger!