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By Van Waffle


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A new study from the United Kingdom suggests introducing a high dose of gluten to infants might protect them from celiac disease. However, other experts warn that the evidence shows a benefit only for introducing normal amounts of wheat between 4 and 6 months of age to babies who are being breastfed.

The study from King’s College, London, recruited 1,303 babies into the Enquiring About Tolerance (EAT) Study. It was designed not only to investigate building immune tolerance to gluten, but also common allergens, such as dairy foods. All participants, recruited in England and Wales, were exclusively breastfed until 4 months of age. Then from 4 to 6 months, an intervention group was randomly selected to receive allergenic foods alongside breastfeeding. These included wheat, milk, eggs, peanuts, sesame and fish. A control group continued to breastfeed exclusively until 6 months.

Families answered a monthly food questionnaire for the first year, and a quarterly questionnaire thereafter. The control group consumed a mean 0.49 grams per week of gluten compared to 2.66 grams per week in the intervention group.

At age 3 years, 516 from the control group and 488 from the intervention group attended clinical follow-up and provided blood samples for celiac disease testing. Those who tested positive were referred for further celiac diagnosis based on European guidelines. Most diagnoses did not include an endoscopy and intestinal biopsy. Ultimately, 7 children from the exclusively breastfed group (1.4 percent) and none from the early allergen introduction group were diagnosed with celiac disease by age 3.


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The EAT Study is the first to show that introducing gluten between 4 and 6 months of age may prevent celiac disease. However, other experts warn this may mislead parents of children at risk.

The findings support a theory that introducing allergenic food at a critical stage can help the infant’s digestive and immune systems mature, conferring better tolerance to food allergies and autoimmune conditions such as celiac disease. Previous research suggested that introducing gluten before 3 months or after 6 months led to a higher risk for celiac disease. However, further study disputed this theory concerning late introduction after 6 months.

The EAT Study is the first to show that introducing gluten between 4 and 6 months of age may prevent celiac disease. However, other experts warn this may mislead parents of children at risk.

The study published in JAMA Pediatrics concludes, “These results suggest that early high-dose consumption of gluten should be considered as a strategy to prevent CD in future studies.”

However, Alessio Fasano, MD, professor of pediatrics and division chief of pediatric gastroenterology and nutrition at MassGeneral Hospital for Children, Harvard Medical School, in Boston emphasizes that the gluten doses administered in this study were neither early nor high. The period of 4 to 6 months is normally recommended for introducing solid food, and the amount of gluten administered is comparable to what children would normally consume at this time.


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“Although it was approximately double the dose recommended by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), it was much lower than the daily intake of the typical diet implemented in Southern Europe (1.5-3.8 grams of gluten daily), where the prevalence of celiac disease is similar to Northern European countries,” says Fasano.

While the study offers encouragement that normal introduction of gluten might prevent celiac disease, Fasano says it does not rule out other important factors. For example, to be eligible for participation in the EAT Study, it was essential that the children had been breastfed until enrollment, and breastfeeding rates remained high throughout the study. Consequently, the findings cannot discount a protective effect from breastfeeding itself.


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Fasano emphasizes, "The bottom line message is this is a very preliminary study,” adding it is too early to persuade mothers to change what they are already doing.

Fasano points out that breastfeeding rates differ among countries so the findings cannot be generalized to all populations. It is unclear whether introducing gluten between 4 and 6 months could produce the same protective effect where breastfeeding rates are lower.

He also notes that introducing gluten between 4 and 6 months while breastfeeding might only delay celiac disease onset beyond age 3 rather than preventing it. The study continues to follow this cohort of children to investigate celiac disease prevalence at ages 7 to 10 years.

“There are conditions for which an optimal early introduction of a moderate amount and not high amount of gluten can be beneficial in inducing tolerance,” Fasano emphasizes. “The bottom line message is this is a very preliminary study,” adding it is too early to persuade mothers to change what they are already doing.

Authors of the study from King’s College, London, were not available for comment.


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