Dr. Michael Ruscio: Does timing of introduction of gluten to your child’s diet have an impact on their future risk of Celiac disease and gluten allergy?
Hi, this is Dr. Ruscio and let’s examine this issue. Certainly with the recent popularity and increased, um, credence being played to gluten allergy and gluten intolerances and gluten-related disorders, uh, caution around gluten is certainly starting to grow. So a question that we would logically want to ask is ‘Would delaying the introduction of this into your baby’s food introduction be a good idea or a bad idea?’
I think there is a lot of people that have the belief that you should avoid gluten in your infant’s diet, uh, at all costs and maybe never even introduce gluten. And I actually used to be partially of this persuasion. However, there have been, uh, two very impactful pieces of science published lately that challenge this view. I’ll provide you the references and show you the abstracts in the screen here with some quotes. There are actually two (1 Trusted SourcePubMedGo to source) (2 Trusted SourcePubMedGo to source), multiple-center reviews that found that, um, delaying the introduction of gluten to the diet had no impact on celiac disease in the children.
And these were randomized trials, so, uh, you know, two multi-center randomized trials found no difference between normal introduction or delayed introduction. Possibly more importantly, actually certainly, I think more importantly, a systemic review. A systemic review is a study that examines multiple other studies to try to see what the abrogate, um, opinion is, or the abrogate finding is. It’s a very good way not to get misled, ’cause one study, one study may say one thing, another study may say another thing, but if we look at the summary of the findings we tend to see kinda where the general, um, trend in the evidence is. And this systemic review actually found that introducing gluten early or late may have, uh, may put your child at increased risk for celiac disease. And the time windows here are introducing gluten before 4 months of age or introducing gluten past 7 months of age may increase your child’s risk for celiac disease.
Now the data here are not fully conclusive but I think we have some pretty darn good data to show that introducing gluten within the normal time window is probably a good idea. Now I know there probably some listening to this who are screaming “blasphemy!” and, um, allow me to share with you the process that I go through when I think about this. We have a fairly strong body of evidence suggesting that exposure to, uh, to microbes and germs and bacteria for the developing immune system are very good for the immune system. So even a bad, or what could be a bad bacteria, like H. Pylori, Epstein–Barr virus, or even things like cryptosporidium.
If children are exposed to these early, they tend to have a protective effect on their immune system and they help with immune system development. And, conversely, if the first time you’re exposed to these things is later in life after your immune system has developed, these things can be detrimental. I look at gluten in very much the same way. I look at gluten as an environmental, um, exposure that your immune system has to learn to deal with and identify and be able to recognize, “that’s gluten, um, it’s a food,” and not confuse it for potentially part of your thyroid gland or joint tissue or, uh, stomach tissue. By giving and allowing the body exposure to gluten earlier in life you actually train the immune system.
Now, again, if people have a real hard time with that concept this is where looking at high-level science, where we take thousands and thousands and thousands of children and we observe what happens with either early, normal, or late introduction of gluten and we see what happens.
I think we have really good science to support that posit and we also have a, uh, somewhat reasonable, ancestral paradigm through which we can justify this. So, um, hopefully that makes sense. The take home message here is early or late introduction of gluten may actually be detrimental for your child. Introducing gluten within the normal time window may have an ability to help train your immune system and then prevent gluten-related reactions later in life.
So, I’m Dr. Ruscio, I hope this helps you get healthy and get back to your life. Thanks.
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