In this episode of Dr. Ruscio Radio, the doc and Susan answer a listener question about the timing and feasibility of gluten introduction in babies and children.
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Dr. R’s Fast Facts
- For children –
- There is a spectrum of gluten sensitivity in children, just like in adults, of no sensitivity at all to extreme sensitivity.
- The best way to test gluten sensitivity is to try a gluten-free diet for 30 days to see if symptoms are reduced or disappear completely.
- Look for symptoms like changes in bowel movements and the number and frequency of tantrums.
- Check in with a functional medicine doctor if symptoms don’t improve with a gluten-free diet.
- For children with a family history of celiac or a strong family history of autoimmune disease, lean towards caution with introducing gluten to children.
- For babies –
- Breast-feeding is an important factor in preventing Celiac Disease and other immune-related problems.
- 4-7 months is the ideal age for gluten introduction.
- Gradually introduce gluten, starting with around 1 teaspoon of cereal per day.
- It’s important to introduce gluten while still breast-feeding.
- However, some studies show timing of reintroduction and breast-feeding does not matter.
- Dr. Ruscio speculates that gluten might be like bacteria in that your body needs exposure to learn how to deal with it.
Fast Facts – gluten introduction in children…..4:35
Fast Facts – gluten introduction in babies…..8:28
Gluten and the immune system…..12:25
Children with a family history of celiac or autoimmune disease…..21:35
- (0:56) Susan’s 6 Weeks to Evolved Recovery online course. http://sobercourse.com
- (12:25) Hygiene, Environment & Autoimmunity with Moises Manoff – Author of Epidemic of Absence https://drruscio.com/hygiene-environment-autoimmunity-moises-manoff-author-epidemic-absence-episode-23/
- Infant feeding history shows distinct differences between Swedish celiac and reference children. http://www.ncbi.nlm.nih.gov/pubmed/8792377
- Early Feeding and Risk of Celiac Disease in a Prospective Birth Cohort (100 mg introduction) http://pediatrics.aappublications.org/content/early/2013/10/02/peds.2013-1752.full.pdf+html
- Reshaping the gut microbiota at an early age: functional impact on obesity risk? http://www.ncbi.nlm.nih.gov/pubmed/24217033
- Early-life determinants of overweight and obesity: a review of systematic reviews. http://www.ncbi.nlm.nih.gov/pubmed/20331509
- Systematic review: early infant feeding and the prevention of coeliac disease. http://www.ncbi.nlm.nih.gov/pubmed/22905651
- Breast-feeding protects against celiac disease. http://www.ncbi.nlm.nih.gov/pubmed/11976167
- Dietary strategies of immunomodulation in infants at risk for celiac disease. http://www.ncbi.nlm.nih.gov/pubmed/20579407
- Influence of early feeding practices on celiac disease in infants. http://www.ncbi.nlm.nih.gov/pubmed/20960591
- Gluten Introduction, Breastfeeding, and Celiac Disease: Back to the Drawing Board. http://www.ncbi.nlm.nih.gov/pubmed/26259710
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When to Introduce Gluten Into Your Child’s Diet
Welcome to Dr. Ruscio Radio, discussing the cutting edge in health, nutrition, and functional medicine. To make sure you’re up to date on this and other important topics, visit DrRuscio.com and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.
The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor.
Now, let’s head to the show!
Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. I am with here with Susan McCauley, and it’s been a while since we’ve connected, stranger. How are you?
Susan McCauley: I’m doing really good. I was hiding out. I just released a new online course for people that suffer from drug and alcohol addiction, so I’ve been kind of hunkered down. It was a welcome break for me because I got a lot of work done, but I did miss listening and learning and talking with you about all the science!
DR: I know. It’s good to be reconnected. As I know you know, we’ve had a lot of guests on, done a lot of interviews and all that good stuff, but it’s nice to kind of get back to our core routine here.
SM: Yeah. If anybody’s interested in the course I just talked about, it’s called 6 Weeks to Evolved Recovery, and it lives over at SoberCourse.com (1a). And just remember, everybody knows somebody that suffers from this disease, so I’m hopefully looking to help a lot of people.
DR: Yeah, I think that sounds like a great resource, and I might need that after the wedding I just got back from a while ago! A bunch of guys from Boston!
SM: Well, I don’t think… you might have had a little fun, but I don’t think that… As long as I’ve known you, I’ve never seen you falling down, you’ve never missed an appointment with me. It seems like your life’s pretty good, so I wouldn’t worry too much. I’m an expert.
DR: All right, good. So I guess I have professional clearance then, so I won’t feel so bad.
SM: Yes, you have professional clearance.
DR: All right. Well, I’m excited about today’s topic, and before we jump in, I just wanted to thank people for their continued support with the podcast. Every week, every month, the amount of downloads just goes up and up and up and up at a great growth rate, so thank you, guys, so much for your support because it really makes all the time and effort and energy that goes into putting this podcast out there worth it.
And if you are listening to this and you’ve been liking the podcasts and getting stuff out of them, please head over to iTunes, leave us a quick review. I know we’re all busy and it’s like, “Ugh, one more thing to do,” but it only takes a minute, and it really helps us reach more people. I couldn’t thank you enough for that if you do that.
Also we’ve had a number of questions that people have submitted through the website on the audio submission field, and we’re working our way around to those. I’m working double time right now to finish up this book on the microbiota, and so it’s a little bit harder for me to put in the side research for some of these other topics, but they’re definitely coming, so just hang in there with us, and they’re coming down the pike soon.
SM: Yeah, and I’ve personally been at a couple of dinners and talking to people and say that I help you with the podcast, and they’re like, “Oh, that’s you?!” and “I love that podcast!”
DR: Good, good.
SM: Yeah, some random niceness there, so I will go ahead and play the question from our listener.
DR: All right.
Listener Question: Hi. I was just wondering if I should exclude gluten from my children’s diet. I’m worried about their long-term health and their risk of developing an autoimmune disease. I am non-celiac gluten sensitive and have Hashimoto’s, and I do carry the genes DQ2 and DQ8. They don’t have any GI issues that they complain of. My son gets a frequent stuffy nose, and my daughter does have some sensory processing issues and complains of growing pains in her legs and arms. I’m also just wondering if there are any tests that you would recommend for children. Thank you.
Fast facts – gluten introduction in children
SM: Well, that is a lot of stuff in that one question.
DR: It is, and… gosh, I think we’ve actually answered a lot of that question in some of our past discussions that apply to adults, right?
DR: And so really in children, as long as they’re not very young children—and that’s what we’re going to spend the brunt of the episode today talking about, which is in young children, the timing and how to execute gluten introduction into the diet so as to prevent celiac disease or other diseases later in life, that’s what we’re going to focus on because I thought this was a great kind of lead-in to that topic—but for young children, it’s really all the same stuff that we apply to adults that we apply to children, which would be there is this spectrum gluten sensitivity, and it’s a good idea to at least try 30 days gluten free, see how you respond, bring gluten back in. If you notice a regression of any type, then it may be from gluten. Try to repeat that test a couple of times, and if you notice the same association, then you’re going to want to practice avoidance to whatever degree you need to, and some people, like you, Susan, are very sensitive and have to be very strict. Other people, like myself, can get away with gluten and not have much backlash from that. It’s really as simple as that.
Another piece to it, though, to keep in mind is if you do change the diet and you don’t see any improvement, you may want to check in with a functional medicine doctor because there may be something else there that isn’t allowing them to respond to going gluten free. So if you have a really bad case of SIBO, for example, or candida, and let’s say you have constipation, you go gluten free and the constipation doesn’t go away, well, if the SIBO is still there, it may confound your ability to notice what kind of response you have to a gluten-free diet. So you very well may notice an improvement from having your child go gluten free, and that will make it very easy for you to tell, but if you don’t then I would make my step two checking in with a functional medicine doctor, getting a good GI evaluation. Once the GI is clear, then repeating the elimination and reintroduction of the gluten.
SM: So that would be for a child that can communicate—say, 3, 4, 5, and on—and speak with you and kind of tell you what they’re feeling, correct?
DR: Well, you can also look at behavioral issues.
SM: OK, that’s true.
DR: Right, so if it’s an autistic child, you may notice a difference in stimming or eye contact. You may notice a difference in your child’s eating habits or what their bowel movements look like or even smell like, to be graphic. These are not all things that necessarily need to be communicated. The amount of tantrums that they throw, right? Their general mood may change, so there are certainly nonverbal cues that you can look into.
Now, another thing I should layer into this is you want to look at the context. The higher the risk—in this case, we have some gene findings that are suggestive of celiac—so if you have a positive genotype that’s associated with celiac, if you are celiac or if you are non-celiac gluten sensitive or you have any type of autoimmune disease or a strong family history of autoimmune disease, that’s when you’re going to want to probably lean toward the side of being a little bit more cautious around this whole issue.
SM: Before we get going, we’re still getting to the fast facts and getting fully trained on how to do them, so do you want to pop into the fast facts before we dive too deep into everything else?
Fast facts – gluten introduction in babies
DR: Here are the fast facts for gluten introduction for an infant. We just kind of went through a long version of the fast facts for what to do for gluten with a child, non-infant, but now, if you’re an infant, what’s the information look like there? What are the fast facts?
Breastfeeding is an important factor for preventing celiac disease and other immune problems.
Between four and seven months of age might be the ideal timing of gluten introduction into the diet. (7a)
Regarding amount, around 1 teaspoon of cereal per day or on most days gradually brought into the diet might be the ideal way in terms of an amount, doing this while still breastfeeding.
Now, all of this being said, there are some contradictory data (4a) (11a) that show that the timing doesn’t matter and breastfeeding doesn’t matter, so it’s important for people to understand that, that not all the data agree on this, but some data show benefit from the bullets that I just outlined. So we do not have conclusive data to answer this question. We have some data showing nothing you do matters, and we have some data showing this stuff may help. So with both of those on the table, I look at it like, well, let’s do the stuff that may help and hope for the best rather than blowing this issue off completely.
SM: OK, so let’s back up really quickly to the 4 to 7 months thing. I have to be completely honest with everybody: I don’t have kids. I have cats! So it might not make sense, but I was under the impression that you should breastfeed 100 percent until the age of 6 months, so maybe I don’t understand the process, or would it be that the mother eats the gluten and the baby gets the gluten through the breast milk?
DR: No, it would be orally introduced, so you’d be just feeding the child gluten, and the studies have looked at this window and found this window to be the best.
Now, if you wanted to be very specific within this window—and this is the window that the research publications are suggesting—I would say, looking at this window, 4 to 7 months, I would say between 6 and 7 months would probably be the optimal of that time window just to be on the safe side. There has been one study that found if the introduction was too late, that may also be harmful, and this kind of gets us into the non-fast facts, expanded narrative on some of this stuff, but to zoom this way out, here’s my thought process going through this whole thing. Initially I was more of the camp of thinking that, well, why not avoid gluten as much as possible, knowing the potential deleterious effects that it can have?
DR: And I think a lot of us probably are on board with that. All right, so thinking that it’s not logical to think that we may want to prevent our child from having any gluten exposure at all, knowing some of the deleterious effects, and this is the way that I used to think until I saw some of the research suggesting—and again, we don’t have definitive answers to this from the literature, so we’re taking the evidence, the data that we do have and we’re trying to formulate the best recommendation from it that we can. I want to be clear and mention that to people. But there was some research showing that a highly delayed introduction of gluten may have had a negative impact.
Gluten and the immune system
DR: I started to rethink some of this, and then when I combined that with a recent podcast (2b) where we had Moises Manoff on, who wrote An Epidemic of Absence, it kind of connected a dot for me. The main thing I took away from the conversation with Moises was when children who grow up in a more Western sort of environment, very hygienic, very sterile, if they go and periodically visit a farm, there’s actually some evidence to show that may make immune problems worse, and this really countered some of what I used to previously think, knowing all the literature showing how having a, if you will, using the term loosely, “dirtier” environment is healthy for your immune system, I was very much of the opinion that getting occasional exposure to a farm may be a very beneficial thing for your immune system because of the exposure to all the microbes, and while we don’t really have definitive answers to this, what Moises speculated—and it makes a whole heck of a lot of sense to me—is that if your immune system grows up, 1 to 3-ish years of age, in a sterile environment and then at 7 years old you have asthma and eczema and your parents decide to take you to a farm once a month, you get this whopping dose of bacteria and the immune system is looking at this like, “Holy crap. What just happened?! All of a sudden, we’re flooded with this bacteria.” The immune system is not used to having that in its normal day-to-day environment. And so in this context, it may actually trigger the immune system to act—or to react—negatively. If you were to live on a farm or at least be in contact with farm life frequently, the immune system would look at this as an environmental input, right? It’s always there, it’s always there, it’s always there. But if instead this farm life bacteria that is just an acute burst of bacteria into the system, what may be happening is the immune system may be looking at that like an attempt at invasion rather than the environment.
SM: More reasons to watch out for or be concerned about the whole manipulating of the microbiota that seems to be all the rage, that we need to have the microbiota of some other place, some other where, but maybe our immune system won’t be able to handle that.
DR: Exactly, and that ties in, at least in my speculation, with gluten, where if we don’t give the immune system a chance to sample gluten and look at gluten and figure out what gluten is while it’s developing—now, the immune system window typically develops from even before birth all the way up through maybe about 3 years of age, we think, is when the majority of the microbiota and the associated immune system forms. If we don’t give the immune system ample chance to look at this thing like an environmental exposure in that window, we may really increase the risk that if you then start looking at it for the first time at 4, 5, or 6 years of age, it may really cause significant problems.
Does that make sense, Susan?
SM: Yeah, it does because that’s the age when kids start going to school, too, and they are exposed to more foods and different things, so they might have more problems then than if you would have worried about it when they were in that window, the introduction window.
DR: Right. That’s my current opinion on this issue. Again, we do not really know. We don’t have definitive evidence that tells us one way or the other, but we’re piecing together the evidence that we do have and trying to formulate the best recommendation that we can. So again, I’m thinking on this that even though gluten can be bad, so can something like H. pylori, right? And if you first come into contact with H. pylori when you’re 18, it’s more prone to cause disease than if you come into contact with it when you’re 18 months.
DR: Right, and so I look at gluten in the same context, which is—hopefully, anyway—by having introduction at a reasonable time, you will allow your immune system the training it needs to figure out what gluten is and be able to react to it in an appropriate way rather than a pathogenic way.
SM: And we’re not talking about Twinkies and Ding Dongs either. We’re talking about a little bit of cereal here and there, more of an unprocessed type of gluten. We’re not advocating the Standard American Diet in any way.
DR: Right. Excellent point. We’re talking about the cleanest source of, maybe, a cereal gluten that you can, and we’re not talking about putting your child on a garbage diet of copious amounts of it. We’re talking about 1 teaspoon a day, gradually introduced on most days, almost like a little dusting of probiotic, right?
DR: Just a little something that you’re going to give the immune system a chance to sample and figure out what to do with this.
So that’s my admittedly speculative opinion on this, and I’m hoping that in sharing the thought process, I will help people who maybe are of the camp that gluten is the devil incarnate to rethink that. But again, we don’t know, and so I may be proven wrong in that assertion in a few years. But based upon the evidence that we have, I think that’s a pretty reasonable inference to draw.
There are a couple of other things I just wanted to mention. Breastfeeding seems to be an important factor, and we’ll put some links (3a) (6a) (7a) (8a) (9a) (10a) in the show notes for this, but breastfeeding is definitely an important factor. It’s been shown that breastfed infants compared to bottle-fed infants have been shown to have reduced risk of infection, improved cognitive development, and decreased risk of celiac, asthma, and type 2 diabetes and obesity. So definitely, breastfeeding is going to be very important and will help with preventing celiac and other conditions.
The type of delivery is also very important. There’s certainly been research that has shown that Cesarean-birthed children are at higher risk of inflammatory disorders like celiac and type 1 diabetes and asthma, compared to vaginal birthing. In fact, I mentioned a little while ago that the immune system of the child and the microbiota may form before the child is even born, and this is because we’re starting to realize that—we used to think that nothing really got through the placenta, that inside the placental sac was sterile, where the baby develops, essentially the Ziploc bag that the baby sits in in the uterus, but we’re now learning—or at least we starting to think—that bacteria from mom do penetrate. And what’s even more fascinating that’s recently been published is that the stress of childbirth may induce a transient leaky gut allowing mom’s bacteria to get into circulation, get into the placenta, and permeate the child and start the bacterial colonization even before the child is born.
SM: Yeah, wasn’t there a study about pregnant women going to the farm?
DR: There was. There was. Yes, another great point, where when pregnant women go to the farm, that has a beneficial impact on the immune system of the child. So, yes, another point that reinforces that the immune system of the child is definitely forming and probably the bacterial colonization of the child is definitely forming while still inside mom.
SM: Mm-hmm, good point.
DR: So I’ll put the reference for the timing of introduction in there, and we’ll put a reference for gradual introduction and the breastfeeding and Cesarean, and I’m also going to put a couple of references in there that show that breastfeeding and timing of introduction don’t matter, because, again, there are conflicting data on this and I want to be fully transparent with people and let people know, you know, you may get the annoying Facebook friend that tries to post one study to counter an entire argument, which always just irritates me.
SM: No, that never happens!
DR: Because one study does not a case make.
DR: Again, people are probably used to me saying this, but we shouldn’t look at just one data point to formulate an opinion. We should look at as much data as we can, wade through that, and try to come up with the most reasonable conclusion based upon the body of evidence at large. So I will arm you with the studies showing that this is not an issue in case a friend, a coworker, or just a jerk you know in general wants to try to call you on this, and you can say, “Yes, I’m aware of that, but there are also these other findings,” and yada-yada-yada, blah-blah-blah.
OK, so I think that’s pretty much the brunt of it, Susan. Is there anything you wanted to add?
Children with a family history of celiac or autoimmune disease
SM: In her question, she asked about lab tests, and she also talked a lot about genetic testing and what she had and what her kids—like, should that make a difference. For example, I have IBD, and if I had a child, which isn’t going to happen, but if I did—let’s just use me for an example—would the same process go into effect? Like, would I say I still want to try and introduce gluten to my kid even though I know I’m severely gluten sensitive and I have an autoimmune disease?
DR: Well, I think that in a child with a known history, like I said, you’re going to want to be more cautious with these things.
DR: Especially when it’s a child and not an infant. In her case, I think she may have said 5 and 7, if I’m remembering correctly.
DR: So the infant stuff doesn’t really apply, right?
DR: We’re now past that window of the 4 to 7 months, maybe an ideal window of 6 to 7 months. We’re past that window, and we’re even past the general microbiotal immune system formation development window, which is up to about 3 years. So with them, I would still run through the process of trying to figure out what their level of sensitivity is because that’s something that I think we all have to determine. Now, we can use contextual information, like lab testing and family history, to potentially predict how at risk they are for having celiac or non-celiac sensitivity. But ultimately, I think people should go through a reintroduction and see what sort of impact they notice on the child, either verbal or nonverbal or what have you. And I know that there are people who are going to criticize that comment, saying, “Well, what if they’re eating gluten and it’s fueling an autoimmune attack and you’re not going to see evidence of that autoimmune attack for years and years and years.”
DR: And that’s certainly true, but to be practical, I think if you could work with your child and identify what level of sensitivity they have, that could make you feel a lot more certain about the recommendation you’re going to make rather than just never testing this hypothesis, never seeing how sensitive they appear. If you never have a chance to evaluate how sensitive they appear, it’s—in my opinion—more likely that the child’s not going to be compliant because they’ve never experienced any kind of negative symptom from the gluten, and it may be harder for you to defend and stick with strict gluten-free adherence if you’ve never done anything to try to quantify that. So that’s the practical way that I look at it. Yes, the labs can help you predict risk, but I think a practical way of evaluating this would be great, just through this elimination, reintroduction, and observation.
Also, if you really wanted to try to be super… I guess, objective with this and you do have a family history of autoimmune disease, have the antibodies run that you’re concerned about. If you have a family history of celiac, have the celiac antibodies run. If you have IBD, have the IBD antibodies run. If you have Hashimoto’s, have the Hashimoto’s antibodies run. Have those run at baseline, go through your gluten introduction, have the antibodies run again, and see if you see a spike of the antibodies. That can definitely help you in that context. And then also, if you want to be very cautious with the antibody piece, the hidden, latent antibody piece that may not manifest as symptoms for years and years down the road, have a yearly panel done with your doctor and monitor the antibodies that you have the highest family history risk for. And if at some point you see those antibodies start to climb, then you may want to really ratchet in the diet and see if that has an effect.
SM: Right. And all of this gluten is still, like we talked about earlier, in the context of a whole-foods, real-foods, paleo type of diet, so it’s not eating gluten morning, noon, and night. It’s not like you’re going to be eating all the different cereals and everything. But it’s just more of a real-foods approach.
DR: Exactly. It’s definitely more of a real-foods approach, and remember that gluten—and I don’t want people to think that I am coming off like I don’t think gluten is a big deal. I think, out of all the dietary changes I make, that is the one that is clearly the most helpful for people.
DR: However, it’s also the area I see the most fear and fanaticism around and the most stress induced in patients’ lives around, so I want to provide people the other side of the argument to help bring them back to center. And part of the other side of the argument is that it’s not the only factor because there are populations, certain European populations and definitely more non-Westernized populations, that eat a ton of gluten and grain and have much lower autoimmunity because their environment is vastly different. And again, you can make an argument that maybe there’s different gluten, there’s different processing, there are different additives. That’s certainly legitimate, but even people that are eating a high amount of grain can have a much lower incidence of autoimmunity because the environment is so different. So the point I’m making there is that gluten is not the only factor that is going to influence the formation of an autoimmune disease.
DR: I guess that’s pretty much the lion’s share of the issue. I’m hoping that this helps the caller with her process. There are some simple things you can do to sort this out, and it’s not a one-size-fits-all recommendation, but it’s rather a process of doing a little bit of investigation to see where your children are going to fall on the spectrum because hopefully you’ll find that they can do some gluten without much recourse and you can let them go to a baseball game or a friend’s birthday party and have an occasional splurge and not feel the need to be on top of them and freaking out about it. But you may also notice that they really can’t do that, but at least you will have somewhat objectified that, and hopefully by doing that, the child will have experienced some of these negative symptoms, and then they will be more intrinsically motivated to adhere to the dietary recommendations you as a mother are going to make with them because, of course, you’re not going to be able to control everything they eat, so you have to try to get some buy-in from the child somehow, and this process, hopefully, will help to that endpoint.
SM: Right, and we also need to realize that our kids do mimic what we do, they do what we do, and if we somehow have this fear about gluten… we want to have our kids to have a healthy relationship with food. I know that if I could have a daughter that didn’t ever have to go on a diet, that would be, like, a total win! But if children start to fear food and think, you know, gluten’s the devil and gluten’s really bad, you really don’t want to pass that on to them. They need to realize for themselves how it makes their tummy feel or how it makes their head feel or, “Oh, don’t you remember you had that meltdown, honey?” for them to understand and not just to be scared just for fear’s sake.
DR: Absolutely, and to think critically, right?
DR: And hopefully that’s something throughout this process that the caller can impart partially in her children, is the ability to think critically, because I think, gosh, that has been lost amongst many generations. We want to be told what to do rather than led through a process of thinking for ourselves and figuring out what we think is best.
SM: Yeah, and I get hung up on that. I’ll see a bunch of dairy or something on Facebook, and I’m like, “You know what? I think I can eat dairy.” And then I try! It’s like, “No, Susan. You can’t.” I’ve got it dialed in now. You just need to eat the foods that you know you can eat and not worry about what everybody else is doing or what’s the new fad or what’s come along the line. I spent the last almost five years coming to all those conclusions, and it’s really funny how you can get swept up in some of these ideas.
DR: Absolutely, it is, and that’s why the one thing again I try to always bring myself back to is one study does not a case make. We can’t take one study or one finding and run with that and really change recommendations and change policy. And this is something I think conventional medicine actually does a good job with. They don’t jump on bandwagons. Maybe they’re too slow in updating the recommendations, but at least they try to wade through the evidence at large and formulate opinions based upon the best available evidence, and I think that we want to do the same thing. And so hopefully this dialogue will help people realize how to handle this with an infant, how you can kind of walk through this with a child and do it in a reasonable way that’s not fear based and is practical and will be healthy for you, will be healthy for your child, and it won’t be something that is, again, totally avoidance based or fear based even in the face of no evidence to support that.
SM: Right. So any more last words of wisdom on the topic of gluten introduction for kids?
DR: No, I think that’s it. Hopefully this will help people. I think my kind of speculative theory there is a new one, but if people have thoughts about that, I really welcome you to post something in the comments section on the page for this podcast and open up a dialogue on this and just get a healthy discussion going around this topic.
SM: Yeah, I think it’s important to have that discussion because different people might have had different experiences, whether they have celiac or an autoimmune disease and they have children. Like I said, I don’t have children, and as far as I know, you don’t have children yet!
DR: Not that I know of!
SM: So, you know, we want to hear what you guys think about this topic.
DR: Yes, so please, feel free to participate in the comments, and we can have, hopefully, a polite conversation on this!
SM: Keyword there: “polite.”
DR: Yes. All right, guys. Well, thanks so much, Susan. Thank you, and we’ll talk to you guys next time.
SM: Yeah. It was good to be back! Thanks, guys!
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What do you think? I would like to hear your thoughts or experience with this.