This is a question that I frequently get and that many parents of infants struggle with: Is it important for infants to eat gluten, ie bread and hot cereal, early in life?
Even today the official guidelines encourage parents to introduce foods with wheat early to reduce the risk of gluten intolerance. This is what the Swedish guidelines for infants include:
If the infant is given small amounts of gluten while still nursing, the risk that the child will be gluten intolerant is reduced. At no later than six months, and no earlier than four months, you should start giving the infant some gluten-containing foods… For example, you can let the infant have a bite of white bread or crackers or a small spoon of hot cereal or wheat-based formula a couple of times a week… After six months gradually increase the amount.
This assertive advice is unfortunately based only on uncertain statistics from questionnaire studies, i.e. observational studies. Such statistics prove nothing. The guideline-issuing authorities have a troublesome ability to sound certain without enough supporting evidence.
So is the advice above good or bad? Nobody knew before, but now this has finally been tested seriously.
The other week two critical studies were published in the New England Journal of Medicine – the world’s most respected medical science journal. For the first time studies were designed to test whether the advice works.
In the first study, 944 children with an elevated risk for celiac disease were randomized to receive either gluten or placebo between 4 and 6 months of age. They really tested in the best way whether early gluten exposure prevents gluten intolerance.
The result? It did not help. The children given gluten had just as high a frequency of gluten intolerance, and there was even a non-significant trend towards their showing gluten intolerance more often!
A whopping 5.9 % of the children introduced to gluten early became gluten intolerant, as compared to 4.5 % of those who could avoid gluten early on.
This first test now completely refutes the advice to give gluten early on, it doesn’t work. But it gets worse for the official recommendations…
In the second study 832 children with celiac disease in the family were randomized to receive advice on gluten from either 6 months or 12 months of age.
The result? Clear cut. At two years of age 12 % of the children given advice on gluten from 6 months of age were gluten intolerant. Only 5 percent of those who didn’t introduce gluten until 12 months of age developed gluten intolerance – less than half, a difference that was highly statistically significant.
Advice on postponing gluten at least until 12 months of age more than halved the risk of becoming gluten intolerant!
The Journal’s Comment
In a comment to the studies the journal says that it will now be difficult to advise introducing gluten early on – it just seems to be wrong. The advice to introduce gluten while still nursing also seems to be incorrect – we’re not seeing any benefit to this either.
Background: early gluten exposure produced an epidemic of gluten intolerance.
There’s a sad back drop to the story. In the 80’s, Sweden started to give advice that resulted in larger amounts of gluten in infant formula. The result was a disastrous increase in gluten intolerance and that’s when they backed off to today’s advice.
However, the new studies show that they haven’t backed enough yet.
Conclusion: More gluten, more gluten intolerance
The results from these first studies, when gluten introduction was clear: it doesn’t help. Instead, all evidence indicates that the official guidelines instead hurt babies. Parents who follow this advice to introduce gluten early on run a higher risk of getting gluten intolerant children! The advice will likely have to be changed.
When and how should parents introduce gluten to their children in order to avoid gluten intolerance? Judging from the best science we have so far, the simple answer may be this:
The less gluten the better and the later gluten is introduced the better.
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