Jean E. Guest, MS, RD, LMNT
Dialogue with a Dietitian
Lifeline, Winter 2004, Vol XXIV, No 1, pp. 22, 24

The American Academy of Pediatrics strongly recommends breastfeeding as the preferred source of nutrition for all infants. In addition to being nutritionally complete breast milk provides immune factors not available in commercial formulas. Breast milk feedings also benefit the infant's gastrointestinal function, neurological development, and psychological well-being.

An interesting fact about breast milk is that nutrient composition changes as nutritional needs of the infant change. Breast milk analysis indicates that nutrient composition changes from beginning to end of a feeding and as the infant grows. Likewise, breast milk nutrient composition in mothers with premature infants is different from that of mothers with full-term infants. Maybe Mother Nature knows best!

History
Prior to the 1900's all newborns were breastfed either by their mother or by a wet nurse. The development of commercial infant formulas changed cultural, lifestyle, and family attitudes toward breastfeeding. Breastfeeding rates began to decline during World War II, and continued until 1971 when only 24.7 percent of all newborns in the United States were breastfed. Through public health and educational programs, breastfeeding rates began increasing in the late 1970's. By 1984 breastfeeding rates were 59.7 percent, and in 2001, 69.5 percent of all newborns in the United States were breastfed. A goal of "Healthy People 2010" is to have 75 percent of all newborns in the United States breastfed.

Immunity
The immune system is one of the human body's most unique and least understood functions. Innate immune function is limited at birth. However, by the end of the first year of life immune function is fully operational. During this maturing process, immune protection is provided by maternal antibodies transferred from mother to infant prior to birth. An additional mode of maternal immune support can be provided via breast milk feedings. Human breast milk contains numerous protective immune components including secretory immunoglobulin A (IgA) antibodies. Some researchers suggest IgA antibodies are important in reducing or delaying onset of clinical symptoms in infants at risk for celiac disease (CD).

Research
Auricchio and co-workers suggested in 1983 that breastfeeding and duration of breastfeeding were associated with decreased risk of developing CD symptoms. In 1985, another group, Greco et al., confirmed this suggestion. These researchers conducted a retrospective study in 146 children aged four months to 11 years with CD. Timing and types of feedings along with presenting symptoms were collected. Statistical analysis demonstrated that children breastfed three months or more had a marked delay in onset of CD symptoms. They also reported a longer latency period from gluten introduction to onset of CD. Onset of CD was positively correlated to duration of breastfeeding, but not with age at which gluten was introduced.

More recent research into the relationship between breastfeeding and CD seems to support the conclusions of earlier researchers. In 2001, Peters et al., studied the duration of breastfeeding, age at first gluten introduction into the infant's diet, and the age of CD onset. In an age and gender case-control methods, these researchers evaluated 143 children with CD and 137 randomly selected non-CD children. Their results indicated that breastfeeding for at least two months significantly decreased (63 percent) risk of developing CD. Similar to the results of Greco et al., the age at first dietary gluten exposure was not significant in this study either.

However, in 2002 Ivarsson et al. in a much larger study were able to show that risk of CD was reduced in children less than two years of age if they were being breast fed at the time dietary gluten was introduced. The risk was also reduced if the amount of gluten introduced was a small or medium amount when compared to large amounts. Additionally, the protective effect of breastfeeding was pronounced if breastfeeding was continued after introduction of dietary gluten. These researchers concluded that gradual introduction of gluten-containing foods while infants are still being breastfed is beneficial in reducing risk of CD and this benefit may extend into early childhood.

Considerations
Parents have many decisions to make for their newborns. "To Breastfeed or Not" may be a question that is not difficult for some. For others family, work, and social considerations have a greater influence. In families with celiac disease this question may have more than nutritional consequences. "To Breastfeed or Not" is a question that must be answered individually. Although the number and size of current medical research studies are limited, they do suggest that breastfeeding may be beneficial in delaying clinical symptoms of CD in infants at risk. A few other considerations to think about when deciding "To Breastfeed or Not" include a nutrient source that is always ready-to-feed, easy to transport, does not require refrigeration, and never runs out in the middle of the night.

References:

American Academy of Pediatrics. Pediatric Nutrition Handbook , 5th ed. Ronald E. Kleinman, editor. American Academy of Pediatrics, 2004.

Auricchio S, Follo D, de Ritis G, Giunta A, Marzorati D, Prampolini L, Ansaldi N, Levi P, Dall'Olio D, Bossi A, et al. "Does breast feeding protect against the development of clinical symptoms of celiac disease in children?" J Pediatr Gastroenterol Nutr . 2(3):428-33, 1983.

Greco L, Auricchio S, Mayer M, Grimaldi MJ. "Case control study on nutritional risk factors in celiac disease." Pediatr Gastroenterol Nutr . May-Jun;7(3):395-9, 1988.

Greco L, Mayer M, Grimaldi M, Follo D, De Ritis G, Auricchio S. "The effect of early feeding on the onset of symptoms in celiac disease." J Pediatr Gastroenterol Nutr . Feb;4(1):52-5, 1985.

Ivarsson A, Hernell O, Stenlund H, Persson LA. "Breast-feeding protects against celiac disease." Am J Clin Nutr., May; 75(5):914-21, 2002.

Ozkan T, Ozeke T, Meral A. "Gliadin-specific IgA antibodies in breast milk." J Int Med Res. Sep-Oct;28(5):234-40, 2000.