In response to my statement:
"It makes a lot of sense for the mom to avoid gluten while
breastfeeding, given that the dad has the condition."
M.Ersilia Armen wrote:
"While agreeing in delaying intro of small amounts of gluten till
appropriate timing, I disagree with the above statement. In my country
we have been started screening for celiac disease well before than in
the US (as a matter of fact I remember the title of an american article
reading *Where have all the American celiac children gone?* well, they
simply did not look for them...) and we carry a mathematically
calculated incidence of CD of 1:100 people. I would be very cautious
advicing mom avoiding wheat etc when there is CD case in the family,
since such an advice would represent only another barrier to
breastfeeding."
But, that is the point--we do not screen for celiac in the US and given
the disastrous nature of celiac, I think mothers ought to know that
there is the option of avoiding gluten to protect the infant. Remember,
it is the dad who has celiac, so mom understands both the risk and the
damage possible. Certainly, I think having the gene test would be a
good idea, but as we learn more and more about celiac disease as well
as non-celiac gluten intolerance, we may be finding that the lines are
blurring and not all of the testing is so very accurate. The blood test
depends upon exposure over time and is only a precursor to the biopsy.
I would never suggest doing this to an infant, nor would there likely
be the damage present for a diagnosis (which I think is incorrect in
and of itself and may also leave those with non-celiac gluten
intolerance at risk of misunderstanding the importance of avoiding
gluten and often ignores the non-digestive symptoms that may depend
upon the often-overlooked gliadan antibody test for identification). I
am always so confounded by how we think information is a barrier to
breastfeeding. IMO, an honest discussion of this topic provides mom
with options, from testing, to partial or complete elimination of
gluten to artificial feeding. She should also know, of course, that
premature weaning has been proven to increase the incidence of
developing celiac in at-risk children.
Jennifer Tow, IBCLC, CT, USA
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