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Subject:
From:
"Jennifer Tow, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 22 May 2006 00:32:27 -0400
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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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