Advice on gluten

[xtinak]

I'm pretty confused about the guidance on weaning. I understand that you are not advised to begin before 6 months, but that if you decide to begin 'early' there are things you are to avoid. I'm having difficulty sourcing supporting evidence for several aspects of this guidance but I just want to ask about one thing specifically. Where is the evidence that it could be detrimental to introduce gluten within the 4-6 month window? I know people have very strong feelings about these things but I'm really just seeking some robust science! Can anyone point me in the right direction?

My little one and every child I have weaned (there's been a few over 11 years) have always just eaten small portions of the adults meal either mushed or cut up small and cooked till soft. I've never actively avoided anything but added sugars or salts.

Since wheat is an allergen, some people think that it should be avoided in a baby’s diet until after 12 months old – as other allergenic foods often are. This belief however, is not based on most current pediatric recommendations.
In fact, this study concluded that delaying exposure until after 6 months was associated with an increase risk of wheat allergy, not a protective effect. In addition, the findings confirmed the role of family history of allergy as the biggest predictor of food allergy outcomes in children. pediatrics.aappublications.org/content/117/6/2175.full?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

www.ncbi.nlm.nih.gov/pmc/articles/PMC2659557/
This study also found that although solid foods should not be introduced before 4 to 6 months of age, there is no current convincing evidence that delaying their introduction beyond this period has a significant protective effect on the development of an allergy.

However, is best to wait to introduce wheat until you are certain that your infant has no reactions to rice, oats or barley.

Thanks both for your thoughts!

@Ricekrispie22 I'm confused about why studies like the second one you reference talk about 4 to 6 months, but then the guidance focuses on 6 months. What is the magic that happens between 4 and 6 months that leads the NHS to advise potential allergens such as gluten only being introduced beyond 6 months, while at 4 months only things like fruit and rice that don't have these allergenic proteins? I know that there are theories about the gut closing fully by 6 months, before which time large protein allergens can pass through..and also theories about the virgin gut and the impact of introducing solids on the microbiome....but besides these theories do we know of actual evidence like a randomised control trial say that, indeed, giving gluten at 4 months produces some worse outcomes than at 6 months?

Really appreciate any input on this as it's driving me mad!

I suspect (I’m a scientist, but not in this area) that the advice is given this way because the lowest risk of developing allergens is when babies are started on solids (of all kinds, including wheat, nothing to do specifically with the gluten in wheat) between 4-6 months. That’s not between the start of 4 months and the start of 6 months, it’s to the very last day of 6 months just before they turn 7 months. After 7 months, the risk of allergies significantly increases if there has been no exposure (same as before 4 months).

But the guidance is likely from the start of 6 months for things other than fruit/veg/baby rice, because it’s not ideal for babies to get significant calories from non-milk sources before 1, especially not before 6 months. There’s no calories really in fruit/veg/baby rice so it shouldn’t interrupt milk intake or the intake of key nutrients in it.

So I think the guidance is simply pragmatic in that way. Introducing major allergens before 7 months = good. Cutting milk intake at 4 months = bad. 6 months is a pragmatic middle ground that allows needs for both allergen exposure and optimal milk intake to be attained. Guidelines have to be simple or else people get confused and can’t follow them.

OP, try this excellent article from Science of Mom. Looks like the timing of gluten introduction makes no difference--but there is some interesting discussion in the comments.

scienceofmom.com/2014/10/03/new-research-on-gluten-introduction-to-infants-and-risk-of-celiac-disease/

@mindutopia That's really helpful, thank you. It would be great to have access to their reasoning and the relevant studies. Conversely, the fact that these guidelines are so simple and lacking in explanation has made them pretty confusing for me!

The potential problem I can see however, is that it could take quite a while after introducing foods for a baby to start really consuming then (i.e. even that 6th month might not be enough) and I have read - though not clear on how reliable this is - that this can mean insufficient iron etc. in the interim. That would seem to me to be a possible argument to start smaller and sooner. Secondly, I know in some cases where weight gain is slow people have been advised to wean early, which suggests to me that the calories can sometimes be important. So I continue to be confused.

@Kokeshi123 Thanks for this. I had actually read the article but not the comments! Interesting points I see are about allergen exposure during gestation and through breast-feeding and it would be good to know more about the role of these factors. Something else that occurred to me is that surely exposure is happening all time anyway e.g. while I'm eating peanuts and also feeding my baby with peanuty hands. By accident yesterday she ended up with yoghurt on her face. Actually I've just seen a comment to this effect further down!

Very interested still to hear any more thoughts people may have.