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There have been many posts about breast-feeding a CD recently, and I
thought it might be helpful to summarize some prior posts on the topic
and offer some data.  There seem to be several interrelated questions:


(1) For the non-Celiac mother, with an existing celiac child and a new
infant:  If the mother ingests gluten while breastfeeding, does the gluten
travel through the milk to the child?

The short answer to this is "yes".

The following journal article is one example of data on this subject:
Troncone R, Scarcella A, Donatiello A, Cannataro P, Tarabusco A and
Auricchio S (1987) Passage of gliadin into human breast milk . Acta Paed
Scand 76: 453-456.


(2) Does the gluten which a genetically at-risk-for-celiac infant ingest
via breastmilk increase the risk for Celiac Disease?

There is no well-documented answer to this question (to my knowledge).
It appears that the amount of gluten is far too small to cause a
celiac response, and there is some evidence that the gliadin-ANTIBODIES
(which are also passed in breast milk along with the gliadin itself)
have a significant protective factor against celiac disease.  Here are
the details:

I wrote to Dr Troncone, who is a subscriber to our Cel-pro network, to
ask how much gliadin passed through in mothers milk.   He said as much
as 95 nanograms gliadin per milliliter of brest milk.

Next we have to convert the measurement of gliadin into the amount of
"gluten" commonly used by celiacs.  Dr Kasarda has said on our List in
the past:

K>Gliadin makes up about half of the gluten.  The other half is
K>often called glutenin, but it is very similar to the gliadin half in
K>composition and structure and I suspect that it is toxic to a large
K>extent.

[My comment: I never asked for articles showing glutenin's possible
toxicity, so I cannot offer them here]

Using Kasarda's assumption that gliadin is about half of gluten by
weight,but that the OTHER half is also toxic to celiacs, let's assume
there is twice as much "gluten", i.e. 190 ng/ml of "gluten" in
breast milk.

Using an assumption of 10 nursings per day each of 3 ounces = 900 ml per
day of breast milk (Dr Horvath mentioned to me that an infant can ingest
milk weighing about a sixth of their body weight per day, and this yields
about the same numer), and 1,000 mg per gram, yields
total gluten per day of:

    190 x (10^^-9) x 900 x 1000 =  0.17 mg per day of gluten

Of course, there could be dramatic individual differences, these
calculations were just made on Troncone's data.

If a baby has about 5% of the bodyweight of an adult, and if one can
"scale" the problem of gluten consumption with weight (???), this would
be equivalent to 3 mg of gluten per day for an adult (0.17 divided by
5%). Many previous posts cover the topic of how much gluten is
necessary to cause damage to a celiac.  Without covering old material,
3 milligrams per day is well under the amount that most celiac experts
would say causes damage (somewhere from 10 mg to 100 mg per day).
However there could always be a non-celiac allergic response, and
the "scalability" by body weight is total speculation by a non-
medical professional with no research experience (me).

As for the benefits of anti-gliadin antibodies, Dr Troncone went on to
say:

T>As  a matter of fact, breast feeding has been clearly
T>shown to be protective vs coeliac disease, and in principle it
T>cannot be excluded that the gluten present in breast milk is
T>responsible for such a tolerant antigliadin mucosal immune response.


Dr. Karoly Horvath has also written about this in the past on our
List, in the context of a mother who has CD (very minor editing on
the prior post was recently made by Dr Horvath):

H>BREAST-FEEDING AND CELIAC DISEASE

H>   The breast milk contains antibodies against all the antigens the
H>mother immune system has met prior to or during the pregnancy and
H>has produced antibodies to them.
H>   This system is the wisdom of nature and this  is the way how the
H>mother milk protects babies from all the antigens (infectious
H>agents, toxins etc) occurring in the environment where the mother
H>live. These antigens without this protection may enter the body
H>through the digestive or respiratory systems.  The best example is
H>that breast milk protects babies from bacteria causing diarrheas in
H>the underdeveloped countries.
H>The antibodies are produced by the cells (plasma cells) localized
H>in the gut and the lung. These cells are migrating to the lactating
H>breast-tissue for hormonal trigger  (enteromammal plasma cell
H>circle) and they continue producing these antibodies in the breast.
H>These antibodies appear in the breast milk.
H>In briefly,  the breast milk may contain all the antibodies the
H>mother has in her digestive and respiratory systems.
H>   The function of these antibodies [IS] to block the entrance of
H>antigens(infectious agents, toxins, allergens etc) across the
H>digestive or H>respiratory tract of babies.

H>   In case of CD, it means that if the mother has circulating
H>antibodies to gliadin, these antibodies appear in the milk. If the
H>breast fed baby ingests gliadin (or the mother ingests accidentally
H>and traces of gliadin appear in the milk)  the antibodies in the
H>milk blocks the gliadin and it will not able to cross the intestinal
H>wall and meet with the baby's immune system. Theoretically, the
H>breast-fed infant do not have any immune reaction to gliadin.
H>   If the mother with CD accidentally ingests gliadin during
H>breast feeding it is likely that the concentration of antigliadin
H>antibodies become higher in the breast milk.

H>   To answer the question: the antibodies in breast milk are likely
H>protective and do not "trigger" celiac disease in genetically
H>predisposed babies.  There are several data showing that breast
H>feeding has a protective effect in case of celiac disease.

H>Furthermore, it is well documented that breast feeding in the
H>first year of life decreases the risk of allergies by 50% in
H>babies whose parents have allergies.


(3)  After reading the above, one might ask:  If the mother has eaten
gluten in the past, she ought to already have antibodies to it.
Therefore, wouldn't be optimal for her to NOT eat gluten during
breast-feeding, or for that matter, even during pregnancy, and that
way her child could have the benefits of the gluten antibodies without
the potential harm of the gluten itself?

The short answer to this question is that no one knows.  Dr Horvath sent
the following to me in a private communication being posted with his
permission:

H> The gluten ingestion during pregnancy is a very interesting problem.
H>It is supposed that a certain stage on intrauterine development the
H>immune system of fetus meets with different antigens. If during this
H>stage the immune system met with antigenic gluten molecules, based
H>on this theory (which is generally accepted)  it will recognize the
H>gliadin antigen as his own and would not start immune reaction
H>against it. If this theory in immunology is true, it would be better
H>to ingest gluten during the pregnancy to have the fetal immune
H>system accept the gluten as not antigen. This is a simplistic argument.
H> Of course, the real situation can be more complex.
H>
H> For me the basic question is whether we are able to measure gluten
H>accurately in the milk. Whether what we are measuring is a real or
H>pseudoreaction. From scientific point of view, someone should isolate
H>the gluten-gliadin molecules from mothers milk (to find them among
H>thousands of peptides) and analyze their amino acid sequence and
H>compare with the known sequence of gliadin sequences.
H> If we would know the celiac-inducing peptides in the gluten (if it
H>were only 10-20 peptides ) the alternative would be an immunization.
H>Until this work is down all the other aspect is speculative.


Bill Elkus
Los Angeles