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Why Some Children Develop Celiac Disease and How to Reduce Risk

Home / Why Some Children Develop Celiac Disease and How to Reduce Risk
Three toddlers sit on a colorful foam mat in a playroom. Two of them examine toys together, while the third holds a purple toy and looks away. In the background are chairs, a chalkboard, and shelves with blocks.

After a diagnosis, many patients may ask, “Why me? Why did this happen?” Although we don’t know for sure what causes celiac disease, scientists have discovered a few clues and, therefore, some tactics for reducing the chances that future generations will develop celiac.

Hearing From Experts

In a recent episode of the podcast Bowel Sounds, hosts Dr. Temara Hajjat and Dr. Peter Lu talk to Dr. Maureen Leonard, a pediatric gastroenterologist and associate professor at Massachusetts General Hospital, about what factors may increase the risk of a child developing celiac disease.

The episode was created for an audience of pediatric gastroenterologists, but the information is worth sharing with patients and their families, too!

Why Some People Develop Celiac Disease

The doctors discussed which factors of early life specifically may influence who develops celiac disease and who doesn’t. Here’s what they shared:  

  1. Celiac disease occurs in individuals with certain genes.
  2. Celiac disease occurs in more females than males.
  3. Celiac disease is associated with early introduction to gluten at less than 3 months of age.
  4. More work on gluten exposure during infancy has found that timing of gluten exposure after 3 months of age is less important than the amount of exposure.  Though a specific amount is not known, there is an association with higher intake of gluten prior to age 5 and the development of celiac disease in genetically-susceptible children.
  5. Enterovirus or other GI (enteric) viruses are associated with the development of celiac disease in genetically-susceptible children. This may be associated with an increase in intestinal permeability or leaky gut, which allows materials to pass through the intestinal wall.
  6. The microbiome, the bacteria and their products living in the gut, influences the development of celiac disease. As early as 18 months prior to the development of celiac disease, there are changes in the gut microbiome.
  7. Diet, which also relates to the microbiome, can influence the development of celiac disease. A Mediterranean diet; a highly diverse diet with fruits, vegetable and other unprocessed foods; and a high fiber diet seem to be protective against the development of celiac disease.
  8. Increased use of antibiotics is associated with a higher risk of celiac disease, probably due to increased intestinal permeability (leaky gut).

Recommendations

Be aware that there are factors you can’t control, such as genetic predisposition, giving antibiotics when needed, or feeding a child who may be a picky eater, so focus on controlling what you can.

  1. If your child has a family history of celiac disease, do not give large amounts of gluten in early childhood (it is not necessary or recommended to go on a fully gluten-free diet, as there are important nutrients in gluten-based products).
  2. If your child is sick with a GI virus, do not give a large amount of gluten at that time.
  3. Have your child eat a diverse diet with a few ultra-processed foods and a lot of fruits, vegetables and other fiber sources.

Looking Ahead

There’s so much more to learn about celiac disease. We need more information on other interventions; for example, we may learn which microbes are important and whether certain pre- or pro-biotics can change the course of disease. We also need to continue with treatment trials to find ways to treat celiac disease beyond the gluten-free diet, so that our community can eat without fear.