Skip to content

Posts tagged ‘starting solids’

What’s Up With the Virgin Gut? Do Babies Really Have an “Open Gut” Until 6 Months of Age?

There is a persistent myth about infant gut development that comes up in nearly every online discussion of starting solid foods. It’s the myth that infants have a “virgin” or “open” gut until around 6 months of age. I’ve received so many emails, Facebook posts, and comments about the virgin gut over the last few years that I thought it was finally time to take a look at the science – and lack thereof – behind this myth.

I have written before, in my book and on my blog, about the controversy around when to begin introducing solid foods to a baby. Some health organizations recommend 6 months of exclusive breastfeeding, while others recommend starting to offer solids between 4 and 6 months, following baby’s cues of readiness as your ultimate guide. Based on my analysis of the most current science, I believe that the second approach is more evidence-based and helps parents to focus on their baby’s unique development rather than the calendar. I also think that it’s just fine to wait until 6 months if that is your preference.

However, whenever I discuss this science, someone lectures me about infant gut development, and they usually send me a link to KellyMom’s page on the topic, which urges parents not to offer solids before 6 months. Here’s what it says:

“In addition, from birth until somewhere between four and six months of age babies possess what is often referred to as an “open gut.” This means that the spaces between the cells of the small intestines will readily allow intact macromolecules, including whole proteins and pathogens, to pass directly into the bloodstream. This is great for your breastfed baby as it allows beneficial antibodies in breastmilk to pass more directly into baby’s bloodstream, but it also means that large proteins from other foods (which may predispose baby to allergies) and disease-causing pathogens can pass right through, too.”

Wow, that does sound scary! I can see how this “open gut” idea would worry parents approaching the transition to solid foods. But here’s the thing: There are no references given to support these statements, and in all my reading of the research literature on readiness for solids, I have not encountered science backing this concern. Yet somehow this idea of the open gut comes up over and over in online discussions, complete with judgment for parents who offer solids before 6 months and non-evidence-based suggestions about how to “heal” a baby’s gut. All of this only serves to increase anxiety in parents, which is the last thing any of us need.

It’s time to get to the bottom of this. Let’s look at some science…

What do we mean when we talk about an “open” or “closed” gut? How do we measure this? Read more

How Often Should a Baby Poop? And Other Important Questions…

My 6-month-old baby didn't poop for 7 days, and I wondered if I should be worried. Here's what I found out.

Read more

The Whole Truth About Infant Cereals: 7 Science-Based Tips

Readers Brenda and Leah wonder if they need to feed their baby a commercial infant cereal. Here's the answer, in 7 parts, all supported by science.

Read more

Breastfeeding, Gluten Introduction, and Risk of Celiac Disease

A study published yesterday in the journal Pediatrics suggests that later introduction of gluten and breastfeeding beyond 12 months both increase the risk of a child developing celiac disease. These new findings add to the already muddy waters of our current understanding of the role of infant feeding in celiac disease.

Photo by Shree Krishna Dhital, via Wikimedia Commons

Celiac disease is an immune response to gluten, a protein found in wheat, barley, and rye. Celiac is characterized by inflammation and damage to the small intestine, leading to symptoms such as diarrhea and digestive pain. In the U.S., celiac disease is present in about 1 in 141 people, although many of these cases go undiagnosed. Infants that develop celiac disease often have poor growth or weight loss, because intestinal damage compromises nutrient absorption. They also may have chronic diarrhea and a swollen, painful belly.

Celiac can usually be treated with a gluten-free diet, but there isn’t a cure for the disease. Multiple genetic markers have been identified for celiac disease, but many genetically susceptible individuals tolerate gluten and never develop symptoms, leading to speculation about other risk factors, including early childhood nutrition.

This latest study was a large, prospective survey of infant feeding practices and development of celiac disease in Norwegian children. Parents were asked when they first introduced gluten and how long they breastfed their babies. Children that developed celiac disease were tracked through Norway’s national medical system. The study included 324 children with diagnosed celiac disease and 81,843 without celiac. The researchers then looked for patterns in the data that might help to explain why some children developed celiac disease and others did not.

There were two major findings to emerge from this study:

  1. Children that had not yet tried gluten by 6 months of age were more likely to develop celiac disease.
  2. Breastfeeding at the time of introduction to gluten did NOT appear to be protective. In fact, breastfeeding for longer than 12 months was associated with an increased risk, although it was borderline significant (P=0.046).

Both of these findings are contradictory to current infant feeding advice in the U.S. The AAP’s Section on Breastfeeding recommends exclusive breastfeeding for about 6 months before introducing solid foods, followed by “continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.” The same AAP policy goes on to say, “There is a reduction of 52% in the risk of developing celiac disease in infants who were breastfed at the time of gluten exposure.” But this Norwegian study effectively found that following the current advice of the AAP seems to increase a baby’s risk of celiac, not decrease it.

Obviously, we need more information here. And as usual, one study isn’t enough to give us the full picture of what we know and don’t know about this topic.

To understand the evolving hypotheses around celiac disease and infant feeding, we need to go back to Sweden in the mid-1980’s, when the rates of celiac disease in young kids suddenly quadrupled from an incidence of 1 in 1000 births to 4 in 1000 births over just a few years. It was an epidemic, and it appeared to be isolated to Sweden; neighboring countries weren’t affected. What’s more, celiac was showing up in really young kids. The median age of diagnosis during the epidemic was just about a year old. In 1995, celiac disease in Sweden plummeted back to pre-epidemic levels, and the median age of diagnosis increased to 4 years of age. Read more