Grains, Allergies and Infant Feeding

Let's talk gluten, grains, and allergies for infants who are ready to eat solid food. When my youngest son turned 6 months old and was ready to start solid food, I wondered about grains (bread, pasta, cereal, etc.), “Are they ok to give? Should I limit?” Well, here’s some interesting information that certainly clarified the topic for me.

Some people have read babies aren't able to digest grains until after 1 year of age and they should delay grains until they're older. While I don't think grains are the healthiest food group (especially when enriched - aka highly processed - and eaten in large quantities as many toddlers eat them), I don't expect kids to avoid them their whole life. I personally don't want my sons to miss out on awesome foods like really good pizza, mouth-watering French toast, a lightly toasted bagel with cream cheese, or a simple PB & J.

I'm all about being realistic and know my sons’ exposure to foods won't always be under my control. It already isn't. I want them both to love all foods and be able to navigate the food world listening to their hunger and fullness cues.  

New Recommendations for Introducing Complementary Foods for Prevention of Allergies in Children 

My first and personally most important reasoning for not avoiding grains and other allergenic foods in infancy is the current data available on allergies. There are a TON of studies on this, but I like this summary paper by the American Academy of Allergy, Asthma and Immunology. It states, "delayed introduction of solid foods, especially the highly allergenic foods, may increase the risk of food allergy or eczema." The document was released in January 2013, and the recommendations were written after finding that delayed introduction of solid foods, including the top allergenic foods as previously recommended (in 2000), did not lead to fewer food allergies among children at risk for developing allergies based on family history. In fact, over the past decade, the incidence and prevalence of food allergy and allergic diseases in general have increased substantially, which led to the re-evaluation of the 2000 recommendations. For specific information about this, here’s my detailed blog, New Recommendations for Introducing Complementary Foods for Prevention of Allergies in Children

When to Introduce Grains to an Infant

The American Academy of Allergy, Asthma and Immunology recommends introducing solids between 4 and 6 months, but they make it clear that baby should be able to sit up with support and have sufficient head and neck control before eating solid food. For this reason, and because we think gut closure occurs sometime closer to 6 months, I still recommend watching for developmental signs of readiness and waiting until closer to 6 months to introduce solid food. This is especially appropriate for baby-led feeding, which means letting your child feed themselves from the very start of introducing solid foods, as most babies aren't developmentally ready for it until then.

Some babies may not be interested in eating at 6 months, but it's important to sit them down and offer food so they become comfortable with the eating experience as long as they're showing the ability to sit relatively unassisted and don't have a tongue thrust. You don't want to forgo solids altogether until age 1 because they do have an important sensory, developmental, and even nutritional role (iron, zinc, allergies) in that first year.

Carbohydrate Digestion and "Traditional" Theories 

Some Paleo groups say since babies don't have a lot of pancreatic amylase (an enzyme that digests carbohydrates), they shouldn't receive grains. While pancreatic amylase has a huge role in carbohydrate digestion, it's not the only enzyme responsible for it.

Digestion is a relatively complicated process that starts in your mouth. Digestive enzymes and other compounds are released in your saliva, and as food travels through the stomach, it is mechanically broken down via peristaltic waves ("mixing waves") and chemically broken down by hydrochloric acid and other gastric enzymes. The broken down food bolus then goes into the small intestine, and when it hits the duodenum (the first portion of the small intestine) the pancreas releases a variety of enzymes, including pancreatic amylase. Other enzymes such as sucrase, lactase, maltase, and other carbohydrates live in the lining of the small intestine, and digestion and absorption continue on from there.

According to Mobassaleh et al, the intestinal enzymes, lactase, sucrase, maltase, isomaltase, and glucoamylase, are at mature levels in a full-term infant. Mature levels of pancreatic amylase activity and glucose transport occur postnatally, and levels are low in both the term and preterm neonate. The interesting thing is, once a baby is born, an adaptive response to ingested carbohydrates takes place, which leads to competent carbohydrate absorption. Inadequately absorbed carbohydrates are salvaged by colonic flora through fermentation of carbohydrates to hydrogen gas and short-chain fatty acids; the latter are readily absorbed by the colon. In this setting, carbohydrate tends to be absent in the stool. What this means is even if carbs aren't well absorbed in the small intestine, the bacteria of the large bowel take care of it because carbohydrate is not present in the stool. 

Our Bodies are Wildly Adaptive!

To further explain what happens with pancreatic amylase…pancreatic amylase activity is present within a fetus at 16 weeks gestation, but amylase activity in a full-term baby is only about 10% of that found in adults. After the first month of life, secreted amylase activity can be increased several hundredfold upon stimulation by pancreozymin and secritin, and this activity increases tenfold IN RESPONSE TO INCREASING THE QUANTITY OF INGESTED STARCH. This adaptive response, and the presence of adequate intestinal glucoamylase activity, prevents starch intolerance in the vast majority of infants despite a low level of pancreatic amylase secretion (Mobassaleh et al). What this means is pancreatic amylase is made in much larger quantities when starch is introduced to the gut. Our bodies are wildly adaptive.

Carbohydrates and Breast Milk

What about breast milk? Human milk contains...AMYLASE! According to Lindberg and Skude in their Pediatrics publication "Amylase in Human Milk," "A substantial amylase activity of salivary (human milk) type is found in the duodenal juice of infants after a meal of human milk. Thus, feeding human milk adds considerably to the infant's ability to degrade starch." By breastfeeding, you're improving your kiddo's ability to handle grains. Win!

How To Make Grains More Digestible

How can you make grains more digestible? Germination, fermentation and soaking (as many traditional groups like Weston A. Price recommend). “Germination, fermentation, and soaking can be used to enhance bioavailability of iron and zinc, and probably copper and manganese in complementary foods, by reducing the content of phytic acid, and in some cases, polyphenols." (Gibson. The adequacy of micronutrients in complementary foods. Pediatrics. 2000). 

I understand "traditional" theories say to avoid grains because babies aren't ready to digest them, and I can also see sweeping recommendations like this potentially causing issue in the general population. Remember, however, that it's YOUR child, YOUR choice.

In Summary:

1. Recommendations say it’s important to introduce wheat/gluten around 6 months to prevent allergies. Delaying allergenic foods will INCREASE risk of allergies. This alone is why I didn’t wait to introduce grains to my kids. They were eating bread as one of their first foods.

2. The body has adaptive mechanisms to digest starches/grains. Introducing these foods to the gut when it's ready (and absolutely not before 4 months) causes the body to increase the amount of pancreatic amylase it makes substantially.

3. Breast milk contains amylase and helps with starch absorption.

4. To make grains more digestible, consider sprouting/soaking.

5. Remember that grains don't have to be the focus of your child's diet, and in fact, most kids eat too many of them. Vegetables, fruits, legumes, lentils, and milk/yogurt all provide carbohydrate, so your child doesn't have to eat all grains, all the time.

6. I'm not a fan of rice cereal as a first food because it's a refined white carb, it causes a blood sugar spike, and it likely contains a decent dose of arsenic. Good sources of iron - which is why rice cereal is sometimes recommended - are from meat/poultry, fish, beans/lentils, whole grains, and a variety of fruits/veggies.

In Health and Happiness,

Kelly Harrington, MS, RDN

Registered Dietitian Nutritionist for Healthy Goods


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