Our three month old son, who is currently breast feeding, has one genetic marker for diabetes, and, while I understand that this does not mean that he will develop diabetes, my question is about introducing solids and later cow’s milk. If, when he does start solids, we withhold certain foods will it decrease his odds for getting diabetes? If so, what foods should not be introduced?

Before making any decisions about diet, I think you should get a more precise idea of what the one genetic marker actually was, if only to find out a little more exactly what the chances of clinical diabetes are.

The cow’s milk story is still a controversial one. It started with some good studies in Finland where there is a very high incidence of type 1A (autoimmune) diabetes. However, in the USA, when this was repeated in the DAISY (Diabetes and AutoImmune Syndromes in Youth) study, no such relationship could be confirmed. Later work has suggested that the specific environmental trigger may be not be cow’s milk generally but a specific milk alpha1 beta casein variant that is only present in certain herds.

Even more recently (and the rationale is a little too complex to explain here), it has been suggested that in circumstances like those of your small son, it might make sense to avoid both cow’s milk and wheat protein. Here again, the evidence is conflicting, and my personal advice would be to avoid either dietary course and to breast feed as long as is convenient.

Finally, you might think to talk to your son’s diabetes team about the possibility of giving the B vitamin nicotinamide to delay insulin dependence. There are clinical studies under way involving more elaborate immunomodulation, but your son is too young for these.

DOB