Thursday, March 30, 2023

A new study published by researchers at the very prestigious Walter Reed Hospital in the October issue of “Pediatrics” investigated possible causes and risk factors for celiac disease and the childhood risk factors. More information about this can be found at the end of this article, but it may be a good idea to check with expert pediatricians about possible long-term repercussions and childhood risks of certain anti-acid medications given to infants under 6 months of age.


Protecting Our Children

As a general rule, it is important to research possible dangers associated with things we give our children. We are not discussing internet research of dubious or quackery medicine. We are discussing evidence based recommendations by legitimate researchers. The mitzvos in doing so are many:

  • Hashavas aveida: The verse in Parshas Ki Taytzai (Devarim 22:2) discusses the mitzvah of hashavas aveida, returning an object, with the words “vahashaivoso lo, and you shall return it to him.” The Gemara in Sanhedrin (73a), however, includes within its understanding of these words the obligation of returning “his own life to him as well.” For example, if thieves are threatening to pounce upon him, there is an obligation of “vahashaivoso lo.” In other words, this verse is the source for the mitzvah of saving someone’s life. I believe this is the general mitzvah the Shulchan Aruch refers to in Shulchan Aruch Orech Chaim 325.
  • Lo saamod al dam rayacha: There is a negative mitzvah of not standing idly by your brother’s blood as well. This is mentioned in Shulchan Aruch (CM 426:1) and in the Rambam. If we research things properly, we can ensure that we do not stand idly by our brother’s blood.
  • Lo suchal l’hisalaym: There is yet another negative commandment associated with the positive commandment of hashavas aveida, and that is the verse in Devarim (22:3), “You cannot shut your eyes to it.” This verse comes directly after the mitzvah of hashavas aveida. The Netziv (HeEmek Sheilah) refers to this mitzvah as well.
  • V’chai achicha imach: The Sheiltos (Sheilta #37), based upon the Gemara in Bava Metziah 62a, understands these words to indicate an obligation to save others with you. The Netziv in his HeEmek Sheilah understands it as a full-fledged obligation according to all opinions. He writes that he must exert every effort to save his friend’s life, until it becomes pikuach nefesh for himself.
  • V’ahavta l’rayacha kamocha: The Ramban, Toras haAdam Shaar HaSakana (p42-43) understands the verse of “and love thy neighbor as yourself” as a directive to save him from danger as well. Although he discusses the issue of medical danger, it is clear that this is an example, and it would apply to danger as well.

These are the mitzvos associated with dangers to our children and protecting them. We now move on to other mitzvos involving catered events.


Torah Mitzvah in Catered Events

We present here a way to get a Torah mitzvah at any catered simcha or event. It is important to know that there is a Torah mitzvah to be sensitive to people with celiac disease. People who suffer from this digestive disorder, also known as sprue, have it very hard at pretty much any simcha.

In order for them to eat, they need to know what items may have gluten, and, unfortunately, it is generally not at the top of people’s agenda. Caterers and chefs usually only have a general idea of what they put in the foods that are cooked and it is often difficult to ascertain what was put in the foods that were ordered from elsewhere.

It is a Torah mitzvah to put this at the top of one’s agenda. The mitzvah is, “v’ahavta l’rayacha kamocha, love your neighbor as yourself.” It can also be a negative mitzvah too – the prohibition of “v’lifnei iver lo sitain michshol, do not put a stumbling block in front of the blind.”


How They Feel

A celiac patient once remarked, “Do you know how people cannot wait to buy pizza or eat chometz after Pesach? That is how I feel all year round.” About one in 141 people in the United States have celiac according to the National Institute of Diabetes and Digestive and Kidney Diseases, but it seems that it is significantly higher, according to schools and caterers.

Another important note: Cakes and desserts over Pesach are often gluten-free. After Pesach, why not offer them to someone with celiac disease? It would be a fantastic method of fulfilling v’ahavta l’rayacha kamocha.


What Is Gluten and What Does It Do?

Gluten is a protein that is found in foods made with wheat, barley, rye and something that was artificially made from female wheat and male rye called triticale.

In celiac disease, the body’s immune response to gluten creates poisons or toxins. These poisons destroy the villi in the small intestine, the tiny finger-like protrusions that enable the body to absorb nutrients. This can lead to malnutrition and other very serious health issues including permanent damage to the intestines. The poisons literally eat out the kishkes.

The following foods are what celiacs need to watch out for.

  • beer
  • bread
  • cakes and pies
  • candy
  • cereals
  • cookies
  • crackers
  • croutons
  • gravies
  • imitation meat or fish
  • oats
  • pasta
  • processed meats
  • salad dressings
  • sauces (includes soy sauce)
  • basted poultry
  • soups

Gluten can also be found in some medicines, many vitamins and even in lipsticks.


Pesach Halachos

There are also special instructions for celiacs associated with Pesach, which, for now, is beyond the scope of this article. Pesach is different from challah on Shabbos, because on Pesach there is a Torah mitzvah to consume matzah. But we do have some time for that.


Back to the Survey on Causes

The researchers found an increased association with the administering of three different types of prescriptions in the first six months of life and celiac disease. Of course, before we go crazy and stop all of these medications for our children and grandchildren, we should consult with expert doctors.

The three medicines were:

Proton pump inhibitors (PPI), certain stomach acid reducing drugs. Some common ones listed below. [They generally end with azole]

○ Omeprazole (Prilosec), also available over-the-counter (without a prescription)

○ Esomeprazole (Nexium), also available over-the-counter (without a prescription)

○ Lansoprazole (Prevacid), also available over-the-counter (without a prescription)

○ Rabeprazole (AcipHex)

○ Pantoprazole (Protonix)

Histamine-2 receptor antagonist (H2RA), other stomach acid reducing drugs. Some common ones listed below. [They generally end with idine.]

○ Zantac—ranitidine

○ Pepcid—famotidine

○ Axid—nizatidine

○ Tagamet—cimetidine

○ Pepcid Complete

○ Pepcid AC, generic name: famotidine, calcium carbonate

○ Heartburn relief maximum strength

○ Generic name: famotidine

○ Heartburn relief—famotidine

○ Duo fusion—famotidine

○ Dual action— famotidine

Antibiotic prescriptions—many

Of course, always check with expert doctors and pediatricians. The Walter Reed study also highlights modifiable factors such as medication stewardship that can change the childhood risk of celiac disease. The link to the article is https://www.sciencedirect.com/science/article/abs/pii/S0022347622009003

By Rabbi Yair Hoffman

 The author can be reached at [email protected]

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