CELIAC DISEASE: a lot of news!

04.04.2014 16:28

Celiac Disease Linked to Almost Doubled Risk of CAD

Marlene Busko

March 29, 2014

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WASHINGTON, DC — Compared with the general population, individuals with celiac disease were almost twice as likely to have CAD, according to a large retrospective study presented here today at the American College of Cardiology (ACC) 2014 Scientific Sessions ^[1]. Even patients younger than aged 65 years were at higher risk.

Celiac disease—a chronic inflammatory condition of the digestive system that can damage the small intestine—was also linked with a 1.4-fold greater risk of stroke.

The study highlights a specific patient population that might be at higher risk of CAD, even in the absence of traditional CV risk factors, said coinvestigator Dr Rama Dilip Gajulapalli(Cleveland Clinic, OH). "Primary-care physicians, gastroenterologists, and [other] healthcare practitioners need to be mindful of their celiac patients; they have to be on the watch for probable cardiac diseases," he said during a press briefing.

The possible mechanism for the heightened risk may be related to chronic inflammation. "People with celiac disease have some persistent low-grade inflammation in the gut that can spill immune mediators into the bloodstream, which can then accelerate the process of atherosclerosis and, in turn, CAD," Gajulapalli explained in a statement. "Our findings reinforce the idea that chronic inflammation, whether it's from an infection or a disease, can have an adverse role in CAD and heart health in general."

"These data remind us that other inflammatory states like lupus erythematosus, rheumatoid arthritis, and inflammatory bowel disease have also been linked to CAD, so perhaps we can add celiac disease to this list," echoed moderator Dr Jeffrey Kuvin (Tufts Medical Center, Boston, MA).

Celiac Disease on the Rise

Dr Rama Dilip Gajulapalli

Celiac disease affects an estimated one in 133 Americans, according to an ACC statement. However, more than 80% of people with the disease may be undiagnosed or wrongly diagnosed with, for example, lactose intolerance or irritable bowel syndrome. The disease is four times more common now than 50 years ago, and the only treatment is a gluten-free diet.

Celiac disease has been linked to arrhythmias and possible heart failure, so investigators hypothesized the disease is also associated with CAD.

They examined electronic health records of patients from 13 healthcare systems seen between January 1999 and September 2013. From nearly 22.4 million patients, they identified 24 530 diagnosed with celiac disease. The remaining patients served as controls.

The prevalence of CAD was significantly higher in all patients—as well as younger and older patients—with celiac disease than controls.

Prevalence of CAD in Patients With Celiac Disease

Age group	CAD prevalence (%),patients with celiac disease (n=24 530)	CAD prevalence (%), patients without celiac disease (n= 22 360 810)	p
All ages (>18 y)	9.5	5.6	<0.0001
>65 y	28.6	13.2	<0.0001
18–65	4.5	2.4	<0.0001

"This is an important study because it highlights a specific patient population who might be at higher risk for CAD, even in the absence of traditional CV risk factors," Gajulapalli said. "We were surprised by the strength of the association, especially in younger people. Patients and doctors should be aware of this association."

Further prospective studies are needed to confirm the findings, however. Future research should also investigate whether the larger population with gluten sensitivity may also be at increased risk of CAD.

Full results from this study are being presented during ACC 2014 but were released early via a special preconference press briefing, focused on consumer-interest news.

Maggiori informazioni https://www.metodologia-pediatrica.it/news/celiac-disease-linked-to-almost-doubled-risk-of-cad/

Celiac Disease in Children and Adolescents

03.04.2014 10:09

Megan Moreno, MD, MSEd, MPH

JAMA Pediatr. 2014;168(3):300. doi:10.1001/jamapediatrics.2013.3331. Text Size: A A A

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Celiac disease (CD) involves the inability for the small intestine to digest gluten, which is found in many grains such as wheat, barley, rye, buckwheat, or millet.

In addition to the gastrointestinal system, CD can also involve other body systems and cause conditions including short stature, osteoporosis, and iron-deficiency anemia. It develops in people who are genetically predisposed to having an immune system that reacts to gluten in the diet and are exposed to gluten.

Image not available.

In the United States, an estimated 3 to 13 per 1000 people have CD. Some research studies suggest that although CD is likely present in about 1% of people, only about 10% to 15% of those know they have it and are being treated.

For babies, CD symptoms may initially appear after a baby is first given cereal containing gluten. Symptoms may include irritability, poor weight gain, or even loss of weight. Common symptoms for children and adolescents may include chronic diarrhea, although some patients are constipated. Some children may vomit, complain of abdominal pain or distension, or have pale or foul-smelling stools.

Symptoms of CD can arise at any age; the older the child is at symptom onset, the more likely it is for the symptoms to be unusual and include symptoms other than those related to the gastrointestinal tract. These may include fatigue, iron-deficiency anemia, or dental problems. Some children get a rash called dermatitis herpetiformis, which involves itchy blisters mostly on the outer surfaces of the elbows, knees, and buttocks.

Because CD is a serious condition and requires lifelong avoidance of gluten, confirming the diagnosis with a laboratory test is often necessary. Your doctor may recommend a blood test to look for high levels of antibodies, which are proteins in the immune system that may react to gluten. Your doctor may recommend referral to a gastrointestinal specialist for further evaluation. Another potential test is a biopsy, which involves using a thin tube called an endoscope to take a tissue sample from the small intestine.

The only treatment of CD is complete and lifelong avoidance of foods containing gluten including cereals, pastas, breads, and other baked goods. Families need to also monitor other foods, such as canned soups and stews, that may be thickened with grains. Even small amounts of gluten can cause symptoms.

Today, there are many gluten-free options available including gluten-free grains and pastas. Many products provide clear labels indicating gluten-free status. Some families find it helpful to meet with a nutritionist as they learn about creating a balanced and nutritional gluten-free diet, and websites can also be helpful in selecting healthy gluten-free menus.

Farewell to gluten free: Why we are so easily fooled by pseudoscience and marketing gimmicks when it comes to food

01.04.2014 23:46

Farewell to gluten free: Why we are so easily fooled by pseudoscience and marketing gimmicks when it comes to food

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Joseph Brean | March 28, 2014 4:40 PM ET

More from Joseph Brean | @JosephBrean

The rise of gluten-free was “a function of people wanting simple solutions to complex problems,” Dr. Yoni Freedhoff says.

Chris Roussakis/National PostThe rise of gluten-free was “a function of people wanting simple solutions to complex problems,” Dr. Yoni Freedhoff says.

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Gluten gives fresh bread its pull and chew. A complex protein, it is to baked goods as tannin is to wine, more a feel than a flavour, but a key part of the sensory magic. It makes cereals satisfying, pasta al dente and crackers crisp. Bagels bounce on springs of gluten.

But gluten has lately acquired a famously bad reputation among trend-savvy nutritionistas, who blame it for everything from irritable bowels and autoimmune disorders to bloating and lethargy, even diabetes, depression, autism and schizophrenia. A whole industry has risen up to capitalize on its wholesale rejection, in which gluten-free foods are often sold at a massive mark-up over “regular” products.

bagels

But cracks are appearing, not so much in the medical science, which for the truly gluten-intolerant has made major strides in lockstep with the trend, but in gluten as the pop cultural food obsession du jour.

From nearly nothing a decade ago, by 2012, the Canadian gluten-free market was worth nearly half a billion dollars. But a forecast by industry watcher Packaged Facts suggests the market has now “peaked.”

Growth has slowed, early adopters have made most of the profit they will ever make, and if you missed the train three years ago, there is no sense trying to jump on now as it slows down. As one report for the pizza industry put it, “If the decision is made to enter the trend either: Prepare to downsize production as the trend downsizes to the appropriate audience … [and] have a fast-acting exit strategy.”

How we got here is a familiar story, said Yoni Freedhoff, an Ottawa doctor specializing in nutrition and obesity, and it reflects a modern dietary “guruism” characterized by fundamentalist claims and aggressive zealotry.

Helped along by the messianic testimonials of self-help pseudoscience and blatantly misleading advertising, “gluten free” appears to be on track to become the latest health food megatrend to collapse under the weight of time and common sense, like the low-carbohydrate Atkins diet, and the mantra of “no saturated fats,” recently undermined by a broad scientific review.

“Oh my gosh, has [gluten free] ever taken off in the last few years. … It’s pretty amazing how as a society we’re going back to basics,” said Kathy Smart, a nutritionist/chef and advocate of a gluten-free diet who did a cooking show and has been on the Dr. Oz Show. She also has celiac disease, so her motivation is medical as much as nutritional.

In this sense, she is unusual.

Banned — milk, yogurt, chocolate, cheese, eggs: Father says school’s list of allergenic foods makes preparing lunch impossible

Gluten free craze growing: Only 1% of Canadians are celiacs, but nine million people are on restricted diet, industry expert claims

Removing saturated fats from diets has made heart disease risk higher, not lower: U.K. cardiology expert

What grains and gluten mean (or don’t mean) for weight loss

As a shortcut to health for the busy modern eater who does not have celiac disease, the rise of gluten free was “a function of people wanting simple solutions to complex problems. That’s just human nature. It’s not laziness,” said Dr. Freedhoff. “It’s fitting into the desire for ease: ease of thought and ease of implementation.”

As an eliminationist strategy, “gluten free” is the flip side of the nutrient fetish, in which substances are added, rather than subtracted, on much the same grounds, notably Omega 3s, polyphenols, amino acids, electrolytes and amino acids.

The problem is that, as Dr. Freedhoff has found, when you try to tell people they are fooling themselves by, for example, buying bread with “vegetables” in it (as per a current marketing campaign), or that Omega 3s don’t make their eggs any healthier, they react as if a foundational belief has been threatened, not just a dietary preference.

toast

“People treat food like religion, it’s really strange. I can’t think of many other areas of life where there’s so much personal passion. If you believe and buy into one of these particular styles of eating, often you end up becoming very zealous in your description of same, and your preaching of same, and you want everybody else to do what you’re doing,” he said. “People really want to be right when it comes to the way we eat.”

On this view, we are not too far away from answering the door to evangelical nutritionists, asking us if we have heard the good news. And woe betide the unfortunate skeptic who points out the absence of proof.

Other interpretations can be put on the numbers, however.

“Is it a fad, or is it that there’s an epidemic?” said Margaret Dron, organizer of the Gluten Free Expo, a popular national trade show in that offers everything from basic gluten-free flours and baked goods to imported African tribal products, curry spices, sausages, gourmet camelina cooking oil, chocolate flavours “that represent the seven main chakras in the body,” even cosmetics. (Glutinous rice is so called because it is gluey, not because it has a lot of gluten.)

She said 91% of attendees go for medical reasons, which is a curious number, given that maybe one person in 200 has celiac disease. Many others, it seems, have a tendency to see food as either poison or medicine.

In the products at the expo, which include meats, there is an obvious overlap with organic, natural, pesticide-free, non-genetically modified foods. Gluten free, in this sense, is almost a proxy for “natural.”

‘People treat food like religion, it’s really strange’

Ms. Smart agrees it has taken on more than its literal meaning, and people are seeing it as meaning “healthier.”

“What I’m seeing in the industry is people will automatically assume gluten free is better for me,” Ms. Smart said.

The effects of such misinformed zealotry can be damaging, as in the “no saturated fats” message, which was over-simplified, and drove people from animal fats to processed flours and sugars. In breakfast terms, this is like switching from bacon and eggs to Cap’n Crunch.

But the impulse to medicalize food choices, to couch them in the concepts of science is an old one. As the Belgian food historian Peter Scholliers put it in a recent scholarly paper: “Media attention about acute food crises strikes the public’s imagination, leading to vehement sentiments of insecurity, anguish and occasionally panic. These sentiments, in turn, lead to eating behaviour that involves (rather harmless) vivacious food sensitivity (e.g., search for organic, authentic and light foods), as well as to (very harmful) binge eating, obesity and anorexia.”

Kaz Ehara for the National Post

Kaz Ehara for the National PostThe “no saturated fats” message was over-simplified and drove people from animal fats to processed flours and sugars.

Food and nutrition is a problem for many people in many ways, both in quality and quantity, but public discussion of these problems is often hyperbolic and over-simplified to slogans, from fear-mongering to dubious remedies, in which food is both problem and solution, deeply moral, infused with scientific controversy, and rarely just lunch.

Thanks to such books as Wheat Belly and The Gluten Syndrome, not to mention celebrity endorsements from Hollywood types and even tennis star Novak Djokovic, gluten free has become a cure-all, an escape hatch from the rampant pessimism.

“It’s an easy thing to latch onto as something to do to combat all of the awfulness that the alarm bells keep saying exists,” said Dr. Freedhoff. “Ultimately, we’re stuck with the the unfortunate and inconvenient truth that healthy living requires effort and there is no one simplified solution.”

‘Is it a fad, or is it that there’s an epidemic?’

It was not always this way, and it is only recently that people with celiac disease, or gluten-sensitive enteropathy, have become the darlings of popular nutrition. Once they were barely acknowledged, rarely diagnosed and poorly served at the supermarket, never mind the restaurant.

The legal literature, especially in tax court where celiac disease is frequently acknowledged as imposing a greater financial burden, is full of stories of dire medical hardship, even a woman who would get violently ill from the merest taste of grain. This financial problem only gets worse as gluten free becomes a mark of healthy luxury, and thus more expensive.

Others include a dispute over a Canadian Food Inspection Agency investigation of a (possibly, not quite) “gluten free” food wholesaler, and a divorce in which father was less diligent than mother in respecting their celiac daughter’s gluten-free diet.

From the fringes to the mainstream, like all trends, gluten has caught on, taken off, and is now starting to lose its street cred. Once a medical cure, it has become a lifestyle, a puff phrase, an advertising gimmick, a clueless self-deprivation of the perpetually cleansing, epitomized in the nutritional absurdity of the bunless burger.

Matthew Stockman/Getty Images

Matthew Stockman/Getty ImagesTennis star Novak Djokovic is a proponent of gluten free.

Often this is how restaurants nod to the glutenophobic customer, by adapting a traditional item, or making pasta or bread out of unusual grains.

Some have taken it to new gourmet heights, revealing the potential of unusual ingredients in baking, leaving flour behind and never looking back. Ms. Smart, for example, makes a pie crust out of ground almonds and coconut oil, and a tourtiere with chickpea flour. But for the true celiac, avoiding gluten is a supermarket challenge, once spoiled by lack of choice, now spoiled by rising prices.

Like many gluten-free proponents, Ms. Smart favourably cites a review article in the New England Journal of Medicine in 2002 — long before the trend took off — that listed 55 diseases linked to gluten, including migraines, dementia, arthritis, even schizophrenia, which is famously mysterious.

There is also talk about a link to autism, another baffling human condition, which links the gluten-free trend to the far kookier world of anti-vaccine fear-mongering.

Part of the popularity of gluten free is an almost nostalgic desire for simplicity in the face of unprecedented food options, a wish that can be spoiled when big business gets involved.

“I believe that we should have never started tampering with our food,” Ms. Smart said. “When you start tampering with your foods, strange things do happen.”

But part of it is just basic cultural evolution, as trends come and go, bringing a grain of truth amid the chaff of marketing, but leaving the “problem” of nutrition unsolved, and just as complex as ever.

As Dr. Freedhoff put it: “Any time a box needs to convince you the contents are healthful, they’re probably not.”

National Post

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nuove linee-guida per la CELIACHIA

02.04.2014 09:14

nuove linee-guida per la CELIACHIA

01.03.2014 16:44

World Gastroenterology Organisation global guidelines on celiac disease.

J Clin Gastroenterol. 2013; 47(2):121-6 (ISSN: 1539-2031)

Bai JC; Fried M; Corazza GR; Schuppan D; Farthing M; Catassi C; Greco L; Cohen H; Ciacci C; Eliakim R; Fasano A; González A; Krabshuis JH; LeMair A;

Department of Medicine, Dr C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina. jbai@intramed.net

La CELIACHIA è ancora molto sotto-stimata e sotto-diagnosticata

02.04.2014 09:00

La CELIACHIA è ancora molto sotto-stimata e sotto-diagnosticata

28.02.2014 14:00

Murch S, Jenkins H, Auth M, et al. Joint BSPGHAN and Coeliac UK guidelines for the diagnosis and management of coeliac disease in children. Arch Dis Child 2013;98:806–11.

https://www.ncbi.nlm.nih.gov/pubmed/23986560

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