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Celiac Disease Goes Undiagnosed In 90% Of Cases, Canadian Researchers Find

Detection complicated by popularity of gluten-free diet among many who don’t have illness

Celiac disease is common but mostly goes undiagnosed, say Canadian nutrition researchers who studied the blood work of nearly 3,000 people.

For those with celiac disease, eating gluten triggers an immune reaction in the small intestine that, over time, causes signs of damage that can be measured in the blood. Symptoms such as abdominal pain, bloating, gas, diarrhea, anemia and weight loss can result.

Ahmed El-Sohemy, a professor of nutritional science at the University of Toronto, wanted to see whether celiac disease results in subpar nutrition because of poorer absorption of vitamins and minerals. Iron deficiency, for example, can cause fatigue; too little vitamin C can lead to bleeding gums; and a shortage of calcium and vitamin D can cause brittle bones.

But to find out, he needed Canadian data on the frequency of undiagnosed celiac disease.

To that end, El-Sohemy and his colleagues checked blood samples from more than 2,800 individuals in Toronto. One group had an average age of 23, and the other 45.

Findings consistent with other countries

Their results bore out findings from other countries, showing celiac disease occurs in about one per cent of the population, the researchers said in Friday’s issue of the journal BMJ Open.

However, the vast majority of people who may have the disease don’t even know it.

“The prevalence of it being undiagnosed is incredibly high: 90 per cent,” El-Sohemy said in an interview with CBC News.

This too is consistent with what’s been reported in other countries such as the U.S. and the U.K., the researchers said.

“What I guess was a little bit surprising is just how common [undiagnosis] still remains given that gluten-free started becoming popularized well over a decade ago,” El-Sohemy said.

Info ‘essential’ for health care planning

Celiac disease has a strong genetic component. About 30 per cent of the population has the version of a gene needed to develop celiac disease, but that alone doesn’t mean an individual will develop it, he said.

Estimating the frequency of celiac disease in the Canadian population is important, said Dr. Maria Ines Pinto Sanchez, a physician specialist in gastroenterology and nutrition at McMcaster University’s celiac clinic. She was not involved in the study.

“This [study] will give us an idea of the magnitude of the problem in our country, and is essential for health care planning.”

Studies in the U.S., Europe, Middle East, North Africa and South Asia also suggest about one per cent of people are positive for celiac disease based on blood tests for antibodies.

Gastroenterologists say diagnosing celiac disease can be difficult in part because symptoms such as fatigue are common in many other medical conditions.

There are two antibody tests to measure markers in the blood to evaluate someone for celiac disease.

Celiac disease is a genetic autoimmune disease in which people are unable to fully digest certain proteins from wheat.
The partially digested products that remain trigger inflammation and can damage the lining of the small intestine.
(Health Canada)

“It is very important to highlight that blood samples and biopsies to confirm celiac disease should be tested while the patient is consuming gluten, to prevent false negative results,” Pinto Sanchez and clinic co-director Dr. Premysl Bercik said in an email. “A great proportion of the population is following a gluten-free diet even though celiac disease was not confirmed, which makes the diagnosis difficult.”

A biopsy of the duodenum, the first section of the small intestine, is the gold standard to confirm the diagnosis.

False positives can occur, for instance, in people who have other autoimmune disorders, said Dr. Sheila Crowe, a  Canadian professor of medicine working in the gastroenterology division at the University of California, San Diego.

“We call that latent celiac disease,” Crowe said in an interview. “This study does not differentiate whether they have latent celiac disease or actually have celiac disease.”

Nonetheless, Crowe called the study interesting and important for raising awareness.

Researchers will need to conduct studies in other provinces to clarify whether or not the findings are representative of the whole country.

El-Sohemy also points out that gluten-free foods are more expensive, and in some cases less nutritious, than their gluten-containing counterparts, and he worries that some people are spending money needlessly.

One potential conflict of interest in El-Sohemy’s research is that he is the founder and chief scientific officer of Nutrigenomix Inc., which provides genetic testing for nutritional issues, including gluten intolerance.

The research was funded by the Canadian Institutes of Health Research.

With files from CBC’s Amina Zafar

Oct 06, 2017
source: www.cbc.ca
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10 Signs you are Gluten Intolerant

Gluten intolerance, also called gluten sensitivity or Celiac Disease- when it’s in its most severe form- can have symptoms that range from no symptoms to life threatening or debilitating chronic health problems and anywhere in between. Often, these symptoms are not consistent from person to person and this is part of what makes gluten testing or Diagnosing Gluten Sensitivity so difficult for medical professionals.

According to Dr. Amy Myers the following are 10 signs of gluten intolerance:

1. Digestive issues such as gas, bloating, diarrhea, and even constipation. I see the constipation particularly in children after eating gluten.

2. Keratosis pilaris, also known as “chicken skin” on the back of your arms. This tends be as a result of a fatty acid deficiency and vitamin A deficiency secondary to fat-malabsorption caused by gluten damaging the gut.

3. Fatigue, brain fog, or feeling tired after eating a meal that contains gluten.

4. Diagnosis of an autoimmune disease such as Hashimoto’s thyroiditis, rheumatoid arthritis, ulcerative colitis, lupus, psoriasis, scleroderma or multiple sclerosis.

5. Neurologic symptoms such as dizziness or feeling of being off balance

6. Hormone imbalances such as PMS, PCOS, or unexplained infertility.

7. Migraine headaches.

8. Diagnosis of chronic fatigue or fibromyalgia. These diagnoses simply indicate your conventional doctor cannot pinpoint the cause of your fatigue or pain.

9. Inflammation, swelling, or pain in your joints such as fingers, knees, or hips.

10. Mood issues such as anxiety, depression, mood swings, and ADD.

According to The Examiner.com below are five not-so-obvious signs of gluten intolerance that you could be missing:

1.”You’re a full-grown adult but you still have breakouts like a teenager: Your skin is the body’s biggest organ and provides a window into your internal health. That may be why Dr. Alessio Fasano, at the University of Maryland’s Center for Celiac Research argues that persistent acne is a sign of inflammation from gluten that can affect other organs.

2.You wake up feeling sluggish, you’re fatigued all day, and never feel rested: If you aren’t burning the midnight oil every night and you are still hitting the snooze button repeatedly ever morning, your diet may actually be to blame. A gluten-filled diet can not only induce fatigue in someone with gluten intolerance, it can actually disrupt your sleep patterns and create a feeling of general malaise, according to studies.

3.You suffer from mood issues, anxiety, depression, or ADD. A gluten intolerance or allergy might not create anxiety or depression out of thin air, but they can certainly make symptoms worse. A 2010 study by the National Institutes of Health (NIH) cited “significant concerns about increased rates of psychological symptoms and mental disorders in celiacs” patients.

4.You mysteriously suffer from join pain in your hands, knees, or hips: Join pain can be signs of several different autoimmune diseases. If you’re not hitting the heavy weights, logging serious miles running, or suffering from arthritis, the inflammatory response from a gluten intolerance may be one reason your system is triggering a reaction in your joints.

 

5.You are plagued by frequent headaches and migraines: The causes of migraines are various and mysterious, but some studies have made a connection between an increased rate of headaches and migraines in Celiac patients, compared to the general population. In a 2001 study, Dr. Marios Hadjivassiliou from the Royal Hallamshire Hospital in the UK documented patients actually lessening their migraine symptom by following gluten-free diets”.

And it gets worse, gluten has been linked to over 55 diseases! Yes, I said 55 diseases.
Gluten Sensitivity: One Cause, Many Diseases

A review paper in The New England Journal of Medicine listed 55 “diseases” that can be caused by eating gluten. (iv) These include osteoporosis, irritable bowel disease, inflammatory bowel disease, anemia, cancer, fatigue, canker sores, (v) and rheumatoid arthritis, lupus, multiple sclerosis, and almost all other autoimmune diseases. Gluten is also linked to many psychiatric (vi) and neurological diseases, including anxiety, depression, (vii) schizophrenia, (viii) dementia, (ix) migraines, epilepsy, and neuropathy (nerve damage). (x) It has also been linked to autism.(ix)

According to Dr. Mark Hyman, “we used to think that gluten problems or celiac disease were confined to children who had diarrhea, weight loss, and failure to thrive. Now we know you can be old, fat, and constipated and still have celiac disease or gluten sensitivity.

Gluten sensitivity is actually an autoimmune disease that creates inflammation throughout the body, with wide-ranging effects across all organ systems including your brain, heart, joints, digestive tract, and more. It can be the single cause behind many different “diseases.” To correct these diseases, you need to treat the cause–which is often gluten sensitivity–not just the symptoms.

Of course, that doesn’t mean that ALL cases of depression or autoimmune disease or any of these other problems are caused by gluten in everyone–but it is important to look for it if you have any chronic illness.

By failing to identify gluten sensitivity and celiac disease, we create needless suffering and death for millions of Americans. Health problems caused by gluten sensitivity cannot be treated with better medication. They can only be resolved by eliminating 100 percent of the gluten from your diet.”

So, what’s a person to do? Well, first get tested by your doctor have him/her do the run down to make sure that there is nothing else going on then try a gluten elimination diet.
( http://www.nourishingmeals.com/p/elimination-diet.html )

References
(i) Ludvigsson JF, Montgomery SM, Ekbom A, Brandt L, Granath F. Small-intestinal histopathology and mortality risk in celiac disease. JAMA. 2009 Sep 16;302(11):1171-8.
(ii) Rubio-Tapia A, Kyle RA, Kaplan EL, Johnson DR, Page W, Erdtmann F, Brantner TL, Kim WR, Phelps TK, Lahr BD, Zinsmeister AR, Melton LJ 3rd, Murray JA. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology. 2009 Jul;137(1):88-93
(iii) Green PH, Neugut AI, Naiyer AJ, Edwards ZC, Gabinelle S, Chinburapa V. Economic benefits of increased diagnosis of celiac disease in a national managed care population in the United States. J Insur Med. 2008;40(3-4):218-28.
(iv) Farrell RJ, Kelly CP. Celiac sprue. N Engl J Med. 2002 Jan 17;346(3):180-8. Review.
(v) Sedghizadeh PP, Shuler CF, Allen CM, Beck FM, Kalmar JR. Celiac disease and recurrent aphthous stomatitis: a report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94(4):474-478.
(vi) Margutti P, Delunardo F, Ortona E. Autoantibodies associated with psychiatric disorders. Curr Neurovasc Res. 2006 May;3(2):149-57. Review.
(vii) Ludvigsson JF, Reutfors J, Osby U, Ekbom A, Montgomery SM. Coeliac disease and risk of mood disorders–a general population-based cohort study. J Affect Disord. 2007 Apr;99(1-3):117-26. Epub 2006 Oct 6.
(viii) Ludvigsson JF, Osby U, Ekbom A, Montgomery SM. Coeliac disease and risk of schizophrenia and other psychosis: a general population cohort study. Scand J Gastroenterol. 2007 Feb;42(2):179-85.
(ix) Hu WT, Murray JA, Greenaway MC, Parisi JE, Josephs KA. Cognitive impairment and celiac disease. Arch Neurol. 2006 Oct;63(10):1440-6.
(x) Bushara KO. Neurologic presentation of celiac disease. Gastroenterology. 2005 Apr;128(4 Suppl 1):S92-7. Review.
(xi) Millward C, Ferriter M, Calver S, Connell-Jones G. Gluten- and casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev. 2004;(2):CD003498. Review.
(xii) Green PH, Jabri B. Coeliac disease. Lancet. 2003 Aug 2;362(9381):383-91. Review.

Sources for Article:
http://www.huffingtonpost.com/dr-mark-hyman/gluten-what-you-dont-know_b_379089.html
http://www.easy-immune-health.com/Symptoms-of-Gluten-Intolerance.html#ixzz2bGphgedV
http://www.dramymyers.com/2013/02/03/10-signs-your-gluten-intolerant/
http://www.healthy-holistic-living.com/10-signs-you-are-gluten-intolerant.html


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Gluten-free not just a fad for some

A gluten-free diet is the only medical treatment for two health conditions
By Lee Marshall, CBC News Posted: May 1, 2013

When arm pain made it difficult for Victoria Yeh to play her electric violin, she decided to make a change.

Yeh suffered from chronic headaches, nausea, sinus inflammation, stomach pain, gas and digestive issues for several years. But the pain was Yen’s biggest motivation to follow her doctor’s advice to avoid gluten, a protein found in wheat, barley and rye.

“I consider gluten-free to be a diet of necessity. I wasn’t healthy, I was really thin and I would get sick often,” said Yeh.

Eliminating gluten from her diet had a positive effect. “I put on more weight and put on more body fat, and I’m much healthier now.”

These days, lots of people are giving up gluten. Eighteen per cent of American adults buy gluten-free products, according to market researcher Packaged Facts. Some eat gluten-free to treat celiac disease, the autoimmune disorder triggered by gluten. Some are fad dieters who think it will help them lose weight.

But Yeh is eating gluten-free for another reason.

She is one of an increasing number who are reporting non-celiac gluten-sensitivity.

Experts estimate that celiac disease affects one per cent of Canadians. It prevents the uptake of nutrients from food by damaging the small intestine and can lead to neurological disorders and vitamin deficiencies, like anemia or osteoporosis. Celiac disease has even been linked to infertility, schizophrenia and cancer. The only treatment is a strict gluten-free diet.

Less is known about non-celiac gluten-sensitivity.

Dr. Mohsin Rashid, a gastroenterologist at the IWK Health Centre in Halifax, says that non-celiac gluten-sensitivity is a newly coined phenomenon. “We don’t know exactly what happens. We’re just trying to probe the surface of this issue.”

What doctors do know is that people with non-celiac gluten-sensitivity have celiac-like gastrointestinal and neurological side- effects but no autoimmune reaction to gluten. There is no way to diagnosis sensitivity: the blood-tests and biopsy for celiac disease come back negative.

But some researchers think non-celiac gluten-sensitivity may be more prevalent than celiac disease and that the prevalence may be increasing at a faster rate.

It’s a lifestyle, not a diet

The gluten-free industry is valued at $4.2 billion US and it’s still growing. Industry sales are projected to exceed $6.6 billion US by 2017, according to Packaged Facts.

But eating gluten-free is still challenging because gluten is so ubiquitous. It’s in the obvious products, like bread, pasta, and cookies, but it is also lurking in many prepared foods, like soup, salad dressing, and soy sauce.

“You will never be successful with the gluten-free diet if you just simply see it as a diet. It really is a lifestyle change,” said Yeh.

Registered dietitian Alexandra Anca in Toronto says that gluten-free eating isn’t inherently healthy for those without a medical reason to follow the diet. She says gluten-free processed foods are often low in fibre and nutrients like calcium, vitamin D and folate.

Diet books, like Wheat Belly by Dr. William Davis, encourage the gluten-free diet as a weight loss strategy.

But Anca said the diet can actually lead to weight gain. “Most [processed] gluten-free foods offer a higher amount of carbohydrates, fat and calories all in all,” said Anca.

For anyone eating gluten-free, Anca recommends eating a variety of healthy carbohydrates like quinoa, flax, sorghum, millet and teff.

Potential future treatments

Dr. Rashid says it isn’t yet clear why the prevalence of celiac disease and non-celiac gluten-sensitivity seem to be increasing. “All autoimmune disorders and allergies are on the rise — celiac disease is just one of them.”

But a number of therapies for gluten-related disorders are already in clinical trials.

Larazotide acetate is the pill attracting the most attention: the theory is that it works by preventing gluten from entering the lining of the small intestine.

One therapy in development involves using enzymes to break gluten into smaller non-toxic parts. Another is thought to work by attaching a chemical to gluten that makes it too big to be absorbed during digestion.

The biotechnology company ImmusanT is developing a vaccine that will increase tolerance to gluten in people with celiac disease.

Dr. Rashid says these options may be on the market within five to 10 years. But the treatments won’t reverse celiac disease or gluten-sensitivity.

“It seems that the cure will probably not be that one can eat everything,” said Dr. Rashid. Rather, treatment will protect people from small quantities of gluten.

Even without a cure, being gluten-free is becoming easier and more affordable.

There are more gluten-free products on the market, manufacturers are labeling food that contains gluten, and people with celiac disease are eligible for a gluten-free tax breaks.

Going gluten-free is hard at first but can lead to delicious and healthy eating. “One of the ancillary benefits of a gluten-free diet is that it makes you really think about what you’re eating,” said Yeh. “You’re forced to discover new foods.”

For Yeh, the initial difficulty of changing her lifestyle has been worth it. “I had been living with this brain fog for the past number of years, and I didn’t realize that I did until it was sort of lifted away from me. My pain went away.”

She is still playing her electric violin.

source: CBC