Is celiac disease worse in anemia sufferers?

“Current medical science describes diarrhea as a classical symptom of celiac disease, while anemia is described as an atypical or silent manifestation,” this according to Jefferson Adams in an article recently published on celiac.com.

I found this statement particularly interesting, especially considering that it was 20 years of chronic unexplained anemia that eventually led to my celiac diagnosis.

The article goes on to say that very little information exists that “accurately compares the severity of celiac disease between patients who present with anemia against those who present with diarrhea”.

Consequently, a research team affiliated with the Celiac Disease Center, Department of Internal Medicine at the Columbia University College of Physicians and Surgeons in New York embarked on a study to determine whether celiac disease is worse in anemia sufferers than people with diarrhea.

“For their study,” the article continues, “the researchers selected a study group of 727 patients from a database of celiac disease patients evaluated at a tertiary referral center between 1990 and 2011. They used the degree of villous atrophy and clinical and serologic parameters to determine the severity of the celiac disease for each patient.

“The team compared patients according to mode of presentation and sex. They also conducted age and sex-adjusted multi-variable analyses to assess the association between the mode of celiac disease presentation and cholesterol level, bone density, severity of Villous atrophy, erythrocyte sedimentation rate (ESR), and level of anti-tissue transglutaminase (anti-tTG).

“They found that just over three-quarters of the patients presented with diarrhea, while just under one-quarter presented with anemia; 92% of which was iron deficient anemia.

“Multiple regression analysis showed that celiac disease with anemia was associated with lower levels of total cholesterol (P=.02) and high-density lipoprotein (P=.002), and a higher ESR (P=.001) and level of anti-tTG (P=.01). In women only, celiac disease with anemia was associated with a lower level of cholesterol.

“Anemic patients were more than twice as likely to have severe villous atrophy and a low bone mass density at time they were diagnosed with celiac disease than were patients who presented with diarrhea.

The research concluded that “celiac disease patients who present with anemia have more severe disease than those who present with diarrhea”. It stated further that there seems to be sex-specific differences with respect to the connection between anemia and the various features of celiac disease, such as cholesterol.

In the 20 years leading up to my diagnosis, diarrhea never featured as a symptom and I can’t help wondering whether, had I been a diarrhea sufferer, this would have led to a quicker diagnosis. Then again, so many celiac sufferers who present with diarrhea are incorrectly diagnosed with IBS or similar ailments, so perhaps I should consider myself fortunate to have be diagnosed at all.

By the time I was diagnosed, the damage to my small intestine was so bad that my body could no longer absorb iron at all and I was forced to undergo intravenous iron transfusions at least once every two years. Additionally, I had become an ice-aholic, chewing ice cubes at a rate that drove my family crazy.

Today, almost three years later, I continue to enjoy the incredible lightness of being Glutenoptic, and am still free of more than just gluten. The journey can be tough at times, but it is most certainly worthwhile.

Source:

• Clin Gastroenterol Hepatol. 2013 Jun 8. pii: S1542-3565(13)00775-1. doi: 10.1016/j.cgh.2013.05.030.

 

Gwyneth Paltrow talks gluten-free in advance of Iron Man 3

Celiac.com 24 May 2013 – Gwyneth Paltrow is gluten-free and on a publicity swing as part of her role in Iron Man 3.

In an interview in Self magazine, Oscar winner Gwyneth Paltrow spoke a bit about the benefits of eating gluten-free, and about her gluten-free cook book due out next month.

The 40-year old actor explained how giving up gluten has changed her life for the better. For one thing, she says, she feels lighter and more relaxed. Before going gluten-free, Paltrow says she had “a lot of unexpressed anger. I made everyone else’s feelings more important than my own. I’d suck it up and then be alone in my car yelling at traffic or fighting with hangers in my closet when they got stuck together.”

Paltrow has been derided by some for perhaps being too strict with her children’s diets, by some for making her children a gluten-free diet, and by others for allowing them to break that diet.

But the “Iron Man” star explained to Dr. Mehmet Oz, that the dietary restrictions were due to her children’s allergies, rather than stern parenting style. She said that Moses, 6, “has very bad eczema and he’s allergic to gluten and she [daughter Apple, 8] is allergic to cow dairy.”

She adds that, at home, she tries “to make everything gluten-free for him because the difference in his comfort is unbelievable when he’s sticking to what he’s meant to be eating.”

Paltrow’s new cookbook, “It’s All Good,” details how she steers clear of processed grains when feeding her children, and goes out of her way to avoid gluten.

 

2012 in review

The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

600 people reached the top of Mt. Everest in 2012. This blog got about 3,700 views in 2012. If every person who reached the top of Mt. Everest viewed this blog, it would have taken 6 years to get that many views.

Click here to see the complete report.

 

I can so relate…

 

The top eight diseases related to Celiac (and how to reduce your risk of them)

February 07, 2012 by Zach Rachins

Celiac disease doesn’t just cause weight loss or gain, diarrhea, bloating and fatigue. It is linked to a variety of diseases and conditions, some of which can be life-threatening.

The good news?

A 100 per cent gluten-free diet will do wonders. Add nutritional support through supplementation, and you’ll be on the road to healing the intestinal damage from celiac disease while dramatically reducing your risk of developing many of the diseases associated with untreated celiac disease.

Here are the top eightdiseases related to celiac disease. If you have celiac, a gluten-free diet will dramatically reduce your risk of all of them. However, for those of you looking to treat celiac disease beyond the gluten-free diet, here is some additional guidance for reducing your risk of developing these diseases.

Dermatitis Herpetiformis (DH) – This is a skin manifestation of celiac disease that results in itchy blistery rashes. The most common sites for this rash are the elbows, knees and buttocks. People with this condition may or may not have digestive celiac symptoms. It can be resolved through a gluten-free diet, the strict use of gluten-free body care products, and specific antibiotics.

Osteoporosis – In untreated celiac disease, excess fat is lost in one’s bowel movements. This fat interferes with Vitamin D and calcium absorption, which in turn causes softening of the bones (osteomalacia) and bone density loss (osteoporosis). Make sure you’re getting plenty of calcium, vitamin D and magnesium through your diet or through supplementation. Adding a regimen of weight-bearing exercise will help as well.

Iron Deficiency Anemia – Caused by malabsorption, this is a common condition that results from celiac disease and can be addressed through improved nutrient absorption via intestinal healing. The gluten-free diet is paramount, but supplementation with things like zinc, glutamine and citrus bioflavonoids initiates and increases the speed at which your gut heals. Short-term iron supplementation may be necessary as well. Consume vitamin C-containing foods with iron-rich foods in order to improve iron absorption.

Depression and Anxiety – The cause of these conditions is not known but may be associated with malnutrition resulting from malabsorption, as well as neurological impacts of untreated celiac disease. Omega 3 fatty acids, B-complex vitamins, exercise and a balanced diet can help. There are also some new theories, and as times goes on, hopefully we’ll continue to see progress on this topic. It sure is a serious one.

Infertility and Recurring Miscarriage – Malabsorption of key nutrients contributes to these challenges. Fertility may be affected in men as well as women. Nutritional imbalances must be corrected, including malabsorption of zinc, selenium, iron, and folate. Supplementing with these nutrients may be necessary while the gut’s absorptive abilities are slowly improved through a gluten-free diet.

Lactose Intolerance – The inability to digest lactose, the sugar in milk products, is very common in celiacs due to intestinal damage. After a while on a gluten-free diet you may be able to digest it again. Anyone with lactose intolerance will benefit from probiotic supplementation, and some may be able to digest lower-lactose foods such as yogurt and hard cheeses in moderation.

Intestinal Cancer – Intestinal lymphoma and bowel cancer are the biggest risks for celiacs, and are most effectively addressed through gluten-free diet compliance. However, eating a diet based around fruits, vegetables and whole grains and containing minimal red meat may help reduce your risk factors. Needless to say, maintaining a healthy lifestyle complete with exercise and stress-reduction helps as well.

Neurological Disorders – From migraines to numbness, celiac patients report all types of neurological disturbance. These are best aided by diet compliance but can also be aided in some cases by vitamin B12 supplementation and prescription medications where necessary.

The number one goal for reducing one’s risk of any of these diseases is total compliance with the gluten-free diet. The second goal is to help the gut gradually heal and restore its ability to absorb nutrients, which can be attained via a balanced diet, probiotics, and supplements designed to help you meet your nutrient needs while you heal.

via Celiac Nutrition and Gluten Free Health Blog.

 

42 000 children may die every year from Coeliac Disease

3 August 2011: One of Africa’s and Asia’s biggest public health problems has had greater light shed on it through a study undertaken by researchers at Wits University and Umea University, Sweden, who have compiled the first global estimates of coeliac disease and associated mortality.

Their findings, published in the journal PLoS ONE, estimates that around 42 000 children may die every year from coeliac disease, mostly from the African and Asian continents.

Coeliac disease is an auto-immune disorder of the small intestine that occurs in genetically predisposed people of all ages from middle infancy onward. It is caused by a reaction to gliadin, a prolamin (gluten protein) found in wheat, and similar proteins found in other common grains such as barley and rye.

In the 1930s, before the discovery of the gluten-free diet as the way to manage coeliac disease, results from Great Ormond Street Hospital in London¹ showed very high mortality among children with coeliac disease. Mostly these days, the disease is well-managed by avoiding gluten. However in poorer settings, particularly where other diarrhoeal diseases are common, questions about gluten intolerance may not be raised, and consequently children may die.

“Coeliac disease may not be one of the world’s biggest killers, but it is a readily preventable cause of death. Much more awareness is needed in the poorer parts of the world – and in particular gluten-bearing food supplements for malnourished children need to be used in the knowledge that they could be harmful to the small proportion suffering from coeliac disease,” says Prof. Peter Byass, research team leader from the Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine at Umeå University.

Coeliac disease has emerged as an increasingly recognised public health problem over the last half-century, and is now seen as a global phenomenon, despite a profound lack of globally representative epidemiological data. Since children with coeliac disease commonly present with chronic diarrhoea and malnutrition, diagnosis is often overlooked, particularly in poorer settings where children often fail to thrive and water-borne infectious diarrhoeas are common. This is the first attempt to make global estimates of the burden of coeliac disease in childhood.

Building a model of childhood coeliac disease, the researchers took into account estimates of population prevalence, probability of non-diagnosis, and likelihood of mortality among the undiagnosed across all countries from 1970 to 2010, based around the few available data.

According to the model, in 2010 there were around 2.2 million children under five years of age living with coeliac disease. Among these children there could be 42 000 deaths related to coeliac disease annually. In 2008, deaths related to coeliac disease probably accounted for approximately 4% of all childhood diarrhoeal mortality.

The researchers found that although coeliac disease may only account for a small proportion of diarrhoeal mortality, these deaths are not preventable by applying normal diarrhoea treatment guidelines, which may even involve gluten-based food supplements. As other causes of diarrhoeal mortality decline, coeliac disease will become a proportionately increasing problem unless consideration is given to trying gluten-free diets for children with chronic diarrhoea and malnutrition.

The authors hope that increased awareness of the consequences of gluten intolerance will lead to better data and the saving of lives in the future.

To read the paper in PLoS one, click here

For further information contact Professor Kathleen Kahn at Kathleen.Kahn@wits.ac.za

Source: http://www.wits.ac.za/newsroom/newsitems/201108/13452/news_item_13452.html

 

Quick and yummy scrambled eggs

I woke up one morning feeling like scrambled eggs for breakfast, but wanted to make them a little more interesting. After surveying the contents of my fridge, I came up with the following recipe, which I think is just yum:

For a single serving, beat together two eggs  and one tablespoon of milk. Add salt and pepper to taste.

Strip the needles from a few sprigs of fresh thyme and add them to the egg mixture.

Heat a little olive oil in a pan over moderate heat and pour in the egg mixture and thyme. Scrape and fold the eggs until just before they are done the way you like it.

Crumble in the feta cheese and give the eggs another scrape and fold. Serve immediately while the cheese is still melting.

Enjoy.

 

Santa is clearly not gluten intolerant

 

Free at last! I’m free at last!

Hello, my name is Aurette and I’m glutenoptic. I have been gluten-free for seven months and 13 days.

I am also anemia-free, depression-free and most recently, anti-depressant-free.

Yes, it’s true. My psychiatrist has finally pronounced me “cured”, which means for the first time in more than eleven years I no longer have to rely on a drug in order to feel good. Liberating news indeed, and once again, I am astonished at how eliminating this protein composite from my diet has changed my life.

Granted, there are days when the aroma of freshly toasted bread makes my mouth water, and it’s really hard to resist the delicious cakes and other baked goodies provided at our weekly Sunday morning Church teas, but the benefits of just saying no are so monumental, it’s a no-brainer.

I love that I now wake up every morning feeling – awake. No more struggling to get out of bed and then trying to garner the energy required to get through the day. No more having to ingest all sorts of vitamin and energy supplements in attempt to acquire desperately needed get-up-and-go. Now my body does that of its own accord. It’s a completely new experience for me, and it feels wonderful.

Here comes the strange part. Much of my newly acquired energy is being put to use in the kitchen. Me! Cooking? Who woulda thunk it? But it’s true. I have developed a new interest in food preparation and spend a lot of my free time producing all sorts of new dishes. A while ago I even baked a chocolate cake – my first from scratch – and it turned out a success.

Living gluten-free is certainly not without its down sides, but if it means the difference between a significantly improved quality of life and one plagued with chronic anemia, depression and all the associated ailments, then I choose the former. Every time.

 

Djokovic: wheat and the tennis ace

Health24.com: US Open champion Novak Djokovic’s transformation from good player to supremo has set the world of tennis alight. Could his new wheat-free diet really have made such an impact? DietDoc has a closer look.

My hubby is an avid tennis and sports fan, so I have also been watching the television coverage of the US Open Tennis Championships for the past two weeks. It has been highly entertaining and surely the most amazing player of them all is Novak Djokovic. This man has set the world of tennis alight with his run of more than 65 wins, nine titles, four Grand Slam titles and his total transformation from a somewhat fragile player to an unstoppable tour de force.

What has changed?

Anyone who has been watching Novak’s metamorphosis, must be wondering what on earth changed in his life to permit him to become unstoppable. The commentators at Flushing Meadows and at many of his earlier matches this year, all mentioned that he has made changes to his diet and that these changes together with an improved training programme, have lifted Djokovic from a good player to the dizzying heights of a supremo.

Public deductions

According to the same commentators Novak has a wheat allergy and by simply avoiding wheat, he has written himself into the history books. As a nutritionist, I am of course pleased that nutrition is taking centre court, but I must admit that I am still a bit sceptical. I am also rather worried about the nutritional conclusions the public will arrive at.

It is a well known phenomenon that if sports stars or celebs announce that they are drinking a mixture of chilli and honey to lose weight or like Djokovic that they are avoiding wheat, desperate slimmers and other individuals who may be suffering from a variety of conditions, will follow suit. Wheat and carbohydrates are already the pariahs of the diet world, so the news about Djokovic’s supposed wheat aversion, will probably trigger another anti-carb movement, to the detriment of balanced nutrition.

Coeliac disease?

Intrigued, I did a Google search to see what theories are being put forward to explain Djokovic’s phenomenal performance. As predicted, many members of the public have jumped to the conclusion that Djokovic suffers from coeliac disease.

Now coeliac disease according to a fact sheet on “Food Allergy and Coeliac Disease” published by the Food Standards Agency of the UK Government (2006), is not an allergy, but an “autoimmune disease” (i.e. the body of a patient suffering from coeliac disease produces antibodies that attack its own tissues). The autoimmune reaction is initiated by gluten, a protein that is found in cereals such as wheat, rye, barley, oats, kamut and spelt.

Coeliac disease is diagnosed when a patient had undergone an endoscopy and a biopsy of the intestines has shown clear signs of coeliac disease. According to amost entertaining blog posted by Alex Gazzola (2011), who has published several books on food allergy, intolerance and coeliac disease, there is no evidence that Djokovic has undergone any of these investigations. I am inclined to agree with Alex Gazzola, because patients with coeliac disease have really serious, debilitating symptoms which if untreated for two decades would probably preclude a highly active sports career and have stunted our tennis star’s growth.

It is more likely that the World No 1 tennis player has a more general wheat sensitivity and/or that his general diet has just been fine tuned to exclude foods that contain wheat. This will of course automatically exclude other potential allergens such as colourants, flavourants, preservatives, yeast and other additives, which may, or may not, have been contributing to Djokovic’s previous tendency to run out of steam or go into a dramatic decline at crucial stages of a match. I suspect that he may have a more general allergy to wheat because in the past, he did exhibit symptoms such as breathing difficulties, irritated eyes and low energy levels.

Typical symptoms of coeliac disease

Patients who test positive for coeliac disease usually suffer from the following symptoms:

• nausea
• bloating
• tiredness
• constipation
• reduced or stunted growth
• skin problems

If you suspect that you, or a member of your family, may be suffering from coeliac disease then it is important to be tested because following a strict gluten-free diet (i.e. free of wheat, rye, barley and oats, as well as the lesser known and used cereals, kamut and spelt) is much more difficult and complicated than avoiding wheat alone. Patients with coeliac disease need to be counselled and guided by aregistered dietician so that they do not inadvertently ingest gluten and trigger their debilitating symptoms. In addition, the dietician will have to ensure that young coeliac patients do not develop deficiencies of essential nutrients, which will further retard their growth.

Importance of correct diagnosis

Besides the above mentioned problems, obtaining a correct diagnosis will help to identify those patients you have other digestive problems such as Irritable Bowel Syndrome (IBS), milk and dairy intolerance, or a deficiency of digestive enzymes, which may not require elimination of wheat. Each condition has its specific diet. For example,  patients with milk intolerance need to cut out milk and dairy products, while patients with constipation-linked IBS may need to increase their intake of insoluble dietary fibre which is specifically found in wholewheat products (i.e. these patients generally need to increase their wheat intake!).

In all these cases, patients who cut out food groups at random after self-diagnosis, may expose themselves to deficiencies, which can in turn lead to negative consequences. Anyone who is diagnosed with a milk intolerance or allergy would need to take extra calcium supplements to compensate for the loss of calcium from their diets. Patients who avoid wheat may develop severe constipation because they have eliminated their prime source of insoluble dietary fibre which stimulates peristalsis and ensures regularity.

Consequently it is safer and more sensible if you have the necessary examinations and tests to determine what condition you suffer from and then to consult a registered dietitian to assist you not only to avoid the offending foods, but to compensate for lost nutrients resulting from an avoidance diet.

Coeliac disease and slimming

A Health24 reader recently asked me for a slimming diet that is tailored to the needs of coeliac patients. The basic principles for weight loss in coeliac patients are to reduce total energy intake by eating less or smaller portions of your permitted foods, cutting down on fats and doing regular exercise. Once again I would recommend that coeliac patients should consult their dieticians when they need to lose weight, because many standard slimming aids may contain gluten (e.g. most diet shakes and slimming bars). The dietician will adjust the energy content of your coeliac diet to help you lose weight.

To find a registered dietician in your area, visit the Association for Dietetics in SA (Adsa) website and click on “Find a Dietician”. You can also phone the Adsa Head Office at 011 789 6621 or 011 789 1383, to obtain the contact details of your nearest dietician.

Djokovic does it again!

I watched the exhilarating US Open Men’s Finals match between Djokovic and Raffa Nadal, and Novak did it again! Djokovic won the match beating Nadal with a blistering score of 6-4, 6-2, 6-7, 6-1, to garner his third  Grand Slam title this year – a performance to remember.

If this is what a change in diet can do for a champion, then you too can achieve great goals such as losing weight and improving your health by eating the correct diet. Just keep in mind that you must find out which dietary changes will benefit your condition with the aid of trained experts and not blindly follow the lead of the rich and famous when it comes to diets.

– (Dr IV van Heerden, DietDoc, September 2011)

References

(Gazzola R, 2011. Novak Djokovic: Wimbledon champion, gluten free, probably not a coeliac. Coeliac, Food Allergy and Intolerance Ink. 4 July 2011.http://foodallergyandintolerance.blogspot.com/; Food Standards Agency (2006). Food intolerance and coeliac disease. Food Standards Agency, September 2006 )

 Any questions? Ask DietDoc

 Read more:

Wheat allergy
Allergy, intolerance: which is it?
Coeliac disease