• Join our community!

    Do you have questions about celiac disease or the gluten-free diet?

  • Ads by Google:
     




    Get email alerts Subscribe to Celiac.com's FREE weekly eNewsletter

    Ads by Google:



       Get email alertsSubscribe to Celiac.com's FREE weekly eNewsletter

  • Member Statistics

    77,315
    Total Members
    3,093
    Most Online
    Jane.cinicola
    Newest Member
    Jane.cinicola
    Joined
  • 0

    What if Fad Gluten-free Diets Aren't so Fad After All?


    Jefferson Adams


    • Are fad gluten-free dieters getting more benefits than originally suspected?


    Image Caption: Photo: CC--mattwi1s0n

    Celiac.com 02/15/2017 - There's been a lot of talk in the media and among researchers about the large numbers of people who adopt a gluten-free diet without a celiac disease diagnosis. Many of these dieters are regarded with a bit of suspicion. The question areises as to whether gluten was causing them any problems that could be improved by a gluten-free diet. Most have been regarded as simple fad dieters.


    Ads by Google:




    ARTICLE CONTINUES BELOW ADS
    Ads by Google:



    Well, what if the gluten-free fad isn't such a fad after all? What if many of those without celiac disease who eat gluten-free are actually gaining some heretofore undiscovered benefits?

    That's the intriguing possibility raised by the latest study from the Mayo Clinic's Dr. Joseph Murray, and his colleagues at the forefront of research in celiac disease and gluten intolerance. Dr. Murray's colleagues and coauthors include Rok Seon Choung, MD, PhD, Aynur Unalp-Arida, MD, PhD, Constance E. Ruhl, MD, PhD, Tricia L. Brantner, BS, and James E. Everhart, MD.

    Today, according to the team's research, published this month in the journal Mayo Clinic Proceedings, some 3.1 million Americans currently avoid gluten without a celiac diagnosis for celiac disease. That number tripled between 2009 and 2014, while the number of cases of celiac disease stayed flat.

    When we designed this study 10 years ago, we didn't think to ask why people avoid gluten, because no one avoided gluten without a celiac diagnosis, said Murray. So, could these folks be avoiding gluten for legitimate health reasons? Very possibly, says Murray. There's definitely growing evidence that severe non-celiac gluten sensitivities exist.

    Patients with these sensitivities frequently experience intestinal problems, as well as fatigue, stomachaches and a sense of mental fogginess. And while researchers don't understand the underlying mechanism, clinical studies have shown that a gluten-free diet does relieve symptoms in many gluten-sensitive non-celiac patients. It's possible that gluten may play some role in inflammation, though this is unproven. It's also possible that non-celiacs who cut gluten from their diet might also cut out other irritants and allergens.

    The researchers call for further investigation of long-term health consequences of a gluten-free diet in people without celiac disease.

    How about you? Do you or someone you know not have celiac disease, but avoid gluten?

    Source:

    0


    User Feedback

    Recommended Comments

    TEST Driven partly by a perception among consumers that gluten-free foods are healthier than their non-gluten-free counterparts, the global gluten-free packaged food market is projected to grow at a compound annual growth rate of approximately 6% between 2015 and 2019, according to a recent market report from Technavio....

    Share this comment


    Link to comment
    Share on other sites
    Guest Mary Thorpe

    Posted

    I am one of those not diagnosed with celiac disease but have been gluten free for 19 years, since before it became popular. After a double round of antibiotics following a root canal, I developed diarrhea. When it didn't stop after going off the antibiotics, after a month I sought help from my GP. She was no help. I started experimenting with my diet. Finally I heard that wheat affected some people which I never would have thought. I went off, and bingo, the diarrhea stopped (by this time it was black), a rash that was climbing up my legs vanished and after a couple of months I realized I hadn't had a migraine, something that had plagued me once or twice a month for 30 years. I have a list of things that no longer happen, like canker sores, heart arrhythmias, esophageal spasms, twitching eye muscles, muscle spasms in my back, bronchitis after a cold. That´s what I remember off the top of my head. When I get gluten accidentally I get a migraine in a day or two and often get physically ill if something is going around. Otherwise, I don't get sick. I take no prescription drugs, only vitamins. So, I am one of those that Dr. Murray is talking about, though maybe I had undiagnosed celiac disease. I'll never know because I'm not tempted to go on gluten to get tested properly though I do miss chewy bread. As the article implies, we don´t need it. It's poor man's food. We eat like kings without it.

    Share this comment


    Link to comment
    Share on other sites

    I avoid gluten because I was having digestive issues which subsided when I went gluten free. I have no need to get tested when the proof is in avoiding gluten. If I eat gluten I immediately have a reaction. Avoid gluten and I am fine. Celiac or not doesn't matter to me. I just avoid it altogether and I feel much better. Dairy products I avoid also due to mucus production.

    Share this comment


    Link to comment
    Share on other sites
    Guest Gillian

    Posted

    I have Hashimotos hypothyroid (age 68) whilst suffering with intestinal problems I surfed the net for remedies, I found that a gluten-free diet was recomended for Hashi sufferers so decided to try it for a few days.....after 3 days my intestinal problems subsided, my lifelong migraines disappeared and I felt better than I had for months so I continued the diet. One year on I accidently ate something with gluten and had an occurence of Dermatitis Hepetiformis, after this my endocrinologist assumes I am celiac. I do not wish to have a bi-opsy and so am not officially Celiac but after almost 5 years on a gluten-free diet I have never felt better!

    Share this comment


    Link to comment
    Share on other sites


    Your content will need to be approved by a moderator

    Guest
    You are commenting as a guest. If you have an account, please sign in.
    Add a comment...

    ×   Pasted as rich text.   Paste as plain text instead

      Only 75 emoji are allowed.

    ×   Your link has been automatically embedded.   Display as a link instead

    ×   Your previous content has been restored.   Clear editor

    ×   You cannot paste images directly. Upload or insert images from URL.


  • Popular Contributors

  • Ads by Google:

  • Who's Online   13 Members, 1 Anonymous, 1,022 Guests (See full list)

  • Related Articles

    Jefferson Adams
    Celiac.com 04/14/2016 - Driven partly by a perception among consumers that gluten-free foods are healthier than their non-gluten-free counterparts, the global gluten-free packaged food market is projected to grow at a compound annual growth rate of approximately 6% between 2015 and 2019, according to a recent market report from Technavio.
    In addition to health and wellness, Technavio identifies demand from millennials and increased marketing activities as prime emerging trends driving the gluten-free market. Once seen as medical products for gluten intolerant people gluten-free products have evolved into "a lifestyle choice across all customer segments," says Brijesh Kumar Choubey, a lead food industry analyst at Technavio.
    Many consumers associate gluten-free foods with better energy energy levels, and with weight loss. Technavio cites a 2013 market survey conducted by Monash University that revealed nearly 80% people buying gluten-free products report perceived health benefits as the main reason.
    Just five to ten years ago, buyers of gluten-free foods were likely to be older. Today, younger consumers, specifically 32% of millennials, and 38% of Generation Z, said they would pay higher prices for gluten-free products.
    Bakery products, cookies and snacks are the top gluten-free foods among this consumer group, said Technavio.
    Driven by growing demand, and by new product development, the bakery segment leads the gluten-free packaged food market with 64% market share in 2014. Technavio predicts the segment will outpace the rest of the market through the end of 2019, growing at a rate of about 7%.
    Increased marketing activities from big and small manufacturers alike is the last key driver Technavio cites as a driver for gluten-free packaged food demand.
    An example is Heinz, which in 2014 launched a social media campaign for its gluten-free pasta and sauces, Technavio said.
    Source:
    Foodbusinessnews.net

    Jefferson Adams
    Celiac.com 08/11/2016 - In many ways, millennials are the special diet generation. To drive that point home, a new survey shows that a full one in five 18-34 year olds now have a food intolerance. That means 20% of millennials must either avoid certain foods, and/or eat special dietary foods to be healthy.
    So, while one in three consumers are actively avoiding gluten right now, that number rises to 40% with millennials.
    With the gluten-free market now worth GBP 210m, the Swedish bakers are calling upon chefs, caterers and operators to take a second look at their offerings. Andrew Ely, managing director at gluten-free cake maker Almondy, says that an in-house company survey confirms that more and more consumers are avoiding gluten, with three quarters of people having bought a gluten-free product in the last year.
    Meanwhile, market researcher Mintel projects annual gluten-free market growth to increase another 50% by 2019. The research also found that over 25% of people would be more likely to order a gluten-free cake than a non-gluten-free cake, making celiac friendly desserts a solid bet for boosting profits and driving sales of hot drinks.
    Companies like Almondy are perched to take full advantage of the market. A recent survey showed that nearly half of those with a gluten-intolerance had heard of the Swedish cake company, while a staggering 71% of millennials would buy Almondy's globally best-selling branded cakes, Daim Cake and Toblerone Cake.
    Stay tuned for more gluten-free market research and food trends.

    Jefferson Adams
    Celiac.com 10/07/2016 - Sales of gluten-free products continue to rise, with global the market expected to approach $5 billion by 2021, up from $2.84 billion in 2014, according to a new report from Transparency Market Research.
    Analysts are projecting annual revenue growth of about 7.7% across the sector from 2015 to 2021. They also project that, by 2021, North America will become the fastest growing gluten-free market, though Europe still currently dominates with a 52.5% share. Rising consumer belief in the potential health benefits of gluten-free products is a main factor driving growth in the gluten-free market. That, together with more cases of celiac disease and/or gluten sensitivity, increased use of gluten-free products as a weight management tool. Also a major factor is the high demand for gluten-free bakery products, the largest category in the gluten-free market.
    The sharp growth in gluten-free foods continues, even as scientists question its effectiveness for people with out celiac disease. The fact that there is no evidence to support the idea that people without celiac disease gain any health benefits from gluten-free products, seems to have little impact, and so the trend continues apace. Never ones to miss major consumer trends, companies from PepsiCo Quaker to Snyder's-Lance to General Mills' cereal brands are working to offer gluten-free options.
    The move by manufacturers toward more gluten-free products is probably a wise one. Even though nearly half of consumers claim gluten-free food is a fad, nearly one-in-four consumers said they consumed gluten-free products last year, and the demand for gluten-free products shows no sign of slowing down.

    Jefferson Adams
    Celiac.com 01/27/2017 - US retail sales of gluten-free products rose 11% in 2015, and are predicted to rise a more modest 6% to $1.66bn in 2016, according to a new report from Packaged Facts, which predicts that as the market matures, growth rates are "expected to slow considerably."
    To provide context, Packaged Facts notes that growth rates have slowed from 81% in 2013 and 30% in 2014 to 11% in 2015, and predicts they will settle at a steady 5-6% a year in the next five years.
    Unlike some other market research reports, which include everything with a gluten-free label in their market definitions, even those product that typically contain no gluten, Packaged Facts does not. The Packaged Facts reports are notable because they focus more closely on traditionally grain-based product categories: Salty Snacks, Crackers, Fresh Bread, Pasta, Cold (ready-to-eat) Cereal, Baking Mixes, Cookies, Flour, and Frozen Bread/Dough.
    They do not cover "naturally gluten-free foods," such as potato chips or ready-to-eat popcorn, and do not include things like gluten free frozen pizza, lasagna, stuffing mix or entrees
    The latest report notes that, while the market is maturing, it is still quite fragmented. Packaged Facts notes that only Hain Celestial and Pinnacle Foods have market shares exceeding 10%.
    Read more about the Packaged Facts report.

  • Recent Articles

    Jefferson Adams
    Celiac.com 06/18/2018 - Celiac disease has been mainly associated with Caucasian populations in Northern Europe, and their descendants in other countries, but new scientific evidence is beginning to challenge that view. Still, the exact global prevalence of celiac disease remains unknown.  To get better data on that issue, a team of researchers recently conducted a comprehensive review and meta-analysis to get a reasonably accurate estimate the global prevalence of celiac disease. 
    The research team included P Singh, A Arora, TA Strand, DA Leffler, C Catassi, PH Green, CP Kelly, V Ahuja, and GK Makharia. They are variously affiliated with the Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Lady Hardinge Medical College, New Delhi, India; Innlandet Hospital Trust, Lillehammer, Norway; Centre for International Health, University of Bergen, Bergen, Norway; Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Gastroenterology Research and Development, Takeda Pharmaceuticals Inc, Cambridge, MA; Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; Department of Medicine, Columbia University Medical Center, New York, New York; USA Celiac Disease Center, Columbia University Medical Center, New York, New York; and the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
    For their review, the team searched Medline, PubMed, and EMBASE for the keywords ‘celiac disease,’ ‘celiac,’ ‘tissue transglutaminase antibody,’ ‘anti-endomysium antibody,’ ‘endomysial antibody,’ and ‘prevalence’ for studies published from January 1991 through March 2016. 
    The team cross-referenced each article with the words ‘Asia,’ ‘Europe,’ ‘Africa,’ ‘South America,’ ‘North America,’ and ‘Australia.’ They defined celiac diagnosis based on European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines. The team used 96 articles of 3,843 articles in their final analysis.
    Overall global prevalence of celiac disease was 1.4% in 275,818 individuals, based on positive blood tests for anti-tissue transglutaminase and/or anti-endomysial antibodies. The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% in 138,792 individuals. That means that numerous people with celiac disease potentially remain undiagnosed.
    Rates of celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was 0.6% in female vs 0.4% males. Celiac disease was significantly more common in children than adults.
    This systematic review and meta-analysis showed celiac disease to be reported worldwide. Blood test data shows celiac disease rate of 1.4%, while biopsy data shows 0.7%. The prevalence of celiac disease varies with sex, age, and location. 
    This review demonstrates a need for more comprehensive population-based studies of celiac disease in numerous countries.  The 1.4% rate indicates that there are 91.2 million people worldwide with celiac disease, and 3.9 million are in the U.S.A.
    Source:
    Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037.

    Jefferson Adams
    Celiac.com 06/16/2018 - Summer is the time for chips and salsa. This fresh salsa recipe relies on cabbage, yes, cabbage, as a secret ingredient. The cabbage brings a delicious flavor and helps the salsa hold together nicely for scooping with your favorite chips. The result is a fresh, tasty salsa that goes great with guacamole.
    Ingredients:
    3 cups ripe fresh tomatoes, diced 1 cup shredded green cabbage ½ cup diced yellow onion ¼ cup chopped fresh cilantro 1 jalapeno, seeded 1 Serrano pepper, seeded 2 tablespoons lemon juice 2 tablespoons red wine vinegar 2 garlic cloves, minced salt to taste black pepper, to taste Directions:
    Purée all ingredients together in a blender.
    Cover and refrigerate for at least 1 hour. 
    Adjust seasoning with salt and pepper, as desired. 
    Serve is a bowl with tortilla chips and guacamole.

    Dr. Ron Hoggan, Ed.D.
    Celiac.com 06/15/2018 - There seems to be widespread agreement in the published medical research reports that stuttering is driven by abnormalities in the brain. Sometimes these are the result of brain injuries resulting from a stroke. Other types of brain injuries can also result in stuttering. Patients with Parkinson’s disease who were treated with stimulation of the subthalamic nucleus, an area of the brain that regulates some motor functions, experienced a return or worsening of stuttering that improved when the stimulation was turned off (1). Similarly, stroke has also been reported in association with acquired stuttering (2). While there are some reports of psychological mechanisms underlying stuttering, a majority of reports seem to favor altered brain morphology and/or function as the root of stuttering (3). Reports of structural differences between the brain hemispheres that are absent in those who do not stutter are also common (4). About 5% of children stutter, beginning sometime around age 3, during the phase of speech acquisition. However, about 75% of these cases resolve without intervention, before reaching their teens (5). Some cases of aphasia, a loss of speech production or understanding, have been reported in association with damage or changes to one or more of the language centers of the brain (6). Stuttering may sometimes arise from changes or damage to these same language centers (7). Thus, many stutterers have abnormalities in the same regions of the brain similar to those seen in aphasia.
    So how, you may ask, is all this related to gluten? As a starting point, one report from the medical literature identifies a patient who developed aphasia after admission for severe diarrhea. By the time celiac disease was diagnosed, he had completely lost his faculty of speech. However, his speech and normal bowel function gradually returned after beginning a gluten free diet (8). This finding was so controversial at the time of publication (1988) that the authors chose to remain anonymous. Nonetheless, it is a valuable clue that suggests gluten as a factor in compromised speech production. At about the same time (late 1980’s) reports of connections between untreated celiac disease and seizures/epilepsy were emerging in the medical literature (9).
    With the advent of the Internet a whole new field of anecdotal information was emerging, connecting a variety of neurological symptoms to celiac disease. While many medical practitioners and researchers were casting aspersions on these assertions, a select few chose to explore such claims using scientific research designs and methods. While connections between stuttering and gluten consumption seem to have been overlooked by the medical research community, there is a rich literature on the Internet that cries out for more structured investigation of this connection. Conversely, perhaps a publication bias of the peer review process excludes work that explores this connection.
    Whatever the reason that stuttering has not been reported in the medical literature in association with gluten ingestion, a number of personal disclosures and comments suggesting a connection between gluten and stuttering can be found on the Internet. Abid Hussain, in an article about food allergy and stuttering said: “The most common food allergy prevalent in stutterers is that of gluten which has been found to aggravate the stutter” (10). Similarly, Craig Forsythe posted an article that includes five cases of self-reporting individuals who believe that their stuttering is or was connected to gluten, one of whom also experiences stuttering from foods containing yeast (11). The same site contains one report of a stutterer who has had no relief despite following a gluten free diet for 20 years (11). Another stutterer, Jay88, reports the complete disappearance of her/his stammer on a gluten free diet (12). Doubtless there are many more such anecdotes to be found on the Internet* but we have to question them, exercising more skepticism than we might when reading similar claims in a peer reviewed scientific or medical journal.
    There are many reports in such journals connecting brain and neurological ailments with gluten, so it is not much of a stretch, on that basis alone, to suspect that stuttering may be a symptom of the gluten syndrome. Rodney Ford has even characterized celiac disease as an ailment that may begin through gluten-induced neurological damage (13) and Marios Hadjivassiliou and his group of neurologists and neurological investigators have devoted considerable time and effort to research that reveals gluten as an important factor in a majority of neurological diseases of unknown origin (14) which, as I have pointed out previously, includes most neurological ailments.
    My own experience with stuttering is limited. I stuttered as a child when I became nervous, upset, or self-conscious. Although I have been gluten free for many years, I haven’t noticed any impact on my inclination to stutter when upset. I don’t know if they are related, but I have also had challenges with speaking when distressed and I have noticed a substantial improvement in this area since removing gluten from my diet. Nonetheless, I have long wondered if there is a connection between gluten consumption and stuttering. Having done the research for this article, I would now encourage stutterers to try a gluten free diet for six months to see if it will reduce or eliminate their stutter. Meanwhile, I hope that some investigator out there will research this matter, publish her findings, and start the ball rolling toward getting some definitive answers to this question.
    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
    Celiac.com 06/14/2018 - Refractory celiac disease type II (RCDII) is a rare complication of celiac disease that has high death rates. To diagnose RCDII, doctors identify a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs). 
    However, researchers really don’t have much data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023

    Jefferson Adams
    Celiac.com 06/13/2018 - There have been numerous reports that olmesartan, aka Benicar, seems to trigger sprue‐like enteropathy in many patients, but so far, studies have produced mixed results, and there really hasn’t been a rigorous study of the issue. A team of researchers recently set out to assess whether olmesartan is associated with a higher rate of enteropathy compared with other angiotensin II receptor blockers (ARBs).
    The research team included Y.‐H. Dong; Y. Jin; TN Tsacogianis; M He; PH Hsieh; and JJ Gagne. They are variously affiliated with the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School in Boston, MA, USA; the Faculty of Pharmacy, School of Pharmaceutical Science at National Yang‐Ming University in Taipei, Taiwan; and the Department of Hepato‐Gastroenterology, Chi Mei Medical Center in Tainan, Taiwan.
    To get solid data on the issue, the team conducted a cohort study among ARB initiators in 5 US claims databases covering numerous health insurers. They used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy‐related outcomes, including celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy. In all, they found nearly two million eligible patients. 
    They then assessed those patients and compared the results for olmesartan initiators to initiators of other ARBs after propensity score (PS) matching. They found unadjusted incidence rates of 0.82, 1.41, 1.66 and 29.20 per 1,000 person‐years for celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy respectively. 
    After PS matching comparing olmesartan to other ARBs, hazard ratios were 1.21 (95% CI, 1.05‐1.40), 1.00 (95% CI, 0.88‐1.13), 1.22 (95% CI, 1.10‐1.36) and 1.04 (95% CI, 1.01‐1.07) for each outcome. Patients aged 65 years and older showed greater hazard ratios for celiac disease, as did patients receiving treatment for more than 1 year, and patients receiving higher cumulative olmesartan doses.
    This is the first comprehensive multi‐database study to document a higher rate of enteropathy in olmesartan initiators as compared to initiators of other ARBs, though absolute rates were low for both groups.
    Source:
    Alimentary Pharmacology & Therapeutics