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Could Less Cigarette Smoking Mean More Celiac Disease?

Celiac.com 12/07/2015 - Could population changes in smoking habits help explain the change in incidence and prevalence of celiac disease?

Photo: Jefferson AdamsCould lower rates of cigarette smoking be contributing to higher rates of celiac disease?

It is pretty well documented that cigarette smokers have lower natural rates of celiac disease than the non-smoking population, which implies that tobacco might offer some measure of prevention with regard to celiac disease.

Now, a gastroenterologist is asking whether a reduction in public smoking levels might be associated with a rise in rates of celiac disease.

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In a letter to the editors of the American Journal of Gastroenterology regarding the study "Incidence and prevalence of celiac disease and dermatitis herpetiformis in the UK over two decades: population-based study" by West et al., Dr. S. Veldhuyzen van Zanten, MD, PhD, of the Division of Gastroenterology, University of Alberta in Edmonton, Alberta, Canada, wonders whether lower rates of cigarette smoking in the preceding decades "might help explain the study findings."

Data from several studies regarding reduced celiac rates in cigarette smokers offer support for Dr. van Zanten’s line of thinking; including data that show a new diagnosis of celiac disease is made significantly less frequently in smokers than in non-smokers.

Interestingly, there also is some evidence that cigarette smoking might actually mask the clinical manifestations of celiac disease rather than prevent its occurrence. Either way, Dr. van Zanten's hypothesis would cast some interesting light on celiac disease if proven correct.

The good news is that Dr. van Zanten’s hypothesis is easy to test. Because Canada has such a large health care database, they can easily compare rates of smoking and celiac diagnosis, and adjust for necessary factors to give a better picture of any possible connection.

Sources:

  • Am J Gastroenterol. doi: 10.1038/ajg.2014.345
  • West J , Fleming KM , Tata LJ et al. Incidence and prevalence of celiac disease and dermatitis herpetiformis in the UK over two decades: population-based study . Am J Gastroenterol 2014 ; 109 : 757 – 68 
  • Snook JA , Dwyer L , Lee-Elliott C et al. Adult coeliac disease and cigarette smoking . Gut 1996 ; 39 : 60 – 2 .
  • Lear JT , English JSC . Adult coeliac disease, dermetitis herpetiformis and cigarette smoking. Gut 1997 ; 40 : 289 .
  • van Zanten SJOV . Case Report: Recurrent diarrhea and weight loss associated with cessation of smoking in a patient with undiagnosed celiac disease . Gut 2001 ; 49 : 588.
  • Office for National Statistics UK. Smoking prevalence among adults has declined by half since 1974. Part of General Lifestyle Survey, 2011. Released: 28 March 2013. http://www.ons.gov.uk/ons/rel/ghs/general-lifestyle-survey/2011/sty-smoking-report.html 

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3 Responses:

 
David
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said this on
16 Dec 2015 8:45:27 PM PDT
Well, I for one don't fit the model. Used to be a cigarette addict and have DH. Diagnosed at 50.

 
Loretta
Rating: ratingfullratingfullratingfullratingfullratingfull Unrated
said this on
18 Dec 2015 4:38:47 PM PDT
Smoke so you don't get Celiac? Ummmm...STUPID! I smoke and I have celiac disease. I also react to all in the night shade family when eaten. Tobacco is a night shade but my stomach doesn't hurt when I smoke. I can't cure the damage to my lungs but, I can make my gut better by not ingesting gluten (actually gliadin). The fact that I smoke indeed may have masked my symptoms of celiac.

 
Jefferson
Rating: ratingfullratingfullratingfullratingfullratingfull Unrated ( Author)
said this on
29 Dec 2015 12:30:15 PM PDT
The article doesn't say that smokers can't get celiac disease. Neither does the doctor's letter. The doctor's letter simply notes a correlation between the decrease in the number of smokers and the rise in celiac disease, and notes several studies that point to tobacco possibly providing some protection against celiac disease, and suggests following it up to prove or disprove. He also notes your last sentence: Interestingly, there also is some evidence that cigarette smoking might actually mask the clinical manifestations of celiac disease rather than prevent its occurrence.




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It took me 20 years or more Barry so I wouldn't claim any great insight on this I had a 'eureka' moment, up until then I was walking around with multiple symptoms and not connecting any dots whatsoever. It is very, very difficult to diagnose and that's something that's reflected in so many of the experiences detailed here. A food diary may help in your case. It helped me to connect the gaps between eating and onset. It could help you to track any gluten sources should you go gluten free. It is possible for your reactions to change over time. As to whether its celiac, that's something you could explore with your doctor, stay on gluten if you choose to go that way. best of luck! Matt

I took Zoloft once. Loved it until it triggered microscopic colitis (colonoscopy diagnosed it). Lexapro did the same. However, I have a family member who is fiagnosed celiac and tolerates Celexa well.

Thanks for the update and welcome to the club you never wanted to join! ?

Jmg, I am glad you were able to come to the realisation that the culprit was in fact gluten. For me its not so simple. IBS runs in the family, as do several food intolerances. Its just in the last while that I can finally reach the conclusion that for me its gluten. The fact that it is a delayed effect-several hours after, made it harder. Friday I had some KFC, felt great. Saturday evening felt sleepy, Sunday felt awful and my belly was huge. I think I have gone from mildly sensitive to full blown celiac over the course of five years-if that possible. Thanks for all your help.

I thought I'd take a moment to provide an update, given how much lurking I've done on these forums the last year. It took a long time, but I've since had another gastroenterologist visit, many months of eating tons of bread, and an endoscopy where they took several biopsies. I have to say, the endoscopy was a super quick and efficient experience. During the procedure they let me know that it looked somewhat suspicious, causing them to take many biopsies, and then did comprehensive blood work. About a month later, I received a call telling me that the TTG came back positive a second time, and that the biopsies were a mix of negative (normal) results and some that were positive (showing blunting of the villi). As a result, I've been given a celiac diagnosis. It's been about a month now that I've been eating gluten free. Not sure if I'm really feeling all that different yet. It's a bit twisted to say, but in some way I was hoping for this diagnosis ? thinking how nice it would be to have an explanation, a plan of action, and feeling better. It's certainly no small change to be totally gluten free, but I'm hopeful.