The research team included T. A. Kabbani, A. Goldberg, C. P. Kelly, K. Pallav, S. Tariq, A. Peer, J. Hansen, M. Dennis & D. A. Leffler. They are affiliated with the Department of Medicine and Division of Gastroenterology at Beth Israel Deaconess Medical Center in Boston, Massachusetts.

Diagnosis for celiac disease is on the rise, and many people who are diagnosed experience weight changes once they adopt a gluten-free diet. There's a pretty good amount of study data on weight change on a gluten-free diet, but a very limited amount of data regarding changes in body mass.

The researchers wanted to look at a large population of people with celiac disease, who followed a gluten-free diet to better understand changes in body mass index (BMI) following celiac diagnosis.

To do this, they looked at a total of 1018 patients with biopsy confirmed celiac disease. The patients had all previously visited the Beth Israel gastroenterology clinic in Boston.

The team recorded data for initial and follow-up BMIs, and used an expert dietitian to assess patient compliance with a gluten-free diet. They found a total of 679 patients with at least two recorded BMIs and GFD adherence data, and used data from those patients in their study. The average amount of time from first BMI measurement to follow-up measurement was 39.5 months.

When they compared the results against data for the general population, they found that celiac disease patients on a gluten-free diet were significantly less likely to be overweight or obese (32% vs. 59%, P < 0.0001).

They also found that average body mass increased significantly after patients adopted a gluten-free diet (24.0 to 24.6; P < 0.001). Overall, 21.8% of patients with normal or high BMI at study entry increased their BMI by more than two points.

The results of this study show that celiac disease patients on a gluten-free diet have lower BMI than the regional population at diagnosis, but that BMI increases with a gluten-free diet, especially in those who follow the diet closely.

Still, even though overall risk of obesity is lower than the regular population, once celiac patients adopt a gluten-free diet, 15.8% of patients move from a normal or low BMI class into an overweight BMI class, and 22% of patients overweight at diagnosis gain weight.

As a result, the study team feels that weight maintenance counseling should be an integral part of celiac dietary education.

Source:

• Open Original Shared Link

A research team recently set out to assess the frequency of obesity in newly diagnosed celiac disease.

The research team included Elizabeth Tucker, Kamran Rostami, Sudhakaran Prabhakaran, and Daivid Al Dulaimi. They are affiliated variously with the Institute of Health and Society of Worcester University, School of Clinical and Experimental Medicine in Worcester, the University of Birmingham, and the department of Gastroenterology at Alexandra Hospital in Redditch, in the United Kingdom.

The research team wanted to assess the frequency of obesity in newly diagnosed celiac disease.

To do so, they reviewed dietetic records and patient demographic of people with celiac disease, along with initial assessment date, and Body Mass Index (BMI) recorded and statistically analyzed.

In all, they reviewed data for 187 celiac disease patients diagnosed between 1999 and 2009. Of those, 127 patients were female (68%) and 60 male (32%), a ratio of 2 to 1.

Patients ranged in age from 18 to 87 years of age, with an average age of 54 years.

BMI inter-quartile range (IQR) ran from 21.5 to 28.1, with an average BMI of 23.6. IQR was 21.8 to 27.3 for men, with an average BMI of 23.9.

For females, the BMI IQR ran from 21.4 to 28.6, with an average of 23.2. Overall, 83 patients (44%) registered a BMI of 25 or above.

The team found no significant difference gender, age or year of referral among patients with a BMI of 25 or above.

Twenty-five patients (13 %) had a BMI of 30 or above. Of those, twenty were female, and ranged in age from 18 to 71 years old, with an average age of 56 years.

In all, 11% of females registered a BMI of 30 or more, compared with only 3% males, a 5 to 1 ratio. Only 5 patients (3%) had a BMI below 18.5.

They found that nearly half of those diagnosed with celiac disease registered with a BMI of 25 or over. Compared to males, females showed a wider range of BMI and were more likely to be obese, registering a BMI of 30 or more.

Source:

• Open Original Shared Link

Celiac.com 03/19/2012 - A clinical gastroenterology research team recently weighed in on the practice of using weight as a factor to screen for celiac disease. They are calling for doctors to ignore body-mass when assessing patients for possible celiac disease screening.

The team was made up of Fabio Meneghin, Dario Dilillo, Cecilia Mantegazza, Francesca Penagini, Erica Galli, Giulia Ramponi, and Gian Vincenzo Zuccotti. They are affiliated with the Department of Pediatrics of the Università di Milano Luigi Sacco Hospital in Milan, Italy.

The team argues that, more and more, people with clinical celiac disease are presenting widely varied symptoms, while classic gastrointestinal symptoms like diarrhea or failure to thrive are becoming less frequent at diagnosis.

In fact, data shows that symptoms once considered to be atypical are now appearing at least as often as classical symptoms related to nutritional malabsorption.

Recent studies and case reports show that the expected clinical-condition of malnutrition, typical in a disease where there is a disorder of absorption, is less frequent than in the past. Meanwhile, overweight and even obesity are increasingly common in people with as yet undiagnosed celiac disease.

The team points out that obesity has become the most prevalent nutritional disorder among children and adolescent of United States, and also in many European countries. They note that a rates of overweight and obesity have doubled in a single generation.

They use these facts to encourage doctors to screen for celiac disease without regard for the patient’s body weight, and thus speeding diagnosis and avoiding possible clinical consequences for patients.

For now, their call has been rejected by the editors of Gastroenterology Research and Practice. However, look for this kind of call to be echoed in the future, as data are compiled, and the realities of celiac disease are better understood.

Source:

• Open Original Shared Link

The research team included Norelle Rizkalla Reilly, Kathleen Aguilar, Benjamin G. Hassid, Jianfeng Cheng, Amy R. DeFelice, Philip Kazlow, Govind Bhagat, and Peter H. Green. They are variously affiliate with Columbia University School of Medicine.

The team reviewed data from patients treated at their specialty clinic from 2000 to 2008, for whom follow-up growth data available. In all, they evaluated 142 children from 13 months to 19 years in age, all with biopsy-proven celiac disease.

To compare the results, they assessed patient height, weight, and BMI by age (z score), and grouped results by BMI as underweight, normal, or overweight.

To be certain which of the patients were following a gluten-free diet, the team used results of serological assays, and data of noncompliant patients, which they assessed separately.

Their analysis included only data gathered during the observation period, which they then expressed as change in height, weight, and BMI z score per month of dietary treatment.

They found that almost 1 in 5 (19%) of patients showed an elevated BMI at diagnosis (12.6% were overweight, while 6% obese). Nearly 3 out of 4 patients (74.5%) showed normal BMI.

The team followed each patient for an average of 35.6 months. Three out of four patients (75%) with an elevated BMI at diagnosis showed a substantial decrease in BMI z scores after following a gluten-free diet. Nearly half (44%) of those patients showed a normalized BMI after following a gluten-free diet.

North American children with celiac disease frequently present as either normal weight or overweight. Patients with normal BMI at diagnosis showed sharply higher weight z scores after following a gluten-free diet, and 13% became overweight. This means that normal weight individuals will likely gain weight on a gluten-free diet, and that just over one in ten will become overweight.

However, for overweight and obese children with celiac disease, the results indicate that a gluten-free diet may be helpful in lowering BMI.

Source:

• JPGN 2011;53: 528–531

Celiac.com 12/02/2011 - Some rumors have been circulating in the health foods community that gluten-free eating can encourage weight loss. Unfortunately, this theory is completely unfounded. Wendy Marcason, a registered dietician, published an article in the Journal of the American Dietetic Association in November that reviews some of the theories and controversy surrounding this issue. The article concludes that there is no scientific evidence to support a connection between eating gluten-free and losing weight.

For those of us with celiac disease who start a gluten-free diet, weight gain is more often the case. The healing of the damaged intestines allows better absorption of food, and unless you rapidly change the amount of food you eat when you go gluten-free, most celiacs gain a substantial amount of weight after the switch. If you do not have celiac disease, however, eating gluten-free is unlikely to have any affect on weight independent from decreases in the overall calorie intake due to eating more carefully.

The consequence of this conclusion by the American Dietetic Association may be that more non-celiacs recognize that gluten-free does not necessarily mean more healthy. Unfortunately, some of the increased availability of gluten-free food over the last decade is owed to these non-celiac gluten-free folks. If these non-celiacs stop eating gluten-free, the demand for gluten-free food will fall and te number of options may decrease.

All of that said, the paper said that no evidence exists because there are no studies that look at weight loss on a gluten-free diet. While it's impossible to conclude that gluten-free diets cause weight loss, its also impossible to conclude that they don't cause weight-loss. Only a clinical study will be able to put the issue to rest.

Reference:

• Marcason W. "Is There Evidence to Support the Claim that a Gluten-Free Diet Should Be Used for Weight Loss?" Journal of the American Dietetic Association. Nov 2011; 111(11): 1786.

Weight Loss and the Gluten Free Diet by Ron Hoggan, Ed. D.

First, I’d like to set Dr. O’Connell’s mind at rest. The claims for weight loss following adoption of a gluten-free diet aren’t merely rumors. They are credible claims based on peer reviewed and anecdotal reports, as well as published data from a qualified medical practitioner. For instance, Cheng and colleagues found that “54% of overweight and 47% of obese patients lost weight” (1). They investigated 81 subjects who were overweight and had celiac disease. Congruently, Venkatasubramani et al found that one half of their eight overweight pediatric patients also lost weight on a gluten free diet (2).

These reports alone cast an ominous shadow over Dr. Marcason’s claims if Dr. O’Connell has represented them correctly. Marcason, we are told, asserts that no research has been done on this question. Yet there are three such reports in the peer reviewed literature (1, 2, 3). One reports a preponderance of weight gain among overweight and obese celiac patients after beginning a gluten free diet, while the other two groups report that about half of the overweight and obese celiac patients, children and adults, lose weight on a gluten free diet. Not only has this research been conducted and most of the findings not only contradict the claim that no such research has been done, but two of the three reports indicate that the gluten free diet helps with weight loss in some individuals. I think it is important to notice that the study showing that a large majority of overweight/obese celiacs was conducted where wheat starch is accepted as appropriate for celiac patients, while the two studies that showed weight loss were conducted in the USA. We still don’t know enough about the interaction between various constituents of gluten and people who lose weight on a gluten free diet.  However, given the contradictions in findings, between research conducted in the USA and some parts of Europe, it is not unreasonable to suggest that these differences may result from wheat starch.  

Each of the three studies mentioned above have one large, consistent weakness. They are dealing with small numbers of patients. However, Dr. William Davis, a cardiologist has recently authored a book titled WHEAT BELLY, in which he reports that he has seen weight loss and other health improvements in more than 2,000 of his patients following adoption of a gluten free diet. And, of course, there are all the other anecdotal reports of similar benefits.

Dr. O’Connell’s opposition to the use of a gluten free diet ignores the dynamics of appetite enhancement and satiation that are largely driven by hormones resulting from variations in nutrient density in various parts of the body. From insulin to glucagon to leptin to ghrelin, these and several other fat mobilizing hormones enhance and suppress our hunger based on the nutrients in our bloodstreams, gastrointestinal tract, and adipose tissues.  

Dr. O’Connell also ascribes Marcason’s views to the American Dietetic Association which is the body that publishes the journal in which Dr. Marcason’s opinion article appears. While it may be true that the American Dietetics Association takes this position, it would be unusual for a journal, and the association that operates that journal, to underwrite the claims of one of its authors so I am skeptical that it has done so. I am especially skeptical of endorsement by the association, if Marcason has, indeed, stated that no studies have been conducted to investigate changes in body mass resulting from the gluten free diet among people who are overweight or obese at diagnosis. Clearly, this is an inaccurate claim whether it emanates from O’Connell or Marcason or even the American Dietetics Association.  

I am also left wondering if there are any studies that show that “gluten-free does not necessarily mean more healthy” [sic]. I haven’t seen any and I would be very surprised if any exist. Dr. O’Connell didn’t cite any such studies, yet she asserts that a gluten free diet is not a healthy choice for those who do not have celiac disease. This is especially troubling in view of the growing recognition of non-celiac gluten sensitivity as a legitimate disease entity (5, 6, 7, 8, 9, 10). 

I frequently write opinion articles so I would not want to inhibit such writing. Nonetheless, I believe that taking a rigid stance on either side of this issue is premature. Clearly we all have a lot to learn about weight loss and the gluten-free diet. The scanty evidence that is currently available is entirely too limited to say, with confidence, that the gluten-free diet is an effective weight loss tool, even for overweight patients with celiac disease. It appears to work for some, but other, unseen factors may be at work here.   

Sources:

1. Cheng J, Brar PS, Lee AR, Green PH. Body mass index in celiac disease: beneficial effect of a gluten-free diet. J Clin Gastroenterol. 2010 Apr;44(4):267-71.
2. Venkatasubramani N, Telega G, Werlin SL. Obesity in pediatric celiac disease. J Pediatr Gastroenterol Nutr. 2010 Sep;51(3):295-7.
3. Dickey W, Kearney N. Overweight in celiac disease: prevalence, clinical characteristics, and effect of a gluten-free diet. Am J Gastroenterol. 2006 Oct;101(10):2356-9.
4. Davis W. Wheat Belly.Rodale, NY, NY 2011.
5. Bizzaro N, Tozzoli R, Villalta D, Fabris M, Tonutti E. Cutting-Edge Issues in Celiac Disease and in Gluten Intolerance. Clin Rev Allergy Immunol. 2010 Dec 23.
6. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
7. Sbarbati A, Valletta E, Bertini M, Cipolli M, Morroni M, Pinelli L, Tatò L. Gluten sensitivity and 'normal' histology: is the intestinal mucosa really normal? Dig Liver Dis. 2003 Nov;35(11):768-73. PubMed PMID: 14674666.
8. Di Cagno R, De Angelis M, De Pasquale I, Ndagijimana M, Vernocchi P, Ricciuti P, Gagliardi F, Laghi L, Crecchio C, Guerzoni ME, Gobbetti M, Francavilla R. Duodenal and faecal microbiota of celiac children: molecular, phenotype and metabolome characterization. BMC Microbiol. 2011 Oct 4;11:219.
9. Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, Shepherd SJ, Muir JG, Gibson PR. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 2011 Mar;106(3):508-14
10. Bizzaro N, Tozzoli R, Villalta D, Fabris M, Tonutti E. Cutting-Edge Issues in Celiac Disease and in Gluten Intolerance. Clin Rev Allergy Immunol. 2010 Dec 23.

Amy O'Connell, MD, PhD's Reply to Dr. Ron Hoggan:

This is Dr. O'Connell replying. My piece was merely a summary of an article in the Journal of the ADA. The short summary I wrote was not intended to be an end-all conclusive statement about the matter. That said, the Cheng article that is cited by Ron Hoggard. M.Ed. was not designed to look at the outcome of weight loss in overweight celiacs and is underpowered to make the conclusions that he cites. Another quote from the same article said, "Overall, 54% [of patients who started a gluten-free diet] gained weight and 38% lost weight." The same problem with a lack of statistical power exists for the Venkatasubramani paper. Four obese patients lost weight on a gluten-free diet but 2 gained weight and 1 was lost to follow up. I'd like to apologize if my brief summary seemed too closed-ended, but I will stand by my article conclusion, "While it's impossible to conclude that gluten-free diets cause weight loss, its also impossible to conclude that they don't cause weight-loss. Only a clinical study will be able to put the issue to rest."

Celiac.com 10/11/2010 - People who follow a gluten-free diet solely for the purposes of losing weight may be setting themselves up for failure.

For people with celiac disease and gluten intolerance, following a gluten-free diet is both necessary and beneficial from a medical standpoint. People with celiac disease or gluten sensitivity must not eat the gluten proteins found in wheat, rye, and barley.

For people with celiac disease, eating even minute traces of gluten can trigger an autoimmune reaction damages the lining the small intestine. An estimated three million Americans have celiac disease—and the vast majority remain undiagnosed because the symptoms can vary or mimic other diseases.

Symptoms commonly include bloating, gas, diarrhea and constipation, as well as early osteoporosis. People with celiac disease also suffer high rates of skin rashes, chronic fatigue, bone and joint pain, neurological problems, liver problems, diabetes, infertility in both men and women and cancers, including lymphoma.

Rates of celiac disease are up 400% in the last 50 years, and, according to the Archives of Internal Medicine Clinical Gastroenterology and Hepatology, celiac disease diagnoses have increased 20-fold since 1989. Some doctors think gluten sensitivity could affect up to 10% of the population.

Until now, doctors diagnosed gluten sensitivity mainly by ruling out celiac disease in people who show symptoms. But researchers are looking more and more at antibodies to gliadin, a gluten component, as a possible biomarker. About 7% of people have these anti-gliadin antibodies (AGA); interestingly, so do 18% of people with autism, and 20% of people with schizophrenia, according to studies by Dr. Alessio Fassano.

These numbers, coupled major advances in diagnosis, greater awareness among doctors and better information sharing among those affected, have made for rapid expansion of the gluten-free food markets, and great buzz on the part of manufacturers, advertisers, retailers, and consumers.

That's made for an explosion of new gluten-free products on the food market in the last few years. All of this buzz may tempt many to wonder what it's all about, and if eliminating gluten can provide benefits, such as losing weight.

For some, gluten-free foods have become a new health craze, with promises of a slimmer, fitter, healthier body for those who go gluten-free. Sounds great, right? Just stop eating wheat and gluten and get slim and healthy and live happily-ever-after.

Not so fast.

A gluten-free diet is simply not for everyone. For some, depending on what kind of gluten-free foods they eat, going gluten-free may have the opposite effect. A gluten-free diet will not automatically help people lose weight or avoid carbohydrates.

"Many packaged gluten-free products are even higher in carbs, sugar, fat and calories than their regular counterparts, and they tend to be lower in fiber, vitamins and iron," says Shelley Case, a registered dietician on the medical advisory board of the Celiac Disease Foundation. Gluten-free does not automatically mean nutritious, she notes.

Gluten is not only a key ingredient in baked goods. It's also used as a thickening agent in ketchup and ice cream. But, just like their regular, gluten-containing counterparts, gluten-free products like cake, brownie and cookie mixes are often high in fat and calories. For example, a serving of regular pasta provides 41 grams of carbohydrates, compared to 46 grams for a similar gluten-free pasta.

So, most experts agree that a gluten-free diet is both necessary and beneficial for those with celiac disease and gluten-intolerance. In such cases, avoiding gluten with usually help people to stabilize and reverse either weight gain, or loss, depending on the case. Otherwise, there's no scientific evidence to suggest that adopting a gluten-free diet is a good way to lose weight.

These and other valuable insights into gluten-free diet can be found in Emily Beckman's full-length article for Open Original Shared Link.

Doctors at the Celiac Disease Center ofColumbia University studied the BMI of 369 patients proven throughbiopsy to have celiac disease, spanning from 1981 to 2007. Men andwomen were evaluated separately for the sake of this study and thetest patients were classified as “classical” meaning diarrheaprominent, or “atypical” meaning they had no diarrhea at the timeof celiac diagnosis. Atypical patients were further divided intogroups of 'anemia present' and 'no anemia present' at time ofdiagnosis. Body Mass Index was then categorized into four groupsbased on the criteria of the World Health Organization.

The BMI of all test celiac patientswere compared to the general United States population. Using theregression model, the study found that there are obvious predictorsfor low BMI; patients classified as “classical” celiac,female, and with severe villous atrophy, were all revealed aspredictors for low BMI. These findings further exemplify that themost dramatic changes in BMI rates were in underweight females withceliac disease. Celiac females had a considerably lower mean BMIthan the general population, thereby indicating an importantassociation between females with celiac disease and low BMI. In fact,celiac females that tested with a normal or low BMI were also foundto have higher rates of critical villous atrophy than those with ahigher BMI. However, more males with celiac were found to beoverweight compared to the general population.

After initiating a gluten free diet,most BMI changes were shown to be directly associated with an initialbaseline appearance of “classical” symptoms. While on a glutenfree diet, over 50% of the overweight and obese patients lostweight, and of the group who initially had a low BMI, 42.4% attaineda normal weight. Thereby concluding that treatment of a gluten freediet after celiac diagnosis provides advantageouschanges in BMI results. Further evidence of the importance in earlydiagnosis and prompt treatment of celiac disease.

Of course it is critical to note that,all the patients utilized for this study were monitored closely by a care center dedicated to celiac disease, and continually followed byan experienced dietician with expert knowledge of celiac disease. And, while you may not be able to afford the kind of dietician thesepatients were provided with, it is always very important to be underthe care of a doctor or clinic dedicated to treating celiac disease,as well as to be receiving experienced dietary counseling whentransitioning to a gluten free diet.

Source:

• Open Original Shared Link

For those who want to read more about this topic be sure to have a look at the following articles:

Below is the Abstract for the latest study, which was conducted by William Dickey, M.D., Ph.D., F.A.C.G.: