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

Ursa Major

Health Letter About Celiac Disease

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I am subscribed to get several daily letters from alternative health sites, who will report on the nonsense from mainstream medicine, amongst other things.

This is an excerpt from today's daily dose (it starts out with a report on Merck's lawsuits, but keep reading).

Dear Reader,

You wake up. It's pouring rain. You jam your toe on the foot of the bed. You burn the toast. You open up the morning paper and your horoscope says: "Go back to bed. Things just aren't going to go your way."

That's what I imagine life must be like for executives at the drug giant Merck & Co. these days. A few months ago their best selling arthritis drug Vioxx had to be pulled from the market because of proven increased risks of heart attacks and strokes. This was followed by a perfect storm of Vioxx lawsuits (as many as 10,000 by some counts), along with accusations that Merck insiders knew about the drug's dangers for years.

And now Fosamax has taken a hit.

Fosamax is Merck's $3 billion per year osteoporosis drug that's drawing fresh controversy with a court battle over an unusual side effect. And then - as if all that weren't enough - along come alternative health care writers who tell their readers about safe, non-drug methods for treating and preventing osteoporosis.

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Rain, rain, rain

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According to the Associated Press (AP), a lawsuit filed in Florida claims that Merck has been negligent by attempting to downplay one of the drug's side effects.

In the e-Alert "Bad to the Bone" (4/30/03), I told you about a New England Journal of Medicine report that linked Fosamax (and other drugs in a class of pharmaceuticals known as bisphosphonates) with ocular inflammation. When untreated, this condition causes blurred vision, swelling and even blindness.

The Florida lawsuit highlights another unusual bisphosphonate side effect: osteonecrosis of the jaw; also known as "jaw necrosis" or "jaw death," prompted by a loss of blood supply to the jawbone. The suit has been filed on behalf of 250 Fosamax users who developed this condition.

The AP article notes that Merck representatives responded to the suit by stating that no cases of osteonecrosis of the jaw were reported among more than 17,000 subjects in clinical trials. Nevertheless, in January 2005 the FDA directed Merck to update the Fosamax label with a warning about the side effect. The company complied later in the year, but the lawsuit claims that the warning is not sufficient.

According to the Fosamax web site, other side effects include inflammation and ulceration of the esophagus, painful swallowing, stomach pain, indigestion and nausea.

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Grain drain

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When the subject of osteoporosis comes up, you'll rarely see any mainstream attention given to the fact that diet may be a key aggravating factor for many osteoporosis patients.

The problem: celiac disease (celiac disease), a condition in which gluten - a component of grains - reduces the small intestine's ability to absorb essential nutrients, such as calcium. The gluten dilemma is further complicated by the fact that celiac disease symptoms are so subtle that doctors often miss the diagnosis.

A 2005 study published in the Archives of Internal Medicine examined the link between celiac disease and osteoporosis in a test that compared 260 celiac patients with 580 healthy subjects. Blood tests revealed that celiac disease was much more common among subjects with osteoporosis. In addition, subjects with the most severe cases of celiac disease tended to have the most severe cases of osteoporosis.

Subjects who were diagnosed with celiac disease were asked to follow a gluten-free diet for one year. Bone mineral density (measured before and after the follow up year) was considerably improved in subjects who followed the non-gluten diet.

Barley, rye, oat and wheat are the four gluten-rich grains that celiac disease patients need to avoid. Unfortunately, gluten is hidden in many processed foods such as soups, soy sauce, low-fat or non-fat products, and even candy. Some common food ingredients that may contain gluten include modified food starch, hydrolyzed vegetable or plant protein, and some binders and fillers, as well as malt and natural flavorings.

Long-term calcium deficiency also plays a key role in osteoporosis. I'll address the calcium issue in an e-Alert next week.

From Jenny Thompson, from the Health Sciences Institute HSI

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