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Celiac.com 09/16/2009 - People with certain genetic markers may be more likely to develop adverse gut-reactions, which may help trigger the development of other immune problems, such as Type 1 diabetes, according to Dr. Fraser Scott, a member of the research team and a senior scientist at the Ottawa Hospital Research Institute. In a recent study of 42 Ottawa-area young adults with Type 1 diabetes researchers analyzed white blood cells, looking for a response to partially-digested wheat proteins. They found that people with certain genes are more likely to develop an over-reaction to wheat in the gut. Type 1 diabetes occurs when the immune system attacks the pancreas, the organ that regulates blood sugar. No such response was seen in another 22 diabetics in the study, nor in a separate control group of non-diabetics. The gastrointestinal tract is home to the largest variety of immune cells in the human body. In healthy people, the presence of food molecules in the gut does not spark an immune response against food molecules, Scott said. However, if the normal process breaks down, the gut can become inflamed or damaged. Celiac disease is one example of such a breakdown. Folks with Type 1 diabetes suffer higher rates of celiac disease than non-diabetics. One hypothesis for this is that certain immune cells may be stimulated by food triggers and migrate to the pancreas, where they damage insulin-producing cells, Scott said. The human gut is one of the main places where the human body interacts with its environment, including food, chemicals, bacteria and toxins. “It important to understand the role the gastrointestinal tract plays in this disease and other autoimmune diseases,” says Scott. “There are probably a large number of people who have diabetes risk genes, but only a small proportion of them develop Type 1 diabetes. These people have difficulty handling what is present in the environment.” Previous research has shown a gluten-free diet to reduce rates of diabetes in animal models. However, that does not mean that parents who want to keep their children from developing diabetes should adopt a gluten-free diet, says Scott. The genetic risk for diabetes is very complex, he adds. First, it's not easy to know for certain who will contract diabetes; 9 out of 10 people who develop Type 1 diabetes don’t have a relative with Type 1, Scott said. In the mean time, the Ottawa study touches on a very important part of the diabetes mystery. A number of scientists have suspected a link between diet, the gut and Type 1 diabetes for about 20 years now, Scott said. This is one of the first studies to affirm this connection in human cells. For Scott, the fact that 22 diabetics in the Ottawa study did not show a reaction to wheat protein means only that the condition is far more complicated than clinicians can conceive at present. In theory, there are myriad ways in which people may come to develop diabetes, and, says Scott, each may have developed by a separate route. Source: Ottawa Hospital Research Institute

Celiac.com 09/25/2009 - Scientists at the Ottawa Hospital Research Institute and the University of Ottawa have uncovered what looks to be an important clue regarding the causes of type 1 diabetes. A research team led by Dr. Fraser Scott recently screened 42 patients with type 1 diabetes and found that nearly half showed an abnormal immune response to wheat proteins. Dr. Scott is a Senior Scientist at the Ottawa Hospital Research Institute and Professor of Medicine at the University of Ottawa. The research team includes Dr. Majid Mojibian, Dr. Habiba Chakir, Dr. David E. Lefebvre, Jennifer A. Crookshank, Brigitte Sonier and Dr. Erin Keely. In most people, the immune system functions normally, identifying and attacking dangerous foreign visitors, like viruses and bacteria, without harming healthy body tissue or other benign molecules, including food molecules in the digestive tract. The breakdown of this process contributes to the development of various autoimmune diseases and allergies. In the case of Type 1 diabetes, the immune system wrongly targets the cells of the pancreas, the organ responsible for regulation of blood sugar. Globally, diabetes afflicts nearly 250 million people. Type 1 diabetes, the most severe form of the disease, makes up about 10 percent, or about 25 million, of that worldwide total. There is currently no cure for Type 1 diabetes, and sufferers require daily insulin injections can help control blood sugar levels. Dr. Scott’s results offer the first suggestions that T cells in the immune systems of type 1 diabetics are also more likely to have adverse immune reactions to wheat. His results also suggest that such over-reaction is tied to genes associated with type 1 diabetes. According to Dr. Scott, the research suggests that "people with certain genes may be more likely to develop an over-reaction to wheat and possibly other foods in the gut and this may tip the balance with the immune system and make the body more likely to develop other immune problems, such as type 1 diabetes.” Dr. Scott adds that the immune system has to find "the perfect balance to defend the bodyagainst foreign invaders without hurting itself or over-reacting to theenvironment and this can be particularly challenging in the gut, wherethere is an abundance of food and bacteria.” In side comments that accompany the paper, diabetes expert Dr. Mikael Knip of Finland suggest that the team's results "add to the accumulating concept that the gut is an active player in the diabetes disease process.” Earlier animal models studies by Dr. Scott have shown that a wheat-free diet can reduce the risk of developing diabetes, but he notes that more research is needed to confirm the association and to assess possible effects of diet changes in humans. More research is also needed to examine possible connections to celiac disease, an autoimmune disease associated with adverse immune reactions to wheat proteins that has significant associations with diabetes. This research project was funded by the Juvenile Diabetes Research Foundation and the Canadian Institutes of Health Research. Source: Diabetes - August 2009

Patients Diagnosed in Childhood Might Evolve toward Latency on a Normal Diet Celiac.com 05/23/2007 - The results of a study recently published in the journal Gut indicate that some people who suffer from celiac disease might not need to remain on a gluten free diet for their entire lives, and that some celiac patients might be able to safely introduce gluten containing foods without suffering a relapse. Previous Studies Showing Positive Response to Wheat Introduction in Patients with Celiac Disease are Promising, But Incomplete Several studies have shown that some patients diagnosed with celiac disease in childhood were able to remain on a gluten-containing diet after gluten challenge without suffering a relapse. However, most of these studies included a small number of patients, or followed the patients for only a short period after gluten was reintroduced into their diets. These previous studies also limited their evaluation largely to assessment of celiac disease serology and histology of duodenal biopsies, and did not attempt to identify what factors might predict the development of tolerance to gluten. Determining Long-term Response to Gluten Consumption in Celiac Disease Patients A research team made up of doctors Tamara Matysiak-Budnik (1), Georgia Malamut (1,2), Natacha Patey-Mariaud de Serre (3), Etienne Grosdidier (2), Sylvie Seguier (3), Nicole Brousse (3), Sophie Caillat-Zucman (4), Nadine Cerf-bensussan (1), Jacques Schmitz (5) and Christophe Cellier (1,2), set out to determine whether children diagnosed with celiac disease must follow a gluten free diet for life. To determine the effects of reintroducing gluten into the diets of celiac patients, the research team set out to monitor the clinical and physical progress of adult celiac patients who had been diagnosed as children, who underwent a gluten challenge, and who were asymptomatic. The study focused on a specific group of patients, all but two of whom were diagnosed as children and followed until adulthood in the Department of Pediatric Gastroenterology in Necker Hospital and thereafter at the Georges Pompidou European Hospital in Paris; after which, they were entered into a local register of adult celiac patients and were recruited for the study based on two criteria: celiac disease diagnosed in childhood; and adherence to a normal diet. The patients in the study were from 18 to 65 years old, and had been diagnosed with celiac disease in childhood. The research team recorded data in the following categories: biological parameters of malabsorption; bone mineral density; clinical celiac status; gluten intake; HLA genotype; serological markers of celiac disease; as well as histological and immuno-histochemical parameters in duodenal biopsies. Results Show 20% Long-term Latency in Celiac Patients who Eat Normal Diet Of those studied, 61 patients had returned to a normal diet, and were asymptomatic. 48 showed various degrees of villous atrophy (silent celiac disease), and 13 had no detectable atrophy (latent celiac disease) on duodenal biopsies. Compared to those with silent celiac disease, patients with latent celiac disease showed markedly less osteopenia/osteoporosis [1/9 (11%) versus 23/33 (70%), p<0.001)], and lower TcR- + intraepithelial T cell counts (38±20 vs. 55±15, p<0.01). Patients with latent celiac disease had a lower mean age at the time of their first gluten free diet compared to patients with silent celiac disease (14.4±5 vs 40.1±47 months, p<0.05). Compared to the seven control patients on a long-term gluten free diet, the latent patients did not differ significantly, except for a higher frequency of celiac disease-specific serum antibodies. However, a follow-up found that two of the patients with latent celiac disease had suffered a clinical and histological relapse. Results showed that of those patients who remained asymptomatic after the reintroduction of gluten, 20% showed long-term latency. The study concludes that some patients with celiac disease may not need to remain on a life-long gluten free diet, and that some may indeed be able to safely reintroduce gluten into their diets with no adverse effects. However, the latency patients may experience may be transient, and therefore a regular follow-up is necessary. Also, patients with silent celiac disease should remain on a gluten free diet. Participating hospitals: (1) INSERM, U793, Faculté de Médecine René Descartes, IFR94, Paris, France. (2) AP-HP, H&OCIRC;pital Européen Georges Pompidou, Department of Hepato-Gastroenterology, Paris, France. (3) AP-HP, H&OCIRC;pital Necker-Enfants Malades, Department of Pathology, Paris, France. (4) INSERM, Equipe Avenir, Faculté de Médecine René Descartes, Paris, France. (5) AP-HP, H&OCIRC;pital Necker-Enfants Malades, Department of Pediatric Gastroenterology, Paris, France. Gut 2006;13(10). Comments on this Study by Ron Hoggan This is dressed up like a new finding, but it isn't. There are a number of studies that show similar findings. Part of that problem lies in the interpretation of the biopsies, and part of the problem arises out of failing to recognize the variable nature of the disease. It has long been known to wax and wane for reasons beyond our ken. Samuel Gee (1888) and Gibbons (1889) both reported the cyclic nature of their patients symptoms. They cited a study to support the idea of a two year rule saying that relapse would usually occur within two years, yet Kuitunen P, Savilahti E, Verkasalo M., in Late mucosal relapse in a boy with coeliac disease and cows milk allergy. Acta Paediatr Scand. 1986 Mar;75(2):340-2. reported one patient who at 4.3 years on a normal diet showed normal villous architecture. It was not until a follow-up biopsy at more than 8 years of eating a gluten-containing diet that he showed villous atrophy. These findings, along with all the other studies that have shown long delays in some patients before relapsing, argue strongly for Michael N. Marsh's position that we should concentrate on treating any immune system that is sensitized to gluten with a gluten-free diet. His rectal challenge is an excellent tool for identifying such sensitized immune systems. Dr. Fines fecal antibody test probably fits into the same category. The underlying assumption is that the biopsy will identify all cases of intestinal lesion regardless of the possibility of patchy lesions that are well documented in the literature. They deal with increased IEL counts as if they were a feature of latent celiac disease when that is not the case. There are several other points on which this study falters. They admit that the latency can be transient. Unfortunately, they have not exchanged emails with people where they have returned to eating gluten and have developed an abdominal cancer. I exchanged emails with such a young man who blamed himself for having killed himself with his carelessness about his diet. How awful that was for him! Yet these authors seem to think it is quite acceptable for patients to indulge during their latency periods and only consider a diet if there is a relapse of intestinal lesion.

Gastroenterology, Volume 129, Issue 2, Pages 454-463 (August 2005) Celiac.com 08/11/2005 - A large study by Swedish and American researchers has determined that untreated celiac disease is associated with an increased risk of adverse fetal outcome. In contrast to several small studies that have been done in the past that produced conflicting results, this study looked at 2,078 births to women who were diagnosed with celiac disease—1,149 were diagnosed prior to their child’s birth, while 929 were diagnosed after. The researches employed a national register-based cohort study (1964-2001) that was restricted to women between 15-44 years old who had a single live birth. The researchers measured intrauterine growth retardation, low birth weight, very low birth weight, preterm birth, very preterm birth and birth by caesarean section for each child in the study. The results of the study indicate that undiagnosed celiac disease is associated with an increased risk of intrauterine growth retardation (OR = 1.62; 95% CI: 1.22-2.15), low birth weight (OR = 2.13; 95% CI: 1.66-2.75), very low birth weight (OR =2.45; 95% CI: 1.35-4.43), preterm birth (OR = 1.71; 95% CI: 1.35-2.17), and caesarean section (OR = 1.82; 95% CI: 1.27-2.60). In contrast, those diagnosed with celiac disease before their births were not at increased risk for these adverse fetal outcomes. The researchers conclude that undiagnosed celiac disease increases the risk of unfavorable fetal outcomes—a risk that is reduced in those with diagnosed celiac disease, presumably because they have been treated with a gluten-free diet.

Gut 2000;46:327-331. March 10, 2000 Celiac.com 03/17/2000 - Finish researchers report that people with celiac disease who eat oats show no adverse autoantibody or intraepithelial lymphocyte level effects. According to Dr. M. I. J. Uusitupa (University of Kuopio), and colleagues: Wheat, rye, and barley have harmful effects on the small intestinal mucosa of patients with coeliac disease, whereas maize and rice are harmless...(H)owever, the place of oats in the coeliac diet has been debated. The researchers studied two groups: 40 adults with newly diagnosed celiac disease and 52 adults whose celiac disease was in remission. The people in both groups were randomized to either a conventional gluten-free diet, or a gluten-free diet that also included oats. Both groups were monitored for autoantibodies and intraepithelial lymphocytes over a 6- or 12-month period. In the patients with newly diagnosed celiac disease the disappearance rates of antireticulin antibodies, antigliadin antibodies, and intraepithelial lymphocytes were the same, regardless of their diet. Likewise the people with celiac disease that was in remission had similar antibody and intraepithelial lymphocyte levels between both dietary groups. According to the researchers: These results strengthen the view that adult patients with coeliac disease can consume moderate amounts of oats without adverse immunological effects. The researchers also note that: more clinical studies are needed to ensure the safety of oats when consumed permanently in a coeliac diet as well as to determine the effect of larger amounts of oats.