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Found 8 results

  1. Dr. Ron Hoggan, Ed.D.

    The Many Benefits of a Gluten-Free Diet

    Celiac.com 03/16/2018 - Celiac awareness has increased exponentially over the last decade among physicians and the general public alike. Increasing numbers of research publications and very active support groups and individuals have contributed to this growing awareness. Knowledge of the many and varied manifestations is also growing rapidly although some individuals continue to cling to the notion that celiac disease is characterized by malabsorption and that nutrient deficiency is the dominant feature of this ailment. This misses the broader understanding of the many ways in which gluten grains negatively impact on human health. From toes to head, any and all of our human body systems may be harmed by ingesting gluten under some circumstances. Although the wide range of signs and symptoms of celiac disease is impressive, a similar, even broader range of impacts may be attributed to gluten in the context of non-celiac gluten sensitivity. Those with celiac disease only comprise a small portion of the population of people who are afflicted by non celiac gluten sensitivity. Dr. Rodney Ford has offered the all encompassing term of 'gluten syndrome' to identify everyone whose health is compromised by gluten consumption (1). From Dr. Fasano's most conservative estimate that 6% of the population is afflicted by non-celiac gluten sensitivity (2), to Dr. Rodney Ford's estimate that 10% is afflicted (3), to Dr. Kenneth Fine's finding that IgG class anti-gliadin antibodies are found in about 11% of the population (4), to this writer's assertion that non-celiac gluten sensitivity includes well more than 20% of the population, the paucity of research in this area offers a wide range of estimates without a solid basis for refuting any of them. Nonetheless, it is clear that those with non-celiac gluten sensitivity outnumber those with celiac disease by a ratio of somewhere between 6 to 1 and more than 20 to 1. The gluten syndrome may therefore include from seven percent to more than twenty percent of the population. The importance of these percentages and ratios is that we are seeing growth in the diagnosis of celiac disease, and in the number of people who have celiac disease (4). It has been argued that a similar trend may be seen across the spectrum of the gluten syndrome, attributing that trend to the genetic modifications that have been made to grains, and the increased consumption of these foods (5). But this is just the tip of the iceberg. Dr. Fasano bases his estimate of non-celiac gluten sensitivity on those who mount an innate immune reaction to gluten grains. While there is likely some overlap between innate immune reactions and selective antibody reactions, most estimates of non-celiac gluten sensitivity are based on IgG class antibodies against one of the proteins of several protein families found in gluten. It makes eminent sense to me that when our bodies are mounting a measurable immune response against the most common food in our diets, whether the reaction is by the innate immune system or by creating selective antibodies, that food might be harmful to our health. I do not quarrel with the basis on which these sensitivities are identified. I simply argue that they are only identifying a sub-fraction of many more possible cases of non-celiac gluten sensitivity. To put this issue into sharper focus, there are several protein families to be found in each of the gluten grains. In wheat, for instance, each family, glutelin, gliadin, and glutenin contains a number of individual proteins. The antibody test for gliadin ignores possible reactions to proteins in either of the other two families. Further, IgG class antibodies are the most common and widespread class of selective antibody we produce. But they form only one of five types of selective antibodies (known as immunoglobulins). Further, as is obvious from Dr. Fasano's conservative approach to identifying non-celiac gluten sensitivity, there are other facets of the immune system that do not involve selective antibodies, and can also be enlisted in a reaction against gluten grains. Thus, when we test for IgG anti-gliadin antibodies, the most common test for non-celiac gluten sensitivity, positive results are identifying reactions against only one of the several protein families found in gluten, and only one of the five possible selective antibody reactions against this single protein family. It therefore seems wholly improbable that testing for reactions against a single protein family in only a single class of selective antibody would identify all or even most cases of gluten sensitivity. Admittedly, some researchers test for IgA antibodies but those investigators usually do not test for IgG antibodies. However, even with testing for both classes of selective antibodies, which most published reports on this issue have not done, it is clear that many possible immune reactions to any other protein fractions of gluten might well be overlooked, either in the form of other selective antibodies or as other immune reactions and various innate reactions against gluten grains. I'm sure that, by now, the reader will see that there are many possible immune reactions against this most common food, and that most of these reactions will go undetected, both in the context of standard medical testing and in most research conducted in this venue. On a more practical plane, when Dr. Curtis Dohan identified significant improvements among patients with schizophrenia patients eating a gluten-free, dairy-free diet (6), and Singh and Kay replicated their findings (7), many looked for celiac disease among patients with schizophrenia and found only a small increase. Dohan and Singh's publications were followed by several sloppy studies that ignored the guiding principles expressed in this pioneering work. These weak studies further undermined acceptance of the connection between gluten and schizophrenia. The net result was a growing belief that Dohan had erred and his heroic work was widely dismissed. Yet, more than twenty years after his death, one of Dohan's most vigorous critics is listed among the authors of a paper that reports an immune reaction against gluten that, while different from the reaction seen in celiac disease, is common among people with schizophrenia (8). Similarly, I think that we can expect, sometime in the future, to see research that identifies immune reactions and damaging dynamics caused by gluten consumption among people with learning disabilities. There is, for instance, one newspaper report of an informal study conducted at the Nunnykirk School in Northumberland, a school that serves only children with dyslexia, a condition that is reported to afflict about 10% of children in the United Kingdom. After six months of eating a gluten free diet, more than 80% of these children improved their reading at a rate of at least twice that of normal children. Some leaped ahead, in their reading skills, by as much as 2.5 years over this six month period (9). Relatedly, I had the privilege of working with Dr. Rodney Ford on a retrospective analysis of indicators of school readiness among children who had celiac disease, non-celiac gluten sensitivity (as measured by selective antibody testing) and children who showed no signs of either reaction to gluten. A large majority of those who reacted to gluten improved dramatically. There was a small but significant sub-group whose school readiness improved following a gluten free diet, and these improvements happened within 6 months of avoiding gluten (unpublished data). Autism, especially where normal development was curtailed after one or several years, is another condition in which excluding gluten seems to provide substantial improvements even in the absence of celiac disease. Some research in this area suggests that toxins (generated by bacteria resident in the intestines) are allowed access to the bloodstream and the brain (10). Perhaps exclusion of dietary gluten is the factor that limits access to the bloodstream through reducing zonulin production. Similarly, although not as well supported, there is some evidence to suggest that gluten contributes to bi-polar disorder. Just how frequent and significant the contribution may be is still open to debate, but I have observed some evidence to support this hypothesis in my own family. A range of types of epilepsy have been found in association with celiac disease, many of which are mitigated by the gluten free diet (11). The manifestations of undetected non-celiac gluten sensitivity are not limited to brain function. We know that celiac disease is much more frequent in the context of other autoimmune diseases. We also know that antibody tests show even higher rates of non-celiac gluten sensitivity. Since we are only identifying a fraction of those who may be reacting to gluten, it seems reasonable to suggest that everyone with an autoimmune disease, or antibodies suggesting that an autoimmune disease is imminent, should begin a strict gluten free diet and follow it for at least one year. If there is any reduction of auto-antibodies or symptoms of autoimmunity, the diet should be continued. Although difficult in the early stages, it is an entirely benign intervention/treatment. There are no unwanted side effects or hazards. There are more than 200 autoimmune and other medical conditions reported in association with gluten and are listed in Appendix D of Dangerous Grains (12). In each case, a lengthy trial of a gluten free diet would be well advised. Again, there are no negative side effects of the gluten free diet. It is an entirely benign intervention. A significant proportion of those who suffer from IBS, Crohn's or any of the various types of colitis have also been reported to benefit from a gluten free diet on various websites. Similarly, many people with MS and a host of other neurological diseases have been shown to benefit from a gluten free diet (13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23). Even many AIDS patients are helped by a gluten free diet. It reduces their diarrhea and improves nutrient absorption (24). This is an important discovery that can be harnessed in conjunction with the improved treatments now available for this very serious illness. Overweight, obesity, and weight loss are contentious issues with regard to the gluten free diet. Until quite recently, there were two reports of small studies of changes in body mass index in the USA and one report from Ireland, following institution of a gluten free diet. The two American studies showed weight loss among overweight subjects on a gluten free diet. The study from Ireland showed only weight gain among overweight subjects after following a gluten free diet. In November of 2011, another small study was published. Their conclusion states "The GFD (gluten free diet) has a beneficial effect upon the BMI (body mass index) of overweight children with celiac disease" (25), which is congruent with the earlier two American studies. I have previously suggested that the discrepancy between the findings may be due to the acceptance of wheat starch as part of the gluten free diet in the United Kingdom. However, regardless of the cause, the preponderance of evidence supports the notion that a gluten free diet can be used as an effective weight loss strategy in some cases of celiac disease. Other evidence suggests it may be a more broadly effective weight loss tool. Thus, my estimate of the prevalence of non-celiac gluten sensitivity includes the 6% who show signs of innate immune reactions to gluten, in addition to those who show IgG antibodies against gluten, at about 11% of the population (although there may be some overlap between these 6% and 11% groups). My estimate also includes many of those with schizophrenia who number about 1% of the general population, and a portion of those with autism who are quickly approaching 1% of the population. I am also including 80% of the approximately 10% of the population with some degree of dyslexia. Because of overlaps between groups, and because gluten's impact is often only demonstrable through a gluten free diet, I only assert that non-celiac gluten sensitivity is a factor in more than 20% of the general population. However, I remain open to findings that will show a much greater negative impact from eating foods derived from gluten grains. The portion of the human population that may be negatively impacted by gluten consumption can range as high as the 80% portion that produce haptaglobin 2, for which zonulin is the precursor. The take away point here is that the gluten free diet may aid overall health for up to as much as 80% of the general population. In that context, my estimate that 20+% of the population is showing signs that they are variously mounting immune reactions against gluten or are otherwise harmed by gluten appears modest. The overlapping symptoms make it extremely difficult to narrow my estimate further. Nonetheless, gluten is one of the most harmful substances in our diet. Yet it is the most ubiquitous factor in our diets. Sources: 1. www.doctorgluten.com 2. Sapone A, Lammers KM, Casolaro V, Cammarota M, Giuliano MT, De Rosa M, Stefanile R, Mazzarella G, Tolone C, Russo MI, Esposito P, Ferraraccio F, Cartenì M, Riegler G, de Magistris L, Fasano A. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med. 2011 Mar 9;9:23. 3. personal communication 4. personal communication 5. Wheat Belly 6. Dohan FC, Grasberger JC. Relapsed schizophrenics: earlier discharge from the hospital after cereal-free, milk-free diet. Am J Psychiatry. 1973 Jun;130(6):685-8. 7. Singh & Kay 8. Samaroo D, Dickerson F, Kasarda DD, Green PH, Briani C, Yolken RH, Alaedini A. Novel immune response to gluten in individuals with schizophrenia. Schizophr Res. 2010 May;118(1-3):248-55. 9. Blair, Alexandra. Wheat-free diet gives food for thought. http://www.timesonline.co.uk/tol/news/uk/article444290.ece 10. Sandler RH, Finegold SM, Bolte ER, Buchanan CP, Maxwell AP, Väisänen ML, Nelson MN, Wexler HM. Short-term benefit from oral vancomycin treatment of regressive-onset autism. J Child Neurol. 2000 Jul;15(7):429-35. 11. Ribaldone DG, Astegiano M, Fagoonee S, Rizzetto M, Pellicano R. Epilepsy and celiac disease: review of literature. Panminerva Med. 2011 Dec;53(4):213-6. 12. Braly J, Hoggan R, Dangerous Grains. Avery, New York, 2002. 13. Hadjivassiliou M, Sanders DS, Grünewald RA, Woodroofe N, Boscolo S, Aeschlimann D. Gluten sensitivity: from gut to brain. Lancet Neurol. 2010 Mar;9(3):318-30. 14. Turner MR, Chohan G, Quaghebeur G, Greenhall RC, Hadjivassiliou M, Talbot K. A case of celiac disease mimicking amyotrophic lateral scl Nat Clin Pract Neurol. 2007 Oct;3(10):581-4. 15. Hadjivassiliou M, Chattopadhyay AK, Grünewald RA, Jarratt JA, Kandler RH, Rao DG, Sanders DS, Wharton SB, Davies-Jones GA. Myopathy associated with gluten sensitivity. Muscle Nerve. 2007 Apr;35(4):443-50. 16. Hadjivassiliou M, Grünewald RA, Kandler RH, Chattopadhyay AK, Jarratt JA, Sanders DS, Sharrack B, Wharton SB, Davies-Jones GA. Neuropathy associated with gluten sensitivity. J Neurol Neurosurg Psychiatry. 2006 Nov;77(11):1262-6. Epub 2006 Jul 11. 17. Hadjivassiliou M, Sanders DS, Grünewald RA. Multiple sclerosis and occult gluten sensitivity. Neurology. 2005 Mar 8;64(5):933-4; author reply 933-4. 18. Hadjivassiliou M, Williamson CA, Woodroofe N. The immunology of gluten sensitivity: beyond the gut. Trends Immunol. 2004 Nov;25(11):578-82. Review. 19. Hadjivassiliou M, Sanders DS, Grünewald RA, Akil M. Gluten sensitivity masquerading as systemic lupus erythematosus. Ann Rheum Dis. 2004 Nov;63(11):1501-3. 20. Hadjivassiliou M, Grünewald RA, Davies-Jones GA. Gluten sensitivity as a neurological illness. J Neurol Neurosurg Psychiatry. 2002 May;72(5):560-3. 21. Hadjivassiliou M, Grünewald RA, Lawden M, Davies-Jones GA, Powell T, Smith CM. Headache and CNS white matter abnormalities associated with gluten sensitivity. Neurology. 2001 Feb 13;56(3):385-8. 22. Hadjivassiliou M, Grünewald RA, Davies-Jones GA. Gluten sensitivity: a many headed hydra. BMJ. 1999 Jun 26;318(7200):1710-1. 23. 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. 24. Quiñones-Galvan A, Lifshitz-Guinzberg A, Ruíz-Arguelles GJ. Gluten-free diet for AIDS-associated enteropathy. Ann Intern Med. 1990 Nov 15;113(10):806-7. 25. Reilly NR, Aguilar K, Hassid BG, Cheng J, Defelice AR, Kazlow P, Bhagat G, Green PH. Celiac disease in normal-weight and overweight children: clinical features and growth outcomes following a gluten-free diet. J Pediatr Gastroenterol Nutr. 2011 Nov;53(5):528-31. 26. 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. 27. Murray JA, Watson T, Clearman B, Mitros F. Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease. Am J Clin Nutr. 2004 Apr;79(4):669-73.
  2. Celiac.com 05/11/2017 - As research continues to show the remarkable nutritional advantages of bone broth, it is gaining a spotlight in the nutritional world, especially in nutrient focused diets like the paleo diet, clean eating, and more. But though the attention may be new, it is actually an age old dietary staple dating back to paleo era days when utilizing every part of animals was essential. Bone broth has remained a dietary staple around the world for generations. It is an exceptionally nutrient dense broth made by simmering the bones and connective tissues of animals. It's surprisingly easy to make and the benefits offered are astounding. If you are new to this wonder food read on to find out about bone broth benefits and the real truth about all it offers! Top Benefits of Bone Broth Bone and Ligament Health. As bones are simmered in the making of bone broth, key bone health minerals such as calcium and phosphorous are infused into the broth. Additionally, the breakdown of the connective tissue used for bone broth provides a natural source of glucosamine and chondroitin which supports joint health. Gut Health. The gelatin produced from animal collagen provides a healing effect for the GI tract. People starting a gluten free or paleo diet in hopes of calming down an inflamed digestive tract may especially appreciate this benefit. Immune Health. Turns out the old wives tale of chicken soup to cure illness holds some truth. The rich mineral content and in particular the amino acids in bone broth support a healthy immune system. Women's Health. Bone broth also offers help when it comes to women's hormones. This is because poor nutrient absorption is closely tied to hormonal health. When the gut is inflamed, nutrient absorption suffers. By healing the gut, the body can better regulate hormone levels. Anti-Aging. The collagen rich gelatin found in bone broth may just be the fountain of youth. Adding to this anti-aging effect, the amino acid proline further helps to give strong and shiny hair, skin, and nails. Tips to Making Bone Broth Yourself Quality Matters. To avoid the chemicals conventionally raised animals are exposed to and gain maximal nutritional benefits, opt for bones from grass-fed cows and/or free range chickens. Pick the Right Parts. The bones, ligaments, and cartilage used in bone broth each offer benefits. The bones give the broth vitamins and minerals while the ligaments and cartilage provide all important collagen as they break down. Opt to include knuckles as much as possible as they are particularly collagen rich. Go Slow. The secret to bone broth is going 'low and slow.' Cooking broth in a slow cooker on a lower heat setting for a longer period of time allows the collagen, vitamins, and nutrients to best be released into your broth. Add an Acid. Be sure to add a spoonful of an acid such as apple cider vinegar to help break down the connective tissue and collagen. This is a very simple approach to adding something extremely beneficial to just about anyone's diet or health routine.
  3. Celiac.com 11/13/2015 - Celiac disease sufferers, and others in the UK, are unhappy with a government proposal to cut financial support for gluten-free food. UK celiac patients are currently allowed up to 18 lots of gluten-free bread, pasta and flour a month on the NHS. One unit is equal to a 400g loaf of bread, 250g of pasta or 250g flour or bread mix. Under the proposal the NHS budget of 209,000 pounds a year for gluten-free food prescriptions for gluten free food will face substantial cuts. But Alison Smith, of the Clinical Commissioning Groups (CCGs), says the current system is out of date and unfair. NHS organizations set up by the Health and Social Care Act 2012 to organize the delivery of NHS services. According to Smith, the wide variety of gluten-free foods available in supermarkets and even corner shops these days invites the creation of a new way of alloying gluten-free benefits that will be "fairer for everyone, not just people with celiac disease, so that we can actually share out NHS resources as fairly as possible." The range of foods currently allowed includes bread, rolls and baguettes, bread mixes, flour, pasta, crackers, pizza bases and breakfast cereals. The CCGs are proposing to change the allowance to eight units per month of bread, pasta and/or flour/bread mixes for everyone eligible for prescription gluten-free food. The change is needed, says Smith, because gluten-free food is vital for people with celiac disease and gluten-sensitivity. Source: mix96.co.uk
  4. Celiac.com 10/30/2015 - Writing for the Times of India, Pooja Makhija has an interesting little article on the various types of flour commonly used in Indian cooking, including a number of gluten-free flours. The articles features short descriptions of the various commonly used grain flours, and their characteristics. The article includes flours made from wheat, of course, but the gluten free flours include millet, sorghum, amaranth, rice, soy and quinoa. Wheat Flours (Contain Gluten of course!) Most of the wheat or atta used in Indian cooking is culled from the semi-hard wheat varieties or durum, including, atta, cracked wheat/lapsi fada and semolina/sooji. Millet Flours Millet is a small-seeded grass that is also gluten-free. Millet flours are a great option for people with any kind of gluten sensitivity. Sorghum Flours Jowar is the Indian name for sorghum, which is also called white millet. This grain, and its close relative, bajra, both belong to the millet family, and are gluten-free. Jowar has been linked to lowering the risk of heart diseases as well as cholesterol. It also has cancer-fighting properties because of the presence of antioxidants, and brims with protein, calcium and iron. Bajra is a high energy food that is said to aid digestion, promote good heart-health, and to increase insulin sensitivity, making it a great option for diabetics. Amaranth Flour Rajgira is the Indian name for amaranth. Amaranth is a highly nutritious relative of quinoa, and also similarly described as a superfood. This tasty gluten-free grain is high in iron, calcium, protein and antioxidants. Rice Flour Used a great deal in Indian cooking, including dishes like neer dosa, rice flour is gluten-free, and makes a great substitute for wheat. Soy Flour Soy flour is made from ground soy beans, and is rich in vitamins and minerals, and vegetarian Omega-3 fatty acids. Soy protein is great for women in menopause, and also for elderly women. Quinoa Flour Quinoa is a 100% vegetarian reference protein, which means that the body absorbs 100% of quinoa's protein content. Read more at the Times of India.
  5. Celiac.com 03/03/2014 - Spotting celiac disease early is important for optimal patient outcome. However, serological markers of celiac disease aren't much good for spotting mild histopathological lesions in adults at risk for celiac. A team of researchers recently set out to assess the usefulness of human leukocyte antigen (HLA)-DQ2/8 genotyping, followed by duodenal biopsy for the detection of celiac disease in adult first-degree relatives (FDRs) of patients with celiac disease. The research team included L. Vaquero, A. Caminero, A. Nuñez, M. Hernando, C. Iglesias, J. Casqueiro, and S. Vivas. They are variously affiliated with the Gastroenterology Unit, the Pathology Department, and the Pediatric Department of the University Hospital of León, Altos de Nava, with the Institute of Molecular Biology (INBIOMIC), the Microbiology Department and the Institute of Biomedicine (IBIOMED) at the University of León, all in León, Spain. For their study, the team looked at ninety-two adult DQ2/8 positive FDRs. They offered duodenal biopsy irrespective of the serology result or associated symptoms. They then noted clinical features, associated autoimmune diseases and biochemical parameters. The team conducted duodenal biopsies on sixty-seven FDRs, averaging 34 years of age. Thirty-two of those patients (48%) showed histopathological changes, which broke down as follows: twelve patients Marsh I (18%), one Marsh II (1.5%), four Marsh IIIA (6%), five Marsh IIIB (7.5%) and ten Marsh IIIC (15%). Seventeen of the sixty-seven patients (25%) showed positive serological markers, with only one showing Marsh I and the remainder presenting some degree of duodenal atrophy (Marsh III). Thirty-three of the sixty-seven patients (54%) suffered gastrointestinal symptoms, with dyspepsia being the most common complaint. The distribution of symptoms, anaemia and autoimmune disease was not changed by a patient's duodenal histopathological stage. Overall, in first-degree relatives, current blood-based screening would diagnose 50% of the cases that displayed any celiac disease characteristic, and miss 6% of the cases with mucosal atrophy. From these results, the team concludes that adult first-degree relatives of patients with celiac disease can benefit from a screening strategy on the basis of HLA-DQ genotyping, followed by a duodenal biopsy. FDRs with gastrointestinal and other symptoms may see improvement on a gluten-free diet. Source: Eur J Gastroenterol Hepatol. 2014 Mar;26(3):263-7. doi: 10.1097/MEG.0000000000000020.
  6. Celiac.com 02/22/2013 - Scientists estimate that about 1% of the global population has celiac disease. For those who suffer, following a gluten-free diet is the only treatment available. Among doctors such treatment is known as 'medical nutritional therapy (MNT).' Recently, researchers have paid more attention to sourdough lactic acid bacteria as a way to improve the therapeutic benefits of gluten-free bread and baked goods for people on a gluten-free diet due to celiac disease. A team of researchers recently set out to assess use of sourdough lactic acid bacteria as a cell factory for delivering functional biomolecules and food ingredients in gluten free bread. The research team included Elke K Arendt, Alice Moroni and Emanuele Zannini. They are variously affiliated with the School of Food and Nutritional Sciences at University College Cork, Western Road, and the National Food Biotechnology Centre at University College Cork, in Cork, Ireland. More and more, consumers are demanding higher quality gluten-free bread, clean labels and natural products. Still, replacing gluten in bread presents significant technological challenges due to the low baking performance of gluten free products (gluten-free). Sourdough has been used since ancient times to improve quality, nutritional properties and shelf life of traditional breads, sourdough fermentation may offer a better solution for commercial production of gluten-free breads. In a recent issue of Microbial Cell Factories, the research team highlights how sourdough lactic acid bacteria can be an efficient cell factory for delivering functional biomolecules and food ingredients to enhance the quality of gluten free bread. Source: Microbial Cell Factories 2011, 10(Suppl 1):S15. doi:10.1186/1475-2859-10-S1-S15
  7. Celiac.com 05/02/2012 - Doctors and researchers are still debating the usefulness of active blood screening for spotting celiac disease in older populations. Studies do suggest that many cases of celiac disease go undetected, especially in the older population. One unanswered question is whether screening does any good for older people who have been eating gluten many decades. A team of researchers recently studied the clinical benefit of a gluten-free diet in screen-detected older celiac disease patients. The research team included Anitta Vilppula, Katri Kaukinen, Liisa Luostarinen, Ilkka Krekelä, Heikki Patrikainen, Raisa Valve, Markku Luostarinen, Kaija Laurila, Markku Mäki, and Pekka Collin. They are affiliated with the Department of Neurology, the Department of Internal Medicine and the Department of Surgery at Päijät-Häme Central Hospital, and the University of Helsinki's Department of Education and Development in Lahti, Finland, the Department of Gastroenterology and Alimentary Tract Surgery the School of Medicine, and the Paediatric Research Centre at the University of Tampere and Tampere University Hospital, Tampere, Finland. For their study, the researchers evaluated the benefit of active detection and implementation of a gluten-free diet in elder populations with for celiac disease. The team evaluated thirty-five biopsy-proven celiac patients over 50 years of age, each of whom had celiac disease detected by mass blood screening. They looked at bone mineral density, dietary compliance, disease history, quality of life, and symptoms at baseline and after 1-2 years of a gluten-free diet. They also looked at small bowel biopsy, serology, laboratory parameters assessing malabsorption, and bone mineral density. Using surveys, the team established gastrointestinal symptom ratings and quality of life by psychological general well-being. The used this information to rate symptoms. They found patient dietary compliance to be good overall. Initial tests on the patients showed reduced serum ferritin levels, pointing to subclinical iron deficiency. This trend reversed after patients followed a gluten-free diet. Initially low vitamin B12, vitamin D and erythrocyte folic acid levels increased significantly on a gluten-free diet. Patient histories showed that those with celiac disease had sustained more low-energy fractures, and sustained such fractures more frequently than the general population. A gluten-free diet brings with it a beneficial increase in bone mineral density. The team also noticed that many gastrointestinal symptoms disappeared, even though though many patients reported only subtle symptoms upon diagnosis. Quality of life remained unchanged. According to the study team, two out of three patients would have been diagnosed even without screening if the family history, fractures or concomitant autoimmune diseases had been factored in. Results showed that patients who had celiac disease detected by mass blood screen did, in fact, benefit from a gluten-free diet. For doctors evaluating older patients, the team advocates a high index of suspicion and active case-finding in celiac disease as an alternative to mass screening. Source: BMC Gastroenterology 2011, 11:136. doi:10.1186/1471-230X-11-136
  8. Celiac.com 04/08/2009 - A study published in Journal of Insurance Medicine has delineated clear economic benefits to diagnosing celiac disease on a national level using a managed-care approach. A team of researchers based at Columbia University Medical Center's Celiac Disease Center recently set out to estimate the rate of celiac disease diagnosis and assess the economic benefits of diagnosis by reviewing retrospective cohort studies from a national managed-care-population database. The research team was made up of Peter H. R. Green, Alfred I. Neugut, Afzal J. Naiyer, Z. Collette Edwards, Susan Gabinelle, and Vijit Chinburapa. Using the data, the team isolated cases of newly diagnosed with celiac disease. They also isolated 3 control groups that included people without a diagnosis of celiac disease, but who showed 1, 2, or 3 or more symptoms common to the disease. They used claim, incident, and eligibility information from 10.2 million managed care individuals across America from January 1999 and December 2003. They quantified and compared direct standardized relative value based (RVU) medical cost and use of medical services across the whole of the 4 study base. What they found was that the rate of newly diagnosed cases of celiac disease had increased more than 100% over the study period. The celiac disease group showed substantial overall shrinkage in direct standardized medical costs compared with the control subjects. RVU-based medical costs for the celiac subjects were 24%, 33%, and 27% below cohort 1 (p,0.05), 29.0%, 38%, and 24% below cohort 2 (p,0.05), and 38%, 33%, and 31% below cohort 3 (p,0.01) for the 12-month, 24-month and 36-month post-diagnosis periods, respectively. The reduced costs correlated with a reduction in office visits, lab, diagnostic, imaging, and endoscopy procedures compared to the 3 other cohorts over the 3-year follow-up period. The researchers found increased rates of celiac disease diagnosis, which was tied directly to a substantial reduction in direct standardized RVU-based medical costs and use of selected health care services over the period of the study. Journal of Insurance Medicine 2008;40:218–228
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