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Celiac.com 09/12/2006 - Symptoms of celiac disease prominently include fat malabsorption. One would expect this to impact levels of essential fatty acids in celiacs. The omega-3 essential fatty acids, especially eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids available in fish oil supplements have been demonstrated to have numerous health benefits. However, there are almost no studies on the effect of celiac disease on essential fatty acid levels. I am currently in the process of writing an article on essential fatty acids that will appear in Celiac.coms Scott-Free Newsletter, so a new study on lipid profiles in celiac disease caught my eye with promise. I was disappointed to find the study only measured cholesterol levels in celiacs, which showed an improvement in the "bad" to "good", LDL to HDL, ratio and an increase in "good" HDL cholesterol in patients on a gluten-free diet. The opportunity to study essential fatty acid levels in celiacs was again missed. However, omega-3 fatty acids have a proven beneficial effect on cholesterol levels, and improved fat absorption of omega-3 fatty acids due to a gluten-free diet may be responsible for the results presented in this new celiac disease lipid profile study. Below are the abstract of this study and two studies on the effects of omega-3 fatty acids on cholesterol levels: Am J Med. 2006 Sep;119(9):786-90. Change in lipid profile in celiac disease: beneficial effect of gluten-free diet. Brar P, Kwon GY, Holleran S, Bai D, Tall AR, Ramakrishnan R, Green PH. Am J Cardiol. 2006 Aug 21;98(4 Suppl 1):71-6. Clinical overview of omacor: a concentrated formulation of omega-3 polyunsaturated Fatty acids. Bays H. Am J Clin Nutr. 2000 May;71(5):1085-94. Purified eicosapentaenoic and docosahexaenoic acids have differential effects on serum lipids and lipoproteins, LDL particle size, glucose, and insulin in mildly hyperlipidemic men. Mori TA, Burke V, Puddey IB, Watts gluten-free, ONeal DN, Best JD, Beilin LJ. New Fatty Acid Celiac Disease Study No sooner do I complain there arent any studies of essential fatty acid levels in celiac disease then, at least, a limited pediatric study of essential fatty acids appears! The results of this study on 7 pediatric patients with active celiac disease, 6 with celiac disease in remission, and 11 controls, show serum levels of fatty acids are similar between celiac disease and control patients, but abnormal fatty acid levels exist in intestinal mucosa tissue of active celiac disease patients. Results suggest an omega-6 fatty acid deficiency, at least in the mucosa. Not too surprising because prostaglandin E2 secretion increases in the intestines of active celiac disease patients, and prostaglandin E2 is produced from omega-6 fatty acids. It should be noted that fatty acid profiles may prove to be different in adult celiac disease patients. Also while omega-6 fatty acids may be deficient, increasing intake of omega-3 fatty acids may help reduce inflammatory processes in celiac disease. J Pediatr Gastroenterol Nutr. 2006 Sep;43(3):318-323. Abnormal Fatty Acid Pattern in Intestinal Mucosa of Children with Celiac Disease is Not Reflected in Serum Phospholipids. Steel DM, Ryd W, Ascher H, Strandvik B. Abstract: "Objective: Celiac disease (celiac disease) is characterized by chronic inflammation of the small intestinal mucosa with disturbed epithelial transport. The fatty acid (FA) composition of intestinal membranes is important for epithelial function, and disturbances may contribute to the pathophysiology of the disease. We aimed to evaluate whether the intestinal mucosal FA status was reflected in serum phospholipids of patients with celiac disease." "Patients and Methods: Samples were obtained from 7 pediatric patients with active celiac disease showing mucosal atrophy, 6 pediatric patients with celiac disease in remission, and 11 control pediatric patients with morphologically healthy intestinal mucosa. Small intestinal biopsies were obtained using a Watson biopsy capsule under fluoroscopic control. Blood samples were collected on the same morning after an overnight fast. Tissue phospholipids were isolated by high-performance liquid chromatography, and FAs were analyzed by capillary gas-liquid chromatography." "Results: Serum phospholipid FA showed marginal differences between the patients with celiac disease and the controls. Significant differences were observed in mucosa with active celiac disease compared with controls. Linoleic acid (18:2n-6) level was decreased, whereas those of its derivatives were elevated, indicating increased transformation of n-6 FA. Mead acid (20:3n-9) level was increased, with an increased ratio of Mead acid to arachidonic acid (20:4n-6) levels, suggesting essential fatty acid deficiency. The n-3 FA levels were not significantly changed. During remission, the FA pattern of the intestinal mucosa was mainly similar to that in controls." "Conclusions: The FA abnormality of intestinal mucosa in patients with active celiac disease was not reflected in serum values. Altered FA content may contribute to the pathophysiology of the disease because FAs are important for enzymes and for the transport and receptor functions of epithelial membranes."

Celiac.com 07/03/2009 - A new study provides demonstrates that small intestinal bacterial overgrowth and increased intestinal permeability are both associated with non-alcoholic fatty liver disease (NAFLD). Previous studies have suggested that bacteria from the intestine might play a role in NAFLD, which is the hepatic component of the Metabolic Syndrome. NAFLD can worsen to nonalcoholic steatohepatitis, and some experts have wondered if this progression might be promoted by liver exposure to gut bacteria. A team of researchers, led by Antonio Grieco of Rome, set out to answer this question by investigating gut permeability in patients with NAFLD and comparing the results to patients with untreated celiac disease and known susceptibility to this condition, and with healthy volunteers. The research team included Luca Miele, Venanzio Valenza, Giuseppe La Torre, Massimo Montalto, Giovanni Cammarota, Riccardo Ricci, Roberta Masciana, Alessandra Forgione, Maria Gabrieli, Germano Perotti, Fabio Vecchio, Gian Ludovico Rapaccini, Giovanni Gasbarrini, Christopher Day, and Antonio Grieco. They studied 35 patients with biopsy-confirmed NAFLD, 27 with celiac disease and 24 healthy volunteers. For each participant, the research team checked levels of small intestinal bacterial overgrowth using a glucose breath test. They evaluated intestinal permeability by examining urinary excretion of Cr-EDTA. They then assessed the integrity of tight junctions within the gut via duodenal biopsy. "The main findings of this study are that both intestinal permeability and the prevalence of small intestinal bacterial overgrowth are increased in patients with NAFLD and correlate with the severity of steatosis," the authors report. "Disruption of tight junction integrity may explain the increased permeability in these patients." The authors hypothesize that small intestinal bacterial overgrowth and/or the associated increase in gut permeability may cause steatosis. This hypothesis is supported by studies on mice, and by reports that probiotics can improve steatosis resulting from a high fat diet. One important note was that the study showed no connection between either small intestinal bacterial overgrowth or intestinal permeability and steatohepatitis or fibrosis, which suggests gut bacteria do not play a role in the transformation of NAFLD to more serious liver disease. "In conclusion," the authors write, "we have demonstrated that NAFLD is associated with increased intestinal permeability and small intestinal bacterial overgrowth and that these factors are associated with the severity of hepatic steatosis." More study is needed to nail down the exact causal relationship, which, once understood, could help scientists develop new therapies for NAFLD that incorporate the microbiome of the gut.'' According to colleagues Elisabetta Bugianesi and Ester Vanni of the University of Turin, "The study...raises the possibility that gut microbiota and intestine permeability are important mediators of diet-induced metabolic disturbances in NAFLD." Bugianesi and Vanni add that lifestyle-focused therapy would likely present the best treatment for NAFLD, but suggest that influencing gut flora by antibiotics, prebiotics, and probiotics might help offset the effects of unbalanced diets on metabolic conditions. Article: "Increased Intestinal Permeability and Tight Junction Alterations in Non-Alcoholic Fatty Liver Disease (NAFLD)." Editorial: "The Gut-Liver Axis in Nonalcoholic Fatty Liver Disease (NAFLD): Another Pathway to Insulin Resistance?" Bugianesi, Elisabetta; Vanni, Ester. Hepatology; June 2009. Hepatology. 2009 Jun;49(6):1877-87.