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Celiac.com 01/02/2015 - What an odd thing to say: “Do not mask the appearance of celiac disease.” Inferring that you keep on eating gluten, despite early signs of celiac disease, until you get enough damage to your intestines that it can be seen under a microscope. I totally disagree with this concept—but this is still a common belief of medical practitioners. For instance a dietitian said this recently: “Gluten-free diet as an experiment to see if you (or your children) feel better, can be beneficial, but this approach can mask underlying celiac disease.” Have you ever heard of a doctor “masking” the diagnosis of heart disease by failing to treat high blood pressure or high cholesterol until the patient has a heart attack? Ridiculous! Have you ever heard of a doctor “masking” the diagnosis of depression so that the person is suicidal before given help? Ridiculous! A colleagues writes: “As far as ‘masking’ celiac disease, that would be like saying that a person who is pre-diabetic should continue to eat lots of sugar and carbs so they can destroy enough beta cells to develop full blown diabetes. That eating low carb might mask diabetes. Meanwhile the pre-diabetic blood sugars can continue to damage the body in many insidious ways. Maybe these dietary changes should be looked at as preventive measures that are good.” So why is the “masking” concept reserved for celiac disease? I regard a slightly raised tTG result as a ‘smoking gun’ (this also goes for EMA and DGP). Yes, the concept of “do not go gluten-free so that you do not mask celiac disease diagnosis” is contentious. There are many threads to this problem: Celiac disease is a progressive condition—it slowly gets worse the longer you eat gluten; In the early stages of celiac disease, it cannot be diagnosed by endoscopy biopsy; The biopsy test is inaccurate and relies on experts to recognize early disease; Most people who get gluten-illness do not have celiac disease; Gluten-related-disorders-without-gut-damage are indistinguishable from early-celiac-without-gut-damaage-yet; Carrying the HLA DQ2/DQ8 gene cannot be used to make a diagnosis, but if you do not carry the gene, it will be very unlikely that you have celiac disease; The “masking” concept originated a few decades ago when biopsy was the only way to diagnose celiac disease; Now, the blood tests for celiac disease (EMA, tTG, DGP) are more accurate than the biopsy, and can turn positive BEFORE there is any histologic evidence of gut damage; Once celiac disease has become established, you cannot guarantee complete remission; Gluten challenge is detrimental to your health; A gluten challenge (to create serious bowel damage) can take years, during which time ongoing body damage (brain, skin and bowel) is ongoing; Celiac disease and gluten-senitivity often co-exist. This concept is addressed in my new book “Gluten-related disorder: sick? tired? grumpy?” Available as an ebook at http://www.GlutenRelatedDisorder.com.
Celiac.com 12/07/2015 - Could population changes in smoking habits help explain the change in incidence and prevalence of celiac disease? Could lower rates of cigarette smoking be contributing to higher rates of celiac disease? It is pretty well documented that cigarette smokers have lower natural rates of celiac disease than the non-smoking population, which implies that tobacco might offer some measure of prevention with regard to celiac disease. Now, a gastroenterologist is asking whether a reduction in public smoking levels might be associated with a rise in rates of celiac disease. In a letter to the editors of the American Journal of Gastroenterology regarding the study "Incidence and prevalence of celiac disease and dermatitis herpetiformis in the UK over two decades: population-based study" by West et al., Dr. S. Veldhuyzen van Zanten, MD, PhD, of the Division of Gastroenterology, University of Alberta in Edmonton, Alberta, Canada, wonders whether lower rates of cigarette smoking in the preceding decades "might help explain the study findings." Data from several studies regarding reduced celiac rates in cigarette smokers offer support for Dr. van Zanten’s line of thinking; including data that show a new diagnosis of celiac disease is made significantly less frequently in smokers than in non-smokers. Interestingly, there also is some evidence that cigarette smoking might actually mask the clinical manifestations of celiac disease rather than prevent its occurrence. Either way, Dr. van Zanten's hypothesis would cast some interesting light on celiac disease if proven correct. The good news is that Dr. van Zanten’s hypothesis is easy to test. Because Canada has such a large health care database, they can easily compare rates of smoking and celiac diagnosis, and adjust for necessary factors to give a better picture of any possible connection. Sources: Am J Gastroenterol. doi: 10.1038/ajg.2014.345 West J , Fleming KM , Tata LJ et al. Incidence and prevalence of celiac disease and dermatitis herpetiformis in the UK over two decades: population-based study . Am J Gastroenterol 2014 ; 109 : 757 – 68 Snook JA , Dwyer L , Lee-Elliott C et al. Adult coeliac disease and cigarette smoking . Gut 1996 ; 39 : 60 – 2 . Lear JT , English JSC . Adult coeliac disease, dermetitis herpetiformis and cigarette smoking. Gut 1997 ; 40 : 289 . van Zanten SJOV . Case Report: Recurrent diarrhea and weight loss associated with cessation of smoking in a patient with undiagnosed celiac disease . Gut 2001 ; 49 : 588. Office for National Statistics UK. Smoking prevalence among adults has declined by half since 1974. Part of General Lifestyle Survey, 2011. Released: 28 March 2013. http://www.ons.gov.uk/ons/rel/ghs/general-lifestyle-survey/2011/sty-smoking-report.html
Is excessive consumption of gluten-containing food a risk factor for celiac? I was wondering whether it worked on a similar principal to too much alcohol and alcoholism or sun exposure and skin cancer. I never had any of the symptoms or signs of celiac that have been documented when I was in grade school. A few years prior to being diagnosed I loved my bread and did a lot of home baking with organic unbleached flour and even added vital wheat gluten to breads and cakes. Neighbours always said that our baked items were the best they'd ever come across. This video by Joseph Murray MD at Mayo Clinic seems to sum it up well. Do you think there's a connection???
This article was posted to the Celiac Listserv by Ashton Embry at: firstname.lastname@example.org in January, 1998: I became interested in the concept of a Paleolithic Diet in a circuitous way which began with the diagnosis of my oldest son with multiple sclerosis two and a half years ago. I hit the med library soon after I was told that there was no known cause and no effective treatment for MS. My goal was to determine the most likely cause and to then devise a therapy which countered this cause. After reading hundreds of papers and countless more abstracts I reached the conclusion that the main cause of MS is dietary and that dairy, gluten and saturated fat were the three main offending foods. I have summarized this analysis in an essay which is at The evidence I used to reach my interpretation was a combination of epidemiology, theory (molecular mimicry) and anecdotal data. After the essay was on the web I was contacted by Loren Cordain who pointed out that the foods implicated in MS were recently introduced to the human diet from a genetic point of view and he gave me the references to Boyd Eatons classic papers on Paleolithic Nutrition. From my geological background this concept seemed eminently reasonable so now I had an excellent unifying concept to go along with all the other data. One shortcoming of the evidence was that it was all circumstantial. There was no smoking gun evidence, that is, empirical evidence which demonstrates beyond a reasonable doubt that food proteins really do cause cell-mediated, organ-specific autoimmunity. As a dutiful civil servant, I made one of my required pilgrimages to Ottawa last week to participate in various mind-numbing meetings. I had a free afternoon so I went out to the Nutrition Research Division of Health Canada where I had the good fortune to meet with Dr Fraser Scott. Dr. Scott has been studying the effect of diet on the development of Type 1 Diabetes in BBdp rats for 20 years. He and co-workers have demonstrated conclusively that Type 1 diabetes can be generated by proteins derived from wheat, soy and milk. So now I had found the smoking gun. Food proteins can indeed induce cell-mediated autoimmunity and not surprisingly the foods which supply the pathogenic proteins are those added to the human diet during the Neolithic. I believe Dr. Scotts work is of great significance for understanding the cause of autoimmune disease and strongly supports Eatons suggestion the diet of our ancestors is the best defense against the diseases of civilization. References: The best reference for Scotts work is: Scott, FW, 1996, Food-induced Type 1 Diabetes in the BB Rat. Diabetes/Metabolism Reviews, v.12, p. 341-359. This paper summarizes all his results up to 1996 and contains references to all his earlier work.