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Celiac.com 11/19/2021 - The association between celiac disease and a range of respiratory diseases has long been recognized(1). An exploration of the literature on this point brought me several new insights. For instance, I learned that gluten sensitivity is also an important risk factor for certain lung disorders. Although celiac disease was only slightly more frequent (one of 29 subjects had celiac disease) a whopping 40% (12 of 29) of patients with sarcoidosis showed gluten sensitivity(2). I also learned that some researchers are even pointing to celiac disease as an underlying cause of some cases of lymphocytic bronchoalveolitis(3) which is an inflammation that narrows the airways in the lungs. Perhaps the most startling new insight I gained was that despite compliance with a gluten-free diet, patients with celiac disease continue to show signs of a mucosal defect in the lungs(4). From a personal standpoint, although I experienced asthma and many breathing problems as a child, I have blamed my 25 years of smoking cigarettes for the bulk of my lung problems. While I remain confident that this is a large factor in the lung disease I have today, I am also realizing that my celiac disease is a contributing factor. I have made some important strides in improving my lung function as a result of my studies, and it is these that I would like to share with you here. Although my memory is vague on this point, I’m sure I experienced improvement from the celiac diagnosis and subsequent gluten-free diet. I’m also sure that food allergy testing, and subsequent avoidance of problem foods, helped stabilize my breathing to the point where I have rarely experienced breathing crises in the last six years. Nonetheless, I have been limited by a very small capacity for exercise and the predictable losses in conditioning. In the process of researching ketogenic and low carb dieting for a video I am working on, I chanced upon a reference(5) to a study of healthy women that claimed a 5% increase in peak flow and a 10% improvement in pulmonary function after one week on a low carbohydrate diet(6). I have now been following a low carbohydrate diet for more than a month. My average peak flow has increased by about 15%. Far more importantly, my tolerance for exercise has increased quite dramatically. Although I still become breathless after vigorous exercise, I can engage in mild to moderate exercise for considerable periods without any breathing difficulty. This constitutes a considerable improvement in my breathing and provides an important increase in the quality of my life. I realize that smoking is a foolish habit to start. Despite many warnings I continued this habit for many years, until six months prior to my celiac diagnosis. I know I am fortunate in not having contracted any of the deadly diseases caused by smoking. Thus, I take solace in the research that shows that tobacco smoking is a way of self-treating the symptoms of celiac disease(7,8,9,10). These publications have helped me deal with the self-recrimination that accompanies the knowledge that I created my own breathing problems. It has also led me to a deeper understanding of the powerful addiction I experienced, the illness I felt after I did finally quit, and the recognition that celiac disease has shaped a great deal of my life. References: Stevens FM, Connolly CE, Murray JP, McCarthy CF. Lung cavities in patients with coeliac disease. Digestion. 1990;46(2):72-80. Papadopoulos KI, Sjoberg K, Lindgren S, Hallengren B. Evidence of gastrointestinal immune reactivity in patients with sarcoidosis. J Intern Med. 1999 May;245(5):525-31. Brightling CE, Symon FA, Birring SS, Wardlaw AJ, Robinson R, Pavord ID. A case of cough, lymphocytic bronchoalveolitis and coeliac disease with improvement following a gluten free diet. Thorax. 2002 Jan;57(1):91-2. Robertson DA, Taylor N, Sidhu H, Britten A, Smith CL, Holdstock G. Pulmonary permeability in coeliac disease and inflammatory bowel disease. Digestion. 1989;42(2):98-103. The Ketogenic Diet: A Complete Guide for the Dieter and Practitioner by Lyle McDonald. 1998. Kwan RM, Thomas S, Mir MA. Effects of a low carbohydrate isoenergetic diet on sleep behavior and pulmonary functions in healthy female adult humans. J Nutr. 1986 Dec;116(12):2393-402. Suman S, Williams EJ, Thomas PW, Surgenor SL, Snook JA. Is the risk of adult coeliac disease causally related to cigarette exposure? Eur J Gastroenterol Hepatol. 2003 Sep;15(9):995-1000. Austin AS, Logan RF, Thomason K, Holmes GK. Cigarette smoking and adult coeliac disease. Scand J Gastroenterol. 2002 Aug;37(8):978-82. Vazquez H, Smecuol E, Flores D, Mazure R, Pedreira S, Niveloni S, Maurino E, Bai JC. Relation between cigarette smoking and celiac disease: evidence from a case-control study. Am J Gastroenterol. 2001 Mar;96(3):798-802. Snook JA, Dwyer L, Lee-Elliott C, Khan S, Wheeler DW, Nicholas DS. Adult coeliac disease and cigarette smoking. Gut. 1996 Jul;39(1):60-2.

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

Celiac.com 05/13/2019 - You might remember earlier headlines touting lower celiac disease risk in people who smoke cigarettes compared with people who never smoked. Several studies have shown a negative association between cigarette smoking and celiac disease, but results have been inconsistent. A study published in 2004 in the European Journal of Gastroenterology & Hepatology, found that cigarette smoking provided protection against the development of adult celiac disease. In a 2015 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." So, do cigarette smokers have a lower risk of celiac disease than non-smokers? To find a conclusive answer, a team of researchers recently set out to summarize all available data, using meta-analysis, and to demonstrate any decreased risk of celiac disease among current smokers compared with people who never smoked. The research team included Karn Wijarnpreecha, Susan Lou, Panadeekarn Panjawatanan, Wisit Cheungpasitporn, Surakit Pungpapong, Frank J. Lukens, and Patompong Ungprasert. The team used MEDLINE and Embase databases to identify all group studies and case-control studies that compared the risk of celiac disease among current and/or former smokers versus people who never smoked. They then extracted the effect estimates from each study and combined them using the random-effect, generic inverse variance method of DerSimonian and Laird. The team's meta-analysis of seven studies, with 307,924 total participants, showed that current smokers have a substantially reduced risk of celiac disease compared with those who never-smoked. However, they found no significant difference in celiac disease risk between former smokers and those who never smoked. The team suggests that the impact of cigarette smoking on immune system and gut permeability are the likely biological reasons for earlier findings. Read more at Sagepub.com The researchers are variously affiliated with the Department of Internal Medicine, Bassett Medical Center, Cooperstown, USA; the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, USA; the Department of Medicine, University of Minnesota, Minneapolis, USA; the Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; the Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, USA; and the Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

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.