celiac disease | MY SPECIAL DOCTOR

Celiac disease: characteristics and numbers in Italy

25 February 20246 January 2024 by psalari

Celiac disease: What it is

Celiac disease is one of the most common hereditary diseases of pediatric age but fortunately also one of the treatable conditions: in fact, the remedy is to eliminate all foods containing gluten (bread, pasta, cookies, rusks, cakes, and even some medications). Gluten comprises a family of plant proteins, the polyamines, contained in wheat (gliadins), barley (hordeins), rye (secalins) and, still controversially, oats (avenins). Such proteins have little nutritional value-that is, they are not essential to the body-and gluten gives flour, once mixed with water, the ability to form a compact and elastic dough, which is among other things an essential prerequisite to breadmaking.

The numbers

A large survey had already estimated in 1994 a prevalence of people with celiac disease at a 1:200 ratio, which in fact is even higher today (1:100-1:150). On the other hand, celiac disease until the 1990s was misrecognized, but the advent of increasingly simple, rapid, and widespread laboratory techniques has enabled the recognition of more cases and thus a significant improvement in diagnostic possibilities.

It is currently believed that there are at least 100 individuals with celiac disease in a population sample of 100 thousand individuals. A number, therefore, that certainly does not justify the characterization as a rare disease, considering also the fact that there are 35,000 certified celiacs and every year new diagnoses increase by 10 percent, amounting to 5,000 cases of which 2,800 are in newborns. The intake of gluten, suggested in children as young as 6 months of age, basically activates an immune response that leads to flattening of the intestinal villi, resulting in generalized malabsorption and stunting of growth, which is the most striking sign (although some cases, which escaped initial diagnosis, are recognized in later life ages).

The consequences and risks

Numerous gastroenterological diseases, each burdened with a different clinical impact, such as irritable bowel syndrome, recurrent aphthous stomatitis, and hypertransaminemia (i.e., increased transaminases, enzymes produced by the liver, assayed in the blood) may be associated with celiac disease with different prevalence.

From celiac disease, with the unavoidable support of the physician, should be distinguished from the wheat allergy, which mainly affects the skin and respiratory tract, and the “gluten sensitivity“, which is always caused by ingestion of this food, but does not affect patients with celiac disease or allergy to wheat (in Italy, it is estimated that it could affect between 5 and 10 percent of the population). The latter causes clinical symptoms similar to those of irritable bowel syndrome (abdominal pain, bloating, and so on) and nonspecific extraintestinal manifestations (eczema, itching, headache), which usually arise within a short distance of gluten intake and just as quickly regress following an exclusion diet.

Celiac disease: possibly a food additive among the causes

21 February 20246 January 2024 by rosanna.feroldi

Considered a “rare” disease until a decade ago, celiac disease today seems to be increasingly prevalent in countries around the world. A phenomenon undoubtedly related, at least in part, to the increased attention to symptoms and more frequent diagnosis, which allow many more people with celiac disease to be identified and characterized than in the past, but not only that. Dietary habits could also play a far from minor role in promoting the onset of the disease. And among the risk factors are not necessarily grains.

A recent literature review published in the scientific journal Frontiers in Pediatrics suggests, in fact, that among the many possible causes of celiac disease (all of which, it should be emphasized, have yet to be precisely verified) might include microbial transglutaminase: a bacterial enzyme capable of binding and transforming cereal gluten, which is often added to industrially produced foods to improve their organoleptic properties and prolong their shelf life.

Studies to date suggest that by binding to gliadin (a major protein in gluten), the bacterial transglutaminase included as an additive in many packaged foods can form complexes characterized by immunogenic properties, that is, capable of prompting the human immune system to react against them, just as it would against a virus or bacterium dangerous to the body.

This initial immune activation would, then, be persistently maintained not only against the “bacterial tranglutaminase-gliadin complex,” but also against the gluten naturally present in cereals, causing the classic symptoms of celiac disease (abdominal cramps, gastrointestinal discomfort, malabsorption, etc.) whenever the affected person takes in non-gluten-free bread, pasta, pizza, cookies, brioches, etc., even if they are artisanally prepared and additive-free.

Industrial products that may contain bacterial transglutaminase are countless and, often, unsuspected because they are not only foods containing flour or grain seeds and because, in general, the presence of the enzyme as an additive is not made explicit in the list of ingredients. These range from preserved meat to sauces, from dairy products to fish preparations (including surimi), from soups to jellies.

How to be risk-free? First of all, it should be made clear that one should not be overly concerned because, even if the involvement of bacterial tranglutaminase in the onset of celiac disease were confirmed, the risk would only affect people with a particular genetic predisposition and/or one or more additional risk factors for developing the disease.

For those who want to protect themselves while waiting for new evidence on the subject, the best choice is to try to eating mostly fresh, good-quality food, cooked with one’s own hands or prepared by persons/merchants (bakers, delis, delicatessens, rotisseries, ice cream parlors, pastry shops, restaurants, etc.) who use only fresh raw materials, handled naturally, without the addition of flavorings, coloring agents, thickeners or preservatives, and in full compliance with hygienic standards.

Source: Torsten M, Aaron L. Microbial Transglutaminase Is Immunogenic and Potentially Pathogenic in Pediatric Celiac Disease. Front Pediatr 2018; https://doi.org/10.3389/fped.2018.00389)

Celiac disease: what it is and how to deal with it

17 February 20246 January 2024 by Redazione My Special Doctor

Celiac disease presents as an abnormal immune response in the small intestine after ingestion of gluten, a protein found in many grains: wheat, but also spelt, barley, rye, oats, and Khorasan wheat.

This response causes chronic inflammation and thus serious damage to the gut resulting in an inability to absorb certain nutrients. This has repercussions throughout the entire body: a deficiency of nutrients in different organs, such as the brain, bones, nervous system, or liver, for example, can lead to diseases, sometimes very serious ones. Let’s think about how important various substances are in children who are in the midst of development and what consequences you may face if you continue to feed them foods containing gluten. Indeed, one of the most obvious “clues” in children with celiac disease is stunted growth, due precisely to the lack of several nutrients. But the symptoms are not always so striking. They can be silent and more subtle, so a diagnosis of celiac disease can be arrived at a long time after its onset. In fact, celiac disease can manifest itself in a variety of ways, such as with diarrhea and stunting immediately after weaning, but it can also appear later in life with different symptoms: anemia, irritable bowel syndrome, skin issues, or nervous disorders.

It should not be underestimated! A deficiency of vitamins A, B12, D, E, K and folic acid may result from the failure to absorb the various substances. There may also be a loss of calcium, from which other complications may result: calcium oxalate kidney stones and osteomalacia, a deficit of mineralization of bone tissue resulting in weakened bones in the body, which become less rigid.

Those who, despite a diagnosis of celiac disease, continue to ingest gluten can face serious complications, including osteoporosis, anemia, alopecia, infertility, and even various forms of cancer, especially intestinal lymphoma. Therefore, it is absolutely essential for people with celiac disease not to ingest foods containing gluten.

Personally, I am against all those products that are marketed gluten-free: pasta, pizza, cookies, rusks, etc. If you read the ingredients, you can find additives and preservatives within them that are harmful to your health. They are also made from devitalized flours: in fact, flours begin to “age” as early as the eighth day after milling and are completely “dead” by the fifteenth. This means that instead of providing us with important nutrients, they lead our bodies to suffer from deficiency, since, not finding the substances in food that are needed for the digestive processes themselves, they take them away from us, and so gradually we will have less and less magnesium, B vitamins, zinc, manganese and many others available to us.

Therefore, the best way is to buy products that are naturally gluten-free: to feel alive, vital, and full of energy, it is essential to feed ourselves with foods that can provide all the nutrients. Pasta, for example, even if made from corn or rice, is not a complete food because it is processed and processed: better to use the “live” grain, which carries the vital sprout and is rich in nutrients. Here is the list of naturally gluten-free grains and pseudocereals:

Brown rice
Mile
Quinoa
Buckwheat
Teff
Sorghum
Amaranth
Corn

Flours can then be made from grains: as I mentioned above, flour is “alive,” that is, rich in nutrients, until the eighth day after milling, after which it oxidizes and by the fifteenth day is completely devitalized. To prepare flour, you can buy an electric mill (you can also find ones that can be purchased on the Internet, just search for grain mill with stone mill): this will make it easy to produce cookies, cakes, and breads with homemade flours.

Of course, fruits, all seasonal vegetables and legumes should not be missing from the tables, varying the products as much as possible so as not to incur deficiencies.

Source: Crudostyle

Too much gluten in young children could increase risk of celiac disease

15 February 20246 January 2024 by Renato Torlaschi

High gluten intake early in life was associated with an increased risk of celiac disease in a new study by a team of researchers in northern Europe.

“We found that a one-year-old child in the highest range of gluten intake has twice the risk of developing autoimmunity of celiac disease, a stage that often preludes to full-blown celiac disease; â€ research coordinator Karl Marild of theNorwegian Institute of Public Health and Queen Silvia Children’s Hospital in Gothenburg, Sweden-. It was surprising to me to find such a strong association, given the ubiquitous nature of gluten in our diet.”

Marild and colleagues used data on 1,875 children provided by another study (Daisy – Diabetes AutoImmunity Study in the Young) that aimed instead to investigate susceptibility to type 1 diabetes mellitus. Among the plus points was the very long follow-up: participants were followed from 1993 until January 2017. The children were divided into three groups according to their dietary gluten intake during the period when they were one year to two years old. The researchers then compared the data of the now-adult participants in the higher gluten intake bracket with those in the lower bracket, showing for the former a 96 percent higher risk of celiac disease and 117 percent higher risk of celiac disease autoimmunity: in other words, a doubling of risk. “If our results are confirmed ,” said Marild. may provide a somewhat better understanding of a significant aspect of the likely multifactorial etiology of this disease. Importantly, we do not recommend a change in pediatric feeding practices, because ours was an observational study and unable to show a cause-and-effect relationship.” It is also necessary to specify that the consumption of gluten-rich foods in non-celiac adults has never been associated with any adverse effects. Gluten-free diets, much in vogue in the United States, challenging, unnecessary and expensive, may carry risks, and their health effect is among the many unproven but widespread “hoaxes” in nutrition.

Mårild K, Dong F et al. Gluten Intake and Risk of Celiac Disease: Long-Term Follow-up of an At-Risk Birth Cohort. Am J Gastroenterol. 2019 May 9.

Gluten does not produce symptoms in healthy people

14 February 20246 January 2024 by Redazione My Special Doctor

Intake of gluten-containing foods can be very harmful to people with celiac disease, but it causes no gastrointestinal symptoms in people without a related disorder, a double-blind, randomized controlled trial (DRCT) published in the September issue of Gastroenterology by a group of British researchers confirms.

The research is particularly relevant because of its methodological rigor and because it addresses a topic that, for many people, is still a source of great confusion. In fact, perhaps influenced by the dietary choices of some celebrities, 44% of Americans buy gluten-free foods for reasons other than celiac disease, and 65% believe that avoiding this substance is synonymous with healthier eating.

The British study debunking this belief looked at 28 participants, 21 of them women, with an average age of 38, all of whom underwent serologic testing to rule out celiac disease.

The authors divided them into two groups, both of which were educated by a dietitian and put on a gluten-free diet for two weeks, at the end of which any gastrointestinal symptoms, abdominal pain, reflux, episodes of indigestion, diarrhea and constipation were assessed; a visual analog scale was also used to measure “overall fatigue.”

Next, the researchers randomly assigned participants to add flour sachets with or without gluten to their food, twice a day for two more weeks. The daily dosage, for the intervention group, was 14 gluten proteins.

Comparison between the two groups showed no significant differences in symptoms with the exception of episodes of diarrhea, which were reduced among participants who had consumed gluten, a fact the latter was considered abnormal by the authors themselves.

The results of the study thus suggest that gluten does not cause gastrointestinal symptoms in most people, but the British researchers remind that there are many people with undiagnosed celiac disease and recommend that if they have problems, they should be tested for the disease.

Source: Croall ID, Aziz I, et al. Gluten Does Not Induce Gastrointestinal Symptoms in Healthy Volunteers: A Double-Blind Randomized Placebo Trial. Gastroenterology. 2019 Sep;157(3):881-883.

Gluten the enemy of celiacs

5 February 20246 January 2024 by Redazione My Special Doctor

Gluten is the No. 1 enemy for people with celiac disease and is difficult to avoid. Episodes of this chronic autoimmune disease can be triggered by ingestion of gluten, a key protein in wheat and some other grains. The researchers explored how gut bacteria, particularly bifidobacteria, could be used as a treatment. Scientists publishing the results of laboratory experiments in the ACS Journal of Agricultural and Food Chemistry also explain how specific types of bifidobacteria work.

Humans have many types of bacteria living in their digestive systems, but those with celiac disease have altered levels of “beneficial” bacteria and “harmful” gut bacteria. This implies that patients with celiac disease, even by sticking to a strict gluten-free diet, generally cannot reestablish an ideal gut microbiome on their own.

In particular, the levels of bacteria in the bifidobacteria family are lower in those patients with that condition than in healthy individuals.

These bacteria can cut gluten proteins into smaller fragments that are not as aggressive or harmful to patients, which led researchers to try using the microbes as probiotics to treat gastrointestinal diseases.

So Edson Rodrigues-Filho, Natália E. C. de Almeida and colleagues began to look at exactly how various strains of bifidobacteria break down gluten peptides and what effects these gluten-derived peptides would have, which are more reduced as far as immune response.

The researchers extracted gluten proteins from wheat flour and cultured four strains of the bifidobacteria family, either separately or in a large group. In an artificial intestinal environment, B. longum broke down gluten proteins into a higher number of fragments, compared with the other strains and the mixture of all four strains.

From there, the team analyzed cytotoxic and inflammatory responses to various peptides and found that those of the B. longum strain caused the least damage to intestinal cells in Petri dishes.

These results mark the first identification of specific peptides derived from gluten and generated directly from gluten proteins, which remained intact with respect to bifidobacteria activity and immunological responses by human cells . All of this for researchers will pave the way for new treatments and better outcomes for patients.

Source: American Chemical Society