Friday, December 12, 2008
"Celiac Disease and Gluten Sensitivity"
The William K. Warren Medical Research Center for Celiac Disease (WMRCCD) in San Diego recently held another educational meeting. Thanks to YouTube and UCTV you can virtually attend the meeting, which featured Dr. Martin Kagnoff, Dr. Kimberly Newton, and Dr. Susan Algert, a registered dietician. Like last year's installment, the video is long but informative—and highly recommended!
Kagnoff's talk, "Celiac Disease and Gluten Intolerance: How to Tell the Difference" surveys many basics, including a discussion of differences between oats and wheat, barley, and rye. I was surprised by his estimate that about 15%-20% of all cases of celiac disease have been diagnosed—I've heard the that diagnoses were much lower than that—but not surprised by his remark that "there is a huge amount of individuals walking the face of the United States who have celiac disease and don't know it." In his discussion of the frequency of celiac disease he says that mild cases are more common than severe cases, and notes that Japan is unusual in being nearly free of the condition due to genetic factors. He also devotes much time to issues related to testing, including the advisability of family screening and the problems posed by people who go gluten-free before they've been tested. He acknowledge the phenomenon of gluten intolerance or sensitivity but noted that very few studies have been done on the subject so far.
Newton's talk, "Growing Without Gluten: Update on Pediatric Celiac Disease," offers an overview of special issues regarding child patients. She lists possible non-gastronomical manifestations as enamel defects, mouth sores, short stature, delayed puberty, low bone density, arthritis, headaches, ADHD, depression, epilepsy, dermatitis herpetiformus, anemia, and inflammation of the liver. Something she mentions that I've heard elsewhere is that the tTg test (very popular with Kagnoff) may not be as reliable as anti-gliadin tests when used on children under two years of age.
Algert's "Tips on Eating Gluten-Free" includes advice to include many non-processed foods that can often be found along the perimeter of the store, as they are naturally gluten-free.
The Q&A session includes an interesting comment on advice for pregnant women who want to protect infants from celiac disease. In Newton's answer, she acknowledges the study that recommended introduction of gluten during months 4-6 of breastfeeding, but also noted forthcoming studies suggesting that waiting more than 12 months might be more advisable. Also during the Q&A period, Kagnoff discusses trials of treatments for refractory sprue and notes that dozens of peptide sequences can trigger the damage associated with celiac disease.