"Celiac Disease and Gluten Sensitivity"

Source (1:23:11)


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.

"DIABETES AND THE GASTROINTESTINAL TRACT"

Following on the heels of the excellent video What You Need to Know about Celiac Disease and the Gluten-Free Diet, University of California Television (UCTV) now offers "Diabetes and the Gastrointestinal Tract," part of a book tie-in series called Taking Control of Your Diabetes.

The commercially supported video, featuring host Dr. Steven Edelman and guest Dr. James Wolosin, offers some basics about the gastrointestinal (GI) system and some GI conditions that are more likely to affect people who have diabetes.

Following a discussion about heartburn, acid reflux, and endoscopies, the conversation moves on to gastroparesis (around the 8:00 mark) and then celiac disease (around the 11:00 mark).

As the video states, people with Type 1 diabetes are more likely than the general population to have celiac disease; the same goes for people with first-degree relatives who have been diagnosed with celiac disease. (Even if you have a different type of diabetes, there's probably about a 1% chance of having undiagnosed celiac disease.)

Around the 14:40 mark there's a segment where a woman with diabetes raves about Whole Foods and talks about how her gastroparesis (delayed gastric emptying) went away after she adopted a gluten-free diet. (Heartburn also can go away after someone with celiac disease goes gluten-free.)

The coverage seems largely sound to me except for Dr. Wolosin's remarks differentiating people with celiac disease who show extreme sensitivity to gluten and people who do not show symptoms, saying that some people in the latter group can cheat a little bit on their diets every once in a while. Basically, almost all people with celiac disease who follow a gluten-free diet are likely to be accidentally contaminated every now and then (see my own confession, for instance), so it's probably not a great idea to compound the problem by giving patients a license to cheat intentionally, especially when damage to the body (such as bones and the intestines) can occur long before being noticed through symptoms. Cheating on the diet every now and then, like smoking every now and then, isn't likely to kill anyone, but it's still not the kind of thing I like to hear a doctor advocating.

As the video continues, the doctors also discuss ulcers, fatty liver, and colon cancer screening. The video ends with a summary.



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WHAT YOU NEED TO KNOW ABOUT CELIAC DISEASE AND THE GLUTEN-FREE DIET

Have you ever been to a medical panel discussion about celiac disease? Now, free on YouTube, you can see a comprehensive seminar on the basics of celiac disease and the gluten-free diet offered by the William K. Warren Medical Research Center for Celiac Disease at the University of California, San Diego.

Originally aired on November 29, 2007 by University of California Television (UCTV), the panel features director Martin Kagnoff ("What is Celiac Disease?"), gastroenterologist Gregory S. Harmon ("Do You Have Celiac Disease? Understanding Testing in Celiac Disease"), and nutritionist Susan J. Algert ("Mastering the 8 Principles of the Gluten-Free Diet"), plus a Q&A session.

One point that comes up in the program: Of the estimated 3-4 million people with celiac disease in the United States, only 40,000 have been diagnosed so far! Elsewhere, it's interesting to see how much faith Dr. Harmon has in the tTG for diagnostic testing, but I suspect the full panel of blood tests might still be worth giving just to get a good baseline and overview, especially in light of persistent questions regarding non-celiac gluten sensitivity. Dr. Harmon also mentions chronic borderline anemia as a red flag that can be investigated via tests for ferritin. Regarding the hot subject of whether one would take a pill (or just adhere to the diet), Dr. Kagnoff says that many gluten-free Netherlanders say they're very happy with the diet and wouldn't want to switch to a pill, though younger people and those new to the diet seem more enthusiastic about such medication.

Anyway, this is a very good and clear presentation. Instead of being broken up into several portions, it's offered in one big serving that's about as long as a feature film, so get out the popcorn and M&Ms and make yourself nice and cozy to watch it if you want to know what you need to know. After all, seeing the presentation via YouTube is a helluva lot cheaper than going back in time to see it live in San Diego! Plus, in this format, you have the power to pause the lectures to make sure you don't miss anything for whatever reasons.



Source (1:26:48)