Monday, January 31, 2011

Gluten Sensitivity Disease Can Increase Reproductive Problems

Infertility, small for dates babies, miscarriages and unexplained stillbirths are tragic events for a couple trying to conceive. If this should be occurring,  I recommend screening for celiac disease or gluten sensitivity because there is a higher incidence of these problems; with small for dates babies, there is a 7.75 times increased incidence according to this study.

This report comes from Jefferson Adams.

Dr. Kumar, of Maulana Azad Medical College & Lok Nayak Hospital in New Delhi, reported in a study published in the World Journal of Gastroenterology that women with latent celiac disease, those who test positive for celiac antibodies but show normal small bowel biopsies, may develop more reproductive problems.

"Women having unexplained infertility, recurrent abortions, stillbirths or intrauterine growth retardation could have subclinical celiac disease, which can be detected by serological screening tests," Dr. Ashok Kumar told Reuters Health by email.

Improved diagnostic tools, and greater access to screening have led to more diagnosis of latent or subclinical celiac disease, says Dr. Kumar.

Doctors know that women with full, biopsy-proven, untreated celiac disease have more reproductive problems if they don't follow a gluten-free diet.

To study the effect of latent celiac disease on reproductive performance, the researchers examined 893 women.

They found that a total of 104 women had undergone idiopathic recurrent abortion, 104 had unexplained stillbirth, 230 had unexplained infertility, and 150 were pregnant, but showed idiopathic intrauterine growth restriction. The remaining 305 women, with normal obstetric histories, and served as control subjects.

Based on IgA tTG antibody titers, latent celiac disease was 5.43 times more common in the group with recurrent spontaneous abortion than in the control group.

Rates of latent celiac disease for the group with stillbirth were 4.61 times greater than the control group.

Rates for the group with intrauterine growth restriction were 7.75 times greater than control subjects, while rates for those with unexplained infertility were 4.51 higher.

The researchers also found that women with positive blood screens showed higher rates of  previous early births, low-weight births, and cesarean sections than did seronegative subjects.

Moreover, the researchers note that "the classic presentation of diarrhea and malabsorption is now less common, and atypical and silent presentations are increasing."

As a result of their findings, Dr. Kumar and his colleagues are recommending celiac disease blood screens for women with idiopathic cases of poor reproductive performance.


Ron Hoggan's response to article about "gluten-free dieting"

Dr. Ron Hoggan, co- author of Cereal Killers  and Dangerous Grains, has some interesting things to say in regards to some common myths about gluten-free eating and he emphasizes that gluten sensitivity has been found to be more dangerous than celiac disease.

Recently I have noticed a trend in articles that demonize the gluten-free diet, and imply that there is something unhealthy or even dangerous about it. Here is an example of one that I forwarded to Dr. Ron Hoggan:
and below is his response to its author:

Dear China Millman,
Thank you for your interesting article on gluten-free dieting.  I was very pleased to read that you include patients with non-celiac gluten sensitivity among those who should follow a gluten free diet.  I assume that you have arrived at your estimate of 20 million who are afflicted with wheat allergy, non-celiac and celiac gluten sensitivity using Dr. Fasano’s  estimate that 6 to 7 percent of Americans have what you refer to as this “milder form of gluten intolerance”.  There are other estimates. For instance, Dr. Kenneth Fine did random blood draws at a shopping center in Dallas, Texas and found an 11% rate of gluten sensitivity. Congruently, Dr. Marios Hadjivassiliou has reported rates as high as 12% in the United Kingdom and Dr. Rodney Ford reports a prevalence estimate of 10% in New Zealand.  Each investigator used different methods to arrive at their estimate, and each method is likely to underestimate the true prevalence of non-celiac gluten sensitivity. For instance, they all rely on a single class of antibody reaction against a single sub-group of proteins found in gluten grains. Thus, Dr. Fasano’s estimate may be unduly conservative as it is substantially lower than others have found in similar populations and the testing used to arrive at Dr. Fasano's estimate also carries all of the other limitations mentioned above.

As for the notion that non-celiac gluten sensitivity is milder than celiac disease, Anderson et al, in their study titled “Malignancy and mortality in a population-based cohort of patients with coeliac disease or ‘gluten sensitivity’ World J Gastroenterol 2007 January 7; 13(1): 146-151, report a higher rate of malignancy and early mortality among those with non-celiac gluten sensitivity than among those with celiac disease.  This finding may be the result of the common recommendation that patients ignore test results that show non-celiac gluten sensitivity, as many physicians believe that such results are “non-specific” and do not warrant a gluten free diet. However, it may also reflect that non-celiac gluten sensitivity is a more serious illness than celiac disease. It may also reflect something entirely different than these two interpretations, but it does make a very good case for the need for more research in this very neglected area.

As for the comments by Heather Mangieri and the American Dietetics Association, they might benefit from reading studies such as the one by Dr. Cheng et al titled “Body Mass Index in Celiac Disease Beneficial Effect of a Gluten-free Diet” in the 2009 Journal of Clinical Gastroenterology. They found that, after diagnosis with celiac disease, about half of the overweight and obese patients lost weight. Given the conservative data you report, suggesting that at least 90% of American cases of celiac disease go undiagnosed, there can be little doubt that a large portion of those with undiagnosed celiac disease who are overweight or obese would be likely to lose weight. The number who would lose weight should be greater among those who chose to follow a gluten free diet to lose weight, as some of those who are diagnosed with celiac disease do not comply with the diet.  If one accepts the proposition that those with non-celiac gluten sensitivity, IBS, and IBD often have similarly problematic reactions to gluten, the number of Americans who could lose weight and live healthier, and therefore happier, lives (eating a gluten free diet) rises exponentially.

....In the current context of excessive under-diagnosis of celiac disease and limited understandings of the dynamics by which a gluten free diet causes weight loss among celiac patients, and an enormously greater number of Americans who have non-celiac gluten sensitivity, it is difficult to understand why anyone would be cautioned against following a gluten free diet with weight loss as their objective.  Whether these individuals are undiagnosed celiac patients, have undiagnosed non-celiac gluten sensitivity, or they find that a gluten free diet is helping them to achieve their body mass objectives, there is little legitimate cause to "warn" people away from a gluten free diet. Overall, your article does raise awareness of gluten as a potential health threat, so its overall impact is positive despite the misinformation that a gluten free diet does not help with weight loss.

Ron Hoggan, Ed. D.