Early detection, diagnosis and treatment of celiac disease lowers medical costs

Early detection, diagnosis and treatment of celiac disease lowers medical costs, by an average of US $1,764 per year and will likely benefit patients and health care providers alike, so a team at Mayo clinic determined. They also commented that costs associated with celiac disease pose a significant economic burden, but most startling was the economic burden especially for men with the disease.

The obvious conclusion is that we should increase testing for celiac disease in all but especially in men, especially in those with illness and no obvious cause.

This was reported in this week’s celiac.com by Jefferson Adams.(My emphasis in bold)

To carry out their population-based cohort, the team used administrative data on celiac disease cases and matched controls from Olmsted County, Minnesota.

They compared: 1) direct medical costs one year before and one year after celiac disease diagnosis for 133 index cases and for control subjects; and 2) cumulative direct medical costs over four years for 153 index celiac cases and for control subjects. Their analysis did not include diagnostic-related and outpatient pharmaceutical costs.

They found that a diagnosis of celiac disease lowers the average total costs by $1,764 in the year following diagnosis (pre-diagnosis cost of $5,023 vs. $3,259; 95% CI of difference: $688 to $2,993).

They found also that, over a 4-year period, people with celiac disease faced an average of $1,457 in higher outpatient costs (P = 0.016), and an average of $3,964 in higher total costs of $3,964; (P = 0.053), compared with the control group.

Men with celiac disease bore the brunt of those higher costs, with excess average total costs of just over $14,000 compared to costs of $4,000 for male controls; 95% CI of difference: $2,334 to $20,309).
Costs associated with celiac disease pose a significant economic burden, especially for men with the disease.

The abstract for the research article can be found at Alimentary Pharmacology & Therapeutics Volume pages 261–269, July 2010.

Dr Fasano's Insights in Scientific America: Clues to Solving Autoimmunity

Dr. Alessio Fasano, professor of pediatrics, medicine and physiology at the Center for Celiac Research at the University of Maryland School of Medicine, has been studying celiac disease and has uncovered a process that may contribute to many autoimmune disorders. He makes some interesting comments on the use of probiotics to prevent and treat celiac disease. And he says "leaky gut" in a major pathogenesis of the illnesses, especially autoimmune diseases that complicate this food borne illness.

Tina Turbin reports on Dr. Fasano's article in Scientific American:



This research into the leaky gut of celiacs can explain a question that has been perplexing researchers regarding the disease's pathogenesis: Why do some people not develop celiac disease until later in life? According to Dr. Fasano, this issue could be associated with the microbes in the digestive tract. The microbicrobial population varies among individuals and groups and even over the course of one's life.

"Apparently they can also influence which genes in their hosts are active at any given time," he says. "Hence, a person whose immune system has managed to tolerate gluten for many years might suddenly lose tolerance if the microbiome changes in a way that causes formerly quiet susceptibility genes to become active." Should this prove true, we may be able to prevent or treat celiac disease with probiotics.

Probiotics, supplements and other ways to eliminate "leaky gut" are a foundation in my treatment recommendations for people with gluten sensitivity and celiac diseases. Read Dr. Natasha Campbell- McBride's book, Gut and Psychology Syndrome Diet , for more details.

MSG is a neurotoxin. It's easier now to avoid it!

Canada now has a law that requires food manufacturers to label their products clearly if they have gluten or MSG in it. This information can be found in the ingredients section of the label. 
Since MSG commonly contains gluten, the person who is trying to avoid gluten must be aware of this.

However  MSG is potentially toxic to all persons, it is neurotoxic, crosses the blood-brain barrier which is the protective barrier to the brain and more. 

Some information about MSG is presented by  http://www.dorway.com/msg2.txt


When consumers refer to MSG they are referring to PROCESSED FREE GLUTAMIC ACID. If glutamic acid hasn't been processed, it doesn't cause adverse reactions. MSG is MANUFACTURED (and it has 30 different names... why?) MSG is NOT FOUND NATURALLY IN FOOD or in the human body. MSG is NOT IDENTICAL TO FREE GLUTAMIC ACID THAT HAS NOT BEEN MANUFACTURED.
The glutamic acid found naturally in human beings and other higher organisms is not MSG. MSG enters the body through the mouth, through the nose, through the skin, and through the placental barrier. MSG can enter the brain through the blood brain barrier, which is incomplete through childhood, never intact in certain regions of the hypothalamus, and is easily damaged by things like a blow to the head, high fever, seizures, stroke, and the normal process of aging. MSG is potentially toxic to everyone.

Glutamic acid, also called glutamate is a natural food for the enterocytes, or cells lining the bowel. It is useful to heal the bowel and is found in gelatin. In the Gut and Psychology Diet protocol gelatin is used for this reason. Using gelatin, which is not processed allows the consumption of glutamate without the risk of getting MSG from processed sources.

Persons with celiac disease and gluten sensitivity must avoid MSG !
And ,regularly take some foods with gelatin in it!

“Ultimate” Probiotic Treatment Beats Deadly Superbug, C. Difficile

I've been getting questions about the risks of C. Difficile in light of the news of the recent deaths of patients in hospitals from this super bug. This issue of C. Difficile is especially relevant to persons with celiac/ gluten sensitivity as persons with celiac/gluten sensitivity have abnormally large amounts and abnormal varieties of bacteria growing in their bowel compared to others. There is a higher rate of C. Difficile in persons with CD/gluten sensitivity. And most don't know they have CD.

There are many reasons why this is so: the causes include immunocompromised or weak immune system (10% minimum IgA deficiency, low vitamin A status) which allows abnormal bacteria to grow. And more frequent antibiotic use because of more infections due to being immunocompromised and antibiotics kill the healthy bacteria in the gut that are the directors of our immune system. (C. Difficile is not killed by the most common antibiotics). Healthy bacteria in the gut are sometimes called probiotics and they need to feed on special fibers in our food called prebiotiocs. We need 30 grams a day of fiber to stay well and one reason is that it feeds the good bacteria; they stay healthy and keep out immune system strong.And we need to eat sources of healthy bacteria every day from fermented foods or supplements.

But what to do if you have been told you (or an elderly relative in hospital) have a C. Difficile overgrowth and you know there is a risk of death! Here is a report from an Australian gastroenterologist who has had some success treating C.Difficile with Bacteriotherapy or fecal transplants from the guts of healthy donors directly into the colons of infected patients.

The results, reported in "Sara, TheHealthyHomeEconomist.com”, are nothing short of amazing.

 Termed “the ultimate probiotics treatment”, a single infusion of a healthy donor’s fecal material into the infected colon resulted in a cure rate of no less than 97% according to Professor Thomas Borody from the Center for Digestive Diseases in Sydney which so far has conducted over 1500 such transplants.

Robert Silberstein, a 38 year old attorney and father of 3, is one patient quickly cured by this amazing new therapy.   Mr. Silberstein had been fighting a clostridium difficile infection involving severe pain and diarrhea for over 6 months with conventional antibiotics to no avail. Faced with either losing his colon or death, Mr. Silberstein was referred to the Center for Digestive Diseases for a fecal transplant.

“I had the procedure done at midday and I woke that night and felt completely normal.  I was shocked.  I had been so ill for six months and I felt normal.  The transplant was amazing.  It worked.” said Mr. Silberstein. Mr. Silberstein’s doctor agreed.  “It has cured him,” said Dr. Bernie Hudson, a Royal North Shore Infectious Diseases Specialist. Dr. Hudson went on to say that he felt that all New South Wales hospitals should become equipped to perform these transplants in order to save more lives.

Avoiding Clostridium Difficile Infections

Avoiding infection with a dangerous super bug such as clostridium difficile obviously involves keeping the gut healthy with beneficial bacteria dominating over any pathogenic strains.

Making and consuming traditionally prepared fermented foods and drinks is an important way to accomplish this goal.   To source “probiotics” cultures for making these healthy foods in your home, please refer to my Resources page.

Source: Deadly Superbug Beaten Using Poo Transplants from Healthy People

Hopefully, this wildly successful treatment for established C. difficile overgrowth, already practiced in some centers in Canada will quickly make its way to hospitals and become standard of care given the alarming and rapidly rising cases of clostridium difficile infections.

Overwhelmed by the GAPS Diet? Help Has Arrived!

The Specific Carbohydrate diet (SCD) and the updated version by Dr. Campbell-Mcbride called the GAPS Diet is the best approach for healing the gut and putting autoimmune disease of all kinds into remission that I have ever come across. I was first introduced to the Specific Carbohydrate diet by a patient who cured herself of endometreosis by using the book " Breaking the vicious cycle " by Elaine Gottschall.

I, myself have been on the SCD since 2005 and I love it. I even go out to restaurants at least once a week.

Asking my patients to start the GAPS diet can be asking alot, especially if they don't cook for scratch. And it takes 6 months to three years to reverse the symptoms, and there are frequent reversals, especially triggered by prescription medications.

It's a huge change from the way they were eating before – even if they were eating a whole food based, traditional diet. Most people eat the "Standard American Diet" or SAD diet which is based on grains, seed oils and processed sugar. Many say, "forget it, it's impossible!  
But there is help online!

 Sarah, The Healthy Home Economist writes about getting help to succeed managing the transition to a GAPS diet.

My friend Cara, from the blog Health, Home, and Happiness and a fellow Real Food Media blogger has come up with two indispensable resources in the implementation of the GAPS Diet. Cara is a GAPS expert.  She has used GAPS to tackle her children’s autoimmune issues with great success.
I so wish these resources had been available to me last year when my husband and I went on GAPS.  It would have made the transition process so much easier and less stressful on our household!

GAPS Resources

The first resource is a new e-book called What Can I Eat Now? A 30 Day GAPS Intro Meal Plan.
The second resource is Grain Free Meal Plans once you are off the GAPS Intro Diet and into full blown GAPS or if you just want to jump right into full blown GAPS or the very similar SCD (Specific Carbohydrate) Diet from the get go.
The Grain Free Meal Plans include the following:

• Menu plans for 3 meals a day, 7 days a week, plus snacks and sweets
• Kid-tested recipes
• Complete shopping lists
• A Members only forum for questions, problems, encouragement, and success stories

If you are even remotely considering GAPS for your family, make sure you check out these resources! 

Consistency is key on the GAPS Diet – falling off the wagon can really set you back.

Gluten then and now

Many people wonder why the prevalence of celiac disease and gluten sensitivity has increase by over 400 percent in the last 40 years. It is good to know the history of both dietary traditions of ancient peoples, and the modern stresses on those traditions.

Julie McGinnis, M.S., R.D., certified herbalist holds a Master's degree in nutrition from the University of Bridgeport in Connecticut writes a summary of the history of grains and writes about some theories on the causes of the rise of the risk of developing celiac disease.

In my opinion, what is missing from her informative article is the significant risk of developing celiac disease ( and it's often fatal complications) from vitamin D deficiency. Since 1945, there has been a great reduction in the average persons blood level of vitamin D, so much so that some scientists think 90% of Canadians are deficient in the winter months.And vitamin D deficiency is a trigger for celiac disease. Vitamin D controls over 400 genes.

She writes:

Experts such as Dr. Alessio Fasano, medical director of the Center for Celiac Research at the University of Maryland School of Medicine, believe this recent increase in the amount of gluten in our diethas given rise to the number of people suffering from gluten intolerance and celiac disease.

According to Fasano, "The prevalence of celiac disease in this country is soaring partly because changes in agricultural practices have increased gluten levels in crops." He further states, "We are in the midst of an epidemic."

For example, the ancient wheat that Moses ate was probably very different from our wheat today. Moses lived about 3,500 years ago, when wheat, spelt, and barley were all popular grains. Modern wheat varieties, however, have been bred to grow faster, produce bigger yields, harvest more efficiently, and bake better bread. The downside to today's hybridized cereal grains is that they contain more gluten.

Celiac disease was once considered a rare malady and was estimated to have afflicted approximately 1 in 2,000 people in the United States. According to research done by the Mayo Clinic, CD is four times more common today that it was five decades ago. This increase is due to increased awareness and diagnostics, and the estimate today is that 1 out of every 133 people in the United States has celiac disease. To read more facts and figures please read The University of Chicago Celiac Disease center at http://www.uchospitals.edu/pdf/uch_...

Here are estimates for other parts of the world:
· 3 in 100: United Kingdom
· 1 in 370: Italy
· 1 in 122: Northern Ireland
· 1 in 99: Finland
· 1 in 133: United States
· Once thought rare for African-, Hispanic- and Asian-Americans, current estimates in these populations: 1 in 236
· 1 in 30 are estimated to have gluten intolerance in the United States.

Learn more: http://www.naturalnews.com/032823_gluten_intolerance_celiac_disease.html#ixzz1QUiApj4T

Gluten Contributes to Irritable Bowel Syndrome Even in Non-Celiacs

Someone, Dr.Elena Verdu wondered if gluten might contribute to IBS and she did a study. She's discovering what others have discovered, that there is an entity, "non-celiac gluten sensitivity" where people who don't fit the diagnosis of celiac, get better on a gluten-free diet. I know it's real. It has a higher rate of morbidity and mortality, compared to the general population, according to Ludvigsson. He says:"Patients with mild inflammation and gluten sensitivity have a higher risk of death, even if their symptoms are not severe enough to warrant a diagnosis of full-blown celiac disease."

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

Let's hope there are more studies to help us sort things out. This study is reported by Diana Gitig PhD at Celiac.com 05/18/2011

“Irritable bowel Syndrome (IBS) is based on a clinical description only; there are no pathophysiological pathways definitively associated with it. It is characterized as gastrointestinal symptoms with no discernable cause. A diagnosis of IBS depends on recurrent abdominal pain or discomfort for at least three days per month in the last three months, with the onset of the discomfort either associated with a change in frequency or appearance of stool or alleviated by defecation. A number of different mechanisms have been suggested as potential causes of IBS. These range from psychological origins, to increased visceral hyperalgesia (sensitivity to pain), to the low grade gut inflammation and altered gastrointestinal permeability and motility observed in IBS patients. Complicating matters is that most patients exhibit only a subset of symptoms. Since gluten has been demonstrated to negatively affect even people without celiac disease by an unknown mechanism (see Study Shows Gluten Intolerance Without Celiac Disease), and the underlying causes of IBS remain unclear, Dr. Elena Verdu wondered if gluten might contribute to IBS.

Like those with IBS, patients with gluten sensitivity lack the antibodies against tissue transglutaminase that are the hallmark of celiac disease but nonetheless suffer immune mediated inflammation in their gut. Interestingly, when IBS patients without celiac eliminated gluten from their diet, 68% of them reported more severe pain, bloating, and tiredness upon gluten rechallenge. But how?  By what mechanism? No changes were detected in intestinal permeability or fecal lactoferrin, a marker of intestinal inflammation. However, it is possible that these phenomena persisted, just at below the level of detection.

Based on these data, and other evidence that is rapidly accruing suggesting that gluten can negatively affect those without celiac disease, Dr. Verdu suggests that IBS patients might be screened for anti-gliadin antibodies even if they lack antibodies against tissue transglutaminase. These nonspecific antibodies can indicate an immunological response to gluten, and thus their presence could used to determine if their symptoms might be alleviated by adherence to a gluten free diet. She makes sure to point out, though, that this is probably not the case for all IBS patients.

Read the abstract here Am J Gastroenterol 2011; 106:516–518


Intestinal Permeability
The trigger for so many diseases caused by gluten sensitivity appear to come from "intestinal permeability" which is found at the microscopic level. With or without villous damage. Here is a schematic representation of "intestinal permeability" and look at the bottom and see the influence on the immune system especially Th2CD4 and it's effects on Mast cells and ultimately the brain.