Elsevier Authors Peter HR Green and Benjamin Lebwohl offer Insights into Celiac Disease and the Risks of a Gluten-Free Diet
PHILADELPHIA, April 25, 2013 /PRNewswire/ -- In the last 50 years, the rates of Celiac Disease in the U.S. population increased four-fold, according to a 2009 Mayo Clinic study. The reasons are still not clearly understood, but researchers believe that both genetic and environmental factors are behind the spike in cases.
With awareness of the disease has come an expansion of gluten-free products available on supermarket shelves and restaurant menus. However, a gluten-free diet is not a great idea for the general public, according to Peter H.R. Green, MD and Benjamin Lebwohl, MD, MS, co-editors of Celiac Disease, An Issue of Gastrointestinal Endoscopy Clinics (Elsevier 2012).
"We've seen an increasing number of patients who say they feel better on a gluten-free diet, but don't appear to have the disease and we call this non-celiac gluten sensitivity. People who have symptoms should first be screened to rule out Celiac Disease before starting a gluten-free diet because once they start, all the parameters might improve, but they won't get an accurate diagnosis," says Dr. Green, director of the Celiac Disease Center at Columbia University and an attending physician at New York-Presbyterian Hospital.
He adds, "A gluten free diet is not necessarily a healthy diet. Non-wheat flour is not fortified the way wheat flour is, and this can lead to someone becoming B-vitamin and iron deficient. Also, some gluten-free foods have added sugar and fat to provide taste. However, a gluten-free diet can be a healthy diet if guided by an experienced dietitian."
Celiac Disease is an autoimmune condition triggered by dietary gluten. When a person with Celiac Disease eats gluten, the body sees it as a foreign enemy and begins to attack the gluten and the intestinal wall. This can result in damage to the bowel wall and the flattening of villi that help to maximize the absorption of nutrients. While weight loss and diarrhea are the most well-known side effects of Celiac Disease, epidemiologists now know that it can lead to anemia, peripheral neuropathy, and even infertility.
Only 20 percent of patients with Celiac Disease know they have it and the remaining 80 percent remain undiagnosed, often from improper screening, according to Dr. Lebwohl, Assistant Professor of Clinical Medicine and Epidemiology at Columbia University Medical Center. Many have adopted a gluten-free diet for a variety of reasons, including weight loss, a connection that has yet to be proven.
"We're very interested in better understanding risk factors for developing celiac disease," Dr. Lebwohl says. "Genes for celiac disease are found in 40% of all Americans and yet only 1% have symptoms of the disease. We're studying populations to understand the environmental triggers and develop prevention strategies. There is some evidence, for example, that introducing gluten too early or too late in an infant's diet can increase the risk of developing celiac disease and that combining gluten introduction with breast feeding when an infant is between 4 to 6 months of age can be protective."
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