His power point started with the current list of Gluten Related Disorders. There are now 3 recognized distinct disorders. First is CD and Dermatitis Herpetiformis(DH), the skin affected form of celiac which affects 8% of celiacs. Second is Gluten Intolerance or Sensitivity (GS) ( see my Point of Interest on Alessio Fasano, MD. in this issue). And last is wheat allergy. There are many crossover symptoms one would expect to see with celiac, but each affect the immune system in different ways. The main difference is that CD has a mortality risk, whereas the others don't. But GS and wheat allergy are real, even though there is no test yet for GS. If someone has the symptoms of celiac disease but do not have the blood antibodies nor does an endoscopy show damage, then they are either among the 15% of celiacs who pass those tests but have the symptoms and the gene, or they are sensitive. The test for those with GS is, if one feels better off gluten, then one is GS. This gives validity to those who suffer from this condition, and who have been saying so for years. Dr. Fasano, said, "once again, the patients have been the visionaries," in reference to the Maryland Univ. study published in March of this year, which announced that biomarkers prove this sensitivity.

 

With regard to wheat allergy, Green stated that 3% of baking school students develop asthma from wheat exposure. One can get exercise induced wheat allergy as well, or develop a contact rash from working with wheat. It is my belief that culinary schools should be warning students of this possibility and the government should forewarn OSHA and the nurses in wheat mills and food manufacturing plants.

 

The total of GF consumers is estimated between 8-12% of Americans. The GF food industry is now at 20 billion worldwide and growing at 20% a year! This information should be taught at culinary schools across the country, and restaurants should take heed. Advertising a GF menu will mean friends and family members can now dine out together. However, is important that restaurants, and up-and-coming chefs truly understand the seriousness of our disorders, and fully understand the extent of the precautions required to avoid cross-contamination.

 

CD is now considered to affect 1% worldwide, with certain countries, higher. It is an equal opportunity disease, affecting every country and ethnicity. Some countries are now mandating their physicians to do serological testing of their citizens, like Finland and Australia. Consequently, Finland's over-55 population shows a rate of 2.4%. In the U.S. it is now 1%. Yet, most still go undiagnosed, and most present in adulthood. Women are diagnosed more then men, because women go to the doctor much more readily and often than men. Green said that 40% of us carry the gene. But he claims this may not mean one has CD. He relies on the blood and biopsy to determine whether the person has the activation of the gene. He suggests testing for antibodies every 3 years if one has the gene, and advised that in NY, a biopsy must be kept for 50 years. Thus, another look at a negative test, done by a specially trained technician today, might produce a different outcome. The key point here is: Listen to your body.

Kudos to whoever organized it. My daughter went to Gold Orchard and ran into a GF business. In case you haven't heard of it, check this out: www.gluten-free-dessert-kitchen.com

She brought me back a scone (delicious) and an applesauce cake which I haven't touched yet.

 

He mentioned that in Europe, they are recommending breast feeding for at least 6 months and introducing a few crumbs of wheat to the infant between the age of 4 and 6 months, not before or after, but in that limited window. It appears to provide protection from triggering the onset, whereas, if done before 4 months and after 7, it increases their risk of onset.

 

Some good news Dr Green related is there is lower risk of colon and breast cancers in the CD population. Also, while gluten can be in some medications, most are now GF, made with corn starch instead of wheat.

 

Some bad news: CD causes lower fertility rates, in men as well as women, possibly due to absorption and nutritional deficiencies problems. 70% of celiacs are overweight. Canker sores are common. Celiacs have a 3-10 times higher rate of autoimmune disorders. Green says that anyone with a chronic autoimmune condition, requires specific follow-up medical and nutritional care. He said B1, B6 and B12, Vitamin E and copper deficiencies are often found in CD. If one is suffering from fatigue, then iron levels and serum carnitine tests should be run as well. He strongly recommended seeing a dietitian with the results.

 

Symptoms that alert him for possible CD are diverse and include: anemia, ataxia, bloating, bone disease, dental issues, GERD, hyperalbuminema, hyperamylasemia, hypocalcimic with secondary hyperparathyoidim, low ferritin, low HDL, abnormal LFT, thyroid disorder, weight loss. Misdiagnosed skin conditions that occur anywhere on the body, including the face, may be dermatitis herpetiformis. The correct way to test DH is to biopsy 1mm from the margin of the outbreak. He warned that if one has DH, then you must restrict iodine and NSAIDS intake.

 

Peripheral neuropathy affects 30% of CD where it occurs in only 15% of the general population. (don't forget to try methylcobalamin (B12) for PN) . Osteoporosis is very common in CD with higher rates of fractures. He does not recommend bone density drugs. He feels they can be dangerous.

 

A small group of celiacs have refractory CD, meaning they still have bowel issues while on a GF diet. He offered several tests to help rule other possible factors. Green stated that pancreatic insufficiency is quite common in celiacs and he recommended a stool test called fecal pancreatic elastase. Another cause of refractory CD might be an overgrowth of bacteria in the small intestine, and cautioned the use of probiotic supplements. However, several audience members commented that probiotics helped them recover more quickly after exposure to gluten. Other tests include lactose and/or fructose intolerance breath tests.

 

Celiac disease increases the higher rate of melanoma, cancer of the esophagus (many celiacs suffer from heartburn for years before diagnose), and a 23% higher rate of thyroid cancer. The mortality rate of lymphoma of the intestines is 40-80% higher than the rest of the population, with those not adhering to the GF diet having the greater risk. However, the longer one is on a GF diet (over 15 years), the risk of developing these cancers is lower.

 

Dr. Green ended his talk with a plea for donations to the Center, which is celebrating its ten-year anniversary. Checks can be made out to the Trustees of Columbia University and mailed to the Celiac Disease Center at Columbia Univ. Medical Center, Harkness Pavilion, Suite 934, 180 Fort Washington Ave., New York, NY 10032-9803.

 

This lecture was sponsored by the new Shop Rite in Niskayuna. Shop Rite provided samples of gluten free (GF) products and re-usable shopping bags to take them home in, and their dietitian was present for inquiries.