Some exciting news has come forward on the much discussed, non-biopsy approach to celiac disease. We have, for years, adopted this approach for our paediatric population, however now their is further evidence to support it’s use in our adult population. From a study published in Gastroenterology, titled, “Accuracy of the No-Biopsy Approach for the Diagnosis of Celiac Disease in Adults: A Systematic Review and Meta-Analysis” it was found that adult patients exhibiting immunoglobulin A-tissue transglutaminase antibody levels (IgA-tTG) equal to or exceeding 10 times the upper limit of normal, along with a moderate-to-high pretest probability of celiac disease, may be diagnosed without the need for invasive endoscopy and duodenal biopsy.
“This study systematically collates the growing data supporting the accuracy of antibody testing to diagnose celiac disease,” said Benjamin Lebwohl, MD, professor of medicine and epidemiology at Columbia University Medical Center and director of clinical research for the Celiac Disease Center at Columbia University. “We have historically relied on duodenal biopsy to confirm the diagnosis of celiac disease, and the biopsy will still have a central role in most cases in the foreseeable future,” he said. “But as we hone our understanding of antibody testing, one day we may be able to accept or even recommend a biopsy-free approach in select patients.”
This is exciting news for our community, as wait times for biopsies can be a barrier to diagnosis.
To get the study click HERE
New research suggests that intermittent fasting significantly increases risk of cardiovascular disease.
Epidemiology and Prevention / Lifestyle and Cardiometabolic Scientific Sessions 2024 suggests that among over 20,000 U.S. adults studied, those who practiced time-restricted eating, limiting their eating to less than 8 hours per day, were at a higher risk of cardiovascular disease-related mortality compared to those who consumed their meals over a span of 12-16 hours per day. The conference, held from March 18-21 in Chicago, focused on delivering the newest findings in population-based health and wellness, along with their implications for lifestyle choices.
Time-restricted eating, a form of intermittent fasting, entails restricting the hours allotted for eating to a set duration each day, typically ranging from a 4- to 12-hour window within a 24-hour period. Researchers observed that a common approach among adherents is the 16:8 eating regimen, wherein all food intake occurs within an 8-hour window, with a fasting period of 16 hours daily. Prior studies have indicated that time-restricted eating yields beneficial effects on various cardiometabolic health indicators, including blood pressure, blood glucose, and cholesterol levels.
The analysis revealed the following key findings:
- Individuals who consumed all their meals within less than an 8-hour window per day faced a 91% increased likelihood of dying from cardiovascular disease.
- This elevated risk of cardiovascular mortality was also observed among individuals with pre-existing heart disease or cancer.
- Among those with pre-existing cardiovascular conditions, maintaining an eating duration of at least 8 but less than 10 hours per day correlated with a 66% higher risk of death from heart disease or stroke.
- Time-restricted eating did not demonstrate a reduction in the overall risk of mortality from any cause.
- Conversely, consuming meals over a period exceeding 16 hours per day was associated with a decreased risk of cancer-related mortality among individuals diagnosed with cancer.
Limitations of the study encompassed its dependence on self-reported dietary data, susceptible to memory bias and potentially inaccurate portrayal of usual eating habits. Additionally, factors beyond daily eating duration and cause of death, pertinent to health, were not accounted for in the analysis.
The authors highlighted the necessity for future investigations to delve into the biological mechanisms underlying the link between time-restricted eating patterns and detrimental cardiovascular outcomes. They also suggested exploring whether these findings hold true for populations residing in diverse geographical regions across the globe.
Does taking Vitamin D help to lower your risk for developing metastatic or fatal cancer?
In a study involving over 25,000 individuals, participants randomly allocated to receive a daily dosage of 2,000 international units (IU) of vitamin D for an average duration of 5.3 years exhibited a nearly 20% lower likelihood of developing advanced cancer, characterized as metastatic or fatal, compared to those administered a placebo.
Upon closer examination of the data, Dr. JoAnn Manson, a co-author of the study and professor of medicine at Harvard Medical School, noted that the risk reduction, amounting to a 38% decrease, was primarily observed among individuals with a normal weight, as opposed to those with higher body weights. Dr. Manson remarked that researchers did not observe a corresponding benefit among individuals classified as overweight or obese.
Individuals who supplemented with vitamin D exhibited similar risks of initial cancer diagnosis compared to those who received the placebo. However, they were less prone to developing metastatic cancer or succumbing to it.
Dr. Manson elucidated that previous research provides insight into why this phenomenon might occur. Animal studies have indicated that vitamin D can alter tumor behavior, influencing the cellular biology in a manner that reduces aggressiveness and the likelihood of metastasis. Furthermore, the study authors noted previous research associating higher vitamin D levels at the time of cancer diagnosis with prolonged survival.
Overall: it appears that Vitamin D may be protective over metastatic and fatal cancers. Although initial diagnosis rates, appear to be the same outcomes vary.
To read more click this link to a review from Harvard Health.
Celiac disease and women’s health disorders. New evidence suggests higher frequency.
In a recent large scale, nationwide study, researchers conducted a retrospective analysis using TriNetX—a database that gathers real-time patient records from 80 healthcare organizations. This study suggests that women with celiac disease (CD) may face a higher frequency of women’s health disorders, including polycystic ovarian syndrome, irregular menstruation, infertility and primary ovarian failure. It was previously known that woman with CD are at an increased risk for infertility, however this research provides a broader scope of the potential issues women with CD may face.
The study did not look at gluten-free dietary compliance and therefore could not comment on diet adherence and the increased/ decreased risk of various health conditions.
This study highlights how celiac disease can affect women’s health in ways other than infertility and supports the need for a multidisciplinary team approach. It also supports the need for increased screening for CD in women with these conditions. Finally, it was found that the fertile period for women with CD was shorter than those without CD, potentially affecting family planning.
For more information please see the original article from the Cleveland Clinic.
The Power of Lifestyle Changes in Alzheimer’s disease
Alzheimer’s disease (AD) is a difficult diagnosis in its early stages when individuals face mild cognitive impairment (MCI) or early dementia. A groundbreaking study led by Dean Ornish, titled “Effects of Intensive Lifestyle Changes on the Progression of Mild Cognitive Impairment or Early Dementia Due to Alzheimer’s Disease: A Randomized, Controlled Clinical Trial,” offers a beacon of hope.
Study Highlights
This study explored whether comprehensive lifestyle changes could improve cognitive function and overall health in individuals with MCI or early Alzheimer’s. Over a 20-week period, participants who adopted these lifestyle modifications showed remarkable improvements in various cognitive and functional measures. In stark contrast, those in the control group experienced a decline in these areas.
Key Findings
- Improvement in Cognition and Function: Participants undergoing intensive lifestyle changes exhibited significant enhancements in several standard measures of cognition and function.
- Control Group Decline: The control group, which did not adopt these changes, showed a worsening in all four measures of cognition and function over the same period.
- Microbiome Configuration: There was a notable beneficial shift in the microbiome configuration in the intervention group, suggesting a link between diet, gut health, and brain function.
Lifestyle Changes Implemented
- Diet: A whole foods, minimally-processed plant-based diet rich in fruits, vegetables, whole grains, legumes, soy products, seeds, and nuts and low in harmful fats, sweeteners, and refined carbohydrates. The diet composition was approximately 14-18% of calories from fat, 16-18% protein, and 63-68% from carbohydrates.
- Exercise: Aerobic exercises, such as walking for at least 30 minutes per day, coupled with mild strength training exercises at least three times per week, guided by an exercise physiologist through in-person or virtual sessions.
Implications
This study’s findings are profound. Many individuals dread learning about their risk for Alzheimer’s, fearing there is nothing they can do. However, this research suggests that proactive, intensive lifestyle changes can not only halt but potentially reverse cognitive decline in its early stages. This opens the door to the possibility that less extensive lifestyle changes might help prevent MCI or early dementia due to AD altogether.
Conclusion
The evidence is clear: intensive lifestyle changes hold substantial promise for those suffering from early-stage Alzheimer’s disease. These changes go beyond just maintaining health—they actively enhance it. For anyone concerned about cognitive decline, adopting a whole foods, plant-forward diet coupled with regular exercise could be the key to a healthier brain and a brighter future.
Exploring the Link Between Eating Disorders, Body Image Dissatisfaction, and Gluten-Free Diet Adherence Among Celiac Disease Patients
A recent study published in the BMC Journal on July 18, 2024, delves into the association between eating disorders, body image dissatisfaction, and adherence to a GFD among CD patients. This cross-sectional study sheds light on the mental health challenges faced by individuals with CD, revealing significant findings and providing insights into potential interventions.
Celiac disease (CD) is a chronic autoimmune inflammatory disorder of the small intestine triggered by the ingestion of dietary proteins found in wheat, barley and rye. Regular oats are a known fourth source of gluten, due to extremely high levels of cross-contamination. CD affects approximately 1% of the global population. The only effective treatment for CD is strict adherence to a gluten-free diet (GFD). However, this dietary requirement has been seen in previous studies to increase psychological challenges, including eating disorders (EDs) and body image issues.
Understanding Eating Disorders and Their Impact
Eating disorders (EDs) are psychiatric conditions characterized by abnormal or disturbed eating habits that negatively impact physical and mental health . Common EDs include binge-eating disorder, avoidant/restrictive food intake disorder, bulimia nervosa (BN), and anorexia nervosa (AN). AN, in particular, is marked by extremely low body weight, an intense fear of gaining weight, and a distorted body image, leading individuals to engage in behaviors that promote weight loss or maintenance at a dangerously low level.
The study found a strikingly high prevalence of EDs among CD patients, with 43.5% of participants affected. This rate is significantly higher compared to the general population and previous studies. Satherley et al. reported an ED prevalence of 19.1% among British celiac patients, while Australian patients exhibited a prevalence of 29.3% . The researchers suggest that the COVID-19 pandemic may have contributed to the increased prevalence of EDs observed in their study. The pandemic’s impact on stress, depression, physical activity, and eating habits may have exacerbated the psychological burden on CD patients.
The Role of a Gluten-Free Diet in Managing Eating Disorders
This study identified an inverse relationship between adherence to a gluten-free diet and the prevalence of EDs. This finding aligns with previous research indicating that following a GFD can reduce anxiety levels, improve psychological functioning, and positively influence eating behaviors. The belief that a GFD is associated with weight gain may lead some individuals to avoid adherence, opting instead for potentially harmful dietary patterns aimed at weight loss. These disordered eating behaviors can span a wide spectrum, further complicating the management of CD .
The current study hypothesized that non-adherence to a GFD may result in nutritional deficiencies, which can initiate or exacerbate EDs. Conversely, strict adherence to a GFD improves intestinal villi health, enhancing nutrient absorption and reducing the risk of EDs.
Recommendations for Healthcare Providers
Given the high prevalence of EDs and body image dissatisfaction among CD patients, the study recommends incorporating psychological interventions into standard care. Additionally, dietitians and healthcare providers should be aware of potential psychological barriers that may hinder adherence to a GFD.
The intricate link between eating disorders and gluten-free diet adherence among celiac disease patients calls for a holistic approach to treatment. By addressing both dietary and psychological needs, healthcare providers can help improve the overall well-being of individuals living with CD.