Tag Archives: non-tropical sprue

University of Illinois Chicago study: Gluten-free diet may increase risk of arsenic, mercury exposure

13 Feb

The Celiac Disease Foundation describes celiac disease:

Celiac disease is a serious genetic autoimmune disorder where the ingestion of gluten leads to damage in the small intestine.  It is estimated to affect 1 in 100 people worldwide.  Two and one-half million Americans are undiagnosed and are at risk for long-term health complications.

When people with celiac disease eat gluten (a protein found in wheat, rye and barley), their body mounts an immune response that attacks the small intestine. These attacks lead to damage on the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body. The only treatment currently for celiac disease is a strict, gluten-free diet. Most patients report symptom improvement within a few weeks, although intestinal healing may take several years.

Celiac disease is hereditary, meaning that it runs in families. People with a first-degree relative with celiac disease (parent, child, sibling) have a 1 in 10 risk of developing celiac disease.

Celiac disease is also known as coeliac disease, celiac sprue, non-tropical sprue, and gluten sensitive enteropathy.
Read more at https://celiac.org/celiac-disease/understanding-celiac-disease-2/what-is-celiac-disease/#O1Qf0xDwg1T9hTmR.99

Beyond Celiac has statistics about celiac disease.

According to Beyond Celiac:

  • An estimated 1 in 133 Americans, or about 1% of the population, has celiac disease.

  • Celiac disease can affect men and women of all ages and races.

  • It is estimated that 83% of Americans who have celiac disease are undiagnosed or misdiagnosed with other conditions.

  • 6-10 years is the average time a person waits to be correctly diagnosed. (Source: Daniel Leffler, MD, MS, The Celiac Center at Beth Israel Deaconness Medical Center)

  • Celiac disease can lead to a number of other disorders including infertility, reduced bone density, neurological disorders, some cancers, and other autoimmune diseases.

  • Over a four-year period, people with undiagnosed celiac disease cost an average of $3,964 more than healthy individuals. (Source: Long et al, 2010)

  • 5-22% of people with celiac disease have an immediate family member (first degree relative) who also has celiac disease.

  • There are no pharmaceutical treatments or cures for celiac disease.

  • A 100% gluten-free diet is the only existing treatment for celiac disease today.

  • The celiac disease diagnosis rate may reach 50-60% by 2019, thanks to efforts to raise public awareness of celiac disease. (Source: Datamonitor Group, 2009)

  • Gluten-free sales reached more than $2.6 billion by the end of 2010 and are now expected to exceed more than $5 billion by 2015. (Source: Packaged Facts, 2011)                            https://www.beyondceliac.org/celiac-disease/facts-and-figures/

Many of those diagnosed with celiac disease have a gluten free diet.

Gluten Free Living describes the basic gluten free diet:

Is it Gluten Free? A Basic Diet Guide for Celiacs

Getting the gluten-free diet right is easy when you know the ground rules. Follow the guidelines below and you will be on your way to a happy, healthy gluten-free life.

This material is not intended to provide medical advice, which should be obtained directly from a physician.

YES

Foods made from grains (and grain-like plants) that do not contain harmful gluten, including:

  • Corn in all forms (corn flour, corn meal, grits, etc.).
  • Plain rice in all forms (white, brown, wild, basmati, enriched rice, etc.).
  • Amaranth, arrowroot, buckwheat (kasha), cassava, flax, millet, quinoa, sorghum, soy, tapioca and teff.
  • Flours made from gluten-free grain, nuts, beans and coconut. Look for products labeled gluten-free to avoid cross-contamination.

Gluten-free ingredients:

Annatto, glucose syrup, lecithin, maltodextrin (even when it is made from wheat), oat gum, plain spices, silicon dioxide, starch, food starch and vinegar (only malt vinegar might contain gluten). Also citric, lactic and malic acids as well as sucrose, dextrose and lactose; and these baking products: arrowroot, cornstarch, guar and xanthan gums, tapioca flour or starch, potato starch flour and potato starch, vanilla.

The following foods:

  • Milk, butter, margarine, real cheese, plain yogurt, most ice cream without gluten-containing add-ins.
  • Vegetable oils, including canola.
  • Plain fruits, vegetables (fresh, frozen and canned), meat, seafood, potatoes, eggs, nuts, nut butters, beans and legumes.
  • Distilled vinegar is gluten free. (See malt vinegar under NO below).
  • Distilled alcoholic beverages are gluten free because distillation effectively removes gluten. They are not gluten free if gluten-containing ingredients are added after distillation, but this rarely happens.
  • Mono and diglycerides are fats and are gluten free.
  • Spices are gluten free. If there is no ingredient list on the container, it contains only the pure spice noted on the label.

NO

Wheat in all forms including spelt, kamut, triticale (a combination of wheat and rye), durum, einkorn, farina, semolina, cake flour, matzo (or matzah) and couscous. Wheat is found in many bread, cakes, cereals, cookies, crackers, pretzels, pasta, and pizza crusts, but it can turn up in other products, too. Read labels to be sure.

Most ingredients with “wheat” in the name including hydrolyzed wheat protein and pregelatinized wheat protein. Buckwheat, which is gluten free, is an exception.

Barley and malt, which is usually made from barley, including malt syrup, malt extract, malt flavoring and malt vinegar.

Rye, which is most often found in bread products. It is not typically used to make ingredients.

Breaded or floured meat, poultry, seafood and vegetables, when the breading is made with wheat. Also meat, poultry and vegetables when they have a sauce or marinade that contains gluten, such as soy and teriyaki sauces.

Foods that are fried in the same oil as breaded products are not considered to be safe on the gluten free diet.

Licorice, which is made with wheat flour, and other candies that contain wheat or barley.

MAYBE

Beer is gluten-free when made from gluten-free grains. Beer made from barley and processed to remove gluten is not considered to be gluten free.

Dextrin can be made from wheat, which would be noted on the label, and would not be gluten free.

Flavorings are usually gluten free, but in rare instances can contain wheat or barley. By law, wheat would have to be labeled in foods regulated by the Food and Drug Administration (FDA). Barley is usually called malt flavoring. In extremely rare instances, neither barley nor malt is specified when used in a flavoring.

Modified food starch is gluten free, except when wheat is noted on the label, either as “modified wheat starch,” modified starch (wheat) or if the “Contains” statement at the end of the ingredients list includes wheat.

Wheat starch is allowed in gluten-free foods if the wheat starch has been processed to remove the gluten protein. In addition to a gluten-free label, the packaging of any product using safe wheat starch will note that it has been processed to meet FDA gluten-free standards. Wheat starch in foods that do not also have a gluten-free label are not safe on the gluten-free diet.

Oats are considered safe on the gluten-free diet if they have been specially processed to prevent cross-contamination by gluten-containing grains. These oats are labeled gluten free. Mainstream oats, including those commonly used in breakfast cereals, are not considered safe unless they are labeled gluten free.

Oats are allowed as an ingredient in products labeled gluten-free as long as the final food meets the FDA gluten-free standard. This includes granola, granola bars, cookies and other products. Products that are made with oats but do not have a gluten-free label are not gluten free.

Prescription and over-the-counter drugs can contain gluten, although most are gluten free. Check with the pharmaceutical company, especially if you take the medication on a continuing basis.

Processed cheese (spray cheese, for example) may contain gluten. Real cheese is gluten free.

Seasonings and seasoning mixes can contain gluten. Wheat will be noted on the label as required by law.

Soy sauce is usually fermented from wheat. Only soy sauce made without wheat is gluten free. Look for soy sauce with a gluten-free label.

SPECIAL CASES

Caramel color is almost always made from corn, and most companies in North America use corn because it makes a better product. Malt syrup can be used but rarely is, so caramel color is almost guaranteed to be gluten free.

Hydrolyzed vegetable protein is a phrase that under federal regulation should not be used on a food label. Food processors have to identify the “vegetable.” So you might read “hydrolyzed wheat protein,” which would not be gluten free, or “hydrolyzed soy protein,” which is gluten free….                                                                                                                                                     https://www.glutenfreeliving.com/gluten-free-foods/diet/basic-diet/

Research from the University of Illinois Chicago concludes that the gluten free diet may pose certain risks.

Science Daily reported in Gluten-free diet may increase risk of arsenic, mercury exposure:

People who eat a gluten-free diet may be at risk for increased exposure to arsenic and mercury — toxic metals that can lead to cardiovascular disease, cancer and neurological effects, according to a report in the journal Epidemiology.

Gluten-free diets have become popular in the U.S., although less than 1 percent of Americans have been diagnosed with celiac disease — an out-of-control immune response to gluten, a protein found in wheat, rye and barley.

A gluten-free diet is recommended for people with celiac disease, but others often say they prefer eating gluten-free because it reduces inflammation — a claim that has not been scientifically proven. In 2015, one-quarter of Americans reported eating gluten-free, a 67 percent increase from 2013.

Gluten-free products often contain rice flour as a substitute for wheat. Rice is known to bioaccumulate certain toxic metals, including arsenic and mercury from fertilizers, soil, or water, but little is known about the health effects of diets high in rice content.

Maria Argos, assistant professor of epidemiology in the UIC School of Public Health, and her colleagues looked at data from the National Health and Nutrition Examination Survey searching for a link between gluten-free diet and biomarkers of toxic metals in blood and urine.

They found 73 participants who reported eating a gluten-free diet among the 7,471 who completed the survey, between 2009 and 2014. Participants ranged in age from 6 to 80 years old.

People who reported eating gluten-free had higher concentrations of arsenic in their urine, and mercury in their blood, than those who did not. The arsenic levels were almost twice as high for people eating a gluten-free diet, and mercury levels were 70 percent higher.

“These results indicate that there could be unintended consequences of eating a gluten-free diet,” Argos said. “But until we perform the studies to determine if there are corresponding health consequences that could be related to higher levels of exposure to arsenic and mercury by eating gluten-free, more research is needed before we can determine whether this diet poses a significant health risk….”                                                                                   https://www.sciencedaily.com/releases/2017/02/170213131150.htm

Citation:

Gluten-free diet may increase risk of arsenic, mercury exposure

Date:     February 13, 2017

Source: University of Illinois at Chicago

Summary:

People who eat a gluten-free diet may be at risk for increased exposure to arsenic and mercury — toxic metals that can lead to cardiovascular disease, cancer and neurological effects, according to a report in the journal Epidemiology.

Journal Reference:

  1. Catherine M. Bulka, Matthew A. Davis, Margaret R. Karagas, Habibul Ahsan, Maria Argos. The Unintended Consequences of a Gluten-Free Diet. Epidemiology, 2017; 1 DOI: 10.1097/EDE.0000000000000640

Here is the press release from the University of Illinois Chicago:

Gluten-free diet may increase risk of arsenic, mercury exposure

Sharon Parmet
February 13, 2017

People who eat a gluten-free diet may be at risk for increased exposure to arsenic and mercury – toxic metals that can lead to cardiovascular disease, cancer and neurological effects, according to a report in the journal Epidemiology.

Gluten-free diets have become popular in the U.S., although less than 1 percent of Americans have been diagnosed with celiac disease – an out-of-control immune response to gluten, a protein found in wheat, rye and barley.

A gluten-free diet is recommended for people with celiac disease, but others often say they prefer eating gluten-free because it reduces inflammation – a claim that has not been scientifically proven. In 2015, one-quarter of Americans reported eating gluten-free, a 67 percent increase from 2013.

Gluten-free products often contain rice flour as a substitute for wheat. Rice is known to bioaccumulate certain toxic metals, including arsenic and mercury from fertilizers, soil, or water, but little is known about the health effects of diets high in rice content.

Maria Argos, assistant professor of epidemiology in the UIC School of Public Health, and her colleagues looked at data from the National Health and Nutrition Examination Survey searching for a link between gluten-free diet and biomarkers of toxic metals in blood and urine.

They found 73 participants who reported eating a gluten-free diet among the 7,471 who completed the survey, between 2009 and 2014. Participants ranged in age from 6 to 80 years old.

People who reported eating gluten-free had higher concentrations of arsenic in their urine, and mercury in their blood, than those who did not. The arsenic levels were almost twice as high for people eating a gluten-free diet, and mercury levels were 70 percent higher.

“These results indicate that there could be unintended consequences of eating a gluten-free diet,” Argos said. “But until we perform the studies to determine if there are corresponding health consequences that could be related to higher levels of exposure to arsenic and mercury by eating gluten-free, more research is needed before we can determine whether this diet poses a significant health risk.”

“In Europe, there are regulations for food-based arsenic exposure, and perhaps that is something we here in the United States need to consider,” Argos said. “We regulate levels of arsenic in water, but if rice flour consumption increases the risk for exposure to arsenic, it would make sense to regulate the metal in foods as well.”

Catherine Bulka of UIC; Matthew Davis of the University of Michigan; Margaret Karagas of Dartmouth University; and Habibul Ahsan of the University of Chicago are co-authors on the paper.

This research was supported by National Institutes of Health grants R01 ES024423, R21 ES024834, R01 CA107431, P42 ES010349 and T32 HL125294.                                                                                                   https://news.uic.edu/gluten-free-diet-may-increase-risk-of-arsenic-mercury-exposure

Before embracing a gluten free lifestyle it is imperative that a person be tested for celiac disease. According to the Mayo Clinic:

Researchers estimate that only 20 percent of people with celiac disease may receive a diagnosis.

Doctors may order two blood tests to help diagnose celiac disease.

  • Serology testing looks for antibodies in your blood. Elevated levels of certain antibody proteins indicate an immune reaction to gluten.
  • Genetic testing for human leukocyte antigens (HLA-DQ2 and HLA-DQ8) can be used to rule out celiac disease.

If the results of these tests indicate celiac disease, your doctor may order an endoscopy to view your small intestine and to take a small tissue sample (biopsy) to analyze for damage to the villi.

It’s important to be tested for celiac disease before trying a gluten-free diet. Eliminating gluten from your diet may change the results of blood tests so that they appear to be normal.                             http://www.mayoclinic.org/diseases-conditions/celiac-disease/diagnosis-treatment/diagnosis/dxc-20214633

Given the findings of the University of Illinois Chicago study, those who are pursuing a gluten free lifestyle must consult competent medical professionals.

Resources:

What Is Celiac Disease?                                                                                                          http://www.webmd.com/digestive-disorders/celiac-disease/celiac-disease#1

Celiac disease                                                                                                                               http://www.mayoclinic.org/diseases-conditions/celiac-disease/home/ovc-20214625

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