Gluten-free diet may help complications of type I diabetes

Children with type 1 diabetes are at a higher risk of developing celiac disease, with approximately 4-8% of diabetic children being also diagnosed as celiacs. Celiac disease requires a completely gluten-free diet, so modern management practices include elimination of gluten from the diet in diabetic children.
A recent study by Dr. Malalasekera and collaborators (from the Department of Endocrinology and Diabetes, Royal Children’s Hospital in Melbourne, Australia) has shown that, while this is effective in reducing the symptoms and long-term complications of celiac disease, a gluten-free diet can also have a positive impact on diabetic complications.

Hyperglycemia is still considered the main cause of major diabetes complications. When excess glucose settles into the cells it forms sugar-derived substances called AGEs (advanced glycation end products), which can play a role in diabetic kidney disease. The formation of AGEs is accelerated in diabetes due to the higher availability of glucose, but AGEs also seem to be acquired from the diet.

Dr. Malalasekera and his collaborators then hypothesized that – since the gluten-free diet is low in high-temperature processed foods and in flour-based items (which are high in AGEs) – a gluten-free diet could lead to lower levels of AGEs in children with celiac disease and reduced kidney damage compared with matched diabetic patients without celiac disease.

Their analysis – which included 21 children with type 1 diabetes and celiac disease, and 38 individuals with diabetes alone – indeed showed that those diabetic children who also had celiac disease indeed had significantly lower blood levels of circulating AGEs, independently of metabolic control, diabetes management and other potentially confounding variables.

Replication of these findings, as well as their confirmation involving non-celiac diabetic patients following a gluten-free diet is required to determine whether the diet could be beneficial to non-celiac diabetics. Still, the results of this new study suggest that adherence to a gluten-free diet may provide additional benefits for diabetic children with celiac disease.

More information:  Malalasekera V, Cameron F, Grixti E, Thomas MC. 2009. Potential reno-protective effects of a gluten-free diet in type 1 diabetes. Diabetologia. 52(5):798-800.

Food Allergies May Be Linked to Obesity

Researchers studying more than 4,000 children ages 2 to 19 enrolled in a larger survey of childhood health found a significant association of overweight and obesity with allergic reactions to eggs, peanuts and other common allergens. For example, overweight and obese children were over 50 percent more likely than those of normal weight to be allergic to milk. Over all, the obese and overweight children were about 25 percent more likely to have one or more food allergies.

“While there’s nothing conclusive about our findings,” said Cindy M. Visness, the lead author, “this is one more motivation to try to prevent obesity in children.” Dr. Visness is an epidemiologist with Rho Inc., a company that provides research and statistical services for clinical trials.

The scientists also found an association between being overweight and levels of C-reactive protein, a marker of inflammation, which suggests that systemic inflammation may also play a role in the development of allergies. The authors acknowledge that their study, published in the May issue of The Journal of Allergy and Clinical Immunology, does not prove that obesity causes allergies, and that other explanations for the association are possible.

Source: The New York Times

Reference: Visness CM, London SJ, Daniels JL, Kaufman JS, Yeatts KB, Siega-Riz AM, Liu AH, Calatroni A, Zeldin DC. Association of obesity with IgE levels and allergy symptoms in children and adolescents: Results from the National Health and Nutrition Examination Survey 2005-2006 (The Journal of Allergy and Clinical Immunology)

Safety of Swine flu medication for allergics and celiacs

Following the outbreak of H1N1 flu many may be wondering about the suitability of the two antiviral drugs prescribed to lessen the symptoms of the infection (Tamiflu and Relenza) to those with some sort of allergy or celiac disease. There are two types of medication:
Tamiflu – in both forms (capsules and suspension) would appear to be suitable for all patients, and according to Roche (its makers) is gluten-free and lactose-free.
Relenza is contra-indicated for patients with Airways disease as it causes Broncho-spasm (asthma) and also contains Lactose so is not suitable for anyone with a Milk Allergy.

Source: Jefferson Adams, Examiner

Gluten link with schizophrenia and diabetes

Gluten-rich foodstuffs such as bread could help to trigger schizophrenia in people with a genetic predisposition to the mental disease, scientists believe.

Researchers at UHI, the prospective University of the Highlands and Islands, are looking at the links between schizophrenia and diabetes. Two studies are being undertaken by geneticist Dr Jun Wei and his team at the UHI Department of Diabetes and Cardiovascular Science in Inverness, after winning £300,000 of grant funding from the Schizophrenia Association of Great Britain (SAGB).

One project is exploring the links between schizophrenia and diabetes, while the other focuses on the role of gluten – the protein commonly found in rye, wheat and barley – in schizophrenia and diabetes.

Gluten has long been recognised as a trigger for serious diseases related to the gut, most notably coeliac disease. However, it is now emerging that this dietary component might also be associated with the incidence of other auto-immune diseases, including schizophrenia and type 1 diabetes.

Professor Ian Megson, head of the UHI Department of Diabetes and Cardiovascular Science, explained: “The reason that gluten might provide a link between these apparently quite different diseases is that, in people with a particular genetic make-up that results in their bodies’ inability to handle gluten in the normal way, the immune system becomes unusually active. In this way, cells in the blood that are designed to combat infections begin to target healthy tissue, which can lead to impaired function of affected organs (gut, brain or pancreas) and disease.

“This research is at an early stage, but if the theory is correct and those at risk are identified very early in life, a simple change in diet might prevent these diseases developing in some individuals.”
Dr Wei, senior researcher and reader in genetics, added: “An individual’s inherited genes, together with factors from the environment in which they have lived, are now considered to be central to development of both schizophrenia and diabetes.

“Gluten is one such environmental factor. More than 30 per cent of schizophrenia sufferers have high levels of antibodies against wheat gluten in their body so a gluten-free diet might help to reduce the symptoms of this mental condition. We are also investigating if gluten acts as a trigger for schizophrenia in people who have a genetic predisposition to it.” Gwynneth Hemmings, honorary executive director of the SAGB, commented: “We are pleased to be supporting this very important research which we hope will benefit the many people suffering, or likely to suffer, from the illness.”

Dr Wei is being assisted in the gluten work by postdoctoral researcher Dr Matthew Law and PhD student Matilda Bradford, and in the other project by PhD colleague Aditi Mathur. They are working at the UHI department’s new base at the Centre for Health Science in Inverness. “Our unit is just over two years old and we are making fantastic progress, with funding come in from bodies such as the SAGB, the Chief Scientist Office, Medical Research Council and the Natural Environment Research Council,” Professor Megson said. “We have a wonderful facility here in Inverness to rival any in the country, and we are punching above our weight in terms of our ability to attract funding for research which will deliver significant benefits to people’s health, especially those with diabetes and cardiovascular conditions.”

 Source: UHI MIllenium Institute

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Health issues back continued gluten-free growth in the US

Increased diagnosis of celiac disease and a fad for gluten-free diets are driving strong predicted growth to 2012 in the gluten-free foods market, according to a new report from Packaged Facts.

The primary reason for this growth is an increased diagnosis of celiac disease, an autoimmune disorder caused by a reaction to gluten protein. While only 40,000 to 60,000 Americans are diagnosed as celiac, the federal government estimates that there could be as many as 3m who are undiagnosed – or just under one percent of the population. At the same time, there has been a surge in the number of consumers choosing a gluten-free diet for perceived health benefits.

The gluten-free market has grown at an average annual rate of 28 percent since 2004, when it was valued at $580m, to reach $1.56bn last year. Packaged Facts estimates that sales will be worth $2.6bn by 2012. But it added: “Market growth will slow substantially due to the recession, slipping to a still sizable 11 percent in 2009 and then bottoming out with nine percent growth in 2010.”

The market researcher expects to see a much wider range of gluten-free products on shelves by 2012, and said that this will be driven by companies reformulating existing products for gluten-free acceptability, as well as by releasing new ones.

‘Explosion of interest’

It said: “Americans have a lot of health problems, limited access to health care, and a culture that drives them to resolve those problems themselves. This has led to an explosion of interest in the benefits of a gluten-free diet.”

This trend was initially picked up by health food specialists, and large scale food manufacturers “have only just begun to aggressively pursue a gluten-free marketing strategy.”

Large companies to have become involved in the gluten-free market over the past few years include Anheuser-Busch, which released a gluten-free beer in 2006, and General Mills, which converted its Rice Chex brand into a gluten-free product last year.

Internet self-help

The report also mentions the importance of the internet in this growing trend, with thousands of sites dedicated to gluten-free diets as an answer to a variety of medical problems.

“Despite a lack of current medical evidence connecting gluten with autism, ADHD, irritated bowel syndrome and various other conditions, it does not deter a public seeking self-help…The hard lines that medical professionals draw between a valid reason for a gluten-free diet and a fad do not exist among these patients and consumers.”

Packaged Facts predicts that the healthy image – and sales volume – of gluten-free foods will only improve as more manufacturers of healthy products reformulate with gluten free ingredients.

Gluten-free food labeling standards proposed by the Food and Drug Administration (FDA) were expected to be finalized by the end of 2008 and are now overdue. If the FDA’s proposed standards are enacted, only products that contain less than 20 micrograms of gluten per gram will be allowed to carry a gluten free label.

Source: Caroline Scott-Thomas (Food-Navigator, USA)

Vaccine trial flags challenge to coeliac disease

An effective clinical treatment for coeliac disease (or gluten intolerance) is the ultimate objective of WEHI clinician scientist, Dr Bob Anderson. This month will see the beginning of a Phase 1 clinical trial for an experimental vaccine in Melbourne.

If the vaccine development and public awareness endeavours of Dr Anderson and his scientific team prove successful, a strict gluten free diet for coeliacs could become a thing of the past, while previously undiagnosed coeliacs could be detected and spared from premature deaths.

Using forty volunteers who suffer from coeliac disease, the early trial will test for drug safety – in particular, an appropriate drug dose range will be ascertained and any adverse effects will be noted. If within the course of a year the Phase 1 trial is deemed successful, a Phase 2 trial will beckon to determine the clinical effectiveness of the vaccine.

Coeliac disease is a chronic, autoimmune digestive disorder. It is characterised by the body’s own immune system mistakenly attacking the lining of the small intestine. The attack is caused by the body’s reaction to gluten, which is a protein found in wheat, rye, barley and oats. The immediate physiological result is that the small intestine’s villi – the small, upright folds and nodules that absorb nutrients – are flattened and incapacitated by errant inflammatory action.

Globally, the disease is estimated to affect the lives of more than 6 million people in Europe, North America and Australia – but at least 5 million may be unaware that they are suffering from the disease. While people in this latter group are likely to feel the direct effects and sometimes life-threatening complications of coeliac disease, the root cause of their debilitation nevertheless remains undiagnosed.

Long-term risks for untreated coeliac disease include malnutrition, male and female infertility, osteoporotic fractures, liver failure and cancer. Presently, the only effective treatment for coeliac disease is a life-long avoidance of any food or drink that contains the slightest trace of gluten.

Dr Anderson said, “As both a coeliac disease researcher and treating gastroenterologist, I am in an interesting position. I have overseen my basic scientific discovery about the troublesome elements in gluten being translated into an experimental vaccine that may eventually help my patients.

“There is actually a third aspect to my involvement in this project. While WEHI has provided the essential infrastructure for my scientific research, I have gone a step further and created a company, Nexpep, to lead development of the vaccine and to work closely with other Melbourne based, early stage pharmaceutical development specialists, Medicines Development Ltd and Nucleus Network.

“The vaccine itself is intended to gradually desensitize the coeliac sufferer, so that gluten is tolerated. Consequently, the villi in the small intestine [see picture of intestinal villi damages - picture from the Walter and Eliza Hall Institute of Medical Research] should revive and absorb nutrients in the normal way. Ideally, that would mean the end of gluten-free diets for people with coeliac disease.”

Source: The Walter and Eliza Hall Institute of Medical Research