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Should we all go gluten-free?

William F. Balistreri, MD

February 04, 2016

The question of whether to adopt a gluten-free diet is especially timely, given its impressive increase in popularity over the past decade. In fact, gluten avoidance has become the most popular dietary trend in the United States, with approximately 100 million Americans consuming gluten-free products last year.

Presently, there are at least three proposed clinical syndromes related to gluten ingestion: celiac disease, an autoimmune-mediated disorder; wheat allergy, an immunoglobulin E (IgE)-mediated entity; and gluten sensitivity, in which celiac disease and wheat allergy have been ruled out. Therefore, the decision to “go gluten-free” is either mandatory or elective; a gluten-free diet is mandatory for those individuals with appropriately diagnosed celiac disease and possibly wheat allergy. However, many individuals elect to follow a gluten-free diet because of a presumed sensitivity. While approximately 1% of the population are believed to have celiac disease, it is estimated that as many as 60% of Americans believe that a gluten-free diet will improve their physical and/or mental health.[1-4] It is their choice to follow a gluten-free diet in the hopes of improving digestion and bolstering their immune system, while also enabling enhanced performance and weight loss.

This belief has been fostered by the testimony of celebrities and athletes who attribute their success and well-being to adherence to a gluten-free diet. A survey done by Lis and colleagues[5] of 910 world-class athletes and Olympic medalists found that 41% followed a gluten-free diet, the majority because of a self-diagnosis of “sensitivity to gluten” and perceived ergogenic or health benefits. The same authors investigated the effects of a gluten-free diet on exercise performance, gastrointestinal symptoms, perceived well-being, intestinal injury, and inflammatory responses in nonceliac endurance athletes.[6] The short-term gluten restriction had no overall beneficial effect on any of these outcomes. In addition, numerous books and websites cater to this gluten-free phenomenon. Claims have even been made that gluten can be harmful to all of us.

The appeal of a gluten-free diet has become big business, leading to greater gluten-free product availability and a wider variety of dietary options. The market for gluten-free foods continues to expand and is estimated to have reached over $4 billion in retail sales in the past year. However, there are barriers to going gluten-free, including the cost and long-term safety of gluten-free foods and the potential for gluten cross-contamination of products. In addition, a gluten-free diet could present social restrictions, possibly leading to nonadherence.[7-9] Continue Reading

Nonceliac Gluten Sensitivity

Nonceliac gluten sensitivity (NCGS) is the newly minted term used to describe a clinical disorder related to ingestion of gluten or gluten-containing cereals.[8-13] Lebwohl and colleagues[14] suggest that a more accurate term for this condition is simply “people who avoid gluten.”

Clinical Spectrum

NCGS has largely been characterized by a series of self-reported gastrointestinal symptoms such as abdominal pain, gastroesophageal reflux, gas/bloating, nausea, diarrhea, and/or constipation.[15] However, a wide variety of nongastrointestinal symptoms has also been reported, including headache, fatigue, “foggy mind,” anxiety, depression, muscle aches, and skin rashes. A similar spectrum of symptoms has been reported in children.[16,17] Aziz and Hadjivassiliou[9] demonstrated that in patients with NCGS, gluten is independently associated with depression, which might share pathophysiologic mechanisms with other neurologic manifestations observed in gluten-related disorders, such as ataxia and encephalopathy.

Working Definition

A recent report by Fasano and colleagues[8] reviewed the current understanding of NCGS and outlined steps to dissipate some of the confusion related to this disorder. They propose a working definition as follows: “a clinical entity induced by ingestion of gluten leading to intestinal and/or extraintestinal symptoms that resolve once gluten is eliminated.” This definition requires that celiac disease and wheat allergy have been ruled out. They further propose that NCGS is associated with prevalent gluten-induced activation of innate—rather than adaptive—immune responses in the absence of detectable changes and mucosal barrier function. Gluten sensitivity was similarly defined by an international panel as the occurrence of intestinal and extraintestinal symptoms related to the ingestion of gluten-containing food in subjects without celiac disease or wheat allergy.[18-21]


Aziz and colleagues conducted a survey in order to estimate the prevalence of self-reported NCGS in the general population and the frequency of adherence to a gluten-free diet outside of celiac disease.[1,22] They determined that 13% of the population (79% female; mean age, 39.5 years) self-reported gluten sensitivity, only 0.8% of whom had a valid diagnosis of celiac disease. During investigation of another cohort of 200 patients with presumed gluten sensitivity (84% female; mean age, 39.6 years), 7% were found to have celiac disease and 93% to have NCGS.[1,22] All patients with celiac disease were HLA (human leucocyte antigen) DQ2 or DQ8 positive compared with 53% of the subjects with NCGS. Nutritional deficiencies, autoimmune disorders (23% vs 10%), and a lower mean body mass index were significantly associated with celiac disease compared with NCGS.

In a survey of more than 1000 Australians, 7% reported adverse effects when ingesting wheat products, although the majority had not undergone formal assessment for celiac disease or wheat allergy.[23]

Biesiekierski and colleagues[15] also surveyed a series of adults who believed that they had NCGS. They learned that a gluten-free diet was most commonly self-initiated among respondents (44%) and was less often prescribed by alternative health professionals (21%), dietitians (19%), or general practitioners (16%). Initiation of a gluten-free diet without adequate exclusion of celiac disease was common; no investigations to rule out celiac disease had been performed in 15% of respondents. In 25%, symptoms are poorly controlled despite gluten avoidance.

Caffeinated Energy Drinks Linked to Diabetes

Peter Russell

December 07, 2015
Young people who consume caffeinated energy drinks can experience a spike in their blood insulin levels. This could make them more prone to a condition which increases their susceptibility to type 2 diabetes later in life, according to early results from a small Canadian study.

However, one UK expert says linking caffeinated energy drinks to diabetes is premature.

Insulin Resistance

Canadian researchers who tested the effects of these popular drinks on adolescents say caffeine inhibits the body’s ability to deal with a high load of sugar. They say this could lead to ‘ insulin resistance’ in which the body has to produce increasing amounts of insulin to clear blood sugar circulating in tissues.

Young people are more vulnerable to these effects because they are smaller than adults and therefore likely to consume relatively larger quantities of caffeine per drink, they say.

Heidi Virtanen from the University of Calgary, who led the study, explains in a statement: “Results show that consumption of a caffeine-containing energy drink results in a 20 to 30% increase in insulin and glucose levels in response to a glucose load.

“Since caffeine persists in the system for 4 to 6 hours after consumption, continuous insulin resistance associated with regular caffeine-containing energy drink consumption in adolescents could contribute to increased metabolic risk in susceptible individuals later in life through persistent interference with their regular glucose metabolism.”

Metabolic Risk

The study was overseen by Jane Shearer from the University of Calgary who says: “Elevated glucose and insulin responses may contribute to increased metabolic risk, including type 2 diabetes and cardiovascular disease in susceptible individuals later in life.”

The researchers note that despite warning labels on caffeinated energy drinks that say they are not suitable for children, their marketing often makes them appealing to children, adolescents and young adults. They estimate that in Canada, around 30% of adolescents regularly drink them, while 50% of athletes in full-time education report using them.

The study involved 10 males and 10 females aged 13 to 19 with an average age of 17. After fasting for 24 hours, abstaining from caffeine and taking no exercise, the adolescents were randomly assigned to have either a caffeinated energy drink or one without caffeine. Both energy drinks were sugar-free in order to determine the effects of the caffeine in the drink.

Blood samples were taken periodically during a 2 hour period and a standard oral glucose test was administered 40 minutes after drinking.

The results displayed a 25% increase in blood glucose levels over a 2 hour period for those who had been given the caffeinated drink compared to those having the decaffeinated version.

Elevations in glucose with the caffeine containing energy drink were accompanied by a 26% increase in insulin levels. The researchers say that, since the half-life of caffeine is in the range of 4 to 6 hours, these results suggest that consumption of a caffeine-containing energy drink in adolescents could affect glucose regulation for hours after it is drunk.

The results, presented at the World Diabetes Congress in Vancouver, should be treated with caution as they have not yet been published in a peer-reviewed journal.

Further Trials

The researchers are planning a follow-up trial in which energy drinks will be given to adolescents containing both caffeine and glucose. Participants will then be followed for 3 days.

Commenting on the findings in a statement, Tom Sanders, professor emeritus of nutrition and dietetics at King’s College London, says: “The measurement made in this study does not really predict diabetes. Caffeine stimulates the release of non-esterified fatty acids which may transiently influence insulin sensitivity.

“It is a jump too far to suggest caffeine containing beverages increase the risk of [type 2 diabetes] based on acute measurement in such a small sample… especially as there can be marked variation in women with the menstrual cycle.”

He adds: “This is also a pilot study, so further studies will be needed to corroborate the findings.”


‘Energy drink consumption impairs oral glucose tolerance in adolescents: a randomized, double-blind, crossover pilot study’, H Virtanen et al, poster presentation, World Diabetes Congress.

Science Media Centre.

Reviewed on December 03, 2015

How to live to 100: Researchers find new genetic clues

In a new analysis, researchers explore whether people live longer because they avoid disease or because they possess some anti-aging secret

If you live to be 100, you’re in a special group, one that longevity scientists are eagerly studying for clues to battling aging. But are these centenarians long-lived because they don’t get the diseases that fell the rest of us—heart problems, diabetes, dementia, arthritis and more—or because they are protected somehow against the effects of aging? Based on the data so far, most experts have concluded that centenarians get to where they are because they have some anti-aging secret that shields them against the effects of aging. That’s because studies found that centenarians had just as many genes that contribute to disease as those with more average life spans.

But in a paper published in PLOS Genetics, researchers led by Stuart Kim, professor of developmental biology and genetics at Stanford University, questions that dogma. He found that on the contrary, centenarians may have fewer of the genes that contribute to major chronic diseases. That doesn’t mean that people who live to their 100s also don’t possess some protective anti-aging genes as well, but Kim’s study shows that they don’t experience as much disease as people who are shorter-lived.

Kim’s team came to that conclusion after conducting a novel type of genetic analysis. Most attempts to look for genes related to aging compare the genomes of centenarians and people with average life spans and pick out the regions where the maps differ. Those are potential targets for aging, but, as Kim notes, they could also be red herrings. “Because you search through hundreds of thousands, and now millions of variants, there is a lot of noise. So it makes it difficult to see the signal amidst all the noise.”

To purify the signal, Kim layered another piece of information on this comparison. He made the assumption that disease genes can reduce the chances of someone reaching their 100s, and focused just on known disease-causing genes in his analysis. “With that, we can make better guesses about what is really bad for becoming a centenarian,” he says.

The filtered analysis pumped out five major regions of interest for longevity. Four are familiar; they involve the gene connected to Alzheimer’s, an area involved with heart disease, the genes responsible for the A-B-O blood type and the immune system’s HLA region that needs to be matched for organ transplants to avoid rejection. These four have known connections to longevity. The Alzheimer’s gene, ApoE, for example, is linked to shorter life span, while the heart disease variants are involved in directing a cell’s life span and the O blood type is known to be connected to better health outcomes and survival.

The fifth region was one that had never been linked to longevity before, and Kim admits that not much is known about how it might contribute to longer life, except that mutations in the gene region can contribute to neurological diseases such as ALS and that in fruit flies, other mutations help the insects to live longer.

“It seems intuitively obvious, that avoiding disease is part of the strategy of becoming a centenarian,” says Kim. “But there is a really, really strong dogma in the field that there was no depletion of disease genes in centenarians, and that all of their survival benefit was coming from protection from anti-aging genes. I think they were wrong.”

Those previous studies that pointed to this anti-aging effect over the effect of fewer disease-causing genes were generally smaller, and might not have isolated the signal from the noise.

Kim’s team shows that the way centenarians reach their second century may involve more than just being blessed with anti-aging genes. “We found that, at least in part, they live longer because they don’t get sick,” he says. He also readily admits that they may also benefit from some anti-aging factor that researchers haven’t uncovered—yet.

Alice Park –

What Casual Drinking Does to Your Body Over Time

The effects of having a few drinks can differ person to person, but often people may not realize just how risky their drinking patterns are, or what that alcohol is doing to them under the hood.

There are two definitions for “safe” drinking. The U.S. Dietary Guidelines say moderate alcohol consumption is OK, which means having up to 1 drink per day for women and up to 2 drinks per day for men. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has its own recommendation it calls “low risk” drinking, which sets limits for what levels of drinking will put you at a low risk for developing an alcohol abuse issue later on. This comes out to no more than three drinks on any single day and no more than 7 drinks per week for women, and no more than four drinks on any single day and no more than 14 drinks per week for men.

According to Dr. George Koob, director of the NIAAA, the current body of evidence doesn’t show whether there are significant differences between someone who drinks at this level versus someone who never drinks. In some cases, there’s strong evidence to suggest that moderate wine consumption could actually benefit the heart. Though Koob says some studies have been controversial and it’s not determined what it is about wine or other parts of a person’s lifestyle that could be at play. There are also individual patterns and sensitivities that people should take into consideration at this level. Some people can handle the amount better than others.

If you genuinely stay within the healthy drinking limits, you’re likely at a low risk for alcohol-related health problems down the line.

The concept of binge drinking is often associated with college students and drinking to get “drunk.” But evidence suggests that people beyond college age also maintain those heavy drinking behaviors. The NIH defines it as five or more drinks for men and four or more drinks for women within two hours. Some of the risks associated with binge drinking are well known. It increases the risk for sexual assault, violence and self harm. But the physical effects of such behaviors on the body are often less discussed. According to the National Institutes of Health (NIH), there’s strong evidence to suggest that regular binge drinking can damage the frontal cortex and areas of the brain involved in executive functions and decision making. Alcohol slows down the pace of the neurotransmitters in your brain that are critical for proper body responses and even moods.

“Abstaining from alcohol over several months to a year may allow structural brain changes to partially correct,” the NIH says. “Abstinence also can help reverse negative effects on thinking skills, including problem­ solving, memory, and attention.”

Long term drinking can also hurt your heart muscles making them unable to contract properly. It can also harm liver, pancreas and immune system function. Heavy drinking can prevent the protective white blood cells in your body to attack bacterial invaders like they’re supposed to. Drinking too much alcohol can also increase your risk for certain cancers like mouth and breast. Regular heavy drinking also increases the risk for some alcohol dependence. “It creeps up on people,” says Koob.Social Drinking

Sleeping medication use may increase risk for car accidents

NBC Nightly News (6/11, story 9, 2:10, Holt, 7.86M) reported on “a big wake-up call for the millions of Americans who take certain kinds of sleeping” medications. Correspondent Ann Thompson explained, “A new study…finds three sedatives nearly double the risk of vehicle accidents among new users.” In addition, “the study…finds the risk of accidents increases over time and can last up to a year after you start taking the drugs.”

The NBC News (6/12, Fox) website reports that for the study, investigators “collected data on…zolpidem, sold under the brand name Ambien; trazodone, sometimes sold under the brand name Oleptro; and temazepam, brand name Restoril.” The researchers found “that people who took any one of” these “three popular sleeping aids had anywhere between a 25 percent and three times higher risk of being involved in an accident while driving.” The study was published online in the American Journal of Public Health.

Health Day (6/12) reports that physicians, “pharmacists and patients should discuss this potential risk when selecting a sleep medication, the researchers said.”