WhiteCoat

A New “Silent Killer”?

07_07_53---Wheat_webHypertension has often been dubbed the “silent killer” because most people don’t feel any different when their blood pressure is elevated, yet longstanding hypertension has adverse effects on so many organ systems – heart, brain, eyes, kidneys, etc – that it will eventually kill the patient if the hypertension is left untreated.

A study out this month in the journal “Gastroenterology” shows that there may be a new “silent killer” on the block.

The authors analyzed blood samples from 9100 adults at the Warren Air Force Base collected between 1948 and 1954, looking for serum markers of celiac disease. They then compared the rates of undiagnosed celiac disease with recent blood samples from patients in a Minnesota town. The study had two surprising conclusions.

First, the incidence of celiac disease in patients 60 years ago was 0.2% while the incidence of celiac disease in the current blood samples was 0.8% to 0.9%. I wasn’t able to access the whole study on the Gastroenterology web site, but other confounding factors such as sampling bias may have explained at least some of these differences.

Second, patients with undiagnosed celiac disease had a nearly 4-fold increase in risk of death during the 45 year follow up period. Again, correlation does not necessarily mean causation, so it would be interesting to see the causes of death in the study population. Untreated celiac disease is associated with an increased incidence of lymphomas, thyroid disease, and gastrointestinal cancers, so an increase in death from those diseases in the study population would be more impressive than a bunch of deaths from car accidents or drug overdoses.

Celiac disease was featured in an episode of “House” and has affected Elisabeth Hasselbeck from “The View”.

Will have to go to the medical library and pull the article to read through it further, but just found the conclusions surprising.

6 Responses to “A New “Silent Killer”?”

  1. EAST says:

    Trust me, Celiac sucks. I just started my gluten free diet a few months ago. I now notice fewer problems with neuropathy, I’m less grouchy/ depressed, and don’t get lost on the freeway anymore… I’d like the distention / abd swelling to go down so I don’t have to wear maternity pants anymore (or have people ask if I’m pregnant- I want to tell them that I’m infertile), but that is more of a good day vs. bad day issue.

  2. MedZag says:

    Was just talking with the endocrine fellow about this today… weird.

    She said some places are even instructing patients to go gluten-free if they’re GGT/endomysial (+) and BIOPSY (-). That seems a little overkill to me, though putting a slew of people on gluten-free diets may help drop obesity a bit.

    • WhiteCoat says:

      Not sure that we know enough about celiac diagnosis to say one way or another. There’s no perfect test. Biopsy only shows the body’s reaction to the gluten, so it might not pick up subclinical cases. Tissue transglutaminase isn’t 100% sensitive – especially in IgA deficient patients and celiac disease is also associated with IgA deficiency. EMA is specific, but may be falsely negative if there isn’t much villous atrophy. Genetic testing for DQ2 or DQ8 may exclude celiac disease if they are negative, but negative genetic testing does not exclude allergy to gluten, which can cause symptoms similar to celiac disease.
      Don’t know that gluten free diets have any less calories – they just switch some grains for others.
      But if people feel better on the diet even if they don’t have celiac disease, more power to them.

      • CardioNP says:

        Gluten free diets can actually have much higher caloric content than gluten containing diets. I did try a gluten free diet for a year due to equivocal testing. It did not help my neuropathy.
        To truly follow a strict gluten free diet is extremely difficult. It essentially means that you must eat only home prepared meals or special GF foods. Food starch is a ubiquitous ingredient in commercially prepared foods. I’m glad to have gone back to eating a regular diet.

  3. Rob says:

    There are whole panels that reference labs will do for testing for celiacs. You’re right that there is no perfect test. but there are groups of tests that can give you a pretty clear cut yes or no. The fact that that the endomysial antibody test is sensitive to low total IGA is an easy fix, you just run a total IGA, along with it, as a sort of a control. You combine it with a ttg a reticulin and a gliadin, and you can pretty well get a “positive” or negative answer. Thanks for the great post, something else to think about.

  4. Sarah says:

    It recently came up in conversation with the dietician that I work with that celiac is more common in people of certain ancestry (east-asian for one), so perhaps the study populations weren’t the same? I imagine that an air-force base 60 years ago was a fairly homogenous population…

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