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House CallFeb/Mar 2012 Issue

Research Roundup: Good Bacteria at Birth, Celiac Pill, and More!

The latest medical news for people with allergies and food sensitivities

©Thinkstock 2011/iStockphoto

©Thinkstock 2011/iStockphoto

Good Bacteria at Birth

Last year, a study suggested a possible link between birth by cesarean and celiac disease (in the offspring). Now a team collaborating at several university hospitals in Sweden and at the Mayo Clinic has found elective—but not emergency—cesarean delivery is associated with increased risk of celiac disease. The finding indicates that the newborn’s bacterial flora—the normal bacteria present throughout the body, notably the gut, beginning at birth—may play a role in the development of celiac disease. In elective cesareans, babies avoid contact with the birth canal and, as a result, colonization with their mother’s bacterial flora. (Note: Celiac disease can occur only in those with a genetic predisposition for it.)

The researchers underscore that the increased risk of celiac associated with elective cesarean was small and shouldn’t alter delivery advice. The study was published in Gastroenterology.

In other research, a team from Maastricht University in the Netherlands found that place of delivery—home versus hospital—affects the composition of bacteria in a newborn’s gut, which may, in turn, influence the risk of developing allergic disorders. Just 19 percent of children born at home were colonized with C. difficile (bacteria linked to allergic disorders in an earlier study), compared to 27 percent born vaginally in the hospital. Among those children born at home who also had a family history of allergic disorders, such as eczema and hay fever, odds of having asthma or sensitization to food allergens (egg, milk and peanut) were significantly lower than children born vaginally in the hospital.

Previous studies have suggested a link between cesarean delivery and allergic disorders, especially asthma, but this is the first study to implicate place of delivery, too. More work is needed, say the Dutch researchers, particularly investigations that look at the complete microbial composition of the newborn gut. Such studies could strengthen the evidence of a relationship between type and place of birth and the development of allergic disorders, as well as identify specific microbes that may be important intermediaries, providing new leads for the primary prevention of allergies. The study was published in the Journal of Allergy and Clinical Immunology.

Hidden Veggies

Sneaking pureed veggies into preschoolers’ meals can double their intake of vegetables and cut calories, according to a study in the American Journal of Clinical Nutrition.

Researchers from Penn State gave 3- to 5-year-old children favorite foods, like pasta with tomato sauce and chicken noodle casserole, prepared with and without pureed vegetables. When the tots consumed the veggie-enhanced meals, they upped their vegetable consumption while taking in, on average, 11 percent fewer calories—a finding not attributed to eating less. The youngsters ate similar weights of food throughout the study and rated their liking of foods comparably.

Hiding pureed veggies in foods served to adults produced similar results in an earlier study by the Penn State team.

Food Hypersensitivities

A high percentage of people with irritable bowel syndrome (IBS) may actually suffer from food hypersensitivities, say researchers from the University of Palermo in Italy.

IBS and food hypersensitivity—a type of food intolerance marked by a delayed response to trigger food(s)—can have overlapping symptoms, such as abdominal pain, bloating and altered bowel habits. As with IBS, there’s not yet a specific test to help diagnose food hypersensitivities.

In the new study, researchers asked adults with IBS to undergo a 4-week food elimination diet, cutting out milk, wheat, egg, tomato and chocolate. Those who reported improvements in symptoms then underwent double-blind, placebo-controlled, oral food challenges with milk and wheat.

Of the 160 adults with IBS in the study, 25 percent were diagnosed with food hypersensitivities, most to both milk and wheat, and their symptoms improved significantly or resolved on the elimination diet. These participants also had increased levels of eosinophil cationic protein, a fecal marker of intestinal inflammation, which researchers say could be useful in detecting food hypersensitivities in individuals with IBS-like symptoms.

The study was published in Clinical Gastroenterology and Hepatology.

ADHD Updates

Untreated celiac disease may predispose people to attention deficit hyperactivity disorder (ADHD), suggests Helmut Niederhofer, MD, PhD, of the Psychiatric Hospital of Rodewisch in Germany. Niederhofer found a high rate of undiagnosed celiac disease in a sample of 67 adults and children with ADHD. Ten of the patients tested positive for celiac antibodies and after six months of treatment with the gluten-free diet, they (or their parents) reported significant improvements in ADHD symptoms.

A link between celiac disease and ADHD has been previously reported. Now with the new findings, published in The Primary Care Companion for CNS Disorders, Niederhofer says more work on that link is “urgently required,” including an investigation into whether individuals with ADHD should be screened for celiac disease to potentially avoid unnecessary treatment with prescription stimulants.

Separately, a study in the Journal of the American Academy of Child and Adolescent Psychiatry recently reported omega-3 fatty acid supplementation, particularly with higher doses of EPA (eicosapentaenoic acid), was modestly effective in the treatment of ADHD. EPA is found in cold water fatty fish, such as salmon, as well as in fish oil supplements. Study results were based on data pooled from 10 omega-3 fatty acid supplement studies involving 699 children with ADHD.

Discuss use and proper dosage with a physician before giving children supplements.

Celiac Pill Shows Promise

A drug that could become the first non-dietary treatment for celiac disease has passed an important milestone. Known as ALV003, the drug demonstrated in a randomized controlled trial (the gold standard in clinical research) that it can reduce gluten-induced injury to the small intestine in people with celiac disease.

ALV003 works by chopping up the gluten protein further than the digestive system does naturally, blighting gluten’s ability to trigger an immune response.

Formulated as a capsule, ALV003 is intended to be used in conjunction with the gluten-free diet (not as a replacement for it) to provide a safety net against everyday cross contamination.

Results of the clinical trial, conducted in Finland, were presented at the 2011 United European Gastroenterology Week in Stockholm. ALV003 is slated to begin the next phase of clinical testing in 2012.

Celiac Guidelines

When it comes to the diagnosis and management of celiac disease, there is significant disagreement between celiac experts and community gastroenterologists, according to a study published in the Journal of Clinical Gastroenterology.

Celiac experts are more likely than community gastroenterologists to follow practice guidelines, such as screening high-risk patients, including first-degree relatives of celiacs and type-1 diabetics. Experts are also more likely to utilize the gluten challenge and/or genetic testing in hard-to-diagnose cases when the patient may already be on the gluten-free diet. Experts more often endorse eating uncontaminated oats, too.

Findings were based on a survey of 169 community gastroenterologists and 22 celiac experts attending a 2009 gastroenterology conference. Results underscore the need to promote existing celiac guidelines, say the study authors, a team from the University of Chicago and North Shore University Health System.

BPA’s Effects on Behavior

Research continues into the effects of Bisphenol A (BPA), the synthetic chemical that can be found in everyday items from shower curtains to soup cans.

In this latest study, published in Pediatrics, a team led by researchers at the Harvard School of Public Health found BPA may affect some children’s behavior and that exposure to BPA in utero may have more impact than exposure during childhood.

Researchers tracked BPA levels in the urine of 244 mothers during their pregnancies and, once born, in their children at ages 1, 2 and 3. Higher BPA levels during pregnancy (but not childhood) were associated with worse scores on measures of anxiety, hyperactivity, emotional control and behavioral inhibition in the 3 year olds, especially among girls. However, additional studies are needed to better understand gender susceptibilities to BPA at different periods of development.

The Harvard team says those concerned about BPA can reduce their exposure by avoiding canned and packaged foods and polycarbonate bottles with the recycling symbol 7.

Medical writer Christine Boyd lives in Baltimore.

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