House CallApr/May 2014 Issue

Research Roundup: Safety of Oats, Fibromyalgia, IBS and Celiac

Safety of Oats

In a study of adults with celiac disease, long-term consumption of pure, uncontaminated gluten-free oats had no harmful effects, say researchers from Tampere University in Finland. They studied a group of celiac adults who had been eating oats on a daily basis for up to eight years. This daily intake didn’t result in small-bowel mucosal damage, inflammation or gastrointestinal symptoms. In fact, the small-bowel mucosa looked better in those who had consumed oats in larger amounts or over a longer time period than in those who avoided oats altogether.

In Finland, gluten-free oats weren’t considered safe for those with celiac disease until 1997, after a study showed no difference in clinical, laboratory or tissue outcomes after 12 months of oat consumption. Although some data has suggested that a small fraction of celiacs may, in fact, react to oats—oats have some wheat-like sequences in their protein structure—researchers found no evidence of this in their study. They did note that the high fiber content in oats can cause temporary bloating and flatulence, symptoms also seen in those without celiac disease. The study was published in Nutrients.

In a separate study published in Nutrients, Italian researchers reported preliminary results on the safety of gluten-free oats in celiac children. Because pure, uncontaminated gluten-free oats aren’t widely available in Italy (oats aren’t a Mediterranean staple), researchers were able to look at the effect of adding these oats to the diets of celiac children who’d never eaten them previously. Six months of daily consumption of a “considerable” amount of oats did not lead to any relevant change in intestinal permeability or gastrointestinal symptoms. This study is a rigorous double-blind, randomized, placebo-controlled trial which is ongoing.

© Inspirestock International/123RF

© Inspirestock International/123RF

Editor’s note: Many commercially available oat products are contaminated with wheat and barley during harvesting and processing. Look for certified gluten-free oats.

Fibromyalgia, IBS and Celiac

A new study conducted by a team at Central University Hospital of Asturias in Spain suggests a significant number of individuals with both fibromyalgia and irritable bowel syndrome (IBS) may also have celiac disease. Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. About half of those with fibromyalgia also have IBS.

Study participants found to have celiac disease showed improvement of symptoms once on the gluten-free diet. The findings are important because there’s currently no satisfactory treatment for fibromyalgia.

Results were published in Arthritis Research and Therapy.

Is Wheat Sensitivity an Allergy?

Researchers from the University of Palermo in Italy say a type of food allergy may play a role in non-celiac wheat sensitivity. “Non-celiac wheat sensitivity” and “non-celiac gluten sensitivity” are often used interchangeably but the Palermo team prefers “wheat” since it’s not clear which components of wheat cause symptoms in non-celiac gluten sensitivity. In addition, they add, there’s no definite proof that gluten is really the culprit.

In the new study, researchers reviewed data from 276 patients with irritable bowel syndrome who also had a diag-nosis of non-celiac wheat sensitivity. These patients had higher rates of food allergy in childhood, more atopic diseases like eczema and other markers of food allergy compared to a group who had IBS not due to non-celiac wheat sensitivity.

The finding strengthens the team’s hypothesis that patients with non-celiac wheat sensitivity may suffer from non-IgE mediated food allergy. Still, other mechanisms need to be considered, they caution.

Food allergies are typically considered IgE or non-IgE mediated. In IgE mediated food allergies, symptoms develop immediately after eating a trigger food and blood and skin tests for the allergic marker, IgE, are positive. In non-IgE mediated food allergies, the GI tract is affected, often leading to GI symptoms; these symptoms may not appear for hours or even days, making diagnosis difficult.

The study was published in the American Journal of Gastroenterology.

Disordered Eating

There’s a higher frequency of eating disorder behaviors in those with newly diagnosed (thus, untreated) celiac disease, especially women, according to a study from the University of Naples Federico II in Italy. In the study, those with celiac disease tended to exhibit greater dissatisfaction with their bodies, more concern about food ingestion, and altered food intake. They also had more feelings of inadequacy, social insecurity and perfectionism, traits often associated with eating disorders.

Interestingly, the presence of anxiety or depressive symptoms, which are common in eating disorders, didn’t appear to account for the findings, nor did the presence of gastrointestinal symptoms, which can alter feelings about food.

Most of the celiac women didn’t score high enough on the screening questionnaires to suggest true clinical eating disorders, which involve much more extreme thoughts, emotions and behaviors surrounding food, weight and body image.

The study was published in Gastroenterology Research and Practice.

Gluten Sensitivity in Kids

Numerous studies describe non-celiac gluten sensitivity in adults but few have homed in on children with the disorder—until now. Researchers from the University of Bari in Italy examined a series of 15 children who didn’t have celiac disease or wheat allergy but had clear-cut evidence of a relationship between eating wheat and the development of symptoms.

Abdominal pain, diarrhea, bloating, headache and fatigue were common. Half of the children had antigliadin IgG antibodies and half had the genetic marker associated with celiac disease, DQ2. Biopsies of their GI tracts came back normal or nearly normal. Finally, no differences in markers of nutritional, biochemical or inflammatory indices were detected between these children and a comparison group of kids with GI disorders like irritable bowel syndrome.

Researchers say these findings support the existence of non-celiac gluten sensitivity in children. The characteristics observed in these children closely overlap those documented in adults.

Results were published in the Journal of Pediatrics.

Senior medical correspondent Christine Boyd lives in Baltimore.

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