Celiac disease is believed to affect more than 1 million people in the US.

The primary symptoms of Celiac disease are abdominal pain, diarrhea (often with blood), and slow development (physical). But if persons with Celiac disease avoid those grains with gluten, they are virtually symptom free.

Avoiding symtpoms sounds like it would be easy, but with today's manufacturing and processing of foods it is not. Makers of processed foods often use partial ingredients, can hide ingredients using synonyms, and in some cases my improperly label a food wheat or gluten free when it is not.

So earlier this year the Food and Drug Administration (FDA), proposed new labeling standards concerning gluten free food. The new rules would require manufacturers of food to indicate any possilbe containment of gluten in the product and also any possibility of contamination due to shared equipment, etc.

The new rules would specifically affect foods that contain wheat, rye, or barley. The rules would also require labels that state foods are gluten free to indicate that all such foods are gluten free if it occurs naturally, such as in the case of rice cereals. (There is no gluten in rice)

The study, published in the Journal of the National Cancer Institute, investigated the association of calcium supplementation with the long term risk of colon polyp recurrence. Researchers at Dartmouth Medical School in New Hampshire analyzed the data of 822 adults who completed the Calcium Polyp Prevention Study and participated in the Calcium Follow-Up Study. The Calcium Polyp Prevention Study found that calcium supplementation reduced the risk of polyp recurrence over a four year period. In the Calcium Follow-Up Study the participants were followed for an additional seven years after the Calcium Polyp Prevention Study treatment period. Colonoscopy results and follow-up data were obtained from the participants.

The researchers found that participants in the calcium group had a 31.5 percent lower risk of polyp recurrence for five years after the previous study's treatment period, compared with 43.2 percent in the placebo group. Furthermore, calcium's protective effect continued even for participants who did not use calcium supplements after the Calcium Polyp Prevention Study treatment period. However, calcium's protective effect did not continue over the next five year period.

"The protective effect of calcium supplementation on risk of colorectal adenoma recurrence extends up to 5 years after cessation of active treatment, even in the absence of continued supplementation," the study authors conclude.

REFERENCES:
1. Grau MV et al. Prolonged effect of calcium supplementation on risk of colorectal adenomas in a randomized trial. J Natl Cancer Inst 2007 Jan 17;99(2):129-36.

A study released this month in the Journal of American Medical Association found evidence that chronic use of proton pump inhibitors in men and women over the age of 50 greatly increases the risk for hip fracture.

Proton pump inhibitors work to block the production of hydrochloric acid (HCl) in the stomach. They are effective for treating GERD because it is often the result of excess HCl. But because the production of HCl is decreased, digestion and absorption of important nutrients, including calcium, may be hampered.

This is the theory behind the findings, as presented by the lead researchers. Decreased HCl causes decreased calcium absorption. Therefore the bones must release more of their calcium, or less bone is rebuilt, both of which result in lowered bone mineral density.

Bone mineral density begins to decline naturally with advanced age. When it is declining too rapidly, in response to poor nutrition or medication side effects individuals can develop osteopenia or osteoporosis. These conditions are characterized by weak or thin bones.

Individuals with osteoporosis or osteopenia have an increased risk for fracture.

In this particular study more than 13,000 men and women over the age of 50 were assessed for use of proton pump inhibitors including duration and incidence of hip fracture.

They found that use of a proton pump inhibitor such as Prevacid, Prilosec, or Protonix for more than one year increases the risk for fracture by 42 percent. The longer a person is on the proton pump inhibitor and the higher the dose the greater the risk. The highest doses carry a risk greater than two and a half that of a healthy person.

This is the first study to find results that highlight a negative effect on bone health by proton pump inhibitors. These medications have provided positive treatment to many people, and if you are currently on any of these medications you should always discuss treatment options including risks and benefits with your healthcare provider.

The study was published in the journal Nature this month. There appears to be an imbalance of two main types of good flora in the gut, Bacteroides and Firmicutes. Researchers found this imbalance in both laboratory mice and humans.

It appears if obese individuals have a greater percentage of Firmicutes compared to Bacteroides in their gut compared to non-obese or lean persons. Lean person have a greater percentage of Bacteroides. These same ratios were also observed in mice.

Then researchers took 12 obese individuals and placed them on a low-calorie diet for 12 months with a goal of weight loss. During the 12 month period weight and levels of gut bacteria were measured.

As the obese participants lost weight, the percentage of Bacteroides increased. The relationship was linear, meaning the more weight lost the greater the increase in Bacteroides, and subsequent decrease in Firmicutes.

The researchers believe there may be some connection between the bacteria in the GI tract and obesity. It is not clear if the diet and amount of fat dictates the bacteria. Or perhaps the bacteria alters absorption of fat. But this area is definately going to be recieving more attention as answers to the obesity epidemic are being saught.

As obesity is on the rise, high cholesterol and triglycerides follow suit. This abnormal amount of fat in the diet and body puts a high burden on the liver, which then resorts to storing extra fat and cholesterol around its cells.

In serious cases fatty liver can lead to cirrhosis, or fibrosis of the liver. Cirrhosis can lead to liver failure or liver cancer, and an early death.

There is no drug to treat fatty liver once it has developed, though diet and exercise can help the liver clean itself up, as long as cirrhosis has not set in.

A recent study in adolescents examined the effect regular exercise had on fatty liver. More than 70 obese teenagers were placed on a diet and exercise regimen for 12 weeks.

The regimen consisted of nutrition classes and two one hour workout sessions per week.

Scans of their livers were obtained pre and post study period. Weight, body mass index, and fat surrounding other organs was also measured.

More than 50 percent of the participants had fatty liver on one or both sides at onset of the study. After the 12 week program, this number was reduced to only 29 percent.

Other positive changes were observed in the teens, including weight loss, lower BMI, and less fat around other organs.

The authors had two main points to make in their conclusion. First, it should be alarming that the rate of fatty liver in teenagers who are obese is above 50 percent. Second, diet and exercise changes (even modest ones such as in this study) are significantly effective at reversing fatty liver disease.

Now a study reports that the healthy diet pattern is associated with a decreased the risk of colorectal tumors in women. However, the less healthy diets are associated with an increased the risk of colon cancer.

The study, published in the American Journal of Epidemiology, investigated the association between dietary patterns and risk of colorectal tumors. Researchers at Inserm in France analyzed the dietary data of 100,000 women, as part of the European Prospective Investigation into Cancer and Nutrition (EPIC) study, from 1993 to 2000. Dietary questionnaires were obtained from the participants at the beginning of the study. The participant's diets were analyzed according to the four dietary patterns.

The researchers found that the Western and drinker diets were associated with an increased risk of colorectal adenomas (a precursor to colorectal cancer). The meat-eater diet was linked with an increased risk of colorectal cancer. However, the healthy diet was associated with a decreased risk of colorectal adenomas.

"Dietary patterns that reflect a Western way of life are associated with a higher risk of colorectal tumors," the study authors conclude.

REFERENCES:
1. Kesse E et al. Dietary patterns and risk of colorectal tumors: a cohort of French women of the National Education System (E3N). Am J Epidemiol 2006 Dec 1;164(11):1085-93. Epub 2006 Sep 21.

Crohn's disease affects the upper part of the large intestine, while UC primarily affects the lower part, but can affect the whole large intestine. Both conditions result in damage to the intestinal wall. Children with IBD experience severe symptoms such as gas, bloating, abdominal pain, cramping, diarrhea, and blood in their stool.

Researchers investigated more than 130 children age 8-18 with IBD. They took measurements of Vitamin D in their blood as well as parathyroid hormone, a chemical that helps regulate Vitamin D in the body. They also did bone density scans of the hip and lower spine.

Vitamin D is involved in many processes in the body from the immune system to bone health. However, one of the most important roles is bone metabolism. It helps mineralized the bones to allow for proper strenght. Vitamin D deficiency can result in osteomalacia, or weak bones, in children. It can increase the risk for fractures and for osteoporosis later in life.

Forty-five children in the study were found to have Vitamin D deficiency, with 11 percent of those having severe deficiency. Children with UC had similar results to those with Crohn's. There was no effect on parathyroid hormone.

As expected bone mineral density was related to Vitamin D status. Children who had a longer duration of the disease also had lower levels of Vitamin D as did those with darker skin and those who lived in less sunlight.

The authors did not determine the mechanism, but perhaps it is related to decreased absorption of Vitamin D and its precursors. Children who have IBD should be screened for Vitamin D deficiency because of the major health implications this deficiency can have.

The study, published in The Lancet, reviewed studies to determine the prevalence of heartburn. Researchers at the McMaster University Medical Centre, in Ontario, Canada, reviewed 31 heartburn studies published worldwide.

The researchers found that heartburn is more common in Western countries than other countries. Twenty five percent of people in Western countries, as compared to 11 percent of people in eastern Asian countries, report having heartburn at least once a month. Findings also revealed that 12 percent of people living in Western countries and 4 percent of people in Eastern Asian countries report heartburn symptoms weekly. Furthermore, 5 percent of people in Western countries and 2 percent of people in eastern Asian countries report heartburn symptoms daily

"Transient relaxation of the lower esophageal sphincter is believed to be the primary mechanism of the disease although the underlying cause remains uncertain," the study authors write. "Obesity and smoking are weakly associated with the disease and genetic factors might be important."

REFERENCES:
1. Moayyedi P and Talley NJ. Gastro-oesophageal reflux disease.
Lancet 2006 Jun 24;367(9528):2086-100.

The report presented evidence from an animal study that found mice who consumed diets high in fructose, a specific type of sugar, gained more weight but also suffered from fatty liver. Mice who were not given the high sugar diet did not gain excess weight or experience fatty liver.

This is one of the first studies to show that high sugar intake effects organ health as much as weight. Fatty liver can lead to more serious liver conditions including cancer, if untreated. And because the liver is so important for many other processes in the body, fatty liver can preceed many other disorders.

Previously fatty liver was thought to be due to only high fat intake and obesity, genetic causes, or alcoholism. Now high sugar intake can be added to that list of causes.

Colorectal cancer is the number two cause of cancer related deaths in the United States. Current treatments include surgery, radiation, and chemotherapy but depending on the staging of the disease effectiveness is not always guaranteed.

Researchers from the University of Colorado measured the effects of grape seed extract (GSE) on colorectal cancer cells in animal models and in lab dishes. They found that GSE caused cell death via apoptosis. It also interupted normal replication of the cancer cells.

They were also able to determine the exact mechanism of GSE effect on colorectal cancer cells. It appeared to act in the early phase of cell cycle replication, an area which often is functioning improperly in cancer cells, which allows for their unchecked growth.

Those involved in this study were optimistic that GSE may be an effective means of preventing and treating early colorectal cancer. More studies are needed to back up this information, including clinical trials in humans.

Many people do not have a colonoscopy because of fear or embarrassment about the procedure. But the fact of the matter is it could be lifesaving. Colorectal cancer when caught early is easily treated, but if not detected it can spread to other parts of the body and become deadly. Also, removal of polyps, which are pre-cancerous, can prevent the development of colorectal cancer and avoid chemotherapy and more invasive surgeries.

Recently a new procedure was developed to provide an option for those not wishing to undergo the standard colonoscopy procedure. It is a non-invasive CT colonography that uses computer images obtained via x-ray to find the presence of polyps or cancerous growths. Because the procedure was so new, there were limited studies on the efficacy of the CT colonography and even fewer comparing its results to the standard colonoscopy.

But this October a study comparing the two procedures was completed at the University of Wisconsin Medical School and published in the journal Radiology.

The study had more than 1,000 participants. Each person underwent the CT colonography. Those individuals who had a positive finding were then offered the standard colonoscopy.

A total of 10 percent or about 100 participants had positive findings from the CT colonography, of which 71 had a repeat colonoscopy.

Of those who had the second procedure, 65 had the same findings. The researchers were satisfied with the results and feel it is a viable alternative to those not wanting the traditional colonoscopy.

One drawback to the CT colonography is the inability to remove polyps or take a biopsy, which can be done with the traditional colonoscopy.

The major symptoms of IBS are increased gas and bloating, alternating constipation and diarrhea, and painful abdominal cramps. Many believe IBS is strongly effected by stress and dietary choices.

The researchers were working on the idea that IBS is caused by an abnormal growth of bacteria in the gut. This unchecked growth causes the GI tract to contract and work ineffectively which results in the most common symptoms of IBS.

The study was published in the Annals of Internal Medicine this October. A total of 87 men and women completed the study. They were split into two groups. The first group, the treatment group, was given 400 mg of rifaximin three times a day and the second group, the control group, was given a placebo. Each group took their pills for a total of 10 days.

Symptoms were assessed in each person via a questionaire at the onset of the study and weekly for up to 10 weeks after beginning the 'treatment'.

They found that the individuals in the antibiotic treatment group had an improvement in their symptoms during the 10 day treatment course, but that the improvement continued beyond up to the 10th week. This effect was not observed in the placebo group, which showed some improvement during the 10 days of 'treatment' only.

The researchers believe that excess levels of normal bacteria in the gut could be affecting the function of smooth muscle in the digestive tract. The excess bacteria may also be making more gas as a by-product of its own digestion. Treatment with antibiotics may offer new hope for sufferers of IBS, a difficult condition to treat.

The study, published in Archives of Internal Medicine, performed a literature search of heartburn studies to determine the efficacy of dietary measures. Researchers at the Stanford University School of Medicine in Stanford, California, reviewed 2,039 heartburn studies published worldwide between 1975 and 2004. They identified 100 relevant articles, including 16 clinical trials examining the impact of lifestyle measures on GERD.

The researchers found that there was no evidence that avoiding certain foods and beverages, or eliminating tobacco and alcohol, can help reduce GERD symptoms. Eliminating foods such as chocolate or carbonated beverages was not shown to prevent heartburn. Findings also revealed that maintaining a healthy weight and elevating the head of the bed to help keep the acid contents in the stomach, were the only lifestyle changes that helped prevent heartburn.

"Weight loss and head of bed elevation are effective lifestyle interventions for GERD," the study authors conclude. "There is no evidence supporting an improvement in GERD measures after cessation of tobacco, alcohol, or other dietary interventions."

REFERENCES:
1. Kaltenbach T et al. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med 2006 May 8;166(9):965-71.

The study looked at the connection between GERD, belching, and air swallowing in 24 subjects. Each subject had air injected into their stomach and then the occurance of belching and air swallowing was assessed in each as well as the incidence of acid reflux, the key component of GERD.

Twelve of the subjects had GERD and twelve were healthy with no current reflux symptoms.

Both belching and air swallowing were higher in the GERD subjects. On average a GERD subject burped 52 times after the air infusion and the non-GERD subject only an average of 7 times. The GERD group swallowed air an average of 287 times compared to only 176 times in the non-GERD group. There was no effect on acid reflux due to the air infusion, nor any difference between the two groups.

Belching and air swallowing are thought to be increased in patients with GERD because the muscle between the esophagus and stomach, the lower esophageal sphincter (LES) is thought to be relaxed and lets contents move easier between the two organs. Relaxation of the LES is also why acid reflux occurs so frequently.

But based on the results of this study, acid reflux and belching/air swallowing are not related, even though they share a common variable, relaxation of the LES.

For the review doctors from the Dartmouth-Hitchcock Medical Center in New Hampshire looked at all the reported cases of inflammatory bowel disease (IBD) that were associated with use of isotretinoin. IBD is a common diagnosis for two primary conditions, Ulcerative Colitis (UC) and Crohn's Disease. Both UC and Crohn's affect the large intestine to varying degrees.

A total of 85 cases of isotretinoin related IBD were reviewed. Each case had been reported to the FDA over a period of 5 years. In order to determine if the condition (IBD) was in fact related to medication use, a standardized scale for adverse drug reaction was used by the researchers.

In a majority of the cases, 62 of 85, isotretinoin was deemed highly probable or probable cause for the IBD. While in no cases was the association deemed doubtful.

These finding may significantly effect informed consent and general warnings concerning side effects of the popular medication for severe acne. At this time the greatest concern or warning concerning use of isotretinoin is the risk of damage to a developing fetus if used in a pregnant female.

Now patients must pay particular attention to the risk of IBD, especially if there is a history of bowel disease in the patient or a strong family history of IBD. In many cases IBD is difficult to treat and cure, and patients may be dealing with this debilitating condition for the rest of their life.