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Healthwatch
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Healthwatch
Celiac Disease: Exploring Four Myths
~4.2 mins read
An expert shines light on common misconceptions about this genetic autoimmune disease triggered by gluten.
Celiac disease is diagnosed with blood tests that look for specific antibodies. If antibodies are present, a definitive diagnosis requires an intestinal biopsy to look for signs of damage that characterize the condition.
Non-celiac gluten sensitivity does not trigger antibodies or cause intestinal damage. Yet some people with this problem say they also experience brain fog, trouble concentrating, muscle aches and pain, and fatigue after eating gluten-containing foods.
One possibility is sugarlike molecules known as FODMAPs, which are found in many foods — including wheat. Short for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, gas and bloating can occur when gut bacteria feed on FODMAPs.
Another possibility is an allergy to wheat, which can cause symptoms such as swelling, itching, or irritation of the mouth and throat after eating wheat. Other symptoms include a skin rash, stuffy nose, and headache, as well as cramps, nausea, and vomiting. Some people may develop a life-threating allergic reaction known as anaphylaxis.
Enzymes that break down gluten, which people could take alongside gluten-containing foods. "It's a similar concept to the lactase pills taken by people who are lactose intolerant to help them digest dairy products," says Dr. Kelly.
Dampening the immune response to gluten by inhibiting an enzyme called tissue transglutaminase that makes gluten more potent as an antigen.
Reprogramming the immune response to prevent the body from reacting to gluten.
Celiac disease is a digestive and immune disorder that can keep the body from absorbing necessary nutrients. "Our conception and awareness of celiac disease has evolved over the past few decades, but there are still aspects that remain poorly understood," says Dr. Ciaran Kelly, medical director of the Celiac Center at Beth Israel Deaconess Medical Center and professor of medicine at Harvard Medical School.
Perhaps not surprisingly, misconceptions are widespread among the general public. One example? Many people assume that everyone who has celiac disease is plagued by abdominal pain, bloating, or diarrhea. But actually, many adults newly diagnosed with this inherited gluten intolerance don't have these symptoms.
What's more, gluten — the sticky protein found in grains such as wheat, barley, and rye — can cause gastrointestinal distress and other symptoms in people who don't have celiac disease. Read on for a deeper dive into four myths and facts about celiac disease and related digestive conditions.
Myth # 1: Celiac disease is usually diagnosed at a young age
Not typically. While celiac disease can develop any time after a baby's first exposure to gluten, it's usually diagnosed much later in life. According to the National Celiac Association, the average age of diagnosis is between 46 and 56. Around 25% of people are diagnosed after age 60.
Celiac disease is slightly more common in women and among people with other autoimmune conditions, including type 1 diabetes, Hashimoto's thyroiditis (a common cause of low thyroid levels), and dermatitis herpetiformis (a rare condition marked by an itchy, blistering rash).
"We don't know why some people go from being susceptible to actually having celiac disease," says Dr. Kelly. The prevailing theory is that some sort of physical or emotional stress — such as a viral infection, surgery, or anxiety from a stressful life event — may "flip the switch" and cause the disease to appear, he says. "Increasing numbers of people are being diagnosed at midlife and older, often after they're found to have conditions such as anemia or osteoporosis caused by nutrient deficiencies," says Dr. Kelly.
Myth #2: Celiac disease only affects the gut
When people have celiac disease, eating gluten triggers an immune system attack that can ravage the lining of the small intestine. A healthy small intestine is lined with fingerlike projections, called villi, that absorb nutrients. In celiac disease, the immune system attacks the villi, causing them to flatten and become inflamed — and thus unable to adequately absorb nutrients.
While gastrointestinal problems can occur, they aren't always present. In fact, celiac disease can present with many different symptoms that affect the nervous, endocrine, and skeletal systems. A few examples are brain fog, changes in menstrual periods, or muscle and joint pain.
Myth # 3: Celiac disease versus gluten intolerance
If you feel sick after eating gluten, you probably have celiac disease, right? Actually, that may not be true. Some people have non-celiac gluten sensitivity (also called gluten intolerance), which can cause uncomfortable digestive symptoms after eating gluten. But gluten intolerance differs from celiac disease.
"Non-celiac gluten sensitivity appears to be a real phenomenon, but it's not well defined," says Dr. Kelly. It's unclear whether people experiencing it are intolerant to gluten or to something else in gluten-containing foods.
Myth #4: A gluten-free diet always relieves the symptoms and signs of celiac disease
The sole treatment for celiac disease — adopting a diet that avoids all gluten-containing foods — doesn't always help. This problem is known as nonresponsive celiac disease.
"About 20% of people with celiac disease have ongoing symptoms, despite their best efforts to stick to a gluten-free diet," says Dr. Kelly. Others have intermittent signs and symptoms, particularly when they are accidentally exposed to gluten. Accidental exposures often happen when people eat prepared or restaurant foods that claim to be gluten-free but are not. Cross contamination with gluten-containing foods is another potential route.
Potential solutions to nonresponsive celiac disease are being studied. Three promising approaches are:
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BBNs Tacha And Life Coach Solomon Buchi Lock Horns Over His Recent Reaction To Her Video
~4.6 mins read
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Healthwatch
Respiratory Health Harms Often Follow Flooding: Taking These Steps Can Help
~4.9 mins read
Mold growth and contaminants left after major storms may pose health hazards.
Repair the roof, clean gutters, and seal around skylights, vent pipes, and chimneys to prevent leaks. These are some of the most vulnerable components of a building during storms and hurricanes.
Declutter drains and empty septic tanks.
Construct barriers and seal cracks in outer walls and around windows, to prevent heavy rain and floodwater from entering.
Install a sump pump to drain water from the basement, and backflow valves on sewer lines to prevent water from backing up into the home.
Minimize your stay in flooded regions (particularly after hurricanes) or buildings until they are dry and safe.
Check building for traces of water intrusion, dampness, and mold growth immediately after flooding.
Drain floodwater and dispose of remaining sediment.
Remove affected porous materials. If possible, dry them outdoors under sunlight.
Increase the ventilation rate by leaving all windows and doors open, or use a large exhaust fan to dry out the building as fast as possible.
Use dehumidifiers in damp spaces such as basements.
Upgrade the air filters in your HVAC system to at least MERV 13, or use portable air cleaners with HEPA filters to reduce your exposure to airborne mold spores.
Wear a well-fitted N95 face mask, gloves, and rubber boots to clean.
Clean and disinfect anything that has been in contact with water using soap, detergents, and/or antibacterial cleaning products.
Dispose of moldy materials in sealed heavy-duty plastic bags.
Heavy rains and sea level rise contribute to major flooding events that are one effect of climate change. Surging water rushing into buildings often causes immediate harms, such as drowning deaths, injuries sustained while seeking shelter or fleeing, and hypothermia after exposure to cold waters with no shelter or heat.
But long after news trucks leave and public attention moves on, flooding continues to affect communities in visible and less visible ways. Among the less visible threats is a higher risk of respiratory health problems like asthma and allergic reactions. Fortunately, you can take steps to minimize or avoid flooding, or to reduce respiratory health risks after flooding occurs.
How does flooding trigger respiratory health issues?
Flooding may bring water contaminated with toxic chemicals, heavy metals, pesticides, biotoxins, sewage, and water-borne pathogens into buildings. Afterward, some toxic contaminants remain in dried sediments left behind. When disturbed through everyday actions like walking and cleaning, this turns into microscopic airborne dust. Anything in that dried flood sediment — the toxic chemicals, the metals, the biotoxins — is now in the air you breathe into your lungs, potentially affecting your respiratory health.
Buildings needn't be submerged during flooding to spur respiratory problems. Many homes we studied after Hurricane Ida suffered water intrusion through roofs, windows, and ventilation ducts — and some were more than 100 miles away from coastal regions that bore the brunt of the storm.
The growth of mold can also affect health
Another common hazard is mold, a fungal growth that forms and spreads on damp or decaying organic matter. Indoor mold generally grows due to extensive dampness, and signals a problem with water or moisture. Damp materials inside buildings following a flood create perfect conditions for rapid mold growth.
Mold can be found indoors and outdoors in all climates. It spreads by making tiny spores that float through the air to land in other locations. No indoor space is entirely free from mold spores, but exposure to high concentrations is linked with respiratory complications such as asthma, allergic rhinitis, and sinusitis. Thus, flooding affects respiratory health by increasing the risk of exposure to higher concentrations of mold spores outdoors and indoors.
For example, after Hurricane Katrina in New Orleans in 2005, the average outdoor concentration of mold spores in flooded areas was roughly double that of non-flooded areas, and the highest concentrations of mold spores were measured indoors. A study on the aftermath of Hurricane Katrina and the flooding in the UK in 2007 showed that water damage accelerated mold growth and respiratory allergies.
Children are especially vulnerable to health problems triggered by mold. All respiratory symptoms — including asthma, bronchitis, eye irritation, and cough — occurred more often in homes reporting mold or dampness, according to a study on the respiratory health of young children in 30 Canadian communities. Other research demonstrates that mold contributes to development of asthma in children.
What can you do to protect against the health harms of flooding?
Our research in New Orleans, LA after Hurricane Ida in 2021 identified common factors — both in housing and flooding events — with great impact on respiratory health. Preliminary results suggest two deciding factors in whether substantial indoor mold appeared were the age of a building's roof and how many precautionary measures people took after flooding from the hurricane. The impact on respiratory health also varied with flood water height, days per week spent at home, and how many precautionary measures were taken after Ida swept through.
Informed by this and other research, we offer the following tips — some to tackle before flooding or heavy rains, and some to take afterward. While you may not be able to entirely prevent flooding from hurricanes or major storms, taking these and other steps can help.
Before seasonal storms, flooding, or heavy rains start: Protect against water intrusion
After flooding or major rainstorms: Move quickly to reduce dampness and mold growth
The Environmental Protection Agency recommends limiting contact with flood water, which may have electrical hazards and hazardous substances, including raw sewage. Additionally:
What to do if you spot mold growth
Taking steps like these — before and after a major storm — goes a long way toward protecting your respiratory health.
Read Flooding Brings Deep Trouble in Harvard Medicine magazine to learn more about the health hazards related to floods.
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