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  • Jefferson Adams
    Jefferson Adams

    Risk of Non-alcoholic Fatty Liver Disease is Nearly Double for Celiacs on Gluten-Free Diet

    Reviewed and edited by a celiac disease expert.

    Does a gluten-free diet put people with celiac disease at risk for non-alcoholic fatty liver disease?

    Risk of Non-alcoholic Fatty Liver Disease is Nearly Double for Celiacs on Gluten-Free Diet - Non-alcoholic fatty liver disease. Image: CC BY-SA 3.0--Nephron
    Caption: Non-alcoholic fatty liver disease. Image: CC BY-SA 3.0--Nephron

    Celiac.com 11/08/2021 - Researchers know that non-alcoholic fatty liver disease is strongly associated with metabolic syndrome. But, are rates for non-alcoholic fatty liver disease higher in patients with celiac disease on a gluten-free diet? What about rates of celiac disease in patients with non-alcoholic fatty liver disease?

    A team of researchers recently set out to determine risk of non-alcoholic fatty liver disease for people with celiac disease on a gluten-free diet. The research team included M Aggarwal, P Kumar, R Garg, CC Lindenmeyer, J Wakim-Fleming, and A Rubio-Tapia.

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    For their systemic review and meta-analysis, they included 12 studies involving nearly 5,000 subjects. Five of those studies, totaling 1,268 participants, determined rates of non-alcoholic fatty liver disease in patients with celiac disease, while seven studies on just over 3,700 subjects assessed rates of celiac disease in patients with non-alcoholic fatty liver disease. Their analysis included only studies with fifty or more cases of celiac disease with most participants over 15 years of age. They assessed new diagnoses of serology- and histology-positive celiac disease.

    Researchers reported pooled rates of non-alcoholic fatty liver disease of 12.3% in celiac patients before initiating a gluten-free diet, and 21.4% in celiac patients after initiating a gluten-free diet. They saw a significant increase in the odds of celiac patients developing non-alcoholic fatty liver disease after starting a gluten-free diet.

    They saw a pooled rate of 5.3% (95% CI, 3.5-8.0; I2 = 76%) and 3.1% (95% CI, 1.7-5.6; I2 = 79%) in patients with non-alcoholic fatty liver disease with serology-positive and histology-positive celiac disease, respectively.

    Based on their data, the team concludes that the odds of people with celiac disease developing non-alcoholic fatty liver disease nearly double after they begin a gluten-free diet. The team recommends close monitoring of celiac patients for non-alcoholic fatty liver disease over time. 

    Given the long-term metabolic consequences of non-alcoholic fatty liver disease, the team suggests that doctors consider non-alcoholic fatty liver disease screening in celiac patients.

    The information was presented at the Annual Meeting of the American College of Gastroenterology, from October 22 to 27, 2021. 

    Read more in Gastroenterology Advisor



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    yuluyouyue

    What would be the reason for that, does anyone know? 

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    Wheatwacked

    Not eating enough food with choline.

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    yuluyouyue
    1 hour ago, Wheatwacked said:

    Not eating enough food with choline.

    Thank you! But why is that a problem of those on gluten free diet? Do they not eat eggs, fish, liver, beef, chicken, vegetables, etc?? Or is it again people who only eat packaged gluten free food and don't get any vitamins because they don't eat fortified wheat products... I must say these things really baffle me as I personally eat just as varied as while l was still eating gluten. 

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    Wheatwacked

    Wheat products fortified with folic acid covers up some of the effects of insuffient choline.

    It has been linked to neural tube defects in fetuses dispite the folic acid fortification in non GFD foods. Open Original Shared Link

    It clears lipids in the liver It donates methy groups in collaboration with the B vitamins to metabolize homocystein.  It is needed to create acetylcholine essential to nerve transmission and possibly memory storage.

    Eggs and red meat were once an important source of choline since eggs have fallen out of favor in a mistaken attempt to reduce plasma cholesteral levels there does'nt seem to be a good alternative to take their place.

    To put it in perspective to achieve adequate intake of choline you need to eat every day: 

    4 large hard boiled eggs or

    15 ounces of lean top round beef or

    30 ounces of chicken breast or

    10 large baked potatoes with skin or

    13 cups of boiled cauliflower or

    8 cups of boiled broccoli.

    Quote

     

    Most people in the United States consume less than the AI for choline...Plasma choline levels do not decline below 50% of normal, even in individuals who have not eaten for more than a week...  Open Original Shared Link


     

    Quote

    Animal studies have shown that choline is essential for optimal brain development and influences cognitive function in later life...Excessive consumption of choline (≥7,500 mg) has been associated with blood pressure lowering, sweating, fishy body odor, and gastrointestinal side effects. The tolerable upper intake level (UL) for adults is 3,500 mg/day.   Open Original Shared Link

    Quote

    Hanin et al. (1987) reported that choline plays an important role in the metabolism of fat; it breaks fat down for use as an energy source. This action of choline makes it valuable in preventing conditions like fatty liver or excess fat in the blood. Choline’s efficient metabolism of fats has also been linked to a greater level of satiety, which, in turn, leads to a decreased consumption of calories, resulting in overall weight loss. According to studies conducted by the Louisiana State University Pennington Biomedical Research Center (2007), the addition of choline-rich eggs to breakfast helped obese patients on a low-fat diet lose weight compared to patients who ate a bagel for breakfast with the same number of calories.   Open Original Shared Link

     

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    Elizabeth Butler

    Thank you for the choline tip! I’m like 99.9 percent vegan diet..so this could apply to me! Fatty liver disease may also get the ball rolling towards diabetes despite low “sugar” consumption. I eat a lot of califlower but not that much lol. I also feel as if I’ve always had a “sluggish liver” anyway. I don’t handle B-supplements very well at all. Thank you very much for the info. I’m going to do some research on choline! 

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    trents

    What do you mean when you say you don't handle B supplements well at all. What happens when you take them? Are you sure you have used gluten free B-complex?

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    Elizabeth Butler

    I've always had severe and strange "acne". After years and countless treatments(some homeopathic, some dermatologist prescribed) that didn't quite "work". I started to suspect Dermatitis Herpetiformis(sorry incorrect spelling in a hurry) or the skin affliction of celiac disease. i got into an argument with my dermatologist who basically said it didn't exist. I had requested to be tested for the condition. He refused, said my acne was hormonal and birth control was my option or the prescribed creams( one of which not ironically was used in treating skin celiac at least on the internet readings). needless to say i left that office and i haven't been back to a dermatologist since. one of the treatments I've seen used with success was b-vitamins that were missing from the diet( pre-gluten free times). I took them and my acne got worse. Thru the years since.. despite being on a gluten free diet ( i suspect not 100% due to my consumption of some processed good) my acne did improve but didn't disappear. it got worse when i consumed monster energy drinks or any drinks containing supplemental b-vitamins, so i removed them( it could be a number of things in those! i realize it may not be the vitamins but when i was supplementing them it got worse and didn't improve). I've never been much of meat eater and didn't eat alot of it ever in my life. Now i'm 99% vegan. By removing everything but fruits, veggies, nuts and seeds. and very few processed foods; my skin is the best its ever been in my whole life. i even removed or do my best to avoid fluoride!  I'm going to add some choline to my diet and see if i can get even more improvement, so i thank you for the tip off. i do believe i get enough of b-vitamins through non-grain foods(beans, nuts, seeds) sometimes by adding fortified yeast( yes its gross tasting solo) to my breakfast solution: which is definitely gluten free and someone might see this so i''ll share! 1-2 cups of pumpkin. 1 cup of frozen spinach or kale( suppose you could use fresh but i find it better frozen and quickly zapped in the wave machine)add crushed almonds, pecans, and walnuts, chia seeds, frozen/thawed mixed berries, ground flax, and either honey, maple syrup, brown sugar, or agave syrup( due to pumpkin and fruit being sweet not alot of sweetner if any is actually needed). it is super good and reminds me of hearty cream of wheat, museli type breakfast. its good texture( hides the taste of the greens lol) and a variety of important nutrients and fiber is received! with canned squash, and inexpensive frozen fruit and veggies it is pretty economical to eat every morning as well. expense is the nuts and sweetners but minimal is needed plus the variety in there helps cut costs and widen nutritional profile to make complete amino acid chains!

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    trents
    7 minutes ago, Elizabeth Butler said:

    I've always had severe and strange "acne". After years and countless treatments(some homeopathic, some dermatologist prescribed) that didn't quite "work". I started to suspect Dermatitis Herpetiformis(sorry incorrect spelling in a hurry) or the skin affliction of celiac disease. i got into an argument with my dermatologist who basically said it didn't exist. I had requested to be tested for the condition. He refused, said my acne was hormonal and birth control was my option or the prescribed creams( one of which not ironically was used in treating skin celiac at least on the internet readings). needless to say i left that office and i haven't been back to a dermatologist since. one of the treatments I've seen used with success was b-vitamins that were missing from the diet( pre-gluten free times). I took them and my acne got worse. Thru the years since.. despite being on a gluten free diet ( i suspect not 100% due to my consumption of some processed good) my acne did improve but didn't disappear. it got worse when i consumed monster energy drinks or any drinks containing supplemental b-vitamins, so i removed them( it could be a number of things in those! i realize it may not be the vitamins but when i was supplementing them it got worse and didn't improve). I've never been much of meat eater and didn't eat alot of it ever in my life. Now i'm 99% vegan. By removing everything but fruits, veggies, nuts and seeds. and very few processed foods; my skin is the best its ever been in my whole life. i even removed or do my best to avoid fluoride!  I'm going to add some choline to my diet and see if i can get even more improvement, so i thank you for the tip off. i do believe i get enough of b-vitamins through non-grain foods(beans, nuts, seeds) sometimes by adding fortified yeast( yes its gross tasting solo) to my breakfast solution: which is definitely gluten free and someone might see this so i''ll share! 1-2 cups of pumpkin. 1 cup of frozen spinach or kale( suppose you could use fresh but i find it better frozen and quickly zapped in the wave machine)add crushed almonds, pecans, and walnuts, chia seeds, frozen/thawed mixed berries, ground flax, and either honey, maple syrup, brown sugar, or agave syrup( due to pumpkin and fruit being sweet not alot of sweetner if any is actually needed). it is super good and reminds me of hearty cream of wheat, museli type breakfast. its good texture( hides the taste of the greens lol) and a variety of important nutrients and fiber is received! with canned squash, and inexpensive frozen fruit and veggies it is pretty economical to eat every morning as well. expense is the nuts and sweetners but minimal is needed plus the variety in there helps cut costs and widen nutritional profile to make complete amino acid chains!

    What are you doing to get B12? There are no vegetable sources of B12 apart from some fermented soy bean products I believe.

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    Elizabeth Butler

    yes b-12 has to be "supplemented" however, have you noticed that just about all of them are huge amounts!!???  so I periodically throw some grass fed beef in my mouth.. like once every 6-8 weeks...or eat stew ect. The reason I'm not super concerned about this required vitamin or.. the others Bs is because i truly suspect that the body's bacteria in the gut is actually what "makes b-vitamins" or assists in assimilation in the body( with the naturally ocuring levels in real foods). If they add it back in after processing..because it is "necessary' its because "they" ( dont know exactly who this is but i suspect CMS/AMA) know gluten screws up GI tract and they are trying to make up for the screw up with lots of added b-vitamins. also how do animals get it... from the "foods they eat" processed or wheat, corn, soy  not fit for human consumption( yuck!) ect.. which is why i totally reduced animal consumption as well.. I do not want what they eat! yikes and yuck! I even cook for my dog! and she is doing way better! shes lost weight, more energy and she is 10 plus years old( she gets human grade animal food products). my dog is not a VEGAN LMAO. I recently completed the American Medical Associations class for medical coding. If you can get your hands on a CPT 2021 manual and or an ICD-10 manual. It will blow your mind whats written in there... its the books on how your doctor turns your disease/ treatment plan into a "bill". Also another book(s) that will rock your knowledge socks off are by Jason Fung M.D. excellently crafted science/story tellling ability for average folks.. hes not blasting on the profession, hes not touting any special diets. Hes just explaining what hes seeing in real life and he explains the science too in a way that just about anyone who has graduated high school can make sense of. 

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    trents
    41 minutes ago, Elizabeth Butler said:

    The reason I'm not super concerned about this required vitamin or.. the others Bs is because i truly suspect that the body's bacteria in the gut is actually what "makes b-vitamins" or assists in assimilation in the body( with the naturally ocuring levels in real foods) . . . also how do animals get it... from the "foods they eat" 

    Can you sight any research to support your conviction that our bodies can manufacture B12 from the food we eat?

    It is no secret that animals can manufacture some amino acids and some vitamins and other nutrients that humans cannot. That is why bovines get all the essential amino acids that carnivores must get from meat and why carnivores don't need to consume vegetation to get vitamin C. It's different from humans to animals and from animal to animal.

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    Wheatwacked
    Quote

    Although cobalamin is synthesized by some human gut microbes, it is a precious resource in the gut   Open Original Shared Link

    "[Fortified yeast] contains many B vitamins: One tablespoon of nutritional yeast contains 30–180% of the RDI for B vitamins. When fortified, it is especially rich in thiamine, riboflavin, niacin, vitamin B6 and vitamin B12."    Open Original Shared Link

    We are constantly killing off our benificial bacteria through antibiotics and a diet not really conducive to their health.  Killing off Candida also kills other benificial bacteria. Scott ran an article not too long ago on research into fecal transplant as a cure for some metabolic diseases. It used to be known that most of the lactase we use comes from said bacteria. That's where home fermented pickles come in. Our de novo production is only enough for infants and according to some, that ability is genetically turned off as we mature. The rest depends on our sybiotic relationship with certain bacteria.  Our diet and medications kill them, so we become increasingly lactose intolerant. Sadly, we on the SAD (Dr Fuhrman coined it the MAD diet) are not good hosts.

    8 hours ago, Elizabeth Butler said:

    It will blow your mind whats written in there... its the books on how your doctor turns your disease/ treatment plan into a "bill".

    It is the medical industries equivalent to the car dealerships' warranty administration.

    Nice breakfast.

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    trents

    But the yeast is fortified with B vitamins. What's the difference between that and taking a B12 supplement via tablet?

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  • About Me

    Jefferson Adams

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University. His articles, essays, poems, stories and book reviews have appeared in numerous magazines, journals, and websites, including North American Project, Antioch Review, Caliban, Mississippi Review, Slate, and more. He is the author of more than 2,500 articles on celiac disease. His university coursework includes studies in science, scientific methodology, biology, anatomy, physiology, medicine, logic, and advanced research. He previously devised health and medical content for Colgate, Dove, Pfizer, Sharecare, Walgreens, and more. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of numerous books, including "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

    >VIEW ALL ARTICLES BY JEFFERSON ADAMS

     


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