Sept 14, 2021 — Overall cancer risk is slightly increased in patients older than 40 within their first year of a celiac disease diagnosis, but the risk drops within a year of diagnosis, shows a Swedish study of 47,000 people with celiac disease.
“Celiac disease is associated with an increased risk of types of cancer, and we believe that this is due to the longstanding inflammation that is induced by gluten,” says study author Benjamin Lebwohl, MD, director of clinical research at the Columbia University Celiac Disease Center in New York.
Writing in the journal Clinical Gastroenterology and Hepatology, the authors explain that most studies looking at cancer risk in patients with celiac disease were done before both the widespread use of serologic testing for celiac disease and access to gluten-free food was widely available. Earlier studies linked celiac disease to gastrointestinal malignancies, such as small intestinal adenocarcinoma, and lymphomas.
A prior analysis of this Swedish cohort found that the risk of small intestinal adenocarcinoma, while low, continued for up to 10 years after diagnosis with celiac disease. In the study, which was published in Gastroenterology, the authors found the risks of small-bowel adenocarcinoma and adenomas were significantly increased in people with celiac disease, compared with those without this disease.
“We have known from prior studies that people with celiac disease are at increased risk of developing certain cancers, but there has been limited study of this risk in celiac disease in the 21st century, where there is increased recognition (leading to more prompt diagnosis) and increased access to gluten-free food options (which may allow for more effective treatment),” says Lebwohl, who is also the director of quality improvement in the division of digestive and liver diseases at Columbia University. “We aimed to determine whether there is still an increased risk of cancer in this modern era, and we found that there is still an increased risk, but this increase is small and that it diminishes beyond the first year after the diagnosis of celiac disease. ”
This nationwide cohort study in Sweden included 47,241 patients with celiac disease (62% female; mean age, 24), of which 64% were diagnosed since 2000. Each patient was age and sex matched to up to five controls. After a median follow-up of 11.5 years, a 1.11-fold increased risk of cancer overall was found in patients with celiac disease, compared with controls. The respective incidences of cancer were 6.5 and 5.7 per 1,000 person-years, and most of the excess risk was caused by gastrointestinal and hematologic cancer.
The overall risk of cancer was increased in the first year after celiac disease diagnosis but not afterwards.
“It appears that the increased risk of cancer in people with celiac disease decreased over time, and this may be related to the beneficial effect of the gluten-free diet in the long term,” Lebwohl says.
The authors suggest that cancer risk, followed by a decline to no risk, may alternatively be due to the increased monitoring and medical examinations among patients with celiac disease. So,
symptoms of cancer, such as weight loss, may lead to broad testing that identifies celiac disease, the authors write.
For cancer subtypes, the strongest association between celiac disease and cancer was found for hematologic, lymphoproliferative, and gastrointestinal cancers. Among gastrointestinal cancer subtypes, elevated risks were found for hepatobiliary and pancreatic cancer, but not for gastric or colorectal cancer. The cancer risk in celiac disease decreased in breast and lung cancer, which the authors suggest may be attributed to lower body mass index and smoking rates, respectively, observed in individuals with celiac disease.
Certain Cancer Types Persist After 1 Year
Although there was no overall cancer risk for more than 1 year after celiac disease diagnosis, the risks of hematologic and lymphoproliferative cancers persisted. While the increased risk of gastrointestinal cancers collectively was no longer significant beyond 1 year after celiac disease diagnosis, the risk persisted for hepatobiliary and pancreatic cancer.
“We found that the risk of gastrointestinal cancers is increased in people with celiac disease, compared to the general population, but these risks vary according to the cancer type,” Lebwohl says. “For instance, the risk of pancreatic cancer is increased in people with celiac disease, compared to the general population, while the risk of colon cancer in people with celiac disease is not increased, compared to the general population.
“But pancreatic cancer is far less common than colon cancer. We found that pancreatic cancer occurs in 1 in 5,000 people with celiac disease per year, whereas colorectal cancer occurred in 1 in 1,400 people per year. Taken all together, the risk of any gastrointestinal cancer was around 1 in 700 per year among people with celiac disease,” Lebwohl says.
The overall cancer risk was highest in patients diagnosed with celiac disease after age 60 and was not increased in those diagnosed with celiac disease before age 40. The authors noted that in recent years, there has been a pronounced increase in the diagnosis of celiac disease in People aged over 60, in an age group with a higher risk of developing severe outcomes related to refractory celiac disease. The cancer risk was similar among patients diagnosed with celiac disease before or after 2000.
Since this is an observational study, causality cannot be proven, and the authors suggested that the findings may not be applicable to settings outside of the relatively homogeneous ethnic population of Sweden.
Carol E. Semrad, MD, professor of medicine and director of clinical research in the Celiac Center at the University of Chicago Medicine, says, “This is an observational study and therefore cannot answer whether celiac disease is the cause of cancer or merely an association .” She adds that “it is unknown why the risk for some cancers is higher in celiac disease.
“This paper argues against delayed diagnosis and low detection rate to explain the increase in cancer risk as those diagnosed with celiac disease prior to 2000 had the same cancer risk as those diagnosed after 2000 when diagnostic testing, earlier diagnosis, and access to a gluten- free diets were better,” Semrad says.
Link to Mortality Data
The authors say increased cancer risk being restricted to the first year of diagnosis is consistent with prior celiac disease studies of morbidity and mortality.
A study published in 2019 in United European Gastroenterology looked at mortality risk in 602 patients with celiac disease from Lothian, Scotland, identified between 1979 and 1983 and
followed up from 1970 to 2016. All-cause mortality was 43% higher than in the general population, mainly from hematologic malignancies, and this risk was greatest during the first few years of diagnosis.
An analysis of cause-specific mortality in the Swedish cohort, published in 2020 in JAMA, found that celiac disease was associated with a small but statistically significant increased mortality risk. After a median follow-up of 12.5 years of 49,829 patients with celiac disease, the mortality rate was 9.7 and 8.6 deaths per 1,000 person-years, compared with the general population, respectively. People with celiac disease were at increased risk of death from cancer, cardiovascular disease, and respiratory disease. The overall mortality risk was greatest in the first year after diagnosis with celiac disease, after which the risk decreased with the establishment of the gluten-free diet but remained modestly elevated in the long term.
However, a Finnish population-based study, published in the American Journal of Gastroenterology, found no increase in overall mortality in patients with celiac disease. The study included 12,803 adults diagnosed with celiac disease between 2005 and 2014. Participants were followed for an average of 7.7 years, and mortality from all malignancies, gastrointestinal tract malignancies, or cardiovascular diseases were not increased among patients with celiac disease, compared with the general population. Mortality from lymphoproliferative diseases was increased in patients with celiac disease but was lower than previously reported.
Lebwohl and colleagues note that the incidences of cancer types vary by the age and geographical region of the study population, as does the diagnosis of celiac disease, which may explain why increased risk for cancer or cancer-related mortality in patients with celiac disease has not always been reported.
Ludvigsson coordinates a study on behalf of the Swedish IBD quality register. This study has received funding from Janssen. The remaining authors disclosed no conflicts.
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Guiding the way to thrive
Jan Juc naturopath Rebecca Winkler has always found joy in the practice of cooking nourishing meals for others.
That pastime spilled over into developing recipes and it was during lockdown that her culinary passion led her to become a qualified plant-based chef and a raw dessert chef.
Now the mum-of-two has expertly thrown all of her skills into the mix to achieve a long-held goal of producing a book.
Released as an eBook, with a print version to hopefully follow, 14 Day Whole Food Feast is a comprehensive two-week meal plan designed to nourish the body and delight the tastebuds.
Within its pages are recipes for whole food snacks, lunch and dinner meals, lunchbox ideas, and time-saving tips.
14 Day Whole Food Feast by Rebecca Winkler is available now as an eBook.
“My motivation was both personal and professional,” Rebecca says.
“On a professional note, I found so many patients were having difficulty finding family-friendly, whole food recipes to help them navigate various dietary needs.
“The recipes are easy to follow, a shopping list is provided and time frames are taken into account so slower cooked meals or more time-consuming recipes are saved for weekends.”
Rebecca says the eBook can function purely as a recipe resource or be followed meticulously for a 14-day reset.
“Food prep guidance is given at the start of each week in order to get ahead and be organized as possible.
The eBook includes lunch, dinner and snack ideas, as well as shopping lists and naturopathic advice.
“Dinners are often incorporated into leftovers for lunch the next day and naturopathic guidance is provided around ways to maximize your time by incorporating regular exercise and practicing self-care.”
The idea for the book began to brew in 2019 during a solo trip Rebecca took with colleagues which gave her the space to establish a clear vision for the content she wanted to share.
“I began developing and refining recipe, enlisting a beautiful photographer and graphics team to allow my dream to be realised.
“The long-term plan is to release a number of other eBooks and, eventually, print a hard copy, real-life book to be loved and to splash your chocolate and bolognaise sauce on. The kind of recipe book that you find yourself grabbing time and time again.”
The eBook is filled with nutritious recipes and much more.
So, what are some of Rebecca’s personal favorites featured in her carefully curated eBook?
“Ooh, that’s like trying to choose a favorite child,” she laughs.
“I know it might seem boring, but the slow-cooked bolognaise with hand-made gluten-free fettucine is an absolute favourite.
“We make it weekly in my house and every time my kids exclaim ‘this is the best bolognaise ever’.”
The slow cooked beef pie, kafir lime chicken balls and whole food cranberry bliss balls are also hard to pass up, she says.
Rebecca avoids listing ideal ingredients for people to incorporate into their diet, instead saying the most beneficial ingredients are those that make you feel at your best.
“Not everyone tolerates grains, some don’t tolerate fruit, others have difficulty digesting meat and protein.
“My advice is to listen and take note of how your body feels when you eat.
“Are you bloated, do you have pain in your gut, loose stools, headaches or fatigue?
Rebecca is a qualified naturopath, as well as being a plant-based chef and raw dessert chef.
“I am more inclined to advise people to source good quality ingredients, grow what they can, and cook from scratch as much as time and money allows.
“Eat three meals a day and snack only if you are hungry, growing, pregnant or exercising.
“Try to consume 30-35ml of water per kg of body weight. Add plenty of vegetables, fresh herbs, variety and colour.
“Our gut flora thrives on variety, so mix up your veggies, fruits, grain, legumes and proteins. Eat the rainbow.”
To get the most out of the eBook, the author suggests reading it from cover-to-cover and choosing a 14-day period where you are at home and have minimal social engagements.
Rebecca is passionate about naturopathy which she describes as a holistic, comprehensive view of the body in its entirety and “a wonderful adjunct to Western Medicine for patients as it ensures medical due diligence is exercised, adequate diagnostic testing where appropriate and an individualized approach to restoring health”.
Rebecca’s advice is to “eat the rainbow” when it comes to healthy food choices.
She says many of her clients are seeking ways to regain optimal health following extended periods of lockdown during the pandemic.
“There is no doubt that most of us found ourselves allowing more in alcohol and comfort foods over lockdown, which is nothing to feel ashamed about.
“In such a difficult, confining and overwhelming time, we sought comfort where ever it may lie for us.
“This is not a failure, it was merely a way for so many to cope. I never judge anyone’s choices, I merely try to support, understand and listen.
“Often we already know what we need to do to rebuild or move forward, simply sharing and being heard without shame or judgment is therapeutic.
“I cannot describe to you the genuine joy that seeing people thrive provides.”
14 Day Whole Food Feast retails for $19.95 and on the Rebecca Winkler website. Discover more and contact Rebecca via her Facebook page, Instagram @rebeccawinklernaturopath or email [email protected]
Get to know farro and other superfood whole grains
By Casey Barber, CNN
Quinoa has reached a level of superfood status not seen since the great kale takeover of the aughts. Equally embraced and mocked in pop culture, it’s become the symbol of the grain bowl generation. It’s not the only whole grain that’s worth bringing to the table, however.
The world of whole grains is wide, and if quinoa and brown rice have been the only grains on your plate, it’s time to expand your palate. Here’s an introduction to whole grains, along with tips for cooking and enjoying them.
What’s a whole grain?
The term “whole grains” encompasses all grains and seeds that are, well, whole. They retain all their edible parts: the fiber-rich outer bran layer; the carbohydrate-rich endosperm center, which makes up the bulk of the grain itself; and the inner core, or germ, which is packed with vitamins, protein and healthy fats.
On the other hand, refined grains such as white rice and all-purpose flour have been milled to remove the bran and germ, stripping away much of the fiber, protein and vitamins, and leaving only the starchy endosperm.
“A lot of people don’t realize that whole grains contain several grams of protein in addition to vitamins and antioxidants,” said Nikita Kapur, a registered dietitian nutritionist in New York City. With every serving of whole grains, “you get a ton of minerals, B vitamins and fiber, which is especially important for good health.”
So-called “ancient grains” fall under the umbrella of whole grains, though the phrase is more of a marketing term than a marker of a more nutritious option. Ancient grains refer to whole grains like millet, amaranth, kamut and, yes, quinoa that have been the staple foods of cultures for several hundred years. They are not hybridized or selectively bred varieties of grains, like most modern wheat, rice and corn.
And though quinoa has gotten all the press as a whole grain superfood, there’s good reason to try others. Trying a variety of whole grains isn’t just a way to mix up your same-old side dish routine. It’s also a chance to get a wider portfolio of minerals and more into your diet.
“Suffice to say, we need to have a more diverse plant-based diet” to get the full complement of recommended nutrients in our meals, Kapur said, “and we can’t get it from the same 10 or 20 foods.
“One grain might have more manganese, another more zinc or magnesium, and another more protein,” she added. “Try one as a pasta, one as a porridge — you do you, as long as there’s a variety.”
Familiar foods like oats, corn, brown and other colors of rice, as well as wild rice (which is an aquatic grass), are all considered whole grains, but there are many others you’ll want to add to your regular repertoire.
Some whole grains to get to know
amaranth is a tiny gluten-free grain that can be simmered until soft for a creamy polenta-like dish, but it also makes a deliciously crunchy addition to homemade energy bars or yogurt bowls when it’s been toasted. To toast amaranth seeds, cook over medium heat in a dry pan, shaking frequently until they begin to pop like minuscule popcorn kernels.
Buckwheat is gluten-free and botanically related to rhubarb, but these polygonal seeds (also called groats) don’t taste anything like fruit. You might already be familiar with buckwheat flour, used in pancakes and soba noodles, or Eastern European kasha, which is simply toasted buckwheat.
Faro is the overarching Italian name for three forms of ancient wheat: farro piccolo, or einkorn; farro medio, or emmer; and farro grande, or spelled. The farro you typically find at the store is the emmer variety, and it’s a rustic, pumped-up wheat berry that’s ideal as a grain bowl base. Or make an Italian-inspired creamy Parmesan farro risotto.
Freekeh is a wheat variety that’s harvested when unripe, then roasted for a surprisingly smoky, nutty flavor and chewy texture. Freekeh’s taste is distinctive enough that it steals the spotlight in your meals, so use it in ways that highlight its flavor. It’s fantastic in a vegetarian burrito bowl paired with spicy salsa, or in a warming chicken stew.
kamut is actually the trademarked brand name for an ancient type of wheat called Khorasan, which features large grains, a mild taste and tender texture. It’s a good, neutral substitute for brown rice in a pilaf or as a side dish. Or try this high-protein grain in a salad with bold flavors like arugula, blood orange and walnut.
millet is a gluten-free seed with a cooked texture similar to couscous. Teff is a small variety of millet that’s most frequently used as the flour base for Ethiopian injera flatbread. Try raw millet mixed into batters and doughs for a bit of crunch, like in this millet skillet cornbread recipe, or use either teff or millet cooked in a breakfast porridge.
How to cook any whole grain
While cooking times vary for each grain, there’s one way to cook any whole grain, whether it’s a tiny seed or a large, chewy kernel: Boil the grains like pasta.
Bring a large pot of water to a boil and add a handful of kosher salt. Add the grains and cook, tasting as you go, until tender. Small grains like amaranth and quinoa can cook fully in five to 15 minutes, while larger grains like farro and wild rice can take anywhere from 30 minutes to one hour — so keep an eye on your pot and check it frequently.
Drain well in a mesh strainer (to catch all those small grains) and either use immediately or allow to cool slightly, then refrigerate for later meals. Cooked whole grains can also be portioned, frozen and stored in airtight bags for up to six months.
If you want to cook your whole grains in an Instant Pot or other multicooker, this chart offers grain-to-water ratios for many of the grains mentioned here.
The CNN Wire
™ & © 2021 Cable News Network, Inc., a WarnerMedia Company. All rights reserved.
Casey Barber is a food writer, illustrator and photographer; the author of “Pierogi Love: New Takes on an Old-World Comfort Food” and “Classic Snacks Made from Scratch: 70 Homemade Versions of Your Favorite Brand-Name Treats”; and editor of the website Good. foods Stories.
Travel: A quaint county seat with Mayberry charm | Lifestyles – Travel
I finally ventured out for my first road trip of 2022 earlier this month. It’s been way too long since I took a little trip and it was long overdue. My last little getaway was in Chicago the week of Christmas. The day I returned I wasn’t feeling very well and an at-home test confirmed that I had COVID — again.
The first time was in November 2020 and it was a severe case that landed me in the hospital with pneumonia and difficulty breathing and then many months of recovery. Luckily this time around it just lasted a couple of weeks. At the same time I was pushing through COVID we were in the process of moving. And my Dad, who had tested positive for COVID not long before me, passed away. So, it’s been a heck of a start to 2022. A getaway was much needed.
It was a brief 24 hours in the Indianapolis area, but as always I packed a bit in and had a lot of good food. On our way down we stopped off in Rensselaer for lunch at Fenwick Farms Brewing Co. and took a little walk to check out the murals that are part of the Ren Art Walk. That evening I attended a media opening of the newly reopened Dinosphere exhibit at the Children’s Museum of Indianapolis.
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It’s a place I adore and still enjoy visiting even though my kids are teenagers and young adults now. I love being greeted by the huge Bumblebee character on the way in from what is probably my favorite action move, “The Transformers.” The largest children’s museum in the world has so much to see and I’ve loved having the chance to explore it both with and without my kids.
After the event it was a quick overnight at Staybridge Suites in Plainfield, and in the morning we headed to Danville. Danville is the county seat of Hendricks County. I adore county seats with downtown squares and this is one of my favorites. On an earlier visit there we were in town for the Mayberry in the Midwest festival, which had lots of activities related to the classic TV show “The Andy Griffith Show” that was set in the fictional town of Mayberry.
Danville definitely has that charming, inviting, friendly small town vibe that feels like it could be a sitcom setting. We ate at the Mayberry Cafe where old episodes play on television screens and the menu is full of down-home, made-with-love comfort foods, with a specialty being “Aunt Bee’s Famous Fried Chicken.” I tried it and it was very tasty. The whole place made me smile like Opie after a fishing outing with his dad.
This time our dining destination was The Bread Basket. I had tried their desserts at a few events, but it was my first time dining in. It’s located in a house that was built for the president of Central Normal College in 1914 and is cute and cozy. It’s a breakfast and lunch spot, so plan to go early and be prepared for a wait during peak times (but it’s well worth it).
My Dilly Turkey Sandwich on fresh wheat nut bread with an Orchard Salad was delicious. I loved that they had a combo option where you could pick a half sandwich and half salad or cup of soup. But the desserts are the real star here. I stared at that dessert case for several minutes — and I wasn’t the only one.
I was seated next to it, and watched intently each time they removed a pie or cake from the case to cut a slice. I tried the Hummingbird Cake, which was a perfect treat without being too rich, and then noticed another that was so unique I had to get a slice to take home — the Blackberry Wine Chocolate Cake. If you go there and are overwhelmed with choices, go with this. You won’t regret it.
After lunch, we made our way over to the Hendricks County Historical Museum & Old County Jail, which is just off the square. For someone like me who loves history, this was a wonderful stop to incorporate into our day. It was built in 1866 and used as a jail all the way up until 1974. You can go into the old jail cells (two on the female side and four on the male side) and tour the sheriff’s home.
An exhibit has information and artifacts from when Central Normal College existed (later Canterbury College). There’s also a temporary chronological exhibit about music and musicians, featuring many Hoosier hitmakers.
After the visit, I took a breezy little walk around the square, where I was reminded that there is a nostalgic old movie theater. The historic Danville Royal Theater dates back to the early 1900s and shows current movies for just $5 a ticket.
It was then getting close to dinner time, so we decided to eat before we headed back home. A place in the nearby town of North Salem had been recommend to me and I am so glad we took time to visit. I chatted for a few minutes with Damiano Perillo, owner of Perillo’s Pizzeria. He’s a native of Palermo, the capital of Sicily. The food is authentic and almost all of it is made fresh daily, including their garlic rolls, marinara and alfredo sauces. The New York-style pizzas are perfection.
They even have a nearby garden where they grow many of the fresh vegetables and herbs used in their dishes. They have gluten free pastas, too, and the lady at the next table had some and was raving about it. We also tried the homemade Sicilian cannoli and the limoncello flute, and trust me when I say to definitely not skip dessert.
There was one last food stop. Although we had just eaten, I realized we’d be driving right by Rusted Silo Southern BBQ & Brewhouse in Lizton and just couldn’t pass it up. I made my husband pull in and pick up some food to go. We got the brisket and their house made pimento cheese, chorizo and kielbasa and took it home. I was introduced to it last fall and there is a reason they have been voted Best BBQ in the Indy area four years in a row. I loved hearing about how this eatery located next to a railroad literally stops trains in their tracks to get food from this award-winning BBQ joint.
All three of these places — The Bread Basket, Perillo’s Pizzeria and Rusted Silo are ones that you should absolutely include in your itinerary if you happen to be in the Indianapolis area.
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Guiding the way to thrive
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