High Risk Of Coeliac Disease In Punjabis. Epidemiological Study In The South Asian And European Populations Of Leicestershire
The title of this post, is the same as that of this peer-reviewed paper on PubMed.gov.
This is the abstract of the paper.
The purpose of this study was to measure the incidence of coeliac disease in different ethnic communities and investigate the hypothesis that the incidence is decreasing in most European countries and the role incomplete retrieval of data may play. In a retrospective study of histologically confirmed cases of coeliac disease between 1975 and 1989 in the City of Leicester, 106 patients with coeliac disease were identified. Of these 86 were European and 20 Asian. The overall incidence of coeliac disease in Europeans was 2.5/10(5)/year (95% CI 2-3.2), in Gujaratis 0.9/10(5)/year (95% CI 0.4-1.8), and in Punjabis 6.9 (95% CI 3.2-12.3). These differences were independent of religious belief. The relative risk to Punjabis compared with Europeans is 2.9 (95% CI 1.5-5.3; chi 2 = 12.5, p < 0.01) and to Gujaratis 8.1 (95% CI 3-22.4; chi 2 = 25; p < 0.001). Gujaratis were at 0.4 risk of Europeans (90% CI 0.2-0.8; chi 2 = 6.7; p < 0.01). The incidence in the urban populations of Leicester was 6/10(5)/year (95% CI 1.3-1.9) which was significantly lower than the 3.2/10(5)/year (95% CI 2.7-3.8; chi 2 = 5.6; p < 0.001) in surrounding rural areas. This study shows that the incidence of coeliac disease in Punjabis (Sikhs, Hindus and Muslims) is 8 times higher than in Gujaratis (Hindus and Muslims) and 4 times higher than in Europeans in Leicester.
I find the last sentence in particular very significant.
I’m no medic, but I think it is reasonable to assume, that in a particular community for every diagnosed coeliac, there will be several undiagnosed coeliacs out there.
In this overview of coeliac disease on the NHS web site, this is said about the incidence of coeliac disease.
Coeliac disease is a condition that affects at least 1 in every 100 people in the UK.
But some experts think this may be underestimated because milder cases may go undiagnosed or be misdiagnosed as other digestive conditions, such as irritable bowel syndrome (IBS).
Reported cases of coeliac disease are around 3 times higher in women than men.
The one-in-100 figure is often used in web pages in European countries or Australia, Canada and the United States, so I’ll go along with that.
So does that mean that Punjabis living in Leicester, have a one-in-twenty-five likelihood of being coeliac?
Whether you have been diagnosed though, is a matter of pure luck.
I had been having gut problems for years and then one Autumn, I didn’t see my GP, but a very elderly locum, who as I had recently had my fiftieth birthday, gave me a present of my first blood test.
It turned out my B12 levels were very low and after several months of B12 injections, which made little difference to my B12, my GP decided to send me to a consultant at Addenbrooke’s Hospital in Cambridge.
My appointment was on a Monday morning and consultant took about ten minutes to ask a few questions, after which he said they would take a few bloods.
On the Wednesday morning, I received a letter that said, that I was probably suffering from coeliac disease and this would be confirmed by endoscopy.
Was I diagnosed solely by analysis of my blood? This was in 1997, which is after the date of the Leicester study.
Two endoscopies without sedative or anaesthetic were performed and I was confirmed as coeliac.
The first was performed by Dr. Richard Hardwick and the second by Dr. Rebecca Fitzgerald.
Both doctors feature in this story on the Cambridge University Hospitals web site, which is entitled Familial Gastric Cancer – Case Study.
My problems have been minor compared to the two sisters in the story.
My luck had been good and I recommend that everyone who feels they could be coeliac should get themselves tested.
Cases Of Covid-19 In Leicestershire
This article on the Leicester Mercury is entitled 11 Areas Of Leicestershire Have Among Worst Infection Rates in the UK.
In Coeliac Disease: Can We Avert The Impending Epidemic In India?, I started like this.
The title of this post, is the same as that of this article on the Indian Journal Of Research Medicine.
With the high levels of COVID-19 in Leicester and an Indian population who make up 28.3 % of the population of the city, I was searching the internet to see if there was any connection between those of Indian heritage and coeliac disease.
I know you should not try to prove a theory. But as a coeliac, I’m very interested to see how the millions of diagnosed coeliacs on a gluten-free diet like me, are faring in this pandemic.
I then talk about some extracts from the Indian research.
In a section entitled, which is entitled All Wheats Are Not Equal, I say this.
The other dimension to this problem is that not all wheat is alike when it comes to inducing celiac disease. The ancient or diploid wheats (e.g. Triticum monococcum) are poorly antigenic, while the modern hexaploid wheats e.g. Triticum aestivum) have highly antigenic glutens, more capable of inducing celiac disease in India, for centuries, grew diploid and later tetraploid wheat which is less antigenic, while hexaploid wheat used in making bread is recently introduced. Thus a change back to older varieties of wheat may have public health consequences.
So did all these factors come together to create the high levels of Covid-19 in Leicestershire?
Conclusion
I am getting bored with saying this. More research needs to be done!
Why Do More Elderly Men Die Of The Covids Than Women?
I asked this question of the Internet and found this article from The Times, which is entitled Why Are Men more Likely To Die From Covid Than Women?.
These are the first two paragraphs.
On Valentine’s Day last year, researchers at China’s Centre for Disease Control and Prevention submitted one of the first studies into who was dying of the new coronavirus that was spreading through Wuhan.
Two clear findings jumped out. Firstly, the virus appeared to hit the elderly hardest. Secondly, if you were a man, you were much more likely to die.
The article goes on to say, that men are 24 percent more likely to die.
I am coeliac and here are some facts about coeliac disease.
This page on the NHS web site is an overview of coeliac disease.
There is a sub-section called Who’s Affected?, where this is said.
Coeliac disease is a condition that affects at least 1 in every 100 people in the UK.
But some experts think this may be underestimated because milder cases may go undiagnosed or be misdiagnosed as other digestive conditions, such as irritable bowel syndrome (IBS).
Reported cases of coeliac disease are around 3 times higher in women than men.
It can develop at any age, although symptoms are most likely to develop:
during early childhood – between 8 and 12 months old, although it may take several years before a correct diagnosis is made
in later adulthood – between 40 and 60 years of age
People with certain conditions, including type 1 diabetes, autoimmune thyroid disease, Down’s syndrome and Turner syndrome, have an increased risk of getting coeliac disease.First-degree relatives (parents, brothers, sisters and children) of people with coeliac disease are also at increased risk of developing the condition.
The three most important facts in this are.
- The condition affects 1 in every 100 people in the UK.
- Reported cases are three times higher in women than men.
- First degree relatives of coeliacs are at increased risk of developing the condition.
I am sure my father was an undiagnosed coeliac.
When I was born in 1947, there was no test for coeliac disease in children, as one wasn’t developed until 1960.
Testing for many years was by the Gold Standard of endoscopy, which for a child is not an easy procedure.
I’m certain, that in 1997, I was one of the first to be diagnosed in a General Hospital by genetic testing.
At fifty, a locum had given me a blood test and I had been found to be very low on B12. Despite a course of injections, it refused to rise so I was sent to Addenbrooke’s Hospital, where I saw a consultant, who gave me a short chat and then got a nurse to take some blood samples.
Two days later, I received a letter, saying I was probably coeliac and it would be confirmed by endoscopy.
I can’t think how else it was done so quickly, unless they were using a genetic test.
I went gluten-free and the rest as they say is history.
In some ways there’s been two of me.
- BC – Before Coeliac – Frequently unwell, lots of aches and pains and weak mentally.
- AD – After Diagnosis – Healthier, few aches and pains and much stronger mentally.
My immune system appears to be much stronger now!
I believe my son was also coeliac.
Undiagnosed coeliacs tend to have poor immune systems and he died of pancreatic cancer at just 37, because he refused to get himself tested.
As there was no test for coeliac disease in children until 1960, anybody over sixty has a higher chance of being coeliac with a poor immune system and be at higher risks from both the covids and cancer.
It should be noted that according to the NHS, there are three times more female coeliacs than male.
Could this be explained by the fact that undiagnosed coeliac disease can be a cause of female infertility? So when a lady has difficulty conceiving, doctors test for it. So perhaps, by the time they get to 70 a higher proportion of female coeliacs have been diagnosed, compared to male ones, which may explain why more elderly men than women die of the covids.
More research needs to be done.
Goodbye To My Gallstones
It is now some weeks since I said goodbye to my gallstones.
They were in my bile duct and were discovered by using an ultrasound probe on an endoscopy at Homerton Hospital. I didn’t even put on a hospital gown.
I had that endoscopy, as I did my two previous ones at Addenbrooke’s Hospital in Cambridge to check for coeliac disease without a sedative, as Addenbrooke’s likes to be efficient and cutting out sedatives reduces the manpower required, cuts the need for recovery beds and allows patients to drive home.
After this endoscopy, I came home the way I arrived – on the bus!
I would say that a good endoscopy operator should be able to do the procedure without a sedative. Although in this case, the nurse holding the oxygen tubes up my nose, was stroking my beard to calm me down. Not that I needed it! But it was a nice action!
I had the removal of the gallstones with a sedative, but I only remember the anaesthetist saying something like “Lovely” as he threaded the camera and attachments down my throat.
They broke into my bile duct from the duodenum and then inserted a balloon, which was then inflated to flush the stones back into my duodenum.
I must have dropped off and I woke without any pain or even discomfort.
One complication for me, was that I am on Warfarin, but I dropped my INR to one before the operation, so that there wasn’t blood everywhere.
I have had some after effects.
Where Has My Constipation Gone?
Since I was about sixty, I have suffered from constipation and my GP has prescribed a laxative.
I felt it was a family trait as my father was also a sufferer.
But since the operation, I have only taken one pill, that may not have been necessary.
My Appetite Has Returned
I am certainly eating better and I have not put on any weight.
Conclusion
If you have gallstones and removal is suggested, go for it!
Prioritising Patients
Homerton hospital is hoping to remove my gallstones on Thursday by endoscopy, so it’s just a fairly small procedure.
I do wonder if there is a shortage of nurses, doctors and other staff at the hospital caused by either the Covids or the fuel crisis, if some operations will be cancelled.
At no time, in the diagnostic process was I asked if I was in pain. Which I am not!
Surely, in the Age of Covid-19, where there is great uncertainty about predicting hospital capacity just a few weeks in the future, I should have been asked a few questions, so that urgent cases could be given priority if necessary.
As they must have been there for a few months causing me no trouble, surely a few extra weeks won’t make much difference to me.
The Diagnosis Of My Gallstones
I arrived at Homerton hospital as instructed today for the endoscopy.
Strangely, it was C’s birthday.
The procedure would involve passing an ultrasound probe down my throat and through my stomach to take an ultrasound image of the lump close to my liver.
I’d had two endoscopies before in the late 1990s at Addenbrookes to check for coeliac disease. One was a normal one, but in the second, I was also providing a sample of fluid for a research project at Cambridge University.
I seem to remember at Addenbrookes, I had been instructed to turn up in something like a tee-shirt and shorts, which is what I did. In this case, I took my shirt off and put a hospital gown over my cord trousers.
As I’d had the two endoscopies at Addenbrookes without a sedative, I suggested strongly, that they do the investigation without one this time as well.
The doctor, who was of an age to be very experienced, said he was up for it and we went for it without a sedative.
There was two big differences to the procedure at Addenbrookes.
- There were more staff, than Addenbrooke’s doctor and a technician.
- They were fully gowned up, as opposed to normal clothes.
But, then I got the expression at Addenbrooke’s they were aiming for speed and they were only confirming their earlier diagnosis of coeliac disease. that had been made by a genetic test.
Everything this time, went without a hitch.
- I was laying on my left side.
- I had oxygen tubes up my nose.
- With my right hand I can feel the probe in my stomach.
- To calm me down, a nurse was stroking my beard.
After not a long time, everything was done and I was walked back to recovery area.
Within half an hour, I was informed by the second doctor, that I had got gallstones and they would be taken out by endoscopy on September the 30th. Later they will take out my gall bladder by surgery.
I got the impression, it was the first time, that he’d seen this procedure without a sedative, as he described me as the Star-Of-The-Day. But then I’m a London Mongrel, with more survival genes than a garden full of Japanese knotweed.
I went home the way I came – On the bus!
After Effects
The only after effects were that the air in the theatre had dried me out and my left left arm hurt because I’d been lying on it.
So I vowed to drink a lot of fluids before the operation and do something to improve the strength of my damaged left arm.
A Lump Near My Liver
In A Mysterious Attack On My Body, I explained how I ended up in the Royal London hospital after my hand stopped working, probably due to an infection.
A couple of weeks afterwards my GP called me in to the surgery and repeated the blood tests on my liver, as the first taken in the hospital, weren’t quite what they should be!
These blood tests didn’t show the improvement they should have done, so I went to Homerton Hospital for an ultrasound on my liver.
This didn’t satisfy the GP, so he arranged for a CT-Scan at Homerton hospital.
After the scan, but before the results were known I saw a consultant, who told me about the lump.
He said it could be benign or something nasty and hopefully after he reviews the CT-Scan next week, we’ll know.
He said an endoscopy will probably sort out what it is!
The weird thing, is that, I’m not in any pain.
Except that is, for the lower back pain, I’ve had since I was about twenty.
As I can never sit comfortably in a car and my mother told me, my spine turns the wrong way, that probably explains that.
When I’m working at the computer, about every half-hour, I lie flat on my back on the floor and that seems to sort it.
Why did I get such an odd body?
Any advice gratefully accepted.
Should The NHS Adopt A Whack-A-Coeliac Policy?
The Wikipedia entry for Whac-a-Mole, says this about the colloquial use of the name of an arcade game.
In late June 2020, Boris Johnson based the UK’s COVID-19 strategy on the game.
Because of the high number of diagnosed coeliacs in the Cambridge area, I believe that I was diagnosed to be coeliac, by possible use of a Whack-a-Coeliac policy at Addenbrookes Hospital in Cambridge, in the last years of the Twentieth Century.
- I was suffering from low B12 levels and my GP sent me to the hospital to see a consultant.
- It was only a quick visit and all I remember, is the speed with which the nurse took my blood.
- A couple of days later, I received a letter from the hospital, saying it was likely I was a coeliac and it would be confirmed by an endoscopy.
- A point to note, is that I had my endoscopy with just a throat spray and this must have increased the efficiency and throughput and reduced the cost of the procedure.
The only way, I could have been diagnosed so quickly would have been through an analysis of my genes and blood. But I was never told, what method was used.
I have a few further thoughts.
My Health Since Diagnosis
It has undoubtedly improved.
Cancer And Diagnosed Coeliacs On A Gluten-Free Diet
Joe West of Nottingham University has shown, that diagnosed coeliacs on a gluten-free diet have a 25% lower risk of cancer compared to the general population.
That is certainly a collateral benefit of being a coeliac. But is it being a coeliac or the diet?
I’m no medic, but could the reason be, that diagnosed coeliacs on a gluten-free diet have a strong immune system?
Coeliac Disease Is A Many-Headed Hydra
I have heard a doctor describe coeliac disease or gluten-sensitivity as a many-headed hydra, as it can turn up in so many other illnesses.
Type “coeliac disease many-headed hydra” into Google and this article on the NCBI , which is entitled Gluten Sensitivity: A Many Headed Hydra, is the first of many.
This is the sub-title of the article.
Heightened responsiveness to gluten is not confined to the gut
My son; George was an undiagnosed coeliac, who had a poor diet consisting mostly of Subways, cigarettes and high-strength cannabis. He died at just thirty-seven of pancreatic cancer.
Did George have a poor immune system, which was useless at fighting the cancer?
Undiagnosed Coeliac Disease In The Over-Sixty-Fives
In A Thought On Deaths Of The Elderly From Covid-19, I used data from Age UK and Coeliac UK to estimate the number of coeliacs in the UK over the age of sixty-five. I said this.
Age UK has a figure of twelve million who are over 65 in the UK. If 1-in-100 in the UK are coeliac, that is 120,000 coeliacs over 65.
But some research shows that the number of coeliacs can be as high as 1-in-50.
If that 120,000 were all diagnosed, I would have several coeliacs amongst my over-65 friends. I have just one and she is self-diagnosed.
Are all these undiagnosed coeliacs out there, easy targets for diseases like cancer and COVID-19?
The Ease Of Testing For Coeliac Disease
I was worried that my granddaughter was coeliac and I asked my GP, how difficult a test is to perform.
He said, that a genetic test is usually quick and correct and only a few borderline cases need to be referred to a consultant.
Diagnosis has moved on a lot in twenty years.
Cambridge, Oxford and Covid-19
Six weeks ago I wrote Oxford And Cambridge Compared On COVID-19, to try to find out why the number of Covid-19 cases are so much lower in Cambridge than Oxford.
Checking today, the rate of lab-confirmed cases of COVID-19 per 100,000 residents is as follows.
- Cambridge 336.6
- Oxford 449
So why the difference?
In the related post, this was my explanation.
Is the large number of diagnosed coeliacs around Cambridge, the reason the area has a lower COVID-19 rate than Oxford?
It sounds a long shot, but it could be a vindication of a possible Whack-a-Coeliac policy at Addenbrooke’s in the last years of the Twentieth Century.
Conclusion
I think the NHS should seriously look at a Whack-a-Coeliac problem!
- The health of a large number of people would improve.
- There would be less cancer in the UK.
- A better combined National Immune System might help in our fight against the next virus to follow COVID-19.
It would be a very simple testing program, that would be mainly in the hands of the GPs.
Why Does Rebekah Brooks Remind Me of My Endoscopy?
I’ve had two endoscopies to check on my coeliac disease. Neither was any problem and both were done without any sedative at all, as the first doctor explained, this was better in a lot of ways. In both cases I was able to walk out the hospital and drive myself home.
Every time though, I see a picture of Mrs. Brooks, she reminds me of the doctor, who performed the second procedure. It’s the hair mainly, although both are probably about the same height and build. But that’s probably as far as it goes.
I certainly know, who I would prefer to perform an endoscopy.
The Anonymous Widower 