Autoimmune disease rare in Middle East, says new doc in Denver

PaleoPathologist sometimes takes on young docs to help mentor them into Pathology. My newest mentee (is that a real word?) was looking at some slides for tomorrow’s liver disease conference, and one of the cases was autoimmune hepatitis. We see that diagnosis all the time at Porter Adventist Hospital, Transplant center. My new doc asked me, “What is going on here? Where I trained (somewhere in the Middle East; I’ll keep the exact country confidential) we almost never saw any autoimmune diseases or allergies. They are everywhere in the United States!  Is it maybe all the processed foods?”

Interestingly, the middle eastern peoples have been eating wheat probably longer than any other ethnic group. We talked about how my ancestors were eating elk in northern Europe and scrambling for a few berries; PaleoPathologistPapa has Celiac disease! She also commented on how common celiac is here compared to back home in the desert.

You always have to consider a form of bias where you confuse lower or higher incidence of disease with lower or higher ability to diagnose the disease. If autoimmune hepatitis is just as common in two countries, but in one they don’t have the diagnostic testing, it will appear to be rare. As that country develops economically, often the health care system will develop in parallel and diseases will appear to become more common. Are they really more common, or are the docs just better at catching them?

Perhaps I’ll look into incidence of Autoimmune diseases in my “spare time.” When she asked about what she should do for her kids, I suggested that anything in a bag or box is suspect! Little did she know how unwise it could be to ask PaleoPathologist something about nutrition if you don’t have a lot of time.

Any thoughts? I don’t know if it is a diagnosis problem, or a true incidence problem?

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