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Celiac.com 04/16/2024 - The GIP technology has been a boon for our understanding of celiac disease and especially the frequency of inadvertent exposures, and their effects on intestinal recovery. GIP testing is currently in use in virtually all clinical trials for celiac therapeutics to monitor trial subjects and is the subject of dozens of scientific publications. Gluten Detect, the at-home version of the GIP test has allowed people with celiac disease the ability to self-monitor their gluten free dietary compliance to ensure they are not getting exposed to gluten inadvertently, and to provide positive reinforcement for all the work and cost that they are incurring with the gluten free diet. Even with all the impressive benefits that Gluten Detect and the GIP technology in general can provide, when trying to manage a gluten free diet on a planet in which gluten is seemingly everywhere the most important might be its ability to help intestinal recovery. Think about it – before Gluten Detect there was really no good objective way for clinicians to determine if continual intestinal damage was the result of inadvertent gluten exposure, or if there was some other cause. Also, it was difficult to determine how much of an effect a single exposure could have, and what if any additive effects do multiple or frequent exposures have on intestinal recovery. Gluten Detect and the GIP technology is a tool that celiacs can use to help them recover their intestinal absorption capacity. The dangers of persistent villous atrophy (intestinal damage) are highlighted in a recently published article entitled Persistent villous atrophy predicts development of complications and mortality in adult patients with coeliac disease: a multicentre longitudinal cohort study and development of a score to identify high-risk patients. In this study the authors reported finding that "persistent villous atrophy despite a GFD is a common clinical scenario, occurring in roughly one-fifth of patients in a multi-centre retrospective cohort spanning >20 years", and that 80% of the time the cause of this is poor adherence to the gluten free diet. The authors went so far as to state that "poor GFD adherence was the most significant predictor of persistent villous atrophy in all analyses. This is not surprising and confirms that poor GFD adherence is a risk factor for poor outcomes in CD, including increased mortality. This underlines the importance of strictly following a GFD for patients with CD". If not properly treated, celiac disease can lead to a variety of secondary complications including vitamin and mineral deficiencies, osteoporosis, malnutrition, Infertility and miscarriage, lactose intolerance, cancer and various nervous system conditions among others. Ok so we know that the gluten free diet when managed properly, can be effective and can result in intestinal recovery but how do we ensure compliance with the gluten free diet? One of the best papers on this subject was a prospective study published in 2022 investigating the utility of determining urinary gluten immunogenic peptides (u-GIP, the technology in Gluten Detect at home urine test kits) for monitoring adherence to a gluten-free diet and its impact on intestinal damage in patients with celiac disease. The key findings are: At baseline, 25.8% of celiac patients on a GFD for at least 24 months still had intestinal damage (villous atrophy), indicating poor dietary adherence. After only 12 months of follow-up with repeated urinary GIP testing, the percentage with villous atrophy reduced to 12.7%. Urinary GIP detection correlated better with histological improvement than serological tests, symptoms, or dietary adherence questionnaires. Subjects who had at least 4 positive urine GIP test results out of 12 collected during the 12-month period was predictive of persisting villous atrophy with a 93% specificity. In contrast, repeated negative urinary GIP tests after more than 2 follow-up visits correlated with absence of histological lesions in 94% of patients. The authors therefore propose an algorithm (below) which includes checking urinary GIP every 6 months (3 samples over 1 week including weekends) for better monitoring of GFD adherence and mucosal healing in celiac patients. One of the key reasons for those with celiac disease to diligently maintain a gluten free diet is to stop any further intestinal damage and allow the villi in the small intestine to heal, and thereby resume full intestinal absorption of nutrients and minerals. Based on the two studies cited in this article, despite trying to eat gluten free, more than 20% of celiac’s are not reversing their intestinal damage, and 80% of the time that’s a result of still getting exposed to gluten from time to time. Urinary gluten testing done according to the proposed algorithm can objectively monitor for inadvertent exposure to gluten, and if followed, can help increase incidence of mucosal recovery in celiac patients on a GFD compared to other methods. Regular urinary GIP monitoring using Gluten Detect may help improve dietary adherence and histological remission. Gluten Detect is available at on our website and on Amazon. So the next time poop (and other "stuff") happens, be ready for it with Gluten Detect! GlutenDetect for Home Use - Because We Live On A Planet With Gluten. Visit our site for more info. Garzón-Benavides M, Ruiz-Carnicer Á, Segura V, Fombuena B, García-Fernandez F, Sobrino-Rodriguez S, Gómez-Izquierdo L, Montes-Cano MA, Millan-Domínguez R, Del Carmen Rico M, González-Naranjo C, Bozada-García JM, Coronel-Rodríguez C, Espin B, Díaz J, Comino I, Argüelles-Arias F, Cebolla Á, Romero-Gómez M, Rodriguez-Herrera A, Sousa C, Pizarro-Moreno Á. Clinical utility of urinary gluten immunogenic peptides in the follow-up of patients with coeliac disease. Aliment Pharmacol Ther. 2023 May;57(9):993-1003. doi: 10.1111/apt.17417. Epub 2023 Mar 8. PMID: 36890679. Schiepatti A, Maimaris S, Raju SA, et al Persistent villous atrophy predicts development of complications and mortality in adult patients with coeliac disease: a multicentre longitudinal cohort study and development of a score to identify high-risk patients Gut 2023;72:2095-2102.

Celiac.com 04/13/2024 - In recent legal proceedings, a Biden-appointed judge made a significant decision that could impact the way prisoners receive medical care, particularly concerning dietary needs. The case in question, Phoenix v Amonette, shed light on the challenges faced by prisoners with specific medical conditions, such as celiac disease. Judge Toby Heytens, nominated to the Fourth Circuit court of appeals, rendered a decision that overturned a lower court ruling, providing prisoners with an opportunity to prove their claims of constitutional and statutory rights violations. The Phoenix case centers around Daniel Phoenix, a Virginia prisoner suffering from celiac disease, an autoimmune disorder triggered by gluten consumption that can lead to severe digestive issues and other health complications. Despite being diagnosed with celiac disease and receiving medical advice to adhere to a gluten-free diet, Phoenix's condition worsened while in prison. He experienced sharp abdominal pain and even vomited blood, necessitating hospitalization. Following hospital discharge, Phoenix was instructed to follow a strict gluten-free diet. Prison Doctor Discontinued Phoenix's Gluten-Free Diet However, complications arose when the prison doctor discontinued the diet order, citing reports that Phoenix had consumed gluten-containing food from the commissary. This decision persisted despite further medical tests confirming Phoenix's celiac disease diagnosis. Feeling neglected and facing deteriorating health, Phoenix resorted to legal action, accusing the prison and the doctor of disregarding his serious medical needs in violation of constitutional rights. Initially, the lower court ruled against Phoenix, citing missed deadlines and the absence of expert testimony. However, Judge Heytens' recent decision overturned this ruling, emphasizing the need to consider disputed factual issues and the doctor's potential indifference to Phoenix's medical condition. Importantly, Heytens highlighted that expert testimony might not be necessary to contest summary judgment, opening the door for Phoenix to present his case without additional expert witness reports. Lack of Gluten-Free Diets in Prisons is a Worldwide Issue While the legal battle in Phoenix v Amonette unfolds, it raises broader questions about medical care access for prisoners worldwide, especially those with specific dietary requirements like gluten-free diets. The lack of availability or acknowledgment of such specialized diets in prison settings can lead to severe health consequences for affected individuals. This issue is not unique to the United States but extends to prisons globally, highlighting the need for comprehensive policies and practices that prioritize prisoners' medical rights and accommodations. As discussions around prisoner rights and medical care continue, it's crucial to address the challenges faced by individuals like Daniel Phoenix and advocate for systems that ensure equitable access to necessary medical treatments, including specialized diets like gluten-free options. By recognizing and addressing these issues, we can work towards a more just and inclusive approach to healthcare within carceral environments. Read more at: pfaw.org

Celiac.com 12/04/2020 - We get more than a few questions about steak sauce. One question we get a lot is: Is A-1 Steak Sauce gluten-free and safe for people with celiac disease? While A-1 Steak Sauce, now simply called A-1 Sauce, is not labeled gluten-free, it is very likely gluten-free, and safe for people with celiac disease. A-1 is made by Kraft Foods, which openly discloses any potential allergens or gluten containing ingredients on their labels. A-1 Sauce ingredients are naturally gluten-free and include: tomato purée, raisin paste, spirit vinegar, corn syrup, salt, crushed orange purée, dried garlic and onions, spice, celery seed, caramel color, potassium sorbate, and xanthan gum. Since A-1 contains no gluten ingredients, and since distilled spirit vinegar is gluten-free, A-1 sauce can be considered tp be naturally gluten-free, although it does not have "gluten-free" on its label. Some people with celiac disease may not want to include it in their diets because of this. Still, for anyone wanting to play it safe, there are numerous gluten-free steak sauce brands for your enjoyment. List of Gluten-Free Steak Sauce Brands Here's a list gluten-free steak sauce brands.

Celiac.com 04/05/2023 - Over the past few years, the gluten-free food market has grown significantly. However, it is important to question whether these products are actually contributing to balanced diets. A recent study aimed to investigate the nutritional composition of various gluten-free products produced nine years apart. The study also compared the nutritional compositions of 104 gluten-free products currently marketed in Spain with their gluten-containing counterparts. The Researchers The study team included Claudia Mármol-Soler, Silvia Matias, Jonatan Miranda, Idoia Larretxi, María del Pilar Fernández-Gil, María Ángeles Bustamante, Itziar Churruca, Olaia Martínez, and Edurne Simón. They are variously affiliated with the Gluten Analysis Laboratory, Department of Pharmacy and Food Science, University of the Basque Country (UPV/EHU), 01006 Vitoria-Gasteiz, Spain; the GLUTEN3S Research Group, Department of Nutrition and Food Science, University of the Basque Country, 01006 Vitoria-Gasteiz, Spain, the Bioaraba, Nutrición y Seguridad Alimentaria, 01006 Vitoria-Gasteiz, Spain; and the Centro Integral de Atención a Mayores San Prudencio, 01006 Vitoria-Gasteiz, Spain. The Methods Three descriptive and comparative studies were done on gluten-free products. The first study compared the nutritional information panel (NIP) of 104 gluten-free products from 11 specific brands in 2013 against the same products currently available in 2022. The second study made a nutritional comparison between 104 currently available gluten-free products and their analogs with gluten. Both studies recorded NIP data and analyzed nutrient composition. The third study aimed to highlight the impact on nutritional value of a possible gluten-free product inclusion in a celiac diet by comparing a diet that includes gluten-free products and the same diet with gluten foodstuffs. The Findings Their research showed nutritional differences between gluten-free products produced in 2013 and 2022, particularly in the areas of cookies, breakfast cereals, doughs/puff pastries/pizzas, and breads. Additionally, the pasta group had significant decreases in energy, protein, simple carbohydrates, saturated lipids, dietary fiber, and salt. When comparing gluten-free and similar gluten-containing products in 2022, the major differences were found in protein and salt. This indicates that gluten-free products lead to a diet lower in protein and higher in salt and carbohydrates. Although there have been some improvements in the formulation of gluten-free products, the macronutrient profile still varies greatly, and gluten-free products cannot be considered nutritionally equivalent, let alone superior, to their gluten-containing counterparts. Basically, in many cases, the nutritional value of gluten-free products has gone down over the years. Because of this, celiacs need to update our knowledge, and learn more about the nutritional composition of the foods we eat, especially gluten-free products. This will help us to make better choices, and and to better manage our condition. As always, stay informed, choose carefully, and trust your gut. Read more in Foods 2022.

Celiac.com 02/24/2024 - A recent poll conducted by Celiac.com shed light on various aspects of celiac disease knowledge and experiences among respondents. However, one finding stands out starkly: 18% of respondents admitted to cheating on their gluten-free diet. This revelation underscores the critical importance of emphasizing the necessity of strict dietary compliance for individuals with celiac disease. Cheating on a gluten-free diet can have serious consequences, ranging from uncomfortable symptoms to long-term health complications such as intestinal damage, malnutrition, and an increased risk of other autoimmune conditions. In this article, we explore the implications of this poll result and why maintaining a gluten-free diet is paramount for the health and well-being of individuals living with celiac disease. Question 1: Celiac disease is an autoimmune disorder. Celiac.com's poll revealed that 100% of respondents correctly identified this statement as true. This is an essential fact about celiac disease. When individuals with celiac disease consume gluten, their immune system mistakenly attacks the lining of the small intestine, leading to various symptoms and potential long-term complications. The autoimmune nature of the condition underscores the seriousness of adhering to a strict gluten-free diet to manage symptoms and prevent further damage. Question 2: Celiac disease is primarily a genetic condition. While 58% of respondents recognized this statement as true, it's crucial to emphasize that genetics play a significant role in celiac disease. Having certain genetic markers, such as the HLA-DQ2 and HLA-DQ8 genes, increases the likelihood of developing the condition. However, genetics alone do not determine who will develop celiac disease, as environmental factors also play a role. Question 3: Cross-contamination with gluten can trigger symptoms in individuals with celiac disease. Nearly all respondents (98%) correctly identified this statement as true. Cross-contamination occurs when gluten-free foods come into contact with gluten-containing products or surfaces, leading to the inadvertent ingestion of gluten. Even trace amounts of gluten can provoke symptoms in individuals with celiac disease, highlighting the importance of strict dietary adherence and careful food preparation practices. Question 4: What is the name of the protein in wheat that triggers the immune response in celiac disease? The majority of respondents (76%) correctly selected gliadin as the protein in wheat responsible for triggering the immune response in celiac disease. Understanding the specific components of gluten, such as gliadin, is crucial for individuals with celiac disease to effectively identify and avoid gluten-containing foods. Question 5: Celiac disease is more common in people of European descent. A significant majority of respondents (68%) correctly identified this statement as true. While celiac disease can affect individuals of any ethnicity, it is more prevalent among those of European descent. This highlights the importance of considering genetic predisposition when assessing the risk of celiac disease in different populations. Question 6: Dermatitis herpetiformis is a skin manifestation associated with celiac disease. A vast majority of respondents (92%) correctly recognized this statement as true. Dermatitis herpetiformis is a chronic, blistering skin rash that is strongly associated with celiac disease. It is caused by the same immune response to gluten that damages the intestinal lining in individuals with celiac disease. Question 7: What percentage of people with celiac disease may go undiagnosed? 28% of respondents correctly identified 50% as the percentage of people with celiac disease who may go undiagnosed. This statistic sheds light on a concerning reality within the celiac disease community. Despite increased awareness and diagnostic tools, a significant portion of individuals with celiac disease remain undiagnosed. There are several factors contributing to this high rate of underdiagnosis. Firstly, the symptoms of celiac disease can vary widely and overlap with those of other gastrointestinal disorders, making it challenging for healthcare providers to recognize the condition. Additionally, some individuals with celiac disease may experience mild or atypical symptoms, leading them to dismiss their symptoms or attribute them to other causes. Cultural and societal factors may also play a role, as misconceptions about celiac disease and gluten sensitivity persist, leading to delays in seeking medical attention or reluctance to undergo testing. Furthermore, lack of access to healthcare, particularly in underserved communities, can further exacerbate the problem of underdiagnosis. Addressing these barriers to diagnosis and increasing awareness among both healthcare providers and the general public are crucial steps in improving the identification and management of celiac disease. Question 8: Medications can sometimes contain gluten as an inactive ingredient. An overwhelming majority of respondents (96%) correctly identified this statement as true. It's essential for individuals with celiac disease to carefully check the ingredients of medications, as gluten can sometimes be present in inactive ingredients or as a coating on tablets. Question 9: The terms "wheat-free" and "gluten-free" are interchangeable. While 91% of respondents correctly identified this statement as false, it's worth emphasizing the important distinction between "wheat-free" and "gluten-free." While a wheat-free diet excludes wheat and its derivatives, a gluten-free diet eliminates all sources of gluten, including wheat, barley, and rye. Question 10: Which nutrient deficiency is commonly associated with untreated celiac disease? A significant majority of respondents (70%) correctly selected vitamin D deficiency as a common nutritional consequence of untreated celiac disease. Malabsorption of nutrients due to damage to the intestinal lining can lead to deficiencies in various vitamins and minerals, highlighting the importance of proper nutritional management in individuals with celiac disease. Question 11: Celiac disease can affect the neurological system, leading to issues such as gluten ataxia. An overwhelming majority of respondents (96%) correctly identified this statement as true. Neurological manifestations of celiac disease, such as gluten ataxia, underscore the systemic nature of the condition and the potential for diverse symptoms beyond gastrointestinal issues. Question 12: What is the most reliable treatment for celiac disease? An overwhelming majority of respondents (98%) correctly selected a gluten-free diet as the most reliable treatment for celiac disease. Strict adherence to a gluten-free diet is essential for managing symptoms, promoting intestinal healing, and preventing long-term complications associated with celiac disease. Question 13: Celiac disease has been linked to an increased risk of osteoporosis. A vast majority of respondents (90%) correctly identified this statement as true. Malabsorption of calcium and vitamin D, along with chronic inflammation associated with celiac disease, can contribute to decreased bone density and an increased risk of osteoporosis. Question 14: Quinoa is a grain that contains gluten. 86% of respondents correctly identified this statement as false. Quinoa is a gluten-free grain that can be safely consumed by individuals with celiac disease as part of a gluten-free diet. Question 15: What is the medical term for the biopsy procedure used to diagnose celiac disease? The majority of respondents (79%) correctly selected endoscopy as the medical term for the biopsy procedure used to diagnose celiac disease. During an endoscopy, a small tissue sample is taken from the small intestine to assess for characteristic changes associated with celiac disease. Question 16: Do you cheat on your gluten-free diet? This question delves into a significant issue within the celiac disease community: adherence to a gluten-free diet. While 82% of respondents reported not cheating on their gluten-free diet, 18% admitted to doing so. This highlights the challenges that individuals with celiac disease may face in maintaining strict dietary compliance and underscores the need for ongoing education, support, and access to gluten-free resources to help individuals effectively manage their condition and prevent potential health complications. Additionally, it's worth noting the significant advancements in gluten-free food options in recent years. With the increasing awareness of celiac disease and gluten sensitivity, there has been a proliferation of gluten-free products available in grocery stores and online retailers. Moreover, many whole foods are naturally gluten-free, including fruits, vegetables, meats, fish, dairy, and gluten-free grains like quinoa and rice. Restaurants have also responded to the demand for gluten-free options, with many establishments now offering dedicated gluten-free menus or clearly labeling gluten-free choices on their regular menus. With such wide availability of gluten-free alternatives, individuals with celiac disease have more options than ever to enjoy delicious and safe meals without the need to compromise their dietary restrictions. This accessibility underscores the importance of making informed choices and prioritizing health by adhering to a strict gluten-free diet. In 2002 Celiac.com ran a similar poll question where ~42% of people reported cheating regularly on their gluten-free diets, so in comparison to 22 years ago there has been a significant decrease in the number of people who cheat on their gluten-free diets. In conclusion, Celiac.com's latest poll provides valuable insights into the knowledge, experiences, and challenges faced by individuals living with celiac disease. From understanding the autoimmune nature of the condition to recognizing the importance of dietary adherence and vigilance in avoiding gluten, these findings underscore the multifaceted nature of managing celiac disease and the ongoing need for education, support, and advocacy within the celiac disease community.

Celiac.com 02/08/2024 - Living with celiac disease often means navigating a complex landscape of symptoms, dietary restrictions, and the quest for an optimal quality of life. Understanding Patterns Behind Persistent Celiac Symptoms Celiac disease is not a one-size-fits-all condition. A subgroup of adults experiences persistent symptoms, both gastrointestinal and extraintestinal, the origins of which are often elusive. A team of researchers recently conducted an observational study to uncover patterns within this diverse symptom landscape and explore their connections to gluten-free diet adherence, mental health, and quality of life. The research team included Cara Dochat, Niloofar Afari, Rose-Marie Satherley, Shayna Coburn & Julia F. McBeth. They are variously affiliated with San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; the VA San Diego Healthcare System, San Diego, CA, USA; the University of California San Diego, La Jolla, CA, USA; the Department of Psychological Interventions, University of Surrey, Guildford, UK; the Children’s National Health System, Washington, DC, USA; the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; and the Celiac Disease Foundation, Woodland Hills, CA, USA. The Study in Focus Their study included 523 U.S. adults with self-reported, biopsy-confirmed celiac disease. Participants voluntarily completed a set of questionnaires addressing various aspects of their condition: Celiac Symptoms Index (CSI): Capturing physical symptoms and subjective health. Celiac Dietary Adherence Test: Assessing adherence to a gluten-free diet. PROMIS-29, SF-36, and Celiac Disease Quality of Life Survey: Exploring psychiatric symptoms and quality of life. Latent profile analysis identified four distinct symptom profiles: Little to No Symptoms (37%): Individuals in this profile reported excellent subjective health and minimal symptoms. Infrequent Symptoms (33%): Experience relatively moderate symptoms with a focus on extraintestinal symptoms. Occasional Symptoms (24%): Moderate symptoms, particularly gastrointestinal, physical pain, and fair to poor subjective health. Frequent to Constant Symptoms (6%): Enduring significant symptoms and fair to poor subjective health. Beyond Symptoms: The Mental Health and Quality of Life Equation Interestingly, profiles did not significantly differ in terms of clinical characteristics, gluten-free diet adherence, or overall quality of life. However, distinctions emerged in mental health dimensions. Profiles 2 and 3 reported moderate symptomology, with Profile 2 leaning toward more extraintestinal symptoms and Profile 3 showing a dominance of gastrointestinal symptoms, physical pain, and lower subjective health. Profile 3, despite its moderate symptom burden, surprisingly reported the lowest psychiatric symptoms and the highest quality of life on standardized measures. Implications and Future Directions The study’s findings underscore the complexity of celiac disease, emphasizing that a one-size-fits-all approach may not be effective. Notably, even lower symptom burden did not always correlate with better mental health and quality of life, suggesting a need for nuanced behavioral interventions. The lack of profile differences in gluten-free diet adherence implies the necessity for additional dietary or medical assessments and interventions. As we navigate the intricate terrain of celiac disease, personalized and comprehensive care emerges as a key consideration, addressing not only symptoms but also the broader aspects of mental health and overall well-being. Read more in BMC Gastroenterology volume 24, Article number: 9 (2024)

Celiac.com 10/19/2023 - Fibromyalgia is a condition marked by widespread pain and other symptoms. While prior research on dietary treatments for fibromyalgia has provided conflicting results, researchers recently set out to treat fibromyalgia patients with a gluten-free diet, alternated with a non-restricted gluten-containing diet, followed by a re-challenge of the gluten-free diet. The research team included V. Bruzzese; C. Marrese; P. Scolieri; and J. Pepe. They are variously affiliated with the Department of Internal Medicine and Rheumatology, P.O. S. Spirito-Nuovo Regina Margherita Hospital, Rome, Italy; and the Department of Clinical, Internal, Anesthesiological and Cardiovascular Disease, Sapienza University of Rome, Italy. Their study aimed to understand the impact of dietary changes, specifically a gluten-free diet, on fibromyalgia symptoms in post-menopausal women. Study Participants: Non-Celiac Post-Menopausal Women with Fibromyalgia The study looked at twenty post-menopausal women with fibromyalgia. Importantly, none of these women had celiac disease, a known gluten-related condition. The study followed a unique approach. Participants were first put on a gluten-free diet for six months. During this period, their pain levels were measured using the widespread pain index and symptom severity scale scores. The results were promising, with a significant reduction in widespread pain index and symptom severity scale scores. The widespread pain index decreased by approximately 24%, and the symptom severity scale decreased by about 36% after six months of the gluten-free diet. However, what makes this study stand out is the subsequent phases. After six months of gluten-free eating, the participants were placed on a regular diet containing gluten for three months. During this period, their pain levels increased significantly, with a 74% increase in severity scale and a 21% increase in widespread pain index. The most intriguing part is the final phase: a re-challenge of the gluten-free diet. When the participants returned to a gluten-free diet after the three months of consuming gluten, their pain levels improved significantly again. The WPI and SS scores returned to levels similar to the initial gluten-free diet phase, with a 24% decrease in widespread pain index and a 36% decrease in severity scale. Key Findings: Statistically Significant Reduction in both the Widespread Pain Index and Symptom Severity Scale After six months on the gluten-free diet, there was a statistically significant reduction in both the widespread pain index and symptom severity scale, indicating an improvement in fibromyalgia symptoms. When participants reintroduced gluten into their diet, there was a significant increase in their pain scores (both widespread pain index and symptom severity scale). Notably, when they returned to the gluten-free diet after the gluten-containing "re-challenge" phase, there was once again a significant improvement in their pain scores. Body mass index (BMI) remained unchanged throughout the study. The results suggest that a gluten-free diet can indeed help alleviate symptoms of fibromyalgia. This study is significant because it provides evidence that a gluten-free diet can lead to an improvement in fibromyalgia symptoms, as measured by reductions in pain scores. Moreover, the study reinforced these findings through a re-challenge phase, where participants returned to the gluten-free diet after a period of consuming gluten. It's important to emphasize that this study involved post-menopausal women with fibromyalgia who did not have celiac disease. The dietary effects on fibromyalgia symptoms might not be the same for everyone, including celiacs, so further research is needed to understand the underlying mechanisms. Nonetheless, these findings offer hope and a potential dietary strategy for people with fibromyalgia who seek relief from their symptoms. Also, while this research suggests a potential benefit of a gluten-free diet for fibromyalgia patients, individual responses to dietary changes can vary. Therefore, anyone considering dietary interventions for managing fibromyalgia should consult with a healthcare provider or dietitian to create a personalized plan that suits their specific needs and preferences. Additionally, more study is needed to further understand the relationship between diet and fibromyalgia and to confirm these findings in larger and more diverse populations, including people with celiac disease. Read more at Rheumatismo.org

Celiac.com 09/14/2023 - As of 2019, Wimbledon champion Novak Djokovic was crediting a gluten-free diet for on-court success. So what's the story now? Is Novak Djokovic still gluten-free? From what we can learn from his public statements, the answer is yes. But what about celiac disease? Here's what we know. Djokovic is Gluten-Free Back in 2010 Serbian Dr. Igor Cetojevic discovered Djokovic's sensitivity to gluten. Jordaan Sanford, writing in Tennis Magazine, describes the process of Djokovic's gluten sensitivity diagnosis as follows: "Cetojevic asked Djokovic to stretch out his right arm and place his left hand on his stomach. He then applied pressure to Djokovic's right arm by pushing down on it while Djokovic resisted the pressure. The Grand Slam champ's strength was solid, but when asked to hold a loaf of bread in his left hand while he pushed down on his right arm, Djokovic was left in shock. His arm felt significantly weaker." However unscientific that description sounds, it led Djokovic to make massive changes to his diet. That meant eliminating nearly all gluten and dairy, cutting out as much sugar as possible, and sticking to vegetables, beans, white meat, fish, fruit, nuts, seeds, chickpeas, lentils and healthy oils. Djokovic wrote about the importance of his new diet, in his book, Serve To Win. Here's a sample of a single day from Novak's weekly meal and snack list. Djokovic Goes 'Vegan' Djokovic turned to a plant-based gluten-free diet in 2015. In 2016, his commitment to diet led him to open a vegan restaurant in Monaco, ‘Eqvita’. “My diet hasn’t just changed my game, it’s changed my life – my wellbeing," he told reporters at the time. According to Djokovic, the dietary change helped eliminate frequent on-court meltdowns, paving the way for numerous championships and Grand Slam titles. After beating Roger Federer in the final at Wimbledon in 2019, Djokovic talked about his diet in one of his press interviews with US journalist Graham Bensinger. He explained how he doesn’t use the label ‘vegan’ to describe his diet because of the misinterpretation of the word but added that he does eat a plant-based diet and has done for many years. More recently, in an interview with the BBC, the 20-time Grand Slam champion spoke about being a "great student of wellness." Does Djokovic Have Celiac Disease? Djokovic has been coy about his celiac disease status over the years, but he has also indicated that his diet is not 100% gluten-free. If that's true, it's unlikely that Djokovic has celiac disease, as eating gluten would just be too risky at his level of professional competition. If he does occasionally eat gluten, it's more likely that he is simply following a gluten-free diet as part of a fitness and training program. So What's the Verdict? It doesn't seem that Djokovic has clinical celiac disease. If he does, he's not announced it publicly. It does looks like Djokovic is following a plant-based, gluten-free and dairy free diet as both a fitness and wellness choice. With a string of Grand Slam titles under his belt, the results seem to be speaking for themselves.

Celiac.com 08/08/2023 - If you have celiac disease, you've likely encountered various attitudes from people as you try to navigate the world of gluten-free eating and dining. A nationwide survey conducted by The Harris Poll on behalf of Beyond Celiac help to put some detail into the attitudes Americans have toward gluten-free dieters. Those Who eat Gluten-Free are Seeking Attention The poll results indicates that Americans lack understanding and hold misconceptions about celiac disease. The survey, conducted among 2,081 U.S. adults in April 2023, found that 28% of Americans believe that those who eat gluten-free are merely seeking attention. However, for the 3.2 million Americans living with celiac disease, adhering to a strict gluten-free diet is vital to manage this serious autoimmune condition. The survey also highlighted other key misunderstandings about the disease. Only 27% of respondents realized that getting diagnosed with celiac disease is challenging, because many individuals without typical stomach or digestion-related symptoms do not get tested, and are misdiagnosed with other conditions. Only 40% of Americans Aware that Untreated Celiac Disease can Lead Cancer Moreover, only 40% of Americans were aware that if left undiagnosed or untreated, celiac disease can lead to lymphoma, other cancers, additional autoimmune problems, and various life-threatening medical conditions. Another misconception found in the survey was that 43% of Americans thought that attending social events and parties would be difficult for individuals limited to gluten-free food. Beyond Celiac CEO Alice Bast emphasized the importance of increasing awareness about celiac disease. She stated that while celiac disease awareness has improved over the years, there is still work to be done to create a world where people with celiac disease can lead healthy lives without fear of social stigma or gluten exposure. Celiac disease causes damage to the small intestine and results in debilitating symptoms. If left untreated, it can lead to severe long-term health issues such as infertility and certain types of cancer. While research into possible treatments continues, there are currently no medications or cure for celiac disease. Following a strict gluten-free diet that excludes wheat, barley, and rye is the only way for those with celiac disease to manage their condition and live a healthy life. However, it's important to note that even with a gluten-free diet, there may still be health risks associated with the disease. Clearly, more work needs to be done on educating both the celiac patients, and the general public about the facts and risks of living with celiac disease. Read the full report on the survey, including methodology information, at beyondceliac.org

Celiac.com 07/31/2023 - In a recent study, researchers investigated rates of HLA-DQ2 and HLA-DQ8 in women diagnosed with lipedema, a condition characterized by abnormal fat accumulation. The research team included Alexandre C. Amato, Lorena L. Amato, Daniel Benitti, and Juliana L. Amato. They are variously affiliated with the department of Vascular Surgery, Instituto de Medicina Avançada, Sao Paulo, BRA; the department of Endocrinology, Instituto de Medicina Avançada, São Paulo, BRA; the Department of Vascular and Endovascular Surgery, Medical Valens Center, São Paulo, BRA; and the Gynecology department, Instituto de Medicina Avançada, São Paulo, BRA. Women Diagnosed with Lipedema & HLA-DQ2 and HLA-DQ8 Rates For their study, they analyzed the leukocyte histocompatibility antigen (HLA) tests of 95 women diagnosed with lipedema, using non-probabilistic sampling for convenience. They then compared rates of HLA-DQ2 and HLA-DQ8 to the general population. Study Results: Significantly Higher Rates of HLA-DQ2, HLA-DQ8 in Lipedema Patients The results showed that nearly 50% of lipedema patients had HLA-DQ2, while more than one-in-five had HLA-DQ8. Additionally, 61.1% of patients had either HLA-DQ2 or HLA-DQ8 associated with celiac disease, and 7.4% had both HLAs. In contrast, nearly 40% of patients had no HLA associated with celiac disease. Comparing the lipedema patients to the general population, the study found significantly higher rates of HLA-DQ2, HLA-DQ8, and any HLA-associated celiac disease. Moreover, patients with HLA-DQ2+ had lower average weight than the overall study population, and their BMI significantly differed from the overall mean BMI. The findings suggest that lipedema patients seeking medical help are more likely to have HLA-DQ2 and HLA-DQ8. Given the role of gluten in inflammation, this information could be an important step in exploring alternative approaches for managing lipedema, and improving the quality of life for those affected by this condition. The researchers recommend further investigation to understand if eliminating gluten from the diet could potentially improve the management of lipedema symptoms. Read more at cureus.com.

Celiac.com 07/25/2023 - Non-celiac gluten sensitivity is a gluten-related disorder that results from immune-mediated reactions in predisposed people. Non-celiac gluten sensitivity usually manifests with gastrointestinal symptoms. However, in rare cases, it might present with psychiatric symptoms that could be severe enough to impair functioning. We've done a number of articles on the psychological and psychiatric manifestations of celiac disease, which can include, anxiety, depression, and eating disorders. There are also studies linked celiac disease to neurological manifestations, along with schizophrenia. Every so often, we cover a case study that may be relevant to celiac disease, in general. Our latest case involves a 15-year-old Sudanese girl, with no prior psychiatric history, who visited the emergency department due to anxiety, behavioral changes, and hallucinations of her deceased father. Girl Treated for Psychosis and Delusions After witnessing her father's burial, she started experiencing flashbacks and intrusive images of him, along with anxiety about death and paranoia towards others. The patient was agitated and psychotic, requiring rapid tranquilization. She was later diagnosed with hyperthyroidism due to Grave's disease. A team of clinicians, including Olfa Selmi, Banan Khalid, and Saleem Al-Nuaimi, present the girl's case report. They are variously affiliated with the Department of Psychiatry and the Mental Health Service at Hamad Medical Corporation and Hospital in Doha, Qatar. Despite receiving appropriate thyroid medication, her psychiatric symptoms did not improve, leading to further investigations. Blood tests revealed positive anti-transglutaminase IgA antibodies, suggesting possible celiac disease. Psychosis Improves on a Gluten-Free Diet A gastroscopy showed mild duodenal changes, and she began a gluten-free diet. Within weeks of starting the gluten-free diet, the patient's psychotic symptoms improved significantly. Whenever she consumed gluten in large quantities, her delusions resurged, and they subsided again with a return to the gluten-free diet. The case suggests a potential link between gluten and psychosis, although the exact mechanism remains uncertain. Prior case reports also show improvements in psychotic symptoms after adopting a gluten-free diet in patients with gluten allergies or sensitivities. As a gluten-free diet is safe and low-cost, it may be considered as part of the treatment plan for reducing psychotic symptoms in patients with gluten-related disorders or autoimmune diseases. This case adds to the growing literature exploring the role of gluten in atypical psychotic presentations and the potential benefits of a gluten-free diet in such cases. It also highlights the importance of considering nonconventional treatments when standard therapeutic interventions do not yield satisfactory results, as aggressive treatments may carry higher risks. The significant improvement of the girl's psychosis upon starting on a strict gluten-free diet suggests a potential connection between gluten ingestion and psychiatric disorders. However, further research is needed to better understand the relationship between gluten and psychiatric symptoms, and to guide the use of a gluten-free diet in appropriate cases. Read more at Cureus 15(7): e41807.

Celiac.com 06/01/2023 - The rising popularity of gluten-free diets has captured public attention in recent years. With claims of weight loss, improved digestion, and increased energy, many individuals have jumped on the gluten-free bandwagon. However, it's important to base dietary decisions on scientific evidence, rather than mere trends. To shed some scientific light on the subject, a team of researchers conducted a controlled study to investigate the effects of gluten intake on body weight, body composition, resting energy expenditure, and the changes in nutrient intake caused by gluten-free diets. Study on Effects of Gluten Intake The research team included Hirla Karen Fialho Henriques, Luana Moreira Fonseca, Karine Silva de Andrade, Nitin Shivappa, James R. Hébert, Adaliene Versiani Matos Ferreira & Jacqueline Isaura Alvarez Leite. They are variously affiliated with the Department of Biochemistry and Immunology - ICB, Federal University of Minas Gerais, Belo Horizonte, Brazil; the Department of Nutrition, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil; the Department of Biochemistry and Immunology - ICB, Federal University of Minas Gerais, Belo Horizonte, Brazil; and the Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina, USA. Their study enrolled twenty-three women, who adhered to a gluten-free diet for a duration of six weeks. During this period, the participants were provided with muffins containing either 20 grams of gluten isolate (known as the gluten period) or gluten-free muffins (the gluten-free period) in a crossover, single-blind, non-randomized trial. The researchers assessed the subjects' habitual diet, including gastrointestinal symptoms, food frequency questionnaires, body composition, resting energy expenditure, and recorded daily food intake for the entire six-week duration. The Findings - Increase in Fat and Sodium Intake Surprisingly, the data showed that body weight, body composition, gastrointestinal symptoms, and resting energy expenditure remained similar during both the gluten and gluten-free periods. These results indicate that consuming up to 20 grams of gluten per day does not affect body weight or composition in healthy women without caloric restriction, at least over a relatively short period of three weeks. However, the team saw some concerning changes when the nutrient composition of the gluten-free period was compared to the participants' habitual diet. The gluten-free diet led to an increase in fat and sodium intake, while reducing the intake of fiber, as well as vitamins B1, B6, B12, and folate. This imbalance in nutrient intake resulted in an elevated dietary inflammatory index, indicating a higher inflammatory potential associated with gluten-free diets. These findings highlight the importance of considering the overall nutritional quality of a diet, rather than focusing solely on the absence of gluten. While a gluten-free diet may be necessary for individuals with specific medical conditions, such as celiac disease, the results suggest that adopting a gluten-free diet without medical necessity may have adverse effects on nutrient intake and potentially contribute to inflammation. The study offers some potentially valuable insights into the impact of gluten intake and gluten-free diets on health, especially with regards to nutrient intake, but it's important to note that it has certain limitations. The small sample size and the short duration of the trial invite further research with larger populations and longer intervention periods, to validate and expand upon these findings. Additionally, the study focused solely on healthy women, so the results may not be generalizable to other populations, or those with specific health conditions. It's also important to note that following a gluten-free diet can lead to imbalances in nutrient intake, particularly a reduction in fiber and essential vitamins, and an increase in dietary inflammation potential, even in non-celiacs. As with any dietary decision, it's best to consult with a healthcare professional or registered dietitian to ensure a well-rounded and nutritionally adequate diet that suits individual needs. Read more in the J Am Nutr Assoc. 2022 Nov-Dec;41(8):771-779.

Celiac.com 04/21/2023 - If you're trying to lose weight, you might want to think about the amount of gluten in your diet. A study from 2015 found that wheat gluten intake can contribute to weight gain and fat accumulation, at least in mice. The study sheds some light on the relationship between gluten and weight gain by investigating the effects of gluten intake on weight gain, fat metabolism, and energy expenditure in mice. The Study For the study, researchers fed mice different diets for eight weeks. The diets included a control-standard diet, a standard diet with added wheat gluten, a high-fat diet, and a high-fat diet with added wheat gluten. Mice that had wheat gluten added to their diets gained more weight, and had more fat deposits, despite having the same energy intake as mice in the control group. The Findings Tests also found gluten in the blood, liver, and visceral adipose tissue, suggesting that it can reach organs beyond the intestinal tract. The study found that gluten intake reduced thermogenesis-related protein expression in subcutaneous and brown adipose tissues and lowered oxygen volume consumption, which points to reduced energy expenditure. Mice on a high-fat diet with added gluten also had lower levels of adiponectin, peroxisome proliferator-activated receptor (PPAR)-α and PPARγ, and hormone-sensitive lipase in cultures of isolated adipocytes. By contrast, in mice on a standard diet, added gluten intake increased interleukin-6 expression, and tended to increase tumor necrosis factor expression. This suggests that gluten may have different effects on fat metabolism and inflammation, depending on the diet. Conclusions: Wheat Gluten Intake Can Lead to Increased Weight Gain and Fat Deposits Overall, the study suggests that wheat gluten intake can lead to increased weight gain and fat deposits, along with reduced thermogenesis and energy expenditure, especially in mice on a high-fat diet. The study also highlights the potential systemic effects of gluten, which can reach organs beyond the intestine. While the study was conducted in mice, the findings suggest that gluten may play a role in human weight gain as well. While more research is needed to better assess any connection between these findings and gluten consumption in humans, the study does offer some interesting food for thought. Stay tune for more on this and related stories. Read more at Int J Obes (Lond)

Celiac.com 04/03/2023 - People with celiac disease must follow a gluten-free diet for their entire lives in order to stay healthy. But, gluten-free foods are traditionally high in salt, sugar and fat, among other things. So, what's the impact of a gluten-free diet on the nutritional levels of people with celiac disease? A team of researchers recently looked at studies of adults and children with celiac disease who followed a gluten-free diet, to see if they were getting the proper nutrients in their diets. The Research Team The research team included Monica Gessaroli, Leonardo Frazzoni, Usama Sikandar, Gabriele Bronzetti, Andrea Pession, Rocco Maurizio Zagari, Lorenzo Fuccio & Maria Luisa Forchielli. They are variously affiliated with theDepartment of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; the IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; the Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; and the Health Sciences and Technologies Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy. The Gluten-Free Diet Nutritional Study The researchers searched through several databases for studies, conducted through October 2022, that looked at the nutrient intake of celiacs who followed a gluten-free diet. They used statistics to combine the results from different studies and see if there were any patterns. They found thirty-eight studies covering a total of 2,114 patients. On average, people with celiac disease on a gluten-free diet consumed 1,995 calories per day. Almost half of these calories came from carbohydrates, 16% from proteins, and 36% from fats. Teenagers consumed the most fats, while adults did not get enough dietary fiber. Calcium, magnesium, and iron intake was particularly low in teenagers, while vitamin D intake was low for all age groups. Conclusion In conclusion, people with celiac disease who follow a gluten-free diet may not get enough essential nutrients, and may consume too much fat. Since a gluten-free diet is a lifelong treatment, it is important to regularly check on people's nutrient intake to prevent other health problems, and to take supplements if needed. That means that people with celiac disease should work with their doctors to create a plan for monitoring their nutrition over time. Read more in European Journal of Clinical Nutrition

Celiac.com 03/15/2023 - A recent study by Indiana University School of Medicine's Jonathan Montrose, DO, found that only one out of 36 patients with both celiac disease and inflammatory bowel disease (IBD) adhered to a gluten-free diet long-term. That's less than 3% of those patients following a gluten-free diet. According to Montrose, the lack of formal education on gluten-free diets is a factor, as only six of the 36 patients had received dietary education from a celiac dietitian. The majority of patients in the study were white women, and 50% of patients required escalation of IBD medication despite adhering to a gluten-free diet. "Overall, our study showed that there was suboptimal adherence to gluten-free diets." Montrose and his colleagues suggested that the establishment of celiac disease centers at tertiary hospitals could be one way to address the lack of formal gluten-free diet education. Montrose and colleagues suggest establishing celiac disease centers at tertiary hospitals to provide adequate clinical guidance. Perseus Patel, MD, of the University of California San Francisco, agreed that getting adults to stick to a gluten-free diet is challenging and that more education is needed in this area. He noted that "If you go out to eat, you often don't have many choices, so it is not always the easiest thing to do." The fact that only 3% of patients in the study followed a gluten-free diet long-term is concerning because it suggests that many patients with celiac disease and IBD may not be getting the optimal treatment they need. Furthermore, the study found that 50% of patients required escalation of IBD medication despite adhering to a gluten-free diet, indicating that there may be other factors contributing to the management of these conditions. The recommendation to establish celiac disease centers at tertiary hospitals is a practical solution that could improve patient outcomes by providing adequate clinical guidance and support. In conclusion, this study highlights the challenges of managing celiac disease and IBD, particularly in terms of adherence to a gluten-free diet. Healthcare professionals need to be more proactive in educating patients about the importance of a gluten-free diet. There's also a need for more resources and support for patients with these conditions. The establishment of celiac disease centers could be an effective way to address this issue and improve patient outcomes. Read more at: Metpagetoday.com

Celiac.com 03/18/2023 - It can be very confusing to person newly diagnosed with gluten intolerance to sort through all the information that abounds about celiac disease and the gluten-free diet. The information is inconsistent—support groups are not saying the same things— why is there a difference? No wonder celiacs are confused. Fundamentally, all the national support groups in the U.S. have missions that are similar—to serve and support persons with gluten intolerance. The five national groups: Celiac Disease Foundation (CDF), Gluten Intolerance Group® (GIG®), Raising Our Celiac Kids (R.O.C.K.), Celiac Sprue Association, Inc. (CSA/USA), and American Celiac Society all list this as their primary objective. So, what is the difference between them? Very little. All five have a network of support groups throughout the country—Chapters, Connections, and Partners. All provide local and national literature and support. All are 501c3 nonprofit organizations. Some groups are larger than others, but size alone does not determine the quality or value of the work that each does. Unfortunately, there will always be disagreements between similar organizations, and what constitutes a gluten-free diet seems to be where U.S. national groups disagree. Three groups follow the American Dietetic Association gluten-free guidelines, while the others do not. The controversy surrounding the gluten-free diet began about 25- 30 years ago when the first gluten intolerance support groups began to form. At that time medical experts on celiac disease and the gluten-free diet were few and far between, and support groups were forced to develop their own gluten-free dietary guidelines. Some of the recommendations were based on the meager scientific information available at that time, and other recommendations were based on speculation, assumption, antidotal evidence or hearsay. Over the years the field of nutrition has seen fad diets come and go. If a disease treatment includes a diet, the thinking has often been ‘if some restriction is good, more is better.’ There have been some very restrictive diets developed over the years that most people fail to maintain. One example of this is the dramatic change in recommendations for the diabetic diet. Somewhere along the way, the gluten-free diet became one of those diets where it got more and more restrictive— without sound scientific evidence and reasoning for it. In the last ten years, medical professionals—researchers, medical practitioners, dietitians and pharmacists have become more interested in and aware of celiac disease. Research data collected during this time has changed the face of celiac disease and the gluten-free diet. Health care professionals have developed expertise in all areas related to gluten intolerance diseases. Some dietitian experts now spend their time working solely in the area of gluten intolerance. These people have the ability to make sound recommendations about the diagnosis, care and treatment of celiac patients, including recommendations about the gluten-free diet. Several years ago dietitians with expertise in gluten intolerance and the gluten-free diet began scrutinizing the original diet recommendations, and investigating the rationale and science behind those recommendations. They soon began to question the validity of the original recommendations. Their exhaustive research has helped to reshape the gluten-free diet into what became the revised 2000 American Dietetic Association Gluten-Free Diet recommendations. These dietary revisions were the result of joint work and partnerships among many researchers in the U.S. and Canada whose work has modernized the gluten-free diet. The gluten-free diet has changed over the years, just as nearly every aspect of what we know about celiac disease has changed. Do today’s support groups still have the role of dictating what the gluten-free diet is—even when experts in the field have made new recommendations? As more and more celiac centers are created, support groups are finding that their roles are also changing. They no longer have to make decisions about what constitutes a gluten-free diet, but instead only have to disseminate information that has been prepared by experts. Change is difficult, but resistance to change can cause confusion, discontentment, lack of respect for support groups and professionals, anger and sometimes—outright hostility. Some have questioned the American Dietetic Association’s gluten-free dietary recommendations, and have suggested that their science was weak or flawed. In response to this, and in response to the outcry by support group members and the medical community for a single, standard gluten-free diet, the National Gluten-Free Diet Project (NGFDP) has been created. The NGFDP will be the work of dietitians in Dietitians in Gluten Intolerance Diseases (DIGID) and a multi-disciplinary professional team. The final product will address areas of controversy and make recommendations based on sound science and well-documented research. Research information will be evaluated according to standards used for rating all research in the medical community. Will the NGFDP end the controversy? Not if people are not willing to accept science, but it will clearly provide a diet accepted by celiac professionals. To facilitate an agreement for the diet all national support groups will be invited to have input into the process. DIGID dietitians are a highly energetic group of dietitians with expertise in the glutenfree diet. Soon they will have a published referral list for support group members, a speaker’s bureau and other exciting products and information.

Celiac.com 01/25/2023 - Studies that have tried to measure the effects of a gluten-free diet on the clinical, biochemical and psychological condition of youths with both type 1 diabetes and celiac disease have delivered mixed results. A team of researchers recently set out to evaluate the impact of gluten-free diet on growth, metabolic control and quality of life in children and adolescents with type 1 diabetes and celiac disease. The research team included Enza Mozzillo, Roberto Franceschi, Francesca Di Candia, Francesco Maria Rosanio, Letizia Leonardi, Ludovica Fedi, Valentina Rosà, Vittoria Cauvin, Adriana Franzese, and M. Loredana Marcovecchio. They are variously affiliated with theDepartment of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy; the Department of Pediatrics, S. Chiara Hospital in Trento, Italy; the Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital inTrento, Italy; and the Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. The team first performed a systematic search of studies published in the last 15 years. They used PICOS framework to inform the selection process, and assessed evidence using the GRADE system. Their systematic review included only studies of moderate-high evidence quality level and reporting data on objectively assessed adherence to a gluten-free diet. Their findings highlight pre-adult adherence to a gluten-free diet in youth with type 1 diabetes and celiac disease leads to regular growth, stable BMI, without any negative effect on HbA1c and insulin requirements. Their main finding was that patients who followed a gluten-free diet experienced regular growth without any adverse increase in BMI. Moreover, the gluten-free diet does not negatively affect HbA1c and insulin, but is associated with higher post-meal glucose levels. Evidence from several studies indicate that a gluten-free diet is associated with better lipid profile and major quality of life and the psychological condition of juveniles with both type 1 diabetes and celiac disease. This study offers strong evidence that a gluten-free diet offers major benefits to juveniles with both type 1 diabetes and celiac disease. Read more at Diabetes Research and Clinical Practice.

Celiac.com 01/06/2023 - Non-responsive celiac disease (NRCD) affects up to 15% of children with celiac disease. A Gluten Contamination Elimination Diet (GCED) is a more stringent diet consisting of fresh, whole, and unprocessed naturally gluten-free foods. A team of researchers recently set out to assess their approach to identifying and treating NRCD with budesonide and the Gluten Contamination Elimination Diet (GCED). Their results were encouraging. Here's what they found. The research team included Awab Ali Ibrahim, Victoria Kenyon, Alessio Fasano, and Maureen M Leonard. They are variously affiliated withthe Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA; the Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA; the Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA; the Mucosal Immunology and Biology Research Center, MassGeneral Hospital for Children, Boston, MA; the Celiac Research Program, Harvard Medical School, Boston, MA. NRCD Defined Non-responsive celiac disease is defined as patients having persistent symptoms and enteropathy, with at least Marsh 3 histology, after following a gluten-free diet for at least 12 months. Researchers think that NRCD affects up to 15% of children with celiac disease, but there is limited data, and no research to date, describing treatment of children with this NRCD. Retrospective, Single Center Analysis The team performed a retrospective, single center analysis over a 5-year period of patients with celiac disease 18 years of age and under, who received treatment for persistent symptoms and enteropathy despite following a gluten-free diet. NRCD Patients Respond to GCED and Budesonide The team found a total of 22 patients with NRCD. Of the thirteen patients treated with the GCED for 3 months, nearly half experienced both histological and symptomatic resolution of celiac disease. Of the nine patients were treated with budesonide (6-9 mg), nearly ninety percent experienced both symptomatic and histologic resolution after treatment averaging three months. Further, more than two-thirds of patients who responded to the GCED, and 100% of patients who responded to budesonide, experienced remission of at least 6 months following treatment transition back to a gluten-free diet. Treatment of NRCD with the GCED and budesonide can provide benefit most NRCD patients. Most patients with NRCD can return to a standard gluten-free diet after about three months of treatment. This is some of the most promising treatment information we've seen with regard to NRCD. The article shows that many celiac patients not responding to a gluten-free diet can respond to a more stringent approach. The high response rate to this treatment offers exciting news for patients with NRCD and their physicians. Stay tuned for more on this and related stories. Read more at J Pediatr Gastroenterol Nutr. 2022 Nov 1;75(5):616-622.

Celiac.com 01/02/2023 - There's been a good bit of research to show that a gluten-free diet can reduce symptoms in some patients with irritable bowel syndrome (IBS), but there are currently no good answers for why that might be. To get a better idea for the reasons, a team of researchers recently set out to compare the effects of a gluten-free and gluten-containing diet on IBS symptoms and the gut microenvironment, and to identify predictors of response to the gluten-free diet in IBS. Here's what they found. The research team included Joost P. Algera; Maria K. Magnusson; Lena Öhman; Stine Störsrud; Magnus Simrén; and Hans Törnblom. They are variously affiliated with theDepartment of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; the Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden; and the Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. Randomized Controlled Trial For their randomized controlled trial, the team followed twenty patients with IBS, along with 18 healthy control subjects, all of whom followed a gluten-free diet during two 14-day intervention periods, during which they received meals sprinkled with either gluten, totaling 14 grams a day, or rice flour powder. Main outcomes included effects of the interventions on IBS symptoms and bowel habits. Secondary outcomes included effects of gluten-free diet on fecal microbiota and metabolite profile. IBS symptoms improve on gluten-free diet IBS symptoms improved during the gluten-free diet period, but not the gluten-containing period, with no difference between the interventions. Among other things, IBS patients on a gluten-free diet reported fewer loose stools. Meanwhile, patients with IBS and healthy control subjects showed specific metabolite profiles related to the gluten-free diet. True responders showed a reduction of IBS symptoms of 50 or greater solely after gluten-free period. The team distinguished non-responders based on microbiota and metabolite profiles resulting from the gluten-free diet. Based on the patient's metabolite profile before the intervention, the team was able to predict patient response to a gluten-free diet. Gluten-free diet seems to improve gut health From their findings, the team concludes that a gluten-free diet seems to improve the gut biome, and may help to reduce symptoms in some patients with IBS, especially with respect to bowel habits. Patient metabolite profiles can predict responsiveness to the gluten-free diet. This study is important for people with IBS, as it provides some good data for the benefits of a gluten-free diet in many cases. Read more in Aliment Pharmacol Ther. 2022;56(9):1318-1327

Celiac.com 12/07/2022 - What is the nutritional and health impact of a long-term gluten-free diet on people with celiac disease? A team of researchers recently set out to take a deep look at the influence of a long-term gluten-free diet on nutritional status, body composition, and associated factors in adult Saudi females with celiac diseases. One Year Study of Fifty-one Diagnosed Celiac Patients For their study, the team included fifty-one diagnosed celiac patients who had followed a gluten-free diet for over one year. They collected data on patient dietary patterns, along with a complete analysis of anthropometric parameters, levels of vitamins B12 and D, and complete blood count (CBC). The data show that all patients suffered from an insufficient intake of all micro and macro-nutrients, including vitamin D, folate, calcium, and iron. Otherwise, their bloodwork fell within the expected ranges. While one-third of patients were slim, nearly half showed decreased total body fat, more than half of the patients showed low waist/hip ratios, and more than sixty-percent showed decreased levels of visceral fat. On the whole, patients with poor nutritional status also tended to have poor educational levels and some psychosocial factors that may have influenced their results. However, the team did find that a gluten-free diet in women with celiac disease negatively affects their nutritional intake and anthropometric indices, and leads to a deficiency in major nutrients, vitamins, and ions. Study Conclusions This study confirms other studies that show that gluten-free foods often have poorer nutritional quality than their non-gluten-free counterparts, and that many people with celiac disease suffer from poor nutrition or malnutrition. The results highlight the need for women, but also for all celiacs on a gluten-free diet, to be extra vigilant about making sure to get enough nutrition, fiber and nutrients. Nutrients 2022, 14(10), 2090 The research team included Aeshah Ibrahim Alhosain, Ghedeir M. Alshammari, Barakat Lafi Almoteri, Mohammed A. Mohammed, Manal Abdulaziz Binobead, and Mohammed Abdo Yahya. They are variously affiliated with theDepartment of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University in Riyadh, Saudi Arabia, and the Department of Gastroenterology, Buraidah Central Hospital, Ministry of Health in Buraydah, Saudi Arabia.

Celiac.com 01/19/2021 - Typically, when people with celiac disease eat gluten, they experience gastrointestinal discomfort, or even symptoms like a skin rash, anemia, and headaches. In some extreme cases, though, the side effects could be much, much worse. But, in rare cases, celiac disease can manifest with psychiatric symptoms and behavioral disturbances. Interestingly, celiac disease in children often manifests mainly as behavioral disturbance, such as increased aggression or anxiety, with milder or absent gastrointestinal symptoms. That was the case with a 37-year-old, successful PhD student, from Massachusetts. Woman Begins to Have Delusions The woman began experience severe unexplained hallucinations, paranoia. She became convinced that everyone she knew were conspiring against her, and that friends, family members and even strangers were acting out pre-scripted scenes in some kind of a “game.” Her dissociation from reality became so severe that she alarmed those around her, and they sought to get her help. Doctors Suspect Psychotic Disorder The woman was admitted to a psychiatric hospital, where doctors diagnosed a psychotic disorder, and prescribed powerful antipsychotic drugs in order to control her symptoms. However, the drugs had practically no effect. On follow-up, the doctors found the woman suffered from numerous mineral and vitamin deficiencies, along with thyroid problems. She had also lost a substantial amount of weight. Eventually, they screened her for celiac disease, and discovered that she had it. Doctors Confirm Gluten Causing Woman's Delusions Once the doctors confirmed celiac disease, they advised the woman to avoid gluten, and eat a standard gluten-free diet. However, the woman's delusions had not subsided, and she regarded the doctors as just another part of the conspiracy of people working against her. This belief led her to completely disregarded the gluten-free diet. Sadly, the woman's condition spiraled out of control, and she soon lost her job, her home, and became alienated from her family and friends. After becoming homeless and desperate, the woman unsuccessfully attempted suicide. Fortunately, she was returned to the hospital, where she began to embrace a gluten-free diet. Return to Normal on a Gluten-Free Diet According to Dr. Alessio Fasano, Director of the Center for Celiac Research and Treatment at Massachusetts General Hospital, the woman's condition improved quickly. In no time, she was able to think clearly, and to understand that gluten had been causing her to have serious mental problems. The woman was remorseful, and apologetic for causing so much trouble. Eating Gluten Leads to Murder Attempt The woman began to follow her prescribed diet, but, after accidentally eating gluten, her psychosis returned, and she attempted to kill her parents. Thankfully, she did not succeed, but she was arrested, tried, and sent to prison. The woman's case proves that, in rare cases, celiac disease can cause severe psychotic and other behavioral symptoms. The Link Between Gluten and Psychosis Researchers don't have much good information on the connection between gluten disease and mental disorders. Dr. Fasano suspects a connection lies in the human immune system. When people with celiac disease eat gluten, they typically experience inflammation of the gut. Dr. Fasano believes that, in some cases, such as with the woman in question, gluten-triggered inflammation moves beyond the gut to the brain, which could explain the kind of psychotic delusions experienced by the woman. A better understanding of the connection between gluten and psychosis in such cases could help improve the treatment of celiac disease and gluten sensitivity. Until then, cases such as this are a reminder of just how much we don't know, and how much further we have to go in learning about and treating celiac disease in all its manifestations. Read more at oddee.com and nejm.org

Celiac.com 12/03/2022 - Studies estimate that the number of celiacs who follow a strict gluten-free diet ranges between 30-40%. We receive a number of calls from people with celiac disease who don’t quite follow the gluten-free diet. Others have a hard time understanding why they need to follow the diet when they were asymptomatic to begin with. Then we hear from worried parents, scared that they may have given something to their toddler with celiac disease that caused familiar gluten-reaction symptoms. While some gluten ingestion in people with celiac disease is intentional, others ingest gluten accidentally or cause another to do so. When an individual calls the University of Chicago Celiac Disease Program, we try to assess the reason behind the gluten ingestion, and often find that it is the result of a lack of access to a knowledgeable dietitian at the time of diagnosis (Often, this is found when a caller articulates that they were unaware of problems like cross-contamination, the gluten-content of medications or they needed to ask more questions when eating out at a restaurant). Fortunately, this is a relatively easy problem to remedy. We offer referrals and dietary resources, and will send our care package to those who require it. Others callers choose not to follow the diet, or to allow themselves “rewards” on special occasions or when they feel stressed. We often hear from people who prepare gluten-containing meals for the rest of their family which they cannot resist, or they eat the meal because they are not willing to prepare themselves a gluten-free meal. Some who travel on business do not wish to call attention to their dietary needs in front of their boss or colleagues. Sometimes, all that is required is guidance regarding how to place an order in a restaurant, how to prepare ahead of time for a business breakfast, or meal preparation tips. All of the people who call our program regarding their gluten ingestion, regardless of their circumstance, are motivated by fear. Parents often talk about their fear of poisoning their child. Some adults eat very little due to fear of gluten contamination. While it seems of the utmost importance to establish the medical need for a strict gluten-free diet, psychologists and others would probably agree that human beings are seldom motivated to adopt life-long behaviors out of fear. It seems fair to take a brief look at what we know, and what we don’t know about the need to follow a 100% gluten-free diet, in order to replace fear with knowledge. First, it is important to examine how a research study would be designed to measure the effect of minimal gluten ingestion (i.e., the purposeful or unintentional consumption of gluten) in a group of individuals with celiac disease. In order to test this question, we would need a group of people with celiac disease to knowingly or unknowingly ingest gluten. People with celiac disease who already ingest gluten would not be eligible because they would bias the result. So a randomly selected group of celiacs would be needed to participate in the study. These individuals would need to eat gluten in small amounts and be followed for five, ten or more years. Then, any results would need to be confirmed in other randomly selected groups of celiacs to rule out any effect of disease status, age, gender, geography, dietitian instruction, etc. Here’s the catch—even if it were theoretically possible to obtain a group of people to knowingly participate in studies, the studies would never be approved based on ethical grounds. Hospitals that conduct studies and the physicians who run them are governed by a code of ethics that does not permit a patient to receive a procedure or be exposed to any type of intervention that is known to be harmful to them. So, the question is, how do we determine, in a less direct way, the effect of gluten ingestion in people with celiac disease? Professor Giovanni Corrao and colleagues attempted to address this question through a prospective cohort study which enrolled 1,072 patients between 1962 and 1994. The study was designed to measure important factors that influenced mortality in people with celiac disease and their immediate relatives. The study, published in the Lancet in 2001, found that mortality in people with celiac disease was most significantly affected by diagnostic delay, pattern of presentation, and adherence to the gluten free diet. A delay in diagnosis of more than one year and a severe presentation of celiac disease at diagnosis doubled the observed deaths during the study. Non-adherence to the gluten-free diet, defined as eating gluten once a month or more, increased the relative risk of death six-fold. These factors were highly statistically significant. There are limitations to this study, however, including the fact that people diagnosed in the 1960’s were more likely to present with a severe case of celiac disease, including intestinal lymphoma. Researchers also found that people with mild or symptomless celiac disease had a slightly increased risk of death; it’s also likely that these people were diagnosed later on in the study when more screenings were available, decreasing the length of the delay in diagnosis. Alessandro Ventura and colleagues conducted an important study on the presence of autoimmune disorders in people with celiac disease. Published in 1999 in the journal Gastroenterology, these researchers recruited 909 patients with celiac disease, as well as 1,268 healthy controls and 163 patients with Crohn’s disease. The results were dramatic, and highly statistically significant. Ventura found that the risk for developing other autoimmune disorders increased relative to the age of the person with celiac disease at diagnosis. For instance, a child that is 2 years of age has a 5% chance of developing another autoimmune disorder, but a person over 20 years of age at diagnosis has a 34% chance. Ventura and his colleagues equated the age of a celiac at diagnosis with the number of years that individual had been exposed to gluten, and postulated that the increasing risk was related to gluten exposure. Other researchers have reported results for and against Ventura’s claim, but a consensus has yet to be reached. Osteoporosis and osteopenia studies have almost consistently supported the benefit of a strict gluten-free diet in rebuilding bone mass, even in post-meopausal women and patients with incomplete mucosal recovery. Researchers note, however, that the diagnosis should be made early and the diet followed strictly. These studies indicate that in people who have not yet been diagnosed with celiac disease, gluten is very harmful. However, Marco Maki and colleagues have noted that the strict definition of celiac disease, that the intestinal mucosa flattens when gluten is consumed, is not necessarily true. We know that the damage that is created in the intestine can be patchy and variable, depending on the individual. According to the celiac prevalence study conducted by Alessio Fasano and colleagues, most Americans (diagnosed in the study) have Marsh 2 lesions, which indicate less damage in the intestine. What is a celiac to do? Scientists and researchers in the U.S. and throughout the world do agree on one thing: There are no clinical data to sufficiently establish a safe threshold for gluten ingestion in people with celiac disease. This includes the well-known Codex Alimentarius Standard for gluten-free foods, which allows 200 parts per million as an acceptable threshold value in gluten-free foods. An independent observer group to the Codex commission (The Prolamine Working Group) has been working to establish a reference gliadin for use in uniform testing programs by food manufacturers, and advocates for a single testing standard. These researchers, including Martin Stern, Paul Ciclitira, Conleth Feighery and Ricardo Troncone, have openly questioned the Codex standard of 200 ppm in gluten-free foods and have reiterated that there is little clinical data to back up the Codex standard that a small amount of gluten in the diet of celiacs is safe. Like the researchers who have conducted studies involving celiac patients, physicians who treat people with celiac disease also have an ethical standard, to “first do no harm.” At this time, that means that physicians and dietitians must educate patients to follow a 100% gluten-free diet. If you’re accidentally ingesting gluten, or have accidentally offered your child a gluten containing food, chances are you have not caused a problem that will lead to life-long complications. However, if you are consistently ingesting gluten or having repeated accidents, it is more likely that persistent damage may exist in your intestine leading to potential problems down the road. In either case, find out more about the gluten-free diet by contacting one of your national or local celiac organizations and get back on track. We’re here to help.

Celiac.com 11/21/2022 - Following a gluten-free diet for life can be difficult, Most celiacs on a gluten-free diet get exposed to gluten on a regular basis, especially if they eat in restaurants. Currently, a gluten-free diet is the only effective treatment for celiac disease. Because of this, there is substantial interest in drug therapies that can help to protect celiacs on a gluten-free diet, and, ideally, free them from a strict gluten-free diet. There are a number of drugs still in the pipeline that promise the former, at least. So what's the status of the multiple new therapies that are under investigation? To answer this question, a team of researchers recently set out to review existing and upcoming clinical trial programs for pharmacologic agents for celiac disease. The team conducted a narrative review using searches of MEDLINE, Embase, the Cochrane CENTRAL Library and clinicaltrials.gov. In their review, the team summarizes the pathophysiology of celiac disease, and the specific steps that might help to speed pharmacologic treatment. They also assess the evidence in support of current and future drug targets, including trials of peptidases, gluten sequestrants, tight junction regulators, anti-transglutaminase 2 therapies, immune tolerizing agents, advanced biologics and small molecules, and microbiome-targeted strategies. The team also spotlights the special challenges of conducting celiac disease trials, including identifying appropriate study populations, assessing results in the context of a gluten challenge, and interpreting celiac disease-specific clinical and histologic outcomes. Understanding these factors is crucial for accurately appraising the evidence. Finally, they outline what the future of celiac disease therapy may hold with the introduction of viable drug treatments. There is a definite need for drug options for treating celiac disease, either for accidental or intentional gluten exposures, as part a gluten-free diet, or for refractory disease. The big takeaway, is that, according to the team's reading of the data, multiple promising celiac disease drug therapies are in development, and these trials are likely to lead to approvals for the first generation of pharmacologic agents for celiac disease within the next 5 years. Color us skeptical, but that seems a pretty bullish view, especially given the crowded graveyard of once seemingly promising celiac drug therapies, especially the very recent demise of the highly touted Larazotide. Basically, we'll believe in successful drug treatments for celiac disease when we see a successful product make it to celiacs. Meanwhile, stay tuned for more on this and related stories. Read more in Aliment Pharmacol Ther. 2022;55(10):1277-1296 The research team included Michael Klonarakis, Christopher N. Andrews, Maitreyi Raman, Remo Panaccione and Christopher Ma. They are variously affiliated with theDepartment of Medicine, University of Calgary, Calgary, Alberta, Canada; the Division of Gastroenterology & Hepatology, University of Calgary, Calgary, Alberta, Canada; the Alberta's Collaboration of Excellence for Nutrition in Digestive Diseases, Calgary, Alberta, Canada; and the Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

Celiac.com 09/21/2022 - The dream of creating a safe, effective drug that can help people with celiac disease to tolerate small amounts, or perhaps even large amounts, of gluten. Until its recent failure, 9 Meters' larazotide was the only celiac drug in Phase 3 clinical trials. The recent discontinuation of larazotide, based on disappointing interim results, highlights the unmet need for effective alternatives to a gluten-free diet for treating celiac disease. Larazotide's failure also opens the doors for current and future Phase 1 and Phase 2 celiac therapies to be first-to-market. It also highlights the lack of a good lineup of potential new drugs. The reality is that, with the collapse of several once promising candidates, the bench for viable alternative celiac disease treatments is shallow, at best. Current Celiac Disease Pipeline Therapies Include: Latiglutenase (ImmunogenX) PRV-015 (Provention Bio, Inc. with Amgen) TAK-101 (Takeda Pharmaceuticals) ZED-1227 (ZEDIRA GmbH) KAN-101 (Anokion SA) In an effort to assess the current and future alternatives for treating celiac disease without a gluten-free diet, data marketing company Spherix recently interviewed one-hundred US gastroenterologists, and conducted eight qualitative interviews to compile a report on the issue. Spherix has issued a recent report on the form gastroenterologists engaged in a thorough review of these pipeline product descriptions (based on publicly available clinical information for each product). The report assesses celiac diagnostic and treatment trends emerging, as well as physician reactions to potential therapies in the pipeline. The 2022 report reveals a greater sense of urgency from gastroenterologists versus the 2021 report. Indeed, the number of respondents in the 2022 survey who say that their celiac patient load has increased in the past year, is up by 60% over 2021. Read more at PRNewswire.com