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Celiac Disease & Gluten-Free Diet Blogs

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  • Cheryl
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  • Gluten Challenge
  • twins2's Blog
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  • Celiac Teen
  • MNBelle blog
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  • Coeliac Disease or Coeliac Sprue or Non Tropical Sprue
  • karalto's Blog
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  • Madison Papers: Living Gluten-Free in a Gluten-Full World
  • babinsky's Blog
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  • Celiac Diagnosis at Age 24 months in 1939
  • Sandy R's Blog
  • mary m's Blog
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  • Guts & Brains
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  • Connie C.'s Blog
  • garden girl's Blog
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  • Jersey Shore wheat no more's Blog
  • swezzan's Blog
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  • glutenfreecosmeticcounter
  • Reasons Why Tummy tuck is considered best to remove unwanted belly fat?
  • alfgarrie's Blog
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  • Musings and Lessons Learned
  • txwildflower65's Blog
  • Uncertain
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  • KCG91's Blog
  • Yolo's Herbs & Other Healing Strategies
  • scrockwell's Blog
  • Sandra45's Blog
  • Theresa Marie's Blog
  • Skylark's Blog
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  • Anna'sMommy's Blog
  • Skylark's Oops
  • Jehovah witnesses
  • Celiac in Seattle's Blog
  • March On
  • honeybeez's Blog
  • The Liberated Kitchen, redux
  • onceandagain's Blog
  • JoyfulM's Blog
  • keepingmybabysafe's Blog
  • To beer, with love...
  • nana b's Blog
  • kookooto's Blog
  • SunnyJ's Blog
  • Mia'smommy's Blog
  • Amanda's Blog
  • jldurrani's Blog
  • Why choosing Medical bracelets for women online is the true possible?
  • Carriefaith's Blog
  • acook's Blog
  • REAGS' Blog
  • gfreegirl0125's Blog
  • Gluten Free Recipes - Blog
  • avlocken's Blog
  • Thiamine Thiamine Thiamine
  • wilbragirl's Blog
  • Gluten and Maize-Free (gluten-free-MF)
  • Elimination Diet Challenge
  • DJ 14150
  • mnsny's Blog
  • Linda03's Blog
  • GFinDC's Blog
  • Kim UPST NY's Blog
  • cmc's Blog
  • blog comppergastta1986
  • JesikaBeth's Blog
  • Melissa
  • G-Free's Blog
  • miloandotis' Blog
  • Confessions of a Celiac
  • Know the significance of clean engine oil
  • bobhayes1's Blog
  • Robinbird's Blog
  • skurtz's Blog
  • Olivia's Blog
  • Jazzdncr222's Blog
  • Lemonade's Blog
  • k8k's Blog
  • celiaccoach&triathlete's Blog
  • Gluten Free Goodies
  • cherbourgbakes.blogspot.com
  • snow dogs' Blog
  • Rikki Tikki's Blog
  • lthurman1979's Blog
  • Sprue that :)'s Blog
  • twinkletoes' Blog
  • Ranking the best gluten free pizzas
  • Gluten Free Product
  • Wildcat Golfer's Blog
  • Becci's Blog
  • sillyker0nian's Blog
  • txplowgirl's Blog
  • Gluten Free Bread Blog
  • babygoose78's Blog
  • G-freegal12's Blog
  • kelcat's Blog
  • Heavy duty 0verhead crane
  • beckyk's Blog
  • pchick's Blog
  • NOT-IN-2gluten's Blog
  • PeachPie's Blog
  • Johny
  • Breezy32600's Blog
  • Edgymama's Gluten Free Journey
  • Geoff
  • audra's Blog
  • mfrklr's Blog
  • 2 chicks
  • I Need Help With Bread
  • the strong one has returned!
  • sabrina_B_Celiac's Blog
  • Gluten Free Pioneer's Blog
  • Theanine.
  • The Search of Hay
  • Vanessa
  • racecar16's Blog
  • JCH13's Blog
  • b&kmom's Blog
  • Gluten Free Foodies
  • NanaRobin's Blog
  • mdrumr8030's Blog
  • Sharon LaCouture's Blog
  • Zinc, Magnesium, and Selenium
  • sao155's Blog
  • Tabasco's Blog
  • Amanda Smith
  • mmc's Blog
  • xphile1121's Blog
  • golden exch
  • kerrih's Blog
  • jleb's Blog
  • RUGR8FUL's Blog
  • Brynja's Grain Free Kitchen
  • schneides123's Blog
  • Greenville, SC Gluten-Free Blog
  • ramiaha's Blog
  • Kathy P's Blogs
  • rock on!'s Blog
  • Carri Ninja's Blog
  • jerseygirl221's Blog
  • Pkhaselton's Blog
  • Hyperceliac Blog
  • abbiekir's Blog
  • Lasister's Thoughts
  • bashalove's Blog
  • Steph1's Blog
  • Etboces
  • Rantings of Tiffany
  • GlutenWrangler's Blog
  • kalie's Blog
  • Mommy Of A Gluten Free Child
  • ready2go's Blog
  • Maureen
  • Floridian's Blog
  • Bobbie41972's Blog
  • Everyday Victories
  • Intolerance issue? Helpppp!
  • Feisty
  • In the Beginning...
  • Cheri46's Blog
  • Acne after going gluten free
  • sissSTL's Blog
  • Elizabeth19's Blog
  • LindseyR's Blog
  • sue wiesbrook's Blog
  • I'm Hungry's Blog
  • badcasper's Blog
  • M L Graham's Blog
  • Wolicki's Blog
  • katiesalmons' Blog
  • CBC and celiac
  • Kaycee's Blog
  • wheatisbad's Blog
  • beamishmom's Blog
  • Celiac Ninja's Blog
  • scarlett54's Blog
  • GloriaZ's Blog
  • Holly F's Blog
  • Jackie's Blog
  • lbradley's Blog
  • TheSandWitch's Blog
  • Ginger Sturm's Blog
  • The Struggle is Real
  • whataboutmary's Blog
  • JABBER's Blog
  • morningstar38's Blog
  • Musings of a Celiac
  • Celiacchef's Blog
  • healthygirl's Blog
  • allybaby's Blog
  • MGrinter's Blog
  • LookingforAnswers15's Blog
  • Lis
  • Alilbratty's Blog
  • 3sisters' Blog
  • MGrinter's Blog
  • Amanda
  • felise's Blog
  • rochesterlynn's Blog
  • mle_ii's Blog
  • GlamourGetaways' Blog
  • greendog's Blog
  • Tabz's Blog
  • Smiller's Blog
  • my vent
  • newby to celiac?'s Blog
  • siren's Blog
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  • Relieved and confused
  • carb bingeing
  • scottish's Blog
  • maggiemay832's Blog
  • Cristina Barbara
  • ~~~AnnaBelle~~~'s Blog
  • nikky's Blog
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  • mfarrell's Blog
  • Kat-Kat's Blog
  • Kelcie's Blog
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  • pasqualeb's Blog
  • My girlfriend has celiacs and she refuses to see a doctor
  • Ki-Ki29's Blog
  • mailmanrol's Blog
  • Sal Gal
  • WildBillCODY's Blog
  • Ann Messenger
  • aprilz's Blog
  • the gluten-free guy
  • gluten-free-wifey's Blog
  • Lynda MEADOWS's Blog
  • mellajane's Blog
  • Jaded's Celiac adventures in a non-celiac world.
  • booboobelly18's Blog
  • Dope show
  • Classic Celiac Blog
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  • Bada
  • Sherry's blurbs
  • addict697's Blog
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  • Shawn C
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  • little_d's Blog
  • Gluten, dairy, pineapple
  • The Fat (Celiac) Lady Sings
  • Periomike
  • Sue Mc's Blog
  • BloatusMaximus' Blog
  • It's just one cookie!
  • Kimmy
  • jacobsmom44's Blog
  • mjhere's Blog
  • tlipasek's Blog
  • You're Prescribing Me WHAT!?!
  • Kimmy
  • nybbles's Blog
  • Karla T.'s Blog
  • Young and dealing with celiacs
  • Celiac.com Podcast Edition
  • LCcrisp's Blog
  • ghfphd's allergy blog
  • https://www.bendglutenfree.com/
  • Costume's and GF Life
  • mjhere69's Blog
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  • CeliacChoplin
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  • celiac<3'sme!'s Blog
  • William Parsons
  • Gluten Free Breeze (formerly Brendygirl) Blog
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  • Daily Life and Compromising
  • Vonnie Mostat
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  • farid's Blog
  • Sandra Lee's Blog
  • Demertitis hepaformis no Celac
  • Vonnie Mostat, R.N.
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  • Kim
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  • Living in the Gluten Free World
  • lisajs38's Blog
  • Mary07's Blog
  • Treg immune celsl, short chain fatty acids, gut bacteria etc.
  • questions
  • A Blog by Yvonne (Vonnie) Mostat, RN
  • ROBIN
  • covsooze's Blog
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  • Adventures of a Gluten Free Mom
  • Fiona S
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  • Carla
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  • Jim L Christie
  • Debbie65's Blog
  • Alcohol, jaundice, and celiac
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  • Gluten Free Mastery
  • james
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  • Feline's Blog
  • Linda Atkinson
  • Auntie Lur: The Blog of a Young Girl
  • KathyNapoleone's Blog
  • Gluten Free and Specialty Diet Recipes
  • Why are people ignoring Celiac Disease, and not understanding how serious it actually is?
  • miasuziegirl's Blog
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  • Amyy's Blog
  • Pete Dixon
  • abigail's Blog
  • CHA's Blog
  • Eczema or Celiac Mom?'s Blog
  • Thoughts
  • International Conference on Gastroenterology
  • Deedle's Blog
  • krackers' Blog
  • cliniclfortin's Blog
  • Mike Menkes' Blog
  • Juanita's Blog
  • BARB OTTUM
  • holman's Blog
  • It's EVERYWHERE!
  • life's Blog
  • writer ann's Blog
  • Ally7's Blog
  • Gluten Busters: Gluten-Free Product Alerts by Celiac.com
  • K Espinoza
  • klc's Blog
  • Pizza&beer's Blog
  • CDiseaseMom's Blog
  • sidinator's Blog
  • Dr Rodney Ford's Blog
  • How and where is it safe to buy cryptocurrency?
  • lucedith's Blog
  • Random Thoughts
  • Kate
  • twin#1's Blog
  • myadrienne's Blog
  • Nampa-Boise Idaho
  • Ursa Major's Blog
  • bakingbarb's Blog
  • Does Celiac Cause Sensitivites To Rx's?
  • delana6303's Blog
  • psychologygrl25's Blog
  • Alcohol and Celiac Disease
  • How do we get it???
  • cooliactic_BOOM's Blog
  • GREAT GF eating in Toronto
  • Gluten-free Food Recommendations!
  • YAY! READ THIS!!
  • BROW-FREE DIET BLOG
  • carib168's Blog
  • A Healing Kitchen
  • Shawn s
  • AZ Gal's Blog
  • mom1's Blog
  • The Beginning - The Diagnosis
  • PeweeValleyKY's Blog
  • solange's Blog
  • Cate K's Blog
  • Layered Vegetable Baked Pasta (gluten-free Vegetarian Lasagna)
  • Gluten Free Teen by Ava
  • mtdawber's Blog
  • sweeet_pea's Blog
  • DCE's Blog
  • Infertility and Celiac Disease
  • What to do in the Mekong Delta in 1 Day?
  • glutenfreenew's Blog
  • Living in the Garden of Eden
  • toddzgrrl02's Blog
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  • Gluten Free High Protein
  • Ari
  • Great Harvest Chattanooga's Blog
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  • Being in Control of Your Gluten-Free Diet on a Cruise Ship
  • jayshunee's Blog
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  • Yummy or Yucky Gluten-Free Foods
  • Electra's Blog
  • Cocerned husband's Blog
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  • A Little History - My Celiac Disease Diagnosis
  • How to line my stomach
  • sewfunky's Blog
  • Oscar's Blog
  • Chey's Blog
  • The Fun of Gluten-free Breastfeeding
  • Dawnie's Blog
  • Sneaky gluten free goodness!
  • Chicago cubs shirts- A perfect way of showing love towards the baseball team!
  • Granny Garbonzo's Blog
  • GFzinks09's Blog
  • How do I get the Celiac.com podcast on my mp3 player?
  • quantumsugar's Blog
  • Littlebit's Blog
  • Kimberly's Blog
  • Dayz's Blog
  • Swimming Breadcrumbs and Other Issues
  • Helen Burdass
  • celiacsupportnancy's Blog
  • Life of an Aggie Celiac
  • kyleandjra.jacobson's Blog
  • Hey! I'm Not "Allergic" to Wheat!
  • FoOdFaNaTic's Blog
  • Wendy Cohan, RN's Gluten-Free and Dairy-Free Cooking Classes
  • Lora Derry
  • Dr. Joel Goldman's Blog
  • The Ultimate Irony
  • Lora Derry
  • ACK514's Blog
  • katinagj's Blog
  • What Goes On, Goes In (Gluten in Skin Care Products)
  • What’s new in hydraulic fittings?
  • cannona3's Blog
  • citykatmm's Blog
  • Adventures in Gluten-Free Toddling
  • tahenderson67's Blog
  • The Dinner Party Drama—Two Guidelines to Assure a Pleasant Gluten-Free Experience
  • What’s new in hydraulic fittings?
  • sparkybear's Blog
  • justbikeit77's Blog
  • To "App" or Not to "App": The Use of Gluten Free Product List Computer Applications
  • Onangwatgo
  • Raine's Blog
  • lalla's Blog
  • To die for Cookie Crumb Gluten-Free Pie Crust
  • DeeTee33's Blog
  • http://glutenfreegroove.com/blog/
  • David2055's Blog
  • Gluten-Free at the Fancy Food Show in San Francisco
  • Kup wysokiej jakości paszporty, prawa jazdy, dowody osobiste
  • Janie's Blog
  • Managing Hives & Gluten Allergies
  • User Is it safe to use GB WhatsApp pro in 2024?
  • Bogaert's Blog
  • Janie's Blog
  • RaeD's Blog
  • Dizzying Disclaimers!
  • Dream Catcher's Blog
  • PinkZebra's Blog
  • Hibachi Food and Hidden Gluten Hazards (How to Celebrate Gluten-Free)
  • jktenner's Blog
  • OhSoTired's Blog
  • PinkZebra's Blog
  • gluten-free Lover's Blog
  • Gluen Free Health Australia
  • Melissamb21's Blog
  • Andy C's Blog
  • halabackgirl9129's Blog
  • Liam Edwards' Blog
  • Celiac Disease in Africa?
  • Suz's Blog
  • Gluten-Free Fast Food
  • mis_chiff's Blog
  • gatakat's Blog
  • macocha's Blog
  • Newly Diagnosed Celiacs Needed for Study in Chicago
  • Poor Baby's Blog
  • the loonie celiac's Blog
  • jenlex's Blog
  • Sex Drive/Testosterone can be Depleted by Certain Foods
  • samantha79's Blog
  • 21 Months into the Gluten-free Diet
  • WashingtonLady's Blog-a-log
  • James S. Reid's Blog
  • Living with a Gluten-Free Husband
  • runner girl's Blog
  • kp3972's Blog
  • ellie_lynn's Blog
  • trayne91's Blog
  • Gluten-free Lipstick!
  • Nonna2's Blog
  • Schar Chocolate Hazelnut Bar (Gluten-Free)
  • pnltbox27's Blog
  • Live2BWell's Blog
  • melissajohnson's Blog
  • nvsmom's Blog
  • Diagnosed with Celiac Disease and Still Sick
  • snowcoveredheart's Blog
  • Gluten Free Nurse
  • Gluten-Free Frustration!
  • Melody A's Blog
  • novelgutfeeling's Blog
  • Trouble Eating Out Gluten-Free...Good or Bad?!
  • dilsmom's Blog
  • theceliachusband's Blog
  • amanda2610's Blog
  • Pancreas and Celiac Disease Link?
  • epiphany's Blog
  • Patty55's Blog
  • The Latest Gluten-Free Food Recalls
  • kenzie's blog
  • CVRupp's Blog
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  1. Celiac.com 12/15/2023 - Celiac disease is a chronic condition triggered by gluten consumption, which often reveals itself through symptoms like chronic diarrhea and malabsorption. However, a significant number of patients exhibit atypical manifestations such as iron deficiency anemia, idiopathic short stature, hypertransaminasemia, or infertility. Unfortunately, due to a lack of awareness among healthcare professionals about these diverse presentations, many patients with atypical symptoms are not screened for celiac disease. A recent review aims to shed light on the considerations for diagnosing this condition, delving into screening criteria, atypical manifestations, and diagnostic tools. Patients with atypical manifestations often first approach primary care physicians or specialists outside of gastroenterology. Recognizing this, the research team conducted an extensive review of literature to understand the prevalence of celiac disease in various gastrointestinal conditions like chronic diarrhea and non-gastrointestinal conditions such as short stature, cryptogenic hypertransaminasemia, cryptogenic cirrhosis, and idiopathic ataxia. The research team included Prashant Singh, Achintya Dinesh Singh, Vineet Ahuja, and Govind K Makharia. They are variously associated with the Department of Gastroenterology, University of Michigan, Ann Arbor, MI, United States; the Department of Medicine, Cleveland Clinic, Cleveland, OH, United States; and the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. Their review emphasizes the importance of awareness among healthcare professionals regarding atypical presentations of celiac disease, to facilitate timely screening and diagnosis. Additionally, it highlights special scenarios where screening is crucial, even in the absence of symptoms. Individuals with type 1 diabetes, Down’s syndrome, and first-degree relatives of celiac disease patients fall into this category, requiring careful consideration for screening. Definite Indications for Celiac Disease Screening: Patients with chronic diarrhea - Found in 43%-85% of patients. Patients with iron deficiency anemia - Affects approximately 1 in 31 celiac disease patients. Patients with short stature - Affects around 11.2% of patients with celiac disease Patients with type 1 diabetes - Around 6% of type 1 diabetics also have celiac disease. First-degree relatives of patients with celiac disease - The approximate risk of developing celiac disease is 1 in 13 in sons, 1 in 16 in brothers, 1 in 32 in mothers and 1 in 33 in fathers. Patients with dermatitis herpetiformis - Around two-third of patients with dermatitis herpetiformis have villous abnormalities and one third of them have no enteropathy, and 17% of those with celiac disease have dermatitis herpetiformis. Patients with Down’s syndrome - 5.8% of those with Down's syndrome also have celiac disease. Probable Indications for Celiac Disease Screening: Patients with liver diseases Cryptogenic hypertransaminesemia Cryptogenic cirrhosis Patients with auto-immune hepatitis Patients with irritable bowel syndrome Patients with osteoporosis Possible Indications for Celiac Disease Screening: Patients with dyspepsia Women with infertility Women with unexplained or idiopathic infertility Women with “all-cause infertility” Patients with idiopathic cardiomyopathy Patients with autoimmune thyroid diseases Patients with idiopathic epilepsy Patients with idiopathic cerebellar ataxia Patients with dental enamel defects Furthermore, the review provides insights into the diagnostic performance and limitations of various screening tests for celiac disease. It discusses specific antibodies, including IgA anti-tissue transglutaminase antibodies, anti-endomysial antibodies, and anti-deamidated gliadin antibodies. The team proposes a diagnostic algorithm based on current recommendations for patients suspected of having celiac disease. In conclusion, the review serves as a comprehensive guide for healthcare professionals, offering a nuanced understanding of who should be screened and how. By delineating atypical manifestations and considering special scenarios, it encourages a more proactive approach to celiac disease diagnosis. The proposed diagnostic algorithm aims to streamline the process, ensuring that individuals with suspected celiac disease receive timely and accurate assessments. Lastly, the review underscores the importance of broadening the perspective on celiac disease beyond its classical gastrointestinal symptoms, contributing to improved healthcare outcomes for affected individuals. Read more at: World J Gastroenterol 2022; 28(32): 4493-4507
  2. Celiac.com 11/15/2023 - Imagine enjoying your favorite pasta dish one day, and the next day, experiencing mysterious and uncomfortable symptoms like stomach pain, vomiting, fatigue, or skin rashes. What could be causing these problems? One possibility might be celiac disease. Celiac disease is a relatively common autoimmune disorder that affects the small intestine. It's triggered by the consumption of gluten, a protein found in wheat, barley, and rye. When someone with celiac disease eats gluten, their immune system reacts by damaging the lining of the small intestine, which can lead to a wide range of symptoms and complications. Getting the diagnosis correct is important, because celiac disease is often misdiagnosed. Symptoms of Celiac Disease The symptoms of celiac disease can vary greatly from person to person, and some individuals may not experience any symptoms at all. Here are some common signs to watch out for: Digestive Troubles: Symptoms often involve the digestive system, such as diarrhea, constipation, bloating, gas, and abdominal pain. Fatigue: Many people with celiac disease report feeling excessively tired, even after a full night's sleep. Weight Loss: Unintended weight loss can occur due to malabsorption of nutrients caused by intestinal damage. Skin Issues: Some individuals develop skin conditions, itchy rashes, like dermatitis herpetiformis, which is closely linked to celiac disease. Joint Pain: Joint pain and inflammation may affect those with celiac disease. Mood Changes: Mood swings, depression, or anxiety can be related to the condition. Delayed Growth in Children: Celiac disease can hinder proper growth and development in children. Diagnosis of Celiac Disease Getting a proper diagnosis is crucial for managing celiac disease effectively. Here's how doctors typically diagnose it: Blood Tests: Initially, blood tests are done to check for elevated levels of certain antibodies, such as anti-tissue transglutaminase (tTG) and anti-endomysial antibodies (EMA). Higher levels of these antibodies can be a sign of celiac disease. Biopsy: If blood tests indicate celiac disease, a small intestine biopsy may be performed. During this procedure, a tiny sample of the intestinal lining is taken and examined under a microscope. Damage to the lining is a key indicator of the disease. In more and more cases, celiac disease can be diagnosed without biopsy. Treatment of Celiac Disease The primary treatment for celiac disease is a strict gluten-free diet. Once diagnosed, individuals need to eliminate all sources of gluten from their diet, including bread, pasta, cakes, and even certain sauces. This can be challenging, as gluten can hide in unexpected places, so reading food labels and avoiding gluten ingredients is a must. Most people with celiac disease notice significant improvements in their symptoms once they adopt a gluten-free lifestyle. Over time, the intestinal lining often heals, allowing for better nutrient absorption. In some cases, complications of celiac disease may require additional medical attention. For instance, individuals with severe malabsorption may need vitamin and mineral supplements. Dermatitis herpetiformis may be treated with medications. Living with Celiac Disease While a gluten-free diet is the cornerstone of managing celiac disease, it's also essential to be vigilant about cross-contamination. This means avoiding utensils, kitchen appliances, and cooking surfaces that have come into contact with gluten-containing foods. Celiac.com offers numerous forums for discussing celiac disease and gluten-free challenges with other celiacs who can share experience and help guide your celiac and gluten-free journey. Support groups and dietary counselors can be incredibly helpful for those newly diagnosed with celiac disease. They provide practical tips for maintaining a gluten-free lifestyle and offer emotional support during the transition. In conclusion, celiac disease is a common but manageable condition. By recognizing its symptoms, seeking a proper diagnosis, and committing to a gluten-free diet, individuals with celiac disease can lead healthy and fulfilling lives. If you suspect you have celiac disease, don't hesitate to consult a healthcare professional for guidance and testing. Your well-being is worth it!

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  4. Celiac.com 10/23/2023 - A recent study conducted by a team of US investigators is shedding light on the use of European thresholds for diagnosing celiac disease in North America. This study seeks to determine how often biopsies are performed on children who are considered at high risk for celiac disease based on common diagnostic tests, yet meet the criteria for non-biopsy diagnoses according to European standards. Dr. Denis Chang, the study's lead author, discussed the trial's design and its implications for celiac disease diagnostics in North America during an interview with HCPLive at the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) 2023 Annual Meeting in San Diego. Celiac disease is an autoimmune disorder that affects the small intestine and is triggered by the consumption of gluten, a protein found in wheat, rye, and barley. The gold standard for diagnosing celiac disease is through an endoscopy, which involves taking biopsies to confirm the damage caused by gluten. However, serology, or blood testing, has become a game-changer in the diagnostic process. It helps identify individuals who require an endoscopy based on a positive blood test, typically the tissue transglutaminase (tTG-IgA) test. While tTG-IgA is a reliable biomarker, it is not infallible and can yield false positives or negatives. In 2012, European colleagues established guidelines that allow for a celiac disease diagnosis in some cases where a highly positive tTG-IgA result is combined with another positive blood marker, EMA IgA. These guidelines initially included genetic risk and symptoms but no longer do. In contrast, North American guidelines have not incorporated these standards, partially due to the wide array of diagnostic assays used to identify celiac disease, each with its own methodology. Dr. Chang also emphasizes the concern of potentially overlooking other diagnoses by not conducting an endoscopy, such as eosinophilic esophagitis, which is commonly seen in celiac patients. In an ideal world, a standardized and widely accepted diagnostic assay strategy would simplify the diagnostic process and potentially pave the way for developing new clinical therapies for celiac disease. Currently, there are no FDA-approved drugs for treating celiac disease, and the most promising agents in development are primarily intended for adult patients. Dr. Chang explained that an alternative diagnosis method could help expand the pool of individuals, both providers and patients, who can collaborate to advance celiac disease research and treatment options. Additionally, it could offer clarity for patients who have received a presumed celiac disease diagnosis based solely on high blood markers, without undergoing a biopsy. This investigation into the use of European diagnostic thresholds in North America is a significant step toward streamlining the diagnosis of celiac disease. See more at the Conference|North American Society For Pediatric Gastroenterology, Hepatology & Nutrition
  5. Celiac.com 04/15/2023 - Celiac disease is a chronic autoimmune disorder that affects the small intestine, triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. One often overlooked consequence of untreated and undiagnosed celiac disease is the potential for nutrient deficiencies. Due to the damage caused to the lining of the small intestine, absorption of various essential nutrients may be impaired, leading to deficiencies that can have wide-ranging health effects. In this article, we will explore the connection between celiac disease and nutrient deficiencies, focusing on several key vitamins, minerals, and other essential nutrients. The most common nutrient deficiencies associated with celiac disease that may lead to testing for the condition include iron, vitamin D, folate (vitamin B9), vitamin B12, calcium, zinc, and magnesium. Celiac disease can disrupt the absorption of these essential nutrients, potentially leading to anemia, bone health issues, and other health complications. After a celiac disease diagnosis it is important to do follow up testing for these nutrient deficiencies, as well as a follow-up endoscopies/biopsies to make sure that a patient's damaged villi are healing properly. Many of those with celiac disease will need to take vitamin and mineral supplements at the time of their diagnosis, and some will need to continue taking them for life. Note that having nutrient deficiencies alone would not be enough for a definitive diagnosis of celiac disease, and further testing is required to make a formal diagnosis. Boron Boron is a trace mineral that plays a role in bone health, brain function, and metabolism of certain nutrients. Deficiency in boron is rare, but it can lead to symptoms such as muscle weakness, joint pain, and impaired cognitive function. Untreated and undiagnosed celiac disease can cause malabsorption of boron due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of boron may be needed for individuals with celiac disease, especially if they have prolonged untreated celiac disease or other risk factors for deficiency. Calcium Calcium is an essential mineral that is crucial for bone health, nerve function, and muscle contraction. Deficiency in calcium can lead to symptoms such as weakened bones, muscle cramps, and numbness and tingling in the extremities. Malabsorption of calcium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of osteoporosis and other bone-related complications in individuals with celiac disease. Measuring blood levels of calcium alone is not always an accurate indicator of calcium deficiency because the body will leach calcium from the bones to maintain normal blood levels of calcium. Therefore, bone density loss and other secondary indicators are often better diagnostic tools for detecting calcium deficiency. Calcium supplementation, along with a calcium-rich diet, may be necessary for individuals with celiac disease to maintain adequate calcium levels and support bone health. Chloride Chloride is an electrolyte that is involved in maintaining proper fluid balance, nerve function, and acid-base balance in the body. Deficiency in chloride is rare, but it can lead to symptoms such as muscle weakness, lethargy, and irregular heartbeat. Malabsorption of chloride can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can disrupt the body's fluid balance and electrolyte levels, further complicating the health of individuals with celiac disease. Proper monitoring of chloride levels and supplementation may be necessary for individuals with celiac disease, especially if they have prolonged untreated celiac disease or other risk factors for deficiency. Choline Choline is an essential nutrient that plays a role in brain development, nerve function, and liver health. Deficiency in choline can lead to symptoms such as cognitive decline, liver dysfunction, and muscle damage. In celiac disease, malabsorption of choline can occur due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of choline may be necessary for individuals with celiac disease, especially if they have prolonged untreated celiac disease or other risk factors for deficiency. Image: CC BY-SA 2.0--User: Pumbaa (original work by commons:User: Greg Robson Chromium Chromium is a trace mineral that is important for glucose metabolism and insulin function. Deficiency in chromium can lead to symptoms such as impaired glucose tolerance, increased insulin resistance, and poor blood sugar control. Malabsorption of chromium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of chromium may be needed for individuals with celiac disease, especially if they have poor blood sugar control or other risk factors for deficiency. Copper Copper is an essential trace mineral that plays a role in various processes in the body, including energy production, connective tissue formation, and immune function. Deficiency in copper can cause symptoms such as anemia, bone abnormalities, and impaired immune function. In celiac disease, malabsorption of copper can occur due to damage to the small intestine lining, potentially leading to a deficiency. This can further compromise the overall health of individuals with celiac disease and increase the risk of related complications. Supplementation of copper may be necessary for individuals with celiac disease to maintain adequate copper levels and support overall health. Iodine Iodine is a trace mineral that is essential for thyroid function, metabolism, and brain development. Deficiency in iodine can cause symptoms such as goiter, fatigue, weight gain, and impaired cognitive function. Malabsorption of iodine can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further disrupt thyroid function and metabolism, and impair cognitive development in individuals with celiac disease, especially in children. Iodine supplementation, along with a well-balanced diet that includes iodine-rich foods such as seafood and iodized salt, may be necessary for individuals with celiac disease to maintain adequate iodine levels and support overall health. Iron Iron is an essential mineral that is required for the production of hemoglobin, the protein in red blood cells that carries oxygen to all parts of the body. Deficiency in iron can cause symptoms such as anemia, fatigue, weakness, and pale skin. Malabsorption of iron can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further exacerbate the risk of anemia and related health issues in individuals with celiac disease. Iron supplementation, along with a well-balanced diet that includes iron-rich foods such as meat, poultry, beans, and fortified cereals, may be necessary for individuals with celiac disease to maintain adequate iron levels and support overall health. Lutein Lutein is a carotenoid antioxidant that is important for eye health and vision. Deficiency in lutein can cause symptoms such as blurred vision, macular degeneration, and increased risk of eye-related disorders. Malabsorption of lutein can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of eye-related issues and compromised vision in individuals with celiac disease. Lutein supplementation, along with a diet rich in lutein-containing foods such as leafy green vegetables, egg yolks, and corn, may be necessary for individuals with celiac disease to maintain adequate lutein levels and support overall eye health. Lycopene Lycopene is a carotenoid antioxidant that is known for its role in prostate health and reducing the risk of certain cancers. Deficiency in lycopene can cause symptoms such as increased risk of prostate cancer, cardiovascular disease, and oxidative stress. Malabsorption of lycopene can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of prostate cancer, cardiovascular issues, and other health complications in individuals with celiac disease. Lycopene supplementation, along with a diet rich in lycopene-containing foods such as tomatoes, watermelon, and red bell peppers, may be necessary for individuals with celiac disease to maintain adequate lycopene levels and support overall health. Image: CC BY-SA 2.0--User: Pumbaa (original work by commons: User: Greg Robson) Magnesium Magnesium is a vital mineral that plays a critical role in numerous physiological processes, including nerve function, muscle contraction, and bone health. Deficiency in magnesium can cause symptoms such as muscle weakness, tremors, irregular heartbeat, and bone loss. Malabsorption of magnesium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of muscle weakness, nerve-related issues, and compromised bone health in individuals with celiac disease. Magnesium supplementation, along with a diet rich in magnesium-containing foods such as leafy green vegetables, nuts, seeds, and whole grains, may be necessary for individuals with celiac disease to maintain adequate magnesium levels and support overall health. Manganese Manganese is an essential trace mineral that is involved in various metabolic processes, including carbohydrate metabolism and bone formation. Deficiency in manganese can cause symptoms such as impaired glucose tolerance, bone abnormalities, and altered cholesterol levels. Malabsorption of manganese can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of metabolic issues, bone-related complications, and altered cholesterol levels in individuals with celiac disease. Manganese supplementation, along with a diet rich in manganese-containing foods such as whole grains, nuts, seeds, and legumes, may be necessary for individuals with celiac disease to maintain adequate manganese levels and support overall health. Molybdenum Molybdenum is a trace mineral that is essential for various enzymatic reactions in the body, including detoxification processes and metabolism of certain nutrients. Deficiency in molybdenum is rare but can cause symptoms such as rapid heartbeat, neurological issues, and growth retardation. Malabsorption of molybdenum can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of cardiovascular issues, neurological complications, and growth retardation in individuals with celiac disease. Molybdenum supplementation, along with a diet rich in molybdenum-containing foods such as legumes, whole grains, and nuts, may be necessary for individuals with celiac disease to maintain adequate molybdenum levels and support overall health. Nickel Nickel is a trace mineral that is required in very small amounts for various enzymatic reactions in the body. Deficiency in nickel is rare and typically occurs in individuals with specific health conditions. Malabsorption of nickel can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised enzymatic reactions and related health issues in individuals with celiac disease. Nickel supplementation is not typically necessary, as the body requires only trace amounts of nickel. However, it is important for individuals with celiac disease to maintain a well-balanced diet that includes nickel-containing foods such as nuts, legumes, and whole grains to support overall health. Phosphorus Phosphorus is an essential mineral that plays a crucial role in bone formation, energy metabolism, and cellular function. Deficiency in phosphorus is rare and usually occurs in individuals with specific health conditions or imbalanced diets. Malabsorption of phosphorus can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised bone health, energy metabolism, and cellular function in individuals with celiac disease. Phosphorus supplementation is not typically necessary, as phosphorus is abundant in many foods. However, it is important for individuals with celiac disease to maintain a well-balanced diet that includes phosphorus-containing foods such as dairy products, meat, fish, nuts, seeds, and whole grains to support overall health. Image: CC BY-SA 2.0--User: Pumbaa (original work by commons: User: Greg Robson) Potassium Potassium is a crucial mineral that is involved in numerous physiological processes, including nerve function, muscle contraction, and heart health. Deficiency in potassium can cause symptoms such as muscle weakness, fatigue, irregular heartbeat, and increased blood pressure. Malabsorption of potassium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of nerve-related issues, muscle weakness, and cardiovascular complications in individuals with celiac disease. Potassium supplementation, along with a diet rich in potassium-containing foods such as fruits, vegetables, dairy products, meat, and legumes, may be necessary for individuals with celiac disease to maintain adequate potassium levels and support overall health. Selenium Selenium is an essential trace mineral that is involved in various antioxidant and immune functions in the body. Deficiency in selenium can cause symptoms such as compromised immune function, muscle weakness, fatigue, and hair loss. Malabsorption of selenium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of impaired immune function, muscle weakness, and related health issues in individuals with celiac disease. Selenium supplementation, along with a diet rich in selenium-containing foods such as fish, meat, dairy products, nuts, and seeds, may be necessary for individuals with celiac disease to maintain adequate selenium levels and support overall health. Silicon Silicon is a trace mineral that is involved in various processes such as bone formation, connective tissue health, and hair, skin, and nail health. Deficiency in silicon is rare, as it is found in many foods, but it can cause symptoms such as compromised bone health, weak connective tissue, and brittle nails. Malabsorption of silicon can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised bone health, connective tissue issues, and related health concerns in individuals with celiac disease. Silicon supplementation is not typically necessary, as silicon is abundant in many foods. However, it is important for individuals with celiac disease to maintain a well-balanced diet that includes silicon-containing foods such as whole grains, fruits, vegetables, nuts, and seeds to support overall health and prevent deficiency. Vanadium Vanadium is a trace mineral that has been suggested to play a role in blood sugar regulation and bone health, although its exact functions are not yet fully understood. Vanadium deficiency is rare, as it is found in small amounts in many foods, and its requirement in the body is low. However, malabsorption of vanadium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised blood sugar regulation and bone health in individuals with celiac disease. Vanadium supplementation is not typically necessary, as the body's requirement for vanadium is minimal, and excessive intake can be toxic. However, it is important for individuals with celiac disease to maintain a well-balanced diet that includes foods rich in vanadium, such as seafood, mushrooms, whole grains, and vegetable oils, to support overall health. Vitamin A (Preformed) Vitamin A is a fat-soluble vitamin that plays a crucial role in vision, immune function, and cellular growth. Deficiency in vitamin A can lead to night blindness, dry skin, and increased susceptibility to infections. Untreated celiac disease can cause malabsorption of vitamin A due to damage to the small intestine lining, leading to a deficiency. It is important for individuals with celiac disease to monitor their vitamin A levels and consider supplementation if necessary. Vitamin A (Betacarotenes) Vitamin A in the form of betacarotenes is a precursor that is converted to vitamin A in the body as needed. Betacarotenes are found in colorful fruits and vegetables, and they play a role in maintaining healthy skin, vision, and immune function. Deficiency in betacarotenes can result in similar symptoms as vitamin A deficiency, including impaired vision and weakened immune system. In celiac disease, impaired absorption of betacarotenes can occur due to damage to the small intestine lining, leading to a potential deficiency. Vitamin B1 (Thiamine) Vitamin B1, also known as thiamine, is a water-soluble vitamin that is essential for energy metabolism, nerve function, and brain health. Deficiency in thiamine can cause symptoms such as muscle weakness, fatigue, and mental confusion. Severe, prolonged thiamine deficiency can result in beriberi, and symptoms include loss of sensation in extremities, symptoms of heart failure, swelling of the hands and feet, chest pain, feelings of vertigo, double vision, and memory loss. Untreated celiac disease can impair thiamine absorption due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their thiamine levels and consider supplementation if needed. Vitamin B2 (Riboflavin) Vitamin B2, also known as riboflavin, is another water-soluble vitamin that plays a key role in energy production, growth, and red blood cell formation. Deficiency in riboflavin can lead to symptoms such as cracked lips, sore throat, and skin rash. Celiac disease can cause impaired absorption of riboflavin due to damage to the small intestine lining, leading to a potential deficiency. Supplementation may be necessary for individuals with celiac disease to maintain adequate riboflavin levels. Vitamin B3 (Niacin) Vitamin B3, also known as niacin, is essential for energy metabolism, nervous system function, and DNA repair. Deficiency in niacin can result in a condition known as pellagra, characterized by symptoms such as diarrhea, dermatitis, and mental confusion. Malabsorption of niacin can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their niacin levels and consider supplementation if necessary. Vitamin B5 (Pantothenic Acid) Vitamin B5, also known as pantothenic acid, is involved in energy production, hormone synthesis, and nerve function. Deficiency in pantothenic acid can lead to symptoms such as fatigue, numbness and tingling in the hands and feet, and difficulty in coordination. In celiac disease, malabsorption of pantothenic acid can occur due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation may be necessary for individuals with celiac disease to maintain adequate pantothenic acid levels. Vitamin B6 Vitamin B6, also known as pyridoxine, is a water-soluble vitamin that is important for brain development, immune function, and protein metabolism. Deficiency in vitamin B6 can cause symptoms such as depression, irritability, and weakened immune system. Untreated celiac disease can impair the absorption of vitamin B6 due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their vitamin B6 levels and consider supplementation if needed. Vitamin B7 (Biotin) Vitamin B7, also known as biotin, is essential for healthy skin, hair, and nails, as well as for metabolism of carbohydrates, fats, and proteins. Deficiency in biotin can result in symptoms such as hair loss, brittle nails, and skin rash. Malabsorption of biotin can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation may be necessary for individuals with celiac disease to maintain adequate biotin levels. Vitamin B8 (Inositol) Vitamin B8, also known as inositol, is involved in cell signaling, nerve function, and brain health. Deficiency in inositol can lead to symptoms such as mood swings, anxiety, and difficulty in concentration. In celiac disease, impaired absorption of inositol can occur due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their inositol levels and consider supplementation if necessary. Vitamin B9 (Folate) Vitamin B9, also known as folate, is important for DNA synthesis, red blood cell formation, and fetal development during pregnancy. Deficiency in folate can result in symptoms such as anemia, fatigue, and neural tube defects in newborns. Malabsorption of folate can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of folate may be necessary for individuals with celiac disease, especially during pregnancy. Vitamin B9 (Folic Acid) Folic acid is the synthetic form of folate, often used in dietary supplements and fortified foods. It is converted to folate in the body and plays similar roles in DNA synthesis, red blood cell formation, and fetal development during pregnancy. Deficiency in folic acid can lead to the same symptoms as folate deficiency, including anemia and neural tube defects in newborns. Malabsorption of folic acid can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their folic acid levels and consider supplementation if needed. Vitamin B12 ( Cobalamin) Vitamin B12, also known as cobalamin, is essential for nerve function, DNA synthesis, and red blood cell formation. Deficiency in vitamin B12 can cause symptoms such as fatigue, weakness, and numbness and tingling in the hands and feet. In celiac disease, malabsorption of vitamin B12 can occur due to damage to the small intestine lining, potentially leading to a deficiency. This can further exacerbate the symptoms of celiac disease and affect overall health. Supplementation of vitamin B12 may be necessary for individuals with celiac disease to maintain adequate levels and prevent deficiency-related complications. Vitamin C (Ascorbic Acid) Vitamin C, also known as ascorbic acid, is a powerful antioxidant that plays a critical role in immune function, collagen synthesis, and wound healing. Deficiency in vitamin C can cause symptoms such as fatigue, weakened immune system, and slow wound healing. A severe vitamin C deficiency can also result in scurvy, and early symptoms of scurvy include weakness, feeling tired and having sore arms and legs. In celiac disease, malabsorption of vitamin C can occur due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of vitamin C may be necessary for individuals with celiac disease to maintain adequate levels and support immune function. Vitamin D3 Vitamin D3, also known as the "sunshine vitamin," is crucial for bone health, immune function, and mood regulation. Deficiency in vitamin D3 can cause symptoms such as bone pain, muscle weakness, and increased susceptibility to infections. Malabsorption of vitamin D3 is common in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of osteoporosis, weakened immune system, and mood disorders in individuals with celiac disease. Vitamin D3 supplementation, along with adequate sunlight exposure and a vitamin D-rich diet, may be necessary for individuals with celiac disease to maintain adequate vitamin D levels and support overall health. Vitamin E (Food Sourced) Vitamin E is a powerful antioxidant that protects cells from damage, supports immune function, and helps with DNA repair. Deficiency in vitamin E can cause symptoms such as muscle weakness, impaired vision, and increased oxidative stress. Malabsorption of vitamin E can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of oxidative stress and related health issues in individuals with celiac disease. Vitamin E supplementation, along with a vitamin E-rich diet, may be necessary for individuals with celiac disease to maintain adequate vitamin E levels and support overall health. Vitamin E (Alpha-Tocopherol) Vitamin E, specifically alpha-tocopherol, is the most active and common form of vitamin E in the body. It plays a crucial role in protecting cells from damage, supporting immune function, and maintaining cardiovascular health. Deficiency in alpha-tocopherol can cause symptoms such as muscle weakness, vision problems, and increased risk of cardiovascular disease. Malabsorption of alpha-tocopherol can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of cardiovascular issues and other health complications in individuals with celiac disease. Supplementation of alpha-tocopherol, along with a vitamin E-rich diet, may be necessary for individuals with celiac disease to maintain adequate alpha-tocopherol levels and support overall health. Vitamin K Vitamin K is a fat-soluble vitamin that plays a crucial role in blood clotting and bone metabolism. Deficiency in vitamin K can cause symptoms such as easy bruising, prolonged bleeding, and weakened bones. Malabsorption of vitamin K can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of bleeding disorders and weakened bones in individuals with celiac disease. Vitamin K supplementation, along with a well-balanced diet that includes vitamin K-rich foods such as leafy green vegetables, may be necessary for individuals with celiac disease to maintain adequate vitamin K levels and support overall health. Zinc Zinc is an essential mineral that is involved in various enzymatic reactions, immune function, and wound healing. Deficiency in zinc can cause symptoms such as impaired immune function, delayed wound healing, hair loss, and skin issues. Malabsorption of zinc can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised immune function, delayed wound healing, and related health issues in individuals with celiac disease. Zinc supplementation, along with a diet rich in zinc-containing foods such as meat, fish, dairy products, nuts, and seeds, may be necessary for individuals with celiac disease to maintain adequate zinc levels and support overall health. Conclusion In conclusion, untreated and undiagnosed celiac disease can lead to deficiencies in various nutrients due to malabsorption caused by damage to the small intestine lining. These deficiencies can result in a wide range of symptoms and health effects, including compromised bone health, impaired immune function, nerve-related issues, skin, hair, and nail problems, and other related health concerns. Therefore, it is crucial for individuals with celiac disease to be vigilant about their nutrient intake and work with healthcare professionals to ensure proper monitoring and management of their nutrient levels through a well-balanced diet and, if necessary, appropriate supplementation. Proper management of celiac disease, including adherence to a gluten-free diet, regular monitoring of nutrient levels, and appropriate supplementation when needed, can help individuals with celiac disease maintain optimal health and prevent nutrient deficiencies. Vitamins and Minerals Generally Safe in Excess of Recommended Daily Allowance (RDA): Vitamin C (Ascorbic Acid): Excess vitamin C is usually excreted in the urine and is considered safe in higher doses. However, very high doses may cause digestive upset in some individuals. Vitamin B1 (Thiamine): Water-soluble, excess thiamine is generally excreted through urine. It is considered safe in higher doses but consult with a healthcare professional. Vitamin B2 (Riboflavin): Water-soluble, excess riboflavin is excreted in the urine and is generally safe in higher doses. Vitamin B3 (Niacin): Water-soluble, niacin has a well-defined upper limit, but moderate excess is often excreted. Consultation with a healthcare professional is advisable. Vitamin B5 (Pantothenic Acid): Water-soluble, excess pantothenic acid is generally excreted through urine and considered safe in higher doses. Vitamin B6 (Pyridoxine): While excessive intake from supplements can lead to nerve damage, moderate overages are generally excreted through urine. Vitamin B7 (Biotin): Water-soluble, excess biotin is typically excreted and is considered safe in higher doses. Vitamin B9 (Folate): Excess folate is usually excreted, but extremely high levels from supplements may have potential risks. It's generally safe when consumed through natural food sources. Vitamin B12 (Cobalamin): Water-soluble, excess B12 is typically excreted in the urine and is considered safe in higher doses. Consultation with a healthcare professional is advisable. Choline: While not a true vitamin, choline is water-soluble, and excess is usually excreted. It's considered safe in higher doses but consult with a healthcare professional. Vitamins and Minerals with Potential for Toxicity in Excess of Recommended Daily Allowance (RDA): Vitamin A (Retinol): Excessive vitamin A intake, especially from supplements, can lead to toxicity, causing symptoms like nausea, dizziness, and, in severe cases, organ damage. Vitamin D - While moderate excess may be excreted, prolonged high doses can lead to vitamin D toxicity, resulting in hypercalcemia, kidney damage, and other complications. Vitamin E (Tocopherols): Excess vitamin E is usually excreted, but high doses from supplements may have adverse effects. Obtaining it through a balanced diet is preferable. Vitamin K: Excess vitamin K from supplements can interfere with blood thinning medications and cause issues in some individuals. Iron: Excessive iron intake, especially from supplements, can lead to iron toxicity, causing symptoms like nausea, abdominal pain, and, in severe cases, organ failure. Zinc: While zinc is essential, excessive intake can lead to zinc toxicity, affecting the immune system and causing digestive issues. Copper: High copper levels, often from supplements, can lead to toxicity, causing symptoms such as nausea, vomiting, and liver damage. Selenium: Excessive selenium intake, especially from supplements, can lead to selenosis, causing symptoms like hair loss, gastrointestinal issues, and neurological problems. It's crucial to note that individual tolerances can vary, and supplementation should be done under the guidance of a healthcare professional. Sources: National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Celiac Disease. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray, J. A. (2013). ACG clinical guidelines: Diagnosis and management of celiac disease. The American Journal of Gastroenterology, 108(5), 656-676. doi:10.1038/ajg.2013.79 Complementary Medicine, Penn State Hershey. (n.d.). B vitamins. Retrieved from https://pennstatehershey.adam.com/content.aspx?productId=107&pid=33&gid=000336 National Institutes of Health, Office of Dietary Supplements. (2021). Vitamin B5 (Pantothenic Acid) - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Vitamin B12 - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Chloride - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Iodine - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Magnesium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Phosphorus - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Silicon - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Vanadium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Manganese - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Lycopene - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Lutein and Zeaxanthin - Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Nickel - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Selenium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Iron - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Calcium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Zinc - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Chromium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/
  6. Hi All, I am looking for recommendations for a reliable private uk blood testing company / provider to test me for endomysial antibodies. I don't need a full panel, just those specifically. Can anyone give any recommendations? I am based in north east england, so somewhere nearby or that I can post my sample to would be ideal. But let me know anywhere reliable in the UK. Thanks!
  7. 09/18/2023 - Vomiting and nausea are considered common symptoms related to gluten ingestion in treated celiac disease. However, the overall rates and associated factors of these symptoms after chronic gluten exposure, and acute re-exposure during gluten challenge, remain poorly understood. A team of researchers recently set out to explore the rates and factors associated with vomiting and nausea in individuals with celiac disease, both at the time of diagnosis and during gluten challenges. The research team included Iida Ahonen, Pilvi Laurikka, Sara Koskimaa, Heini Huhtala, Katri Lindfors, Katri Kaukinen, Kalle Kurppa, and Laura Kivelä. They are variously affiliated with the Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; the Department of Internal Medicine, Tampere University Hospital, Tampere, Finland; the Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University and Tampere University Hospital, Tampere, Finland; the Faculty of Social Sciences, Tampere University, Tampere, Finland; and the University Consortium of Seinäjoki, Seinäjoki, Finland. For their study, the researchers collected medical data from 815 adult celiac disease patients at the time of their diagnosis, and an additional 74 patients underwent a three-day gluten challenge. Here are the team's key findings: At The Time of Celiac Disease Diagnosis About one in three patients presented with vomiting at the time of their celiac disease diagnosis. These patients were less likely to have been identified through screening, and more likely to experience various other symptoms. Specifically, patients who suffered from vomiting had about a 20% higher occurrence of abdominal pain, diarrhea, and weight loss, along with a nearly 30% higher rates of childhood symptoms, compared to those without vomiting. During a Gluten Challenge During the short-term gluten challenge, nearly 20% of patients experienced vomiting/nausea. Interestingly, those who consumed gluten-free oats less frequently were about 30% more likely to experience these symptoms. There were no significant differences between the two groups in terms of other clinical-demographic characteristics, duration of a gluten-free diet, or other symptoms. Literature Review The study also conducted a literature review, which revealed a wide range in the prevalence of vomiting/nausea in celiac disease patients, both at diagnosis (ranging from 3% to 46%), and during gluten challenges (ranging from 13% to 61%). Overall, vomiting and nausea appear to be relatively specific symptoms associated with gluten ingestion in individuals with treated celiac disease. At diagnosis, those experiencing vomiting tended to have a higher rates of other gastrointestinal symptoms and an earlier onset of symptoms in childhood. During a gluten challenge, reduced consumption of gluten-free oats was linked to a higher likelihood of vomiting/nausea. The prevalence of these symptoms varied widely in the existing literature. This research provides valuable insights into the presentation of symptoms in celiac disease patients, shedding light on factors associated with vomiting and nausea both at diagnosis and during gluten challenges. Read more at bmcgastroenterology.com

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  9. Celiac.com 09/27/2023 - A team of researchers recently set out to explore duodenal villous atrophy in adults with suspected celiac disease without IgA deficiency. The research team included Prof Carolina Ciacci, MD, Prof Julio Cesar Bai, MD, Geoffrey Holmes, MD, Abdulbaqi Al-Toma, MD, Prof Federico Biagi, MD, Prof Antonio Carroccio, MD, Rachele Ciccocioppo, MD, Prof Antonio Di Sabatino, MD, Rachel Gingold-Belfer, MD, Mariana Jinga, MD, Prof Govind Makharia, MD, Sonia Niveloni, MD, Gary L Norman, PhD, Kamran Rostami, MD, Prof David S Sanders, MD, Edgardo Smecuol, MD, Vincenzo Villanacci, MD, Santiago Vivas, MD, and Fabiana Zingone, MD, on behalf of theBi.A.CeD study group. The team conducted a multi-center, prospective cohort study to assess the accuracy of serum anti-tissue transglutaminase IgA (tTG-IgA) in diagnosing celiac disease in adults. The study included adult participants aged 18 years or older, with suspected celiac disease, who were not on a gluten-free diet, and did not have IgA deficiency. The participants were enrolled from 14 tertiary referral centers across different regions from February 27, 2018, to December 24, 2020. The main objective was to determine whether serum tTG-IgA tests could reliably diagnose celiac disease based on duodenal villous atrophy. The study included 436 participants (296 women and 140 men) with complete data on serum tTG-IgA and duodenal histology. Of these, 363 participants had positive serum tTG-IgA results, and 73 had negative results. After local review, it was found that 341 of the participants with positive serum tTG-IgA had positive histology (true positives), while 22 had negative histology (false positives). Among the 73 participants with negative serum tTG-IgA, seven had positive histology (false negatives), and 66 had negative histology (true negatives) after local review. Study Findings: Positive Predictive Value of 95.9% for Celiac Disease Serum tTG-IgA The study's findings showed a positive predictive value of 93.9% and a negative predictive value of 90.4% for serum tTG-IgA in diagnosing celiac disease. The sensitivity was 98.0%, indicating the test's ability to correctly identify true positive cases, while the specificity was 75.0%. After central re-evaluation of duodenal histology in discordant cases, the positive predictive value increased to 95.9%, and specificity improved to 81.5%. The sensitivity remained high at 98.0%. The study also found that the positive predictive value of serum tTG-IgA increased as the serological threshold was defined at higher multiples of the upper limit of normal (ULN). The area under the receiver operating characteristic curve (AUC) for serum tTG-IgA was 0.87 for the categorical definition (positive vs. negative) and 0.93 for the numerical definition (multiples of the ULN) in predicting duodenal villous atrophy. Conclusion Based on the data, the study suggests that in adults with a reliable suspicion of celiac disease and high serum tTG-IgA levels, a biopsy may reasonably be avoided in the diagnostic process. This information can be valuable in improving the efficiency and accuracy of diagnosing celiac disease in certain cases, reducing the need for biopsy. Read more in The Lancet Gastroenterology and Hepatology Note: The researchers are variously affiliated with the Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy; the Research Institutes, Universidad del Salvador, Buenos Aires, Argentina; the Small Bowel Section, Dr C Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina; Department of Gastroenterology, Royal Derby Hospital, Derby, UK; the Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands; the Department of Internal Medicine and Medical Therapy, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy; the Gastroenterology Unit of Pavia Institute, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy; the Unit of Internal Medicine, Cervello Hospital, University of Palermo, Palermo, Italy; the Gastroenterology Division, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel; the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; the Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, Central Military Emergency University Hospital, Bucharest, Romania; the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India; the Research and Development, Headquarters and Technology Centre for Autoimmunity, Werfen, San Diego, CA, USA; the Gastroenterology Unit, MidCentral DHB, Palmerston North, New Zealand; the Academic Unit of Gastroenterology, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK; the Institute of Pathology, Spedali Civili University of Brescia, Brescia, Italy; the Gastroenterology Unit, University Hospital of Leon, Leon, Spain; and the Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy, on behalf of the Bi.A.CeD study group.
  10. Celiac.com 08/11/2023 - Celiac disease is a chronic autoimmune disorder marked by an immune-mediated response to gluten, resulting in small intestinal mucosal damage. Every so often, we share reports of individual cases that are relevant to celiac disease. Here, we share the case of a 52-year-old woman who was discovered to have celiac disease after being treated for extreme thrombocytosis and severe anemia. While gastrointestinal symptoms are commonly associated with celiac disease, atypical presentations can pose diagnostic challenges, particularly when hematological abnormalities are the primary manifestation. A team of clinicians report the case of a 52-year-old female patient who presented with unusual symptoms, including numbness in her hands and feet, extreme thrombocytosis, extreme thinness, severe anemia, high platelet count, and mild electrolyte imbalance. The Research Team The clinical team included Cuauhtemoc Jeffrey Soto, Lokeshwar Raaju Addi Palle, Mefthe Berhanu, Yordanos G. Negassi, Saima Batool, and Shaniah S. Holder. They are variously affiliated with the department of Research and Development at the Universidad Juarez del Estado de Durango, Mexico, the department of General Surgery, Hackensack Meridian Health-Palisades Medical Center, North Bergen, USA; the Department of Surgery, Kamala Children's Hospital in Chennai, India; the Health Science Department, University of Texas Health Science Center at Houston, Texas, USA; the department of Internal Medicine, Orotta, California, USA; the department of Internal Medicine, Hameed Latif Hospital in Lahore, Pakistan; and the department of Medicine, American University of Barbados School of Medicine in Bridgetown, Barbados. Physical examination of the patient showed nothing remarkable, except for notable thinness. The patient showed no gastrointestinal symptoms, and had no family history of gastroenterological diseases. Diagnostic tests, including blood tests and duodenal biopsy, confirmed the diagnosis of celiac disease with grade 4 Marsh 3C classification, even though the patient lacked typical gastrointestinal symptoms. Celiac Disease as a Cause of Thrombosis This case highlights the importance of considering celiac disease as a potential cause for atypical hematological manifestations, such as extreme thrombocytosis resulting from severe anemia. Prompt recognition and appropriate management, such as adhering to a gluten-free diet, can lead to symptom improvement and the resolution of hematological abnormalities. Identifying celiac disease even in the absence of typical gastrointestinal symptoms can lead to important treatment and improved quality of life for patients. Healthcare professionals need to be aware of such atypical presentations to ensure early diagnosis and better patient outcomes. Read more at cureus.com
  11. Celiac 08/01/2023 - The Schär company is known for making a wide range of popular gluten-free foods, including gluten-free pastas and breads. However, a test the company is offering, for self-diagnosing celiac disease, has come under scrutiny for potentially promoting misdiagnosis of people with the condition. The test, available online on the company’s website, has raised concerns over its accuracy, and the growing trend of promoting self-diagnosis of celiac and other diseases. Celiac disease is a serious autoimmune condition triggered by gluten consumption. Many cases of celiac disease go undiagnosed, leading to individuals ignoring, or dismissing their symptoms. Early detection is now possible, but self-diagnosis has become a growing trend. Schär Questionnaire About Gluten Consumption & Symptoms To deliver results, the Schär test asks individuals questions about their gluten consumption and symptoms. While not intended to replace professional diagnosis, the test suggests potential gluten intolerance based on common symptoms like fatigue or headaches. Critics argue that the test may overstate celiac disease risk, even for minor symptoms. In a test trial, an individual without any gluten intolerance symptoms took the Schär test. Although it did not detect any potential celiac disease, the individual still sought medical advice due to the questionnaire's prompting. This raises concerns about the test's accuracy and reliability, as well as the growing self-diagnosis trend. Medical professionals emphasize the importance of consulting doctors for proper diagnosis, warning against relying solely on online tests. Celiac disease is complex and requires thorough evaluation by medical professionals to avoid unnecessary dietary restrictions and health risks. Seeking professional medical advice is crucial for an accurate diagnosis and proper management of the condition. Read more at breakinglatest.news
  12. Celiac.com 07/25/1996 (Updated: 12/29/2020) - Like many people with celiac disease (it's an autoimmune disease and not a wheat allergy or the same as gluten sensitivity, gluten intolerance, or sensitivity to gluten), I spent a lot of years and money and endured many tests and misdiagnoses before doctors finally discovered that I needed to avoid gluten (including all gluten containing ingredients). Gluten is a protein found in gluten containing grains that include wheat, rye, and barley, and is often hidden in processed foods. To treat my celiac disease I had to go on a gluten-free diet for life, which meant that I had to learn to read food labels, and I ate mostly naturally gluten-free foods like meats, fruits, nuts, vegetables, gluten-free breads, and foods that were labeled gluten-free or made using gluten-free grains. My symptoms, which included weight loss, abdominal pain (especially in my middle-right section while sleeping), bloating, and long-term diarrhea, slowly disappeared. Because of the large variety of symptoms associated with celiac disease, and the fact that many celiacs have few or no symptoms, diagnosis can be very difficult, which is why is still takes an average of 6-10 years to get diagnosed. Most medical doctors are taught to look for classic symptoms and often make a wrong diagnosis, or no diagnosis at all. During my doctor visits my diet was never discussed, even though most of my symptoms were very typical, and greatly related to food digestion. A simple (and free!) exclusionary diet would have quickly revealed my problem. An exclusionary diet involves eliminating wheat, rye, oats, barley, dairy products, soy and eggs for several weeks, and recording any reaction as you slowly add these foods back into your diet. Unfortunately it took my doctors over two years to make a diagnosis, and during that time I was misdiagnosed with Irritable Bowel Syndrome (IBS), told that I could have cancer or a strange form of Leukemia, treated for a non-existent ulcer with a variety of antibiotics that made me very ill, and was examined for a possible kidney problem. I also underwent many unnecessary and expensive tests including CAT Scans, thyroid tests, an MRI, tests for bacterial infections and parasites, ultrasound scans, and gall bladder tests. Ultimately the only reason I every got my diagnosis was because I ended up reading something about it in a book on nutrition, which led me to ask my doctor to be screened for it. I was finally diagnosed via a blood test for celiac disease, followed by a biopsy of my small intestine (which is not as bad as it sounds). A full recovery took me 2-3 years, and during that time I also had temporary food intolerance issues to things like dairy (casein), corn, tomatoes, and chicken eggs. During the 1-2 year time period after going 100% gluten-free I was thankfully able to add those things back to my diet. I created Celiac.com to help others avoid a similar ordeal. I also want to provide people who know they have the problem with information which will improve their quality of life, and broaden their culinary horizons. To do this, I have compiled information from a large variety of sources including medical journals, books, doctors, scientists, and news sources, and posted it all right here. Many of our articles are written by medical professionals such as nurses, doctors, and other celiac disease experts.
  13. Celiac.com 06/09/2023 - Natasha Contardi's three-year-old daughter, Teagan, had gluten-related health issues to since birth. Concerned about whether Teagan had celiac disease or was simply gluten intolerant, Contardi sought medical advice. Teagan had already tested positive for the celiac gene, so Contardi decided to have her undergo tests for celiac disease at the Montreal Children's Hospital. To ensure accurate results, doctors advised that Teagan needed to consume gluten for 12 weeks before the blood tests. During this period, Teagan suffered from various symptoms, including loss of appetite, stomach pain, emotional distress, itchy rashes, and discomfort during bowel movements. After enduring the 12-week period and undergoing the blood tests, Contardi faced another setback. Weeks passed without receiving any test results. After persistent inquiries, she discovered that the tests had not been performed due to an error, rendering the samples unusable. The hospital staff then informed a distraught Contardi that Teagan would need to restart the entire process, including another 12 weeks of consuming gluten. Contardi expressed her devastation, both physically and emotionally, upon receiving this news, as her daughter had unnecessarily suffered for three months. "I do not even have the words to get across how physically and emotionally ruined I was when the doctor called me. It was devastating,” Contardi said. “Three full months of suffering for my daughter that did not have to happen." The Montreal Children's Hospital did not comment on Teagan's case specifically, but acknowledged that errors in testing are rare and delays can occur due to staffing issues. Contardi emphasized the importance of advocating for one's child's health, and not accepting prolonged delays or dismissive attitudes from medical professionals. She urged parents to continue fighting and seeking answers to ensure the well-being of their children. Contardi is anxiously awaiting the completion of the second testing process for Teagan, and hopes to find clarity regarding her daughter's condition. Read more at globalnews.ca
  14. Hi all, I had a colonoscopy and endoscopy for GI symptoms, my report came back stating: Diagnosis A. DUODENAL BIOPSIES SHOWING PARTIAL VILLOUS ATROPHY WITH INCREASE IN MUCOSAL AND EPITHELIAL LYMPHOCYTES SUGGESTIVE OF CELIAC DISEASE. SUGGEST RESULTS OF BLOOD TESTS AND PATIENT'S RESPONSE TO GLUTEN FREE DIET FOR A DEFINITIVE DIAGNOSIS. B. GASTRIC BIOPSY SHOWING ANTRAL MUCOSA WITH MILD CHRONIC GASTRITIS. I had my bloodwork done today and all numbers are within normal range so I’m confused whether it is celiac or not? Or wondering if the bloodwork is a false negative? I was supposed to start the gluten-free diet this week but wondering if I need to hold off? My doctor takes ages to get back with follow ups. Bloodwork: IgG results: 12.54 reference: 6.00-16.00g/L IgM results: 1.13 reference: 0.30-2.30 g/L Immunoglobulin IgA results: 1.82 reference: 0.54-4.17 g/L I’ll ultimately wait for the doctor to respond but unsure if i should go gluten free in the meantime or not? Thanks!
  15. Hi everyone, I am new to this site and hoping people may have a bit of advice for me. We’ve recently started trying to conceive, but unfortunately have had two miscarriages with a growth of under 6 weeks each. I’ve never had an official diagnosis, but myself/my doctor suspected I had gluten sensitivity around eight years ago when I was also being diagnosed with endometriosis. As I didn’t have any pain/bloating that was particularly bad, I continued with my normal diet including gluten. Not until my second miscarriage did anyone mention a link between eating gluten and miscarriages. I’m now on a strict gluten diet - but the wait time for testing to see how bad the damage is isn’t for another nine months, which seems like a really long time to just have the test done, let alone wait for results and know if I’m on the right track. I want to do as much as possible to limit the chances of another miscarriage, while knowing this might not be the only cause of the problems (e.g endometriosis). can people advise on how long I should be gluten free before I even consider trying again, and what vitamins etc I should be taking in the meantime to try and boost my chances?
  16. Celiac.com 04/26/2023 - Celiac disease is a common chronic disorder, but there's a lack of information on its current prevalence and detection rate. To get a better picture of the actual situation on the ground, a research team conducted a mass screening of school-ages children in Italy to assess the prevalence and detection rate of celiac disease among school-age children in Italy using a multi-center mass screening approach. The team included Elena Lionetti, Dorina Pjetraj a, Simona Gatti a, Giulia Catassi, Antonella Bellantoni c, Massimo Boffardi, Mara Cananzi, Mauro Cinquetti j, Ruggiero Francavilla, Basilio Malamisura, Monica Montuori, Gianvincenzo Zuccotti, Fernanda Cristofori, Paola Gaio, Tiziana Passaro, Francesca Penagini, Alessandra Testa, Chiara Maria Trovato, and Carlo Catassi. Nearly 6,000 children were eligible for the study, 4.438 participated and nearly 2,000 showed predisposing haplotypes for celiac disease. The team used HLA-DQ2 and -DQ8 determination on a drop of blood and total serum IgA and IgA anti-transglutaminase to determine the diagnosis of celiac disease, as per the European guidelines. The overall prevalence of celiac disease was 1.65%, with only 40% of children diagnosed prior to the school screening. Interestingly, symptoms of celiac disease were as common in celiac children as in control subjects. The study revealed that the rate of celiac disease in school-age Italian children was one of the highest in the world, and without a mass screening strategy, 60% of celiac patients remain currently undiagnosed in Italy. This highlights the importance of mass screening strategies and early detection of celiac disease to reduce the burden of the disease and its associated complications. The study also showed that determination of HLA predisposing genotypes is an easy and fast first-level screening test for celiac disease, which can be used to identify children who require further diagnostic testing. Read more in Science Direct The researchers are variously affiliated with the Division of Pediatrics and Center for Celiac Research, DISCO Department, Marche Polytechnic University, Ancona, Italy; the Pediatric Gastroenterology and Liver Unit, Department of Maternal and Child Health, Sapienza-University of Rome, Rome, Italy; the Department of Pediatrics, Bianchi-Melacrino Morelli Hospital in Reggio Calabria, Italy; the Pediatric Unit and Center for Celiac Disease - University Hospital of Salerno, Campus of Cava de' Tirreni, Italy; the Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, Dpt. of Women's and Children's Health, University Hospital of Padova, Italy; the Pediatric Section, Department of Interdisciplinary Medicine, University of Bari, Italy; the Department of Pediatrics, Vittore Buzzi Children's Hospital at University of Milan, Italy; the Clinical Biochemistry Unit, National Research Council, Reggio Calabria, Italy; the Hepatology Gastroenterology and Nutrition Unit, "Bambino Gesù" Children Hospital in Rome, Italy; and the Department of Pediatrics, "G. Fracastoro" Hospital in Verona, Italy.
  17. Celiac.com 01/16/2023 - We get a lot of questions about celiac disease and related conditions. Recently, we've seen a lot of questions from people wondering about the difference between Irritable Bowel Syndrome (IBS), and celiac disease. We've done a number of articles on how the two conditions can sometimes have similar symptoms. How do you know which is which? What's the difference in symptoms, diagnosis, and treatment? Celiac disease is an auto-immune condition in which wheat, rye, or barley triggers gut damage. Irritable bowel syndrome (IBS) is a complex gastrointestinal disorder that can cause a significant decrease in patient quality of life. Doctors and researchers still know very little about the origins or triggers for IBS. IBS is More Common than Celiac Disease While celiac disease affects about one percent of the population, IBS affects 10 to 15 percent of the U.S. population. It is more common in women, but can affect individuals of both genders and all ages. IBS and Celiac Can Have Similar Symptoms The cause of IBS remains poorly understood by medical professionals. Experts believe IBS symptoms may have more than one cause. IBS is often marked by numerous symptoms, including abdominal pain, constipation and diarrhea, or both constipation and diarrhea, as well as bloating, nausea and vomiting. The most common symptom associated with IBS is abdominal pain. Symptoms of celiac disease can include diarrhea, constipation, nausea, vomiting, stomach cramps, gas and bloating, or weight loss. Some people also have anemia, acid reflux or heartburn, itchy skin rashes or blisters, numb or tingly feet or hands, joint pain, headaches, mouth sores, or damage to tooth enamel. However, many IBS symptoms are also common in celiac disease. To make matters more confusing, numerous studies have shown that a high percentage of patients with IBS are also sensitive to gluten. Even though many of these symptoms can mimic celiac disease, most people with IBS typically do not have celiac disease. In addition to celiac disease, a number of other diseases can mimic IBS, including inflammatory bowel disease, bacterial infections, colon cancer, and thyroid disease. These diseases typically show more severe symptoms, including rectal bleeding, weight loss and low blood counts, which are not normally seen in patients with IBS. However, IBS does not lead to an increased risk of cancer. No Easy Way to Diagnose IBS Whereas many conditions, like celiac disease, can be spotted by screening, examinations or testing, IBS is a disease that requires ruling out other contains for a diagnosis. Once other diseases and conditions are ruled out, IBS is often left as the only option standing, and so becomes the the accepted diagnosis. Rule Out Other Diseases to Diagnose IBS In order to diagnose IBS, other diseases, including celiac disease, must first be ruled out. That usually means a celiac disease blood screen, and possibly a colonoscopy or upper endoscopy. It also typically means screens and tests to rule out other conditions with similar symptoms. Easy to Rule Out Celiac Disease While some of the symptoms of IBS and celiac disease can be similar, it's usually fairly easy to test for celiac disease, and to rule it in or out based on screening results. Unlike people with celiac disease, most people with IBS do not suffer from damage to the intestinal villi. Most people with IBS will test negative for a celiac disease blood screen, and show no celiac-associated gut damage. Obviously, patients with celiac disease rarely also have IBS. So, if celiac disease is diagnosed, that's usually the end of the confusion. If celiac disease is ruled out, then the diagnostic journey can continue until other possible conditions and diseases are ruled out as well. Treatment for IBS Unlike celiac disease, where a gluten-free diet usually resolves symptoms and returns normal gut health, treatment of IBS is largely a matter of managing the symptoms. First treatment options should start with diet. If you suspect you have IBS, it's good to keep a food journal. Write down everything you eat and drink, and how you feel afterward. Try to eliminate any foods or drinks that seem to cause symptoms. Gluten-Free Diet Helps Some IBS Patients Many patients with IBS respond to a gluten-free diet. However, a gluten-free diet is typically not recommended for the treatment of IBS. That's because it usually won't resolve the symptoms on its own, and many people with IBS do seem to tolerate gluten with no issues. Low FODMAP Diet Helps Some IBS Patients One recent study shows that IBS patients on a low FODMAP diet show marked reduction in IBS symptom severity, along with reduced levels of fecal calprotein after the gut microbiota return to normal. If your doctor suspects IBS, it's best to consult a dietician or nutritionist before you embark on a gluten-free or a low-FODMAP diet. Typically, foods that may trigger symptoms are slowly reintroduced into the diet after about six weeks. In addition to dietary measures, psychological interventions, such as counseling and exercise, have been shown to improve IBS symptoms. Yogurt Can Help Resolve IBS Symptoms A recent study shows that homemade yogurt resolves IBS symptoms in most patients. Medicine Can Help Control IBS Symptoms Unlike celiac disease, medicines, such as peppermint oil, fiber, minimally absorbed antibiotics, anti-nausea medications, anti-diarrheal medication, laxatives, anti-spasmodics and anti-depressants, can sometimes help improve IBS symptoms. Probiotics are not typically used to treat IBS, but might be an option based on your particular symptoms. Check with your doctor. Exercise and Counseling Can Help IBS Patients Regular gentle exercise, such as walking, yoga and swimming are helpful for IBS. Exercise helps to relieve stress, release anti-oxidants and endorphins, and improve gut health. Some research indicates that alternative therapy, including acupuncture, yoga, hypnosis, meditation, and physical therapy, may help to alleviate IBS symptoms. Counseling, especially cognitive behavioral therapy, can also help IBS patients to keep an eye on their GI symptoms. No cure for IBS Unlike celiac disease, in which gut damage usually reverses, and symptoms usually improve, on a gluten-free diet, IBS cannot be cured. But IBS can be managed to achieve minimal symptoms. Therapy for IBS must be tailored for each patient, usually in consultation with the physician, often by trial and error. There are many great resources available for IBS patients, including helpful websites, support groups, and phone apps to track symptoms and food intake. Though IBS can be painful and confusing, many patients improve once they are diagnosed and begin to work actively to reduce symptoms and manage the condition. Read more at WebMD.com
  18. Celiac.com 12/24/2022 - My doctor is a nice guy. He is also very bright and has an impressive memory for many things. He couldn’t have gotten through medical school—he couldn’t even have gotten acceptance into medical school without being pretty capable. But he can’t know as much about me as I do. Neither has he observed my children for as long or with as much concern as I have. If we are ever to achieve balanced relationships with physicians, we must all acknowledge our own, and each others’ expertise. The history of the discovery of the gluten-free diet is really a story that should improve doctor-patient collaboration if the facts ever become widely known. World War II Grain Shortages or Concerned Mom? Not long ago I listened to a speaker, once again, crediting World War II grain shortages in The Netherlands for Dr. Dicke’s discovery of the gluten-free diet as the treatment of choice for patients with celiac disease. This is a myth that has been perpetuated for far too long. This faulty tale sullies the memory of a great scientist, Dr. Willem Karel Dicke, and robs a concerned mother of the credit she richly deserves. The facts are available in Dr. Dicke’s Ph. D. thesis. Dr. Chris Mulder has generously provided an English translation of Dr. Dicke’s thesis. In his thesis, Dr. Dicke clearly states that the insight came from a 1932 meeting with two colleagues and a discussion of their observations of a child with celiac disease. This was long before World War II even began, and the grain shortages actually occurred late in the war. Further, in the follow-up commentary at the end of the translation, Dr. Mulder reveals that the idea, which led to these 1932 insights, originated with a concerned mother’s observations of her own child, and her comments to Dicke’s colleagues. The myth about World War II grain shortages simply does not jibe with the facts. It seems far more likely that a concerned mom, not a busy pediatrician, would notice what a child ate and how that affected his bowel movements. To my ears, this latter explanation has the ring of truth. The question of who deserves the credit for this pivotal insight may not appear very important. However, our increasingly specialized society pressures us to place more and more trust in the specialist, whether lawyer, doctor, or auto mechanic. When we are placing our own and our children’s health and safety in the hands of another person, we may reasonably expect these specialists get their facts straight on simple historical issues that can easily be investigated. Investigating a Mother's Hypothesis Dr. Dicke’s important role, as a physician and a man of science, was to investigate this concerned mother’s hypothesis. His memory is enhanced by the recognition he freely rendered to the originators of the idea. We not only violate his memory, we insult his stature as a scientific investigator, when we perpetuate the false claim that the chance occurrence of WW II grain shortages led to the discovery of the treatment value of a gluten-free diet. More importantly, this question speaks to the importance of trusting ourselves, our own observations, and our own assessments—our own gut, if you will, in our quest for health. Dr. Dicke’s work was extremely important and it constituted a huge contribution to Humanity. His research has already saved countless lives and will continue to do so. But we need to remember that the original insight that identified the trigger for celiac disease came from an observant mother. In remembering this, many of us will feel empowered to collaborate with our physicians, rather than blindly accepting yet another useless prescription. And that is the pivotal importance of publicly recognizing where the idea of a gluten-free diet originated. We need to recognize that the physician’s expertise is only one important element in the diagnostic and treatment process. We may often defer to doctors’ superior knowledge of medical issues. However, our own expertise, as the occupants of our bodies, or as parents, must also contribute to this process and our subsequent healing. We need to trust our own observations and judgement. Dismissal or denigration of our unique expertise bespeaks a competitive spirit; not a collaborative one. Such a competitive attitude may weaken the diagnostic process and hinder our recovery.
  19. Celiac.com 03/04/2004 - Gluten sensitivity is the process by which the immune system reacts to gluten contained in wheat, barley, rye, and oats. The reaction begins in the intestine because that is where the inciting antigen, gluten, is present (from food). When this immunologic reaction damages the finger-like surface projections, the villi, in the small intestine (a process called villous atrophy), it is called celiac disease (or sometimes celiac sprue or gluten-sensitive enteropathy). The clinical focus of gluten-induced disease has always been on the intestine because that is the only way the syndrome was recognized before screening tests were developed. The intestinal syndrome consists mainly of diarrhea, gas, bloating, nausea, vomiting, fat in the stool, nutrient malabsorption, and even constipation. Although the small intestine is always the portal of the immune response to dietary gluten, it is not always affected in a way that results in villous atrophy. Even though recent research has shown that celiac disease is much more common than previously suspected, affecting 1 in 100-200 Americans and Europeans, past and emerging evidence indicates that it accounts for only a small portion of the broader gluten sensitive clinical spectrum (often referred to as the "Tip of the Gluten Sensitive Iceberg"). With better understanding of how gluten triggers immune and autoimmune reactions in the body under the control of various genes, and advancing techniques of detecting these reactions, it is becoming apparent that the majority of the gluten sensitive population (the submerged "mass of the iceberg") do not manifest villous atrophy in its classic, complete form and therefore do not have celiac disease. In these non-celiac, gluten sensitive individuals, the brunt of the immune reaction either affects the function of the intestine, causing symptoms without structural damage, affects other tissues of the body (and virtually all tissues have been affected in different individuals), or both. This is important because the commonly used diagnostic tests of clinically important gluten sensitivity (blood tests for certain antibodies and intestinal biopsies) are only positive when villous atrophy of the small intestine is present. But if only a small minority of gluten sensitive individuals actually develop celiac disease, the majority, who have not yet or may never develop villous atrophy, with or without symptoms, can remain undiagnosed and untreated for years. This can result in significant immune and nutritional consequences, many of which are irreversible even after treatment with a gluten-free diet. Some of these disorders include loss of hormone secretion by glands (hypothyroidism, diabetes, pancreatic insufficiency, etc), osteoporosis, short stature, cognitive impairment, and other inflammatory bowel, liver, and skin diseases, among others. Only with early diagnosis, can these problems be prevented or reversed. I am here to report on a scientific paradigm shift regarding early diagnosis of gluten sensitivity based on about 30 years of medical research by myself and others. My message is that earlier and more inclusive diagnosis of gluten sensitivity than has been allowed by blood tests and intestinal biopsies must be developed to prevent the nutritional and immune consequences of long-standing gluten sensitivity. Imagine going to a cardiologist because your blood pressure is high or you're having chest pain, and the doctor says he is going to do a biopsy of your heart to see what is wrong. If it "looks" O.K., you are told you have no problem and no treatment is prescribed because you have not yet had a heart attack showing on the biopsy. You would not think very highly of the doctor utilizing this approach because, after all, isn't it damage to the heart that you would want to prevent? But for the intestine and gluten sensitivity, current practice embraces this fallacious idea that until an intestinal biopsy shows structural damage, no diagnosis or therapeutic intervention is offered. This has to change now because with newly developed diagnostic tests, we can diagnose the problem before the end stage tissue damage has occurred, that is "before the villi are gone," with the idea of preventing all the nutritional and immune consequences that go with it. There are many misconceptions regarding the clinical presentation of gluten sensitivity or celiac disease: For example, that you cannot be gluten sensitive if you have not lost weight, are obese, have no intestinal symptoms, or are an adult or elderly. However, the most widely held and clinically troublesome misconception is that a negative screening blood test, or one only showing antigliadin antibodies (without the autoimmune antiendomysial or anti-tissue transglutaminase antibody) rules out any problem caused by gluten at that time or permanently. For some reason, the high "specificity" of these blood tests has been tightly embraced. Specificity means if the test is positive, you surely have the disease being tested for with little chance that the positive is a "false positive." But sadly, a negative test does not mean you do not have the problem. This is the biggest pitfall of all because the only thing a very specific test, like blood testing for celiac disease, can do is "rule in" the disease; it can not "rule it out." If you've got very far advanced and/or long-standing celiac disease, it is likely that the test will be positive. However, several studies have now revealed that it is only those with significant villous atrophy of the small intestine who regularly show a positive antiendomysial or anti-tissue transglutaminase antibody, the specific tests relied upon most heavily for diagnosis of gluten-induced disease. When there was only partial villous atrophy, only 30% had a positive test. More disturbing perhaps, were the results with respect to screening first degree relatives of celiacs with blood tests. Despite some biopsy-proven early inflammatory changes in the small intestine but without villi damage, all blood tests were negative. For some reason, it's been perfectly acceptable to celiac diagnosticians that a patient must have far advanced intestinal gluten sensitivity, i.e., villous atrophy, to be diagnosed and a candidate for treatment with a gluten-free diet. That means from the specific testing standpoint, there's never (or rarely) a false positive. But what about the larger majority of gluten-affected people who do not presently have or may never get this end stage, villous atrophic presentation? They are out of luck as far as blood testing is concerned. So the fact is that we have erroneously relied on specificity (always picks up gluten sensitivity after it has caused villous atrophy, never having a false positive) instead of sensitivity (doesn't miss gluten sensitive people even though they might be picked up early, even before full-blown celiac disease develops). Would a test relying on specificity rather than sensitivity be good enough for you, or your children? Consider the risk of not getting an early diagnosis versus going on a gluten free diet a few months or years prematurely. While I do not recommend anyone to have a biopsy (especially children) for diagnosis because of the shortcomings and invasive nature of this technique, I particularly do not want someone to have a biopsy showing villous atrophy, since by that time, associated bone, brain, growth, and/or gland problems are all but guaranteed. And here is another related problem: You have a positive blood test, but, if a small bowel biopsy comes back normal or nearly normal, you are told that the blood test must have been a "false positive" and that gluten is not your problem. Would you believe that, especially in light of the fact that most such people would have gotten the blood test in the first place because of a specific symptom or problem? Let's hope not. All that means (positive blood test, negative biopsy) is that the gluten sensitivity (evidenced by antibodies to gliadin in the blood) has not yet damaged your intestines severely. Evidence of this comes from a study that I performed. We tested 227 normal volunteers with blood tests for celiac disease. Twenty-five of these people (11%) had either antigliadin IgG or IgA in their blood versus only one (0.4%) that had antiendomysial, anti-tissue transglutaminase, and antigliadin IgA in the blood. So for every one person in a population that has the antibodies that have 100% specificity for celiac disease of the intestine (antiendomysial and anti-tissue transglutaminase), there are 24 that have antibodies to gliadin that may not have celiac disease. So what is going on with the 11% with antigliadin antibodies in blood? Are these false positives (rhetorically)? You're telling me that there is a disease called celiac disease and it is associated with antibodies to gliadin in the blood and sometimes it damages the intestine? But people with antigliadin antibody in their blood but no other antibodies do not have a clinically significant immunologic reaction to gluten? Do you see the problem? How can 11% be false positives? What about the 89% with none of these antibodies? You cannot equate having no antibodies at all (a negative test) with having antigliadin antibodies alone. If you have antibodies to gliadin, something is going on here. Where there's smoke there's fire. The purpose of this study was to test this hypothesis: That an antigliadin antibody alone does indicate the presence of an immune reaction to gluten that may be clinically important. Using tests for intestinal malabsorption and abnormal permeability (i.e., tests of small bowel function, unlike a biopsy which says nothing about function), we found that 45% of people with only an antigliadin IgG or IgA antibody in blood (without either antiendomysial or anti-tissue transglutaminase antibody) already had measurable intestinal dysfunction, compared to only 5% of people with no antibodies to gliadin in their blood. When we did biopsies of these people's intestines, none had villous atrophy with only a few showing some early inflammation. Thus, having an antigliadin antibody in your blood does mean something: That there is nearly a 1 in 2 chance that functional intestinal damage is already present even though it may not be visible structurally at the resolution attained by a light microscope assessment of a biopsy. As mentioned at the outset, not all gluten sensitive individuals develop villous atrophy. Evidence for this has been around for a long time. In 1980, a medical publication titled "Gluten-Sensitive Diarrhea" reported that eight people with chronic diarrhea, sometimes for as long as 20 years, that resolved completely when treated with a gluten-free diet, had mild small bowel inflammation but no villous atrophy. In 1996 in a paper called "Gluten Sensitivity with Mild Enteropathy," ten patients, who were thought to have celiac disease because of a positive antiendomysial antibody blood test, had small bowel biopsies showing no villous atrophy. But amazingly, these biopsies were shown to react to gluten when put in a Petri dish, proving the tissue immunologically reacted to gluten (which was likely anyway from their positive blood tests). Two other reports from Europe published in 2001 showed gluten sensitivity without villous atrophy (and hence without celiac disease). In one of these studies, 30% of patients with abdominal symptoms suggestive of irritable bowel syndrome having the celiac-like HLA-DQ2 gene but no antibodies to gliadin in their blood, had these antibodies detected in intestinal fluid (obtained by placing a tube down into the small intestine). Thus, in these people with intestinal symptoms, but normal blood tests and biopsies, the antigliadin antibodies were only inside the intestine (where they belong if you consider that the immune stimulating gluten also is inside the intestine), not in the blood. This is the theme we have followed in my research, as we are about to see. More proof that patients in these studies were gluten sensitive came from the fact that they all got better on a gluten-free diet, and developed recurrent symptoms when "challenged" with gluten. Although the gluten-sensitive patients in these studies did not have the villous atrophy that would yield a diagnosis of celiac disease, small bowel biopsies in many of them showed some, albeit minimal, inflammatory abnormalities. Yet, when a symptomatic patient in clinical practice is biopsied and found to have only minimal abnormalities on small bowel biopsy, clinicians do not put any stock in the possibility of their having gluten sensitivity. As much as I would like to take credit for the concept, you can see from these studies that I did not invent the idea that not all gluten sensitive patients have villous atrophy. It has been around for at least 23 years, and reported from different parts of the world. For many years there has also been proof that the intestine is not the only tissue targeted by the immune reaction to gluten. The prime example of this a disease called dermatitis herpetiformis where the gluten sensitivity manifests primarily in skin, with only mild or no intestinal involvement. Now from more recent research it seems that the almost endless number of autoimmune diseases of various tissues of the body also may have the immune response to dietary gluten and its consequent autoimmune reaction to tissue transglutaminase as the main immunologic cause. A study from Italy showed that the longer gluten sensitive people eat gluten, the more likely they are to develop autoimmune diseases. They found that in childhood celiacs, the prevalence of autoimmune disease rose from a baseline of 5% at age two to almost 35% by age 20. This is a big deal if you think of how much more complicated one's life is when one is both gluten sensitive AND has an additional autoimmune disease. So preventing autoimmune disease is one very important reason why early diagnosis and treatment of gluten sensitivity is important. Early diagnosis before celiac disease develops also holds the potential of preventing other clinical problems such as malnutrition, osteoporosis, infertility, neurologic and psychiatric disorders, neurotube defects (like spina bifida) in your children, and various forms of gastrointestinal cancer. Another reason for early diagnosis and treatment is very straightforward and that is because many gluten sensitive individuals, even if they have not yet developed celiac disease (villous atrophy), have symptoms that abate when gluten is removed from their diet. Furthermore, from a study done in Finland, a gluten sensitive individual who reports no symptoms at the time of diagnosis can improve both psychological and physical well-being after treatment for one year with a gluten-free diet. Despite the common sense and research evidence that early diagnosis of gluten sensitivity offers many health advantages over a diagnostic scheme that can only detect the minority and end-stage patients, until now, the limitation was still in the tests being employed. As mentioned above, the main tests used for primary (before symptoms develop) and secondary (after symptoms develop) screening for celiac disease, blood tests for antigliadin and antiendomysial/anti-tissue transglutaminase antibodies, are only routinely positive after extensive damage to intestinal villi. As shown in a 1990 publication, this is because unless you have full blown, untreated celiac disease, the IgA antibodies to gliadin are only INSIDE the intestine not in the blood. Measuring antigliadin antibody in blood and intestinal fluid (obtained by the laborious technique of having research subjects swallow a long tube that migrates into the upper small intestine), researchers found that in untreated celiacs, antigliadin antibody was present in the blood and inside the intestine, whereas after villous atrophy healed following a year on a gluten-free diet, the antigliadin antibody was no longer in the blood but was still measurable inside the intestine in those with ongoing mild inflammation. An important conclusion can be drawn from these results, as these researchers and myself have done: Gluten sensitive individuals who do not have villous atrophy (the mass of the iceberg), will only have evidence of their immunologic reaction to gluten by a test that assesses for antigliadin IgA antibodies where that foodstuff is located, inside the intestinal tract, not the blood. This makes sense anyway, because the immune system of the intestine, when fighting an antigen or infection inside the intestine, wages the fight right in that location in an attempt to neutralize the invading antigen, thereby preventing its penetration into the body. It does this with T cells on the surface of the epithelium, the intraepithelial lymphocytes, and with secretory IgA made with a special component called secretory piece that allows its secretion into the intestine. The excellent English researchers that made the discovery that they could detect the immunologic reaction to gluten inside the intestine before it was evident on blood tests or biopsies knew it was a breakthrough, testing it many times over in different ways, and further extending the clinical spectrum of gluten-induced disease to include a phase before the villi are damaged, so-called "latent celiac sprue". Furthermore, they developed this technique of assessing the intestinal contents for antigliadin antibodies into what they viewed as a "noninvasive screening test for early or latent celiac sprue" (what others and I would simply call "gluten sensitivity"). However, this was not exactly noninvasive, nor was it simple. It still required the patient to swallow a tube, followed by a complete lavage of all their gastrointestinal contents with many gallons of nonabsorbable fluid that had to be passed by rectum and collected into a large vat to be analyzed for the presence of antigliadin antibodies. While this was indeed a conceptual breakthrough, it practically went unnoticed by the medical community because the cumbersome procedure of washing out the intestine just could not be done in a normal clinical setting. To this day, I am not sure how many people even know that it was not me, but rather this well known celiac research group, led by the late Dr. Anne Ferguson, who pioneered the assessment of the intestinal contents as a viable and more sensitive source of testing material for the early reactions of the immune system to gluten. What we did in my research was to refine and simplify the method of collecting and measuring these intestinal IgA antigliadin antibodies before they can be detected in blood. That is, instead of washing out the antibodies from the intestine, we allow them to be excreted naturally in the stool (feces). And so with that idea, and our ability to measure these antibodies in stool, as others before us had done for fecal IgE antibodies directed to food antigens, our new gluten (and other food) sensitivity stool testing method was born. It was actually my research of microscopic colitis that led me to discover that stool analysis was the best way of assessing for gluten sensitivity before celiac disease develops. Microscopic colitis is a very common chronic diarrheal syndrome, accounting for 10% of all causes of chronic diarrhea in all patients, and is the most common cause of ongoing chronic diarrhea in a treated celiac, affecting 4% of all celiac patients. However, from my published research, despite the presence of the celiac HLA-DQ2 gene in 64% of patients with microscopic colitis, very few get positive blood tests or biopsies consistent with celiac disease. Yet, small bowel biopsies revealed some degree of inflammation sometimes with mild villous blunting in 70% of cases. According to the facts and previously discussed shortcomings of celiac blood tests, antibodies to gliadin are unlikely to be detected in the blood in these patients because they lack villous atrophy. So negative blood tests for antigliadin antibodies per se did not, in my mind, rule out the possibility that these patients with microscopic colitis, a disease that under the microscope looks like celiac disease (but of the colon), and that affects many celiac patients, were not gluten sensitive themselves. But as Dr. Ferguson's research revealed, these antibodies might be detectable inside the intestine. And since we surely were not going to perform that cumbersome intestinal lavage test in my patients, we decided to see if we could find these antibodies in the stool as a reflection of what is coming through the intestine. Here's the first set of data that we found showing the superior sensitivity of stool testing versus blood tests for antigliadin IgA antibodies. In untreated celiac disease patients, we found a 100% positivity in the stool versus only 76% in blood. In hundreds of microscopic colitis patients since tested, only 9% have antigliadin antibody in blood but 76% have it in stool. And the same is true of 79% of family members of patients with celiac disease; 77% of patients with any autoimmune disease; 57% of people with irritable bowel syndrome-like abdominal symptoms; and 50% of people with chronic diarrhea of unknown origin, all of whom have only about a 10-12% positivity rate for blood tests (like normal volunteers). Thus, when you go to the source of production of these antibodies for testing, the intestine, the percentage of any population at a higher than normal genetic and/or clinical risk of gluten sensitivity showing a positive antigliadin stool test is 5 to 7.5 times higher than would be detected using blood tests. In normal people without specific symptoms or syndromes, the stool test is just under 3 times more likely to be positive than blood (29% vs. 11%, respectively). That's a lot more people reacting to gluten than 1 in 150 who have celiac disease. 29% of the normal population of this country, almost all of whom eat gluten, showing an intestinal immunologic reaction to the most immune-stimulating of dietary proteins really is not so high or far fetched a percentage, especially in light of the fact that 11% of them display this reaction in blood, and 42% carry the HLA-DQ2 or DQ8 celiac genes. Why is this so important? Because some people with microscopic colitis never get better when they're treated, and most autoimmune syndromes only progress with time, requiring harsh and sometimes dangerous immunosuppressive drugs just for disease control. If the immune reaction to gluten is in any way at the cause of these diseases as research suggests, and if we had at our disposal a sensitive test that can diagnose this gluten sensitivity without having to wait for the intestinal villi to be damaged, then treatment with a gluten free diet might allow the affected tissues to return to normal or at least prevent progression. We now have that test in fecal antigliadin antibody. Just a few weeks ago we completed the first follow-up phase of our study: What happens when a gluten sensitive person without villous atrophy goes on a gluten-free diet for one or two years. While I am still gathering and analyzing the data, most of the subjects reported a much improved clinical status (utilizing an objective measure of symptoms and well being). Not everybody gets well, because sadly not everyone stays on a gluten-free diet (as they sometimes admit on the surveys). Some people have the misconception that if they don't have celiac disease, but "I just have gluten sensitivity" then maybe they do not have to be strict with their gluten elimination diet. I do not think that is the case. Although a gluten free diet is like anything: Less gluten is not as damaging as more gluten, but certainly no gluten is optimal if a gluten sensitive person desires optimal health. Of the first 25 people with refractory or relapsing microscopic colitis treated with a gluten-free diet, 19 resolved diarrhea completely, and another five were notably improved. Thus, a gluten-free diet helped these patients with a chronic immune disease of a tissue other than small bowel (in this case the colon), who have been shown to be gluten sensitive by a positive stool test in my lab. The same may be true of patients with chronic autoimmune diseases of any other tissue, but who do not have full-blown celiac disease. Gluten-free dietary treatment, sometimes combined with dairy-free diet as well, has been shown to help diabetes, psoriasis, inflammatory bowel disease, eczema, autism, and others. Thus, my approach (and I believe the most sensitive and most complete approach) for screening for early diagnosis and preventive diagnosis for clinically important gluten sensitivity is a stool test for antigliadin and anti-tissue transglutaminase IgA antibodies (IgG is not detectable in the intestine) and a malabsorption test. The malabsorption test we developed is special, because you no longer have to collect your stool for three days; we can find the same information with just one stool specimen. Stool testing in combination with HLA gene testing, which we do with a cotton-tipped swab rubbed inside the mouth, is the best diagnostic approach available for gluten sensitivity. Who should be screened for gluten sensitivity? Certainly family members of celiacs or gluten sensitive people being at the highest genetic risk. For the most part, all of the following patient groups have been shown to be at higher risk than normal for gluten sensitivity: Chronic diarrhea; microscopic colitis; dermatitis herpetiformis; diabetes mellitus; any autoimmune syndrome (of which there is an almost end-less number like rheumatoid arthritis, multiple sclerosis, lupus, dermatomyositis, psoriasis, thyroiditis, alopecia areata, hepatitis, etc.); Hepatitis C; asthma; chronic liver disease; osteoporosis; iron deficiency anemia; short stature in children; Down's syndrome; female infertility; peripheral neuropathy, seizures, and other neurologic syndromes; depression and other psychiatric syndromes; irritable bowel syndrome; Crohn's Disease; and people with severe gastroesophageal reflux (GERD). Autism and possibly the attention deficit disorders are emerging as syndromes that may improve with a gluten- free (and additionally casein-free) diet. A diagnosed celiac might be interested in our testing to know (after some treatment period no shorter than a year) that there is no on-going damage from malabsorption, for which we have a test. If a celiac is having ongoing symptoms or other problems, a follow-up test should be done just to be sure there's no hidden gluten in the diet, or something else that could be present, like pancreatic enzyme deficiency which often accompanies celiac disease, especially in its early stages of treatment. Historically, with respect to diagnostic methods for celiac disease, from 100 A.D., when celiac disease was first described as an emaciating, incapacitating, intestinal symptom-causing syndrome, to 1950, we had just one diagnostic test: Clinical observation for development of the end stage of the disease. Then in 1940 to 1960, when the discovery of gluten as the cause of celiac disease occurred, the best diagnostic test was removing gluten from the diet and watching for clinical improvement. It was during this period that the 72-hour fecal fat and D-xylose absorption tests were developed as measures of gluten-induced intestinal dysfunction/damage. In the mid- to late1950's, various intestinal biopsy methods were pioneered and utilized, showing total villous atrophy as the diagnostic hallmark of celiac disease. You've heard the intestinal biopsy called the "gold standard"; well as you can see, it is a 50 year-old test, and thus, the "old" standard. It was not until the 1970's and 80's (and improved upon in the 1990's) that blood tests for antigliadin and antiendomysial/anti-tissue transglutaminase were developed, but again these tests like all methods before, can reliably reveal only the "heart attack" equivalent of the intestinal celiac syndrome: Significant villous atrophy or bad celiac disease. We are in a new century, a new millennium, and I have built upon what my research predecessors have started; mostly on the work of researchers who laboriously put down tubes and sucked out intestinal fluid for testing for antigliadin antibody when it was not present in blood. We now know that a stool test for antigliadin antibody is just as good and much simpler. The wide-reaching ramifications of knowing that so many more people and patients are gluten sensitive than have ever been previously known has led me to assume a professional life of medical public service. To do so, I started a 501©3 not-for-profit institute called the Intestinal Health Institute, have brought these new diagnostic tests to the public on the internet (at http://www.enterolab.com), and volunteer my time helping people with health problems by email and by lecturing. With greater awareness and education of both the public and medical community that early diagnosis of gluten sensitivity can be achieved before the villi are gone, more of the gluten sensitive iceberg will be diagnosed and treated early, leading to far fewer gluten-related symptoms and diseases than has ever been experienced before. Dr. Fine has been an intestinal researcher and an academic and clinical gastroenterologist for 15 years. He is the Director of The Intestinal Health Institute and The www.EnteroLab.com Clinical Laboratory in Dallas Texas.
  20. I’ve had issues for many years with my digestion and abdominal cramping/diarrhea. I have been told for so long that I have IBS, but recently my symptoms seemed to be getting worse and more random so I went back to the doctor for additional testing. The doctor ordered multiple blood tests and also stool tests. One test was the TTG-IgA test for celiacs disease, which I had done back in October and tested negative for. This time, the test for celiac came back positive, but I also tested positive for a GI bacteria that I seemed to have picked up in my recent travels to Portugal. I’m curious if there’s any possibility that the bacterial infection would have given me a false positive for the celiac test? Celiac makes sense based on the symptoms I’ve had for so long, but I can’t help but question it with having multiple diagnoses and a negative test last October. I know I can move forward and do the endoscopy, but am also happy to just try being gluten free and see how I feel. Thoughts?
  21. Celiac.com 03/08/2018 - A team of researchers recently set out to study delays in diagnosing patients who have biopsy-proven celiac disease with gastrointestinal complaints, compared to those without non-gastrointestinal complaints. The research team included Marco A. Paez, MD, Anna Maria Gramelspacher, MD, James Sinacore, PhD, Laura Winterfield, MD, and Mukund Venu, MD. They are variously affiliated with the Division of Gastroenterology, Department of Medicine, Howard College of Medicine, Washington, DC; the Department of Medicine, the Department of Public Health Sciences, the Division of Gastroenterology, and the Department of Medicine at Loyola University Medical Center in Maywood, Illinois. The research team first conducted a medical chart review of 687 adult patients diagnosed with celiac disease. All patients they studied had biopsy-proven celiac disease and were grouped according to presence or absence of gastrointestinal symptoms before diagnosis. The team found 101 biopsy-proven celiac patients that met their study criteria. The groups were roughly equal in size, with 52 patients showing gastrointestinal symptoms before diagnosis, and 49 with no gastrointestinal symptoms. The results for the groups were starkly different. Statistical analysis revealed an average diagnosis delay of 2.3 months for the group with gastrointestinal symptoms, while the group that showed no symptoms showed an average delay of 42 months. That’s a difference of nearly 3½ years. Nearly half of the patients with non-gastrointestinal symptoms had abnormal thyroid-stimulating hormone, as opposed to 15.5% in the gastrointestinal symptom group (P = .004). Nearly 70% of patients without gastrointestinal symptoms had anemia, compared with just 11.5% of the group with gastrointestinal symptoms. Also, nearly 70% of patients in the non-gastrointestinal symptom group showed abnormal bone density scans, compared with 41% in the gastrointestinal symptom group. The team saw no sex differences on chi-squared analysis between the 2 groups. Although there is growing awareness of celiac disease, the delay in diagnosis for patients without gastrointestinal symptoms remains prolonged, with an average delay of 3.5 years for celiac diagnosis, compared with just over two months for those with symptoms. Clearly, more needs to be done with regard to diagnosing celiac disease in patients who show no symptoms. On the upside, researchers are currently working on ways to better diagnose celiac disease via faster, more accurate tests, even in patients who have already gone gluten-free. Source: amjmed.com
  22. Celiac.com 08/15/2022 - In a significant finding, a celiac disease registry at University of Alabama reveals significant issues in accurately testing Black people for celiac disease using the TTG antibody test. The new registry of celiac disease patients at the University of Alabama at Birmingham is the work gastroenterologist Dr. Amanda Cartee, MD, and fellow colleagues at UAB. Among the most important findings, the registry reveals that Black people with biopsy confirmed celiac disease are exponentially more likely than non-Hispanic whites to show negative results on the most common diagnostic celiac disease blood test. For people with celiac disease, a positive TTG antibody test is the most common path to an endoscopy and biopsy to confirm or negate celiac disease. For most people with celiac disease, especially non-Hispanic whites, a positive TTG test is highly predictive of celiac disease, hence the routine endoscopy and biopsy to follow-up a positive test. In fact, less than ten percent of non-Hispanic whites with biopsy-proven celiac disease have a "negative" TTG test. However, according to the registry data, high percentages of Black people with celiac disease are testing negative for TTG antibodies, and so being denied a swift and properly diagnosis, simply because they never meet themes common threshold for biopsy. It's the TTG threshold currently used to determine the definition of positive and negative TTG that might just be at the heart of the problem. That's because the numbers are nearly reversed for Black people. While less than ten percent of non-Hispanic whites with celiac disease show negative TTG results, the registry data shows that a whopping eighty percent of Black people with biopsy-proven celiac disease have a "negative" TTG test. The means that these folks were unlikely to have gotten a biopsy as quickly as someone with a positive TTG test. It also means they may have had to suffer longer, and/or self diagnose. And those facts are also borne out by the registry data, which point to longer times to diagnosis and less biopsy-driven diagnoses for Black celiac patients. Black patients were also much less likely to have received genetic testing for celiac-associated genes. There is limited data on celiac disease and Black people, said Dr. Cartee, noting that only a single study with the primary goal of investigating the clinical characteristics of celiac disease and Black people has been done. While the registry revealed differences in TTG test results and BMI, it showed similarities in celiac disease diagnosis for non-Hispanic white and Black patients. These included symptoms as the primary cause for testing, length of time to diagnosis, and a diagnosis that did not include recommended blood tests and a biopsy. Basically, the data show that TTG tests will be negative in the vast majority of Black patients with biopsy-proven celiac disease. That means further study is needed to determine whether the TTG test is useful for Black patients, and more research needs to be done to figure out how to make sure they can get quickly and properly diagnosed. Stat tuned for more on this and related stories regarding celiac disease testing, screening, and diagnosis in Black people, and in other ethnic populations. Read more about the celiac registry data and findings presented by UAB gastroenterologist Dr. Amanda Cartee, MD, at Digestive Disease Week.
  23. Hello! I am looking for some advise on what to do in the midst of being diagnosed. So far I have had blood tests and tested positive for Tissue Transglutaminase. I am due to have an endoscopy with biopsy in August and until then I will not receive a diagnosis of Celiac Disease. I have had some serious stomach/GI issues for years and only now have had some light shed on the cause. I am even having my gallbladder removed next week due to these GI issues. My question is: should I start cutting gluten out now, or should I wait for diagnosis? I have read on a few sites that cutting gluten now can in turn result in a false negative for some celiac testing. The thing is my stomach is in such bad shape right now that I'm almost exclusively living off of yogurt and rice bowls. Waiting a month like this might not be an option. I'm hoping my gallbladder removal will help mitigate some symptoms, but I'm not so sure. Please let me know if you have any advise. Thank you all!
  24. Celiac.com 07/08/2022 - My name is Mandy and I’m 16 years old. I was diagnosed with celiac disease less than a year ago after having symptoms for about four years. I love playing soccer, hanging out with my friends, listening to Coldplay and Dave Matthews Band, and now, eating! My eyes are shut tight. I’m relying on my senses of smell, taste, and touch to keep this piece of pizza real, just in case when I open my eyes it’s not there. The crust is warm and moist in my hands. I can feel some rogue strands of cheese dangling over the edge, and droplets of grease and rich tomato sauce fall onto my hand. I open my eyes just for a split second, and the pepperoni seems to smile at me, just waiting for me to enjoy this delicacy. I close my eyes again and slowly start to bring this slice of pizza toward my mouth, which is already watering at the thought of this culinary delight coming into contact with my taste buds—”Mandy!” My eyes fly open and I’m face to face with a friend of mine, who’s just exited the lunch line. I guiltily hand over her pizza, which I was holding while she purchased a carton of milk and three luscious looking chocolate chip cookies. My daydream is shattered, and I’m back in the real world, the world of rice pasta, corn flour, and of course, pieces of pizza that beckon unfairly. However, I’m not disappointed. The daydream will be back again. Until then, I have a delicious chocolate fudge brownie to enjoy, made, of course with the oh-so-decadent rice flour. I may be only 16 years old, and barely starting to make any sort of distinguishable impact on the world around me, but I am already one of the most unique people at my high school. I have the honor of having an immune system that amuses itself by pretending gluten is poison, and intestines that, apparently bored of their mundane life, go along with the joke. Yes, I am a celiac, a proud member of the exclusive club of funky immune systems. A part of me still thinks this is a pretty unfair deal. The same part of me that wants to scream like a maniac as I watch my friends eat. But another part of me, the rational part, thinks that, along with my disease, I am pretty unique—and so is my story. I experienced the first of what I call celiac attacks when I was 12. That incident seems to have blocked itself from my memory, but I do recall one night during my family’s Cold Days and Clear Skies By Mandy Taylor vacation in Hawaii. I don’t remember what I ate, but I remember the worst stomach pain I have ever had, and being in the bathroom all night. My memory then flash forwards up two years to a soccer practice with my club team. Running along in a scrimmage, I was suddenly stricken with the most intense stomach pain. My brain couldn’t even seem to comprehend this pain, and I lay on the grass dizzy and in a fog. On the way home, I brilliantly ate a chicken quesadilla on, of course a flour tortilla. When I got home, it was all I could do to writhe on my bed. My 14-year-old brain figured this sort of pain must be death. Sitting up on my bed, my bedroom began to spin in fast circles, and I passed out on my floor. Upon waking up, sweaty, the pain was gone, and there was a buzzing in my ears so loud it sounded like there was a bee hive hidden in my shirt. I don’t remember telling my parents what happened. All I know is soon I was in the emergency room, being told the pain was simply that time of the month that every girl has to endure. I figured these doctors knew what they were talking about, and I let it go. This horrible experience left a huge impression on me, and I would never forget that pain. I only prayed it wouldn’t happen again. But it did. It happened again, and again, and again, until I was afraid to eat anything, afraid to leave the house, afraid to live my life. Each time the waves of pain and dizziness swept over me, I only wanted it to kill me. It seemed to be the only thing to make the pain stop. And each time I woke up from passing out, whether it was lying shivering in the bathroom or huddled in the hallway, the hopelessness I felt was nearly as unbearable as the pain. An entire year of having these attacks slowly went by. When I was fifteen, I underwent arthroscopic knee surgery for my right knee, as a result of chronic knee pain that had mysteriously developed. The surgeon discovered numerous cracks on the underside of my kneecap. I didn’t know it then, but this too was a result of this disease that was ravaging my body. Along with the knee problem and the stomach pain attacks, I experienced bad headaches almost daily. I had trouble sleeping and focusing on school. My stomach was so bloated that I sometimes appeared pregnant. My vision deteriorated as well. When I was 13 I had been told that I was legally blind in my left eye, and over a year later my once perfect right eye vision rapidly began to join my left. Whatever illness I had, it was taking over my life. I began to lose touch with my best friends, because I was always sick. Some days I would simply go without eating; during one particular severe episode after my knee operation, I lost eleven pounds in a week from living off a bowl of applesauce a day. I needed answers—and fast. I began to see doctor after doctor. My childhood doctor, having known me since babyhood, figured because I had nearly always been a little sickly (I suffered from sinus infections from infancy on), that this was just another one of those times. I saw her at least four times, and she told me at least four times that my problems were bad cramps and a sensitive stomach. The doctors at the emergency room also thought it was cramps, and perhaps a little anxiety. After countless blood, stool, and urine tests that seemed to find nothing, I was told I would grow out of it. Everyone else seemed to think I was a hypochondriac, and my hope was fading fast. One afternoon, while surfing the Internet looking for illnesses with my symptoms, I found a medical message board website. Pure impulse made me post my symptoms on that website, sparking what tiny shreds of hope for a diagnosis I had left. Over the next few days, I read the answers to my post, which told me it sounded like I had Irritable Bowel Syndrome. I was elated, thrilled that I was finally getting some sort of answer. After spending days reading about this syndrome I received an email from someone from the message board site. The email told me it may very well be Irritable Bowel Syndrome—but, had I heard of Celiac disease? My mom made countless urgent phone calls to my doctor, who finally got me an appointment with a gastroenterologist. The day I walked into this doctor’s office was the day that changed me forever. Right away he seemed to recognize my symptoms as Celiac disease, or Celiac Sprue and wanted to get a definite diagnosis right away. Although this would involve a colonoscopy, not the friendliest of procedures, and small bowel biopsy, I was elated. I could finally have a real diagnosis! I spent a weekend prepping for the procedures: two fun-filled days of strong laxatives and clear liquids. It would have gotten a little boring, but luckily I had stocked the bathroom with a good supply of magazines. Another day was spent at the hospital, getting a tube shoved down one end and up another. Not fun at the time, but now I look back and realize it was a little amusing. It was all worth it a week later, when we got a call from the doctor. My diagnosis: a severe case of celiac sprue—and so began my new life. It took several months for the fact to sink in that I could no longer have wheat, oats, rye, malt, and barley, which, of course, are included in seemingly every food, beverage, and sauce on this planet. I felt even sorrier for myself than I had when I was still very sick. It made me want to cry when I looked at pizza or cake, or walked into the mall and smelled the aroma of the world’s best cinnamon rolls. Several months were spent deeply depressed, thinking that my life was over. I couldn’t be around my friends because I couldn’t stop thinking they could eat whatever they wanted. When I was around them, I blew up at them countless times for enjoying their cookies or pasta or numerous other things. Days were spent staring longingly at the box of fettuccine alfredo in our cupboard, and at the package of chocolate muffins on top of the refrigerator. I stifled so many urges to stuff as many hot dogs buns in my mouth as I could. But as the long days passed, something changed. I went a full month without a severe attack. I began to sleep better. I was learning, and along with the learning came living. My mom and I began to enjoy experimenting with different recipes. We mostly made brownies, trying nearly every gluten-free recipe we could find, and then gorging ourselves on them afterward. One evening, for the first time in months, I enjoyed a delicious plate of rich cheese fettuccine, made with the rice pasta I had mistakenly thought would be disgusting. The pasta was, instead, even better than “normal” pasta—so were the brownies—and pretty soon, so was the cake and the pizza. Something changed in those days of experimenting and shopping and making discoveries—it was me. Slowly, my view on life began to change. Yes, I had a disease, and yes, it was a very serious one, but there was no way it was going to stop me from enjoying the life I finally had back. I began enjoying the little things again, something that years before I had prided myself on. I got a few laughs as my friends tried to digest my diagnosis, constantly saying things like “But…pasta doesn’t have wheat in it, right?” and “Well, at least you can have potato bread, since it’s made out of potatoes.” I even got a few “Oh, I know exactly how you feel—I’m on a diet, too.” But gradually the confusion gave way to understanding, and they supported me. So did my parents. My dad by making constant runs to the store to pick up something I was craving, and my mom by spending 24 hours in the kitchen concocting all sorts of meals which always turned out to be surprisingly delicious. My energy came back, and so did my love for life. My headaches subsided, and my stomach bloat began to look only two months pregnant instead of six or seven. After my last surgical procedure (a laparoscopy to check and see if any of my other organs were scarred) was finally over, my junior year in high school began. It was a new beginning after a horrific summer of pain, surgery, and hopelessness. I played on my school’s varsity soccer team, and began to fully enjoy school again. I was finally healthy and planned on staying that way. I knew because of my entire ordeal, I would never even consider drinking, smoking, or drugs. It had taken so much effort and energy to get healthy—I would do nothing to ruin it. One afternoon, I sat at my desk at home studying for a math test and craving about a thousand different foods. As I began to feel slowly overwhelmed, I heard a rumbling outside and looked up to see the UPS truck pull up our driveway. It was the gluten-free donuts and hot dog buns I had ordered from a wonderful gluten-free food company. I tore open the box and took my first bite of a rich chocolate donut. It was the smallest thing for most people: a bite of a donut. But the second it took me to take that bite simply made my day. It’s the little things like that that we celiacs must remember to enjoy. Something important has been taken from us for reasons we’re not sure about—perhaps it’s our genes and a little bad luck. We must learn to fill that void with whatever we can. In a way, we are all blessed. Yeah, this disease isn’t fun, but even though it’s taken many things from my life, it’s given me so much more. I love everything about life now. I love being with my amazing friends and family. I love cold days and clear skies. I love when I look across the road to the car across from me and see the person inside singing along to the same song on the radio I’m listening to. I love putting on clothes warm from the dryer, I love when friends hug me good morning, and I love it when my cat falls off a chair and tries to pretend she meant to all along. In short, I love the little things. I realize that life is not all about everything being perfect—it’s about enjoying what you have—and I have celiac disease to thank for that. I could have been handed a disease that would have ended my life— instead, I was lucky enough to have been handed a disease that would help it to begin again. ©A Personal Touch Publishing, LLC. This article originally appeared in the book A Personal Touch On...™ Celiac Disease
  25. Hey there, I'm new! I've spent quite some time on this site reading up and thought I'd ask the experts. In end of November I started experiencing symptoms (toilet and gas focus) which in January really started escalating enough to send me to the doctor. I explained my symptoms and got a blood test and results about 10 days ago. My 'Deamidated Gliadin IgA was high at 31 U/mL (normal being <15) while the other results were all normal. Doc told me to go to GI for endoscopy, although stated this isn't a 'huge' increase. Meanwhile my symptoms started escalating to the occasional vomit, massive fatigue and feeling like I would collapse while walking to work. I'm reading a lot about this now (though still don't feel knowledgeable at all), and I'm wondering 1) does this number give any indication of celiac as a stand alone? No family history. 2) Is it possible that if it could be celiac, that it can happen so quickly? It just seems to be so sudden so I'm quite confused. I'm seeing the GI next week for next steps. It's just been a tough couple of weeks and I don't seem to get much help from the GP. Any tips would be appreciated!
  26. Celiac.com 06/06/2022 - Researchers have shown that tissue-transglutaminase antibodies (TGA) can be used to diagnose celiac disease without biopsy, but there's no good data on how accurate it is in real life conditions. A team of researchers recently set out to investigate real-life performance of a Bioplex2200 automated celiac serology analyzer, and to explore the correlation between tissue-transglutaminase antibody levels and intestinal biopsies in children. The research team included Anat Guz-Mark; Michal Kori; Chani Topf-Olivestone; Ronit Weinberger; Sara Morgenstern; Nadya Ziv-Sokolovskaya; and Raanan Shamir. They are variously affiliated with the Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva; the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv; the Pediatric Gastroenterology, Kaplan Medical Center, Rehovot; the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem; the Immunology Laboratory, Clalit Health Services, Tel Aviv; the Institute of Pathology, Rabin Medical Center, Pitach-Tikva; and the Institute of Pathology, Kaplan Medical Center, Rehovot, Israel. The team conducted a retrospective review in two pediatric gastroenterological centers, between November 1, 2018 and April 1, 2020. They included patients with both tissue-transglutaminase antibody serology testing and duodenal biopsies. They gathered data including patient demographics, medical background, TGA levels, and biopsy results. In all, the team looked at 538 children. They found 256 with positive tissue-transglutaminase antibodies, and 282 with negative tissue-transglutaminase antibodies. Among patients with positive tissue-transglutaminase antibodies, intestinal biopsies confirmed celiac disease in 219, or nearly 86% of cases. The team found positive serology with normal histology in about fifteen percent of the cases. In more than half, they found tissue-transglutaminase antibody ranges of 1 to 3 times upper limit of normal. About twenty percent had tissue-transglutaminase antibody ranges 3 to 5 times upper limit of normal; about twenty percent had tissue-transglutaminase antibody ranges 5 to 10 times upper limit of normal; and just over 4% had tissue-transglutaminase antibody ranges above 10 times upper limit of normal, respectively. Nearly eighty-five percent of patients with positive tissue-transglutaminase antibodies also had positive anti-endomysial antibodies. However, overall diagnostic performance in these patients was inferior. The team found that the Multiplex tissue-transglutaminase antibody assay accurately diagnosed celiac disease in real world conditions. EMA screening did not improve the diagnostic accuracy in patients with positive tissue-transglutaminase antibodies. Meanwhile, false-positives varied depending on tissue-transglutaminase antibody range, but were low in patients with tissue-transglutaminase antibody levels above 10 times upper limit of normal. The ability to use multiplex tissue-transglutaminase antibodies for accurate celiac diagnosis offers clinicians another cheap and easy tool for catching celiac disease early. The easier and cheaper it becomes to diagnose celiac disease, and the earlier it can be caught, the more long term damage can be avoided for celiac sufferers. Read more in the Journal of Pediatric Gastroenterology and Nutrition
  27. Celiac.com 05/13/2022 - It all began when Dr. Malawer called. “Good news,” he said! “We found out what’s causing your symptoms. The tests confirmed you have celiac disease” (Gastroenterologists, he explained, rarely find definitive causes for their patients’ intestinal complaints; hence his excitement). “What this means is that you’ll have to be on a strict gluten-free diet for the rest of your life—no wheat, no rye, no barley, no oats. And no cheating—you have to stick with the diet 100 percent! But let me warn you that once get the gluten out of your system and start absorbing your food you may gain weight. I had one patient who gained 50 pounds in three months!” Dr. Malawer was elated. I was depressed. Give up bread—for the rest of my life? It seemed a sentence too cruel for someone whose favorite food, second only to fruit, was the staff of life! Tearing into a long loaf of French bread fresh from Marvelous Market and slathering it with butter was one of my favorite pastimes. I could eat the whole thing in one sitting. And what about the six-grain loaves and the Jewish ryes (with seeds, please) from Breads Unlimited where I shopped every Saturday morning? And oh my God, bagels! Big fat garlic bagels, onion bagels, cinnamon bagels, poppy seed bagels right out of the oven from Whatsa Bagel, and the flatbread bagels smothered with onions and poppy seed called bialys—never again? This was seriously depressing. Dr. Malawer had suspected celiac disease (also known as gluten intolerance) and ordered a biopsy of my small intestine and blood tests when, in taking my family history, he learned that I had a third cousin with the disease and that when I was very young I had heard my parents mention the possibility of celiac disease when discussing the cause of my many food allergies with my pediatrician. My symptoms had begun at least ten years prior to my diagnosis. I had frequent bouts of abdominal distress, gas, and diarrhea, which I could not associate with anything in my diet. I frequently talked with my internist about this, and for about a year I kept a daily journal on the state of my abdomen and what I had done or eaten, but no pattern emerged. Over that time period several sigmoidoscopies were performed and they repeatedly tested me for parasites and giardia—all test results were negative. The only thing we could figure out was lactose intolerance. When I went on a lactose-free diet or used lactose pills my distress lessened, but the diarrhea continued. My doctor finally told me that if I had another bout of diarrhea he would refer me to a gastroenterologist. That is how I became a patient of Dr. Malawer’s. While trying to absorb the news about my diagnosis of celiac disease and its implications, I asked Dr. Malawer if there were any organizations that could help me with the dietary and life style changes that I’d need to make. His receptionist directed me to the Washington Area Celiac Sprue Support Group (WACSSG), which meets bimonthly and puts out a highly informative newsletter about all aspects of the disease that includes gluten-free recipes and listings of gluten-free products available in local supermarkets or by mail. To my surprise, WACSSG’s membership of adults, children, and families of celiacs was more than 100 when I joined about 12 years ago, at a time when the disease was thought to be relatively rare. Membership has been increasing with heightened awareness of the true prevalence of the disease in the United States—about 1 in 133 Americans and 1 in 22 family members of diagnosed celiacs, according to a recent epidemiologic study. The first meeting of WACSSG I attended featured a speaker from the FDA (Food and Drug Administration) on hidden glutens found in the “fillers” of prescription and over the counter drugs. Fillers are the non-therapeutic ingredients used as binders. She urged us to contact the manufacturer of each drug we were taking to find out what substances they used as fillers. Certain fillers were not acceptable, and we needed to find out whether they came from corn, potatoes, or wheat, and of course avoid taking drugs with wheat starch fillers. What a tedious process! Not only was it almost impossible to read the fine print containing the ingredients and the manufacturer’s phone number (if listed) on a bottle of antihistamines or my prescription drugs, but when I called the manufacturers I was cycled through numerous “experts” on the abstruse matter of fillers before I got my answer. Fortunately, in most cases, the fillers were made of corn or potato starch and I was able to continue using the drug. In some cases, however, the type of starch used as filler varied from batch to batch, as the manufacturers competed on the open market for the lowest priced ingredients. If the manufacturer could not guarantee that wheat starch was never used, I could not take the drug. Aside from the obvious things I could no longer buy for myself, such as bread and wheat pasta, I had to learn, first and foremost, to read the ingredient labels on every food item I intended to eat. I was surprised to learn how many canned, bottled, and packaged food items contain wheat or oats, or barley. Wheat, in particular, seems to be ubiquitous. In a long list of ingredients, it is not atypical to find the words “wheat starch” toward the end, even in such products as soups and chicken broth, catsup, and soy sauce. Hidden glutens, I was to learn, lurked everywhere! Once I got over the shock of the diagnosis (an autoimmune disorder, which can manifest itself at any age) and stopped focusing on all those things I could no longer eat, I became aware of excellent gluten-free packaged products, cookbooks, and recipes for breads and baked goods which I could easily prepare. Among my first purchases was a “Zo” (Zojirushi) bread machine, which is particularly effective with gluten-free flours, such as white and brown rice flour, potato flour, tapioca flour, and cornstarch, to which xanthan or guar gum can be added to provide the elasticity which is lost when gluten-containing flours such as wheat cannot be used. A perennial challenge for celiacs, however, is eating in restaurants or dining with friends in their homes. I’m still shocked at the number of waiters who don’t realize that noodles, at least in this country, are typically made from wheat flour. What they lack in knowledge, however, they are usually quite willing to ask about in the kitchen. If they cannot find out whether or not a particular soup or meat dish I’m contemplating contains any gluten, I choose something else. On the other hand, some restaurants, such as Bonefish Grill (I just recently discovered), can provide a diner with a gluten-free menu; and some stores, such as Trader Joe’s, have a list of all the gluten-free products that they carry. When I eat out with friends or acquaintances, I tell them that the only kind of restaurant I really have to avoid is a pizza joint. My solution to eating in other people’s homes is to bring a dish I can eat to share with others. I tell the cook to prepare whatever they want for the guests and not to worry about me. Usually there are some things I can eat and some I can’t. To my surprise and pleasure, after I became gluten-free I was able to tolerate dairy products—including milk, yogurt, and most cheeses—quite well. Whenever people start eating something I can’t eat in my presence, they usually apologize when it dawns on them that I can’t have it. I am now able to say, “It’s OK. I remember exactly what that tastes like and I’m getting vicarious enjoyment watching you eat it.” Sometimes I’ll take a plate of frosting from a chocolate cake, or scrape out the innards of a cheesecake that is coated with graham cracker crumbs (once I’ve verified that the innards contain no gluten). But then there’s the fresh bread…that’s when I have to look away! A celiac always needs to be thinking about emergency foods, particularly sources of carbohydrates or high energy foods for travel, in case one cannot count on gluten-free products being available, such as at airports, train stations, or in foreign countries. I travel with Balance Bars (not advertised as gluten-free, but they are in fact), raw almonds, raisins, and hard-boiled eggs, or corn chips. I keep a couple of Balance Bars in my car at all times, in case I’m on the road and become hungry. One Balance Bar can usually forestall the need for a meal until I arrive home or at my destination.
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