Search the Community

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

Celiac.com 08/10/2023 - If you love Chick-fil-A’s signature frosted lemonade, then you'll really love this easy home version. Chick-fil-A’s signature frosted lemonade is a popular summertime treat. Even though it claims to be a lemonade, it's basically a sweet and tangy lemon milkshake, and it's super easy to make a version at home. Here's our homespun take on making a copycat version of Chick-fil-A’s signature frosted lemonade. This version is naturally gluten-free, as we assume is the case with the Chick-fil-A original. Gluten-Free Frosted Lemonade Ingredients: 4 cups vanilla ice cream 12 ounces frozen lemonade concentrate 1 teaspoon lemon zest Directions: Scale ingredients as needed. Place ice cream, frozen lemonade concentrate, and lemon zest in the jar of a blender, and blend until smooth. Divide into 4 chilled glasses, and serve immediately. Find some shade. Kick up your feet. Enjoy.

Celiac.com 05/04/2020 - The demise of the Nexvax2 vaccine for celiac disease, coupled with more research that shows regular gluten ingestion for most people with celiac disease, points to a more prominent roll for enzymes, but absent a vaccine, what does a perfect world look like for people with celiac disease? Easy home celiac testing, regular gluten monitoring, and gluten-busting enzymes are three things that people with celiac disease would have in a perfect world. Regular Gluten Exposure for Most Gluten-Free Celiacs If you have celiac disease, you’re probably eating gluten more frequently than you realize, whether or not you have symptoms. Whether they know it or not, the vast majority of celiacs are eating gluten on a regular basis. In fact, one recent study showed that up to 90% people with celiac disease are being exposed to gluten when they eat outside their homes. Celiac and Gluten Testing In a perfect world, people who suspected celiac disease would be able to do an easy, reliable test at home to determine if they had celiac disease, or if they needed further screened and assessment by a doctor. They would also be able to test regularly to see if they are getting exposed to gluten in their otherwise gluten-free diet. We've written about when to use home celiac test kits. We've reviewed the LetsGetChecked Home Celiac Disease Test Kit Home celiac test kits are a popular topic on our celiac and gluten-free forum. Gluten Monitoring in Celiac Patients In a perfect word, people with celiac disease would be regularly monitored for gluten levels, much like diabetics are monitored for glucose levels. Currently, there are no home kits that monitor gluten without the user sending samples to a lab. However, there are a few good home test kits that use clinical labs to deliver accurate results fairly quickly. These tests are great for monitoring general gluten levels to spot check your diet. Home Gluten Test Kits Finger Prick Blood Test for Gluten Microdrop Health, a Houston-based company today began offering its imaware™ celiac disease test to patients for monitoring, through use of anti-tissue transglutaminase (tTG) and deaminated gliadin peptide (DGP) blood test results. Home Stool & Urine Testing for Gluten Stool and urine testing is slowly moving mainstream. Gluten Detective claims to offer the only home test for gluten exposure. They also claim that stool testing can detect celiac disease before gut damage occurs, in many cases. Enzymes to Break Down Gluten For individual consumption - Oral are enzymes are enzymes that you take by mouth and which break down gluten. For oral enzymes to protect people with celiac disease, the enzymes need to break down the gluten proteins in the stomach, before they get to the small intestine, where they cause the gut damage typical of untreated celiac disease. That can be tricky for many reasons, including the amount of gluten consumes, individual gluten sensitivity levels, and level of gut healing, etc. AN PEP is one enzyme currently proven to break down gluten in the stomach before it gets to the gut, but it's only intended to protect against incidental gluten ingestion, and not meant to make gluten safe for people with celiac disease. Currently, there are no oral enzymes on the market that can make gluten safe for people with celiac disease to consume. All enzymes, including AN PEP, are intended solely for episodes of minor and occasional gluten ingestion. Still, regular or strategic use of an oral AN PEP enzyme could provide some protection against the gluten ingestion that seems to be so common with celiacs. The anecdotal evidence is convincing, and stories like the one that found its way into a review of a particular brand of AN PEP formula, called GliadinX, are not uncommon. Dry Enzymes For Manufacturing - Dry enzymes are enzymes that could be added to traditional gluten ingredients, such as flour, in bulk manufacturing, to break down the gluten and render the products safe for people with celiac disease. In a perfect world, food manufacturers could add a dry, temperature stable gluten-busting enzyme to traditional wheat ingredients to render foods safely gluten-free, or gluten-removed. Dry glutenase enzymes would work much the same way lactase works to make milk lactose free and safe for most people with milk intolerance. A team of researchers at Clemson University is currently pursuing a project to make dry enzymes heat stable for breaking down gluten in manufactured foods to create safe, gluten-removed foods for people with celiac disease or gluten sensitivity. Why Digesting Gluten is Better than Dissolving Gluten We see numerous comments in our forums where people seem to refer to the concept of "dissolving" gluten, instead of digesting or breaking down gluten. In healthy digestion, gluten gets broken down into tiny particles that the body can handle, without causing inflammation or adverse immune reactions. That's what most people mean when the refer to 'dissolving' gluten. Simply dissolving gluten wouldn't help people with celiac disease, because merely dissolving gluten wouldn't render it safely digestible. So, enzymes work by breaking down gluten gluten, not by dissolving gluten. The distinction is important. In a perfect world people with celiac disease would have access to easy, reliable home testing and gluten monitoring. They would also have access to effective enzymes to help prevent damage from the gluten exposure that is common in celiacs, even among those on a gluten-free diet.

Celiac.com 04/01/2019 - Over the years, testing for celiac disease has become easier and more reliable. There are a number of home tests for celiac disease antibodies, and a number of reasons people might want to test for celiac disease at home. Those reasons include privacy, cost, and convenience. There are two kinds of tests for celiac disease, antibody tests and genetic tests. Let's start with antibody tests. Celiac Antibody Testing The main antibodies targeted by celiac disease blood testing are Tissue Transglutaminase Antibodies (tTG-IgA). The tTG-IgA test will be positive in about 98% of patients with celiac disease. The trick is that people need to be eating gluten for the test to work properly. That’s an issue for some people who have already given up gluten. Tissue transglutaminase antibody (tTG)-IgA in adults has a sensitivity greater than 90%, and a specificity of over 95%. Another antibody, endomysial antibody (EMA)-IgA, usually correlates with tTG. It is more costly and is identified manually, thus it is not the first line marker. Home testing for celiac disease antibodies offers convenience and privacy. These tests are a great way to see if you need to be clinically tested for celiac disease. Test for Celiac Antibodies at Home There are a number of home tests for celiac disease antibodies. These test kits are great for pre-diagnosis in advance of clinical testing. Home test kits offer several advantages. The Advantages of Home Celiac Antibody Tests Convenience—No worries about lab appointments and clinics. Home kits allow you to test in the privacy of your own home. Confidence—to increase your confidence when consulting with a doctor to request testing and diagnosis. Price—Often cheaper than clinical tests. Privacy—Results kept private and not shared with insurers. This could keep your insurance rates lower. Celiac Home Testing Companies Companies making home test kits for celiac disease include: Imaware™—The Imaware™ home collection kit, is sold online. The test has two main components, lancets to pierce the skin and a micro-container to collect a blood sample. Using the lancet, you draw three to four drops of blood from your finger and deposit them in the micro-container. Only a small sample is needed because the test measures the antibodies in whole blood. Once the blood is collected, you send it in a pre-paid bag to Microdrop’s CLIA-certified lab. After the sample gets to the lab, it’s processed within 48 hours, with testing done for four celiac disease biomarkers, tTG-IgA, tTG-Igg, DGP-IgA and DGP-IgG. Overall, Imaware™ reports sensitivity of 95 percent and specificity of 99 percent. That means the test will correctly spot people with celiac disease 95 times out of 100, and people without celiac disease 99 times out of 100. Let’s Get Checked—Let's Get Checked offers an at home celiac test to identify celiac disease antibodies with online results in 5 days. Biomarkers include Tissue Transglutaminase (tTG), and Endomysial Antibodies (EMA) Stool & Urine Testing Gluten Detective—Stool and urine testing is still in its infancy, and not considered mainstream. However, Gluten Detective claims to offer the only home test for gluten exposure. They also claim that stool testing can detect celiac disease before gut damage occurs, in many cases. Clinical Celiac Antibody Testing Many major laboratories, such as Quest Diagnostics, handle analysis of clinical celiac disease testing. In most cases, home test kits are processed by the same labs that process clinical tests. Confirm Positive Test Results Celiac.com recommends a follow-up visit to a primary care physician for clinical confirmation and an official diagnosis of celiac disease before embarking on a life-long gluten-free diet. Genetic Celiac Testing Genetic testing won’t tell you if you have celiac disease, but it will tell you whether you are at risk of developing celiac disease. HLA-DQ2 & HLA-DQ8 About 95% of celiacs carry HLA-DQ2; while about 25% carry HLA-DQ8. Both the DQ type, and number of copies a person carries influences risk, and the potential severity of celiac disease. Two copies of DQ2 carries more risk than one copy of DQ8, or only partial DQ2. However, the absence of genes DQ2 and/or DQ8 does not preclude gluten intolerance or sensitivity. Some people respond to a gluten free diet, even if they don't have DQ2 or DQ8 or clinical celiac disease. In some rare individuals, especially some men, a negative genetic test may not exclude the possibility of celiac disease anymore than a negative blood test. Celiac Genetic Testing Companies Celiac Disease DNA Test Invitae Further information on testing companies can be found at the Celiac.com Forum. More helpful information about celiac genetic testing can be found in the Celiac.com article Ten Facts About Celiac Disease Genetic Testing. Read more at The New York Times.