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      Frequently Asked Questions About Celiac Disease   04/24/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What is Celiac Disease and the Gluten-Free Diet? What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes
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    Scott Adams
    WHAT IS CELIAC DISEASE?
    Celiac disease is an autoimmune condition that affects around 1% of the population. People with celiac disease suffer an autoimmune reaction when they consume wheat, rye or barley. The immune reaction is triggered by certain proteins in the wheat, rye, or barley, and, left untreated, causes damage to the small, finger-like structures, called villi, that line the gut. The damage occurs as shortening and villous flattening in the lamina propria and crypt regions of the intestines. The damage to these villi then leads to numerous other issues that commonly plague people with untreated celiac disease, including poor nutritional uptake, fatigue, and myriad other problems.
    Celiac disease mostly affects people of Northern European descent, but recent studies show that it also affects large numbers of people in Italy, China, Iran, India, and numerous other places thought to have few or no cases.
    Celiac disease is most often uncovered because people experience symptoms that lead them to get tests for antibodies to gluten. If these tests are positive, then the people usually get biopsy confirmation of their celiac disease. Once they adopt a gluten-free diet, they usually see gut healing, and major improvements in their symptoms. 
    CLASSIC CELIAC DISEASE SYMPTOMS
    Symptoms of celiac disease can range from the classic features, such as diarrhea, upset stomach, bloating, gas, weight loss, and malnutrition, among others.
    LESS OBVIOUS SYMPTOMS
    Celiac disease can often less obvious symptoms, such fatigue, vitamin and nutrient deficiencies, anemia, to name a few. Often, these symptoms are regarded as less obvious because they are not gastrointestinal in nature. You got that right, it is not uncommon for people with celiac disease to have few or no gastrointestinal symptoms. That makes spotting and connecting these seemingly unrelated and unclear celiac symptoms so important.
    NO SYMPTOMS
    Currently, most people diagnosed with celiac disease do not show symptoms, but are diagnosed on the basis of referral for elevated risk factors. 

    CELIAC DISEASE VS. GLUTEN INTOLERANCE
    Gluten intolerance is a generic term for people who have some sort of sensitivity to gluten. These people may or may not have celiac disease. Researchers generally agree that there is a condition called non-celiac gluten sensitivity. That term has largely replaced the term gluten-intolerance. What’s the difference between celiac disease and non-celiac gluten-sensitivity? 
    CELIAC DISEASE VS. NON-CELIAC GLUTEN SENSITIVITY (NCGS)
    Gluten triggers symptoms and immune reactions in people with celiac disease. Gluten can also trigger symptoms in some people with NCGS, but the similarities largely end there.

    There are four main differences between celiac disease and non-celiac gluten sensitivity:
    No Hereditary Link in NCGS
    Researchers know for certain that genetic heredity plays a major role in celiac disease. If a first-degree relative has celiac disease, then you have a statistically higher risk of carrying genetic markers DQ2 and/or DQ8, and of developing celiac disease yourself. NCGS is not known to be hereditary. Some research has shown certain genetic associations, such as some NCGS patients, but there is no proof that NCGS is hereditary. No Connection with Celiac-related Disorders
    Unlike celiac disease, NCGS is so far not associated with malabsorption, nutritional deficiencies, or a higher risk of autoimmune disorders or intestinal malignancies. No Immunological or Serological Markers
    People with celiac disease nearly always test positive for antibodies to gluten proteins. Researchers have, as yet, identified no such antobodies or serologic markers for NCGS. That means that, unlike with celiac disease, there are no telltale screening tests that can point to NCGS. Absence of Celiac Disease or Wheat Allergy
    Doctors diagnose NCGS only by excluding both celiac disease, an IgE-mediated allergy to wheat, and by the noting ongoing adverse symptoms associated with gluten consumption. WHAT ABOUT IRRITABLE BOWEL SYNDROME (IBS) AND IRRITABLE BOWEL DISEASE (IBD)?
    IBS and IBD are usually diagnosed in part by ruling out celiac disease. Many patients with irritable bowel syndrome are sensitive to gluten. Many experience celiac disease-like symptoms in reaction to wheat. However, patients with IBS generally show no gut damage, and do not test positive for antibodies to gliadin and other proteins as do people with celiac disease. Some IBS patients also suffer from NCGS.

    To add more confusion, many cases of IBS are, in fact, celiac disease in disguise.

    That said, people with IBS generally react to more than just wheat. People with NCGS generally react to wheat and not to other things, but that’s not always the case. Doctors generally try to rule out celiac disease before making a diagnosis of IBS or NCGS. 
    Crohn’s Disease and celiac disease share many common symptoms, though causes are different.  In Crohn’s disease, the immune system can cause disruption anywhere along the gastrointestinal tract, and a diagnosis of Crohn’s disease typically requires more diagnostic testing than does a celiac diagnosis.  
    Crohn’s treatment consists of changes to diet and possible surgery.  Up to 10% of Crohn's patients can have both of conditions, which suggests a genetic connection, and researchers continue to examine that connection.
    Is There a Connection Between Celiac Disease, Non-Celiac Gluten Sensitivity and Irritable Bowel Syndrome? Large Number of Irritable Bowel Syndrome Patients Sensitive To Gluten Some IBD Patients also Suffer from Non-Celiac Gluten Sensitivity Many Cases of IBS and Fibromyalgia Actually Celiac Disease in Disguise CELIAC DISEASE DIAGNOSIS
    Diagnosis of celiac disease can be difficult. 

    Perhaps because celiac disease presents clinically in such a variety of ways, proper diagnosis often takes years. A positive serological test for antibodies against tissue transglutaminase is considered a very strong diagnostic indicator, and a duodenal biopsy revealing villous atrophy is still considered by many to be the diagnostic gold standard. 
    But this idea is being questioned; some think the biopsy is unnecessary in the face of clear serological tests and obvious symptoms. Also, researchers are developing accurate and reliable ways to test for celiac disease even when patients are already avoiding wheat. In the past, patients needed to be consuming wheat to get an accurate test result. 
    Celiac disease can have numerous vague, or confusing symptoms that can make diagnosis difficult.  Celiac disease is commonly misdiagnosed by doctors. Read a Personal Story About Celiac Disease Diagnosis from the Founder of Celiac.com Currently, testing and biopsy still form the cornerstone of celiac diagnosis.
    TESTING
    There are several serologic (blood) tests available that screen for celiac disease antibodies, but the most commonly used is called a tTG-IgA test. If blood test results suggest celiac disease, your physician will recommend a biopsy of your small intestine to confirm the diagnosis.
    Testing is fairly simple and involves screening the patients blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis. Also, it is now possible to test people for celiac disease without making them concume wheat products.

    BIOPSY
    Until recently, biopsy confirmation of a positive gluten antibody test was the gold standard for celiac diagnosis. It still is, but things are changing fairly quickly. Children can now be accurately diagnosed for celiac disease without biopsy. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide.

    WHY A GLUTEN-FREE DIET?
    Currently the only effective, medically approved treatment for celiac disease is a strict gluten-free diet. Following a gluten-free diet relieves symptoms, promotes gut healing, and prevents nearly all celiac-related complications. 
    A gluten-free diet means avoiding all products that contain wheat, rye and barley, or any of their derivatives. This is a difficult task as there are many hidden sources of gluten found in the ingredients of many processed foods. Still, with effort, most people with celiac disease manage to make the transition. The vast majority of celiac disease patients who follow a gluten-free diet see symptom relief and experience gut healing within two years.
    For these reasons, a gluten-free diet remains the only effective, medically proven treatment for celiac disease.
    WHAT ABOUT ENZYMES, VACCINES, ETC.?
    There is currently no enzyme or vaccine that can replace a gluten-free diet for people with celiac disease.
    There are enzyme supplements currently available, such as AN-PEP, Latiglutetenase, GluteGuard, and KumaMax, which may help to mitigate accidental gluten ingestion by celiacs. KumaMax, has been shown to survive the stomach, and to break down gluten in the small intestine. Latiglutenase, formerly known as ALV003, is an enzyme therapy designed to be taken with meals. GluteGuard has been shown to significantly protect celiac patients from the serious symptoms they would normally experience after gluten ingestion. There are other enzymes, including those based on papaya enzymes.

    Additionally, there are many celiac disease drugs, enzymes, and therapies in various stages of development by pharmaceutical companies, including at least one vaccine that has received financial backing. At some point in the not too distant future there will likely be new treatments available for those who seek an alternative to a lifelong gluten-free diet. 

    For now though, there are no products on the market that can take the place of a gluten-free diet. Any enzyme or other treatment for celiac disease is intended to be used in conjunction with a gluten-free diet, not as a replacement.

    ASSOCIATED DISEASES
    The most common disorders associated with celiac disease are thyroid disease and Type 1 Diabetes, however, celiac disease is associated with many other conditions, including but not limited to the following autoimmune conditions:
    Type 1 Diabetes Mellitus: 2.4-16.4% Multiple Sclerosis (MS): 11% Hashimoto’s thyroiditis: 4-6% Autoimmune hepatitis: 6-15% Addison disease: 6% Arthritis: 1.5-7.5% Sjögren’s syndrome: 2-15% Idiopathic dilated cardiomyopathy: 5.7% IgA Nephropathy (Berger’s Disease): 3.6% Other celiac co-morditities include:
    Crohn’s Disease; Inflammatory Bowel Disease Chronic Pancreatitis Down Syndrome Irritable Bowel Syndrome (IBS) Lupus Multiple Sclerosis Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Psoriasis Rheumatoid Arthritis Scleroderma Turner Syndrome Ulcerative Colitis; Inflammatory Bowel Disease Williams Syndrome Cancers:
    Non-Hodgkin lymphoma (intestinal and extra-intestinal, T- and B-cell types) Small intestinal adenocarcinoma Esophageal carcinoma Papillary thyroid cancer Melanoma CELIAC DISEASE REFERENCES:
    Celiac Disease Center, Columbia University
    Gluten Intolerance Group
    National Institutes of Health
    U.S. National Library of Medicine
    Mayo Clinic
    University of Chicago Celiac Disease Center
    Jefferson Adams
    Celiac.com 05/23/2018 - Yes, we at Celiac.com realize that rye bread is not gluten-free, and is not suitable for consumption by people with celiac disease!  That is also true of rye bread that is low in FODMAPs.
    FODMAPs are Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. FODMAPS are molecules found in food, and can be poorly absorbed by some people. Poor FODMAP absorption can cause celiac-like symptoms in some people. FODMAPs have recently emerged as possible culprits in both celiac disease and in irritable bowel syndrome.
    In an effort to determine what, if any, irritable bowel symptoms may triggered by FODMAPs, a team of researchers recently set out to compare the effects of regular vs low-FODMAP rye bread on irritable bowel syndrome (IBS) symptoms and to study gastrointestinal conditions with SmartPill.
    A team of researchers compared low-FODMAP rye bread with regular rye bread in patients irritable bowel syndrome, to see if rye bread low FODMAPs would reduce hydrogen excretion, lower intraluminal pressure, raise colonic pH, improve transit times, and reduce IBS symptoms compared to regular rye bread. The research team included Laura Pirkola, Reijo Laatikainen, Jussi Loponen, Sanna-Maria Hongisto, Markku Hillilä, Anu Nuora, Baoru Yang, Kaisa M Linderborg, and Riitta Freese.
    They are variously affiliated with the Clinic of Gastroenterology; the Division of Nutrition, Department of Food and Environmental Sciences; the Medical Faculty, Pharmacology, Medical Nutrition Physiology, University of Helsinki in Helsinki, Finland; the University of Helsinki and Helsinki University, Hospital Jorvi in Espoo, Finland; with the Food Chemistry and Food Development, Department of Biochemistry, University of Turku inTurku, Finland; and with the Fazer Group/ Fazer Bakeries Ltd in Vantaa, Finland.
    The team wanted to see if rye bread low in FODMAPs would cause reduced hydrogen excretion, lower intraluminal pressure, higher colonic pH, improved transit times, and fewer IBS symptoms than regular rye bread. 
    To do so, they conducted a randomized, double-blind, controlled cross-over meal study. For that study, seven female IBS patients ate study breads at three consecutive meals during one day. The diet was similar for both study periods except for the FODMAP content of the bread consumed during the study day.
    The team used SmartPill, an indigestible motility capsule, to measure intraluminal pH, transit time, and pressure. Their data showed that low-FODMAP rye bread reduced colonic fermentation compared with regular rye bread. They found no differences in pH, pressure, or transit times between the breads. They also found no difference between the two in terms of conditions in the gastrointestinal tract.
    They did note that the gastric residence of SmartPill was slower than expected. SmartPill left the stomach in less than 5 h only once in 14 measurements, and therefore did not follow on par with the rye bread bolus.
    There's been a great deal of interest in FODMAPs and their potential connection to celiac disease and gluten-intolerance. Stay tuned for more information on the role of FODMAPs in celiac disease and/or irritable bowel syndrome.
    Source:
    World J Gastroenterol. 2018 Mar 21; 24(11): 1259–1268.doi:  10.3748/wjg.v24.i11.1259
    Jefferson Adams
    Celiac.com 05/22/2018 - Proteins are the building blocks of life. If scientists can figure out how to create and grow new proteins, they can create new treatments and cures to a multitude of medical, biological and even environmental conditions.
    For a couple of decades now, scientists have been searching for a biological Rosetta stone that would allow them to engineer proteins with precision, but the problem has remained dauntingly complex.  Researchers had a pretty good understanding of the very simple way that the linear chemical code carried by strands of DNA translates into strings of amino acids in proteins. 
    But, one of the main problems in protein engineering has to do with the way proteins fold into their various three-dimensional structures. Until recently, no one has been able to decipher the rules that will predict how proteins fold into those three-dimensional structures.  So even if researchers were somehow able to design a protein with the right shape for a given job, they wouldn’t know how to go about making it from protein’s building blocks, the amino acids.
    But now, scientists like William DeGrado, a chemist at the University of California, San Francisco, and David Baker, director for the Institute for Protein Design at the University of Washington, say that designing proteins will become at least as important as manipulating DNA has been in the past couple of decades.
    After making slow, but incremental progress over the years, scientists have improved their ability to decipher the complex language of protein shapes. Among other things, they’ve gained a better understanding of how then the laws of physics cause the proteins to snap into folded origami-like structures based on the ways amino acids are attracted or repelled by others many places down the chain.
    It is this new ability to decipher the complex language of protein shapes that has fueled their progress. UCSF’s DeGrado is using these new breakthroughs to search for new medicines that will be more stable, both on the shelf and in the body. He is also looking for new ways to treat Alzheimer’s disease and similar neurological conditions, which result when brain proteins fold incorrectly and create toxic deposits.
    Meanwhile, Baker’s is working on a single vaccine that would protect against all strains of the influenza virus, along with a method for breaking down the gluten proteins in wheat, which could help to generate new treatments for people with celiac disease. 
    With new computing power, look for progress on the understanding, design, and construction of brain proteins. As understanding, design and construction improve, look for brain proteins to play a major role in disease research and treatment. This is all great news for people looking to improve our understanding and treatment of celiac disease.
    Source:
    Bloomberg.com
    Jefferson Adams
    Celiac.com 05/21/2018 - Just a year ago, Starbucks debuted their Canadian bacon, egg and cheddar cheese gluten-free sandwich. During that year, the company basked in praise from customers with celiac disease and gluten-sensitivity for their commitment to delivering a safe gluten-free alternative to it’s standard breakfast offerings.
    But that commitment came to an ignoble end recently as Starbucks admitted that their gluten-free sandwich was plagued by  “low sales,” and was simply not sustainable from a company perspective. The sandwich may not have sold well, but it was much-loved by those who came to rely on it.
    With the end of that sandwich came the complaints. Customers on social media were anything but quiet, as seen in numerous posts, tweets and comments pointing out the callous and tone-deaf nature of the announcement which took place in the middle of national Celiac Disease Awareness Month. More than a few posts threatened to dump Starbucks altogether.
    A few of the choice tweets include the following:  
    “If I’m going to get coffee and can’t eat anything might as well be DD. #celiac so your eggbites won’t work for me,” tweeted @NotPerryMason. “They’re discontinuing my @Starbucks gluten-free sandwich which is super sad, but will save me money because I won’t have a reason to go to Starbucks and drop $50 a week,” tweeted @nwillard229. Starbucks is not giving up on gluten-free entirely, though. The company will still offer several items for customers who prefer gluten-free foods, including Sous Vide Egg Bites, a Marshmallow Dream Bar and Siggi’s yogurt.
    Stay tuned to learn more about Starbucks gluten-free foods going forward.
    Jefferson Adams
    Celiac.com 05/19/2018 - Looking for a nutritious, delicious meal that is both satisfying and gluten-free? This tasty quinoa salad is just the thing for you. Easy to make and easy to transport to work. This salad of quinoa and vegetables gets a rich depth from chicken broth, and a delicious tang from red wine vinegar. Just pop it in a container, seal and take it to work or school. Make the quinoa a day or two ahead as needed. Add or subtract veggies as you like.
    Ingredients:
    1 cup red quinoa, rinsed well ½ cup water ½ cup chicken broth 2 radishes, thinly sliced 1 small bunch fresh pea sprouts 1 small Persian cucumber, diced 1 small avocado, ripe, sliced into chunks Cherry or grape tomatoes Fresh sunflower seeds 2 tablespoons red wine vinegar  Kosher salt, freshly ground pepper Directions:
    Simmer quinoa in water and chicken broth until tender.
    Dish into bowls.
    Top with veggies, salt and pepper, and sunflower seeds. 
    Splash with red wine vinegar and enjoy!
    Jefferson Adams
    Celiac.com 05/18/2018 - Across the country, colleges and universities are rethinking the way they provide food services for students with food allergies and food intolerance. In some cases, that means major renovations. In other cases, it means creating completely new dining and food halls. To document both their commitment and execution of gluten-free and allergen-free dining, these new food halls are frequently turning to auditing and accreditation firms, such as Kitchens with Confidence.
    The latest major player to make the leap to allergen-free dining is Syracuse University. The university’s Food Services recently earned an official gluten-free certification from Kitchens with Confidence for four of the University’s dining centers, with the fifth soon to follow.
    To earn the gluten-free certification from Kitchens with Confidence, food services must pass a 41 point audit process that includes 200 control check points. The food service must also agree to get any new food item approved in advance, and to submit to monthly testing of prep surfaces, to furnish quarterly reports, and to provide information on any staffing changes, recalls or incident reports. Kitchens with Confidence representatives also conduct annual inspections of each dining center.
    Syracuse students and guests eating at Ernie Davis, Shaw, Graham and Sadler dining centers can now choose safe, reliable gluten-free food from a certified gluten-free food center. The fifth dining center, Brockway, is currently undergoing renovations scheduled for completion by fall, when Brockway will also receive its certification.
    Syracuse Food Services has offered a gluten-free foods in its dining centers for years. According to Jamie Cyr, director of Auxiliary Services, the university believes that the independent Gluten-Free Certification from Kitchens with Confidence will help ease the anxiety for parents and students.”
    Syracuse is understandably proud of their accomplishment. According to Mark Tewksbury, director of residence dining operations, “campus dining centers serve 11,000 meals per day and our food is made fresh daily. Making sure that it is nutritious, delicious and safe for all students is a top priority.”
    Look for more colleges and universities to follow in the footsteps of Syracuse and others that have made safe, reliable food available for their students with food allergies or sensitivities.
    Read more.
    Zyana Morris
    Celiac.com 05/17/2018 - Celiac disease is not one of the most deadly diseases out there, but it can put you through a lot of misery. Also known as coeliac, celiac disease is an inherited immune disorder. What happens is that your body’s immune system overreacts to gluten and damages the small intestine. People who suffer from the disease cannot digest gluten, a protein found in grain such as rye, barley, and wheat. 
    While it may not sound like a severe complication at first, coeliac can be unpleasant to deal with. What’s worse is it would lower your body’s capacity to absorb minerals and vitamins. Naturally, the condition would cause nutritional deficiencies. The key problem that diagnosing celiac is difficult and takes take longer than usual. Surprisingly, the condition has over 200 identified symptoms.
    More than three million people suffer from the coeliac disease in the United States alone. Even though diagnosis is complicated, there are symptoms that can help you identify the condition during the early stages to minimize the damage. 
    Here is how you can recognize the main symptoms of celiac disease:
    Diarrhea
    In various studies conducted over years, the most prominent symptom of celiac disease is chronic diarrhea.
    People suffering from the condition would experience loose watery stools that can last for up to four weeks after they stop taking gluten. Diarrhea can also be a symptom of food poisoning and other conditions, which is why it makes it difficult to diagnose coeliac. In certain cases, celiac disease can take up to four years to establish a sound diagnosis.
    Vomiting
    Another prominent symptom is vomiting.  
    When accompanied by diarrhea, vomiting can be a painful experience that would leave you exhausted. It also results in malnutrition and the patient experiences weight loss (not in a good way though). If you experience uncontrolled vomiting, report the matter to a physician to manage the condition.
    Bloating
    Since coeliac disease damages the small intestine, bloating is another common system. This is due to inflammation of the digestive tract. In a study with more than a 1,000 participants, almost 73% of the people reported bloating after ingesting gluten. 
    Bloating can be managed by eliminating gluten from the diet which is why a gluten-free diet is necessary for people suffering from celiac disease.
    Fatigue
    Constant feeling of tiredness and low energy levels is another common symptom associated with celiac disease. If you experience a lack of energy after in taking gluten, then you need to consult a physician to diagnose the condition. Now fatigue can also result from inefficient thyroid function, infections, and depression (a symptom of the coeliac disease). However, almost 51% of celiac patients suffer from fatigue in a study.
    Itchy Rash
    Now the chances of getting a rash after eating gluten are slim, but the symptom has been associated with celiac disease in the past. The condition can cause dermatitis herpetiformis, which causes a blistering skin rash that occurs around the buttocks, knees, and elbows. 
    A study found out that almost 17% of patients suffering from celiac disease might develop dermatitis herpetiformis due to lack of right treatment. Make sure you schedule an online appointment with your dermatologist or visit the nearest healthcare facility to prevent worsening of symptoms.
    Even with such common symptoms, diagnosing the condition is imperative for a quick recovery and to mitigate the long-term risks associated with celiac disease. 
    Sources:
    ncbi.nlm.nih.gov  Celiac.com ncbi.nlm.nih.gov  mendfamily.com
    Jefferson Adams
    Celiac.com 05/16/2018 - Galectins are a family of animal lectins marked by their affinity for N-acetyllactosamine-enriched glycoconjugates. Galectins control several immune cell processes and influence both innate and adaptive immune responses. A team of researchers recently set out to assess the role of galectins, particularly galectin-1 (Gal-1), in the treatment of celiac disease.
    The research team included Victoria Sundblad, Amado A. Quintar, Luciano G. Morosi, Sonia I. Niveloni, Ana Cabanne, Edgardo Smecuol, Eduardo Mauriño, Karina V. Mariño, Julio C. Bai, Cristina A. Maldonado, and Gabriel A. Rabinovich.
    The researchers examined the role of galectins in intestinal inflammation, particularly in Crohn’s disease, ulcerative colitis, and celiac disease patients, as well as in murine models resembling these inflammatory conditions. 
    Maintaining the fine balance between host immunity and tolerance promotes gut homeostasis, and helps to prevent inflammation. To gain insight into the role of Gal-1 in celiac patients, the team demonstrated an increase in Gal-1 expression following a gluten-free diet along with an increase in the frequency of Foxp3+ cells. 
    The resolution of the inflammatory response may promote the recovery process, leading to a reversal of gut damage and a regeneration of villi. Among other things, the team’s findings support the use of Gal-1 agonists to treat severe mucosal inflammation. In addition, Gal-1 may serve as a potential biomarker to follow the progression of celiac disease treatment.
    Gut inflammation may be governed by a coordinated network of galectins and their glycosylated ligands, triggering either anti-inflammatory or pro-inflammatory responses. That network may influence the interplay between intestinal epithelial cells and the highly specialized gut immune system in physiologic and pathologic settings.
    The team’s results demonstrate that the anti-inflammatory and tolerogenic response associated with gluten-free diet in celiac patients is matched by a substantial up-regulation of Gal-1. This suggests a major role of this lectin in favoring resolution of inflammation and restoration of mucosal homeostasis. 
    This data highlights the regulated expression of galectin-1 (Gal-1), a proto-type member of the galectin family, during intestinal inflammation in untreated and treated celiac patients. Further study of this area could lead to better understanding of the mechanisms behind celiac disease, and potentially to a treatment of the disease.
    Source:
    Front. Immunol., 01 March 2018.  
    The researchers in this study are variously affiliated with the Laboratorio de Inmunopatología, Instituto de Biología y Medicina Experimental (IBYME), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; the Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina; the Instituto de Investigaciones en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina; the Laboratorio de Glicómica Funcional y Molecular, Instituto de Biología y Medicina Experimental (IBYME), Consejo de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; the Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología Dr. C. Bonorino Udaondo, Buenos Aires, Argentina; the Unidad de Patología, Hospital de Gastroenterología, Bonorino Udaondo, Buenos Aires, Argentina; the Instituto de Investigaciones, Universidad del Salvador, Buenos Aires, Argentina; and the Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina.
    Jefferson Adams
    Celiac.com 05/15/2018 - There is a good amount of anecdotal evidence that people with non-celiac gluten sensitivity can tolerate sourdough bread, but there is no good science to support such claims. To determine if sourdough bread help conquer wheat sensitivity, the Alberta Wheat Commission (AWC) is funding a team of researchers to see if the sourdough fermentation process can reduce or eliminate wheat components that trigger wheat sensitivity.
    The project will study the way the sourdough bread fermentation process breaks down proteins and carbohydrates in wheat flour.
    Chair of the AWC Research Committee, Terry Young, said new research suggests that wheat protein may not be the cause of gluten sensitivity in people without celiac disease. Longer fermentation, aka sourdough fermentation, is more common in Europe. Young says that reports indicate that “incidents of non-celiac sensitivity…are actually lower in Europe." He adds the current research will focus on the fermentation, but the future may include the development of wheat varieties for gluten sensitive individuals.
    The research will be led by food microbiologist at the University of Alberta, Dr. Michael Gänzle, who said the use of sourdough bread in industrial baking reduces ingredient costs and can improve the quality of bread as well.
    Dr. Gänzle wants to assess anecdotal claims that people with non-celiac wheat or gluten intolerance can tolerate sourdough bread. His team wants to “determine whether fermentation reduces or eliminates individual wheat components that are known or suspected to cause adverse effects.”
    The team readily admits that their project will not create products that are safe for people with celiac disease. They may, however, create products that are useful for people without celiac disease, but who are gluten sensitivity.
    The AWC is collaboratively funding the project with the Saskatchewan Wheat Development Commission, and the Minnesota Wheat Research Promotion Council, which will contribute $57,250, and $20,000, respectively. The research team will issue a report of its findings after the project is completed in 2021.
    Studies like this are important to shed light on the differences between celiac and non-celiac gluten sensitivity. Stay tuned for more developments in this exciting area of research.
    Source:
    highriveronline.com
    Jefferson Adams
    Celiac.com 05/14/2018 - An imbalance or defect in gut bacteria function may be a major cause of hair loss and pattern baldness. Pattern baldness (alopecia areata) affects approximately 1.7 per cent of the population and we still don’t know precisely what causes it. In addition to promoting a healthy digestive tract, our gut bacteria play an important function in our overall health. 
    Recent experiments with antibiotics and bacteria-free mice reveal how a single a single gut bacteria, Lactobacillus murinus, could cause pattern baldness by triggering deficiencies in biotin. Biotin, vitamin B7, is a crucial vitamin. Biotin deficiency can lead to skin disease and hair loss. Some bacteria in our gut produces biotin, while other bacteria breaks down and consumes biotin. Biotin deficiency is most often seen in patients with serious conditions, such as celiac disease, but it can also be common among pregnant women. Previous research has shown that bacteria-free mice that lack biotin in their diet, develop mild hair loss (alopecia). 
    Could an imbalance or defect in gut bacteria function be a major cause of hair loss and pattern baldness? To determine if the underlying cause of hairless might be an imbalance of our gut bacteria, a team of Japanese scientists conducted experiments with antibiotics and bacteria-free mice to see if variations gut bacteria might cause pattern baldness by influencing biotin levels.
    The team first fed laboratory mice a diet with and without biotin, but saw no impact on hair loss. They then repeated the experiment, but this time they also gave the mice a long course of antibiotics to destroy the balance of bacteria in their gut.  The laboratory mice on a biotin-free diet coupled with antibiotics saw an increase in a particular gut bacteria that corresponded to patten hair loss, as was previously shown in bacteria-free mice. By studying what had happened in the gut bacteria of these mice, the scientists discovered that a particular type of lactic acid bacteria, Lactobacillus murinus, had expanded after the antibiotic treatment.
    When the team fed bacteria-free mice with Lactobacillus murinus, they saw that the hair loss became even worse and the mice became almost entirely bald. Further tests followed, in which regular mice and bacteria-free mice received a regular diet with normal levels of biotin, but added Lactobacillus murinus. These mice showed no hair loss at all. Direct injections of biotin also stopped hair loss; although the team did concede that skin bacteria could also play a role.
    The discovery that gut bacteria and diet to influence hair loss creates new avenues for treating baldness and hair loss simply by adjusting gut microbiota. It’s possible that probiotic dietary supplements can be used to influence gut bacteria, and prevent the biotin-eating bacteria now known to cause hair loss. Stay tuned for news on the role of gut bacteria in hair loss, and on any new treatment approaches to hair loss and alopecia that may result.
    Their results appear in the scientific journal Cell Reports.
    Gordon Heinrichs, DC
    Celiac.com 05/12/2018 - Dear researchers/scientists at NIDDK: RE: Misinformation on your website?
    I am encouraged that you have information about celiac disease on your website (Provider Points: Testing for Celiac Disease). My wife has had celiac disease (CD) for more than 35 years and we always welcome more public/professional exposure for this perplexing condition. I'm a gluten-sensitive-patient advocate and concerned that your information does not appear to be supportable by laboratory science. (Yes, I saw the references and the reviewers—very prestigious literature and referees for your document.) Let's review the information from an accountant's perspective.  
    Before we get into the details of your site, I must mention that I was a medical laboratory technologist in California for 15 years and am quite familiar with the issues that you discuss related to laboratory testing. I was actually working in the lab years ago when the PSA (prostate-specific antigen) was proclaimed the ultimate test for prostate cancer. Now the U.S. Preventive Services Task Force (USPSTF) recommends against PSA screening. Because of this reversal of support for the PSA and other similar tests that were first introduced with blazing reviews throughout the years, I take a skeptic's view whenever I see amazing claims about lab tests. I have read much of the CD research literature and have not changed my cynical ways after reviewing the astounding claims for the blood tests and the biopsy in preparation for writing my book, Celiac Disease & Gluten Sensitivity: A Troubled Past but a Promising Future.
    Before we put the accountant to work, I want to point out that you have taken the safe road when stating that, "For accurate diagnostic test results, patients must be on a gluten-containing diet." One reason you made that statement is because the news sources certainly give us the impression that an expanding portion of the population is attempting the gluten-free diet (GFD) first, before any testing. Many patients would therefore need to return to a gluten-containing diet. Most major celiac organizations designate a certain number of weeks or months for a person to be on this diet in order to get the accurate results to which you refer. I assume you are aware that no one really knows exactly how long patients must consume gluten to ensure high rates of accuracy for the blood tests. You will find a variety of time spans on the various university and public advocacy websites. 
    Since yours is a Provider Points site, it would seem prudent for you to explain to the providers that the exact length of time is unknown—therefore the doctor would need to take his/her best guess because each person is unique. It's worth noting that currently most doctors know little or nothing about CD and its myriad ramifications. This is my first point. Before we stick that needle in the patient's arm, we may already be in error by specifying a certain time span for the gluten-containing diet and therefore introducing inaccurate results for those patients who did not perform within the limitations. And neither you nor the providers know how large, or small, that number may be. 
    Now the accountant can clock in. You seem to favor the tTG test as the best. You say that it has a sensitivity of more than 90% (very few false negatives) and a specificity of more than 95% (very few false positives). As you know, those are remarkably good numbers for any lab test (not to mention the EMA, which Dr. Green says is approaching 100% accuracy). Let's break those figures down. You assert that 2–3% of celiac patients have selective IgA deficiency. Are those people included in the 90/95? I assume they are, since we can't know who these patients are until they're tested. If they are included, then those 90/95 numbers are even more amazing, because we now have a small (but significant) percentage of cases who will immediately show up as false negatives. 
    Let's move to the other group that you've stated might not be accurate because the "tTG and EMA tests may yield false negative results"—young tykes. Again, every individual is unique, and to assume that your 18-month cutoff age will work for every child is pushing the limits. I noticed you also did not include the elderly here, although the two clusters have similar problems—immune systems that are immature (kids) or faulty (seniors). So both ends of the age continuum may show false negative results for the tTG. 
    In fact, it wouldn't be a scientific stretch to expand this idea further, because we know there are millions worldwide within these age specifications that are immunocompromised due to undernutrition. When you add the age factor plus the nutrition factor together in one patient, he/she is even more unlikely to be able to produce a robust autoantibody response, and therefore would show up as a false negative. I'm not sure the accountant can keep track of these numbers—they keep adding up and making those 90/95 values seem like a dream. 
    I've already introduced the undernutrition topic, so let's throw in a few million people who are undernourished, and therefore may be immunocompromised but are not at the extremes of the age spectrum. Let's now go beyond the undernutrition group and identify more of the immunocompromised. That list is quite long, but here are just a few examples of patient conditions/illnesses: HIV/AIDS, alcoholism, diabetes, corticosteroid use, and immunosuppressant use.
    There are two recent developments that help answer a question that may be rolling around in the back of your mind, "How many more hours do I need to pay this accountant before she's finished calculating the total number of patients who may show false negative results on the CD blood tests?" The answer is, "You're going to need to her full time." 
    First, new research on patients' responses to vaccines (International Journal of Obesity, "Obesity Affects Influenza Vaccine Response", October, 2011) suggests that obesity may impede a person's immune system such that they may not be able to produce sufficient antibodies as would normally be expected: another subset of the population who may show false negatives when tested for CD. This is preliminary research which will be further explored because the finding is critical to the vaccine industry.  If true, can you imagine the number of people added to the accountant's ledger in the U.S. alone?
    Second, on page 27 of a monograph titled, 21st Century Medicine: A New Model for Medical Education and Practice, by David Jones, MD, Laurie Hofmann, MPH, and Sheila Quinn, the researchers describe the affect that various influences may have on gene expression. 
    "The evidence clearly reveals that each patient is a unique individual—one whose gene expression patterns are constantly in flux and whose complex and ever-changing response to treatment, environment, and lifestyle will challenge physicians to listen differently, see differently, and respond differently than taught by the linear model of acute care."
    That statement allows us to question the accepted position of the CD community which clings to the principle that once the celiac genes are turned on, they stay on forever—theoretically at the same level of expression—such that once a patient becomes sensitive to gluten, that patient is forever relegated to a gluten–free diet.  
    The authors' statement adds support to the controversial concept of "transient celiac disease," which suggests that a person may have a full blown case of symptomatic CD with all the tests showing positive, and then at some time later in life, the gene expression modulates and the person either becomes less sensitive to gluten or even may return to a totally normal diet without any untoward consequences. The patients' blood tests and biopsies would also potentially resort to normal. If you decide to read my book, you will observe that we already have documented cases of blood tests that reverted back to normal in people who had been officially diagnosed with CD but continued on a normal diet (fluctuating antibody levels).
    I think you get the picture. All of the aforementioned patients may show up as false negatives; I suspect the accountant can give you a strong estimate as to how accurate the 90/95 numbers are. Since you have only briefly discussed the biopsy on these web pages, I won't critique it, beyond stating that using that test as the "gold standard" also pushes the limits of credibility. If you would like to read my ebook it's on Amazon.com. It clearly identifies the shortcomings of the testing suggested for CD using accepted research and common laboratory knowledge. 
    I am, as you are, a gluten-sensitive-patient advocate, but misinformation can be just as bad as no information. I'd love to have a professional conversation with you about the issues I have raised. 
    Thank you for your time,
    Gordon Heinrichs, DC
    P.S. I am retired from seeing patients and write about gluten-health issues as a hobby and passion.
    Jefferson Adams
    Celiac.com 05/11/2018 - Nestled in the foothills of Tuscany just a few miles north of Lucca, the Italian village of Fabbriche di Vallico is home to a famous chestnut mill that still produces chestnut flour. One of a very few in existence, and one of just two left in the region, the town’s mill is the only one to produce exclusively gluten-free flour. 
    In fact, this quiet village about forty miles northwest of Florence has been making gluten-free chestnut flour since 1721. These days the town is known for for its hotels, such as the Renaissance Tuscany II Ciocco Resort & Spa that overlooks the Lucca valley. 
    The hotel offers tours to the traditional Fabbriche di Vallico mill, which produces exclusively gluten-free flour, where guests can learn about the ancient tradition of grinding autumn chestnuts into sweet gluten-free chestnut flour and maybe even meet mill owner Fosco Bertogli, who's revived the nearly 300 year tradition.
    After the tour, visitors can learn to make pasta from these chestnuts with the property's head chef.
    Mr Bertogli tells me his "passion" is what got the mill running again in 1999. He sells the delicious, high quality chestnut flour for between ten and 12 euros for a one kilogram bag.
    Read more about this romantic gluten-free travel experience at DailyMail.co.uk.
    Jefferson Adams
    Celiac.com 05/10/2018 - Most people who suffer from inflammatory bowel diseases (IBD) have either Crohn’s disease or ulcerative colitis. Some research has suggested that patients with Crohn's disease have an altered response to vitamin D, among other issues. The exact mechanism behind this is not well understood. 
    To get a better picture of the problem, a team of researchers recently set out to investigate disease-specific gene expression profiles of peripheral blood mononuclear cells (PBMCs) from Crohn’s disease patients in clinical remission. The research team included Holger Schäffler, Maria Rohde, Sarah Rohde, Astrid Huth, Nicole Gittel, Hannes Hollborn, Dirk Koczan, Änne Glass, Georg Lamprecht, and Robert Jaster, with the Department of Medicine II, Division of Gastroenterology, Rostock University Medical Center in Rostock, Germany.
    The team began by genotyping patients with Crohn's disease in clinical remission or with very low disease activity according to nucleotide-binding oligomerization domain 2 (NOD2), and PBMCs from wild-type (WT)-NOD2 patients, and patients with homozygous or heterozygous NOD2 mutations.
    Meanwhile the team isolated healthy donors for further analysis. The team then cultured the cells with vitamin D, peptidoglycan (PGN) and lipopolysaccharide (LPS) for defined periods of time before RNA was isolated and subjected to microarray analysis using Clariom S assays and quantitative real-time PCR.  They assessed the NOD2- and disease-specific gene expression profiles with repeated measure ANOVA using a general linear model.
    The team used microarray assays to find 267 genes that were significantly up- or downregulated in PBMCs of WT-NOD2 patients, compared to healthy donors after challenge with vitamin D and/or a combination of LPS and PGN (P < 0.05; threshold: ≥ 2-fold change).  For further analysis by real-time PCR, the team selected genes with known impact on inflammation and immunity that fulfilled predefined expression criteria. 
    In a larger group of patients and controls, the team found a disease-associated expression pattern, with higher transcript levels in vitamin D-treated PBMCs from patients, in three of these genes, CLEC5A (P < 0.030), lysozyme (LYZ; P < 0.047) and TREM1 (P < 0.023).  The team found six genes that were expressed in a NOD2-dependent manner (Crohn's disease101, P < 0.002; CLEC5A, P < 0.020; CXCL5, P < 0.009; IL-24, P < 0.044; ITGB2, P < 0.041; LYZ, P < 0.042). 
    Interestingly, the team saw the highest transcript levels in patients with heterozygous NOD2 mutations.
    This study identifies CLEC5A and LYZ as Crohn's disease- and NOD2-associated genes of PBMCs and supports the need for further studies on their pathomechanistic roles. The team found that PBMCs of patients with Crohn's disease display alterations in their response to vitamin D and PAMPs. 
    Disease-associated and NOD2-dependent gene expression profiles are preserved even during clinical remission. The team’s data identifies CLEC5A, LYZ and TREM1 as good candidates for follow-up study.  The researchers propose that these genes may act in a common network relevant to celiac disease development. 
    The research team remains committed to the longterm goal of biomarkers to that will accurately predict the clinical course of celiac disease.
    Source:
    World J Gastroenterol. 2018 Mar 21; 24(11): 1196–1205. doi: 10.3748/wjg.v24.i11.1196
    Advertising Product-Review
    Celiac.com 05/10/2018 - I remember how depressing it was to discover, soon after I was diagnosed with celiac disease and had to go gluten-free, that most licorice candies contain gluten. It's hard for me to convey just how exciting it was for me, a true licorice lover, to discover a gluten-free alternative for my black licorice cravings: Xtreme ZOT Organic Licorice Original.  
    It's amazing to me that its only ingredients are “organic licorice root juice extract.” Did you know that for centuries licorice has been a natural treatment for stomach and other ailments? According to the ZOT Web site: “The ancient Greeks, Egyptians, Chinese, and Hindus recognized the natural medicinal qualities of licorice. In the United States, anise seed is a popular substitute flavoring for licorice. Although the anise seed has an unmistakable licorice flavor, it is not related to the European plant whose roots are the source of true licorice.” Is it possible that I've been eating mostly the anise substitute for many years, and now I've finally discovered REAL licorice? 
    It's hard to put into words the “black licorice power” that explodes from a single, Tic-Tac-sized piece of ZOT. It's like all the amazing black licorice taste of an entire box of candy licorice, all distilled down to one very small piece of “original licorice root extract,” which, is probably is why it is called “Xtreme.” They definitely don't fool around over at ZOT, and they make the perfect fix for licorice lovers like me.
    One thing that is missing, however, is all the junk like sugar, coloring, etc., that are normally included in the candy-form of licorice, so it is truly a healthy choice. Each piece of ZOT takes time to slowly melt in your mouth, so enjoy every moment of it, as I did. The aftertaste of a ZOT reminds me of the tail-end of a full-bodied fine wine, complete with the tannin finish.
    Visit their site for more info.
    Jefferson Adams
    Celiac.com 05/09/2018 - Is there a difference in celiac disease rates between people born via cesarian section versus those born via natural birth? To answer that question, a team of researchers recently set out to investigate the association between mode of delivery and the risk of celiac disease in two large population-based birth cohorts with different rates of diagnosed celiac disease.
    The research team included Stine Dydensborg Sander, Anne Vinkel Hansen, Ketil Størdal, Anne-Marie Nybo Andersen, Joseph A Murray, and Steffen Husby. They are variously affiliated with the Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark; the Institute of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark; the Department of Public Health, University of Copenhagen, Copenhagen, Denmark; the Statistics Denmark, Copenhagen, Denmark; the Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway; the Department of Pediatrics, Ostfold Hospital Trust, Grålum, Norway; and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
    For their observational register-based cohort study, the team used data from administrative and health registers from Denmark and Norway and linked the data at the individual level.  Their study group included all children born in Denmark from January 1, 1995 to December 31, 2010 and all children born in Norway from January 1, 2004 to December 31, 2012.
    The study group included included 1,051,028 children from Denmark, and 537,457 children from Norway. In total, cesarean sections 286,640 children were delivered by cesarian section, while a total of 3,314 children were diagnosed celiac disease. 
    The team found no connection between the mode of delivery and the risk of diagnosed celiac disease. 
    The adjusted odds ratio for celiac disease for children delivered by any type of cesarean section compared to vaginal delivery was 1.11 (95% CI: 0.96–1.29) in the Danish cohort and 0.96 (95% CI: 0.84–1.09) in the Norwegian cohort. The adjusted odds ratio for celiac disease for children delivered by elective cesarean section compared to vaginal delivery was 1.20 (95% CI: 1.00–1.43) in the Danish cohort and 0.96 (95% CI: 0.79–1.17) in the Norwegian cohort.
    This large registry-based study provides strong evidence that the mode of birth delivery does not have any influence on whether a child will go on to develop celiac disease.
    Source:
    Clin Epidemiol. 2018; 10: 323–332.Published online 2018 Mar 19. doi: 10.2147/CLEP.S152168
    Jefferson Adams
    Celiac.com 05/08/2018 - The US Food and Drug Administration (FDA) has issued an alert to healthcare providers about the risk of cross-contamination with certain endoscope connectors used in gastrointestinal endoscopy. 
    The FDA warns that ”24-hour multi-patient use endoscope connectors,” carry cross-contamination risks. To help reduce the risk of cross-contamination and possible infection between patients, the FDA recommends that providers use connectors with backflow prevention features that prevent patient fluids from flowing back into the endoscope. 
    The FDA warns that these connectors carry cross-contamination risks. "To date, the FDA has not received acceptable testing to demonstrate the safe use of these products, and recommends against their use," the FDA said.
    To help reduce the risk of cross-contamination and possible infection between patients, the FDA recommends that providers use connectors with backflow prevention features that prevent patient fluids from flowing back into the endoscope.
    Erbe USA Inc’s Erbeflow port connector is currently the only 24-hour, multi-patient-use endoscope connector with no back-flow prevention feature, so the FDA warning is clearly targeted at that device.
    According to an FDA assessment, because “the connector, tubing, and/or water bottle can become contaminated with blood, stool, or other fluids from previous patients,” the Erbeflow port connector does not “adequately mitigate the risks of cross-contamination for endoscopy patients.”
    The agency is encouraging health providers to use single-use and reusable endoscope connectors with backflow prevention features, and to make certain that reusable connectors are processed properly for each procedure.
    The agency is also encouraging healthcare professionals to report problems with these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program.
    Read more at FDA.gov.
    Jefferson Adams
    Celiac.com 05/07/2018 - Pursuing a hypothesis that Gilles de la Tourette syndrome (GTS) and Non-Celiac Gluten Sensitivity (NCGS) may be related, a team of researchers recently set out to assess the efficacy of a gluten-free diet in 29 patients with Gilles de la Tourette Syndrome GTS in a prospective pilot study. The research team then evaluated patient progress after one year on a gluten-free diet. 
    The research team included Luis Rodrigo, Nuria Álvarez, Enrique Fernández-Bustillo, Javier Salas-Puig, Marcos Huerta, and Carlos Hernández-Lahoz. To establish a baseline of conditions, the team used a series of questionnaires, including YGTSS, Y-BOCS/CY-BOCS and GTS-QOL, which they then compared before and after the gluten-free diet. 
    The YGTSS questionnaires measured tics, while the Y-BOCS/CY-BOCS questionnaires measured the intensity and frequency of OCD. The study group included 23 children and 6 adults. In all, 74% of children and 50% of adults were male. When the study began, nearly 70% of children and 100% of adults showed OCD (NS).  Both groups showed frequent symptoms of NCGS, with nearly half of the children and 83.6% of adults reporting headaches. 
    After one year of gluten-free diet, both child and adult patients showed a substantial reduction in tics (YGTSS), a reduction in the intensity and frequency of OCD, along with improved QOL measurements. 
    This study showed that both children and adults with Tourette syndrome and non-celiac gluten sensitivity who followed a gluten-free diet for one year showed a significant reduction in tics and OCD. A gluten-free diet seems to reduce tics and OCD both in both children and adults with Tourette syndrome and gluten sensitivity. 
    Clearly larger studies are needed to confirm these finding, but this is exciting news for those with Tourette syndrome and the doctors who treat them. Meantime, the number of conditions that seem to improve with gluten-free diet treatment continues to grow. Stay tuned for more developments.
    Source:
    Preprints 2018, 2018040332. doi: 10.20944/preprints201804.0332.v1
    Jefferson Adams
    Celiac.com 05/05/2018 - With warm days on the horizon and hot days around the corner, a cool beverage will be mandatory, and a tasty new cool beverage recipe will be like money in the bank. This tart, fruity twist marries classic lemonade with fresh mint and smokey grilled pineapple for a delightfully refreshing afternoon drink that goes perfectly with your favorite grilled foods and snacks. Be sure to add a chunk of pineapple or a slice of lemon to the rim of the glass. 
    This glorious marriage grilled pineapple, mint and lemonade is a crisp, fruity twist marries classic lemonade with fresh mint and smokey grilled pineapple for a delightfully refreshing afternoon drink that goes perfectly with your favorite grilled foods and snacks.
    Ingredients:
    12 ounces fresh pineapple, sliced  8 cups hot water  6-7 tablespoons granulated sugar, to taste  2 cups fresh lemon juice (10-12 large lemons) Sprigs of fresh mint Directions: 
    Grill peeled and cored pineapple slices on a hot, well-oiled grill until juicy, but with nice char marks on both sides.
    Set grilled pineapple slices aside to cool.
    Combine 48 cups hot water and sugar in a large pitcher, and stir with a whisk until sugar is fully dissolved.
    Process pineapple 1 mint sprig and lemon juice in a blender until relatively smooth.
    Pour mixture through a fine-mesh strainer into pitcher with sugar mixture; discard solids. 
    Stir well until fully blended. 
    Serve over muddled mint and ice.
    Garnish with a seared pineapple slice, fresh lemon slices and/or sprigs of mint.
    If you're a grown-up who is booze inclined, you can add vodka, tequila or clear rum as desired.
    Alexander R. Shikhman, MD, PhD, FACR
    Celiac.com 05/04/2018 - It has been recognized for several decades that both children and adults with celiac disease have a significantly increased frequency of osteoporosis and increased risk of fractures as compared to the age-matched non-celiac healthy individuals. Based on published data the prevalence of osteoporosis among celiac patients varies from as low as 4% to as high as 70%. The data from our clinic indicate that prevalence of osteoporosis among adults with gluten intolerance and celiac disease is in the vicinity of 30-40%.
    Characteristics and causes of osteoporosis 
    Osteoporosis is a bone disease characterized by the reduced bone mineral density and impaired bone architecture that leads to an increased risk of fracture. The three main mechanisms by which osteoporosis develop include an inadequate peak bone mass, excessive bone resorption and inadequate formation of new bone during remodeling. 
    At a given age, bone mass results from the amount of bone acquired during growth (the peak bone mass) minus the acquired bone loss due to variety of reasons including age-related processes, malabsorption syndromes, chronic steroid use etc.  The rate and magnitude of bone mass gain during the pubertal years may markedly differ from one individual to another. It has been demonstrated that pediatric onset of celiac disease and poor compliance with gluten-free diet during childhood do significantly reduce peak bone mass. 
    One of the main causes of osteoporosis is an alteration in bone remodeling due to imbalance between bone formation and resorption, with a predominance of resorption resulting in a reduction in bone mass and increased risk of fractures. Formation of the new bone is facilitated by specialized cells, osteoblasts, which actively synthesize bone matrix. Bone resorption is mediated by other specialized cells, osteoclasts.
    One of the main regulators of bone remodeling is the RANK/RANKL/OPG system. During bone remodeling, bone marrow cells and osteoblasts produce RANKL(receptor activator for nuclear factor kB ligand), which bonds with a transmembrane receptor of the osteoclast precursor, RANK(receptor activator of nuclear factor kB), causing their differentiation and activation. Osteoprotegerin (OPG) binds to RANKL before it has an opportunity to bind to RANK, and hence suppresses its ability to increase bone resorption.
    Normal bone remodeling is based on the permanent renovation of the skeleton and consists of an initial phase of bone resorption followed by a phase of formation, both of which are regulated by general (endocrine) factors and local (paracrine) factors. The main endocrine factors include parathyroid hormone [PTH] and vitamin D as well as estrogens and, to a lesser extent, testosterone, thyroid hormones, growth hormone and leptin. Local factors include various cytokines (IL-1, IL-6 and TNF-a playing a role) key growth factors that regulate the process.
    There are several well-characterized risk factors which contribute to the development of osteoporosis in celiac patients. These include:
    1. Malabsorption of vitamin D and secondary hyperparathyroidism
    Villous atrophy in celiac patients reduces the active absorption surface and induces steatorrhea (exces fat in feces), which has a chelating effect on calcium and vitamin D, making their absorption difficult. This reduces levels of the vitamin D transporting protein (calbindin and calciumbinding protein) and increases PTH synthesis which, in turn, lead to increased bone resorption causing osteoporosis.
    2. Malabsorption of vitamin K
    Malabsorption of fat soluble vitamins including vitamin K is a common finding in celiac patients. Three vitamin-K dependent proteins have been isolated in the bone: osteocalcin, matrix Gla protein (MGP), and protein S. 
    Osteocalcin is a protein synthesized by osteoblasts. The synthesis of osteocalcin by osteoblasts is regulated by the active form of vitamin D—1,25-dihydroxy-cholecalciferol. The mineral-binding capacity of osteocalcin requires vitamin K-dependent gamma-carboxylation of three glutamic acid residues. 
    MGP has been found in bone, cartilage, and soft tissue, including blood vessels. The results of animal studies suggest MGP facilitates normal bone growth and development. 
    The vitamin K-dependent anticoagulant protein S is also synthesized by osteoblasts, but its role in bone metabolism is unclear. Children with inherited protein S deficiency suffer complications related to increased blood clotting as well as decreased bone density.
    The data on the role of vitamin K in osteoporosis came from the clinical observations indicating that a chronic use of vitamin K antagonists such as warfarin increases risk of vertebral and rib fractures. Accordingly, vitamin K supplementation significantly lowers risk of vertebral and hip fractures. 
    3. Magnesium deficiency
    Magnesium deficiency may be an additional risk factor for celiac-associated osteoporosis. This may be due to the fact that magnesium deficiency alters calcium metabolism and the hormones that regulate calcium. Several human studies have suggested that magnesium supplementation may improve bone mineral density. Magnesium deficiency is easily detected with laboratory tests (eg, low serum magnesium, low serum calcium, resistance to vitamin D) or clinical symptoms (eg, muscle twitching, muscle cramps, high blood pressure, irregular heartbeat). Screening for magnesium deficiency should be routinely included in the screening of celiac patients with osteoporosis.
    4. Chronic diarrhea and metabolic acidosis
    Chronic diarrhea in patients with celiac disease results in significant bicarbonate losses and development of metabolic acidosis. Bone is a major site for the extracellular buffering of the retained acid. Therefore, one of the main compensatory mechanisms maintaining a stable serum bicarbonate level in the face of an uncorrected metabolic acidosis is the dissolution of bone buffers and net efflux of calcium from bone. Bicarbonate supplementation in patients with metabolic acidosis decreases urinary calcium, phosphorus and hydroxyproline wasting supporting the concept of negative effects of acidosis on bone health.
    5. Hypogonadism
    Decline of estrogen production and activity is one of the main events in the development of age-related osteoporosis. It is well known that estrogen deficiency is important in the pathogenesis of osteoporosis not only in women but also in men. Increase in bone mineral density in young men and declines in older men are related to circulating free estrogen, not testosterone. In general, patients with celiac disease are characterized by low levels of circulating estrogens which contributes to the development of premature osteoporosis. 
    6. Chronic use of Proton Pump Inhibitors 
    Proton pump inhibitors (PPIs) are one of the most widely used classes of drugs. The commonly used PPIs include such drugs as Omeprazole (brand name: Prilosec), Lansoprazole (brand name: Prevacid), Dexlansoprazole (brand names: Kapidex, Dexilant), Esomeprazole (brand name: Nexium), Pantoprazole (brand name: Protonix) and Rabeprazole (brand name: AcipHex). Chronic use of PPIs for gastroesophageal reflux disease and other related conditions has been associated with impaired calcium and magnesium absorption and increased risk of vertebral and nonvertebral fractures. 
    7. Chronic use of Selective Serotonin Reuptake Inhibitors 
    Selective Serotonin Reuptake Inhibitors (SSRIs) are frequently used in celiac patients for treatment of depressive disorders. The commonly used SSRIs include such drugs as Citalopram (brand name: Celexa), Escitalopram (brand name: Lexapro), fluoxetine (brand name: Prozac), fluvoxamine (brand name: Luvox), Paroxetine (brand name: Paxil) and Sertraline (brand name: Zoloft). It has been demonstrated that SSRIs increase extracellular 5-HT (5-Hydroxytryptophan) levels that have deleterious skeletal effects. The skeletal serotonergic system consists of 5-HT receptors and the 5-HT transporter (5-HTT) in osteoblasts and osteocytes. 5-HTT is a transmembrane protein targeted by SSRIs. 5-HT restrains osteoblastic activity, thus leading to bone loss. 
    8. Autoimmune mechanisms
    Autoimmune mechanisms have been long suspected as risk factors contributing to development of osteoporosis in celiac patients. Near a decade ago, it was demonstrated that sera from celiac patients with osteoporosis contains significantly high titers of antibodies against bones as compared to non-celiac osteoporotic patients. The immunostaining was localized in areas where an active mineralization process occurred and was similar to the distribution of the native bone tissue transglutaminase. Recently, it has been described that a subset of patients with celiac disease has autoantibodies to osteoprotegerin, which block the inhibitory effect of osteoprotegerin on signaling by the receptor activator of nuclear factor (NF)-kappaB (RANK), and are associated with severe osteoporosis and high bone turnover. 
    9. Chronic inflammation
    Chronic inflammatory diseases, including celiac disease, are associated with overproduction of proinflammatory cytokines such as TNF-a, interleukin(IL)-1, IL-6, IL-11, IL-15 and IL-17 among others which activate osteoclasts and accelerate bone resorption leading to osteoporosis.
    In conclusion, osteoporosis associated with celiac disease is not a coincidental problem. It is a consequence of disease-specific (autoantibodies to osteoprotegerin), disease-nonspecific (malabsorption of vitamin D, K and magnesium, hypogonadism, chronic inflammation, chronic diarrhea and metabolic acidosis) and jatrogenic (overuse of PPIs and SSRIs) events accelerating resorptive processes in the skeleton. Correction of the aforementioned risk factors in celiac patients can reverse the development of osteoporosis and reduce the risk of osteoporosis-associated fractures.
    Bibliography:
    Bab I, Yirmiya R. Depression, selective serotonin reuptake inhibitors, and osteoporosis. Curr Osteoporos Rep. 2010 Dec;8(4):185-91. Bianchi ML. Inflammatory bowel diseases, celiac disease, and bone. Arch Biochem Biophys. 2010 Nov 1;503(1):54-65. Ito T, Jensen RT.  Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Curr Gastroenterol Rep. 2010 Dec;12(6):448-57. Katz S, Weinerman S.  Osteoporosis and gastrointestinal disease. Gastroenterol Hepatol (N Y). 2010 Aug;6(8):506-17. Riches PL, McRorie E, Fraser WD, Determann C, van't Hof R, Ralston SH. Osteoporosis associated with neutralizing autoantibodies against osteoprotegerin. N Engl J Med. 2009 Oct 8;361(15):1459-65. Stazi AV, Trecca A, Trinti B.  Osteoporosis in celiac disease and in endocrine and reproductive disorders. World J Gastroenterol. 2008 Jan 28;14(4):498-505. Sugai E, Cherñavsky A, Pedreira S, Smecuol E, Vazquez H, Niveloni S, Mazure R, Mauriro E, Rabinovich GA, Bai JC.  Bone-specific antibodies in sera from patients with celiac disease: characterization and implications in osteoporosis. J Clin Immunol. 2002 Nov;22(6):353-62. Turner J, Pellerin G, Mager D.  Prevalence of metabolic bone disease in children with celiac disease is independent of symptoms at diagnosis. J Pediatr Gastroenterol Nutr. 2009 Nov;49(5):589-93. Vasquez H, Mazure R, Gonzalez D, Flores D, Pedreira S, Niveloni S, Smecuol E, Mauriño E, Bai JC. Risk of fractures in celiac disease patients: a cross-sectional, case-control study. Am J Gastroenterol. 2000 Jan;95(1):183-9.
     
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    Celiac.com 05/03/2018 - My son Jackson was diagnosed with autism at the age of 3 years. There was no scientific evidence to link autism to gluten allergy or intolerance. However, there was anecdotal evidence. If it can't hurt, but can help I'm in!
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    Healing Home Foods was born from the creations made to feed Jackson and improve his health. There is no turning back.
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    Celiac.com 04/01/2018 - Scientists at Yale reported in April in the journal, NUTRITION & METABOLISM, in a paper entitled, A Leukocyte Activation Test Identifies Food Items Which Induce Release of DNA by Innate Immune Peripheral Blood Leukocytes, that the Alcat Test, a blood test for identifying patient specific reactions to foods and chemicals, may help doctors and patients unveil a hidden cause of autoimmune and other inflammation related conditions.
    The scientists studied various immunological phenomena associated with cellular reactions measured by the Alcat Test, wherein a patient’s blood is exposed to specific food extracts and a sensitive instrument records innate immune cell responses. The Yale researchers, led by the late Dr. Ather Ali, ND, MPH, and Wajahat Mehal, M.D., Ph.D., had previously reported that diets determined by Alcat testing significantly reduce symptoms of irritable bowel syndrome (IBS). (bmjopengastro.bmj.com/content/4/1/e000164)
    The investigators wondered if this improvement in IBS symptoms is linked to release of DNA from activated white blood cells. Numerous studies from various institutions have found that DNA released from activated immune cells trigger inflammatory responses.
    The Yale team did find that positive Alcat reactions are associated with a greater release of DNA than are Alcat Test, “non-reactive” foods. They also identified the immunological pathway most involved, Protein Kinase C (PKC) as well as the primary cell type initiating the reactivity; the eosinophil. Activation of this cell type, and this pathway, are often associated with aberrant immune responses. Epigenetic studies show that foods modify gene expression and, quite possibly, the immune system can recognize foods that do so negatively.
    The findings suggest that dietary triggers may play a role in wide ranging and disparate inflammation associated disorders; such as, multiple sclerosis, gastro enteropathies, asthma, arthritis, metabolic syndrome (obesity, cardiovascular disease and Type 2 diabetes) inflammation of the liver and other target organs, dementia, eczema, psoriasis, and eosinophilic esophagitis, to name a few.
    With the costly and dramatic rise in recent years in autoimmune and inflammatory disorders, for which there are many treatments, some having serious side effects, but very few real cures, an inexpensive preventive approach involving a scientifically directed personalized diet could provide a powerful adjunct to existing medical therapies.
    The Alcat Test is manufactured and performed by Cell Science Systems, Corp. (CSS) at their laboratory in Deerfield Beach, FL. “The advantage of the Alcat Test is that it’s quick, simple, and inexpensive. It’s the only test for food sensitivities (not allergies, but, “sensitivities”) to have been clinically validated,” says Cell Science Systems’ CEO, Roger Deutsch. “Unlike genetic tests for dietary guidance, that provide only general information as to how someone may react to a particular food; or, antibody tests, which only show previous exposure to a food, but not active sensitivity, the Alcat Test shows a person’s actual, real time, biological cellular response to the foods in question,” he adds. “The results are much more accurate and have been confirmed by double blind challenges, the gold standard for this type of testing.”
    The Alcat Test offered by Cell Science Systems, Corp., measures the response of innate immune cells following exposure to foods and other substances.  It's been validated in studies from Yale School of Medicine and other institutions. In recognition of Celiac Awareness Month, now thru May 31, Cell Science Systems will offer a free genetic screen for celiac genes (HLA DQ 2 and DQ8) when you purchase an Alcat Test. Cover all bases! Go to GutHealth.com or, CellScienceSystems.com for details; or, call 1(800) US-ALCAT – (800) 872 5228.
    For more info visit their site.
    Yvonne (Vonnie) Mostat
    Celiac.com 05/03/2018 - Time to spring into action and take control of your celiac disease and dermatitis herpetiformis! This means I have to "Scare you Silly" about not fully conforming to the gluten-free diet. Anemia, tiredness, and vitamin deficiency will continue to dog you if your gluten-free diet is non-compliant. You know those "just can't resist" items in your diet, the ones where the ingredient list does not actually say it is gluten-free, which may leave you open to cross-contamination that is common in the food industry?
    There is an estimated three million Americans with celiac disease, yet the vast majority still remain undiagnosed. The prevalence of celiac disease in Canada and the United States is growing, not diminishing! The high prevalence of celiac disease is also found in individuals with other disorders such as Type 1 diabetes, autoimmune thyroid disease and Down Syndrome. The prevalence of celiac disease in Type 1 diabetes around the world is 3 – 16%. According to Shelley Case, Author of Gluten-Free Diet: A Comprehensive Resource Guide: "Studies by Columbia University in New York and the Canadian Celiac Association revealed that adults suffer from the disease for an average of 10 - 12 years before being correctly diagnosed." The rare, but wise, physician who has diagnosed celiac disease correctly also sends the patient to be checked for diabetes and thyroid disease. 
    Do you know what Gluten Ataxia is? Ataxia is a symptom in many conditions that affect the nervous system. Ataxia causes clumsiness or loss  of balance and coordination that is not due to muscle weakness. Ataxia symptoms can be worrisome, and more so if you have been cheating on your celiac diet. Symptoms may vary but can include:
    Trouble using fingers, hands, arms and/or/legs Trouble speaking Trouble moving eyes Poor coordination and/or balance Tingling in extremities Gait problems Damage to the cerebellum (the part of the brain that controls coordination). Gluten ataxia is a rare immune-mediated disease in which the body's immune system attacks the nervous system as a reaction to the ingestion of gluten. It is a rare condition, but it can be related to celiac disease as well as non-celiac gluten sensitivity. Those with gluten ataxia often do not always have digestive issues or other symptoms. A strict gluten-free diet usually improves symptoms for those with gluten ataxia. Early diagnosis and treatment through the gluten-free diet can help stop progression and further cerebellum damage. 
    People who have dermatitis herpetiformis know only too well what that gluten-containing doughnut or tart can do to their bodies. The DH sores are so itchy, and well, just sore, that prior to my first diagnosis I thought I had head lice and self-treated myself it on three separate occasions! Though DH is a miserable disorder to have, and the sores appear in the same places time and time again leaving scars, it at least leads to a faster diagnosis once a dermatologist sees the itchy sores, which often appear in bunches on your scalp, upper arms, shoulders and shins.  While other people are watching television you are itching at sores in your head, picking off scabs, and in general feeling very miserable until the DH sores eventually heal. A biopsy of one of the lesions by that dermatologist can show dermatitis herpetiformis, but sometimes only after two or even three biopsies. The IgA deposits remain under the skin and that is why the DH sores keep coming back to the same place in your body. They are still there, and just come to the surface when you ingest gluten. 
    Some with DH have to remain on dapsone for the rest of their lives. I have been on dapsone for over 30 years, even though I attempted on several occasions to stop taking it. To me it is a wonder drug, but one that I have to be careful not to abuse, because dapsone can cause anemia, and something similar to anorexia because when you ingest it regularly you do not feel hungry, and thus lose weight. To heavy people this may seem like the perfect weight loss program. Believe me, it isn't. It can also cause Methemaglobinemia which, when ingesting will prevent your arteries from functioning as an oxygen carrier and can seriously affect your body so that oxygenated blood does not reach your starved blood cells. You either carry a SAT Machine to measure the oxygen levels in your blood, or go to the Emergency Department where they can check your saturation levels. If below 90 they will admit you, run a battery of tests, and you may be put into a side room somewhere to get an infusion of Methane Blue to flush out your blood system, and you may need to have a blood transfusion. If you are away on holidays this can be a very serious condition where you are unaware you have Methemaglobinemia, except for a feeling of being out of breath, and NEED to get to hospital as soon as possible so your SAT levels can be monitored. 
    Scaring you straight means not cheating day after day and then hoping a few dapsone will improve the condition. It won't—if you have passed the safe guideline of one pill daily. It is not simply a matter of taking dapsone in a 5 - 4- 3 - 2 - 1 as I was advised to do by an internist when I was first diagnosed with dermatitis herpetiformis. Ingestion over five days will no longer help you, and to my chagrin, can cause the condition to worsen. It is a serious condition; you can actually die from lack of oxygen in your blood!
    These few descriptions do not cover the fall out (of your hair) and the scarring of the sores on your legs and upper arms the Prednisone that they want to give you can cause a "roid rage" similar to what weight lifters have when they purposely ingest Prednisone to build up their muscles and become extremely irritable because of the Prednisone. ONE helpful clear lotion that I have to buy across the border in the U.S.A. is Scalpacin or Renewal, the latter being the generic name for Salicylic Acid (3%) which lessens the intense itching when applied directly to the sores (not to be ingested!). It says only 3% Salicylic Acid and I will confess that when I first "latched" onto this amazing "scalp itch and Dandruff relief liquid" I often applied twice daily to all the sores in my scalp and on my body.
    Did you know that approximately 3% of the general population in the U.S.A., according to Dr. Peter Green, have celiac disease? Once a patient develops one autoimmune condition the odds of developing another are greatly increased. Autoimmune disorders run in families, and different diseases may affect different parts of the body. A friend of our grandson was diagnosed as having celiac disease simply because she went to her doctor with complaints of a stomach ache. The doctor could have easily asked her if she had exams coming up, sent her for a blood test to rule out an appendicitis and left it at that, but he was a wise doctor who asked more questions and ordered the celiac blood tests. When that cameback positive he actually followed it up with a biopsy of the jejunum. She, as a teenager, was positive for celiac disease, but that doctor could have easily not ventured past the  stomach ache at that first visit and gone no further with his investigations. Fortunately, vigilance paid off this time. 
    He was thorough enough to refer her to a dietitian, but you know, she still cheats! I believe the reason she cheats is because she does not suffer from any of the symptoms of celiac disease right now, and does not have dermatitis herpetiformis. Amazing how vigilant you become with your diet when you break out in painful sores over 25% of your body, and experience diarrhea, stomach aches, nausea and vomiting!
    We never got into the other diseases she could possibly get from cheating on the gluten-free diet. Sjogren's Disease, Turner Syndrome, Type 1 diabetes, Williams Syndrome, Juvenile idiopathic arthritis, lactose intolerance, migraines, peripheral neuropathy, liver disease, are but a few of the disorders that can be connected to celiac disease. Have you ever looked up the symptomatology of these autoimmune diseases? Time you did!
     
    Did you know that there is a Celiac Disease Center at Columbia University which is one of the leading authorities for unexplained infertility issues, and that the prevalence of celiac disease in women with unexplained fertility is higher than the general population? Celiac disease may also be asymptomatic, meaning you show no symptoms at all. This is one of the reasons why it may be difficult for some people and their doctors to connect the dots between celiac disease and unexplained fertility.  
    I worked with obstetrician/gynecologists for years and never found one that, when doing the laboratory testing, included a test for celiac disease, yet it is common knowledge now that a celiac disease screening should definitely be part of the work-up that is done for infertility issues. People of reproductive age spend an enormous amount of money, time and energy trying to become pregnant and carrying the baby to term. There are more women depressed because they cannot conceive or those that cannot bring a baby to term. Several studies over the past ten years have found a link between celiac disease, infertility and spontaneous abortion. It is not known yet whether the nutritional issues (malabsorption) that occurs with untreated celiac disease is the cause of the reproductive issues, or if the immune system may be to blame.
    Many doctors define infertility as the inability to get pregnant after one year of unprotected sex. In women, fertility difficulties often result from a problem with ovulation, while in men, infertility usually occurs because the man does not produce enough sperm or produces abnormal sperm. Note that undiagnosed or untreated celiac disease can lead to a host of seemingly unrelated problems, including osteoporosis, depression, and anemia. Medical researchers “along with some observant obstetrician/gynecologists are realizing that undiagnosed celiac disease may also be a cause of otherwise unexplained infertility in both men and women."  A study undertaken in England, which has one of the world's largest celiac populations, indicates that fertility often returns after you start the gluten-free diet. 
    There are many causes for infertility, but up to 30 percent of couples who are infertile will be told that no specific reason for their infertility can be found. When this happens a diagnosis of unexplained infertility is given. In recent years, awareness of celiac disease has increased. You may not be able to quote "Celiac Disease is a chronic autoimmune disorder", but it is a good sentence to spread around to those who ask you, "Do you follow the gluten-free diet because it is trendy or you want to lose weight"? As awareness for celiac disease has increased, some researchers have started looking at a possible like between celiac disease and unexplained infertility.
    Some of the known causes are:
    Low sperm count, - sperm with mobility or motility issues Enlarged veins in the scrotum called varicocele. Klinefelter syndrome, a genetic disorder.  Although Klinefelter syndrome carries with it the risk testicular cancer, autoimmune diseases have been associated with this disorder, which is a chromosomal disorder. KS might increase the risk of some autoimmune diseases. It has been suggested that some autoimmune diseases may be more common in people with Klinefelter syndrome than in others, but the evidence so far is sparse. A research paper out of Oxford, England entitled "Associations between Klinefelter's Syndrome and Autoimmune Diseases” came to the conclusion that those with Klinefelter syndrome have increased risk of some autoimmune diseases. 
    If you have the test for celiac disease, at least the blood test, and if your partner has the ultrasound done for it you can go into the obstetricians office with a list of questions, including family history, research you have undertaken yourself.  I have seen so much heartache while nursing, watching a couple lose their baby prior to delivery, and those than cannot conceive but cannot afford invitro- fertilization. The damage that undiagnosed or untreated celiac disease can result in ongoing gastrointestinal symptoms such as vomiting, chronic diarrhea, stomach pain, and cramps. A number of these symptoms may also affect the reproductive system of women, for example:
    Delayed onset of menstruation Irregular periods No periods at all, known as amenorrhea Chronic pelvic pain And yes, endometriosis (where part or parts of the uterine lining attaches itself to the uterus and begins to grow) needs to be mentioned here. Many women who have this painful disease have been told that their only way of ridding themselves of this very painful disorder is to get a total hysterectomy. This is not always the case. There are now medications to help rid the uterus of endometriosis. Many obstetricians will perform a laparoscopy to determine the extent of the endometriosis, endeavour to lyse the adhesions from the wall of the uterus. Often this is all that is needed to ensure an introduction from the egg to the sperm and conception takes place. Other, more difficult cases can be referred to an infertility specialist, but be prepared for large costs. Many infertility specialists will tell you that if you can obtain a pregnancy while still struggling with endometriosis it often alleviates the problem. 
    Did you know that men with celiac disease may have gonadal dysfunction, which could complicate fertility issues? (That was a big learning surprise for me!) This ultrasound test can be ordered by your family physician, a gonadal ultrasound to rule out a cystocele. Finding out that your husband has a cystocele is not Earth shattering—it involves a small corrective surgery. 
    Did you know that Semen issues (specifically sperm morphology) found in men with celiac disease improved after following a gluten-free diet? Few studies have been conducted on celiac disease and male infertility. There is also a lack of scientific information and research studies on the potential link between non-celiac gluten sensitivity (NCGS), also commonly referred to as "gluten intolerance" and infertility. While research needs to be done, those with non-celiac gluten sensitivity are thought to possibly be at an increased risk of reproductive issues. However, the connection between NCGS and infertility is not yet known or proven.  One case review did suggest that a strict gluten-free diet may improve fertility for those with NCGS. 
    According to Healthline experts do not fully understand the effects of celiac disease on the reproductive system. The effects may be caused by malabsorption of nutrients, the impact it has on the immune system, or another currently unexplained reason. Some studies have noticed a link in untreated celiac disease in the mother and recurrent miscarriage, pre-term birth, and low birth weight.  In a meta analysis that looked at studies on infertility and celiac disease, researchers noted that women with infertility were over three times more likely to have celiac disease than the control group. You have to admit that is a large number, and what upsets me is the fact that numerous obstetrician/gynecologists do not automatically send this part of the women's population for celiac disease screening. 
    Yet women with unexplained infertility, were six times more likely to have celiac disease than women in the control group. Despite these studies, not all experts in the field are convinced about the connection. They state that more research is needed. BUT wouldn't you want to know that there is strong evidence that infertility and celiac disease are connected, and at least make your own decision with regards to getting tested? The tests undertaken by people with infertility are difficult to endure, are not only embarrassing but invasive. If celiac disease or gluten sensitivity runs in your family, or you suspect you have celiac disease, make a list of your symptoms. You'll want to discuss your concerns with your doctor and ask to be screened for celiac disease. A Reproductive Endocrinologist is who you would be referred to here in Canada, but you may have another title in the United States.
    If you are vigilante about eliminating gluten from your diet, you will stop the damage celiac disease is doing to your body. This may include lessening or eliminating the impact it may be having on your reproductive system.
     
    Sources:
    https://www.ncbi.nim.nih.gov/pubmed/25564410 Celiac Disease A Hidden Epidemic,  Dr. Peter H.R. Green American College of Obstetricians and Gynecologists (ACOG) Resource Center: http://www.acog.org American Society for Reproductive Medicine: http://www.asrm.org  Reproductive Changes Associated with Celiac Disease: https://www.ncbi.nim.nih.gov/pmc/articles/PMC3001971/  Healthline https://www.ncbi.nml.nih.gov/pmc/articles/PMC4600520/ 
    Jefferson Adams
    Celiac.com 05/02/2018 - Celiac disease is an autoimmune disorder, not an allergy. Celiac disease affects abut 1 in 100 people, and requires professional diagnosis and treatment with a gluten-free diet. There is a good deal of confusion and inaccurate information about celiac disease and a gluten-free diet. Here are some important things to know about celiac disease:
    1) Celiac Disease Doesn’t Always Have Obvious Symptoms
    People with celiac disease may have few or no symptoms. In fact, these days, most people diagnosed with celiac disease, report few or no symptoms.
    Classic gastrointestinal symptoms include bloating, diarrhea, gas, constipation, and gut pain after consuming wheat, barley or rye. Other prominent symptoms can include fatigue, headache, poor weight gain, and depression. 
    Less classic, but still common celiac symptoms include one or more of the following: anemia, anxiety, skin rashes, infertility, irritability, joint pain, pale mouth sores, thin bones, tingling and/or numbness in hands and feet.

    2) No Symptoms Doesn't Mean No Damage
    The level of celiac-related symptoms or complaints a person has does not equate to the level of gut damage. Few or no symptoms does not mean little or no gut damage. People can have severe celiac symptoms, yet relatively light gut damage on biopsy, or conversely, they can have light symptoms and still have serious gut damage on biopsy.

    3) A Simple Antibody Test Can Point the Way
    If you suspect celiac disease, be sure to talk with your doctor. A simple antibody test or two is usually sufficient to rule celiac disease in or out. If the test is positive, then a doctor will likely recommend a biopsy for confirmation. Recent studies show that a combination of two antibody tests may be better than biopsy. Usually, patients need to be eating wheat when they are tested for celiac disease, but that is changing. There are also some promising new approaches to blood testing for celiac disease.

    4) Early Diagnosis is Key
    The longer you go without treatment, the higher the risk of gut damage, and the greater the likelihood of developing associated conditions. Early diagnosis is especially important in the elderly, as they have a greater risk of developing associated conditions and complications from untreated celiac disease. Still diagnosing celiac disease can be tricky and can take time, partly because the symptoms can be vague, seem unrelated, and can mimic other conditions.
    5) No Cure
    Currently, there is no cure for celiac disease. Several companies are working to develop a vaccine, or other immune therapy for celiac disease, but until we see a major scientific breakthrough, there is no cure for celiac disease. 
    6) Gluten-Free Diet is Mandatory
    A gluten-free diet is the only treatment for celiac disease. For people with celiac disease, a gluten-free diet is mandatory, not optional. If people with celiac disease consume wheat, rye or barley proteins they risk causing serious damage to their health, including gut damage and potential cancer, especially in the long term.
    7) Full Gut Healing Can Take Time
    Recent studies show that most people with celiac disease begin to see gut healing in the first year or year and a half. The vast majority of celiacs on a gluten-free diet heal within two to three years. Gut healing usually corresponds to healing in other affected parts of the body, such as improvements in bone microarchitecture, neuropathy, and other areas of celiac-associated damage.
    8) Gluten Sensitivity Can Increase
    The longer you go without gluten, the more sensitive you may become to accidental gluten ingestion. It’s not uncommon for people with celiac disease to see their sensitivity to gluten increase in the weeks and even years after they give up gluten. That can mean that accidental gluten ingestion can bring on symptoms that are more severe than their original complaints. For many people, this sensitivity may slowly taper off and decrease over time. For others, sensitivity remains high and requires extra vigilance about to make sure food is gluten-free.
    Remember, increased gluten sensitivity does not equal increased gut damage. For some, a fully healed gut may be more sensitive to gluten than a damaged one, and vice versa. 
    Among people on a gluten-free diet due to celiac disease, sensitivity can vary.
    9) Non-Celiac Gluten Sensitivity (NCGS) is a Thing
    You can be sensitive to gluten and not have celiac disease. Researchers have recently confirmed a condition called non-gluten sensitivity. People with this condition experience celiac-like symptoms when they consume gluten. However, they typically do not test positive for antibodies to gliadin, and they typically have a clean biopsy, so no gut damage. Some studies have cast doubt on the existence of non-gluten-celiac sensitivity. Other studies have shown that many people with NCGS react to gluten. Still other studies show that Fructan has emerged as one possible culprit. 
    10) You Can Still Live a Healthy Life and Eat Delicious Food
    Having celiac disease means making some important adjustments to your diet, but it’s still possible to live a healthy life and eat tasty food. Read more about the best gluten-free breads, burgers, pizzas, and all your favorite gluten-free treats.
    Here is a list of SAFE and UNSAFE foods for people with celiac disease. 
    Here is a list of easy, list of easy, delicious gluten-free recipes.
    Here is a list of great gluten-free sandwich breads.
    Here is a list of great gluten-free Mexican Fast Food Chains.
    Here's a recipe for a delicious gluten-free No-Bake Cheesecake.
    Knowledge is Power
    Use Celiac.com, and the Celiac.com Forums to get important information and to share your experience with others like you. Other great celiac disease resources include:
    The Mayo Clinic Celiac Disease Center at Columbia University Gluten Intolerance Group of North America
    Jefferson Adams
    Celiac.com 05/01/2018 - Celiac disease is marked by a variety of intestinal and extra-intestinal symptoms. One of the most common and best described expressions of celiac disease outside the gut is the presence of osteopenia and osteoporosis, which make for a higher fracture risk.
    A team of researchers recently set out to see if a gluten-free diet (GFD) improves bone mineralization. The research team included MB Zanchetta, AF Costa, V Longobardi, R Mazure, F Silveira, MP Temprano, H Vázquez, C Bogado, SI Niveloni, E Smecuol, ML Moreno, A González, E Mauriño, JR Zanchetta, and JC Bai.
    They are variously associated with the Instituto de Diagnóstico e Investigaciones Metabólicas, Buenos Aires, Argentina; Research Institute, Universidad del Salvador, Buenos Aires, Argentina; the Department of Medicine, Dr C. Bonorino Udaondo Gastroenterología Hospital, Buenos Aires, Argentina; and with Consejo de Investigaciones en Salud, Health Ministry, Buenos Aires City Government, Buenos Aires, Argentina.
    These researchers previously identified a significant deterioration of bone microarchitecture in premenopausal women with newly diagnosed celiac disease using high‐resolution peripheral quantitative computed tomography (HRpQCT). In that study, the team also compared 1‐year results with those of a control group of healthy premenopausal women of similar age and BMI in order to assess whether the micro-architectural parameters of treated celiac patients had reached the values expected for their age.
    While that study showed that a year on a gluten-free diet had improved most of the women’s bone parameters, it also showed that those parameters continued to be significantly lower than those of healthy control subjects.
    In a recent paper, the team describes the results of their study that offers data to show improvements bone mineralization microarchitecture in celiac patients after three years on a gluten-free diet.
    Source:
    Clin Gastroenterol Hepatol. 2017 Oct 6. pii: S1542-3565(17)31200-4. doi: 10.1016/j.cgh.2017.09.054.
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    Celiac.com 05/01/2018 - When you get the awful news that a loved one is impacted with a diagnosis such as celiac disease, you want to do everything in your power to help them! So, when one of my family members was diagnosed with celiac, I made it my personal goal to learn everything I could about it. I also looked for ways that I could help my family member and anyone else that was affected in the world with the same diagnosis.
    As an oral care scientist, I’d long dreamed of creating my own oral care line, with products that could help aide in the overall well-being of individuals. I envisioned creating products everyone could use, without sacrificing quality or price - products that avoided the use of harsh chemicals and abrasives. My dream was manifested in the form of SprinJene®, an oral care line I launched after years of research and development. SprinJene® toothpastes feature a patented formula of black seed oil and zinc, and are certified Gluten-Free, Vegan, Cruelty-Free, Halal and Kosher. SprinJene toothpastes are now offered in two product lines: SprinJene Original® and SprinJene Natural® (featuring options for adults and kids). 
    While toothpaste isn’t ingested in large quantities, some will always remain in the mouth after brushing. For individuals with celiac, even a little bit of gluten can be harmful. Most people don’t realize that in some toothpastes gluten can be used as a stabilizer, binder or thickener. SprinJene's toothpastes are certified gluten-free by the International Certification Services (ICS). In addition, all of the toothpaste formulas are tested after they’re produced to make certain that they totally gluten-free before products hit store shelves. 
    To learn more visit www.sprinjene.com.
    Order SprinJene at: Costco's Web Site or www.sprinjene.com.

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    Jefferson Adams
    Celiac.com 05/23/2018 - Yes, we at Celiac.com realize that rye bread is not gluten-free, and is not suitable for consumption by people with celiac disease!  That is also true of rye bread that is low in FODMAPs.
    FODMAPs are Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. FODMAPS are molecules found in food, and can be poorly absorbed by some people. Poor FODMAP absorption can cause celiac-like symptoms in some people. FODMAPs have recently emerged as possible culprits in both celiac disease and in irritable bowel syndrome.
    In an effort to determine what, if any, irritable bowel symptoms may triggered by FODMAPs, a team of researchers recently set out to compare the effects of regular vs low-FODMAP rye bread on irritable bowel syndrome (IBS) symptoms and to study gastrointestinal conditions with SmartPill.
    A team of researchers compared low-FODMAP rye bread with regular rye bread in patients irritable bowel syndrome, to see if rye bread low FODMAPs would reduce hydrogen excretion, lower intraluminal pressure, raise colonic pH, improve transit times, and reduce IBS symptoms compared to regular rye bread. The research team included Laura Pirkola, Reijo Laatikainen, Jussi Loponen, Sanna-Maria Hongisto, Markku Hillilä, Anu Nuora, Baoru Yang, Kaisa M Linderborg, and Riitta Freese.
    They are variously affiliated with the Clinic of Gastroenterology; the Division of Nutrition, Department of Food and Environmental Sciences; the Medical Faculty, Pharmacology, Medical Nutrition Physiology, University of Helsinki in Helsinki, Finland; the University of Helsinki and Helsinki University, Hospital Jorvi in Espoo, Finland; with the Food Chemistry and Food Development, Department of Biochemistry, University of Turku inTurku, Finland; and with the Fazer Group/ Fazer Bakeries Ltd in Vantaa, Finland.
    The team wanted to see if rye bread low in FODMAPs would cause reduced hydrogen excretion, lower intraluminal pressure, higher colonic pH, improved transit times, and fewer IBS symptoms than regular rye bread. 
    To do so, they conducted a randomized, double-blind, controlled cross-over meal study. For that study, seven female IBS patients ate study breads at three consecutive meals during one day. The diet was similar for both study periods except for the FODMAP content of the bread consumed during the study day.
    The team used SmartPill, an indigestible motility capsule, to measure intraluminal pH, transit time, and pressure. Their data showed that low-FODMAP rye bread reduced colonic fermentation compared with regular rye bread. They found no differences in pH, pressure, or transit times between the breads. They also found no difference between the two in terms of conditions in the gastrointestinal tract.
    They did note that the gastric residence of SmartPill was slower than expected. SmartPill left the stomach in less than 5 h only once in 14 measurements, and therefore did not follow on par with the rye bread bolus.
    There's been a great deal of interest in FODMAPs and their potential connection to celiac disease and gluten-intolerance. Stay tuned for more information on the role of FODMAPs in celiac disease and/or irritable bowel syndrome.
    Source:
    World J Gastroenterol. 2018 Mar 21; 24(11): 1259–1268.doi: &nbsp;10.3748/wjg.v24.i11.1259
    Jefferson Adams
    Celiac.com 05/22/2018 - Proteins are the building blocks of life. If scientists can figure out how to create and grow new proteins, they can create new treatments and cures to a multitude of medical, biological and even environmental conditions.
    For a couple of decades now, scientists have been searching for a biological Rosetta stone that would allow them to engineer proteins with precision, but the problem has remained dauntingly complex.  Researchers had a pretty good understanding of the very simple way that the linear chemical code carried by strands of DNA translates into strings of amino acids in proteins. 
    But, one of the main problems in protein engineering has to do with the way proteins fold into their various three-dimensional structures. Until recently, no one has been able to decipher the rules that will predict how proteins fold into those three-dimensional structures.  So even if researchers were somehow able to design a protein with the right shape for a given job, they wouldn’t know how to go about making it from protein’s building blocks, the amino acids.
    But now, scientists like William DeGrado, a chemist at the University of California, San Francisco, and David Baker, director for the Institute for Protein Design at the University of Washington, say that designing proteins will become at least as important as manipulating DNA has been in the past couple of decades.
    After making slow, but incremental progress over the years, scientists have improved their ability to decipher the complex language of protein shapes. Among other things, they’ve gained a better understanding of how then the laws of physics cause the proteins to snap into folded origami-like structures based on the ways amino acids are attracted or repelled by others many places down the chain.
    It is this new ability to decipher the complex language of protein shapes that has fueled their progress. UCSF’s DeGrado is using these new breakthroughs to search for new medicines that will be more stable, both on the shelf and in the body. He is also looking for new ways to treat Alzheimer’s disease and similar neurological conditions, which result when brain proteins fold incorrectly and create toxic deposits.
    Meanwhile, Baker’s is working on a single vaccine that would protect against all strains of the influenza virus, along with a method for breaking down the gluten proteins in wheat, which could help to generate new treatments for people with celiac disease. 
    With new computing power, look for progress on the understanding, design, and construction of brain proteins. As understanding, design and construction improve, look for brain proteins to play a major role in disease research and treatment. This is all great news for people looking to improve our understanding and treatment of celiac disease.
    Source:
    Bloomberg.com
    Jefferson Adams
    Celiac.com 05/21/2018 - Just a year ago, Starbucks debuted their Canadian bacon, egg and cheddar cheese gluten-free sandwich. During that year, the company basked in praise from customers with celiac disease and gluten-sensitivity for their commitment to delivering a safe gluten-free alternative to it’s standard breakfast offerings.
    But that commitment came to an ignoble end recently as Starbucks admitted that their gluten-free sandwich was plagued by  “low sales,” and was simply not sustainable from a company perspective. The sandwich may not have sold well, but it was much-loved by those who came to rely on it.
    With the end of that sandwich came the complaints. Customers on social media were anything but quiet, as seen in numerous posts, tweets and comments pointing out the callous and tone-deaf nature of the announcement which took place in the middle of national Celiac Disease Awareness Month. More than a few posts threatened to dump Starbucks altogether.
    A few of the choice tweets include the following:  
    “If I’m going to get coffee and can’t eat anything might as well be DD. #celiac so your eggbites won’t work for me,” tweeted @NotPerryMason. “They’re discontinuing my @Starbucks gluten-free sandwich which is super sad, but will save me money because I won’t have a reason to go to Starbucks and drop $50 a week,” tweeted @nwillard229. Starbucks is not giving up on gluten-free entirely, though. The company will still offer several items for customers who prefer gluten-free foods, including Sous Vide Egg Bites, a Marshmallow Dream Bar and Siggi’s yogurt.
    Stay tuned to learn more about Starbucks gluten-free foods going forward.
    Jefferson Adams
    Celiac.com 05/19/2018 - Looking for a nutritious, delicious meal that is both satisfying and gluten-free? This tasty quinoa salad is just the thing for you. Easy to make and easy to transport to work. This salad of quinoa and vegetables gets a rich depth from chicken broth, and a delicious tang from red wine vinegar. Just pop it in a container, seal and take it to work or school. Make the quinoa a day or two ahead as needed. Add or subtract veggies as you like.
    Ingredients:
    1 cup red quinoa, rinsed well ½ cup water ½ cup chicken broth 2 radishes, thinly sliced 1 small bunch fresh pea sprouts 1 small Persian cucumber, diced 1 small avocado, ripe, sliced into chunks Cherry or grape tomatoes Fresh sunflower seeds 2 tablespoons red wine vinegar  Kosher salt, freshly ground pepper Directions:
    Simmer quinoa in water and chicken broth until tender.
    Dish into bowls.
    Top with veggies, salt and pepper, and sunflower seeds. 
    Splash with red wine vinegar and enjoy!
    Jefferson Adams
    Celiac.com 05/18/2018 - Across the country, colleges and universities are rethinking the way they provide food services for students with food allergies and food intolerance. In some cases, that means major renovations. In other cases, it means creating completely new dining and food halls. To document both their commitment and execution of gluten-free and allergen-free dining, these new food halls are frequently turning to auditing and accreditation firms, such as Kitchens with Confidence.
    The latest major player to make the leap to allergen-free dining is Syracuse University. The university’s Food Services recently earned an official gluten-free certification from Kitchens with Confidence for four of the University’s dining centers, with the fifth soon to follow.
    To earn the gluten-free certification from Kitchens with Confidence, food services must pass a 41 point audit process that includes 200 control check points. The food service must also agree to get any new food item approved in advance, and to submit to monthly testing of prep surfaces, to furnish quarterly reports, and to provide information on any staffing changes, recalls or incident reports. Kitchens with Confidence representatives also conduct annual inspections of each dining center.
    Syracuse students and guests eating at Ernie Davis, Shaw, Graham and Sadler dining centers can now choose safe, reliable gluten-free food from a certified gluten-free food center. The fifth dining center, Brockway, is currently undergoing renovations scheduled for completion by fall, when Brockway will also receive its certification.
    Syracuse Food Services has offered a gluten-free foods in its dining centers for years. According to Jamie Cyr, director of Auxiliary Services, the university believes that the independent Gluten-Free Certification from Kitchens with Confidence will help ease the anxiety for parents and students.”
    Syracuse is understandably proud of their accomplishment. According to Mark Tewksbury, director of residence dining operations, “campus dining centers serve 11,000 meals per day and our food is made fresh daily. Making sure that it is nutritious, delicious and safe for all students is a top priority.”
    Look for more colleges and universities to follow in the footsteps of Syracuse and others that have made safe, reliable food available for their students with food allergies or sensitivities.
    Read more.