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    Scott Adams
    What is Celiac Disease and the Gluten-Free Diet?
    Image Caption: Image: CC—Ed Uthman
    WHAT IS CELIAC DISEASE?
    Celiac disease is an autoimmune condition that affects around 1.4% of the population (91.2 million people worldwide, and 3.9 million in the U.S.A.). 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:
    Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clinical Gastroenterology and Hepatology 2018;16:823–836 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
    Lindsay Cochrane
    Living with Celiac Disease in South Korea
    Image Caption: Image: CC--Republic of Korea
    Celiac.com 09/21/2018 - The English as a Second Language (ESL) pie is so large in countries such as South Korea that there seem to be enough helpings for anyone interested. However, these generous slices may be off limits to individuals with severe food allergies or intolerances, including those with celiac disease. If you have diet restrictions and are thinking of heading to South Korea or another Asian country, the following information will help you decide whether or not this move is a good idea.
    One might think that Asia, the land of rice-based meals, would be a celiac’s paradise. As one naïve dietician told me before I moved to Seoul, “You couldn’t be going to a better place.” This assumption could not be further from the truth. If cooked with traditional ingredients, many local dishes are gluten-free. However, in Korea, wheat flour is now cheaper than other kinds of flour, despite the fact that it has to be imported. Wheat flour and barley are currently the two most common ingredients in Korean food products.
    In Korea, eleven major food allergens must be included on product labels: poultry eggs, milk, buckwheat, peanuts, soybean, wheat, mackerel, crab, pork, peaches, and tomatoes. As for anything else, the Korean Food and Drug Administration states that only the five major ingredients in a product have to be labeled. Furthermore, a label need only include intentional ingredients, not things accidentally mixed into a product through cross-contamination. So you can say goodbye to warnings like: “this product may contain traces of peanuts.” Stricter labeling regulations will be put into effect in September 2006. However, these laws will remain less stringent than those in North America and Europe. According to a source at the KFDA, labeling restrictions are similar in Japan and more lax in China and South East Asia.
    One can easily learn Korean for “I’m allergic to ____” in any phrasebook or from a Korean coworker, friend, or even the guy in the next seat on your Korean Air flight. Yet it is the cultural barrier, not the language barrier, which poses the most difficulties for a celiac.
    Korean culture revolves around the sharing of food due to food shortages during the Japanese occupation; Koreans do not ask, “How are you?” but, “Have you had your meal?” Co-workers, friends, and even the occasional stranger will offer to share food. The politest way to refuse is by saying, “Thank you, but I can’t. I’m allergic.” Also, rather than saying you are allergic to something in Korean—allerugi—it is much more effective to say you cannot have it. (see the list of useful phrases). Unfortunately, even these statements are unlikely to be fully effective when eating Korean food. Many Koreans are completely unaware that frequently-used ingredients such as tashida soup flavouring and soybean powder contain wheat.
    Most Koreans I spoke with were shocked to hear that, as a celiac, I could not eat food which had so much as touched gluten. Generally, they assume that people with food allergies are still able to consume a product with a 1-2% trace of the allergen. Food allergies, celiac disease, vegetarianism, and other kinds of diet restrictions are rare in this country and are not taken very seriously. Furthermore, according to gastroenterologist Dr. Kim of Severance Hospital in Seoul, only two people were ever diagnosed with celiac disease in Korea.
    The world of North American restaurants, where servers cater to those with food allergies, food sensitivities, and plain old picky eaters, is very far away. Koreans generally order what is on the menu without making any special requests. Even Westerners who learn enough of the Korean language to explain their diets often end up being served something they asked specifically not to have. Furthermore, Korean food is not served on personal plates: everyone at the table reaches his or her chopsticks into the various communal dishes, causing cross-contamination.
    I was at a restaurant with some Korean friends and was trying to explain my gluten-intolerance to them, when one young man told me he was so sensitive to peaches that he could not so much as touch a peach without breaking out into a rash. Five minutes later I saw him eat a dish containing peach slices. This is the attitude of Koreans to food allergies—both theirs and yours.
    The gluten-free meal which is safest and easiest to find in Korea is samgyupsal. This dish features fatty, thick slices of pork cooked over a clean grill right at your table. Just make sure that all sauces are kept off the grill. Bibimbop is a rice, vegetable, and egg dish usually served with kochujang, a red pepper paste which unfortunately contains wheat. Bibimbop can be ordered, however, with the kochujang on the side.
    Most foreigners are in Korea to work rather than visit, and having an apartment provides the extra advantage of having one’s own cooking space. There are a few of us who have managed the gluten-free diet in Korea. However, it has not been easy. If you have celiac disease or food allergies and are thinking of moving to this part of the world, I can guarantee you that it will be a monumental challenge.
    Useful Korean phrases:
    Thank you, but I can’t. I’m allergic: kamsa hamnida man, allerugi issoyo. I cannot have barley, rye, or wheat: chonun pori hago homil hago mil motmuhgeyo. Barley: pori Wheat: mil Rye: homil Bibimbop with the red pepper paste on the side: bibimbop kochujang garu Grilled Pork: samgyupsal
    Jefferson Adams
    What’s the Deal with Gluten Sniffing Dogs?
    Image Caption: Image: CC--David Kessler
    Celiac.com 09/20/2018 - Some people with celiac disease experience extreme symptoms when they eat gluten. These folks adopt various strategies for navigating the world. One of those strategies involves getting a gluten-sniffing service dog.
    We’ve done a few stories on gluten-sniffing dogs over the years. Dogs like Zeus and Hawkeye are famous for helping their owners sniff out gluten before they can eat it.
    Can Gluten-Sniffing Dogs Help People with Celiac Disease?  The stories are always popular. People love the stories, and people love the dogs. After all, pretty much anyone with celiac disease who has ever read about gluten-sniffing dogs would love to have one. Who could say no to a warm, fuzzy dog that can take a sniff of your food and signal you when it contains gluten?
    The stories almost always generate plenty of feedback and more than a few questions. To answer some of those questions, we’ve decided to do an article that provides some facts about gluten-sniffing dogs.
    Here are a few factors to keep in mind about gluten-sniffing service dogs:
    Gluten-free Dog Status:
    One thing to remember is that proper gluten-sniffing dogs are professionally trained service animals, much like seeing-eye dogs or hearing-ear dogs. 
    As professional service animals, the dogs must be trained and certified as service animals. The dogs may then accompany their master pretty much anywhere they go, and are available to assess all food and snacks.
    Gluten-free Dog Training:
    Proper training takes time, which equals money. Professional trainers might only train one or two dogs, and the training can take about a year. There are very few trainers for gluten-sniffing dogs, and there are also currently no official guidelines or certification.
    Gluten-free Dog Cost:
    In our recent story on the gluten-sniffing black Lab, Hawkeye, we noted that the dog cost $16,000, not including food, and vet bills. 
    Gluten-free Dog Reliability:
    Nimasensor.com notes that “[g]luten-sniffing dogs may detect gluten in amounts as small as .0025 parts per million with 95 percent to 98 percent accuracy.”
    The Mercola.com website says that Willow, a gluten-sniffing German shorthaired pointer in Michigan, can detect gluten with 95 percent to 98 percent accuracy. 
    Read more on gluten-sniffing dogs:
    Gluten-Sniffing Dogs Are Game Changers for People With Celiac Disease Gluten-sniffing dogs help people with celiac disease What to Know About Gluten-Sniffing Dogs Gluten-Sniffing Assistance Dog Helps Celiac Sufferer Lead Normal Life
    Jefferson Adams
    The Girl Scouts Adds New Gluten-Free Cookie to Popular Lineup
    Image Caption: Image: CC--Deanna Davis
    Celiac.com 09/19/2018 - Great news for gluten-free cookies lovers!  Girl Scouts has announced the debut of a new gluten-free cookie to its enormously popular cookie brand. 
    The new Caramel Chocolate Chip is a chewy cookie that contains caramel, semi-sweet chocolate chips, and a hint of sea salt. also happens to be gluten-free. The new gluten-free treat will be available in select areas during the 2019 cookie-selling season; which typically runs from February to April each year.
    The gluten-free Caramel Chocolate Chip joins the Girl Scouts’ two other gluten-free offerings: Toffee-tastic, a buttery cookie with sweet and crunchy golden toffee bits, and Trios, a peanut butter oatmeal cookie with chocolate chips. 
    The Girl Scouts of America has been around for over 100 years and now hosts more than 1.8 million girl members. Every year, about 100 million scouts between the ages of five and 18 sell approximately 200 million boxes of cookies nationwide. According to the Girl Scouts website, that money stays local to develop local leadership training activities, summer camps, and more activities.
    According to a 2016 study conducted by the Girl Scout Research Institute, approximately 85% of Girl Scouts surveyed said that Girl Scout Cookie Program helped them learn how to set goals and meet deadlines, while 88% said it helped them become effective decision-makers. Another 88% said they learned how to manage money, while 94% said the program helped them to learn business ethics.
    The Girl Scouts have also added online sales and iOS and Android apps that allow people to find cookies or order from their phones.
    Jefferson Adams
    No Gluten-Free Diet for Tennis Champion Roger Federer
    Image Caption: Image: CC--Justin Smith
    Celiac.com 09/18/2018 - With a number of major tennis stars singing the praises of a gluten-free diet, including top players like Novak Djokovic, Swiss great Roger Federer weighed in on the topic.
    The 20-time Grand Slam winner says that he’s never tried the gluten-free diet, and that he doesn’t not “even know what that all means…I eat healthy, and I think that's what people should do, too, if they have the options. It's sure important the right diet for an athlete.”
    Djokovic, the 2018 US Open winner has been gluten-free since 2011, and calls the diet his biggest key to his success.
    For Federer, diet is helpful, but not the whole story. “[Diet] can help you, you know. I mean, I think every athlete should be in good shape. I don't think we should have any fat athletes, to be honest. We do too much sports and we should be too professional to let that happen to ourselves.
    If it happens, well, we should wake up. You don't have the right entourage. They're not telling you that you're a bit fat. Players try different things, and whatever works for them. I do my thing. It's been very easy and natural and healthy, and it's worked.”
    So, while Novak Djokovic, and a number of other athletes, have gone gluten-free and continue to tout the benefits, look for Federer to remain faithful to his generally nutritious non-gluten-free diet.
    Read more at: TennisWorldUSA.org
    Jefferson Adams
    Hawkeye the Service Dog Sniffs Out Gluten for Sensitive Six-Year-Old
    Image Caption: Image: CC--USDA
    Celiac.com 09/17/2018 - Her name is Hawkeye, she’s a black lab, and her mission is to detect gluten for a young man named Toby, who gets terribly sick if he eats food that contains gluten. Hawkeye is up to 98% accurate at detecting gluten with just a few sniffs. 
    Hawkeye was also expensive, costing a princely $16,000, not including food, and vet bills. That may sound expensive, but, says Toby’s mom, Amy "when you think about it trainers are often training only one to two dogs at a time and our trainer, she only trained one dog at a time and it took a year.”
    In Toby’s case, the community rallied to raise the money to buy Hawkeye, who is a registered service dog, and so can accompany Toby nearly everywhere. Everyone loves Hawkeye and her role in Toby’s life. Amy calls Hawkeye a “life-giver, and says that  Amy continued “she's breathed life and confidence into Toby that we haven't seen in a really long time."
    She adds that the family has “really seen just growth and development in him because he's not getting sick as often and he's now able to learn more. So he can now say his alphabet, learn his numbers and colors, things that just a year ago he wasn't doing."
    Gluten-sniffing dogs are rare, but their numbers are growing. The Mercola.com website says that Willow, a gluten-sniffing German shorthaired pointer in Michigan, can detect gluten with 95 percent to 98 percent accuracy. The website Nimasensor.com notes that “[g]luten-sniffing dogs may detect gluten in amounts as small as .0025 parts per million with 95 percent to 98 percent accuracy.”
    Love the idea of a gluten sniffing dog, but maybe daunted by the price, logistics or commitment? There are portable gluten sensors currently on the market, with greater accuracy than Hawkeye, for a few hundred dollars.
    Disclosure: Nima Labs is a paid advertiser for Celiac.com
    Connie Sarros
    All About Eggplant
    Image Caption: Image: CC--Jeff Peterson
    Celiac.com 09/15/2018 - People have a love/hate relationship with the purple fruit called ‘eggplant’. Eggplants, first cultivated in southern India and Sri Lanka, are also known as aubergine, Guinea squash, melazana, and ‘poor-man’s caviar’. Like potatoes they are members of the nightshade family, and despite the fact that we all consider eggplant to be a vegetable, biologically it is defined as a berry, and therefore it is a fruit.
    When selecting the fruit, select ones that are firm to the touch, have a smooth and shiny skin and are heavy. Avoid those with brown or soft spots and have a dull color. Gently push with your thumb or forefinger. If the flesh gives slightly but then bounces back, it is ripe. If the indentation remains, it is overripe and the insides will be mushy. If there is no give at all, the eggplant was picked too early. Once you bring it home, avoid placing it near tomatoes and apples, as they give off a gas that quickens the ripening process. Try to use the eggplant within two days of purchase.
    There are several cooking hints that will make your ‘eggplant experience’ more tasteful. Do not cook this fruit in an aluminum pan as it may cause discoloration (both of the pan and the fruit!). The skin is edible on small, younger plants, but should be removed on coarser, older ones. Once you cut the eggplant and cook it right away because the flesh will brown (similar to cut bananas). This fruit absorbs oil very easily, so it is recommended that you coat the slices with cornmeal before frying or baking. To help reduce the bitter flavor in older plants, ‘de-gorge’ the eggplant—Slice the eggplant into ½-inch pieces, salt well, then weigh down each slice in a colander to allow the liquid to drain out of the eggplant for 30 minutes—then rinse with cold water and pat dry.
    Equivalents and Nutritional Value—one pound of eggplant equals 3½ cups of diced eggplant and 1¾ cups cooked eggplant. One medium eggplant weights about 1 pound. It contains vitamin C and potassium, has anti-bacterial and diuretic effects, as well as flavanoids (cancer fighting antioxidants). One cup cooked eggplant contains 25 calories.
    The different ways to prepare eggplant are limited only by your imagination. Cut it into matchsticks to add to a stir-fry. Cube it for vegetable stews (Ratatouille). Shred it to make fritters, or puree it for a hummus-style dip. You can also slice it lengthwise and grill it.
    This fruit is probably most famous for the Italian rendition of Eggplant Parmigiana. But the Greeks have taken this dish one step further, ‘Moussaka’. If you have never eaten this, it is a delight to savor. Lean ground beef may be substituted for the ground lamb. Three zucchini may be used in place of the eggplant (if you prefer). Even if you hate eggplant, you will love Moussaka.
    The beauty of Moussaka is that this casserole may be made in advance, then covered and refrigerated overnight, or covered with foil and frozen—before you bake it (thaw in the refrigerator completely before baking). Time is precious for us all, and this concoction does take some time to assemble, but every moment is worth it. This makes an impressive side dish for company, it is perfect for a buffet table, or it can be used as a main dish for a family dinner.
    The following recipe is from my “Wheat-free Gluten-free Reduced Calorie Cookbook”. Traditional Moussaka is ‘loaded’ with calories and fat and cholesterol. This version is lower in calories and fat without sacrificing any of the delicious taste.
    Moussaka (Greek Casserole Dinner)
    Ingredients:
    1 large eggplant, peeled 2 teaspoons olive oil 1 large onion, chopped ½ pound lean ground lamb 5 teaspoons tomato paste ¼ cup white wine ¼ cup chopped fresh parsley 1/8 teaspoon cinnamon 18 teaspoon salt 1/8 teaspoon pepper 1 tablespoon margarine 1 ½ tablespoon cornstarch 1 cup scalded 1% milk 1 egg beaten until frothy 1/8 teaspoon nutmeg ½ cup gluten-free lowfat cottage cheese 1/3 cup gluten-free corn muffin crumbs, dried 1/3 cup Parmesan cheese, shredded Directions:
    Preheat broiler. Cut the peeled eggplant lengthwise into ½-inch thick slices. Spray both sides of the slices with gluten-free nonstick spray; set on a broiler pan and broil until browned, turning once. Preheat oven to 350F. Heat olive oil in a skillet; add onion and sauté until lightly browned. Add the lamb and cook, breaking meat up with a fork, for 10 minutes or until the meat is browned. In a small bowl, stir together the tomato paste, wine, parsley, cinnamon, salt and pepper; add to the meat and simmer, stirring frequently, until all liquid has been absorbed. Remove from heat. Melt the margarine in a medium-size saucepan; blend in the cornstarch with a whisk. Slowly stir the hot milk into the cornstarch; cook over medium heat, stirring constantly, until thickened. Cool slightly, and then stir in the beaten egg, nutmeg, and cottage cheese. Spray a 9-inch square pan with gluten-free nonstick spray. Sprinkle the bottom lightly with 2 tablespoons of the corn muffin crumbs. Arrange alternate layers of eggplant slices and meat mixture in the pan. Sprinkle each meat layer with the Parmesan cheese and remaining corn muffin crumbs. Pour the cottage cheese mixture over the top. Bake 45 minutes or until the top is golden. Cool slightly before cutting. Makes 6 (4 ½ X3-inch) serving.
    Jefferson Adams
    Nima Labs Claps Back at Gluten Free Watchdog Over Gluten Sensor Data
    Image Caption: Image: Nima Labs
    Celiac.com 09/14/2018 - Celiac.com was all set to do a story on the latest peer-reviewed data on the Nima gluten testing device, when along comes Gluten-Free Watchdog with another of their famous non-recommendations. Gluten-Free Watchdog says they cannot recommend the Nima gluten test kit because of alleged flaws.
    But what does the science say? The latest Nima article and Gluten-Free Watchdog’s complaint both focus on the science, so let’s start there.
    Nima makes two different food sensors: one detects gluten, the other detects peanuts. Each sensor comprises a small, handheld electronic device and a cartridge. To test food, consumers place a pea sized amount into the cartridge, place the cartridge inside the sensor, and run the device.  They then receive a smiley face or wheat symbol with "gluten found," depending on whether or not the Nima device detected the allergen.
    Nima reported their original data in a peer-reviewed scientific journal. Among the conclusions: “Compared with reference R5, Nima antibodies (13F6 and 14G11) had 35- and 6.6-fold higher gliadin affinities, respectively. Nima demonstrated device performance using a comprehensive list of foods, assessing detection sensitivity, reproducibility, and cross-reactivity. Nima presented a 99.0% true positive rate, with a 95% confidence interval of 97.8%–100%.”
    Gluten Free Watchdog says that:
    “Based on third party testing data, the Nima Sensor fails to detect gluten at the 20 ppm level over 20 percent of the time. It isn’t until a sample contains a level of gluten at the 40 ppm level, that a gluten found result is received close to 100% of the time.” Gluten Free Watchdog suggests that this is a problem, because:
    “At a level of gluten in a sample from less than 2 ppm up to a level of gluten between 30 ppm and 40 ppm, the result displayed on the Nima Sensor may be either smiley face or gluten found. If a sample is tested with a Nima Sensor and the result is a smiley face, there is no practical way for a consumer to know if the level of gluten in the sample is less than or more than 20 ppm. If a sample is tested with a Nima Sensor and the result is gluten found, there is no practical way for a consumer to know if the level of gluten in the sample is less than or more than 20 ppm. As a result, the data point received from the Nima Sensor for gluten presents major interpretation problems.” Gluten Free Watchdog charges that Nima uses “NOT the scientifically validated Ridascreen Gliadin R5 ELISA Mendez Method from R-Biopharm used by Gluten Free Watchdog.” The fact is that R5 Elisa remains the industry standard for most testing applications. 
    Gluten Free Watchdog closes its warning with a word from their independent expert: According to Adrian Rogers, Senior Research Scientist at Romer Labs, “It could be argued that the device is not fit for purpose as the company states that there is a clear differentiation between safe and unsafe products based on a 20 ppm level which the validation data does not corroborate.”
    It’s worth noting that for all his accomplishments, Rogers is neither a doctor, nor a PhD. Rogers' LinkdIn page lists his education as: Bsc (Hons), Microbiology, University of Wales, Aberystwyth. A Bachelor of Science degree may not necessarily make an expert in this subject, yet he is presented as one.
    Rogers also seems to have a potential conflict of interest that was omitted in Thompson’s press release. Directly from Rogers’ LinkdIn site:
    “Romer Labs®, Inc. developed an immunochromatographic lateral flow assay for the qualitative detection of gluten in raw ingredients, processed foods, finished food products, and environmental surfaces, using the G12 antibody developed by Belén Morón. The G12 antibody targets a 33-mer peptide which is resistant to enzymatic digestion and heat denaturation, as well as being the fragment of the gliadin protein to which celiac disease sufferers react, making it a reliable analytical marker.” The company Rogers works for, Romer Labs, makes its own gluten testing kits. It seems a bit disingenuous for Gluten Free Watchdog to use a spokesperson from a potentially competing company to try to counteract a peer-reviewed scientific publication for a device which is made by a potential competitor.
    Nima’s Scientific Advisory Board includes some of the most highly respected celiac disease researchers and scientists in the world. They include: Peter HR Green, MD Phyllis and Ivan Seidenberg Professor of Medicine. Director, Celiac Disease Center at Columbia University; Jody Puglisi, PhD Stanford University Professor of Structural Biology; Lucille Beseler, MS, RDN, LDN, CDE, FAND Family Nutrition Center of South Florida; Benjamin Lebwohl, MD, MS Director of Clinical Research Celiac Disease Center at Columbia University; John Garber, MD Gastroenterology, Mass General; and Thanai Pongdee, MD Consultant, Division of Allergic Diseases, Mayo Clinic.
    Nima says that Gluten Free Watchdog’s view of their recently published validation is incomplete and misleading. Nima wrote:
    “All the studies show Nima is highly sensitive across a range of both low and high levels of gluten." "The Nima third party data accurately reported gluten found at 20 ppm and above between 93.3% for food as prepared (a food item that is spiked with an intended quantity of gluten) and 97.2% for food as quantified by an ELISA lab kit (used to determine the exact ppm of gluten in the food)." "The Nima peer reviewed study published in the Food Chemistry Journal reported gluten found at 20 ppm and above at 96.9% accuracy." The statement that:
    “'Nima will fail to detect gluten at 20 ppm 20% of the time' is almost entirely driven by 1 specific food out of 13 tested. That sample, when quantified, was actually below 20 ppm." "In real life, people get glutened at many different ppm levels, not just 20 ppm. Nima has been shown to detect gluten at levels below, at and above 20 ppm across a variety of foods in a number of studies.” Reading the peer reviewed data provided by Nima, and reading Gluten Free Watchdog’s complaints, it becomes clear that Gluten Free Watchdog’s complaints sound serious and authoritative, but ring a bit hollow. 
    Consider the Following Analogy
    Imagine a gluten-sniffing dog that performed as well as Nima in scientific trials; same performance, same exact data. 
    You can give this dog a sniff, or a small bite of food, and he can signal you if the food’s got gluten in it with 97% accuracy at 20ppm or below. Nearly 100% accuracy at 40ppm or above (as stated by Gluten Free Watchdog).
    People would think that the dog was not only cute and fluffy, but wonderfully helpful and everyone would love it, and everyone with celiac disease would want one. And it would be a great big gushing warm and fuzzy feel-good story. Pretty much no one would be arguing that the dog was potentially dangerous, or somehow unfit for people with celiac disease. Such dogs would also be far more expensive to own and maintain than the Nima device. Apparently such dogs can cost upwards of $16,000, not including the cost of food, vet bills, etc.
    So, what’s the accuracy rate of a gluten-sniffing dog, anyway? From Mercola.com: Willow, a German shorthaired pointer, is another gluten-sniffing dog, in this case living in Michigan. Her owner, Dawn Scheu, says she can detect gluten with 95 percent to 98 percent accuracy. She worked with a trainer (the same one who trained Zeus) to teach her own dog to detect gluten, with excellent results.
    Gluten-sniffing dogs may detect gluten in amounts as small as .0025 parts per million with 95 percent to 98 percent accuracy. So, will Gluten Free Watchdog be warning against gluten-sniffing dogs anytime soon?
    Somehow, because Nima is a mechanical device made by a company, it's not so warm and fuzzy, not so feel-good. Maybe Nima needs to shape their device like a cute little doggy, or a Pez candy dispenser?
    But the data remains, as does the fact, whatever its drawbacks, anything that detects gluten like Nima does, as well as it does, is potentially very helpful for celiac disease in numerous situations. And it is extremely unlikely to do them any harm.
    Nima seems very much committed to transparency, scientific excellence, and continual product improvement. These are noble goals and generally a win for people with celiac disease. Think of it, just ten years ago, a portable gluten-sensor with the kind of accuracy Nima is reliably achieving would have been the stuff of fantasy. Yet here it is. More accurate than any gluten-sniffing dog, and for a couple hundred bucks. People with celiac disease are living in a very different world than just a few years ago.
    Nima did not have to publish its data, but it chose to do so, and in a reputable, peer-reviewed scientific journal. Nima conducted its research using solid scientific standards, and reported those results publicly. They explained their methodology and results, they acknowledged product limitations and expressed a commitment to improvement. How is this remotely controversial?
    The celiac disease community is fortunate to have companies committed to investing time and money into products and devices that help to improve the lives of people with celiac disease. We feel strongly that the perfect should not be the enemy of the good. Devices like the Nima gluten sensor can be helpful for numerous people with celiac disease.  
    Disclosure: Nima is a paid advertiser on Celiac.com. Celiac.com's advertisers do not influence our editorial content. 
    Read Nima’s full report on test data at: Food Chemistry.com Read Gluten Free Watchdog’s Statement on the Nima device at: Glutenfreewatchdog.org Read Nima’s Reply to Gluten Free Watchdog at: Nimasensor.com
    Edward R. Arnold
    To HAIT and Back: The Musings of a Thyroid Patient on the Vagaries of Medical Diagnosis and Treatment in America
    Image Caption: Image: CC--katieg93
    Celiac.com 09/14/2018 - If it is really true that nobody really wants to see a grown man cry, then certainly nobody would have wanted to hang around me near the onset of a long illness whose mystery would take 14 years to solve.
    It began subtly and mildly in 1989, my 43rd year. I had just finished a long and exhausting malpractice suit on behalf of my daughter, an attractive, genetically-normal child who had contracted quadriplegic cerebral palsy in a completely avoidable incident of post-natal asphyxia which had radically changed the nature of life for my spouse and I. By the time 1989 rolled around, I was thoroughly exhausted and carrying a toxic load of anger directed at an incompetent member of the medical profession who had never learned the importance of state-of-the-art skills in a profession that literally has the power of life, death, and disability.
    From late 1989 on through 1990, I experienced strange episodes of profound sadness, usually of one to two hours duration, that became increasingly disruptive to my ability to handle a job and child-care duties. Initially, these episodes seemed to come from nowhere. Later on, I found that playing certain pieces of music of which I was fond, would send me into such intense sobbing that I would be forced to pull over if this occurred while driving.
    By the time 1991 rolled around, something was to be added to these periodic bouts of intense sadness. Early in that year, my daughter became very ill, keeping both my spouse and I awake at night for weeks on end. By the time the problem was diagnosed to be a dental infection and dental surgery was done, I had begun to have a sensation of “hollowness”, as though I really weren’t part of this world, most of the time. In late summer of that year, a series of events in which my subconscious had informed me that a friend had a serious illness, sent me into a final “dive”: I simply stopped sleeping more than about two hours per night. When I first stopped sleeping, I soon noticed that even low-level use of alcoholic beverages would further interrupt sleep and throw me into a state in which I couldn’t think of anything but how terrible I felt. This state of pronounced alcohol intolerance would continue for 14 years.
    The final blow came in November 1991, when I went into a completely disabling panic/anxiety attack that sent me to bed, cowering. I had no alternative but to seek treatment from the psychiatric profession. Unfortunately, the first two psychiatrists prescribed drugs which either had no effects, or had effects that seemed worse than the problem they were supposed to solve. The third psychiatrist, whom I stuck with for about six months, came up with a treatment plan that was partially effective (but certainly not restorative). I stayed with this psychiatrist until it became clear that his treatment was equivalent to Jefferson Airplane singing “one pill makes you larger, and one pill makes you small”. I was being jacked up every morning by a toxic, activating SSRI anti-depressant so I could semi-function, and then dropped by benzodiazepenes every night into a non-restorative twilight sleep state.
    In retrospect, the most amazing thing about these first three psychiatrists was that not one of them ordered any tests of my endocrine function. Treatment consisted solely of a series of benzodiazepenes, anti-depressants, mood stabilizers, and anti-psychotics, administered in a trial-and-error fashion that yanked my psyche and body chemistry around like a manic pit bull on a two-foot leash.
    Throughout the latter part of 1992, I transitioned to care with my primary-care physician, mostly because I trusted him more than any of the psychiatrists I had seen up to that time. He was able to stabilize me with one of the old tri-cyclic anti-depressants, doxepin, along with low doses of valium. Although doxepin packs a big morning hangover for many who use it, and has very strong anti-cholinergic effects, its ability to put me out at night helped me function satisfactorily for much of the 1990s, even at doses as low as 10mg, once daily in the evening.
    In 1993 I consulted a highly-recommended psychiatrist, who was the first psychiatrist who actually looked at my thyroid function. When my TSH was measured at 3.5, without also checking my FT3 and FT4, that doctor concluded that thyroid was not my problem. Of course, standards of thyroid diagnosis and treatment have changed radically in the 12 years since. Under the new AACE guidelines, a TSH of 3.5 would now be suspect, because studies of patients with TSH over 3.0 have shown that most progress to hypothyroidism (i.e., TSH greater than 5.5). The new AACE guidelines would mean that further testing and evaluation should be done.
    Until the fall of 1997, I continued treatment with doxepin and intermittent valium, adding the practice of meditation to help calm myself. At that time, I came back to my primary-care physician with the symptom of profound exhaustion on top of the symptoms of insomnia, anxiety, and depression I had suffered for years. Fortunately, my GP was suspicious of thyroid function, and found that my TSH was floating above 8. Since this was well above the old/traditional limit of 5.5, he was ready to start treatment, with (as would be expected of most GPs) T4-only replacement.
    I began taking thyroxine (T4) shortly thereafter with high hopes. Initially, the treatment was successful: getting the added thyroxine into my system caused an immediate improvement in quality of sleep.
    However, the use of T4 did not turn out to be an unqualified success. After use of T4 for about a month, it was apparent that use of thyroxine alone did not produce a full recovery—I still suffered from anxiety, which the medication seemed to be increasing.
    In the meantime, hair loss became an issue. Several years earlier, I had noticed that running my fingers through my hair would produce an unpleasant sensation, almost as though the hair roots were tender. By the time of my 50th birthday, in 1996, I had noticed that my pillow was virtually coated with hair by the time I would remove it for washing. Unfortunately, nobody, including my GP, reminded me that hair loss is a prime symptom of hypothyroidism; and, like most males, I was ready to assume it was plain old male pattern baldness. By the time I was treated correctly and the hair loss stopped, I had pronounced thinning on the crown which was too advanced to be reversed in response to the treatment of the thyroid problem.
    In about 1998, I began experimentation with amino acids which was to last for almost seven years. I found that use of tryptopan, 5-HTP, and GABA could reduce (but not correct) the worst of my symptoms. In retrospect, though, use of amino acids is a poor substitute for a well-functioning thyroid, as well as being expensive and inconvenient.
    By the summer of 1999, I had reached a paradoxical situation. Experimentation had shown that my body needed on the order of 100 micrograms of thyroxine (T4) to keep my TSH down to a reasonable level; yet taking that much T4 was causing intense anxiety, requiring me to use strong sleeping medications. By late summer 1999, I had noticed another distressing symptom—my acute sense of hearing was being increasingly impacted by tinnitus. Evidently, the root cause that drove me into hypothyroidism, could also impact hearing.
    It was soon after a household move in the spring of 2000, that I had a partially-disabling attack of severe epicondylitis (more commonly known as tennis elbow). It was obvious that my body was no longer able to handle the short-term stresses of the hard physical work required by a move. This obvious physical symptom, accompanied by increasing periodontal issues and continuing mental issues, prompted me to seek other treatment.
    In September 2000, I began seeing a prominent “metabolic” doctor (M.D.) who is well known for his treatment of the metabolic disorders of diabetics. This doctor has written a number of books related to dietary changes and supplements needed to stave off metabolic degeneration as one ages. I was switched to Armour thyroid, and began treatment with other hormones (primarily hydrocortisone in low doses to supplement adrenal function, and pregnenolone). I took an enormous range of nutritional supplements recommended by this doctor, and also made radical changes in diet, which I maintained for nearly two years. Unfortunately, nothing seemed to really work—I did not obtain substantial relief of my symptoms. A thyroid test in Sep 2001 still showed unsatisfactory results—my TSH was 4.7, and my FT3 was below the bottom of the normal range.
    By the spring of 2002, I had decided I would have to take my care elsewhere if there were to be progress. After doing a brief telephone consult with a naturopath outside my home state, I began seeing a naturopath in my home town for whom I had obtained very positive recommendations via a web search. By March 2002, the naturopath had informed me that testing showed my hypothyroidism was due to anti-thyroid antibodies, i.e., my body was attacking its own thyroid gland. This condition is officially known as Hashimoto’s Autoimmune Thyroiditis (HAIT—as I now know, HAIT is the leading cause of hypothyroidism). I found this discovery quite amazing; how come the three endocrinologists I had seen between 1998 and 2002, had not given me this information? I was started on Thyrolar (synthetic combination T3/T4) by the naturopath, because she said that my body’s ability to make T3 may have been compromised by HAIT.
    Soon after beginning to see the naturopath, I learned that Dr. Stephen Langer of Berkeley, CA might have additional information on the problem I had been having with thyroid hormone causing anxiety in a hypothyroid patient. I had searched for information about this syndrome in a number of places but found nothing; for instance, the well-known book “Thyroid Solution”, by Ridha Arem M.D., contains no information on the condition. So, I consulted with Dr. Langer and learned that a small percentage of people with Hashimoto’s are exquisitely sensitive to even low doses of Thyrolar. In fact, the condition is rare enough that virtually no GPs, and only a few endocrinologists, know of its existence. Apparently, it does not have an official name attached to it. I decided to refer to it as “HAIT anxiety syndrome”, although there are a few doctors who prefer to refer to any neurological symptoms accompanying HAIT as “Hashimoto’s Encephalopathy”.
    I began to feel a little better between March 2002 and June 2003. I’m not sure why the message about gluten grains had not penetrated before, but by June 2003, the naturopath reminded me again that she had seen a positive result to a test for antibodies to gliadin (one of the two major proteins in gluten grains) in 2002, and that I really should consider removing gluten grains from my diet. This recommendation was based on three factors:
    I had antibodies to the protein gliadin found in wheat and other gluten grains such as rye and barley; I had anti-thyroid antibodies which were over the threshold that defines HAIT; Medicine really is an experimental science, and this experiment, in spite of its inconvenience, appeared to be worth a try. In a numbers sense, the response of my anti-thyroid antibodies to the removal of gluten grains from my diet was slow, but gratifying. My thyroperox test started off at 25, dropped to 19 within 6 months, 7 within 10 months, and became zero in less than 2 years. I eventually concluded that the removal of gluten grains from my diet was not all that difficult, partly because I wasn’t a celiac who had to worry about that last 1%. I also concluded that removal of gluten would have a positive health effect in terms of the reduced glycemic index of the foods I consumed.
    My symptomatic improvement thereafter was not immediate. It soon became obvious that T3/T4 treatment is not an exact science, and the proportion of T3 to T4 needs to be closer to the human body’s need, not the pig’s need (Both Armour and Thyrolar have the T3/T4 ratio of one part T3 for every four parts T4, typical of the pig’s biochemistry). For instance, in late 2003, my TSH had dropped very low, i.e. I had become clinically hyperthyroid due to excess T3 as revealed by a free T3 test. I have since gone through a couple more of these “yo-yo” episodes while being treated, which is a not uncommon event—thyroid treatment is as much art as science.
    Cost of treatment also became a problem. By June 2004, I began seeing a highly-recommended Physician’s Assistant (P.A.), who was known locally to be very good at thyroid treatment, and whose clinic would accept my health insurance. I continued to see the naturopath, although at less frequent intervals, since my insurance (like most) would pay nothing for naturopathy. The P.A. and the naturopath did not completely agree on treatment methods, particularly the use of adrenal supplements (hydrocortisone and DHEA in low/biologic doses) along with thyroid supplements; but they were both in agreement that I should continue to pursue combination T3/T4 therapy. So, I blended recommendations from the two for awhile, transitioning to T3 and T4 in separate tablets of Cytomel and Synthroid, so the percentage of T3 could be altered.
    I gradually transitioned off adrenal supplements during 2005, and very gradually increased my T3/T4 supplementation over the course of the year. Finally, by September 2005, I began to realize that I truly had recovered my health—I had episodes of feeling really good again! Still, my sleep was not perfect—I had discovered what Ridha Arem M.D. has documented in the book Thyroid Solution: a return to the euthyroid state may not immediately eliminate all symptoms. After going to a small dose of the atypical anti-depressant mirtazapine, I finally could feel, every day, like I had in my 30s. Unfortunately, it had taken an agonizing 14 years to get there.
    Today, I religiously take my 10 micrograms T3, and 75 micrograms T4, split into two doses each day. I also religiously avoid all traces of gluten grains in my diet because I now understand that the gluey, hard-to-digest proteins in them are a substance which can cause major metabolic disruption. Like the co-author of the book “Dangerous Grains”, Ron Hoggan, with whom I have corresponded, I have come to realize that our society’s over-use of a potentially toxic substance isn’t just dangerous to the 1 in 133 people who have full-blown celiac disease—it can cause a very poor quality of life for the approximately 1 in 5 who have gluten intolerance. I have also come to the realization that, to those few who are unlucky enough to encounter the HAIT Anxiety Syndrome, you may require combination T3/T4 therapy to feel better; and, you may never feel as well as you did when you were young, unless you find a way to stop your immune system from waging war on your thyroid.
    Most of all, 14 years after it started, I feel as though a significant part of my life has been taken from me. I was unable get joy or pleasure from life, I was unable to work effectively, and I was unable to be the kind of parent I could have been between my 45th and 59th years of life.
    I never imagine that I would be looking forward to the relatively advanced age of 60. However, given that I now feel better than I did at anytime between the ages of 43 and 59, 60 looks like a good place to be.
    Summary:
    In retrospect, the most important things I ended up learning from 14 years of very unpleasant experience are:
    If you have psychiatric symptoms, e.g., depression, anxiety, panic disorder, etc., make sure your endocrine system is evaluated, with thyroid testing as the cornerstone. Beware of doctors who offer an antidepressant first thing, without endocrine evaluation. The emotional/psychiatric effects of hypothyroidism are just as important, and just as damaging, as the physical ones. Unfortunately, many MD’s focus on the physical. If you want to get well, you have to apply all your skills and intelligence to investigating your problem, which most MD’s may not understand. You may also have to turn to “alternative” practitioners. If your TSH is above 3.0, or maybe even 2.5, and your doctor will not do more comprehensive testing (e.g. FT3/FT4), and/or try a test run of thyroid supplementation, find another doctor. If your doctor diagnoses you as hypothyroid, demand that a test for anti-thyroid antibodies be done. If you have any antibodies, even if they are under the threshold where HAIT is considered to start, get testing for allergy to foods, and testing for allergy to common environmental toxins if food testing reveals nothing. You may find, as did I, that you won’t feel as well as possible until you free your body from antibodies.
    Celiac.com Sponsor: Review
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    I was pleasantly surprised how great Biena Chickpeas taste—they are light and crunchy, and are much easier on your teeth than traditional snacks like corn nuts. They are lightly roasted, and, combined with a bit of salt, have a very pleasant flavor.
    In addition to their great flavor, they are also very healthy. They contain only chickpeas, sunflower oil, and sea salt. One serving contains 6 grams protein, and 6 grams (24% of RDA) of fiber. They are also low in fat, and contain 70% less fat than peanuts.
    It's rare to find such a great tasking snack that also happens to be so healthy.
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    Jefferson Adams
    Lawsuit Claims Bob’s Red Mill Ignores RoundUp Pesticide in its Oat Products
    Image Caption: Image: CC--Mike Mozart
    Celiac.com 09/13/2018 - Bob’s Red Mill finds itself under fire by two women who claim the company knowingly hides the presence of an allegedly cancer-causing weed killer in its steel cut oat and rolled oat products, and falsely advertises those products as healthy. 
    Tamara Frankel and Natasha Paracha filed a federal class action in San Francisco, alleging that parent company Bob’s Red Mill Natural Foods knows that its oat products contain or likely contain glyphosate, but fails to disclose it on the label. The women cite a recent report by the Environmental Working Group, an environmental research and advocacy group, which claimed to find traces of controversial herbicide glyphosate in Cheerios, Quaker Oats and other oat-based breakfast foods. The women contend that Bob’s uses labels such as “gluten free,” “wheat free” and “purity tested,” which lead consumers to falsely believe them to be healthy.
    Both U.S. and European regulators have concluded that glyphosate is safe, while that World Health Organization’s International Agency for Research on Cancer classifies it as a probable human carcinogen.
    Bayer subsidiary Monsanto, maker of the glyphosate-based herbicide Roundup has faced numerous lawsuits over its product.  A San Francisco jury recently found that exposure to Roundup caused the cancer of a school groundskeeper, and awarded him $289 million in damages. Shortly after that verdict, the Environmental Working Group released a report claiming that 31 of 45 oat-based food samples tested positive for glyphosate, and that levels exceeded safety limits of 160 parts per billion.
    EWG applies a more stringent standard than the 2 mg/kg/day of glyphosate standard used by the U.S. Environmental Protection Agency, and the 1.1 mg per day standard used by the State of California.
    Frankel and Paracha are represented by Patricia Syverson of the San Diego law firm Bonnett, Fairbourn, Friedman & Balint.
    Stay tuned for more developments on this and related stories.
    Jefferson Adams
    Gluten-Free Diet Likely Improves Neuropathic Pain in Patients with Gluten Neuropathy
    Image Caption: Image: CC--Thanh Liêm
    Celiac.com 09/12/2018 - Many people with celiac disease develop peripheral neuropathy, also known as gluten neuropathy. A team of researchers recently set out to determine rates of neuropathic pain in patients with seemingly idiopathic peripheral neuropathy and gluten sensitivity, and to make note of any contributing factors. They included patients with positive antigliadin, endomysial, and/or transglutaminase antibodies, with or without enteropathy.
    The research team included P Zis, PG Sarrigiannis, DG Rao, and M Hadjivassiliou. They are affiliated with the Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Rd, Sheffield, South Yorkshire, UK.
    They invited all consecutive patients with gluten neuropathy attending a specialist gluten/neurology clinic to participate in the study. They used the DN4 questionnaire and the visual analog scale to assess pain levels. They used the Overall Neuropathy Limitations Scale to assess the severity of neuropathy, along with the Mental Health Index (MHI-5) to assess patients' general mental health status.
    A total of 33 out of 60 patients with gluten neuropathy showed neuropathic pain. The team found no significant differences between the painful, and the non-painful groups in terms of age, gender, neuropathy severity and neuropathy type. 
    Over half of patients with painless gluten neuropathy followed a strict gluten-free diet, compared with just 21.2% of those with painful neuropathy. Patients with painful gluten neuropathy also showed significantly worse MHI-5 scores. 
    After adjusting for age, gender and MHI-5 scores, multivariate analysis showed that, strict gluten-free diet lowered the odds of peripheral neuropathic pain by nearly 90%.
    Most patients with gluten neuropathy commonly have neuropathic pain, which is associated with poorer mental health status. 
    A strict gluten-free diet might substantially reduce rates of peripheral neuropathic pain in patients with gluten neuropathy.
    Read more at: J Neurol. 2018 Jul 21. doi: 10.1007/s00415-018-8978-5.PMID: 30032386
    Jefferson Adams
    Pentraxin 3 Tied to Major Gastrointestinal Damage in Celiac Disease Patients
    Image Caption: Image: CC--altemark
    Celiac.com 09/11/2018 - Gluten sensitivity is the most common sign of celiac disease. Clinical celiac diagnosis usually involves a positive blood test followed by biopsy confirmation of a typical enteropathy.
    The body’s immune response to celiac disease involves both adaptive and innate immunity, and is marked by anti-gliadin (AGA) and anti-transglutaminase 2 antibodies (tTGA), lymphocytic infiltration in the intestinal epithelial membrane, and expression of multiple cytokines. Researchers know that long pentraxin 3 (PTX3), an acute-phase inflammatory molecule, plays an important role in innate immunity.
    A pair of researchers recently set out to assess the relationship between Pentraxin 3 and biopsy status in celiac patients. Roberto Assandri and Alessandro Montanelli of the Department of Clinical Pathology, Clinical Chemistry Laboratory ASST Ospedale Maggiore di Crema, Italy, and the Clinical Chemistry Laboratory, Spedali Civili di Brescia, Italy, set out to explore a possible relationship between PTX3 and celiac disease.
    They used Marsh Histological grade following Marsh criteria classification to dividing 108 celiac disease patients into three groups: Group 1: Marsh 0, patients with a known history of celiac disease under gluten free diet, complete remission; Group 2: Marsh 1 and Marsh 2; Group 3: Marsh 3.
    As a control group, they used 30 healthy age-matched individuals with no known history of celiac disease or gastrointestinal symptoms. They used sandwich ELISA on an automated platform to measure PTX3 serum levels.
    They found that PTX3 serum levels were substantially higher in group 3 and group 2 compared with the healthy control group. They found no statistically significant differences between group 1 and the healthy control group. They noted a strong linear correlation between PTX3 serum levels and AGA levels in group 2, and group 3, but no such correlations between PTX3 serum levels and tTGA levels. 
    Blood tests showed that PTX3 correlated with major gastrointestinal damage in celiac patients. PTX3 is a part of the innate immune system’s humoral branch. Data from this study show that PTX3 serum levels are high in active disease patients with pathological levels of AGA. They also show that patients with normal AGA IgA levels had PTX3 serum levels compared to healthy control subjects. 
    The team proposes that PTX3 can modulate the innate response to gliadin in celiac disease, and may also regulate the adaptive immune response. 
    Read more at: Gastroenterology and Hepatology
    Jefferson Adams
    How Much Gluten Exposure Do Celiacs Get on a Gluten-Free Diet?
    Image Caption: Image: CC--Stig Nygaard
    Celiac.com 09/10/2018 - Anyone diagnosed with celiac disease needs to eat a gluten-free diet if they hope to see their condition improve, and not lead to worse outcomes. So, how much gluten exposure do celiacs get on a gluten-free diet?
    William F. Balistreri, MD, Director Emeritus, Pediatric Liver Care Center; Medical Director Emeritus, Liver Transplantation at Cincinnati Children's Hospital in Cincinnati, Ohio presented data at this year's Digestive Disease Week that focused on the challenges celiac patients face in trying to follow a gluten-free diet. 
    Gluten-free standards and labels help improve awareness, but even so, eating gluten-free can be a challenge. Anyone with celiac disease can tell you that the chances of accidental gluten contamination are many, and that consent vigilance is required.
    Even ”gluten-free foods" are not always free from variable amounts of gluten, whether by imprecise food production, processing, packaging, or preparation.  Accidental gluten exposure can also come via non-foods, such as lipstick, shampoo, toothpaste and the like. Regular, low-level gluten exposure can cause many celiac patients to have mucosal inflammation despite maintaining a gluten-free diet.
    Product by product, gluten levels are generally well-known, but not much is known about how much gluten exposure levels in people with celiac disease who are following a gluten-free diet. Such information could be quite helpful in designing disease management and patient follow-up strategies.
    Gluten immunogenic peptide (GIP) analysis provides direct and quantitative measurement of gluten exposure, has proven useful in diagnosis and clinical management of non-responsive or refractory celiac patients. To figure out the amounts of gluten ingested by highly motivated, educated celiac patients following a gluten-free diet, the research team measured levels of GIPs in food, urine, and stool. They noted the connections between gluten exposure and persistent villous atrophy or related conditions. 
    The study also analyzed food samples from restaurant “doggie bags" saved by the study subjects. The team detected gluten in at least one food sample from nearly 90% of patients consuming a gluten-free diet. That indicates that nearly nine out of ten people with celiac disease, who are trying hard to follow a gluten-free diet, as being exposed to gluten when they eat out.
    Overall, approximately 33% of food samples tested positive for GIPs above 20 ppm, and the estimated GIPs ingested ranged from 0.23 mg to > 40 mg per exposure.
    This new information confirms what many people with celiac disease have long suspected. Namely, that avoiding gluten is really hard to do, even for who are highly aware of gluten-related celiac disease issues, and who work hard to avoid gluten.
    Read more at: Medscape.com
    Carol Fenster, Ph.D.
    Aw Nuts! There’s More Than Meets the Eye in Nut-Crusted Entrees
    Image Caption: Image: CC--Brock Roseberry
    Celiac.com 09/08/2018 - On a recent trip to Hawaii I was often attracted to a particular entrée on the menu of several restaurants. It went by many different names, but basically the dish was fish dredged in a mixture of spices and pulverized nuts to produce a chunky crust. Since Hawaii is the home of macadamia nuts, this popular nut was often used.
    I love fish and I’m very fond of macadamia nuts, so I was particularly enticed by this entrée but I was wary because I know that many chefs like to use panko (Japanese bread crumbs) and add flour to such mixtures even though it isn’t absolutely necessary and is often not mentioned in the entrée’s description on the menu. So, I found myself engaged in a very typical conversation with the waiter. It went something like this:
    Me: I’m wondering about the nut mixture used to coat the fish. Is there wheat flour or bread crumbs in it? Waiter: I don’t know, but I’ll check with the chef and let you know. Me to husband: I better choose another entrée just in case he/she comes back with bad news. Waiter: The chef says there is (flour or bread crumbs or both) mixed in with the nuts and spices. Sorry. Me: That’s fine. Thanks for checking on that for me. Instead, I’ll have the… After I returned from this otherwise fabulous trip, I vowed to create my version of this entrée so I could have it at home whenever I wanted. I will share it here with you, but first a little background on macadamia nuts.
    Macadamia Nuts
    Though expensive, macadamia nuts are a treat and Hawaii is well known for this delicious nut. If macadamia nuts are too expensive or not available in your area, you can use slivered almonds instead. Despite their sometimes “bad” reputation, nuts offer important nutrients and good, healthy fat. But the real reason I was attracted to this dish was the crunchy texture that is so important to me in my gluten-free diet.
    The best way to crush the macadamia nuts is to put them in a small coffee grinder or food processor and grind just until they reach a coarsely chopped stage. Don’t grind them any further or you might end up with “mush” instead of pulverized nuts. To prevent the nuts from sticking together, I grind them with a small amount of cornstarch.
    Some of you may never have traveled to Hawaii. Others, like me, may not get a chance to return to Hawaii for a long time but at least we can bring a little bit of the islands to our dinner table with this tempting dish.
    Macadamia-Crusted Snapper with Pineapple Salsa
    Ingredients:
    4 fish fillets (red snapper, mahi mahi, or firm-flesh fillets--about 6 ounces each) 4 tablespoons olive oil, divided 1 teaspoon ground ginger 1 teaspoon ground coriander 1 teaspoon paprika, plus some for dusting 1 teaspoon salt ½ teaspoon freshly ground pepper 1 cup coarsely ground macadamia nuts or almonds (ground with ¼ cup cornstarch) Additional salt and pepper to taste Salsa Ingredients:
    1 can (8 ounces) pineapple tidbits, drained ½ cup finely diced red bell pepper ½ cup chopped fresh cilantro ¼ cup finely diced red onion 1 tablespoon fresh lime juice 1 tablespoon rice vinegar 1 teaspoon olive oil 1 serrano chile pepper, seeded and finely diced ¼ teaspoon salt ¼ teaspoon sugar Directions:
    At least an hour before dinner, combine all of the salsa ingredients in a small serving bowl, cover, and let sit at room temperature. Preheat the oven to 400°F. Lightly grease a baking dish or sheet large enough to hold the fish fillets side by side and at least 2 inches apart. Use 1 tablespoon of the olive oil or you may line the pan with aluminum oil and lightly coat with cooking spray. Grind the nuts and cornstarch together. Evenly spread the nut mixture on a large dinner plate.
    Combine remaining 3 tablespoons of the oil, ginger, coriander, and paprika. Brush each filet with this mixture; sprinkle both sides with salt and pepper. Dredge each fillet in the nuts, pressing mixture on fish with your fingers to cover it evenly on both sides. Gently transfer fish to prepared baking dish. Sprinkle with a dusting of paprika. Bake fish fillets until they are cooked through and the nut crust is golden brown, anywhere from 10 to 15 minutes or more depending on the thickness of the fish. Season with additional salt and pepper to taste. Serve immediately with 1/3 cup of Pineapple Salsa per serving. Serves 4.
    You don’t have to save this nut crust for fish. It works great on chicken fillets, too. Plan ahead by grinding more nuts than you need then freezing the remainder. That way, it’s just a simple step to mix in the necessary spices or whatever else the recipe calls for.
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