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  • Jefferson Adams
    Image Caption: Why does it take so long for doctors to diagnose celiac disease in patients with no symptoms? Photo: Richard-G
    Celiac.com 03/08/2018 - A team of researchers recently set out to study delays in diagnosing patients who have biopsy-proven celiac disease with gastrointestinal complaints, compared to those without non-gastrointestinal complaints.
    The research team included Marco A. Paez, MD, Anna Maria Gramelspacher, MD, James Sinacore, PhD, Laura Winterfield, MD, and Mukund Venu, MD. They are variously affiliated with the Division of Gastroenterology, Department of Medicine, Howard College of Medicine, Washington, DC; the Department of Medicine, the Department of Public Health Sciences, the Division of Gastroenterology, and the Department of Medicine at Loyola University Medical Center in Maywood, Illinois.
    The research team first conducted a medical chart review of 687 adult patients diagnosed with celiac disease. All patients they studied had biopsy-proven celiac disease and were grouped according to presence or absence of gastrointestinal symptoms before diagnosis. The team found 101 biopsy-proven celiac patients that met their study criteria. The groups were roughly equal in size, with 52 patients showing gastrointestinal symptoms before diagnosis, and 49 with no gastrointestinal symptoms.
    The results for the groups were starkly different. Statistical analysis revealed an average diagnosis delay of 2.3 months for the group with gastrointestinal symptoms, while the group that showed no symptoms showed an average delay of 42 months. That’s a difference of nearly 3½ years.
    Nearly half of the patients with non-gastrointestinal symptoms had abnormal thyroid-stimulating hormone, as opposed to 15.5% in the gastrointestinal symptom group (P = .004). Nearly 70% of patients without gastrointestinal symptoms had anemia, compared with just 11.5% of the group with gastrointestinal symptoms.
    Also, nearly 70% of patients in the non-gastrointestinal symptom group showed abnormal bone density scans, compared with 41% in the gastrointestinal symptom group. The team saw no sex differences on chi-squared analysis between the 2 groups.
    Although there is growing awareness of celiac disease, the delay in diagnosis for patients without gastrointestinal symptoms remains prolonged, with an average delay of 3.5 years for celiac diagnosis, compared with just over two months for those with symptoms.
    Clearly, more needs to be done with regard to diagnosing celiac disease in patients who show no symptoms. On the upside, researchers are currently working on ways to better diagnose celiac disease via faster, more accurate tests, even in patients who have already gone gluten-free.
    Source:
    PlumX Metrics

    Jefferson Adams
    Image Caption: Photo: CC--Steven Depolo
    Celiac.com 03/07/2018 - People with celiac disease can sometimes have hematological issues, including chronic anemia. It might be surprising to hear, but aplastic anemia and celiac disease share a similar underlying autoimmune process, but doctors haven't reported many cases that indicate that the two are connected. In fact, medical literature reveals only three pediatric cases indicating a connection. Recently, clinicians reported the first case in a female pediatric patient.
    The clinical team included Omar Irfan, Sana Mahmood, Heera Nand, and Gaffar Billoo, with the Medical College and the Department of Pediatrics at Aga Khan University Hospital in Karachi, Pakistan. Their team treated a 6-year-old South Asian girl who had bruises, petechiae, and recent history of loose stools. On evaluation, the team diagnosed the girl to have celiac disease and prescribed a gluten-free diet. Follow-up assessment including bone marrow biopsy showed the girl to have pancytopenia.
    The team managed the girl's condition with packed red cells, platelets, and diet restrictions, and the girl showed improving platelet counts over yearly follow up visits. Eventually, the girl will need a bone marrow transplant, and the team spoke about that to the girl's parents.
    This is now the fourth report indicating a connection between celiac disease and aplastic anemia in children, and the clinical team wonders if the connection might be more common than is currently understood.
    Timely treatment of celiac disease through strict gluten-free diet, or aplastic anemia through immunosuppressive therapy, could help reduce the development of other autoimmune conditions.
    Because all four pediatric cases reporting potential celiac disease/aplastic anemia association occurred in South East Asia, the authors suggest larger studies to explore this connection.
    Source:
    J Med Case Reports. 2018;12(16)

    Jefferson Adams
    Image Caption: Photo: CC--Shakreez
    Celiac.com 03/06/2018 - A number of clinicians and researchers have suspected that antibodies against transglutaminase 6 (anti-TG6) play a role in neurological issues in adult patients with genetic gluten intolerance, but it is not known if autoimmunity to TG6 develops after long-term consumption of gluten.
    A team of researchers recently set out to establish a correlation between these autoantibodies and the duration of gluten exposure by measuring the anti-TG6 in children with celiac disease at diagnosis. The team then investigated a correlation between anti-TG6 and the presence of neurological disorders.
    The research team included L De Leo, D Aeschlimann, M Hadjivassiliou, P Aeschlimann, N Salce, S Vatta, F Ziberna, G Cozzi, S Martelossi, A Ventura, and T Not. They are variously affiliated with the Institute for Maternal and Child Health-IRCCS "Burlo Garofolo" Trieste, Trieste, Italy; Matrix Biology and Tissue Repair Research Unit, School of Dentistry, and Arthritis Research UK Biomechanics and Bioengineering Centre of Excellence, College of Biomedical and Life Sciences, Cardiff University, Cardiff; the Department of Neurology at the Royal Hallmshire Hospital, Sheffield, UK; and with the University of Trieste in Trieste, Italy.
    The team used ELISA to measure anti-TG6 (IgA/IgG) in children with biopsy-proven celiac disease and of children experiencing gastrointestinal disorders. Celiac disease patients who tested positive for anti-TG6 were retested after 2 years of gluten-free diet. In all, the team analyzed test results for 274 children with celiac disease, along with 121 control subjects.
    They found anti-TG6 in 68 out of 274 celiac disease patients and in 19/121 control subjects, though the differences between the two groups was significant. None of the celiac patients or the controls who tested positive for anti-TG6 suffered from neurological disorders. Eleven of 18 celiac disease patients with other autoimmune diseases tested positive for anti-TG6. 
    Among the celiac disease patients, the team found a significant correlation between the gluten exposure before the celiac disease diagnosis and anti-TG6 concentration. The gluten-free diet substantially reduced the anti-TG6 concentrations. The team found no significant correlation between anti-TG6 and anti-TG2 serum concentrations.
    Anti-TG6 is much more common in children with untreated celiac disease , but with no apparent neurological disorders. The synthesis of the anti-TG6 is associated with longer exposure to gluten prior to celiac diagnosis, while the autoimmunity against TG6 is gluten dependent and disappears with a gluten-free diet.
    Source:
    J Pediatr Gastroenterol Nutr. 2018 Jan;66(1):64-68. doi: 10.1097/MPG.0000000000001642.

    Jefferson Adams
    Image Caption: Photo: CC--Jamie
    Celiac.com 03/05/2018 - While people with non-celiac gluten sensitivity (NCGS) have neither celiac disease nor wheat allergy (WA), they often do have intestinal and extra-intestinal symptoms that are related to gluten consumption.
    Using a double-blind placebo-controlled (DBPC) gluten challenge with crossover, a team of researchers recently set out to conduct the first assessment of NCGS rates in children with chronic, gluten-associated gastrointestinal symptoms.
    The research team included R Francavilla MD, PhD, F Cristofori MD, L Verzillo MD, A Gentile MD, S Castellaneta MD, C Polloni MD, V Giorgio MD, E Verduci MD, PhD, E D'Angelo MD, S Dellatte MD & F Indrio MD. They are variously affiliated with the Department of Pediatrics, San Paolo Hospital, Bari Italy; the Department of Pediatrics, Santa Maria del Carmine Hospital, Rovereto TN, Italy; the Department of Pediatrics, Catholic University, Rome, Italy; the Department of Pediatrics, University of Milan, S. Paolo Hospital, Milan, Italy; the Department of Pediatrics, Santa Maria Incoronata dell’Olmo Hospital; Cava dei Tirreni SA, Italy; the Tandoi Group Factory, Corato, Italy; and the Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy.
    Their team looked at 1,114 children with chronic gastrointestinal symptoms, but no celiac disease and WA. For children showing a positive connection between symptoms and gluten ingestion, the team offered a four-stage diagnostic challenge that included: run-in, open gluten-free diet (GFD) and DBPC crossover gluten challenge.
    Patients randomly received gluten (10 g/daily) and placebo (rice starch) for 2 weeks each, separated by a washout week. The gluten challenge was considered positive when accompanied by a minimum 30% decrease of global visual analogue scale between gluten and placebo.
    Out of 1,114 children, 96.7% showed no correlation with gluten ingestion. Thirty-six children were eligible for the diagnostic challenge. After the run-in and open GFD, 28 patients underwent gluten challenge. Eleven of these children tested positive (39.2%).
    This is the first such study to demonstrate the need for a DBPC for diagnosing NCGS in children, since the diagnosis is ruled out in more than sixty-percent of cases.
    Source:
    The American Journal of Gastroenterology. doi:10.1038/ajg.2017.483

    Jefferson Adams
    Image Caption: Photo: CC--Surfergirl143
    Celiac.com 03/03/2018 - Want to score major points with your beloved? This loving, gluten-free twist on Toad in a Hole will have you thanking your handsome prince all over again. All you need is a heart-shaped cut-out to make your gluten-free dieter feel the love of this classic breakfast favorite.
    Ingredients:
    2 large eggs 2 slices gluten-free white sandwich bread 4 teaspoons mayonnaise 1 tablespoon butter salt pepper Finely chopped fresh parsley, dill, or chives Directions:
    Spread mayonnaise on both sides of 2 slices white sandwich bread.
    With medium heart-shaped cookie cutter, cut centers from bread.
    In 12-inch skillet, melt butter on medium. Add bread (and centers) to skillet.
    Cook 5 minutes or until golden brown, and then turn the bread over.
    To each heart-shaped hole, add 1 large egg; sprinkle eggs with pinch of salt and pepper.
    Reduce heat to medium-low. Cook 5 to 7 minutes, or until whites are set.
    Sprinkle with finely chopped parsley or chives, as desired.

    Yvonne (Vonnie) Mostat
    Image Caption: Hemoglobin. Image: CC--Scott Robinson
    Celiac.com 03/02/2018 - When I was diagnosed as having celiac disease with severe dermatitis herpetiformis (DH) I was told that the diet was difficult to follow and I would have to be vigilant or Dapsone would not relieve the itching. I suffered abdominal pain, outbreaks of sores, anaemia, and, (big swallow) the horrible bowel disorders. I came out of the dermatologist's office with a prescription for Dapsone to treat the attack of sores on my scalp, on my arms and thighs, along with a slip of paper referring me to the dietician at our local hospital. But that was years ago. My journey has been an ongoing trial of trial and error.
    I was just discharged from hospital again, my third occasion in ICU within the past year. I have been told I am the only person in Langley who can wear that crown, the one of having Methemoglobinemia. {lucky me!}
    This could happen to any celiac with dermatitis herpetiformis who takes Dapsone. And anyone regularly eating packaged meats or bacon, for instance, along with having Zylocaine injections, is at significant risk of methemoglobinemia as well. A person with celiac disease may or may not have dermatitis herpetiformis. Many celiacs go their entire lives without a DH spot on their bodies {you Lucky people}.
    I have learned a lot in this past two weeks, both while hospitalized and from subsequent research, about the reasons it happened and the dangers of it happening to me again. I can never have more than one Dapsone again and I must now have methemoglobinemia tests done every six weeks. It is likely that they cannot use Methylene Blue to treat me again, unless I am at a critical point, because of the danger of the poison still being in my system.
    **A little lesson here on methemoglobinemia:
    Hemoglobin is the molecule in red blood cells that distributes oxygen to the body.
    Methhemoglobinemia can either be inherited or acquired. It is a blood disorder in which an abnormal amount of methemoglobin, a form of hemoglobin, is produced. Methemoglobin cannot release oxygen.
    There are two forms of Methemoglobinemia. The acquired form is caused by exposure to some chemicals and/or drugs and is thought to be more common than those that are inherited.
    Chemicals and drugs that trigger methhemoglobinemia include:
    Anaesthetics such as benzocaine and Xylocaine Benzene Certain antibiotics {including Dapsone and chloroquine} Moi! Nitrites {used as additives to prevent meat from spoiling)!! There are two sub-groups of inherited methemoglobinemia, type 1 and type 2.
    The symptoms of acquired methemoglobinemia include:
    bluish coloring of the skin headache fatigue I did not get "bluish coloring of the skin", even though I was hospitalized on three occasions with this condition and was asked about it repeatedly. I did get full frontal, severe headaches, and I did experience breathlessness when climbing stairs. I had to stop at the top of our the stairs in our home to catch my breath. My most recent admission to the Emergency Department was after such an experience. I was really out of breath, had chest pain, and my headache was so severe that I told my husband that I thought that methemoglobinemia was coming back again.
    I made the mistake of following a physician's instructions - some don't seem to know that this condition can become critical.
    The admissions last year were because I had two of the diagnostic criteria for Type II methemoglobinemia. I had a trapped nerve in my neck and my husband had been trained to give me Zylocaine injections to alleviate severe stabbing pains just above my right eyebrow. (The nerve travels over the head to just above the eye.)
    I had been told that when I was in the throes of a dermatitis herpetiformis outbreak I could go 5 - 4 - 3 - 2 - 1 with Dapsone and Prednisone. On the first day I took 5 tablets, the second day 4 tablets, and so on. If the spots kept re-occurring then I was to follow the same procedure once more.
    When I was discharged last year I was not told to change that protocol. In February, I found myself inundated with dermatitis herpetiformis spots all over the back of my head, backs of my arms and shins. I was conservative in my approach to Dapsone and took only Three Dapsone tablets on two successive days.
    This set me on the path to another hospital admission. I could not climb our stairs without leg pains and becoming breathless. I had frontal headaches and just "did not feel well".
    On one of my last admissions to the intensive care unit, my methemoglobinemia was 29 and the Internist treating me said that if I had sat at home with my oxygen bottle for another week my methemoglobinemia scale could have climbed to 35 which usually means death.
    What to do if you develop the same symptoms: Call your health care provider or emergency services (911) immediately if you have severe shortness of breath and you have previously experienced methemoglobinemia.
    Prevention: Genetic counseling is recommended for couples with a family history of methemoglobinemia who are considering having children.
    After this most recent outbreak of DH I was determined to find out what had caused this last admission to hospital. It was not fun to have my blood drawn daily. Neither was it fun to have the phlebotomist coming in to draw blood gases from my wrist (ouch!) also daily. It was scary when they told me that my hemoglobin was declining daily and when it hit 80 they started the IV drip of two units of packed red cells again.
    They did not do the Methylane Blue flushing during this admission because my methemoglobin was 11, not 17 or 29. Methylane Blue is a poison and they had to check with St. Paul's Hospital in Vancouver in order to determine the amount to be used on this little body. Plus they cannot keep doing this poisonous flushing every nine months. I was told this by a specialist wearing his sternest facial expression, obviously in order to scare me.
    Who knows what amounts still stay in the system? Methylene blue may be dangerous to patients who have or may be at risk for a blood disease called G68PD deficiency and should not be used by them. If you or your child has G6PD deficiency, always tell your health care provider before receiving treatment.
    Another interesting note is that ascorbic acid can also be used to reduce the level of methemoglobin. I don't know much ascorbic acid is required but I intend to find out. Oranges contain ascorbic acid do they not? The normal methemoglobinemia scale is about minus 0.1. Mine seems to stay at about 3.
    This specialist physician also told me that I could no longer increase my dosage of Dapsone. It has to stay at one per day no matter how severe the outbreak. I must also take Cimetidine, a drug that is usually used to control excess stomach acid. It helps to reduce the impact of Dapsone on methemoglobin.
    Dapsone is the dangerous drug for methemoglobinemia, and Zylocaine injections also pose similar dangers. After my admission to hospital last May, I found out that phosphates can also add to the level of methemoglobin. There are phosphates in packaged meats, with lots of those little guys in bacon and cured ham. Were I to double up on Dapsone because of a particularly bad DH outbreak, have a few injections of Zylocaine, then add some back bacon and packaged cold cuts, I might well be back in hospital with elevated levels of methemoglobin.
    This time I also discovered that phosphates are sometimes in chewing gum, malted milk drinks, drinking chocolate, baked beans, instant coffee, curry powder, white pepper, some lipsticks, gravy browning, self basting turkeys, brown rice syrup, supplements and, of course, luncheon meats.
    Fifteen years ago I was told I could use Atarax for the itch. Now they tell me that this drug is not only very sedating, thus slowing the heart down considerably, it is a poison that can cause tardive dyskinesia, a potentially irreversible form of brain damage. Again, fifteen years ago it caused me to experience facial gesticulations, tongue protrusion, hands that trembled and a speech pattern that often defied translation. That was because I was wrongly prescribed Loxapine for the itch, and along with Atarax, it ruined my life forever.
    Misunderstandings persist. Celiac disease can look like Crohn's disease. It can look like colitis. It can look like irritable bowel disease, and because physicians have been taught that celiac disease is very rare and they often simply write it off as irritable bowel syndrome when they cannot find the cause of a GI problem. They forget that it could be celiac disease. It is just under-diagnosed, and peri-menopausal women suffer the most because they are often labeled as "depressive", or worse yet, "neurotic". I was told when working as a nurse that "irritable bowel" often meant "we just don't know".
    The world has yet to define a universal "gluten-free" standard. For international trade purposes, the Codex (WHO - World Health Organization), Committee on Nutrition and Foods for Special Dietary Uses is in the process of revising their standards. At this time they are unable to reach a consensus. {Hey, this has been since 2008 and it's already 2012! What do they do at these Forums?} The Food Allergen Labeling and Consumer Protection Act (FALCPA) has committed to defining "gluten-free" for labeling purposes by 2008. We still do not have a World standard. FDA (Food and Drug Administration) acknowledges that the situation needs to be rectified and it has made a start by including gluten with other major allergens in their ingredient disclosure requirements.
    The greatest progress is among the health declarations on restaurant menus and whole foods markets. Wal-Mart have also cast their lot with this group, establishing entire sections dedicated to gluten-free foods. We are finally starting to get rid of ‘stealth glutens' - those in flavor carriers, binders, fillers and emulsifiers, and used in everything from salad dressings to self-basting turkeys. We have come a long way, but we still have miles to go in reforming the food industry. As a waiter said to my friend when she told him she has celiac disease: "We don't serve fish in our restaurant, in fact we have nothing out of the sea".
    References:
    DeBaun, MR - Frei-Jones M Vichinsky E Hereditary methemoglobinemia in Kliegmann RM, Behrmann RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics 19th ed. Philadelphia. PA Saunders, Fernandez Frackelton M Bocock, J. Cyanosis In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine Concepts and Clinical Practice 7th ed. Philadelphia, Pa, Mosby Elsevier; 2009, chap, 29. "Keeping Food Safety in the Mix: Food Safety in Grain Based Foods and Bakery Products" Gluten-Free Formulation, Kim Decker

    Jefferson Adams
    Image Caption: Photo: Thomas Shahan
    Celiac.com 03/01/2018 - Mortality rates for children under five have been falling steadily for decades. Additionally, there's plenty of data to indicate that rates of celiac disease have been rising in general population.
    Before doctors understood the role that gluten played in celiac disease, the prognosis for young children with the condition was grim. Since doctors didn't understand the underlying disease, many of these deaths were simply logged as deaths due to wasting or failure to thrive. Could fewer children dying from celiac disease help explain the apparent rise in celiac rates? In an attempt to answer that question, a team of researchers recently set out to to investigate a possible relationship between mortality rates in children under five years old and rates of celiac disease.
    The research team included F Biagi, A Raiteri, A Schiepatti, C Klersy, and GR Corazza. They are variously affiliated with the First Department of Internal Medicine, Coeliac Centre, and the Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
    A review of medical literature revealed 27 studies from 17 different countries concerning rates of celiac disease in schoolchildren between 1995 and 2011, 4 studies were performed in Italy. The researchers conducted a meta-analysis of prevalence rates and compared them between specific country under-5 mortality groups, publication year, and age.
    Over the last twenty years or so, mortality rates for kids under 5 have been decreasing all over the world. This reduction has mirrored an increase of the rates of celiac disease. The Spearman correlation coefficient was -63%, 95% confidence interval -82% to -33% (P < 0.001). The data show that higher mortality rates mirrored lower rates of celiac disease. This finding is confirmed by the meta-analysis of the four Italian studies.
    Rates of death for children under 5 years of age seem to influence rates of celiac disease in the general population. Basically, less kids dying young contributes to higher celiac disease rates later on.
    Because gluten-free diet treatment and numerous other developments allow a better survival of children with celiac disease, the number of people with celiac disease will likely increase for some time into the future.
    Source:
    J Pediatr Gastroenterol Nutr. 2018 Feb;66(2):289-294. doi: 10.1097/MPG.0000000000001696.

    Jefferson Adams
    Image Caption: Can a New Genetic Discovery Help Identify Children at Risk for Type 1 Diabetes? Photo: CC--Practical Cures
    Celiac.com 02/28/2018 - In an effort to discover more genes that trigger type 1 diabetes, a team of researchers recently conducted a large, prospective study of children at risk for type 1 diabetes. The end goal is to reveal more targets for treating or even preventing the disease.
    The research team included A Sharma, X Liu, D Hadley, W Hagopian, WM Chen, S Onengut-Gumuscu, C Törn, AK Steck, BI Frohnert, M Rewers, AG Ziegler, Å Lernmark, J Toppari, JP Krischer, B Akolkar, SS Rich, JX She; and TEDDY Study Group.
    The team identified six new chromosomal regions in young people who have already developed type 1 diabetes, or who have started making antibodies against their insulin-producing cells, often a step toward full-blown diabetes that requires lifelong insulin therapy. Their analysis of 5,806 individuals, which is published in the Journal of Autoimmunity, also confirms three regions already associated with one of those related conditions.
    The team observed two top autoantibodies. The first, called IAA, acts directly against insulin. The second, called GADA, acts against the enzyme glutamate decarboxylase, which regulates the insulin-producing beta cells in the pancreas. According to Dr. She, about 90 percent of patients with type 1 diabetes start with one of the autoantibodies, and many patients eventually end up with both. The second autoantibody may surface in a few days or even years later.
    They began this study with 176,586 SNPs, or single nucleotide polymorphisms. Nucleotides are basic building blocks of our genetic information. According to Sharma, the SNPs evaluated by TEDDY scientists were already linked with other autoimmune conditions like rheumatoid arthritis or celiac disease, but not type 1 diabetes.
    The researchers figured out which of these SNPs are different in TEDDY participants with type 1 diabetes versus those with Islet cell autoantibodies versus those with neither. Previous research has shown that the genes associated with IA and actual type 1 diabetes can differ. Dr. She says that even though clinicians regard Islet cell autoantibodies (IA) as a red flag for type 1 diabetes, not every child with IA goes on to develop diabetes, though multiple autoantibodies definitely increase that risk.
    The team notes that it is possible that the genes that promote IA development may differ from those that lead to full-blown disease progression.
    She says that this is the first study of gene identification for any disease to use this sort of longitudinal information. She add that this and other studies by the TEDDY research group help to clarify the search for important non-HLA genes by adding the "time to disease" perspective.
    Source:
    J Autoimmun. 2018 Jan 5. pii: S0896-8411(17)30739-4. doi: 10.1016/j.jaut.2017.12.008.  
    The researchers are variously affiliated with the Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA; Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, US; the Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; the Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom; the Pacific Northwest Research Institute, Seattle, WA, USA; the Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA; the Department of Clinical Sciences, Lund University/CRC, Malmö, Sweden; the Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, Aurora, CO, USA; the Institute of Diabetes Research, Helmholtz Zentrum München, Munich-Neuherberg, Germany; Klinikum rechts der Isar, Technische Universität München, Munich-Neuherberg, Germany; Forschergruppe Diabetes e.V., Munich-Neuherberg, Germany; the Department of Pediatrics, Turku University Hospital, Turku, Finland; the National Institutes of Diabetes and Digestive and Kidney Disorders, National Institutes of Health, Bethesda, MD, USA; and the Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.

    Jefferson Adams
    Image Caption: Photo: CC--DoDNews
    Celiac.com 02/27/2018 - A pair of disabled veterans recently filed a federal lawsuit against a gluten-free bakery, Aimee's Love, and the city of Longmont, Colorado. The suit claims that on two separate occasions the bakery owners and the city both violated the Americans with Disabilities Act when they refused to serve the couple due to the presence of their service dogs.
    The suit also contends that Aimee's Love violated the Colorado Anti-Discrimination Act, and that the city violated the Rehabilitation Act of 1973. The Blocks are seeking unspecified damages. Under the ADA, people with disabilities may bring animals into businesses and other buildings where they would usually be excluded.
    The Blocks allege that they were first denied service by the bakery on March 8, when they attempted to enter with a Great Dane named Rajah, which they term a "service animal in training." The Blocks claim they asked the owners to familiarize themselves with federal laws regarding service animals. They claim that they were later denied service a second time, when they tried to enter the bakery with a different dog.
    According to Jennifer and Gary Block, Longmont police officers responded to the second incident improperly by wrongly making the couple and their dog leave the business. A Longmont police report claims the couple left on their own after the first incident, and that the bakery owners merely asked if the dogs were legitimate service dogs.
    It was during the second incident that the police told the Blocks and their dog to leave the bakery, the suit alleges. The suit also contends that the bakery owners and police violated federal disability law by demanding "proof" that the Blocks' dog was indeed a service animal.
    Under federal law, business owners may ask if a dog is a service animal and what task it performs, but can't ask any further questions of the dog's handler. They are not allowed to ask for "proof" that the service animal is "legitimate."
    Stay tuned for more news on this and other gluten-free-related stories.
    Read more at: Timescall.com

    Jefferson Adams
    Image Caption: Photo: CC--Ted Eytan
    Celiac.com 02/26/2018 - People with celiac disease and gluten-sensitivities react adversely to gluten proteins in wheat, barley and rye. The gold standard for assessing gluten levels in foods is a test called the enzyme-linked immunosorbent assay, aka ELISA. Now, ELISA is, by most measures, a good test. However, it does have some drawbacks.
    ELISA tests do vary by manufacturer, and can provide inconsistent results, including false negatives, which can be harmful for people with celiac disease or gluten-sensitivity.
    Also, for optimal detection, each type of gluten requires a different ELISA. So, barley, wheat and rye all require separate tests.
    Researchers Kevin D. Dorfman, Scott P. White and C. Daniel Frisbie claim they have developed a gluten detector that can rapidly detect and quantify different sources of gluten with a single test.
    Their team says that their gluten assay device is based on floating gate transistor technology, and relies on tiny micro-channels for a sample to move through. Gluten in a sample will bind to one of three capture agents, which can be antibodies or a DNA-based aptamer, that specifically latch onto gluten proteins from certain sources. This binding causes a shift in the voltage read-out of the transistor which acts as a chemical fingerprint that identifies the gluten as being from barley, wheat, or rye.
    As with ELISA, the device could detect gluten below 20 parts per million, which is the maximum threshold allowed by the U.S. Food and Drug Administration for a "gluten-free" label. Because it has fewer processing steps, and uses automated sampling, the new sensor typically produces results 45 minutes faster due than ELISA tests.
    The new test is still in development, and not set to replace ELISA anytime soon. But progress in the gluten-free world is rapid these days, so changes to commercial gluten detection systems are likely on the near future.
    Source:
    American Chemical Society

    Jefferson Adams
    Image Caption: Fondue. Photo: CC--LinaMon
    Celiac.com 02/24/2018 - Forget about Valentine's Day. Well, not literally, you should definitely do something nice for your Valentine; but let's put that aside for a moment. Just about any day can be right for a romantic dinner if you plan ahead and keep it simple. One suggestion: fondue.
    Few dishes can so effortlessly anchor a simple, romantic dinner as traditional Swiss fondue. Yes, you could make your own fondue, but I prefer to make it easy by dropping by my local Trader Joe's.
    Made in Switzerland, Trader Joe's Fondue is a blend of Swiss Emmental and Gruyère cheeses, white wine, kirsch, a dry cherry brandy, and a selection of savory spices.
    Trader Joe's also make a French version called Isigny Ste Mère Fondue Normande, which is made with soft cheeses Camembert, Livarot, and Pont L'Eveque cheeses and apple brandy.
    Want my recipe for the easiest, most romantic gluten-free dinner I know?
    Lightly steam some broccoli, asparagus, carrots, zucchini, potatoes until tender, but firm. Cut them into bite-sized chunks and arrange on a plate. Also add cut apples, pears, some toasted gluten-free bread, and some good ham or sausage.
    Grab a box of Trader Joe's Fondue, and prepare as directed. If you don't have a fondue pot, you can still heat the fondue in the microwave and serve it a ramekin or other ceramic dish. The ceramic will hold the heat well, and help keep the fondue fit for dipping.
    Spread out on a blanket near the fireplace, and if you don't have a fireplace, turn on one of those fireplace videos on YouTube.
    Pour a glass of your favorite wine, dig in, and enjoy your lingering, romantic dinner.
    If you don't have a Trader Joe's nearby, or feeling DIY? Fret not. Here's a great recipe recipe for an easy gluten-free beer and cheddar fondue.

    Gluten-Free Beer and Cheddar Fondue
    Ingredients:
    12 ounces light gluten-free beer ½ teaspoon Dijon mustard 1 clove garlic ¼ teaspoon Gluten-free Louisiana-style hot sauce 4 cups shredded sharp Cheddar cheese 2 tablespoons cornstarch or potato starch Cooked sausage or ham, cut to bite-size New potatoes, steamed and cut to size Gluten-free Bread, toasted and cut into cubes Apples cut into bite-size squares Pear cut into bite-size squares broccoli cauliflower asparagus carrots zucchini Directions:
    Heat beer, Dijon mustard, garlic, and hot sauce in 4-quart saucepan on low; whisk in Cheddar cheese tossed with cornstarch until melted and smooth. Pour into a warm ramekin or other ceramic dish.
    Lightly steam some broccoli, cauliflower, asparagus, carrots, zucchini, potatoes until tender, but firm. Cut into bite-sized chunks and arrange on a plate.
    Add cut apples, pears, toasted gluten-free bread, and good ham or sausage.
    To serve, spear fruit, veggies or meat with a fork and dip in cheese. Eat and repeat.

    Jefferson Adams
    Image Caption: Crispy Roast Duck Breast with Pineapple and Apricot. Photo: Timothy Vollmer
    Want to make an easy, but memorable dinner that will be as romantic as it is delicious? Then this tasty roast duck is just the ticket. In many parts of the world, Europe and Asia especially, it's quite common to eat duck. This recipe will blends white wine with fresh apricots and pineapple to create a delicious sauce that is perfect for this nicely roasted duck.
    Ingredients:
    1 large duck breast
    1 pound parsnips
    1 cups chicken broth
    3 teaspoon olive oil
    ½ small red onion
    ½ cups dry white wine
    ¼ cups fresh apricots
    ¼ cups chopped pineapple (canned okay, drained)
    1 tabelspoon apricot jam
    1 tablespoon red wine vinegar
    Chopped flat leaf parsley
    Directions:
    Heat oven to 400 degrees F. Line small jelly-roll pan with foil.
    Place duck on cutting board. Cover with plastic wrap. Use a meat mallet to pound breast to 1-inch thickness.
    Use a knife to score the breast with ¼-inch-deep cuts diagonally across skin side, about ½ inch apart. Make another set of cuts to create diamond pattern.
    In a medium sauce pot, heat parsnips and broth to simmering on medium-high. Reduce heat to medium. Partially cover and simmer until very tender, about 15 minutes.
    In a skillet, heat 1 teaspoon oil on medium. Sprinkle duck with ¼ teaspoon each salt and pepper to season both sides. Add duck to skillet, skin side down. Cook 5 minutes or until crisp and browned. Turn over. Cook another 2 minutes or until browned.
    Transfer to prepared pan, skin side up. Roast 5 to 7 minutes or until desired doneness (145 degrees F for medium). Transfer to clean cutting board and loosely tent with foil.
    Drain all but 1 teaspoon fat from skillet. Add onion to skillet.
    Cook on medium 2 minutes or until browned, stirring frequently.
    Add wine pineapple and apricots. Cook 2 minutes or until wine is reduced by about half.
    Stir in jam, vinegar, and â…› teaspoon each salt and pepper. Cook 1 minute or until jam is melted, stirring frequently. Remove from heat.
    With slotted spoon, transfer cooked parsnips to food processor along with ¼ cup cooking liquid, remaining 2 teaspoons oil, and â…› teaspoon salt. Pulse just until smooth.
    Divide parsnips between 2 serving plates. Thinly slice duck breast; arrange duck on top of parsnips. Top with apricot sauce and garnish with parsley, if desired.

    Jefferson Adams
    Image Caption: A gluten-free beer brewed from chestnuts is turning heads and winning awards. Photo: CC--Cookbookman17
    Celiac.com 02/23/2018 - A quest to brew gluten-free beer from chestnuts that started as a lark and developed into an obsession has resulted in a proper, award-winning lager.
    Christchurch brewer Hamish Jones will tell you that his quest to brew gluten-free beer from chestnuts began about six years ago, in an effort to please beer-loving cousin with celiac disease. A few years later, in 2016, Jones started The Nuts Brewing Co., and Jones' Cheslic Lager was born.
    Cheslic is a naturally crafted chestnut lager. Recently this unique brew won the Morton Coutts Trophy, presented by the Brewers Guild for outstanding innovation or achievement in the NZ brewing industry.
    Judges commended Jones' innovation in creating a beer that "appeals to a growing section of society who have been deprived of beer and forced to drink only wine and cider".
    "Although chestnuts have been used as an adjunct in beer for some time, the use of them without any barley, to produce a gluten-free beer on a commercial scale, is a worldwide first and furthermore the nuts are locally grown," the trophy citation said.
    Jones said that, even though brewing with chestnuts was a fickle business, the resulting product is "not as bitter, it's slightly closer tasting to cider than it is to beer." Jones has other plans to produce other gluten-free beers, including a five per cent pale ale.
    Currently, Cheslic is stocked in a range of local New Zealand retailers in Christchurch, including Fresh Choice in Parklands and Merivale, New World South City, The Beer Library, The Bottle-O Elmwood and various others.
    Stay tuned for more great stories about gluten-free beer breakthroughs worldwide.
    Source:
    stuff.co.nz

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    Dr. Vikki Petersen D.C, C.C.N
    Image Caption: Image: CC--Chris & Karen Highland
    Celiac.com 02/22/2018 - I am writing this article hoping to help those who have been diagnosed with gluten intolerance but who are still not feeling well, as well as for those who need to be diagnosed or will be in the future.
    Just to clarify our terms, I use 'gluten intolerance' as an umbrella term to encompass both celiac disease and gluten sensitivity.
    I have the privilege of speaking with many individuals, on a weekly basis, who not only live in the locality of my clinic but also those who live across the United States and internationally. Just a few days ago I had phone consultations with individuals living in Shanghai, Philadelphia and Los Angeles.
    My clinic, HealthNOW Medical Center, is a destination clinic where we treat individuals who live at a distance as well as those who live nearby, hence these particular calls. As a result of doing such consultations and receiving responses to my lectures, books, blogs and videos, I have an opportunity to speak with many people and hear their stories.
    Frankly I often wish I had the ability to 'beam them up' utilizing the fictional technology from Star Trek—it would make travel logistics a piece of cake and I'd be able to help more people faster.
    Getting back to reality, I want to review the most common mistakes and misconceptions that I run into with people who are gluten intolerant. These miscues are resulting in ill health both currently and in the individual's future.
    Here's a list of 10:
    1. People who are pretty convinced of their sensitivity based on their own experimentation but who later abandon their own knowledge when a celiac test is negative.
    Discussion: Firstly, they should know that celiac testing is not highly sensitive. If it were, we would be diagnosing more than 5% of the celiacs in this country.
    Secondly, a negative celiac test is NOT an absolute indicator that one doesn't have the disease, it in no way tests for gluten sensitivity, a serious condition affecting likely fifteen times the number of people who have celiac disease.
    Finally, the gold standard test that we utilize here at HealthNow is one that has been established by other researchers to be quite reliable. It is the very test that this person is now ignoring. Namely, eliminating gluten for 30 days to see how you feel. A noticeable improvement in symptoms is a valid test.
    Too often I speak with people who are quite seriously ill. They have ignored, sometimes for years, something they knew to be the truth simply because an insensitive lab test didn't corroborate their own identification of gluten intolerance.
    Don't ignore the knowledge you possess about your body. If you need a lab test to affirm that knowledge, there's always genetic testing for both celiac disease and gluten sensitivity. Entero Labs has a good test for both.
    2. Some people discover they are gluten intolerant by self experimentation or by actually receiving a gluten sensitivity or celiac blood test that has positive results. Unfortunately some doctors have antiquated data regarding these diseases and believe that an intestinal biopsy is needed to confirm a diagnosis.
    Such doctors insist that their patients reintroduce gluten into their diet for a minimum of six weeks and then schedule an intestinal endoscopy and biopsy.
    Discussion: It was once thought that a biopsy was the 'gold standard' for celiac diagnosis. We now know that to be untrue. When I say 'we' I am referring to those in the field who research or who stay on the cutting edge of research. Unfortunately there are many doctors who are not in this category and their lack of current knowledge puts their patients at great risk.
    I cannot tell you how many times I have spoken with individuals who have reintroduced gluten into their diets, despite their knowledge of how sick it would make them, only to get extremely ill, sometimes for months. Worse still, some patients initiated an autoimmune disease due to the reintroduction that we couldn't completely reverse.
    I call reintroducing gluten 'Russian roulette'. Perhaps you can now appreciate why.
    One should NEVER EVER reintroduce gluten once they know they are sensitive to it, regardless of any test result. There is no test that is 'worth' risking your health over, especially not for a biopsy that is very poor at identifying the presence of non-classical celiac disease and gluten sensitivity.
    That brings up some new terminology:
    Classic celiac disease describes the disease as it was originally described as primarily digestive in nature, and associated with destruction of the lining of the small intestine. We now know, through research, that classical celiac forms a minority of celiac cases. Once again, these data are not well known in the medical community, which explains why we miss 95% of those who suffer from the disease.
    Gluten sensitivity is an intolerance to gluten that is not associated with the destruction of the lining of the small intestine but it creates inflammation through the immune system and creates many of the same diseases and symptoms associated with celiac disease. Conservative estimates of the incidence of gluten sensitivity put it at 15% of the population, making it much more prevalent than celiac disease. Assuming other factors, an intestinal biopsy would not be positive in an individual with gluten sensitivity.
    3. Individuals who try the gluten-free diet and find it difficult and decide to limit gluten instead of eliminating it, thinking that less gluten is bound to help.
    Discussion: Unfortunately, whether you have celiac disease or gluten sensitivity, gluten consumption requires a zero tolerance policy. I like to tell patients that consuming gluten is a qualitative factor not a quantitative one. In other words, ANY gluten is problematic.
    It does make intuitive sense that more of a toxic substance is bound to create greater harm than less, but with gluten intolerance that doesn't happen to be the case. It doesn't require much gluten to begin the cascade of inflammation that can create one of the more than 300 diseases and conditions associated with it.
    4. A person does not exemplify the classic symptoms of celiac disease (see point #2 above for a definition) and therefore gets no cooperation from their doctor for appropriate testing.
    Discussion: This scenario can result in many different repercussions. An individual can strongly suspect gluten intolerance based on observing their body's reactions to it, but due to the absence of classic digestive symptoms, their doctor refuses to test them and, worse yet, persuades them that gluten could not possibly be a problem!
    This one frustrates me because the person knows, without question, that gluten is the culprit but they allow a clinician who is operating from a dated knowledge base, to cause them to doubt themselves, and, as a result, the patient damages their health even further.
    I truly cannot tell you how often I hear such stories. These individuals feel completely adrift and helpless because they literally don't know where to turn for help. I'm glad when they find our clinic and we can validate what they know to be true and really get down to work to improve their health.
    5. There are some individuals who cannot 'feel' the effects of cheating and due to this they continue to cheat and eat gluten.
    Discussion: This is a tough one because it is human nature to avoid things that make us feel badly but it's more difficult if there are no obvious effects.
    Someone who has been diagnosed as gluten intolerant is having a reaction to gluten and it is shortening their lifespan and moving them closer to disease, each and every time they cheat.
    In the past, here at HealthNOW, we have used laboratory testing to 'show' patients that their immune system was registering their cheating and thereby (hopefully) convince them that damage is being caused.
    Fortunately a new lab test by Cyrex Labs is due to be released this summer (2012) that will go a step further. This test will reveal if an autoimmune disease is being created as a result of consuming gluten and what part of the body is being targeted.
    We may not 'feel' diseases in the making, so this test will be a wonderful asset to educating patients about what consequences they may be bringing on themselves as a result of their lax diet.
    6. Some people 'cheat' expecting something dramatic to occur within a few hours and when it doesn't they think they are okay to cheat occasionally.
    Discussion: This really is a point of poor education on the part of the doctor, their patient or both. We put in a lot of time with our patients to ensure that they understand that a reaction to gluten can occur within hours or days of ingesting it. We do our very best to ensure that patients understand that a headache or rash (as an example) that appears two days after a gluten 'cheat' is a reaction to that dietary indiscretion.
    We also strive to ensure that they understand that the damage goes way beyond the symptom that they feel. It goes deeper to the degree that they are likely creating a degenerative or autoimmune disease with their lax diet.
    7. I hear too many stories from people who actually received a positive blood test for celiac disease but who were then told by their doctor that the test was not 'for sure' and instead the doctor decided to concentrate on a different disease the patient had rather than prescribe a strict gluten-free diet.
    Discussion: The above may strike you as a little unbelievable. I only wish it was. I don't know if certain clinicians just don't feel comfortable asking their patients to follow a diet that they might not want to follow, or what exactly the issue is. But the above scenario has come up often.
    To add insult to injury the disease process that the doctor has decided to focus on rather than the celiac disease is often a disease CAUSED by gluten!
    I distinctly remember a young adult woman who was told by her endocrinologist that they were going to focus on her diabetes rather than her celiac disease because it would be 'too much' to address both. There is strong research evidence of the correlation between celiac disease and diabetes, not to mention the fact that untreated celiac disease is known to increase the risk of death from all causes.
    8. Individuals with known gluten intolerance let 'peer pressure' cause them to cheat.
    Discussion: You might think that I'm only talking about children here but I'm not. As a matter a fact I often find my younger patients to be quite disciplined. Adults, however, do at times suffer from 'not wanting to be different' or 'not wanting to be rude' and they solve their dilemma by cheating.
    My advice here is to explain to the person urging you to cheat that gluten is like rat poison to you. This works well for those people who say, "Come on, a little won't kill you…". Ask the person how they would feel if you offered them 'just a little' rat poison. Would they take it? After all, it's just a little.
    You get my point. I've been doing this for more than twenty years and patients report that this example does seem to communicate well to others. Feel free to utilize whatever talking points work best for you, but PLEASE, don't let peer pressure damage your good health.
    9. Some people have close relatives they know to have celiac disease or other autoimmune diseases and they don't get tested for gluten intolerance because they're 'afraid to find out' or they don't feel too badly or they just don't know about the strong correlation between gluten intolerance and autoimmune disease.
    Discussion: There's a saying that goes, "What you don't know can't hurt you." Unfortunately that's not true for people with gluten intolerance. Deciding not to get tested doesn't diminish or slow down gluten's degenerative effects.
    Gluten isn't something you can hide from. If gluten intolerance or autoimmune diseases are a part of your family tree I would strongly suggest that you get tested for both celiac disease and gluten sensitivity and if negative, confirm the accuracy or inaccuracy of that test result with a thirty day gluten elimination diet.
    It is that important that you know for sure that you are not part of the genetic predisposition that is present in your family tree.
    10. Patients eliminate gluten due to a diagnosis of gluten intolerance but after initially feeling much better, they begin to feel poorly again and don't know what to do to correct the problem.
    Discussion: This may be the last point on our list but it certainly is not the least important. In fact, when I'm talking with individuals who know they have celiac disease or gluten sensitivity, this is one of the most common complaints I hear.
    Unfortunately the medical profession's sole treatment strategy for celiac disease is gluten avoidance, period. I wish that was enough, but for the vast majority of people it isn't.
    The secondary effects created by gluten intolerance do not remedy themselves when gluten is removed from the diet. Gluten has a devastating effect on the body's immune system and in order to normalize that immune system there are several factors that must be addressed, the most common of which follow:
    a. The presence of pathogenic (disease-causing) organisms. These can be bacteria, parasites, amoeba, etc., but they must be discovered and treated in order to remove excess stress from the immune system and to allow vital healing of the small intestine.
    b. An imbalance of the good bacteria or probiotic population in the small intestine. These probiotics (or microbiome) account for the strength of the immune system and supporting their restoration to a healthy, robust level is critical for the immune system as well as the prevention of disease.
    c. Cross-reactive foods can be part of the patient's diet and these foods can mimic the effects of gluten thereby preventing healing and causing gluten-related symptoms despite a gluten-free diet. These foods are often temporary irritants while the body is healing but we have found some patients who require permanent elimination of some of these foods.
    d. Hormonal imbalance created by the stress on the body that gluten creates is something that must be normalized through natural means in order to regain mental balance, increased energy levels and normalized weight, just to name a few.
    e. Toxic elements including heavy metals and poor detoxification abilities of the body are also a potential hurdle that needs to be overcome when restoring health to someone who is gluten intolerant.
    f. Enzyme and vitamin deficiencies should be evaluated and treated as they are discovered.
    Basically, the stress on the system that gluten has created must be diagnosed and remedied in order for the individual to regain optimal health.
    Addressing these secondary effects is not complicated. It takes the knowledge of what they are, how to correctly test for them and how to effectively treat them, but this is not difficult. The lack of widespread awareness of these factors results in many individuals continuing to suffer despite maintaining their gluten-free lifestyle.
    This just isn't fair and it's something I am passionate about remedying. I hope you found this helpful for yourself, a family member or a close friend. Feel free to contact me if you need assistance. I'm here to help and welcome you to give me a call for a free health analysis. Call 408-733-0400.

    Jefferson Adams
    Image Caption: Photo: CC--Mark Spencer
    Celiac.com 02/21/2018 - There's more than a bit of talk in the sports world these days about the potential benefits of a gluten-free diet, even for athletes with no known gluten-sensitivities. More recent questions have been proposed whether the gluten free diet should be recommended for endurance athletes. Swimmers are endurance athletes, so should swimmers go gluten free?
    Obviously athletes with celiac disease or gluten-sensitivity will see major health and performance benefits by avoiding gluten. Athletes with known gluten-sensitivities include tennis champion Novak Djokovic, who claims to have been diagnosed with a gluten sensitivity in 2010, and Swimmer Dana Vollmer, who is known to suffer from gluten intolerance as well as other allergies.
    However, a number of high profile athletes with no known sensitivity to gluten have also adopted gluten-free diets, including NFL quarterback Tom Brady, baseball players Justin Morneau and Raúl Ibañez, and football player Cedric Benson, among many others. Athletes claim benefits like speedier recovery times to better stamina and energy levels, despite any solid science to support such claims.
    A US National Library of Medicine study done with non-celiac athletes found no benefits in athletic performance, gastro-intestinal symptoms, or well-being by following a gluten-free diet compared with a non-gluten-free diet.
    So, the short answer is no, swimmers and other athletes who are not sensitive to gluten should not adopt a gluten-free diet.
    That said, if you are not celiac and decide to adopt a gluten-free diet, do take extra measures to make sure you are getting proper nutrition and proper fiber in your diet.
    Read more at: Swimmingworldmagazine.com

    Jefferson Adams
    Image Caption: Photo: CC--Jeepers Media
    Celiac.com 02/20/2018 - Party City has pulled a controversial advertising spot that provoked outrage in gluten-free community by tagging gluten-free dieters as 'gross.'
    Moreover, both Party City, and the advertising firm behind the pre-Super bowl ad, Hill Holliday, have issued public apologies in an effort to mitigate the outrage caused by its obviously insensitive ad.
    The ad starred two women attending a Super Bowl party and standing in front of an "inflatable snack stadium."
    When one of the women points out the gluten-free options, the other asks "Do we even know people that are like that?"
    The first woman answers: "Tina."
    To which, the second woman says: "Oh, gross, yeah."
    Perhaps unsurprisingly, furious viewers wasted no time in launching the Twitter hashtag #IAmTina, which called out both Party City and Hill Holliday for insensitivity toward people with celiac disease or gluten-sensitivity.
    Party City apologized via Instagram, and also clarified that celebrity Sunny Anderson played no part in the campaign.
    The company statement reads, in part: "Party City values its customers above all else, and we take your feedback extremely seriously. We recognize that we made an error in judgment by running the recent Big Game commercial, which was insensitive to people with food allergies…We will also be reviewing our internal vetting process on all advertising content to avoid any future issues. In addition, Party City will be making a donation in support of Celiac Disease research."
    Read more at: Adweek.com

    Jefferson Adams
    Image Caption: Photo: Mike George
    Celiac.com 02/19/2018 - It's very important that people with celiac disease maintain a gluten-free diet. Still, there has been some data to suggest that some people with celiac disease may be "hyper vigilant" in their approach to a gluten-free diet, and that such extreme vigilance can cause them stress and reduce their overall quality of life. Can a more relaxed approach improve quality of life for some people with the disease?
    A team of researchers recently set out to determine whether "extreme vigilance" to a strict gluten-free diet may increase symptoms such as anxiety and fatigue, and therefore, lower quality of life (QOL). The research team included Randi L. Wolf, Benjamin Lebwohl, Anne R. Lee, Patricia Zybert, Norelle R. Reilly, Jennifer Cadenhead, Chelsea Amengual, and Peter H. R. Green. They are variously affiliated with the Department of Health and Behavior Studies, Program in Nutrition, Teachers College Columbia University New York USA, the Department of Medicine, Celiac Disease Center Columbia University Medical Center, Harkness Pavilion New York, USA.
    The team assessed the influence of QOL with energy levels and adherence to, and knowledge about, a gluten-free diet. For their cross-sectional prospective study, the team looked at 80 teenagers and adults, all with biopsy-confirmed celiac disease, living in a major metropolitan area. They assessed QOL using celiac disease-specific metrics. The team based dietary vigilance on 24-hour recalls and an interview. They based knowledge on a food label quiz. They used open-ended questions to describe facilitators and barriers to following a gluten-free diet.
    Overall, extremely vigilant adults had greater knowledge, but significantly lower QOL scores than their more relaxed counterparts. Both teens and adults who reported lower energy levels had much lower overall QOL scores than those with higher energy levels.
    To maintain a strict gluten-free diet, hyper-vigilant celiacs were more likely to avoid eating out, to cook at home, and to use internet sites and apps. For hyper vigilant eaters, eating out was especially challenging. Being hyper-vigilant about maintaining a strict gluten-free diet can cause stress and adverse effects in both teens and adults with celiac disease.
    Doctors may want to look toward balancing advocacy of a gluten-free diet with promoting social and emotional well-being for celiac patients. In some cases, allowing a more relaxed approach may increase well-being and, thus, make dietary adherence easier. Obviously, people would need to tailor any relaxation in their gluten-free vigilance to make sure they weren't suffering preventable symptoms or doing themselves any harm.
    Source:
    Dig Dis Sci (2018)

    Jefferson Adams
    Image Caption: Photo: CC--Lindsay Attaway
    Celiac.com 02/17/2018 - Roasted vegetables and smashed potatoes come together with enchilada sauce to deliver a tasty, memorable meal.
    Ingredients:
    10 medium roasted potatoes, smashed 1 head cauliflower, cut into florets 12 ounces whole button mushrooms 3 small zucchini, chopped 2 cups chopped carrots ½ cup black olives (canned, sliced) 3 cups water ½ cup milk, more as needed ¼ cup butter  1 dozen corn tortillas 3 cups gluten-free enchilada sauce, red or green, as desired 8 ounces shredded Cheddar cheese ¼ cup olive oil salt and pepper to taste Directions:
    Heat oven to 425 degrees F (220 degrees C).
    In a large mixing bowl, combine cauliflower, mushrooms, zucchini, potatoes and carrots. Drizzle the vegetables with olive oil, and season with salt and pepper.
    Spread vegetables in a single layer in a shallow baking dish. Roast vegetables until tender, about 30 minutes. Stir once about midway through cooking.
    Remove roasted vegetables from the oven, and reduce oven temperature to 350 degrees F (175 degrees C).
    In a large bowl, mash the potatoes with the butter and milk to standard mashed potato consistency.
    Stir in roasted vegetables.
    In a dry skillet over medium heat, quickly heat each tortilla on both sides to make pliable. Dip the tortillas in enchilada sauce.
    Put a large spoonful of potato-veggie mixture into the center of each tortilla.
    Top mixture with 1 tablespoons cheese, and roll tortillas. Place seam-side down in a 9x13 inch baking dish.
    Pour extra sauce over top, and top with remaining cheese.
    Bake at 350 degrees F (175 degrees C) for approximately 25 minutes, until the enchiladas are heated and cheese is bubbly.

    Diana Gitig Ph.D.
    Image Caption: Image: CC--Ludovic Bertron
    Celiac.com 02/16/2018 - Gluten sensitivity is a real thing. None other than Alessio Fasano, the renowned celiac researcher at the University of Maryland, has said as much. The problem is, there is not really an accurate way to diagnose it. But now that gluten-free foods are Big Business, generating almost $2.5 billion in US sales in 2010, Fasano and fourteen other experts convened in London to characterize exactly who needs to avoid gluten and why. Results are reported in BMC Medicine and covered by the Wall Street Journal.
    Wheat allergies can be diagnosed with a skin prick showing the presence of IgE antibodies. These are not particularly accurate, however, because the reagents used do not necessarily contain all of the allergens present in wheat and because they give a positive result for people who are allergic to grass pollens. Thus, an oral food challenge is often required for a definitive diagnosis.
    Unlike the wheat allergy, celiac disease, dermatitis herpetiformis, and gluten ataxia are autoimmune diseases. They are mediated by the IgA class of antibodies that are induced by the presence of gluten to attack the body's own transglutaminase enzymes at different locations; in celiac disease they attack tissue transglutaminase in the gut, in dermatitis herpetiformis they attack epidermal transglutaminase in the skin, and in gluten ataxia they attack tTG6, a transglutaminase expressed in the brain. In contrast to an allergy these ailments cannot be outgrown, and those who have them must strictly avoid gluten, and the related proteins in barley and rye, for their entire lives.
    People with gluten sensitivity are defined as those have neither an allergic nor an autoimmune response to gluten, but who feel crappy when they eat it and better when they avoid it. There is suggestive evidence that gluten sensitivity might be mediated by the innate immune system, a more primal arm of the immune system than the adaptive immune system that mediates celiac disease. Eating gluten can often make these people feel sicker than it does people with celiac disease, who can be asymptomatic; yet gluten does not destroy their intestines, whereas even the tiniest drop of gluten can cause damage to the intestines of celiac patients.
    Fasano notes that all adverse reactions to gluten are on the rise. Perhaps this is because the wheat variety that is now most common has a much higher gluten content than those varieties that have been used historically, and because gluten is now a hidden ingredient in many processed foods—so we are consuming more of it than we ever have before. However, he also knows a trend when he sees one, noting that "a placebo effect of the dietary treatment is often difficult to determine" and "the market is filled by individuals affected by maladies that have been claimed to be affected by gluten exposure, including autism spectrum disorder, attention deficit hyperactivity disorder, multiple sclerosis and irritable bowel syndrome, but for which there is no evidence of the effectiveness of this diet."
    Sources:
    Sapone et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Medicine 2012, 10: 13. http://online.wsj.com/article/SB10001424052970204136404577206891526292590.html?KEYWORDS=gluten+free  http://blogs.wsj.com/health/2012/02/07/health-journal-deciphering-the-ailments-tied-to-gluten/?KEYWORDS=gluten+free 

    Jefferson Adams
    Image Caption: Photo: Kevin Hutchinson
    Celiac.com 02/15/2018 - If you don't follow Premier League football, or soccer, as it's known in the States, then you can be excused for missing the recent news that Arsenal midfielder Jack Wilshere is touting a gluten-free diet that, he says, has put him in "the best shape of his career."
    After being plagued by injuries the last few years, Wilshire told the London Evening Standard that he has been "dairy and gluten-free now for six weeks." He says he looks and feels better, and is a bit leaner after dropping a bit of weight.
    Most importantly, Wilshire says he feels "sharper and quicker on the pitch…like [he] can last longer."
    For example, at the end of the Chelsea game when we scored the second goal, I felt, "Come on, we can go on again here." I was pressing them and felt good."I know my body well, I know the right foods to eat and the best way to recover. I'm also getting the right amount of sleep."I've learned that over the years and I think I'm in the best shape I have ever been."
    Wilshere starred in a thrilling 2-2 draw at home to Chelsea on Wednesday, opening the scoring with a thumping close-range finish. That draw saw Wilshere play his sixth consecutive full Premier League match.
    Of course, even bearing in mind Jack Wilshire's effusive claims, there is simply no good scientific evidence to support the idea that a gluten-free diet can improve physical fitness in people who do not have celiac disease, or some other medical intolerance to gluten. Still, this is likely not the last such story we will hear about the perceived benefits of a gluten-free diet.
    Source:
    IrishExaminer.com

    Jefferson Adams
    Image Caption: Photo: CC--Rick Flores
    Celiac.com 02/14/2018 - If you have celiac disease, and follow a gluten-free diet by medical necessity, you would likely never regard avoiding gluten as particularly sexy or attractive. Well, you would be wrong.
    Gluten-free eaters are getting more dates, more sex, and more orgasms, than their non-gluten-free counterparts, according to the online dating site Match.com.
    Results from the company's annual Singles in America survey indicate that gluten-free eaters are more than twice as likely to go on a date, and more than one-and-a-half times less likely to have a dating dry spell lasting two or more years.
    And when it comes to orgasms, well, of the 5,000 people who responded to the survey, those reporting orgasms are 43 percent more likely to be gluten-free.
    So, there you have it. Gluten-free is officially sexy.
    Still, exactly what might make gluten-free people sexier and more attractive than gluten eaters, your guess is as good as ours. We'll be happy to hear your thoughts in our comments section below.
    The survey also provided some interesting information on people's willingness to have sex with robots, and on their views about whether surreptitious robot sex constitutes cheating. Guys were twice as likely to be up for robot sex, but both men and women agree that hitting the robot on the side would be cheating.
    Read more at: SFGate.com

    Jefferson Adams
    Image Caption: Photo CC--GFVancouver
    Celiac.com 02/13/2018 - It is perhaps unsurprising that processed gluten-free foods are less nutritious than their gluten-containing counterparts.
    We've had data showing gluten-free foods to be high in sugar. We've had studies that show us they contain more salt. And now, for the trifecta, we have a recent study that shows us they contain more fat, sugar and salt.
    A study by the University of Hertfordshire surveyed more than 1,700 products from five UK supermarket chains and found that gluten-free foods have more fat, salt and sugar than their gluten-including counterparts, despite consumer perception that they "healthier" options. Except for crackers, every gluten-free food in the survey had more saturated fat, sugar and salt than non-gluten-free counterparts.
    On average for gluten-free brown bread and white bread had more than double the fat of regular breads. Gluten-free products also had significantly lower protein content than their gluten-containing equivalents, and were generally lower in ï¬ber and protein.
    Gluten-free products were also more likely to break the budget. On average, gluten-free products were also more than 1½ times more expensive than their counterparts, while gluten-free brown and white bread and gluten-free white and wholegrain flour sold at more than four times the price of comparable regular breads, on average.
    Overall, gluten-free foods are likely to be less nutritious and more expensive than their non-gluten-free counterparts.
    Basically, people on a gluten-free diet need to be extra careful about getting nutritious food. Simply substituting gluten-free versions of a a standard non-gluten-free diet likely means more fat, sugar and salt in your diet, along with less fiber. If you don't have a medically diagnosed reason for avoiding gluten, then be mindful about four food choices.

    Jefferson Adams
    Image Caption: Starbucks in the UK debut new dietary options. Photo: KMF164
    Celiac.com 02/12/2018 - Coffee giant Starbucks is debuting a new line of vegan, gluten-free and dairy-free options on menu throughout the UK.
    The company's announcement was timed to coincide with 'Veganuary,' a month-long promotion of the vegan lifestyle.
    The inclusion of oat milk to the new menu means that Starbucks now offers four dairy-free alternatives for their hot beverages: oat milk; almond milk; coconut milk; and soy milk.
    BBQ jack fruit is apparently the new vegan alternative to pulled pork, so the new item should be both an emotional and nutritious alternative to meat.
    If you're hankering for a meaty, vegan sandwich alternative, then the bbq jackfruit wrap is just the thing for you. The new seeded whole wheat wrap comes with shredded carrot and puréed sweetcorn slaw. According to Starbucks, the jackfruit wrap is chalked full of protein.
    For those who haven't given up meat, but have given up gluten, Starbucks offers a Chicken & Pesto Gluten Free Panini.
    Beginning January 2018, these and other items will be available at Starbucks locations throughout the UK. Hopefully this and more gluten-free options will spread to Starbucks in the USA and other countries.
    Read more at: Gloucestershirelive.co.uk

    Jefferson Adams
    Image Caption: Khorasan wheat, AKA Kamut. Photo: CC--Forest and Kim Starr
    Celiac.com 02/10/2018 - People with celiac disease must avoid all forms of gluten from wheat, rye, or barley. So, what about Kamut? Is Kamut safe for people with celiac disease or gluten-sensitivity?
    Like Spelt, Kamut is simply another form of wheat that is sometimes wrongly thought to be gluten-free.
    Kamut is simply a trademark for a specific kind of wheat, Khorasan wheat, grown under specific conditions. Khorasan wheat is triticum turanicum. It is wheat, and it contains gluten, which people with celiac disease should not eat.
    So, in short, Kamut is NOT safe for people with celiac disease or any sensitivity to gluten.
    Because Kamut is still a type of wheat that contains gluten it is not safe for people with celiac diseases and appears on Celiac.com's UNSAFE food list of non-gluten-free foods.

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    Bakery On Main started in the small bakery of a natural foods market on Main Street in Glastonbury, Connecticut. Founder Michael Smulders listened when his customers with Celiac Disease would mention the lack of good tasting, gluten-free options available to them. Upon learning this, he believed that nobody should have to suffer due to any kind of food allergy or dietary need. From then on, his mission became creating delicious and fearlessly unique gluten-free products that were clean and great tasting, while still being safe for his Celiac customers!
    Premium ingredients, bakeshop delicious recipes, and happy customers were our inspiration from the beginning— and are still the cornerstones of Bakery On Main today. We are a fiercely ethical company that believes in integrity and feels that happiness and wholesome, great tasting food should be harmonious. We strive for that in everything we bake in our dedicated gluten-free facility that is GFCO Certified and SQF Level 3 Certified. We use only natural, NON-GMO Project Verified ingredients and all of our products are certified Kosher Parve, dairy and casein free, and we have recently introduced certified Organic items as well! 
    Our passion is to bake the very best products while bringing happiness to our customers, each other, and all those we meet!
    We are available during normal business hours at: 1-888-533-8118 EST.
    To learn more about us at: visit our site.

    Jefferson Adams
    Celiac.com 06/20/2018 - Currently, the only way to manage celiac disease is to eliminate gluten from the diet. That could be set to change as clinical trials begin in Australia for a new vaccine that aims to switch off the immune response to gluten. 
    The trials are set to begin at Australia’s University of the Sunshine Coast Clinical Trials Centre. The vaccine is designed to allow people with celiac disease to consume gluten with no adverse effects. A successful vaccine could be the beginning of the end for the gluten-free diet as the only currently viable treatment for celiac disease. That could be a massive breakthrough for people with celiac disease.
    USC’s Clinical Trials Centre Director Lucas Litewka said trial participants would receive an injection of the vaccine twice a week for seven weeks. The trials will be conducted alongside gastroenterologist Dr. James Daveson, who called the vaccine “a very exciting potential new therapy that has been undergoing clinical trials for several years now.”
    Dr. Daveson said the investigational vaccine might potentially restore gluten tolerance to people with celiac disease.The trial is open to adults between the ages of 18 and 70 who have clinically diagnosed celiac disease, and have followed a strict gluten-free diet for at least 12 months. Anyone interested in participating can go to www.joinourtrials.com.
    Read more at the website for Australia’s University of the Sunshine Coast Clinical Trials Centre.

    Source:
    FoodProcessing.com.au

    Jefferson Adams
    Celiac.com 06/19/2018 - Could baking soda help reduce the inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease? Scientists at the Medical College of Georgia at Augusta University say that a daily dose of baking soda may in fact help reduce inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease.
    Those scientists recently gathered some of the first evidence to show that cheap, over-the-counter antacids can prompt the spleen to promote an anti-inflammatory environment that could be helpful in combating inflammatory disease.
    A type of cell called mesothelial cells line our body cavities, like the digestive tract. They have little fingers, called microvilli, that sense the environment, and warn the organs they cover that there is an invader and an immune response is needed.
    The team’s data shows that when rats or healthy people drink a solution of baking soda, the stomach makes more acid, which causes mesothelial cells on the outside of the spleen to tell the spleen to go easy on the immune response.  "It's most likely a hamburger not a bacterial infection," is basically the message, says Dr. Paul O'Connor, renal physiologist in the MCG Department of Physiology at Augusta University and the study's corresponding author.
    That message, which is transmitted with help from a chemical messenger called acetylcholine, seems to encourage the gut to shift against inflammation, say the scientists.
    In patients who drank water with baking soda for two weeks, immune cells called macrophages, shifted from primarily those that promote inflammation, called M1, to those that reduce it, called M2. "The shift from inflammatory to an anti-inflammatory profile is happening everywhere," O'Connor says. "We saw it in the kidneys, we saw it in the spleen, now we see it in the peripheral blood."
    O'Connor hopes drinking baking soda can one day produce similar results for people with autoimmune disease. "You are not really turning anything off or on, you are just pushing it toward one side by giving an anti-inflammatory stimulus," he says, in this case, away from harmful inflammation. "It's potentially a really safe way to treat inflammatory disease."
    The research was funded by the National Institutes of Health.
    Read more at: Sciencedaily.com

    Jefferson Adams
    Celiac.com 06/18/2018 - Celiac disease has been mainly associated with Caucasian populations in Northern Europe, and their descendants in other countries, but new scientific evidence is beginning to challenge that view. Still, the exact global prevalence of celiac disease remains unknown.  To get better data on that issue, a team of researchers recently conducted a comprehensive review and meta-analysis to get a reasonably accurate estimate the global prevalence of celiac disease. 
    The research team included P Singh, A Arora, TA Strand, DA Leffler, C Catassi, PH Green, CP Kelly, V Ahuja, and GK Makharia. They are variously affiliated with the Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Lady Hardinge Medical College, New Delhi, India; Innlandet Hospital Trust, Lillehammer, Norway; Centre for International Health, University of Bergen, Bergen, Norway; Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Gastroenterology Research and Development, Takeda Pharmaceuticals Inc, Cambridge, MA; Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; Department of Medicine, Columbia University Medical Center, New York, New York; USA Celiac Disease Center, Columbia University Medical Center, New York, New York; and the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
    For their review, the team searched Medline, PubMed, and EMBASE for the keywords ‘celiac disease,’ ‘celiac,’ ‘tissue transglutaminase antibody,’ ‘anti-endomysium antibody,’ ‘endomysial antibody,’ and ‘prevalence’ for studies published from January 1991 through March 2016. 
    The team cross-referenced each article with the words ‘Asia,’ ‘Europe,’ ‘Africa,’ ‘South America,’ ‘North America,’ and ‘Australia.’ They defined celiac diagnosis based on European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines. The team used 96 articles of 3,843 articles in their final analysis.
    Overall global prevalence of celiac disease was 1.4% in 275,818 individuals, based on positive blood tests for anti-tissue transglutaminase and/or anti-endomysial antibodies. The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% in 138,792 individuals. That means that numerous people with celiac disease potentially remain undiagnosed.
    Rates of celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was 0.6% in female vs 0.4% males. Celiac disease was significantly more common in children than adults.
    This systematic review and meta-analysis showed celiac disease to be reported worldwide. Blood test data shows celiac disease rate of 1.4%, while biopsy data shows 0.7%. The prevalence of celiac disease varies with sex, age, and location. 
    This review demonstrates a need for more comprehensive population-based studies of celiac disease in numerous countries.  The 1.4% rate indicates that there are 91.2 million people worldwide with celiac disease, and 3.9 million are in the U.S.A.
    Source:
    Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037.

    Jefferson Adams
    Celiac.com 06/16/2018 - Summer is the time for chips and salsa. This fresh salsa recipe relies on cabbage, yes, cabbage, as a secret ingredient. The cabbage brings a delicious flavor and helps the salsa hold together nicely for scooping with your favorite chips. The result is a fresh, tasty salsa that goes great with guacamole.
    Ingredients:
    3 cups ripe fresh tomatoes, diced 1 cup shredded green cabbage ½ cup diced yellow onion ¼ cup chopped fresh cilantro 1 jalapeno, seeded 1 Serrano pepper, seeded 2 tablespoons lemon juice 2 tablespoons red wine vinegar 2 garlic cloves, minced salt to taste black pepper, to taste Directions:
    Purée all ingredients together in a blender.
    Cover and refrigerate for at least 1 hour. 
    Adjust seasoning with salt and pepper, as desired. 
    Serve is a bowl with tortilla chips and guacamole.