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    Allergy and Intolerance by Lydia S. Boeken M.D.


    Scott Adams


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    Introduction

    Through his writings, we know that Hippocrates, the father of medicine, had already recognized the presence of allergic reactions in people as early as ancient times. However, the term allergy is a relatively new one, as compared to many other commonly used medical terms. In 1906, Viennese pediatrician Baron Clemens von Pirquet used the term for the first time to describe an altered response of his patients bodies. Von Pirquet believed that this altered reaction manifested itself in changes of the immune system, effected by external influences on the body, such as: food intake, the air breathed or direct skin contact. The term allergen (the substance responsible for the altered reaction) was born. At that point in time, however, von Pirquet had no means of scientifically proving that these immunological changes actually occurred in the body. It was not until the mid-1920s, that a second significant event occurred.

    Researchers found that, by injecting a minute quantity of purified allergen under the skin, certain individuals would develop a clear skin response; a welt, with or without itching and redness, could be provoked. This positive skin test for allergies would show itself most prominently in patients with hay fever, asthma, chronic rhinitis, hives and eczema. The prick test became a method of demonstrating the involvement of the immune system in allergic reactions. However, the precise biological reason for the reaction continued to remain a mystery.

    It was not until the Sixties, when an important discovery occurred which provided long-awaited scientific support for the classical allergy theory and removed any doubts about the relationship of the immune system with allergies. This breakthrough came about with the scientific discovery of immunoglobulin E (IgE) by a Japanese couple named Ishizaka.

    Classical Allergic Reaction

    The following are the chain of events which happen in allergic reactions:

    • An allergen must be present in the body. This allergen is the substance which causes us to have an abnormal immunological response. Allergens tend to be protein molecules. Interestingly enough, the immune system only detects particles of a certain size as potential troublemakers and protein molecules are just the right size. In a small number of cases, the body actually responds to molecules other than proteins. These molecules, which are generally much smaller, are called haptens. By combining with protein molecules, haptens form larger complexes which can then be detected by the immune system.
    • The allergen is detected by the B cells. These are specialized immune cells, capable of producing antibodies. Just like allergens, antibodies are protein molecules, which have the capacity to neutralize allergens.
    • Every B cell produces its own, specific antibody, depending on the type of intruder it needs to respond to. It is easy to understand why the body must have a ready pool of millions of antibodies, in order to combat these numerous offenders. There are five main categories of antibodies (IgG, IgA, IgM, IgD and IgE) which the body releases under different circumstances (for instance to fight off various infections, etc.). In the case of allergies, the body produces the antibody immunoglobulin E (IgE), first discovered by the Ishizakas.
    • Usually, antibodies will bind directly to the appropriate damaging substance and neutralize it. However, IgE deviates from this common path. It first attaches one of its legs to one of the bodys numerous mast cells. The other leg is used to hold on to the offending allergen. This action signals the mast cells to begin disintegrating, thereby releasing histamine.

    Histamine is a chemical substance responsible for a great number of complaints which may arise during allergic reactions. It causes muscle cramps and an inflammation-like process with redness and swelling of mucous membranes.

    Allergic reactions can occur under a variety of circumstances. For instance, inhaling certain substances, such as grass pollen, house dust, etc., may cause an allergic response. However, the consumption of certain foods may do the same. Allergies typically bring on complaints very rapidly upon contact with the allergen. Complaints may vary from a runny nose, sinusitis, earache or runny eyes to itching of the skin, eczema and shortness of breath.

    Intolerance

    Conventional medicine can easily diagnose and treat allergies for foods or inhalants. Here, the so-called RAST test plays a very important role, because this test can demonstrate the presence of IgE.

    However, demonstrating the presence of intolerance is more difficult. In this situation, similar to the case of classical allergies, the body responds abnormally and, in addition, the immune system does not produce IgE. It quite often takes much longer for complaints to come on, thereby masking the possible link between the offensive substance and the complaints themselves.

    These are only a few of the reasons why food intolerance is considered a fairly controversial concept in conventional medicine. Intolerance can be responsible for a wide variety of complaints which, at first glance, seem to lack a plausible explanation. Intolerance can manifest themselves as the following:

    • Gastrointestinal complaints: stomach ache, irritable bowel, Crohns disease, ulcerative colitis
    • Skin complaints: itching, eczema, hives, acne (in adults)
    • Joint and muscle complaints: ranging from atypical pains to rheumatoid arthritis
    • Headache and migraine
    • Chronic fatigue
    • Asthma, chronic rhinitis or sinusitis
    • Pre-menstrual syndrome
    • Hypoglycemia
    • Depression, anxiety
    • Sleeping disorders

    Diagnosing Intolerance

    It is impossible to accurately demonstrate intolerance through conventional testing methods.

    The Amsterdam Clinic currently uses the following test, which is very reliable.

    • Another useful test is the IgG(4) antibody test. Here, the presence of IgG(4) antibodies is determined. These antibodies are the slowly occurring variety, which do not appear in the blood until 24 to 48 hours after exposure to an offending food or substance. The reliability of this test varies between 80 and 90%.

    Treatment

    Diet

    In the treatment of inhalant allergies (such as asthma, hay fever) and food allergies and intolerance, avoidance (elimination) of allergens plays an extremely important role. In the case of food sensitivities, either the cytotoxic test or IgG(4) test can help determine reactions to specific foods. Based on the test results, an elimination/rotation diet can be specifically tailored.

    Foods causing strong reactions in these tests, should (temporarily) be excluded from the diet. More moderate reactions allow for rotation of certain food items in the diet. These may be eaten once every four days. Especially during the first week(s) of the diet, withdrawal symptoms, similar to complaints stemming from the cessation of coffee, tobacco or alcohol consumption, may occur. The body seems to crave offending food items. Generally, these withdrawal symptoms disappear after a couple of weeks. Concurrently, those complaints relating to food sensitivity also diminish.

    Using this dietary approach, the reaction to food allergens may decrease in the course of time. After a three month moratorium, reintroduction of forbidden food items can be attempted, one at a time. In this way, food items still causing reactions can be isolated more easily. Often, at least part of existing intolerance completely disappear after an elimination/rotation diet.

    With the treatment for inhalant allergies, elimination is also the first step. It is obvious that patients having an allergy for cats or dogs, should avoid any contact with these pets. The situation becomes more difficult when dealing with allergies to grass or tree pollen, since total elimination is basically impossible. The same goes for house dust mite allergy. The house dust mite lives in mattresses, pillows, carpeting, drapes, upholstery, etc. Through mite-killing pesticides, special mattress and pillow covers, non-carpeted floors, etc. reasonable results can be obtained.

    Medication

    Medicines for inhalant allergies, such as antihistamines (Triludan), corticosteroids (Prednisone, Pulmicort, Becotide), cromoglycates (Lomudal, Lomusol), and airway dilating medication (Ventolin, Berotec, Atrovent) do suppress symptoms, however, they do not cure the allergy! In the realm of conventional medicine, effective medications for food allergy and intolerance do not exist at all.

    Desensitisation

    Enzyme-potentiated desensitisation (EPD) and the provocation/neutralization method are very effective treatments for food allergy/intolerance and inhalant allergy problems. These methods tackle allergy problems at the root.

    • During EPD treatment, a small quantity of a food or inhalant allergen mixture is injected intradermally into the skin, in conjunction with the enzyme beta-glucuronidase. This combination causes the body to gradually adjust its exaggerated responses to food and inhalant allergens. In this way, the immune system is readjusted and reset. Initially, the injections have to be given once every two months. Gradually, however, the intervals between injections become longer and the injections can often be discontinued after a time. According to conservative estimates, at least 80% of those patients treated with EPD show considerable improvement in the course of time.
    • Provocation/neutralization can be used both diagnostically and therapeutically. Here, separate extracts of food or inhalants, suspected as possibly offending, are injected intradermally. This causes a welt to appear in the skin. After 10 minutes, the size and nature (firmness, color, etc.) of the welt are evaluated. A positive welt will generally bring on symptoms (provocation). Depending on the size and nature of the welt, as well as, the presence of symptoms, varying concentrations are injected, until a dose is found which does not cause any welt changes or symptoms. This is the neutralizing dose. Injections with the proper neutralizing dose will bring on immediate protection against the symptoms caused by the offending food and/or inhalant.

    Copyright © 1996 the Amsterdam Klikiek

    For further information please contact:

    Also in THE NETHERLANDS:
    Amsterdam Kliniek
    Reigersbos 100
    1107 ES Amsterdam Z.O.
    Telephone 31 (0)20 697 53 61
    Telefax 31 (0)20 697 53 67
    Lydia S. Boeken M.D. London/Amsterdam


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    Guest Dorothy

    Posted

    I have been searching and reading for several years on the subject. Yes, celiac is a damaging thing, however, intolerance is pretty nasty too. The sickness and life alteration it causes is horrific. I have intolerance big time! It is so not worth it for me to try and live a life with wheat allergens. We are all different and let this be a help for ALL of us as it is! I enjoyed reading everyone's spin on it here.

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    Guest Alison

    Posted

    Kelly, I believe you are mistaken. The endoscopy/biopsy was considered the gold standard 50 years ago, when today's sophisticated blood tests were not available. The biopsy has a surprisingly high false-negative rate, as villi damage is often patchy, not visible to the naked eye, and therefore easily missed; healthy areas taken for biopsy might be right next to a damaged area.

     

    People with dermatitis herpetiformis don't always have villi damage, so it is evident that the autoimmune reaction of celiac can bypass the intestines and not cause villi damage.

     

    In addition, with adult-onset celiac, many people with 'gluten intolerance' might actually have early-stage celiac. They would be having the same dangerous autoimmune reactions as anyone with biopsy-diagnosed celiac, and would need to be every bit as careful with their diet.

     

    If you go onto the forum of this site, you will find several members who were severely ill, some nearly dying, but all tests for celiac were negative. Yet, they were only able to recover their lives by removing gluten from their diet; these people were eventually diagnosed as celiac, as their immune systems were obviously involved in a way consistent with celiac, but they should never had to practically lose their lives because of such narrow diagnostic criteria. Their symptoms and dietary responses should have been caught long before, and weren't because of doctors stubbornly clinging to that narrow diagnostic criteria from half a century ago.

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    Mike Munday, no it's not possible to grow out of Celiac disease. This is a great article, very good information.

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    After 6 years of my Doctor telling me I had everything from IBS to Celiac to Diver, last year I had my GALLBLADDER removed and now I am back to normal. DONT STOP ASKING QUESTIONS AND PURSUING, my doctor robbed 6 years of my life because of his incompetence.

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    Guest Marion Donald

    Posted

    I've read the comments. I've come to the conclusion that personal food testing and experimenting is about the best way to find out if one has Celiac Sprue. I'm so much better since eating mostly fresh, steamed veggies and very little non-breaded lean meat/fish.

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    After 6 years of my Doctor telling me I had everything from IBS to Celiac to Diver, last year I had my GALLBLADDER removed and now I am back to normal. DONT STOP ASKING QUESTIONS AND PURSUING, my doctor robbed 6 years of my life because of his incompetence.

    John: Actually, celiac disease has sickened many a gallbladder, mine included. I was very sick for a long time and was discovered to have gallstones. My gallbladder had to come out. I felt better, but had trouble regaining weight. I also happened to have a mysterious skin problem on one arm. While my digestive symptoms improved for a while, eventually they got worse again and my surgeon suggested I had celiac disease. He's not a fan of people consuming wheat anyway, not if they want to stay young and healthy. After about 5 weeks on the diet, I'm much, much better. My twin sister started the diet too, and she's doing well also. I think you should have the blood tests now, before your health goes downhill again and you want to quit eating gluten immediately.

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    After suffering from intestinal pain since a I was a child now at 41 a dear friend of mine nagged me to go off gluten for 3 years. I tried everything to avoid it, I went to multiple doctors, gastro doctor and had a Colonoscopy and still they found nothing except for a lazy colon, which I kind of figured since I only go about once a week, ouch. I fit the bill for Asthma, Fybromyalgia, migraines, and have had depression my entire life. So finally I decided to take my friends advise and stopped eating gluten. Now a year later I am still gluten free and feel great. I find the website as my bible to all the information I need. Recipes, updates, read other peoples ideas and comments, it is just wonderful. Thank you for having such a clean easy flow site that is up to date.

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    I accepted my internal medicine doctor's diagnosis of IBS, but have always tried to be careful not to eat too much wheat/gluten. Nonetheless, the symptoms listed in your article are creeping up on me again, so I think I will see a Naturopath that has been recommended to me. I am very grateful for your information on the presence/non-presence of igE being indicative of whether one has an allergy or an intolerance.

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    Guest Billy Jo

    Posted

    From the responses to this article, it seems that it has been misleading for some people. This article, although a fine summary of food intolerances, does not describe Celiac disease. Gluten intolerance is not Celiac disease. In a world full of medical unknowns, we DO know the exact mechanism of Celiac disease. The body produces an antibody response (IgA) to a protein called gliadin (a small, indigestible part of gluten) as it comes through the small bowel. This creates a hostile inflammatory environment in the wall of the small bowel which destroys the absorptive surface. At the same time, the antibody responding to gliadin, recognizes an enzyme (tTG) because gliadin is bound to it. tTG is found in a lot of different tissues, including the skin. This is why Celiac disease can be called an autoimmune disease. If you eliminate gluten from your diet, the antibody response is eliminated and all returns to normal. Antibodies to tTG can be measured from the blood giving the diagnosis of Celiac disease. This test picks up 90-100% of people with Celiac disease. But the gold standard of diagnosis is endoscopy with small bowel biopsy. If you haven't had this, then you can't exclude Celiac disease. It is true that you can be gluten intolerant, and it is true that you can have an IgE mediated allergy to wheat, but these are not Celiac disease.

    I don't think this article claimed to be a definitive guide to coeliac disease. I have allergies, including wheat, and I found it very informative and helpful.

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    Scott Adams
    The following is a March 11, 1998 post by Kemp Randolph krand@PIPELINE.COM.
    According to Dr. Hugh Sampson, Mt. Sinai Medical Center, at an AMA sponsored press briefing on Nutrition, in a list of Facts vs. Fictions, Fiction: Skin tests or blood tests can be used to diagnose food sensitivities. Fact: ...A positive test does not mean a person will react to a food...furthermore these tests do not tell whether a person has a non-IgE mediated sensitivity to food.
    He describes these tests only as useful guides and points out that diet testing is the only reliable way to identify a food allergy, preferably where the person does not know whether they have eaten the suspect food.
    Q: If I am sensitive to milk and eggs...could they damage my villi in the same way as gluten?
    A: Theres a specific note in Michael Marshs book about food allergies causing villi damage. Thats the book On Coeliac Disease, page 155. Table there shows that the Type 3 stage of intestinal response, flat destructive does occur with milk, egg, soy and chicken or fish allergies. It differs from the celiac response in that only 1 or 3 of the 5 stages of lesion connected with celiac disease occur with an allergy.
    Whats unclear from this reference and from Medline searches Ive made is whether food allergies in adults cause villi damage. All the references I found were for children. Villi destruction does occur in children with milk allergy, but this like other pediatric allergies, apparently is usually outgrown.

    Paul Smith
    Celiac.com 06/29/2009 - Hypersensitive reactions to food are becoming increasingly problematic in society. Allergy experts report that the prevalence of food allergies appears to be rising and while there are no exact figures for this in Australia, some studies have shown marked increases overseas.
    For example, a study from the Isle of Wight in the U.K. has shown a tripling in the rate of peanut allergies over the past 10 years. However, the reason for this is not yet clear.  Auckland allergy expert Dr. Vincent Crump has three theories regarding the increase in peanut allergies.
    More people are eating peanuts and, up until recently, many eczema creams contained peanut oil, possibly exposing an allergy prone person to the food.
    There’s also the 'hygiene theory' of disease, which suggests that children are not exposed to enough dirt and bacteria these days, and therefore do not build up a normal immunity to harmless substances. So when they are exposed, their immune system overreacts and they develop an allergy.
    Despite the overall increase in food allergies, the rate in adults is still pretty low – around one per cent. However, the rate is higher in children, where up to five per cent are believed to have a food allergy.

    Allergy vs. intolerance
    The most common and best understood type of allergy is a reaction in which the body's immune system overreacts to a food and mistakenly produces antibodies (called IgE) to the food. This can cause reactions, sometimes severe, that affect the skin, breathing, gut and heart.
    An intolerance is an adverse reaction to a food that does not involve the immune system. Symptoms are generally less severe, and can include headaches, gut problems and worsening of skin conditions such as eczema. Intolerance is much less likely to be life-threatening than a true allergy.

    What is an allergy?
    According to the Australian Society of Clinical Immunology and allergy (ASCIA) education resources website, the word “allergy” is frequently overused and misused to include any irritating or uncomfortable symptoms after eating.
    Strictly speaking the term should only be used for the symptoms which develop after eating certain foods as part of the immune response.
    In an allergic reaction, the body’s immune system mistakenly believes the food is harmful and tries to protect itself. In doing so it overreacts and produces, for example, harmful antibodies to fight the food “allergens”. In turn, these special antibodies (called IgE) make the body produce histamines and other chemicals, causing reactions that affect the skin, breathing, gut and heart.
    IgE antibodies can also “cross react “with other allergens. For example, someone with a latex allergy may also react after eating a banana, kiwi fruit or avocado. According to allergy specialist Professor Rohan Ameratunga, up to 50 per cent of people who react to one tree nut (including almonds, brazil nuts, Cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios and walnuts) will react to other tree nuts.
    A recently recognized form of food allergy is the “oral allergy syndrome”, where a person experiences a cross reaction between pollens and fresh fruit and vegetables.
    This “cross-reactivity” is also the reason why some adults with a predisposition to other allergies suddenly develop a food allergy.
    For example, a person with a birch pollen allergy can suddenly became allergic to apple or kiwi fruit allergens.
    Dr Crump says more and more adults prone to allergies are developing cross reactions after they are overexposed to certain foods (such as acquiring wheat allergies after working in a bakery).

    What are the most common food allergies?
    Allergies are mostly triggered by nuts, shellfish, fish, milk, eggs, wheat and soybeans.Adults are more likely to be allergic to fish, shellfish and nuts, with children suffering more from allergies to milk, eggs and peanuts.  Reactions to seeds and fruits are also becoming more common.
    There are cultural differences in allergy patterns, according to professor Ameratunga.
    In Japan, rice allergy is common. In the Middle East and Australia, sesame allergy is on the rise.
    We know the treatment for coeliac disease is a gluten-free diet for life. Although people with coeliac disease produce antibodies the allergic process is different from that seen in most other allergic reactions.
    In coeliac disease, gluten reacts with the small intestine, and activates the immune system to attack the delicate lining of the bowel.
    The normally rippled lining of the intestine becomes damaged and inflamed, and forms the characteristic flat appearance of celiac disease.
    The surface area, which enables the absorption of nutrients and minerals from food, is seriously depleted, leading to gastrointestinal and malabsorptive symptoms.

    Common Intolerances
    Almost any food can cause an intolerance, but the repeat offenders are;OFFENDER:
    Lactose
    FOUND IN:
    Milk and milk products. Yoghurts have little lactose and hard cheeses have none.
    OFFENDER:
    Salicylates
    FOUND IN:
    Natural food chemicals found in a wide variety of fruits and vegetables such as cauliflower, eggplant, broccoli, tomato, apple, orange, and pineapple. Also found in nuts, spices and aspirin.

    OFFENDER:
    Amines
    FOUND IN:
    Histamines and histamine-like chemicals produced during fermentation, and the ageing and ripening of foods. Found in wine, processed meats, hard cheese, tomato paste, chocolate, and many fruits and vegetables.

    OFFENDER:
    Glutamate
    FOUND IN:
    An amino acid found naturally in all protein foods such as cheese, processed meats and milk. MSG (additive621) is a type of glutamate, and natural glutamates are also found in soy sauce, broccoli, mushrooms, spinach, tomatoes, grapes, plums and many others foods.
    Anything else you'd like to add?
    Leave a comment
     

    Dr. Vikki Petersen D.C, C.C.N
    This article originally appeared in the Autumn 2010 edition of Celiac.com's Journal of Gluten-Sensitivity.
    Celiac.com 12/06/2010 - The hazards to health created by celiac disease and gluten sensitivity are well understood.  From nutritional deficiencies to osteoporosis, from depression to autoimmune disease, and from psoriasis to thyroid disease, there are few areas of the human body that gluten doesn’t touch in a negative way. 
    There is so much emphasis on our inadequate abilities to diagnose gluten intolerance, that when we do finally make the diagnosis I believe we are guilty of another problem—lack of adequate education to those affected patients.
    Just last month a research study was released by the American Journal of Gastroenterology, 2010 Jun; 105(6):1412-20.  The article was entitled “Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet”.  The research team hailed from the Division of Gastroenterology and Hepatology at Mayo Clinic College of Medicine.
    They stated that while a positive clinical response is typically observed in most adults with celiac disease after treatment with a gluten-free diet, the rate of small intestine recovery is less certain.  Their aims were to estimate the rate of intestinal recovery after a gluten free diet in a cohort [a group of people with statistical similarities] of adults with celiac disease, and to assess the clinical implications of persistent intestinal damage after a gluten-free diet. 
    Of 381 adults with biopsy-proven celiac disease, 241 had both a diagnostic and follow-up biopsy.  Among these 241, the confirmed mucosal recovery at 2 years following diagnosis was 34% and at 5 years was 66%.  Most patients (82%) had some positive clinical response to the gluten-free diet, but it did not prove a reliable marker of intestinal recovery. 
     Poor compliance to the gluten-free diet, severe celiac disease as defined by diarrhea and weight loss, and total villous atrophy at diagnosis were strongly associated with persistent intestinal damage. 
    There was a trend toward an association between mucosal recovery and a reduced rate of all-causes of death, adjusted for gender and age. 
    The conclusions were that intestinal recovery was absent in a substantial portion of adults with celiac disease despite treatment with a gluten-free diet, and that there was an association between confirmed intestinal recovery (vs. persistent damage) and reduced mortality independent of age and gender. 
    So what can we learn from this?

    Eating gluten-free when you are sensitive will cause you to feel better.  Going on a gluten-free diet is not enough to ensure that your intestines will heal. Failing to heal your intestines puts you at increased risk for disease and death. Successfully healing your intestines reduces your incidence of death from disease.
    While you likely knew the first point, 2, 3, and 4 are perhaps less well known.  Where I see that we are failing the gluten intolerant population is in the narrow focus of eliminating gluten as the only needed treatment.  What the above research proves is that, unfortunately, for over 30% of those diagnosed simply eliminating gluten is insufficient to ensure intestinal healing. 
    If patients were educated that healing their intestine would make the difference between contracting disease or not and extending their life expectancy or not, I think they’d be more interested in ensuring that it occurs.
    I am not a researcher but my clinic sees hundreds of patients who align with the results of this study completely.  Patients come to see us who have been told that they shouldn’t consume gluten and for the most part they follow that recommendation.  They know that they feel better when they are gluten-free so that is an impetus to not cheat.  When they do cheat they know that they’ll “pay” for it but they still do so fairly regularly. 
    Why do they cheat?  Because they believe that the diarrhea, headache, bloating, etc is temporary and that when it goes away they are “fine” again.  Their thought process is not unreasonable, it’s just wrong!
    If each patient was educated that cheating created intestinal destruction that in turn put them on a fast track towards disease and early death, I believe that cheating would take on a whole new perspective.
    Patients need this education and they need it often.  Our book “The Gluten Effect” was written with this intention—our patients actually requested it.   They asked for a written reminder of why they should maintain their gluten-free lifestyle.  Later I began taping Youtube videos because other patients preferred a reminder in a video form. 
    I’m trying to say this in a few different ways because it is terribly upsetting to meet patients, as I so often do, who have been diagnosed celiac or gluten sensitive and do not follow their diet solely due to ignorance.
    After almost 25 years of clinical experience I also know that some people “hear what they want to hear” and doctors with the best of intentions cannot get through to everyone.  But I strongly believe that we could be doing a much better job at enlightenment.
    Further, we also need to educate patients about the secondary effects associated with gluten.  When the immune system of the intestine is suppressed, as is the case in the presence of gluten pathology, inhospitable and pathogenic organisms can gain entry into the intestine and remain there.  These organisms may be in the form of bacteria, parasites, amoebas or worms and if they are not identified and eradicated, complete healing of the intestines is all but impossible. 
    The good bacteria that are housed in the gut, known as the microbiome or probiotics, make up much of the intestinal immune system.  In gluten intolerant patients this important population of organisms is often insufficient due to the onslaught from gluten and pathogenic organisms.  If the population of these probiotics is not restored to a healthy, robust balance, any attempt to achieve a healthy intestine will be unsuccessful.
    Lastly, it is an interesting catch-22 that in order to digest our food we need enzymes and enzymes are made from the nutrients we digest.  This circular pattern is dramatically interrupted in the gluten intolerant patient.  Celiacs in particular suffer from very poor absorption.  It shouldn’t then come as a surprise that augmenting with proper enzymes may be critical for “priming the pump” until proper digestion of nutrients is restored.
    Unfortunately I find that few, if any, of these points are made clear to patients who are gluten intolerant.  Most believe they are doing all they need to do simply by maintaining a mostly gluten-free diet.  Nothing could be further from the truth.
    To review we need to do the following:

    Maintain a “perfect” avoidance  of gluten Test for the presence of pathogenic organisms Test for any imbalance of the probiotic organisms Evaluate the need for enzymes Evaluate for the presence of any other food sensitivities, e.g.  dairy Educate the patient until they have a full understanding of the above Test to ensure that the intestine is healed

    Jefferson Adams
    Four Big Differences Between Celiac Disease and Non-Celiac Gluten Sensitivity
    Celiac.com 05/08/2015 - While it's true that all people with celiac disease are intolerant to gluten, not all people who are intolerant to gluten have celiac disease.
    Several studies have confirmed the existence of non-celiac gluten sensitivity (NCGS), a hypersensitivity or form of gluten intolerance that causes numerous symptoms similar to those of celiac disease.
    There are several key differences between celiac disease and NCGS. NCGS is distinguished from celiac disease by the following factors:
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      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 Immumological or Serological Markers
    Researchers have, as yet, identified no immunologic mechanisms 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, and an IgE-mediated allergy to wheat, and by the continued presence of adverse symptoms associated with gluten consumption. Diagnosing celiac disease can be challenging. Misdiagnosis is common, and final and accurate diagnosis can take years and visits to numerous doctors.
    Because of these key differences, non-celiac gluten sensitivity is often even more slippery and difficult to confirm than celiac disease, itself.
    How about you? Do you or someone you know have celiac disease or NCGS? Share your story in our comments section below.
    Source:
    US Pharmacist. 2014;39(12):44-48.

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    Celiac.com 08/14/2018 - Occasionally, Celiac.com learns of an amusing gluten-free story after the fact. Such is the case of the “Gluten-Free Fireworks.” 
    We recently learned about a funny little event that happened leading up to Fourth of July celebrations in the town of Springdale in Northwest Arkansas. It seems that a sign advertising "Gluten Free Fireworks" popped up near a fireworks stand on interstate 49 in Springdale. 
    In case you missed the recent dose of Fourth of July humor, in an effort to attract customers and provide a bit of holiday levity, Pinnacle Fireworks put up a sign advertising "gluten-free fireworks.” 
    The small company is owned by Adam Keeley and his father. "A lot of the people that come in want to crack a joke right along with you," Keeley said. "Every now and then, you will get someone that comes in and says so fireworks are supposed to be gluten-free right? Have I been buying fireworks that have gluten? So then I say no, no they are gluten-free. It's just a little fun."
    Keeley said that their stand saw a steady flow of customers in the week leading up to the Fourth. In addition to selling “gluten-free” fireworks, each fireworks package sold by Pinnacle features a QR code. The code can be scanned with a smartphone. The link leads to a video showing what the fireworks look like.
    We at Celiac.com hope you and your family had a safe, enjoyable, and, yes, gluten-free Fourth of July. Stay tuned for more on gluten-free fireworks and other zany, tongue-in-cheek stories.
    Read more at kark.com
     

    Jefferson Adams
    Stress-Related Disorders Associated with Higher Risk for Autoimmune Disease
    Celiac.com 08/13/2018 - It’s not uncommon for people to have psychiatric reactions to stressful life events, and these reactions may trigger some immune dysfunction. Researchers don’t yet know whether such reactions increase overall risk of autoimmune disease.
    Are psychiatric reactions induced by trauma or other life stressors associated with subsequent risk of autoimmune disease? Are stress-related disorders significantly associated with risk of subsequent autoimmune disease?
    A team of researchers recently set out to determine whether there is an association between stress-related disorders and subsequent autoimmune disease. The research team included Huan Song, MD, PhD; Fang Fang, MD, PhD; Gunnar Tomasson, MD, PhD; Filip K. Arnberg, PhD; David Mataix-Cols, PhD; Lorena Fernández de la Cruz, PhD; Catarina Almqvist, MD, PhD; Katja Fall, MD, PhD; Unnur A. Valdimarsdóttir, PhD.
    They are variously affiliated with the Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; the Department of Rheumatology, University Hospital, Reykjavík, Iceland; the Centre for Rheumatology Research, University Hospital, Reykjavík, Iceland; the National Centre for Disaster Psychiatry, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden; the Stress Research Institute, Stockholm University, Stockholm, Sweden; the Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; the Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; the Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden; the Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
    The team conducted a Swedish register-based retrospective cohort study that included 106, 464 patients with stress-related disorders, 1,064 ,640 matched unexposed individuals, and 126 ,652 full siblings to determine whether a clinical diagnosis of stress-related disorders was significantly associated with an increased risk of autoimmune disease.
    The team identified stress-related disorder and autoimmune diseases using the National Patient Register. They used Cox model to estimate hazard ratios (HRs) with 95% CIs of 41 autoimmune diseases beyond 1 year after the diagnosis of stress-related disorders, controlling for multiple risk factors.
    The data showed that being diagnosed with a stress-related disorder, such as post-traumatic stress disorder, acute stress reaction, adjustment disorder, and other stress reactions, was significantly associated with an increased risk of autoimmune disease, compared with matched unexposed individuals. The team is calling for further studies to better understand the associations and the underlying factors.
    Source:
    JAMA. 2018;319(23):2388-2400. doi:10.1001/jama.2018.7028  

    Jefferson Adams
    Gluten-Free Bacon-Wrapped Chicken Breasts
    Celiac.com 08/11/2018 - Need a quick, easy, reliable gluten-free dish that will satisfy everyone and leave the cook with plenty of time to relax? This recipe is sure to do the trick. Best of all, it's super easy. Just grab some chicken breasts, season them, hit them with a sprig of rosemary, wrap some bacon around them, and chuck them on the grill and call it dinner. Okay, you can add some rice and veggies.
    Ingredients:
    4 skinless, boneless chicken breast halves 4 thick slices bacon 4 teaspoons garlic powder 4 small sprigs fresh rosemary salt and pepper to taste Directions:
    Heat an outdoor grill to medium-high heat, and lightly oil the grate.
    Sprinkle 1 teaspoon garlic powder on a chicken breast and season with salt and pepper. 
    Place a rosemary sprig on each chicken breast. 
    Wrap the bacon around the chicken and the rosemary. 
    Hold bacon in place with a toothpick or extra rosemary stem.
    Cook the chicken breasts until no longer pink in the center and the juices run clear, about 8 minutes per side. 
    Keep an eye out for any grill flare ups from the bacon grease. 
    Remove the toothpicks and serve with steamed rice and your favorite vegetables for a winning meal.

    Connie Sarros
    Five-Minute Healthy Breakfasts
    Celiac.com 08/10/2018 - You’ve heard for years that it’s wise to start your day with a healthy breakfast.  Eating food first thing in the morning gets your metabolism revved so you have energy throughout the day.  There’s also the issue of incorporating healthy foods into your first meal of the day.  Ideally, every meal should include fiber and foods from a variety of food groups.  But the reality is that most people don’t have time in the morning to create an involved meal.  You’re busy getting ready for work, packing the kids’ lunches and trying to get everyone out of the door on time.  
    Don’t fret.  The task of preparing a healthy breakfast just got easier.  You can make 5-minute breakfasts and, with a little bit of planning, you can sneak fiber into those meals without spending a lot of extra time with preparation.  An ideal breakfast will include whole grains (from gluten-free cereals, breads, muffins, or uncontaminated oats), a low-fat dairy item (1% milk, low-fat yogurt, or low-fat cheese), and a source of protein (such as peanut butter or eggs).  Adding fruit is a plus.  
    If you can tolerate uncontaminated oats, make a bowl of oatmeal and add a little extra fiber by stirring in chopped walnuts and dried cranberries.  If you like scrambled eggs, toss some fresh spinach (sliced into thin strips), 1 chopped canned artichoke heart, two tablespoons crumbled feta cheese, and a dash of Italian seasoning to the egg as it cooks.  
    If you have time on weekends to make healthy gluten-free pancakes (which  means that you added perhaps flax seed meal or shredded apples or something that qualifies as fiber to the batter), then freeze the pancakes between sheets of wax paper, place them in a freezer bag, and freeze so they’ll be handy on busy weekday mornings.  If you don’t have time to make them prior to need, you can always use commercial frozen gluten-free pancakes.  In a bowl, mix together a few raisins, half of a chopped pear or apple, a few dashes of cinnamon and a couple of tablespoons of chopped walnuts.  Spoon this mixture down the centers of two toasted (or microwaved) pancakes, drizzle each with 1 teaspoon of pancake or maple syrup, then fold in the sides of the pancakes to make two breakfast sandwiches.
    Brown rice is brown because the bran layer is still on the rice, and the bran layer is the part that’s so high in fiber.  White rice is much lower in fiber and has less nutritional value.  Brown rice isn’t just for dinner anymore.  It offers a nice breakfast alternative from traditional hot cereals.  The next time you make brown rice for dinner, make a little extra and save some for breakfast the next morning.  In the A.M., mix the rice (about 1 cup) with a few chopped pecans, a few raisins, 1/2 cup milk, 3 tablespoons pancake syrup, a dash each of vanilla and cinnamon, then microwave the mixture for 1 minute, stirring once after 30 seconds.  Let it sit for 30 seconds to thicken before eating.  Or stir together 1 cup cooked brown rice, 1/4 teaspoon cinnamon, 1/2 navel orange diced, some chopped dates, dried cranberries, and shredded coconut; heat this in the microwave and then top it off with 1/2 cup low-fat vanilla yogurt.
    Just a note about using the microwave—it’s not an exact science.  Different ovens have different power levels so what cooks in 30 seconds in one person’s microwave may take 45 seconds in someone else’s unit.  Unless you want the food to splatter all over the sides of the oven, you’ll need to cover any liquids or soft foods with waxed paper.  
    There will be days when you don’t have time to sit down at the table and enjoy a leisurely breakfast.  On these days, make a “grab-and-go” breakfast that you can take with you.  Gluten-free wraps keep for several weeks in the refrigerator and they make great fill-and-go containers on busy mornings.  Spread a wrap with peanut butter, sprinkle some fortified gluten-free dry cereal on top, then drizzle with a teaspoon of pancake syrup; roll up the wrap and you have the perfect dashboard dining breakfast to eat on the way to work.  Or scramble an egg, spoon it down the center of the wrap, and then top it off with a little salsa and pepper-jack cheese before rolling it up. If you only have three minutes before you have to leave the house, spoon some low-fat cottage cheese into a cup, stir in a dash of cinnamon, top with a little low-fat gluten-free granola or fortified dry gluten-free cereal, sprinkle berries or chopped peaches over the top, grab a spoon, and you’re ready to go!
    Smoothies can be made in literally one minute.  Toss some frozen raspberries into a blender, add a 12-ounce container of low-fat lemon yogurt, a little milk, and two teaspoons of vanilla; blend, then pour the mixture into a large plastic cup.
    If you oversleep, don’t panic.  Have some back-up foods on hand that you can grab and eat en route to work, like a gluten-free protein bar and a banana, or a bag of nuts and dried fruit, or flax seed crackers with a handful of cheese cubes, or toss some gluten-free granola over a container of yogurt and grab a spoon to take along.
    All of the above suggestions can be made in five minutes or less.  Take the time to start your day off with a healthy breakfast—you deserve to do that for yourself and for your family.
    Apple English Muffins by Connie Sarros
    This recipe is from my newly-released book Student’s Vegetarian Cookbook for Dummies.  While this isn’t a gluten-free cookbook, most of the recipes are naturally gluten-free or can very easily be converted to gluten-free.  
    Preparation time:  4 minutes.  Cooking time:  30 seconds.  Yield:  1 serving
    Ingredients:
    1 tablespoon peanut butter  1 gluten-free English muffin, toasted  1/8 large apple, peeled, cored and sliced thin ½ teaspoon butter  ¾ teaspoon brown sugar 1/8 teaspoon cinnamon Directions:
    Spread peanut butter on one toasted English muffin half.  Lay the apple slices on top. In a small microwave safe bowl, heat the butter in the microwave on high for 15 seconds.  Stir in the brown sugar and cinnamon then nuke for another 15 seconds.  Stir until smooth.  (If necessary, pop it back into the microwave until the brown sugar melts).   Drizzle the cinnamon mixture over the apple slices then place the second half of the English muffin on top. Note:  If you’re out of apples, use a pear, ripe peach or nectarine, mango, or even a banana.

    Jefferson Adams
    Can a New Gluten-Free Cricket-Flour Cookbook Turn Americans on to Eating Bugs?
    Celiac.com 08/09/2018 - Whatever one might say about crawfish, shrimp and crustaceans in general, Americans don’t typically eat bugs. Can a former Ralph Lauren marketing executive turn the world on to flour made from crickets?
    Over the last few years, Americans have been presented with a buffet of alternative proteins and meals. Robyn Shapiro’s company, Seek, has created all-purpose, gluten-free, and Paleo blended flours, which can be used cup for cup in any recipe calling for flour. 
    The company, which makes pure cricket powder for smoothies, ice creams, and other liquid-based foods, is now selling cinnamon-almond crunch cricket protein and snack bites. To get the public interested in its cricket protein and cricket flour products, Shapiro has collaborated with famous chefs to create recipes for The Cricket Cookbook. 
    The book’s cast includes La Newyorkina chef Fany Gerson, a Mexico City native known for her cricket sundaes; noted Sioux chef and cookbook author Sean Sherman; and former Noma pastry chef Ghetto Gastro member, Malcolm Livingston, among others.
    Other companies have sought to promote the benefits of insect protein, including Chapul, which makes cricket protein bars and powders, and Exo, which makes dairy- and gluten-free cricket protein bars in flavors like cocoa nut and banana bread. These companies, along with others in the business tend to aim their products at Paleo dieters by promising more protein and no dairy.
    Seek’s chef-focused approach makes it unique. By pairing with noted chefs who already use bugs and bug protein in their cooking, Shapiro is looking to make the public more comfortable and confident in using bugs to cook and bake. So far, the response has been slow, but steady. Seek has already raised nearly $13,000 from 28 backers, well on its way toward its $25,000 goal. 
    Seek’s cricket flours and other products will initially only be available via Kickstarter. If that goes well, the products will be sold on Seek’s website. Early backers will get a discount and a chance for a signed copy of the book. Seek hopes to debut their products nationwide starting in the fall. 
    Could gluten-free cricket flour and the new cookbook be the next big gluten-free Christmas gift? Stay tuned for more on this and other gluten-free stories.
    Source:
    grubstreet.com