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      Frequently Asked Questions About Celiac Disease   04/07/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes
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    BETTER EDUCATION FOR CELIAC AND GLUTEN SENSITIVE PATIENTS


    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.


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    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?

    1. Eating gluten-free when you are sensitive will cause you to feel better. 
    2. Going on a gluten-free diet is not enough to ensure that your intestines will heal.
    3. Failing to heal your intestines puts you at increased risk for disease and death.
    4. 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

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    Guest Richard Woodside

    Posted

    I have had the question for a long time whether or not my intestine had healed because it still bothers me sometimes. I also have a big problem with chronic fatigue, fibromyalgia, osteo- arthritis, insomnia, heart arrhythmia, and of course diabetes. Added to that, I itch terribly all winter long.

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    I think it is unfair to infer that celiacs with ongoing damage purposely ingest gluten. It is impossible in our society to not get unknowingly "glutenized". We have to eat at restaurants once in a while due to travel or work or social life, and restaurant chefs and servers still don't listen to us or fully understand what it means to check ALL ingredients and possibilities of cross-contamination. What we need is to not continually be told by our Dr.s just to follow a gluten free diet, because we do, but outside hidden sources continuously plague us. Our Dr.s need to start telling us what we can do about constant hidden sources attacking us. I have not had a single Dr or specialist tell me what supplements I can take or what I can do when I feel the symptoms again. It is extremely frustrating.

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    Guest Georgia

    Posted

    I have had the question for a long time whether or not my intestine had healed because it still bothers me sometimes. I also have a big problem with chronic fatigue, fibromyalgia, osteo- arthritis, insomnia, heart arrhythmia, and of course diabetes. Added to that, I itch terribly all winter long.

    Richard, you can get help for those other issues by seeing an acupuncturist. Many of these conditions greatly improve through the proper use of herbs and acupuncture. as for the Fibro; Source Naturals has a great multivitamin specifically aimed at ppl with Fibro.

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    Guest Georgia

    Posted

    You make some very important points in your article. I often deal with this kind of ignorance when dealing with patients. Too many people think "oh just a little bit won't hurt". But as for the non-healing small intestines; Chinese herbs are very good at helping to heal the damage. I've also seen success with treating many of the side effects of gluten intolerance/celiac disease. I will admit that not all acupuncturists are cognizant of gluten issues, but the good thing is that it isn't necessary. Acupuncture & herbal medicine are effective for many of these problems. I can provide a list of herbs that contain gluten that you can give your practitioner if needed.

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    Guest Wendy Cohan, RN

    Posted

    This is a great article, and gets at the heart of what my colleague Nadine Grzeskowiak, RN, and I have been trying to do for the past four years - educate patients about gluten intolerance and celiac disease. We do this separately, through Gluten Free Choice Consulting and Gluten Free RN, and together in our new venture geared toward institutional education and transformation, Celiac Nurse Consultants. The problem is getting doctors to refer patients to us, and of course the significant lack of insurance reimbursement for this type of counseling and educational support. Any suggestions would be appreciated.

     

    Wendy Cohan, RN, Portland, Oregon

    Author of "Gluten Free PORTLAND Resource Guide" and "The Better Bladder Book - A Holistic Approach to Healing Interstitial Cystitis & Chronic Pelvic Pain"

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    Guest Ann Trejo

    Posted

    I was just recently diagnosed with celiac disease, and was only told to start a gluten-free diet. No one mentioned anything about probiotics to me. Thank you for this very important information.

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    One of the best I have read. Not wordy, but gives a great deal of information. Makes me wish I lived near this doctor. Glad to see more research is being done. I am gluten sensitive, not intolerant or celiac and so doctors do not usually classify me as I do not test positive on the EGD or blood test, but I do on the food elimination test. Like this article says, I will die early if I do not adhere religiously to a new diet.

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    Guest lifeischange

    Posted

    I agree that there is much more to achieving a healthy gut than just eating gluten free, but I also believe that if the doctors at the Mayo clinic would stop advising patients that they don't need to worry about gluten in skin care products, etc. (I will put a link to a blog post about this on my blog), they may find a much better rate of healing after patients begin a gluten free diet. They say that gluten is not absorbed through the skin and therefore it doesn't matter, but my opinion is that absorption is not the only concern because anything that touches our skin can likely end up being ingested, as we transfer it with our hands to our mouths in regular daily activity.

     

    Like the commenter before me, I also have chronic fatigue and fibromialgia, as well as Adult ADD, and I notice that all of my other symptoms are much worse when I'm accidentally glutened. I've attributed that to malabsorption of supplements and medications because of the gluten damage. I agree with you completely that doing what we need to ensure the healing of the intestine is as important as a gluten free diet, and that they go hand in hand.

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    Guest Catherine

    Posted

    I think getting this message across is vital. It was suggested to me after an unhappy episode involving antibiotics that I might be coeliac. I laughed as I was the last person in my family to ever have digestive complaints, + I was seriously overweight despite a lifetime of dieting, but biopsy revealed that I had serious villious atrophy and my gastroenterologist was quite firm about going gluten-free asap. I did. Nothing changed. I followed up with some further research and took my dietary restrictions much further - and strange things started to happen. A lot of niggling little health problems disappeared. I am still losing unwanted weight. I have energy I didn't realise I was missing, and I feel happier and calmer than I have for years. Oh, and my 12 month follow up gastroscopy showed 'complete healing'. Why wouldn't you do it if you knew what to do?

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    Guest Sarahrosenwebb@gmail.com

    Posted

    Somewhat somber, but very worthwhile reminder, regarding possible secondary complications.

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    Guest Margaret

    Posted

    I suspect allergies are keeping me from healing 100%.

    And then manufacturers are allowed to have a low percent of gluten in "certified gluten-free" foods.

    Back to plain, home cooked, everything; even crackers!

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    My doctor has recommended hyperberic chamber treatments to help repair my mucus lining. It also helps with related "brain fog". I feel dealing with the psychological issues is just as difficult as the physical ones. Social isolation is a problem because the world seems to revolve around food and socialization. I have an intolerance to gluten, soy and eggs. This makes it virtually impossible to eat away from home. The related comments when I attend events and don't eat along with observations about my thinness are hard to deal with.

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    Thank you for this info. Newly gluten free with dairy and egg allergies, also can't eat meat due to stomach pain. This reinforces with me to not only follow the gluten free diet but also remain, dairy, egg and meat free to not only be without digestive pain, etc., but also to aid healing of the intestine.

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    I think it is unfair to infer that celiacs with ongoing damage purposely ingest gluten. It is impossible in our society to not get unknowingly "glutenized". We have to eat at restaurants once in a while due to travel or work or social life, and restaurant chefs and servers still don't listen to us or fully understand what it means to check ALL ingredients and possibilities of cross-contamination. What we need is to not continually be told by our Dr.s just to follow a gluten free diet, because we do, but outside hidden sources continuously plague us. Our Dr.s need to start telling us what we can do about constant hidden sources attacking us. I have not had a single Dr or specialist tell me what supplements I can take or what I can do when I feel the symptoms again. It is extremely frustrating.

    I agree...I am 100% gluten free in my home and read every label at the grocery store...but even I get "glutienized" as you put it..without my knowledge! It's impossible to stay restaurant free! I too get very angry when within 10-20 minutes of ingesting something with gluten at a rest. where I ASKED and was told NO, I get extremely ill!! I don't ever ever ever take gluten into my body on purpose!! I can't take how ill it makes me...I mean even the tiniest amount makes me so ill. So yes it's unfair to infer we 'don't' follow gluten free..I do! yet I still get sick...because of hidden gluten! It is very very frustrating!

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    Guest Susan

    Posted

    My doctor has recommended hyperberic chamber treatments to help repair my mucus lining. It also helps with related "brain fog". I feel dealing with the psychological issues is just as difficult as the physical ones. Social isolation is a problem because the world seems to revolve around food and socialization. I have an intolerance to gluten, soy and eggs. This makes it virtually impossible to eat away from home. The related comments when I attend events and don't eat along with observations about my thinness are hard to deal with.

    Susan, I get just the opposite,"If you're Celiac why aren't you thin?" Another thing I've learned out in public eating; put a few things on your plate, no one pays attention after that to who eats what. I am trying to take conversations about 'health' off the menu!

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    Guest Katie

    Posted

    I think it is unfair to infer that celiacs with ongoing damage purposely ingest gluten. It is impossible in our society to not get unknowingly "glutenized". We have to eat at restaurants once in a while due to travel or work or social life, and restaurant chefs and servers still don't listen to us or fully understand what it means to check ALL ingredients and possibilities of cross-contamination. What we need is to not continually be told by our Dr.s just to follow a gluten free diet, because we do, but outside hidden sources continuously plague us. Our Dr.s need to start telling us what we can do about constant hidden sources attacking us. I have not had a single Dr or specialist tell me what supplements I can take or what I can do when I feel the symptoms again. It is extremely frustrating.

    Would you eat poison served up at a restaurant? Plan ahead, take your celiac seriously. Eat whole foods in restaurants, steak, chicken, baked potatoes, sweet potatoes, unseasoned, buttered vegetables, etc. I find I have many choices. I even ask that they put on new gloves to avoid cross contamination. Many restaurants offer gluten free menus, Johnny Corrino's, Jason's Deli just to name two.

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    Guest Katie

    Posted

    The article was great, my comments were in reference to another person's comment, about eating at restaurants.

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    Guest Angela

    Posted

    Thank You; recently my husband and I went both gluten and caesin free. I have battled from birth with a mutated blood clotting factor, I clot at an accelerated rate. with this is numerous secondary problems. The worst is digestion and iron deficient. I have never been told by doctors about gluten sensitivity or celiac disease, only told if i have problems digesting then reduce it in my diet. My husband's Mothers' side of family is almost entirely gone including her recent passing - all from cancer. Since we have eliminated Gluten and casein we have felt much better. Immediately my throwing-up in my sleep has stopped and my husbands chronic heart burn is reduced to rare occasions. We have both gradually at healthy rates, lost weight. Best of all we are enjoying the foods we eat now.

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    It's amazing what happens when you don't know until you get older and suffer from something else. I was diagnosed with epilepsy when I was 32 and went three years with no control of seizures, even after brain surgery (although it was quite a bit easier on my head and body). Then someone on one of the epilepsy forums suggested looking into gluten sensitivity due to part of my epileptic diagnosis (hypocampal sclerosis). Upon study of this, I found that it described my situation to a "T" and my primary doctor agreed. Since being gluten free, I have more control over my seizure activity (pretty much gone with gluten my free diet). If I eat gluten, I know that I will be having a seizure pretty soon and maybe multiple.

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    Guest Terry Jaynes

    Posted

    Loving this site and reading all of the other comments. The absolute worst for me at restaurants is PASTA! Can anyone relate? I might as well put a gun to my head... the pain is terrible. Avoid it like the plague! I'm currently reading "Belly Wheat" and decided it is the gluten that is giving me so many physical probs... this is what led me to Google celiac disease and your site. As an RN I see so many disease processes that mimic one another. I'm convinced that many could be reduced if not cured by avoiding gluten.

    Thank you so much for your site and the incredible info.

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    Guest Terry Jaynes

    Posted

    Would you eat poison served up at a restaurant? Plan ahead, take your celiac seriously. Eat whole foods in restaurants, steak, chicken, baked potatoes, sweet potatoes, unseasoned, buttered vegetables, etc. I find I have many choices. I even ask that they put on new gloves to avoid cross contamination. Many restaurants offer gluten free menus, Johnny Corrino's, Jason's Deli just to name two.

    Thank you Katie for your suggestions. I was unaware that these restaurants offers such cuisine!

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    You make some very important points in your article. I often deal with this kind of ignorance when dealing with patients. Too many people think "oh just a little bit won't hurt". But as for the non-healing small intestines; Chinese herbs are very good at helping to heal the damage. I've also seen success with treating many of the side effects of gluten intolerance/celiac disease. I will admit that not all acupuncturists are cognizant of gluten issues, but the good thing is that it isn't necessary. Acupuncture & herbal medicine are effective for many of these problems. I can provide a list of herbs that contain gluten that you can give your practitioner if needed.

    I have recently been diagnosed with celiac disease and my wife has had it for 5 years now. What are the Chinese herbs that are helpful in repairing the cilia?

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    Guest sharon@mac.com

    Posted

    Thank you Katie for your suggestions. I was unaware that these restaurants offers such cuisine!

    I still have not been diagnosed by a mainstream doctor, however I have had the blood work done (on my own time and money) and have come up gluten intolerant. My mainstream doctor still does not believe it (thinking it's time to get a new one) but we have an understanding. Thus the reason I went to the medical facility I mentioned below.

     

    I do not believe that the author meant to suggest that ALL celiacs ingest gluten on purpose. However, I have met some of the people they are describing. "I'll just eat a bagel today," they say, "and it will be okay later." "I don't do it often," they say, "so it's okay." It's because these people have not been correctly educated on what their disease really is and what it can do to them in the future. Most just assume, again like she said, it just makes me feel bad for a while and do not understand they can get cancer, arthritis, fibro, osteoporosis, etc. from continuing to ingest gluten. I was lucky to go to a Medical facility that is strictly gluten-free and educates you on what can truly happen when you still ingest gluten, that a gluten-free diet can relieve or cure most illnesses. They teach you how to care for your immune system, give you recipes, massages, spa treatments, teach you meditation and most of all to relax. Without all their education, I would not understand! It was money well spent!

     

    BJ's also offers gluten-free pizzas and some other menu items.

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    admin

    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.

    Jefferson Adams
    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:
    No Hereditary Link
    Unlike celiac disease, NCGS is not hereditary, and shows no genetic component.
      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.
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    Source:
    US Pharmacist. 2014;39(12):44-48.

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    Jefferson Adams
    Celiac.com 04/19/2018 - Previous genome and linkage studies indicate the existence of a new disease triggering mechanism that involves amino acid metabolism and nutrient sensing signaling pathways. In an effort to determine if amino acids might play a role in the development of celiac disease, a team of researchers recently set out to investigate if plasma amino acid levels differed among children with celiac disease compared with a control group.
     
    The research team included Åsa Torinsson Naluai, Ladan Saadat Vafa, Audur H. Gudjonsdottir, Henrik Arnell, Lars Browaldh, and Daniel Agardh. They are variously affiliated with the Institute of Biomedicine, Department of Microbiology & Immunology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; the Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Karolinska University Hospital and Division of Pediatrics, CLINTEC, Karolinska Institute, Stockholm, Sweden; the Department of Clinical Science and Education, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden; the Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden; the Diabetes & Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden; and with the Nathan S Kline Institute in the U.S.A.
    First, the team used liquid chromatography-tandem mass spectrometry (LC/MS) to analyze amino acid levels in fasting plasma samples from 141 children with celiac disease and 129 non-celiac disease controls. They then crafted a general linear model using age and experimental effects as covariates to compare amino acid levels between children with celiac disease and non-celiac control subjects.
    Compared with the control group, seven out of twenty-three children with celiac disease showed elevated levels of the the following amino acids: tryptophan; taurine; glutamic acid; proline; ornithine; alanine; and methionine.
    The significance of the individual amino acids do not survive multiple correction, however, multivariate analyses of the amino acid profile showed significantly altered amino acid levels in children with celiac disease overall and after correction for age, sex and experimental effects.
    This study shows that amino acids can influence inflammation and may play a role in the development of celiac disease.
    Source:
    PLoS One. 2018; 13(3): e0193764. doi: & 10.1371/journal.pone.0193764

    Jefferson Adams
    Celiac.com 04/18/2018 - To the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service animals.
    If you’ve flown anywhere lately, you may have seen them. People flying with their designated “emotional support” animals. We’re not talking genuine service animals, like seeing eye dogs, or hearing ear dogs, or even the Belgian Malinois that alerts its owner when there is gluten in food that may trigger her celiac disease.
    Now, to be honest, some of those animals in question do perform a genuine service for those who need emotional support dogs, like veterans with PTSD.
    However, many of these animals are not service animals at all. Many of these animals perform no actual service to their owners, and are nothing more than thinly disguised pets. Many lack proper training, and some have caused serious problems for the airlines and for other passengers.
    Now the major airlines are taking note and introducing stringent requirements for service animals.
    Delta was the first to strike. As reported by the New York Times on January 19: “Effective March 1, Delta, the second largest US airline by passenger traffic, said it will require passengers seeking to fly with pets to present additional documents outlining the passenger’s need for the animal and proof of its training and vaccinations, 48 hours prior to the flight.… This comes in response to what the carrier said was a 150 percent increase in service and support animals — pets, often dogs, that accompany people with disabilities — carried onboard since 2015.… Delta said that it flies some 700 service animals a day. Among them, customers have attempted to fly with comfort turkeys, gliding possums, snakes, spiders, and other unusual pets.”
    Fresh from an unsavory incident with an “emotional support” peacock incident, United Airlines has followed Delta’s lead and set stricter rules for emotional support animals. United’s rules also took effect March 1, 2018.
    So, to the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service and emotional support animals.
    Source:
    cnbc.com

    admin
    WHAT IS CELIAC DISEASE?
    Celiac disease is an autoimmune condition that affects around 1% of the population. People with celiac disease suffer an autoimmune reaction when they consume wheat, rye or barley. The immune reaction is triggered by certain proteins in the wheat, rye, or barley, and, left untreated, causes damage to the small, finger-like structures, called villi, that line the gut. The damage occurs as shortening and villous flattening in the lamina propria and crypt regions of the intestines. The damage to these villi then leads to numerous other issues that commonly plague people with untreated celiac disease, including poor nutritional uptake, fatigue, and myriad other problems.
    Celiac disease mostly affects people of Northern European descent, but recent studies show that it also affects large numbers of people in Italy, China, Iran, India, and numerous other places thought to have few or no cases.
    Celiac disease is most often uncovered because people experience symptoms that lead them to get tests for antibodies to gluten. If these tests are positive, then the people usually get biopsy confirmation of their celiac disease. Once they adopt a gluten-free diet, they usually see gut healing, and major improvements in their symptoms. 
    CLASSIC CELIAC DISEASE SYMPTOMS
    Symptoms of celiac disease can range from the classic features, such as diarrhea, upset stomach, bloating, gas, weight loss, and malnutrition, among others.
    LESS OBVIOUS SYMPTOMS
    Celiac disease can often less obvious symptoms, such fatigue, vitamin and nutrient deficiencies, anemia, to name a few. Often, these symptoms are regarded as less obvious because they are not gastrointestinal in nature. You got that right, it is not uncommon for people with celiac disease to have few or no gastrointestinal symptoms. That makes spotting and connecting these seemingly unrelated and unclear celiac symptoms so important.
    NO SYMPTOMS
    Currently, most people diagnosed with celiac disease do not show symptoms, but are diagnosed on the basis of referral for elevated risk factors. 

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

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

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

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

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

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

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

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

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

    ASSOCIATED DISEASES
    The most common disorders associated with celiac disease are thyroid disease and Type 1 Diabetes, however, celiac disease is associated with many other conditions, including but not limited to the following autoimmune conditions:
    Type 1 Diabetes Mellitus: 2.4-16.4% Multiple Sclerosis (MS): 11% Hashimoto’s thyroiditis: 4-6% Autoimmune hepatitis: 6-15% Addison disease: 6% Arthritis: 1.5-7.5% Sjögren’s syndrome: 2-15% Idiopathic dilated cardiomyopathy: 5.7% IgA Nephropathy (Berger’s Disease): 3.6% Other celiac co-morditities include:
    Crohn’s Disease; Inflammatory Bowel Disease Chronic Pancreatitis Down Syndrome Irritable Bowel Syndrome (IBS) Lupus Multiple Sclerosis Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Psoriasis Rheumatoid Arthritis Scleroderma Turner Syndrome Ulcerative Colitis; Inflammatory Bowel Disease Williams Syndrome Cancers:
    Non-Hodgkin lymphoma (intestinal and extra-intestinal, T- and B-cell types) Small intestinal adenocarcinoma Esophageal carcinoma Papillary thyroid cancer Melanoma CELIAC DISEASE REFERENCES:
    Celiac Disease Center, Columbia University
    Gluten Intolerance Group
    National Institutes of Health
    U.S. National Library of Medicine
    Mayo Clinic
    University of Chicago Celiac Disease Center