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    The Specific Carbohydrate Diet is an Excellent Gluten-Free Diet Option


    Carol Frilegh

    Celiac.com 12/20/2007 - The Specific Carbohydrate Diet is an excellent option in dietary intervention for celiac disease and was originally developed for that purpose over fifty years ago by Dr. Sydney Valentine Haas. Dr. Haas treated over 600 cases of celiac disease with his Specific Carbohydrate Diet, maintaining his patients on it for at lease twelve months, and found that the prognosis of celiac disease was excellent. "There is complete recovery with no relapses, no deaths, no crisis, no pulmonary involvement and no stunting of growth."

    Specific Carbohydrate Diet - A Dietary Intervention for Celiac Disease and Autism

    A fifty-year-old diet used by adults to combat Celiac Disease and other digestive and bowel problems is also having a remarkable effect on autistic children.


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    The Specific Carbohydrate Diet restricts but does not eliminate or limit carbohydrate intake. It is neither a low carbohydrate diet nor low calorie diet. The Specific Carbohydrate Diet developed from the research and practice of celiac management by a pioneer in the field, Dr. Sydney Valentine Haas and his son, Dr. Merrill B. Haas. Haas discovered that feeding monosaccharides and restricting polysaccahrides is effective in manipulating the food supply of types of bacteria that damage the intestinal lining, flatten microvilli and interfere with nutrient absorption.

    The late Elaine Gottschall, pursued her study of the effect of food on the functioning of the digestive tract and its effects on behavior for nearly four decades. Gottschall had visited Dr. Haas as a last resort before agreeing to radical surgery for her five year old daughter. The child was cured on Specific Carbohydrate Diet and went on to resume a normal life and diet. Gottschall, sought additional answers and pursued the brain-gut connection after the death of the senior doctor Haas until her own demise at age eighty-four. The diet has enjoyed great success among adults who follow it to heal Celiac Disease, Crohn's Disease, Ulcerative Colitis, and Irritable Bowel Disease. Celiac disease is considered incurable, but this diet can be a very effective treatment for it, especially when it is started very early for children. Recent research shows that more than 50% of children with autism have GI symptoms, food allergies, and mal-digestion or malabsorption issues. The history, an overview of celiac disease and the diet protocols are among topics that appear in in Gottschall's book, "Breaking the Vicious Cycle."

    The Specific Carbohydrate Diet excludes a category of carbohydrates not easily digested. The Specific Carbohydrate Diet is about the type of carbohydrates that will heal and not hurt. It is not about the quantity of carbohydrates and should not be confused with "low carb diets" or even the Paleo or "Caveman" diets to which it is sometimes compared. Elaine Gottschall was emphatic in stressing that the Specific Carbohydrate Diet is a balanced and wholesome diet.

    Thinking of the Specific Carbohydrate Diet as a low carb diet is one of the most common mistakes made by those who are not sufficiently informed. Eliminating
    carbohydrates can lead to a condition called "ketosis," which is why it is essential to include adequate carbohydrates in the daily menu. Carbohydrates contribute energy, essential nutrients, and fiber. People who have validated concerns about yeast may moderate the use of fruit and honey until things improve but should not have to eliminate them.

    Rest assured! You may include plenty of carbohydrates on Specific Carbohydrate Diet. Former choices of starchy foods like rice and potato are replaced with filling items like squash, bananas, peas, apples (and applesauce), avocados, almond flour muffins and others. These are carbohydrates that are easier to digest and more nutritious. Their nutrients are absorbed directly into the bloodstream without taxing a compromised digestive system.

    That is why the word "Specific" was chosen to name Specific Carbohydrate Diet.

    There is a strong brain-gut connection and it appears decreasing bacterial overgrowth is restoring cognitive abilities in many of the children following the special version for Autism, Attention Deficit Disorder (ADD) and Attention Deficit Hyperacticity Disorder.

    The autistic community of parents and doctors have favored popular dietary approaches like the gluten-free casein-free diet until recently, but in light of anectdotal reports of 75% success using the Specific Carbohydrate Diet as a dietary intervention, more physicians are recommending it. Parents and teachers of autistic children report changes in attitude, increases in skills and responsiveness, in some cases after only a few weeks on the diet. Although long term properly controlled studies have not been conducted, these numerous first hand reports attest to the potential this diet holds for the autism community, in addition to celiacs which have been helped by it for decades. The diet is more restrictive in some ways than the gluten-free casein-free diet, as most foods must be homemade, but the diet is varied, balanced, nutritional and the food every appetizing.

    Gluten sensitivity and intolerance to salicylates are symptoms of a damaged digestive system which is overrun with intestinal pathogens. When the health of the gut is restored, these symptoms disappear. It is better to cure the underlying cause than to just try to treat the symptoms. Because Specific Carbohydrate Diet reaches to the root cause of these problems by restoring the health of the digestive system, the Specific Carbohydrate Diet is being viewed as the optimal choice for celiacs and children with Autism Spectrum Disorder.

    As one mother has said, "When you see them emerge, the true child, with a loving personality, like an iridescent butterfly breaking out of its cocoon, well, that's why we all persevere."

    For more information about this diet please visit:
    http://breakingtheviciouscycle.info/
    and
    http://www.pecanbread.com

    Editor's Note: Celiac.com supports the idea that the Specific Carbohydrate Diet is gluten-free and can be very helpful for many people, depending on their situation. We disagree, however, with the assertion that Elaine Gottschall makes in her book Breaking the Vicious Cycle that people with celiac disease can be cured by the Specific Carbohydrate Diet after being on it for a certain time period.

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    Guest Carol Frilegh

    Posted

    As author I am responding to the editor's note by noting that I commented in the article,' Celiac is very difficult to cure in adults but can be effective when started very early for children. In my own case it is apparent that celiac is an auto immune reaction best controlled by avoidance of trigger food like wheat and other grains. I acknowledge that after eight years on SCD I am NOT cured but very well managed and controlled.

    ***********************************************************************

    Comment by Scott Adams (Celiac.com Editor):

    We edited that line in the article because, again, celiac disease is considered by doctors and researchers to be incurable, and only treatable via a gluten-free diet. There has never been a scientific study published that the SCD diet can cure celiac disease, or any other disease, but we do believe that it can aid in the treatment of many diseases, including celiac disease.

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    This diet changed my life. I used to manage celiac with only gluten-free restrictions, but after eating a plain baked potato one day I became terribly ill, then terribly confused because I KNEW I hadn't accidentally ingested gluten. One day a friend told me about the Specific Carb. Diet, I tried it, and I'm healthy again. Not cured, but I feel fantastic now.

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    Guest Ginger Nash

    Posted

    I don't feel Elaine indicated that genetic gluten problems are cured with Special Carbohydrate Diet but other types of stomach ills such as IBS, etc., can be if the diet is adhered to. I have genetic gluten sensitivities and after being gluten-free casein-free still had much pain however when I began following Special Carbohydrate Diet it had made a remarkable change in my stomach pains and other related issues.

     

    I am very happy to see an article of this caliber being posted on Celiac.com

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    This article is a great explanation of the specific carbohydrate diet. I do not have celiac disease, but I have an IgG reaction to gluten, so I have to limit the amount I consume, and I think the Special Carbohydrate Diet approach will be right for me.

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    Our family has followed Special Carbohydrate Diet now for almost 2 yrs in support of our now 7 yr old son.

    He was having major emotional out break several times a day for seemingly no reason. With srick SCD and controlling his exposure to certain chemicals, our family has gone from a stressed explosive environment to a most of the time peaceful one.

     

    Thank you Carol for sharing with others and being such a support to those trying to help themselves and their children.

     

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    After being diagnosed as 'most likely Celiac', I went gluten-free but continued to have debilitating pain after eating. I found a website describing the Specific Carbohydrate Diet on the internet. For me, progress was slower than for others but after 2 1/2 years on the diet, I am pain-free and healthier than I've ever been. Thanks to Carol for clarifying many misunderstandings of SCD!

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    Guest Cameron Hayden

    Posted

    I studied this diet. Everyone is different. Elaine's book does make a bold statement about the specific carbohydrate diet curing Celiac. I could never find any evidence, however, outside of the book that this was clinically tested. To my knowledge, it has not, and anecdotal evidence is mixed at best.

     

    I do give credence to her diet as a treatment, which is to reactivate the brush border enzymes, kill yeast and restore the balance of bacteria in the intestinal tract. In my opinion, however, Gluten Intolerance and all related conditions involve the lack of gluten gliadin degrading enzymes, which causes yeast and bacterial growth, leaky gut, and immune reactions. No one yet knows how to turn these enzyme actions back on. The SCD diet seems to help by restoring other brush border enzymes. I think that the diet is a good one, but could be further enhanced by HCI supplements and the new generation gluten degrading enzymes which seem to survive stomach acid and degrade gluten in vitro.

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    Guest Sandra Bowman

    Posted

    Was considering buying the book on the Specific Carbohydrate Diet...probably will to see if it will help with what the plain gluten-free diet doesn't for me. Even gluten free grains cause problems sometimes for me. So figure it's worth a try at least.

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    I am happy to see an article like this. My son is recovering from autism on this diet. When we began researching the gluten connection I discovered gluten and bakers yeast had been the cause of my own autoimmune health problems and the cause of chronic migraines for my mother. We both follow a gluten free diet and have had complete relief. Because my son is 100 percent on the Specific Carbohydrate Diet, all the snacks in our home are Specific Carbohydrate Diet legal. I find I feel even better on Specific Carbohydrate Diet food than when consuming gluten free grains. Also, due to the bakers yeast allergy, the Specific Carbohydrate Diet baked goods are more suitable for me and taste better than the gluten-free yeast free products. I think every gluten free cookbook library may also want to include a Specific Carbohydrate Diet cookbook as well. Happy Snacking!

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    This explains why gluten free grains still leave us with symptoms.

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    This is a good diet. I recommended this to my mother who was hospitalized with c.dificul due to taking a certain antibiotic. This diet has restored her health and helped rid her of the bad bacterial overgrowth. I myself do better when on this way of eating, because even gluten free grains have that gut bloating starch. By the way, if you wait for them to do a clinical trial on something as simple as a diet, you might be waiting forever. Now if it was a "drug" owned by a big pharmaceutical company, then maybe.

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    Guest Janet

    Posted

    I am happy to find this excellent article about the Specific Carbohydrate Diet on Celiac.com. I had been gluten free for 14 years and over time could digest fewer and fewer healthful foods. One by one I dropped things like broccoli, bananas, cheese, meats, all fruits until I was eating only rice, a few vegetables, fish and eggs. I never could digest gluten free baked goods very well or anything with corn.

    I'm so happy to have found the SCDiet because within a few weeks, all those foods became possible for me to eat again without any stomach or gut issues at all. I feel so good, I think I'll just stay on this diet for life.

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    Guest Katie

    Posted

    I was diagnosed with coeliac disease when I was 13 years old, after no symptoms other than being underweight and having really bad acne. I stuck to a strict gluten-free diet for 4 years, but at the age of 16 I began to develop nausea. By the end of the year, I was so sick I could barely get out of bed. I had dizziness, headaches, extreme, constant nausea and was always tired. I couldn't go to school and there was a good chance I would have to be kept down and repeat grade eleven because I couldn't keep up. I had been to every doctor and specialist and no one knew what was wrong. I had also come down with glandular fever, and was feeling miserable. My mum discovered the Specific Carbohydrate diet, and after being on it for only one week I was feeling better. The glandular fever disappeared very quickly and as the days went on, I went back to school, got a job and even started going to the gym. I felt better than ever and every symptom vanished! I stayed on the diet for one year and it was the only reason I managed to graduate high school with all my friends. I have been back on a relatively normal, (but still gluten-free) diet for the past 6 months and I'm feeling well. I would strongly encourage anyone to give this a go!

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    Guest Barbara Phibbs

    Posted

    I was diagnosed with celiac disease four years ago and went on a strict gluten-free diet. For the first six months the only grain I ate was rice. I felt as if someone had given me my life back! Then I discovered a gluten-free bakery and began eating other gluten-free products. I began to feel ill again and just recently have had terrible fatigue, headaches and intestinal symptoms to the point where I cannot go out. I had not connected this to diet and my gastroenterologist said that I must be eating gluten! I did some research about celiacs who are not completely healed on a gluten-free diet and saw a homeopath/naturopath who tested me and told me that the other grains that I was eating were preventing my gut from healing. This led me to the SCD, which I have begun. I am not better yet, but the bloating is gone, the diarrhea has stopped and I am hopeful after reading all these comments. It is, however, very daunting and frightening to me to have to try and eat this way.

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    Guest Julia Brettschneider

    Posted

    I was diagnosed with celiac disease four years ago and went on a strict gluten-free diet. For the first six months the only grain I ate was rice. I felt as if someone had given me my life back! Then I discovered a gluten-free bakery and began eating other gluten-free products. I began to feel ill again and just recently have had terrible fatigue, headaches and intestinal symptoms to the point where I cannot go out. I had not connected this to diet and my gastroenterologist said that I must be eating gluten! I did some research about celiacs who are not completely healed on a gluten-free diet and saw a homeopath/naturopath who tested me and told me that the other grains that I was eating were preventing my gut from healing. This led me to the SCD, which I have begun. I am not better yet, but the bloating is gone, the diarrhea has stopped and I am hopeful after reading all these comments. It is, however, very daunting and frightening to me to have to try and eat this way.

    It would be wonderful if you could give me an update.

     

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    Well, I just started the SCD praying it gives me some relief. I am 50 years old and I started having problems with gluten over 3 years ago. When I initially went gluten-free, I was better within a few months, however, a year later my symptoms returned with a vengeance. I could not understand, as I had been super cautious not to consume any gluten. I have been suffering for almost 2 years now with severe intestinal issues, fatigue, and depression. I still push myself to exercise, but it's sure a struggle without much energy. After reading all the information and comments about the SCD diet, I feel hope for the first time in quite a while.

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    I have recently been diagnosed (5 months ago) with celiac and was still having symptoms of glutening despite cooking 100% at home with non-processed foods. After trying this diet I immediately started to feel better (within a week).

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    I had fun with this result. I found just what I was looking for. You have ended my four day long hunt! God Bless you man. Have a great day!

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    Guest Christine Heiner

    Posted

    As author I am responding to the editor's note by noting that I commented in the article,' Celiac is very difficult to cure in adults but can be effective when started very early for children. In my own case it is apparent that celiac is an auto immune reaction best controlled by avoidance of trigger food like wheat and other grains. I acknowledge that after eight years on SCD I am NOT cured but very well managed and controlled.

    ***********************************************************************

    Comment by Scott Adams (Celiac.com Editor):

    We edited that line in the article because, again, celiac disease is considered by doctors and researchers to be incurable, and only treatable via a gluten-free diet. There has never been a scientific study published that the SCD diet can cure celiac disease, or any other disease, but we do believe that it can aid in the treatment of many diseases, including celiac disease.

    Can't help but think that when the SCD diet is started early in children, and they appear cured, that maybe what has happened is that they have gone into that "honeymoon" period that many children go through, when celiac seems to disappear...which is why they used to think it was only a childhood disease. The symptoms may disappear, but the damage is still going on.

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  • Related Articles

    Carol Frilegh
    Celiac.com 12/26/2007 - Can children with Autism Spectrum Disorder eat their way out of their cocoons?
    Eight yearsago I knew little about autism. Fifty years ago I heard that a distantacquaintance of mine had an autistic child. It was extremely unusual at thetime. I needed it explained to me and was told that the child was almost totallyunresponsive.
    Recent statistics show that between one and one and ahalf million people in the USA are afflicted with autism, making it the fastest growing developmentaldisability. There has been a thirteen percent increasein autism since 1990.
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    Less thanten years ago a few adults reported that the Specific CarbohydrateDiet was fostering encouraging progress in their Autism Spectrum Disorder children.Gottschall believed that in addition to gluten starches and certainsugars were at the root of digestive disorders. A small support group formedwhich followed the Specific Carbohydrate Diet to treat Autism Spectrum Disorder, and this group has grown from a handful to several thousandsince its inception. The majority of its members transitioned from the gluten-free casein-free diet. Some peoplewere told incorrectly that the Specific Carbohydrate Diet is an extension of the gluten-free casein-free diet, or that it is only suitableif the gluten-free diet fails. The protocols about food restrictions andcontamination differ. The Specific Carbohydrate Diet is, however, a unique stand-alone diet.
    Althoughchildren with autism who are on the Specific Carbohydrate Diet are in a statistical minority compared to those on the gluten-free casein-free diet, anecdotal reports indicate that their success rate is nearly 80%. It often turns out that some of those who initiallyfail have not followed the diet correctly, and they fare quite well when they start it over and do it correctly. In several small studies the Specific Carbohydrate Diet outperformed the gluten-free casein-free diet in the treatment of autism. Alarge scale formal study could cost up to one million dollars and therefore hasnot been conducted. In the absence of such studies mainstream medicinehas bypassed or dismissed the Specific Carbohydrate Diet as inconclusive, but some doctors have commented that sinceit is a healthy and balanced diet it is worth a try. One concern is thatpeople will abandon their medication, but this idea is not advocated by the support group.
    Ibecame interested in the autism-Specific Carbohydrate Diet connection when ElaineGottschall invited my support on the Internet list called "Elaine'sChildren," which was renamed subsequently renamed pecanbread@yahoo.com (www.pecanbread.com). WhenI began to read the stories of improvement, progress in behavior anddigestion, and of some who recovered from Autism Spectrum Disorder, I literally got chills. I began to archive those stories and combined several in a piecewhich I submitted to a parenting magazine. The editors were veryinterested but insisted on having a gluten-free casein-free diet author comment and counter mystory. Since I do not view dietary intervention as a competition thearticle was withdrawn.
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    If you want to read more about ElaineGottschall be sure to read "All Her Children" at Pecanbread.com, and decide if this is a diet that could help your family.
    Editor's Note: Celiac.com supportsthe idea that the Specific Carbohydrate Diet is gluten-free and can bevery helpful for many people, depending on their situation. Wedisagree, however, with the assertion that Elaine Gottschall makes inher book Breaking the Vicious Cycle that people with celiac disease can be cured by the Specific Carbohydrate Diet after being on it for a certain time period.


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    Whatever the reason that stuttering has not been reported in the medical literature in association with gluten ingestion, a number of personal disclosures and comments suggesting a connection between gluten and stuttering can be found on the Internet. Abid Hussain, in an article about food allergy and stuttering said: “The most common food allergy prevalent in stutterers is that of gluten which has been found to aggravate the stutter” (10). Similarly, Craig Forsythe posted an article that includes five cases of self-reporting individuals who believe that their stuttering is or was connected to gluten, one of whom also experiences stuttering from foods containing yeast (11). The same site contains one report of a stutterer who has had no relief despite following a gluten free diet for 20 years (11). Another stutterer, Jay88, reports the complete disappearance of her/his stammer on a gluten free diet (12). Doubtless there are many more such anecdotes to be found on the Internet* but we have to question them, exercising more skepticism than we might when reading similar claims in a peer reviewed scientific or medical journal.
    There are many reports in such journals connecting brain and neurological ailments with gluten, so it is not much of a stretch, on that basis alone, to suspect that stuttering may be a symptom of the gluten syndrome. Rodney Ford has even characterized celiac disease as an ailment that may begin through gluten-induced neurological damage (13) and Marios Hadjivassiliou and his group of neurologists and neurological investigators have devoted considerable time and effort to research that reveals gluten as an important factor in a majority of neurological diseases of unknown origin (14) which, as I have pointed out previously, includes most neurological ailments.
    My own experience with stuttering is limited. I stuttered as a child when I became nervous, upset, or self-conscious. Although I have been gluten free for many years, I haven’t noticed any impact on my inclination to stutter when upset. I don’t know if they are related, but I have also had challenges with speaking when distressed and I have noticed a substantial improvement in this area since removing gluten from my diet. Nonetheless, I have long wondered if there is a connection between gluten consumption and stuttering. Having done the research for this article, I would now encourage stutterers to try a gluten free diet for six months to see if it will reduce or eliminate their stutter. Meanwhile, I hope that some investigator out there will research this matter, publish her findings, and start the ball rolling toward getting some definitive answers to this question.
    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
    Celiac.com 06/14/2018 - Refractory celiac disease type II (RCDII) is a rare complication of celiac disease that has high death rates. To diagnose RCDII, doctors identify a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs). 
    However, researchers really don’t have much data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023

    Jefferson Adams
    Celiac.com 06/13/2018 - There have been numerous reports that olmesartan, aka Benicar, seems to trigger sprue‐like enteropathy in many patients, but so far, studies have produced mixed results, and there really hasn’t been a rigorous study of the issue. A team of researchers recently set out to assess whether olmesartan is associated with a higher rate of enteropathy compared with other angiotensin II receptor blockers (ARBs).
    The research team included Y.‐H. Dong; Y. Jin; TN Tsacogianis; M He; PH Hsieh; and JJ Gagne. They are variously affiliated with the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School in Boston, MA, USA; the Faculty of Pharmacy, School of Pharmaceutical Science at National Yang‐Ming University in Taipei, Taiwan; and the Department of Hepato‐Gastroenterology, Chi Mei Medical Center in Tainan, Taiwan.
    To get solid data on the issue, the team conducted a cohort study among ARB initiators in 5 US claims databases covering numerous health insurers. They used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy‐related outcomes, including celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy. In all, they found nearly two million eligible patients. 
    They then assessed those patients and compared the results for olmesartan initiators to initiators of other ARBs after propensity score (PS) matching. They found unadjusted incidence rates of 0.82, 1.41, 1.66 and 29.20 per 1,000 person‐years for celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy respectively. 
    After PS matching comparing olmesartan to other ARBs, hazard ratios were 1.21 (95% CI, 1.05‐1.40), 1.00 (95% CI, 0.88‐1.13), 1.22 (95% CI, 1.10‐1.36) and 1.04 (95% CI, 1.01‐1.07) for each outcome. Patients aged 65 years and older showed greater hazard ratios for celiac disease, as did patients receiving treatment for more than 1 year, and patients receiving higher cumulative olmesartan doses.
    This is the first comprehensive multi‐database study to document a higher rate of enteropathy in olmesartan initiators as compared to initiators of other ARBs, though absolute rates were low for both groups.
    Source:
    Alimentary Pharmacology & Therapeutics