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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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    OLDER CELIAC PATIENTS ON GLUTEN-FREE DIET SHOW REDUCED COGNITIVE PERFORMANCE


    Jefferson Adams

    Celiac.com 06/21/2012 - Retrospective studies and case reports have suggested that older patients with celiac disease may suffer from impaired cognitive function. To evaluate this possibility, a research team recently conducted a study of people with celiac disease who are over age 65.


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    Photo: CC--jugboThe researchers included S. Casella, B. Zanini, F. Lanzarotto, C. Ricci, A. Marengoni, G. Romanelli, A. Lanzini, of the Gastroenterology Unit of the Department of Medicine at University and Spedali Civili in Brescia, Italy.

    The researchers wanted to evaluate functional and cognitive performances in celiac disease, and in control patients, older than 65 years.

    For their study, they recruited 18 celiac disease patients aged 75-years or older (±4 years, group A) who had been on a gluten free diet for an average of 5.5 years (±3 years), along with a control group of 18 patients matched for sex and age, averaging 76 years of age (±4 years, group B).

    The team then administered a number of functional and cognitive neuropsychological tests. They recorded the results as "row scores" and as "equivalent scores" by relating "raw scores" to reference rank categories.

    For the functional tests, they found that the Barthel Index of functional performance was similar for both groups.

    However, for the cognitive tests, they found that the "raw score" was significantly lower in celiac disease than controls. The cognitive tests included Mini Mental Test Examination (p=0.02), Trail Making Test (p=0.001), Semantic Fluency (p=0.03), Digit Symbol Test (p=0.007), Ideo-motor apraxia (p

    The also found that the "equivalent score" was also lower in celiac disease than controls for tests of Semantic memory. The results showed that cognitive performance is worse in elderly patients with celiac disease than in healthy control patients, despite prolonged treatment with a gluten-free diet.

    They write that "awareness on the increasing phenomenon of late-onset celiac disease is important to minimize diagnostic delay and prolonged exposure to gluten that may adversely and irreversibly affect cognitive function."

    Source:



    Image Caption: Photo: CC--jugbo
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    Guest dappycharlie

    Posted

    How would you prove that cognitive performance is not just a result of their age in general? Some of these studies make no sense at all....

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    Guest Marianne

    Posted

    It would be interesting to find out what the Vitamin B12 levels have been in the patients who had lower scores. Low B12 can also affect cognition.

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    Guest Ayn Gilliland

    Posted

    The title of the article and what the conclusions showed were contradictory. The title suggests that the gluten-free diet may have some bearing on patient cognition, but the article suggests that patients with celiac disease may suffer from a decline in cognition. This was confusing for me. There are a great many people on the gluten-free diet who do not suffer from celiac disease.

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    Guest d. smith

    Posted

    I was diagnosed celiac disease at the end of January and since May, I have been following a gluten-free diet. Last month my doctor began giving me B12 shots so I do hope they will help with cognition.

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    I am younger than that and I have such issues. I can't think of words even if I know of them. I forget things as well. I can also get very angry too over stuff I have no control of. I found I can't eat other things as well as gluten.

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    Guest Sharon

    Posted

    Nutritional deficiencies related to malabsorption of vitamins, minerals, and simple carbohydrates are clearly associated celiac disease, as well as gluten sensitivity, such that patients present with anemia, osteoporosis, low blood sugar, etc. – many of which can impact cognitive function.

     

    Doctors needs to key in on this with patients of all ages to diagnose and support them with not only a gluten-free but vitamin and mineral supplements to restore as soon as possible any longstanding deficits. This therapy should also include omega-3 oil (despite a recent study that disputed omega's connection to brain health). Even if negative for celiac disease, anyone with diseases related to malabsorption, the gastrointestinal system, inflammation, chronic infections and many others should be placed on a trial gluten-free diet for a month as gluten is a known inflammatory. (One major hospital in Boston recommends that folks going through chemotherapy avoid gluten intake to decrease inflammation and lessen potential nausea.) Chances are many elders present with arthritis, gastrointestinal, cardiac issues, and other disorders often dismissed as simple aging issues.

     

    With my diagnosis, I am more convinced that my parents also had issues directly related to gluten. A small town near me received a grant to test elders for celiac disease, and they identified 2-3 folks with celiac disease with long-standing medical issues that are related to the disease.

     

    I can tell you that I feel younger, and people have noted that I look younger since my gluten-free diet. Wouldn't it be great if someone could prove that many "old-age" disorders are associated with gluten or are more severe due to the intake of gluten? Wouldn't it be wonderful if we could eliminate or lessen the use of prescription medications by simply putting elders (and others with chronic disorders) on a gluten-free diet?

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    Guest marketing@celiac.com

    Posted

    The title of the article and what the conclusions showed were contradictory. The title suggests that the gluten-free diet may have some bearing on patient cognition, but the article suggests that patients with celiac disease may suffer from a decline in cognition. This was confusing for me. There are a great many people on the gluten-free diet who do not suffer from celiac disease.

    Sorry for the confusion. We wanted to make it clear that the gluten-free diet does not seem to help prevent or reverse this, which is of course unfortunate.

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    Guest marketing@celiac.com

    Posted

    How would you prove that cognitive performance is not just a result of their age in general? Some of these studies make no sense at all....

    Control group!

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    How would you prove that cognitive performance is not just a result of their age in general? Some of these studies make no sense at all....

    It is true, I felt it on myself.

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    Guest Aliera

    Posted

    It's important to note that if they are 65+ and have only been on the gluten-free diet for ~5.5 years average, then that means most of them discovered celiac disease and started gluten-free diet relatively late in their lives.

     

    The article should point out that this study really says nothing about cognitive effects for people who been on the gluten-free diet much longer than 5 years and those who are younger, of course.

     

    Also, for a proper control, they include the newly diagnosed- confirmed celiacs who haven't started the diet yet.

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    Guest Aliera

    Posted

    Oh also, the p value simply means that the populations are distinctly statistically different. "Significant" in scientific writing simply means not a result of chance, not to be confused with significant meaning huge difference. The actual difference they didn't go to at all, other than the obvious lower numbers- by how much?

     

    Or more simply, the difference in scores does not necessarily imply a level of cognitive difference that would be noticeable by a normal person in their daily lives.

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    Guest Warren

    Posted

    I am younger than that and I have such issues. I can't think of words even if I know of them. I forget things as well. I can also get very angry too over stuff I have no control of. I found I can't eat other things as well as gluten.

    This has been a struggle of mine my whole life.

    I see it in my head and can't get it off my tongue.

    I'm smart, but come across stupid and weird I'm sure of it.

    Angry outbursts are just a common thing for me too.

    I was properly diagnosed 9 months ago (after years of being treated for ulcers and parasites).

    I feel now that I'm eating gluten-free, I am able to recognize my issues, but don't feel they have diminished.

    I certainly don't feel sick anymore though, and NO MORE throwing up!

    That alone is an improvement.

    I however feel like I'm becoming 'stupid.'

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    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