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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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    CELIAC DISEASE TIED TO DEPRESSION IN ADOLESCENTS

    Jefferson Adams

    By Jefferson Adams

    Celiac.com 06/23/2016 - Digestive Disease Week 2016 took place in San Diego from May 21-24. Among the presentations given was one that stood out for its obvious health impacts. That presentation was given by Jonathan Cordova, DO, pediatric gastroenterologist at the University of Chicago Medical Center. His presentation tied celiac disease to major depressive disorder in adolescents, and stated that most adolescents with celiac disease have symptoms consistent with the disorder.


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    Dr. Cordova said that "...interim analysis does suggest that a majority of adolescents living with celiac disease may have symptoms consistent with major depressive disorder," and that the depression has a negative impact on their quality of life, "but does not appear to be associated with their celiac disease state." That is, the depression does not seem to be impacted by how well their celiac disease is doing. Healthy gut and gluten-free diet, or unhealthy gut, with symptoms, it doesn't seem to matter. The depression levels seem about the same whatever the case.

    A number of recent studies indicate that depression and anxiety are the main reasons people with celiac disease report decreased quality of life, Dr. Cordova and his colleagues wrote. But, most of these studies were done on adults, almost none used adolescents, and adolescents may be more susceptible to depression.

    The research team was able to connect celiac disease with mental health disorders in adolescents by administering questionnaires to adolescents and their parents. Average age of adolescents was 14.6 years at the time of survey and 11.2 years at the time of diagnosis.

    The researchers found no correlation between celiac disease and depression, anxiety, ADHD, age at survey, quality of life, age at diagnosis or length of time on a gluten free diet. However, the majority of adolescents and parental reports screened positive for major depressive disorder.

    Interestingly, a parent's perception of the state of their child's celiac disease impacted their perception of depression in their child.

    Dr. Cordova says that "the data suggests that early screening for depression in any adolescent with celiac disease is crucial to help optimize behavioral health,"

    Dr. Cordova's team plans to follow these patients into young adulthood, and aims to re-screen them again in 5 years.

    Reference: 

    • Cordova J, et al. Abstract #844. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego
    Image Caption: Teens with celiac disease often have symptoms of depression. Image: CC--Rui Barros
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    Guest Heather

    Guest Heather

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    As an adult diagnosed with celiac, I began to feel much better after about a year on the gluten free diet, and was pleased that the major depression subsided. However, a new sadness and anxiety was ushered in when food choices became a tense exercise in label-reading, and when I could no longer participate the same way in social gatherings that were centered around group meals, or as it's said "breaking bread" together. Being that teens are at the most social point in their lives, I wonder if some of the depression is caused by the extra and sometimes sudden challenges of having to majorly change their diets, having to feel singled-out and "different", feeling excluded from various food-centered activities they once shared with friends, etc. As many of us know, depending on the amount of or lack of family and friend support regarding the gluten-free diet, it can be a very tough and scary time when you learn that foods you formerly enjoyed are now "the enemy". Pile this on top of all the unique social issues celiac teens must grapple with along with just the normal social issues all teens must tackle and you have a ripe environment for depression, it would seem.

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    admin
    Psychosomatics 45:325-335, August 2004
    Celiac.com 07/30/2004 - Past studies have reported a higher prevalence of depressive symptoms in adults with celiac disease, perhaps due to serotonergic dysfunction, and an increased prevalence of depressive and disruptive behavioral disorders in adolescence with the disease, especially before treatment. In an effort to further study any possible connections, researchers looked at 29 adolescents with celiac disease and 29 matched controls. The researchers used semi-structured psychiatric interviews and symptom measurement scales to examine all subjects. Their findings indicate that the subjects with celiac disease had significantly higher prevalence of major depressive disorder compared to the controls--31% versus 7%, and a significantly higher prevalence of disruptive behavior disorders--28% versus 3%. The researchers also found that most of the mental disorders occurred before the patients were diagnosed and treated with a gluten-free diet. The prevalence of current mental disorders was similar in both of the groups studied.
    Jefferson Adams
    Celiac.com 07/13/2010 - More and more, researchers are showing connections between inflammatory diseases, like celiac disease, and complex disorders, such as anxiety and depression. There's also a good amount of anecdotal evidence to suggest that people with celiac disease have higher rates of anxiety and depression than the general population.
    A study of the German population is the first to show that female adults following a gluten-free diet for celiac disease show higher levels of anxiety than do members of the general population.
    The researchers are recommending that female celiacs on a gluten-free diet be screened for anxiety. The researchers included W. Häuser, K. H. Janke, B. Klump, M. Gregor, and A. Hinz of the Department of Internal Medicine I of the Klinikum Saarbrücken, Winterberg in Saarbrücken, Germany.
    The team set out to examine levels of depression and anxiety between adults with celiac disease following a gluten-free diet (GFD), and in control subjects drawn from the general population.
    For their study, the team used the Hospital Anxiety and Depression Scale to measure levels of anxiety, depression, and likely anxiety or depressive disorder, in 441 adult patients with celiac disease recruited by the German Celiac Society. They then conducted the same assessments on 235 comparable patients with inflammatory bowel disease (IBD), either in remission or with slight disease activity. They did the same for the cross-sample control group of 441 adults from the general population.
    The team used regression analysis to test possible demographic and disease-related predictors of anxiety and depression in celiac disease. Demographic predictors included age, sex, social class, and family status. Disease-related predictors included latency to diagnosis, duration of GFD, compliance with GFD, thyroid disease.
    The team found that female gender (P = 0.01) was the main predictor (R(2) = 0.07) of anxiety levels in patients with celiac disease. Female patients had a higher risk for a probable anxiety disorder (OR = 3.6, 95% CI: 1.3-9.4, P = 0.01)  Patients who lived alone (OR = 0.5, 95% CI: 0.2-0.9, P = 0.05) enjoyed a lower risk of anxiety disorder. None of the demographic and medical variables for which the team screened predicted either depression levels or risk for a probable depressive disorders.
    Patients with celiac disease showed anxiety levels of 6.6 +/- 3.4, and those with IBD, anxiety levels of 6.9 +/- 3.7, both higher than the general population's level of 4.6 +/- 3.3 - (both P < 0.001). Depression levels were similar for people with celiac disease (4.2 +/- 3.4), IBD (4.6 +/- 3.4) and the general population (4.2 +/- 3.8) (P = 0.3). Rates of likely anxiety disorders in people with celiac disease were 16.8%, and 14.0% for IBD, both higher than the rates of 5.7% in the general population (P < 0.001). All three groups showed similar rates of probable depressive disorder (P = 0.1).
    Their results provide strong indications that adult women with celiac disease on a gluten-free diet suffer higher rates of anxiety than persons of the general population. They encourage clinicians to provide anxiety screens for adult women with celiac disease on a gluten-free diet.
    Source:

    World J Gastroenterol. 2010 Jun 14;16(22):2780-7. PMID 20533598
    Jefferson Adams
    Celiac.com 10/03/2011 - A number of studies show that people with celiac disease have higher risk of depression and death from external causes, but there are no conclusive studies on death from suicide.
    A research team set out to more deeply examine the risk of suicide in people with celiac disease. The team included J. F. Ludvigsson, C. Sellgren, B. Runeson, N. Långström, and P. Lichtenstein. They are affiliated with the Department of Paediatrics at Örebro University Hospital in Sweden.
    The team examined suicide risk in individuals with celiac disease where the small intestinal biopsy showed no villous atrophy.
    For their study, the team collected biopsy data from all 28 clinical pathology departments in Sweden for 29,083 individuals diagnosed during 1969-2007 with celiac disease with Marsh 3 villous atrophy, with inflammation without villous atrophy (Marsh 1-2; n=13,263), or with positive celiac disease serology, but normal mucosa (Marsh 0, n=3719).
    The team used Cox regression to calculated hazard ratios for suicide as recorded in the Swedish Cause of Death Register.
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    The results showed that suicide was more common among those who suffered from inflammation (HR=1.96; 95%CI=1.39-2.77), but the team found no such increase in people who showed positive celiac disease serology, but normal mucosa. (HR=1.06; 95%CI=0.37-3.02).
    Overall, the team found a slightly higher risk of suicide in patients with celiac disease than in the general population. The increased risk is one that merits attention from doctors, when treating patients with celiac disease.
    Source:

    Dig Liver Dis. 2011 Aug;43(8):616-22.
    Jefferson Adams
    Celiac.com 01/09/2012 - Women with celiac disease face a higher risk for depression than the general population, even once they have adopted a gluten-free diet, according to U.S. researchers.
    A team of researchers recently used a Web-mediated survey to assess a range of physical, behavioral and emotional experiences in 177 U.S. adult women, who reported a physician-provided diagnosis of celiac disease.
    The team was led by Josh Smyth, professor of biobehavioral health and medicine at Pennsylvania State University, and included members from  Syracuse University and Drexel University.
    The survey gathered information about how closely people follow a gluten-free diet and assessed various symptoms of celiac disease from physical symptoms to the respondents' experience and management of stressful situations, along with charting symptoms of clinical depression and frequency of thoughts and behaviors associated with eating and body image.
    Perhaps unsurprisingly, many women with celiac disease suffer from disordered eating, given that the management of celiac disease requires careful attention to diet and food, Smyth said.
    "What we don't know is what leads to what and under what circumstances," Smyth said. "It's likely that the disease, stress, weight, shape and eating issues, and depression are interconnected."
    The findings are forthcoming in the journal of Chronic Illness.
    Source:

    http://www.upi.com/Health_News/2011/12/28/Celiac-ups-depression-risk-for-women/UPI-75401325131984/#ixzz1iQynze9k.

  • Recent Articles

    Connie Sarros
    Celiac.com 04/21/2018 - Dear Friends and Readers,
    I have been writing articles for Scott Adams since the 2002 Summer Issue of the Scott-Free Press. The Scott-Free Press evolved into the Journal of Gluten Sensitivity. I felt honored when Scott asked me ten years ago to contribute to his quarterly journal and it's been a privilege to write articles for his publication ever since.
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    Jefferson Adams
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    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.
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    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.
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    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.”
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    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