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    The Gluten Intolerance Group of North America on Iodine and Dermatitis Herpetiformis


    Scott Adams

    The the connection between iodine and Dermatitis Herpetiformis is briefly described by the following excerpt from a resource guide of the Gluten Intolerance Group of North America:

    • Iodine can trigger eruptions in some people (with dermatitis herpetiformis). However, iodine is a essential nutrient and should not be removed from the diet without a physicians supervision.
    • Iodine does not contain gluten. Iodine can worsen the symptoms of skin lesions in patients with dermatitis herpetiformis.
    • When the deposits of IgA have been cleared from the skin over time by following a gluten free diet, iodine should no longer present any problem for dermatitis herpetiformis patients.


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    As background, for those who are not familiar with Dermatitis Herpetiformis, the following description comes from a resource guide of the Gluten Intolerance Group of North America:

    • Dermatitis herpetiformis (dermatitis herpetiformis) is a chronic disease of the skin marked by groups of watery, itch blisters. The ingestion of gluten (the proteins gliadin and prolamines contained in wheat, rye, oats, and barley) triggers an immune system response that deposits a substance, IgA (immonuglobin A), under the top layer of skin. IgA is present in affected as well as unaffected skin. dermatitis herpetiformis is a hereditary autoimmune disease linked with celiac disease. If you have dermatitis herpetiformis, you always have celiac disease. With dermatitis herpetiformis the primary lesion is on the skin rather than the small intestine. The degree of damage to the small intestine is often less severe or more patchy then those with only celiac disease. Both diseases are permanent and symptoms/ damage will occur after comsuming gluten.

    When my husband was diagnosed with dermatitis herpetiformis last November, he went to visit a expert in dermatitis herpetiformis, Dr. John J. Zone, at the University of Utah (USA). The written instructions Dr. Zone gave him included the following statement:

    • The mineral iodine is known to make the disease (dermatitis herpetiformis) worse. For this reason, foods and supplements high in iodine should be avoided. Table salt which is not iodized should be used. This can be found in most grocery stores with the other salts. Avoid kelp and other seaweed products, and do not use sea salt. If you take any nutritional supplements, examine them carefully to avoid any iodine containing ingredients.

    It is not necessary for dermatitis herpetiformis patients to eliminate iodine completely from their diet, merely to avoid foods high in iodine as described above. Dr. Zone also explained that dermatitis herpetiformis patients need not avoid iodine indefinitely. Iodine is an important mineral for our bodies. dermatitis herpetiformis patients can stop avoiding iodine when their rash symptoms clear up which can take anywhere from a few months to a couple of years on a gluten-free diet.

    More about iodine:

    • Intake of large amounts of inorgana iodide is known to exacerbate symptoms and a few patients have been reported to improve on low iodide diets. However, this is not a mainstay of treatment and need only be considered if patients are consuming excessive iodide in the form of vitamin pills, kelp, or seafood. Likewise, some patients have reported exacerbation with thyroid hormone replacement therapy and thyrotoxicosis. In such cases, excessive thyroid replacement should be avoided and thyrotoxicosis treated appropriately.
    • Dermatitis Herpetiformis, John J. Zone MD, Curr Probl Dermatol, Jan/Feb 1991, p36
    • Dermatitis Herpetiformis is considered a rare skin disease.
    • The true incidence and prevalence of dermatitis herpetiformis appears to vary in different areas of the world and may vary within the same country. During 1987, 158 cases of documented dermatitis herpetiformis were identified in the state of Utah out of a population of 1.6 million, a prevalence of 9.8 per 100,000.
    • Dermatitis Herpetiformis, John J. Zone MD, Curr Probl Dermatol, Jan/Feb 1991, p15

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    Guest maria edh

    Posted

    Having been recently diagnosed. I was unaware about Iodine's role, which makes me believe that staying away from shell fish (for 20 years) has played some role in this illness. Thank you

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    An eye opener, no one ever told me about this link. I have used sea salt since diagnosis, found I have an intolerance to all seaweed products, and now I'm wondering if this is why I can't get my dermatitis to clear up. Thanks for starting this thought process!!

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    Guest Rebecca Johnson

    Posted

    I never heard about iodine before and now I will talk to my doctor about it. Thanks !!!

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    Guest Laura H.

    Posted

    I made the connection between my Dermatitis Herpetiformis and iodine 16 years ago and was able to clear up the blisters by avoiding sources of iodine. However, even after I found out I had celiac five years ago, I didn't connect the blister outbreaks to celiac until I read Dr. Green's book. When he stated that iodine was the trigger, I almost jumped out of my chair. Now everything was clear-- celiac was actually the cause, while iodine was merely the trigger. Unfortunately, because I avoided iodine for 16 years, my thyroid essentially 'died' last year, and since all thyroid meds contain iodine, I break out in blisters at the slightest gluten contamination. My back is also covered with an itchy rash, my throat is sore, and my thyroid is inflamed. My doctors seem at a loss at treating this sensitivity to iodine. So, I would like to reiterate Dr. Green's advice to not completely avoid iodine--your thyroid needs it to be healthy.

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    Guest Ursula

    Posted

    Thank you for this insightful information. I have always found that my eczema gets worse when I eat prawns and now I know why. I will definitely be on the look-out for foods high in iodine in the future so as to avoid them.

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    Guest Carol Z.

    Posted

    Really helpful. Since so many of us have thyroid problems too and must take supplements, this is a big issue. There is not much clear information out there and doctors don't seem so well informed.

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    Guest Julie M.

    Posted

    My son Andrew is 15 years old now, he was diagnosis with Dermatitis Herpetaformis at 8, has been rash-free for 5 years by being on a Gluten Free diet continuously and Iodine free diet for approximately 6 months after his initial diagnosis). He has recently relapsed, I believe he has been eating more fast foods, going through puberty, and has been in the ocean 3-4 times a week for several months now possibly absorbing iodine through his skin. I am unsure if puberty and the absorption through the skin can trigger Dermatitis Herpetaformis. He is looking and feeling terrible, so frustrating for him and me as a mother.

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    Guest Michelle E

    Posted

    At 33 years old I finally got diagnosed with celiac this year with a simple blood test (after 3 years of gut pain). To make up for my lack of vitamins - I was taking a fantastic, all inclusive vitamin religiously in addition to a gluten free diet. My gut was great, but I got wicked cases of 'poison ivy' 3 times in one summer - a record even for me. THANK YOU for this article. I switched off the vitamin, which was high in iodine and haven't had a major outbreak since. I did get a prescription for Fluocinonide .05% a topical steroid that helped before I knew to cut back on iodine. Now it seems that I can usually just cut back on shrimp intake (had a flare up on vacation when eating lots of shrimp) and that stops the rash from spreading and turning into the big bumps.

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    Usually going in the ocean soothes skin rashes. Does anyone know if it's bad for a person with Dermatitis Herpetiformis to go into the ocean?

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    Guest Katey

    Posted

    Thank you! I recently started taking kelp, and the watery blisters I got from gluten intolerance multiplied and became worse. I had no idea about the relationship between the two until now.

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    Guest Anna Mae Schroeder

    Posted

    Very informative, thank you very much for this. Research keeps bringing us new information.

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    Guest Jeannie

    Posted

    Usually going in the ocean soothes skin rashes. Does anyone know if it's bad for a person with Dermatitis Herpetiformis to go into the ocean?

    Live in Hawaii and our ocean is like a medicine for lots of ailments. BUT, nowadays, if you have an open cut, it's advised not to go into the ocean. There are "new unknown" bacteria or particles in the ocean more than ever. Your little cut can become infected so quickly. In my days, it was good to go into the waters and have nature's ocean clean the cut and heal it.

    I'd say, with an inflamed case of dermatitis herpetiformis, don't go in the waters. When my son's skin looks better I'll take him to the beach. He'll even tell me when his skin feels better.

     

    My 7 year old son just got diagnosed with dermatitis herpetiformis. With the help of a new dermatologist, my son's mystery skin has a name. Our doctor was so nice to explain to me about dermatitis herpetiformis and its nickname "suicidal itch".

     

    After 5 years of 3 dermatologists, 1 allergist, and pediatricians all saying that he just has an extreme eczema or dyshidrosis or some severe mystery skin. Though I had pictures of his "angry skin", no one went outside the "box" of eczema. I knew something was different. Every one would tell me that they knew what we were going through, Yet none of them could understand or relate to me and my son when I told them that there has been lots of staph infections and ER nights and just no sleeping.

    Even my son's school staff has been challenging.

     

    Sorry, just so happy with this new world of dermatitis herpetiformis and trying to go gluten-free 100% (or as much as possible) yet a little perturbed with professionals that are closed minded to "outside of the box" learning something new.

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    Guest Darren

    Posted

    Did I read that right? If you have dermatitis herpetiformis you have celiac. I made the mistake of going off gluten prior to testing, and all my tests with the exception of the "visual" results from my endoscopy, were all negative. I had this rash last year when I went to mayo clinic and they said they had no idea what it was and gave me hydro cream. Well it came back again and is still there now. Thank you for the information on iodine. I had been snacking on cashews with salt but have stopped thinking they may have been exposed to gluten. My rash isn't as red now. Eating gluten made it itch like the devil. And when the blisters open up they sting like mad. I have so many of these symptoms but nothing indicates it in my tests. The doctor who did the endoscopy came in afterward and said it "looked" like celiac but the labs said otherwise. Any ideas what I should do next. Eating gluten causes cramps, bloating, and severe diarrhea and back pain within hours.

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    Guest Joe Eustis

    Posted

    I have celiac (no tummy issues) and DH and started the gluten free diet 18 months. I have made no progress in clearing up the rash / itch. Have been on iodine free salt and vitamins at home with no help. Six months ago I started levothyroxine for newly diagnosed Hashimotos and noticed itch slowly got worse. Stopped for a while, seemed to get better, then took Armour and it flared up. I stopped Armour and started a very low iodine diet - bought only no salt or low sodium packaged items from grocery (canned, boxed, frozen). It made a big difference so far. Culprit seems to be all the iodized salt in the processed foods we all buy. Never the less I have an appointment to see Dr. John Zone (expert) at Salt Lake City University Hospital next month to understand / get help on the "iodine connection. It will be a long trip from New Orleans, but worth it to get real answers.

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    Guest Joe Eustis

    Posted

    Follow up - upon reviewing the foods I recently eliminated in going on a low iodine diet (which makes a big difference) I think the dairy products, i.e., milk, cheese, and in particular Weight Watchers fudge bars and Wendy's Frosties which have carregeenen - an iodine rich food thickener could be the smoking gun.

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    Guest Kara Larocco

    Posted

    I am hypothyroid. I do take kelp too. I got my thyroid levels correct first and then I did a few iodine patch tests to see if it picked up a deficiency. It showed I was deficient, so I started the kelp. Many people do fine with a little bit of iodine, then there are others that don't. I started out by taking powdered kelp, but the problem with powdered kelp is that there are no dosages. Plus, iodine deficiency is a symptom, not a cause. There are other, more pressing headaches associated with hypothyroidism. Metabolism, for starters, which can play hell with your immune system, and also your mental health. If you look at a nurses' guide, you'll see that thyroid issues can lead to some chemical difficulties in brain/body day-to-day functioning.

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    Guest Julie

    Posted

    Thank you for this article, it has pretty much changed my life. I have been dealing with intermittent flare-ups of this type of dermatitis for the past year having no idea what was causing it or how to address it. Having been diagnosed with extreme gluten intolerance within the past two weeks with IgA readings off the charts (and incidentally, plenty of iodine in my diet), it all makes sense now. I found this article after eating some kelp and having the worst flare-up ever immediately after. Now that I've finally identified the correlation, I believe I will finally be able to beat this by avoiding iodine rich foods and switching to a strict gluten-free diet. Thanks again!

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    Thank you so much for this information. My inability to clear up the DH rash for over 3 years on a gluten free diet has been so frustrating. One question I have never seen answered is whether there is a treatment or topical product which will calm the intense inching? Any information on palliative treatment would certainly be very welcome.

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    Guest Linda Cabaniss

    Posted

    Thank you so much for this information. My inability to clear up the DH rash for over 3 years on a gluten free diet has been so frustrating. One question I have never seen answered is whether there is a treatment or topical product which will calm the intense inching? Any information on palliative treatment would certainly be very welcome.

    I have had success with cold pressed/processed castor oil soaked bandages along with applied heat at bedtime. This usually clears up the DH within a week. This is an old Edgar Cayce remedy for many ailments including internal

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    Thank you for this information.

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    I was wondering why my skin gets those hives when I eat salty food and this link explains it. Thank you for sharing this.

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    Guest Brenda

    Posted

    I am just now self-diagnosing (no health insurance) my 30 year intestinal problem and associating gluten to it all... But I have a suspicion that MSG in most the foods I eat in Asia (every 4 months of the year) are the trigger to the miserable DH skin rash that occurs while in warm tropical areas, eating Asian food plus added nervous system problems (ie: stress). I rarely have DH in the states. If anyone has similar thoughts, please share. Thank you all for your comments!

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    Guest Tammy Price

    Posted

    Thank you so much for this information. My inability to clear up the DH rash for over 3 years on a gluten free diet has been so frustrating. One question I have never seen answered is whether there is a treatment or topical product which will calm the intense inching? Any information on palliative treatment would certainly be very welcome.

    I have found that the only thing that comes close to helping the rash is thayers alcohol witch hazel (with cucumber/ rose water) to clean and calm the burn... Let it dry... Then i put some white pine salve on it. I order the salve on line from some nice herbal lady. But i have found it at some health food stores. Wise ways herbals. It helps cut the time in half. And helps it a lot in general.

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    Guest Tammy Price

    Posted

    Sad... I just flared up a week ago... Just a little. It is just calming some and I think I just ate some sea noodles with some iodine. Eeek! I had about 9 noodles.

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    Guest Angela

    Posted

    I was diagnosed with celiac disease 4 years ago after being really sick for about 6 years. I have DH as well. It was tons of fun trying to figure out what that was. I have had it under control, but occasionally I will have an outbreak. Potato chips seem to be a big culprit. I found that benedryl at night helps the itching and with sleeping. It seems to lessen the length of the outbreak. Also, watch ALL hair products. I was losing handfuls a day until I looked at my mousse. Hydrolized wheat protein was one of the first ingredients.

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    Celiac.com 04/25/2012 - In my experience growing up with undiagnosed celiac disease, I had to deal with several symptoms that my doctors had no answers for. One of the most frustrating of these was my skin troubles—dermatitis herpetiformis. After my experiences with misdiagnoses, and finally more recently, learning how to effectively get rid of dermatitis herpetiformis, I encourage parents to be particularly watchful for signs of dermatitis herpetiformis in their children, and I have some useful advice for those—children and adults—who have already been diagnosed with this annoying and sometimes quite troublesome rash. Since dermatitis herpetiformis occurs in 15 to 20% of celiacs, it’s worth any celiac’s time to learn more about this condition.
    By definition, dermatitis herpetiformis is a blistering and extremely itchy skin rash. It’s usually symmetrical in shape and is most commonly located on the elbows, knees, buttocks, and upper back. It’s common for people with dermatitis herpetiformis to have rashes appear in the same spot, and they can either be consistent or come and go. People can experience the rash on other parts of the body, and severity of symptoms can vary. Dermatitis herpetiformis is sometimes called the “gluten rash” or “celiac disease rash” because it occurs in people with a gluten intolerance or celiac disease. It is commonly misdiagnosed as eczema.
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    Dermatitis herpetiformis rashes are treated in two main ways--the gluten-free diet, of course, and antibiotics such as dapsone or sulfapyridine for those who aren’t able to tolerate dapsone. A truly gluten-free diet can eliminate dermatitis herpetiformis, but in my experience and according to the National Institutes of Health, a dermatitis herpetiformis rash responds dramatically to dapsone, within 48 to 72 hours. To treat the underlying cause of dermatitis herpetiformis, which is celiac disease, a strict gluten-free diet must be followed, but according to the National Institutes of Health, “Even with a gluten-free diet, dapsone or sulfapyridine therapy may need to be continued for 1–2 years to prevent further dermatitis herpetiformis outbreaks.”
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    Resources:
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    Traditional therapy for Sjogren’s syndrome (treatment of dryness):
    Cyclosporin (brand name Restasis) eye drops and artificial tears for dry eyes. Numoisyn lozenges and liquid, as well as Caphosol for mouth dryness and mucositis. Cevimeline (brand name Evoxac) and pilocarpine (brand name Salagen) for systemic dryness therapy. Treatment of autoimmune disturbances:
    Hydroxychloroquin (brand name Plaquenil). Leflunomide (brand name Arava). Severe autoimmune conditions associated with Sjogren’s syndrome are treated with the biologic drug rituximab (brand name Rituxan). Integrative therapy for Sjogren’s syndrome. Ear acupuncture (auricular therapy) and body acupuncture to stimulate tear and saliva production. Elimination diet based on individual food-intolerance profiles. Oral probiotics (for example, BLIS K12) and intestinal probiotics. Digestive enzymes. Fish and krill oils. Black currant seed oil. Cordyceps sinensis in combination with wormwood extract to treat the autoimmune component of Sjogren’s syndrome. Zinc and elderberry lozenges. N-acetyl-L-cysteine and glutathione. Our extensive clinical experience demonstrate that early cases of Sjogren’s syndrome can be completely reversed (by both clinical and laboratory criteria) by the strict gluten-free and elimination diet. The advanced cases cannot be reversed; however, even in advanced cases the gluten-free and elimination diet can slow the progression of the disease.
    If you’re concerned that dryness may represent Sjogren’s syndrome, see a rheumatologist for further evaluation and management of your condition.
    References:
    Alvarez-Celorio MD, Angeles-Angeles A, Kraus A. Primary Sjögren’s Syndrome and Celiac Disease: Causal Association or Serendipity? J Clin Rheumatol. 2000 Aug;6(4):194-7. Asrani AC, Lumsden AJ, Kumar R, Laurie GW. Gene cloning of BM180, a lacrimal gland enriched basement membrane protein with a role in stimulated secretion. Adv Exp Med Biol. 1998;438:49-54. Feuerstein J. Reversal of premature ovarian failure in a patient with Sjögren syndrome using an elimination diet protocol. J Altern Complement Med. 2010 Jul;16(7):807-9. Iltanen S, Collin P, Korpela M, Holm K, Partanen J, Polvi A, Mäki M. Celiac disease and markers of celiac disease latency in patients with primary Sjögren’s syndrome. Am J Gastroenterol. 1999 Apr;94(4):1042-6. Lemon S, Imbesi S., Shikhman A.R. Salivary gland imaging in Sjogren’s syndrome. Future Rheumatology, 2007 2(1):83-92. Roblin X, Helluwaert F, Bonaz B. Celiac disease must be evaluated in patients with Sjögren syndrome. Arch Intern Med. 2004 Nov 22;164(21):2387. Teppo AM, Maury CP. Antibodies to gliadin, gluten and reticulin glycoprotein in rheumatic diseases: elevated levels in Sjögren’s syndrome. Clin Exp Immunol. 1984 Jul;57(1):73-8.

    Jefferson Adams
    Can a Gluten-Free Diet Normalize Vitamin D Levels for Celiac Patients?
    Celiac.com 08/16/2018 - What is the significance of vitamin D serum levels in adult celiac patients? A pair of researchers recently set out to assess the value and significance of 25(OH) and 1,25(OH) vitamin D serum levels in adult celiac patients through a comprehensive review of medical literature.
    Researchers included F Zingone and C Ciacci are affiliated with the Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; and the Celiac Center, AOU San Giovanni di Dio e Ruggi di Aragona, University of Salerno, Department of Medicine and Surgery, Salerno, Italy. 
    Within the wide spectrum of symptoms and alteration of systems that characterizes celiac disease, several studies indicate a low-level of vitamin D, therefore recent guidelines suggest its evaluation at the time of diagnosis. This review examines the data from existing studies in which vitamin D has been assessed in celiac patients. 
    Our review indicates that most of the studies on vitamin D in adult celiac disease report a 25 (OH) vitamin D deficiency at diagnosis that disappears when the patient goes on a gluten-free diet, independently of any supplementation. Instead, the researchers found that levels of calcitriol, the active 1,25 (OH) form of vitamin D, fell within the normal range at the time of celiac diagnosis. 
    Basically, their study strongly suggests that people with celiac disease can recover normal vitamin D levels through a gluten-free diet, without requiring any supplementation.
    Source:
    Dig Liver Dis. 2018 Aug;50(8):757-760. doi: 10.1016/j.dld.2018.04.005. Epub 2018 Apr 13.  

    Jefferson Adams
    Could Gluten-Free Food Be Hurting Your Dog?
    Celiac.com 08/15/2018 - Grain-free food has been linked to heart disease in dogs. A canine cardiovascular disease that has historically been seen in just a few breeds is becoming more common in other breeds, and one possible culprit is grain-free dog food. 
    The disease in question is called canine dilated cardiomyopathy (DCM), and often results in congestive heart failure. DCM is historically common in large dogs such as Great Danes, Newfoundlands, Irish Wolfhounds, Saint Bernards and Doberman Pinschers, though it is also affects some Cocker Spaniels.  Numerous cases of DCM have been reported in smaller dogs, whose primary source of nutrition was food containing peas, lentils, other legume seeds or potatoes as main ingredients. These reported atypical DCM cases included Golden and Labrador Retrievers, a Whippet, a Shih Tzu, a Bulldog and Miniature Schnauzers, as well as mixed breeds. 
    As a result, the U.S. Food and Drug Administration's Center for Veterinary Medicine, along with a group of veterinary diagnostic laboratories, is investigating the possible link between DCM and pet foods containing seeds or potatoes as main ingredients. The good news is that in cases where the dog suffers no genetic component, and the disease is caught early, simple veterinary treatment and dietary change may improve heart function.
    According to Nutritional Outlook, an industry publication for makers of dietary supplements and healthy foods and beverages, there is a growing market for “free from” foods for dogs, especially gluten-free and grain-free formulations. In 2017, about one in five dog foods launched was gluten-free. So, do dogs really need to eat grain-free or gluten-free food? Probably not, according to PetMD, which notes that many pet owners are simply projecting their own food biases when choosing dog food.
    Genetically, dogs are well adapted to easily digest grains and other carbohydrates. Also, beef and dairy remain the most common allergens for dogs, so even dogs with allergies are unlikely to need to need grain-free food. 
    So, the take away here seems to be that most dogs don’t need grain-free or gluten-free food, and that it might actually be bad for the dog, not good, as the owner might imagine.
    Stay tuned for more on the FDA’s investigation and any findings they make.
    Read more at Bizjournals.com
     

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

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