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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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    DIABETES AND CELIAC DISEASE - BY KEMP RANDOLPH


    admin

    Of the many immune related disorders linked with the celiac condition, the best established connection is with Type I diabetes (mellitus). Type I diabetes occurs at a rate of about 0.5% in the general population, but at a rate estimated at 5-10% among celiacs. Normally the diabetes is diagnosed first, both because this form of diabetes tends to strike early in life and its diagnosis is certain. No connection has been found with the more common form of diabetes (mellitus= honey , from the sugar laden urine when uncontrolled), Type II which occurs at a rate of 2-2.5% in the general population.


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    In Type I diabetes, the insulin producing cells of the pancreas are destroyed by the immune system, perhaps in overreaction to some kind of infection (The incidence of Type I is highest in the winter.) Normally, insulin is released into the blood for distribution to nearly all cells in the body so glucose can be burned for energy. There are indirect connections with protein and fat metabolism as well which give rise to some of the poisons that build up in the absence of insulin. For glucose, cells have an insulin receptor on the surface: once insulin is bound there, glucose can enter and hence be metabolized.

    At diagnosis, the Type I presents itself with a better defined form of malnourishment than celiac disease: hyperglycemia (high blood sugar), weight loss, excessive thirst, excessive urination laden with (un-metabolized) sugar and protein, a fruity smell to the breath and little or no insulin in the blood. Treatment consists of 1-3 subcutaneous injections of insulin a day and control of carbohydrate intake.

    The recommended diet for diabetes, long before it was recommended for everyone, consisted of less fat and protein and more carbohydrate. Complex carbohydrates (less quickly metabolized) were recommended to cut down the peak in blood glucose that occurs about two hours after eating. It was, and is, a perfect Jane Brody diet - lots of fresh fruit and vegetables, hence with lots of fiber. The restriction on sugar is indirect: only the total carbohydrates must be controlled. So, if you have some sugar, you must eliminate something else (less carbohydrates probably), and have to put up with less on the plate.

    Control of Type I is certainly more of a nuisance than celiac disease, but also one with much better information readily available. Food labels are nearly adequate for controlling carbohydrate intake; the risks of the various long term complications versus average blood glucose are well known; relatively inexpensive, reliable home monitoring of blood glucose is possible to even out the daily peaks and valleys; a longer term blood test reliably measures average blood glucose for sufficient monitoring of longer term risks.

    Like celiac disease, Type I diabetes is more common in those of northern European extraction. Like celiac disease, it is highly linked to the so-called HLA markers of the immune system (those marking white blood cells). Celiacs are likely to be positive for both HLA-B8 and HLA-DR3; Type Is are most linked to HLA-B8 and either HLA-DR3 or HLA-DR4. An English study several months ago found that multiple genes were linked to Type I reflecting the fact that parents of a Type I are often diabetes free (the interpretation being that genes were required from both sides). The recent request for celiac siblings for a study of genetic typing intends to duplicate the study which looked for celiac genes.

    Reference:
    • Gluten Intolerance Group of North America newsletter, V. 13, Issue 2, 1987; New York Times, Sept. 13, 1994, genetics study by Dr. John Todd at Oxford

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    This article was posted to the Celiac Listserv by Ashton Embry at: embrya@cadvision.com in January, 1998:
    I became interested in the concept of a Paleolithic Diet in a circuitous way which began with the diagnosis of my oldest son with multiple sclerosis two and a half years ago. I hit the med library soon after I was told that there was no known cause and no effective treatment for MS. My goal was to determine the most likely cause and to then devise a therapy which countered this cause. After reading hundreds of papers and countless more abstracts I reached the conclusion that the main cause of MS is dietary and that dairy, gluten and saturated fat were the three main offending foods. I have summarized this analysis in an essay which is at
    The evidence I used to reach my interpretation was a combination of epidemiology, theory (molecular mimicry) and anecdotal data. After the essay was on the web I was contacted by Loren Cordain who pointed out that the foods implicated in MS were recently introduced to the human diet from a genetic point of view and he gave me the references to Boyd Eatons classic papers on Paleolithic Nutrition. From my geological background this concept seemed eminently reasonable so now I had an excellent unifying concept to go along with all the other data. One shortcoming of the evidence was that it was all circumstantial. There was no smoking gun evidence, that is, empirical evidence which demonstrates beyond a reasonable doubt that food proteins really do cause cell-mediated, organ-specific autoimmunity.
    As a dutiful civil servant, I made one of my required pilgrimages to Ottawa last week to participate in various mind-numbing meetings. I had a free afternoon so I went out to the Nutrition Research Division of Health Canada where I had the good fortune to meet with Dr Fraser Scott. Dr. Scott has been studying the effect of diet on the development of Type 1 Diabetes in BBdp rats for 20 years. He and co-workers have demonstrated conclusively that Type 1 diabetes can be generated by proteins derived from wheat, soy and milk. So now I had found the smoking gun. Food proteins can indeed induce cell-mediated autoimmunity and not surprisingly the foods which supply the pathogenic proteins are those added to the human diet during the Neolithic. I believe Dr. Scotts work is of great significance for understanding the cause of autoimmune disease and strongly supports Eatons suggestion the diet of our ancestors is the best defense against the diseases of civilization.
    References:
    The best reference for Scotts work is: Scott, FW, 1996, Food-induced Type 1 Diabetes in the BB Rat. Diabetes/Metabolism Reviews, v.12, p. 341-359. This paper summarizes all his results up to 1996 and contains references to all his earlier work.

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    J Pediatr Gastroenterol Nutr 2001;33:462-465.
    Celiac.com 11/12/2001 - According to a recent report published in the October issue of the Journal of Pediatric Gastroenterology and Nutrition nearly 5% of US children with juvenile diabetes also have celiac disease. Dr. Steven L. Werlin of the Medical College of Wisconsin in Milwaukee and colleagues tested 218 patients with juvenile diabetes and 117 matched control subjects for the IgA endomysial antibody. Patients with positive results were offered a small bowel biopsy. The patients symptoms were assessed via a parent questionnaire.
    Results: Seventeen diabetic patients tested positive for the IgA endomysial antibody, while no positive results were found among control subjects. Fourteen of the 17 patients who tested positive underwent a follow-up small bowel biopsy. Villous atrophy was found in 11 of the patients. Two patients had increased intraepithelial lymphocytes without villous atrophy. Interestingly, more than half of the patients with biopsy-proven celiac disease were asymptomatic.
    According to Dr. Werlin, the results indicate that there is an association between asymptomatic celiac disease and juvenile diabetes. According to other research the treatment of the celiac disease in these patients will make the management of their diabetes easier. He further states that treating asymptomatic celiac disease will prevent many of its complications, and recommends that children with diabetes mellitus be screened for possible celiac disease with an antibody test and possible follow-up small bowel biopsy.

    admin
    Diabetes Care 2002;25:1111-1122.
    Celiac.com 08/08/2002 - A recent study conducted by Dr. David B. Dunger (Addenbrookes Hospital in Cambridge) and colleagues found that children with type 1 diabetes and latent celiac disease who were put on a gluten-free diet showed significant improvement in their metabolic control and growth. The study, which was published in the July issue of Diabetes Care, looked at 11 children with type 1 diabetes and who were diagnosed with celiac disease using anti-gliadin and anti-endomysial antibodies and a biopsy for confirmation.
    The group with celiac disease had a significantly lower mean BMI standard deviation score (SDS) than that of a control group of 22 age and sex-matched children with diabetes who did not have celiac disease. The mean height SDS and C-peptide levels in the two groups were similar, while the mean HbA-1-c was lower (better) in the group with celiac disease. After one year on a gluten-free diet the group with celiac disease improved its mean BMI score to that of the control group, and its HbA-1-c score went down (improved), while the control groups HbA-1-c score increased (worsened).
    The researchers conclude that more studies are needed to support their findings that a gluten-free diet significantly improves glycemic control in children with type 1 diabetes and celiac disease.

    Jefferson Adams
    Celiac.com 06/08/2007 - This study shows that celiac disease is as common among British Columbians with Type 1 diabetes as it is in Europeans with Type 1 Diabetes.
    The research team was made up of doctors P.M. Gillett, H.R. Gillett, D.M. Israel, D.L. Metzger, L. Stewart, J-P. Chanoine, H.J. Freeman.
    The team looked at 233 children with Type1 diabetes. In a blind study, the children were screened for celiac disease using immunoglublin A endomysium antibody (EmA), and the Immunoglublin A tissue transglutaminase. Children with positive results were offered small bowel biopsies. For those confirmed with celiac disease, doctors recommended a gluten-free diet.
    British Columbians with Type 1 Diabetes Get Celiac Disease at Rates Comparable to their European Counterparts
    Nineteen children tested positive for EmA and showed elevated tTG levels. Of the 18 patients who agreed to biopsies, one was normal, three showed normal morphology with elevated Intraepithelial lymphocyte counts, and 14 biopsies showed morphological changes consistent with celiac disease.
    9 of the 19 children who tested positive for EmA were asymptomatic. Seven patients showed only mildly elevated tTG levels. Of this second group, five refused biopsy and two showed normal biopsies.
    In addition to the four known cases, the doctors uncovered at least 14 new cases of celiac disease. The total rate of biopsy confirmed celiac disease was 18 out of 233, or 7.7%. The doctors concluded that these results confirm that celiac disease is prevalent in pediatric type 1 diabetes.
    The doctors say the study reinforces the importance of celiac screening for children with type 1 diabetes, and also the advisability of keeping an eye on tTg serology as part of determining the effects of and compliance to a gluten-free diet.
    Participating Facilities
    1. Division of Pediatric Gastroenterology at British Columbias Childrens Hospital Vancouver, British Columbia.
    2. Division of Endocrinology, British Columbias Childrens Hospital, Vancouver, British Columbia.
    3. Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia
    Journal of Pediatric Gastroenterology & Nutrition: Volume 29(4)October 1999p 495.
    About the Author: Jefferson Adams is a freelance health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.

  • Recent Articles

    Jefferson Adams
    Celiac.com 04/23/2018 - A team of researchers recently set out to learn whether celiac disease patients commonly suffer cognitive impairment at the time they are diagnosed, and to compare their cognitive performance with non-celiac subjects with similar chronic symptoms and to a group of healthy control subjects.
    The research team included G Longarini, P Richly, MP Temprano, AF Costa, H Vázquez, ML Moreno, S Niveloni, P López, E Smecuol, R Mazure, A González, E Mauriño, and JC Bai. They are variously associated with the Small Bowel Section, Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital; Neurocience Cognitive and Traslational Institute (INECO), Favaloro Fundation, CONICET, Buenos Aires; the Brain Health Center (CESAL), Quilmes, Argentina; the Research Council, MSAL, CABA; and with the Research Institute, School of Medicine, Universidad del Salvador.
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    Celiac disease patients had similar cognitive performance and anxiety, but no significant differences in depression scores compared with disease controls.
    A total of thirty-three subjects were diagnosed with celiac disease. Compared with the 26 healthy control subjects, the 17 celiac disease subjects, and the 17 disease control subjects, who mostly had irritable bowel syndrome, showed impaired cognitive performance (P=0.02 and P=0.04, respectively), functional impairment (P<0.01), and higher depression (P<0.01). 
    From their data, the team noted that any abnormal cognitive functions they saw in adults with newly diagnosed celiac disease did not seem not to be a result of the disease itself. 
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    Source:
    J Clin Gastroenterol. 2018 Mar 1. doi: 10.1097/MCG.0000000000001018.

    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.
    Due to personal health reasons and restrictions, I find that I need to retire. My husband and I can no longer travel the country speaking at conferences and to support groups (which we dearly loved to do) nor can I commit to writing more books, articles, or menus. Consequently, I will no longer be contributing articles to the Journal of Gluten Sensitivity. 
    My following books will still be available at Amazon.com:
    Gluten-free Cooking for Dummies Student's Vegetarian Cookbook for Dummies Wheat-free Gluten-free Dessert Cookbook Wheat-free Gluten-free Reduced Calorie Cookbook Wheat-free Gluten-free Cookbook for Kids and Busy Adults (revised version) My first book was published in 1996. My journey since then has been incredible. I have met so many in the celiac community and I feel blessed to be able to call you friends. Many of you have told me that I helped to change your life – let me assure you that your kind words, your phone calls, your thoughtful notes, and your feedback throughout the years have had a vital impact on my life, too. Thank you for all of your support through these years.

    Jefferson Adams
    Celiac.com 04/20/2018 - A digital media company and a label data company are teaming up to help major manufacturers target, reach and convert their desired shoppers based on dietary needs, such as gluten-free diet. The deal could bring synergy in emerging markets such as the gluten-free and allergen-free markets, which represent major growth sectors in the global food industry. 
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    "Brands with very specific product benefits, gluten-free for example, require precise targeting to efficiently reach and convert their desired shoppers,” says Todd Morris, President of Catalina's Go-to-Market organization, adding that “Catalina offers the only purchase-based targeting solution with this capability.” 
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    Morris says the joint partnership will allow Catalina to “enhance our dataset and further increase our ability to target shoppers who are currently buying - or have shown intent to buy - in these emerging categories,” including gluten-free, allergen-free, and other free-from foods.
    The deal will likely make for easier, more precise targeting of goods to consumers, and thus provide benefits for manufacturers and retailers looking to better serve their retail food customers, especially in specialty areas like gluten-free and allergen-free foods.
    Source:
    fdfworld.com

    Jefferson Adams
    Celiac.com 04/19/2018 - Previous genome and linkage studies indicate the existence of a new disease triggering mechanism that involves amino acid metabolism and nutrient sensing signaling pathways. In an effort to determine if amino acids might play a role in the development of celiac disease, a team of researchers recently set out to investigate if plasma amino acid levels differed among children with celiac disease compared with a control group.
     
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    First, the team used liquid chromatography-tandem mass spectrometry (LC/MS) to analyze amino acid levels in fasting plasma samples from 141 children with celiac disease and 129 non-celiac disease controls. They then crafted a general linear model using age and experimental effects as covariates to compare amino acid levels between children with celiac disease and non-celiac control subjects.
    Compared with the control group, seven out of twenty-three children with celiac disease showed elevated levels of the the following amino acids: tryptophan; taurine; glutamic acid; proline; ornithine; alanine; and methionine.
    The significance of the individual amino acids do not survive multiple correction, however, multivariate analyses of the amino acid profile showed significantly altered amino acid levels in children with celiac disease overall and after correction for age, sex and experimental effects.
    This study shows that amino acids can influence inflammation and may play a role in the development of celiac disease.
    Source:
    PLoS One. 2018; 13(3): e0193764. doi: & 10.1371/journal.pone.0193764

    Jefferson Adams
    Celiac.com 04/18/2018 - To the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service animals.
    If you’ve flown anywhere lately, you may have seen them. People flying with their designated “emotional support” animals. We’re not talking genuine service animals, like seeing eye dogs, or hearing ear dogs, or even the Belgian Malinois that alerts its owner when there is gluten in food that may trigger her celiac disease.
    Now, to be honest, some of those animals in question do perform a genuine service for those who need emotional support dogs, like veterans with PTSD.
    However, many of these animals are not service animals at all. Many of these animals perform no actual service to their owners, and are nothing more than thinly disguised pets. Many lack proper training, and some have caused serious problems for the airlines and for other passengers.
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    Fresh from an unsavory incident with an “emotional support” peacock incident, United Airlines has followed Delta’s lead and set stricter rules for emotional support animals. United’s rules also took effect March 1, 2018.
    So, to the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service and emotional support animals.
    Source:
    cnbc.com