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    Young Adults with Celiac Disease May Risk Early Atherosclerosis


    Jefferson Adams
    Image Caption: Image: CC--chiesADIbeinasco

    Celiac.com 07/25/2013 - Numerous studies have shown that people with immune-mediated disorders can suffer from accelerated progression of atherosclerosis and increased cardiovascular risk, but few studies have been done for people with celiac disease.


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    Image: CC--chiesADIbeinascoA team of researchers recently looked at young adults with celiac disease to see what, if any, added risk they may have for developing atherosclerosis.

    The research team included S. De Marchi, G. Chiarioni, M. Prior, and E. Arosio. They are variously affiliated with the Department of Medicine,and the Division of Vascular Rehabilitation in the Department of Medicine at the University of Verona in Verona, Italy, and with the Division of Gastroenterology and Hepatology, Center for Functional GI and Motility Disorders at the University of North Carolina in Chapel Hill, North Carolina.

    The team wanted to assess instrumental and biochemical signs of atherosclerosis risk in 20 adults at first diagnosis of celiac disease and again after 6–8 months of gluten-free diet with mucosal recovery. They used twenty-two healthy members of the hospital staff as matched controls.

    For their study, the team analyzed total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides, homocysteine, C-reactive protein, folate and vitamin B12.

    They also conducted ultrasound measurement of carotid intima-media thickness (IMT) and endothelium-dependent dilatation at diagnosis and after gluten withdrawal.

    The team found average total and HDL-cholesterol (HDL-C) to be within the normal range, at baseline, while average LDL-cholesterol concentration was slightly higher.

    Diet was tied to increment in total and HDL-C (68.2 ± 17.4 vs. 51.4 ± 18.6 mg/dL; P < 0.001). Meanwhile, total/HDL-C ratio was substantially improved (3.05 ± 0.71 vs. 3.77 ± 0.92; P < 0.02).

    Overall plasma homocysteine was elevated and not changed by diet, while C-reactive protein dropped significantly with diet (1.073 ± 0.51 vs. 1.92 ± 1.38 mg/dL; P < 0.05).

    At baseline, celiacs showed increased IMT (0.082 ± 0.011 vs. 0.058 ± 0.012 cm; P < 0.005), with decreased endothelium-dependent dilatation (9.3 ± 1.3 vs. 11.2 ± 1.2%; P < 0.05). A gluten-free diet returned both of those factors to normal.

    According to these results, vascular impairment and unfavorable biochemical risk pattern increase the potential for young adults with celiac disease to develop early atherosclerosis. This increased risk may be largely due to chronic inflammation.

    The good news is that adopting a gluten-free diet seems to return the body to a healthy mucosal state and returns the body to the normal risk levels of a healthy non-celiac person.

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  • About Me

    Jefferson Adams is a freelance writer living in San Francisco. He has covered Health News for Examiner.com, and provided health and medical content for Sharecare.com. His work has appeared in Antioch Review, Blue Mesa Review, CALIBAN, Hayden's Ferry Review, Huffington Post, the Mississippi Review, and Slate, among others.

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  • Related Articles

    Scott Adams
    Celiac.com 02/26/2003 - The subject of cardiology-related symptoms of celiac disease and celiac disease-associated cardiological disease has not been reviewed. So, here I attempt to summarize readings of research papers and abstracts of research papers dealing with the topic. My interest in cardiac related issues in association with celiac disease is related to a familial history of hypertrophic cardiomyopathy which like celiac disease can be missed and some times before a person is found to have it he/she may experience an episode of sudden cardiac arrest, or syncope (fainting). End stage hypertrophic cardiomyopathy can look like dilated cardiomyopathy. Dilated cardiomyopathy has been associated with celiac disease.
    Celiac disease and Cardiomyopathy and Heart Failure
    A study of 642 patients who were candidates for heart transplant in Italy found that 1.9% had anti-endomysial antibodies (AEA) (compared to 0.35% of 720 healthy controls) and that 2.2% of 275 patients with dilated cardiomyopathy were AEA-positive (compared to 1.6% in the remaining transplant candidates) (Prati D, et al, 2002, Am J Gastroenterol 97:218; Prati D, et al, 2002, Dig Liver Dis 34:39). Although an association was found, there was no way to assess cause and effect. The AEA-positive patients and AEA-negative patients presented with similar cardiologic criteria and had similar 2-year post-transplant survival. Similar, but more limited findings were described in preliminary data (Curione M, et al, 1997, Lancet 354: 222). The authors suggest a study of whether a gluten-free diet improves cardiac function in such patients. A study in Italy found that 5% of 60 elderly (over 65 years) celiac disease patients died during the study due to heart failure (Gasbarrini G, et al, 2001, Gerontology 47:306). The authors determined that this was significantly higher than the non-celiac disease population, but dont give a non-celiac disease rate. Furthermore, 0.4% of 226 non-elderly adult celiac disease patients died with heart failure as the cause and this rate was not significantly higher than the comparable non-celiac disease population. Other cardiological symptoms and disorders were not assessed.
    Common Causes?
    In a case study, similar cellular changes were found in both the intestinal microvilli and the heart muscle of a patient who had both idiopathic congestive cardiomyopathy and celiac disease (Chuaqui B, et al, 1986, Pathol Res Pract 181:604). While this was a limited study and the molecular causes of each were not evaluated, it is an intriguing find. In another case study, a celiac disease patient also had recurrent hemoptysis and developed heart block (Mah MW, et al, 1989, Can J Cardiol 5:191). The authors hypothesize that there is a common cause of the symptoms above. The cause is undefined by the authors. Similarly, a patient who had chronic anemia, cardiomyopathy, and heart block but did not have digestive symptoms was found to have anti-gliadin antibodies (AGA), AEA, and anti-reticulin antibodies (ARA) as well as the typical celiac biopsy (Rubio JLC, et al, 1998, Am J Gastroenterol 93:1391). The authors found that after 1 year of gluten-free diet, blood tests and biopsy were normal and confirm celiac disease as a diagnosis; but they do not mention whether or not the cardiomyopathy and heart block resolved.
    Celiac Disease and Autoimmune Myocarditis
    In an Italian study, 187 patients, including 110 with heart failure and 77 with arrhythmias, diagnosed with myocarditis were tested for celiac disease (Frustaci A, et al, 2002, Circulation 105:2611). Thirteen patients had IgA tissue transglutaminase antibodies (tTGA); all had anemia. Nine of the thirteen were AEA-positive; these patients also had abnormal biopsies. Thus, 4.4% of myocarditis patients had celiac disease (they compare this to 0.6% in the non-myocarditis population; this was statistically significant. Eight of the nine myocarditis patients with celiac disease had HLA DQ2-DR3, the other patient had DQ2-DR5/DR7. Five of the nine myocarditis patients with celiac disease had heart failure and were treated with immunosuppression and gluten-free diet. The other four myocarditis patients with celiac disease had heart arrhythmias and were treated with gluten-free diet. All nine patients markedly improved in cardiologic features and were tTG- and AEA-negative post-treatment (8-12 months) .
    Other Cardiologic Diseases
    Celiac Disease and Ischemic heart disease: In a report made in 1976, celiac disease was associated with a decrease in ischemic heart disease in 77 members of the Coeliac Society of England and Wales (Whorwell PJ, et al, 1976, Lancet 2:113). In another study with 653 celiac disease patients, the authors found no decrease in ischemic heart disease or stroke for celiac disease patients (Logan RF, et al, 1989, Gastroenterology 97:265). A recent study examined the risk factors for ischemic heart disease in dermatitis Herpetaformis patients (Lear JT, et al, 1997, J Royal Soc Med 90:247). The authors found that, compared to the normal population, dermatitis Herpetaformis patients had lower cholesterol, lower triglycerides, lower apolipoprotein B, lower fibrinogen, higher HDL2, smoked less, and were generally of higher social class.
    Pericarditis
    Dermatitis herpetiformis has also been found to be associated with recurrent pericarditis (Afrasiabi R, et al, 1990, Chest 97:1006). The authors found IgG, IgA, and complement in the pericardium, thus demonstrating similarities with the skin deposition of IgA in dermatitis Herpetaformis lesions.
    Summary
    While there hasnt been a comprehensive review by a celiac disease researcher, the research papers summarized here point to a correlation of celiac disease with cardiomyopathy, heart arrhythmias, and heart failure. The authors of the articles summarized here often point to a probable association of autoimmune disease in both celiac disease and related heart diseases.
    Glossary of terms:
    Cardiomyopathy: aberrant heart muscle structure. Congenital: non-inherited, usually referring to what is considered a "birth defect." Heart block: blockage of the conduction of the heart electrical signaling system which regulates the heart beat. Hemoptysis: spitting blood, usually due to lesions to the respiratory tract or voice box. Idiopathic: often used to describe something whose origin is unknown. Ischemic heart disease: heart damage due to insufficient blood flow to the heart (i.e., via the coronary arteries). Myocarditis: inflammation of the heart muscle. Pericarditis: inflammation of the pericardium, a sac which encloses the heart.

    Scott Adams
    Celiac.com 12/11/2006 – A retrospective cohort study presented by Gunnar Midhagen with his Doctoral and Licentiate Theses at Linköping University, Sweden, found that those with diagnosed celiac disease actually have a 47% lower cancer risk than the normal population, presumably because a majority of them follow a gluten-free diet (although the study did not address this). The study also found that those with celiac disease have a 38% higher mortality rate than the normal population, which is due to a 48% higher rate of death due to ischemic heart disease. It would be interesting to determine what causes the higher heart disease risk, and I would speculate that it has to do with fat absorption—specifically the decreased ability of those with celiac disease to absorb omega-3 fatty acids. More on this topic can be found in this article:
    Heart Failure, Cardiomyopathy and Celiac Disease By Laura Yick Here is the abstract of the study:


    High Mortality in Ischemic Heart Disease in Patients with Celiac Disease
    Gunnar Midhagen
    Department of Internal Medicine, Skovde Hospital, Skovde, Sweden
    INTRODUCTION: "Previous reports about increased risks of malignancies and mortality in patients with celiac disease have been criticized as skewed by selection bias, because they emanate from referral centers. Recent register based studies indicate lower risks, but are contingent on complete registration."
    AIMS & METHODS: "Our aim was to perform a retrospective cohort study of all celiac disease patients residing in two Swedish counties and evaluate the risks of malignancies and excess mortality. All diagnosed celiac disease patients 15 years or older who were residents of the örebro and Linköping hospitals primary catchment areas on 31 Dec. 1986 were identified and followed up for at least 15 years. All celiac disease patients were checked against the Swedish hospital inpatient register. Standardized mortality ratios (SMR) and standard incidence ratios of cancer (SIR) were calculated."
    RESULTS: "There was a 47 percent lower risk of all malignancies in our total celiac population SIR=0.53 (95% C.I. 0.31-0.83) as compared with the general population. Total mortality was increased by 38% (SMR 1.38, 95% C.I. 1.08-1.75) as compared with the general population and was most pronounced in patients over 65 years (SMR 1.46).This was mainly explained by a 48% increased death rate in ischemic heart disease, significant in patients over 65 years (SMR 1.58, 95% C.I. 1.00-2.06). "
    CONCLUSION: "In a population based setting including all patients with celiac disease, there was no increased risk of malignancies. However, this study confirms an excess mortality risk, which appears to be attributable to ischemic heart disease mainly in patients over 65 years of age."

    Jefferson Adams
    Celiac.com 04/07/2009 - Idiopathic portal hypertension is a malady ofunknown cause, typically manifesting portal hypertension, splenomegalyand anemia secondary to hypersplenism.
    Recently, a team ofIranian researchers encountered the case of a a 54-year-old maleadmitted for evaluation of malaise, weight loss, abdominal swelling andedema of the lower limbs.
    The reporting team was made up ofdoctors Farhad Zamani, Afsaneh Amiri, Ramin Shakeri, Ali Zare, andMehdi Mohamadnejad, of the Department of Pathology, and theGastrointestinal and Liver Disease Research Center of FirouzgarHospital at the University of Medical Sciences in Tehran, and theDigestive Disease Research Center of Shariati Hospital at TehranUniversity of Medical Sciences.
    The patient's clinicalevaluation showed pancytopenia, large ascites, splenomegaly andesophageal anomalies associated with portal hypertension.
    Bloodtests and small intestinal biopsy showed the presence of celiacdisease. Patient's symptoms improved with a gluten-free diet, butimprovement was further impaired by ulcerative jejunoileitis, andintestinal T-cell lymphoma.
    From these results, the researchersconclude that celiac disease, by means of a heightened immune responsein the splenoportal axis, can lead to the development of idiopathicportal hypertension in susceptible affected patients.
    J Med Case Reports. 2009; 3: 68.


    Jefferson Adams
    Celiac.com 04/20/2009 - Faced with cases of idiopathic dilated cardiomyopathy that seemed to coincide with celiac disease, a team of Turkish researchers recently set out to determine if a possible connection exists between the two conditions.
    The team was made up of Tugcin B. Polat, Nafiye Urganci, Yalim Yalcin, Cenap Zeybek, Celal Akdeniz, Abdullah Erdem, Elnur Imanov, and Ahmet Celebi, affiliated with the Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, and/or with the Clinic of Pediatrics, Sisli Etfal Hospital, Istanbul, Turkey.
    To date, little has been studied about cardiac function specifically as it relates to celiac disease. The researchers undertook their study to assess cardiac functions using Tissue Doppler Echocardiography in patients with celiac disease.
    The team evaluated 45 clinically stable patients. the time of echocardiographic evaluation, 25 patients showed positive serum IgA Antiendomysial Antibody levels (Group 1), 20 patients showed negative serum IgA Antiendomysial Antibody levels (Group 2). 30 healthy, disease-free children served as a control group.
    Group 1 showed substantially lower myocardial systolic wave velocity of the mitral annulus (p < 0.001), while Group 2 showed slightly longer myocardial precontraction and contraction times compared to controls (p = 0.015, p = 0.044, respectively).
    Researchers noted a negative association between the serum IgA Antiendomysial Antibody levels and myocardial systolic wave levels for all subjects (r =−0.633; p < 0.001). A myocardial systolic wave velocity of <8.9 cm/s showed 92% sensitivity and 80% specificity in anticipating patients with positive serum IgA Anti-endomysial Antibody levels.
    The team concluded that children with celiac disease coupled with prominent serum IgA Anti-endomysial antibody reactivity, show higher rates of subclinical systolic dysfunction of the left ventricle. They also noted that Tissue Doppler echocardiography offers a helpful quantifiable indicator for cardiac monitoring of disease during follow up.
    Digestive and Liver Disease 40 (2008) 182–187

    Jefferson Adams
    Celiac.com 10/05/2011 - Researchers have established a number of inflammatory markers as risk factors for atrial fibrillation (AF), but they know very little about how autoimmune diseases affect AF.
    A team of researchers recently set out to examine the association between celiac disease and AF in a large cohort of patients with biopsy-verified celiac disease.
    The research team included Louise Emilsson, J. Gustav Smith, Joe West, Olle Melander, and Jonas F. Ludvigsson.
    They are affiliated variously with Arvika Hospital in Arvika, Sweden, the Department of Cardiology at Lund University in Lund, Sweden, the Broad Institute of Harvard and MIT in Cambridge, MA, USA, the Department of Clinical Sciences at Lund University in Malmö, Sweden, the Division of Epidemiology and Public Health at University of Nottingham, Nottingham City Hospital, the Nottingham Digestive Diseases Centre, NIHR Biomedical Research Unit in Nottingham, UK, the Department of Pediatrics, Örebro University Hospital in Örebro, Sweden, the Clinical Epidemiology Unit, Department of Medicine at Karolinska University Hospital and Karolinska Institutet in Stockholm, Sweden.
    For their study, the team used reports from biopsies performed between 1969 and 2008 at all 28 pathology departments in Sweden. They used reports of March 3 villous atrophy to identify 28,637 patients with celiac disease.
    The team then used the Swedish Total Population Register to compile a group of 141,731 individuals, who were matched for age and sex.
    The team gathered data on AF via the Swedish Hospital Discharge Register, the Hospital Outpatient Register, and the Cause of Death Register. They used Cox regression to estimated hazard ratios (HRs) for AF.
    Over an average follow-up period of nine-years, 941 individuals form the group with celiac disease developed AF, compared with 2918 from the control group.
    The adjusted HR for AF was 1.34 (95% CI = 1.24–1.44). The absolute risk of AF for the group with celiac disease was 321 for each 100,000 person-years, with an excess risk of 81 of 100,000.
    People with a prior AF diagnosis also faced a higher risk of subsequent celiac disease (odds ratio = 1.45, 95% CI = 1.31–1.62).
    The data show that atrial fibrillation is slightly more common both before and after celiac disease diagnosis in patients with celiac disease.
    Potential explanations for higher AF risk in people with celiac disease include chronic inflammation and shared risk factors, but sampling bias may also play a part.
    These results indicate that people with  biopsy-proven celiac disease face a slightly higher risk of atrial fibrillation.
    These findings are consistent with previous studies that increased levels of inflammatory markers means higher levels of atrial fibrillation.
    However, further study is required to isolate the direct link between atrial fibrillation and autoimmune diseases, such as celiac disease.
    Source:

    http://eurheartj.oxfordjournals.org/content/early/2011/06/07/eurheartj.ehr167.short?rss=1

    Jefferson Adams
    Celiac.com 05/05/2014 - People with celiac disease face double the risk of coronary artery disease compared with the general population, according to research to be presented at the American College of Cardiology's 63rd Annual Scientific Session.
    The data for the study were gathered by researchers using electronic health records of patients from 13 participating health care systems between January 1999 and September 2013. Out of a total of nearly 22.4 million patients, they found 24,530 with celiac disease. Patients without celiac disease served as controls.
    The researchers found was no difference in smoking status or diabetes rates between the two groups. Those with celiac disease had slightly higher cholesterol levels, but lower rates of high blood pressure.
    All patients were adults. For both groups, the team found comparable rates of traditional risk factors for coronary artery disease including sex, race, diabetes, high cholesterol, high blood pressure and smoking.
    Overall, the researchers found a significantly higher rates of coronary artery disease among patients with celiac disease compared to the control population. The rates were 9.5 percent for patients with celiac disease, compared to 5.6 percent, of the general population.
    Data showed a similar trend among younger patients, those under age 65, with with 4.5 percent of patients with celiac disease compared to 2.4 percent for those without celiac disease.
    People with celiac disease have some persistent low-grade inflammation in the gut that can spill immune mediators into the bloodstream, which can then accelerate the process of atherosclerosis and, in turn, coronary artery disease," said R.D. Gajulapalli, M.D., clinical associate at the Cleveland Clinic and co-investigator of the study.
    These findings “reinforce the idea that chronic inflammation, whether it's from an infection or a disease, can have an adverse role in coronary artery disease and general heart health, even in the absence of traditional cardiovascular risk factors," Gajulapalli said.
    The team was surprised by the “strength of the association, especially in younger people,” and, in addition to further study, they are calling for patients and doctors to be aware of this association.
    Source:
    Medical express.com

  • Recent Articles

    Jefferson Adams
    Celiac.com 06/23/2018 - If you’re looking for a great gluten-free Mexican-style favorite that is sure to be a big hit at dinner or at your next potluck, try these green chili enchiladas with roasted cauliflower. The recipe calls for chicken, but they are just as delicious when made vegetarian using just the roasted cauliflower. Either way, these enchiladas will disappear fast. Roasted cauliflower gives these green chili chicken enchiladas a deep, smokey flavor that diners are sure to love.
    Ingredients:
    2 cans gluten-free green chili enchilada sauce (I use Hatch brand) 1 small head cauliflower, roasted and chopped 6 ounces chicken meat, browned ½ cup cotija cheese, crumbled ½ cup queso fresco, diced 1 medium onion, diced ⅓ cup green onions, minced ¼ cup radishes, sliced 1 tablespoon cooking oil 1 cup chopped cabbage, for serving ½ cup sliced cherry or grape tomatoes, for serving ¼ cup cilantro, chopped 1 dozen fresh corn tortillas  ⅔ cup oil, for softening tortillas 1 large avocado, cut into small chunks Note: For a tasty vegetarian version, just omit the chicken, double the roasted cauliflower, and prepare according to directions.
    Directions:
    Heat 1 tablespoon oil in a cast iron or ovenproof pan until hot.
    Add chicken and brown lightly on both sides. 
    Remove chicken to paper towels to cool.
     
    Cut cauliflower into small pieces and place in the oiled pan.
    Roast in oven at 350F until browned on both sides.
    Remove from the oven when tender. 
    Allow roasted cauliflower to cool.
    Chop cauliflower, or break into small pieces and set aside.
    Chop cooled chicken and set aside.
    Heat 1 inch of cooking oil in a small frying pan.
    When oil is hot, use a spatula to submerge a tortilla in the oil and leave only long enough to soften, about 10 seconds or so. 
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    Roxanne Bracknell
    Celiac.com 06/22/2018 - The rise of food allergies means that many people are avoiding gluten in recent times. In fact, the number of Americans who have stopped eating gluten has tripled in eight years between 2009 and 2017.
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    The Irish capital of Dublin, meanwhile, has the most gluten-free establishments, with a huge 330 to choose from, while Amsterdam and Barcelona also feature prominently thanks to their variety of top-notch gluten-free fodder.
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    The full top ten gluten-free cities are shown in the graphic below:
     

    Jefferson Adams
    Celiac.com 06/21/2018 - Would you buy a house advertised as ‘gluten-free’? Yes, there really is such a house for sale. 
    It seems a Phoenix realtor Mike D’Elena is hoping that his trendy claim will catch the eye of a buyer hungry to avoid gluten, or, at least one with a sense of humor. D’Elena said he crafted the ads as a way to “be funny and to draw attention.” The idea, D’Elena said, is to “make it memorable.” 
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    Still, the signs seem to be working. D'elena had fielded six offers within a few days of listing the west Phoenix home.
    "Buying can sometimes be the most stressful thing you do in your entire life so why not have some fun with it," he said. 
    What do you think? Clever? Funny?
    Read more at Arizonafamily.com.

    Advertising Banner-Ads
    Bakery On Main started in the small bakery of a natural foods market on Main Street in Glastonbury, Connecticut. Founder Michael Smulders listened when his customers with Celiac Disease would mention the lack of good tasting, gluten-free options available to them. Upon learning this, he believed that nobody should have to suffer due to any kind of food allergy or dietary need. From then on, his mission became creating delicious and fearlessly unique gluten-free products that were clean and great tasting, while still being safe for his Celiac customers!
    Premium ingredients, bakeshop delicious recipes, and happy customers were our inspiration from the beginning— and are still the cornerstones of Bakery On Main today. We are a fiercely ethical company that believes in integrity and feels that happiness and wholesome, great tasting food should be harmonious. We strive for that in everything we bake in our dedicated gluten-free facility that is GFCO Certified and SQF Level 3 Certified. We use only natural, NON-GMO Project Verified ingredients and all of our products are certified Kosher Parve, dairy and casein free, and we have recently introduced certified Organic items as well! 
    Our passion is to bake the very best products while bringing happiness to our customers, each other, and all those we meet!
    We are available during normal business hours at: 1-888-533-8118 EST.
    To learn more about us at: visit our site.

    Jefferson Adams
    Celiac.com 06/20/2018 - Currently, the only way to manage celiac disease is to eliminate gluten from the diet. That could be set to change as clinical trials begin in Australia for a new vaccine that aims to switch off the immune response to gluten. 
    The trials are set to begin at Australia’s University of the Sunshine Coast Clinical Trials Centre. The vaccine is designed to allow people with celiac disease to consume gluten with no adverse effects. A successful vaccine could be the beginning of the end for the gluten-free diet as the only currently viable treatment for celiac disease. That could be a massive breakthrough for people with celiac disease.
    USC’s Clinical Trials Centre Director Lucas Litewka said trial participants would receive an injection of the vaccine twice a week for seven weeks. The trials will be conducted alongside gastroenterologist Dr. James Daveson, who called the vaccine “a very exciting potential new therapy that has been undergoing clinical trials for several years now.”
    Dr. Daveson said the investigational vaccine might potentially restore gluten tolerance to people with celiac disease.The trial is open to adults between the ages of 18 and 70 who have clinically diagnosed celiac disease, and have followed a strict gluten-free diet for at least 12 months. Anyone interested in participating can go to www.joinourtrials.com.
    Read more at the website for Australia’s University of the Sunshine Coast Clinical Trials Centre.

    Source:
    FoodProcessing.com.au