• Join our community!

    Do you have questions about celiac disease or the gluten-free diet?

  • Ads by Google:
     




    Get email alerts Subscribe to Celiac.com's FREE weekly eNewsletter

    Ads by Google:



       Get email alertsSubscribe to Celiac.com's FREE weekly eNewsletter

  • Member Statistics

    77,936
    Total Members
    3,093
    Most Online
    Bushet
    Newest Member
    Bushet
    Joined
  • 0

    The Role of Microscopic Enteritis in Celiac Disease Malabsorption


    Jefferson Adams
    Image Caption: New research on microscopic enteritis and celiac disease.

    Celiac.com 04/27/2011 - People with microscopic enteritis have microscopic and sub-microscopic changes that are associated with symptoms of gluten sensitive enteropathy, and which lead to micronutrient deficiencies. A team of researchers recently set out to examine microscopic enteritis and the pathomechanism of malabsorption.


    Ads by Google:




    ARTICLE CONTINUES BELOW ADS
    Ads by Google:



    The research team included Kamran Rostami, David Al Dulaimi, Mohammad Rostami Nejad, Vincenzo Villanacci, and Mihai Danciu. They are affiliated variously with the School of Medicine, University of Birmingham, UK, the Department of Gastroenterology, Alexander Hospital in Redditch, UK, the Nejad Research Center of Gastroenterology and Liver disease, Shaheed Beheshti University, M.C., in Tehran, Iran, the 2nd Department of Pathology, Spedali Civili, University of Brescia Italy, and the “Gr. T. Popa” University of Medicine and Pharmacy in Iasi, Romania.

    Signs of microscopic enteritis include subtle mucosal abnormalities with no pronounced inflammation, villous effacement, erosions or ulcerations when observed with conventional light microscopy.

    In cases of microscopic enteritis intraepithelial lymphocytes usually fall within the normal range <25/100 enterocytes (microenteropathy), or increased (lymphocytic enteritis).

    Microscopic enteritis is the driving force behind atypical forms of celiac disease, previously known as 'potential' and 'latent' celiac disease. Even when there are no major mucosal changes, systemic, microscopic inflammation is a key player in pathophysiology of micro-nutrient deficiency.

    Microscopic enteritis or celiac disease with milder, Marsh 0–II, enteropathy is the most common feature of atypical gluten sensitivity, while celiac disease with macroscopic enteritis, and Marsh IIa–c  is less common.

    Importantly, and in contrast to much prevailing belief, symptom severity in celiac disease seems to be unrelated to the degrees or length of affected bowel.

    The microenteropathy may eventually develop into pronounced villous atrophy, but one interesting finding was that severe mucosal damage does not necessarily mean worse symptoms. People with mild symptoms can have more severe damage, while those with little or no visible damage can have more severe symptoms.

    The finding that nutritional deficiency can be seen in patients presenting with even submicroscopic enteropathy casts doubt on the notion that severe mucosal changes, such as villous atrophy, are the sole driver of malabsorption.

    In fact, more and more, systemic inflammation seems to be the main driver of nutritional deficiency in such cases.

    Pro-inflammatory cytokines, such as TNF, appear to act at the enterocyte level, inhibiting the uptake of micronutrients like iron and phosphate. From this, it appears that malabsorption in celiac disease is secondary to inflammation and cytokine stimulation.

    This might explain why some patients experience milder, 'atypical' enteropathy that acts just like full-blown celiac disease. In fact, inflammation triggered by gluten-sensitized lymphocytes and cytokine stimulation seems to drive the micronutrient deficiencies in celiac disease patients, with or without villous atrophy.

    This finding is supported by several studies that show malabsorption syndrome to be no worse in patients with villous atrophy than in those with microenteropathy (Marsh 0–II).

    This theory is further bolstered by the fact that many people suffer from non-symptomatic, silent celiac disease with villous atrophy, and mucosal lesions that persist after years of successful gluten-free treatment.

    Over the last few years, the only type of gluten sensitivity doctors have identified is atypical presentation with microenteropathy resulting in micronutrient deficiencies.

    However, the team points to recent studies by Kurppa et al., and Ludvigsson et al., that suggest simple changes can improve life quality for celiac disease patients with milder enteropathy.

    The researchers feel strongly that patients with milder enteropathy and positive serology may benefit from a gluten-free diet, and that autoantibodies might have a more reliable positive predictive value than histology, especially in early enteropathy.

    Diagnosing celiac disease in its early stages, especially with little or no mucosal damage, can be very challenging. However, new studies are paving the way toward a better understanding of gluten sensitivity with microenteropathy. As a result, more patients with microenteropathy, symptoms of micronutrient deficiency and positive serology are being presented with the possible benefits of a gluten-free diet.

    Source:

    0


    User Feedback

    Recommended Comments

    Guest Cristina

    Posted

    Very important for celiac people. Thanks

    Share this comment


    Link to comment
    Share on other sites
    Guest Melissa

    Posted

    Excellent information

    Share this comment


    Link to comment
    Share on other sites
    Guest Suzanne

    Posted

    Great article. Thanks for sharing this info.

    Share this comment


    Link to comment
    Share on other sites


    Your content will need to be approved by a moderator

    Guest
    You are commenting as a guest. If you have an account, please sign in.
    Add a comment...

    ×   Pasted as rich text.   Paste as plain text instead

      Only 75 emoji are allowed.

    ×   Your link has been automatically embedded.   Display as a link instead

    ×   Your previous content has been restored.   Clear editor

    ×   You cannot paste images directly. Upload or insert images from URL.


  • Ads by Google:

  • 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.

  • Popular Contributors

  • Ads by Google:

  • Who's Online   9 Members, 0 Anonymous, 430 Guests (See full list)

  • Related Articles

    Scott Adams
    Dig Dis Sci. 2005 Apr;50(4):785-90.
    Celiac.com 05/09/2005 – To determine the effect a long-term gluten-free diet has on intestinal permeability in those with celiac disease, Canadian researchers divided celiac disease patients into three groups based on the length of time on a gluten-free diet: Group A less than 1 month; Group B, 1 month-1 year; Group C more than 1 year. Groups B and C were tested three times over the course of 12 weeks for lactulose/mannitol intestinal permeability, endomysial antibody, and 3-day food record. These results were compared to that of Group A and control subjects. The researchers found that intestinal permeability was elevated in those newly diagnosed with celiac disease and in those who were on a gluten-free diet for less than one year. They also found that it increased in those on a gluten-free diet for more than one year in those whose diets were contaminated with gluten. The researchers conclude that intestinal permeability normalizes in most people with celiac disease on a gluten-free diet, and gluten ingestion as determined by a 3 day food record correlates with intestinal permeability measurements. Further studies need to be done on the role of intestinal permeability testing in the follow-up care of those with celiac disease.

    Roy Jamron
    Celiac.com 07/01/2006 - With the likelihood that increased intestinal permeability in celiacs caused by gluten damage to the intestinal mucosa leads to a high prevalance of liver damage as well as an increase in food allergy and possible other medical conditions, emphasis on healing the intestinal mucosa should be given an elevated priority. Simply going on a gluten-free diet and waiting months or years for the intestine to heal may not be enough.
    Friendly commensal gut bacteria are an important part of the intestinal barrier, and thus probiotics, such as yogurt, kefir, or supplemental
    probiotic capsules, do help diminish the amount of endotoxins released by pathogenic gut bacteria getting through the barrier. Liver disease studies confirm the benefit of probiotics by reducing inflammation and infection. However, to date, there is no product currently available which can enhance the repair and regeneration process of the mucosal epithelia.
    Undergoing current clinical studies in Crohns patients, Teduglutide may enhance mucosal healing, but requires multiple daily injections:

    Cell Prolif. 2004 Dec;37(6):385-400.
    Teduglutide ([Gly2]GLP-2) protects small intestinal stem cells from
    radiation damage.
    Booth C, Booth D, Williamson S, Demchyshyn LL, Potten CS.
    Abstract:
    http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2184.2004.00320.x
    New Crohns Disease Drug Induces Remission Through Mucosal Healing
    By Martha Kerr
    (Free article, free Medscape registration may be required.)
    http://www.medscape.com/viewarticle/533109
    A while back I posted an abstract about a protein called R-spondin1 which is "a specific and potent stimulator of the human epithelial cells that line the gastrointestinal tract and mouth." R-spondin1 is a product being developed by Nuvelo, Inc. of San Carlos, CA designated as NU206. The press release describing NU206 is:
    Nuvelo Announces NU206 Publication in Science (August 18, 2005)
    http://www.corporate-ir.net/ireye/ir_site.zhtml?ticker=NUVO&script=410&item_id=744876
    An article discussing the discovery and potentials of R-spondin1 is available in the New England Journal of Medicine, and free full text of
    that article is available at the address below:
    NEJM.-Volume 353:2297-2299 November 24, 2005 Number 21
    Inducing Intestinal Growth
    Clara Abraham, M.D., and Judy H. Cho, M.D.
    Free Full Text Reprint of NEJM article:
    http://www.e-medicum.com/newsletters/medicinaInterna/verNoticia.php?noticia=51479
    Nuvelo has recently announced plans for the "initiation of a Phase 1 study of NU206, which is being developed for the treatment of cancer therapy-induced mucositis in the second half of 2006." Obviously the benefits of NU206 go beyond that of cancer therapy. Healing the epithelial tissues of celiacs with NU206 may rapidly eliminate increased intestinal permeability and other associated conditions. Nuvelo had a live webcast of its annual shareholder meeting this Wednesday, May 24, at 11:00 am PDT. No new information on NU206 was provided at the meeting other than that plans to initiate the NU206 Phase 1 study are proceding.
    Replay of Nuvelo Webcast:
    http://www.corporate-ir.net/ireye/ir_site.zhtml?ticker=NUVO&script=1010&item_id=1234084


    Roy Jamron
    Celiac.com 05/06/2013 - After a diagnosis of celiac disease, it is unlikely a gluten-free diet alone will provide expeditious relief from its various associated symptoms and health problems.  Additional steps and remedies to restore the integrity of the damaged intestinal mucosal barrier are often needed, at least, to hasten the process.  The first step all patients should take after a celiac disease diagnosis is to establish a "baseline" measurement of the intestinal damage which can be used to assess how well the gut is healing over time.  Assessing the status of the gut via multiple endoscopic biopsy procedures is not a very practical choice of method. It is expensive, invasive, uncomfortable, subject to possible risks and complications, and only assesses the intestinal mucosa at the sites biopsied.[1]  The downsides of biopsies can be avoided by using a low-cost, non-invasive leaky gut or intestinal permeability test to provide a useful baseline measurement and following up with future periodical testing for comparison.   
    A new, simple and easy-to-use home Carbon-13 or 13C-Sucrose Breath Test to assess for leaky gut is now available.  The 13C-Sucrose Breath Test takes only 90 minutes, requiring drinking a sucrose (20 grams) solution and collecting 4 breath samples 30 minutes apart following an 8 hour fast.  13C-Sucrose Breath Test samples, collected in 4 small screw-capped glass tubes, are simply mailed to the laboratory within 14 days in the original shipping box that also serves as a pre-paid U.S. Postal Service First Class Mailer.  13C-Sucrose Breath Test results are emailed back within 24 hours after the breath test samples are received.[2] 
    In comparison, the better known and established Lactulose/Mannitol Intestinal Permeability Test requires an 8 hour overnight fast, collecting a pretest urine specimen, drinking a Lactulose(5 grams)/Mannitol(1 gram) solution, drinking water every 2 hours, and sampling and collecting all the urine excreted over a 6 hour period.  The Lactulose/Mannitol Test urine specimens must be kept refrigerated and shipped to and received by the laboratory within 24 hours in a special frozen gel pack shipper via FedEx overnight delivery.  Lactulose/Mannitol Test results are emailed around 7 days after the specimens are received.[3]
    The 13C-Sucrose Breath Test is based on the level of sucrase activity in cells of the intestinal mucosa.  Sucrase enzymes break down sucrose into its constituent components, fructose and glucose, which, when metabolized in the liver, produce carbon dioxide (CO2) exhaled in the breath.  Sucrase enzymes are synthesized and embedded in the "brush border" of cells comprising the villi of the intestinal mucosa.  The brush border is composed of numerous microvilli which extend into the intestinal lumen from the face of the villus cells.[1,4,5]
    Natural sucrose from cane sugar contains 2 forms of carbon atoms, carbon-12 (12C) and the stable, non-radioactive isotope, carbon-13 (13C).  12C and 13C carbon dioxide can be detected and measured using an isotope ratio mass spectrometer (IRMS).  By using natural 13C-enriched sucrose in which the ratio of 13C to 12C has been previously measured, measurement and analysis of the relative amounts of 13C and 12C in the carbon dioxide exhaled by an individual after ingesting a known quantity of the 13C-enriched sucrose provides an indicator of the sucrase activity in the brush border.  Damage to villus cells and the brush border results in both a decrease in sucrase activity and an increase intestinal permeability.  This forms the basis for a leaky gut test where low carbon-13 measured in the breath means the intestinal villi are damaged.[1,4]
    The Metabolic Solutions, Inc. 13C-Sucrose Breath Test is taken after a minimum 8 hour fast.  No sleep or exercise is allowed during the test.  A baseline breath sample is first collected.  Then a 20 gram packet of 13C-enriched sucrose is stirred into an 8 ounce glass of water and ingested.  Breath samples are then collected at 30, 60, and 90 minutes after sucrose ingestion.  Breath samples are collected into 4 small labeled 10 ml glass tubes with color-coded screw caps by simply unscrewing the cap, taking a full breath, and blowing into the tube through an ordinary straw.  Breath will be felt escaping out of the tube as it is blown through the straw.  That is normal.  All that is required is to screw the cap back on the tube, finger-tight, within 5 seconds.  If screwing the cap back on takes more than 5 seconds, one can simply take another breath and blow again.  After the test, the 4 tubes and the instruction sheet, filled-in with the test taker's name, email address, date of birth, sex, height and weight, are repacked into the original shipping box and dropped into any U.S. mail box within 14 days.  A prepaid U.S. Postal Service First Class mailing label is printed on the box.  Test results are emailed back within 24 hours after receipt by Metabolic Solutions, Inc.  If the percentage cumulative dose of 13C recovered from the sucrose at 90 minutes is less than 5.10% 13C for females or less than 3.91% 13C for males, the test is considered positive for intestinal damage.[2,4]
    The percentage cumulative dose of 13C recovered from sucrose over 90 minutes is calculated from the area under the curve formed by plotting the amount 13C carbon dioxide measured in each 10 ml breath sample against time, the ratio of 13C to 12C in the 20 grams of sucrose ingested, and a formula where age, sex, height and weight are used in a to compute the total amount of carbon dioxide (both 12C and 13C) that would be expirated by the test subject during the test time period.  Together, these considerations yield the desired test result expressing how much of the 20 grams of sucrose ingested has been metabolized by brush border sucrase enzymes and the liver and expelled in the breath within 90 minutes.[6,7]
    The 13C-Sucrose Breath Test was invented and developed by scientists at The Centre for Paediatric and Adolescent Gastroenterology, Children, Youth and Women’s Health Service, University of Adelaide, North Adelaide, SA Australia.  U.S. Patent 7338454 (March 4, 2008) and U.S. Patent Application 20080160504 (July 3, 2008) are assigned to Children, Youth and Women's Health Service Incorporated, North Adelaide, AU.[7,8]  Development of the 13C-Sucrose Breath Test began prior to 2002, the year an international patent application for the test was filed.[9]  Only recently has the test become available in the United States.  Because of limited published clinical studies, the 13C-Sucrose Breath Test has not yet become fully established as a standard for intestinal permeability testing, but has advantages over other tests and appears to be reliable.  Except in cases of intestinal damage, sucrase levels generally remain consistent thoughout life and across differing ethnicities.  Only 0.2% of the population has a genetic sucrase deficiency.[1,4,7]
    In only one study concerning zinc absorption in children with celiac disease has the 13C-Sucrose Breath Test been compared against Marsh scores of celiac disease patients.  That study recruited 51 children, aged 2 to 18 years, who underwent routine endoscopy for the diagnosis or exclusion of celiac disease.  There were no significant differences in 13C-Sucrose Breath Test results between children with a Marsh score of 0 and Marsh scores of 3a, 3b, and 3c.  All participants, including those with Marsh score 0, had a mean percentage cumulative dose of 13C recovered from sucrose at 90 minutes slightly below the 5.06% cut-off for a normal 13C-Sucrose Breath Test.  In a prior study, the average test result for normal healthy children (aged 11.2 +/- 0.8 years) was 8.5%.  Since all recruited children had bowel symptoms prompting an endoscopy, those children with March scores of 0, while not diagnosed with celiac disease, were not normal and healthy.  The study shows the 13C-Sucrose Breath Test is potentially useful to monitor gut integrity in celiac disease children.[10]
    Lactulose/Mannitol and the similar Lactulose/Rhamnose dual-sugar permeability tests have been studied since 1979.   Mannitol and rhamnose are small sugar molecules which normally cross the intestinal barrier via absorption through healthy intestinal cell membranes.  Lactulose is a large sugar molecule that crosses the intestinal barrier by passing between intestinal cells through the "tight junctions".  These sugars are non-metabolizable, and, therefore, the molecules which cross the intestinal barrier are excreted unchanged in the urine.  Loss of tight junctions elevates lactulose urinary levels.  Damage to intestinal cell membranes compromises absorption of mannitol or rhamnose molecules, and, thus, lowers mannitol or rhamnose urinary levels.  A high urinary lactulose to mannitol or lactulose to rhamnose ratio, therefore, indicates intestinal damage.[1]
    Lactulose/Mannitol permeability tests have been studied in celiac disease patients with mixed results as to whether the test is suitable as a screening test for celiac disease.[11-15]  Like the 13C-Sucrose Breath Test, the Lactulose/Mannitol test is probably best used to monitor the progress of gut healing by first testing intestinal permeability at the time of celiac disease diagnosis to establish a baseline for subsequent follow-up tests.
    The two tests are available online at competitive prices.  Metabolic Solutions Inc. currently offers the 13C Sucrose Breath Test for $129 which includes shipping.  The Genova Diagnostics Lactulose/Mannitol Intestinal Permeability Test is available at similar discounted prices from several online sellers.
    13C-Sucrose Breath Leaky Gut Test Kits are available directly from:
    Metabolic Solutions, Inc.
    460 Amherst Street
    Nashua, NH 03063
    866-302-1998
    For Health Professionals:
    http://www.metsol.com/leaky-gut-syndrome
    To Order Home Test Kits:
    http://www.breathtestingathome.com/leaky-gut/
    Lactulose/Mannitol Intestinal Permeability Test Kits are available (through retail website sellers) from:
    GDX/Genova Diagnostics
    63 Zillicoa Street
    Asheville, NC 28801
    800-522-4762
    http://www.gdx.net/product/10122
    I have personally taken the Metabolic Solutions, Inc. 13C-Sucrose Breath Leaky Gut Test.  A kit ordered online on a Monday was picked up from my post office box on Friday of the same week.  The test was taken on the following Monday, and the prepaid shipping box was dropped off at the U.S. Post Office the next day, Tuesday.  The test result was received in an email sent from Metabolic Solutions, Inc. Thursday evening, only 2 days later.  The test result was normal, 6.97% cumulative dose of 13C recovered, well above the cut-off of 3.91% for males. 
    Since no such simple and easy leaky gut test existed more than a dozen years ago when leaky gut was first suspected, no baseline was ever established for test result comparison.  Following years of diet and supplements targeted to heal leaky gut and treat its symptoms, a general indication of current gut status was desired.  Some  symptoms still remain.  A normal test result suggests the symptoms are likely due to other factors occurring before or during the leaky gut healing process, such as inflammation due to the continued presence of previously "leaked" environmental toxins accumulated in adipose tissue.   
    Sources
    1. Mucositis and non-invasive markers of small intestinal function.
    Tooley KL, Howarth GS, Butler RN.
    Cancer Biol Ther. 2009 May;8(9):753-8.
    http://www.landesbioscience.com/journals/cbt/article/8232/01-TooleyCBT8-9.pdf
    2. Instructions for Leaky Gut Breath Test.
    Metabolic Solutions, Inc.
    http://www.breathtestingathome.com/leaky-gut/instructions-leaky-gut/
    3. GDX Lactulose/Mannitol Intestinal Permeability Test Kit Instructions.
    Genova Diagnostics.
    http://www.gdx.net/core/domestic-kit-instructions/Intestinal-Permeability-Instructions.pdf
    4. 13C-Sucrose Breath Test for Leaky Gut Syndrome.
    Metabolic Solutions, Inc.
    http://www.metsol.com/leaky-gut-syndrome
    5. Small Intestine: Brush Border Enzymes.
    R. Bowen.
    Pathophysiology of the Digestive System, Colorado State University.
    http://www.vivo.colostate.edu/hbooks/pathphys/digestion/smallgut/bbenzymes.html
    6. Recent Results of the Development and Application of 13C–Breath Tests.
    Klaus Wetzel and Heinz Fischer.
    Fischer ANalysen Instrumente GmbH (FAN), Leipzig, December 1999, Page 33.
    http://www.fan-gmbh.de/docs/13c_recent_results.pdf
    7. Breath Test.
    Butler RN, Tivey D, Davidson GP, Pelton N.
    U.S. Patent 7338454, March 4, 2008.
    http://www.google.com/patents/US7338454
    8. Breath Test.
    Butler RN, Tivey D, Davidson GP, Pelton N.
    U.S. Patent Application 20080160504, July 3, 2008.
    http://www.google.com/patents/US20080160504
    9. Breath test.
    Butler RN, Tivey D, Davidson GP, Pelton N.
    International Application No.: PCT/AU2002/001666, December 9, 2002.
    10. Zinc homeostasis and gut function in children with celiac disease.
    Tran celiac disease, Katsikeros R, Manton N, Krebs NF, Hambidge KM, Butler RN, Davidson GP.
    Am J Clin Nutr. 2011 Oct;94(4):1026-32.
    http://ajcn.nutrition.org/content/94/4/1026.long
    11. Follow-up of adult celiac patients: which noninvasive test reflects mucosal status most reliably?
    Vecsei AK, Graf UB, Vogelsang H.
    Endoscopy. 2009 Feb;41(2):123-8.
    http://www.ncbi.nlm.nih.gov/pubmed/19214890
    12. Intestinal permeability in long-term follow-up of patients with celiac disease on a gluten-free diet.
    Duerksen DR, Wilhelm-Boyles C, Parry DM.
    Dig Dis Sci. 2005 Apr;50(4):785-90.
    http://www.ncbi.nlm.nih.gov/pubmed/15844719
    13. Lactulose-mannitol intestinal permeability test: a useful screening test for adult coeliac disease.
    Johnston SD, Smye M, Watson RG, McMillan SA, Trimble ER, Love AH.
    Ann Clin Biochem. 2000 Jul;37 ( Pt 4):512-9.
    http://www.ncbi.nlm.nih.gov/pubmed/10902869
    14. Lactulose-mannitol intestinal permeability test: a useful screening test for adult coeliac disease.
    Johnston SD, Smye M, Watson RG, McMillan SA, Trimble ER, Love AH.
    Ann Clin Biochem. 2000 Jul;37 ( Pt 4):512-9.
    http://www.ncbi.nlm.nih.gov/pubmed/10902869
    15. Is the sugar intestinal permeability test a reliable investigation for coeliac disease screening?
    Catassi C, Fabiani E, Rätsch IM, Bonucci A, Dotti M, Coppa GV, Giorgi PL.
    Gut. 1997 Feb;40(2):215-7.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1027051/
     

  • 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. 
    Remove soft tortilla to a paper towel and repeat with remaining tortillas.
    Pour enough enchilada sauce to coat the bottom of a large casserole pan.
    Dunk a tortilla into the sauce and cover both sides. Add more sauce as needed.
    Fill each tortilla with bits of chicken, cauliflower, onion, and queso fresco, and roll into shape.
    When pan is full of rolled enchiladas, top with remaining sauce.
    Cook at 350F until sauce bubbles.
    Remove and top with fresh cotija cheese and scallions.
    Serve with rice, beans, and cabbage, and garnish with avocado, cilantro, and sliced grape tomatoes.

     

    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.
    Whatever your rationale for avoiding gluten, whether its celiac disease, a sensitivity to the protein, or any other reason, it can be really hard to find suitable places to eat out. When you’re on holiday in a new and unknown environment, this can be near impossible. As awareness of celiac disease grows around the world, however, more and more cities are opening their doors to gluten-free lifestyles, none more so than the 10 locations on the list below.
    Perhaps unsurprisingly, the U.S is a hotbed of gluten-free options, with four cities making the top 10, as well as the Hawaiian island of Maui. Chicago, in particular, is a real haven of gluten-free fare, with 240 coeliac-safe eateries throughout this huge city. The super hip city of Portland also ranks highly on this list, with the capital of counterculture rich in gluten-free cuisine, with San Francisco and Denver also included. Outside of the states, several prominent European capitals also rank very highly on the list, including Prague, the picturesque and historic capital of the Czech Republic, which boasts the best-reviewed restaurants on this list.
    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.
    Finally, a special mention must go to Auckland, the sole representative of Australasia in this list, with the largest city in New Zealand rounding out the top 10 thanks to its 180 coeliacsafe eateries.
    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.” 
    Though D’Elena’s marketing seeks to capitalizes on the gluten-free trend, he knows Celiac disease is a serious health issue for some people. “[W]e’re not here to offend anybody….this is just something we're just trying to do to draw attention and do what's best for our clients," he said. 
    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