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      Frequently Asked Questions About Celiac Disease   04/24/2018

      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 is Celiac Disease and the Gluten-Free Diet? 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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    TREATMENT FOR INTESTINAL PERMEABILITY BY ROY JAMRON


    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.


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    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


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    admin

    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.

    Jefferson Adams
    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.
    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:

    Autoimmun Highlights (2010) 1:37–38. DOI 10.1007/s13317-010-0006-4

    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 04/25/2018 - A team of Yale University researchers discovered that bacteria in the small intestine can travel to other organs and trigger an autoimmune response. In this case, they looked at Enterococcus gallinarum, which can travel beyond the gut to the spleen, lymph nodes, and liver. The research could be helpful for treating type 1 diabetes, lupus, and celiac disease.
    In autoimmune diseases, such as type 1 diabetes, lupus, and celiac disease, the body’s immune system mistakenly attacks healthy cells and tissues. Autoimmune disease affects nearly 24 million people in the United States. 
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    Celiac.com 04/24/2018 - Did you know in 2017 alone, the United States had OVER TENS OF THOUSANDS of people evacuate their homes due to natural disasters such as fires, floods, hurricanes, tornadoes and tsunamis? Most evacuation sites are not equipped to feed your family the safe gluten free foods that are required to stay healthy.  Are you prepared in case of an emergency? Do you have your Gluten Free Emergency Food Bag ready to grab and go?  
    I have already lived through two natural disasters. Neither of which I ever want to experience again, but they taught me a very valuable lesson, which is why I created a Gluten Free Emergency Food Bag (see link below). Here’s my story. If you’ve ever lived in or visited the Los Angeles area, you’re probably familiar with the Santa Ana winds and how bitter sweet they are. Sweet for cleaning the air and leaving the skies a brilliant crystal blue, and bitter for the power outages and potential brush fires that might ensue.  It was one of those bitter nights where the Santa Ana winds were howling, and we had subsequently lost our power. We had to drive over an hour just to find a restaurant so we could eat dinner. I remember vividly seeing the glow of a brush fire on the upper hillside of the San Gabriel Mountains, a good distance from our neighborhood. I really didn’t think much of it, given that it seemed so far from where we lived, and I was hungry! After we ate, we headed back home to a very dark house and called it a night. 
    That’s where the story takes a dangerous turn….about 3:15am. I awoke to the TV blaring loudly, along with the lights shining brightly. Our power was back on! I proceeded to walk throughout the house turning everything off at exactly the same time our neighbor, who was told to evacuate our street, saw me through our window, assuming I knew that our hillside was ablaze with flames. Flames that were shooting 50 feet into the air. I went back to bed and fell fast asleep. The fire department was assured we had left because our house was dark and quiet again. Two hours had passed.  I suddenly awoke to screams coming from a family member yelling, “fire, fire, fire”! Flames were shooting straight up into the sky, just blocks from our house. We lived on a private drive with only one way in and one way out.  The entrance to our street was full of smoke and the fire fighters were doing their best to save our neighbors homes. We literally had enough time to grab our dogs, pile into the car, and speed to safety. As we were coming down our street, fire trucks passed us with sirens blaring, and I wondered if I would ever see my house and our possessions ever again. Where do we go? Who do we turn to? Are shelters a safe option? 
    When our daughter was almost three years old, we left the West Coast and relocated to Northern Illinois. A place where severe weather is a common occurrence. Since the age of two, I noticed that my daughter appeared gaunt, had an incredibly distended belly, along with gas, stomach pain, low weight, slow growth, unusual looking stool, and a dislike for pizza, hotdog buns, crackers, Toast, etc. The phone call from our doctor overwhelmed me.  She was diagnosed with Celiac Disease. I broke down into tears sobbing. What am I going to feed my child? Gluten is everywhere.
    After being scoped at Children's Hospital of Chicago, and my daughters Celiac Disease officially confirmed, I worried about her getting all the nutrients her under nourished body so desperately needed. I already knew she had a peanut allergy from blood tests, but just assumed she would be safe with other nuts. I was so horribly wrong. After feeding her a small bite of a pistachio, which she immediately spit out, nuts would become her enemy. Her anaphylactic reaction came within minutes of taking a bite of that pistachio. She was complaining of horrible stomach cramps when the vomiting set in. She then went limp and starting welting. We called 911.
    Now we never leave home without our Epipens and our gluten free food supplies. We analyze every food label. We are hyper vigilant about cross contamination. We are constantly looking for welts and praying for no stomach pain. We are always prepared and on guard. It's just what we do now. Anything to protect our child, our love...like so many other parents out there have to do every moment of ever day!  
    Then, my second brush with a natural disaster happened, without any notice, leaving us once again scrambling to find a safe place to shelter. It was a warm and muggy summer morning, and my husband was away on a business trip leaving my young daughter and me to enjoy our summer day. Our Severe Weather Alert Radio was going off, again, as I continued getting our daughter ready for gymnastics.  Having gotten used to the (what seemed to be daily) “Severe Thunderstorm warning,” I didn’t pay much attention to it. I continued downstairs with my daughter and our dog, when I caught a glimpse out the window of an incredibly black looking cloud. By the time I got downstairs, I saw the cover to our grill literally shoot straight up into the air. Because we didn’t have a fenced in yard, I quickly ran outside and chased the cover, when subsequently, I saw my neighbor’s lawn furniture blow pass me. I quickly realized I made a big mistake going outside. As I ran back inside, I heard debris hitting the front of our home.  Our dog was the first one to the basement door! As we sat huddled in the dark corner of our basement, I was once again thinking where are we going to go if our house is destroyed. I was not prepared, and I should have been. I should have learned my lesson the first time. Once the storm passed, we quickly realized we were without power and most of our trees were destroyed. We were lucky that our house had minimal damage, but that wasn’t true for most of the area surrounding us.  We were without power for five days. We lost most of our food - our gluten free food.
    That is when I knew we had to be prepared. No more winging it. We couldn’t take a chance like that ever again. We were “lucky” one too many times. We were very fortunate that we did not lose our home to the Los Angeles wildfire, and only had minimal damage from the severe storm which hit our home in Illinois.
      
    In 2017 alone, FEMA (Federal Emergency Management Agency) had 137 natural disasters declared within the United States. According to FEMA, around 50% of the United States population isn’t prepared for a natural disaster. These disasters can happen anywhere, anytime and some without notice. It’s hard enough being a parent, let alone being a parent of a gluten free family member. Now, add a natural disaster on top of that. Are you prepared?
    You can find my Gluten Free Emergency Food Bags and other useful products at www.allergynavigator.com.  

    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.
    The team enrolled fifty adults with symptoms and indications of celiac disease in a prospective cohort without regard to the final diagnosis.  At baseline, all individuals underwent cognitive functional and psychological evaluation. The team then compared celiac disease patients with subjects without celiac disease, and with healthy controls matched by sex, age, and education.
    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. 
    Their results indicate that cognitive dysfunction in celiac patients could be related to long-term symptoms from chronic disease, in general.
    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. 
    Under the deal, personalized digital media company Catalina will be joining forces with Label Insight. Catalina uses consumer purchases data to target shoppers on a personal base, while Label Insight works with major companies like Kellogg, Betty Crocker, and Pepsi to provide insight on food label data to government, retailers, manufacturers and app developers.
    "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.” 
    Label Insight’s clients include food and beverage giants such as Unilever, Ben & Jerry's, Lipton and Hellman’s. Label Insight technology has helped the Food and Drug Administration (FDA) build the sector’s very first scientifically accurate database of food ingredients, health attributes and claims.
    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