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    In 1994 I was diagnosed with celiac disease, which led me to create Celiac.com in 1995. I created this site for a single purpose: To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives. Celiac.com was the first site on the Internet dedicated solely to celiac disease. In 1998 I founded The Gluten-Free Mall, Your Special Diet Superstore!, and I am the co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

  • Related Articles

    Roy Jamron
    Celiac.com 05/31/2006 - I previously discussed how liver abnormalities are highly prevalent in celiac disease. Why damage to the liver occurs is unknown, and gluten toxicity and increased intestinal permeability have been proposed as factors. The following free full text article appearing in the current issue of Gastroenterology may shed light on why liver damage occurs in celiacs.
    Toll-like receptors (TLRs) reside on the surface of many cells which participate in the immune system. TLRs sense molecules present in pathogens but not the host, and when the immune system senses these molecules, chemicals are released which set off inflammatory and anti-pathogen responses. One class of molecules recognized by TLRs and common to most pathogenic bacteria is lipopolysaccharides (LPS).
    Gluten increases intestinal permeability in celiacs. The disruption of the intestinal barrier permits endotoxins, such as LPS, from gut bacteria to reach the portal vein of the liver triggering a TLR response from immune cells in the liver. Proinflammatory mediators are released cascading into the release of more chemicals leading to inflammation and liver damage. This may be the cause of liver damage in celiacs. Gluten itself could also trigger a liver immune response. Kupffer cells in the liver are capable of antigen presentation to T cells, along with liver dendritic cells, and could initiate a T cell response to gluten within the liver.
    The following article is somewhat technical, but discusses the role of various liver cells involved in the immune process and how intestinal permeability and TLRs contribute to liver injury. The article is a good read and provides valuable information about the liver I have not seen elsewhere.
    Gastroenterology Volume 130, Issue 6, Pages 1886-1900 (May 2006)
    Toll-Like Receptor Signaling in the Liver
    Robert F. Schwabe, Ekihiro Seki, David A. Brenner
    Free Full Text:
    http://www.gastrojournal.org/article/PIIS0016508506000655/fulltext

    Jefferson Adams
    Celiac.com 12/06/2007 - About one person or so in every hundred has celiac disease, which means they suffer from a variety of associated symptoms along with intestinal damage and associated conditions. Research shows a connection between celiac disease and a variety of hepatic disorders. People with celiac disease have a higher instance of certain disorders of the liver. One of the most commonly presented liver problems among celiac patients is isolated hypertransaminasemia with non-specific histologic changes.
    Following a gluten-free diet usually returns the liver enzymes and histologic function to their normal state. People with celiac disease can also have unrelated liver conditions, such as primary biliary cirrhosis, autoimmune hepatitis, or primary sclerosing cholangitis.
    Most people don’t know much, if anything about celiac disease. Even most people with celiac disease or gluten intolerance face a long learning curve to get up to speed on all of the related issues that concern them. Many people with celiac disease understand that it is a condition in which an auto-immune mediated reaction to the presence of gluten from wheat, rye or barley cause damage to the lining of the intestine, which, if left untreated exposes them to greater risks of certain types of cancer, along with diabetes, and many other conditions.
    Even though it is well known among physicians that celiac disease is associated with a variety of other conditions, until recently, those associated with malabsorption were the best documented. Most doctors and researchers believed that these associated conditions were the direct result of, or closely associated with the malabsorption and a compromised nutrient uptake facing untreated celiac patients.  
    Recently, however, evidence has begun to emerge that shows celiac disease to be a multi-system disorder that might affect a wide array of organs, including the bones, the heart, the skin, the liver, and the nervous system. Evidence is emerging that shows that beyond damaging the liver outright, celiac disease might also compound the impact of chronic liver diseases when the two occur together.
    To better understand the relationship between celiac disease and various liver disorders, researchers Alberto Rubio-Tapia and Joseph A. Murray conducted a review aimed at exploring the spectrum and pathogenesis of liver maladies associated with celiac disease, and to better describe the connection between celiac disease and those liver maladies to better establish a baseline for diagnosis and therapy to help those with chronic liver ailments and to better diagnose and treat celiac disease.
    Study Method
    In June 2007, the researchers searched PubMed for English-language journals that included full-length articles with the following keywords: celiac disease, sprue, liver disorders, liver involvement, liver tests, hepatitis, cholangitis, and cirrhosis. The researchers looked at 259 cases of patients with chronic hepatitis C, and found that they were three times more likely than a control group of normal volunteers to have celiac disease. The rate was 1.2% versus .4% for the control group.
    A second study showed a prevalence of celiac in 534 patients with chronic hepatitis to be 1.3%. Lastly, people with celiac disease show a high rate of non-response to hepatitis B vaccine. Non-response rates were 54% in children with celiac disease and 68% in adult celiacs.
    Hemochromatosis
    Celiac’s connection to hemochromatosis is twofold. Case histories show that iron overload and diagnosis of hereditary hemochromatosis often follows successful celiac treatment. Also, British patients with celiac disease showed a greater occurrence of mutation in the gene (HFE) controlling hemochromatosis, which might indicate that enhanced iron production is an adaptation to the reduced nutrient absorption associated with celiac. However, a study of Italian celiac patients showed no such increase in mutations. Researchers suspect that any relationship might be coincidental, as both conditions affect large numbers of Caucasians.
    Nonalcoholic Fatty Liver Disease
    About 10% to 25% of the general population will develop nonalcoholic fatty liver disease.  Nearly 1 in 3 Americans diagnosed with celiac disease is overweight or obese. Two different studies have shown the number of biopsy-confirmed celiac disease in about 3.5%, or over three times that of the normal population.
    Liver Transplant
    Of 185 patients who underwent transplant, 4.3%, over 4 times the normal population, were positive for celiac disease. In nearly all cases, the cause of the end-stage liver disease requiring transplantation was autoimmune.
    Gluten Withdrawal
    In patients with nonalcoholic fatty liver disease, a gluten-free diet coincided with a normalization of liver blood test abnormalities, but the exact effects of a gluten-free diet on liver abnormalities in non-alcoholic fatty liver disease and other liver disorders needs to be clarified through further study.
    Conclusions
    A gluten-free diet is an effective medical therapy for most patients with celiac disease and liver disorders. The effect of a gluten-free diet on the progression of liver diseases associated with celiac disease is less clear. Clearly more studies need to be conducted to further elucidate the relationship between celiac disease and various disorders of the liver.
    HEPATOLOGY 2007; 46:1650-1658.


    Jefferson Adams
    Celiac.com 09/16/2008 - A team of researchers recently set out to examine the connection between celiac disease and primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis.
    The research team was made up of Alberto Rubio-Tapia, Ahmad S. Abdulkarim, Patricia K. Krause, S. Breanndan Moore, Joseph A. Murray, and Russell H. Wiesner.
    The team measured the rates of occurrence for tissue transglutaminase antibodies (tTGAs) and endomysial antibodies (EMAs) in end-stage autoimmune liver disease (ESALD). They then correlated autoantibodies and the human leucocyte antigen (HLA) haplotype. Finally, they assessed the effect of liver transplantation on antibody kinetics.
    The team tested tTGA levels on blood samples from 488 prior to transplant. 310 of these had ESALD, and 178 had non-autoimmune disease. The team tested positive samples for EMAs, and retested at 6-12 and =24 months after transplant. They then correlated their results with the HLA type of the recipient.
    The results showed that 3% of ESALD patients showed evidence of celiac disease compared to 0.6% of those with non-autoimmune disease.  This represents a five-fold greater risk for those with ESALD. The prevalence of tTGAs was 14.2 for ESALD patients compared to 5.4% for those with non-autoimmune disease (P = 0.0001). The prevalence of EMAs was 4.3 for ESALD patients compared to 0.78% for those with non-autoimmune disease (P = 0.01)—significantly higher for those with HLA-DQ2 or HLA-DQ8 haplotypes.
    After transplant, tTGAs and EMAs normalized in 94% and 100%, respectively, without gluten elimination. Also, three out of five patients with classical symptoms of celiac disease improved. The research team found two cases of intestinal lymphoma in two cases that showed no clinical signs of celiac disease.
    Patients with ESALD, particularly those with HLA-DQ2 or HLA-DQ8 gene haplotypes, showed greater occurrances of celiac disease-associated antibodies. Following liver transplants, both tTGA and EMA levels decreased without gluten withdrawal.
    The team also concluded that symptoms of celiac disease might be improved through immune suppression, but those improvements may not prevent the disease from progressing to intestinal lymphoma.
    The study doesn’t tell what effect, if any, early detection and treatment of celiac disease might have on rates of ESALD. It would be helpful to know if celiac disease contributes to liver disease, if liver disease contributes to celiac disease, or if some third connection links the two. Until then, we’ll just have to keep a tight eye on developments concerning celiac disease and liver disease.
    Liver Int. 2008; 28(4): 467-476.


    Jefferson Adams
    Celiac.com 09/09/2013 - Many people with celiac disease show slightly elevated liver enzymes, though these enzyme levels usually return to normal after gluten-free diet.
    A team of researchers recently set out to investigate the cause and prevalence of altered liver function tests in celiac patients, basally and after 1 year of gluten-free diet.
    The research team included Giovanni Casella, Elisabetta Antonelli, Camillo Di Bella, Vincenzo Villanacci, Lucia Fanini, Vittorio Baldini, and Gabrio Bassotti.
    They are affiliated with the Medical Department, and the Clinical Pathology Department of Desio Hospital in Monza and Brianza, Italy, the Department of Clinical and Experimental Medicine, Gastroenterology and Hepatology Section at the University of Perugia in Perugia, Italy, and with the Department of Laboratory Diagnostics, Pathology Section, Brescia, Italy.
    The team gathered data from 245 untreated celiac disease patients, 196 women and 49 men, ranging in age from 15 to 80 years. They then analyzed the data, and assessed the results of liver function tests performed before and after diet, as well as associated liver pathologies.
    They found that 43 (17.5%) of the 245 patients, showed elevated levels of one or both aminotransferases;
    In 41 patients (95%) the elevation was mild, meaning that it was less than five times the upper reference limit. The remaining two patients (5%) showed marked elevation, meaning levels more than ten times the upper reference limit.
    After patients eliminated gluten for one year, aminotransferase levels normalized in all but four patients, who had HCV infection or primary biliary cirrhosis.
    Celiac patients who show hypertransaminaseaemia at diagnosis, and who do not show normalization of liver enzymes after 12 months of gluten-free diet, likely suffer from coexisting liver disease.
    In such cases, the research team recommends further assessment to assess the possible coexisting liver disease.
    Spotting and treating coexisting liver disease in celiac patients is important for improving liver function and preventing possible complications.
    Source:
    Liver International. 2013;33(7):1128-1131.

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    https://www.beyondceliac.org/research-news/View-Research-News/1394/postid--113788/?utm_campaign=Research%20Opt-In&utm_source=hs_email&utm_medium=email&utm_content=72057667&_hsenc=p2ANqtz-8yrOYJPTT1rDzm2fM-8c6LNDfji6dWJBX6wgzPHwxkG5NAnnnX8dB-mRkjQxwnBpdS6lACeNHo_2tE-jEk-0ThBe1yEw&_hsmi=72057667 This study provides information that may be relevant to under standing RCD - why some don't experience remission despite eating gluten free. New gene studies show there may be a ge
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    Derp points out that cider is naturally gluten-free, which has made it a go-to for those with celiac disease. It was essential to have a menu that is also ... View the full article
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