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      Frequently Asked Questions About Celiac Disease   04/07/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes
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    CAN A GLUTEN-FREE DIET PREVENT OBESITY AND METABOLIC DISORDERS?


    Jefferson Adams

    Celiac.com 08/04/2014 - Can excluding gluten, the protein complex present in many cereals, help to prevent diseases other than celiac disease? Seeking to gain insight into the effects of gluten-free diets on obesity, and its mechanisms of action, a research team set out to assess whether gluten exclusion can prevent the development and expansion of adipose tissue.


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    Photo: CC--FBellonSpecifically, they wanted to determine if a gluten-free diet reduces adiposity, inflammation and insulin resistance associated with the induction of PPAR-alpha and PPAR-gamma expression. The researchers included F.L. Soares, R. de Oliveira Matoso, L.G. Teixeira, Z. Menezes, S.S. Pereira, A.C. Alves, N.V. Batista, A.M. de Faria, D.C. Cara, A.V. Ferreira, and J.I. Alvarez-Leite. The are affiliated with the Departamento de Alimentos, Faculdade de Farmácia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais in Belo Horizonte, Brazil.

    For their study, they fed a high-fat diet containing 4.5% gluten to a control group of C57BL/6 mice, and a gluten-free diet to another group of C57BL/6 mice. The team measured body weight and adiposity gains, leukocyte rolling and adhesion, macrophage infiltration and cytokine production in adipose tissue. They also measured blood lipid profiles, glycaemia, insulin resistance and adipokines, and determined expression of the PPAR-α and γ, lipoprotein lipase (LPL), hormone sensitive lipase (HSL), carnitine palmitoyl acyltransferase-1 (CPT-1), insulin receptor, GLUT-4 and adipokines in epidydimal fat.

    The gluten-free mice had less body weight gain and adiposity, with no changes in food intake or lipid excretion. These results are associated with up-regulation of PPAR-α, LPL, HSL and CPT-1, which are related to lipolysis and fatty acid oxidation.

    Gluten-free mice also showed improved glucose homeostasis and pro-inflammatory profile-related over-expression of PPAR-γ. Moreover, intravital microscopy showed a lower number of adhered cells in the adipose tissue microvasculature. The overexpression of PPAR-γ is related to the increase of adiponectin and GLUT-4.

    The study data support the beneficial effects of gluten-free diets in reducing adiposity gain, inflammation and insulin resistance. The data suggests that a gluten-free diet should be tested as a new dietary approach to preventing obesity and metabolic disorders.

    Source:


    Image Caption: Photo: Wikimedia Commons--James Heilman, M.D.
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  • Related Articles

    Amy O'Connell
    Celiac.com 12/02/2011 - Some rumors have been circulating in the health foods community that gluten-free eating can encourage weight loss. Unfortunately, this theory is completely unfounded. Wendy Marcason, a registered dietician, published an article in the Journal of the American Dietetic Association in November that reviews some of the theories and controversy surrounding this issue. The article concludes that there is no scientific evidence to support a connection between eating gluten-free and losing weight.
    For those of us with celiac disease who start a gluten-free diet, weight gain is more often the case. The healing of the damaged intestines allows better absorption of food, and unless you rapidly change the amount of food you eat when you go gluten-free, most celiacs gain a substantial amount of weight after the switch. If you do not have celiac disease, however, eating gluten-free is unlikely to have any affect on weight independent from decreases in the overall calorie intake due to eating more carefully.
    The consequence of this conclusion by the American Dietetic Association may be that more non-celiacs recognize that gluten-free does not necessarily mean more healthy. Unfortunately, some of the increased availability of gluten-free food over the last decade is owed to these non-celiac gluten-free folks. If these non-celiacs stop eating gluten-free, the demand for gluten-free food will fall and te number of options may decrease.
    All of that said, the paper said that no evidence exists because there are no studies that look at weight loss on a gluten-free diet. While it's impossible to conclude that gluten-free diets cause weight loss, its also impossible to conclude that they don't cause weight-loss. Only a clinical study will be able to put the issue to rest.
    Reference:

    Marcason W. "Is There Evidence to Support the Claim that a Gluten-Free Diet Should Be Used for Weight Loss?" Journal of the American Dietetic Association. Nov 2011; 111(11): 1786.
    Weight Loss and the Gluten Free Diet by Ron Hoggan, Ed. D.
    First, I’d like to set Dr. O’Connell’s mind at rest. The claims for weight loss following adoption of a gluten-free diet aren’t merely rumors. They are credible claims based on peer reviewed and anecdotal reports, as well as published data from a qualified medical practitioner. For instance, Cheng and colleagues found that “54% of overweight and 47% of obese patients lost weight” (1). They investigated 81 subjects who were overweight and had celiac disease. Congruently, Venkatasubramani et al found that one half of their eight overweight pediatric patients also lost weight on a gluten free diet (2). These reports alone cast an ominous shadow over Dr. Marcason’s claims if Dr. O’Connell has represented them correctly. Marcason, we are told, asserts that no research has been done on this question. Yet there are three such reports in the peer reviewed literature (1, 2, 3). One reports a preponderance of weight gain among overweight and obese celiac patients after beginning a gluten free diet, while the other two groups report that about half of the overweight and obese celiac patients, children and adults, lose weight on a gluten free diet. Not only has this research been conducted and most of the findings not only contradict the claim that no such research has been done, but two of the three reports indicate that the gluten free diet helps with weight loss in some individuals. I think it is important to notice that the study showing that a large majority of overweight/obese celiacs was conducted where wheat starch is accepted as appropriate for celiac patients, while the two studies that showed weight loss were conducted in the USA. We still don’t know enough about the interaction between various constituents of gluten and people who lose weight on a gluten free diet.  However, given the contradictions in findings, between research conducted in the USA and some parts of Europe, it is not unreasonable to suggest that these differences may result from wheat starch.  
    Each of the three studies mentioned above have one large, consistent weakness. They are dealing with small numbers of patients. However, Dr. William Davis, a cardiologist has recently authored a book titled WHEAT BELLY, in which he reports that he has seen weight loss and other health improvements in more than 2,000 of his patients following adoption of a gluten free diet. And, of course, there are all the other anecdotal reports of similar benefits.
    Dr. O’Connell’s opposition to the use of a gluten free diet ignores the dynamics of appetite enhancement and satiation that are largely driven by hormones resulting from variations in nutrient density in various parts of the body. From insulin to glucagon to leptin to ghrelin, these and several other fat mobilizing hormones enhance and suppress our hunger based on the nutrients in our bloodstreams, gastrointestinal tract, and adipose tissues.  
    Dr. O’Connell also ascribes Marcason’s views to the American Dietetic Association which is the body that publishes the journal in which Dr. Marcason’s opinion article appears. While it may be true that the American Dietetics Association takes this position, it would be unusual for a journal, and the association that operates that journal, to underwrite the claims of one of its authors so I am skeptical that it has done so. I am especially skeptical of endorsement by the association, if Marcason has, indeed, stated that no studies have been conducted to investigate changes in body mass resulting from the gluten free diet among people who are overweight or obese at diagnosis. Clearly, this is an inaccurate claim whether it emanates from O’Connell or Marcason or even the American Dietetics Association.  
    I am also left wondering if there are any studies that show that “gluten-free does not necessarily mean more healthy” [sic]. I haven’t seen any and I would be very surprised if any exist. Dr. O’Connell didn’t cite any such studies, yet she asserts that a gluten free diet is not a healthy choice for those who do not have celiac disease. This is especially troubling in view of the growing recognition of non-celiac gluten sensitivity as a legitimate disease entity (5, 6, 7, 8, 9, 10). 
    I frequently write opinion articles so I would not want to inhibit such writing. Nonetheless, I believe that taking a rigid stance on either side of this issue is premature. Clearly we all have a lot to learn about weight loss and the gluten-free diet. The scanty evidence that is currently available is entirely too limited to say, with confidence, that the gluten-free diet is an effective weight loss tool, even for overweight patients with celiac disease. It appears to work for some, but other, unseen factors may be at work here.   
    Sources:

    Cheng J, Brar PS, Lee AR, Green PH. Body mass index in celiac disease: beneficial effect of a gluten-free diet. J Clin Gastroenterol. 2010 Apr;44(4):267-71. Venkatasubramani N, Telega G, Werlin SL. Obesity in pediatric celiac disease. J Pediatr Gastroenterol Nutr. 2010 Sep;51(3):295-7. Dickey W, Kearney N. Overweight in celiac disease: prevalence, clinical characteristics, and effect of a gluten-free diet. Am J Gastroenterol. 2006 Oct;101(10):2356-9. Davis W. Wheat Belly.Rodale, NY, NY 2011. Bizzaro N, Tozzoli R, Villalta D, Fabris M, Tonutti E. Cutting-Edge Issues in Celiac Disease and in Gluten Intolerance. Clin Rev Allergy Immunol. 2010 Dec 23. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29. Sbarbati A, Valletta E, Bertini M, Cipolli M, Morroni M, Pinelli L, Tatò L. Gluten sensitivity and 'normal' histology: is the intestinal mucosa really normal? Dig Liver Dis. 2003 Nov;35(11):768-73. PubMed PMID: 14674666. Di Cagno R, De Angelis M, De Pasquale I, Ndagijimana M, Vernocchi P, Ricciuti P, Gagliardi F, Laghi L, Crecchio C, Guerzoni ME, Gobbetti M, Francavilla R. Duodenal and faecal microbiota of celiac children: molecular, phenotype and metabolome characterization. BMC Microbiol. 2011 Oct 4;11:219. Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, Shepherd SJ, Muir JG, Gibson PR. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 2011 Mar;106(3):508-14 Bizzaro N, Tozzoli R, Villalta D, Fabris M, Tonutti E. Cutting-Edge Issues in Celiac Disease and in Gluten Intolerance. Clin Rev Allergy Immunol. 2010 Dec 23.

    Amy O'Connell, MD, PhD's Reply to Dr. Ron Hoggan:
    This is Dr. O'Connell replying. My piece was merely a summary of an article in the Journal of the ADA. The short summary I wrote was not intended to be an end-all conclusive statement about the matter. That said, the Cheng article that is cited by Ron Hoggard. M.Ed. was not designed to look at the outcome of weight loss in overweight celiacs and is underpowered to make the conclusions that he cites. Another quote from the same article said, "Overall, 54% [of patients who started a gluten-free diet] gained weight and 38% lost weight." The same problem with a lack of statistical power exists for the Venkatasubramani paper. Four obese patients lost weight on a gluten-free diet but 2 gained weight and 1 was lost to follow up. I'd like to apologize if my brief summary seemed too closed-ended, but I will stand by my article conclusion, "While it's impossible to conclude that gluten-free diets cause weight loss, its also impossible to conclude that they don't cause weight-loss. Only a clinical study will be able to put the issue to rest."

     

    Jefferson Adams
    Celiac.com 03/04/2013 - Morbid obesity is a common medical condition. In many cases, bariatric surgery is necessary. Although for decades celiac disease has been associated with chronic diarrhea and weight loss, and other classic symptoms, recent data shows that the clinical spectrum of celiac disease is extremely wide.
    A group of researchers recently reported on the benefits of diagnosing celiac disease during pre-operative work-up for bariatric surgery.
    The researchers included Federico Cuenca-Abente, Fabio Nachman, and Julio C. Bai of the Department of Surgery and Department of Medicine at Dr C. Bonorino Udaondo Gastroenterology Hospital in Buenos Aires, Argentina.
    They reported on the cases of five morbidly obese patients diagnosed with celiac disease during preoperative work-up for bariatric surgery. Celiac disease was suspected upon routine upper endoscopy, and confirmed by histology and positive celiac disease-specific blood tests.
    Interestingly, four of the five patients had no obvious symptoms. One complained of chronic diarrhea and anemia. All patients began a gluten-free diet. Due to their celiac disease diagnosis, doctors offered all five patients a purely restrictive bariatric procedure. At the time of the report, three of the patients had received a sleeve gastrectomy, while the other two were still undergoing pre-operative evaluation.
    The team's findings help to enlarge the clinical spectrum of untreated celiac disease. Even though rates of celiac disease in obese patients seems to be similar to that in the general population, the team recommends that patients with morbid obesity be tested for celiac disease in order to determine the best surgical strategy and outcome.
    Source:
    Acta Gastroenterol Latinoam 2012;42:321-324

    Jefferson Adams
    Celiac.com 11/28/2014 - According to a new study, obesity plays a major part in triggering and prolonging autoimmune diseases, such as celiac disease, Crohn's disease and multiple sclerosis.
    The study appeared recently in Autoimmunity Reviews by Prof. Yehuda Shoenfeld, the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases at Tel Aviv University's Sackler Faculty of Medicine and Head of Zabludowicz Center for Autoimmune Diseases at Chaim Sheba Medical Center, Tel Hashomer.
    According to the research, obesity erodes the body's ability to protect itself, triggering a pro-inflammatory environment that promotes the development of autoimmune diseases, hastens their progression, and impairs their treatment.
    For some time now, says Professor Shoenfeld, researchers have been aware of the “negative impact of contributing disease factors, such as infections, smoking, pesticide exposure, lack of vitamins, and the like. But in last five years, a new factor has emerged that cannot be ignored: obesity.”
    According to the World Health Organization, about one-third of the global population is overweight or obese, nearly a dozen autoimmune diseases are now associated with excess weight, which now impact nearly 5-20% of the global population. That is why, according to Shownfeld, it is “critical to investigate obesity's involvement in the pathology of such diseases."
    The main culprit is not fat itself, but adipokines, compounds secreted by fat tissue, which impact numerous physiological functions, including the immune response.
    In tandem with their own study, Shoenfeld and his colleagues reviewed 329 studies from across the globe that focused on the connections between obesity, adipokines, and immune-related conditions like rheumatoid arthritis, multiple sclerosis, type-1 diabetes, psoriasis, inflammatory bowel disease, psoriatic arthritis, and Hashimoto thyroiditis.
    "According to our study and the clinical and experimental data reviewed, the involvement of adipokines in the pathogenesis of these autoimmune diseases is clear," says Shoenfeld. "We were able to detail the metabolic and immunological activities of the main adipokines featured in the development and prognosis of several immune-related conditions."
    One of the team’s more interesting findings was that obesity also promotes vitamin D deficiency, which, “once corrected, alleviated paralysis and kidney deterioration associated with the disorder… [and] improved the prognosis and survival of the mice.”
    Source:
    Science Daily, November 10, 2014

    Jefferson Adams
    Celiac.com 03/10/2015 - Up to now, celiac disease has been described only in sporadic cases of obesity. A research team recently set out to evaluate retrospectively celiac disease rates in a large group of overweight/obese children and adolescents.
    The research team included Raffaella Nenna, Antonella Mosca, Maurizio Mennini, Raffaele E. Papa, Laura Petrarca, Roberta Mercurio, Monica Montuori, Alessandra Piedimonte, Maria Bavastrelli, Ilaria C. De Lucia, Margherita Bonamico, and Andrea Vania.
    For their study, the team consecutively evaluated 1,527 overweight/obese children and adolescents, 10 girls and 7 boys had positive celiac serology and showed villous atrophy.
    All celiac patients immediately began a well-balanced gluten-free diet, and rapid weight loss followed.
    The study shows that celiac rates in overweight/obese children are similar to rates in the general Italian pediatric population, and that those children benefit from proper diagnosis and a healthy gluten-free diet.
    Source:
    Journal of Pediatric Gastroenterology & Nutrition: March 2015 - Volume 60 - Issue 3 - p 405–407. doi: 10.1097/MPG.0000000000000656

  • Recent Articles

    Jefferson Adams
    Celiac.com 04/19/2018 - Previous genome and linkage studies indicate the existence of a new disease triggering mechanism that involves amino acid metabolism and nutrient sensing signaling pathways. In an effort to determine if amino acids might play a role in the development of celiac disease, a team of researchers recently set out to investigate if plasma amino acid levels differed among children with celiac disease compared with a control group.
     
    The research team included Åsa Torinsson Naluai, Ladan Saadat Vafa, Audur H. Gudjonsdottir, Henrik Arnell, Lars Browaldh, and Daniel Agardh. They are variously affiliated with the Institute of Biomedicine, Department of Microbiology & Immunology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; the Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Karolinska University Hospital and Division of Pediatrics, CLINTEC, Karolinska Institute, Stockholm, Sweden; the Department of Clinical Science and Education, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden; the Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden; the Diabetes & Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden; and with the Nathan S Kline Institute in the U.S.A.
    First, the team used liquid chromatography-tandem mass spectrometry (LC/MS) to analyze amino acid levels in fasting plasma samples from 141 children with celiac disease and 129 non-celiac disease controls. They then crafted a general linear model using age and experimental effects as covariates to compare amino acid levels between children with celiac disease and non-celiac control subjects.
    Compared with the control group, seven out of twenty-three children with celiac disease showed elevated levels of the the following amino acids: tryptophan; taurine; glutamic acid; proline; ornithine; alanine; and methionine.
    The significance of the individual amino acids do not survive multiple correction, however, multivariate analyses of the amino acid profile showed significantly altered amino acid levels in children with celiac disease overall and after correction for age, sex and experimental effects.
    This study shows that amino acids can influence inflammation and may play a role in the development of celiac disease.
    Source:
    PLoS One. 2018; 13(3): e0193764. doi: & 10.1371/journal.pone.0193764

    Jefferson Adams
    Celiac.com 04/18/2018 - To the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service animals.
    If you’ve flown anywhere lately, you may have seen them. People flying with their designated “emotional support” animals. We’re not talking genuine service animals, like seeing eye dogs, or hearing ear dogs, or even the Belgian Malinois that alerts its owner when there is gluten in food that may trigger her celiac disease.
    Now, to be honest, some of those animals in question do perform a genuine service for those who need emotional support dogs, like veterans with PTSD.
    However, many of these animals are not service animals at all. Many of these animals perform no actual service to their owners, and are nothing more than thinly disguised pets. Many lack proper training, and some have caused serious problems for the airlines and for other passengers.
    Now the major airlines are taking note and introducing stringent requirements for service animals.
    Delta was the first to strike. As reported by the New York Times on January 19: “Effective March 1, Delta, the second largest US airline by passenger traffic, said it will require passengers seeking to fly with pets to present additional documents outlining the passenger’s need for the animal and proof of its training and vaccinations, 48 hours prior to the flight.… This comes in response to what the carrier said was a 150 percent increase in service and support animals — pets, often dogs, that accompany people with disabilities — carried onboard since 2015.… Delta said that it flies some 700 service animals a day. Among them, customers have attempted to fly with comfort turkeys, gliding possums, snakes, spiders, and other unusual pets.”
    Fresh from an unsavory incident with an “emotional support” peacock incident, United Airlines has followed Delta’s lead and set stricter rules for emotional support animals. United’s rules also took effect March 1, 2018.
    So, to the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service and emotional support animals.
    Source:
    cnbc.com

    admin
    WHAT IS CELIAC DISEASE?
    Celiac disease is an autoimmune condition that affects around 1% of the population. People with celiac disease suffer an autoimmune reaction when they consume wheat, rye or barley. The immune reaction is triggered by certain proteins in the wheat, rye, or barley, and, left untreated, causes damage to the small, finger-like structures, called villi, that line the gut. The damage occurs as shortening and villous flattening in the lamina propria and crypt regions of the intestines. The damage to these villi then leads to numerous other issues that commonly plague people with untreated celiac disease, including poor nutritional uptake, fatigue, and myriad other problems.
    Celiac disease mostly affects people of Northern European descent, but recent studies show that it also affects large numbers of people in Italy, China, Iran, India, and numerous other places thought to have few or no cases.
    Celiac disease is most often uncovered because people experience symptoms that lead them to get tests for antibodies to gluten. If these tests are positive, then the people usually get biopsy confirmation of their celiac disease. Once they adopt a gluten-free diet, they usually see gut healing, and major improvements in their symptoms. 
    CLASSIC CELIAC DISEASE SYMPTOMS
    Symptoms of celiac disease can range from the classic features, such as diarrhea, upset stomach, bloating, gas, weight loss, and malnutrition, among others.
    LESS OBVIOUS SYMPTOMS
    Celiac disease can often less obvious symptoms, such fatigue, vitamin and nutrient deficiencies, anemia, to name a few. Often, these symptoms are regarded as less obvious because they are not gastrointestinal in nature. You got that right, it is not uncommon for people with celiac disease to have few or no gastrointestinal symptoms. That makes spotting and connecting these seemingly unrelated and unclear celiac symptoms so important.
    NO SYMPTOMS
    Currently, most people diagnosed with celiac disease do not show symptoms, but are diagnosed on the basis of referral for elevated risk factors. 

    CELIAC DISEASE VS. GLUTEN INTOLERANCE
    Gluten intolerance is a generic term for people who have some sort of sensitivity to gluten. These people may or may not have celiac disease. Researchers generally agree that there is a condition called non-celiac gluten sensitivity. That term has largely replaced the term gluten-intolerance. What’s the difference between celiac disease and non-celiac gluten-sensitivity? 
    CELIAC DISEASE VS. NON-CELIAC GLUTEN SENSITIVITY (NCGS)
    Gluten triggers symptoms and immune reactions in people with celiac disease. Gluten can also trigger symptoms in some people with NCGS, but the similarities largely end there.

    There are four main differences between celiac disease and non-celiac gluten sensitivity:
    No Hereditary Link in NCGS
    Researchers know for certain that genetic heredity plays a major role in celiac disease. If a first-degree relative has celiac disease, then you have a statistically higher risk of carrying genetic markers DQ2 and/or DQ8, and of developing celiac disease yourself. NCGS is not known to be hereditary. Some research has shown certain genetic associations, such as some NCGS patients, but there is no proof that NCGS is hereditary. No Connection with Celiac-related Disorders
    Unlike celiac disease, NCGS is so far not associated with malabsorption, nutritional deficiencies, or a higher risk of autoimmune disorders or intestinal malignancies. No Immunological or Serological Markers
    People with celiac disease nearly always test positive for antibodies to gluten proteins. Researchers have, as yet, identified no such antobodies or serologic markers for NCGS. That means that, unlike with celiac disease, there are no telltale screening tests that can point to NCGS. Absence of Celiac Disease or Wheat Allergy
    Doctors diagnose NCGS only by excluding both celiac disease, an IgE-mediated allergy to wheat, and by the noting ongoing adverse symptoms associated with gluten consumption. WHAT ABOUT IRRITABLE BOWEL SYNDROME (IBS) AND IRRITABLE BOWEL DISEASE (IBD)?
    IBS and IBD are usually diagnosed in part by ruling out celiac disease. Many patients with irritable bowel syndrome are sensitive to gluten. Many experience celiac disease-like symptoms in reaction to wheat. However, patients with IBS generally show no gut damage, and do not test positive for antibodies to gliadin and other proteins as do people with celiac disease. Some IBS patients also suffer from NCGS.

    To add more confusion, many cases of IBS are, in fact, celiac disease in disguise.

    That said, people with IBS generally react to more than just wheat. People with NCGS generally react to wheat and not to other things, but that’s not always the case. Doctors generally try to rule out celiac disease before making a diagnosis of IBS or NCGS. 
    Crohn’s Disease and celiac disease share many common symptoms, though causes are different.  In Crohn’s disease, the immune system can cause disruption anywhere along the gastrointestinal tract, and a diagnosis of Crohn’s disease typically requires more diagnostic testing than does a celiac diagnosis.  
    Crohn’s treatment consists of changes to diet and possible surgery.  Up to 10% of Crohn's patients can have both of conditions, which suggests a genetic connection, and researchers continue to examine that connection.
    Is There a Connection Between Celiac Disease, Non-Celiac Gluten Sensitivity and Irritable Bowel Syndrome? Large Number of Irritable Bowel Syndrome Patients Sensitive To Gluten Some IBD Patients also Suffer from Non-Celiac Gluten Sensitivity Many Cases of IBS and Fibromyalgia Actually Celiac Disease in Disguise CELIAC DISEASE DIAGNOSIS
    Diagnosis of celiac disease can be difficult. 

    Perhaps because celiac disease presents clinically in such a variety of ways, proper diagnosis often takes years. A positive serological test for antibodies against tissue transglutaminase is considered a very strong diagnostic indicator, and a duodenal biopsy revealing villous atrophy is still considered by many to be the diagnostic gold standard. 
    But this idea is being questioned; some think the biopsy is unnecessary in the face of clear serological tests and obvious symptoms. Also, researchers are developing accurate and reliable ways to test for celiac disease even when patients are already avoiding wheat. In the past, patients needed to be consuming wheat to get an accurate test result. 
    Celiac disease can have numerous vague, or confusing symptoms that can make diagnosis difficult.  Celiac disease is commonly misdiagnosed by doctors. Read a Personal Story About Celiac Disease Diagnosis from the Founder of Celiac.com Currently, testing and biopsy still form the cornerstone of celiac diagnosis.
    TESTING
    There are several serologic (blood) tests available that screen for celiac disease antibodies, but the most commonly used is called a tTG-IgA test. If blood test results suggest celiac disease, your physician will recommend a biopsy of your small intestine to confirm the diagnosis.
    Testing is fairly simple and involves screening the patients blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis. Also, it is now possible to test people for celiac disease without making them concume wheat products.

    BIOPSY
    Until recently, biopsy confirmation of a positive gluten antibody test was the gold standard for celiac diagnosis. It still is, but things are changing fairly quickly. Children can now be accurately diagnosed for celiac disease without biopsy. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide.

    WHY A GLUTEN-FREE DIET?
    Currently the only effective, medically approved treatment for celiac disease is a strict gluten-free diet. Following a gluten-free diet relieves symptoms, promotes gut healing, and prevents nearly all celiac-related complications. 
    A gluten-free diet means avoiding all products that contain wheat, rye and barley, or any of their derivatives. This is a difficult task as there are many hidden sources of gluten found in the ingredients of many processed foods. Still, with effort, most people with celiac disease manage to make the transition. The vast majority of celiac disease patients who follow a gluten-free diet see symptom relief and experience gut healing within two years.
    For these reasons, a gluten-free diet remains the only effective, medically proven treatment for celiac disease.
    WHAT ABOUT ENZYMES, VACCINES, ETC.?
    There is currently no enzyme or vaccine that can replace a gluten-free diet for people with celiac disease.
    There are enzyme supplements currently available, such as AN-PEP, Latiglutetenase, GluteGuard, and KumaMax, which may help to mitigate accidental gluten ingestion by celiacs. KumaMax, has been shown to survive the stomach, and to break down gluten in the small intestine. Latiglutenase, formerly known as ALV003, is an enzyme therapy designed to be taken with meals. GluteGuard has been shown to significantly protect celiac patients from the serious symptoms they would normally experience after gluten ingestion. There are other enzymes, including those based on papaya enzymes.

    Additionally, there are many celiac disease drugs, enzymes, and therapies in various stages of development by pharmaceutical companies, including at least one vaccine that has received financial backing. At some point in the not too distant future there will likely be new treatments available for those who seek an alternative to a lifelong gluten-free diet. 

    For now though, there are no products on the market that can take the place of a gluten-free diet. Any enzyme or other treatment for celiac disease is intended to be used in conjunction with a gluten-free diet, not as a replacement.

    ASSOCIATED DISEASES
    The most common disorders associated with celiac disease are thyroid disease and Type 1 Diabetes, however, celiac disease is associated with many other conditions, including but not limited to the following autoimmune conditions:
    Type 1 Diabetes Mellitus: 2.4-16.4% Multiple Sclerosis (MS): 11% Hashimoto’s thyroiditis: 4-6% Autoimmune hepatitis: 6-15% Addison disease: 6% Arthritis: 1.5-7.5% Sjögren’s syndrome: 2-15% Idiopathic dilated cardiomyopathy: 5.7% IgA Nephropathy (Berger’s Disease): 3.6% Other celiac co-morditities include:
    Crohn’s Disease; Inflammatory Bowel Disease Chronic Pancreatitis Down Syndrome Irritable Bowel Syndrome (IBS) Lupus Multiple Sclerosis Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Psoriasis Rheumatoid Arthritis Scleroderma Turner Syndrome Ulcerative Colitis; Inflammatory Bowel Disease Williams Syndrome Cancers:
    Non-Hodgkin lymphoma (intestinal and extra-intestinal, T- and B-cell types) Small intestinal adenocarcinoma Esophageal carcinoma Papillary thyroid cancer Melanoma CELIAC DISEASE REFERENCES:
    Celiac Disease Center, Columbia University
    Gluten Intolerance Group
    National Institutes of Health
    U.S. National Library of Medicine
    Mayo Clinic
    University of Chicago Celiac Disease Center

    Jefferson Adams
    Celiac.com 04/17/2018 - Could the holy grail of gluten-free food lie in special strains of wheat that lack “bad glutens” that trigger the celiac disease, but include the “good glutens” that make bread and other products chewy, spongey and delicious? Such products would include all of the good things about wheat, but none of the bad things that might trigger celiac disease.
    A team of researchers in Spain is creating strains of wheat that lack the “bad glutens” that trigger the autoimmune disorder celiac disease. The team, based at the Institute for Sustainable Agriculture in Cordoba, Spain, is making use of the new and highly effective CRISPR gene editing to eliminate the majority of the gliadins in wheat.
    Gliadins are the gluten proteins that trigger the majority of symptoms for people with celiac disease.
    As part of their efforts, the team has conducted a small study on 20 people with “gluten sensitivity.” That study showed that test subjects can tolerate bread made with this special wheat, says team member Francisco Barro. However, the team has yet to publish the results.
    Clearly, more comprehensive testing would be needed to determine if such a product is safely tolerated by people with celiac disease. Still, with these efforts, along with efforts to develop vaccines, enzymes, and other treatments making steady progress, we are living in exciting times for people with celiac disease.
    It is entirely conceivable that in the not-so-distant future we will see safe, viable treatments for celiac disease that do not require a strict gluten-free diet.
    Read more at Digitaltrends.com , and at Newscientist.com

    Jefferson Adams
    Celiac.com 04/16/2018 - A team of researchers recently set out to investigate whether alterations in the developing intestinal microbiota and immune markers precede celiac disease onset in infants with family risk for the disease.
    The research team included Marta Olivares, Alan W. Walker, Amalia Capilla, Alfonso Benítez-Páez, Francesc Palau, Julian Parkhill, Gemma Castillejo, and Yolanda Sanz. They are variously affiliated with the Microbial Ecology, Nutrition and Health Research Unit, Institute of Agrochemistry and Food Technology, National Research Council (IATA-CSIC), C/Catedrático Agustín Escardin, Paterna, Valencia, Spain; the Gut Health Group, The Rowett Institute, University of Aberdeen, Aberdeen, UK; the Genetics and Molecular Medicine Unit, Institute of Biomedicine of Valencia, National Research Council (IBV-CSIC), Valencia, Spain; the Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire UK; the Hospital Universitari de Sant Joan de Reus, IISPV, URV, Tarragona, Spain; the Center for regenerative medicine, Boston university school of medicine, Boston, USA; and the Institut de Recerca Sant Joan de Déu and CIBERER, Hospital Sant Joan de Déu, Barcelona, Spain
    The team conducted a nested case-control study out as part of a larger prospective cohort study, which included healthy full-term newborns (> 200) with at least one first relative with biopsy-verified celiac disease. The present study includes 10 cases of celiac disease, along with 10 best-matched controls who did not develop the disease after 5-year follow-up.
    The team profiled fecal microbiota, as assessed by high-throughput 16S rRNA gene amplicon sequencing, along with immune parameters, at 4 and 6 months of age and related to celiac disease onset. The microbiota of infants who remained healthy showed an increase in bacterial diversity over time, especially by increases in microbiota from the Firmicutes families, those who with no increase in bacterial diversity developed celiac disease.
    Infants who subsequently developed celiac disease showed a significant reduction in sIgA levels over time, while those who remained healthy showed increases in TNF-α correlated to Bifidobacterium spp.
    Healthy children in the control group showed a greater relative abundance of Bifidobacterium longum, while children who developed celiac disease showed increased levels of Bifidobacterium breve and Enterococcus spp.
    The data from this study suggest that early changes in gut microbiota in infants with celiac disease risk could influence immune development, and thus increase risk levels for celiac disease. The team is calling for larger studies to confirm their hypothesis.
    Source:
    Microbiome. 2018; 6: 36. Published online 2018 Feb 20. doi: 10.1186/s40168-018-0415-6