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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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    FOOD CRAVINGS, OBESITY AND GLUTEN CONSUMPTION BY DR. RON HOGGAN, ED.D.


    Dr. Ron Hoggan, Ed.D.


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    This article appeared in the Spring 2006 edition of Celiac.coms Scott-Free Newsletter.

    Celiac.com 07/10/2006 - Increased consumption of gluten, according to Dr. Michael Marsh, raises the risk of celiac disease symptoms1. Although these symptoms may not indicate celiac disease, they reflect some biological realities. Grain-based foods simply do not offer the nutrients necessary to human health and they damage the human body. USDA and Canada Food Guides notwithstanding, if people eat grain-laden diets, they may develop symptoms of celiac disease (but in most cases, without the diagnostic intestinal lesion). The connection between eating disorders and celiac disease is well known and well documented2,3,4,5. Thus, the dynamics at work in celiac disease may offer insight into the broader realm of obesity, especially among those who are eating the recommended, daily quantities of grain-derived foods, while attempting to keep their weight down by eating low-fat foods.

    The primary, defining characteristic of celiac disease is gluten induced damage to the villi in the intestinal lining. Since malabsorption of vitamins and minerals are well known in the context of celiac disease, it should not be surprising that some celiac patients also demonstrate pica (Pica is an ailment characterized by eating dirt, paint, wood, and other non-food substances). Other celiac patients eat excessive quantities of food, coupled with a concurrent failure to gain weight. Yet another, perhaps larger, group of celiac patients refuse to eat (One may wonder if the latter find that eating makes them feel sick so they avoid it).

    Perhaps the most neglected group is that large portion of untreated celiac patients who are obese. Dr. Dickey found that obesity is more common than being underweight among those with untreated celiac disease6. When I ran a Medline search under the terms "obesity" and "celiac disease" 75 citations appeared. A repeated theme in the abstracts and titles was that celiac disease is usually overlooked among obese patients. While obesity in celiac disease may be common, diagnosis appears to be uncommon. Given the facts, I certainly believe that some of the North American epidemic of obesity can be explained by undiagnosed celiac disease. However, that is only a small part of the obesity puzzle, and I suspect that celiac disease may offer a pattern for understanding much of the obesity that is sweeping this continent.

    One example, a woman diagnosed by Dr. Joe Murray when he was at the University of Iowa, weighed 388 pounds at diagnosis7. Dr. Murray explained her situation as an over-compensation for her intestinal malabsorption. I want to suggest a two faceted, alternative explanation which may extend to a large and growing segment of the overweight and obese among the general population. As mentioned earlier, anyone consuming enough gluten will demonstrate some symptoms of celiac disease. If large scale gluten consumption damages the intestinal villi—but to a lesser degree than is usually required to diagnose celiac disease—fat absorption will be compromised. Deficiencies in essential fatty acids are a likely consequence.

    The natural response to such deficiencies is to crave food despite having absorbed sufficient calories. Even when caloric intake is huge, and excess calories must be stored as body fat, the need to eat continues to be driven by the bodys craving for essential fats. Due to gluten-induced interference with fat absorption, consumption of escalating quantities of food may be necessary for adequate essential fatty acid absorption. To further compound the problem, pancreatic glucagon production will be reduced, compromising the ability of the individual to burn these stored fats, while the cells continue to demand essential fats.

    Poor medical advice also contributes to the problem. The mantra of reduced fat continues to echo in the offices of health professionals despite a growing body of converse research findings. In February of this year, the results of a powerful, eight year study of almost 49,000 women showed little difference between the health of women consuming low fat diets when compared to those consuming normal diets8. Alarmingly, this low fat diet seems to have resulted in weight gain, a well recognized risk factor for a variety of diseases.

    For some of us, this result was predictable. The likely result of a low-fat diet is an increased intake of carbohydrates while food cravings are fuelled by a deficiency of essential fatty acids. If my sense of the underlying problem (caloric excess combined with essential fatty acid deficiency due to fat malabsorption at the microvilli) is accurate, then a low fat diet is exactly the wrong prescription. Many obese persons are condemned, by such poor medical advice, to a life of ever deepening depression, autoimmune diseases, and increasing obesity.

    At the end of the day, when these folks drop dead from heart attacks, strokes, or some similar disaster, the self-righteous bystanders will just know that the problem was a lack of willpower.

    I watched my mom steadily gain weight for 35 years. I watched her exercise more will power beyond the capacity of most folks. Still, she could not resist her compulsive eating. I have seen her take something from the freezer and chew on it while agreeing that she had just eaten a very large meal and should feel full.

    In December of 1994 I was diagnosed with celiac disease. According to the published experts in this area, my mom should also have been invited for testing. Yet, when asked for testing, her doctor refused her. Through persistence, and a pervasive faith in her son, mom finally (after months of negotiation) swayed her doctor to do the anti-gliadin antibody blood test. Despite the fact that she had been on a reduced gluten diet for the past year, her antibody levels were elevated.

    She never sought a biopsy diagnosis, and the EMA and tTG were not available here in Canada at that time. However, she has been gluten-free for the past seven years or so. She dropped a considerable amount of weight.

    Her weakness was never will power. She was battling an instinct so basic that few of us could have resisted. That, I think, is the story behind much of North American obesity. The widespread, excessive consumption of gluten at every meal, in addition to the low-fat religion that has been promulgated throughout the land, is resulting in intestinal damage and a widespread deficiency in essential fats is among North Americans.

    Ron Hoggan is an author, teacher and diagnosed celiac who lives in Canada. His book "Dangerous Grains" can be ordered at www.celiac.com. Rons Web page is: www.DangerousGrains.com

    References:

    • Marsh, Michael N. Personal communication. 2002.
    • Ferrara, et. al. "Celiac disease and anorexia nervosa" New York State Journal of Medicine 1966; 66(8): 1000-1005.
    • Gent & Creamer "Faecal fats, appetite, and weight loss in the celiac syndrome" Lancet 1968; 1(551): 1063-1064.
    • Wright, et. al. "Organic diseases mimicking atypical eating disorders" Clinical Pediatrics 1990; 29(6): 325-328.
    • Grenet, et. al. "Anorexic forms of celiac syndromes" Annales de Pediatrie 1972; 19(6): 491-497.
    • Dickey W, Bodkin S. Prospective study of body mass index in patients with coeliac disease. BMJ. 1998 Nov 7;317(7168):1290.
    • Murray, J. Canadian Celiac Association National Conference. 1999.
    • Howard BV, Van Horn L, Hsia J, et. al. Low-fat dietary pattern and risk of cardiovascular disease: the Womens Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006 Feb 8;295(6):655-66.

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    Guest Teresa Huffman

    Posted

    I have been overweight since I was a teenager. Just got diagnosed with ceilac disease last year in January . I was in a coma for 4 days and in hospital almost a month and in a rehab hospital for almost a month and was not able to walk or talk. I had lost weight to 176 lbs going in to hospital, and now I have gained up to 330lbs. and I am very depressed. I can't understand why some people lose weight on a gluten free diet while it caused me to gain so much weight. So not all people are alike.

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    I found this article informative and well-written. As an individual with gluten sensitivity and a constellation of attendant problems (morbid obesity, hypoglycemia, cognitive impairment, ADD, chronic, treatment-resistant depression, excema and hives, just to name a few) I found conventional 'dieting' plans (such as Weight Watchers) an easy way to actually gain weight, instead of losing it. It wasn't until I removed from my diet all wheat and 'white stuff'-- white flour, sugar, white rice, and the like-- that I began to lose weight. During the first four months on a restricted food plan I lost 40 pounds. I also experienced extreme withdrawal-- quitting cigarettes was a walk in the park compared to this. Headaches. Cravings. Flu-like symptoms. And mood swings? I felt like I'd had all my skin ripped off and was walking around with all my nerve endings exposed. I was irritable, angry, or sad for no reason. Holding a simple conversation was an ordeal. I wouldn't wish it on my worst enemy, When withdrawal eventually ended, the weight loss didn't. I lost 103 pounds in 18 months, and for almost two years until, I spectacularly 'fell off the wagon' (it involved half a sheet cake-- don't ask), kept it off. It took almost three years, and 100 pounds regained, to reestablish a steady footing on the food plan (worked out with a nutritionist) but the weight gain (100 pounds) stopped and I have started to lose (20 so far) again. But the gluten-free diet is key to having no food cravings to distract me, and keeping my brain clear. Mr. Hoggan has addressed an under served audience with this article.

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    This article has hit home with me as well. I have watched the same symptoms in my father. I have celiac and he refuses to get tested. I hope this may have an influence on him as well. Thank you for writing informative articles.

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    Guest Stephanie Morey

    Posted

    I found this very informative! Thank you so much! I haven't been diagnosed with celiac, but I visited my mom's naturopathic doctor and she recommended switching to a gluten-free lifestyle. I've been digging around trying to find the connection to obesity (which I am). This article has been very eye-opening and hopefully in a few months I'll be able to report back with my success story. Thanks again for posting this!

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    Guest Marie Zarankevich

    Posted

    Your view of this malady is refreshing, and I was delighted to find something which was not just a repetition of Mayo data. Four generations of my family have or had Celiac, some of them died from it. Nobody knew what was wrong. It's such a relief just to be able to move around again, and think clearly. Keep up your good research, and I'll keep up mine. I think the grains were the god's answer of how to control us after the Tower of Babel story.

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    Guest Colleen MacDonell

    Posted

    This tells a story that is so common. Desire to eat without appetite. Give up gluten and your desire disappears. Very important message.

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    Guest citykatmm

    Posted

    I think this is a very logical explanation for obesity. However, I am anorexic and I just found out I have celiac disease. Somehow the two are related but there is the very strong psychological portion of the eating disorder that is present. I don't think celiac disease causes anorexia nervosa. Interestingly though, I have both anorexia nervosa and celiac in my family background. I have been looking for more research on this and I can't find a lot. It is mostly about celiacs who become anorexic. There must be some component to the anorexia though, or else everyone who was celiac would becaome anorexic. I would be interested to find out any more information.

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    Guest Carla

    Posted

    Thank you so much for this! It all makes so much sense, especially when put together with all my other symptoms. This has really motivated me to get serious about my health and get the gluten out!

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    Guest Marie Zarankevich

    Posted

    I am now responding to response number 7. Celiac disease gives a person tremendous amounts of gas. My aunt died as an anorexic, partly because she could no longer bear being a lady, and being so flatulent as well. To her, it was disgusting. It destroyed her joy in living.

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    Guest KWHudson

    Posted

    I have battled compulsive cravings my whole life. I have been gluten-free for a short while now and no longer have stomach upset or cravings, and my innards feel different, 'lighter' or something. This may sound strange but I feel FREE. You couldn't pay me to eat a bagel or pizza or crusty french bread, I feel much too good. I didn't even realize just how terrible I felt when I was eating gluten. My overweight daughter exhibits severe cravings, and we are weaning her off of gluten now. You are ON to something here, for a large portion of us I suspect. Keep up the good work, and THANK YOU!

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    Guest K Sommers

    Posted

    I have eaten only gluten-free products for the past week. The food cravings, bloating, and tiredness are GONE! Though I am still about 20 pounds overweight, I have dropped three pounds this past week without even trying -- without dieting. My energy level is also way up. Thank you for the information.

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    I am concerned that the problem isn't only with gluten. In addition to gluten, I am very sensitive to caseinate & eggs. There is something about those glycoproteins....

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    Guest Karen Vaughan

    Posted

    A very good article. I notice that when I eat gluten or other carbohydrates, I get addictive cravings. So I do think that macro nutrients along with the gluten are involved. I Couldn't agree with you more on the essential fatty acids.

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    Guest Nicqizi

    Posted

    Unfortunately, I have been fairly gluten-free for the past 2 years, and I have been packing on the pounds like never before. Help - I'd love some feedback.

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    Unfortunately, I have been fairly gluten-free for the past 2 years, and I have been packing on the pounds like never before. Help - I'd love some feedback.

    I must agree with Nicqizi, I to have been packing on the weight and it just does not end. I work out and eat healthy. I've never had a weight problem before. I wish that someone out their can tell me why the weight keeps coming and when will it stop. I feel more depressed now than when I was sick and found out that I was celiac.

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    Guest glutenfreenow

    Posted

    I think this is a very logical explanation for obesity. However, I am anorexic and I just found out I have celiac disease. Somehow the two are related but there is the very strong psychological portion of the eating disorder that is present. I don't think celiac disease causes anorexia nervosa. Interestingly though, I have both anorexia nervosa and celiac in my family background. I have been looking for more research on this and I can't find a lot. It is mostly about celiacs who become anorexic. There must be some component to the anorexia though, or else everyone who was celiac would becaome anorexic. I would be interested to find out any more information.

    You may have been reacting to the effects of celiac at a very young age and not have even been aware of it. I have been watching my daughter waste away and not grow like the rest of her peers. For two years, I pressed her Doctors, I knew she had this disease. Finally at age 8 and after seeing two Pediatric GI's she was diagnosed. Her eating behaviors could only be described as anorexic and mealtime was always a battle. She never had the typical stomach issues that are classic celiac symptoms. Her "normal" reaction to eating food was a stomach floating sensation. She associated this feeling with food and stopped eating. I had know idea she was experiencing a physical reaction to food because at her age it had always been this way and she never thought to share it with me. I definitely see how this disease has impacted her eating habits. For anyone who wants to dismiss the impact of celiac disease and following a gluten free diet, my now nine year old daughter has grown four inches in one year. Which is startling when you consider she hadn't grown an inch for the two years prior to her diagnosis. I was just tested myself and my blood work just came back positive. I didn't think I could have this disease because I am about 40 pounds overweight. Go figure.

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    Guest Linda

    Posted

    I found this article informative and well-written. As an individual with gluten sensitivity and a constellation of attendant problems (morbid obesity, hypoglycemia, cognitive impairment, ADD, chronic, treatment-resistant depression, excema and hives, just to name a few) I found conventional 'dieting' plans (such as Weight Watchers) an easy way to actually gain weight, instead of losing it. It wasn't until I removed from my diet all wheat and 'white stuff'-- white flour, sugar, white rice, and the like-- that I began to lose weight. During the first four months on a restricted food plan I lost 40 pounds. I also experienced extreme withdrawal-- quitting cigarettes was a walk in the park compared to this. Headaches. Cravings. Flu-like symptoms. And mood swings? I felt like I'd had all my skin ripped off and was walking around with all my nerve endings exposed. I was irritable, angry, or sad for no reason. Holding a simple conversation was an ordeal. I wouldn't wish it on my worst enemy, When withdrawal eventually ended, the weight loss didn't. I lost 103 pounds in 18 months, and for almost two years until, I spectacularly 'fell off the wagon' (it involved half a sheet cake-- don't ask), kept it off. It took almost three years, and 100 pounds regained, to reestablish a steady footing on the food plan (worked out with a nutritionist) but the weight gain (100 pounds) stopped and I have started to lose (20 so far) again. But the gluten-free diet is key to having no food cravings to distract me, and keeping my brain clear. Mr. Hoggan has addressed an under served audience with this article.

    I have been diagnosed with hypoglycemia, morbid obesity, anxiety disorder, severe eczema and rosacia. I feel at times like I have ADD and lack of concentration. I always feel tired and suffered on and off from diarrhea and abdominal pains. Your story is eerily mirroring my experiences so I am going to get checked. Thank so much for the honesty.

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    Unfortunately, I have been fairly gluten-free for the past 2 years, and I have been packing on the pounds like never before. Help - I'd love some feedback.

    Nicqizi, based on conversation with my doctor and nutritionist, along with personal research, eating a "fairly gluten-free" diet is simply not helpful. Your gut has to heal, all those villi need to grow back. Having something even once a month is not okay for someone who should be on a gluten-free diet. While I am no expert on how this relates to weight gain, I know that your gut cannot heal and the rest of your body will not function properly until you cut out gluten completely. Personally, I've also had to cut out dairy. Though I said I could never stop eating cheese, my body is grateful that I have!

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    THANK YOU so much for this article. I discovered my gluten intolerance a few years ago when I became a vegetarian in an attempt to feel better. I got SO sick eating 1,200 calories a day- a strict diet of organic home made breads, pastas and fresh fruits and veggies and fresh juices. I finally researched my symptoms (distended stomach, weakness, clouded thinking, bouts of depression and anxiety, inability to loose weight, muscle tension/spasms) and I heard about celiac for the first time.

     

    I cut gluten out completely and within days the clouds started to clear for me. Since then, I've also had to cut out most other grains, and now dairy as well. I still have relapses, but I don't beat myself up as much since I now finally understand the addictive component. *** I have found a HUGE hindrance on this journey back to health has been hidden MSG which many gluten free and 'health' food is full of (it can slip past even the most ardent label readers) For those of you who have commented that you are still continuing to gain weight even on a strict gluten free diet- check the labels- you may be eating food that, while labeled gluten free- is spiked with 'flavor enhancing' chemicals which are incredibly addictive and will leave you feeling just as compulsive, out of control and sick. Google "other names for MSG" and see if you don't find a connection. And good luck!

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    Guest SandraB

    Posted

    Exactly. I am gluten sensitive - I didn't know this for years, and throughout two pregnancies went through the horrible experience of feeling both sick and hungry all the time. Put on lots of baby weight as my body fought to absorb the necessary nutrients. There seem to be few studies of pregnancy while undiagnosed celiac.

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    I am a woman in her twenties who suffer from anxiety and OCD.

    A couple of years back I started bingeing from time to time, and it became increasingly frequent. A few months ago I actually started purging because I was so uncomfortable after stuffing myself with bread, cereal and crackers for the most part.

    Looking back last summer, there was a period of 15 days where I only ate meat and veggies. My mood was significantly better and my compulsions decreased by a lot.

    I am going to try very hard to go 2 weeks without gluten and see where it takes me. Fingers Crossed!!

    Thank you for the wonderful article.

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    Guest Tessa

    Posted

    I've been tirelessly researching this disease for almost two years. All of the skin issues that come with it, allergy to gluten and common allergy to dairy are markers for something. I once read that allergies come from the liver. Maybe we should all try a liver cleanse and see if we feel better?

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    Guest Molly

    Posted

    At age 50 I finally discovered that what was making me sick is gluten, dairy and sugar. I used to stalk my GP with a variety of symptoms, ranging from dizziness, bloating, vision problems, constipation, severe joint pain (without swelling), fatigue, food allergies, shortness of breath, asthma and the list goes on ... I am certain there was a big "H" on my medical chart for hypochondriac. Since going on a gluten free lifestyle I have dropped 25 kg without trying. I am no longer hungry after meals and the cravings have gone. I feel 30 years younger. I have lots of energy. Just sorry I didn't realize it sooner and that neither the medical profession did.

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    Guest Becci

    Posted

    I am in the process of looking for this very answer. I have celiac, fibromyalgia and Hashimoto's. I actually had a gastrointestinal doctor tell me last year that he didn't believe I had celiac because "celiacs are usually thin" (I'm 5'4" and weigh about 200lbs). The last time I was able to lose a significant amount of weight was in my late 20s when I eliminated refined carbs and sugars from my diet. No white stuff, cereal or breads and even though I didn't know it at the time, most of that was the gluten I consumed. I am now diagnosed with malnutrition and have been living very ill for the past several months. This article gives me hope that if I eliminate these things I can lose weight again and begin to feel more normal. I will check back and let you know how I'm doing soon.

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    Guest Miranda

    Posted

    I have been overweight since I was a teenager. Just got diagnosed with ceilac disease last year in January . I was in a coma for 4 days and in hospital almost a month and in a rehab hospital for almost a month and was not able to walk or talk. I had lost weight to 176 lbs going in to hospital, and now I have gained up to 330lbs. and I am very depressed. I can't understand why some people lose weight on a gluten free diet while it caused me to gain so much weight. So not all people are alike.

    Did you eat the packaged gluten-free foods? If you did, that's probably the cause. I'd suggest eating only fresh veggies, lean meat and fruits, and see how you feel after that.

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    admin
    Celiac.com 11/29/2006 – Contrary to popular beliefs (not to metion outdated medical training), this study demonstrates that 39% of those who are diagnosed with celiac disease are actually overweight rather than underweight. A full 30% of celiac disease patients were in the obese range at the time of their diagnosis. Unfortunately many medical doctors still wont even consider testing overweight patients for celiac disease because they erronously believe that the disease can only occur in individuals who are underweight. This line of reasoning is outdated and incorrect, and is also very dangerous to those who happen to have celiac disease are are overweight—which is now known to be quite common.
    For those who want to read more about this topic be sure to have a look at the following articles:
    Celiac Disease and Obesity—There is a Connection by Melissa Croda Food Cravings, Obesity and Gluten Consumption by Dr. Ron Hoggan, Ed.D.
    Below is the Abstract for the latest study, which was conducted by William Dickey, M.D., Ph.D., F.A.C.G.:

    Am J Gastroenterol. 2006;101(10):2356-2359.
    Overweight in Celiac Disease: Prevalence, Clinical Characteristics, and Effect of a Gluten-Free Diet
    Posted 11/14/2006
    William Dickey, M.D., Ph.D., F.A.C.G.; Natalie Kearney, B.Sc. Abstract:

    Background: It is well established that a minority of celiac patients present with classic symptoms due to malabsorption. However, few studies have focussed on the distribution of body mass index (BMI) in celiac populations and its relationship to clinical characteristics, or on its response to treatment.
    Methods: We reviewed BMI measurements and other clinical and pathological characteristics from a database of 371 celiac patients diagnosed over a 10-yr period and seen by a single gastroenterologist. To assess response to gluten exclusion, we compared BMI at diagnosis and after 2 yr treatment in patients with serological support for dietary compliance.
    Results: Mean BMI was 24.6 kg/m2 (range 16.3–43.5). Seventeen patients (5%) were underweight (BMI Conclusions:
    Few celiac patients are underweight at diagnosis and a large minority is overweight; these are less likely to present with classical features of diarrhea and reduced hemoglobin. Failed or delayed diagnosis of celiac disease may reflect lack of awareness of this large subgroup. The increase in weight of already overweight patients after dietary gluten exclusion is a potential cause of morbidity, and the gluten-free diet as conventionally prescribed needs to be modified accordingly.

    Jefferson Adams
    Celiac.com 03/19/2012 - A clinical gastroenterology research team recently weighed in on the practice of using weight as a factor to screen for celiac disease. They are calling for doctors to ignore body-mass when assessing patients for possible celiac disease screening.
    The team was made up of Fabio Meneghin, Dario Dilillo, Cecilia Mantegazza, Francesca Penagini, Erica Galli, Giulia Ramponi, and Gian Vincenzo Zuccotti. They are affiliated with the Department of Pediatrics of the Università di Milano Luigi Sacco Hospital in Milan, Italy.
    The team argues that, more and more, people with clinical celiac disease are presenting widely varied symptoms, while classic gastrointestinal symptoms like diarrhea or failure to thrive are becoming less frequent at diagnosis.
    In fact, data shows that symptoms once considered to be atypical are now appearing at least as often as classical symptoms related to nutritional malabsorption.
    Recent studies and case reports show that the expected clinical-condition of malnutrition, typical in a disease where there is a disorder of absorption, is less frequent than in the past. Meanwhile, overweight and even obesity are increasingly common in people with as yet undiagnosed celiac disease.
    The team points out that obesity has become the most prevalent nutritional disorder among children and adolescent of United States, and also in many European countries. They note that a rates of overweight and obesity have doubled in a single generation.
    They use these facts to encourage doctors to screen for celiac disease without regard for the patient’s body weight, and thus speeding diagnosis and avoiding possible clinical consequences for patients.
    For now, their call has been rejected by the editors of Gastroenterology Research and Practice. However, look for this kind of call to be echoed in the future, as data are compiled, and the realities of celiac disease are better understood.
    Source:

    Gastroenterology Research and Practice

    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

  • 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