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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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    BLOOD TESTING FOR CELIAC DISEASE ISN'T VERY ACCURATE


    Tina Turbin

    This article originally appeared in the Autumn 2010 edition of Journal of Gluten Sensitivity.


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    Celiac.com 01/10/2011 - As an author, researcher, and gluten-free advocate, I work hard to raise awareness for celiac disease and gluten issues, particularly when it comes to increasing the diagnosis rate. Part and parcel of improving diagnosis is proper testing. Evidence is mounting that indicates that blood testing may not be the most effective way to test for celiac disease, and I would recommend that people who suspect they have celiac disease to check with their doctors about other testing options.

    Celiac disease, which is essentially an autoimmune reaction to gluten, a protein found in wheat, barley, and rye, affects approximately three million Americans, but according to estimates, only three percent of them have been properly diagnosed with the disease. Once celiac disease is diagnosed, treatment is simple—following a gluten-free diet. With so many American celiacs going without a diagnosis,  this painful and potentially fatal autoimmune disorder, with its easy method of treatment, attention needs to be focused on effective, efficient testing.

    Although awareness of celiac disease and gluten-free living is increasing in the various medical fields, accurate and reliable testing has not been definitively tackled or uniformly implemented by medical practitioners. Currently a popular method of testing is a blood test, but some people with celiac disease can get blood testing many times and the results will nevertheless be negative.

    Although blood testing has been successful in diagnosing some people with celiac disease, this method is inaccurate at least 80 percent of the time, according to Dr. Datis Kharrazian, Blood Chemistry Seminar instructor and the formulator for Apex Energetics, Inc. supplements. To understand how blood testing works, a basic grasp of the workings of the immune system is essential. Antibodies are part of the immune system and designed to attack specific antigens, or invaders, of the body. Tests can be conducted that find an increase of antibodies in the system, which are on the prowl for certain foreign invaders. Specifically, anti-gliadin, or anti-gluten antibodies, can be tested for; when these exist in the system in large amounts, it is a sign of the autoimmune disorder, celiac disease. Although this may sound workable in theory, in practice blood testing is insufficient and inaccurate due to the fact that the autoimmune response doesn’t occur in the blood stream, but in the small intestine, as the immune system attacks this organ’s absorptive finger-like structures called villi which line the inside. Thus, for the sake of reliability, this suggests that testing should be focused on the gut.

    So what method can we turn to? Fortunately, there is another method apart from an intestinal biopsy, which is an invasive as well as expensive procedure. It turns out that the immune cells which surround the gut also can be located in large numbers in the stool, making a stool anti-gliadin antibody test a reliable alternative to blood testing.

    Stool testing may be more accurate than blood testing and is more convenient. One doesn’t need a doctor’s prescription for the test, which can be conducted in the privacy of one’s own home with an online-ordered kit from EnteroLab, which according to its website, is “a registered and fully accredited clinical laboratory specializing in the analysis of intestinal specimens for food sensitivities.”

    Enterolab offers the Anti-Gliadin Antibodies Stool Test as well as additional tests which can be ordered may be important diagnostic tools for people who have celiac disease or gluten-sensitivity. These additional tests include the Tissue Transglutaminase Stool Test, which tests whether gluten is actively attacking the intestine and other tissues, the Malabsorption Test, used to determine whether the intestine is malabsorbing nutrients due to the autoimmune reaction to gluten, or the Celiac and Gluten-Sensitivity Gene Test. The lab also offers a Milk Sensitivity Test, which tests for reactions to casein, a milk protein

    With millions of celiac Americans living with their disease undiagnosed, we can’t afford to waste time with inaccurate and inefficient testing. The anti-gliadin antibodies stool test, so easily available to the public, is a great stride forward for the celiac community.

    Talk with your health care provider today about this alternative to celiac blood testing.


    Image Caption: Tina Turbin is an author, researcher, and gluten-free advocate.
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    Guest bo denski

    Posted

    Does not cite any scientific literature just the company selling the stuff. Do a pubmed search, talk to a few doctors that will go on record, then the article.

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    Guest Kristine

    Posted

    All the "scientific evidence" comes from companies who market products like supplements and other nontraditional treatments, such as Apex Energetics and EnteroLab. Celiac.com should weed out such marketing efforts that are posing as objective science.

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    Guest CeliBelli

    Posted

    Ms. Trubin displays a dismally poor grasp of human anatomy and autoimmune response. Based on her logic, there could be no grounds for the correlation between celiac disease and Hashimoto's Thyroiditis. And yet there is such a correlation, just as there is a correlation between celiac disease and lymphoma. Why? Because - contrary to Ms. Turbin's assertion that celiac all happens in the gut - Celiac is a systemic disease that involves complex processes all over the body. Those processes entail the communication of antibodies throughout the body via the blood stream. While it is true old methods of blood testing were not as reliable, there are labs that have developed highly accurate blood and saliva tests both for celiac antibody and genetic testing. Among these are Prometheus Lab based in San Diego, and Kimball Genetics in Denver. Both use the most advanced testing available for celiac disease available today. And both now offer cheek swab testing which can be done at home.

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    As far as I know, NO medical community agrees with stool testing as having any indication to suggest celiac disease. Furthermore, many people can have positive anti-gliadin antibodies and NOT have Celiac. Anti-gliadin is false positive in many subgroups of people, hence why it is not usually used anymore to diagnose celiac. Stool antibodies are even less specific as far as I know. Enterolab has not ever released its work for peer review, so there is little data to say stool testing means anything other then your immune system has simply had exposure to the food protein in question and remembers it. It may or may not mean anything. I do think the article raises some good questions, though.

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    I also wanted to add that EMA blood testing is almost 100% specific for Celiac (although not quite that sensitive), so it is very accurate in that regard. Mayo Clinic now also uses a form of an IgG anti-gliadin test and/or another test they designed (I forget the name) which is more specific than the IgA anti-gliadin test, which often is not accurate. Some Drs still use TTG as well. Regardless, a biopsy is still usually considered the standard for testing, along with blood work and clinical symptoms (if any). Genetic testing can be done as well, which doesn't prove Celiac on its own, but if negative can virtually rule it out. Non-Celiac gluten sensitivity is a whole different condition it seems, so most of those cases would likely test negative to all current Celiac testing, including blood work. Bottom line, if you think you truly have Celiac, it's crucial to have an official diagnosis on your chart. You don't want to be fed gluten in the hospital while recovering from surgery for example. Unfortunately, only blood work combined with a biopsy can offer that at this time. Don't waste your money elsewhere.

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    Forget the blood test, save your money for Enterolab. I see 5-10 people everyday at my gluten free bakery that had a positive biopsy but negative blood test. The blood test is a crime sending patients out the door with a 80% false reading to then later develop an irreversible life threatening disease(s). Many scientifc papers and real life people prove the blood test is "old school".

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    Guest KC Nelson

    Posted

    Although I can't verify the veracity of Enterolab, I do know that my blood work has been frustratingly negative. I've known I had Celiac for 10 years, I've been tested twice: both negative. I do an elimination diet and within days I am a different person. With a diagnosis I would have much more credibility, but I have determined to live my life gluten-free like I know I should. It is unfortunate we don't have a basic standard we can all agree on.

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    Guest Halli Magg

    Posted

    Is this really an autoimmune disease? The immune system attacks the gluten which is not auto (one self) and the damage to the villi is collateral damage.

    I'm just asking as I have never seen gluten intolerance being described as an autoimmune disease, although I understand it can be a starting point for one.

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    Guest superluminal11

    Posted

    I am impressed that many of you can see the marketing (how can I make more money) off this scientific data. The Pharma Giants do this to the doctors as well in 1 hour meetings by sales people with lovely personalities. The result...no one ever really gets WELL. But hey...more money is floating around out there in the market right? Money is what makes the world go around right? Mmmmmmm mmm...LOVE THAT MONEY

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    Is this really an autoimmune disease? The immune system attacks the gluten which is not auto (one self) and the damage to the villi is collateral damage.

    I'm just asking as I have never seen gluten intolerance being described as an autoimmune disease, although I understand it can be a starting point for one.

    It is an autoimmune disorder, yes. The immune system does not attack the gluten, it directly attacks the lining of the small intestine. Gluten intolerance is different than celiac disease, and is not an autoimmune disorder.

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    Although I am typically skeptical of less-accepted resources, I'd say that this article is spot-on. I tested negative for celiac disease for 8 years. I was severely ill, had multiple vitamin deficiencies, yet always tested negative. Finally, after another bout of severe illness, I tested positive. Funnily enough, my gastroenterologist knew that the test results weren't accurate, and knew to keep retesting me for it.

     

    My biopsy, however, was negative. But it was then I learned that due to the endoscopy's limited ability to reach even most of the intestine, the results of biopsy are actually a) positive or B) inconclusive; as opposed to positive or negative. My gastroenterologist made the diagnosis based on a positive blood test, vitamin b12 deficiency and a positive reaction to the gluten free diet.

     

    Yet what happened during those 8 years? There are many theories as to why blood tests are inaccurate, and I'd say the theory presented in this article is the best theory: the antibodies measured in testing only measure antibodies in the blood stream, not the digestive tract.

     

    If you are looking for a more acceptable resource, then look no further than the British Medical Journal and a study written back in the 70s about antibodies in the gut, and the lack of reliability of testing, and which suggests that there is more reliability from testing conducted on feces and saliva. Because URLs are no allowed in comments, evidently, please Google "The demonstration and function of antibodies in the intestinal tract."

     

    I'd personally say save your money and get genetic testing, vitamin/mineral testing, and try the gluten free diet. I'd even bet that many people with supposed "gluten intolerance" actually have celiac disease, but had negative test results.

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    Guest Sandi S.

    Posted

    As far as I know, NO medical community agrees with stool testing as having any indication to suggest celiac disease. Furthermore, many people can have positive anti-gliadin antibodies and NOT have Celiac. Anti-gliadin is false positive in many subgroups of people, hence why it is not usually used anymore to diagnose celiac. Stool antibodies are even less specific as far as I know. Enterolab has not ever released its work for peer review, so there is little data to say stool testing means anything other then your immune system has simply had exposure to the food protein in question and remembers it. It may or may not mean anything. I do think the article raises some good questions, though.

    I just went to my doctor yesterday, and he recommended the same lab and tests that are suggested in this article. So, clearly the medical community does support this type of testing for this issue. He used this lab/tests for his own family and recommends it to patients. I am going to do more research before I do this testing on my daughter. I thought this article was very enlightening.

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    Guest Smart Donkey

    Posted

    Ms. Trubin displays a dismally poor grasp of human anatomy and autoimmune response. Based on her logic, there could be no grounds for the correlation between celiac disease and Hashimoto's Thyroiditis. And yet there is such a correlation, just as there is a correlation between celiac disease and lymphoma. Why? Because - contrary to Ms. Turbin's assertion that celiac all happens in the gut - Celiac is a systemic disease that involves complex processes all over the body. Those processes entail the communication of antibodies throughout the body via the blood stream. While it is true old methods of blood testing were not as reliable, there are labs that have developed highly accurate blood and saliva tests both for celiac antibody and genetic testing. Among these are Prometheus Lab based in San Diego, and Kimball Genetics in Denver. Both use the most advanced testing available for celiac disease available today. And both now offer cheek swab testing which can be done at home.

    This company was purchased by Nestle last year. Sure, feed us all Gerber, Nesquik, and Hot Pockets. No problem, I'll send you my DNA so you can test me for GI diseases and other disorders for eating too much bad food. Conflict of interest? Noooo, not at all. I would rather pay for an endoscopy and find out for sure instead of paying for probability analysis.

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    Guest Morna Erwin

    Posted

    I suffered from dermatitis herpetiformis for over a year before being diagnosed as celiac. The rash on my buttocks was bilateral and the itching would wake me up in the middle of the night. My doctor kept treating me for herpes, although it never improved even a little bit.

     

    Once I found out what it was, I sent away for testing from Enterolab, and tested positive on IgA antibodies and Anti-tissue transglutaminase IgA antibodies. I immediately went on a gluten-free diet and the rash went away completely, although it will itch if I get accidental cross-contamination.

     

    My gastroenterologist ran the blood test on me and did endoscopic biopsy, but both were negative. Of course, I was already 3 weeks into my gluten-free diet.

     

    My primary care physician accepts Enterolab results. Other food sensitivities Enterolab found (milk, corn, oats, pork) have also helped me design a diet that has improved my health.

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    Guest Kareng

    Posted

    Don't get your "medical info" from someone with a product to sell. Ask real doctors who study and treat the disease.

     

    "Why don't you recognize tests (stool tests or otherwise) for non-celiac gluten sensitivity that are currently available through companies like Enterolab or Cyrex?

     

    We only embrace tests that have endured rigorous scientific evaluations. So far, these tests have received no evidence-based support.

     

    Enterolab has never successfully published anything on the accuracy of stool tests (nor have any other stool test manufacturers, to our knowledge) making it difficult to confirm the research results. Because of this, we must make our decisions based on what has been published; Harvard, UCSD, and the American College of Gastroenterology all agree that stool tests are simply not sensitive or specific enough methods in screening for celiac disease.

     

    We can say therefore with confidence that the test currently being used by these labs is not good enough. In fact, while it is true that about 40% of people with proven gluten sensitivity have elevated AGA-IgG, it is also true that about 15-25% of the healthy individuals who have absolutely nothing wrong also have elevated AGA-IgG. Hence, about 60% of gluten sensitive people do not have elevated AGA-IgG (making the test not sensitive enough); and about 20% of normal, non-gluten sensitive people have elevated AGA-IgG for no apparent reason (making the test not specific enough)."

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    Guest Stella

    Posted

    There is no scientific research validating antibody stool tests. However, Ms Turbin is correct in that the traditional blood test for Celiac disease, which measures antibodies to only one protein from wheat, produces many false negatives. That is why many researchers have concluded that assessing immune responses to multiple wheat fractions, not just alpha-gliadin-33, is the best method for assessing gluten reactivity (see the various publications of Camarca, Vader and Vojdani). Just because a healthcare practitioner orders the stool test, it doesn't mean it has been accepted by the medical industry. Many practitioners turned to the stool test because of convenience, or frustration with the many false negatives of the blood test. The best thing is to simply avoid gluten altogether. If you feel better, then you know. Why waste time and money with doctors and tests when the solution is within your own power? Your doctor can better serve you by fixing the gut damage you have acquired after consuming gluten (and dairy) for decades.

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    Guest kelley

    Posted

    Another consideration is the cost I just had celiac blood work done from the Cleveland Clinic at a cost of over $500 dollars, and it was negative so the doctor wants to do a colosomy.

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    Guest Jeff Kelly

    Posted

    I just went to my doctor yesterday, and he recommended the same lab and tests that are suggested in this article. So, clearly the medical community does support this type of testing for this issue. He used this lab/tests for his own family and recommends it to patients. I am going to do more research before I do this testing on my daughter. I thought this article was very enlightening.

    I do agree that Enterolab does good work, although if I have one criticism, it is only that it fails to understand that if a patient does not have malabsorption during testing, it doesn't mean no celiac exists and malabsorption did not exist at some prior point in time(or could exist at some future point in time under the "right conditions" for the celiac). Thus, the criticism I heard above does not strike me as accurate, balanced, or according to what we sufferers have had to go through out there. Enterolab is certainly better than no testing, including the gene testing for certain, which has been shown in the literature, and thus to characterize Enterolab as off in the vapor or ether somewhere is quite inaccurate. I do agree that as more and more labs do this kind of testing, we need to look at others too. For me it was 45 years of being ignored and wasting away. Photos of myself as a child demonstrate the emaciation. I was thrown into Psychiatry back then and have been many times since, and I can tell you any science is better than no science, any affirmation is better than none, and what we seem to be seeing is physicians catching up with what is going on in labs out there--as opposed to the labs catching up with the ignorance of physicians in the past. That's a positive development--and while some criticism might be leveled on certain aspects and details, overall what we are seeing out there is positive.

    Now also it has been discussed in professional seminars that the blood tests are not as accurate as they could be, so this assertion is quite according to established facts and discussion on this topic, and cannot be just dismissed. The biopsy portion is what G.I. docs hang their hat on--yet most do not order any. I certainly suffered for 45 years without having one being ordered, and once one was, I was strictly gluten free and of course it turned up nothing under those conditions. G.I. docs have a long way still to go with this--which is of course contrary to their medical training, which, as the film "Patch Adams" documented, is akin to teaching religion and doctrines. Sometimes religion and doctrines on certain topics have to be unlearned before actual learning can occur. And that is most certainly the case in celiac sprue. I wish everyone would return to the original medical name of celiac sprue, because it just seems to me the name itself has been bastardized to the point of being an easy target for a joke.

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    Guest Jeff Kelly

    Posted

    I also wanted to add that EMA blood testing is almost 100% specific for Celiac (although not quite that sensitive), so it is very accurate in that regard. Mayo Clinic now also uses a form of an IgG anti-gliadin test and/or another test they designed (I forget the name) which is more specific than the IgA anti-gliadin test, which often is not accurate. Some Drs still use TTG as well. Regardless, a biopsy is still usually considered the standard for testing, along with blood work and clinical symptoms (if any). Genetic testing can be done as well, which doesn't prove Celiac on its own, but if negative can virtually rule it out. Non-Celiac gluten sensitivity is a whole different condition it seems, so most of those cases would likely test negative to all current Celiac testing, including blood work. Bottom line, if you think you truly have Celiac, it's crucial to have an official diagnosis on your chart. You don't want to be fed gluten in the hospital while recovering from surgery for example. Unfortunately, only blood work combined with a biopsy can offer that at this time. Don't waste your money elsewhere.

    I would agree folks SHOULD go for the intestinal biopsy, but many doctors pooh-pooh it. It sometimes isn't enough to be EMACIATED either--the docs simply have unreformable BIASES against evaluating for celiac sprue (they were taught in their INDOCTRINATION in med. school that they would never see a case in their lifetimes and if they ever did it would be a serious FLUKE). Fasano's data states 1% of AMERICA. That's hugely more common than med. school training teaches, and it is a waste of time arguing with someone who believes in a RELIGION moreso than actual reality such as what we celiacs have had to go through in our WASTED LIVES, in many cases. PERIOD!!

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    Guest Jeff Kelly

    Posted

    I also wanted to add that EMA blood testing is almost 100% specific for Celiac (although not quite that sensitive), so it is very accurate in that regard. Mayo Clinic now also uses a form of an IgG anti-gliadin test and/or another test they designed (I forget the name) which is more specific than the IgA anti-gliadin test, which often is not accurate. Some Drs still use TTG as well. Regardless, a biopsy is still usually considered the standard for testing, along with blood work and clinical symptoms (if any). Genetic testing can be done as well, which doesn't prove Celiac on its own, but if negative can virtually rule it out. Non-Celiac gluten sensitivity is a whole different condition it seems, so most of those cases would likely test negative to all current Celiac testing, including blood work. Bottom line, if you think you truly have Celiac, it's crucial to have an official diagnosis on your chart. You don't want to be fed gluten in the hospital while recovering from surgery for example. Unfortunately, only blood work combined with a biopsy can offer that at this time. Don't waste your money elsewhere.

    You make EXCELLENT POINTS HERE, but in my experience physicians remain UNHELPFUL with any of this due to certain BIASES AGAINST celiac sprue, particularly in MEN. John F. Kennedy was a man, wasn't he? The steroids literally kept him functional as a celiac (then as the old saw goes life sucks and then you die). Well anyway doctors don't or won't consider celiac sprue in men unless and until you are at death's door and then they might do something useful, like snip off your penis or something. That's about the level of expertise they have in my experience--and continue to have. They still don't know a damn thing about it, and do not wish to know and do not wish to know mostly that what they've been taught about it is in many cases WRONG--such as prevalence, and such as the sequelae from it being as WRONG as their ignoring this issue FOREVER. PERIOD. PARAGRAPH!!

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    Guest Jeff Kelly

    Posted

    Although I am typically skeptical of less-accepted resources, I'd say that this article is spot-on. I tested negative for celiac disease for 8 years. I was severely ill, had multiple vitamin deficiencies, yet always tested negative. Finally, after another bout of severe illness, I tested positive. Funnily enough, my gastroenterologist knew that the test results weren't accurate, and knew to keep retesting me for it.

     

    My biopsy, however, was negative. But it was then I learned that due to the endoscopy's limited ability to reach even most of the intestine, the results of biopsy are actually a) positive or B) inconclusive; as opposed to positive or negative. My gastroenterologist made the diagnosis based on a positive blood test, vitamin b12 deficiency and a positive reaction to the gluten free diet.

     

    Yet what happened during those 8 years? There are many theories as to why blood tests are inaccurate, and I'd say the theory presented in this article is the best theory: the antibodies measured in testing only measure antibodies in the blood stream, not the digestive tract.

     

    If you are looking for a more acceptable resource, then look no further than the British Medical Journal and a study written back in the 70s about antibodies in the gut, and the lack of reliability of testing, and which suggests that there is more reliability from testing conducted on feces and saliva. Because URLs are no allowed in comments, evidently, please Google "The demonstration and function of antibodies in the intestinal tract."

     

    I'd personally say save your money and get genetic testing, vitamin/mineral testing, and try the gluten free diet. I'd even bet that many people with supposed "gluten intolerance" actually have celiac disease, but had negative test results.

    Beautiful comment, and spot on. Love that reference to the medical literature too. Everything about your post was excellent. Rock on, baby!!!

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    Guest Jeff Kelly

    Posted

    There is no scientific research validating antibody stool tests. However, Ms Turbin is correct in that the traditional blood test for Celiac disease, which measures antibodies to only one protein from wheat, produces many false negatives. That is why many researchers have concluded that assessing immune responses to multiple wheat fractions, not just alpha-gliadin-33, is the best method for assessing gluten reactivity (see the various publications of Camarca, Vader and Vojdani). Just because a healthcare practitioner orders the stool test, it doesn't mean it has been accepted by the medical industry. Many practitioners turned to the stool test because of convenience, or frustration with the many false negatives of the blood test. The best thing is to simply avoid gluten altogether. If you feel better, then you know. Why waste time and money with doctors and tests when the solution is within your own power? Your doctor can better serve you by fixing the gut damage you have acquired after consuming gluten (and dairy) for decades.

    You ask a good question but another poster had a good answer: because official medical affirmation is useful, such as if you are in the hospital with some surgery or something and your diet needs to be strictly gluten free(hospitals do a notoriously bad job at knowing what this is or how to serve it anyway, but at least you have a step up on this). It can also serve as notice to Psychiatrists, which is a human rights abusive industry(ie, the mental illness industry), that you have an affirmed medical condition and not a b$#@@#$$ invented condition to make Psychiatry, hospitals, and pharmaceuticals rich or should I say "keep them rich." Ok, and the other reason is for family, friends, and perhaps even the community at large, who may regard you positively if some or all of those know you have an actual medical condition instead of a phony, Psychiatric industry sounding nonsense condition. That about wraps up my answer!!

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    admin
    Celiac.com 10/29/2002 - Dr Robert Anderson, Research Fellow at the Nuffield Department of Medicine at the University of Oxford (now based at the Royal Melbourne Hospital in Australia), and colleagues recently announced their intent to begin work on a vaccine that could cure celiac disease. The Australian teams work will be based on Dr. Andersons earlier groundbreaking Oxford research that identified the specific set of protein sequences in gluten that cause damage to the guts of those with celiac disease (see: Nature Medicine 6, 337 - 342 - 01 Mar 2000). In addition to finding a possible cure for celiac disease the teams research could open the door for a specific diagnostic test for the disease, new treatment and prevention strategies, and even the possibility of producing grains that do not contain the harmful sequences. Dr. Andersons future research will focused on proving that a specific "toxic peptide" can be used to desensitize or induce tolerance in people with celiac disease, and any vaccine would likely be the "toxic peptide" itself or a modified form of it.
    The Australian team also announced their agreement for the commercialization of new celiac disease technology developed by the University of Oxford. BTG and Isis will develop diagnostic tests and treatments for gluten intolerance. BTG is a London-based technology transfer company which has bought the rights to the teams discovery, and Isis Innovation Ltd, is Oxford Universitys wholly-owned technology transfer company that was established in 1988 and is a world leader in university technology transfer. Under the terms of the Isis agreement, BTG will have exclusive access to the Universitys technology for use in the diagnosis, prevention and treatment of celiac disease. The technology is based on identification of the particular epitopes that cause priming of the immune system in celiac disease. BTG will underwrite all costs associated with the development and commercialization of the technology, and will share any revenue from commercialization of the technology with Isis and the University.


    Destiny Stone
    Celiac.com 03/26/2010 - Mass screening studies among the general population for celiac disease show a prevalence of approximately 0.5-1.0% in adults and in children. Yet, despite the growing numbers of newly diagnosed celiac disease patients, most cases still remain undiagnosed and therefore, untreated. In part, the masses of misdiagnosed or undiagnosed  celiac disease  patients are a result of the variety of disguises  celiac disease can have. Celiac disease can manifest into a multitude of symptoms including, but by no means exclusive to, malabsorption syndrome, diarrhea, anemia, infertility and osteoporosis.
    It has been demonstrated that there is a clear advantage to early testing for celiac disease. Early testing can aide in  avoiding the irreversible damages that come from diagnosis later in life, such as stunted growth and organ damage. It is also faster for children to heal from intestinal lesions caused from undiagnosed celiac disease, when diagnosed early on. New evidence shows that 10 years after being diagnosed with celiac disease, 66% of the children diagnosed exhibited improvement in their health and overall quality of life; indicating that mass screening at an early age is critical.
    This study was based on a previous study performed by  mass screening for celiac disease by a group of scientists in the Netherlands between 1997 and 1998, who studied 6,127 asymptomatic children between the ages of two and four. Using endomysial antibodies (IgA EmA) testing, the children were screened for celiac disease. 57 seropositive children were then given biopsies. The scientists compared different testing methods for celiac disease, evaluated their serological persistence over time, and determined optimum cut-off points for the testing. Using serological samples obtained at biopsy, EmA and tTGA was assessed for each subject studied. Human leukocyte antigen  (HLA)-typing was obtained from 55 children; 26 of those had normal biopsies and were genetically predisposed for celiac disease and 29 of the children had small-bowel alterations known to be  distinctive traits for celiac disease. Of the 26 children with normal biopsies, 4% of them tested positively for HLA-DQ8, and the other 96% tested positive for HLS-DQ2. Of the 29 children diagnosed with celiac disease, all of them tested positive for HLA-DQ2. However, a proportionately  large number of children who tested EmA-positive and were diagnosed with celiac disease, had normal biopsies and were thus regarded as  false positives.
    The results of this test confirmed that celiac disease antibody levels may fluctuate in children who are genetically predisposed for  celiac disease. While the reason for the transient antibodies is still not known, it has been suggested that children who are seropositive but have normal small-intestine biopsies, potentially have celiac disease, and are susceptible to developing gluten sensitive enteropathy as they get older. Future testing is needed to establish results for this hypothesis.
    However, children with histological alterations in their small-intestine biopsy indicative of celiac disease, had considerably higher antibodies for EmA than those without celiac disease.  The tTGA levels were significantly higher and occurred with more frequency in children with celiac disease than in children without celiac disease. EmA persisted in all celiac disease children, but only in 50% of the non-celiac disease children. tTGA was evident in 83% of celiac disease children, and 15% in non-celiac disease children. Additionally, increasing the cut-off points  provided a reduction of false positives, but resulted in lowering test sensitivity. While optimization of standard cut-off points reduced unnecessary biopsies by 50%-96%, it also reduced test sensitivity.
     In conclusion, celiac disease antibodies are proven to be transient in children genetically predisposed to celiac. It is therefore crucial for medical providers to reduce the number of unnecessary biopsies. As this study has demonstrated,  to reduce the number of unnecessary biopsies by 85%, serological mass screening methods may be improved by repeating EmA and/or tTGA in children who test seropositive after 6 months, and before continuing to biopsy.
    Source:

    http://www.ncbi.nlm.nih.gov/pubmed/20047580

    Jefferson Adams
    Celiac.com 03/18/2015 - Getting high-quality biopsy specimens is key to making accurate celiac disease diagnoses. Endoscopists may take either a single- or double-biopsy specimen with each pass of the forceps.
    Does it matter whether they take one or two? Is two better than one?
    A team of researchers recently set out to answer those questions, by comparing the quality of biopsy specimens obtained with the single-biopsy and double-biopsy techniques.
    The research team includes M. Latorre, S.M. Lagana, D.E. Freedberg, S.K. Lewis, B. Lebwohl, G. Bhagat, and P. H. Green of the Celiac Disease Center, Department of Medicine, Columbia University, New York, New York, USA.
    Their prospective cohort study looked at patients undergoing upper endoscopy with confirmed, suspected, or unknown celiac disease status. A total of 86 patients enrolled in the study, 47% with known celiac disease, 36% with suspected celiac disease, and 17% with an unknown celiac disease status.
    In each case, patients received four biopsy specimens from the second portion of the duodenum. Two were made using the single-biopsy technique of 1 bite per pass of the forceps, and two more using the double-biopsy technique, which takes 2 bites per pass of the forceps.
    Specimens were blindly reviewed to determine orientation, consecutive crypt-to-villous units, and Marsh score. Well-oriented biopsy specimens were noted in 66% of patients with the single-biopsy technique and 42% of patients with the double-biopsy technique (P < .01).
    Analysis of matched pairs showed improved orientation with the single-biopsy technique (odds ratio 3.1; 95% confidence interval, 1.5-7.1; P < .01). This persisted in subgroup analysis of patients with known celiac disease (P = .02), villous atrophy (P = .02), and a final diagnosis of celiac disease (P < .01).
    Now, this is just a single-center trial, so results need to be compared with results from additional cities.
    Interestingly, these results suggest that one bite is actually better than two, because the single-biopsy technique improves the yield of well-oriented duodenal biopsy specimens.
    For best results, the endoscopists should consider taking only one biopsy specimen per pass of the forceps in patients undergoing biopsies of the duodenal mucosa.
    Source:
    Gastrointest Endosc. 2015 Jan 29. pii: S0016-5107(14)02380-3. doi: 10.1016/j.gie.2014.10.024.

  • Recent Articles

    Jefferson Adams
    Celiac.com 04/20/2018 - A digital media company and a label data company are teaming up to help major manufacturers target, reach and convert their desired shoppers based on dietary needs, such as gluten-free diet. The deal could bring synergy in emerging markets such as the gluten-free and allergen-free markets, which represent major growth sectors in the global food industry. 
    Under the deal, personalized digital media company Catalina will be joining forces with Label Insight. Catalina uses consumer purchases data to target shoppers on a personal base, while Label Insight works with major companies like Kellogg, Betty Crocker, and Pepsi to provide insight on food label data to government, retailers, manufacturers and app developers.
    "Brands with very specific product benefits, gluten-free for example, require precise targeting to efficiently reach and convert their desired shoppers,” says Todd Morris, President of Catalina's Go-to-Market organization, adding that “Catalina offers the only purchase-based targeting solution with this capability.” 
    Label Insight’s clients include food and beverage giants such as Unilever, Ben & Jerry's, Lipton and Hellman’s. Label Insight technology has helped the Food and Drug Administration (FDA) build the sector’s very first scientifically accurate database of food ingredients, health attributes and claims.
    Morris says the joint partnership will allow Catalina to “enhance our dataset and further increase our ability to target shoppers who are currently buying - or have shown intent to buy - in these emerging categories,” including gluten-free, allergen-free, and other free-from foods.
    The deal will likely make for easier, more precise targeting of goods to consumers, and thus provide benefits for manufacturers and retailers looking to better serve their retail food customers, especially in specialty areas like gluten-free and allergen-free foods.
    Source:
    fdfworld.com

    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