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      Frequently Asked Questions About Celiac Disease   04/07/2018

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


    Jefferson Adams

    Celiac.com 04/08/2015 - The goal of growth-monitoring programs in children is the early detection of any disorders that affect growth. Celiac disease is under-diagnosed in kids whose symptoms include faltering linear growth, short stature, or poor weight gain. A team of researchers recently set out to develop new evidence-based parameters for screening for growth disorders and to evaluate the performance of these cutoffs among children with celiac disease measured regularly in a nationwide growth screening program.


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    Photo: CC--James EmeryThe research team included Antti Saari, MD; Samuli Harju, BM; Outi Mäkitie, MD, PhD; Marja-Terttu Saha, MD, PhD; Leo Dunkel, MD, PhD; and Ulla Sankilampi, MD, PhD. They are variously affiliated with the Department of Pediatrics, School of Medicine, University of Eastern Finland, Kuopio, the Children’s Hospital at the University of Helsinki and Helsinki University Hospital in Helsinki, Finland, the Folkhälsan Research Centre in Helsinki, Finland, the Department of Molecular Medicine and Surgery at the Karolinska Institute in Stockholm, Sweden, the Department of Pediatrics at Tampere University Hospital in Tampere, Finland, the Centre for Endocrinology at the William Harvey Research Institute of Barts and the London School of Medicine and Dentistry at Queen Mary University of London in London, England and the Department of Pediatrics at Kuopio University Hospital, Kuopio, Finland.

    Their longitudinal retrospective study included growth data of healthy children from primary health care providers, and children with celiac disease from primary health care, and three university hospital outpatient clinics in Finland, Kuopio University Hospital, Tampere University Hospital, and Helsinki University Hospital, from January 1, 1994, to April 9, 2009.

    Children of the reference population were under 20 years of age, while children in the celiac disease group were between 1 and 16 years of age. In the reference population of 51,332 healthy children, the team screened according to five age- and sex-specific growth parameters: height standard deviation score and body mass index standard deviation score, distance from the population mean, distance from target height, change in height standard deviation score, and change in body mass index standard deviation score.

    They evaluated these parameters and their combination in 177 children with celiac disease by analyzing longitudinal growth data from birth until diagnosis of celiac disease.

    They measured the screening accuracy for detecting abnormal growth in children with celiac disease by using receiver operating characteristics analysis expressed as the area under the curve. When the team screened using the combination of all 5 growth-screening parameters, they detected celiac disease with good accuracy ([95% CI] = 0.88 [0.84–0.93] for girls and 0.84 [0.77–0.91] for boys).

    When they set the screening specificity at 90%, they saw abnormal growth in 57% of the girls with celiac disease, and in 48% of the boys with celiac disease for two years prior to diagnosis. This study shows that most kids with celiac disease experience faltering growth prior to diagnosis. An effective growth-monitoring program could have detected celiac disease in these kids several years earlier.

    By using several growth-monitoring parameters in combination, preferably using computerized screening algorithms that are integrated into an electronic health record system, researchers can improve sreening accuracy.

    Source:


    Image Caption: Photo: CC--James Emery
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    admin

    IgA class Reticulin antibodies are found only in Celiac disease and dermatitis herpetiformis. These antibodies are found in approximately 60% of celiac disease patients and 25% of DH patients. This test is falling into disuse because of the limited utility and the availability of better tests. IgA class endomysial antibodies are very specific, occurring only in celiac disease and DH. These antibodies are found in approximately 80% of patient with DH and in essentially 100% of patients with active celiac disease. IgA endomysial antibodies are more sensitive and specific than either reticulin or gliadin antibodies for diagnosis of celiac disease. Antibody titers are found to parallel morphological changes in the jejunum and can also reflect compliance with gluten-free diets. Titers decrease or become negative in patients on gluten free diets and reappear upon gluten challenge.
    The purpose of testing for anti-gliadin antibodies includes, in addition to diagnosis of gluten sensitive enteropathy, monitoring for compliance to a gluten free diet. IgA gliadin antibodies increase rapidly in response to gluten in the diet, and decrease rapidly when gluten is absent from the diet. The IgA anti-gliadin antibodies can totally disappear in 2-6 months on a gluten-free diet, so they are useful as a diet control. By contrast, IgG anti-gliadin antibodies need a long time, sometimes more than a year, to become negative.
    The reverse is also true. That is, a patient with celiac disease who has been on a gluten-free diet and tests negative for IgA anti-gliadin antibodies, will show a rapid increase in antibody production when challenged by gluten in the diet. Approximately 90% of challenged patients will yield a positive IgA anti-gliadin result within 14-35 days after being challenged. The test results you reported are consistent with a patient who is conforming to a gluten-free diet.

    admin

    The following article was published in The Sprue-nik Pres, Volume 9, Number 1 January 2000, Published by the Tri-County Celiac Sprue Support Group, a chapter of CSA/USA, Inc. serving southeastern Michigan. Members receive this newsletter, a shopping guide, and a new member packet full of articles and useful information. Mail-in subscriptions are welcome. For subscription information, send a note to tccssg@yahoo.com.
     
    Ann gave us TIPS: Five food tips, five health tips, five quickie tips, and five things to look forward to, always in a Lets Be Positive mode.
    Food Tips:
    Concentrate on what you CAN eat, not what you cant. Try not to blow the gluten-free (gluten-free) diet out of proportion. If you take processed foods out of the equation, you can eat almost anything: fruits, vegetables, beans, meat, fish, rice, corn, etc. When you eat plain food, you start to really taste food the way you never tasted before. What we can eat is good for us. Get used to the fact that you have to do more cooking and baking. Turn this factor into an asset and become a good gluten-free cook. Eat
    simply. For breakfast Ann eats eggs, yogurt, fruit, Jowar (sorghum) Jo Crisps Cereal, or even vegetables. For lunch you can eat leftovers. Leftover rice mixed with a vegetable is always a good idea; you can keep bags of frozen peas,
    corn, or broccoli in the freezer. One of Anns favorite lunches is to put plain peanut butter on a rice cake and slice apples on top.
    For snacks try fruit, Jell-O, or home-popped popcorn, all of which can be quickly prepared.
    In a restaurant, first check the menu to see what you can eat without question, what you might be able to eat if you ask questions, what youd better stay away from, and what you might want to look into a little bit. Try not to make an issue of it and dont be embarrassed or afraid to ask questions. Ann says she figures whatever the gathering is for, its not to discuss her diet
    Forget about getting dietary advice from your doctor. A gastroenterologists primary job is to diagnose your illness and then send you on to a dietitian and a support group. Please dont get mad at doctors for not knowing all the details of the gluten-free diet. Dietitians, too, may not know a lot about the gluten-free diet. We celiacs need to partner with dietitians to get them up to speed and help those we educate teach other dietitians. There are many pieces of the celiac pie that need to be improved, and adopting and educating dietitians is an important step toward getting more reliable
    information to more people.
    Join a support group. The best place to get information about the disease and the gluten-free diet is from a support group because the leaders and members deal with diet issues every day. Celiacs need to support their group leaders and volunteer assistance. Ann says she feels strongly about all of us giving something back to society for the richness that we have managed in our own personal lives. So if you are really interested in making celiac disease your thing, you can volunteer to work with a support group
    Accept that there are very few absolutes and very many points of disagreement about what is and is not gluten-free or what is and is not appropriate for celiacs. We know with certainty that the things we should not eat are wheat, barley, rye, oats, spelt, triticale and kamut. The next thing we need to find out is where those grains actually are, not necessarily where they might be. We should have a basic diet we can rely on before we waste valuable time and effort looking for needles in haystacks. In her research Ann has discovered that a lot of the things we celiacs believe but have
    never checked out are not necessarily true in the real world. Misinformation takes hold in the celiac community and then we are left trying to disprove something that should never have been proposed in the first place. In other words, we are left trying to prove a negative.
    For example, research shows that canola oil is gluten-free, so it should be appropriate for any celiac except those with a special sensitivity to it. Since it is gluten-free, any sensitivities to canola oil cant be gluten problems. But it has been publicized that canola oil is not appropriate for any celiac, so everyone (especially food vendors) has been forced to decide what to do about this product, which actually happens to be a healthy oil. Canola oil did not belong on any list of products that all celiacs should avoid in the first place. Celiacs need to make their own judgments and realize that no one can tell them what they cannot eat without explaining and/or proving that it is dangerous. You have to do the best you can with the diet, but try to stay away from any gluten-fearing paranoia that exists. Try to know your sources and the reasons why you should be avoiding something.
    Health Tips:
    Eat a varied diet, which will provide a wider variety of vitamins and minerals for better nutrition. Iron, calcium and folic acid are the three nutrients most frequently malabsorbed by celiacs, so be sure you eat the foods that contain them. Whatever your age and whatever your sex, do get a bone density test. Many celiac experts say that most celiac patients have some degree of abnormal bone loss, often serious, at diagnosis. If your doctor is not up to speed on celiac disease, you may have to firmly request the simple, noninvasive bone density test. The treatments for osteoporosis include hormone therapy and some new drugs, primarily Fosamax. There are 10 million Americans today who have osteoporosis, and 18.5 million more who have some early signs of osteoporosis. The cost of treating these problems is enormous. Yet if a person has osteoporosis and also has hidden celiac disease, and is taking osteoporosis medications and eating calcium-rich foods, the treatment will probably not be optimum if the patient is malabsorbing the calcium she is eating and perhaps even the medications. Since the celiac connection to osteoporosis is the malabsorption of calcium, treating the cause of the malabsorption--the gluten-free diet --needs to come before consideration of Fosamax or other drugs.
    Celiacs need to eat dairy products because they are a prime source of calcium. Calcium, which has such a strong connection with osteoporosis, is one of the most malabsorbed nutrients in celiac disease. Some celiacs have difficulty eating dairy products because of associated lactose intolerance, but it is extremely important to get dairy products into your body in whatever way works. Of all the dairy products available, one of the best is yogurt; its low fat, easily digested (even for some who are lactose intolerant), and readily available.
    Have an annual physical exam that includes a complete blood count (CBC) and stool testing, according to Dr. Joseph Murray of the Mayo Clinic. He thinks you should have thyroid testing every other year, but if you already have thyroid disease, more frequent testing might be advantageous. The experts also say you should have serology antibody testing once a year to test for compliance with the gluten-free diet. A positive result almost always means some gluten has been inadvertently ingested. Dr. Murray says you then have to: Check your diet, check your diet again, and check your diet a third time. He also recommends taking one good multi-vitamin a day that includes 100 percent of the recommended
    daily amount of B-complex vitamins, iron, folate and other vitamins and minerals.
    Whatever other supplements you take will depend on your own personal needs. You will need to investigate the possible gluten content in everything you ingest, including (and especially!) vitamins and medications. We have to be careful of everything that goes into our mouths, but especially of anything we take every day.
    Encourage your first-degree relatives to get screened for celiac disease. Usually these relatives are not comfortable with your request because they dont want to follow your diet, but 10% of them will probably have celiac disease, and of the 10% who have it, 50% will have no symptoms but will have flat intestinal villi. How can we get our relatives tested? First of all, dont make an issue of your diet around them. Make them drool over the delicious gluten-free dishes you are eating. Keep the current complexities about the diet to yourself. And dont nag!
    If you can, send donations to the University of Maryland Prevalence Study, which is testing first-degree relatives (and others) to try to find out what the true prevalence of celiac disease is in the United States. If it turns out that celiac disease is not rare, then the FDA and food manufacturers will have to pay more attention to our problems. Please make checks payable to the UM Foundation, Inc. Center for Celiac Research, Attn: Pam King, 700 W. Lombard St., Room 206, Baltimore, MD 21201. These funds are administered by the University of Maryland Foundation, Inc.
    The very best thing you can do for yourself is to have a life beyond celiac disease. Dont let having this disorder stop you from doing anything! Make sure you have other interests. Make sure you exercise. Make sure you get out and eat with gluten-eating people. Make sure you travel. Make sure you stay all-around healthy.
    Five Quick Tips:
    Buy your own toaster or toaster oven. This is an easy way to avoid cross contamination. Try not to complain about the cost of gluten-free products. They are expensive for a reason. The manufacturers have to pay more to get supplies, pay more to process the food, and they have to pay more to market it because they dont have normal marketing avenues. We have to pay more because we have to order a lot by mail. It helps to remember that we usually dont have to take expensive medications as treatment for gluten sensitivity and, unlike medications, the foods we eat have no side effects.
    Buy a bread machine. When you bake your own bread, it is ultimately cheaper than any ready-made bread. Plus it usually tastes better.
    Not everyone can do this, but it helps to avoid processed food. Even when you investigate products over the phone or get a letter from the manufacturers or consult some of the commercial product listings that are available, you are still not totally sure the product is safe. Life is simpler and safer when you avoid processed foods--or eat them as infrequently as possible.
    Remember that Europe is well ahead of the U.S. in dealing with celiac disease. We know physicians there have been diagnosing celiac disease for a longer time
    and celiacs have been on a gluten-free diet longer in Europe than here. Yes, several European countries do allow a small amount of wheat starch in international products, but their research has not shown an increased morbidity or mortality rate in their celiac population. Ann says she tends to think of this when she hears Americans going nuts about potential (versus actual) trace amounts of scientifically immeasurable gluten in certain ingredients.
    Unfortunately, we dont have our act together in the U.S. when it comes to celiac disease and the gluten-free diet. All U.S. celiacs have a lot in common and we all need to pull together, not apart, for our common good.
    Five Things to Look Forward To:
    A good possibility that doctors will be able to diagnose celiac disease without the biopsy in the years to come. The Celiac International Conference in August 2000 in Baltimore. Those who attend can plan a nice east coast vacation around the dates (August 10-13) if theyd like. gluten-free food that gets better and more varied as the number of vendors grows. Hopefully our specialty foods will be more easily available locally. In the meantime, ask your supermarket managers to stock specific products in their stores. You might be surprised at how quickly they agree to do so. More awareness of celiac disease, especially in terms of research, doctors understanding, availability of gluten-free food, and interest from the federal government and FDA. We need to make celiac disease a household word because it impacts so many peoples lives. A united U.S. effort to support celiacs!!

    Dr. Rodney Ford M.D.
    This article appeared in the Summer 2007 edition of Celiac.com's Scott-Free Newsletter.
    This question, “how early can you diagnose celiac disease?” is a major concern for both parents and paediatricians.  This is because, like many diseases, celiac disease comes on slowly.  This means that it can take a long time to make the diagnosis.
    Celiac disease can develop slowly?
    Yes, celiac disease can develop very slowly.  The symptoms can be subtle.  It is a progressive disease.  When you are first born, you cannot have celiac disease as you have never been exposed to gluten.  However, if you have the right genetic make up (that is you have the celiac gene) and the right environmental circumstances (eating gluten and getting gut inflammation), then celiac disease can develop.
    Finding tissue damage
    Celiac disease is a condition that is recognised when you get damage to your small bowel tissue.  This damage is triggered by gluten.
    The standard way to detect this tissue damage is by taking a gut biopsy of the small bowel skin (also called the mucosa).  This is done by the technique of upper endoscopy whilst under an anaesthetic.  Tiny fragments of gut tissue are snipped off with a pair of forceps.   This tissue is then sent to a pathology lab.  The lab people (histologists) look down their microscopes at this tissue sample.  They are looking for the gut damage called villous atrophy which is characteristic of disease.
    Early antibody changes – IgG-gliadin
    Importantly, long before the tissue becomes obviously damaged by gluten, your body can begin to react to the gluten in your diet.
    An early sign of a gluten immune reaction is that your body produces antibodies to the gluten in your diet.  This can be seen in a blood test that looks for an antibody called the IgG-gliadin antibody (also known as anti-gliadin-antibody).  Also the IgA-gliadin antibody can develop at this time.
    Even in these early stages of gluten reactions (before the development of any gut damage of celiac disease), you or your child can be feeling unwell.  Many of the symptoms of celiac disease can be recognized in these early stages.  This is before the tissue damage can be seen by the histologist.
    The blood test to look for tissue damage is called the tissue transglutaminase antibody (abbreviated as tTG).
    Early bowel damage cannot be seen
    The next thing to happen is that the tissue in the small bowel gets slightly injured but not enough to be identified by the histologist.  However, such damage can be shown by an electron microscope.  This early damage can also be detected by the presence of the tTG antibody.
    Usually, when the tTG blood test goes up, then this is an indication to do the endoscopy and look for any tissue damage.  However, early in the progression of celiac disease, this damage may not show up by conventional methods.  This means that the small bowel biopsy and the histology results are good for confirming celiac disease, but they cannot rule it out.
    To act or to wait?
    In my experience, I have seen a number of children develop celiac disease whilst I have watched and waited.  While we doctors wait and see if the gut will become progressively damaged, these children will continue to experience their gut symptoms and they may not be growing so well. We doctors are waiting to make a certain diagnosis of celiac disease.  We want to repeat their blood tests and do another endoscopy.
    Is this reasonable?  Experience has changed my mind.  I have come to the conclusion that this is not an appropriate way to deal with these children.  Currently, most medical specialists are adamant. They will not make a diagnosis of celiac disease until the histologist can confirm the typical tissue damage.
    How long can you wait?
    I have given up the “wait and see” approach.  I act.  I carefully scrutinize the symptoms and the blood test results - the gluten antibodies (IgG-gliadin) and tissue damage antibody (tTG) levels.  I may organise an endoscopy test.  If these findings suggest the development of celiac disease, then I make a pre-emptive diagnosis of “early celiac disease”, often before the gut gets badly damaged.  I give these children a trial of a gluten-free diet – I see what their clinical response is.  Pleasingly, most get completely better!  If they get better, then they want to stay gluten-free.
    The problem is that the diagnosis of celiac disease currently hinges on the abnormal appearance of the small bowel.  This damage can take years to develop.  
    The main argument against my approach is that if you do not have a “definite” diagnosis of celiac disease, then you cannot advise a gluten-free diet for life.  In my opinion, the decision to go on a gluten-free diet is not a black and white choice.  For children, I give them the option of a gluten-free diet early in their disease.  Let them feel well.  Let them grow properly.  Later, as an adult, they can challenge their diagnosis and have a formal gluten challenge when they understand the issues.       
    Conclusion – my approach
    As you can see, it is difficult to say how early you can diagnose celiac disease.  It is my practice to carefully assess children regarding their symptoms, their antibody levels, their genetic status and their endoscopy results (if appropriate).
    I do not think it is logical to leave children with significant symptoms waiting for the small bowel damage to eventually occur.  Indeed, I think that these long delays in treatment are inhumane.  Postponement of a gluten-free diet will cause these children to suffer ongoing symptoms.  Worse, they can have growth failure, from which they may not recover.
    My approach is to put these children on a gluten-free diet early.  I watch and see if thy have a clinical response: if they get better.   The evidence shows that you cannot rely entirely on the small bowel biopsy for your diagnosis of celiac disease.  These children can have a gluten challenge later in their lives.
    The onset of celiac disease is progressive.  Why wait until the bitter end before going gluten-free? The onset of celiac disease is progressive.  Why wait until the bitter end before going gluten-free?  You can find out a lot more from my webpage: www.doctorgluten.com


    Jefferson Adams
    Celiac.com 04/16/2010 - In most adults with celiac disease, clinical symptoms disappear with a gluten-free diet. However, the exact effects of a gluten-free diet on rates of mucosal recovery in adults with celiac disease is less certain.
    A group of clinicians recently set out to estimate the rate of mucosal recovery under a gluten-free diet in adult subjects with celiac disease, and to gauge the clinical prospects of ongoing mucosal damage in celiac patients following a gluten-free diet.
    The study group included: Alberto Rubio-Tapia, MD; Mussarat W. Rahim, MBBS; Jacalyn A. See , MS , RD, LD; Brian D. Lahr , MS; Tsung-Teh Wu, MD; and Joseph A. Murray, MD.
    Each patient in the study had biopsy-proven celiac disease, and was assessed at the Mayo Clinic. Also, each patient received duodenal biopsies at diagnosis. After beginning a gluten-free diet, each patient had at least one follow-up intestinal biopsy to assess mucosal recovery.
    The study team focused on mucosal recovery and overall mortality. Of 381 adult patients with biopsy-proven celiac disease, a total of 241 (175 women - 73%) had both a diagnostic and follow-up biopsy available for re-review.
    Using the Kaplan–Meier rate of confirmed mucosal recovery on these 241 patients, the study group found that 34% of patients enjoyed mucosal recovery at 2 years following diagnosis  (95% with a confidence interval (CI): 27–40 % ), and 66% of patients enjoyed mucosal recovery at 5 years (95% CI: 58–74 % ).
    More than 80% of patients showed some clinical response to the gluten-free diet, but clinical response was not a reliable marker of mucosal recovery ( P = 0.7). Serological response was, by far, the best marker for confirmed mucosal recovery ( P = 0.01).
    Patients who complied poorly with a gluten-free diet ( P < 0.01), those with severe celiac disease defined by diarrhea and weight loss ( P < 0.001), and those with total villous atrophy at diagnosis ( P < 0.001) had high rates of persistent mucosal damage.
    With adjustments for gender and age, patients who experienced confirmed mucosal recovery had lower mortality rates overall (hazard ratio = 0.13, 95 % CI: 0.02 – 1.06, P = 0.06).
    One of the most important findings from this study was that a large number of adults with celiac disease see no mucosal recovery, even after treatment with a GFD.
    Compared to those patients who suffered persistent damage, patients who experienced confirmed mucosal recovery had lower rates of mortality independent of age and gender.
    The group notes that systematic follow-up via intestinal biopsies may be advisable in patients diagnosed with celiac disease as adults.

    SOURCE: Am J Gastroenterol. 9 February 2010; doi: 10.1038/ajg.2010.10


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    PLoS One. 2018; 13(3): e0193764. doi: & 10.1371/journal.pone.0193764

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    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