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    Probiotics: A Future Answer to Celiac Disease?


    Tina Turbin
    Image Caption: Alessio Fasano, M.D. (photo courtesy of University of Maryland)

    In my work as an author, researcher, and gluten-free advocate, I strive to raise awareness for celiac disease and gluten intolerance because I know that with increased awareness will come more research, more proper diagnoses, and even improved treatment. Illustrating this, studies linking the onset of celiac disease to changes in microbes in the digestive tract are not only addressing the question of delayed onset, but they may lead to new research that could eventually result in a probiotic treatment for celiacs. 


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    Celiac disease is an autoimmune disease. The source of this being gluten, a protein found in wheat, barley, and rye, affecting about one percent of the population of 300 million Americans. It works by attacking the villi, the finger-like structures which line the small intestine, resulting in stomach problems and malabsorption of nutrients. Left untreated, the disease can cause severe health conditions and complications such as mental illness, osteoporosis, anemia, miscarriage, and even cancer.

    Alessio Fasano, professor of pediatrics, medicine and physiology as well as the director of the Mucosal Biology Research Center and the Center for Celiac Research at the University of Maryland School of Medicine, has been researching celiac disease, paying particular attention to the way intestinal “permeability” influences the development of disease. In an article, published in Scientific American, called “Surprises from Celiac Disease,” Dr. Fasano poses the question of why some celiacs, who are born genetically predisposed to develop the disease, develop symptoms later than others. He suggests that reason for this is associated with the microbiome—the community of bacteria or microbes—living in the digestive tract.

    According to Dr. Fasano, the digestive tract microbiome varies among individuals and even in the same individual over the course of a lifetime. What’s more, Dr. Fasano says they can also have an effect on the genes which are active in their host. Therefore, someone genetically predisposed to celiac disease may have been able to handle gluten for quite some time, but upon shifting of the microbiome, and a subsequent activation of the gluten intolerance gene, the symptoms of celiac disease will show themselves.

    Not only do Dr. Fasano’s studies shed light into a question that has been perplexing researchers, but it also opens the door to a treatment for, or even prevention of, celiac disease—good bacteria for the digestive track, otherwise known as “probiotics.”

    I spent years running in circles from doctor to doctor trying to find the cause of my painful symptoms, finally driving me to research my symptoms on my own. I’m grateful to have been properly diagnosed, but managing the gluten-free diet can be a challenge. The prospect of a treatment such as probiotics to offset genetic factors will appeal to many celiacs like myself. Although the treatment for celiac disease is simple, it calls for a lot of work and can be disheartening at times, requiring a total lifestyle change.

    With Dr. Fasano’s celiac disease research, we can look forward to more research, more awareness, and perhaps another treatment option. Meanwhile, let’s keep doing our parts to raise awareness and funds for celiac disease research.

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    Guest Melie

    Posted

    I am 38 and was diagnosed with celiac two years ago after years of fighting vague symptoms that started right after college. What is interesting about the probiotic treatment theory to me is that a year before my diagnosis, I started probiotics on my own to treat severe heart burn. I have always marked that as the beginning of my healing because it was my first autonomous act of taking control of my own health rather than completely relying on doctors. But, I never connected it with my celiac when later diagnosed. Now I'm wondering if there is connection between alcohol consumption and the microbiome. As I mentioned, looking back, my symptoms started as my college days were winding down. I never touched a drop of alcohol in high school, but I made up for 'lost' time in college. Now I wonder if the binge drinking was not only immature, stupid and pointless, but also the initial gunshot to my system.

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    Guest Jennifer

    Posted

    Love reading articles about and by Dr. Fasano. His article about the microbiome and how it could trigger celiac disease makes me wonder if those same genes could be turned off if someone developed just the right probiotic cocktail. I'm sure he's working on it.... For now, I take multiple strains of probiotics because it gives me hope that I might be fixing something!

    Thanks for posting!

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    I was diagnosed late in life with celiac disease. I had no symptoms, but started having digestive problems, and an endoscopy showed celiac disease. The culprit for the digestive problems turned out to be a medication I was on. However, because of all the tests and medications, I developed a lot of diarrhea with a sense of urgency. I began taking Align, a probiotic, and it cleared up the problem. I still am asymptomatic for celiac disease without the aid of a gluten-free diet, and I still take the probiotic. So I'm hoping there is something to Dr. Fasano's research.

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    Oh ,one more thing fresh probiotic stuff like real foods is the best. But if you live or work in a remote area, or live deep in the city or suburb and not near a supermarket, then it might be best to get the probiotic pills.

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    Guest holly

    Posted

    My son was diagnosed at 15 months old. The field of probiotics is still very new. I know that some yogurts contain probiotic cultures. Anything out there that can help is always beneficial.

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    Love reading articles about and by Dr. Fasano. His article about the microbiome and how it could trigger celiac disease makes me wonder if those same genes could be turned off if someone developed just the right probiotic cocktail. I'm sure he's working on it.... For now, I take multiple strains of probiotics because it gives me hope that I might be fixing something!

    Thanks for posting!

    Hello Jennifer, Thank you very much for your comment and I'm glad you enjoyed the article. To your health! Tina

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    Oh ,one more thing fresh probiotic stuff like real foods is the best. But if you live or work in a remote area, or live deep in the city or suburb and not near a supermarket, then it might be best to get the probiotic pills.

    Yes, Jami, fermented foods are incredible. Happy they have helped you so much.

    Tina

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    Oh ,one more thing fresh probiotic stuff like real foods is the best. But if you live or work in a remote area, or live deep in the city or suburb and not near a supermarket, then it might be best to get the probiotic pills.

    Yes, you are right. I also highly suggest Bio-K Plus ( in many stores) as an excellent pro-biotic unless one wants to try the organic fermented cabbage- which is loaded but can cause a bit of gas and some celiacs have trouble adapting. The Bio-K Plus site is: biokplus.com/en/ Best, Tina

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    My son was diagnosed at 15 months old. The field of probiotics is still very new. I know that some yogurts contain probiotic cultures. Anything out there that can help is always beneficial.

    Yes Holly, you are so right. Sometimes the "sugars" in the diet exasperate the Candida/yeast growth in some individuals from what I have read and researched, but I am not an MD. You can do a bit of a search on this and see if that is an issue with your son too. Also, I assume he is doing well on dairy since he likes Dannon. Good for him! Many celiacs do not have the enzymes to digest it and have issues that arise, as a result.

     

    Tina Turbin

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    I am 38 and was diagnosed with celiac two years ago after years of fighting vague symptoms that started right after college. What is interesting about the probiotic treatment theory to me is that a year before my diagnosis, I started probiotics on my own to treat severe heart burn. I have always marked that as the beginning of my healing because it was my first autonomous act of taking control of my own health rather than completely relying on doctors. But, I never connected it with my celiac when later diagnosed. Now I'm wondering if there is connection between alcohol consumption and the microbiome. As I mentioned, looking back, my symptoms started as my college days were winding down. I never touched a drop of alcohol in high school, but I made up for 'lost' time in college. Now I wonder if the binge drinking was not only immature, stupid and pointless, but also the initial gunshot to my system.

    Thank you for not only the information but your question. It is an extremely good question and yet I am not sure of the answer. I have my suspicions based off of research I have on probiotics yet my reply would not be facts, which I feel you are due. I think if you called the team up in Canada at BioK Plus and asked them. They may be able to help get this answered. I'd love to know their reply, and any other answers you get elsewhere. Thanks Malie.

    Best, Tina Turbin

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    Guest Tummy Ache

    Posted

    I would love to know which specific probiotics help!

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    Guest Paula

    Posted

    Kefir is a great probiotic and can be found in most supermarkets.

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    Guest Tina Turbin

    Posted

    I would love to know which specific probiotics help!

    Bio-K Plus is really a good one but to find the right one for you will require your own homework. Look for ones that can guarantee their potency when ingested not at time of manufacturing. Many of the strains "die" by the time they hit the shelves and worse arrive to our homes.

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    My mother and brother are confirmed celiacs and I have had significant food challenges; going gluten free was like a light switch going off for my health. Alternatively, I have been taking probiotics (which is high in bifidobacteria and acidolphilis etc) and enzyme. I have had no problems for over two years both digestive, joints and eyes stay white and nasal inflammation low (some leaky gut I think before this). It works for me but have not seen clinical trials as to whether or not cancer risks are lowered. Its your risk but for me the probiotics three to four times a day have done well for me.

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    Guest ruby oliver

    Posted

    I am 38 and was diagnosed with celiac two years ago after years of fighting vague symptoms that started right after college. What is interesting about the probiotic treatment theory to me is that a year before my diagnosis, I started probiotics on my own to treat severe heart burn. I have always marked that as the beginning of my healing because it was my first autonomous act of taking control of my own health rather than completely relying on doctors. But, I never connected it with my celiac when later diagnosed. Now I'm wondering if there is connection between alcohol consumption and the microbiome. As I mentioned, looking back, my symptoms started as my college days were winding down. I never touched a drop of alcohol in high school, but I made up for 'lost' time in college. Now I wonder if the binge drinking was not only immature, stupid and pointless, but also the initial gunshot to my system.

    I am a 50 year old female and I am having problems digesting all starchy foods. and any thing with milk. I'm not sure if this is called celiac? But it affects my breathing and my bathroom habits also! I have been on a gluten free diet but I'm still having problems. not as bad but i still do. I have lost weight. that's a plus. I just need help knowing the difference?

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    Um, excuse me, but if the disease affects 300 million Americans and there are only about 290 million of us total, does that mean all Americans are affected by celiac disease? Just a question.

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    Guest Michelle M

    Posted

    Interesting research. Surprisingly enough, both of my children, who have been on probiotics since they were 6 months old each, have celiac. I have long been a proponent of probiotics (mainly because I despise - DESPISE - the stomach flu, and that is how we avoid getting it), so nothing would make me happier than to give my children a probiotic that could help their disease!

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    Guest Cammy M

    Posted

    I was diagnosed a few months ago and am just now finding my way with diet, etc. My diagnosis explains a lot about different health issues I've experienced my whole life, particularly the past decade (I'm 49). I have found a product called Candex which blasts candida cells. It's been like a miracle for my celiac and my interstitial cystitis (bladder disease).

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    Guest Teresa

    Posted

    I was diagnosed a few months ago and am just now finding my way with diet, etc. My diagnosis explains a lot about different health issues I've experienced my whole life, particularly the past decade (I'm 49). I have found a product called Candex which blasts candida cells. It's been like a miracle for my celiac and my interstitial cystitis (bladder disease).

    Thank you for the information. I have "new" gastro problems and was diagnosed with interstitial cystitis over five years ago. None of the prescribed meds have worked. Probiotics and herbal supplements have been the only remedies that have helped my symptoms. I will be sure to try Candex.

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    Guest Shannon

    Posted

    Interesting research. Surprisingly enough, both of my children, who have been on probiotics since they were 6 months old each, have celiac. I have long been a proponent of probiotics (mainly because I despise - DESPISE - the stomach flu, and that is how we avoid getting it), so nothing would make me happier than to give my children a probiotic that could help their disease!

    I can't figure out what is wrong with my daughter...diarrhea and a light rash to her neck and chest for weeks/months at a time since about 6 months old (when she started food). She has been to many MDs including 2 gastro docs and one allergist. I started her on probiotics which helped some but the allergist said she might be allergic to milk even though it didn't show it on her blood test. I cut milk out and now the only time she has diarrhea/rash is when I ether introduce milk or stop the probiotics...could it be both celiac and milk allergy? Since you are a mom of 2 children I thought you might know...or where I could go for info.

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    Great article! I recently found out my 8 year old has celiac disease. All of the doctors in the past passed her off as a "colicy" Baby but in my heart I knew it was something else. Her symptoms ranged from fatigue, severe abdominal pain, vomiting, muscle spasms, headaches, nasal congestion and eczema. She has been gluten free for one month and the change in her is amazing. It makes my over joyed to see my baby enjoy eating and not worry about tummy aches. I am a chef and love to cook for her so the gluten free issue has not been an issue. As long as she sticks to what God makes, i.e., fresh fruits and veggies and grass fed meats, she does wonderfully. Today I purchased probiotics and am hearing wonderful things about them but am apprehensive to start her with concerns of diarrhea or extra need to use the bathroom at school. Thank you so much!

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    Great article! I recently found out my 8 year old has celiac disease. All of the doctors in the past passed her off as a "colicy" Baby but in my heart I knew it was something else. Her symptoms ranged from fatigue, severe abdominal pain, vomiting, muscle spasms, headaches, nasal congestion and eczema. She has been gluten free for one month and the change in her is amazing. It makes my over joyed to see my baby enjoy eating and not worry about tummy aches. I am a chef and love to cook for her so the gluten free issue has not been an issue. As long as she sticks to what God makes, i.e., fresh fruits and veggies and grass fed meats, she does wonderfully. Today I purchased probiotics and am hearing wonderful things about them but am apprehensive to start her with concerns of diarrhea or extra need to use the bathroom at school. Thank you so much!

    Interesting to hear other accounts of celiac disease, my daughter was also diagnosed with being "colicy" and stranger anxiety, on different formulas as an infant all of which seemed to not work any different than the next, but had screaming fits as an infant making her hoarse! She has always complained about tummy aches and I thought it was anxiety maybe or for attention. My brother was diagnosed a few years ago, my daughter's "tummy aches" gradually became worse hunched up in a ball tears streaming down her face, so we are still trying to do away with gluten completely and started a probiotic a couple months ago. Ii feel like there are less tummy aches than before but having trouble with what to pack for lunches, tried rice cake PBJ she's sick of those. Thanks for your story anyway, and it's good to hear you're not alone!

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    Um, excuse me, but if the disease affects 300 million Americans and there are only about 290 million of us total, does that mean all Americans are affected by celiac disease? Just a question.

    Um, "affecting about one percent of the population of 300 million Americans" equates to 3 million. Perhaps a second, slower reading will help.

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    I am a 50 year old female and I am having problems digesting all starchy foods. and any thing with milk. I'm not sure if this is called celiac? But it affects my breathing and my bathroom habits also! I have been on a gluten free diet but I'm still having problems. not as bad but i still do. I have lost weight. that's a plus. I just need help knowing the difference?

    I think your problem has to do more with your female hormones. Menopause causes what your describing.

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    Scott Adams
    Vijay Kumar, MD, Research Associate Professor at the University of Buffalo and President and Director of IMMCO Diagnostics
    I enjoyed reading J. Murrays comments related to the diagnosis of celiac disease and agree that taking multiple biopsies is still the gold standard of diagnosing celiac disease. However, I am sure he will agree that there are limitations in the histopathological methods of diagnosing celiac disease.
    As we know, histological features occur in continuum, with flat lesions at one end of the spectrum and a mucosa with normal villous and crypt architecture but abnormally high density or count of villous intraepithelial lymphocytes at the other, which may be reported normal.
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    Scott Adams
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    Celiac.com 05/28/2013 - Is an intestinal biopsy always necessary to diagnose celiac disease, or can diagnosis be made without biopsy? To answer that question, a team of researchers recently set out to compare celiac disease–specific antibody tests to determine if they could replace jejunal biopsy in patients with a high pretest probability of celiac disease.
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    Source:
    BMC Gastroenterol. 2013;13(19)

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    Jefferson Adams
    Celiac.com 06/18/2018 - Celiac disease has been mainly associated with Caucasian populations in Northern Europe, and their descendants in other countries, but new scientific evidence is beginning to challenge that view. Still, the exact global prevalence of celiac disease remains unknown.  To get better data on that issue, a team of researchers recently conducted a comprehensive review and meta-analysis to get a reasonably accurate estimate the global prevalence of celiac disease. 
    The research team included P Singh, A Arora, TA Strand, DA Leffler, C Catassi, PH Green, CP Kelly, V Ahuja, and GK Makharia. They are variously affiliated with the Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Lady Hardinge Medical College, New Delhi, India; Innlandet Hospital Trust, Lillehammer, Norway; Centre for International Health, University of Bergen, Bergen, Norway; Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Gastroenterology Research and Development, Takeda Pharmaceuticals Inc, Cambridge, MA; Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; Department of Medicine, Columbia University Medical Center, New York, New York; USA Celiac Disease Center, Columbia University Medical Center, New York, New York; and the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
    For their review, the team searched Medline, PubMed, and EMBASE for the keywords ‘celiac disease,’ ‘celiac,’ ‘tissue transglutaminase antibody,’ ‘anti-endomysium antibody,’ ‘endomysial antibody,’ and ‘prevalence’ for studies published from January 1991 through March 2016. 
    The team cross-referenced each article with the words ‘Asia,’ ‘Europe,’ ‘Africa,’ ‘South America,’ ‘North America,’ and ‘Australia.’ They defined celiac diagnosis based on European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines. The team used 96 articles of 3,843 articles in their final analysis.
    Overall global prevalence of celiac disease was 1.4% in 275,818 individuals, based on positive blood tests for anti-tissue transglutaminase and/or anti-endomysial antibodies. The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% in 138,792 individuals. That means that numerous people with celiac disease potentially remain undiagnosed.
    Rates of celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was 0.6% in female vs 0.4% males. Celiac disease was significantly more common in children than adults.
    This systematic review and meta-analysis showed celiac disease to be reported worldwide. Blood test data shows celiac disease rate of 1.4%, while biopsy data shows 0.7%. The prevalence of celiac disease varies with sex, age, and location. 
    This review demonstrates a need for more comprehensive population-based studies of celiac disease in numerous countries.  The 1.4% rate indicates that there are 91.2 million people worldwide with celiac disease, and 3.9 million are in the U.S.A.
    Source:
    Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037.

    Jefferson Adams
    Celiac.com 06/16/2018 - Summer is the time for chips and salsa. This fresh salsa recipe relies on cabbage, yes, cabbage, as a secret ingredient. The cabbage brings a delicious flavor and helps the salsa hold together nicely for scooping with your favorite chips. The result is a fresh, tasty salsa that goes great with guacamole.
    Ingredients:
    3 cups ripe fresh tomatoes, diced 1 cup shredded green cabbage ½ cup diced yellow onion ¼ cup chopped fresh cilantro 1 jalapeno, seeded 1 Serrano pepper, seeded 2 tablespoons lemon juice 2 tablespoons red wine vinegar 2 garlic cloves, minced salt to taste black pepper, to taste Directions:
    Purée all ingredients together in a blender.
    Cover and refrigerate for at least 1 hour. 
    Adjust seasoning with salt and pepper, as desired. 
    Serve is a bowl with tortilla chips and guacamole.

    Dr. Ron Hoggan, Ed.D.
    Celiac.com 06/15/2018 - There seems to be widespread agreement in the published medical research reports that stuttering is driven by abnormalities in the brain. Sometimes these are the result of brain injuries resulting from a stroke. Other types of brain injuries can also result in stuttering. Patients with Parkinson’s disease who were treated with stimulation of the subthalamic nucleus, an area of the brain that regulates some motor functions, experienced a return or worsening of stuttering that improved when the stimulation was turned off (1). Similarly, stroke has also been reported in association with acquired stuttering (2). While there are some reports of psychological mechanisms underlying stuttering, a majority of reports seem to favor altered brain morphology and/or function as the root of stuttering (3). Reports of structural differences between the brain hemispheres that are absent in those who do not stutter are also common (4). About 5% of children stutter, beginning sometime around age 3, during the phase of speech acquisition. However, about 75% of these cases resolve without intervention, before reaching their teens (5). Some cases of aphasia, a loss of speech production or understanding, have been reported in association with damage or changes to one or more of the language centers of the brain (6). Stuttering may sometimes arise from changes or damage to these same language centers (7). Thus, many stutterers have abnormalities in the same regions of the brain similar to those seen in aphasia.
    So how, you may ask, is all this related to gluten? As a starting point, one report from the medical literature identifies a patient who developed aphasia after admission for severe diarrhea. By the time celiac disease was diagnosed, he had completely lost his faculty of speech. However, his speech and normal bowel function gradually returned after beginning a gluten free diet (8). This finding was so controversial at the time of publication (1988) that the authors chose to remain anonymous. Nonetheless, it is a valuable clue that suggests gluten as a factor in compromised speech production. At about the same time (late 1980’s) reports of connections between untreated celiac disease and seizures/epilepsy were emerging in the medical literature (9).
    With the advent of the Internet a whole new field of anecdotal information was emerging, connecting a variety of neurological symptoms to celiac disease. While many medical practitioners and researchers were casting aspersions on these assertions, a select few chose to explore such claims using scientific research designs and methods. While connections between stuttering and gluten consumption seem to have been overlooked by the medical research community, there is a rich literature on the Internet that cries out for more structured investigation of this connection. Conversely, perhaps a publication bias of the peer review process excludes work that explores this connection.
    Whatever the reason that stuttering has not been reported in the medical literature in association with gluten ingestion, a number of personal disclosures and comments suggesting a connection between gluten and stuttering can be found on the Internet. Abid Hussain, in an article about food allergy and stuttering said: “The most common food allergy prevalent in stutterers is that of gluten which has been found to aggravate the stutter” (10). Similarly, Craig Forsythe posted an article that includes five cases of self-reporting individuals who believe that their stuttering is or was connected to gluten, one of whom also experiences stuttering from foods containing yeast (11). The same site contains one report of a stutterer who has had no relief despite following a gluten free diet for 20 years (11). Another stutterer, Jay88, reports the complete disappearance of her/his stammer on a gluten free diet (12). Doubtless there are many more such anecdotes to be found on the Internet* but we have to question them, exercising more skepticism than we might when reading similar claims in a peer reviewed scientific or medical journal.
    There are many reports in such journals connecting brain and neurological ailments with gluten, so it is not much of a stretch, on that basis alone, to suspect that stuttering may be a symptom of the gluten syndrome. Rodney Ford has even characterized celiac disease as an ailment that may begin through gluten-induced neurological damage (13) and Marios Hadjivassiliou and his group of neurologists and neurological investigators have devoted considerable time and effort to research that reveals gluten as an important factor in a majority of neurological diseases of unknown origin (14) which, as I have pointed out previously, includes most neurological ailments.
    My own experience with stuttering is limited. I stuttered as a child when I became nervous, upset, or self-conscious. Although I have been gluten free for many years, I haven’t noticed any impact on my inclination to stutter when upset. I don’t know if they are related, but I have also had challenges with speaking when distressed and I have noticed a substantial improvement in this area since removing gluten from my diet. Nonetheless, I have long wondered if there is a connection between gluten consumption and stuttering. Having done the research for this article, I would now encourage stutterers to try a gluten free diet for six months to see if it will reduce or eliminate their stutter. Meanwhile, I hope that some investigator out there will research this matter, publish her findings, and start the ball rolling toward getting some definitive answers to this question.
    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
    Celiac.com 06/14/2018 - Refractory celiac disease type II (RCDII) is a rare complication of celiac disease that has high death rates. To diagnose RCDII, doctors identify a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs). 
    However, researchers really don’t have much data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023

    Jefferson Adams
    Celiac.com 06/13/2018 - There have been numerous reports that olmesartan, aka Benicar, seems to trigger sprue‐like enteropathy in many patients, but so far, studies have produced mixed results, and there really hasn’t been a rigorous study of the issue. A team of researchers recently set out to assess whether olmesartan is associated with a higher rate of enteropathy compared with other angiotensin II receptor blockers (ARBs).
    The research team included Y.‐H. Dong; Y. Jin; TN Tsacogianis; M He; PH Hsieh; and JJ Gagne. They are variously affiliated with the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School in Boston, MA, USA; the Faculty of Pharmacy, School of Pharmaceutical Science at National Yang‐Ming University in Taipei, Taiwan; and the Department of Hepato‐Gastroenterology, Chi Mei Medical Center in Tainan, Taiwan.
    To get solid data on the issue, the team conducted a cohort study among ARB initiators in 5 US claims databases covering numerous health insurers. They used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy‐related outcomes, including celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy. In all, they found nearly two million eligible patients. 
    They then assessed those patients and compared the results for olmesartan initiators to initiators of other ARBs after propensity score (PS) matching. They found unadjusted incidence rates of 0.82, 1.41, 1.66 and 29.20 per 1,000 person‐years for celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy respectively. 
    After PS matching comparing olmesartan to other ARBs, hazard ratios were 1.21 (95% CI, 1.05‐1.40), 1.00 (95% CI, 0.88‐1.13), 1.22 (95% CI, 1.10‐1.36) and 1.04 (95% CI, 1.01‐1.07) for each outcome. Patients aged 65 years and older showed greater hazard ratios for celiac disease, as did patients receiving treatment for more than 1 year, and patients receiving higher cumulative olmesartan doses.
    This is the first comprehensive multi‐database study to document a higher rate of enteropathy in olmesartan initiators as compared to initiators of other ARBs, though absolute rates were low for both groups.
    Source:
    Alimentary Pharmacology & Therapeutics