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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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    AUSTRALIAN CELIACS FACE INDUSTRY PUSH TO ALLOW GLUTEN IN 'GLUTEN-FREE' FOODS


    Jefferson Adams

    Celiac.com 07/09/2013 - In Australia, and New Zealand, people with celiac disease currently benefit from regulations that require food sold as "gluten-free" to contain no detectable levels of gluten.


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    Photo: CC--VintuitiveHowever, that may be set to change, as Australian food manufacturers and retailers push the government agency that regulates gluten-free food to allow gluten to be included in foods labeled ''gluten-free.''

    That agency, called Food Standards Australia New Zealand, is facing pressure by the Australian Food and Grocery Council (AFGC), which wants foods sold as "gluten-free" to be able to contain up to 20 milligrams of gluten per kilogram, thus bringing Australia in line with British and European standards.

    The push by AFGC for a new gluten limit has drawn little praise from dietitians, who say Australians with celiac disease and an associated condition, dermatitis herpetiformis, rely on gluten-free foods.

    Now, while the Australian standard of "no detectable gluten" in foods sold as "gluten-free" may sound great in theory, it is not without problems.

    The standard of "no detectable gluten" means that acceptable gluten-levels will be pushed ever lower as newer, more sensitive tests become available. And such tests are now becoming more sensitive all the time.

    Dr Sue Shepherd, a dietitian specializing in food intolerance and gastrointestinal nutrition, says that Australia must rethink its current rule precisely because tests are growing so sensitive that foods currently meeting the ''undetectable gluten'' standard might soon fail to meet standards.

    Under the Australian/New Zealand standard, many foods from EU and the United States are currently not permitted, and any that might meet current standards face the same problem: future standards may disqualify currently acceptable products.

    Also, having changing standards and changing products that meet that standard is confusing for shoppers and grocery retailers.

    Others worry that changing the current rule will allow unfair competition from imported products. Many of those imported "gluten-free" products are cheaper, in part because lower standards mean higher acceptable gluten levels and lower cost.

    Michael Bracka, chief executive of Freedom Foods and former boss of Kellogg Australia, opposes weakening gluten content standards for gluten-free foods.

    Bracka fears that weakening standards could result in cheap imports flood Australian shelves and damaging what is currently a very successful local industry. Moreover, he adds, the changes proposed by AFGC are "misleading to consumers."

    A spokeswoman for Food Standards said that the agency is working with AFGC on its application and that it intends to consult all stakeholders.

    What do you think? Should the standard for gluten-free foods be "no detectable gluten?" What does that mean for food producers? For consumers? For prices? Share your comments below.

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    I have celiac disease, and have gluten reactions to many products in the US that have the gluten-free label. The companies claim that their products have no more then 20 ppm. However, the US FDA has never made any ruling about what gluten-free on a label actually means. If I eat something gluten-free that 'supposedly' contains less then 20 ppm, and react to it, then trace amounts of gluten makes me sick. And I need products with 'no' gluten at all. Companies are out to make a profit, and don't really give a darn about celiacs, as long as they can sell their products. It's all about their money, not our health.

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    I have to agree with DJ. I react to many supposedly gluten-free foods. If I were the Australians, I wouldn't mess with a good thing. I wish the goal for gluten-free food was always zero gluten. If 20ppm is considered safe, does that mean per serving? What if you eat a packaged food that contains two servings? What if several things you eat during the day have 20ppm gluten? There are all kinds of opportunities to get too much gluten.

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    Guest Lauren

    Posted

    As an Australian and mother of a sensitive coeliac, this concerns me as it does many other Australians! Google "gluten free petition Australia" - there are over 19,000 people that have signed that they disagree.

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    Guest Susie

    Posted

    They have it backwards!!! Australia and New Zealand should be encouraging the US to change to their standards. Yes, DJ they don't care about our health, it's all about the profit for them. I can detect a minute amount of gluten, probably due to the permanent damage to my GI tract, due to the 40+ years of being sick before someone finally diagnosed me. Australia, the US doesn't know what they're doing, why would you listen to them? I buy Australian products whenever I can because of their standards, please, I beg of you, do NOT change!!!

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    Guest Sharon

    Posted

    Maybe both: a totally no gluten "gluten-free" label, and a "low gluten" rating is needed for items with under 20 PPM gluten.

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    Guest Laith

    Posted

    I live in Australia, but before that I lived in the UK where there is a much broader range of gluten-free products available. The 20 ppm rule presents no risk to coeliacs, who undoubtedly benefit from a global free trade of gluten-free goods to make a much broader range of choices available.

    For this reason, standardizing internationally would be a great idea - especially if it means we can start to get codex wheat starch, which is a fantastic gluten-free product.

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    Guest Zloduska

    Posted

    I am a celiac and despite a strict gluten-free diet still have issues, mainly with cross-contamination. Could you please tell me which supposedly gluten-free products specifically you have reactions to? Thanks!

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    Guest Sandy

    Posted

    I agree! No gluten should mean NO gluten! I also am very sensitive and need to rely on labeling to mean what it says. Maybe we need for the gluten content to be listed by ppm on all packages so there is no misunderstanding, regardless of what country you are in.

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    Sue Shepherd has a point regarding the level changing downwards with better testing. Surely that can be satisfied by setting the standard at whatever the detectable level is now (in Australia) as that doesn't seem to be causing a problem. I too have problems with the 'standard' in the US when I visit.

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    Guest Lowcarbhiker

    Posted

    Absolutely agreed! We have had problems with sausage and seaweed labeled gluten-free. I'm guessing the seaweed was a problem because of sharing the equipment with soy sauce-containing varieties. The sausage may have been gluten-free when they designed the packaging, then the manufacturer didn't keep up with changes in their spices/spice providers. Plenty of products do not contain gluten. It would be nice if the label were preserved for those products.

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    Guest Daphne

    Posted

    I live in Australia, but before that I lived in the UK where there is a much broader range of gluten-free products available. The 20 ppm rule presents no risk to coeliacs, who undoubtedly benefit from a global free trade of gluten-free goods to make a much broader range of choices available.

    For this reason, standardizing internationally would be a great idea - especially if it means we can start to get codex wheat starch, which is a fantastic gluten-free product.

    I too live in Australia and was horrified when I first heard this news. However, I've since changed my view having heard from my State Coeliac Society that it is supporting this move. I quote from its newsletter last month:

    "This standard applies in the UK, Europe and Canada and is soon to be adopted in the USA.

    Coeliac Australia supports a change to a gluten free standard of less than 20ppm. Evidence based medical research has found this to be a safe level for people with coeliac disease.

    A gluten free standard of less than 20ppm would result in more choice and affordability in the gluten free food market. The high cost of gluten free food is a significant barrier to compliance with the gluten free diet, for people with coeliac disease.

    Coeliac Australia currently endorses food products that contain less than 20ppm of gluten. The change proposed by the AFGC is consistent with Coeliac Australia's position on the safe level of gluten in manufactured foods."

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    Guest ScottR13

    Posted

    I am a celiac and despite a strict gluten-free diet still have issues, mainly with cross-contamination. Could you please tell me which supposedly gluten-free products specifically you have reactions to? Thanks!

    It's easier to name the company's that don't contain any gluten in their gluten-free labeled foods. Bob's Red Mill and DeLallo.

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    Guest Gillian

    Posted

    Completely agree with DJ, Sue, Susie et al, Australia should keep its own standard set as it is now, then there will be no confusion with detectable amounts later. Besides, do Australians really want US food imports? I wouldn't touch them with a barge pole, they're full of dodgy additives and GMOs, no thanks.

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    Why can't they create labels that indicate the quantity, such as FDA-approved gluten-free=less than 20mg/kg, or no detectable gluten? Then consumers can decide for themselves.

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    Guest Beryle

    Posted

    I live in Australia, but before that I lived in the UK where there is a much broader range of gluten-free products available. The 20 ppm rule presents no risk to coeliacs, who undoubtedly benefit from a global free trade of gluten-free goods to make a much broader range of choices available.

    For this reason, standardizing internationally would be a great idea - especially if it means we can start to get codex wheat starch, which is a fantastic gluten-free product.

    Laith, I do not understand how the greater availability of products with greater amounts of gluten is a good thing. If someone with coeliac is highly sensitive (and you are blessed to not be in this category) he will have even less options. Please do not state that, "The 20 ppm rule presents no risk to coeliacs" as this is simply not true.

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    Why can't they create labels that indicate the quantity, such as FDA-approved gluten-free=less than 20mg/kg, or no detectable gluten? Then consumers can decide for themselves.

    I come from a family where celiac disease is the norm, not the exception. Some of us react severely to the slightest crumb of gluten-containing foods and some do not. That being said, why would we want to subject our bodies to damage that after time will not reverse and cause us to be at even more risk of cancers of the bowel and other health issues? If a product says it does not contain gluten, it should not. Food processors should not remove this choice from those of us who suffer greatly from gluten ingestion.

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    The answer for myself is really simple. Change the rules and I change my shopping habits, I will buy only naturally gluten free food.

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    Guest Janelle

    Posted

    If it does go to this standard everywhere I will just go on a cave man diet. Fruit Veg and meat. Naturally gluten free. Yes, I'll miss out on my treats but at least I know that I am not going to get sick. No one understands what it's like being a coeliac unless you are a coeliac yourself. A simple crumb curls me over for 24 hours and I'm tired and nauseated for the next 48.

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    Guest sue

    Posted

    Gluten episode can leave me in hospital for 5 days on a drip. It could also kill me if I don't get medical help immediately. It is also frustrating that when I arrive in Emergency dept at a hospital they have trouble believing me and it could be upwards of 12 hours before treatment is started. I become so dehydrated from lose of body fluids from what could described as horrific bowel discharge that leaves me breeding. So no I want the standards to stay, that gluten free is truly gluten free.

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

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

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

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

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

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

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

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

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

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

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

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

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