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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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    CELIAC PATIENTS TOLERATE WHEAT SPAGHETTI AFTER HOOKWORM TREATMENT


    Jefferson Adams

    Celiac.com 10/03/2014 - Celiac disease patients in Australia have shown a major improvement in gluten tolerance after receiving experimental hookworm treatments. The study is part of an effort to determine if parasitic helminths, such as hookworm, might help to treat inflammatory disorders, including celiac disease.


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    Photo: Nnaluci--Wikimedia CommonsIn this case, the research team assessed the influence of experimental hookworm infection on the predicted outcomes of three escalating gluten challenges in volunteers with confirmed celiac disease.

    The research team included John Croese, MD, Paul Giacomin, PhD, Severine Navarro, PhD, Andrew Clouston, MD, Leisa McCann, RN, Annette Dougall, PhD, Ivana Ferreira, BSc, Atik Susianto, MD, Peter O'Rourke, PhD, Mariko Howlett, MD, James McCarthy, MD, Christian Engwerda, PhD, Dianne Jones, BHSc, and Alex Loukas, PhD.

    They are variously affiliated with the Department of Gastroenterology and Hepatology at The Prince Charles Hospital, Brisbane, Australia, the Center for Biodiscovery and Molecular Development of Therapeutics at the Australian Institute of Tropical Health and Medicine of James Cook University in Cairns, Australia, Envoi Specialist Pathologists in Brisbane, Australia, QIMR Berghofer Medical Research Institute in Brisbane, Australia, the Royal Brisbane and Women's Hospital, and with Logan Hospital, Brisbane, Australia.

    This particular study followed twelve adult volunteers with diet-managed celiac disease. The volunteers were inoculated with 20 Necator americanus (hookworm) larvae, and then consumed increasing amounts of gluten in the form of spaghetti.

    The volunteers first received 10 to 50 milligrams for 12 weeks (microchallenge); they then received 25 milligrams daily + 1 gram twice weekly for 12 weeks (GC-1g); and finally 3 grams daily (60-75 straws of spaghetti) for 2 weeks (GC-3g).

    The subjects were then evaluated for symptomatic, serologic, and histological outcomes of gluten toxicity. They were also examined for regulatory and inflammatory T cell populations in blood and mucosa. Two gluten-intolerant subjects withdrew after micro-challenge. Ten completed GC-1g, and eight of these ten volunteers enrolled in and completed the full course of the study.

    Most celiacs who are exposed to gluten challenge will show adverse changes in the intestinal villi, which is measured in terms of villous height-to-crypt depth ratios. Also, such patients will usually show an increase in blood antibodies, such as IgA-tissue transglutaminase, indiucating an adverse reaction to gluten. However, the results here showed that median villous height-to-crypt depth ratios (2.60-2.63; P = .98) did not decrease as predicted after GC-1g. Moreover, mean IgA-tissue transglutaminase titers declined, contrary to the predicted rise after GC-3g.

    Other results showed that quality of life scores improved (46.3-40.6; P = .05); while celiac symptom indices (24.3-24.3; P = .53), intra-epithelial lymphocyte percentages (32.5-35.0; P = .47), and Marsh scores remained unchanged by gluten challenge.

    Intestinal T cells expressing IFNγ were reduced following hookworm infection (23.9%-11.5%; P = .04), with corresponding increases in CD4+ Foxp3+ regulatory T cells (0.19%-1.12%; P = .001).

    Hookworms in the form of Necator americanus promoted tolerance and stabilized, or improved, all tested measures of gluten toxicity in volunteers with celiac disease. So, after being voluntarily infected with 20 hookworms, these celiac disease volunteers were able to eat increasingly large amounts of gluten with none of the usual changes or adverse symptoms.

    Could hookworm treatments represent the future of treatment for celiac disease, and maybe other inflammatory conditions? Clearly, further tests are needed to determine exactly how safe it is for celiac patients receiving this treatment to eat gluten. So far, however, the future looks bright.

    What do you think? If swallowing a small dose of hookworms would eliminate your adverse reactions, and allow you to safely eat gluten, would you do it?

    The radio program Radiolab has an interesting segment on hookworm, which you can stream here: Radiolab

    Source:


    Image Caption: Photo: Nnaluci--Wikimedia Commons
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    Who wants hookworms living inside them? Sounds utterly grotesque! Maybe I missed something, but was there any mention of how long the hookworms squirm around in your intestines or side effects from them? Since a few dropped out of the study, I will take a guess that they became very ill from gluten exposure. I will take another guess that they are more sensitive to gluten than the other subjects and possibly have other intolerance as well. Lastly, since I was symptomatic from birth and I didn't have "problems" every day of my life until diagnosis (40+years) add in the "reliability factor" of testing (very poor) is it possible that the subjects that remained in the program in its entirety were actually still sick and worsening from their exposure but just don't realize it yet?

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    Guest Michael

    Posted

    This pretty much defines, demonstrates and proves the practice of eating wheat is an addiction and an obsession, as does 50 to 60 different names for that many shapes of pasta.

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    Interesting. Although I would do just about anything to eat gluten, this sounds a little gross!

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    I don't know about the swallowing - I might prefer to be injected....

     

    However - after more than twenty years of being a confirmed celiac, I have become accustomed to this lifestyle and taste of gluten-free. I actually prefer to be gluten free now.

     

    I guess the costs might help persuade some of the masses of celiacs, and to be alleviated from some of the other side-affects of being a celiac is surely high on the scale of choice. However, my lifestyle has kept me from that for many years.

     

    Yet - there is that small tickling doubt that would say yes. I would like to be able to make a choice whenever I wanted.

     

    And if the small wigglers could also alleviate other inflammatory conditions I certainly would be all for it - just give me some mind-blockers so I wouldn't think about them in my body doing their thing!

     

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    Guest Andrea

    Posted

    The article was interesting but the study has a fatal flaw. There are two variables working here. One the hookworm, and other the incremental addition of gluten to the subjects. Since there is such a great variation among those of us with celiac Disease as to our degrees of sensitivity, there is also no way to know if some of the subjects could tolerate the gluten because of the gradual increase in amounts of gluten. This gradual increasing in the amounts of gluten is similar to allergy desensitizing. Possibly some subjects improved because of a simple gradual increase in tolerance. The study implies that the hookworms saved the day, probably by consuming the gluten themselves.When people are infected with any parasites, their absorbion of nutrients goes down. Why would any intelligent person want to infect themselves in order to eat something that they already know is so bad for them? There is so much available in the way of whole foods to thrive on. I for one am grateful for the diagnosis. Aside from celiac disease, gluten causes a host of other problems. I'm glad it is out of my diet.

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    Interesting article to say the least. Besides everything that everybody commented on above what about absorption of critical nutrients over the long-term? I can't imagine that the hookworms wouldn't consume all valuable nutrients as well.

    I would say that is nice in a pinch if somebody had to consume gluten for a situation that arose such as a wedding or traveling to a different country but this sounds a little ridiculous to me.

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    This is as dumb as dirt. Are people so desperate to eat gluten? I've lived healthy for over 18 years being diagnosed as a celiac and very happy to have proactively gained a food education to learn to stay away from garbage in the food supply including wheat in USA. People common.

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    Guest Darrell

    Posted

    I also have become accustomed to a gluten free diet. But I would do this in a heart beat because I am a 5 parts per Million type and am constantly being contaminated. I would so welcome my face, hands and stomach being free from inflammation and the mad dashes to the toilet, along with the cramps being a thing of the past. YES, I would eat a lot of worms if it will work. Its all just protein anyway and Simba ate grubs?

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    Absolutely, I would do this. I'd actually stay gluten free, but to guard against cross contamination, for sure. I've had three airborne glutenings in the last year, two in grocery stores where I was not near the bakery or flour aisle, one in a building where drywall was being used unbeknownst to me in another part of the building. Day to day life is dangerous for me right now, and if this makes it less so, give me a plate of hookworms, or anything!

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    Guest Amy Sutherland

    Posted

    First of all, ewww! I try to be open minded, but this one is stretching my limits. Secondly, I want to know what the hookworms are doing that prevents the usual response to gluten. What is it about hookworms that made the scientists think of them in the first place? And why is it that normally if one gets hookworms, doctors treat them for it? Do they have negative consequences? And lastly, I assume that the little beggars are going to reproduce. How many would one have residing in one's gut? This article needs lots more explanation.

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    Guest Jacquie

    Posted

    I definitely would not follow the hookworm practice. I would rather go without gluten than swallow or be injected with hookworms

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    Guest Claire

    Posted

    Do you know the life cycle of the hookworm? The larvae burrow through the skin and enter the bloodstream. From there, they travel to the lungs -- which causes the host to cough them up and swallow them, resulting in an infestation of the bowels. It is my understanding that they sometimes travel the wrong way and end up in the brain. Yes, swallowing them is disgusting, but it might mitigate the risk of a parasite with poor direction. That being said, there has to be a better way.

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    Guest Christine

    Posted

    I'm sorry, but 12 participants isn't big enough a sample population to warrant relevant results. Besides, hookworms cause other diseases (they don't call those little bastards "parasites" for nothing. I read that they cause intestinal bleeding. I have enough of a damaged intestine from Endometriosis. I don't want any more.

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    Guest mgrant7209

    Posted

    I have had hookworm infections as a child. I remember the side effects of that - no thank you. I am used to a gluten-free life style now. No amount of tasty pasta, or bread, or pizza, would be worth having worms to me. Who the hell thinks up these idiotic studies?

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    I think that people should seriously look into this a little deeper. Check out what hookworms can do. They can cause serious intestinal issues and anemia that can lead to heart failure among other things. It may be difficult being gluten-free, but is it really worth the damage you could do? ---The rating above is only rating the quality of the writing and information provided not in support of the ideas of the materials

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    Guest Hansen

    Posted

    Based on additional readings NO: If you have a hookworm infection that lasts a long time, you could become anemic. Anemia is characterized by a low red blood cell count, which can lead to heart failure in severe cases. Anemia results from hookworms feeding on your blood. You're more at risk of having severe anemia if you also don't eat well, are pregnant, or have malaria.

     

    Other complications that can develop from these infections include nutritional deficiencies and a condition known as ascites. This condition is caused by serious protein loss and results in fluid buildup in your abdomen.

     

    Children who have frequent hookworm infections can experience slow growth and mental development from losing a lot of iron and protein.

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    Guest Jefferson

    Posted

    Heck no the worms could make us have something else we didn't want! Nope won't do it!

    The only negative side effect of hookworm is anemia. That only occurs if there are a large amount of hookworms in the gut. Anemia is slow to develop, easy to spot and easy to cure. Hookworms are easily eliminated by simple prescription drugs. Then, if desired, they can be reintroduced as desired.

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    Guest Jefferson

    Posted

    Who wants hookworms living inside them? Sounds utterly grotesque! Maybe I missed something, but was there any mention of how long the hookworms squirm around in your intestines or side effects from them? Since a few dropped out of the study, I will take a guess that they became very ill from gluten exposure. I will take another guess that they are more sensitive to gluten than the other subjects and possibly have other intolerance as well. Lastly, since I was symptomatic from birth and I didn't have "problems" every day of my life until diagnosis (40+years) add in the "reliability factor" of testing (very poor) is it possible that the subjects that remained in the program in its entirety were actually still sick and worsening from their exposure but just don't realize it yet?

    Are hookworms any more disgusting than the thousands of bacteria in your gut? Side effects of small numbers of hookworm in the gut are minimal. Anemia is the only side effect, and then, only with large numbers of hookworms. Having 10-20 hookworms in the gut is essentially harmless. The benefits include the elimination of adverse gut reactions to gluten in celiac disease patients.

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    Guest Jefferson

    Posted

    The article was interesting but the study has a fatal flaw. There are two variables working here. One the hookworm, and other the incremental addition of gluten to the subjects. Since there is such a great variation among those of us with celiac Disease as to our degrees of sensitivity, there is also no way to know if some of the subjects could tolerate the gluten because of the gradual increase in amounts of gluten. This gradual increasing in the amounts of gluten is similar to allergy desensitizing. Possibly some subjects improved because of a simple gradual increase in tolerance. The study implies that the hookworms saved the day, probably by consuming the gluten themselves.When people are infected with any parasites, their absorbion of nutrients goes down. Why would any intelligent person want to infect themselves in order to eat something that they already know is so bad for them? There is so much available in the way of whole foods to thrive on. I for one am grateful for the diagnosis. Aside from celiac disease, gluten causes a host of other problems. I'm glad it is out of my diet.

    Wheat and gluten are not "bad" for people who do not have celiac disease. In this case, the hookworm is eliminating both the adverse reaction in people with celiac disease, and the inflammation in the gut. Hookworm may be useful in the treatment of many inflammatory conditions, including heart disease, diabetes, etc. Stay tuned.

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    admin

    Celiac.com 2/13/2003 - This new study emphasizes the importance of following a strict gluten-free diet, and getting regular follow-up biopsies after your diagnosis. It also speaks to the need to discover whether or not you may have additional food intolerance, such as to cows milk (casein), soy, corn, etc., as some of these can also cause intestinal damage similar to that of celiac disease. -Scott Adams

    Lee SK, Lo W, Memeo L, Rotterdam H, Green PH.
    Gastrointest Endosc 2003 Feb;57(2):187-91
    Current affiliations: Department of Surgical Pathology and Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
    BACKGROUND: The diagnosis of celiac disease requires characteristic histopathological changes in an intestinal biopsy with clinical improvement in response to a gluten-free diet. Endoscopy with procurement of biopsy specimens is often performed to document response to the diet, but there are little data on the appearance of treated celiac disease. This study examined the endoscopic and histopathological appearance of the duodenum of patients with celiac disease whose diet was gluten-free.
    METHODS: A cohort of 39 adult patients (mean age 52 years, range 20-74 years) with biopsy-proven celiac disease was retrospectively reviewed. All had responded clinically to a gluten-free diet that they had maintained for a mean of 8.5 years (range 1-45 years). The endoscopic and histopathological appearances of the duodenal mucosa were reviewed. Blinded review of the diagnostic (initial) and post-treatment biopsy specimens was also performed to assess response of individual patients to the diet.
    RESULTS: The endoscopic appearance was normal in 23%, reduced duodenal folds were present in 46%, scalloping of folds in 33%, mucosal fissures in 44%, and nodularity in 33%. There was more than 1 abnormality present in 46%. Histology was normal in only 21%. The remainder had villous atrophy (69% partial, 10% total). Paired (diagnostic and follow-up) biopsy specimens were reviewed blindly for 12 patients. The mean (SD) intraepithelial lymphocyte count fell from 61 (22) to 38 (17) (normal
    CONCLUSIONS: Despite a good clinical response, abnormal endoscopic and histopathological appearances persist in the majority of patients with celiac disease treated with a gluten-free diet.
    PMID: 12556782

    Jefferson Adams
    Celiac.com 11/16/2009 - Could unknown benefits from one of the oldest parasites of the human digestive tract hold the key to cure for celiac disease?
    Australian scientists think so. Encouraged by successful treatments of Crohn's and ulcerative colitis by American researchers using a pig whipworm (Trichuris sues), a team of Australian researchers is recruiting volunteers with celiac disease for trials using human hookworm (Necator americanus).
    The researchers have undertaken a similar preliminary study using a human hookworm in Crohn's patients.
    Researchers hypothesize that the disappearance of intestinal parasites from humans in developed countries may be responsible for the upsurge in many diseases including Celiac Disease, Crohn's, ulcerative colitis, asthma and hay fever.
    Using a small group of healthy people with celiac disease, the investigators will look to see if human hookworm interferes with the human immune reaction to gluten.
    Parasites survive partly by interfering with the host's immune response. The mechanisms they use to accomplish this are similar to those required by a person to regulate against the so-called autoimmune disorders, wherein the body begins to fight against itself.
    The investigators suspect that when parasites are excluded from the environment, some individuals become sufficiently self-reactive to develop an autoimmune disease.
    Using a small group of healthy people with celiac disease, the investigators will test if a human hookworm, Necator americanus, inhibits immune responsiveness to gluten.
    Specifically, they will examine whether hookworm infection will change the immune processes and suppress gluten sensitivity in people with celiac disease.
    Celiac disease is a good model for studying Crohn's disease because both involve similar immune changes. However, celiac patients are usually healthier overall, and, importantly, are not taking powerful immune suppressive drugs, and the provocative antigens (molecules that engage the immune system and provoke the disease) are well known and can be administered or cut out at will.
    In addition to directly benefitting celiac disease sufferers, this study may provide potential guidance in the use of hookworms to control inflammatory bowel disease.
    The study is open to people with proven celiac disease who reside in Brisbane, Australia. Those who enroll will be required to avoid gluten for six months.
    The blinded study will compare disease activity and immunity after a controlled break from the gluten-free diet in celiac patients, before and after hookworm infection.
    The team will use conventional and experimental methods to examine the disease severity and the immune system of celiac subjects before and after being inoculated with N. americanus.
    They will then compare immunity levels of the study subjects
    against those of matched, celiac control subjects (not infected with hookworm), before and after eating four pieces of standard white bread each day for three to five days.
    The initial study group will be small. The researchers will recruit ten subjects for each arm of the study, for a total of twenty.
    Initially, ten larvae will be placed on the skin under a light dressing for thirty minutes, followed by five more after twelve weeks.
    The researchers intend to asses whether the hookworm infection will change the immune processes and suppress gluten sensitivity in people with celiac disease. Outcomes to be measured will be those that reflect the activity of celiac disease.
    Stay tuned to see if hookworm therapy will be coming to a gastroenterologist near you! Tell us what you think. Would you sign up? Comment below.
    Source:
    ClinicalTrials.gov


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    Celiac.com 11/23/2009 - Welcome To Celiac.com Podcast Edition!

    Click the icon to listen to this Podcast: Be sure to subscribe to our Podcasts. Here are the articles mentioned in this podcast:In The News:

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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