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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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    DOES CELIAC DISEASE FOLLOW THE MASON DIXON LINE?


    Jefferson Adams


    • A new study shows that people living in the southern United States have less celiac disease than their Northern counterparts, regardless of race or ethnicity, socioeconomic status, or body mass index.


    Celiac.com 04/11/2017 - A new study shows that people living in the southern United States have less celiac disease than their Northern counterparts, regardless of race or ethnicity, socioeconomic status, or body mass index.


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    Rates of celiac disease vary by region, with a sharp variation between Americans living in the northern United States and Americans living in the southern part of the country. A team of researchers recently examined geographic, demographic, and clinical factors associated with prevalence of celiac disease and gluten-free diet in the United States.

    The research team included Aynur Unalp-Arida, M.D., Ph.D, of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Constance E. Ruhl, M.D., Ph.D., of Social & Scientific Systems, Inc., Silver Spring, MD, and Rok Seon Choung, M.D., Ph.D., Tricia L. Brantner, and Joseph A. Murray, M.D., of the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.

    For their population-based study, their team analyzed data on gluten-related conditions from the US National Health and Nutrition Examination Survey, from 2009 through 2014, on 22,277 participants 6 years and older. The team found celiac patients using results of serum tests for immunoglobulin A against tissue transglutaminase and endomysium, or of both, a health clinical diagnosis, and adherence to a gluten-free diet.

    The team also accounted for patients who follow a gluten-free diet without a diagnosis of celiac disease. Using the patients' status of gluten-related conditions, the team then compared average serum levels of biochemical and nutritional markers.

    Their results showed that 0.7% of participants had celiac disease, while 1.1% of participants avoid gluten without celiac disease. People who lived at latitudes of 35–39º North or at latitudes of 40º North were more likely to have celiac disease than individuals who lived at latitudes below 35º North, regardless of race or ethnicity, socioeconomic status, or body mass index. People who lived at 40º North or higher were more likely to avoid gluten without a celiac diagnosis, regardless of demographic factors and BMI.

    People with undiagnosed celiac disease, as determined by positive blood tests, had lower average levels of B12 and folate than persons without celiac disease. People with a clinical celiac diagnosis diagnosis had a lower average level of hemoglobin than those without celiac disease.

    Both those with gluten-related conditions and those without showed comparable average levels of albumin, calcium, iron, ferritin, cholesterol, vitamin B6, and vitamin D.

    American living at latitudes of 35º North or greater have higher rates of celiac disease and/or avoid gluten than persons living south of this latitude, independent of race or ethnicity, socioeconomic status, or body mass index.

    Average levels of B12 and folate are lower in individuals with undiagnosed celiac disease, and levels of hemoglobin are lower in participants with a diagnosis of celiac disease, compared to individuals without celiac disease.

    Source:


    Image Caption: Photo: CC--Nicholas A. Tonelli
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    Guest Bertie

    Posted

    I follow a strict glutenfree diet although never tested. Years ago I was found to be folic acid deficient, but no one picked up why I was, despite a good diet. I suffered from eczema, urticaria, alopecia, but no one linked these symptoms. When I omitted gluten I lost 1.5 stone, my constant indigestion disappeared, and the fatigue disappeared too. My sister and two of her children are coeliacs, we all live 54/55 degrees north.

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  • Related Articles

    Jefferson Adams
    Celiac.com 02/20/2013 - Scientific evidence indicates that the risk of developing celiac disease cannot be explained solely by genetic factors. There is some evidence to support the idea that the season in which a child is born can influence the risk for developing celiac disease. It is known that babies born in summer months are likely to be weaned and introduced to gluten during winter, when viral infections are more frequent.
    A number of studies indicate that early viral infections can increase risk levels for celiac disease, however, earlier studies on birth season and celiac disease have been small, and their results have been contradictory.
    To better answer the question, a research team recently set out to conduct a more thorough study of the relationship between birth month and celiac disease.
    The research team included B. Lebwohl, P.H. Green, J.A. Murray, and J.F. Ludvigsson. The study was conducted through the Department of Paediatrics at Örebro University Hospital in Örebro, Sweden.
    To conduct the study, the team used biopsy reports from all 28 Swedish pathology departments to identify individuals with celiac disease, which they defined as small intestinal villous atrophy (n=29 096).
    Using the government agency Statistics Sweden the team identified 144,522 control subjects, who they matched for gender, age, calendar year and county.
    The team then used conditional logistic regression to examined the association between summer birth (March-August) and later celiac disease diagnosis (outcome measure).
    They found that 54.10% of people with celiac disease were born in the summer months compared with 52.75% of control subjects.
    So, being born in the summer is associated with a slightly higher risk of later celiac disease (OR 1.06; 95% CI 1.03 to 1.08; p).
    While summer birth was not associated with a higher rates of celiac diagnosis in later childhood (age 2-18 years: OR 1.02; 95% CI 0.97 to 1.08), it did show a slightly higher risk of developing celiac disease in adulthood (age ≥18 years: OR 1.04; 95% CI 1.01 to 1.07).
    In this study, the data show that people born during the summer months had a slightly higher risk of developing celiac disease, but that excess risk was small, and general infectious disease exposure early in life were not likely to increase that risk.
    Source:
    Arch Dis Child. 2013 Jan;98(1):48-51. doi: 10.1136/archdischild-2012-302360.

    Jefferson Adams
    Celiac.com 04/29/2013 - In an effort to determine the accuracy of claims that rates of celiac disease are on the rise, a team of researchers recently examined rates of celiac disease in a well-defined US county.
    The research team included Jonas F. Ludvigsson, Alberto Rubio-Tapia, Carol T. van Dyke, L. Joseph Melton, Alan R. Zinsmeister, Brian D. Lahr and Joseph A. Murray. They are variously affiliated with the Division of Gastroenterology and Hepatology in the Departments of Medicine and Immunology at the College of Medicine of the Mayo Clinic in Rochester, Minnesota, USA, and the Department of Pediatrics of Örebro University Hospital in Örebro, Sweden.
    For their population-based study, the team used medical, histopathology, and celiac disease serology records from the Rochester Epidemiology Project to identify all new cases of celiac disease in Olmsted County, Minnesota, USA since 2000.
    They then calculated age- and sex-specific incidence rates for celiac disease and adjusted those rates to the US white 2000 population. The team also assessed clinical presentation of celiac disease upon diagnosis.
    Overall, they found 249 cases of celiac disease, 92 cases in men and 157 cases in women, in Olmsted County, between 2000 and 2010. Average patient age was 37.9 years. Once adjusted for age and sex, the overall rate of celiac disease within the time studied was 17.4 (95% confidence interval (CI)=15.2–19.6) per 100,000 person-years. That means an increase of over six percent; from 11.1 per 100,000 person-years (95% CI=6.8–15.5) in 2000–2001. The data show the increase leveling off after 2004.
    The data also show that cases of celiac disease with classical symptoms of diarrhea and weight loss decreased over time between 2000 and 2010 (P=0.044).
    Overall, rates of celiac disease have continued to rise over the last decade in this North-American population. This study supports the observation that celiac disease rates in America are, in fact, going up.
    Source:
    The American Journal of Gastroenterology, 19 March 2013. doi:10.1038/ajg.2013.60

    Jefferson Adams
    Celiac.com 09/09/2016 - Celiac disease incidence has increased in recent decades. How much do sex, age at diagnosis, year of birth, month of birth and region of birth have to do with celiac disease risk?
    A team of researchers recently conducted a nationwide prospective cohort longitudinal study to examine the association between celiac disease diagnosis and season of birth, region of birth and year of birth. The research team included Fredinah Namatovu, Marie Lindkvist, Cecilia Olsson, Anneli Ivarsson, and Olof Sandström. They are variously affiliated with the Department of Food and Nutrition, the Department of Clinical Sciences, Pediatrics, and the Department of Public Health and Clinical Medicine, Epidemiology and Global Health at Umeå University in Umeå, Sweden.
    Their study included 1,912,204 children aged 0–14.9 years born in Sweden from 1991 to 2009. They found a total of 6,569 children diagnosed with biopsy-verified celiac disease from 47 pediatric departments. The team used Cox regression to examine the association between celiac disease diagnosis and season of birth, region of birth and year of birth.
    They found that children born during spring, summer and autumn had higher celiac disease risk, as compared with children born during winter: adjusted HR for spring 1.08 (95% CI 1.01 to 1.16), summer 1.10 (95% CI 1.03 to 1.18) and autumn 1.10 (95% CI 1.02 to 1.18). Increased celiac disease risk was highest for children born in the south, followed by central Sweden, as compared with children born in northern Sweden.
    The birth cohort of 1991–1996 had increased celiac disease risk if born during spring, for the 1997–2002 birth cohort the risk increased for summer and autumn births, while for the birth cohort of 2003–2009 the risk was increased if born during autumn.
    Both independently and together, season of birth and region of birth are associated with increased risk of developing celiac disease during the first 15 years of life. These seasonal differences in risk levels are likely due to seasonal variation in infectious disease exposure.
    Source:
    Arch Dis Child. doi:10.1136/archdischild-2015-310122

    Jefferson Adams
    Celiac.com 09/26/2016 - Previous studies have indicated an increase in celiac disease rates in the United States, but these studies have been done on narrow populations, and did not produce results that are nationally representative.
    Researchers recently released an new comprehensive report, called, Time Trends in the Prevalence of Celiac Disease and Gluten-Free Diet in the US Population: Results From the National Health and Nutrition Examination Surveys 2009-2014. The research team included Hyun-seok Kim, MD, MPH; Kalpesh G. Patel, MD1; Evan Orosz, DO; Neil Kothari, MD; Michael F. Demyen, MD; Nikolaos Pyrsopoulos, MD, PhD, MBA; and Sushil K. Ahlawat, MD. They are variously affiliated with the Division of Gastroenterology and the Department of Medicine at Rutgers New Jersey Medical School in Newark.
    Using data from the National Health and Nutrition Examination Surveys, a team of researchers recently examined current trends in both celiac disease rates, and gluten-free diet adherence.
    Currently, far more people follow a gluten-free diet than have celiac disease. The numbers of people eating gluten-free food far outpace the levels of celiac disease diagnosis. This may be due to perceptions that the diet is healthier than a standard non-gluten-free diet.
    This research teams recent surveys examine the current trends in the prevalence of celiac disease and adherence to a gluten-free diet, including people without celiac disease, using nationally representative data from the National Health and Nutrition Examination Surveys (NHANESs) 2009-2014.
    The study evaluated 22,278 individuals over the age of 6 who completed surveys and blood tests for celiac disease. The subjects were interviewed directly regarding their prior diagnosis of celiac disease and adherence to a gluten-free diet.

    The researchers found that 106 (0.69%) individuals had a celiac disease diagnosis, and 213 (1.08%) followed a gluten-free diet but didn't have celiac disease. These results correlate to an estimated 1.76 million people with celiac disease, and 2.7 million people who follow a gluten-free diet without a diagnosis of celiac disease in the United States.

    Overall, the researchers found that the prevalence of celiac disease has remained steady (0.70% in 2009-2010, 0.77% in 2011-2012, and 0.58% in 2013-2014), however, those who follow a gluten-free diet but don't have celiac disease have increased over time (0.52% in 2009-2010, 0.99% in 2011-2012, and 1.69% in 2013-2014). The researchers conclude that the two might be related, as the decrease in gluten consumption could contribute to a plateau in those who are being diagnosed with celiac disease.
    Source:
    JAMA Intern Med. Published online September 06, 2016. doi:10.1001/jamainternmed.2016.5254

  • Recent Articles

    Connie Sarros
    Celiac.com 04/21/2018 - Dear Friends and Readers,
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    Jefferson Adams
    Celiac.com 04/19/2018 - Previous genome and linkage studies indicate the existence of a new disease triggering mechanism that involves amino acid metabolism and nutrient sensing signaling pathways. In an effort to determine if amino acids might play a role in the development of celiac disease, a team of researchers recently set out to investigate if plasma amino acid levels differed among children with celiac disease compared with a control group.
     
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    First, the team used liquid chromatography-tandem mass spectrometry (LC/MS) to analyze amino acid levels in fasting plasma samples from 141 children with celiac disease and 129 non-celiac disease controls. They then crafted a general linear model using age and experimental effects as covariates to compare amino acid levels between children with celiac disease and non-celiac control subjects.
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    This study shows that amino acids can influence inflammation and may play a role in the development of celiac disease.
    Source:
    PLoS One. 2018; 13(3): e0193764. doi: & 10.1371/journal.pone.0193764

    Jefferson Adams
    Celiac.com 04/18/2018 - To the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service animals.
    If you’ve flown anywhere lately, you may have seen them. People flying with their designated “emotional support” animals. We’re not talking genuine service animals, like seeing eye dogs, or hearing ear dogs, or even the Belgian Malinois that alerts its owner when there is gluten in food that may trigger her celiac disease.
    Now, to be honest, some of those animals in question do perform a genuine service for those who need emotional support dogs, like veterans with PTSD.
    However, many of these animals are not service animals at all. Many of these animals perform no actual service to their owners, and are nothing more than thinly disguised pets. Many lack proper training, and some have caused serious problems for the airlines and for other passengers.
    Now the major airlines are taking note and introducing stringent requirements for service animals.
    Delta was the first to strike. As reported by the New York Times on January 19: “Effective March 1, Delta, the second largest US airline by passenger traffic, said it will require passengers seeking to fly with pets to present additional documents outlining the passenger’s need for the animal and proof of its training and vaccinations, 48 hours prior to the flight.… This comes in response to what the carrier said was a 150 percent increase in service and support animals — pets, often dogs, that accompany people with disabilities — carried onboard since 2015.… Delta said that it flies some 700 service animals a day. Among them, customers have attempted to fly with comfort turkeys, gliding possums, snakes, spiders, and other unusual pets.”
    Fresh from an unsavory incident with an “emotional support” peacock incident, United Airlines has followed Delta’s lead and set stricter rules for emotional support animals. United’s rules also took effect March 1, 2018.
    So, to the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service and emotional support animals.
    Source:
    cnbc.com

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

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

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

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

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

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

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

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

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

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

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