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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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    GLUTEN DEFINITELY TRIGGERS SYMPTOMS IN SOME NCGS PATIENTS


    Jefferson Adams

    Celiac.com 08/09/2016 - Some researchers have suggested that gluten may not be the actual trigger of symptoms in non-celiac gluten sensitivity. Others feel that gluten is definitely the trigger, especially in certain cases.


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    A team of researchers recently set out to evaluate patients with clinical non-celiac gluten sensitivity (NCGS), who presented with lymphocytic enteritis, positive celiac genetics and negative celiac blood tests. The team felt that the results would confirm that gluten is, in fact, the trigger of symptoms in this subgroup of patients.

    The research team included M Rosinach, F Fernández-Bañares, A Carrasco, M Ibarra, R Temiño, A Salas, and M Esteve. They are variously affiliated with the Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain, the Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain, and with the Department of Pathology, Hospital Universitari Mutua Terrassa, Terrassa in Barcelona, Spain.

    The team conducted a double-blind randomized clinical trial of gluten vs placebo re-challenge on 18 patients over 18 years of age, HLA-DQ2/8+, negative celiac serology and gluten-dependent lymphocytic enteritis, and GI symptoms, with clinical and histological remission at inclusion.

    Eleven of the patients received 20 grams per day of gluten, while the seven others received a non-gluten placebo. The team measured clinical symptoms, quality of life (GIQLI), and presence of gamma/delta+ cells and transglutaminase deposits.

    The results showed that 91% of patients had clinical relapse during gluten challenge compared with just 28.5% after placebo (p = 0.01). Clinical scores and GIQLI worsened after gluten, but not after placebo (p<0.01).

    This study shows that gluten is definitely the trigger for symptoms in a subgroup of patients with clinical NCGS. After a gluten-free diet patients experienced positive celiac genetics, lymphocytic enteritis, and clinical and histological remission.

    Source:


    Image Caption: Gluten triggers symptoms in some types of non-celiac gluten sensitivity. Photo: CC--Joe Dyer
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  • Related Articles

    Gryphon Myers
    Celiac.com 09/03/2012 - Celiac disease numbers in Western countries are currently somewhere in the 1:100 range, but this does not account for a host of non-celiac gluten intolerant people. For many, it is common knowledge that gluten and wheat intolerance manifests in a variety of forms, and not all of them are diagnosable as celiac disease. This has not prevented scientific circles from debating the existence of such non-celiac wheat sensitivities though. A double-blind placebo-controlled study spanning 2001-2011 demonstrates that wheat sensitivity exists as a distinct clinical condition, separate from celiac disease.
    Many who go to their doctors seeking a celiac disease diagnosis are disappointed when they are told that they do not have celiac disease, but the more catch-all, and less conclusive IBS, even though they have self-diagnosed and know that gluten aggravates their symptoms. Such IBS-diagnosed patients who attended the outpatient center at the Department of Internal Medicine at the University Hospital of Palermo or the Department of Internal Medicine of the Hospital of Sciacca between January 2001 and June 2011 were considered for the study.
    After a number of diagnostic inclusion and exclusion criteria were applied, 920 patients were invited to participate in the study. Patients were monitored for 2-4 weeks while on a 30g minimum wheat-containing diet, then put on a standard elimination diet (no wheat, cow's milk, eggs, tomatoes or chocolate). Any further known food sensitivities were avoided as well.
    After 4 weeks on the elimination diet, patients underwent double-blind placebo-controlled challenges, with single foods being presented at a time. Placebo and wheat (or other eliminated food) were administered for two weeks at a time, one after the other with a one week washout period in between.
    Severity of symptoms was recorded during all phases of the study. Challenges were stopped if symptoms presented, and considered positive if the symptoms were the same symptoms originally diagnosed as IBS.
    There were two control groups: 50 patients with IBS who were not classified as suffering from wheat or food sensitivities, and 100 patients who had received celiac disease diagnoses.
    Of the 920 participants, 276 (30%) suffered wheat sensitivity symptoms, became asymptomatic on elimination diet and symptomatic again during the DBPC challenge. 70 of these patients were diagnosed with wheat sensitivity alone, and two hundred and six were diagnosed with multiple food hypersensitivity. The first group of patients' symptoms resembled celiac disease, whereas the patients in the second group had symptoms that more closely resembled food allergy.
    Relevant markers to distinguish wheat sensitivity from IBS include anemia, weight loss and history of food allergy in infancy. Wheat sensitive patients also tended to have more coexistent atopic diseases.
    From this study, we know that non-celiac wheat sensitivity exists. Further studies will explore the distinction between the celiac-like and allergy-like types of the condition.
    Source:
    http://www.ncbi.nlm.nih.gov/pubmed/22825366

    Jefferson Adams
    Celiac.com 11/14/2013 - Until now, rates of non-celiac gluten sensitivity were largely a matter of clinical speculation, basically, educated guesswork among doctors.
    Some thought that rates of non-celiac gluten-sensitivity might by much higher than rates of celiac disease in the USA. But there was just no actual clinical data supporting these claims.
    A team of researchers recently set out to get some good clinical data that would tell them how common non-celiac gluten sensitivity actually is.
    The research team included Daniel V. DiGiacomo, Christina A. Tennyson, Peter H. Green, and Ryan T. Demmer. They are variously affiliated with the Department of Medicine, Celiac Disease Center at Columbia University, and the Department of Epidemiology at the Mailman School of Public Health at Columbia University in New York.
    The authors used the Continuous National Health and Nutrition Examination Survey (NHANES) 2009–2010 to enroll 7762 people from the civilian, non-institutionalized, US population free of celiac disease.
    They then analyzed the data to estimate rates of adherence to a gluten-free diet among participants without celiac disease as a surrogate marker for non-celiac gluten sensitivity in the US.
    They also used the data to characterize the demographics and general health status of the study participants.
    Overall, forty-nine participants reported adherence to a gluten-free diet. With a weighted national prevalence of 0.548%, this represents 1.3 million individuals between 6 and 80 years old in the US.
    The prevalence of a gluten-free diet was higher in females (0.58%) than males (0.37%), although this was not statistically significant (p = 0.34).
    Participants reporting a gluten-free diet were older (46.6 vs. 40.5 years, p = 0.005), had higher high-density lipoprotein, lower iron and lower body mass index.
    These numbers put the estimated national prevalence of non-celiac gluten sensitivity at 0.548%, about half the rate of celiac disease.
    However, the team calls for further studies in order to better understand the population burden of non-celiac gluten sensitivity.
    Source:
    Rev Esp Enferm Dig. 2013 Apr;105(4):187-193. doi:10.3109/00365521.2013.809598

    Jefferson Adams
    Non-celiac wheat sensitivity (NCWS) is a newly described clinical condition marked by symptoms which may affect the gastrointestinal tract, the nervous system, the skin, and other organs.
    There is little data regarding the origins of NCWS, and it is likely that numerous factors influence the various clinical manifestations of the condition.
    The one common thread in NCWS is wheat consumption. Symptoms disappear when wheat is eliminated from the diet, and reappear when wheat is consumed.
    Looking into the possibility that their NCWS patients might in fact be suffering from non-immunoglobulin E (IgE)-mediated wheat allergy, a team of researchers conducted a review their own earlier data regarding NCWS, with a corresponding review of relevant medical literature on NCWS.
    The research team included Antonio Carroccio, Pasquale Mansueto, Alberto D'Alcamo and Giuseppe Iacono. Together, they reviewed data on 276 patients diagnosed with NCWS by means of double-blind placebo-controlled (DBPC) wheat challenge.
    They then examined data indicating a possible wheat allergy diagnosis, and reviewed other study data, along with the role of serum immunoglobulin G antibodies and the basophil activation assay in food allergy, and the histology findings in the food allergy diagnosis.
    By comparing patients with NCWS and irritable bowel syndrome (IBS) against controls with non-IBS-related NCWS, the team determined that NCWS was marked by: food allergy in the pediatric age (0.01); coexistent atopic diseases (0.0001); positive serum anti-gliadin (0.0001) and anti-betalactoglobulin (0.001) antibodies; positive cytofluorimetric assay revealing in vitro basophil activation by food antigens (0.0001); and a presence of eosinophils in the intestinal mucosa biopsies (0.0001).
    Patients with NCWS and multiple food sensitivity show several clinical, laboratory, and histological characteristics that suggest they might actually be suffering from non-IgE-mediated food allergy.
    This is potentially very interesting news regarding NCWS, but the team does note that other pathogenic possibilities need to be considered and investigated before this can be confirmed.
    Source:
    The American Journal of Gastroenterology, 5 November 2013. doi:10.1038/ajg.2013.353

    Jefferson Adams
    Celiac.com 06/13/2016 - Researchers Umberto Volta, Giacomo Caio, and Roberto De Giorgio, of the Department of Medical and Surgical Sciences at the University of Bologna in Bologna, Italy, recently submitted a letter to the medical journal Gastroenterology.
    In their letter, the researchers respond to a recent paper, published by Carroccio et al, reporting on the prevalence of autoimmunity (as identified by positivity of antinuclear antibodies [ANA] and associated autoimmune disorders) in non-celiac wheat sensitivity (NCWS) compared with celiac disease and irritable bowel syndrome (IBS). They note that the study results, based on retrospective and prospective data, showed that the prevalence of ANA in NCWS was significantly higher than in celiac disease and IBS (46% in NCWS vs 24% in celiac disease and 2% in IBS, retrospectively; and 28% in NCWS vs 7.5% in celiac disease and 6% in IBS, prospectively).
    They note also that both retrospective and prospective analysis show autoimmune disorders (mainly autoimmune thyroiditis) in a slightly higher proportion in NCWS (29% vs 24%) than celiac disease (21% vs 20%). Meanwhile, both NCWS and celiac patients showed substantially higher rates of autoimmune disorders than IBS. In both both retrospective and prospective data, ANA showed a strong relation to HLA-DQ2 and -DQ8 in NCWS, whereas these autoantibodies were associated with autoimmune disorders only in the prospective arm.
    The team found these results from the Carroccio study to be scientific interesting because NCWS, more than better known autoimmune disorders, such as celiac disease, shows a surprisingly high autoimmune profile. They note that celiac disease is a well-established autoimmune condition often marked by different types of autoantibodies and associated autoimmune disorders. Such autoimmune features have not been seen so far in NCWS and the odds of these patients developing autoimmune dysfunction remains unknown.
    The team's data showed that only 14% of 486 patients with NCWS had an associated autoimmune disorder including thyroiditis, psoriasis, Graves disease, type 1 diabetes mellitus, and atrophic gastritis. In contrast, about 30% of 770 celiac patients showed the same autoimmune manifestations. These findings are in line with previously published data.
    They point out that another interesting aspect that came out of Carroccio study is the very high rate of ANA in their cohort of NCWS versus celiac disease and IBS patients. The team notes that their own experience shows ANA to be higher in celiac disease than NCWS and IBS (49% vs 37% vs 6%), which indicates a substantial autoimmune profile in celiac disease, compared with the two other conditions. They also note that evidence showing patients with NCWS to have higher rates of ANA compared with IBS is in line with the results presented by Carroccio et al.
    They conclude their letter by stating that consistent evidence supports a major role of adaptive immunity in celiac disease more than NCWS, and this peculiarity is reflected by a predominant occurrence of autoimmune disorders and autoantibodies (eg, ANA).
    However, the challenging data shown by Carroccio et al provide the basis to understand whether NCWS, like celiac disease, show a wide array of autoimmune expressions mediated by adaptive mechanisms.
    They call for further studies to better understand what they term the "intriguing relationship between autoimmunity and NCWS."
    Source:
     Gastroenterology. 2016 Jan;150(1):282. doi: 10.1053/j.gastro.2015.08.058. Epub 2015 Nov 23.

  • Recent Articles

    Jefferson Adams
    Celiac.com 04/23/2018 - A team of researchers recently set out to learn whether celiac disease patients commonly suffer cognitive impairment at the time they are diagnosed, and to compare their cognitive performance with non-celiac subjects with similar chronic symptoms and to a group of healthy control subjects.
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    Source:
    J Clin Gastroenterol. 2018 Mar 1. doi: 10.1097/MCG.0000000000001018.

    Connie Sarros
    Celiac.com 04/21/2018 - Dear Friends and Readers,
    I have been writing articles for Scott Adams since the 2002 Summer Issue of the Scott-Free Press. The Scott-Free Press evolved into the Journal of Gluten Sensitivity. I felt honored when Scott asked me ten years ago to contribute to his quarterly journal and it's been a privilege to write articles for his publication ever since.
    Due to personal health reasons and restrictions, I find that I need to retire. My husband and I can no longer travel the country speaking at conferences and to support groups (which we dearly loved to do) nor can I commit to writing more books, articles, or menus. Consequently, I will no longer be contributing articles to the Journal of Gluten Sensitivity. 
    My following books will still be available at Amazon.com:
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    Jefferson Adams
    Celiac.com 04/20/2018 - A digital media company and a label data company are teaming up to help major manufacturers target, reach and convert their desired shoppers based on dietary needs, such as gluten-free diet. The deal could bring synergy in emerging markets such as the gluten-free and allergen-free markets, which represent major growth sectors in the global food industry. 
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    "Brands with very specific product benefits, gluten-free for example, require precise targeting to efficiently reach and convert their desired shoppers,” says Todd Morris, President of Catalina's Go-to-Market organization, adding that “Catalina offers the only purchase-based targeting solution with this capability.” 
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    Morris says the joint partnership will allow Catalina to “enhance our dataset and further increase our ability to target shoppers who are currently buying - or have shown intent to buy - in these emerging categories,” including gluten-free, allergen-free, and other free-from foods.
    The deal will likely make for easier, more precise targeting of goods to consumers, and thus provide benefits for manufacturers and retailers looking to better serve their retail food customers, especially in specialty areas like gluten-free and allergen-free foods.
    Source:
    fdfworld.com

    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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    Compared with the control group, seven out of twenty-three children with celiac disease showed elevated levels of the the following amino acids: tryptophan; taurine; glutamic acid; proline; ornithine; alanine; and methionine.
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    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