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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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    HAVE RESEARCHERS FOUND A SAFE WAY FOR CELIAC PATIENTS TO CONSUME WHEAT?


    Jefferson Adams

    Celiac.com 05/18/2015 - It is well known that fermenting wheat flour with sourdough lactobacilli and fungal proteases reduces the amount of gluten. A team of researchers recently assessed whether patients with celiac disease can safely consume baked goods made from this hydrolyzed kind of wheat flour.


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    Photo: Christina D. C. HoeppnerThe research team included Luigi Greco, Marco Gobbetti, Renata Auricchio, Raffaella Di Mase, Francesca Landolfo, Francesco Papro, Raffaella Di Cagno, Maria De Angelis, Carlo Giusseppi Rizzello, Angela Cassone, Gaetano Terrone, Laura Timpone, Martina D’Aniello, Maria Maglio, Riccardo Troncone, and Salvatore Auricchio.

    They are variously affiliated with the Department of Pediatrics and European Laboratory for the Study of Food Induced Diseases at the University of Naples, Federico II in Naples, and with the Department of Plant Protection and Applied Microbiology at the University of Bari in Bari, Italy.

    For their study, the team randomly assigned patients to receive 200 grams per day of natural flour baked goods (NFBG) (80,127 ppm gluten; n 6), extensively hydrolyzed flour baked goods (S1BG) (2480 ppm residual gluten; n 2), or fully hydrolyzed baked goods (S2BG) (8 ppm residual gluten; n 5) for 60 days.

    Two of the 6 patients who consumed natural flour baked goods discontinued the challenge due to adverse symptoms; all patients showed increased levels of anti–tissue transglutaminase (tTG) antibodies and mucosal damage to the small bowel.

    • The 2 patients who ate the S1BG goods had no complaints and showed no symptoms, but developed subtotal atrophy.
    • The 5 patients who ate the S2BG had no clinical symptoms or complaints. They showed no increase in anti-tTG antibodies, and their Marsh grades indicated no damage to small intestinal mucosa.
    • The results showed that a 60-day diet of baked goods made from hydrolyzed wheat flour, manufactured with sourdough lactobacilli and fungal proteases, was not toxic to patients with celiac disease.

    Obviously further study is needed, along with a combined analysis of serologic, morphometric, and immunohistochemical parameters, which is the most accurate way to assess new celiac therapies.

    However, hydrolyzing wheat flour and treating it with sourdough lactobacilli and fungal proteases is not especially complicated. If these results stand, researchers may have developed the first wheat products that are safe for people with celiac disease.

    What do you think? Exciting news? Or one more thing to be skeptical about? Share your comments below.

    Source:


    Image Caption: Photo: Christina D. C. Hoeppner
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    Interesting - did the researchers really think that the subjects getting sick would continue to eat the wheat products?

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    Guest MB Armstrong

    Posted

    Very interesting. I would like to see the study replicated in the U.S. with a larger test group. I believe U.S. wheat is very different than Italian wheat because of genetic modifications in the U.S. I have a friend who shows severe allergy symptoms when eating wheat in the U.S., but can eat all the bread and pasta in Italy with no symptoms.

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    Guest Char

    Posted

    While the findings were interesting regarding the fully hydrolyzed wheat, I was shocked and appalled to read that the researchers gave normal bread (w/ over 80,000 ppm gluten!) to six people with celiac disease. Evidence showing that gluten causes long term damage and possibly severe health outcomes to celiacs patients has been well documented. As such, I think this study was completely unethical in its design. Biomedical research ethics require that the subjects should not be exposed to excess harm, which is exactly what happened here. The authors, the funders, and the journal editor that published this article should be ashamed.

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    Guest L.A. Stevns

    Posted

    This would, of course, be a blessing for all of us with this disease. Though I nearly died of my disease (lost more than 60 percent of my body weight in 2 months), I am not particularly sensitive to wheat contamination in the short term now that I am being treated. So, this might really be a possibility for me.

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    But the only group not showing symptoms at all were the ones who ate 8 ppm gluten. Since 20 ppm is allowed in gluten-free foods, it really is not surprising the 8 ppm did not cause issue.

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    Guest diana

    Posted

    This is quite intriguing, especially since I am a huge sourdough bread fan. I wonder if no other gluten-related symptoms were observed. For me, migraines are my primary symptom after consuming gluten.

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    Guest Alicia

    Posted

    This would, of course, be a blessing for all of us with this disease. Though I nearly died of my disease (lost more than 60 percent of my body weight in 2 months), I am not particularly sensitive to wheat contamination in the short term now that I am being treated. So, this might really be a possibility for me.

    Just because you are not sensitive, doesn't mean you are not being damaged. I wouldn't go anywhere near it.

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    Guest Angela

    Posted

    Hopefully it is a step in the right direction. Anything that will give my son hope that one day he can eat normally again is a blessing. God willing there will be a cure for all who suffer from this disease.

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    Guest Jefferson

    Posted

    While the findings were interesting regarding the fully hydrolyzed wheat, I was shocked and appalled to read that the researchers gave normal bread (w/ over 80,000 ppm gluten!) to six people with celiac disease. Evidence showing that gluten causes long term damage and possibly severe health outcomes to celiacs patients has been well documented. As such, I think this study was completely unethical in its design. Biomedical research ethics require that the subjects should not be exposed to excess harm, which is exactly what happened here. The authors, the funders, and the journal editor that published this article should be ashamed.

    Short-term exposure to gluten during the study is unlikely to cause any long-term problems for the study volunteers.

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    Guest Jefferson

    Posted

    Very interesting. I would like to see the study replicated in the U.S. with a larger test group. I believe U.S. wheat is very different than Italian wheat because of genetic modifications in the U.S. I have a friend who shows severe allergy symptoms when eating wheat in the U.S., but can eat all the bread and pasta in Italy with no symptoms.

    Nearly all commercial wheat strains grown globally are the same. Also, flour is a globally traded commodity, thus these anecdotal reports are to be taken with a grain of salt.

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    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
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    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
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    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