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      Frequently Asked Questions About Celiac Disease   04/24/2018

      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 is Celiac Disease and the Gluten-Free Diet? 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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    Higher-Than-Normal Thyroxine Doses Offer a Clue to Celiac Disease


    Jefferson Adams

    Celiac.com 03/26/2012 - People with thyroiditis and untreated celiac disease may suffer from reduced thyroid-stimulating hormone levels, a new study has found. Those people may require supplemental doses of thyroxine to normalize their thyroid-stimulating hormone levels.


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    That study, which appears in the Journal of Clinical Endocrinology and Metabolism, also indicates that following a gluten-free diet seems to require less thyroxine to push thyroid hormone back toward normal levels.

    Photo: CC - sanofi pasteurMore and more, people diagnosed with celiac disease, show atypical symptoms, many without the classic gastrointestinal complaints that traditionally characterized celiac disease.

    The study team notes that the need for higher thyroxine doses may offer a clue to such atypical celiac disease.

    Leader of the study, endocrinologist Dr. Marco Centanni, of Sapienza University of Rome, in Italy, encourages doctors to consider the "possibility of the presence of other occult autoimmune disorders…every time they see a patient with autoimmune thyroiditis."

    Dr. Centanni adds that doctors should consider malabsorption, and possible celiac disease, whenever standard thyroxine doses fail to reduce thyroid-stimulating hormone levels to under 2.5mU/L. For Dr. Centanni, an individually-tailored dose of thyroxine that fails to hit the therapeutic target is a powerful "tool to unveil occult gastrointestinal disorders."

    Dr. Centanni and his team analyzed replacement T4 doses in 35 hypothyroid patients with Hashimoto's thyroiditis (HT) and atypical celiac disease. They also looked at 68 patients with Hashimoto's alone.

    After an about five months of thyroxine doses averaging 1.31 mcg/kg/day, the 68 patients without celiac disease reached target serum thyroid-stimulating hormone levels of a median of 1.02 mU/L.

    After receiving similar thyroxine doses over a similar span of time, the 35 patients with celiac disease showed much higher hormone levels, averaging 4.20 mU/l, and just a single patient had reached the target level.

    The team then encouraged patients with celiac disease to adopt a gluten-free diet, and found 21 willing patients.

    When they measured those 21 patients again after an average of 11 months, they found that the patients had returned to target serum hormone levels on a average thyroxine dose of 1.32 mcg/kg/day, which is similar to the dose originally used in the non-celiacs.

    To get normal target serum hormone levels in the 14 celiac patients who did not comply with the gluten-free diet, the team had to increase the dosage substantially.

    From these results, the researchers conclude that malabsorption of thyroxine may offer an as yet undiscovered way detect celiac disease in certain cases.

    Source:


    Image Caption: Photo: CC - sanofi pasteur
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  • Related Articles

    Scott Adams

    Author: Troncone R; Greco L; Auricchio S
    Address: Department of Pediatrics, University Federico II, Naples, Italy.
    Source: Pediatr Clin North Am, 43: 2, 1996 Apr, 355-73
    Abstract:
    Gluten-sensitive enteropathy is induced by dietary wheat gliadin and related proteins in genetically susceptible individuals. Most evidence suggests that the mucosal lesion represents an immunologically mediated injury triggered by gluten in the context of a particular assortment of major histocompatibility complex genes. The amino acid residues of gliadin and related proteins responsible for toxicity have not been identified; in vitro systems are available, but definitive conclusions must rely on in vivo jejunal challenges. At a conservative estimate, symptomatic gluten-sensitive enteropathy affects approximately 1 in 1000 individuals in Europe; however, it is now becoming clear that a greater proportion of individuals has clinically silent disease, and probably many others have a minor form of the the enteropathy. In most countries, the clinical presentation has changed over the past few years coming closer to the adult type of the disease, and the age of onset of symptoms is shifting upward. Liver, joint, hematologic, dental, and neurological symptoms are increasingly being recognized. Several diseases are associated the gluten-sensitive enteropathy, such as IgA deficiency, insulin-dependent diabetes mellitus, and a range of other autoimmune diseases. Tests based on the measurement of antigliadin and antiendomysium antibodies have gained success as noninvasive screening tests; however, the ultimate diagnosis still is based on the finding of a severe histologic lesion of the jejunum while the patient is on a gluten-containing diet and on its disappearance once the gluten is excluded from the diet. A lifelong, strict gluten-free diet is mandatory for celiac children. Among other long-term problems, an increased risk of intestinal lymphoma has been reported in patients on a normal gluten-containing diet.

    Jefferson Adams
    A team of Swiss researchers recently set out to examine the nature of T cell-mediated immuno-regulation in the gastrointestinal tract. The research team was made up of doctors L. Saurer and C. Mueller of the Institute of Pathology at the University of Bern in Switzerland.
    In the human intestinal tract, just a single layer of epithelial cells divides innate and adaptive immune effector cells from a wide array of antigens. Here, the immune system faces a tall task in accepting beneficial flora and dietary antigens while preventing the dissemination of potential pathogens. When the tightly controlled process of immune system reactions breaks down, harmful inflammation and damage may result.
    In light of this, a great deal of focus has shifted toward 'conventional' regulatory CD4+ T cells, including naturally occurring and adaptive CD4+ CD25+ Foxp3+ T cells, Th3 and Tr1 cells.
    However, control mechanisms in the intestinal mucosa are highly intricate, and include adaptations of non-haematopoietic cells and innate immune cells in addition to the presence of unconventional T cells with regulatory properties such as resident TCRγδ or TCRαβ CD8+ intraepithelial lymphocytes.
    In the study, L. Saurer and C. Mueller seek to provide an overview of the present body of knowledge on standard and non-standard regulatory T cell subsets (Tregs), with particular focus on clinical data and the potential role or malfunctioning of Tregs in four major human gastrointestinal diseases, i.e. inflammatory bowel diseases, celiac disease, food allergy and colorectal cancer.
    Their data confirms most of the findings derived from experimental animal models, and has implications for clinical immunology, food allergy, immunoregulation, immunotherapy, mucosal immunology, and regulatory T cell protocols. Their findings appear in the February 2009 issue of Allergy.



    Gryphon Myers
    There have been several studies of celiac disease sufferers and health-related quality of life (HRQoL), but few of these studies have focused on children. Since diseases that develop through childhood (as celiac disease often does) usually negatively impact physical, social and psychological development, it is important to determine the extent to which celiac children suffer as a result of the disease.
    In the present study, 160 celiac children (55 males and 105 females) were given questionnaires to assess mental health, social health and physical health over the four weeks prior to when the test was taken. Children were divided into three age groups: 8-11 years, 12-15 years and 16-18 years. Parents were given a proxy version of the questionnaire to assess their children. Questions came from the short version of the DISABKIDS questionnaire (a well-validated research method used for different chronic disease diagnostic groups). Age and severity of disease at onset were examined to determine if these factors influenced self-valuation later in life.
    Children rated their HRQoL surprisingly high, with a median score of 92/100 (85 points for mental health, 95 for social health and 100 for physical health). Sex and age did not show any significant correlation, though years since diagnosis showed slight correlation (children rated themselves higher the longer it had been since disease onset). Children who were younger at diagnosis also rated themselves higher, which is likely because young children have not grown accustomed to gluten-containing foods, and thus miss them less. It is also likely that children closer to adolescent age have a harder time accepting their 'otherness' due to their psychological development.
    Children with more severe symptoms at onset rated their HRQoL higher than children who had more mild symptoms, or were asymptomatic at onset. This is likely because more symptomatic children are able to perceive more of a dramatic change in their overall health after starting on gluten-free diet. They feel relatively better, so they rate themselves higher.
    Parents tended to rate their children's HRQoL lower than then the children themselves did. This underestimation is probably a result of parental worrying, guilt and/or sense of responsibility. Parents whose children were younger at onset of disease, or had lived with the disease longer tended to judge their children's HRQoL more accurately.
    This study suggests that children adapt well to celiac disease, and that parents tend to overestimate the negative impact the disease has on their children. At risk of overtreatment of the psychological, social and physical impacts of the disease, it is important that parents of celiac children let their children be heard about their perceived quality of life.
    Source:
    http://www.hindawi.com/journals/grp/2012/986475/

    Jefferson Adams
    Celiac.com 01/18/2013 - Up-regulation of T-bet and phosphorylated signal transducers and activators of transcription (pSTAT)1 are key transcription factors for the development of T helper type 1 (Th1) cells, and have been found in the mucosa of patients with untreated celiac disease.
    A team of researchers recently set out to determine if T-bet and pSTAT-1 expression in PBMC from celiac disease patients might offer new genetic markers of disease activity.
    The research team included G. Frisullo, V. Nociti, R. Iorio, A.K. Patanella, D. Plantone, A. Bianco, A. Marti, G. Cammarota, P.A. Tonali, A.P. Batocchi. They are affiliated with the Department of Neurosciences at Catholic University in Rome, Italy.
    For their study, the team used transcription factor analysis to determine whether T-bet and pSTAT1 expressions are up-regulated in the peripheral blood of celiac disease patients, and if they correlate with disease activity.
    They used flow cytometry to analyse T-bet, pSTAT1 and pSTAT3 expression in CD4(+), CD8(+) T cells, CD19(+) B cells and monocytes from peripheral blood of 15 untreated and 15 treated celiac disease patients and 30 controls. They also conducted a longitudinal study of five celiac patients before and after treatment with a gluten-free diet.
    For their evaluation, the team used enzyme-linked immunosorbent assay (ELISA), interferon (FN)-gamma, interleukin (IL)-17 and IL-10 production by peripheral blood mononuclear cell (PBMC) cultures.
    They found that T-bet expression in CD4(+), CD8(+) T cells, CD19(+) B cells and monocytes and IFN-gamma production by PBMC was higher in untreated than in treated celiac disease patients and control subjects.
    They also found that pSTAT1 expression was higher in CD4(+)T cells, B cells and monocytes from untreated celiac disease patients than from treated patients and control subjects.
    Compared with treated celiac disease patients and control subjects, untreated patients showed increased pSTAT3 only in monocytes.
    They confirmed their results using data obtained from the longitudinal evaluation of transcription factors.
    From their results, they conclude that flow cytometric analysis of pSTAT1 and T-bet protein expression in peripheral blood mononuclear cells could be useful and sensible markers in the follow-up of celiac disease patients to evaluate disease activity and response to dietary treatment.
    Source:
     Clin Exp Immunol. 2009 Oct;158(1):106-14. doi: 10.1111/j.1365-2249.2009.03999.x.

  • Recent Articles

    Jefferson Adams
    Celiac.com 05/22/2018 - Proteins are the building blocks of life. If scientists can figure out how to create and grow new proteins, they can create new treatments and cures to a multitude of medical, biological and even environmental conditions.
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    Source:
    Bloomberg.com

    Jefferson Adams
    Celiac.com 05/21/2018 - Just a year ago, Starbucks debuted their Canadian bacon, egg and cheddar cheese gluten-free sandwich. During that year, the company basked in praise from customers with celiac disease and gluten-sensitivity for their commitment to delivering a safe gluten-free alternative to it’s standard breakfast offerings.
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    Jefferson Adams
    Celiac.com 05/19/2018 - Looking for a nutritious, delicious meal that is both satisfying and gluten-free? This tasty quinoa salad is just the thing for you. Easy to make and easy to transport to work. This salad of quinoa and vegetables gets a rich depth from chicken broth, and a delicious tang from red wine vinegar. Just pop it in a container, seal and take it to work or school. Make the quinoa a day or two ahead as needed. Add or subtract veggies as you like.
    Ingredients:
    1 cup red quinoa, rinsed well ½ cup water ½ cup chicken broth 2 radishes, thinly sliced 1 small bunch fresh pea sprouts 1 small Persian cucumber, diced 1 small avocado, ripe, sliced into chunks Cherry or grape tomatoes Fresh sunflower seeds 2 tablespoons red wine vinegar  Kosher salt, freshly ground pepper Directions:
    Simmer quinoa in water and chicken broth until tender.
    Dish into bowls.
    Top with veggies, salt and pepper, and sunflower seeds. 
    Splash with red wine vinegar and enjoy!

    Jefferson Adams
    Celiac.com 05/18/2018 - Across the country, colleges and universities are rethinking the way they provide food services for students with food allergies and food intolerance. In some cases, that means major renovations. In other cases, it means creating completely new dining and food halls. To document both their commitment and execution of gluten-free and allergen-free dining, these new food halls are frequently turning to auditing and accreditation firms, such as Kitchens with Confidence.
    The latest major player to make the leap to allergen-free dining is Syracuse University. The university’s Food Services recently earned an official gluten-free certification from Kitchens with Confidence for four of the University’s dining centers, with the fifth soon to follow.
    To earn the gluten-free certification from Kitchens with Confidence, food services must pass a 41 point audit process that includes 200 control check points. The food service must also agree to get any new food item approved in advance, and to submit to monthly testing of prep surfaces, to furnish quarterly reports, and to provide information on any staffing changes, recalls or incident reports. Kitchens with Confidence representatives also conduct annual inspections of each dining center.
    Syracuse students and guests eating at Ernie Davis, Shaw, Graham and Sadler dining centers can now choose safe, reliable gluten-free food from a certified gluten-free food center. The fifth dining center, Brockway, is currently undergoing renovations scheduled for completion by fall, when Brockway will also receive its certification.
    Syracuse Food Services has offered a gluten-free foods in its dining centers for years. According to Jamie Cyr, director of Auxiliary Services, the university believes that the independent Gluten-Free Certification from Kitchens with Confidence will help ease the anxiety for parents and students.”
    Syracuse is understandably proud of their accomplishment. According to Mark Tewksbury, director of residence dining operations, “campus dining centers serve 11,000 meals per day and our food is made fresh daily. Making sure that it is nutritious, delicious and safe for all students is a top priority.”
    Look for more colleges and universities to follow in the footsteps of Syracuse and others that have made safe, reliable food available for their students with food allergies or sensitivities.
    Read more.

    Zyana Morris
    Celiac.com 05/17/2018 - Celiac disease is not one of the most deadly diseases out there, but it can put you through a lot of misery. Also known as coeliac, celiac disease is an inherited immune disorder. What happens is that your body’s immune system overreacts to gluten and damages the small intestine. People who suffer from the disease cannot digest gluten, a protein found in grain such as rye, barley, and wheat. 
    While it may not sound like a severe complication at first, coeliac can be unpleasant to deal with. What’s worse is it would lower your body’s capacity to absorb minerals and vitamins. Naturally, the condition would cause nutritional deficiencies. The key problem that diagnosing celiac is difficult and takes take longer than usual. Surprisingly, the condition has over 200 identified symptoms.
    More than three million people suffer from the coeliac disease in the United States alone. Even though diagnosis is complicated, there are symptoms that can help you identify the condition during the early stages to minimize the damage. 
    Here is how you can recognize the main symptoms of celiac disease:
    Diarrhea
    In various studies conducted over years, the most prominent symptom of celiac disease is chronic diarrhea.
    People suffering from the condition would experience loose watery stools that can last for up to four weeks after they stop taking gluten. Diarrhea can also be a symptom of food poisoning and other conditions, which is why it makes it difficult to diagnose coeliac. In certain cases, celiac disease can take up to four years to establish a sound diagnosis.
    Vomiting
    Another prominent symptom is vomiting.  
    When accompanied by diarrhea, vomiting can be a painful experience that would leave you exhausted. It also results in malnutrition and the patient experiences weight loss (not in a good way though). If you experience uncontrolled vomiting, report the matter to a physician to manage the condition.
    Bloating
    Since coeliac disease damages the small intestine, bloating is another common system. This is due to inflammation of the digestive tract. In a study with more than a 1,000 participants, almost 73% of the people reported bloating after ingesting gluten. 
    Bloating can be managed by eliminating gluten from the diet which is why a gluten-free diet is necessary for people suffering from celiac disease.
    Fatigue
    Constant feeling of tiredness and low energy levels is another common symptom associated with celiac disease. If you experience a lack of energy after in taking gluten, then you need to consult a physician to diagnose the condition. Now fatigue can also result from inefficient thyroid function, infections, and depression (a symptom of the coeliac disease). However, almost 51% of celiac patients suffer from fatigue in a study.
    Itchy Rash
    Now the chances of getting a rash after eating gluten are slim, but the symptom has been associated with celiac disease in the past. The condition can cause dermatitis herpetiformis, which causes a blistering skin rash that occurs around the buttocks, knees, and elbows. 
    A study found out that almost 17% of patients suffering from celiac disease might develop dermatitis herpetiformis due to lack of right treatment. Make sure you schedule an online appointment with your dermatologist or visit the nearest healthcare facility to prevent worsening of symptoms.
    Even with such common symptoms, diagnosing the condition is imperative for a quick recovery and to mitigate the long-term risks associated with celiac disease. 
    Sources:
    ncbi.nlm.nih.gov  Celiac.com ncbi.nlm.nih.gov  mendfamily.com