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    Point-of-Care Test Helps Spot Undiagnosed Celiac Disease


    Jefferson Adams

    Celiac.com 01/19/2015 - A team of researchers set out to determine what factors might influence dissemination of a new and validated commercial Point-of-Care Test (POCT) for celiac disease, in the Mediterranean area, when used in settings where it was designed to be administered, especially in countries with poor resources.


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    Photo: CC--JYL4032The research team included S. Costa, L. Astarita, M. Ben-Hariz, G. Currò, J. Dolinsek, A. Kansu, G. Magazzu, S. Marvaso, D. Micetic-Turku, S. Pellegrino, G. Primavera, P. Rossi, A. Smarrazzo, F. Tucci, C. Arcidiaco, and L. Greco.

    For their study, the team relied on family pediatricians in Italy, and nurses and pediatricians in Slovenia and Turkey, to look for celiac disease in 3,559 children aged 1-14 years, 1,480 (ages 14-23 years) and 771 (1-18 years) asymptomatic subjects, respectively. This was done at pediatrician offices, schools and university primary care centers

    The team used a new POCT that detects IgA-tissue antitransglutaminase antibodies and IgA deficiency in a finger-tip blood drop. Subjects with positive screens and those suspected of having celiac disease were referred to a Celiac Centre to confirm the diagnosis.

    The team then estimated POCT Positive Predictive Value (PPV) at tertiary care (with Negative Predictive Value) and in primary care settings, and POCT and celiac disease rates per thousand in primary care.

    At tertiary care setting, PPV of the POCT and 95% CI were 89.5 (81.3-94.3) and 90 (56-98.5) with Negative Predictive Value 98.5 (94.2-99.6) and 98.7% (92-99.8) in children and adults, respectively.

    In primary care settings of different countries where POCT was performed by a different number of personnel, PPV ranged from 16 to 33%, and the celiac disease rates per thousand ranged from 4.77 to 1.3, while and POCT rates ranged from 31.18 to 2.59, respectively.

    This study shows that interpretation of POCT results by different personnel may influence the performance of POC, but that use of POCT is an urgent priority for diagnosing celiac disease among people of countries with limited resources, such as rural populations and school children.

    Source:


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  • About Me

    Jefferson Adams is a freelance writer living in San Francisco. He has covered Health News for Examiner.com, and provided health and medical content for Sharecare.com. His work has appeared in Antioch Review, Blue Mesa Review, CALIBAN, Hayden's Ferry Review, Huffington Post, the Mississippi Review, and Slate, among others.

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    Destiny Stone
    Celiac.com 06/10/2010 - New research is currently underway in Ireland, as researchers test "pseudo-cereals" to determine the quality of  replacements for glutenous grains such as, wheat, rye and barley. Many celiacs, especially those with delayed diagnosis', suffer from malabsorbtion and malnutrition. It is therefore more important for celiacs to ingest grains that are vitamin fortified than it is for non-celiacs. Researchers at Teagasc Food Research Ashtown are attempting to address the nutritional concerns for gluten-free products. They are working to  formulate gluten-free bread products that are tasty, and have higher nutritional properties.
    Doctor Eimear Gallagher, of Teagasc Food Research Ashtown, is leading the current research project which primarily focuses on using “pseudo-cereals” such as amaranth, quinoa and buckwheat, to replace gluten containing grains,  also known as wheat, rye and barley. Dr. Gallagher suggests that the demand for new and improved gluten-free bread products is growing  rapidly due to greater public awareness of celiac disease, and the rise in positive celiac diagnoses'.
    Celiac affects approximately 1 percent of the population. Which means that 1 percent of the population must look for alternatives to favored grain products such as bread, pizza and cereals to name a few. While there is a large variety of gluten-free products on the market, many gluten-free products are described as being crumbly, brittle, bland and often rendered  inedible. Gluten-free products are not only considered inferior in texture and taste to their wheat counterparts, but they are also criticized for having inferior nutritional value. Most mainstream breads and grains are vitamin fortified and therefore contain many essential nutrients, vitamins, and fiber. However, most gluten-free grains are typically made with starches and refined flours such as rice, corn and potato starches, which are low in nutrients and are not usually fortified.
    Dr. Gallagher and researchers are studying characteristics of pseudo-cereals to replace wheat in grain products. Amaranth, quinoa and buckwheat are naturally high in nutritional values with high levels of protein and dietary fiber, which make them excellent grain alternatives  for celiacs. Dr. Gallagher's findings showed that all of the pseudo-cereal breads revealed a significant increase in antioxidant and polyphenol activity, compared to the gluten-free control group.
    Teagasc  food researchers are also working hard to create a dairy-based ingredient that can produce the same properties in bread as gluten does. So far researchers have discovered that casein aggregates and forms a protein network which can retain gas in gluten-free dough. The reactions are similar to gluten containing wheat dough, but this is a work in progress and more studies are needed.
    Dr. Gallagher's studies have revealed significant information on ingredients, formulations and technologies used to make gluten-free products, which will help provide edible and healthy alternatives to gluten-free products.
    Source:

    ScienceDaily (May 26, 2010)

    Destiny Stone
    Celiac.com 07/09/2010 - The enteropathy associated with common variable immunodeficiency (CVID) is the most common  symptomatic primary antibody deficient syndrome, with an estimated prevalence of one in one-hundred thousand to one in fifty thousand. However, the relationship between CVID and Enteropathy is still unclear.
    CVID is characterized by decreased levels of of two or more serum immunoglobulin (Ig) isotypes and the presentation of reoccurring infections specifically in the respiratory tract. Gastrointestinal symptoms are widespread with CVID patients as exhibited in as many as 50% of patients presenting with chronic diarrhea.
    A team of doctors evaluated the medical files of 50 CVID patients who exhibited gastrointestinal symptoms to determine the “clinical and hitopathological features of the enteropathy associated with CVID”. Fifteen patients were excluded from the study because they did not meet the recognized criteria for CVID. Data was collected from all patients and included, gender, age, symptoms, body mass index (BMI), as well as parasitological stool testing. Blood samples were taken from each test patient including hemogram, serum protein electrophoresis and measurements of serum folic acid, vitamin B12, iron, and calcium.
    The doctors found the mean age for initial CVID diagnosis to be 36.8 years. Four of the patients were discovered to have a family history of immunodeficiency. 40% of the patients that were tested were determined to have immunodeficiency as revealed by their digestive symptoms. Chronic diarrhea was observed as the most common gastrointestinal symptom with a rate of 92% of the patients studied.
    Gluten-free diet was initiated by 12 patients with villous atrophy, but clinical improvements and partial villous healing only occurred in two patients. Interestingly,  the two patients presenting with celiac antibodies,  did not show an improvement of symptoms. All patients showed positive improvements from steroid therapy. Furthermore, as a result of this study, the observing doctors concluded, that of the  CVID patients exhibiting gastrointestinal symptoms, histological lesions were found in around 80% of the biopsies taken from the colon, stomach, or small bowel.
    The enteropathy corresponding with CVID was found to have has many features that differentiate it from other etiopathological conditions including celiac disease. While replacement Ig therapy was demonstrated to be inadequate for improving gastrointestinal symptoms, steroids, specifically budesonide,were proven successful in reducing inflammation and restoring mucosal architecture.
    Source:

    The American Journal of Gastroenterology , (15June2010) | doi:10.1038/ajg.2010.214

    Jefferson Adams
    Celiac.com 09/20/2010 - People with celiac disease face increased risk of cancer and a large amount of circumstantial evidence suggests that oxidatively damaged DNA may be used to help predict future cancer development in celiac patients.
    To evaluate that hypothesis, a research team set out to assess and describe oxidative stress and oxidative DNA damage in celiac disease patients.
    Anna Szaflarska-PopÅ‚awska, Agnieszka Siomek, MieczysÅ‚awa Czerwionka-Szaflarska, Daniel Gackowski, RafaÅ‚ Różalski, Jolanta Guz, Anna Szpila, Ewelina Zarakowska and Ryszard OliÅ„ski comprised the research team. They are associated with the college of medicine at Nicolaus Copernicus University, in Bydgoszcz, Poland.
    They found that children with celiac disease have higher than normal levels of the oxidative DNA damage biomarkers urinary 8-oxodG and 8-oxoGua, regardless of following a gluten-free diet.
    To measure urinary excretion of 8-oxodG and 8-oxoGua, and levels of oxidative DNA damage in the leukocytes, as well as the level of antioxidant vitamins, the team used high-performance liquid chromatography (HPLC) and HPLC/gas chromatography with isotope dilution mass detection.
    They observed parameters for DNA damage in a group of children with untreated celiac disease, in a group of children with celiac disease following a strict gluten-free diet, and in a control group of healthy children.
    They found that the two groups of celiacs showed significantly higher overall levels of 8-oxodG in DNA isolated from the leukocytes and from the urine samples than did the control subjects, without regard to diet. There was no significant difference  between treated and untreated celiacs. That means being on a gluten-free diet offered no protection from oxidative DNA damage for all children with celiac disease.
    One key difference was that the untreated celiac children showed significantly lower levels of retinol and α-tocopherol, vitamin A and E, compared to the treated celiac children. Between group difference of 0.31 and 3.76 µmol/l, respectively, suggests that a gluten-free diet offers some protection against oxidative damage in treated celiacs.
    From the results indicate that oxidative stress and/or oxidatively damaged DNA in celiac patients cannot be explained by diet alone, and that factors independent of diet play an important role.
    Supplemental vitamin A and E in celiac disease patients may help minimize the risk of cancer development.
    Source:

    Cancer Epidemiol Biomarkers Prev 2010; 19: 1960–1965

    Jefferson Adams
    Celiac.com 12/15/2011 - Until now, studies have only shown a connection between celiac disease and functional gastrointestinal disorders in adults. No solid information exists regarding children.
    Due to the fact that gluten-induced gut inflammation is reversible by dietary manipulation, celiac disease may offer a useful model for examining the role of inflammatory triggers in various functional gastrointestinal disorders.
    Gut inflammation is a well-known cause of functional and structural changes in the central nervous system. Researchers suspect that the culprit is an abnormal afferent input from the gut. Psychological factors may play a role in triggering overt symptoms.
    A research team recently set out to examine connections between childhood celiac disease and functional gastrointestinal disorder in children meeting Rome III criteria. The team included R. Turco, G. Boccia, E. Miele; E. Giannetti, R. Buonavolontà, P. Quitadamo, R. Auricchio, and A. Staiano.
    Their goal was to assess the prevalence of functional gastrointestinal disorders at one year, along with the role of psychological aspects on the development of functional gastrointestinal disorders in celiac disease children.
    For the study, the team enrolled a group of 36 boys and 64 girls (Total = 100 children) with celiac disease, and followed them for one year. They also assembled a control group of 56 children, 25 boys and 31 girls.
    The team had all children and/or their parents complete validated questionnaires for GI symptoms, depression, and anxiety.  The team then compared GI symptoms at diagnosis and after 1 year of gluten-free diet.
    The team was able to follow up on 82 of the patients with celiac disease who followed a gluten-free diet for at least one year. Of those, 23 patients  (28%) met Rome III criteria for functional gastrointestinal disorders compared with 5 of 56 (8.9%) patients from the control group (P = 0.008; χ2 = 6.8; OR: 3.97; 95% CI: 1.40–11.21).
    Most of those children who met Rome III criteria for functional gastrointestinal disorders after one year on a gluten-free diet complained of GI symptoms alone; 21 of 52 children (40.3%) overall.
    Children with celiac disease with FGDIs showed substantially higher levels of anxiety and depression compared to control subjects, and to celiac disease children without functional gastrointestinal disorders (P = 0.02).
    The study shows that children with celiac disease, who follow a gluten-free diet for a year, have much higher rates of functional GI symptoms than do non-celiac control subjects.
    The risk may be due to residual chronic inflammation, and/or to psychological factors, but further study is needed to make that determination.
    Source:

    Alimentary Pharmacology & Therapeutics. 2011;34(7):783-789.

  • Recent Articles

    Jefferson Adams
    Celiac.com 07/21/2018 - These easy-to-make tortilla wraps make a great addition to your lunchtime menu. Simply grab your favorite gluten-free tortillas, a bit of cream cheese, some charred fresh sweet corn, creamy avocado and ripe summer tomato. Add a bit of sliced roast beef and some mayonnaise and hot sauce, and you’re in business. And it's all ready in about half an hour. If you cook the corn the night before, they can be ready in just a few minutes.
    Ingredients:
    12 ounces thinly sliced cooked beef, sliced 6 burrito-sized gluten-free tortillas 1 ripe medium avocado, diced 1 large tomato, diced ½ medium red onion, thinly sliced ¼ cup mayonnaise 2 ears sweet corn, husks and silk removed 1 teaspoon olive oil ¾ cup soft cream cheese spread 1-2 teaspoons gluten-free hot sauce of choice Sprouted pea greens, as desired fresh salsa, as desired Directions:
    Heat grill to medium-hot. 
    Brush corn with olive oil. 
    In a small dish, blend mayonnaise and hot sauce. Adjust mixture, and add fresh salsa, as desired.
    Grill corn for 8 to 12 minutes, turning as it browns and lowering heat as needed until corn is tender and charred in some places. 
    Cool slightly; cut kernels from cobs.
    Spread 2 tablespoons cream cheese on one side of each tortilla to within ½-inch of edge; arrange beef slices to cover.
    Spread beef with mayonnaise hot sauce mixture as desired.
    Place a bit of grilled corn kernels, avocado, tomato and red onion in a 3-inch strip along one edge of each tortilla. 
    Fold ends and roll into a burrito shape, and serve. I like to add sweet, crunchy pea greens for some extra crunch and nutrition.

    Christina Kantzavelos
    Celiac.com 07/20/2018 - During my Vipassana retreat, I wasn’t left with much to eat during breakfast, at least in terms of gluten free options. Even with gluten free bread, the toasters weren’t separated to prevent cross contamination. All of my other options were full of sugar (cereals, fruits), which I try to avoid, especially for breakfast. I had to come up with something that did not have sugar, was tasty, salty, and gave me some form of protein. After about four days of mixing and matching, I was finally able to come up with the strangest concoction, that may not look the prettiest, but sure tastes delicious. Actually, if you squint your eyes just enough, it tastes like buttery popcorn. I now can’t stop eating it as a snack at home, and would like to share it with others who are looking for a yummy nutritious snack. 
    Ingredients:
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    Directions (1.5 Servings):
    Crunch up the rice into small bite size pieces.  Throw a liberal amount of nutritional yeast onto the pieces, until you see more yellow than white.  Add salt to taste. For my POTS brothers and sisters, throw it on (we need an excess amount of salt to maintain a healthy BP).  Add olive oil  Liberally sprinkle sunflower seeds. This is what adds the protein and crunch, so the more, the tastier.  Buen Provecho, y Buen Camino! 

    Jefferson Adams
    Celiac.com 07/19/2018 - Maintaining a gluten-free diet can be an on-going challenge, especially when you factor in all the hidden or obscure gluten that can trip you up. In many cases, foods that are naturally gluten-free end up contain added gluten. Sometimes this can slip by us, and that when the suffering begins. To avoid suffering needlessly, be sure to keep a sharp eye on labels, and beware of added or hidden gluten, even in food labeled gluten-free.  Use Celiac.com's SAFE Gluten-Free Food List and UNSAFE Gluten-free Food List as a guide.
    Also, beware of these common mistakes that can ruin your gluten-free diet. Watch out for:
    Watch out for naturally gluten-free foods like rice and soy, that use gluten-based ingredients in processing. For example, many rice and soy beverages are made using barley enzymes, which can cause immune reactions in people with celiac disease. Be careful of bad advice from food store employees, who may be misinformed themselves. For example, many folks mistakenly believe that wheat-based grains like spelt or kamut are safe for celiacs. Be careful when taking advice. Beware of cross-contamination between food store bins selling raw flours and grains, often via the food scoops. Be careful to avoid wheat-bread crumbs in butter, jams, toaster, counter surface, etc. Watch out for hidden gluten in prescription drugs. Ask your pharmacist for help about anything you’re not sure about, or suspect might contain unwanted gluten. Watch out for hidden gluten in lotions, conditioners, shampoos, deodorants, creams and cosmetics, (primarily for those with dermatitis herpetaformis). Be mindful of stamps, envelopes or other gummed labels, as these can often contain wheat paste. Use a sponge to moisten such surfaces. Be careful about hidden gluten in toothpaste and mouthwash. Be careful about common cereal ingredients, such as malt flavoring, or other non-gluten-free ingredient. Be extra careful when considering packaged mixes and sauces, including soy sauce, fish sauce, catsup, mustard, mayonnaise, etc., as many of these can contain wheat or wheat by-product in their manufacture. Be especially careful about gravy mixes, packets & canned soups. Even some brands of rice paper can contain gluten, so be careful. Lastly, watch out for foods like ice cream and yogurt, which are often gluten-free, but can also often contain added ingredients that can make them unsuitable for anyone on a gluten-free diet. Eating Out? If you eat out, consider that many restaurants use a shared grill or shared cooking oil for regular and gluten-free foods, so be careful. Also, watch for flour in otherwise gluten-free spices, as per above. Ask questions, and stay vigilant.

    Jefferson Adams
    Celiac.com 07/18/2018 - Despite many studies on immune development in children, there still isn’t much good data on how a mother’s diet during pregnancy and infancy influences a child’s immune development.  A team of researchers recently set out to assess whether changes in maternal or infant diet might influence the risk of allergies or autoimmune disease.
    The team included Vanessa Garcia-Larsen, Despo Ierodiakonou, Katharine Jarrold, Sergio Cunha,  Jennifer Chivinge, Zoe Robinson, Natalie Geoghegan, Alisha Ruparelia, Pooja Devani, Marialena Trivella, Jo Leonardi-Bee, and Robert J. Boyle.
    They are variously associated with the Department of Undiagnosed Celiac Disease More Common in Women and Girls International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America; the Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom; the Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom; the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom; the Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom; the Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom; and Stanford University in the USA.
    Team members searched MEDLINE, Excerpta Medica dataBASE (EMBASE), Web of Science, Central Register of Controlled Trials (CENTRAL), and Literatura Latino Americana em Ciências da Saúde (LILACS) for observational studies conducted between January 1946 and July 2013, and interventional studies conducted through December 2017, that evaluated the relationship between diet during pregnancy, lactation, or the first year of life, and future risk of allergic or autoimmune disease. 
    They then selected studies, extracted data, and assessed bias risk. They evaluated data using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). They found 260 original studies, covering 964,143 participants, of milk feeding, including 1 intervention trial of breastfeeding promotion, and 173 original studies, covering 542,672 participants, of other maternal or infant dietary exposures, including 80 trials of 26 maternal, 32 infant, or 22 combined interventions. 
    They found a high bias risk in nearly half of the more than 250 milk feeding studies and in about one-quarter of studies of other dietary exposures. Evidence from 19 intervention trials suggests that oral supplementation with probiotics during late pregnancy and lactation may reduce risk of eczema. 44 cases per 1,000; 95% CI 20–64), and 6 trials, suggest that fish oil supplementation during pregnancy and lactation may reduce risk of allergic sensitization to egg. GRADE certainty of these findings was moderate. 
    The team found less evidence, and low GRADE certainty, for claims that breastfeeding reduces eczema risk during infancy, that longer exclusive breastfeeding is associated with reduced type 1 diabetes mellitus, and that probiotics reduce risk of infants developing allergies to cow’s milk. 
    They found no evidence that dietary exposure to other factors, including prebiotic supplements, maternal allergenic food avoidance, and vitamin, mineral, fruit, and vegetable intake, influence risk of allergic or autoimmune disease. 
    Overall, the team’s findings support a connection between the mother’s diet and risk of immune-mediated diseases in the child. Maternal probiotic and fish oil supplementation may reduce risk of eczema and allergic sensitization to food, respectively.
    Stay tuned for more on diet during pregnancy and its role in celiac disease.
    Source:
    PLoS Med. 2018 Feb; 15(2): e1002507. doi:  10.1371/journal.pmed.1002507

    Jefferson Adams
    Celiac.com 07/17/2018 - What can fat soluble vitamin levels in newly diagnosed children tell us about celiac disease? A team of researchers recently assessed fat soluble vitamin levels in children diagnosed with newly celiac disease to determine whether vitamin levels needed to be assessed routinely in these patients during diagnosis.
    The researchers evaluated the symptoms of celiac patients in a newly diagnosed pediatric group and evaluated their fat soluble vitamin levels and intestinal biopsies, and then compared their vitamin levels with those of a healthy control group.
    The research team included Yavuz Tokgöz, Semiha Terlemez and Aslıhan Karul. They are variously affiliated with the Department of Pediatric Gastroenterology, Hepatology and Nutrition, the Department of Pediatrics, and the Department of Biochemistry at Adnan Menderes University Medical Faculty in Aydın, Turkey.
    The team evaluated 27 female, 25 male celiac patients, and an evenly divided group of 50 healthy control subjects. Patients averaged 9 years, and weighed 16.2 kg. The most common symptom in celiac patients was growth retardation, which was seen in 61.5%, with  abdominal pain next at 51.9%, and diarrhea, seen in 11.5%. Histological examination showed nearly half of the patients at grade Marsh 3B. 
    Vitamin A and vitamin D levels for celiac patients were significantly lower than the control group. Vitamin A and vitamin D deficiencies were significantly more common compared to healthy subjects. Nearly all of the celiac patients showed vitamin D insufficiency, while nearly 62% showed vitamin D deficiency. Nearly 33% of celiac patients showed vitamin A deficiency. 
    The team saw no deficiencies in vitamin E or vitamin K1 among celiac patients. In the healthy control group, vitamin D deficiency was seen in 2 (4%) patients, vitamin D insufficiency was determined in 9 (18%) patients. The team found normal levels of all other vitamins in the healthy group.
    Children with newly diagnosed celiac disease showed significantly reduced levels of vitamin D and A. The team recommends screening of vitamin A and D levels during diagnosis of these patients.
    Source:
    BMC Pediatrics