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    Study Shows Gluten Sensitivity and Celiac Disease Clinically Different


    Jefferson Adams

    Celiac.com 03/30/2011 - A team of medical researchers set out to compare gut permeability and mucosal immune gene expression in celiac disease and gluten sensitivity.


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    The research team included Anna Sapone, Karen M Lammers, Vincenzo Casolaro, Marcella Cammarota, Maria T Giuliano, Mario De Rosa, Rosita Stefanile, Giuseppe Mazzarella, Carlo Tolone, Maria I Russo, Pasquale Esposito, Franca Ferraraccio, Maria Carteni, Gabriele Riegler, Laura de Magistris  and Alessio Fasano.

    People with celiac disease suffer an adverse autoimmune reaction when they consume gluten. People with gluten-sensitivity cannot tolerate gluten and may develop gastrointestinal symptoms similar to those in celiac disease.

    However, for people with gluten intolerance, the overall clinical picture is usually less severe, and is not accompanied by the concurrence of tissue transglutaminase autoantibodies or autoimmune comorbidities.

    By examining and comparing mucosal expression of genes associated with intestinal barrier function, along with innate and adaptive immunity the team sought to better understand the similarities and differences between celiac disease and gluten sensitivity.

    For their study, the team enrolled a group of subjects with celiac disease, a group with gluten sensitivity, and a control group of healthy, gluten-tolerant individuals.

    They assessed intestinal permeability using a lactulose and mannitol probe, and collected mucosal biopsy specimens to study the expression of genes involved in barrier function and immunity.

    They found that gluten sensitivity, unlike celiac disease, is not associated with increased intestinal permeability.

    In fact, subjects with gluten sensitivity showed significantly reduced intestinal permeability compared with controls (P = 0.0308). This was accompanied with significantly increased expression of claudin (CLDN) 4 (P = 0.0286).

    Relative to controls, subjects with celiac disease expressed higher levels of adaptive immunity markers interleukin (IL)-6 (P = 0.0124) and IL-21 (P = 0.0572), while those with gluten sensitivity showed no higher levels.

    Subjects with gluten intolerance showed increased expression of the innate immunity marker Toll-like receptor (TLR) 2, but subjects with celiac disease showed no such increase (P = 0.0295).

    Finally, subjects with gluten intolerance showed significantly reduced expression of the T-regulatory cell marker FOXP3 relative to controls (P = 0.0325) and celiac subjects (P = 0.0293).

    This study supports the existence of gluten sensitivity and celiac disease as two clinically different gluten-associated disorders.

    The study also supports the characterization of gluten sensitivity as a condition associated with prevalent gluten-induced activation of innate, rather than adaptive, immune responses in the absence of detectable changes in mucosal barrier function.

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    Guest Jay K.

    Posted

    Interesting study that proves that there truly is a difference between gluten sensitivity and celiac disease.

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    Guest Susan Lederer

    Posted

    Not enough details but a worthwhile study.

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    Guest Ellen

    Posted

    Interesting study that proves that there truly is a difference between gluten sensitivity and celiac disease.

    My take away is that both gluten sensitivity and gluten intolerance are mediated by the immune system--just different expressions of the same problem, an immune response to gluten. Are they mediated by the same genetic basis?

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    Guest Sarah

    Posted

    I do hope this stops those from gluten sensitivity from calling themselves celiacs. As a celiac, it's rather frustrating. These are seemingly 2 different conditions, and there is no benefit to either group by gluten intolerant people considering themselves celiac. You are not celiac. As a celiac, a crumb of gluten will destroy my intestines. This does not happen in gluten intolerance. Now hopefully we can find a way to prevent and cure these conditions (the gluten-free diet is not a cure, it is a treatment, just as insulin does not cure diabetes or nor does an epi pen cure allergies).

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    Guest Clarkie

    Posted

    This article left me wondering whether this means that people who test positive for antibodies to tissue transglutaminase (is that the common blood test for celiac?) have celiac versus a sensitivity. I got the gene test and an antibody test. The gene test showed that I have a pair of genes more commonly associated with gluten sensitivity but my antibody reaction was significant. I've always wondered whether I have celiac or just sensitivity. I suspect that I've got a very permeable gut too as I'm allergic to everything, not just gluten. The permeability could be due to something else though--candida for instance (which is also one of my challenges). Thanks for all the great info. Your articles give me hope for myself and especially for my six year old boy who also has it.

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    Guest Ann C.

    Posted

    While I agree somewhat overall with the team's finding, I also have some major issues with this report:

     

    I have gluten intolerance, and I also have tissue transglutaminase autoantibodies or autoimmune comorbidities. That is, I have low threshold markers of all of the same lab markers that are noted for Celiac disease, just that none of mine put me over the edge of having Celiac disease. The biopsy I had done also showed no Celiac disease, and I had the genetics test taken that showed no propensity for having the Celiac markers. But stating that those with gluten intolerance do not have any of the same lab markers that those with Celiacs do is simply false, as I and my blood work can attest to.

     

    “They found that gluten sensitivity, unlike celiac disease, is not associated with increased intestinal permeability.†This is ONLY true if the only issue you have wrong with your body is gluten intolerance. I also had soy intolerance and a casein allergy when my gluten intolerance was diagnosed, along with a multitude of other intolerances to different foods. I ALSO had severe malabsorption and Leaky Gut, meaning that I had (maybe still have?) very increased intestinal permeability.

     

    Our local gluten intolerance/Celiac group had a researcher from the Celiac research department at the Univ of Chicago come and speak to our group. When I talked to her and mentioned the fact that along with my gluten intolerance not only did I have soy intolerance and casein allergy, but I also had a wide variety of other food intolerances, this researcher then went on to tell me that she does not believe it is possible for a person to have multiple food intolerances and/or allergies to different areas that are not connected or are so very different from each other. And all I could think of was—huh? I and my family are living with multiple food intolerances (we all have gluten intolerance) and all this researcher can say is that she doesn't believe in it? She's not interested in researching to discover WHY our bodies react differently than that of a Celiacs?

     

    Both gluten intolerance and Celiac disease are, at the moment, able to be tolerated with a gluten free diet. As someone else mentioned, it isn't a cure but rather a treatment. Until the real cause of both Celiac and Gluten Intolerance is found, a gluten free diet is the only way to manage symptoms and to prevent more from occurring. I am glad that, finally, scientists/the medical community have discovered that Celiac disease and Gluten Intolerance are two totally different dis-eases with different pathologies. Maybe now we'll finally get someone who is interested in helping those of use with gluten intolerance as well. Although I tend to doubt it, because while ours makes us sick (with a lot of the same issues and problems as Celiac disease), ours doesn't compromise our autoimmune system/give us autoimmune disorders and therefore, we aren't candidates for “drugs.†Well, at least at the moment. Maybe they'll discover after all that they can find a drug to help “cure†us. I suspect, though, that the only cure will be to get rid of wheat/rye/barley from the diet, quit playing around with the germoplasma, and quit playing God with GMOs, chemicals, pesticides, and anything else manmade and not natural. It will be interesting to see what comes about from this study.

     

    Oh! Two things I wanted to mention. 1) While many Celiacs discover they have lactose intolerance, I have been finding out that many people I know who have Gluten Intolerance have either a casein or a whey allergy, along with numerous intolerances to other foods. 2) I also tested positive for severe heavy metal toxicity when I discovered I had gluten intolerance (mine is to the gliadin protein, not the gluten). My question was: why was it so extremely high? I read about the P450 cytochrome--specifically the CYP2C9 gene—and how if you have mutations in this specific cytochrome/gene, your body can't detoxify and metabolize correctly. I was tested, and I have no active alleles and three mutations—meaning my body is unable to detoxify and metabolize at all without help (which I give it with organic food and various supplements, both to support my health/body and to help it detoxify). Once I told my Naturopathic doctor about this specific genetic liver mutation, he told me he'd had 3 more patients after me who had the same liver mutation AND also had gluten/gliadin intolerance.

     

    Perhaps a researcher should look more closely into that.

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    Guest Kristin

    Posted

    Great article. It affirms that gluten sensitivity is a real issue. So often I get "oh so your celiac"...well not I'm not, but....This also is more evidence to the doctors (like my first doctor) that it there is validity to what my body is doing!

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    Guest Tonya

    Posted

    What about people who test positive for gluten sensitivity but also have a positive test for and autoimmune reaction to gluten but do not have celiac? Are they celiac, gluten sensitive or something else entirely?

     

    Also, in response to Sarah, what does it matter to you what they call themselves? A crumb of gluten may not be destroying my intestines, but that small crumb gives me all kinds of other symptoms, pain, ataxia, dizziness, vomiting, bloating, and anxiety for an entire week not to mention the gastrointestinal symptoms that occur within twenty minutes of exposure.

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    Guest Lisa

    Posted

    What about people who test positive for gluten sensitivity but also have a positive test for and autoimmune reaction to gluten but do not have celiac? Are they celiac, gluten sensitive or something else entirely?

     

    Also, in response to Sarah, what does it matter to you what they call themselves? A crumb of gluten may not be destroying my intestines, but that small crumb gives me all kinds of other symptoms, pain, ataxia, dizziness, vomiting, bloating, and anxiety for an entire week not to mention the gastrointestinal symptoms that occur within twenty minutes of exposure.

    Exactly, I have the same problems. Although I had gone on a gluten-free diet per my doctor when I was diagnosed as gluten intolerant, and have been so for 2 years now. I do not know if I am celiac or not, and am unwilling to eat gluten again. All I know is that I cannot tolerate even a crumb of gluten or food with gluten containing substance in it at all.

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    Guest Cheryl Keeney

    Posted

    I had both my daughter and I tested for celiac and was told we didn't have it. I had osteoporosis at age 32, IBS, thyroid nodules, autoimmune skin disease and arthritis, and my daughter was born with a Learning Disorder..we've both been dx'd with low vitamin D. I cannot tolerate soy I just found out and I have to take multiple vitamins to treat my symptoms. I am very short, have very short fingers and toes compared to everyone else. I just feel that they are missing something in the diagnosis of gluten disorders. I am way too sick to say there is no damage. And I could not work nor could I get disability since the doctors said nothing is wrong with me.

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    Guest Gerard

    Posted

    I do hope this stops those from gluten sensitivity from calling themselves celiacs. As a celiac, it's rather frustrating. These are seemingly 2 different conditions, and there is no benefit to either group by gluten intolerant people considering themselves celiac. You are not celiac. As a celiac, a crumb of gluten will destroy my intestines. This does not happen in gluten intolerance. Now hopefully we can find a way to prevent and cure these conditions (the gluten-free diet is not a cure, it is a treatment, just as insulin does not cure diabetes or nor does an epi pen cure allergies).

    A rather strange take from someone who has a condition similar to my own yet implies that NCGS is not worth comment, Being frustrated at this would seem to imply a particular mindset that is not helpful.

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    Guest Melinda

    Posted

    I do hope this stops those from gluten sensitivity from calling themselves celiacs. As a celiac, it's rather frustrating. These are seemingly 2 different conditions, and there is no benefit to either group by gluten intolerant people considering themselves celiac. You are not celiac. As a celiac, a crumb of gluten will destroy my intestines. This does not happen in gluten intolerance. Now hopefully we can find a way to prevent and cure these conditions (the gluten-free diet is not a cure, it is a treatment, just as insulin does not cure diabetes or nor does an epi pen cure allergies).

    I understand. My son has severe milk allergies and people are constantly calling him lactose intolerant. I'm like, 'No, he is allergic. He can die from it."

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    Guest Jim Ford

    Posted

    I do hope this stops those from gluten sensitivity from calling themselves celiacs. As a celiac, it's rather frustrating. These are seemingly 2 different conditions, and there is no benefit to either group by gluten intolerant people considering themselves celiac. You are not celiac. As a celiac, a crumb of gluten will destroy my intestines. This does not happen in gluten intolerance. Now hopefully we can find a way to prevent and cure these conditions (the gluten-free diet is not a cure, it is a treatment, just as insulin does not cure diabetes or nor does an epi pen cure allergies).

    My son tests negative for celiac disease but develops extreme psychosis from gluten (has very high anti-gliadin antibodies). In celiac disease gluten causes the immune system to attack the lining of the gut. GS can affect many organ systems, especially the nervous system and is linked to ataxia, epilepsy, schizophrenia, ADHD, autism and very likely MS. These can be just as severe and in some cases as deadly as celiac disease.

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    Guest RDon

    Posted

    Would be interesting to see how many people have heart problems with their gluten sensitivity? I have arrhythmia within half an hour of having small quantities of gluten. Large quantities, as well as rice, send me into tachycardia...along with all the other gut issues etc.

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    Guest Heidi

    Posted

    While I agree somewhat overall with the team's finding, I also have some major issues with this report:

     

    I have gluten intolerance, and I also have tissue transglutaminase autoantibodies or autoimmune comorbidities. That is, I have low threshold markers of all of the same lab markers that are noted for Celiac disease, just that none of mine put me over the edge of having Celiac disease. The biopsy I had done also showed no Celiac disease, and I had the genetics test taken that showed no propensity for having the Celiac markers. But stating that those with gluten intolerance do not have any of the same lab markers that those with Celiacs do is simply false, as I and my blood work can attest to.

     

    “They found that gluten sensitivity, unlike celiac disease, is not associated with increased intestinal permeability.†This is ONLY true if the only issue you have wrong with your body is gluten intolerance. I also had soy intolerance and a casein allergy when my gluten intolerance was diagnosed, along with a multitude of other intolerances to different foods. I ALSO had severe malabsorption and Leaky Gut, meaning that I had (maybe still have?) very increased intestinal permeability.

     

    Our local gluten intolerance/Celiac group had a researcher from the Celiac research department at the Univ of Chicago come and speak to our group. When I talked to her and mentioned the fact that along with my gluten intolerance not only did I have soy intolerance and casein allergy, but I also had a wide variety of other food intolerances, this researcher then went on to tell me that she does not believe it is possible for a person to have multiple food intolerances and/or allergies to different areas that are not connected or are so very different from each other. And all I could think of was—huh? I and my family are living with multiple food intolerances (we all have gluten intolerance) and all this researcher can say is that she doesn't believe in it? She's not interested in researching to discover WHY our bodies react differently than that of a Celiacs?

     

    Both gluten intolerance and Celiac disease are, at the moment, able to be tolerated with a gluten free diet. As someone else mentioned, it isn't a cure but rather a treatment. Until the real cause of both Celiac and Gluten Intolerance is found, a gluten free diet is the only way to manage symptoms and to prevent more from occurring. I am glad that, finally, scientists/the medical community have discovered that Celiac disease and Gluten Intolerance are two totally different dis-eases with different pathologies. Maybe now we'll finally get someone who is interested in helping those of use with gluten intolerance as well. Although I tend to doubt it, because while ours makes us sick (with a lot of the same issues and problems as Celiac disease), ours doesn't compromise our autoimmune system/give us autoimmune disorders and therefore, we aren't candidates for “drugs.†Well, at least at the moment. Maybe they'll discover after all that they can find a drug to help “cure†us. I suspect, though, that the only cure will be to get rid of wheat/rye/barley from the diet, quit playing around with the germoplasma, and quit playing God with GMOs, chemicals, pesticides, and anything else manmade and not natural. It will be interesting to see what comes about from this study.

     

    Oh! Two things I wanted to mention. 1) While many Celiacs discover they have lactose intolerance, I have been finding out that many people I know who have Gluten Intolerance have either a casein or a whey allergy, along with numerous intolerances to other foods. 2) I also tested positive for severe heavy metal toxicity when I discovered I had gluten intolerance (mine is to the gliadin protein, not the gluten). My question was: why was it so extremely high? I read about the P450 cytochrome--specifically the CYP2C9 gene—and how if you have mutations in this specific cytochrome/gene, your body can't detoxify and metabolize correctly. I was tested, and I have no active alleles and three mutations—meaning my body is unable to detoxify and metabolize at all without help (which I give it with organic food and various supplements, both to support my health/body and to help it detoxify). Once I told my Naturopathic doctor about this specific genetic liver mutation, he told me he'd had 3 more patients after me who had the same liver mutation AND also had gluten/gliadin intolerance.

     

    Perhaps a researcher should look more closely into that.

    I would really like to hear more of what you have to say. I am just beginning all of this and you seem to have a lot of knowledge.

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    I suspect that I am celiac. I am short, skinny, and recently have been suffering from strange bowl movements like steatorrhea, constipation and diarrhea, as well as nausea. I want to do a biopsy but I am somewhat lazy and pessimistic about the test. I eat a lot but I can't gain any weight. I guess that my villi can't absorb the nutrients. I ask God to help me find my disease so that I start my gluten free diet. I can't try a gluten few diet because my mom always cooks wheat food and she gets really angry when I don't eat.

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    Guest Janet Brewer

    Posted

    I do hope this stops those from gluten sensitivity from calling themselves celiacs. As a celiac, it's rather frustrating. These are seemingly 2 different conditions, and there is no benefit to either group by gluten intolerant people considering themselves celiac. You are not celiac. As a celiac, a crumb of gluten will destroy my intestines. This does not happen in gluten intolerance. Now hopefully we can find a way to prevent and cure these conditions (the gluten-free diet is not a cure, it is a treatment, just as insulin does not cure diabetes or nor does an epi pen cure allergies).

    WHOA Girl, you seem very angry Sarah, you sound pretty worked up over someone with gluten intolerance saying they have celiac disease. Too many other things in life a lot worse than that! Settle down!

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    Guest EPowell

    Posted

    Because the diagnosis for celiac is a biopsy and some of us never get a biopsy- and we are gluten intolerant- how do we know if we are celiacs or not? I tested negative for the antigen test and therefore could not be given a biopsy- but I have the DNA markers for celiac and have elected to go gluten-free and get sick if I accidentally eat anything containing gluten. I would be labelled "Gluten Intolerant," but now that I am on a gluten-free diet and not willing to go back to gluten- how would I know I am not a celiac- a latent celiac or a silent celiac?? Is it possible that there is a range of symptoms for anyone who cannot tolerate gluten in their diet? Maybe at one end they get the "Celiac" label and at the other they get "Gluten Intolerant" label for the same problem? Certainly, I need better information and the doctors need to have better information. There needs to be more studies.

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    Jefferson Adams
    Celiac.com 10/26/2010 - A recent study shows that, since 1974, the rate of celiac disease has doubled every fifteen years, and that celiac rates increase as people grow older, with many developing the disease in their 50s or 60s.
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    SOURCE:
    Annals of Medicine: October 2010, Vol. 42, No. 7 , Pages 530-538
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    Jefferson Adams
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    Source:

    American Journal of Gastroenterology: 11 January 2011. doi: 10.1038/ajg.2010.487

    Jefferson Adams
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    Jefferson Adams
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    They found IgA AGA in 7.7% of patients with gluten-sensitivity, and in 75% of patients with celiac disease, which shows lower enzyme-linked immunosorbent assay activities in gluten-sensitivity patients than in patients with celiac disease.
    Only 1 of the 78 patients with gluten-sensitivity tested positive for IgG DGP-AGA, which was found in nearly 90% of patients with celiac disease.
    All patients with gluten-sensitivity tested negative for IgA tTGA and IgA EmA, while 98.7% of patients with celiac disease tested positive for IgA tTGA, and 95% were positive for IgA EmA.
    Patients with gluten-sensitivity presented a variety of intestinal and extra-intestinal symptoms, including abdominal pain, bloating, diarrhea, constipation, foggy mind, tiredness, eczema/skin rash, headache, joint/muscle pain, numbness of legs/arms, depression, and anemia. Small intestinal mucosa for these patients was either normal or only mildly abnormal.
    The data from these blood tests show that more than half of patients with gluten sensitivity will test positive for IgG AGA, and a small number will test positive for IgA AGA, but none will show positive results for EmA, tTGA, and DGP-AGA, which are the specific markers of celiac disease.
    Source:
    J Clin Gastroenterol. 2012 Sep;46(8):680-5.

  • Recent Articles

    Jefferson Adams
    Celiac.com 06/19/2018 - Could baking soda help reduce the inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease? Scientists at the Medical College of Georgia at Augusta University say that a daily dose of baking soda may in fact help reduce inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease.
    Those scientists recently gathered some of the first evidence to show that cheap, over-the-counter antacids can prompt the spleen to promote an anti-inflammatory environment that could be helpful in combating inflammatory disease.
    A type of cell called mesothelial cells line our body cavities, like the digestive tract. They have little fingers, called microvilli, that sense the environment, and warn the organs they cover that there is an invader and an immune response is needed.
    The team’s data shows that when rats or healthy people drink a solution of baking soda, the stomach makes more acid, which causes mesothelial cells on the outside of the spleen to tell the spleen to go easy on the immune response.  "It's most likely a hamburger not a bacterial infection," is basically the message, says Dr. Paul O'Connor, renal physiologist in the MCG Department of Physiology at Augusta University and the study's corresponding author.
    That message, which is transmitted with help from a chemical messenger called acetylcholine, seems to encourage the gut to shift against inflammation, say the scientists.
    In patients who drank water with baking soda for two weeks, immune cells called macrophages, shifted from primarily those that promote inflammation, called M1, to those that reduce it, called M2. "The shift from inflammatory to an anti-inflammatory profile is happening everywhere," O'Connor says. "We saw it in the kidneys, we saw it in the spleen, now we see it in the peripheral blood."
    O'Connor hopes drinking baking soda can one day produce similar results for people with autoimmune disease. "You are not really turning anything off or on, you are just pushing it toward one side by giving an anti-inflammatory stimulus," he says, in this case, away from harmful inflammation. "It's potentially a really safe way to treat inflammatory disease."
    The research was funded by the National Institutes of Health.
    Read more at: Sciencedaily.com

    Jefferson Adams
    Celiac.com 06/18/2018 - Celiac disease has been mainly associated with Caucasian populations in Northern Europe, and their descendants in other countries, but new scientific evidence is beginning to challenge that view. Still, the exact global prevalence of celiac disease remains unknown.  To get better data on that issue, a team of researchers recently conducted a comprehensive review and meta-analysis to get a reasonably accurate estimate the global prevalence of celiac disease. 
    The research team included P Singh, A Arora, TA Strand, DA Leffler, C Catassi, PH Green, CP Kelly, V Ahuja, and GK Makharia. They are variously affiliated with the Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Lady Hardinge Medical College, New Delhi, India; Innlandet Hospital Trust, Lillehammer, Norway; Centre for International Health, University of Bergen, Bergen, Norway; Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Gastroenterology Research and Development, Takeda Pharmaceuticals Inc, Cambridge, MA; Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; Department of Medicine, Columbia University Medical Center, New York, New York; USA Celiac Disease Center, Columbia University Medical Center, New York, New York; and the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
    For their review, the team searched Medline, PubMed, and EMBASE for the keywords ‘celiac disease,’ ‘celiac,’ ‘tissue transglutaminase antibody,’ ‘anti-endomysium antibody,’ ‘endomysial antibody,’ and ‘prevalence’ for studies published from January 1991 through March 2016. 
    The team cross-referenced each article with the words ‘Asia,’ ‘Europe,’ ‘Africa,’ ‘South America,’ ‘North America,’ and ‘Australia.’ They defined celiac diagnosis based on European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines. The team used 96 articles of 3,843 articles in their final analysis.
    Overall global prevalence of celiac disease was 1.4% in 275,818 individuals, based on positive blood tests for anti-tissue transglutaminase and/or anti-endomysial antibodies. The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% in 138,792 individuals. That means that numerous people with celiac disease potentially remain undiagnosed.
    Rates of celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was 0.6% in female vs 0.4% males. Celiac disease was significantly more common in children than adults.
    This systematic review and meta-analysis showed celiac disease to be reported worldwide. Blood test data shows celiac disease rate of 1.4%, while biopsy data shows 0.7%. The prevalence of celiac disease varies with sex, age, and location. 
    This review demonstrates a need for more comprehensive population-based studies of celiac disease in numerous countries.  The 1.4% rate indicates that there are 91.2 million people worldwide with celiac disease, and 3.9 million are in the U.S.A.
    Source:
    Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037.

    Jefferson Adams
    Celiac.com 06/16/2018 - Summer is the time for chips and salsa. This fresh salsa recipe relies on cabbage, yes, cabbage, as a secret ingredient. The cabbage brings a delicious flavor and helps the salsa hold together nicely for scooping with your favorite chips. The result is a fresh, tasty salsa that goes great with guacamole.
    Ingredients:
    3 cups ripe fresh tomatoes, diced 1 cup shredded green cabbage ½ cup diced yellow onion ¼ cup chopped fresh cilantro 1 jalapeno, seeded 1 Serrano pepper, seeded 2 tablespoons lemon juice 2 tablespoons red wine vinegar 2 garlic cloves, minced salt to taste black pepper, to taste Directions:
    Purée all ingredients together in a blender.
    Cover and refrigerate for at least 1 hour. 
    Adjust seasoning with salt and pepper, as desired. 
    Serve is a bowl with tortilla chips and guacamole.

    Dr. Ron Hoggan, Ed.D.
    Celiac.com 06/15/2018 - There seems to be widespread agreement in the published medical research reports that stuttering is driven by abnormalities in the brain. Sometimes these are the result of brain injuries resulting from a stroke. Other types of brain injuries can also result in stuttering. Patients with Parkinson’s disease who were treated with stimulation of the subthalamic nucleus, an area of the brain that regulates some motor functions, experienced a return or worsening of stuttering that improved when the stimulation was turned off (1). Similarly, stroke has also been reported in association with acquired stuttering (2). While there are some reports of psychological mechanisms underlying stuttering, a majority of reports seem to favor altered brain morphology and/or function as the root of stuttering (3). Reports of structural differences between the brain hemispheres that are absent in those who do not stutter are also common (4). About 5% of children stutter, beginning sometime around age 3, during the phase of speech acquisition. However, about 75% of these cases resolve without intervention, before reaching their teens (5). Some cases of aphasia, a loss of speech production or understanding, have been reported in association with damage or changes to one or more of the language centers of the brain (6). Stuttering may sometimes arise from changes or damage to these same language centers (7). Thus, many stutterers have abnormalities in the same regions of the brain similar to those seen in aphasia.
    So how, you may ask, is all this related to gluten? As a starting point, one report from the medical literature identifies a patient who developed aphasia after admission for severe diarrhea. By the time celiac disease was diagnosed, he had completely lost his faculty of speech. However, his speech and normal bowel function gradually returned after beginning a gluten free diet (8). This finding was so controversial at the time of publication (1988) that the authors chose to remain anonymous. Nonetheless, it is a valuable clue that suggests gluten as a factor in compromised speech production. At about the same time (late 1980’s) reports of connections between untreated celiac disease and seizures/epilepsy were emerging in the medical literature (9).
    With the advent of the Internet a whole new field of anecdotal information was emerging, connecting a variety of neurological symptoms to celiac disease. While many medical practitioners and researchers were casting aspersions on these assertions, a select few chose to explore such claims using scientific research designs and methods. While connections between stuttering and gluten consumption seem to have been overlooked by the medical research community, there is a rich literature on the Internet that cries out for more structured investigation of this connection. Conversely, perhaps a publication bias of the peer review process excludes work that explores this connection.
    Whatever the reason that stuttering has not been reported in the medical literature in association with gluten ingestion, a number of personal disclosures and comments suggesting a connection between gluten and stuttering can be found on the Internet. Abid Hussain, in an article about food allergy and stuttering said: “The most common food allergy prevalent in stutterers is that of gluten which has been found to aggravate the stutter” (10). Similarly, Craig Forsythe posted an article that includes five cases of self-reporting individuals who believe that their stuttering is or was connected to gluten, one of whom also experiences stuttering from foods containing yeast (11). The same site contains one report of a stutterer who has had no relief despite following a gluten free diet for 20 years (11). Another stutterer, Jay88, reports the complete disappearance of her/his stammer on a gluten free diet (12). Doubtless there are many more such anecdotes to be found on the Internet* but we have to question them, exercising more skepticism than we might when reading similar claims in a peer reviewed scientific or medical journal.
    There are many reports in such journals connecting brain and neurological ailments with gluten, so it is not much of a stretch, on that basis alone, to suspect that stuttering may be a symptom of the gluten syndrome. Rodney Ford has even characterized celiac disease as an ailment that may begin through gluten-induced neurological damage (13) and Marios Hadjivassiliou and his group of neurologists and neurological investigators have devoted considerable time and effort to research that reveals gluten as an important factor in a majority of neurological diseases of unknown origin (14) which, as I have pointed out previously, includes most neurological ailments.
    My own experience with stuttering is limited. I stuttered as a child when I became nervous, upset, or self-conscious. Although I have been gluten free for many years, I haven’t noticed any impact on my inclination to stutter when upset. I don’t know if they are related, but I have also had challenges with speaking when distressed and I have noticed a substantial improvement in this area since removing gluten from my diet. Nonetheless, I have long wondered if there is a connection between gluten consumption and stuttering. Having done the research for this article, I would now encourage stutterers to try a gluten free diet for six months to see if it will reduce or eliminate their stutter. Meanwhile, I hope that some investigator out there will research this matter, publish her findings, and start the ball rolling toward getting some definitive answers to this question.
    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
    Celiac.com 06/14/2018 - Refractory celiac disease type II (RCDII) is a rare complication of celiac disease that has high death rates. To diagnose RCDII, doctors identify a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs). 
    However, researchers really don’t have much data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023