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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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    CELIAC DISEASE GENETICS


    Dr. Scot Lewey

    This article appeared in the Spring 2008 edition of Celiac.com's Scott-Free Newsletter.


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    Celiac.com 08/17/2008 - Are you confused about genetic testing for celiac disease? Do you want to know what tests you should request and which laboratory to use?  Have you already had celiac DQ genetic testing but are not sure what the results mean or what your risk is of developing celiac disease or gluten sensitivity? These are the questions I will answer in the next few pages. 

    What is HLA DQ celiac genetic testing?
    To understand celiac DQ genetics and the risk estimates you must also understand how the DQ types are determined and some basic terminology.  Each of us has 46 chromosomes, 23 pairs received from our parents.  We all have two copies of chromosome 6, one from each parent.  Homozygous is when a person has two copies of the same gene, one from each parent.  Our white blood cells (leukocytes) have proteins called human leukocyte antigens or HLA proteins that are inherited from our parents.  The genetic code that determines our HLA patterns resides on chromosome 6.  We all have two DQ patterns, one from each of parents, such that we are all DQx/DQx, where x is a number between 1 and 9.  I am DQ2/DQ7 and my wife is DQ2/DQ5.  We are both therefore heterozygous for DQ2.  That is, we have only one copy of DQ2.  Scott Adams, the founder of celiac.com is DQ8/DQ8.  He is homozygous for DQ8.  There are several HLA patterns.  Some are proteins that reside within cells and others are on the outer surface of cells, and are called class II.  The class II HLA proteins have very important immune functions.  There are several class II HLA protein types but DQ have been found to be important in celiac disease, specifically DQ2 and DQ8. 

    What does it mean to be homozygous or heterozygous for celiac genes?
    Homozygous means that you have two copies e.g.  DQ2/DQ2, DQ8/DQ8 whereas heterozygous means you have one copy of DQ2 or DQ8.  Some people have one copy of DQ2 and one of DQ8 (DQ2/DQ8) and they have a greater risk for celiac disease than someone with only one copy of either DQ2 or DQ8 but not as great a risk as someone with two copies of DQ2 (DQ2/DQ2).  Since DQ2 is associated with a greater risk of celiac disease than DQ8, then one copy of DQ2 plus a DQ8 (DQ2/DQ8) indicates a higher risk than having two copies of DQ8 (DQ8/DQ8).  Hopefully, I have not lost you yet but if I have please continue to read on because the information that follows will still be helpful to you.

    What is this alpha and beta subunit typing and why is it important?
    HLA DQ typing consists of two subunits of the DQ molecule, an alpha and beta subunit.  So, both DQ types that indicate a risk of celiac disease, DQ2 and DQ8, are made up of two protein subunits designated alpha and beta.  They determine the complex letter and number combinations reported.  For example, the full DQ2 molecule is typically HLA DQA1*05xx DQB1*02xx.  The A1 is the alpha unit and the B1 is the beta subunit. 

    The beta subunit is the most important component of the DQ molecule, but the alpha subunit has also been shown to carry an increased risk for celiac disease.  Unfortunately, since testing for both is more complicated and expensive it is not always done. 

    Also, some think that since the beta subunit carries most of the risk and the alpha unit only minor risk, testing for only the beta subunit is adequate.  Several clinical laboratories have chosen this approach.  They only test for, and report on, DQ2 and DQ8 based on beta subunit types, so their results typically look like this: HLA DQB1*02 detected, DQ2 positive, etc.  This is the policy of the laboratory at Bonfils, who also does testing for Quest Diagnostics and Enterolab as well as many hospitals.  However, the alpha subunit of DQ2 also carries some risk for celiac disease. 

    What if you are positive for the beta subunit of DQ2 or DQ8 by testing from Bonfils, Enterolab or Quest?
    If the beta subunit is present then Bonfils, Enterolab and Quest tests will report DQ2 and/or DQ8 positive.  Sometimes the report will just report DQ2 negative and DQ8 negative, especially when a hospital is reporting the results obtained from Bonfils.  However, when the beta subunit is not present and they report DQ2 negative and/or DQ8 negative, it is still possible that an alpha subunit could be present.  Results reported in this manner are, in my opinion, potentially misleading.  I believe they can lead a doctor to assume that an individual is not at increased risk for, or cannot have celiac disease, when this may or may not be true.  Unfortunately, the patient in such circumstances may be told that they can not have celiac disease, yet they may not only be at risk for the disease, they may well have it while being told it is impossible or extremely improbable. 

    What does Prometheus do and how do they report their results?
    Prometheus, like Kimball and LabCorp, includes alpha and beta subunit typing.  In the past they did not indicate whether there was one or two copies of DQ2 or DQ8 if someone was positive.  If a patient was DQ2 and DQ8 positive then these labs reported their full genetic DQ type.  However, if one or the other was negative, their exact genotype was not reported.  Recently, not only has Prometheus started reporting the full DQ2 and DQ8 genotype, but they are now reporting whether someone is homozygous or heterozygous as well.  They are also reporting the relative risk for celiac disease based on the pattern shown by testing.  However, they are still not reporting the other DQ types. 

    What is the advantage of the new Prometheus reporting?
    Since Prometheus results now include a calculation of the individual’s risk of celiac disease, compared with the general population, the patient can see how high their risk of celiac disease is, as well as being able to estimate the risk for their parents and their children. 

    As you can see, the risk of celiac disease has a wide range of possibilities, which depend on the individual’s DQ results.  This risk can be below 0.1% if you do not have any portion of the high-risk genes DQ2 and DQ8.  On the other hand, the risk may be very high (more than 31 times the risk of the general population) if you have two copies of the full complement of DQ2 molecule.  Again, I would like to point out that if you have DQ2/DQ2, DQ2/DQ8, or DQ8/DQ8, then both of your parents and all of your children have to have at least one copy of an at-risk celiac gene.  Your child’s complete type will depend on the DQ contribution from their other parent. 

    What other laboratories do both alpha and beta subunit testing?
    Kimball Genetics and LabCorp also report both alpha and beta subunit results but the advantage of their testing is that they report the other specific DQ types detected.  Gluten sensitivity is found in all DQ types except DQ4.  Other DQ types, particularly DQ1, DQ5, are associated with a risk of gluten related neurological and skin problems.  Microscopic colitis, food allergies and oral allergy syndrome reactions are also found in association with other DQ types.  Though Enterolab does report other DQ types, including these markers of risk for gluten sensitivity, they do not test for, or report, alpha subunits since their DQ testing is done by Bonfils.  Based on the limited data I have accumulated so far, DQ2 and DQ8 also seem to carry a risk of mastocytic enterocolitis. 

    What if you do not have DQ2 or DQ8?
    According to data accumulated, but as of February 2008, not yet published by Dr. Ken Fine, unless you are DQ4/DQ4 you are still at risk for being sensitive to or intolerant of gluten.  According to Fine’s fecal gliadin antibody data all DQ types except for DQ4 carry a risk of gluten sensitivity.  My clinical experience supports this claim.  The presence of one copy of DQ1, DQ3, DQ5, DQ6, DQ7, or DQ9, even with one DQ4, is associated with a risk for elevated stool gliadin antibody and symptoms of gluten sensitivity that responds to a gluten free diet. 

    What if your genetic testing was done by Enterolab, Quest, Bonfils or a hospital that utilized Bonfils, and it indicated that you were DQ2 and DQ8 negative? 
    Since Bonfils does not test for the alpha subunit and they perform the testing for Enerolab and Quest, you may not be completely negative for DQ2 or DQ8.  You do not have the beta subunits associated with the highest risk for celiac disease.  For example, you could be “half-DQ2” positive and still be genetically at risk for the autoimmune form of gluten sensitivity that we know as celiac disease, along with all of its risks. 

    What if you have not yet had celiac DQ genetic testing? 
    I recommend that everyone have the testing.  I realize that most insurance companies and doctors, including some celiac experts, would disagree with me.  However, the value of DQ testing is that it can provide a great deal of information about your risk, especially if you have testing done for both alpha and beta subunits.  I recommend that you have testing done by Kimball Genetics, LabCorp or Prometheus if you have not yet had genetic testing done.  If your insurance or budget does not allow for this more expensive testing, but does cover testing by Quest or Bonfils or you can afford the $159 that Enterolab charges, then I still recommend that you get DQ testing using one of these laboratories.  You just need to be aware of the limitations of the results as I have reviewed them here.

    What are the advantages of DQ testing through Kimball Genetics?
    Kimball can perform testing on either blood or mouth swab samples.  The tests can be ordered without a doctor’s order.  You can purchase testing on mouth swab sample for $345.  The advantages of Kimball’s tests include alpha and beta subunit testing and full DQ typing to determine if you carry the other gluten sensitive DQ patterns besides DQ2 and DQ8.

    What about LabCorp?
    LabCorp also provides both alpha and beta subunit testing and they report the other DQ types.  They only provide testing on blood samples, a doctor must order the testing, and preauthorization is required. 

    Do health insurance companies cover celiac DQ genetic testing?
    Many but not all health insurance companies cover HLA DQ testing and almost all require preauthorization.  The ICD9 diagnostic codes that typically are honored are V18.5 genetic predisposition for gastrointestinal disease; V84.8, genetic predisposition for other diseases; and 579.0, celiac disease. 

    Why are the genetics so difficult to understand and why are so many doctors either unaware of the testing or reluctant to order the tests?
    I write and speak about DQ genetic testing frequently, and try to get testing for as many of my patients as possible.  However, many insurance companies will not cover the cost of these tests.  Most primary care doctors and even some GI doctors are completely unaware of the existence of a genetic test for celiac disease.  The testing is difficult to understand and the reporting by some labs is very confusing and even misleading. 

    I realize that understanding the DQ genetics is difficult for the average layperson.  Most scientists and doctors don’t understand this information, so don’t despair if you are having difficulty following this or understanding your results, and don’t be surprised if your doctor does not understand them either.  However, you do not need to completely understand the complexities of HLA typing to locate your DQ types and determine your risk of celiac disease, non-celiac gluten sensitivity, etc. 

    Then what do you need to know or remember about celiac DQ genetics?
    Hopefully, you now understand enough to know that you should consider having celiac DQ testing, if possible, especially if you have symptoms, laboratory tests, or an intestinal biopsy that is suggestive of celiac disease.  You should also know that the testing can be done on blood or mouth swabs, and many insurance companies will cover the testing but most require pre-authorization.  You should also be aware that the testing is available without a doctor’s order, if you are willing to pay for it, and that some tests are better than others.  I also hope you understand that the tests can help you determine your risk for celiac disease or if you are at risk for non-celiac gluten sensitivity.  You should also know that your results, especially when combined with those of one or more family members, may help you determine, to some degree, the risks for your parents and your children.  You should also know what laboratories offer testing, what test codes your doctor should use to order the tests, and that the absence of DQ2 or DQ8 does not exclude risk of gluten sensitivity or intolerance.  Depending on what laboratory conducts your DQ testing, your results also may fail to exclude your risk of celiac disease. 

    What if I am still confused or I don’t know how to interpret my genetic results or my previous evaluation for celiac disease?
    If you are still confused by your test results or want more a personalized review of your results, symptoms or diagnostic tests I recommend that you see a physician who is an expert in celiac disease and understands these tests.  I also offer on-line consultation for a reasonable fee through a secure consultation site, www.medem.com.  You simply register (registration is free) for secure on-line communication and request a consultation.  The consultation fee is $50, and some insurance companies will cover on-line communication.  I also see many patients from outside of Colorado Springs for consultation if you are willing to travel here. 



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    Guest Frances Collier, MT, VMD

    Posted

    Excellent information. But we are still assuming that certain genes like to travel together and therefore certain white cell antigens travel with the genetic determinants of celiac disease. Will there eventually be a specific chromosome test for celiac?

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    Guest Diane Dreiling

    Posted

    I understood the explanation! I will send this to my [grown] son to present to his family physician who seems to resist allowing my son to be tested.

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    One of the most informative and understandable articles I've read in a very long time. Thank you!

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    This is the best explanation that I have seen thus far that is in understandable layman's terms. I'll pass it on to my daughter who often wonders if she, too, will become a celiac

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    Thank you for this article! I was just attempting to figure this out by discussing this with a fellow boardie this past month. While your 'Ten Facts' article was great, this article makes things as crystal clear as it can for the lay-person, and now I have better understanding for what our fellow boardie was sharing and then some!

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    Guest Beatrice

    Posted

    Genetic testing should be a part of every family's medical regimen. Speak to your congressional representative. The later a person is diagnosed with celiac disease or any other inherited disorder the more damages a person must attempt to overcome. Seems to me an obvious course of action.

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    Excellent Article... it has been very helpful and we appreciate your clear communication. Our family bears out the research on genetic testing and specific alpha and beta sub-unit findings you mention here.

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    Guest G. F. Barbato

    Posted

    I have been a 'working' geneticist dealing with a variety of species for the past 30 years. My wife and her family have been identified as having celiac disease -- hers being one of the horror stories of being caught in the 'system'.

    However, I find the emphasis on HLA typing to be misguided. HLA types 'may' be associate with risk factors -- but, these are fundamentally no more than simple correlation analyses and say nothing of causation. therefore, I would truly recommend against calling them 'celiac genes'. More than likely, the HLA subtypes determine the immune response of the individual when exposed to the gluten/gliadin (or possibly other) amino acid sequences. The true 'gene' for celiac -- if there is such a thing -- is more than likely an enzyme that prevents complete digestion of the glutamine-rich portion of the gluten molecule. Of course, this means that one should understand celiac disease as a 2-stage disease. The first being exposure to the antigen and the second being responses to that antigen. I strongly suspect that the DQx series of HLA subtypes are involved with the latter and NOT the former.

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    Guest G. F. Barbato

    Posted

    One more thing. IMHO, genetic testing should NOT be part of 'every family's medical regimen'. Most people and a majority of doctors don't know a thing about simple mendelian inheritance -- not to mention complex multifactorial diseases. To arbitrarily test for something with no knowledge of meaning or context is just plain irresponsible. I recognize that there are a lot of people in pain and misery -- desperate for a solution, heck, even a piece of the question. But, snake-oil don't cut it.

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    Guest Marie

    Posted

    It is not possible to get this genetic testing in my large city in Canada. My daughter had been suffering with diarrhea, nausea, bloating, pain, pale for several years. Also as a student relying on pasta, pizza etc.

    I have an autoimmune disease (Sjogrens) & a bad rash so I went to Scripps in La Jolla,Ca. They didn't help my rash but blood tests came back HLADQ2, & they said get more tests but they won't do them here. We sent daughter to our Dr. & a blood test suggested Coeliac but she would need to wait 6mths for biopsy & eat gluten! We paid to fly her to another province where she found out the same day for $500, plus hotel & airfare. Villi were flat,she has a picture. So much for our medicare system! Be careful what you wish for.

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    Guest Halllie

    Posted

    G. F. Barbado wrote: 'The true 'gene' for celiac -- if there is such a thing -- is more than likely an enzyme...'

     

    Sorry, but this is false. Genes are DNA, not protein. They CREATE proteins. The HLA proteins are each created by a certain gene. Certain of these HLA proteins have been shown to be associated with an increased risk of celiac disease, so it may be safe to say that the corresponding genes which created them are associated with this increased risk. That it is why it is easiest to say 'The HLA DQ8 gene,' rather than saying 'the gene that codes for the HLA DQ8 protein.'

     

    Now certain proteins also have an enzymatic function. Enzymes are proteins which serve as catalysts (speed up) certain biochemical reactions. It's quite possible that these HLA proteins either do mediate biochemical reactions in some altered fashion, or have defective ability to catalyze certain reactions?!

     

    This was an excellent article!

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    Guest david turkheimer

    Posted

    I wish I had your article in hand when I reviewed the test I had a few years ago. The doctor (and this was at the Columbia University Celiac Center) said that she couldn't confirm celiac from the genetic result (and I was already symptomatic!).

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    Guest Crayons574

    Posted

    This is an excellent article! So well written--understandable and with thorough explanations. Thank you!!

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    Guest Joan White

    Posted

    What a great, simple to read, informative article. Many thanks for the clear explanation. As someone with HLA2,2 and symptoms, this article helps me understand celiac disease and GSE even if my gastroenterologist doesn't.

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    Halllie, your response, "Now certain proteins also have an enzymatic function. Enzymes are proteins which serve as catalysts (speed up) certain biochemical reactions. It's quite possible that these HLA proteins either do mediate biochemical reactions in some altered fashion, or have defective ability to catalyze certain reactions?!" strikes a nerve with me. I have had RA for most of my life (JRA to be precise) and my gluten issues started around the same time I started Enbrel, an RA med, which is an injectible protein. I have no scientific knowledge to back up my hunch but I often wondered if the Enbrel, which does an amazing job on my RA, was the catalyst that caused the gluten issues to surface. I'm awaiting test results to see if I have celiac. I'm pretty sure I do since my symptoms go away with a gluten-free diet. I'll be sure to re-read this article once I get my results so I can understand what's going on. BTW, my rheumatologist knew nothing about celiac. From everything I've been reading it seems as if any doc who has patients with a auto immune disease need to be reeducated about celiac. I'm in a high risk group and I wish that when I started complaining about these GI issues 6 years ago a doc would have put 2 and 2 together. Alas, like so many of you, I've been left to figure this out on my own. I live in a big city and go to an award winning hospital for care so there's no excuse. I guess you can say I'm in the anger phase of the gluten free journey.

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    It is not possible to get this genetic testing in my large city in Canada. My daughter had been suffering with diarrhea, nausea, bloating, pain, pale for several years. Also as a student relying on pasta, pizza etc.

    I have an autoimmune disease (Sjogrens) & a bad rash so I went to Scripps in La Jolla,Ca. They didn't help my rash but blood tests came back HLADQ2, & they said get more tests but they won't do them here. We sent daughter to our Dr. & a blood test suggested Coeliac but she would need to wait 6mths for biopsy & eat gluten! We paid to fly her to another province where she found out the same day for $500, plus hotel & airfare. Villi were flat,she has a picture. So much for our medicare system! Be careful what you wish for.

    Marie,

    Trust me, our medicare is so much better! We live in Montreal but since my daughter had her US university insurance, I allowed her to have her biopsy there (also, it went faster there than here). Our portion of the cost of the biopsy was $10,000! The US system sucks. Also, my son with his Harvard health insurance had to pay $14,400 for room and board (!) for one night stay at a hospital. Only medical procedures were covered not room and board. Your $500 plus hotel was nothing compared the madness that is the US. I'm so grateful to live in Canada.

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    Guest Betty Beyea

    Posted

    Thank you!

    Five years ago I found the only test I could trust was the blood test for the gluten gene. Celiac is certainly in my families.

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    Excellent article. Thank you for clarifying so much of this subject. I am interested in the parallels and correlations in genetic testing for diabetes. The doubled risk for diabetics of celiac disease poses the question, what genetic pointers do the two diseases have in common?

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    Guest keri Brooks

    Posted

    I recently had a client go through Kimball Genetic instead of Enterolab, based on this article where Dr. Lewey states that Kimball tests for all celiac alleles as well as other alleles associated with gluten sensitivity but this doesn't appear to be the case?!?!?!? Enterolabs identifies which alleles you actually have verses Kimball Genetics which only identifies if you test positive for the specific celiac alleles but non associated with gluten intolerance. In my experience having one or two gluten sensitivity genes can be just as severe as being diagnosed as a celiac in which case knowing if you have a predisposition to gluten sensitivity is important too.

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    Foods derived from cereal grains (wheat, rye, barley, oats) are popular staples in our diet. In the past decade especially, a renewed enthusiasm for "whole grains", and increased dietary fiber, has lead to increased consumption of these cereals in relatively unrefined form, and often in combination, as with granola cereals, and whole wheat breads fortified with bran, coarse flours, and other additives. The argument in favor of whole grains is based on two considerations:
    1) The nutrient content of whole grains and their unrefined flours is greater than refined flours. White flour has been considered by some an inferior food since it is missing some micro-nutrients. However white flours and light white bread are sometimes better tolerated than the whole grain foods.
    2) The indigestible fiber in whole grains contributes to stool bulk, reduces the opportunity for constipation, and absorbs toxic or harmful molecules, which, escorted from the bowel by fiber, have less opportunity to do harm. The regulating and binding actions of grain fibber, it is argued, would reduce the incidence of bowel cancer, if eaten over a lifetime. The favorable fibers are probably better found in vegetables and fruit. While there favorable arguments for a high cereal grain intake there are major problems with these foods. Craving and compulsive eating of flour-based foods is common, especially the reward an dessert foods, containing sugar. These high-carbohydrate foods contribute the major caloric input to obese persons.
    The diseases clearly associated with Cereal grains or "Gluten intolerance" are the bowel disorders bearing the names,"celiac Disease", "Non-Tropical- Sprue", or "Gluten-Enteropathy", and the skin disorder, dermatitis herpetiformis.
    The clinical presentations of cereal-grain intolerance, which can be recognized from the history or pattern of illness alone include: Diarrhea, chronic with malabsorption, weight loss, micro-nutrient deficiencies, blood loss and anemia. Abdominal pain may be recurrent and associated with flutulence, distention, and intermittent bowel motility disturbance. Minor gluten-enteropathy may not involve diarrhea, and malabsorption may be inconspicuous or inconsistent. A nutritional anemia may be the presenting problem, although the patient will have an associated history of intermittent abdominal pain and distension. The anemia results from malabsorption iron, folic acid and/or vitamin B12.
    Arthritic or Fibrositic Syndromes: Aching, stiffness, and fatigue are three common symptoms which occur together in a variety of disorders, and occasionally remit completely on an elimination diet which excludes cereal-grains and other allergenic foods.
    Brain Disturbances: symptoms include deep, burning sensations in arms and legs, restless legs, numbness and tingling which comes on rapidly with sitting, squatting, and lying in bed; brain effects are manifest by a sense of confusion or "fuzzy-head, disorganization, irritability, and memory impairment. The occurrence of resting pain in joints, particularly the hands with slight swelling, and stiffness is the early prevention of rheumatoid arthritis; it can occur strictly as a manifestation of wheat (and other food) allergy. The activity of rheumatoid arthritis may be reduced in some patients by cereal grain and other allergenic food restriction.
    There are at least four mechanisms involved at the bowel level for gluten intolerance:
    1) Lack of the digestive enzyme, intestinal glutaminase.
    2) Antibody production to the prolamine, or a fragment of it.
    3) Increased permeability of the bowel to macromolecules including the antigenic protein and its fragments.
    4) Increased production and release of mediators such as histamine, seratonin, kinins, prostaglandins, and interleukins.
    A wheat gluten-triggered mechanism has been studied in rheumatoid arthritis patients. The clinical observation is that wheat ingestion is followed within hours by increased joint swelling and pain. Little and his colleagues studied the mechanism, as it developed sequentially, following gluten ingestion. Platelet Seratonin Release in Rheumatoid Arthritis: A study in Food Intolerant Patients. Little C. Stewart A.G., Fennesy M.R. Lancet 1983.297-9.
    The Gluten Proteins
    Gluten is a mixture of individual proteins, classified in two groups, the prolamines and the glutelins. The most troublesome component of Gluten is the Prolamine, Gliadin. It is Gliadin in wheat that causes the major problem in celiac disease, and Gliadin antibodies are most commonly found in the immune complexes, associated with major systemic disease (Unsworth, D.J., et. al., IgA Anti-Gliadin Antibodies in Celiac disease, Clin Exp Immunol. 1981: 46:286-93.Keiffer M, et. al., Wheat Gliadin Fractions and Other Cereal Antigens Reactive with Antibodies in the Sera of of Celiac Patients, Clin Exp Immunol. 1982;50:651-60).
    We eat the seeds of the grain plants. The seed has a bran casing, a starchy endosperm which contains 90 % of the protein, and a small germ nucleus which is the plant embryo, waiting to grow. Any flour made from the starchy endosperm contains prolamines and is potentially toxic to the grain intolerant person.
    If we look at the different grains we find that each has its own prolamine. The following list gives the type of prolamine each grain contains, and the percentage of protein the prolamine has in relationship to the entire grain:
    Wheat - Gliadin - 69% Rye - Secalinin - 30-50% Oats - Avenin - 16% Barley - Hordein - 46-52% Millet - Panicin - 40% Corn - Zien - 55% Rice - Orzenin- 5% Sorghum - Kafirin - 52% Celiac disease may serve as a model of wheat allergy. No-one should make the mistake of assuming this is the only form of wheat allergy. When wheat is the principle problem food, there is a consensus that barley, oats, and rye must be excluded as well. Millet, is intermediate in the list of offenders; corn and rice are usually tolerated when gluten prolamines are the chief and only food intolerance, although corn is a major food-allergen in its own right. Triticale is a new hybrid grain with the properties of wheat and rye, and is excluded on a gluten-free diet [bell L., Hoffer M., Recommendations for Foods of Questionable Acceptance for Patients with Celiac Disease,J.Can. Dietetic Ass'n: 1981; 42:2; 143-15]. The identity and the amount of the prolamine decides the kind of reaction that is likely to occur. It should be noted that there is considerable variability in the prolamine content of various foods made from cereal grains, and this variability is one of the many reasons why food reactions are not consistent.
    The usual definition of celiac disease links chronic diarrhea, with evidence of malabsorption, and changes in the surface of the small bowel. Most medical textbooks dogmatically state that an intestinal biopsy must be taken and must show typical changes before the diagnosis is made. The biopsy allows a pathologist to examine microscopically the surface of the small intestine. The surface of the small intestine is covered by a dense mat of projecting nipples called villi which shed cells containing digestive enzymes, and absorb food molecules. In long-standing celiac disease one expects the villi to be blunted and the surface to be smoothed out. While the biopsy is a useful procedure it has several drawbacks;
    It is a procedure with a small incidence of dangerous complication, especially bowel perforation.
    It is a small sample and may miss patchy or irregular bowel changes.
    Significant protein intolerance, and increased bowel porosity may exist despite normal appearance of the bowel lining under the microscope.
    Patients in remission or with intermittent symptoms may have normal biopsy results but remain exquisitely sensitive to some prolamine, or peptide fragment challenges. [bjarnson, I., et. al., Intestinal Permeability Defect in Celiac Disease, Lancet. 1983 1284-85].
    The most significant test of gluten intolerance is remission of symptoms when grains are eliminated for a trial period of 3-6 weeks. I have often reviewed the history of patients with chronic diarrhea, and associated abnormalities, who have been "thoroughly investigated" in an academic center and left untreated because their biopsy result was normal. Physicians, who make therapeutic decisions solely on the basis of biopsy results are being dogmatic, not scientific, and certainly not serving the best interests of their patients who simply want to be better. Investigations which do not lead to effective therapy are of no value to patients.
    Diagnosis of gluten-sensitivity in all disorders may be facilitated in the near future by better immunological laboratory tests, including measurement of circulating serum antibodies directed against these proteins, and of circulating immune complexes which contain food antigens. [O'Farrelly, et. al., Alpha-Gliadin Antibody Levels: A Serological Test for Celiac Disease, 1983 Lancet; 286:2007-2010]. Better tests would permit the demonstration of increased GITPERM, and the entrance of abnormal macromolecules after test meals. Eventually the path through the body of such molecules may be studied by labeling them with isotopes, and tracking them with scanning methods like positron emission tomography.
    Irritable Bowel Syndrome
    An unexplained bowel disturbance, characterized by abdominal pain, gas, diarrhea, often alternating with constipation, is diagnosed as the "Irritable Bowel Syndrome" and too often attributed to "psychogenic causes". We recognize right away that the label "psychogenic causes" describes the lack of biological understanding more than it describes the patient's problem. The treatment usually offered includes bulk laxatives, tranquilizers mixed with antispasmodic drugs, and not infrequently, a trip to the psychiatrist, who is not likely to do a dietary history. The success rate with these methods in one study was only 12%! [Waller, S.L., Misiewicsz: Lancet 1969 ii: 753-6, Prognosis in Irritable Bowel Syndrome].Food studies are seldom undertaken in the assessment of patients with irritable bowel syndrome. Not a single patient whom I have seen with this disorder has had a food diary examined, nor any trial of exclusion diets. Dietary advice commonly-given includes "high-fibber" diets, usually increased cereal grains, which are contraindicated. Studies which allege to rule out food intolerance are poorly conducted, often basing negative results on limited, selected food challenges. Proper studies would utilize the complete methodology of diet revision therapy, and would observe patients in real-life conditions, ingesting real food over a significant period of time.
    The irritable bowel syndrome is at least in part a food-intolerance disorder, and the program outlined in this book will generally be helpful. In a recent study by V. Alum Jones et al, food intolerance was shown to be a major factor in causing the irritable bowel syndrome in 25 patients. This study is of particular interest because it was arranged to reveal something of the mechanism of this disorder. The results indicate that this particular presentation of food intolerance was not the result of immune events, was not associated with high blood-histamine levels, nor circulating immune complexes. Rather the disturbance seemed to be related to increased levels of Prostaglandin E2 (PGE2), synthesized and secreted by the bowel itself. Prostaglandin production is inhibited by ASA, and all of the other anti-arthritic medications, and may prevent the irritable bowel effect if taken before meals. The foods causing the irritable-bowel symptoms were (in order of frequency)
    Wheat...9 Corn .... 5 Milk.... 4 Coffee. 4 Tea..... 3 Citrus.. 2 All the patients found to be intolerant of wheat had normal results of intestinal biopsy. Not all wheat-induced bowel disorders are celiac disease! The important point, once again, is that the mechanisms of food intolerance are multiple and complex! The only practical way to study food intolerance is by trials of dietary revision, and challenges with real food. One interesting observation made by several of my patients is that they always got somewhat better while in hospital, having multiple tests done. Psychological factors? No. Hospital tests for gastrointestinal disorders always involve days of fasting. If you stop eating foods that are hurting you, your symptoms improve! Proper NP may avoid the waste, in terms of dollars and disappointment, that inappropriate medical investigation and treatment incurs, when a trial of appropriate DRT will often cure the "disease" under investigation.
    This not to deny that emotions influence bowel function, since this is clearly the case. The "Gut Brain Axis" has become a subject of specialized study because of the complexity of interaction of these two life-determining organ systems. Food selection, emotional experiences, and eating behaviors interact complexly. Anger, frustration, fear will profoundly influence food selection, appetite, digestion, and metabolism; while food selection, digestion and metabolism will determine your emotional reactivity. There is a continuous loop of causal relationships, not a one-way vector. When patients are told they have bowel dysfunction because of stress, tension, or anxiety, this is only a half truth. The other half of the truth is that patients have stress, tension, and anxiety because of bowel dysfunction.
    The more subjective mood-related symptoms are difficult to assess, and are attributed to "psychiatric causes" although no authority seems to know what that means! The brain effects are an expression of disorderly molecular flow through the brain. Specific nuero-active effects of grains include the circulating peptides, which have been described earlier in the book, as WMOD, and are further discussed in the last section of this chapter.
    Indications for Trial of Gluten Restriction
    NP advocates liberal gluten restrictions in a variety of circumstances, simply because the results are surprisingly good. The core diet developed by clinical trials, and described in subsequent chapters is initially free of cereal grains, since they are frequent offenders in food intolerance problems. Not only patients with bowel disorders benefit, but also people whose bowels function apparently well but suffer, fatigue, aching, swelling, and brain disturbances, expressed as mental and emotional upheavals.
    The specific patterns of disturbance which should invite a trial of the food-testing plan, and gluten restriction specifically are: Diarrhea, prolonged over three weeks, not associated with infections, or evidence of parasites or pathogenic bacteria in stool samples.
    Abdominal pain, especially if frequently recurrent, and associated with excess gas, and abdominal distensio (Irritable Bowel Syndrome).
    Anemia from iron, folic acid, or nutrient deficiency which is unexplained by blood loss, or dietary inadequacy, especially if associated with abdominal symptoms.
    Aching disorder, especially if the aching is generalized, associated with stiffness with inactivity, and dysethesiae ( odd burning, tingling sensations), and tender muscles. Any arthritic pattern, associated with diarrhea should be vigorously managed with gluten, milk, and egg restriction with careful testing of other foods for possible reactions.
    Fatigue, especially if associated with irritability, confusion or fuzzy-headedness, headache, and abdominal discomforts.
    Chronic asthma and rhinitis.
    Neurological symptoms which are unexplained by recognized abnormalities in physical examination and laboratory investigations. These symptoms include the above mentioned, memory disturbances, sleep disturbances, visual distortions, muscle weakness, and fasiculations (wiggly, jerking movements within muscles). A trial of gluten restriction is also appropriate in children with learning disability, schizophrenics, alcoholics, and patients with refractory mood disorders.
    Treatment of Grain Intolerance
    Exclusion of wheat, rye, barley, oats, and millet are the initial steps when gluten intolerance is suspected. The exclusion includes all the foods made with the flours of these common grains - Durham flour, Triticale, and Bugler are all excluded. The bran of these cereals is also excluded. A trial of an elimination diet lasting 3-6 weeks is sufficient to experience significant improvement in most bowel conditions. Longer periods of exclusion are required in conditions with chronic tissue inflammation, especially arthritis, and the skin disorders, eczema, and dermatitis herpetiformis, which sometimes requires an exclusion of several months before the skin condition remits completely.
    It is important to realize that multiple food intolerance are common and should be assumed, rather than assuming that single food intolerance's are the problem. NP does not consider it adequate therapy for a single food group to be eliminated, on the assumption that every other food will be well tolerated. Gluten restriction should be part of a more comprehensive dietary study, preferably in the form outlined in the food-testing plan. The best dietary plans are based on what is good to eat, more than what is bad to eat! No-one wants to be confronted with long lists of foods they must avoid. It is better to build a diet from scratch, emphasizing the positive. There is an entire universe of foods not related to milk, gluten-cereals, and eggs, the commonest problem foods!
    If improvement occurs, gluten restriction is maintained for many months at least before any effort is made to re-challenge with gluten foods. There are two exceptions, millet and oats. Millet is occasionally acceptable, early in an exclusion program although few people find it an attractive food, and it is potentially a trouble-maker.
    Oats is probably the best cereal to be re-introduced, and is often tolerated when wheat, rye, millet and barley are not. If gluten restriction is beneficial, oats may be tried after 2-3 months of abstinence. Some people, however, have specific and dramatic allergic reactions to oats, and acceptability must not be assumed. The major substitute for cereal grains is Rice The rice prolamine, orzenin, is different enough from gliadin to avoid immunological cross-reaction.
    Rice: Desirable Staple Food
    Rice is the staple food chosen for the core diet because it has low allergenicity, is versatile, widely available, and provides a carbohydrate caloric base to the diet. Rice comes in many varieties some of which are sufficiently different to be treated almost as separate foods.
    Converted white rice is preferred at the start of a core-diet program. Brown rice does contain more nutrients, and some prefer it by taste and texture; however, the husk also contains more potential problems. Rice-eating peoples generally polish their rice, removing the husk, because empirically the result is better. Again the nutritional arguments based on the nutrient content of foods outside of the body may be misleading! Brown rice may be well-tolerated, but should be introduced after tolerance for converted white rice is established. There are definite exceptions to this rule, as with all rules, since some patients do report better tolerance of selected varieties of brown rice.
    Rice can be utilized in a variety of forms, including rice cereals, rice pablum, puffed rice, rice-cakes, rice noodles, rice vermicelli, and rice flour (starch). Different rices vary sufficiently in taste, and texture to maintain culinary interest. Rice may be boiled with sunflower seeds, buckwheat, wild rice, other seeds, and legumes for added nutritional and culinary variety.
    All foods, including rice have the potential to be allergenic, however, and are not exempt from suspicion when adverse food reactions continue on a substitution diet. The most typical symptoms of rice intolerance are heavy fatigue, and chilliness. Rice may also produce the total grain syndrome, although this is uncommon in my experience. Following the core hypoallergenic diet plan, you will simply not miss cereal grains for a while, and find the variety and diversity of other vegetables, sufficient to sustain your interest and nutrition. The biggest challenge is to make the effort to choose different foods, and to prepare them attractively.
    Corn is less well tolerated than rice
    Our packaged, fast-food, and restaurant-food industries rely heavily on wheat flour to produce their products. The person on a gluten-free diet must make an extra effort to avoid these products, and to eat instead primary foods, including fresh produce, meats, fish, and rice.
    Most of my patients crave a carbohydrate food, if not a sugar food, then bread, buns, crackers, chips, nuts and so-on. Rice is a good alternative, being a starchy vegetable which turns sweet if you chew it for a while. Having rice available in a bowl in the refrigerator, mixed with vegetables, herbs, meats or fish offers an alternative to gluten-laden snack foods. Pasta is made with high gluten flour and is off our list of core diet foods. Again Rice is good alternative to pastas.
    Buckwheat
    Buckwheat is an interesting grain-like food to add to your diet, especially if Rice is not acceptable because of an adverse response to it. Buckwheat is not a grain, but belongs to the Polygonaceae family which includes sorrel, rhubarb and dock. Buckwheat is a seed, however, and resembles the grains in having a starchy endosperm, and can be ground into a flour, or cooked as a cereal, or prepared as rice. Buckwheat is not toxic to the celiac bowel, although some people react adversely to it. Buckwheat flour is disappointing for baking since it lacks gluten, the elastic, chewy component of bread.
    Other Alternatives to Cereal Grains
    Other starchy vegetables may stand in for grains. The potato is a starchy tuber, and potato starch can be used as a weak imitation of flour. Other roots are available, including Cassava an African vegetable which produces Arrowroot flour Tapioca is made by heating and moistening arrowroot. Flour is also made from Taro, a Japanese tuber, which is common in Hawaii where POI is a staple paste made from Taro roots. Soya beans are versatile and highly nutritious seeds which can be utilized as a flour as well. Tofu is the protein fraction of Soya beans, and is an inexpensive, nutritious food, used widely in the orient as a protein staple. It must be mixed with corn or another legume to produce a full complement of essential amino acids. The main problem with tofu is learning how to cook with it. Other legumes including, chick peas, lentils, peanuts are useful foods, on a gluten restricted diet, but have their own problems which must be considered before regular use of these foods is entertained.
    Each recommended food is still subject to testing, however, for each food may produce allergens or cause other problems. As with all foods in a sensitive person, the basic rule is - Find out how the food works in your body! Gluten-free diets specify food exclusions, including a variety of manufactured foods which contain Gluten. One generally can figure out what is not desirable by thinking of the probable origins of the food in question. Gluten exclusion does include malt, a barley product, and malt containing beverages (Postum, Ovaltine); beer and ale. Alcohol is usually excluded, although some tolerance may be found to selected wines, and distilled beverages. [Food for Celiacs; Campbell, J.A. : Journal of the Canadian Dietetic Ass'n., Jan '82 ; 43:1; 20-24; Gluten Free Cookbook: Leicht, L., RR#1 Box 54, Pender Island B.C. VON 2MO; Club House Foods 316 Rectory St. PO Box 788 London Ont. N6A 4Z2].
    The focus of a gluten-free cookery is often on replacing gluten flour in baked goods with starches made from rice, arrowroot, potato, Soya beans, other legumes like chickpeas,and wheat starch (all the protein has been carefully removed). While baking can be done with these non-gluten "flours", the results are never as satisfying as with wheat flour. Gluten is the most desirable ingredient in flour for producing bread, and baked goods, and its absence is conspicuous. In many respects it is easier, kinder, and nutritionally wiser to forgo the baked goods in large measure and eat other foods. The task of changing your diet is very much like moving to another country and culture. You may try to bring all your old habits with you, and struggle to get all of the ingredients that you are used to forming into meals, or you can gracefully, and with a sense of adventure try the new cuisine. Certainly bakery foods are delicious and tempting, but so are creatively prepared rice, vegetable, fruit, fish, and meat meals. Even with multiple exclusions, an appealing, varied diet is within reach if you are willing to change your eating style. A book of recipes which de-emphasizes, cereal-grains, eggs, and milk is a great asset. The cookbook "Oriental Food Feasts" is full of recipe ideas from China, Japan, Indonesia, and India. One has to select recipes that utilize foods, appropriate to your dietary needs. The main thing is to be inspired to create and enjoy a new cuisine that will diminish your disturbances, sustain your interest in food, and provide balanced nutrition. [shepard, S.M., Oriental Food Feasts, Arco Publishing, Inc. New York 1979]. Vegetable selection and preparation is one of the prerequisites of a successful diet revision. The Tassajara cookbook is my favorite introduction to the subject [Tassajara Cooking; 1973 Zen Centre; San Francisco; Shambala Publications, Inc. Boulder, CO.] .
    Neuropsychiatry & Gluten Intolerance
    We have recognized that Gluten intolerance may involve the absorption of complete proteins like gliadin, or its peptide- fragments; anti-protein antibodies circulating in the blood, which form immune-complexes with the food protein, and provoke the release of mediators which may cause multiple disturbances in all body systems, and even tissue damage. These circulating problems may also influence brain function in a variety of undesirable ways. There is vague circumstantial evidence of an adverse grain effect on metal status. A family history of psychiatric problems is more common in patients with celiac disease. Celiac disease is genetically determined involving two or more concurrent genes. The genes involved are part of the immune-recognition complex, which determine the "Self" identity markers, protecting one's own cells from attack by the immune system. Celiac patients have an increased frequency of the serum histocomptability antigens (self-markers) of the HLA-B8 and HLA-Dw3 types. This genetic marker may indicate a predisposition for bowel absorption abnormalities or immunologic propensities, which result not only in celiac disease itself but other contingent abnormalities as well.
    Schizophrenia has been associated with gluten intolerance. The diagnosis, schizophrenia, describes a variety of differing individuals who belong to complex group of brain-disordered people. The schizophrenic brain distorts sensing, feeling, remembering, deciding, and acting. It is unlikely that schizophrenia is a single disease with a single cause. The milder, but similar brain dysfunctions which I observe commonly with gluten and other food intolerance, suggests that food allergy may play a role in schizophrenia, with gluten as a frequent triggering antigen. Dr. F.C.Dohan has consistently advocated a gluten-schizophrenia link for 20 years [Dohan, F.C., Cereals and Schizophrenia: Data and Hypothesis, 1966 Acta Psychiatr. Scand 42:125-42; Dohan, F.C. More, Celiac Disease as a Model for Schizophrenia, 1983 Biol. Psychiatry 18:561-4].
    Dr. Dohan states:
    [" Many diseases are caused by genetically-deficient utilization of specific food substances. Perhaps the best studied example is phenyketonuria... far more common disorders, for example, atherosclerosis, and coronary heart disease, are strongly suspected of being due to genetically defective utilization of certain food constituents. " Similarly, considerable evidence indicates that the major cause of schizophrenia is the inborn inability to process certain digestion products of some food proteins, especially cereal grain glutens..."]
    Among Dr. Dohan's interesting an relevant recommendations is the idea of a "Gluten tolerance test". Such a test has not yet been developed, but is the sort of evaluation method that NP advocates in general. A gluten tolerance test could be initiated with routine evaluations before and after ingestion of grain foods. More sophisticated versions would measure gluten proteins and derived peptides in the blood, and would track the path of these molecules into organs, especially the brain. Finally the impact of these molecules would be evaluated by monitoring the function of the target organ in real time. I have been eager to do real-time monitoring of brain activity, topologically-computed in gluten-sensitive patients. These patients report changes in their PSYE, cognitive abilities, and emotional state which no researcher to date has documented objectively. The problem of adverse brain effects of molecules derived from food is a major under-recognized phenomenon of nutrition and molecular pathophysiology. Research in the next 10-20 years will, I am convinced, reveal a great deal about the extent, mechanisms, and importance of this consequence of eating to our mental status.
    Extracted from "Nutrition Therapy" by Stephen J. Gislason, MD
    For more information, please visit Nutramed's Web site at: http://www.nutramed.com/.

    Dr. Rodney Ford M.D.
    Celiac.com 10/22/2008 - This article appeared in the Autumn 2007 edition of Celiac.com's Scott-Free Newsletter.
    The Gluten Syndrome refers to the cluster ofsymptoms that you experience if you react to gluten.  Gluten can affectyour gut, your skin, and your brain.  It applies to any reaction thatis caused by gluten.  It includes celiac disease, along with the myriadsymptoms that can be experienced throughout your gastro-intestinaltract in response to gluten.  It also includes many other symptoms thatdo not stem from your gut.  These include brain and behavior disorders,irritability and tiredness, skin problems, muscular aches and pains andjoint problems.
    The effects of gluten are wide ranging and arenow brought together under the term Gluten Syndrome.  In mostinstances, a simple blood test (the IgG-gliadin antibody test) canidentify those people who are affected.  
    10% Affected by Gluten
    TheGluten Syndrome affects about one in ten people.  However, most peoplewho are affected are unaware that their life is being hindered bygluten.  The gluten symptoms are most likely to be caused by damage tothe nerves and brain.  The earlier the problem is identified, thebetter the response to a gluten-free diet will be.
    Tummy Pains and not Growing
    Jontiis 3 years old.  His gluten story is typical.  His mother brought himto see me because she was concerned about his poor growth, and hisdistressing abdominal pains.  His blood tests showed a high gluten test(His IgG gliadin was 94 units.  This test result is usually less than15 at this age).  Other tests, including the gene test for celiacs,showed that he did not have celiac disease.
    I suggested that hego on a gluten-free diet.  Within days he began to eat better, and histummy pains went.  He is now growing again on a gluten-free diet.  Hismum wrote:
    “I really haven’t found the gluten-free diet thatdifficult.  I found people to be incredibly helpful actually, both inthe supermarket and in restaurants.  In the supermarket there is a lotof normal type food that is gluten-free and it is all clearly labeledthat it is gluten-free.  Even if you go to the delicatessen departmentthey will tell you which luncheon sausage is gluten-free.  There aregluten-free sausages all labeled and it’s normal food that tastes great.
    Forthe baking mixes and bread mixes, you don’t even have to go to thespecialist health food shops.  I go to no other shops other than thesupermarket to get food for him and I haven’t really found it thatdifficult.”
    Amazed how Jonti has Adapted
    Ihave been amazed, actually, by how easily Jonti has adapted to thegluten-free diet.  I tell him it is special food for him and that itwon’t hurt his tummy.  We have got nice biscuits from a bakery and heis allowed to choose which one he wants for morning tea.  He still hasnormal foods like chips and sweets.  He is not missing out and theother biscuits he hasn’t even really asked for.  The only thing is thebread!  I have yet to perfect the making of the bread.  Toast is aboutthe only thing he asked for.  You can get specialist cornflakes andcereals, porridge he loves, again, at the supermarket.  It has beensurprisingly easy actually
    I’m so pleased that he is now well again.  Gluten-free has made such a huge difference.”
    The Main Points:

    The Gluten Syndrome refers to the cluster of symptoms that youexperience if you react to gluten.  It can affect your gut, skin andnerves. Medical practitioners accept that gluten causes celiac disease(gut damage) but often resist the notion that gluten can cause a widerspectrum of illness. Celiac disease, gluten intolerance and gluten sensitivity are all part of The Gluten Syndrome. Rapidly accumulating medical evidence shows that gluten is nowcreating a massive health problem throughout the Western world. However, woefully few people are aware of the catalogue of harm thatgluten is causing.  About one in ten people—that is millions ofpeople—are affected by The Gluten Syndrome. Gluten could be responsible for one-third of all cases of chronicillness and fatigue.  People suffering from these conditions arecurrently just tolerating their symptoms, unaware that gluten is theculprit.  This is because the link to gluten is not yet recognized bythe medical community. Gluten-containing products are being added to our food chain inincreasing amounts.  Our wheat is being engineered to have even highergluten content.  This gluten overload is occurring without ourcommunities being unaware of the harm that this is causing. Gluten can cause malfunctions of the brain and neural networks ofsusceptible people.  The incidence of mental, neurological and braindisorders is on the rise.  However, the diagnosis of gluten-sensitivityis seldom made. The community is already embracing the notion ofgluten-sensitivity.  More and more people are opting for a gluten-freelifestyle.  These people are looking for a term to identify theirillness.  Their search is over.  They have been affected by The GlutenSyndrome. A strong gluten-free movement is developing globally in responseto the knowledge that going gluten-free can be so beneficial to so manypeople.  What has been missing up until now is a name that captures thegluten problem.  The missing name is The Gluten Syndrome.

    Get Your Blood TestsThe Gluten Tests
    Glutenis a protein that is found in wheat grains.  This protein has a numberof components, one of which is called gliadin.  People who get sickfrom gluten are usually reacting to the gliadin component.  
    You are a Long Tube
    Tounderstand what the blood tests mean, first you need to know a littlemore about your immune system.  It is the job of your immune system toprotect you from the outside world.  It protects you from the invasionof microbes (viruses and bacteria), and it also protects you from thetoxins and poisons in the food that passes through your gut.  Your gutis a long tube inside you that travels from your mouth to your anus. This is your gastrointestinal tract, also called your bowel.  Eventhough it is inside your body, the contents of this tube are still onthe ‘outside’ from your body’s point of view.  Lots of your immunecells coat the skin (called the mucosa) of this tube and work hard toprotect you from anything that might prove to be harmful.
    Gluten (Gliadin) can be Toxic
    Gliadin,the toxic component of the gluten protein, is one such harmfulsubstance.  Your immune system defends your body strongly againstgliadin using weapons called antibodies and the gliadin is repelled. The outcome of your immune system’s fight against gliadin is theproduction of antibodies that are specifically targeted towardsgliadin: these are called anti-gliadin antibodies.
    Gliadin Antibodies
    Anti-gliadinAntibodies (commonly called the IgG-gliadin antibody) are weapons thathave been made specifically to fight against gluten in the diet. Remember, gliadin is a component of the gluten protein.  This antibodyis very sensitive.  It is made very specifically by your immune systemto fight against gliadin.  However, a high level of this antibody doesnot necessarily mean that you have any gut damage, so it is not veryaccurate in assisting the identification of patients with celiac gutdamage.  On the other hand, tests for this antibody are nearly alwaysstrongly positive in people with celiac disease who are not on agluten-free diet.  Once people are placed on a strict diet, theseantibodies will fall to normal levels within a period ranging from fewmonths to a year or two.
    Gluten Tests Not Getting Done
    Thereis a problem.  Unfortunately, this gluten blood test (the IgG-gliadinantibody test) is no longer available from most communitylaboratories.  This year many laboratories have decided to discontinuethis test.  Their opinion is that it is worthless (for detecting celiacdisease).
    I disagree with their decision.  My latest data shows thathuge numbers of people remain undiagnosed with serious symptoms becauseof the misinterpretation of this gluten test result.  At the moment itis difficult to get the medical labs to do your gluten test.  They areunwilling to consider that gluten causes a wide spectrum of illnessthat has been written up in the international medical literature.  Theyhave turned a blind eye to the problem.  If you can’t test for glutenreactions, then you will not be able to make the diagnosis!
    A Diagnosis at Last!
    Mandywrote this letter to me: “Hi Dr Rodney Ford, for many, many, years Ihave been to doctors complaining of a bloated tummy, extreme crampingpains, and diarrhea (to the point I had no time to get to the toilet). I have recently had some blood test for celiacs done by my GP.  Myresults showed: the tTG was negative; and the IgG-Gliadin resultstrongly positive.  He could not explain it to me, but he said that Idid not have celiac disease.”
    “I have no idea what these testsmean.  Although I got no answers, I had to try something.  I was at theend of my nerves!  My bad health has always been upsetting my socialand working life.  I often have to rush home to the toilet.”
    Amazing on a Gluten-free Diet
    “SoI decided to try a gluten-free diet!  I have now been gluten-free for amonth.  It is amazing! Already I feel like a different person!  No morebloating, just the odd stomach cramp.  Also, all my headaches havegone.  But I still feel really tired and not sure how to overcomethis.  Can you help me please by explaining my blood test results—andshould I have anymore tests?  What else I can do to help myself?   Ihope you can help me Dr Ford.  Gluten, up to now, seems to have made mylife a misery.  Even though I feel so much better already, I want toget even better.  Kind regards, Mandy.”
    The Gluten Syndrome
    Ireplied: “Thanks.  I am glad that you are feeling a lot better offgluten.  From your story and your blood test results, you havegluten-sensitivity.  You do not have celiac disease (your low tTG levelshows that you do not have any gut damage from gluten).  But you arestill getting sick from gluten (your high IgG-gliadin level shows thatyour body reacts to gluten).  The good news is that it takes manymonths to get the full benefits of a gluten-free diet.  I expect thatyou will continue to feel better over the next few months.  You shouldbe taking some additional iron and a multivitamin supplements becauseyou will be relatively iron deficient—that will be making you tired.”
    The Time has Come
    Thehistory of science and medicine is littered with vehement argumentsagainst any new idea that runs contrary to traditional beliefs. Ironically however, it takes new ideas to make progress.  It was GeorgeBernard Shaw who said that “The reasonable man adapts himself to theworld: the unreasonable one persists in trying to adapt the world tohimself.  Therefore, all progress depends on the unreasonable man.”
    Thousands Convinced
    Manypeople are joining the ranks of the gluten-free.  There are thousandsof people like you who have read this information and who are concernedabout how gluten might be affecting them; there a millions of peoplewho are sick and tired of being ignored and who are looking for moreenergy and vitality; there are the practitioners in the field ofcomplementary medicine who are aware of the concept ofgluten-sensitivity; there are the laboratories who have developed thegliadin antibody test and know that their tests are specific for glutenreactions; there are the gluten-free food manufacturers who haverecognised that there is an ever-increasing demand for gluten-freeproducts; there are the networks of people in the health food industrywho appreciate the value of high-quality food and a gluten-free diet;and there are the supermarkets and grocery stores that are sensitive tothe demands of their customers.
    Who Might Oppose this Trend?
    Aspreviously discussed, medical practitioners are wary of overturningtradition.  They do not want to be seen as alternative and want toavoid acting outside of the recommended clinical guidelines.  Inaddition, there are the grain-growers and the bread-makers who maketheir living from gluten, and the pharmaceutical companies who maketheir living from the sick and unwell.  
    Bad Behavior on Gluten
    Kimberleyis 12 years old.  She has The Gluten Syndrome and her behavior getsdisturbed with gluten.  She does not have celiac disease but she doeshave a high gluten test.  (Her IgG-gliadin level was 55 units—It shouldbe less than 20.)
    Her mum said: “It is interesting about howbehavior troubles are linked to gluten!  Our youngest, Kimberley, isnow 12 years old.  She had her IgG-gliadin measured and it was high. She was clearly a lot better when she was off gluten.  However then shedecided to ‘try’ gluten again.  Rodney suggested a small amount but shewent for it—big time!”
    By the end of a week, two other parentshad asked what was wrong with her.  Another parent asked “what onearth’s the matter with her” she seemed so different and stroppy.  Sheadmitted she felt “absolutely awful” but really didn’t want to admit itas she knew it meant she’d have to completely give up gluten.”
    Anyway,after a lot of talking, she agreed it wasn’t in her best interests toeat gluten.  From that day she has been gluten-free ever since, withthe odd very long envious glance at French bread!  With our supportshe’s very compliant with being gluten-free now, which I think is remarkable forher age.  Clearly she now understands and gets the benefits of gluten-free.  ButI was really shocked at how affected her behavior was after areintroduction of gluten.”
    Could You Have The Gluten Syndrome?
    Onein every ten people is affected by gluten.  If you have chronic symptom(feeling sick, tired and grumpy) then you should get checked for TheGluten Syndrome. 


    Jennifer Arrington
    I would hate to add up all the hundreds of dollars I have wasted trying to get healthy.  Now, however, I get healthy by focusing on one thing:  making my intestines healthy.  If my intestines are healthy, I can absorb food.  If I can absorb food, my body will be receiving the nutrition it needs to function, and thus I will be healthy.
    Of course, rule number one for all of us is to stay gluten free.  But, focusing on avoidance alone, can get depressing.  Instead, I like to focus on what I can do to strengthen my digestive system.  That way, all the good gluten free food I am consuming can actually benefit my body.  What good is eating healthy if you are unable to absorb the nutrients?  Pouring healthy food into a compromised gut would be as wasteful as pouring dollar bills over an ATM machine and hoping in vain to strengthen your bank account balance.
    Research shows that those of us with celiac disease/gluten intolerance often have decreased absorption despite following a strict gluten free diet.  Scott Adams summarized one of these articles on the celiac.com website back in 2003.  The article by Lee SK, et al. entitled “Duodenal Histology in Patients with Celiac Disease after Treatment with a Gluten-free Diet” implied that even though patients may feel better on a gluten-free diet, there may still be damaged intestinal areas that are incapable of optimal nutrient absorption.  Since specific nutrients are absorbed along specific locations in the small intestine, this can have long-term ramifications.  For instance, the proximal portion of the intestine is the site for absorption of vitamin B6 (pyroxidine).  If that portion is damaged, there will be decreased absorption, and your body will be deficient in B6.  You may then experience a range of neurological symptoms such as nervousness, irritability, and shakiness.  And, as happened in my case, you may see a doctor, only to be told you are having anxiety attacks and be handed a prescription for a mild tranquilizer.  Thankfully, I discovered that a good B6 supplement (Solgar “Magnesium with B6”) was all I needed and threw away the offending prescription, but this serves as an excellent—albeit oversimplified—example as to why we have to focus on improving the health of our intestines.
    Before I go on, I do want to say that the products listed below do not benefit me financially in the least.  Additionally, these are the products that work best for my body.  You may find a different brand works better for you, but as long as our focus is on getting those intestines healthy, we are all heading in the right direction!
    So, read on about what I personally consider the top four intestinal healing supplements…
    The first and best all-round product I have found that truly aids in restoring the intestinal lining is a glutamine supplement put out by a company called Metagenics.  The supplement, called “Glutagenics”, contains glutamine, licorice root, and aloe vera.  While studying for my masters in nutrition at Texas A&M University, we learned that glutamine is a key amino acid that aids in restoring the intestinal lining in patients that are transitioning from being tube-fed to a normal diet.   So, when my own chiropractor suggested this supplement and mentioned it contained glutamine, I purchased it and have been taking it on and off for three years.  
    Glutagenics is available online through various websites that carry the Metagenics brand. The supplement is unfortunately a bit cost prohibitive, but you can shop around for other brands that contain a similar blend, or buy the three active ingredients separately. Unfortunately, this did not work for me (I have an expensive gut), but it may for you.
    The next product is a good omega-3 fatty acid. Omega-3 fatty acids have so many benefits that even if you weren’t working on building up your intestines, they would still be beneficial. During my graduate research, I was fortunate to be part of an ongoing study on the mechanism whereby omega-3 fatty acids reduce the inflammatory response. Obviously, when our intestines are damaged, there is plenty of inflammation. So, including omega-3 fatty acids in our diet is vital.
    Thankfully, omega-3 fatty acids are getting easier and easier to come by. My family eats the high omega-3 brand eggs and the Smart Balance peanut butter and butter spreads. You can also purchase wonderful oil blends by Nordic Naturals. My favorite is the lemon-flavored Omega-3 liquid. The lemon flavor truly masks the fishy taste and even my children swallow the oil with minimal grumbling. Nordic Naturals is quite expensive (around $20.00 for 8 oz) but if you compare the amount of DHA you are getting per serving, it is definitely the most DHA for your dollar!
    Another great healing nutrient is zinc. Zinc is wonderful for wound healing- you’ll see it in many topical creams, but it also helps restore the intestines. Metagenics puts out a great supplement and their products are great for sensitive individuals. I find that 10mg works best for me. I don’t take it every day – too much will give you a bad taste in your mouth. Once I get that bad taste, I know I need to go off it for awhile.
    Finally (for now), find a great probiotic. The one that everyone recommends, by Garden of Life, contains wheat grass, so we have to avoid it. I do extremely well, however, on a product called Lacidophil by Xymogen. My energy levels actually improve on this brand. Xymogen has their own website where you can purchase products directly. Taking a good probiotic restores a healthy balance to your gut flora, which aids in overall health and digestion. I have just recently ordered one from Emerson Ecologics through a natural doctor and it’s supposed to be even better. It has many more strains of the good bacteria so I’m going to try it as soon as it comes in.
    Of the four products listed above, the two that I take daily are the probiotic and omega-3 oil. The other two I take on an ‘as-I-need-it’ basis.
    Unfortunately, our bodies don’t tolerate a lot of extra supplements, so go slowly and only add one at a time. Keep track of how you feel. You may never tolerate the mass quantities that some companies will try to sell you. But, since you are your own best manager, work with yourself slowly and patiently and you will find your health improves over time.
    May God bless you with the wisdom and discernment you need to live a healthy and vibrant life!


  • Recent Articles

    Jefferson Adams
    Celiac.com 04/20/2018 - A digital media company and a label data company are teaming up to help major manufacturers target, reach and convert their desired shoppers based on dietary needs, such as gluten-free diet. The deal could bring synergy in emerging markets such as the gluten-free and allergen-free markets, which represent major growth sectors in the global food industry. 
    Under the deal, personalized digital media company Catalina will be joining forces with Label Insight. Catalina uses consumer purchases data to target shoppers on a personal base, while Label Insight works with major companies like Kellogg, Betty Crocker, and Pepsi to provide insight on food label data to government, retailers, manufacturers and app developers.
    "Brands with very specific product benefits, gluten-free for example, require precise targeting to efficiently reach and convert their desired shoppers,” says Todd Morris, President of Catalina's Go-to-Market organization, adding that “Catalina offers the only purchase-based targeting solution with this capability.” 
    Label Insight’s clients include food and beverage giants such as Unilever, Ben & Jerry's, Lipton and Hellman’s. Label Insight technology has helped the Food and Drug Administration (FDA) build the sector’s very first scientifically accurate database of food ingredients, health attributes and claims.
    Morris says the joint partnership will allow Catalina to “enhance our dataset and further increase our ability to target shoppers who are currently buying - or have shown intent to buy - in these emerging categories,” including gluten-free, allergen-free, and other free-from foods.
    The deal will likely make for easier, more precise targeting of goods to consumers, and thus provide benefits for manufacturers and retailers looking to better serve their retail food customers, especially in specialty areas like gluten-free and allergen-free foods.
    Source:
    fdfworld.com

    Jefferson Adams
    Celiac.com 04/19/2018 - Previous genome and linkage studies indicate the existence of a new disease triggering mechanism that involves amino acid metabolism and nutrient sensing signaling pathways. In an effort to determine if amino acids might play a role in the development of celiac disease, a team of researchers recently set out to investigate if plasma amino acid levels differed among children with celiac disease compared with a control group.
     
    The research team included Åsa Torinsson Naluai, Ladan Saadat Vafa, Audur H. Gudjonsdottir, Henrik Arnell, Lars Browaldh, and Daniel Agardh. They are variously affiliated with the Institute of Biomedicine, Department of Microbiology & Immunology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; the Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Karolinska University Hospital and Division of Pediatrics, CLINTEC, Karolinska Institute, Stockholm, Sweden; the Department of Clinical Science and Education, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden; the Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden; the Diabetes & Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden; and with the Nathan S Kline Institute in the U.S.A.
    First, the team used liquid chromatography-tandem mass spectrometry (LC/MS) to analyze amino acid levels in fasting plasma samples from 141 children with celiac disease and 129 non-celiac disease controls. They then crafted a general linear model using age and experimental effects as covariates to compare amino acid levels between children with celiac disease and non-celiac control subjects.
    Compared with the control group, seven out of twenty-three children with celiac disease showed elevated levels of the the following amino acids: tryptophan; taurine; glutamic acid; proline; ornithine; alanine; and methionine.
    The significance of the individual amino acids do not survive multiple correction, however, multivariate analyses of the amino acid profile showed significantly altered amino acid levels in children with celiac disease overall and after correction for age, sex and experimental effects.
    This study shows that amino acids can influence inflammation and may play a role in the development of celiac disease.
    Source:
    PLoS One. 2018; 13(3): e0193764. doi: & 10.1371/journal.pone.0193764

    Jefferson Adams
    Celiac.com 04/18/2018 - To the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service animals.
    If you’ve flown anywhere lately, you may have seen them. People flying with their designated “emotional support” animals. We’re not talking genuine service animals, like seeing eye dogs, or hearing ear dogs, or even the Belgian Malinois that alerts its owner when there is gluten in food that may trigger her celiac disease.
    Now, to be honest, some of those animals in question do perform a genuine service for those who need emotional support dogs, like veterans with PTSD.
    However, many of these animals are not service animals at all. Many of these animals perform no actual service to their owners, and are nothing more than thinly disguised pets. Many lack proper training, and some have caused serious problems for the airlines and for other passengers.
    Now the major airlines are taking note and introducing stringent requirements for service animals.
    Delta was the first to strike. As reported by the New York Times on January 19: “Effective March 1, Delta, the second largest US airline by passenger traffic, said it will require passengers seeking to fly with pets to present additional documents outlining the passenger’s need for the animal and proof of its training and vaccinations, 48 hours prior to the flight.… This comes in response to what the carrier said was a 150 percent increase in service and support animals — pets, often dogs, that accompany people with disabilities — carried onboard since 2015.… Delta said that it flies some 700 service animals a day. Among them, customers have attempted to fly with comfort turkeys, gliding possums, snakes, spiders, and other unusual pets.”
    Fresh from an unsavory incident with an “emotional support” peacock incident, United Airlines has followed Delta’s lead and set stricter rules for emotional support animals. United’s rules also took effect March 1, 2018.
    So, to the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service and emotional support animals.
    Source:
    cnbc.com

    admin
    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
    Researchers know for certain that genetic heredity plays a major role in celiac disease. If a first-degree relative has celiac disease, then you have a statistically higher risk of carrying genetic markers DQ2 and/or DQ8, and of developing celiac disease yourself. NCGS is not known to be hereditary. Some research has shown certain genetic associations, such as some NCGS patients, but there is no proof that NCGS is hereditary. No Connection with Celiac-related Disorders
    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
    Doctors diagnose NCGS only by excluding both celiac disease, an IgE-mediated allergy to wheat, and by the noting ongoing adverse symptoms associated with gluten consumption. WHAT ABOUT IRRITABLE BOWEL SYNDROME (IBS) AND IRRITABLE BOWEL DISEASE (IBD)?
    IBS and IBD are usually diagnosed in part by ruling out celiac disease. Many patients with irritable bowel syndrome are sensitive to gluten. Many experience celiac disease-like symptoms in reaction to wheat. However, patients with IBS generally show no gut damage, and do not test positive for antibodies to gliadin and other proteins as do people with celiac disease. Some IBS patients also suffer from NCGS.

    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