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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—GLUTEN SENSITIVITY: WHAT'S THE DIFFERENCE? BY RON HOGGAN


    Dr. Ron Hoggan, Ed.D.


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    This article appeared in the Spring 2005 edition of Celiac.coms Scott-Free Newsletter.

    Celiac.com 04/10/2005 - Celiac disease is, by definition, a condition in which the intestinal wall is damaged as a result of eating gluten. It is a chronic illness in which the symptoms wax and wane1 for reasons that are not yet understood. Celiac disease is the result of genetic and environmental factors. We now know two HLA markers (DQ2 and DQ8) for the predisposition for celiac disease2. One environmental factor is, of course, the consumption of gluten, but there may be other environmental contributors. Recent research reveals that about 1% of the population suffers from this condition3 although most remain undiagnosed.

    On the other hand, gluten sensitivity is characterized by antigliadin antibodies. This condition afflicts at least 12% of the general population4 and is found in patients with a wide variety of autoimmune diseases. In some studies of neurological diseases of unknown origin, a majority of patients show signs of gluten sensitivity4. These patients are mounting an immune response to the most common food in the western diet, yet many practitioners consider gluten sensitivity to be a non-specific finding, frequently counseling patients to ignore these test results. This is particularly unfortunate since a strict gluten-free diet has repeatedly proven helpful to patients who are fortunate enough to consult a practitioner who is versed in gluten sensitivity and its connection with autoimmunity.

    Untreated celiac disease carries an added risk for a wide variety of additional autoimmune diseases. The most likely cause of this predisposition to additional autoimmune disease is a condition sometimes referred to as leaky gut syndrome. We know that gluten causes intestinal damage. We also know that this damage allows large undigested and partly digested proteins to leak into the bloodstream through the damaged intestinal wall. This leakage results in immune system production of antibodies to attack these foreign proteins as if they were invading microbes. The result is the production of a huge variety of selective antibodies, and each type recognizes a particular short chain of amino acids located somewhere in the proteins structure. Unfortunately, our own tissues can contain very similar or identical sequences of amino acids. Hence, by a process called molecular mimicry, we are producing antibodies that attack both the foreign food proteins that are leaked into our blood through the damaged intestinal wall, and similar amino acid sequences in our own tissues, often resulting in an autoimmune disease5.

    The supposedly non-specific antigliadin antibodies in gluten sensitivity provide two important pieces of information: 1) That the intestinal wall has been damaged and is permitting leakage of food proteins into the bloodstream, and; 2) That the dynamic contributing to increased autoimmunity in celiac disease may well be an important contributing factor in gluten sensitivity5. The currently common view that celiac disease is a serious illness, while disregarding gluten sensitivity, is dangerous to gluten sensitive patients.

    This bias is also a divisive element in the gluten-sensitive/celiac community. Whether a person has "biopsy proven" damage to the intestinal wall, if this person gets sick from eating gluten, or mounts an immune response to gluten, we are all in the same leaky boat (please pardon the pun). We need to work together to get a better understanding of gluten sensitivity in all its forms (including celiac disease). As a community, we need to discourage any kind of dismissal of illnesses that are partly or wholly mediated by gluten.

    If we can stand together in our quest for widespread recognition of the damaging impact of gluten consumption, we can all enjoy a healthier life. Our descendants will also inherit a more gluten-savvy world.

    Ron Hoggan is an author, teacher and diagnosed celiac who lives in Canada. His book "Dangerous Grains" can be ordered at Celiac.com. Rons Web page is: www.DangerousGrains.com

    Sources:

    • Cooke W, Holmes G. Coeliac Disease. Churchill Livingstone, New York, N.Y. 1984.
    • Fasano A. Celiac disease--how to handle a clinical chameleon.
      N Engl J Med. 2003 Jun 19;348(25):2568-70.
    • Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003 Feb 10;163(3):286-92.
    • Hadjivassiliou M, Grunewald RA, Davies-Jones GA. Gluten sensitivity as a neurological illness. J Neurol Neurosurg Psychiatry. 2002 May;72(5):560-3.
    • Braly J, Hoggan R.. Dangerous Grains, Penguin-Putnam-Avery, New York, N.Y., 2002.


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    Guest Judy Alva

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    I wish I could have read this article years ago, it would have saved me from years of suffering.

    Thank you.

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    I loved your article. Thank you for writing it, and for your dedication to helping the gluten-free community--whether celiac or gluten sensitive!

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    Guest Vangie Webb

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    I read the article because I had an EGD last week and the gut shows no evidence of celiac disease yet when I knowingly or otherwise consume even small amounts of wheat, I am uncomfortable within 20 minutes so must be gluten sensitive. I have a daughter who was diagnosed as allergic to wheat as an infant.

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    Guest NickD

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    Many times gluten sensitivity is so low that we accept a state of being that we believe is normal when , in fact, our health is compromised. I underwent a cleansing diet that eliminated gluten and was amazed at how well I felt after 10 days on the diet.

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    Very good article! I have spent the last 5 years suffering from this condition and have been told by many doctors its just ulcerative colitis from stress or the usual acid burns from indigestion and the good old IBS I have rehab myself to a better lifestyle vegetarian that works extremely well lettuce meats protein shakes eggs D3 vitamins, avoiding all that is wheat based. I no longer have my skin falling off my face from heavy fat clustering pimples nor am I anemic nor am I suffering major weight loss from eating wheat once oh and the unbearable crippling cramps in my abdominal area. this is a serious condition and I wish there was an easier way to enjoy life and eat whatever but hey life is full of challenges.

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    Guest Judith

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    I was recently diagnosed with celiac by a rheumatologist. My doctor prescribed antidepressants basically out of frustrastion as he continually told me there was nothing wrong. I am now learning about this disease. Your information has been crucial in both educating and helping me to heal. Thank You!

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    Thank you so much for this informative article. I have been suffering from leaky gut symptoms and mood ailments for quite some time. I have recently started my journey with a gluten-free diet, and have been amazed with the results. Yes, it is challenging to stay committed, but I know I don't ever want to feel mentally and physically drained again merely because of what I'm eating. It's reassuring that there is proven hope!

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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/.

    admin

    CELIAC DISEASE TREATMENT

    By admin, in Celiac Disease,


    Celiac.com 02/08/2007 - There is presently no cure for celiac disease. Celiac patients can vary greatly in their tolerance to gluten. Some patients may not notice any symptoms when they ingest tiny amounts of gluten, for example if something they ingest has been cross-contaminated, while others suffer pronounced symptoms after ingesting even the slightest amount of gluten. Avoiding gluten is crucial
    A life-long diet free of gluten is the standard treatment for celiac disease. To manage the disease and prevent complications, its essential to avoid all foods that contain gluten. That means it is crucial to:
    Avoid all foods made with wheat, rye, or barley. Including types of wheat like durum, farina, graham flour, and semolina. Also, bulgur, kamut, kasha, matzo meal, spelt and triticale. Examples of products that commonly contain these include breads, breading, batter, cereals, cooking and baking mixes, pasta, crackers, cookies, cakes, pies and gravies, among others. Avoid oats, at least during initial treatment stages, as the effects of oats on celiac patients are not fully understood, and contamination with wheat in processing is common. So, its best to eliminate oats at least until symptoms subside and their reintroduction into the diet can be fairly monitored and evaluated. Avoid processed foods that may contain hidden gluten. Wheat is commonly used in many processed foods that one might never suspect. A few examples include: candy bars canned soup canned meat energy bars ketchup ice cream instant coffee lunch meat mustard pastas processed meat sausages Avoid capsules and tablets that contain wheat starch, which is a common used binding agent in their production. Gluten is also commonly found in many vitamins and cosmetics, such as lipstick. Avoid beer (wine, brandy, whiskey and other non-wheat or barley alcohols are okay). Eat a diet rich in fish, fresh meats, rice, corn, soybean, potato, poultry, fruits and vegetables. Avoid milk and other dairy products, as it is common for patients with untreated celiac disease to be lactose intolerant. Successful treatment often means dairy products can be slowly reintroduced into the diet over time. Identify gluten-free foods. Because a gluten-free diet needs to be strictly followed, and because food ingredients may vary from place to place and even over time for a given product, it is important to always read the label. Consider purchasing commercial listings of gluten-free foods and products. For specific advice on adopting, shaping and maintaining the gluten-free diet that is right for you, you may wish to consult a registered dietitian who is experienced in teaching the gluten-free diet. Always read labels, as ingredients often change over time and products that that were once gluten-free may be reformulated and now include gluten in some form. Products that are gluten-free in one country are sometimes not gluten-free in another. Most patients who remove gluten from their diets find that their symptoms improve as inflammation of the small intestine begins to subside, usually within several weeks. Many patients who adopt a gluten-free diet report an improvement within 48 hours.
    Results of a gluten-free diet can be especially dramatic in children with celiac disease. Not only does their diarrhea and abdominal distress usually subside but, frequently, their behavior and growth rate are often markedly improved.
    A reappearance of intestinal villi nearly always follows an improvement in symptoms.
    In younger people, the villi may complete healing and regrowth in several months, while in older people, the process may take as long as two to three years.
    In cases where nutritional deficiencies are severe, celiac patients may require vitamin and mineral supplements to help bring about a healthier vitamin profile: folic acid and B12 for patients with anemia due to folate or B12 deficiency; vitamin K for patients with an abnormal ProTime; calcium and vitamin D supplements for patients with low blood calcium levels or with osteoporosis. For all such cases, individuals should consult their health professional.
    Skin lesions common in patients with dermatitis herpetiformis often improve with adherence to a gluten-free diet.
    For patients with celiac disease, the importance of maintaining a life-long diet free of gluten can hardly be over-stressed. Research indicates that only half of those patients who have had celiac disease for at least 20 years were following a strict gluten-free diet. Up to 30% of those patients showed evidence of bone loss and iron deficiency. These are but a few of the long-term consequences for celiac patients failing to follow a gluten-free diet.
    health writer who lives in San Francisco and is a frequent author of articles for Celiac.com. 

    Dr. Scot Lewey
    Celiac.com 04/24/2008 - Genetic tests for celiac disease and gluten sensitivity are readily available. Testing can be performed on either blood and mouth swab samples. If the testing is performed by certain laboratories not only will you have quite an accurate prediction of your risk of Celiac disease but also you may have information about the statistical probability that your children will inherit the risk, your likelihood of more severe Celiac disease, whether one or both of your parents had the risk gene, and for some laboratories you may determine your risk of gluten sensitivity without Celiac disease.
    The absence of any portion of the high-risk genetic patterns DQ2 and DQ8 nearly excludes the possibility of celiac disease with an approximate accuracy of 99.9%. However, there is a big caveat about relying on "negative celiac genetic testing". To definitively declare you have negative celiac genetic tests requires that the laboratory test for and report the presence or absence of the entire HLA DQ genetic pattern, including both alpha and beta subunits. The DQ genetic patterns DQ2 and DQ8 have two subunits but some laboratories only test for the beta subunit. This DQ typing is complicated and difficult to understand even by physicians and scientists. I have written an updated detailed review that appears in the Spring 2008 issue of Scott-Free newsletter published by celiac.com.
    Data collected by Dr. Ken Fine of Enterolab has supported the well-known fact that the absence of DQ2 and DQ8 does not exclude the risk of being gluten intolerance or sensitive though it now generally believed that one or both of those genetic white blood cell patterns are required to develop the autoimmune disorder known as Celiac disease or Celiac Sprue. However, there is a new study that reports that being negative for DQ2 and DQ8 does not completely exclude the possibility of celiac disease, especially in men. Previous studies have well documented blood test negative Celiac Sprue, also more common in elderly men with long-standing severe disease. Since DQ2 or DQ8 is almost universally present with the specific blood tests tissue transglutaminase and anti-endomysial antibodies are present it is not surprising that individuals without DQ2 or DQ8 that are negative for these two blood tests are being reported that meet criteria for Celiac disease.
    These new studies are also providing further information that the genetics of Celiac is gender specific. If you are a man, your risk of celiac disease may be higher than a woman if you don't have the classic genetic patterns. Again, in this situation your blood tests may be negative. If you are a woman, the risk for Celiac disease is generally higher than a man, especially if you have received the at risk gene from your father instead of your mother.
    Celiac is arguably the most common autoimmune disease. It is very common. It is easily treated. It affects 1/100 people worldwide. However, most people with celiac disease (~90%) are unaware, undiagnosed or misdiagnosed. Most adults finally diagnosed with celiac disease have suffered at least 10-11 years and have seen more than 3 or more doctors. Genetic testing is not only available but can be extremely helpful in determining your risk of developing Celiac disease, how severe it may be and the risk of your family members. Don't be one of those whose diagnosis is missed or needlessly delayed for over a decade. Get tested! Learn about the genetic tests for Celiac disease and if necessary educate your doctor about this testing.
    Here are ten facts you should know and remember about Celiac genetic testing.

    Genetic testing can help determine your risk as well as your children's risk. Celiac genetic tests can be done on blood or a mouth swab sample but your doctor may be unaware of the tests, not know how to order them, or know how to interpret the results. Genetic testing is not affected by diet. You can be eating gluten or on a gluten free diet. Blood tests for celiac disease antibodies, however, need to be done while eating gluten. They can become negative within a few weeks of restricting gluten so if you are going to get the diagnostic antibody blood tests don't begin a gluten free or restricted diet before being tested. Some insurance companies do not for the Celiac genetic test and almost all who do require pre-authorization first. The following diagnostic codes are helpful when requesting insurance coverage: 579.0 (Celiac disease); V18.59 (family history of GI disease); and/or V84.89 (genetic susceptibility to disease). Some laboratories do not perform the all of the necessary components of the test to completely exclude the possible genetic risk of Celiac disease and most don't test for or report the other gluten sensitive DQ patterns. Before you accept that have a negative test you need to know if your test included both the alpha and beta subunits of HLA DQ or did they just perform the beta typing. In some rare individuals, especially some men, a negative genetic test may not exclude the possibility of celiac disease anymore than a negative blood test. Men more commonly have negative genetic tests and blood tests, especially older men with long-standing severe disease. Both the DQ type, and number of copies you have, matter when determining not only your risk but also the possible severity of celiac disease. Two copies of DQ2 carries more risk than one copy of DQ8 or only partial DQ2. Even a single copy of DQ2 alpha subunit ("half DQ2 positive") carries risk for celiac disease but most of the commonly used laboratories for Celiac genetics do not test for or report the presence of this component of the celiac genes. The absence of at risk genes DQ2 and/or DQ8 does not exclude the possibility of being gluten intolerant or sensitive. You may respond to a gluten free diet even if you don't have DQ2 or DQ8 or true autoimmune Celiac disease. You can get genetic testing without a doctor's order and the tests can be done without having blood drawn or insurance authorization if you are willing to pay between $150-400 (www.kimballgenetics.com and www.enterolab.com). Laboratories in the U.S. that are known to offer complete alpha and beta subunit genetic testing include Kimball Genetics, Prometheus, and LabCorp. Bonfils, Quest and Enterolab only test for the beta subunit portions and therefore their test can miss part of a minor alpha subunit that carries a risk of Celiac disease. A negative DQ2 and DQ8 report from these labs may not necessarily be truly negative for the risk of Celiac disease.
    References and Resources:
    HLA-DQ and Susceptibility to Celiac Disease: Evidence for Gender Differences and Parent-of-Origin Effects. Megiorni F et al. Am Journal Gastroenterol. 2008;103:997-1003. Celiac Genetics. Dr. Scot Lewey. Scott-Free, Spring 2008.


  • Recent Articles

    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

    Jefferson Adams
    Celiac.com 04/16/2018 - A team of researchers recently set out to investigate whether alterations in the developing intestinal microbiota and immune markers precede celiac disease onset in infants with family risk for the disease.
    The research team included Marta Olivares, Alan W. Walker, Amalia Capilla, Alfonso Benítez-Páez, Francesc Palau, Julian Parkhill, Gemma Castillejo, and Yolanda Sanz. They are variously affiliated with the Microbial Ecology, Nutrition and Health Research Unit, Institute of Agrochemistry and Food Technology, National Research Council (IATA-CSIC), C/Catedrático Agustín Escardin, Paterna, Valencia, Spain; the Gut Health Group, The Rowett Institute, University of Aberdeen, Aberdeen, UK; the Genetics and Molecular Medicine Unit, Institute of Biomedicine of Valencia, National Research Council (IBV-CSIC), Valencia, Spain; the Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire UK; the Hospital Universitari de Sant Joan de Reus, IISPV, URV, Tarragona, Spain; the Center for regenerative medicine, Boston university school of medicine, Boston, USA; and the Institut de Recerca Sant Joan de Déu and CIBERER, Hospital Sant Joan de Déu, Barcelona, Spain
    The team conducted a nested case-control study out as part of a larger prospective cohort study, which included healthy full-term newborns (> 200) with at least one first relative with biopsy-verified celiac disease. The present study includes 10 cases of celiac disease, along with 10 best-matched controls who did not develop the disease after 5-year follow-up.
    The team profiled fecal microbiota, as assessed by high-throughput 16S rRNA gene amplicon sequencing, along with immune parameters, at 4 and 6 months of age and related to celiac disease onset. The microbiota of infants who remained healthy showed an increase in bacterial diversity over time, especially by increases in microbiota from the Firmicutes families, those who with no increase in bacterial diversity developed celiac disease.
    Infants who subsequently developed celiac disease showed a significant reduction in sIgA levels over time, while those who remained healthy showed increases in TNF-α correlated to Bifidobacterium spp.
    Healthy children in the control group showed a greater relative abundance of Bifidobacterium longum, while children who developed celiac disease showed increased levels of Bifidobacterium breve and Enterococcus spp.
    The data from this study suggest that early changes in gut microbiota in infants with celiac disease risk could influence immune development, and thus increase risk levels for celiac disease. The team is calling for larger studies to confirm their hypothesis.
    Source:
    Microbiome. 2018; 6: 36. Published online 2018 Feb 20. doi: 10.1186/s40168-018-0415-6