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  • Dr. Rodney Ford M.D.
    Dr. Rodney Ford M.D.
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    The Gluten Syndrome—Gut, Skin and Brain

    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 Tests

    The 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. 


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    Excellent article. I have 10 members with celiac disease and 7 or 8 with gluten sensitivity. Some Doctors don't recognize this and I would like a printed version of this article. Great Job!

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    This is an excellent, direct, and very informative article. It makes it easier for a Celiac or Gluten Intolerant individual to help family members and friends understand how important it is for them to completely abstain from gluten in their diet. It also heightens awareness as to how common this Gluten Intolerance is becoming in the western world.

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    Enjoyed the article. Elaborating on adult symptoms would also be helpful as I also tested negative for celiac disease - I have many health issues including muscle and joint pains that improve when I fast and when I avoid gluten in my diet. I am 59 and when I was younger did not have chronic health issues, I guess my immune system was able to handle the toxins, but now it has caught up with me and I have had problems for the last 10 years. As an older adult celiac manifests itself in different ways than children who are affected at an early stage of life. Many adults refuse to believe they have a problem with gluten and do not see that they might. Opening their eyes to adult symptoms may shed new light on correct diet. Thanks for the great article.

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    I have celiac disease. I have constipation instead of diarrhea. I have been gluten free but still have the constipation. Can you make a suggestion in regard to possible help with it?

    Thanks, Pauline

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    I've been having GI issues along with additional aches and pains, mood swings for some time (more frequently and severe for the past 6-8 months). Had my first migraine ever maybe 5 months ago (never want another one). A co-worker and real close friend mentioned gluten. I began delving into it and noticed a lot of the symptoms were similar to what I've been experiencing. Not being keen on doctors and hospitals in general, I thought what is the harm in going gluten free for a while and monitor what happens. A lot of the symptoms diminished and was actually somewhat better.

     

    The GI symptoms quickly diminished and decided it was time for a test. I tried a grilled burger (not a fast food meal either) for lunch and for the remainder of the afternoon and throughout the evening I had searing pains across my abdomen.

     

    Upon returning home, I just laid on the sofa and went to bed early. The next day there was minor discomfort across the abdomen, but not serious. For lunch I went home and ate a gluten free lasagna frozen entrée, munching on gluten free pretzels and plan on eating a gluten free pizza for supper when I return home. I plan on purchasing more gluten-free foods after work and going back on it. Also planning on being tested for gluten intolerance (knowing full well that for the test to be accurate, I will have to indulge in meals containing gluten).

     

    Whether coincidence or not, going gluten-free (even for a short time) has made me feel better. I'm sure a longer duration would be much more conclusive.

     

    Fabulous article as are many that I've read along with many recipes I've accumulated and plan to start implementing.

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    I have suffered from all of the symptoms of celiac disease and never knew what it was. I had an upper and lower GI and was found fine. After discovering celiac and its symptoms I went gluten free. I feel so much better. Thank you for these articles. The only thing I don't understand is why didn't my Gastroenterologist do a simple blood test to see if I had Celiac. I still had the same problems after getting the GI come back good. You would think they would check if you are allergic to gluten.

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    My 81 year old husband was diagnosed with celiac after being miserably sick after Easter. We thought it was food poisoning, but someone in the family ate everything he did and weren't sick.After emergency tests we were told no gluten. What a difference. His 20 year long itchy back is cured, his eyes are better, his appetite is back [he was down to 118lbs.] Life is much better even though I'm learning to cook a different way.

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    I suffered with so called "fibromyalgia" for 12 years only to find out that I have celiac disease. I am on a gluten free diet now and feel 99% better. Years of not knowing has left my muscles weak but I have now started using weight machines and increasing my muscle strength. By the way, my symptoms were not with my digestive tract. I had muscle pain and weakness, joint pain, could not sleep, brain fog, extreme fatigue, etc. I requested that my previous doctors test for celiac before making a fibromyalgia diagnosis. I could go on and on. I thank God every day that I finally found the answer to my problem. I am glad that you are linking other problems besides just intestinal problems to celiac.

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    Guest Jackie MacIlroy

    Posted

    I have suffered for years oddities of health issues, some stories although not funny at the time, I can laugh at it now. However, over the last 10 years I have been treating my own symptoms of irritable bowl syndrom, fatigue, fibroblast, irritability, joint pain and much more. Although I had managed to treat them symptoms to a degree as the years passed my symptoms became more disruptive. By the grace of a great gastric intestinal specialist it was discovered that I tested blood positive for celiac and I am going for the biopsy this week. After reading these articles, which I might add that I have avoided reading until now, I am looking forward to a gluten free diet to start feeling better.

     

    When first told I had celiac or gluten intolerance I didn't believe the doctors because I am obese and I have never met an obese celiac person, they have all been skinny and struggling with their health. Even though I struggle with health issue, skinny has never been my problem. But something I have not read anywhere here is my gastric intestinal specialist said to me: You just might find that the weight will resolve itself with a gluten free diet. That would be nice, but what would be nicer is feeling healthy. So I am looking forward to feeling better and getting better, as for the weight, well I have 70lbs off so far I am hoping that gluten free will only add to that number.

     

    Reading these articles have been eye opening. Thank you.

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    I have been gluten-free for 2 years now and am feeling much better now. Every once in a while I have an urge to eat something with gluten but stay away. I have epilepsy and calcium deficiency and think they are due to my gluten syndrome. Since I have gone gluten-free I no longer have pains in my skull and I don't have the achy joints. It is worth it.

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  • About Me

    Dr. Rodney Ford is a Pediatric Gastroenterologist. He was Professor of Pediatrics at the Christchurch School of Medicine. He runs the Children's Gastroenterology and Allergy Clinic in New Zealand. He has written a series of 7 books on gluten (www.DrRodneyFord.com). His main theory is that symptoms from gluten reactions arise from brain and nerve damage. His latest book is "The Gluten Syndrome" which encapsulates current ideas and concepts of gluten and the harm that it does.

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    Celiac Disease Diagnosis
    Celiac disease can be challenging to diagnose, because its symptoms are often similar to those of other diseases. Celiac disease is easily taken for other diseases such as Crohns disease, chronic fatigue syndrome, diverticulitis, various intestinal infections, irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss. Thus, celiac disease is often misdiagnosed, and greatly under-diagnosed.
    Celiac practice guidelines call for routine screening of anyone with a family history of celiac disease or of disorders such as thyroid disease, anemia of unknown cause, type 1 diabetes or other immune disorders or Downs syndrome. Otherwise, patients are generally screened case by case according to individual symptoms.
    Considerations for Celiac Disease
    As a general practice, celiac disease should be considered in the earliest stages of differential diagnosis of children with persistent diarrhea, especially with failure to thrive. Celiac disease should also be considered in the differential diagnosis of children with persistent GI symptoms, including recurrent abdominal pain, constipation and vomiting, and any other GI issues commonly associated with celiac disease.
    Testing is recommended for children with celiac-associated non-gastrointestinal symptoms, such as delayed puberty, dental enamel hypoplasia of permanent teeth, dermatitis herpetiformis, iron-deficient anemia resistant to oral iron, osteoporosis, and short stature. Testing is also recommended for asymptomatic children whose relatives have celiac, and those who have celiac-associated conditions, such as autoimmune thyroiditis, Down syndrome, selective IgA deficiency, Turner syndrome, type 1 diabetes mellitus, or Williams syndrome.
    Celiac practice guidelines call for testing asymptomatic children who belong to at-risk groups at around 3 years of age, as long as they have eaten gluten regularly for at least 1 year before testing.
    First-degree relatives of individuals with celiac disease may or may not manifest symptoms of the disease.
    Predisposition to gluten sensitivity has been mapped to the major histocompatibility (MHC) D region on chromosome 6. The most important HLA haplotype is DQw2, which is often in linkage with DR3. Other important HLA haplotypes identified are DR7 and DPB 1, 3, 4.1 and 4.2.
    The sites on these MHC class 2 expressed proteins responsible for interacting with gliadin and host T cell receptors thereby sensitizing the intestine to gluten have not been identified.
    Therefore, guidelines call for regular testing of asymptomatic individuals with negative serological tests, and who belong to at-risk groups. Treatment guidelines do not presently call for routinely testing autistic children for celiac disease, as there is no evidence that celiac is more in autistic children than in the general population.
    Celiac Disease Testing
    There is currently no test for diagnosing celiac disease with 100% certainty. For most people, the disappearance of symptoms, and/or the appearance of a "normal" biopsy following the adoption of a gluten-free diet provide the strongest evidence for celiac disease or gluten intolerance.
    A blood test, such as anti-tissue transglutaminase and anti-endomysial antibodies, can detect abnormally levels of antibodies, and is often used in the initial detection of celiac in people who are most likely to have the disease, and for those who may need further testing.
    Based on the current evidence and practical considerations, including accuracy, reliability, and cost, measurement of IgA antibody to human recombinant tissue transglutaminase (TTG) is recommended for initial testing for celiac disease. Although as accurate as TTG, measurement of IgA antibody to endomysium (EMA) is observer dependent and therefore more subject to interpretation error and added cost. Because of the inferior accuracy of the antigliadin antibody tests (AGA), the use of AGA IgA and AGA IgG tests alone is no longer recommended for detecting celiac disease.
    Several serological markers are useful in diagnosing celiac disease. The first of these is IgG class antigliadin antibody (AGA). This antibody is sensitive to gluten, but it is also found in other diseases and thus is not a good a specific indicator of celiac.
    Generally, IgA class AGA is more specific, but about 2% of celiac patients show selective IgA deficiency, and thus show negative results, even though they have celiac.
    A positive IgG and IgA AGA gives a reported sensitivity of 96% to100% and specificity of 96% to 97%. Recent studies show Anti-reticulin antibodies (ARA) in people with celiac disease, but these appear to be nonspecific. In fact, taken alone, IgG ARA is largely ineffective. However, IgA ARA has sensitivity of 97% and a specificity of 98% in adults. These figures are much lower in children.
    IgA class anti-endomysial antibody (EMA) and human jejunal antibody (JAB) have recently been identified as both sensitive and specific for celiac disease.
    The antibody EMA, which reacts against endomysium reticulin fibers, has been found only in people with active celiac and not other diseases. As EMAs are associated with other diseases in children, they are a less accurate indicator of celiac in children than in adults.
    Studies in children less than 2 years old with celiac disease have shown a steep fall in EMA sensitivity, so EMA appears even less useful than in children over 2 years of age.
    Finally, since the EMA and JAB antibody tests may be negative in adults with celiac disease and IgA deficiency, they cannot be considered definitive for diagnosis of celiac disease.
    A complete panel of antibody tests seems to be most accurate method of diagnosing celiac disease.
    Taken together, a positive panel of IgG AGA, IgA AGA and EMA can predict the presence of celiac disease in 99.3% of patients. A negative panel of IgG AGA, IgA AGA and EMA can predict the absence of celiac in 99.6% of patients.
    These antibodies tend to diminish or disappear when individuals maintain a gluten-free diet.
    More than 90% of patients with celiac disease have genetic markers HLA DQalpha *0501, and HLA DQbeta *0201. Negative tests for these markers in conjunction with negative serum antibody tests suggest an absence of celiac disease. However, positive tests for the genetic markers do not necessarily mean that the patient has celiac disease. In conclusion, genetic markers can be used as a test to exclude celiac disease as a diagnosis.
    Celiac Disease Biopsy
    A diagnosis of celiac disease is generally confirmed through a biopsy, by looking for celiac associated damage to the small intestine.
    One important fact is that intestinal biopsies are regularly obtained endoscopically from the duodenum and therefore provide no information regarding the extent of disease along the jejunum.
    Flattening of the villi usually occurs first, and most severely, in the duodenum, as it the duodenum is the first part of the intestine to be exposed to gluten. Conversely, the villi of the jejunum, which receives much less exposure, are often asymptomatic, and nearly normal.
    In most of these individuals, treatment with a gluten-free diet results in the return of all villous and crypt structures to normal or near normal.
    Certain conditions, especially infection, can yield intestinal biopsy results that are similar to those of celiac disease, and it is important to consider and/or exclude these conditions when celiac disease is suspected.
    Practice Guidelines for Treatment of Celiac Disease with an Aggressive Life-long Gluten-free Diet
    As there is presently no cure for celiac disease, avoiding gluten is crucial. Practice guidelines call for a life-long gluten-free diet as the standard treatment for celiac disease. To manage the disease and prevent complications, its essential that patients avoid all foods that contain gluten. That means it is crucial for the patient to avoid all foods made with wheat, rye, or barley. This includes 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.
    It is also good practice for patients to 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 a good practice when first adopting a gluten-free diet to eliminate oats, at least until symptoms subside, and their reintroduction into the diet can be fairly monitored and evaluated.
    Another good practice is coaching celiac patients to avoid processed foods that may contain hidden gluten. Wheat flour 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, lunchmeat, mustard, pastas, processed meat, sausages, and yogurt.
    Also, gluten is also commonly found in many vitamins and cosmetics, such as lipstick, and in the production of many capsules and tablets, where wheat starch is a commonly used binding agent.
    Obviously, patients must avoid beer made with barley or wheat (there are gluten-free beers), though wine, brandy, whiskey and other non-wheat or non-barley alcohols are okay.
    Encourage patients to eat a diet rich in fish, fresh meats, rice, corn, soybean, potato, poultry, fruits and vegetables. Patients should also avoid milk and other dairy products, as it is common for patients with celiac disease to be lactose intolerant. Dairy products can often be slowly reintroduced into the diet over time with successful treatment.
    It is also important for patients to learn to 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.
    For lists of gluten-free foods and products, and for specific advice on adopting, shaping and maintaining the gluten-free diet that is right for them, patients may wish to consult a registered dietitian who is experienced in teaching the gluten-free diet.
    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 re-growth 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.
    The Importance of Follow-up Testing for Celiac Patients on a Gluten-free Diet
    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.
    Thus, it is important to conduct follow-up testing of celiac patients to determine the success of their gluten-free diets, and the progress of their treatment, and to make any necessary adjustments to each. Even done properly, with no accidental consumption of gluten, the elimination of gluten antibodies from the blood takes months. To estimate the treatments effectiveness, current guidelines call for a single serological testing after 3-6 months on a gluten-free diet.
    For patients who are free of antibodies, and actively following a gluten-free diet, it is wise to consult a doctor if there is any recurrence of celiac-associated symptoms. First-degree relatives of celiac patients should have a repeat blood test every 2-3 years.
    health writer who lives in San Francisco and is a frequent author of articles for Celiac.com. 

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    I have a theory about my lipomas. I have just recently been diagnosed with hashimotos which is an auto immune disorder. Apparently having one auto immune disorder puts you at greater risk for other immune disorders. I believe cancerous tumors come from the immune system trying to contain and fight the cancer. And my theory is that lipomas come from the immune system targeting fat cells thinking they are bad invaders so they get contained just as a malignant tumor would. I have several lipomas on my lower arms and thighs. I have just been put on a gluten free diet by my doctor for my hashimotos as well as having to take selenium, probiotics and L glutamine daily. Anyways, I believe lipomas are just another auto immune disorder that just might also be fixed by diet and fixing gut issues since the immune system is tightly connected to gut health. Just my two cents.
    Again Primal Kitchen is canola free, they use Avocado Oil in all their mayo, dressings, sauces. I would suggest them for Mayo, Salad Dressings, Sauces, and Condiments. They are grain free also with Paleo Diet base (diet of our ancestors)
    https://thrivemarket.com/brand/primal-kitchen
    https://www.primalkitchen.com/collections
    I use Best Foods which is on the west coast.  Hellman’s is on the east.  It is safe as far as gluten free goes.  I do not have soy issues.  You can make mayo from scratch.  It is easy.  Scan the internet for the type of oil is best for you.   https://m.youtube.com/watch?v=-CVYVFj1vmQ  
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