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    All Aboard for Sorrento: One Couple's Quest for a Gluten-Free Holiday in Italy (Part Two)


    Jill Schaefer

    Celiac.com 09/11/2008 - After a two-leg flight and multiple trains, Jeff and I finally stepped off the local Circumvesuviana train in sunny Sorrento, our first destination on the fabled Amalfi Coast. It was hot, or as the Italians say, molto caldo. We’d been traveling for nearly 24 hours straight, and as we lugged our bags along the final stretch of cobbled sidewalks toward Casa Astarita, we both felt exhausted, ravenous and more than a bit disoriented.


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    Jill: Any nourishment from our 10-hour flight from Chicago to Rome had long since faded. However, American Airlines had made good on its promise to provide Jeff with decent gluten-free meals. The attendant had confirmed his special meal selection at the beginning of the flight, and at both dinner and breakfast he was among the first to be served (much to the envy of the other hungry passengers!).

    Jeff: For dinner American served me a gluten-free meal of blackened chicken on a bed of quinoa, with green beans, melon and a gluten-free German chocolate cookie. Now, airline food is never going to win any Michelin stars, but I was grateful that my meal was gluten-free, hot and reasonably palatable.

    As we checked into Casa Astarita, the helpful receptionist Marella suggested that we try Bar Syrenuse, a nearby ristorante with gluten-free menu options. Marella even gave us a referral card good for a 10 percent discount. After freshening up, we sauntered a couple blocks to the Piazza Tasso, the main square, where we easily found the cheerful and airy establishment.

    Jill: Bar Syrenuse offered a separate gluten-free menu selection. Many of the items, such as the meats and salads, were regular staples on the menu. Jeff had many options to choose from – including gluten-free pasta. I opted for a club sandwich, stuffed with local ham and cheese, and a caffe alla nocciola (hazelnut coffee).

    Jeff: The intense heat of the day was just beginning to break, and I wasn’t in a pasta mood at that moment, so I ordered pollo al forno (grilled chicken with balsamic vinegar, parsley and chili flakes) and an insalata verde (green salad). The food was delicious, and sitting on the terrace made for a lovely introduction to Italy. All this for two for under 25 euros. Perfecto!

    Day Two: Our stay at Casa Astarita included breakfast, and we’d been assured via email of gluten-free options. The staff did not disappoint and even offered to prepare an omelet if Jeff wished. He ultimately chose from the standard offerings of orange/pineapple yogurt, fresh juices, individually brewed coffee, cheese and corn flakes (which for some might best be avoided) before we began our morning walk.

    Jill: During our meanderings through the town and along the cliffs overlooking the spectacular Bay of Naples, we checked out a few potential lunch spots and perused their menus. We decided on a simple outdoor restaurant, Angelina Lauro, near that train station that offered shaded tables and faced a grassy piazza bearing the same name. Jeff had a vegetable and cheese omelet along with fries, which would frequently become his reliable substitute for bread. I had a scrumptious margherita pizza. It was so big that I was able to save half for lunch the next day.

    Jeff: After a short nap followed by another evening walk along the Marina Grande, we again headed for Bar Syrenuse – this time, with gluten-free pasta in mind! We decided to share a few dishes and ordered gluten-free penne pasta with tiny tomatoes, grilled seasonal vegetables and an insalata caprese. The pasta was nicely cooked, with a flavorful sauce. Jill commented it tasted so good she’d have never known it was gluten-free. It was then I realized just how good it felt to be in Italy, sitting outside and eating pasta, an almost forgotten favorite, as the sun went down.

    The manager of Bar Syrenuse is a personable gentleman named Toni. We were able to pull him aside during a pause in his busy dinner rush and ask a few questions about how the restaurant came to offer gluten-free options. Toni explained that there are so many special diets that it is important to offer many choices to attract the fullest clientele, and noted that a wide range of food options is a reflection of good service, which is good for business. Consequently, Bar Syrenuse offers numerous items that cater to a number of specialty diets.

    Day Three: After a torrid afternoon spent traipsing through the ruins at Pompeii, where we’d consumed just a few snacks – gelato, granita and coconut snack bars – we were ready for a proper meal. The day before, we’d spotted several quaint restaurants tucked away in the alleys near our hotel, and so we headed in that direction.

    We nestled in at Ristorante Sorrento, a charming establishment with a large awning and phalanx of outdoor tables adorned in crisp white tablecloths. Jeff started with minestrone soup, followed by a main course of fresh local white fish with tomatoes in a white wine sauce and a green salad. I choose lemon risotto with shrimp and an order of pane (bread). Jeff got a little extra protein that night as I quickly passed over the jumbo shrimp to his plate. Their heads, with those little black eyes staring back at me, were more than I could take!

    During our stroll back to the hotel, we stopped to purchase a few postcards and sip some cappuccino before settling in for a good night’s rest, before moving on to what would be the absolute gem of our trip, picture-perfect Positano. Check back for our next article featuring our gluten-free gastronomical adventures in this serene oasis by the sea!

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    Guest Amy Lewis

    Posted

    I just returned from Florence, Italy and had a wonderful time. I found it easier to eat over there than it is here in the USA! If you make it to Florence, there is a great restaurant called 'Yellow Bar'. The insalata yellow is fantastic! Wonderful nice people as well. Enjoy your trip!

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    Guest Richard

    Posted

    Good article with good info. I have always, to one degree or another, given up on eating while in Europe. I have been so wary of eating anything that might, just might, have gluten in it that I typically lose 30+ pounds. While the weight loss is welcome (I am not overweight exactly but could always stand to lighten the load a bit) the hungry feeling that never leaves is understandably bothersome. Next time I am over there I will have a new sense of freedom and will definitely report back.

     

    Thanks Jeff and Jill. Keep up the good fight!

     

     

    Richard

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    Guest Mario M

    Posted

    Very good post, I just returned from my holiday in Sorrento, I've been in there few weeks ago, and it was a beautiful holiday! Nice food, wonderful sea and so many things to do! I spend 5 days in Sorrento e 3 days in Amalfi visiting all the nearest areas.

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  • Related Articles

    Jill Schaefer
    Celiac.com 08/07/2008 - We'd begun practicing basic Italian⎯buon giorno! We'd practically memorized the Frommer's travel guide. We'd scoured multitudes of online travel sites and finally made all the arrangements for our once-in-a-lifetime romantic getaway to the sun-kissed shores of the Amalfi Coast.
    As the date of our departure approached, we grew more excited to spend our first major vacation together, tucked away in cliffside hotels, taking in sweeping views of the Mediterranean from our seaside balconies. We had some lingering doubts, though. Jeff follows a gluten-free diet, and I was concerned about how well he'd be able to eat in Italy, the land of pizza, pasta and bread. I know how difficult it can be to dine out, even in our neighborhood in San Francisco. What could he possibly find that would be gluten-free in Italy? And, with the language barrier, how would we be able to easily communicate his needs?
    Jeff: I know a little Italian, but solo un po’ (only a little), as the Italians say. So I, too, was a bit worried. At home, I keep tight control over what I buy, prepare most of my own meals and eat out only at select places that I know are safe. I was worried that consuming every meal at a hotel or restaurant for two weeks straight would present challenges. Like so many people with celiac disease, I've lost more than a few days to gluten contamination. That's the last thing I wanted to happen on such a special trip.
    One of the first things we did was to e-mail the hotels several weeks in advance to see what gluten-free options they might offer. We crafted a short inquiry in English, and just in case the staff only spoke Italian, put it through a free online translation service called Babel Fish. We included both versions in our messages. All four hotels responded within a day or  two, most in English. Three confirmed gluten-free options in the hotel and/or its restaurant. One pledged a solution upon arrival, suggesting that Jeff could communicate a preference for breakfast, and the hotel would meet his needs.
    Jill: I was especially impressed with Casa Astarita, a bed and breakfast along the first leg of our trip in Sorrento. The staff at Casa Astarita noted that we could request food without wheat or barley, recommended a restaurant in the square and pledged to help us during our stay in Sorrento. In addition, the Hotel Margherita in Praiano, a charming seaside town off the beaten path, assured us of gluten-free pasta and biscuits (probably what we would call crackers) in the hotel.
    Another step we took about two weeks before our flight was to contact the airline about gluten-free meal options. We wondered if Jeff would be able to eat gluten-free on both legs of the trip⎯from San Francisco to Chicago, and more importantly, the nine-hour haul from Chicago to Rome. Either way, we planned to pack plenty of gluten-free snacks to have on hand as a precautionary measure.
    Jill:  The American Airlines customer service representative told me the airline did not offer gluten-free meals on the short flight from Chicago to San Francisco, and we'd need to bring our own food. However, on the longer flight from Chicago to Rome, they could accommodate gluten-free needs. The representative confirmed a special meals code for the gluten-free food request (GFML is the code) that was entered into the reservation.
    American Airlines also pointed us to its Web site, which lists sample menu options that may vary month to month:

    Brunch/hot breakfast - Mushroom cheddar omelet with sweet potato hash, yogurt, seasonal fruit Cold breakfast - Yogurt, seasonal fruit, breakfast cookie Lunch/dinner - Sweet chili salmon, green beans, white rice, salad, fresh fruit Snack - Penne pasta  with artichokes, fresh fruit
    The quick and positive responses from the hotels and airline immediately put us at ease. A little online research into gluten-free travel in Italy promised a smooth experience.Jeff: It turns out that the Italians are actually at the forefront of celiac disease awareness and treatment. In fact, all Italians are screened for celiac disease before they are six years old. [1,2]
    Those with celiac disease receive excellent support, including monthly payments from the government for gluten-free food, as well as more vacation to offset extra time used to shop for and prepare gluten-free food.
    Italians are also on the vanguard of the gluten-free food movement. The country's robust celiac association, called the Associazione Italiana Celiachia (AIC), the Italian government and several large Italian companies that make and distribute gluten-free foods have joined together to promote awareness and understanding of celiac disease. This makes for knowledgeable restaurant owners, managers, chefs and waiters. [3]
    Italians are among the most expert crafters of gluten-free pastas and baked goods. Italian companies like Beretta and BioLand make delicious gluten-free rice pasta and a variety of other gluten-free food products, while others produce numerous gluten-free specialty items for import, such as chestnut flour.
    AIC has a helpful Web site and convenient 24/7 telephone hotline. Both offer celiac information and support in English and Italian, along with tips on gluten-free food and dining in every region of Italy. [4]
    So, all of the useful information we turned up in our search made us hopeful that our first vacation together just might be a gluten-free gastronomic delight.
    Tune in next month to find out how things turned out on the ground. Until then, happy gluten-free travels and, as the Italians say, Mangia bene! Eat well!

    http://healthlink.mcw.edu/article/1009402816.html http://celiac-disease.emedtv.com/celiac-disease/ celiac-disease-screening.html http://www.prlog.org/10063446-at-last-the-gluten-free-guide-to-italy-guide-to-the-gluten-free-land-of-pasta.html http://www.celiachia.it/default.asp
    Co-written by Jefferson Adams

    Jill Schaefer
    Celiac.com 11/19/2008 - Day Four: After a ride on a local public bus, which hugged the narrow road's teetering edge and rounded hairpin curves with an alarming sense of speed, we felt grateful for the solid earth beneath our feet in Positano. Our first order of business was to check into the Hotel Villa Rosa and find a nearby trattoria to fill our grumbling stomachs! One of the staff, Stefania, recommended Caffè Positano on the Fornillo side of the town and arranged for a courtesy taxi to deposit us at its doorstep. Without a doubt, its chief allure was the alfresco terrace facing the sea. Situated across the road from the main restaurant and kitchen, the terrace held a dozen or so umbrella-topped tables and beckoned foreigners with unforgettable views.
    Jill: We decided to share an enormous plate of salty prosciutto and cold sweet melon as an appetizer. Jeff ordered pesce spada griglia (grilled swordfish) and I chose petto di pollo aceto (grilled chicken with a balsamic vinaigrette, parmesan and arugula). We nibbled at each other's dishes and savored every bite of that culinary welcoming, so much so that we'd find ourselves back for more during our stay. Days later, upon seeing zuppa di verdura (minestrone soup) on the menu, Jeff asked how it was prepared. Our server confirmed it did not contain any noodles/macaroni or gluten, and Jeff was pleased to have his fill of the strictly vegetable-based soup, which we learned is how minestrone is typically prepared in the region. Experimental cook that he is, Jeff was eager already to replicate the recipe when we returned home to San Francisco.
    Jeff: The Villa Rosa provided an ample gluten-free breakfast. Each morning my tray included a gluten-free chocolate croissant and gluten-free toast with butter and jam, along with our usual assortment of coffee, tea and yogurt. After we finished a late breakfast, lounging at the beach was one of our favorite things to do. Like many beach areas, lunch fare leaned toward sandwiches, pizzas and the like. The few restaurants tended to be overpriced, but we found a reliable alternative in the salumeria, the Italian version of the delicatessen which means "cured meat shop." It had a variety of cheeses, meats and salads priced by the kilo. In addition to fresh pasta and pasta salads, the place usually had salads that were pasta-free and gluten-free.   
    Also, once I discovered that French fries were readily accessible (yes, in Italy) and the minestrone was, in my experience, always gluten-free, I knew I had a reliable fallback. This reinforced my confidence and led us to make an exception of avoiding sit-down lunches near the beach. We tried La Cambusa, where the waiter called us by our city of origin: Mr. and Mrs. San Francisco.  I had my staple fallback meal, and Jill snacked on a tasty ham and cheese omelet that she washed down with a glass of prosecco.
    Jill: While most of our experiences were positive, we had a few missteps along the way. During our first evening at a beach snack shop, Jeff ordered saltimbocca, a dish generally prepared with rolled veal, prosciutto or ham and cooked in a wine and butter sauce. However, what he ended up with was a sandwich version, pressed between thick slabs of bread, that I stuck in our fridge for my lunch the following day. Another time for dinner, we visited Donna Rosa, a family-run trattoria perched high in the hills of nearby Montepertuso, where the locals know to go to eat well and on the cheap. For an appetizer we chose scallops which, to our consternation, were lightly dusted with a bread-crumb gratin that wasn't described on the menu. These surprises could have been averted, though, if we hadn't let down our guard and relied too heavily on the menu. Ultimately, these experiences nudged us to remember to ask questions upfront and not get too comfortable.
    Day Nine: When we arrived in the more isolated fishing village of Praiano, a veritable country cousin to cosmopolite Positano, Jeff plopped down in the pastel-hued restaurant of the Hotel Margherita mere minutes after dropping his bags. He was famished and awaited a sumptuous plate of spaghetti posillipo, made with the hotel's gluten-free spaghetti and mushrooms. In fact, Jeff was so enamored with the heaping dish of gluten-free goodness that he borrowed my digital camera to snap a photo and in a flurry of excitement accidentally erased all of our other pictures! Well, at least we've got the memories...
    The Hotel Margherita proprietor Suela and her husband Andrea were also attentive to Jeff's breakfast needs. In addition to the standard buffet that had a generous gluten-free assortment of eggs, deli meat, cheeses, yogurt, coffee and tea, they purchased extras for Jeff, including a sweet, gluten-free lemon muffin and gluten-free toast.
    Jeff: On the Vettica side of Praiano, the Trattoria San Gennaro was a brisk fifteen-minute walk from the hotel and sat above the main piazza and church. The view from the terrace was both panoramic and quaint, with the Mediterranean offsetting glittering Positano at night and the piazza coming alive with families sitting about while their children played soccer. The place had been recommended by a kind gentleman named Nicola who works at the Villa Rosa in Positano and lives in Praiano. The restaurant served the best bowl of gluten-free minestrone yet! It was so big I have described it as a “tankard” of soup, loaded with fresh vegetables. Though, you do need to ask the kitchen to hold off on the freshly toasted bread garnish. I’ve rarely been so completely well- fed as when I ordered the fries, minestrone and local fish specialty for dinner on our first night. We lingered well into the night, sipping the local wine and taking in the smell of the sea.
    Day Twelve: Perched on the cliffs, Ravello is often heralded for its gardens, Villa Rufulo and Villa Cimbrone, and has played host to departing Crusaders, famous authors and numerous other visitors throughout history. The town's stone walls, quaint walkways and tight, cobblestone streets exude the charm of antiquity. Gluten-free dining proved to be equally simple here. We arrived at the Hotel Graal early afternoon and were starving after two long cramped bus rides from Praiano. We headed to the restaurant, where the maître d' guided us to a shaded table on the terrace. Soon we lunched on gluten-free mushroom penne pasta and salad and took in stunning views of the ocean and the nearby seaside village of Minori.
    Jill: Perusing our guidebook, we found a trattoria tucked away beyond the main piazza called Cumpa' Cosimo and decided to give it a try for dinner. Thankfully we'd made a reservation, as the medieval-inspired place that was dotted with pictures of celebrities and run by Italian nonna (grandmother) Netta Bottone filled up fast. Everything on the menu looked enticing. The roasted rabbit caught Jeff's eye, along with more minestrone soup. He couldn't seem to get enough of the stuff! Craving comfort food, I bypassed the local specialties for a four-cheese pizza and glass of beer. After trying a bit of Jeff's entrée, though, I had a serious case of rabbit envy! We were pushing our last-bite limits when Netta paraded over to our table with a complimentary dessert, something like a cross between cheesecake and tiramisù, which Jeff picked at in order to avoid the crust (Celiac.com does not recommend doing this), and I couldn't resist polishing off. When Jeff mentioned that he was a writer as we paid our tab, Netta darted back to the kitchen and returned with a plate of figs and grapes. From her garden, she said, and insisted we put them in our pockets for later.
    Day Fourteen: Rome may be the Eternal City, but we had all of a day and a half there to explore, with the half starting after our nine-hour transit by private car, Amtrak train and then a female Formula One taxi driver at Termini Station. Since the next day was Sunday and we had no desire to fight the faithful who would attend mass, we opted for a quick visit to St. Peter's and from there trotted over to the Trastevere district for dinner. The Trastevere, a bohemian counterpart to New York's East Village, is one of my favorite places and it won over Jill, who hadn't quite been captured by the Roman magic.
    Even in August when the area was thick with tourists, street vendors and buskers, it seemed like a breath of fresh air in a city that can be every bit as overbearing as New York or London. We eyeballed a few menus and sniffed out a crowded place that seemed to move food at a good clip. It was elbow-to-elbow seating at our cramped alleyway table, with throngs of tourists shuffling past, but soon we dined under a blue Roman sky at dusk. We enjoyed a flavorful gluten-free meal of fresh salads, veal marsala, mushroom risotto and handmade local sausages. Despite being stuffed already, we couldn't resist some stracciatella (chocolate chip) and nocciola (hazelnut) gelato near the Piazza Santa Maria, where a polished quartet of young classical musicians serenaded the crowd.
    In general, we noticed an abundance of gluten-free salads, soups, roasted meats and risottos in Rome and in all four towns we passed through along the Amalfi Coast. We found reliable delis and easy access to fresh fruit. When we asked, places that did not have gluten-free pasta showed a willingness to prepare any that you provided. So, with a quick trip to the local pharmacy for some gluten-free pasta, you could dine with confidence! Contrary to our fears before the trip, eating gluten-free while traveling in Italy proved easy to do. With a bit of planning, a call to the airline to line up a gluten-free meal, an Italian/English explanation of your dietary needs and the standard caution nearly all people with gluten intolerance bring to eating out, anyone can look forward to an enjoyable, gluten-free holiday in Italy.
    Co-written by Jefferson Adams


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

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

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

    Jefferson Adams
    Celiac.com 06/13/2018 - There have been numerous reports that olmesartan, aka Benicar, seems to trigger sprue‐like enteropathy in many patients, but so far, studies have produced mixed results, and there really hasn’t been a rigorous study of the issue. A team of researchers recently set out to assess whether olmesartan is associated with a higher rate of enteropathy compared with other angiotensin II receptor blockers (ARBs).
    The research team included Y.‐H. Dong; Y. Jin; TN Tsacogianis; M He; PH Hsieh; and JJ Gagne. They are variously affiliated with the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School in Boston, MA, USA; the Faculty of Pharmacy, School of Pharmaceutical Science at National Yang‐Ming University in Taipei, Taiwan; and the Department of Hepato‐Gastroenterology, Chi Mei Medical Center in Tainan, Taiwan.
    To get solid data on the issue, the team conducted a cohort study among ARB initiators in 5 US claims databases covering numerous health insurers. They used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy‐related outcomes, including celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy. In all, they found nearly two million eligible patients. 
    They then assessed those patients and compared the results for olmesartan initiators to initiators of other ARBs after propensity score (PS) matching. They found unadjusted incidence rates of 0.82, 1.41, 1.66 and 29.20 per 1,000 person‐years for celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy respectively. 
    After PS matching comparing olmesartan to other ARBs, hazard ratios were 1.21 (95% CI, 1.05‐1.40), 1.00 (95% CI, 0.88‐1.13), 1.22 (95% CI, 1.10‐1.36) and 1.04 (95% CI, 1.01‐1.07) for each outcome. Patients aged 65 years and older showed greater hazard ratios for celiac disease, as did patients receiving treatment for more than 1 year, and patients receiving higher cumulative olmesartan doses.
    This is the first comprehensive multi‐database study to document a higher rate of enteropathy in olmesartan initiators as compared to initiators of other ARBs, though absolute rates were low for both groups.
    Source:
    Alimentary Pharmacology & Therapeutics

    Jefferson Adams
    Celiac.com 06/12/2018 - A life-long gluten-free diet is the only proven treatment for celiac disease. However, current methods for assessing gluten-free diet compliance are lack the sensitivity to detect occasional dietary transgressions that may cause gut mucosal damage. So, basically, there’s currently no good way to tell if celiac patients are suffering gut damage from low-level gluten contamination.
    A team of researchers recently set out to develop a method to determine gluten intake and monitor gluten-free dietary compliance in patients with celiac disease, and to determine its correlation with mucosal damage. The research team included ML Moreno, Á Cebolla, A Muñoz-Suano, C Carrillo-Carrion, I Comino, Á Pizarro, F León, A Rodríguez-Herrera, and C Sousa. They are variously affiliated with Facultad de Farmacia, Departamento de Microbiología y Parasitología, Universidad de Sevilla, Sevilla, Spain; Biomedal S.L., Sevilla, Spain; Unidad Clínica de Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Celimmune, Bethesda, Maryland, USA; and the Unidad de Gastroenterología y Nutrición, Instituto Hispalense de Pediatría, Sevilla, Spain.
    For their study, the team collected urine samples from 76 healthy subjects and 58 patients with celiac disease subjected to different gluten dietary conditions. To quantify gluten immunogenic peptides in solid-phase extracted urines, the team used a lateral flow test (LFT) with the highly sensitive and specific G12 monoclonal antibody for the most dominant GIPs and an LFT reader. 
    They detected GIPs in concentrated urines from healthy individuals previously subjected to gluten-free diet as early as 4-6 h after single gluten intake, and for 1-2 days afterward. The urine test showed gluten ingestion in about 50% of patients. Biopsy analysis showed that nearly 9 out of 10 celiac patients with no villous atrophy had no detectable GIP in urine, while all patients with quantifiable GIP in urine showed signs of gut damage.
    The ability to use GIP in urine to reveal gluten consumption will likely help lead to new and non-invasive methods for monitoring gluten-free diet compliance. The test is sensitive, specific and simple enough for clinical monitoring of celiac patients, as well as for basic and clinical research applications including drug development.
    Source:
    Gut. 2017 Feb;66(2):250-257.  doi: 10.1136/gutjnl-2015-310148.