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    Why Many Restaurants Should Not Offer Gluten-Free Menu Options...Yet


    Tracy Grabowski


    • Journal of Gluten Sensitivity Summer 2014 Issue


    Image Caption: Image: CC--James Kim

    Celiac.com 11/28/2016 - The title of my article might seem a little shocking to most of the celiac community. Why wouldn't I want restaurants to offer high quality, safe meals to those who suffer from celiac disease or from non-celiac gluten intolerance so they could also enjoy dining out with their family and friends like everyone else? It's not that I don't want restaurants to offer gluten-free options: I do. But, I want them to be high quality, high integrity, and offered by a properly trained and knowledgeable staff. Otherwise, I truly don't think your establishment should bother offering gluten-free options to your diners and guests.


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    The truth is that genuinely gluten-free dishes should be more than just replacing a bun, or using a corn or rice version of pasta in your dishes. Claiming to be "gluten-free" or "celiac-friendly" needs to go much further than just claiming such or simply swapping a product for your gluten-free diner.

    Without the benefit of training and education, many restaurants are not going to take into account any cross-contamination factors such as where the food is prepared, or who has touched it (and what did they touch last?) or where the plate was prepped and cleaned. It doesn't consider the air-borne flour coating almost every surface of a bakery or kitchen, and, it certainly doesn't involve investigating ingredients in the finished dishes for "hidden" sources of wheat, rye, or barley whose derivatives (such as malt or "flavorings") might be lurking around the kitchen and in prepared foods.

    There are so many sources of cross-contamination that are simply not explored, or may not even be known by a dining establishment. Unless a typical restaurant or bakery staff is well-versed and knowledgeable in what to look for, the questions to ask, and the proper procedures that will ensure a safe dining experience for gluten-free guests, and until all of the sources of cross contamination are explored and eliminated, it is highly doubtful that a gluten-free dish is truly gluten-free at all.

    With the FDA's recent updates to the gluten-free standard, restaurants, bakeries and dining establishments need to start following suit. Anyone offering a gluten-free meal should be aware that not only are their customers expecting adherence to the 20ppm of gluten (or less) standard that has been accepted as the standard for certifying something is gluten-free, but that the FDA expects their dining establishment to live up to that standard.

    As with any product that comes to market with a claim, restaurant menus are subject to abide by the same guidelines. For instance, if you claim something is "reduced fat", then it better, by all means, be reduced fat from the original version of the same dish. The same principal applies to gluten-free dishes with the standards taking full affect in the summer months of 2014. If your restaurant claims it is gluten-free, then it better be gluten-free, and not just "assumed" gluten-free.

    Living in blissful ignorance can not be an option for restaurants or for any establishment offering gluten-free products. As with any other food allergy or intolerance (FAI) there can be dire consequences for not adhering to procedures for safe preparation and service of food. Not to mention the damage that can be done to an establishment's reputation should the word get out that their integrity or food knowledge is questionable.

    Personally, I believe restaurants have a lot to gain in terms of offering gluten-free meals, or menu options in their establishment. I believe that restaurants who establish—and enforce- gluten-free procedures to eliminate cross contamination, accidental exposure, and provide training to their staff can benefit greatly in terms of business growth and satisfied repeat guests and their referrals from gluten-free diners to both gluten-free dieters and "traditional" diners alike.

    Gluten-free diners, just like all diners, place a great deal of faith and trust in people who prepare their meals at restaurants, diners, bakeries and cafes. With this great measure of trust being established at the first encounter with a restaurant guest, it pays to educate everyone from host/hostess to head chef on the proper way to handle gluten-free meals, and for that matter, all FAI's.

    That is why I recommend that until you are completely certain that your food is gluten-free, and that your staff is in complete compliance with your establishment's gluten-free policy, it is probably better that your establishment NOT offer gluten-free menu options. Those with gluten intolerance and celiac disease would appreciate your honesty and your integrity in doing so. The good news is that we'll be willing to become your dinner guests when you can honestly say that your kitchen staff, servers, management team, and even your host or hostess are educated, trained, and 100% on-board with providing a safe gluten-free experience for all of us.

    Trust and integrity go a long, long way for those of us with special dietary needs.


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    Guest Bruce Danziger

    Posted

    I understand the point of the blog and IMO it has great intentions. But I cannot agree unless you are strictly talking about labeling. I myself have Celiac and cross contamination is and has been something that I have to deal with multiple times a day. But if all food establishments went strictly by the book, I might not ever eat out again. They just wouldn't do it. I would hate my life. Instead I have learned to manage it. It's not fun but you get used to it and I get to eat some great food along the way. And yes, occasionally, there is that mishap where everything goes south. At that point my choices are to discuss with the restaurant to help them make things better in the future and I can decide whether I ever go back again. I also have the option based on such discussions to let people know this is not a place to be trusted when it comes to gluten-free. Over the last 5 years, I have helped a number of restaurants improve the gluten-free experience for myself and others and I have also found places I will never go again. As for what I do, I read reviews. Assuming they are available you can get a good sense where not to go. Then I always talk to the manager. I ask how they deal with the gluten free issue. If they say nothing free here...I leave. This happened to me at a Chinese restaurant. They had no clue what I was talking about. You can quickly tell if a restaurant has no clue. I always talk to the waiter and even if they write gluten free on the order, I ask them to double check with the chef. But, over time you find restaurants that you can trust. I will say that most restaurants I have eaten out at I have never had an issue and I eat out often. Then there are the restaurants that I have encouraged to get separate toasters, cut the bread with separate knives away from the rest of the food, change a few ingredients here and there, setup dedicated fryers where they never mix the oil if they clean/filter it at night. Optimally, I would love it if all restaurants would do proper training but I live in the real world. It´s not that simple. And yes, optimally truly gluten-free restaurants would be the best and it´s a great goal but realistically that is way in the future if at all and I am alive now.

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    I completely agree with this article! Eating out is NOT a necessity, but keeping your gut healthy is. Anytime you are exposed to cross contamination you are doing damage whether you have symptoms or not. This damage takes time to heal. If you are being exposed on a regular basis then your gut is never going to heal. I know life gets crazy and its hard to always prepare a meal. I work 50 hours a week, have a family of four that all eat gluten free out of necessity, we don't eat out at all. In the past I have trusted restaurants that had great gluten free reviews and wonderful policies and procedures in place. Mistakes will always happen and I have been served gluten many times that comes out labeled gluten free. I no longer trust any kitchen with my families health but my own!

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    Guest kwixote

    Posted

    Hard to argue with this. I would love it if every restaurant offered truly gluten-free food, but that's not happening in the US soon. Then again, I just spent a week in Sydney, Australia -- where real, good numerous gluten-free choices were on nearly every menu, and nearly every staff person I spoke to seemed to be well-trained in gluten-free issues -- and truly happy to accommodate. This is all just part of the scene there -- not government mandate. Makes you realize how much of the US's celiac-unfriendly environment is really just a matter of culture and habit and unwillingness to learn new things...rn

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    Indeed, what is the point of having a gluten-free menu if it is not? It is false advertisement and should be illegal. For the folks who are gluten-free for the fun of it, or to get attention, or because they think it is healthier, great, just don't say it is gluten-free. As it is now, they can use that gluten-free menu to raise the price because it is "gluten-free", using our illness to make a buck. That is the rub! If a restaurant wants to say it is gluten-free, then they need to be certified gluten-free and celiac disease safe; the law needs to be changed.

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    What a perfect world it would be if we as celiacs can go into a restaurant and know for sure that our meal is truly gluten free. There are practically no "all gluten free restaurants" out there and the two that I know in NYC are exorbitantly expensive. I believe that I have not completely healed because I do eat out occasionally, and while I believe the food itself has no gluten, somewhere along the way....it gets cross contaminated. The less I eat out, the better I feel. It's kind of sad to be so restricted but our health is more important than a meal away from home. Let's stay strong and try to help each other in this forum.

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    Guest Rebecca Goldfeder

    Posted

    I agree with the author that it isn't possible to guarantee a gluten free meal in a restaurant that isn't a dedicated gluten free facility. I have worked in them most of my life so I know. My local grocery store (Wegmans) will label their prepared foods as "made without gluten containing ingredients" and then you can decide how much risk you are willing to take. I think eventually more establishments will take this approach but until then you have to assume everything on a "gluten free" menu means made without gluten containing ingredients.

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    I agree with this article completely. My name is Katon Claborn and I am a manager at an establishment that proudly serves hyper-local ingredients, and does so while catering to any dietary concern a guest may have. Our restaurant is Odd Duck in Austin TX. I will say, it is not an easy task to fully train a staff on how to cater to not only celiac conditions, but other allergies and intolerances or preferences that our guests may have. It takes time, investigation and research, as well as very specific questions that must be posed to said guests. It is a labor of love and I cannot speak to other cities in the US, but here in Austin it is commonplace for restaurants such as ours to take these precautions and ensure that everyone, no matter how severe the condition, be able to enjoy dining out safely and without feeling as though they are a burden. It saddens me that this is not the case throughout the industry, but I believe this is something that can be changed through teaching and leadership in the industry. i cannot say I know how anyone with these conditions feel, however, I and many others I know empathize. Please know that if ever you are in Austin it would be my sincere pleasure to make sure you are safely taken care of as though you were a guest in our home and feel free to share my name and this message with whomever may come our way.

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    Guest Tracy Gibson

    Posted

    Indeed, what is the point of having a gluten-free menu if it is not? It is false advertisement and should be illegal. For the folks who are gluten-free for the fun of it, or to get attention, or because they think it is healthier, great, just don't say it is gluten-free. As it is now, they can use that gluten-free menu to raise the price because it is "gluten-free", using our illness to make a buck. That is the rub! If a restaurant wants to say it is gluten-free, then they need to be certified gluten-free and celiac disease safe; the law needs to be changed.

    I agree with you completely. I always wonder what the point of offering gluten-free on menus is. Once you explain to the staff what your specific gluten problems are and their response is either: telling you they do not guarantee that they do not prep or cook the food in it´s own gluten-free area OR they really do not understand what gluten free really means. I think the fad diet people have ruined it for us celiacs!

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    Although it couldn't come close, I tried to pay some of our debt to them by inviting the family of seven over to a big dinner of spaghetti, meatballs (complete with homemade marinara), fresh grated Parmesan and garlic bread and a big green salad (obviously, this was a time previous to my celiac diagnosis.) Ahn and her family all seemed to enjoy the meal, but she confessed to me afterward that she needed to go home for a bowl of rice in order to feel full. This after she had eaten two big plates of spaghetti!
    Clearly, her discomfort wasn't a matter of getting enough starch.
    My best guess is that she missed the specific opioids in rice that she had likely consumed at every meal. I can't help but wonder now whether some Tinkyada rice pasta would have done the trick for her. Perhaps the opioids in the wheat-based food helped somewhat but they just couldn't satisfy her craving for that tiny amount of rice opioid; that narcotic-like substance on which her brain and body had come to depend.
    The Role of Ketones
    Another possible mechanism at work might be the unusual difficulty that some people have in converting fatty acids into ketones. When human beings don't have enough sugar or starch available from our diet to convert into glucose, we really feel it in fatigue and mental sluggishness. We may become uncommonly irritable as well. Luckily, our bodies have the marvelous adaptive ability to convert fatty acids to ketone bodies. These ketone bodies may be converted from either dietary fatty acids or from our own fat stores. Ketones are the only known source outside of glucose that lend energy to our brains and bodies.
    Unfortunately, about 14% of the population (including me) has an APOe4 gene variant that makes our livers less efficient at getting energy from fat; we have a harder time producing ketone bodies than everyone else when our glucose stores suddenly plummet. Note that this gene is also associated with a marked increase in the risk of Alzheimer's disease. Some researchers believe that this is due to the difficulty in making ketones, which may protect the brain from insulin resistance.
    For those of us with APOe4, it may just be that much more difficult to achieve a fat-adapted state that will allow the production of ketone bodies. Those of us with APOe4 and everyone who has a harder time going low-carb may just need a little more time in the adaptation process to get our livers to change their stubborn ways. It can't be healthy, while waiting for ketones to kick in, for our brains and bodies to be starved of energy.
    Is it possible that there is one answer to all of these problems? Could a much more gradual transition from high carb to low carb or gluten-free put less strain on body systems?
    I propose that we examine the possibility that cold turkey isn't the best way to cut back on either gluten or carbs. What evidence do we have that the best way is the hard way?
    Yes, for some of us, wheat or gluten is absolute poison and we want to be rid of it as soon as possible. But will taking a week or two to wean off of it really have any lasting negative impact on our overall health? For those who don't have severe digestive symptoms at the point of a celiac or NCGS diagnosis, a strategy of careful withdrawal should be considered.
    So, let's say you have just been diagnosed with celiac disease. Or diabetes, or metabolic syndrome, or hypoglycemia or SIBO, or epilepsy or you simply want to drop excess weight on the Atkins diet. You've been told, or have figured out on your own, that cutting down on carbs or cutting out gluten is your next step back to health. How do you go about it?
    Should you simply throw out all the crackers? Toss all your mixes, breads, flours and pastas? File all your cupcakes, cookies and brownies to the round file?
    Well, yes and no.
    Get rid of everything but your last loaf of bread and put that in the freezer. It will help to get those slices apart later if you can stagger the slices inside the wrapper or even put a square of wax paper between them. This also works well for people on a gluten free diet who are cutting carbs. In that case, use gluten-free bread.
    If you feel significant distress when cutting carbs or grains, let your head tell you when to eat that slice of bread. When you get dizzy, foggy and irritable, that's the time. Just try to spread them apart as much as possible without suffering overly for it. Trust me on this, in a couple of weeks it will all be over!
    Those who don't experience discomfort may still benefit by following this guideline:
    Days 1-3: two slices of bread maximum Days 4-6: one slice of bread daily; you may want to eat 1/2 slice twice a day Days 7-14: 1/2 slice of bread per day, maximum After day 14, quit eating it altogether When it's time to have your slice of bread, take a piece out of the freezer, put it in the toaster or thaw it in the microwave for 10 seconds and eat it with a big slab of good butter. Kerry Gold is my favorite butter. It's from grass-fed cows so it has lots of healthy omega-3 fatty acids. If this is your last loaf of real bread, you might as well make it count! Consider this as the long goodbye and the first step in the mourning process.
    Spread those slices out for as long as you can stand it, but don't let yourself suffer for long.
    Pretty soon, one slice a day will keep all those annoying withdrawal symptoms completely at bay. After that point, you only need to eat a half a slice at a time. You may soon go a day or two without noticing any problems; at that point, you're home free, and you need never eat it again. Throw the rest out or leave it out for your family, if you have an gluten-eaters in the household.
    Clearly, this whole subject needs a lot more research. I'd like to see more study on exactly what happens to thyroid levels during carb restriction. I'd like to know what it does to our blood sugar, our livers and our brains when we make huge lifestyle changes such as these. I'd like to know how we vary in our ability to produce ketones and how many of us function optimally on ketones in the absence of glucose. We should also know what happens to our microbiome, the bacterial colony that lives mainly in our guts when we change our diets. I think we are just now scratching the surface in learning how food interacts with our bodies.
    Yes, there is a lot to learn and some are making strides in discovering how food helps and hurts our health. In the meantime, we are wise to tread carefully, even when making a necessary lifestyle upgrade.
    References:
    Decline in T3 after low carb diet: Ullrich IH, Peters PJ, Albrink MJ. Journal of the American College of Nutrition [1985, 4(4):451-459] http://dev.europepmc.org/abstract/MED/3900181/ GAPS diet: http://www.gapsdiet.com/ FODMAPS diet: http://stanfordhospital.org/digestivehealth/nutrition/DH-Low-FODMAP-Diet-Handout.pdf Atkins diet: http://www.atkins.com/Home.aspx Paleo diet: http://robbwolf.com/what-is-the-paleo-diet/

    Jefferson Adams
    Celiac.com 02/02/2017 - Scientists have devised a universal gluten cross-contamination checklist they hope will help to reduce gluten contamination in the food services industries.
    The newly created food services checklist was compiled after an extensive literature review, input from 11 different experts with PhDs and experience with food services and/or gluten and celiac issues, along with documents from various organizations such as the Gluten-Free Certification Program from the Canadian Celiac Association.
    The final checklist consists of 88 items divided into 12 sections, which cover everything from building and facilities maintenance, cleaning and ventilation, to employee clothing and hygiene, to food production and transport.
    The checklist also includes a robust section on planning and communication with an eye toward maintaining a gluten-free facility and supporting gluten-free customers. The tool is notable in that it is the first comprehensive checklist designed to promote a proper understanding of the issues across all manufacturing and food production processes.
    All of which make it, "an interesting tool since it helps to assure proper understanding of the items, which is crucial for the correct evaluation of conformities/non-conformities situations in loco and ultimately might impact the safety of the food produced in certain establishments," according to the authors.
    Such an understanding is crucial for making correct on-site assessments of conformities/non-conformities.
    Properly employed, the checklist might impact, and ultimately improve the safety of gluten-free food across the entire industry.
    Read more at: mdpi.com and cantechletter.com

  • Recent Articles

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

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

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

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

    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