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      Frequently Asked Questions About Celiac Disease   04/07/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes
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    HOW TO SUCCEED AT REDUCING OXALATE ON A GLUTEN-FREE DIET


    Monique Attinger


    • Journal of Gluten Sensitivity Summer 2015 Issue - Originally published July 16, 2015


    Celiac.com 11/03/2015 - Many people today are dealing with the need to be gluten-free, whether from allergies, intolerance or celiac disease. Being gluten-free can be the difference between being healthy and having chronic, potentially debilitating, symptoms.


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    However, sometimes being gluten-free is not enough.

    The challenge with a gluten-free diet is that many of the most popular gluten-free flours are actually high in oxalate! Oxalate is a toxin that occurs naturally in most plant foods, but at very different levels, some relatively safe, and some not. Oxalate can even kill at high enough doses. The scientific challenges in the oxalate field, as well as oxalate's potential relationship to celiac sprue, were discussed in the feature article by Susan Costen Owens which appeared in the Spring issue of this journal. In this follow up article, you'll find the practical advice on how you can reduce the level of oxalate in your gluten-free diet.

    A great example of a popular high oxalate gluten-free flour is almond flour. Almonds are one of the very highest oxalate foods, with about 300 mg of oxalate for one half cup of whole nuts. Given that you will actually have more nuts in a half cup of flour than you will in a half cup of whole nuts, you could have 400 or more milligrams of oxalate in that single half cup of flour.

    So, your daily morning muffin made with almond flour could be 200-250 mg of oxalate. This means that you may not feel as good on your gluten-free diet as you might expect because your digestive tract can be suffering with ongoing inflammation from a new source – oxalate.

    Now 250 mg of oxalate might not seem so bad – unless you consider that a low oxalate diet is defined as 40-60 mg of oxalate per day! That makes your morning muffin the equivalent of 4-5 days worth of oxalate, for someone who is eating a typical low-oxalate eating plan.

    If you've been eating a lot of nut flours, you might be wondering what you can substitute instead? The one nut flour that is low oxalate is coconut flour. This can be a great option, if you like the density of nut flours, and want a flour with higher nutrition. All other nut flours are high; most seed flours are high too. Nuts themselves are some of the highest oxalate foods in nature. Baked products made with nut flours will be particularly high in oxalate – and if you add chocolate, you compound the problem.

    Unfortunately, this is more bad news for lovers of chocolate baked goods. Chocolate is another extremely high oxalate ingredient: cocoa has more than 35 mg of oxalate per tablespoon and the substitute carob, is no better! Given that many baked goods could easily have 1-2 tablespoons of chocolate or carob per serving, you can see how your oxalate intake could really add up. Of course, this doesn't include the fact that many baked goods – like brownies – will combine both cocoa and nuts, for a double hit of oxalate.

    The same problem arises with many of our common gluten-free baking flours and spices. They can often add an overload of oxalate to each serving, with the potential for problems later as oxalate accumulates in the body. So, how can you avoid gluten, and not introduce more of a known toxin into your body?

    The trick is knowing enough about oxalate to avoid it effectively.

    The first thing to learn is how to get flavor in your food without the oxalate. Oils and extracts are typically much lower in oxalate than the whole herb or spice, and yet retain the flavor for baking and cooking purposes. The process by which oils are pressed and extracts are made appears to leave the oxalate behind.

    This rule of thumb gives us a way to get the taste we want, and avoid oxalate. For instance, to get a chocolate taste without too much cocoa, you can carefully craft a recipe that balances the use of cocoa with chocolate extract, chocolate flavoring and even a bit of coffee. Using food grade cocoa butter, which has zero oxalate, in place of butter or oil, is another way to boost that chocolate flavor. If you use the lowest oxalate flours as well, you leave some room for a bit more cocoa because you are not adding a lot of oxalate in the flour. By doing this, you can get the flavor you want while avoiding the oxalate.

    Another example of baking smart is an almond flavored cookie. You can actually make a cookie with almond oil as well as almond extract for extra taste – while almonds themselves are extremely high, both the oil and the extract have almost no oxalate at all!

    This concept of using oils and extracts is particularly important if you like the sweet taste of cinnamon. Cinnamon is a very high oxalate spice with over 38 mg of oxalate for just one teaspoon! Choose instead cinnamon oil or cinnamon extract. Cinnamon oil is available from various outlets that sell culinary oils. You can get cinnamon extract in the supplement section of your grocery or health food store – generally, it is sold in capsules. When cooking with it, you simply open the capsules and put the powdered extract into your dish. Substitute about the equivalent amount of dry extract for ground cinnamon.

    The second thing to learn is how to pick low oxalate flours. While many of the gluten-free flours are high in oxalate, the process of picking appropriate flours may not be as hard as it first appears.

    Oxalate is often present in the "bran" of a grain. As a result, most whole grain flours are actually high in oxalate. This seems strange to us because we are told to get more fiber and eat whole grain. But the truth is that not all whole grains are good for us and we can get our fiber in other ways not so tied to oxalate.

    Interestingly, most starches are low oxalate (even if they come from high oxalate whole foods), in the same way that oils are low oxalate. This means that starches are our friends when we want to cook! Most starches (including potato, corn, green bean and sweet potato) are low in oxalate, and can be used as part of the flour combination in a baked good to get a lighter, fluffier result.

    Again, the explanation is similar to the explanation regarding oils and extracts: when we remove the starch from even a high oxalate food, we appear to leave the majority of the oxalate behind. But be careful to get starches and not flours when you are dealing with high oxalate whole foods – items like potato flour or sweet potato flour are extremely high in oxalate, and should be avoided. Only the starches are safe on a low-oxalate eating plan.

    You can consume some medium oxalate foods, and still remain low oxalate overall. This expands the possible flours that you can use. Good options include white masa (which is a corn flour), green pea, lupin, sorghum, and sweet rice flours. While buckwheat and quinoa are also common in gluten-free foods, these grains are very high in oxalate. You should ideally avoid them.

    So what do you do if you are used to baking with nut flours? If you want high nutrition flours that are much lower in oxalate than nut flours, look to legume flours. Consider black-eyed pea flour (also called cowpea bean flour), garbanzo bean flour, or yellow pea flour. All of these legume flours are low in oxalate. However, because legume flours can be heavy, combine them with low oxalate starches, like corn, rice, green bean, potato or sweet potato starch to get the right texture in your baked goods.

    When we combine the lowest oxalate flours with others that are medium (and sometimes small amounts of higher oxalate flours), we can get the right kind of flavor and texture, yet remain low in oxalate per serving. A great example is a flour mix that contains a variety of flours. One easy combination of flours is ½ cup of sweet rice flour (medium oxalate), with ½ cup of coconut flour (medium oxalate), ½ cup of potato starch (low oxalate) and ½ cup of cornstarch (low oxalate). This particular flour combination can be used in crepes, and results in a crepe that has the same kind of stretch that you have with gluten flours, because of the properties of the various flours used in the combination.

    While some of us will be experimental and will like the idea of playing with flours and starches to develop our own recipes, others will not. If you are looking for a good quality gluten-free flour mix that you can use at home, consider Orgran. Another great option for baking (as well as pancakes) is gluten-free Bisquick.

    So far we've presumed that you are baking or making your own gluten-free items. But what if you are buying packaged gluten-free foods?

    When looking at baked goods, look for starches in the first five ingredients. So, you should see low oxalate flours early in the ingredients, because these will be the largest components of your baked good. Avoid items with buckwheat flour, hemp, quinoa, sesame seeds, and teff in general. All of these ingredients are so high in oxalate, that even small amounts would be a problem. While tapioca starch and white rice flour are high in oxalate, in smaller amounts, they should be fine.

    If you are considering reducing oxalate in your diet, the best way to do that is slowly! When you reduce oxalate too quickly, you can experience stressful symptoms as the oxalate that is stored in your body leaves too quickly. The process of oxalate moving out of your tissues and into your blood, seeking then a site of secretion, is called "dumping" by our project since it is a very common experience. This can be the culprit behind digestive symptoms, fatigue, brain fog, rashes and other symptoms.

    Ideally, you would slowly phase high oxalate foods out of your diet. So rather than completely abandoning your morning muffin made with almond flour, you would slowly reduce your portion by ¼ of a muffin per week, until you were no longer eating an almond flour muffin after 4 weeks. During those 4 weeks, you slowly introduce your new morning muffin, ¼ at a time, which is now made with coconut flour.

    You would also want to remove only one food at a time in this way – so that oxalate is very slowly phased out, and you can also use up some of the high oxalate foods that you have in your home. It's not only easier on your body to do this change slowly, but it's also easier on your pocket book!

    Oxalate is not just an issue with grains and flours – it can also be an issue with other foods. So while this article has focused more on the specific issues with gluten-free baking and cooking, there are other high oxalate foods that you need to be aware of if you want to reduce oxalate in your overall diet.

    You may have heard or seen information that points at leafy greens as high oxalate foods. While such common staples as spinach, beets and Swiss chard are extremely high in oxalate, you can enjoy other greens in a healthy diet. Consider other leafy greens like arugula, turnip greens, mustard greens or certain varieties of kale, like dino / lacinto or purple, to get leafy veggies in your diet. Most lettuces are low in oxalate and high in nutrition, including romaine and leaf lettuce. Eating low oxalate does not have to mean removing whole food groups from your diet, nor losing all your high nutrition options!

    Many of the common fruits are lower in oxalate and can be incorporated in your diet – including berries. Many people have mistakenly heard that all berries are high oxalate. Testing done by Dr. Michael Liebman of the University of Wyoming shows this is not true! According to test results from his lab, both blueberries and strawberries are low oxalate, and raspberries are medium oxalate. So while you might want to avoid blackberries (which are very high in oxalate), you can safely eat other healthy berries.

    However, other fruit can be extremely high in oxalate. Citrus can be tricky because it's important to know not just which fruit you are eating, but which parts. Many citrus juices, like grapefruit, orange, lemon and lime, are low oxalate per serving, so you can still get the taste of these items when cooking with the juice. But don't eat a lot of grapefruit – the whole fruit is high oxalate. Similarly, if you use citrus zest for extra flavor, you'll find that it's a problem: the oxalate levels are too high.

    Sometimes you need to know the variety of a food, or need to watch your serving size. Pears are a great example. Some varieties of pears have tested low; others have tested high. When choosing pears, go for Bartlett (also called Williams pear).

    Many exotic and tropical fruits are high, including kiwi, figs, papaya, gauva, and pomegranate. Some are so high that they could be dangerous to consume in a single serving! Star fruit has this dubious distinction: it is so high that people have had seizures and even died from eating star fruit when their kidneys were in trouble.

    It is important to recognize that many of the foods that we think of as being the healthiest may also contain a lot of oxalate. Vegans can be particularly susceptible to eating a very high oxalate diet, as they may be getting their protein primarily from high oxalate legumes, including soybeans. If you want to include legumes in your diet for the fiber and nutritional benefits, focus on the low and medium oxalate legumes. That list includes red, green, brown and yellow lentils, green peas, red kidney beans, tofu, garbanzo beans, yellow and green split peas, lima beans and black-eyed peas.

    Note that tofu is okay – but whole soybeans are not. This is one of the most challenging aspects of the diet. Some foods are okay in the right form, or with the proper processing. So much as extracts, oils and starches are lower in oxalate than the whole foods they come from, some processed forms of foods are lower than the whole, unprocessed food. So you can eat tofu – but don't eat edamame.

    A last point that can help you to reduce oxalate in your diet is to consider how a food is cooked. When a food is boiled, you may actually reduce the amount of oxalate in the food. Oxalate can be soluble, and so it will leach into the cooking water, and can then be thrown away. There is no other cooking method that can reliably reduce oxalate, other than cooking or soaking in water. However, this flies in the face of current nutritional advice, which focuses on eating as many foods as possible raw. While you don't have to boil everything you eat – there are a number of very low oxalate veggies and fruits that can be eaten and enjoyed raw – boiling can be a valuable strategy to reduce this known toxin, and leave you with a more nutritious end result.

    If you have more questions about oxalate and your diet, please see the website www.lowoxalate.info. There is also an associated support group, which is currently at Yahoo, called Trying_Low_Oxalates. In addition, we have a Facebook group with the same name. On Facebook, we also have two additional recipe groups, one of which is focused specifically on vegan eating. These support groups can help you to make lower oxalate choices part of your diet and can also help you gain a perspective on how oxalate may have been affecting other issues in your health.

    Lower Oxalate Flours, Starches and Products

    • Potato starch
    • Cornstarch
    • Green Bean starch
    • Sweet Potato starch
    • Flax meal / seed
    • White masa corn flour
    • Green pea flour
    • Lupin flour
    • White rice flour
    • Sweet rice flour
    • Coconut flour
    • Black-eyed pea (cowpea) flour
    • Garbanzo bean (chickpea) flour
    • Water chestnut flour
    • Yellow pea flour

    Low Oxalate per serving

    • General Mills Corn Chex (1/2 cup)
    • General Mills Rice Chex (1/2 cup)
    • Arrowhead Mills gluten-free Popcorn (1 cup)
    • Eden Kuzu Pasta (1/2 cup)
    • Thai Kitchen Rice Noodles (1/2 cup)
    • Annie's Homegrown Macaroni and Cheese, gluten-free (1/2 cup)
    • Tinkyada White Rice Spaghetti (1/2 cup)
    • Lotus Foods Bhutan Red Rice (1/2 cup cooked)

    Higher Oxalate Gluten-free Products

    • Medium oxalate per serving
    • Udi's White Sandwich Bread (1 slice)
    • Nabisco Cream of Rice (1/4 cup dry)
    • Envirokids Gorilla Munch (1 cup)
    • Orville Redenbacher's Popcorn (1 cup)
    • Mission Yellow Corn Tortillas (1)
    • Tinkyada Brown Rice Spaghetti (1/2 cup cooked)
    • Tolerant Foods Red Lentil Rotini (1/2 cup cooked)
    • Lundberg Brown Jasmine Rice, boiled (1/2 cup)

    Extremely High Oxalate foods

    • Beans (Anasazi, Black/Turtle, Cannellini, Great Northern, Navy, Pink, Pinto, Red, Soy, White)
    • Cactus/Nopal
    • Carob
    • Cocoa Powder/dark and milk chocolate
    • Fruits (Apricot, Blackberries, Figs, Guava, Kiwi, Pomegranate, Rhubarb, Star Fruit/Carambola)
    • Grains (Amaranth, Buckwheat, Quinoa, Teff)
    • Nuts (Almonds, Cashew, Brazil, Hazelnut/filberts, Macadamia, Peanuts/Spanish Peanuts, Pine)
    • Seeds (Caraway, Chia, Hemp, Poppy, Sesame)
    • Herbs/Spices (Allspice, Cinnamon, Clove, Cumin, Curry Powder, Ginger, Onion Powder, Turmeric)
    • Potatoes (Russet, Burbank, Idaho, Fingerling)
    • Vegetables (Artichoke, Beets, Eggplant, Hearts of Palm, Jerusalem Artichokes, Okra, Plantain, Swiss chard,
    • Spinach, Sweet Potato/Yam)

     

    Guide to Lower Oxalate Substitutions 

    (chart on substitutions is used by permission from: https://www.facebook.com/pages/Low-Ox-Coach/551330634959001/)

     

    High Oxalate Ingredient(s)

    What it's used for

    Lower Oxalate Substitution

    1. Spinach

    • Greens in a stir fry

    • Cooks down for sauces / dips

    ARUGULA. Similar flavour and consistency. Substitute one for one.

     

    1. Beets

    • Greens in a stir fry

    • Sweet root veggie

    • Used for detox

    For stir-fries, try other greens, like turnip or kohl rabi. You can also use red cabbage for a red veggie (if you need something red). Try boiled carrots or parsnip for dishes that need a root veggie. If you want a gentle detox, try lemon juice in water to start your day.

     

    1. Swiss Chard

    • Greens in a stir fry

    • Steamed

    • Boiled

     

    Dino / Lacinto Kale. Lowest ox when boiled. Can also try mustard greens or dandelion greens.

    1. Almonds

    • Snack

    • Baking

    • Gluten free crusts

    For snacks, try pumpkin seeds. For baking, either go to coconut flour (rather than almond flour) or use a lower ox nut and smaller quantities. For bread, try pumpkin seed butter or sunflower seed butter. Pecans or walnuts are the lowest ox nuts.

     

    1. Almond or peanut butter

    • Spread for bread

     

    Sunflower seed butter, macadamia nut butter, pumpkin seed butter, golden pea butter (golden pea is the lowest oxalate)

     

    1. Sesame seeds

    • Used for both flavour and as the whole seed

    While sesame seeds are high, the oil is zero oxalate! So, try using either plain or toasted sesame seed oil to flavour dishes.

     

    1. Most dried beans, including red beans, adzuki beans, black beans, etc

    • Chili

    • Savory dishes

    • Dips

    Try subbing lower ox legumes like black-eyes peas, red lentils, green and yellow split peas, garbanzo beans and lima beans.

     

    1. Brown rice

    • Side dish

    • Casseroles

    • Stir-fries

    Sub with either brown rice that is soaked, drained and cooked like pasta (in lots of water), or use white rice. Uncle Ben's is one of the lowest rices.

     

    1. Chocolate / Cocoa

    • Desserts of all kinds!

    Try lesser amounts of chocolate, or a combination of cocoa and chocolate flavoured stevia. Also, can sub white chocolate in many applications, like white chocolate chips for cookies. In a recipe, sub food grade cocoa butter in place of other specified oils / butter.

     

    1. Tomato sauce

    • Sauces

    • Casseroles

    • Pastas

    Instead of 100% tomato sauce, sub with 1-2 tablespoons of tomato paste, ½ cup pumpkin or butternut squash puree and water to thin as required. Add appropriate spices for the dish.

     

    1. Black tea

    • Beverages

    Decaf green tea, many herbal teas or coffee

    1. Nutmeg

    • Spice

    Mace

     

    1. Black pepper

    • Spice

    White pepper

     

    1. Sweet potatoes

    • Dishes of all kinds

    Butternut squash or other suitable squash with the right texture and flavour.

     

    1. Onion, carrot and celery to use to start soup

    • One of the most common combinations to start soup or stir fry

    Garlic, shallot and red pepper is a favourite. You can also use garlic, shallot and green cabbage.

     

    1. Lemon or orange rind

    • Dishes of all kinds

    Lemon or orange juice, with a thickener. In some cases, lemon or orange extract.

     

    1. Cinnamon

    • Dishes of all kinds

    Cinnamon extract (purchased in a dry capsule supplement at the health food store. Break open capsules and put contents in your dish).

     

    1. Regular potatoes

    • Boiled, or used in dishes

    • Baked

    You can boil new, red-skinned, white-fleshed potatoes and then add to dishes. You can also sub cauliflower or radishes, 1 to 1. (Radishes are great cooked!) To sub for a baked potato or for a dish that uses potato raw, try rutabaga or turnip (which can be scalloped or turned into a baked fry.)

     

    1. Regular pasta

    • Usually for main dishes or side dishes

    Zucchini "noodles", or cornstarch noodles, or other tested and low ox pasta like Shiritaki noodles (which are also low carb and zero calories). You can get cornstarch "angel hair" pasta or Shiritaki noodles at Asian food markets.

    1. Oatmeal

     

    • Breakfast

    • Baking

     

    Sub with ½ oatmeal and ½ flax meal for cooked cereal with the same texture but lower oxalate.

    1. Turmeric

    • Baking

    • Flavor

    Sub with curcumin extract. This can be purchased as a health supplement in capsules. Capsules can be opened and the contents added to food and beverages.

    1. Ground ginger

    • Baking

    • Flavor

     

    Sub with fresh ginger or ginger root extract.

     

    From the author:

    If you have ever been diagnosed with an autoimmune disease and have been trying to lower oxalate, will you participate in the development of this science by filling out a survey?

    We would also like to find out whether reducing oxalate has affected your autoimmune condition.

    The link to our survey is here: https://www.surveymonkey.com/r/CMN5KK7


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    Recommended Comments

    Guest sc'Que?

    Posted

    As far as thoroughness and attention to science-driven (yet accessible) information, this may be one of the best write-ups I've seen on Celiac.com! (MORE LIKE THIS, PLEASE!)

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    Guest JFStinson

    Posted

    There is very little evidence that oxalates are harmful. Any substance (even water) is harmful if you get too much. Many of the foods condemned here as being high oxalate, are actually quite good for you and should be part of a balanced diet. We need to stick to science in this forum and present information that is proven, accurate and useful.

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    Guest Big Mike

    Posted

    I think one glaring exception in this article is that most medical professionals recommend increasing calcium intake (calcium binds to oxalate and is excreted in the stool) rather than reducing oxalate unless you have a high genetic propensity for (family history of) kidney stones. Seems relevant...

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    Guest Glenna Adams

    Posted

    Excellent article. I had no idea so many of the foods I eat are high oxalate foods. I'll use this article to make some corrections in my diet.

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    Guest John Spartan

    Posted

    There is very little evidence that oxalates are harmful. Any substance (even water) is harmful if you get too much. Many of the foods condemned here as being high oxalate, are actually quite good for you and should be part of a balanced diet. We need to stick to science in this forum and present information that is proven, accurate and useful.

    I have to stay away from pretty much all oxalate or I get constipation, chronic non-bacterial prostatits, and ED. Have had these symptoms since around 17 and it took me 15 years to figure out how to eliminate them. As soon as I eat a food or drink with oxalate, symptoms come back until oxalate is cleared from system - takes about a week for this. While on diet, all symptoms are gone. Have done this over and over again hundreds of times. so, there are ample data-points. Oxalate is toxic for some people, particularly those who have had any kind of intestinal disease. Oxalate gets into the bloodstream and inflames the surrounding tissues.

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    I had so much pain until I found out what my problem was a few years ago, Oxalates! Brain fog, slow urine stream, eye crust in the morning, numb legs, I could go on and on. Thanks for the info!

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    Guest sheila

    Posted

    There is very little evidence that oxalates are harmful. Any substance (even water) is harmful if you get too much. Many of the foods condemned here as being high oxalate, are actually quite good for you and should be part of a balanced diet. We need to stick to science in this forum and present information that is proven, accurate and useful.

    If you had a problem with oxalates like I do you wouldn't make your comment. Oxalates cause so many problems for those of us who have the problem. Pain, eyes with hard abrasive matter in them, brain fog and on and on.... Little evidence they are harmful? Educate yourself before you comment.

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    I have experienced hyperoxaluria that is affected by dietary intake of oxalates for almost twenty years. My personal experience is that carob has little or almost zero oxalates. Carob beans contain larger amounts, as do many seeds, but carob pods, the fruit of the plant possesses little and does not show evidence to affect those with hyperoxaluria.

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    Guest Margie

    Posted

    I had the OAT test done to find out I was right! I have secondary Hyper-Oxaluria. I have deposits in my eyes and it is so painful I have battled this for 2 years now. If you think you have an issue with oxalates, please don't wait to do something about it. This has been the most painful thing I have ever experienced in my entire life. Praying for you all that have this dreaded issue. So hard to eat.....

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    Guest Regina Sagal-Hendry

    Posted

    I had so much pain until I found out what my problem was a few years ago, Oxalates! Brain fog, slow urine stream, eye crust in the morning, numb legs, I could go on and on. Thanks for the info!

    I have been searching for the cause of my eye pain and other symptoms - joint pain being one of them, and believe this may be the case of many of the chronic issues I have. I have already stopped eating all grains, nightshades, nuts, seeds and sugars but I could not eliminate all the pain issues. I am looking forward to trying this program as a way of clearing up some of these problems. Kidney stones are not an issue. My biggest problem is trying not to lose so much weight.

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    Can you make the necessary lifestyle adjustments to feel better and regain your health?  Absolutely!  Everyone’s pace is different and you need to give yourself time.  Is there a way that may help you to adjust a bit more quickly and with less frustration?  Yes:  consider hiring a personal coach that specializes in food challenges.
    What Is A Personal Coach?
    Coaching is a powerful, ongoing relationship which focuses on clients making important changes in their lives.  Coaching uses a process of inquiry and personal discovery to build a client’s level of awareness and responsibility, and provides the client with structure, support, and feedback.  The coaching process helps clients to both define and achieve personal and professional goals faster and with more ease than would be possible otherwise.   In coaching, the focus is on designing the future, not getting over the past.
    The field of coaching is booming and there are many coaching niche areas.  Business coaching for executives and teams has become quite popular.  Coaching children and teens to help them excel with academics is on the rise, as is parenting coaching.  Many small business owners higher coaches to help them increase revenue.
    Coaching usually occurs in the context of a long-term relationship, where the client’s goals, dreams, and vision drive the action.  The belief is that there are multiple paths to reach a goal, and that the client knows the way (though they might not realize it at the time).  The coach assists the client to become a “change master.”  To this end, coaching and adjustment to dietary changes go hand-in-hand.
    A Personal Coach Specializing In Dietary Restrictions Can Help You To:

    Learn the gluten-free lifestyle - Where to buy gluten-free food, product reviews, how to prepare gluten-free recipes, where to eat out, how to become a skilled label reader, understanding the safe & unsafe ingredient lists, decrease cross-contamination risk, how to set up your kitchen, where to find out if your cosmetics, hair care products, and medications are safe. Develop a support network - Website resources, how to get the most out of your primary care doctor, engaging a specialist such as a dietician or nutritionist. Vary your diet, taking into consideration essential nutrients. Adjust for the financial impact- Learn to live gluten-free on a budget. Brush up on your advocacy and education skills – Practice explaining celiac to friends, relatives, and coworkers, advocate to you/your child’s school, learn how to eat out safely, manage your anxiety. Monitor any ongoing symptoms and known associate health risks - Iron deficiency anemia, osteoporosis, fertility problems, leaky gut syndrome, candida, food sensitivities, other auto-immune disorders. Keep up on the latest research and what it may mean for you – there are many exciting studies happening that may have an impact on how you take care of yourself. Assist with other goals to help your life feel more balanced.
    How Does Coaching Work?
    Generally, most coaches have a structure that includes three to four sessions each month, with quick check-ins by phone and email in between.  Coaching sessions can be either one-on-one, in small groups, or a combination of both.  They can be in-person, via phone, or a combination of both throughout the month, which allows for financial and logistical flexibility.  In-person sessions can include shopping, practice with advocating, and cooking.A coach will encourage clients to set goals that they truly want, ask them to do more than they have done on their own, help them focus in order to produce results more quickly, and provide the tools, information, support, and structure to help them accomplish more.   It’s like having a personal trainer to assist you with making adjustments to improve your life.
    Who Should Consider Hiring A Coach?

    If you are feeling unsure as to how to adjust your lifestyle around your food challenges. If you are feeling limited by food allergies/intolerance/sensitivities. If you are not sure where to go for information or are overwhelmed by all the information you are finding. If you are restricting yourself from enjoying going out to restaurants, parties, etc. If you are having difficulty sticking to the gluten-free diet. It’s important to find someone that you “click” with.  Most coachesoffer a free initial session to help get to know them, and to answerany questions you might have about the coaching process.

    Jefferson Adams
    Celiac.com 01/14/2010 - Most people with celiac disease will tell you that faithfully maintaining a gluten-free diet can be very challenging, especially for those who enjoy dining out or in the homes of friends.
    "Going to restaurants or dinner at a friend's house can pose dangers to a person with celiac disease," says said Dr. Ali Keshavarzian, vice chairman of medicine and gastroenterologist at Rush University Medical Center. "It can really impact a person's quality of life."
    For most people, maintaining a gluten-free diet will stop symptoms, heal existing intestinal damage, and prevent further damage, along with potentially preventing numerous associated conditions, such as diabetes. But setting up and sticking to a gluten-free diet can be a challenge.
    A team of Gastroenterologists at Rush have designed a new study to determine if mind and body techniques could help people with celiac disease adhere to the very strict diet.
    "Eating even a small amount of gluten can damage the small intestine," says Dr. Ali Keshavarzian, vice chairman of medicine and gastroenterologist at Rush. "The damage will occur in anyone with the disease, including people without noticeable symptoms."
    Hidden sources of gluten are sometimes additives such as modified food starch, preservatives and stabilizers made with wheat. Also, numerous corn and rice products made in factories that also make wheat products can be contaminated with wheat gluten.
    "The purpose of this study is to determine whether participation in one of two mind/body courses can help patients cope with the restricted diet," says Keshavarzian. "It can be very hard and stressful for people with celiac disease to stick to a gluten-free diet."
    Healing existing intestinal damage and preventing further damage means that people with celiac disease must go on a lifelong gluten-free diet. Patients must be trained by health professionals on how to understand safe and unsafe ingredient on food labels, and to spot foods containing gluten in order to make safer, more effective choices when grocery shopping or eating out.
    People with celiac disease or gluten intolerance usually begin to feel better within days of starting a gluten-free diet.
    The small intestine usually heals in three- to six-months in children, but can take several years in adults. A healed intestine means a person now has healthy intestinal villi that can properly absorb nutrients from food into the blood.
    Patients enrolled in the study on Celiac disease and mind/body techniques at Rush will be randomly assigned to two course assignments for eight weeks.
    To be eligible for the study, patients must be over 18 years of age, have received a diagnosis of celiac disease in the past four weeks or within two weeks of starting a gluten-free diet, and have not previously attempted a gluten-free diet.
    Source: ScienceDaily (Jan. 11, 2010)


    Dr. Ron Hoggan, Ed.D.
    Recently I have noticed a trend in articles that demonize the gluten-free diet, and imply that there is something unhealthy or even dangerous about it. Here is an example of one that I forwarded to Dr. Ron Hoggan:
    http://www.post-gazette.com/pg/11017/1118230-114.stm
    and below is his response to its author:
    Dear China Millman,
    Thank you for your interesting article on gluten-free dieting.  I was very pleased to read that you include patients with non-celiac gluten sensitivity among those who should follow a gluten free diet.  I assume that you have arrived at your estimate of 20 million who are afflicted with wheat allergy, non-celiac and celiac gluten sensitivity using Dr. Fasano’s  estimate that 6 to 7 percent of Americans have what you refer to as this “milder form of gluten intolerance”.  There are other estimates. For instance, Dr. Kenneth Fine did random blood draws at a shopping center in Dallas, Texas and found an 11% rate of gluten sensitivity. Congruently, Dr. Marios Hadjivassiliou has reported rates as high as 12% in the United Kingdom and Dr. Rodney Ford reports a prevalence estimate of 10% in New Zealand.  Each investigator used different methods to arrive at their estimate, and each method is likely to underestimate the true prevalence of non-celiac gluten sensitivity. For instance, they all rely on a single class of antibody reaction against a single sub-group of proteins found in gluten grains. Thus, Dr. Fasano’s estimate may be unduly conservative as it is substantially lower than others have found in similar populations and the testing used to arrive at Dr. Fasano's estimate also carries all of the other limitations mentioned above.
    As for the notion that non-celiac gluten sensitivity is milder than celiac disease, Anderson et al, in their study titled “Malignancy and mortality in a population-based cohort of patients with coeliac disease or ‘gluten sensitivity’ World J Gastroenterol 2007 January 7; 13(1): 146-151, report a higher rate of malignancy and early mortality among those with non-celiac gluten sensitivity than among those with celiac disease.  This finding may be the result of the common recommendation that patients ignore test results that show non-celiac gluten sensitivity, as many physicians believe that such results are “non-specific” and do not warrant a gluten free diet. However, it may also reflect that non-celiac gluten sensitivity is a more serious illness than celiac disease. It may also reflect something entirely different than these two interpretations, but it does make a very good case for the need for more research in this very neglected area.
    As for the comments by Heather Mangieri and the American Dietetics Association, they might benefit from reading studies such as the one by Dr. Cheng et al titled “Body Mass Index in Celiac Disease Beneficial Effect of a Gluten-free Diet” in the 2009 Journal of Clinical Gastroenterology. They found that, after diagnosis with celiac disease, about half of the overweight and obese patients lost weight. Given the conservative data you report, suggesting that at least 90% of American cases of celiac disease go undiagnosed, there can be little doubt that a large portion of those with undiagnosed celiac disease who are overweight or obese would be likely to lose weight. The number who would lose weight should be greater among those who chose to follow a gluten free diet to lose weight, as some of those who are diagnosed with celiac disease do not comply with the diet.  If one accepts the proposition that those with non-celiac gluten sensitivity, IBS, and IBD often have similarly problematic reactions to gluten, the number of Americans who could lose weight and live healthier, and therefore happier, lives (eating a gluten free diet) rises exponentially.
    On a personal level, my mother lost 66 pounds during her first years on a gluten free diet. Now, some 15 years later, she has lost almost 100 pounds. I doubt that she would still be alive had she not undertaken the gluten free diet purely on the basis of test results suggestive of non-celiac gluten sensitivity.  
    In the current context of excessive under-diagnosis of celiac disease and limited understandings of the dynamics by which a gluten free diet causes weight loss among celiac patients, and an enormously greater number of Americans who have non-celiac gluten sensitivity, it is difficult to understand why anyone would be cautioned against following a gluten free diet with weight loss as their objective.  Whether these individuals are undiagnosed celiac patients, have undiagnosed non-celiac gluten sensitivity, or they find that a gluten free diet is helping them to achieve their body mass objectives, there is little legitimate cause to "warn" people away from a gluten free diet. Overall, your article does raise awareness of gluten as a potential health threat, so its overall impact is positive despite the misinformation that a gluten free diet does not help with weight loss.
    Sincerely,
    Ron Hoggan, Ed. D.
    Royal Roads University, Continuing Studies

    Jefferson Adams
    Celiac.com 07/09/2012 - These handy tips will help you to better navigate the challenges of gluten-free living in both dorm rooms and shared housing. Having the right tools, and adopting some wise practices will help you eat gluten-free week-in and week-out, without breaking your bank account, or risking gluten exposure.
    Having a few tools can help your efforts come together much more easily, and keep your eating consistent over the semester.
    Helpful tools:
    Rice Cooker Small Crock Pot Microwave Blender Fridge/freezer (even a miniature one will come in handy) Resealable freezer bags Sharpie permanent marker Shop wisely by making lists
    What's the old saying? Proper prior preparation prevents poor performance? Nowhere is this more true than with a gluten-free diet. Planning your meals in advance can save you time, money, stress, and, of yes, the pain of an adverse reaction to gluten. This practice starts with shopping, and shopping starts with planning.
    Make lists and use them. Check out Asian, Mexican, and other ethnic markets in your area. They often have good, gluten-free food at reasonable prices.
    Cook your food in advance
    You can make the most of your smart shopping practices by planning and preparing your meals in advance.
    Consider spending one day each week, or at least a good block of time, cooking and prepping food. Just a few hours of gluten-free cooking can prepare you to sail smoothly through the week ahead. Use all the tools at your disposal. Use your crockpot, use your rice cooker, your freezer bags, and your markers.
    Keep your own shelf and label your foods
    Package and label the food you make, then store it in your fridge or freezer. By packaging and labeling food, your housemates are less likely to "accidentally" eat it. If they do, you'll likely be on top of the situation.
    Keep gluten-free dry goods on hand
    Having a drawer full of gluten-free food that does not require a fridge or freezer is also helpful. Good items to have include microwaveable rice, gluten-free pretzels, crackers, chips tuna fish, fruit snacks, and beef jerky.
    Gluten-free Condiments
    Keep a collection of spices and sauces to help keep your snacks from getting boring. Good things to keep on hand include honey, gluten-free tamari, mayonnaise, ketchup, mustard, and hot sauce.
    Cover the Basics
    Make sure you keep simple items that are rich in protein and carbohydrates on hand, so that you won’t go hungry and will always have gluten-free food available.
    Avoid the Dining Hall
    Unless your dining hall is one of the more progressive campus dining halls that offer a variety of good, reliable gluten-free foods, you should avoid it.
    Some good foods to prepare in advance or keep on hand include:
    Fried rice - Frying rice is a good way to use leftover food, and it's easy to pack and take with you to campus. Try it with lots of veggies, meat, eggs, and any other items that seem tasty.
    Grilled or roasted chicken, or other meats cut into small slices - These are great items to add to your fried rice, or to your pasta sauce.
    Stews, soups or casseroles - Stews, soups and casseroles freeze easily and age well. They can be prepackaged and frozen ahead of time. They can be easily thawed in the bag by placing them in the microwave, or in lukewarm water.
    Sauces - Making sauces in advance and freezing them can cut your food prep time during the week. They can give you plenty of room for adjustment and broaden your options. Ideas include: Pasta sauce, pizza sauce, sweet and sour sauce, teriyaki sauce,
    Pizza - Use your favorite gluten-free pizza crust to make gluten-free pizza. Then place it in individual bags, label and freeze. If you have hungry roommates with boundary issues, consider numbering the bags to keep track of them.
    French toast - Making French toast with your favorite gluten-free bread is a great way to have a quick, reliable breakfast ready to go.
    Fruit - cutting up fruit and putting it in bags for the week ahead is a great way to be ready to make quick breakfast smoothies, or to have a great fruit salad ready to go.
    Yogurt and kefir are also good to have on hand. They are excellent for making fruit smoothies, or for giving you much needed protein and fat with that fruit smoothie.
    Dessert items - Chocolate chip cookies, brownies, and cakes are a great way to enjoy dessert when you want it without being forced to choose from the often dismal gluten-free selection at the local coffee shop, or the over-priced frozen section of your local grocery store.
    Lastly, compile a list of reliable local eateries where you can get good, safe gluten-free food when you are in a pinch, or need to dine on the spur of the moment.

    Maria Larkin, M.Ed, RDN/LD
    Celiac.com 02/16/2016 - About two years ago, as a result of two comprehensive review articles written by research scientists, Anthony Samsel and Stephanie Seneff, the term "glyphosates" made media headlines.
    Based on more than 200 citations, their reviews concluded that long term exposure to glyphosates via ingestion (in food and water) and/or inhalation seems to parallel the incidence and clinical features of celiac disease and may contribute to a number of diseases including autism, cancer, Parkinson's Disease, Alzheimer's Disease, infertility, depression, inflammatory bowel disease, Multiple Sclerosis, cancer, allergies, eosinophilic esophagitis (EOE), obesity, and kidney disorders.
    In case you don't already know, glyphosate (an organophosphate) is the active chemical ingredient in Monsanto's trademarked herbicide called RoundUp, which in the last 15 or more years has become very popular and is used throughout the world. It is largely used in "no-till non-organic production systems" as a desiccant (drying agent) for many genetically engineered (GE) food crops, especially those considered "RoundUp Ready" such as corn, soy, canola, cotton, sugar beets and alfalfa. RoundUp Ready foods are genetically engineered to resist being killed by RoundUp.
    While wheat is not a genetically engineered food crop, RoundUP is used on all non-organic wheat crops to produce a greater yield and reduce any rye grass weeds. The glyphosates in the RoundUp kill weeds by disrupting the shikimate pathway in the plant.
    I once used RoundUp to kill some weeds in my yard thinking that it was safe and nontoxic. It was thought then that humans and animals could not be affected by this weed-killing herbicide because humans and animals don't possess the shikimate pathway, only plants and bacteria do.
    That was until Samsel and Seneff set me straight. The bacteria in the human gut, which outnumbers the cells in our body, do have shikimate pathways. Glyphosates suppress the enzyme necessary for the shikimate pathway to produce aromatic amino acids such as tyrosine, tryptophan and phenylalanine. This happens in plant cells, too, where reduced levels of other amino acids have been discovered including serine, glycine and methionine.
    What does this mean for we humans? These amino acids are precursors to neurotransmitters (found in the gut and in the brain). Tryptophan alone is necessary for the production of serotonin, "the happy hormone." An impaired supply of serotonin frequently found in celiac disease causes depression. Impaired serotonin receptors in the gut sets the stage for inflammatory bowel disease.
    So besides blocking the shikimate pathway for the production of nutrients in foods, glyphosates seem to reduce the overall bioavailability of nutrients in the foods we eat. I have been a regular advocate for taking a daily multi vitamin and mineral, contending that the food we eat may lose nutrients from farm to table. Low and behold, Samsel and Seniff's review substantiated my contention. They cite two studies, which showed multiple mineral depletions in soybean crops treated with glyphosates. The depleted nutrients in the soybeans mirrored those frequently found in celiac disease, including cobalamin (B12), iron, molybdenum, selenium and sulfur. The authors hypothesize that the association between celiac disease and autoimmune hypothyroid disease may be due to a selenium deficiency.
    Samsel and Seniff suspect that chelation in the gut due to glyphosate ingestion may further account for deficiencies in cobalt, molybdenum and iron in these foods. This confirms yet another contention of mine that a single nutrient can indeed disrupt a whole system. The chelation of cobalamin in the gut is suspected to contribute to neurodegeneration and heart disease; the synergistic dynamic of molybdenum deficiency altering the body's supply of sulfate can have the consequence of cancer, anemia and insulin resistance. The authors purport that glyphosates disruption of the sulfur transport in the body is "the most important consequence of glyphosate's insidious slow erosion of health."
    The health of the human intestinal tract is affected by glyphosate ingestion and inhalation. Citing a study on the effects of glyphosates on predatory fish, Samsel and Seneff's review showed that glyphosates cause damage to the intestinal mucosal folds and microvilli similar to what is seen in celiac disease. Beneficial gut bacteria are killed, allowing the pathogenic (disease-causing) bacteria to proliferate, producing a state of bacterial dysbiosis (microbial imbalance). With reductions in the beneficial Bifidobacteria and Lactobacillus bacteria, the breakdown of both gluten and phytase are impaired, leading to the inability to digest gluten. The pathogenic bacteria such as E. Coli and C. Difficile can lead to kidney failure and inflammation. These authors argue that other digestive pathologies, such as pancreatitis, fatty liver disease and EOE are due to impaired CYP function in the liver. Could there also be a link between the high rates of small intestinal bacterial overgrowth (SIBO) and gut dysbiosis caused by glyphosate disruption of these enzymes?
    Glyphosates disruption of CYP enzymes in the liver occurs with celiac disease. These enzymes are involved in detoxification of xenobiotics (foreign chemical substances), so theoretically a reduction of CYP enzymes slows detoxification. Vitamin D3 and cholesterol synthesis and regulation of retinoic acid are also a part of the CYP enzyme system. It has puzzled me at times, that some of my patients do not respond to high dose vitamin D supplementation. The concept that glyphosates effect on CYP enzyme inhibition results in inadequate vitamin D activation in the liver could be a mystery solved. CYP enzymes are also important in bile acid production, gallbladder and pancreatic function. Samsel and Seneff hypothesize that glyphosate "disrupts the transport of sulfate from the gut to the liver and pancreas", resulting in bile acid insufficiency and gall bladder disease. Excess retinoic acid as a result of glyphosate exposure is similarly found in celiac disease and has been linked to reproductive disorders.
    How can we avoid glyphosate exposure? The obvious answer is not to use this herbicide to kill weeds in your yard. In the best interest of health, eat organic foods as much as possible, avoid the "the dirty 15" and genetically engineered foods. Check out your local farmer's market and buy from certified organic farmers. Eat animal products fed with non- genetically engineered foods. If you eat wheat, choose organic wheat. Glyphosates cannot be washed off of food, and there is yet no known way of detoxifying glyphosates from the body. The authors suggest eat garlic or soak in an Epsom salts bath to ensure adequate sulfur intake. Sea salt is a natural way to include minerals in your diet along with eating vegetables.
    Maria Larkin, M.Ed, RDN/LD owns Better Gut Better Health, LLC, a nutrition counseling practice in Durham and Portsmouth, NH. She is a registered dietitian and functional medicine provider, specializing in gastrointestinal concerns, food allergies and sensitivities. Website: www.bettergutbetterhealth.com.
    References:
    Samsel, A. and Seneff, S. Glyphosate's Suppression of Cytochrome P450 Enzymes and Amino Acid Biosynthesis by the Gut Microbiome: Pathways to Modern Diseases. Entropy, 2013: 15 (4): 1416-1463. Samsel, A. and Seneff, S. Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance. Interdisciplinary Toxicology, 2013: 6 (4): 159-184.

    Amie  Valpone
    Celiac.com 05/31/2016 - Dipping your spoon into this bell pepper–sweet potato combo is like dipping into a bowl of sunshine. It's stunning—and the perfect antidote to a gloomy winter's day. This soup also freezes well, so if you're not serving a crowd, store the leftovers for a later date (or make a double batch). I like to enjoy this soup accompanied by my Massaged Kale Salad with Spicy Hazelnuts
    Serves 6 to 8
    Ingredients:
    ¼ cup extra-virgin olive oil ½ small onion, diced 2 medium carrots, peeled and diced 1 celery stalk, diced Sea salt and freshly ground black pepper, to taste 8 yellow, red and/or orange bell peppers, chopped 1 large sweet potato, peeled and chopped 4 cups low-sodium vegetable broth 3 teaspoon finely chopped fresh marjoram 1 recipe Gluten-Free Herbed Croutons, for garnish Sliced avocado, for garnish; optional Finely chopped fresh cilantro, for garnish; optional Drizzle Seriously Sensational Sriracha Sauce, for garnish; optional Directions:
    In a large pot, heat the oil over medium heat. Add the onion, carrot, celery, and a pinch of salt and black pepper. Cook until the vegetables are tender, about 4 minutes. Add the bell peppers and cook until soft, about 6 minutes. Add the sweet potatoes and broth. Season with salt and black pepper, cover the pot, and bring to a boil. Lower the heat and add the marjoram. Simmer until the vegetables are tender, about 20 minutes.
    Let the soup cool slightly, and then, in batches, transfer to a blender and puree until smooth. If needed, thin the soup with water. Adjust the seasoning with salt and black pepper if necessary. Return the soup to the pot to keep warm until serving. Serve garnished with the Herbed Croutons and, if desired, the avocado and cilantro on top and Seriously Sensational Sriracha Sauce on the side.
    Text excerpted from EATING CLEAN, © 2016 by AMIE VALPONE. Reproduced by permission of Houghton Mifflin Harcourt. All rights reserved.

    Monique Attinger
    Celiac.com 06/07/2016 - The world of nutrition is currently obsessed with "super foods". Super foods are loosely defined as foods that are extremely high in nutrients – particularly antioxidants and vitamins – and which everyone is heartily advised to add to their diet.
    The problem with this approach is that, while focused firmly on nutrients, we are ignoring anti-nutrients! According to Wikipedia, an anti-nutrient is a compound in food that interferes with your absorption of other nutrients from a food. Most foods have varying amounts of anti-nutrients, toxins and other problematic compounds. A truly healthy diet will include weighing the good against the bad, while maintaining as much variety as possible. Once we have a clearer picture of how a food helps to support our nutrition, we can then decide how to include it in our diet and in what amount.
    Obviously, certain health conditions mean that certain foods are no longer healthful. For those with celiac disease, this means that grains with gluten in them are damaging to their health. It really doesn't matter how healthy wheat bran is for some – for celiacs, wheat bran is harmful. For those with allergies, you have a similar issue. Foods that may be healthy for some may not be for others.
    Another issue with food and health can be related to anti-nutrients. For instance, in the vegetarian world, we now hear more about phytate – often found in legumes – and how to reduce it in a plant-based diet. Salicylate is another anti-nutrient found in plant foods, and more people are finding that they need to consider this when choosing foods.
    Plants may also contain toxins, which are totally natural to the plant, but not good for you. Wikipedia indicates that a toxin is a substance that is directly poisonous, and capable of causing disease. For instance, some foods may contain naturally occurring cyanide compounds, or even arsenic in various forms. While we may not get enough to cause immediate problems, we certainly don't want to consume a lot of these toxins!
    Oxalate is another toxin present in many otherwise healthy foods. Oxalate poses many challenges for human health. It's a free radical. It promotes inflammation in your body. Because of its biochemistry, oxalate can be stored throughout your body, and can be particularly concentrated at the sites of previous injury, inflammation or surgery. Fundamentally, oxalate can be stored in tissues wherever the cells have taken it up. As a result, if you are someone who is absorbing too much oxalate from your diet, you can be contributing substantial stress to your body.
    Reducing the amount of oxalate in your diet cannot hurt you – you are reducing a totally non-nutritive substance for which the human body has no need and which contributes directly to health issues.
    However, reducing too many food types or nutrients in your diet can have negative impacts. The greater the variety in your diet, the better the chance that you are getting all your needed nutrients. The good news is that you can have a nutritious, high variety diet, and retain "super foods" in your diet which are high nutrition, gluten-free and low oxalate.
    Get Your Fiber
    The preponderance of processed foods in our diets can often leave us with hardly any fiber in our diet! Many gluten-free options are very low in fiber, and this can affect gut health. Fiber is not a direct nutrient for us per se – but it is a needed component that contributes to better gut flora and better health overall.
    Insoluble fiber adds bulk to the stool and promotes regularity. Most of us are not getting enough of this fiber, and as a result, can develop poor motility and constipation.
    Given that many whole grains are not good alternatives for those on a gluten-free diet, and the bran of many grains are actually high in oxalate, how can we get more healthy insoluble fiber? The good news is that one nutritional powerhouse is not only full of healthy insoluble fiber – it's also a plant source of Omega 3's. So a great solution to lack of insoluble fiber is flax seeds.
    Flax seeds can be eaten whole – but to really get the best benefits from this super food, it's best to grind your flax. Keep whole flax seeds in the freezer to preserve their freshness, and don't grind until just before using them. The recommended daily serving (which will also provide some soluble fiber) is two tablespoons.
    According to the Mayo Clinic, the right fiber goes much further than just regularity. If you increase soluble fiber, it can help reduce both blood sugar and cholesterol. Soluble fiber creates a gel-like material in the gut, and some research indicates that it may help to feed our gut bacteria.
    The benefits of soluble fiber are well known when it comes to cholesterol. The recommended food to get more soluble fiber is oats. However, whole oats are high in oxalate, and the oat bran has confusing test data.
    The solution? Psyllium! Pysllium is the medicinal ingredient in the popular product, Metamucil. Psyllium contains both soluble and insoluble fiber – and research on it shows that it can help to reduce cholesterol as well as normalize blood sugar. You can add it to baked products (but adjust the liquids), or sprinkle on foods. It's virtually tasteless – although you might find it does add some thickness or texture to liquids or foods.
    Fruits and vegetables are also good sources of both soluble and insoluble fiber and many are lower oxalate. Cabbages, lettuces, onions, cucumbers (with the skin) red bell peppers, orange, mango and grapes are all good low oxalate sources of fiber in your diet.
    Fruits
    There is no shortage of healthy options in fresh fruits that are also low oxalate, but the blueberry holds a special place among even the healthiest fruits.
    Research shows that blueberries are one of the most antioxidant rich foods available, and are included in most lists of super foods. Blueberries are one of the highest rated foods on the ORAC scale. The ORAC scale was developed by researchers at Tufts University, and is the measure of Oxygen Radical Absorbance Capacity (hence the abbreviation ORAC). What this really means for you is that the higher something ranks on the ORAC scale, the more antioxidants you are getting.
    Blueberries are stars on this scale, with an ORAC value of 4,669 per 100 grams, according to Superfoodly.com. Wild blueberries rank higher than cultivated ones – but you can't go wrong with any blueberry.
    Another fruit that ranks very high in ORAC is the lowly cranberry. While very tart (and difficult to eat raw), cranberries are second only to blueberries in antioxidant levels. To reduce the acidity of the fruit, and make them more palatable, cook with water and some honey. Cranberries are very easy to cook and make a lovely side dish for fattier meats like lamb. They aren't just for turkey anymore! Consuming these tangy fruits also help to contribute to bladder health.
    For nutrition on the go, turn to golden seedless raisins. While dark raisins are tasty treats, the golden seedless variety is both lower in oxalate and higher in antioxidants. In fact, golden seedless raisins actually have a higher ORAC score than fresh blueberries! Combine that with convenience and portability, and you have an easy way to get more antioxidants in your day. Raisins also make a great treat for kids, because of their sweetness.
    Is the apple a super food? Yes it is! Easy to purchase and pack for lunch, this popular fruit is full of quercetin, which protects cells from damage and is often recommended for those with allergies. Not only is it full of healthy antioxidants, it also has twice the fiber of other commonly eaten fruits, including peaches, grapes and grapefruit, according to the site EverydayHealth.com.
    Veggies
    When looking at veggies, many of the foods that are considered most healthy are also very high in oxalate. Everyone talks today about how healthy the sweet potato is for us: but did you know that a ½ cup of sweet potato can have over 90 mg of oxalate in it? For people trying to eat a low oxalate diet, a single serving would be more oxalate than they should consume in a whole day!
    However, while avoiding high oxalate foods, you do need to eat color and variety to get your needed nutrition. If you want a lower carbohydrate, orange veggie – consider the kabocha squash. Not only does this lower carb, low oxalate veggie work as a substitute for many recipes that require sweet potato, it also has a very good nutrient profile. Self Nutrition Data lists Vitamin A and Vitamin C as well as a good serving of Folate, in addition to good amounts of calcium, magnesium, phosphorus and potassium.
    Of course, you want other colors in your veggies as well – and green leafy veggies are particularly known for their nutrition. While spinach would be a bad choice because of extremely high oxalate, you have lots of other greens to choose from. Focus on lower oxalate varieties of kale, including purple kale. The website, The World's Healthiest Foods, lists kale as a food that can lower cholesterol (if steamed) as well as lower your risk of cancer. Of course, kale is part of the cruciferous vegetable family, and these foods have many anti-cancer benefits. Kale is an excellent source of Vitamin K (your blood clotting factor), as well as vitamin A, vitamin C, manganese, copper, B6 and others.
    Don't forget your other brassicas while you are focusing on kale! The cruciferous veggies also support our bodies natural detox processes, which is very valuable in today's world where we are exposed to many environmental toxins. Broccoli is another low oxalate brassica that is good for you, whether you are eating the mature broccoli heads, or feasting on broccoli sprouts. Note that broccoli sprouts do have an edge over their more mature cousins – they might just taste better, and given that they can be added to a sandwich for some satisfying crunch, might be easier to work into your daily diet. Research gives the sprouts a further edge in cancer risk reduction and some research indicates they may actually help to prevent stomach cancer.
    Another excellent leafy green is the lowly turnip green. Turnip greens are very high in calcium, and are even lower in oxalate than kale. A cup of cooked turnip greens will also get you more than 100% of the RDA for vitamin K. In addition, you'll get vitamin A, vitamin C, folate, copper, manganese, calcium, and vitamin E. Each serving will give you 15% of your daily requirement for B6.
    When thinking of deep red veggies, go for red cabbage. This versatile veggie is very low in oxalate, and that lovely red color means that it has even more protective phytonutrients, according to World's Healthiest Foods, than its green sibling! One serving of red cabbage delivers more than four times the polyphenols of green cabbage.
    Fats and Oils
    You can't read on super food nutrition anywhere and not run into the avocado. A great source of healthy monounsaturated fat, the avocado has also been linked to reduced risk of cancer, as well as lowered risk of heart disease and diabetes. While we think of avocados as a fatty food, they are actually a good source of fiber, with 11 to 17 grams of fiber per fruit! You'll also get a dose of lutein, an antioxidant recommended for eye health.
    Web MD says that lutein is a potent antioxidant, which is found in high concentrations in the eye. The combination of lutein and zeaxanthin (another antixodant) help to protect your eyes from damaging, high energy light. Some research indicates that a diet high in lutein and zeaxanthin may reduce the risk of cataracts by as much as 50%.
    Coconut oil is another excellent fat that can benefit our bodies in a host of ways. Doctor Oz lists a number of benefits, including supporting thyroid health and blood sugar control. This may be related to the form of saturated fat that is found in coconut oil, called lauric acid. Lauric acid is a medium-chain triglyceride. This kind of fat actually boosts immune system, and has antibiotic, antiviral and antifungal properties. It may also be a tool in your weight loss arsenal. A study in 2009 actually showed the eating 2 Tablespoons of coconut oil daily, allowed subjects to lose belly fat more effectively. Even better news for those who are following a low oxalate diet: both avocado and coconut oil have zero oxalate!
    Nuts, Seeds and Legumes
    Unfortunately, many foods in this category are high oxalate – and so won't qualify for our super food list. While you might be able to have a couple of walnut halves, or a similar amount of pecans, nuts are generally just to high to have in servings of more than 3-5 pieces.
    However, if you are looking for a superfood in this category, look no further than pumpkin seeds! Pumpkin seeds are an excellent source of vegetable-based protein, and are another portable food. A great snack for the health conscious can be made with raisins and pumpkin seeds – both are low oxalate, and the protein of the pumpkin seeds will help you to stay fuller longer. According to LiveStrong.com, a handful of pumpkin seeds will give you over 8 grams of protein. At the same time, pumpkin seeds are low in sugar, and provide you with fiber as part of the carbohydrate in them. You will also get vitamin A, vitamin B, vitamin K, thiamine, riboflavin, niacin, magnesium, calcium, iron, manganese, zinc, potassium, copper and phosphorus in that small and compact package!
    If pumpkin seeds don't qualify as a super food, it's hard to say what would!
    When it comes to legumes, many are stars for protein, but one of the best options is the red lentil. Lentils in general are easier to prepare than other types of legumes – they do not require the soaking and preparation time that many legumes do. At the same time, they are powerhouses of nutrition, with molybdenum, folate, fiber, copper, phosphorus and manganese all at more than 50% of your daily requirement. One cup of cooked lentils will also give you 36 % of your daily need for protein, according to World's Healthiest Foods. And all this nutrition is provided in a food that is virtually fat free and low in calories. You cannot go wrong!
    As an added benefit, some studies have found that eating high fiber foods like red lentils may reduce the risk of heart disease. The more fiber, the lower the risk of heart disease.
    Fish
    We are always hearing that we need to have more fish in our diets. It seems sometimes that not a week goes by when we are not hearing that we should be eating less meat, and getting less fat – with the suggestion that more fish would benefit us.
    When you think of the super food of fish, you have to think of salmon. Salmon is a fatty fish, and it's one of the best sources available for omega-3 fatty acids. In today's world of processed foods, omega-3's are one of the nutrients that we don't get enough of.
    Your best bet with salmon is to get wild-caught fish. Farmed salmon do not have the same nutrient profile, which may be related to the kind of food they are fed. Along with the decreased nutrient profile, studies have indicated that farmed salmon contains significantly higher concentrations of a number of contaminants (including PCBs, dieldrins, toxaphenes, dioxins and chlorinated pesticides) than wild caught salmon.
    World's Healthiest Foods states that a 4 ounce piece of Coho salmon will get you 55% of your daily requirements for omega-3 fats. On top of that, you'll get more than 50% of your daily requirement for vitamin B12, vitamin D, selenium, vitamin B3, protein and phosphorus, as well as other B vitamins and minerals.
    Omega-3 fatty acids will provide you a host of benefits, from reduction of inflammation, to better brain function. Omega-3 fat is also heart healthy, and can contribute to a reduced risk of heart attack, stroke, high blood pressure and other cardiovascular disease. Research indicates that eating salmon at least 2 to 3 times a week will give you the best benefits.
    Spice it up
    Spices can be a bit tricky, if you want to keep your oxalate low. Many spices – while tasty – are very high in oxalate!
    A great example of this is turmeric. A staple in most curry recipes, turmeric is extremely high oxalate – so while it has a reputation as a super food, it would not be a good choice if you are trying to keep your oxalate low.
    So what is your option if you love to eat foods spiced with turmeric? Well, the easiest approach is to stock your spice rack with a health food store supplement; cook with curcumin extract! While it may seem a bit odd at first, if you buy a curcumin extract (which is the extract from turmeric), you can get the flavor and leave the oxalate behind.
    While not technically a "food" when you cook with a supplement, you certainly get all the benefits of the original super food – turmeric – without the downside of oxalate.
    Another highly beneficial spice is cinnamon. Research clearly shows how helpful cinnamon is for managing blood sugar. However, ground cinnamon is an extremely high oxalate spice. So how can you get the flavor you want, while avoiding the oxalate?
    One solution is to cook with a cinnamon extract that you buy at the health food store! One brand known to be low oxalate is Doctor's Best. It is a dry extract in capsules – simply break open the capsules and use the contents in your dish. This allows you to get all the therapeutic benefits of the extract as well as the taste.
    You can also cook with essential oils and culinary oils – but use them carefully. Essential oils can be very strong and can irritate the tissues of the mouth and digestive tract. One drop of good quality essential cinnamon oil will replace as much as 1 tablespoon of ground cinnamon. Culinary oils are made for flavoring – follow the directions on the product that you buy. Either way, you will get the taste – and you avoid the oxalate.
    Enjoying Your Food!
    As with anyone who wants to eat a healthy diet full of super foods, the trick is to focus on the best nutrition, and get lots of variety. While some foods may not be as "super" as others, if you are making colorful meals, with healthful selections from across the spectrum, you'll be doing your body a favor with flavor!
    Where Does Oxalate Go?
    Once you have eaten oxalate, you have to excrete it through urine, feces or sweat. But what happens if you don't? A study on rats was able to trace where in the body a dose of oxalate remained. The scientists used a special carbon molecule – carbon 14 – in the oxalate they gave to the rats, so that they could find the oxalate wherever it went in the body.
    What they found is that if the oxalate was not excreted from the body, it was stored everywhere:
    68% in the bones 9% in the spleen 8% in the adrenal glands 3% in the kidneys 3% in the liver 8% in the rest of the body These results are in direct opposition to conventional medical thinking, that oxalate only affects the kidneys. It clearly shows us that the whole body – but particularly the bones, key glands and detoxification organs – are all affected. This is another good reason to reduce the amount of oxalate in your diet!
    Is Spinach Really That Bad For You?
    A relatively simple study in the late 1930's looked at rats fed a diet that was only adequate in calcium. To bring the levels of calcium up, the rats were given spinach, equaling about 8% of their diet. While most of us think of spinach in terms of iron, it is also relatively high in calcium. The results of the study were shocking:
    47. A high percentage of rats died between the age of 21 days and 90 days 48. The bones of the rats were extremely low in calcium (despite adding it to the diet through the spinach) 49. Tooth structure was poor and dentine of the teeth poorly calcified 50. For these animals, reproduction was impossible. Researchers concluded that not only did spinach not supply the needed calcium (because of the oxalate), but the spinach also rendered the calcium from other foods unavailable. What we know now is that oxalate is a mineral chelator – and rather than delivering minerals, it was robbing them from the rats.
    Getting Your Vitamin K
    Vitamin K is a very important nutrient. Life Extension indicates that new research from 2014 links vitamin K to longevity. In fact, the highest intakes of vitamin K reduced the likelihood of dying from any cause by 36%! So, you definitely want to get vitamin K in your diet.
    However, most of us think that we need to eat high oxalate greens – like spinach – in order to get good amounts of vitamin K. Nothing could be further from the truth! Kale, collards and turnip greens are all higher in vitamin K than spinach, and they have a fraction of the oxalate.

    Susan Costen Owens
    Celiac.com 07/29/2016 - Celiac is an autoimmune condition, and along with other autoimmune diseases, scientists are beginning to have a larger context for understanding what could be contributing to its immune dysregulation. In the last decades we've seen diseases becoming prevalent now that look very different from the diseases of our ancestors. The American Autoimmune and Related Diseases Association lists 159 autoimmune diseases on their website (1), but most of these diseases are very new.
    In recent years, scientists began to identify and explore a new complex that was identified within our cells and belongs to our immunological line of defense. This new player is part of innate immunity, which is also called cell-mediated immunity. This is our body's rapid responder, and its approach to immunity is more like hand to hand combat. Its role is surveillance, and it uses generalized markers to identify something as an enemy and something the immune system needs to defeat. It looks for evidence of infection from bacteria, fungi, viruses and parasites but it also analyzes cellular debris. It is looking for any sort of danger signal that conveys the message that life is not normal as it ought to be (2). This analysis can even include looking for changes in pH (3).
    The innate branch of the immune system is dependent on cells that are called phagocytes, and these cells like to engulf small pieces of things they encounter, in a process called phagocytosis. Often these cells will be breaking down those pieces it engulfs and then will returning the nutrition it contained back into the extracellular space. After fragments from outside are internalized, cells needed a way to decide if what was engulfed should lead to a stepped up immune response. That's why it is not surprising that scientists recently discovered a whole network of molecules internal to these cells that form a complex called an inflammasome. There are various types of inflammasome that cover different biological niches (4).
    What this means is that, in response to what is deemed an enemy, a phagocytic cell will gather together a distinctive list of parts to assemble into an inflammasome, and then that inflammasome will produce specific cytokines called IL-1 beta and IL-18. These chemical messengers can then go and recruit more help.
    In contrast, antibody mediated immunity is more like having an air defense. The antibodies made by this part of our immune system function more like missiles that are sent out to find a designated target.
    Vaccines are designed for the antibody side of the immune response. Future recognition of a previous invader involves selecting a piece of protein, called a peptide, that is large enough to recognize. This side of our immune response forms a memory of that peptide so that in the future, our cells will use that memory to recognize that we have seen that germ before. If the germ is recognized from a previous infection, then the immune system can respond very quickly and with more hands on deck. The piece of the intruder's identity that will be remembered is determined by our HLA type, and that is determined by a section of DNA on our sixth chromosome. The vulnerability to celiac disease is defined by the genes that are behind the formation of HLA-DQ2 and/or HLA-DQ8.
    Scientists have known for many years that these two branches of immunity compete with each other and need to stay in balance. The chemical immune messengers called cytokines will shift our immune response between a dominance of cell mediated or antibody-mediated immunity. Until very recently, all the attention in celiac was on the antibody mediated branch whose major decision-makers are T cells, but even T cells can form inflammasomes (5).
    Scientists are now studying the innate immune response to gluten. Our innate immunity relies on a specialized call type called a phagocyte. Cells of this type of include monocytes, macrophages, neutrophils, granuloctyes, mast cells, dendritic cells, osteoclasts and even migroglial cells in the brain. Phagocytic cells will incorporate debris that comes close to them into a vesicle, and that is a sort of bubble with liquid and other contents inside. This vesicle is taken into the cell through a process called endocytosis. After that, this type of cell will quickly process the contents of that vesicle probably much faster than other cell types. This competence is likely why this type of cell is given the job of surveillance for invaders. It is also is useful as a tool for recycling things from the outside that they take in. Scientists prefer to call this set of cells the professional phagocytic cells. Other cell types can be enlisted for the job of phagocytosis but they don't have that role as their main purpose. That is why this different set is called the non-professional phagocytic cells and they may also form inflammasomes but may need more stimulation. (6).
    Scientists in the last decade have done experiments to learn how inflammasomes work. These intracellular immune complexes are assembled often in response to exposures to a type of molecule called a lipopolysaccharide that can be detected after engulfing the cell membranes of invading organisms. There are many other triggers, all recognized by their ability to tell us when something inside us is not as it should be. ATP, our body's energy molecule, when it is identified as coming in from the outside, can be a trigger for the inflammasome. Engulfing this sort of molecule suggests to our phagocytes that cell death events may have occurred in the environment of that cell (7). Some of our cells have been found to extrude nucleotides in self-defense, because leftovers from that kind of event may tell the inflammasome machinery that the cell is encountering a dangerous situation (8).
    This system recognizes that certain pathogens create holes in cell walls, so when a phagocyte encounters evidence of damaged membranes with holes in them, that alone can trigger a cell danger response that enlists inflammasomes. That means two popularly used medicines that kill fungus by inserting holes in their cells, Nystatin and Amphotericin B, have by themselves been found to create this danger signal even when there is no infectious agent. Doctors and lay people need to know that many signs that are usually associated with an infection, including fever, can occur when there is nothing infectious involved (9). Another inflammasome trigger is excess alcohol which can be very damaging when it triggers inflammasomes in the nervous system. (10) Another concern is environmental contaminates like asbestos and silica which have been studied the most when they are inhaled. (11)
    Crystals of uric acid associated with gout or other cell debris can also trigger the inflammasome, as can crystals of oxalate, which may be important to celiac disease since scientists have found higher levels of oxalate in celiac sprue. These crystals must reach a critical concentration to generate this cell danger mechanism in phagocytic cells (12). In the past, nobody really was aware that oxalate could have a major effect on the immune system outside of what it does in the kidneys.
    Scientists for so many years thought the kidney alone contained cells that oxalate could influence. That's why other cell types were not studied. At least now, we realize this narrow focus had been based on some premature conclusions. We should have known to look more broadly because there was so much evidence from Primary Hyperoxaluria, a genetic disorder where a defective liver produces oxalate that travels to the whole body, creating a condition called oxalosis. That's how we know that oxalate goes all over the body. For the longest time, nobody was measuring oxalate outside of kidney disease, even though there were a few exceptions, like in people after bariatric surgery, and in celiac sprue and in cystic fibrosis, and eventually, in autism (13).
    Because there already was a literature about oxalate in celiac sprue, when our project began, we started informing the public about these links on our website, www.lowoxalate.info. More recently we have written a series of articles about oxalate in this journal, discussing the science, and also practical issues about how to reduce oxalate while on a gluten free diet. That was working with knowledge we had then, but now we know that this issue of inflammasomes has been a part of the story we didn't know, but it holds great promise of possibly addressing why there could be complications in celiac sprue that do not resolve by merely going gluten free.
    Another trigger for the inflammasome is homocysteine (14). The pathway to recycle homocysteine back to methionine is called remethylation, and this process requires both methylcobalamin and the folic acid cycle. Others on internet groups have brought attention to polymorphisms in one of the relevant enzymes, called MTHFR. This system is also tied to the process of making sulfate, taurine and glutathione, because homocysteine can be routed that direction when the body is trying to resolve oxidative stress. Many of these steps require B6, and heme is also needed to direct homocysteine towards transsulfuration. The issue of excess homocysteine may prove to be more important to our non-professional phagocytic cells that are found lining our blood vessels, because these same vessels can also take up oxalate, creating a condition of vascular swelling called livedo reticularis (15). Issues with both homocysteine and oxalate have been associated with atherosclerosis (16).
    Did your child's pediatrician recommend giving your child Tylenol before his immunizations to make him more comfortable about his body's reaction to his shots? Scientists have now found that Tylenol not only depletes our body's ability to deal with the oxidative stress from immunization, but it also turns on the inflammasome (17). The inflammasome will skew immune defense away from Th2 adaptive immunity, and that is unfortunate, in this case, because the process of developing a Th2 response was the whole point of giving a child a vaccine. Our vaccines are designed to contain adjuvants that skew the immune response in the Th2 direction (18) but some adjuvants may not be working as expected (19).
    Researchers sometimes look for the evidence that someone has developed antibodies before they will call an immunization a success. That test will ordinarily not be ordered by a pediatrician, but instead, a child will simply later be given, by default, a booster shot. Is there any chance the recommendation of Tylenol or other inflammasome activators could have impaired the antibody response in some children? Certainly, the new research on inflammasomes might suggest that in children who fail to make antibodies after a vaccine, a look at what is happening with innate immunity could be in order before assuming that these systems are working normally. Are doctors testing antibody titres or doing other immune testing in children with celiac sprue? This may be more important if such a child has developed another autoimmune condition.
    Has gluten had other ways of affecting the immune response? We have known that gluten and proteins from milk, soy, and even spinach will form opioid peptides as they are broken down. Like other opiates, these active peptides can be addictive and would be able to skew an immune response (20).Opioids can also paradoxically activate inflammasomes in the spinal column which then may provoke, amplify, and prolong pain. (21) Other work showed us that activation at the same opioid receptors that drugs use can limit our absorption of the amino acid cysteine. This amino acid is needed by our bodies in order to provide glutathione, the primary cellular antioxidant that protects us from oxidative stress, and this is especially important to save us from neurodgeneration (22).
    Why is that important? The formation of glutathione can calm down a mitochondrion that is upset enough for it to be generating reactive oxygen species (ROS). Unfortunately, scientists recently learned that the ROS produced by a mitochondrion under such stress will also trigger the inflammasome. Having adequate glutathione is especially important when our bodies are coping with the demands of immune activity, as during illness or after immunization. Unfortunately, oxalate at those times may compete with glutathione for entry into the mitochondrion at the mitochondrial dicarboxylate carrier (23).
    Until very recently, we did not know that partially digested pieces formed from gliadin could trigger the formation of the inflammasome. This occurred more in peripheral blood mononuclear cells (PBMCs) from people with celiac sprue compared to healthy donors (24). The people who did this research may not have known that people with celiac tend to be higher in oxalate than other people, and they also may not have known that oxalate by itself has been found to trigger the formation of the inflammasome. People with celiac may need to be careful about avoiding both triggers for inflammasome formation.
    In a different context, another group of scientists discovered that PBMC's exposed to titanium salts made from oxalate caused immunotoxicity when other salts of titanium did not produce that toxic effect. That experiment tells us that oxalate does enter the type of cell that was also found to respond in celiac disease to these digests of gliadin by formation of the inflammasome (25).
    The well-studied vulnerability of individuals with celiac to antibody mediated effects of gliadin came from the adaptive arm of our immunity. The HLA type is definitely known to be relevant there, but it would not be relevant to an issue of cell-mediated immunity. That is why it is a puzzle that the authors of this study did not control for oxalate by matching the control and celiac subjects for the oxalate content of their cells.
    The differences they saw in response to the gliadin digest may have required higher levels of oxalate in those cells. Do we know? If that could be the case, then it becomes possible that the response they recorded in celiac cells might also happen in those who are higher in oxalate for other reasons, but who lack the HLA risk genes that are definitional of celiac. We simply cannot tell if the risk of inflammasome activation in their experiment involved having the oxalate content of these cells also working in some kind of synergism with gluten. It is important to note that here we are talking about oxalate that this type of cell may have accumulated earlier in its life or during its time in the blood. Here we are not talking about oxalate that someone may have just eaten.
    It is possible that an inflammasome-mediated function could explain why there are so many people who don't have celiac disease discovering that removing gluten from the diet makes them feel better. The academic community and others are still having a hard time believing this story (26), and cannot understand the recent popularity of gluten free foods in the general population.
    A different reason for thinking about a possible synergism between a gluten free and a reduced oxalate diet came from a recent poll done by the Oxalate Project at www.lowoxalate.info. Those results revealed that the majority of those who reported positive effects in their autoimmune disease by reducing oxalate had been extremely high in oxalate before they reduced oxalate. Curiously, 58% of those responding to the poll said they were also gluten free, but only 16% had celiac sprue. Those who were both gluten free and low oxalate reported a 10% higher positive effect from reducing oxalate than those who were not also gluten free. That could be important.
    Many scientists still think a standard American diet will keep oxalate below 200 mgs a day, but 84% of the individuals answering that poll said that they started out with levels of oxalate over 300 mgs a day. Recent changes in eating habits for high oxalate foods may have been the result of powerful advertising that has been telling people that high oxalate foods are the healthiest foods available. Anonymous poll data has no way to be verified, and that fact keeps us from assuming that we can derive information from this poll about oxalate's role (if any) in contributing to their autoimmune condition. Even so, the poll told us that out of all respondents, 73% reported a positive effect in their autoimmune condition by reducing oxalate, but those with celiac sprue (some who had other autoimmune conditions) did much better. 88% of them reported a positive effect on their autoimmune condition. That was actually a higher percentage than what was recorded for any of the other autoimmune conditions. Does that mean that it might be important for autoinflammatory processes to be careful about both gluten and oxalate? (27) We may learn the answer to that question as more people with these issues try both dietary changes together.
    Some scientists now are generating data that they feel supports the idea that excessive activity of inflammasomes could be related to the etiology of autoimmune disease (28). The changes that the inflammasome makes to our bodies can be harsh, and in fact, some scientists studied sepsis in animals and found that just by blocking inflammasome activity by various inhibitors, they could save those animals from a certain death. The irony is that the animals were still infected, but survived anyway. That means that what had been killing them was their immunological response to infection instead of the infection itself. This type of research is still very new, but it may change some of our assumptions (29).
    What interventions have scientists found that will suppress inflammasome activity? The good news is that a lot of their research has involved supplements that anyone can buy in a health food store, and some people were already using them for different reasons. One of those items is resveratrol. When it was first studied, it seemed to have been made out of red wine, mostly, but our project has discovered that commercially, the usual product is made from an herb called Japanese knotwood, which is known to be high in oxalate (30). The Oxalate Project has not yet tested the oxalate content of commercially available brands of resveratrol to see how much oxalate ends up in a capsule, but that testing is on its agenda.
    The supplement quercitin is also an inflammasome inhibitor (31). CoQ10 is another supplement that has become widely available in drug stores and health food stores because it is needed to correct a mitochondrial problem created by statin drugs. Fortunately, CoQ10 also inhibits the inflammasome, mainly by keeping the mitochondrion happier and better protected from the need to generate reactive oxygen species (32). A popular source of sulfur called MSM (methylsulfonylmethane) also was found to inhibit inflammasomes (33). So has its close cousin DMSO, a solvent that was once used as a delivery system for secretin, when it was proposed as a treatment for autism (34, 35).
    Another exciting inhibitor is 3-hydroxybutyrate, which is one of the two ketones (along with acetoacetate) that our bodies make in ketosis (36). Ketosis occurs when the body is not getting enough energy from carbohydrate, and it switches into a mode of burning fat, and that produces these ketones. Some people will try to induce this switch in metabolism on purpose, like those dealing with seizures who find the seizures are controlled with a ketogenic diet. If the change that this ketogenic diet accomplished was due to down regulation of inflammasome activity, that might bring new hope or strategies to mind for individuals where this diet treatment by itself failed. Such individuals may have had a different environmental component that was still activating inflammasomes in spite of their use of the use of the ketogenic diet. This mechanism may point to yet another reason that obesity, which may have come from excess consumption of carbohydrate, has been linked with inflammasome activation (37).
    We can hope that more investigation of other activators and other inhibitors for those with seizures might yield better success. Also, the association with ketosis may explain a previously overlooked benefit experienced by people who were exercising the discipline of fasting…the age-old tradition that comes from many cultures. These traditions are more striking when realizing that obesity can activate inflammasomes and inflammasomes are thought to be behind the roots of metabolic syndrome and diabetes (38, 39).
    Pharma does have some drugs already in its cabinet which scientists have found will inhibit inflammasomes. There are probably more such drugs in the pipeline and we may soon hear advertisements for this new class of drugs. Our Oxalate project has already begun to hear of some doctors and hospitals using the over the counter inhibitors resveratrol or coQ10 to successfully protect patients who were at risk for developing sepsis.
    More research obviously needs to be done in this area and this new frontier has become very attractive to scientists. One of the first big questions they may need to ask is whether our health care protocols in Western medicine have led to over-stimulating this arm of immunity by emphasizing killing strategies with antimicrobial therapies or other drugs that may leave crystals or other debris behind. Why might that have been a problem?
    Phagocytes are upset about cellular debris and disrupted membranes. Some scientists have been finding that our bodies may stay healthier by tolerating some infections rather than experiencing the excessive immune activity that comes from activating inflammasomes. It will take a long time for some of these scientific ideas to trickle down and begin persuading doctors to make changes in their prescribing habits for antibiotics and other antimicrobials. Some doctors and other practitioners are already finding that inflammasome inhibitors could be an appropriate adjunct therapy during antibiotics. Of course, since this is such a new scientific area to study, it may take years before proper clinical studies can be done to address all these issues.
    In the meantime, it seems wise for anyone prone to autoimmune disease to avoid triggers for inflammasomes that are easy to avoid. This would include things like being overweight, eating foods that encourage uric acid formation (and the risks known for gout). It could include situations that encourage the body to make oxalate and that could include deficiencies of B6 or thiamine, or excess use of Vitamin C. It could come from excess dietary oxalate. We also need to consider the use of drugs or supplements that are known to form crystals in blood, or Tylenol, or antifungals that punch holes in cell membranes. We need to be vigilant about our status for homocysteine. We need to be careful about our level of consumption of alcoholand our exposureto other environmental contaminants. In time, we will learn of many other triggers.
    If there is a suspicion that inflammasomes are related to a disease process that we find in our bodies, then we should at least think about using one of the over the counter and safe and well-studied inflammasome suppressors. As the research continues, we can hope that scientists studying in this area will show us more ways to dial down the frequency and the unpleasant symptoms and other consequences of autoimmune disease and autoinflammation.
    References:
    1. (http://www.aarda.org/autoimmune-information/list-of-diseases/)
    2. Doria A, Zen M, Bettio S, Gatto M, Bassi N, Nalotto L, Ghirardello A, Iaccarino L, Punzi L. Autoinflammation and autoimmunity: bridging the divide. Autoimmun Rev. 2012 Nov;12(1):22-30. doi: 10.1016/j.autrev.2012.07.018. Epub 2012 Aug 2. Review. PubMed PMID: 22878274.
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    Yvonne (Vonnie) Mostat
    Celiac.com 01/11/2017 - Did you know that Advertising has "Cottoned onto us?" In December all the magazines are about baking, foods, cakes and bakes, candies and calories. If you are not aware of what "Cottoned up" actually means, it means that even if we have celiac disease, gluten sensitivity or dermatitis herpetiformis, they know that in December, prior to Christmas, we are geared up to baking tasty, sweet, gluten-free treats. And in January we are into healthy eating, like natural soups, low calorie warm and nutritious eating, cost saving ideas, because we have just gone through Thanksgiving gluttony and Christmas eating.
    At one time we celiac people did not have the options that we have today. It was white rice bread from the freezer of the store, full of frosty tops, and vague cookies that cost $3.00 each. Now we have so many options we can get fat too, starting with Thanksgiving right up to New Year, when the new magazines come out with calorie cutting ideas, weight loss regimes, and a stringent diet!
    Did you know that celiac disease affects people differently? According to the The University of Chicago Celiac Disease Center: "There are more than 200 signs and symptoms of celiac disease, yet a significant percentage of people with celiac disease have no symptoms at all. However, people without symptoms are still at risk for some of the complications of celiac disease". For example, my 19 year old grandson's girlfriend has celiac disease, and she likely had it all her life. She was tested for celiac disease because she had "tummy aches before I write exams". That was it! Fortunately she had a bright mother who took her to the doctor and asked for the simple blood test for celiac disease. Sure enough, after doing the blood test and undergoing the biopsy of the jejunum, she had celiac disease.
    She was not skinny because she was 18 and growing, she was skinny because of malabsorption and eating her daily breakfast of cinnamon toast, and her usual lunch of peanut butter and jelly sandwiches. I am a little wary of the biopsy of the jejunum because as a nurse I found several discrepancies in the testing process. I have seen where a gastroenterologist who did failed to biopsy the correct area and told patients that they were negative for celiac disease. The patients became quite ill and the test was repeated by another gastroenterologist, and the test proved positive for celiac disease. In other words, the two patients did indeed have celiac disease.
    Did you know that the Head of dermatology at the University of British Columbia recommends Dapsone as the drug of choice for clearing up dermatitis herpetiformis? It is called the “Golden Standard” of treatment, which he teachers to all his students of dermatology. I had three biopsies of the lesions on three different places in my body. It was not until the fourth biopsy that they acquired a Positive for dermatitis herpetiformis. It is very difficult to obtain punch biopsies of the DH. But if they put you on Dapsone for four days the lesions begin to clear up almost immediately. It took longer for the lesions in my scalp to go away, around six month, and four days for those on the other parts of my body to disappear. And they were so itchy (as any of you with DH know) that I actually contemplated cutting all my hair off. I tried Quellada liquid thinking it might be fleas, bed bugs, or some other strange skin disorder. "A little learning is a dangerous thing", that is what they say to all nurses.
    Those of you who are newly diagnosed with DH and placed on Dapsone, please remind your doctor if he has not already told you that Dapsone can cause anemia. I was advised to take 2,000 Units of Vitamin C daily because it helps significantly with the anemia.
    According to an article by Lisa Fittterman in the Winter 2016 issue of Allergic Living magazine, a 28 year old California Mom was stymied by her child's reactions and celiac outbreaks because they are so vigilant about reading labels when shopping. The culprit was a new generic controller inhaler for her asthma. The Mom looked up the medication on the Internet and saw the word, "Starch". She says the drug turned out to contain gluten as an additive. She hit roadblocks at every turn.
    With celiac disease now affecting 1% of the people in North America, "drugs can present a distressing unknown". What is an excipient they ask? Inactive ingredients used as binding agents tent to give bulk and allow them to absorb water and disintegrate. They are derived from foods such as corn, potato or wheat starch. Independent investigations have shown that wheat starch is used less frequently than the other two because it doesn't bind well." When you ingest a new drug without knowing what it contains it is like walking down a road blindfolded says Sue Newell, the Canadian Celiac Association's manager of operations. "We teach people how to read labels and cut through jargon to identify every ingredient - but with prescription drugs they can't do that...they may need to take drugs, but they don't feel safe."
    The US. Based National Foundation for Celiac Awareness (NCA) released in the Fall of 2014, almost 25 percent of the 5,625 people with celiac disease and gluten sensitivity reported having experienced gluten-related symptoms to medication. Patients and health–care providers said this has led to anxiety and non-compliance in taking drugs. Both Canada and the U.S.A. Food and Drug Administration have national standards of less than 20 parts per million (ppm) of gluten for a packaged food to claim to be gluten-free, but the requirements for food labeling do not apply to prescription or over-the-counter drugs. In May 2015, the FDA denied the request of a citizen's petition to either ban gluten as an inactive drug ingredient or require that its presence be labeled. The FDA said that "No oral-drug product is expected to contain more gluten than the amounts potentially present in foods that can be labeled 'gluten-free' under the FDA's food-labeling regulations."
    It is far from an official requirement in Canada. The Canadian Food and Drugs Act sets the regulations for labeling gluten and allergens, but the focus has been far more on food. A Health Canada spokesperson says that the 2014 plain-language labeling initiative additionally makes it necessary for pill package inserts to list ingredients. But Newell of the CCA says these listings are not as transparent as they sound. Though the protein is not often present in our medications, the bad news is that finding out for certain may take the skill of a detective or a sleuthing pharmacist.
    It is time for the celiac and gluten sensitive community, to unite and fight, write letters, speak to their pharmacists and repeat the fact that the person ordering the drug is "A brittle celiac," and all drugs need to be researched by the pharmacist prior to filling prescriptions.
    Steve Plogsted, a pharmacist with a special interest in tracking gluten, suggests: "Watch for the word 'STARCH' as an excipient on a medicine, as it's the only likely culprit to contain gluten. If the word is there, try to drill down through the manufacturer as to what kind of starch. If it is wheat, you will need to avoid it."
    One man took a stand for gluten-free drugs. Michael Weber was diagnosed with celiac disease on 2004, and immediately adopted the gluten-free diet to protect his health. BUT, after taking a generic for only a few days, the resident of Eastchester, New York, was distressed to find he was again developing symptoms, such as the dermatitis herpetiformis skin rash he had incurred before the condition was discovered. It turned out the pills contained gluten as an inactive ingredient. Shocked to find this undeclared exposure after he had been so careful, Weber contacted the FDA, but he was informed that the manufacturer wasn't braking any rules by not stating gluten's presence overtly. In 2008, Weber filed a citizen's petition requesting that the FDA either ban gluten outright in medications, or require manufacturers to label for the protein. Then, for seven long years, he got politicians to write letters of support, and made follow-up inquiries, but he received no replies.
    Finally, in 2016 the U.S. consumer protection group Pullback Citizen filed a lawsuit to elicit a response from the FDA. Last May the agency issued a 21 page decision that denied the request for a ban and stated that manufacturers already needed to identify gluten as an intentionally added inactive ingredient to any drug that is taken orally. The FDA said it did, however, plan to issue "draft guidance" for industry regarding gluten in drug products, but no time-line was given. FDA spokesman Stephen King explained the decision in an interview saying that if people with celiac disease are doing well on a gluten-free diet, they "should" not be harmed by the very low amounts of gluten potentially present in oral drug products. Conversely, if they aren't doing well, "we would expect {them} to consult with [their] physician about ways to further reduce overall exposure to gluten. Such efforts might first focus on the diet as the most significant potential course for oral gluten exposure."
    But Katie Einspanier, Weber's lawyer through Public Citizen, criticized the ruling as nothing more than a super-technical reading of the petition since the FDA's response focused on the possibility of gluten itself being an inactive ingredient. "The most likely scenario for gluten in drugs is that gluten is simply a natural component of another inactive ingredient and not separately added as an inactive ingredient." Weber is considering whether to draft a new petition with more precise language. We will keep you informed regarding this one man's fight for gluten-free drugs. He needs to be cheered, and we all need to sit down at our computer and help by writing to pharmacists, the FDA, and the College of Pharmacy.

  • Recent Articles

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

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

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

    admin
    WHAT IS CELIAC DISEASE?
    Celiac disease is an autoimmune condition that affects around 1% of the population. People with celiac disease suffer an autoimmune reaction when they consume wheat, rye or barley. The immune reaction is triggered by certain proteins in the wheat, rye, or barley, and, left untreated, causes damage to the small, finger-like structures, called villi, that line the gut. The damage occurs as shortening and villous flattening in the lamina propria and crypt regions of the intestines. The damage to these villi then leads to numerous other issues that commonly plague people with untreated celiac disease, including poor nutritional uptake, fatigue, and myriad other problems.
    Celiac disease mostly affects people of Northern European descent, but recent studies show that it also affects large numbers of people in Italy, China, Iran, India, and numerous other places thought to have few or no cases.
    Celiac disease is most often uncovered because people experience symptoms that lead them to get tests for antibodies to gluten. If these tests are positive, then the people usually get biopsy confirmation of their celiac disease. Once they adopt a gluten-free diet, they usually see gut healing, and major improvements in their symptoms. 
    CLASSIC CELIAC DISEASE SYMPTOMS
    Symptoms of celiac disease can range from the classic features, such as diarrhea, upset stomach, bloating, gas, weight loss, and malnutrition, among others.
    LESS OBVIOUS SYMPTOMS
    Celiac disease can often less obvious symptoms, such fatigue, vitamin and nutrient deficiencies, anemia, to name a few. Often, these symptoms are regarded as less obvious because they are not gastrointestinal in nature. You got that right, it is not uncommon for people with celiac disease to have few or no gastrointestinal symptoms. That makes spotting and connecting these seemingly unrelated and unclear celiac symptoms so important.
    NO SYMPTOMS
    Currently, most people diagnosed with celiac disease do not show symptoms, but are diagnosed on the basis of referral for elevated risk factors. 

    CELIAC DISEASE VS. GLUTEN INTOLERANCE
    Gluten intolerance is a generic term for people who have some sort of sensitivity to gluten. These people may or may not have celiac disease. Researchers generally agree that there is a condition called non-celiac gluten sensitivity. That term has largely replaced the term gluten-intolerance. What’s the difference between celiac disease and non-celiac gluten-sensitivity? 
    CELIAC DISEASE VS. NON-CELIAC GLUTEN SENSITIVITY (NCGS)
    Gluten triggers symptoms and immune reactions in people with celiac disease. Gluten can also trigger symptoms in some people with NCGS, but the similarities largely end there.

    There are four main differences between celiac disease and non-celiac gluten sensitivity:
    No Hereditary Link in NCGS
    Researchers know for certain that genetic heredity plays a major role in celiac disease. If a first-degree relative has celiac disease, then you have a statistically higher risk of carrying genetic markers DQ2 and/or DQ8, and of developing celiac disease yourself. NCGS is not known to be hereditary. Some research has shown certain genetic associations, such as some NCGS patients, but there is no proof that NCGS is hereditary. No Connection with Celiac-related Disorders
    Unlike celiac disease, NCGS is so far not associated with malabsorption, nutritional deficiencies, or a higher risk of autoimmune disorders or intestinal malignancies. No Immunological or Serological Markers
    People with celiac disease nearly always test positive for antibodies to gluten proteins. Researchers have, as yet, identified no such antobodies or serologic markers for NCGS. That means that, unlike with celiac disease, there are no telltale screening tests that can point to NCGS. Absence of Celiac Disease or Wheat Allergy
    Doctors diagnose NCGS only by excluding both celiac disease, an IgE-mediated allergy to wheat, and by the noting ongoing adverse symptoms associated with gluten consumption. WHAT ABOUT IRRITABLE BOWEL SYNDROME (IBS) AND IRRITABLE BOWEL DISEASE (IBD)?
    IBS and IBD are usually diagnosed in part by ruling out celiac disease. Many patients with irritable bowel syndrome are sensitive to gluten. Many experience celiac disease-like symptoms in reaction to wheat. However, patients with IBS generally show no gut damage, and do not test positive for antibodies to gliadin and other proteins as do people with celiac disease. Some IBS patients also suffer from NCGS.

    To add more confusion, many cases of IBS are, in fact, celiac disease in disguise.

    That said, people with IBS generally react to more than just wheat. People with NCGS generally react to wheat and not to other things, but that’s not always the case. Doctors generally try to rule out celiac disease before making a diagnosis of IBS or NCGS. 
    Crohn’s Disease and celiac disease share many common symptoms, though causes are different.  In Crohn’s disease, the immune system can cause disruption anywhere along the gastrointestinal tract, and a diagnosis of Crohn’s disease typically requires more diagnostic testing than does a celiac diagnosis.  
    Crohn’s treatment consists of changes to diet and possible surgery.  Up to 10% of Crohn's patients can have both of conditions, which suggests a genetic connection, and researchers continue to examine that connection.
    Is There a Connection Between Celiac Disease, Non-Celiac Gluten Sensitivity and Irritable Bowel Syndrome? Large Number of Irritable Bowel Syndrome Patients Sensitive To Gluten Some IBD Patients also Suffer from Non-Celiac Gluten Sensitivity Many Cases of IBS and Fibromyalgia Actually Celiac Disease in Disguise CELIAC DISEASE DIAGNOSIS
    Diagnosis of celiac disease can be difficult. 

    Perhaps because celiac disease presents clinically in such a variety of ways, proper diagnosis often takes years. A positive serological test for antibodies against tissue transglutaminase is considered a very strong diagnostic indicator, and a duodenal biopsy revealing villous atrophy is still considered by many to be the diagnostic gold standard. 
    But this idea is being questioned; some think the biopsy is unnecessary in the face of clear serological tests and obvious symptoms. Also, researchers are developing accurate and reliable ways to test for celiac disease even when patients are already avoiding wheat. In the past, patients needed to be consuming wheat to get an accurate test result. 
    Celiac disease can have numerous vague, or confusing symptoms that can make diagnosis difficult.  Celiac disease is commonly misdiagnosed by doctors. Read a Personal Story About Celiac Disease Diagnosis from the Founder of Celiac.com Currently, testing and biopsy still form the cornerstone of celiac diagnosis.
    TESTING
    There are several serologic (blood) tests available that screen for celiac disease antibodies, but the most commonly used is called a tTG-IgA test. If blood test results suggest celiac disease, your physician will recommend a biopsy of your small intestine to confirm the diagnosis.
    Testing is fairly simple and involves screening the patients blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis. Also, it is now possible to test people for celiac disease without making them concume wheat products.

    BIOPSY
    Until recently, biopsy confirmation of a positive gluten antibody test was the gold standard for celiac diagnosis. It still is, but things are changing fairly quickly. Children can now be accurately diagnosed for celiac disease without biopsy. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide.

    WHY A GLUTEN-FREE DIET?
    Currently the only effective, medically approved treatment for celiac disease is a strict gluten-free diet. Following a gluten-free diet relieves symptoms, promotes gut healing, and prevents nearly all celiac-related complications. 
    A gluten-free diet means avoiding all products that contain wheat, rye and barley, or any of their derivatives. This is a difficult task as there are many hidden sources of gluten found in the ingredients of many processed foods. Still, with effort, most people with celiac disease manage to make the transition. The vast majority of celiac disease patients who follow a gluten-free diet see symptom relief and experience gut healing within two years.
    For these reasons, a gluten-free diet remains the only effective, medically proven treatment for celiac disease.
    WHAT ABOUT ENZYMES, VACCINES, ETC.?
    There is currently no enzyme or vaccine that can replace a gluten-free diet for people with celiac disease.
    There are enzyme supplements currently available, such as AN-PEP, Latiglutetenase, GluteGuard, and KumaMax, which may help to mitigate accidental gluten ingestion by celiacs. KumaMax, has been shown to survive the stomach, and to break down gluten in the small intestine. Latiglutenase, formerly known as ALV003, is an enzyme therapy designed to be taken with meals. GluteGuard has been shown to significantly protect celiac patients from the serious symptoms they would normally experience after gluten ingestion. There are other enzymes, including those based on papaya enzymes.

    Additionally, there are many celiac disease drugs, enzymes, and therapies in various stages of development by pharmaceutical companies, including at least one vaccine that has received financial backing. At some point in the not too distant future there will likely be new treatments available for those who seek an alternative to a lifelong gluten-free diet. 

    For now though, there are no products on the market that can take the place of a gluten-free diet. Any enzyme or other treatment for celiac disease is intended to be used in conjunction with a gluten-free diet, not as a replacement.

    ASSOCIATED DISEASES
    The most common disorders associated with celiac disease are thyroid disease and Type 1 Diabetes, however, celiac disease is associated with many other conditions, including but not limited to the following autoimmune conditions:
    Type 1 Diabetes Mellitus: 2.4-16.4% Multiple Sclerosis (MS): 11% Hashimoto’s thyroiditis: 4-6% Autoimmune hepatitis: 6-15% Addison disease: 6% Arthritis: 1.5-7.5% Sjögren’s syndrome: 2-15% Idiopathic dilated cardiomyopathy: 5.7% IgA Nephropathy (Berger’s Disease): 3.6% Other celiac co-morditities include:
    Crohn’s Disease; Inflammatory Bowel Disease Chronic Pancreatitis Down Syndrome Irritable Bowel Syndrome (IBS) Lupus Multiple Sclerosis Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Psoriasis Rheumatoid Arthritis Scleroderma Turner Syndrome Ulcerative Colitis; Inflammatory Bowel Disease Williams Syndrome Cancers:
    Non-Hodgkin lymphoma (intestinal and extra-intestinal, T- and B-cell types) Small intestinal adenocarcinoma Esophageal carcinoma Papillary thyroid cancer Melanoma CELIAC DISEASE REFERENCES:
    Celiac Disease Center, Columbia University
    Gluten Intolerance Group
    National Institutes of Health
    U.S. National Library of Medicine
    Mayo Clinic
    University of Chicago Celiac Disease Center

    Jefferson Adams
    Celiac.com 04/17/2018 - Could the holy grail of gluten-free food lie in special strains of wheat that lack “bad glutens” that trigger the celiac disease, but include the “good glutens” that make bread and other products chewy, spongey and delicious? Such products would include all of the good things about wheat, but none of the bad things that might trigger celiac disease.
    A team of researchers in Spain is creating strains of wheat that lack the “bad glutens” that trigger the autoimmune disorder celiac disease. The team, based at the Institute for Sustainable Agriculture in Cordoba, Spain, is making use of the new and highly effective CRISPR gene editing to eliminate the majority of the gliadins in wheat.
    Gliadins are the gluten proteins that trigger the majority of symptoms for people with celiac disease.
    As part of their efforts, the team has conducted a small study on 20 people with “gluten sensitivity.” That study showed that test subjects can tolerate bread made with this special wheat, says team member Francisco Barro. However, the team has yet to publish the results.
    Clearly, more comprehensive testing would be needed to determine if such a product is safely tolerated by people with celiac disease. Still, with these efforts, along with efforts to develop vaccines, enzymes, and other treatments making steady progress, we are living in exciting times for people with celiac disease.
    It is entirely conceivable that in the not-so-distant future we will see safe, viable treatments for celiac disease that do not require a strict gluten-free diet.
    Read more at Digitaltrends.com , and at Newscientist.com