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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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    VITAMIN B12 AND CELIAC DISEASE


    Betty Wedman-St Louis, PhD, RD


    • Journal of Gluten Sensitivity Winter 2016 Issue - Originally published January 5, 2016


    Celiac.com 04/12/2016 - Vitamin B12 is a group of cobalt containing compounds described by Alan R. Gaby, M.D. in Nutritional Medicine called cobalamins. Methylcobalamin is the coenzyme form of B12 that is critical for human health. Hydroxocobalamin is a more stable form of B12 but it first needs to be converted to an active form before use in metabolism.


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    Vitamin B12 is important in DNA synthesis, red blood cell formation, homocysteine metabolism and the production of S-adenosylmethionine (SAMe). Adequate B12 is essential for proper neurological and immune function.

    The importance of Vitamin B12 in health and anemia management began during the Depression era when animal protein foods were limited in the American diet. Three physicians who reversed pernicious anemia in dogs were awarded the 1934 Nobel Prize for medicine. Dr. George Hoyt Whipple and two other physicians fed the dogs and humans 1/2 pound of fresh liver per day as a means to control anemia.

    Animal proteins—meat, poultry, fish, eggs—are the sources of Vitamin B12 for humans. Plants do not need or produce B12. How B12 gets into your blood is a complex dance of stomach acids and intrinsic factors that starts with pepsin in the stomach splitting off the B12 from the protein compound. The intrinsic factor made by the parietal cells of the stomach attaches to the B12 to be shuttled to the ileum where receptors pull it into the blood.

    Once in the blood, B12 is picked up by transcobalamin to be carried to cells throughout the body. Any excess is stored in the liver or excreted in the urine.

    If inadequate intrinsic factor is available—loss from aging or proton pump inhibitor use—B12 deficiency symptoms such as macrocytic anemia, neurological disorders and psychiatric symptoms (memory loss, depression, confusion, paranoia) may occur. Severe B12 deficiency can result in intestinal damage, hyper-pigmentation of the skin, hypotension, and immune dysfunction.

    The Institute of Medicine indicates that only 2 to 4 mcg Vitamin B12 is needed daily. The average American diet contains 5-15 mcg per day according to NHANES studies. Vegetarians and infants breastfed by vegan mothers are at greatest risk of developing B12 deficiency.

    Other factors increase the risk of developing Vitamin B12 insufficiency. Achlorydria secondary to gastritic, gastric bypass surgery, and ileal resection for Crohn’s disease need assessment due to malabsorption. Apathy abounds throughout the medical community despite the 2009 Centers for Disease Control and Prevention statistics indicating 1 out of every 31 people over 50 being B12 deficient. With increasing numbers of gastric bypass patients and Crohn’s resections, this deficiency could be significantly higher.

    Adverse symptoms can first be noted with the CBC test indicating large RBC or macrocytosis—a folate and B12 deficiency. Other symptoms may include balance problems, numb hands and feet, leg pains, early onset dementia, pre-Parkinson’s-like disease, infertility and depression.

    Many physicians are poorly educated on Vitamin B12 importance since it is a vitamin and easy to treat. Treatment with methylcobalamin injections with few definitive ways to test efficacy seems to be a primary factor. A complete medical history assessing for gut inflammation, celiac disease, GERD, recent nitric oxide use in surgery, and genetic factors like MTHFR should trigger a closer look at B12 adequacy even with a normal homocysteine (HCY) plasma test. High levels of B12 on standard blood analysis usually indicates poor absorption and not intoxification of Vitamin B12. Elevated B12 results >800pg/ml frequently indicate PPI use or low stomach acid malabsorption. Lab results <350pg/ml may still be inadequate for a patient with celiac disease, gluten enteropathy or gastric bypass surgery, so supplementation should be considered.

    Medications matter when considering Vitamin B12 status. Below are common drugs that impair absorption:

    • Antacids- maalox, MOM, Mylanta, Tums
    • Histamine blockers- Zantac, Tagamet, Axid, Pepcid
    • Proton Pump Inhibitors- Prevacid, Prilosec, Nexium,. Omeprazole, Acidhex
    • Colchicine
    • Questran
    • Metformin, Glucophage
    • Celexa, Effexor, Elavil, Nardil, Paxil, Prozac, Zoloft, Wellbutrin
    • Ativan, Librium, Valium, Xanax
    • Viagra, Cialis, Levitra
    • Compazine, Haldol, Risperdal, Tegretal

    Vitamin B12 supplementation is probably the safest medical treatment available. Many people need B12 injections to show improvement in their symptoms. Effectiveness of injections depends more on frequency of administration than on amount given with each injection. Those who improve with injections rarely improve with oral or sublingual products no matter how large the dose because the routes of administration are not capable of achieving high enough absorption levels.

    Treatment with Vitamin B12 needs to be continued for life. Until more research on efficacy and safety of oral B12 is available, intramuscular daily or weekly injections should be considered a standard of care, especially in celiac disease and those with gastric bypass surgery.

    A 20 page handout on Digestive Wellness is available for $15 from Dr. Betty Wedman-St Louis, 17920 Gulf Blvd, Ste 606, St. Petersburg, FL 33708. It includes information on how GMO foods destroy health which will be covered in a future article.


    Image Caption: Photo: CC--francois schnell
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    Guest Galixie

    Posted

    The dogs in the experiment didn't have Pernicious Anemia. After World War I, doctors were interested in finding a way to more quickly reverse anemia (mainly the type caused by battle wounds), so they bled dogs and fed them different foods to see what worked the best. It turned out that liver worked the best. Liver happens to be high in iron, which the dogs were deficient in. Liver also happens to be high in B12, which Pernicious Anemia patients are deficient in and which is a vitamin that wouldn't be discovered for several more years. Pernicious Anemia was not well understood at the time. It was basically just lucky that liver helped correct both types of anemia.

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    Guest Aleka Munroe

    Posted

    The article stated that many physicians are poorly educated about B12. I found this to be sadly true. My terminal ileum had to be resected a year before I was diagnosed with celiac disease. That is where B12 is absorbed. I was advised that I would need regular injections. Ever since then 26 years ago, I've gotten injections. I have had to beg my family physician to test my blood levels regularly. At one point, when my level was in the normal range (about 200-1200) my physician told me I didn't need the injections anymore and wouldn't prescribe it. About 8 months later I was called on the carpet at school for a huge mistake I made teaching math. I had other symptoms that were neurological. When I saw my neurologist he asked what my B12 levels were. They were 200. "Normal" Long story short on his advice I keep my levels close to 1000 by getting an injection every 3 weeks. Every six months I have a blood test. If you have to fight for it, ask the doctor to put pernicious anemia down as the reason, or the test most likely will not get covered.

     

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    Guest Lisa Purcell

    Posted

    I have celiac disease and am not taking any of the medicines that would impair absorption. My B12 was just tested at >1500. I did not take my sublingual B12 supplement the day of the blood draw. I found this article very interesting but leaving me wondering what my test results mean.

    The article says, "High levels of B12 on standard blood analysis usually indicates poor absorption and not intoxification of Vitamin B12". Does this mean I need injections of B12? Further testing?

    Further clarification would be most welcome. Thank you for a well written and timely article.

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    Guest Busby

    Posted

    I know that I suffer from B12 deficiency from time to time, and can often be alerted by mood changes. I take 8 1,000 mg sublingual methylcobalamin tabs and usually feel a positive effect within half an hour. I find I do not necessarily need it every day. I take medications and have 2-3 medical conditions which would lead to B12 loss, so am encouraged that I do not seem to have to stick a needle in myself. I did learn about the use of B12 from a severe Crohn's survivor.

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    Guest Pippy

    Posted

    I give this a 4 star, because I need more information. My B12 numbers are ridiculously high, am I understanding that the B12 is not absorbing? What should I do then? The doc was concerned I was getting too much. This may not be so according to this article. Why does the doc think I am getting too much? Shouldn't she know if I am getting too much or not absorbing? She told me to stop taking it. I am so confused. How do I talk to a doctor and have this investigated further?

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    Guest Dawna

    Posted

    I was diagnosed with B12 deficiency 15 years ago, I went from getting shots once a month to having to do them once a week. I was diagnosed with Celiac 3 years ago and always wondered if they were related somehow. Thanks for the arrival.

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    Betty Wedman-St Louis, PhD, RD
    Celiac.com 07/18/2016 - Dietary phosphorus occurs naturally in dairy foods, animal meats, and legumes but according to the Institute of Medicine, high levels of phosphorus can be a contributor to cardiovascular, kidney and osteoporosis disorders.
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    Peanuts (1 ounce) 150 mg
    Yogurt (1 cup) 300 mg
    M&M Peanuts (1.74 oz pkg) 93 mg
    Rice Krispies Cereal (1 cup) 200 mg
    Dietary recommendations for an adult for Phosphorus is 800 to 1000 mg.

    Yvonne Vissing Ph.D.
    Celiac.com 07/25/2016 - Celiac disease is a tricky rascal. Just when you think you've got it under control, it sneaks up and manifests into new and often unexpected problems. At least, this is what we have found over the last decade. From contacts with others who have celiac disease, we know we're not alone. I'm in my early thirties and find that sometimes my body acts more like that of an old man's. For instance, I've had gout even though my diet contains almost none of the food culprits traditionally associated with that disorder. Then I learned that what gout and celiac disease have in common is that they are both auto-immune diseases. My skin is quirky and has been since I've been little; I can't wear certain types of fabric and have to use soaps and detergents for people with "sensitive skin". Celiac disease, I gather, is associated with a variety of skin problems, including psoriasis. I had to have my gall bladder removed a couple of years ago. I have elevated liver rates. Why me? I'm too young for this! Then I found that it is common for people with celiac disease to have liver and gall bladder problems.
    This spring, I started becoming so tired that I couldn't wait to go to bed, even though the sun was still shining. I finally went in to see my MD who took my blood for testing. The results? I had no vitamin D. None. I have a good diet (see my book Going Gluten Free for proof of this!), and I know that vitamins are important. I know that sunshine is associated with vitamin D, and while I'm not outside all the time, I'm not like a vampire that only goes out at night. I do get sunshine. I also have a sun lamp over my desk. So why did my blood levels indicate I have no vitamin D? Evidently I'm in good company again – lots of people with celiac disease have vitamin D problems.
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    Based on its review of data of vitamin D needs, a committee of the Institute of Medicine concluded that persons are at risk of vitamin D deficiency at serum 25(OH)D concentrations 125 nmol/L (>50 ng/mL) are associated with potential adverse effects [1] (Table 1).
    Table 1: Serum 25-Hydroxyvitamin D [25(OH)D] Concentrations and Health* [1]
    nmol/L**
    ng/mL*
    Health status
    <30
    <12
    Associated with vitamin D deficiency, leading to rickets
    in infants and children and osteomalacia in adults
    30 to <50
    12 to <20
    Generally considered inadequate for bone and overall health
    in healthy individuals
    ≥50
    ≥20
    Generally considered adequate for bone and overall health
    in healthy individuals
    >125
    >50
    Emerging evidence links potential adverse effects to such
    high levels, particularly >150 nmol/L (>60 ng/mL)
    * Serum concentrations of 25(OH)D are reported in both nanomoles
    per liter (nmol/L) and nanograms per milliliter (ng/mL).
    ** 1 nmol/L = 0.4 ng/mL
    Reference Intakes
    Intake reference values for vitamin D and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine of The National Academies (formerly National Academy of Sciences) [1]. DRI is the general term for a set of reference values used to plan and assess nutrient intakes of healthy people. These values, which vary by age and gender, include:
    30. Recommended Dietary Allowance (RDA): average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy people.
    31. Adequate Intake (AI): established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy.
    32. Tolerable Upper Intake Level (UL): maximum daily intake unlikely to cause adverse health effects.
    The FNB established an RDA for vitamin D representing a daily intake that is sufficient to maintain bone health and normal calcium metabolism in healthy people. RDAs for vitamin D are listed in both International Units (IUs) and micrograms (mcg); the biological activity of 40 IU is equal to 1 mcg (Table 2). Even though sunlight may be a major source of vitamin D for some, the vitamin D RDAs are set on the basis of minimal sun exposure.
    Table 2: Recommended Dietary Allowances (RDAs) for Vitamin D
    Age
    Male
    Female
    Pregnancy
    Lactation
    0–12 months
    400 IU
    (10 mcg)
    400 IU
    (10 mcg)
        1–13 years
    600 IU
    (15 mcg)
    600 IU
    (15 mcg)
        14–18 years
    600 IU
    (15 mcg)
    600 IU
    (15 mcg)
    600 IU
    (15 mcg)
    600 IU
    (15 mcg)
    19–50 years
    600 IU
    (15 mcg)
    600 IU
    (15 mcg)
    600 IU
    (15 mcg)
    600 IU
    (15 mcg)
    51–70 years
    600 IU
    (15 mcg)
    600 IU
    (15 mcg)
        >70 years
    800 IU
    (20 mcg)
    800 IU
    (20 mcg)
       
     
    References:
    Gluten Free Society. Celiac disease linked to gall bladder and liver problems. https://www.glutenfreesociety.org/celiac-disease-linked-to-gall-bladder-and-liver-problems/ Holick MF. Vitamin D and Health: Evolution, Biologic Functions, and Recommended Dietary Intakes of Vitamin D. In Vitamin D: Physiology, Molecular Biology and Clinical Applications by Holick MF. Humana Press 2010. Middleton, Bert. Gout and Celiac Disease: What is the connection? http://www.selfgrowth.com/articles/gout-and-celiac-disease-what-is-the-connection National Institutes of Health. Office of Dietary Supplements. Vitamin D. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ Reasoner, Jordan. Why everyone with celiac disease desperately needs vitamin D. http://scdlifestyle.com/2012/07/why-everyone-with-celiac-disease-needs-vitamin-d/ Rottman, Leon. Vitamin D revisited. http://www.csaceliacs.org/vitamin_d.jsp Tavakkoli, A. Analysis of Vitamin D Levels in Patients with Celiac Disease and Co-Existing Autoimmune Disorders. http://www.biomath.info/Protocols/PGY2/docs/AnnaTavakkoli.pdf Tavakkoli A, Digiacomo D, Green PH, Lebwohl B. Vitamin D Status and Concomitant Autoimmunity in Celiac Disease. J Clin Gastroenterol. 2013; Jan 16. Vitamin D Council. Am I deficient in Vitamin D? https://www.vitamindcouncil.org/about-vitamin-d/am-i-deficient-in-vitamin-d/ Watson, Lisa. Nutrient Deficiencies in Celiac Disease. http://drlisawatson.com/nutrient-deficiencies-celiac

    Betty Wedman-St Louis, PhD, RD
    Celiac.com 10/18/2016 - Vitamin K was discovered in 1929 and named for the German word koagulation with Herrick Dam and Edward A. Doisy receiving the Nobel Prize for their research in 1943. But Vitamin K is a multi-functional nutrient.
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    Vitamin K2 or menaquinone (referred to as MK-4 through MK-10) comes from natto (fermented soybeans), organ meats, egg yolks, and raw milk cheeses. It circulates throughout the body over a 24 hour period and is synthesized in the human gut by microbiota according to the Annual Review of Nutrition 2009. Aging and antibiotic use weakens the body's ability to produce K2 so supplementation needs to be considered.
    The Rotterdam Study in the Journal of Nutrition 2004 brought into focus the role of K2 as an inhibitor of calcification in the arteries and the major contributor to bone rebuilding osteocalcin- NOT calcium supplementation that many health professionals had recommend. The study reports K2 resulted in 50 percent reduction in arterial calcification, 50 percent reduction in cardiovascular deaths, and 25 percent reduction in all cause mortality. K1 had no effect on cardiovascular health.
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    Menaquinones (K2 or MK) are rapidly depleted without dietary intake of natto or animal sources needed for repletion which results in bone health issues, especially in menopause. Without it, the body does not use calcium and Vitamin D3 to activate osteoblasts to rebuild bone. Menaquinones cause cells to produce a protein called osteocalcin which incorporates the calcium into the bone. Without it, calcium moves into the artery wall and soft tissues of the body leading to hardening of the arteries and osteoporosis.
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    The richest food source of K2 is the Japanese fermented soybean natto, which is produced with Bacillus natto, a bacterium that converts K1 to MK-7. Fermented cheeses like Swiss and Jarlsberg contain Mk-8 and Mk-9 which can be converted to K2 at a 20 to 40 percent lower rate than from natto, but more appealing to the western taste buds. Grass-fed beef and egg yolks are the most common source of K2 in the American diet.
    For those who have not acquired a taste for fermented soybeans or natto, my nutrition mentor, Adelle Davis, had it right when she recommended eating liver once a week. Celiacs need to be sure that their diets include ample red meats, eggs and fermented cheeses or yogurt or else dietary supplementation with Vitamin K2 (MK-4) is recommended. Without it, bones can become soft tissues and arteries "turn to stone" or calcified.
    A Chart of Vitamin K levels in Foods can provide insight into food choices for menaquinone compared to Vitamin K1. It was adapted from Schurgers et al. Nutritional intake of vitamins K1 (phylloquinone) and K2 (menaquinone) in the Netherlands. J Nutr. Environ. Med. 1999.
     
    Food K1 MK-4 MK-7,8,9 Meats 0.5-5 1-30 0.1-2 Fish 0.1-1 0.1-2   Green Vegetables 100-750     Natto 20-40   900-1200 Cheese 0.5-10 0.5-10 40-80 Eggs (yolk) 0.5-2.5 10-25    
    The American Heart Association and many medical professionals who advocated no organ meats or red meat and egg yolks, deprived Americans of primary sources of Vitamin K2 which is essential for bone and cardiovascular health.

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    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