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    10 Celiac Disease Tips for Surviving a Holiday Gathering


    Lauren Lindsey
    Image Caption: Photo: CC--Ladycliff

    Celiac.com 12/11/2013 - The most wondrous season is upon us. The family gathers to create memories and cherish each moment of the holidays. Wait…wait…what?? With family?@#$?!


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    Photo: CC--LadycliffWe often emerge from these gatherings planning the next appointment with our therapist. No need to guess how it'll go this year: Mom locked herself in the bedroom with a bottle of wine again. Grandma has no reservations pointing out that you're still single. Your cousin whom suffers from chronic ‘one up syndrome' is compelled to interject conversations failing to encompass their exceeding significance.  

    There are circumstances and people we cannot change. Your family may not exemplify the magical fuzziness of a Thomas Kinkade painting but so what. What we can take control over is our well-being and attitude. Despite being thrust into drama comparable to a Kardashian marriage, let's focus on our diet. Managing celiac disease is exhausting enough without the added stress from the holidays. With the influx of food, there are more chances that forbidden goodies will bombard their way to the dinner plate. But don't sweat it. Consider the following tips to ease you celiac disease concerns and have one less thing to worry about this season. You'll need the energy for breaking up temper-mantrums over fantasy football scores and equipping the fire extinguisher for the first turkey fry attempt. 

    1. Eat before you arrive: Never walk into an occasion hungry. There are few worse mood killers than discovering carrot sticks are the only gluten-free item in the room. The hunger will also hinder your inhibitions, tempting to eat something you normally wouldn't.  Otherwise, you must wait to eat once the night is over. As nice as you look scowling over the abandoned vegetable tray and dragging your date out of door, I'm certain there are more enticing activities to engage in.

    2. Bring your own dish: Coordinate with the host beforehand to avoid confusion about portions. Consider bringing enough for others to try as well. Take the opportunity to share with family and loved ones. After all, you've spent the past year meticulously creating and photographing Pinterest worthy meals. Show them what those eight albums dedicated to food are all about.

    3. Help with cooking:  Cooking a gluten-free meal may seem easy enough to the uninformed individual. Although the cook has good intentions, their lack in experience with intricate details of the diet may lead to contamination. Insist upon helping even if your offer is declined. This way you can ensure the safety of the meal. Surely, any helping hand with cooking and cleaning duties will be appreciated.

    4. Label your food: It only takes one serving spoon dipped into the crunchy green bean casserole to contaminate your food. Set aside a table for a buffet clearly labeled "do not contaminate" and "gluten-free," etc., on the dishes. Better yet, don't put them out with everything else. There's a chance your food will mistakenly be eaten or contaminated within the vicinity of hungry mouths and gluten-filled goodies.

    5. Don't be afraid to say NO:   Your peachy little grandma, the one who spends the remainder of the year shuffling to the living room for afternoon soap operas has impeccably presented a homemade turkey dinner with all the fixins. Wow grandma, we didn't know you had it in you… Desserts, sides, more desserts, all made from scratch from her mother's, mother's, mother's recipes (she will then spend the next half hour monopolizing conversation regarding how easy we kids have it). None of which are gluten-free since, regardless of your various efforts, Grandma doesn't know what gluten means. The moral of the story: despite it being the super bowl of family dinners in your grandma's world, you must decline the meal. Politely of course but don't be afraid of assertion. Many people do not understand reasoning behind diet restrictions and some will never accept them. There are other ways to show Grandma she is loved and appreciated besides eating her food.

    6. When in doubt go without: It's always better to pass on a dish when the ingredients remain unclear. If you must ask yourself, "I don't know if I should eat this" and there's no way to confirm its safety, the answer is do not eat it. This is particularly difficult but worth avoiding the undoing of your well-being. You'll beat yourself up while gripping the toilet at your significant other's childhood home as their newly acquainted relative repeatedly knocks behind the door asking if you're ok.

    7. Avoid over indulging: "Well, since it's the holidays I guess it's alright to have this cupcake, a piece of pie, and chocolate cake." Special occasions are used as justification for eating things we normally wouldn't. We tend to overeat at these gatherings because food sits in front of us, not because we're hungry. Remember, 20 parts per million of gluten are permitted in gluten-free certified products. Eating multiple items compile trace amounts of gluten, posing for a likely reaction. Consider sticking to only one gluten-free product with your meal. The gluten-free biscuits, stuffing, corn bread, and apple pie all look delicious but choose one of those. Otherwise, the spandex pants of shame are ready to waddle through your food hangover tomorrow.

    8. Communicate with the host and guests: Simply informing the host and cook beforehand may prevent unwanted mishaps. There will be guests who show excitement in trying new dishes and wish to hear your sentiments regarding diet. Share your honest thoughts and opinions without coming across critical of their personal choices. Other guests may not be so willing to converse topics concerning diet or health but don't take offense. Remember, the diet is not simply a fad that you're following. Your life, health, and well-being depend on it and people need to know that.

    9. Limit your alcohol: Most parties mean food and booze. Since party food is rarely gluten-free, it's tempting to keep the wine and alcohol pouring in. Grab a glass of soda water and lime as your security blanket. You'll be surprised how efficiently this wards off needless drinks. It's easy to have one glass of wine here, one glass there, but then you're on glass number four. With little food in your stomach you will not be feeling too hot. Not to mention, the company Christmas party may not be the place for that extra glass. Your naughty elf impression may seem very original and hilarious at the time, but come Monday morning…not so much. 

    10. Mentally prepare yourself: Get your mind right. First, relax. Don't you just hate it when someone tells you to relax during a stressful situation? Truly though, getting worked up will exhaust you before the events even take place. Secondly, be prepared. There will be many tempting foods and opportunities to sabotage your diet. Be mindful and expectant of this beforehand. Lastly, think with a positive attitude. Bring the expectations down a notch and take it easy on yourself and others. Take on too much and be bothered by things outside of your control or choose to have a great holiday. (I'd go with the last choice- you deserve it).

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    Guest Lauren Lindsey

    Posted

    Hi readers! What are your ways of staying gluten-free over the holiday season?

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    Guest Jacki B.

    Posted

    After doing this 14 years, I still appreciated the reminders. They were right on! One more thing - I have to remember not to get angry at the callous remarks. They're borne out of ignorance.

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    Guest babsesl

    Posted

    After doing this 14 years, I still appreciated the reminders. They were right on! One more thing - I have to remember not to get angry at the callous remarks. They're borne out of ignorance.

    Yes, but they are still a bit annoying...well, more than a bit.

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    Guest Debbie Sadel

    Posted

    Be happy and cheerful. Don't make your diet the center of conversation--also go easy on the booze. It's much easier to make dietary mistakes if you've had a few too many.

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    Guest Lauren Lindsey

    Posted

    After doing this 14 years, I still appreciated the reminders. They were right on! One more thing - I have to remember not to get angry at the callous remarks. They're borne out of ignorance.

    I have to remember as well. I attended a Christmas party last night and a stranger said, " Just eat a Cheeseburger and some fries and you'll be fine..."

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    Many types of alcohol are grain based, including vodka. I take a very small, single serve casserole and push small amounts of food around on my plate while eating my safe food. Happy and pain free holidays to all.

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    Bring your own gravy, maybe a roll, or small portions of other foods that you'll want, so that you don't feel left out when other people are loading up on them. Also bring a few gluten-free snacks in case you get really hungry after or before the meal. bring your own appetizer, like gluten-free crackers and hummus. I second the remark of not making the diet the center of conversation.

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    Sayer Ji
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    Destiny Stone
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    Sources:
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    Dr. Ron Hoggan, Ed.D.
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    Dear China Millman,
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    Royal Roads University, Continuing Studies

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

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

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