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      Frequently Asked Questions About Celiac Disease   04/24/2018

      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 is Celiac Disease and the Gluten-Free Diet? 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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    BLOOD PRESSURE DRUG SIDE EFFECTS MIMIC CELIAC DISEASE


    Gryphon Myers

    Celiac.com 06/25/2012 - If you have received a celiac disease diagnosis while taking heart pressure medication, it turns out you might not actually have celiac disease. An investigation led by Dr. Joseph Murray has shown that certain blood pressure medication can cause symptoms not unlike those commonly attributed to celiac disease, and going off the drug can stop the symptoms.


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    CC_Jesse_AlwinBetween 2008 and 2011, 22 patients on the blood pressure medication olmesartan (sold as Benicar) exhibited clear symptoms of celiac disease: intestinal inflammation and abnormalities, chronic diarrhea and weight loss (median weight loss of 39 pounds). One of the patients lost an astounding 125 pounds, and fourteen of the patients exhibited symptoms so severe as to require hospitalization.

    All of the patients were diagnosed with celiac disease based on symptoms and intestinal biopsy results, but gluten-free diet caused no improvement in any of the patients. Furthermore, their blood tests came back with results that did not match up with a celiac disease diagnosis.

    After taking the patients off olmesartan, all of their symptoms showed dramatic improvement. Eighteen of the 22 had subsequent intestinal biopsies, which revealed improvement in that area as well. It would seem then, that the medication causes celiac-like symptoms.

    Some in the medical community have questioned the causal relationship of olmesartan to the symptoms though. As Dr. Franz Messerli of St. Luke's-Roosevelt Hospital, New York argues, “Only re-exposure [to the drug] can confirm the GI side effects were indeed due to olmesartan.”

    The sample size has also been called into question by Dr. Henry Black of NYU-Langone Medical Center, who claims that the side effects are highly uncommon and that he uses the drug all the time with no adverse effects. Some have even proposed that the reaction is the result of a drug allergy rather than symptoms related to the mechanism of the drug itself.

    The conclusion one can draw from Dr. Murray's findings and subsequent criticisms, is that it is highly likely that olmesartan can cause celiac-like symptoms, but it is not entirely clear how often or why. Those who take it and experience such symptoms (or have gotten a celiac diagnosis while on the drug) should discuss switching to another medication with their doctors. It is still unclear if these symptoms are specific to olmesartan, or can be caused by the entire ARB family of drugs.

    As Dr. Murray says, "it's really an awareness issue. We want doctors to be aware of this issue, so if they see a patient who is having this type of syndrome — they think about medications as a possible association."

    Sources:

     


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    Guest Sharon

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    I started to respond to the original release of this information in Physician's First Watch (June 22) - entitled "Case Series Associates Olmesartan with Spruelike Disease." I was disappointed that the Mayo Clinic physicians Murray et al. made no mention of looking at the inactive ingredients in Olmesartan as a cause, as well as two other antihypertensive medications that also seem to cause celiac-like symptom. Two if not three of these have more than one form of cellulose and even talc (which should not be an issue); however Olmesartan, as well as at least one of the other contain lactose in as few forms. Seems like lactose intolerance would have been looked at as well - and this is often associated with celiac disease (or celiac-like response) from the damage to the epithelial cells that can't produce the lactase - though there is not mention of this in the full publication. Perhaps this is the reason there was no response to a gluten-free diet - perhaps dairy needed to be removed as well. You would have thought the patients would be aware of any lactose intolerance issue. In one of the medications I believe the lactose was 5x the amount of the active ingredient.

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    admin

    Gregory M. Glenn is in the USDA-ARS Bioproduct Chemistry and Engineering Research Unit. Celiac.com 09/29/2004 - Those lightweight, polystyrene containers that some restaurants give you for carrying home leftovers or take-out meals are known in the foodservice industry as clamshells. Their hinged-lid construction indeed resembles the architecture nature uses for clams, oysters, and other familiar bivalves.
    Every year, billions of these clamshells and other foodservice containers made from petroleum-based foams end up in already overstuffed landfills. Slow to decompose, they become yet another environmental burden.
    But the containers, along with other disposable foodservice items such as plates, bowls, and cups, can also be manufactured with biodegradable ingredients.
    ARS plant physiologist Gregory M. Glenn is working with EarthShell Corp., the California-based innovators of potato-starch-based foam products such as burger boxes, to create environmentally friendly disposables made with starch from wheat, the worlds most widely planted grain. His wheat-starch-based prototypes are sturdy, attractive, convenient to use, and just as leakproof as their polystyrene counterparts. Glenn is with the Bioproduct Chemistry and Engineering Research Unit at ARSs Western Regional Research Center in Albany, California.
    Why use wheat starch in packaging? Because it offers manufacturers of foodservice products another choice among starches when theyre buying raw materials. That purchasing flexibility can help keep their prices competitive with the polystyrene products. Another important cost savings: The machinery already used to make EarthShells potato-starch-based containers is suitable for the wheat-starch products as well. That sidesteps the need for costly retooling at manufacturing plants.
    The machines are presses or molds that work something like giant waffle irons, explains Glenn. First, a wheat-starch batter is poured onto the heated mold, which is then closed and locked. Moisture in the batter generates steam that, in turn, causes the batter to foam, expand, and fill the mold. The steam is vented and, when the baking is finished, the mold is opened, the product is removed, and the cycle starts again. This whole process takes less than a minute.
    A water-resistant coating, added later, helps the container keep its strength and shape when its filled with a hot, juicy cheeseburger or creamy pasta alfredo leftovers, for example. But once the container hits the backyard compost pile or municipal landfill, it biodegrades in only a few weeks.
    Perhaps having our ready-to-eat meal packed for us in a guilt-free throwaway container, such as a wheat-starch-based clamshell, will make eating those foods even more enjoyable.—By Marcia Wood, Agricultural Research Service Information Staff.
    This research is part of Quality and Utilization of Agricultural Products, an ARS National Program (#306) described on the World Wide Web at www.nps.ars.usda.gov.
    Gregory M. Glenn is in the USDA-ARS Bioproduct Chemistry and Engineering Research Unit, Western Regional Research Center, 800 Buchanan St., Albany, CA 94710; phone (510) 559-5677, fax (510) 559-5818.
    Wheat—A New Option for Carry-Out Containers was published in the September 2004 issue of Agricultural Research magazine.
    Additional comments by USDA Plant Physiologist Gregory Glenn on 9/20/2004:
    Due to a current market shortage of wheat starch, the containers will be made of corn starch. However, you bring up a very valid concern and at some point the containers may be made of wheat starch. We are very sensitive to the concerns that Celiac sufferers have regarding wheat-based products. I spoke with Dr. Bassi of MGP Ingredients. MGP is a major supplier of wheat starch. Dr. Bassi is very aware of the concerns about Celiac disease and serves on an international committee that addresses this concern. Dr. Bassi can be reached at MGP Ingredients at 800-255-0302. Let me summarize our conversation. Wheat allergens are comprised of protein or wheat gluten. The starch component itself is safe and would only be a risk if contaminated by gluten. Dr. Bassi explained that current food regulations specify that gluten levels below 200 ppm can be labeled gluten free and are deemed safe for consumption by the general public. Wheat starch produced by MGP has a protein level of 5 to 30 ppm which is well below the required 200 ppm level. Our wheat starch containers are only about 50% wheat starch and they have a film or coating on the container that provides moisture resistance.
    It would also act as a barrier between the food product and the wheat starch. Thus, a food product would not come into direct contact with the wheat starch. As I mentioned earlier, the containers are currently being made of corn starch. However, the containers would be safe, even for those with wheat allergens, if the containers were made of wheat starch.

    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 07/15/2013 - For gluten-free Americans who love donuts, life just got a little bit better. That's because Dunkin’ Donuts has announced plans to offer gluten-free donuts and muffins in all its US stores by the end of the 2013.
    The Canton-based company field tested gluten-free products in a handful of locations around Boston and Miami, news of which generated considerable social media buzz.
    This news is certainly much heralded by many gluten-free eaters, so it will be interesting to see what the response is like, and how Dunkin' Donuts fares.
    Certainly, the timing is right, with the market for gluten-free goods continuing to see double digit growth, and predicted to top $6.6 billion by 2017.
    Moreover, a recent survey by market research firm The NPD Group, Inc. found about one in three American adults say they want to reduce or eliminate gluten from their diets. For many people,
    Dunkin’s wheat-free cinnamon sugar doughnut clocks in at 320 calories, compared to 260 calories in a regular glazed doughnut. The gluten-free blueberry muffin is 400 calories -- 60 calories less than the standard version. The company said the pastries will be packaged separately to avoid cross-contamination.
    Those who must eat gluten-free, and might want to grab a donut now and then, will be pleased to learn that Dunkin' Donuts says that each donut will be individually wrapped to prevent contamination.

    Jefferson Adams
    Celiac.com 12/12/2014 - Are celebrity claims of weight loss and improved health on a gluten-free diet driving people without celiac disease to temporarily inflate the market for gluten-free foods? Is that market headed for a downtrun if these people go back to gluten?
    The market for gluten-free food has definitely gotten a boost from people looking to gluten-free food to help them lose weight or to improve their health, even though there is no good science to support such claims. More than half of the 90-plus million Americans who follow a gluten-free diet believe the diet to be “healthier” and more than one-quarter do so to lose weight. So what happens if these reasons are not borne out by science, or by experience? Will the market for gluten-free products begin to shrink?
    Fassano thinks this is a possibility, saying that people who embrace “junk” reasons for following a gluten-free diet will likely not follow the diet for a lifetime. He explained that people without celiac disease or gluten-intolerance will only loose weight or become healthier if “they cut out pizza and donuts or other unhealthy foods made with gluten.”
    There’s currently no hard evidence of a downturn in the demand for gluten-free food, but the high percentage of people eating and buying gluten-free for incorrect or whimsical reasons certainly has industry analysts a bit concerned. If a significant portion of those people switch back to gluten-containing foods, the market could see swift shrinkage, and many gluten-free products and offerings might disappear.
    Certainly, people with celiac disease have benefitted from the explosion in gluten-free products, but has the gluten-free diet become too associated with fad dieters and celebrity health claims? Could reduced gluten-free demand have a negative impact on product options for people with celiac disease?
    Source:
    Foodnavigator-usa.com

  • Recent Articles

    Jefferson Adams
    Celiac.com 04/26/2018 - Emily Dickson is one of Canada’s top athletes. As a world-class competitor in the biathlon, the event that combines cross-country skiing with shooting marksmanship, Emily Dickson was familiar with a demanding routine of training and competition. After discovering she had celiac disease, Dickson is using her diagnosis and gluten-free diet a fuel to help her get her mojo back.
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    Jefferson Adams
    Celiac.com 04/25/2018 - A team of Yale University researchers discovered that bacteria in the small intestine can travel to other organs and trigger an autoimmune response. In this case, they looked at Enterococcus gallinarum, which can travel beyond the gut to the spleen, lymph nodes, and liver. The research could be helpful for treating type 1 diabetes, lupus, and celiac disease.
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    Read the full study in Science.

    Tammy Rhodes
    Celiac.com 04/24/2018 - Did you know in 2017 alone, the United States had OVER TENS OF THOUSANDS of people evacuate their homes due to natural disasters such as fires, floods, hurricanes, tornadoes and tsunamis? Most evacuation sites are not equipped to feed your family the safe gluten free foods that are required to stay healthy.  Are you prepared in case of an emergency? Do you have your Gluten Free Emergency Food Bag ready to grab and go?  
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    That is when I knew we had to be prepared. No more winging it. We couldn’t take a chance like that ever again. We were “lucky” one too many times. We were very fortunate that we did not lose our home to the Los Angeles wildfire, and only had minimal damage from the severe storm which hit our home in Illinois.
      
    In 2017 alone, FEMA (Federal Emergency Management Agency) had 137 natural disasters declared within the United States. According to FEMA, around 50% of the United States population isn’t prepared for a natural disaster. These disasters can happen anywhere, anytime and some without notice. It’s hard enough being a parent, let alone being a parent of a gluten free family member. Now, add a natural disaster on top of that. Are you prepared?
    You can find my Gluten Free Emergency Food Bags and other useful products at www.allergynavigator.com.  

    Jefferson Adams
    Celiac.com 04/23/2018 - A team of researchers recently set out to learn whether celiac disease patients commonly suffer cognitive impairment at the time they are diagnosed, and to compare their cognitive performance with non-celiac subjects with similar chronic symptoms and to a group of healthy control subjects.
    The research team included G Longarini, P Richly, MP Temprano, AF Costa, H Vázquez, ML Moreno, S Niveloni, P López, E Smecuol, R Mazure, A González, E Mauriño, and JC Bai. They are variously associated with the Small Bowel Section, Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital; Neurocience Cognitive and Traslational Institute (INECO), Favaloro Fundation, CONICET, Buenos Aires; the Brain Health Center (CESAL), Quilmes, Argentina; the Research Council, MSAL, CABA; and with the Research Institute, School of Medicine, Universidad del Salvador.
    The team enrolled fifty adults with symptoms and indications of celiac disease in a prospective cohort without regard to the final diagnosis.  At baseline, all individuals underwent cognitive functional and psychological evaluation. The team then compared celiac disease patients with subjects without celiac disease, and with healthy controls matched by sex, age, and education.
    Celiac disease patients had similar cognitive performance and anxiety, but no significant differences in depression scores compared with disease controls.
    A total of thirty-three subjects were diagnosed with celiac disease. Compared with the 26 healthy control subjects, the 17 celiac disease subjects, and the 17 disease control subjects, who mostly had irritable bowel syndrome, showed impaired cognitive performance (P=0.02 and P=0.04, respectively), functional impairment (P<0.01), and higher depression (P<0.01). 
    From their data, the team noted that any abnormal cognitive functions they saw in adults with newly diagnosed celiac disease did not seem not to be a result of the disease itself. 
    Their results indicate that cognitive dysfunction in celiac patients could be related to long-term symptoms from chronic disease, in general.
    Source:
    J Clin Gastroenterol. 2018 Mar 1. doi: 10.1097/MCG.0000000000001018.

    Connie Sarros
    Celiac.com 04/21/2018 - Dear Friends and Readers,
    I have been writing articles for Scott Adams since the 2002 Summer Issue of the Scott-Free Press. The Scott-Free Press evolved into the Journal of Gluten Sensitivity. I felt honored when Scott asked me ten years ago to contribute to his quarterly journal and it's been a privilege to write articles for his publication ever since.
    Due to personal health reasons and restrictions, I find that I need to retire. My husband and I can no longer travel the country speaking at conferences and to support groups (which we dearly loved to do) nor can I commit to writing more books, articles, or menus. Consequently, I will no longer be contributing articles to the Journal of Gluten Sensitivity. 
    My following books will still be available at Amazon.com:
    Gluten-free Cooking for Dummies Student's Vegetarian Cookbook for Dummies Wheat-free Gluten-free Dessert Cookbook Wheat-free Gluten-free Reduced Calorie Cookbook Wheat-free Gluten-free Cookbook for Kids and Busy Adults (revised version) My first book was published in 1996. My journey since then has been incredible. I have met so many in the celiac community and I feel blessed to be able to call you friends. Many of you have told me that I helped to change your life – let me assure you that your kind words, your phone calls, your thoughtful notes, and your feedback throughout the years have had a vital impact on my life, too. Thank you for all of your support through these years.