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    Children, Gluten Sensitivity and Other Food Related Issues


    Paul Smith

    Celiac.com 11/03/2009 - Many infants, toddlers and young children are either born with or develop a variety of protein allergies with symptoms including anaphylaxis, intolerance or sensitivity to milk, egg, shellfish, crustacean, peanuts, nuts, sesame seeds, soy and gluten. These symptoms can manifest themselves in a variety of ways including coeliac (celiac) disease (gut damage), eczema, shock, migraines, headaches, crankiness, aggression, depression, listlessness, chronic fatigue, irritable bowel, wind, flatulence, diarrhea, bloating, fluid retention, poor growth patterns, feeling vaguely and sometimes seriously unwell: a general failure to thrive.Unfortunately, we do not understand all the reasons.


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    There are nutritional, neurological and hormonal implications, which often go unconsidered, to many of the foods we eat. In some instances, with babies, the problems are transmitted via the mother’s breast milk and there are many instances of babies, for example plainly uncomfortable at being entirely covered in a painful rash due to their reactions to gluten and other foods in their mother’s diets. Such problems are more common where there is a history of asthma, colic, gluten sensitivity and other immune system issues in the family.

    In other instances, the problems may be caused by too early an introduction of solid foods and food types and in some cases by simple over exposure to particular food categories. These issues require awareness and careful observation on the part of the mother to try and relate/identify the problem foods to the problems in the child. In some instances, these problems may also overlap with lactose intolerance, fructose malabsorption and other fermentable sugar issues. There can also be cumulative issues with preservatives and the histamines in chocolate/cocoa and orange juice. Histamines and gluten, either singly or in combination, can both contribute to headache, migraine and behavioral problems.

    I recall one young mother, the wife of a colleague, who found that her normally happy and contented baby son reacted negatively to the coffee, cabbage, curry, chocolate, pasta and occasional alcohol in her diet – all foods his mother enjoyed, particularly the chocolate - by becoming red in the face, grizzly, plainly uncomfortable and often with diarrhea. Fortunately, she was perceptive enough to relate these incidents to her diet and chose to abstain from consuming the offending foods for the duration of the breast-feeding period.

    We had spent some time discussing and theorizing about the underlying reasons.With the coffee we suspected the caffeine. With the cabbage we suspected the nitrogenous (high protein) fertilizers used in growing the vegetable and the sugar content. With the pasta we suspected the gluten and possibly the fructose content of the garlic and perhaps the garlic as an irritant. The curry and chili plainly had an irritant effect and we suspected the histamines in the chocolate.

    Michael, now in his late teens, eats all these foods sparingly but is pleased to avoid them where possible. He thrives on plain, simple meals with careful food combinations. Although not a celiac he is not fond of bread, biscuits and cakes etc and appears to instinctively avoid them. He likes his fruit and, particularly, his vegetables. He prefers to avoid spicy foods, deep fried foods, meat pies and the like where he struggles to digest the combination of meat and pastry: of protein and carbohydrate. He also prefers to avoid consuming orange juice in combination with toast and breakfast cereals: the combination of acid and carbohydrate. He deliberately avoids cucumber, garlic, onion, soft drinks, coffee and alcohol due to sugar fermentation and acidity issues.

    An intelligent, fun loving and well adjusted young man who towers over both his parents and enjoys robust good health, he has learned, with his mother’s support, to select and develop a diet which suits him and upon which he obviously thrives. He is living proof of the adage “that one man’s meat is another man’s poison”: that a single diet does not suit everyone. A lesson many people have yet to learn.

    Recently, via my blogs and Youtube videos I have made “friends” with three young men in their early twenties: one of Hispanic background from California and two from Melbourne. All are coeliacs (celiacs) with diabetes and thyroid complications overlapping with their gluten induced gut damage. All I suspect the result of long term poor food choices exacerbated by having to fend for themselves in early adulthood without the parental support, awareness and perception enjoyed by Michael.

    Interestingly, one of these young men from Melbourne has come to the conclusion that, unless he urgently does something to help himself, he will seriously compromise both his longevity and quality of life if he continues going down the path he has pursued to date. He has come back several times for reassurance, to seek further information and to express his determination to reach 80 years of age in good health. He is slowly, painfully and somewhat belatedly trying to go down the path pursued by Michael and his mother since Michael was a baby: that of finding the diet that suits his individual nutritional and health needs. He is making solid progress with the occasional setback like a recent bout of Ataxia (poor co-ordination, a classic symptom of gluten sensitivity, in addition to his severe gut damage) resulting from the eating of potato chips deep fried in gluten contaminated oil: an all too frequent occurrence.

    In some instances the child may outgrow the problem but in many others the problems or tendencies may be lifelong, for example, in the case of coeliac disease and many forms of gluten sensitivity and as in the case of Michael, recounted above, where many of the food sensitivities of early childhood remain into adulthood. In some other health problems, the degree of exposure to a particular food or food additive may be the issue. A small amount is OK but too much may lead to eczema, mucus, arthritis or headache problems etc. The consumption of such a food needs to be managed carefully. It is my belief that it is often better to eat a small amount of as many foods as possible – to build some tolerance to them - rather than to go down the road of the total exclusion of every offending food. Often, this approach is not only socially desirable but sometimes a necessity where there is limited opportunity to organize the food. In these circumstances, it is important for the dietary challenged individual to be selective and to know and understand their dietary limits and the consequences of exceeding those limits.

    I am a firm believer in the old adage of moderation and diversity in the diet and of gentle shifts in dietary regimes if making any changes. It is possible, for example, and often desirable to reduce the intake of sugar, salt, coffee, milk etc., in the diet and these changes are all best done gradually over a few weeks to enable the body, digestive system and the taste buds to acclimatise to the new regime. The same applies to the introduction of a new food. A gradual introduction of any new food is often more beneficial and pleasant than a sudden change in diet as this allows the body to adjust without adverse and off-putting reactions.

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  • Related Articles

    Dr. Ron Hoggan, Ed.D.
    The following is a post from Ron Hoggan - Q: I asked the doctor what an inflamed mucosa could mean and he shrugged and then added parasites, maybe? She was tested for parasites way back before her first biopsy (October 96).
    A: Have you tried eliminating dairy? Volta et. al. have demonstrated that 36% to 48% of celiacs tested were also intolerant to milk protein. Borner et. al. have demonstrated sequence homology, from the N-terminal, between casein and gliadin. The other three cited below are also identifying milk protein intolerances associated with celiac disease.
    Playing the odds, exclusion of dairy is most likely to help. But there are other significant dietary allergens that might be eliminated if a dairy free diet, in addition to the Gluten-free diet, doesnt help.
    Borner H, Isolation of antigens recognized by coeliac disease auto-antibodies and their use in enzyme immunoassay of endomysium and reticulin antibody-positive human sera. Clin Exp Immunol 106(2), 344-350 (1996)
    Hvatum M, Serum IgG subclass antibodies to a variety of food antigens in patients with coeliac disease. Gut 33(5), 632-638 (1992)
    Ciclitira PJ, Gliadin antibody production by small intestinal lymphocytes from patients with coeliac disease.Int Arch Allergy Appl Immunol 89(2-3), 246-249 (1989)
    Volta U, Antibodies to dietary antigens in coeliac disease. Scand J Gastroenterol 21(8), 935-940 (1986)
    Ciclitira PJ, Secretion of gliadin antibody by coeliac jejunal mucosal biopsies cultured in vitro. Clin Exp Immunol 64(1), 119-124 (1986)

    Jefferson Adams
    Celiac.com 09/21/2009 - Failure of the hepatitis B vaccine in people with celiac disease is common. In fact, vaccine failure occurs in about 50% of all attempts to vaccinate people with celiac disease against hepatitis B. Research shows that age at celiac diagnosis and other factors can influence response rates.
    The August 12 issue of the medical journal Vaccine features a timely article on failure of the hepatitis B vaccine in people with celiac disease, which asks the very sensible question of whether it is time to reevaluate our current vaccine procedures.
    One of the most important signs of non-responsiveness to the hepatitis B vaccine is a genetic marker called human leukocyte antigen (HLA) phenotype DQ2. It's interesting that people with celiac disease often carry these same genetic markers, and that fact is at the center of one hypothesis about why celiac patients are less able to respond to the hepatitis B vaccine.
    A team of researchers recently set out to assess responsiveness rates to the hepatitis B vaccine among patients with celiac disease. The team was made up of S. Leonardi, M. Spina, L. Spicuzza, N. Rotolo, and M. La Rosa of the Broncho-Pneumology & Cystic Fibrosis Unit of the Department of Pediatrics at the University of Catania, in Catania, Italy.
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    Their results showed that half of the celiac disease patients (50%) failed to respond to the vaccine course, and that those who did best were less than 18 months of age at the time of diagnosis for celiac disease; that group showed a significantly higher response rate to the vaccine.
    The study confirms that celiac patients have a far higher failure rate for hepatitis B vaccination than healthy control subjects. These results strengthen the call to re-evaluate current hepatitis B vaccine strategies for patients with celiac disease and to assess whether to recommend a course of re-vaccination.
    Source: Vaccine - August 12, 2009.


    Rebecca  Herman
    In 2010, the U.S. market for gluten-free products was valued at $2.6 billion.  Projected sales in this market are expected to exceed $5 billion by 2015.(1) 
    As the gluten-free product market expands, and as we continue to seek out new tools to aid us in our search for truly gluten-free products, we are in for a treat with the recent launch of Gluten Free Watchdog.  Tricia Thompson, the founder of Gluten Free Watchdog, agreed to discuss it with us.
    Can you explain what Gluten Free Watchdog is, and what is novel about it?
    Gluten Free Watchdog (www.glutenfreewatchdog.org) is a food testing site that was started to make expensive state-of-the-art gluten testing available to the gluten-free community at a fraction of the true cost. This is the first time this type of resource has been offered.
    Can you share your personal story – how you became interested in celiac disease and gluten sensitivity?
    I have been gluten free for over 27 years. In the early years, I became very frustrated by the contradictory information available on several key gluten-free issues—Are oats safe to eat? Why is wheat starch eaten by the gluten-free community in Europe? Why do some support groups say “grains” such as buckwheat, amaranth, and quinoa should be avoided? And then there was the issue of nutritional quality. Back then almost all gluten-free processed foods were made using refined rice/corn and starch. So after finishing graduate school I made a list of all the topics I wanted to research and then started writing (and writing and writing!). 
    In December 2008, the Chicago Tribune investigated three Wellshire Kids brand gluten-free products, sold exclusively at Whole Foods Market — Dinosaur Shapes Chicken Bites, Chicken Corn Dogs, and Beef Corn Dogs — and analytical results indicated that they contained gluten, ranging from 116 to 2,200 parts per million.  More recently, Paul Seeling, a North Carolina baker, was convicted of fraud relating to the packaging of wheat bread as a gluten-free product.  Have events like these influenced the Gluten Free Watchdog?
    Events such as what occurred with Wellshire Farms made me realize that some manufacturers, while well-intentioned, did not understand how consumers in the US define gluten free when they see it on a food label. It also made me realize that some manufacturers did not know how to accurately test their labeled gluten free products for gluten, and that some of them were operating under the mistaken belief that if a product is (or is made from) a naturally gluten-free grain the product does not need to be tested. We have learned a lot over the years about cross contamination, starting with the study published in the New England Journal of Medicine on gluten contamination of oats and more recently with the study on gluten contamination of naturally gluten-free grains and flours published in the Journal of the American Dietetic Association.
    Combined, these events and studies may have undermined consumer confidence in labeled gluten-free foods. Most manufacturers are doing things right. It is my hope that Gluten Free Watchdog will allow consumers to have confidence in the products they eat and feed their family.
    Over the last ten years, you have published a significant amount of research on gluten-free product labeling.  And you recently authored a chapter on gluten-free product labeling in Melinda Dennis’ and Daniel Leffler’s new book, Real Life with Celiac Disease:  Troubleshooting and Thriving Gluten Free, which was published by the American Gastroenterological Association.  How has your research influenced Gluten Free Watchdog?
    From the consumer perspective the most important thing to understand about allergen labeling is that it pertains to ingredients only—it does not pertain to allergens that may be in a product due to cross contact. Currently, Gluten Free Watchdog is only testing foods labeled gluten free. In the future, we may test foods that appear to be gluten free based on ingredients.
    The Food Allergy Labeling and Consumer Protect Act (FALCPA) does not currently require the disclosure of barley or rye; or, contamination by manufacturers on product labeling.  Can Gluten Free Watchdog help us to decipher product labeling that may be difficult to understand?

    Gluten Free Watchdog is primarily a food testing site. My other website www.glutenfreedietitian.com contains extensive information on labeling laws and ingredients.
    Under FALCPA, the Federal Food & Drug Administration (FDA) is considering a proposed government definition of the term “gluten-free” for food product labeling purposes.  Once FDA approves a final rule, will the role of Gluten Free Watchdog change?

    Possibly but it will remain primarily a food testing site. Consumers will still want to know the level of gluten at which foods are testing and will still want the added confidence that independent transparent third party testing provides.
    On your blog, Gluten Free Dietitian, you discuss R5 ELISA tests, Ridascreen 7001 and Ridascreen R7011.  What is the importance of these tests, and are these the tests that Gluten Free Watchdog is using?  Are home-test kits accurate?
    The standard sandwich R5 ELISA is one of only two commercially available ELISAs validated at the levels used for regulatory purposes and official governmental methods (the other is the Morinaga Wheat Protein ELISA). The R5 and Morinaga ELISAs also are included in the FDA’s proposed gluten-free labeling rule as possible methods for rule enforcement. The competitive R5 ELISA may be used in conjunction with the sandwich R5 ELISA when a food is highly hydrolyzed.
    Gluten Free Watchdog tests food using the standard sandwich R5 ELISA and will, if necessary, also use the competitive R5 ELISA.
    What products does Gluten Free Watchdog plan to test in the upcoming months?  Are there any products that are difficult to test; and if so, why?
    We have been and will continue to test a wide variety of products—grains, flours, breads, cereals, pastas, cookies, etc. Anyone can visit the site and browse through the products that have been tested to date. However, testing data is available only to subscribers. One of the nice features of Gluten Free Watchdog is that subscribers can request that certain products be tested.
    One of the keys to successful testing of products is getting a homogenized sample—meaning any contaminant is evenly distributed throughout the sample being tested and there are no “hot spots.” This is why we test two extractions of each “homogenized” sample at Gluten Free Watchdog—we want to make sure the sample is truly homogenized. It can sometimes be tricky to get a homogenized sample when testing raw grains in grain versus flour form.
    FALCPA does not cover foods regulated by the United States Department of Agriculture (USDA), and the Alcohol and Tobacco Tax and Trade Bureau (TTB) has yet to finalize an allergen labeling rule for distilled spirits, beer, and wine.  Under TTB’s current labeling provisions, the term “gluten-free” is considered a health claim and its use is prohibited.  Are USDA and TTB adequately protecting consumers?  If not, does Gluten Free Watchdog plan to test any products regulated by either?
    Neither the TTB nor the USDA have mandatory allergen labeling and it will be interesting to see how they proceed with gluten-free labeling once the FDA’s gluten-free labeling law is in place. I have been told by representatives of the USDA that they will adopt the FDA’s gluten-free labeling law rather than develop their own.
    Gluten Free Watchdog will test USDA-regulated foods that are labeled gluten free. As mentioned earlier, we may start testing foods that appear to be gluten free based on ingredients. When we do, we would be happy to test beverages regulated by the TTB.
    Is Gluten Free Watchdog affiliated with any companies that sell or market gluten-free products?
    Nope! That is why we really need the support of gluten-free consumers!! It is my hope that members of the gluten-free community will see the value in having this type of resource available and will be willing to contribute a relatively small amount in exchange for access to expensive testing and input on what is tested—similar to a co-op.
    Source:

    Gluten-Free Foods and Beverages in the U.S., 3rd Edition.  Packaged Facts, February 2011.

    Jefferson Adams
    Celiac.com 01/09/2015 - A recent article by Jody Berger provides a cautionary tale for anyone suffering from non-classic symptoms of gluten-sensitivity or celiac disease.
    Berger, it turns out, has non-celiac gluten-sensitivity. Sounds simple enough, right? But in Berger’s case, it took her one year and visits to a dozen doctors to get an accurate diagnosis.
    Berger’s main symptom was tingling in her fingertips, a feeling of slight pins and needles, as if they were waking from a deep sleep. The sensation wasn’t painful, she said, but it was persistent, and concerned her enough that she sought medical help to figure out the cause.
    When her first doctor diagnosed her with multiple sclerosis after a very brief visit, Berger sought a second, then a third, then a fourth opinion. In the course of her many visits, doctors told her she had nutritional deficiencies, heavy metal toxicity, Lyme disease, and depression.
    After a dozen visits, she finally found an osteopath who was “well-versed in systems thinking,” and another physician who had trained in ayurvedic medicine, a holistic system of healing.
    The tingling, which the first doctor believed to be a sign of MS, is actually a fairly common, though not classic, symptom of gluten sensitivity.
    This story highlights the amount of work patients can face when they present with atypical symptoms of gluten-sensitivity. Many times, well-intended doctors can simply miss the dietary connection and get the diagnosis wrong.
    Do you have a similar story of well-intended, but misguided doctors wrongly diagnosing gluten-sensitivity or celiac disease? 
    Read more about Berger’s year-long Odyssey here.

  • Recent Articles

    Jefferson Adams
    Celiac.com 06/19/2018 - Could baking soda help reduce the inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease? Scientists at the Medical College of Georgia at Augusta University say that a daily dose of baking soda may in fact help reduce inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease.
    Those scientists recently gathered some of the first evidence to show that cheap, over-the-counter antacids can prompt the spleen to promote an anti-inflammatory environment that could be helpful in combating inflammatory disease.
    A type of cell called mesothelial cells line our body cavities, like the digestive tract. They have little fingers, called microvilli, that sense the environment, and warn the organs they cover that there is an invader and an immune response is needed.
    The team’s data shows that when rats or healthy people drink a solution of baking soda, the stomach makes more acid, which causes mesothelial cells on the outside of the spleen to tell the spleen to go easy on the immune response.  "It's most likely a hamburger not a bacterial infection," is basically the message, says Dr. Paul O'Connor, renal physiologist in the MCG Department of Physiology at Augusta University and the study's corresponding author.
    That message, which is transmitted with help from a chemical messenger called acetylcholine, seems to encourage the gut to shift against inflammation, say the scientists.
    In patients who drank water with baking soda for two weeks, immune cells called macrophages, shifted from primarily those that promote inflammation, called M1, to those that reduce it, called M2. "The shift from inflammatory to an anti-inflammatory profile is happening everywhere," O'Connor says. "We saw it in the kidneys, we saw it in the spleen, now we see it in the peripheral blood."
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    The research was funded by the National Institutes of Health.
    Read more at: Sciencedaily.com

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

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

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