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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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    DEAR SUBWAY: PLEASE SHARE THE GLUTEN-FREE OREGON LOVE


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    Celiac.com 08/14/2015 – Recently I took a last minute, end of Summer road trip with my family and on one of our pit stops I was delighted to discover the often rumored, highly elusive and possibly "Holy Grail" of gluten-free food: Subway's gluten-free sub rolls! Yes, I am here to tell you that they do indeed exist, even though I almost couldn't believe it even when I saw them—but there they were...a whole stack of six inch long gluten-free Subway rolls—sitting right in front of me in tidy, individually wrapped cellophane packages.


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    Photo: Scott AdamsI had to rub my eyes and look twice to make sure that I wasn't dreaming because I, like many people, believed that Subway had discontinued them after a temporary Oregon-only trial run, and had decided against a permanent gluten-free roll out. Apparently though, in Oregon at least (and perhaps in other states?), they are still going strong many months after their rumored demise. To top this off, they even offered a gluten-free brownie for dessert!

    Rather than getting stuck with a chopped Subway salad again I was finally able to order a real submarine sandwich—just like everyone else. So, I immediately honed in on an old favorite and decided to try their Spicy Italian sub on a gluten-free roll. What...no bewildered look on their faces when I asked for gluten-free? They seemed to know exactly what I wanted, and the employee who prepared my sandwich seemed to follow a carefully prepared script—she first cleaned off the prep counter, then changed into a new pair of clean gloves, and finally pulled out a new, clean sheet of paper onto which she set the packaged roll. The roll was pre-cut, thus she didn't have to use the bread knife to cut it, which was likely contaminated. While making the sandwich I was offered the option of having it toasted (some sensitive celiacs may want to skip the toaster oven part), and I noticed that when she toasted mine she made sure that it went into the oven solo, so that it would not touch other sandwiches (it was also on its original sheet of clean paper when it went in).

    At this point you are probably wondering how it tasted, right? It was simply fantastic! Why can't other companies make gluten-free bread taste like this? It was soft, strong and slightly chewy. It wasn't at all dry, and seemed very fresh. My wife wanted me to ask them if they were sold separately so that I could take some home with me, which I didn't do, but you get the idea—they were really good and tasted very fresh.

    I was so excited about the prospect of being able to once again eat Subway sandwiches that I ended up stopping at Subway several times during our road trip.

    Each time I visited a Subway in Oregon I noticed that other people were also ordering or eating gluten-free subs, and in each case the staff seemed to follow their gluten-free script perfectly. It is difficult to estimate the exact ratio of gluten-free customers from such a small sampling, but it seemed to me that around 10-20% of total visitors ordered the gluten-free roll. Most companies would do almost anything to grow their business by 10-20%, but in this case the opposite could be the case—businesses should be willing to offer gluten-free options so they don't lose 10-20% of their business! I certainly hope that Subway's Oregon test bed is going well, and that Subway has learned that offering gluten-free sub rolls is great for business.

    And now for the $64,000 question: Will Subway roll out their gluten-free rolls to other states, and if so, when? It's time for Subway to share the gluten-free love beyond just Oregon! Of course with the P.F. Chang's litigation still ongoing, they are likely now in a holding pattern to see how that case turns out.

    Have you seen gluten-free Subway rolls outside of Oregon? Please let us know below.


    Image Caption: Photo: Scott Adams
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    Guest Leslie

    Posted

    Does the script include avoiding cross contamination from dipping into the "fixings" and putting them on gluten filled bread? Aren't the fixings then contaminated? Is there a separate area for fixings that have not been used to make non-gluten free subs? I'm not posing these questions hoping for an answer. I'm just saying I wouldn't eat a gluten-free Subway sandwich unless I'm sure these issues are included in their script.

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    Does the script include avoiding cross contamination from dipping into the "fixings" and putting them on gluten filled bread? Aren't the fixings then contaminated? Is there a separate area for fixings that have not been used to make non-gluten free subs? I'm not posing these questions hoping for an answer. I'm just saying I wouldn't eat a gluten-free Subway sandwich unless I'm sure these issues are included in their script.

    Clearly you have that choice. I'd like the option of eating at Subway exactly as they've set it up in Oregon.

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    Guest Forress

    Posted

    I live in Washington state and we have them here also. I don't know if they make the buns themselves or buy them somewhere, but they are the BEST.... Leslie every time I have gone in there they clean every thing off and bring out fresh stuff from the back so that I am not getting any cross contamination. I have never gotten sick there and I am very sensitive. They do a great job to make sure I am taken care of in a safe and very friendly manor.

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    I wouldn't trust the counter personnel at Subway, but applaud the effort of the owner in Oregon. It is personal for him so I know he will take care, but the rest, not so much.

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    Guest Migdalia Hettler

    Posted

    Great news! I do not even go into a Subway because is depressing to only be able to eat a salad while my family eat the sandwiches. Please bring to Florida!!!

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    Guest Alan Corbin

    Posted

    Does the script include avoiding cross contamination from dipping into the "fixings" and putting them on gluten filled bread? Aren't the fixings then contaminated? Is there a separate area for fixings that have not been used to make non-gluten free subs? I'm not posing these questions hoping for an answer. I'm just saying I wouldn't eat a gluten-free Subway sandwich unless I'm sure these issues are included in their script.

    I presume the bread was baked and cooled on racks all in a gluten-free dedicated area either on site or delivered in a gluten-free dedicated vehicle.

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    Guest Heather

    Posted

    Having watched my husband's sandwiches made there, I would not eat there due to contamination of fixings. However, for those who are simply gluten intolerant and don't have the potentially fatal risks of gluten exposure this is wonderful news. For those like myself, the only answer is to never eat out at restaurants that have any gluten on the menu. As long as the food is served by people who have never had to worry about gluten, there is a strong possibility of exposure. Shortly after diagnosis, I would explain to restaurant staff about my needs. I would be assured those needs would be met. Then I would get terribly sick from gluten exposure, roughly nine times out of ten. It is just not worth the risk. If establishments are noticing our needs though, it brings us closer to a day of completely gluten free restaurants available in every town. Right now the nearest one to me is over an hour's drive away (Worth it)

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    Does the script include avoiding cross contamination from dipping into the "fixings" and putting them on gluten filled bread? Aren't the fixings then contaminated? Is there a separate area for fixings that have not been used to make non-gluten free subs? I'm not posing these questions hoping for an answer. I'm just saying I wouldn't eat a gluten-free Subway sandwich unless I'm sure these issues are included in their script.

    I agree. What about the cross-contamination of the fixings?

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    I ran across gluten-free Subway in Washington, maybe that's progress? Anyway still waiting for Canada to catch up.

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    I agree. What about the cross-contamination of the fixings?

    If you are super sensitive you may want to avoid Subway (and any other restaurant situation).

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    I presume the bread was baked and cooled on racks all in a gluten-free dedicated area either on site or delivered in a gluten-free dedicated vehicle.

    They are not made in Subway stores and are packaged, unlike their regular wheat rolls. The rolls are undoubtedly gluten-free, and would test below 20 ppm, otherwise they could not make the claim that the rolls are gluten-free.

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    I wouldn't trust the counter personnel at Subway, but applaud the effort of the owner in Oregon. It is personal for him so I know he will take care, but the rest, not so much.

    I'm not sure if you understand that it is in all Oregon Subway stores, and apparently in some Washington ones as well.

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    We have them even in a rural area outside Pittsburgh. My gluten-free daughter hasn't tried it yet, but it's so nice to know she has that option.

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    Guest Annette

    Posted

    Just called our local Subway and asked if they carried them and sadly they do not. That's here in Ohio. Should have known.

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    Guest Brenda Smith

    Posted

    Saw gluten free in Texas a while back....

    Where in Texas? I would love to have a subway sandwich again!

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    Does the script include avoiding cross contamination from dipping into the "fixings" and putting them on gluten filled bread? Aren't the fixings then contaminated? Is there a separate area for fixings that have not been used to make non-gluten free subs? I'm not posing these questions hoping for an answer. I'm just saying I wouldn't eat a gluten-free Subway sandwich unless I'm sure these issues are included in their script.

    I was "glutened" by the toppings when I asked for a salad. I didn't notice at the time but even though they put on clean gloves each time they made a sandwich. The process of making regular sandwiches makes getting glutened likely i.e., put the pickles on the bread (touching bread) then dipping into pickles etc and again touching bread.

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    Guest Huntress

    Posted

    It would be great if Subway A) rolled this out nationwide in their restaurants and B) came out with a line of gluten-free rolls and buns similar to the way Dunkin' Donuts sells its coffee or Panera and Olive Garden sell their salad dressings in supermarkets.

     

    To the naysayers: Remember the perfect is often the enemy of the good. Not everyone who avoids gluten is hyper-sensitive to the point of being overly concerned with potential trace amounts of gluten from cross-contamination. It's this kind of all-or-nothing attitude that likely prevents more companies from jumping on the gluten-free bandwagon and giving us all more gluten-free choices.

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    Guest Sheila

    Posted

    Please bring to Montana!

    I was in Seattle in June with a group of friends who wanted Subway, so I thought I would have a salad. Lo and behold they had gluten-free rolls!!! All the people who worked on my sandwich put on new plastic gloves to make my sandwich...it was delightful. I haven't found any Subways here in Arizona who have gluten-free rolls.

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    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? 
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    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
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    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