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    Did Japan's ANA Airlines Really Give a Single Banana as a Gluten-free Meal?


    Jefferson Adams
    Image Caption: Image: CC--yamaguchi yoshiaki

    Celiac.com 05/04/2017 - Japan's ANA airline is catching some public relations heat this week after reports that a man flying from Tokyo to Australia received a banana instead of the gluten-free meal that he booked in advance.


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    London resident, and celiac disease sufferer, Martin Pavelka flew All Nippon Airways flight from Tokyo this week, a nine-hour flight.

    Numerous media have reported Mr. Pavelka's plights in glaring terms, such as the Independent's alarming headline: Man Given Banana as Gluten-free "Meal"Â on Nine hour Flight, with the equally sensational sidebar: Londoner flying from Tokyo to Sydney was handed a banana as the gluten-free inflight "meal." However, a closer reading shows those claims to be pretty misleading.

    The fact is that Mr. Pavelka did receive his specially-ordered gluten-free meal at dinner, shortly after departure. The banana was part of the breakfast meal, the second meal service for the flight, which is where the trouble began for Mr Pavelka, who said he was "expecting something more substantial."Â

    "All other passengers were served full breakfast meal consisting of eggs, sausage, mushrooms, bread, and yogurt,"Â Pavelka told the Standard, while all he received was a single banana,"Â which though "definitely gluten free…did not keep me full for very long."Â

    So, let's add this all up. On a nine-hour flight, Mr. Pavelka received his special gluten-free meal for dinner, and then about 5 hours later, about 2 hours or so before landing, he received a banana in lieu of a full breakfast? But he wanted more? And this is a new story?

    In the account given by the Standard, Mr. Pavelka's first words to the flight attendant were "is this some kind of joke?"Â Not exactly diplomatic language. Nor, by the Standard's account did Mr. Pavelka ask for anything more, such as a yogurt, or additional fruit?

    Clearly Mr. Pavelka received less food at breakfast than the other passengers, but the food was gluten-free, as was his earlier dinner. It's entirely reasonable for Mr. Pavelka to expect to be treated like the other passengers, and to receive more for breakfast.

    However, without more detail, it's hard to know exactly what ANA offered at the time of booking, or whether there was some kind of mix-up with the caterers who provide meals, including specialty meals, to ANA. Do we know for sure that ANA actually offered a full gluten-free breakfast on that flight? Or that Mr. Pavelka was promised one? That said, both Mr. Pavelka and the newspapers covering the story owe it to the public to be more clear and less sensational about the actual facts. Expecting two gluten-free meals, and receiving one gluten-free meal and a banana is a very different story than just receiving a banana.

    Reports that the banana was the only gluten-free food ANA provided Mr. Pavelka for the entire nine-hour flight are simply wrong. ANA in fact provided Mr. Pavelka with a gluten-free dinner. The Standard managed to bury that important detail in paragraph ten of an eighteen paragraph article, while the Independent slipped it into paragraph seven of a thirteen paragraph article. Both papers carefully avoid mentioning the fact that the dinner was gluten-free.

    The paragraph in the Standard reads: "Although he had been given a larger meal the previous evening when his flight left, Mr Pavelka said he was expecting something more substantial for breakfast."Â

    Yet, somehow, the Standard published the story under the fact-mashed title, "Londoner who ordered gluten free meal on nine-hour flight is given a single banana to eat with knife and fork."

    Both the newspapers and Mr. Pavelka seem focused on spinning a story that the banana was the only food ANA provided Mr. Pavelka during the flight, which was simply not the case.

    Such obfuscation, presumably in search of readership, does little to provide clarity on the actual details, and much to cause doubt and confusion about what are actually fairly simple, if inconvenient, facts to a fairly mundane, and not-altogether newsworthy, story.

    If Mr. Pavelka received only a banana for his nine-hour flight, that would truly be an outrage. If he received a gluten-free meal, plus a banana, that would be an inconvenience. The story was presented as an outrage, when the facts indicated it was clearly more of an inconvenience.

    This article was revised for clarity by the author on 5/10/2017.

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    Guest Robyn

    Posted

    That actually IS a big deal. He WAS given a banana instead of a meal, which is ridiculous. Sir, one banana is NOT a meal! Surely they could have at least boiled a couple of eggs and some form of gluten free cereal or yogurt. Breakfast, more than any other meal, needs to provide a hefty serving of protein. Many sufferers of Celiac have sugar control issues or other problems because of their autoimmune state. Never being guaranteed a safe food source is frightening, as this can lead not only to discomfort, but sudden drops in sodium or blood sugar, resulting in physical weakness, trembling, unsteadiness, panic and emotional meltdown. Not only was this passenger in need of a meal at the expected time, but even if he landed an hour later, he had no guarantee of substantial available sustenance. Packs of nuts and berries in ones pocket does not truly energize and satisfy, especially if one has not had sufficient nutrition when needed. If you claim to be Celiac yourself and write an article​ this lacking in solid research and compassion for the people who struggle with it 24/7, I must call you out. If you do not have celiac, it's obvious you are in no way qualified to "report on" something you are so ignorant of and so calloused about. As for the airline... it's not as if they had no chance to prepare. It's the job of those responsible for preparing food to always be prepared to meet the dietary needs of passengers with known handicaps unless they require tube feeding or some medical intervention in their feeding process. An American or European company who pulled a trick like this would be in violation of their nations laws. As backwards as the US is about things like this, even we finally have some legal standards set in this area.

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    It wasn't anything. Ok, the headline was misleading. But only a banana for breakfast is ludicrous and deserves to be called out. Yes, he was given a gluten-free dinner but humans need feeding at regular intervals - especially over a 9 hour time span. OTOH, this is why most Celiac veterans will advise you to never travel without taking your own snack stash along. A gluten-free granola bar may not be ideal but it would have made that banana go farther.

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    Guest Mary

    Posted

    I just read an article that said ANA was reviewing their gluten-free meals, so some good my come out of this bad experience.

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    Guest JasonF

    Posted

    Fly Qantas or SingaporeAir and you realize how bad the gluten-free "meals" on US and Japanese airlines really are...inedible steamed fish anyone?

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    Guest Helen Vajk

    Posted

    At least he did not get the wrong food. A few years back flying 14 hours on Lufthansa SFO to Dubai (and on to parts beyond), I was given a gluten-free, safe but taste-free dinner, labeled gluten-free. However for breakfast I was given a tray with buns looking like the other passengers', and on asking the steward was very sneeringly told that "We don't do special meals for breakfast." I explained that I was still specially a celiac in the morning too, and handed the tray back. Honestly, his voice was so rude that several passengers around me applauded. But what if I'd trusted the airlines? And last week on Avianca they did not provide a gluten-free meal in spite of an advance order. Be vigilant.

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    Guest Rick

    Posted

    THANK YOU Robyn for you comment. Tell us again Jefferson, who's side are you actually on again??!! And since 75% of my replies and comments never get published I am not expecting you to post this one either, since everything has to be censored and approved! Even though this may not get published, I still know you or someone else is reading this along with all my other posts that never seemed to make it to the comment section. You're supposed to be an advocate and voice for those of us with celiac and this is ANYTHING BUT!

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    Guest John

    Posted

    Clearly the articles could have been more accurate. But to the question posed by the article "Did Japan´s ANA Airlines Really Give a Single Banana as a Gluten-free Meal?" the answer is clearly yes they did. And, no, that is not acceptable. I'm disappointed in the tone of the article implying that providing that same level of food to a celiac as to other passengers is somehow acceptable. Presumably the author of this article does not have celiac disease and is unaware of the damage articles like this can do. The fact this article was published on Celiac.com is even more disappointing. Celiacs have major food restrictions which are not granted protection as a handicap or on religious grounds. To state that a token effort is all that is require to meet the gluten-free medical requirements of celiacs is an unacceptable stand for the Celiac.com website to take.

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    Guest Jane

    Posted

    I agree with Mr. Adams that the story had been overblown and sensationalized but I also agree that a banana alone for breakfast is problematic. I really don't feel that castigating the author and accusing him of being unaware of the realities of celiac disease is appropriate or fair. Having said that, probably not one of your strongest articles, Jeff. I flew from NY to England in 2015 and got the same thing. I was provided a pretty substantial gluten-free dinner (for an airline meal) but the banana for breakfast was a tad disappointing. Other passengers had these large brioche rolls or croissants with cheese. I had the banana with a granola bar I had on me and it was more than adequate to get me through customs, after which I went out and found a gluten-free full English breakfast. I agree with Mr. Adams that the story was sensationalized but a banana alone truly isn't adequate when other passengers are given protein in addition to carbs for a meal. Why the airlines don't give people a choice of a hard boiled egg or yogurt (and, yes, even then there will be folks who can't eat either of those choices) is beyond me. Add a banana or other fruit and that should see most people through for a couple of hours. We were given breakfast about two hours, maybe a little less, before landing. Why this gentleman didn't think to pack some safe snacks is also beyond me. Lots of people are not thrilled with the food on airlines and think to bring something with them -- with or without celiac. I've been dealing with a gluten-free diet since 1989 (good luck getting a gluten-free meal back then -- on or off an airplane!) and even now I still carry a couple of bars in my handbag. Just in case.

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    Guest mary

    Posted

    Good article, and one that bears attention. Some years ago, and I do say some years ago, I was promised repeatedly by Alaska Airlines that they would provide me a wonderful gluten-free meal. I trusted them. when we were on the plane and it was too late for me to go grab - anything! That I might be able to eat, the stewards discovered that my gluten-free meal was the same meal as everyone else's - smothered in gravy, biscuits, no indication that it was not the same meal as everyone else's. the much embarrassed and very kind flight attendants stole the carrot sticks off everyone else's trays and that was my meal. A tray full of carrot sticks. I have never trusted again. A few years ago, Virginia Mason Hospital in Seattle repeatedly promised me a gluten-free meal for a hospice seminar. I took my lunch just in case. the meal they provided for everyone else was choice of a several huge baguette sandwiches, choice of mac or potato or green salads (choice of dressing), and beverage of their choice = juice, milk, pop, coffee, myGF lunch was a very small green salad with no dressing, a 1/4 cup of mixed fruit cocktail and a bottle water. the RN I worked with took one look and said, "well, that may be gluten-free, but it's not lunch. I always bring my own food. BTW, I am not a robot; I tried to select around the street signs, but all that was selected was a line from one street sign to another.

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    Guest Wolf T.

    Posted

    A banana is not a meal. No matter how you surround it with words, at the end (or beginning) of the day, a banana is not a meal. No matter what the passenger did or did not do, it remains: a banana is not a meal. He ordered a meal and received a banana. I daresay that if you paid for a meal in a restaurant and received a banana, you'd be venting your outrage in an article. Likely you'd say, a banana is not a meal. I grant that the stories were not accurate, but why continue this streak of inaccuracy by claiming that it's not a big deal? Reverse the roles: you are on a 9 hour flight and after eating dinner you awake to a breakfast of a banana. All around you passengers are eating three sources of protein - eggs, sausage and yogurt. You are given a banana. As has been said, eggs can be served boiled. Gluten free sausage is not hard to find; neither is gluten free yogurt. No matter how you spin it, a banana is not a meal. That's the bottom line. A banana is not a meal.

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    Guest Kathryn Sparks

    Posted

    I was on an Emarites flight from Orlando to Dubai then Manila. I pre-ordered my gluten free meals. I did get them, except when they gave my breakfast meal to my boyfriend. It clearly had my name on it but we had switched seats. The night before they gave me the meal even though we were in switched seats. They were very sorry and I was given a meal that I had to decide if it had gluten in it or not. On the return flight they were giving out snacks of pizza. I was given one but told them I couldn't have that, it not gluten free. She didn't know what to do and went back to the galley. I was brought a banana, a pear and an apple. All gluten free, of course! This was a very long flight so I had brought some gluten free things to eat with me, just in case. All my other meals were fine.

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    Guest Sueps

    Posted

    As others say, he was entitled to a proper breakfast like everyone else. The silly thing is he could probably have had most of what the others had for breakfast anyway!

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    Guest Bozena Benton

    Posted

    I would have been happy with a banana. I travel both short and long haul and have used many airlines. My problem or rather it is the airline's problem is that I need not only a gluten-free meal but a vegetarian one. No airline can cope with this dietary combination so I never get a meal on any flight and have to take my own. I would welcome a fruit platter or any fruit but this seems to be beyond most airlines lateral thinking.

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    Guest Linda

    Posted

    I am appalled by this article.

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    Guest Carie

    Posted

    I had a similar incident in March of this year, when traveling from the US to Italy. Although we had phoned American Airlines weeks in advance and spent more than 30 minutes on the phone to insure our 12-year-old son would have a gluten-free meal, no meal was available on the flight. The Flight Attendant told us it was our fault for not confirming at the ticket counter, and proceeded to give us two "salads" which consisted of only lettuce! This is simply heartbreaking.

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    Guest Claire

    Posted

    For celiacs, this is our life. People without celiac just don't understand how hard it is to be expected "to be grateful" for the inequalities that we endure.

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    Guest Laura Boggs

    Posted

    Clearly ANA paid you to write this article. The banana was an insult to all celiac sufferers. The man paid for an actual meal. Whose advocate are you?

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    Guest Carol Zimmel

    Posted

    Okay, so the news story was a bit exaggerated. Nothing unusual there. But the only thing that makes it "not news" is that thus sort of thing happens all the time. It is a real problem, though one many of us have learned to just accept live with. Two meals on a nine hour flight is minimal, and a banana does not constitute a meal. It is ridiculous that they could not come up with something more.

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    Guest Aims

    Posted

    And yet - Jefferson Adams used the same headline as his own click bait. Sad.

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    Guest Nancy Christine

    Posted

    I travel on airlines many times a year, I have celiac disease and order gluten-free meals ahead of time. However, problems do occur and I ALWAYS carry my own food. One should take personal responsibility when you have a condition that may cause diet difficulties. Celiac disease is not that well-known and for the sake of your own well-being, physical and mental, it is really simple to take some of your own food. This should not be the cause of great drama. And I, too, have been offered as little as an apple at times. Now move on.

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    Guest CJ Russell

    Posted

    Only a banana? The full breakfast meal consisted of eggs, sausage, mushrooms, bread, and yogurt. They couldn't serve him that without the bread? Unless they were all packaged together, there is no gluten in eggs, sausage, mushrooms, or yogurt. They did a lot better than some flights I've been on, though. Most US airlines don´t have any gluten free options available. I have to make do with what I bring along. Even when I fly first class I have to pick out the offending parts of the meal (eat the salad & meat, but not the potato which was prepackaged with gravy).

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    Guest Dee

    Posted

    Mr. Adams, Sometimes I wonder if you have celiac disease, I want to know, do you? This is the most dismissive article I have seen you pen in a long while. Not being fed a proper breakfast IS a big deal! He may have had dinner, but he ordered meal(s) for the flight. Many celiac disease sufferers have things like diabetes or hypoglycemia, blood sugar dropping can be deadly. He paid for the meals; the airline needs to take responsibility for their mistake and at least apologize. At least he didn't get beaten up and thrown off the flight! You Mr. Adams also owe the people reading this dismissive article an apology as well.

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    Guest admin

    Posted

    Clearly ANA paid you to write this article. The banana was an insult to all celiac sufferers. The man paid for an actual meal. Whose advocate are you?

    ANA did not pay anyone to write anything on this site.

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    Guest Jenn

    Posted

    Isn't a huge part of learning to live with celiac advocating for yourself?! The customer had every right to complain! Yes, the British press exaggerated the headlines as they often do. But to receive a banana in the place of a meal, especially one that was likely naturally gluten free besides the bread and possibly the sausage is ridiculous!!! Just a little prior planning and label reading, and they at least could've provided him eggs and yogurt in addition to the banana.

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    Guest Jefferson Adams

    Posted

    Clearly ANA paid you to write this article. The banana was an insult to all celiac sufferers. The man paid for an actual meal. Whose advocate are you?

    ANA did not pay anyone to write this article. The facts indicate that the man received a gluten-free meal for dinner. He received a banana for breakfast. The banana has been repeatedly reported as the only food the man received. This is simply not true. Should the man receive a full breakfast? In a perfect world, yes. But when I read the facts of this article, I see an airline attempting to accommodate a passenger's dietary request, perhaps imperfectly. The man asked for, and received, gluten-free food for both meals. News agencies covering this story did their best to hide that fact, and to give the impression that some horrible injustice took place, when what happened seems much more like an inconvenience. Such sloppy reporting does not help people with celiac disease get better treatment or service.

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    Don’t be afraid to say “Hey you just brought me the same salad back and I can see the crumbs from the croutons.” Oh yeah that is a true story. Check your food carefully when it comes out to you.  If you see the tiniest piece of something that doesn’t look right say NO WAY.  You order a steak and you see a bit of carrot on it THAT PROBALLY MEANS HE USED TONGS THAT HE USED TO PICK UP CARROTS WITH. The carrots are not on your plate.  My wife has to deal with me when we go out to eat but I have no choice because the smallest crumb takes me out for four days. I’d rather go hungry then get sick. When that salad came out I gave them one chance and if they don’t do it right I don’t take the chance with the local “hot head” cook to get one over on me.  I POLITLY SAY “NO THANK YOU,  I DON’T WANT TO EAT HERE ANYMORE” . It’s my money, my health and sadly, during the subsequent four days that I am sick they don’t care about me, so I’d rather get some cheese or chips or something simple. In these cases I leave the restaurant and they take my food off of the bill because I don’t eat a thing.
    So always have an alternative plan if you can’t eat.  My wife and kids can eat but if I don’t feel the right vibe in the restaurant I must move on, and you should to.  It’s not hard for any restaurant to make a burger and fries for the family so let them eat and you move on to plan B.  Again each person’s tolerance is different so you have to make up your mind but it is your trip and your health.
    When you are on the road you have to choose your restaurant and always have a plan B.  I choose the fast food because I can watch them make my food. You might like to be pampered so pick a nice restaurant and try to make sure it is not during peak hours--this will help a lot.
    I hope this is Helpful
    Chef Daniel P.
    I will continue with staying at hotels and motels in my next article.


    Daniel Moran
    Celiac.com 05/08/2008 - I am here to help you with your needs as you travel, and to be able to keep the "Gluten Monster" away, so you can enjoy your trip.
    When getting ready to fly you have to expect long delays.  As a celiac that means you have to try to find food.  If you haven’t traveled by plane before you will be in for a big surprise.  The restaurants that are in the airports are always busy.  This means that it is like going to a restaurant at peak time, and, in my opinion, that is not the best time for celiacs to eat in restaurants.  You might want to try the fast food places that are chains if they are in the airport.  The usual method is to try to get the manager to help you.  Give the manager a fresh plastic fork to retrieve your meat or chicken so they don’t use gloves that have bread crumbs on them.  Ask for catsup or mayo packages so you can read the ingredients.  You can ask for them to make a fresh salad if that is what you like.  One of the good things about most of the restaurants in airports is that at many of them you will be able to see the cooks prepare your food. Never be afraid to say “I saw you put my food on the table and bread got on it” and ask for a new meal.
    If there are no chain restaurants at the airport go to one of the restaurants where you can watch your food get made.  Some of the restaurants have the cooking grill right in front of you.  See if they can cook the food (hamburger, chicken) on the grill.  You have to determine if they put the buns on the grill. If they do grill the buns on the same grill where they cook your food there is a good chance that crumbs are there and you should stay away or ask them to clean the grill with the razor blade tool.  You have to determine how busy they are and if they are too busy don’t ask for something like that.  Sometimes I ask for my food to be covered and microwaved.  This is a very safe way to have your food cooked and if it is busy in the kitchen, your food is well protected.
    You still need to be careful with the salads in these types of restaurants.  Remember that these places are usually busy and crumbs fly around everywhere.  If they are slow ask if they can open a fresh bag of processed salad for you because you get very ill from the smallest crumb.
    What Chef Daniel does when Flying
    When I fly I always have a plan B.  I bring a carry on bag with some gluten-free food that is in a clear plastic bag.  This is food that if security says throw it away, I do.  So far all the times I have traveled by air I haven’t been asked to throw anything away. I bring food that can last all day without spoiling.  I bring food that if it gets hot and melts it is still good to eat.  I like ham, pepperoni, cheese, vegetables, peanuts and some candy to keep me going. Just remember to tell the security that you have a special diet in case they ask, but don’t offer the info unless they ask.  You need to be truthful and most folks are going to understand.  Let the security know that you are unable to eat in the local airport restaurants and you have a long day ahead of you. You don’t want to cause any trouble in an airport so be willing to throw it away the second they ask.  You could pull out your chef Daniel restaurant paper to show them how serous you take eating and by providing your list it will show them that you are very serious.  It is just a way to show security how serious you take your health.
    Now you should be ok if you got through security and when the flight attendant comes around offering food, especially if you are on a flight for a long time, you have some food that will carry you over.  Most airlines will take special requests for meals but you are taking a huge chance on eating that food.  The caterers who do these meals for the planes do thousands and thousands of meals.  I don’t take the chance of eating such a meal.  I get way to sick if there is any contamination. When I call in for a special request for a meal I ask for whole fruit or whole vegetables, anything I know that hasn’t been on a cutting board.  
    I usually ask for carrots or other vegetables or fruit that I like.  I am scared of being sick so I will cut or break my food then eat it.  Even at restaurants I ask for whole vegetables for me to cut myself.  If you read my last article about my salad with croutons coming to me you can see why I am so scared of restaurants. Once you are burned you never forget...but you do learn.
    If you call ahead to the airport to ask for a special diet request make sure you are thorough with your request and tell them how sick you can get.  Ask the airlines if you can send a request per email or snail mail with your directions in how to prepare your meal.  I would ask the caterer to tape your request right to your plate so when you board the plane it will be easy to see.  As you board notify the stewards you are the special meal request.  Be sure to have a plan B. Look at your meal carefully when you get it and determine if it is up to your standards.
    I believe this article can help you travel gluten-free on board any airline.  There are always little stops where you can buy a piece of fruit or packaged products but if you want something more like a hot meal you will need to follow my advice to stay safe.
    Gluten-Free Air Travel Hints:

    You should always try to getthe manager to help you.  In any restaurant they have the most time tohelp you and they will help you because they typically care more thanthe regular workers (today’s restaurants have employees that come inone day and are gone the next.help.  It is sad but that is the way itis so at least try to get the manager. Don’t be ashamed to askfor anything. If you want a hot dog or the chips they put on the sideof the plate ask for a bag with the product inside.  Take out your safeand forbidden lists if needed and look at them to see if you can eat aproduct. 
    Always have your Chef Daniel's restaurant paper with you in your walletor purse.
    Always have a copy of your safe and forbidden lists with youin case you need it to read ingredients. Always have a gluten-free restaurant card in the language you need.
    Crosscontamination is the greatest risk for a celiac when traveling.  Crosscontamination can happen and you would never know it, such as when thechef uses a knife to cut a piece of bread, and then they use the sameknife on your vegetables, or when the chef uses a pair of tongs to flipa breaded chicken and then uses them to flip your sauté chicken.Thereare too many other ways to mention, but the main thing is that glutencould be on the tool before it is used on your meal, and it doesn’tmatter how safe the chef thought he was because you got one crumb andyou are sick for days and that ruins your vacation. Chef Daniel

    Daniel Moran
    Celiac.com 05/20/2008 - I am going to be honest—I have not traveled outside the U.S.A. except for Mexico and Canada.  When I went to Mexico it was on a cruise ship, so that meant I could eat on the ship.  I would take snacks to tide me over or get a bag of chips.  Hopefully I will one day be able to tour the world and educate everyone on how to make true gluten-free meals for all of us.  I also hope that my when the time is right I will go on such trips with my loving wife.  So I will tell you how I would approach a trip to another country and you can decide if this is worth a try.
     Planning for the Trip (All per emails and internet and phone calls)

    I would contact the area chamber of commerce or tourist office in the country that I will be going to and see if they have heard of the gluten-free diet or celiac disease. If I was staying at a hotel or resort I would ask them to look into gluten-free meals and if they have a kitchen where I could talk with the executive chef or manager of food and beverages.  I would also tell them that I am a chef from the U.S.A. I would go to celiac.com to locate the nearest celiac support group to where I will be staying.  If there is one I would find out about local spots that I might be able to visit to get gluten-free meals, and if there are any bake shops or natural food stores where I could get some supplies and snacks. I would find a book on the languages that they speak and make a chef Daniel restaurant form so I could eat in a restaurant.  I would have it in all the languages including English for the chef to make sure they understand I am very serous about my health. I would have a card that said “May I speak to the manager and I have a special diet request.” Hopeful I could say that in their language. I would have a gluten-free restaurant card in their language and present it to the chef or manager. I would have a safe and forbidden list in the language where I was visiting.  That way I could check foods from the store so I could eat snacks. I would try to stay at a place with a microwave and possibly a refrigerator.  By doing this if I ran into a language problem I could cook chicken or meats in the microwave (I have cooked whole chickens in a microwave on vacation before and put it in the refrigerator for later). I would carry cards with me to ask for directions or to ask a wait staff for something I might be able to eat.  Like maybe some cheese, beverage, snacks or any type food of the area that I might like.  If you were at a port on the ocean your card could be sauté seafood and with olive oil.  Even if I didn’t look at the menu I would know that because I am at a town on the water, they would have fresh fish coming in. If any of you watch the Travel Channel  you know that there are a lot of different types of foods.  Being a chef I would want to experience all types of different foods.  If I knew something about the local cuisine and how it is prepared before I got there, it could give me an advantage. In Hong Kong I would love to eat some of the hot foods.  Could I eat them?  Is it just the chilies or is it the sauce?  Those are some of the questions I would wonder, so I would research the area and review cookbooks to see how they prepare their foods. If I knew where I would be traveling I would try to contact a local restaurant beforehand to see if I could view their menu for the time when I would be visiting.  If I did this, I could make my Chef Daniel restaurant form up ahead of the visit. I would make sure that when I was at my vacation spot I could get Internet access.  By doing this I could look up restaurants that I see when I am walking around to see if their menus were available online.  Also I would be able to translate a chef Daniel P restaurant form for that place if we decide to go there. I would make sure that I had a phone with internet access to look up info at any time. Also with the phone I could translate a sentence with a Web site I know about.
    As you see I have put a great deal of thought into traveling, but not one of them has been tested.  I wish I could say that these ideas all worked for me and they will for you too.  My thought is that the greatest asset for us celiacs is the Chef Daniel P restaurant form you take into the restaurant.I would have every direction I could give on paper for the chef to see.  When I was cooking I cooked with chefs from around the world.  We all had the same common cause:  To make our customers happy so they will spread the word and come again.  So to me it doesn’t matter if they can read English or Spanish.  It comes down to me as the customer to tell them I have to have a gluten-free meal.  To tell them that if they don’t do as I ask, I could get very sick and it would be their fault, and no restaurant wants to hear that their food caused a person to get sick.
    If you are like me, you are going to want to taste some of the home town small restaurants.  I would know the area as mentioned before, and find out about any fresh vegetables or meats that I would like to try.  On my phone I would access the Internet and I would find information on the town I was in.  When I walked in I would ask for a manager, and if that person doesn’t speak English I would get one of my restaurant cards out to let them read what I am trying to say.  I also would try to read the card out so they could see that I am trying very hard to speak their language.  I believe that shows I am not a stuck up rich person who hires everyone to do what I want. If I mess it up, I would feel it is okay as long as I look like I am trying to commutate to them “I am very serous about my health.”  Asking them questions would be hard but I would have cards with questions on them and I would know what yes or no sound like.  If it was a small café I would ask to talk with the chef.  At least try to speak through my cards and being a chef I usually have no trouble seeing the kitchen.  It is an advantage to be a chef from a very popular resort that is known world wide and I would use that to my advantage.  Even if they never knew of me, I know my way around the kitchen and I would be able to look around to see if I could eat there. I would look to see:

    Is it dirty or clean? Does it look like they cut everything on the same cutting board? Does the cook look very sloppy?
    Even if I don’t go to the back where the kitchen is, the dinning room represents the kitchen too.  I am not expecting a clean perfect kitchen.  I am expecting the cook who might be this little old lady who has had this restaurant in her family for four generations to care about me. That is what all restaurants usually want—if they care about their customers they will survive for years and years.  It is a hospitality business in America or in Russia—and it doesn’t matter what you language you speak.   That is when you don’t have to worry so much about the Gluten Monster.I would be honored to walk into some of these smaller kitchens of the world and find out about their history and who they have cooked for.  Just thinking about it gets me all wiggly in side.  You can tell a lot about a restaurant when you walk in—if you only take the time to notice.
    So when you plan your vacation as a celiac you need to keep this in mind:  It is just like over here and it will take you some time to order and eat.  If you are in a hurry, I suggest that you take your safe and forbidden lists to the store and get some snacks.  If you have the time you need to sit and relax and take a stab at eating restaurant food from another country.
    Chef Daniel P.


    Destiny Stone
    This is the time of year when familiestake vacations and travel the world. Traveling can often be stressfuleven under normal circumstances; packing problems, flight delays,getting lost, are all possible when trying to get from point A topoint B. So imagine how stressful it can be for a celiac orgluten-sensitive person to get ready for a big trip, especially to alocation that doesn't cater to the gluten-free lifestyle.The following tips are geared towardhelping even the most sensitive celiac to have a fun filled andgluten-free vacation while minimizing the stress factor as much aspossible. This article covers the following: preparing for yourgluten-free travel adventure, gluten-free travel by plane,automobile, train or ship, gluten-free accommodations, gluten-freemeals and snacks, what to do if you accidentally ingest gluten.
    Before beginning your vacation, thereare many important things you will want to consider, like method oftravel, your destination, and gluten-free options in the city ortown in which you will be staying. To help find gluten-freeaccommodations and eatery's in your location, perform a “Google”search for 'gluten-free restaurants and accommodations' in the areayou will be traveling to.

    Planes Trains and Automobiles-Tips forGluten-Free Travel by Danna Korn Gluten-Free Transportation
    Traveling by car is the best way totravel, if you have a choice. That way you can stop at stores asneeded and load up on your gluten-free snacks. Trains are also good,because they allow and encourage you to bring your own food on the train. Planesand ships are where it starts to get a little trick, especially if you have a long trip ahead of you.
    Airlines are fairly easy to manage,because you can bring your own food aboard the flight. However,there is a limit to what and how much you are allowed to bringaboard, which can be a problem on a long flight. While many airlinesoffer vegetarian or Kosher options for those with special dietaryneeds, most airlines do not have gluten-free menu options for thoseof us with gluten-intolerance. However, Continental Airlinescurrently offers gluten-free food options. Although, if you areextremely sensitive to cross-contamination, it is still safer tobring your own food.

    More Gluten-Free Airline Travel Tips
    Continental Airlines
    However, if you are planning to travela cruise-line, most cruise-lines do not allow you to bring your ownfood aboard. So in this situation it is important to find acruise-line that will accommodate your special needs. RoyalCaribbean Cruise-lines, and Orbridge ships are two cruise-lines thatoffer gluten-free menu options, as well as catering to other dietaryneeds.
    Royal Caribbean Cruise Orbridge
    Gluten-free accommodations
    Most motels or hotels offer acontinental breakfast and that's about it. Short of eating coffee andorange juice for breakfast,there usually isn't much in the way ofmeal options for a celiac. However, many small bed and breakfast'swill accommodate you special dietary needs if you talk to them andset it up in advanced, and some even offer gluten-free options. To find a gluten-free Inn, perform a “Google” search for'gluten-free accommodations' in the area you will be traveling to.
    Staying with family or friends can bestressful if they aren't sensitive to your dietary needs. It can alsobe difficult to explain to your friends and loved ones, what it meansfor you to be gluten-free, and who really wants to spend their entirevacation educating the everyone you meet on what it means to beceliac or gluten-sensitive? That could literally take the entirevacation. If cross-contamination is an issue for you and you areconcerned about eating in a gluten based house, the following linkwill help you determine what you need to be free from gluten whileyou are staying with others. It might be a good idea to print theinformation and share it with your host, maybe even emailing them alink with the information, prior to your visit.

    What to do if you can't have agluten-free kitchen Gluten-Free Meals and Snacks
    Finger foods, gluten-freechips/crackers, veggie sticks, gluten-free sandwiches, these are allwonderful foods to keep with you on a trip. Bring as muchgluten-free, shelf-stable food with you as possible. Find out wherethe local farm market is, for fresh and local, organic produce andbuy fresh produce when you arrive at your location.
    Many people getting ready for a trip,will place an order online in advance and have it delivered to thelocation they will be visiting. The Gluten-Free Mall is veryaccommodating and can ship shelf stable food Nationally andInternationally and frozen goods can be shipped within theContinental US. Having a package of gluten-free food delivered toyour location, gives you one less thing to worry about. No extrapacking, or extra luggage, no worries about your food getting crushedor apprehended at customs or tossed out at an airport. It's assimple as placing an order online or by phone.

    Gluten-Free Mall The National Foundation for CeliacAwareness (NFCA) works very hard to train chefs and kitchen staff allacross the globe, on the dos and don't s of cooking gluten-free fortheir guests with extreme gluten sensitivities. Check out the listthey have compiled of of GREAT kitchens that have the stamp ofapproval from NFCA for a possible location near you.

    NFCA GREAT Gluten-Free Kitchens list Unfortunately, not all restaurants havethe GREAT seal of approval from NFCA and the likelihood of one beingat your chosen destination is pretty slim, and finding a dedicated gluten-free restaurants are also rare depending on where you travel. That's why it is important to knowwhat to do when you go out to eat with a group of gluten-eaters.There is a great deal of information on this subject, but here aresome links to get you started.

    How to eat a gluten-free breakfastwhile traveling Eating gluten-free when traveling What to do if you Accidentally Ingest Gluten
    There are varying opinions of what thebest thing to do is when you accidentally ingest gluten, drink gingertea, take laxatives, hot water bottle on the abdomen; there really isno right answer, as everybody is different and has differentreactions to gluten. However, here are some tips that might help ifyou accidentally ingest gluten.

    Accidental Gluten Ingestion What to do if you accidentally eat gluten
    The most important thing you can do for yourself is to have fun. Stress can affect how youdigest your food, and then it won't matter if you avoid gluten, you stillwon't feel good. 
    Happy and safe travels everyone!


  • Recent Articles

    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.
    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

    Jefferson Adams
    Celiac.com 06/12/2018 - A life-long gluten-free diet is the only proven treatment for celiac disease. However, current methods for assessing gluten-free diet compliance are lack the sensitivity to detect occasional dietary transgressions that may cause gut mucosal damage. So, basically, there’s currently no good way to tell if celiac patients are suffering gut damage from low-level gluten contamination.
    A team of researchers recently set out to develop a method to determine gluten intake and monitor gluten-free dietary compliance in patients with celiac disease, and to determine its correlation with mucosal damage. The research team included ML Moreno, Á Cebolla, A Muñoz-Suano, C Carrillo-Carrion, I Comino, Á Pizarro, F León, A Rodríguez-Herrera, and C Sousa. They are variously affiliated with Facultad de Farmacia, Departamento de Microbiología y Parasitología, Universidad de Sevilla, Sevilla, Spain; Biomedal S.L., Sevilla, Spain; Unidad Clínica de Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Celimmune, Bethesda, Maryland, USA; and the Unidad de Gastroenterología y Nutrición, Instituto Hispalense de Pediatría, Sevilla, Spain.
    For their study, the team collected urine samples from 76 healthy subjects and 58 patients with celiac disease subjected to different gluten dietary conditions. To quantify gluten immunogenic peptides in solid-phase extracted urines, the team used a lateral flow test (LFT) with the highly sensitive and specific G12 monoclonal antibody for the most dominant GIPs and an LFT reader. 
    They detected GIPs in concentrated urines from healthy individuals previously subjected to gluten-free diet as early as 4-6 h after single gluten intake, and for 1-2 days afterward. The urine test showed gluten ingestion in about 50% of patients. Biopsy analysis showed that nearly 9 out of 10 celiac patients with no villous atrophy had no detectable GIP in urine, while all patients with quantifiable GIP in urine showed signs of gut damage.
    The ability to use GIP in urine to reveal gluten consumption will likely help lead to new and non-invasive methods for monitoring gluten-free diet compliance. The test is sensitive, specific and simple enough for clinical monitoring of celiac patients, as well as for basic and clinical research applications including drug development.
    Source:
    Gut. 2017 Feb;66(2):250-257.  doi: 10.1136/gutjnl-2015-310148.