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    FODMAPs, Food Intolerance and You


    Jefferson Adams

    Celiac.com 02/13/2015 - Food intolerance is non-immunological and is often accompanied by gastrointestinal symptoms. 


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    Image: Wikimedia Commons--BlausenWhat can a review of scientific literature teach us about the causes, diagnosis, mechanisms and clinical evidence regarding food intolerance and gastrointestinal symptoms? Researcher M. C. E. Lomer recently set out to critically analyze the scientific literature related to etiology, diagnosis, mechanisms and clinical evidence as it relates to food intolerance.

    To do so, Lomer searched Pubmed, Embase and Scopus for the terms and variants of food intolerance, lactose, FODMAP, gluten, food chemicals. He restricted his search to human studies published in English. Lomer also conducted a physical search for references to these terms from relevant papers and appropriate studies.

    By Lomer’s assessment, food intolerance affects 15–20% of the population and may be due to pharmacological effects of food ingredients, non-celiac gluten sensitivity or defects in enzyme and transport.

    One area researchers now have a bit more solid scientific data about is the role of short-chain fermentable carbohydrates (FODMAPs) in causing gastrointestinal food intolerance. Food exclusion followed by gradual food reintroduction is the best way to diagnose such food intolerance, and to relieve symptoms.

    There is increasing evidence to support the use of a low FODMAP diet to manage gastrointestinal symptoms in cases of suspected food intolerance. A low FODMAP diet is effective, but changes gastrointestinal microbiota, so reintroducing FODMAPs to the point of tolerance is part of the overall management strategy.

    Exclusionary diets should be as brief as possible. They should be just long enough to induce symptom improvement. They should then be followed by gradual food reintroduction to establish individual tolerance.

    This will help to increase dietary variety, ensure nutritional adequacy and minimize impact on the gastrointestinal microbiota.

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    Guest Barbara Kirch

    Posted

    I was recently put on a Low FODMAP diet by my gastroenterologist. I am also celiac. I find that I have not had great success with this Low FODMAP diet which is extremely restrictive and limits the ability to eat outside my own kitchen.

    I am still reintroducing foods, but other than lactose, for me this diet has not proved valuable.

     

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    Guest Jamie Pomana

    Posted

    I guess I don't understand. I have celiac disease and any and I mean any gluten and I am sick for weeks. It's been 14 months since I started my gluten free diet. Just how long before I am supposed to reintroduce gluten into my diet. The truth is I am terrified of the idea of reintroducing gluten.

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    I guess I don't understand. I have celiac disease and any and I mean any gluten and I am sick for weeks. It's been 14 months since I started my gluten free diet. Just how long before I am supposed to reintroduce gluten into my diet. The truth is I am terrified of the idea of reintroducing gluten.

    Someone with celiac disease would never re-introduce gluten into their diet.

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  • Related Articles

    Dr. Ron Hoggan, Ed.D.
    This article appeared in the Autumn 2007 edition of Celiac.com's Scott-Free Newsletter.
    Celiac.com 03/10/2008 - Virtually every parent and every professional person who works with children wants to see them learn, grow, and achieve to the greatest extent of their potential.  The vast majority of these caregivers know that nutrition plays an enormous role in each child’s realizing their potential.  Unfortunately, that is where agreement ends.  There are almost as many perspectives on what constitutes a healthy diet as there are people on this planet.  Some claim that the healthiest diet is that of a vegetarian which almost invariably leads to a heavy reliance on grains and which is devoid of vitamin B12.  Others assert, based on cardiovascular disease being our number one killer that the best diet includes the smallest amount of fats.  They believe that fat consumption is related to blood cholesterol levels and that blood cholesterol levels are the best predictor of heart attacks.  Yet low cholesterol has been linked to increased cancer risk.  Still others argue for the health benefits conferred by a high protein diet.  They point out the importance of proteins in providing the building blocks for immune system function and the body’s maintenance and repair at the cellular level.  A small but growing faction points to the health benefits of a diet dominated by fats with little or no carbohydrate content.  Other diets target refined sugars and flours as problematic.  Added to this diversity, there is a plethora of dietary perspectives that advocate rigid proportions of fat, protein, and carbohydrates.  The proportions of each component vary according to the data that is given the most credence by the creators and advocates of each diet.  Many dietary rituals have grown up around cancer avoidance or therapy, weight loss strategies, treatments for cardiovascular disease or its avoidance, and autoimmune diseases.  Book, video tape, audio tape, menu guides, and other media sales are just a starting point.  Some advocates of specific dietary strategies are even selling special foods that comply with their recommendations.  The profit motive can be a powerful factor in creating bias.  Then there are the government sponsored healthy eating guides.  Of course, each paradigm assumes that one diet can be recommended for all people.  The USDA has recently devised recommendations that do make concessions to gender and stage-of-life (with separate recommendations for children, adults, and seniors) but even with these changes, the USDA provides a clear message advocating plenty of grains and little fat.  It is difficult to determine just how much these recommendations have been influenced by special interest lobbies.  Agricultural and food production corporations have made astronomical investments in current dietary practices and shaping new dietary trends.  Is it reasonable to expect them to be responsive to evolving research findings?  
    Those of us who have experienced the painful shock that we were ill, sometimes deathly ill, from grain proteins that come highly recommended by government food guides, have had to revise our views of healthy eating and reject such flawed guidance.  Gluten sensitivity and celiac disease often crop up in the context of what many health care professionals tout as a healthy diet.  Prior to my own diagnosis of celiac disease, I remember one physician recommending that I eat bran every morning to reverse some of the gastrointestinal problems I was having.  He would not believe that eating bran made me vomit.  There is a persistent sense that we should all know what constitutes a good diet.  Almost every one of us who have to avoid gluten knows that avoiding it is a healthy choice for us, irrespective of government or private sector recommendations for healthy eating.  We have learned not to trust these prescriptions filled with certitude and rigidity.  We have found new-found health in eating habits that are diametrically opposed to those recommendations.
     
    Thus, many of us will have a very different view of conventional dietary wisdom.  For instance, Dr. Eve Roberts, a scientist at Toronto’s Hospital for Sick Children, was quoted on Monday, September 24th in the Victoria Times Colonist as saying: “I do not want children to grow up with liver disease because we forgot to tell them how to eat” (1).  I’m sure that same attitude abounds throughout the medical profession.  Unfortunately, despite the overwhelming consensus that children should not suffer such diet-induced illnesses, there is little agreement on exactly what we should be telling children (or adults for that matter) to help them avoid fatty liver disease.  The medical literature provides research reports of several contradictions on this point. 
    In fact, contradictions abound throughout the medical literature.  So how are we to choose a healthy diet? What can we teach our children about eating well? For those of us who are gluten sensitive or have celiac disease, gluten avoidance is a given.  For our children, the answer is less clear.  They will be at greater risk of having celiac disease or gluten sensitivity, but what should we teach them about these grains? Should they avoid gluten entirely? Should they eat normally until they become ill—perhaps risking permanent neurological damage or a deadly cancer? Should they be constantly vigilant with regular blood tests, endoscopies, or IgG allergy testing?
    Many of us have been told to “just eat a balanced diet”.  It sounds appealing, but it is so vague as to provide little meaningful direction.  What is a healthy diet and how do we judge if any special interest group is more interested in health than profits? Just how much can we trust information that has a price tag attached to it? Somebody is profiting.  Can they really provide objective guidance? These questions should form part of our search for information.  There is nothing wrong with making a profit or earning a living from providing dietary advice.  However, it is important to be aware of any possible conflicts of interest.  
    For these reasons, I have developed my own strategy for determining what advice and guidance I can provide to my children and grandchildren.  I acknowledge that this approach is limited by my own biases, my finite capacity for assimilating and synthesizing information, my incomplete familiarity with nutritional research, and my own personal experiences.  On the other hand, I don’t have to worry about being directly influenced by profiteering or lobby groups diverting me from my primary purpose.
    On that basis, I have proceeded to explore my own dietary program.  I have conducted some trial-and-error experiments on myself, and I have read as extensively as my part-time avocation of dietary investigation permits.  From this, I have learned to trust my own gut.  If something doesn’t feel right in my stomach, I avoid it.  I have also learned to trust my sense of smell.  If a food does not smell appetizing to me, I don’t eat it.  I suspect that this is a tool that evolution has provided us with to determine what is and is not safe to eat.  Those without it probably stopped contributing to the human gene pool.  I have learned that IgG allergy testing is an effective tool with which I can reduce the lengthy trial-and-error process necessary for identifying the majority of allergies.  I realize that this testing has its weaknesses, but so does almost every other form of medical testing.  I have come to accept that as long as human beings are involved, we will have imperfect testing, regardless of claims to the contrary.  Finally, although I try to read critically, I read medical and scientific research reports to stay abreast of new findings and gain a better understanding of this complex field.
    The tentative conclusions I have reached, pending new information, are as follows:

    Gluten grains probably aren’t very good for people.  They are highly allergenic affecting at least 10% of the general population, and perhaps as much as 40%  of the population.  These grains also contain opioids morphine-like substances that can be highly addictive and have a deleterious effect on our ability to resist cancer.  They also contain large quantities of starch that is converted very rapidly into sugars. The evidence suggests that refined sugars and starchy foods cause many of our problems with obesity, vision problems due to growth related distortions of the eyeball, type II diabetes, and hypoglycemia.  Dairy products probably aren’t very good for anyone either.  They are also highly allergenic and contain opioids similar to those found in gluten.  Further, about two thirds of the world’s adult populations are lactose intolerant.  They don’t retain enzymes for digesting milk sugars after childhood. I think it is wise to avoid processed foods where possible.  The more they’ve been processed, the further they are from the state in which we evolved eating them. I believe it is a good idea to avoid eating soy because it has been linked to neurological diseases and other health problems that I don’t want to develop. I avoid foods to which IgG blood testing has shown to cause an immune reaction in me. I try to avoid juices, as these are mostly sugar.  Those are the things I try to avoid.  On a more positive note, there are several specific strategies that I try to follow:
    I take supplements of vitamins and minerals which evidence has shown that I either absorb poorly or have been depleted from the soils in which my food is grown. I try to eat whole fruits and vegetables. I try to eat when I am hungry—not according somebody else’s idea of appropriate mealtimes. If I am ever diagnosed with cancer, I will follow a ketogenic diet.  That is a diet that is dominated by fats, includes about 30% protein, and includes no carbohydrates.  I have tried this diet for about a month.  I can’t say that I enjoy it very much, but I’d be happy to forego the pleasure of carbohydrates if my life is at stake.
    I’m very grateful to my wife who works very hard at finding tasty treats so I don’t have to feel isolated or deprived in social situations where food is consumed.
    I’m convinced that even a little exercise is a critical feature of a well balanced diet, but that belongs in another column.
    I realize that these strategies are often impractical and I don’t pretend to live up to all of them, except for gluten and dairy avoidance.  I also suspect that I would be better off if I ate organic fruits and vegetables along with range fed meat.  I also suspect that I should avoid any genetically modified food.  We really don’t know what’s in that stuff! I haven’t reached the point yet where I am sufficiently motivated to change my diet to that extent, although I do realize that it would probably be a good idea.  I am convinced that Dr. Barry Sears is onto something when he advocates specific proportions of each food type for optimal health and performance.  Unfortunately, my diet is already complex enough that without some specific and highly motivating reason, I’m just too busy or lazy to be bothered with measuring such things.  I just let my taste buds and availability (my wife only cooks one cake at a time) determine my portion sizes.This is the balanced diet I recommend.  I sorely doubt that my children or my grandchildren follow my advice, except when they visit during mealtimes.  However I am confident that such a diet, should they choose to accept it, will not cause them to self-destruct due to dietary disease.


    Sayer Ji
    Approximately 70% of all American calories come from a combination of the following four foods: wheat, dairy, soy and corn - assuming, that is, we exclude calories from sugar.
    Were it true that these four foods were health promoting, whole-wheat-bread-munching, soy-milk-guzzling, cheese-nibbling, corn-chip having Americans would probably be experiencing exemplary health among the world's nations. To the contrary, despite the massive amount of calories ingested from these purported "health foods," we are perhaps the most malnourished and sickest people on the planet today. The average American adult is on 12 prescribed medications, demonstrating just how diseased, or for that matter, brainwashed and manipulated, we are.
    How could this be? After all, doesn't the USDA Food Pyramid emphasize whole grains like wheat above all other food categories, and isn’t dairy so indispensible to our health that it is afforded a category all of its own? 
    Unfortunately these “authoritative” recommendations go  much further in serving the special interests of the industries that produce these commodities than in serving the biological needs of those who are told it would be beneficial to consume them.  After all, grains themselves have only been consumed for 500 generations – that is, only since the transition out of the Paleolithic into the Neolithic era approximately 10,000 years ago.  Since the advent of homo sapiens 2.5 million years ago our bodies have survived on a hunter and gatherer diet, where foods were consumed in whole form, and raw!  Corn, Soy and Cow's Milk have only just been introduced into our diet, and therefore are “experimental” food sources which given the presence of toxic lectins, endocrine disruptors, anti-nutrients, enzyme inhibitors, indigestible gluey proteins, etc, don’t appear to make much biological sense to consume in large quantities - and perhaps, as is my belief, given their deleterious effects on health, they should not be consumed at all.
    Even if our belief system doesn’t allow for the concept of evolution, or that our present existence is borne on vast stretches of biological time, we need only consider the undeniable fact that these four “health foods” are also sources for industrial adhesives, in order to see how big a problem they present.
    For one, wheat flour is used to make glues for book binding and wall-papering, as well as being the key ingredient for paper mache mortar. Sticky soy protein has replaced the need for formaldehyde based adhesives for making plywood, and is used to make plastic, composite and many other things you probably wouldn’t consider eating. The whitish protein known as casein in cow's milk is the active ingredient in Elmer's glue and has been used for paint since ancient times. Finally, corn gluten is used as a glue to hold cardboard boxes together. Eating glue doesn't sound too appetizing does it?  Indeed, when you consider what these sticky glycoproteins will do to the delicate microvilli inside our intestines, a scenario, nightmarish in proportions, unfolds. 
    All nutrients are absorbed in the intestine through the microvilli. These finger-like projections from off the surface of the intestine amplify the surface area of absorption in the intestine to the area the size of a tennis court. When coated with undigested or partially digested glue (glycoproteins), not only is the absorption of nutrients reduced leading to malabsorption and consequently malnourishment, but the villi themselves become damaged/dessicated/ inflammed and begin to undergo atrophy - at times even breaking off.  The damage to the intestinal membrane caused by these glues ultimately leads to perforation of the one cell thick intestinal wall, often leading to "leaky gut syndrome": a condition where undigested proteins and plant toxins called lectins enter the bloodstream wreaking havoc on the immune system. A massive amount of research (which is given little to no attention both in the mass media and allopathic medicine) indicates that diseases as varied as fibromyalgia, diabetes, autism, cancer, arthritis, crohn's, chronic fatigue, artheroscerosis, and many others, are directly influenced by the immune mediated responses wheat, dairy, soy and corn can provoke.
    Of all four suspect foods Wheat, whose omnipresence in the S.A.D or Standard American Diet indicates something of an obsession, may be the primary culprit.  According to Clinical Pathologist Carolyn Pierini the wheat lectin called "gliadin" is known to to participate in activating NF kappa beta proteins which are involved in every acute and chronic inflammatory disorder including neurodegenerative disease, inflammatory bowel disease, infectious and autoimmune diseases.
    In support of this indictment of Wheat’s credibility as a “health food,” Glucosamine – the blockbuster supplement for arthritis and joint problems – has been shown to bind to and deactivate the lectin in wheat that causes inflammation. It may just turn out to be true that millions of Americans who are finding relief with Glucosamine would benefit more directly from removing the wheat (and related allergens) from their diets rather than popping a multitude of natural and synthetic pills to cancel one of Wheat’s main toxic actions. Not only would they be freed up from taking supplements like Glucosamine, but many would also be able to avoid taking dangerous Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) like Tylenol, Aspirin and Ibuprofen, which are known to cause tens of thousands of cases of liver damage, internal hemorrhaging and stomach bleeding each and every year.
    One might wonder:  “How is it that if America's favorite sources of calories: Wheat and Dairy, are so obviously pro-inflammatory, immunosuppressive, and generally toxic, why would anyone eat them?”  ANSWER: They are powerful forms of socially sanctioned self-medication.
    Wheat and Dairy contain gliadorphin and gluten exorphins, and casomorphin, respectively.  These partially digested proteins known as peptides act on the opioid receptors in the brain, generating a temporary euphoria or analgesic effect that has been clinically documented and measured in great detail.  The Institute of Pharmacology and Toxicology in Magdeburg, Germany has shown that a Casein (cow's milk protein) derivative has 1000 times greater antinociceptive activity (pain inhibition) than morphine. Not only do these morphine like substances create a painkilling "high," but they can invoke serious addictive/obsessive behavior, learning disabilities, autism, inability to focus, and other serious physical and mental handicaps. 
    As the glues destroy the delicate surface of our intestines, we for the life of us can't understand why we are so drawn to consume these "comfort foods", heaping "drug soaked" helping after helping.  Many of us struggle to shake ourselves out of our wheat and dairy induced stupor with stimulants like coffee, caffeinated soda and chocolate, creating a viscous “self-medicating” cycle of sedation and stimulation.
    As if this were not enough, Wheat, Dairy, and Soy also happen to have some of the highest naturally occurring concentrations of Glutamic Acid, which is the natural equivalent of monosodium glutamate. This excitotoxin gives these foods great "flavor" (or what the Japanese call umami) but can cause the neurons to fire to the point of death.  It is no wonder that with all these drug-like qualities most Americans consume wheat and dairy in each and every meal of their day, for each and every day of their lives.
    Whether you now believe that removing Wheat, Dairy, Soy and Corn from your diet is a good idea, or still need convincing, it doesn’t hurt to take the “elimination diet” challenge. The real test is to eliminate these suspect foods for at least 2 weeks, see how you feel, and then if you aren’t feeling like you have made significant improvements in your health, reintroduce them and see what happens.  Trust in your feelings, listen to your body, and you will move closer to what is healthy for you.
    This article owes much of its content and insight to the work of John Symes whose ground-breaking research on the dangers of wheat, dairy, corn and soy have been a great eye opener to me, and a continual source of inspiration in my goal of educating myself and others.


    Jefferson Adams
    Celiac.com 07/05/2012 - As more people seek out affordable medical services in foreign countries, the variety of available medical services continues to grow. Stem cells are just the latest in the list of medical services being targeted at foreign visitors.
    A company called MediCAREtourism, a division of an Oman-based travel and hospitality company called Travel Point LLC, is introducing medical packages, including, stem cell treatments, to foreign travelers visiting destinations in Asia and the far east (Korea, Malaysia, and Singapore).
    Stem cell treatments are a type of intervention strategy that introduces new cells into damaged tissue in order to treat disease or injury. Many medical researchers believe that stem cell treatments have the potential to change the face of human disease with minimal risk of rejection and side effects.
    Medical researchers anticipate that adult and embryonic stem cells will soon be able to treat cancer, Type 1 diabetes mellitus, Parkinson's disease, Huntington's disease, Celiac Disease, cardiac failure, muscle damage and neurological disorders, liver cirrhosis and most importantly spinal injuries/paralytic cases from road accidents.
    Stem cell treatment is one of the fastest growing medical medical services in the world today, and provides many people with tremendous benefits, says Mr. Aslam Sayed Mohamed, Manager for MediCAREtourism, said.
    Travel Point is teaming up with Ming Medical Services of Malaysia to offer the stem cell packages, along with free medical consultation and general health checkups for all of their passengers traveling to Thailand & Malaysia.
    The health checkups will be held at accredited hospitals like Paulo Memorial Hospital in Bangkok (Thailand), Prince Court Medical Centre in Kuala Lumpur (Malaysia) and Sime Darby Medical Centre Ara Damansara in Selangor (Malaysia).
    This means that, in addition to free medical consultation, and general health checks, Travel Point customers traveling in Asia and the Far East can choose very affordable stem cell therapy packages to Malaysia and Thailand.
    Commenting on the importance of these treatment options, Dr. Sean NG, Managing Director, Ming Medical Services says stem cell treatments can give "100% cure to ailments like Vitiligo, Aging, Diabetes, Diabetic Ulcers, Autism, Cosmetic Abnormalities and end stage heart diseases."
    In a related story for the HuffingtonPost, Anthonia Akitunde notes that what was once regarded as an option only for the rich, medical tourism is becoming more and more popular among regular people. She cites estimates by Patients Beyond Borders, which produces guidebooks on medical travel, that in 2012, 600,000 people traveled abroad for treatment -- a number anticipated to grow 15 to 20 percent annually as boomers age.
    Source:
    http://www.ameinfo.com/travel-offers-health-check-east-introduces-301973

    Jefferson Adams
    Celiac.com 09/25/2014 - Nine out of ten wheat crops around the globe are susceptible to a killer fungus that attacks wheat. The pathogen is Puccinia rust fungus. Puccinia triticina causes 'black rust', P.recondita causes 'brown rust' and P.striiformis causes 'Yellow rust'.
    Originally named Ug99, but now known as wheat stem rust, the fungus affects wheat, barley and rye stems, leaves and grains, and causes plants to rot and die just a few weeks after infection. Infections can lead up to 20% yield loss exacerbated by dying leaves which fertilize the fungus. The fungus regularly causes serious epidemics in North America, Mexico and South America and is a devastating seasonal disease in India, and a widespread outbreak could destroy flour supplies as we know them.
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    Scientists now use what they say is a more effective method of thwarting rust, wheat breeding, called “pyramiding,” in which multiple rust resistant genes are loaded onto a single wheat strain, potentially keeping rust at bay for decades to come, but pyramiding takes up to 15 years to produce a rust-resistant wheat strain. This means that the vast majority of wheat strains under cultivation could be subject to rust in the mean time.
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    However, if these efforts fail, or lose traction, look for non-wheat crops to fill the gap. That will mean large numbers of people going gluten-free for reasons having nothing to do with celiac disease or dietary fads.

  • Recent Articles

    Jefferson Adams
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    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.
    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