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      Frequently Asked Questions About Celiac Disease   04/07/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes
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    HOW TO FIND OUT IF YOUR DRUGS OR MEDICINES CONTAIN GLUTEN


    Jefferson Adams

    Celiac.com 05/06/2015 - Gluten is a common ingredient in many commercial food products. Less commonly known, however, is that many manufacturers use gluten as an inert ingredient in such products as medications, supplements, and vitamins. For people with celiac disease, exposure to as little as 30 to 50 mg of gluten per day can damage the mucosa of the small intestine. So, it is important to know the gluten content of prescription and nonprescription medications, even though a lack of labeling laws can make it challenging to find products that are gluten-free.


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    Photo: CC-- Yahann LeGrandGiven the lack of resources to verify the gluten content of prescription and non-prescription medications, it is best to check with the manufacturer. Your pharmacist can help make the process a bit simpler than doing it yourself. There are three things you and/or your pharmacist can do to determine the gluten status of any prescription drug. First is the use of a package insert (PI). You or your pharmacist can use the PI to review drug formulations, and find contact information for pharmaceutical manufacturers.

    Gluten is used in numerous medications, supplements, and vitamins, often as an inert ingredient known as an excipient. For prescription medications, the PI should include a detailed listing of excipients; however, if this information is not readily available, the FDA provides drug labeling information for prescription and some OTC medications at DailyMed (dailymed.nlm.nih.gov). 

    For non-prescription products, there often is nothing in the PI regarding gluten content, which means you will likely need to check with the manufacturer to be sure.

    Second, you or your pharmacist can visit company websites to help determine whether a medication potentially contains gluten.

    Third, you can find manufacturer contact information on the product or its packaging, by conducting an Internet search using the manufacturer's name, or by accessing online drug-information resources such as Clinical Pharmacology, Facts & Comparisons, and Martindale. When requesting information from a manufacturer, it is helpful to provide the lot number.

    Recent research by Mangione and colleagues showed that information about the gluten content of non-prescription products is usually available and easy to access through the manufacturer.

    Fourth, there are some third-party websites, such as GlutenFreeDrugs.com, which is maintained by a clinical pharmacist, contains a detailed chart listing selected brand and generic medications that are gluten-free, as well as those free of lactose or soy. However, this is not a comprehensive or definitive list of products, as ingredients and formulations can change from lot to lot in the manufacturing process.

    Lastly, Celiac.org, the Celiac Disease Foundation offers a variety of resources and provides information on the treatment of celiac disease, tips on living gluten-free, and support-group contact information.

    Source:


    Image Caption: Photo: CC-- Yahann LeGrand
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  • Related Articles

    Melissa Blanco
    This article originally appeared in the Fall 2009 edition of Journal of Gluten Sensitivity.
    Celiac.com 12/11/2009 - I recently embarked on a quest for family-friendly restaurants that offered gluten-free selections.  I explained this vision to my husband and three children as we set the rules of our experiment: five family members to eat at five restaurants during a five week period.  The challenge - the children were to choose the restaurant, the chosen restaurant couldn’t sell Happy Meals or have a drive-thru window and the restaurant had to be a franchise rather than a local venue.  Additionally, the mom, me, and the only celiac in the family, had the option of not eating if it might compromise her small intestines.  Here is what we discovered:
    Restaurant # 1: Applebee’s
    My children chose to eat at Applebee’s on a Sunday afternoon for lunch.  The atmosphere was friendly and a plentiful kids’ menu was offered.  With over 1900 restaurants nationwide and in 15 other countries, according to the company website, it seems there is an Applebee’s almost everywhere.  Additionally, Applebee’s offers a Weight Watcher’s menu for restaurant patrons who are counting points, which led me to hope an allergy/gluten-free menu would also be provided.
    After we were seated, I perused the menu to read this statement, “To our guests with food sensitivities or allergies.  Applebee’s cannot ensure that menu items do not contain ingredients that might cause an allergic reaction.  Please consider this when ordering.”
    I spoke to a manager and asked if a gluten-free menu was available.  I was informed, “Applebee’s policy is not to guarantee allergy-free food.  Our company does not carry a gluten-free menu, but we can modify food.  For example, we can prepare grilled chicken breast strips for kids, rather than giving them breaded chicken fingers.  Again, we don’t guarantee the food will not come in contact with the allergen.”
    Restaurant #2: Red Robin
    The next stop on our restaurant expedition was Red Robin, which also offers an extensive children’s menu.  According to the company website, there are over 430 Red Robin restaurants, in North America.  After we were seated in our booth, I asked our server if a gluten-free menu was available.  She immediately went to the kitchen and returned with a printed Wheat/Gluten Allergen menu.  Printed on the top of the menu was the statement, “Red Robin relied on our suppliers’ statements of ingredients in deciding which products did not contain certain allergens.  Suppliers may change the ingredients in their products or the way they prepare their products, so please check this list to make sure that the menu item you like still meets your dietary requirements.  Red Robin cannot guarantee that any menu item will be prepared completely free of the allergen in question.”
    Gluten-free offerings were grouped in the following categories: salads; salad dressings; burgers; chicken burgers; entrees; and available side dishes.  The Kids’ menu offered a beef patty burger, turkey patty, and chicken-on-a-stick.  It stated: “Kids may also select from any items listed on the Wheat/Gluten menu as adult items to custom design a wheat/gluten free meal for your child.  This menu is current and valid until 10/1/09.”
    I was informed by our server that when a customer orders from the gluten-free menu, an allergy alert is put on their ticket and the area of food preparation is cleaned to avoid cross-contamination.  Additionally, the fries are prepared in oil specifically designated for fries, and those with a gluten allergy should avoid the fry seasoning.
    I ordered off of the Red Robin gluten-free menu and personally recommend the Crispy Chicken Tender Salad with grilled chicken rather than crispy, no garlic bread, and the honey mustard dressing.
    Restaurant #3: Garlic Jim’s Famous Gourmet Pizza
    It was a Friday evening and my children decided they really wanted to eat pizza for dinner.  This led us to almost break our fast food rule by ordering carryout from a pizza restaurant.  Ordering pizza is an extreme challenge for those suffering from gluten intolerance. Therefore, I had to do my research ahead of time.  I called Papa John’s, Domino’s, Papa Murphy’s and Pizza Hut to confirm that gluten-free pizza is not offered, at any of these pizza chains.  I did find a pizza franchise in my state, called Garlic Jim’s, which offers a gluten-free crust. 
    According to the chain website, “Garlic Jim’s is proud to be the first pizza chain accredited for gluten free food service by the Gluten Intolerance Group of North America.”  Garlic Jim’s Famous Gourmet Pizza is currently located in seven states including; Washington, Oregon, California, Idaho, Colorado, Tennessee, and Florida.
    I was informed at the restaurant that the gluten-free crust is covered with sauce in a separate area in order to avoid cross contamination although the toppings are put on in the same location where wheat-based crusts are prepared.  Different pans and utensils are used in the preparation of this gluten-free thin crust which costs three dollars more than their traditional pizzas.  The restaurant also posts a sign stating that although they do offer gluten-free pizza, they cannot guarantee the pizza will not come in contact with allergens.
    I recommend the gluten-free pepperoni pizza, and can attest that pizza has never tasted so good.
    Restaurant #4:  The Old Spaghetti Factory
    The Old Spaghetti Factory was established in 1969, and as of today, boasts 39 locations nationwide.  I was quite pleased to discover, when my children chose to eat at The Old Spaghetti Factory, that they offer gluten-free pasta.  Before being seated, I inquired at the hostess desk if a gluten-free menu was available and I was presented with a laminated copy. 
    Each entré includes complimentary salad, bread, and ice cream. Obviously, those with gluten intolerance need to give the bread a pass, but there are viable options available for the remainder of the meal.  Gluten-free salad dressings include pesto and vinaigrette—hold the croutons on the salad.  The main course is a rice pasta with the following sauce choices: marinara; meat; mushroom; mizithra cheese, and; brown butter.  Diners also have the option of adding gluten-free sausage and sliced chicken breast to their meal.  For dessert, a choice of spumoni or vanilla ice cream is offered. 
     I ordered the Manager’s Favorite pasta, which includes a combination of two sauces.  I chose gluten-free pasta topped with marinara sauce and mizithra cheese.  My dinner also included a salad with vinaigrette dressing and spumoni for dessert. 
    Restaurant #5: Outback Steakhouse
    Our final dining choice was the Outback Steakhouse which, according to the company’s website, is an Australian Steakhouse with over 950 locations worldwide.  I was offered a gluten-free menu that is nearly as large as the main menu.  Offerings included appetizers, steaks, chicken, seafood, salads, side dishes, and even a brownie dessert.  The entire gluten-free menu is available on the Outback Steakhouse website, www.outback.com .
    Our server was very knowledgeable of gluten intolerance. I ordered off of the gluten-free menu.  When ordering salads, it is recommended that you request that they be mixed separately to avoid cross contamination.  Overall, it was a very pleasant dining experience for my entire family, with a plentiful menu for me and an ample kids’ menu.
    I would certainly recommend what I ordered— Victoria’s Filet with a baked potato and a salad without croutons.  I passed on the bread which accompanies every meal.  It was a pleasant dining experience at what is quite possibly the restaurant that has set the current gold standard for gluten-free dining.
    Overall, our experiment was a great success with four of the five restaurants we visited offering gluten-free menus.  I advise diners to be cautious wherever they eat because even if a company offers gluten-free options you must also take into account the knowledge of the chef preparing your food and the server assisting you.  It is encouraging that major restaurant chains are acknowledging the need to modify their menus for those suffering from gluten intolerance.  Good luck and happy dining.


    Jefferson Adams
    Celiac.com 09/07/2012 - Many people with celiac disease will tell you that getting a proper diagnosis is just part of the battle. Maintaining a strict gluten-free diet, and getting adequate medical follow-up care can be nearly as challenging as getting a proper diagnosis.
    A group of researchers, led by Joseph A. Murray, MD, AGAF, of Mayo Clinic, confirms that assessment in a new study. The study appears in Clinical Gastroenterology and Hepatology, and shows that follow-up care for patients with celiac disease is often poor and inconsistent.
    For their study, researchers collected data on 122 patients diagnosed with celiac disease between 1996 and 2006 in Olmsted County, MN. The patients were 70 percent women, and averaged 42 years of age.
    The researchers then calculated the rates at which patients were given follow-up exams from six months to five years after celiac disease diagnosis.
    Of the 113 patients the study followed for more than four years, only 35 percent received follow-up analyses that met AGA guidelines. The other patients did not receive medical follow-up that met "even the most lax interpretation of current guidelines,” said Dr. Murray.
    The researchers used the Kaplan-Meier method to estimate event rates at 1 and 5 years. They classified patients according to categories of follow-up procedures recommended by the American Gastroenterological Association (AGA).
    The study shows that even with widespread circulation of follow-up recommendations, plenty of patients are not getting proper follow-up for celiac disease.
    According to Dr. Murray, gastroenterologists with the expertise in celiac disease need to encourage active follow-up of celiac patients and improve their overall quality of medical care.
    Basically, says Dr. Murray, celiac disease "should not be different from other chronic conditions for which medical follow up is a given such as liver disease, inflammatory bowel disease or even gastroesophageal reflux disease."
    Anecdotally, many patients with celiac disease feel that they must manage celiac disease on their own,” Murray adds, pointing out that it is important for doctors and patients to understand the need for proper medical follow-up of celiac disease.
    The authors note that, since gastroenterologists are leading the way in the detection of celiac disease, and since it is a chronic condition, with possible long-term complications, improved communication between gastroenterologists and patients can help to ensure that patients get important follow-up care, and thus improve outcomes in celiac disease.
    What are your thoughts? Do you feel that you've gotten adequate follow-up care for your celiac disease? Share your comments below.
    Source:
    Clinical Gastroenterology and Hepatology

    Jefferson Adams
    Celiac.com 01/24/2014 - To create a gluten-free, allergen-free station in a dining hall that serves about 10,000 to 14,000 students each week, and offers a different daily menus for each meal, Lehigh University in Bethlehem went the distance. The result was Simple Servings.
    Lehigh's earlier dining hall offered gluten-free cereals, soups, pastas and breads via their Your Choice station. That original station has been incorporated into Simple Servings, and Lehigh students with gluten intolerance can now experience the same range of choices as their non-sensitive counterparts.
    Joseph Kornafel, Lehigh's executive chef, says that the school has really paid attention to details, from getting the right equipment when the station was being built, to maintaining a database of allergen-free recipes,
    Lehigh has also reached out to coaches and student-athletes to make sure they understand how the system works and to always get a clean plate before taking food from the station to avoid cross-contamination.
    Purple is the color adopted to designate allergen-free items in the food industry, and Lehigh uses purple to designate all gluten-free food preparation items, including utensils, carts and cutting boards.
    All gluten-free preparation equipment is dedicated, and never leaves that station to prevent cross-contamination. All chefs working that station are specially trained, and and all ingredients are clearly labeled for each dish.
    Source:
    Lehigh Valley Live

    Jefferson Adams
    Celiac.com 05/16/2014 - More than half of U.S. chain restaurants plan to expand their gluten-free menus in the next year, according to a national menu price survey by restaurant supply-chain co-op SpenDifference.
    "Operators recognize that a growing number of customers have health-related dietary restrictions, and they are revamping their menus to include choices for them, as well as for those who simply want more healthful choices,” said SpenDifference president and CEO Maryanne Rose.
    Currently, 55 percent of restaurants surveyed serve gluten-free menu items. According to the new survey, the majority of those businesses will be expanding that selection in the coming year.
    The survey supports projections that indicate that the demand for gluten-free menu items “will be with us for a long time," said Rose.
    The findings are included in SpenDifference's third menu price survey, which for the first time asked chain-restaurant operators about their plans to offer more healthful menu options.
    Read more at: Fastcasual.com.

  • Recent Articles

    Jefferson Adams
    Celiac.com 04/19/2018 - Previous genome and linkage studies indicate the existence of a new disease triggering mechanism that involves amino acid metabolism and nutrient sensing signaling pathways. In an effort to determine if amino acids might play a role in the development of celiac disease, a team of researchers recently set out to investigate if plasma amino acid levels differed among children with celiac disease compared with a control group.
     
    The research team included Åsa Torinsson Naluai, Ladan Saadat Vafa, Audur H. Gudjonsdottir, Henrik Arnell, Lars Browaldh, and Daniel Agardh. They are variously affiliated with the Institute of Biomedicine, Department of Microbiology & Immunology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; the Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Karolinska University Hospital and Division of Pediatrics, CLINTEC, Karolinska Institute, Stockholm, Sweden; the Department of Clinical Science and Education, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden; the Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden; the Diabetes & Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden; and with the Nathan S Kline Institute in the U.S.A.
    First, the team used liquid chromatography-tandem mass spectrometry (LC/MS) to analyze amino acid levels in fasting plasma samples from 141 children with celiac disease and 129 non-celiac disease controls. They then crafted a general linear model using age and experimental effects as covariates to compare amino acid levels between children with celiac disease and non-celiac control subjects.
    Compared with the control group, seven out of twenty-three children with celiac disease showed elevated levels of the the following amino acids: tryptophan; taurine; glutamic acid; proline; ornithine; alanine; and methionine.
    The significance of the individual amino acids do not survive multiple correction, however, multivariate analyses of the amino acid profile showed significantly altered amino acid levels in children with celiac disease overall and after correction for age, sex and experimental effects.
    This study shows that amino acids can influence inflammation and may play a role in the development of celiac disease.
    Source:
    PLoS One. 2018; 13(3): e0193764. doi: & 10.1371/journal.pone.0193764

    Jefferson Adams
    Celiac.com 04/18/2018 - To the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service animals.
    If you’ve flown anywhere lately, you may have seen them. People flying with their designated “emotional support” animals. We’re not talking genuine service animals, like seeing eye dogs, or hearing ear dogs, or even the Belgian Malinois that alerts its owner when there is gluten in food that may trigger her celiac disease.
    Now, to be honest, some of those animals in question do perform a genuine service for those who need emotional support dogs, like veterans with PTSD.
    However, many of these animals are not service animals at all. Many of these animals perform no actual service to their owners, and are nothing more than thinly disguised pets. Many lack proper training, and some have caused serious problems for the airlines and for other passengers.
    Now the major airlines are taking note and introducing stringent requirements for service animals.
    Delta was the first to strike. As reported by the New York Times on January 19: “Effective March 1, Delta, the second largest US airline by passenger traffic, said it will require passengers seeking to fly with pets to present additional documents outlining the passenger’s need for the animal and proof of its training and vaccinations, 48 hours prior to the flight.… This comes in response to what the carrier said was a 150 percent increase in service and support animals — pets, often dogs, that accompany people with disabilities — carried onboard since 2015.… Delta said that it flies some 700 service animals a day. Among them, customers have attempted to fly with comfort turkeys, gliding possums, snakes, spiders, and other unusual pets.”
    Fresh from an unsavory incident with an “emotional support” peacock incident, United Airlines has followed Delta’s lead and set stricter rules for emotional support animals. United’s rules also took effect March 1, 2018.
    So, to the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service and emotional support animals.
    Source:
    cnbc.com

    admin
    WHAT IS CELIAC DISEASE?
    Celiac disease is an autoimmune condition that affects around 1% of the population. People with celiac disease suffer an autoimmune reaction when they consume wheat, rye or barley. The immune reaction is triggered by certain proteins in the wheat, rye, or barley, and, left untreated, causes damage to the small, finger-like structures, called villi, that line the gut. The damage occurs as shortening and villous flattening in the lamina propria and crypt regions of the intestines. The damage to these villi then leads to numerous other issues that commonly plague people with untreated celiac disease, including poor nutritional uptake, fatigue, and myriad other problems.
    Celiac disease mostly affects people of Northern European descent, but recent studies show that it also affects large numbers of people in Italy, China, Iran, India, and numerous other places thought to have few or no cases.
    Celiac disease is most often uncovered because people experience symptoms that lead them to get tests for antibodies to gluten. If these tests are positive, then the people usually get biopsy confirmation of their celiac disease. Once they adopt a gluten-free diet, they usually see gut healing, and major improvements in their symptoms. 
    CLASSIC CELIAC DISEASE SYMPTOMS
    Symptoms of celiac disease can range from the classic features, such as diarrhea, upset stomach, bloating, gas, weight loss, and malnutrition, among others.
    LESS OBVIOUS SYMPTOMS
    Celiac disease can often less obvious symptoms, such fatigue, vitamin and nutrient deficiencies, anemia, to name a few. Often, these symptoms are regarded as less obvious because they are not gastrointestinal in nature. You got that right, it is not uncommon for people with celiac disease to have few or no gastrointestinal symptoms. That makes spotting and connecting these seemingly unrelated and unclear celiac symptoms so important.
    NO SYMPTOMS
    Currently, most people diagnosed with celiac disease do not show symptoms, but are diagnosed on the basis of referral for elevated risk factors. 

    CELIAC DISEASE VS. GLUTEN INTOLERANCE
    Gluten intolerance is a generic term for people who have some sort of sensitivity to gluten. These people may or may not have celiac disease. Researchers generally agree that there is a condition called non-celiac gluten sensitivity. That term has largely replaced the term gluten-intolerance. What’s the difference between celiac disease and non-celiac gluten-sensitivity? 
    CELIAC DISEASE VS. NON-CELIAC GLUTEN SENSITIVITY (NCGS)
    Gluten triggers symptoms and immune reactions in people with celiac disease. Gluten can also trigger symptoms in some people with NCGS, but the similarities largely end there.

    There are four main differences between celiac disease and non-celiac gluten sensitivity:
    No Hereditary Link in NCGS
    Researchers know for certain that genetic heredity plays a major role in celiac disease. If a first-degree relative has celiac disease, then you have a statistically higher risk of carrying genetic markers DQ2 and/or DQ8, and of developing celiac disease yourself. NCGS is not known to be hereditary. Some research has shown certain genetic associations, such as some NCGS patients, but there is no proof that NCGS is hereditary. No Connection with Celiac-related Disorders
    Unlike celiac disease, NCGS is so far not associated with malabsorption, nutritional deficiencies, or a higher risk of autoimmune disorders or intestinal malignancies. No Immunological or Serological Markers
    People with celiac disease nearly always test positive for antibodies to gluten proteins. Researchers have, as yet, identified no such antobodies or serologic markers for NCGS. That means that, unlike with celiac disease, there are no telltale screening tests that can point to NCGS. Absence of Celiac Disease or Wheat Allergy
    Doctors diagnose NCGS only by excluding both celiac disease, an IgE-mediated allergy to wheat, and by the noting ongoing adverse symptoms associated with gluten consumption. WHAT ABOUT IRRITABLE BOWEL SYNDROME (IBS) AND IRRITABLE BOWEL DISEASE (IBD)?
    IBS and IBD are usually diagnosed in part by ruling out celiac disease. Many patients with irritable bowel syndrome are sensitive to gluten. Many experience celiac disease-like symptoms in reaction to wheat. However, patients with IBS generally show no gut damage, and do not test positive for antibodies to gliadin and other proteins as do people with celiac disease. Some IBS patients also suffer from NCGS.

    To add more confusion, many cases of IBS are, in fact, celiac disease in disguise.

    That said, people with IBS generally react to more than just wheat. People with NCGS generally react to wheat and not to other things, but that’s not always the case. Doctors generally try to rule out celiac disease before making a diagnosis of IBS or NCGS. 
    Crohn’s Disease and celiac disease share many common symptoms, though causes are different.  In Crohn’s disease, the immune system can cause disruption anywhere along the gastrointestinal tract, and a diagnosis of Crohn’s disease typically requires more diagnostic testing than does a celiac diagnosis.  
    Crohn’s treatment consists of changes to diet and possible surgery.  Up to 10% of Crohn's patients can have both of conditions, which suggests a genetic connection, and researchers continue to examine that connection.
    Is There a Connection Between Celiac Disease, Non-Celiac Gluten Sensitivity and Irritable Bowel Syndrome? Large Number of Irritable Bowel Syndrome Patients Sensitive To Gluten Some IBD Patients also Suffer from Non-Celiac Gluten Sensitivity Many Cases of IBS and Fibromyalgia Actually Celiac Disease in Disguise CELIAC DISEASE DIAGNOSIS
    Diagnosis of celiac disease can be difficult. 

    Perhaps because celiac disease presents clinically in such a variety of ways, proper diagnosis often takes years. A positive serological test for antibodies against tissue transglutaminase is considered a very strong diagnostic indicator, and a duodenal biopsy revealing villous atrophy is still considered by many to be the diagnostic gold standard. 
    But this idea is being questioned; some think the biopsy is unnecessary in the face of clear serological tests and obvious symptoms. Also, researchers are developing accurate and reliable ways to test for celiac disease even when patients are already avoiding wheat. In the past, patients needed to be consuming wheat to get an accurate test result. 
    Celiac disease can have numerous vague, or confusing symptoms that can make diagnosis difficult.  Celiac disease is commonly misdiagnosed by doctors. Read a Personal Story About Celiac Disease Diagnosis from the Founder of Celiac.com Currently, testing and biopsy still form the cornerstone of celiac diagnosis.
    TESTING
    There are several serologic (blood) tests available that screen for celiac disease antibodies, but the most commonly used is called a tTG-IgA test. If blood test results suggest celiac disease, your physician will recommend a biopsy of your small intestine to confirm the diagnosis.
    Testing is fairly simple and involves screening the patients blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis. Also, it is now possible to test people for celiac disease without making them concume wheat products.

    BIOPSY
    Until recently, biopsy confirmation of a positive gluten antibody test was the gold standard for celiac diagnosis. It still is, but things are changing fairly quickly. Children can now be accurately diagnosed for celiac disease without biopsy. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide.

    WHY A GLUTEN-FREE DIET?
    Currently the only effective, medically approved treatment for celiac disease is a strict gluten-free diet. Following a gluten-free diet relieves symptoms, promotes gut healing, and prevents nearly all celiac-related complications. 
    A gluten-free diet means avoiding all products that contain wheat, rye and barley, or any of their derivatives. This is a difficult task as there are many hidden sources of gluten found in the ingredients of many processed foods. Still, with effort, most people with celiac disease manage to make the transition. The vast majority of celiac disease patients who follow a gluten-free diet see symptom relief and experience gut healing within two years.
    For these reasons, a gluten-free diet remains the only effective, medically proven treatment for celiac disease.
    WHAT ABOUT ENZYMES, VACCINES, ETC.?
    There is currently no enzyme or vaccine that can replace a gluten-free diet for people with celiac disease.
    There are enzyme supplements currently available, such as AN-PEP, Latiglutetenase, GluteGuard, and KumaMax, which may help to mitigate accidental gluten ingestion by celiacs. KumaMax, has been shown to survive the stomach, and to break down gluten in the small intestine. Latiglutenase, formerly known as ALV003, is an enzyme therapy designed to be taken with meals. GluteGuard has been shown to significantly protect celiac patients from the serious symptoms they would normally experience after gluten ingestion. There are other enzymes, including those based on papaya enzymes.

    Additionally, there are many celiac disease drugs, enzymes, and therapies in various stages of development by pharmaceutical companies, including at least one vaccine that has received financial backing. At some point in the not too distant future there will likely be new treatments available for those who seek an alternative to a lifelong gluten-free diet. 

    For now though, there are no products on the market that can take the place of a gluten-free diet. Any enzyme or other treatment for celiac disease is intended to be used in conjunction with a gluten-free diet, not as a replacement.

    ASSOCIATED DISEASES
    The most common disorders associated with celiac disease are thyroid disease and Type 1 Diabetes, however, celiac disease is associated with many other conditions, including but not limited to the following autoimmune conditions:
    Type 1 Diabetes Mellitus: 2.4-16.4% Multiple Sclerosis (MS): 11% Hashimoto’s thyroiditis: 4-6% Autoimmune hepatitis: 6-15% Addison disease: 6% Arthritis: 1.5-7.5% Sjögren’s syndrome: 2-15% Idiopathic dilated cardiomyopathy: 5.7% IgA Nephropathy (Berger’s Disease): 3.6% Other celiac co-morditities include:
    Crohn’s Disease; Inflammatory Bowel Disease Chronic Pancreatitis Down Syndrome Irritable Bowel Syndrome (IBS) Lupus Multiple Sclerosis Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Psoriasis Rheumatoid Arthritis Scleroderma Turner Syndrome Ulcerative Colitis; Inflammatory Bowel Disease Williams Syndrome Cancers:
    Non-Hodgkin lymphoma (intestinal and extra-intestinal, T- and B-cell types) Small intestinal adenocarcinoma Esophageal carcinoma Papillary thyroid cancer Melanoma CELIAC DISEASE REFERENCES:
    Celiac Disease Center, Columbia University
    Gluten Intolerance Group
    National Institutes of Health
    U.S. National Library of Medicine
    Mayo Clinic
    University of Chicago Celiac Disease Center

    Jefferson Adams
    Celiac.com 04/17/2018 - Could the holy grail of gluten-free food lie in special strains of wheat that lack “bad glutens” that trigger the celiac disease, but include the “good glutens” that make bread and other products chewy, spongey and delicious? Such products would include all of the good things about wheat, but none of the bad things that might trigger celiac disease.
    A team of researchers in Spain is creating strains of wheat that lack the “bad glutens” that trigger the autoimmune disorder celiac disease. The team, based at the Institute for Sustainable Agriculture in Cordoba, Spain, is making use of the new and highly effective CRISPR gene editing to eliminate the majority of the gliadins in wheat.
    Gliadins are the gluten proteins that trigger the majority of symptoms for people with celiac disease.
    As part of their efforts, the team has conducted a small study on 20 people with “gluten sensitivity.” That study showed that test subjects can tolerate bread made with this special wheat, says team member Francisco Barro. However, the team has yet to publish the results.
    Clearly, more comprehensive testing would be needed to determine if such a product is safely tolerated by people with celiac disease. Still, with these efforts, along with efforts to develop vaccines, enzymes, and other treatments making steady progress, we are living in exciting times for people with celiac disease.
    It is entirely conceivable that in the not-so-distant future we will see safe, viable treatments for celiac disease that do not require a strict gluten-free diet.
    Read more at Digitaltrends.com , and at Newscientist.com

    Jefferson Adams
    Celiac.com 04/16/2018 - A team of researchers recently set out to investigate whether alterations in the developing intestinal microbiota and immune markers precede celiac disease onset in infants with family risk for the disease.
    The research team included Marta Olivares, Alan W. Walker, Amalia Capilla, Alfonso Benítez-Páez, Francesc Palau, Julian Parkhill, Gemma Castillejo, and Yolanda Sanz. They are variously affiliated with the Microbial Ecology, Nutrition and Health Research Unit, Institute of Agrochemistry and Food Technology, National Research Council (IATA-CSIC), C/Catedrático Agustín Escardin, Paterna, Valencia, Spain; the Gut Health Group, The Rowett Institute, University of Aberdeen, Aberdeen, UK; the Genetics and Molecular Medicine Unit, Institute of Biomedicine of Valencia, National Research Council (IBV-CSIC), Valencia, Spain; the Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire UK; the Hospital Universitari de Sant Joan de Reus, IISPV, URV, Tarragona, Spain; the Center for regenerative medicine, Boston university school of medicine, Boston, USA; and the Institut de Recerca Sant Joan de Déu and CIBERER, Hospital Sant Joan de Déu, Barcelona, Spain
    The team conducted a nested case-control study out as part of a larger prospective cohort study, which included healthy full-term newborns (> 200) with at least one first relative with biopsy-verified celiac disease. The present study includes 10 cases of celiac disease, along with 10 best-matched controls who did not develop the disease after 5-year follow-up.
    The team profiled fecal microbiota, as assessed by high-throughput 16S rRNA gene amplicon sequencing, along with immune parameters, at 4 and 6 months of age and related to celiac disease onset. The microbiota of infants who remained healthy showed an increase in bacterial diversity over time, especially by increases in microbiota from the Firmicutes families, those who with no increase in bacterial diversity developed celiac disease.
    Infants who subsequently developed celiac disease showed a significant reduction in sIgA levels over time, while those who remained healthy showed increases in TNF-α correlated to Bifidobacterium spp.
    Healthy children in the control group showed a greater relative abundance of Bifidobacterium longum, while children who developed celiac disease showed increased levels of Bifidobacterium breve and Enterococcus spp.
    The data from this study suggest that early changes in gut microbiota in infants with celiac disease risk could influence immune development, and thus increase risk levels for celiac disease. The team is calling for larger studies to confirm their hypothesis.
    Source:
    Microbiome. 2018; 6: 36. Published online 2018 Feb 20. doi: 10.1186/s40168-018-0415-6