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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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    P.F. CHANG'S DODGES LAWSUIT OVER GLUTEN-FREE SURCHARGE


    Jefferson Adams

    Celiac.com 5/23/2016 - Plenty of people have followed the news of the woman who sued Chinese food chain P.F. Chang's, claiming that they discriminated against her by charging more for gluten-free dishes than for other non-gluten-free options.


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    Celiac.com covered P.F. Chang's efforts to have the suit dismissed, and also P.F. Chang's failure to prevent the woman from modifying the lawsuit, thus keeping it viable, if only for a time.

    U.S. District Judge Ronald Whyte, of the Northern District of California, had dismissed the original complaint in August, but reinstated the suit once plaintiff Anna Marie Phillips amended her complaint. On Nov. 23, 2015, Whyte ruled that Phillips had sufficiently pleaded her claims in that amended complaint.

    Many in the restaurant industry were watching the suit carefully since it was first filed in December 2014, as the claim of discrimination, based on higher charges for gluten-free items at P.F. Chang's, could have serious repercussions for the industry as a whole.

    Phillips has now asked the judge to dismiss her lawsuit.

    At least for now, the question to whether surcharges or higher charges for gluten-free food options constitute some form of discrimination against those with celiac disease or gluten-intolerance, remains un-litigated.

    The position of the Department of Justice is that celiac disease is not a disability in every case, and that there are plenty of cases in which it is not a disability.

    Read more at Legal News Line.



    Image Caption: A plate at P.F. Chang's. Photo: CC--Parker Knight
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    Guest Brenda

    Posted

    I was so happy that PF Chang's had gluten free food, they have to take extra precautions. I'll pay extra!

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    Guest Food!over

    Posted

    gluten-free eaters who want options should welcome reasonable charges for gluten-free food in restaurants. True gluten-free preparation requires significant resources in a restaurant kitchen. To say nothing of potential liability in case of cross contamination. If they aren't allowed to recoup their costs, gluten-free options will quite reasonably decrease. P.F. Chang's has wonderful gluten-free choices and we should support them, not sue them.

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    Guest Sean

    Posted

    As someone who dramatically reacts to gluten, food costs whatever people want to charge for it. Gluten-free food is more expensive to make, so it makes sense that those costs would be passed down to the consumer. I'm just glad we have any gluten-free options at all in restaurants.

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    Guest Sandy

    Posted

    Did the menu price mislead the customer? Did the restaurant tack on an additional charge after ordering? If not, then the customer chose to pay the price for a gluten-free meal. There are extra costs incurred by restaurants like PF Chang's to assure food safety, and as those with celiac disease know, the ingredients are more expensive in general. I applaud restaurants for going the extra mile to provide certified gluten-free menus. I do disagree with the DOJ statement that celiac disease is not always a disability. It is a disability, but it can be managed through strict adherence to a gluten-free diet.

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    Guest alba

    Posted

    Did the menu price mislead the customer? Did the restaurant tack on an additional charge after ordering? If not, then the customer chose to pay the price for a gluten-free meal. There are extra costs incurred by restaurants like PF Chang's to assure food safety, and as those with celiac disease know, the ingredients are more expensive in general. I applaud restaurants for going the extra mile to provide certified gluten-free menus. I do disagree with the DOJ statement that celiac disease is not always a disability. It is a disability, but it can be managed through strict adherence to a gluten-free diet.

    This person knows what they are talking about celiac disease, it's a disability. What are the gluten-free foods they're using in place of the non gluten-free foods to charge extra money? What like rice/corn flour, gluten-free soy sauce which can be used in non gluten-free foods as well. Most same restaurants use cornstarch in their foods. All the non gluten-free items can be used in all their foods, the taste is not very different. It's Just another way to cheat a customer. Their food needs quite a bit of improvement whether it be gluten-free or non gluten-free.

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    Guest Kelvin S.

    Posted

    Sandy, the term "disability" has a specific definition when used in most legal contexts, such as the Americans with Disabilities Act: "a physical or mental impairment that substantially limits one or more 'major life activities'" or a history or perception of such impairment. Celiac disease does not substantially limit eating, even though it does limit what one can eat. I'm not aware of any successful litigation to require a restaurant to serve particular kinds of food to meet someone's dietary limitations, even though some of them could well reach the legal definition of "disability"--the son of a friend of mine can only eat about 4 foods due to severe multiple food allergies. Restaurants do, of course, need to be accessible to those with mobility impairments and the like.

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    The policy of charging more is quite reasonable given the additional ingredient cost and effort the restaurant incurs in preparing the gluten free meals, including maintaining a gluten free prep area. As a long time Celiac sufferer I remember when restaurants did not make this accommodation and this ill conceived lawsuit may cause restaurants to choose not to accommodate us. I enjoy the food at PF Changs and I appreciate that they are one of the few chains that have made a genuine effort to reach out to us enabling me to eat out with my family. This could cause more restaurant chains to put a disclaimer on their menu about all allergens and not bother to accommodate any allergies. If this person does not relent in their attack of PF Changs perhaps we can start a go fund me site to help them afford the extra $20-$40 per year for food...

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    admin
    Celiac.com 02/02/2015 - On December 9th, 2014, Anna Marie Phillips filed a lawsuit in Santa Clara County Superior Court against P.F. Chang's China Bistro, Inc., headquartered in Scottsdale, Arizona, for discrimination and violation of the Americans with Disabilities Act. The suit claims that P.F. Chang's forces people with celiac disease to pay higher prices for gluten-free versions of their menu items. According to the complaint, P.F. Chang's charges one extra dollar per gluten-free item, however, they do not add these surcharges on to their regular menu items.
    The lawsuit is seeking class action status, and claims that over the past four years more than 3,000 people in 39 states have been affected at P.F. Chang's 204 restaurants. The plaintiff claims that the gluten-free diet is medically necessary for those with celiac disease, and those who eat at P.F. Chang's are forced to pay higher prices for gluten-free dishes, even if the dishes they order are naturally gluten-free. The plaintiff asserts that this arbitrary and unequal treatment constitues discrimination against consumers who have celiac disease and gluten intolerance, and that the added surcharge is a violation of the Americans with Disabilities Act.
    In the lawsuit Ms. Phillips and her attorneys, Anthony J. Orshansky and Justin Kachadoorian of Counselone, P.C. in Beverly Hills, California, seek an immediate injunction against any further surcharges on gluten-free items, civil penalties, compensatory damages and punitive damages. P.F. Chang's is represented by Jon P. Karbassakis and Michael K. Grimaldi of Lewis Brisbois Bisgaard & Smith LLP, in Los Angeles, California.
    On January 23, 2015, P.F. Chang's removed the case to U.S. District Court for the Northern District of California (case number 5:15-cv-00344).
    Source:
    legalnewsline.com

    Jefferson Adams
    Celiac.com 08/05/2015 - Should restaurants be required to provide gluten-free food at the same prices it charges for regular gluten-containing items? That question is at the heart of a lawsuit brought by a woman who claims P.F. Chang's has violated federal anti-discrimination laws by charging more for gluten-free items. A federal judge has now "tentatively" dismissed that lawsuit.
    P.F. Chang's had asked the judge in February to dismiss Anna Marie Phillips' class action lawsuit, claiming that her celiac disease does not make her a disabled person under the Americans with Disabilities Act. At that time, lawyers for Chang's urged U.S. District Judge Ronald Whyte to dismiss the suit to prevent what they termed a 'negative impact' upon restaurant industry as a whole.
    Phillips originally sued P.F. Chang's in a California state court in December, but the case was later moved to U.S. District Court for the Northern District of California. According to the motion, the dismissal rests largely on the failure of the plaintiff "to plausibly allege that she is disabled under any applicable statute since her condition constitutes only a minimal limitation on the major life activity of eating."
    In words that may raise the eyebrows of many people impacted by celiac disease, the judge goes on to say that the plaintiff can "still consume all gluten-free foods. No authority supports plaintiff's baseless position that she is disabled." P.F. Chang's also maintained that, because it charges the same price to all customers of its gluten-free items, it is charging based on the food cost, not adding a surcharge based on the gluten-free status of the customer, and is thus not discriminating on the basis of disability.
    The class action suit states that because a gluten-free diet is medically necessary for individuals with celiac disease, gluten-free patrons have no choice but to order at the higher price.
    Phillips brought suit on behalf of persons with celiac disease or gluten intolerance who ordered items from P.F. Chang's gluten-free menu in California within four years prior to the suit.
    In an interesting legal wrinkle, the CEO of the Celiac Disease Foundation said in a February Legal Newsline article that it did not agree with Phillips' claims.
    "Celiac Disease Foundation recognizes that restaurants bear a financial burden for the employee training and other accommodations that are required to serve meals that are safe for those with celiac disease," Marilyn G. Geller said.
    P.F. Chang's cited the article in its motion to dismiss.
    What do you think? If P.F. Chang's provide gluten-free food in accordance with the law, must it provide the food at the same price as its non-gluten-free items, or can it charge more to reflect its costs?
    Read more at: Legalnewsline.com

    Jefferson Adams
    Celiac.com 11/16/2015 - P.F. Chang's seeking to dismiss an amended complaint filed by a woman who claims the restaurant chain violated federal anti-discrimination laws by charging higher prices for gluten-free items than for non-gluten-free items.
    Plaintiff Anna Marie Phillips initially sued P.F. Chang's in California state court in December, but P.F. Chang's got the case moved to U.S. District Court for the Northern District of California.
    Lawyers for P.F. Chang's first moved to dismiss Phillips' class action in February, claiming her celiac disease does not make her a disabled person under the Americans with Disabilities Act. Federal Judge Ronald Whyte heard oral arguments in May, and "tentatively granted" the motion to dismiss, with a final ruling to be issued later.
    In August, the federal judge granted P.F. Chang's motion to dismiss Phillips' original complaint. The court ruled that the plaintiff failed to allege facts showing that the restaurant chain discriminated against her and other guests with celiac disease or a gluten allergy/intolerance, by charging $1 more for some gluten-free menu items compared to non-gluten-free versions of menu items with a similar name but prepared and handled much differently.
    However, Whyte did grant Phillips a leave to amend, while expressing his "reservations" that she could ever mount a viable claim using her discrimination theory.
    P.F. Chang's, in its Sept. 24 motion to dismiss the amended complaint, contends the new complaint asserts the same disability-discrimination claims and offers "few additional facts" and "none that warrant a different result."
    The plaintiff asserts, P.F. Chang's notes, that the gluten-free menu items are "essentially the same" and are "not truly different dishes" because they have the same basic ingredients.
    What do you think? Are restaurants wrong to charge more for gluten-free food? Share your thoughts and opinions below.
    Read More: Legalnewsonline.com

    Jefferson Adams
    Celiac.com 01/04/2016 - Does P.F. Chang's Asian Bistro discriminate against people with celiac disease by charging more for gluten-free dishes than for their non-gluten-free counterparts? A complaint filed in federal court says it does, and a ruling by a federal judge means that the lawsuit against P.F. Chang's over its gluten-free menu won't be dismissed just yet.
    That means a class action lawsuit against P.F. Chang's for allegedly charging more for gluten-free menu items can continue. Judge Ronald Whyte's Nov. 23 order denied the company's motion to dismiss plaintiff Anna Marie Phillips' first amended complaint.
    "Neither party has cited, and the court has not found, any case specifically discussing whether celiac disease constitutes a disability under the ADA (Americans with Disabilities Act) or Unruh Act," Whyte wrote in his 13-page ruling. "However, accepting the additional detail in the FAC (first amended complaint) about the consequences of ingesting or being exposed to gluten, which plaintiff must guard against, plaintiff has pled sufficient facts to support her claim that she has a disability that impacts a major life activity.
    "The court notes that on a more complete factual record, the court might reach a different conclusion."
    Phillips sued P.F. Chang's in a California state court last December. Chang's then successfully moved the case to U.S. District Court for the Northern District of California. Basically, the outcome of the move to dismiss hinges on whether or not celiac disease constitutes a disability under the state's Unruh Act.
    In his order last month, Whyte concluded that Phillips, in her new complaint, pled sufficient facts to claim that the immune reaction to eating gluten meets the definition of a "medical condition" under the state's Unruh Act for people with celiac disease.
    The law specifically outlaws discrimination based on sex, race, color, religion, ancestry, national origin, age, disability, medical condition, marital status or sexual orientation. In her amended complaint, Phillips also claims that celiac disease is an "inheritable and hence genetic characteristic."
    P.F. Chang's argues that the plaintiff must allege that she actually inherited characteristics known to cause disease under the second prong of the "medical condition" definition.
    At stake in the lawsuit is whether or not P.F. Chang's, and, by extension, other restaurants can charge more money for gluten-free food than they do for similar, non-gluten-free menu items.
    The restaurant chain first moved to dismiss Phillips' class action in February, claiming her celiac disease does not make her a disabled person under the ADA. It urged Whyte to dismiss the lawsuit before the entire restaurant industry was impacted.
    Whyte heard oral arguments in May. According to the case's docket, the motion to dismiss was "tentatively granted" at the hearing, with a final ruling to be issued by the court later.
    In August, the judge granted P.F. Chang's motion to dismiss Phillips' original complaint. Whyte ruled that the plaintiff failed to allege facts showing that the restaurant chain discriminated against her and other guests with celiac disease or a gluten allergy/intolerance, by charging $1 more for some gluten-free menu items compared to non-gluten-free versions of menu items with a similar name but prepared and handled much differently.
    However, Whyte granted Phillips a leave to amend. In doing so, the judge expressed his "reservations" about whether the plaintiff could ever state a viable claim under her discrimination theory. Phillips filed her first amended complaint soon after.
    In September, P.F. Chang's filed a motion to dismiss the new complaint, arguing that it asserts the same disability-discrimination claims and offers "few additional facts" and "none that warrant a different result."
    But a detailed list of Phillips' symptoms and reactions when ingesting gluten forced the judge to change his mind.
    As to whether or not the lawsuit will gain traction, stay tuned.

  • 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