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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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    TAKE CHARGE OF YOUR MEAL WHEN EATING OUT


    admin

    This article originally appeared in the Autumn 2002 edition of Celiac.com's Journal of Gluten-Sensitivity.


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    The results of my latest Celiac.com survey indicate that 71 percent of 983 respondents dine out less often now than before they went on a gluten-free diet.  Further, 74 percent of those who do eat out are now more nervous and uncomfortable during their dining experience, and 50 percent of them felt this way because it is either too much trouble to explain their diet, or because they felt that restaurant employees are in too big of a hurry to worry about their special needs.  As a resident of San Francisco, a city that supposedly has enough table space in its restaurants to seat everyone in the city at once, these results disappoint me.  Not because I eat out less due to my gluten-restricted diet, or am uncomfortable when I do so, but because I don’t believe that anyone with celiac disease who is armed with the proper knowledge needs to fear or avoid eating out.

    In order to eat out safely the first thing that you must check before going into a restaurant is your attitude.  If you are the type of person who is too embarrassed to send your meal back because they didn’t follow your instructions or if you are the opposite type and are so demanding that you often annoy the staff—you will need to find some middle ground.  It took me a while to reach this point, but I can now go into a restaurant with confidence and look at getting a good gluten-free meal there as a personal challenge that begins when I walk through their door. 

    Upon entering a restaurant the first thing that you need to notice is how busy the place is, including how stressed out the workers seem to be—the more stressed out they are, the more tactful you will need to be to get what you want—a safe meal.  One rule that has served me well in all situations is to keep it simple—both your order and how you place it.  I never try to give a scientific discourse on celiac disease to restaurant workers, as I have found that it only serves to frustrate or confuse them.  Tell them only what they need to know—that you have an allergy to wheat (using the term gluten will typically lead back into long explanations) and need to make sure that your dish is wheat-free.  I wouldn’t tell them that you’ll get violently ill if ANY wheat ends up in your meal, as some people recommend, because they probably won’t want to serve you.  I also wouldn’t go into detail about hidden ingredients that contain wheat—it will take too long to explain and you will again run the risk of scaring them into not serving you. 

    I usually don’t approach the chef unless it’s very slow because he is probably the busiest person in a restaurant.  When it’s busy I always ask the waiter to give the chef special order instructions, both verbally and in writing on the order ticket.  Rather than try to educate the staff and make them experts on gluten, it’s far more efficient if you are the one who becomes more educated with regard to the dishes you like to eat so that you can order them in a manner that will ensure your safety.  I strongly believe that your diet is ultimately your responsibility and not a restaurant’s (with the exception of any mistakes that they might make).

    The key to ordering a gluten-free meal is your beforehand knowledge of its ingredients and how it is prepared.  Most people who have cooked have a basic understanding of how certain dishes are prepared, and how they could contain gluten.  Even if you aren’t a cook you might have had the meal you want to order enough times to know something about its ingredients and preparation methods.  You need only to know enough about the meal to ask the right questions so that you can alter any preparation methods that might cause it to contain gluten.  For example, whenever I order a salad I always tell them no croutons, and to bring me olive oil and vinegar for dressing.  If I order fried rice in a Chinese restaurant I order it without soy sauce, or I give them my own bottle to cook with.  If you order something properly and it arrives incorrectly, send it back!  I recently ordered Chinese food with my family and did everything right—I told them about my wheat allergy, gave them my bottle of soy sauce, and told the waitress that I wanted to make sure that there was no wheat flour in or on anything that I ordered (but that corn starch is fine—if you don’t clarify this point it might unnecessarily eliminate or alter many Chinese dishes).  When our food arrived the chicken I ordered was breaded.  After inquiring about it I found out that they used wheat flour so I sent it back, the waitress apologized, and it was no big deal.

    I recommend that you purchase and read basic cookbooks for the types of foods that you like to eat so that you can place your order with confidence.  For example, I own several cookbooks for my favorite cuisines, including ones that cover Mexican, Chinese, Thai, Italian, Vietnamese, Indian and American foods.  I typically look over the relevant cookbook before I go to a particular restaurant so that I can get an idea of what I want to order and how to order it.  The more up-front knowledge you have about how the dishes you like are prepared, the easier it will be for you to order them in a manner that ensures that they are safe.  Having these books around is also great should you begin to cook more at home, which 65 percent of my survey respondents already do, and this is something that I also highly recommend.

    Generally speaking I try to avoid large chain restaurants as much as possible because many of their items are highly processed and contain a huge number of ingredients.  Their employees typically have no idea what’s in their foods.  I think that many of the survey respondents are with me on this, as 70 percent of them also eat less processed and junk foods due to their gluten-free diets.  I only eat at chain restaurants if I am able to check their Web sites in advance for safe items, and if I can’t do this I am extra careful about what I order.  I try to eat at smaller, family-owned establishments because they usually know the ingredients and preparation methods for all of their dishes.  Additionally, authentic ethnic foods such as Mexican, Vietnamese, Thai, Indian, Indonesian, Japanese and Korean typically use little wheat, so I lean more towards these types of foods when I eat out. 

    The transition to a gluten-free diet isn’t easy—74 percent of survey respondents thought it was difficult or very difficult.  Like many things in life, it took some up-front work on your part to be able to make the successful transition to a gluten-free diet, and the same is true for eating out.  I like to think that what you put into it, you will get out of it—the more you learn about cuisine and its various methods of preparation, the more pleasant and care-free your dining experiences will be, and the more likely you will be to get a safe meal.  Life’s too short to not enjoy the basic pleasure of eating out, so the next time you get the urge, do your homework first, then take charge of your meal at the restaurant!


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    Guest Dolores Eilers

    Posted

    Very good advice. It is hard to get through to some waiters when you try to explain our problems. Thank you for such good information.

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    Of course you can recognize breading and croutons! But how do you know if the chefs used YOUR soy sauce, or if there is cross-contamination in the kitchen despite your best efforts. There are a myriad of ways to be glutenous in a restaurant that this article does not address. It's not this simple and formulaic.

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    Guest Oateater

    Posted

    Be careful with Chinese food. It's often thickened with 'wheaten' cornflour, which is cheaper for the restaurant...at least in Australia.

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    Guest charlotte

    Posted

    This may be the best article I have read since I joined the site in the last six months.

     

    Thank you.

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    Guest Diana

    Posted

    Sorry but I don't agree with this article. For those extremely sensitive celiacs, this doesn't work. Cross contamination is a major problem and you haven't addressed it.

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    Good article. I recently went to a chain restaurant and asked if they had a gluten free menu. The waitress wasn't sure so I asked for the manager. he manager came to our table and assured me that they have gluten free food. I asked what they have and he said "chicken wings". I love chicken wings so I asked him if the wings are cooked separately or in the same fryer as everything else. He looked at me with glazed eyes and said, "with everything else". I wound up having a glass of water and eating my gluten free energy bar. Ask, ask, and then ask again. It sure beats getting sick.

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    Guest Scott Adams

    Posted

    Of course you can recognize breading and croutons! But how do you know if the chefs used YOUR soy sauce, or if there is cross-contamination in the kitchen despite your best efforts. There are a myriad of ways to be glutenous in a restaurant that this article does not address. It's not this simple and formulaic.

    If you have no trust in your fellow human being this approach will not work for you--this article does require some level of trust in other people's competence levels, combined with some skill on your part in being able to communicate well and understand how to order things. If you don't have the trust or the understanding you'd better stay home...

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    Guest Scott Adams

    Posted

    Sorry but I don't agree with this article. For those extremely sensitive celiacs, this doesn't work. Cross contamination is a major problem and you haven't addressed it.

    You either choose to eat out or you choose not to--I can't make that choice for you (but it sounds like you don't eat out). I do, and this is how I've been doing it successfully for 15+ years with very few issues, so I thought I'd share it to be helpful. How is criticizing my successful approach helpful to anyone--why not share with us some tips that are helpful, like how you eat out successfully (oh, I forgot, you probably don't eat out)?

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    Guest Deborah Booth

    Posted

    Well written and practical article. Thanks. We love to go out to eat and it has been more of a challenge since our youngest daughter (5 yrs. old) was diagnosed with celiac. But one we have tackled by applying the same principles that helped us at home and at friends' houses to go gluten free by using common sense, educating ourselves on options, trying new things, and politely communicating our needs to others. I like your suggestions and your attitude. People are much more likely to accommodate you when you have a good attitude.

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    Guest Danielle

    Posted

    Good article. I recently went to a chain restaurant and asked if they had a gluten free menu. The waitress wasn't sure so I asked for the manager. he manager came to our table and assured me that they have gluten free food. I asked what they have and he said "chicken wings". I love chicken wings so I asked him if the wings are cooked separately or in the same fryer as everything else. He looked at me with glazed eyes and said, "with everything else". I wound up having a glass of water and eating my gluten free energy bar. Ask, ask, and then ask again. It sure beats getting sick.

    I have been going out to eat since my diagnosis a few years ago, and I have not had many problems. I do always stay away from chain restaurants (unless they have a gluten free menu). When I do go out I always say I'm highly allergic to wheat which includes Flour, Sauce, Stock, and Breading's. This usually works. I did go back to a restaurant recently to get their steak I had about a year ago that I loved. Thank god the waitress had a friend that was gluten free, because she told me it was marinated in soy sauce. I had it while I was following my gluten free diet. So always ask about Marinades as well.

     

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    Guest Pamela

    Posted

    Thanks for the article! I have recently been diagnosed and probably have a more mild case. Luckily, most of my favorite restaurants have gluten free menus. The only problem is that I am also a vegetarian and most gluten free menus are meat based. I have learned that I can go into many places and describe a dish to make and they are happy to make me an 'off the menu' meal as long as it is simple. I usually ask for them to take a little of every vegetable they have, grill it and throw on some feta cheese. It is a wonderful, satisfying dish and I can enjoy an evening out.

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    Guest Sherida

    Posted

    Thanks, Scott, for another thought provoking article. We are on a trip right now & had just eaten at a Caberra's in Florida where they have a limited gluten free menu. My husband thinks I do a good job at explaining, but it still upsets me when no one knows what's in the garlic mashed potatoes. It always ends up that you can eat a broiled chicken breast, baked potato, steamed broccoli---but that's too boring and I can make those better at home. So I try something less ordinary on the gluten free menu, no matter how limited the choices. Usually balsamic vinaigrette is gluten free and tonight I had sun-dried tomato/basil inaigrette. I get really tired of vinegar and oil, which I used to love. If it's a decent salad to begin with vinegar will bring out the flavor. In a Cuban restaurant earlier this week, they were confident they had safe food for me. Then the waiter accidentally threw a slice of bread on my salad---he had checked out the dressing, but brought me a new salad apologetically.

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    Unfortunately this article doesn't address (as several people have pointed out) the serious issues with cross contamination. I've worked at several restaurants and it is virtually impossible to ensure that gluten (such as from flour, sauces, or even a bread crumb) does not contaminate the meal requested by a celiac. How do you know that the pans, utensils, grill, etc have been thoroughly cleaned and not shared between other meals with gluten? (Answer: you probably don't). So unfortunately when a celiac eats out, they ARE taking a risk. Perhaps they are comfortable with that risk (as the author seems to be), or they are not (as many sensitive celiacs are). But the risk is always there, and celiacs need to be aware of that. It isn't as simple as "taking charge" of your meal as the author writes.

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    Unfortunately this article doesn't address (as several people have pointed out) the serious issues with cross contamination. I've worked at several restaurants and it is virtually impossible to ensure that gluten (such as from flour, sauces, or even a bread crumb) does not contaminate the meal requested by a celiac. How do you know that the pans, utensils, grill, etc have been thoroughly cleaned and not shared between other meals with gluten? (Answer: you probably don't). So unfortunately when a celiac eats out, they ARE taking a risk. Perhaps they are comfortable with that risk (as the author seems to be), or they are not (as many sensitive celiacs are). But the risk is always there, and celiacs need to be aware of that. It isn't as simple as "taking charge" of your meal as the author writes.

    Apparently you skipped over actually reading the article. Of course there is still a risk--the article is designed to teach people how to minimize any risk. As mentioned in the article--go in when the restaurant is slow, and speak to the staff politely to get a meal that is safe. Yes, I agree with you--there are no guarantee's in life!

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    Guest Daphne

    Posted

    Thanks for the positive article! I too am always concerned with cross contamination, but in going out I have to understand there is an element of risk. You said it best by saying this disease and knowledge of it is ultimately our responsibility. I am always extremely kind and straightforward and (knock on wood) this has worked for me until now. It's a relief to know other people go through this routine. My only problems have been at restaurants where there is a language barrier. Again, ultimately my responsibility. I have learned "wheat" in several languages! Taking charge and being kind are always a good combination. Thanks again for sharing your tips and tricks.

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    As a result, more and more universities are scrambling to make safe food alternatives available to students with severe food allergies, including those with celiac disease, as required by the under the Americans with Disabilities Act.
    This adjustment includes gluten-free food offerings, and colleges and universities in Massachusetts are among the first to attempt the adjustment. Their approaches differ slightly, but the goal is to provide a safe, reliable dining experience to students with food allergies.
    The University of Massachusetts Boston and Boston University have created gluten-free zones in cafeterias and food courts, while others are taking a more individual approach. Tufts and Harvard University, for example, are having nutritionists and dining hall staff work with students to figure out what prepared foods can and cannot be eaten and ordering specialty items as necessary.
    Tufts' plan also includes establishing a dedicated freezer-refrigerator unit in its two dining halls that is stocked with gluten-free foods. The units are kept locked, and only students with special dietary needs are given keys
    UMass Amherst publishes dining hall menus online, and identifies gluten-free offerings with a special icon. The school also has an extensive handout on what foods to avoid and whom to contact if students need gluten-free food.
    About a year ago, UMass Boston created a gluten-free zone in its food court, with a dedicated refrigerator, microwave, and toaster to minimize the risk of contamination.
    Look for the trend to continue as more and more colleges deal with the new legal realities of feeding students who have food allergies.
    Sources:
    http://www.bostonglobe.com/metro/2013/01/16/college-dining-halls-latest-challenge-gluten-free/ZGWMFABp0ruPI87L8BV8wM/story.html http://www.dailynebraskan.com/news/article_32cd62de-6908-11e2-951f-0019bb30f31a.html

  • Recent Articles

    Jefferson Adams
    Celiac.com 04/20/2018 - A digital media company and a label data company are teaming up to help major manufacturers target, reach and convert their desired shoppers based on dietary needs, such as gluten-free diet. The deal could bring synergy in emerging markets such as the gluten-free and allergen-free markets, which represent major growth sectors in the global food industry. 
    Under the deal, personalized digital media company Catalina will be joining forces with Label Insight. Catalina uses consumer purchases data to target shoppers on a personal base, while Label Insight works with major companies like Kellogg, Betty Crocker, and Pepsi to provide insight on food label data to government, retailers, manufacturers and app developers.
    "Brands with very specific product benefits, gluten-free for example, require precise targeting to efficiently reach and convert their desired shoppers,” says Todd Morris, President of Catalina's Go-to-Market organization, adding that “Catalina offers the only purchase-based targeting solution with this capability.” 
    Label Insight’s clients include food and beverage giants such as Unilever, Ben & Jerry's, Lipton and Hellman’s. Label Insight technology has helped the Food and Drug Administration (FDA) build the sector’s very first scientifically accurate database of food ingredients, health attributes and claims.
    Morris says the joint partnership will allow Catalina to “enhance our dataset and further increase our ability to target shoppers who are currently buying - or have shown intent to buy - in these emerging categories,” including gluten-free, allergen-free, and other free-from foods.
    The deal will likely make for easier, more precise targeting of goods to consumers, and thus provide benefits for manufacturers and retailers looking to better serve their retail food customers, especially in specialty areas like gluten-free and allergen-free foods.
    Source:
    fdfworld.com

    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