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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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    U.S DEPARTMENT OF JUSTICE SAYS CELIAC DISEASE NOT A DISABILITY IN ALL CASES


    Jefferson Adams

    Celiac.com 01/11/2016 - Is celiac disease a disability under the federal Americans with Disabilities Act? The Department of Justice says not necessarily.


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    Photo: CC--DonkeyhoteyOn the heels of a federal lawsuit that claiming that restaurants are violating federal disability laws by charging more for gluten-free food than for non-gluten-free counter parts, a Department of Justice spokesperson has stated that a 2012 civil rights settlement on behalf of Lesley University students with celiac disease does not make the condition a disability in all cases.

    DOJ public affairs specialist, Patrick Rodenbush, said settlement at Leslie University did not set a legal precedent, because the "…settlement enforces the rights of students whose food allergies were disabilities, [but] it doesn't necessarily make celiac disease a disability in all cases."

    This is relevant to a case in California, where federal judge recently denied a motion to dismiss a class action lawsuit alleging P.F. Chang's violates the Americans with Disabilities Act because it charges more for gluten-free items.

    In the P.F. Chang's case, Judge Ronald Whyte denied P.F. Chang's motion to dismiss because, he wrote, that, although the court had not found specific information proving that celiac disease constituted a disability under the ADA, the "plaintiff has pled sufficient facts to support her claim that she has a disability that impacts a major life activity."

    Whyte noted "on a more complete factual record, the court might reach a different conclusion." He also stated that it may be difficult, or impossible for Phillips to prove her claims.

    "The ultimate question is whether P.F. Chang's, in providing gluten-free meals, is providing different products or whether the price differential with regular meals is a pretext for discrimination against those with celiac disease," Whyte wrote.

    At stake is whether or not food vendors, such as P.F. Chang's can charge higher prices for gluten-free foods than they do for non-gluten-free items.

    The results of this case are being watched closely by celiacs and by restaurant companies, because a ruling that establishes that people with celiac disease are covered under the federal Americans with Disabilities Act could conceivably have a serious impact on how the restaurant industry approaches gluten-free food.

    Stay tuned for new developments.

    Source:


    Image Caption: When is celiac disease a disability under the ADA? Photo: CC--Donkeyhotey
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    I just want restaurants to serve me. Once I mention I have Celiac Disease, I have been denied food at many restaurants including big chains like Cracker Barrel, Olive Garden, and Hard Rock. "Love all; Serve all"...apparently not....

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    I just want restaurants to serve me. Once I mention I have Celiac Disease, I have been denied food at many restaurants including big chains like Cracker Barrel, Olive Garden, and Hard Rock. "Love all; Serve all"...apparently not....

    I agree -willing to pay a little extra if that is what it takes to be served fairly. Consider how much more we pay for e.g. gluten-free pasta in the grocery store.

    Personally, while I understand the frustrations that led to this lawsuit, I am concerned about the potential consequences if we 'win.'

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    This lawsuit is ridiculous and a waste of time and money. I have had celiac for so long that if I found one loaf of gluten free bread and plain rice flour I was lucky-let alone trying to eat in a restaurant. Is she going of sue grocery stores because most gluten-free products cost more than their non-gluten-free counterparts? Don't speak for me in this craziness - I will gladly pay a few extra dollars to get a gluten free meal and be happy to do it.

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    Charging more is not my issue. Making sure the food is prepared safely and not cross-contaminated is!!

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    I'm just thankful that ANY restaurants are willing to tackle offering safe gluten free food. Many of us remember not too very long ago when NO restaurants offered gluten free items and NO restaurant staff knew what you were talking about. It's important for those of us with Celiac/gluten intolerance/gluten sensitivity to remember that no restaurant MUST keep gluten free food on their menu. We must be gracious while still working to make sure that restaurants understand how to offer safe gluten free options. When we become indignant and too demanding about it, more restaurants are just as likely to abandon catering to people with dietary "needs". Remember that businesses like restaurants are manned by people earning a living and that they are not some human-free entity that owes us what we personally deem to be important. There are so many different food allergies and intolerances out there. GFer's do best not to expect entitlement, but instead let establishments know that we appreciate when they make a choice to cater to the gluten free crowd. Eating out is a privilege, not a right. If it costs more than I want to pay, I can make the choice not to go to that particular restaurant...simple.

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    If people like this woman continue stupid lawsuits, we will go back to no gluten free items on a menu. I am THRILLED how far restaurants have come. Please don't blow this for us!

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    I have celiac disease and I don't think it's a disability. I consider it more of an inconvenience. I am very willing to pay more for a gluten free meal at a restaurant if that ensures I get a meal that isn't contaminated. (And I think PF Changes does gluten free very well - never had any issues.) Eating out isn't a necessity; I (and the plaintiff in this case) can always buy food at the grocery and eat at home. I am afraid that if the court rules in this moron's favor it may signal the end of gluten free meals at restaurants for everyone.

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    Guest G. Harrison

    Posted

    I agree with the other comments regarding these lawsuits. It is mind boggling to a Canadian that someone would waste the court's time with this kind of lawsuit. What is the anticipated outcome? If gluten free food costs more to buy, it will cost more to make a meal at home OR at a restaurant. Force the restaurant to charge the same price, and you're going to get substandard quality ingredients in your gluten free meal.

     

    I've seen prices come down since I was diagnosed, but that was from the increase in people looking for gluten free options. Increased demand = increased supply and more competition. If this lady had waited, it is likely that many restaurants would choose on their own to charge less if they knew they could increase their customers. But now, they are likely to view all celiacs as trouble.

     

     

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    I just want restaurants to serve me. Once I mention I have Celiac Disease, I have been denied food at many restaurants including big chains like Cracker Barrel, Olive Garden, and Hard Rock. "Love all; Serve all"...apparently not....

    I'd be concerned that if restaurants are forced to charge the same price for gluten-free food as they do for non-gluten-free, they might stop serving gluten-free food. I have celiac and I'm sensitive to the fact that it's a form of discrimination to charge more; however, I also realize that it's more effort on the restaurant side, in terms of taking extra precautions against contamination, and gluten-free products (such as gluten-free bread or pasta) may cost them more. I'm happy to pay a little more to ensure that the kitchen is being careful with my meal. I don't feel like I have a disability; people with severe anaphylactic-type allergies are in the same situation as those with celiac. I appreciate when the restaurant management comes over to me to ensure me that my food was prepared with the utmost care--that's worth paying extra for, to ensure I won't get sick!

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    If people like this woman continue stupid lawsuits, we will go back to no gluten free items on a menu. I am THRILLED how far restaurants have come. Please don't blow this for us!

    I couldn't agree more! I've had celiac disease since 1989 and lawsuits will only put us back to that time when nothing was labeled gluten-free or offered as such in restaurants. Many restaurants don't have the space or extra equipment to be sure they are offering us gluten-free.

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    I just want restaurants to serve me. Once I mention I have Celiac Disease, I have been denied food at many restaurants including big chains like Cracker Barrel, Olive Garden, and Hard Rock. "Love all; Serve all"...apparently not....

    I had no problem with the Olive Garden in Reno, Nevada. They had a gluten-free menu when I went there with my sister's family in 2014.

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    Guest L Stevens

    Posted

    There's a bigger issue here: namely whether restaurants will refuse to carry gluten-free food at all.

     

    Our country (US) gives huge subsidies to Wheat and Corn industries. As a result, it's been cheaper to use wheat as a filler than other potential grains (like rice). If rice costs more because of the our historically-predominant use of wheat then why wouldn't a restaurant or supplier be free to charge more? But, more importantly, why would we, as celiacs, want to discourage restaurants from carrying alternatives for us because we insist they eat the profit loss? Sure I'd like things to change so that wheat isn't the most cost-effective filer to use. But given that isn't the case now, do we really want to lose any options at restaurants?

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    I have a extreme sensitivity myself, to the point of it being disabling for a few days from crumbs/residue. Restaurants have been a no go for years, aside from this one sushi place where I know the chef. Most of the time I just bring my own foods in mention I have celiac disease and a corn allergy, then order a beverage. Only do this when I am meeting with others or want to feel "Normal" and eat out. Eating out is a option, if you do not like, trust, or find where you are going to be overly expensive, but must eat out. Bring your own food and order whats safe with no price difference like steamed broccoli and a drink.

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    I have mixed feeling about this whole thing. The restaurants are charging more for the product at the get go, because it costs more for. They also have doors widened for wheel chairs, push buttons for easy access, wider isles, larger restrooms, and they build ramps for people to make it possible to get to and fro.

     

    So why not accommodate celiacs? Is or isn't it a disability? Why are we comparing disabilities? Where do we draw the line? The overall cost of accommodations is distributed all over. Making it possible for everyone to eat out is what this person is trying to change. Having any disability is going to cost more, but who should pay?

     

    If you are on disability, and require a wheel chair, who pays for that, and how about the big van that holds the wheel chair, and all the meds one needs to take?

     

    It is hard to be sick; we all know that. it is hard and expensive to live with this disease/disability. They first have to establish whether it is a disability or not.

     

    I have more questions then answers. I sure would love to be a fly on the wall in this case.

     

    Thanks for the update Jefferson, I look forward to reading more as it comes to fruition.

     

    BTW, for the folks doing some name calling, it is just uncalled for. The person filing this lawsuit might be saving your ass. Rosa Parks was called a few names too, but look what she did! I hope this wins, really.

     

    She and I, and anyone who thinks differently, are not, "morons" or "stupid". This person who filed is brave and courageous. Imagine for a second how hard it had to have been for this young college student. We could stand beside her and support her; it could help everyone with disabilities.

     

    Change is hard, it is scary, but I am glad she is standing up for what she believes in!

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    I have celiac disease and still don't trust "gluten free" menus at restaurants. I absolutely expect to pay more for a truly gluten free option. It is an expensive endeavor to serve gluten free at home with separate utensils, toasters, etc. Can you imagine the nightmare for one restaurant?

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    A lot of food for thought on both sides. It is frustrating to pay a lot more for gluten-free products, however, with the gluten-free food items purchased at the grocery store, these can be claimed on your taxes at the end of the year. I have celiac disease, and, yes it's hard to go out to eat, however, it could be a whole lot worse.

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    I would like receive information to help me to know what to eat.

    Alice, a Registered Dietitian is an excellent source of nutrition information. An RD will instruct you in the gluten free diet choices. A gluten free diet individualized and tailored for you, will ensure you meet the missing nutrients from eliminating gluten from your diet.

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    I just want restaurants to serve me. Once I mention I have Celiac Disease, I have been denied food at many restaurants including big chains like Cracker Barrel, Olive Garden, and Hard Rock. "Love all; Serve all"...apparently not....

    I have eaten at Olive Garden and told them I have celiac and have never been denied. They have told me and it is written on their gluten-free menu that there are shared facilities and they cannot guarantee me that it will be completely gluten-free. It is up to me to decide if I want too eat there. They have been very accommodating every time and I will return.

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    We are paying more and still getting cross-contaminated. When you pay more at a restaurant, who is getting the money? Not the kitchen staff. Not the wait staff. You pay more for gluten-free items because that is what they charge, but you have no idea what they paid. If a bag of flour costs $5 extra, and it makes 20 dishes, that "little bit extra" you're paying just netted that corporation 150% profit. I wonder if you would find it reasonable if the restaurant charged $1 extra to sit at a handicap-accessible table, or use the wheelchair ramp? I eat at several local restaurants that provide gluten-free at no extra cost. If a small business can afford to provide gluten-free food, why is a corporate-owned business charging so much?

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    I have mixed feeling about this whole thing. The restaurants are charging more for the product at the get go, because it costs more for. They also have doors widened for wheel chairs, push buttons for easy access, wider isles, larger restrooms, and they build ramps for people to make it possible to get to and fro.

     

    So why not accommodate celiacs? Is or isn't it a disability? Why are we comparing disabilities? Where do we draw the line? The overall cost of accommodations is distributed all over. Making it possible for everyone to eat out is what this person is trying to change. Having any disability is going to cost more, but who should pay?

     

    If you are on disability, and require a wheel chair, who pays for that, and how about the big van that holds the wheel chair, and all the meds one needs to take?

     

    It is hard to be sick; we all know that. it is hard and expensive to live with this disease/disability. They first have to establish whether it is a disability or not.

     

    I have more questions then answers. I sure would love to be a fly on the wall in this case.

     

    Thanks for the update Jefferson, I look forward to reading more as it comes to fruition.

     

    BTW, for the folks doing some name calling, it is just uncalled for. The person filing this lawsuit might be saving your ass. Rosa Parks was called a few names too, but look what she did! I hope this wins, really.

     

    She and I, and anyone who thinks differently, are not, "morons" or "stupid". This person who filed is brave and courageous. Imagine for a second how hard it had to have been for this young college student. We could stand beside her and support her; it could help everyone with disabilities.

     

    Change is hard, it is scary, but I am glad she is standing up for what she believes in!

    Please remember the American with Disabilities Act requires only a reasonable accommodations. If you're an electrician and require a wheelchair is the person's employer going to purchase a lift so the person can reach any elevated lines? The answer is no. Pippy if a person is on disability and requires a wheelchair and van the answer to the question is if you're lucky & have excellent medical insurance they may pay for an electric wheelchair, but under no circumstances will they ever pay for a van or even a small trailer to place the wheelchair on for travel. All the meds a person must take are either paid for by your insurance company with you paying your copay, or you beg the manufacturer of available medications to see if they'll give them to you for free. To obtain assistance you must then jump through every hoop they create& many doctors don't want to deal with all the paperwork so they refuse to assist. That leaves one the option of doing without, or begging a Dr to prescribe a different medication.

    I believe the court is going to have to decide is it reasonable for the restaurant to absorb the extra cost of paying for the raw food product, staff education, any supplies needed to make sure no contamination to occur, etc. I think what is ultimately going to happen is the market will be flooded with gluten free raw products decreasing the overall raw product cost. The education and awareness whether accurate, or not has been provided by celebrities leaving the cost of enforcing keeping items separate so there's no cross contamination which for some items may cost specific equipment and I don't see the court stating it's reasonable for the restaurant to bear the cost of additional equipment. Thankfully a brilliant individual created reusable bags that can be used in a toaster, or toaster oven, but I don't see the court mandating purchasing commercial grills, etc.

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    I'd be concerned that if restaurants are forced to charge the same price for gluten-free food as they do for non-gluten-free, they might stop serving gluten-free food. I have celiac and I'm sensitive to the fact that it's a form of discrimination to charge more; however, I also realize that it's more effort on the restaurant side, in terms of taking extra precautions against contamination, and gluten-free products (such as gluten-free bread or pasta) may cost them more. I'm happy to pay a little more to ensure that the kitchen is being careful with my meal. I don't feel like I have a disability; people with severe anaphylactic-type allergies are in the same situation as those with celiac. I appreciate when the restaurant management comes over to me to ensure me that my food was prepared with the utmost care--that's worth paying extra for, to ensure I won't get sick!

    Except that, behind kitchen doors, they are not as careful as they would like to portray. Preparers, in many cases, just use the same work surfaces, pans, etc.

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    I couldn't agree more! I've had celiac disease since 1989 and lawsuits will only put us back to that time when nothing was labeled gluten-free or offered as such in restaurants. Many restaurants don't have the space or extra equipment to be sure they are offering us gluten-free.

    Then what safety to your health are they actually providing with their food? None. And if you end up sick, will you continue to go back there ??

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    Charging more is not my issue. Making sure the food is prepared safely and not cross-contaminated is!!

    Yep. And most just present themselves as doing that when they actually do not.

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    I have celiac disease and still don't trust "gluten free" menus at restaurants. I absolutely expect to pay more for a truly gluten free option. It is an expensive endeavor to serve gluten free at home with separate utensils, toasters, etc. Can you imagine the nightmare for one restaurant?

    This is true - however - if you have ever had the opportunity to look into a restaurant kitchen, you would find that most do nothing about "where" the gluten-free food is prepared. They may use a different product for your meal, but all else remains the same. Cross-contamination, in most cases, is just inevitable.

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    Due to personal health reasons and restrictions, I find that I need to retire. My husband and I can no longer travel the country speaking at conferences and to support groups (which we dearly loved to do) nor can I commit to writing more books, articles, or menus. Consequently, I will no longer be contributing articles to the Journal of Gluten Sensitivity. 
    My following books will still be available at Amazon.com:
    Gluten-free Cooking for Dummies Student's Vegetarian Cookbook for Dummies Wheat-free Gluten-free Dessert Cookbook Wheat-free Gluten-free Reduced Calorie Cookbook Wheat-free Gluten-free Cookbook for Kids and Busy Adults (revised version) My first book was published in 1996. My journey since then has been incredible. I have met so many in the celiac community and I feel blessed to be able to call you friends. Many of you have told me that I helped to change your life – let me assure you that your kind words, your phone calls, your thoughtful notes, and your feedback throughout the years have had a vital impact on my life, too. Thank you for all of your support through these years.

    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