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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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    PUNJABI AMERICANS HAVE HIGHEST CELIAC DISEASE RATES


    Jefferson Adams

    Celiac.com 06/03/2016 - Among patients diagnosed with celiac disease by small intestinal biopsy in the U.S., people from the Punjab region of India have the highest rates of disease, according to new research published in Clinical Gastroenterology and Hepatology.


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    In an effort to better understand celiac disease distribution in Americans of various ethnicities, a team of researchers led by Benjamin Lebwohl, MD, Herbert Irving Assistant Professor of Medicine and Epidemiology at the Celiac Disease Center at Columbia University Medical Center in New York, recently looked at more than 400,000 intestinal biopsies from a nationwide database. The team identified patients with celiac disease based on the presence of villous atrophy in the small intestine.

    The researchers used a previously published algorithm based on patient names to identify celiac disease distribution among North Indian, South Indian, East Asian, Hispanic, Middle Eastern, Jewish and other Americans.

    The team's data shows that celiac disease is much less common among U.S. residents of South Indian, East Asian and Hispanic ancestry, while celiac disease rates among patients of Jewish and Middle Eastern ethnicities was similar to that of the general American population.

    Earlier studies have suggested that celiac disease might be more common in women, but these findings show that men and women have similar rates of celiac disease when tested, regardless of ethnicity.

    These findings show that, contrary to the previous medical thinking that celiac is a disease predominantly affecting Caucasian Europeans, the condition is better understood as "one of the most common hereditary disorders worldwide," noted Dr. Lebwohl.

    Source:


    Image Caption: Man demonstrates Bhangra, a traditional dance from the Punjab region of India. Photo: CC--Timothy J.
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  • Related Articles

    Destiny Stone
    Celiac.com 07/01/2010 - Celiac disease is a genetic auto-immune disease which, until now,  has primarily been considered a Western epidemic. However, we are seeing a rise of celiac disease  in  Middle Eastern and North African countries.
    Celiac disease prevalence is grossly underestimated by the medical profession and as such, there is very little data available regarding malignant complications resulting from undiagnosed celiac.
    Once considered a Western epidemic, celiac is now acknowledged as a common disease among North African and Middle Eastern populations. A research team at the Division of Gastroenterology, department of Internal Medicine, American University of Beirut Medical Center, formally assess why celiac disease is rising in North Africa and the Middle East. The researchers use the electronic databases pubMed and Medline from 1950 through 2008 for the search engine, and “celiac disease” was used for a Mesh term. For this study, the perimeters of the search for celiac prevalence was limited to the Middle East and North African countries only.
    Celiac disease is demonstrated to be prevalent in first and second degree relatives of patients with celiac. In the US the prevalence is shown to be between 4% and 12% as assessed by biopsy. Studies in Algeria and Turkey showed a prevalence of 1.7% respectively among first degree relatives. Of the 381 first degree relatives that  were tested, 26 had positive serology,  and villous atrophy was found in 13 of the 16 patients that had biopsy's performed.  Celiac disease clusters among families were also present in Jordan and Algeria. It is noted that the high rate of consanguinity in Middle Eastern and North African countries may be responsible for generating a greater prevalence of celiac. However, further studies on this subject are needed .
    Clinical variations in presentation of celiac disease were also studied by the researchers. There are many variations when it comes to the results for clinical variations. It is suggested that the reason for the variations may be due to  the small number of patients studied, or delay in their presentation of symptoms.  Gastrointestinal discomfort is the  most common symptom of celiac disease, including diarrhea, constipation, bloating, flatulence, nausea and vomiting. Studies performed in Middle Eastern and North African countries had a celiac prevalence of 6.5%-21%. Patients with celiac disease in Iran, Lebanon, Iraq, Saudi Arabia and Kuwait had diarrhea as the most common symptom of celiac. 4.7% of Egyptian children exhibiting  diarrhea and failure to thrive, had celiac disease.
    Approximately one third of children with celiac in Western countries exhibit short stature. The highest prevalence of short stature is found in Jordan, where 26% of children with celiac disease also had rickets. In Turkey, 51% of patients with celiac had a height well below the standard mean. In the United States, 36% of Americans with celiac were previously diagnosed with irritable bowl syndrome (IBS) and in Iran 12% of those labeled with IBS were later diagnosed with celiac disease.
    Iron deficiency anemia (IDA) is the most common form of anemia, and is often sited as the only way to diagnose sub-clinical celiac disease in patients.  Worldwide, the prevalence of celiac among patients with IDA is 2.8% to 8.7%,  and possibly as high as 15%. In North Africa and the Middle East, anemia is found in 20%-80% of celiac patients. In Egypt, 4% of insulin dependent diabetes mellitus (IDDM) patients with anemia had celiac disease. In Saudi Arabia, the osteomalacia and IDA account for 43.5%  of celiac patients. The high prevalence of osteoporosis may be attributed to delays in celiac diagnosis.
    Approximately 30% of celiac patients have other autoimmune diseases like IDDM and autoimmune thyroiditis. IDDM has very high rates among those with celiac disease with rates from 6.7% to 18.5%.  The rates for autoimmune diseases are are a low 1.9% in Turkey, and a high 33% in Iran. Many of those patients were discovered to also have celiac disease after long delays.
    Whether or not prevalence of celiac is rising in Middle Eastern and North African countries is not clear, and more studies are required. More studies are also needed to determine the connections between celiac and other diseases. Reason's sited for the lack of data regarding celiac in Middle Eastern and North African countries,  are the inconsistencies with screening methods from different populations and socioeconomic back grounds,  the efficacy of treatment modalities employed, patient compliance, disease complications and response to treatments.
    Source:

    World J Gastroenterol. 2010 March 28; 16(12): 1449-1457.

    Jefferson Adams
    Celiac.com 05/06/2011 - Recent epidemiological studies show that the prevalence of Celiac disease had been underestimated, affecting not only Europeans, but also populations of the Mediterranean countries, such as Middle East (1-4) and North Africa (5-7), where its prevalence is similar to that of Western countries.
    A international team of researchers recently set out to estimate the global burden related to undiagnosed Celiac Disease in the Mediterranean Area, as computed by morbidity, mortality and crude health cost.
    The team included Luigi Greco, Laura Timpone, Carmela Arcidiaco, Abkari Abdelhak, Attard Thomas, Barada Kassem, Bilbao Josè Ramon, Boudraa Ghazalia, Cullufi Paskal, Hugot Jean Pierre, Abu-Zekry Mona, Kuloglu Zarife, Roma Eleftheria, Shamir Raanan, Ter Terzic Selma, and Zrinjka MiÅ¡ak.
    Prevalence of celiac disease among low risk populations varies from 0.14% to 1.17% (15-17): 1%-1.3% in Turkey (18.19), 0.6%-0.96% in Iran (20-21), 0.5% in Egypt (22), 0.6% in Tunisia and Israel (23-24), <0.5% in Jordan, Lebanon, and Kuwait (1.10,16.25). Among high risk groups (patients with positive family history, insulin dependent diabetes mellitus, thyroiditis, etc.) the prevalence of celiac disease ranges from 2.4% to 44% assessed by serological markers and biopsy (26-27).
    The team discovered a celiac disease prevalence of 1%, an incidence, based on new Cases/year estimated on 1% of the live births of 1 in 7 symptomatic adults, and 1 in 5 children. Their results showed standardized mortality rate of 1.8 compared to age and sex matched population.
    They found that the delay between symptoms and diagnosis was six years for adults, and two years for children.
    The team found associated conditions in 10% of the total cohort (KB 30%: Turkey 2% Iran 33% , IDDM 10% (6.7-18.5%).
    Sixteen percent of symptomatic patients showed celiac disease-related complications.
    The team found the following non GI Symptoms among symptomatic patients: short stature 25% Anemia 40% (20-80%) Osteopenia 30% (30-50%), abnormal liver function 10% (Turkey 38%, Iran 25%).
    In the Northern Africa Region and in the Middle East very high incidence of celiac disease has recently been reported both in the general population and in at risk-group. These high frequencies are due to the wide consumption of wheat and barley and to the high frequency of the DR3-DQ2 celiac disease predisposing haplotypes in these population (13,14).
    Source:

    http://www.medicel.unina.it/00_materiali/materiali_evento_napoli/the_burden.pdf

    Gryphon Myers
    Celiac.com 09/04/2012 - North India has what has come to be referred to as a “celiac belt”, where a greater than average number of people exhibit symptoms of celiac disease. This is partially because more wheat is consumed in this region, but also because the population possesses haplotypes necessary for celiac disease to develop. For this reason, it would make sense that emigrants from the area would also be prone to celiac disease. A study centered in Debyshire, UK investigates celiac disease as it manifests in the North Indian, Pakistani and Bangladeshi immigrant populations.
    All celiac disease patients (both Asian and white) who were diagnosed via biopsy in Derbyshire, UK between 1958 and 2008 were identified. Population data from the Office of National Statistics was used to calculate prevalence. Presenting symptoms, adherence to a gluten-free diet and follow up record were also assessed. Asian patients were compared against matched white patients.
    1305 eligible celiac disease patients were identified, 82 of whom were Asian. The prevalence of celiac disease in Asians was considerably higher than in white groups. In the white population, celiac rates were 1:356, whereas in the Asian population they were 1:193. Particularly high celiac rates were seen in Asian women between 16 and 60 years of age: 1:116. No cases of celiac disease were reported in Asian men over 65 years of age.
    A previous study from Leicester has already demonstrated some propensity for Asian populations to develop celiac disease. It is thought that diet plays some role in this tendency.
    One of the most significant findings of the present study is that no Asian man over the age of 65 was diagnosed with celiac disease. It is possible that celiac disease rarely manifests in this group, but is more likely that cultural or other factors lead to a lack of reporting, preventing diagnosis.
    Another finding of the study shows that Asians with celiac disease are more likely to be anemic. This tells us that celiac disease should be considered as a diagnosis for unexplained anemia in Asian patients.
    The study also found that Asians with celiac disease are less likely to adhere to a gluten-free diet. Roughly one third of Asian patients successfully adhered to the diet, whereas nearly two thirds of white patients did. This could be a language issue (an inability to detect gluten-containing foods), or because of family pressure to comply with cultural norms, or because of difficulty adapting cuisine to be gluten-free. In any case, there should be more discussion with Asian immigrant populations to determine the best way to improve gluten-free diet adherence rates.
    Source:
    http://fg.bmj.com/content/early/2012/08/10/flgastro-2012-100200.abstract  

    Jefferson Adams
    Celiac.com 09/18/2013 - New tests and new histological criteria for diagnosing celiac disease, along with changing perspectives on the disease's natural history are causing a number of researchers to question past prevalence estimates for celiac disease.
    A team of researchers recently set out to establish a more accurate estimate of celiac disease rates by using a new serogenetic method.
    The research team included Robert P Anderson, Margaret J Henry, Roberta Taylor, Emma L Duncan, Patrick Danoy, Marylia J Costa, Kathryn Addison, Jason A Tye-Din, Mark A Kotowicz, Ross E Knight, Wendy Pollock, Geoffrey C Nicholson, Ban-Hock Toh, Matthew A Brown and Julie A Pasco.
    They are variously affiliated with the Walter and Eliza Hall Institute of Medical Research, the Department of Medical Biology at the University of Melbourne, the Department of Gastroenterology at The Royal Melbourne Hospital, Melbourne Health in Parkville, Australia, ImmusanT Inc., One Kendall Square, Building 200, LL, Suite 4, Cambridge, MA, USA, the School of Medicine at Deakin University in Geelong, Australia, Healthscope Pathology in Melbourne, Australia, the Human Genetics Group at the University of Queensland Diamantina Institute, Level 5, Translational Research Institute in Woolloongabba, Australia, Endocrinology at Royal Brisbane and Women’s Hospital, Herston, Australia, the NorthWest Academic Centre of the Department of Medicine at The University of Melbourne in St Albans, Australia, Geelong Gastroenterology, Level 1, in Geelong, Australia, the Rural Clinical School at the School of Medicine of The University of Queensland in Toowoomba, Australia, and Roche Diagnostics Australia, in Castle Hill, Australia.
    The researchers assessed human leukocyte antigen (HLA)-DQ genotype in 356 patients with biopsy-confirmed celiac disease.
    They did the same for two age-stratified, randomly selected community groups of 1,390 women and 1,158 men, who served as controls. They tested and screened all patients for celiac-specific serology.
    They found that only five patients with biopsy-confirmed celiac disease lacked the susceptibility alleles HLA-DQ2.5, DQ8, or DQ2.2, and four of these patients had been misdiagnosed. HLA-DQ2.5, DQ8, or DQ2.2 was present in 56% of all women and men in the community cohorts.
    Transglutaminase (TG)-2 IgA levels were abnormal in 4.6% of the community women, and in 6.9% of the community men. Composite TG2/deamidated gliadin peptide (DGP) IgA/IgG were abnormal in 5.6% of the community women and in 6.9% of the community men.
    But in the screen-positive group, only 71% of women and of women and 65% of men possessed HLA-DQ2.5, DQ8, while 75% of women and 63% of men possessed DQ2.2.
    Medical review was possible in 41% of seropositive women and 50% of seropositive men, and led to biopsy-confirmed celiac disease in 10 women (0.7%) and 6 men (0.5%). Based on relative risk for HLA-DQ2.5, DQ8, or DQ2.2, celiac disease affected 1.3% of men and women with positive TG2 IgA screens, and 1.9% of women and 1.2% of men with positive TG2/DGP IgA/IgG screens
    Serogenetic data from these community cohorts indicated that testing screen positives for HLA-DQ, or carrying out HLA-DQ and further serology, could have reduced unnecessary gastroscopies due to false-positive serology by at least 40% and by over 70%, respectively.
    Requiring biopsy confirmation based on TG2 IgA serology leads to substantial underestimations of the community prevalence of celiac disease.
    Testing for HLA-DQ genes and affirmative blood results could reduce the numbers of unnecessary gastroscopies.

    Source:
     BMC Medicine 2013, 11:188. doi:10.1186/1741-7015-11-188

  • 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