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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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    WHO MAKES THE BEST GLUTEN-FREE SANDWICH BREAD?


    Jefferson Adams


    • There are many companies who make gluten-free sandwich bread, but which one is the best?


    Celiac.com 01/02/2018 - Sandwich lovers can get mighty particular about which breads make the best sandwich. There's plenty of room for opinion, and personal taste can include opinions on toasting versus non-toasting, seeded versus non-seeded, white versus whole grain, and on and on.


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    That means that this list of gluten-free sandwich breads is not meant to be authoritative. It is not written in stone. In fact, it is subject to revision based on input and suggestions by our readers.

    That said, these are some of the stand-out gluten-free sandwich breads that we have tried.

    Bread Srsly
    Bread Srsly uses long fermentation of organic millet, sorghum and arrowroot with a wild sourdough culture to deliver a tasty gluten-free classic with a delightful sourdough tang.

    Okay, it's not pre-sliced, so technically it may not quality as sandwich bread, but I'm such a fan of Bread Srsly. Toast this bread up and it makes a lovely base for a sandwich. The tangy sourdough is perfect for ham, or tuna salad, or just a bout anything else you want on your sandwich. Breadsrsly.com

    Canyon Bakehouse
    Canyon Bakehouse makes a wide variety of gluten-free bread products. Canyon's gluten-free breads can also be stored at room temperature without becoming crumbly, making them perfect for sandwiches. Canyon. Breads are also excellent for grilled sandwiches. Certified gluten-free, Dairy Free, Soy Free, Nut Free, Non GMO. Canyonglutenfree.com

    Franz
    Seattle favorite Franz bakery makes a respectable sandwich bread.
    Franz makes gluten-free bread with a nice, chewy consistency that doesn't crumble, so you can make a sandwich with or without toasting. Great for lunches! Franzbakery.com

    Glutino 
    Glutino gluten-free breads come in four styles: Cinnamon Raisin; Multigrain; Seeded and White. Glutino breads are light enough to eat right out of the bag. They also come in a nice, full size slices so you can make a proper sandwich. Glutino.com

    Rudi's
    Once found only in the frozen section, Rudi's now makes a soft, fluffy sliced bread that can be eaten right out of the bag.
    Rudi's keeps it simple with just two varieties of gluten-free fresh sliced bread, Original and Multigrain. Both are perfect for sandwiches as is, but toast up nicely. RudisBakery.com

    Schär
    Schär uses top quality rice, corn or buckwheat, along with sorghum, a traditional African grain, or quinoa, to make its long-fermented gluten-free sourdough sliced loaves and baguettes.

    Sourdough enzymes help the bread to stay fresh longer after baking, enrich the bread with vitamins, and eliminates the need for artificial preservatives. Schaer.com

    Trader Joe's
    Yes, Trader Joe's offers a gluten-free bread. Trader Joe's Gluten Free Whole Grain Bread is dairy, soy, nut, and gluten-free. It's made with brown rice flour, teff (a grass cultivated for grain), whole grain amaranth, whole grain sorghum (also in the grass family, and cultivated for grain), tapioca, potato, and flaxseed meal.

    According to Trader Joe's website, their Gluten Free Whole Grain Bread is “lower in fat, with fewer calories than its big-brand counterpart.” Traderjoes.com

    Three Bakers
    Three Bakers gluten-free sliced sandwich bread comes in four varieties: White Bread Whole Grain; 7 Ancient Grain Whole Grain Bread; Rye Style Whole Grain Bread; and MAXOMEGA™ Whole Grain AND 5 Seed Bread. Threebakers.com

    Udi's Gluten-Free White
    Light, airy and fiber-rich, Udi's popular sandwich loaf bread is made with all natural ingredients without added fillers. Udisglutenfree.com


    Image Caption: Photo: CC--Johanna Alderson
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    Guest Ruslan

    Posted

    Bread Srsly uses long fermentation of organic millet, check following study: ´Antithyroid and goitrogenic effects of millet: role of C-glycosylflavones´. I would prefer to stay away from that Trader Joe's... flaxseed meal. Google ´flaxseed testosterone study´. And you'll see how it plays with hormones. Especially - testosterone. I would avoid that. Sadly the article is not helpful at all.

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    Guest Rosalyn

    Posted

    I find Udi's to be overpriced and full of holes. Tastes better if toasted. Udi's frozen bagles don't slice evenly, and , of course, have to be defrosted before being sliced and toasted. Some of the breads recommended are not universally distributed. I would not recommend Udi's.

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    Guest Marci

    Posted

    I don't like Udi's at all, although it seems that they have a great sales rep in the Dallas area because most of the frozen gluten-free bread space is taken up with it. I particularly like Canyon Bakehouse, especially the Heritage style which has larger slices. The whole grain version, however, has flax seed which I am allergic to. The honey white does not. I also like Three Bakers, but it is rather pricey and slices are small. I have never seen Srsly here.

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    Guest Lara

    Posted

    Breads baked from boxed flour by breadsfromanna.com are always overlooked when rating gluten free bread. Anna offers several varieties, which can be baked in the oven or in a gluten-free bread machine. The first time I tasted it at her facility, it was a sandwich using fresh out-of-the- machine herb bread.

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    Guest Kiya

    Posted

    For creating a proper hoagie (Philadelphia for Italian submarine sandwich), I have tried all of the brands available in this region. The only gluten-free roll I have found that does not fall apart, leaving me with a bread salad, is the Schar baguette. They simulate a "real" Italian bread roll, and maintains shape. Better yet, the packaging allows it to be kept for months, and refreshed as needed by putting in the oven for a few minutes (not necessary).

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    Guest jwoolman

    Posted

    I really like Happy Camper. They're small slices but sturdy, sort of a gluten-free version of Dave's Killer Bread. And no egg, which is an allergen for me. BFree products are good also.

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    Guest JaredM

    Posted

    I agree that Udi's often has annoying holes in it. However, I like the texture of the bread. In my experience, it holds up well with a light toasting when making a "dagwood" type sandwich. The flavor isn't outstanding, but also not objectionable. It's better than any white bread I used to eat. The other advantage of Udi's is that if you buy it from Costco, you can get the larger loaves. They are as wide as Oroweat and provide lots of slices. Most other gluten-free breads come in tiny loaves that are impractical for sandwiches. I don't want a sandwich that only lasts for three bites!

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    Guest Michael Mann

    Posted

    I find Schar's breads to be somewhat pasty, the way rice/tapioca breads are. And while I really like the offerings from Udi's (a lot of variety) they have for years suffered from huge gas bubbles in the loaf, which make it look like mice have eaten out sections ranging from marble to golf ball plus size. Which can mean four or six slices are only useful as "halves". It is wonderful that there is so much variety in pre-made gluten-free bread these days, at all.

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    Guest Jefferson

    Posted

    Breads baked from boxed flour by breadsfromanna.com are always overlooked when rating gluten free bread. Anna offers several varieties, which can be baked in the oven or in a gluten-free bread machine. The first time I tasted it at her facility, it was a sandwich using fresh out-of-the- machine herb bread.

    Thanks for the tip!

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    Guest Jefferson

    Posted

    Bread Srsly uses long fermentation of organic millet, check following study: ´Antithyroid and goitrogenic effects of millet: role of C-glycosylflavones´. I would prefer to stay away from that Trader Joe's... flaxseed meal. Google ´flaxseed testosterone study´. And you'll see how it plays with hormones. Especially - testosterone. I would avoid that. Sadly the article is not helpful at all.

    Re: Millet--The study you site is a study about evidence that millet may play a role in the genesis of endemic goiter in areas where the population consumes low or absent rate of iodine. The study is about third-world areas and dietary problems resulting from low iodine. That scenario is simply unlikely to occur in the Untied States or any other developed country. Basically, it is not applicable to Americans.

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    Guest Jefferson

    Posted

    Bread Srsly uses long fermentation of organic millet, check following study: ´Antithyroid and goitrogenic effects of millet: role of C-glycosylflavones´. I would prefer to stay away from that Trader Joe's... flaxseed meal. Google ´flaxseed testosterone study´. And you'll see how it plays with hormones. Especially - testosterone. I would avoid that. Sadly the article is not helpful at all.

    Regarding your comment to "Google flaxseed testosterone study." I'm afraid your scientific literacy needs some work. The main study that comes up is a case study--that means a single person. That study describes the impact of flaxseed supplementation (30 g/day) on hormonal levels in a 31-year old woman with PCOS. So, basically a single individual was eating up to an ounce of flaxseed per day, and experienced issues. Issues that may or may not be due to the flax consumption. A simple dietary levels, there is basically ZERO chance that flax will cause any issues, hormonal or otherwise. Flax and millet are both safe at basic dietary levels.

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    Guest Jefferson

    Posted

    Bread Srsly uses long fermentation of organic millet, check following study: ´Antithyroid and goitrogenic effects of millet: role of C-glycosylflavones´. I would prefer to stay away from that Trader Joe's... flaxseed meal. Google ´flaxseed testosterone study´. And you'll see how it plays with hormones. Especially - testosterone. I would avoid that. Sadly the article is not helpful at all.

    Lastly, the patient cited in the flaxseed study was a women, not a man. Even if flaxseed were the cause, it is unlikely to impact men in the same way. At the end of the day, that single case study tells us nothing about the dietary safety of flax seed.

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    Jefferson Adams
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    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