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    A Word on Gluten and Beer


    Scott Adams

    Celiac.com 07/12/2004 - There have been numerous claims that traditional barley-based beers are gluten free or that all beers are gluten free. Unfortunately, the area is very grey and substantiated on technicalities. The purpose of this post is to eliminate the confusion about gluten as it relates to beer.


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    Gluten is an umbrella term used to describe a mixture of individual proteins found in many grains. Celiac disease (celiac sprue or gluten intolerance, gluten sensitivity) is an autoimmune disorder that is triggered by the ingestion of some of these glutens. People with classic celiac disease are intolerant to the gluten proteins found in wheat, barley, rye, spelt and a couple other lesser known grains. All these grains have a relative of the gluten protein. Interestingly, corn, rice and sorghum also have gluten proteins but are not toxic to celiacs. Herein lies one of the fundamental problems; the use of the term gluten intolerance to cover only certain gluten containing grains is confusing for consumers and food manufacturers alike. Unfortunately, it seems that the inertia for using celiac disease and gluten intolerance as synonyms is unstoppable. Therefore, it becomes the responsibility of both consumers and manufacturers to make sure the terms being discussed are defined and understood.

    As this relates to beer, there is a gluten protein found in barley. This protein is known as hordein. Wheat gluten is known as gliadin. Rye gluten is known as secalin. Presently, assay tests (or lab tests) are only commercially available for the testing of gliadin. We are unaware of any tests for hordein or any manufacturer that presently tests for hordein (Note: If you know of anyone that does in fact test specifically for hordein, please let us know). Therefore the idea that a barley based beer can be considered gluten free based upon the lack of testing is very difficult to fathom. It should be understood that a company using an assay test for gliadin to test for hordein will not return accurate results.

    There has been widespread speculation that the brewing process eliminates these hordein proteins making all beers gluten-free. Although commercial assay tests for hordein are not available there is conclusive evidence that the brewing process does not degrade hordein to non-toxic levels. A research study in Australia on improving beer haze shows that hordein is still present in beer after the brewing process (http://www.regional.org.au/au/abts/1999/sheehan.htm). Therefore, claims that hordein or gluten is destroyed in the brewing process is unsubstantiated and clearly, based upon the Australian research, is highly questionable.

    Based upon the continuous claims by beer companies that beers are gluten free, it is clear that the issue is misunderstood and, as always, it is up to the consumer to educate them on the facts. Hopefully, the information provided here will give consumers and manufacturers alike the ability to discuss these gluten issues intelligently and effectively.

    About the author: Kevin Seplowitz is the President and Co-founder of the Bards Tale Research Company, LLC and organization that researches the correlations between nutrition, diet, and autoimmune disorders. Bards Tale Research owns and operates Bards Tale Beer Company, LLC (www.bardsbeer.com) a company that develops commercial gluten-free beers. Mr. Seplowitz is a diagnosed Celiac.


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    Guest Rita Martino

    Posted

    Have found the Red Bridge beer from sorghum goes down good with gluten-free pizza!

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    Guest andy davis

    Posted

    As a man who this week is going on the wagon regarding all beers I have been looking for an excuse, any excuse, to legitimize my reasoning for drinking ales and as such

    therefore this article tells me that it is not wise...thanks.

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    Guest Valerie

    Posted

    I drank two beers a couple of weekends ago and was sick for a day and a half. I'm 100% certain I consumed nothing else with gluten, but for whatever reason it didn't occur to me that beer would be a problem. I so rarely drink at all that I guess I just didn't think about it. I will definitely think about it next time...that's the sickest I have ever been after a gluten misstep.

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    Valerie, it may have been the yeast in the beer not the gluten. Yeast can cause reactions that are similar to gluten

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    Guest Giusi

    Posted

    When I found out I was intolerant to gluten I also stopped drinking beer, which always gave me bloating, even if I was not a hard drinker (only one small bottle at night). So even if I haven't done an analysis I am sure that I am intolerant to beer, probably to yeast, if not barley.

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    So...you noted that gliadin was tested - it would be helpful if your article explained the results of the gliadin testing.

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    I tried the Hambleton Ales Gluten free real ale on the weekend. It claims to be gluten free and carries the official mark. However within half of the bottle drank I suffered allergic reactions. I usually drink cider and wine no problems. I suffered the same symptoms from this ale that I used to suffer prior to going gluten free.

     

    I read somewhere since that the regular gluten-free tests carried out for food/drinks are for wheat gluten and indeed ale contains malted barley. I understand that there is not a test developed yet to establish the presence of barley gluten. It would appear this is what may of triggered my reaction. Will we ever understand all this?

    In future if food shows ingredients of wheat barley or rye I will steer clear regardless of gluten-free claims.

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    Guest Yan Sever

    Posted

    So...you noted that gliadin was tested - it would be helpful if your article explained the results of the gliadin testing.

    Though I am a celiac, I do not have any immediate reaction to consuming gluten. I love beer, but I am not sure about its contribution to my health problems.

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    Guest k.byrne

    Posted

    I have Just started, I am trying to find my way, This very helpful.

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    I have a strong gluten allergy. When I used to eat pasta, noodles, flour dumplings, I would get a terrible reaction. 6 months gluten free, I feel like im 16 again!

     

    In the case of beer, I do not have any reactions. However, which darker beers or cloudier ales (which I do not drink anymore), I had reactions.

     

    I now only drink clear lagers (Becks, Kokanee, etc) and I have no problems so far.

     

    If anyone has any information regarding gluten in beer, or if they have a undeniable gluten reaction to drinking beer please let me know.

     

    As of now, I'm weening my self off beer and drinking wine.... but nothing beats wings and beer!

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    I too am starting my cassein free probably gluten free quest. Bud Light is my beer and so I called Bud and they said "yes" Bud Light is not gluten free because of the barley malt. Red Bridge was their suggestion.

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    Guest Manny

    Posted

    Valerie, it may have been the yeast in the beer not the gluten. Yeast can cause reactions that are similar to gluten

    Dan, most beers don't have any traces of yeast because beer is pasteurized/filtered before carbonation. It's another story if Valerie was drinking a bottle fermented ale.

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    Though I am a celiac, I do not have any immediate reaction to consuming gluten. I love beer, but I am not sure about its contribution to my health problems.

    Yan,

    I could have said the same thing two weeks ago before I landed in the hospital with diverticulitis and a fever of 103.5 F. Diverticula don't develop overnight. The problem with gluten is, IF you have an intolerance to gluten, you may be unknowingly damaging your intestinal track. I have known for years that I have gluten sensitivity and cheated from time to time (taking communion, eating half a slice of rye toast) with little more than upper gastrointestinal gas. But the night before my major distress I visited my home town and ate stromboli. Not one bite, or two, but the whole splendid, poisonous stromboli. I will never cheat again. Never never. Not beer, not malt, not communion wafer. And in my case, I think I'm sensitive to gluten-free oatmeal so no more McCann's.

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    Guest gguess

    Posted

    Home brewing gluten-free beer is a great solution. I also love beer and got back into home brewing just to make a gluten-free beer to my tastes. Be sure to see Homebrewtalk for great suggestions. Clarity Ferm can crack the gluten related proteins in barley-only beers, but there is debate as to its completeness for celiacs. One test with it seemed to solve the issue for me, but another test batch it did not.

     

    Browning a couple of grains at home is used to favor the beer since a straight sorghum-malt beer tastes a bit odd. A couple of standard beer drinkers like my brew, which of course I do as well. However, a chance to try a full barley beer is a real joy.

     

    BTW: Bard's beer is a decent gluten-free beer similar to some types of Adams beer. Both of which are too bitter for my tastes. Commercial craft beers seem to prefer bitter hops over aromatic hops. Home brewing solves this issue since I can dry hop the beer for great aroma and no bitterness.

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    Guest Anonymous User

    Posted

    It's nice to hear some details and some facts!

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    I am gluten intolerant and my favorite gluten free beer is Red Bridge. I had a few seizures before discovering the gluten issue and have been seizure free ever since.

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    Guest confused

    Posted

    I get a migraine when I eat anything with a significant amount of wheat in it, like pasta or a sandwich. I can eat small amounts but I get an uncomfortable "histaminey" reaction and after several days of eating small amounts I get the migraine. But I can drink real beer (the darker the better) a couple times a week, or even two in one day, and I don't get the same reaction. The mass produced crap lite beer crap makes me ill though. Anybody know what my problem is? (I don't.)

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    Guest Mike Getzlaf

    Posted

    "People with classic celiac disease are intolerant to the gluten proteins found in wheat, barley, rye, spelt and a couple other lesser known grains."

    Might be good to know of the "couple other lesser known grains." I guess you don't.

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    I also would have liked to see something about the Gliadin. That is my main concern.

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    There are so many sorghum based beers to choose from (at least in Phoenix) that it isn't worth it for me to suffer normal beer. Plus, vodka is completely gluten free.

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    I have Just started, I am trying to find my way, This very helpful.

    Same here, what a minefield!

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    There are so many sorghum based beers to choose from (at least in Phoenix) that it isn't worth it for me to suffer normal beer. Plus, vodka is completely gluten free.

    Not all vodka is gluten free. Sometimes once the vodka has been distilled some companies add mash back into the product for flavor and thus adding glutens back into the product. I would do some research on that if I were you.

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    Not all vodka is gluten free. Sometimes once the vodka has been distilled some companies add mash back into the product for flavor and thus adding glutens back into the product. I would do some research on that if I were you.

    This is a common myth, but they would never do this after distillation as it would not be clear. The quality of vodka is determined by how many times and its method of distillation.

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    I am gluten intolerant and my favorite gluten free beer is Red Bridge. I had a few seizures before discovering the gluten issue and have been seizure free ever since.

    Chuck. I am interested to know what you mean by "seizures" I have recently started having non epileptic seizures (although they can look like epileptic fits). I'm also having terrible trouble with my bowels which lead me to this site. I'm looking into reducing wheat from diet. Thanks.

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    Celiac.com 08/05/2013 - It's well-publicized that the market for gluten-free products continues to experience double-digit growth. A new analysis of the various segments of the global gluten-free product market is helping researchers to better understand the finer aspects of the market, and to better forecast global volume and revenue prospects for gluten-free products. It also looks at the major forces both driving and impeding the global gluten-free product market.
    The report, called the "Gluten-Free Products Market By Type (Bakery & Confectionery, Snacks, Breakfast Cereals, Baking Mixes & Flour, Meat & Poultry Products), Sales Channel (Natural & Conventional) & Geography - Global Trends & Forecasts To 2018,"is issued by RnRMarketResearch.com.
    The report data is is broken down on the basis of geographic region, by gluten-free product type: bakery and confectionery; breakfast cereals; snacks; baking mixes and flour; meat and poultry products, or other gluten-free foods, such as sauces, dressings, beverages, dairy products, etc.
    It is also broken down by type of sales channel, that is natural health food stores, or conventional retailers.
    The data are further divided by chain or single store, grocery, mass merchandiser, club store, drug store, or other type of retailer, such as e-retailers, mail orders etc.
    According to the report, public perception that gluten-free foods are healthier than conventional products is the most important factor fueling gluten-free food sales. Other factors include ongoing improvement of gluten-free products, and increasing retail availability.
    Detracting from growth is the fact that many consumers do not know the difference between an allergy and intolerance, and many consumers remain undiagnosed for celiac disease, or gluten-intolerance.
    Be that as it may, the global gluten-free products market is projected to maintain a compound annual growth rate (CAGR) of 10.2%, and to exceed of $6.2 billion by 2018.
    Once again, the data show that gluten-free bakery and confectionery products account for the largest share of gluten-free product sales, at about 46%, followed by gluten-free snacks, which account for about 20%.
    During the time projected, the north American market will account for nearly 60% of total global gluten-free food revenues.
    Highest consumption of gluten-free product in the global market was through conventional sales channels. This rising demand and rising variety of goods has made chain supermarkets and mass merchandisers the preferred retail channel for gluten-free product purchases.
    Globally, the market for gluten-free products market has seen rapid growth, but nothing like the consistent double-digit growth seen in North America and Europe.
    There, companies The Hain Celestial Inc. (U.S.), General Mills Inc. (U.S.), Dr. Schar (Italy), Amy's Kitchen Inc. (U.S.), and Boulders Brand Inc. (U.S), have a huge influence on overall market dynamics.
    Source:
    rnrmarketresearch.com.

  • Recent Articles

    Jefferson Adams
    Celiac.com 06/19/2018 - Could baking soda help reduce the inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease? Scientists at the Medical College of Georgia at Augusta University say that a daily dose of baking soda may in fact help reduce inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease.
    Those scientists recently gathered some of the first evidence to show that cheap, over-the-counter antacids can prompt the spleen to promote an anti-inflammatory environment that could be helpful in combating inflammatory disease.
    A type of cell called mesothelial cells line our body cavities, like the digestive tract. They have little fingers, called microvilli, that sense the environment, and warn the organs they cover that there is an invader and an immune response is needed.
    The team’s data shows that when rats or healthy people drink a solution of baking soda, the stomach makes more acid, which causes mesothelial cells on the outside of the spleen to tell the spleen to go easy on the immune response.  "It's most likely a hamburger not a bacterial infection," is basically the message, says Dr. Paul O'Connor, renal physiologist in the MCG Department of Physiology at Augusta University and the study's corresponding author.
    That message, which is transmitted with help from a chemical messenger called acetylcholine, seems to encourage the gut to shift against inflammation, say the scientists.
    In patients who drank water with baking soda for two weeks, immune cells called macrophages, shifted from primarily those that promote inflammation, called M1, to those that reduce it, called M2. "The shift from inflammatory to an anti-inflammatory profile is happening everywhere," O'Connor says. "We saw it in the kidneys, we saw it in the spleen, now we see it in the peripheral blood."
    O'Connor hopes drinking baking soda can one day produce similar results for people with autoimmune disease. "You are not really turning anything off or on, you are just pushing it toward one side by giving an anti-inflammatory stimulus," he says, in this case, away from harmful inflammation. "It's potentially a really safe way to treat inflammatory disease."
    The research was funded by the National Institutes of Health.
    Read more at: Sciencedaily.com

    Jefferson Adams
    Celiac.com 06/18/2018 - Celiac disease has been mainly associated with Caucasian populations in Northern Europe, and their descendants in other countries, but new scientific evidence is beginning to challenge that view. Still, the exact global prevalence of celiac disease remains unknown.  To get better data on that issue, a team of researchers recently conducted a comprehensive review and meta-analysis to get a reasonably accurate estimate the global prevalence of celiac disease. 
    The research team included P Singh, A Arora, TA Strand, DA Leffler, C Catassi, PH Green, CP Kelly, V Ahuja, and GK Makharia. They are variously affiliated with the Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Lady Hardinge Medical College, New Delhi, India; Innlandet Hospital Trust, Lillehammer, Norway; Centre for International Health, University of Bergen, Bergen, Norway; Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Gastroenterology Research and Development, Takeda Pharmaceuticals Inc, Cambridge, MA; Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; Department of Medicine, Columbia University Medical Center, New York, New York; USA Celiac Disease Center, Columbia University Medical Center, New York, New York; and the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
    For their review, the team searched Medline, PubMed, and EMBASE for the keywords ‘celiac disease,’ ‘celiac,’ ‘tissue transglutaminase antibody,’ ‘anti-endomysium antibody,’ ‘endomysial antibody,’ and ‘prevalence’ for studies published from January 1991 through March 2016. 
    The team cross-referenced each article with the words ‘Asia,’ ‘Europe,’ ‘Africa,’ ‘South America,’ ‘North America,’ and ‘Australia.’ They defined celiac diagnosis based on European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines. The team used 96 articles of 3,843 articles in their final analysis.
    Overall global prevalence of celiac disease was 1.4% in 275,818 individuals, based on positive blood tests for anti-tissue transglutaminase and/or anti-endomysial antibodies. The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% in 138,792 individuals. That means that numerous people with celiac disease potentially remain undiagnosed.
    Rates of celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was 0.6% in female vs 0.4% males. Celiac disease was significantly more common in children than adults.
    This systematic review and meta-analysis showed celiac disease to be reported worldwide. Blood test data shows celiac disease rate of 1.4%, while biopsy data shows 0.7%. The prevalence of celiac disease varies with sex, age, and location. 
    This review demonstrates a need for more comprehensive population-based studies of celiac disease in numerous countries.  The 1.4% rate indicates that there are 91.2 million people worldwide with celiac disease, and 3.9 million are in the U.S.A.
    Source:
    Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037.

    Jefferson Adams
    Celiac.com 06/16/2018 - Summer is the time for chips and salsa. This fresh salsa recipe relies on cabbage, yes, cabbage, as a secret ingredient. The cabbage brings a delicious flavor and helps the salsa hold together nicely for scooping with your favorite chips. The result is a fresh, tasty salsa that goes great with guacamole.
    Ingredients:
    3 cups ripe fresh tomatoes, diced 1 cup shredded green cabbage ½ cup diced yellow onion ¼ cup chopped fresh cilantro 1 jalapeno, seeded 1 Serrano pepper, seeded 2 tablespoons lemon juice 2 tablespoons red wine vinegar 2 garlic cloves, minced salt to taste black pepper, to taste Directions:
    Purée all ingredients together in a blender.
    Cover and refrigerate for at least 1 hour. 
    Adjust seasoning with salt and pepper, as desired. 
    Serve is a bowl with tortilla chips and guacamole.

    Dr. Ron Hoggan, Ed.D.
    Celiac.com 06/15/2018 - There seems to be widespread agreement in the published medical research reports that stuttering is driven by abnormalities in the brain. Sometimes these are the result of brain injuries resulting from a stroke. Other types of brain injuries can also result in stuttering. Patients with Parkinson’s disease who were treated with stimulation of the subthalamic nucleus, an area of the brain that regulates some motor functions, experienced a return or worsening of stuttering that improved when the stimulation was turned off (1). Similarly, stroke has also been reported in association with acquired stuttering (2). While there are some reports of psychological mechanisms underlying stuttering, a majority of reports seem to favor altered brain morphology and/or function as the root of stuttering (3). Reports of structural differences between the brain hemispheres that are absent in those who do not stutter are also common (4). About 5% of children stutter, beginning sometime around age 3, during the phase of speech acquisition. However, about 75% of these cases resolve without intervention, before reaching their teens (5). Some cases of aphasia, a loss of speech production or understanding, have been reported in association with damage or changes to one or more of the language centers of the brain (6). Stuttering may sometimes arise from changes or damage to these same language centers (7). Thus, many stutterers have abnormalities in the same regions of the brain similar to those seen in aphasia.
    So how, you may ask, is all this related to gluten? As a starting point, one report from the medical literature identifies a patient who developed aphasia after admission for severe diarrhea. By the time celiac disease was diagnosed, he had completely lost his faculty of speech. However, his speech and normal bowel function gradually returned after beginning a gluten free diet (8). This finding was so controversial at the time of publication (1988) that the authors chose to remain anonymous. Nonetheless, it is a valuable clue that suggests gluten as a factor in compromised speech production. At about the same time (late 1980’s) reports of connections between untreated celiac disease and seizures/epilepsy were emerging in the medical literature (9).
    With the advent of the Internet a whole new field of anecdotal information was emerging, connecting a variety of neurological symptoms to celiac disease. While many medical practitioners and researchers were casting aspersions on these assertions, a select few chose to explore such claims using scientific research designs and methods. While connections between stuttering and gluten consumption seem to have been overlooked by the medical research community, there is a rich literature on the Internet that cries out for more structured investigation of this connection. Conversely, perhaps a publication bias of the peer review process excludes work that explores this connection.
    Whatever the reason that stuttering has not been reported in the medical literature in association with gluten ingestion, a number of personal disclosures and comments suggesting a connection between gluten and stuttering can be found on the Internet. Abid Hussain, in an article about food allergy and stuttering said: “The most common food allergy prevalent in stutterers is that of gluten which has been found to aggravate the stutter” (10). Similarly, Craig Forsythe posted an article that includes five cases of self-reporting individuals who believe that their stuttering is or was connected to gluten, one of whom also experiences stuttering from foods containing yeast (11). The same site contains one report of a stutterer who has had no relief despite following a gluten free diet for 20 years (11). Another stutterer, Jay88, reports the complete disappearance of her/his stammer on a gluten free diet (12). Doubtless there are many more such anecdotes to be found on the Internet* but we have to question them, exercising more skepticism than we might when reading similar claims in a peer reviewed scientific or medical journal.
    There are many reports in such journals connecting brain and neurological ailments with gluten, so it is not much of a stretch, on that basis alone, to suspect that stuttering may be a symptom of the gluten syndrome. Rodney Ford has even characterized celiac disease as an ailment that may begin through gluten-induced neurological damage (13) and Marios Hadjivassiliou and his group of neurologists and neurological investigators have devoted considerable time and effort to research that reveals gluten as an important factor in a majority of neurological diseases of unknown origin (14) which, as I have pointed out previously, includes most neurological ailments.
    My own experience with stuttering is limited. I stuttered as a child when I became nervous, upset, or self-conscious. Although I have been gluten free for many years, I haven’t noticed any impact on my inclination to stutter when upset. I don’t know if they are related, but I have also had challenges with speaking when distressed and I have noticed a substantial improvement in this area since removing gluten from my diet. Nonetheless, I have long wondered if there is a connection between gluten consumption and stuttering. Having done the research for this article, I would now encourage stutterers to try a gluten free diet for six months to see if it will reduce or eliminate their stutter. Meanwhile, I hope that some investigator out there will research this matter, publish her findings, and start the ball rolling toward getting some definitive answers to this question.
    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
    Celiac.com 06/14/2018 - Refractory celiac disease type II (RCDII) is a rare complication of celiac disease that has high death rates. To diagnose RCDII, doctors identify a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs). 
    However, researchers really don’t have much data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023