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    An Amusement Park? Has Gluten-free Gone Too Far?


    Jefferson Adams

    Celiac.com 07/03/2014 - Gluten-free eaters and people with celiac disease may soon be able to enjoy an entire amusement park dedicated solely to healthy, gluten-free food.


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    Photo: CC--stevageWorld Gardens Café recently announced plans to build ‘Healthy Land’ a celiac-friendly amusement park dedicated to healthy, gluten-free eating and nutritional awareness.

    If successfully launched, Healthy Land will the first North American amusement park of its kind.

    In addition to vegetable-shaped roller coasters, and cartoon character versions of super foods such as avocados and coconuts, all food and beverages at Healthy Land will be gluten free, and the park experience will offer child-focused educational entertainment about healthy eating.

    Slated to open in early summer 2015, Healthy Land will feature 23 attractions on 14 acres in Southern California, near the 57, 60 and 10 freeways.

    What do you think? Excited about a totally gluten-free amusement park? Or is it taking the gluten-free idea too far?

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    Guest Cara

    Posted

    Yes- "gluten free" has gone too far. Instead of raising awareness about an autoimmune disease that far too often goes diagnosed, the gluten free 'fad' will fade, but those of use with celiac disease will still have to manage this everyday. Anyone who has celiac disease, and/or has children who also have celiac, would likely embrace the idea of actually going on a vacation, or to an amusement park, without constant vigilance around not getting sick. Why would celiac.com publish an article written by someone who clearly believes gluten free is a silly fad? Clearly the writer lacks some insight into the true upside of offering celiacs a real vacation from the vigilance required to manage their illness. Let's not give air time to ignorance on a page for individuals living with celiac disease.

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    Guest Donnie

    Posted

    Great idea, and I hope it will be very successful. Gluten free diets are being demonized as just a silly fad, and are claimed to be harmful to the health of people who follow them. That is not true, and they are much healthier then the junk foods that a lot of people are eating.

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    Guest Terry M.

    Posted

    I think the idea of teaching kids about healthy eating via an amusement park is fine but making the entire thing gluten free is over the top. Why not just have a generous offering of gluten free items along with regular foods for non-gluten free folks. This is the type of thing that is fodder for the late night comics who are already mocking the gluten-free "trend" thanks to the fools who have adopted the diet, not even knowing what gluten is, is the hope of losing weight, etc. This just makes it hard for those of us with celiac to be taken seriously.

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    Guest Michael

    Posted

    This is absolutely not going too far. I agree with Dr. Rodney Ford that gluten needs to be eradicated from the planet: one amusement park, restaurant and whatever venue at a time. Read the books Gluten Zero Global, Wheat Belly and Grain Brain.

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    What a great idea! Once a year I go to a celiac walk... it's the only time of the year I can eat whatever there is there. It's great to go somewhere and know I can eat anything! I always hear kids say, mommy what can I eat here? Their mom will say everything here is gluten free and the kids get so excited!

    I would love an amusement park that I could eat things- Maybe they will have fried dough!

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    Guest Mary Thorpe

    Posted

    I think it's a cool idea but that they ought to pay the most attention to making it a cool amusement park and downplay the gluten-free aspect, just make that known as a side note. Then it would be a fun place for everyone to go with the benefit that the gluten sensitive can really relax and have fun knowing that everything there is safe to eat. Those who don't need gluten-free food can enjoy it, too, because hopefully there will be good food that just happens to be gluten free.

     

    Can't figure out from the article where it will be- I don't know of a 57 freeway exactly. Interstate 60 and 10 intersect and there's a state route 57 but it's further to the east. Maybe it qualifies as a freeway and maybe it's somewhere in between? If so, that's cool because it would be near my sister's home so hopefully we'll get to go someday!

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    Guest Mary Thorpe

    Posted

    I think it's a cool idea but that they ought to pay the most attention to making it a cool amusement park and downplay the gluten-free aspect, just make that known as a side note. Then it would be a fun place for everyone to go with the benefit that the gluten sensitive can really relax and have fun knowing that everything there is safe to eat. Those who don't need gluten-free food can enjoy it, too, because hopefully there will be good food that just happens to be gluten free.

     

    It will be fairly near my sister's home in Whittier so hopefully we'll get to go someday!

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    Guest Cindy

    Posted

    I don't think it's gone too far. Everyone can at least eat a gluten free diet so no one will be deprived and they might see just how easy it is to adopt a gluten free diet. I think it's great. I hear how well other countries respond to gluten free diets is amazing compared to the US.

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    Guest Christine

    Posted

    I like it! I hope they continue up the road to organics, non GMOs! This will open doors to what healthier eating is all about. For those of us with autoimmune disorders due to wheat gluten, let's pray they do it right!

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    Guest babsesl

    Posted

    Love the idea! It would have made going to an amusement park for my kids and me a whole lot more enjoyable and carefree. And what is wrong with eating healthy? Nothing!

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    Guest Purplejackets

    Posted

    This is a great start. It might become a kind of test lab for all the allergies and issues children deal with, since parents will come with the expectation that it's "safe." Lots of learning curve will happen, I'm sure. I hope this takes off and duplicates itself, as new industries learn that it's good ethics and good business to support people's wellness and health.

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    Guest ACurtis

    Posted

    Yes- "gluten free" has gone too far. Instead of raising awareness about an autoimmune disease that far too often goes diagnosed, the gluten free 'fad' will fade, but those of use with celiac disease will still have to manage this everyday. Anyone who has celiac disease, and/or has children who also have celiac, would likely embrace the idea of actually going on a vacation, or to an amusement park, without constant vigilance around not getting sick. Why would celiac.com publish an article written by someone who clearly believes gluten free is a silly fad? Clearly the writer lacks some insight into the true upside of offering celiacs a real vacation from the vigilance required to manage their illness. Let's not give air time to ignorance on a page for individuals living with celiac disease.

    If I remember correctly (having read somewhere), the author's sister has celiac disease, and he himself also eats gluten free. I think they are rhetorical questions he posted; he does not believe celiac disease is a fad or that people living with celiac disease don't deserve a real family vacation. Perhaps he could have thought a bit on how what he wrote would be perceived.

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    Guest Angela

    Posted

    Such a great way to help kids/adults feel more comfortable to eat at an amusement park where they can have gluten-free food and not worry! I would hope that maybe even having fun shows gearing towards eating healthy in a fun way! Letting the kids know they're not alone in having celiac disease.

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    I love the idea! My family never eats out, even on vacation, cause we are so sensitive to cross contamination. I also know how hard it is to avoid gluten, just when you think you know it all, BAM you get in trouble. Although I love the idea I would have a hard time trusting that the powers that be would take it as serious as I need to.

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    This was an April Fool's Day joke. See the World Gardens Cafe Facebook page.

     

    Erin Smith Is this for real or an April Fools joke?

    April 2 at 8:11am · Like

     

    World Gardens Café: It's an April Fools Day joke. We would love to do something like this but there would have to be enough interest first.

     

    April 2 at 1:07pm · Like

     

    Erin Smith It is really too bad that this isn't for real and that Celiac was the butt of so many April Fools jokes yesterday . The idea of having an amusement park where everything is safe to eat for people with celiac sounds like a wonderful vacation to me.

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    Melissa Blanco
    Celiac.com 01/06/2010 - I’ve always loved the season of Advent—the beauty of a new beginning—of celebrating the birth of Jesus.  Each Sunday of December, as I watch another candle burning within the Advent wreath, I am reminded of those early years in my youth when I anticipated Christmas by observing the candles on the wreath; two purples, a pink, and lastly, another purple.  As children, we always knew, when the final purple candle was lit, Christmas would soon arrive.
    As I sat in my Church pew this Christmas Eve, I marveled at the large trees lit by white lights, amid a backdrop of fresh poinsettias, along with the smell of incense accompanying our Parish Priest to the altar.  I joined the Children’s Choir in singing the beautiful Christmas Carols I still remember brilliantly from my Catholic School days—“Silent Night,” “Away in a Manger,” and “We Three Kings.”  I found my eyes filling with tears thinking of family members who live far away, loved ones who have gone before us, and those of our military who are celebrating the holidays away from their spouses and children.  I smiled watching youth from the Faith Formation program convene on the Altar dressed as Mary and Joseph, angels, shepherds, and the three wise men, one of which had a very impressive beard attached to his innocent face.
    After publishing my article titled, Catholicism and Celiac Disease, I was amazed and humbled by the number of responses received from celiac sufferers and their family members.  I realized that my first article was just that—a first article—because a second one became necessary in order to pass on information which so many other Catholic celiacs deserve the opportunity to hear.  What began as a very personal and profound journey for me has become a chance to help others who are finding peace amid a life altering diagnosis.
    The Benedictine Sisters of Perpetual Adoration, in an effort to help Catholics with celiac disease, have developed a low gluten communion host which still satisfies the Code of Cannon Law stating that Eucharist hosts must be made of water and wheat.  Their website states, “Our low gluten bread is made with wheat starch and water.  The gluten content is 0.01%.  It is made, stored, and shipped in a dedicated gluten-free environment.”  The Benedictine Sisters have served over 2,000 Catholics with gluten intolerance, and because of the extremely low gluten content, it appears to be perfectly safe for most celiacs.  Their website contains a link to their low gluten host order form.
    Many Priests, Parishes, and Diocese are now accepting the substitution of traditional Eucharist with these low gluten hosts, developed by the Benedictine Sisters.  I advise anyone desiring to receive Eucharist through both the Body and Blood of Christ to speak with your Pastor, and share your diagnosis to find if this option is possible in your Parish.  What an amazing opportunity for Catholic Celiacs.  I thank those who commented on my first article—noting that their bodies tolerated the low gluten host, and their Priests were open to offering this special host at Holy Communion.
    If the low gluten host is not an option for your weekly sacrament, please remember some other important advice I was given, Jesus knows your body and what is in your heart.  Partaking of Communion through the Blood of Christ is still a full participation of the Holy Sacrament.
    This spring I will proudly stand behind my son as he receives his First Holy Communion.  I am once again reminded of that day long ago when I received the Sacrament for the first time.  I pray that he will always find the comfort I have in the love surrounding him each week when he attends Mass.
    Helpful websites for Catholics with Celiac Disease:
    Benedictine Sisters of Perpetual Adoration : www.benedictinesisters.org
    Catholic Celiac Society: www.catholicceliacs.org


    Jefferson Adams
    Celiac.com 03/02/2012 - Riding high on a gluten-free diet and new training regimen, Novak Djokovic survived eleven grueling hours of tennis over three days to emerge as the 2012 Australian Open men's champion.
    Less than two days after an impressive five set victory over Andy Murray, Djokovic was back on court at Melbourne Park for a six-hour battle against Rafael Nadal.
    So what's fueling such remarkable feats of endurance by a player once derided by fellow pro Andy Roddick as a hypochondriac?
    Djokovic adopted a gluten free diet in July 2010, after nutritionist Igo Cetojevic discovered that the Serb suffered from celiac disease, and thus from poor nutritional absorption and other problems associated with his body's adverse reaction to gluten.
    Since going gluten-free, Djokovic has seen quick and steady results, including a 64-match victory streak and won four grand titles.
    Now, lest we chalk-up his success to a gluten-free diet, it's important to realize that Djokovic spends many hours working on physical development, in addition to lots of heavy drilling on the court. That includes three intense interval sessions in a week, and three heavy lifting sessions in a week. All tolled, it adds up to twenty hours or more of serious training.
    When nutrition, training and skill come together in an athlete as strong and talented as Novak Djokovic, the results are stunning to behold.
    Will Djokovic continue his gluten-free domination of men's tennis? Stay tuned for more news.


  • 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