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    Is Beer Gluten-Free and Safe for People with Celiac Disease?


    Scott Adams

    This statement is being distributed by Sapporo Breweries:
    "A representative from Sapporo Breweries, Ltd./Tokyo has advised that Sapporo beer does contain barley. However, after the barley is boiled, the gluten is filtered out along with the barley skins. The representative assured me that although the barley itself does contain gluten, their brewing process effectively removes all the gluten from their beer."


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    The following comments were written by Donald D. Kasarda who is a research chemist in the Crop Improvement and Utilization Research Unit of the United States Department of Agriculture. If you have any questions or comments regarding the piece, you can address them to Don at: kasarda@pw.usda.gov.

    The reason that this doesnt make sense for celiac patients has to do with the digestion of the barley hordeins, the proteins that are similar to wheat gliadins in barley. During the malting and fermentation processes, the barley hordeins are broken down into smaller pieces called peptides. It is true that no intact hordein proteins can generally be found in beer. However, the smaller pieces of these proteins resulting from enzymatic digestion are often quite water soluble so that they remain in the beer throughout the complete processing to the final product. (Remember that beer is not a distilled product as are whiskey or vodka. Filtration of the beer will not remove these small water-soluble hordein polypeptides.) A barley hordein might have a polypeptide chain including 300 amino acids in its sequence, yet it is reasonably well established by experiments that polypeptides with as few as 13 amino acid residues in the chain can still retain toxicity for celiac patients. These small pieces of the original proteins can (and do) have very different properties from the original larger proteins. In the strict sense, Sapporo is correct that there are no more intact hordeins in their beer. What they cannot claim is that there are no hordein peptides in the beer that might harm celiac patients.

    There is some evidence from analytical methods involving antibodies prepared to gliadins that there are peptides in beer that react with these antibodies. It is not proved beyond any doubt that the peptides in beer are actually toxic to celiac patients, but it is quite possible that the peptides remaining in any barley-based or wheat-based beer, Sapporo included, are harmful to celiac patients. The amount of harmful peptides, if they are present, is likely to be small, but there is no satisfactory analytical data, in my opinion, that defines the amount exactly. So it could be in a range that would be harmful to a celiac patient drinking beer on a regular basis. My guess is, and I emphasize that I cant back this up with scientific results, that a glass of beer once every few months would not do lasting harm to the average celiac patient. By average celiac patient, I mean those who have no obvious allergic character to their disease and do not notice any immediate reaction when they ingest gluten. 

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    Guest louise

    Posted

    It seems to me that there is some very jumbled thinking when it comes to whether or not celiacs 'react' to substances. One of the first things doctors in the UK tell you is that a lack of obvious reaction does not equate necessarily with a lack of internal damage. Indeed many celiacs are diagnosed from biopsy with ruined guts who have never had any obvious symptoms of intestinal irritation. Yet despite knowing that external symptoms are not a good indicator of the damage which can be done by this 'silent disease' we are continually told in the UK and in the States it would appear that if such things as oats and beer don't appear to make you sick then small amounts probably won't hurt you. It's not just unscientific - it's dangerous.

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    An excellent discussion except in the conclusion- because celiac disease dramatically increases the risk of developing lymphoma, and that risk is dose-related, any chance of exposure to gluten/gliadins increases the risk of lymphoma. Not worth a beer a month...

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    Guest jeannie

    Posted

    I'm a fan of beer especially with sushi or Mexican food and have been round and round with information regarding whether it is effectively gluten free. What I have personally observed is that pale, light beers do not cause any obvious physical reaction for me, but even an amber kind of lager will, for me, cause a problem. I know this does not speak to the problems that are below that obvious threshold. I wish there was better info on this.

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    Guest Dheak

    Posted

    I am a beer lover and could not imagine life without it. Beer is literally my greatest pleasure. As such, if I were to be diagnosed with celiac disease, my life would then become automatically less complete. While I understand that it is possible for celiac patients to consume alcohol by way of distilled spirits, I would have a hard time accepting that. I love a good glass of beer like a regular person likes a piece of chocolate. The consumption and recently the creation of (I started home-brewing recently, can't wait to taste the results) of delicious beer is pretty much my life. Much respect to those who have similar tastes to me but can't fulfill said pleasures.

     

    I drank a beer once called Redbridge, brewed by Anheiser Busch, that advertised itself as being celiac safe. It is brewed with sorghum rather than barley. It wasn't bad but it wasn't Guinness by a long shot.

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    Guest Shadowboricua

    Posted

    Yeah, beer is your greatest pleasure and lymphoma can be your biggest nightmare. Just cause there is no reaction when you drink beer, it does not mean that you are damaging your bowel. Most celiacs are asymptomatic but it still can result in lymphoma.

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    Guest ciarraighli

    Posted

    So sad. I love me a good beer too, especially the dark kind you can chew. However, though I have not been diagnosed with celiac, I have discovered that I seriously have a problem with grains, especially wheat. (& so does everyone I know who has gone on a Paleo diet like I have--we really should stick to meat, fruit, & veggies as a species). I do notice a problem, albeit not severe, when I have a beer. So if you are severe enough to have sought medical help, I strongly advise against having beer at all. Really.

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    Guest Michael

    Posted

    It's pretty misleading for people without celiac disease to comment on this, we all love a great beer, and as a poor college student I'm always looking for more gluten free beers. I'd love to hear that Sapporo is gluten free but the results seam inconclusive. Redbridge, Bards and New grist are the only ones out there right now.

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    Guest Laura

    Posted

    As a celiac who has been eliminating things from my diet for going on 10 years, I don't hold any hope that there is anything out there that is totally gluten-free. My system is so sensitive to any lectin that looks like gluten, I have problems: candy. Manufacturers use wheat flour to keep the candy from sticking to the conveyor belt. Not only do wheat, rye, barley and spelt bother me, but due to something I can't understand, I also have to avoid dried beans, chocolate and chilis. Now, the gluten in corn bothers me. People tell me that a deep fat fryer gets up to 335 degrees, so no gluten would survive. If the oil is fresh, I have no problems. If it is used, I can tell. I can't eat food with Distilled White Vinegar because my body can find the gluten in it.

     

    With the two most common food allergies being wheat and cow's milk and type O blood having to avoid wheat, potatoes and corn because of metabolic inhibitors.

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    I am a beer lover with celiac disease. Redbridge made by Amheiser Busch is the choice for me. The only problem is when you are out and about very few bars or stores carry it. Was on vacation last week and did try the Sapporo beer. Felt fine but who knows what it did to my gut.

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    Guest Kestrel

    Posted

    Estrelle Damm has the best gluten free beer hands down.. a little expensive unfortunately. It's called Daura I believe. It's actually made from barley but filtered to 6ppm if i remember.

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    Guest Colleen Moore

    Posted

    As a celiac who has been eliminating things from my diet for going on 10 years, I don't hold any hope that there is anything out there that is totally gluten-free. My system is so sensitive to any lectin that looks like gluten, I have problems: candy. Manufacturers use wheat flour to keep the candy from sticking to the conveyor belt. Not only do wheat, rye, barley and spelt bother me, but due to something I can't understand, I also have to avoid dried beans, chocolate and chilis. Now, the gluten in corn bothers me. People tell me that a deep fat fryer gets up to 335 degrees, so no gluten would survive. If the oil is fresh, I have no problems. If it is used, I can tell. I can't eat food with Distilled White Vinegar because my body can find the gluten in it.

     

    With the two most common food allergies being wheat and cow's milk and type O blood having to avoid wheat, potatoes and corn because of metabolic inhibitors.

    Thanks for the insight.. are you allergic to any shellfish?

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    If you can find Estrelle Damm Daura, BUY it. REAL beer, NOT made with sorghum comes from Spain, $40 a case but worth it.

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    Guest Christy

    Posted

    Estrella Daura! It's gluten free and amazing! Worth every penny <3 I drink Sapporo often and no huge reaction so I feel it's safe. If I have a Stella or amber beer I feel death.

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    Fantastic explanation -- thank you.

     

    It would seem to follow then that beers that are advertised as being gluten-free are in the same class as Sapporo and other light beers. While technically there is no or very little intact lectin proteins, the remaining peptides could precipitate an immune response. Is that accurate?

     

    Thanks again.

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    Fantastic explanation -- thank you.

     

    It would seem to follow then that beers that are advertised as being gluten-free are in the same class as Sapporo and other light beers. While technically there is no or very little intact lectin proteins, the remaining peptides could precipitate an immune response. Is that accurate?

     

    Thanks again.

    FYI: Sapporo does not advertise that they are gluten-free, and I've never seen any test data on their beer.

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    FYI: Sapporo does not advertise that they are gluten-free, and I've never seen any test data on their beer.

    I have not been diagnosed with celiac, but for years I have had bowel, chronic indigestion and abdominal bloating so I decided to try gluten free. Now my gut is like a mood ring for gluten. I was at a party, and the only thing I had was 3 beers...pow, I was like 4 months pregnant. I was hoping it wasn't the beer, but it is not looking good eh!

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    As a celiac who has been eliminating things from my diet for going on 10 years, I don't hold any hope that there is anything out there that is totally gluten-free. My system is so sensitive to any lectin that looks like gluten, I have problems: candy. Manufacturers use wheat flour to keep the candy from sticking to the conveyor belt. Not only do wheat, rye, barley and spelt bother me, but due to something I can't understand, I also have to avoid dried beans, chocolate and chilis. Now, the gluten in corn bothers me. People tell me that a deep fat fryer gets up to 335 degrees, so no gluten would survive. If the oil is fresh, I have no problems. If it is used, I can tell. I can't eat food with Distilled White Vinegar because my body can find the gluten in it.

     

    With the two most common food allergies being wheat and cow's milk and type O blood having to avoid wheat, potatoes and corn because of metabolic inhibitors.

    There is no gluten in corn. There is no gluten in vinegar.

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    Guest Robert LaRue

    Posted

    This article is totally unscientific. Kasarda's comments regarding the react-ability of celiac sufferers to beer are based on nothing but specious assumptions. He presents no evidence that the gluten-derived peptides in beer cause the T-cells to attack the epithelial cells in the intestine. Heck, he even admits it! It's nothing but wild speculation.

     

    My former GI--a specialist in celiac disease, who has written a popular book on it--told me beer is "probably safe."

     

    But there is one reliable test: do celiac beer-drinkers have normal TTG levels? And the answer is, "many do." I have read on the web comments from several celiacs who drink beer and claim to have normal TTG. I do, too. So, if you like beer, drink some--and then get a TTG blood test. If your levels are still normal, chalk one up for us celiac beer lovers!

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    As a celiac who has been eliminating things from my diet for going on 10 years, I don't hold any hope that there is anything out there that is totally gluten-free. My system is so sensitive to any lectin that looks like gluten, I have problems: candy. Manufacturers use wheat flour to keep the candy from sticking to the conveyor belt. Not only do wheat, rye, barley and spelt bother me, but due to something I can't understand, I also have to avoid dried beans, chocolate and chilis. Now, the gluten in corn bothers me. People tell me that a deep fat fryer gets up to 335 degrees, so no gluten would survive. If the oil is fresh, I have no problems. If it is used, I can tell. I can't eat food with Distilled White Vinegar because my body can find the gluten in it.

     

    With the two most common food allergies being wheat and cow's milk and type O blood having to avoid wheat, potatoes and corn because of metabolic inhibitors.

    I too have been celiac for over a decade. You mention not being able to hand beans, chocolate, and chilis as well as potatoes, I am hoping to help out with some possible information.

     

    I have been trying to have a high performance body and without gluten for going on almost 15 years now. I have done well. There are always new things one learns, and then about 5 years ago, the joint and buttocks muscle pain started. It was diagnosed as Fibromylgia. Heads up, I hated it - it rocked my world and me me more and more weak. It, like celiac disease is auto-immune. One day I had enough I started looking for what triggers arthritis and other auto-immune disorders. That is when I stumbled on the detox diet that takes all nightshades out of a person's diet to get pain free from arthritis. SOLD, I would try it for one month. after two weeks my Jump Spin side kicks were a foot higher, my splits were a foot lower, and I stopped being on a pain scale of 0-10, daily a 7 or 8, down to daily 0, possibly once to twice a week 4-5. That was September, I haven't gone back! I have slipped twice and within a 1/2 hour of the potato starch being consumed... the knees and GLUTT /hip muscles were SCREAMING in scale 8-9 pain.

    So, try it out for a few weeks, no Nightshade family means, no: Tobacco, potato, tomato, sweet or hot peppers, eggplant, and no goji berry. This means watching the capsasin, or paprika. But I tell you, though the diet is rough, even for someone who does already read everything. I have quantifiable results, and measured my quality of happiness in practical total lack of pain!

    I gave up chocolate during this detox as well. Cause once I started the detox, chocolate gave me wicked headaches. Three months later, I tried some chocolate. No headache. So again, Quality of life. Possibly this will help you.

     

    Also I am so sick of hearing people say, well we filtered it... There isn't any wheat... look, bleach and heat don't kill gluten. Cross contamination is a problem, and direct ignorance of science is scary. I am glad there are scientists out there trying to find the answers.

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    Guest Zach

    Posted

    An excellent discussion except in the conclusion- because celiac disease dramatically increases the risk of developing lymphoma, and that risk is dose-related, any chance of exposure to gluten/gliadins increases the risk of lymphoma. Not worth a beer a month...

    It is totally worth it to some people. Beer is the only joy I have in my life. I have been a homebrewer for 17 years and am getting ready to start my own commercial brewery. I was diagnosed with celiac disease this week. Guess what? Beer is totally worth the risk to many people, including myself. I would rather die 15 years earlier and enjoy my beer on a daily basis than give it up.

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    I am a beer lover and could not imagine life without it. Beer is literally my greatest pleasure. As such, if I were to be diagnosed with celiac disease, my life would then become automatically less complete. While I understand that it is possible for celiac patients to consume alcohol by way of distilled spirits, I would have a hard time accepting that. I love a good glass of beer like a regular person likes a piece of chocolate. The consumption and recently the creation of (I started home-brewing recently, can't wait to taste the results) of delicious beer is pretty much my life. Much respect to those who have similar tastes to me but can't fulfill said pleasures.

     

    I drank a beer once called Redbridge, brewed by Anheiser Busch, that advertised itself as being celiac safe. It is brewed with sorghum rather than barley. It wasn't bad but it wasn't Guinness by a long shot.

    Redbridge is a very good alternative for gluten-free people. There are several alternatives in the gluten-free market, but unfortunately all are very expensive.

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    I really enjoyed New Grist beer. It's gluten free (sorghum-based) and quite delicious. I'm a huge beer lover, so I was happy to find a tasty gluten-free beer.

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    Guest Robyn

    Posted

    As a celiac who has been eliminating things from my diet for going on 10 years, I don't hold any hope that there is anything out there that is totally gluten-free. My system is so sensitive to any lectin that looks like gluten, I have problems: candy. Manufacturers use wheat flour to keep the candy from sticking to the conveyor belt. Not only do wheat, rye, barley and spelt bother me, but due to something I can't understand, I also have to avoid dried beans, chocolate and chilis. Now, the gluten in corn bothers me. People tell me that a deep fat fryer gets up to 335 degrees, so no gluten would survive. If the oil is fresh, I have no problems. If it is used, I can tell. I can't eat food with Distilled White Vinegar because my body can find the gluten in it.

     

    With the two most common food allergies being wheat and cow's milk and type O blood having to avoid wheat, potatoes and corn because of metabolic inhibitors.

    Hi there. I do not have celiac disease, but I have very bad intolerance to all gluten. I wonder if you have ever considered a yeast or mold allergy or candida as part of the problem for corn, chocolate, potatoes and vinegar. I only ask because some of those intolerances were actually related to yeast/candida issues for me...and not related to gluten problems specifically. I've had really nice success with a yeast free, sugar free candida diet for a limited period of time. (Plus tons of probiotics and digestive enzymes.) You can find the diet online and it asks you to forgo some of the exact foods that are problematic for you. Vinegar especially! I'm now able to add in some limited quantities of foods that before we're awful for me. I've never responded to a post before and really have little experience but hopefully you'll find relief. Good luck!

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    Omission Lager and Omission Pale Ale, both are gluten free.

     

    Made with barley, they filter out the gluten.

     

    I have been making up for lost time. I am going to crack another lager right now.

     

    The sorghum brews are not too good.

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    Guest janie diaz

    Posted

    It is totally worth it to some people. Beer is the only joy I have in my life. I have been a homebrewer for 17 years and am getting ready to start my own commercial brewery. I was diagnosed with celiac disease this week. Guess what? Beer is totally worth the risk to many people, including myself. I would rather die 15 years earlier and enjoy my beer on a daily basis than give it up.

    Good for you, Zach. I have to steer clear of gluten because of my psoriasis and psoriatic arthritis, so my reaction to gluten is primarily based on me trying to keep all inflammation as low as possible and keep my weight in check. Since kicking gluten to the curb, I have lost 25 pounds, but I do LOVE beer, and gluten-free beer to me is more a marketing and branding effort than producing a quality beverage. I'd love to connect with you. Please message me about your beer company! janie at prado-media dot com.

     

    All my best to everyone here. It's a big deal, most "non-sick" people don't get that. I hurt all the time, and I have solved a lot of my issues by connecting with others who fight the good fight like you all.

     

    Cheers!

     

    Janie

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    Dear Michael,
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    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

    Jefferson Adams
    Celiac.com 06/13/2018 - There have been numerous reports that olmesartan, aka Benicar, seems to trigger sprue‐like enteropathy in many patients, but so far, studies have produced mixed results, and there really hasn’t been a rigorous study of the issue. A team of researchers recently set out to assess whether olmesartan is associated with a higher rate of enteropathy compared with other angiotensin II receptor blockers (ARBs).
    The research team included Y.‐H. Dong; Y. Jin; TN Tsacogianis; M He; PH Hsieh; and JJ Gagne. They are variously affiliated with the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School in Boston, MA, USA; the Faculty of Pharmacy, School of Pharmaceutical Science at National Yang‐Ming University in Taipei, Taiwan; and the Department of Hepato‐Gastroenterology, Chi Mei Medical Center in Tainan, Taiwan.
    To get solid data on the issue, the team conducted a cohort study among ARB initiators in 5 US claims databases covering numerous health insurers. They used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy‐related outcomes, including celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy. In all, they found nearly two million eligible patients. 
    They then assessed those patients and compared the results for olmesartan initiators to initiators of other ARBs after propensity score (PS) matching. They found unadjusted incidence rates of 0.82, 1.41, 1.66 and 29.20 per 1,000 person‐years for celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy respectively. 
    After PS matching comparing olmesartan to other ARBs, hazard ratios were 1.21 (95% CI, 1.05‐1.40), 1.00 (95% CI, 0.88‐1.13), 1.22 (95% CI, 1.10‐1.36) and 1.04 (95% CI, 1.01‐1.07) for each outcome. Patients aged 65 years and older showed greater hazard ratios for celiac disease, as did patients receiving treatment for more than 1 year, and patients receiving higher cumulative olmesartan doses.
    This is the first comprehensive multi‐database study to document a higher rate of enteropathy in olmesartan initiators as compared to initiators of other ARBs, though absolute rates were low for both groups.
    Source:
    Alimentary Pharmacology & Therapeutics

    Jefferson Adams
    Celiac.com 06/12/2018 - A life-long gluten-free diet is the only proven treatment for celiac disease. However, current methods for assessing gluten-free diet compliance are lack the sensitivity to detect occasional dietary transgressions that may cause gut mucosal damage. So, basically, there’s currently no good way to tell if celiac patients are suffering gut damage from low-level gluten contamination.
    A team of researchers recently set out to develop a method to determine gluten intake and monitor gluten-free dietary compliance in patients with celiac disease, and to determine its correlation with mucosal damage. The research team included ML Moreno, Á Cebolla, A Muñoz-Suano, C Carrillo-Carrion, I Comino, Á Pizarro, F León, A Rodríguez-Herrera, and C Sousa. They are variously affiliated with Facultad de Farmacia, Departamento de Microbiología y Parasitología, Universidad de Sevilla, Sevilla, Spain; Biomedal S.L., Sevilla, Spain; Unidad Clínica de Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Celimmune, Bethesda, Maryland, USA; and the Unidad de Gastroenterología y Nutrición, Instituto Hispalense de Pediatría, Sevilla, Spain.
    For their study, the team collected urine samples from 76 healthy subjects and 58 patients with celiac disease subjected to different gluten dietary conditions. To quantify gluten immunogenic peptides in solid-phase extracted urines, the team used a lateral flow test (LFT) with the highly sensitive and specific G12 monoclonal antibody for the most dominant GIPs and an LFT reader. 
    They detected GIPs in concentrated urines from healthy individuals previously subjected to gluten-free diet as early as 4-6 h after single gluten intake, and for 1-2 days afterward. The urine test showed gluten ingestion in about 50% of patients. Biopsy analysis showed that nearly 9 out of 10 celiac patients with no villous atrophy had no detectable GIP in urine, while all patients with quantifiable GIP in urine showed signs of gut damage.
    The ability to use GIP in urine to reveal gluten consumption will likely help lead to new and non-invasive methods for monitoring gluten-free diet compliance. The test is sensitive, specific and simple enough for clinical monitoring of celiac patients, as well as for basic and clinical research applications including drug development.
    Source:
    Gut. 2017 Feb;66(2):250-257. &nbsp;doi: 10.1136/gutjnl-2015-310148.