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      Frequently Asked Questions About Celiac Disease   04/07/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes
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    OKTOBERFEST BEER GUIDE! GLUTEN-FREE VS. GLUTEN-REMOVED BEERS


    Jefferson Adams

    Celiac.com 10/14/2016 - It's almost October, and that means beer, or, at least it means Oktoberfest is near. And in so many ways, gluten-free beer lovers have never had it better, with dozens of selections now available commercially, and more on the way every month, it seems.


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    So grab a beer, and celebrate Oktoberfest. But before we get to the list of beer purveyors, let's quickly review some basics of gluten-free versus gluten removed.

    Naturally Gluten-free Beers—Naturally gluten-free beers are made with all gluten-free source ingredients, and use grains like sorghum instead of barley. This is important to many people, especially those with high sensitivity, or the belief that gluten-removed beers may trigger celiac-related problems.

    • Pros: Guaranteed gluten-free from start to finish. As close to 100% gluten-free final product as it gets.
    • Cons: Beers made without barley can taste tart, or have a shallow flavor profile. Aren't considered beer under German standards.

    Gluten-removed beers—Use traditional source ingredients like barley to brew beer traditionally, then use various enzyme processes to break down the gluten.

    • Pros: Traditional source ingredients. Traditional beer flavor. Test under 20 ppm gluten. Can be labeled as beer according to German purity laws.
    • Cons: While many people with celiac disease seem to be able to tolerate gluten-removed beers, many claim that these beers trigger adverse symptoms. The jury is still out on whether gluten-reduced beers are safe for people with celiac disease.

    From a purely technical standpoint, beers brewed from all gluten-free source ingredients cannot be called beer in Germany, due to strict labeling laws in effect since the 14th century.

    The standard set by the FDA for gluten-free labeling in the United States requires that products be made with gluten-free ingredients, and must contain less than 20ppm of gluten.

    The standard set in Europe allows manufacturers to use gluten, rye, or barley in the manufacturing process, so long as the final product tests below 20 ppm gluten.

    Many European beers follow that method, and use wheat and or barley to brew their gluten-free beers. The beers are then treated with enzymes to break down and filter out any gluten. The result is a beer that looks and tastes like a traditional beer, but which is also gluten-free, according to the European labeling standard.

    A List of Naturally Gluten-free Beers

    • Anheuser-Busch Redbridge
    • Bard's Gold
    • Bard's Tale Beer
    • Brasserie Dupont Forêt Libre
    • Brasseurs Sans Gluten Glutenberg Blanche
    • Brunehaut Bio Ambrée
    • Brunehaut Blonde Bio
    • Brunehaut Blanche
    • Burning Brothers Brewing
    • Coors Peak
    • Dogfish Head Craft Brewed Ales: Tweason'ale
    • Drummond Gluten Free
    • Epic Brewing Company: Glutenator
    • Ghostfish Brewery
    • Glutenberg American Pale Ale
    • Glutenberg Blonde
    • Glutenberg Belgian Double
    • Glutenberg India Pale Ale
    • Glutenberg Rousse
    • Green's Discovery Amber Ale
    • Green's Endeavour
    • Green's Enterprise Dry-Hopped Lager
    • Green's India Pale Ale
    • Green's Quest Tripel Blonde Ale
    • Ground Breaker Corsa Rose Gold Ale
    • Ground Breaker IPA No. 5
    • Ground Breaker Dark Ale
    • Ipswich Ale Brewery: Celia Saison
    • Joseph James Brewing Fox Tail
    • Lakefront New Grist Ginger Style Ale
    • Lakefront New Grist Pilsner Style
    • Minhas Lazy Mutt Gluten Free
    • Mongozo Premium Pilsener
    • New Planet Belgian Style Ale
    • New Planet Blonde Ale
    • New Planet Pale Ale
    • New Planet Raspberry Ale
    • New Planet Seclusion IPA
    • New Planet Tread Lightly Session Ale
    • Nickel Brook Gluten Free
    • Nouvelle France La Messagère
    • Nouvelle-France Messagère Aux Fruits
    • Nouvelle-France Messagère Red Ale
    • Schnitzer Bräu Hirse Lemon
    • Schnitzer Bräu Hirse Premium
    • Sprecher Brewing Company's Shakparo Ale
    • Steadfast Beer gluten-free Blonde and Pale Ales
    • Steadfast Beer Company's Oatmeal Cream Stout
    • To Øl Reparationsbajer Gluten Free
    • Whistler Forager

    A List of Gluten-Removed Beers

    • Alley Kat Scona Gold Kölsch
    • Brunehaut Bio Tripel
    • Estrella Damm Daura
    • Estrella Damm Daura Marzen
    • Lammsbräu Glutenfrei Lager Beer
    • Mikkeller American Dream Gluten Free
    • Mikkeller Green Gold Gluten Free
    • Mikkeller I Wish Gluten Free IPA
    • Mikkeller Peter, Pale And Mary Gluten Free
    • New Belgium Glutiny brand Golden and Pale Ales
    • Short's Brewing Space Rock
    • Stone Delicious IPA
    • Sufferfest Brewing Company Pale Ale and Lager
    • Widmer Omission Lager
    • Widmer Omission IPA
    • Widmer Omission Pale Ale
    • Wold Top Against The Grain
    • Wold Top Marmalade Porter
    • Wold Top Scarborough Fair IPA

    Resources:


    Image Caption: Gluten-free beers are more popular then ever this Oktoberfest. Photo: CC--Maria Eklind
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    Harvester is the former name of Ground Breaker Brewing. The Corsa hasn't been made in ages. Their year-round beers are Dark Ale, Pale Ale, IPA No. 5 and Olallie. They have a more recent list of seasonals on their website as well.rnrnhttp://www.groundbreakerbrewing.com/seasonal-gluten-free-beers/

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    Guest Julie Anderson

    Posted

    You are missing the line of naturally gluten free beers from Ghostfish in Seattle.

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    I am curious why you did not include the Coors Peak gluten-free beers on the list. They are made with brown rice and Pacific Northwest hops and are certified gluten-free. And even better, I did not get a headache from them as I normally do with the sorghum beers.

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    You say: "use various enzyme processes to break down the gluten... Can be labeled as beer according to German purity laws."Is that true? I thought the only allowed ingredients were water, barley, hops, and yeast. I second Jessica on Burning Brothers - also available in Wisconsin, North Dakota, and Nebraska. Steadfast also produces gluten-free Blonde and Pale ales. Estrella Damm Daura also brews a "Marzen", a true Oktoberfest-style beer. I had it last year and it was great. New Belgium offers gluten reduced Glutiny brand Golden and Pale ales. The Pale is my favorite - very drinkable.

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    You say: "use various enzyme processes to break down the gluten... Can be labeled as beer according to German purity laws."Is that true? I thought the only allowed ingredients were water, barley, hops, and yeast. I second Jessica on Burning Brothers - also available in Wisconsin, North Dakota, and Nebraska. Steadfast also produces gluten-free Blonde and Pale ales. Estrella Damm Daura also brews a "Marzen", a true Oktoberfest-style beer. I had it last year and it was great. New Belgium offers gluten reduced Glutiny brand Golden and Pale ales. The Pale is my favorite - very drinkable.

    Yes, there are various ways to remove gluten from beer, and they do qualify as "beer" in Germany, including but not limited to this one: Lammsbräu Glutenfrei Lager Beer

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    Guest JustinDurden

    Posted

    I am curious why you did not include the Coors Peak gluten-free beers on the list. They are made with brown rice and Pacific Northwest hops and are certified gluten-free. And even better, I did not get a headache from them as I normally do with the sorghum beers.

    It's on there.

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    Guest Jefferson Adams

    Posted

    I am curious why you did not include the Coors Peak gluten-free beers on the list. They are made with brown rice and Pacific Northwest hops and are certified gluten-free. And even better, I did not get a headache from them as I normally do with the sorghum beers.

    My mistake. I'll note it.

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    Jefferson Adams
    Celiac.com 04/22/2016 - To label a beer 'gluten-free' it must contain no gluten ingredients from start to finish. But, without wheat or barley, how does a brewer create the foundation for the beer?
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    Jefferson Adams
    Celiac.com 06/17/2016 - What role does individual sensitivity play in celiac disease severity and reactions to gluten?
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    Jefferson Adams
    Celiac.com 07/15/2016 - Germans are particular about their beer. Since the 14th century, they have had a beer purity law, called Reinheitsgebot. That law says that beer must be made with wheat or barley, if it is to be called beer.
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    Jefferson Adams
    Celiac.com 07/29/2016 - There's a great little story by Pete Brown about his visit to the Zatec brewery in the Czech Republic. Officially known as Zatecky Pivovar, but called Zatec, the brewery offers both an interesting war history, and a great dark beer that just happens to be gluten-free.
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    Jefferson Adams
    Celiac.com 12/23/2016 - As gluten-free beers gain in popularity, it's not unusual that more beer schools are offering lessons in the art of gluten-free brewing.
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    Jefferson Adams
    Celiac.com 12/02/2016 - Plenty of folks commenting on our story about Žatecky Pivovar, a storied Czech brewery that crafts gluten-free beers, thought the beer sounded like a good idea.
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    Jefferson Adams
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    Source:
    Journal of AOAC International. DOI: https://doi.org/10.5740/jaoacint.16-0184

    Jefferson Adams
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    Jefferson Adams
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    Source:
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    Connie Sarros
    Celiac.com 04/21/2018 - Dear Friends and Readers,
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    fdfworld.com

    Jefferson Adams
    Celiac.com 04/19/2018 - Previous genome and linkage studies indicate the existence of a new disease triggering mechanism that involves amino acid metabolism and nutrient sensing signaling pathways. In an effort to determine if amino acids might play a role in the development of celiac disease, a team of researchers recently set out to investigate if plasma amino acid levels differed among children with celiac disease compared with a control group.
     
    The research team included Åsa Torinsson Naluai, Ladan Saadat Vafa, Audur H. Gudjonsdottir, Henrik Arnell, Lars Browaldh, and Daniel Agardh. They are variously affiliated with the Institute of Biomedicine, Department of Microbiology & Immunology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; the Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Karolinska University Hospital and Division of Pediatrics, CLINTEC, Karolinska Institute, Stockholm, Sweden; the Department of Clinical Science and Education, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden; the Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden; the Diabetes & Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden; and with the Nathan S Kline Institute in the U.S.A.
    First, the team used liquid chromatography-tandem mass spectrometry (LC/MS) to analyze amino acid levels in fasting plasma samples from 141 children with celiac disease and 129 non-celiac disease controls. They then crafted a general linear model using age and experimental effects as covariates to compare amino acid levels between children with celiac disease and non-celiac control subjects.
    Compared with the control group, seven out of twenty-three children with celiac disease showed elevated levels of the the following amino acids: tryptophan; taurine; glutamic acid; proline; ornithine; alanine; and methionine.
    The significance of the individual amino acids do not survive multiple correction, however, multivariate analyses of the amino acid profile showed significantly altered amino acid levels in children with celiac disease overall and after correction for age, sex and experimental effects.
    This study shows that amino acids can influence inflammation and may play a role in the development of celiac disease.
    Source:
    PLoS One. 2018; 13(3): e0193764. doi: & 10.1371/journal.pone.0193764

    Jefferson Adams
    Celiac.com 04/18/2018 - To the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service animals.
    If you’ve flown anywhere lately, you may have seen them. People flying with their designated “emotional support” animals. We’re not talking genuine service animals, like seeing eye dogs, or hearing ear dogs, or even the Belgian Malinois that alerts its owner when there is gluten in food that may trigger her celiac disease.
    Now, to be honest, some of those animals in question do perform a genuine service for those who need emotional support dogs, like veterans with PTSD.
    However, many of these animals are not service animals at all. Many of these animals perform no actual service to their owners, and are nothing more than thinly disguised pets. Many lack proper training, and some have caused serious problems for the airlines and for other passengers.
    Now the major airlines are taking note and introducing stringent requirements for service animals.
    Delta was the first to strike. As reported by the New York Times on January 19: “Effective March 1, Delta, the second largest US airline by passenger traffic, said it will require passengers seeking to fly with pets to present additional documents outlining the passenger’s need for the animal and proof of its training and vaccinations, 48 hours prior to the flight.… This comes in response to what the carrier said was a 150 percent increase in service and support animals — pets, often dogs, that accompany people with disabilities — carried onboard since 2015.… Delta said that it flies some 700 service animals a day. Among them, customers have attempted to fly with comfort turkeys, gliding possums, snakes, spiders, and other unusual pets.”
    Fresh from an unsavory incident with an “emotional support” peacock incident, United Airlines has followed Delta’s lead and set stricter rules for emotional support animals. United’s rules also took effect March 1, 2018.
    So, to the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service and emotional support animals.
    Source:
    cnbc.com

    admin
    WHAT IS CELIAC DISEASE?
    Celiac disease is an autoimmune condition that affects around 1% of the population. People with celiac disease suffer an autoimmune reaction when they consume wheat, rye or barley. The immune reaction is triggered by certain proteins in the wheat, rye, or barley, and, left untreated, causes damage to the small, finger-like structures, called villi, that line the gut. The damage occurs as shortening and villous flattening in the lamina propria and crypt regions of the intestines. The damage to these villi then leads to numerous other issues that commonly plague people with untreated celiac disease, including poor nutritional uptake, fatigue, and myriad other problems.
    Celiac disease mostly affects people of Northern European descent, but recent studies show that it also affects large numbers of people in Italy, China, Iran, India, and numerous other places thought to have few or no cases.
    Celiac disease is most often uncovered because people experience symptoms that lead them to get tests for antibodies to gluten. If these tests are positive, then the people usually get biopsy confirmation of their celiac disease. Once they adopt a gluten-free diet, they usually see gut healing, and major improvements in their symptoms. 
    CLASSIC CELIAC DISEASE SYMPTOMS
    Symptoms of celiac disease can range from the classic features, such as diarrhea, upset stomach, bloating, gas, weight loss, and malnutrition, among others.
    LESS OBVIOUS SYMPTOMS
    Celiac disease can often less obvious symptoms, such fatigue, vitamin and nutrient deficiencies, anemia, to name a few. Often, these symptoms are regarded as less obvious because they are not gastrointestinal in nature. You got that right, it is not uncommon for people with celiac disease to have few or no gastrointestinal symptoms. That makes spotting and connecting these seemingly unrelated and unclear celiac symptoms so important.
    NO SYMPTOMS
    Currently, most people diagnosed with celiac disease do not show symptoms, but are diagnosed on the basis of referral for elevated risk factors. 

    CELIAC DISEASE VS. GLUTEN INTOLERANCE
    Gluten intolerance is a generic term for people who have some sort of sensitivity to gluten. These people may or may not have celiac disease. Researchers generally agree that there is a condition called non-celiac gluten sensitivity. That term has largely replaced the term gluten-intolerance. What’s the difference between celiac disease and non-celiac gluten-sensitivity? 
    CELIAC DISEASE VS. NON-CELIAC GLUTEN SENSITIVITY (NCGS)
    Gluten triggers symptoms and immune reactions in people with celiac disease. Gluten can also trigger symptoms in some people with NCGS, but the similarities largely end there.

    There are four main differences between celiac disease and non-celiac gluten sensitivity:
    No Hereditary Link in NCGS
    Researchers know for certain that genetic heredity plays a major role in celiac disease. If a first-degree relative has celiac disease, then you have a statistically higher risk of carrying genetic markers DQ2 and/or DQ8, and of developing celiac disease yourself. NCGS is not known to be hereditary. Some research has shown certain genetic associations, such as some NCGS patients, but there is no proof that NCGS is hereditary. No Connection with Celiac-related Disorders
    Unlike celiac disease, NCGS is so far not associated with malabsorption, nutritional deficiencies, or a higher risk of autoimmune disorders or intestinal malignancies. No Immunological or Serological Markers
    People with celiac disease nearly always test positive for antibodies to gluten proteins. Researchers have, as yet, identified no such antobodies or serologic markers for NCGS. That means that, unlike with celiac disease, there are no telltale screening tests that can point to NCGS. Absence of Celiac Disease or Wheat Allergy
    Doctors diagnose NCGS only by excluding both celiac disease, an IgE-mediated allergy to wheat, and by the noting ongoing adverse symptoms associated with gluten consumption. WHAT ABOUT IRRITABLE BOWEL SYNDROME (IBS) AND IRRITABLE BOWEL DISEASE (IBD)?
    IBS and IBD are usually diagnosed in part by ruling out celiac disease. Many patients with irritable bowel syndrome are sensitive to gluten. Many experience celiac disease-like symptoms in reaction to wheat. However, patients with IBS generally show no gut damage, and do not test positive for antibodies to gliadin and other proteins as do people with celiac disease. Some IBS patients also suffer from NCGS.

    To add more confusion, many cases of IBS are, in fact, celiac disease in disguise.

    That said, people with IBS generally react to more than just wheat. People with NCGS generally react to wheat and not to other things, but that’s not always the case. Doctors generally try to rule out celiac disease before making a diagnosis of IBS or NCGS. 
    Crohn’s Disease and celiac disease share many common symptoms, though causes are different.  In Crohn’s disease, the immune system can cause disruption anywhere along the gastrointestinal tract, and a diagnosis of Crohn’s disease typically requires more diagnostic testing than does a celiac diagnosis.  
    Crohn’s treatment consists of changes to diet and possible surgery.  Up to 10% of Crohn's patients can have both of conditions, which suggests a genetic connection, and researchers continue to examine that connection.
    Is There a Connection Between Celiac Disease, Non-Celiac Gluten Sensitivity and Irritable Bowel Syndrome? Large Number of Irritable Bowel Syndrome Patients Sensitive To Gluten Some IBD Patients also Suffer from Non-Celiac Gluten Sensitivity Many Cases of IBS and Fibromyalgia Actually Celiac Disease in Disguise CELIAC DISEASE DIAGNOSIS
    Diagnosis of celiac disease can be difficult. 

    Perhaps because celiac disease presents clinically in such a variety of ways, proper diagnosis often takes years. A positive serological test for antibodies against tissue transglutaminase is considered a very strong diagnostic indicator, and a duodenal biopsy revealing villous atrophy is still considered by many to be the diagnostic gold standard. 
    But this idea is being questioned; some think the biopsy is unnecessary in the face of clear serological tests and obvious symptoms. Also, researchers are developing accurate and reliable ways to test for celiac disease even when patients are already avoiding wheat. In the past, patients needed to be consuming wheat to get an accurate test result. 
    Celiac disease can have numerous vague, or confusing symptoms that can make diagnosis difficult.  Celiac disease is commonly misdiagnosed by doctors. Read a Personal Story About Celiac Disease Diagnosis from the Founder of Celiac.com Currently, testing and biopsy still form the cornerstone of celiac diagnosis.
    TESTING
    There are several serologic (blood) tests available that screen for celiac disease antibodies, but the most commonly used is called a tTG-IgA test. If blood test results suggest celiac disease, your physician will recommend a biopsy of your small intestine to confirm the diagnosis.
    Testing is fairly simple and involves screening the patients blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis. Also, it is now possible to test people for celiac disease without making them concume wheat products.

    BIOPSY
    Until recently, biopsy confirmation of a positive gluten antibody test was the gold standard for celiac diagnosis. It still is, but things are changing fairly quickly. Children can now be accurately diagnosed for celiac disease without biopsy. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide.

    WHY A GLUTEN-FREE DIET?
    Currently the only effective, medically approved treatment for celiac disease is a strict gluten-free diet. Following a gluten-free diet relieves symptoms, promotes gut healing, and prevents nearly all celiac-related complications. 
    A gluten-free diet means avoiding all products that contain wheat, rye and barley, or any of their derivatives. This is a difficult task as there are many hidden sources of gluten found in the ingredients of many processed foods. Still, with effort, most people with celiac disease manage to make the transition. The vast majority of celiac disease patients who follow a gluten-free diet see symptom relief and experience gut healing within two years.
    For these reasons, a gluten-free diet remains the only effective, medically proven treatment for celiac disease.
    WHAT ABOUT ENZYMES, VACCINES, ETC.?
    There is currently no enzyme or vaccine that can replace a gluten-free diet for people with celiac disease.
    There are enzyme supplements currently available, such as AN-PEP, Latiglutetenase, GluteGuard, and KumaMax, which may help to mitigate accidental gluten ingestion by celiacs. KumaMax, has been shown to survive the stomach, and to break down gluten in the small intestine. Latiglutenase, formerly known as ALV003, is an enzyme therapy designed to be taken with meals. GluteGuard has been shown to significantly protect celiac patients from the serious symptoms they would normally experience after gluten ingestion. There are other enzymes, including those based on papaya enzymes.

    Additionally, there are many celiac disease drugs, enzymes, and therapies in various stages of development by pharmaceutical companies, including at least one vaccine that has received financial backing. At some point in the not too distant future there will likely be new treatments available for those who seek an alternative to a lifelong gluten-free diet. 

    For now though, there are no products on the market that can take the place of a gluten-free diet. Any enzyme or other treatment for celiac disease is intended to be used in conjunction with a gluten-free diet, not as a replacement.

    ASSOCIATED DISEASES
    The most common disorders associated with celiac disease are thyroid disease and Type 1 Diabetes, however, celiac disease is associated with many other conditions, including but not limited to the following autoimmune conditions:
    Type 1 Diabetes Mellitus: 2.4-16.4% Multiple Sclerosis (MS): 11% Hashimoto’s thyroiditis: 4-6% Autoimmune hepatitis: 6-15% Addison disease: 6% Arthritis: 1.5-7.5% Sjögren’s syndrome: 2-15% Idiopathic dilated cardiomyopathy: 5.7% IgA Nephropathy (Berger’s Disease): 3.6% Other celiac co-morditities include:
    Crohn’s Disease; Inflammatory Bowel Disease Chronic Pancreatitis Down Syndrome Irritable Bowel Syndrome (IBS) Lupus Multiple Sclerosis Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Psoriasis Rheumatoid Arthritis Scleroderma Turner Syndrome Ulcerative Colitis; Inflammatory Bowel Disease Williams Syndrome Cancers:
    Non-Hodgkin lymphoma (intestinal and extra-intestinal, T- and B-cell types) Small intestinal adenocarcinoma Esophageal carcinoma Papillary thyroid cancer Melanoma CELIAC DISEASE REFERENCES:
    Celiac Disease Center, Columbia University
    Gluten Intolerance Group
    National Institutes of Health
    U.S. National Library of Medicine
    Mayo Clinic
    University of Chicago Celiac Disease Center