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    Scott Adams
    Gut 2001;49:169-175.
    Celiac.com 08/03/2001 - According to a study published in the August issue of Gut, treated celiac disease in either the mother or the father can still have a negative effect on their newborn babies. The study shows that infants run a five times greater risk of low birth weight and a three times greater risk of prematurity if the father has celiac disease. Interestingly, fathers with celiac disease were four times more likely to have babies with low birth weight than fathers who had other autoimmune diseases. In line with past studies, mothers with celiac disease were six times more likely to have babies with low birth weight. The study did not find low birth weight associated with people who had relatives with celiac disease but did not have it themselves. With the exception of diabetes, infants whose parents have celiac disease have the highest outcome of low birth weight than all other autoimmune diseases.

    Scott Adams
    Nutritionist Melissa Diane Smith, author of Going Against the Grain, has written a new book, Gluten Free Throughout the Year: A Two-Year, Month-to-Month Guide for Healthy Eating. I’m happy that today we at Celiac.com have the exclusive first interview with Melissa about her book.
    Scott: Hi Melissa, thank you for stopping by to answer my questions about your new book. I think this is a book that will interest many Celiac.com readers and we’re delighted to have you here.
    Melissa: I am delighted to be here. I really admire the work you do on this site and I’m thrilled to have Celiac.com be the first place to begin spreading the word about my new book.
    Q: Let’s start with this question: What was your primary goal in writing Gluten Free Throughout the Year?
    A: My primary goal was to help people learn how to eat gluten free and healthy so that they can experience improved health and protect themselves against disease.
    If you stop and think about it, improving and protecting our health is the reason all of us began eating gluten free in the first place. We all know that it’s quite a challenge to go from the diet that most of us were used to eating, to avoiding all sources of gluten in our diet. Because of that, many of us focus on gluten free and nothing else, either not knowing or just plain ignoring basic rules of nutrition that could keep us healthy. By doing that, we often end up getting brand new health problems, including unintended weight gain or blood-sugar- or insulin-related health problems such as diabetes or prediabetes. Many people think “Eating gluten free is so hard, I can’t make any more improvements to my diet.” But in my book, I wanted to show people that it’s not as difficult as they think. You can live the gluten-free lifestyle you’re currently living and gradually learn how to make better food choices that are very tasty and that keep you healthier over the long term.

    Q: You have organized the information in your book in an interesting way. Can you tell our readers about the format in the book and how that came to be?

    A: The chapters in the book are organized in a month-to-month format and cover seasonal topics or common issues that gluten-free eaters run into. The chapters are short, easy to read, and packed with practical tips. With this format, people who don’t have much time can quickly grasp the main concepts that are covered and how to apply them in their gluten-free life.
    That format came to me in large part because after the publication of my Going Against the Grain book in 2002, I held in-person Going Against the Grain Group monthly support meetings for six and a half years. From those meetings, I came to understand the issues and seasonal topics most people had questions about and wanted the most help with at various times of year. I also came to understand that people couldn’t learn everything about nutrition all at once. People need time to learn how to eat gluten free and to improve their diet in other ways. They need time to learn helpful nutrition information, to have it soak into their minds, to learn how to choose tasty but higher-quality gluten-free foods, and how to combine gluten-free foods in simple yet delicious ways.
    Because we’re all busy, most of us learn in bits and pieces, and what we learn first is usually based on what is most timely, applicable or helpful to us right now. So, the book is organized as a handbook to help you eat better no matter what time of year it is. You can flip to the March chapter (“Spring-Clean Your Diet”), to July (“Eating Out in Restaurants”), to September (“Gluten-Free School Days!”), to December (“How to Have a Healthier Holiday Season”), depending on the information you need at the time.
    Q: In your book you indicated that consumers seem to know how to manage their symptoms of gluten sensitivity, regardless of the fact that most doctors are still clueless. Why do you think doctors are so behind times with this vastly growing epidemic?
    A: Many doctors are so busy in their everyday practices that they simply don’t have time to stay up to date on the latest research. Most doctors who now practice medicine were taught in medical school that the only gluten-related disease was celiac disease and that it was very rare and only showed itself with severe gastrointestinal symptoms, such as diarrhea, malabsorption and weight loss. That’s what doctors look for, if they’re looking for gluten-related illness at all. We now know that all of that “information” is out of date.

    We also know that gluten sensitivity is a bona fide medical condition that affects far more people than celiac disease and provokes an astounding array of symptoms, but most people with non-celiac gluten sensitivity simply aren’t diagnosed with it and needlessly suffer from unwanted, uncomfortable symptoms. Without adequate help from doctors who understand gluten sensitivity, more and more people who were told they didn’t have celiac disease started taking matters into their own hands and began taking gluten out of their diets to relieve and eradicate their symptoms. Going gluten free helped many people when modern medicine didn’t and couldn’t. When people go a bit further and eat gluten free and healthy, they can take their health to a whole new level.
    Q: In your book you suggest that a gluten free diet can be harmful if done incorrectly. What do you mean by this?
    A:  Far too many people who avoid gluten for their health eat foods that are made with disease-causing processed ingredients, including refined flours (such as white rice flour), refined sugars (such as sugar or evaporated cane juice), and refined fats (such as soybean oil, corn oil, and partially hydrogenated oil). Refined flours, sugars and fats don’t cause illness in the same way that gluten does, but they interfere with healthy blood sugar metabolism and fatty acid metabolism and set the stage for degenerative diseases to develop and worsen over time. Overall, many people who eat gluten free are so focused on avoiding gluten that they often don’t concentrate on selecting healthy sources of carbohydrates, fat, and protein, and foods rich in vitamins and minerals. That takes its toll on health in the long term in a different way than what gluten was doing to them.
    Earlier this spring many people saw Jamie Oliver’s Food Revolution TV show, which focused on teaching people that they need to avoid junky processed foods and eat more fresh foods, especially more vegetables, to lose weight and improve their health. Well, we need a food revolution in the gluten-free community. We need to realize that we are not immune to the negative health effects of junky processed foods, even if those foods are gluten free, and we need to bring more fresh, nutritious, whole foods into our diets. That’s what my book is all about.

    Q: What do you think is the biggest mistake people make when initiating a gluten-free diet?
    A: The biggest mistake by far is trying to eat what most people in the United States eat but just make it gluten free. The United States is the fattest nation on Earth. We shouldn’t want to emulate the Standard American Diet, appropriately abbreviated SAD, with all its pizza, pasta, bread, baked goods, desserts and snack foods. It’s not a healthy diet. It spikes blood sugar levels, which spikes insulin levels, which sets off a cascade of events to occur in the body that promote unhealthy weight gain and numerous heart disease risk factors to develop. You can switch to pizza, pasta, bread, baked goods, desserts and snack foods that are all gluten free. By doing that, your immune system won’t be reacting to gluten. But, unfortunately, gluten-free versions of those foods still are high in blood-sugar-spiking carbohydrates, wreak havoc on blood sugar and hormonal systems in the body, and set off that same cascade of events to occur that lead in time to insulin-related conditions, including weight gain, type 2 diabetes, heart-disease risk factors, and more.
    It’s great that we have so many gluten-free food options available today, and we can have substitutes for wheat-based foods occasionally. But all of us really need to cut down on grain products and sweets, select those that we eat more carefully, and eat more lower-carbohydrate, nutrient-rich, fresh vegetables and fruits. That is the answer to long-term weight control and good health that many people, including those who eat gluten free, miss.
    Q: What are some of the main issues and topics you cover in your book?
    A: Everything from gluten-free traveling and gluten-free parties, to the difference between lactose intolerance and a milk allergy, to the little-known troubles that people have with corn. I of course also cover the various seasons, such as in the chapters, Enjoying the Juicy Fruits of Summer and Celebrating Autumn’s Bounty. And I have a recipe or two at the end of every chapter.
    Q: Could you give us a little taste of some of the practical information you offer in your book? For example, we're getting to that time of year when people have outdoor picnics but some of us who eat gluten free get stuck as to what we can take on picnics. Can you name a few suggestions from your book?
    A: Sure. For a quick brown-bag type picnic, you can make sandwiches with meat leftovers or gluten-free deli meat on gluten-free bread, organic corn tortillas, or a lower-carbohydrate, grain-free tortilla substitute that is just now coming to market. Throw in some veggie sticks and fruit for a quick, well-balanced meal.
    Picnics also are a great time to use salads as main dishes, side dishes or desserts. You can make a main-dish salad with greens, assorted vegetables, nuts or seeds, and chilled cooked steak, chicken or fish. You can fix a nutrient-rich side dish using quinoa in place of couscous to make tabouli or iodine-rich Sea Tangle Kelp Noodles in place of rice pasta to make pasta salad. Or make the recipe in the book for Greek Potato Salad made with olive oil and lemon juice instead of soybean oil-based mayonnaise. For dessert, you can prepare a colorful assorted fruit salad such as blueberries, raspberries and sliced strawberries.
    Finally, you don’t have to take a big assortment of pre-made food. Sometimes the best picnics of all are spreads of finger food to nibble on, such as slices of cold pot roast or roast chicken or meat kabob pieces, garlic-stuffed olives, guacamole or salsa with organic blue corn chips or Mexican-style flax crackers, assorted nuts, and red or green grapes. These foods are fun to grab as needed in between good conversation or throwing a Frisbee or football back and forth.
    Q: Would you say the recipes in your book are different in any way from recipes in other books? And could you name a few of your recipes?
    A: My recipes are as no-fuss as possible and they’re also as nutritious as possible.
    Contrary to what many people think, eating food that is good for you does not need to involve a lot of work or deprivation. In fact, when you do it right, simply prepared food actually has a gourmet taste. My grandfather was a Greek chef and I love good, tasty food. A few of the recipes in the book are Dairy-Free Brown Rice Pudding, Almond Pancakes, Chestnut Stuffing, Pink Rice Pilaf with Roasted Asparagus and Mushrooms, and Chicken and Strawberry Salad with Cilantro-Lime Dressing. I even have the recipe for Quinoa Pancakes with Peanut Sauce that Dr. Rodney Ford, his wife Chris, and I shared at a local restaurant when they visited my hometown last year. In my recipes, common food allergens are avoided as much as possible, and the book mentions convenient, healthy, gluten-free food products to try by name.

    Scott: Your book is really unique, and informative. I loved the recipes and can't wait to try them! Thank you for stopping by and answering my questions, Melissa.
    Melissa: It was my pleasure. Thank you for having me.


    Dr. Ron Hoggan, Ed.D.
    Below is Ron Hoggan's reply the editor of the Montreal Gazette regarding the article: "Is gluten really something that most people should avoid?"
    Dear Health Editor:
    Mr. Dunning represents corn as a choice for bread-making prior to the advent of wheat, rye, and barley cultivation. However, the evidence suggests that corn was not yet available 10 to 15 thousand years ago when wheat, the earliest of these three grains, was first cultivated so it wasn’t available more than 20 thousand years ago when wild barley was first exploited ( 1 ). The evidence also indicates that corn was not available in the Near East, where wheat was first cultivated, as corn was a New World food developed by Mesoamerican indigenous peoples ( 2 ) half a world away.  In short, corn was not a discarded option for bread making when and where gluten grains were first cultivated.
    Perhaps Mr. Dunning should be forgiven such a relatively minor mistake. After all, he is a journalist, not a cereal scientist. However, as he is identified, in the article in question, as a science writer and a critical analyst, that should set the bar a little higher. Surely we may expect him to conduct basic research in an area by at least glancing at some of the peer reviewed reports on this topic. The one time he does this, he harkens to a report on autism as a tool for arguing against the connection between ADHD and gluten*.  For instance, he decries the adoption of a gluten free diet by those without celiac disease, gluten induced neuropathy, or wheat allergy.  Yet more than 90% of those with celiac disease currently go undiagnosed in the USA (3) and the average delay between onset of symptoms and diagnosis is 11 years (4). Here in Canada, we have very long delays before most of us can get to see a gastroenterologist, so our delays to diagnosis may be even longer.  This suggests that our rates of diagnosis are even lower than those of the USA. Perhaps Mr. Dunning’s querulous rhetoric could be more constructively directed at these long delays and the alarming rates of under-diagnosis of celiac disease. 
    In the interim, it seems very sensible for those with undiagnosed celiac disease to follow a gluten free diet and experience the improved health and quality of life which Mr. Dunning admits are available to these individuals through a gluten free diet.  This is an issue that might be revisited when our health care system is providing a timely diagnosis to at least a majority of cases of celiac disease.
    Recent research has also shown that those with non-celiac gluten sensitivity, which afflicts about 12% of the general population ( 5), experience even higher rates of morbidity and early mortality than those with celiac disease (6 ). Yet this group is either entirely ignored in Mr. Dunning’s  article, or, more likely, it is the unstated focus of his attack.
    Mr. Dunning also seems to be unaware that humans lack the full compliment of enzymes necessary for full digestion of gluten proteins thus making many of the constituent amino acids beyond our ability to metabolize when he states that gluten is “a protein that your body uses.” He further asserts that there is no good reason to avoid gluten if one does not have one of the three conditions he lists. Yet my own work suggests that the morphine-like opioids derived from gluten grains may be a contributing factor in several types of malignancy ( 7).    
    I was pleased to read that Mr. Dunning had at least glanced at data on gluten sensitive idiopathic neuropathy, but chagrined to read his speculation regarding the prevalence of this condition. I have devoted many years to the study of gluten’s impact on human health and have yet to read any work suggesting its prevalence. Perhaps Mr. Dunning could at least hint at his source when making such contentious claims.
    Nonetheless, there is clear evidence that a majority of those who experience gluten sensitive idiopathic neuropathy (5) do so in the presence of non-celiac gluten sensitivity, an autoimmune dynamic. Closer to home, our own Scott Frazer has demonstrated that consumption of gluten proteins is a potent force behind the development of many cases of type 1 diabetes (8). Reports of the causal connection between gluten consumption and autoimmune disease abound in the peer reviewed literature and are too numerous to warrant citing.
    Mr. Dunning also asserts “there is no evidence that incidence of disease increased worldwide once wheat became a staple.”  The field of Archaeology differs dramatically with Mr. Dunning’s claim. In general, it is quite well established that pre-agricultural, hunter-gatherers were much taller and had stronger bones than their descendants who adopted agriculture (9). For instance, a common finding in the skeletal remains of early farmers is a condition of porotic hyperostosis (10).
    Mr. Dunning also seems to be unaware that fats, per gram, provide more than twice the energy available in either carbohydrates or proteins and this ignores the added weight of indigestible fibre. The increased caloric density of fats is a principle that most students learn in high school Biology classes. Yet Mr. Dunning asserts that bread was a source of high energy and light weight.
    While science requires scepticism and criticism to function, polemic rhetoric based on personal bias generates more heat than light.  Mr. Dunning’s report is rife with errors and emotion. Publication of such dogma does little to enhance either the Gazette’s or Mr. Dunning’s credibility. Newspapers are given considerable credence as many readers, myself included, assume that journalists are exercising due diligence in checking their facts prior to publication of these reports. It is only when I read an article such as this one, that is deeply flawed and falls within my area of expertise, that my faith in journalists and the media is undermined.  
    *note: The only report I could find that fits the meagre description provided by Mr. Dunning is one that involved 15 children who were studied over a 12 week period (11). If this is, indeed, the study Mr. Dunning referred to, it hardly provides conclusive evidence of anything beyond the obvious need for more comprehensive study in this area. His use of these data as a springboard for his absolutist claims seems highly questionable, to say the least.
    Sincerely,
    Ron Hoggan, Ed. D.
    Royal Roads University, Continuing Studies
    co-author: Dangerous Grains ISBN: 978158333-129-3 www.dangerousgrains.com
    editor: Journal of Gluten Sensitivity www.celiac.com     
    editor/co-author: Cereal Killers  http://tiny.cc/s7neg
    Sources:
    http://en.wikipedia.org/wiki/Wheat http://en.wikipedia.org/wiki/Maize     Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003 Feb 10;163(3):286-92 Green PHR, Stavropoulos SN, Panagi SG, Goldstein SL, Mcmahon DJ, Absan H, Neugut AI. Am J Gastroenterol. 2001 Jan;96(1):126-31 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. Anderson LA, McMillan SA, Watson RG, Monaghan P, Gavin AT, Fox C, Murray LJ. Malignancy and mortality in a population-based cohort of patients with celiac disease or "gluten sensitivity". World J Gastroenterol. 2007 Jan 7;13(1):146-51. Hoggan R. Considering wheat, rye, and barley proteins as aids to carcinogens. Med Hypotheses. 1997 Sep;49(3):285-8. http://www.ohri.ca/profiles/scott.asp Lutz W. [The carbohydrate theory]. Wien Med Wochenschr. 1994;144(16):387-92. Wright L, Chew F, Porotic Hyperostosis and Paleoepidemiology: A Forensic Perspective on Anemia among the Ancient Maya. Am Anthro. 1998 Dec; 100: 924-939. Elder JH, Shankar M, Shuster J, Theriaque D, Burns S, Sherrill L.    The gluten-free, casein-free diet in autism: results of a preliminary double blind clinical trial. J Autism Dev Disord. 2006 Apr;36(3):413-20.

    Dr. Ron Hoggan, Ed.D.
    Celiac.com 03/06/2012 - I was disappointed to read the opinion article by   Dr. Di Sabatino and Dr. Corazza  published in February 2012 by Annals of Internal Medicine (1).  The article itself is mostly  reasonable and thoughtful. However,  they implicitly assert gluten to be a healthy food by stating that they wish to prevent "a gluten preoccupation from evolving into the conviction that gluten is toxic for most of the population" (1).  In that single statement they are making dietary recommendations in the absence of evidence; the very situation they claim to want to rectify.
    Their published opinion has spawned a number of articles online and in the popular press which  seem to ignore all of the concessions to non-celiac gluten sensitivity in the source article. Some of these spin-off commentaries even use the original article to support their suggestions that a gluten free diet is inappropriate even for those with symptoms that are relieved by the diet. This definitely contravenes the opinions expressed by Di Sabatino and Corazza.  For instance, one of them states "That hasn’t stopped many people from declaring they are gluten sensitive, even though they may not be." (2)
    Please take a moment to consider this proposition. The gluten free diet is restrictive, inconvenient, and expensive. Why would anyone continue to follow such a diet without being convinced that it was valuable to them?  Di Sabatino and Corazzo freely acknowledge that there is a dearth of diagnostic tests and protocols for non-celiac gluten sensitivity.  
    Doctors  Di Sabatino and Corazza  not only acknowledge non-celiac gluten sensitivity as a cause for symptoms very similar to those of celiac disease, they  call for further research to develop and codify diagnostic protocols that will help clinicians better recognize and treat this newly recognized ailment. They go on to acknowledge that conditions including "headache, lethargy, attention-deficit/hyperactivity disorder, ataxia, or recurrent oral ulceration" in the absence of celiac disease often improve or resolve on a gluten free diet.  Their unfortunate denial of gluten as toxic seems to have invited much of the spin-off conjecture under such titles as "Gluten-free diets not always necessary, study suggests" (3).   Even the characterization of this opinion article as a study is misleading in the extreme.       
    Di Sabatino and Corazza focus mostly on gastrointestinal symptoms when discussing non-celiac gluten sensitivity.  It is clear that their focus does not extend far beyond such symptoms. What is also clear is that many cases of non-celiac gluten sensitivity, just like celiac disease, manifest with a wide range of signs and symptoms including neurological illnesses. Dr. Marios Hadjivassiliou, chief neurologist at the Royal Hallamshire Hospital in Sheffield, U.K. has repeatedly demonstrated that a majority of his patients with neurological disease of unknown origin show evidence of gluten sensitivity, the majority of whom do not have celiac disease (4). 
    My disappointment stems not so much from doctors Di Sabatini and Corazza's article and their assertion that gluten grains are not toxic to the general population, as from the spin-off claims that the gluten free diet is being excessively followed  in the belief that it is more healthful.  A rapidly growing body of evidence is showing  that increasing numbers of ailments among increasing numbers of people are driven by this ubiquitous food.  Gluten may well be toxic for most of the population. We don't know.  We can't know that without more research. 
    The growing numbers of people who are willing to accept the inconvenience and expense of a gluten free diet because of the benefits they experience should be considered.  Gluten may be toxic to many more people than are currently identifiable by available testing. Asserting one side or the other of this argument is at least premature. At most it could prove very harmful to those individuals who listen and obey the voices of experts, even when they err and when relayed inaccurately by the media.  
    For a more detailed account of this controversy please see the spring 2012 issue of the Journal of Gluten Sensitivity.
    Sources:

    Di Sabatino A, Corazza G. Nonceliac Gluten Sensitivity: Sense or Sensibility? Ann Intern Med. 2012;156:309-311. http://www.latimes.com/health/boostershots/la-heb-gluten-sensitivity-20120221,0,4517592.story http://www.cbsnews.com/8301-504763_162-57381966-10391704/gluten-free-diets-not-always-necessary-study-suggests/ 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.

  • 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