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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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    COMMENTS REGARDING A LOW-GLUTEN DIET BY DONALD D. KASARDA, FORMER RESEARCH CHEMIST FOR THE UNITED STATES DEPARTMENT OF AGRICULTURE


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    Celiac.com - 07/24/2001


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    Study:
    Holmes, Prior, Lane, et. al. Malignancy in Coeliac Disease - Effect of a Gluten-Free Diet Gut 1989; 30: 333-338

    Comments Regarding the Study to the List (January 8, 1997):

    I would like to suggest that you check out some of the information on malignancy and celiac disease, especially lymphoma. One of the studies established three categories: One for those who adhere to the diet strictly; one for those who follow the diet, but not very strictly; and one for those who do not follow the diet.

    • The first group, after 5 years, shows a significant reduction in risk. In fact, it is quite close to the risk experienced by members of the general population.
    • The second group does experience some reduction in risk, but it remains closer to the rate of malignancy in untreated celiac disease.
    • The third group has a very high risk of malignancy.

    Response by Donald D. Kasarda (January 9, 1997 - Donald D. Kasarda is a research chemist in the Crop Improvement and Utilization Research Unit of the United States Department of Agriculture):

    I point out that the people in the first group, which supposedly was adhering to a strict gluten-free diet, were likely to have been including foods made with wheat starch in their diet because that was, and is, common in England where the study was carried out. I have asked several celiac researchers in England if I am correct in this assumption. They agreed that I am. Therefore these people in the strictly gluten-free group were likely to be eating a small amount of gluten each day. The amount is unknown because we dont know the amount of gluten in the starch (this varies according to the manufacturer and possibly according to lot) nor which subjects ingested how much starch.

    The apparent small increase in cancer risk for the first group was not statistically significant for those who had been on the diet more than 5 years.

    In the group with a normal diet, the relative risk of lymphoma was increased 78 fold, but it should be pointed out that the incidence of lymphoma of the gastrointestinal tract in the normal population is rather low. For the 210 patients in the study, the cancer morbidity was expected to be 0.21. For the 46 patients in the normal diet group, 7 cases of lymphoma were observed. For the 108 patients on the strict gluten-free diet, 3 cases of lymphoma were observed. The statistical significance of the numbers is weak because of the relatively small numbers of patients involved. These are extremely valuable and well-done studies. No criticism is intended. To arrange a study with larger numbers will be extremely difficult although a group in Leiden (The Netherlands) is trying to arrange such a study.

    I have no quarrel with those who wish to play it safe, but I dont think we can say for sure that small amounts of gluten in the range of a milligram to a few milligrams per day are harmful on the basis of any scientific study of which I am aware. They may be, or they may not be.

    I offer these comments only with the intent of providing as much information to celiac patients as possible so that they can make informed decisions. If anything I have said is incorrect, I hope someone will point out my errors on the net.

    Don Kasarda, Albany, CA

    FYI: According to the calculations made with Don Kasarda in Nov 1995, 0.1 grams = 100 milligrams is about one-50th of a slice. Therefore,
    10 milligrams is about one-500th of a slice of bread.


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    Scand J Gastroenterol 1999 Sep;34(9):909-14
    AW Morrow Gastroenterology and Liver Centre, Dept of Histopathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

    SPECIAL NOTE: European Codex Alimentarius quality wheat starch was used in this study.
    (Celiac.com 06/25/2000)
    BACKGROUND: It is expected that in patients with coeliac disease the small bowel mucosal mucosa will return to normal if they adhere to a gluten-free diet (GFD). However, in many this is not the case. This study aims to determine whether this persistent villous atrophy (VA) could be due to continued ingestion of the trace amounts of gluten in gluten-free foods, as defined by the WHO/FAO Codex Alimentarius.
    METHODS: Duodenal biopsy specimens from 89 adults with long-standing coeliac disease were examined, and the findings correlated with their form of gluten-free diet.
    RESULTS: In 51 subjects the duodenal specimen was normal, whereas in 38 there was villous atrophy (partial, 28; subtotal, 8; total, 2). There was no relationship between the presence or absence of VA and ingestion of either a GFD as defined by the Codex Alimentarius (Codex-GFD; 39 patients) or a GFD that contained no detectable gluten (NDG diet: 50 patients). Intraepithelial lymphocyte counts were higher, and lactase levels lower, in subjects with an abnormal biopsy specimen than in those in whom it was normal. However, within each of these biopsy groups there was no difference in these variables between patients on a Codex-GFD and those on an NDG-GFD. IgA antigliadin antibody was detected in 4 of 29 patients on a Codex-GFD and in 3 of 13 on a NDG-GFD (NS).
    CONCLUSION: The persistent mucosal abnormalities seen in patients with coeliac disease on a GFD are not due to the ingestion of trace amounts of gluten. The consequences of these abnormalities have yet to be determined.

    admin

    Alimentary Pharmacology & Therapeutics, Volume 19 Issue 12 Page 1277 - June 2004
    Celiac.com 06/28/2004 – According to celiac disease researchers gluten contamination in gluten-free products cannot be totally avoided. With this in mind they set out to determine the safe threshold of gluten in the diets of those with celiac disease. To determine this level they measured the gluten content of 59 naturally gluten-free and 24 Codex quality wheat starch-based gluten-free products using the enzyme-linked immunosorbent assay test. The daily intake of flours was calculated in 76 adults on gluten-free diets and was then compared with their biopsies (mucosal histology). The researchers found that 13 of the 59 naturally gluten-free products and 11 of 24 Codex quality wheat starch-based gluten-free products contained gluten in the amount of 20 to 200 ppm (=mg/kg). The average flour intake for the group was 80g, and this ranged between 10g at the low end, and 300g on the high end.
    The researchers conclude that the threshold for gluten in the diets of those with celiac disease can safely be set at 100 ppm. Even those in the study who consumed flour at the high end--300g per day with a gluten level of 100 ppm--only consumed 30mg of gluten per day. The researchers determined that this level was safe when correlated to their histology in both clinical and challenge studies. Last, this level can be achieved by the food industry, will not make the diet too cumbersome, and will have the additional benefit of encouraging additional food companies to get into the gluten-free food market.

    Jefferson Adams
    Celiac.com 10/07/2008 - Even though nearly 1 out of every 100 people in the world suffers from celiac disease, proper celiac diagnosis can be difficult to diagnose based on symptoms alone, an is often delayed for years. In fact, in the U.S., the average amount of time from first onset of celiac symptoms to a diagnosis for celiac disease is 10 years.
    Currently, the only accepted treatment for celiac disease is a life-long gluten-free diet. However, gluten is present in many processed foods, and many patients with celiac disease are regularly exposed to trace amounts of gluten via contamination and other means.
    One of the challenges of maintaining a life-long diet free of gluten is that so many foods and food products contain gluten. Examples include dried fruit and fruit pie fillings, cold cuts, sandwich spreads, canned meats, many salad dressings and condiments, prepared soups, flavored yogurt, and even flavored instant coffees and herbal teas.
    Following a “strict” gluten-free diet is no guarantee against mucosal damage associated with celiac disease. In two different studies of gluten-free diets, nearly half of the subjects showed villous atrophy. However, the precise level of gluten in each diet was not measured.
    The World Health Organization (WHO) defines naturally gluten-free foods as those with 20 parts of gluten per million (PPM) or less, whereas foods that have been artificially rendered gluten-free must have no more than 200 PPM of gluten. Now, this standard is not universally accepted, in part because of the difficulty of precisely determining the amount of gluten present in different foods. Still, it is obvious that a large number of patients with celiac disease can tolerate foods with minimal amounts of gluten.
    Researchers A. K. Akobeng, and A. G. Thomas recently set out to examine the threshold for gluten consumption among patients with celiac disease by reviewing the results of a number of previous studies.
    In one previous study, researchers examined 4,126 asymptomatic individuals, and found celiac disease in about 1 of 133 of them. The rate for patients with gastrointestinal (GI) symptoms was 1 in 56 subjects. For first-degree relatives of patients with celiac disease, the rate jumped to 1 in 22, while 1 in 39 second-degree relatives tested positive for celiac disease. These figures reflect the existence of a genetic predisposition for the development of celiac disease, as most patients who have celiac disease expressing human leukocyte antigen DQ2 or DQ8 haplotypes.
    One population-based study of 1,612 patients with celiac disease that sheds some light on the demographics and symptoms of the disease shows that nearly three times as many women as men develop celiac disease, while about a third of celiac sufferers had seen 2 or more gastroenterologists. In that study, symptoms persisted for an average of 11 years before a diagnosis of celiac disease.
    Often, such delays are due to the fact that symptoms of celiac disease are similar to many common GI disorders. In addition to the diarrhea experienced by 85% of celiac sufferers, other common symptoms are abdominal pain and distension, Borborygmi, flatulence, and weight loss. Because celiac disease is tied to numerous medical conditions outside of the GI tract, including osteoporosis, iron-deficiency anemia, neuropathy, asthma, and dermatitis herpetiformis, early and accurate diagnosis is important.
    When people with celiac disease eat wheat, rye, or barley, the gluten proteins in these grains sparks inflammation in a part of the small intestine called the lamina propria, which brings about symptoms of the disease.
    In 2007, clinicians proposed new diagnostic guidelines to help doctors diagnose celiac disease more accurately. Under these guidelines, the gliadin antibodies previously used to test for celiac disease have been abandoned because of poor sensitivity and specificity. Serologic testing that focuses on immunoglobulin (Ig)A endomysial antibody, or IgA tissue transglutaminase (tTG) antibody, has been shown to have sensitivity and specificity values above 95% for celiac disease.
    The Review
    Researchers examined electronic databases using a broad search strategy that included randomized controlled trials, cohort studies, case control studies, and cross-sectional studies. In all cases, celiac disease was clinically confirmed through small intestinal histology.
    Initial research uncovered 35 studies, but only 13 were included for analysis. Most studies were excluded because they were reviews of the diet in celiac disease. Of the studies included in the full analysis, 7 were cross-sectional in design and 3 were randomized controlled trials. The research team gauged the cross-sectional studies to be at moderate risk for bias. Because of the varied nature of the results of the many studies, it was not possible to conduct a pooled statistical analysis of the results. The studies tended to focus more on histologic changes instead of patient symptoms of celiac disease. The review indicated that the total amount of gluten consumed, as opposed to the levels of gluten in individual foods, is the key factor connected with histologic abnormalities in the small intestine. Consumption of gluten at levels of 200 mg/day or more was clearly tied to the development of intestinal abnormalities. Whereas these changes usually show up within a few weeks, one trial that looked at different levels of gluten consumption showed differences in villous height/crypt depth ratio within just one week.
    The results of research evaluating consumption of lower levels of gluten have been more uneven. In one study, more than half of subjects consuming only 10 mg of gluten per day experienced worsening of their villous height/crypt ratio. However, another study showed no histologic abnormalities among patients who ingested an average of 34 mg of gluten per day.
    Conclusion
    The current study basically confirms other recent examinations of the limits of gluten consumption in celiac disease, including one study that recommended a daily gluten consumption limit between 10 mg and 100 mg, and another, based on just 83 subjects, that indicated that the mucosa of the small intestine showed no negative long-term changes when subjects consumed up to 80mg of gluten a day.
    While it’s tough to draw specific conclusions from the current study, it seems clear that the standard of 200 PPM or less of gluten in some foods labeled as gluten-free will not protect most celiac disease patients. Instead, the study suggests that a new standard set at a maximum of 20 PPM of gluten will equate to an approximate daily gluten consumption of 6 mg. The body of science suggests that consuming 6mg per day of gluten intake would not promote mucosal abnormalities among most people with celiac disease.
    While more conservative, the 6mg per day figure seems to offer the best assurance of avoiding intestinal damage of any kind. Still, the researchers noted the need for more research on the threshold of gluten consumption for people with celiac disease. They specifically noted that standardization of outcomes along with trials to compare particular concentrations of dietary gluten would be helpful.
    Until the results of such research, this review offers a reasonable guideline as the threshold gluten consumption for people with celiac disease.
    References
    1. Lo W, Sano K, Lebwohl B, Diamond B, Green PH. Changing presentation of adult celiac disease. Dig Dis Sci 2003; 48:395-8.
    Aliment Pharmacol Ther. 2008; 27:1044-1052. Epub 2008 February 29.



    Jefferson Adams
    Celiac.com 11/15/2010 - Fermentation of wheat flour with sourdough lactobacilli and fungal proteases decreases the concentration of gluten in wheat. Depending on the level of hydrolyzation, gluten levels can be reduced as low as 8 parts per million.
    A team of researchers recently conducted a small study to assess whether people with celiac disease can eat baked goods made with wheat flour that is hydrolyzed via sourdough lactobacilli and fungal proteases during food processing.
    The team included L. Greco, M. Gobbetti, R. Auricchio, R. Di Mase, F. Landolfi, F. Paparo, R. Di Cagno, M. De Angelis, C. G. Rizzello, A. Cassone, G. Terrone, L. Timpone, M. D'Aniello, M. Maglio, R. Troncone, S. Auricchio.
    They are affiliated with the Department of Pediatrics and European Laboratory for the Study of Food Induced Diseases, University of Naples, Federico II in Naples Italy.
    The team evaluated the safety of daily administration of baked goods made from this hydrolyzed form of wheat flour for patients with celiac disease.
    Patients who volunteered for the study were assigned at random to consume 200 grams per day of baked goods from one of three groups. The did so every day for 60 days.
    The first group of six patients ate natural flour baked goods (NFBG), with a gluten content of 80,127 ppm gluten.
    The second group of 2 patients ate baked goods made from extensively hydrolyzed flour (S1BG), with a residual gluten content of 2,480 ppm.
    The third group of patients ate baked goods made from fully hydrolyzed flour (S2BG), with just 8 ppm residual gluten.
    In the first group, two of the six patients consuming baked goods made with natural flour (NFBG) discontinued the challenge because of adverse symptoms. All six patients in this group showed increased levels of anti-tissue transglutaminase (tTG) antibodies and small bowel deterioration.
    The two patients who ate baked goods made from extensively hydrolyzed flour (S1BG) had no clinical complaints, but biopsy showed intestinal damage in the form of subtotal villous atrophy.
    The five patients who ate baked goods made with made from fully hydrolyzed flour (S2BG), at just 8 ppm residual gluten had no clinical complaints. Also, they showed no increase in anti-tTG antibodies, and Marsh grades of their small intestinal mucosa showed no adverse change.
    Evidence with this small 60-day dietary study shows that people with celiac disease can safely consume baked goods made from fully hydrolyzed wheat flour, manufactured with sourdough lactobacilli and fungal proteases. This flour shows no toxicicity to patients with celiac disease.
    The team notes that a combined analysis of serologic, morphometric, and immunohistochemical parameters is the most accurate method to assess new therapies for this disorder.
    The results need to be borne out by further study, but, in the future, baked goods made with fully hydrolyzed wheat flour, manufactured with sourdough lactobacilli and fungal proteases may become another option for people with celiac disease.
    Source:

    Clin Gastroenterol Hepatol. 2010 Oct 15. doi:10.1016/j.cgh.2010.09.025

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    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.
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    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

    Jefferson Adams
    Celiac.com 04/17/2018 - Could the holy grail of gluten-free food lie in special strains of wheat that lack “bad glutens” that trigger the celiac disease, but include the “good glutens” that make bread and other products chewy, spongey and delicious? Such products would include all of the good things about wheat, but none of the bad things that might trigger celiac disease.
    A team of researchers in Spain is creating strains of wheat that lack the “bad glutens” that trigger the autoimmune disorder celiac disease. The team, based at the Institute for Sustainable Agriculture in Cordoba, Spain, is making use of the new and highly effective CRISPR gene editing to eliminate the majority of the gliadins in wheat.
    Gliadins are the gluten proteins that trigger the majority of symptoms for people with celiac disease.
    As part of their efforts, the team has conducted a small study on 20 people with “gluten sensitivity.” That study showed that test subjects can tolerate bread made with this special wheat, says team member Francisco Barro. However, the team has yet to publish the results.
    Clearly, more comprehensive testing would be needed to determine if such a product is safely tolerated by people with celiac disease. Still, with these efforts, along with efforts to develop vaccines, enzymes, and other treatments making steady progress, we are living in exciting times for people with celiac disease.
    It is entirely conceivable that in the not-so-distant future we will see safe, viable treatments for celiac disease that do not require a strict gluten-free diet.
    Read more at Digitaltrends.com , and at Newscientist.com

    Jefferson Adams
    Celiac.com 04/16/2018 - A team of researchers recently set out to investigate whether alterations in the developing intestinal microbiota and immune markers precede celiac disease onset in infants with family risk for the disease.
    The research team included Marta Olivares, Alan W. Walker, Amalia Capilla, Alfonso Benítez-Páez, Francesc Palau, Julian Parkhill, Gemma Castillejo, and Yolanda Sanz. They are variously affiliated with the Microbial Ecology, Nutrition and Health Research Unit, Institute of Agrochemistry and Food Technology, National Research Council (IATA-CSIC), C/Catedrático Agustín Escardin, Paterna, Valencia, Spain; the Gut Health Group, The Rowett Institute, University of Aberdeen, Aberdeen, UK; the Genetics and Molecular Medicine Unit, Institute of Biomedicine of Valencia, National Research Council (IBV-CSIC), Valencia, Spain; the Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire UK; the Hospital Universitari de Sant Joan de Reus, IISPV, URV, Tarragona, Spain; the Center for regenerative medicine, Boston university school of medicine, Boston, USA; and the Institut de Recerca Sant Joan de Déu and CIBERER, Hospital Sant Joan de Déu, Barcelona, Spain
    The team conducted a nested case-control study out as part of a larger prospective cohort study, which included healthy full-term newborns (> 200) with at least one first relative with biopsy-verified celiac disease. The present study includes 10 cases of celiac disease, along with 10 best-matched controls who did not develop the disease after 5-year follow-up.
    The team profiled fecal microbiota, as assessed by high-throughput 16S rRNA gene amplicon sequencing, along with immune parameters, at 4 and 6 months of age and related to celiac disease onset. The microbiota of infants who remained healthy showed an increase in bacterial diversity over time, especially by increases in microbiota from the Firmicutes families, those who with no increase in bacterial diversity developed celiac disease.
    Infants who subsequently developed celiac disease showed a significant reduction in sIgA levels over time, while those who remained healthy showed increases in TNF-α correlated to Bifidobacterium spp.
    Healthy children in the control group showed a greater relative abundance of Bifidobacterium longum, while children who developed celiac disease showed increased levels of Bifidobacterium breve and Enterococcus spp.
    The data from this study suggest that early changes in gut microbiota in infants with celiac disease risk could influence immune development, and thus increase risk levels for celiac disease. The team is calling for larger studies to confirm their hypothesis.
    Source:
    Microbiome. 2018; 6: 36. Published online 2018 Feb 20. doi: 10.1186/s40168-018-0415-6