• Join our community!

    Do you have questions about celiac disease or the gluten-free diet?

  • Ads by Google:
     




    Get email alerts Subscribe to Celiac.com's FREE weekly eNewsletter

    Ads by Google:



       Get email alertsSubscribe to Celiac.com's FREE weekly eNewsletter

  • Member Statistics

    77,691
    Total Members
    3,093
    Most Online
    JHAllen
    Newest Member
    JHAllen
    Joined
  • 0

    How Much Gluten is Safe for Folks with Celiac Disease?


    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.


    Ads by Google:




    ARTICLE CONTINUES BELOW ADS
    Ads by Google:



    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.


    0


    User Feedback

    Recommended Comments

    This article is great! I've always wondered about the 20 ppm issue.

    Thank you.

    Share this comment


    Link to comment
    Share on other sites
    Guest patty Brandt

    Posted

    Very Good... I am going to forward this to my sisters.

    Share this comment


    Link to comment
    Share on other sites

    I can not have even one micron of gluten per month without being sick for the whole month! To suggest that there is an acceptable daily level is mind-boggling!

    Share this comment


    Link to comment
    Share on other sites

    I eat foods like cornflakes. It's only barley malt, and it's not like I eat the cereal excessively, so I figure there's nothing worth getting too worked up about with this food in terms of gluten.

     

    My blood test is negative for celiac disease despite this 'cheating' (so far I have only tested positive during two separate 'on gluten' trials, when major stuff like pasta or bread was included in my diet). I am asymptomatic, but I do accept the fact that even if I can't feel it, bread is actually damaging my insides. However, I genuinely believe that there might be different levels of sensitivity, and I that I might actually be tolerant enough to not have to worry about cross-contamination, or using a toaster that's also used with regular bread. I feel quite alone in this belief. Is there no one out there who thinks a toaster not devoted to gluten free use is not the end of the world?

    Share this comment


    Link to comment
    Share on other sites
    Guest Lori Smith

    Posted

    I agree that there may be varying levels of sensitivity, just as in asthma and other allergy - related health issues. When I was first diagnosed, I tried to keep to the strict gluten free diet - and hated it. I came to the conclusion that a longer life, lived miserably, was not worth it. I can eat wheat products occasionally with few side effects; if I plan ahead, I take Imodium beforehand to stave off the worst of it. I have not had other body systems involved thus far, no rash or such.

    Share this comment


    Link to comment
    Share on other sites

    I too have been diagnosed with Celiac and was asymptomatic up to now. When I went on the gluten free diet I too was as miserable as Lori and also felt alone in my belief that some gluten was OK - I too have decided that a longer more miserable life was not worth the misery now. So really glad to hear I am not alone in those beliefs. Also when I was on the gluten free diet I GOT the symptoms I did not have before!! Which was REALLY strange to me.

    Share this comment


    Link to comment
    Share on other sites

    I could imagine that a person with no symptoms would think that a person reacting from a crumb in a toaster is paranoid. But there are certainly different levels of sensitivity. As long as you are keeping up with the testing, don't worry. But, don't think that someone else is over reacting because they use a separate toaster and watch every ingredient.

    Share this comment


    Link to comment
    Share on other sites
    Guest ColoradoSue

    Posted

    I agree with Diane. I am so hypersensitive to gluten I have to avoid the bread aisle in the grocery store. That's No Joke. I was diagnosed in 2004 but I suspect I had been active for many years. You know.... like you think you have the stomach flu or ate something really bad. I can recall several incidents of lying on the bathroom floor in severe pain over the years. It wasn't until my youngest sister was diagnosed two years before I was, that I realized I had celiac disease. Unfortunately, I have passed it on to my only child who was confirmed in 2005. I hope and pray that she hasn't passed it on to my two grandsons. Genetics being what they are, she probably has. I just want to make the point that even a so-called minimal amount of gluten contamination will destroy parts of your small intestine whether you feel it or not. Extreme vigilance are the words to good health. The consequences can be deadly.

    Share this comment


    Link to comment
    Share on other sites

    I would never purposely take the chance and consume even 2mg of gluten daily. Any trace amounts and I retain fluid, feel moody, and chance getting a yeast infection. I was diagnosed in Aug. 2004 and from the time I was 15-24 I had a yeast infection almost every month. Since the start of a strict gluten free diet I haven't had one, I just wouldn't chance it, it is just not worth it for me.

    Share this comment


    Link to comment
    Share on other sites

    Site answered most of my concerns. Thank you.

    Share this comment


    Link to comment
    Share on other sites

    I am so glad to see that some others feel as I do that there must be a spectrum of reactions to gluten. I decided to broaden my menu and now when I'm out or confronted with gluten containing foods I go ahead and eat. As long as i am on a MOSTLY gluten-free diet the rest of the time I'm fine! Life is much easier that way! I don't think all of us need to be as super-strict as I first thought.

    Share this comment


    Link to comment
    Share on other sites
    I am so glad to see that some others feel as I do that there must be a spectrum of reactions to gluten. I decided to broaden my menu and now when I'm out or confronted with gluten containing foods I go ahead and eat. As long as i am on a MOSTLY gluten-free diet the rest of the time I'm fine! Life is much easier that way! I don't think all of us need to be as super-strict as I first thought.

    Alice: I would not recommend your approach to anyone with celiac disease or even gluten sensitivity...

    Share this comment


    Link to comment
    Share on other sites

    Very helpful article thank you! And all these folks who claim they can eat gluten and enjoy life must not be truly sensitive and if they are, somehow, they will all be very sorry someday....

    Share this comment


    Link to comment
    Share on other sites
    I am so glad to see that some others feel as I do that there must be a spectrum of reactions to gluten. I decided to broaden my menu and now when I'm out or confronted with gluten containing foods I go ahead and eat. As long as i am on a MOSTLY gluten-free diet the rest of the time I'm fine! Life is much easier that way! I don't think all of us need to be as super-strict as I first thought.

    I do so hope you are right. I was just diagnosed with celiac although I have never had any symptoms (I went to the doctor suffering from what turned out to be food poisoning and he tested me for celiac without telling me he was doing so). I have always lived for food and cannot IMAGINE going the rest of my life without a slice of baguette or a piece of chocolate cake. I'm happy to strictly limit gluten, but never eat it again? I cannot fathom it.

    Share this comment


    Link to comment
    Share on other sites


    Your content will need to be approved by a moderator

    Guest
    You are commenting as a guest. If you have an account, please sign in.
    Add a comment...

    ×   Pasted as rich text.   Paste as plain text instead

      Only 75 emoji are allowed.

    ×   Your link has been automatically embedded.   Display as a link instead

    ×   Your previous content has been restored.   Clear editor

    ×   You cannot paste images directly. Upload or insert images from URL.


  • Ads by Google:

  • About Me

    Jefferson Adams is a freelance writer living in San Francisco. He has covered Health News for Examiner.com, and provided health and medical content for Sharecare.com. His work has appeared in Antioch Review, Blue Mesa Review, CALIBAN, Hayden's Ferry Review, Huffington Post, the Mississippi Review, and Slate, among others.

  • Popular Contributors

  • Ads by Google:

  • Who's Online   2 Members, 0 Anonymous, 275 Guests (See full list)

  • Related Articles

    Scott Adams
    Celiac.com 01/10/2007 – Celiac disease researchers in Italy and at the Center For Celiac Research in Baltimore, Maryland have conducted a multi center, double-blind, placebo-controlled, randomized trial involving 49 adult individuals who have biopsy-proven celiac disease, and who have been on a gluten-free diet that contains less than 5mg of gluten per day for a minimum of two years. The aim of this study was to determine whether there is a safe threshold for prolonged, daily exposure to minute amounts of gluten. Subjects in the study were divided into 3 groups which were given daily capsules that contained 0mg, 5mg or 50mg of gluten. They were given biopsies and serological screening before and after a gluten challenge. One patient who was given 10mg of gluten daily did experience a clinical relapse, but at the end of the study no significant differences in the IEL count were found between the 3 groups, which lead the researchers to conclude that "(t)he ingestion of contaminating gluten should be kept lower than 50 mg/d in the treatment of celiac disease."
    This study is in line with past gluten threshold studies, and to help you put the amounts of gluten used in the study into perspective, and to demonstrate why the 20 ppm for naturally gluten-free products used in the Codex Alimentarius gluten-free standards is considered to be a safe threshold for those with celiac disease, the following discussion will attempt to quantify just how much gluten it takes to make 50mg.
    The amount of gluten contained in your average 30g slice of wheat bread is around 4.8 grams, or 4,800 milligrams (amount of gluten in wheat bread is normally 10% by weight). If you divide 4,800 by 50 it equals 96, so if divide an ordinary slice of bread into 96 pieces, that is roughly how much daily gluten, according to this study, appears to be safe for those with celiac disease.
    Here is a formula that can be used to determine the number of milligrams of gluten in foods based on the parts per million (ppm) of gluten in the product. The formula is: Products ppm times the number of grams of food divided by 1,000 which equals the number of milligrams. The Codex Alimentarius specifies that naturally gluten-free products contain less than 20ppm, and products that are rendered gluten-free such as Codex quality wheat starch contain less than 200ppm. Using this formula we can determine how many slices of 20ppm and 200ppm gluten-free bread a person with celiac disease would have to eat to consume 50mg of gluten. Here is the math:
    20ppm x 30g/1,000 = 0.6 mg. So each slice of 20ppm gluten bread contains 0.6mg of gluten. To get 50mg of gluten per day while eating this type of bread you would have to consume 83.33 slices of it! 200ppm x 30g/1,000 = 6 mg. So each slice of 200ppm gluten bread contains 6mg of gluten. To get 50mg of gluten per day while eating this type of bread you would have to consume 8.33 slices of it. The goal of this study (and this article) is not to encourage people with celiac disease to eat gluten. The reality is that cross-contamination of supposedly gluten-free products is very common, and many of us who are on gluten-free diets still unknowingly ingest tiny amounts of gluten on a daily basis. Studies like this can help provide some sense of perspective with regard to how concerned one should be about minute gluten ingestion, and hopefully this article will help you to understand exactly what the 50mg threshold found in the study means. An article called Gluten-phobia in the Winter 2007 issue of Scott-Free Newsletter further addresses what can happen when someone takes their fear of gluten too far and lets it disrupt their life in ways that are so psychologically unhealthy that the negative effects to the author and those around her may actually rival those of the disease itself.
    Here are some links to additional information on this topic:
    FDAs Responses to Public Comments on the Draft Report Approaches to Establish Thresholds for Major Food Allergens and for Gluten in Food Detection of Cereal Proteins and DNA Using MS, ELISA, and PCR  
    Comments by Susan Phillips Clavarino:
    I read with interest your remarks about the Catassi/Fasano study. As an active member of the AIC (Association of Italian Celiacs), sponsors of the study, and as the person responsible for revising the language of the text for publication…the study does raise some serious queries about background gluten contamination and its impact on the celiac intestine. When the authors remark that the IELs do not show a difference among the three groups of celiacs on long term gluten free diet (though not compared to the non celiac disease controls), they point out that the villous height/crypt depth ratio is a more valid and more sensitive marker of gluten trace contamination in celiacs on long-term dietary treatment. They also remark that "Despite the restricted criteria adopted in this study, the baseline duodenal biopsy results showed evidence of histologic damage (decreased median Vh/celiac disease count and increased median IEL count in adult celiac disease patients receiving long-term dietary treatment. Furthermore, 4 of 49 subjects had to be excluded from the protocol because severe enteropathy (obscuring the possible effects of the micro challenge) was detected at the baseline evaluation. These results confirm that an abnormal small bowel morphology persists in a significant proportion of celiac disease patients treated with a gluten-free diet, despite full resolution of their symptoms..."(due to)"... the ongoing ingestion of gluten, either deliberate or inadvertent, causing persistent inflammation in the small-intestinal mucosa..." etc.
    As all medically diagnosed Italian celiacs receive a free monthly allowance of naturally (i.e. no wheat starch) gluten free products containing less than 20 ppm from the Italian government health service, and as all the volunteers for the study considered themselves to be healthy (otherwise they would certainly not have volunteered), the finding that 4 out of 49 had to be excluded for severe enteropathy and that histologic damage persists in a significant proportion of adult celiac disease patients on long-term gluten-free diet, besides the other findings of the study (i.e. that 50 mg of gluten per day for only 3 months of trial results in measurable intestinal damage, while there was significant improvement in the placebo group during the strictly monitored trial) is not reassuring. In the light of the Catalan study on the amount of gluten-free dietary foods actually consumed by celiacs in Europe - together with the constant risk of involuntary background contamination and the varying degrees of individual sensitivity - the absolute maximum threshold of ppm in gluten-free products must be kept below 20 ppm. This is a very far cry from the current wording of the Codex Alimentarius which is based on the old standard of the nitrogen content in food.
    I hope that these words may help to clarify the importance of the work done by Profs. Catassi and Fasano, the Association of Italian Celiacs, the study by the Catalan research group (previously cited on your website), and the need for further research and information as to the impact of micro-traces of gluten on celiac disease and its complications so as to ensure that celiacs may make fully informed decisions about their dietary choices.


    Kathleen La Point
    Celiac.com 09/08/2008 - Processed foods often contain ingredients derived from starch, such as dextrose (glucose) and maltodextrins. In the United States, these starch products are typically made from corn and are safe for people with celiac disease. However, more than 50% of the processed foods from Europe contain ingredients that are made from wheat starch and therefore contain trace amounts of gluten. This can pose a problem when eating imported foods or when traveling because the amount of gluten required to trigger symptoms in people with celiac disease is still under investigation and not yet completely understood.  For this reason, researchers in Finland have tested the safety of eating processed foods containing these wheat starch products.
    Researchers recruited 90 adults who had been eating a strict gluten-free diet for at least a year, and randomly assigned them to one of three groups. Depending on the group assignment, participants daily consumed drinks containing wheat-based glucose syrup, wheat-based maltodextrins, or a placebo with no wheat starch. The amount of glucose syrup or maltodextrins given to the participants in the first two groups was comparable to the amount of gluten a person might consume while eating an average amount of processed foods.
     Effects of the wheat starch products were tested in several ways. To determine whether the trace amounts of gluten were sufficient to trigger an immune reaction, researchers examined biopsies of the small intestine for signs of inflammation and damage, and tested the blood for specific antibodies that are elevated after gluten consumption.  Small intestine biopsies taken after 24 weeks of wheat starch product consumption did not show increased damage or inflammation compared to biopsies taken before the study began, or compared to biopsies of subjects consuming the placebo.  Similarly, levels of antibodies were not increased by daily consumption of this very small quantity of gluten.
    Because eating gluten reduces nutrient absorption in people with celiac disease, blood levels of iron, folic acid, and calcium were tested in all three groups before and after the 24 week study.  Concentrations of these nutrients did not decrease in any of the groups during the study, indicating that nutrient absorption was not affected by this amount of wheat starch consumption. Additionally, gastrointestinal symptoms, such as diarrhea, indigestion, constipation, abdominal pain, and gastro-esophageal reflux, did not increase significantly in any group and none of the patients who suffered from dermatitis herpetiformis developed a rash during the study.
    Results of this study suggest that the trace amounts of gluten in processed foods containing wheat starch products were not harmful for most people with celiac disease. Although additional studies will help clarify the issue, it may be unnecessary for people to avoid these products, making it easier to adhere to a “gluten-free” diet.
    Kaukinen K, Salmi T, Huhtala H, et al. Clinical trial: gluten microchallenge with wheat-based starch hydrolysates in celiac disease patients:  a randomized, double-blind, placebo-controlled study study to evaluate safety. Alimentary Pharmacolgy 
    Aliment Pharmacol Ther. 2008 Aug 17.
    Departments of Gastroenterology and Alimentary Tract Surgery, University of Tampere and Tampere University Hospital, Tampere, Finland.


  • Recent Articles

    Jefferson Adams
    Celiac.com 06/21/2018 - Would you buy a house advertised as ‘gluten-free’? Yes, there really is such a house for sale. 
    It seems a Phoenix realtor Mike D’Elena is hoping that his trendy claim will catch the eye of a buyer hungry to avoid gluten, or, at least one with a sense of humor. D’Elena said he crafted the ads as a way to “be funny and to draw attention.” The idea, D’Elena said, is to “make it memorable.” 
    Though D’Elena’s marketing seeks to capitalizes on the gluten-free trend, he knows Celiac disease is a serious health issue for some people. “[W]e’re not here to offend anybody….this is just something we're just trying to do to draw attention and do what's best for our clients," he said. 
    Still, the signs seem to be working. D'elena had fielded six offers within a few days of listing the west Phoenix home.
    "Buying can sometimes be the most stressful thing you do in your entire life so why not have some fun with it," he said. 
    What do you think? Clever? Funny?
    Read more at Arizonafamily.com.

    Advertising Banner-Ads
    Bakery On Main started in the small bakery of a natural foods market on Main Street in Glastonbury, Connecticut. Founder Michael Smulders listened when his customers with Celiac Disease would mention the lack of good tasting, gluten-free options available to them. Upon learning this, he believed that nobody should have to suffer due to any kind of food allergy or dietary need. From then on, his mission became creating delicious and fearlessly unique gluten-free products that were clean and great tasting, while still being safe for his Celiac customers!
    Premium ingredients, bakeshop delicious recipes, and happy customers were our inspiration from the beginning— and are still the cornerstones of Bakery On Main today. We are a fiercely ethical company that believes in integrity and feels that happiness and wholesome, great tasting food should be harmonious. We strive for that in everything we bake in our dedicated gluten-free facility that is GFCO Certified and SQF Level 3 Certified. We use only natural, NON-GMO Project Verified ingredients and all of our products are certified Kosher Parve, dairy and casein free, and we have recently introduced certified Organic items as well! 
    Our passion is to bake the very best products while bringing happiness to our customers, each other, and all those we meet!
    We are available during normal business hours at: 1-888-533-8118 EST.
    To learn more about us at: visit our site.

    Jefferson Adams
    Celiac.com 06/20/2018 - Currently, the only way to manage celiac disease is to eliminate gluten from the diet. That could be set to change as clinical trials begin in Australia for a new vaccine that aims to switch off the immune response to gluten. 
    The trials are set to begin at Australia’s University of the Sunshine Coast Clinical Trials Centre. The vaccine is designed to allow people with celiac disease to consume gluten with no adverse effects. A successful vaccine could be the beginning of the end for the gluten-free diet as the only currently viable treatment for celiac disease. That could be a massive breakthrough for people with celiac disease.
    USC’s Clinical Trials Centre Director Lucas Litewka said trial participants would receive an injection of the vaccine twice a week for seven weeks. The trials will be conducted alongside gastroenterologist Dr. James Daveson, who called the vaccine “a very exciting potential new therapy that has been undergoing clinical trials for several years now.”
    Dr. Daveson said the investigational vaccine might potentially restore gluten tolerance to people with celiac disease.The trial is open to adults between the ages of 18 and 70 who have clinically diagnosed celiac disease, and have followed a strict gluten-free diet for at least 12 months. Anyone interested in participating can go to www.joinourtrials.com.
    Read more at the website for Australia’s University of the Sunshine Coast Clinical Trials Centre.

    Source:
    FoodProcessing.com.au

    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.