• 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

    71,839
    Total Members
    3,093
    Most Online
    Cheech
    Newest Member
    Cheech
    Joined
  • Announcements

    • admin

      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
  • 0

    RESEARCH STUDY ON THE ESTABLISHMENT OF A SAFE GLUTEN THRESHOLD FOR CELIAC DISEASE PATIENTS


    admin


    Ads by Google:




    ARTICLE CONTINUES BELOW ADS
    Ads by Google:



    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:

     

    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.


    0


    User Feedback

    Recommended Comments

    Guest john hardesty

    Posted

    I only need 1 part per million and it puts me in the hospital. I just ate a "gluten free" loaf and I'm very sick right now.

    Share this comment


    Link to comment
    Share on other sites

    I have eaten an estimated 4 slices of whole wheat bread (120 grams) daily for several years. Using the 10% figure described above, this is 12 grams/day. Suppose I reduced it to 1 gram/day (a 92% reduction). This is still way more than the 50 mg/day limit described above. If I am gluten sensitive, shouldn't this help a lot?

    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 emoticons maximum 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.


  • Popular Contributors

  • Ads by Google:

  • Who's Online   4 Members, 0 Anonymous, 1,151 Guests (See full list)

  • Related Articles

    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.



  • Recent Articles

    Jefferson Adams
    Celiac.com 04/20/2018 - A digital media company and a label data company are teaming up to help major manufacturers target, reach and convert their desired shoppers based on dietary needs, such as gluten-free diet. The deal could bring synergy in emerging markets such as the gluten-free and allergen-free markets, which represent major growth sectors in the global food industry. 
    Under the deal, personalized digital media company Catalina will be joining forces with Label Insight. Catalina uses consumer purchases data to target shoppers on a personal base, while Label Insight works with major companies like Kellogg, Betty Crocker, and Pepsi to provide insight on food label data to government, retailers, manufacturers and app developers.
    "Brands with very specific product benefits, gluten-free for example, require precise targeting to efficiently reach and convert their desired shoppers,” says Todd Morris, President of Catalina's Go-to-Market organization, adding that “Catalina offers the only purchase-based targeting solution with this capability.” 
    Label Insight’s clients include food and beverage giants such as Unilever, Ben & Jerry's, Lipton and Hellman’s. Label Insight technology has helped the Food and Drug Administration (FDA) build the sector’s very first scientifically accurate database of food ingredients, health attributes and claims.
    Morris says the joint partnership will allow Catalina to “enhance our dataset and further increase our ability to target shoppers who are currently buying - or have shown intent to buy - in these emerging categories,” including gluten-free, allergen-free, and other free-from foods.
    The deal will likely make for easier, more precise targeting of goods to consumers, and thus provide benefits for manufacturers and retailers looking to better serve their retail food customers, especially in specialty areas like gluten-free and allergen-free foods.
    Source:
    fdfworld.com

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

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

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

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

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

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

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

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

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

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

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

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

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

    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