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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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    AUSTRALIAN CELIACS FIGHT TO KEEP TOUGH GLUTEN-FREE STANDARDS


    Jefferson Adams

    Celiac.com 02/06/2015 - Australia is home to some of the most stringent gluten-free product standards in the world. Under current standards, all “gluten free" products sold in Australia must contain about three parts or fewer per million.


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    Photo: CC--Pabak SarkarThe food industry would like the standard set at 20 parts per million, which would bring Australia into line with the United States, and the EU.

    Moreover, Coeliac Australia, a major celiac advocacy group, has suggested that Australia’s strict standards are becoming unworkable, as improved tests permit detection of smaller and smaller amounts of the gluten protein. The group has signaled an openness to the industry plan to lower the standards to 20ppm gluten content.

    Such a move would allow a much wider range of products to be sold in Australia as “gluten-free, ” but would potentially impact hundreds of thousands of Australians who suffer from celiac disease and gluten-sensitivity, many of whom who fear it will save money for manufacturers while triggering severe illnesses in their population.

    The push to change the definition of "gluten free” is being driven by the food and grocery council, which includes major grocery chain Coles.

    Coles happens to be one of Coeliac Australia’s biggest sponsors.

    However, in the face of vociferous opposition to such changes, Coeliac Australia has backtracked from its initial support, and has announced that it will now review its position.

    What do you think? Is Australia’s gluten-free standard too tough? Will it be better to change the standard to match that of the U.S. and the E.U.? Or would it be better to change American and European standards to match Australia. Share your thoughts below.

    Read more at SMH.com.


    Image Caption: Photo: CC--Pabak Sarkar
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    I hope they hold tough. I feel the 20 ppm standard in the U.S. is not good enough for me. I find I have a slight celiac reaction (rash) going most of the time even though I eat only gluten free foods.

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    Guest SHansen

    Posted

    Definitely have US/Canada standards change to Australia's standards. As previously read in another article, and for those that have celiac ... 20ppm still has gluten and therefore bad for celiac ... 10ppm still has gluten and therefore bad for celiac. 3ppm still has gluten and therefore bad for Celiac.

     

    Yet again we see the standards of our health being at risk all for the convenience of an industry - in this case manufacturers. This is just as horrible as marking the packages May Contain just to be lazy/safe!! Keep Australia Safe!! Fix the standards in other countries to match!!

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    Guest Michael

    Posted

    When I met with Dr. Rodney Ford of New Zealand in October 2012, he urged us to not accept the 20ppm gluten-free labeling standard. I am an extra sensitive celiac and ataxia and cannot consume food processed in a facility that processes wheat. I hope the Australians fight to keep 3ppm.

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    I am an Australian and have not traveled to US/EU since diagnosis 5 years ago. I do, however, live in another country where products are imported from both Australia/NZ and the US.

     

    Whilst I will purchase products from the US labelled as gluten-free, I still read the labels. To date, I have not had an adverse reaction. It is useful to note that Australians who are diagnosed with coeliac disease are told not to eat oats - so purchasing products from US/EU is more challenging as they may be labelled gluten-free but could still contain oats.

     

    In respect to whether it would be better for Australia to increase to 20ppm or for EU/US to change to Australian rules - I would suggest that consistency would be good, but the consistency would also need to consider whether oats are in or out of a gluten-free diet.

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    20ppm is obviously good enough for those eliminating gluten for general health purposes. For those with extreme gluten sensitivity this may well be 'not good enough'. Extensive testing of what levels are ok for everybody should surely be a prerequisite to legislating a standard (anywhere).

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    Guest Deborah

    Posted

    I too believe they should hang tough - those of us who are extremely sensitive are better served by the stricter standard.

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    Guest Sherine

    Posted

    I fully agree that all the countries must meet up to the standards of Australia. As I dream of a day that I can travel and eat out without fear of falling sick.

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    I do hope they hold out (and win) for the 3 ppm gluten levels. I feel that the 20 ppm standard is too high here (I am a very sensitive celiac). Our policy makers have the habit of lowering standards, whether it be for water contaminants, pesticides, et al. Never to our benefit. I rarely eat gluten-free products but opt for fresh, whole foods.

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    Guest Susie

    Posted

    First, Australia should be the standard all the other countries should rise to meet. For those of you who can tolerate the 20ppm which I cannot, please remember that even though you might not be having visible symptoms, the damage could still be happening! Second, since when should standards be determined by the food industry? They already charge more just to say "gluten free" and now you've made it easier for them to not be careful when preparing "gluten free" foods.

    3) Would a food containing 20ppm of sugar be able to be labeled "sugar free"?

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    Guest admin

    Posted

    First, Australia should be the standard all the other countries should rise to meet. For those of you who can tolerate the 20ppm which I cannot, please remember that even though you might not be having visible symptoms, the damage could still be happening! Second, since when should standards be determined by the food industry? They already charge more just to say "gluten free" and now you've made it easier for them to not be careful when preparing "gluten free" foods.

    3) Would a food containing 20ppm of sugar be able to be labeled "sugar free"?

    You are making the mistake of assuming that the highest possible level of gluten allowed in foods, 20 ppm, is actually in those foods. This is not the case. Most gluten-free foods test well under this level, and yes, if a food contained only 20 ppm of sugar your would not be able to taste any sweetness, and it likely could easily be labelled "sugar free."

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    Guest Crystal

    Posted

    I think the U.S. and Europe should change their standards to match up with Australia's current standards. Just because a food is certified doesn't mean somebody with celiac disease won't get a glutened when they eat it. 20 ppm is too much for some people to tolerate, so that label isn't trustworthy. The FDA's standards are clearly set too low and need to be more stringent.

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    admin
    This article comes to us from Frederik Willem Janssen, Zutphen, The Netherlands, e-mail: teizjanz@PI.NET. If you have specific questions about it, please contact him directly.
    The Codex Alimentarius provides the gluten-free standard for European food manufacturers.  This article will deal with  foods that are officially labeled as "gluten free."
    In the European Union there is a directive on foods for special dietary uses (89/398/EEG), and this directive is the basis for all national legislation in the countries of the European Union. Though the directive deals with gluten-free foods there is no assigned limiting level of gluten for gluten-free food yet, so it is up to the national regulatory bodies of the member states to set their own level. There is however, an international body handling these matters: Codex Alimentarius.
    Codex Alimentarius is a Geneva based International organization jointly run by the WHO and the FAO, and its aim is to establish worldwide standards for foods in the broadest sense. Food legislation in many countries is based on Codex Standards, although it is not mandatory to implement them in all cases. There is a Codex committee producing standards on food labeling, on hygiene, on composition etc., etc. There is a committee on Foods for Special Dietary Uses (FSDU) and ... there is a Standard on gluten-free Food!
    The oldest Standard dates from 1981, and it says that foods may be labeled as "gluten-free" only if the nitrogen content of the protein derived from wheat is less than 50 mg N/100 gm on dry matter, which may be equivalent to about 20-30 mg gliadin in wheat starch. The calculation is quite complicated by the fact that most of the protein in wheat starch is "starch granule protein" and not gluten.
    There is a new Codex Standard in preparation, and a proposal to set the limiting level of gluten to 200-mg gluten/kg (20-mg/100 g) gluten-free food on dry matter. If we assume that half of the gluten is gliadin, this equals 10-mg gliadin/100 g o.d.m., so the level has gone down by a factor two in comparison to the "old" standard. If accepted, the new standard will be valid for end products and not for raw materials. In my previous posting I already mentioned that there are comments on the proposal from Sweden (
    One of the reasons why the level in the Standard has not yet been effected (the proposal has been dealt with already two years ago) is that there is no validated analytical method (ring-tested) available to check compliance to this level. Though it might look rather simple to analyze gluten, it is generally done with an Enzyme Linked Immuno Sorbent Assay - ELISA, it is in fact very tricky, and especially as the term gluten is very imprecise. Gluten is a mixture of gliadin and glutenin - each composed of several sub-fractions - and its composition with respect to sub-fractions is cultivar dependent. There is also an effect on the recovery caused by the heat processing of the food, and although excellent work has been done by Dr Skerrit of CSIRO in Australia to circumvent this problem (he designed a method based on omega gliadin, which is the most heat stable gliadin fraction), there is still a feeling that this method still needs to be improved. Remember that agencies charged with enforcement of food laws must be able to bring suits against producers of non-complying gluten-free foods. So analytical methods need to be robust and accurate.
    Codex Alimentarius bases its standard on scientific facts, and thats why there is no zero tolerance. There is simply no scientific evidence that this is required (at least there is no concordant view among scientists about the maximum tolerable gluten intake), and it is reasoned that any unduly reduction in the permissive level will reduce the number of gluten-free food available unnecessary.
    Though Codex Alimentarius has been criticized in the past for being a food-producer driven body it is still the only world-wide forum for food standards, and its role within the framework of the GATT and WTO makes its work of sterling importance in settling trade disputes. In 1993 the National Food Alliance (UK NGO) produced a report titled "Cracking the Codex." This report stated that even though the voting in Codex is nationwide, and quite often by consensus, there is a large impact of the producer lobby, especially in the preliminary stages of decision making.
    Even though there is no implemented standard in national legislation many countries will stick to the Codex Standard. The conclusion is that in many countries food labeled as "gluten free" will almost definitely contain gluten. As the regulatory agencies of most countries will not press charges against producers of gluten-free foods if the level is below the Codex Standard limit (though, as said, some countries may have lower regulatory levels). Codex Standards still do not have the status of national laws.


    admin
    Celiac.com 01/25/2007 - Under an FDA proposal published yesterday, food companies will have to meet new standards before labeling their products as gluten-free. It also provided a new definition for gluten-free which will give individuals with celiac disease greater confidence that specially labeled foods are in fact, safe for them to eat, according to the American Celiac Disease Alliance (ACDA).
    The Food Allergen Labeling and Consumer Protection Act (FALCPA) passed by Congress in 2004, requires food manufacturers to clearly state if a product contains any of the eight major food allergens: milk, eggs, peanuts, tree nuts, fish, shellfish, wheat, and soy. It also required the FDA to develop and implement rules for using the term ‘gluten-free’ on food packaging.
    Adhering to the gluten-free diet is the only course of treatment for celiac disease, a genetic digestive disorder. The condition, triggered by eating the protein gluten which is found in the grains wheat, rye, and barley, and hybrids of these grains affects an estimated 2 to 3 million Americans.
    There is no single, world-wide accepted definition of gluten-free labeling. The levels of acceptable gluten vary from country to country, as do the symbols and terminology, permissible in the labeling. Research establishing a safe threshold of gluten consumption for those with celiac disease was recently published in the American Journal of Clinical Nutrition. The study, conducted by members of the ACDA at the University of Maryland and referenced by the FDA, concludes that celiacs can safely tolerate up to 20 parts per million (ppm) of gluten a day.
    “The FDA listened to patients, food manufacturers, and members of the scientific community and came up with a well thought out proposal,” said Andrea Levario, Executive Director of the ACDA.
    There is so little research about the gluten-free diet and safe consumption levels that the agency is seeking comments on a number of related issues including: The appropriateness of 20 ppm gluten as the proposed threshold level as determined using an ELISA based testing method; The effect that adoption of a lower threshold level would have on individuals with celiac disease and on industry; Whether a lower threshold level might effect (limit availability of) commercially available foods labeled gluten-free in the United States; Whether a reduced availability would have a negative impact individuals with celiac disease; and Whether oats should be included in the definition of prohibited grains. In the absence of federal rules, food companies have been using a variety of standards in manufacturing gluten-free products. This creates confusion and skepticism among individuals whose health depends on clear, accurate labeling. With only 90,000 out of an estimated 2 million celiacs diagnosed, manufacturers know that uniformity and consistency will benefit them as well consumers, said Levario.
    The FDA has prepared a series of questions and answers to help consumers understand the provisions of the proposal. For a copy go to: http://www.cfsan.fda.gov/~dms/glutqa.html ; and for a copy of the gluten-free labeling guidelines go to: http://www.cfsan.fda.gov/~lrd/fr070123.html .
    About the ACDA
    The American Celiac Disease Alliance (ACDA) was established in March 2003 to provide leadership on public policy issues affecting those with celiac disease, an inherited autoimmune disorder affecting children and adults. The non-profit serves as a national umbrella organization representing all segments of the celiac community -- research centers, physicians, patients, food manufacturers, print media, and the service industry.

    Jefferson Adams
    Celiac.com 07/23/2008 - Folks who follow a gluten-free diet can take comfort that the Codex Alimantarius, the international body responsible for setting food safety standards, has moved a step closer to adopting the gluten-free standards they drafted in November 2007, and their new standards are, for the most part, in-line with the proposed FDA regulations. However, those hoping for speedy adoption of similar standards by the FDA will just have to wait until the FDA takes one last round of public comment and evaluates safety standards used in developing the standards. Certainly, anticipation has been running high, as several blogs and otheronline sources have wrongly claimed that the new FDA standards will go intoeffect in August 2008.
    From June 30 to July 5, 2008, the Codex Alimentarius Commissionrecently held their 31st session, where they accepted without changethe 2007 Draft Revised Codex Standard for Foods for Special Dietary Usefor Persons Intolerant to Gluten. According to the latest CodexAlimentarius standard, any product labeled “gluten-free,” includingthose made from de-glutened wheat starch will contain no more than 20parts gluten per million. This last part is especially important, astheir earlier standards for the use of “gluten-free” on labels allowedup to 200 parts gluten per million if the product contained ingredients that normally contained gluten. The 2007 standard still includes a special category for foods that are not naturallygluten-free, but have been rendered gluten-free through processing, such as wheat starch that has had its gluten removed. Thiscategory is called “foods specially processed to reduce gluten to alevel above 20 up to 100 milligrams per kilogram.” The Codex Alimentarius Committee has yet to post the new standard on the their website.
    The adoption of a less than 20 ppm standard on foods labeled "gluten-free" by both the Codex Alimentarius and the FDA would mean that consumers across Europe and North America could count on a single, uniform standard for food that is labeled "gluten-free." This new standard has been driven primarily by the efforts of celiac disease support groups, people diagnosed with celiac disease, and gluten-free diet followers, whose influence also led to the creation and passage of the Food Allergen Labeling and Consumer Protection Act in 2004.
    The FDA will not issue their final ruling until they make the draft available for public review and consider one more round of commentary, along with previous public comments, as well as publishing a notice on the safety assessment made in developing the final rule. The FDA will likely publish the notice on the safety assessment soon, but there is no indication as to just when they will issue the final rule.
    A large part of the celiac community has been eagerly anticipating the announcement of the final rule. Until that great day, all of you gluten-free folks will just have to be content knowing that solid, reliable standards for the use of the term "gluten-free" on food labels are just around the corner.
    The next session of the Codex Alimentarius Commission will be held from 29 June to 4 July 2009 in Rome.
    Here are the new Codex Alimentarious Standards for Gluten-Free foods, which will appear on their Web site soon:

    2.1.1 Gluten-free foods
    Gluten-free foods are dietary foods
    a) consisting of or made only from one or more ingredients which do not contain wheat (i.e., all Triticum species, such as durum wheat, spelt, and kamut), rye, barley, oats1 or their crossbred varieties, and the gluten level does not exceed 20 mg/kg in total, based on the food as sold or distributed to the consumer,and/or
    consisting of one or more ingredients from wheat (i.e., all Triticum species, such as durum wheat, spelt, and kamut), rye, barley, oats1 or their crossbred varieties, which have been specially processed to remove gluten, and the gluten level does not exceed 20 mg/kg in total, based on the food as sold or distributed to the consumer.
    2.1.2 Foods specially processed to reduce gluten content to a level above 20 up to 100 mg/kg
    These foods consist of one or more ingredients from wheat (i.e., all Triticum species, such as durum wheat,spelt, and kamut), rye, barley, oats1 or their crossbred varieties, which have been specially processed to reduce the gluten content to a level above 20 up to 100 mg/kg in total, based on the food as sold or distributed to the consumer.
    Decisions on the marketing of products described in this section may be determined at the national level.

    Jefferson Adams
    Celiac.com 07/20/2012 - Many of the millions of Americans who suffer from celiac disease and gluten-intolerance are eagerly awaiting the FDA's forthcoming standards for gluten-free product labeling. Until then, different agencies may apply differing standards, often with confusing results.
    The recent dust-up between Widmer Bros. brewing of Oregon, one of many breweries crafting gluten-free beers, and the Treasury Alcohol and Tobacco Tax and Trade Bureau ("TTB") over the ingredients in Widmer's gluten-free brew, provides a good illustration of the confusion that can arise when different sets of standards and rules govern what can and cannot be called 'gluten-free.'
    Widmer Bros. is a division of Craft Brew Alliance (CBA), the nation’s ninth’s largest brewing company, and recently unveiled two new gluten-free beers, Omission Gluten Free Lager and Omission Gluten Free Pale Ale. Unlike most gluten-free beers, which are brewed from sorghum and usually taste very different than traditional beers, Omission is made using traditional ingredients, including barley--which contains gluten.
    Widmer then uses enzymes to reduce the gluten in both beers to a level that is well below the 20 parts per million (ppm) gluten threshold set by the World Health Organization for gluten-free products; the very standard likely to be followed soon by the FDA. Professional testing show gluten levels for Omission beers at just 5-6 ppm. Meanwhile, those familiar with the final products say they taste very much like traditional beers.
    However, it is not the gluten levels in the beer that seems to be at issue, but the fact that Widmer begins their brewing process with barley and other traditional ingredients. According to the TTB, wine, beer or distilled spirits made from ingredients that contain gluten cannot be labeled as ‘gluten-free.’
    Certainly the commonly accepted European standard of 20 ppm means that the vast majority of products labeled 'gluten-free' still contain measurable levels of gluten, a good deal of those likely above the 5-6 ppm of Widmer's beers.
    For beer drinkers with celiac disease, finding a gluten-free beer that tastes like a traditional beer is like finding the Holy Grail. Given that Omission beers supposedly taste closer to traditional beers than most gluten-free beers currently on the market, and given that they come in well below the standard for products to be labeled gluten-free, there are undoubtedly a number of people with celiac disease and gluten-intolerance that are hoping Widmer will prevail in their battle against the TTB.
    What do you think? Should the gluten-free standard be based on scientifically established gluten levels of the final product, or on the gluten levels in the ingredients originally used to create it? Should Widmer be allowed to label and sell their Omission beers as 'gluten-free?'
    Source:
    KXL.com

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    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.
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    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.
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    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