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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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    FORM LETTER TO CONGRESS TO URGE SUPPORT FOR BETTER FOOD LABELING REGULATION


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    The following letter was prepared by Nancy of the Gluten Intolerance Group in Seattle, WA:

     

    Directions:

    • Find your representatives e-mail addresses at: http://www.house.gov/writerep/.
    • Highlight the letter below with your mouse.
    • Copy (Control-C) it to your notepad.
    • Paste it (Control-V) into an e-mail to them, or into the e-mail form at the site above.

    Representative or Senator
    Address

    Honorable (Senator)
    Or
    Distinguished (Representative)

    I urge you to cosponsor the legislation that Representative Nita Lowey and Senator Edward Kennedy will introduce to tighten the regulation of food-allergens. Millions of Americans have food allergies, and each year about 150 people in the United States die from anaphylactic shock caused by a food allergy. Metabolic disorders, such as gluten intolerance, also require careful and strict elimination of certain foods from a persons diet to maintain normal health. Over 1.3 million people in the USA suffer from gluten intolerance, which requires strict elimination of wheat, rye and barley from the diet.

    A 2000 survey conducted jointly by the Food and Drug Administration, Minnesota, and Wisconsin found that one-quarter of the bakery products, candy, and ice cream sampled were contaminated with peanut or egg ingredients that were not declared on the product labels. Undeclared allergens may cause immediate reactions, or slow destruction of the intestine and long-term health complications associated with malnutrition.

    Representative Lowey has said that the legislation would require companies to list the major allergens (including those in spices, flavorings, and colorings) by their common English names and to include a telephone number on the label that consumers could call for more information. The legislation would also require manufacturers to better prevent cross-contact between products made in the same facility or on the same production line, allow the Food and Drug Administration to assess penalties against firms that violate the food allergen requirements, and require the Centers for Disease Control to establish a system for tracking food allergy-related deaths. In addition, Congress should also require companies to indicate on labels that the food may contain allergens when the possibility of contamination cannot be totally excluded.

    Rye and barley must be included in the list of allergens declared on labels. This addition will better serve all persons with allergies and intolerances.

    I urge you to cosponsor this important public health legislation, with the above-recommended addition.

    Sincerely,


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    admin


    This update comes to us from Frederik Willem Janssen, The Netherlands: fwjanssen@WXS.NL
    About a week ago I promised to post info about agenda item 4 (Gluten Free Food) as dealt with at the meeting of Codex Alimentarius NFSDU (Nutrition and Food for Special Dietary Uses) which was held in September in Berlin Germany. As usual this meeting starts on Monday and continues till Wednesday, Thursday is a day off (time for the secretariat to draw resolutions) and on Friday these draft resolutions are discussed. Unfortunately I wasnt able to stay till Friday. However, the resolutions as discussed on Friday were handed to me afterwards however and I pass them with some corrective changes accepted during that day. For those of you who have no interest in reading this clerical stuff I summarize:
    The proposed limits (20) for food gluten-free by nature and 200 for food "rendered gluten-free" will stay between square brackets (so no decision has been made). The same holds for oats, awaiting further toxicological data about its celiac-toxicity it should be considered as toxic. The main obstacle for finalizing the standard is the lack of an appropriate method of analysis. Progress has been made but still not to that extent that enforcing agencies can be satisfied. Maybe we will see some progress in the next 2 years!
    Proposed Revisions: Alinorm 99/26, Draft Revised Standards for Gluten-Free Foods (Agenda Item 4):
    31. The Committee recalled that the Twenty-second Session of the CAC adopted the Proposed Draft Standard for Gluten-Free Foods at Step 5 while recommending that comments on methods of analysis and on amounts of gluten in gluten free foods should be taken into account when finalizing the standard. The Committee noted that without an appropriate method of analysis it was not scientifically justified to advance the Draft further.
    32. The Delegation of Sweden introduced their recent study on gluten determination in foods by an enzyme immunoassay using a monoclonal antibody against omega-gliadin (CRD 33), noting that the detection limit of the method (ref. AOAC 991.19) was about 20 - 40 ppm and the repeatability was acceptable. Some Delegations pointed out that the method presented raised some technical concerns: it was performed only on wheat and due to this, uncertainty exists as regards its applicability to other cereals. There were also concerns about the reproducibility of the method. It measured only omega-gliadin and other gliadins should also be taken into account. The need of further improvement was raised. Spain expressed concern about setting units where no method of analysis is available and not all the different types of gliadins can be detected.
    33. The Committee noted that in some cases a proprietary method was the most specific way to detect an analyte, such as in the case of gluten detection. Since Codex had not endorsed these techniques as methods of analysis of Codex, the CCMAS (Codex committee on Methods of Analysis and Sampling) should consider this problem.
    34. Several delegations suggested that the Committee should ask FAO and WHO to convene an Expert Consultation to address the issue of the level and the method of analysis. Other delegations proposed to consult the CCMAS on this issue. The Secretariat informed the Committee that on the request of the CCFL (Codex committee on Food Labeling), JECFA (Joint expert committee on Food Additives) was prepared to consider the question of hypersensitivity at its 53rd Session (June 1999) and the intolerance to gluten might be discussed in this context. The Secretariat recalled that the role of the CCMAS was to endorse methods of analysis proposed by specialized Committees and the CCNFSDU needed to specify the method.
    35. Several delegations and the Observer from the AAC (Association des Amidonneries Cooperative) proposed that the discussion of this draft should be adjourned until a reliable method of analysis became available. Other delegations were in favor of continuing work on it in order to meet the urgent need of the patients suffering from coeliac disease and proposed to advance the proposed draft for a single level of 200 ppm to step 8. Taking into account the absence of an appropriate and accurate method of analysis, it was proposed to maintain the gluten free level at 200 ppm for all foods and to include a new preamble suggesting the a revision of the standard when a method of analysis or new scientific evidence became available.
    36. While concerning the proposed definition of "gluten-free" foods, several delegations wanted to point out that the current approach was confusing and misleading the consumer and that the level should be uniform for all foods. However, other delegations and the Observer from AOECS stressed the need for two levels with regard to the naturally gluten free foods and the products which had been rendered gluten free. The Committee noted that the proposed term "gluten-free" might mislead the consumer and recognized that the term "low or reduced in gluten" should be considered.
    37. The Observer from AOECS, supported by some delegations, expressed the view that the level of 200 ppm for all gluten-free foods was too high to protect coeliacs and the gluten level should refer only to the end product for better consumer protection.
    38. The Delegation of Finland proposed to remove the oats from the list as scientific studies showed that oats can be tolerated by celiacs and allows to provide dietary fibers for coeliacs. The Observer from AOECS, supported by some delegations, stressed that the square brackets on oats should be removed as oats might have negative impact on the health of coeliacs and that the medical experts had not reached consensus on this issue.
    39. The Committee recognized that the development of reliable method of analysis of gluten was the key point of this discussion and that the development of the method should be encouraged by all means. Status of the Draft Revised Standard for Gluten-Free Foods
    40. The Committee agreed to leave the text of the draft as it was in CX/NFSDU 98/4 and to return it to Step 6 for further consideration. The Committee also agreed that the question regarding the proprietary techniques should be raised to the CCMAS as a general matter.
    The following documents were discussed during the meeting: CX/NFSDU 98/4 - Add 1 (Comments from Australia, Spain, UK, AAC, ISDI); CX/NFSDU 98/4 - Add 2 (AOECS); CRD 3 (Uruguay, ISDI); CRD 13 (USA); CRD 21 (Spain); CRD 33 = CRD 42 (Sweden); CRD 44 (India); CRD 51 (Norway).

    admin

    Celiac.com 06/02/2002 Prepared by Laura Yick - There are currently two bills in congress regarding food labeling that affect people with celiac disease. Both HR 1356 and HR 4704 were introduced by Representative Nita M. Lowey (D-NY) in the House of Representatives. S 2499 is the same as HR 4704 and was introduced by Senator Edward M. Kennedy (D-MA) in the Senate. It appears that HR 1356 is somewhat conflicting with HR 4704 and is a weaker version with less detail. HR 4704/S 2499 bill looks to be more beneficial for us (we all know the frustrations of having to verify the gluten status of foods, even if they are labeled gluten-free!), as it contains a section that deals with cross-contamination (see p.9 lines 13-25, p.10, and p.11 lines 1-2). HR 4704/S 2499 is under the control of the Secretary of Health and Human Services, however, the enforcement of cross-contamination labeling is not clear. You can compare them for yourself by going to the US Congress websites listed below. Here is a summary of each bill and a listing of the committee and subcommittee members who have control over the fate of the bills:
    House Bill H.R.1356
    Sponsor: Rep Lowey, Nita M.(introduced 4/3/2001)
    Title: To amend the Federal Food, Drug, and Cosmetic Act to require that foods containing spices, flavoring, or coloring derived from meat, poultry, other animal products (including insects), or known allergens bear labeling stating that fact and their names.
    SUMMARY AS OF: 4/3/2001--Introduced.
    Food Ingredient Right to Know Act
    Amends the Federal Food, Drug, and Cosmetic Act to provide that a food shall be deemed to be misbranded if it contains any spice, flavoring, or coloring derived from meat, poultry, any other animal product (including insects), or a known food allergen unless its labeling bears a statement with appropriate prominence on the information panel providing that fact and the name of the meat, poultry, other animal product, or known food allergen.
    STATUS:
    4/3/2001: Referred to the House Committee on Energy and Commerce (see below for list of committee members).
    4/25/2001: Referred to the Subcommittee on Health (see below for list of subcommittee members).
    07/29/2002: The food Allergen Bill S.2499 has been rescheduled for discussion after the August recess.

    House Bill H.R.4704
    Sponsor: Rep Lowey, Nita M.(introduced 5/9/2002)
    Title: To amend the Federal Food, Drug, and Cosmetic Act to establish labeling requirements regarding allergenic substances in food, and for other purposes.
    STATUS: (color indicates Senate actions)
    5/9/2002: Referred to the House Committee on Energy and Commerce.
    5/17/2002: Referred to the Subcommittee on Health.
    Senate Bill S.2499
    Sponsor: Sen. Kennedy, Edward M.(introduced 5/9/2002)
    Title: A Bill to amend the Federal Food, Drug, and Cosmetic Act to establish labeling requirements regarding allergenic substances in food, and for other purposes.
    STATUS:
    5/9/2002: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
    The current laws of the United States can be found at:
    http://law2.house.gov/download.htm
    Note that HR 4704 and S 2499 have exactly the same wording except for the sponsors. Bills in committees or subcommittees have three fates: (1) Tabled (i.e., they are essentially postponed, possibly forever), (2) Releasing it for a full House or Senate vote with a recommendation to pass it, (3) Revised and then released as in (2). Bills in committees also may be referred to subcommittees within the committee. It is possible that the Senate Committee on Health, Education, Labor, and Pensions may refer S 2499 to the Subcommittee on Public Health. The bill needs to pass with a simple majority (218 of 435 in the House, 26 of 50 in the Senate). The bill then goes to the other congressional body where the process begins again. Once both the House and Senate pass the bill, any differences between the House version and Senate version must be worked out by a conference committee of both House and Senate members. Then the bill must finally be approved by both the House and Senate. Because HR 4704 and S 2499 are concurrent, the entire process may be faster than if only one body of Congress were working on it. Finally, the President needs to approve it; otherwise, the bill goes back to the House and Senate and must pass by a 2/3 majority in both.
    If your representative or senator is listed below on a committee and/or subcommittee that is reviewing a bill, it is important that you request them to speed the committee recommendation of the bill to the full House or Senate vote and to ensure that it is not weakened. If your representative or senator is not on one of the committees or subcommittees, you could still urge them to support the speedy passage of the bills. Speedy passage is essential because there is a clause that gives a four year grace period.
    Politically, it may be especially effective for you to write your congress people regarding these bills if they are up for re-election, or if they are seeking higher office in an upcoming election, but any e-mail to your representatives will be helpful. To see who your representative is:
    http://www.house.gov/house/MemberWWW.html
    To write your representative:
    http://www.house.gov/writerep/
    To see who your senators are:
    http://www.senate.gov/senators/senator_by_state.cfm
    To write your senators:
    http://www.senate.gov/contacting/index.cfm

    Tips from the GIG on writing your letters or e-mails:
    Address the Congressman as Honorable. Keep the letter to one page. Stay on the message - The passage of Representative Lowey and Senator Kennedy Bill, the Food Allergen Consumer Protection Act is important to the health and safety of thousands of persons suffering from allergies and intolerances. Use the language used in the Bill ...gluten and allergens, not celiac disease. Tell them what you want -- for them to support passage of this Bill. Sharing a bad experience and how passage of this bill would have made a difference can be helpful...but keep it brief. Remind them you follow their votes and that you appreciate their support. Sign your name, provide your full address, and phone number. The names of Subcommittee and Committee Members who control the fate of these bills. We can make a difference with our letters and e-mail to them:
    The current House Committee on Energy and Commerce:
    W. J. Billy Tauzin, Chairman
    Michael Bilirakis, Florida
    Joe Barton, Texas
    Fred Upton, Michigan
    Cliff Stearns, Florida
    Paul E. Gillmor, Ohio
    James C. Greenwood, Pennsylvania
    Christopher Cox, California
    Nathan Deal, Georgia
    Richard Burr, North Carolina, Vice Chairman
    Ed Whitfield, Kentucky
    Greg Ganske, Iowa
    Charlie Norwood, Georgia
    Barbara Cubin, Wyoming
    John Shimkus, Illinois
    Heather Wilson, New Mexico
    John B. Shadegg, Arizona
    Charles Chip Pickering, Mississippi
    Vito Fossella, New York
    Roy Blunt, Missouri
    Thomas Davis, Virginia
    Ed Bryant, Tennessee
    Robert Ehrlich, Maryland
    Steve Buyer, Indiana
    George Radanovich, California
    Charles F. Bass, New Hampshire
    Joseph Pitts, Pennsylvania
    Mary Bono, California
    Greg Walden, Oregon
    Lee Terry, Nebraska
    Ernie Fletcher, Kentucky
    John D. Dingell, Michigan, Ranking Member
    Henry A. Waxman, California
    Edward J. Markey, Massachusetts
    Ralph M. Hall, Texas
    Rick Boucher, Virginia
    Edolphus Towns, New York
    Frank Pallone Jr., New Jersey
    Sherrod Brown, Ohio
    Bart Gordon, Tennessee
    Peter Deutsch, Florida
    Bobby L. Rush, Illinois
    Anna G. Eshoo, California
    Bart Stupak, Michigan
    Eliot L. Engel, New York
    Tom Sawyer, Ohio
    Albert R. Wynn, Maryland
    Gene Green, Texas
    Karen McCarthy, Missouri
    Ted Strickland, Ohio
    Diana DeGette, Colorado
    Tom Barrett, Wisconsin
    Bill Luther, Minnesota
    Lois Capps, California
    Mike Doyle, Pennsylvania
    Chris John, Louisiana
    Jane Harman, California
    House Committee on Energy and Commerce Subcommittee on Health:
    Michael Bilirakis, Florida, Chairman
    Joe Barton, Texas
    Fred Upton, Michigan
    James C. Greenwood, Pennsylvania
    Nathan Deal, Georgia
    Richard Burr, North Carolina
    Ed Whitfield, Kentucky
    Greg Ganske, Iowa
    Charlie Norwood, Georgia, Vice Chairman
    Barbara Cubin, Wyoming
    Heather Wilson, New Mexico
    John B. Shadegg, Arizona
    Charles W. Chip Pickering, Mississippi
    Ed Bryant, Tennessee
    Robert L. Ehrlich, Jr., Maryland
    Steve Buyer, Indiana
    Joseph R. Pitts, Pennsylvania
    W.J. Billy Tauzin, Louisiana
    Sherrod Brown, Ohio, Ranking Member
    Henry A. Waxman, California
    Ted Strickland, Ohio
    Tom Barrett, Wisconsin
    Lois Capps, California
    Ralph M. Hall, Texas
    Edolphus Towns, New York
    Frank Pallone, Jr., New Jersey
    Peter Deutsch, Florida
    Anna G. Eshoo, California
    Bart Stupak, Michigan
    Eliot L. Engel, New York
    Albert R. Wynn, Maryland
    Gene Green, Texas
    John D. Dingell, Michigan
    Senate Committee on Health, Education, Labor, and Pensions:
    Edward M. Kennedy, MA, Chairman
    Christopher Dodd, CT
    Tom Harkin, IA
    Barbara Mikulski, MD
    James Jeffords, VT
    Jeff Bingaman, NM
    Paul Wellstone, MN
    Patty Murray, WA
    Jack Reed, RI
    John Edwards, NC
    Hillary Clinton, NY
    Judd Gregg, NH, Ranking Member
    Bill Frist, TN
    Mike Enzi, WY
    Tim Hutchinson, AR
    John Warner, VA
    Christopher Bond, MO
    Pat Roberts, KS
    Susan Collins, ME
    Jeff Sessions, AL
    Mike DeWine, OH
    Senate Committee on Health, Education, Labor, and Pensions Subcommittee on Public Health:
    Edward M. Kennedy, MA, Chairman
    Tom Harkin, IA
    Barbara Mikulski, MD
    James Jeffords, VT
    Jeff Bingaman, NM
    Paul Wellstone, MN
    Jack Reed, RI
    John Edwards, NC
    Hillary Clinton, NY
    Judd Gregg, NH,
    Bill Frist, TN
    Michael Enzi, WY
    Tim Hutchinson, AR
    Christopher Bond, MO
    Pat Roberts, KS
    Susan Collins, ME
    Jeff Sessions, AL

    admin
    Celiac.com 08/05/2013 - People with celiac disease can now have confidence in the meaning of a "gluten-free" label on foods.
    The Food and Drug Administration (FDA) has issued a final rule that defines what characteristics a food has to have to bear a label that proclaims it "gluten- free." The rule also holds foods labeled "without gluten," "free of gluten," and "no gluten" to the same standard.
    This rule has been eagerly awaited by advocates for people with celiac disease, who face potentially life-threatening illnesses if they eat the gluten found in breads, cakes, cereals, pastas and many other foods.
    As one of the criteria for using the claim "gluten-free," FDA is setting a gluten limit of less than 20 ppm (parts per million) in foods that carry this label. This is the lowest level that can be consistently detected in foods using valid scientific analytical tools. Also, most people with celiac disease can tolerate foods with very small amounts of gluten. This level is consistent with those set by other countries and international bodies that set food safety standards.
    "This standard 'gluten-free' definition will eliminate uncertainty about how food producers label their products and will assure people with celiac disease that foods labeled 'gluten-free' meet a clear standard established and enforced by FDA," says Michael R. Taylor, J.D., deputy FDA commissioner for foods and veterinary medicine.
    Andrea Levario, executive director of the American Celiac Disease Alliance, notes that there is no cure for celiac disease and the only way to manage the disease is dietary—not eating gluten. Without a legal definition of "gluten-free," these consumers could never really be sure if their body would tolerate a food with that label, she adds.
    "This is a tool that has been desperately needed," Levario says. "It keeps food safe for this population, gives them the tools they need to manage their health, and obviously has long-term benefits for them."
    "Without proper food labeling regulation, celiac patients cannot know what the words 'gluten free' mean when they see them on a food label," says Allessio Fasano, M.D., director of the Center for Celiac Research at MassGeneral Hospital for Children, visiting professor of pediatrics at Harvard Medical School and member of the American Celiac Disease Alliance.
    What Is Gluten?
    Gluten means the proteins that occur naturally in wheat, rye, barley, and crossbreeds of these grains.
    As many as 3 million people in the United States have celiac disease. It occurs when the body's natural defense system reacts to gluten by attacking the lining of the small intestine. Without a healthy intestinal lining, the body cannot absorb the nutrients it needs. Delayed growth and nutrient deficiencies can result and may lead to conditions such as anemia (a lower than normal number of red blood cells) and osteoporosis, a disease in which bones become fragile and more likely to break. Other serious health problems may include diabetes, autoimmune thyroid disease and intestinal cancers.
    Before the rule there were no federal standards or definitions for the food industry to use in labeling products "gluten-free." An estimated 5 percent of foods currently labeled "gluten-free" contain 20 ppm or more of gluten.
    How Does FDA Define 'Gluten-Free'?
    In addition to limiting the unavoidable presence of gluten to less than 20 ppm, FDA will allow manufacturers to label a food "gluten-free" if the food does not contain any of the following:
    An ingredient that is any type of wheat, rye, barley, or crossbreeds of these grains; An ingredient derived from these grains and that has not been processed to remove gluten; An ingredient derived from these grains and that has been processed to remove gluten, if it results in the food containing 20 or more parts per million (ppm) gluten. Foods such as bottled spring water, fruits and vegetables, and eggs can also be labeled "gluten-free" if they inherently don't have any gluten.
    The regulation will be published Aug. 5, 2013 in the Federal Register, and manufacturers have one year from the publication date to bring their labels into compliance. Taylor says he believes many foods labeled "gluten free" may be able to meet the new federal definition already. However, he adds, "We encourage the food industry to come into compliance with the rule as soon as possible."
    Under the new rule, a food label that bears the claim "gluten-free," as well as the claims "free of gluten," "without gluten," and "no gluten," but fails to meet the requirements of the rule would be considered misbranded and subject to regulatory action by FDA.
    Those who need to know with certainty that a food is gluten-free are heralding the arrival of this definition. "This is a huge victory for people with celiac disease," says Levario. "In fact, that's the understatement of the year."
    Says Taylor, "FDA's 'gluten-free' definition will help people make food choices with confidence."
    This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.
    Source: August 2, 2013 - http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm363069.htm

    Jefferson Adams
    Celiac.com 09/12/2013 - Good news for consumers of gluten-free foods and other products: The FDA's new standards for the labeling of gluten-free food and other products apply to all foods and products labeled gluten-free, including dietary supplements and vitamins.
    The FDA rules state that any product declaring the contents to be "gluten-free," "no gluten," "free of gluten" or "without gluten," must meet all parts of FDA's gluten-free definition, including the requirement that the food contains less than 20 parts per million of gluten.
    People with celiac disease who consume gluten from wheat, rye, or barley risk gradual damage to the intestines, leading to poor absorption of vitamins and minerals and leading to a host of other health problems, including nutritional deficiencies, osteoporosis, miscarriages, and cancer," according to Virginia Cox, Associate Commissioner of FDA's Office of External Affairs.
    Creating uniform rules and conditions for the use of the term 'gluten-free' in the labeling of foods and other products is "necessary to ensure that individuals with celiac disease are not misled and are provided with truthful and accurate information with respect to foods so labeled, " according to the text of the final rule, which was published last week in the Federal Register.
    FDA projects the new requirements will yield annual health benefits of roughly $110 million, compared to estimated annual costs (related to testing and relabeling) of $7 million.
    Manufacturers of gluten-free foods and products will have one year to comply with the FDA's labeling requirements.
    Source:
    http://www.naturalproductsinsider.com/news/2013/08/fda-gluten-free-definition-applies-to-dietary-sup.aspx

  • Recent Articles

    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

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