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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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    NEARLY ALL TESTED GLUTEN-FREE FOOD PRODUCTS MEET FDA STANDARDS


    Jefferson Adams


    • A new compliance survey shows over 99 percent of gluten-free foods meet FDA standards.


    Celiac.com 07/10/2017 - For anyone with celiac disease or gluten intolerance who was wondering how well food manufacturers are complying with FDA standard for gluten-free labeling, or wondering exactly how gluten-free is my gluten-free food, some early answers are in, and the news looks good.


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    A recent report by the agency indicates that the vast majority of food manufacturers are getting it right, and, correcting where they do get it wrong.

    The FDA's final rule for compliance in gluten-free labeling was August 5, 2014. To gauge compliance in gluten-free food labeling, the agency conducted a sampling assignment of products labeled "gluten free" from July 2015 to August 2016.

    The compliance testing is an important part of the FDA's mission to ensure that products labeled on or after the compliance date are properly labeled as "gluten-free."

    In all, the agency's team analyzed more than 250 types of products, and tested 702 individual samples in the categories of cereals, grain bars, and flours.

    Their complete survey showed that just five samples from one product source contained gluten in excess of the regulatory limit of 20 parts per million (ppm). That left the overall gluten-free product-based compliance rate above 99.5 percent.

    The good news here is that producers major gluten-free food products are doing a very good job of following FDA labeling standards. Also, the manufacturer of the samples that showed gluten levels above 20 ppm carried out a voluntary recall, conducted an extensive root cause analysis, and immediately implemented additional corrective actions to prevent recurrence.

    Follow-up testing by the FDA showed acceptable levels of gluten.

    This is the first hard data the FDA has gathered regarding compliance with gluten-free labeling standards. To see such high levels of compliance and responsiveness by manufacturers is encouraging.

    Read the Analytical Results of FY2015/16 Gluten-Free Food Product Sampling. SOURCE: FDA.gov


    Image Caption: A new FDA compliance survey shows over 99 percent of gluten-free foods meet FDA standards. Photo: CC--a.mina
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    Guest AWOL cast iron stomach

    Posted

    I am very glad to hear this. My concern prior to the FDA ruling of 20 ppm on 8-5-14 effective date was that some companies were not consistent or confused. The label standard 20ppm appeared to give it some needed clarity. The companies who were founded by celiacs or had relatives or employees that were celiac seemed to grasp the importance prior to 8-5-14. I'm glad to hear they are testing and keeping watch that there is compliance with the labeling standards, that more companies understand and are taking the proper GMP' s, testing , and food industry guidelines that gluten-free requires.

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    Guest Susan

    Posted

    This headline is very misleading. It implies that 99% of the gluten free products on the shelves are safely below the 20ppm standard. But this is total lie. The only thing that this “study†shows is that OF THE LIMITED LIST of products TESTED, 99% of them are actually within the legal definition of gluten free. That cannot be extrapolated to ALL PRODUCTS. What actions has the FDA taken against those who produce products that are above the standard? They are the ones with the power to ensure that this legal definition of gluten free is followed. What has the FDA done to ensure that 100% of products labeled gluten free are within the standard? Just testing them does nothing to keep celiacs safe from harm. What difference does it make to anyone that most products are within the legal standard? If the one dangerous products is being used by people, then they are getting sick and having their bodies damaged in a very serious way. That damage leads to starvation and cancer and death. Gluten Free Watchdog has evidence of products that are well about the standard. When they contacted the FDA, the report was ignored. 7 months later one dangerous product is still allowed to be marketed with the gluten free label and the dangerously high PPM. Then we have General Mills who advertises that their products are safe for celiacs. Yet, their testing process is very flawed. And people are still being made very ill by their gluten free oat four. This is very disappointing. I expected this site to be helpful to celiacs. Apparently, the news here is just more sensationalism.

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    Guest admin

    Posted

    This headline is very misleading. It implies that 99% of the gluten free products on the shelves are safely below the 20ppm standard. But this is total lie. The only thing that this “study†shows is that OF THE LIMITED LIST of products TESTED, 99% of them are actually within the legal definition of gluten free. That cannot be extrapolated to ALL PRODUCTS. What actions has the FDA taken against those who produce products that are above the standard? They are the ones with the power to ensure that this legal definition of gluten free is followed. What has the FDA done to ensure that 100% of products labeled gluten free are within the standard? Just testing them does nothing to keep celiacs safe from harm. What difference does it make to anyone that most products are within the legal standard? If the one dangerous products is being used by people, then they are getting sick and having their bodies damaged in a very serious way. That damage leads to starvation and cancer and death. Gluten Free Watchdog has evidence of products that are well about the standard. When they contacted the FDA, the report was ignored. 7 months later one dangerous product is still allowed to be marketed with the gluten free label and the dangerously high PPM. Then we have General Mills who advertises that their products are safe for celiacs. Yet, their testing process is very flawed. And people are still being made very ill by their gluten free oat four. This is very disappointing. I expected this site to be helpful to celiacs. Apparently, the news here is just more sensationalism.

    We are just reporting an FDA press release that is relevant to our readers.

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    Guest Laura

    Posted

    This headline is very misleading. It implies that 99% of the gluten free products on the shelves are safely below the 20ppm standard. But this is total lie. The only thing that this “study†shows is that OF THE LIMITED LIST of products TESTED, 99% of them are actually within the legal definition of gluten free. That cannot be extrapolated to ALL PRODUCTS. What actions has the FDA taken against those who produce products that are above the standard? They are the ones with the power to ensure that this legal definition of gluten free is followed. What has the FDA done to ensure that 100% of products labeled gluten free are within the standard? Just testing them does nothing to keep celiacs safe from harm. What difference does it make to anyone that most products are within the legal standard? If the one dangerous products is being used by people, then they are getting sick and having their bodies damaged in a very serious way. That damage leads to starvation and cancer and death. Gluten Free Watchdog has evidence of products that are well about the standard. When they contacted the FDA, the report was ignored. 7 months later one dangerous product is still allowed to be marketed with the gluten free label and the dangerously high PPM. Then we have General Mills who advertises that their products are safe for celiacs. Yet, their testing process is very flawed. And people are still being made very ill by their gluten free oat four. This is very disappointing. I expected this site to be helpful to celiacs. Apparently, the news here is just more sensationalism.

    I agree with your assessment. I remember seeing the 4 to 5-foot amber waves of grain waving in the wind. Modern wheat differs from its origins as the result of intense cross-breeding (hybridization) programs. "The crops are neither physically nor genetically like its old self." Modern wheat (grown in 99 percent of the world's wheat fields) is dubbed "dwarf wheat." The FDA was made aware of the changes in the wheat gluten content, but did not require further research regarding the effects of gluten protein increase on humans. Modern wheat exceeds the 1960's content by 17 times. I ate wheat, barely and rye for over half- a-decade before the 2008 variation hit the grocery shelves. Modern wheat is an assault on the health of many thousands of people. Celiac enteritis, celiac encephalopathy, celiac steatorrhea, gluten-sensitive enteropathy, celiac related dermatitis hepetiformis, and gluten ataxia are a few of the modern wheat era diseases that are captured by the W.H.O. Most of the above disease listing are NEW disease occurrences that have been added to the disease reporting statistics. An estimated 1% of the world population has celiac disease alone. Keep in mind, that for many persons, it takes up to 14 years from the start of symptomology to receive a confirmed diagnosis. Physicians now consider “modern wheat†as exacerbating: fibromyalgia, irritable bowel syndrome, dementia, rheumatoid arthritis and diabetes. Think back for a moment. When did your first heart of the term: gluten? When did you first hear the news media attack on: gluten? When did you first hear comedian jokes and advertisements poking fun at persons who did not consume gluten?

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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.
    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