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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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    WHAT YOU NEED TO KNOW ABOUT FALSE GLUTEN-FREE LABELING


    Melanie Weir

    Celiac.com 01/30/2012 - Over the last decade, many companies are adding labels to their products like: "gluten-free," "low gluten," "no gluten," "no gluten ingredients used," "naturally gluten-free" and "celiac friendly."  To many celiacs and individuals with gluten intolerance, the idea of companies labeling products without gluten is refreshing.  To experts on celiac disease and gluten intolerance, the gluten labeling currently happening in the United States is frightening. 


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    Photo: CC - liberalmind1012United States versus Other Countries' Gluten Free Labeling Laws
    Many countries diligently regulate gluten-free labeling.  A few months ago, an exchange student from Italy stopped by our Gluten Free Specialty Market and told me that she was horrified by the gluten-free labeling laws in the United States.  For the first time in her life, she was being contaminated by products that weren’t safe for her to eat.  After purchasing bakery products that were manufactured in a non-dedicated gluten-free environment, she became deathly ill for more than a week and told me she was only just starting to feel like she could travel more than a few steps from the nearest restroom.  “I’m afraid to eat anywhere,” she told me, “Every time I eat out in this country, I get sick.  I can’t wait to be home where I don’t have to worry like this.”

    This is not the first or even the 100th time I’ve heard a story like this.  For 4 years, I have heard story after story of individuals eating what appeared to be a ‘gluten-free’ product and getting violently ill.  So what does gluten-free mean?

    What Does Gluten Free Mean?
    According to the FDA, as of September 2011, gluten-free labeled products should (a) not include ingredients from gluten or gluten derivatives and (B) maintain a status of less than 20ppm of gluten for all gluten-free labeled products.  For more information about the FDA’s Gluten Free Food Labeling Request, go to:
    http://www.fda.gov/Food/LabelingNutrition/FoodAllergensLabeling/GuidanceComplianceRegulatoryInformation/ucm111487.htm#q9

    Though many companies try to follow the FDA's current gluten-free recommendation, mistakes are often made.  In food manufacturing, companies are driven by supply and demand.  Right now, the supply of gluten-free product options is low and the demand for gluten-free products is high.  For this reason, companies are jumping on the band wagon trying to produce options to fill the demand.  Some companies are started by an individual that is gluten intolerant, gluten allergic or has celiac disease.  Other companies are producing gluten-free products solely for profit.  While companies do their best to provide gluten-free products to the public, they often don’t understand what gluten-free actually means.

    Common Mistakes Made by Product Manufacturers
    While product manufacturers are trying to produce safe products, mistakes are often made.  Most mistakes occur due to lack of education regarding what "gluten-free" really means and what it takes to prevent cross-contamination.

    The Product is Gluten Free Enough for Me 
    Many gluten free products are created by individuals that have celiac disease, gluten intolerance or a gluten allergy.  Many of these products are made to be safe enough for the individual that made the product.  This is a problem because, experts like Dr. Alessio Fasano from the Stanford Celiac Center, estimate that only 1% of the population diagnosed with celiac disease is aware that they are being contaminated.  In other words, contamination may be affecting the health of an individual with celiac, even when they are not experiencing blatant symptoms. 

    Example 1:
    A brownie company produced their product in a facility that also produced regular gluten products.  The company is asked if they test their products for gluten, and they answer, "no, we don’t need to.  If the product wasn’t gluten-free someone would have let us know by now.  We’ve been in business for 4 years."

    Example 2:
    A pie company reports that their product is "celiac safe," and the company reports that they use a flour that tests above the safe range of 20ppm and the pies are made in a facility that produces gluten.  Research presented by the Celiac Sprue Association has shown that facilities that use gluten flours generally create products that contain gluten.

    Heterogeneous Mixtures Versus Homogeneous Mixtures
    This problem sometimes happens when gluten-free companies are trying to keep the price down on their products.  Flours produced in facilities that produce gluten are often times cheaper than flours produced in dedicated facilities and tested on import and export.  Companies often believe that when you mix one flour that’s above 20ppm with another flour that’s non-detectable at 5 or 10ppm, then the outcome of the flour blend will be below 20ppm.  This is not true because flour mixtures are not homogenous, they are heterogenous.  In other words, if you have a chocolate chip size morsel of gluten in one bag of flour, even if you mix it with a another flour that doesn’t have any gluten in it, the morsel of gluten still exists.  Therefore, the flour is not gluten-free.

    Example 1:
    Customers were reporting contamination after consuming a specific product from a gluten-free bakery.  The facility was visited and it was found that both flours and corn meal were being made in facilities that produce gluten.  Additionally, those facilities had reported that their flours routinely test above the safety zone of 20ppm.  When the bakery was questioned about the flours, it was reported that they knew that some of their flours were above 20ppm but they didn’t use very much of them in the flour blend so it shouldn’t matter.

    If a Product Contains Gluten, it Contains Gluten
    If you put gluten in a product, it contains gluten.  If your tests show results below 20ppm, they (1) might be read or performed inaccurately, (2) multiple samples could result in discrepancies (in other words, some samples may show higher than 20ppm and others lower).

    Example:
    A barbecue sauce has gluten as an ingredient and states "gluten free*" on their product label.  At the bottom of the label the product states: "*tested below 20ppm for gluten."  Though the end product might test as non-detectable, the product still contains gluten and should not be labeled gluten free.

    Manufacturer Produces Gluten, but the Product has "No Gluten Ingredients Used" on the Label
    Many manufacturers produce both gluten-containing and non-gluten containing products in their facilities.  When a product is produced on machinery that produces gluten or in a facility that has flour dust in the air, the product should be tested for its gluten status before it is labeled gluten-free.

    Example 1:
    A clam chowder company labels it’s product as gluten-free and reports that the soup is gluten-free.  Then later reports that wheat flour is used in other soups they make and that there is no allergen sterilization that occurs between the soup with wheat flour and the clam chowder without wheat flour.  The company does not test for gluten status, but decides to label their soups as gluten free anyway.  It is very possible that the soup will not test below 20ppm.

    Example 2:
    A flour company produces flours that appear to be gluten-free, but the flours are made in a facility that produces gluten-containing flours and are produced on equipment  with gluten and exposed to gluten flour dust from the air.  To cut back on the amount of gluten in their product, the company throws away the initial batches of flour and only keeps later batches.  The later batches on average test around 30-35ppm.  The flour is not labeled as gluten-free, nor does it state on the label made in a facility that produces gluten.

    Labeling Mishaps
    Lawyers often recommend that products not be recalled even when a gluten-free labeled product is determined to contain gluten. 

    Example 1:
    Wellshire Farms products were sold with a gluten-free label despite having tests showing a ppm reading far above 20ppm.

    Example 2:
    A chocolate fitness bar was certified to be below 20ppm.  The ingredients changed and wheat starch was added instead of corn starch.  The starch was listed on the ingredients as “starch” and the product was labeled as “gluten-free” and noted to be tested below 20ppm. 

    The Product is "Naturally Gluten-Free"
    Oftentimes, companies report that their product is gluten-free, because they use naturally gluten-free ingredients.  The problem with this statement is that even a naturally gluten-free ingredient can become contaminated with gluten through production, storage or shipment.

    Example 1:
    A chia beverage company reports on their label that their product is naturally gluten-free.  When informed that chia is often cross-contaminated with gluten, the company stated that "our chia tests at 30ppm, but since chia is naturally gluten-free they can still place gluten-free on their label."

    Example 2:
    To protect their consumers, Kettle Cuisine soups tests "naturally gluten-free" ingredients before using them in their manufactured products.  More than once their cumin and coriander tested above 20ppm, and Morjoram tested above 5ppm.  As a side note the company reports that they have had no problems with their current supplier of organic spices.  So far, the organic spices have been consistently testing below 5ppm.  Like many companies attempting the safest standards possible for their customers, Kettle cuisine requires that both the ingredients going into their product and the final product test below 5ppm.  This allows even the most sensitive of gluten reactors to feel safe consuming their products.

    Many gluten-free product manufacturers regularly test their ingredients for gluten status.  Naturally gluten-free products that should always be double checked for their parts per million (ppm) status include: vinegar, chia seed, hemp seed, oats, buckwheat, spices, produce stored with flour, flours or grains made in a facility producing gluten, B vitamins, E vitamins, modified food starch (should be listed as wheat if from wheat, but this doesn’t always happen).

    Offering Safe Gluten-Free Options to the Community
    At the Gluten Free Specialty Market in Sacramento, California we work hard to educate the community and manufacturing companies regarding the need for safe products.  Local companies often ask us for information on how to provide safe gluten-free options.  Nachez, a dairy free and vegan Nacho cheese sauce, contacted us last year while setting up the manufacturing of their cheese sauce.  After speaking with us, it was decided that the product would be produced by a company that regularly batch tests the product to be below 20ppm.  It is very empowering to feel like we, as a market, are activists for the health and wellness of our customers.

    In the past four years we have learned vast amounts of information on the manufacturing of gluten-free products throughout the United States.  In 2012, we hope to press local legislators to help us do this by creating a gluten-free labeling standard for California.  We hope that if the FDA doesn’t pass a gluten-free labeling law in the next year, California will pass a state law to help protect us.  In the meantime, we continue to drill gluten-free manufacturers on their products and do our best to provide the safest gluten-free options to our customers.


    Image Caption: Photo: CC - liberalmind1012
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    Excellent article! Thanks for your continued work towards keeping the celiac and gluten-sensitive community safe.

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    Took me a few months to figure out that the gluten-free labeled rice crackers I was eating, was not actually free of gluten. I was having serious celiac symptoms, despite the belief that I was eating totally gluten-free foods. I learned not to trust gluten-free labels. They are not always truthful.

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    I have had celiac symptoms from supposedly gluten free foods such as nuts, candy, hot chocolate mixes, plain popcorn. The list is long. I'm always finding something new that should be, but obviously isn't, gluten free. Contamination can happen as far back as the farm. Our neighbors harvest both corn and wheat and use the same equipment for both.

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    I am one of those overly sensitive individuals that cannot tolerate the new gluten free Chex cereals , the cornmeal etc.

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    Thanks for a great article. I am sometimes amused by "Gluten Free" labeling. The companies that state "Manufactured on equipment that handles gluten products, but does not contain gluten ingredients", would they be so proud to state "Mixed in a dirty dog bowl, but contains no kibble" on their packages? It goes to the opposite extreme as well. I once saw an 8oz bag of "Gluten Free" marshmallows for $4.50, about 5 times the cost of ordinary marshmallows. I know that the only reason *some* companies resort to these specious labeling practices is so they can jack-up their prices for the sake of profit, but it absolutely disgusts me that they're willing to make people sick to do it. The same thing happens with Tartrazine, (Yellow#5 which also makes me sick). It's happened to me often enough that I don't trust *ANY* label anymore, and I make my own Marshmallows!

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    Maybe Canada is different than the U.S for labeling but in response to the comment about Chex cereals I've been eating them for a year now and have had no bad reaction. They are made by General Mills and they are a lot cheaper. They are labeled gluten-free.

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    Guest Melanie

    Posted

    Excellent article! Thanks for your continued work towards keeping the celiac and gluten-sensitive community safe.

    As a side note: Dr. Alessio Fasano is with the University of Maryland, but the following comment, "only 1% of the population diagnosed with celiac disease is aware that they are being contaminated" came from Dr. Fasano's lecture at the Stanford Celiac Conference in 2010.

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    Guest Katrina

    Posted

    Great article makes me want to move to Italy so I can eat and not worry every second about the validity of the product I'm using. I'm very sensitive because it affects my nerves so I would say to even stay away from pre-packaged foods. Food most of the time I get glutened at least once every two weeks.

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    Fantastic article! I didn't realize it was that bad in the states. I am heading over to California in March, coming from Australia, and suddenly I'm not liking the idea of eating anything over there now that I know even things that state gluten-free may not actually be gluten-free!

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    Guest Emily D.

    Posted

    I am in so much fear of having a reaction, and I read all labels. Thanks for the information you've given!

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    I live in Argentina. Myself and most of my family are celiac. I am going to start a self help group for celiac people in this community. I will need to get in touch with psychologists with experience in this field. Thanks.

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    Fantastic article. I have had to abandon processed gluten free foods due to the problems listed in the article. Nice to have someone bring it to light in a public forum. As usual, US policies are profit driven. Another thing I have noticed is that some companies give you evasive answers when you quiz them on things like processing and sourcing. It would be great to find products you could use, but the double talk makes you throw up your arms and say "just forget it!"

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    Guest Lee-Anne

    Posted

    Thank you for an article that supports what I've been telling my husband for a couple of years. I am very sensitive as well (I can't eat oats at all), so I have to read labels extremely carefully. I have bought items many times that have "Gluten-Free Oats" in them and had reactions later. For the people who have problems with Chex (Rice, Corn, Chocolate, Honey Nut): there IS a preservative on them, maybe that's where the problem is. I wish Oats were still included in "Gluten-Free". I'm also Lactose & Casein intolerant, and cannot have cooked apple products (protein in cooked apples is too close to a milk protein). All of this is really a challenge when you add "no preservatives, artificial flavors, food dyes"... and expensive!

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    Guest Melanie

    Posted

    This news is so discouraging.

    @Heather Don't be discouraged. As a community we have the strength to fight for proper gluten free labelling. Currently in California, we are working on a gluten free and wheat free labeling bill. It can help us by creating a common gluten free definition for food manufacturers. If all goes well we will one day have a properly regulated labeling program. If you'd like to support the bill, contact Senator Emmerson at:

    State Capitol, Room 4082

    Sacramento, CA 95814

    Phone: (916) 651-4037

    Fax: (916) 327-2187

    Email: senator.emmerson@sen.ca.gov

     

    For more information on Senate Bill 1293 introduced in March 2012, go to: e-lobbyist.com/gaits/text/587563

     

    You can also contact your local chamber of commerce. Go to: uschamber.com/about/contact for more information.

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    Guest Annah

    Posted

    Thank you for this article. I wish you had used the names of the products. If it is for fear of being sued, I am sorry about that. As a group we would have more power in class action suits against these companies that do not care that they are making us sick. The best thing we can do is NOT buy their products. Annie's is a big offender. There are others. Eat fresh good food. Do not eat packaged foods!

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    Guest kschatz

    Posted

    I would like to put something in THEIR food that will, almost immediately after they've eaten it, give them unbelievable stomach pain, massive diarrhea, and nausea for days that leaves them on a liquid diet of ginger ale. Then when they ask me what happened, I will look at them with a blank stare and stand there hands upturned.

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    admin
    Celiac.com 07/24/2001 - In an effort to make food ingredient labels easier for everyone to understand, the Food and Drug Administration (FDA) is currently revising its food labeling laws. If Congress passes the current proposed legislation it will make life much easier for those with food allergies and intolerance. The Food Allergy Anaphylaxis Network (FAAN) spearheaded the yearlong label revision project and worked with 18 food companies to create voluntary guidelines for food labels that will help consumers avoid foods that could trigger an allergic reaction. The current recommended FAAN guidelines will identify the top eight allergens that cause 90 percent of food allergies, and will also avoid the use of technical food language in favor of easier to understand terms. For example, instead of using simply natural flavors on labels, the new labels would include the source of the ingredient: natural peanut or milk flavor. According to the guidelines common allergens such as peanuts, tree nuts like walnuts and pecans, fish, shellfish, eggs, milk, soy, and wheat should be clearly identified on all labels.
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    fdfworld.com

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

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

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

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

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

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

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

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

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

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

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

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

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

    Jefferson Adams
    Celiac.com 04/17/2018 - Could the holy grail of gluten-free food lie in special strains of wheat that lack “bad glutens” that trigger the celiac disease, but include the “good glutens” that make bread and other products chewy, spongey and delicious? Such products would include all of the good things about wheat, but none of the bad things that might trigger celiac disease.
    A team of researchers in Spain is creating strains of wheat that lack the “bad glutens” that trigger the autoimmune disorder celiac disease. The team, based at the Institute for Sustainable Agriculture in Cordoba, Spain, is making use of the new and highly effective CRISPR gene editing to eliminate the majority of the gliadins in wheat.
    Gliadins are the gluten proteins that trigger the majority of symptoms for people with celiac disease.
    As part of their efforts, the team has conducted a small study on 20 people with “gluten sensitivity.” That study showed that test subjects can tolerate bread made with this special wheat, says team member Francisco Barro. However, the team has yet to publish the results.
    Clearly, more comprehensive testing would be needed to determine if such a product is safely tolerated by people with celiac disease. Still, with these efforts, along with efforts to develop vaccines, enzymes, and other treatments making steady progress, we are living in exciting times for people with celiac disease.
    It is entirely conceivable that in the not-so-distant future we will see safe, viable treatments for celiac disease that do not require a strict gluten-free diet.
    Read more at Digitaltrends.com , and at Newscientist.com