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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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    IS WINE AGED IN WHEAT-GLUED OAK BARRELS GLUTEN-FREE?


    Gryphon Myers

    Celiac.com 10/22/2012 - Wine is naturally gluten-free, making it a go-to alcoholic drink for sufferers of celiac disease. However, some vintners use oak barrels sealed with wheat paste, which has made some people wonder if it is really gluten-free. An article posted by Tricia Thompson, MS, RD on her Gluten-Free Watchdog website may have finally put this worry to rest, as she has done a series of sandwich R5 ELISA and competitive R5 ELISA tests of various wines aged in such barrels.


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    Photo: CC--Alberto AlerigiSo there's a wine you'd like to try, but you've heard that wine can be cross contaminated from the wheat paste some vintners use to seal oak barrels. The first thing to consider before spending too much time researching is that the Tobacco Tax and Trade Bureau currently disallows gluten-free labeling of alcoholic beverages if the producer used “storage materials that contained gluten.” This means any wine that is labeled as gluten-free was aged using a barrel alternative, and thus carries no danger of cross-contamination.

    Another factor to consider is that while many wineries still use oak barrels, barrel alternatives are highly common as well. Roughly speaking, the more expensive ($12+) Cabernet Sauvignons, Merlots, Zinfandels and red blends are more likely to be aged in oak barrels (and for a longer period of time).

    For those wines that are fermented in barrels, most wineries thoroughly pressure wash all barrels with boiling hot water before they are used. Additionally, it is not the staves of the barrels that are sealed with a wheat flour paste, but the barrel heads. The amount used to seal the head is minimal. Even so, the possibility of cross contamination has been a lingering question.

    To get a sense of just how risky this cross contamination might be, Tricia Thompson tested a single winery's Cabernet Sauvignon and Merlot, which were the two wines that spent the most time in wheat-sealed oak barrels. She tested each wine four times: twice with the Sandwich R5 ELISA test, and twice with the competitive R5 ELISA test. The competitive R5 ELISA is the current standard for testing for hydrolyzed (broken down) gluten (as would be found in fermented products), while the sandwich R5 ELISA would detect any non-hydrolyzed gluten (as from a wheat paste).

    Both extractions of both wines came back with the lowest possible results for both tests:

    Cabernet Sauvignon

    • Sandwich R5 ELISA extraction 1: < 5 ppm gluten
    • Sandwich R5 ELISA extraction 2: < 5 ppm gluten
    • Competitive R5 ELISA extraction 1: < 10 ppm gluten
    • Competitive R5 ELISA extraction 2: < 10 ppm gluten

    Merlot

    • Sandwich R5 ELISA extraction 1: < 5 ppm gluten
    • Sandwich R5 ELISA extraction 2: < 5 ppm gluten
    • Competitive R5 ELISA extraction 1: < 10 ppm gluten
    • Competitive R5 ELISA extraction 2: < 10 ppm gluten

    Thompson's findings indicate that even wine that is aged in wheat-glue-sealed oak barrels contains less gluten than we are currently capable of testing for, whether hydrolyzed or not. If you're still skeptical, you can always do your own research and find out which of your favorite wines are aged using barrel alternatives.

    Source:



    Image Caption: Photo: CC--Alberto Alerigi
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    Guest Patrick

    Posted

    Wine is great. It naturally reduces your odds of getting cancer, it's good for your digestive system, and now I find out it's (mostly) Gluten-free!

     

    As far as the gluten testing, I'm curious to find out what steps you can take to do this. I browsed the link you provided and didn't find a readily-visible process or set of steps. I don't suffer from celiac disease, but I'm sure that someone who does will be interested in a quick way to test their wines at home.

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    Wine is great. It naturally reduces your odds of getting cancer, it's good for your digestive system, and now I find out it's (mostly) Gluten-free!

     

    As far as the gluten testing, I'm curious to find out what steps you can take to do this. I browsed the link you provided and didn't find a readily-visible process or set of steps. I don't suffer from celiac disease, but I'm sure that someone who does will be interested in a quick way to test their wines at home.

    ELISA - enzyme linked immunosorbent assay

     

    Don't try this at home.

     

    This is a very specialized assay which requires training and skill to perform, not to mention the correct materials including the appropriate material in the specialized plates and a spectrophotometric plate reader to perform.

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    Then why am I SOOOO sick from a half of a glass???

     

    This article should include the rationale for the TTB's decision on gluten-free labeling. They chose to do so because there is not enough proof that the ELISA test is able to correctly estimate gluten in hydrolyzed products.

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    Guest gryphon

    Posted

    Then why am I SOOOO sick from a half of a glass???

     

    This article should include the rationale for the TTB's decision on gluten-free labeling. They chose to do so because there is not enough proof that the ELISA test is able to correctly estimate gluten in hydrolyzed products.

    Just because the TTB has not approved the R5 Competitive ELISA test for detection of hydrolyzed gluten does not mean it is not effective... they are merely taking a conservative stance. The gluten-free diet has not been approved by the FDA as a treatment for celiac disease... does that mean it doesn't work?

     

    Furthermore, as the article we cited points out, in this particular situation, gluten contamination would come from a non-hydrolyzed source (wheat paste). The sandwich R5 ELISA assay, which is the current standard for gluten testing set by the Codex Alimentarius, would detect any contamination. BOTH tests were used and NEITHER detected anything within their respective detection thresholds.

     

    You could be getting sick from something else entirely, as it's probably not gluten. Have you verified that the wine you're drinking was aged in a barrel? Do you have issues with yeast, sulfites or egg whites (which are often used as a clarifying agent)?

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    Guest Melissa

    Posted

    Then why am I SOOOO sick from a half of a glass???

     

    This article should include the rationale for the TTB's decision on gluten-free labeling. They chose to do so because there is not enough proof that the ELISA test is able to correctly estimate gluten in hydrolyzed products.

    Are you allergic to "Sulfa"?

     

    I am and can't do wine or medications containing "Sulfa"

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    Guest Jennifer

    Posted

    For the sickly one drinking the half glass: perhaps there are other things that you are having issues with that are in the wine? Could be a number of things, not just gluten.

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    Wine is great. It naturally reduces your odds of getting cancer, it's good for your digestive system, and now I find out it's (mostly) Gluten-free!

     

    As far as the gluten testing, I'm curious to find out what steps you can take to do this. I browsed the link you provided and didn't find a readily-visible process or set of steps. I don't suffer from celiac disease, but I'm sure that someone who does will be interested in a quick way to test their wines at home.

    I most definitely respond to gluten in wine and sherry. I wrote to a number of wine producers and supermarkets to ask if they supplied any wines that had been produced without contact with gluten. Only Waitrose responded with a wine list. I haven't had any problems with the listed wines so far - but I don't drink much so haven't tried many. I have just had a gluten response to Harvey's Bristol Cream sherry, and I see on the Waitrose website that it is listed as 'gluten free'.

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    I most definitely respond to gluten in wine and sherry. I wrote to a number of wine producers and supermarkets to ask if they supplied any wines that had been produced without contact with gluten. Only Waitrose responded with a wine list. I haven't had any problems with the listed wines so far - but I don't drink much so haven't tried many. I have just had a gluten response to Harvey's Bristol Cream sherry, and I see on the Waitrose website that it is listed as 'gluten free'.

    I continue to offer a challenge to anyone who can point me to any normal bottle of wine that will test positive for gluten. So far I've not heard of any.

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    Guest Vince Vega

    Posted

    I have been commercially making wine for 20 years. I keep getting questions from this crowd about 'wheat paste' used in wine barrels. You can find hundreds of websites that make this claim but I have been unable to find a single oak supplier who can confirm this. Even if there is some glue used in barrel productions do you know how impossible that would be to get into your wine? You breathe more gluten on a daily basis than you would drink if you consumed an entire 60 gallon barrel of wine. It's such a ridiculous myth ---- please inform yourselves and stop wasting wineries time asking this ridiculous question. On a more scientific note - gluten is a protein --- even if a wine was fermented completely from rye, almost all wines go through some type of protein stability which would drop the protein out of the wine prior to racking, filtering clarifying.. If this didn't happen you would have a haze precipitate on the bottom of the bottle - ie. protein instability. You could simply rack this off and drink what's left.

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    Guest Michelle

    Posted

    I was ill recently after having eaten at a local restaurant, I had the house wine to drink. After emailing the restaurant and advising them of my illness, they were very shocked. After doing some research I was informed that I was ill due to the wheat paste used to seal the oak barrels. I had not heard of this before but on several occasions felt ill after drinking certain wines. Very odd. I was advised that none of the food I consumed had any gluten in.

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    I was ill recently after having eaten at a local restaurant, I had the house wine to drink. After emailing the restaurant and advising them of my illness, they were very shocked. After doing some research I was informed that I was ill due to the wheat paste used to seal the oak barrels. I had not heard of this before but on several occasions felt ill after drinking certain wines. Very odd. I was advised that none of the food I consumed had any gluten in.

    Wine is gluten-free and this myth about wheat-paste making it not safe is just that--a myth!

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    Guest AFARPACK

    Posted

    I browsed the link you provided and didn't find a readily-visible process or set of steps. but this is also a warning to us. Excellent post.

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    Guest Dominic

    Posted

    Another commercial winemaker chiming in on the topic... non celiac. Coopers use a mixture of flour and water to seal the head of the barrel along the staves. My barrel supplier uses a rice flour at our direction to avoid any possibility of a gluten intolerant having an issue. I just got a call from someone complaining of getting 'sick' from my wine due to gluten intolerance. I was unable to convince her this was impossible. As mentioned earlier by the other winemaker, gluten, being a protein is highly unlikely to make it past clarification, fining, and filtration. It is my sincere belief that celiacs are sickly people in general and the mind is a powerful device that can manifest illness, pain, depression, anxiety to satisfy a subconscious need for attention. I'm sympathetic to the lifestyle but I resent the constant vilification from anecdotal evidence.

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    Another commercial winemaker chiming in on the topic... non celiac. Coopers use a mixture of flour and water to seal the head of the barrel along the staves. My barrel supplier uses a rice flour at our direction to avoid any possibility of a gluten intolerant having an issue. I just got a call from someone complaining of getting 'sick' from my wine due to gluten intolerance. I was unable to convince her this was impossible. As mentioned earlier by the other winemaker, gluten, being a protein is highly unlikely to make it past clarification, fining, and filtration. It is my sincere belief that celiacs are sickly people in general and the mind is a powerful device that can manifest illness, pain, depression, anxiety to satisfy a subconscious need for attention. I'm sympathetic to the lifestyle but I resent the constant vilification from anecdotal evidence.

    You, Dominic are a jerk! I hope to find out what wine you make so as to avoid giving you one red cent. I wouldn't wish celiac on my own worst enemy but now I am reconsidering that because of your rude and insensitive comments. KARMA is a b%$@#!

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    I have been commercially making wine for 20 years. I keep getting questions from this crowd about 'wheat paste' used in wine barrels. You can find hundreds of websites that make this claim but I have been unable to find a single oak supplier who can confirm this. Even if there is some glue used in barrel productions do you know how impossible that would be to get into your wine? You breathe more gluten on a daily basis than you would drink if you consumed an entire 60 gallon barrel of wine. It's such a ridiculous myth ---- please inform yourselves and stop wasting wineries time asking this ridiculous question. On a more scientific note - gluten is a protein --- even if a wine was fermented completely from rye, almost all wines go through some type of protein stability which would drop the protein out of the wine prior to racking, filtering clarifying.. If this didn't happen you would have a haze precipitate on the bottom of the bottle - ie. protein instability. You could simply rack this off and drink what's left.

    I hear what you are saying, but I have had a "reaction" to a Malbec reserve wine from Argentina and not other red wines. So maybe the aging in the barrel for reserve wines adds to a gluten level in the wine from the extended time held in the oak barrels? I am not sure, and I do understand that the wine in filtered and clarified prior to bottling as well. So for now I am going to drink red wines that do not bother me and try to replicate this problem with another reserve wine not made in the USA. PS- I love red wine and will not give it up!

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    Guest Martino

    Posted

    Good article, great that you added test results. I think it is most likely that wine is gluten-free. Don't forget all you who say you get reactions that lots of gluten-free certified food also has gluten in it, it just has less than 20 parts per million by weight. That is still quite a considerable amount, as the body of evidence shows Coeliacs can cope with small levels of gluten. So drink red wine and be happy. After 5 years on a gluten-free diet I do not think it is so bad an affliction, there again I have had Leukemia, so maybe it is relative!

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    admin

    Rice and soy beverages because their production process may utilize barley enzymes. Bad advice from health food store employees (i.e., that spelt and/or kamut is/are safe for celiacs). Cross-contamination between food store bins selling raw flours and grains (usually via the scoops). Wheat-bread crumbs in butter, jams, toaster, counter, etc. Lotions, creams and cosmetics (primarily for those with dermatitis herpetaformis). Stamps, envelopes or other gummed labels. Toothpaste and mouthwash. Medicines: many contain gluten. Cereals: most contain malt flavoring, or some other non-gluten-free ingredient. Some brands of rice paper. Sauce mixes and sauces (soy sauce, fish sauce, catsup, mustard, mayonnaise, etc.). Ice cream. Packet & canned soups. Dried meals and gravy mixes. Laxatives. Grilled restaurant food - gluten contaminated grill. Fried restaurant foods - gluten contaminated grease. Ground spices - wheat flour is sometimes used to prevent clumping.

    admin

    Celiac.com 12/10/2000 - As reported in Ann Whelans September/October issue of Gluten-Free Living, the American Dietetic Association (ADA) has released the 6th edition of its Manual of Clinical Dietetics, which offers revised guidelines for the treatment of celiac disease. This manual is currently used by hospitals and doctors all over North America, and represents the most up-to-date source of information with regard to the dietary treatment of various illnesses. The new standards set in this publication conform more closely with current international standards. Included on their safe list are items that have been on Celiac.coms safe list for over five years, including: amaranth, buckwheat, distilled vinegar (no matter what its source), distilled alcoholic beverages (including rum, gin, whiskey and vodka), millet, quinoa and teff.
    A team of American and Canadian dietitians wrote the new gluten-free guidelines, including: Shelley Case, RD, Mavis Molloy, RD, Marion Zarkadas, M.Sc.RD (all from Canada and all members of the Professional Advisory Board of the Canadian Celiac Association), and Cynthia Kupper, CRD, CDE (Executive Director of the Gluten Intolerance Group and celiac). Additional findings of this team regarding buckwheat and quinoa contradict what has been accepted as common knowledge for years by some US support groups, mainly that these two grains are more likely to be contaminated by wheat than other grains. In fact, according to the team, buckwheat and quinoa are far less likely to be contaminated than most other grains.
    At the most basic level the new guidelines mean that celiacs do not need to avoid foods containing unidentified vinegar or distilled alcohol, this alone will allow much more freedom when shopping or eating out. Further, celiacs who drink alcohol will have much more freedom and a far greater choice when they want to have a drink. Additionally, celiacs will be able to more easily maintain a well-rounded and nutritious diet because they will have access to a far greater number of highly nutritious and safe grains.
    The ADAs 6th edition of the Manual of Clinical Dietetics represents the first time that Canadian and United States dietary guidelines have come together to create a united North American gluten-free standard, and will hopefully lead to the adoption of a single standard by all US support groups so that hundreds of thousands of celiacs will not have to unnecessarily exclude more foods than necessary. These new guidelines go a long way towards an international standard, which should be the ultimate goal for all celiacs and celiac organizations in the world.

    Megan Tichy

    What is Gluten?
    Gluten is a huge molecule held together by smaller molecules linked together called amino acids. A very tiny part of the gluten molecule can initiate a response. If each amino acid that makes up gluten is represented as a single letter that very tiny part would be: SGQGSFQPSQQ. There are other sequences of amino acids that cause a reaction in gluten sensitive individuals, but the point is, as tiny as this fragment is with respect to the entire gluten protein, it is still HUGE with respect to the size of ethanol (the stuff you are drinking).
    What is Alcohol?
    The alcohol you drink is ethanol. Ethanol is smaller than the size of the smallest amino acid in the smallest fragment of gluten that has been shown to initiate an autoimmune reaction. More specifically, ethanol is about 10 atomic mass units smaller than just the G in the sequence shown above.
    What are Amino Acids?
    The G is glycine, and by the way, each of these amino acids (represented by letters) by themselves is safe, and sold at most health food stores. For example Q = glutamine (yes, “L-glutamine,” the same amino acid mentioned in a recent post and used to heal intestinal damage). If the protein is viewed as beads on a string, then one of those beads might be good for you, but certain sequences strung together can initiate an allergic reaction of many types from acute peanut allergy to less-than-obvious gluten sensitivity.
    What is Distillation?
    When a distillation is performed, pure ethanol is separated away from all of the other “stuff” that forms as a result of fermentation. This is because ethanol is volatile (meaning it becomes a gas in the distillation process). Imagine a vat of fermentation products, you heat it, and only the volatile molecules like ethanol enter a tube attached to the vat. This tube is not just any tube - it is a curved condensation tube! Here is what it does: While the heated gas form of ethanol floats into it (because that is what gases do), the molecules are cooled and condense back into a liquid, and fall into a new sparkling clean vessel containing the stuff that intoxicates you and any other volatiles. So the fancier distillation columns that are actually used industrially also purify the ethanol away from other volatiles. Gluten does not stand a chance of “crossing over” because it is not volatile.
    Here is a simplified analogy. Let's say you put some sand in the bottom of your tea kettle. If you take the spout off your tea kettle, and attach a condensing tube to the opening (a curved tube would be the simplest type of condensing tube but there are many elaborate types), you could distill your water away from the sand. The condensing tube would be curved so as to open into a new clean pot. Let us pretend that the sand is gluten and the water is ethanol. When you heat to the boiling point, the liquid becomes gas so it travels into the condenser, cools and becomes liquid, then falls into the clean pot.
    Now having read that, is there any way that the new clean pot would contain any sand? No, and distilled alcohol (ethanol) does not contain any gluten. Remember, gluten is not volatile. Another non-volatile compound is table salt. So you could perform a distillation at home, with salt water. Has anyone ever inadvertently done this? Boiled a pot of salt water, perhaps to make some Tinkyada pasta, and walked away to do something else. You came back to find your pot almost empty with white crusty stuff (salt) all inside the pot.
    So the gluten is left behind in a distillation process. If malt is added to the distilled product it will be disclosed on the ingredients label.
    What is Vinegar?
    Vinegar is formed by fermentation in a similar way that ethanol is formed by fermentation. The process is to take ethanol and ferment it with bacteria. Later, there is a filtration to remove the bacteria. Rarely, vinegar is fermented from wheat-based alcohol. “Distilled vinegar,” gets its name from the fact that it was fermented from distilled alcohol.
    Why is Vinegar Still Questioned?
    The answer could be, perhaps, because so many people report a reaction to it and vinegar-based products. The never-ending fear is that cross-contamination during the fermentation process is leading to barely detectable amounts of gluten in the finished product (by barely detectable, I mean in terms of commercially available tests). Since the vinegar is rarely distilled post fermentation from the ethanol, the “messy” nature of the second fermentation step could pose a problem, especially for highly sensitive individuals. If the alcohol gets all used up by the bacteria, the bacteria go on to form carbon dioxide and water from the vinegar. So alcohol is periodically added in the fermentation process. Conceivably, one “shortcut” would be to just add beer at this juncture. Adding beer or some other form of cheap malted alcohol would keep the culture alive, and increase the “quality” and yield of the vinegar. Another fear is that the bacterial “mother” as it is called, contains trace gluten through cross-contamination. Claims that these practices actually take place are unsubstantiated by evidence.
    Why are Distilled Spirits Still Questioned?
    That is a good question, I do not know.Take a Short Quiz on this Topic:
    You bought mustard and pickles at the grocery store. These products contain “distilled vinegar” according to the ingredients labels, and the label does NOT say “contains: wheat.” Are the mustard and pickles gluten-free? Rum, gin, whiskey, and vodka are distilled beverages. If they are not flavored with something that contains wheat (would be declared on the label), rye, or barley (usually in the form of “malt”), are they gluten-free?  What is wrong with the following statements (they have all been cut and pasted from various blogs and forums on the topic of celiac disease)?a. “Most alcohols are distilled in such a way that any wheat gluten is no longer present.”b. “Even trace amounts of gluten that make it past the filter system can be harmful.”c. “It seems improbable to me, too, that gliadin could survive the distillation process.”

    Answers:
    Yes, unless you have reason to believe otherwise, in which case you should simply avoid them.
    Yes.
    3a. All alcohols, if distilled, have been removed from any type of gluten.
    3b. Distillation is nothing like a filtration. We are not separating small from large, there is no filter. Filtration would be like how your coffee pot separates water from the coffee grains. A tear in the filter would result in a big problem, right? Filtration is a separation based on size, distillation is a separation based on volatility.
    3c. Do we care whether gliadin (a name given to part of wheat gluten) “survives” the process or not? No, because it has been left behind to stew in its own juices in the distillation pot. Your stuff (the ethanol) has floated away, and entered a new, clean pot. Some people have this idea that we heat the fermented mixture to smithereens and it somehow decomposes the molecules of gluten. Clearly, such a process would be ineffective or else we could simply “cook,” “roast,” “fry,” or “burn” the gluten out of our foods, and we know that we cannot do that.

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    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