• Popular Contributors

  • Who's Online   13 Members, 1 Anonymous, 233 Guests (See full list)

  • Related Articles

    Scott Adams
    Acacia Gum
    Acesulfame K
    Acesulfame Potassium
    Acetanisole
    Acetophenone
    Acorn Quercus
    Adipic Acid
    Adzuki Bean
    Acacia Gum
    Agar
    Agave
    Albumen
    Alcohol (Distilled Spirits - Specific Types)
    Alfalfa
    Algae
    Algin
    Alginic Acid
    Alginate
    Alkalized Cocoa
    Allicin
    Almond Nut
    Alpha-amylase
    Alpha-lactalbumin
    Aluminum
    Amaranth
    Ambergris
    Ammonium Hydroxide
    Ammonium Phosphate
    Ammonium Sulphate
    Amylose
    Amylopectin
    Annatto
    Annatto Color
    Apple Cider Vinegar
    Arabic Gum
    Arrowroot
    Artichokes
    Artificial Butter Flavor
     Artificial Flavoring
    Ascorbic Acid
    Aspartame (can cause IBS symptoms)
    Aspartic Acid
    Aspic
    Astragalus Gummifer
    Autolyzed Yeast Extract
    Avena Sativia (Oats3)
    Avena Sativia Extract (from Oats3)
    Avidin
    Azodicarbonamide
    Baking Soda
    Balsamic Vinegar
    Beeswax
    Beans
    Bean, Adzuki
    Bean, Hyacinth
    Bean, Lentil
    Bean, Mung
    Bean Romano (Chickpea)
    Bean Tepary
    Benzoic acid
    Besan (Chickpea)
    Beta Glucan (from Oats3)
    Betaine
    Beta Carotene
    BHA
    BHT
    Bicarbonate of Soda
    Biotin
    Blue Cheese
    Brown Sugar
    Buckwheat
    Butter (check additives)
    Butylated Hydroxyanisole
    Butyl Compounds
    Calcium Acetate
    Calcium Carbonate
    Calcium Caseinate
    Calcium Chloride
    Calcium Disodium
    Calcium Hydroxide
    Calcium Lactate
    Calcium Pantothenate
    Calcium Phosphate
    Calcium Propionate
    Calcium Silicate
    Calcium Sorbate
    Calcium Stearoyl Lactylate
    Calcium Stearate
    Calcium Sulfate
    Calrose
    Camphor
    Cane Sugar
    Cane Vinegar
    Canola (Rapeseed)
    Canola Oil (Rapeseed Oil)
    Caprylic Acid
    Carageenan Chondrus Crispus
    Carbonated Water
    Carboxymethyl Cellulose
    Caramel Color
    Caramel Flavoring
    Carmine
    Carnauba Wax
    Carob Bean
    Carob Bean Gum
    Carob Flour
    Carrageenan
    Casein
    Cassava Manihot Esculenta
    Castor Oil
    Catalase
    Cellulose1
    Cellulose Ether
    Cellulose Gum
    Cetyl Alcohol
    Cetyl Stearyl Alcohol
    Champagne Vinegar
    Channa (Chickpea)
    Chana Flour (Chickpea Flour)
    Cheeses - (most, but check ingredients)
    Chestnuts
    Chickpea
    Chlorella
    Chocolate Liquor
    Choline Chloride
    Chromium Citrate
    Chymosin
    Citric Acid
    Citrus Red No. 2
    Cochineal
    Cocoa
    Cocoa Butter
    Coconut
    Coconut Vinegar
    Collagen
    Colloidal Silicon Dioxide
    Confectioner's Glaze
    Copernicia Cerifera
    Copper Sulphate
    Corn
    Corn Gluten
    Corn Masa Flour
    Corn Meal
    Corn Flour
    Corn Starch
    Corn Sugar
    Corn Sugar Vinegar
    Corn Syrup
    Corn Syrup Solids
    Corn Swetener
    Corn Vinegar
    Corn Zein
    Cortisone
    Cotton Seed
    Cotton Seed Oil
    Cowitch
    Cowpea
    Cream of Tartar
    Crospovidone
    Curds
    Cyanocobalamin
    Cysteine, L
    Dal (Lentils)
    D-Alpha-tocopherol
    Dasheen Flour (Taro)
    Dates
    D-Calcium Pantothenate
    Delactosed Whey
    Demineralized Whey
    Desamidocollagen
    Dextran
    Dextrin
    Dextrimaltose
    Dextrose
    Diglycerides
    Dioctyl Sodium
    Dioctyl Sodium Solfosuccinate
    Dipotassium Phosphate
    Disodium Guanylate
    Disodium Inosinate
    Disodium Phosphate
    Distilled Alcohols
    Distilled Vinegar
    Distilled White Vinegar
    Dutch Processed Cocoa
    EDTA (Ethylenediaminetetraacetic Acid)
    Eggs
    Egg Yolks
    Elastin
    Ester Gum
    Ethyl Alcohol
    Ethylenediaminetetraacetic Acid
    Ethyl Maltol
    Ethyl Vanillin
    Expeller Pressed Canola Oil
    FD&C Blue No. 1 Dye
    FD&C Blue No. 1 Lake
    FD&C Blue No. 2 Dye
    FD&C Blue No. 2 Lake
    FD&C Green No. 3 Dye
    FD&C Green No. 3 Lake
    FD&C Red No. 3 Dye
    FD&C Red No. 40 Dye
    FD&C Red No. 40 Lake
    FD&C Yellow No. 5 Dye
    FD&C Yellow No. 6 Dye
    FD&C Yellow No. 6 Lake
    Ferric Orthophosphate
    Ferrous Gluconate
    Ferrous Fumerate
    Ferrous Lactate
    Ferrous Sulfate
    Fish (fresh)
    Flaked Rice
    Flax
    Folacin
    Folate
    Flavoring
    Flavoring Extracts
    Folic Acid-Folacin
    Food Starch
    Food Starch Modified
    Formaldehyde
    Fructose
    Fruit (including dried)
    Fruit Vinegar
    Fumaric Acid
    Galactose
    Garbanzo Beans
    Gelatin
    Glucoamylase
    Gluconolactone
    Glucose
    Glucose Syrup
    Glutamate (free)
    Glutamic Acid
    Glutamine (amino acid)
    Glutinous Rice
    Glutinous Rice Flour
    Glycerides
    Glycerin
    Glycerol Monooleate
    Glycol Monosterate
    Glycol
    Glycolic acid
    Gram flour (chick peas)
    Grape Skin Extract
    Grits, Corn
    Guar Gum
    Gum Acacia
    Gum Arabic
    Gum Base
    Gum Tragacanth
    Hemp
    Hemp Seeds
    Herbs
    Herb Vinegar
    Hexanedioic Acid
    High Fructose Corn Syrup
    Hominy
    Honey
    Hops
    Horseradish (Pure)
    HPP
    HVP
    Hyacinth Bean
    Hydrogen Peroxide
    Hydrolyzed Caseinate
    Hydrolyzed Meat Protein
    Hydrolyzed Plant Protein
    Hydrolyzed Protein
    Hydrolyzed Soy Protein
    Hydrolyzed Vegetable Protein
    Hydroxypropyl Cellulose
    Hydroxypropyl Methylcellulose
    Hypromellose
    Illepe
    Iodine
    Inulin
    Invert Sugar
    Iron Ammonium Citrate
    Isinglass
    Isolated Soy Protein
    Isomalt
    Job's Tears
    Jowar (Sorghum)
    Karaya Gum
    Kasha (roasted buckwheat)
    Keratin
    K-Carmine Color
    K-Gelatin
    Koshihikari (rice)
    Kudzu
    Kudzu Root Starch
    Lactalbumin Phosphate
    Lactase
    Lactic Acid
    Lactitol
    Lactose
    Lactulose
    Lanolin
    Lard
    L-cysteine
    Lecithin
    Lemon Grass
    Lentils
    Licorice
    Licorice Extract
    Lipase
    L-leucine
    L-lysine
    L-methionine
    Locust Bean Gum
    L-tryptophan
    Magnesium Carbonate
    Magnesium Hydroxide
    Magnesium Oxide
    Maize
    Maize Waxy
    Malic Acid
    Maltitol
    Maltodextrin (except in pharmaceuticals)
    Maltol
    Maltose
    Manganese Sulfate
    Manioc
    Masa
    Masa Flour
    Masa Harina
    Meat (fresh)
    Medium Chain Triglycerides
    Menhaden Oil
    Methyl Cellulose2
    Microcrystalline Cellulose
    Micro-particulated Egg White Protein
    Milk
    Milk Protein Isolate
    Millet
    Milo (Sorghum)
    Mineral Oil
    Mineral Salts
    Mixed Tocopherols
    Modified Food Starch
    Modified Starch
    Modified food Starch
    Molybdenum Amino Acid Chelate
    Monocalcium Phosphate
    Monoglycerides
    Mono and Diglycerides
    Monopotassium Phosphate
    Monosaccharides
    Monosodium Glutamate (MSG)
    Monostearates
    MSG
    Mung Bean
    Musk
    Mustard Flour
    Myristic Acid
    Natural Flavoring
    Natural Flavors
    Natural Smoke Flavor
    Niacin-Niacinamide
    Neotame
    Niacin
    Niacinamide
    Nitrates
    Nitrous Oxide
    Non-fat Milk
    Nuts (except wheat, rye & barley)
    Nut, Acron
    Nut, Almond
    Oats3
    Oils and Fats
    Oleic Acid
    Oleoresin
    Olestra
    Oleyl Alcohol/Oil
    Orange B
    Oryzanol
    Palmitic Acid
    Pantothenic Acid
    Papain
    Paprika
    Paraffin
    Patially Hydrogenated Cottonseed Oil
    Patially Hydrogenated Soybean Oil
    Peas
    Pea - Chick
    Pea - Cow
    Pea Flour
    Pea Starch
    Peanuts
    Peanut Flour
    Pectin
    Pectinase
    Peppermint Oil
    Peppers
    Pepsin
    Peru Balsam
    Petrolatum
    PGPR (Polyglycerol Polyricinoleate)
    Phenylalanine
    Phosphoric Acid
    Phosphoric Glycol
    Pigeon Peas
    Polenta
    Polydextrose
    Polyethylene Glycol
    Polyglycerol
    Polyglycerol Polyricinoleate (PGPR)
    Polysorbates
    Polysorbate 60
    Polysorbate 80
    Potassium Benzoate
    Potassium Caseinate
    Potassium Citrate
    Potassium Iodide
    Potassium Lactate
    Potassium Matabisulphite
    Potassium Sorbate
    Potatoes
    Potato Flour
    Potato Starch
    Povidone
    Prinus
    Pristane
    Propolis
    Propylene Glycol
    Propylene Glycol Monosterate
    Propyl Gallate
    Protease
    Psyllium
    Pyridoxine Hydrochloride
    Quinoa
    Ragi
    Raisin Vinegar
    Rape
    Recaldent
    Reduced Iron
    Rennet
    Rennet Casein
    Resinous Glaze
    Reticulin
    Riboflavin
    Rice
    Rice (Enriched)
    Rice Flour
    Rice Starch
    Rice Syrup
    Rice Vinegar
    Ricinoleic Acid
    Romano Bean (chickpea)
    Rosematta
    Rosin
    Royal Jelly
    Saccharin
    Saffron
    Sago
    Sago Palm
    Sago Flour
    Sago Starch
    Saifun (bean threads)
    Salt
    Seaweed
    Seeds (except wheat, rye & barley)
    Seed - Sesame
    Seed - Sunflower
    Shea
    Sherry Vinegar
    Silicon Dioxide
    Smoke Flavoring
    Soba (be sure its 100% buckwheat)
    Sodium Acid Pyrophosphate
    Sodium Acetate
    Sodium Alginate
    Sodium Ascorbate
    Sodium Benzoate
    Sodium Caseinate
    Sodium Citrate
    Sodium Erythrobate
    Sodium Hexametaphosphate
    Sodium Lactate
    Sodium Lauryl Sulfate
    Sodium Metabisulphite
    Sodium Nitrate
    Sodium Phosphate
    Sodium Polyphosphate
    Sodium Silaco Aluminate
    Sodium Stearoyl Lactylate
    Sodium Sulphite
    Sodium Stannate
    Sodium Tripolyphosphate
    Sorbic Acid
    Sorbitan Monostearate
    Sorbitol-Mannitol (can cause IBS symptoms)
    Sorghum
    Sorghum Flour
    Soy
    Soybean
    Soy Lecithin
    Soy Protein
    Soy Protein Isolate
    Spices (pure)
    Spirits (Specific Types)
    Spirit Vinegar
    Starch (the single word ingredient is, by law, cornstarch)
    Stearates
    Stearamide
    Stearamine
    Stearic Acid
    Stearyl Lactate
    Stevia
    Subflower Seed
    Succotash (corn and beans)
    Sucralose
    Sucrose
    Sulfosuccinate
    Sulfites
    Sulfur Dioxide
    Sweet Chestnut Flour
    Tagatose
    Tallow
    Tapioca
    Tapioca Flour
    Tapioca Starch
    Tara Gum
    Taro
    Tarro
    Tarrow Root
    Tartaric Acid
    Tartrazine
    TBHQ is Tetra or Tributylhydroquinone
    Tea
    Tea-Tree Oil
    Teff
    Teff Flour
    Tepary Bean
    Textured Vegetable Protein
    Thiamin Hydrochloride
    Thiamine Mononitrate
    Thiamine Hydrochloride
    Titanium Dioxide
    Tofu (Soy Curd)
    Tolu Balsam
    Torula Yeast
    Tragacanth
    Tragacanth Gum
    Triacetin
    Tricalcium Phosphate
    Tri-Calcium Phosphate
    Trypsin
    Turmeric (Kurkuma)
    TVP
    Tyrosine
    Urad/Urid Beans
    Urad/Urid Dal (peas) Vegetables
    Urad/Urid flour
    Urd
    Vinegar (All except Malt)
    Vanilla Extract
    Vanilla Flavoring
    Vanillin
    Vinegars (Specific Types - Except Malt Vinegar)
    Vitamin A (retinol)
    Vitamin A Palmitate
    Vitamin B1
    Vitamin B-12
    Vitamin B2
    Vitamin B6
    Vitamin D
    Vitamin E Acetate
    Waxy Maize
    Whey
    Whey Protein Concentrate
    Whey Protein Isolate
    White Vinegar
    Wines
    Wine Vinegars (& Balsamic)
    Wild Rice
    Xanthan Gum
    Xylitol
    Yam Flour
    Yeast (except brewer's yeast)
    Yogurt (plain, unflavored)
    Zinc Oxide
    Zinc Sulfate
    1) Cellulose is a carbohydrate polymer of D-glucose. It is the structural material of plants, such as wood in trees. It contains no gluten protein. 2) Methyl cellulose is a chemically modified form of cellulose that makes a good substitute for gluten in rice-based breads, etc. 3) Recent research indicates that oats may be safe for people on gluten-free diets, although many people may also have an additional, unrelated intolerance to them. Cross contamination with wheat is also a factor that you need to consider before choosing to include oats in your diet.

    Scott Adams
    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.

    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.

  • Recent Articles

    Alexander R. Shikhman, MD, PhD, FACR
    The Connection between Gluten Intolerance and Sjogren’s Syndrome
    Celiac.com 08/17/2018 - Mucosal dryness is among the top non-gastrointestinal complaints of patients with gluten intolerance and celiac disease.
    Prolonged eye dryness, itching and chronic inflammation of the eye lids (blepharitis), mouth dryness, excessive thirst, frequent yeast infections, skin dryness and vaginal dryness in women may represent clinical symptoms of Sjogren’s syndrome. Named after Swedish ophthalmologist Henrik Sjögren, Sjogren’s syndrome is one the most common (and one of the most commonly underdiagnosed) rheumatic/autoimmune diseases. The disease most frequently affects women (10 women for every man) and usually appears in women around and after menopause. However, the disease can affect either gender at any age.
    In addition to mucosal and skin dryness, Sjogren’s syndrome can cause joint pain and stiffness, damage to peripheral nerves leading to numbness and tingling of fingers and toes, fatigue, brain fog, inflammation of blood vessels, hair loss, poor food digestion due to pancreatic damage and various problems with the cardiac muscle and its conduction system causing arrythmia and myocarditis. Patients suffering from Sjogren’s syndrome quite frequently deal with recurring yeast infections, chronic periodontal disease, recurring canker sores and poor dental health.
    The diagnosis of Sjogren’s syndrome is based on:
    Demonstration of mucosal dryness upon physical examination Specific blood tests (positive anti-SSA/Ro and anti-SSB/La antibodies, elevated levels of serum immunoglobulin G) Ultrasound imaging of salivary glands On rare occasions, a diagnosis of Sjogren’s syndrome requires confirmation through a small salivary gland biopsy or special nuclear medicine studies.
    It is well documented that patients with gluten intolerance and celiac disease have an increased risk of Sjogren’s syndrome. Similarly, patients with Sjogren’s syndrome are characterized by the increased prevalence of gluten intolerance and celiac disease.
    The connection between Sjogren’s syndrome and gluten intolerance is not a coincidental one: there are well-studied molecular mechanisms explaining this link. In the late 1980s/early 1990s genetic studies in Sjogren’s patients demonstrated an increased presence of the class II major histocompatibility complex protein HLA DQ2. Furthermore, HLA DQ2 positivity was found to be associated with increased titers of Sjogren’s specific anti-SSA/Ro and anti-SSB/La antibodies. The link between gluten and Sjogren’s syndrome became obvious in the mid to late 1990s when it was discovered that HLA-DQ2 binds to deamidated gluten peptides and presents them to mucosal CD4+ T cells thus initiating a chain of events eventually leading to autoimmune responses.
    The second set of data came from the discovery of BM180 protein. This protein regulates tear secretion in the lacrimal acinar cells. Suprisingly, amino acid sequence of BM180 has a similarity with alpha-gliadin and, therefore, can attract inflammatory cells activated by gluten thus contributing to the development of eye dryness.
    The actual prevalence of gluten intolerance in Sjogren’s patients based on published data varies from 20% to 40% depending on the criteria used to define gluten intolerance. The data from our clinic (Institute for Specialized Medicine) indicate that gluten intolerance can affect almost half of patients with Sjogren’s syndrome. Additionally, our data show that one third of patients with gluten intolerance have evidence of mucosal dryness and Sjogren’s syndrome.
    The frequency of documented celiac disease in patients with Sjogren’s syndrome is in the vicinity of 5%.
    The following is a patient case history from our clinic:
    A 28 year old woman was seen in our clinic due to her complaints of long-standing irritable bowel syndrome and recent onset of eye dryness. Her initial presentation included abdominal pain, bloating and irregular bowel movements. She was seen by several gastroenterologists and underwent several upper endoscopies and colonoscopies with mucosal biopsies which were non-diagnostic. Her lab test results showed positive IgG anti-gliadin antibodies and she was told that “this is a common finding among healthy people, and is not indicative of any illnesses.” She was seen by her ophthalmologist and prescribed with contact lenses which she could not wear due to significant eye discomfort and irritation. Further eye examination showed that she had diminished tear production and was referred to our clinic to rule out Sjogren’s syndrome. Upon physical examination in our clinic the patient not only demonstrated profound eye dryness but also showed evidence of dry mouth, fissured tongue and patchy areas of thrush as well as very dry skin. A sonographic evaluation of her major salivary glands was suspicious for moderately advanced Sjogren’s syndrome. Her laboratory test results showed: positive anti-SSA/Ro antibodies, elevated serum immunoglobulin G, low neutrophil count as well as low levels of vitamin D and ferritin (a serum marker of iron storage state). Also, the patient was found to have positive serum IgG and salivary IgA anti-gliadin antibodies as well as positive HLA DQ2 (a molecular marker associated with gluten intolerance).
    Based on a combination of clinical history, physical findings and laboratory test results, the patient was diagnosed with gluten intolerance and Sjogren’s syndrome. In addition to the aforementioned tests, the patient underwent food intolerance testing based on serum IgG4 antibodies which showed not only gluten but also cow’s casein intolerance. Her treatment options included a traditional route of therapy based on drugs or an integrative approach based on dietary modifications and food supplements. She opted for the integrative approach and started a gluten-free and dairy-free diet as well as iron glycinate, vitamin D, specific probiotics and digestive enzymes.
    After the first month on the diet and supplements, she reported a remarkable improvement of her irritable bowel symptoms and in three months, she started noticing an improvement of the dryness. Laboratory tests performed six months after initiation of the therapy showed normalization of the IgG level, disappearance of anti-SSA/Ro antibodies and a slightly suppressed neutrophil count. Through following the prescribed diet and supplements she is now symptom free.
    Why do we need to treat Sjogren’s syndrome? Left untreated, Sjogren’s syndrome can cause debilitating dryness affecting gastrointestinal and respiratory tracts. Clinically, this manifests as difficulty in swallowing solid foods, heartburn, malabsorption of nutrients and minerals, bloating, weight loss, chronic sinus infections and prolonged dry cough. Sjogren’s syndrome also significantly increases the risk for malignancies affecting lymphatic nodules, known as lymphomas.
    Therapy for Sjogren’s syndrome is based on the treatment of mucosal dryness and the autoimmune component of the disease. In addition, patients affected by Sjogren’s syndrome need to have regular screenings for malignancies (specifically lymphomas) and premalignant conditions.
    Traditional therapy for Sjogren’s syndrome (treatment of dryness):
    Cyclosporin (brand name Restasis) eye drops and artificial tears for dry eyes. Numoisyn lozenges and liquid, as well as Caphosol for mouth dryness and mucositis. Cevimeline (brand name Evoxac) and pilocarpine (brand name Salagen) for systemic dryness therapy. Treatment of autoimmune disturbances:
    Hydroxychloroquin (brand name Plaquenil). Leflunomide (brand name Arava). Severe autoimmune conditions associated with Sjogren’s syndrome are treated with the biologic drug rituximab (brand name Rituxan). Integrative therapy for Sjogren’s syndrome. Ear acupuncture (auricular therapy) and body acupuncture to stimulate tear and saliva production. Elimination diet based on individual food-intolerance profiles. Oral probiotics (for example, BLIS K12) and intestinal probiotics. Digestive enzymes. Fish and krill oils. Black currant seed oil. Cordyceps sinensis in combination with wormwood extract to treat the autoimmune component of Sjogren’s syndrome. Zinc and elderberry lozenges. N-acetyl-L-cysteine and glutathione. Our extensive clinical experience demonstrate that early cases of Sjogren’s syndrome can be completely reversed (by both clinical and laboratory criteria) by the strict gluten-free and elimination diet. The advanced cases cannot be reversed; however, even in advanced cases the gluten-free and elimination diet can slow the progression of the disease.
    If you’re concerned that dryness may represent Sjogren’s syndrome, see a rheumatologist for further evaluation and management of your condition.
    References:
    Alvarez-Celorio MD, Angeles-Angeles A, Kraus A. Primary Sjögren’s Syndrome and Celiac Disease: Causal Association or Serendipity? J Clin Rheumatol. 2000 Aug;6(4):194-7. Asrani AC, Lumsden AJ, Kumar R, Laurie GW. Gene cloning of BM180, a lacrimal gland enriched basement membrane protein with a role in stimulated secretion. Adv Exp Med Biol. 1998;438:49-54. Feuerstein J. Reversal of premature ovarian failure in a patient with Sjögren syndrome using an elimination diet protocol. J Altern Complement Med. 2010 Jul;16(7):807-9. Iltanen S, Collin P, Korpela M, Holm K, Partanen J, Polvi A, Mäki M. Celiac disease and markers of celiac disease latency in patients with primary Sjögren’s syndrome. Am J Gastroenterol. 1999 Apr;94(4):1042-6. Lemon S, Imbesi S., Shikhman A.R. Salivary gland imaging in Sjogren’s syndrome. Future Rheumatology, 2007 2(1):83-92. Roblin X, Helluwaert F, Bonaz B. Celiac disease must be evaluated in patients with Sjögren syndrome. Arch Intern Med. 2004 Nov 22;164(21):2387. Teppo AM, Maury CP. Antibodies to gliadin, gluten and reticulin glycoprotein in rheumatic diseases: elevated levels in Sjögren’s syndrome. Clin Exp Immunol. 1984 Jul;57(1):73-8.

    Jefferson Adams
    Can a Gluten-Free Diet Normalize Vitamin D Levels for Celiac Patients?
    Celiac.com 08/16/2018 - What is the significance of vitamin D serum levels in adult celiac patients? A pair of researchers recently set out to assess the value and significance of 25(OH) and 1,25(OH) vitamin D serum levels in adult celiac patients through a comprehensive review of medical literature.
    Researchers included F Zingone and C Ciacci are affiliated with the Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; and the Celiac Center, AOU San Giovanni di Dio e Ruggi di Aragona, University of Salerno, Department of Medicine and Surgery, Salerno, Italy. 
    Within the wide spectrum of symptoms and alteration of systems that characterizes celiac disease, several studies indicate a low-level of vitamin D, therefore recent guidelines suggest its evaluation at the time of diagnosis. This review examines the data from existing studies in which vitamin D has been assessed in celiac patients. 
    Our review indicates that most of the studies on vitamin D in adult celiac disease report a 25 (OH) vitamin D deficiency at diagnosis that disappears when the patient goes on a gluten-free diet, independently of any supplementation. Instead, the researchers found that levels of calcitriol, the active 1,25 (OH) form of vitamin D, fell within the normal range at the time of celiac diagnosis. 
    Basically, their study strongly suggests that people with celiac disease can recover normal vitamin D levels through a gluten-free diet, without requiring any supplementation.
    Source:
    Dig Liver Dis. 2018 Aug;50(8):757-760. doi: 10.1016/j.dld.2018.04.005. Epub 2018 Apr 13.  

    Jefferson Adams
    Could Gluten-Free Food Be Hurting Your Dog?
    Celiac.com 08/15/2018 - Grain-free food has been linked to heart disease in dogs. A canine cardiovascular disease that has historically been seen in just a few breeds is becoming more common in other breeds, and one possible culprit is grain-free dog food. 
    The disease in question is called canine dilated cardiomyopathy (DCM), and often results in congestive heart failure. DCM is historically common in large dogs such as Great Danes, Newfoundlands, Irish Wolfhounds, Saint Bernards and Doberman Pinschers, though it is also affects some Cocker Spaniels.  Numerous cases of DCM have been reported in smaller dogs, whose primary source of nutrition was food containing peas, lentils, other legume seeds or potatoes as main ingredients. These reported atypical DCM cases included Golden and Labrador Retrievers, a Whippet, a Shih Tzu, a Bulldog and Miniature Schnauzers, as well as mixed breeds. 
    As a result, the U.S. Food and Drug Administration's Center for Veterinary Medicine, along with a group of veterinary diagnostic laboratories, is investigating the possible link between DCM and pet foods containing seeds or potatoes as main ingredients. The good news is that in cases where the dog suffers no genetic component, and the disease is caught early, simple veterinary treatment and dietary change may improve heart function.
    According to Nutritional Outlook, an industry publication for makers of dietary supplements and healthy foods and beverages, there is a growing market for “free from” foods for dogs, especially gluten-free and grain-free formulations. In 2017, about one in five dog foods launched was gluten-free. So, do dogs really need to eat grain-free or gluten-free food? Probably not, according to PetMD, which notes that many pet owners are simply projecting their own food biases when choosing dog food.
    Genetically, dogs are well adapted to easily digest grains and other carbohydrates. Also, beef and dairy remain the most common allergens for dogs, so even dogs with allergies are unlikely to need to need grain-free food. 
    So, the take away here seems to be that most dogs don’t need grain-free or gluten-free food, and that it might actually be bad for the dog, not good, as the owner might imagine.
    Stay tuned for more on the FDA’s investigation and any findings they make.
    Read more at Bizjournals.com
     

    Jefferson Adams
    Did You Miss the Gluten-Free Fireworks This Past Fourth of July?
    Celiac.com 08/14/2018 - Occasionally, Celiac.com learns of an amusing gluten-free story after the fact. Such is the case of the “Gluten-Free Fireworks.” 
    We recently learned about a funny little event that happened leading up to Fourth of July celebrations in the town of Springdale in Northwest Arkansas. It seems that a sign advertising "Gluten Free Fireworks" popped up near a fireworks stand on interstate 49 in Springdale. 
    In case you missed the recent dose of Fourth of July humor, in an effort to attract customers and provide a bit of holiday levity, Pinnacle Fireworks put up a sign advertising "gluten-free fireworks.” 
    The small company is owned by Adam Keeley and his father. "A lot of the people that come in want to crack a joke right along with you," Keeley said. "Every now and then, you will get someone that comes in and says so fireworks are supposed to be gluten-free right? Have I been buying fireworks that have gluten? So then I say no, no they are gluten-free. It's just a little fun."
    Keeley said that their stand saw a steady flow of customers in the week leading up to the Fourth. In addition to selling “gluten-free” fireworks, each fireworks package sold by Pinnacle features a QR code. The code can be scanned with a smartphone. The link leads to a video showing what the fireworks look like.
    We at Celiac.com hope you and your family had a safe, enjoyable, and, yes, gluten-free Fourth of July. Stay tuned for more on gluten-free fireworks and other zany, tongue-in-cheek stories.
    Read more at kark.com
     

    Jefferson Adams
    Stress-Related Disorders Associated with Higher Risk for Autoimmune Disease
    Celiac.com 08/13/2018 - It’s not uncommon for people to have psychiatric reactions to stressful life events, and these reactions may trigger some immune dysfunction. Researchers don’t yet know whether such reactions increase overall risk of autoimmune disease.
    Are psychiatric reactions induced by trauma or other life stressors associated with subsequent risk of autoimmune disease? Are stress-related disorders significantly associated with risk of subsequent autoimmune disease?
    A team of researchers recently set out to determine whether there is an association between stress-related disorders and subsequent autoimmune disease. The research team included Huan Song, MD, PhD; Fang Fang, MD, PhD; Gunnar Tomasson, MD, PhD; Filip K. Arnberg, PhD; David Mataix-Cols, PhD; Lorena Fernández de la Cruz, PhD; Catarina Almqvist, MD, PhD; Katja Fall, MD, PhD; Unnur A. Valdimarsdóttir, PhD.
    They are variously affiliated with the Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; the Department of Rheumatology, University Hospital, Reykjavík, Iceland; the Centre for Rheumatology Research, University Hospital, Reykjavík, Iceland; the National Centre for Disaster Psychiatry, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden; the Stress Research Institute, Stockholm University, Stockholm, Sweden; the Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; the Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; the Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden; the Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
    The team conducted a Swedish register-based retrospective cohort study that included 106, 464 patients with stress-related disorders, 1,064 ,640 matched unexposed individuals, and 126 ,652 full siblings to determine whether a clinical diagnosis of stress-related disorders was significantly associated with an increased risk of autoimmune disease.
    The team identified stress-related disorder and autoimmune diseases using the National Patient Register. They used Cox model to estimate hazard ratios (HRs) with 95% CIs of 41 autoimmune diseases beyond 1 year after the diagnosis of stress-related disorders, controlling for multiple risk factors.
    The data showed that being diagnosed with a stress-related disorder, such as post-traumatic stress disorder, acute stress reaction, adjustment disorder, and other stress reactions, was significantly associated with an increased risk of autoimmune disease, compared with matched unexposed individuals. The team is calling for further studies to better understand the associations and the underlying factors.
    Source:
    JAMA. 2018;319(23):2388-2400. doi:10.1001/jama.2018.7028