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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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    TAX DEDUCTION FOR GLUTEN-FREE FOODS AS A MEDICAL EXPENSE FOR DIAGNOSED CELIACS ONLY


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    The following guidelines were received from the Oct. 1993 CSA/USA National Conference in Buffalo, NY:

    1) You can claim only the EXTRA COST of the gluten-free product over what you would pay for the similar item at a grocery store. For example, if wheat flour costs $0.89 per 5 lbs. and rice flour is $3.25 per 5 lbs., the DIFFERENCE of $2.36 is tax deductible. You may also claim mileage expense for the extra trip to the health food store and postal costs on gluten-free products ordered by mail.

    2) The cost of xanthan gum (methylcellulose, etc.) used in gluten-free home baked goods is completely different than anything used in an ordinary recipe, so in the opinion of the IRS, the total cost of this item can be claimed.

    3) Save all cash register tapes, receipts, and canceled checks to substantiate your gluten-free purchases. You will need to prepare a list of grocery store prices to arrive at the differences in costs. You need not submit it with your return, but do retain it.

    4) Attach a letter from your doctor to your tax return. This letter should state that you have Celiac Sprue disease and must adhere to a total gluten-free diet for life.

    5) Under MEDICAL DEDUCTIONS list as Extra cost of a gluten-free diet the total amount of your extra expenses. You do not need to itemize these expenses.

    Suggestions:

    1) You may want to write the Citations (as given below) on your tax return. Always keep a copy of your doctors letter for your own records.

    2) Your IRS office may refer you to Publication 17 and tell you these deductions are not permissible. IRS representatives have ruled otherwise and this is applicable throughout the US Refer them to the following Citations:

    • Revenue Ruling 55-261
    • Cohen 38 TC 387
    • Revenue Ruling 76-80, 67 TC 481
    • Flemming TC MEMO 1980 583
    • Van Kalb TC MEMO 1978 366

    0


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    Recommended Comments

    Guest Nancy Bond

    Posted

    My sister said I could, then when I asked my tax preparer she said no. I'm back to saving my receipts.Thank you, and I have to thank the saleslady for telling me about your website.

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    Guest Chester Ayres

    Posted

    I'm not only intolerant to gluten but also to dairy, soy and now I think cinnamon, so I have to really watch what I eat. My job keeps me on the road over 225 days a year.

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    Guest suzanne evans

    Posted

    I'm glad to see we can claim this food. It's not cheap. I only hope I can do it in my next taxes. I spend a lot on food and also I have Type 1 diabetes. It would help me a very much.

    Thank you

    Suzanne

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    I'm new to the celiac diet. I went shopping for Gluten Free food today and was shocked by the high prices of everything. Glad to hear you can take a tax deduction, but you can only claim medical expenses if they are 5% of your salary for the year.

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    Guest Peggy Bare

    Posted

    Thank You so much for putting this tax deduction info out here on your site. I have had Celiac for 2 yrs now and did not know this. Sometimes I don't purchase the foods I need because of the price. Now I will purchase the foods I need thanks to your article. I love your website.

    God Bless You,

    Peggy

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    Guest Miss New

    Posted

    Does anyone know if this is truly possible? I visited the irs.gov website, and could not find anything to confirm the above. This would be great.

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    Guest miserere nobis

    Posted

    I believe this is in reference to the use of an HSA or FSA account. Here is a link to the IRS website explaining Qualified Medical Expenses.

     

    http://www.irs.gov/publications/p502/ar02.html#en_US_publink100014757

     

    Which states:

    'You can deduct only the amount of your medical and dental expenses that is more than 7.5% of your adjusted gross income (Form 1040, line 38). '

     

    However with an HSA account you can debit anything that is labeled as a Qualified Medical Expense.

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    Guest Melisa Murray

    Posted

    Thank you so much for information that even at a recent training I attended the presenter did not know the answer to the tax questions.

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    Guest Sydney

    Posted

    I'm not only intolerant to gluten but also to dairy, soy and now I think cinnamon, so I have to really watch what I eat. My job keeps me on the road over 225 days a year.

    I am intolerant to gluten, dairy, soy, oil like butter and mayo...I think intolerance grows...still there is a lot to eat and enjoy...PF Chang's restaurant is wonderful to go out to eat... good luck

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    Guest patsy

    Posted

    I was very pleased to hear I could deduct on my income tax. The food is very expensive. Sometimes we just look & don't buy because of the high prices. Thank you.

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    A qualified long-term-care policy is considered health insurance under the federal income tax rules.

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    Guest Bill Gazica`

    Posted

    Too bad there isn't a flat deduction for the entire year to cover the cost of gluten-free foods.

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    Guest Cyndi

    Posted

    You rock! I have set up a spreadsheet, with columns, indicating what was purchased, the date, the store the price of the gluten-free item and then what it would cost to purchase a "regular" item and then set a formula to calc the difference. I then keep a total by month. It is amazing to see it add up, and be able to deduct it at the end.

     

    Your website is so helpful, it is saved as one of my favorites.

     

    I was diagnosed and then I pushed to have my daughter tested as her Doc wanted to start her on growth hormone shots as she is very small. I fought it, and had her tested as it is in the genes. She tested positive. Since living gluten-free she has grown over 6" in less than a year!

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    Guest Nutrition

    Posted

    This site is really fascinating. You actually provide up some great points concerning your write-up… .. Regards for the particular very good important information regarding site.. That will be my newbie in this article inside this particular web site so great work…

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    Guest Patsy

    Posted

    Maybe Cyndi could share her spreadsheet form with this site for all to use..... (Re: she made a spreadsheet to keep up with gluten-free Items purchased.)

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    I am so pleased with having found this site and the newsletters! Thank you so much for all the help and advice. I am self diagnosed since we can not afford to see a regular doctor as many of my husband's jobs do not offer a benefit plan, and due to the fact we travel (he is a crane operator) finding gluten-free products is iffy.

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    You rock! I have set up a spreadsheet, with columns, indicating what was purchased, the date, the store the price of the gluten-free item and then what it would cost to purchase a "regular" item and then set a formula to calc the difference. I then keep a total by month. It is amazing to see it add up, and be able to deduct it at the end.

     

    Your website is so helpful, it is saved as one of my favorites.

     

    I was diagnosed and then I pushed to have my daughter tested as her Doc wanted to start her on growth hormone shots as she is very small. I fought it, and had her tested as it is in the genes. She tested positive. Since living gluten-free she has grown over 6" in less than a year!

    I would love a copy of your spreadsheet! I am not too good with making them, but love using spreadsheets!

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    Guest Celia Slagowski

    Posted

    Would love to have a copy of that spreadsheet referred to by Cyndie 30 Mar 2011 as it would be so helpful to keep track of gluten free purchases. Wonderful article and advice. Any breaks appreciated. Keep up the good work. Thanks.

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    Howard J. Kass, CPA
    This is a good summary of the proper tax treatment for the additional costs of complying with a gluten-free diet, under a doctors direction. Let me offer a couple of points of clarification and amplification.
    Revenue Ruling 76-80 is more on point in that it specifically discusses the deductibility of the additional costs one incurs in purchasing a special form of a product versus the normal cost of the non-special version.
    Additionally, if one has to purchase items that they would not otherwise purchase if not for the underlying medical condition (such as xanthan gum) then the full cost of such items are deductible.
    It is important to point out that one of the requirements for deducting a medical expense is that the expenditure must be incurred to treat or alleviate a specific medical condition. It is necessary, then, to establish to the IRS that such a medical condition exists. This is best done by a letter of verification from your doctor. This requirement obviously places a celiac in the position of having to obtain a medical diagnosis in order to deduct the additional costs of following a gluten-free diet.
    As far as the mechanics of the deduction are concerned, you must first establish the amount of your excess costs associated with the gluten-free diet. This is done by maintaining detailed records of your purchases, as well as maintaining records of comparable normal products, accumulating those costs and subtracting the costs of the normal versions of those products over the tax year in question. The deduction would then be taken as a medical deduction on schedule A of form 1040. To obtain the benefit of the deduction, then, you must first be able to itemize deductions, and you must have enough non-reimbursed medical expenses to exceed the threshold of 7.5% of your Adjusted Gross Income. The amount by which your aggregate medical expenses, including the additional cost of a gluten-free diet, exceed that threshold amount would be deductible.
    Does anyone have any experiences or rulings on the legality of deducting as a medical expense the costs for attending a CSA/USA seminar?
    IRS publication 502 (Medical and Dental expense handbook) does not give any specific examples for seminars, but they do ok the cost of special schools for medical or physical reasons. I can rationalize the cost of a Celiac seminar as a medical education expense.
    According to Internal Revenue Code Section 213, travel expenses that may be deducted are those primarily for and essential to medical care . . .
    Regulation 1.213-1(e)(1)(i) defines medical care as the diagnosis, cure, mitigation, treatment, or prevention of disease.
    Depending upon how aggressive or conservative one wishes to be, one could interpret this to mean that meetings that educate individuals in the prevention of a disease are expenses incurred in the mitigation or prevention of disease. All of the case law that I saw dealt with travel to warmer climates, not to medical meetings and conventions.
    Some practitioners might be inclined to take a somewhat aggressive approach and play the audit lottery, while advising their clients that there is risk in taking the deduction. Before taking a deduction, however, it is only prudent to consult with your tax advisor.
    Obviously, this discussion only pertains to taxpayers in the United States.
    I understand that this can be quite confusing. My best advice is to contact your tax advisor. I would be willing to answer questions of a general nature. If I dont answer immediately, please be patient. You can E-mail me at: hkass@zinnerco.com.
    I do have the full text of the two Rev. Rulings mentioned above, as well as the two court cases, but the files are large (about 20K each) and I am unsure of what the copyright law allows as far as distributing this information. The materials are copyrighted.
    Hope this helps clarify (rather than confuse) some of the tax issues.

    Howard J. Kass, CPA
    The information posted by Sandra Leonard that she received from the American Celiac Society was factually correct, and is essentially the same information that can be found in my article on Scott Adams Web site (www.celiac.com). I think it is important, though, to say that only a limited number of people are going to actually benefit from compiling all the information required to take the deduction because of the limitations in the Internal Revenue Code for deducting medical expenses.
    In order to take a deduction for medical expenses, the total amount incurred, NET OF INSURANCE REIMBURSEMENTS, must exceed 7.5% of Adjusted Gross Income (AGI). In other words, if a taxpayer (and spouse, if applicable) had AGI of $80,000, they would have to accumulate over $6,000 of out-of-pocket medical expenses before they would realize any benefit at all.
    In my practice, the only taxpayers who actually deduct medical expenses, because of the above limitations, are those who pay for their own health insurance, and those who had an extraordinary amount of medical expense that their insurance didnt cover. To summarize, the following individuals should consider compiling and deducting the cost of the gluten-free diet: Those who pay for their own health insurance, and those who had large, uninsured medical bills.
    For most everyone else, such an exercise would, most likely, be an exercise in futility.
    I hope this is helpful. If you have any questions, e-mail me at: hkass@zinnerco.com
    Howard J. Kass, CPA
    Partner, Zinner & Co. LLP
    29125 Chagrin Blvd.
    Cleveland, OH 44122
    Tel: (216) 831-0733
    Fax: (216) 765-7118

    Howard J. Kass, CPA
    Celiac.com 03/05/2012 - When I first wrote about the tax treatments available to diagnosed Celiacs for the additional costs they incur by following a Gluten-Free diet fifteen years ago, the law was pretty well established and there were no significant changes in the works. The advent of Section 125 plans shortly thereafter, also known as Flexible Spending Arrangements (FSA) added a new twist to the quest for tax deductions. With all the hoopla that has taken place in the last year, both with health care reform and tax legislation, what has changed?
    Overview of the Medical Expense Deduction
    Before I talk about what has changed, it is important to review the basics of the medical expense deduction and how it relates to the additional costs of following a Gluten-Free diet. Section 213 of the Internal Revenue Code (IRC) provides an itemized deduction for qualified medical expenses incurred. Under present law, medical expenses are deductible to the extent that they exceed 7.5% of Adjusted Gross Income (AGI). AGI is the number shown on the last line of the first page of form 1040.
    So, for an individual who has an AGI of $100,000, the “floor” they have to exceed is $7,500 before any of their medical expenses begin to be deductible. If one is in relatively good health and if their employer pays for their health insurance, it is unlikely that one would have enough qualified medical expenses to take the deduction.
    The Gluten-Free Component
    Now, let’s bring the cost of Gluten-Free food into the equation. Based on a variety of Revenue Rulings and court cases, sufficient precedent has been established for one who has been diagnosed with Celiac Disease (or any other medical condition requiring adherence to a Gluten-Free diet) to claim a medical deduction for the additional costs of following a Gluten-Free diet. I will cite the applicable law at the end of this article.
    So, how does one calculate the cost of following the Gluten-Free diet and, equally important, how does one document those costs? Calculating the cost of following the diet is a matter of tracking the costs of purchasing food items that are necessary to the diet and subtracting the costs of comparable non-Gluten-Free versions of the same food. So, for example, if a loaf of Gluten-Free bread costs you $6.00 and a comparable loaf of “regular” bread costs $2.00, the deductible cost of the Gluten-Free bread would be $4.00.
    What about those items for which there is no counterpart in the non-Gluten-Free community? One example of this would be Xantham Gum. In that event, the total cost of the product would be deductible.
    It’s easy to discuss this process on an item by item basis, but how does one accumulate this data and perform the calculations for a year? First, it is important to collect and retain detailed receipts of every purchase you wish to deduct. You would then need to create a spreadsheet on which to track this data for the year. While I recommend the use of an electronic spreadsheet, pencil and paper will also serve the purpose. If cost is what stands in your way of using a product like Microsoft Excel, check out OpenOffice.org. It is a free Microsoft compatible office suite that should serve your purposes quite well. I would strongly encourage you to collect this data and update your spreadsheet after each shopping trip.
    Where do Flexible Spending Arrangements Come In?
    As mentioned earlier, depending on the amount of your AGI, you may still not have accumulated enough in deductible medical expenses to be able to take the deduction. However, under current law, if you participate in a Section 125 plan with an FSA and, if your FSA plan allows it, you may be able to reimburse yourself for the additional costs of following a Gluten-Free diet. If you can do that, you have effectively achieved an “above the line” deduction for following the Gluten-Free diet. Similarly, since Health Savings Accounts (HSAs) follow the same rules as FSAs, that may also provide you with an opportunity to get your medical deductions, including the additional costs of observing a Gluten-free diet above the line. For those who are unfamiliar with HSAs, they are only available to those who use them in conjunction with a high-deductible health insurance plan. See your tax advisor for more information or e-mail me with your questions.
    Getting back to the discussion on FSAs, however, before you rejoice, there are a couple of caveats to be aware of. First, your 125 plan has to permit this reimbursement. You will need to check with your plan administrator and, perhaps, read the plan document yourself. Be prepared to educate the plan administrator on this issue. Also, after you read the effect that Health Care Reform is going to have on health care expenses in FSAs, you may determine that it isn’t worth the effort. More on that later.
    So, What’s Changed?
    Two significant changes that will affect one’s ability to deduct the costs of following a Gluten-Free diet are slated to occur in the name of Health Care Reform.
    First, the floor for deducting medical expenses is scheduled to increase from 7.5% of AGI to 10% beginning in 2013. If you or your spouse will be age 65 or over at that time, the increase to 10% will take place in 2017. Going back to our example from before, if one has an AGI of $100,000, instead of medical expenses having to exceed a floor of $7,500 to be deductible, they would have to exceed $10,000. This increase would obviously make one think twice about accumulating all the data described earlier!
    Another change slated to take place in 2013 would affect the strategy of paying for the costs of following a Gluten-Free diet from an FSA. Beginning in 2013, the maximum amount that could be contributed to a health FSA will be limited to $2,500. There is currently no limit! This cap will reduce the value of paying the costs of following a Gluten-Free diet because doing so will limit the amount available to pay for other health related expenses. Since HSAs are less restrictive, there may be an opportunity here to improve your deduction options.
    So, What’s the Bottom Line?
    Until the end of 2012, as the law currently stands, it is business as usual in terms of how (if at all) you have been deducting your costs of following a Gluten-Free diet. You must have a diagnosis that requires you to follow a Gluten-Free diet and your costs are potentially deductible as an itemized deduction to the extent they exceed 7.5% of your AGI. If you participate in an FSA, you may be able to pay those expenses through your plan. Check with your plan administrator.
    Beginning in 2013, however, the landscape changes. You will have a higher hurdle to overcome to take the itemized deduction and you will be subject to new restrictions in the amounts that can be paid through an FSA. That’s all true as of this writing. As you must certainly be aware, Health Care is a very volatile issue in Washington right now and there are many who believe that it will look very different than it does right now, by the time 2013 rolls around. Congress isn’t done tinkering yet – stay tuned.
    Cites to the Law
    For those who want to learn more, here are some of the more relevant cites to the tax law:

    §213 of the Internal Revenue Code Rev Rul 55-261 Rev Rul 76-80 Cohen v. Commissioner, 38 TC 387 Randolph v. Commissioner, 67 TC 481 Fleming, TC MEMO 1980 583 Van Kelb, TC MEMO 1978 366 §9013(a)-( of the Patient Protection and Affordable Care Act, P.L. 111-148, 3/23/2010 §125(i)(1) of the Internal Revenue Code as amended by 2010 Health Care Act §10902(a)

    Jefferson Adams
    Celiac.com 03/21/2014 - According to the National Foundation for Celiac Awareness, the burden of celiac disease can cost an extra $1,000 to $2,500 per year. However, many people who eat gluten-free diets as treatment for celiac disease or other medical conditions are eligible for tax breaks.
    Those who do eat gluten-free due to medical conditions will be happy to learn that both the Internal Revenue Service and the Canada Revenue Agency list gluten-free food as an eligible medical expense. That means that filers may be eligible for tax relief for gluten-free-related food expenses.
    For example, according to the Canada Revenue Agency website, celiac disease suffers are "entitled to claim the incremental costs associated with the purchase of gluten-free products as a medical expense." That means Canadians with celiac disease can claim the difference between the cost of their gluten-free food and the cost of comparable regular food. However, there are a few hoops to jump through. To claim the credit, Canadian taxpayers need a doctor's letter confirming celiac disease; a receipt for every item claimed; and a summary for each item calculating the cost differential for gluten-free products.
    U.S. residents can deduct the extra cost for gluten-free foods and goods purchased to meet celiac dietary needs. Shipping and delivery costs for those gluten-free products can also be deducted. Also, for any special trip to purchase gluten-free foods, the cost of transportation to and from the store is deductible, including mileage, tolls and parking fees. The vehicle deduction for trips during 2013 is 24 cents per mile.
    To claim these deductions, taxpayers first need an official, written celiac diagnosis from a doctor. A copy of this diagnosis must be submitted with other completed tax forms.
    Taxpayers will then complete form 1040 schedule A for medical deductions. For reference taxpayers may cite: IRS Publication 502; Revenue Rulings: 55-261, 76-80, 2002-19 and 67 TC 481; Cohen 38 TC 387; Flemming TC MEMO 1980 583; and Van Kalb TC MEMO 1978 366
    This must be supported with copies of receipts for all gluten-free purchases, along with lists of prices for gluten-free food and regular counterparts being claimed.
    The difference between those prices is tax-deductible. For example, if a pound of wheat flour costs $0.60 and a pound of rice flour costs $3.40, then you may deduct $2.80 for each pound of rice flour you are claiming for that tax year.
    Remember, some specialty products like xanthan gum and sorghum flour are fully tax-deductible as they have no "regular" counterpart but are purchased to meet your dietary needs.
    Of course, for specific advice, contact an accountant.
    Sources:
    CAFinance.com CeliacCentral.org
    Celiac.com.

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    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.
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    This study shows that amino acids can influence inflammation and may play a role in the development of celiac disease.
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    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.
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    Now the major airlines are taking note and introducing stringent requirements for service animals.
    Delta was the first to strike. As reported by the New York Times on January 19: “Effective March 1, Delta, the second largest US airline by passenger traffic, said it will require passengers seeking to fly with pets to present additional documents outlining the passenger’s need for the animal and proof of its training and vaccinations, 48 hours prior to the flight.… This comes in response to what the carrier said was a 150 percent increase in service and support animals — pets, often dogs, that accompany people with disabilities — carried onboard since 2015.… Delta said that it flies some 700 service animals a day. Among them, customers have attempted to fly with comfort turkeys, gliding possums, snakes, spiders, and other unusual pets.”
    Fresh from an unsavory incident with an “emotional support” peacock incident, United Airlines has followed Delta’s lead and set stricter rules for emotional support animals. United’s rules also took effect March 1, 2018.
    So, to the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service and emotional support animals.
    Source:
    cnbc.com

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

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

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

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

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

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

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

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

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

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

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

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

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