Celiac.com 11/11/2017 - (NOTE: This article is from 2012 and is being made available as Celiac.com rolls our past issues of Journal of Gluten Sensitivity) It's just like being a little kid with a super sore throat and your mom taking you to the doctor to get a test for strep throat. The doctor swabs your throat with two sticks to find out what nasty bacteria is camping out. In just moments you've got a diagnosis of strep throat and can start antibiotics to miraculously make the pain go away. You go home with a prescription, get in bed and eat mom's homemade chicken rice soup until you feel better in a couple of days. How cool would it be if getting diagnosed with celiac disease was this easy?

The wonderful news is that we're getting closer to having a test that will diagnose celiac disease with just a simple prick of a finger and a 10-minute wait. The CeliacSure Test Kit measures (anti-tTG) IGA antibodies from a fingertip blood sample. It works by taking a small drop of blood, mixing it with a buffer and applying the mixture onto a test cartridge. Within moments two red lines appear if the test is positive, while only one line appears if the result is negative. And, you can take the test at home without ever getting out of your pajamas!

"The test kit is a point-of-care, at-home test that's very similar to reading results of a pregnancy test," said Dr. Daniel Leffler of the Celiac Disease Center at Beth Israel Deaconess Medical Center in Boston. Dr. Leffler, a gastroenterologist by training with a background in nutrition, has a long-standing interest in celiac disease. Several years ago he teamed up with Dr. Ciaran Kelly and Dietitian Melinda Dennis to found the Celiac Disease Center at Beth Israel Deaconess Medical Center where they focus not only on providing top notch patient care, but also on high level disease research. The latest project: studying the efficacy of the CeliacSure test for celiac disease diagnosis.

Dr. Leffler said his team got involved with the finger prick test study because they feel it's important to take down barriers to patients getting diagnosed with celiac disease. "We do a lot with educating other medical providers about offering in-clinic testing, but I think it's really important to put a tool in the hands of the people."

"We've teamed up with the [marketers] of the test kit at GlutenPro/Biocard CeliacSure Test to see how effective this test is in the USA. We're providing 2 kits per family to use on first-degree relatives of people with celiac disease. To qualify, participants in the study must not be on a gluten-free diet. We send them the test kit to take as well as a survey about their ability to use and understand the test. The goal is that this small study comes out favorable [sic] so we can move on to large scale studies that will compare the finger prick test to the gold standard laboratory serology testing."

Dr. Leffler says he's really excited about the potential of this point-of-care test because it will "allow us to reach a population that might not otherwise come in to get tested, mainly first degree relatives of patients already diagnosed with celiac disease."

It's important to note that right now the CeliacSure test is only for research purposes, not actual diagnosis. It is available in Canada and other countries, but it's still under evaluation here in the United States. And, while the strep throat analogy is a great way to think about how this test will work, it's extremely important to understand that if you get a positive result with the CeliacSure test, do not start a gluten-free diet until you have followed up with a doctor to confirm the diagnosis.

As with all medical studies there's some fine print you need to know about. Participants in the study must meet all of the following criteria:

1. Over the age of 18
2. A first or second degree relative with celiac disease
3. Not previously diagnosed with celiac disease
4. Not on a gluten-free diet or low-gluten diet within the past 3 months
5. Able and willing to self administer the test, complete a short survey form and return both in the envelope provided
6. Willingness to have follow up medical evaluation in the event of a positive test
7. A resident of the United States

Listen to a full interview with Dr. Leffler about the CeliacSure study on the Hold the Gluten Podcast (http://traffic.libsyn.com/holdthegluten/050_HoldTheGluten-05Apr2012.mp3) with Vanessa Maltin Weisbrod and Maureen Stanley now! And, if you would like to participate in the study, please contact Dr. Toufic Kabbani at celiac@bidmc.harvard.edu or by phone at 617-667-0528.

Celiac.com 10/27/2017 - It has long been understood that two autoimmune diseases, celiac disease and type 1 diabetes are related. They share common genes and the incidence of celiac disease is higher among type 1 diabetics. There have been some anecdotal reports regarding children diagnosed with type 1 diabetes who were put on a gluten-free diet soon after their diagnosis and for a period of two years or more didn't require any insulin. The thought was that the gluten-free diet effectively halted the progression of the diabetes, at least for the duration of the study.

Studies of mice have shown that despite utilizing a genetic strain of mice that were strongly in-bred to increase the risk of type 1 diabetes, 2/3 of them did not do so when a drug was administered to prevent leaky gut. This study was performed by Dr. Alessio Fasano at the University of Maryland Celiac Research Center. Dr. Fasano is one of the world's acclaimed researchers in the area of celiac disease and gluten sensitivity.

Leaky gut is associated with the initiation and continuation of autoimmune disease and Dr. Fasano's work with these genetically predisposed mice shed a great deal of light on the power of an undamaged gut lining to effectively forestall development of a genetic condition, in this case type 1 diabetes.

A recent study out of Immunology, dated August 22, 2012, is titled "Dietary gluten alters the balance of proinflammatory and anti-inflammatory cytokines in T cells of BALB/c mice". The title is a mouthful but here is what the researchers out of Denmark found:

Their initial premise was based on the idea, as I mentioned above, that dietary modifications, specifically a gluten-free diet, could reduce the risk of developing type 1 diabetes. The question they posed was, "How did this occur?"

They discovered that wheat gluten induced the production of pro-inflammatory chemicals called cytokines that would damage the intestinal lining and immune tissues of the small intestine. More importantly, a gluten-free diet didn't just neutralize the negative effects just mentioned, but it actually caused the production of anti-inflammatory chemicals that would provide protection for the immune system and gut. So, while gluten is a known bad guy, a gluten-free diet doesn't just take the negative away, it actually induces a positive, healing response.

Clinically we frequently see this with patients. As soon as we meet a patient with any history of autoimmune disease, we quickly test them for celiac disease and gluten sensitivity via lab tests and a 30 day elimination diet. If we discover any negative immune reaction to gluten, we begin a strict gluten-free diet.

Happily, we often see stabilization, if not reversal, of their autoimmune disease. We support the gluten-free diet with our other protocols for normalizing gut permeability (healing a leaky gut) and strengthening the immune system. Taken together this program yields excellent results.

If you know anyone suffering from an autoimmune disease, please show them this article. Gluten could be a component in furthering their disease and a gluten-free diet could be a positive influence in their journey to improved health.

I hope this was helpful. Please feel free to contact me should you have any questions. And if your health is not at the level you would like, I can also offer you a free health analysis. Call us at 408-761-3900.

Our destination clinic treats patients from across the country and internationally and we would be delighted to help you.

To your good health.

Celiac.com 10/19/2017 - When I first saw the big advertisement that came through the mail I thought, "Wow, we are really getting somewhere!" However, when I read their advertisement my mind was quickly changed by what seems like false advertising.

It reads like a great deal of boasting, followed by the "disclaimer" (At the bottom. Who reads to the end of an advertisement?)

Here's the disclaimer:

If I hadn't read that disclaimer, I could have gone out that night and purchased a Domino's Gluten Free Pizza just to be able to try one of my favorite dishes.

ABC News had a brief visit with Domino's CEO, J Patrick Doyle, who said, "Offering Domino's Gluten Free Crust is a big step for us, and we wanted to make sure we were doing it right."

Well, you haven't done it right, Mr. Doyle, because celiacs cannot eat your pizza, and bless the person with gluten sensitivity who eats your pizza. Many celiacs suffer greatly after they have ingested gluten-containing flour. Even a few grains of gluten flour can cause abdominal pain, diarrhoea and bloating for days.

Doyle went on to explain their strategy for ‘doing it right': "Domino's is doing that by partnering with experts at the NFCA and by empowering the gluten sensitive community with the information they need." [NFCA is the National Foundation for Celiac Awareness.]

Domino's new gluten free crust is available in stores across the U.S. in a small 10 inch size only, and prices vary by store. In Italics it says, "Domino's pizza made with a Gluten Free Crust is prepared in a common kitchen with the risk of gluten exposure. The National Foundation for Celiac Awareness supports the availability of Domino's Gluten Free Crust, but cannot recommend the pizza for customers with celiac disease. Customers with gluten sensitivities should exercise judgment in consuming this pizza."

Chat lines lit up with questions such as "What is Domino's relationship with the NFCA?". "Does Domino's offer a substitution for a gluten free crust?" The only substitution acceptable to us is a totally clean sweep of gluten in a kitchen. Baking bowls kept separate and a separate area for preparing and cooking the dough. Nothing else is acceptable.

One Post by Allison on May 7th states "You can't say it is gluten free and then say oh well celiacs can't eat it. Make no sense. Also if they truly worked diligently with the Celiac Foundation because they wanted to make a huge thing out of a gluten free pie the Foundation would have definitely said absolutely no cross contamination. The fact that there is , is not helping anyone with a gluten sensitivity." I could go on with the disappointed complaints from several chat lines, but I'm pleased to report that The Medical Office Assistant's Association was on the ball as of May 15, 2012. Their warning title states "Say what? Domino's offers 'gluten-free'crust not appropriate for celiac".

It wasn't long before the news travelled to the Penticton satellite and the West Kootenay Satellite (sub-chapters of the Canadian Celiac Association). The Medical Office Assistant's Association is not formed for people with celiac disease, but watches for health warnings and posts them to their chapters immediately. The Kelowna Chapter article, by David Fowler, states that "Meanwhile here in Canada, Boston Pizza figured out how to do it right and as a celiac I have enjoyed their gluten-free pizza many times without incident."

A poster from Ann Arbor, Michigan, on May 7, 2012, wrote a full page praising Domino's Gluten Free Crust. She quotes Domino's Pizza President and CEO as saying, "The prevalence of gluten sensitivity has become a real issue with significant impact on consumer choice, and we want to be a part of the solution. Now, the whole group can enjoy Domino's with the addition of our new Gluten Free Crust." She also quotes Alice Bast, NFCA founder and president as saying, "The NFCA is thrilled that Domino's Pizza has developed a product that will improve the quality of life for many of the estimated 18 million Americans who are gluten sensitive." Bast went on to say "Not only is Domino's Gluten Free Crust a huge win for much of the gluten free community who can now get pizza delivered to their door, and it's also delicious."

How can we eat the gluten free crust knowing that it was prepared in a common kitchen with the attendant risk of gluten contamination? Further, since a lot of students work at Domino's, how can we know whether they are being vigilant in their food preparation work? I don't know but I am going to check with David Fowler and see if Domino's here in Canada has actually ‘gotten it right'. Being a celiac with dermatitis herpetiformis, I can tell if I have gotten some gluten within the first twenty-four hours. I am sure that many readers can also tell quickly if they have been ‘glutened'.

I am also going to check out one Boston Pizza here in Canada just to check on David Fowler's report from the Kelowna Chapter on May 15, 2012. He, too, offers a disclaimer saying, "This article is my opinion only and does not necessarily reflect that of the Kelowna Chapter or the CCA."

I have just spoken with the managers of the Langley Boston Pizza Store and the Abbotsford Boston Pizza Store. Neither Store has heard of a Gluten Free Pizza Crust. One woman, a sub-manager, stated that the manager of their store had just had a meeting with the Boston Pizza people, but she thought it was about their super thin crust. She again reiterated she had never heard of a gluten free pizza coming to our area. So Kelowna, good for you! You may be the first city in Canada to carry gluten free pizza. But I am determined to check with other stores because I want to know whether their Gluten Free Pizza Crust is prepared in a gluten-free environment.

I will end with one chat line quote by Andrew on May 11, 2012: "What good is a gluten free pizza if it may come in contact with gluten? As a mom with three celiacs in the family, this is very disturbing and there is no way would I allow them to eat there. What a shame! Domino's, you need to get a clue!"

Celiac.com 10/12/2017 - Despite the economic downturn, the cost of healthy products has not diminished. Sales have continued to grow in this sector thanks to the many information campaigns aimed at raising consumer awareness of the health benefits of consuming gluten free products. Manufacturers have responded to the growing demand by expanding the variety of products they offer. Many consumers, including those that cannot eat gluten, do not want to give up eating products specially designed for them although they cost even more than traditional food. The demand for products that address food intolerance continues to grow.

In Poland, the number of people who are on special diets because of their health problems and food allergies is still growing. More and more people suffer from intolerance to different nutrients. This creates market conditions that encourage developing products that are safe for this group of consumers. Demand, among one sub-set of this market - gluten-free products, is growing among many consumers. Even manufacturers of standard food products have entered this market segment because they see a large and growing potential. The gluten-free food market is growing steadily. The causes, in addition to the increasing number of diagnosed patients, is an increasing awareness among doctors and patients.

Celiac disease affects not just children. Currently 60% of diagnosed cases are adults, of which 15-20% are over 60 years of age. Coeliac disease is diagnosed in Europe in 1:200 and in 1:250 people in the U.S. Approximately 70% of those diagnosed are women. Celiac disease is a non-allergic food hypersensitivity, which is caused by a genetic intolerance to gluten, a protein found in cereals such as wheat, rye, and barley. It is estimated that celiac disease affects around 1 percent of the population and this number is likely to grow in the future. In some European countries, patients with celiac disease form more than 2 percent of population.

Yet, the most developed market for gluten-free foods is in the United States. The number of newly introduced gluten-free packaged foods and beverages in the U.S. increased by 80% from 2005 to 2010. This trend is expected to continue through the years 2011-2014. Market analysis suggests that gluten-free food sales will grow at least until 2014. Companies producing food should therefore take advantage of the growing trend of food consumption in this category.

Traditional gluten-free products such as bread, biscuits, crackers, cereals and pasta products are still in the development stage. In their group, in recent years, producers have continued to introduce new choices. However, we have also seen many innovations among the products in categories such as snacks, dairy products, sauces, spices, desserts and confectionery. Some of these products may already be free from gluten. However, to attract consumers they are now being labeled as gluten-free products.

In the United States between 2008-2010 about 300 products in the category of gluten-free snacks were introduced. The U.S. achieved the highest number and value of sales in 2010. In Poland, only some of the really sick people are the diagnosed cases. Associations of people with celiac disease, such as the Polish Association of people with celiac disease and gluten-free diet is trying to raise public awareness of more aspects of the disease. This is another factor that will lead to increased demand for gluten-free foods. Such activities are already producing effects in the West, where preventive information campaigns have been widely carried out. The current emergence, in the Polish market, of western gluten-free food manufacturers and their products, demonstrates both the development of this branch of the food industry and growing awareness among people in other parts of Europe and the USA.

For now, Polish brands dominate in our home market. This is due to lower prices compared to imported products. The quality of Polish products is also competitive. The current political situation allows distribution within the country and also for export. Competitive prices offered by Polish companies may be attractive for residents of other countries.

Entering into foreign markets, managers should also take into account local eating habits and preferences. For foreign companies it is harder to attract customers, not only because of the price difference, but also because of the taste and form of food. Eating habits are also a strong factor, which influences customers' purchasing choices. So this factor must be included in designing process and entering new markets.

Invariably, the problem of much higher priced gluten-free products arises. Gluten-free products are generally much more expensive than wheat-based products. This is due to less demand for them and the continuing refinement of this kind of food, which, so far, offers an inferior taste. A survey conducted by the Gluten-Intolerance Group of North America, estimates that people buying gluten free products spend about 30% of their monthly expenditures on food. This is still a big barrier to overcome for gluten-free food producers. The difference stems from the fact that the materials are non-standard and not as widely available as conventional ingredients. The development of new production technologies also generates additional costs. Furthermore, innovative products will be subjected to laboratory tests. Still, domestic products are cheaper by significant margins compared to products from abroad.

Gluten-free food is specially marked by the manufacturers. The characteristic feature is the sign of the crossed head of grain, which indicates that product contains less than 20 ppm of gluten, which corresponds to 20 mg per 1 kg. Use of clear and legible labels will encourage customers to choose these products. The symbol tells the customer what to expect from the product. He can quickly and easily identify what he needs.

Many leading companies monitor development of this branch of the food industry. They emphasize packaging and eye-catching labels. They also consider opening separate production lines to produce only this kind of products. Even companies not currently engaged in production of gluten-free food are starting to invest in development of these technologies.

Much depends on the purpose of a producer who has to remember that gluten free food is a specialized product. If its purpose is mass production, entry into the gluten-free market may not produce the desired financial results. On the other hand, the advantage, in this case, is the extended offering of products at more competitive prices, which makes the products more attractive in the eyes of customers. At the same time, retailers will appreciate manufacturers that offer a wider choice of products. Financial planning should take into account the above factors and consider investing in new technologies.

Access to the widest choice of gluten-free products is the best at Internet stores or health food stores. Supermarkets are not able to provide as wide a choice as the online stores. Potential clients are not just city dwellers who have easy access to health food stores. A package ordered from an online store reaches into every area of the country, and they are open at all hours and on all days. These store types are worth keeping in mind as they pose increasing competition. However, from a price perspective, they cannot compete with supermarkets.

The demand for gluten-free foods is growing from year to year, among other reasons, because it also fits with the current trend of preventive health care. The gluten-free food market is characterized by outstanding performance over many years. Even during the recession in 2009, it grew by 11% in global sales (calculated on the basis of USD 2009 exchange rate), compared to the more sedate level of 3% for products in the category of health and wellness. In 2004-2009, gluten-free products reached a 15% annual growth rate (data Euromonitor). In 2009, global sales reached $ 2.3 billion for gluten-free products which represents 27% of food sales from food intolerance groups. Half of those sales were generated by bread, traditionally the most important category. According to Euromonitor analysis, a wide media campaign about celiac disease symptoms such as fatigue, weight gain, skin rashes and lack of concentration, also increased its sales in this category, turning gluten into the "enemy" of good health. As of today, many of the gluten-free product buyers are people who have not been diagnosed with the disease, and who consider themselves to be people sensitive to gluten. They believe that eating gluten-free products improves their health. According to Euromonitor analyses, retail markets around the world, are not only responding to this trend, but also actively helping to increase growth in sales by offering a number of gluten-free products. Researches predict that the market for gluten-free foods will continue to grow over the next five years, although at a slower pace. Forecasts predict that the U.S. market of gluten-free foods and beverages in 2015 will reach sales of $ 5.5 billion.

My Clean eating philosophy is about fresh and simple ingredients. That's right, how about starting with some avocado, roasted turkey, fresh raspberries and balsamic vinegar that you can easily whip up in a food processor for a tasty turkey pate to use throughout the week with crudités or corn tortillas? It takes five minutes to make and you can store it in the fridge for a quick dose of protein any time of the day whether it be a meal or snack.

How about adding some to your morning omelet, spread it atop your afternoon sandwich with lettuce and tomato or added to your burritos for dinner? See how easy it can be? And guess what? It's naturally gluten-free and delicious. You don't have to think twice or worry about eating anything out of a box when you can visit your local farmers' market for fresh produce and your butcher for lean proteins such as turkey, chicken, bison and eggs.

If you're a vegetarian or vegan, simply use tofu and you're all set. It's as easy as 1,2,3 and you've got a week's worth of eats to enjoy when your stomach starts rumbling. So, next time you are yearning for a processed food, think again and slice up some veggies to serve with your new pate recipe. Believe me I know first-hand about eating Clean as my whole approach to Clean eating started a few years ago when my body started reacting negatively to packaged foods. What helped me heal? Food. That's right. Real, Clean food; I have real food to thank. Because gluten-free is not about the gluten-free cookies and packaged, over-processed foods. It's about eating Clean. Eating fresh fruits and vegetables, lean proteins and healthy fats. That's exactly what I eat. I love it and I know you will to!

Bon Appetite.

Celiac.com 09/22/2017 - I run into many parents who are in quite a quandary about instituting a gluten-free diet for their child. A typical scenario is that one of the parents is gluten intolerant and is highly suspicious that their child is as well. Due to the child being 'relatively healthy' the non-gluten intolerant spouse suggests that the child be able to 'live a little' and enjoy the cake and pizza that is so prevalent during children's parties and sporting events.

In my opinion, there is no question about whether a gluten-free diet should be implemented, after confirmation that gluten intolerance exists that is. I know that gluten intolerance vastly increases your risk of developing diseases that can affect almost any system and/or organ in the human body. The evidence shows that it vastly increases your risk for autoimmune disease. I also know that it can be rather silent in a younger body, but if a positive test exists, then it IS doing damage, regardless of whether it is felt or not.

To add a little more strength to my argument is the result of a recent study published by the Journal of Human Nutrition and Dietetics wherein researchers aimed to evaluate the influence of celiac disease on the social aspects of life in those living in the U.S.

Not surprisingly celiac disease did have a negative impact on the quality of life in social settings, specifically in the area of travel and dining out. However, and this is where I find that most people make their mistake with their children, the researchers found that 'those diagnosed in childhood and maintained on the diet experienced a reduced impact on their quality of life as an adult'.

So it turns out that you aren't doing any favors to your at-risk child by putting off the implementation of a gluten-free diet. You're not only creating negative impacts health-wise, as mentioned above, but by delaying a gluten-free diet you are also condemning them to the perception of a lower quality of life.

If you think about it, if gluten-free is pretty much all you've ever known, you would be less likely to miss it. You haven't built up the memories of gluten-containing cakes and pizzas and pancakes.

Please do not put off testing your child because you think you're doing him or her a favor by putting it off. The truth is quite the contrary. Waiting could allow an autoimmune or other illness to develop that could have been avoided. There is absolutely NO benefit to one's health to continue eating gluten when one is gluten intolerant, and it turns out that there is no benefit psychologically either.

Have you run into this argument from friends or family? Have you put off diagnosing a child because you were made to feel guilty? Please write to me and let me know your experiences and thoughts.

To your good health.

Reference:

• Journal of Human Nutrition and Dietetics. 2012 Feb 25. Living with coeliac disease: survey results from the USA. Volume 25, Issue 3, pages 233–238, June 2012

Celiac.com 09/22/2017 - Misdiagnosed my sophomore/ junior year of High School, 3 years ago, with celiac disease, I became obsessed with the science of this ailment and how it was supposedly affecting me. I was shocked by how little is known about this autoimmune disease and the many gaps in research done on it. One such gap is that of cross-contamination in the household, where it is likely to have a daily impact on those following gluten-free diets. Because of this, I decided to help fill this gap in scientific knowledge with a manageable project based on cross-contamination in the home, asking whether one can share common kitchen cookware that is used with gluten containing foods, or if people, to help maintain a gluten-free diet, need designated ones for their food preparation.

Either way that this research played out would be beneficial to the gluten-free community. For example, some families with members on gluten-free diets will spend a lot of money to buy all new ‘gluten-free' designated cookware and utensils to help minimize cross-contamination. Part of the relevancy of this project is economical, as designated cookware can be very costly. Despite the cost, other factors affect the value of this research, including the impracticality of having a double set of kitchen appliances, which would be very bulky and impractical for those with limited space. Another factor that influences the significance of this project is beyond one's home; celiac disease brings a lot of social stress. By assuring there is limited or no cross-contamination from common kitchen appliances after customary washing, these individuals would be able to have some confidence when eating at friends' or families' homes. On the other end, if this research shows that there is cross-contamination with shared supplies it will highlight the need for dedicated ones to maintain a strict gluten-free diet. Just because a gluten-free recipe is used, a given dish may not be genuinely gluten free if there is contamination from cookware.

Hazards and Concerns
To fully understand the hazards of gluten contamination, a few things must first be established: What is gluten? Who is it harmful to? How and to what extent must it be avoided? How does cross-contamination occur?

What is Gluten?
The United States Food and Drug Association (FDA) have been trying to define "gluten" for years. The current proposed definition is, "the proteins that naturally occur in a ‘prohibited grain' that may cause adverse health effects in persons with celiac disease."(1) These prohibited grains are any species belonging to triticum, hordeum and secale or more commonly called respectively: wheat, barley, and rye, though other prohibited grains exist as hybrids of any of the three.(2) That being said, not all proteins in these three types of grains are toxic to those with celiac disease as there are two parts to glutens: prolamins, the immunotoxic ones, and glutenins, the safe ones.(3) The prolamins in the three main prohibited grains, wheat, barley, and rye, are gliadin, hordein, and secalin.(4)

Who Does Gluten Harm?
Gluten is toxic to certain individuals with celiac disease, an autoimmune disease that also goes by the names of: coeliac disease, celiac sprue, nontropical sprue, and gluten-sensitive enteropathy.(5) A Thomson Healthcare Company study estimated that up to 1.5 Million Americans, or one in 133 people, have celiac disease, though other individuals avoid gluten as well, such as those with gluten intolerance, or other ailments where a gluten-free diet is believed to lessen their symptoms.(6) This strict abstention from gluten is because celiac disease cannot be cured, or mediated with medication as yet. The only way to help those affected is by following this strict diet.

How and to What Extent Must it be Avoided?
Foods that contain wheat, rye, and barley, or any hybrid of these grains contain gluten. Gluten is a very common protein in foods, whether from bread, or as an additive to provide a thicker texture, such as in soups. This versatility makes processed foods, in the eyes of those on gluten-free (gluten-free) diets, something to be wary of. Because of this caution, companies want their products to be certified gluten-free, which according to the FDA calls for

Despite current unknowns regarding contamination, a strict gluten-free diet must exclude all foods that contain gluten and minimize cross-contamination. This means from eating out, to staying in, gluten must be avoided. Topical products where gluten is added, such as in some lotions or body washes, should also be avoided. Despite the widespread use of gluten there are gluten-free grains and foods, such as beans, rice, millet, corn, amaranth, and soy.

How Does Cross-contamination Occur?
Cross-contamination is a term usually directed toward accidental spread of bacteria due to not cooking food, washing hands or materials. However, in this article it refers to the accidental transfer or content of gluten, the protein that is toxic to those with celiac disease.

In my personal experience and research on celiac forums, when a member of a family goes gluten-free the family will most likely continue eating a regular diet. In addition, as the average time it takes to be diagnosed from the first onset of symptoms is 10 years in the United States, these families have kitchen supplies that they have been using with gluten.(8) With little public knowledge about celiac disease and going gluten-free, people tend to overlook cross-contamination. Theoretically, in the simple act of making a sandwich with gluten-free bread there are many different ways for it to become contaminated. For example, from a shared jar of peanut butter or jelly with crumbs accidentally getting into it and then dipped out onto the gluten-free bread, or crumbs on the surface it's prepared on sticking to the gluten-free bread.

Research Investigation
The investigation of common kitchen appliances that are frequently exposed to gluten and cleaned by customary sanitation techniques calls for the conduction of an enzyme linked immunoassay (ELISA) test when using them to prepare gluten-free food. Various well used kitchen appliances, wood and plastic cutting boards, cast iron skillets, both seasoned and unseasoned, Teflon and aluminum pans, and ceramic and glass bowls were contaminated with gluten, using whole wheat flour slurry, and then washed by their standard cleaning technique, either scrubbing with hot soapy water, or wiping with a paper towel and water.

Afterward a certified gluten-free substance, in this case millet flour, was added and let sit to allow adherence of any gluten remaining on the ‘cleaned' surface. Figure 1 illustrates the extraction solutions that were made from the samples and injected into the Microwell plates with the anti-body coating and the various washes of the ELISA test.

Then, the gliadin, if present, bound to the walls of the wells due to its antibody coating and the wells were washed to eliminate remaining parts in the well. Next, the enzyme Horseradish Peroxidase, or HRP enzyme, adheres post-injection to any gliadin present as an amplifier and is again washed to remove extra parts. Lastly, a 3,3', 5,5'-Tetramethylbenzidine, or TMB substrate was added which turns blue in the presence of a peroxidase, in this case the adhered HRP enzyme, which can only be there if there was gliadin to attach to. This color after a acid stop solution, which turns it yellow, is added is then assessed using a Microwell plate reader for its absorbency which, when compared with a standards curve made from known samples, by the company, will be used to determine the gluten content, in parts per million, of all the samples individually.

Results
Intuition may lead one to think that well developed standard cleaning techniques for most appliances, and the difficulty in transferring proteins to a gluten-free medium from a surface that has been cleaned, will make gluten cross-contamination unlikely. However, due to factors such as porosity and oiliness, some surfaces may harbor gluten. Typically, far less rigorous cleaning techniques are used on the seasoned cast iron skillet and it is very porous and oily so the gluten proteins have a better chance of binding to it and then transferring to a gluten free medium. Given the test results of the ELISA test, this is mostly true. Despite the logic being the same, and it being the intuitive most likely candidate for cross-contamination a different appliance with the same sanitation technique proved to exceed the gluten parts per million limit where as the cast iron did not.

The only absorbency ratings from the samples that interpolated to be greater than the 20 ppm of gluten allowance were two extractions from the Teflon pan. All other ratings, including two other Teflon pan extractions, were below the limit.

Conclusion
Ninety-four percent of the sample extractions showed less than the 20 parts per million of gluten which is the threshold for something to be declared gluten-free. Teflon had half of its extractions above the limit, as such Teflon should be deemed cross-contaminated. However, the Teflon's other extraction samples had well below 20ppm. This could have been due to the sample's gluten free sample being rather large and thus only part of it could have gotten contaminated (positive cross-contamination) and other parts not (negative cross-contamination). All others samples were classified as gluten-free due to being below the 20ppm allowance.

In conclusion, the values of gluten cross-contamination, in ppm, were too small to hinder the integrity of the gluten-free medium in all but Teflon. Thus, to the extent of the experiment done, having tested only eight different kitchen appliances, with only two different sanitation techniques, common kitchen appliances that are frequently exposed to gluten, can be cleaned by customary methods and used to prepare gluten-free food with the exception of Teflon appliances.

This research project could be extended by more trials. For example, eight types of common kitchen appliance were used, but only one appliance was used to represent each type. More trials could be done within each type, using different brands, variations in extent of wear, etc. In addition, the only type of contaminant used was whole-wheat slurry. Other forms of contaminant should be tested as well, to show the universality of the cross-contamination, or lack thereof. This should include different gluten-containing substances, as well as some dry and some wet.

Unfortunately, this research question will have exceptions as the extent of washing and wear on an appliance is a more subjective issue. This means that even if it is found on a larger scale that certain appliances have been found to be safe for producing gluten-free foods, it should still be avoided when possible for those with celiac disease as if not washed properly; it could go beyond the 20ppm allowance and be immunotoxic to these individuals.

Vested interest is always a concern with research, and thus it must be pointed out that no company or university holds any interest in this project and no help was given financially or academically, only that The University of Detroit Mercy allowed me to use their lab for the duration of the experiment and Microwell plate reader. In addition, both sides of the results would prove beneficial, so the data were not interpreted with a bias toward any desired result.

Eleanore Dara is a "rising scientist" and is an incoming biochemistry student on a Research Track Major at the University of Scranton in Pensnsylvania.

References:

1. "Questions and Answers on the Gluten-Free Labeling Proposed Rule." U S Food and Drug Administration. N.p., 23 Jan. 2007. Web. 31 Jan. 2011.  https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Allergens/ucm362880.htm 
2. Ibid.
3. Amaya-González, et al. "Amperometric Quantification of Gluten in Food Samples Using an ELISA Competitive Assay and Flow Injection Analysis." Electoanaylsis 23.1 (2010): 108+. Wiley Online Library. Web. 8 Mar. 2011.
4. "What Is Gliadin? What Is Its Role In Gluten Sensitivity?." Gluten Free Around The World, Traditional Foods Make Eating an Adventure. N.p., n.d. Web. 25 Mar. 2012. http://www.gluten-free-around-the-world.com/gliadin.html 
5. Snyder, Cara et al. "Celiac Disease Coeliac Disease, Celiac Sprue, Nontropical Sprue, Gluten-Sensitive Enteropathy." The National Center for Biotechnology Information. N.p., 3 June 2008. Web. 31 Jan. 2011.
6. Cerrato, Paul L. "Gluten Intolerance: more common than thought. (Complementary Therapies Update)." RN 66.8 (2003): 23. General One File. Web. 28 Mar. 2011.
7. "Questions and Answers on the Gluten-Free Labeling Proposed Rule." U S Food and Drug Administration. N.p., 23 Jan. 2007. Web. 31 Jan. 2011.   https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Allergens/ucm362880.htm 
8. Adams, Scott. "USA - Average Time to Diagnosis = 10 Years - Celiac.com." Celiac Disease & Gluten-free Diet Information at Celiac.com. Scott Adams, 26 July 1996. Web. 16 Feb. 2012. 

Celiac.com 09/15/2017 - In Pennsylvania, there is a six-year-old little girl (we'll call her Amy) who has not been allowed to see her mother (we'll call her Cindy) since June 21st because Amy's dad takes issue with a diet that excludes gluten and other allergenic foods. You might think that this is due to a dispute arising out of the dissolution of a marriage, but that is not the case. However, I'm getting ahead of myself. I need to start describing this situation as it began about six years ago, when her father was arrested for public drunkenness, resisting arrest, and creating a public disturbance, when Amy was less than a year old. Dad (we'll call him Steve) struggled with unemployment and part-time employment as a truck driver, falling further and further into arrears on his child support payments. Cindy had primary custody, and every second weekend, Steve took care of Amy.

Conflicts between Cindy and Steve quickly arose over the dietary restrictions mentioned above. Cindy wanted Amy to be healthy and she thought she could achieve that goal by allowing her to eat only wholesome foods, excluding cow's milk, gluten, soy, tree nuts, and refined sugar. She made these choices partly because she observed better behavior in Amy when she excluded these foods, partly because she observed gastrointestinal symptoms, including abdominal bloating, when Amy ate these foods, and partly because Amy tested positive for IgE antibodies against tree nuts, and other testing, conducted after Amy was on a diet that had already excluded these foods, showed mildly positive results for gluten, cow milk, and soy. Who can say how strongly Amy would react to these foods if she were eating them on a daily basis?

However, Steve apparently does not believe in such diets or testing. He refused to cooperate with the prescribed dietary restrictions despite a court ordering him to do so. This court order had been in place for four years, yet when he testified in court, asserting that he had been following the diet for Amy, he could not even say what gluten is, or what foods contain gluten.

Not surprisingly, despite the court's provision of visitation rights for Cindy, Steve has found one excuse after another to refuse Cindy access to their daughter, since gaining full custody based on a deeply flawed claim that Cindy has Munchausen's syndrome by proxy (MSBP). My comments, of course, only represent one side of the story. However, most of us who follow a gluten free diet have, at some point, had to deal with similarly resistant attitudes, although they are not usually taken to such extremes.

After years of support payment delinquency and non-compliance with court orders, Steve showed up in court on June 21st, with legal counsel, a psychiatrist's report asserting that Cindy has MSBP, and claiming that he has a full-time job and is therefore able to support Amy, despite long standing arrears on his child support payments to Cindy. Where did all this money come from to pay for these expensive representatives and expert reports? And how is it that Steve overlooked bringing his child support payments up to date before paying these other expenses? Further, Steve is demanding child support payments when he has yet to pay up his own arrears.

The court took away her daughter based on a flimsy report that accused Cindy of Munchausen's Syndrome by Proxy. At that time, Cindy was not allowed to defend herself or speak on her own behalf. She was not even allowed to read the report that accused her of MSBP! The judge has also sealed the record so Cindy cannot get a copy of it! It appears that she doesn't have a right to face her accuser.

One of Steve's experts ignored the fact that Amy was only getting gluten on every second weekend, at the time she was tested, and asserted that Amy's mildly positive test results for food sensitivities to gluten, soy, and cow's milk were somehow meaningless. (This may also be rooted in the currently contested value of IgG food allergy testing, which would fill another article.) The psychiatrist asserted that Cindy's dietary restrictions for Amy indicate that Cindy has Munchausen's syndrome by proxy and that Cindy is therefore abusing Amy with this diet. The most insane part of this whole scenario is that any of the many Paleodiet advocates, including S. Boyd Eaton, M.D., professor Loren Cordain, Ph.D., professor Melvin Konner, M.D., Ph.D., and professor Staffan Lindeberg, M.D., Ph.D. would endorse this diet as almost universally healthful. Many low carbohydrate advocates, such as professor Stephen Phinney, M.D., Ph.D., professor Jeff Volek Ph.D., R.D., and professor Jay Wortman, M.D., would similarly approve this diet as providing a much more healthful start for this child than the conventional American diet that most American children her age are eating. Some of these Paleodiet and low carbohydrate experts have raised their own children on similar diets because of the health benefits such eating habits confer. Do they have Munchausen's syndrome by proxy too?

Let's take a look at this diet, one element at a time. Cindy wants her daughter to avoid refined sugar. Not only is it unhealthy, Cindy believes that Amy's behavior deteriorates when consuming refined sugar, and the work of all of the above scientists supports Cindy's concerns. One research group, Fiorito et al, showed that sweetened beverage consumption at age five predicts lifelong elevated sugar consumption, and both current and future adiposity (1). With obesity looming as one of the greatest health challenges facing Americans today, it is little wonder that Cindy is concerned.

Relatedly, the Center for Science in the Public Interest (CSPI) quotes Marion Nestle, chair of the Department of Nutrition and Food Studies at New York University, as saying, "Because sugary foods often replace more healthful foods, diets high in sugar are almost certainly contributing to osteoporosis, cancer, and heart disease" (2). Similarly, Mohammad Akhter, the executive director of the American Public Health Association stated that "Health officials must take prudent action to stem the dilution of the American diet with sugar's empty calories" (2). The CSPI offered these and other statements from a number of health experts and organizations in their petition asking the U.S. government's Food and Drug Administration (FDA) to require labeling that would specify the sugar content of beverages and processed foods. They also want the FDA to provide guidelines that will recommend a limit on daily consumption of refined sugars, just as they do with vitamins. There can be little doubt that refined sugar is an important and pervasive health threat to Americans. Certainly the reduction or exclusion of refined sugars provides no basis for legitimate criticism of Cindy's exclusion of this harmful food substance from Amy's diet.

Cindy also wants Amy to avoid soy. Some evidence suggests that chronic ingestion of soy-derived genestein induces chromosomal imbalances in epithelial cells of human breast tissues, thereby increasing one's risk of developing breast cancer later in life (3). Further, soy, as with many other legumes, contain high concentrations of several types of anti-nutrients. Soy protein isolate, a very common processed food additive, has the highest saponin content of all legumes, at 10,600 mg/kg (4). These saponins can damage and penetrate the membranes of almost all human cell lines. This is the means by which they penetrate the intestinal mucosal barrier, enter the circulation, and damage red blood cells, inhibiting their capacity to carry oxygen (4). Soy is also very high in phytate content. Phytates bind to iron, calcium, zinc, and magnesium, forming a bond that cannot be broken by human digestive processes or enzymes. The net result is that when soy is consumed, much of the important trace minerals from other foods consumed at the same time are wasted in one's fecal matter rather than being absorbed through the gut enterocytes (5).

The impact of soy-derived phytates alone may not be sufficient to induce deficiency in the context of a mineral-rich diet. However, children often experience trace mineral deficiencies during growth spurts, and soy consumption would serve to accentuate these deficiency states (5). Similarly, the approximately 20% of the protease inhibitors in soy that survive cooking (assuming that all soy is cooked prior to consumption) incite the pancreas to increase production and excretion of protease enzymes, particularly trypsin. This particular protease induces increased intestinal permeability. Soybean lectin also increases intestinal permeability. Both combine to cause a leaky gut and an increased risk of developing additional food sensitivities. Also, soy isoflavones impair iron metabolism (4). Clearly, there is no good reason to question Cindy's dietary choices for Amy based on her exclusion of soy.

Cindy also wants to protect her daughter from the health hazards of cow's milk, which is both a very common allergen and has long been reported to induce iron deficiency in infants and young children (5). This latter may be the result of the high levels of bio-available calcium in milk. Calcium competes for the absorptive mechanisms that also moves, zinc, magnesium, and iron into our circulation (5). Zinc is critical to healthy function of the innate immune system. Magnesium serves in a wide range of processes that aid the healthy development of a child's body. And iron is critical to a child's intellectual development and wellbeing (5).

Milk has also been implicated in causing or raising insulin resistance, acne, and a host of hormonal abnormalities. Some evidence suggests that these problems are caused by the hormones in cow's milk and their impact on our hormonal receptors and our own hormonal production (4). These harmful hormones from cow milk include bovine insulin, insulin-like growth factor 1, and estrogen, all of which have been shown to impact on human health (4). Further, soy and dairy proteins are both numbered among the eight most allergenic foods in the U.S. food supply, along with tree nuts and wheat (4). Cow milk allergy alone is estimated to afflict "from 2 to 3 percent of children between the ages of one and three" (4). Milk has also been implicated in some cases of asthma. Others argue that the health benefits of dairy consumption outweigh the detriments. However, "a 2007 meta analysis from the Harvard School of Public Health reported that high calcium intake had no therapeutic effect on hip fractures in 170,000 women and 68,000 men" (4) p. 102.

Now let's look at gluten. Most research regarding the impact of a gluten free diet has only examined its impact on children with celiac disease, who almost universally benefit in learning and behavior from gluten avoidance. However, a gluten free diet has also been shown, in the context of a test group of 533 children, to improve school readiness among 100% of children with celiac disease, 86% of those with non-celiac gluten sensitivity (as measured by IgG and/or IgA antibodies against gliadin) and among at least 43% of gluten insensitive patients who attended a pediatric gastroenterology practice in New Zealand, between 2001 and 2005 (6). Others have reported, in the absence of celiac disease, significant reductions in the number and severity of learning disabilities following a six months trial of a gluten free diet (7). Still others are now reporting that non-celiac gluten sensitivity is an important clinical condition (8) and that this newly recognized clinical condition may be accompanied by consequences as dire as those found in untreated celiac disease (9). Long standing evidence, and considerable new research combine to support dietary exclusion of gluten for from 12% to 40%+ of the U.S. Population (10, 11).

We are forced to wonder exactly which facet of the diet Cindy is trying to keep Amy on could suggest a condition of Munchausen's syndrome by proxy? This is a condition that is defined by the fabrication of symptoms or symptoms induced by the caregiver. I can understand someone who is not well versed in recent nutritional research claiming that this is a harsh and restrictive diet. However, the health benefits such a diet confers are far greater than the inconvenience it imposes. It is a completely benign diet that only offers benefit to the child. And, after repeated demonstrations that he has little regard for court orders that do not suit him, Steve now has custody of this young child, and he is blocking her mother and Amy from spending time together. That behavior alone says a great deal about just how concerned he is about the welfare of this child.

The MSBP diagnosis is largely based on Steve's claims that he never saw any symptoms related to the foods to which Cindy believes Amy is allergic/sensitive when Amy was with him. However, in the short term it is quite likely that she did not display any signs or symptoms, especially for those symptoms caused by the opioids in gluten and dairy (12). Cindy would be dealing with the withdrawal symptoms in the first week or so after Amy returned home from a weekend with her dad, but not while being fed those opioid-containing foods (13, 14, 15).

I understand that MSBP mothers can cause their children a great deal of harm. I also understand that such a diet would be a huge undertaking for someone like Steve, who doesn't believe in such things. However, for those of us who have experienced the miraculous improvements that come with the kind of healthy diet that Cindy is insisting on for Amy, this harmless diet only offers improved health and development. To suggest MSBP on the basis of this diet reflects a gross level of ignorance on a dietary level. It also says a great deal about the current state of Medicine and the field of Psychiatry that a practitioner could construe such a diet as suggestive of any mental illness, unless independent thinking is now a diagnostic characteristic of one of the maladies defined in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV).

Sources:

1. Fiorito LM, Marini M, Francis LA,Smiciklas-Wright H,Birch LL. Beverage intake of girls at age 5 y predicts adiposity and weight status in childhood and adolescence1,2,3 Am J Clin Nutr. 2009 October; 90(4): 935–942. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2744622/ 
2. http://www.cspinet.org/new/sugar.html
3. Kim YM, Yang S, Xu W, Li S, Yang X. Continuous in vitro exposure to low-dose genistein induces genomic instability in breast epithelial cells. Cancer Genet Cytogenet. 2008 Oct 15;186(2):78-84. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2590788/
4. Cordain L, The Paleo Answer. Wiley & Sons. Hoboken, NJ, 2012 p. 72 -147
5. Hoggan R, The Iron Edge . Waterside Works. Calgary, Canada. 2008.
6. Ford R, Hoggan R, Fung T, Marini A. School readiness paper - unpublished data
7. Blair A, Wheat-free diet gives food for thought: A school claims dyslexic children show astonishing improvements with special meals The Times, June 12, 2004 http://www.timesonline.co.uk/tol/news/uk/article444290.ece
8. Carroccio A, Mansueto P, Iacono G, Soresi M, D'Alcamo A, Cavataio F, Brusca I, Florena AM, Ambrosiano G, Seidita A, Pirrone G, Rini GB. Non-Celiac Wheat Sensitivity Diagnosed by Double-Blind Placebo-Controlled Challenge: Exploring a New Clinical Entity. Am J Gastroenterol. 2012 Jul 24.
9. Anderson LA, McMillan SA, Watson RG, Monaghan P, Gavin AT, Fox C, Murray LJ. Malignancy and mortality in a population-based cohort of patients with coeliac disease or "gluten sensitivity". World J Gastroenterol. 2007 Jan 7;13(1):146-51.
10. Braly J, Hoggan R, Dangerous Grains. Penguin/Avery, NY. 2002
11. Davis W, Wheat Belly. Rodale, NY. 2011
12. Fanciulli G, Dettori A, Demontis MP, Tomasi PA, Anania V, Delitala G. Gluten exorphin B5 stimulates prolactin secretion through opioid receptors located outside the blood-brain barrier. Life Sci. 2005 Feb 25;76(15):1713-9. Epub 2004 Dec 20.
13. Yoshikawa M, Takahashi M, Yang S. Delta opioid peptides derived from plant proteins. Curr Pharm Des. 2003;9(16):1325-30.
14. Horváth K, Gráf L, Walcz E, Bodánszky H, Schuler D. Naloxone antagonises effect of alpha-gliadin on leucocyte migration in patients with coeliac disease. Lancet. 1985 Jul 27;2(8448):184-5.
15. Schick R, Schusdziarra V. Physiological, pathophysiological and pharmacological aspects of exogenous and endogenous opiates. Clin Physiol Biochem. 1985;3(1):43-60.