Celiac disease has gotten the most attention in antibody research, but the current data on cross-reactivity of antibodies is allowing a better understanding of gluten sensitivity. Antigen reactivity to alpha-gliadin can trigger immune attacks on many individuals beyond those with positive DQ 2, DQ 8 and TTG test results.

Gluten ataxia has been identified not only in people with celiac disease, but also in autism, lupus and multiple sclerosis. The lack of muscle control for movement, speech, eye coordination and swallowing can now be assessed in most autoimmune disorders.

Gliadin reacts with foods and human tissue antigens causing symptoms beyond the gastro-intestinal tract. A low inflammatory diet customized to each person through testing for cross-reactivity or elimination diet protocols is needed to restore a state of health and well-being (for a copy of Low Inflammatory Diet & Elimination Diets check the author's website at the end of this article).

According to Aristo Vojdani, PhD, professor of neuroimmunology at Carrick Institute and Chief Science Advisor for Cyrex Labs, about 50 percent gluten-sensitive individuals are also sensitive to dairy proteins (cow's milk, casein, whey) and sensitivity to oats depends on the variety of the grain and not just contamination from the milling process.

In the author's personal experience, a gluten-free diet has many limitations. The reactivity between alpha gliadin and corn, millet, oats, rice and dairy has been denounced as invalid by gastroenterologists and celiac disease researchers. While at a medical school in Missouri, biopsies did not show improvement in villous atropy until all alpha gliadin sources and corn, millet, rice and oats were removed from the diet.

Intestinal permeability or leaky gut allows antigens into the blood stream including food proteins, pathogens, and toxic chemicals which can cause inflammation. Continuous antigen exposure to tissues and organs is a factor in developing autoimmune disorders. Symptoms develop silently in the gut, joints and endocrine glands for several years. Tissue destruction with T and B lymphocyte reactions are a warning that autoimmune issues are developing during the next 5 to 10 year period until immunosuppressive drugs like corticosteroids are needed.

To reduce the triggers to autoimmune diseases early, nutrition and lifestyle habits need adjusting.

A Gluten-free Diet may seem easier today than 10 years ago, but current regulations in many countries allow up to 20 ppm gluten to be labeled "gluten-free". Many gliadin and cross -reactive proteins are most likely still available to create inflammatory symptoms.

Assessing Viral Activity is key to managing autoimmune disease symptoms. Viral panels for EBV, Lyme, Bartonella, Mycoplasma, Chlamydia, CMV are available. Nutrition management of viral load is critical for the person with celiac disease and other autoimmune diseases.

Reducing Toxic Chemicals is just as important as omitting gluten. Plastics like bisphenol A, heavy metals, pesticide residues, solvents all create inflammation. Water filtration devices that remove fluoride, heavy metals and pathogens plus stainless steel water bottles could reduce the body burden of chemicals that influence digestive function, joint movement, and immune well-being.

Celiac.com 08/22/2016 - The issue of cross-contamination keeps coming up in articles, conferences, blogs and every other venue in which celiacs discuss ways of living with our disease. For all the talk there has been precious little, if any, thoughtful analysis, so I felt it was time for one. Some will appreciate this analysis—others will not. For reference, I don't work for the food industry in any way, shape or form, so I'm not presenting arguments to help anyone make money. I just think that the way gluten permeates our food culture, we celiacs have become overly cautious and worried about where the next molecule of gluten may be hiding, ready to attack us, and as a result walk around in constant fear, significantly degrading our overall quality of our life and doing more harm to our health through stress than a rare, chance episode of cross-contamination might actually do.

Using the FDA's 20ppm limit as the definition of gluten-free, and some simple, first grade arithmetic, I want to look at the cross-contamination issue and see what's worth worrying about and what's not.

Because cross-contamination is a situational, process-related issue, it is best to separate the issue into categories that relate to the situation: a) at home, in food production lines shared with gluten products, c) at the prepared food counter in the local grocery store, d) in restaurants.

What's E.coli Got to do With It?
Cross-contamination at home is mostly an issue for someone just starting out on a gluten-free life and for those 'blended' families that have some individuals on a gluten-free diet and the rest of the family not.

There have been many posts over the years with this sentiment: "I just got diagnosed with celiac disease, I have started on the gluten-free diet and other celiacs are telling me to get rid of most of my cooking utensils, especially wooden spoons, plastic spoons, basting syringes as well as brushes I use with oil and butter."

The concern behind this statement is that porous wood and scratches in plastic spoons and syringes or the hairs of a brush can harbor gluten particles that can contaminate our food. A reasonable sounding argument on the face of it, but one that has absolutely no merit when examined in the light of science and reason!

E.coli found in beef and salmonella found in chicken are living nasty organisms that multiply and spread and can cause health problems from mild GI upset to death in some cases. And yet there has never been a case of someone throwing away their kitchen utensils after cooking chicken or beef. The utensils—wood, plastic or otherwise—get washed and re-used. If we trust proper washing to get rid of nasty, living, growing organisms that can kill us, there is no reason to doubt that the same proper washing can get rid of some particles of gluten—a non-living, non-growing, non-spreading food ingredient.

Playing the devil's advocate, let's assume that our washing left behind a thin layer of wheat flour on a wooden spoon—certainly an amount so small that cannot be seen, else it would have been wiped away. How much flour is that? The flour from one fifth of a grain of wheat is enough to completely cover the spoon. One fifth of a grain of wheat is 16mg of wheat; of which no more than 3mg is gluten. So let's assume we use that wooden spoon to prepare pasta in a 1-quart pot and all the flour on the spoon dissolves into the water with the pasta. That's 3mg of gluten in 1,000grams of water (1-quart = 1,000g of water). That works out to around 3ppm gluten in the pot. That is well below the 20ppm definition of gluten-free in the new FDA regulations; it is actually below any level today's best science can even measure! What's more, since we assumed that ALL the flour on the spoon dissolved into the water, the spatula is from now on, forever gluten-free, just as un-contaminated as a brand new spatula from the store!

Moral of the story: either the washing will remove the gluten from the utensils, or the gluten left over will be below the 20ppm limit in the first food cooked with that utensil and leave the spoon completely uncontaminated ever after. So if you want to use gluten as an excuse to get some new cooking utensils, that's OK, but there is certainly no cross-contamination reason to do so. If you are really concerned, take all your utensils, put them in a pot of boiling water for 10 minutes and you're done! After all, that's how hospitals used to sterilize syringes before throw-away ones became the norm.

Additionally this argument would indicate that a family that cooks both gluten-free and non-gluten-free could use one set of utensils as long as they get washed after every use. To feel more comfortable, one could use two sets of utensils, one for gluten-free the other for the rest.

That's False Advertising—I'm Suing You!
Cross-contamination concerns for foods from shared lines come up as we read food labels that say: "Prepared on a production line that also processes wheat and tree nuts."

A couple of things to start the discussion: Making customers sick is a bad business plan, the only thing worse is having customers sue for severe illness or death. For these reasons food companies that use allergens in their products - wheat, milk, soy, nuts, shellfish, etc., take the precaution of cleaning their production lines between runs of different products to avoid the very cross-contamination that could sicken or kill their customers. However, in our extremely litigious society, even when a company knows its production line is clean and free of cross-contaminants, it is safer to simply slap the label: "Prepared on a production line that also processes wheat and tree nuts" on the product and completely avoid any nuisance lawsuit.

Of course this leaves all of us celiacs scratching our heads trying to decide whether it's OK to consume such a product or not. Opinions vary; for my part, I note the label, keep it in mind, but operate on the basis that the company does have a standard process for cleaning their equipment between product runs.

With that assumption, the only chance of cross-contamination is in the first few batches of the product to go through the line, batches that most, if not all, manufacturers test and discard if found to be cross-contaminated. Even if such a 'spot' contaminated batch made it through to the market the analysis would follow along the same lines as all other cases in this article. The amount of wheat flour (and therefore gluten) that is left on the processing line must be too small to even be seen, otherwise it would have been wiped away. That small amount spread over several 'units' of the product could only result in a few ppm gluten for each 'unit' of the product. Certainly not a cross-contamination concern.

There's Gluten in Salmon! Really?
Cross-contamination at the grocery store; primarily a problem in any of the many grocery stores that prepare foods on premises, like sushi and salads or getting fresh-sliced cold-cuts at a deli.

Pick up a tray of salmon or tuna sushi - nigiri, sashimi, maki—and the ingredient list includes wheat, but the person that prepared it says they don't use wheat. Pick up a salad that obviously has no wheat in it and yet the label lists wheat as a potential allergen. What is going on?

The most probable culprit in all such cases is the packet of condiments 'on the side'. Sushi almost always includes a sealed soy sauce packet or two for people to use if they want. As we celiacs know most soy sauce contains wheat so, the label on the entire sushi container—which includes the soy sauce packets—lists wheat because of the soy sauce. Skip the soy sauce and enjoy your gluten-free sushi! Same argument with a salad—if wheat is listed as an ingredient but there is no obvious wheat in the salad (croutons, bread, etc.) then the wheat listed is most probably in the dressing offered on the side—skip the dressing.

Getting fresh cold-cuts at a deli to make sandwiches with your favorite gluten-free bread can raise the question of cross-contamination at the slicer from cured meat products that may contain gluten. First, any reputable deli wipes down their slicer between orders. To add a level of safety, explain the cross-contamination concern and ask the person preparing the order to set aside the first 5 slices—they will always oblige. Any residual gluten will stick to the first few slices and the rest will be fine.

A Gluten Fog: Your Local Pizzeria—Not That Scary!
We're all getting used to pizza places that have become enlightened enough to add gluten-free pizza options to their menu. They prepare gluten-free dough and cook the pizza in a dedicated corner of their oven or on baking sheets reserved for gluten-free pizzas. Giving them the benefit of the doubt that they spread out the toppings with no cross-contamination—which is easily checked by a few questions—this leaves one more cross-contamination concern. In 'high end' pizza places that roll their own dough for the regular (wheat) pizzas there's flour dust in the air. It would seem to be a valid cross-contamination concern, but the numbers are again, against it—unless the flour dust in the kitchen is so thick you can't see from one end of the kitchen to the other—not likely because flour dust that thick is a fire hazard!

So the analysis again reveals a non-issue: the amount of flour dust that lands on a 10" pizza is less than one wheat grain's worth. That's 65mg of wheat, worst case that is 10mg of gluten which translates to less than 10ppm for the entire 10" pizza, again well below the 20ppm definition of gluten-free in the new FDA regulations! So if you're feeling GI distress after eating your favorite gluten-free pizza at your favorite pizzeria, it's probably the pepperoni!

Salads at a restaurant are the next big concern because of the increasing tendency to see croutons or pita wedges as part of the salad. Of course you ask for your salad without the gluten item. And wouldn't you know it when the salad comes you see a big pita wedge right on top! Of course you ask that they take it back and bring you one without pita. And you wonder—did they make a new one or just serve you the old one after taking the pita off? Or maybe it's a business lunch with an important client and you don't want to make a fuss and don't even ask for a new salad. This is where my analysis goes a bit too far for some. I will remove the pita or pick around the croutons and eat the salad without a worry about getting 'glutened'. In my scientific brain the case is quite simple and clear: the thing we miss the most about gluten is its sticky property—it's a glue that sticks things together, and makes it possible to have light, airy, crusty baguettes to die for! Well, that same great property is what gives me the confidence to eat that salad. During baking, the gluten is completely bound up in that pita or in the croutons—it is not going to come loose just to contaminate me. It has not been laying in wait for the opportunity to be put on a celiac's plate and launch an attack on my villi—it's just not going to happen, nature does not work that way.

So, worry a little less and enjoy a lot more! I leave you with this empirical fact: There was a report back in the late '90s about a 10-year research program that went around the world interviewing people that were in their 90's to try and find a common thread to their longevity. Every factor was considered, food, smoking, physical activity level, genetics, drinking—everything. Once all the data was analyzed there was one and only one, crystal clear, common factor among all these people: they knew how to let go of worry, stress, loss, pain. Regardless of what life threw at them, they moved past it to the other side and kept on going. Don't let unfounded, irrational fear of gluten rob you of your life—move past it!

Celiac.com 08/15/2016 - Let's celebrate the good news first, and leave the disappointments until the end, where they belong.

Did you know that we are powerful when united? 5/19/2014 - The NFCA's Kristin Voorhees, MA, Director of Healthcare Initiatives, explains how advancing research lies in the hands of people living with celiac disease. A quick e-mail to a company that claims to have gluten-free food and does not even know the meaning of "gluten-free" needs to be educated and may even appreciate a quick note from you.

For instance, a fellow celiac sufferer recently telephoned a company that carried gluten-free muffins to tell them that the inserted package of blueberry filler contained wheat flour, and since there was no e-mail site listed she asked for a full refund on the product and payment of her telephone call. She had the nerve to do it and received full compensation plus the cost of her long distance telephone call. She also received several coupons for other products claiming to be gluten-free.

I, too, returned something that listed "gluten-free, wheat free, and even listed itself as "celiac friendly". They did not list an e-mail address so I asked for a refund and the cost of the postage stamp. I could not believe it when I received the entire refund; even though I had to use the money to purchase another product in the same store, I felt I had won a small battle.

Did You Know that a little advance work from you can get you a gluten-free Dairy Queen cake? I went in three years ago and explained my allergy to gluten, indicated that I could not even tolerate a cookie crumb coming into contact with my Dairy Queen cake, "Which I loved so much". It would have to be made separately and the person would have to wear gloves when preparing it. The whipped cream topping needed to be pure whipped cream.... and boldly I listed how deathly ill gluten can make me. They used frozen strawberries as the base, had the two types of ice cream and the fancy topping and I have never been sick eating the family Birthday cakes. Their ice cream has never contained gluten and I have tried this in the United States and Canada and have become well known in both stores.

Did You Know that Campbell's three mushroom, cream of mushroom soup suddenly changed their recipe? We always bought the three mushroom cream soup. Thankfully, my husband now carries a magnifying glass with him when he shops. Without any notice, they added flour to the soup and I have written to them. I received an apology and numerous coupons.

Did You Know that Catelli now had a "Pasta Freedom" line of pasta products? In the mail in May a small catalogue arrived listing their pastas, numerous recipes and a $1.00 coupon off any Catelli gluten-free pasta product. It is made in a dedicated gluten-free facility and has a web page to visit called catelliglutenfree.ca. There is also a U.S. web site; it took me two minutes at most to send a line to them essentially stating "Good on you Catelli". On June 2nd I received a further $1.00 savings coupon and was asked to tell my celiac friends about their certified site. That made my day!

Did You Know that manufacturers such as Bob's Red Mill and Pamela's Products test for the presence of gluten as an extra layer of protection? They have websites such as BobsRedMill.com, and PamelasProducts.com, If you find a flour or mix you really like and want to buy it in bulk rather than the small packages, try searching it at Amazon.com.

Did You Know that the NFCA declared May to be Celiac Disease Awareness Month through their "Our Heroes Within Us" campaign? Celiac disease is no longer a "rare" disease, and though there is still work to be done, we truly have come a long way. Who would have thought that Robin Hood Flour would produce a gluten-free flour in a large bags?

Every time you talk to someone both in and out of the gluten-free community you are a Hero; we do not choose to follow this restrictive diet because of weight loss. Every week the NFCA will unveil a community member who is having an impact on the lives of those around them.

DID YOU KNOW: I am still raving about the Allergy Free Restaurant Translation Cards? They really help communicate your special dietary needs in foreign countries. They offer basic phrases in various languages about your gluten concerns, specific ingredients, and preparation requests. They come in Arabic, Dutch, French, German, Greek, Italian, Korean, Latvian, Norwegian, Portuguese, Russian, Spanish, and Swedish. It comes in either paperback or e-book format. If you have a smart phone download the FREE Travel Checklist app to jump start your planning efforts detailing airlines, meals, snacks, hotels, cruises and foreign language considerations. Chef dining cards for gluten-free and celiac/coeliac travel will get you to their web site.

Did You Know; the top SIX supplements for celiac disease and gluten sensitivity? Melinda Dennis, MS, RD,LDN, nutrition coordinator of the Celiac Center at Beth Israel Deaconess Medical Center and lead nutrition author for CeliacNow.org indicates that a family multivitamin/mineral supplement is a base-line protection for getting a lot of the key vitamins and trace minerals that are not present in your diet. Make sure your supplements are gluten-free bearing the gluten-free label indicating they contain under 20 ppm gluten. Natural does not always mean safe! Look for chelated minerals and gently absorbable formulations, like calcium citrate, minerals that come in oxides like magnesium oxide, are not the most easily absorbed formulations.

Calcium is really important but it is also easy to overdose. Melinda Dennis says that she tries to get patients to reach their calcium goal through diet and then make up any difference with a calcium supplement. Calcium citrate is better absorbed than calcium carbonate, plus it does not cause as much gas or boating. It should also contain vitamin D and magnesium to help with absorption. Vitamin D: almost everyone needs vitamin D as it is so protective. It helps heal the small intestinal lining, helps with hormone regulation, and helps calcium absorption. It helps prevent colon cancer and is a mood enhancer. It is naturally produced by skin exposure to sunlight.

B Complex or B12: B vitamins can help with flagging energy and fatigue, since they are important for metabolism, red blood cell production, and tissue repair. Also, when the stomach is damaged, the body cannot absorb vitamin B12 properly, sometimes leading to a B12 deficiency. The B's are water soluble so your body mostly gets rid of anything you don't need. They are good when you are travelling, have high stress, or when fatigued. Be careful though, as synthetic B6 (pyridoxine) taken for prolonged periods at high doses can cause nerve damage.

Zinc: Many people newly diagnosed with celiac disease have low zinc. This trace mineral is involved in over 200 enzyme systems in the body and is responsible for growth and development, helping to heal wounds and protecting our immune system. It can also help with quality of our fingernails, skin, gums and hair.

Did You Know That the pharmaceuticals associations in the U.S. and Canada make a directory sized book available to every pharmacy or drugstore in the country? Try going to the pharmacy that you deal with and asking them for their out-dated issue of the compendium and see if they will give you their out-dated copy. It contains the names of the companies producing the drugs and their e-mail or web pages. This is the perfect way to check whether the drug or vitamin you are taking is actually gluten-free. I was taking a drug that was in pill form and made on machinery with other pills containing gluten. Having dermatitis herpetiformis which restricts ingesting gluten I broke out in DH sores in some amazing places - in my ears, back of my knees and chest as well as the places considered normal for the IgA deposits. I itched and stung as I scratched the tops off the lesions and had to go on Prednisone for two weeks. Is there anyone else out there that has had to take Prednisone and found it made them irritable, and as my husband stated, "it makes you really weird and wired".

Now the BAD NEWS: According to Jason Clevenger, PhD, research editor for Gluten-Free Living, who is a principal scientist with the consulting firm Exponent, Inc., and is the former editor of a Boston celiac support group, there is more evidence that ancient strains of wheat are as toxic to those with celiac disease as more modern types. Researchers harvested immune system cells from thirteen patients with biopsy proven celiac disease. They then tested the response of the cells to ancient and modern strains of wheat, including varieties known as spelt and kamut. All of the strains tested, regardless of being ancient or modern, triggered responses in the immune cells. The CONCLUSION; This report adds to the evidence that kamut, spelt and other wheat varieties should be avoided on a gluten-free diet. They provoke the same immune system response in those who have celiac disease as more modern strains of wheat. "Evaluation of the safety of ancient strains of wheat in celiac disease reveals heterogeneous small intestinal T cell response suggestive of celiac toxicity." That is from a report dated February 14, 2013 by Sulgo T.Gregoin.

The real cause of the gluten-free athlete's improved athletic performance may be harder to uncover than you think. Could the serious athlete's diet, free from gliadin and glutenin (the two protein groups found in wheat, barley, rye and triticale which create what we collectively label as "gluten"), cause improved physical output? Or, is it possible that these high-performing machines we call athletes may have had an undiscovered intolerance to the gluten substance before they ever discovered the diet?

The "cause and effect" here may be hard to define; or, quite possibly, impossible.
Most data now supports that as many as 10% of people may have negative reactions, or an intolerance to, the gluten found in wheat, barley and rye products and by-products(1). However, most people may not even realize they have symptoms, and like many of us, chalk them up to numerous other issues: I worked out too much. I have a sensitive stomach. I ate something bad. It's too hot out to digest properly… and, of course, the list goes on.

If a marathon runner, soccer player, football player, Olympic athlete, or anyone else who trains recreationally, semi-professionally, or professionally, were to have some level of intolerance and remove gluten from their diet, it is very likely they would see a marked improvement in their performance. This boost in athleticism could be credited to a number of factors including increased and improved absorption of vital nutrients such as iron, calcium, and vitamin D as well as secondary nutrients such as B12, copper, folate, magnesium, niacin, riboflavin and zinc. Athletic improvement can also be attributed to better overall awareness and tracking of what is being consumed. (This better management and awareness generally leads most athletes to eat cleaner, less refined and less processed foods as a result.)

On the flip side, the reverse is also true: Athletes might be seeing better performance results… even if they are not intolerant to gluten or have celiac disease. The improved performance may, in fact, be a product of increased protein intake (which tends to happen when processed carbohydrates are removed from the diet), better overall decision-making (like choosing whole foods or "clean" foods in order to avoid gluten), as well as higher natural fiber intake (from beans, vegetables, and whole grains such as quinoa, rice, and even amaranth) which aid the body's systems and digestion. The foods that performance and endurance athletes eat on a strict gluten-free diet are less likely to have been processed, and therefore low in salt, low in chemicals, and anti-inflammatory. (Thus, making it easier to train harder, faster, and longer.)

As you can see, it's a real "what came first.. chicken or the egg" dilemma. Both groups, both gluten intolerant and non-intolerant athletes could be showing improvement on a gluten-free diet. So how do you know if the athlete has an intolerance that led to the improvement?

In a landmark study, conducted by the University of Chicago Celiac Disease Center(2), it was estimated that 60% of children and 41% of adults who were diagnosed with celiac disease were asymptomatic when they received their diagnosis. Yes, asymptomatic. That means they didn't have any clue that they were negatively, medically, affected by gluten. One can only imagine in highly-maintained, otherwise "fit" populations, such as athletes who are striving for peak health, aimed at peak performance, these sample numbers might be even higher. These numbers seem to imply that it is very likely that athletes who see an increase in athletic performance may, indeed, be suffering from either celiac disease or non-celiac gluten intolerance symptoms…that they didn't even know they had.

However, that being said, it might be next to impossible to render a celiac diagnosis without subjecting the athlete to a rash of testing which will include the request that they, once again, consume gluten. (Try telling an athlete who is performing better than ever to change their ways. It's not likely to happen, especially during peak season.) Adding to the difficulty in diagnosis of gluten sensitivity is the lack of a verified blood or stool marker. The closest factor that can be studied to determine gluten sensitivity is the AGA-IgG antibodies. (Antibodies the body from exposure to "foreign" substances. AGA stands for antigliadin antibodies, which are antibodies produced by the body in response to contact with gliadin, a part of the gluten molecule. IgG stands for immunoglobulin G, which are generalized antibody molecules(3)) While it is true that about 40% of people with proven gluten sensitivity have elevated AGA-IgG, it is also true that about 15-25% of healthy individuals also have elevated AGA-IgG. Therefore, about 60% of gluten sensitive people do not have elevated AGA-IgG (making the test not sensitive enough); and about 20% of "normal", or non-gluten sensitive people have elevated AGA-IgG for no apparent reason (making the test not specific enough(4)).

In either case, many high-level athletes are finding comfort and elevated performance in a gluten-free diet. In The Gluten-Free Edge: A Nutrition and Training Guide for Peak Athletic Performance and an Active Gluten-Free Life (Bronsky, McLean Jory, Yoder Begley, Published by The Experiment, December 2012) there are several real-life gluten-free athletes who are discussed. They also provide insight into the "fuel" these athletes use instead of typical carbohydrates found in wheat-based pastas and products. There are also several websites dedicated to the insights, training methods, and nutrition of athletes that also promote the gluten-free diet to promote enhanced performance, better recovery, and increased stamina as a result of stabilized blood sugars (reducing the hypoglycemic effect of intense exercise) as well as decreased inflammation, and leaner muscle.

Sources:

1. National Institutes of Health, Univ. of Chicago Celiac Disease Center, May 7, 2013.
2. A multi-center study on the sero-prevalence of celiac disease in the United States among both at risk and not at risk groups. Fasano et. al., Archives of Internal Medicine. February 2003.
3. Celiac Disease Center at Columbia University. Open Original Shared Link February 14, 2011.
4. Detection of secretory IgA antibodies against gliadin and human tissue transglutaminase in stool to screen for coeliac disease in children: validation study (Published 26 January 2006) BMJ 2006;332:213

Wow, how times have changed! When I was a kid, and yes, my saying that makes me sound ancient, but it was only the 80's...back then we were sent outside in the morning and all of the neighborhood kids convened in someone's backyard. We went home for lunch and moms certainly did not hand out treats, especially not butterfly shaped waffles or any of the other Pinterest-inspired foods out there. We considered ourselves pretty lucky if someone had Freeze Pops in their house. If you are raising a child gluten-free, you know how much of a challenge it is that everything revolves around food.

The diagnosis of celiac disease or non-celiac gluten sensitivity is a huge eye opener for many. I think one of the hardest things for a family starting a gluten-free diet is how different our diet is from the way most people cook and eat. Since the 1950's we have morphed from TV dinners to buying entire meals from the grocery store deli, and our breads, cakes, and rolls from the bakery. And we've moved from a dinner out being a rare treat to the drive-thru being the norm for many families. Some parents never learned how to cook themselves, so it can be quite a shock to go from a world of just picking up dinner at the drive-thru or the deli, to a world of cooking from scratch at home. I know. I was a processed foods kid, and now I am definitely a "semi-homemade" cook.

Going gluten-free can be overwhelming at first. It will get easier. Here are a few tips and resources for raising a gluten-free child.

Take advantage of the internet and your smart phone. I love subscribing to digital gluten-free magazines, finding new recipes and reading books from my Kindle App. Make grocery shopping easy by using The Gluten-Free Grocery Guide by Triumph Dining (1). They have produced an app that tells you which foods are gluten-free at the grocery store. The app features popular brands and even includes store brands. They have done the research for you by calling brands and manufacturers to create this resource. I know how hard it is getting through the grocery store with kids in tow. It needs to be as easy as possible!

Know that you are not alone. There are many other parents facing the same obstacles as you. Surround yourself with support. R.O.C.K, Raising Our Celiac Kids (2) is a support group that can help you with the challenges ahead. Two other support groups you may look into are The Gluten Intolerance Group (3) and Celiac Sprue Association (4), while these are not groups for kids, they still provide valuable help and information.

Talk to family and friends about the seriousness of your child's needs. A lot of people don't understand how celiac disease or gluten sensitivity effects someone. Educate them. Make it clear that foods can't just be given to your kid, even a food that one may think of as gluten-free. Tell them about hidden sources of gluten. Let them know why a gluten-free menu at a restaurant may not actually be gluten-free. If your child spends a lot of time with a relative go over items in their home, like their toaster, that may be sources of cross contamination.

Teach your child the effects of cheating on their diet can do. Short term and long term. There are going to be many times of temptation. They are eventually going to be teenagers and have their own transportation and money. They need to be able to make smart choices as young adults.

Be prepared for class parties and classmates' birthdays. I suggest making it easier for yourself by giving a good supply of treats to your kid's teacher and having a good store of treats at home. Some yummy pre-packaged treats are Jelly Belly Snack Packs, Enjoy Life Cookies, and Lucy's Cookies. These are great choices for multiple food sensitivities. I also recommend packing snacks for around town, play dates, and after school activities. Having healthy gluten-free snacks on hand is important for when there may not be any allergy-friendly snacks available.

I try to stick to as many natural foods as possible, but occasionally, I like a treat or an easy meal. Thanks to the huge growth in gluten-free consumers there are a ton of food choices available. Gluten-free pizza, mac 'n' cheese, chicken tenders, cookies, pasta, even gluten-free toaster pastries. If you live in a rural area, with stores that don't carry a lot of gluten-free items, take advantage of online shopping. I like the ease of shopping from Amazon, Vitacost and The Gluten-Free Mall. As a busy mom I love that I can get items delivered to my door.

Get your kids in the kitchen. Teaching your kids to cook is an invaluable resource that will serve them life-long. Learning how to make a meal from whole natural foods can be fun and it teaches them how to eat a healthy diet. You can do this yourself or there are a lot of kids' cooking programs at local culinary centers, grocery stores, and community centers.

Kids will adapt and adjust. If they are older and have been eating gluten-containing foods their whole lives, it will be more difficult because their palates have been formed. Try to ease the transition by having them go grocery shopping with you so they can learn what is still available to them, and then do something fun like chocolate gluten-free waffles. Or pick up some gluten-free ice cream cones and ice cream. Let them know they don't have to give up everything. Having a positive attitude is essential. Children will model what you show them.

References:

1. Triumph Dining
2. Raising Our Celiac Kids
3. Open Original Shared Link
4. CSA Celiacs

Celiac.com 07/26/2016 - What a gross title–it bothers me and I wrote it! It wasn't my idea originally. The research paper the data came from was entitled, "Experimental hookworm infection and gluten microchallenge promote tolerance in celiac disease" published recently in the Journal of Allergy and Clinical Immunology.

It might be gross but the results were pretty darn interesting. Now don't try this at home, needless to say, but let's look at what these professional researchers discovered.

The hookworm, also known as a parasitic helminth, is known to have beneficial effects in inflammatory disorders. Therefore the researchers decided to see what would occur if they induced a hookworm infection into known celiacs and fed them escalating amounts of gluten.

A one year study was embarked upon with 12 consenting adults. They were given the hookworm larvae (Necator americanus–glad to know it was an "American" hookworm–joke) and increasing amounts of gluten, consumed as pasta were administered.

The initial microchallenge consisted of a small 10 to 50 mg for 12 weeks, followed by 1 gram plus 25 mg given twice per week for an additional 12 weeks, and finally 3 grams daily, the equivalent of 60-75 straws of spaghetti, for 2 weeks.

Symptoms, blood and tissue specimens from the small intestine were all utilized to ascertain gluten toxicity.

The results were surprising even to the researchers. While two of the subjects withdrew after the initial microchallenge, the remaining 10 completed the next 1 gram phase with the final 8 completing the entire process and ingesting 3 grams of gluten daily.

Lab results revealed no decrease in villi height, something one would suspect in a classic celiac who ingested gluten. The classic blood test that reveals damage occurring to the lining of the intestine, tTG did not rise, as expected, but levels actually declined, despite the 3 gram intake of gluten. A quality of life questionnaire showed improved quality of life scores, while a celiac symptom index, level of inflammation of the gut and Marsh scores evaluating degree of damage to the lining of the intestine were all unchanged.

Additionally a substance known as interferon gamma that is produced by immune fighting cells was reduced following the hookworm infection, illustrating that the hookworm somehow caused the immune system to not "react" to the ingestion of gluten. Another group of immune cells called regulatory T cells increased, further supporting the theory that the immune system did not in any way react to the presence of the ingested gluten despite the patients having celiac disease.

The researchers' conclusions were that our new best friend, hookworm Necator Americanus, promoted tolerance while stabilizing or improving all the gluten toxicity indexes evaluated in these 8 patients.

Fascinating, isn't it? There are several questions that come to my mind that I would like answered:
Are there any downsides to having a hookworm infection?
If not, and the upsides are decreased inflammation and tolerance to gluten, how do we know if we have enough hookworms to get these benefits?
Are the benefits local but not systemic? In other words we know that gluten can create problems in distant organs and systems. Does the hookworm infection successfully address these problems or not?
If one has a leaky gut, for instance, does the hookworm infection help the condition?
Is the hookworm a friendly beast that is designed to cohabitate in our guts, or will it naturally rid itself from our body if not reinocculated?

There's obviously more we need to know about this, but I wanted to share this information. We should remember that our gut houses trillions of organisms that we call our microbiome or probiotic population, therefore it is not a "stretch" to consider that the presence of organisms in the gut is something that could be quite healthy and normal.

Personally I like this idea far better than taking a drug with the ever-present side effects associated with putting a foreign substance in the body.

While we are deciding if this little beast will be part of our population of friendly organisms and potentially solve our reactions to gluten, please let me know if there's any assistance you need in improving your health. Whether you have celiac disease, gluten sensitivity or some other issue that is continuing to compromise your health, consider contacting us for a FREE health analysis – call 408-733-0400.

We are a destination clinic and we treat patients from across the country and internationally. We are here to help. I look forward to hearing from you!

Reference:

• Journal of Allergy and Clinical Immunology, "Experimental hookworm infection and gluten microchallenge promote tolerance in celiac disease". Published Online: September 20, 2014. DOI: Open Original Shared Link

Approaching this issue from a different angle, we know that between 10% and 15% of the U.S. population has dyslexia (3). About 60% of those with ADHD have dyslexia (3). If we calculate the prevalence of ADHD, at 8.8% of the population (4), then just the ADHD component, it should give us 5.28% of the population with dyslexia. But we can't tell how much overlap there is between this group and the group that constitutes between 10% and 15% of the population that are reported as having dyslexia. These disabilities have been given considerable attention and have been studied for some time, yet we really know little about their causes, except in cases of traumatic brain injury.

However, there is a startling study, reported in The Times ten years ago, from the Nunnykirk School in Northumberland, U.K. (5). The astounding results of this study continue to cry out for further research and possible replication. After 6 months on a gluten-free diet, testing showed that 11 of the 12 (92%) live-in students had improved their reading and comprehension at more than twice the rate at which regular students are expected to improve. Among the 22 students living in the community and attending this special school for dyslexic students during the day, 17 of them (77%) showed similar improvements (5). To put these results in perspective, special needs teachers are often very proud when they can help students achieve at rates similar to regular students. Doubling the rates of improvement is an astonishingly positive result! And a few of these students leaped ahead at six times the rate of normal students! The numbers of students involved in this study are too small to allow us to extrapolate to other dyslexic populations. And, given that the research was done in the United Kingdom, where definitions of learning disabilities, and other factors may be dissimilar, and that the work was reported in a newspaper instead of a peer reviewed journal, and the startlingly positive nature of these results, we really need further, carefully designed studies to explore this phenomenon.

The Nunnykirk findings are consistent with the extensive brain and neurological research that has been done at the Royal Hallamshire Hospital at the University of Sheffield, over the last two decades, by Marios Hadjivassiliou and his colleagues. They have found that a strict gluten-free diet can often relieve central and peripheral neurological symptoms.

Further, many prominent researchers who work with children and adults who have dyslexia characterize it as a neurobiological condition, and can demonstrate, with MRI, altered brain function in dyslexia (8). It is also clear that many cases of dyslexia are at least partly genetically conferred (8, 9). Neither are learning disabilities limited to dyslexia. Although some practitioners lump two or more learning disabilities together, the literature distinguishes between dyslexia, dysgraphia, dyspraxia, dyscalculia, dysphasia/aphasia, auditory processing disorders, visual processing disorders, etc. Some such practitioners not only differentiate between types of learning disabilities, they also differentiate between sub-types of disabilities. For instance, motor dysgraphia (where fine motor speed is impaired), dyslexic dysgraphia (where normal fine motor speed allows them to draw or copy but impairs spontaneous writing) and spatial dysgraphia (where handwriting is illegible due to distortion) can each be identified based on symptoms (10). Similar sub-types are seen in other learning disabilities.

But what if the findings at Nunnykirk School are broadly applicable to all of these types of learning problems? Or perhaps further research can tell us which types and sub-types of learning disabilities can often be alleviated by a gluten-free diet.

My own professional observations suggest that the number of students helped by a gluten-free diet would be similar to the proportions seen at Nunnykirk School. I have also observed that as the strictness of the diet increases, so does the number of students who improve. However, the diagnosing professionals are becoming reluctant to differentiate, even between general types of learning disabilities such as dyslexia and dysgraphia. As teachers, we were told that a child had learning disabilities and then, if not specified in the documents we were given, we had to figure out exactly what type of disability they had, then devise or research effective ways of teaching these students. I have done a little of both, but my experience is that this choice varies from one teacher to the next, and one situation to the next. Unfortunately, depending on the individual teacher's workload, teaching background, and personal biases, these children can sometimes be neglected or under-served, a choice that is often dictated by excessive workloads and demands on teachers' time to perform other tasks, especially extensive reporting and supervising sports and other extra-curricular activities.

Please recall the overlap between dyslexia and ADHD mentioned earlier (3), and consider that there are ten reports of connections between attention deficit disorders and celiac disease published in the peer reviewed medical literature. Now, please recall that about 60% of these ADHD children will have dyslexia (3). Since the current, and past issues, of the Diagnostic and Statistical Manual of Mental Disorders, require that ADHD and learning disorders each be differentiated from any medical condition that might be causing the same symptoms and be alleviated by resolution of the medical condition in question. On that basis alone, almost every child being considered for a diagnosis of learning disorders or ADHD should be thoroughly tested for celiac disease and non-celiac gluten sensitivity.

Yet, I would be very surprised to learn that this is commonly being done. Thus, we have a situation in which we are forced to rely upon a study conducted by a group of teachers, in cooperation with parents and students, that was published in The Times (5) and we must take action on our own because, as yet, celiac disease and non-celiac gluten sensitivity are not yet being differentiated from ADHD and/or learning disabilities. The really tragic part of this story is that a gluten-free diet, if started early enough, can reduce or completely eliminate all of these problems with learning disabilities and attention deficits, when gluten is the underlying problem.

If you or your spouse are gluten sensitive, or have celiac disease, do you also have children who struggle in school? Based on the data from Nunnykirk School, current blood tests are probably not sufficient to rule out those who would benefit from a gluten-free diet. For the moment, you may need to institute a trial of a gluten-free diet, as mentioned above, while we await further research in this area. But wouldn't it be valuable for succeeding generations to know, or have a pretty clear idea whether the diet could help? And with what types and/or sub-types of learning disorders? That's where more research could really help. We already know that there is an association between gluten sensitivity and seizure disorders, ataxia and cerebellar degeneration, neuropathy (damage to peripheral nervous system), schizophrenia, depression, migraine, anxiety disorders, autism, multiple sclerosis, myasthenia gravis (an autoimmune neuromuscular disease), and white matter lesions in the brain (11). It should not be surprising if gluten underlies many or most cases of learning disorders and attention deficits. And if research can tell us which cases would be most likely to benefit from the diet, that will be a huge step forward for parents, students, teachers, and government agencies that provide funding for the education of those who are afflicted with these ailments.

In the meantime, we only have the information that we have. So, despite its many weaknesses, the Nunnykirk investigation of dyslexic children argues for experimental implementation, on a trial basis. I would suggest at least a six-months-long period of strict gluten avoidance to determine whether it will help individuals who suffer from dyslexia and/or other learning disabilities.

Sources:
1. Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003 Feb 10;163(3):286-92.
2. Hadjivassiliou M, Grünewald R A, Davies-Jones G A B. Gluten sensitivity as a neurological illness. J Neurol Neurosurg Psychiatry 2002;72:560-563.
3. Dyslexia Research Institute Open Original Shared Link
4. National Resource Center on ADHD Open Original Shared Link
5. Blair Open Original Shared Link
6. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.
7. Aziz I, Hadjivassiliou M. Coeliac disease: noncoeliac gluten sensitivity--food for thought. Nat Rev Gastroenterol Hepatol. 2014 Jul;11(7):398-9.
8. Shaywitz SE, Shaywitz BA. The Neurobiology of Reading and Dyslexia. Focus on Basics - Connecting Research & Practice, Volume 5,A: Aug. 2001. Open Original Shared Link
9. Eicher JD, Powers NR, Miller LL, Mueller KL, Mascheretti S, Marino C, Willcutt EG, DeFries JC, Olson RK, Smith SD, Pennington BF, Tomblin JB, Ring SM, Gruen JR. Characterization of the DYX2 locus on chromosome 6p22 with reading disability, language impairment, and IQ. Hum Genet. 2014 Jul;133(7):869-81.
10. About Education Open Original Shared Link
11. Jackson JR, Eaton WW, Cascella NG, Fasano A, Kelly DL.Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity. Psychiatr Q. 2012 Mar;83(1):91-102.
12. Diaconu G, Burlea M, Grigore I, Anton DT, Trandafir LM. Celiac disease with neurologic manifestations in children. Rev Med Chir Soc Med Nat Iasi. 2013 Jan-Mar;117(1):88-94. PubMed PMID: 24505898.
13. Niederhofer H. Association of attention-deficit/hyperactivity disorder and celiac disease: a brief report. Prim Care Companion CNS Disord. 2011;13(3). pii: PCC.10br01104PMCID: PMC3184556.
14. Niederhofer H, Pittschieler K. A preliminary investigation of ADHD symptoms in persons with celiac disease. J Atten Disord. 2006 Nov;10(2):200-4.
15. Zelnik N, Pacht A, Obeid R, Lerner A. Range of neurologic disorders in patients with celiac disease. Pediatrics. 2004 Jun;113(6):1672-6.
16. Kozłowska ZE. [Evaluation of mental status of children with malabsorption syndrome after long-term treatment with gluten-free diet (preliminary report)]. Psychiatr Pol. 1991 Mar-Apr;25(2):130-4. Polish.
17. Diaconu G, Burlea M, Grigore I, Anton DT, Trandafir LM. Celiac disease with neurologic manifestations in children. Rev Med Chir Soc Med Nat Iasi. 2013 Jan-Mar;117(1):88-94. PubMed PMID: 24505898.
18. Niederhofer H. Association of attention-deficit/hyperactivity disorder and celiac disease: a brief report. Prim Care Companion CNS Disord. 2011;13(3). pii: PCC.10br01104. PMCID: PMC3184556.
19. Niederhofer H, Pittschieler K. A preliminary investigation of ADHD symptoms in persons with celiac disease. J Atten Disord. 2006 Nov;10(2):200-4.
20. 4: Zelnik N, Pacht A, Obeid R, Lerner A. Range of neurologic disorders in patients with celiac disease. Pediatrics. 2004 Jun;113(6):1672-6.
21. Kozłowska ZE. [Evaluation of mental status of children with malabsorption syndrome after long-term treatment with gluten-free diet (preliminary report)]. Psychiatr Pol. 1991 Mar-Apr;25(2):130-4. Polish.

Hearing about these ailments caused by gluten, I started connecting some of my own experiences with the signs and symptoms he was talking about, especially in relation to my journey through the education system. Physical and behavioral problems had plagued my educational life, making it a disaster. I worked with various educational specialists, from the very beginning, yet they did not seem to be able to help me much. I couldn't maintain a pace of learning that was even remotely close to that of my peers, in most of my scholastic endeavors. As my self-esteem dropped, my behavior worsened. I found myself increasingly being removed from classes and from schools. I sometimes thought that if I heard the words "he just does not apply himself" one more time, I would spontaneously explode. That being said, I am still very thankful for some compassionate, caring teachers and coaches who saw through all my issues and stayed committed trying to help me muddle through and keep moving along in my educational journey.

As a high school athletics coach and teacher of Health and Physical Education, now, I often find myself offering dietary concepts and information to students and colleagues that is at odds with what I learned at university just over 20 years ago. And the misinformation I learned is still commonly being touted, even today. Admittedly, research in the field of Nutrition has undergone some dramatic changes over the last two decades, but what I'm talking about is a more fundamental shift in thinking about what we eat and whether it will promote optimum athletic performance, protection from disease, longevity, and a healthy body composition that is more in line with wellness.

For instance, I was taught that carbohydrates are the preferred fuel for our muscles, and that carbing-up prior to an athletic event is an effective and desirable strategy. I was also taught that weight loss could be achieved through increased physical activity. I now view these issues very differently. Athletic performance is often enhanced by avoiding many of the foods, such as gluten and sugar, that I was taught to value. Today, I am constantly seeing articles or interviews about high performance athletes who have left the old nutrition paradigm behind and are having great success and increased career longevity in their chosen field. Novak Djokovic is one prominent example where the underlying problem was celiac disease. Vande Velde and Tom Danielson are two professional cyclists who also report performance increases from a gluten-free diet (1). Such a shift in eating can also, especially among young people, remove or reduce learning disabilities as reported by one school that works only with children who struggle with dyslexia (2).

Conventional thinkers seem to believe that these benefits have something to do with improved nutrient absorption. However, they may come from enhanced nerve conduction or function. After all, Marios Hadjivassiliou and his colleagues at the Royal Hallamshire Hospital at the University of Sheffield have long been reporting that gluten, even in the absence of celiac disease, is responsible for a large portion of neurological ailments of unknown origin (3). Or the improvements may come from something entirely different. But wherever the improved performance and health are coming from, the gluten-free diet seems to be a great starting place.

For instance, a former student, C.W., who has given his permission for me to talk about his case, experienced dramatic changes on a gluten-free and dairy free diet. Already an accomplished athlete, C.W. had also struggled for years with serious academic problems. He struggled with his reading and his writing and was still functioning at the level of an elementary student. A colleague and I recommended that C.W. try this diet to hone his fitness. Not only did he enhance his athletic performance, his reading skills improved abruptly and dramatically. Both his comprehension and his reading speed increased significantly over just a few months. Before he had been on the diet a full year, he was reading novels for pleasure. This was a far cry from his prior brushes with reading, where he was often unable to remember what was said in a sentence he had just finished reading. Certainly, by the end of a paragraph he was previously unable to say how it had begun. Now, he is reading novels, enjoying the experience, and he remembers them well enough to be able to talk, in detail, about the story.

My own experience with the gluten-free diet has not produced such rapid results, at least regarding my reading and writing. I certainly felt healthier very quickly, and found it much easier to have a leaner body composition. Many of my minor physical complaints also disappeared, but it has taken years for my struggles with reading to diminish. Today, I am able to read highly technical reports from the peer reviewed medical and nutritional literature. I also find myself reading large, technical books about nutrition and other health issues. I read them cover-to-cover, and I understand most of what I read.

My writing is also improving gradually. There is no question in my mind that the gluten-free diet has helped me enormously in these areas, although much more slowly than they helped C.W. Neither do I know how many other children that a gluten-free diet could help. I can only say that if you or someone close to you experiences a learning disability or unexplained gastro intentional issues or withdrawal symptoms when trying to eliminate wheat for a short time, it would be very worthwhile to follow a strict gluten-free diet for six months.

Sources:

• Open Original Shared Link
• Alexandra Blair. Wheat-free diet gives food for thought. Open Original Shared Link
• Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. (1996). Does cryptic gluten sensitivity play a part in neurological illness? Lancet. Feb 10;347(8998):369-71.

Celiac.com 01/02/2015 - What an odd thing to say: “Do not mask the appearance of celiac disease.” Inferring that you keep on eating gluten, despite early signs of celiac disease, until you get enough damage to your intestines that it can be seen under a microscope. I totally disagree with this concept—but this is still a common belief of medical practitioners.

For instance a dietitian said this recently: “Gluten-free diet as an experiment to see if you (or your children) feel better, can be beneficial, but this approach can mask underlying celiac disease.”

Have you ever heard of a doctor “masking” the diagnosis of heart disease by failing to treat high blood pressure or high cholesterol until the patient has a heart attack? Ridiculous! Have you ever heard of a doctor “masking” the diagnosis of depression so that the person is suicidal before given help? Ridiculous!

A colleagues writes: “As far as ‘masking’ celiac disease, that would be like saying that a person who is pre-diabetic should continue to eat lots of sugar and carbs so they can destroy enough beta cells to develop full blown diabetes. That eating low carb might mask diabetes. Meanwhile the pre-diabetic blood sugars can continue to damage the body in many insidious ways. Maybe these dietary changes should be looked at as preventive measures that are good.”

So why is the “masking” concept reserved for celiac disease? I regard a slightly raised tTG result as a ‘smoking gun’ (this also goes for EMA and DGP). Yes, the concept of “do not go gluten-free so that you do not mask celiac disease diagnosis” is contentious.

There are many threads to this problem:

1. Celiac disease is a progressive condition—it slowly gets worse the longer you eat gluten;
2. In the early stages of celiac disease, it cannot be diagnosed by endoscopy biopsy;
3. The biopsy test is inaccurate and relies on experts to recognize early disease;
4. Most people who get gluten-illness do not have celiac disease;
5. Gluten-related-disorders-without-gut-damage are indistinguishable from early-celiac-without-gut-damaage-yet;
6. Carrying the HLA DQ2/DQ8 gene cannot be used to make a diagnosis, but if you do not carry the gene, it will be very unlikely that you have celiac disease;
7. The “masking” concept originated a few decades ago when biopsy was the only way to diagnose celiac disease;
8. Now, the blood tests for celiac disease (EMA, tTG, DGP) are more accurate than the biopsy, and can turn positive BEFORE there is any histologic evidence of gut damage;
9. Once celiac disease has become established, you cannot guarantee complete remission;
10. Gluten challenge is detrimental to your health;
11. A gluten challenge (to create serious bowel damage) can take years, during which time ongoing body damage (brain, skin and bowel) is ongoing;
12. Celiac disease and gluten-senitivity often co-exist.

This concept is addressed in my new book “Gluten-related disorder: sick? tired? grumpy?” Available as an ebook at Open Original Shared Link.