Celiac.com 08/29/2016 - What does it cost to have celiac disease? A team of researchers recently set out to make a close analysis of direct costs.

The researchers included Stefano Guandalini, Namita Tundia, Roopal Thakkar, Dendy Macaulay, Kirk Essenmacher, Mahesh Fuldeore. They are variously associated with the University of Chicago, AbbVie Inc., Analysis Group, and with Alvine Pharmaceuticals.

The research team measured the burden of total direct costs associated with celiac disease in patients with celiac disease versus patients without celiac disease using administrative claims data.

They selected cases of celiac disease diagnoses at a randomly chosen index date from the OptumHealth Reporting and Insights database from 01/01/1998 through 03/31/2013. They continuously enrolled patients throughout baseline, from 1 year before index date, and study, 1 year after index date, periods. They categorized patients as full remission and partial remission and matched them 1 to 1 based on age, sex, region, index date, company, and employment status. They then calculated total all-cause and celiac disease-related costs.

They matched a total of 12,187 patients with an equal number of controls. On average, total all-cause costs for celiac disease cases was $12,217 versus $4,935 in controls (P < 0.0001). Average total all-cause direct costs for the 10,181, or 83.5%, of full remission patients versus controls was $11,038 versus $4,962, while in the 2006, or 16.5 % of partial remission patients, average total all-cause direct costs were $18,206 compared to costs of $4,796 for control subjects.

All-cause medical costs were $9,839 for all cases, $8,723 for full remission patients, and $15,499 for partial remission patients. These costs accounted for most all-cause total costs and included outpatient costs of $6,675; $6,456; and $7,785, respectively, along with hospitalizations costing $2,776; $1,963; and $6,906, respectively. Celiac disease-related medical costs were 13% and 27% of all-cause medical costs for all cases and partial remission cases, respectively.

People with celiac disease, and partial remission of celiac disease, face expenses 2.5 and 3.8 times higher for total all-cause costs compared with matched controls, and they pay much higher total costs than people without celiac disease.

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Celiac.com 08/26/2016 - News that ImmusanT company is beginning full human trials for their celiac disease vaccine, NexVax 2, brought a number of comments from our readers.

We first reported on their effort way back in 2002, with our story, Australian Researchers Begin Work on a Vaccine for Celiac Disease.

We followed up over the years, with stories in 2009, First Ever Celiac Disease Vaccine Trials Underway in Australia and again in 2011, with articles reporting on the company's efforts to raise investment funds, titled ImmusanT Raises $20 Million in Series A Financing to Advance Immunotherapeutic and Diagnostic for Celiac Disease and on how ImmusanT's Celiac Vaccine Passed Phase I Clinical Trials and in 2012, with Is a Vaccine for Celiac Disease Just Around the Corner?

Comments generally ran toward the affirmative side, with many people expressing excitement or interest in such a vaccine.

From Jared M: I hope this research goes well. The bread, crackers and pizza I can live without. But I would really like to be able to drink a good IPA again. The sorghum beers are horrible. I am quickly growing tired of ciders. I would definitely pay for this treatment if it works.

From Toni: I have celiac. That [a vaccine] would be wonderful.

From Traci: I would like to be involved in a study for this immunization.

From Linda Haas: Can't wait to hear more about the progress made on this vaccine...it sounds very promising!

From Donda: I'm thrilled with the possibility of this coming to market.

From Muriel Weadick: This is what all celiacs have been waiting for, and I am sure I am not alone in wishing the company success.

From Suzanne: A vaccine like this would make it easier to eat out and go on vacation.

Jeanne Burge wrote: I would gladly volunteer for the trials in the US. Hope this works!

Still, a few comments ran toward the less than glowing side, with some people expressing trepidation, or outright distrust toward such a vaccine.

From Cathi: My Question is, "What will be the side effects of this turning off the body's ability to fight Gluten?" Will there still be destruction some place else and maybe worse? So, many times a pill is created to help one thing only to find out that it created another problem some place else in the body. Frankly, I am worried.

From Donna: Absolutely agree with you, Cathi. There is always a problem and side effects with ANY drug! My question is this - WHAT ELSE will be shut off? Will we be even MORE susceptible to other illnesses? I am worried as well!

From Balm: Thanks but no thanks. I'll remain a celiac and continue to eat healthy. While trying to fix one problem, some will end up with far worse problems.

From Jonnys: Stupid idea! Just another way to make more money off of people.

Certainly, those who may have a weakened or compromised immune system should consult with a physician before receiving most vaccines. But, in adults with a healthy immune system, such a vaccine would likely present little or no danger to the recipient. Most people with celiac disease have healthy immune systems, so the likelihood of any adverse reaction will be slight.

Of course, this is all theoretical, even at this point, as vaccine trials have so far not proven how well the vaccine actually works in preventing or curing celiac disease.

So, the question is, if such a vaccine is proven safe and effective, would you be open to trying it, or not?

Celiac.com 08/25/2016 - You just got diagnosed Celiac and are wondering how serious this really is. What if there is just a little gluten in your food? What if you use the same toaster for your gluten-free bread as your wife's/husband's regular bread? What if those french fries are gluten-free but they fry them in the same fryer as those nice gluten coated onion rings?

Well, my answer is always that no amount of gluten is "safe". Items that are certified gluten-free must be tested and must pass, having less than 20 parts per million (ppm) of gluten. That means that less than .002% parts of that item contain gluten. That is quite a small amount but not necessarily small enough to not have a reaction to it. Some products even test as low as 10 ppm or 5ppm.  Anything lower than 3ppm is undetectable by any test out there right now. Some products state they are less than 20ppm but you really don't know if that is 19ppm or 5ppm so I always assume the worst just in case.

So let's assume these french fries are nice and crispy and they share that fryer with those delicious onion rings. The answer is, stay away. You most definitely will end up consuming gluten. You may not have a reaction that you notice from these french fries, as some people are more sensitive or less sensitive, but that does not mean they are not causing an autoimmune reaction and causing damage internally.

My advice: get your own dedicated gluten-free toaster; ask and ask again if sauces contain gluten; ask if the fryer shares space with gluten containing items and even let your server know you have celiac disease and to let the chef know. Your server may not know enough about gluten and celiac disease, but chefs almost always do and will understand the severity of it. I have had much better luck eating out when I have my server actually let the chef know I am celiac. There have been many occasions where my server said something was gluten-free without asking the chef and in the end I ended up sick in bed because of it.

Anyone who has ever tried a gluten-free bread or cake has likely found what sufferers of celiac disease have long known. They often don't taste very good. Gluten-free baked goods are often dry, crumbly and flat tasting.

As long as there has been gluten-free bread, there has been mediocre gluten-free bread. This is not the fault of bakers. The problem is structural, chemical. Gluten, the protein found in wheat, rye, and barley, triggers adverse immune reactions in people with celiac disease. But that same gluten also has uniquely elastic properties that make it perfect for mixing with water, kneading into dough, and baking into chewy delicious bread.

Gluten is what makes our breads spongy, and chewy, and delicious. Cereals and grains like rice, sorghum, buckwheat, which are often milled into gluten-free flours, lack this important component.

Now two inventive Italian food scientists, Virna Cerne and Ombretta Polenghi, are being lauded for their isolation of a protein called zein, that is found in corn. Under the right temperature, humidity, and pH, zein forms an elastic network similar to gluten.

These days, says Cerne, "gluten-free products include a lot of fiber but the fiber cannot be really elastic." Added to different gluten-free flours like rice or corn flour, Cerne adds, isolated zein protein "solves the problem of no elasticity." That means that products using zein protein can be used to develop gluten-free products with many of the same chewy, flaky attributes as bread and baked goods made from wheat flour.

Currently, products using isolated zein protein are still in the research and development phase, but food scientists hope the abundance of low-priced corn will allow the protein to be made cheaply, and thus give rise to more affordable gluten-free alternatives. Cerne and her co-inventor Polenghi, who both work with Italian-based food company Dr Schär, say that their research remains focused on people with serious medical reasons to avoid gluten.

Stay tuned to see how Cerne and Polenghi's work develops and what food breakthroughs might result from their efforts.

Read more at Open Original Shared Link.

The application for patent protection covers numerous mechanical separation processes on a variety of grains, including oat grains and gluten-containing grains, using, among other things, width grading steps, multiple length grading steps, aspirating steps and a potential de-bearding step.

Federal labeling regulations require products labeled 'gluten-free' to have gluten levels below 20 ppm. The process allow the production of oat grains with gluten levels below 20 parts per million, and optimally at 10 ppm.

The resulting oats are gluten-free oats and suitable for use in a variety of gluten-free oat food products, including cereal and granola products, according to the patent US 2016/0207048 A1, filed on July 21st 2016.

Mechanical separation techniques, such as these covered by the patent application, have the potential to be highly efficient and economical. The patent does not mention more expensive optical systems.

Oats are naturally gluten-free, but, according to the patent, "oats cultivated in North America, Europe and other parts of the world commonly are contaminated by gluten-containing grains such as wheat, barley, rye and triticale."

Contamination can result from rotating grains on the same crop land, and from harvesting, transporting, storing and merchandising.

General Mills experienced problems with wheat contamination of gluten-free products last year, when they were forced to recall an estimated 1.8 million boxes of gluten-free Cheerios and Honey Nut Cheerios at its Lodi, Calif., plant. The product was contaminated with gluten. However, the company has maintained that the gluten contamination was due to an employee processing error, not any defect in their grain sorting equipment covered under the patent protection.

Stay tuned to find out if General Mills receives their patent, and if their process has a significant impact on the quality, availability and cost of gluten-free oats.

Celiac.com 08/16/2016 - The short answer, yes! Although some women, due to certain complications are told not to exercise, for the most part exercise is totally fine while pregnant and actually quite a valid implementation to a healthy pregnancy.

There used to be this myth that women had to be extremely careful with physical activity while pregnant due to the risk of possible miscarriage. Now we see pregnant women doing CrossFit, running, lifting weights, etc., as well as all sorts of beautiful yoga poses. This doesn't mean that if you haven’t worked out in 5 years and are pregnant you should suddenly start running 12 hours a day. No, not at all. On the other hand, if you have kept up a normal exercise routine it is totally fine to keep it up.

Listen to your own body and understand things may feel different so don’t push yourself too much. I worked out plenty before getting pregnant and continued my many normal activities up until around 7 months. At that point I was very round and more tired than usual and going for regular walks, swimming and yoga was plenty enough "exercise" for me.

I am celiac and I maintained my gluten-free diet during my pregnancy. I felt it was extremely important for me to be as healthy as I could so my body would feel good and therefore make my pregnancy that much easier. I have read that exercising throughout one's pregnancy can possibly shorten the labor too. Now this is a win-win in my eyes!

The benefits of exercising while pregnant also include a lower risk of getting sick, lower risk of gestational diabetes, lower risk of depression and the list goes on. Plus, you can work on that lower core and strengthen your pelvis which will help a lot with back pains and hip issues that are all too familiar to pregnant women.

Ask your OB-GYN or midwife for approval and once you get the green light go have some fun. You are more than likely to meet some other wonderful "future" moms, many of which are also looking to connect up and make friends.

This is also a perfect opportunity to help other moms who may have some "odd symptoms", and if you are well-versed in the gluten-free diet and the symptoms of gluten sensitivity or intolerance, you can help another woman in need, hence her future baby. Moms uniting and sharing their tested knowledge is a lovely aspect of pregnancy these days.

I hope this has inspired you and please feel free to contact me at any time with any questions. I focus on the gluten-free diet as well as the grain free diet, celiac disease, motherhood, and children issues. These are all subjects that I'm very passionate about.

Celiac.com 08/12/2016 - Cereal-maker General Mills has announced the debut of five varieties of gluten-free cereals in Canada by the end of summer.

The five varieties include Original Cheerios, Honey Nut Cheerios, Multi-Grain Cheerios, Apple Cinnamon Cheerios and Chocolate Cheerios.

General Mills is excited to offer gluten-free Canadians more gluten-free cereal options, says Emma Eriksson, director of marketing for General Mills Canada, said in a release.

She adds that "gluten-free Cheerios products will maintain the same great taste that consumers love at the same price they're used to."

All gluten-free Cheerios products will be clearly labelled "gluten free" on the front of the box.

Gluten-free Cheerios was first introduced in the U.S. last summer. Gluten-free Cheerios products join other gluten-free cereals already sold by General Mills, including Rice Chex, Chex Honey Nut and Cinnamon Chex, with Chocolate Chex also launching in Canada this summer.

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Celiac.com 08/04/2016 - With all the hype about gluten-free diets going around, it's only natural that dog owners might wonder about potential benefits of a gluten-fee diet for their pet. Before rushing out and spending money on a bunch of new gluten-free grub for Fido, it's wise to first ask a few questions.

First, figure out whether the dog is sensitive to gluten from wheat, barley, oats or rye, or if the dog is sensitive to grains including soy and corn. It's also possible that the dog has no sensitivities to the current food.

Most dogs do not suffer from celiac disease, so a gluten-free diet is not necessary, nor will it be likely to improve the dog's health in any way. There are, however, some important exceptions. For example, Irish setters and dogs with Irish setter genetics can suffer from hereditary gluten intolerance. Gluten-sensitivity affects only a minority of Irish setters, but it does exist, and it's important to address in pets with symptoms.

Gluten sensitivity is also a factor in epileptoid cramping in Border Terriers, so be on the lookout if your Border Terrier suffers from epilepsy-like cramping or seizures.

While any dog may develop food sensitivities, some breeds are more predisposed than others. Boston terriers are often allergic to products containing corn or gluten, resulting in skin issues, or atopic dermatitis. Switching to a corn-free, wheat-free food can lead to significant improvements.

The main point to remember is that even gluten-free dog food, with no wheat, barley, oats or rye, can still contain soy or corn, while many dog foods labeled as 'grain-free' happen to also be gluten-free.

Dog foods that omit grains often contain other high-carbohydrate ingredients, such as sweet potato or tapioca. Whether grain intolerance, or gluten-intolerance is the problem, it is important to read the dog food label, and to slowly and carefully test out any new foods before switching over completely.

Also, even though some dogs are allergic to grains, other ingredients, especially beef and dairy, are far more likely to trigger allergic skin reactions.

Here are some top dog-food brands that offer gluten-free options that contain ingredients less likely to cause allergies. Remember, dogs have individual tastes and preferences. Some dogs will prefer and do better with some foods than others, no matter how highly rated the food. Obviously let your dog help guide you on this.

A dog's needs also vary according to life stage. When you change dog foods, do so over a period of several days. So, it's best to try small samples at a time, and make the full switch to a new food slowly. Even the best new food may upset a dog's digestive system if it's not given time to adjust.

Choosing the wrong food for your dog, or forcing a change too quickly can leave both you and the dog unsatisfied. That may be why even the highest quality dog foods can have unsatisfied customers posting poor reviews of a particular item.

To help you with your search, here's a list of Open Original Shared Link from Heavy.com.

Here's a list of Open Original Shared Link from thealternativedaily.com.

Here's the list of Open Original Shared Link, including tubs or cups, according to dogfoodadvisor.com.

Lastly, here's a list of Open Original Shared Link, including dehydrated or freeze-dried, according to dogfoodadvisor.com. 

There's been some really good stuff coming out of Digestive Disease Week 2016 in San Diego. One example is a talk given by Norelle Reilly, MD, from the division of pediatric gastroenterology and the Celiac Disease Center at Columbia University Medical Center in New York City.

According to data presented by Dr. Reilly many patients diagnosed with celiac disease as children do not pursue follow-up gastroenterology care as adults, unless symptoms worsen.

Reilly and colleagues sent a 33-question survey to nearly 8,000 recipients via the medical center's proprietary distribution list and received 98 qualified responses.

According to Reilly, 37% of respondents said they were not seeking ongoing care for celiac disease. These respondents reported an average of 2 to 5 years, and sometimes as many as 10 years, between doctor visits for their celiac disease. Compare that with an average of six months between doctor visits for people who were getting regular care.

Large numbers of patients diagnosed with celiac disease in childhood do not seek follow-up care as adults, especially those diagnosed earlier in childhood, who may have fewer ongoing symptoms, Reilly said.Â

She ended her talk by asking "providers caring for children and adolescents with celiac disease [to] educate early as to the importance of ongoing care, emphasize the importance of follow-up and the reasons for follow-up, particularly with patients who lack symptoms and may not seek care otherwise and to provide a referral, and formally transition the patient to adult care to improve compliance."

Reference: Reilly N, et al. Abstract #35. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego.

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In his presentation at Digestive Disease Week 2016, Dr. Abhik Roy, gastroenterologist at New York-Presbyterian University Hospital of Columbia and Cornell, said that his team's recent study "...shows that partner burden is quite common in celiac disease with more than one-third of partners experiencing at least mild to moderate burden."

Partner burden had been previously reported in cases of irritable bowel syndrome and cancer, but had not been assessed in celiac disease, the researchers wrote.

To best measure the level of relationship burden in partners and patients with celiac disease, Roy and his colleagues at Columbia University Medical Center surveyed 94 patients, averaging 52.4 years of age, with biopsy-confirmed celiac disease. They also surveyed the partner of each patient. The patients had been with their current partner about 25 years. Patients were 98% white, 93% were college-educated, 85% married, and 65% had had celiac disease for more than 5 years.

Patients completed the Celiac Symptom Index (CSI) survey, to measure the extent of celiac disease, while their partners competed the Relationship Satisfaction (RS) scale, a measure of relationship quality.

Partners completed the Zarit Burden Interview (ZBI), which measures the level of partner burden, and answered questions about overall "sexual satisfaction."

Afterward, the researchers used the data from both portions of the study to assess the relationship between celiac disease and partner burden. When CSI scores were tallied, sixteen percent of celiac patients reported poor quality of life, with 37% reporting a ZBI score that indicated at least mild or moderate burden from celiac disease. At the same time, twenty-three percent of the partners reported an RS score associated with moderate-to-low relationship satisfaction, while 14% reported moderate-to-low sexual satisfaction.

Overall, the researchers found that ZBI score was associated with CSI score (P = .008) and that ZBI score was inversely associated with RS score (P < .001) as well as sexual satisfaction (P < .001). Basically, the lower the burden, the higher the basic relationship and sexual satisfaction, and vice versa.

Interestingly, partner's RS score (OR = 17.06; 95% CI, 2.88-101.09) and relationships over 10 years (OR = 14.42; 95% CI, 1.69-123.84) were both significantly associated with mild to moderate patient burden.

So, for those who do report being dissatisfied, the longer you're together, the more of an issue it seems to become. Also, half of partners report sometimes experiencing "feeling they should be doing more for the patient" and 44% reported that they sometimes experienced "feeling they could have done a better job for the patient." That shows a level of burden, but also a concern by partners for their loved one.

This study showed similar levels of dissatisfaction to those reported by IBS and cancer patients, the researchers noted. The research implies that patients might be helped by having health care providers address these relationship factors in their care of patients with celiac disease, and the team suggested as much.

One the upside, you could also say that the great majority of celiac patients and partners seem satisfied, and do no feel any burden from celiac disease. I wonder what the baseline scores for these tests are for non-celiac couples?

Read more at Open Original Shared Link.

Past advice was based on observational studies, but two clinical trials published in the past two years have shown that the age at which gluten is introduced to the diet does not affect overall rates of celiac disease during childhood.

In response to those recent studies, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) has already changed its guidance to recommend that infants be introduced to small amounts of gluten sometime between four and 12 months of age. Meanwhile, Sweden's national food agency, Livsmedelsverket, is reviewing recent scientific studies make sure its current advice regarding gluten introduction matches the best current data.

The new research suggested that "it does not matter when during the first four to 12 months food with gluten is introduced," reads a note on the Livsmedelsverket website. "The new research provides important knowledge about what affects the risk of gluten intolerance," said Ylva Sjögren Bolin, the agency's immunologist and nutritionist.

These changes could have an impact on the market for baby food, which has seen sales fall recently as more and more parents follow specialized diets for their infant children. In the last few years, more parents have turned to allergen-free foods for their children, which has created a lucrative market for the products, especially in the gluten-free category.

Exactly how lucrative? About 14% share of the global market was gluten-free in 2014, according to Euromonitor International. Major markets for gluten-free baby food include Russia, Spain and Italy.

Look for that market share to increase, as "more babies and toddlers are used to gluten-free, and mums believe that gluten-free is a better diet for their kids," noted Mintel's Yannick Troalen.

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A newly published study quantifying the cost of gluten-free foods shows a family with two children can pay nearly 20% more for gluten-free food. The costs are even greater for single men on welfare.

The study is the first of its kind to prove "that a gluten-free diet is a significant financial burden for many Australian family types," say University of Wollongong researchers Kelly Lambert and Caitlin Ficken, the study's authors.

The study was supported by the Dieticians Association (DAA) of Australia, and the results appear in its scientific journal Nutrition and Dietetics. For their study, Lambert and Ficken compared gluten-free diet groceries with a standard non-gluten-free shopping basket using data from supermarkets in five varying suburbs in the Illawarra region south of Sydney.

They found that flour actually showed the highest cost differential, with gluten-free flour costing 570 per cent more than plain flour, "so even making things from scratch is exorbitantly more expensive," said Ms Lambert, who is also a dietician at Wollongong Hospital.

The study showed that wholemeal gluten-free bread was nearly five times more expensive than comparable non-gluten-free bread.

In the face of these results, the DAA is calling for gluten-free diets to be subsidized for those with medical need.

What do you think? Is a gluten-free diet for people in medical need something that deserves to be subsidized?

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