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    Jefferson Adams
    Celiac Disease Research Could Lead to Diabetes Vaccine
    Celiac.com 10/19/2018 - Work to develop a vaccine for celiac disease could soon lead to a vaccine for diabetes.
    After successful phase 1 studies of Nexvax2, their peptide-based therapeutic vaccine for celiac disease, ImmusanT has seen a significant investment from venture philanthropy organization JDRF T1D. ImmusanT's peptide therapy program for celiac disease may provide lessons for a similar therapeutic treatment for Type 1 diabetes.
    The investment will support ImmusanT as it attempts to develop a vaccine to prevent Type 1 diabetes, based on the early success of its peptide immunotherapy program for celiac disease, the two entities announced in a press release.
    ImmusanT’s celiac peptide therapy program works by identifying antigens that trigger an inflammatory responses in people with autoimmune diseases. Once identified, the peptide therapy is used to neutralize the autoimmune response. This celiac disease program goes back to 1998, when Anderson first began his efforts to find and identify the peptides. 
    The findings were published in 2010, and the company was founded shortly afterward by Leslie Williams, BS, RN, MBA, director, president and CEO of ImmusanT. 
    From there, ImmusanT conducted five phase 1 trials for its celiac therapy. Those trials have proven very promising, and the latest investment into a similar drug for diabetes is proof of that promise. In the case of celiac disease, the drug works by “targeting T cells in patients. Those T cells that are engaged as peptides are distributed throughout the body after the injection, and we see evidence that the T cells are being activated about 2 hours later,” Robert Anderson, BMedSc, MB, ChB, PhD, FRACP, chief scientific officer for ImmusanT, told Endocrine Today. “We found that if we gradually increase the dose in patients building up to a maintenance dose level, they become non-reactive to those peptides.”
    With much of the early research targeted towards demonstrating the drug’s safety, and getting the right dose and dose regimen, the development of a version targeted at diabetes, says Anderson, “should be more streamlined due to the lessons learned during the celiac disease program.
    That’s partly because the team knows “a lot more going into Type 1 diabetes about how peptide therapy works and how to optimize it than we did when we started celiac disease, where it was a blank slate.”
    This is really exciting news. A vaccine for celiac disease is exciting, to be sure, but a viable vaccine for diabetes would be a major development in disease prevention. Stay tuned for more news as the story develops. 
    Read more at Healio.com

    Jefferson Adams
    Human Leukocyte Antigen DQ2/DQ8 More Common in Women with History of Stillbirth
    Celiac.com 10/18/2018 - A team of researchers recently set out to investigate the prevalence of human leukocyte antigens (HLA) DQ2 and DQ8 haplotypes, two common polymorphisms associate with celiac disease, in women who have had previous stillbirth, but who do not have celiac disease.
    The research team included Mauro Cozzolino, Caterina Serena, Antonino Salvatore Calabró, Elena Savi Marianna, Pina Rambaldi, Serena Simeone, and Serena Ottanelli, Giorgio Mello, Giovanni Rombolá, Gianmarco Troiano, Nicola Nante, Silvia Vannuccini, Federico Mecacci, and Felice Petraglia. They are variously affiliated with the Division of Obstetrics and Gynecology, and the Department of Experimental and Clinical Biomedical Sciences, Gastroenterology Unit, at Careggi University Hospital, University of Florence in Florence, Italy.
    For their study, the team enrolled 56 women with history of unexplained term stillbirth referred to our Center for High‐Risk Pregnancies for a preconception counseling. As a control group, they enrolled 379 women with previous uncomplicated pregnancies. They excluded women with celiac women from the study. 
    The team then conducted genetic tests for HLA DQ2/DQ8 on both groups, and compared patients data against controls. They found that 50% of women with history of unexplained term stillbirth tested positive for HLA‐DQ2 or DQ8, compared with just 29.5% for controls. Women with HLA DQ8 genotype showed a substantially higher risk of stillbirth (OR: 2.84 CI: 1.1840‐6.817).
    For patients with the DQ2 genotype, the OR for stillbirth was even higher, at 4.46 with a CI of 2.408‐8.270. In the stillbirth group, the team found that SGA neonates in 85.7% those with HLA‐DQ2/DQ8 haplotypes, and in just 42.8% with negative genetic testing.
    The team found significantly higher rates of HLA DQ2/DQ8 haplotypes in women with history of unexplained term stillbirth than in women with previous uneventful pregnancies.  Moreover, they found that HLA DQ2/DQ8 positivity was significantly associated with suboptimal fetal growth in intrauterine fetal death cases, as shown by an increased prevalence of SGA babies.
    This study will definitely be of interest to women with HLA DQ2/DQ8 haplotypes, and to those who have experienced unexplained stillbirths. Stay tuned for more information on this important topic as news becomes available.
    Read more at: American Journal of Reproductive Immunology

    Jean Duane
    Surmounting Social Situations: Sabotage and Scrutiny Surrounding the Gluten-Free Diet
    Celiac.com 10/17/2018 - In the interviews I conducted last year, the Celiac.com viewers shared with me some disturbing stories about how others either sabotaged their gluten-free diet or how their gluten-free requirements are continually scrutinized and doubted. Here are a few examples:
    A co-worker at my office ate a gluten-containing burrito and thought it would be funny to cross-contaminate my work space.  With his gluten-coated hands, he touched my phone, desk, pencils, pens, etc. while I was not at my desk.  I came back and was contaminated.  I had to take several days off of work from being so sick. The waiter at a restaurant where I was eating dinner asked me if I was really “a celiac” or if I was avoiding gluten as a “fad dieter.” He told me the food was gluten-free when he served it, only to come up to me after I ate the dinner and admit there was “a little” gluten in it. My cleaning people were eating Lorna Doones (gluten-containing cookies) while cleaning my gluten-free kitchen, cross-contaminating literally everything in it. When I noticed I exclaimed, “I am allergic to gluten, please put your cookies in this plastic bag and wash your hands.”  They chided, “You have insulted our food.  We are hungry and we will eat anything we want to, when we want to.” At a family dinner, Aunt Suzie insisted that I try her special holiday fruit bread. In front of everyone around the table, she brushed off my protests and insisted that I over exaggerated my food sensitivities saying, “a little bit wouldn’t hurt you.”   These are but a few of an exhaustive list of situations that we regularly contend with. What can possibly be the rationale for any of this conduct?  I’m providing some recent headlines that may impact the attitudes of those we interact with and would like to hear what you think influence this behavior (see questions below). 
    Recently, the New York Times published an article entitled, “The Myth of Big, Bad Gluten.”  The title alone casts doubt on the severity of gluten exposure for those with CD (Myth, 2015)   In his political campaign, Senator Ted Cruz stated that if elected President, he would not provide gluten-free meals to the military, in order to direct spending toward combat fortification (Wellness, 2/18/16).  Business Insider.com called Tom Brady’s gluten, dairy free diet “insane” (Brady, 2017). Michael Pollen is quoted as saying that the gluten-free diet was “social contagion.” Further, he says, “There are a lot of people that hear from their friends, ‘I got off gluten and I sleep better, the sex is better, and I’m happier,’ and then they try it and they feel better too.  [It’s] the power of suggestion” (Pollan, 2014). Jimmy Kimmel said, “Some people can’t eat gluten for medical reasons… that I get. It annoys me, but that I get,” and proceeded to interview people following a gluten-free diet, asking them “what is gluten.” Most interviewed did not know what gluten is. (ABC News, 2018). Do headlines like this enable others to malign those of us making our dietary needs known?  Do these esteemed people talking about gluten cast doubt on what we need to survive? 
    Humans are highly influenced by others when it comes to social eating behavior. Higgs (2015) asserts that people follow “eating norms” (p. 39) in order to be liked. Roth, et al. (2000) found that people consumed similar amounts of food when eating together.  Batista and Lima (2013) discovered that people consumed more nutritious food when eating with strangers than when eating with familiar associates. These studies indicate that we are hypersensitive of what others think about what we eat. One can surmise that celebrity quips could also influence food-related behaviors. 
    Part of solving a social problem is identifying the root cause of it, so please weigh in by answering the following questions:  
    How do you handle scrutiny or sabotage of others toward your dietary requirements? Please speculate on what cultural, religious or media influences you suppose contribute to a rationalization for the sabotage and/or scrutiny from others when we state we are observing a gluten-free diet? Are people emulating something they heard in church, seen on TV, or read online?    We welcome your answers below.
    References:
    ABC. (2018). Retrived from https://abcnews.go.com/Health/video/jimmy-kimmel-asks-what-is-gluten-23655461  Batista, M. T., Lima. M. L. (2013). Who’s eating what with me? Indirect social influence on ambivalent food consumption. Psicologia: Reflexano e Critica, 26(1), 113-121.  Brady. (2017). Retrieved from https://www.businessinsider.com/tom-brady-gisele-bundchen-have-an-insane-diet-2017-2  Higgs, S. (2015). Social norms and their influence on eating behaviors. Appetite 86, 38-44. Myth. (2015). Retrieved from https://www.nytimes.com/2015/07/05/opinion/sunday/the-myth-of-big-bad-gluten.html  Pollan, M. (2014). Retrieved from https://www.huffingtonpost.com/2014/05/14/michael-pollan-gluten-free_n_5319357.html  Roth, D. A., Herman, C. P., Polivy, J., & Pliner, P. (2000). Self-presentational conflict in social eating situations: A normative perspective. Appetite, 26, 165-171. Wellness. (2016). Retrieved from  https://www.huffingtonpost.com/entry/ted-cruz-gluten-free-military-political-corectness_us_56c606c3e4b08ffac127f09f

    Jefferson Adams
    Woman Calls Radio Show to Admit Lying About Gluten-Free Baked Goods
    Celiac.com 10/16/2018 - Apparently, local St. Louis radio station Z1077 hosts a show called “Dirty Little Secret.” Recently, a woman caller to the show drew ire from listeners after she claimed that she worked at a local bakery, and that she routinely lied to customers about the gluten-free status of baked goods.
    The woman said she often told customers that there was no gluten in baked goods that were not gluten-free, according to local tv station KTVI.
    Apparently the woman thought this was funny. However, for people who cannot eat gluten because they have celiac disease, telling people that food is gluten-free when it is not is about as funny as telling a diabetic that food is sugar-free when it is not. Now, of course, eating gluten is not as immediately dangerous for most celiacs as sugar is for diabetics, but the basic analogy holds.
    That’s because many people with celiac disease suffer horrible symptoms when they accidentally eat gluten, including extreme intestinal pain, bloating, diarrhea, and other problems. Some people experience more extreme reactions that leave them in emergency rooms.
    As part of a story on the “joke” segment, KTVI interviewed celiac sufferer Dana Smith, who found the punchline to be less than funny. “It’s absolutely dangerous, somebody could get very sick,” said Smith. 
    KTVI also interviewed at least one doctor, Dr. Reuben Aymerich of SSM St. Clare Hospital, who pointed out that, while celiac disease is “not like diabetes where you can reduce the amount of sugar intake and make up for it later, it’s thought you need to be 100 percent compliant if you can.”
    For her part, Smith sought to use the incident as a teaching moment. She alerted the folks at Z1077 and tried to point out how serious being gluten-free is for many people. Mary Michaels, owner of Gluten Free at Last Bakery in Maryville, Illinois, says it’s time people became more respectful.
    “I wouldn’t make fun of you if you had diabetes or a heart condition it’s kind of like that,” Michals said.
    We will likely never know if the radio station caller was telling the truth, or just putting listeners on. The Z1077 morning team did post a follow-up comment, which stated that they take celiac disease seriously, and that they did not intend to offend anyone. One host said his mom has celiac disease.
    It’s good to see a positive response from the radio station. Their prank was short-sighted, and the caller deserved to be called out on her poor behavior. Hopefully, they have learned their lesson and will avoid such foolishness in the future. Let us know your thoughts below.

    Jefferson Adams
    New Study Says One in Three 'Gluten-Free' Restaurant Foods Contain Gluten
    Celiac.com 10/15/2018 - If you’re on a gluten-free diet for medical reasons, then you’re probably already cautious about eating out. A new study tells us exactly why people with celiac disease and other gluten-sensitive conditions have reason to be very careful about eating out.
    According to the latest research, one in three foods sold as "gluten-free" in U.S. restaurants actually contain trace levels of gluten.
    This is partly due to the fact that the gluten-free diet has become popular with many non-celiacs and others who have no medical need for the diet. That has led many restaurants to offer gluten-free foods to their customers, says study author Dr. Benjamin Lebwohl, of Columbia University's Celiac Disease Center. 
    But, if this research is any indication, too many restaurants don’t do a good job with gluten-free. For the study, more than 800 investigators set out to assess the true gluten content of dishes listed as "gluten-free" on menus. Armed with portable gluten sensors, they tested for gluten levels that met or exceeded 20 parts per million, the standard cutoff for any gluten-free claim.
    Based on more than 5,600 gluten tests over 18 months, the investigators determined that 27 percent of gluten-free breakfast meals actually contained gluten. At dinner time, this figure hit 34 percent. The rise could reflect a steady increase in gluten contamination risk as the day unfolds, the researchers said.
    Off course, the risk is not all equal. Some restaurants are riskier than others. Unsurprisingly, the biggest culprit seems to be restaurants that offer gluten-free pastas and pizzas. Nearly half of the pizza and pasta dishes from those establishments contained gluten, according to the study.
    Why is that? Well, as most folks with celiac disease know all too well,  kitchens aren’t really set up to segregate gluten, and "sharing an oven with gluten-containing pizza is a prime setting for cross-contamination," says Lebwohl. Also, too many restaurants use the same water to cook gluten-free pasta as they do for regular pasta, which contaminates the gluten-free pasta and defeats the purpose.
    Moreover, although the U.S. Food and Drug Administration regulates gluten-free labels on packaged food products, there is currently no federal oversight of gluten-free claims in restaurants. 
    The results of the study will be presented today at a meeting of the American College of Gastroenterology, in Philadelphia. Research presented at meetings is usually considered preliminary until published in a peer-reviewed medical journal.
    In the absence of federal enforcement at the restaurant level, the burden for making sure food is gluten-free falls to the person doing the ordering. So, gluten-free eaters beware!
    These results are probably not surprising to many of you. Do you have celiac disease? Do you eat in restaurants? Do you avoid restaurants? Do you have special tactics?  Feel free to share your thoughts below.
    Read more at UPI.com

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