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      Frequently Asked Questions About Celiac Disease   04/07/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes
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Kelly&Mom

Which French Fries Can We Have?

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My daughter was diagnosed in Sept. and me in February. She's 14 and of course loves fast food but we're still figuring out what we can have and can't have. We knew we could have In n' Out fries because they don't fry anything else and used to eat Del Tacos but now they are serving chicken fingers..... Rats! I've seen some debate on whether McDonald's fries are OK. Any answers?

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Burger King should be using a dedicated fryer. Double-check at the particular restaurant you visit.

McDonald's does declare a wheat ingredient in the seasoning used in a processing step to make their fries. The finished fries have been independently tested and do not contain enough residual gluten to show up on an ELISA assay. That means they shouldn't cause damage, but not everyone can tolerate them without any GI symptoms. (They're probably safer than Amy's pizza! :P)

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Five Guys is supposed to be good. They only fry fries. They keep the buns away from the grill according to my son.

Chick fill a says their waffle fries are.

I like to get Ore-Ida frozen fries. The plain crinkle ones come out good if you cook them a little longer. They probably have less fat by baking them then a fast food place.

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We actually had a Mcdonalds employee tell us not to get the fries as the oil is absolutely cross contaminated . If asked The manager is required to say the FF are gluten free and they take great care in cleanliness, but cannot guarantee with 100% certainty the CC will not occur.

I have heard Red Robin is very clean, considerate and have a designated gluten-free cooking area. We stick with Ore-Ida to be safe. But we indulge in the Outback for meals (never ever had a problem there).

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... but cannot guarantee with 100% certainty the CC will not occur.

Nobody can honestly guarantee that, and anyone who claims to is at best mistaken and at worst lying.

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LOVE me some Chik-fil-A fries!! There are none where we live, so when I see one in our travels... I always have to stop!!

I don't eat them anywhere else tho. I've heard that McD's are gluten-free and have enjoyed them twice w/o problems in the past, but I don't trust 'em at all!

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Nobody can honestly guarantee that, and anyone who claims to is at best mistaken and at worst lying.

I believe YOU misread the statement .

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My point is that, no matter how hard an establishment tries, they can never guarantee 100% against cross-contamination. Nobody can, because there are too many possible sources. Anyone who makes such a claim is either misinformed or lying outright.

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We'll do ChicFilet fries from time to time and In N Out when we travel to states w/ an In N Out. We avoid BK, Wendy's, and McD's fries. Even with dedicated fryers, I've seen chicken nuggets and onion rings sneak into the friers an I don't trust McD's as far as I can throw them.

For sit down meals, we go to Red Robin for fries (ask for no seasoning).

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I've just about given up on fast food fries being safe. I've gotten sick from Chick-fil-a and McDonalds. The best I have found is Cheeseburger in Paradise, but I got sick once out of the two times I ate there. No way to tell if it was the fries or not. SO it's a 50-50 gamble to me. I like to make oven fries at home. It's really simple to do, just time consuming.

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The McD's controversy is pretty well documented. My son eats them regularly with no problem (and his tTg is tested once a year). Red Robin's are independantly owned so you'd need to ask. (We were once asked to leave a Red Robin in Harrisburg PA; the manager didn't want us to "risk illness" by even being inside). BK is notorious for their poorly run deep fryers (how many people get a "free" onion ring or chicken nugget in their fries?) Some Wendy's are dedicated fryers, but most are not. Outback fries are not gluten-free, neither are Ruby Tuesday's or EatNPark.

No restaurant will guarantee food is free of CC. They are opening themselves to a lawsuit if they do --- you just have to ask, and fries are high on the list of hard-to-find

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My son can't eat McD's fries. We only eat In& Out fries. Otherwise we make them at home. Like someone else said...fries are difficult to find without CC issues. I can say that we recently went to Disneyland and there are quite a few of the places in the park that have a specially dedicated fries fryer specifically for gluten-free guests.

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Just check the McD's website if you really want to know the officially published ingredients.

French Fry ingredients currently listed on the McDonald's website:

Ingredients (Allergen statement in ALL CAPS.)

Potatoes, vegetable oil (canola oil, hydrogenated soybean oil, natural beef flavor [wheat and milk derivatives]*, citric acid [preservative]), dextrose, sodium acid pyrophosphate (maintain color), salt. Prepared in vegetable oil (Canola oil, corn oil, soybean oil, hydrogenated soybean oil with TBHQ and citric acid added to preserve freshness). Dimethylpolysiloxane added as an antifoaming agent.

CONTAINS: WHEAT AND MILK *(Natural beef flavor contains hydrolyzed wheat and hydrolyzed milk as starting ingredients).

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I must be lucky. Fries at the BK near work have not made me sick. It's actually one of the "safer" foods when I don't bring lunch.

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BK fries make me sick within hours of eating them every time. However, I seem to do just fine with the McD's fries.

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There's only Red Robin here that I trust. I know it's a gamble every time you eat out, but-knock on wood-the kids have never gotten sick there from anything. Also, wherever we go, we ALWAYS make sure it is NOT peak meal times. Definitely more dangerous!

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My daughter was diagnosed in Sept. and me in February. She's 14 and of course loves fast food but we're still figuring out what we can have and can't have. We knew we could have In n' Out fries because they don't fry anything else and used to eat Del Tacos but now they are serving chicken fingers..... Rats! I've seen some debate on whether McDonald's fries are OK. Any answers?

McDonald's french fries are not only cross-contaminted but they also contain wheat in the basic ingredients list.

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McDonald's french fries are not only cross-contaminted but they also contain wheat in the basic ingredients list.

Much discussion has taken place over the last four years. McDonalds fries have been independently tested and found to contain no detectable gluten using the most sensitive ELISA test available. Cross-contamination is on a case-by-case basis and cannot accurately be generalized.

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Much discussion has taken place over the last four years. McDonalds fries have been independently tested and found to contain no detectable gluten using the most sensitive ELISA test available. Cross-contamination is on a case-by-case basis and cannot accurately be generalized.

Given the declared ingredients, and the statements on their website regarding allergies and even the link to a Celiac organization's website, I don't care what any tests might suggest. Is the ELISA test so reliable that it can be depended upon so much?

I have reacted to numerous products which state gluten-free right on the label, and aren't supposed to contain any gluten, wheat, etc, etc. So I could care less what any test says. My immune system knows better.

And for those who don't get sick, I just hope that there isn't any reaction going on undetected. After all, not feeling or noticing the effects is common enough to be a concern.

I just did a quick search for documentation about the ELISA test, and it turns out that it DOES NOT TEST FOR THE PRESENCE OF GLUTEN. It is apparently supposed to detect immune response of a blood sample to a given allergen. That means if you test with blood from someone who isn't sensitive to a given substance, the result will be negative! According to this article, ELISA testing is plagued with various problems.

As far as I can tell, trusting such a test is like trusting a room full of people eating the fries, saying they don't feel sick. It has nothing to do with actually measuring the presence or absence of a substance within the food, but rather the reaction of a blood sample to a food sample. Read the article and decide for yourself.

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Given the declared ingredients, and the statements on their website regarding allergies and even the link to a Celiac organization's website, I don't care what any tests might suggest. Is the ELISA test so reliable that it can be depended upon so much?

I have reacted to numerous products which state gluten-free right on the label, and aren't supposed to contain any gluten, wheat, etc, etc. So I could care less what any test says. My immune system knows better.

And for those who don't get sick, I just hope that there isn't any reaction going on undetected. After all, not feeling or noticing the effects is common enough to be a concern.

I just did a quick search for documentation about the ELISA test, and it turns out that it DOES NOT TEST FOR THE PRESENCE OF GLUTEN. It is apparently supposed to detect immune response of a blood sample to a given allergen. That means if you test with blood from someone who isn't sensitive to a given substance, the result will be negative! According to this article, ELISA testing is plagued with various problems.

As far as I can tell, trusting such a test is like trusting a room full of people eating the fries, saying they don't feel sick. It has nothing to do with actually measuring the presence or absence of a substance within the food, but rather the reaction of a blood sample to a food sample. Read the article and decide for yourself.

There are two types of ELISA tests. The one you have mentioned is the clinical test for antibodies against ingested or environmental proteins. That is not the test used by food manufacturers to determine gluten levels in foods. There are indeed tests that directly measure gluten levels in foods and these are the ones that people refer to when they are discussing foods that have been determined to be gluten-free by ELISA.

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Topic: Five Guys only fries potatoes in their fryer. I ate there (bunless cheeseburger and fries) and had no problems other than a temporary bout of indigestion from the grease and soda.

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The McDonald's fry issue has been hashed and rehashed. Foods that are below the 3 ppm ELISA detection limit have been shown to be safe for celiacs in terms of not causing serum markers or villous damage by multiple studies. This includes things like <20 ppm wheat starch (NOT 200 ppm codex stuff), "gluten-free" products like Amy's pizza, and McDonald's fries. Not all celiacs will be able to TOLERATE them though, as the threshold for uncomfortable symptoms in some folks seems to be lower than the threshold for damage. If you only tolerate naturally gluten-free foods, you would avoid the McDonald's fries. Remember that some people are so sensitive they even react to distilled vinegars or whisky, even though most celiacs eat them fine.

This does NOT address CC in the fryers. All bets are off if breaded foods are put into the french fry fryer. Back when I worked at McDonalds doing that was grounds for disciplinary action, as the fryers were at different temperatures and it would have ruined the food. I never saw anything other than hash browns and fries at the french fry station.

@RiceGuy ELISA stands for "Enzyme Linked ImmunoSorbent Assay". There are a number of different ELISA formats (direct, sandwich, competitive) and the assay is used widely to measure all sorts of proteins, small molecules and antibodies. That article you linked is trying to address the current consumer scam of mail order IgG4 "food allergy" ELISAs. People send off hundreds of dollars and a blood sample and get back a bunch of difficult-to-interpret information that is often misrepresented as an absolute result. (People reading that article would do well to keep the Enterolab fecal antibody tests in mind...)

This wikipedia article explains ELISA assays pretty well and might help you understand the difference between serum antibody assays and gluten ELISAs. Gluten is usually measured with a sandwich ELISA or competitive ELISA.

http://en.wikipedia.org/wiki/ELISA

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There are two types of ELISA tests. The one you have mentioned is the clinical test for antibodies against ingested or environmental proteins. That is not the test used by food manufacturers to determine gluten levels in foods. There are indeed tests that directly measure gluten levels in foods and these are the ones that people refer to when they are discussing foods that have been determined to be gluten-free by ELISA.

I've searched, and every single ELISA test I found, including both the industrial and home test kits for food testing, rely upon antibodies. Please post a link to an ELISA test which doesn't use antibodies.

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I've searched, and every single ELISA test I found, including both the industrial and home test kits for food testing, rely upon antibodies. Please post a link to an ELISA test which doesn't use antibodies.

Perhaps I misunderstood your post. When you wrote:

I just did a quick search for documentation about the ELISA test, and it turns out that it DOES NOT TEST FOR THE PRESENCE OF GLUTEN. It is apparently supposed to detect immune response of a blood sample to a given allergen. That means if you test with blood from someone who isn't sensitive to a given substance, the result will be negative!

I though you were confused as to how an ELISA could test for a protein like gluten, rather than testing for the presence or absence of antibodies in someone's blood. The Wikipedia I article I linked above explains how the various ELISAs work in great detail. Antibodies used in an ELISA where you are testing for a hapten like gliadin are laboratory-produced monoclonal antibodies. They are very different from serum polyclonal antibodies and are extremely sensitive and specfic.

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I've searched, and every single ELISA test I found, including both the industrial and home test kits for food testing, rely upon antibodies. Please post a link to an ELISA test which doesn't use antibodies.

Yes, they do all use antibodies. They don't all measure antibodies. ELISAs use specific antibodies to measure levels of any protein, including gluten or other antibodies. Here's a brief explanation:

Gluten in food is probably measured using a standard quantitative sandwich ELISA (I say probably because I don't know for sure). In this assay, an antibody specific for gluten (or whatever is the protein of interest) is coated on test plates in a known quantity. Then the test food dissolved in buffer is applied to the plates in a known amount. After an incubation (in my lab, we let our ELISAs incubate from three hours to overnight), the excess sample is washed off and a second antibody that binds to a different part of the gluten molecule is applied. This second antibody has a reporter molecule attached to it. After that binds, the excess is washed off and a chemical that will react with the reporter molecule is added. In our lab, we use a colorimetric reagent- the more color change we see, the more second antibody is bound and thus the more target protein was in our original sample. We read these using plate readers that measure light absorbance at specific wavelengths. These assays are nice because you can set up extra plate wells and add known quantities of your target protein, so then you can compare your sample wells to your known wells and extrapolate how much target protein is in the sample wells. These assays are highly sensitive and are limited only by the lower detection limit of the plate reader (and user error, but that's why there is value in repeating the same sample several times).

The ELISAs used in the clinic to measure, say, TTG are a little different. I'm guessing (again, I don't know for sure as I'm a research immunologist and not a clinician) that in these assays, a known quantity of TTG is bound to the test plate. Then patient serum is added. Any TTG-specific antibodies in that patient's serum will bind to the TTG on the plate. The excess serum is washed off, and then a reporter antibody (like the one described above) can be added. The reporter antibody can be specific for the Fc or tail region of human antibody and will depend on what the clinic wishes to test- there are antibodies against human IgG, IgA, and IgE. The rest of it proceeds as described above. I don't know how the labs quantitate this, or what control samples are used, as I don't run these in my lab.

Hope this helped.

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

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

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

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

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

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