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Celiac.com 02/07/2024 - Celiac disease is a systemic disorder triggered by gluten ingestion in genetically susceptible individuals that poses a significant global health challenge. The diversity in its clinical presentation, ranging from digestive issues to entirely asymptomatic cases, complicates timely diagnosis, leading to many cases being undetected or misdiagnosed. A research team including Govind K. Makharia, Prashant Singh, Carlo Catassi, David S. Sanders, Daniel Leffler, Raja Affendi Raja Ali & Julio C. Bai, recently catalogued the opportunities and challenges at the heart of the global burden of celiac disease. Diagnosing celiac disease involves a combination of serological tests checking for disease-related antibodies and examining duodenal biopsy samples for villous abnormalities. However, the variability in histological grading and the inconsistency in the performance of certain serological tests present significant hurdles. Confirmatory tests are also not universally accessible, particularly in some regions of the world. The linchpin of managing celiac disease currently involves a strict, lifelong gluten-free diet. This treatment, while effective, faces various obstacles hindering patient adherence. Issues like the limited availability and high cost of gluten-free products, the risk of cross-contamination, and the diet's overall restrictiveness contribute to these challenges. Ensuring adherence to a gluten-free diet requires routine follow-ups, yet here too, a lack of standardized protocols creates considerable variation. Determining the optimal strategy for managing celiac disease becomes a puzzle with missing pieces. Amid these challenges, however, lie opportunities for groundbreaking research. Addressing the diagnostic inconsistencies, developing universally accessible confirmatory assays, and finding innovative solutions to enhance patient adherence to gluten-free diets are areas ripe for exploration. The global burden of celiac disease extends beyond its immediate health impacts. It underscores the need for a comprehensive and accessible diagnostic framework that considers the diversity in clinical presentations. Moreover, the management strategies call for a nuanced approach that acknowledges the socio-economic factors influencing dietary adherence. In the evolving landscape of celiac disease, where challenges abound, researchers are presented with a chance to reshape the narrative. Through collaborative efforts, advancements in diagnostics, and innovative strategies for patient management, the journey towards effective solutions for celiac disease holds promise. The obstacles faced today become the stepping stones for tomorrow's breakthroughs in understanding, diagnosing, and managing this complex global health concern. Read more in Nature Reviews Gastroenterology & Hepatology

Celiac.com 12/18/2023 - Eating out can be a delightful experience, but for those with celiac disease, it often becomes a delicate dance with uncertainty. The UK-based blog North East Bylines features an insightful piece by Carol Westall, in which she shares letters and phone call exchanges between herself and restaurants during 2023. Four of her encounters shed light on the highs, lows, and nuances of dining out with gluten sensitivity. You can read more at North East Bylines. Newcastle, October 2023: The Unfortunate Slip A meticulous online booking and explicit gluten-free requests set the stage for a promising evening. Yet, despite assurances and a seemingly safe meal, a gluten attack ensued. The subsequent investigation revealed a chef's decision to alter the gluten-free dish in the evening, causing the unfortunate slip. The restaurant offered a generous refund, but the trust was compromised. Trust Verdict: No. The inconsistency in gluten-free offerings raises concerns. Oslo, September 2023: A Genuine Apology Dining in Oslo brought unanticipated gluten exposure due to an oversight with their papadums (usually made with gluten-free flours like lentil or chick pea flour). The restaurant took immediate responsibility, investigated the incident, and, recognizing their error, offered a sincere apology, along with a free meal. The server's apologetic demeanor added a layer of understanding. Trust Verdict: Unlikely. Despite the sincere apology, the risk may not be worth a return. Devon, June 2023: Investigating All Angles A case in Devon prompted a meticulous investigation. The restaurant enlisted external food safety partners, identified potential allergen cross-contact, and implemented corrective measures. Despite a thorough response, the incident raised concerns about the reliability of the gluten-free menu and the need for QR code checking. Trust Verdict: No. The reliance on QR codes for allergen information poses a significant hurdle. Northumberland, March 2023: A Supplier's Oversight A gluten attack linked to dressed crab prompted a swift response from the restaurant. An investigation traced the issue to a supplier's oversight, leading to a suspension of the dish until safety could be guaranteed. The restaurant's commitment to corrective actions demonstrated responsibility. Trust Verdict: Yes. The prompt actions and transparency inspire confidence. Northumberland, January 2023: A Regrettable Oversight A beloved cafe in Northumberland slipped up when a gluten-free order was overlooked, leading to a sandwich made with non-gluten-free bread. The cafe admitted the error, promised retraining, and offered a complimentary meal as an apology. Trust Verdict: Yes, with caution. The cafe's sincerity and corrective actions signal a commitment to improvement. Newcastle, November 10th, 2023: A Topping Mishap In a Newcastle restaurant, an error in topping, not gluten, brought a slight hiccup. The restaurant swiftly acknowledged the mistake and promised extra vegetables to compensate. Trust Verdict: Yes. A minor error unrelated to gluten suggests a reliable understanding of dietary needs. In the intricate dance of dining out with celiac disease, trust is hard-earned. Each encounter underscores the importance of clear communication, rigorous training, and transparent investigations. While some restaurants stumbled, others rose to the occasion, offering hope that, with increased awareness, the dining landscape for those with gluten sensitivity may become more trustworthy in the future. For even more encounters at northeastbylines.co.uk

Celiac.com 01/25/2021 - What's the connection between celiac disease, and cognitive impairment? Does the connection change over time? Does following a gluten-free diet help reduce cognitive impairment? There really hasn't been much good study data on this so far. One of the main problems, according to researchers, previous reports of cognitive deficit in celiac disease often study widely variable groups of patients at multiple stages of the disease, and/or lack control data. To better understand the connection between cognitive impairment and celiac disease duration and gluten-free diet adherence, a team of researchers recently set out to examine groups of newly diagnosed and long-standing celiac disease patients. The research team included Iain D Croall, Claire Tooth, Annalena Venneri, Charlotte Poyser, David S Sanders, Nigel Hoggard and Marios Hadjivassiliou. They are variously affiliated with the Department of Neuroscience, the Department of Infection, Immunity & Cardiovascular Disease, and the Institute for Silico Medicine, at the University of Sheffield in Sheffield, UK; the Department of Psychological Services, Royal Hallamshire Hospital, STH, Sheffield, UK; the South West Yorkshire Partnership NHS Foundation Trust in Wakefield, UK; the Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK; and the Department of Neurology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust in Sheffield, UK. The team recruited 21 healthy control subjects, along with 19 newly diagnosed celiac patients (NCD) and 35 established celiac patients (ECD). Each participant took cognitive tests that established seven baseline domain scores. Patients also responded to SF-36 quality of life (QoL) questionnaires. The team then controlled for age, and compared data in between-group ANCOVAs with Tukey’s post-hoc test. The team then compared significant outcomes in the ECD group between fully gluten-free patients patients who not fully gluten-free diet, as defined by Biagi scores and blood tests. In visual, verbal, and memory tasks, the NCD and ECD groups underperformed relative to controls, by comparable measures. The ECD group only underperformed in visual-constructive tasks. In terms of QoL measures, the NCD patients reported lower vitality, while the ECD patients reported more bodily pain. Comparisons based on dietary adherence were non-significant. The team's findings confirm cognitive deficit in celiac patients, which seems to exist at the time of diagnosis, after which it seems to level off. While it seems that a gluten-free diet may be that cause of the leveling off, more research is needed to establish the degree to which this is true, and to what extent any further decline might result from ongoing gluten exposure. Read the team's paper entitled, Brain fog and non-coeliac gluten sensitivity: Proof of concept brain MRI pilot study, in Nutrients 2020, 12(7), 2028

Celiac.com 07/10/2020 - Gluten-free cookies are easy to prepare and the payoff is huge! But sometimes, baking disasters occur. Expressions such as: that’s the way the cookie crumbles, one tough cookie or cookie monster can, at times, have double meanings for the gluten-free baker. Questions such as: Why does a cookie batch turn out one time and the next time fail? Why do my cookies spread so much? My cookies are dry and hard, what am I doing wrong? What happened? It’s time to put on the oven mitts and baker’s hat and find some cookie cures. First of all, subtle changes in a cookie recipe can bring varied results. Inferior ingredients (or different brands), inaccurate measurements, differences in baking equipment, variations between ovens (inaccurate temperature), oven rack position, baking times and even weather conditions can have an effect on the outcome of gluten-free cookies. To fine-tune your cookie-baking skills and minimize cookie disasters, here are a few suggestions. What to Do If: 1) Cookies Spread Too Much Start with butter at “room temperature” not squishy but malleable (still feeling firm). To determine if butter is at “room temperature”, insert an instant read thermometer in the center of the stick of butter. It should read 65 to 68 degrees F. Use a combination of vegetable shortening and butter. Cookies made with butter have an outstanding taste, but those made with shortening hold their shape better. You can control spread by using a combination of butter and shortening. Diet margarine or whipped spreads are not suitable for baking. These products contain too much water. Reduce the amount of sugar in the dough. Measure accurately: use the “spoon in and level off” method. Use a higher-protein flour mix. The greater the protein value in the flour mix, the more liquid it will absorb. Examples of protein flours include brown rice, sorghum, bean, almond meal and others. Use suggested flour mix given in the recipe since the recipe was developed and tested with that particular flour mixture. Use less liquid in the dough. Use the correct size egg given in the recipe and measure accurately with proper measuring cup. For liquids, use a measuring cup that has a spout. Always drop dough portions on a cool cookie sheet. Use 2-3 identical cookie sheets, while one is baking, another is cooling and the third one is ready to be placed in the oven. For a quick cool-down, place cookie sheet in refrigerator for a few minutes. Bake at correct oven temperature. A too-low temperature may lead to spreading. Preheat oven at least 15 minutes and check oven accuracy by using free-standing oven thermometer. Over-greased cookie sheets. Consider lining cookie sheets with parchment paper. It reduces spread, promotes even baking and reduces cleanup. 2) Cookies Are Dry and Hard Used too much flour/gluten-free oats. Measure accurately. Stir flour in container to aerate; use spoon to fill dry measuring cup and level off with knife. Hard and stale brown sugar. Use fresh, soft, moist brown sugar. Hard and very dry dried fruit. Soak dried fruit in water (or other liquid) to absorb some moisture so it won’t take it from the dough. Drain fruit, pat dry and then stir into dough. Overmixed dough. Stop mixing when dough is just incorporated. Too-hot oven temperature. Keep free-standing oven thermometer in oven to check oven accuracy. Overbaked cookies. Check cookies at the minimal baking time. Bake one “test” cookie to make adjustments for your oven. Cookies continue to bake on the cookie sheet once they are removed from the oven. Oven may be hotter than the temperature the dial reads. Purchase an oven thermometer and keep in oven to ensure accurate temperature. Improperly stored cookies. GF cookies are best when eaten within 2 days or placed in the freezer in airtight containers for extended storage. Cookies Crumble. Forgot to add xanthan gum to dough. Xanthan gum acts as a binder with other ingredients in gluten-free baking. It is a necessary ingredient in most gluten-free baking. Used diet margarine or whipped spreads as the fat. Diet margarines and whipped spreads are full of air and water which makes them unacceptable for baking. Use stick butter (unsalted preferred), shortening or oil. Measure accurately. 3) Cookies Break When Removed From Cookie Sheet Cookies still too warm. Let cookies cool on cookie sheet for specified time given in recipe before transferring them to wire racks to cool completely. For delicate cookies, bake them on parchment paper-lined cookie sheet. When baked, slide the parchment paper off cookie sheet to a wire rack to cool. For the best results Watch your cookies very carefully until you know how a particular recipe bakes in your oven and on your cookie sheets. Be consistent: use the same “brand” ingredients and stick with them, measure the same way, preheat oven for at least 15 minutes and check oven accuracy by keeping thermometer in oven. Bake one or two “test” cookies first so adjustments can be made without ruining the whole batch. Keep cookie dough refrigerated until ready to bake especially if kitchen is hot, humid or dough is soft. Always place dough on cool cookie sheets. If All Else Fails Use cookie disasters for future crumb crusts. Freeze the cookies then put them in a food processor and make cookie crumbs. Store the crumbs in the freezer and use them when you make desserts with crumb crusts. Your cookie disasters may end up as wonderful crust creations! Happy Baking! Triple Chocolate Bliss This recipe is from the cookbook, Gluten-Free Cookies (What No Wheat Enterprises, 2008) by Jeanne Basye, The Gluten-Free Cookie Lady. Ingredients: 2 tablespoons gluten-free flour mix 1/8 teaspoon xanthan gum 1/8 teaspoon baking powder 1/8 teaspoon salt 4 (1 oz.) squares semisweet chocolate, coarsely chopped 2 tablespoons unsalted butter ½ cup granulated sugar ½ teaspoon pure vanilla extract 1 large egg ½ cup coarsely chopped macadamia nuts ¼ cup each semisweet chocolate chips, milk chocolate chips and white chocolate chips Directions: 1. Preheat oven to 350 degrees F. Line cookie sheets with parchment paper. 2. Sift flour, xanthan gum, baking powder and salt in bowl; add nuts and flavored chips; stir. Set aside. 3. Put chocolate squares and butter in large microwave-safe bowl. Microwave, uncovered, on High (100 percent power) in 30 second intervals until melted. Stir after each interval. Cool 5 minutes. Stir in sugar, vanilla and egg. Gradually stir in flour mixture. 4. Measure dough in 1 ½ tablespoon portions; drop 3 inches apart on prepared cookie sheet. 5. Bake 11 to 12 minutes or until tops are glossy and centers are soft. Cool 4 minutes on cookie sheet then transfer to wire rack to cool completely. 6. Store in airtight container up to 2 days or freeze up to one month. Makes 15 (2 ½-inch) cookies

Celiac.com 12/06/2016 - Neurological problems are a very common effect of gluten intolerance. Whether you have celiac disease or gluten sensitivity, there is research showing that gluten can cause nervous system problems in affected individuals. What kind of problems? When it comes to the nervous system, symptoms run the gamut from depression to schizophrenia, from migraines to brain fog, and from seizures to numbness and pain. I want to share more information with you about a particular type of nervous system ailment called peripheral neuropathy. The name basically means damage to the nerves of the extremities (arms and legs) that typically manifests in numbness and pins and needles-type pain that all of us have experienced at one time or another if we sat on our feet too long or fell asleep in a weird position and had a hand ‘go to sleep'. While these latter type incidents are normal, having such symptoms occur when no pressure is being put on the nerve is abnormal. Not only is it uncomfortable to have such sensations, but when truly numb, accidents from tripping or burning oneself can occur due to not having adequate sensation. I think it is interesting to note that the most common occurrence of peripheral neuropathy is seen in type I diabetes, an autoimmune disease. Celiac is also an autoimmune disease and according to the University of Chicago's Center for Peripheral Neuropathy, 10% of those diagnosed with celiac disease have a neurological problem, and peripheral neuropathy is quite common. Taking it a step further, we know that gluten creates a leaky gut and we know that a leaky gut is associated with autoimmune disease, through several wonderful studies brought to us by Dr. Alessio Fasano and his team. Therefore, seeing a connection between gluten and peripheral neuropathy is not unexpected based on research. Further, despite a dearth, or scarcity, of research on gluten sensitivity, doctors currently engaged in such research cite peripheral neuropathy as one of the most common symptoms associated with gluten sensitivity. In fact neurological symptoms are frequently associated with gluten sensitivity before any digestive symptoms ever develop. And in some cases, the nervous system disorders are present with no digestive disturbances. A lack of any digestive symptoms is perhaps one of many reasons why these individuals' gluten sensitivity is missed by their doctors. When it comes to comparing gluten sensitivity to celiac disease, according to Dr Fasano, 30% of the patients he diagnoses with gluten sensitivity suffer a neurological ailment, a much higher percentage than that associated with celiac disease. How Do You Know if You Have Peripheral Neuropathy? The symptoms of peripheral neuropathy are numbness, a feeling of hot/cold or a pins and needles feeling that tends to start at the ends of your body's long nerves, meaning your feet and hands, before moving upwards. The symptoms can be in legs and/or arms, right side and/or left. Certainly, considering that type 1 diabetes is the most common cause of peripheral neuropathy, with an estimated 50% suffering some type of nerve damage, that would be the first thing to rule out. What Should You Do? If you have these symptoms and your doctor has ruled out diabetes and any other obvious sources of the problem (including any drugs you may be taking that create neuropathy as side effects), you may fit into the category of "idiopathic neuropathy". This means that you have the problem but the reason is unknown. Or is it? Let's look at the result of a study where researchers worked with more than 200 individuals with neuropathy, 140 of whom fell within the ‘idiopathic' category. These smart doctors tested those 140 people for antibodies to gluten, specifically utilizing the anti-gliadin antibody test – AGA-IgA and AGA-IgG. This blood test is a general blood test that is not specific to celiac disease or gluten sensitivity, but shows that the body's immune system is reacting negatively to these proteins in gluten called gliadin. Of those tested, 34% were positive to one or both tests, compared to 12% of the general population. Interestingly, a full 9% of those tested in the ‘idiopathic' group actually had celiac disease, compared to 1% of the general population. And perhaps even more interesting, 80% of that same idiopathic group had the genes for celiac disease, either HLA-DQ2 or HLA-DQ8. 80%!! In the normal population that number is about 40%. Our takeaway message is that peripheral neuropathy has a rather high correlation to immune reaction to gluten – be it celiac disease or gluten sensitivity. Therefore anyone you know who suffers with such symptoms absolutely should be checked for gluten intolerance. Regaining one's strength and correcting nervous system abnormalities is well worth the change in diet when gluten is the cause. Such cases have been described in the literature where the only treatment that led to success was a gluten-free diet. So many diseases and symptoms can be prevented and reversed by discovering their true underlying root cause and for many of those ailments it is gluten that is the culprit. Don't continue suffering nor let you friends and family members suffer. Find out why the symptom is there rather than just masking it with a drug. If you need assistance, consider calling us for a free health analysis – call 408-733-0400. Our destination clinic treats patients from across the country and internationally. You don't need to live local to us to receive assistance. We are here to help! To your good health, References: Hadjivassiliou M. et al. Neuropathy associated with gluten sensitivity. Journal of Neurology, Neurosurgery, and Psychiatry. 2006 Nov;77(11):1262-6. Rigamonti A. et al. Celiac disease presenting with motor neuropathy: effect of gluten-free diet. Muscle & Nerve. 2007 May;35(5):675-7. University of Chicago Center for Peripheral Neuropathy. Types of Peripheral Neuropathy - Inflammatory - Celiac Disease.

Celiac.com 01/17/2011 - Women with latent celiac disease, those who test positive for celiac antibodies but show normal small bowel biopsies, may develop more reproductive problems, according to a report by Indian published in the World Journal of Gastroenterology. "Women having unexplained infertility, recurrent abortions, stillbirths or intrauterine growth retardation could have subclinical celiac disease, which can be detected by serological screening tests," Dr. Ashok Kumar told Reuters Health by email. Improved diagnostic tools, and greater access to screening have led to greater meant more latent or subclinical celiac disease, says Dr. Kumar, of Maulana Azad Medical College & Lok Nayak Hospital in New Delhi. Doctors know that women with full, biopsy-proven, untreated celiac disease have more reproductive problems if they don't follow a gluten-free diet. Until now, there have been "very few studies regarding the effect of latent celiac disease on reproductive performance; the association has never before been investigated in India," say the authors. To study the effect of latent celiac disease on reproductive performance, the researchers examined 893 women. They found that a total of 104 women had undergone idiopathic recurrent abortion, 104 had unexplained stillbirth, 230 had unexplained infertility, and 150 were pregnant, but showed idiopathic intrauterine growth restriction. The remaining 305 women, with normal obstetric histories, and served as control subjects. Based on IgA tTG antibody titers, latent celiac disease was 5.43 times more common in the group with recurrent spontaneous abortion than in the control group. Rates of latent celiac disease for the group with stillbirth were 4.61 times greater than the control group. Rates for the group with intrauterine growth restriction were 7.75 times greater than control subjects, while rates for those with unexplained infertility were 4.51 higher. The researchers also found that women with positive blood screens showed higher rates of previous early births, low-weight births, and cesarean sections than did seronegative subjects. Not every study shows a clear reduction in fertility, the researchers admit, but a number do show a higher risk of adverse pregnancy outcomes for women with latent celiac disease. Spotting the celiac disease and treating it with a gluten free diet may reduce these associated risks. Moreover, the researchers note that "the classic presentation of diarrhea and malabsorption is now less common, and atypical and silent presentations are increasing." As a result of their findings, Dr. Kumar and his colleagues are recommending celiac disease blood screens for women with idiopathic cases of poor reproductive performance. Source: World J Gastroenterol. 2010 Dec 14;16(46):5810-4