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    Scott Adams
    WHAT IS CELIAC DISEASE?
    Celiac disease is an autoimmune condition that affects around 1.4% of the population (91.2 million people worldwide, and 3.9 million in the U.S.A.). People with celiac disease suffer an autoimmune reaction when they consume wheat, rye or barley. The immune reaction is triggered by certain proteins in the wheat, rye, or barley, and, left untreated, causes damage to the small, finger-like structures, called villi, that line the gut. The damage occurs as shortening and villous flattening in the lamina propria and crypt regions of the intestines. The damage to these villi then leads to numerous other issues that commonly plague people with untreated celiac disease, including poor nutritional uptake, fatigue, and myriad other problems.
    Celiac disease mostly affects people of Northern European descent, but recent studies show that it also affects large numbers of people in Italy, China, Iran, India, and numerous other places thought to have few or no cases.
    Celiac disease is most often uncovered because people experience symptoms that lead them to get tests for antibodies to gluten. If these tests are positive, then the people usually get biopsy confirmation of their celiac disease. Once they adopt a gluten-free diet, they usually see gut healing, and major improvements in their symptoms. 
    CLASSIC CELIAC DISEASE SYMPTOMS
    Symptoms of celiac disease can range from the classic features, such as diarrhea, upset stomach, bloating, gas, weight loss, and malnutrition, among others.
    LESS OBVIOUS SYMPTOMS
    Celiac disease can often less obvious symptoms, such fatigue, vitamin and nutrient deficiencies, anemia, to name a few. Often, these symptoms are regarded as less obvious because they are not gastrointestinal in nature. You got that right, it is not uncommon for people with celiac disease to have few or no gastrointestinal symptoms. That makes spotting and connecting these seemingly unrelated and unclear celiac symptoms so important.
    NO SYMPTOMS
    Currently, most people diagnosed with celiac disease do not show symptoms, but are diagnosed on the basis of referral for elevated risk factors. 

    CELIAC DISEASE VS. GLUTEN INTOLERANCE
    Gluten intolerance is a generic term for people who have some sort of sensitivity to gluten. These people may or may not have celiac disease. Researchers generally agree that there is a condition called non-celiac gluten sensitivity. That term has largely replaced the term gluten-intolerance. What’s the difference between celiac disease and non-celiac gluten-sensitivity? 
    CELIAC DISEASE VS. NON-CELIAC GLUTEN SENSITIVITY (NCGS)
    Gluten triggers symptoms and immune reactions in people with celiac disease. Gluten can also trigger symptoms in some people with NCGS, but the similarities largely end there.

    There are four main differences between celiac disease and non-celiac gluten sensitivity:
    No Hereditary Link in NCGS
    Researchers know for certain that genetic heredity plays a major role in celiac disease. If a first-degree relative has celiac disease, then you have a statistically higher risk of carrying genetic markers DQ2 and/or DQ8, and of developing celiac disease yourself. NCGS is not known to be hereditary. Some research has shown certain genetic associations, such as some NCGS patients, but there is no proof that NCGS is hereditary. No Connection with Celiac-related Disorders
    Unlike celiac disease, NCGS is so far not associated with malabsorption, nutritional deficiencies, or a higher risk of autoimmune disorders or intestinal malignancies. No Immunological or Serological Markers
    People with celiac disease nearly always test positive for antibodies to gluten proteins. Researchers have, as yet, identified no such antobodies or serologic markers for NCGS. That means that, unlike with celiac disease, there are no telltale screening tests that can point to NCGS. Absence of Celiac Disease or Wheat Allergy
    Doctors diagnose NCGS only by excluding both celiac disease, an IgE-mediated allergy to wheat, and by the noting ongoing adverse symptoms associated with gluten consumption. WHAT ABOUT IRRITABLE BOWEL SYNDROME (IBS) AND IRRITABLE BOWEL DISEASE (IBD)?
    IBS and IBD are usually diagnosed in part by ruling out celiac disease. Many patients with irritable bowel syndrome are sensitive to gluten. Many experience celiac disease-like symptoms in reaction to wheat. However, patients with IBS generally show no gut damage, and do not test positive for antibodies to gliadin and other proteins as do people with celiac disease. Some IBS patients also suffer from NCGS.

    To add more confusion, many cases of IBS are, in fact, celiac disease in disguise.

    That said, people with IBS generally react to more than just wheat. People with NCGS generally react to wheat and not to other things, but that’s not always the case. Doctors generally try to rule out celiac disease before making a diagnosis of IBS or NCGS. 
    Crohn’s Disease and celiac disease share many common symptoms, though causes are different.  In Crohn’s disease, the immune system can cause disruption anywhere along the gastrointestinal tract, and a diagnosis of Crohn’s disease typically requires more diagnostic testing than does a celiac diagnosis.  
    Crohn’s treatment consists of changes to diet and possible surgery.  Up to 10% of Crohn's patients can have both of conditions, which suggests a genetic connection, and researchers continue to examine that connection.
    Is There a Connection Between Celiac Disease, Non-Celiac Gluten Sensitivity and Irritable Bowel Syndrome? Large Number of Irritable Bowel Syndrome Patients Sensitive To Gluten Some IBD Patients also Suffer from Non-Celiac Gluten Sensitivity Many Cases of IBS and Fibromyalgia Actually Celiac Disease in Disguise CELIAC DISEASE DIAGNOSIS
    Diagnosis of celiac disease can be difficult. 

    Perhaps because celiac disease presents clinically in such a variety of ways, proper diagnosis often takes years. A positive serological test for antibodies against tissue transglutaminase is considered a very strong diagnostic indicator, and a duodenal biopsy revealing villous atrophy is still considered by many to be the diagnostic gold standard. 
    But this idea is being questioned; some think the biopsy is unnecessary in the face of clear serological tests and obvious symptoms. Also, researchers are developing accurate and reliable ways to test for celiac disease even when patients are already avoiding wheat. In the past, patients needed to be consuming wheat to get an accurate test result. 
    Celiac disease can have numerous vague, or confusing symptoms that can make diagnosis difficult.  Celiac disease is commonly misdiagnosed by doctors. Read a Personal Story About Celiac Disease Diagnosis from the Founder of Celiac.com Currently, testing and biopsy still form the cornerstone of celiac diagnosis.
    TESTING
    There are several serologic (blood) tests available that screen for celiac disease antibodies, but the most commonly used is called a tTG-IgA test. If blood test results suggest celiac disease, your physician will recommend a biopsy of your small intestine to confirm the diagnosis.
    Testing is fairly simple and involves screening the patients blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis. Also, it is now possible to test people for celiac disease without making them concume wheat products.

    BIOPSY
    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:
    Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clinical Gastroenterology and Hepatology 2018;16:823–836 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
    Christina Kantzavelos
    Celiac.com 07/20/2018 - During my Vipassana retreat, I wasn’t left with much to eat during breakfast, at least in terms of gluten free options. Even with gluten free bread, the toasters weren’t separated to prevent cross contamination. All of my other options were full of sugar (cereals, fruits), which I try to avoid, especially for breakfast. I had to come up with something that did not have sugar, was tasty, salty, and gave me some form of protein. After about four days of mixing and matching, I was finally able to come up with the strangest concoction, that may not look the prettiest, but sure tastes delicious. Actually, if you squint your eyes just enough, it tastes like buttery popcorn. I now can’t stop eating it as a snack at home, and would like to share it with others who are looking for a yummy nutritious snack. 
    Ingredients:
    4 Rice cakes ⅓ cup of Olive oil  Mineral salt ½ cup Nutritional Yeast ⅓ cup of Sunflower Seeds  Intriguing list, right?...
    Directions (1.5 Servings):
    Crunch up the rice into small bite size pieces.  Throw a liberal amount of nutritional yeast onto the pieces, until you see more yellow than white.  Add salt to taste. For my POTS brothers and sisters, throw it on (we need an excess amount of salt to maintain a healthy BP).  Add olive oil  Liberally sprinkle sunflower seeds. This is what adds the protein and crunch, so the more, the tastier.  Buen Provecho, y Buen Camino! 
    Jefferson Adams
    Image Caption: Image: CC--Kurtis Garbutt
    Celiac.com 07/19/2018 - Maintaining a gluten-free diet can be an on-going challenge, especially when you factor in all the hidden or obscure gluten that can trip you up. In many cases, foods that are naturally gluten-free end up contain added gluten. Sometimes this can slip by us, and that when the suffering begins. To avoid suffering needlessly, be sure to keep a sharp eye on labels, and beware of added or hidden gluten, even in food labeled gluten-free.  Use Celiac.com's SAFE Gluten-Free Food List and UNSAFE Gluten-free Food List as a guide.
    Also, beware of these common mistakes that can ruin your gluten-free diet. Watch out for:
    Watch out for naturally gluten-free foods like rice and soy, that use gluten-based ingredients in processing. For example, many rice and soy beverages are made using barley enzymes, which can cause immune reactions in people with celiac disease. Be careful of bad advice from food store employees, who may be misinformed themselves. For example, many folks mistakenly believe that wheat-based grains like spelt or kamut are safe for celiacs. Be careful when taking advice. Beware of cross-contamination between food store bins selling raw flours and grains, often via the food scoops. Be careful to avoid wheat-bread crumbs in butter, jams, toaster, counter surface, etc. Watch out for hidden gluten in prescription drugs. Ask your pharmacist for help about anything you’re not sure about, or suspect might contain unwanted gluten. Watch out for hidden gluten in lotions, conditioners, shampoos, deodorants, creams and cosmetics, (primarily for those with dermatitis herpetaformis). Be mindful of stamps, envelopes or other gummed labels, as these can often contain wheat paste. Use a sponge to moisten such surfaces. Be careful about hidden gluten in toothpaste and mouthwash. Be careful about common cereal ingredients, such as malt flavoring, or other non-gluten-free ingredient. Be extra careful when considering packaged mixes and sauces, including soy sauce, fish sauce, catsup, mustard, mayonnaise, etc., as many of these can contain wheat or wheat by-product in their manufacture. Be especially careful about gravy mixes, packets & canned soups. Even some brands of rice paper can contain gluten, so be careful. Lastly, watch out for foods like ice cream and yogurt, which are often gluten-free, but can also often contain added ingredients that can make them unsuitable for anyone on a gluten-free diet. Eating Out? If you eat out, consider that many restaurants use a shared grill or shared cooking oil for regular and gluten-free foods, so be careful. Also, watch for flour in otherwise gluten-free spices, as per above. Ask questions, and stay vigilant.
    Jefferson Adams
    Image Caption: Image: CC--Eugene Luchinin
    Celiac.com 07/18/2018 - Despite many studies on immune development in children, there still isn’t much good data on how a mother’s diet during pregnancy and infancy influences a child’s immune development.  A team of researchers recently set out to assess whether changes in maternal or infant diet might influence the risk of allergies or autoimmune disease.
    The team included Vanessa Garcia-Larsen, Despo Ierodiakonou, Katharine Jarrold, Sergio Cunha,  Jennifer Chivinge, Zoe Robinson, Natalie Geoghegan, Alisha Ruparelia, Pooja Devani, Marialena Trivella, Jo Leonardi-Bee, and Robert J. Boyle.
    They are variously associated with the Department of Undiagnosed Celiac Disease More Common in Women and Girls International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America; the Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom; the Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom; the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom; the Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom; the Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom; and Stanford University in the USA.
    Team members searched MEDLINE, Excerpta Medica dataBASE (EMBASE), Web of Science, Central Register of Controlled Trials (CENTRAL), and Literatura Latino Americana em Ciências da Saúde (LILACS) for observational studies conducted between January 1946 and July 2013, and interventional studies conducted through December 2017, that evaluated the relationship between diet during pregnancy, lactation, or the first year of life, and future risk of allergic or autoimmune disease. 
    They then selected studies, extracted data, and assessed bias risk. They evaluated data using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). They found 260 original studies, covering 964,143 participants, of milk feeding, including 1 intervention trial of breastfeeding promotion, and 173 original studies, covering 542,672 participants, of other maternal or infant dietary exposures, including 80 trials of 26 maternal, 32 infant, or 22 combined interventions. 
    They found a high bias risk in nearly half of the more than 250 milk feeding studies and in about one-quarter of studies of other dietary exposures. Evidence from 19 intervention trials suggests that oral supplementation with probiotics during late pregnancy and lactation may reduce risk of eczema. 44 cases per 1,000; 95% CI 20–64), and 6 trials, suggest that fish oil supplementation during pregnancy and lactation may reduce risk of allergic sensitization to egg. GRADE certainty of these findings was moderate. 
    The team found less evidence, and low GRADE certainty, for claims that breastfeeding reduces eczema risk during infancy, that longer exclusive breastfeeding is associated with reduced type 1 diabetes mellitus, and that probiotics reduce risk of infants developing allergies to cow’s milk. 
    They found no evidence that dietary exposure to other factors, including prebiotic supplements, maternal allergenic food avoidance, and vitamin, mineral, fruit, and vegetable intake, influence risk of allergic or autoimmune disease. 
    Overall, the team’s findings support a connection between the mother’s diet and risk of immune-mediated diseases in the child. Maternal probiotic and fish oil supplementation may reduce risk of eczema and allergic sensitization to food, respectively.
    Stay tuned for more on diet during pregnancy and its role in celiac disease.
    Source:
    PLoS Med. 2018 Feb; 15(2): e1002507. doi:  10.1371/journal.pmed.1002507
    Jefferson Adams
    Image Caption: Image: CC--Matthew Hurst
    Celiac.com 07/17/2018 - What can fat soluble vitamin levels in newly diagnosed children tell us about celiac disease? A team of researchers recently assessed fat soluble vitamin levels in children diagnosed with newly celiac disease to determine whether vitamin levels needed to be assessed routinely in these patients during diagnosis.
    The researchers evaluated the symptoms of celiac patients in a newly diagnosed pediatric group and evaluated their fat soluble vitamin levels and intestinal biopsies, and then compared their vitamin levels with those of a healthy control group.
    The research team included Yavuz Tokgöz, Semiha Terlemez and Aslıhan Karul. They are variously affiliated with the Department of Pediatric Gastroenterology, Hepatology and Nutrition, the Department of Pediatrics, and the Department of Biochemistry at Adnan Menderes University Medical Faculty in Aydın, Turkey.
    The team evaluated 27 female, 25 male celiac patients, and an evenly divided group of 50 healthy control subjects. Patients averaged 9 years, and weighed 16.2 kg. The most common symptom in celiac patients was growth retardation, which was seen in 61.5%, with  abdominal pain next at 51.9%, and diarrhea, seen in 11.5%. Histological examination showed nearly half of the patients at grade Marsh 3B. 
    Vitamin A and vitamin D levels for celiac patients were significantly lower than the control group. Vitamin A and vitamin D deficiencies were significantly more common compared to healthy subjects. Nearly all of the celiac patients showed vitamin D insufficiency, while nearly 62% showed vitamin D deficiency. Nearly 33% of celiac patients showed vitamin A deficiency. 
    The team saw no deficiencies in vitamin E or vitamin K1 among celiac patients. In the healthy control group, vitamin D deficiency was seen in 2 (4%) patients, vitamin D insufficiency was determined in 9 (18%) patients. The team found normal levels of all other vitamins in the healthy group.
    Children with newly diagnosed celiac disease showed significantly reduced levels of vitamin D and A. The team recommends screening of vitamin A and D levels during diagnosis of these patients.
    Source:
    BMC Pediatrics
    Jefferson Adams
    Image Caption: Image: CC--Wheeler Cowperthwaite
    Celiac.com 07/16/2018 - Did weak public oversight leave Arizonans ripe for Theranos’ faulty blood tests scam? Scandal-plagued blood-testing company Theranos deceived Arizona officials and patients by selling unproven, unreliable products that produced faulty medical results, according to a new book by Wall Street Journal reporter, whose in-depth, comprehensive investigation of the company uncovered deceit, abuse, and potential fraud.
    Moreover, Arizona government officials facilitated the deception by providing weak regulatory oversight that essentially left patients as guinea pigs, said the book’s author, investigative reporter John Carreyrou. 
    In the newly released "Bad Blood: Secrets and Lies in a Silicon Valley Startup," Carreyrou documents how Theranos and its upstart founder, Elizabeth Holmes, used overblown marketing claims and questionable sales tactics to push faulty products that resulted in consistently faulty blood tests results. Flawed results included tests for celiac disease and numerous other serious, and potentially life-threatening, conditions.
    According to Carreyrou, Theranos’ lies and deceit made Arizonans into guinea pigs in what amounted to a "big, unauthorized medical experiment.” Even though founder Elizabeth Holmes and Theranos duped numerous people, including seemingly savvy investors, Carreyrou points out that there were public facts available to elected officials back then, like a complete lack of clinical data on the company's testing and no approvals from the Food and Drug Administration for any of its tests.
    SEC recently charged the now disgraced Holmes with what it called a 'years-long fraud.’ The company’s value has plummeted, and it is now nearly worthless, and facing dozens, and possibly hundreds of lawsuits from angry investors. Meantime, Theranos will pay Arizona consumers $4.65 million under a consumer-fraud settlement Arizona Attorney General Mark Brnovich negotiated with the embattled blood-testing company.
    Both investors and Arizona officials, “could have picked up on those things or asked more questions or kicked the tires more," Carreyrou said. Unlike other states, such as New York, Arizona lacks robust laboratory oversight that would likely have prevented Theranos from operating in those places, he added.
    Stay tuned for more new on how the Theranos fraud story plays out.
    Read more at azcentral.com.
    Jefferson Adams
    Image Caption: Image: CC--Bert Kimura
    Celiac.com 07/14/2018 - If you’re looking for a simple, nutritious and exciting alternative to standard spaghetti and tomato sauce, look no further than this delicious version that blends ripe plum tomatoes, garlic, olive oil, basil, and firm sliced ricotta to deliver a tasty, memorable dish.
    Ingredients:
    12 ounces gluten-free spaghetti 5 or 6 ripe plum tomatoes ¼ cup extra virgin olive oil 2 cloves garlic, crushed ¾ teaspoons crushed red pepper ¼ cup chopped fresh basil 2 tablespoons chopped fresh parsley Kosher salt and black pepper ⅓ cup pecorino Romano cheese, grated ½ cup firm ricotta, shaved with peeler Directions:
    Finely chop all but one of the tomatoes; transfer to large bowl with olive oil and ¼ teaspoon salt.
    Cook spaghetti until al dente or desired firmness, and drain, reserving ¼ cup cooking water. 
    Meanwhile, chop remaining tomato, and place in food processor along with garlic, red pepper, and ½ teaspoon salt; puree until smooth. 
    Gently stir mixture into the bowl of chopped tomatoes.
    Add cooked spaghetti, basil and parsley to a large bowl.
    Toss in tomato mixture, adding some reserved pasta water, if needed. 
    Spoon pasta into bowls and top with Romano cheese, as desired.
    Jean Duane
    Image Caption: Image: CC--Christian Scheja
    Celiac.com 07/13/2018 - I went to a friend’s home for dinner.  A few days before, she called and asked me what I could eat.  I asked her what she was planning to make, and she said she was grilling meats with side dishes.  I said, “Great.  Please just grill a piece of chicken for me with salt and pepper, and I’ll be happy to bring a side.” She said, “No need to bring a side.  I’ve got this.” When I arrived, she greeted me and said, “I spent all day cooking tonight’s dinner so you can eat it. Hey would you just check this salad dressing to see if it is OK for you?” I looked at the ingredients and it contained gluten and dairy, both of which I cannot eat.  Then I glanced around the kitchen and saw evidence of wheat cross-contamination, including buns being toasted on the grill, and gluten-containing barbeque sauce spilling on the grill where my “clean” chicken was cooking. She had other guests to tend to, and I couldn’t offer instruction or read the ingredients of everything she used in the meal. 
    At social gatherings, I’ve been challenged too by those who ask if I am really “allergic,” or just eating gluten free as a “fad.” I’ve been told many times by hosts and hostesses that, “a little won’t hurt you,” or “everything in moderation,” or “if it is made with loving hands, it is good for you to eat.”  Of course, all of this is bunk for those with food allergies or celiac disease.  A little bit may kill us, and whether made with loving hands or not, it will certainly make us sick. 
    Those of us with food allergies and/or celiac disease walk a tightrope with friends and relatives. The old rules of etiquette just don’t work anymore.  We don’t want to insult anybody, we don’t want to be isolated, and we also don’t want to risk our health by eating foods that may contain ingredients we cannot tolerate.  So what do we do? 
    Etiquette books advise us to eat what is put in front of us when we are guests in someone’s home. They caution us at all costs not to insult our hostess. Rather, we are instructed to compliment the hostess on her good cooking, flavor combinations, and food choices.  But when foods are prepared in a cross-contaminated environment with ingredients we are allergic to, we cannot follow the old social constructs that do not serve us.  We need to work together to rewrite the rules, so that we can be included in social gatherings without fear of cross-contamination, and without offending anyone.
    Let’s figure out how to surmount these social situations together.  
    Each edition of this column will present a scenario, and together, we’ll determine appropriate, polite, and most importantly, safe ways to navigate this tricky gluten-free/food allergies lifestyle in a graceful way.  If someone disagrees with our new behavior patterns, we can refer them to this column and say, “Here are the new rules for those of us with food allergies or celiac disease.”  When we are guests in someone’s home, we can give them links to this column so they understand the plight we are faced with, bite after bite. Perhaps this will help those of us living with us to understand, be more compassionate, and accepting of our adaptations to keep ourselves safe. 
    This column will present a scenario such as the one above, and ask that you comment on how you would navigate it. Let’s talk about it. Let’s share ideas.  Using the example above, here’s the scenario for this issue:
    What would you do?
    Your kind-hearted friend invites you to dinner and insists on cooking for you.  You arrive and the first thing she says is, “I’ve spent all day making this for you. Oh, I bought this salad dressing for you, but you might want to read the ingredients first.”  You do, and it contains malt vinegar.  You look around the kitchen and notice evidence of cross-contamination in the rest of the meal.  What do you do? 
    Please comment below and feel free to share the tricky scenarios that you’ve encountered too.  Let’s discuss how to surmount these social situations.  What would you do?
    Jefferson Adams
    Image Caption: Image: CC--United Soybean Board
    Celiac.com 07/12/2018 - Previous research has shown that the oral administration of Bifidobacterium infantis Natren Life Start super strain (NLS-SS) reduces of gastro-intestinal symptoms in untreated celiac disease patients. The reduction of symptoms was not connected with changes in intestinal permeability or serum levels of cytokines, chemokines, or growth factors. Therefore, researchers suspected that the reduction of symptoms might be related to the modulation of innate immunity.
    To test that hypothesis, a team of researchers set out to assess the potential mechanisms of a probiotic B.infantis Natren Life Start super strain on the mucosal expression of innate immune markers in adult patients with active untreated celiac disease compared with those treated with B. infantis 6 weeks and after 1 year of gluten-free diet.
    The research team included Maria I. Pinto-Sanchez, MD, Edgardo C. Smecuol, MD, Maria P. Temprano,RD, Emilia Sugai, BSBC, Andrea Gonzalez, RD, PhD, Maria L. Moreno,MD, Xianxi Huang, MD, PhD, Premysl Bercik, MD, Ana Cabanne, MD, Horacio Vazquez, MD, Sonia Niveloni, MD, Roberto Mazure, MD, Eduardo Mauriño, MD, Elena F. Verdú, MD, PhD, and Julio C. Bai, MD. They are affiliated with the Medicine Department, Farcombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada; the Small Intestinal Section, Department of Medicine and the Department of Alimentation at Dr. C. Bonorino Udaondo, Gastroenterology Hospital and Research Institute at the Universidad del Salvador in Buenos Aires, Argentina.
    The team determined the numbers of macrophages and Paneth cells, along with the expression of a-defensin-5 expression via immunohistochemistry in duodenal biopsies.
    Their results showed that a gluten-free diet lowers duodenal macrophage counts in celiac disease patients more effectively than B. infantis, while B. infantis lowers Paneth cell counts and reduces expression of a-defensin-5.
    This study documents the differential innate immune effects of treatment with B. infantis compared with 1 year of gluten-free diet. The team calls for further study to better understand the synergistic effects of gluten-free diet and B. infantis supplementation in celiac disease.
    Source:
    J Clin Gastroenterol
    Jefferson Adams
    Image Caption: Image: CC--Yuichi Shiraishi
    Celiac.com 07/11/2018 - For people with celiac disease, finding decent gluten-free bread is like searching gold. Many have given up on bread entirely and others begrudgingly relate themselves to the ignominious frozen aisle at their supermarket and content themselves with one of the many dry, shriveled, flavorless loaves that proudly tout the gluten-free label. 
    For these people, the idea of freshly baked bread is a distant, if comforting, memory. The idea of going to Paris and marching into a boulangerie and walking out with a warm, tasty, gluten-free baguette that was freshly baked on the premises that morning, is like a dream. Now, in some Parisian bakeries, that dream is becoming a reality. And the tear of joy from the thankful gluten-free masses are sure to follow.
    These days, a single sign on the awning speaks to hungry customers who peruse the tarts and chou buns, and the loaves that fill the cooling on racks behind a glass pane at Chambelland boulangerie and café in Paris’ 11th arrondissement. The sign lettered in French translates: “artisan baker; flour producer; naturally gluten free.” That’s right. Naturally gluten-free. At a bakery. In Paris. 
    Only the flat, focaccia-style loaves, and the absence of baguettes, tells customers that this bakery is something different. Chambelland opened its doors in 2014 and continues to do a brisk business in delicious, freshly baked gluten-free breads and other goods.
    The boulangerie is the work of Narhaniel Doboin and his business partner, Thomas Teffri-Chambelland. They use flour made of grains including rice, buckwheat and sorghum to make delicious gluten-free baked goods. Doboin says that customers queued in the rain on the first day, hardly believing their eyes, some began to cry. 
    For gluten-free Parisians, there was a time before Chambelland, and the time after. If you find yourself in Paris, be sure to search them out for what is sure to be a gluten-free delight.
    Or maybe book your ticket now.
    Read more at: Independent.co.uk
    Jefferson Adams
    Image Caption: Image: CC--neiljs
    Celiac.com 07/10/2018 - As part of its 50th Anniversary activities, Celiac UK has launched a research fund and accompanying fundraising appeal to support new research and development. The fund has already received an injection of £500k from Innovate UK, in addition to £250k from the charity. 
    Together, Coeliac UK and Innovate UK have opened applications for grants from the £750,000. Researchers and businesses can apply for a grants ranging from £50k to £250k for healthcare diagnostics, digital self-care tools and better gluten free food production. 
    Food businesses can receive grants by developing more nutritious and affordable gluten free food, by using new ingredients, improving nutritional value, flavor and/or texture, and creating better methods of preservation.
    The three main goals of the program are: To improve celiac disease diagnostics; to improve the quality of gluten-free foods, and to promote digitally supported self-care for people with celiac disease. 
    The matching industry funds will bring spending for new research on the growing global gluten-free foods market to nearly £1m.
    Ultimately, Coeliac UK is looking to raise £5 million to improve understanding and treatment of celiac disease and gluten related autoimmune conditions. 
    Sarah Sleet, Chief Executive of Coeliac UK said: “With the global diagnosis for coeliac disease increasing year on year, this is a chance for UK business and researchers to get ahead and develop competitive advantages in innovation which will be of benefit to a badly underserved patient group.
    Read more at: NewFoodMagazine.com
    Jefferson Adams
    Image Caption: Image: CC--Presidencia de la Repúblic Mexicana
    Celiac.com 07/09/2018 - In a seemingly innocuous case of gluten-contamination, an Australian woman was hospitalized with serious health issues after mistakenly eating a waffle she thought was gluten-free. The incident began when Williams and her husband Scott dined at a local Perth restaurant where they had eaten before. This time, though, after eating a meal of chicken and what she took to be gluten-free waffles, she became ill. The mistake caused her to lose consciousness several times, and resulted in mild kidney failure.
    Diagnosed as celiac at 12 months of age, the 27-year old Williams is a CrossFit fanatic, a fact she believes helped her to survive. “If I was already sick or if I was an elderly person and I had this sort of reaction, I could have died,” Ms Williams said. Williams wants to help spread the word that, for some people, celiac disease is a serious and potentially life-threatening medical condition.
    The owner of the restaurant seems to be taking the incident seriously, and has said she would be investigating what went wrong that day. “I’m trying to find out what happened because we’ve never had an issue with this,” she said, and that she “would never want to hurt anyone at all.”
    While the Perth restaurant’s menu did carry a disclaimer that gluten-free items may contain traces of gluten. The owner said the gluten-free options were not recommended for people who are “coeliac or really gluten intolerant.” The restaurant has offered Ms Williams a $40 refund with a confidentiality clause, which she intends to decline so she can speak out and educate others about the risks of dining out.
    Coeliac Australia’s Cathy Di Bella said restaurants can’t use a “may contain traces of” disclaimer to offset a claim that food is gluten-free. Any restaurant that advertises gluten-free food should take necessary measures to ensure that their gluten-free items are if fact free of gluten. This is an important point, as this incident comes amid recent news reports that indicate nearly one out of ten meals sold as gluten-free at cafes and restaurants across Melbourne were contaminated with gluten.
    For Ms Williams’ part, she said she has “lost faith in going out for dinner and it’s going to take me a long time to be able to go out and do that without fear of this happening.”
    Do you or a loved one have a gluten-free horror story to tell? Share it in our comments below.
    Read more at: Thewest.com.au
    Jefferson Adams
    Image Caption: Image: CC--Waldo Jaquith
    Celiac.com 07/07/2018 - Summer means many things, but among them, summer means peaches and fresh salsa. This happy salsa blends roasted tomatoes, peaches, and onion with a dash of jalepeño pepper for a tasty refreshing summertime salsa treat.
    Ingredients: 
    2-3 8-ounce fresh peaches, pitted and peeled—about 2 cups 4-5 medium tomatoes—about 1½ cups ½ medium red onion, diced small 1 small or ½ large jalapeño or Serrano pepper, stemmed, seeded Small handful cilantro Juice of 2-3 fresh limes 1 teaspoon kosher salt, or more as needed Tortilla chips, for serving Note: Goes great with guacamole!
    Directions:
    In a cast iron skillet or pan, roast 8-10 tomatoes, jalapeño and onion. Add add peach chunks last, Roast tomatoes, pepper, onion, until blackened and soft. Roast peaches until browned, or even a bit charred.
    In a blender, combine about 1 cup of roasted tomatoes, peaches, red onion, pepper, cilantro, lime juice and salt, and purée until smooth.
    Adjust flavor with additional ingredients or salt, as needed.
    Serve with tortilla chips and guacamole, as desired.
    Christina Kantzavelos
    Image Caption: Company Cafe’s Bumblebee Scratch: Fried chicken, poached eggs, hollandaise, honey butter, mascarpone, and our gluten-free biscuit.
    Celiac.com 07/06/2018 - I had the chance to road trip through Texas. It’s an awfully large state, and there is a lot to see, eat and appreciate. I was surprised by the amount of amazing food I was able to consume without concern of cross contamination. I had the opportunity to visit Dallas, Houston, San Antonio and Austin. I compiled a list of my favorite options from each city. 
    Dallas
    Company Cafe (2104 Greenville Avenue, Dallas, TX 75206)
    Ladies and Gentleman, I finally got to eat some DELICIOUS fried chicken and couldn’t have been happier. I also had their version of french toast bites, which tasted a million times better than what I remembered. A 100% gluten free restaurant and bakery. Everything we ate here melted in our mouths. We got to meet the owners, and hear their story, which made the food taste all of the more better. Let them know if you have any dairy allergies, and they will be happy to accomodate you. Also be mindful of their hours, as they are open everyday but only for brunch. Hopefully they expand to San Diego soon, fingers crossed! 
     
    Back Home BBQ (5014 Ross Ave., Dallas, TX 75206)

    Back Home BBQ’s Smoked Meat Selection: Sliced Brisket, Sausage and Smoked Chicken
    Brought to you by the same owners of Company Cafe. It’s not 100% gluten free, but the BBQ is, as is the cornbread and pecan pie. Authentic BBQ delicious that is safe to eat (yeehaw). 
     
    HG Sply Co. (2008 Greenville Ave, Dallas, TX 75206)
    A restaurant where ALL items can be made dairy and/or gluten free. Yaaaasss! We ordered and absolutely loved the HG Chips and Queso (cashew cheese), Beet Poke (actually tastes like you’re eating fish because of the white seaweed), the curried sweet potato soup and Pulled Pork Tacos. They have a second location in Fort Worth. 
     
    Houston
    Pondicheri / Pondicheri Bake Lab - Upstairs (2800 Kirby Dr B132, Houston, TX 77098)

    Pondicheri’s Gluten Free Avocado Dosa 
    Indian, GF and vegan option deliciousness! Chickpea Masala fried chicken… Yes, this is real life. They have a restaurant downstairs, open during specific hours. While their upstairs cafe and bakery is open all day, it has a different menu, as well as enough interesting GF baked goods (like honey mesquite cake) to fill your heart’s desire. They also sell Indian spices, ghee and other fun supplies in their small shop. Be sure to check out India1948 for recipes, their online store and cooking classes. In case you’re wondering, they have NY location.

    True Food Kitchen (1700 Post Oak Blvd, Houston, TX 77056)

    True Food’s Strawberry & Rhubarb Crisp: almond crumble, chia seed, vanilla ice cream
    I truly love this place, and it’s no wonder they now have so many locations in the USA. They are known to have a health conscious, organic, and seasonal menu. Although not 100% gluten free, they use all separate equipment if you are Celiac, or have other food allergies. I feel safe and satisfied each time I eat there. My favorite? A side of their gluten-free pita to dip in their ponzu sauce, and their almond ricotta pizza. Now, wait until you try one of their seasonal desserts, with a side of their homemade coconut ice cream. Sign up for their birthday list, and get one for free. You’re welcome. 
     
    San Antonio 
    5 Points Local (1017 North Flores, San Antonio, TX 78212)

    Karma Bowl (v): Fluffy quinoa, roasted rosemary sweet potatoes, whole black beans, fresh kale salad, and drizzled with our chipotle cashew crema aka "Kitchen Crack"
    An organic, 100% gluten free restaurant, serving ingredients that are all consciously sourced. They cater to all types of diets, and are consistent in tasting delicious. I recommend any of their bowls, and fluffy pancakes. They also have a yoga studio and school attached! Can’t get any cooler. 
     
    Green Vegetarian Cuisine (200 E Grayson St #120, San Antonio, TX 78215)
    Since most restaurants in San Antonio are closed on Mondays (still not entirely sure why), this was a great option for us. Located in the very hip Pearl Brewery District, this is a fun little vegan restaurant with gluten-free options. I was quite happy with my nachos and enchiladas (the plates are huge FYI), and cupcake. The best part of our experience, was our waiter, Heath. He made the experience a lot of fun. Parking in the lot there allows you to explore the river walk a bit, which we loved. They have a another location in San Antonio, and one in Houston. 
     
    Larder Coffee (Hotel Emma, 136 E. Grayson, San Antonio, TX 78215)

    Larder’s gluten Free Avocado Toast with house smoked salmon. And their Gluten Free Bagel with cream cheese, housemade jam and strawberries.  
    This is attached to my new favorite hotel, Hotel Emma, also located inside hip Pearl Brewery District. It is an adorable coffee shop, that serves many dairy alternative options, and gluten free toasts and treats. There is also a small market inside. Be sure to check out the bar area right next door, and the hotel, which has the coolest architecture. P.S. They also have a restaurant attached with Gluten Free options, called Supper. 


    Austin
    Picnik (4801 Burnet Rd, Austin, TX 78756)

    Picnik’s Chicken Tenders: Rice flour tempura, honey-mustard aioli. Available at their brick-and-mortar restaurant on Burnet Road.
    Our friend half-joked when she said she moved to Austin from LA because of this restaurant… I now can understand how that might be a real thing. They are 100% gluten, corn, soy and peanut free. The food is just, wow, and can be modified to fit most dietary restrictions. Did we visit twice in less than 24 hours? Yes. The chicken tenders aren’t like anything else, and I would recommend ordering at least two orders to start off with, including two of their honey aioli sides. They also have a couple grab and go trailers in Austin. 
     
    Wild Wood Bakehouse (3016 Guadalupe St., Ste. 200 Austin, Texas 78705)
    Another great 100% gluten free restaurant and bakery. They serve some yummy comfort food, like fried calamari and chips, chicken and waffles, biscuits, sausage and bakery. Did I mention their amazing bakery? A mountain of gluten free options. 
    Thanks for treating me well Texas...until we meet (I mean eat) again. 
    As Always, 
    Buen Camino
    Jefferson Adams
    Image Caption: Image: CC--Zdenko Zivkovic
    Celiac.com 07/05/2018 - We’ve known for a while that dental enamel defects can be an indicator of celiac disease. Now, a new study has evaluated the pathological conditions of the stomatognathic system observed in celiac patients on a gluten-free diet, and found that non-specific tooth wear can be seen nearly 20% of celiac patients, while such wear is seen in just under 6% of non-celiac control subjects. 
    The data come from a team of researchers that recently set out to evaluate the pathological conditions of the stomatognathic system observed in celiac patients on a gluten-free diet. The research team included Massimo Amato, Fabiana Zingone, Mario Caggiano Orcid, Paola Iovino, Cristina Bucci and Carolina Ciacci. They are variously affiliated with the Department of Medicine, Surgery and Dentistry, Medical School of Salerno in Salerno, Italy.
    For their study, the team consecutively recruited celiac patients on a gluten-free diet, along with healthy control volunteers, from the team’s celiac clinic. Two dentists examined all patients and controls and examined them for mouth disorders. 
    The study included forty-nine patients with celiac disease, and 51 healthy volunteer subjects. The team found recurrent aphthous stomatitis in 26 patients (53.0%) and in 13 (25.5%) controls. They found dental enamel disorders in 7 patients (14.3%) and in 0 controls (p = 0.002), with no cases of geographic tongue. 
    They found non-specific tooth wear, characterized by loss of the mineralized tissue of the teeth, in 9 patients (18.3%) and in 3 (5.9%) controls. From this data, the team notes that recurrent aphthous stomatitis and enamel hypoplasia are “risk indicators” that indicate the possible presence of celiac disease. 
    Among patients with celiac disease, the team found high rates of non-specific tooth wear that can be caused by several factors such as malocclusion, sleep bruxism, parafunctional activity, and age.
    This study, and previous studies on dental enamel defects, confirms that non-specific tooth wear and enamel defects can be strong indications of celiac disease, and may lead to a more active role for dentists in helping to spot and diagnose celiac disease.
    Source:
    mdpi.com
    Jefferson Adams
    Image Caption: Image: CC--Jeff Kubina
    Celiac.com 07/04/2018 - For the vast majority of people, gluten is nothing to worry about. However, for people with celiac disease, gluten triggers an immune reaction that can be uncomfortable and lead to damage of the intestinal lining, and, left untreated, other conditions, including certain types of deadly cancers. Actually, the real offender is a protein in gluten called gliadin. It's the gliadin that triggers the immune reaction in people with celiac disease. For our purposes today, I will talk about gluten, even though it's really gliadin that's the culprit. Still, avoiding gliadin means avoiding gluten, so let's just keep it simple, if a bit unscientific, for now.
    There are some people who are sensitive to gluten, but who don’t have celiac disease, a condition know as Non-Celiac Gluten Sensitivity (NCGS). When people with NCGS eat gluten, they often experience symptoms similar to those with celiac disease, yet they lack the same antibodies to gluten, as well as the intestinal damage seen in celiac disease.
    People with celiac disease and gluten sensitivity need to follow a gluten-free diet that excludes all products containing wheat, barley and rye ingredients. These people can still enjoy a healthy diet filled with fruits, vegetables, meats, poultry, fish, beans, legumes and most dairy products. Many delicious foods are naturally gluten-free, and safe for people with celiac disease.
    That said, gluten is found in a wide variety of foods, even those you wouldn’t expect, such as soy sauce and even some french fries. Foods containing wheat, barley or rye contain gluten, but the protein can also be hidden in many foods as an additive, especially processed foods. Gluten can also sometimes be found in certain medications, personal hygiene products and more.
    For people with celiac disease, even tiny amounts of gluten can cause damage to the small intestine and prevent nutrients from being absorbed into the bloodstream. The safest bet is to purchase naturally gluten-free grains, flours and starches labeled gluten-free and, when possible, certified gluten-free by a third party.
    For a more complete list, see Celiac.com’s gluten-free Safe Foods List  and the non-gluten free Unsafe Foods List.

    What Foods and Products Contain Gluten?
    Gluten is found in any products with ingredients derived from wheat, barley and rye. This includes:
    1) Wheat products (Triticum), including: All species of wheat contain gluten, including durum, semolina, spelt, kamut, einkorn, faro and triticale, which is a hybrid of wheat and rye.
    2) Barley Products (Hordeum vulgare)
    3) Rye Products (Secale)
    4) Any bakery item, beer, breads, candy (not all), cereal, flour, pastas, non-dairy milk (not all), sauces (not all), soups (not all), or other product made with wheat, rye, barley, including the following ingredients:
    Abyssinian Hard (Wheat triticum durum) Alcohol (Spirits - Specific Types) Atta Flour Barley Grass (can contain seeds) Barley Hordeum vulgare Barley Malt Beer (most contain barley or wheat) Bleached Flour Bran Bread Flour Brewer's Yeast Brown Flour Bulgur (Bulgar Wheat/Nuts) Bulgur Wheat Cereal Binding Chilton Club Wheat (Triticum aestivum subspecies compactum) Common Wheat (Triticum aestivum) Cookie Crumbs Cookie Dough Cookie Dough Pieces Couscous Criped Rice Dinkle (Spelt) Disodium Wheatgermamido Peg-2 Sulfosuccinate Durum wheat (Triticum durum) Edible Coatings Edible Films Edible Starch Einkorn (Triticum monococcum) Emmer (Triticum dicoccon) Enriched Bleached Flour Enriched Bleached Wheat Flour Enriched Flour Farik Farina Farina Graham Farro Filler Flour (normally this is wheat) Freekeh Frikeh Fu (dried wheat gluten) Germ Graham Flour Granary Flour Groats (barley, wheat) Hard Wheat Heeng Hing Hordeum Vulgare Extract Hydroxypropyltrimonium Hydrolyzed Wheat Protein Kamut (Pasta wheat) Kecap Manis (Soy Sauce) Ketjap Manis (Soy Sauce) Kluski Pasta Maida (Indian wheat flour) Malt Malted Barley Flour Malted Milk Malt Extract Malt Syrup Malt Flavoring Malt Vinegar Macha Wheat (Triticum aestivum) Matza Matzah Matzo Matzo Semolina Meripro 711 Mir Nishasta Oriental Wheat (Triticum turanicum) Orzo Pasta Pasta Pearl Barley Persian Wheat (Triticum carthlicum) Perungayam Poulard Wheat (Triticum turgidum) Polish Wheat (Triticum polonicum) Rice Malt (if barley or Koji are used) Roux Rusk Rye Seitan Semolina Semolina Triticum Shot Wheat (Triticum aestivum) Small Spelt Spirits (Specific Types) Spelt (Triticum spelta) Sprouted Wheat or Barley Stearyldimoniumhydroxypropyl Hydrolyzed Wheat Protein Strong Flour Suet in Packets Tabbouleh Tabouli Teriyaki Sauce Timopheevi Wheat (Triticum timopheevii) Triticale X triticosecale Triticum Vulgare (Wheat) Flour Lipids Triticum Vulgare (Wheat) Germ Extract Triticum Vulgare (Wheat) Germ Oil Udon (wheat noodles) Unbleached Flour Vavilovi Wheat (Triticum aestivum) Vital Wheat Gluten Wheat, Abyssinian Hard triticum durum Wheat Amino Acids Wheat Bran Extract Wheat, Bulgur Wheat Durum Triticum Wheat Germ Extract Wheat Germ Glycerides Wheat Germ Oil Wheat Germamidopropyldimonium Hydroxypropyl Hydrolyzed Wheat Protein Wheat Grass (can contain seeds) Wheat Nuts Wheat Protein Wheat Triticum aestivum Wheat Triticum Monococcum Wheat (Triticum Vulgare) Bran Extract Whole-Meal Flour Wild Einkorn (Triticum boeotictim) Wild Emmer (Triticum dicoccoides)
     
    Jefferson Adams
    Image Caption: Image: CC--US Army Africa
    Celiac.com 07/03/2018 - The vast majority of celiac disease remain undiagnosed, and clinical testing is usually done on a case by case basis. Factor in vague or atypical symptoms, and you have a recipe for delayed diagnosis and unnecessary suffering. What determines who gets tested, and are current screening methods working?
    A team of researchers recently set out to assess the factors that determine diagnostic testing, along with the frequency of clinical testing in patients with undiagnosed celiac disease. The research team included I. A. Hujoel, C. T. Van Dyke, T. Brantner, J. Larson, K. S. King, A. Sharma J. A. Murray, and A. Rubio‐Tapia. They are variously affiliated with the Division of Biomedical Statistics and Informatics, the Division of Internal Medicine, at the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, Minnesota.
    For their case‐control study the team identified 408 cases of undiagnosed celiac disease from a group of 47,557 adults with no prior diagnosis of celiac disease. Their team identified undiagnosed cases through sequential serology, and selected unaffected age‐ and gender‐matched controls. They made a comprehensive review of medical records for indications for and evidence of clinical testing.

    Over time, people with undiagnosed celiac disease were more likely than control subjects to present with symptoms or conditions that invite testing. This study makes a strong case that current clinical methods are ineffective in detecting undiagnosed celiac disease. Accordingly, the researchers urge the development and adoption of more effective methods for detecting celiac disease.
    Source:
    Alimentary Pharmacology & Therapeutics.
    Jefferson Adams
    Image Caption: Image: CC--Discos Konfort
    Celiac.com 07/02/2018 - We know from earlier studies that diagnosed celiac disease is more common in women than in men, but there isn’t much good data on sex-based differences in undiagnosed celiac disease. To address this discrepancy, Claire L. Jansson-Knodell, MD, and her colleagues at the Mayo Clinic, in Rochester, Minnesota, conducted a meta-analysis of studies that performed both a screening and confirmatory test that included either a second serological study or a small intestine biopsy, and that that provided clear and complete data regarding sex. 
    According to data they presented at Digestive Disease Week 2018 in Washington, D.C., women are significantly more likely than men to have undiagnosed celiac disease, and the numbers are even higher for younger girls.
    In all, the researchers found 88 studies that met their inclusion criteria. These studies included data on nearly 300,000 patients. When they got done crunching the numbers, the research team demonstrated for the first time that women also had a higher rate of undetected celiac disease than men. When the team analyzed data from one subgroup focused on children, they found that rates of undiagnosed celiac disease were even higher in girls compared with boys.

    Timely diagnosis of celiac disease is important for preventing unnecessary suffering, and potential damage and disease associated with untreated celiac disease. In one recent case, a doctors found that a woman's psychotic delusions were caused by undiagnosed celiac disease and an adverse reaction to continued gluten exposure. Her condition improved quickly once she began a gluten-free diet. 
    The research team says that their findings could change approaches to clinical screening, diagnosis and management of celiac disease. They also suggest that physicians might do well to increase their suspicion levels for celiac disease when evaluation women and girls.
    Source:
    Helio.com
    Celiac.com Sponsor: Banner
    Image Caption: Image: MRM
    From the top-down, we are a science-based company focused on our mission to help everyone - and we mean everyone - live a healthy and balanced life. Quality, efficacy, and safety have been our focus since MRM was established in 1996. While the first supplement was created for the CEO's mother, our line has expanded to over 150 products catering to all individuals, but none more so than those who are gluten sensitive or intolerant. Not only is our entire line gluten-free, our manufacturing facility is certified gluten-free as well. This ensures that even if a product has not been certified gluten-free you can still trust it to be, as it would be impossible for us to create a product that contains gluten as it is not legally allowed at our facility.
    At MRM we are in complete control, from soil to shelf, to ensure quality and peace of mind. We understand the impact that gluten can have on the human body and believe everyone ought to have access to our products that can help make it easier to live a healthy and balanced life. From day one, it only made sense to us to use natural ingredients which help us provide the highest quality products on the market. We are a company committed to suit the needs of everybody with products you can safely enjoy and always trust. 
    For more information visit their site.
    Jefferson Adams
    Image Caption: Image: CC--meesh
    Celiac.com 06/30/2018 - It seems there’s a bit of a gluten-free and halal food controversy going on across the pond. For those who don’t know, ‘Halal’ is the Muslim equivalent of what Jewish folks call ‘Kosher.’ Basically, it means food prepared to certain standards and blessed for consumption.
    The Aureus School in Didcot, Oxfordshire, England is being decried by angry parents as “like a dictatorship” after the school banned packed lunches and began serving pupils gluten-free options, including halal meat, water and salad. The ruckus began when the school recently banned students from bringing lunches and snacks from home, and began a program to make sure that “all students have access to a daily nutritious home-cooked family meal.”
    This is fine in principal, say angry parents, but in practice has become “draconian.” One father, who asked not to be named, said that he and his wife were “thinking of taking [their daughter] out of the school, adding that the situation was “getting silly and more like a dictatorship. Their views are quite extreme.”
    The dad said that "It's about choice. It's supposed to be an inclusive school but they are only catering for one particular religion.” He added that he had tried unsuccessfully to get the policies changed since September.
    So, whereas in days past, lunch might mean whatever mom saw fit to pack, these days at Aureus School lunch means the choice of a hot halal meat meal, hot gluten-free vegetarian meal, a jacket potato, a salad, a pasta pot or a baguette. The school insists that only water be drunk on site because “hydrated brains learn better”.
    The school states that their Halal kitchen policy is simply a move to “celebrate the diversity of our country’s culture,” in addition to providing nutritious food for the children.
    What do you think? A gluten-free and Halal lunch bridge too far, or a good meal for the kids?
    Roy Jamron
    Image Caption: Image: Roy Jamron
    Celiac.com 06/29/2018 - Warning!  If you crave the taste of "real" bread, this gluten free bread may be addictive. 
    No rice flour here.  This totally satisfying, wholesome, nutritious, hearty gluten free bread exudes the robust taste and firm, springy texture of rye bread.  It really, really tastes like REAL bread, no exaggeration.  The bread is absolutely delicious toasted or untoasted, keeps fresh for over 2 weeks in the refrigerator, and does not tear, sink in the center, dry out or crumble.  This incredible 4 inch tall loaf can even be sliced nearly paper thin and still hold together.  It is vegan, free of soy, corn, wheat, gluten, nuts, dairy, or eggs.  Add caraway seeds and you'll want to break out the mustard, pickles, and coleslaw.  It makes the perfect deli bread.  Want pizza?  Toasted slices of this bread make great pizza crusts for quick and easy gluten free mini pizzas.  Even those not on a gluten free diet will find this bread utterly irresistible.
    A Quest Begins
    This outstanding GF bread is the result of a years long quest for the perfect GF bread recipe.  It began with the classic GF bread recipe of rice flour, tapioca starch, corn or potato starch, powdered dry milk, eggs, oil, sugar, salt, xanthan gum, yeast and water.  It later evolved to include bean flours.  These early GF bread recipes, mostly starch and "empty" calories, simply tasted horrible and left a bitter aftertaste.
    Rice flour, bean flours and corn starch were quickly eliminated.  After scientific studies concluded oats were gluten free and safe (except for possible wheat contamination), oat flour became a central ingredient.  Starches were limited to no more than one third of the flour mix.  Mashed banana, apple sauce, pumpkin puree, and yogurt were added to increase bread height and volume.  Oat flour was blended with flour from other seeds and grains, including sorghum, millet, amaranth, quinoa, and buckwheat.  A blend of oat and sorghum flour, tapioca and potato starch, mashed banana and low fat vanilla yogurt became standard GF bread recipe ingredients.
    Einkorn
    Einkorn an ancient form of wheat, was separately investigated.  At that time, einkorn was considered potentially safe for celiacs.  Samples of einkorn were obtained from Prime Grains [1] in Saskatchewan, Canada.  Einkorn flour was found to have most of same height, volume, and sinking in the center problems as with any other gluten free flour blend in creating a GF bread.  Einkorn bread, however, does not require the addition of starches.  An oat/einkorn bread recipe similar to an oat/sorghum recipe minus the starches was created, but it became necessary to end the einkorn investigation when new research on einkorn came out showing that einkorn does contain gluten epitopes potentially harmful to celiacs.  However, gluten content in einkorn is very low.  The investigation produced no ill effects from consuming einkorn.  Those with gluten sensitivity rather than celiac disease may well tolerate einkorn with no problems.
    Flaxseed
    Along with the Prime Grains einkorn samples sent from Saskatchewan, samples of golden and brown flaxseed were also sent. Using a coffee grinder to grind the flaxseed, the ground flaxseed was steeped in near-boiling water and used as egg replacer in GF bread recipes.  The steeping releases mucilage from the outer coating of flaxseed to create a thick, slimy emulsion.  Flaxseed mucilage seems to have a synergy with beta glucan in oats, a soluble fiber, forming a hydrocolloid combination that increases bread volume.  When the Prime Grains flaxseed ran out, flaxseed was locally purchased.  It was immediately noticed locally purchased flaxseed produced a much thinner emulsion than did the Prime Grains flaxseed.  The local flaxseed had a much lower mucilage content.  GF bread made with the local flaxseed had less volume and height and more sinking in the center than the Prime Grains flaxseed.  Were it not for the flaxseed samples sent with the einkorn, the great variation in mucilage content in different varieties of flaxseed grown in different localities would have been missed.  Little information is available on the mucilage content of flaxseed grown in North America.  One study was found [2,3,4].
    Prime Grains flaxseed is currently distributed through Farmer Direct Co-op [5] in Regina, Saskatchewan.  High mucilage Farmer Direct Co-op flaxseed has been available from Whole Foods in the bulk foods section.  Amazon's recent Whole Foods purchase may change that as bulk bin labels no longer state "Farmer Direct", only that it originates from Canada.  However, the issue of high mucilage versus low mucilage flaxseed may be moot.  The reason is buckwheat.  Buckwheat, like flaxseed, also releases mucilage.  It turns out buckwheat mucilage also increases bread height and volume, and, when used together with flaxseed, high mucilage flaxseed has no more effect on bread height and volume than lower mucilage flaxseed.  More on buckwheat later.
    Deep Loaf Pans
    GF breads containing eggs and mostly starch can achieve high height and volume without collapsing using an ordinary loaf pan.  But to achieve a full 4 inch loaf height using flaxseed as egg replacer and a low starch content requires a loaf pan with high sides.  The deepest loaf pans available are 4 inch deep pullman loaf pans.  Ideally a pan deeper than 4 inches is desired because GF breads tend to rise above the loaf pan and then fall during baking.  Additionally, during baking, the loaf shrinks and pulls away from the pan side walls, more at the top than the bottom, resulting in a loaf narrowing toward the top rather than straight sides.  Ideally the the sides of the loaf pan should taper so the bottom is narrower than the top.  This cancels out the narrowing of the loaf at the top creating a finished loaf with straight sides.  A small batch of 4-1/2 inch depth by 4-1/4 inch width by 8-1/2 inch and 13 inch length tapered heavy duty 16 gauge solid aluminum loaf pans were custom made by a USA baking pan manufacturer for this author to sell online.  These long-life, heavy duty pans were ideal, but, unfortunately, high cost and price made for underwhelming online sales.  The website was shut down years ago.  However, a cheaper 13 inch long by 4 inch width by 4 inch depth aluminum-coated, folded thin steel pullman loaf pan should be adequate for the recipe which later follows.  The cover is not needed.  The following pans are suggested:  USA Pan 13x4x4 Large Pullman Loaf Pan & Cover 1160PM-1 [6] or Chicago Metallic 44615 Pullman pan,single 13x4x4 [7].
    Xanthan Gum and Konjac Glucomannan
    In the early development of oat and einkorn bread recipes, xanthan gum caused some problems.  The use of xanthan gum alone often produced strange odd loaf shapes with concave sides.  In one case an extra added teaspoon of xanthan gum caused the loaf to balloon well above the 4-1/2 inch deep loaf pan.  When done, the sides of the loaf were sucked inwards and a cross section of loaf had the appearance of a giant mushroom.  Konjac glucomannan powder [8] was then investigated.  Konjac glucomannan is a natural, odorless soluble fiber that is found in the konjac plant and is the most viscous hydrocolloid available.  Konjac used by itself produces a very firm loaf and restricts the bread height and volume.  Xanthan gum produces a softer, more elastic bread.  Konjac used together with xanthan gum have a synergy which allows the firmness of bread to be adjusted depending on their ratio and amounts.  Konjac also "tames" xanthan gum so that the loaf has straight sides instead of turning into a mushroom.  For a long time, 1-1/2 teaspoons each of konjac powder and xanthan gum, a one to one ratio, was used in the standard GF bread recipe.  But this ratio and amount always resulted in at least some sinking in the center of the loaf.  Recalling that additional xanthan gum creates a "mushroom" effect which results in a rounded top, the ratio was changed to 3 teaspoons of xanthan gum and 1 teaspoon konjac powder.  This worked, resulting in a loaf with a slightly rounded or flat top, no longer sinking in the center.  Psyllium husk was never tried as it generally decreases bread volume and height, not the desired effect [9].
    Attempts That Did Not Work
    For years a standard GF bread recipe consisting of oat flour, sorghum flour, tapioca starch, potato starch, flaxseed, banana, low fat vanilla yogurt, molasses, sugar, canola margarine, cinnamon, ginger, salt, yeast, xanthan gum, konjac powder, apple cider vinegar, and water became standard daily fare.  This recipe provided an acceptable GF bread, but was by no means perfect.  It tended to crumble, required delicate handling, sank in the center, and had less volume and height than desired. It was not vegan or dairy free, and its taste could stand improvement.  Deciding it was time for a change, numerous attempts to fix these short-comings were made.  The attempts that failed included using citrus pectin, sugar beet fiber, gum arabic, and aquafaba (liquid from cooked chickpeas).  High methoxyl citrus pectin did succeed in increasing height and volume and reducing crumbling, but its strong, bitter taste made it totally unacceptable.
    Choosing the Best GF Starches - Arrowroot and Potato Starch: Yes - Tapioca: No
    After the previous failures, investigations focused on how choice of starch affects GF bread volume. One especially interesting published research paper looked at GF breads made using a single starch in place of flour [10].  The study compared breads made with wheat, potato, tapioca, corn, and rice starch.  Only wheat and potato starch produced any real bread structure.  Corn starch had some bread structure.  Tapioca and rice starch produced structures too far gone to be fully analyzed in the study.  Tapioca starch produced a shapeless blob.  Rice starch produced a crust circling a large empty center.  The study revealed that potato starch would be the best GF starch for achieving greater volume and preventing sinking in the center.  Unfortunately, the study did not look at arrowroot starch which later was found to be superior to tapioca starch.
    The standard oat/sorghum GF bread recipe used equal amounts of potato and tapioca starch.  Two baking tests with these starches were performed using the standard GF bread recipe.  One test used 3 parts potato to 1 part tapioca starch and the other test used 1 part potato to 3 parts tapioca starch.  The test favoring potato starch produced a higher volume and height bread with reduced center sinking, as expected.  The test favoring tapioca starch resulted in a drop in volume and height with increased center sinking.  Potato starch has a bland, supposedly neutral taste.  In the test favoring potato starch the "bland" taste dominated the entire taste of the bread covering up the taste of all other ingredients including molasses, spices, and banana, oats and sorghum, a totally unacceptable result.  In the test favoring tapioca starch, a slight off taste was noted, but, worse, when toasted, the tapioca caused increased burning of the crust  resulting in a bitter crust taste.  It was concluded one should not make excessive use of potato starch and that tapioca starch may not be the best choice for a starch.  This led to arrowroot starch as the next subject for investigation.
    Arrowroot and tapioca starches appear to be very similar.  They definitely are not.  Two baking tests were performed with arrowroot and potato starch.  One test used 3 parts arrowroot to 1 part potato starch and the other test used equal parts of arrowroot and potato starch.  In the test favoring arrowroot starch, the bread did not sink in the center or lose as much volume as when tapioca starch was favored.  When toasted, the crust did not burn as with tapioca starch or produce any bitterness.  Arrowroot starch also had no off taste as with tapioca starch.  In the test with equal parts arrowroot and potato starch, there was a slight improvement in volume and less center sinking than with tapioca and potato starch at equal parts.  The conclusion was that arrowroot starch is a superior choice over tapioca starch.  Arrowroot may cost more than tapioca starch, but arrowroot starch now replaces tapioca starch as the preferred choice for a perfect GF bread recipe.  Arrowroot starch can be found online in bulk at reasonable prices.
    Buckwheat - The Key to Volume, Height, Amazing Taste and a Bread That Does Not Sink or Crumble
    Still seeking the key to increasing bread volume and height, the world wide web was scoured for ideas.  Intrigued by the impressive volume and height of GF breads made with buckwheat and rice flours by Strange Grains Gluten Free Bakery [11] in Perth, Australia, the question was asked, "Could buckwheat be the key?"  Buckwheat had previously been rejected from consideration in the course of earlier oat bread recipe development due to a strong, unpleasant bitter taste.  It turns out however, toasted buckwheat groats (kasha) were unknowingly used in that earlier trial years ago, a very bad and unfortunate choice.  The world wide web provides many learning opportunities, one being that buckwheat flour does not have to taste awful.
    Buckwheat flour can be ground from three different forms of buckwheat, each having a completely different taste.  The three forms are: 1) whole unhulled buckwheat; 2) raw dehulled buckwheat or buckwheat groats; 3) toasted buckwheat groats or kasha.  The familiar earthy slightly bitter taste comes from the buckwheat hulls.  In fact, some whole buckwheat flour contains added ground hulls for a stronger earthy flavor.  The hulls create a greyish colored flour.  Buckwheat groats are dehulled buckwheat seeds.  Dehulling removes the source of the familiar earthy flavor.  Flour from raw buckwheat groats has a creamy white color and a very mild sourdough rye flavor acceptable to just about everybody except for those who really miss having that earthy buckwheat hull flavor.  Kasha or toasted buckwheat groats, on the other hand, has an extremely strong taste and odor that is popular in some cultures, but absolutely repulsive to most people.  Kasha has a taste slightly suggestive of rye on the plus side but an odor strongly reminiscent of rotting food waste on the minus side.  Kasha can easily be made by stirring raw buckwheat groats in a pan on medium heat for about 5 minutes until evenly brown and "fragrant".  If the "fragrance" drives you out of your house into a freezing snowstorm, then you probably won't like kasha.  Actually, after about a week of storage in a plastic bag in the refrigerator, the odor of rotting waste in bread made with kasha flour dissipates leaving the desirable sourdough rye flavor.
    Buckwheat flour can easily be made by grinding groats or whole buckwheat in a coffee grinder.  Raw buckwheat groat flour is not readily available, especially gluten free certified flour, so a coffee grinder is needed.  Gluten free whole buckwheat and raw buckwheat groats are readily available.  Bob's Red Mill whole buckwheat flour is NOT certified gluten free (its groats are) but Anthony's Goods has certified gluten free whole buckwheat flour.  Whole Foods has raw buckwheat groats in the bulk section at a very reasonable price.  Bulk raw buckwheat groats are available online at reasonable prices. 
    To test if buckwheat was the key to a perfect GF bread, a blend of one cup each of buckwheat, oat, and sorghum flours together with 2/3 cup each of potato and arrowroot starches went into the bread dough for the baking test.  The buckwheat flour made the dough much more workable and elastic.  Into to oven it went.  The result?  Success!  Buckwheat indeed proved to be the missing key.  The bread volume and height increased, reaching just over 4 inches tall.  The use of 3 teaspoons xanthan gum and 1 teaspoon konjac powder contributed to a loaf with a slightly rounded top and absolutely no sinking in the center.  The bread did not crumble.  The rye-like taste was amazing.  Why did buckwheat work?  Buckwheat, like flaxseed, contains mucilage, and that slimy fiber likely gives buckwheat flour its high viscosity and unique baking properties [12].
    Making GF Bread Dairy Free
    The final challenge was making the GF bread recipe vegan and dairy free.  Low fat vanilla yogurt had been used to increase bread volume and protein.  A substitute was needed.  The latest trend in protein supplements is yellow pea isolate [13,14].  Yellow pea's protein amino acid profile compares favorably to that of dairy whey although it is not a totally complete protein.  One study determined yellow pea protein added to GF bread had the highest level of sensory perception consumer acceptance compared to other proteins added to GF bread [15].  Yellow pea protein has also been used as the basis for a dairy free milk made by Ripple Foods [16].  Yellow pea protein is available from a number sources including Anthony's Goods, Bob's Red Mill, and Bulk Food Supplements.  For the new GF bread vegan recipe, 2/3 cup of low fat vanilla yogurt was replaced with 1/4 cup yellow pea protein isolate powder plus 5 oz water.  Yellow pea is a legume.  If you have allergies to soy or peanuts (also legumes) use with caution, though yellow pea is considered to be much less likely to be an allergen.  The yellow pea protein powder can be omitted with little effect on the overall GF bread recipe.  Just replace it with another heaping tablespoon each of buckwheat, oat and, sorghum flours to maintain bread volume.
    Another vegan consideration is choice of oil.  Canola oil, olive oil, coconut oil or a vegan buttery flavored spread like Smart Choice Original or Earth Balance Soy Free can be used.  Smart Choice Original and Earth Balance Soy Free use yellow pea protein in place of dairy whey and sunflower lecithin in place of soy lecithin.
    Molasses or Maple Syrup?
    Molasses is used in the standard GF bread recipe to achieve a satisfying robust rye flavor.  For an alternative subtle, delicate, sweet maple taste, grade A very dark and strong flavor maple syrup can be used in place of the molasses and granulated sugar.  Pure maple syrup is a very pricey ingredient.  The subtle change in taste using maple syrup may not really be worth the syrup's high cost, but the option is included in the recipe below, nonetheless.  Maple syrup is sold in four grades:  grade A golden color and delicate taste; grade A amber color and rich flavor; grade A dark color and robust flavor; and grade A very dark and strong flavor.  Only use grade A very dark and strong flavor maple syrup for baking.  The maple flavor of lighter shades of maple syrup is too weak to be tasted when used in most baked goods.  The money spent using lighter shades of pricey maple syrup will only be wasted.  Grade A very dark and strong flavor maple syrup is mostly used for cooking and not available in most grocery stores.  It is readily available online and direct from maple syrup farms.  Shipping from the east coast to the west coast may cost more than the maple syrup itself.  Try to find an online deal with free shipping.
    RECIPES
    Oat-Sorghum-Buckwheat-Banana-Flaxseed GF Bread
    This recipe produces a 56 ounce (1.588 kg) gluten free bread loaf yielding 28 slices 7/16 inch (11.11 mm) thick.  Preparation time is about 2 hours 15 minutes.  Baking time is 1 hour 40 minutes.
    Kitchen Essentials:
    Coffee grinder (preferably burr-type) Electric mixer (preferably a stand mixer) Mixing bowl Pullman loaf pan, 13 inch x 4 inch x 4 inch (33.02 cm x 10.16 cm x 10.16 cm) Lidded 2 quart/liter (or larger) plastic food container Quart/liter glass or plastic measuring cups (2) 5 ounce (150 ml) glass measuring cup Potato/banana masher, ricer or food processor Hard rubber bowl scraper, specifically Rubbermaid FG1901000000 Scraper 9-1/2 inch 1 inch pastry brush A good set of stainless steel measuring cups and spoons 10 inch x 14 inch (25.4 cm x 35.56 cm) plastic food storage bags with twist ties Cooling rack Dry Ingredients:
    1 cup (240 ml) oat flour 1 cup (240 ml) sorghum flour 1 cup (240 ml) buckwheat flour milled from raw dehulled buckwheat groats 2/3 cup (160 ml) potato starch 2/3 cup (160 ml) arrowroot starch ~3/4 cup (180 ml) (approx.) milled flaxseed freshly ground from 1/2 cup (120 ml) whole flaxseed 1/4 cup (60 ml) yellow pea protein isolate powder (* can be replaced with 1 heaping tablespoon (20 ml) each of oat, sorghum and buckwheat flour) 2 tablespoons (30 ml) granulated sugar (* omit granulated sugar if using maple syrup in place of molasses) 2 tablespoons (30 ml) caraway seed (* optional for deli rye flavor) 1-1/2 (7.5 ml) teaspoons salt 1-1/2 (7.5 ml) teaspoons ground cinnamon 1-1/2 (7.5 ml) teaspoons ground ginger 1 teaspoon (5 ml) baking soda 3 teaspoons (15 ml) xanthan gum 1 teaspoon (5 ml) konjac glucomannan powder 4 teaspoons (20 ml) fast acting yeast Wet Ingredients:
    2 cups (480 ml) cold water to mix with milled flaxseed Additional water to mix with mashed banana and molasses (or maple syrup) to achieve 2 cups total mixture ~1 cup (240 ml) (approx.) mashed ripe banana (2 medium to large bananas) 4-1/2 tablespoons (67.5 ml) molasses, unsulphured, mild (or full flavor) to one's taste  (* Alternately, omit molasses and use 3/4 cup (180 ml) maple syrup, grade A very dark and strong flavor) 2 + 1 tablespoons (30 + 15 ml) canola, olive or melted coconut oil or melted vegan buttery flavored spread Additional oil or vegan spread to grease loaf pan 1 teaspoon (5 ml) apple cider vinegar (as an antimicrobial, anti-mold agent) Directions:
    1. Grind enough raw dehulled buckwheat groats in a coffee grinder to make 1+ cups (260 ml) buckwheat flour.
    2. Grind 1/2 cup (120 ml) whole flaxseed in a coffee grinder.
    3. Place 2 cups (480 ml) COLD water in a quart/liter measuring cup and stir in the ground flaxseed with a fork.
    4. Heat water and flaxseed mixture in a microwave oven until near boiling.  Let steep for 10 to 20 minutes.
    5. Combine all dry ingredients EXCEPT flaxseed into a lidded 2 quart/liter (or larger) plastic food container.
    6. Thoroughly shake and blend dry ingredients together in the food container holding lid down securely.
    7. Mash, rice, or puree 2 medium to large bananas into a separate quart/liter measuring cup.
    8. Using 5 ounce (150 ml) glass measuring cup, warm 4-1/2 tablespoons (67.5 ml) molasses in microwave oven to thin and add to mashed bananas, or, in place of molasses, add 3/4 cup (180 ml) maple syrup to mashed bananas 
    9. Add enough water to the bananas and molasses (or maple syrup) and stir together so that the liquid mixture measures 2 cups (480 ml).
    10. Warm up the banana molasses (or maple syrup) mixture in a microwave oven for 2-3 minutes.
    11. Melt 2 tablespoons (30 ml) of coconut oil or vegan spread in a microwave oven in a small bowl, if these oils used.
    12. Stir banana molasses (or maple syrup) mixture and steeped flaxseed into a mixing bowl.
    13. Add 2 tablespoons (30 ml) oil plus 1 teaspoon (5 ml) apple cider vinegar to the mixing bowl.
    14. Grease a 13 inch x 4 inch x 4 inch pullman loaf pan.  Use a pastry brush for applying liquid oil.
    15. Using an electric mixer with a dough hook, blend liquids for 1-2 minutes at a high medium speed.
    16. Stop mixer and add dry ingredients to the bowl. Start mixing at low speed for 15 seconds, then increase to a low medium speed and mix for 16 minutes to a smooth, thick, moist (not wet), elastic dough consistency.
    17. Preheat oven to 300-325° F (150-160° C).
    18. Using a hard rubber bowl scraper, transfer dough from mixing bowl to the greased pullman loaf pan.
    19. Plunge the hard rubber bowl scraper up and down in the dough to level and even out the dough.
    20. Melt remaining 1 tablespoon (15 ml) coconut oil or vegan spread in the microwave in a small bowl, if oils used.
    21. Use a pastry brush to spread 1 tablespoon (15 ml) oil on top of the dough.  Smooth and round the top of the dough with the pastry brush.
    22. Allow the dough to rise to just above the top of the pullman loaf pan.
    23. Place the pullman loaf pan (uncovered) in the preheated oven and bake for 1 hour 40 minutes maintaining an oven temperature slightly above 300° F (150° C) to avoid burning the crust.
    24. When done, remove loaf pan from oven and allow the loaf to cool in pan for only about 10 minutes to avoid the crust becoming soggy from trapped pan moisture.
    25. Remove loaf from pan, tapping pan bottom corner edges on counter to loosen loaf.  Transfer loaf to cooling rack.
    26. Allow bread to cool to room temperature before slicing the loaf into 2 halves with a sharp, smooth edged (not serrated) slicing knife.
    27. Store each loaf half in 10 inch x 14 inch plastic food storage bags with twist ties and place in the refrigerator.
    28. If you can wait, keep it in the refrigerator overnight before consuming.  The bread taste and texture actually improve overnight as it firms up in the fridge.  When firm, the bread can easily be sliced nearly paper thin without falling apart.  The bread will keep fresh in the fridge for well over 2 weeks and seems to improve in taste as it ages.  
     
    Quick and Easy Gluten Free Mini Pizzas
    Making mini pizzas using bread slices for crusts is nothing new.  But finding a GF bread suitable for a pizza crust is somewhat elusive.  Just finding a GF bread with tall enough slices is a challenge.  The Oat-Sorghum-Buckwheat-Banana-Flaxseed GF Bread presented above works great!  Its full size slices, taste, and texture make for a wonderful mini crust upon which to build an easy, tempting GF mini pizza. 
    The recipe is simple.  Key to this recipe is the use of a cooling rack on top of a metal baking sheet.  The cooling rack raises the pizza crust above the surface of the baking sheet allowing hot oven air to circulate under the crust.  This keeps the crust dry and crispy, preventing the crust from getting soggy due to moisture trapped between the crust and baking sheet. 
    Directions for one 2-slice pizza serving:
    Prepare or slice any toppings you desire. Preheat the oven to 450° F (232° C). Toast 2 slices of Oat-Sorghum-Buckwheat-Banana-Flaxseed GF Bread to a golden brown. Place toast on top of a cooling rack sitting on top of a metal baking sheet. Spread a generous tablespoon of your favorite pizza sauce, canned or homemade, on each slice. Spread a layer of shredded mozzarella cheese on top of the sauce, about 1/3 cup (80 ml) per slice. Spread any other cheeses, such as diced or shredded sharp cheddar, on top of the mozzarella. Add your toppings and a touch more mozzarella. Slide the mini pizzas, cooling rack, and baking sheet together into the hot oven. Bake for 9 minutes until cheese melts and bubbles. Slide the baking sheet and rack out from the oven and transfer pizzas to a plate using a metal spatula. Serve. About Gluten Free Toasters
    Toasting gluten free bread in a typical kitchen 2 or 4-slice toaster cannot be completed in one toasting cycle.  To achieve a golden brown toast requires 2 or even 3 toaster cycles.  Typical toasters provide toasting times of no more than 2-1/2 minutes maximum per cycle.  A few more expensive toasters can toast up to 3 minutes.  It is common for GF breads to require a single cycle toasting time of more than 5 minutes to toast golden brown.  It takes 5 minutes 15 seconds starting in a cold 1000 watt kitchen toaster to toast slices of Oat-Sorghum-Buckwheat-Banana-Flaxseed GF Bread to a golden brown in a single cycle.  
    A toaster-oven can provide a longer single cycle toasting time, but may require 10 minutes or longer to toast GF bread golden brown.  A toaster-oven is less efficient for toasting bread than a 2 or 4-slice toaster because it must heat up a much larger volume than a 2 or 4-slice toaster which has heating elements up against the bread.
    A few manufacturers have provided toasters with a "Gluten Free" button to extend the maximum single cycle toasting time.  These include Crux 2 and 4-Slice Toasters [17] available exclusively at Macy's, Bella Pro Series and Ultimate Elite 2 and 4 Slice Toasters [18,19], and the Williams Sonoma Open Kitchen 2-Slice Stainless Steel Toaster [20].  There are several problems with these toasters.  First, the maximum toasting times on the "Gluten Free" setting are still not long enough.  Maximum toasting times provided by Bella for its Ultimate Elite Toaster are 3 minutes 50 seconds for the "Gluten Free" setting and 4 minutes 20 seconds for the "Gluten Free" + "Frozen" setting.  Second, a gluten-free toaster for celiacs, by necessity, must be used exclusively for GF breads to avoid wheat contamination.  A gluten free toaster does not need a "Gluten Free" button.  A gluten free toaster simply requires a 6 minute maximum toasting time to adequately toast gluten free breads.  One should not have to remember to push a "Gluten Free" button every time they toast bread.  Is it so hard for manufacturers to offer a toaster with a 6 minute timer? 
    For those with some basic electronic technical skills, there is a relatively easy solution to having a toaster with a sufficiently long 6 minute maximum toasting time for GF bread.  The electronic toaster controller board in a toaster can be modified to extend the maximum toasting time by simply replacing a resistor and/or a capacitor on the board.  First one needs to find a toaster in which the controller board can easily be accessed.  It turns out the Nesco T1000 toaster [21] is well-suited to the task.  As toasters go, almost all are made in China and tend to have a high percentage of manufacturing defects per customer product reviews.  The Nesco T1000 is a nice looking, sturdy toaster with nice features.  With the right screwdriver to remove the "tamper proof" screws, the controller board is easy to get to and easy to modify.  The only flaw in the Nesco T1000 is that the toasting time is shorter in a hot Nesco T1000 toaster than the toasting time in a cold Nesco T1000 toaster at the same browning setting, resulting in inconsistent browning.  If toasting always begins in a cold toaster, browning is always consistent, and the browning setting need never be touched to achieve the same results every time.
    Below, instructions on modifying the Nesco T1000 are provided.  A modified Nesco T1000 toaster has been perfectly toasting GF bread daily for over 4 years without a single problem.  These notes are of a technical nature.  Modifying the Nesco T1000 toaster will void the warranty.  Any modifications you perform are done so at your own risk.  If you are not familiar with electronic components or a soldering iron, do not attempt the modification.  Find a friend or someone with the technical skills if you wish to have a modified Nesco T1000 toaster.  

    Nesco T1000 Toaster Tech Notes - How to Increase the Toasting Cycle Time
    Summary:
    The browning control circuit of the Nesco T1000 toaster is designed around the AO201D toaster controller chip, an 8-pin DIP integrated circuit.  Toaster cycle timing is achieved by adjusting the frequency of a timer oscillator on board the AO201D via an external RC circuit.  The frequency is inversely proportional to RC.  Increasing R (resistance) and/or C (capacitance) decreases frequency and increases the toasting cycle time.  R in the Nesco toaster is a summation of a 250k potentiometer (variable resistor) in parallel with a 390k resistor (R6) in series with a 68k thermistor (NTC) in parallel with a 180k resistor (R5).  C is a .033µf capacitor (C3).  The Defrost button increases the toasting cycle time by switching in an additional .0047µf capacitor (C4) in parallel with C3.  The thermistor decreases the resistance as the toaster ambient temperature rises and is supposed to help stabilize the oscillator frequency which is affected by heat.  Ideally, temperature compensation provided by the thermistor and the AO201D should keep the oscillator frequency stable and browning shade the same from batch to batch as the toaster ambient temperature rises.  Unfortunately, in the Nesco toaster, the oscillator frequency becomes unstable and increases as the toaster heats up, significantly reducing the toaster cycle time when the toaster is hot compared to the cycle time of a cold toaster.  Hence, to maintain the same browning shade of a cold toaster, the browning control must be turned up higher when toasting in a hot toaster.  The modifications below will increase the original factory maximum toasting cycle time of about 2.5 minutes to about 5.5 minutes when the toaster is cold.  The Defrost button adds up to 30 seconds or so additional time.  (Note: There is no datasheet available online for the AO201D chip.  A datasheet in chinese is available for a similar MCU CMS12530 chip [22] with some diagrams and tables labelled in english.  The Pericom PT8A2514A toaster controller chip [23] is also of interest with an english datasheet and a timer that can be adjusted from 30 sec to 10 min.)
    Tools Required:
    TA23 triangle head screwdriver (Silverhill Tools ATKTR4 Triangle Head 5 Size Screwdriver Set) #1 Phillips head screwdriver Mini needle nose pliers Mini wire cutter 25 watt taper point soldering iron Desolder bulb, wick, or tool 60/40 Tin/Lead rosin core solder Parts Required:
    .02µf 25v to 100v ceramic or polyester film capacitor 68k 1/4-watt resistor (blue-gray-orange) Disassembly:
    Lay some newspaper or a towel on the work surface. Have a container handy to keep the small screws and parts from getting lost. Remove the crumb tray (which makes 2 tabs on the plastic base that slip under the shell lip more visible). Lay the toaster upside down on the work surface. Using the TA23 screwdriver, remove the tiny black screw from the bottom of the chrome pop-up lever knob. Insert a tool slightly larger than the TA23 screwdriver into the screw hole (the TA27 driver if you have it) and push  the black plastic insert out of the chrome portion of the pop-up lever knob to free the knob from the metal lever. Slip the knob off the metal pop-up lever. Remove the 4 triangle head screws which attach the black plastic base to the metal shell. Separate and lift the metal shell off the plastic base noting the 2 tabs that were under the crumb tray and the 4 metal tabs at the ends of the toaster slots that insert into small slots on top of the inner metal cage. Disconnect the 4-wire cable small white nylon connector connected to the browning control circuit board attached to the toaster shell. Completely separate the base and inner cage from the outer metal shell and set aside the base. Using the #1 Phillips screwdriver, remove the 2 broad head screws securing the insulation board to the browning control circuit board attached to the outer metal shell. Remove the 4 Phillips screws securing the browning control circuit board. Turn the browning control to an extreme so that you can easily realign it on reassembly. Lift up and slip the browning control circuit board from out behind the browning control knob and push buttons (the knob and buttons remain in place and do not have to be removed). Modifications:
    Desolder and remove the 390k resistor (orange-white-yellow) labelled R6 (no replacement needed). Desolder and remove the 180k resistor (brown-gray-yellow) labelled R5.  Replace R5 with a 68k 1/4-watt resistor (blue-gray-orange). Locate capacitor C3 (.033µf) which is numbered 2A333J. Turn the circuit board over and on the back side solder a .02µf 25v to 100v ceramic or polyester film capacitor across the two C3 capacitor connections keeping the .02µf capacitor flat against the circuit board and trimming off excess leads. Reassembly:
    Before reassembling, take a look at the pop-up lever spring mechanism and make sure the small metal plate beneath the lever properly aligns with the electromagnet arms when lowered.  If skewed, twist the the metal plate until it is properly aligned (the plate in my toaster was skewed at the factory which caused a glitch preventing the pop-up lever from latching when first testing the toaster out of the box). Reverse the steps used in disassembly. Be sure to reconnect the 4-wire connecter, use the 2 broad head screws for the insulator board, and carefully align and insert the 4 outer metal shell tabs into the inner metal cage slots. Make sure you properly align the small notch in the black plastic insert with metal pop-up lever notch before pressing it back into the chrome portion of the pop-up knob. Do not over-tighten the triangle head screws, especially the tiny black screw in the pop-up knob (tighten just enough to bottom-out the screw heads). Testing:
    Make sure all functions still work (you don't need bread in the toaster to test). Get a watch and time the toasting cycles at "1" and "6" settings both in hot and cold conditions (give the toaster plenty of time to cool to the touch for cold testing). At "1" you should get about 32 sec hot and 1 min 23 sec cold. At "6" you should get about 4 min 25 sec hot and 5 min 35 sec cold. Pressing the "Defrost" button will add additional time. SOURCES
    Prime Grains Inc. http://www.primegrains.com/about-us.htm Variation of Mucilage Content in the Flaxseed Coat;  Diederichsen A, Raney JP, Duguid SD; Saskatchewan Flax Grower Oct 2003 Vol 5 No 1 https://saskflax.com/quadrant/media/Pdfs/Newsletters/flaxfall03.pdf Variation of mucilage in flax seed and its relationship with other seed characters; Diederichsen A, Raney JP, Duguid SD; Crop Science Feb 2005 Vol 46 No 1, p 365-371 https://dl.sciencesocieties.org/publications/cs/abstracts/46/1/365 Selection for increased seed mucilage content in yellow mustard; J Philip Raney and Gerhard FW Rakow; (Describes method used for determining mucilage content in seed); The Regional Institute, Online Publications http://www.regional.org.au/au/gcirc/4/79.htm Farmer Direct Co-op http://www.farmerdirect.coop/ USA Pan 13x4x4 Large Pullman Loaf Pan & Cover 1160PM-1 https://www.usapan.com/13-x-4-x-4-large-pullman-loaf-pan-and-cover-1160pm Chicago Metallic 44615 Pullman pan,single 13x4x4 https://www.bundybakingsolutions.com/product/44615/ Konjac Glucomannan Powder http://www.konjacfoods.com/product/1.htm The Gluten-Free-Bread Baking-with-Psyllium-Husks-Powder Test by Annalise Roberts http://mygluten-freetable.com/2014/04/the-gluten-free-bread-baking-with-psyllium-husks-powder-test/ Fundamental Study on the Impact of Gluten-Free Starches on the Quality of Gluten-Free Model Breads; Horstmann SW, Belz MC, Heitmann M, Zannini E, Arendt EK; Foods. 2016 Apr 21;5(2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5302342/pdf/foods-05-00030.pdf Strange Grains Gluten Free Bakery https://www.strangegrainsbakery.com.au/gluten-free-bread-perth Technological Properties of Pea and Buckwheat Flours and Their Blends; Ilze Beitane, Gita Krumina-Zemture, Martins Sabovics; Latvia University of Agriculture Research for Rural Development 2015, Annual 21st International Scientific Conference Proceedings Vol 1, p 137-42 http://llufb.llu.lv/conference/Research-for-Rural-Development/2015/LatviaResearchRuralDevel21st_volume1-137-142.pdf Northern Pulse Grower Association Pea Flour Brochure http://www.northernpulse.com/uploads\resources\661\pulse-flour-brochure.pdf USA Dry Pea & Lentil Council Brochures https://www.usapulses.org/brochures Non-gluten proteins as structure forming agents in gluten free bread; Ziobro R, Juszczak L, Witczak M, Korus J; J Food Sci Technol. 2016 Jan;53(1):571-80 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4711467/pdf/13197_2015_Article_2043.pdf Ripple Foods Pea Milk https://www.ripplefoods.com/ Crux Toasters http://www.cruxkitchen.com/crux_toaster_2slice.php Bella Pro-Series Toasters https://bellahousewares.com/products-bella/?taxonomy=productscategories&term=pro-series Bella Ultimate-Elite Toasters https://bellahousewares.com/products-bella/ultimate-elite-collection-2-slice-digital-toaster/ Williams Sonoma Open Kitchen Toaster https://www.williams-sonoma.com/products/willaims-sonoma-open-kitchen-2-slice-stainless-steel-toaster/ Nesco T1000 2-Slice Toaster http://www.nesco.com/products/Small-Appliances/Toasters/TWO-SLICE-TOASTER-THUNDER-GREY/ MCU CMS12530 toaster controller chip (in chinese) http://mcu.com.cn/uploads/file/2015/20150819163253_26043.pdf Pericom PT8A2514A toaster controller chip https://www.diodes.com/assets/Datasheets/PT8A2514A.pdf
    Jefferson Adams
    Image Caption: Image: CC--Ray Swi-hymn
    Celiac.com 06/28/2017 - Announcements from colleges revamping their dining halls to offer gluten-free and allergen-free foods to students, faculty and guests with food allergies or sensitivities are coming at a rapid clip. 
    The latest gluten-free feather in the cap goes to Cornell University, which has restructured its campus dining halls and food services to include 100-percent gluten-, tree nut- and peanut-free kitchens, including offering a new 100-percent plant-based burger at two campus locations.
    Cornell received its gluten-free facility certification from Kitchens with Confidence after cleaning or replacing equipment and meeting the rest of the qualifications for gluten-free certification. Still, even before the certification was official, Cornell had been quietly serving gluten-free dishes for the last two years.  During that time, Risley offered a stir-fry station that served only rice noodles, and also served rich brownies and fluffy biscuits made with gluten-free flour. 
    Risley’s plant-forward, made-from-scratch menu items also include house-made soups and salad dressings, and the introduction of a 100-percent plant-based Impossible Burger at two Cornell Dining eateries on campus. These initiatives are part of Cornell’s commitment to the Menus of Change principles of healthy, sustainable eating, including a focus on whole, minimally processed food and transparency in menu items. 
    As an additional part of that commitment, Cornell Dining will soon implement high-quality ingredient standards in several clean ingredient categories. The department's Clean Ingredients team has already changed more than 50 ingredients currently purchased, and is actively changing recipes at both the AYCTE locations and the retail eateries.
    Cornell Dining now oversees concession operations at Cornell Athletics facilities, while Cornell Catering manages events at Moakley House, offering snacks, meals and beverages at Big Red games, the winter season at Bartels Hall, and adding more concession sites for Cornell's spring sports season. 
    Meanwhile, Cornell Concessions will manage events at Moakley House, the clubhouse at Cornell University's Robert Trent Jones Golf Course. Students, faculty and visitors at Cornell can look for these gluten-free and other menu changes at all campus food locations and events.
    Look for stories like this to become commonplace as more colleges and universities provide accommodations for students, faculty and visitors with food allergies and sensitivities.
    Jefferson Adams
    Image Caption: Death Valley. Image: CC--Peretz Partensky
    Celiac.com 06/27/2018 - Data shows that since celiac blood screening came into use, people with celiac disease are living longer, and dying of things not-related to celiac disease.
    With screening tests for celiac disease becoming more common, researchers suspected that milder cases of celiac disease coming to diagnosis might bring a reduced risk of mortality for celiac patients. However, there was no consensus for that opinion, so researchers Geoffrey K T Holmes and Andrew Muirhead of the Royal Derby Hospital, and the Department of Public Health for the Derby City Council, Derby, UK., recently set out to re-examine the issue in a larger number of patients for a further 8 years.
    For their study, the researchers prospectively followed celiac disease patients from Southern Derbyshire, UK, from 1978 to 2014, and included those diagnosed by biopsy and serology. For each patient, the researchers determined cause of death, and calculated standardized mortality ratios for all deaths, cardiovascular disease, malignancy, accidents and suicides, respiratory and digestive disease. 
    To avoid ascertainment bias, they focused analysis on the post-diagnosis period that included follow-up time beginning 2 years from the date of celiac disease diagnosis. They stratified patients by date of diagnosis to reflect increasing use of serological methods. Total all-cause mortality increase was 57%, while overall mortality declined during the celiac blood test era.
    Mortality from cardiovascular disease, specifically, decreased significantly over time, which means that fewer people with celiac disease were dying from heart attacks. Death from respiratory disease significantly increased in the post-diagnosis period, which indicates that people are living long enough to have lung problems.  The standardized mortality ratio for non-Hodgkin’s lymphoma was 6.32, for pneumonia 2.58, for oesophageal cancer 2.80 and for liver disease 3.10. 
    Overall, celiac blood tests have lowered the risk of mortality in celiac disease. The number of celiac patients dying after diagnosis decreased by three times over the past three decades. Basically, people with celiac disease are living longer, and dying of things unrelated to celiac disease, which is good news.
    The researchers see this data as an opportunity to improve celiac disease survival rates further by promoting pneumonia vaccination programs, and more swift, aggressive treatments for celiac patients with liver disease.
    Source:
    BMJ Open Gastroenterology
    Jefferson Adams
    Image Caption: Image: CC--Pedro Ribeiro Simões
    Celiac.com 06/26/2018 - Gliadin is an alcohol-soluble wheat protein that is toxic for people with celiac disease. Gliadin toxicity is not lowered by digestion with gastro-pancreatic enzymes. It’s been documented that an innate immunity to gliadin plays a key role in the development of celiac disease. This is mainly due to an immune response that induces epithelial stress and reprograms intraepithelial lymphocytes into natural killer (NK)-like cells, leading to enterocyte apoptosis and an increase in epithelium permeability.
    A team of researchers recently set out to elaborate on the role played by innate immunity to gliadin in the development of celiac disease by assessing the in vitro effects of enzymatic digested gliadin on the functionality of the process of autophagy, or natural cell destruction.
    The research team included Federico Manai, Alberto Azzalin, Fabio Gabriele, Carolina Martinelli, Martina Morandi, Marco Biggiogera, Mauro Bozzola, and Sergio Comincini. They are variously affiliated with the Department of Biology and Biotechnology, and with the Pediatrics and Adolescentology Unit in the Department of Internal Medicine and Therapeutics at University of Pavia, Fondazione IRCCS, Pavia, Italy.
    They reported recently that the administration of enzymatically digested gliadin (PT-gliadin) in in Caco-2 cells significantly reduced the expression of the autophagy-related marker LC3-II. Moreover, analysis by electron and fluorescent microscope suggests a compromised functionality of the autophagosome apparatus. 
    The team established the rescue of the dysregulated autophagy process, along with a reduction of PT-gliadin toxicity, by using a starvation induction protocol, and by 3-methyladenine administration. Rapamycin, a well-known autophagy inducer, did not trigger significant improvement in the clearance of extra- and intra-cellular fluorescent PT-gliadin amounts. 
    These results show the potential role of the autophagy process in the degradation and reduction of extra-cellular gliadin peptides, and provides new molecular targets for counteracting adverse gliadin reactions in celiac patients.
    Source:
    Int J Mol Sci. 2018 Feb; 19(2): 635. doi:  10.3390/ijms19020635
    Jefferson Adams
    Image Caption: Image: CC--Conor Lawless
    Celiac.com 06/25/2018 - The latest studies show that celiac disease now affects 1.2% of the population. That’s millions, even tens of millions of people with celiac disease worldwide. The vast majority of these people remain undiagnosed. Many of these people have no clear symptoms. Moreover, even when they do have symptoms, very often those symptoms are atypical, vague, and hard to pin on celiac disease.
    Here are three ways that you can help your healthcare professionals spot celiac disease, and help to keep celiacs gluten-free: 
    1) Your regular doctor can help spot celiac disease, even if the symptoms are vague and atypical.
    Does your doctor know that anemia is one of the most common features of celiac disease? How about neuropathy, another common feature in celiac disease? Do they know that most people diagnosed with celiac disease these days have either no symptoms, or present atypical symptoms that can make diagnosis that much harder? Do they know that a simple blood test or two can provide strong evidence for celiac disease?
    People who are newly diagnosed with celiac disease are often deficient in calcium, fiber, folate, iron, magnesium, niacin, riboflavin, vitamin B12, vitamin D, and zinc. Deficiencies in copper and vitamin B6 are less common, but still possible. Also, celiac disease is a strong suspect in many patients with unexplained nutritional anemia. Being aware of these vague, confusing symptoms of celiac disease can help people get bette advice, and hopefully speed up a diagnosis.
    2) Your dentist can help spot celiac disease
    Does your dentist realize that dental enamel defects could point to celiac disease? Studies show that dental enamel defects can be a strong indicator of adult celiac disease, even in the absence of physical symptoms. By pointing out dental enamel defects that indicate celiac disease, dentists can play an important role in diagnosing celiac disease.
    3) Your pharmacist can help keep you gluten-free
    Does your pharmacist know which medicines and drugs are gluten-free, and which might contain traces of gluten? Pharmacists can be powerful advocates for patients with celiac disease. They can check ingredients on prescription medications, educate patients to help them make safer choices, and even speak with drug manufacturers on patients’ behalf.
    Pharmacists can also help with information on the ingredients used to manufacture various vitamins and supplements that might contain wheat.
    Understanding the many vague, confusing symptoms of celiac disease, and the ways in which various types of health professionals can help, is a powerful tool for helping to diagnose celiac disease, and for managing it in the future. If you are suffering from one or more of these symptoms, and suspect celiac disease, be sure to gather as much information as you can, and to check in with your health professionals as quickly as possible.

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    Christina Kantzavelos
    Celiac.com 07/20/2018 - During my Vipassana retreat, I wasn’t left with much to eat during breakfast, at least in terms of gluten free options. Even with gluten free bread, the toasters weren’t separated to prevent cross contamination. All of my other options were full of sugar (cereals, fruits), which I try to avoid, especially for breakfast. I had to come up with something that did not have sugar, was tasty, salty, and gave me some form of protein. After about four days of mixing and matching, I was finally able to come up with the strangest concoction, that may not look the prettiest, but sure tastes delicious. Actually, if you squint your eyes just enough, it tastes like buttery popcorn. I now can’t stop eating it as a snack at home, and would like to share it with others who are looking for a yummy nutritious snack. 
    Ingredients:
    4 Rice cakes ⅓ cup of Olive oil  Mineral salt ½ cup Nutritional Yeast ⅓ cup of Sunflower Seeds  Intriguing list, right?...
    Directions (1.5 Servings):
    Crunch up the rice into small bite size pieces.  Throw a liberal amount of nutritional yeast onto the pieces, until you see more yellow than white.  Add salt to taste. For my POTS brothers and sisters, throw it on (we need an excess amount of salt to maintain a healthy BP).  Add olive oil  Liberally sprinkle sunflower seeds. This is what adds the protein and crunch, so the more, the tastier.  Buen Provecho, y Buen Camino! 
    Jefferson Adams
    Celiac.com 07/19/2018 - Maintaining a gluten-free diet can be an on-going challenge, especially when you factor in all the hidden or obscure gluten that can trip you up. In many cases, foods that are naturally gluten-free end up contain added gluten. Sometimes this can slip by us, and that when the suffering begins. To avoid suffering needlessly, be sure to keep a sharp eye on labels, and beware of added or hidden gluten, even in food labeled gluten-free.  Use Celiac.com's SAFE Gluten-Free Food List and UNSAFE Gluten-free Food List as a guide.
    Also, beware of these common mistakes that can ruin your gluten-free diet. Watch out for:
    Watch out for naturally gluten-free foods like rice and soy, that use gluten-based ingredients in processing. For example, many rice and soy beverages are made using barley enzymes, which can cause immune reactions in people with celiac disease. Be careful of bad advice from food store employees, who may be misinformed themselves. For example, many folks mistakenly believe that wheat-based grains like spelt or kamut are safe for celiacs. Be careful when taking advice. Beware of cross-contamination between food store bins selling raw flours and grains, often via the food scoops. Be careful to avoid wheat-bread crumbs in butter, jams, toaster, counter surface, etc. Watch out for hidden gluten in prescription drugs. Ask your pharmacist for help about anything you’re not sure about, or suspect might contain unwanted gluten. Watch out for hidden gluten in lotions, conditioners, shampoos, deodorants, creams and cosmetics, (primarily for those with dermatitis herpetaformis). Be mindful of stamps, envelopes or other gummed labels, as these can often contain wheat paste. Use a sponge to moisten such surfaces. Be careful about hidden gluten in toothpaste and mouthwash. Be careful about common cereal ingredients, such as malt flavoring, or other non-gluten-free ingredient. Be extra careful when considering packaged mixes and sauces, including soy sauce, fish sauce, catsup, mustard, mayonnaise, etc., as many of these can contain wheat or wheat by-product in their manufacture. Be especially careful about gravy mixes, packets & canned soups. Even some brands of rice paper can contain gluten, so be careful. Lastly, watch out for foods like ice cream and yogurt, which are often gluten-free, but can also often contain added ingredients that can make them unsuitable for anyone on a gluten-free diet. Eating Out? If you eat out, consider that many restaurants use a shared grill or shared cooking oil for regular and gluten-free foods, so be careful. Also, watch for flour in otherwise gluten-free spices, as per above. Ask questions, and stay vigilant.
    Jefferson Adams
    Celiac.com 07/18/2018 - Despite many studies on immune development in children, there still isn’t much good data on how a mother’s diet during pregnancy and infancy influences a child’s immune development.  A team of researchers recently set out to assess whether changes in maternal or infant diet might influence the risk of allergies or autoimmune disease.
    The team included Vanessa Garcia-Larsen, Despo Ierodiakonou, Katharine Jarrold, Sergio Cunha,  Jennifer Chivinge, Zoe Robinson, Natalie Geoghegan, Alisha Ruparelia, Pooja Devani, Marialena Trivella, Jo Leonardi-Bee, and Robert J. Boyle.
    They are variously associated with the Department of Undiagnosed Celiac Disease More Common in Women and Girls International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America; the Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom; the Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom; the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom; the Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom; the Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom; and Stanford University in the USA.
    Team members searched MEDLINE, Excerpta Medica dataBASE (EMBASE), Web of Science, Central Register of Controlled Trials (CENTRAL), and Literatura Latino Americana em Ciências da Saúde (LILACS) for observational studies conducted between January 1946 and July 2013, and interventional studies conducted through December 2017, that evaluated the relationship between diet during pregnancy, lactation, or the first year of life, and future risk of allergic or autoimmune disease. 
    They then selected studies, extracted data, and assessed bias risk. They evaluated data using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). They found 260 original studies, covering 964,143 participants, of milk feeding, including 1 intervention trial of breastfeeding promotion, and 173 original studies, covering 542,672 participants, of other maternal or infant dietary exposures, including 80 trials of 26 maternal, 32 infant, or 22 combined interventions. 
    They found a high bias risk in nearly half of the more than 250 milk feeding studies and in about one-quarter of studies of other dietary exposures. Evidence from 19 intervention trials suggests that oral supplementation with probiotics during late pregnancy and lactation may reduce risk of eczema. 44 cases per 1,000; 95% CI 20–64), and 6 trials, suggest that fish oil supplementation during pregnancy and lactation may reduce risk of allergic sensitization to egg. GRADE certainty of these findings was moderate. 
    The team found less evidence, and low GRADE certainty, for claims that breastfeeding reduces eczema risk during infancy, that longer exclusive breastfeeding is associated with reduced type 1 diabetes mellitus, and that probiotics reduce risk of infants developing allergies to cow’s milk. 
    They found no evidence that dietary exposure to other factors, including prebiotic supplements, maternal allergenic food avoidance, and vitamin, mineral, fruit, and vegetable intake, influence risk of allergic or autoimmune disease. 
    Overall, the team’s findings support a connection between the mother’s diet and risk of immune-mediated diseases in the child. Maternal probiotic and fish oil supplementation may reduce risk of eczema and allergic sensitization to food, respectively.
    Stay tuned for more on diet during pregnancy and its role in celiac disease.
    Source:
    PLoS Med. 2018 Feb; 15(2): e1002507. doi:  10.1371/journal.pmed.1002507
    Jefferson Adams
    Celiac.com 07/17/2018 - What can fat soluble vitamin levels in newly diagnosed children tell us about celiac disease? A team of researchers recently assessed fat soluble vitamin levels in children diagnosed with newly celiac disease to determine whether vitamin levels needed to be assessed routinely in these patients during diagnosis.
    The researchers evaluated the symptoms of celiac patients in a newly diagnosed pediatric group and evaluated their fat soluble vitamin levels and intestinal biopsies, and then compared their vitamin levels with those of a healthy control group.
    The research team included Yavuz Tokgöz, Semiha Terlemez and Aslıhan Karul. They are variously affiliated with the Department of Pediatric Gastroenterology, Hepatology and Nutrition, the Department of Pediatrics, and the Department of Biochemistry at Adnan Menderes University Medical Faculty in Aydın, Turkey.
    The team evaluated 27 female, 25 male celiac patients, and an evenly divided group of 50 healthy control subjects. Patients averaged 9 years, and weighed 16.2 kg. The most common symptom in celiac patients was growth retardation, which was seen in 61.5%, with  abdominal pain next at 51.9%, and diarrhea, seen in 11.5%. Histological examination showed nearly half of the patients at grade Marsh 3B. 
    Vitamin A and vitamin D levels for celiac patients were significantly lower than the control group. Vitamin A and vitamin D deficiencies were significantly more common compared to healthy subjects. Nearly all of the celiac patients showed vitamin D insufficiency, while nearly 62% showed vitamin D deficiency. Nearly 33% of celiac patients showed vitamin A deficiency. 
    The team saw no deficiencies in vitamin E or vitamin K1 among celiac patients. In the healthy control group, vitamin D deficiency was seen in 2 (4%) patients, vitamin D insufficiency was determined in 9 (18%) patients. The team found normal levels of all other vitamins in the healthy group.
    Children with newly diagnosed celiac disease showed significantly reduced levels of vitamin D and A. The team recommends screening of vitamin A and D levels during diagnosis of these patients.
    Source:
    BMC Pediatrics
    Jefferson Adams
    Celiac.com 07/16/2018 - Did weak public oversight leave Arizonans ripe for Theranos’ faulty blood tests scam? Scandal-plagued blood-testing company Theranos deceived Arizona officials and patients by selling unproven, unreliable products that produced faulty medical results, according to a new book by Wall Street Journal reporter, whose in-depth, comprehensive investigation of the company uncovered deceit, abuse, and potential fraud.
    Moreover, Arizona government officials facilitated the deception by providing weak regulatory oversight that essentially left patients as guinea pigs, said the book’s author, investigative reporter John Carreyrou. 
    In the newly released "Bad Blood: Secrets and Lies in a Silicon Valley Startup," Carreyrou documents how Theranos and its upstart founder, Elizabeth Holmes, used overblown marketing claims and questionable sales tactics to push faulty products that resulted in consistently faulty blood tests results. Flawed results included tests for celiac disease and numerous other serious, and potentially life-threatening, conditions.
    According to Carreyrou, Theranos’ lies and deceit made Arizonans into guinea pigs in what amounted to a "big, unauthorized medical experiment.” Even though founder Elizabeth Holmes and Theranos duped numerous people, including seemingly savvy investors, Carreyrou points out that there were public facts available to elected officials back then, like a complete lack of clinical data on the company's testing and no approvals from the Food and Drug Administration for any of its tests.
    SEC recently charged the now disgraced Holmes with what it called a 'years-long fraud.’ The company’s value has plummeted, and it is now nearly worthless, and facing dozens, and possibly hundreds of lawsuits from angry investors. Meantime, Theranos will pay Arizona consumers $4.65 million under a consumer-fraud settlement Arizona Attorney General Mark Brnovich negotiated with the embattled blood-testing company.
    Both investors and Arizona officials, “could have picked up on those things or asked more questions or kicked the tires more," Carreyrou said. Unlike other states, such as New York, Arizona lacks robust laboratory oversight that would likely have prevented Theranos from operating in those places, he added.
    Stay tuned for more new on how the Theranos fraud story plays out.
    Read more at azcentral.com.