Frequently Asked Questions About Celiac Disease

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    Scott Adams
    What is Celiac Disease and the Gluten-Free Diet?
    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
    Jefferson Adams
    Can a Gluten-Free Diet Normalize Vitamin D Levels for Celiac Patients?
    Image Caption: Image: CC--NASA/Goddard/SDO
    Celiac.com 08/16/2018 - What is the significance of vitamin D serum levels in adult celiac patients? A pair of researchers recently set out to assess the value and significance of 25(OH) and 1,25(OH) vitamin D serum levels in adult celiac patients through a comprehensive review of medical literature.
    Researchers included F Zingone and C Ciacci are affiliated with the Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; and the Celiac Center, AOU San Giovanni di Dio e Ruggi di Aragona, University of Salerno, Department of Medicine and Surgery, Salerno, Italy. 
    Within the wide spectrum of symptoms and alteration of systems that characterizes celiac disease, several studies indicate a low-level of vitamin D, therefore recent guidelines suggest its evaluation at the time of diagnosis. This review examines the data from existing studies in which vitamin D has been assessed in celiac patients. 
    Our review indicates that most of the studies on vitamin D in adult celiac disease report a 25 (OH) vitamin D deficiency at diagnosis that disappears when the patient goes on a gluten-free diet, independently of any supplementation. Instead, the researchers found that levels of calcitriol, the active 1,25 (OH) form of vitamin D, fell within the normal range at the time of celiac diagnosis. 
    Basically, their study strongly suggests that people with celiac disease can recover normal vitamin D levels through a gluten-free diet, without requiring any supplementation.
    Source:
    Dig Liver Dis. 2018 Aug;50(8):757-760. doi: 10.1016/j.dld.2018.04.005. Epub 2018 Apr 13.  
    Jefferson Adams
    Could Gluten-Free Food Be Hurting Your Dog?
    Image Caption: Image: CC--angela n.
    Celiac.com 08/15/2018 - Grain-free food has been linked to heart disease in dogs. A canine cardiovascular disease that has historically been seen in just a few breeds is becoming more common in other breeds, and one possible culprit is grain-free dog food. 
    The disease in question is called canine dilated cardiomyopathy (DCM), and often results in congestive heart failure. DCM is historically common in large dogs such as Great Danes, Newfoundlands, Irish Wolfhounds, Saint Bernards and Doberman Pinschers, though it is also affects some Cocker Spaniels.  Numerous cases of DCM have been reported in smaller dogs, whose primary source of nutrition was food containing peas, lentils, other legume seeds or potatoes as main ingredients. These reported atypical DCM cases included Golden and Labrador Retrievers, a Whippet, a Shih Tzu, a Bulldog and Miniature Schnauzers, as well as mixed breeds. 
    As a result, the U.S. Food and Drug Administration's Center for Veterinary Medicine, along with a group of veterinary diagnostic laboratories, is investigating the possible link between DCM and pet foods containing seeds or potatoes as main ingredients. The good news is that in cases where the dog suffers no genetic component, and the disease is caught early, simple veterinary treatment and dietary change may improve heart function.
    According to Nutritional Outlook, an industry publication for makers of dietary supplements and healthy foods and beverages, there is a growing market for “free from” foods for dogs, especially gluten-free and grain-free formulations. In 2017, about one in five dog foods launched was gluten-free. So, do dogs really need to eat grain-free or gluten-free food? Probably not, according to PetMD, which notes that many pet owners are simply projecting their own food biases when choosing dog food.
    Genetically, dogs are well adapted to easily digest grains and other carbohydrates. Also, beef and dairy remain the most common allergens for dogs, so even dogs with allergies are unlikely to need to need grain-free food. 
    So, the take away here seems to be that most dogs don’t need grain-free or gluten-free food, and that it might actually be bad for the dog, not good, as the owner might imagine.
    Stay tuned for more on the FDA’s investigation and any findings they make.
    Read more at Bizjournals.com
     
    Jefferson Adams
    Did You Miss the Gluten-Free Fireworks This Past Fourth of July?
    Image Caption: Image: CC--MATSUOKA Kohei
    Celiac.com 08/14/2018 - Occasionally, Celiac.com learns of an amusing gluten-free story after the fact. Such is the case of the “Gluten-Free Fireworks.” 
    We recently learned about a funny little event that happened leading up to Fourth of July celebrations in the town of Springdale in Northwest Arkansas. It seems that a sign advertising "Gluten Free Fireworks" popped up near a fireworks stand on interstate 49 in Springdale. 
    In case you missed the recent dose of Fourth of July humor, in an effort to attract customers and provide a bit of holiday levity, Pinnacle Fireworks put up a sign advertising "gluten-free fireworks.” 
    The small company is owned by Adam Keeley and his father. "A lot of the people that come in want to crack a joke right along with you," Keeley said. "Every now and then, you will get someone that comes in and says so fireworks are supposed to be gluten-free right? Have I been buying fireworks that have gluten? So then I say no, no they are gluten-free. It's just a little fun."
    Keeley said that their stand saw a steady flow of customers in the week leading up to the Fourth. In addition to selling “gluten-free” fireworks, each fireworks package sold by Pinnacle features a QR code. The code can be scanned with a smartphone. The link leads to a video showing what the fireworks look like.
    We at Celiac.com hope you and your family had a safe, enjoyable, and, yes, gluten-free Fourth of July. Stay tuned for more on gluten-free fireworks and other zany, tongue-in-cheek stories.
    Read more at kark.com
     
    Jefferson Adams
    Stress-Related Disorders Associated with Higher Risk for Autoimmune Disease
    Image Caption: Image: CC--Jacob Bøtter
    Celiac.com 08/13/2018 - It’s not uncommon for people to have psychiatric reactions to stressful life events, and these reactions may trigger some immune dysfunction. Researchers don’t yet know whether such reactions increase overall risk of autoimmune disease.
    Are psychiatric reactions induced by trauma or other life stressors associated with subsequent risk of autoimmune disease? Are stress-related disorders significantly associated with risk of subsequent autoimmune disease?
    A team of researchers recently set out to determine whether there is an association between stress-related disorders and subsequent autoimmune disease. The research team included Huan Song, MD, PhD; Fang Fang, MD, PhD; Gunnar Tomasson, MD, PhD; Filip K. Arnberg, PhD; David Mataix-Cols, PhD; Lorena Fernández de la Cruz, PhD; Catarina Almqvist, MD, PhD; Katja Fall, MD, PhD; Unnur A. Valdimarsdóttir, PhD.
    They are variously affiliated with the Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; the Department of Rheumatology, University Hospital, Reykjavík, Iceland; the Centre for Rheumatology Research, University Hospital, Reykjavík, Iceland; the National Centre for Disaster Psychiatry, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden; the Stress Research Institute, Stockholm University, Stockholm, Sweden; the Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; the Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; the Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden; the Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
    The team conducted a Swedish register-based retrospective cohort study that included 106, 464 patients with stress-related disorders, 1,064 ,640 matched unexposed individuals, and 126 ,652 full siblings to determine whether a clinical diagnosis of stress-related disorders was significantly associated with an increased risk of autoimmune disease.
    The team identified stress-related disorder and autoimmune diseases using the National Patient Register. They used Cox model to estimate hazard ratios (HRs) with 95% CIs of 41 autoimmune diseases beyond 1 year after the diagnosis of stress-related disorders, controlling for multiple risk factors.
    The data showed that being diagnosed with a stress-related disorder, such as post-traumatic stress disorder, acute stress reaction, adjustment disorder, and other stress reactions, was significantly associated with an increased risk of autoimmune disease, compared with matched unexposed individuals. The team is calling for further studies to better understand the associations and the underlying factors.
    Source:
    JAMA. 2018;319(23):2388-2400. doi:10.1001/jama.2018.7028  
    Jefferson Adams
    Gluten-Free Bacon-Wrapped Chicken Breasts
    Image Caption: Image: CC--megan.chromik
    Celiac.com 08/11/2018 - Need a quick, easy, reliable gluten-free dish that will satisfy everyone and leave the cook with plenty of time to relax? This recipe is sure to do the trick. Best of all, it's super easy. Just grab some chicken breasts, season them, hit them with a sprig of rosemary, wrap some bacon around them, and chuck them on the grill and call it dinner. Okay, you can add some rice and veggies.
    Ingredients:
    4 skinless, boneless chicken breast halves 4 thick slices bacon 4 teaspoons garlic powder 4 small sprigs fresh rosemary salt and pepper to taste Directions:
    Heat an outdoor grill to medium-high heat, and lightly oil the grate.
    Sprinkle 1 teaspoon garlic powder on a chicken breast and season with salt and pepper. 
    Place a rosemary sprig on each chicken breast. 
    Wrap the bacon around the chicken and the rosemary. 
    Hold bacon in place with a toothpick or extra rosemary stem.
    Cook the chicken breasts until no longer pink in the center and the juices run clear, about 8 minutes per side. 
    Keep an eye out for any grill flare ups from the bacon grease. 
    Remove the toothpicks and serve with steamed rice and your favorite vegetables for a winning meal.
    Connie Sarros
    Five-Minute Healthy Breakfasts
    Image Caption: Image: CC--Karen
    Celiac.com 08/10/2018 - You’ve heard for years that it’s wise to start your day with a healthy breakfast.  Eating food first thing in the morning gets your metabolism revved so you have energy throughout the day.  There’s also the issue of incorporating healthy foods into your first meal of the day.  Ideally, every meal should include fiber and foods from a variety of food groups.  But the reality is that most people don’t have time in the morning to create an involved meal.  You’re busy getting ready for work, packing the kids’ lunches and trying to get everyone out of the door on time.  
    Don’t fret.  The task of preparing a healthy breakfast just got easier.  You can make 5-minute breakfasts and, with a little bit of planning, you can sneak fiber into those meals without spending a lot of extra time with preparation.  An ideal breakfast will include whole grains (from gluten-free cereals, breads, muffins, or uncontaminated oats), a low-fat dairy item (1% milk, low-fat yogurt, or low-fat cheese), and a source of protein (such as peanut butter or eggs).  Adding fruit is a plus.  
    If you can tolerate uncontaminated oats, make a bowl of oatmeal and add a little extra fiber by stirring in chopped walnuts and dried cranberries.  If you like scrambled eggs, toss some fresh spinach (sliced into thin strips), 1 chopped canned artichoke heart, two tablespoons crumbled feta cheese, and a dash of Italian seasoning to the egg as it cooks.  
    If you have time on weekends to make healthy gluten-free pancakes (which  means that you added perhaps flax seed meal or shredded apples or something that qualifies as fiber to the batter), then freeze the pancakes between sheets of wax paper, place them in a freezer bag, and freeze so they’ll be handy on busy weekday mornings.  If you don’t have time to make them prior to need, you can always use commercial frozen gluten-free pancakes.  In a bowl, mix together a few raisins, half of a chopped pear or apple, a few dashes of cinnamon and a couple of tablespoons of chopped walnuts.  Spoon this mixture down the centers of two toasted (or microwaved) pancakes, drizzle each with 1 teaspoon of pancake or maple syrup, then fold in the sides of the pancakes to make two breakfast sandwiches.
    Brown rice is brown because the bran layer is still on the rice, and the bran layer is the part that’s so high in fiber.  White rice is much lower in fiber and has less nutritional value.  Brown rice isn’t just for dinner anymore.  It offers a nice breakfast alternative from traditional hot cereals.  The next time you make brown rice for dinner, make a little extra and save some for breakfast the next morning.  In the A.M., mix the rice (about 1 cup) with a few chopped pecans, a few raisins, 1/2 cup milk, 3 tablespoons pancake syrup, a dash each of vanilla and cinnamon, then microwave the mixture for 1 minute, stirring once after 30 seconds.  Let it sit for 30 seconds to thicken before eating.  Or stir together 1 cup cooked brown rice, 1/4 teaspoon cinnamon, 1/2 navel orange diced, some chopped dates, dried cranberries, and shredded coconut; heat this in the microwave and then top it off with 1/2 cup low-fat vanilla yogurt.
    Just a note about using the microwave—it’s not an exact science.  Different ovens have different power levels so what cooks in 30 seconds in one person’s microwave may take 45 seconds in someone else’s unit.  Unless you want the food to splatter all over the sides of the oven, you’ll need to cover any liquids or soft foods with waxed paper.  
    There will be days when you don’t have time to sit down at the table and enjoy a leisurely breakfast.  On these days, make a “grab-and-go” breakfast that you can take with you.  Gluten-free wraps keep for several weeks in the refrigerator and they make great fill-and-go containers on busy mornings.  Spread a wrap with peanut butter, sprinkle some fortified gluten-free dry cereal on top, then drizzle with a teaspoon of pancake syrup; roll up the wrap and you have the perfect dashboard dining breakfast to eat on the way to work.  Or scramble an egg, spoon it down the center of the wrap, and then top it off with a little salsa and pepper-jack cheese before rolling it up. If you only have three minutes before you have to leave the house, spoon some low-fat cottage cheese into a cup, stir in a dash of cinnamon, top with a little low-fat gluten-free granola or fortified dry gluten-free cereal, sprinkle berries or chopped peaches over the top, grab a spoon, and you’re ready to go!
    Smoothies can be made in literally one minute.  Toss some frozen raspberries into a blender, add a 12-ounce container of low-fat lemon yogurt, a little milk, and two teaspoons of vanilla; blend, then pour the mixture into a large plastic cup.
    If you oversleep, don’t panic.  Have some back-up foods on hand that you can grab and eat en route to work, like a gluten-free protein bar and a banana, or a bag of nuts and dried fruit, or flax seed crackers with a handful of cheese cubes, or toss some gluten-free granola over a container of yogurt and grab a spoon to take along.
    All of the above suggestions can be made in five minutes or less.  Take the time to start your day off with a healthy breakfast—you deserve to do that for yourself and for your family.
    Apple English Muffins by Connie Sarros
    This recipe is from my newly-released book Student’s Vegetarian Cookbook for Dummies.  While this isn’t a gluten-free cookbook, most of the recipes are naturally gluten-free or can very easily be converted to gluten-free.  
    Preparation time:  4 minutes.  Cooking time:  30 seconds.  Yield:  1 serving
    Ingredients:
    1 tablespoon peanut butter  1 gluten-free English muffin, toasted  1/8 large apple, peeled, cored and sliced thin ½ teaspoon butter  ¾ teaspoon brown sugar 1/8 teaspoon cinnamon Directions:
    Spread peanut butter on one toasted English muffin half.  Lay the apple slices on top. In a small microwave safe bowl, heat the butter in the microwave on high for 15 seconds.  Stir in the brown sugar and cinnamon then nuke for another 15 seconds.  Stir until smooth.  (If necessary, pop it back into the microwave until the brown sugar melts).   Drizzle the cinnamon mixture over the apple slices then place the second half of the English muffin on top. Note:  If you’re out of apples, use a pear, ripe peach or nectarine, mango, or even a banana.
    Jefferson Adams
    Can a New Gluten-Free Cricket-Flour Cookbook Turn Americans on to Eating Bugs?
    Image Caption: Image: CC--Katja Schulz
    Celiac.com 08/09/2018 - Whatever one might say about crawfish, shrimp and crustaceans in general, Americans don’t typically eat bugs. Can a former Ralph Lauren marketing executive turn the world on to flour made from crickets?
    Over the last few years, Americans have been presented with a buffet of alternative proteins and meals. Robyn Shapiro’s company, Seek, has created all-purpose, gluten-free, and Paleo blended flours, which can be used cup for cup in any recipe calling for flour. 
    The company, which makes pure cricket powder for smoothies, ice creams, and other liquid-based foods, is now selling cinnamon-almond crunch cricket protein and snack bites. To get the public interested in its cricket protein and cricket flour products, Shapiro has collaborated with famous chefs to create recipes for The Cricket Cookbook. 
    The book’s cast includes La Newyorkina chef Fany Gerson, a Mexico City native known for her cricket sundaes; noted Sioux chef and cookbook author Sean Sherman; and former Noma pastry chef Ghetto Gastro member, Malcolm Livingston, among others.
    Other companies have sought to promote the benefits of insect protein, including Chapul, which makes cricket protein bars and powders, and Exo, which makes dairy- and gluten-free cricket protein bars in flavors like cocoa nut and banana bread. These companies, along with others in the business tend to aim their products at Paleo dieters by promising more protein and no dairy.
    Seek’s chef-focused approach makes it unique. By pairing with noted chefs who already use bugs and bug protein in their cooking, Shapiro is looking to make the public more comfortable and confident in using bugs to cook and bake. So far, the response has been slow, but steady. Seek has already raised nearly $13,000 from 28 backers, well on its way toward its $25,000 goal. 
    Seek’s cricket flours and other products will initially only be available via Kickstarter. If that goes well, the products will be sold on Seek’s website. Early backers will get a discount and a chance for a signed copy of the book. Seek hopes to debut their products nationwide starting in the fall. 
    Could gluten-free cricket flour and the new cookbook be the next big gluten-free Christmas gift? Stay tuned for more on this and other gluten-free stories.
    Source:
    grubstreet.com  
    Jefferson Adams
    Can a Less Strict Gluten-Free Diet Increase Compliance for Some Celiac Teens?
    Image Caption: Image: CC--David Fulmer
    Celiac.com 08/08/2018 - A number of studies have cataloged the numerous challenges faced by adolescents with celiac disease  attempting to comply with a gluten-free diet.  A team of researchers recently set out to reevaluate gluten-free dietary compliance and the current clinical condition of 123 now teenage celiac patients, who were diagnosed in the first three years of life and were followed up for at least 10 years to determine whether a less strict approach to a gluten-free diet can actually increase gluten-free dietary compliance.
    The research team included M Mayer, L Greco, R Troncone, S Auricchio, and M N Marsh. They are variously affiliated with the University Department of Medicine, Hope Hospital, Salford, Manchester, UK.
    The team used computerized image analysis to assess mucosal structure and lymphocytes in small intestinal biopsy specimens obtained from 36 subjects. Of these adolescents with celiac disease, 65% were adhering to a strict gluten free diet, 11.4% followed a gluten-free diet with occasional gluten intake, while nearly 25% ate a gluten containing diet.
    Patients on a gluten containing diet had more frequent clinical gluten-related symptoms, while patients on a semi-strict diet did not. Occasional intake of small amounts (0-06-2 g/day) of gluten did not produce increased concentrations of anti-gliadin antibodies, but did result in a substantially greater crypt epithelial volume and expanded crypt intraepithelial lymphocyte numbers.
    So, could a semi-strict gluten-free diet benefit celiac teenagers who eat a gluten containing diet? These numbers suggest that a semi-strict gluten-free diet may be better than no gluten-free diet at all. Of course, the best choice would always be a 100% gluten-free diet.
    Source:
    Gut  
    Jefferson Adams
    Can a New Drug Reduce Symptoms of Accidental Gluten Exposure in Celiac Patients?
    Image Caption: Image: CC--ZaldyImg
    Celiac.com 08/07/2018 - A new drug designed to reduce symptoms of accidental gluten ingestion in celiac disease sufferers has yielded some encouraging data. The drug in question is a monoclonal antibody designed to reduce adverse reactions in celiacs who are accidentally exposed to gluten. The results, presented at Digestive Disease Week, held in Washington DC from 2–5 June 2018, suggest that monoclonal antibodies could provide protection for people with celiac disease.
    Celiac patients on a gluten-free diet who randomly received six injections of a monoclonal antibody, called AMG 714, over a ten-week period, enjoyed a substantial reduction in intestinal inflammation. Over a ten week study period, celiac patients on a gluten-free diet received six randomly assigned injections of either a placebo, or of AMG 714 at a dose of either 150mg or 300mg. 
    Patients then underwent a dietary gluten challenge from week through until week twelve. As tested, the drug did not reduce damage to intestinal villi for either treatment group, which was the trial’s primary goal, but it did significantly reduce celiac-related inflammation and symptoms in response to gluten consumption.
    Patients receiving the highest dose of AMG 714 had no clinically active disease at week twelve of the study, and also had a significant improvement in self-reported outcomes, compared with the placebo group. No matter how diligently people with celiac disease follow a gluten-free diet, they can still suffer accidental gluten exposure ingestion.
    Treatments like AMG 714 could become important adjunct to gluten-free diet in for people with celiac disease, including non-responsive celiac disease.
    Read more in Pharmaceutical-journal.com
    Jefferson Adams
    Dunkin’ Donuts Looks to Score with New Gluten-Free Brownie
    Image Caption: Image: CC--Mike Mozart
    Celiac.com 08/06/2018 - Okay, so it’s not a gluten-free donut, but Dunkin’ Donuts has announced the debut of a gluten-free fudge brownie, the company’s first-ever gluten-free bakery product, that will be available in all of Dunkin's 8,500 US stores.
    A company statement said that Dunkin’ Donuts recognizes "the importance of providing alternative choices for people with dietary restrictions or who choose a gluten-free diet." Gluten-free food sales are projected to exceed $2 billion in sales by 2020, up 20% from 2015, according to industry research group Packaged Facts. 
    Dunkin's gluten-free brownie is one of several new items the company is introducing, although it is the only one that is gluten-free. Other new non-gluten-free items include waffle-breaded chicken tenders, pretzel bites and ham and cheese roll-ups. All of these items are priced at $2 each, as part of the chain's new Dunkin' Run menu, which the company hopes will draw customers beyond the usual breakfast rush.
    The latest menu changes are all part of a concerted effort by the company to rebrand, including ditching the ”Donuts" part of its name in some new stores, reducing its food offerings, emphasizing its drink selections, and pursuing plans to double the number of stores. 
    Gluten-free donut lovers may have to wait indefinitely for a genuine gluten-free Dunkin’ donut, but a reliable, readily available gluten-free brownie is a good start.
    If you get a chance to try Dunkin’s new gluten-free brownie, please let us know your thoughts. 
    Bev Messner
    Are Celiac Support Group Numbers Dwindling?
    Image Caption: Image: CC--Luisangel
    Celiac.com 08/04/2018 - December 16, 2000, a date that is etched in my mind forever. My husband and I went out for dinner with friends and returned to their home to play some cards for the evening. By around 9 p.m., I noticed my stomach rumbling and I began to make many trips to the bathroom with diarrhea. In fact, it was the beginning of a month-long siege of severe diarrhea. Up until that day, I never had any problems with digestion, bowel problems, or food issues. But suddenly my life was changing. After about four days, I saw my family doctor who started me out with a course of Flagyl, which did nothing to stop the diarrhea over the ensuing week. Following that was my visit to the ER, only to be told to follow up the next morning with my family doctor. When I showed up without an appointment, he told his nurse that he didn’t know what to do with me, so he didn’t see me at all. I was pushed off on the nurse practitioner, who was so sure her treatment would work that all I had to do was consume 2 TBS of water every 2 hours for 2 days, guaranteeing I would be better. My heart knew it wasn’t so, and the continued diarrhea proved it. I was losing one to two pounds a day, but no one was even paying any attention to my weight changes on each visit. After three weeks and another subsequent visit to the ER, I was down 25 pounds.
    A visit with a gastroenterologist was a huge waste of time. All he could think of doing was a colonoscopy and maybe three weeks more of Flagyl. I told him that in three weeks I would be dead. I refused the colonoscopy and walked out.
    All during this month, I could not eat a single thing without consequence, and by the end of the month, even water went straight through me. I did the BRAT diet (bananas, rice, applesauce, toast), but mostly stuck to the toast with a bit of butter on it. Seeing that it didn’t work, I stopped eating altogether. My husband thought my downfall with the BRAT diet was that I was spreading butter on the bread. How little we knew!!
    The visits to all the doctors and ER’s were worthless, and I grew weaker by the day. I had to give up work during this time and spent most of my days in a recliner. It was the holidays and going out to eat meant I was drinking water while everyone else ate such wonderful-looking foods. After the first couple of weeks, my strength was zapped. Taking a shower wore me out, and drying my hair left me breathless. I needed to take 15 minute breaks trying to recover just so I could continue. I confided in my son that I didn’t feel I was going to live much longer, but I could not say those words to my husband. He was angry that no one was figuring out what was wrong with me. I downplayed how sick I was, but I am sure he began to wonder how badly things were going for me.
    Taking matters into my own hands, I called a friend who worked for a neurosurgeon. A new doctor had just joined the practice and I thought perhaps he came from somewhere else in Ohio. To make a long story short, he grew up in Ohio and did his training here so he was able to contact those old teachers of his and get me admitted to their hospital about an hour away. Keep in mind that this man did not know me, but he had the presence of mind to know things were quite serious. Within an hour, I was at his teaching hospital and being admitted. I stayed in the hospital for five days and was now down about 30 pounds. I was nothing but a bag of bones. I took a book with me to read. How ironic it was that it was Stephen King’s novel, A Bag of Bones! At least I could make some jokes about it when a nurse or intern would stop to see me. Finally a gastroenterologist came to my room on my second day of admission and spoke with me for about 5 minutes and felt he knew what the problem was. He asked me why no one in my hometown could figure anything out in three weeks’ time, and he knew in 5 minutes. A subsequent endoscopy proved his suspicions of celiac disease.
    Then came the hard part: The Gluten Free Diet!!! A dietician handed me about 30 pages of information, all of which made no sense to me. I was told to go on the internet. The first thing I did was cry! My husband and I made a trip to the grocery store and spent over two hours reading labels. I knew of no one in my area that was familiar with celiac disease. In the first two weeks home, I ate 5 jumbo bags of Lay’s Potato Chips. I didn’t know what else to eat and was literally starving to death. About four weeks into the diet, realization set in about this diet and the tears came again. I just didn’t want this disease anymore as it was much too difficult to handle.
    Since no one locally could help me, I joined a support group an hour away and went once a month. It was okay, but it really didn’t fulfill my needs. It was more of a social club and I needed speakers and educators. That was when I decided to start my own group less than 3 months into my diagnosis. I took in everything I learned at the group I attended, figured out what was missing, and then decided how I wanted to format my own meetings. I had the local newspaper write a story about celiac disease and my desire to start a group. Thirty people contacted me and the group began. The very first meeting had 15 people attending, and we had samples from Kinnikinnick. Everyone thought they had died and gone to heaven, as they had all been settling for whatever was available in the local health food stores. From that point on, I never looked back and never cried again about having this disease. I now knew what it was that I needed to do, and it was to help others so they didn’t go through the same trials and tribulations that I experienced.
    Over the next ten years, our small town had a support group. We didn’t need to drive an hour to a big city to get help. We had it here every month. Each year the numbers grew with more and more people coming through the group. Our meetings consisted of passing out the monthly handouts and any articles I gleaned from various publications. We would go over all the information that was passed out, discussing it along the way. As soon as that part of the meeting was finished, usually within about 15 to 20 minutes, we turned to social discussion about anything and everything. We also had speakers….lots of speakers!! We went to conferences. We had reporters in at least 3 or 4 times to do stories. We did about 13 half-hour radio shows over those years with great success. We had Gluten-Free days once a year at the hospital. We did about 9 years worth of walks…..all small in numbers but large in spirit. We had a booth for a week at our local fair for about 4 years and gave out information. Some members did a health fair occasionally. We had annual picnics and Christmas dinners. We were getting the word out and people were coming to us. Our most fantastic years were 2006 through about 2009. We were averaging up to 26 people a month. We had a low of 15 and a high of 44 in 2008. It was a great time and we all looked so forward to learning as much as possible during each meeting and telling others of our experiences eating out, shopping, and cooking, etc. At the end of each of our meetings, we would sample what others had brought in, grab a copy of the recipe if we were interested and sit back down and talk amongst ourselves until we just finally had to go home!
    Everyone in the group was well educated. Books and other resources were recommended through the group and the knowledge grew. Meetings with speakers were well attended and appreciated.
    But how many times can you ask the same speakers to come again and again? Many were three-time repeaters, which was good because we always had new members. Our resident dietitians came monthly and sometimes spoke as well as local doctors and gastroenterologists. We also had a physician speak who was celiac. He had visited our group at least three times. Connie Sarros, a cookbook author, came to our meeting three times. Our speakers brought in many people, but I began to see a trend happening. In the later years, the speakers weren’t drawing as many people and the attendance at regular meetings began to dwindle. It wasn’t a whole lot to start with, but the monthly average dropped in 2009, 2010, and even worse three-fourths of the way through 2011. We have come full circle and are getting back down towards the numbers we originally began with at the first meeting – 15!
    As a result of what I was seeing, along with what was happening with two other support groups in neighboring counties, I could tell that the attendance was dropping off everywhere. A new group that was only about two years old brought in about 15 their first night and then it dropped severely, sometimes with only 1 or 2 showing up. We put our heads together trying to figure out what was going on. There had to be answers. The question was whether we were going to quit having meetings, have them quarterly, every other month, or perhaps just send information via email. But what would happen to those people who relied on us and did not have computer access???
    I turned to the Listserv and threw out the question, asking other group leaders and members to respond. I wanted to know if they saw the same trend happening in their area. It was a resounding YES from over 60 responses that I received.
    Here are some reasons why people were not attending meetings:
    Easier to find GF food on their own. Some come for the information packets, never to be seen again. Gas prices. Unemployment. The family is busy with their own/kids schedules. After a few months or years, they feel confident to be on their own. A few disliked the leaders, feeling they either monopolized meetings or couldn’t control them. Some didn’t want to deal with the diet. Summer is a bad time. Some didn’t care for the agenda: wanting only health information, not cooking classes or social hour. Others only wanted the social aspects of the meeting and didn’t want to listen to other information. Seating arrangements made some feel like they were at a lecture, seated in rows rather than at tables. They use the internet more now, have cell phone apps or go on facebook. The following are issues voiced by group leaders:
    People do not want to come to meetings every month. Many are not compliant with the diet and don’t take it seriously. No one wants to volunteer to help out. This could involve activities the group does, such as walks, publicity, taking over a meeting occasionally, or even staying to help clean up and put things away. Getting burned out by having to do everything themselves. I then decided I should survey my own support group. I did it anonymously via the internet so that everyone could answer honestly without worry. I wanted to find out what my own group thought about these same issues so that I could decide on the future of our group by the year’s end.
    I sent the survey to approximately 104 people. These were people who had contacted me over the years, either via email, coming to some of the meetings, or perhaps just a telephone conversation. Fifty people did the survey. The results were quite interesting and are listed below:
    44% said they have only attended between 1-5 meetings, and 23% said 13 or more. The reasons they do not attend showed 46% very comfortable with the diet, and 35% responded that their schedules were too busy to attend. Some used the group’s website while others found their information online.
    The leadership and presentation of materials was rated as excellent. The discussion time was rated as good, but many wanted more time discussing issues. 100% felt the information they received was helpful in managing their diet and understanding celiac disease.
    Some felt the meetings could be quarterly, but 75% stated they would not be lost if the meetings folded. At least 25% of the respondents said they never use our website to read the monthly handouts.
    When asked about the need for support groups, 45% said there is a real need, while 38% stated they are nice to have around when you need them. Another 13% said they only needed them to get started on the GF diet.
    An overwhelming 70% felt the best format for meetings was educational with discussions as opposed to having just a social hour with discussions.
    Yet with all these answers above, it still comes down to that one person who is newly diagnosed and coming to us begging for help. How do we turn our backs on them??? I don’t think we can. I know I can’t. I have not arrived at an answer for myself, but many of the things I am considering might be having meetings either every other month or quarterly, or not having any meetings at all during the winter when I travel to Florida and have no one to take over. Even when I was in Florida, I did all the paperwork for the meetings, but attendance was down even more dramatically and those helping me had a hard time trying to run the meetings as they were not comfortable speaking in front of a group of people.
    So what decision will I come to?? I don’t know yet, but I have given myself until December of this year to make some kind of decision. We are still needed, but I just don’t think it is to the extent that it used to be five or ten years ago. It is not a hardship anymore having celiac disease because so many manufacturers are on board with GF products. It is so much easier, but there are still tiny loopholes in the diet that we need to help the newly diagnosed plug up and not make mistakes that could cause them to be sick.
    We will never be without the Internet, telephones, or other means of communication for obtaining information, but finding the correct information that is not outdated will sometimes be a challenge to a person searching on their own. So much is out there, but I think it still takes some form of a support chain with very strong links to help others when they call. I think I have that with my group, even if we should ever disband in the future. I am the information researcher, but I know who to send people to when they have questions regarding baking as we have two of the best bakers around, not to mention some others locally who will bake for a price. I know the parents with autistic and diabetic children and I refer people to them when needed. They are all my links in this very strong chain and I depend on them more than they can ever know. And my thanks always go out to them for being there for me.
    Addendum: As I was wrapping up this article, my September support group meeting came and went. Only seventeen people attended. Many were worried about whether I would fold the group or not. What I learned from all this was that our meetings were really pretty good over the years, but people were managing on their own. It is okay if they choose not to come to the meetings, but they were possibly missing out on some very important changes. I also learned that many would like even more discussion time, so we will have to urge more people to speak up. They all felt there was a certain “core group” that kept coming to the meetings because we needed each other. We knew what the others were going through, we had new ideas, new recipes and some interesting happenings outside the group that we needed to share. And many times we just needed to “vent”. Yes, our feelings are hurt when we attend family events such as a potluck and not one person has tried to create something for us. Other times we rejoice because someone has gone above and beyond the call of duty to see that we have something to eat. In the end, what it all boiled down to was that we needed each other! So, even if our numbers are dwindling, we plan to keep on going. We will only meet from May through December with telephone and email support in between and we will continue to help those in need! So whether I am in Florida or Ohio, the support will ALWAYS BE THERE! We are the Richland County Celiac Support Group in Mansfield, Ohio...HEAR US ROAR!!
    Also, as we neared the deadline for this article, Scott at Celiac.com decided to send my survey to his email list. 79 people responded. As was expected, most of their answers matched those we already had. Below is a compilation of answers and comments made.
    CELIAC SUPPORT GROUP SURVEY:
    How many meetings have you attended?
    37% none 20% 1-5 13% 6-12 18% 13 or more 13% monthly If you no longer attend meetings, why?
    29% comfortable with diet 35% find info online 6% use website 19% busy schedules 4% don’t care for format 6% needs new leader 0% no longer follow the diet 29% live too far away 6% not interested 33% other Responses:
    Some do not have support groups, some chapter closed, leader retired, inconvenient time/place, understand diet, groups very hopeless and clique-y and off-putting, and cost of gas. One respondent would like to start a group in East Hampton NY 11937.
    Rate the Meetings:
    Leadership:
    Poor 3.8% / Fair 13.5% / Good 38.5% / Excellent 44.2% Presentation/Materials:
    Poor 1.9% / Fair 15.4% / Good 42.3% / Excellent 40.4% Speakers:
    Poor 9.8% / Fair 13.7% / Good 33.3% / Excellent 43.1% Discussion Time:
    Poor 2.0% / Fair 20% / Good 52% / Excellent 26%
    GF Samples:
    Poor 7.4% / Fair 18.5% / Good 31.5% / Excellent 42.6%
    Responses:
    People are very vocal about wanting more GF restrictions and should learn to quietly educate people and try to make changes without making others feel forced to comply. Some material offered nothing new or do better on their own, but like hearing stories and such from other people. Some meetings are boring. Difficult to get free speakers. Redundant format, but good for newly diagnosed. A group is essential to understanding both the diet and disease. Food tasting is wonderful. Have you ever attended a meeting that turned your off and you never returned?
    13.8% yes 87.7% no Responses:
    One speaker promoted a very limited diet along with being GF. She went on and on, people left, & she still kept talking. Prefer reading articles. Some groups get a bit quirky or boring. No one my age, and because I am only “intolerant” I felt not as important as everyone else. Another big factor goes back to the time and place. It was a peer support group and other long time members laughed at my symptoms saying they could not be gluten reactions, but others I know have the same symptoms. About 5 years ago I attended a meeting where a book author mentioned that cancer from celiac is very rare and it was printed in her book. I raised my hand to mention that about 4 people in our group had cancer and I had previously completed intense chemo with a bone marrow transplant which was directly from lack of diagnosis with celiac. I wanted people to know that they should not mess with cheating on the diet because they might not know if they were injuring themselves. She assured everyone that cancer was rare. I guess when you are the one with cancer, you don’t want anyone else to go through it. So, my warning to others is not to cheat. 1 person is still too many with a disease that could have been diagnosed and wasn’t. I survived, but 2 more people in town did not.... with the same cancer. Meetings are controlled by support group founders. I don’t know - I just didn’t like their attitude. Negative and closed to newcomers. Lots of people were gluten sensitive not celiac, & felt it was more social about eating out rather than any support or information. I belong to 2 support groups. One I always attend. The other lacks leadership and, thus, I find it a waste of my time. The first group meetings eventually dwindled to the same, very few, members and I had the diet info mastered then. Not much more was offered until a local group formed a year or so ago. The Healthy Villi used to be an affiliate of CSA/USA. After going to several national CSA conferences, I found their leadership to be too restrictive and decided to no longer affiliate myself with them or attend their conferences. The Healthy Villi also severed their ties with CSA. Do you find the information you receive to be helpful in managing your diet and understanding celiac disease?
    87.7% yes 12.3% no What meeting times would suit you best?
    43.3% monthly 22.4% every other month 22.4% quarterly 13.4% none If your group folded, would you be lost without it?
    18.5% yes 81.5% no Do you ever go to your group’s website to read the updated information and articles?
    41.3% yes 31.7% occasionally 27.0% never What is your feeling about support groups?
    56.8% there is a real need 5.4% only need them to get started 36.5% nice to have around when you need them 1.4% people can do without them now 0% telephone support is all that is needed. Which format do you think would be best for a meeting?
    70.1% educational with discussions 38.8% social hour with discussions 14.9% potluck dinners every month 1.5% different member taking over each month 4.5% dining out monthly instead of meetings 26.9% cooking demos by members 35.8% cooking demos by chefs Responses:
    Some thought all of above and also vary the meetings. Discussions and speakers very helpful. Definitely education, but cooking demos would be interesting and open up discussions for new people, plus doctors should have packets to give to the newly diagnosed.
    Yvonne (Vonnie) Mostat
    Did You Know? Tips to Reduce Inflammation Should You Accidentally Ingest Gluten
    Image Caption: Image: CC--Johnny Silvercloud
    Celiac.com 08/03/2018 - Do you know that there are numerous sites on the web to help you with the symptoms of getting glutened, and other suggestions to prevent you from ever getting "glutened". There are tips to help heal gluten exposure even for the gluten sensitive or person with dermatitis herpetiformis to speed up the process of getting the gluten out of your system. The dermatitis herpetiformis sores can be assisted with some simple home remedies that can ease you through to the scabbing and eventual disappearance, save for the scarring which is slower to heal.. First, we need to really "get" the fact that this is a disease that you will not grow out of despite what some advertisers attest. There are fewer people being mis-diagnosed today because of the blood test being readily available. Most physicians have crawled into the 21st Century and know about the symptoms of celiac disease, but some are still at a loss when looking at a severe outbreak of dermatitis herpetiformis.
    The United States and Canada have different laws concerning allergy labeling. A recent survey presented at the AAAAI Allergists' Convention in Los Angeles in March revealed that 40 percent of consumers avoiding one or more allergens when buying foods "Manufactured in a facility that also processes allergens.” Beyond buying habits the researchers also found a lack of awareness of labeling.
    Another problem occurs with differences in the food laws between the United States and Canada, and with the fluctuating Canadian dollar many Americans close to the border are taking advantage of the savings and shopping in Canada. 45% of people were unaware that precautionary labeling is not required by law. In Canada, labeling regulations require manufacturers to clearly indicate if major allergens are ingredients of a product. But there are no legal guidelines on how companies should identify products that may have come into contact with food allergens during manufacturing. 
    I did a survey of six bakeries this past month that baked gluten free products. Out of the six, four cleaned their ovens and pans by pressure washing and only baked gluten-free on one particular day a week. Even their gluten-free home made noodles were made on a separate day and had to be ordered ahead of time. Recently Health Canada recommended companies limit the advisories to the phrase "May contain", but even that is not yet a legal issue, just a precautionary one I was told. A recent study tested 186 products with precautionary peanut labels and found 16 (just under 9%) contained the allergen. It becomes very serious after a 22 year old Minnesota man, with a peanut allergy died in January of anaphylaxis after eating a chocolate candy with a label that it had been made in a plant that also processed peanuts. "Not the same', you say but it brings to the foreground the fact that there are too many different types of wording, says author Dr. Susan Waserman, a professor of medicine in the division of allergy and immunology at McMaster University in Hamilton, Ontario. "Patients assume that differences in wording imply a lower level of risk, which they don't. " Gupta and Waserman would like to see precautionary labels reduced to one or two clearly defined phrases. For instance, Dr. Gupta says if a "May Contain" label meant that the food might have up to 100 milligrams of an allergen, then the patient could work with their doctors to find out just how much of their allergen may be safe to consume and purchase foods accordingly. The study shows that there is already research "underway to develop thresholds for such labels."
    Did you know that the outward manifestations of getting glutened may be different for everyone, and can cause a variety of symptoms such as brain fog, diarrhea, constipation, headache, rash, weakness, joint pain, swelling, vomiting and fatigue. Inside your body gluten is perceived as a
    toxin that causes inflammation and damage to the intestines. Ridding yourself of this toxin, reducing inflammation and healing your gut from the damage are essential to recovering as quickly as possible.
    Did you know that digestive enzymes help speed up the breakdown and absorption of micronutrients. Be sure to take an enzyme that includes dipeptidyl peptidase (DPP-IV) and or AN-PEP, both of which help to break down gluten. In fact several sites recommend that those with celiac and gluten intolerance take enzymes with DPP-IV and/or AN-PEP when dining out.
    Activated charcoal and bentonite clay rid toxins and help reduce gas and bloating. It is best to increase water intake when taking either of these to avoid constipation, which will only delay healing. Speaking of water intake, it is one of the biggest ways of removing gluten from your body. Cleanse, don't drown yourself, but drink as much water or a pure juice, (not pop) is one of the fastest ways of doing a body cleanse from a celiac outbreak, whether a diagnosed celiac, gluten sensitive, or those afflicted with dermatitis herpetiformis. I have been nagged so many times to drink more water when experiencing a dermatitis herpetiformis outbreak. You can try coconut water, which contains electrolytes that may have been lost through vomiting or diarrhea.
    Decreasing inflammation occurs naturally in our body when there has been an insult or inflammation to it. Decreasing inflammation is essential in healing your gut. 
    10 tips may help you reduce inflammation and recover quickly should you accidentally ingest gluten:
    Omega-3 fatty acids, fish oils, flax and chia seeds are full of anti-inflammatory omega 3 fatty acids. It is recommended to take 1 - 2 grams of omega 3 oils daily. You can go up to 4 grams a day for a week after an accidental gluten ingestion. Never play guessing games with celiac disease, or cheat. In the scheme of things it is NOT worth it, and deep inside when you are really suffering you know that sneaking a regular donut is definitely not worth it. The man that said to me, "Every time I come back from Japan to the U.S.A. I have to have Kentucky Fried Chicken and to heck with the consequences", I noticed the last sabbatical when he came over for a visit he did not succumb to his favorite Kentucky Fried Chicken. He now had dermatitis herpetiformis, which is basically celiac disease of the skin. I have been told it can often be caused by extreme stress or constantly cheating on the gluten-free diet. If you think being a celiac is "The Poor Me Syndrome" think again! Dermatitis herpetiformis on your scalp can give you an extreme desire to shave your hair off, and pick the itchy sores off your legs until they not only scar, but look like a shark attack. Don't do it!    And I am not even telling you about what it does to the lining in your bowel and the nutrients that are flowing through your body right down the toilet. Ginger has high levels of gingerol, which gives it a natural spicy flavor and acts as an anti-inflammatory in the body. It also has potent anti-nausea properties and can ease stomach cramping, Drinking warm ginger tea is a great idea. Turmeric is a member of the ginger family that contains the active ingredient curcumin, which is known for its antioxidant and anti-inflammatory properties. Try an anti-inflammatory smoothie with turmeric. It is a great drink to help you quickly recover from getting glutened. Did you know that nearly 70% of our immune system is in our gut? Having a healthy gut is crucial for optimal health. Probiotics. Many researchers suggest or recommend taking a highly concentrated probiotic (24-100 billion units a day). Amy Myers, M.D., is a renowned leader in functional medicine and a New York Times best selling author of "The Auto-Immune Solution".She received her doctorate in Autoimmune Diseases and has several books on celiac disease and its mystifying complex symptoms. Celiac disease reacts differently with each person, and childhood celiac disease symptoms are often different than adult onset celiac disease. L-Glutamine. It is an amino acid that is great for repairing damage to the gut, helping the gut lining to regrow and repair, undoing the damage caused by gluten. Dr, Myers recommends 3 -5 grams a day for a week after exposure. *MY ADVICE to you all is to write these suggestions down and show them to your general practitioner, research them on the internet, Do not take my word for it or the words of these authors; check and re-check your facts. It is your body, and just like you would change grocery stores if they sold you a bunch of out-dated food products, you would complain and possibly shop somewhere else. You have a right to read about new things and be heard. Slippery Elm. It contains mucilage, which stimulates nerve endings in he gastrointestinal (GI) tract to increase its secretion of mucus. Mucus forms a barrier in the gut to protect it and promote healing. Deglycyrrhizinated licorice (DGL). DGL is a herb that is being used for more than 3,000 years in Marshmallow root is a multipurpose supplement that can be used for respiratory or digestive relief. Like slippery elm, it contains mucilage, which eases the inflammation in the stomach lining, heals ulcers and treats both diarrhea and constipation by creating a protective lining on the digestive tract. Bone Broth is very high in the anti-inflammatory amino-acids glycine and proline. The gelatin in bone broth protects and heals the mucosal lining of the digestive tract that may et disrupted by being glutened. Baking Soda Remember, be your own researcher and look into each of these before trying them.
     
    Jefferson Adams
    Kylie Jenner Names New Eye Shadow Shade “Gluten-Free” And Twitter Hilarity Ensues
    Image Caption: Image: CC--mrlsrt04
    Celiac.com 08/02/2018 - For those who’ve been craving a juicy gluten-free social media story, crave no longer. None other than Kylie Jenner, younger sister to Kim and Kourtney Kardashian, has stepped up to oblige by labeling one of the shades of her eye shadow collection “Gluten Free.” It’s true, you can Google it.
    In case you, like me, have been out of the Kardashian loop lately, Kylie has most recently hitched her star to the growing makeup empire of sister Kourtney, after working with Kim and Khloe on their makeup lines.
    It seems that Kylie decided that one of the colors in their eye shadow palette was just begging to be called “Gluten Free.” Cue the reaction.
    Meanwhile, on Twitter some celiac folk thought it was hilarious, others less than funny.
    @paytoncalder tweeted: The fact that Kylie Jenner actually named a shade "gluten free" makes me cringe so hard. @business_poodle tweeted: Kylie Jenner is rly selling an eyeshadow called “gluten-free” and I’m working minimum wage????? For her own part, Kourtney explained on her app (who knew?) how she came to, embrace a gluten-free diet:
    “I have noticed a great positive change in behavior with my children when we stick to a gluten-free and dairy-free diet. I don’t think everyone needs to eat this way but we had muscle testing done, which showed we all have sensitivities to corn, gluten and dairy.”
    Between welcoming daughter Stormi Webster in February, Kylie and doing things like attending Coachella, Kylie has been busy as she looks to burnish her own makeup credentials.
    So, is Kylie’s eye shadow actually gluten-free? Let’s hope so, otherwise we’ll be back with more about this delicious, if un-nutritious story. Meantime, for more on this zany story de jour, Google it, or check your Twitter.
    Jefferson Adams
    Worker with Celiac Disease Wins Retrial Against Kelly Staffing Firm
    Image Caption: Image: CC--Matt Wade
    08/01/2018 - A federal appeals court has ordered a new trial for a terminated worker who sued a staffing company for allegedly violating the Americans with Disabilities Act by not accommodating her celiac disease.
    Laurie Peterson suffers from celiac disease, and worked as a staffing supervisor for Troy, Michigan-based Kelly Services Inc. until her termination in January 2014 according to court papers filed in Laurie Peterson v. Kelly Services Inc. Peterson had originally sued Kelly in U.S. District Court in Spokane, Washington, alleging failure to accommodate, discrimination and retaliation under the ADA. 
    The original court issued a partial summary judgment granting Kelly’s motion on Ms. Peterson’s claims that the company had failed to accommodate her celiac disease and had fired her in retaliation for protected activity, but allowed related charges in the case to proceed. A jury later found that Kelly had not retaliated against Ms. Peterson.
    A three-judge panel of the 9th U.S. Circuit Court of Appeals recently issued a unanimous reversal of the district court’s original ruling.  The panel wrote that the district court had “failed to construe the facts in the light most favorable to Peterson as the non-moving party as required on summary judgment.”
    The case originally arose out of Peterson’s work as interim district manager in fall 2013 while Kelly Services was looking for a new district manager. According to the complaint in the case, when the new district manager learned Ms. Peterson had celiac disease, he began treating her differently than other employees, including changing her work schedule. 
    The change in work schedule allegedly caused Ms. Peterson stress and anxiety, which aggravated her celiac-related condition. Ms. Peterson sought to return to her previous 8 a.m. to 5 p.m. shift. According to the complaint, the district manager told Ms. Peterson to take unpaid leave under the Family Medical Leave Act instead of seeking an accommodation from the company. Peterson and the supervisor were later fired.
    In reversing the lower court and remanding for trial the claims decided on summary judgment, the court found that the district supervisor’s statement “is direct evidence of retaliatory intent.” The ruling added that the supervisor’s declaration “also raises a genuine issue of material fact as to whether Kelly Services engaged in the interactive process in good faith.” Ms. Peterson’s battle against Kelly Services, Inc., has important implications for how companies treat people with celiac disease under the ADA. To find out how the retrial turns out, keep an eye on Celiac.com
    Source:
    businessinsurance.com
    Celiac.com Sponsor: Banner
    Nush Foods for Low Carb Gluten-Free Cakes
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    Celiac.com 08/01/2018 - Muffy Mead-Ferro knew her whole family would be healthier if they ate less sugar and fewer carbs. But as the primary grocery shopper, it was hard to find prepared foods that weren’t full of sugar and carbs. And let’s face it, we need prepared foods to live this nutty life we live. We’re on the run sometimes! Especially in the morning, right? So she started baking. Tasting. Re-searching. And baking some more. Eventually what came out of the oven was a new company: nush.  Oh, and by the way, it is gluten-free too. 
    The more we read and the more we know about how our bodies work, the more committed we are to helping people get off the sugar-and-carb roller coaster. And it is a roller-coaster! Have you ever noticed when you have one chocolate chip cookie, all you want is 10 more? That’s partly because your blood sugar is spiked, and then crashes, and the quickest way to prop it up again is more sugar. Meanwhile, you’re growing a huge colony of sugar-loving microbes in your gut that are also demanding more sugar. We think it’s time to turn this train around!  
    We know this is especially tough in the gluten-free community.  It seems like all the manufacturers are pumping their products full of sugar to compensate for the cardboard goods they are selling.  
    It’s been about a year and a half since we first started shipping our gluten-free, low-carb, low-to-no-sugar snack cakes. During that time we’ve made a lot of new friends and customers, and we’ve learned a lot. Most of the feedback has been incredibly positive and it let us know we were on the right track!
    We developed four delicious new flavors: Peanut Butter, Cherry Almond, Blueberry, and Pineapple Mango. We have kept two of our old favorites, Carrot Spice and Banana Nut.  We promise you, you’ll love them. Each one of them is truly bursting with flavor and they have an even softer, more cake-y texture than before.
    Visit our site for details. 20% OFF PROMO CODE “CELIAC.COM”
     
    Celiac.com Sponsor: Banner
    Testing for Celiac Disease, Non-celiac Gluten Sensitivity, and Other Adverse Reactions to Foods by Alcat Food Allergy Testing
    Celiac.com 08/01/2018 - Celiac disease is an autoimmune disorder characterized by destruction of intestinal villi, followed by malabsorption and greater risk of developing other autoimmune disorders, such as type 1 diabetes.  It can be triggered in genetically susceptible people by gluten.  The test for the genetic risk for celiac has high negative predictive value; meaning, if you do not have the genes, you cannot get the disorder.  
    However, if you do have the genes, you may, depending on other factors, principal among them being your gut microbiota, and you do consume gluten, you may develop celiac disease.
    In either circumstance, you may have other health issues, Chrohn’s disease, IBS, UC, fatigue, and/or many other inflammatory and autoimmune conditions, brought on by consuming gluten; or, any other foods, herbs, or chemicals, that you are sensitive to.
    Despite all the noise out there about tests for food sensitivities, there is only one test that has been clinically and technically validated at a major institution through a randomized controlled, double blinded trial, and that is the Alcat test, available from Cell Science Systems, which has also been recognized as, “Company of the Year for Food Intolerance Testing – N. America” by the international consulting firm, Frost & Sullivan.
    The Alcat Test® can test for almost five hundred individual items, including foods, additives, functional foods and herbs, molds, common drugs, and others.  You can customize a test according to your needs and budget.    CSS also offers nutrition, dietary and lifestyle counseling through its sister company, PreviMedica.
    For the month of August, Cell Science is offering a free celiac gene risk assessment with the ordering of any Alcat test.
    Log on to CellScienceSystems.com; or wellio.co, or call 1-800-Get-tested for more information or to speak with a counselor. 
    For more info visit their site.
     
    Celiac.com Sponsor: Banner
    New Veggie Medley Potapas Gluten Free Potato Tortillas
    Image Caption: $1 off coupon here
    Celiac.com 08/01/2018 - Kale is hot!  Plant based proteins are hot!  New Veggie Medley Potapas has joined Original Potato and Sweet Potato Potapas for a new taste adventure.  We have added Kale, Spinach, Carrot and Pea Protein for a balanced veggie flavor and double the protein.
    Potapas are gluten free, soy free, corn free, dairy free, nut free, grain free, non GMO and Kosher.  They are on trend, meeting a wide variety of consumer dietary needs along with being Vegan and Paleo friendly. 
    With their savory potato flavor and soft, pliable texture, the whole family will enjoy Potapas to make tacos, mini-wraps, quesadillas or use as flatbread with your favorite meal.  Veggie Medley Potapas make great veggie tacos filled with black beans and shredded broccoli slaw.  Or Asian fusion inspired tacos using teriyaki chicken and grilled bok choy.
    For the month of August, Potapas are $1 off per package at all Sprouts Market locations across the county.  Visit our website to find hundreds of other markets offering Potapas Tortillas.
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    Celiac.com Sponsor: Banner
    Genetic Test for Celiac Disease and Gluten Intolerance. MTHFR.com's Celiac and Gluten Intolerance Report
    Celiac.com 08/01/2018 - You have suffered from gluten intolerance most of your life, and you wonder how you can find out if you have celiac disease without undergoing an invasive and expensive medical procedure. You also wonder if you don’t have celiac disease, what the likelihood is of developing it during your lifetime?
    Your genes can tell a great deal. Interpretation of genetic information is an extremely accurate process. A negative result nearly excludes the possibility of your ever developing celiac disease. A positive test is about 97 percent accurate. This information is available in MTHFR.com’s Celiac and Gluten Intolerance Report.
    Have you wondered if you have some level of gluten intolerance or what your chances are of developing celiac disease? 
    MTHFR.com is one of the few companies, if not the only company, in the market that provides your results with a table that explains to you how likely you are to have celiac disease, not just whether you are positive or negative. Your genetic report will display your HLA-DQ results, which will clearly show you if you have a mutation and what type of mutation you have. The report will also display your likelihood of developing celiac disease as low, high, or very high based on your unique combination of mutations of the HLA-DQ genes. 
    The more likely you are to develop celiac disease, the more likely you are to develop gluten intolerance. The higher you are on the interpretation table, the more strictly you should avoid gluten.
    According to research, a positive result will give you a likelihood of developing celiac disease with an accuracy of 97%, while the negative result's accuracy are over 99%.
    Visit our site for more info.
     
    Jefferson Adams
    Are Gluten-Free Foods Aimed at Children Actually Nutritious?
    Image Caption: Image: CC--Mike Mozart
    Celiac.com 07/31/2018 - Using funds from the Canadian Institutes of Health Research Canada Research Chairs Program, researcher Charlene Elliott, PhD, of the Department of Communication, Media, and Film, University of Calgary recently set out to assess the nutritional quality of gluten-free products specifically marketed for children.  
    For her assessment, Elliott bought child-targeted gluten-free food products from two major supermarket chains in Calgary, Alberta, Canada. Elliott used the Pan American Health Organization Nutrient Profile Model to compare the nutritional quality of products labeled gluten-free with those not so labeled. A secondary analysis compared the nutritional profile of child-targeted gluten-free products to their non-gluten-free “equivalents.”
    Elliott’s analysis showed that child-targeted gluten-free products generally had lower amounts of sodium, total fat, and saturated fat, However, those same foods also had less protein and about the same amount of calories from sugar as child-targeted products without a gluten-free claim. 
    According to the Pan American Health Organization criteria, both gluten-free products and "regular" products designed for children can be classified as having poor nutritional quality (88% vs 97%).  Compared to their non-gluten-free equivalents, products with a gluten-free claim had similarly high sugar levels, (79% vs 81%).
    So, the big picture is that gluten-free supermarket foods targeted at children are generally less nutritious than their non-gluten-free counterparts, and both types have alarmingly high sugar content. 
    A gluten-free label is no guarantee of healthier, more nutritious food for kids, and it’s a mistake for parents to buy gluten-free products believing they are healthier than their non-gluten-free equals. The evidence shows that is simply not true.
    The takeaway here seems to be that, gluten-free or not, supermarket foods aimed at children are generally poor in nutrition and loaded with sugar, and parents should choose wisely when buying food for their children.
    Source:
    Pediatrics, July 2018
    Jefferson Adams
    Stella Artois Looks for Big Hit with New Gluten-Free Version
    Image Caption: Image: Stella Artois
    Celiac.com 07/30/2018 - In what looks like great news for UK beer drinkers, beverage giant AB InBev has announced plans to launch a gluten-free version of its popular and widely distributed Stella Artois lager in the UK. Stella Artois Gluten Free will hit UK grocery shelves in August in 4-packs of 330ml bottles, before a more comprehensive roll out this fall. 
    AB InBev said that Stella Artois Gluten Free “will maintain the high quality and exacting standards of the original Stella Artois recipe,” and will use the same four natural ingredients. The final product will use a specific protein to remove gluten, which the company claims has no affect on the beer’s flavor or other characteristics.
    Stella Artois Gluten Free will be displayed outside traditional alcohol aisles, raising brand visibility. AB InBev is clearly motivated by sales and revenues in the rapidly growing gluten-free market. The company noted that UK sales of free-from products grew 36% between 2016 and 2017, while revenues from gluten-free beer sales rose 83%.
    Stella Artois Europe marketing director Alexis Berger says that the company is “incredibly excited to be…making the UK’s favorite beer brand more accessible to those who follow a gluten-free lifestyle.”
    Making Stella Artois gluten-free will allow gluten-free consumers, to enjoy “the UK’s number one selling alcohol brand,” Berger added.
    No word on whether AB InBev will be making Stella Artois Gluten Free available in the United States. Read more in this press release.
    Are you a beer drinker who appreciates a good gluten-free lager? Let us know your thoughts on the news that Stella Artois Gluten Free will soon be a thing, if only in the UK for now. Also, please be sure to let us know your thoughts if you get a chance to try the product.
    Jefferson Adams
    Avocado Shrimp Ceviche (Gluten-Free)
    Image Caption: Image: CC--Gary Stevens
    Celiac.com 07/28/2018 - What do you get when you cross pico de gallo, guacamole and shrimp? The answer is this fresh, delightful ceviche that can also be served as a fancy salsa, and is sure to be the breakout star for your next food gathering.
    Ingredients:
    1¼ pounds raw shrimp peeled and deveined 4 medium limes, juiced 2 medium/large avocados ½ Persian cucumber 4 medium fresh tomatoes 1 small onion diced ½ cup cilantro chopped 1 tablespoon olive oil ¼ tsp salt and black pepper, or to taste Tortilla chips and gluten-free hot sauce of choice, as desired Directions:
    Season shrimp lightly with salt and pepper. 
    Place a large skillet over medium high heat. Once the pan is hot, add 1 tablespoon olive oil. Add shrimp in a single layer and sauté about 1½ minutes on each side. 
    When shrimp is cooked through, remove from the pan.
    Transfer shrimp to cutting board, coarsely chop and place into a large mixing bowl.
    Squeeze the lime juice over the shrimp, stir and set aside to marinate.
    As shrimp marinates, dice cucumber, tomato and avocado and add them to the mixing bowl with shrimp.
    Add dice onion and chopped fresh cilantro. 
    Gently stir everything together until well combined. 
    Serve in small bowls, with hot sauce and tortilla chips, as desired.
    Daniel Cojanu
    Traveling Gluten-Free
    Image Caption: Image: CC--fdecomite
    Celiac.com 07/27/2018 - As we all know, traveling either on driving vacations or internationally presents challenges to those of us with celiac disease.  We normally pack enormous amounts of baked goods and look somewhat silly as we travel.  I believe however that with a little research, we can now cut down on our extra “baggage”.
    When we travel in Michigan, the first thing I do is Google “gluten free groceries”.  With some luck, I usually find a local specialty market with some gluten free items.  This is followed by an email with specific requests such as bread, baked goods, etc.  The markets are more than willing to share this information, and I can pack my food supply accordingly.  
    I then follow up with a Google search for “gluten free restaurants”.  Again, I normally get a few responses and I look at the menu section of their websites to verify the selection.
    I was very impressed with a recent trip to Marquette Michigan in the Upper Peninsula.  Since Marquette is in the very northern section of Michigan, I was worried about finding a gluten-free groceries, much less gluten-savvy restaurants.
    Was I in for a surprise!  They had bakeries, groceries (Marquette Food Co-op) as well as a number of excellent restaurants that had gluten free selections. I was in heaven. Besides being in one of the most beautiful cities in Michigan, I could actually go out and have a wonderful, gluten free dinner.  Be sure to check out the Lagniappe Cajun Grille, the Border Grill, Sweetwater Café and Aubrees Pizza. All have exceptional food.
    I was curious as to why the restaurants were so up to date on celiac disease so I asked at a local bar / grill.
    The answer is Northern Michigan University. It seems that cities with universities are more aware of the needs of folks who want to remain gluten free.  Some of the residents have made this choice either out of necessity after being diagnosed with celiac disease or as a healthy life choice. With this in mind, it may be beneficial when travelling to look for cities close to colleges and universities for groceries and restaurants.  
    Now let’s look at international travel.  Since retiring three years ago, my wife and I plan on one big trip every year. We usually alternate between cruises and land-based trips.  We have seen a dramatic increase in gluten free accommodations on board ship.  Our cruise line of choice has been Princess although I suspect other lines have similar menus. Princess gave me the next night’s menu so I could order in advance.  They would prepare what I wanted, gluten free.  As a bonus, the chef would prepare a surprise dessert every evening for me.  This is what keeps me coming back to Princess.
    We recently took a cruise to Norway and again, were curious about what kind of gluten free restaurants would be available in port.  I emailed the Norwegian Youth Celiac League and received a mountain of information.  I got bakeries, restaurants, alcoholic beverages with addresses and phone numbers so I could visit these places.  They were so helpful and made the trip that much more enjoyable.
    We had a funny experience on a trip to Peru a few years ago.  We had just returned from Machu Picchu and stopped at a local restaurant for a snack. I had ordered chips and guacamole and since there was so much corn farmed there, assumed they would have corn chips.  Wrong!!!  I received a plate of chips that resembled a fried, flour tortilla chip.  I gave the waiter my “I have celiac disease, please don’t make me sick “ card which he read and took to the restaurant owner.  He looked horrified and asked if I liked French fries. I indicated I like fries as long as precautions were taken.  He returned with a grin on his face along with a huge glob of guacamole with these enormous fries stuck in the glob.  Not wanting to offend our host, I ate the somewhat interesting mix and enjoyed every bite.
    Whenever traveling internationally, always carry a dozen or so of these cards to give to waiters. They are available free at celiactravel.com  in all languages.
    Most will go out of their way to accommodate your diet restrictions.  I think the implied message of these cards is that “If you feed me anything with gluten, I will get horribly sick on the floor and scare away your customers”. It has an enormous impact.
    My final thought is that allowing celiac disease to control your leisure time is not necessary.  A little research and a few emails can save you a tremendous amount of aggravation when planning a vacation.
    As more and more vacations destinations become aware of the needs of celiac patients, I believe traveling will become more enjoyable. One final note, always compliment the restaurant owner on having a gluten free menu. It will encourage both that establishment as well as others to follow suit.
    Bon Appetit!
    Jefferson Adams
    Can an Energy Guru Really Help Your Celiac Disease?
    Image Caption: Image: CC--erokism
    Celiac.com 07/26/2018 - Currently, the only medically proven treatment for celiac disease is a life-long gluten-free diet. That’s been true for many years, but that doesn’t stop people from making curious or questionable celiac disease claims. Today in the arena of likely bogus medical claims, we ask ourselves if long-distance energy channeling can help people with their celiac disease symptoms? The obvious answer is that it’s highly unlikely.
    According to the group's recent press release titled, Trivedi Global, Inc. and Su-Mei Liu Announce Research Results on the Impact of a Biofield Energy Treated Nutraceutical for Decreasing Inflammation and Autoimmune Disorders, such treatments do help.
    The company is called Trevedi Global, Inc., and claims that "tests" conducted in the research laboratory of Dabur Research Foundation, near New Delhi, India, show that just 5 minutes of Biofield Energy Treatment, conducted using the “healers' unique Biofield Energy Transmission process remotely to the test samples under laboratory conditions” improves celiac disease and numerous other conditions for people using nutraceutical supplements. Whatever their appeal may be, there’s reason to be skeptical of such claims.
    The press release claims that “Human Biofield Energy has subtle energy that…can be harnessed and transmitted by the gifted into living and non-living things via the process of a Biofield Energy Healing Treatment or Therapy.”
    Of course, this process involves paying money for both nutraceuticals and for the self-labeled “energy healers” working from a remote location. These “healers” then use their “unique” abilities to “channel energy” to the afflicted person for about five minutes.
    Again, as per the press release, these “healing” sessions were conducted by someone called “Sui-Me Liu as part of a group of 20 energy healers. Eighteen were remotely located in the U.S.A and two in Canada.” 
    It goes on to add that “Lui, along with another 19 Biofield healers participating in this research never visited the laboratory in person, nor had any contact with the nutraceuticals samples.” The release calls Liu “an evidence-based energy healer, today announces research based on the impact of a biofield energy treated nutraceutical to improve overall immunity and to combat inflammation and autoimmune disorders.”
    Without addressing any alleged clinical significance the press release goes on to claim the following results:
    “Up to 260% increase overall immunity as seen by elevation of antibody levels" "Over 50% increase in delayed hypersensitivity reaction" "Over 30% decrease in uric acid levels" "Over 25% increase in blood cell counts” The press release claims that these “research findings suggest that the biofield energy treatment enhanced the nutraceutical's anti-inflammatory and immunomodulatory properties with a safe therapeutic index. Another promising indication for the supplement is improvement of overall health and quality of life.”
    So the company is basically selling their nutraceuticals as a cure-all that, coupled with remote energy channeling treatments, allegedly translates into improvements for people with celiac disease.
    They go on to claim that their product “can be used to combat autoimmune diseases and inflammatory disorders like Celiac Disease (gluten-sensitive enteropathy), Irritable Bowel Syndrome (IBS), Parkinson’s Disease, Graves’ Disease, chronic peptic ulcers, Hepatitis, Addison's Disease, Multiple Sclerosis (MS), Tuberculosis, Rheumatoid arthritis, Chronic periodontitis, Crohn's disease, Ulcerative colitis, Lupus, Vitiligo, Hashimoto Thyroiditis, Chronic sinusitis, Type 1 Diabetes, Asthma, Rheumatoid Arthritis, Sjogren Syndrome, Alopecia Areata, Dermatitis, Psoriasis, Fibromyalgia, Diverticulitis, Chronic Fatigue Syndrome, Alzheimer’s Disease, Atherosclerosis and more.”
    Aside from the addition of the strange energy channeling claim, the claims made by Trevedi Global about their nutraceuticals are pretty standard pseudo-medical hype. It’s common for companies to make vague, unsupported health claims while hawking products that are unlikely to have any impact at all upon particular health problems, including celiac disease, and any other serious disorder.
    So, take these claims, and any other claims such as this, with a grain of salt, and don’t give up your gluten-free diet just yet.
    Jefferson Adams
    Do Intestinal Microbiota Influence Non-intestinal Related Autoimmune Diseases?
    Image Caption: Image: CC--Joonie Jatho
    Celiac.com 07/25/2018 - Several recent research articles have emphasized the connection between intestinal autoimmune diseases, such as Crohn's disease with dysbiosis or an imbalance in the microbiota composition in the gut. However, little is known about the role of the microbiota in autoimmune pathologies affecting other tissues than the intestine. 
    A team of researchers recently set out to examine the role played by gut microbiota in the pathogenesis of non-intestinal autoimmune diseases, such as Grave's diseases, multiple sclerosis, Type-1 diabetes, systemic lupus erythematosus, psoriasis, schizophrenia, and autism spectrum disorders. They wanted to see if microbiota can influence and determine the function of cells of the immune system.
    In their report, the team discusses how metabolites derived from bacteria could be used as potential therapies for non-intestinal autoimmune diseases.
    The report was reviewed by Richard Eugene Frye of Phoenix Children's Hospital, United States, and Matej Oresic at the University of Turku in Finland. The report was edited by Marina I. Arleevskaya of Kazan State Medical Academy in Russia. 
    The authors conclude: "The current evidence supports the notion that changes or alterations of the microbial species that form part of the intestinal microbiota will affect the balance of Tregs and Th17 cells at the intestine, which could modify the immune response of non-intestinal autoimmune diseases. The experimental evidence suggesting that the cytokines secreted from Treg and Th17 will determine and influence non-intestinal autoimmune responses. It could also be possible that cells of the immune system located at the intestine could to move other organs to establish or modify an autoimmune response. The major message of this review is that the abundant data support the notion that the intestine is a critical organ the appropriate immune balance and for the prevention of non-intestinal autoimmune diseases. The key point is that by modifying the intestinal microbiota of a patient that suffers non-intestinal autoimmune disease it might be possible to improve the outcome of such illness."
    For more on the role of microbiota in influencing immune cell function and promoting individual wellbeing, read the full report in Frontiers in Microbiology.
     
    The research team included Maria C. Opazo, Elizabeth M. Ortega-Rocha, Irenice Coronado-Arrázola, Laura C. Bonifaz, Helene Boudin, Michel Neunlist, Susan M. Bueno, Alexis M. Kalergis, and Claudia A. Riedel. They are variously affiliated with the Laboratorio de Biología Celular y Farmacología, Departamento de Ciencias Biológicas, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Universidad Andres Bello, Santiago, Chile; Facultad de Medicina, Millennium Institute on Immunology and Immunotherapy, Universidad Andres Bello, Santiago, Chile; Laboratorio de Inmunobiología, Facultad de Medicina, Departamento de Biología Celular y Tisular, Universidad Nacional Autónoma de México, Mexico City, Mexico; Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile; Unidad de Investigación Médica en Inmunoquímica Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Institut National de la Santé et de la Recherche Médicale U1235, Institut des Maladies de l'Appareil Digestif, Université de Nantes, Nantes, France; and the Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad, Metropolitana, Chile.

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  • Recent Articles

    Jefferson Adams
    Can a Gluten-Free Diet Normalize Vitamin D Levels for Celiac Patients?
    Celiac.com 08/16/2018 - What is the significance of vitamin D serum levels in adult celiac patients? A pair of researchers recently set out to assess the value and significance of 25(OH) and 1,25(OH) vitamin D serum levels in adult celiac patients through a comprehensive review of medical literature.
    Researchers included F Zingone and C Ciacci are affiliated with the Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; and the Celiac Center, AOU San Giovanni di Dio e Ruggi di Aragona, University of Salerno, Department of Medicine and Surgery, Salerno, Italy. 
    Within the wide spectrum of symptoms and alteration of systems that characterizes celiac disease, several studies indicate a low-level of vitamin D, therefore recent guidelines suggest its evaluation at the time of diagnosis. This review examines the data from existing studies in which vitamin D has been assessed in celiac patients. 
    Our review indicates that most of the studies on vitamin D in adult celiac disease report a 25 (OH) vitamin D deficiency at diagnosis that disappears when the patient goes on a gluten-free diet, independently of any supplementation. Instead, the researchers found that levels of calcitriol, the active 1,25 (OH) form of vitamin D, fell within the normal range at the time of celiac diagnosis. 
    Basically, their study strongly suggests that people with celiac disease can recover normal vitamin D levels through a gluten-free diet, without requiring any supplementation.
    Source:
    Dig Liver Dis. 2018 Aug;50(8):757-760. doi: 10.1016/j.dld.2018.04.005. Epub 2018 Apr 13.  
    Jefferson Adams
    Could Gluten-Free Food Be Hurting Your Dog?
    Celiac.com 08/15/2018 - Grain-free food has been linked to heart disease in dogs. A canine cardiovascular disease that has historically been seen in just a few breeds is becoming more common in other breeds, and one possible culprit is grain-free dog food. 
    The disease in question is called canine dilated cardiomyopathy (DCM), and often results in congestive heart failure. DCM is historically common in large dogs such as Great Danes, Newfoundlands, Irish Wolfhounds, Saint Bernards and Doberman Pinschers, though it is also affects some Cocker Spaniels.  Numerous cases of DCM have been reported in smaller dogs, whose primary source of nutrition was food containing peas, lentils, other legume seeds or potatoes as main ingredients. These reported atypical DCM cases included Golden and Labrador Retrievers, a Whippet, a Shih Tzu, a Bulldog and Miniature Schnauzers, as well as mixed breeds. 
    As a result, the U.S. Food and Drug Administration's Center for Veterinary Medicine, along with a group of veterinary diagnostic laboratories, is investigating the possible link between DCM and pet foods containing seeds or potatoes as main ingredients. The good news is that in cases where the dog suffers no genetic component, and the disease is caught early, simple veterinary treatment and dietary change may improve heart function.
    According to Nutritional Outlook, an industry publication for makers of dietary supplements and healthy foods and beverages, there is a growing market for “free from” foods for dogs, especially gluten-free and grain-free formulations. In 2017, about one in five dog foods launched was gluten-free. So, do dogs really need to eat grain-free or gluten-free food? Probably not, according to PetMD, which notes that many pet owners are simply projecting their own food biases when choosing dog food.
    Genetically, dogs are well adapted to easily digest grains and other carbohydrates. Also, beef and dairy remain the most common allergens for dogs, so even dogs with allergies are unlikely to need to need grain-free food. 
    So, the take away here seems to be that most dogs don’t need grain-free or gluten-free food, and that it might actually be bad for the dog, not good, as the owner might imagine.
    Stay tuned for more on the FDA’s investigation and any findings they make.
    Read more at Bizjournals.com
     
    Jefferson Adams
    Did You Miss the Gluten-Free Fireworks This Past Fourth of July?
    Celiac.com 08/14/2018 - Occasionally, Celiac.com learns of an amusing gluten-free story after the fact. Such is the case of the “Gluten-Free Fireworks.” 
    We recently learned about a funny little event that happened leading up to Fourth of July celebrations in the town of Springdale in Northwest Arkansas. It seems that a sign advertising "Gluten Free Fireworks" popped up near a fireworks stand on interstate 49 in Springdale. 
    In case you missed the recent dose of Fourth of July humor, in an effort to attract customers and provide a bit of holiday levity, Pinnacle Fireworks put up a sign advertising "gluten-free fireworks.” 
    The small company is owned by Adam Keeley and his father. "A lot of the people that come in want to crack a joke right along with you," Keeley said. "Every now and then, you will get someone that comes in and says so fireworks are supposed to be gluten-free right? Have I been buying fireworks that have gluten? So then I say no, no they are gluten-free. It's just a little fun."
    Keeley said that their stand saw a steady flow of customers in the week leading up to the Fourth. In addition to selling “gluten-free” fireworks, each fireworks package sold by Pinnacle features a QR code. The code can be scanned with a smartphone. The link leads to a video showing what the fireworks look like.
    We at Celiac.com hope you and your family had a safe, enjoyable, and, yes, gluten-free Fourth of July. Stay tuned for more on gluten-free fireworks and other zany, tongue-in-cheek stories.
    Read more at kark.com
     
    Jefferson Adams
    Stress-Related Disorders Associated with Higher Risk for Autoimmune Disease
    Celiac.com 08/13/2018 - It’s not uncommon for people to have psychiatric reactions to stressful life events, and these reactions may trigger some immune dysfunction. Researchers don’t yet know whether such reactions increase overall risk of autoimmune disease.
    Are psychiatric reactions induced by trauma or other life stressors associated with subsequent risk of autoimmune disease? Are stress-related disorders significantly associated with risk of subsequent autoimmune disease?
    A team of researchers recently set out to determine whether there is an association between stress-related disorders and subsequent autoimmune disease. The research team included Huan Song, MD, PhD; Fang Fang, MD, PhD; Gunnar Tomasson, MD, PhD; Filip K. Arnberg, PhD; David Mataix-Cols, PhD; Lorena Fernández de la Cruz, PhD; Catarina Almqvist, MD, PhD; Katja Fall, MD, PhD; Unnur A. Valdimarsdóttir, PhD.
    They are variously affiliated with the Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; the Department of Rheumatology, University Hospital, Reykjavík, Iceland; the Centre for Rheumatology Research, University Hospital, Reykjavík, Iceland; the National Centre for Disaster Psychiatry, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden; the Stress Research Institute, Stockholm University, Stockholm, Sweden; the Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; the Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; the Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden; the Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
    The team conducted a Swedish register-based retrospective cohort study that included 106, 464 patients with stress-related disorders, 1,064 ,640 matched unexposed individuals, and 126 ,652 full siblings to determine whether a clinical diagnosis of stress-related disorders was significantly associated with an increased risk of autoimmune disease.
    The team identified stress-related disorder and autoimmune diseases using the National Patient Register. They used Cox model to estimate hazard ratios (HRs) with 95% CIs of 41 autoimmune diseases beyond 1 year after the diagnosis of stress-related disorders, controlling for multiple risk factors.
    The data showed that being diagnosed with a stress-related disorder, such as post-traumatic stress disorder, acute stress reaction, adjustment disorder, and other stress reactions, was significantly associated with an increased risk of autoimmune disease, compared with matched unexposed individuals. The team is calling for further studies to better understand the associations and the underlying factors.
    Source:
    JAMA. 2018;319(23):2388-2400. doi:10.1001/jama.2018.7028  
    Jefferson Adams
    Gluten-Free Bacon-Wrapped Chicken Breasts
    Celiac.com 08/11/2018 - Need a quick, easy, reliable gluten-free dish that will satisfy everyone and leave the cook with plenty of time to relax? This recipe is sure to do the trick. Best of all, it's super easy. Just grab some chicken breasts, season them, hit them with a sprig of rosemary, wrap some bacon around them, and chuck them on the grill and call it dinner. Okay, you can add some rice and veggies.
    Ingredients:
    4 skinless, boneless chicken breast halves 4 thick slices bacon 4 teaspoons garlic powder 4 small sprigs fresh rosemary salt and pepper to taste Directions:
    Heat an outdoor grill to medium-high heat, and lightly oil the grate.
    Sprinkle 1 teaspoon garlic powder on a chicken breast and season with salt and pepper. 
    Place a rosemary sprig on each chicken breast. 
    Wrap the bacon around the chicken and the rosemary. 
    Hold bacon in place with a toothpick or extra rosemary stem.
    Cook the chicken breasts until no longer pink in the center and the juices run clear, about 8 minutes per side. 
    Keep an eye out for any grill flare ups from the bacon grease. 
    Remove the toothpicks and serve with steamed rice and your favorite vegetables for a winning meal.