Scott Adams

Celiac.com 01/08/2025 - For Catholics with celiac disease, safely partaking in Holy Communion can be a deeply personal and complex issue. The unique challenge lies in balancing religious practices with medical requirements. Here, we explore the intricacies of low-gluten hosts and their safety, offering practical advice for individuals and parishes.
Understanding Gluten-Free Standards and Church Accommodation
Celiac disease requires strict dietary adherence, but the Catholic Church accommodates these needs by allowing low-gluten hosts for communion. Australia, in particular, upholds some of the world’s strictest gluten-free standards. The Coeliac Society of Australia has confirmed that low-gluten hosts—though not entirely free of gluten—are likely safe for many individuals with celiac disease.
The key to understanding their safety lies in the numbers. People with celiac disease are typically advised to limit gluten intake to less than 10 milligrams per day. While this threshold may vary slightly, it is a useful guideline. Comparatively, a typical slice of bread far exceeds this amount, containing thousands of milligrams of gluten.
Low-Gluten Hosts: A Breakdown of Gluten Levels
Low-gluten hosts, such as those manufactured by companies like Cavanagh Altar Breads, weigh about 33 milligrams each and contain between 5 and 70 parts per million (ppm) of gluten. At the lower end of this spectrum, a host would contain approximately 0.0002 milligrams of gluten—an amount significantly below the daily safe limit.
Even at higher ppm levels, the amount of gluten in these hosts is minimal, especially since they are consumed infrequently. The Coeliac Society of Australia supports this conclusion, though individuals with heightened sensitivity may need to proceed with extra caution.
Addressing Gluten Reactions
Despite these assurances, some individuals still experience reactions to low-gluten hosts. There are two primary reasons for this: heightened sensitivity or cross-contamination.
For those who are hypersensitive, consuming the Blood of Christ only—an acceptable alternative under Catholic doctrine—may be the safest option. However, cross-contamination during the liturgy is a more common issue.
Preventing Cross-Contamination
During Mass, there are several opportunities for gluten to inadvertently transfer to a low-gluten host. For instance, when the priest breaks the Eucharistic bread (the fraction rite), crumbs may fall near or into the pyx containing low-gluten hosts. This risk can be reduced by positioning the pyx away from the main altar bread.
Handling practices also play a role. The priest or minister distributing communion should avoid direct contact with the low-gluten host to minimize contamination. The Australian Catholic Bishops Conference recommends handing the pyx directly to the communicant rather than touching the host itself.
Managing the Chalice and Cleansing Rituals
For individuals receiving the Blood of Christ, additional precautions are necessary. The chalice used for celiac communicants should be separate from those used during the rite of commingling, where a fragment of the host is added to the wine. This ensures that gluten does not accidentally enter the chalice.
Cleansing practices also require attention. If a chalice is improperly cleaned after a previous service, trace amounts of gluten could remain. Assigning a specific acolyte to handle celiac-safe chalices and ensuring thorough cleaning are effective ways to mitigate this risk.
Collaboration Between Individuals and Parishes
Successful navigation of low-gluten communion requires open communication between individuals with celiac disease and their parish. Discussing specific needs with the priest and clarifying the available accommodations can prevent misunderstandings and enhance safety.
Parishes can further support congregants by training liturgical ministers on best practices for preventing cross-contamination. Dedicating specific chalices and maintaining clear protocols for cleaning vessels are simple yet impactful measures.
The Importance of Medical Monitoring
Finally, individuals with celiac disease should continue regular medical monitoring, even if they appear to tolerate low-gluten hosts. This allows for early detection of potential damage and ensures long-term health. Consulting with healthcare providers about any symptoms or concerns provides an additional layer of protection.
The Goal: Safe Communion for All
Low-gluten hosts offer a viable option for many Catholics with celiac disease, enabling them to fully participate in the sacrament of Holy Communion. By understanding the gluten content, implementing safeguards against cross-contamination, and fostering dialogue between parishioners and clergy, the Church can ensure that all members can partake safely. For those living with celiac disease, these measures represent both a physical and spiritual opportunity to embrace their faith without compromising their health.
Read more at: catholicweekly.com.au
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Celiac.com 12/13/2024 - The study investigates whether there is a causal relationship between autoimmune diseases and schizophrenia. Schizophrenia, a severe neuropsychiatric disorder, has been associated with immune system dysfunction in prior research. However, conflicting evidence has left the nature of this connection unclear. By using advanced genetic analysis, the researchers sought to determine whether autoimmune diseases and schizophrenia directly influence each other.
Why Study Schizophrenia and Autoimmune Diseases?
Schizophrenia is a complex disorder with genetic, environmental, and biological contributors. It affects approximately 1% of the global population and significantly reduces life expectancy. Autoimmune diseases, where the immune system mistakenly attacks the body, have also been linked to schizophrenia in observational studies. However, these links could be due to overlapping genetic or environmental factors rather than direct causation. Understanding these connections could pave the way for improved prevention and treatment strategies for both conditions.
Study Design: Using Genetics to Uncover Causality
This research used Mendelian randomization, a statistical method that analyzes genetic data to infer causality between factors. By examining genetic variations associated with both schizophrenia and 10 common autoimmune diseases, the study aimed to identify whether there are direct effects between the two. These diseases included conditions like celiac disease, lupus, type 1 diabetes, and psoriasis, among others.
The bidirectional nature of the analysis meant that researchers looked at whether autoimmune diseases influenced schizophrenia and vice versa. A variety of statistical approaches were used to ensure robust results and account for confounding factors.
Key Findings
The study found distinct patterns in how schizophrenia and autoimmune diseases are linked:
Autoimmune Diseases Increasing Schizophrenia Risk:
Ankylosing Spondylitis: Genetic predisposition to this inflammatory arthritis was associated with a higher risk of developing schizophrenia. Autoimmune Diseases Decreasing Schizophrenia Risk:
Celiac Disease, Type 1 Diabetes, and Lupus: Genetic markers for these conditions were linked to a lower risk of schizophrenia, challenging prior studies that suggested an increased risk. Schizophrenia Increasing Autoimmune Disease Risk:
Schizophrenia was found to heighten the risk of certain autoimmune diseases, including inflammatory bowel disease (encompassing Crohn’s disease and ulcerative colitis) and psoriasis. No Causal Link Identified:
Multiple sclerosis and rheumatoid arthritis showed no causal relationship with schizophrenia in either direction. Exploring Biological Mechanisms
The study delved into why these links might exist. Several immune-related factors could explain the relationship:
Immune Dysregulation: Schizophrenia and autoimmune diseases share immune system irregularities, such as imbalances in certain immune cells and altered cytokine levels. Genetic Overlap: Some genetic regions associated with schizophrenia also contribute to autoimmune diseases, suggesting shared pathways in their development. Inflammatory Triggers: Chronic inflammation and infections might simultaneously predispose individuals to both schizophrenia and autoimmune diseases. Antibodies and Neural Impact: In conditions like celiac disease, antibodies produced in response to gluten have been implicated in psychiatric symptoms, possibly linking immune responses to brain function. Study Strengths and Limitations
This study was the first to use a large-scale genetic approach to comprehensively assess the relationship between schizophrenia and autoimmune diseases. By relying on genetic data, it avoided biases often present in observational studies. Sensitivity analyses further validated the results.
However, the study had limitations:
The genetic data came exclusively from individuals of European ancestry, so findings may not apply to other populations. It only included 10 autoimmune diseases, leaving the potential for overlooked associations with other conditions. Nonlinear relationships and environmental factors, such as stress or diet, were not accounted for. Implications for Those With Celiac Disease
One of the most significant findings for individuals with celiac disease is the evidence suggesting a protective effect against schizophrenia. This aligns with earlier studies that found improvements in psychiatric symptoms for some schizophrenia patients who adopted a gluten-free diet. Although more research is needed, this connection underscores the potential importance of nutrition and immune health in managing mental health conditions.
Why This Matters
Understanding the links between autoimmune diseases and schizophrenia is crucial for advancing medical care. This research provides evidence of specific causal relationships, shedding light on potential shared biological mechanisms. For individuals with celiac disease, it offers reassurance that their condition may not increase—and could even reduce—their risk of schizophrenia. More broadly, the findings could inspire new treatment strategies that address the immune system to improve outcomes for those with schizophrenia.
Read more at: bmcpsychiatry.biomedcentral.com
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Celiac.com 11/04/2024 - Celiac disease is an autoimmune disorder that primarily affects the digestive system, but its influence extends far beyond the gut. When individuals with celiac disease consume gluten, an immune response is triggered that can damage the small intestine and lead to a wide array of health problems. Recent research has been exploring the potential connection between celiac disease and other organ systems, including the kidneys. This study focuses on whether there is a causal relationship between celiac disease and various forms of kidney disease, specifically through genetic predisposition. The researchers used a method called Mendelian randomization to assess this potential link, which helps reduce the chance of bias in observational studies.
Methods: Using Genetics to Explore Connections
To investigate the possible connection between celiac disease and kidney disease, the researchers used data from European populations. They applied a technique known as Mendelian randomization, which analyzes genetic data to identify potential causal relationships. This method reduces the impact of confounding factors and helps establish whether genetic susceptibility to celiac disease might lead to an increased risk of kidney-related issues. Specifically, they looked at 10 different kidney traits, such as immunoglobulin A nephropathy (a kidney disorder involving deposits in the kidneys), chronic glomerulonephritis (a condition where the kidney’s filtering units become inflamed), and a decline in estimated glomerular filtration rate, which measures kidney function.
Key Findings: Increased Risk of Kidney Disease
The study found that individuals with a genetic predisposition to celiac disease have a higher risk of developing certain kidney diseases. The data showed a significant increase in the risk of immunoglobulin A nephropathy, with a 44% higher likelihood for those genetically inclined toward celiac disease. Additionally, the study noted a 15% increased risk of chronic glomerulonephritis. A decline in kidney function, as measured by a decrease in the estimated glomerular filtration rate, was also observed.
Interestingly, the study also hinted at a potential connection between celiac disease and membranous nephropathy, a type of kidney disease where the immune system attacks the membranes in the kidneys. Although this relationship was not as strong as others, it remains a possibility that requires further investigation.
Mechanisms: How Celiac Disease Might Affect the Kidneys
One proposed mechanism for this connection is that in individuals with celiac disease, gluten triggers an immune response that does not remain confined to the gut. Instead, this response may cross-react with other tissues, including the kidneys. Specifically, circulating antibodies, which are produced in response to gluten, may end up targeting kidney tissues. These immune reactions and the associated inflammation could damage the kidneys over time, leading to the development of kidney disease.
In particular, the study draws attention to the similarity between the damage caused to the intestinal barrier in celiac disease and the type of damage seen in certain kidney diseases, such as immunoglobulin A nephropathy. Some research has shown that antibodies produced in response to gluten can be found in the kidneys of people with this condition, which strengthens the idea that the immune system’s misdirected response in celiac disease can have broader consequences for other organs.
Contradictory Evidence: No Clear Link with All Kidney Conditions
While the study highlights the increased risk for certain kidney conditions, it also shows that not all kidney diseases are strongly associated with celiac disease. For instance, the research found no significant correlation between celiac disease and diabetic nephropathy, a type of kidney damage commonly seen in people with diabetes. This suggests that the connection between celiac disease and kidney disease may depend on the specific type of kidney condition in question, and not all kidney issues share the same underlying mechanisms with celiac disease.
Implications for Individuals with Celiac Disease
For individuals diagnosed with celiac disease, the findings of this study underscore the importance of monitoring kidney health. Although kidney problems may not be a common or immediate concern for all celiac patients, there is enough evidence to suggest that people with this condition should be aware of their potential risk for certain types of kidney disease. Regular screenings, such as urine tests or blood tests to assess kidney function, could help detect any early signs of kidney issues before they progress.
Moreover, adopting a strict gluten-free diet remains crucial for people with celiac disease. While this study did not directly address the impact of a gluten-free diet on kidney health, other research has suggested that reducing gluten intake can have a positive effect on various health outcomes in celiac patients. Maintaining a gluten-free diet may help minimize the immune response that could contribute to kidney damage.
Valuable Insights into the Relationship Between Celiac Disease and Kidney Health
This study adds valuable insight into the relationship between celiac disease and kidney health. By using genetic data, the researchers were able to show that individuals with a genetic predisposition to celiac disease may be at a higher risk of developing certain kidney diseases, such as immunoglobulin A nephropathy and chronic glomerulonephritis. While not all kidney diseases are linked to celiac disease, the findings highlight the need for continued research into how autoimmune responses triggered by gluten can affect other organs beyond the gut.
For those with celiac disease, understanding this potential link to kidney health could help improve long-term outcomes through early detection and prevention. If future research confirms these findings, routine kidney screenings could become an important part of managing celiac disease, ultimately reducing the risk of serious kidney complications.
Read more at: journals.lww.com

Celiac.com 11/04/2024 - Celiac disease is an autoimmune disorder that primarily affects the digestive system, but its influence extends far beyond the gut. When individuals with celiac disease consume gluten, an immune response is triggered that can damage the small intestine and lead to a wide array of health problems. Recent research has been exploring the potential connection between celiac disease and other organ systems, including the kidneys. This study focuses on whether there is a causal relationship between celiac disease and various forms of kidney disease, specifically through genetic predisposition. The researchers used a method called Mendelian randomization to assess this potential link, which helps reduce the chance of bias in observational studies.
Methods: Using Genetics to Explore Connections
To investigate the possible connection between celiac disease and kidney disease, the researchers used data from European populations. They applied a technique known as Mendelian randomization, which analyzes genetic data to identify potential causal relationships. This method reduces the impact of confounding factors and helps establish whether genetic susceptibility to celiac disease might lead to an increased risk of kidney-related issues. Specifically, they looked at 10 different kidney traits, such as immunoglobulin A nephropathy (a kidney disorder involving deposits in the kidneys), chronic glomerulonephritis (a condition where the kidney’s filtering units become inflamed), and a decline in estimated glomerular filtration rate, which measures kidney function.
Key Findings: Increased Risk of Kidney Disease
The study found that individuals with a genetic predisposition to celiac disease have a higher risk of developing certain kidney diseases. The data showed a significant increase in the risk of immunoglobulin A nephropathy, with a 44% higher likelihood for those genetically inclined toward celiac disease. Additionally, the study noted a 15% increased risk of chronic glomerulonephritis. A decline in kidney function, as measured by a decrease in the estimated glomerular filtration rate, was also observed.
Interestingly, the study also hinted at a potential connection between celiac disease and membranous nephropathy, a type of kidney disease where the immune system attacks the membranes in the kidneys. Although this relationship was not as strong as others, it remains a possibility that requires further investigation.
Mechanisms: How Celiac Disease Might Affect the Kidneys
One proposed mechanism for this connection is that in individuals with celiac disease, gluten triggers an immune response that does not remain confined to the gut. Instead, this response may cross-react with other tissues, including the kidneys. Specifically, circulating antibodies, which are produced in response to gluten, may end up targeting kidney tissues. These immune reactions and the associated inflammation could damage the kidneys over time, leading to the development of kidney disease.
In particular, the study draws attention to the similarity between the damage caused to the intestinal barrier in celiac disease and the type of damage seen in certain kidney diseases, such as immunoglobulin A nephropathy. Some research has shown that antibodies produced in response to gluten can be found in the kidneys of people with this condition, which strengthens the idea that the immune system’s misdirected response in celiac disease can have broader consequences for other organs.
Contradictory Evidence: No Clear Link with All Kidney Conditions
While the study highlights the increased risk for certain kidney conditions, it also shows that not all kidney diseases are strongly associated with celiac disease. For instance, the research found no significant correlation between celiac disease and diabetic nephropathy, a type of kidney damage commonly seen in people with diabetes. This suggests that the connection between celiac disease and kidney disease may depend on the specific type of kidney condition in question, and not all kidney issues share the same underlying mechanisms with celiac disease.
Implications for Individuals with Celiac Disease
For individuals diagnosed with celiac disease, the findings of this study underscore the importance of monitoring kidney health. Although kidney problems may not be a common or immediate concern for all celiac patients, there is enough evidence to suggest that people with this condition should be aware of their potential risk for certain types of kidney disease. Regular screenings, such as urine tests or blood tests to assess kidney function, could help detect any early signs of kidney issues before they progress.
Moreover, adopting a strict gluten-free diet remains crucial for people with celiac disease. While this study did not directly address the impact of a gluten-free diet on kidney health, other research has suggested that reducing gluten intake can have a positive effect on various health outcomes in celiac patients. Maintaining a gluten-free diet may help minimize the immune response that could contribute to kidney damage.
Valuable Insights into the Relationship Between Celiac Disease and Kidney Health
This study adds valuable insight into the relationship between celiac disease and kidney health. By using genetic data, the researchers were able to show that individuals with a genetic predisposition to celiac disease may be at a higher risk of developing certain kidney diseases, such as immunoglobulin A nephropathy and chronic glomerulonephritis. While not all kidney diseases are linked to celiac disease, the findings highlight the need for continued research into how autoimmune responses triggered by gluten can affect other organs beyond the gut.
For those with celiac disease, understanding this potential link to kidney health could help improve long-term outcomes through early detection and prevention. If future research confirms these findings, routine kidney screenings could become an important part of managing celiac disease, ultimately reducing the risk of serious kidney complications.
Read more at: journals.lww.com

Celiac.com 10/16/2024 - Celiac disease and fibromyalgia are two medical conditions that affect a significant number of people worldwide. While celiac disease is an autoimmune disorder triggered by gluten, fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain. Despite being distinct conditions, celiac disease and fibromyalgia share similar symptoms, such as fatigue, gastrointestinal issues, and muscle pain. This study aimed to investigate whether there is a relationship between the two conditions, focusing on whether individuals with celiac disease are more likely to develop fibromyalgia.
Celiac Disease Overview
Celiac disease is a disorder that causes the immune system to react negatively to gluten, a protein found in wheat, barley, and rye. When people with celiac disease consume gluten, their immune system attacks the small intestine, causing damage and preventing the absorption of nutrients. Celiac disease affects roughly 1% of the population, though it is more common in certain genetic groups. Symptoms of celiac disease vary and can include gastrointestinal distress, anemia, osteoporosis, skin conditions, and neurological symptoms.
In many cases, people with celiac disease experience symptoms beyond the digestive tract. These extraintestinal manifestations, such as joint pain, chronic fatigue, and depression, can often resemble fibromyalgia symptoms, making it difficult to differentiate between the two conditions.
Fibromyalgia Overview
Fibromyalgia is a chronic condition that affects the musculoskeletal system and causes widespread pain, tenderness, and fatigue. It is estimated that fibromyalgia affects 2-5% of the population, predominantly women. Common symptoms of fibromyalgia include pain, morning stiffness, non-restorative sleep, and cognitive difficulties, often referred to as "fibro fog."
Interestingly, many people with fibromyalgia also experience gastrointestinal issues, such as irritable bowel syndrome, which further blurs the line between the two conditions. This has led researchers to explore whether there is a deeper connection between fibromyalgia and other autoimmune disorders, such as celiac disease.
Study Design and Methods
This cross-sectional study examined 60 adult patients diagnosed with celiac disease based on criteria established by the American College of Gastroenterology. The study participants were evaluated for fibromyalgia symptoms using a series of diagnostic tools, including the Widespread Pain Index, the Symptom Severity Scale, and the Fibromyalgia Impact Questionnaire. These tools measure both the presence and severity of fibromyalgia in individuals.
The study sought to determine whether there was a significant correlation between the presence of celiac disease and the development of fibromyalgia. The researchers also analyzed the relationship between specific celiac disease biomarkers, such as tissue transglutaminase antibodies and endomysium antibodies, and the likelihood of developing fibromyalgia.
Results and Findings
The study found no significant relationship between the clinical presentation of celiac disease and the likelihood of developing fibromyalgia. Similarly, the results showed no correlation between the severity of celiac disease and the presence of fibromyalgia. However, the study did find that individuals with positive antibody tests, such as tissue transglutaminase antibodies, were more likely to have fibromyalgia compared to those who did not test positive for these antibodies. This suggests that the immune response triggered by gluten in celiac disease may play a role in the development of fibromyalgia.
Although the findings were not statistically significant in some areas, the study highlights the importance of recognizing the overlap between celiac disease and fibromyalgia symptoms. Given that both conditions share many similar symptoms, patients with celiac disease who experience extraintestinal manifestations, such as chronic pain and fatigue, may benefit from being evaluated for fibromyalgia.
Discussion and Implications
The potential link between celiac disease and fibromyalgia raises important questions for healthcare providers. Currently, the diagnosis of fibromyalgia is often made through exclusion, meaning that other conditions, such as autoimmune disorders, must be ruled out first. However, this study suggests that individuals with celiac disease, particularly those with positive antibody tests, may be more prone to developing fibromyalgia.
The immune system's response to gluten in individuals with celiac disease could trigger or exacerbate the chronic pain and sensitivity seen in fibromyalgia. This connection suggests that treating one condition may help alleviate symptoms of the other. For instance, maintaining a strict gluten-free diet may not only improve gastrointestinal symptoms but also reduce the severity of fibromyalgia symptoms in celiac patients.
Furthermore, the study underscores the importance of early diagnosis and treatment for both conditions. Since fibromyalgia is notoriously difficult to treat, identifying patients with celiac disease who may also have fibromyalgia could allow for more targeted therapies. Simultaneously managing the gastrointestinal symptoms of celiac disease and the musculoskeletal pain of fibromyalgia may lead to better overall outcomes for patients.
Conclusion: What This Means for People with Celiac Disease
This study's findings are particularly meaningful for individuals with celiac disease. Since celiac disease and fibromyalgia share many similar symptoms, recognizing the potential for co-occurrence could lead to earlier diagnoses and more effective treatments. For those with celiac disease, staying vigilant about extraintestinal symptoms, such as chronic pain, fatigue, and depression, may help detect fibromyalgia earlier. By working closely with healthcare providers to manage both conditions, people with celiac disease can achieve better symptom control and overall quality of life.
The study also highlights the need for further research to explore the connection between these two conditions. While the results are not definitive, they provide a starting point for future studies that could lead to more comprehensive treatment approaches for individuals affected by both celiac disease and fibromyalgia.
Read more at: hcplive.com

Celiac.com 10/10/2024 - In the last decade, the gluten-free food industry has experienced substantial growth, not only in the number of products available but also in consumer awareness. As demand has risen, so too has the need for clear and accurate labeling. For individuals with celiac disease and gluten sensitivity, strict adherence to a gluten-free diet is essential for maintaining health. The ever-evolving landscape of food labeling regulations continues to be a vital topic for those navigating this space. Here’s a breakdown of the most important updates and considerations regarding gluten-free labeling as we head into 2024.
Understanding Gluten-Free: What Does It Really Mean?
To understand gluten-free labeling, it’s important to first clarify what gluten is and why it poses a problem. Gluten is a protein found in wheat, barley, rye, and their derivatives. For people with celiac disease, consuming even trace amounts of gluten can trigger an autoimmune response that damages the small intestine, leading to serious health issues.
Gluten-free labeling is designed to ensure that foods labeled as such are safe for individuals with gluten-related disorders. According to U.S. Food and Drug Administration (FDA) guidelines, any product labeled as gluten-free must contain less than 20 parts per million (ppm) of gluten. This standard is widely accepted as safe for people with celiac disease. However, not all countries have the same threshold or regulations, making it essential for consumers to understand the rules in the regions where they shop.
Key Changes in Gluten-Free Labeling in 2024
1. More Stringent Cross-Contamination Guidelines
One of the most significant developments in gluten-free labeling for 2024 is the increased focus on cross-contamination. In previous years, gluten-free labeling often referred only to the ingredients used in a product. However, food products could still be contaminated with gluten during manufacturing or packaging. As we move into 2024, new regulations and voluntary certifications are pushing manufacturers to ensure that cross-contamination risks are minimized. This includes more rigorous cleaning processes and dedicated production lines to prevent gluten exposure.
These guidelines are particularly relevant for multi-ingredient products, such as baked goods or processed snacks, where there’s a higher chance that gluten-containing ingredients could be inadvertently introduced.
2. Rise of Gluten-Free Certification Programs
While governmental standards like those from the FDA set minimum requirements for gluten-free labeling, many manufacturers are now seeking third-party certifications to build consumer trust. Programs like the Gluten-Free Certification Organization (GFCO) offer stricter testing and certification processes, often requiring gluten levels to be below 10 ppm or even 5 ppm.
In 2024, more brands are turning to these certifications to differentiate their products in an increasingly competitive market. For consumers, looking for these certification logos can offer an added layer of assurance that the product meets rigorous standards for gluten-free safety.
3. International Differences and Harmonization Efforts
For people who travel or purchase imported goods, it’s important to note that gluten-free labeling standards vary around the world. In the European Union, for example, products must also contain less than 20 ppm of gluten to be labeled gluten-free, but there are additional categories, such as “very low gluten,” which can confuse consumers. In countries like Canada and Australia, the rules are similarly strict but may have slight variations in enforcement.
As the global gluten-free market continues to expand, efforts to harmonize these standards have been gaining traction. In 2024, the World Health Organization (WHO) and the Codex Alimentarius Commission are leading initiatives to develop clearer global standards for gluten-free labeling, aiming to reduce confusion for consumers across borders. These efforts are expected to enhance consumer safety and make it easier for people with celiac disease to shop confidently, regardless of the country of origin of the products they purchase.
4. Digital Tools and Traceability
Another emerging trend in 2024 is the integration of digital tools to verify gluten-free status. Smart labels and QR codes are becoming increasingly common, allowing consumers to scan products with their smartphones to access detailed information about ingredients, testing protocols, and potential cross-contamination risks. These tools provide real-time information that can be updated by manufacturers, offering greater transparency and helping consumers make informed choices.
Traceability systems are also evolving to track a product’s journey from farm to table. This ensures that gluten-free claims are valid throughout the entire supply chain, and not just at the final stage of packaging. Such advancements are especially useful in complex food systems where ingredients might come from multiple sources.
Why Accurate Gluten-Free Labeling Matters
For people with celiac disease, the stakes are high. Ingesting even small amounts of gluten can lead to symptoms ranging from digestive issues to long-term complications like malnutrition, osteoporosis, and an increased risk of certain cancers. Beyond celiac disease, many people suffer from non-celiac gluten sensitivity, which can cause discomfort and other health problems without the autoimmune response seen in celiac disease.
Clear, accurate, and reliable gluten-free labeling is critical to the well-being of millions of people worldwide. The growing popularity of gluten-free diets, sometimes for lifestyle reasons rather than medical necessity, has also led to more products being marketed as gluten-free. However, without proper labeling and adherence to strict standards, there’s a risk that some products might not be safe for those who genuinely need to avoid gluten.
How to Stay Informed and Make Safe Choices
As consumers, staying informed about gluten-free labeling regulations is crucial. Here are a few steps you can take to ensure that the products you choose are truly safe:
Look for Certification Seals: While any product labeled gluten-free must meet regulatory standards, third-party certifications offer additional assurance that the product has been thoroughly tested. Check Ingredient Lists and Allergen Statements: Always review the full list of ingredients and allergen statements. Be on the lookout for terms like “may contain gluten” or “processed in a facility that also processes wheat,” as these could indicate potential cross-contamination risks. Use Digital Tools: Take advantage of apps and online resources to verify gluten-free claims. Many platforms offer databases of certified gluten-free products and allow you to scan barcodes for instant information. Be Cautious with Imported Goods: If you’re purchasing products from international sources, familiarize yourself with the gluten-free labeling laws in that country. Different regions may have different definitions or thresholds for gluten content. Conclusion: The Future of Gluten-Free Labeling
As we progress into 2024, gluten-free labeling is becoming more transparent, standardized, and consumer-friendly. New regulations, improved cross-contamination prevention, and technological advances are making it easier than ever to make safe, informed choices. For those living with celiac disease or gluten sensitivity, these developments are not only a convenience but a necessity for maintaining health and well-being. By staying informed and vigilant, consumers can navigate the evolving gluten-free landscape with confidence.

Celiac.com 08/30/2021 - In August of 2020, the FDA issued a final rule regarding gluten-free labeling of fermented and hydrolyzed foods. The rule established a compliance date of August 13, 2021.
The rule doesn't change the gluten-free definition established by the agency's original 2013 rule, which basically requires foods bearing a gluten-free claim to be made without gluten containing ingredients, or processed so that no more than 20 ppm of gluten remain in the final food product. 
But the FDA did decide that fermented and hydrolyzed foods required additional regulation to ensure compliance with the 2013 final rule, because currently the “FDA knows of no scientifically valid analytical method effective in detecting and quantifying with precision the gluten protein content in fermented or hydrolyzed foods in terms of equivalent amounts of intact gluten proteins.”
Therefore, the 2020 rule established a records-based system to ensure that fermented and hydrolyzed foods are gluten-free consistent with the definition established in 2013. 
The 2020 rule requires food manufacturers of foods that bear gluten-free claims are required to keep records that show that:
The food is gluten-free before fermentation or hydrolysis; The manufacturer has adequately evaluated the potential for cross-contact with gluten during the manufacturing process; If necessary, measures are in place to prevent the introduction of gluten into the food during the manufacturing process.  Companies are required to keep records only for food ingredients for which there are no good analytical tests for gluten content, such as hydrolyzed and fermented foods.  Records must be kept for at least 2 years after introduction of the food into interstate commerce, and must be reasonably accessible to FDA during inspection at each manufacturing facility. 
Starting on the compliance date, manufacturers of gluten-free foods should collect and review documentation from suppliers of any hydrolyzed or fermented food ingredients to ensure compliance with new the rule.
Lastly, the rule applies to enzymes grown on media containing gluten, such as wheat, because gluten from the growth media may be carried over and hydrolyzed via fermentation, making it undetectable to current gluten tests.
Read more at the National Law Review

Celiac.com 09/26/2024 - The Spanish Tortilla, also known as Tortilla Española or Tortilla de Patatas, is a beloved staple of Spanish cuisine with roots dating back to the 19th century. This humble yet hearty dish is traditionally made from simple ingredients like eggs, potatoes, and onions, reflecting Spain’s agricultural heritage. Originally a food of the working class, the tortilla has evolved into a national dish, enjoyed in homes and tapas bars across the country. Whether served as a main course, a snack, or as part of a tapas spread, the Spanish Tortilla embodies the essence of Spain’s culinary tradition: simple, flavorful, and deeply satisfying.
Our gluten-free version of this classic dish stays true to its origins while ensuring that it can be enjoyed by those with gluten sensitivities. The rich, savory blend of tender potatoes, sweet onions, and fluffy eggs creates a comforting dish that’s as versatile as it is delicious. Perfect for any meal of the day, this Spanish Tortilla brings a taste of Spain’s rich history and culture right to your table.
Gluten-Free Spanish Tortilla Recipe
Ingredients:
6 large eggs 4 medium potatoes (Yukon Gold or Russet), peeled and thinly sliced 1 medium onion, thinly sliced ½ cup olive oil Salt, to taste Freshly ground black pepper, to taste Optional: ¼ cup chopped fresh parsley or chives for garnish Instructions:
Prepare the Potatoes and Onions:
Heat olive oil in a large non-stick skillet over medium heat. Add the sliced potatoes and onions, making sure they are evenly coated with the oil. Season with salt and pepper. Cook, stirring occasionally, until the potatoes are tender but not browned, about 15-20 minutes. The potatoes should be soft enough to break apart easily with a spoon. Drain and Cool:
Once the potatoes and onions are cooked, use a slotted spoon to transfer them to a bowl, leaving the excess oil in the skillet. Let them cool slightly. Prepare the Egg Mixture:
In a large bowl, beat the eggs with a pinch of salt. Gently fold in the cooked potatoes and onions until well combined. Cook the Tortilla:
Return the skillet to medium heat with a tablespoon of the reserved oil. Pour the egg mixture into the skillet, spreading it out evenly. Cook for 5-7 minutes, or until the edges start to set and the bottom is golden brown. Flip the Tortilla:
Carefully place a large plate over the skillet, and flip the tortilla onto the plate. Slide the tortilla back into the skillet, uncooked side down, and cook for an additional 5 minutes, until the tortilla is fully set and cooked through. Serve:
Slide the finished tortilla onto a serving plate and allow it to cool slightly before slicing. Garnish with fresh parsley or chives if desired. Enjoy:
Serve warm or at room temperature. Spanish Tortilla is delicious on its own or paired with a simple salad for a light meal. This gluten-free Spanish Tortilla is a classic dish that’s perfect for breakfast, lunch, or dinner. Its simple yet flavorful combination of eggs, potatoes, and onions creates a satisfying meal that captures the essence of traditional Spanish cuisine.

This recipe comes to us from M. Haggerty. Ingredients:
1 egg
½ cup sugar
1 tablespoon oil
3/8 cup buttermilk
1 ¾ cup all purpose gluten-free flour
1 ¾ teaspoons xanthan gum
1 teaspoon gluten-free baking powder
½ teaspoon baking soda
¼ teaspoon salt
¼ teaspoon nutmeg
¼ teaspoon cinnamon
Directions:
Beat egg and add sugar and oil and buttermilk, then mix together and add dry ingredients.
Fry in a skillet at 370-380F: Drop by teaspoons as donut holes, about 6 at a time so as to maintain the temperature. While still warm shake them in a paper bag with sugar/cinnamon.

This recipe comes to us from Lin Goldkrantz.
Mix dry ingredients in a large bowl:
1 cup rice four
½ cup tapioca flour
¼ cup corn starch
2 tablespoons sugar
1 tablespoon baking powder
½ teaspoon salt
½ teaspoon xanthan gum
Add 2 large eggs and stir until egg is mostly absorbed. Add 1 cup of milk and stir again. Add a little less than 1 cup water, and only add the rest if needed. Be careful stirring. Dont beat. You need to get past the gelatinous, sticky stage, but you shouldnt over mix pancake batter. It should still have some lumps. Consistency should be a little thick, but liquid enough to pour.
Melt butter in frying pan or on griddle. Scoop batter onto pan. When the top side starts to have bubbles or holes around the edges, flip pancakes.
Makes 10 four inch pancakes.

Celiac.com 07/25/1996 (Updated: 12/29/2020) - Like many people with celiac disease (it's an autoimmune disease and not a wheat allergy or the same as gluten sensitivity, gluten intolerance, or sensitivity to gluten), I spent a lot of years and money and endured many tests and misdiagnoses before doctors finally discovered that I needed to avoid gluten (including all gluten containing ingredients). Gluten is a protein found in gluten containing grains that include wheat, rye, and barley, and is often hidden in processed foods. To treat my celiac disease I had to go on a gluten-free diet for life, which meant that I had to learn to read food labels, and I ate mostly naturally gluten-free foods like meats, fruits, nuts, vegetables, gluten-free breads, and foods that were labeled gluten-free or made using gluten-free grains. My symptoms, which included weight loss, abdominal pain (especially in my middle-right section while sleeping), bloating, and long-term diarrhea, slowly disappeared.
Because of the large variety of symptoms associated with celiac disease, and the fact that many celiacs have few or no symptoms, diagnosis can be very difficult, which is why is still takes an average of 6-10 years to get diagnosed. Most medical doctors are taught to look for classic symptoms and often make a wrong diagnosis, or no diagnosis at all. During my doctor visits my diet was never discussed, even though most of my symptoms were very typical, and greatly related to food digestion. A simple (and free!) exclusionary diet would have quickly revealed my problem. An exclusionary diet involves eliminating wheat, rye, oats, barley, dairy products, soy and eggs for several weeks, and recording any reaction as you slowly add these foods back into your diet.
Unfortunately it took my doctors over two years to make a diagnosis, and during that time I was misdiagnosed with Irritable Bowel Syndrome (IBS), told that I could have cancer or a strange form of Leukemia, treated for a non-existent ulcer with a variety of antibiotics that made me very ill, and was examined for a possible kidney problem. I also underwent many unnecessary and expensive tests including CAT Scans, thyroid tests, an MRI, tests for bacterial infections and parasites, ultrasound scans, and gall bladder tests. Ultimately the only reason I every got my diagnosis was because I ended up reading something about it in a book on nutrition, which led me to ask my doctor to be screened for it. I was finally diagnosed via a  blood test for celiac disease, followed by a biopsy of my small intestine (which is not as bad as it sounds). 
A full recovery took me 2-3 years, and during that time I also had temporary food intolerance issues to things like dairy (casein), corn, tomatoes, and chicken eggs. During the 1-2 year time period after going 100% gluten-free I was thankfully able to add those things back to my diet.
I created Celiac.com to help others avoid a similar ordeal. I also want to provide people who know they have the problem with information which will improve their quality of life, and broaden their culinary horizons. To do this, I have compiled information from a large variety of sources including medical journals, books, doctors, scientists, and news sources, and posted it all right here. Many of our articles are written by medical professionals such as nurses, doctors, and other celiac disease experts.

Celiac.com 09/16/2024 - Celiac disease is an autoimmune condition that affects individuals when they consume gluten, a protein found in wheat, barley, and rye. In those with the disease, the ingestion of gluten triggers an immune response that damages the small intestine. One of the key enzymes involved in this process is transglutaminase 2, which modifies gluten peptides, making them more likely to cause inflammation. This study focuses on a new therapeutic approach using a transglutaminase 2 inhibitor called ZED1227, which aims to reduce gluten-induced damage in individuals with celiac disease.
Objective of the Study
The main goal of the study was to investigate how effective the transglutaminase 2 inhibitor ZED1227 is at preventing gluten-induced damage in the intestines of people with celiac disease. Participants in the study had been on a gluten-free diet for a long time but were given a six-week gluten challenge while also taking either ZED1227 or a placebo. Researchers analyzed biopsies from the small intestine before and after this period to assess the molecular effects of ZED1227 and its potential to protect against gluten-induced damage.
Mechanism of Action
Transglutaminase 2 plays a central role in celiac disease by modifying gluten peptides, making them more reactive to the immune system. This reaction leads to the activation of immune cells that cause inflammation and damage to the intestinal lining. The inhibitor ZED1227 works by blocking the activity of this enzyme, which theoretically should prevent the gluten peptides from triggering the harmful immune response. The study sought to confirm this effect at the molecular level by analyzing the genetic activity in the intestinal cells of participants.
Study Methodology
Participants with celiac disease were divided into two groups. Both groups underwent a gluten challenge, meaning they consumed gluten for six weeks. One group received a daily dose of ZED1227, while the other group received a placebo. Duodenal biopsies were taken from the participants both before and after the gluten challenge, and researchers performed a detailed analysis of the gene expression in these tissue samples.
Key Findings
The results of the study were significant. The researchers found that ZED1227 effectively prevented the majority of the harmful gene activity that gluten normally triggers in people with celiac disease. In particular, the treatment preserved the structure and function of the intestinal lining.
One of the key findings was that ZED1227 blocked the immune response driven by interferon-gamma, a molecule that plays a major role in the inflammation seen in celiac disease. By inhibiting this pathway, ZED1227 protected the intestines from gluten-induced damage, including villous atrophy (the flattening of the intestinal surface) and crypt hyperplasia (an abnormal increase in the depth of the intestinal lining).
Genetic Considerations
The study also highlighted the role of genetics in how individuals respond to gluten. Specifically, it showed that people with certain genetic variants related to human leukocyte antigen DQ2 were more sensitive to gluten. These individuals, who carry a homozygous form of the gene, had a more intense immune response to gluten, even when taking ZED1227. This suggests that genetic factors could influence how well individuals respond to treatments like ZED1227, and some people may require higher doses or longer treatment durations to achieve optimal protection.
Potential Benefits for Celiac Patients
For individuals with celiac disease, the only current treatment is a strict gluten-free diet. However, following such a diet is challenging and does not always fully prevent gluten exposure or intestinal damage. This study suggests that ZED1227 could offer a new therapeutic option for these patients. By inhibiting transglutaminase 2, ZED1227 could prevent the damage caused by accidental gluten ingestion, providing an additional layer of protection for those who are highly sensitive to gluten or struggle to maintain a perfectly gluten-free diet.
Study Limitations and Future Directions
While the findings of this study are promising, the researchers noted a few limitations. The study involved a relatively small number of participants, and further research with larger groups will be needed to confirm the results. Additionally, the study only tested one dose of ZED1227, and future studies may explore whether higher or lower doses are more effective for different genetic subgroups of patients.
Another area of interest for future research is the long-term safety and effectiveness of ZED1227. The six-week gluten challenge provided valuable insights, but longer-term studies will be necessary to understand how the treatment works over months or even years. The researchers also suggested that a more personalized approach to treatment, where doses of ZED1227 are tailored to individual genetic profiles, could enhance the effectiveness of the therapy.
Conclusion and Implications for Celiac Patients
This study presents a hopeful new direction for the treatment of celiac disease. ZED1227, by inhibiting transglutaminase 2, shows strong potential to prevent the intestinal damage caused by gluten. For those with celiac disease, this could mean fewer symptoms, less inflammation, and overall better intestinal health, even in cases of accidental gluten exposure. While more research is needed to confirm the long-term benefits and fine-tune the treatment for different genetic profiles, ZED1227 represents a promising step toward improving the quality of life for people with celiac disease.
Read more at: nature.com

Celiac.com 09/16/2024 - Celiac disease is an autoimmune condition that affects individuals when they consume gluten, a protein found in wheat, barley, and rye. In those with the disease, the ingestion of gluten triggers an immune response that damages the small intestine. One of the key enzymes involved in this process is transglutaminase 2, which modifies gluten peptides, making them more likely to cause inflammation. This study focuses on a new therapeutic approach using a transglutaminase 2 inhibitor called ZED1227, which aims to reduce gluten-induced damage in individuals with celiac disease.
Objective of the Study
The main goal of the study was to investigate how effective the transglutaminase 2 inhibitor ZED1227 is at preventing gluten-induced damage in the intestines of people with celiac disease. Participants in the study had been on a gluten-free diet for a long time but were given a six-week gluten challenge while also taking either ZED1227 or a placebo. Researchers analyzed biopsies from the small intestine before and after this period to assess the molecular effects of ZED1227 and its potential to protect against gluten-induced damage.
Mechanism of Action
Transglutaminase 2 plays a central role in celiac disease by modifying gluten peptides, making them more reactive to the immune system. This reaction leads to the activation of immune cells that cause inflammation and damage to the intestinal lining. The inhibitor ZED1227 works by blocking the activity of this enzyme, which theoretically should prevent the gluten peptides from triggering the harmful immune response. The study sought to confirm this effect at the molecular level by analyzing the genetic activity in the intestinal cells of participants.
Study Methodology
Participants with celiac disease were divided into two groups. Both groups underwent a gluten challenge, meaning they consumed gluten for six weeks. One group received a daily dose of ZED1227, while the other group received a placebo. Duodenal biopsies were taken from the participants both before and after the gluten challenge, and researchers performed a detailed analysis of the gene expression in these tissue samples.
Key Findings
The results of the study were significant. The researchers found that ZED1227 effectively prevented the majority of the harmful gene activity that gluten normally triggers in people with celiac disease. In particular, the treatment preserved the structure and function of the intestinal lining.
One of the key findings was that ZED1227 blocked the immune response driven by interferon-gamma, a molecule that plays a major role in the inflammation seen in celiac disease. By inhibiting this pathway, ZED1227 protected the intestines from gluten-induced damage, including villous atrophy (the flattening of the intestinal surface) and crypt hyperplasia (an abnormal increase in the depth of the intestinal lining).
Genetic Considerations
The study also highlighted the role of genetics in how individuals respond to gluten. Specifically, it showed that people with certain genetic variants related to human leukocyte antigen DQ2 were more sensitive to gluten. These individuals, who carry a homozygous form of the gene, had a more intense immune response to gluten, even when taking ZED1227. This suggests that genetic factors could influence how well individuals respond to treatments like ZED1227, and some people may require higher doses or longer treatment durations to achieve optimal protection.
Potential Benefits for Celiac Patients
For individuals with celiac disease, the only current treatment is a strict gluten-free diet. However, following such a diet is challenging and does not always fully prevent gluten exposure or intestinal damage. This study suggests that ZED1227 could offer a new therapeutic option for these patients. By inhibiting transglutaminase 2, ZED1227 could prevent the damage caused by accidental gluten ingestion, providing an additional layer of protection for those who are highly sensitive to gluten or struggle to maintain a perfectly gluten-free diet.
Study Limitations and Future Directions
While the findings of this study are promising, the researchers noted a few limitations. The study involved a relatively small number of participants, and further research with larger groups will be needed to confirm the results. Additionally, the study only tested one dose of ZED1227, and future studies may explore whether higher or lower doses are more effective for different genetic subgroups of patients.
Another area of interest for future research is the long-term safety and effectiveness of ZED1227. The six-week gluten challenge provided valuable insights, but longer-term studies will be necessary to understand how the treatment works over months or even years. The researchers also suggested that a more personalized approach to treatment, where doses of ZED1227 are tailored to individual genetic profiles, could enhance the effectiveness of the therapy.
Conclusion and Implications for Celiac Patients
This study presents a hopeful new direction for the treatment of celiac disease. ZED1227, by inhibiting transglutaminase 2, shows strong potential to prevent the intestinal damage caused by gluten. For those with celiac disease, this could mean fewer symptoms, less inflammation, and overall better intestinal health, even in cases of accidental gluten exposure. While more research is needed to confirm the long-term benefits and fine-tune the treatment for different genetic profiles, ZED1227 represents a promising step toward improving the quality of life for people with celiac disease.
Read more at: nature.com

Celiac.com 09/09/2024 - Celiac disease is an autoimmune disorder affecting about one percent of the global population. Those with celiac disease must adhere to a strict gluten-free diet, as there is currently no other treatment option available. A recent study by researchers at Stanford University and the Stanford Synchrotron Radiation Lightsource at the U.S. Department of Energy's SLAC National Accelerator Laboratory has provided new insights into the key enzyme transglutaminase 2 (TG2), which plays a significant role in the disease's pathology.
The Function of Transglutaminase 2
Transglutaminase 2 is a multifunctional enzyme involved in various physiological and pathological conditions, including celiac disease. The enzyme requires calcium to perform its primary chemical reactions, transamidation and deamidation. These reactions are crucial because they enable TG2 to modify gluten peptides in a way that triggers the immune response seen in celiac disease. Specifically, TG2 deamidates certain glutamine residues in gluten peptides, creating a strong immune response that leads to the body attacking its own intestinal tissues.
Structural Analysis of TG2
One of the significant achievements of this study was obtaining a high-resolution X-ray crystallographic structure of TG2 bound to calcium. This structure revealed the conformations of TG2 when interacting with calcium, providing detailed insights into its catalytic cycle. The researchers identified two key calcium-binding sites, S1 and S3, which play distinct roles in the enzyme's function. The S1 site regulates the formation of an inhibitory disulfide bond, while the S3 site is essential for the formation of γ-glutamyl thioester, an intermediate state crucial for TG2's activity.
Mechanistic Insights into TG2 Activity
The study uncovered several important mechanistic details about TG2. Two residues, H305 and E363, were found to be critical for resolving the thioester intermediate into an isopeptide bond, a key step in the transamidation process. However, these residues do not play a role in thioester hydrolysis, which is involved in deamidation. Additionally, residues N333 and K176 help stabilize TG2 substrates and inhibitors by forming hydrogen bonds with nonreactive backbone atoms. These findings provide a more comprehensive understanding of how TG2 functions at a molecular level and how it transitions between different states during its catalytic cycle.
Implications for Drug Development
The insights gained from this study are not just of academic interest; they have practical implications for drug development. By revealing the detailed structure and mechanisms of TG2, the researchers have provided a valuable framework for designing better therapeutic inhibitors of the enzyme. Currently, drugs targeting TG2 are being developed for celiac disease and other related conditions, such as idiopathic pulmonary fibrosis. This study's findings can inform the design of these drugs, potentially leading to more effective treatments.
Conclusion
This research represents a significant step forward in understanding the molecular mechanisms underlying celiac disease. By elucidating the structure and function of TG2, the study provides crucial insights that could lead to the development of new treatments for celiac disease. For those affected by this condition, these advancements offer hope for alternatives to the strict gluten-free diet that currently remains the only effective treatment. The findings underscore the importance of structural biology in uncovering the intricacies of disease mechanisms and paving the way for innovative therapeutic approaches.
Read more at: pnas.org and phys.org

Celiac.com 09/12/2024 - Celiac disease is an autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. This condition affects roughly one in 133 people worldwide, though it often goes undiagnosed due to its diverse symptoms. Celiac disease can co-occur with other autoimmune diseases, complicating its presentation and management. The disease’s prevalence and diagnosis are influenced by demographic and genetic factors, making it a significant health concern globally.
Ophthalmic Manifestations of Celiac Disease
Celiac disease is not just a gastrointestinal disorder; it can also have various ophthalmic manifestations. Patients with celiac disease may exhibit a range of eye-related issues that are not typically associated with the condition, such as decreased endothelial cell density, vitamin A deficiency causing dryness, altered corneal nerve density, cataracts, uveitis, changes in choroidal thickness, papilledema, and neurological issues like nystagmus. These manifestations highlight the systemic nature of celiac disease and the importance of comprehensive care.
The Need for Thorough Evaluation Before Corneal Refractive Surgery
Corneal refractive surgery, which includes procedures like LASIK, is increasingly popular for correcting vision problems. However, for patients with celiac disease, it is crucial to conduct a thorough evaluation before proceeding with such surgeries. The variability in ocular manifestations among celiac patients necessitates individualized assessments to determine surgical candidacy and optimize outcomes. This evaluation should include both subjective and objective assessments.
Subjective Assessments
A detailed medical history focusing on the patient’s experience with celiac disease is essential. This includes questions about dietary gluten intake, weight loss, joint pain, and cognitive impairments like brain fog. Understanding these aspects can help in identifying potential complications that might affect surgical outcomes.
Objective Assessments
A comprehensive objective assessment should include several diagnostic tests:
Slit-lamp biomicroscopy to examine the eye’s structures. Schirmer test and tear break-up time (TBUT) to assess tear production and dry eye. Optical coherence tomography (OCT) to measure retinal and choroidal thickness. Scheimpflug imaging and fundoscopy to evaluate the anterior and posterior segments of the eye. Specific Considerations for Celiac Disease Patients
Given the diverse ocular manifestations associated with celiac disease, several specific considerations should be addressed:
Dry Eye Disease: Patients with celiac disease are more prone to dry eye disease. Symptoms like ocular discomfort, irritation, redness, and burning can be managed with artificial tears and punctal plugs before surgery. Endothelial Cell Density (ECD): Celiac disease patients may have lower ECD, which can lead to corneal edema post-surgery. Specular microscopy is recommended to evaluate ECD before proceeding with surgery. Anterior Chamber Depth (ACD): Some celiac disease patients might have shallower ACDs, which can indicate early-onset cataracts. Scheimpflug imaging can help assess ACD. Choroidal and Retinal Health: OCT is crucial to evaluate choroidal thickness and retinal health. Thinner choroids and other posterior segment abnormalities can affect visual outcomes post-surgery. Thyroid-Associated Orbitopathy (TAO): Celiac disease patients may also suffer from TAO, which can impact corneal health and refractive surgery outcomes. Thyroid function tests and orbital ultrasound are necessary for a thorough evaluation. Vitamin A Deficiency: This can lead to dryness and other ocular surface issues. Serum retinol levels should be checked, and vitamin A supplementation should be managed appropriately. Neurological Issues: Conditions like gluten ataxia and nystagmus can complicate surgery due to motor control issues. These conditions need careful assessment and management. Autoimmune Co-morbidities: The presence of other autoimmune conditions, like Type 1 Diabetes Mellitus, can increase the risk of complications like diabetic retinopathy, impacting surgical outcomes. Comprehensive retinal evaluations are necessary in these cases. Conclusion: The Importance of Comprehensive Care
This study underscores the need for a thorough and individualized evaluation of celiac disease patients considering corneal refractive surgery. By addressing the various ophthalmic manifestations and related autoimmune conditions, healthcare providers can improve surgical outcomes and patient satisfaction. The recommendations provided in this study serve as preliminary guidelines, highlighting the importance of further research to better understand the impact of celiac disease on corneal refractive surgery outcomes. For celiac patients, these insights are crucial, as they emphasize the need for comprehensive care and tailored management strategies to ensure the best possible surgical results.
Read more at: cureus.com

Celiac.com 08/20/2024 - Captain Mark MacKenzie, a pilot diagnosed with celiac disease, has filed a lawsuit against United Airlines for failing to provide him with gluten-free food during flights. The lawsuit, filed in Colorado federal court on August 12, claims that United Airlines has neglected to make necessary accommodations for MacKenzie, a violation of his rights under the Americans with Disabilities Act (ADA). This case highlights significant concerns about how airlines accommodate the dietary needs of employees with specific medical conditions.
Background of the Case
Captain MacKenzie, a seasoned pilot with over 35 years of experience and a clean flying record, is based out of Denver, Colorado. Due to his celiac disease, he must adhere to a strict gluten-free diet to avoid severe health complications. Celiac disease is an autoimmune disorder triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. Exposure to gluten can cause various health issues, including digestive problems, malnutrition, and anemia, as outlined by the Mayo Clinic.
Despite notifying United Airlines of his condition and requesting gluten-free meals, MacKenzie claims the airline has failed to provide appropriate accommodations. The lawsuit emphasizes that United Airlines not only refuses to supply him with gluten-free food but also charges him for meals he cannot consume due to his medical condition. This, according to the lawsuit, constitutes discrimination under Title I of the ADA, which requires employers to provide reasonable accommodations for employees with disabilities.
Impact on Captain MacKenzie
The lawsuit details the significant impact United Airlines' actions have had on Captain MacKenzie. On one occasion, during an 11-hour duty day from Denver to Roatan, Honduras, and back, United Airlines allegedly did not provide him with any gluten-free food. As a result, MacKenzie was forced to endure the long flight without eating, leading to fatigue and potential health risks. This is not an isolated incident, as the lawsuit claims that MacKenzie often has to purchase his own meals while on duty, unlike other pilots who are provided with meals they can safely eat.
In 2020, MacKenzie formally notified United Airlines of his celiac disease and the challenges he faces in accessing safe food during flights and layovers. Despite this, the airline has not made the necessary adjustments, leading to the current legal action. MacKenzie is seeking a court order requiring United Airlines to provide gluten-free meals, along with damages and reimbursement for legal fees.
Legal and Ethical Implications
This case raises important questions about the responsibilities of employers, particularly in industries like aviation, where employees are often required to work long hours away from home. Under the ADA, employers are legally obligated to provide reasonable accommodations for employees with disabilities, which in MacKenzie’s case would mean offering gluten-free meal options. The failure to do so not only violates federal law but also endangers the health and well-being of employees like MacKenzie.
Furthermore, the case touches on broader ethical issues concerning equal treatment in the workplace. Charging an employee for meals they cannot safely eat due to a medical condition could be seen as an unfair burden, particularly when other employees receive their meals at no additional cost. This practice could be viewed as discriminatory and may set a concerning precedent for how other employees with dietary restrictions are treated.
Why This Case Matters to Those with Celiac Disease
For individuals with celiac disease, the outcome of this lawsuit could have significant implications. It underscores the challenges that people with celiac disease face in environments where access to gluten-free food is limited. If successful, MacKenzie's lawsuit could lead to stricter enforcement of ADA guidelines in the workplace, ensuring that employers take the dietary needs of employees with medical conditions seriously.
Additionally, this case brings attention to the broader issue of accessibility and accommodation for people with dietary restrictions, particularly in industries like aviation, where employees may not have the ability to bring their own food or access alternative options easily. It highlights the need for greater awareness and sensitivity towards the needs of those with celiac disease and other similar conditions, advocating for a more inclusive and supportive work environment.
In conclusion, Captain Mark MacKenzie’s lawsuit against United Airlines is not just a legal battle over meal accommodations; it is a critical test of how companies should treat employees with medical conditions that require special dietary considerations. The outcome of this case could set a precedent that may influence policies across various industries, ensuring that individuals with celiac disease receive the necessary support and accommodations in their workplaces.
More: newsweek.com

Celiac.com 08/20/2024 - Captain Mark MacKenzie, a pilot diagnosed with celiac disease, has filed a lawsuit against United Airlines for failing to provide him with gluten-free food during flights. The lawsuit, filed in Colorado federal court on August 12, claims that United Airlines has neglected to make necessary accommodations for MacKenzie, a violation of his rights under the Americans with Disabilities Act (ADA). This case highlights significant concerns about how airlines accommodate the dietary needs of employees with specific medical conditions.
Background of the Case
Captain MacKenzie, a seasoned pilot with over 35 years of experience and a clean flying record, is based out of Denver, Colorado. Due to his celiac disease, he must adhere to a strict gluten-free diet to avoid severe health complications. Celiac disease is an autoimmune disorder triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. Exposure to gluten can cause various health issues, including digestive problems, malnutrition, and anemia, as outlined by the Mayo Clinic.
Despite notifying United Airlines of his condition and requesting gluten-free meals, MacKenzie claims the airline has failed to provide appropriate accommodations. The lawsuit emphasizes that United Airlines not only refuses to supply him with gluten-free food but also charges him for meals he cannot consume due to his medical condition. This, according to the lawsuit, constitutes discrimination under Title I of the ADA, which requires employers to provide reasonable accommodations for employees with disabilities.
Impact on Captain MacKenzie
The lawsuit details the significant impact United Airlines' actions have had on Captain MacKenzie. On one occasion, during an 11-hour duty day from Denver to Roatan, Honduras, and back, United Airlines allegedly did not provide him with any gluten-free food. As a result, MacKenzie was forced to endure the long flight without eating, leading to fatigue and potential health risks. This is not an isolated incident, as the lawsuit claims that MacKenzie often has to purchase his own meals while on duty, unlike other pilots who are provided with meals they can safely eat.
In 2020, MacKenzie formally notified United Airlines of his celiac disease and the challenges he faces in accessing safe food during flights and layovers. Despite this, the airline has not made the necessary adjustments, leading to the current legal action. MacKenzie is seeking a court order requiring United Airlines to provide gluten-free meals, along with damages and reimbursement for legal fees.
Legal and Ethical Implications
This case raises important questions about the responsibilities of employers, particularly in industries like aviation, where employees are often required to work long hours away from home. Under the ADA, employers are legally obligated to provide reasonable accommodations for employees with disabilities, which in MacKenzie’s case would mean offering gluten-free meal options. The failure to do so not only violates federal law but also endangers the health and well-being of employees like MacKenzie.
Furthermore, the case touches on broader ethical issues concerning equal treatment in the workplace. Charging an employee for meals they cannot safely eat due to a medical condition could be seen as an unfair burden, particularly when other employees receive their meals at no additional cost. This practice could be viewed as discriminatory and may set a concerning precedent for how other employees with dietary restrictions are treated.
Why This Case Matters to Those with Celiac Disease
For individuals with celiac disease, the outcome of this lawsuit could have significant implications. It underscores the challenges that people with celiac disease face in environments where access to gluten-free food is limited. If successful, MacKenzie's lawsuit could lead to stricter enforcement of ADA guidelines in the workplace, ensuring that employers take the dietary needs of employees with medical conditions seriously.
Additionally, this case brings attention to the broader issue of accessibility and accommodation for people with dietary restrictions, particularly in industries like aviation, where employees may not have the ability to bring their own food or access alternative options easily. It highlights the need for greater awareness and sensitivity towards the needs of those with celiac disease and other similar conditions, advocating for a more inclusive and supportive work environment.
In conclusion, Captain Mark MacKenzie’s lawsuit against United Airlines is not just a legal battle over meal accommodations; it is a critical test of how companies should treat employees with medical conditions that require special dietary considerations. The outcome of this case could set a precedent that may influence policies across various industries, ensuring that individuals with celiac disease receive the necessary support and accommodations in their workplaces.
More: newsweek.com

Celiac.com 08/26/2024 - The study "Gluten is a Proinflammatory Inducer of Autoimmunity" explores the significant and diverse ways in which gluten, a protein found in many grains, affects human health. Although gluten is well-known for its role in celiac disease, its influence extends beyond this condition. The study reveals that gluten can trigger inflammation and contribute to the development of various autoimmune and chronic inflammatory diseases. This summary will break down the key findings of the study to explain how gluten affects the body and why this research matters, particularly for those with celiac disease.
How Gluten Triggers Inflammation
Gluten is composed of peptides that are difficult to digest, and when consumed, these peptides can cause harm by interacting with the immune system in the gut. Normally, the intestines act as a barrier, keeping harmful substances out while allowing nutrients to pass through. However, gluten disrupts this barrier by weakening the tight junctions between cells, making the gut more permeable. This increased permeability allows foreign molecules, including gluten peptides, to enter the bloodstream and reach various organs. Once in the bloodstream, these peptides can cause inflammation in distant parts of the body, not just in the intestines.
The study also highlights that gluten can activate several inflammatory pathways in the body. One particular gluten component, gliadin, induces stress in the cells lining the gut, triggering a series of events that lead to a local inflammatory response. This response involves the activation of immune cells and the release of inflammatory molecules, which can cause further damage to the gut lining and contribute to chronic inflammation.
Gluten and the Immune System
Gluten is not just a trigger for inflammation; it also has a strong immunogenic effect, meaning it can stimulate the immune system in ways that lead to autoimmune diseases. In individuals with celiac disease, gluten peptides are modified by an enzyme called tissue transglutaminase (tTG), making them more likely to be recognized as harmful by the immune system. This recognition leads to the production of specific antibodies against gluten and tTG, which attack not only the gluten peptides but also the body’s own tissues, resulting in the symptoms of celiac disease.
Interestingly, the study suggests that gluten can have similar effects even in people who do not have celiac disease. For example, gluten has been shown to elicit an immune response in individuals with non-celiac gluten sensitivity, a condition where people experience symptoms related to gluten intake despite not having the typical markers of celiac disease. This broad immunogenic potential of gluten underscores its role as a universal trigger of inflammation and autoimmunity.
Systemic Distribution of Gluten Peptides
One of the most concerning aspects of gluten's impact on health is its ability to affect organs far from the gut. After gluten peptides enter the bloodstream, they can travel to various parts of the body, where they may contribute to different health problems. The study provides evidence that gluten peptides can be found in tissues and organs such as the brain, thyroid, and other peripheral organs. In these locations, gluten can induce or exacerbate inflammatory and autoimmune processes.
For instance, gluten has been implicated in neurological conditions, such as gluten ataxia, where it causes damage to the cerebellum, a part of the brain that controls coordination. This condition, like many other gluten-related disorders, is thought to arise from the immune system mistakenly attacking brain tissue in response to gluten peptides. Additionally, gluten peptides have been found in the thyroid gland, where they may play a role in autoimmune thyroid diseases like Hashimoto's thyroiditis.
The Broader Implications of Gluten Consumption
The findings of this study have broad implications, especially for individuals with celiac disease or other gluten-related disorders. The fact that gluten can trigger inflammation and contribute to autoimmune diseases even in people without celiac disease suggests that gluten might be a more widespread health concern than previously thought. The study also highlights the potential benefits of a gluten-free diet, not only for those with celiac disease but also for individuals with other chronic inflammatory or autoimmune conditions.
For those with celiac disease, this research reinforces the importance of strict adherence to a gluten-free diet as the only effective way to prevent the harmful effects of gluten. For others, especially those with unexplained chronic inflammation or autoimmune diseases, it may be worth exploring the role of gluten in their diet and considering gluten withdrawal as a potential therapeutic strategy.
Conclusion: Why This Study Matters
This study sheds light on the multifaceted and far-reaching effects of gluten on the human body. It reveals that gluten is not just a concern for people with celiac disease but may also play a role in a wide range of other chronic inflammatory and autoimmune conditions. By understanding how gluten affects gut permeability, triggers immune responses, and spreads systemically to various organs, we gain valuable insights into its role in human health. For those with celiac disease, this research underscores the importance of a gluten-free diet, while also opening up new avenues for investigating gluten's impact on other conditions. This study could be a pivotal step in redefining our understanding of gluten and its potential risks for broader populations.
Read more at: xiahepublishing.com

This is a list of unsafe and forbidden ingredients for those who have celiac disease. We keep it up to date, and feel free to use the comment field below to suggest any changes or additions.
A
Abyssinian Hard (Wheat triticum durum)
Atta Flour
Autolyzed yeast (msg)
Autolyzed Yeast Extract (msg)
B
Barley Grass (can contain seeds)
Barley Hordeum vulgare
Barley Malt
Beer (most contain barley or wheat)
Bleached Flour
Bran (wheat, rye or barley bran)
Bread Flour
Brewer's Yeast
Brown Flour
Bulgur (Bulgar Wheat/Nuts)
Bulgur Wheat
C
Cereal Binding
Chilton
Club Wheat (Triticum aestivum subspecies compactum)
Common Wheat (Triticum aestivum)
Cookie Crumbs
Cookie Dough
Cookie Dough Pieces
Couscous
Criped Rice
D
Dinkle (Spelt)
Disodium Wheatgermamido Peg-2 Sulfosuccinate
Durum wheat (Triticum durum)
E
Edible Coatings
Edible Films
Edible Starch
Einkorn (Triticum monococcum)
Emmer (Triticum dicoccon)
Enriched Bleached Flour
Enriched Bleached Wheat Flour
Enriched Flour
F
Farik
Farina
Farina Graham
Farro
Filler
Flour (normally this is wheat)
Freekeh
Frikeh
Fu (dried wheat gluten)
G
Germ (wheat, rye or barley bran)
Graham Flour
Granary Flour
Groats (barley, wheat)
H
Hard Wheat
Heeng
Hing
Hordeum Chilense (Wild Barley)
Hordeum Vulgare Extract
Hydroxypropyltrimonium Hydrolyzed Wheat Protein
K
Kamut (Pasta wheat)
Kecap Manis (Soy Sauce)
Ketjap Manis (Soy Sauce)
Kluski Pasta
M
Maida (Indian wheat flour)
Malt
Malted Barley Flour
Malted Milk
Malt Extract
Malt Syrup
Malt Flavoring
Malt Vinegar
Macha Wheat (Triticum aestivum)
Matza
Matzah
Matzo
Matzo Semolina
Meripro 711
Mir
N
Nishasta
O
Oriental Wheat (Triticum turanicum)
Orzo Pasta
P
Pasta
Pearl Barley
Persian Wheat (Triticum carthlicum)
Perungayam
Poulard Wheat (Triticum turgidum)
Polish Wheat (Triticum polonicum)
R
Rice Malt (if barley or Koji are used)
Roux
Rusk
Rye
S
Seitan
Semolina
Semolina Triticum
Shot Wheat (Triticum aestivum)
Small Spelt
Spirits (Specific Types)
Spelt (Triticum spelta)
Sprouted Wheat or Barley
Stearyldimoniumhydroxypropyl Hydrolyzed Wheat Protein
Strong Flour
Suet in Packets
T
Tabbouleh
Tabouli
Teriyaki Sauce
Timopheevi Wheat (Triticum timopheevii)
Triticale X triticosecale
Triticum Durum (Durum Wheat)
Triticum Vulgare (Wheat) Flour Lipids
Triticum Vulgare (Wheat) Germ Extract
Triticum Vulgare (Wheat) Germ Oil
Tritordeum (combination of durum wheat - Triticum Durum - and wild barley (Hordeum Chilense)
U
Udon (wheat noodles)
Unbleached Flour
V
Vavilovi Wheat (Triticum aestivum)
Vital Wheat Gluten
W
Wheat, Abyssinian Hard triticum durum
Wheat Amino Acids
Wheat Bran Extract
Wheat, Bulgur
Wheat Durum Triticum
Wheat Germ Extract
Wheat Germ Glycerides
Wheat Germ Oil
Wheat Germamidopropyldimonium Hydroxypropyl Hydrolyzed Wheat Protein
Wheat Grass (can contain seeds)
Wheat Nuts
Wheat Protein
Wheat Starch
Wheat Triticum aestivum
Wheat Triticum Monococcum
Wheat (Triticum Vulgare) Bran Extract
Whole-Meal Flour
Wild Barley (Hordeum Chilense)
Wild Einkorn (Triticum boeotictim)
Wild Emmer (Triticum dicoccoides)
Y
Yeast Extract (msg)
The following items may or may not contain gluten depending on where and how they are made, and it is sometimes necessary to check with the manufacturer to find out:
Amp-Isostearoyl Hydrolyzed Wheat Protein2 Artificial Color2 Baking Powder2 Clarifying Agents2 Coloring2 Dry Roasted Nuts2 Emulsifiers2 Enzymes2 Fat Replacer2 Gravy Cubes2 Ground Spices2 Hydrolyzed Wheat Gluten2 Hydrolyzed Wheat Protein2 Hydrolyzed Wheat Protein Pg-Propyl Silanetriol2 Hydrolyzed Wheat Starch2 Hydrogenated Starch Hydrolysate2 Hydroxypropylated Starch2 Miso2 Natural Juices2 Non-dairy Creamer2 Pregelatinized Starch2 Protein Hydrolysates2 Seafood Analogs2 Seasonings2 Sirimi2 Soba Noodles2 Soy Sauce2 Soy Sauce Extract2 Soy Sauce Solids2 Sphingolipids2 Stabilizers2 Starch1, 2 Stock Cubes2 Suet2 Tocopherols2 Vegetable Broth2 Vegetable Gum2 Vegetable Protein2 Vegetable Starch2 Vitamins2 1) If this ingredient is made in North America it is likely to be gluten-free. 2) Can utilize a gluten-containing grain or by-product in the manufacturing process, or as an ingredient.

Celiac.com 08/13/2024 - Gluten Free Watchdog, an advocacy site for people with celiac disease, recently responded to a study by Moms Across America, which claimed that Trader Joe's Everything Gluten-Free Bagels contained nearly 300 ppm of gluten—a controversy that has already led to a class action lawsuit against Trader Joe's. 
The gluten testing was performed by Health Research Institute (HRI), an ISO17025 accredited lab approved by the FDA, and examined 46 products, including 32 GFCO-certified ones. It found that nearly 15% of the certified products exceeded the 10 ppm gluten-free standard, with nearly 10% surpassing the FDA's 20 ppm gluten-free limit, meaning they cannot be labeled gluten-free and should be subject to a product recall. A recent analysis by Celiac.com uncovered potential issues with GFCO's certification process, which may have contributed to the high failure rate found in the study, and suggests ways to improve the certification program.
Gluten Free Watchdog, however, suggests that these findings might be false positives, possibly due to HRI not using an extra protein to prevent non-specific binding during testing. Gluten Free Watchdog tested three different batches of Trader Joe's bagels using two different assays (R5 ELISA and G12 ELISA) with and without a milk additive for protein blocking. They argue that the inconsistent results—depending on whether the milk additive was used—indicate that HRI should rerun their tests with the additive, as their original results might have been false positives.
HRI's Response
Celiac.com reached out by email to John Fagan, Ph.D., Chief Science Officer at HRI for comment about Gluten Free Watchdog's article, and according to him: 
When describing their testing procedure he explained: 
Romer, the manufacturer of the AgraQuant G12 ELISA test, supported Dr. Fagan's claims, stating that while the milk additive is an option, it is not mandatory for all tests, and while certain ingredients like chocolate, soy, and oats, may require adding an extra protein during the testing procedure to prevent non-specific binding, they confirmed that no such ingredients were present in the Trader Joe's bagels. 
Tara J. Miller, Vice President of Marketing at Trader Joe's, however, claims that their tests on the same batch tested by HRI showed the bagels met FDA and GFCO standards for gluten-free labeling (below 10 ppm). When Celiac.com asked Dr. Fagen how his lab could find high gluten in a batch where Trader Joe's found none, he concurred with the possibility of "hot spots" within the sample, which could explain the discrepancy.
Why Did Gluten Free Watchdog Test Different Batches?
Gluten Free Watchdog's testing did not involve the same batches of bagels tested by HRI. When Celiac.com asked Dr. Fagan for his comment on the Gluten Free Watchdog article he replied with:
The last email we received from Dr. Fagan on this topic further emphasized his position:
Unfortunately, Gluten Free Watchdog's posts do not address how HRI found zero detectable gluten in most of the products they tested, including three types of bagels similar to Trader Joe's bagels, one of which also contained brown rice flour and sorghum flour (Canyon Bakehouse Plain Bagels). If HRI's testing required extra protein for accuracy, shouldn't these very similar products have also shown false positives?
Every Romer AgraQuant® Gluten G12 ELISA Test Kit Includes Fish Gelatin to Prevent Non-Specific Binding
According to the product documentation for the Romer AgraQuant® Gluten G12 ELISA Test Kit, the kits include the following:
Package Insert Certificate of Performance 5 standards (0, 4, 20, 80, 200 ppm), calibrated to the Prolamin Working Group (PWG) Gliadin. Gluten G12 antibody coated microwells Ready to use Extraction Solution 5x concentrated Diluent Buffer 10x concentrated Wash Buffer Ready to use Conjugate, Substrate and Stop Solutions 1 sachet of Fish Gelatin The fish gelatin included in the AgraQuant® Gluten G12 ELISA test kit is likely used to prevent non-specific binding. In ELISA assays, non-specific binding can occur when proteins or other molecules in the sample adhere to the microwells in an undesired manner, potentially leading to inaccurate results.
Fish gelatin is a commonly used blocking agent in such assays. It coats the surfaces of the microwells that are not already occupied by the specific antibodies, reducing the likelihood that other proteins or molecules from the sample will bind non-specifically to the microwells. This helps ensure that the only significant interactions are between the specific antibodies and the target gluten proteins, leading to more accurate and reliable test results.
Do We Accept or Reject the Results of an FDA Accredited Laboratory?
Celiac.com believes that Gluten Free Watchdog's recent stance is misguided and deviates from its mission to protect people with celiac disease from gluten exposure. Instead of cautioning people to avoid the products found to contain high gluten levels and possibly calling for their recall and reassessing GFCO's certification standards, Gluten Free Watchdog is creating confusion by questioning HRI's testing protocol and results.
Given Celiac.com's understanding of the Romer AgraQuant G12 ELISA test and its testing protocol, and the fact that the Romer test is on GFCO's Approved Kit List, we see no reason to doubt the validity of HRI's results or their testing competence. We continue to recommend that people with celiac disease avoid all products in the study that tested at or above 20 ppm of gluten, and for those who are highly sensitive, products that tested at or above 10 ppm.
Read more at: foodriskmanagement.com
Join our forum discussion on this topic, and feel free to comment below.
 
08/19/2024 - Added the section: "The Romer AgraQuant® Gluten G12 ELISA Test Kit Includes Fish Gelatin to Prevent Non-Specific Binding."

Celiac.com 08/13/2024 - Gluten Free Watchdog, an advocacy site for people with celiac disease, recently responded to a study by Moms Across America, which claimed that Trader Joe's Everything Gluten-Free Bagels contained nearly 300 ppm of gluten—a controversy that has already led to a class action lawsuit against Trader Joe's. 
The gluten testing was performed by Health Research Institute (HRI), an ISO17025 accredited lab approved by the FDA, and examined 46 products, including 32 GFCO-certified ones. It found that nearly 15% of the certified products exceeded the 10 ppm gluten-free standard, with nearly 10% surpassing the FDA's 20 ppm gluten-free limit, meaning they cannot be labeled gluten-free and should be subject to a product recall. A recent analysis by Celiac.com uncovered potential issues with GFCO's certification process, which may have contributed to the high failure rate found in the study, and suggests ways to improve the certification program.
Gluten Free Watchdog, however, suggests that these findings might be false positives, possibly due to HRI not using an extra protein to prevent non-specific binding during testing. Gluten Free Watchdog tested three different batches of Trader Joe's bagels using two different assays (R5 ELISA and G12 ELISA) with and without a milk additive for protein blocking. They argue that the inconsistent results—depending on whether the milk additive was used—indicate that HRI should rerun their tests with the additive, as their original results might have been false positives.
HRI's Response
Celiac.com reached out by email to John Fagan, Ph.D., Chief Science Officer at HRI for comment about Gluten Free Watchdog's article, and according to him: 
When describing their testing procedure he explained: 
Romer, the manufacturer of the AgraQuant G12 ELISA test, supported Dr. Fagan's claims, stating that while the milk additive is an option, it is not mandatory for all tests, and while certain ingredients like chocolate, soy, and oats, may require adding an extra protein during the testing procedure to prevent non-specific binding, they confirmed that no such ingredients were present in the Trader Joe's bagels. 
Tara J. Miller, Vice President of Marketing at Trader Joe's, however, claims that their tests on the same batch tested by HRI showed the bagels met FDA and GFCO standards for gluten-free labeling (below 10 ppm). When Celiac.com asked Dr. Fagen how his lab could find high gluten in a batch where Trader Joe's found none, he concurred with the possibility of "hot spots" within the sample, which could explain the discrepancy.
Why Did Gluten Free Watchdog Test Different Batches?
Gluten Free Watchdog's testing did not involve the same batches of bagels tested by HRI. When Celiac.com asked Dr. Fagan for his comment on the Gluten Free Watchdog article he replied with:
The last email we received from Dr. Fagan on this topic further emphasized his position:
Unfortunately, Gluten Free Watchdog's posts do not address how HRI found zero detectable gluten in most of the products they tested, including three types of bagels similar to Trader Joe's bagels, one of which also contained brown rice flour and sorghum flour (Canyon Bakehouse Plain Bagels). If HRI's testing required extra protein for accuracy, shouldn't these very similar products have also shown false positives?
Every Romer AgraQuant® Gluten G12 ELISA Test Kit Includes Fish Gelatin to Prevent Non-Specific Binding
According to the product documentation for the Romer AgraQuant® Gluten G12 ELISA Test Kit, the kits include the following:
Package Insert Certificate of Performance 5 standards (0, 4, 20, 80, 200 ppm), calibrated to the Prolamin Working Group (PWG) Gliadin. Gluten G12 antibody coated microwells Ready to use Extraction Solution 5x concentrated Diluent Buffer 10x concentrated Wash Buffer Ready to use Conjugate, Substrate and Stop Solutions 1 sachet of Fish Gelatin The fish gelatin included in the AgraQuant® Gluten G12 ELISA test kit is likely used to prevent non-specific binding. In ELISA assays, non-specific binding can occur when proteins or other molecules in the sample adhere to the microwells in an undesired manner, potentially leading to inaccurate results.
Fish gelatin is a commonly used blocking agent in such assays. It coats the surfaces of the microwells that are not already occupied by the specific antibodies, reducing the likelihood that other proteins or molecules from the sample will bind non-specifically to the microwells. This helps ensure that the only significant interactions are between the specific antibodies and the target gluten proteins, leading to more accurate and reliable test results.
Do We Accept or Reject the Results of an FDA Accredited Laboratory?
Celiac.com believes that Gluten Free Watchdog's recent stance is misguided and deviates from its mission to protect people with celiac disease from gluten exposure. Instead of cautioning people to avoid the products found to contain high gluten levels and possibly calling for their recall and reassessing GFCO's certification standards, Gluten Free Watchdog is creating confusion by questioning HRI's testing protocol and results.
Given Celiac.com's understanding of the Romer AgraQuant G12 ELISA test and its testing protocol, and the fact that the Romer test is on GFCO's Approved Kit List, we see no reason to doubt the validity of HRI's results or their testing competence. We continue to recommend that people with celiac disease avoid all products in the study that tested at or above 20 ppm of gluten, and for those who are highly sensitive, products that tested at or above 10 ppm.
Read more at: foodriskmanagement.com
Join our forum discussion on this topic, and feel free to comment below.
 
08/19/2024 - Added the section: "The Romer AgraQuant® Gluten G12 ELISA Test Kit Includes Fish Gelatin to Prevent Non-Specific Binding."

Celiac.com 08/03/2024 - Pico de Gallo, a vibrant and refreshing salsa, traces its origins to the rich culinary tapestry of Mexico. Known for its bright flavors and crisp textures, this traditional dish has deep roots in Mexican street food culture, where vendors would skillfully prepare it fresh to accompany tacos, quesadillas, and other savory delights. The name "Pico de Gallo," which translates to "rooster's beak," is believed to evoke the idea of small, finely chopped ingredients resembling the pecking of a rooster. Originally crafted from simple ingredients like tomatoes, onions, and chili peppers, Pico de Gallo has evolved over time, incorporating regional variations and becoming a beloved staple both in Mexican homes and international kitchens.
This Authentic Mexican Gluten-Free Pico de Gallo recipe stays true to its heritage by focusing on fresh, wholesome ingredients that celebrate the essence of Mexican cuisine. With ripe Roma tomatoes providing a juicy base, crisp white onions adding a pungent bite, and jalapeño peppers lending a hint of heat, each element harmonizes to create a salsa that is as vibrant in flavor as it is in color. Enhanced with zesty lime juice, fragrant cilantro, and a touch of sea salt, this Pico de Gallo offers a burst of freshness that complements a variety of dishes or stands deliciously on its own. Embrace the spirit of Mexico with every bite of this irresistible salsa, perfect for elevating your culinary creations to new heights of authenticity and flavor.
Authentic Mexican Gluten-Free Pico de Gallo Recipe
Ingredients:
6 Roma tomatoes, finely diced 1 medium white onion, finely chopped 2 jalapeño peppers, finely chopped (seeds removed for less heat) ½ cup fresh cilantro, chopped 3 cloves garlic, minced 2 limes, juiced ½ teaspoon sea salt ¼ teaspoon black pepper Optional: 1 teaspoon apple cider vinegar for a tangy twist Instructions:
Prepare the Vegetables: Finely dice the Roma tomatoes, chop the white onion, and finely chop the jalapeño peppers. Combine them in a large mixing bowl. Add Fresh Herbs and Garlic: Add the chopped cilantro and minced garlic to the bowl with the tomatoes, onions, and jalapeños. Mix gently to combine. Season: Squeeze the juice of the two limes over the mixture. Add the sea salt and black pepper. If you want a tangier flavor, add the optional apple cider vinegar. Stir well to ensure all ingredients are evenly distributed. Marinate: Let the pico de gallo sit for at least 15-20 minutes before serving. This allows the flavors to meld together. Serve: Transfer the pico de gallo to a serving bowl. Enjoy it fresh with gluten-free tortilla chips, as a topping for tacos, grilled meats, or any of your favorite Mexican dishes. Tips:
Adjusting Heat: If you prefer a milder pico de gallo, use only one jalapeño pepper or remove the seeds entirely. For more heat, keep the seeds or add an extra jalapeño. Storage: Store any leftovers in an airtight container in the refrigerator for up to 3 days. The flavors will continue to develop over time. Enjoy this authentic, gluten-free Pico de Gallo that captures the essence of fresh, vibrant Mexican cuisine!

Celiac.com 02/27/2019 - Celiac disease is an autoimmune condition with numerous symptoms, and associated conditions. People with celiac disease often have gastrointestinal symptoms, including upset stomach, abdominal pain, gas, bloating, indigestion, and diarrhea. Some suffer from many of these on a regular basis.
However, many people show few or no symptoms. No single set of signs or symptoms is typical for everyone with celiac disease. Signs and symptoms can vary greatly from person to person.
Symptoms of Celiac Disease Fall Into 7 Major Categories
Digestive symptoms such as abdominal pain, bloating, gas, diarrhea, constipation, nausea, vomiting, and steatorrhea (fatty stools); Non-digestive symptoms such as fatigue, weakness, anemia, weight loss, malnutrition, delayed growth, irritability, depression, anxiety, and cognitive impairment; Dermatological symptoms such as skin rash, itching, blistering, and dermatitis herpetiformis; Musculoskeletal symptoms such as joint pain, muscle pain, muscle cramps, and osteoporosis; Neurological symptoms such as headache, migraine, ataxia, neuropathy, seizures, and cognitive impairment; Reproductive symptoms such as infertility, menstrual irregularities, and recurrent miscarriage. No obvious symptoms or asymptomatic; Symptoms Can Vary Between Children and Adults
The signs and symptoms of celiac disease can vary greatly and are different in children and adults. The most common signs for adults are diarrhea, fatigue and weight loss. Adults may also experience bloating and gas, abdominal pain, nausea, constipation, and vomiting. Many symptoms caused by celiac disease are the result of nutritional deficiencies caused by flattened villi and subsequent malabsorption. 
Symptoms in Children
Children under 2 years old celiac symptoms often include vomiting, chronic diarrhea, failure to thrive, muscle wasting, poor appetite, and swollen belly. Older children may experience diarrhea, constipation, weight loss, irritability, short stature, delayed puberty, and neurological symptoms, including attention-deficit/hyperactivity disorder (ADHD), learning disabilities, headaches, lack of muscle coordination and seizures
Vague Symptoms Can Delay Celiac Diagnosis
It is not uncommon for symptoms of celiac disease to be vague or confusing. Vague or confusing symptoms can include dental enamel defects, bone disorders like osteoporosis, depression, irritability, joint pain, mouth sores, muscle cramps, skin rash, stomach discomfort, and even neuropathy, often experienced as tingling in the legs and feet. 
To make matters more challenging, celiac symptoms can also mimic symptoms of other diseases, such as anemia, Crohns disease, gastric ulcers, irritable bowel, parasitic infection, even various skin disorders or nervous conditions. Vague or confusing symptoms can delay celiac disease diagnosis.
Signs and Symptoms of Celiac Disease
Abdominal cramps, gas and bloating Acne Anemia Ataxia (gluten ataxia) Borborygmi—stomach rumbling Coetaneous bleeding Delayed puberty Dental enamel defects Diarrhea Dry skin Easy bruising Epistaxis—nose bleeds Eczema Failure to thrive or short stature Fatigue or general weakness Flatulence Fluid retention Folic acid deficiency Foul-smelling yellow or grayish stools that are often fatty or oily Gastrointestinal symptoms Gastrointestinal hemorrhage General malaise, feeling unwell Hematuria—red urine Hypocalcaemia/hypomagnesaemia Infertility, or recurrent miscarriage Iron deficiency anemia Joint Pain Lymphocytic gastritis Malabsorption Malnutrition Muscle weakness Muscle wasting Nausea Obesity/Overweight Osteoporosis Pallor—pale, unhealthy appearance Panic Attacks Peripheral neuropathy Psychiatric disorders such as anxiety and depression Skin Problems—acne, eczema, DH, dry skin  Stunted growth in children Underweight Vertigo Vitamin A deficiency Vitamin B6 deficiency Vitamin B12 deficiency Vitamin D deficiency Vitamin K deficiency Vomiting Voracious appetite Weight loss/gain Zinc deficiency Conditions Associated with Celiac Disease
People with one or more of these associated conditions are at higher risk for celiac disease:
Addison's Disease  Anemia  Anorexia Nervosa, Bulimia  Arthritis  Asthma  Ataxia, Nerve Disease, Neuropathy, Brain Damage  Attention Deficit Disorder  Autism  Bacterial Overgrowth  Cancer, Lymphoma  Candida Albicans  Canker Sores—Aphthous Stomatitis)  Casein / Cows Milk Intolerance  Chronic Fatigue Syndrome  Cognitive Impairment  Crohn's Disease  Depression  Dermatitis Herpetiformis Diabetes  Down Syndrome  Dyspepsia, Acid Reflux Eczema Epilepsy  Eye Problems, Cataract  Fertility, Pregnancy, Miscarriage  Fibromyalgia  Flatulence—Gas  Gall Bladder Disease  Gastrointestinal Bleeding  Geographic Tongue—Glossitis  Growth Hormone Deficiency  Hashimoto’s Thyroiditis Heart Failure  Infertility, Impotency  Inflammatory Bowel Disease  Intestinal Permeability  Irritable Bowel Syndrome  Kidney Disease  Liver and biliary tract disorders (transaminitis, fatty liver, primary sclerosing cholangitis, etc.) Low bone density Lupus  Malnutrition, Body Mass Index  Migraine Headaches  Multiple Sclerosis  Myasthenia Gravis Celiac Disease Obesity, Overweight  Osteopenia, osteoporosis, osteomalacia  Psoriasis  Refractory Celiac Disease & Collagenous Sprue Sarcoidosis  Scleroderma  Schizophrenia / Mental Problems  Sepsis  Sjogrens Syndrome  Sleep Disorders  Thrombocytopenic Purpura  Thyroid & Pancreatic Disorders  Tuberculosis  Nutritional Deficiencies Associated with Celiac Disease and their Related Clinical Manifestations
.divTable{ display: table; width: 100%; } .divTableRow { display: table-row; } .divTableHeading { background-color: #EEE; display: table-header-group; } .divTableCell, .divTableHead { border: 1px solid #999999; display: table-cell; padding: 3px 10px; min-width: 120px; } .divTableHeading { background-color: #EEE; display: table-header-group; font-weight: bold; } .divTableFoot { background-color: #EEE; display: table-footer-group; font-weight: bold; } .divTableBody { display: table-row-group; } Nutritional deficiency Most frequent signs and symptoms Iron Hypochromic, microcytic anemia, glossitis, koilonychia, fatigue, pallor, cognitive impairment Folate Megaloblastic anemia, glossitis, diarrhea, cognitive impairment Vitamin B12 Megaloblastic anemia, posterior columns syndrome, dementia, depression, psychosis Vitamin D Osteomalacia (deformity of bone, pathologic fractures), osteoporosis, cognitive impairment, secondary hyperparathyroidism Zinc Growth retardation, hypogonadism, infertility, dysgueusia, poor wound healing, diarrhea, dermatitis on the extremities and periorificial, glossitis, alopecia, corneal clouding Less frequently occurring Protein Edema, muscular atrophy Vitamin B1 (thiamine) Irritability, fatigue, headaches, peripheral neuropathy, wet Beriberi: congestive heart failure; Wernicke: nystagmus, ophtalmoplegia, ataxia; Korsakoff: hallucinations, impaired short-term memory and confabulation Vitamin B3 (niacin) Pellagra: diarrhea, dementia, pigmented dermatitis; Glossitis, stomatitis, vaginitis, vertigo, burning dysesthesias Vitamin B6 (pyridoxine) Stomatitis, angular cheilosis, glossitis, irritability, depression, confusion, normochromic normocytic anemia Vitamin A Follicular hyperkeratosis, night blindness, conjunctival xerosis, keratomalacia Vitamin E Hemolytic anemia, peripheral neuropathies, ophtalmoplegia, posterior columns syndrome Vitamin K Easy bleeding  
Top Scientific References on Celiac Symptoms
University of Chicago Celiac Disease Center Mayo Clinic Celiac Disease Center Vitamin and Mineral Deficiencies Common in Newly Diagnosed Celiac Disease Patients Celiac Disease: Extraintestinal Manifestations and Associated Conditions

Celiac.com 04/15/2023 - Celiac disease is a chronic autoimmune disorder that affects the small intestine, triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. One often overlooked consequence of untreated and undiagnosed celiac disease is the potential for nutrient deficiencies. Due to the damage caused to the lining of the small intestine, absorption of various essential nutrients may be impaired, leading to deficiencies that can have wide-ranging health effects. In this article, we will explore the connection between celiac disease and nutrient deficiencies, focusing on several key vitamins, minerals, and other essential nutrients.
The most common nutrient deficiencies associated with celiac disease that may lead to testing for the condition include iron, vitamin D, folate (vitamin B9), vitamin B12, calcium, zinc, and magnesium. Celiac disease can disrupt the absorption of these essential nutrients, potentially leading to anemia, bone health issues, and other health complications. After a celiac disease diagnosis it is important to do follow up testing for these nutrient deficiencies, as well as a follow-up endoscopies/biopsies to make sure that a patient's damaged villi are healing properly. Many of those with celiac disease will need to take vitamin and mineral supplements at the time of their diagnosis, and some will need to continue taking them for life. Note that having nutrient deficiencies alone would not be enough for a definitive diagnosis of celiac disease, and further testing is required to make a formal diagnosis.
Boron
Boron is a trace mineral that plays a role in bone health, brain function, and metabolism of certain nutrients. Deficiency in boron is rare, but it can lead to symptoms such as muscle weakness, joint pain, and impaired cognitive function. Untreated and undiagnosed celiac disease can cause malabsorption of boron due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of boron may be needed for individuals with celiac disease, especially if they have prolonged untreated celiac disease or other risk factors for deficiency.
Calcium
Calcium is an essential mineral that is crucial for bone health, nerve function, and muscle contraction. Deficiency in calcium can lead to symptoms such as weakened bones, muscle cramps, and numbness and tingling in the extremities. Malabsorption of calcium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of osteoporosis and other bone-related complications in individuals with celiac disease. Measuring blood levels of calcium alone is not always an accurate indicator of calcium deficiency because the body will leach calcium from the bones to maintain normal blood levels of calcium. Therefore, bone density loss and other secondary indicators are often better diagnostic tools for detecting calcium deficiency. Calcium supplementation, along with a calcium-rich diet, may be necessary for individuals with celiac disease to maintain adequate calcium levels and support bone health.
Chloride
Chloride is an electrolyte that is involved in maintaining proper fluid balance, nerve function, and acid-base balance in the body. Deficiency in chloride is rare, but it can lead to symptoms such as muscle weakness, lethargy, and irregular heartbeat. Malabsorption of chloride can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can disrupt the body's fluid balance and electrolyte levels, further complicating the health of individuals with celiac disease. Proper monitoring of chloride levels and supplementation may be necessary for individuals with celiac disease, especially if they have prolonged untreated celiac disease or other risk factors for deficiency.
Choline
Choline is an essential nutrient that plays a role in brain development, nerve function, and liver health. Deficiency in choline can lead to symptoms such as cognitive decline, liver dysfunction, and muscle damage. In celiac disease, malabsorption of choline can occur due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of choline may be necessary for individuals with celiac disease, especially if they have prolonged untreated celiac disease or other risk factors for deficiency.

Image: CC BY-SA 2.0--User: Pumbaa (original work by commons:User: Greg Robson
Chromium
Chromium is a trace mineral that is important for glucose metabolism and insulin function. Deficiency in chromium can lead to symptoms such as impaired glucose tolerance, increased insulin resistance, and poor blood sugar control. Malabsorption of chromium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of chromium may be needed for individuals with celiac disease, especially if they have poor blood sugar control or other risk factors for deficiency.
Copper
Copper is an essential trace mineral that plays a role in various processes in the body, including energy production, connective tissue formation, and immune function. Deficiency in copper can cause symptoms such as anemia, bone abnormalities, and impaired immune function. In celiac disease, malabsorption of copper can occur due to damage to the small intestine lining, potentially leading to a deficiency. This can further compromise the overall health of individuals with celiac disease and increase the risk of related complications. Supplementation of copper may be necessary for individuals with celiac disease to maintain adequate copper levels and support overall health.
Iodine
Iodine is a trace mineral that is essential for thyroid function, metabolism, and brain development. Deficiency in iodine can cause symptoms such as goiter, fatigue, weight gain, and impaired cognitive function. Malabsorption of iodine can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further disrupt thyroid function and metabolism, and impair cognitive development in individuals with celiac disease, especially in children. Iodine supplementation, along with a well-balanced diet that includes iodine-rich foods such as seafood and iodized salt, may be necessary for individuals with celiac disease to maintain adequate iodine levels and support overall health.
Iron
Iron is an essential mineral that is required for the production of hemoglobin, the protein in red blood cells that carries oxygen to all parts of the body. Deficiency in iron can cause symptoms such as anemia, fatigue, weakness, and pale skin. Malabsorption of iron can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further exacerbate the risk of anemia and related health issues in individuals with celiac disease. Iron supplementation, along with a well-balanced diet that includes iron-rich foods such as meat, poultry, beans, and fortified cereals, may be necessary for individuals with celiac disease to maintain adequate iron levels and support overall health.
Lutein
Lutein is a carotenoid antioxidant that is important for eye health and vision. Deficiency in lutein can cause symptoms such as blurred vision, macular degeneration, and increased risk of eye-related disorders. Malabsorption of lutein can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of eye-related issues and compromised vision in individuals with celiac disease. Lutein supplementation, along with a diet rich in lutein-containing foods such as leafy green vegetables, egg yolks, and corn, may be necessary for individuals with celiac disease to maintain adequate lutein levels and support overall eye health.
Lycopene
Lycopene is a carotenoid antioxidant that is known for its role in prostate health and reducing the risk of certain cancers. Deficiency in lycopene can cause symptoms such as increased risk of prostate cancer, cardiovascular disease, and oxidative stress. Malabsorption of lycopene can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of prostate cancer, cardiovascular issues, and other health complications in individuals with celiac disease. Lycopene supplementation, along with a diet rich in lycopene-containing foods such as tomatoes, watermelon, and red bell peppers, may be necessary for individuals with celiac disease to maintain adequate lycopene levels and support overall health.

Image: CC BY-SA 2.0--User: Pumbaa (original work by commons: User: Greg Robson)
Magnesium
Magnesium is a vital mineral that plays a critical role in numerous physiological processes, including nerve function, muscle contraction, and bone health. Deficiency in magnesium can cause symptoms such as muscle weakness, tremors, irregular heartbeat, and bone loss. Malabsorption of magnesium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of muscle weakness, nerve-related issues, and compromised bone health in individuals with celiac disease. Magnesium supplementation, along with a diet rich in magnesium-containing foods such as leafy green vegetables, nuts, seeds, and whole grains, may be necessary for individuals with celiac disease to maintain adequate magnesium levels and support overall health.
Manganese
Manganese is an essential trace mineral that is involved in various metabolic processes, including carbohydrate metabolism and bone formation. Deficiency in manganese can cause symptoms such as impaired glucose tolerance, bone abnormalities, and altered cholesterol levels. Malabsorption of manganese can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of metabolic issues, bone-related complications, and altered cholesterol levels in individuals with celiac disease. Manganese supplementation, along with a diet rich in manganese-containing foods such as whole grains, nuts, seeds, and legumes, may be necessary for individuals with celiac disease to maintain adequate manganese levels and support overall health.
Molybdenum
Molybdenum is a trace mineral that is essential for various enzymatic reactions in the body, including detoxification processes and metabolism of certain nutrients. Deficiency in molybdenum is rare but can cause symptoms such as rapid heartbeat, neurological issues, and growth retardation. Malabsorption of molybdenum can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of cardiovascular issues, neurological complications, and growth retardation in individuals with celiac disease. Molybdenum supplementation, along with a diet rich in molybdenum-containing foods such as legumes, whole grains, and nuts, may be necessary for individuals with celiac disease to maintain adequate molybdenum levels and support overall health.
Nickel
Nickel is a trace mineral that is required in very small amounts for various enzymatic reactions in the body. Deficiency in nickel is rare and typically occurs in individuals with specific health conditions. Malabsorption of nickel can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised enzymatic reactions and related health issues in individuals with celiac disease. Nickel supplementation is not typically necessary, as the body requires only trace amounts of nickel. However, it is important for individuals with celiac disease to maintain a well-balanced diet that includes nickel-containing foods such as nuts, legumes, and whole grains to support overall health.
Phosphorus
Phosphorus is an essential mineral that plays a crucial role in bone formation, energy metabolism, and cellular function. Deficiency in phosphorus is rare and usually occurs in individuals with specific health conditions or imbalanced diets. Malabsorption of phosphorus can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised bone health, energy metabolism, and cellular function in individuals with celiac disease. Phosphorus supplementation is not typically necessary, as phosphorus is abundant in many foods. However, it is important for individuals with celiac disease to maintain a well-balanced diet that includes phosphorus-containing foods such as dairy products, meat, fish, nuts, seeds, and whole grains to support overall health.

Image: CC BY-SA 2.0--User: Pumbaa (original work by commons: User: Greg Robson)
Potassium
Potassium is a crucial mineral that is involved in numerous physiological processes, including nerve function, muscle contraction, and heart health. Deficiency in potassium can cause symptoms such as muscle weakness, fatigue, irregular heartbeat, and increased blood pressure. Malabsorption of potassium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of nerve-related issues, muscle weakness, and cardiovascular complications in individuals with celiac disease. Potassium supplementation, along with a diet rich in potassium-containing foods such as fruits, vegetables, dairy products, meat, and legumes, may be necessary for individuals with celiac disease to maintain adequate potassium levels and support overall health.
Selenium
Selenium is an essential trace mineral that is involved in various antioxidant and immune functions in the body. Deficiency in selenium can cause symptoms such as compromised immune function, muscle weakness, fatigue, and hair loss. Malabsorption of selenium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of impaired immune function, muscle weakness, and related health issues in individuals with celiac disease. Selenium supplementation, along with a diet rich in selenium-containing foods such as fish, meat, dairy products, nuts, and seeds, may be necessary for individuals with celiac disease to maintain adequate selenium levels and support overall health.
Silicon
Silicon is a trace mineral that is involved in various processes such as bone formation, connective tissue health, and hair, skin, and nail health. Deficiency in silicon is rare, as it is found in many foods, but it can cause symptoms such as compromised bone health, weak connective tissue, and brittle nails. Malabsorption of silicon can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised bone health, connective tissue issues, and related health concerns in individuals with celiac disease. Silicon supplementation is not typically necessary, as silicon is abundant in many foods. However, it is important for individuals with celiac disease to maintain a well-balanced diet that includes silicon-containing foods such as whole grains, fruits, vegetables, nuts, and seeds to support overall health and prevent deficiency.
Vanadium
Vanadium is a trace mineral that has been suggested to play a role in blood sugar regulation and bone health, although its exact functions are not yet fully understood. Vanadium deficiency is rare, as it is found in small amounts in many foods, and its requirement in the body is low. However, malabsorption of vanadium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised blood sugar regulation and bone health in individuals with celiac disease. Vanadium supplementation is not typically necessary, as the body's requirement for vanadium is minimal, and excessive intake can be toxic. However, it is important for individuals with celiac disease to maintain a well-balanced diet that includes foods rich in vanadium, such as seafood, mushrooms, whole grains, and vegetable oils, to support overall health.
Vitamin A (Preformed)
Vitamin A is a fat-soluble vitamin that plays a crucial role in vision, immune function, and cellular growth. Deficiency in vitamin A can lead to night blindness, dry skin, and increased susceptibility to infections. Untreated celiac disease can cause malabsorption of vitamin A due to damage to the small intestine lining, leading to a deficiency. It is important for individuals with celiac disease to monitor their vitamin A levels and consider supplementation if necessary.
Vitamin A (Betacarotenes)
Vitamin A in the form of betacarotenes is a precursor that is converted to vitamin A in the body as needed. Betacarotenes are found in colorful fruits and vegetables, and they play a role in maintaining healthy skin, vision, and immune function. Deficiency in betacarotenes can result in similar symptoms as vitamin A deficiency, including impaired vision and weakened immune system. In celiac disease, impaired absorption of betacarotenes can occur due to damage to the small intestine lining, leading to a potential deficiency.
Vitamin B1 (Thiamine)
Vitamin B1, also known as thiamine, is a water-soluble vitamin that is essential for energy metabolism, nerve function, and brain health. Deficiency in thiamine can cause symptoms such as muscle weakness, fatigue, and mental confusion. Severe, prolonged thiamine deficiency can result in beriberi, and symptoms include loss of sensation in extremities, symptoms of heart failure, swelling of the hands and feet, chest pain, feelings of vertigo, double vision, and memory loss. Untreated celiac disease can impair thiamine absorption due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their thiamine levels and consider supplementation if needed.
Vitamin B2 (Riboflavin)
Vitamin B2, also known as riboflavin, is another water-soluble vitamin that plays a key role in energy production, growth, and red blood cell formation. Deficiency in riboflavin can lead to symptoms such as cracked lips, sore throat, and skin rash. Celiac disease can cause impaired absorption of riboflavin due to damage to the small intestine lining, leading to a potential deficiency. Supplementation may be necessary for individuals with celiac disease to maintain adequate riboflavin levels.
Vitamin B3 (Niacin)
Vitamin B3, also known as niacin, is essential for energy metabolism, nervous system function, and DNA repair. Deficiency in niacin can result in a condition known as pellagra, characterized by symptoms such as diarrhea, dermatitis, and mental confusion. Malabsorption of niacin can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their niacin levels and consider supplementation if necessary.
Vitamin B5 (Pantothenic Acid)
Vitamin B5, also known as pantothenic acid, is involved in energy production, hormone synthesis, and nerve function. Deficiency in pantothenic acid can lead to symptoms such as fatigue, numbness and tingling in the hands and feet, and difficulty in coordination. In celiac disease, malabsorption of pantothenic acid can occur due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation may be necessary for individuals with celiac disease to maintain adequate pantothenic acid levels.
Vitamin B6
Vitamin B6, also known as pyridoxine, is a water-soluble vitamin that is important for brain development, immune function, and protein metabolism. Deficiency in vitamin B6 can cause symptoms such as depression, irritability, and weakened immune system. Untreated celiac disease can impair the absorption of vitamin B6 due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their vitamin B6 levels and consider supplementation if needed.
Vitamin B7 (Biotin)
Vitamin B7, also known as biotin, is essential for healthy skin, hair, and nails, as well as for metabolism of carbohydrates, fats, and proteins. Deficiency in biotin can result in symptoms such as hair loss, brittle nails, and skin rash. Malabsorption of biotin can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation may be necessary for individuals with celiac disease to maintain adequate biotin levels.
Vitamin B8 (Inositol)
Vitamin B8, also known as inositol, is involved in cell signaling, nerve function, and brain health. Deficiency in inositol can lead to symptoms such as mood swings, anxiety, and difficulty in concentration. In celiac disease, impaired absorption of inositol can occur due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their inositol levels and consider supplementation if necessary.
Vitamin B9 (Folate)
Vitamin B9, also known as folate, is important for DNA synthesis, red blood cell formation, and fetal development during pregnancy. Deficiency in folate can result in symptoms such as anemia, fatigue, and neural tube defects in newborns. Malabsorption of folate can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of folate may be necessary for individuals with celiac disease, especially during pregnancy.
Vitamin B9 (Folic Acid)
Folic acid is the synthetic form of folate, often used in dietary supplements and fortified foods. It is converted to folate in the body and plays similar roles in DNA synthesis, red blood cell formation, and fetal development during pregnancy. Deficiency in folic acid can lead to the same symptoms as folate deficiency, including anemia and neural tube defects in newborns. Malabsorption of folic acid can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their folic acid levels and consider supplementation if needed.
Vitamin B12 ( Cobalamin)
Vitamin B12, also known as cobalamin, is essential for nerve function, DNA synthesis, and red blood cell formation. Deficiency in vitamin B12 can cause symptoms such as fatigue, weakness, and numbness and tingling in the hands and feet. In celiac disease, malabsorption of vitamin B12 can occur due to damage to the small intestine lining, potentially leading to a deficiency. This can further exacerbate the symptoms of celiac disease and affect overall health. Supplementation of vitamin B12 may be necessary for individuals with celiac disease to maintain adequate levels and prevent deficiency-related complications.
Vitamin C (Ascorbic Acid)
Vitamin C, also known as ascorbic acid, is a powerful antioxidant that plays a critical role in immune function, collagen synthesis, and wound healing. Deficiency in vitamin C can cause symptoms such as fatigue, weakened immune system, and slow wound healing. A severe vitamin C deficiency can also result in scurvy, and early symptoms of scurvy include weakness, feeling tired and having sore arms and legs. In celiac disease, malabsorption of vitamin C can occur due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of vitamin C may be necessary for individuals with celiac disease to maintain adequate levels and support immune function.
Vitamin D3
Vitamin D3, also known as the "sunshine vitamin," is crucial for bone health, immune function, and mood regulation. Deficiency in vitamin D3 can cause symptoms such as bone pain, muscle weakness, and increased susceptibility to infections. Malabsorption of vitamin D3 is common in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of osteoporosis, weakened immune system, and mood disorders in individuals with celiac disease. Vitamin D3 supplementation, along with adequate sunlight exposure and a vitamin D-rich diet, may be necessary for individuals with celiac disease to maintain adequate vitamin D levels and support overall health.
Vitamin E (Food Sourced)
Vitamin E is a powerful antioxidant that protects cells from damage, supports immune function, and helps with DNA repair. Deficiency in vitamin E can cause symptoms such as muscle weakness, impaired vision, and increased oxidative stress. Malabsorption of vitamin E can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of oxidative stress and related health issues in individuals with celiac disease. Vitamin E supplementation, along with a vitamin E-rich diet, may be necessary for individuals with celiac disease to maintain adequate vitamin E levels and support overall health.
Vitamin E (Alpha-Tocopherol)
Vitamin E, specifically alpha-tocopherol, is the most active and common form of vitamin E in the body. It plays a crucial role in protecting cells from damage, supporting immune function, and maintaining cardiovascular health. Deficiency in alpha-tocopherol can cause symptoms such as muscle weakness, vision problems, and increased risk of cardiovascular disease. Malabsorption of alpha-tocopherol can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of cardiovascular issues and other health complications in individuals with celiac disease. Supplementation of alpha-tocopherol, along with a vitamin E-rich diet, may be necessary for individuals with celiac disease to maintain adequate alpha-tocopherol levels and support overall health.
Vitamin K
Vitamin K is a fat-soluble vitamin that plays a crucial role in blood clotting and bone metabolism. Deficiency in vitamin K can cause symptoms such as easy bruising, prolonged bleeding, and weakened bones. Malabsorption of vitamin K can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of bleeding disorders and weakened bones in individuals with celiac disease. Vitamin K supplementation, along with a well-balanced diet that includes vitamin K-rich foods such as leafy green vegetables, may be necessary for individuals with celiac disease to maintain adequate vitamin K levels and support overall health.
Zinc
Zinc is an essential mineral that is involved in various enzymatic reactions, immune function, and wound healing. Deficiency in zinc can cause symptoms such as impaired immune function, delayed wound healing, hair loss, and skin issues. Malabsorption of zinc can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised immune function, delayed wound healing, and related health issues in individuals with celiac disease. Zinc supplementation, along with a diet rich in zinc-containing foods such as meat, fish, dairy products, nuts, and seeds, may be necessary for individuals with celiac disease to maintain adequate zinc levels and support overall health.
Conclusion
In conclusion, untreated and undiagnosed celiac disease can lead to deficiencies in various nutrients due to malabsorption caused by damage to the small intestine lining. These deficiencies can result in a wide range of symptoms and health effects, including compromised bone health, impaired immune function, nerve-related issues, skin, hair, and nail problems, and other related health concerns. Therefore, it is crucial for individuals with celiac disease to be vigilant about their nutrient intake and work with healthcare professionals to ensure proper monitoring and management of their nutrient levels through a well-balanced diet and, if necessary, appropriate supplementation. Proper management of celiac disease, including adherence to a gluten-free diet, regular monitoring of nutrient levels, and appropriate supplementation when needed, can help individuals with celiac disease maintain optimal health and prevent nutrient deficiencies.
Vitamins and Minerals Generally Safe in Excess of Recommended Daily Allowance (RDA):
Vitamin C (Ascorbic Acid): Excess vitamin C is usually excreted in the urine and is considered safe in higher doses. However, very high doses may cause digestive upset in some individuals. Vitamin B1 (Thiamine): Water-soluble, excess thiamine is generally excreted through urine. It is considered safe in higher doses but consult with a healthcare professional. Vitamin B2 (Riboflavin): Water-soluble, excess riboflavin is excreted in the urine and is generally safe in higher doses. Vitamin B3 (Niacin): Water-soluble, niacin has a well-defined upper limit, but moderate excess is often excreted. Consultation with a healthcare professional is advisable. Vitamin B5 (Pantothenic Acid): Water-soluble, excess pantothenic acid is generally excreted through urine and considered safe in higher doses. Vitamin B6 (Pyridoxine): While excessive intake from supplements can lead to nerve damage, moderate overages are generally excreted through urine. Vitamin B7 (Biotin): Water-soluble, excess biotin is typically excreted and is considered safe in higher doses. Vitamin B9 (Folate): Excess folate is usually excreted, but extremely high levels from supplements may have potential risks. It's generally safe when consumed through natural food sources. Vitamin B12 (Cobalamin): Water-soluble, excess B12 is typically excreted in the urine and is considered safe in higher doses. Consultation with a healthcare professional is advisable. Choline: While not a true vitamin, choline is water-soluble, and excess is usually excreted. It's considered safe in higher doses but consult with a healthcare professional. Vitamins and Minerals with Potential for Toxicity in Excess of Recommended Daily Allowance (RDA):
Vitamin A (Retinol): Excessive vitamin A intake, especially from supplements, can lead to toxicity, causing symptoms like nausea, dizziness, and, in severe cases, organ damage. Vitamin D -  While moderate excess may be excreted, prolonged high doses can lead to vitamin D toxicity, resulting in hypercalcemia, kidney damage, and other complications. Vitamin E (Tocopherols): Excess vitamin E is usually excreted, but high doses from supplements may have adverse effects. Obtaining it through a balanced diet is preferable. Vitamin K: Excess vitamin K from supplements can interfere with blood thinning medications and cause issues in some individuals. Iron: Excessive iron intake, especially from supplements, can lead to iron toxicity, causing symptoms like nausea, abdominal pain, and, in severe cases, organ failure. Zinc: While zinc is essential, excessive intake can lead to zinc toxicity, affecting the immune system and causing digestive issues. Copper: High copper levels, often from supplements, can lead to toxicity, causing symptoms such as nausea, vomiting, and liver damage. Selenium: Excessive selenium intake, especially from supplements, can lead to selenosis, causing symptoms like hair loss, gastrointestinal issues, and neurological problems. It's crucial to note that individual tolerances can vary, and supplementation should be done under the guidance of a healthcare professional.
Sources:
National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Celiac Disease. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease  Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray, J. A. (2013). ACG clinical guidelines: Diagnosis and management of celiac disease. The American Journal of Gastroenterology, 108(5), 656-676. doi:10.1038/ajg.2013.79 Complementary Medicine, Penn State Hershey. (n.d.). B vitamins. Retrieved from https://pennstatehershey.adam.com/content.aspx?productId=107&pid=33&gid=000336  National Institutes of Health, Office of Dietary Supplements. (2021). Vitamin B5 (Pantothenic Acid) - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/  National Institutes of Health, Office of Dietary Supplements. (2021). Vitamin B12 - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/  National Institutes of Health, Office of Dietary Supplements. (2021). Chloride - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/  National Institutes of Health, Office of Dietary Supplements. (2021). Iodine - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Magnesium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/  National Institutes of Health, Office of Dietary Supplements. (2021). Phosphorus - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Silicon - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Vanadium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Manganese - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Lycopene - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Lutein and Zeaxanthin - Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Nickel - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Selenium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Iron - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Calcium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Zinc - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Chromium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/

Celiac.com 03/10/2021 - Even though the FDA recently confirmed that all distilled spirits, including rum, are gluten-free, we get a lot of questions from celiac community members wondering if certain brands and products are gluten-free. One question we see a lot is about Malibu Rum. Specifically, is Malibu Rum gluten-free and safe for people with celiac disease?
This is logical as some ingredients added to flavor distilled alcohol can include gluten. Original Malibu Rum is just rum liqueur flavored with coconut. All distilled rum is gluten-free, unless gluten is added after distillation, which is very rare. According to the Malibu website, the company does "not add any known gluten ingredients in Malibu Original or in any of the Malibu Flavors.” The only allergen listed it coconut, which is a tree nut.
The short answer is that Original Malibu Rum is considered gluten-free and safe for celiacs. The same is true for other Malibu Rum flavors, and associated Malibu Rum products, including Malibu Splash, Malibu Cans, Malibu Pouches. 
Still, always be careful with any pre-made drink mixes that contain rum, such as those intended for piña coladas — many of these contain gluten ingredients. Read labels and choose carefully.
Malibu Rum's Gluten-Free By Ingredient Products:
Malibu Rum Malibu Original Malibu Watermelon Malibu Lime Malibu Strawberry Malibu Pineapple Malibu Mango Malibu Passion Fruit Malibu Tropical Banana Malibu Black Malibu Red Malibu Fizzy Pink Lemonade Malibu Strawberry Kiwi Malibu Fizzy Mango Malibu Pina Colada Malibu Pineapple Malibu Rum Punch Pouches Malibu Blue Hawaiian Pouches Lastly, Malibu makes a coconut-flavored beer that is NOT gluten-free, so be careful with that. Also, according to their site, Malibu Splash products contain wheat as an allergen and are NOT gluten-free:
Malibu Splash Strawberry
Malibu Splash Lime
Malibu Splash Passion Fruit
Malibu Splash Pineapple