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Found 1,242 results

  1. Celiac.com 12/10/2018 - More and more people are eating gluten-free for non-medical reasons. These days, people with celiac disease make up a small percentage of overall gluten-free food sales. However, the effects of eliminating or reducing wheat, barley and rye ingredients from the diets of in healthy adults have not been well studied. A team of researchers recently set out to assess the effects of a gluten-free diet in healthy adults. To make their assessment, the researchers conducted a randomized, controlled, cross-over trial of 60 middle-aged Danish adults with no known diseases. The trial included two 8-week assessments comparing a low-gluten diet of 2 grams of gluten per day, and a high-gluten diet of 18 grams of gluten per day, separated by a washout period of at least six weeks with habitual diet including 12 grams of gluten per day. Compared with a high-gluten diet, the data show that a low-gluten diet triggers slight changes in the intestinal microbiome, increases food and drink intake and postprandial hydrogen exhalation, and reduces self-reported bloating. The team’s data indicate that results of a low-gluten diet in non-celiac adults are likely triggered by qualitative changes in dietary fiber. Studies like this are important for understanding the effects of a gluten-free diet in both celiacs and non-celiacs alike. Better understanding of a gluten-free diet will help doctors, celiac patients, and healthy individuals to make better, more informed dietary decisions. Source: Nature Communications; volume 9, Article number: 4630 (2018) The research team included Lea B. S. Hansen, Henrik M. Roager, Nadja B. Søndertoft, Rikke J. Gøbel, Mette Kristensen, Mireia Vallès-Colomer, Sara Vieira-Silva, Sabine Ibrügger, Mads V. Lind, Rasmus B. Mærkedahl, Martin I. Bahl, Mia L. Madsen, Jesper Havelund, Gwen Falony, Inge Tetens, Trine Nielsen, Kristine H. Allin, Henrik L. Frandsen, Bolette Hartmann, Jens Juul Holst, Morten H. Sparholt, Jesper Holck, Andreas Blennow, Janne Marie Moll, Anne S. Meyer, Camilla Hoppe, Jørgen H. Poulsen, Vera Carvalho, Domenico Sagnelli, Marlene D. Dalgaard, Anders F. Christensen, Magnus Christian Lydolph, Alastair B. Ross, Silas Villas-Bôas, Susanne Brix, Thomas Sicheritz-Pontén, Karsten Buschard, Allan Linneberg, Jüri J. Rumessen, Claus T. Ekstrøm, Christian Ritz, Karsten Kristiansen, H. Bjørn Nielsen, Henrik Vestergaard, Nils J. Færgeman, Jeroen Raes, Hanne Frøkiær, Torben Hansen, Lotte Lauritzen, Ramneek Gupta, Tine Rask Licht and Oluf Pedersen. They are variously affiliated with the National Food Institute; the Department of Biotechnology and Biomedicine, Technical University of Denmark; the Department of Bio and Health Informatics; the Department of Chemical and Biochemical Engineering at the Technical University of Denmark in Lyngby, Denmark; the Department of Plant and Environmental Sciences; the Department of Nutrition, Exercise and Sports; the Department of Nutrition, Exercise and Sports; and the Department of Veterinary Disease Biology, Faculty of Science, University of Copenhagen in Frederiksberg, Denmark; the Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark; the Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre in Hvidovre, Denmark; the Department of Radiology, Bispebjerg Hospital in Copenhagen, Denmark; the Department of Autoimmunology & Biomarkers, Statens Serum Institut in Copenhagen, Denmark; the Department of Biology and Biological Engineering, Chalmers University of Technology in Gothenburg, Sweden; the School of Biological Sciences, The University of Auckland in Auckland, New Zealand; the Bartholin Institute, Rigshospitalet in Copenhagen, Denmark; the Research Centre for Prevention and Health, The Capital Region of Denmark in Frederiksberg, Denmark; the Research Unit and Department of Gastroenterology, Herlev and Gentofte Hospital, the Capital Region of Denmark in Herlev, Denmark; with Clinical-Microbiomics A/S in Copenhagen, Denmark; the Department of Microbiology and Immunology, KU Leuven–University of Leuven, Rega Institute; and VIB, Center for Microbiology in Leuven, Belgium; with Biostatistics, Department of Public Health, University of Copenhagen in Copenhagen, Denmark; the Laboratory of Genomics and Molecular Biomedicine, Department of Biology; the Novo Nordisk Foundation Center for Basic Metabolic Research; the Department of Radiology, Bispebjerg Hospital, Copenhagen, Denmark; and the Department of Biomedical Sciences; and the department of Biostatistics at the Department of Public Health at the University of Copenhagen, Copenhagen, Denmark.
  2. Celiac.com 12/08/2018 - Recently CNN published an article entitled “Will a Gluten Free Diet Improve Your Health?” Honestly there were a lot of plus-points to this article. But unfortunately the negatives could very well outweigh them if you’re considering, or are new to, the gluten-free diet. Let’s review the positives and negatives as they appear in the article: 1. Dr Leffler from Harvard Medical School was quoted as saying that: “Gluten is fairly indigestible in all people.” “There’s probably some kind of gluten intolerance in all of us.” Bravo! I was very excited to read this remark. Although I often promote this information, I haven’t heard it from others aside from Dr. Fasano. The fact that humans can’t properly digest gluten is an important truth that should be better known and more widely taught. 2. Experts now believe that celiac disease represents just one extreme of a broad spectrum of gluten intolerance that includes millions of people. It can sometimes be interesting when unnamed “experts” are quoted, but in this case I agree. I’ve often written about my belief that celiac disease to gluten sensitivity is likely one spectrum. The fact that those with gluten sensitivity don’t undergo the outright destruction of the small intestine as in the case of celiac disease, in no way puts gluten sensitivity in a less serious category. It’s a “different” reaction but no less serious. 3. They go on to state that people with celiac disease and gluten sensitivity usually have stomach aches, gas, and diarrhea -- as do people with IBS. “Usually” is not the case and it would give someone without digestive complaints a false sense that they do not have gluten intolerance. In fact, according to research, for every person with celiac disease who experiences digestive symptoms, there are eight without digestive complaints. This is why, all too often, people continue to live with migraines, depression, infertility, skin problems, obesity and autoimmune disease that is gluten related but the gluten connection remains undiagnosed because they have no digestive complaints. Let’s not kid ourselves. We’re only diagnosing, at best, seven percent of the celiacs in our country. In our medically advanced society, missing over ninety percent of those suffering with the most common lifelong disorder in the US and Europe, is beyond pitiful. Unfortunately, it is statements such as the above, limiting our focus to digestive complaints that are partly to blame for our poor rate of diagnosis. 4. Gluten sensitivity, on the other hand, is a gray area that “lacks any defining medical tests,” Leffler says. People who fall into this group exhibit the classic symptoms of celiac disease yet have no detectable intestinal damage, and test negative for certain key antibodies (though in some cases they may have elevated levels of others). The issue here might be “medical tests” and Dr. Leffler may not know about the gluten sensitivity tests that are available. However, they are available and they have recently taken a nice jump in sensitivity due to a new lab in the US (Cyrex Labs – again, I have no affiliation with this lab). I also take umbrage to the reference to the lab tests as almost an afterthought in parentheses. The truth lies within those parentheses – gluten sensitive individuals do show elevation of key antibodies that are different than those seen in celiac disease. Does that make those elevations somehow less important? Of course not! They are just different. 5. “A recent study by Fasano and his colleagues offers some clues about what gluten sensitivity is, and how it differs from celiac disease. Although they show no signs of erosion or other damage, the study found, the intestines of gluten-sensitive patients contain proteins that contribute to a harmful immune response, one that resembles -- but is distinct from -- the process underlying celiac disease. “ This is a very good point. First, Dr Fasano is spending his time researching gluten sensitivity. This is not something we would have seen several years ago. His latest research showed that the immune system DOES create a harmful immune response in the intestines of those suffering from gluten sensitivity. Is it the same response as that seen in celiacs? No. But we didn’t expect that it would be. We know that small intestinal erosion doesn’t happen in the gluten sensitive patient. What’s earth shattering about this research finding is that it completely validates what I and other clinicians like me have been saying for several years – gluten sensitivity is the adverse effect of the body’s immune system having a deleterious reaction to gluten. This research proves that point. 6. “Recommendations for people with gluten sensitivity aren’t as clear-cut. Unlike celiac disease, gluten sensitivity hasn’t been linked to intestine damage and long-term health problems, so some experts say that people on the less severe end of the spectrum should feel comfortable eating as much gluten as they can handle without feeling sick.” Ah, so easy to write, so hard to take back or explain. This is a dangerous couple of sentences. Let’s dissect: They join “intestine damage” with “long-term health problems” as if it were impossible to have a long-term health problem without intestinal damage. Nothing could be further from the truth! I have many, many patients with gluten sensitivity, and therefore none of the intestinal destruction seen with celiac disease, who would beg to differ as regards long-term health problems being associated with gluten sensitivity, not just celiac disease. These patients have seen their serious long-term health problems resolve as a result of eliminating gluten from their diet. And they did not have celiac disease. Is schizophrenia a health problem? What about migraines? How about eczema? Is infertility a health problem when you’re trying to get pregnant? What about depression? I could go on and on. And it’s not just my opinion or my patients’ opinions. This is very well substantiated by research. You cannot “feel” damage and inflammation to certain organs of your body. In fact, autoimmune disease markers can be present for well over a decade before the first symptoms show themselves. Should we wait? Is that smart? Let’s continue: In the last sentence of point #6 above, we come across those unnamed “experts” I was referring to earlier. I would really like to know names on this one. Perhaps they were misquoted, or misunderstood. The truth of the matter is that gluten is not called the “great masquerader” because it creates overt symptoms all the time, quite the contrary. That is why one never is quite sure what symptoms will improve until one actually embarks on a gluten-free diet. In fact it was this realization that caused us to write the book “The Gluten Effect” two years ago. There was little appreciation at that time of all the effects that gluten could create in the non-celiac individual, which is why we were compelled to share our experiences. 7. “Some people can be exquisitely sensitive and have to be as strict as people with celiac disease, while others can eat a pizza,” Fasano says. [he was referring to gluten sensitivity] You might imagine that a newly diagnosed individual might very well read this sentence and be keeping their fingers crossed that they might be one of the lucky ones who could eat the pizza. I am a huge fan of Dr. Fasano’s and to give this quote the benefit of the doubt I’m going to give you my interpretation. I have patients who have gone out and eaten pizza and “felt fine”. In fact they seemed to feel so “fine” that they did it again. Did they ultimately end up fine? No, they did not. They found themselves days, weeks or months later quite ill, not only with old symptoms returning but often with new ones as well. What, then, could Dr. Fasano have meant by his comment? I believe that he was trying to make a point about the difference between a celiac and a person with gluten sensitivity. A celiac could have a miniscule amount of a crouton drop into their salad and be very ill almost immediately, while a person with gluten sensitivity would not necessarily have such an acute reaction. But to take that to mean that it is in some way “fine” or healthy for them to eat gluten is definitely not the case and I don’t believe that’s what Dr. Fasano meant. 8. “If you suspect your body can’t tolerate gluten, the first thing you should do is get tested for celiac disease. If the test comes back negative, try a gluten-free diet for a week to see if you feel better, Leffler says.” The cells in the intestine take about a month to turn over and renew themselves. A week on a gluten-free diet is not sufficient, in the main, to determine whether one has a problem. A month of absolutely no gluten is a more appropriate standard. With that said, some people do feel better almost immediately but I wouldn’t want to miss those who take several weeks to feel the change by not pointing out the 30 day recommendation. 9. Finally, ending on an up note: “People with gluten sensitivity who don’t respond this way [meaning feeling ill immediately] aren’t necessarily in the clear, however. Experts like Marlisa Brown, a registered dietitian and author worry that gluten could have long-term negative consequences that just haven’t been identified yet.” As we’ve been discussing many of the consequences are known and they are serious. But I do agree with her that just because you don’t feel sick right away is no reason to eat gluten when you are sensitive to it. I hope this helps clarify this recent article and gives you and those you care about the support you need to continue your gluten-free lifestyle. It is worth it, I promise! References: www.CyrexLabs.com www.Enterolab.com Alimentary Pharmacology & Therapeutics. 2009 Jun 15;29(12):1299-308. Epub 2009 Mar 3.
  3. Celiac.com 12/07/2018 - What do hypertension, obesity, smoking and celiac disease have in common? They’re all important risk factors for coronary heart disease (CHD), a disease that kills more than a half a million people annually in the U.S. alone.(1) Based on emerging research, celiac disease may be a major contributor to heart disease in the Western world –making celiac disease an even greater public health threat than is currently understood. CHD and Celiac Disease: A Brief History The connection between CHD and celiac disease has a 35-year history. It began with a 1976 study conducted by Southampton University Hospital researchers, who found that there was an “… apparent protective effect of coeliac disease on CHD risk which “…might result from malabsorption of dietary lipids.”(2) However, this study had a number of significant flaws including a small sample size of only seventy seven. The most significant confounder in this study was the mortality rate of young subjects, which precluded them from the privilege of living long enough to develop CHD. Additionally, our understanding of CHD has undergone a paradigm shift since the low-fat 1970’s. CHD is not the result of excess dietary fat consumption, but instead is a manifestation of prolonged inflammation.(3) Based on this study and two others published around the same time period which found no link between CHD and celiac disease, researchers largely stopped investigating the heart health of people with celiac disease. The assumption was that celiac disease provided protection or, at the very least, was benign in terms of CHD risk. Then came a paper published in the July 2003 Archives of Internal Medicine which reported that celiac disease patients had a sixty percent increased risk of CHD death.(4) More recently, in a January 2011 Circulation paper, Swedish researchers published eye-catching results from an investigation of more than 15,000 individuals with celiac disease.(5) The key finding from this research was an approximately twenty percent increased risk of CHD death in people with celiac disease. While this research remains in its infancy, the biological connections between celiac disease and CHD are crystal clear, bolstering the epidemiological findings that people with celiac disease are at heightened CHD risk. CHD Today Before delving into the physiological link between CHD and celiac disease, it’s crucial to understand the pathogenesis of atherosclerosis, or narrowing of the heart’s arteries. Atherosclerosis begins with an injury to the endothelial lining of the coronary artery. A hyperactive response by immune cells, particularly macrophages and inflammatory cytokines, causes macrophage cells to become lodged inside the injured endothelium. Through a complex cascade of cell signaling, “trapped” macrophages transform into what are known as foam cells. These foam cells take in circulating blood lipids, especially low density lipoproteins (LDL). Over time this LDL/foam cell mishmash transforms into the arterial plaque most people are familiar with.(6) Inflammation fuels atherosclerosis from start to finish –from the initial injury to the development and accumulation of plaque. The Inflammation Connection Unfortunately, inflammation is something that people with celiac disease have more than enough of. Serum C-reactive protein (CRP) is a commonly used parameter for celiac disease diagnoses –suggesting that nearly all uncontrolled celiac disease patients have elevated inflammation levels.(7) CRP also happens to be a more sensitive indicator of impending heart disease risk than serum cholesterol. Cleveland Clinic cardiologist Eric Topol claims that “…in the past, people talked about their cholesterol levels. In the next decade everyone will need to know their C-reactive protein level (a marker of inflammation).”(8) Other inflammatory mediators –such as IL-6 and TNF-a—are also present in greater amounts in celiac disease patients compared to the general population. In addition to the inflammatory response to ingested gluten, a March 2009 genetic analysis found that individuals with celiac disease were more likely to have polymorphisms that promote inflammatory cytokine production. (9) Other Links in the Chain And, there’s more to this celiac disease/CHD story than inflammation. People with celiac disease tend to have comorbidities that compound celiac disease’s damage to the cardiovascular system. Fat Malabsorption Dietary fats are a heart-health double edged sword. Excessive intake of trans fats are strongly linked to dyslipidemia and heart disease. However, a recent American Journal of Clinical Nutrition meta-analysis which included over 340,000 research subjects in its analysis found no connection between saturated fat and heart disease. (10) Monounsaturated and polyunsaturated fats are protective against atherosclerosis. Omega-3 fats appear to confer a particularly strong cardiovascular disease prevention benefit.(11) Adequate intake and absorption of fats is crucial for CHD prevention. Indeed, a low-fat dietary pattern was shown to increase heart disease risk in a large-scale randomized control trial involving more than 48,000 subjects.(12) Absorption of dietary fats is severely impacted by celiac disease due to villous atrophy, pancreatic insufficiency and dysbiosis. Lewis et al found that untreated celiac disease patients had approximately twenty one percent lower serum cholesterol levels compared to the general population, suggesting severe fat malabsorption.(13) Based on this research and others it’s conceivable that many celiac disease patients don’t absorb the dietary fats required to combat heart disease. Vitamin Malabsorption Suboptimal nutrient absorption is a near-universal issue in celiac disease patients – even for individuals consuming a gluten free diet. Fat soluble vitamin absorption is particularly affected by celiac disease.(14) Poor absorption of fat soluble vitamins E and D has been tied to increased heart disease risk in several studies. (15) Homocysteine Homocysteine is an amino acid that becomes elevated in cases of vitamin B6, folic acid or vitamin B12 deficiency. Poor B-complex vitamin absorption is common in both newly diagnosed celiac disease and in celiac disease patients following a gluten free diet.(16) An October 2002 Meta-analysis found that homocysteine levels twenty five percent above normal levels boosted heart attack risk by eleven percent.(17) Due to its strong correlation with heart disease, the American Heart Association suggests that individuals with malabsorption symptoms, including celiac disease, should be screened for homocysteine.(17) Simone Saibeni, MD and her University of Milan colleagues justified this recommendation by finding that celiac disease patients were 3.5 times more likely to have elevated hyperhomocysteinemia than the general population.(16) Type 1 Diabetes (DM1) Approximately five percent of people with celiac disease also suffer from DM1.(18) Hyperglycemia promotes inflammation, endothelium stiffness and arterial plaque formation. Rheumatism Symptoms of rheumatism, especially Sjogrens syndrome and unexplained joint pain, are common symptoms of undiagnosed celiac disease. Lubrano et al found that twenty five percent of individuals with celiac disease also have arthritis.(19) A 2008 population study discovered that people with rheumatoid arthritis have double the heart attack and stroke risk of the general population.(20) Whole Grain Intake Whole grain intake is strongly associated with a decreased risk of CHD.(21). Avoidance of fortified whole grains by people with celiac disease may impact dietary intake of B-vitamins, dietary fiber and antioxidants. How People With Celiac Disease Can Fight CHD Preventing CHD in the celiac disease population isn’t dramatically different from what’s typically recommended to the general population. Maintaining a healthy body weight, eating adequate amounts of dietary fiber, staying physically active, avoiding trans fats and consuming monounsaturated fats regularly are the keys to cardiovascular health whether or not one has been diagnosed with celiac disease. However, there are a few important heart health caveats that those with celiac disease should keep in mind. Gluten-Free Diet The importance of a 100 percent gluten free diet for CHD risk reduction and overall health cannot be emphasized enough. Not only is it the most effective treatment for celiac disease, but it is also critical for limiting the inflammatory response that promotes atherosclerosis.(22,23) Additionally, a strict gluten free diet allows the intestine to heal and recover, boosting absorption of nutrients necessary for cardiovascular health. Multivitamin Supplementation Multivitamin/Multimineral supplementation is standard treatment for celiac disease today.(24) Supplementation helps partly compensate for malabsorption and suboptimal intake of vitamins and minerals. A multivitamin supplement for CHD prevention should include at least 100 percent of the RDA for folic acid, vitamin B12, vitamin B6, and fat-soluble vitamins D and E. Dietary Fats “Fat is the most commonly and severely affected nutrient in celiac disease,” reports Jay W. Marks, M.D., of Baylor University College of Medicine.(25) Individuals with celiac should aim to consume at least twenty five percent of their calories in the form of dietary fat. Healthy monounsatured and polyunsatured fat sources such as extra virgin olive oil, nuts, legumes, fatty fish, and seeds should form the foundation of a heart healthy celiac disease diet. Pancreatic enzymes may be used to aid lipid absorption and reduce gastrointestinal symptoms like diarrhea and bloating. Omega-3 Fats Omega-3 fats reduce inflammation, increase HDL cholesterol and make cardiovascular arteries resistant to injury. Zhang et al discovered that habitual fish consumption was associated with a forty percent reduction in CHD mortality in healthy populations.(26) Omega-3 fatty acids may have additional benefits for celiac disease patients, especially acceleration of intestinal healing. Celiac disease patients should consume fatty fish like mackerel and salmon at least twice weekly. Conclusion Celiac disease needn’t be an automatic CHD death sentence. Although the connection between heart disease and celiac disease is very real, lifestyle changes can dramatically reduce the chances that someone with celiac disease will develop CHD. Simply eating a gluten-free diet, supplementing with vitamins, minerals and pancreatic enzymes and consuming omega-3 fats –four measures that those with celiac disease should be doing anyway – will shield the cardiovascular system from much of the celiac disease-derived damage that can lead to CHD. In fact, this new link can ultimately become a net positive for many celiac disease patients as it can motivate them to become more proactive and aggressive in their self-care. References: 1. Centers for Disease Control and Prevention; Heart Disease Facts; Available at: https://www.cdc.gov/heartdisease/facts.htm. Accessed April 18th 2011. 2. Whorwell PJ, Foster KJ, Alderson MR, Wright R. Death From Ischaemic Heart-Disease and Malignancy in Adult Patients With Celiac Disease. Lancet 1976;113-114. 3. Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease, application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation [serial online].2003;107:499-511 4. Peters U, Askling J, Gridley G, et al. Causes of death in patients with celiac disease in a population-based Swedish cohort. Arch Intern Med. 2003;163:1566–1572. 5. Ludvigsson JF, James S, Askling J, Stenestrand U, Ingelsson E. Nationwide cohort study of risk of ischemic heart disease in patients with celiac disease. Circulation. 2011 Feb 8;123(5):483-90 6. Gotta A, Farmer F. Atherosclerosis: Pathogenesis, Morphology, and Risk Factors. Cardiovascular Medicine. 3rd Edition, Springer, London, pp. 1593-1613. 7. Lahat N, Shapiro S, Karban A, et al. Cytokine profile in coeliac disease. Scand J Immunol 1999;49:441–446 8. Role of inflammation-Growing proof inflammation is a major risk factor for heart disease. Available at: http://www.clevelandclinic.org/heartcenter/pub/news/hot/inflammation8_02.asp?firstCat=1&secondCat=429&thirdCat=524. Updated 8/02. Accessed April 18th 2011. 9. Dema B, Martínez A, Fernández-Arquero M, The IL6-174G/C polymorphism is associated with celiac disease susceptibility in girls. Hum Immunol 2009;70:191-4 10. Siri-Tarino SW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr [serial online]. 2010;91:535-546. 11. Perez-Jimenez F, Lopez-Miranda J, Mata P. Protective effect of dietary monounsaturated fat on arteriosclerosis: beyond cholesterol. Atherosclerosis 2002;163:385–98 12. Howard BV, Van Horn L, Hsia J, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006; 295:655-66 13. Lewis NR, Sanders DS, Logan RF, Fleming KM, Hubbard RB, West J. Cholesterol profile in people with newly diagnosed coeliac disease: a comparison with the general population and changes following treatment. Br J Nutr. 2009 Aug;102(4):509-13 14. Hallert C, Grant C, Grehn S, Granno C, Hulten S, Midhagen G, Strom M, Svensson H, Valdimarsson T. Evidence of poor vitamin status in coeliac patients on a gluten-free diet for 10 years. Aliment Pharmacol Ther. 2002;16:1333–1339 15. Sesso HD et al.Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial. JAMA. 2008 Nov 12;300(18):2123-33 16. Saibeni S, Lecchi A, Meucci G, et al. Prevalence of hyperhomocysteinemia in adult gluten-sensitive enteropathy at diagnosis: role of B12, folate, and genetics. Clin Gastroenterol Hepatol 2005;3:574e80 17. Malinow MR, Bostom AG, Krauss RM. Homocyst(e)ine, diet, and cardiovascular diseases: a statement for healthcare professionals from the Nutrition Committee, American Heart Association. Circulation. 1999;99:178–182 18. Ludvigsson JF, Olsson T, Ekbom A, Montgomery SM. A population-based study of coeliac disease, neurodegenerative and neuroinflammatory diseases. Aliment Pharmacol Ther 2007; 25:1317 19. Lubrano E, Ciacci C, Ames PR, et al. The arthritis of celiac disease: prevalence and pattern in 200 adult patients. Br J Rheumatol 1996;35:1314-8 20. Dhawan SS, Quyyumi AA. Rheumatoid arthritis and cardiovascular disease. Curr Atheroscler Rep. 2008;10:128-133 21. Jensen MK, Koh-Banerjee P, Hu FB, et al. Intakes of whole grains, bran, and germ and the risk of coronary heart disease in men. Am J Clin Nutr. 2004;80(6):1492-1499 22. Meresse B, Cerf-Bensussan N. Celiac disease: from oral tolerance to intestinal inflammation, autoimmunity and lymphomagenesis. Mucosal Immunol. 2009;2:8e23 23. Popa C, Netea MG, van Riel PL, van der Meer JW, Stalenhoef AF. The role of TNF-a in chronic inflammatory conditions, intermediary metabolism, and cardiovascular risk. J Lipid Res. 2007;48:751–62 24. See J, Murray JA. Gluten-free diet: the medical and nutrition management of celiac disease. Nutr Clin Pract. 2006;21(1):1-15. 25. Marks, J. “Celiac Disease (Gluten Enteropathy)”Available at: https://www.medicinenet.com/celiac_disease_gluten_enteropathy/article.htm. Accessed April 29th 2011. 26. Zhang J, Sasaki S, Amano K, et al. Fish consumption and mortality from all causes, ischemic heart disease, and stroke: an ecological study. Prev Med. 1999; 28: 520–529.
  4. Celiac.com 12/06/2018 - The growing popularity of gluten-free foods has led to numerous new products for consumers, but it has also led to some problems. One recent study showed that up to one-third of foods sold as gluten-free contain gluten above 20ppm allowed by federal law. Other studies have shown that restaurant food labeled as “gluten-free” is often contaminated with gluten. The problem of gluten in commercial food labeled gluten-free is not isolated to the United States. Recent studies abroad show that the problem exists in nearly every gluten-free market in every country. In Australia, for example, researchers from the Walter and Eliza Hall Institute in Melbourne found detectable gluten in almost 3% of 256 commonly purchased “gluten-free” manufactured foods, a study published in the Medical Journal of Australia on Monday says. Furthermore, the study shows that nearly 10% of restaurant dishes sold as "gluten-free" contain unacceptable levels of gluten. Now, the Australians have a stricter standard than nearly anyone else, so look for them to be on top of potential problems with gluten contamination in gluten-free products. The study did not name the food manufacturers responsible for the contaminated products, but did note that better, more frequent gluten testing by manufacturers would make gluten-free foods safer for people with celiac disease. In a related study, the same researchers found in May that nearly one in ten samples of “gluten-free” dishes from restaurants within the City of Melbourne contained gluten levels in excess of the official Food Standards Australia New Zealand definition of gluten-free. “It’s troubling to think that these foods could be hindering the careful efforts of patients trying their best to avoid gluten,” an author of the study, Dr Jason Tye-Din, said. A spokeswoman from Coeliac Australia said the organization was taking the findings seriously. “The research team that conducted this study has liaised with the food companies and is following up the positive samples with further retesting to ensure the issue is resolved,” she said. In addition to urging consumers to be diligent in reading labels, and to report any suspect products, “Coeliac Australia advises all people with coeliac disease to have regular medical check-ups as they do have a serious autoimmune condition and medical assessment is important to determine that their gluten-free diet is going well and no complications are developing.” Read more at: TheGuardian.com
  5. Celiac.com 12/04/2018 - In a major development in wheat genetics, the International Wheat Genome Sequencing Consortium (IWGSC) recently presented the first high-quality fully annotated reference genome sequence of the bread wheat variety Chinese Spring. The IWGSC Reference Sequence (RefSeqv1.0), catalogues the location and structure of more than 107,000 genes, and 4 million markers, across all 21 chromosomes of the wheat variety - some associated with important agricultural features. According to the authors, the sequence can be used for both genetic research projects and CRISPR- based genome modification. The results of a later study appear in Science. In that study, researchers used the new reference genome to perform a genome-wide analysis of the expression of homoelogs, genetic copies that are similar, but have different origins. Mapping these genetic features will improve scientists’ understanding of the basic structures of polyploid wheat. By combining gene expression datasets with the IWGSC RefSeqv1 wheat genome sequence, the researchers demonstrated the balance of gene expression among homeologs across the various tissues, developmental stages and cultivars of wheat. The team identified tissue-specific biases in gene expression and co-expression networks during development and exposure to stress, and their work offers a way to target key genes responsible for valuable agricultural traits in wheat. In a third study that also made use of the new IWGSC reference sequence, researchers closely examined the proteins contributing to various wheat-immune diseases and allergies, such as celiac disease, baker's asthma and wheat-dependent exercise-induced anaphylaxis (WDEIA). Certain proteins in wheat can trigger serious allergic reactions in sensitive individuals. Celiac disease, for example, is triggered by prolamin proteins gliadin and glutenin in wheat. Moreover, respiratory or skin exposure to other types of proteins have also been implicated in adverse immune responses. However, because of the complexity of the wheat genome, and the paucity of comprehensive genome information, a detailed description of these proteins has remained out of reach until now. A research team led by Angela Juhász used the IWGSC RefSeqv1.0 wheat genome to search for the genes that encode known allergy-inducing wheat proteins and mapped each across the entire sequence. The team’s analysis revealed previously unknown genes potentially related to immune-responsive proteins. Their results show that the genes associated with celiac and WDEIA are found in wheat’s starchy endosperm, the main ingredient in baking flour. Also, several lipid transfer proteins and alpha-amylase trypsin inhibitor gene families play a role in baker's asthma. Interestingly, the study showed that temperature stress during flowering can boost wheat’s natural levels of prominent celiac and WDEIA proteins. The researchers' detailed analysis offers important insights into the role of environment and growing conditions on the levels of proteins problematic for human consumers, they say. Their work will also inform production of low allergy wheat varieties, among others useful to the food industry. The many discoveries and breakthroughs in genetic analysis and engineering promise a very bright future when it comes to understanding and treating celiac disease, and numerous other anti-inflammatory diseases. Stay tuned as more developments unfold. Read more at Eurekalert.org
  6. Celiac.com 12/03/2018 - Biomarkers in blood samples are not effective indicators for diagnosis or monitoring of celiac disease. A team of researchers recently set out to assess biomarkers of celiac disease derived from neoepitopes of deamidated gliadin peptides (DGP) and tTG fragments, and to assess their usefulness in identifying patients with celiac disease with mucosal healing. The research team included RS Choung, SK Rostamkolaei, JM Ju, EV Marietta, CT Van Dyke, JJ Rajasekaran, V Jayaraman, T Wang, K Bei, KE Rajasekaran, K Krishna, HK Krishnamurthy, and JA Murray. They are variously affiliated with the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA; Vibrant Sciences LLC, San Carlos, CA, USA; and with the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. The team began by analyzing serum samples from 90 patients with biopsy-proven celiac disease, along with 79 healthy control subjects for immune reactivity against the tTG-DGP complex. They used a fluorescent peptide microarray platform to estimate the antibody binding intensity of each synthesized tTG-DGP epitope. They validated results in 82 patients with newly diagnosed celiac disease, and in 217 control subjects. They assessed the ability of the peptide panel to spot patients with mucosal healing based on histologic results and using serum samples from 85 patients with treated and healed celiac disease; 81 patients with treated but unhealed celiac disease who showed villous atrophy despite adhering to a gluten-free diet; 82 patients with untreated celiac disease; 27 disease control subjects who showed villous atrophy without celiac disease; and 217 healthy control subjects. To assess their data, they relied on principal component analysis followed by machine learning and support vector machine modeling. In all, the team found 172 immunogenic epitopes of the tTG-DGP complex. Compared with control subjects, celiac patients showed substantially higher immune reactivity against these epitopes. In the test group, neoepitopes derived from the tTG-DGP complex identified people with celiac disease with a remarkable 99% sensitivity and 100% specificity. Blood samples from untreated celiac patients showed the greatest average antibody-binding intensity against the tTG-DGP complex. Blood from patients with treated but unhealed CeD mucosa (15.1 ± 7.5) showed significantly higher average antibody-binding intensity than blood from patients with treated and healed CeD mucosa (5.5±3.4) (P<.001). The test spotted celiac patients with healing mucosa with 84% sensitivity and 95% specificity. The research team discovered immunogenic epitopes of the tTG-DGP complex, and found that a test that measures immune response to epitopes accurately identified both celiac patients and patients with mucosal healing. From this study, the team concludes that the biomarker method for celiac testing could be useful in both the detection and monitoring of celiac disease. Read more at: Gastroenterology.
  7. Celiac.com 11/28/2018 - Patients with gluten ataxia without enteropathy have lower levels of antigliadin antibodies (AGA) compared to patients with celiac disease. Magnetic Resonance Spectroscopy (NAA/Cr area ratio) of the cerebellum improves in patients with gluten ataxia following a strict gluten-free diet, and is associated with an improvement in symptoms. A team of researchers recently set out to present their experience of the effect of a gluten-free diet in patients with ataxia and low levels of AGA antibodies measured by a commercial assay. The research team included Marios Hadjivassiliou, Richard A Grünewald, David S Sanders, Panagiotis Zis, Iain Croall, Priya D Shanmugarajah, Ptolemaios G Sarrigiannis, Nick Trott, Graeme Wild, and Nigel Hoggard. They are variously affiliated with the Academic Departments of Neurosciences and Neuroradiology; the Departments of Gastroenterology, the Departments of Dietetics; the Departments of Immunology, Sheffield Teaching Hospitals NHS Trust, in Sheffield, UK. The team conducted MR spectroscopy on 21 consecutive patients with ataxia and serum AGA levels below the positive cut-off for celiac disease, but above a re-defined cut-off in the context of gluten ataxia, at baseline and after a gluten-free diet. Of the 21 included patients with gluten ataxia, the team found that ten were on a strict gluten-free diet with elimination of AGA, 5 were on a gluten-free diet, but continued to have AGA, while 6 patients did not follow a gluten-free diet. The NAA/Cr area ratio from the cerebellar vermis increased in all patients on a strict gluten-free diet, increased in only 1 out of 5 patients on a gluten-free diet with persisting circulating AGA, and decreased in all patients who did not follow a gluten-free diet. From these results, the team concludes that patients with ataxia and low levels of AGA benefit from a strict gluten-free diet. The results suggest an urgent need to redefine the serological cut-off for circulating AGA in the diagnosis of gluten ataxia. Read more in Nutrients 2018, 10(10), 1444; doi:10.3390/nu10101444
  8. Celiac.com 11/26/2018 - Many people with celiac disease suffer from headaches. A team of researchers recently set out to more thoroughly explore the relationship between celiac disease and headaches. The research team included Panagiotis Zis, Thomas Julian, and Marios Hadjivassiliou. They are variously affiliated with the Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK, and the Medical School of the University of Sheffield in Sheffield, UK. The team's goal was to establish the relationship between headaches and celiac disease, and vice versa, to explore the role of a gluten-free diet, and to describe the imaging findings in celiac patients affected by headaches. For their systematic review and meta-analysis, the team reviewed 40 articles published in the the PubMed database between 1987 and 2017. They included information regarding study type, population size, the age group included, prevalence of celiac disease among those with headache and vice versa, imaging results, the nature of headache, and response to gluten-free diet. They found that the average pooled rate of headaches in celiac patients was 26% (95% CI 19.5–33.9%) in adult populations and 18.3% (95% CI 10.4–30.2%) in pediatric populations. The headaches usually resemble migraines. Children with headaches of unknown origin, have celiac disease rates of 2.4% (95% CI 1.5–3.7%). There is presently no good data for adult populations. In such cases, brain imaging can be normal, but can also reveal cerebral calcifications with CT, white matter abnormalities with MRI, and deranged regional cerebral blood flow with SPECT. The good news is that a gluten-free diet seems to be an effective treatment. Up to 75% of celiac patients saw their headaches resolve when they followed a gluten-free diet. Celiac patients have high rates of idiopathic headache (that is, headaches of unknown cause), and patients with such headaches have higher rates of celiac disease. Therefore, patients with headache of unknown origin should be screened for celiac disease, since they may gain symptom relief from a gluten-free diet. Source: Nutrients 2018, 10(10), 1445; doi:10.3390/nu10101445
  9. Celiac.com 11/23/2018 - The complex factors that lead to the development of celiac disease in a given individual are the subject of much research. The immune system, genetics and the environment (meaning factors in an individual’s life that would influence the development of disease) all play an important part in this process. Current research on celiac disease focuses on the immune system; scientists are working to understand the exact chain of events that occur in the gut when gluten is introduced for the first time. Understanding these events could yield insight into treatments for celiac disease that interrupt this process. Celiac disease is the only autoimmune disorder where the trigger is known: gluten. Researchers use celiac disease as a model for studying the pathogenesis of other autoimmune diseases. Other researchers are examining the role of environmental factors and the added risk they bring to an individual who already is at risk for celiac disease. These factors include the influence of breastfeeding, the timing of the introduction of cereals, intestinal infection as a precursor to celiac disease, cultural factors, geography, and more. Genetic research has determined that there are two genetic haplotypes that are necessary for the development of celiac disease; an affected individual need only to have one of these genetic haplotypes to be at risk. These factors are HLA DQ2 and HLA DQ8. HLA stands for Human Leukocyte Antigen. Antigens are substances that produce an immune response—we have many antigens in our bodies that are supposed to do that. HLA are molecules that present on the surface of cells to help the immune system to distinguish antigens that are supposed to be in the body, versus antigens that aren’t. While other genes may play a role in the process, we can conclude with virtual certainty that an individual who tests negative for DQ2 or DQ8 will not develop celiac disease. We also know that 30% of the US population has the genetic makeup for celiac disease. While it is encouraging to see a surge of interest in celiac disease research, people with celiac disease have to make choices every day that affect their health, and knowing a bit more about the immune system may make this process easier. Myths about what it means to have an autoimmune disorder are common. Knowledge about this area can help one sort out the myths and find the facts about what it means to have celiac disease. What Does the Immune System Do? The immune system provides the human body with several levels of defense from foreign invaders like bacteria and viruses. The first layer of protection is our skin. If an invader finds its way into the body, however, the second level of defense mobilizes to destroy the invader before it can replicate. Some types of invaders already replicate and invade surrounding cells before the immune system can destroy them—and there is a sophisticated type of immune response to eliminate these types of invaders. The most important decision that the immune system makes when it encounters an “invader” is to determine whether or not it is “self” (is it supposed to be in the human body?) or “non-self” (is this a virus or bacteria that will cause illness?). HLA helps the immune system by tagging cells as “self” or “non-self” to allow the immune system to attack the true invaders. In the case of celiac disease, HLA tags the antigen presenting cell as non-self, when it should be tagged as self. The human body as a house Think of the human body as a house. The exterior of the house (the roof, the brick, the door, and the windows) is like the skin of a human body, protecting everything inside. The house has an alarm system, to detect invaders. The alarm system is the body’s immune system. There is a cat inside the house, sleeping on the couch. How is the immune system supposed to work? If a burglar (who is not supposed to be in the house) comes to the side window and tries to break in, there may be a broken window, but the alarm sounds and the burglar runs away. Everything inside the house is safe. How does the immune system work when someone has celiac disease? The cat wakes up from its nap and gets a drink of water. The alarm goes off, when it’s not supposed to. The cat sets off the alarm every time it moves, but other than this, the alarm works perfectly, keeping out all of the true invaders. In other words, the immune system of an individual with celiac disease is healthy and normal in every respect, save one. The presence of gluten, and only gluten, causes a malfunction of the immune system. In our example, the cat represents gluten—it is supposed to be in the house, yet every time it moves the alarm goes off. This means that removing gluten from the diet of a person with celiac disease returns their immune system to a normal and healthy state, equal to that of someone who does not have celiac disease. Many people with celiac disease feel that they are immune compromised, which is not the case. If the house in our example represented someone with an immune compromised condition, the alarm would rarely if ever go off (invaders could enter the body without any resistance). For this reason, flu shots for people with celiac disease do not represent a concern (unless you are allergic to eggs) and people with celiac disease should receive the shot with the general population, and not the special populations who are immune compromised (the elderly, children, etc.). When should gluten be introduced to a child at risk for celiac disease? When a person with celiac disease has a baby, there is a great deal of concern regarding the child’s potential for developing celiac disease—this is understandable. One of the most troubling questions facing parents is when to introduce gluten to their child. It is a common recommendation to delay the introduction of gluten until one year of age. Unfortunately, this recommendation is based on wheat allergy, and not autoimmunity. Fortunately, recent research published in the Journal of the American Medical Association has affirmed earlier research from Finland on this subject as well as what has been a common practice throughout Europe. A protective window Researchers at the University of Colorado recently announced the results of a 10 year study on the introduction of cereals in children at risk for celiac disease. Their study demonstrated that infants who received cereals containing gluten between four to six months of age were not as likely to develop celiac disease by the age of five as were children who received gluten containing cereals at younger and older ages. The infants who received cereals between one and three months of age were five times as likely to develop celiac disease, and children who received cereals after six months of age had an elevated risk for developing celiac disease, but not to the extent of the youngest age group. Is it a gluten response? Many parents are concerned about whether or not their child will have an autoimmune response to gluten when introduced to cereals. It may help to know that it typically takes six to nine months for a child to mount an autoimmune response to gluten—if celiac disease is to occur early in their life. Therefore, a response (such as diarrhea or vomiting) shortly after cereals are introduced or eaten is usually not related to celiac disease. What about breast milk? A mother with celiac disease needs to remain on the gluten-free diet throughout pregnancy and breast-feeding. However, it is a common misconception that breast-feeding moms who are not celiac should go on a gluten-free diet while nursing. Microscopic amounts of gluten are carried in breast milk, but it is not enough to harm a child. In fact, research from Finland shows that breast milk has a protective effect in the gut when gluten is introduced to a child. This research recommends that when introducing gluten between four and six months of age, breast feeding should continue during this time to confer an added immune benefit. Understanding a bit more about the immune system may be helpful as you make decisions about your health, and the health of your family. It can be reassuring to know that the immune system of a person with celiac disease on the gluten-free diet is as healthy as an average person without celiac disease.
  10. Hello, What does my results mean? Am I allergic to gluten? tTg-IgG 8.62 tTg-IgA 3.02 Anti Gliadin IgA 93.24 And what’s the normal range for each? Thank you!
  11. Celiac.com 11/19/2018 - People with celiac disease cannot reliably determine whether they ate gluten or not based on symptoms, however severe those symptoms may be, according to research presented by Amanda K. Cartee, MD, of the Mayo Clinic, and her colleagues, at the American College of Gastroenterology Annual Meeting in Philadelphia. Because there is presently no FDA-approved test to confirm gluten exposure, celiac patients commonly rely on the presence or absence of gastrointestinal or other symptoms as an indicator of gluten exposure. But how reliable is that method? Not very reliable at all, says Dr. Cartee. Now, the study was small, but it was also rigorous. Dr. Cartee and her associates developed a double-blind, placebo-controlled gluten challenge to identify the rapid onset of symptoms after gluten ingestion, and to figure out if celiac patients could really tell whether they had been exposed to gluten. Researchers recruited 14 patients with celiac disease and 14 healthy controls for the trial. They then randomly assigned each patient to receive either a 6 g gluten suspension or placebo. Each patient completed a 100 mm visual analog questionnaire to assess their symptoms at baseline, every 30 minutes to 60 minutes for 6 hours and then daily for 3 days. The researchers also asked patients at each time point if they believed they received gluten. During the study, only two of the seven celiac patients who received gluten were able to correctly identify the gluten suspension. Cartee said it took a full day for one patient to come to that conclusion, while another gave varied responses sporadically throughout the study. Nausea and abdominal pain were the most common symptoms for celiac patients. Interestingly, there was no statistical difference in symptoms in the gluten celiac disease group compared with the placebo celiac disease group. That is, celiac disease patients receiving the placebo reported symptoms that the same rate as those who received actual gluten. So, not only could the celiac patients not tell when they got gluten, they also couldn’t tell when they got a placebo. Dr. Cartee said because physical symptoms are subjective and non-specific, they are largely unreliable for self-diagnosing gluten exposure. Dr. Cartee is calling for the development of a better, more objective way to identify gluten-related symptoms, especially in celiac patients with ongoing gastrointestinal symptoms. Do you have celiac disease? Would you welcome an easy reliable way to determine gluten exposure? How would you find it helpful? Source: Healio
  12. Celiac.com 11/16/2018 - The best part of being diagnosed with celiac disease is finding out what you or your child has so that you can get back in control and in a position to do something about it. This article is dedicated to “getting back to basics.” Many of you will already be familiar with these topics. Still, every now and then we need to be reminded—for our well being or the well being of our loved ones—we must not take for granted the everyday food items we grab from the shelves or the medications we must take. We must always remember to read labels, as ingredients in products change constantly. You need to remember that even though you may experience a reaction from a “gluten-free product,” it doesn’t necessarily mean that it was contaminated with gluten. You might be having a reaction from something you ate within the 48 hours prior to becoming ill; having an allergic reaction; or you may just be sick. Keep in mind that a resource book that was once full of current information may no longer be accurate. Check the date it was printed, who compiled the information, and look to see if there is a more current version. Here are some suggestions to help make being gluten-free easier: Understand that it is sometimes difficult for family members to acknowledge that your diagnosis of celiac disease is an inherited autoimmune disease. Parents can have a problem accepting that they may have been the one who gave their child the disease. Other family members can be afraid that they too have the disease. Spouses may be angry that your lifestyle must change—or simply fear the unknown. Be honest with your friends. Hopefully, they will want to know more about celiac disease and what kinds of food you can and can’t have. Find a dessert that you get compliments on and volunteer to bring it when you visit a friend’s house for dinner, or to share it at a school or social function. When dining at a friend’s house, ask what will be served and plan to bring something similar for yourself. Never count on the host providing a gluten-free meal unless they offer. If you are not comfortable with bringing something, eat before you go. You can also choose from the meal what is appropriate. This applies to children as well. If they are newly diagnosed and embarrassed, get them a treat before or after the function and let them know you are proud of them for not eating something that contains gluten. Knowledge is power. Learn as much as you can from a qualified and up-to-date source, i.e. National support groups, doctors, and dietitians. Be wary of Internet chat rooms about celiac disease. The amount of information is overwhelming and is not always accurate, which can cause more frustration. There is, however, a lot of useful information, particularly Internet sites with recipes and food preparations. Volunteer. By focusing on other people and their needs, you will, in time, realize how fortunate you are that you have celiac disease and not something worse. A version of this article originally appeared in the Winter 2004 edition of the Celiac Disease Foundation Newsletter. The Celiac Disease Foundation is a national celiac disease support group that is based in Studio City, CA. For more information visit their Web site: www.celiac.org.
  13. Celiac.com 11/15/2018 - Gluten-free products, marketed as such, were largely unknown 20 years ago, but the gluten-free industry is set to reach an estimated $2.34 billion in sales by 2019. That’s more than double figures for 2014. The growth has been exponential. What sets gluten-free foods apart from other culinary trends or diet fads is that they address a legitimate health concern that affects millions of people around the world. With the massive influx of gluten-free products, and the expansion of “gluten-free” restaurant options, it’s easy to forget that gluten exists in some obvious and not so obvious places that people with celiac disease need to avoid. Here are 15 foods or food ingredients that many people wrongly assume are gluten-free: Beer Light or dark, lager, IPA or Stout, traditional beer is brewed with barley, and is not gluten-free. However, a number of major and micro breweries create tasty gluten-free alternatives. There are a number of tasty, award winning beers that are brewed from gluten-free ingredients and are fully gluten-free. There are also gluten-reduced beers. These beers are brewed like traditional beers and EU regulations allow for gluten-removed beer to be labeled as gluten-free. Plenty of people with celiac disease do fine drinking these beers, but many do not. Know your beer, know your body, and drink accordingly. Read more at Celiac.com's Oktoberfest Beer Guide! Gluten-free vs. Gluten-removed Beers. Barbecue Sauce Many barbecue sauces use artificial colors, flavorings or thickeners that may contain gluten, so it’s important to check labels, and even contact a manufacturer if you're not sure about something. Couscous, Tabbouleh and Falafel Couscous and bulgar are wheat and are used in many different Middle-eastern foods, and some people do not realize that they contain gluten. Bulgar or couscous are also used to make another popular Middle-eastern dish called tabbouleh (salad). Couscous or wheat flour are sometimes used to make falafel, so be sure to ask about the ingredients before eating. Candy Always be careful about candy. Many candies are safe and gluten-free, but many candies are not. Sometimes trusted products can change. Read labels, check websites, contact manufacturers as needed, and be careful! If you’re not sure, Celiac.com’s Annual Safe Gluten-Free Halloween Candy List is a good place to start. Cookie Dough This might seem obvious, but cookie dough, unless specifically gluten-free, almost always contains standard wheat flour and is not gluten-free. Dried Spices Some manufacturers actually use flour to keep their spices from clumping. Pay special attention to spice blends and mixes, including curry powders, which may contain wheat. Gravies, Soups, Sauces and Mixes—Packaged, Canned, or Jarred If you’ve ever made gravy from scratch, you might recall that it involves making a roux, a paste of butter and flour which thickens the gravy and gives it a nice sheen. Well, roux is also used as a thickening agent in many packaged, canned or jarred gravies, soups, sauces and mixes. Even some fresh soups may contain wheat or flour. Gazpacho, for example, can be made gluten-free, but most recipes call for a piece of bread soaked in sherry vinegar and blended into the soup. When it comes to gluten in soup, eater beware! Hot Dogs & Sausages The bun is an obvious source of gluten, but the dog itself can contain traces of wheat as well in the form of both filler and binder. So check labels, know the ingredients, and double-check when it comes to hot dogs and sausages. Ice Cream Although many ice creams are gluten-free, some may contain wheat in the form of added ingredients, like cookie dough, toppings or candy pieces. Double-check the ingredients to be safe. Packaged Deli Meats, Marinated or Pre-Seasoned Meats & Vegetable Proteins Packaged, marinated meat, fish, chicken, or other meats may contain gluten as a binder or hidden ingredient. Some vegetable-based proteins like Seitan contain gluten. Also, many deli meats claim to be gluten-free, but the same companies have released specific lines of gluten-free meats, raising the question of why they needed a separate product in the first place. Deli meats are controlled by the U.S. Department of Agriculture, not the Food and Drug Administration, which currently uses a different gluten-free standard. Prescription Drugs, Vitamins and Supplements Even though they are not technically foods, and they are meant to keep you healthy, prescription drugs, vitamins and supplements may contain gluten as binders, typically in the form of wheat starch. Ask you pharmacist for guidance, read labels closely, and make phone calls to companies or visit their Web sites to be sure. Salad Dressings Many salad dressings have updated their recipes to exclude any wheat or barley-derived additives, but some still contain gluten, especially the powdered mix kind. Soy Sauce Most soy sauces contain wheat and should be avoided. Be sure to find a gluten-free soy sauce. Sushi Although raw fish by itself is gluten-free, there are many ingredients in sushi rolls and other items that contain soy sauce and other sources of gluten. The seaweed wrappers in sushi may contain soy sauce, and the wasabi or fake crab may contain gluten. Teriyaki sauce is another source of gluten because it is made with soy sauce. See our How to Safely Order Sushi article for more info. Teriyaki Sauce Teriyaki is nearly always made with made with soy sauce, and most commercial brands contain wheat, so be careful. Read more on: Celiac.com UNSAFE Food List Celiac.com SAFE Food List Celiac.com's SAFE and UNSAFE Halloween Candy List
  14. Celiac.com 11/13/2018 - Ubiquitin is highly conserved across eukaryotes and is essential for normal eukaryotic cell function. The bacterium Bacteroides fragilis is part of the standard human gut microbiome, and the only bacterium known to encode a homologue of eukaryotic ubiquitin. The B. fragilis gene sequence points to a previous horizontal gene transfer from a eukaryotic source. The sequence encodes a protein (BfUbb) with 63% identity to human ubiquitin, which is exported from the bacterial cell. Is molecular mimicry of human ubiquitin by gut microbe linked to autoimmune diseases like celiac disease? A team of researchers recently set out to determine if there was antigenic cross‐reactivity between B. fragilis ubiquitin and human ubiquitin and also to determine if humans produced antibodies to BfUbb. The research team included L. Stewart, J. D. M. Edgar, G. Blakely and S. Patrick. They are variously affiliated with the School of Biological Sciences, University of Edinburgh, Edinburgh, UK; the School School of Biological Sciences, Queen’s University Belfast, Belfast, UK; the Regional Immunology Laboratory, Belfast Health and Social Care Trust, Belfast, UK; and the Wellcome‐Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, UK. Molecular model comparisons of BfUbb and human ubiquitin predicted likely structural similarity with 99.8% confidence. The team used linear epitope mapping to identify cross-reacting epitopes in BfUbb and human ubiquitin. Also, at least one epitope of BfUbb does not cross‐react with human ubiquitin. The team used enzyme‐linked immunosorbent assay to compare the reaction of human serum to BfUbb and human ubiquitin from 474 subjects among four groups: (1) newly autoantibody‐positive patients, (2) allergen‐specific immunoglobulin (Ig)E‐negative patients, (3) ulcerative colitis patients and (4) healthy volunteers. The team’s data show that the exposure to BfUbb into the human immune system triggers the creation of IgG antibodies. Patients referred for first‐time autoimmune disease testing are more likely to have a high levels of antibodies to BfUbb than are healthy volunteer subjects. From this, the team concludes that molecular mimicry of human ubiquitin by BfUbb could be a trigger for autoimmune disease. Finding and understanding potential triggers for autoimmune conditions helps to take us one step further to understanding and potentially curing celiac disease. Stay tuned for further developments in their arena. First published: 04 August 2018 https://onlinelibrary.wiley.com/doi/full/10.1111/cei.13195
  15. Celiac.com 11/12/2018 - Here’s an uplifting celiac story. Now, this happened a while back, but it's all just coming to light in the way that so many warm and fuzzy family stories do. It starts like this: Once upon a time, a simple check for celiac disease opened the door to parenthood for couple. Just over ten years ago, AnnMarie Bradley from Celbridge, Co Kildare, thought she’d never become a mother. After two devastating miscarriages over a decade, Bradley, who is 47 years old, and her husband Christopher (48) were at wit’s end. "I was just heartbroken,” said Ms Bradley. Then, a simple visit to her doctor changed everything. A blood test indicated she might have celiac disease, which further evaluation confirmed. She began a gluten-free diet, and less than a year later, Bradley was pregnant with her son, Cameron. “Being a mother had been everything I'd wanted," she said. Cameron is nearly 16 now, and has an 11-year old sister, Emily. And they all lived happily and gluten-free ever after. In the UK, the Coeliac Society advises women struggling to conceive to consider celiac testing. Read more at: Independent.ie
  16. Celiac.com 11/07/2018 - A team of researchers recently set out to explore the relationship between dermatitis herpetiformis, as a common extraintestinal manifestation of celiac disease, and a gluten-free diet as a path to overall dermatitis herpetiformis improvement. The research team included Timo Reunala, Teea T. Salmi, Kaisa Hervonen, Katri Kaukinen and Pekka Collin. They are variously affiliated with the Celiac Disease Research Center, Faculty of Medicine and Life Sciences at the University of Tampere, the Department of Dermatology, Tampere University Hospital, the Department of Internal Medicine, Tampere University Hospital, and with the Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital in Tampere, Finland. Dermatitis herpetiformis is a condition marked by itchy papules and vesicles on the elbows, knees, and buttocks. Dermatitis herpetiformis is a common in people with celiac disease. People who have just dermatitis herpetiformis alone rarely have obvious gastrointestinal symptoms. Dermatitis herpetiformis is easily diagnosed by immunofluorescence biopsy showing pathognomonic granular immunoglobulin A (IgA) deposits in the papillary dermis. One theory currently in play is that dermatitis herpetiformis is triggered by celiac disease in the gut and eventually develops into an immune complex deposition of high avidity IgA epidermal transglutaminase (TG3) antibodies, together with the TG3 enzyme, in the papillary dermis. The age at which people are diagnosed with dermatitis herpetiformis has risen steeply in recent decades to the current average of 40–50 years. The researchers found that the ratio of dermatitis herpetiformis to celiac disease is 1:8 in Finland and the United Kingdom (U.K.). Additionally, the incident rates of dermatitis herpetiformis are currently 2.7 per 100,000 in Finland and 0.8 per 100,000 in the U.K., is decreasing, whereas incidents of celiac disease are on the rise. One positive finding is that Dermatitis herpetiformis patients who are on a gluten-free diet face an excellent long-term outlook, with an even lower mortality rate than the general population. Read more in: Nutrients 2018, 10(5), 602; doi:10.3390/nu10050602
  17. Celiac.com 11/06/2018 - Autoimmune pancreatitis is a rare disorder whose association with celiac disease (celiac disease) has never been investigated, although celiac patients show high rates of both endocrine and exocrine pancreatic affections. To address this lack of information, a team of researchers recently set out to evaluate the frequency of celiac disease in patients with autoimmune pancreatitis and in further medical pancreatic disorders. The research team included G De Marchi, G Zanoni, MC Conti Bellocchi, E Betti, M Brentegani, P Capelli, V Zuliani, L Frulloni, C Klersy, and R Ciccocioppo. They are variously affiliated with the Department of Medicine, the Department of Pathology and Diagnostics, the Gastroenterology Unit, the Immunology Unit, and the Pathology Unit of the Department of Pathology and Diagnostics; and the Gastroenterology Unit of the Department of Medicine, AOUI Policlinico G.B. Rossi, University of Verona in Verona, Italy; the Clinica Medica I, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation in Pavia, Italy; and the Clinical Epidemiology & Biometry Unit, IRCCS Fondazione Policlinico San Matteo; Pavia, Italy. They screened for celiac disease by looking for tissue transglutaminase (tTG) autoantibodies in the blood of patients retrospectively enrolled and divided in four groups: autoimmune pancreatitis, chronic pancreatitis, chronic asymptomatic pancreatic hyperenzymemia (CAPH), and control subjects with functional dyspepsia. In patients with borderline or positive anti-tTG values, the team also looked at anti-endomysium autoantibodies. They offered duodenal biopsy to all patients with positive results. They found just one patient out of 72 (1.4%) with autoimmune pancreatitis who had already been diagnosed with celiac and was following a gluten-free diet, while one case out of 71 (1.4%) with chronic pancreatitis and one out of 92 (1.1%) controls were found to have celiac disease. They found no celiac disease in the CAPH group. By contrast, a high prevalence of cases with ulcerative colitis was found in the AIP group (13.8%). Despite an alleged connection between celiac disease and several autoimmune disorders, the data in this study do not support celiac screening for autoimmune pancreatitis patients. Celiac screening may be useful in other pancreatic disorders, but further study is needed to make a determination. Source: Nutrients. 2018 Aug 24;10(9). pii: E1157. doi: 10.3390/nu10091157.
  18. Celiac.com 11/05/2018 - ImmusanT, Inc. is a clinical stage company looking to deliver innovative peptide-based immunomodulatory vaccine therapies to patients with autoimmune diseases, initiated enrollment in Australia and New Zealand for its celiac disease vaccine. Along with Nexvax2, ImmusanT is working to develop vaccines for other HLA-associated autoimmune diseases, including type 1 diabetes. The Phase 2 trials will assess the safety, tolerability and efficacy of its celiac vaccine, Nexvax2, on celiac patients who carry the immune recognition genes for HLA-DQ2.5. Carriers of HLA-DQ2.5 account for approximately 90% of people with disease, and Nexvax2 is designed to protect these patients from the effects of gluten exposure. Nexvax2 is currently the only disease-modifying therapeutic candidate in clinical development for patients with celiac disease. Injections of Nexvax2 are designed to reprogram T cells that trigger an inflammatory response to gluten, thereby suppressing inflammation in patients with celiac disease. Phase 1 studies showed Nexvax2 to be safe and well-tolerated at even its highest dose levels. In Phase 2 clinical trials, ImmusanT hopes to confirm clinical efficacy of Nexvax2 administered by injection into the skin for treatment of celiac disease. The study plan consists of an initial screening period of 6 weeks, an approximately 16 week treatment period, and a 4 week post-treatment observational follow-up. The trials will be conducted at sites in Melbourne, Perth, Adelaide and Brisbane, in addition to sites in New Zealand. For the U.S. study researchers will enroll approximately 150 patients across the U.S., Australia and New Zealand. Phase 2 is a randomized, double-blind, placebo-controlled clinical study of Nexvax2 in adults with confirmed celiac disease who have followed a gluten-free diet for at least a year prior to screening. “This trial is important in establishing clinical proof-of-concept for a treatment that would provide benefit beyond that of the gluten-free diet,” and will “test if Nexvax2 can specifically target the immune response to gluten in people with celiac disease and modify associated symptoms,” said Jason Tye-Din, MBBS, Ph.D., principal investigator at the Royal Melbourne Hospital and head of celiac research at the Walter and Eliza Hall Institute of Medical Research in Melbourne, Australia. For more information about RESET CeD, including inclusion and exclusion criteria, please visit www.clinicaltrials.gov (Identifier: NCT03644069).
  19. I’m new to all this Celiac and gluten free stuff so I apologize if I come off as ignorant. I’ve been to two Gastroenterologists are both have told me that my Gluten issues where not Celiac, I do get stomache cramps when I eat gluten, and if I eat gluten consistently I suddenly become allergic to my cat! Still, my symptoms are nothing compared to the pain that diagnosed Celiacs have described. I’ve taken the blood test to see if I am Celiac, and it came back negative. But Ever since my Gluten issues came about (stomach pain constantly, skin issues, other allergies) so have my diary issues. If I eat Dairy I either get constipation or diarrhea, and if I continue it for a few days I get minimal rectal bleeding, which is a little scary. This is definitely a symptom of dairy intolerance and not gluten intolerance right? I asked the Gastroenterologist about it, and they said it’s most likely just IBS. She said I’m too young for a lot of gastrointestinal issues (I’m 22, in good health). She also said rectal bleeding is really only a concern if it’s enough to fill up a toilet bowl, and mine is only when I wipe, while obviously eating dairy (or maybe gluten? I’m not sure). Has anyone experienced anything like this? I want to get a Colonoscopy at some point, although my Doctor told me I don’t really need too. But rectal bleeding is pretty scary for me.
  20. Celiac.com 10/30/2018 - Products with “gluten-free” were unknown just 20 years ago. Now, driven by new labeling standards and demand that far exceeds those on medical diets, the market for gluten-free foods is expected to hit $2.34 billion in sales by 2019. That’s more than double the 2014 level. How has the influx of new gluten-free products in the last few years changed the experience of people with celiac disease? A team of researchers recently set out to investigate how the recent proliferation of the gluten‐free industry has affected individuals living with celiac disease, with a primary focus on their social lives and relationships. The research team included J. A. King, G. G. Kaplan, and J. Godley. They are variously affiliated with the Department of Sociology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada, and the O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada. The team employed interpretive phenomenology for study design and analysis. Team members held semi‐structured interviews with 17 adults with clinically diagnosed celiac disease in Calgary, Alberta. They recorded the interviews and transcribed them for analysis. These 17 Canadians living with celiac disease reported that they perceive the growth of the gluten‐free industry as a "double‐edged sword." Although they are grateful for more readily available, more palatable gluten‐free options, they are increasingly faced with misunderstandings about the severity of celiac disease as a perceived result of many non-celiac disease individuals subscribing to the gluten‐free diet. Participants also felt they may be perceived or even perceived themselves differently, such as "high maintenance," etc. To help mitigate these social ramifications of following the gluten‐free diet, participants utilized various strategies. According to the study’s authors, simply telling celiac patients to adopt a gluten‐free diet ignores the regular challenges faced by those patients. The authors of the report are calling for doctors to consider the indirect burdens for celiac patients who must adopt a gluten-free diet when making their recommendations. But how? The report says nothing about what exactly doctors are supposed consider, or what they should tell patients about the challenges of a gluten-free diet. People with celiac disease probably do need more information up front as they begin to follow a gluten-free diet, but clearly far more input and study are needed. This study tells us that seventeen people in Alberta, Canada say that being gluten-free by medical necessity is both easier and more challenging than it was in the past. That it was both more manageable, but also more stressful, because gluten-free fad dieters are confusing everything. What are we to make of this? Talking informally with 17 celiac patients and writing up the results may not rise to the level of a solid study, and their input doesn’t really tell us much about how to improve their situation. Also, blaming the popularity of the gluten-free diet as a cause of confusion or stress in people with celiac disease could be an overreaction. Remember, ten or twenty years ago when most people had nearly zero awareness of celiac disease or the gluten-free diet? That included doctors who were trying to diagnose it. To have these inconvenient misunderstandings, people must first have some idea that celiac disease exists, and that a gluten-free diet is part of it. Is it possible that, as annoying as such misunderstandings may be, they represent progress, however incremental? Perhaps the annoyances are real, perhaps they are perceived. Perhaps they are a reflection of slowly rising awareness levels. But the study doesn’t tell us any of these important details. Again, there’s little question that people with celiac disease need more information up front as they begin to follow a gluten-free diet, but clearly more input and study is needed so that we can come up with an accurate picture of the challenges and provide the best ways to meet them. What’s your experience of the rapidly changing gluten-free landscape? Read more at: JOURNAL OF HUMAN NUTRITION & DIETETICS. First published: 02 October 2018 https://doi.org/10.1111/jhn.12597
  21. Celiac.com 10/24/2018 - Although some research has shown a connection between a gluten-free diet, altered macronutrient intake and metabolic syndrome, not much good data exists on the risk of nonalcoholic fatty liver disease in patients with celiac disease who follow a gluten-free diet. A team of researchers recently set out to assess the prevalence and relative risk of nonalcoholic fatty liver disease in celiac patients treated with a gluten-free diet. The research team included F. Tovoli; G. Negrini; R. Farì; E. Guidetti; C. Faggiano; L. Napoli; L. Bolondi; and A. Granito of the Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. For many patients with metabolic syndrome, nonalcoholic fatty liver disease is common. To try to get some better information, the researchers devised a case-control study, with prospective enrollment of celiac disease outpatients following a gluten-free diet and control subjects. For the study, the team matched patients by age, gender and metabolic risk factors, such as overweight, diabetes mellitus, total cholesterol, and triglycerides, using a 1:1 ratio. The team diagnosed nonalcoholic fatty liver disease according to the criteria set by the European Association for the Study of the Liver. In all, they compared 202 celiac disease patients and 202 control subjects. The raw rate of nonalcoholic fatty liver disease was 34.7% and 21.8% in the celiac disease and control group, respectively. Using binary logistic regression, the team demonstrated that those with celiac disease faced an increased risk for nonalcoholic fatty liver disease. Meanwhile, the relative risk for nonalcoholic fatty liver disease was substantially higher in non-overweight celiac disease patients. Nearly 35% of celiac disease patients on a gluten-free diet also had nonalcoholic fatty liver disease, that’s a risk three times greater than the general population. The team recommends that doctors tailor their celiac treatment approaches to better help celiac disease patients with nonalcoholic fatty liver disease to get proper nutritional intake, which will help to reduce the risk of long-term liver-related events. Source: Aliment Pharmacol Ther. 2018;48(5):538-546.
  22. Celiac.com 10/22/2018 - A team of researchers recently set out to determine if there is any association between prenatal gluten exposure and offspring risk of type 1 diabetes in humans. The research team first designed a national prospective cohort study using the national health information registries in Denmark. They looked at data on pregnant Danish women enrolled into the Danish National Birth Cohort, between January 1996 and October 2002, and assessed maternal gluten intake, based on maternal consumption of gluten containing foods, as reported in a 360 item food frequency questionnaire at week 25 of pregnancy. The team gathered information on type 1 diabetes occurrence in the participants’ children, from 1 January 1996 to 31 May 2016 by linking to the Danish Registry of Childhood and Adolescent Diabetes. Overall, their study included data on 101,042 pregnancies in 91,745 women, of whom 70,188 filled out the food frequency questionnaire. Once they corrected the figures to account for multiple pregnancies, pregnancies ending in abortions, stillbirths, lack of information regarding the pregnancy, and pregnancies with implausibly high or low energy intake, they included 67,565 pregnancies and 63,529 women. Gluten intake averaged 13.0 grams per day, ranging from under 7 grams per day to more than 20 grams per day. There were 247 children with type 1 diabetes among the group, for an incidence rate of 0.37%, with an average follow-up of 15.6 years. Risk of type 1 diabetes in offspring increased proportionally with maternal gluten intake during pregnancy per 10 grams per day increase of gluten. Compared to women with the lowest gluten intake of under 7 grams per day, those with the highest gluten intake who consumed 20 or more grams a day had double the risk for type 1 diabetes development in their children. These numbers indicate that high gluten intake by mothers during pregnancy may increase the risk of their children developing type 1 diabetes. However, the team is calling for further study to confirm the findings, preferably in an intervention setting. Read more in BMJ 2018;362:k3547. doi: https://doi.org/10.1136/bmj.k3547 The research team included Julie C Antvorskov, assistant professor, Thorhallur I Halldorsson, professor in food science and nutrition, Knud Josefsen, senior researcher, Jannet Svensson, associate professor5, Charlotta Granström, statistician, Bart O Roep, professor, Trine H Olesen, research assistant, Laufey Hrolfsdottir, director, Karsten Buschard, professor, and Sjudur F Olsen, adjunct professor of nutrition. They are variously affiliated with the Bartholin Institute, Rigshospitalet in Copenhagen, Denmark; the Centre for Foetal Programming, Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark; the Unit for Nutrition Research, Landspitali University Hospital, Reykjavik, Iceland; the Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; the Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Children and Adolescents, Copenhagen University Hospital Herlev, Herlev, Denmark; the Department of Diabetes Immunology, Diabetes and Metabolism Research Institute at the Beckman Diabetes Research Institute, City of Hope, Duarte, CA, USA; the Departments of Immunohematology and Blood Transfusion, Leiden University Medical Centre, Leiden, Netherlands; the Department of Education, Science, and Quality, Akureyri Hospital, Akureyri, Iceland; and the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  23. Celiac.com 10/19/2018 - Work to develop a vaccine for celiac disease could soon lead to a vaccine for diabetes. After successful phase 1 studies of Nexvax2, their peptide-based therapeutic vaccine for celiac disease, ImmusanT has seen a significant investment from venture philanthropy organization JDRF T1D. ImmusanT's peptide therapy program for celiac disease may provide lessons for a similar therapeutic treatment for Type 1 diabetes. The investment will support ImmusanT as it attempts to develop a vaccine to prevent Type 1 diabetes, based on the early success of its peptide immunotherapy program for celiac disease, the two entities announced in a press release. ImmusanT’s celiac peptide therapy program works by identifying antigens that trigger an inflammatory responses in people with autoimmune diseases. Once identified, the peptide therapy is used to neutralize the autoimmune response. This celiac disease program goes back to 1998, when Anderson first began his efforts to find and identify the peptides. The findings were published in 2010, and the company was founded shortly afterward by Leslie Williams, BS, RN, MBA, director, president and CEO of ImmusanT. From there, ImmusanT conducted five phase 1 trials for its celiac therapy. Those trials have proven very promising, and the latest investment into a similar drug for diabetes is proof of that promise. In the case of celiac disease, the drug works by “targeting T cells in patients. Those T cells that are engaged as peptides are distributed throughout the body after the injection, and we see evidence that the T cells are being activated about 2 hours later,” Robert Anderson, BMedSc, MB, ChB, PhD, FRACP, chief scientific officer for ImmusanT, told Endocrine Today. “We found that if we gradually increase the dose in patients building up to a maintenance dose level, they become non-reactive to those peptides.” With much of the early research targeted towards demonstrating the drug’s safety, and getting the right dose and dose regimen, the development of a version targeted at diabetes, says Anderson, “should be more streamlined due to the lessons learned during the celiac disease program. That’s partly because the team knows “a lot more going into Type 1 diabetes about how peptide therapy works and how to optimize it than we did when we started celiac disease, where it was a blank slate.” This is really exciting news. A vaccine for celiac disease is exciting, to be sure, but a viable vaccine for diabetes would be a major development in disease prevention. Stay tuned for more news as the story develops. Read more at Healio.com
  24. Celiac.com 10/17/2018 - In the interviews I conducted last year, the Celiac.com viewers shared with me some disturbing stories about how others either sabotaged their gluten-free diet or how their gluten-free requirements are continually scrutinized and doubted. Here are a few examples: A co-worker at my office ate a gluten-containing burrito and thought it would be funny to cross-contaminate my work space. With his gluten-coated hands, he touched my phone, desk, pencils, pens, etc. while I was not at my desk. I came back and was contaminated. I had to take several days off of work from being so sick. The waiter at a restaurant where I was eating dinner asked me if I was really “a celiac” or if I was avoiding gluten as a “fad dieter.” He told me the food was gluten-free when he served it, only to come up to me after I ate the dinner and admit there was “a little” gluten in it. My cleaning people were eating Lorna Doones (gluten-containing cookies) while cleaning my gluten-free kitchen, cross-contaminating literally everything in it. When I noticed I exclaimed, “I am allergic to gluten, please put your cookies in this plastic bag and wash your hands.” They chided, “You have insulted our food. We are hungry and we will eat anything we want to, when we want to.” At a family dinner, Aunt Suzie insisted that I try her special holiday fruit bread. In front of everyone around the table, she brushed off my protests and insisted that I over exaggerated my food sensitivities saying, “a little bit wouldn’t hurt you.” These are but a few of an exhaustive list of situations that we regularly contend with. What can possibly be the rationale for any of this conduct? I’m providing some recent headlines that may impact the attitudes of those we interact with and would like to hear what you think influence this behavior (see questions below). Recently, the New York Times published an article entitled, “The Myth of Big, Bad Gluten.” The title alone casts doubt on the severity of gluten exposure for those with CD (Myth, 2015) In his political campaign, Senator Ted Cruz stated that if elected President, he would not provide gluten-free meals to the military, in order to direct spending toward combat fortification (Wellness, 2/18/16). Business Insider.com called Tom Brady’s gluten, dairy free diet “insane” (Brady, 2017). Michael Pollen is quoted as saying that the gluten-free diet was “social contagion.” Further, he says, “There are a lot of people that hear from their friends, ‘I got off gluten and I sleep better, the sex is better, and I’m happier,’ and then they try it and they feel better too. [It’s] the power of suggestion” (Pollan, 2014). Jimmy Kimmel said, “Some people can’t eat gluten for medical reasons… that I get. It annoys me, but that I get,” and proceeded to interview people following a gluten-free diet, asking them “what is gluten.” Most interviewed did not know what gluten is. (ABC News, 2018). Do headlines like this enable others to malign those of us making our dietary needs known? Do these esteemed people talking about gluten cast doubt on what we need to survive? Humans are highly influenced by others when it comes to social eating behavior. Higgs (2015) asserts that people follow “eating norms” (p. 39) in order to be liked. Roth, et al. (2000) found that people consumed similar amounts of food when eating together. Batista and Lima (2013) discovered that people consumed more nutritious food when eating with strangers than when eating with familiar associates. These studies indicate that we are hypersensitive of what others think about what we eat. One can surmise that celebrity quips could also influence food-related behaviors. Part of solving a social problem is identifying the root cause of it, so please weigh in by answering the following questions: How do you handle scrutiny or sabotage of others toward your dietary requirements? Please speculate on what cultural, religious or media influences you suppose contribute to a rationalization for the sabotage and/or scrutiny from others when we state we are observing a gluten-free diet? Are people emulating something they heard in church, seen on TV, or read online? We welcome your answers below. References: ABC. (2018). Retrived from https://abcnews.go.com/Health/video/jimmy-kimmel-asks-what-is-gluten-23655461 Batista, M. T., Lima. M. L. (2013). Who’s eating what with me? Indirect social influence on ambivalent food consumption. Psicologia: Reflexano e Critica, 26(1), 113-121. Brady. (2017). Retrieved from https://www.businessinsider.com/tom-brady-gisele-bundchen-have-an-insane-diet-2017-2 Higgs, S. (2015). Social norms and their influence on eating behaviors. Appetite 86, 38-44. Myth. (2015). Retrieved from https://www.nytimes.com/2015/07/05/opinion/sunday/the-myth-of-big-bad-gluten.html Pollan, M. (2014). Retrieved from https://www.huffingtonpost.com/2014/05/14/michael-pollan-gluten-free_n_5319357.html Roth, D. A., Herman, C. P., Polivy, J., & Pliner, P. (2000). Self-presentational conflict in social eating situations: A normative perspective. Appetite, 26, 165-171. Wellness. (2016). Retrieved from https://www.huffingtonpost.com/entry/ted-cruz-gluten-free-military-political-corectness_us_56c606c3e4b08ffac127f09f
  25. Celiac.com 10/16/2018 - Apparently, local St. Louis radio station Z1077 hosts a show called “Dirty Little Secret.” Recently, a woman caller to the show drew ire from listeners after she claimed that she worked at a local bakery, and that she routinely lied to customers about the gluten-free status of baked goods. The woman said she often told customers that there was no gluten in baked goods that were not gluten-free, according to local tv station KTVI. Apparently the woman thought this was funny. However, for people who cannot eat gluten because they have celiac disease, telling people that food is gluten-free when it is not is about as funny as telling a diabetic that food is sugar-free when it is not. Now, of course, eating gluten is not as immediately dangerous for most celiacs as sugar is for diabetics, but the basic analogy holds. That’s because many people with celiac disease suffer horrible symptoms when they accidentally eat gluten, including extreme intestinal pain, bloating, diarrhea, and other problems. Some people experience more extreme reactions that leave them in emergency rooms. As part of a story on the “joke” segment, KTVI interviewed celiac sufferer Dana Smith, who found the punchline to be less than funny. “It’s absolutely dangerous, somebody could get very sick,” said Smith. KTVI also interviewed at least one doctor, Dr. Reuben Aymerich of SSM St. Clare Hospital, who pointed out that, while celiac disease is “not like diabetes where you can reduce the amount of sugar intake and make up for it later, it’s thought you need to be 100 percent compliant if you can.” For her part, Smith sought to use the incident as a teaching moment. She alerted the folks at Z1077 and tried to point out how serious being gluten-free is for many people. Mary Michaels, owner of Gluten Free at Last Bakery in Maryville, Illinois, says it’s time people became more respectful. “I wouldn’t make fun of you if you had diabetes or a heart condition it’s kind of like that,” Michals said. We will likely never know if the radio station caller was telling the truth, or just putting listeners on. The Z1077 morning team did post a follow-up comment, which stated that they take celiac disease seriously, and that they did not intend to offend anyone. One host said his mom has celiac disease. It’s good to see a positive response from the radio station. Their prank was short-sighted, and the caller deserved to be called out on her poor behavior. Hopefully, they have learned their lesson and will avoid such foolishness in the future. Let us know your thoughts below.
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