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Celiac.com 11/08/2023 - Autistic adults often face more significant health challenges than their non-autistic counterparts, as revealed by numerous epidemiological studies. Although this issue has been explored, research has mainly been confined to specific geographical areas and has centered on young autistic individuals aged 35 and under. Recent research points to a higher mortality rate in autistic people and less satisfactory self-reported healthcare experiences. A team of researchers recently set out to examine increased rates of chronic physical health conditions in autistic adolescents and adults. The research team included John H. Ward, Elizabeth Weir, Carrie Allison & Simon Baron-Cohen. They are variously affiliated with the Royal Devon University NHS Foundation Trust, Exeter, Devon, UK; the University of Exeter Medical School, Devon, UK; the University of Oxford, Department of Psychiatry, Oxford, UK; the Oxford Health NHS Foundation Trust, Oxford, UK; and the Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, Cambridge, UK. Do Autistic Individuals Experience Higher Levels of Non-communicable Health Conditions? The team's study aimed to answer two fundamental questions: Do autistic individuals experience higher levels of non-communicable health conditions, and if so, can these disparities be attributed to differences in demographics, lifestyle factors, and family medical history? The researchers conducted a cross-sectional, convenience-sampling study through an anonymous online survey, which included over 2300 participants comprising both autistic and non-autistic adults, with roughly half being autistic. The survey collected self-reported data on demographics, autism diagnosis, lifestyle factors (like diet, exercise, sleep, substance use), personal medical history, and family medical history (for all first-degree, biological relatives). They used binomial logistic regression models of increasing complexity and employed the Benjamini–Hochberg correction to mitigate multiple testing effects. The study analyzed physical health conditions, considering only those with at least 1% endorsement within the sample to reduce the risk of Type I errors. Additionally, they used network analysis methods to explore the presence of multiple health conditions (multi-morbidity) in both autistic and non-autistic individuals. The study uncovered significantly higher rates of non-communicable health conditions across various organ systems in autistic individuals. These systems included the gastrointestinal, neurological, endocrine, visual, ear/nose/throat, skin, liver and kidney, and hematological systems. This study confirmed previous findings of notable differences in neurological and gastrointestinal symptoms between autistic and non-autistic individuals. The study also found a higher prevalence of celiac disease among autistic individuals compared to non-autistic individuals after controlling for sex, ethnicity, country of residence, alcohol use, smoking, and BMI, however, these results became non-significant after accounting for family history. Furthermore, this study, the largest to date, identified a higher likelihood of Ehler-Danlos Syndrome (EDS) in autistic females, compared to their non-autistic counterparts. Notably, the research also revealed higher rates of celiac disease among autistic individuals, even after considering demographic factors such as sex, ethnicity, and country of residence. However, this difference became statistically insignificant when accounting for family history. In essence, the study underscores that autistic adults face disparities in non-communicable health conditions compared to their non-autistic peers. The findings demonstrate the need for tailored healthcare and interventions to address these disparities and improve the overall health and well-being of autistic individuals. Read more in Molecular Autism volume 14, Article number: 35 (2023

Celiac.com 11/06/2023 - Celiac disease is a condition where the body cannot properly process gluten. It is primarily known as a gastrointestinal disorder, but it can also lead to various neurological and psychiatric issues. Often, children receive diagnoses of neurological symptoms, such as epilepsy, attention-deficit hyperactivity disorder (ADHD), restless leg syndrome (RLS), and peripheral neuropathy, without identifying the root cause. Recent research delved into the neurological manifestations of gluten-related disorders and the influence of a gluten-free diet on these conditions, with a particular focus on pediatric patients. A team of researchers recently set out to review the pathological manifestations of gluten-related neuro-psychiatric disorders, and the impact of gluten-free diet in children. The research team included Prajwala Nagarajappa, Sree Mahathi Chavali, and Maneeth Mylavarapu. They are variously affiliated with the Department of Public Health, Adelphi University in Garden City, New Jersey, USA; the Department of Pediatrics, Graduate from GSL Medical College, Charlotte, USA; and the Mysore Medical College and Research Institute in Mysore, India. Many of these pediatric patients experience neuropsychiatric symptoms with no apparent cause. However, these symptoms might be linked to celiac disease, as studies show that antibody levels could be indicators. What's striking is that these neurological manifestations can often be managed, or even eliminated, with a gluten-free diet. Comprehensive Literature Review on Neuropathological Manifestations and the Impact of a Gluten-Free Diet To explore these issues, researchers conducted a comprehensive literature review, sourcing studies from major databases like PubMed and Google Scholar. They sought studies providing individual-level data on neuropathological manifestations and the impact of a gluten-free diet on extra-intestinal celiac disease symptoms. Their research protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO). The inclusion criteria covered prospective studies, observational studies, and case reports on pediatric patients with biopsy-confirmed celiac disease, serologically positive celiac disease, celiac disease with neuropsychiatric symptoms, and research reporting the effects of a gluten-free diet. After a stringent quality assessment to ensure minimal bias, 20 studies were included for discussion. In six studies, patients with neuropsychiatric symptoms had positive serological findings and more severe biopsy results. Seven studies explored the positive influence of a gluten-free diet, and five of these reported statistically significant results. The findings of this study underscore the role of gluten in the severity of neuropsychiatric symptoms in celiac disease. The research strongly indicates that a gluten-free diet can significantly impact the prognosis of this disease. Furthermore, neuropsychiatric symptoms without accompanying gastrointestinal manifestations are more frequently observed in pediatric patients. The study provides clear evidence of a substantial association between gluten and various neurological conditions, including neuropathy, ADHD, epilepsy, and RLS. These conditions can potentially benefit from a gluten-free diet. Given these insights, the study suggests that guidelines should incorporate a combination of serological, biopsy, and imaging techniques for early detection and the initiation of a gluten-free diet. Moreover, the research supports introducing gluten-free diet as a primary preventive measure in the pediatric population. By addressing the significance of gluten in pediatric neurological conditions, this study aims to raise awareness about this frequently misdiagnosed, but manageable disease. Read more in DOI: 10.7759/cureus.47062

Celiac.com 03/27/2023 - Celiac disease, a chronic inflammatory disorder of the intestines, affects about 1% of the world's population. Celiac disease causes diarrhea, abdominal discomfort, bloating, flatulence, and, in rare cases, constipation in the digestive tract. Since the identification of gluten as the disease-causing antigen, celiac patients have been treated with a gluten-free diet, which usually eliminates symptoms and restores gut health, but which also has limitations for some patients. Celiac disease is also associated with numerous neurological and psychological manifestations. A recent article details findings from the most recent study, but here we try to provide more comprehensive information. Neurological Manifestations of Celiac Disease The neurological manifestations of celiac disease are varied and can include psychiatric and neurological symptoms such as ataxia, peripheral neuropathy, seizures, headaches, cognitive impairment, and myoclonus. The specific mechanisms of celiac disease's neurological effects are still being researched, but they may involve gluten-mediated pathogenesis that can lead to antibody cross-reactions, immune-complex deposition, direct neurotoxicity, or extreme vitamin or food deficiencies. A gluten-free diet can alleviate most celiac disease symptoms, except for cortical myoclonus and dementia, which may require immunosuppressive therapy. However, there is currently no consensus on whether serological or neurophysiological data can accurately predict or monitor celiac disease-related neurological involvement. Treatment for gluten-related neurological symptoms typically involves embarking on a strict gluten-free diet as soon as possible, which can have a positive therapeutic effect for most cases. Symptomatic management may also be required. Immunosuppression is only used in cases where a gluten-free diet alone has not been beneficial or for patients with refractory celiac disease. Peripheral Neuropathy and Gluten Ataxia Peripheral neuropathy and gluten ataxia are common in celiac patients, with up to 39% of patients experiencing gluten neuropathy. Gluten-free diets have been shown to improve neuropathy and ataxia. Gluten ataxia is an uncommon immune-mediated neurological disease that can be difficult to identify. The early signs of ataxia may be subtle, but worsen if left untreated. Patients with gluten ataxia may experience structural alterations in different parts of the brain, including the cerebellum and thalamus, and have larger lateral ventricles. Higher Epilepsy Risk Celiac disease increases the risk of epilepsy, especially in children and adolescents. The presence of villus atrophy on follow-up biopsies may reduce the risk of epilepsy but does not affect hospitalizations for epilepsy emergencies. Unexplained epilepsy should prompt celiac disease screening since early identification and therapy may increase the effectiveness of anti-epileptic drugs. Celiac patients also have a higher prevalence of migraines and tension headaches. The underlying relationship between celiac disease and headache involvement is still unknown, but adherence to a gluten-free diet can alleviate neurological symptoms. Celiac disease can also cause cognitive impairment, including memory loss, clouded thinking, personality shifts, and an inability to calculate. Nutrient deficiencies, systemic inflammation, and low brain serotonin levels have been suggested as possible reasons for this. Celiac disease has also been associated with Alzheimer's and vascular and fronto-temporal dementias. Neuropsychological assessments should be conducted in celiac disease patients to assess cognitive function. Psychiatric Manifestations of Celiac Disease Celiac disease is associated with depression, anxiety, eating disorders, autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), bipolar disorder, schizophrenia, and mood disorders. The relationship between celiac disease and these psychiatric disorders is not well-known or established. Particular biological aspects as well as the effect of a gluten-free diet require additional research. Depression and Anxiety Celiac disease has been associated with various psychiatric disorders such as depression, anxiety, eating disorders, autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), bipolar disorder, schizophrenia, and mood disorders. However, the relationship between these disorders and celiac disease remains unclear and requires further research. Research suggests that gastrointestinal disorders have a link with depression and anxiety due to prolonged pain and inflammation, affecting specific brain targets like the anterior cingulate cortex. Gastrointestinal disorder patients have reduced cognitive and mood status, leading to anxio-depressive phenotypes, even in the absence of clear evidence of threats. Children with celiac disease may experience anxiety and depressive symptoms, and pediatric patients with celiac disease should be frequently assessed for mental health issues, especially anxiety and sadness. Adults with celiac disease have reported experiencing anxiety and depression as well, particularly due to clinical illnesses and symptoms. Following a gluten-free diet may worsen symptoms like anxiety and fatigue, leading to a diminished quality of life. Therefore, clinicians must recognize the importance of promoting both dietary adherence and social and emotional well-being in celiac disease patients. Studies have shown that individuals with celiac disease experience low quality of life, anxiety, and depressive symptoms, and nutrition plays a crucial role in reducing these effects. However, the role of motivation in the quality of life and adherence remains unclear and requires further research. Eating Disorders Eating disorders may be a comorbidity with celiac disease (celiac disease) and the need for further investigation. celiac disease patients may experience disordered eating due to the disease itself or other factors such as food neophobia. It is crucial for gastroenterology clinicians to be aware of potential risks for eating disorders in celiac disease patients. The article notes that while numerous examples of eating disorders have been described in celiac disease patients, few epidemiological studies have investigated this potential link. One study found that patients with celiac disease had higher Eating Attitude Test scores than controls when testing individuals aged 13 and up, but no clear differences were seen between patients with celiac disease and controls when using other screening measures for ED. The article suggests that further investigations with larger samples and prospective designs are needed to corroborate these results. The article also discusses how celiac disease may cause food neophobia, which is linked to sensory aversions or fears of the negative effects of eating particular foods. This fear may be more severe in celiac disease patients than in non-celiac disease patients who choose to follow a gluten-free diet and can be linked to the possibility of having an unfavorable reaction to gluten-contaminated food products. The article emphasizes the importance of gastroenterology clinicians being aware of potential risks for eating disorders in celiac disease patients. It notes that eating disorders are defined by thoughts and actions linked to physical and/or psychological problems and that it is crucial to identify past, current, and potential risks for eating disorders in celiac disease patients. Autism Disorder Autism spectrum disorder is caused by a complex interplay of genetic and environmental factors, affecting individuals in diverse ways. Recent studies suggest that immune system dysfunction could contribute to the development of autism spectrum disorder in some people [55]. While some research suggests a connection between celiac disease, an autoimmune disorder triggered by gluten consumption that mainly affects the small intestine, and autism spectrum disorder, other studies have not found a significant association between the two conditions. Attention Deficit Hyperactivity Disorder (ADHD) Research has suggested a potential link between celiac disease and ADHD, with studies showing that celiac disease is overrepresented in ADHD patients, and a gluten-free diet improved ADHD symptoms in celiac disease patients. However, routine screening for ADHD in people with celiac disease or vice versa is not recommended. Cognitive problems similar to those seen in children with ADHD, such as a lack of focus or trouble paying attention, were linked to gluten-free diet noncompliance in childhood celiac disease, as were psychosomatic symptoms and antisocial behavior. Individuals with untreated celiac disease may be at risk for engaging in ADHD-like behavior, specifically inattention. Out of 23 studies, 13 found a favorable correlation between ADHD and celiac disease. Bipolar Disorder Bipolar Disorders refer to a group of serious and long-term mental health conditions that are characterized by manic and depressive episodes. Research has shown that people with bipolar disorder have higher levels of immunoglobulin G (IgG) antibodies against gliadin than those without a history of psychiatric illness. However, there is still a need for further investigation into the specific antibody response to gluten antigens in bipolar disorder. Close associations have also been observed between celiac disease and major depressive disorder, panic disorder, and bipolar disorder, leading to reduced quality of life. Therefore, early reporting of symptoms and screening for celiac disease is recommended, especially for those with a family history of the disease or essential symptoms. Schizophrenia Schizophrenia is a severe mental illness that increases the risk of premature death 2-4 times compared to the general population. Genetic and environmental factors, including drug abuse, especially involving cannabis, are associated with an increased risk of developing schizophrenia. Research suggests an association between schizophrenia and celiac disease, although a causal link has yet to be established. Although having elevated antibodies against gliadin is a common immunological abnormality between schizophrenia and celiac disease, most patients with schizophrenia who had elevated anti-gliadin antibodies (AGA) did not have celiac disease. However, there is evidence that a gluten-restricted diet may benefit schizophrenia patients with immunological gluten sensitivity. One treatment-resistant schizophrenia patient with immunological gluten sensitivity benefited from a gluten-restricted diet improvement in both mental and physical symptoms, as well as a reduction in the plasma quantitative level of AGA-IgG. Chronic inflammation, which is thought to increase due to gluten intolerance, may worsen the symptoms of schizophrenia and make it harder for patients to respond to treatment and absorb medications. Schizophrenia patients also have a higher rate of digestive and liver problems. While removing gluten from the diet may alleviate some symptoms, it is not recommended for all patients. Gluten intolerance is believed to increase chronic inflammation, exacerbating symptoms and reducing medication absorption. However, the available data on the link between celiac disease, gluten allergies, and schizophrenia are inconsistent, and a gluten-free diet is not recommended for people with psychosis and mood disorders without further research. Other Psychiatric Disorders Previous research has shown that people with celiac disease are more likely to suffer from neuropsychiatric disorders than the general population. So far, more than 60 non-human leukocyte antigen (HLA) genes have been linked to celiac disease by genome-wide association studies; of these, it is believed that 15% have a role in neurological health. Many common neuropsychiatric disorders include celiac disease as a primary predisposing factor. It's possible that the co-occurrence of diseases is in large part due to shared molecular networks and biological processes. To determine what causes these disorders, we need to look at the underlying molecular mechanisms. Celiac disease was associated with an increased risk of psychiatric problems in children, raising their lifetime risk by 1.4 times that of the general population. Celiac disease in children has been linked to an increased likelihood of developing psychosocial difficulties later in life, including depression, anxiety, eating disorders, antisocial behavior, attention deficit hyperactivity disorder, autism spectrum disorder, and intellectual disability. It was also more common to have been diagnosed with a mood, eating, or behavioral condition prior to the celiac disease diagnosis. In contrast, no elevated risk was found for any of the psychological diseases studied in the siblings of people with celiac disease. A cohort study included nearly 20,000 children with biopsy-verified celiac disease, pairing each patient with 5 reference child controls. Approximately 16.5% of celiac children were diagnosed with a psychological condition during a median follow-up of 12.3 years, compared to 14.1% of controls. Celiac disease in childhood increased the risk of psychiatric illness by 19% and this risk increases during maturity, in particular, mood, anxiety, eating, ADHD, and autism spectrum problems. There was no statistically significant increase in psychotic disorders, psychoactive substance use, behavioral disorders, personality disorders, suicide attempts, or suicides. Celiac disease increases the use of psychiatric medication. Psychological issues associated with celiac disease were also more prevalent. As a result, the attending physician should conduct routine surveillance of potential psychiatric symptoms in patients of all ages who have gluten-related diseases, including both children and adults. Conclusions In conclusion, celiac disease has been linked to numerous neurological and psychiatric conditions, including depression, anxiety, eating disorders, autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), bipolar disorder, schizophrenia, and mood disorders. Clinicians should assess mental health factors when making a celiac disease diagnosis. Overall, the relationship between celiac disease and these neurological and psychiatric disorders is not well-known or established. More research is needed to understand the pathophysiology of celiac disease's neurological and psychiatric manifestations. Particular biological aspects as well as the effect of a gluten-free diet require additional research. Read more at Cureus.com

Celiac.com 01/04/2021 - Researchers have long known that the common chronic skin disorder atopic dermatitis is associated with other atopic conditions. A growing body of evidence supports a connection with non-atopic conditions, including autoimmune diseases, such as celiac disease, but data are limited with respect to autoimmune conditions. To remedy the situation, a research team recently examined the connection between atopic dermatitis and autoimmune diseases. The research team included L.U. Ivert, C.F. Wahlgren, B. Lindelöf, H. Dal, M. Bradley, and E.K. Johansson. They are variously affiliated with the Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; the unit of Dermatology, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden; the Theme Cancer unit, Karolinska University Hospital, Stockholm, Sweden; and the Dermatological and Venereal Clinic, Södersjukhuset, Stockholm, Sweden. For their case–controlled study, the team looked at the Swedish national healthcare registers, and looked at data from the entire Swedish population, aged 15 years or younger, from 1968 to 2016. The researchers matched all atopic dermatitis cases by sex and age to healthy controls; including cases with an inpatient diagnosis of atopic dermatitis from 1968, and/or a specialist outpatient diagnosis of atopic dermatitis from 2001. In all, the team found 104,832 cases of atopic dermatitis, and matched them to 1,022,435 control subjects. Adults with multiple autoimmune diseases were more likely to develop atopic dermatitis than those with just one autoimmune disease. The associations were especially strong between atopic dermatitis and autoimmune dermatological, gastrointestinal and rheumatological diseases. The study was funded by the Swedish Asthma and Allergy Association Research Foundation, Hudfonden (The Welander‐Finsen Foundation), and The Swedish Society for Dermatology and Venereology. The authors declare no conflicts of interest. These results invite further study of the relationship between atopic dermatitis and autoimmune conditions, such as celiac disease. Read more in the British Journal of Dermatology

Celiac.com 11/03/2020 - After four years of coordination, compilation, rigorous assessment and writing, the Global Down Syndrome Foundation (GLOBAL) has issued its medical care guidelines for adults with Down syndrome, aka the Global Guideline. The Global Guideline was peer reviewed, edited, and published in the October 2020 issue of the Journal of the American Medical Association (JAMA). The Global Guideline is the first of its kind, and is available in full at no cost. Global Guideline contributors include the clinical directors of eight of the country's eight top adult Down syndrome research and treatment centers: Advocate Health Care in Chicago; University of Pittsburgh Medical Center; Kennedy Krieger Institute at Johns Hopkins School of Medicine; University of Kansas Medical Center; University of Arkansas for Medical Sciences; and Denver Health in conjunction with the Anschutz Medical Campus School of Medicine at University of Colorado. The Global Guideline is aimed at clinicians and focuses on nine areas of care: Atlantoaxial Instability, Behavioral Health, Cardiovascular Disease, Celiac Disease, Dementia, Diabetes, Obesity, Osteoporosis, and Thyroid. It is made up of 14 recommendations and 4 statements of good practice. Some of the recommendations align with existing guidelines for individuals without Down syndrome, and two are markedly different. There were several questions associated with the recommendations that had no published research evidence, and therefore were answered based on the clinical expertise of the authors. Successful completion of the project, and publication in JAMA, means that Global can now "focus on collaborating with other Down syndrome and disability organizations as well as medical institutions to ensure clinicians are following our Global Guideline and measuring outcomes," says Global President & CEO Michelle Sie Whitten. "From the beginning, GLOBAL has been leading the way, empowering people with Down syndrome with improved care and health outcomes," says mom Darlene Beals. "The Global Guideline is an important new resource for my 24-year-old son Alan, and I believe if anyone can get to the bottom of health disparities for African Americans with Down syndrome, it's GLOBAL." GLOBAL is supported by over 50 local, national, and international Down syndrome organizations and several generous sponsors. By the end of 2021, GLOBAL plans to translate the guidelines into several languages, and distribute it widely. GLOBAL plans to update and expand the Global Guideline every 6 years. Global Guideline for Down syndrome may be printed and downloaded for personal and clinical use free of charge. Celiac disease is associated with Down syndrome. Celiac disease is common in children with Down syndrome, and celiac screening is important for people with Down syndrome. Read more at in JAMA The Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup includes: Peter Bulova, MD: Associate Professor of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; George Capone, MD: Director, Down Syndrome Clinic & Research Center, Kennedy Krieger Institute, Associate Professor of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Brian Chicoine, MD: Medical Director, Advocate Medical Group Adult Down Syndrome Center, Park Ridge, Illinois; Terry Odell Harville, MD, PhD, D(ABMLI) D(ABHI): Professor of Pathology and Laboratory Services, and Internal Medicine, Department of Pathology and Laboratory Services, and Department of Internal Medicine, Division of Hematology, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Barry A Martin, MD: Associate Professor of Clinical Practice, Division of General Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Center, Aurora, Colorado; Dennis McGuire, LCSW, PhD: Private Practice, Evanston, Illinois; Kent D. McKelvey, MD: Associate Professor, Rockefeller Chair in Clinical Genetics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Moya Peterson, PhD, APRN, FNP-BC: Clinical Professor, University of Kansas Medical Center, Schools of Nursing and Medicine, Kansas City, Kansas; Amy Y Tsou, MD, MSc: Evidence-based Practice Center, ECRI Center for Clinical Excellence and Guidelines, Plymouth Meeting, Pennsylvania; Staff Neurologist, Division of Neurology, Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Carl Tyler, MD, MSc: Director of Developmental Disabilities - Practice-Based Research Network, and Professor, Family Medicine and Community Health, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; Michelle Sie Whitten, MA: President & CEO, Global Down Syndrome Foundation, Denver, Colorado; Bryn Gelaro, MA, LSW: Director of Adult Initiatives, Global Down Syndrome Foundation, Denver, Colorado; and Michael Wells, BS: Formerly Research Coordinator, Developmental Disabilities - Practice-Based Research Network, Cleveland, Ohio.

Celiac.com 06/09/2020 - What can science tell us about celiac disease screening rates and glycemic outcomes of a gluten-free diet in patients with type 1 diabetes who are asymptomatic for celiac disease? A team of researchers recently set out to assess the issue and get some answers. The research team included Farid H. Mahmud, Antoine B.M. Clarke, Kariym C. Joachim, Esther Assor, Charlotte McDonald, Fred Saibil, Heather A. Lochnan, Zubin Punthakee, Amish Parikh, Andrew Advani, Baiju R. Shah, Bruce A. Perkins, Caroline S. Zuijdwijk, David R. Mack, Dror Koltin, Emilia N. De Melo, Eugene Hsieh, Geetha Mukerji, Jeremy Gilbert, Kevin Bax, Margaret L. Lawson, Maria Cino, Melanie D. Beaton, Navaaz A. Saloojee, Olivia Lou, Patricia H. Gallego, Premysl Bercik, Robyn L. Houlden, Ronnie Aronson, Susan E. Kirsch, William G. Paterson, and Margaret A. Marcon. They are all affiliated with the American Diabetes Association. The team conducted celiac disease screening on asymptomatic patients from 8 to 45 years of age. To assess changes in HbA1c, they randomly assigned biopsy-confirmed celiac disease patients to a gluten-free diet or gluten-containing diet (GCD), along with one year of glucose monitoring. Adults tested positive for celiac disease antibodies more often than children with lower rates of prior celiac disease screening. Twenty-seven subjects went on the gluten-free diet, while twenty-four followed the gluten-containing diet. The team saw no HbA1c differences between the groups, though gluten-free patients showed more substantial glucose increases after meals. Celiac disease is common in asymptomatic patients with type 1 diabetes, and the team advises clinicians to be vigilant about starting those patients on a gluten-free diet. Read more in Diabetes Care 2020 May; dc191944.

Celiac.com 04/21/2017 - Adults who have gluten sensitivities cohabitating with non-gluten sensitive adults may have a lot of unanswered questions that need to be asked. Dramatic changes in one family member's diet can have profound effects on a household (Bacigalupe & Plocha, 2015). Numerous studies document how parents and children handle everyday living when the child has food intolerances, but very few studies focus on adults living with food sensitivities. Wouldn't you like to know how other adults with food sensitivities adapt and manage over the long haul? Questions like: Does the person with the sensitivity live in fear of cross-contamination? Does the household employ methods to ensure s/he is safe? If so, what are those methods? Do the non-sensitive members of the household feel resentment? Or have they grown weary of compliance over the long haul? How adherent is the sensitive adult? Is it worth a little risk for a little pleasure once in a while? What do these cohabitating adults do to exist gracefully? These questions will be asked in a forthcoming study (on Celiac.com), and the results will be shared with viewers/readers. Food allergies affect 15 million Americans (FARE, 2015), which means that adults with food sensitivities have gone from being rare to more commonplace as the population ages (Norling, 2012). Dietary restrictions due to disease will soon become common in many households and this can be problematic because severe dietary constraints are positively associated with diminished family social activities (Komulainen, 2010). Studies indicate that adults cohabitating, when one has food sensitivities and others do not, could potentially result in problems between members of the household creating feelings of uncertainty and potentially less adherence to the diet. Regimented dietary requirements affect the quality of life when virtually every bite of food must be scrutinized before consumption. For some households, compliance may fall on the shoulders of the person who cooks. The cook in the household, caregivers, and everyone sharing the same kitchen, must be actively involved in protecting the person with the sensitivities keeping gluten-containing crumbs off the counter, out of condiment jars, thoroughly cleaning utensils, etc. (Crowley, 2012; Bollinger, 2005; Merras-Salmino et al., 2014). Of course, those living with sensitivities know there is a lot more to staying "clean and safe." Family members who share a home with someone with pervasive food sensitivities must express empathy to ensure harmony and compliance (Komulainen, 2010). However, compliance comes with a price -- every meal must be planned and cooked using alternative ingredients to avoid accidental ingestion. This takes diligence, education and ability to accomplish meal after meal (Jackson et al., 1985) especially when allergies are to ubiquitous foods such as dairy, soy, gluten or corn. Dietary restrictions can cause misgivings on the part of the other family members, who may feel deprived of their favorite foods, compromised with recipe adaptations, or forced to unwillingly comply with the other person's diet. On the contrary, the person with food sensitivity may feel pressure not to comply with the diet in order to conform to the other adult's culinary demands. In the Jackson et al. study, forty percent of people with Celiac disease did not comply with the diet because it was too difficult (1985). The relationship between the cohabitating adults may be further complicated as trust issues develop between the sensitive adult and the cook, if the sensitive adult suspects foods that make them sick are creeping into their diet. Other food-sensitive adults report non-adherence because it is "too much trouble" and causes "social isolation" (Coulson, 2007). Non-adherence for those with sensitivities can lead to reactions, anaphylactic shock and even to death (Lee et al., 2003). Even those who do not react immediately risk long-term illness with non-compliance. In my twelve years experience working with people in this arena, I have observed that dietary adherence in the household seems to go through phases. The first phase is what I'm calling the "transition" stage when a person is newly diagnosed, and everyone in the household is learning the new rules. The second stage is the "status quo" stage where cohabitants understand, and hopefully comply. Finally, the third stage is what I'm terming as 'turbulent' when other adult household inhabitants are feeling weary of compliance, may have doubts about the other's sensitivities, or even rebel. This stage may be triggered by an event that disrupts the "status quo", such as a holiday where traditional foods are expected, and where their gluten-free substitutions may not be as satisfying to the other household members. It may be triggered when the food sensitive adult decides they may be reacting to different foods than they thought before, and want to experiment with dietary changes. Dynamics between cohabitants may become turbulent during these times. After the event, the household adjusts back to equilibrium until the next triggering event, which throws them into a different part of this phase-cycle, where they may cheerfully welcome a "transition," or react with "turbulence." This cyclical pattern seems to continue as cohabitants move in and out of phases as life-events occur. One of the goals of this survey will be to determine the validity of this cycle. I also want to test the hypothesis that a component of household compliance may also be associated with the status of the adult who has the dietary restrictions – whether the head of the home enjoys full household compliance, or if a subordinate adult must comply while others are eating the foods s/he are sensitive to. Another factor that may affect compliance is how the sensitive adult was initially diagnosed. Did a medical doctor conduct tests? Or did they read an article, and notice that they had symptoms consistent with gluten sensitivity and decide to go "gluten free?" Does the diagnostic process affect the compliance of the other adult members of the household? There are many factors that need to be assessed in order to help those of us who have food sensitivities who are living with other adults. This survey/study will focus on family interactions when dealing with dietary restrictions, with the potential to increase family member's compliance. It will seek to gain insight on the impact food restrictions for one adult has on the rest of the family. This study has social significance because family unity in the future may rely on developing constructs for compliance to address this emerging social problem. I'll collect data for this study and then share it with Celiac.com and the Journal of Gluten Sensitivity readers in order to create awareness by thoroughly examining the lifestyle of food sensitive people, shedding light on how social influences affect dietary adherence. As a PhD student at the University of Denver, and an adult with Celiac disease and a lifetime of other food allergies, living with another adult who has no food sensitivities, I know first-hand that it takes cooperation and commitment from everyone to ensure my health. I hope the study can help others improve their quality of life with the insight gained from conducting this study. I'll be launching this study on Celiac.com. Thank you to Scott Adams for allowing this study to be conducted on Celiac.com.

Celiac.com 10/07/2019 - Researchers know that people with autoimmune disorders have a higher risk of developing celiac disease, but there's no clear data on the risk of autoimmune disorders in treated patients with celiac disease. To find out if treated celiac patients on a gluten-free diet had an elevated risk of developing autoimmune disorders, a team of researchers recently set out to assess the incidence of autoimmune disorders in treated celiac disease patients. The research team included Muhammad R Khan, Shilpa S Nellikkal, Ahmed Barazi, Joseph J Larson, Joseph A. Murray, Imad Absah. They are variously affiliated with the Division of Pediatric Gastroenterology and Hepatology; the Division of Biomedical Statistics and Informatics; and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. The team used the Rochester Epidemiology Project to search medical records at Mayo Clinic and Olmsted Medical Center from January 1997 to December 2015 for patients with clinical celiac disease. For each celiac patient, the team identified two age and sex-matched control subjects. They calculated rates of diagnosed autoimmune disorder five years after index date using Kaplan-Meier analysis for both celiac cases and control subjects. They then compared the results using the log-rank test. They found a total of 249 celiac patients, who were following a gluten-free diet during the study period, and matched them with 498 control subjects. A total of 85 celiac patients and 170 control subjects were boys. Five years after the index date, 5.0% of patients with celiac disease and 1.3% of controls had a new autoimmune disorder diagnosis. Treated celiac patients face an elevated risk of developing autoimmune disorders. The risk of a new autoimmune disorder is higher in children, especially when >1 autoimmune disorder diagnosis exists. For celiac patients with prior autoimmune disorder, the cumulative risk of a new or additional autoimmune disorder was much higher compared with control subjects. Also, children faced a significantly higher risk of autoimmune disorder development compared with adults. Read more in the Journal of Pediatric Gastroenterology and Nutrition: October 2019 - Volume 69

Celiac.com 02/19/2018 - It's very important that people with celiac disease maintain a gluten-free diet. Still, there has been some data to suggest that some people with celiac disease may be "hyper vigilant" in their approach to a gluten-free diet, and that such extreme vigilance can cause them stress and reduce their overall quality of life. Can a more relaxed approach improve quality of life for some people with the disease? A team of researchers recently set out to determine whether "extreme vigilance" to a strict gluten-free diet may increase symptoms such as anxiety and fatigue, and therefore, lower quality of life (QOL). The research team included Randi L. Wolf, Benjamin Lebwohl, Anne R. Lee, Patricia Zybert, Norelle R. Reilly, Jennifer Cadenhead, Chelsea Amengual, and Peter H. R. Green. They are variously affiliated with the Department of Health and Behavior Studies, Program in Nutrition, Teachers College Columbia University New York USA, the Department of Medicine, Celiac Disease Center Columbia University Medical Center, Harkness Pavilion New York, USA. The team assessed the influence of QOL with energy levels and adherence to, and knowledge about, a gluten-free diet. For their cross-sectional prospective study, the team looked at 80 teenagers and adults, all with biopsy-confirmed celiac disease, living in a major metropolitan area. They assessed QOL using celiac disease-specific metrics. The team based dietary vigilance on 24-hour recalls and an interview. They based knowledge on a food label quiz. They used open-ended questions to describe facilitators and barriers to following a gluten-free diet. Overall, extremely vigilant adults had greater knowledge, but significantly lower QOL scores than their more relaxed counterparts. Both teens and adults who reported lower energy levels had much lower overall QOL scores than those with higher energy levels. To maintain a strict gluten-free diet, hyper-vigilant celiacs were more likely to avoid eating out, to cook at home, and to use internet sites and apps. For hyper vigilant eaters, eating out was especially challenging. Being hyper-vigilant about maintaining a strict gluten-free diet can cause stress and adverse effects in both teens and adults with celiac disease. Doctors may want to look toward balancing advocacy of a gluten-free diet with promoting social and emotional well-being for celiac patients. In some cases, allowing a more relaxed approach may increase well-being and, thus, make dietary adherence easier. Obviously, people would need to tailor any relaxation in their gluten-free vigilance to make sure they weren't suffering preventable symptoms or doing themselves any harm. Source: Dig Dis Sci (2018)

Celiac.com 08/18/2017 - In a recent issue of Journal of Gluten Sensitivity, we announced a research study/survey for adults who are 18 or older and living the "gluten-free" lifestyle in a household with other adults over 18. Click here to read the Survey Overview Article. The survey is a research study conducted by Jean Duane, PhD Student at the University of Denver. It will focus on family interactions when dealing with dietary restrictions, with the potential to increase family members' compliance. It will seek to gain insight on the perceived impact one adult's food restrictions cause in a household when cohabitating with other adults. This study has social significance because family unity in the future may rely on developing strategies for compliance to address this emerging social problem. Please consider participating in this survey if you are an adult living the gluten-free lifestyle who cohabitates with another adult who may or may not have food restrictions. Your responses will be kept confidential. The survey should take around 10 minutes to complete and a compilation of the results will be published in an upcoming issue of the Journal of Gluten Sensitivities on Celiac.com. As a "thank you" for participating in this survey, your name will be entered into a drawing. Four lucky winners will receive a $25 Amazon.com gift card. If you are interested in participating in a more in-depth interview to discuss your coping strategies, successes and struggles, you will be prompted at the end of the survey to provide contact information. Jean Duane will contact you and schedule a mutually agreeable time for the interview. To take the survey, please click here: NOTE: SURVEY CLOSED AS OF 9/18/2017.

Celiac.com 07/13/2010 - More and more, researchers are showing connections between inflammatory diseases, like celiac disease, and complex disorders, such as anxiety and depression. There's also a good amount of anecdotal evidence to suggest that people with celiac disease have higher rates of anxiety and depression than the general population. A study of the German population is the first to show that female adults following a gluten-free diet for celiac disease show higher levels of anxiety than do members of the general population. The researchers are recommending that female celiacs on a gluten-free diet be screened for anxiety. The researchers included W. Häuser, K. H. Janke, B. Klump, M. Gregor, and A. Hinz of the Department of Internal Medicine I of the Klinikum Saarbrücken, Winterberg in Saarbrücken, Germany. The team set out to examine levels of depression and anxiety between adults with celiac disease following a gluten-free diet (GFD), and in control subjects drawn from the general population. For their study, the team used the Hospital Anxiety and Depression Scale to measure levels of anxiety, depression, and likely anxiety or depressive disorder, in 441 adult patients with celiac disease recruited by the German Celiac Society. They then conducted the same assessments on 235 comparable patients with inflammatory bowel disease (IBD), either in remission or with slight disease activity. They did the same for the cross-sample control group of 441 adults from the general population. The team used regression analysis to test possible demographic and disease-related predictors of anxiety and depression in celiac disease. Demographic predictors included age, sex, social class, and family status. Disease-related predictors included latency to diagnosis, duration of GFD, compliance with GFD, thyroid disease. The team found that female gender (P = 0.01) was the main predictor (R(2) = 0.07) of anxiety levels in patients with celiac disease. Female patients had a higher risk for a probable anxiety disorder (OR = 3.6, 95% CI: 1.3-9.4, P = 0.01) Patients who lived alone (OR = 0.5, 95% CI: 0.2-0.9, P = 0.05) enjoyed a lower risk of anxiety disorder. None of the demographic and medical variables for which the team screened predicted either depression levels or risk for a probable depressive disorders. Patients with celiac disease showed anxiety levels of 6.6 +/- 3.4, and those with IBD, anxiety levels of 6.9 +/- 3.7, both higher than the general population's level of 4.6 +/- 3.3 - (both P < 0.001). Depression levels were similar for people with celiac disease (4.2 +/- 3.4), IBD (4.6 +/- 3.4) and the general population (4.2 +/- 3.8) (P = 0.3). Rates of likely anxiety disorders in people with celiac disease were 16.8%, and 14.0% for IBD, both higher than the rates of 5.7% in the general population (P < 0.001). All three groups showed similar rates of probable depressive disorder (P = 0.1). Their results provide strong indications that adult women with celiac disease on a gluten-free diet suffer higher rates of anxiety than persons of the general population. They encourage clinicians to provide anxiety screens for adult women with celiac disease on a gluten-free diet. Source: World J Gastroenterol. 2010 Jun 14;16(22):2780-7. PMID 20533598

Celiac.com 04/22/2010 - Restless leg syndrome (RLS) is a common neurological condition, with generally unknown causes, that is sometimes associated with specific disorders such as iron deficiency. Even though celiac disease is an autoimmune condition, people with celiac disease often suffer from associated malabsorption-related iron deficiency anemia and peripheral neuropathy. A team of researchers recently set out to assess rates of restless leg syndrome in adults with celiac disease. The team included Marcello Moccia, MS, Maria Teresa Pellecchia, MD, PhD, Roberto Erro, MD, Fabiana Zingone, MD, Sara Marelli, MD, Damiano Giuseppe Barone, MD, Carolina Ciacci, MD, Luigi Ferini Strambi, MD, and Paolo Barone, MD, PhD. They are variously associated with the Department of Systematic Pathology, the Department of Neurological Sciences at University Federico II and IDC Hermitage Capodimonte, Naples, Italy, and the Sleep Disorders Center, University Vita-Salute San Raffaele, Milan, Italy. For their study, the team enrolled 100 adult patients for features of celiac disease, iron metabolism, clinical and neurological conditions, and enrolled another 100 people from the general population as control subjects. These subjects were matched for age and sex. To determine the presence of restless leg syndrome in celiac disease patients and controls, the team applied the four essential diagnostic criteria of the International restless leg syndrome Study Group, in addition to conducting a neurological examination. They gauged restless leg syndrome severity using the International restless leg syndrome Study Group rating scale. The results showed a 31% prevalence of restless leg syndrome among subjects with celiac disease, which was much higher than the 4% prevalence in the control population (P < 0.001). The average restless leg syndrome severity among celiac disease patients was moderate (17 ± 6.5). In the subjects with celiac disease, the team saw no significant correlation between restless leg syndrome and either gluten-free diet or iron metabolism; even though the celiac patients with restless leg syndrome showed significantly lower hemoglobin levels than celiac patients without restless leg syndrome (P = 0.003). They also found no connection between restless leg syndrome and other possible causes of secondary restless leg syndrome, including signs of peripheral neuropathy, pregnancy, end-stage renal disease, and pharmacological treatments. Their study increases the number of neurological disorders associated with celiac disease, and supports screening all celiac disease patients for restless leg syndrome. SOURCE: Movement Disorders; 13 Apr 2010 DOI 10.1002/mds.22903

Celiac.com 12/23/2013 - Symptoms of celiac disease negatively impact the social activities and emotional states of some patients. A team of researchers recently set out to assess rates of altered eating behavior in celiac patients. The research team included V. Passananti, M. Siniscalchi, F. Zingone, C. Bucci, R. Tortora, P. Iovino, and C. Ciacci. They are variously affiliated with the Department of Clinical and Experimental Medicine at University Federico II of Naples, Italy, and with the Department of Medicine and Surgery, University of Salerno, Baronissi Campus, in Salerno, Italy. The researchers evaluated 100 celiac adults and 100 control subjects of statistically similar gender, age, and physical activity. The researchers had both celiac patients and control subjects complete a dietary interview and the Binge Eating Staircases, Eating Disorder Inventory (EDI-2), Eating Attitudes Test, Zung Self-Rating Depression Scale, State Trait Anxiety Inventory Forma Y (STAI-Y1 and STAI-Y2), and Symptom Check List (SCL-90). The results showed that, compared with the control group, celiac patients had higher STAI-Y1 and STAI-Y2, Somatization, Interpersonal, Sensitivity, and Anxiety scores of the SLC-90. EDI-2 differed in pulse thinness, social insecurity, perfectionism, inadequacy, aceticisms, and interpersonal diffidences between celiac disease patients and healthy female controls, whilst only in interceptive awareness between celiac disease patients and healthy male controls. Celiac patients with gastrointestinal symptoms showed dependently higher EAT-26 scores. The EAT26 showed a connection between indices of diet-related disorders in both celiac disease, and the feminine gender after controlling for anxiety and depression. Eating disorders appear to be more frequent in young celiac women than in celiac men and in healthy control subjects. Overall, these results indicate that pathological eating behavior in celiac adults may be due to celiac disease itself, rather than the gastrointestinal related symptoms or psychological factors. Source: Gastroenterology Research and Practice Volume 2013 (2013), Article ID 491657

Celiac.com 07/25/2013 - Numerous studies have shown that people with immune-mediated disorders can suffer from accelerated progression of atherosclerosis and increased cardiovascular risk, but few studies have been done for people with celiac disease. A team of researchers recently looked at young adults with celiac disease to see what, if any, added risk they may have for developing atherosclerosis. The research team included S. De Marchi, G. Chiarioni, M. Prior, and E. Arosio. They are variously affiliated with the Department of Medicine,and the Division of Vascular Rehabilitation in the Department of Medicine at the University of Verona in Verona, Italy, and with the Division of Gastroenterology and Hepatology, Center for Functional GI and Motility Disorders at the University of North Carolina in Chapel Hill, North Carolina. The team wanted to assess instrumental and biochemical signs of atherosclerosis risk in 20 adults at first diagnosis of celiac disease and again after 6–8 months of gluten-free diet with mucosal recovery. They used twenty-two healthy members of the hospital staff as matched controls. For their study, the team analyzed total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides, homocysteine, C-reactive protein, folate and vitamin B12. They also conducted ultrasound measurement of carotid intima-media thickness (IMT) and endothelium-dependent dilatation at diagnosis and after gluten withdrawal. The team found average total and HDL-cholesterol (HDL-C) to be within the normal range, at baseline, while average LDL-cholesterol concentration was slightly higher. Diet was tied to increment in total and HDL-C (68.2 ± 17.4 vs. 51.4 ± 18.6 mg/dL; P < 0.001). Meanwhile, total/HDL-C ratio was substantially improved (3.05 ± 0.71 vs. 3.77 ± 0.92; P < 0.02). Overall plasma homocysteine was elevated and not changed by diet, while C-reactive protein dropped significantly with diet (1.073 ± 0.51 vs. 1.92 ± 1.38 mg/dL; P < 0.05). At baseline, celiacs showed increased IMT (0.082 ± 0.011 vs. 0.058 ± 0.012 cm; P < 0.005), with decreased endothelium-dependent dilatation (9.3 ± 1.3 vs. 11.2 ± 1.2%; P < 0.05). A gluten-free diet returned both of those factors to normal. According to these results, vascular impairment and unfavorable biochemical risk pattern increase the potential for young adults with celiac disease to develop early atherosclerosis. This increased risk may be largely due to chronic inflammation. The good news is that adopting a gluten-free diet seems to return the body to a healthy mucosal state and returns the body to the normal risk levels of a healthy non-celiac person. Source: Alimentary Pharmacology & Therapeutics - Volume 38, Issue 2, pages 162–169, July 2013. DOI: 10.1111/apt.12360

Celiac.com 05/08/2013 - A team of researchers recently set out to test determine if an interactive online intervention might help to improve gluten free diet adherence in adults with celiac disease. The research team included Kirby Sainsbury BA/BEd, DCP (candidate), Barbara Mullan PhD and Louise Sharpe PhD. They are affiliated with the School of Psychology, and the Clinical Psychology Unit at the University of Sydney in Sydney, New South Wales, Australia For their controlled trial, the researchers recruited 189 adults with biopsy-confirmed celiac disease. They randomly assigned 101 adults to receive the intervention, and 88 adults to a wait-list control condition. They retrieved post-intervention data for 70 intervention subjects and 64 wait-list participants, along with three month follow-up data for 46 of 50 who completed the intervention period. The team first measured overall gluten-free diet adherence, then measured gluten-free diet knowledge, quality of life and psychological symptoms. The researchers based their results on intention-to-treat analysis, which bases their calculations on initial treatment assignment and not on the treatment eventually received. ITT analysis helps avoid various misleading factors that can color intervention research, such as non-random attrition of participants from the study or crossover. Overall, the intervention group showed strong improvement in gluten-free diet adherence, and gluten-free diet knowledge following the treatment period compared to the wait-list control group. However, changes in knowledge had no effect on adherence. These improvements continued through the 3-month’ follow-up period. The results show that the online intervention program helped improve adherence to a gluten-free diet for people with celiac disease. Such a program can be developed into a valuable resource for celiacs who are struggling with gluten-free diet adherence. Source: Am J Gastroenterol advance online publication 5 March 2013;