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Found 16 results

  1. Celiac.com 11/24/2014 - Following a strict gluten-free diet is the only way to treat celiac disease. However, researchers have been lacking clear agreement on how and when to assess gluten-free dietary adherence in celiac patients or how to determine its effectiveness on villous atrophy. To address this reality, a team of researches conducted a prospective study to determine patient adherence to a gluten-free diet, and its effect on histological recovery after 1-year of gluten-free diet. The research team included G. Galli, G. Esposito, E. Lahner, E. Pilozzi, V. D. Corleto, E. Di Giulio, M. A. Aloe Spiriti, and B. Annibale. They are variously affiliated with the Department of Digestive and Liver Disease, the Department of Haematology, the Department of Pathology, and the Department of Digestive Endoscopy at Sant'Andrea Hospital Sapienza University Rome in Rome, Italy, and with the Centro Ricerche S. Pietro, Ospedale S. Pietro in Rome, Italy. Between 2009 and 2012, the researchers enrolled 65 consecutive newly-diagnosed adult patients (median age 38 years, 18–70) with biopsy-proven atrophic celiac disease. The researchers assessed patients after one year of gluten-free diet, using duodenal histology, serological assays, symptom reports and a dietary interview based on a validated questionnaire. They defined complete histological recovery as the absence of villous atrophy and ≤30/100 intraepithelial lymphocytes. The team found that 81.5% of patients showed adequate gluten-free diet adherence (ADA), whereas 18.5% had inadequate adherence (IADA). Overall, 66% of ADA patients achieved complete histological recovery, but no IADA patients recovered (P < 0.00001). Interestingly, ADA patients who achieved complete histological recovery showed about the same antibody seroconversion and symptoms as those who achieved partial histological recovery with P = 0.309 and P = 0.197, respectively. Multivariate analysis showed that, for ADA patients with incomplete histological recovery, Marsh 3C was still a risk factor (OR 8.74, 95% CI: 1.87–40.83). This study shows that 66% of adult celiac patients who successfully follow a gluten-free diet can make a complete histological recovery after 1-year. However, patients with severe histological damage at diagnosis who successfully follow a gluten-free diet remain at risk for incomplete histological recovery 1 year later. Lastly, patients who do not follow a gluten-free diet have no hope of making a full histological recovery. For clinicians and doctors, this data should serve as a guideline for determining gluten-free diet adherence in celiac patients, and determining the level of patient recovery. For celiac patients, the data should serve to demonstrate the importance of following a strict gluten-free diet. Source: Alimentary Pharmacology & Therapeutics 2014; 40(6):639-647.
  2. Celiac.com 10/03/2014 - Celiac disease patients in Australia have shown a major improvement in gluten tolerance after receiving experimental hookworm treatments. The study is part of an effort to determine if parasitic helminths, such as hookworm, might help to treat inflammatory disorders, including celiac disease. In this case, the research team assessed the influence of experimental hookworm infection on the predicted outcomes of three escalating gluten challenges in volunteers with confirmed celiac disease. The research team included John Croese, MD, Paul Giacomin, PhD, Severine Navarro, PhD, Andrew Clouston, MD, Leisa McCann, RN, Annette Dougall, PhD, Ivana Ferreira, BSc, Atik Susianto, MD, Peter O'Rourke, PhD, Mariko Howlett, MD, James McCarthy, MD, Christian Engwerda, PhD, Dianne Jones, BHSc, and Alex Loukas, PhD. They are variously affiliated with the Department of Gastroenterology and Hepatology at The Prince Charles Hospital, Brisbane, Australia, the Center for Biodiscovery and Molecular Development of Therapeutics at the Australian Institute of Tropical Health and Medicine of James Cook University in Cairns, Australia, Envoi Specialist Pathologists in Brisbane, Australia, QIMR Berghofer Medical Research Institute in Brisbane, Australia, the Royal Brisbane and Women's Hospital, and with Logan Hospital, Brisbane, Australia. This particular study followed twelve adult volunteers with diet-managed celiac disease. The volunteers were inoculated with 20 Necator americanus (hookworm) larvae, and then consumed increasing amounts of gluten in the form of spaghetti. The volunteers first received 10 to 50 milligrams for 12 weeks (microchallenge); they then received 25 milligrams daily + 1 gram twice weekly for 12 weeks (GC-1g); and finally 3 grams daily (60-75 straws of spaghetti) for 2 weeks (GC-3g). The subjects were then evaluated for symptomatic, serologic, and histological outcomes of gluten toxicity. They were also examined for regulatory and inflammatory T cell populations in blood and mucosa. Two gluten-intolerant subjects withdrew after micro-challenge. Ten completed GC-1g, and eight of these ten volunteers enrolled in and completed the full course of the study. Most celiacs who are exposed to gluten challenge will show adverse changes in the intestinal villi, which is measured in terms of villous height-to-crypt depth ratios. Also, such patients will usually show an increase in blood antibodies, such as IgA-tissue transglutaminase, indiucating an adverse reaction to gluten. However, the results here showed that median villous height-to-crypt depth ratios (2.60-2.63; P = .98) did not decrease as predicted after GC-1g. Moreover, mean IgA-tissue transglutaminase titers declined, contrary to the predicted rise after GC-3g. Other results showed that quality of life scores improved (46.3-40.6; P = .05); while celiac symptom indices (24.3-24.3; P = .53), intra-epithelial lymphocyte percentages (32.5-35.0; P = .47), and Marsh scores remained unchanged by gluten challenge. Intestinal T cells expressing IFNγ were reduced following hookworm infection (23.9%-11.5%; P = .04), with corresponding increases in CD4+ Foxp3+ regulatory T cells (0.19%-1.12%; P = .001). Hookworms in the form of Necator americanus promoted tolerance and stabilized, or improved, all tested measures of gluten toxicity in volunteers with celiac disease. So, after being voluntarily infected with 20 hookworms, these celiac disease volunteers were able to eat increasingly large amounts of gluten with none of the usual changes or adverse symptoms. Could hookworm treatments represent the future of treatment for celiac disease, and maybe other inflammatory conditions? Clearly, further tests are needed to determine exactly how safe it is for celiac patients receiving this treatment to eat gluten. So far, however, the future looks bright. What do you think? If swallowing a small dose of hookworms would eliminate your adverse reactions, and allow you to safely eat gluten, would you do it? The radio program Radiolab has an interesting segment on hookworm, which you can stream here: Radiolab Source: Journal of Allergy and Clinical Immunology. DOI: http://dx.doi.org/10.1016/j.jaci.2014.07.022
  3. Celiac.com 01/21/2016 - With sales of non-gluten-free cereals enduring a slow, consistent downward slide in just about every category, gluten-free cereals have been one of the few bright spots for cereal manufacturers. In an effort to combat those falling cereal sales across its existing product line, manufacturer General Mills released five gluten-free Cheerios products. Initial results suggest that their plan is working, at least somewhat. According to General Mills, sales of non-discounted, full-price gluten-free varieties of Cheerios grew 3% to 4% last quarter, offering the fist improvement after multiple quarters of declining sales. This is particularly good news for General Mills, as it follows on the heels of an embarrassing recall of 1.8 million boxes of Cheerios and Honey Nut Cheerios in October, shortly after the introduction of their gluten-free varieties. The company chalked that issue up to "human error." So the fact that the latest numbers are strong so soon after a major product recall suggests that gluten-free Cheerios might just be the ticket for turning around their slumping sales. What do you think? Have you tried gluten-free Cheerios? Will you? Are you happy that major companies like General Mills are making gluten-free products available? Read more: buzzfeed.com
  4. Celiac.com 06/29/2015 - Non-alcoholic fatty liver disease is a common cause of chronic liver disease. There's good data showing that celiac disease changes intestinal permeability, and that treatment with a gluten-free diet often causes weight gain, but so far there is scant documentation of non-alcoholic fatty liver disease in patients with celiac disease. A team of researchers recently set out to assess increased risk of non-alcoholic fatty liver disease following diagnosis of celiac disease. The research team include Norelle R. Reilly, Benjamin Lebwohl, Rolf Hultcrantz, Peter H.R. Green, and Jonas F. Ludvigsson. They are affiliated with the Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, and the Department of Pediatrics at Örebro University Hospital, Örebro University in Örebro, Sweden. The team assessed the for risk of non-alcoholic fatty liver disease diagnosed from 1997 to 2009 in 26,816 individuals with celiac disease to 130,051 matched reference individuals. The team excluded patients with any liver disease prior to celiac disease. They also excluded individuals with a lifetime diagnosis of alcohol-related disorder to minimize misclassification of non-alcoholic fatty liver disease. They used Cox regression estimated hazard ratios for non-alcoholic fatty liver disease. Their results showed that over 246,559 person-years of follow-up, 53 individuals with celiac disease had a diagnosis of non-alcoholic fatty liver disease (21/100,000 person-years). In comparison, in the reference group showed 85 individuals diagnosed with non-alcoholic fatty liver disease during 1,488,413 person-years (6/100,000 person-years). This corresponded to a hazard ratio of 2.8 in the celiac group (95% CI), with the highest risk estimates of 4.6 seen in children (95% CI). The risk increase in the first year after celiac disease diagnosis was 13.3 (95% CI), but remained significantly elevated at 2.5 even beyond 15 years after celiac diagnosis of celiac disease (95% CI). Individuals with celiac disease do have an increased risk of non-alcoholic fatty liver disease compared to the general population. Excess risks were highest in the first year after celiac disease diagnosis, but continued at least 15 years after celiac diagnosis. This much more comprehensive study provides much clearer and convincing data than any of the previous studies, and will likely serve as a baseline that clinicians have been lacking to this point. Source: Journal of Hepatology, June 2015Volume 62, Issue 6, Pages 1405–1411. DOI: http://dx.doi.org/10.1016/j.jhep.2015.01.013
  5. Celiac.com 09/23/2013 - Patients with non-celiac gluten sensitivity (NCGS) do not have celiac disease, but see an improvement in symptoms when they adopt gluten-free diets. A team of researchers recently investigated the specific effects of gluten after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates (fermentable, oligo-, di-, monosaccharides, and polyols [FODMAPs]) in patients with suspected NCGS. The research team included Jessica R. Biesiekierski, Simone L. Peters, Evan D. Newnham, Ourania Rosella, Jane G. Muir, and Peter R. Gibson. The team performed a double-blind cross-over trial of 37 subjects (aged 24−61 y, 6 men) with NCGS and irritable bowel syndrome (based on Rome III criteria), but not celiac disease. They assigned study participants randomly to groups given a 2-week diet of reduced FODMAPs, and were then placed on high-gluten (16 g gluten/d), low-gluten (2 g gluten/d and 14 g whey protein/d), or control (16 g whey protein/d) diets for 1 week, followed by a washout period of at least 2 weeks. The researchers then evaluated serum and fecal markers of intestinal inflammation/injury and immune activation, and indices of fatigue. The team then crossed twenty-two participants over to groups receiving gluten (16 g/d), whey (16 g/d), or control (no additional protein) diets for 3 days, using visual analogue scales to evaluate symptoms. They found that gastrointestinal symptoms consistently and significantly improved for all patients during reduced FODMAP intake, but significantly worsened to a similar degree when their diets included gluten or whey protein. The team saw gluten-specific effects in just 8% of study subjects. They saw no diet-specific changes in any biomarker. During the 3-day re-challenge, participants’ symptoms increased by similar levels among groups. Gluten-specific gastrointestinal effects were not reproduced. An order effect was observed. A placebo-controlled, cross-over re-challenge study showed no evidence of specific or dose-dependent effects of gluten in patients with NCGS placed diets low in FODMAPs. Source: Gastroenterology, Volume 145, Issue 2, Pages 320-328.e3, August 2013. More info on the FODMAP diet from Stanford Univerisity.
  6. Celiac.com 07/04/2014 - Celiac disease can be a factor in many cases of unexplained infertility in women. The recent case in Orlando, Florida of a woman named Vicky Crust, serves to drive home that fact, and to illustrate the potential benefits of a gluten-free diet in such cases. Crust suffered for years from abdominal pain, constipation, weight loss and a skin rash that overtook her nose, mouth and legs. Now, in spite of all these symptoms, Crust married, and began trying to start a family with her husband. She conceived twice, but was unable to carry full term. She couldn’t figure it out, and neither could doctors. Doctor after doctor failed to diagnose her celiac disease, and her symptoms grew worse as she progressed into her twenties. In 2010, Crust was diagnosed with celiac disease and her doctors at the Mayo Clinic believed that because she was otherwise healthy, she could have a successful pregnancy if she adopted a gluten-free lifestyle. Now, to be fair to Crust’s earlier doctors, celiac disease can be hard to spot. "Not everybody has symptoms. Not everybody may have the rash, the diarrhea, just overall weakness and other manifestations of celiac disease," says Dr. Christine Greves, an OB-GYN at Winnie Palmer in Orlando. After her diagnosis, Crust embraced a gluten-free diet, and that paid off nicely for her. Her rash healed, her stomach pains disappeared, and, most delightfully of all, she became pregnant. "My life is great now. I couldn't conceive before and now I am six months pregnant," she said. Obviously, celiac disease will not be a factor in every case of unexplained fertility, and a great deal more work needs to be done. However, Crust’s story is by no means rare, and is perhaps emblematic of the effects of celiac disease and the importance of getting a proper diagnosis, and adopting a gluten-free diet once diagnosed. Do you know anyone with a similar story? This story was first reported by WESH in Orlando, Florida.
  7. Celiac.com 01/06/2014 - A team of researchers recently set out to clarify the role of the immune system and intestinal epithelium in the origins of celiac disease. The research team included S. Ben-Horin, S. Polak-Charcon,I. Barshack, O. Picard, E. Fudim, M. Yavzori, C. Avivi, C. Mardoukh, A. Shimoni, Y Chowers, Y. and Maor, of the Department of Gastroenterology in Chaim Sheba Medical Center at Tel-Aviv University, Tel Hashomer in Tel-Aviv, Israel. For five years, the team followed a patient with childhood celiac disease who had undergone an allogeneic bone marrow transplant (BMT) for chronic myelogenous leukemia, and subsequently resumed consuming a gluten-containing diet. Using standard serology testing, along with CFSE-based proliferation assays of peripheral blood CD4+ cells and of intestinal LPL towards gliadin-TTG antigens, the team assessed immunological memory to gliadin epitopes in both the control patient and in 5 newly diagnosed celiac patients. They used combined immuno-histochemistry and fluorescent in-situ hybridiazation (FISH) to determine the origin of the intestinal lymphocytes. They found that the patient remained healthy for more than 5 years of follow-up after receiving BMT from a HLA-matched woman, and ceasing the gluten-free diet. The continued to show negative periodic antibodies tests and unremarkable serial duodenal biopsies. In vitro tests showed lack of a memory response of the patient's peripheral blood and lamina propria CD4+ T-cells towards TTG, gliadin or TTG-treated gliadin, whereas memory responses were common in the newly diagnosed celiac patients. Immuno-FISH of post-BMT duodenal mucosa showed that all the epithelial cells had the chromosomal phenotype of XY. In contrast, CD45+ lymphocytic lineage cells were all donor-derived XX cells, presumably originating in the transplanted bone marrow and re-populating the intestinal wall. The resolution of celiac disease after allogeneic BMT does occur, and is associated with absent gliadin-specific memory response, and with a dichotomous lymphocyte-epithelial chimeric intestine. These findings suggest that the origins of celiac disease are deeply connected to the immune system, rather than the epithelial area. Source: J Clin Immunol. 2013 Nov;33(8):1395-402. doi: 10.1007/s10875-013-9943-9. Epub 2013 Oct 20.
  8. Celiac.com 05/23/2012 - In April 2012, the National Foundation for Celiac Awareness debuted its Tiered Credentialing system, whereby restaurants can be awarded varying levels of a gluten-free designation. The system has spawned much controversy, as many sufferers of celiac disease argue that there should be no flexibility with the gluten-free term. Many argue that a food either contains gluten, or it does not: leading people to believe gluten-contaminated products are gluten-free could be harmful to celiacs. The issue came to a head when the NFCA awarded Domino's 'gluten-free pizza with an 'amber' gluten-free designation. The controversy is in the preparation: while Domino's may use gluten-free ingredients to make the crust, no extra effort is put forth to avoid contamination (hence, their 'amber' credential rather than 'green', which would be awarded to restaurants who take more care to avoid gluten contamination). Such contamination is almost assured given the volume of gluten flour present in a typical pizza restaurant kitchen, so many have argued that an 'amber' designation is really only useful to people who are gluten-conscious, but do not suffer from any form of gluten sensitivity. A number of celiac disease experts have come forth to denounce Domino's crust and the NFCA's endorsement of it. The NASSCD has even gone so far as to accuse Domino's of “exploitation”, given the gluten-free diet's recent surge in popularity. Domino's or the NFCA might argue that their crust was never intended for those with celiac disease, and that the 'amber' designation indicates that, but as Dr. Steven Guanalini, president of NASSCD argues,“there should be no need for disclaimers. The threshold has to be set at the same level for everybody for the term gluten-free to be meaninful.” In what may be viewed as something of a victory for the celiac community, the NFCA announced that in response to overwhelming public pressure, it is suspending use of its “amber” credential. According to their press release, they will "conduct a review to determine the most effective and clearest way to warn the community of the risk of cross-contamination and the use of the phrase 'Gluten Free'". It is still unclear what this means for Domino's. Sources: http://nrn.com/article/dominos-under-fire-labeling-crust-gluten-free?page=0,0 http://www.celiaccentral.org/nfca-statement-7937/
  9. Celiac.com 03/08/2012 - Eating gluten-free for an entire lifetime is no easy task. Many people with celiac disease and gluten-sensitivities would love an alternative to a gluten-free diet, and a number of companies are looking to develop alternative therapies that would enable people to consume gluten without suffering damage. Even though nearly all drug-development programs include gluten challenges, very little is known about the duration of gluten challenge and gluten dosage. That is, how quickly does gluten cause damage, and at what dosages? A team of researchers recently studied the ways in which antibodies respond and mucosa change when the small bowel is exposed to gluten in people with celiac disease. The study team included Marja-Leena Lähdeaho, Markku Mäki, Kaija Laurila, Heini Huhtala, and Katri Kaukinen. To assess the amount of gluten-exposure needed to cause some small-bowel mucosal deterioration, the team conducted a gluten-challenge on twenty-five adult celiac patients. Each patient received either a low (1-3 g) or moderate (3-5g) doses of gluten daily for 12 weeks. The team assessed patient symptoms, including small-bowel morphology, densities of CD3+ intraepithelial lymphocytes (IELs) and celiac serology. Their results showed that both moderate and low amounts of gluten induced small-bowel damage in 67% of celiac patients. However, moderate gluten doses also caused mucosal inflammation and gastrointestinal symptoms in seven patients that lead to their premature withdrawal from the study. Interestingly, 22% of patients who developed significant small-intestinal damage showed no symptoms. The team concludes that, for most people with celiac disease, even low amounts of gluten can cause significant mucosal changes. However, since many people with celiac disease show no such response, sample sizes must be large enough to be statistically significant. Source: BMC Gastroenterology. 2011;11(129).
  10. Celiac.com 04/15/2010 - Ten years ago, I embarked on a life that came with a warning about the Specific Carbohydrate Diet from my naturopathic practitioner, "it is a great diet, but a hard one." Those were fighting words to someone who has made a lifetime of "cosmetic" dieting with tendencies to yo yo back and forth into the obesity zone. The Specific Carbohydrate Diet diet was chosen to relieve pain. Starting a new weight-loss diet had always been inviting and exciting. The magic of the initial water weight-loss, the restrictive ruthless regimentation, calorie counting, portion control and forced water consumption were as exciting as hair shirts and beds of nails for religious fanatics. Dieting was my religion, food was like the duplicitous friend who is an enemy at the same time. The years marched on and my "stuff and starve" lifestyle beat a destructive highway to digestive hell in the form of celiac disease, an illness that could have been caused by any number of things, age, a compromised immune system, a recent illness or maybe even the evil eye. That was ten years ago. It has turned out that the Specific Carbohydrate Diet is no transient companion to my fork, knife and spoon. It blossomed into a creative and motivating experience, a learning opportunity, a template for sharing, writing and creating recipes and a sometimes tiresome topic at social gatherings (although as we age, health chat is pretty popular). I have made more friends through the Specific Carbohydrate Diet than at the dog park and have been given the opportunity to help strangers. Food at the good restaurants pales in comparison to the ever innovative pure, tasty, quality meals and dishes I create from the Specific Carbohydrate Diet palette of foods. Excluded are refined sugars, starches and gluten and they are not much missed. After eight years on the Specific Carbohydrate Diet, I tried occasional servings of rice and potatoes and some dark chocolate just to see if I had healed. Sometimes I tolerated these well, sometimes not and mainly lost interest. As for grain, it can remain on that plain in Spain. I want no part of it. The Specific Carbohydrate Diet has not cured me, and I doubt that it will, but it is an effective dietary management program. Yes I still get the bloat, the night time rashes, and the irritated bowel and sometimes I still have a very touchy immune system. It depends on the load at a given time. One thing that is really helpful then is a few days back on the initial introductory portion of the Specific Carbohydrate Diet. It calms the "Gut Devils" and clears the "Digestive Decks." If people deal the "pity card" as I describe being on a gastric diet, I ignore it as my diet deals aces and also the "Get Out of Pain Jail" card and of course, to this old dieter, the permanent thrill of the drill.
  11. Celiac.com 04/16/2010 - In most adults with celiac disease, clinical symptoms disappear with a gluten-free diet. However, the exact effects of a gluten-free diet on rates of mucosal recovery in adults with celiac disease is less certain. A group of clinicians recently set out to estimate the rate of mucosal recovery under a gluten-free diet in adult subjects with celiac disease, and to gauge the clinical prospects of ongoing mucosal damage in celiac patients following a gluten-free diet. The study group included: Alberto Rubio-Tapia, MD; Mussarat W. Rahim, MBBS; Jacalyn A. See , MS , RD, LD; Brian D. Lahr , MS; Tsung-Teh Wu, MD; and Joseph A. Murray, MD. Each patient in the study had biopsy-proven celiac disease, and was assessed at the Mayo Clinic. Also, each patient received duodenal biopsies at diagnosis. After beginning a gluten-free diet, each patient had at least one follow-up intestinal biopsy to assess mucosal recovery. The study team focused on mucosal recovery and overall mortality. Of 381 adult patients with biopsy-proven celiac disease, a total of 241 (175 women - 73%) had both a diagnostic and follow-up biopsy available for re-review. Using the Kaplan–Meier rate of confirmed mucosal recovery on these 241 patients, the study group found that 34% of patients enjoyed mucosal recovery at 2 years following diagnosis (95% with a confidence interval (CI): 27–40 % ), and 66% of patients enjoyed mucosal recovery at 5 years (95% CI: 58–74 % ). More than 80% of patients showed some clinical response to the gluten-free diet, but clinical response was not a reliable marker of mucosal recovery ( P = 0.7). Serological response was, by far, the best marker for confirmed mucosal recovery ( P = 0.01). Patients who complied poorly with a gluten-free diet ( P < 0.01), those with severe celiac disease defined by diarrhea and weight loss ( P < 0.001), and those with total villous atrophy at diagnosis ( P < 0.001) had high rates of persistent mucosal damage. With adjustments for gender and age, patients who experienced confirmed mucosal recovery had lower mortality rates overall (hazard ratio = 0.13, 95 % CI: 0.02 – 1.06, P = 0.06). One of the most important findings from this study was that a large number of adults with celiac disease see no mucosal recovery, even after treatment with a GFD. Compared to those patients who suffered persistent damage, patients who experienced confirmed mucosal recovery had lower rates of mortality independent of age and gender. The group notes that systematic follow-up via intestinal biopsies may be advisable in patients diagnosed with celiac disease as adults. SOURCE: Am J Gastroenterol. 9 February 2010; doi: 10.1038/ajg.2010.10
  12. Celiac.com 07/26/2010 - There is very little information currently available regarding the effects of follow up strategies for those celiac patients that follow a gluten-free diet. Therefore, it was the aim of of researchers in Italy to determine the t-transglutaminase antibodies (t-TG) in celiac disease patients while they were enrolled in a community based follow-up program over a 5-year period. Most patients that are diagnosed with celiac disease are told they need to adhere to a gluten-free diet for the remainder of their lives, and then they are usually left to figure it out on their own. However, it is recommended that celiac patients have regularly scheduled follow-ups after diagnosis for early detection of celiac related complications, and to reinforce the importance of adhering strictly to a gluten-free diet. In the year 2000, a community based “celiac disease-Watch” follow-up program was designed by the Local Health Authority of the Brescia Province in Northern Italy. The hope for the celiac disease-Watch program was to increase awareness of celiac disease and to standardize diagnostic criteria for celiac disease among health care professionals. Beginning in January 2003, all celiac patients that reside in the Province of Brescia have been enrolled in an ongoing celiac disease-Watch follow-up program. To encourage celiac patients to enroll in the follow-up program, the Italian government gives patients a bonus to subsidize their gluten-free diets, and all patients are required to contact the Local Health Authority every year to renew their bonuses. Furthermore, the celiac disease-Watch program requires all patients to have their serum tested once a year for detection of t-TG antibodies. Testing for the antibodies begins 12-16 months after a celiac diagnosis. The testing is free of charge to the patients and they can choose any laboratory they like. Results from the t-TG testing is reported to the Local Health Authority, and it is a requirement to continue to receive subsidization, although patients continue to receive subsidization regardless of their t-TG results. Those that test positive for t-TG antibodies during their annual follow up, are referred back to the clinic where they were initially diagnosed. At the clinic they receive a clinical evaluation, and dietary counseling. While those that have a clean bill of health are scheduled for follow up appointments every 3 years. Through this study, researchers found that as a result of the celiac disease-watch program, celiac patients with negative t-TG antibodies advanced from 83% to 93%. Respectively, using mathematical modelling to t-TG conversion rates observed in the study, the projected population of t-TG negative patients increased in population from 90% to 95% over the 5 year period. From this study, researchers were able to determine with confidence that without a follow-up strategy in place, patients with celiac disease will be inconsistent with adhering to a gluten-free diet. It is therefore strongly emphasized that regular serological and clinical follow-ups are a sustainable strategy to promote dedicated compliance to a gluten-free diet. Source: Digestive and Liver Disease doi:10.1016/j.dld.2010.05.009
  13. Celiac.com 10/30/2007 - Many studies over the years have supported the idea that celiac disease is a permanent condition, and that those who strayed from the strict gluten-free diet that forms the core of celiac treatment risked relapsing and suffering the telltale intestinal damage associated with celiac disease. However, it was generally assumed that symptoms of celiac disease and associated intestinal degradation occurred within two years of reintroducing gluten back into the diet. The medical journal GUT recently published a paper by Matysiak-Budnik et al. concerning the natural history of celiac disease, which indicates that classic celiac damage to the intestinal lining may take years or decades to develop in some cases. A team of researchers looked at 61 adults who had been diagnosed with celiac disease as children, and who felt themselves to be asymptomatic for anywhere from 3 to 21 years, with a group average of 11 years. An exam revealed that 48 of the 61 test subjects indeed showed villous atrophy with crypt hypoplasia. The 13 other patients showed no celiac-associated intestinal damage. Strangely, 2 of the 13 patients with no signs of damage had showed such damage a short time after gluten was reintroduced into their diets, only to return to normal as they continued to consume gluten. From this, the researchers concluded that some people might actually become truly latent and tolerate gluten with no adverse effects. It’s also possible that such people actually still have celiac disease and that the intestinal damage has yet to recur, as villous atrophy occurs only at the tail end of celiac disease. In fact, delayed relapse of celiac disease after gluten reintroduction supports the notion that people with normal mucosa may in fact have celiac disease. Still, it is highly uncommon for patients with celiac disease to show no clinical symptoms on a long-term gluten-inclusive diet. The level of celiac disease+ intraepithelial lymphocytes has proven to be more useful than mucosal Marsh Type 1 lymphocytes in revealing early developing celiac disease in such cases and in general. Reliable diagnosis of celiac disease is important, as untreated celiac disease carries a broad range of associated risks including markedly higher rates of certain cancers. A recent study also suggests celiac disease may also adversely impact both the peripheral the central nervous systems. However, regarding the 13 asymptomatic patients, the original diagnosis of celiac would seem to be accurate in each case, as each had celiac-type HLA, either HLA DQ2 or DQ8, and their follow-up exam results showed that 5 of those patients had positive serum antibody results and higher densities of small bowel mucosa celiac disease+ and CD3+ intraepithelial lymphocytes than did the non-celiac control groups. Two of the 13 patients developed symptoms of a relapse during the follow-up. The study team concluded that the “2 year rule” for reintroducing gluten is invalid and supports the view that celiac disease exists beyond villous atrophy. As villous atrophy of the small intestine is only one manifestation of genetic gluten intolerance, and that the present diagnostic guidelines based on mucosal damage and ignoring early developing celiac disease and dermatitis herpetiformis is only one incarnation of celiac disease. GUT 2007; 56:1339-1340 Katri Kaukinen, Pekka Collin, Medical School, University of Tampere and Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland Markku Ma¨ki, Medical School, University of Tampere and Department of Paediatrics, Tampere University Hospital, Tampere, Finland
  14. Celiac.com 02/09/2006 - Do not try this at home. If you have celiac disease you need to remain on a gluten-free diet. This particular study, as indicated below, involved only one person--which is far too small of a sample to draw any solid conclusions from. It does, however, offer some hope that there may be other unknown factors that cause this disease--perhaps factors that can be reversed or kept in check. Many more studies will be needed to determine this. After reading and publishing much of Roy Jamrons work, we thought his comments on this study were very interesting and have reproduced them here. Comments by Roy Jamron: This is interesting, a case of reintroducing gluten to a celiac woman after a 10 year gluten-free diet with no symptoms of celiac disease showing up during a 15 month follow up study. It would be interesting if she remains symptom free in subsequent years. It does bring up the idea of a gluten-ingesting bacteria link which I proposed in my article, Are Commensal Bacteria with a Taste for Gluten the Missing Link in the Pathogenesis of Celiac Disease?. In that article I proposed that a bacteria capable of transporting and internalizing gluten peptides resistant to breakdown could initiate a T cell immune response to gluten. Antigen presenting cells (dendritic cells) might present gluten peptides internalized by the bacteria along with peptides and chemical signals from the bacteria to T cells. The T cells would not be able to distinguish the gluten peptides from the bacteria peptides and would, therefore, initiate an immune response to gluten peptides as though they were components from pathogenic bacteria. The presence or non-presence of such a bacteria in twins offered an explanation as to why one identical twin could develop celiac disease and not the other. After 10 years on a gluten-free diet, it is possible that the numbers of such gluten-ingesting bacteria might diminish to a level too few to initiate a gluten immune response, especially if the bacteria largely depend on gluten for nutrition. So, like the twin who does not develop celiac disease, she remains symptom free. I urged researchers to look for such gluten-ingesting bacteria in my article, and I continue to urge such research. Such bacteria could be found through the use of immunogold electron microscopy. This technique permits gluten peptides to be bound to and labeled with gold particles which show up as distinct opaque spots under the electron microscope. Such spots found within microscopic cross sections of fecal bacteria samples would identify gluten-ingesting bacteria. Abstract of Study: An Attempt of Specific Desensitizing Treatment with Gliadin in Celiac Disease Int J Immunopathol Pharmacol. 2005 Oct-Dec;18(4):709-14. Gluten-free diet is the current treatment of celiac disease. We decided to verify the occurrence of histological and serological modification and/or clinical manifestations during a gradual and progressive introduction of gliadin in the diet and if it may induce a tolerance to food, as it occurs in allergic patients. We studied the case of a celiac woman with complete clinical and histological remittance after 10 years of gluten free diet. She took increasing daily doses of gliadin, reaching the final dose of 9 g of gliadin (15 g of gluten) in 6 months. Then she started a free dietary regimen. During the 15-month follow-up period esophago-gastro-duodenoscopy showed normal Kerckring folds and villi. Anti-gliadin, anti-endomysium and anti-tissue-transglutaminase antibodies, as well as the haematological and biochemical parameters remained normal. Our results represent a new approach in research concerning celiac disease, and could provide a future line of study for its management.
  15. Am J Gastroenterol. 2004 Dec;99(12):2429-36. Celiac.com 02/27/2005 – In order to determine whether body mass index (BMI) may play a role in gut transit time in those with celiac disease, Swedish researchers conducted a study on 27 patients (16 female) with untreated celiac disease, both before and after a gluten-free diet. Detailed gastrointestinal transit times and BMI calculations were determined for each patient prior to the implementation of a gluten-free diet. Ten patients (5 female) were also studied after the implementation of a gluten-free diet. The researchers used a new radiological procedure to determine the exact transit times in each patient, and the results were compared to that of a control group of 83 healthy people. The findings of the study indicate that untreated male patients BMI was lower than that of healthy male controls, and their small bowel transit times were significantly slower (3.9 hours versus 2.5 hours). In the group studied after the implementation of a gluten-free diet patients BMI increased significantly, and small bowel transit times accelerated from 3.6 hours prior to dietary treatment to 2.3 hours after. For untreated females BMI did not differ significantly when compared to that of the healthy controls, but 31% of the female patients were overweight--and the small bowel transit times of this overweight female group were markedly shorter when compared to the lean untreated females. The researchers conclude that: "Small bowel transit seems to be delayed in lean patients with untreated celiac disease. BMI may have some influence on the variations of small bowel transit before and after treatment."
  16. Celiac.com 2/13/2003 - This new study emphasizes the importance of following a strict gluten-free diet, and getting regular follow-up biopsies after your diagnosis. It also speaks to the need to discover whether or not you may have additional food intolerance, such as to cows milk (casein), soy, corn, etc., as some of these can also cause intestinal damage similar to that of celiac disease. -Scott Adams Lee SK, Lo W, Memeo L, Rotterdam H, Green PH. Gastrointest Endosc 2003 Feb;57(2):187-91 Current affiliations: Department of Surgical Pathology and Medicine, Columbia University College of Physicians and Surgeons, New York, New York. BACKGROUND: The diagnosis of celiac disease requires characteristic histopathological changes in an intestinal biopsy with clinical improvement in response to a gluten-free diet. Endoscopy with procurement of biopsy specimens is often performed to document response to the diet, but there are little data on the appearance of treated celiac disease. This study examined the endoscopic and histopathological appearance of the duodenum of patients with celiac disease whose diet was gluten-free. METHODS: A cohort of 39 adult patients (mean age 52 years, range 20-74 years) with biopsy-proven celiac disease was retrospectively reviewed. All had responded clinically to a gluten-free diet that they had maintained for a mean of 8.5 years (range 1-45 years). The endoscopic and histopathological appearances of the duodenal mucosa were reviewed. Blinded review of the diagnostic (initial) and post-treatment biopsy specimens was also performed to assess response of individual patients to the diet. RESULTS: The endoscopic appearance was normal in 23%, reduced duodenal folds were present in 46%, scalloping of folds in 33%, mucosal fissures in 44%, and nodularity in 33%. There was more than 1 abnormality present in 46%. Histology was normal in only 21%. The remainder had villous atrophy (69% partial, 10% total). Paired (diagnostic and follow-up) biopsy specimens were reviewed blindly for 12 patients. The mean (SD) intraepithelial lymphocyte count fell from 61 (22) to 38 (17) (normal CONCLUSIONS: Despite a good clinical response, abnormal endoscopic and histopathological appearances persist in the majority of patients with celiac disease treated with a gluten-free diet. PMID: 12556782
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