Search the Community

Celiac.com 12/10/2000 - As reported in Ann Whelans September/October issue of Gluten-Free Living, the American Dietetic Association (ADA) has released the 6th edition of its Manual of Clinical Dietetics, which offers revised guidelines for the treatment of celiac disease. This manual is currently used by hospitals and doctors all over North America, and represents the most up-to-date source of information with regard to the dietary treatment of various illnesses. The new standards set in this publication conform more closely with current international standards. Included on their safe list are items that have been on Celiac.coms safe list for over five years, including: amaranth, buckwheat, distilled vinegar (no matter what its source), distilled alcoholic beverages (including rum, gin, whiskey and vodka), millet, quinoa and teff. A team of American and Canadian dietitians wrote the new gluten-free guidelines, including: Shelley Case, RD, Mavis Molloy, RD, Marion Zarkadas, M.Sc.RD (all from Canada and all members of the Professional Advisory Board of the Canadian Celiac Association), and Cynthia Kupper, CRD, CDE (Executive Director of the Gluten Intolerance Group and celiac). Additional findings of this team regarding buckwheat and quinoa contradict what has been accepted as common knowledge for years by some US support groups, mainly that these two grains are more likely to be contaminated by wheat than other grains. In fact, according to the team, buckwheat and quinoa are far less likely to be contaminated than most other grains. At the most basic level the new guidelines mean that celiacs do not need to avoid foods containing unidentified vinegar or distilled alcohol, this alone will allow much more freedom when shopping or eating out. Further, celiacs who drink alcohol will have much more freedom and a far greater choice when they want to have a drink. Additionally, celiacs will be able to more easily maintain a well-rounded and nutritious diet because they will have access to a far greater number of highly nutritious and safe grains. The ADAs 6th edition of the Manual of Clinical Dietetics represents the first time that Canadian and United States dietary guidelines have come together to create a united North American gluten-free standard, and will hopefully lead to the adoption of a single standard by all US support groups so that hundreds of thousands of celiacs will not have to unnecessarily exclude more foods than necessary. These new guidelines go a long way towards an international standard, which should be the ultimate goal for all celiacs and celiac organizations in the world.

Celiac.com 3/14/2003 - After conducting an extensive review of the medical literature concerning the safety of oats for people with celiac disease, the American Dietetic Association recently concluded that even though oats are not yet endorsed as safe for people with celiac disease by doctors and support groups in the USA, they should, however, be safe for celiacs who choose to consume them if they limit their consumption to amounts found to be safe in several studies (approximately one-half cup of dry whole-grain rolled oats per day). Ideally, they also should be advised to consume only those products tested and found to be free of contamination. If this is not possible, patients should be counseled on steps they can take to help reduce their chances of consuming contaminated oat products (e.g., avoiding oats sold in bulk from bins, determining from manufacturers whether a dedicated line or facility is used for processing). In addition, patients should be advised to discuss any dietary changes with their physicians. The American Dietetic Associations conditional acceptance of oats as safe for people with celiac disease is another big step forward for celiacs in the USA. For more information see: Oats and the gluten-free diet Journal of the American Dietetic Association March 2003 - Volume 103 - Number 3

Celiac.com 10/15/2013 - Most case reports suggest an association between autistic spectrum disorders (ASDs) and celiac disease (celiac disease) or positive celiac disease serologic test results, but larger studies are contradictory. A team of researchers recently set out to examine the association between ASDs and celiac disease according to small intestinal histopathologic findings. The research team included Jonas F. Ludvigsson; Abraham Reichenberg; Christina M. Hultman; and Joseph A. Murray. They are variously affiliated with the Department of Medicine, Clinical Epidemiology Unit, and the Department of Medical Epidemiology and Biostatistics at the Karolinska Institutet in Stockholm, Sweden, with the Department of Pediatrics at Orebro University Hospital, Orebro University in Orebro, Sweden, with the Division of Gastroenterology and Hepatology of the Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, with the Department of Psychosis Studies at the Institute of Psychiatry at King’s College in London, United Kingdom, and with the Department of Psychiatry at the Mount Sinai School of Medicine in New York, New York. For their nationwide case-control study, the researchers used 28 Swedish biopsy registers to gather data on approximately 26,995 individuals with celiac disease, which they defined as the presence of villous atrophy, Marsh stage 3. They found 12,304 patients with inflammation (Marsh stages 1-2), 3719 patients with normal mucosa (Marsh stage 0), but positive celiac results for IgA/IgG gliadin, endomysium, or tissue transglutaminase. They then compared these results against and results for 213,208 age- and sex-matched control subjects. The team used conditional logistic regression to estimate odds ratios (ORs) for prior ASD diagnosis according to the Swedish National Patient Register and then conducted a second analysis, using Cox proportional hazards regression to estimate hazard ratios (HRs) for future ASDs in individuals undergoing small intestinal biopsy. They found that previous ASD was not associated with celiac disease (OR, 0.93; 95% CI, 0.51-1.68) or inflammation (OR 1.03; 95% CI, 0.40-2.64). However, they did finds that previous ASD was associated with a sharp higher risk of having normal mucosa but positive serologic test result for celiac disease (OR, 4.57; 95% CI, 1.58-13.22). Once the team restricted the data to individuals without no diagnosis for ASD at the time of biopsy, they found that celiac disease (HR, 1.39; 95% CI, 1.13-1.71) and inflammation (HR, 2.01; 95% CI, 1.29-3.13) were both connected with slightly higher risks of later ASDs, compared against the HR of 3.09 (95% CI, 1.99-4.80) for later ASDs in individuals with normal mucosa but positive celiac disease serologic test results. Even though this study showed no connection between previous ASD and celiac disease or inflammation, it did show that individuals with normal mucosa, but positive blood screens for celiac disease, have a much higher risk of ASD. Source: JAMA Psychiatry. Published online September 25, 2013. doi:10.1001/jamapsychiatry.2013.2048

Celiac.com 02/22/2012 - A research team recently conducted a dense genotyping non-HLA risk loci previously associated with immune-mediated diseases in individuals with celiac disease. The study was conducted under the auspices of the Genetics Department, University Medical Center and University of Groningen, The Netherlands. The team used variants from the 1000 Genomes Project pilot European CEU dataset, along with data from additional re-sequencing studies, to densely genotype a total of 183 non-HLA risk loci previously associated with immune-mediated diseases in 12,041 individuals with celiac disease and in 12,228 control subjects. They were able to discover thirteen new celiac disease risk loci reaching genome-wide significance. This discovery brings the number of loci known to be associated with celiac disease, including the HLA locus, to forty. The team found multiple independent association signals in more than one in three of the loci. This is likely due to a combination of common, low-frequency and rare genetic variants. Compared to earlier data, such as those from HapMap3, the large study group and the dense gene mapping made for a much higher resolution of the pattern of linkage disequilibrium and suggested localization of many signals to finer scale regions. In all, the team found that 29 of the 54 fine-mapped signals seemed to be localized to single genes and, in some instances, to gene regulatory elements. Finally, they defined the complex genetic architecture of the risk regions of celiac disease. They also refined the risk signals for celiac disease, which provide support for the next steps in understanding its causes. The research team included G. Trynka, K. A. Hunt, N. A. Bockett, J. Romanos, V. Mistry, A. Szperl, S. F. Bakker, M. T. Bardella, L. Bhaw-Rosun, G. Castillejo, E. G. de la Concha, R. C. de Almeida, K. R. Dias, C. C. van Diemen, P.C. Dubois, R. H. Duerr, S. Edkins, L. Franke, K. Fransen, J. Gutierrez, G. A. Heap, B. Hrdlickova, S. Hunt, L. P. Izurieta, V. Izzo, L. A. Joosten, C. Langford, M. C. Mazzilli, C. A. Mein, V. Midah, M. Mitrovic, B. Mora, M. Morelli, S. Nutland, C. Núñez, S. Onengut-Gumuscu, K. Pearce, M. Platteel, I. Polanco, S. Potter, C. Ribes-Koninckx, I. Ricaño-Ponce, S. S. Rich, A. Rybak, J. L. Santiago, S. Senapati, A. Sood, H. Szajewska, R. Troncone, J. Varadé, C. Wallace, V. M. Wolters, and A. Zhernakova. The study team also included B. K. Thelma, B. Cukrowska, E. Urcelay, J. R. Bilbao, M. L. Mearin, D. Barisani, J. C. Barrett, V. Plagnol, P. Deloukas, C. Wijmenga, and D. A. van Heel, who are variously affiliated with the Spanish Consortium on the Genetics of Coeliac Disease (CEGEC), the PreventCD Study Group, and the Wellcome Trust Case Control Consortium (WTCCC). Source: Nat Genet. 2011 Nov 6;43(12):1193-201. doi: 10.1038/ng.998.

Acta Psychiatr Scand 2005: 1-9. C 2005 Blackwell Munksgaard. Celiac.com 02/09/2006 – After a review of the medical literature, researchers have concluded that many cases of schizophrenia are related to celiac disease or gluten intolerance, and can be successfully treated using a gluten-free diet. Like celiac disease, schizophrenia affects approximately 1% of the population. It is considered one of the top 10 causes of disability worldwide. In many studies the researchers found that in a subset of patients a drastic reduction or total elimination of schizophrenic symptoms occurred after they were treated with a strict gluten-free diet. Based on this the researchers believe that a gluten-free diet may serve as a "safe and economical alternative for the reduction of symptoms in a subset of patients." They conclude: "Large-scale epidemiological studies and clinical trials are needed to confirm the association between gluten and schizophrenia, and address the underlying mechanisms by which this association occurs."

Celiac.com 08/10/2001 - The Celiac Sprue Association, under the new leadership of Mary Schluckebier, has recently taken an important step towards eliminating the lingering confusion surrounding its position on gluten-free foods. According to Janet Rinehart, the CSAs "Basics for a Celiac Diet" guidelines have recently been revised to include the following key changes: Canola oil is not mentioned (except where you might assume the connection for "general recommendations for those with a depressed immune system)." Rather than stating that quinoa, amaranth and teff are not safe for the celiac diet, the document now says: "Some celiacs have demonstrated toxicity or sensitivities to the following cereals: quinoa, amaranth and teff." Distilled vinegar, however, is still on the CSAs "Low Gluten Items to Avoid List." The CSA still maintains that distilled vinegar and alcohol are "questionable," even if there is no detectable gluten/gliadin in them, and even though the Gluten Intolerance Group (GIG), Celiac Disease Foundation (CDF) and the new guidelines from the American Dietetic Association (ADA) all include them on their safe lists . The CSA urges celiacs to ascertain the source of any questionable ingredients from their manufacturers. The CSAs new version of their "Celiac Disease Self-Management Chart for the Clinical Diet" advocates: A "self-management" approach to the diet, where the first stage is to eliminate anything questionable -conservative approach. Zero gluten is the goal. The second stage is to develop good methods for questioning products and controversial items/information. Then introduce new items, one at a time, at least two weeks apart. The third stage is to maintain a stable diet, using as many tools as possible. There is also a sample Food Diary Chart to use when beginning the zero gluten diet to track your meal planning (be sure to include brand names for reference). According to Janet Rinehart the CSAs new guidelines "are not incompatible with the new ADA recommendations in the later stages." Further: "We can use the CSA diet to start with, and then use the ADA recommendations and those published by GIG/CDF, depending on individual food sensitivities." She urges celiacs and support groups to quite blaming the CSA and instead work together to contribute positively to the success of all celiacs in all groups.

Celiac.com 12/28/2006 - The American Diabetes Associations (ADA) Clinical Practice Recommendations have been updated to include new information about treatment and prevention that reflects the latest research. Changes have been made in numerous areas, including the management of hyperglycemia in type 2 diabetes; nutrition recommendations; and screening and treatment for children who have both type 1 diabetes and celiac disease. In 2006, the ADA published Medical Nutrition Therapy (MNT) guidelines for people with diabetes, specific to individual populations, such as those who are obese or pregnant. The Clinical Practice Recommendations have been updated to reflect these guidelines and to encourage people with diabetes or pre- diabetes to seek individualized MNT to help them achieve their treatment goals. Information about how to treat children who are diagnosed with both type 1 diabetes and celiac disease was also added to the Clinical Practice Recommendations this year. Up to 16 percent of children with type 1 diabetes are also diagnosed with celiac disease, an immune disorder that affects the digestive system, damages the small intestine and interferes with the absorption of nutrients from food. The recommendations call for more aggressive screening for celiac disease in children with type 1 diabetes who present symptoms such as weight loss, growth failure, abdominal pain and chronic fatigue. A gluten-free diet is recommended for those who test positive for celiac. Diabetes Care, published by the American Diabetes Association, is the leading peer-reviewed journal of clinical research into the nations fifth leading cause of death by disease. Diabetes also is a leading cause of heart disease and stroke, as well as the leading cause of adult blindness, kidney failure, and non-traumatic amputations. For more information about diabetes call 1-800-DIABETES (1-800-342-2383).

Celiac.com 09/30/2002 - The Canadian Medical Association Journal (Hoey, 2002;166:479-80) published the following, Irritable Bowel Syndrome: Could it be Celiac Disease?, as excerpted below. This was an analysis of a Lancet article (Sander et al, 2001;358:1504-8) called, Association of Adult Coeliac Disease with Irritable Bowel Syndrome: A Case-Control Study in Patients Fulfilling Rome II Criteria Referred to Secondary Care. Here are the CMAJ excerpts: Irritable Bowel Syndrome is found in 10% to 20% of people with the use of standard diagnostic tools such as the Rome II criteria. Rome II criteria is specified below: At least 12 weeks, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that has 2 out of 3 features: Relieved with defecation Onset associated with a change in frequency of stool Onset associated with a change in form (appearance) of stool Symptoms that cumulatively support the diagnosis of irritable bowel syndrome: Abnormal stool frequency (more than 3 bowel movements per day or fewer than 3 bowel movements per week) Abnormal stool form (lumpy/hard or loose/watery stool) Abnormal stool passage (straining, urgency or feeling of incomplete evacuation) Passage of mucus Bloating or feeling of abdominal distention Question: What proportion of patients who meet the Rome II criteria for irritable bowel syndrome have celiac disease? Case subjects: The article cites that 300 people (214 women, 86 men ranging in age from 18 to 87, (mean 56 years)) met the Rome II criteria out of 686 new patients who were referred by a family physician to a university hospital gastroenterology clinic. Control subjects were healthy people without irritable bowel syndrome. Also, most control subjects were companions of the patients who were matched to case subjects by age (within 1 year) and sex, as well as questioned in the same manner as case subjects. All case and control subjects underwent a wide range of baseline investigations, including full blood count, measurement of erythrocyte sedimentations rate, blood urea nitrogen and serum electrolyte levels, and thyroid function tests. In addition, they were investigated for celiac disease by analysis of serum levels of IgG antigliadin, IgA antigliadin and endomysial antibodies. Most of the case subjects, particularly those older than 45, underwent colonoscopy or sigmoidoscopy and barium enema. Case and control subjects with positive antibody test results were offered duodenal biopsy to confirm the possibility of celiac disease. Of the 66 case subjects who had positive antibody test results, 49 had elevated levels of only IgG antigliadin 4 of only IgA antigliadin and 6 of only endomysial antibodies Fourteen of the 66 were subsequently found to have histologic evidence of celiac disease; 11 of the 14 were positive for endomysial antibodies. Nine of the of 66 case subjects were lost to follow-up or refused duodenal biopsy; 1 of them was positive for endomysial antibodies. Of the 44 control subjects who had positive antibody test results, 41 had elevated levels of only IgG antigliadin 1 of only IgA antigliadin and 2 of IgG antigliadin and endomysial antibodies Only the last 2 subjects elected to undergo duodenal biopsy, and both were found to have histologic evidence of celiac disease. Commentary: The authors found that a high proportion of patients (about 5%) who were referred to a university hospital gastroenterology clinic and who met the Rome II criteria did have celiac disease. In addition, the clinic specialists uncovered other organic abnormalities in almost 20% of the referred patients. The study had several weaknesses. For instance, although most of the case subjects underwent extensive investigations of the lower gastrointestinal tract, the control subjects did not. Thus, some of the case subjects who were lost to follow-up or refused investigation and many of the age-matched control subjects might have been found to have irritable bowel disease, celiac disease or other gastrointestinal abnormalities. The authors conclude from their findings that patients who meet the Rome II criteria for irritable bowel syndrome and who are referred to a secondary care centre should be investigated routinely for celiac disease. In an editorial accompanying the Lancet article, a gastroenterologist cautioned that more studies are needed. He noted an earlier study in which 121 consecutive patients were referred for investigation of irritable bowel syndrome. Using Rome I criteria and similarly extensive investigation, the researchers detected no cases of celiac disease. Because of the findings from the Lancet study, the editorialist has decided to further lower his threshold for screening for celiac disease among patients referred for investigation of irritable bowel syndrome. Perhaps other gastroenterologists would be wise to do the same. I verified the five percent as cited in the CMAJ as 14 out of the 300 patients who met the Rome II criteria also had celiac disease. The CMAJ also cites the following, Studies in Europe have shown that up to 1% of the adult population may have celiac disease. We can make our own conclusions from this study in Lancet and we might agree that 1% may be understated but further studies have to be performed to corroborate a higher percentage of undiagnosed celiacs; I hope this definitely encourages closer scrutiny of IBS patients like myself who was diagnosed with IBS in 1997 with only a symptom of left side tenderness below my rib cage and a sigmoidoscopy which revealed no abnormalities except a hemorrhoid. Then, in the summer of 2001, I was diagnosed with lactose intolerance and IBS once more before discovering from medical research and my food dairy taken since May 2001, along with corroboration by an allergist in October 2001, that it may be celiac disease, as my malabsorption symptoms grew worse.