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Celiac.com 12/23/2024 - Celiac disease is an autoimmune disorder that affects the small intestine, making it difficult for the body to absorb essential nutrients. This condition can occur globally, especially in individuals with other autoimmune diseases like Type 1 diabetes. In West Africa, however, there has been little research on celiac disease’s prevalence in populations with Type 1 diabetes, which prompted this study to investigate its occurrence among Nigerian children and adolescents with diabetes. Study Objectives and Design The study aimed to explore how frequently celiac disease autoimmunity occurs in Nigerian children and adolescents diagnosed with Type 1 diabetes. Researchers examined over 100 young patients from pediatric endocrinology clinics across Nigeria, gathering data on socio-demographic factors and clinical details like symptom history and overall health. To detect celiac disease autoimmunity, the study screened for specific antibodies in blood samples. Those with elevated antibody levels were encouraged to undergo an endoscopy and a biopsy to confirm a celiac disease diagnosis. Key Findings on Celiac Disease Autoimmunity Among the participants with Type 1 diabetes, around 6% showed signs of celiac disease autoimmunity based on elevated antibody levels. All cases occurred in females, primarily between ages 3 and 12. Most of the affected children experienced gastrointestinal symptoms, including nausea, vomiting, diarrhea, and bloating, which are typical symptoms of celiac disease. A notable finding was that children diagnosed with Type 1 diabetes before age 10 were more likely to have celiac disease autoimmunity compared to those diagnosed later. Regional and Gender-Based Patterns This study highlighted potential regional trends, finding that most children with celiac disease autoimmunity were from northern Nigeria, which borders regions in North Africa where celiac disease is more prevalent. This geographical proximity may play a role in increased autoimmune conditions due to genetic similarities and environmental factors. Additionally, the study confirmed that celiac disease autoimmunity appears more frequently in females, consistent with broader findings in autoimmune research. Challenges and Diagnostic Limitations Although antibody tests are useful in suggesting celiac disease autoimmunity, a duodenal biopsy is necessary to confirm the diagnosis. However, due to limited healthcare resources in Nigeria, most children with high antibody levels couldn’t complete a biopsy. Given the expense and accessibility issues related to this procedure, the study relied on combined antibody testing to improve diagnostic accuracy. Despite these constraints, researchers could identify patterns and suggest that screening programs might help to better understand the prevalence of celiac disease among high-risk groups in Nigeria. Comparisons with Other Regions The study’s findings align with similar research in Europe and the Middle East, where celiac disease occurs in approximately 5% of children with Type 1 diabetes. However, in certain African and Middle Eastern countries, the prevalence is often higher, likely due to genetic and dietary factors, as well as varying diagnostic practices. For example, countries like Egypt and Morocco report higher prevalence rates in children with diabetes than observed in Nigeria, which could be due to regional differences in food consumption, healthcare access, or population genetics. Implications for Health Practices in Nigeria This study brings attention to the potential for undiagnosed celiac disease in the general Nigerian population, especially among children with Type 1 diabetes. For individuals with both diabetes and celiac disease, untreated symptoms can lead to poor nutrient absorption, impacting their diabetes management and overall health. Diagnosing and managing celiac disease in young diabetic patients could improve their quality of life and reduce health risks related to nutrient deficiencies. Why These Findings Matter for Children with Type 1 Diabetes For healthcare providers, this research underscores the importance of routine screening for celiac disease in children and adolescents diagnosed with Type 1 diabetes. Early detection can help families and medical teams address dietary adjustments, specifically a gluten-free diet, to prevent complications and manage symptoms effectively. This study encourages proactive healthcare approaches, particularly for those at higher risk, and emphasizes the need for accessible diagnostic tools. By raising awareness and improving screening practices, the healthcare community can work to address the significant but often overlooked burden of celiac disease. Read more at: bmcgastroenterol.biomedcentral.com Watch the video version of this article:

Celiac.com 12/05/2023 - Tooth enamel, the outer protective layer of teeth, is formed through a complex process known as amelogenesis, which heavily relies on the function of ameloblasts – specialized epithelial cells in the jaw. The intricate interplay of various ameloblast-derived proteins serves as a scaffold for hydroxyapatite crystals, crucial for enamel structure. However, a recent groundbreaking study conducted by an international team of researchers, including those from the Institute of Dentistry at the University of Eastern Finland, has shed light on a previously unidentified type of autoimmune disorder affecting enamel formation. Autoantibodies and the Breakdown of Central Tolerance The study reveals a remarkable connection between tooth enamel developmental disorders found in autoimmune polyglandular syndrome type-1 (APS-1) and celiac disease. The majority of patients with these conditions develop autoantibodies, primarily of the IgA isotype, against ameloblast-specific proteins. These proteins, whose expression is induced by Autoimmune Regulator (AIRE) in the thymus, play a vital role in enamel formation. The breakdown of central tolerance, triggered by the presence of these autoantibodies, results in interference with the enamel development process. This marks a significant step forward in understanding the mechanisms underlying amelogenesis imperfecta in these autoimmune disorders. Peripheral Tolerance Breakdown and the Role of Gluten in Celiac Disease In the context of celiac disease, the study proposes a distinctive mechanism. The generation of autoantibodies against enamel-specific proteins appears to be driven by a breakdown of peripheral tolerance to intestinal antigens. Intriguingly, these antigens are also expressed in enamel tissue, linking gut proteins to the autoimmune response affecting tooth enamel. This novel insight challenges previous assumptions about the dental manifestations of celiac disease, suggesting that antibodies produced against gut or dietary proteins contribute to enamel defects by binding to proteins crucial for enamel development. Paving the Way for Understanding Autoimmune Amelogenesis Imperfecta This comprehensive study not only deepens our understanding of the intricate processes involved in enamel formation but also introduces a new paradigm – autoimmune amelogenesis imperfecta. The findings provide a foundation for further research into the specific mechanisms underlying this IgA-dependent autoimmune disorder, potentially opening avenues for targeted interventions and improved dental care for individuals with celiac disease and related autoimmune conditions. Read more: nature.com

Celiac.com 10/06/2023 - Typically, treating autoimmune diseases involves broad immunosuppression, which has various side effects. However, a team of researchers have developed a novel approach to suppress established antigen-specific immune responses without the need for global immunosuppression. The research team includes Andrew C. Tremain, Rachel P. Wallace, Kristen M. Lorentz, Thomas B. Thornley, Jennifer T. Antane, Michal R. Raczy, Joseph W. Reda, Aaron T. Alpar, Anna J. Slezak, Elyse A. Watkins, Chitavi D. Maulloo, Erica Budina, Ani Solanki, Mindy Nguyen, David J. Bischoff, Jamie L. Harrington, Rabinarayan Mishra, Gregory P. Conley, Romain Marlin, Nathalie Dereuddre-Bosquet, Anne-Sophie Gallouët, Roger LeGrand, D. Scott Wilson, Stephan Kontos, and Jeffrey A. Hubbell. They are variously affiliated with the Committee on Immunology, University of Chicago, Chicago, IL, USA; the Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA; the Committee on Cancer Biology, University of Chicago, Chicago, IL, USA; the Biomedical Engineering Department, Johns Hopkins University, Baltimore, MD, USA; the Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), Université Paris-Saclay, INSERM, CEA, Fontenay-aux-Roses, France; the Animal Resources Center, University of Chicago, Chicago, IL, USA; and with Anokion US Inc., Cambridge, MA, USA. Their study introduces a new method using a polymer glycosylated with N-acetylgalactosamine (pGal) that is conjugated to the antigen. This approach enables the dissociation of the antigen upon endocytosis, allowing it to be presented in an immunoregulatory environment. The research demonstrates that pGal–antigen therapy can induce antigen-specific tolerance in a mouse model of experimental autoimmune encephalomyelitis, driven by the programmed cell-death-1 pathway and the co-inhibitory ligand CD276. Moreover, this therapy effectively suppresses antigen-specific responses in non-human primates vaccinated against a DNA-based simian immunodeficiency virus. In essence, pGal–antigen therapy offers a promising avenue for addressing autoimmune diseases by specifically targeting and resolving antigen-specific inflammatory T-cell responses. In the future, this approach could be applied to various autoimmune diseases, possibly even celiac disease, offering a more precise and effective alternative to current treatments that rely on broader immunosuppression. Read more in Nature Biomedical Engineering

Celiac.com 10/05/2023 - Celiac disease, a condition that affects millions of individuals worldwide, is a well-known autoimmune disorder with far-reaching implications for those who have it. It's characterized by a unique response to gluten, a protein found in wheat, barley, and rye, leading to damage in the small intestine. While the intricacies of celiac disease itself are significant, what adds another layer of complexity to this condition is its intriguing association with a multitude of other autoimmune diseases. Autoimmune diseases, collectively, are a group of conditions in which the body's immune system mistakenly targets and attacks its tissues, organs, or systems. These conditions often share common features, including chronic inflammation and immune dysfunction. And what makes them even more intriguing is the tendency for individuals with one autoimmune disease to be at a heightened risk of developing others. This phenomenon has led researchers to explore the intricate web of interconnectedness between these conditions. The purpose of this article is to delve into this intricate web and shed light on the profound link between celiac disease and other autoimmune disorders. We'll explore the shared mechanisms that underlie these conditions, the genetic factors that may predispose individuals to multiple autoimmune diseases, and the environmental triggers that play a role in their development. Furthermore, we'll discuss the challenges of diagnosis and management, as well as potential strategies to improve the quality of life for those navigating the complex terrain of autoimmune diseases. As we embark on this journey of exploration, it becomes evident that understanding the connection between celiac disease and other autoimmune conditions not only provides insights into the fascinating workings of the human immune system but also holds promise for improved diagnostics and therapeutics. Whether you're a healthcare professional seeking a deeper understanding of these conditions or an individual living with celiac disease or an associated autoimmune disorder, this article aims to illuminate the path toward greater awareness, knowledge, and empowerment. Celiac Disease Explained Celiac disease, often described as a chameleon among autoimmune disorders, presents a fascinating interplay of genetics, environmental factors, and immune responses. To grasp its intricate connection with other autoimmune conditions, it's essential first to understand celiac disease itself. Defining Celiac Disease as an Autoimmune Disorder At its core, celiac disease is an autoimmune disorder, a classification that sets it apart from other gluten-related conditions like non-celiac gluten sensitivity. This autoimmune nature means that the immune system, our body's defense mechanism, mistakenly identifies a component of our own tissue as a threat and launches an attack. In the case of celiac disease, that target is the lining of the small intestine. When individuals with celiac disease consume gluten, a protein found in wheat, barley, and rye, their immune system mounts an immune response against it. The response involves the production of antibodies, particularly anti-tissue transglutaminase (tTG) and anti-endomysium antibodies. These antibodies target a specific protein called gliadin, found in gluten. The binding of antibodies to gliadin triggers an inflammatory cascade that damages the villi—small, finger-like protrusions—in the lining of the small intestine. As a result of this immune attack, the absorptive capacity of the small intestine is compromised. This is significant because the small intestine plays a crucial role in nutrient absorption. When the villi become damaged and flattened, it leads to malabsorption of essential nutrients like vitamins, minerals, and carbohydrates. This malabsorption can result in a range of symptoms and complications, from gastrointestinal discomfort to nutritional deficiencies, affecting various organ systems. The Role of Gluten in Triggering Celiac Disease Gluten, a protein complex composed of gliadin and glutenin, is the primary culprit in celiac disease. When individuals with a genetic predisposition to celiac disease consume gluten, it acts as the trigger that sets off the autoimmune response. However, not everyone who consumes gluten develops celiac disease. Genetic susceptibility is a crucial factor. The majority of individuals with celiac disease carry specific genetic markers, particularly the human leukocyte antigen (HLA) genes HLA-DQ2 and HLA-DQ8. These genes are not only associated with celiac disease but are also considered risk factors for other autoimmune conditions. It appears that a genetic predisposition to celiac disease may lay the foundation for susceptibility to other autoimmune diseases, creating a web of interconnectedness among these conditions. Prevalence and Demographics of Celiac Disease Celiac disease is more prevalent than once thought and affects individuals of all ages and backgrounds. Historically, it was often underdiagnosed or misdiagnosed due to its diverse clinical presentation. However, increased awareness and advancements in diagnostic tools have shed light on its true prevalence. Recent studies estimate that approximately 1% of the global population has celiac disease. In the United States alone, it is believed to affect at least 1 in 141 individuals. However, these numbers may be underestimations as celiac disease remains underdiagnosed. Celiac disease does not discriminate based on gender, although some studies suggest a slightly higher prevalence in females. It can manifest at any age, from infancy to late adulthood. Interestingly, there is a bimodal distribution, with two peaks of diagnosis: one in early childhood and another in the third to fifth decades of life. This bimodal pattern highlights the importance of considering celiac disease as a potential diagnosis throughout one's lifespan. Common Autoimmune Conditions Associated with Celiac Disease Celiac disease's intricate web of interconnectedness extends beyond its own autoimmune nature. It often walks hand in hand with a cohort of other autoimmune conditions, creating a challenging landscape for individuals managing multiple health concerns. Let's explore some of the autoimmune companions that frequently accompany celiac disease and the statistical associations that underscore their link. Type 1 Diabetes (T1D) Type 1 diabetes is an autoimmune disorder in which the immune system mistakenly targets and destroys insulin-producing cells in the pancreas. Individuals with T1D require insulin therapy for life. The link between celiac disease and T1D is well-established, with studies showing a significantly higher prevalence of celiac disease among individuals with T1D compared to the general population. This association has prompted routine screening for celiac disease in individuals diagnosed with T1D. Autoimmune Thyroid Diseases Celiac disease often forms a bond with autoimmune thyroid diseases, including Hashimoto's thyroiditis and Graves' disease. Hashimoto's thyroiditis is characterized by an immune attack on the thyroid gland, leading to hypothyroidism, while Graves' disease results in hyperthyroidism due to excessive thyroid hormone production. The co-occurrence of celiac disease and autoimmune thyroid diseases is not uncommon, emphasizing the importance of monitoring thyroid function in individuals with celiac disease. Rheumatoid Arthritis (RA) Rheumatoid arthritis is a chronic inflammatory disorder that primarily affects the joints. The relationship between celiac disease and RA is multifaceted. Some studies have shown an increased prevalence of celiac disease among RA patients, while others suggest that individuals with celiac disease may have a higher risk of developing RA. The exact mechanisms underlying this connection are still under investigation. Autoimmune Liver Diseases Autoimmune liver diseases, including autoimmune hepatitis and primary biliary cholangitis, can co-occur with celiac disease. These conditions involve the immune system mistakenly targeting the liver's cells or bile ducts. Routine screening for celiac disease is recommended for individuals diagnosed with autoimmune liver diseases, as prompt diagnosis and management can lead to improved outcomes. Inflammatory Bowel Disease (IBD) Inflammatory bowel disease encompasses conditions like Crohn's disease and ulcerative colitis, both of which involve chronic inflammation of the gastrointestinal tract. While the link between celiac disease and IBD is not as strong as with other autoimmune conditions, some studies have suggested a modestly increased risk of IBD in individuals with celiac disease. Sjögren's Syndrome Sjögren's syndrome is an autoimmune disorder that primarily affects the salivary and tear glands, leading to dry mouth and dry eyes. Although the association between celiac disease and Sjögren's syndrome is less common, it highlights the diverse range of autoimmune conditions that can coincide with celiac disease. Statistical Associations and Increased Risk The statistical associations between celiac disease and these autoimmune conditions are striking. For example, individuals with celiac disease are at a significantly higher risk of developing T1D, with some studies reporting a risk increase of up to 10 times compared to the general population. Similarly, the prevalence of autoimmune thyroid diseases is notably elevated in individuals with celiac disease, underlining the importance of monitoring thyroid function in this group. Understanding these statistical associations is essential for healthcare providers, as it informs screening and monitoring strategies. Individuals diagnosed with celiac disease should be vigilant about potential symptoms of these associated autoimmune conditions and collaborate closely with healthcare teams to manage their health effectively. Shared Mechanisms and Genetic Factors The intricate tapestry of autoimmune diseases suggests a shared genetic thread weaving through these conditions. Understanding the genetic factors at play, and particularly the concept of shared susceptibility genes, sheds light on the intricate connections between celiac disease and other autoimmune disorders. Exploring the Genetic Factors Genetics plays a pivotal role in the development of autoimmune diseases. While the precise genetic factors responsible for each autoimmune condition may vary, there are overarching genetic themes that link these disorders. Among these themes is the concept of shared susceptibility genes. Shared Susceptibility Genes Shared susceptibility genes are genetic variants that increase the risk of developing multiple autoimmune diseases. These genes do not exclusively cause one specific autoimmune condition but rather contribute to a heightened vulnerability to autoimmunity in general. When these susceptibility genes are present, they can manifest as different autoimmune disorders depending on additional factors, such as environmental triggers. In the context of celiac disease, several shared susceptibility genes have been identified. These genes are often associated with the major histocompatibility complex (MHC), a genetic region that plays a critical role in immune regulation. Notably, the HLA-DQ2 and HLA-DQ8 genes within the MHC region have garnered significant attention for their role in celiac disease and their implications for other autoimmune conditions. The Role of HLA-DQ2 and HLA-DQ8 Genes HLA-DQ2 and HLA-DQ8 are human leukocyte antigen genes that encode for proteins involved in presenting antigens to the immune system. These proteins are crucial in distinguishing between self and non-self substances, helping the immune system recognize and respond to potential threats. In the context of celiac disease, HLA-DQ2 and HLA-DQ8 genes are of paramount importance. The majority of individuals with celiac disease carry one or both of these genes, with HLA-DQ2 being the most common genetic marker. Having HLA-DQ2 or HLA-DQ8 does not guarantee the development of celiac disease but significantly increases the risk when combined with gluten exposure. Interestingly, these same HLA-DQ2 and HLA-DQ8 genes are also implicated in other autoimmune conditions. Individuals with celiac disease who carry these genes may find themselves at a higher risk of developing additional autoimmune disorders. The presence of these shared genetic markers creates a genetic bridge that connects celiac disease to a range of autoimmune companions. Understanding the role of HLA-DQ2 and HLA-DQ8 genes not only highlights the genetic commonalities among autoimmune diseases but also underscores the importance of genetic screening and risk assessment for individuals with celiac disease. It also emphasizes the need for vigilance in monitoring for the potential development of other autoimmune conditions, especially in those who carry these shared susceptibility genes. The Role of the Immune System To comprehend the intricate connection between celiac disease and other autoimmune conditions, we must delve into the workings of the immune system in the context of autoimmunity. Here we will explore how the immune system malfunctions, the formation and significance of autoantibodies, and the pivotal role of the gut-immune system connection. The Malfunction of the Immune System in Autoimmune Diseases The immune system is our body's defense mechanism against external threats such as bacteria, viruses, and other pathogens. In a healthy immune system, it distinguishes between the body's own cells and foreign invaders, mounting targeted responses to protect our well-being. However, in autoimmune diseases, this intricate defense system malfunctions. Instead of accurately discerning self from non-self, the immune system becomes confused and mistakenly identifies the body's own tissues, cells, or proteins as threats. This leads to the production of autoantibodies and immune responses that target healthy tissues, ultimately causing damage and inflammation. Formation and Role of Autoantibodies Autoantibodies are antibodies that the immune system produces against the body's own tissues or proteins. These autoantibodies play a central role in autoimmune reactions. In the context of autoimmune diseases like celiac disease, autoantibodies target specific proteins or structures within the body. In celiac disease, for instance, the immune system generates autoantibodies, primarily anti-tissue transglutaminase (tTG) and anti-endomysium antibodies, in response to the presence of gluten. These antibodies bind to gliadin, a component of gluten, and initiate an inflammatory cascade that leads to damage in the small intestine. The production of these autoantibodies is a hallmark of celiac disease and serves as a diagnostic marker. In other autoimmune conditions associated with celiac disease, such as Type 1 diabetes or autoimmune thyroid diseases, distinct autoantibodies target specific tissues or organs. For example, in Type 1 diabetes, autoantibodies may target insulin-producing cells in the pancreas, leading to insulin deficiency. The formation of autoantibodies is a key feature of autoimmune diseases and contributes to tissue damage, inflammation, and the diverse clinical manifestations of these conditions. The presence of autoantibodies can often aid in the diagnosis and monitoring of autoimmune diseases. The Gut-Immune System Connection and Its Significance in Celiac Disease In celiac disease, the gut-immune system connection assumes paramount importance. The gastrointestinal tract houses a significant portion of the body's immune cells and is a primary interface with the external environment, including dietary antigens like gluten. The lining of the small intestine, where gluten-triggered damage occurs in celiac disease, is studded with immune cells that continually surveil the contents passing through. This immune surveillance helps protect the body from harmful pathogens and antigens. However, in celiac disease, the immune system within the gut becomes sensitized to gluten, leading to an autoimmune response. The gut-immune system connection in celiac disease is a complex interplay of immune cells, cytokines (immune system signaling molecules), and the gut epithelial barrier. The autoimmune response initiated by gluten exposure involves the activation of immune cells, particularly T cells, which play a central role in orchestrating the inflammatory response. Understanding the gut-immune system connection highlights the unique nature of celiac disease and its distinction from other autoimmune conditions. It also underscores the importance of the gut environment and immune response in driving the pathogenesis of celiac disease. Environmental Triggers Autoimmune diseases are the result of a complex interplay between genetic susceptibility and environmental triggers. Understanding these triggers is crucial in comprehending why some individuals develop autoimmune conditions like celiac disease and their associated companions. Here we will discuss potential environmental triggers and their impact on the development of autoimmune diseases. Dietary Factors Gluten Exposure in Celiac Disease: Among dietary factors, gluten exposure is the primary trigger for celiac disease. Gluten, a protein found in wheat, barley, and rye, initiates an autoimmune response in individuals with celiac disease, leading to inflammation and damage in the small intestine. For those with genetic susceptibility (HLA-DQ2 and HLA-DQ8 genes), even small amounts of gluten can set off this response. The strict adherence to a gluten-free diet is the cornerstone of managing celiac disease. Infections Infectious Triggers: Infections, particularly viral and bacterial infections, have been proposed as potential triggers for autoimmune diseases. Infections can activate the immune system and, in some cases, lead to autoimmune responses. While the exact mechanisms are not fully understood, there is evidence linking certain infections to the onset or exacerbation of autoimmune conditions. However, it's essential to note that not everyone exposed to infections develops autoimmune diseases, suggesting that additional factors are at play. Lifestyle Choices Smoking and Autoimmunity: Smoking is a lifestyle factor that has been associated with an increased risk of several autoimmune diseases, including rheumatoid arthritis and systemic lupus erythematosus. Smoking can trigger inflammation and immune dysregulation, potentially contributing to the development of autoimmune conditions. Psychological Stress Stress and Autoimmunity: Psychological stress, whether acute or chronic, can influence the immune system and contribute to the development or exacerbation of autoimmune diseases. Stress can lead to changes in immune function and increase susceptibility to inflammation. While stress alone may not be the sole trigger for autoimmunity, it can play a role in the disease process. Environmental Toxins Environmental Toxins and Autoimmunity: Exposure to environmental toxins, such as heavy metals and industrial chemicals, has been investigated as a potential trigger for autoimmune diseases. Some toxins may disrupt immune function and contribute to the development of autoimmunity. However, the relationship between environmental toxins and autoimmune diseases is complex and requires further research. Gut Microbiota Microbiota and Immune Regulation: Emerging research suggests that the composition of the gut microbiota (the community of microorganisms in the digestive tract) may influence immune regulation and autoimmunity. Imbalances in the gut microbiota, often referred to as dysbiosis, have been observed in individuals with autoimmune diseases. Understanding the role of the gut microbiota in autoimmune conditions is an active area of investigation. Potential Triggers for Other Autoimmune Conditions While gluten exposure is a well-established trigger for celiac disease, other autoimmune conditions may have distinct environmental triggers. For example, infections, hormonal changes, and genetic factors may play a more prominent role in the development of Type 1 diabetes. The precise triggers for autoimmune diseases can vary widely, highlighting the complexity of these conditions. In the context of celiac disease, the potential for gluten to act as a trigger for other autoimmune conditions in genetically susceptible individuals is an area of ongoing research. The shared genetic susceptibility (HLA-DQ2 and HLA-DQ8) may predispose individuals to not only celiac disease but also other autoimmune companions. Identifying specific triggers for these associated autoimmune conditions remains an active area of investigation. Understanding the environmental triggers of autoimmune diseases is essential for prevention, early detection, and management. It also emphasizes the importance of individualized care and risk assessment, especially for those with a family history of autoimmune conditions or known genetic susceptibility. Diagnosis and Management Diagnosing and managing autoimmune diseases like celiac disease and their associated companions present a multitude of challenges. Below we will explore these challenges, the importance of diagnostic tests, and the array of treatment options available to individuals navigating the complex landscape of autoimmune diseases. Challenges in Diagnosis Heterogeneity of Symptoms: Autoimmune diseases often exhibit a wide range of symptoms, some of which can overlap with other medical conditions. This heterogeneity can make diagnosis challenging, as symptoms may vary greatly among individuals and may not always point clearly to a specific autoimmune disorder. Delayed Diagnosis: Due to the diversity of symptoms and lack of disease awareness, autoimmune diseases are frequently misdiagnosed or undiagnosed for an extended period. This delay in diagnosis can lead to complications and delayed treatment initiation. Overlapping Autoimmune Conditions: Some individuals may present with multiple autoimmune conditions simultaneously or sequentially. Recognizing these overlapping conditions and their distinct diagnostic criteria can be complex. Diagnostic Tests and Their Importance Serological Tests: Serological tests play a critical role in the diagnosis of autoimmune diseases, including celiac disease. For celiac disease, blood tests measuring specific antibodies, such as anti-tissue transglutaminase (tTG) and anti-endomysium antibodies, are essential diagnostic tools. These tests help identify individuals with potential celiac disease, prompting further evaluation. Genetic Testing: Genetic testing, particularly for HLA-DQ2 and HLA-DQ8 genes, can aid in assessing the risk of celiac disease. While carrying these genes increases susceptibility, genetic testing alone cannot diagnose celiac disease. However, it can inform risk assessment and guide diagnostic decisions. Endoscopy and Biopsy: The gold standard for diagnosing celiac disease remains an upper endoscopy with small intestinal biopsy. During this procedure, a small tissue sample is obtained from the duodenum and analyzed for characteristic changes, such as villous atrophy. This procedure provides a definitive diagnosis and assesses the degree of intestinal damage. Imaging and Additional Tests: Depending on the suspected autoimmune condition, additional tests, such as imaging studies, may be necessary to assess organ involvement and severity. Treatment Options Gluten-Free Diet: The cornerstone of celiac disease management is a strict gluten-free diet. Removing all sources of gluten from the diet is essential to prevent further damage to the small intestine and alleviate symptoms. Adhering to a gluten-free diet requires careful label reading, awareness of hidden sources of gluten, and ongoing vigilance. Medications: In some autoimmune conditions, such as rheumatoid arthritis and systemic lupus erythematosus, medications like disease-modifying antirheumatic drugs (DMARDs) and immunosuppressive agents are used to manage symptoms and prevent disease progression. Medication choices depend on the specific autoimmune condition and individual patient factors. Immunosuppressive Therapies: Immunosuppressive therapies, including corticosteroids and biologic agents, may be prescribed to suppress the immune response in certain autoimmune conditions. These treatments aim to reduce inflammation and minimize immune system activity. Lifestyle Modifications: Lifestyle changes, including stress management, regular exercise, and a balanced diet, can support overall health and well-being for individuals with autoimmune diseases. Smoking cessation is particularly important for conditions where smoking is a known risk factor. Ongoing Monitoring: Regular follow-up and monitoring are critical for individuals with autoimmune diseases. This includes tracking symptoms, assessing treatment effectiveness, and adjusting management strategies as needed. Individualized Care and Multidisciplinary Approach Autoimmune diseases are highly individualized, and management approaches should be tailored to each person's unique needs. A multidisciplinary healthcare team, including specialists in rheumatology, gastroenterology, endocrinology, and other relevant fields, can collaborate to provide comprehensive care. Additionally, patient education and support are essential for empowering individuals to manage their conditions effectively. In conclusion, autoimmune diseases like celiac disease are complex and multifaceted conditions that require a thorough understanding of their diagnosis and management. Despite the challenges they pose, early diagnosis, appropriate treatment, and lifestyle modifications can significantly improve the quality of life for individuals living with autoimmune diseases. By shedding light on the interconnectedness of these conditions and sharing knowledge about their diagnosis and management, we aim to provide valuable insights and support to those navigating the intricate terrain of autoimmunity. Lifestyle and Diet Considerations Living with celiac disease and associated autoimmune conditions presents unique challenges and opportunities for individuals seeking to manage their health effectively. Now we will offer practical advice and insights into lifestyle and dietary considerations that can make a substantial difference in one's journey toward improved well-being. The Foundation: Strict Gluten-Free Diet For individuals with celiac disease, the foundation of managing their condition lies in adhering to a strict gluten-free diet. This dietary approach involves eliminating all sources of gluten, which includes wheat, barley, rye, and their derivatives, from their food intake. Here's why this is crucial: Preventing Intestinal Damage: Gluten consumption triggers an autoimmune response in individuals with celiac disease, leading to inflammation and damage to the lining of the small intestine. Adhering to a gluten-free diet is essential for halting this process and allowing the intestine to heal. Alleviating Symptoms: Strict gluten avoidance helps alleviate the symptoms of celiac disease, which can range from digestive issues to skin problems, joint pain, and neurological symptoms. Reducing Long-Term Risks: By avoiding gluten, individuals with celiac disease can reduce their long-term risks of complications such as osteoporosis, nutritional deficiencies, and certain cancers. Beneficial Effects on Associated Autoimmune Conditions Interestingly, adhering to a strict gluten-free diet may also yield benefits for individuals with associated autoimmune conditions. While not a universal solution, some individuals report improvements in their overall health and reduction in symptoms related to other autoimmune disorders when gluten is removed from their diet. However, it's essential to emphasize that the degree of benefit can vary among individuals and autoimmune conditions. Dietary and Lifestyle Strategies to Reduce Inflammation In addition to gluten avoidance, individuals with autoimmune diseases can consider dietary and lifestyle strategies to reduce inflammation and improve their overall well-being: Anti-Inflammatory Diet: Adopting an anti-inflammatory diet can help manage symptoms and reduce the overall burden of inflammation. This diet typically includes: Fruits and Vegetables: Rich in antioxidants and phytonutrients that combat inflammation. Fatty Fish: Omega-3 fatty acids found in fish like salmon, mackerel, and sardines have anti-inflammatory properties. Healthy Fats: Olive oil, avocados, and nuts provide healthy fats that support immune health. Whole Grains: For those without celiac disease, whole grains like quinoa and brown rice can be part of an anti-inflammatory diet. Herbs and Spices: Turmeric, ginger, and garlic have anti-inflammatory effects. Stress Management: Chronic stress can exacerbate autoimmune symptoms. Stress-reduction techniques such as mindfulness, meditation, yoga, and deep breathing exercises can be valuable tools in managing stress and promoting relaxation. Regular Exercise: Physical activity has numerous health benefits, including reducing inflammation and improving mood. Consult with a healthcare provider to establish an exercise routine that suits your individual needs and capabilities. Adequate Sleep: Quality sleep is essential for immune function and overall health. Aim for 7-9 hours of restorative sleep each night. Hydration: Staying well-hydrated supports bodily functions and helps maintain healthy immune responses. Individualized Approach: It's important to recognize that what works for one person may not work for another. Autoimmune diseases are highly individualized, and it may take time to identify the dietary and lifestyle strategies that are most effective for you. Consulting with healthcare providers and registered dietitians who specialize in autoimmune conditions can provide personalized guidance. Empowering Wellness While living with celiac disease and associated autoimmune conditions can present challenges, it also offers an opportunity to take charge of one's health and well-being. By prioritizing a strict gluten-free diet, adopting anti-inflammatory dietary and lifestyle strategies, and seeking support from healthcare professionals, individuals can empower themselves to manage their conditions effectively and enhance their overall quality of life. Remember that knowledge, self-care, and a supportive network are powerful allies in the journey toward wellness while living with autoimmune diseases. Future Research and Insights As science continues to advance, so does our understanding of the intricate connections between celiac disease and other autoimmune conditions. Here we will explore ongoing research efforts and emerging therapies that hold promise in unraveling the complex web of autoimmunity and improving the management of autoimmune diseases. Ongoing Research Efforts Understanding the link between celiac disease and other autoimmune conditions is an area of active investigation. Ongoing research endeavors aim to shed light on several key aspects: Genetic Discoveries: Researchers are continually identifying new genetic factors associated with autoimmune diseases. These discoveries enhance our understanding of the shared genetic susceptibility among autoimmune conditions and may lead to improved risk assessment and personalized treatment approaches. Environmental Triggers: Investigating the environmental triggers of autoimmune diseases is a priority. Researchers are exploring the roles of infections, microbiota, dietary factors, and environmental toxins in autoimmunity to identify potential prevention strategies and therapeutic interventions. Immunological Insights: Advancements in immunology provide valuable insights into the mechanisms underlying autoimmunity. Research into immune cell interactions, cytokine profiles, and immune system dysregulation deepens our understanding of autoimmune processes. Biomarkers and Diagnostics: The development of more sensitive and specific biomarkers for autoimmune diseases can aid in early diagnosis and monitoring. Biomarker research aims to improve diagnostic accuracy and facilitate timely intervention. Emerging Therapies and Breakthroughs Promising therapies and breakthroughs are on the horizon for autoimmune disease management: Immunomodulatory Therapies: Novel immunomodulatory therapies are being developed to target specific immune pathways involved in autoimmune diseases. These therapies aim to reduce inflammation and suppress aberrant immune responses while minimizing side effects. Precision Medicine: The concept of precision medicine, tailoring treatments to an individual's unique genetic and immunological profile, is gaining traction. This approach may lead to more effective and personalized management strategies. Biologic Therapies: Biologic therapies, such as monoclonal antibodies, are showing promise in treating autoimmune conditions like rheumatoid arthritis and inflammatory bowel disease. These therapies target specific molecules involved in the immune response, providing targeted relief. Microbiome Interventions: Research into the gut microbiome and its role in autoimmunity is paving the way for microbiome-based interventions. Modifying the gut microbiota through diet, probiotics, or fecal microbiota transplantation may offer therapeutic potential. Stem Cell Therapies: Stem cell therapies, including hematopoietic stem cell transplantation, are being explored for certain severe autoimmune diseases. These therapies aim to reset the immune system and halt autoimmune responses. Patient-Centered Care: The shift toward patient-centered care involves recognizing the individuality of autoimmune diseases and tailoring treatment plans to patients' preferences and needs. Shared decision-making and patient education play central roles in this approach. Collaborative Research: Collaborative efforts among researchers, healthcare providers, and patient advocacy groups are fostering a multidisciplinary approach to autoimmune disease research and care. These collaborations accelerate progress and enhance patient support. A Promising Future The ongoing research and emerging therapies in the realm of autoimmune diseases offer hope for improved management and enhanced quality of life for individuals living with these conditions. While challenges persist, the dedication of researchers, healthcare providers, and individuals themselves is driving advancements that hold the potential to transform the landscape of autoimmune disease care. As we look toward the future, the shared goal is to better understand, prevent, and effectively manage autoimmune diseases, ultimately providing individuals with the support and treatments they need to thrive. Conclusion In the complex and interconnected world of autoimmune diseases, the link between celiac disease and other autoimmune conditions serves as a compelling illustration of the multifaceted nature of these disorders. Throughout this article, we have explored the intricate web of autoimmunity, highlighting key insights, challenges, and promising developments. As we conclude, let's recap the key takeaways and underscore the significance of early diagnosis, effective management, and a collaborative, multidisciplinary approach to autoimmune disease care. Key Takeaways Understanding Autoimmunity: Autoimmune diseases, including celiac disease, are characterized by the immune system mistakenly attacking the body's own tissues. These conditions are marked by diversity in symptoms and a complex interplay of genetic and environmental factors. Celiac Disease Explained: Celiac disease is a well-studied autoimmune condition triggered by the consumption of gluten-containing foods. It affects the small intestine and can lead to a wide range of symptoms, making accurate diagnosis crucial. Common Autoimmune Companions: Celiac disease often coexists with other autoimmune conditions, such as Type 1 diabetes, autoimmune thyroid diseases, and rheumatoid arthritis. Individuals with celiac disease may have an increased risk of developing these companions. Shared Genetic Susceptibility: The presence of certain genetic markers, particularly HLA-DQ2 and HLA-DQ8 genes, is associated with an increased risk of celiac disease and may contribute to the development of other autoimmune conditions. Immune System Dysfunction: Autoimmune diseases are characterized by immune system dysfunction, leading to the production of autoantibodies that target the body's own tissues. In celiac disease, gluten exposure triggers this autoimmune response. Environmental Triggers: Environmental factors, such as infections, dietary factors, and lifestyle choices, can influence the development and progression of autoimmune diseases. A strict gluten-free diet is essential for managing celiac disease, while other autoimmune conditions may have distinct triggers. Diagnosis and Management: Diagnosing autoimmune diseases can be challenging due to the heterogeneity of symptoms. Serological tests, genetic testing, endoscopy, and additional evaluations play critical roles in diagnosis. Treatment approaches vary but may include strict dietary measures, medications, immunosuppressive therapies, and lifestyle modifications. Lifestyle and Diet Considerations: Adhering to a strict gluten-free diet is foundational for individuals with celiac disease. Anti-inflammatory dietary choices, stress management, regular exercise, and adequate sleep can support overall well-being and symptom management. Future Research and Insights: Ongoing research efforts aim to uncover the complexities of autoimmune diseases, including the genetic, environmental, and immunological factors at play. Emerging therapies, precision medicine approaches, and collaborative research hold promise for improving autoimmune disease management. The Path Forward As we navigate the intricate terrain of autoimmune diseases, it's essential to emphasize several critical principles: Early Diagnosis: Early diagnosis is paramount for improved outcomes. If you suspect an autoimmune condition, seek medical evaluation promptly. Early intervention can prevent complications and promote better quality of life. Effective Management: Managing autoimmune diseases requires a comprehensive, multidisciplinary approach. Collaborate with healthcare providers, including specialists, registered dietitians, and mental health professionals, to develop personalized care plans. Stay Informed: Stay informed about the latest research and advancements in autoimmune disease care. Knowledge empowers individuals to make informed decisions about their health and treatment options. Advocate for Yourself: Be an advocate for your own health. If you have concerns or questions, don't hesitate to discuss them with your healthcare team. Your active involvement in your care can lead to better outcomes. Connect with Support Networks: Consider connecting with patient advocacy groups and support networks for autoimmune diseases. These communities provide valuable resources, information, and a sense of belonging. In closing, the journey of living with autoimmune diseases, whether it's celiac disease or one of its associated companions, is marked by resilience, adaptability, and the pursuit of wellness. By understanding the complexities of autoimmunity, seeking timely diagnosis and effective management, and embracing a collaborative and informed approach, individuals can navigate the challenges of autoimmune diseases with confidence and hope. Remember that you are not alone on this journey, and together, we continue to advance our understanding and care of autoimmune conditions.

Celiac.com 09/25/2023 - Professor Jeffrey Hubbell and a team of researchers at the University of Chicago's Pritzker School of Molecular Engineering has developed a novel type of vaccine known as an "inverse vaccine." This innovative vaccine has shown promise in laboratory settings for the treatment of autoimmune diseases such as multiple sclerosis, type 1 diabetes, and Crohn's disease. Importantly, it achieves this without suppressing the entire immune system, as is often the case with current treatments. Could such treatment work for celiac disease? How the Inverse Vaccine Works Traditional vaccines are designed to train the immune system to recognize and attack harmful viruses or bacteria. In contrast, the inverse vaccine takes a different approach. It aims to erase the immune system's memory of a specific molecule. This concept is particularly useful in autoimmune diseases, where the immune system mistakenly attacks the body's healthy tissues. The development of the inverse vaccine is based on the liver's natural mechanism of marking molecules from broken-down cells with signals that instruct the immune system not to attack them. Researchers combined an antigen (a molecule targeted by the immune system in autoimmune diseases) with a molecule resembling a fragment of an aged cell. This mimicry tricks the liver into recognizing the antigen as a friend rather than a foe, effectively stopping the autoimmune reaction. The research team successfully demonstrated the effectiveness of this inverse vaccine in halting autoimmune reactions in a disease model resembling multiple sclerosis. In multiple sclerosis, the immune system attacks myelin, the protective coating around nerves, leading to symptoms such as weakness, numbness, vision loss, and mobility problems. By linking myelin proteins to the molecule recognized by the liver, the researchers were able to prevent the immune system from attacking myelin. This allowed nerves to function properly again, ultimately reversing the disease's symptoms in animal subjects. Importantly, the inverse vaccine approach could have significant advantages over current treatments for autoimmune diseases. Many existing treatments involve broadly suppressing the entire immune system, which can lead to various side effects and increase the risk of infections. In contrast, the inverse vaccine offers a more targeted and specific way to modulate the immune response, potentially minimizing side effects. While further research is needed, initial phase I safety trials have already been conducted in humans with celiac disease, and are underway in multiple sclerosis. These trials are sponsored by the pharmaceutical company Anokion SA, which also contributed to the research. The development of clinically approved inverse vaccines is an exciting prospect, as they could provide more effective and precise treatments for autoimmune diseases, improving the quality of life for patients. Read more at the Pritzker School of Molecular Engineering

Celiac.com 05/16/2011 - Nearly 75% of the 24 million Americans suffering from autoimmune disease are women, according to the American Autoimmune Related Diseases Association (AARDA). Women appear to mount larger inflammatory responses than men when their immune systems are triggered, thereby increasing their risk of autoimmunity. The fact that sex hormones are involved is indicated by the fact that many autoimmune diseases fluctuate with hormonal changes such as those that occur during pregnancy, during the menstrual cycle, or when using oral contraceptives. A history of pregnancy also appears to increase the risk for autoimmune disease. The sex hormone that is commonly low in such women is Dehydroepiandrosterone (DHEA). This is a natural steroid and is produced by the adrenal glands, the reproductive organs and the brain. DHEA is used by the body to make the male and female hormones, testosterone and estrogen respectively, and is known to have anti-inflammatory effects. It has been proposed that a DHEA deficiency is a contributing factor in autoimmune diseases. Last year a study was done to look at precisely that effect. The study’s conclusions have been supported by other, similar research and I think you’ll find it quite interesting. The Journal of Clinical Endocrinology & Metabolism Vol. 94, No. 6 2044-2051(2009) published an article entitled “Low Serum Levels of Sex Steroids Are Associated with Disease Characteristics in Primary Sjogren’s Syndrome; Supplementation with Dehydroepiandrosterone Restores the Concentrations”. The authors investigated whether there was a relationship between steroid levels and the disease characteristics of Sjogren’s. They based their study on the known data that DHEA not only declines with aging but is reduced in Sjogren’s, an autoimmune disease. The study was populated by 23 post-menopausal women with primary Sjogren’s syndrome and subnormal levels of DHEA. The investigation was a controlled, double blind crossover study, conducted over a 9 month period, where DHEA was assessed by sophisticated laboratory measurements and typical symptoms of Sjogren’s such as dry mouth and eyes and salivary flow rates were similarly assessed. Results revealed a strong correlation between low DHEA and Sjogren’s symptoms. DHEA and its sex hormone metabolites (testosterone and estrogen) were found to increase with DHEA supplementation but not with the placebo. Symptoms such as dry eyes were seen to improve as estrogen levels The researchers concluded that the disease manifestations of primary Sjogren’s syndrome were associated with low sex hormone levels and the supplementation of DHEA allowed the body to transform into androgens, testosterone and estrogen, with testosterone production predominating. Please allow me to add some personal interpretation. For the most part I agree with the premise and applaud the results. The facts that autoimmune disease occurs more often in women, that women frequently have low DHEA, and that androgens have anti-inflammatory effects that can benefit autoimmune disease are all true. But should we simply give such women DHEA and call it a day? I don’t think so. I propose that we do three things: First, evaluate hormonal levels in women regularly; Second, address WHY their hormonal levels are imbalanced; And third, when supplementing with hormones such as DHEA, ensure that the delivery system is one that mimics what the body does naturally. Remember that autoimmune disease can begin many years before the first symptoms become manifest. Therefore evaluating hormonal levels in our younger women is a good idea. When I find DHEA levels that are low, my first order of business is to assess why. Frequently it is due to a phenomenon known as “pregnenelone steal” that occurs when the adrenal glands are under stress. It is a common occurrence and one of the fantastic abilities of the human body to shift from one pathway to another when under stress. The “steal” pathway diverts the body away from making sex hormones and instead it makes more “stress” hormones. So while adding some DHEA into the mix might very well help, does it make sense to find out WHY it’s being diverted away from making sex hormones? I hope so because it’s the very foundation of the medicine that we practice—functional medicine. Once you understand the root cause of the deficiency you can take steps to truly remedy it rather than simply covering it up by taking DHEA. Not to keep hitting you over the head with this concept, but supplementing with DHEA as your sole treatment misses the underlying cause since the body is designed to make adequate quantities of DHEA. A common reason for the diversion or “steal” pathway to become activated is adrenal stress from poor absorption of nutrients, unstable blood sugar and the presence of infections—all problems we see with the gluten intolerant patient! While I’m not implying that every autoimmune patient has a gluten intolerance, it certainly warrants screening all of them because of its high prevalence. As we travel down the road to optimal health through avoiding any food the body isn’t tolerating well, improving the integrity of the small intestine and normalizing adrenal function, there are certainly times when hormonal supplementation is beneficial. I don’t recommend the oral route because the first place the hormone travels is to the liver and this can be burdensome to that organ. When the body makes hormones naturally it delivers them straight to the bloodstream. In an effort to mimic that delivery system we use a buccal route (placed between cheek and gum in the mouth) that does a good job in bringing the hormone directly to the bloodstream and bypassing the liver and digestive tract. Autoimmune diseases comprise the third leading cause of death in our country and research strongly suggests that its rapid increase is due to environmental factors, especially those that weaken the small intestine. I am committed to earlier diagnosis while the disease is still remediable, as well as overall reduction of incidence through addressing digestive health. I hope you find this informative. Please share this information with those who have autoimmune disease themselves as well as in their family.

Celiac.com 12/12/2022 - Atopic dermatitis is associated with immune dysregulation, but epidemiological data on the pattern of autoimmune comorbidity in people with atopic dermatitis are limited. A team of researchers recently set out to determine the risk of autoimmune conditions in people newly diagnosed with atopic dermatitis. The research team included Simon de Lusignan, MD; Helen Alexander, BSc, MBBS; Conor Broderick, MB, BCh, BAO, MSc; Andrew McGovern, MD; Claire Feeney, PhD; Carsten Flohr, PhD. They are variously affiliated with theNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom; the Royal College of General Practitioners Research and Surveillance Centre, London, United Kingdom; the Unit for Population-Based Dermatology Research, St John’s Institute of Dermatology, Guy’s & St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom; the Momentum Data, Pendragon House, St Albans, United Kingdom; and with Pfizer Ltd, Tadworth, United Kingdom. A Retrospective Cohort Analysis The team used the the UK-based Oxford–Royal College of General Practitioners Research and Surveillance Centre primary care database to conduct a retrospective cohort analysis that covered the period from January 2009 to December 2018. They compared baseline rates and incidents after diagnosis of autoimmune conditions in nearly 175,000 children and adults with new-onset atopic dermatitis, and nearly 700,000 control subjects, matched for age, sex, and general practitioner practice. Outcomes were a composite of any autoimmune condition, including Crohn disease, ulcerative colitis, celiac disease, pernicious anemia, type 1 diabetes, autoimmune hypothyroidism, Graves disease, psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, Sjögren syndrome, vitiligo, alopecia areata, and multiple sclerosis, and each individual autoimmune condition. Their Findings The team found that people diagnosed with atopic dermatitis were more likely to have an existing autoimmune condition, compared to control subjects. Once the team eliminated patients with preexisting autoimmune disease, they found a connection between atopic dermatitis and cases of new-onset autoimmune disease. Patients with more severe atopic dermatitis faced a greater risk than those with moderate or mild atopic dermatitis. People with atopic dermatitis also faced a significantly higher risk for psoriatic arthritis, Sjögren syndrome, Crohn disease, vitiligo, alopecia areata, pernicious anemia, ulcerative colitis, rheumatoid arthritis, and hypothyroidism, but not for other autoimmune conditions. Conclusions From their results, the team concludes that people with atopic dermatitis, especially those with severe atopic dermatitis, face significantly higher risk for developing numerous other autoimmune conditions. Stay tuned for more on this and related stories. Read more in: Allergy and Clinical Immunology

Celiac.com 08/10/2022 - Celiac disease is a common inflammatory disease of the small intestine. Hashimoto's thyroiditis and Graves' disease make up most cases of autoimmune thyroid disease, and are marked by lymphocytic infiltration of the thyroid parenchyma. Both Hashimoto's thyroiditis and Graves' disease are often seen together with celiac disease. Meanwhile, patients with monoglandular and polyglandular autoimmunity have a higher rates of celiac disease. Rising rates of celiac disease among autoimmune thyroid disease patients has prompted researchers to investigate the link between the two. A team of researchers recently set out to review the medical literature to more clearly illuminate the connections between celiac disease and thyroid autoimmunity. The team's goal was to study the shared genetic background, the incidence of celiac disease in autoimmune thyroid disease, the effect of a gluten-free diet on autoimmune thyroid disease, and the need for routine screening of celiac disease in autoimmune thyroid disease patients. The research team included Tejaswini Ashok, Nassar Patni, Mahejabeen Fatima, Aselah Lamis, and Shiza W. Siddiqui. They are variously affiliated with the Research at Dubai Medical College in Dubai, ARE; Research, Dubai Medical College for Girls in Dubai, ARE; and Internal Medicine, Deccan College of Medical Sciences in Hyderabad, India. Researchers think that shared genetic background is likely the main reason for the connection, as there seems to be a substantial overlap in genetic variables between celiac disease and autoimmune thyroid disease. Because of the subclinical aspects of the celiac disease, doctors often miss the diagnosis or make it coincidentally during screening. The rising rates of celiac disease in autoimmune thyroid disease patients is well documented. Moreover, most studies on the effects of a gluten-free diet in autoimmune thyroid disease patients with celiac disease have shown beneficial effects for the management of both diseases. To create a clinical therapy regimen to manage these two concurrent disorders, the team calls for more study on autoimmune thyroid disease patients for genes related to celiac disease, and to subclinical and clinical celiac disease rates. They note that the multi-system nature of celiac disease warrants a multidisciplinary research and treatment approach that meshes with the diagnostic algorithm of autoimmune thyroid diseases to give patients with both autoimmune thyroid disease and celiac disease the best possible treatment. Read more at Cureus.com

Celiac.com 10/20/2020 - Doctors diagnosing children for type 1 diabetes are increasingly finding other autoimmune conditions that can complicate the outlook for these patients. A team of researchers recently set out to study rates of comorbid autoimmune diseases, including celiac disease, and type 1 diabetes mellitus (T1D) in children. Rates of type 1 diabetes mellitus (T1D) in children are on the rise, but it's unclear what relationship, if any, this might have with other coexistent autoimmune conditions, since diabetes onset is not well understood. The team wanted to assess the incidence of T1D, and the rates of coexistent autoimmune illnesses, from the onset of diabetes mellitus in children over a nine year study period. In their retrospective study, the team calculated incidence rate for T1D as the total number of all newly diagnosed cases per 100,000 population in people between 0 and 18 years of age. The team studied 264 boys and 229 girls between 0 and 18 years old with newly diagnosed with T1D in one of the Polish centers from 2010–2018. They determined diagnoses for related autoimmune illnesses from initial data recorded when patients first received diagnosis for T1D. The team found that the standardized incidence rate of T1D in children rose 170% over the 9-year study period, while the incidence rate ratio rose 4% per year. As rates of T1D have risen rapidly in all children of all ages in recent years, so, too have rates of the autoimmune diseases that frequently accompany these conditions. Having an additional autoimmunity disorder is a serious burden for patients with new-onset T1D. Stay tuned for more information on the challenges faced by children with more than one auto-immune disease. Read more in Front Endocrinol (Lausanne). 2020; 11: 476. Reference: Głowińska-Olszewska B, Szabłowski M, Panas P, et al. Increasing co-occurance of additional autoimmune disorders at diabetes type 1 onset among children and adolescents diagnosed in years 2010-2018—single-center study. Front Endocrinol. Published online August 6, 2020. doi:10.3389/fendo.2020.00476. The research team included Barbara Głowińska-Olszewska, Maciej Szabłowski, Patrycja Panas, Karolina Żoła̧dek, Milena Jamiołkowska-Sztabkowska, Anna Justyna Milewska, Anna Kadłubiska, Agnieszka Polkowska, Włodzimierz Łuczyński, and Artur Bossowski. They are variously affiliated with the Department of Pediatrics, Endocrinology, Diabetology With Cardiology Division, Medical University of Bialystok, Białystok, Poland; the Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, Białystok, Poland; the Department of Statistics and Medical Informatics, Medical University of Bialystok, Białystok, Poland; and the Department of Medical Simulations, Medical University of Bialystok, Białystok, Poland.

Celiac.com 02/28/2022 - Immune regulation is important for carcinogenesis; however, the cancer risk profiles associated with immune-mediated diseases, like celiac disease, are not well understood. A team of researchers recently set out to assess the profiles of cancer risk associated with 48 immune-mediated diseases with the risk of total and individual cancers. They also assessed the prospective association of organ-specific immune-mediated diseases with the risk of local and extra-local cancers. The research team included Ming-ming He, MD; Chun-Han Lo, MD, MPH; Kai Wang, MD, PhD; Georgios Polychronidis, MD; Liang Wang, MD; Rong Zhong, PhD; Markus D. Knudsen, PhD; Zhe Fang, MD; and Mingyang Song, MD, ScD. For their prospective cohort study, the team used data from the UK Biobank cohort study on adults aged 37 to 73 years who were recruited at twenty-two assessment centers throughout the UK between January 1, 2006, and December 31, 2010, with follow-up through February 28, 2019. After adjusting for various potential confounders using time-varying Cox proportional hazards regression, the team assessed the connection between immune-mediated diseases with risk of cancer with multivariable hazard ratios (HRs) and 95% CIs. They used the contrast test method to assess heterogeneity in the associations of organ-specific immune-mediated diseases with local and extra-local cancers. In this group study of nearly half a million participants, the team found that immune-mediated diseases were associated with an increased total cancer risk. Organ-specific immune-mediated diseases showed higher associated risk of local cancers than extra-local cancers, and many immune-mediated diseases were associated with increased risk for cancer in the near and distant organs or other systems. Organ-specific immune-mediated diseases had stronger associations with risk of local cancers than extralocal cancers. The associations for individual immune-mediated diseases were largely organ specific, but were also seen for some cancers in the near and distant organs or different systems. Their findings suggest that immune-mediated diseases are associated with risk of cancer at the local and systemic levels, which supports the role of local and systemic immunoregulation in the development of cancers. Read more in JAMA Oncology The researchers are variously affiliated with the Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; the Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston; the Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston; the Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; the Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany; the Center of Gastrointestinal Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; the Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway; the Division of Surgery, Department of Transplantation Medicine, Inflammatory Diseases and Transplantation, Norwegian PSC Research Center, Oslo University Hospital, Oslo, Norway; and the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Celiac.com 01/17/2022 - People with autoimmune disorders face an elevated risk for celiac disease, but there's no clear data to show exactly how high that risk might be. To clarify the issue, a team of researchers recently set out to assess the incidence of autoimmune disorders in treated patients with celiac disease. The research team included Muhammad R. Khan; Shilpa S. Nellikkal; Ahmed Barazi; Joseph J. Larson; Joseph A. Murray; and 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 conduct a retrospective medical record search for patients diagnosed with celiac disease at the Mayo Clinic's Olmsted Medical Center from January 1997 to December 2015. For each patient with celiac disease, the team assigned two non-celiac control subjects matched for age and sex during the study period. They used Kaplan-Meier analysis to determine the incidence rate of autoimmune disorder diagnosis five years after index date, for the celiac disease cases and controls. They then compared the results using the log-rank test. They found nearly 250 treated patients with celiac disease during the study period, matched to just under 500 matched control subjects. About one third of patients were boys. Within five years of the index date, 5.0% of celiac patients had a new autoimmune disorder diagnosis, compared with 1.3% of non-celiac control subjects. In the presence of a prior autoimmune disorder, the celiac disease group faced a much higher cumulative risk of a new or additional autoimmune disorder compared with control subjects. The data show that treated patients with celiac disease face a higher risk of developing autoimmune disorders than non-celiacs. The risk of a new autoimmune disorder is significantly higher in children, especially those with an existing autoimmune disorder. Read more: Journal of Pediatric Gastroenterology and Nutrition, October 2019 - Volume 69 - Issue 4 - p 438-442

Celiac.com 06/03/2021 - With autoimmune conditions on the rise, and concerns about inflammatory conditions growing, more and more people are looking for dietary alternatives to promote immune health and fight inflammation, especially for those with autoimmune conditions. There have been a number of diets aimed at health improvement, but not many focused on autoimmune conditions. The latest approach to using diet to help people improve symptoms of autoimmune conditions is called the Autoimmune protocol diet (AIP diet). What is the AIP Diet? The AIP diet is a nutrition plan to help people with autoimmune conditions lessen symptoms and improve their quality of life. The AIP diet eliminates foods that may worsen symptoms or increase inflammation. The AIP diet is designed to treat most autoimmune conditions, including: Celiac disease Crohn’s disease Hashimoto’s thyroiditis Lupus Multiple sclerosis Rheumatoid arthritis Sjögren’s syndrome Transverse myelitis Ulcerative colitis What foods can you eat on an AIP diet? The AIP diet includes nutrient-dense foods that supposedly reduce inflammation and promote healthy gut bacteria. The idea is that improving gut health will help improve autoimmune conditions. The AIP diet includes: Chicken Coconut Coconut oil Fish Fruits Meat Vegetables (except nightshades) What foods does the AIP diet eliminate? Though formulations can vary, the AIP diet looks to eliminate foods that promote inflammation. The AIP diet eliminates: Dairy Food additives (e.g. nitrates, emulsifiers, preservatives) (1) Gluten Grains Nuts and seeds Legumes (beans, peanuts) Nightshade vegetables (tomatoes, peppers, potatoes, and eggplant) Oils (e.g. soy and canola oil) Added sugars and sweeteners Coffee and alcohol The role of food in autoimmune disease Diet has a great influence on gut health, and more and more clinicians are looking at the role of diet on autoimmune disease. Celiac disease is an autoimmune disorder that is treated solely by diet. We know that the gluten-free diet used to treat celiac disease positively changes gut bacteria. Could an AIP diet provide further improvement? Early research supports AIP diet A number of studies have shown promising results using an Autoimmune Protocol Diet on patients with autoimmune conditions. Inflammatory Bowel Disease ( Crohn’s & Ulcerative Colitis) In 2017, researchers conducted the first known study using the AIP diet to treat inflammatory bowel disease. They assessed 15 patients with either Crohn’s disease or ulcerative colitis, who followed a 6-week elimination diet. During this period, the patients eliminated foods prohibited by the Autoimmune Protocol Diet. After the first 6 weeks, they continued on the AIP diet for 5 weeks. Patients experienced general reduction in inflammation, and after the first 6 weeks, 73% were in remission and stayed in remission for the duration of the diet. Hashimoto's-Autoimmune Hypothyroidism A small 2019 study that assessed the AIP diet in conjunction with lifestyle changes on people with Hashimoto’s thyroid disease showed that after 10 weeks, patients saw a substantial improvement in the quality of life, disease burden, and inflammation markers in the blood. Multiple Sclerosis (MS) When conventional medication and treatment failed to stop multiple sclerosis progression in Dr. Terry Wahls, she designed and adopted a strict, modified paleo AIP diet. Dr. Wahls went from using a wheelchair to riding her bicycle. Her diet formed the basis for a 2015 study that showed dietary changes similar to the AIP diet helped people with multiple sclerosis to feel better and have fewer symptoms. In fairness, Dr. Wahls' approach includes lifestyle modifications, daily stretching, nutritional supplements, and stress management, so the results may not be due solely to diet. However, diet was surely a part of the results. Recent Research On The AIP Diet includes: Efficacy Of The Autoimmune Protocol Diet For Inflammatory Bowel Disease Efficacy Of The Autoimmune Diet For Hashimoto’s Thyroid Disease The Autoimmune Protocol Diet And Effect On Quality Of Life In Inflammatory Bowel Disease The Autoimmune Protocol Diet And It’s Effect On Gene Expression In Inflammatory Bowel Disease The Drawbacks Of AIP Of course, it is important to get plenty of exercise and rest, keep stress low, and maintain healthy vitamin D levels, all of which have been shown to affect inflammation, which is a key component of autoimmune disease. But, now we know the effect of diet on autoimmune disease is real. Thus far, the results of studies done on the specific effect of the AIP diet on autoimmune disease have been encouraging. They have been shown to help lower inflammation and improve quality of life by reducing symptoms and improving energy. Still, the AIP diet isn’t for everyone. It can be emotionally and socially challenging, expensive, and requires people, who can't afford a delivery service, to prepare their own meals. But, for anyone looking for options to help improve their autoimmune symptoms, the AIP diet may be worth trying. It's fairly easy to adopt. It can be done in stages, and the results are usually pretty clear after a few months. Especially for anyone with celiac disease, or other autoimmune conditions, who is having lingering issues, it may be worth exploring the AIP diet. Do you or anyone you know follow the AIP diet to treat celiac disease, or another autoimmune condition? Has it helped? Share your experience below. Read more in The Autoimmune Protocol Diet (AIP Diet): Does it help?

Celiac.com 10/24/2020 - Antioxidants, anthocyanins, phytochemicals, carotenoids, tocopherols, polyphenols, enzymes with antioxidant activity—do those food-related words sound a bit esoteric to you? Like maybe you need to be part of an enlightened inner-circle of scientists to understand what they mean? We’ve made eating rather complicated, haven’t we? Forget the fancy words. If you focus on fresh whole foods, the semantics don’t really matter. Bringing healthy, nourishing food to the table is what is important, especially if you have an autoimmune disorder like celiac disease. But sometimes we get so focused on the individual nutrients and the complicated words that we forget about the big picture. The benefit of these individual ingredients might not be the same without consuming the whole food and letting them work their magic together. Autoimmune diseases are systemic in nature, so healthy nutrition is a vital piece of the wellness puzzle. The Standard American Diet (SAD) is rather dreadful in many ways, so food-industry scientists have come up with substitutions for the real thing and clever ways to fortify processed foods. Nutrients are being added to packaged foods as a marketing tool. Food that is reengineered to come in a box isn’t natural, but to make it more appealing to the consumer, manufacturers add something special like vitamin D, fiber, iron, or omega-3s and boldly announce it on the package. Something to catch your eye and make you wonder if you can live without it. While I’m not totally against boxed and fortified foods, it’s much better to limit your intake and stick with the real thing. That way you don’t get all the junk that often accompanies those food choices—additives, preservatives, chemicals, dyes, artificial flavors, and fillers that often contain gluten. Rather than a food product, enjoy the pleasure and health benefits of eating whole foods. And contrary to what it may sound like from my first couple of paragraphs, I’m actually quite fond of the science behind the food, but we don’t have to get neurotic about all the details, especially if we’re more thoughtful with our food choices to begin with. Back to the complicated science terms and the first word of this article—antioxidants. What are antioxidants and why is it important for us to have plenty of them in our diets? Antioxidants are molecules, or substances in foods, that are protective to normal physiological functions in the human body. They slow or prevent oxidation, which is a chemical reaction that produces free radicals that cause cell damage. Foods high in antioxidants protect the body from oxidation and boost the immune system. Here’s where antioxidants are important to those of us with celiac disease, which is a disorder of the immune system. We want to enhance healthy immune function and reduce cell damage and inflammation. Foods rich in antioxidants help us do that. Selenium, lutein, lycopene, glutathione, beta-carotene, and the vitamins A, C, and E are all antioxidants. Where do we find foods rich in antioxidants? According to a 2006 study published in the American Journal of Clinical Nutrition, researchers analyzed 1,113 food samples and identified the following 15 foods as having the highest antioxidant content per serving. From number #1 to 15: blackberries, walnuts, strawberries, artichokes (prepared), cranberries, coffee, raspberries, pecans, blueberries, ground cloves, grape juice, dark chocolate, cranberry juice, cherries, and red wine. The food groups with the highest overall antioxidant levels were spices and herbs, nuts and seeds, berries, fruits, and vegetables. In general, plants and plant products have much higher antioxidant levels than animal products, so add these foods to your shopping list and enjoy a daily dose of antioxidant protection!

Celiac.com 10/20/2014 - Researchers don’t have much data on rates of celiac disease in patients with autoimmune hepatitis (AIH). To better understand any connections between the two conditions, a Dutch research team recently set out to examine the rates of celiac disease in patients with autoimmune hepatitis. Specifically, the team set out to investigate the relationship between AIH and celiac disease by assessing the prevalence of IgA tissue antitransglutaminase antibodies (TGA) and antiendomysium antibodies (EMA) in a large group of AIH patients. The research team N.M. van Gerven, S.F. Bakker, Y.S. de Boer, B.I. Witte, H. Bontkes, C.M. van Nieuwkerk, C.J Mulder, G. Bouma; and the Dutch AIH working group. They are variously affiliated with the Departments of Gastroenterology and Hepatology, Epidemiology and Biostatistics, and Medical Immunology at the VU University Medical Centre in Amsterdam, The Netherlands. For the first step in their study, the team used TGA antibody serology to determine the frequency of celiac disease in a group of 460 AIH patients. The team conducted EMA screens on any patients showing TGA positivity. They then used digital and written medical records to collect retrospective data on previously diagnosed celiac disease and patient characteristics, and compared those findings with archival data on the prevalence of celiac disease in the Netherlands. They found that six patients had a known history of celiac disease, but were currently in remission, as shown by negative TGA blood screens. In addition, ten of the 460 AIH patients (2.2%) showed positive IgA TGA. Positive EMA antibodies in these patients served to confirm celiac disease diagnosis. Overall, the team found celiac disease in 3.5% of AIH patients compared with just 0.35% in the general Dutch population (P<0.001). Discounting patients with either a primary biliary cirrhosis or primary sclerosing cholangitis overlap, the team found celiac disease in 11 (2.8%) AIH patients. This is the largest serological study to examine connections between AIH and celiac disease, and shows that patients with AIH have rates of celiac disease that are higher than those of the general population, but not as high as some studies have suggested. Still, the team advises doctors to consider the possibility of concurrent celiac disease in all AIH patients. Source: Eur J Gastroenterol Hepatol. 2014 Oct;26(10):1104-7. doi: 10.1097/MEG.0000000000000172.

Celiac.com 09/08/2020 - Women with a type of hair loss called frontal fibrosing alopecia (FFA) have higher rates of autoimmune disease, estrogen deficiency, and thyroid hormone issues, compared with the general population. The study included 711 female UK residents of Eurasian ancestry, and diagnosed with FFA. Women in the study group had scalp hair loss for an average of 7 years, and nearly 75% of those had frontotemporal hairline recession following menopause. More than 77% showed perifollicular erythema, more than 25% showed hyperkeratosis, while 26.0% also showed occipital recession. More than 90% of the women suffered eyebrow loss, while nearly 45% suffered eyelash loss. Hair loss on the limbs was also common, with nearly 78% of the cohort had limb hair loss, usually to the arms and legs, and nearly 70% had concomitant loss of axillary and/or pubic hair. Nearly half of the study participants were taking prescription drugs to treat FFA. Of those, nearly 25% were taking hydroxychloroquine. Nearly twenty percent were taking topical corticosteroids, while ten percent were taking oral tetracycline antibiotics, or a range of other drugs, including topical calcineurin inhibitors (3.8%), intralesional steroids (1.7%), and oral corticosteroids (1.3%). More than twenty percent of participants reported at least 1 comorbid autoimmune disease. Nearly 13% reported autoimmune thyroid disease, while 1.5% reported celiac disease, and 1.2% reported pernicious anemia. In addition, 5.6% of women had a history of estrogen deficiency secondary to oophorectomy or primary ovarian insufficiency, and more than 70% of the women used an oral contraceptive pill for more than 6 months. Though the study was limited by cross-sectional design, lack of a control group, and missing data for some clinical features, the findings "...accord with other epidemiological studies and the results of our genetic investigation, which implicated causal genetic variation related to antigen presentation and hormone/xenobiotic metabolism in FFA pathogenesis,” stated the investigators. The research team is calling for further study to determine the extent of the connection, and the potential implications for diagnosis and treatment. Read more in the Br J Dermatol. doi: 10.1111/BJD.19399

Celiac.com 07/18/2019 - Autoimmune conditions cause the body to attack its own healthy cells. There are nearly one-hundred known autoimmune conditions, including lupus, celiac disease, and rheumatoid arthritis. Diagnosing autoimmune conditions can sometimes be difficult, so any progress toward faster, cheaper, or more reliable testing methods could play a significant role in improving diagnosis and reducing time to treatment. Approval by the FDA is key to making such tests available commercially. A New York startup company, Aesku.NY, has received FDA approval for tests to detect two of those autoimmune diseases, with tests for other diseases expected to follow. The approved tests for celiac disease, and the connective tissue disorder, lupus, would still require patients who screen positive to receive further testing for a specific diagnosis. However, the tests are designed to be cost effective, and efficient, potentially increasing the availability of a reliable screening method for diseases that are best caught and treated early. "In many autoimmune diseases, if you don't have a good test, it takes many years to pinpoint a diagnosis," says company founder Dr. Vijay Kumar. "Again, coming back to celiac disease, it used to be 3-5 years before a diagnosis is made," he added, "[t]hink about how many physicians, clinicians, laboratories, the patient might have gone through." Aesku.NY tests are produced domestically, in Buffalo New York. Stay tuned for more news on developments in celiac disease diagnostics, and related topics. Listen to WBFO's Mike Desmond

Celiac.com 03/31/2020 - There are over one-hundred different autoimmune diseases. One thing they have in common is that they are driven by the body's own cells; by rare and elusive immune cells that target the body's own healthy organs and tissues, instead of harmful foreign bacteria and viruses. Researchers call such cells 'rogue cells." For the first time, a team led by researchers at the Garvan Institute of Medical Research have used patient samples to document the existence of specific cells that cause autoimmune disease. They also figured out the mechanism that allows cells to 'go rogue' by evading checkpoints that normally stop immune cells from targeting the body's own tissues. "We have developed a technique that allows us to look directly at the cells that cause autoimmune disease—it's as though we're looking through a new microscope lens for the first time, learning more about autoimmune disease than was ever possible before," says Professor Chris Goodnow, co-senior author of the paper, and Executive Director of the Garvan Institute and Director of the UNSW Sydney Cellular Genomics Futures Institute. Potential for New Diagnosis and Treatments In addition to revealing the root cause of an autoimmune disease, the research findings offer huge potential for future treatments to target the cause of all autoimmune diseases. "Current treatments for autoimmune disease address only the symptoms, but not the cause. To make more targeted treatments that address disease development and progression, we first need to understand the cause...Identifying these rogue immune cells is a significant step forward for how we study autoimmune disease—and crucially the first step to finding ways to eliminate them from the body entirely," says Professor Goodnow. "In our study, we uncovered specific mutations that mark early stages of autoimmune disease. If we can diagnose a patient at these stages, it may be possible to combine our knowledge of these mutations with new targeted treatments for lymphoma to intervene in disease progression or to track how well a patient is responding to treatments," says Dr. Reed. The researchers are now planning follow-up studies to investigate mutations of autoimmune cells in a range of other diseases, including lupus, celiac disease and type 1 diabetes. The team's findings, published in the journal Cell today, are part of the visionary Hope Research program, could lead to major advances in the diagnosis and treatment of autoimmune disease. Read more in MedicalExpressNews.com