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Found 96 results

  1. Celiac.com 07/31/2018 - Using funds from the Canadian Institutes of Health Research Canada Research Chairs Program, researcher Charlene Elliott, PhD, of the Department of Communication, Media, and Film, University of Calgary recently set out to assess the nutritional quality of gluten-free products specifically marketed for children. For her assessment, Elliott bought child-targeted gluten-free food products from two major supermarket chains in Calgary, Alberta, Canada. Elliott used the Pan American Health Organization Nutrient Profile Model to compare the nutritional quality of products labeled gluten-free with those not so labeled. A secondary analysis compared the nutritional profile of child-targeted gluten-free products to their non-gluten-free “equivalents.” Elliott’s analysis showed that child-targeted gluten-free products generally had lower amounts of sodium, total fat, and saturated fat, However, those same foods also had less protein and about the same amount of calories from sugar as child-targeted products without a gluten-free claim. According to the Pan American Health Organization criteria, both gluten-free products and "regular" products designed for children can be classified as having poor nutritional quality (88% vs 97%). Compared to their non-gluten-free equivalents, products with a gluten-free claim had similarly high sugar levels, (79% vs 81%). So, the big picture is that gluten-free supermarket foods targeted at children are generally less nutritious than their non-gluten-free counterparts, and both types have alarmingly high sugar content. A gluten-free label is no guarantee of healthier, more nutritious food for kids, and it’s a mistake for parents to buy gluten-free products believing they are healthier than their non-gluten-free equals. The evidence shows that is simply not true. The takeaway here seems to be that, gluten-free or not, supermarket foods aimed at children are generally poor in nutrition and loaded with sugar, and parents should choose wisely when buying food for their children. Source: Pediatrics, July 2018
  2. Celiac.com 07/17/2018 - What can fat soluble vitamin levels in newly diagnosed children tell us about celiac disease? A team of researchers recently assessed fat soluble vitamin levels in children diagnosed with newly celiac disease to determine whether vitamin levels needed to be assessed routinely in these patients during diagnosis. The researchers evaluated the symptoms of celiac patients in a newly diagnosed pediatric group and evaluated their fat soluble vitamin levels and intestinal biopsies, and then compared their vitamin levels with those of a healthy control group. The research team included Yavuz Tokgöz, Semiha Terlemez and Aslıhan Karul. They are variously affiliated with the Department of Pediatric Gastroenterology, Hepatology and Nutrition, the Department of Pediatrics, and the Department of Biochemistry at Adnan Menderes University Medical Faculty in Aydın, Turkey. The team evaluated 27 female, 25 male celiac patients, and an evenly divided group of 50 healthy control subjects. Patients averaged 9 years, and weighed 16.2 kg. The most common symptom in celiac patients was growth retardation, which was seen in 61.5%, with abdominal pain next at 51.9%, and diarrhea, seen in 11.5%. Histological examination showed nearly half of the patients at grade Marsh 3B. Vitamin A and vitamin D levels for celiac patients were significantly lower than the control group. Vitamin A and vitamin D deficiencies were significantly more common compared to healthy subjects. Nearly all of the celiac patients showed vitamin D insufficiency, while nearly 62% showed vitamin D deficiency. Nearly 33% of celiac patients showed vitamin A deficiency. The team saw no deficiencies in vitamin E or vitamin K1 among celiac patients. In the healthy control group, vitamin D deficiency was seen in 2 (4%) patients, vitamin D insufficiency was determined in 9 (18%) patients. The team found normal levels of all other vitamins in the healthy group. Children with newly diagnosed celiac disease showed significantly reduced levels of vitamin D and A. The team recommends screening of vitamin A and D levels during diagnosis of these patients. Source: BMC Pediatrics
  3. Celiac.com 04/09/2018 - Children with obstructive sleep apnea (OSA) often have enlarged tonsils and adenoids. Additionally, lymphatic hyperplasia, an increase in the number of normal cells that are contained in lymph nodes, is common to both OSA and celiac disease. Lymphoid hyperplasia is usually due to an infection with bacteria, viruses, or other types of germs and is part of the body's reaction to the infection. A team of researchers recently set out to investigate the effect of a gluten-free diet on OSA symptoms in children with celiac disease. The research team included A Yerushalmy-Feler, R Tauman, A Derowe, E Averbuch, A Ben-Tov, Y Weintraub, D Weiner, A Amir, H Moran-Lev, and S Cohen. They are variously affiliated with the Pediatric Gastroenterology Unit, the Pediatric ENT Unit, and the Pediatric Sleep Center at "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center in Tel Aviv, Israel; and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. The team recruited children with celiac disease from ages 2-18 before the children began a gluten-free diet. As a control group, the team included children with negative celiac serology who underwent gastrointestinal endoscopies for other reasons. All participants completed a validated OSA-related symptoms questionnaire and the pediatric sleep questionnaire (PSQ) at the start of the study, and again 6 months later. The team recruited thirty-four children with celiac disease, along with twenty-four control subjects. Both groups were similar in terms of gender, body mass index or season at recruitment between the two groups. The control group showed more OSA-related symptoms compared to the celiac group, both at recruitment and at the 6-month follow-up. Both groups showed significant improvement in PSQ scores at the 6-month follow-up, but improvement was significantly higher in the celiac group compared to the control group. Kids with celiac disease had fewer OSA-related symptoms than control subjects, but they had much higher levels of symptom improvement once they were on a gluten-free diet. Overall, the data from this study suggests that a gluten-free diet provides strong improvement of OSA-related symptoms in children with celiac disease. Source: BMC Pediatr. 2018 Feb 7;18(1):35. doi: 10.1186/s12887-018-1039-5.
  4. Celiac.com 03/06/2018 - A number of clinicians and researchers have suspected that antibodies against transglutaminase 6 (anti-TG6) play a role in neurological issues in adult patients with genetic gluten intolerance, but it is not known if autoimmunity to TG6 develops after long-term consumption of gluten. A team of researchers recently set out to establish a correlation between these autoantibodies and the duration of gluten exposure by measuring the anti-TG6 in children with celiac disease at diagnosis. The team then investigated a correlation between anti-TG6 and the presence of neurological disorders. The research team included L De Leo, D Aeschlimann, M Hadjivassiliou, P Aeschlimann, N Salce, S Vatta, F Ziberna, G Cozzi, S Martelossi, A Ventura, and T Not. They are variously affiliated with the Institute for Maternal and Child Health-IRCCS "Burlo Garofolo" Trieste, Trieste, Italy; Matrix Biology and Tissue Repair Research Unit, School of Dentistry, and Arthritis Research UK Biomechanics and Bioengineering Centre of Excellence, College of Biomedical and Life Sciences, Cardiff University, Cardiff; the Department of Neurology at the Royal Hallmshire Hospital, Sheffield, UK; and with the University of Trieste in Trieste, Italy. The team used ELISA to measure anti-TG6 (IgA/IgG) in children with biopsy-proven celiac disease and of children experiencing gastrointestinal disorders. Celiac disease patients who tested positive for anti-TG6 were retested after 2 years of gluten-free diet. In all, the team analyzed test results for 274 children with celiac disease, along with 121 control subjects. They found anti-TG6 in 68 out of 274 celiac disease patients and in 19/121 control subjects, though the differences between the two groups was significant. None of the celiac patients or the controls who tested positive for anti-TG6 suffered from neurological disorders. Eleven of 18 celiac disease patients with other autoimmune diseases tested positive for anti-TG6. Among the celiac disease patients, the team found a significant correlation between the gluten exposure before the celiac disease diagnosis and anti-TG6 concentration. The gluten-free diet substantially reduced the anti-TG6 concentrations. The team found no significant correlation between anti-TG6 and anti-TG2 serum concentrations. Anti-TG6 is much more common in children with untreated celiac disease , but with no apparent neurological disorders. The synthesis of the anti-TG6 is associated with longer exposure to gluten prior to celiac diagnosis, while the autoimmunity against TG6 is gluten dependent and disappears with a gluten-free diet. Source: J Pediatr Gastroenterol Nutr. 2018 Jan;66(1):64-68. doi: 10.1097/MPG.0000000000001642.
  5. Celiac.com 03/05/2018 - While people with non-celiac gluten sensitivity (NCGS) have neither celiac disease nor wheat allergy (WA), they often do have intestinal and extra-intestinal symptoms that are related to gluten consumption. Using a double-blind placebo-controlled (DBPC) gluten challenge with crossover, a team of researchers recently set out to conduct the first assessment of NCGS rates in children with chronic, gluten-associated gastrointestinal symptoms. The research team included R Francavilla MD, PhD, F Cristofori MD, L Verzillo MD, A Gentile MD, S Castellaneta MD, C Polloni MD, V Giorgio MD, E Verduci MD, PhD, E D'Angelo MD, S Dellatte MD & F Indrio MD. They are variously affiliated with the Department of Pediatrics, San Paolo Hospital, Bari Italy; the Department of Pediatrics, Santa Maria del Carmine Hospital, Rovereto TN, Italy; the Department of Pediatrics, Catholic University, Rome, Italy; the Department of Pediatrics, University of Milan, S. Paolo Hospital, Milan, Italy; the Department of Pediatrics, Santa Maria Incoronata dell’Olmo Hospital; Cava dei Tirreni SA, Italy; the Tandoi Group Factory, Corato, Italy; and the Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy. Their team looked at 1,114 children with chronic gastrointestinal symptoms, but no celiac disease and WA. For children showing a positive connection between symptoms and gluten ingestion, the team offered a four-stage diagnostic challenge that included: run-in, open gluten-free diet (GFD) and DBPC crossover gluten challenge. Patients randomly received gluten (10 g/daily) and placebo (rice starch) for 2 weeks each, separated by a washout week. The gluten challenge was considered positive when accompanied by a minimum 30% decrease of global visual analogue scale between gluten and placebo. Out of 1,114 children, 96.7% showed no correlation with gluten ingestion. Thirty-six children were eligible for the diagnostic challenge. After the run-in and open GFD, 28 patients underwent gluten challenge. Eleven of these children tested positive (39.2%). This is the first such study to demonstrate the need for a DBPC for diagnosing NCGS in children, since the diagnosis is ruled out in more than sixty-percent of cases. Source: The American Journal of Gastroenterology. doi:10.1038/ajg.2017.483
  6. Celiac.com 02/28/2018 - In an effort to discover more genes that trigger type 1 diabetes, a team of researchers recently conducted a large, prospective study of children at risk for type 1 diabetes. The end goal is to reveal more targets for treating or even preventing the disease. The research team included A Sharma, X Liu, D Hadley, W Hagopian, WM Chen, S Onengut-Gumuscu, C Törn, AK Steck, BI Frohnert, M Rewers, AG Ziegler, Å Lernmark, J Toppari, JP Krischer, B Akolkar, SS Rich, JX She; and TEDDY Study Group. The team identified six new chromosomal regions in young people who have already developed type 1 diabetes, or who have started making antibodies against their insulin-producing cells, often a step toward full-blown diabetes that requires lifelong insulin therapy. Their analysis of 5,806 individuals, which is published in the Journal of Autoimmunity, also confirms three regions already associated with one of those related conditions. The team observed two top autoantibodies. The first, called IAA, acts directly against insulin. The second, called GADA, acts against the enzyme glutamate decarboxylase, which regulates the insulin-producing beta cells in the pancreas. According to Dr. She, about 90 percent of patients with type 1 diabetes start with one of the autoantibodies, and many patients eventually end up with both. The second autoantibody may surface in a few days or even years later. They began this study with 176,586 SNPs, or single nucleotide polymorphisms. Nucleotides are basic building blocks of our genetic information. According to Sharma, the SNPs evaluated by TEDDY scientists were already linked with other autoimmune conditions like rheumatoid arthritis or celiac disease, but not type 1 diabetes. The researchers figured out which of these SNPs are different in TEDDY participants with type 1 diabetes versus those with Islet cell autoantibodies versus those with neither. Previous research has shown that the genes associated with IA and actual type 1 diabetes can differ. Dr. She says that even though clinicians regard Islet cell autoantibodies (IA) as a red flag for type 1 diabetes, not every child with IA goes on to develop diabetes, though multiple autoantibodies definitely increase that risk. The team notes that it is possible that the genes that promote IA development may differ from those that lead to full-blown disease progression. She says that this is the first study of gene identification for any disease to use this sort of longitudinal information. She add that this and other studies by the TEDDY research group help to clarify the search for important non-HLA genes by adding the "time to disease" perspective. Source: J Autoimmun. 2018 Jan 5. pii: S0896-8411(17)30739-4. doi: 10.1016/j.jaut.2017.12.008. The researchers are variously affiliated with the Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA; Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, US; the Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; the Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom; the Pacific Northwest Research Institute, Seattle, WA, USA; the Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA; the Department of Clinical Sciences, Lund University/CRC, Malmö, Sweden; the Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, Aurora, CO, USA; the Institute of Diabetes Research, Helmholtz Zentrum München, Munich-Neuherberg, Germany; Klinikum rechts der Isar, Technische Universität München, Munich-Neuherberg, Germany; Forschergruppe Diabetes e.V., Munich-Neuherberg, Germany; the Department of Pediatrics, Turku University Hospital, Turku, Finland; the National Institutes of Diabetes and Digestive and Kidney Disorders, National Institutes of Health, Bethesda, MD, USA; and the Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.
  7. Celiac.com 10/09/2017 - New trial data suggests that the probiotic strains Lactobacillus plantarum Heal 9 and Lactobacillus paracasei 8700:2 may provide support for the immune system and delay the onset of gluten intolerance in children. The findings, recently presented at the International Celiac Disease Symposium in New Delhi, suggest that Probi's patented probiotic strains have a 'surprisingly consistent' effect on suppressing coeliac autoimmunity and may delay the onset of the disease in children who are genetically pre-disposed to the condition. "To our knowledge this is the first time a probiotic study has been performed on this specific population and the results show immune-supporting properties of these probiotics as well as a potential preventive effect on the development of celiac disease," said Dr Daniel Agardh of Lund University. Agardh and colleagues identified and recruited 78 children with a genetic pre-disposition to coeliac disease. The children were as a subpopulation in a multinational and multiyear autoimmunity study with thousands of children. The randomized, double-blind, placebo-controlled trial lasted six months and found that disease-related antibodies were significantly reduced in the probiotic group and significantly increased in the placebo group during the course of the study. Results show that the probiotic strains had a suppressing effect on celiac autoimmunity and may delay the onset of the disease – with tissue transglutaminase autoantibodies (tTGA) decreased in the treatment group, but increased in the placebo group. In addition, several significant differences were observed between the groups on a cellular level indicating that the probiotic may counteract coeliac disease-associated ongoing immunological and inflammatory response. "This is an excellent example of a well working collaboration between academia and the industry" commented Probi CEO Peter Nählstedt. "We see a growing interest in children's probiotics and these results enable Probi to build a product platform for children." Read more at: Nutraingredients.com
  8. Celiac.com 09/22/2017 - I run into many parents who are in quite a quandary about instituting a gluten-free diet for their child. A typical scenario is that one of the parents is gluten intolerant and is highly suspicious that their child is as well. Due to the child being 'relatively healthy' the non-gluten intolerant spouse suggests that the child be able to 'live a little' and enjoy the cake and pizza that is so prevalent during children's parties and sporting events. In my opinion, there is no question about whether a gluten-free diet should be implemented, after confirmation that gluten intolerance exists that is. I know that gluten intolerance vastly increases your risk of developing diseases that can affect almost any system and/or organ in the human body. The evidence shows that it vastly increases your risk for autoimmune disease. I also know that it can be rather silent in a younger body, but if a positive test exists, then it IS doing damage, regardless of whether it is felt or not. To add a little more strength to my argument is the result of a recent study published by the Journal of Human Nutrition and Dietetics wherein researchers aimed to evaluate the influence of celiac disease on the social aspects of life in those living in the U.S. Not surprisingly celiac disease did have a negative impact on the quality of life in social settings, specifically in the area of travel and dining out. However, and this is where I find that most people make their mistake with their children, the researchers found that 'those diagnosed in childhood and maintained on the diet experienced a reduced impact on their quality of life as an adult'. So it turns out that you aren't doing any favors to your at-risk child by putting off the implementation of a gluten-free diet. You're not only creating negative impacts health-wise, as mentioned above, but by delaying a gluten-free diet you are also condemning them to the perception of a lower quality of life. If you think about it, if gluten-free is pretty much all you've ever known, you would be less likely to miss it. You haven't built up the memories of gluten-containing cakes and pizzas and pancakes. Please do not put off testing your child because you think you're doing him or her a favor by putting it off. The truth is quite the contrary. Waiting could allow an autoimmune or other illness to develop that could have been avoided. There is absolutely NO benefit to one's health to continue eating gluten when one is gluten intolerant, and it turns out that there is no benefit psychologically either. Have you run into this argument from friends or family? Have you put off diagnosing a child because you were made to feel guilty? Please write to me and let me know your experiences and thoughts. To your good health. Reference: Journal of Human Nutrition and Dietetics. 2012 Feb 25. Living with coeliac disease: survey results from the USA. Volume 25, Issue 3, pages 233–238, June 2012
  9. Celiac.com 08/15/2017 - Some evidence indicates that rates of celiac disease in the general population are increasing over time. Prior to the discovery of gluten's role in celiac disease, the prognosis for celiac sufferers was bleak. Did higher betas of death keep celiac disease rates correspondingly lower? To provide an answer, a team of researchers set out to examine a possible relationship between mortality rates for children under five, and prevalence rates of celiac disease. The research team included Federico Biagi; Alberto Raiteri; Annalisa Schiepatti; Catherine Klersy; and Gino R. Corazza. Their team conducted a review of literature, and found 27 studies done in 17 different countries between 1995 and 2011 describing rates of celiac disease in schoolchildren. Four of the studies were conducted in Italy. Their meta-analysis compared prevalence rates between specific-country under-five mortality groups, publication year and age. In recent decades, mortality rates for under-five year olds have been decreasing all over the world. This reduction is paralleled by rising rates of celiac disease. The Spearman correlation coefficient for these terms was -63%, 95%CI -82% to -33% (p < 0.001). So, the higher the mortality rate, the lower the prevalence of celiac disease. This finding is confirmed by the meta-analysis of the 4 studies conducted in Italy over time. The mortality rate for under five-year-olds seems to influence the rate of celiac disease in the general population. They predict a rise, in the near future, of the number of celiac disease patients, due to better survival rates of celiac children. Source: Journal of Pediatric Gastroenterology & Nutrition: Post Acceptance: July 27, 2017. doi: 10.1097/MPG.0000000000001696
  10. Hello all! I'm planning a road trip with my 11-year-old daughter this summer through much of New England. She's Celiac and a vegetarian and we are hoping to explore some of the "off the beaten track" locales to hike, bike, and kayak so I was wondering if anyone could offer any suggestions for restaurants and grocery stores along the way that would keep us safe. We don't have a set itinerary at the moment so we can adjust our travels to incorporate tween/celiac friendly locations. I would really appreciate any suggestions for either as I am a West Coast girl visiting the NE for the first time. We have been lucky for the most part in our travels but I have found it best to ask locals and people who have traveled in the areas before so we can be armed to create memories...the good kind. Thanks al!
  11. My husband just recently got diagnosed with celiac's disease we are wondering if we should get our son tested to see if he carries the gene I guess you would say. Any advice would be greatly appreciated as a lot of you, I have no one else to talk to about it thanks
  12. My youngest daughter is being tested for celiacs disease, just seeing if any other mums that have a child that has celiacs disease had gestational diabetes while pregnant with that child? Any help or advice is warmly welcome thank you 😊
  13. Celiac.com 01/23/2017 - It makes some kind of sense that kids with celiac disease who follow a gluten-free diet will recover, their guts will normalize, and their levels of IgA tissue transglutaminase antibodies would drop to reflect this change; whereas high antibodies likely mean no recovery, right? But is that true? Is there really a correlation on any level? To test this idea, a team of researchers recently set out to document the rate of mucosal recovery in kids with celiac disease on a gluten-free diet. They also wanted to figure out whether IgA tissue transglutaminase (tTG) correlates with mucosal damage at the time of a repeat endoscopy with duodenal biopsy. The research team included Maureen M. Leonard, Dascha C. Weir, Maya DeGroote, Paul D. Mitchell, Prashant Singh, Jocelyn A. Silvester, Alan M. Leichtner, and Alessio Fasano. Their team conducted a retrospective chart review of one-hundred and three pediatric patients, under 21 years of age, with a diagnosis of celiac disease defined as Marsh 3 histology, and who underwent a repeat endoscopy with duodenal biopsy at least twelve months after initiating a gluten free diet. Their result showed that 19% of these pediatric patients treated with a gluten-free diet still had persistent enteropathy. At the time of the repeat biopsy, tTG was elevated in 43% of cases with persistent enteropathy, and in 32% of cases in which there was mucosal recovery. So, high tTG levels could be seen in both recovered patients, and non-recovered patients. The overall positive predictive value of the autoantibody tissue transglutaminase was 25%, and the negative predictive value was 83%, in patients on a gluten free diet for a average of 2.4 years. Nearly one in five children with celiac disease in this study population had persistent enteropathy, even with a gluten free diet. Also, IgA tTG was not an accurate marker of mucosal recovery. Neither the presence of symptoms, nor positive serology predicted a patient's histology at the time of repeat biopsy. These findings could help improve current monitoring and management criteria of celiac disease in children. Source: Journal of Pediatric Gastroenterology & Nutrition. doi: 10.1097/MPG.0000000000001460
  14. Celiac.com 11/10/2015 - Doctors might not need a biopsy to accurately diagnose celiac disease in asymptomatic children who have elevated anti-tTG, according to the latest study. In that study, researchers in Italy evaluated a new biopsy-sparing protocol for diagnosing celiac disease in symptomatic children with high anti-transglutaminase (anti-tTG). Their data showed that this approach might also work in asymptomatic children with elevated antibody levels. In 2012, the European Society of Pediatric Gastroenterology, Hematology, and Nutrition (ESPGHAN) published guidelines that said biopsies could be omitted in children and adolescents with signs and symptoms of celiac disease if they met certain guidelines. Dr. Francesco Valitutti of Rome's Sapienza University led a team that set out to assess the accuracy of serological tests to diagnose celiac disease in asymptomatic patients in 286 children and adolescents who had been diagnosed with celiac disease. Among 196 patients with anti-tTG antibodies at least 10 times ULN and EMA positive, 156 had symptoms and 40 were asymptomatic. More than 90% of the symptomatic children (142/156, 91%) showed severe lesion degree on biopsy, and an even higher percentage of asymptomatic patients (37/40, 92.5%) had severe lesions. There was no significant difference in histological damage between the "high-titer" symptomatic and asymptomatic children, according to the September 15th online report in The American Journal of Gastroenterology. Among the EMA positive children with lower titers of anti-tTG antibodies, 70% of symptomatic children and 81% of asymptomatic children showed severe lesions. The researchers add that asymptomatic patients should follow a gluten-free diet "as strictly as symptomatic ones, in order to prevent other autoimmune diseases and enteropathy-associated T-cell lymphoma." Otherwise, the new guidelines apply to patients with: TTG > 10 times ULN; an EMA of at least 1:80; a positive repeat serology to exclude laboratory error; HLA-DQ2 and/or -8 positivity; and a serological response to a gluten-free diet. If the research team can confirm these results in larger, multi-center prospective studies, their 'biopsy-sparing' protocol might be made available "to both symptomatic and asymptomatic patients with anti-tTG antibody titer (at least) 10 times the upper limit of normal (ULN) and anti-endomysial antibodies (EMA) and HLA-DQ2/DQ8 positive," Dr. Valitutti told reporters. Source: Am J Gastroenterol 2015
  15. Celiac.com 08/10/2016 - Low HDL cholesterol (HDL-C) concentrations have long been tied to increased cardiovascular risk. People with type 1 diabetes (T1D) who presented complications (1) and people with untreated celiac disease also have low HDL-C levels. People with both TID and celiac disease might face a sharper lipid abnormalities and a more aggressive the atherosclerotic process. Can a gluten-free diet reverse that process? A team of researchers recently set out to examine the effects of a gluten-free diet lipid on profiles of patients with Type 1 diabetes. They study was conducted on behalf of the for the Diabetes Study Group of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED). The research team included Silvana Salardi, Giulio Maltoni, Stefano Zucchini, Dario Iafusco, Santino Confetto, Angela Zanfardino, Sonia Toni, Barbara Piccini, Maximiliano Zioutas, Marco Marigliano, Vittoria Cauvin, Roberto Franceschi, Ivana Rabbone, Barbara Predieri, Riccardo Schiaffini, Alessandro Salvatoni, Petra Reinstadler, Giulia Berioli,Valentino Cherubini and Giuseppe d'Annunzio. They are variously affiliated with the Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy, the Department of Pediatrics, Second University of Naples, Naples, Italy, the Meyer Children's Hospital, University of Florence, Florence, Italy, the Regional Center for Pediatric Diabetes, Clinical Nutrition & Obesity, Department of Life & Reproduction Sciences, University of Verona, Verona, Italy, the Pediatric Unit, S. Chiara Hospital, Trento, Italy, the Department of Pediatrics, University of Turin, Turin, Italy, the Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy, the Endocrinology and Diabetes Palidoro Unit at the University Department of Pediatric Medicine, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy, the Pediatric Clinic, Insubria University, Varese, Italy, the Department of Pediatrics, Regional Hospital, Bolzano, Italy, the Department of Gynaecological, Obstetric and Paediatric Sciences at the University of Perugia in Perugia, Italy, the Division of Paediatric Diabetes in Children and Adolescents, Maternal-Infantile Department, Salesi Hospital, Ancona, Italy, and with the Department of Pediatrics, IRCCS Gaslini Children's Hospital at the University of Genova in Genova, Italy. From 13 centers within the Italian Society of Pediatric Endocrinology and Diabetology (ISPED), the team collected data on a large number of children with both T1D and concurrent biopsy-proven celiac disease. They collected data at the time they initiated a gluten-free diet, and again after 1 year of a gluten-free diet. They verified gluten-free status using serum tests for celiac disease-related antibodies. They enrolled 201 children with T1D diagnosed at age of 5.8 +/- 3.8 years, and celiac disease diagnosed at age of 7.5 +/- 4.5 years. To compensate for any metabolic derangement at diabetes onset, they included only cases in which celiac disease diagnosis was made at least 3 months after that of T1D. As a control group, they used 224 patients with T1D only, matched by age, sex, diabetes duration, and HbA1c. Before subjects began a gluten-free diet, the team found that HDL-C values were significantly lower in children with celiac disease and T1D than in the control group, with the greatest decrease found in younger children aged, 6 years. Subjects with HDL-C values below pediatric percentile cutoffs for sex and age were younger than those with normal values (6.2 +/- 4.4 vs. 8.6 +/- 4.3 years, P , 0.0001) and also had lower HbA1c (7.5 +/- 0.8 vs. 8.0 +/- 1.5%, P , 0.005). After a gluten-free diet the average values of HDL-C in the total study population rose sharply to 60.9 +/- 13.7, compared with 51.3 +/- 13.6 mg/dL (P , 0.0001), and returned to normal. The percentage of subjects with HDL-C values lower than pediatric percentile cut points fell significantly (P , 0.0001) from 42 to 16%. Subjects with complete adherence to gluten-free diet showed the most significant improvement of HDL-C, and subjects with partial adherence showed a lower, but significant, improvement of HDL-C. These results dovetail with other data from the past few years, but more clearly indicated the reduction in HDL-C at diagnosis, and the better recovery with a gluten-free diet. The researchers view the reduction HDL-C either as a proxy marker for intestinal inflammation, or as the result of a change in the intestinal secretion of apolipoprotein AI (5), the major HDL structural protein. This change is seen most sharply in the youngest children, who probably suffer more severely, as indicated by signs of malabsorption, e.g., lower HDL-C and HbA1c levels. Children with T1D and untreated celiac disease, especially young children, typically show an unfavorable lipid profile, i.e., low HDL-C values. Following a gluten-free diet normalizes HDL-C levels, with the greatest benefits can be seen in individuals who follow the diet strictly, and in the youngest individuals. Because of the possibility of increased risk of cardiovascular disease, a strict gluten-free diet is mandatory in these children. Source: Diabetes Care. DOI: 10.2337/dc16-0717
  16. Celiac.com 07/19/2016 - We know that celiac disease afflicts almost 1% of the general population (1). We also know that about 12% of the general population has non-celiac gluten sensitivity, as indicated by elevated IgG class anti-gliadin antibodies in their blood (2). Although elevated antibodies identified by this test are often dismissed as "non-specific", they are clear evidence that the immune system is mounting a reaction against the most common food in our western diet. It is also true that many people who produce these antibodies and have then excluded gluten from their diets have also experienced improved health. Unfortunately, most of the individuals who have elevated IgG anti-gliadin antibodies and might benefit from avoiding gluten do not know that they are gluten sensitive and/or have celiac disease. Thus, we really don't know how many, or which, school children should be avoiding gluten to optimize their academic potential as they work their way through the education system. Approaching this issue from a different angle, we know that between 10% and 15% of the U.S. population has dyslexia (3). About 60% of those with ADHD have dyslexia (3). If we calculate the prevalence of ADHD, at 8.8% of the population (4), then just the ADHD component, it should give us 5.28% of the population with dyslexia. But we can't tell how much overlap there is between this group and the group that constitutes between 10% and 15% of the population that are reported as having dyslexia. These disabilities have been given considerable attention and have been studied for some time, yet we really know little about their causes, except in cases of traumatic brain injury. However, there is a startling study, reported in The Times ten years ago, from the Nunnykirk School in Northumberland, U.K. (5). The astounding results of this study continue to cry out for further research and possible replication. After 6 months on a gluten-free diet, testing showed that 11 of the 12 (92%) live-in students had improved their reading and comprehension at more than twice the rate at which regular students are expected to improve. Among the 22 students living in the community and attending this special school for dyslexic students during the day, 17 of them (77%) showed similar improvements (5). To put these results in perspective, special needs teachers are often very proud when they can help students achieve at rates similar to regular students. Doubling the rates of improvement is an astonishingly positive result! And a few of these students leaped ahead at six times the rate of normal students! The numbers of students involved in this study are too small to allow us to extrapolate to other dyslexic populations. And, given that the research was done in the United Kingdom, where definitions of learning disabilities, and other factors may be dissimilar, and that the work was reported in a newspaper instead of a peer reviewed journal, and the startlingly positive nature of these results, we really need further, carefully designed studies to explore this phenomenon. The Nunnykirk findings are consistent with the extensive brain and neurological research that has been done at the Royal Hallamshire Hospital at the University of Sheffield, over the last two decades, by Marios Hadjivassiliou and his colleagues. They have found that a strict gluten-free diet can often relieve central and peripheral neurological symptoms. Further, many prominent researchers who work with children and adults who have dyslexia characterize it as a neurobiological condition, and can demonstrate, with MRI, altered brain function in dyslexia (8). It is also clear that many cases of dyslexia are at least partly genetically conferred (8, 9). Neither are learning disabilities limited to dyslexia. Although some practitioners lump two or more learning disabilities together, the literature distinguishes between dyslexia, dysgraphia, dyspraxia, dyscalculia, dysphasia/aphasia, auditory processing disorders, visual processing disorders, etc. Some such practitioners not only differentiate between types of learning disabilities, they also differentiate between sub-types of disabilities. For instance, motor dysgraphia (where fine motor speed is impaired), dyslexic dysgraphia (where normal fine motor speed allows them to draw or copy but impairs spontaneous writing) and spatial dysgraphia (where handwriting is illegible due to distortion) can each be identified based on symptoms (10). Similar sub-types are seen in other learning disabilities. But what if the findings at Nunnykirk School are broadly applicable to all of these types of learning problems? Or perhaps further research can tell us which types and sub-types of learning disabilities can often be alleviated by a gluten-free diet. My own professional observations suggest that the number of students helped by a gluten-free diet would be similar to the proportions seen at Nunnykirk School. I have also observed that as the strictness of the diet increases, so does the number of students who improve. However, the diagnosing professionals are becoming reluctant to differentiate, even between general types of learning disabilities such as dyslexia and dysgraphia. As teachers, we were told that a child had learning disabilities and then, if not specified in the documents we were given, we had to figure out exactly what type of disability they had, then devise or research effective ways of teaching these students. I have done a little of both, but my experience is that this choice varies from one teacher to the next, and one situation to the next. Unfortunately, depending on the individual teacher's workload, teaching background, and personal biases, these children can sometimes be neglected or under-served, a choice that is often dictated by excessive workloads and demands on teachers' time to perform other tasks, especially extensive reporting and supervising sports and other extra-curricular activities. Please recall the overlap between dyslexia and ADHD mentioned earlier (3), and consider that there are ten reports of connections between attention deficit disorders and celiac disease published in the peer reviewed medical literature. Now, please recall that about 60% of these ADHD children will have dyslexia (3). Since the current, and past issues, of the Diagnostic and Statistical Manual of Mental Disorders, require that ADHD and learning disorders each be differentiated from any medical condition that might be causing the same symptoms and be alleviated by resolution of the medical condition in question. On that basis alone, almost every child being considered for a diagnosis of learning disorders or ADHD should be thoroughly tested for celiac disease and non-celiac gluten sensitivity. Yet, I would be very surprised to learn that this is commonly being done. Thus, we have a situation in which we are forced to rely upon a study conducted by a group of teachers, in cooperation with parents and students, that was published in The Times (5) and we must take action on our own because, as yet, celiac disease and non-celiac gluten sensitivity are not yet being differentiated from ADHD and/or learning disabilities. The really tragic part of this story is that a gluten-free diet, if started early enough, can reduce or completely eliminate all of these problems with learning disabilities and attention deficits, when gluten is the underlying problem. If you or your spouse are gluten sensitive, or have celiac disease, do you also have children who struggle in school? Based on the data from Nunnykirk School, current blood tests are probably not sufficient to rule out those who would benefit from a gluten-free diet. For the moment, you may need to institute a trial of a gluten-free diet, as mentioned above, while we await further research in this area. But wouldn't it be valuable for succeeding generations to know, or have a pretty clear idea whether the diet could help? And with what types and/or sub-types of learning disorders? That's where more research could really help. We already know that there is an association between gluten sensitivity and seizure disorders, ataxia and cerebellar degeneration, neuropathy (damage to peripheral nervous system), schizophrenia, depression, migraine, anxiety disorders, autism, multiple sclerosis, myasthenia gravis (an autoimmune neuromuscular disease), and white matter lesions in the brain (11). It should not be surprising if gluten underlies many or most cases of learning disorders and attention deficits. And if research can tell us which cases would be most likely to benefit from the diet, that will be a huge step forward for parents, students, teachers, and government agencies that provide funding for the education of those who are afflicted with these ailments. In the meantime, we only have the information that we have. So, despite its many weaknesses, the Nunnykirk investigation of dyslexic children argues for experimental implementation, on a trial basis. I would suggest at least a six-months-long period of strict gluten avoidance to determine whether it will help individuals who suffer from dyslexia and/or other learning disabilities. Sources: 1. Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003 Feb 10;163(3):286-92. 2. Hadjivassiliou M, Grünewald R A, Davies-Jones G A B. Gluten sensitivity as a neurological illness. J Neurol Neurosurg Psychiatry 2002;72:560-563. 3. Dyslexia Research Institute http://www.dyslexia-add.org/ 4. National Resource Center on ADHD http://www.help4adhd.org/about/statistics 5. Blair http://www.thetimes.co.uk/tto/news/uk/article1924736.ece 6. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71. 7. Aziz I, Hadjivassiliou M. Coeliac disease: noncoeliac gluten sensitivity--food for thought. Nat Rev Gastroenterol Hepatol. 2014 Jul;11(7):398-9. 8. Shaywitz SE, Shaywitz BA. The Neurobiology of Reading and Dyslexia. Focus on Basics - Connecting Research & Practice, Volume 5,A: Aug. 2001. http://www.ncsall.net/index.html@id=278.html 9. Eicher JD, Powers NR, Miller LL, Mueller KL, Mascheretti S, Marino C, Willcutt EG, DeFries JC, Olson RK, Smith SD, Pennington BF, Tomblin JB, Ring SM, Gruen JR. Characterization of the DYX2 locus on chromosome 6p22 with reading disability, language impairment, and IQ. Hum Genet. 2014 Jul;133(7):869-81. 10. About Education http://specialed.about.com/od/readingliteracy/a/Dyslexia-And-Dysgraphia.htm 11. Jackson JR, Eaton WW, Cascella NG, Fasano A, Kelly DL.Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity. Psychiatr Q. 2012 Mar;83(1):91-102. 12. Diaconu G, Burlea M, Grigore I, Anton DT, Trandafir LM. Celiac disease with neurologic manifestations in children. Rev Med Chir Soc Med Nat Iasi. 2013 Jan-Mar;117(1):88-94. PubMed PMID: 24505898. 13. Niederhofer H. Association of attention-deficit/hyperactivity disorder and celiac disease: a brief report. Prim Care Companion CNS Disord. 2011;13(3). pii: PCC.10br01104PMCID: PMC3184556. 14. Niederhofer H, Pittschieler K. A preliminary investigation of ADHD symptoms in persons with celiac disease. J Atten Disord. 2006 Nov;10(2):200-4. 15. Zelnik N, Pacht A, Obeid R, Lerner A. Range of neurologic disorders in patients with celiac disease. Pediatrics. 2004 Jun;113(6):1672-6. 16. KozÅ‚owska ZE. [Evaluation of mental status of children with malabsorption syndrome after long-term treatment with gluten-free diet (preliminary report)]. Psychiatr Pol. 1991 Mar-Apr;25(2):130-4. Polish. 17. Diaconu G, Burlea M, Grigore I, Anton DT, Trandafir LM. Celiac disease with neurologic manifestations in children. Rev Med Chir Soc Med Nat Iasi. 2013 Jan-Mar;117(1):88-94. PubMed PMID: 24505898. 18. Niederhofer H. Association of attention-deficit/hyperactivity disorder and celiac disease: a brief report. Prim Care Companion CNS Disord. 2011;13(3). pii: PCC.10br01104. PMCID: PMC3184556. 19. Niederhofer H, Pittschieler K. A preliminary investigation of ADHD symptoms in persons with celiac disease. J Atten Disord. 2006 Nov;10(2):200-4. 20. 4: Zelnik N, Pacht A, Obeid R, Lerner A. Range of neurologic disorders in patients with celiac disease. Pediatrics. 2004 Jun;113(6):1672-6. 21. KozÅ‚owska ZE. [Evaluation of mental status of children with malabsorption syndrome after long-term treatment with gluten-free diet (preliminary report)]. Psychiatr Pol. 1991 Mar-Apr;25(2):130-4. Polish.
  17. I recently had lab tests and an endoscopy done. My fecal anti-gliadin test came back at 380 units (normal is less than 10 units) but my endoscopy was clear (negative for Celiac's). My GI told me I had non-Celiac gluten sensitivity. Eliminating gluten from my diet has helped tremendously. I read that sometimes the endoscopy can be wrong; should I worry about this? As as a result of all this, I had my children tested too. Their fecal anti-gliadin test results were 115 units (5 years old) and 40 units (20 months old). Their pedi GI scheduled an endoscopy, but is an endoscopy really necessary? What is the benefit of knowing if it's Celiac's or just gluten sensitivity if they will already be eliminating gluten because of my diet? I'm trying to inconvenience my kids as little as possible while still gaining an accurate diagnosis.
  18. Celiac.com 05/03/2016 - How do you know when your child has gluten sensitivity, gluten intolerance, or celiac disease? If gluten issues run in your family and you know there is a predisposition to having problems with gluten in foods, then you may be alert to signs that it has been passed on to your child. But if you and your biological family members never had problems with it, then you're not expecting gluten to be an issue. Children arrive with a complicated genetic past that we may not always have the details about. We may not know the health history of the families of our child's other parent, or even sometimes our own. We may not know if anyone had reactions to gluten. Because celiac and gluten sensitivities can appear as chameleons, genes for it may be masked as other health issues. Parents may be a carrier and have no identifiable symptoms at all. People may have celiac disease without ever knowing it. It's complicated to raise a child. When they don't feel well, it's hard to figure out when their health problems are physical, emotional, social, or psychosomatic. When it comes to kids, having a belly ache is a common occurrence. So are a variety of symptoms that are linked to celiac disease or gluten intolerance or sensitivity, like headaches, fatigue, skin issues, depression, or GI track problems. When are signs pointing at the normal wear-and-tear of growing up—and when they are related to a syndrome like celiac disease? It takes a significant period of observation to figure this out. Celiac disease is regarded to be an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) found that the prevalence of celiac disease in children between age two-and-a-half and age fifteen ranges from 1 in 80 to 1 in 300 children. This means that in a pediatric practice of 1,500 children there are probably between 5 and 20 children with diagnosed or undiagnosed celiac disease—and potentially a lot more if one adds in gluten intolerance or sensitivities. According to the National Foundation for Celiac Awareness, celiac disease is genetically based, so reactions to gluten are more commonly found in those who have a family history of this autoimmune condition. They collaborated on a multi-phase research project with people diagnosed with celiac disease and at-risk family members who remained untested. Celiac disease was found in 5 to 10 percent of the family members of persons who had been diagnosed with celiac disease. But people may have reactions to gluten yet not have celiac disease. Some may have gluten intolerance or be sensitive to it without being diagnosed with celiac disease, so the actual relationship of health problems potentially associated with gluten may be considerably higher. First and second-degree relatives have more of a risk of developing celiac disease than are more distant relatives. For instance, their research found that celiac disease can occur in about 1 in 22 among children and their parents or siblings. But in analyzing the child's relationship to aunts, uncles, nephews, nieces, cousins, grandparents, half-siblings who may have celiac, the number decreases to 1 in 39. Detailed results of their research can be found from the NFCA's Seriously, Celiac Disease campaign. In our family, Chris never knew he was predisposed to celiac disease until he hit his twenties. Celiac is sneaky—while it can occur within people at any age, sometimes it doesn't show up until people get a bit older. As a child, he grew up on sandwiches, cookies, macaroni and cheese, and Grandma's home-made bread. When he had a tummy upset, as good mom I'd bring him chicken noodle soup and saltines. I never knew about celiac disease. My family came from a long line of gluten aficionados. As he hit adolescence and his teen years, signs of gluten intolerance emerged, only we didn't know that's what they were. Few parents link together migraines, skin problems with belly upsets and food "allergies." Chris's doctor dismissed his symptoms as independent, routine growing-up conditions without putting all the pieces of the puzzle together to realize that they were actually all a part of a larger celiac syndrome. It was only when he took a road trip and visited his father's sister and his cousins that he learned about the family's predisposition to celiac. His grandma always had stomach problems, I recall. She lived at a time and place where regular folks living in small towns were simply unaware of conditions such as celiac. As the old saw goes, you can't know what you don't know. In hindsight, she clearly had gluten issues. The gene seems to have been latent in her children, but passed on to take more active forms into the next generation of Chris and his cousin. It's confusing, because one child in the family can have a severe case of celiac while a full-blood sibling may have no sign of it at all! If he hadn't taken that road trip and stopped to visit his aunt, he may never have known that he had celiac. Upon that realization, suddenly everything made sense. All of his erratic symptoms were actually a picture-perfect portrayal of someone with celiac disease! We learned a bit about the disease, went to the store looking for gluten-free foods and quickly began modifying his diet. Since his MD couldn't figure out what was making him feel so bad, and if cutting out gluten could make him feel better, we decided that was a course worth pursuing. He felt better immediately. He has never been officially tested for celiac disease, although that would probably have been a better course of action. At that point in time, we simply didn't know about the testing options. Testing options have improved significantly over the last decade. The diagnosis of celiac disease can be done with a biopsy of the small intestine mucosa. Blood or serological tests are also helpful but less definitive. The University of Chicago Celiac Disease Center finds that the serum anti-tissue transglutaminase (tTG-IgA) is a widely used antibody blood test for screening for celiac disease, as is a total serum IgA test. The total serum test bolsters the reliability of the tTG test. A newer version of an old anti-gliadin antibody test has been developed called DPG or deamidated gliadin peptides test. Tissue transglutaminase (TTG) measures, endomysial antibody (IgA antibody to endomysium EMA) are recommended by many experts, while formerly used antigliadin antibody tests (AGA) are not as widely used. About 95% of people with celiac disease have the HLA-DQ2 gene and most of the remaining 5% have the HLA-DQ8 gene. Genetic testing can determine if someone has one or both of these genes. If someone has the gene it means they are at risk of developing celiac disease, but it does not mean that you necessarily have it. A positive genetic test should be followed up with a celiac blood panel to determine if someone has celiac disease. Celiac disease experts recommend family member testing as a proactive approach to diagnosis and then follow up with tests every 2-3 years or if potential symptoms start to emerge. They note that it is possible for someone to initially have a negative test result, but then test positive years later. This is worthwhile to know when trying to figure out if a child has celiac disease or not. It also means that re-testing may be a necessary process, since both the child's body and the disease propensity may change over time. What are warning signs that a child may have celiac disease? According to the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition and other celiac experts, there are both gastrointestinal and other symptoms to look for—symptoms that one may not logically associate with gluten. But remember that many of these symptoms may exist independently in children and have no relationship to having celiac disease at all! This is what makes trying to figure out whether or not a child has it extremely challenging. Once a determination is made that a child has celiac disease or is highly predisposed to be gluten intolerant or sensitive, changing the child's exposure to gluten in foods becomes of utmost importance. The problem is, most people aren't aware of gluten issues in general, and they particularly aren't thinking of it occurring in children. As Kay Chick (2014) describes in her article, there are many things that parents and teachers can do to proactively prevent problems in routine situations. She points out that many school cafeterias aren't equipped to safely serve children who have to go gluten-free. Most parents don't realize that making accommodations for children with celiac disease are assured under Section 504 of the Rehabilitation Act of 1973 and the Individuals with Disabilities Education Act; seventy-four percent of parents who participated in her study reported their children did not have a 504 plan or written into an Individualized Education Program (IEP) to help everyone make accommodations for their celiac disease. Children with celiac may also be eligible for services under the Individuals Disabilities Education Act (IDEA) if it has an impact on their ability to learn. Social events like birthday parties, camps, and field trips may expose children to gluten in foods and provide no alternatives for those who can't eat them. Sharing food is a common childhood occurrence, but an experience that leaves celiac kids out unless they are sure the food is safe. Going to another child's house to play or for a sleep-over may be an extra-big deal for a celiac kid. When the team goes out for a pizza party or ice cream cones after a game, the child with celiac has to be extremely careful. It helps enormously when adults and people in supervisory roles understand that when children need to avoid gluten, it is not because it is a choice—it is a health necessity. While a public awareness campaign to help people understand that there are children (and adults) who have to avoid gluten is underway, there's still a long way to go. Children need to learn self-advocacy skills to keep themselves healthy. This is sometimes hard to do when interacting with parents, teachers, and other adults who think that they understand the complications associated with needing to be gluten-free—and they actually don't. Going gluten-free doesn't have to be hard, but when it comes to children and youth, often it is. From identifying that celiac disease could be a problem, to diagnosing it, to addressing it in one's daily lifestyle, children are a special interest population. In order to help celiac children to live long and healthy lives, it begins with educating adults, most of whom will never have to personally go gluten-free. Speaking out on behalf of a celiac kid is an important thing to do. Adults in all professions need to learn what celiac is and how to institute celiac-safe strategies into their organizations. Even if they aren't affected, adults need to realize how their decisions and behavior may adversely impact children. Our youngest citizens count on adults to always be looking out for their best interests. Speak with your local schools, recreation groups, and youth-oriented civic organizations to make sure the leaders understand that the chances are high that they are serving children with celiac disease. Help them to understand that they should learn more about what it is, that they should make sure eating arrangements always take into consideration children with special dietary needs, and have food alternatives readily available. Every parent would expect the same concern and attentive care if their child had celiac. And as a community, aren't all children "our" children? For more information, see our book, Going Gluten Free (Norlights Press 2015). Yvonne Vissing has been appointed by the United Nations to be a Policy Chair for Child Rights, under the UN Convention on the Rights of the Child. Resources: Chick, Kay. The Educational, Social, and Family Challenges of Children with Celiac Disease: What Parents Should Know. 3/19/2014. Celiac.com Children's Digestive Health and Nutrition Foundation (CDHNF). www.cdhnf.org Diagnosis and Treatment of Celiac Disease in Children. Journal of Pediatric Gastroenterology and Nutrition. 2005; Volume 40, Number 1 (Jan): 1-19. National Foundation for Celiac Awareness. http://www.celiaccentral.org/ North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) http://www.naspghan.org//files/documents/pdfs/medical-resources/celiac/CeliacGuidelineSummary.pdf Raising Our Celiac Kids (ROCK). https://www.celiac.com/articles/563/1/ROCK-Raising-Our- celiac-Kids---National- celiac-Disease-Support-Group/Page1.html University of Maryland School of Medicine Center for Celiac Research http://glutendude.com/celiac/celiac-disease-symptoms/
  19. Celiac.com 03/02/2016 - A team of researchers recently completed the first extensive study comparing gene expression in children and adults with celiac disease, and found some key differences between the two groups. The research team included V. Pascual, L. M. Medrano , N. López-Palacios, A. Bodas, B. Dema, M. Fernández-Arquero, B. González-Pérez, I. Salazar, and C. Núñez. They are variously affiliated with Servicio de Pediatría, Servicio de Aparato Digestivo, and Servicio de Inmunología Clínica at the Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain, and with the Departamento de Producción Animal, Facultad de Veterinaria, and the Departamento de Estadística e Investigación Operativa I, Facultad de Matemáticas, Universidad Complutense de Madrid in Madrid, Spain. For their study, the team collected 19 duodenal biopsies of children and adults with celiac disease and compared the expression of 38 selected genes between each other, and in 13 non-celiac disease control subjects matched by age. The team used a Baysian methodology to analyze the differences of gene expression between groups. They found that, compared to controls, children and adults with celiac disease all had seven genes with a similarly altered expression. These were C2orf74, CCR6, FASLG, JAK2, IL23A, TAGAP and UBE2L3. The team found differences in 13 genes, six of which were altered only in adults (IL1RL1, celiac disease28, STAT3, TMEM187, VAMP3 and ZFP36L1) and two only in children (TNFSF18 and ICOSLG); while four genes show a significantly higher alteration in adults (CCR4, IL6, IL18RAP and PLEK) and one in children (C1orf106). Between the two groups, the team found significant differences in the expression level of several genes, most notably the higher alteration seen in adults. The team is calling for further research to assess possible genetic influences behind the changes, along with the specific physical consequences of the reported differences. Source: PLOS.ORG. Published: February 9, 2016. DOI: 10.1371/journal.pone.0146276
  20. Celiac.com 12/24/2015 - Laboratory tests for hemoglobin, ferritin, calcium, folate, vitamin B12, vitamin D, and thyroid function are regularly ordered in children with celiac disease, despite sufficient evidence for their necessity. To determine the frequency of nutritional deficiencies and levels of thyroid dysfunction in children with celiac disease, researches conducted a study that examined children before and after the initiation of a gluten-free diet. The research team included Margaretha Maria Susanna Wessels, MD, Iris I. van Veen, MD, Sabine Lisa Vriezinga, MD, Hein Putter, PhD, Edmond Henri Herman Maria Rings, MD, PhD, and Maria Luisa Mearin, MD, PhD. They are affiliated with the Department of Pediatrics, Department of Statistics, and the Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands. For their study, the team evaluated test results for hemoglobin, ferritin, folate, vitamin B12, calcium, vitamin D (25[OH]D), free thyroxin, and thyroid stimulating hormone of children with celiac disease regularly seen at the Leiden University Medical Center between 2009 and 2014. The team used laboratory reference ranges to define abnormal results. For statistical analysis, they used Pearson χ2 test for trend, unpaired t test, and 1-way ANOVA. Their results for 182 children evaluated, showed 119 were newly diagnosed. About 17% of results were missing for any given year, due to incomplete blood results. The most common deficiencies at the time of celiac diagnosis were iron deficiency, found in 28% of celiac patients, vitamin D deficiencies in 27%, and folate deficiency, in 14%. They also saw iron deficiency anemia in 9%, and vitamin B12 deficiency in 1% of celiac patients. They saw no hypocalcemia or thyroid dysfunction. At follow-up, they observed iron deficiency, iron deficiency anemia, and folate and vitamin D deficiency 8%, 2%, 3%, and 25% of patients, respectively. They found no vitamin B12 deficiency, hypocalcemia, and thyroid disease. From these results, the team concluded that complementary blood investigations are relevant at the time of celiac diagnosis, but have little follow-up use, once the patients adopt a gluten-free diet. They recommend that such tests be conducted only if there is a clear physical issue, such as fatigue or abnormal growth. Source: Journal of Pediatrics. DOI: http://dx.doi.org/10.1016/j.jpeds.2015.09.078
  21. Celiac.com 06/12/2015 - Some researchers have suspected that certain prenatal and perinatal factors might affect risk for development of celiac disease, but there is very little data. With this in mind, a team of researchers set out to determine if any prenatal and perinatal factors might affect risk for development of celiac disease in children. Their team assessed the association of fetal growth, birth weight, and mode of delivery with development of celiac disease within the Norwegian Mother and Child (MoBa) Cohort Study. The research team included Louise Emilsson, Maria Christine Magnus, and Ketil Størdal. They are variously affiliated with the Primary Care Research Unit, Vårdcentralen Värmlands Nysäter, County Council of Värmland, Sweden, the Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Oslo, Norway, the Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway, and the Paediatric Department, Ostfold Hospital Trust, Fredrikstad, Norway. To make their determination, the team used the MoBa cohort, which contains pregnancy information on 95,200 women and data on their 114,500 children. The information was collected in Norway from 1999 through 2008; it is linked to the Norwegian Medical Birth Registry. The team used the National Patient Registry and women’s responses to MoBa questionnaires to identify women and children with celiac disease. The team calculated odds ratios (ORs) for celiac disease by using a multivariable logistic regression model, adjusting for maternal celiac disease, sex of children, and children’s age (model 1). In model 2, they adjusted for age of gluten introduction and duration of breastfeeding. The team identified 650 children with celiac disease and 107,828 controls in the MoBa database. They found no connection between birth weight or height with celiac disease, including for children who were born small for gestational age. They found no celiac disease connection based on mode of delivery (cesarean section, model 1: OR, 0.84; 95% confidence interval [CI], 0.65–1.09, and model 2: OR, 0.83; 95% CI, 0.63–1.09). They did find that maternal celiac disease, adjusted for age and sex of the children and type 1 diabetes were associated with development of celiac disease in children, whereas maternal type 2 diabetes and gestational diabetes were not. Their analysis of the Norwegian MoBa cohort shows that development of celiac disease in children is significantly associated with sex of the child, maternal celiac disease, and type 1 diabetes, but not with gestational development. Source: Clinical Gastroenterology and Hepatology. DOI: http://dx.doi.org/10.1016/j.cgh.2014.10.012
  22. Celiac.com 03/27/2015 - Researchers don't have any solid idea about how common cases of seronegative celiac disease might be, but many feel strongly that rates of seronegative celiac disease are underestimated in children, and may result in misdiagnosis of celiac cases. One team of researchers wondered if an emphasis on "serology-led" diagnosis might be contributing to a low rate of celiac disease diagnosed in children from the United States. That research team included Deborah L. Preston and Yoram Elitsur, and they recently set out to investigate the rate of celiac disease after upper endoscopy (EGD) with no prior positive celiac serology compared with the rate of celiac disease followed by positive serology. The team conducted a retrospective review of that charts of all of the first diagnostic EGDs in children (2009–2013). They split the patients with confirmed celiac disease into 4 groups: group A, positive EGD/positive serology (histology-led diagnosis); group B, positive serology/positive histology (serology-led diagnosis); group C, positive histology followed by negative serology (control 1); and group D, positive serology followed by negative histology (control 2). The team reviewed a total of 761 upper endoscopic charts. They confirmed 15 children with celiac disease, for a rate of 1.97%. Group A and group B had similar demographic data or clinical symptoms, and similar rates of celiac disease between histology-led celiac diagnosis (group A) and serology-led celiac diagnosis (group (1.18% vs 0.79%, P = 0.273). This study showed that endoscopy-led diagnosis and serology-led diagnosis found celiac disease at similar rates. This finding suggests that better diagnosis of celiac disease in children requires performing an adequate number of intestinal biopsies in every diagnostic upper endoscopic procedure. Source: Journal of Pediatric Gastroenterology & Nutrition: March 2015 - Volume 60 - Issue 3 - p 357–359. doi: 10.1097/MPG.0000000000000602
  23. Celiac.com 03/10/2015 - Up to now, celiac disease has been described only in sporadic cases of obesity. A research team recently set out to evaluate retrospectively celiac disease rates in a large group of overweight/obese children and adolescents. The research team included Raffaella Nenna, Antonella Mosca, Maurizio Mennini, Raffaele E. Papa, Laura Petrarca, Roberta Mercurio, Monica Montuori, Alessandra Piedimonte, Maria Bavastrelli, Ilaria C. De Lucia, Margherita Bonamico, and Andrea Vania. For their study, the team consecutively evaluated 1,527 overweight/obese children and adolescents, 10 girls and 7 boys had positive celiac serology and showed villous atrophy. All celiac patients immediately began a well-balanced gluten-free diet, and rapid weight loss followed. The study shows that celiac rates in overweight/obese children are similar to rates in the general Italian pediatric population, and that those children benefit from proper diagnosis and a healthy gluten-free diet. Source: Journal of Pediatric Gastroenterology & Nutrition: March 2015 - Volume 60 - Issue 3 - p 405–407. doi: 10.1097/MPG.0000000000000656
  24. Celiac.com 01/29/2015 - Testing for tissue transglutaminase antibodies (TGA) is currently a common part of attempting to diagnose celiac disease. A research team wanted to find out if determination of antibodies to synthetic deamidatedgliadin peptides (anti-DGP) might work as an alternative or complement to TGA testing. To find out, the team assessed the performance of a time-resolved immunofluorometry (TR-IFMA) based anti-DGP assay in the diagnosis of celiac disease in children, and also retrospectively analyzed the appearance of anti-DGP antibodies before TGA seroconversion. The research team included A. Lammi, P. Arikoski, S. Simell, T. Kinnunen, V. Simell, S. Paavanen-Huhtala, A. Hinkkanen, R. Veijola, M. Knip, J. Toppari, O. Vaarala, O. Simell, and J. Ilonen. They are variously affiliated with the Department of Clinical Microbiology and the A.I. Virtanen Institute for Molecular Sciences at the University of Eastern Finland in Kuopio, Finland, the Department of Pediatrics at Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland, the Department of Pediatrics at the University of Oulu and Oulu University Hospital in Oulu, Finland, the Children's Hospital, and the Institute of Clinical Medicine at the University of Helsinki in Helsinki, Finland, the Folkhälsan Research Center in Helsinki, Finland, the Department of Pediatrics at Tampere University Hospital in Tampere, Finland, the Immunogenetics Laboratory, and the Department of Physiology at the University of Turku, and with the Department of Pediatrics and Adolescent Medicine at the University of Turku and Turku University Hospital in Turku, Finland. For their study, the team assessed 92 children with biopsy-confirmed celiac disease. The team took blood samples at the time of, or just prior to, clinical diagnosis. The team also assessed a control group of 82 TGA-negative children who were positive for HLA-DQ2 or -DQ8. Based on receiver operating characteristics (ROC) curves, they found that the optimal cut-off value for IgA anti-DGP positivity was 153 arbitrary units (AU) with a sensitivity of 92.4% and specificity of 97.6%, while the optimal cut-off value for IgG anti-DGP 119 AU, with a sensitivity of 97.8% and specificity of 97.6%. They found that all 92 children with celiac disease tested positive for either IgA or IgG anti-DGP at the time of diagnosis. Blood results from 48 children with celiac disease, analyzed retrospectively before the diagnosis, showed that anti-DGP antibodies preceded TGA positivity in 35 of 48 celiac disease children and appeared an average of one year earlier. From these results, the TR-IFMA test for detecting anti-DGP antibodies shows high sensitivity and specificity for celiac disease in children. For most of the patients, anti-DGP seropositivity preceded TGA positivity, which means that monitoring anti-DGP antibodies frequently in genetically susceptible children might allow doctors to spot celiac disease earlier than allowed by current tests. Source: J Pediatr Gastroenterol Nutr. 2014 Dec 16.
  25. Celiac.com 10/31/2014 - The relationship between the risk of celiac disease and both the age at which gluten is introduced to a child’s diet and a child’s early dietary pattern is unclear. A team of researchers set out to examine how the introduction of dietary gluten and HLA status impact the risk of celiac disease in children. The research team included Elena Lionetti, M.D., Stefania Castellaneta, M.D., Ruggiero Francavilla, M.D., Ph.D., Alfredo Pulvirenti, Ph.D., Elio Tonutti, M.D., Sergio Amarri, M.D., Maria Barbato, M.D., Cristiana Barbera, M.D., Graziano Barera, M.D., Antonella Bellantoni, M.D., Emanuela Castellano, M.D., Graziella Guariso, M.D., Maria Giovanna Limongelli, M.D., Salvatore Pellegrino, M.D., Carlo Polloni, M.D., Claudio Ughi, M.D., Giovanna Zuin, M.D., Alessio Fasano, M.D., and Carlo Catassi, M.D., M.P.H. They are variously affiliated with the Departments of Pediatrics (E.L.) and Clinical and Molecular Biomedicine (A.P.), University of Catania, the Department of Pediatrics, San Paolo Hospital (S.C.), and the Department of Developmental Biomedicine, University of Bari (R.F.), Bari, the Department of Immunopathology and Allergology, Udine Hospital, Udine (E.T.), the Department of Pediatrics, Azienda Ospedaliera IRCCS Santa Maria Nuova Hospital, Reggio Emilia (S.A.), the Department of Pediatrics, Sapienza University of Rome, Rome (M.B.), the Department of Pediatrics, University of Turin, Turin (C.B.), the Department of Pediatrics, San Raffaele Hospital (G.B.), and the Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milan (G.Z.), the Department of Pediatrics, Bianchi Melacrino Morelli Hospital, Reggio Calabria (A.B.), Pediatric Gastroenterology Unit, Giannina Gaslini Institute, Genoa (E.C.), the Department of Pediatrics, University of Padua, Padua (G.G.), the Department of Pediatrics, Federico II University of Naples, Naples (M.G.L.), Pediatric Gastroenterology and Cystic Fibrosis Unit, University Hospital Gaetano Martino, Messina (S.P.), the Department of Pediatrics, Rovereto Hospital, Rovereto (Trento) (C.P.), the Department of Pediatrics, University of Pisa, Pisa (C.U.), and the Department of Pediatrics, Marche Polytechnic University, Ancona (C.C.) — all in Italy; and the Division of Pediatric Gastroenterology and Nutrition and Center for Celiac Research, MassGeneral Hospital for Children (A.F.), and the Celiac Program, Harvard Medical School (A.F., C.C.) — both in Boston. For their study, the team randomly divided 832 newborns who had first-degree relatives with celiac disease into groups that received their first dietary gluten at 6 months (group A) or 12 months (group . The team determined HLA genotype at 15 months of age, and conducted serologic screening for celiac disease at 15, 24, and 36 months, and again at 5, 8, and 10 years. Patients with positive serologic findings received intestinal biopsies. The primary focus was on rates of celiac disease autoimmunity and of overt celiac disease among the children at 5 years of age. A total of 707 children completed the 36 month trial. Of those, 553 had a standard-risk or high-risk HLA genotype and completed the study. At 2 years of age, substantially higher percentages of children in group A than in group B had celiac disease autoimmunity (16% vs. 7%, P=0.002) and overt celiac disease (12% vs. 5%, P=0.01). At 5 years of age, there were no longer significant differences between the groups in terms of autoimmunity (21% in group A and 20% in group B, P=0.59) or overt disease (16% and 16%, P=0.78 by the log-rank test). At 10 years, the risk of celiac disease autoimmunity was far higher among children with high-risk HLA than among those with standard-risk HLA (38% vs. 19%, P=0.001), as was the risk of overt celiac disease (26% vs. 16%, P=0.05). Other variables, including breast-feeding, were not associated with the development of celiac disease. So, the short take away here is that, according to this study, neither delayed introduction of gluten nor breast-feeding had any effect on celiac disease rates among at-risk infants. However, children who experienced later introduction of gluten showed a delay in the onset of disease. Lastly, the important predictor of disease was having a high-risk HLA genotype. Source: N Engl J Med 2014; 371:1295-1303October 2, 2014. DOI: 10.1056/NEJMoa1400697