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Found 49 results

  1. J Allergy Clin Immunol 2004;113:1199-1203. Celiac.com 07/30/2004 - According to a study by Italian researchers published in the June edition of the Journal of Allergy and Clinical Immunology, the prevalence of atopic dermatitis is much more common in those with celiac disease. The researchers looked at 1,044 adults with untreated celiac disease at the point of their diagnoses, as well as 2,752 of their relatives, and 318 of their spouses. They also looked at the prevalence of allergies in celiacs after one year on a gluten-free diet. The subjects filled out a standardized questionnaire upon their diagnosis, and those who reported having an allergy were tested for it using a standard makeup of 20 antigens for serum specific IgE. The researchers found that one celiac in 173 (16.6%) had at least one additional allergy, compared with 523 of their relatives (19%), and 43 of their spouses (13.5%). Patients with celiac disease were also more likely (3.8%) to have atopic dermatitis than their relatives (2.3%) or their spouses (1.3%). The amount of time that the celiac patients went undiagnosed and therefore untreated did not seem to influence the presence of allergy or atopic dermatitis. It is possible that a longer period of time on a gluten-free diet could influence the prevalence of allergy in those with celiac disease, and more research needs to be done to determine if being gluten-free longer can decrease allergies in those with celiac disease.
  2. Celiac.com 05/22/2015 - The fact that celiac disease is commonly misdiagnosed will come as little surprise to anyone who's ever gone through what can often be a long, circuitous process of getting diagnosed. Celiac symptoms can be vague, and can mirror symptoms of numerous other conditions. Even though celiac awareness is improving, and blood screens are becoming more common, misdiagnosis remains common for people who are eventually diagnosed with celiac disease. Can you guess the most common misdiagnoses that doctors make for patients with celiac disease? The most common misdiagnoses include: Irritable bowel syndrome: People with celiac disease are often told that they have irritable dowel syndrome when they actually have celiac disease. In fact, IBS is the most common misdiagnosis for people with celiac disease. Inflammatory bowel disease: Coming in a close second to IBS, inflammatory bowel disease is another common misdiagnosis for people who actually have celiac disease. Gastro-esophageal reflux disease: People with GERD don't have any higher rates of celiac disease than the rest of the population. However, to be fair, a pretty high percentage of newly diagnosed celiac patients have reflux and/or esophageal dysmotility; which might explain the high prevalence of reflux symptoms in celiac disease patients, and the common misdiagnosis of GERD. Ulcers: Ulcers are often wrongly suspected, well before celiac disease is finally diagnosed. Viral gastroenteritis: Another very common thing doctors suspect long before they suspect celiac disease, is viral gastroenteritis. Chronic fatigue syndrome: Fatigue is a common complaint of many people with celiac disease, so maybe it's understandable why many people with celiac disease find themselves with a misdiagnosis of chronic fatigue, rather than an accurate diagnosis of celiac disease. Allergies: Many people find themselves wrongly diagnosed with environmental allergies long before they are diagnosed with celiac disease. Parasitic infection: Celiac disease symptoms can mirror symptoms of certain gut parasites, which is one reason that many people with celiac disease find themselves being checked for parasites long before they get checked for celiac disease. Gallbladder disease: Celiac disease symptoms can mirror symptoms of gallbladder disease, which is why many people who actually have celiac disease find themselves diagnosed with gallbladder problems. Colitis: Another common culprit for misdiagnosis is colitis, which shares many symptoms with celiac disease. Cystic fibrosis: Many people don't realize that in a number of cases, the symptoms of celiac disease can lead doctors to suspect cystic fibrosis, rather than celiac disease, thus prolonging diagnosis, treatment and recovery. Psychological dysfunction: In many cases, celiac disease symptoms can be so hard to pin down that doctors find themselves wondering if the symptoms aren't really in the patient's head. In their quest for diagnosis, many people with celiac disease have been referred to a psychologist, rather than evaluated for celiac disease. Lactose intolerance: Lactose intolerance is a common misdiagnosis in celiac patients, because the mucosal damage from gluten leaves them unable to digest lactose-containing products. In addition to being frustrating and painful, misdiagnosis of celiac disease is a big deal because, left unaddressed, the damage done by the disease continues unabated, and can snowball into further health and wellness problems. Have you, or anyone you know, suffered through misdiagnosis before being diagnosed with celiac disease? Share your story in our comments section. Source: US Pharmacist. 2014;39(12):44-48.
  3. Celiac.com 05/11/2015 - Many people with celiac disease know that gluten exposure can cause gut damage and trouble absorbing some vitamins and minerals, which can lead to serious deficiencies. However, even celiac who follow gluten-free diets may experience similar issues, including impaired vitamin and mineral absorption. The most common vitamin and mineral deficiencies in celiac patients include the following vitamins and minerals: B vitamins, especially B12 Vitamin A Vitamin D Vitamin E Vitamin K Iron Calcium Carotene Copper Folic acid Magnesium Selenium Zinc As a result, patients with celiac disease can develop iron-deficiency anemia, including a type that resists oral iron supplementation, and may also develop osteoporosis and osteopenia due to bone loss resulting from decreased calcium and vitamin D absorption. For these reasons, it is important that patients with celiac disease be monitored regularly to ensure that they have proper levels of vitamins and minerals in their bodies. Source: U.S. Pharmacist
  4. Celiac.com 09/22/2017 - Misdiagnosed my sophomore/ junior year of High School, 3 years ago, with celiac disease, I became obsessed with the science of this ailment and how it was supposedly affecting me. I was shocked by how little is known about this autoimmune disease and the many gaps in research done on it. One such gap is that of cross-contamination in the household, where it is likely to have a daily impact on those following gluten-free diets. Because of this, I decided to help fill this gap in scientific knowledge with a manageable project based on cross-contamination in the home, asking whether one can share common kitchen cookware that is used with gluten containing foods, or if people, to help maintain a gluten-free diet, need designated ones for their food preparation. Either way that this research played out would be beneficial to the gluten-free community. For example, some families with members on gluten-free diets will spend a lot of money to buy all new ‘gluten-free' designated cookware and utensils to help minimize cross-contamination. Part of the relevancy of this project is economical, as designated cookware can be very costly. Despite the cost, other factors affect the value of this research, including the impracticality of having a double set of kitchen appliances, which would be very bulky and impractical for those with limited space. Another factor that influences the significance of this project is beyond one's home; celiac disease brings a lot of social stress. By assuring there is limited or no cross-contamination from common kitchen appliances after customary washing, these individuals would be able to have some confidence when eating at friends' or families' homes. On the other end, if this research shows that there is cross-contamination with shared supplies it will highlight the need for dedicated ones to maintain a strict gluten-free diet. Just because a gluten-free recipe is used, a given dish may not be genuinely gluten free if there is contamination from cookware. Hazards and Concerns To fully understand the hazards of gluten contamination, a few things must first be established: What is gluten? Who is it harmful to? How and to what extent must it be avoided? How does cross-contamination occur? What is Gluten? The United States Food and Drug Association (FDA) have been trying to define "gluten" for years. The current proposed definition is, "the proteins that naturally occur in a ‘prohibited grain' that may cause adverse health effects in persons with celiac disease."(1) These prohibited grains are any species belonging to triticum, hordeum and secale or more commonly called respectively: wheat, barley, and rye, though other prohibited grains exist as hybrids of any of the three.(2) That being said, not all proteins in these three types of grains are toxic to those with celiac disease as there are two parts to glutens: prolamins, the immunotoxic ones, and glutenins, the safe ones.(3) The prolamins in the three main prohibited grains, wheat, barley, and rye, are gliadin, hordein, and secalin.(4) Who Does Gluten Harm? Gluten is toxic to certain individuals with celiac disease, an autoimmune disease that also goes by the names of: coeliac disease, celiac sprue, nontropical sprue, and gluten-sensitive enteropathy.(5) A Thomson Healthcare Company study estimated that up to 1.5 Million Americans, or one in 133 people, have celiac disease, though other individuals avoid gluten as well, such as those with gluten intolerance, or other ailments where a gluten-free diet is believed to lessen their symptoms.(6) This strict abstention from gluten is because celiac disease cannot be cured, or mediated with medication as yet. The only way to help those affected is by following this strict diet. How and to What Extent Must it be Avoided? Foods that contain wheat, rye, and barley, or any hybrid of these grains contain gluten. Gluten is a very common protein in foods, whether from bread, or as an additive to provide a thicker texture, such as in soups. This versatility makes processed foods, in the eyes of those on gluten-free (gluten-free) diets, something to be wary of. Because of this caution, companies want their products to be certified gluten-free, which according to the FDA calls for Despite current unknowns regarding contamination, a strict gluten-free diet must exclude all foods that contain gluten and minimize cross-contamination. This means from eating out, to staying in, gluten must be avoided. Topical products where gluten is added, such as in some lotions or body washes, should also be avoided. Despite the widespread use of gluten there are gluten-free grains and foods, such as beans, rice, millet, corn, amaranth, and soy. How Does Cross-contamination Occur? Cross-contamination is a term usually directed toward accidental spread of bacteria due to not cooking food, washing hands or materials. However, in this article it refers to the accidental transfer or content of gluten, the protein that is toxic to those with celiac disease. In my personal experience and research on celiac forums, when a member of a family goes gluten-free the family will most likely continue eating a regular diet. In addition, as the average time it takes to be diagnosed from the first onset of symptoms is 10 years in the United States, these families have kitchen supplies that they have been using with gluten.(8) With little public knowledge about celiac disease and going gluten-free, people tend to overlook cross-contamination. Theoretically, in the simple act of making a sandwich with gluten-free bread there are many different ways for it to become contaminated. For example, from a shared jar of peanut butter or jelly with crumbs accidentally getting into it and then dipped out onto the gluten-free bread, or crumbs on the surface it's prepared on sticking to the gluten-free bread. Research Investigation The investigation of common kitchen appliances that are frequently exposed to gluten and cleaned by customary sanitation techniques calls for the conduction of an enzyme linked immunoassay (ELISA) test when using them to prepare gluten-free food. Various well used kitchen appliances, wood and plastic cutting boards, cast iron skillets, both seasoned and unseasoned, Teflon and aluminum pans, and ceramic and glass bowls were contaminated with gluten, using whole wheat flour slurry, and then washed by their standard cleaning technique, either scrubbing with hot soapy water, or wiping with a paper towel and water. Afterward a certified gluten-free substance, in this case millet flour, was added and let sit to allow adherence of any gluten remaining on the ‘cleaned' surface. Figure 1 illustrates the extraction solutions that were made from the samples and injected into the Microwell plates with the anti-body coating and the various washes of the ELISA test. Then, the gliadin, if present, bound to the walls of the wells due to its antibody coating and the wells were washed to eliminate remaining parts in the well. Next, the enzyme Horseradish Peroxidase, or HRP enzyme, adheres post-injection to any gliadin present as an amplifier and is again washed to remove extra parts. Lastly, a 3,3', 5,5'-Tetramethylbenzidine, or TMB substrate was added which turns blue in the presence of a peroxidase, in this case the adhered HRP enzyme, which can only be there if there was gliadin to attach to. This color after a acid stop solution, which turns it yellow, is added is then assessed using a Microwell plate reader for its absorbency which, when compared with a standards curve made from known samples, by the company, will be used to determine the gluten content, in parts per million, of all the samples individually. Results Intuition may lead one to think that well developed standard cleaning techniques for most appliances, and the difficulty in transferring proteins to a gluten-free medium from a surface that has been cleaned, will make gluten cross-contamination unlikely. However, due to factors such as porosity and oiliness, some surfaces may harbor gluten. Typically, far less rigorous cleaning techniques are used on the seasoned cast iron skillet and it is very porous and oily so the gluten proteins have a better chance of binding to it and then transferring to a gluten free medium. Given the test results of the ELISA test, this is mostly true. Despite the logic being the same, and it being the intuitive most likely candidate for cross-contamination a different appliance with the same sanitation technique proved to exceed the gluten parts per million limit where as the cast iron did not. The only absorbency ratings from the samples that interpolated to be greater than the 20 ppm of gluten allowance were two extractions from the Teflon pan. All other ratings, including two other Teflon pan extractions, were below the limit. Conclusion Ninety-four percent of the sample extractions showed less than the 20 parts per million of gluten which is the threshold for something to be declared gluten-free. Teflon had half of its extractions above the limit, as such Teflon should be deemed cross-contaminated. However, the Teflon's other extraction samples had well below 20ppm. This could have been due to the sample's gluten free sample being rather large and thus only part of it could have gotten contaminated (positive cross-contamination) and other parts not (negative cross-contamination). All others samples were classified as gluten-free due to being below the 20ppm allowance. In conclusion, the values of gluten cross-contamination, in ppm, were too small to hinder the integrity of the gluten-free medium in all but Teflon. Thus, to the extent of the experiment done, having tested only eight different kitchen appliances, with only two different sanitation techniques, common kitchen appliances that are frequently exposed to gluten, can be cleaned by customary methods and used to prepare gluten-free food with the exception of Teflon appliances. This research project could be extended by more trials. For example, eight types of common kitchen appliance were used, but only one appliance was used to represent each type. More trials could be done within each type, using different brands, variations in extent of wear, etc. In addition, the only type of contaminant used was whole-wheat slurry. Other forms of contaminant should be tested as well, to show the universality of the cross-contamination, or lack thereof. This should include different gluten-containing substances, as well as some dry and some wet. Unfortunately, this research question will have exceptions as the extent of washing and wear on an appliance is a more subjective issue. This means that even if it is found on a larger scale that certain appliances have been found to be safe for producing gluten-free foods, it should still be avoided when possible for those with celiac disease as if not washed properly; it could go beyond the 20ppm allowance and be immunotoxic to these individuals. Vested interest is always a concern with research, and thus it must be pointed out that no company or university holds any interest in this project and no help was given financially or academically, only that The University of Detroit Mercy allowed me to use their lab for the duration of the experiment and Microwell plate reader. In addition, both sides of the results would prove beneficial, so the data were not interpreted with a bias toward any desired result. Eleanore Dara is a "rising scientist" and is an incoming biochemistry student on a Research Track Major at the University of Scranton in Pensnsylvania. References: "Questions and Answers on the Gluten-Free Labeling Proposed Rule." U S Food and Drug Administration. N.p., 23 Jan. 2007. Web. 31 Jan. 2011. https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Allergens/ucm362880.htm Ibid. Amaya-González, et al. "Amperometric Quantification of Gluten in Food Samples Using an ELISA Competitive Assay and Flow Injection Analysis." Electoanaylsis 23.1 (2010): 108+. Wiley Online Library. Web. 8 Mar. 2011. "What Is Gliadin? What Is Its Role In Gluten Sensitivity?." Gluten Free Around The World, Traditional Foods Make Eating an Adventure. N.p., n.d. Web. 25 Mar. 2012. http://www.gluten-free-around-the-world.com/gliadin.html Snyder, Cara et al. "Celiac Disease Coeliac Disease, Celiac Sprue, Nontropical Sprue, Gluten-Sensitive Enteropathy." The National Center for Biotechnology Information. N.p., 3 June 2008. Web. 31 Jan. 2011. Cerrato, Paul L. "Gluten Intolerance: more common than thought. (Complementary Therapies Update)." RN 66.8 (2003): 23. General One File. Web. 28 Mar. 2011. "Questions and Answers on the Gluten-Free Labeling Proposed Rule." U S Food and Drug Administration. N.p., 23 Jan. 2007. Web. 31 Jan. 2011. https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Allergens/ucm362880.htm Adams, Scott. "USA - Average Time to Diagnosis = 10 Years - Celiac.com." Celiac Disease & Gluten-free Diet Information at Celiac.com. Scott Adams, 26 July 1996. Web. 16 Feb. 2012. http://www.celiac.com/articles/48/1/USA---Average-Time-to-Diagnosis--10-Years/Page1.html.
  5. PEDIATRICS Vol. 108 No. 2 August 2001, p. e21 Kieslich M, Errazuriz G, Posselt HG, Moeller-Hartmann W, Zanella F, Boehles H. Departments of Pediatrics, Johann Wolfgang Goethe University, Frankfurt/Main, Germany. Celiac.com 08/24/2001 - It is well known that celiac disease causes destruction of the villi in the small intestine that results in malabsorption of nutrients in affected individuals. There is solid evidence that additional neurological complications can result, such as epilepsy, possibly associated with occipital calcifications or folate deficiency and cerebellar ataxia. An increase in brain white-matter lesions has been reported in patients with Crohn disease and ulcerative colitis, but until now, not in patients with celiac disease. A recent study published in the August 2, 2001 issue of Pediatrics has now demonstrated a similar increase of these lesions in patients with celiac disease. The study was carried out by Dr. Kieslich and colleagues of the Departments of Pediatrics, Johann Wolfgang Goethe University, Frankfurt/Main, Germany, on 75 biopsy-proven celiac disease patients who were on a gluten-free diet. Most of the patients in the study were between 2.8 and 24.2 years old, and the mean age was 11.6 years. All of the patients underwent prospectively clinical neurological examinations, laboratory investigations, electroencephalography, computed tomography, and magnetic resonance imaging. According to the study the mean period of gluten exposure was 2.4 years, although it was likely longer as recent studies have shown that many celiacs are asymptomatic for many years before damage occurs that is severe enough to cause obvious symptoms. The researchers found that ten of the patients had neurological manifestations such as febrile seizures, single generalized seizures, mild ataxia, and muscular hypotonia with retarded motor development, although no folate deficiencies were found. Further, the hippocampal regions appeared normal, and no cerebral calcifications were found, however, the MRI results showed unilateral and bilateral T2-hyperintensive white-matter lesions in 15 patients (20%). According to the research, there does not appear to be a relationship between these lesions and dietary compliance or neurological or electroencephalographic abnormalities. The researchers conclude that focal white-matter lesions in the brain may represent an extra-intestinal manifestation of celiac disease. They theorize that the lesions may be the result of a decreased blood supply caused by the constriction or obstruction of blood vessels due to inflammation, or caused by the destruction of the nerve fiber due to inflammation. Further, children with white-matter lesions, even if they do not have intestinal symptoms, should be tested for celiac disease. Last, more research needs to be done on people celiac disease of all ages to develop a proper predictive value, and to discover the exact cause of the lesions.
  6. Celiac.com 10/01/2010 - Scleroderma is a chronic, systemic autoimmune disease characterized by tissue fibrosis, or hardening, vascular changes, and autoantibodies. There are two forms of scleroderma. The first is called limited systemic sclerosis/scleroderma cutaneous, and manifests mainly affect the hands, arms and face. This form of scleroderma was earlier known as CREST syndrome, because symptoms included Calcinosis, Raynaud's phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasias. This form of scleroderma triggers pulmonary arterial hypertension in up to one third of patients, which is the most serious problem. The second, less common form of scleroderma is called diffuse systemic sclerosis/scleroderma. This form progresses quickly and affects large areas of skin and one or more internal organs, generally the kidneys, esophagus, heart and lungs. A recent letter by doctors R. Thonhofer M. Trummer, and C. Siegel noted that capillaroscopy shows an active pattern of scleroderma in celiac disease. They are affiliated with the Department of Internal Medicine at the State Hospital Muerzzuschlag, and with the Department of Rheumatology at the Medical University of Graz in Austria. Their letter notes that previous studies have shown celiac disease to be associated with higher rates of Raynaud’s phenomenon, sclerodactyly, arthritis, polymyositis, pericarditis, vasculitis, and scleroderma. The doctors describe the case of a 41-year-old, non-smoking woman, who presented with Raynaud's phenomenon and progressive weight loss. For nearly twenty years, the woman had suffered symptoms of Raynaud's phenomenon, with classical tricolore phenomenon and symmetrical bilateral involvement of hands, with lesser effect on her feet. The woman's weight loss had persisted for two years, accompanied by unspecific abdominal symptoms including meteorism and episodic diarrhea. The attacks of Raynaud's phenomenon seemed to be triggered by exposure to cold or by emotional stress. The doctors ruled out digital ulcers, vibration injury, and ingestion of toxic agents as possible causes. A color Doppler ultrasound examination of the arteries of the upper and lower extremities showed nothing remarkable. Radiographs of the hands, feet, clavicles, cervical, and lumbar spine were also not remarkable. Nailfold capillaroscopy of digits two to five bilaterally showed capillary loss in some areas, mild, focally moderate to severe disorganization of the vascular architecture, frequent giant capillaries, and hemorrhages adjacent to enlarged, nearly normal, and giant capillaries. The patient showed negative test results for anti-nuclear antibodies, complement factors, anti-DNA antibodies, anti-neutrophil cytoplasmic antibodies, anti-cardiolipin antibodies, cryoglobulinaemia, and rheumatoid factor. Erythrocyte sedimentation rate and C-reactive protein were in the normal range. The patient showed positive screens for anti-endomysial antibodies and anti-tissue transglutaminase antibodies. Endoscopy and several biopsies of the large bowel and terminal ileum showed nothing remarkable. Gastroduodenoscopy showed normal mucosa in the upper gastrointestinal tract. Looking at biopsy results from different parts of the duodenum, the team found an increase in intraepithelial lymphocytes, with about 60 to 70 per 100 enterocytes, along with shortening of the epithelial cells, and a reduction of globlet cells. As a result of antibody testing, anamnesis, and histology, the team was able to make a diagnosis of celiac disease. After the patient began treatment with a gluten-free diet, the abdominal symptoms and weight loss subsided, and the Raynaud's phenomenon attacks became less frequent. Clinical and laboratory evaluation over the last four years have not shown any connective tissue disease in the patient. The team used capillaroscopy every 6 months to show that the pattern of damage remained unchanged, and was not improved by the gluten-free diet within the first year. After 18 months, the vascular architecture showed some improvement, with no further bleeding or enlarged capillaries. Repeated examinations after that point showed similar, near-normal findings. There have been previous reports of several rheumatological disorders, including Raynaud's phenomenon in people with celiac disease, but this seems to be the first report of extensive microvascular damage, similar to capillary changes in scelroderma, documented by nailfold capillaroscopy in a patient with celiac disease. Because they excluded any underlying connective tissue disease or other secondary causes of Raynaud's phenomenon, the team's findings support a causal relationship between celiac disease and Raynaud's phenomenon, especially in regards to the described capillary pattern. Normalization of the patient's vascular architecture after a year and a half on a gluten-free diet further bolster their findings. The team admits the possibility of evolving scelroderma in the patient, but points out that the negative laboratory testing, organ screening, and inconspicuous clinical examination would seem to make that scenario highly unlikely. It will be interesting to see what doctors can learn through additional nailfold capillaroscopy investigations into the special capillary pattern in celiac disease patients. Source: Scand J Rheumatol.Vol. 1, No. 1, Jul 2010. DOI: 10.3109/03009742.2010.489230
  7. Celiac.com 11/28/2016 - It's clear from research data that what was once thought to be a childhood disease can affect people well into adulthood and old age. A team of researchers recently set out to assess rates of celiac disease diagnosis in an elderly population, recording the main clinical features of this group respect to young patients. The research team included R. Tortora, F. Zingone, A. Rispo, C. Bucci, P. Capone, N. Imperatore, N. Caporaso, D. D'Agosto, and C. Ciacci. They are variously affiliated with the Department of Clinical Medicine and Surgery at the University "Federico II" of Naples in Napes, Italy, and with the Department of Gastroenterology at the University of Salerno in Salerno, Italy. They conducted a retrospective analysis of celiac disease rates in elderly individuals from 1970 to 2015. They divided patients by age into three groups. Group A included patients 18-34 years old. Group B included patients 35-64 years old. Group C included patients 65 years or older. The team then compared the groups regarding baseline anthropometric and serological variables, clinical features at diagnosis, diagnostic mode, associated autoimmune diseases, and celiac-related neoplastic complications. They made a total of 2,812 celiac disease diagnoses in adults, 2.5% of which occurred in patients 65 years or older at diagnosis. When comparing the three groups, they found no differences in sex, haemoglobin, serum iron, albumin, and anti-tissue transglutaminase (anti-tTG) (p = NS). They did find higher values of cholesterol, glycemia, and triglycerides in older patients (p < 0.0001). Elderly had higher rates of diagnosis for malabsorption symptoms compared to younger patients (OR 2.20, 95%CI 1.3-3.74). The team also found no difference in the risk of autoimmune celiac-related diseases between groups. The researchers found 16 neoplastic complications, 13 of them in patients diagnosed with celiac disease between 35-64 years of age. The number of celiac disease diagnoses increased over time, particularly in elderly. These results show that celiac disease diagnosis in the elderly population is uncommon, but not rare. Elderly celiac patients face a greater risk of being diagnosed with malabsorption symptoms than younger patients, but with a lowr risk of autoimmune and neoplastic complications. Source: Scand J Gastroenterol. 2016 Oct;51(10):1179-83. doi: 10.1080/00365521.2016.1186222. Epub 2016 May 31.
  8. Celiac.com 08/24/2016 - Although serological tests are useful for identifying celiac disease, it is well known that a small minority of celiacs are seronegative, and show no blood markers for celiac disease. A team of researchers wanted to define the prevalence and features of seronegative compared to seropositive celiac disease, and to establish whether celiac disease is a common cause of seronegative villous atrophy. The research team included U Volta, G Caio, E Boschetti, F Giancola, KJ Rhoden, E Ruggeri, P Paterini, and R De Giorgio. They are all affiliated with the Department of Medical and Surgical Sciences, University of Bologna, St. Orsola-Malpighi Hospital, Italy. They looked at clinical, histological and laboratory findings from 810 celiac disease diagnoses, and retrospectively characterized seronegative patients. Of the original 810 patients, they found fourteen patients who fulfilled diagnostic criteria for seronegative celiac disease, which were antibody negativity, villous atrophy, HLA-DQ2/-DQ8 positivity and clinical/histological improvement after gluten free diet. Their review showed that, compared to seropositive patients, seronegative celiac patients showed a significantly higher median age at diagnosis and a higher prevalence of classical phenotype, such as malabsorption, along with autoimmune disorders and severe villous atrophy. The most common diagnosis in the 31 cases with seronegative flat mucosa was celiac disease at 45%, along with Giardiasis at 20%, common variable immunodeficiency at 16%, and autoimmune enteropathy at 10%. Although rare, seronegative celiac disease is the most common cause of seronegative villous atrophy with a high median age at diagnosis; a close association with malabsorption and flat mucosa; and a high prevalence of autoimmune disorders. Physicians treating seronegative villous atrophy should consider seronegative celiac disease as a possibility. Source: Dig Liver Dis. 2016 Jun 11. pii: S1590-8658(16)30460-1. doi: 10.1016/j.dld.2016.05.024.
  9. Celiac.com 06/13/2016 - Researchers Umberto Volta, Giacomo Caio, and Roberto De Giorgio, of the Department of Medical and Surgical Sciences at the University of Bologna in Bologna, Italy, recently submitted a letter to the medical journal Gastroenterology. In their letter, the researchers respond to a recent paper, published by Carroccio et al, reporting on the prevalence of autoimmunity (as identified by positivity of antinuclear antibodies [ANA] and associated autoimmune disorders) in non-celiac wheat sensitivity (NCWS) compared with celiac disease and irritable bowel syndrome (IBS). They note that the study results, based on retrospective and prospective data, showed that the prevalence of ANA in NCWS was significantly higher than in celiac disease and IBS (46% in NCWS vs 24% in celiac disease and 2% in IBS, retrospectively; and 28% in NCWS vs 7.5% in celiac disease and 6% in IBS, prospectively). They note also that both retrospective and prospective analysis show autoimmune disorders (mainly autoimmune thyroiditis) in a slightly higher proportion in NCWS (29% vs 24%) than celiac disease (21% vs 20%). Meanwhile, both NCWS and celiac patients showed substantially higher rates of autoimmune disorders than IBS. In both both retrospective and prospective data, ANA showed a strong relation to HLA-DQ2 and -DQ8 in NCWS, whereas these autoantibodies were associated with autoimmune disorders only in the prospective arm. The team found these results from the Carroccio study to be scientific interesting because NCWS, more than better known autoimmune disorders, such as celiac disease, shows a surprisingly high autoimmune profile. They note that celiac disease is a well-established autoimmune condition often marked by different types of autoantibodies and associated autoimmune disorders. Such autoimmune features have not been seen so far in NCWS and the odds of these patients developing autoimmune dysfunction remains unknown. The team's data showed that only 14% of 486 patients with NCWS had an associated autoimmune disorder including thyroiditis, psoriasis, Graves disease, type 1 diabetes mellitus, and atrophic gastritis. In contrast, about 30% of 770 celiac patients showed the same autoimmune manifestations. These findings are in line with previously published data. They point out that another interesting aspect that came out of Carroccio study is the very high rate of ANA in their cohort of NCWS versus celiac disease and IBS patients. The team notes that their own experience shows ANA to be higher in celiac disease than NCWS and IBS (49% vs 37% vs 6%), which indicates a substantial autoimmune profile in celiac disease, compared with the two other conditions. They also note that evidence showing patients with NCWS to have higher rates of ANA compared with IBS is in line with the results presented by Carroccio et al. They conclude their letter by stating that consistent evidence supports a major role of adaptive immunity in celiac disease more than NCWS, and this peculiarity is reflected by a predominant occurrence of autoimmune disorders and autoantibodies (eg, ANA). However, the challenging data shown by Carroccio et al provide the basis to understand whether NCWS, like celiac disease, show a wide array of autoimmune expressions mediated by adaptive mechanisms. They call for further studies to better understand what they term the "intriguing relationship between autoimmunity and NCWS." Source: Gastroenterology. 2016 Jan;150(1):282. doi: 10.1053/j.gastro.2015.08.058. Epub 2015 Nov 23.
  10. Celiac.com 01/29/2016 - Women and girls who have Turner syndrome are significantly more likely to have celiac disease than those without the sex chromosome anomaly, according to a new study by Scandinavian researchers. Previous reports have suggested a connection between Turner syndrome, which is the partial or complete loss of an X chromosome in females, and celiac disease, but those reports were based mainly on case reports from specialty centers. Estimates of celiac disease rates in this population have varied widely, from 2% to 9%, the researchers note. To get a better picture of the association between celiac disease and Turner syndrome, they queried Sweden's comprehensive computerized registries for data from 28 pathology departments to construct a cohort of women and girls with celiac disease, and then matched each with up to five control patients selected from the Swedish Total Population Register. The research team led by Karl Mårild, MD, PhD, from the Norwegian Institute of Public Health in Oslo, recently conducted a review of pathology records on 7,548 females with biopsy-confirmed celiac disease in Sweden. Their results showed that 20 of the patients (0.26%) also had a diagnosis of Turner syndrome. By contrast, of 34,492 age- and sex-matched controls in the general Swedish population, only 21 (0.06%) were diagnosed with Turner syndrome. This translated into an odds ratio (OR) of 3.29 for celiac disease, with a 95% confidence interval [CI], 1.94 - 5.56. These results are consistent with earlier findings of a positive association between celiac disease and Turner syndrome. They are important because they provide "population-based risk estimates from a population consisting of both in- and outpatients with celiac disease," according to the team. Their data supports the current recommendation of active case-finding for celiac disease in patients with Turner Syndrome. In addition to establishing an overall odds ratio (OR) for celiac disease in females with Turner Syndrome, the investigators found that the risk ranged from an OR of 2.16 (95% confidence interval [CI], 0.91 - 5.11) from birth to age 5 years to an OR of 5.50 (95% CI, 1.53 - 19.78) for females diagnosed with celiac disease after age 10 years. Although women with Turner Syndrome are more prone to type 1 diabetes than women in the general population, the association between Turner Syndrome and celiac disease remained essentially unchanged when the researchers excluded cases and control patients with a diagnosis of type 1 diabetes from the analysis (OR, 3.32; 95% CI, 1.96 - 5.62). One shortfall of the study is that the researchers were not able to establish "…whether patients with celiac disease were symptomatic or asymptomatic. In addition, in Sweden, the threshold for testing individuals with Turner Syndrome for celiac disease is low." Because of this, the team acknowledges that their estimates may have been "somewhat influenced by surveillance bias." The full article appears in January 8 online issue of Pediatrics. Source: Pediatrics
  11. Gluten intolerance often presents itself in ways unexpected, including several common skin conditions. Ranging in severity from dermatitis herpetiformis to dry skin, avoiding gluten may have more to do with your plaguing skin concerns than you imagined. Here are some common dermatological concerns associated with celiac disease: Dermatitits Herpetiformis—This painful, blistery condition can be very stressful, especially when misdiagnosed. An inflamed, itchy rash, dermatitis herpetiformis begins as tiny white filled blisters or red spots around hair follicles. Trying to hide or disguise DH, as well as trying to treat it when misdiagnosed can be incredibly stressful for a person. Eczema—Eating a gluten-free diet is becoming an increasingly popular mode of treatment for eczema. Those who are gluten intolerant also tend to have more advanced psoriasis.Psoriasis—Like eczema, psoriasis has in many cases shown improvement when the person is put on a gluten free diet. In Scott Adams’ 2004 article, he also mentioned that psoriasis in those with celiac tends to be more severe. Acne—Links between celiac and malabsorption, as well as hormonal upset can contribute to a greater production of acne. Many birth control pills boast promises of clearer skin, their method is through hormone manipulation. Because many who suffer from gluten intolerance also experience a disruption of normal hormone function, this disharmony can lead to problems with acne. Dry Skin—Also correlated to malabsorption, dry skin is a very common complaint amongst those with celiac. But this condition is one that many people see even after the prescribed treatment of a gluten free diet. Why? Vitamin E rich grains are vital to maintaining skin harmony, but since many who are gluten intolerant begin avoiding grains completely—even those grains that are gluten-free, getting that important Vitamin E in their diets can become a challenge.
  12. Celiac.com 05/27/2014 - Here are seven common myths people have about celiac disease and gluten-free eating. Myth #1: Rice contains gluten, and people with celiac disease and gluten-intolerance shouldn’t eat it. Status: FALSE. People with celiac disease and gluten-intolerance have adverse immune reactions to gluten proteins in wheat, rye and barley. Rice does contain gluten, just not the kind that causes adverse reactions in people with celiac disease and gluten-intolerance. Plain rice is fine for people with celiac disease. Myth #2: A little gluten is okay for people with celiac disease and gluten-intolerance to eat. Status: MOSTLY FALSE. Gluten levels above 20 parts per million can cause adverse immune reactions and chronic damage in people with celiac disease. Current medical research defines gluten-levels below 20 parts per million as safe for people with celiac disease, and the FDA and other official organizations use that standard in labeling, those levels are so close to zero as to be “gluten-free.” The tiniest crumbs of bread far exceed 20ppm, so eating “a little” gluten is only possible by eating “gluten-free” food. In fact, the only properly recognized treatment for celiac disease is a gluten-free diet. Myth #3: Food made with gluten-free ingredients is safe for people with celiac disease. Status: FALSE Just because food is made with gluten-free ingredients, it is not necessarily safe for people with celiac disease. Case in point, Domino’s Pizza recently introduced gluten-free pizza crusts. However, these pizzas are prepared in the same areas and ovens as Domino’s regular pizzas, and are likely contaminated with gluten from wheat flour. These pizzas are not safe for people with celiac disease. There are many similar cases in the restaurant world. Contamination is a serious issue for some celiacs, so buyers be aware and be wary. Myth #4: Celiac disease is a food allergy. Status: FALSE Celiac disease is not a food allergy or an intolerance, it is an autoimmune disease. People with celiac disease suffer damage to the lining of the small intestine when they eat wheat, rye or barley. They also face higher risks for many other auto-immune conditions. Myth #5: Celiac disease only affects people of European ancestry Status: FALSE Celiac disease is more common in people of northern European ancestry, but it affects all ethnic groups and is found in southern Asia, the Middle East, North Africa and South America. Myth #6: Celiac disease is a children’s condition Status: FALSE Celiac disease can develop at any age. In fact, celiac disease is most commonly diagnosed in people aged 40-60 years old. Myth #7: Celiac disease can be painful, but isn't life-threatening. It’s true that classic celiac disease symptoms, like stomach pain, bone pain, fatigue, headaches, skin rash, and digestive issues, won’t kill patients outright. However, undiagnosed or untreated, celiac disease can trigger other autoimmune disorders, and leave patients at much greater risk of developing certain types of deadly cancer.
  13. Celiac.com 09/22/2014 - The connection between celiac disease and various types of cancer is well supported by scientific evidence. However, to date, there hasn’t been enough data to make accurate predictions of cancer risk in celiac patients. So, we don’t know exactly what the risk levels are for various types of cancer in celiac patients. Using a large population register of diagnosed celiac patients in Finland, a team of researchers recently set out to establish a realistic projection of the cancer risk for celiac patients. The researchers included T. Ilus, K. Kaukinen, L.J. Virta, E. Pukkala, and P. Collin. They are variously associated with the Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and University of Tampere in Finland; the Department of Medicine at Seinäjoki Central Hospital in Seinäjoki, Finland; the Research Department at The Social Insurance Institution in Turku, Finland; the Finnish Cancer Registry at the Institute for Statistical and Epidemiological Cancer Research in Helsinki, Finland; and the School of Health Sciences at the University of Tampere in Tampere, Finland. For the period covering 2002-2011, the register contained 32,439 adult celiac patients. The team paired this data with data from the Finnish Cancer Registry, which includes over 98% of diagnosed malignancies. Using incidence figures for the whole population, the team calculated a standardized incidence ratio (SIR) for the malignancies, They constructed a time-stratified analysis in 11,991 celiac patients diagnosed after 2004. They did not have information on lifestyle factors, such as smoking habits and obesity. They found that the overall incidence ratio of malignant diseases did not increase until five or more years from the diagnosis of celiac disease (1.31, 1.04-1.63). The results showed higher SIRs for non-Hodgkin lymphoma (NHL; 1.94; 1.62-2.29), small-intestinal cancer (4.29; 2.83-6.24), colon cancer (1.35; 1.13-1.58), and basal cell carcinoma of the skin (1.13; 1.03-1.22). However, SIRs for lung cancer (0.60; 0.48-0.74), pancreatic cancer (0.73; 0.53-0.97), bladder cancer (0.53; 0.35-0.77), renal cancer (0.72; 0.51-0.99), and breast cancer (0.70; 0.62-0.79) were lower. SIR for NHL immediately after the diagnosis of celiac disease was 2.56 (1.37-4.38). Overall, there was no increased SIR of cancer in the whole series, but SIR rose after 5 years from the diagnosis of celiac disease. The overall risk of breast and lung cancers in celiac patients was lower, while the risk of small-intestinal cancer and NHL was higher, but not as high as previous data indicated. So, patients with celiac disease over five years showed higher rates of non-Hodgkin lymphoma, small-intestinal cancer, colon cancer, and basal cell carcinoma of the skin. Among other benefits, this study will help clinicians and doctors to better focus their attention toward warning signs for these conditions in people with celiac disease. Source: Am J Gastroenterol. 2014 Sep;109(9):1471-7.doi: 10.1038/ajg.2014.194. Epub 2014 Jul 22.
  14. Celiac.com 04/27/2015 - We know that women with infertility have higher rates of celiac disease than women who are not infertile. There's been some evidence to suggest that celiac disease might have impact women's reproductive health. However, the quest for more solid answers continues. A team of researchers recently set out to assess fertility and outcomes of pregnancy among women with celiac disease. The research team included Stephanie M. Moleski, Christina C. Lindenmeyer, J. Jon Veloski, Robin S. Miller, Cynthia L. Miller, David Kastenberg, and Anthony J. DiMarino. The team crafted a retrospective cohort study in which they analyzed information gathered from patients at a tertiary care celiac center, along with information gathered from members of two national celiac disease awareness organizations. A group of women without celiac disease served as control subjects. Both groups answered an anonymous online survey of 43 questions about menstrual history, fertility, and pregnancy outcomes. The group included 329 women with small bowel biopsy-confirmed celiac disease and 641 control subjects. Of the 970 women included in the study, 733 (75.6%) reported that they had been pregnant at some point. In terms of pregnancy, there was no significant difference between women with celiac disease (n=245/329, 74.5%) and controls (488/641, 76.1%; P=0.57). However, fewer women with celiac disease than controls (79.6% vs. 84.8%) reported giving birth following 1 or more pregnancies (P=0.03). Women with celiac disease had higher rates of spontaneous abortion than did control subjects (50.6% vs. 40.6%; P=0.01). Women with celiac disease also had higher rates of premature delivery, at 23.6% compared to 15.9% among controls (P=0.02). The average age at menarche was a bit higher in the celiac disease group, at 12.7 years, than in the control group, which came in at 12.4 years (P=0.01). This retrospective cohort analysis examining reproductive features of women with celiac disease, found that celiac disease was associated with significant increases in spontaneous abortion, premature delivery, and later age of menarche. Source: Ann Gastroenterol 2015; 28 (2): 236-240
  15. Celiac.com 07/16/2013 - Gluten has a way of popping up in some very unexpected products. Peers (whether online or otherwise) are sometimes our best resource for information regarding these oft-overlooked gluten-containing products, but sometimes speculation gets passed along the grapevine as fact. This has led to some very believable, but ultimately questionable rumors. Alcohol in particular has some of the most persistent rumors regarding gluten content. This is likely because the processes involved with alcohol production are confusing and widely misunderstood. With this article, I hope to address and clear up a few of the most persistent gluten-free alcohol misunderstandings that you've certainly heard before. Misunderstanding #1: “Not all wine is gluten-free: some vintners age their wine in barrels that are sealed with a wheat paste. This paste contaminates the wine, making it dangerous for consumption by celiac disease sufferers.” This is a big one. Wine is naturally gluten-free, but the fact that some vintners use wheat paste to seal their barrels has led many to cut wine out of their diets as a precautionary measure. It's a plausible idea, as some vintners do in fact use wheat paste to seal their barrel heads. However, there are a few key points here that you should consider before cutting wine out of your diet entirely: Because the Tobacco Tax and Trade Bureau currently disallows gluten-free labeling of alcoholic beverages if the producer used “storage materials that contained gluten,” any wine that is labeled gluten-free was aged using a barrel alternative and carries no risk of contamination. Wines that aren't labeled gluten-free might still be aged using barrel alternatives. Roughly speaking, the more expensive ($12+) Cabernet Sauvignons, Merlots, Zinfandels and red blends are more likely to be aged in oak barrels (and for a longer period of time). The amount of wheat paste used to seal barrel heads is minimal. It is not the staves of the barrels that are sealed with a wheat flour paste, but the barrel heads. Furthermore, most wineries thoroughly pressure wash all barrels with boiling hot water before they are used. The last thing vintners want is a contaminated product. In order to lay this contamination issue to rest, Tricia Thompson tested a single winery's Cabernet Sauvignon and Merlot, which she was told by the winery were their two wines that spent the most time in wheat-sealed oak barrels. She tested each wine four times: twice with the Sandwich R5 ELISA test, and twice with the competitive R5 ELISA test. The competitive R5 ELISA is the current standard for detecting hydrolyzed (broken down) gluten, while the sandwich R5 ELISA is the current standard for detecting non-hydrolyzed gluten (1). Combined, the tests can reliably test for any possible form of gluten contamination. Both extractions of both wines came back with the lowest possible results for both tests: Cabernet Sauvignon Sandwich R5 ELISA extraction 1: < 5 ppm gluten Sandwich R5 ELISA extraction 2: < 5 ppm gluten Competitive R5 ELISA extraction 1: < 10 ppm gluten Competitive R5 ELISA extraction 2: < 10 ppm gluten Merlot Sandwich R5 ELISA extraction 1: < 5 ppm gluten Sandwich R5 ELISA extraction 2: < 5 ppm gluten Competitive R5 ELISA extraction 1: < 10 ppm gluten Competitive R5 ELISA extraction 2: < 10 ppm gluten Conclusion: Wine that is aged in oak barrels contains less gluten than we are currently capable of testing for, whether hydrolyzed or not. At this point, a lot of people will begin to shake their heads: “If wine is gluten-free, then why do I get sick when I drink __________ wine?” The likely answer is that you are reacting to something else! Many winemakers use egg whites as a clarifying agent. The amount of egg used is far more substantial than any wheat paste that might have leaked into the wine, so if you know eggs are a problem, this is likely what you are reacting to. If you don't have a problem with eggs, you could also be reacting to sulfites. Many people have problems with them, and some winemakers use them as preservatives. Sometimes, it's best to go out and get information directly from the winemaker. They can tell you more about their aging process, and shed light on what may or may not be making you sick. Misunderstanding #2: “Distilled spirits that are derived from gluten-containing ingredients can be contaminated with gluten. Only distilled spirits made from non-gluten-containing ingredients, like potatoes, are safe for consumption by celiacs.” This idea was likely propagated due to a misunderstanding of the distillation process. Here, I will refer to Megan Tichy, Ph.D's highly informative and clearly written description of the distillation process (2). It is a great read for those who are unclear on the process, and makes it very evident why all distilled spirits are gluten-free by definition. To borrow Dr. Tichy's analogy, the distillation process is like boiling a kettle of water with sand at the bottom of it. Let's say you were to collect the water that boiled away as steam using a condensing tube. After boiling the entire kettle away, you would be left with a kettle with nothing but sand at the bottom of it, and a second container of pure distilled water. There is no way the distilled water could contain any sand, as sand doesn't evaporate. In the same way, gluten doesn't evaporate, and gets left at the bottom of the 'kettle' during distillation. The likelihood of distilled alcohol being contaminated with gluten is about the same as the likelihood of you getting sand in your new cup of perfectly clean water: it would almost have to be intentional! Also keep in mind that many spirits are double, or even triple distilled. Gluten contamination over the course of a single distillation is already highly unlikely, but after consecutive distillations, it is virtually impossible. To this, you might ask, “But what if they were to add other ingredients afterward? Those might contain gluten, right?” That's a perfectly valid concern, and yes, you should be concerned about any added ingredients. However, distilled spirits are almost always marketed based on their purity; this is why they go to all the trouble of double and triple distilling in the first place! Manufacturers of spirits want the most concentrated alcoholic product possible, so it is not exactly in their best interest (nor in common practice) to go adding more ingredients. Even so, you should always be mindful of ingredients lists, and cross check them against a reliable gluten-containing ingredients list (such as ours [3]). Despite the fact that distilled spirits derived from grains are necessarily gluten-free, some people still seem to have problems with them. I don't have a ready explanation for this, as scientifically, it doesn't make sense. Celiac disease is triggered by gluten, and distilled alcohol contains no gluten. Here is a quick checklist to help rule out reasons why you may or may not react to such drinks: [ ] Have you checked for cross contamination possibilities (glass, container, ice cubes, dish washing liquid, drying towel, etc.)? [ ] Are you sure that you do not react to distilled alcoholic beverages that are not derived from grains (e.g. potato vodka)? (It could be a reaction to potent alcohol in general.) [ ] Did you pour the drink yourself? [ ] Are you sure you are not adding anything to the drink that could be cross contaminated or contain gluten? [ ] Have you checked the ingredients list against a reliable gluten-containing ingredients list? [ ] Have you considered any other allergies you have or might have? [ ] Have you contacted the manufacturer for their official response regarding gluten content? Oftentimes (especially soon after adopting GFD), the gut is still sensitive and cannot handle alcohol at high proof levels. If you had a bad experience with distilled spirits derived from grain early on in your GFD regimen, you might want to consider giving it another try after your villi have had a chance to heal. You really should not have a reaction once your gut is adjusted to the gluten-free diet. I know it is hard to trust a product derived from wheat, but distillation really, truly does remove all gluten, and it does so every single time. Misunderstanding # 3: “'Low gluten' or 'gluten-removed' beers are unsafe, as gluten tests underestimate gluten content in beer. This is because the brewing process breaks the gluten molecules down into pieces that are too small for gluten tests to detect, but are still harmful.” This is a point of fierce contention in the gluten-free community, and probably the most confusing argument to follow, as it all surrounds the validity of a variety of super scientific testing procedures. There isn't even a clear answer or 'winner' here, but I'm going to try and break all the information down for you, so you can make an informed decision about these products for yourself. The main beef that people seem to have with gluten-removed beers is that they are derived from gluten-containing ingredients, and the gluten removal process is oftentimes undisclosed. This is an offshoot of the same distrust people feel toward distilled spirits, though perhaps a little more warranted given the fact that distillation is a very well documented and 100% reliable form of gluten removal, whereas as far as we know, these brewers are removing gluten using magic and fairy dust. The reality is that these brewers (Widmer Brothers, Estrella Damm, Lammsbraeu, to name a few) are removing the gluten from their beer using one or the other, or perhaps a combination of two methods: filtration, and enzymes. Superfine filters can remove gluten particles from the beer, while added enzymes can target gluten particles, causing them to break down to a harmless state more quickly. Whatever their methods, these beers need to have their gluten content verified using scientific testing procedures in order to be considered safe for consumption by celiacs. This is where things start to get murky. As Tricia Thompson, MS, RD writes on her blog, Gluten-Free Dietitian, the current standard for testing gluten content in foods is a sandwich ELISA test (4). The R5 and omega-gliadin versions of the test are the most widely used, and both have been validated in collaborative trials. While sandwich ELISA tests are reliable for detecting gluten in heated and non-heated food items, they are notoriously unreliable for detecting hydrolyzed gluten. Many see this as reason not to trust gluten-removed beers: the fermentation process hydrolyzes gluten in beer, so sandwich ELISA tests cannot accurately quantify their gluten content. If the test is unreliable, we are back where we started, with a once-gluten-containing product that has supposedly been rendered gluten-free by unexplained and unverifiable means; it's a hard pill to swallow! However, the sandwich R5 ELISA's weaknesses are well documented and widely known. Most of these brewers are using an entirely different test that was specifically designed to detect partial gluten fragments (peptides) that may still be harmful to the gluten-sensitive. The competitive R5 ELISA is the standard test used to detect these peptides, and although it has not been validated yet, many published studies have found the competitive R5 ELISA to be a reliable indicator of hydrolyzed gluten (5) (6) (7). This would all seem well and good since many of these beers test well under the proposed FDA limit of 20ppm gluten content with the competitive R5 ELISA. (As an aside, studies have shown 20 ppm to be an adequately conservative standard for most celiacs [8]). Unfortunately, the discussion doesn't end there. A recent Australian study tested a broad range of both beers brewed from alternate grains (sorghum, millet, etc.), and gluten-removed beers, and found that most gluten-removed beers contained significant levels of barley gluten (hordein) fragments, while beers brewed with alternative grains did not (9). Many have inferred two things from this study: 1) gluten-removed beers are unsafe, and 2) R5 ELISA testing under-reports, or is incapable of testing for the barley gluten, hordein. I would posit that these are both hasty conclusions to make, as the study begs the following questions: How much gluten are we talking about? It isn't entirely clear from the study what 'significant' levels are, as it quantifies hordein levels on a relative scale, but not in terms of ppm. Yes, it is clear from the study that truly gluten-free beers contain less hordein than gluten-removed beers. It would also seem that some hordein families are just as present in gluten-removed beers as in standard beers whose brewers make no claims as to their gluten content. But this does not mean that any of the beers are over the 20ppm standard. The study actually states that the gluten-removed beers were tested to under 10 ppm, but then indirectly implies that they were not actually under that threshold. This is not necessarily true though! One recent study found that around 50% of standard beers on the market actually test to under 20 ppm gluten content (10). In other words, the average gluten content of beer is lower than you might think. Just because gluten-removed beers may be closer to the average on the study's relative scale than might look safe, this does not mean they contain gluten at levels that would be harmful to the average celiac. Furthermore, the toxicity of hordein and hordein peptides for celiacs still hasn't been conclusively quantified (11). Is R5 ELISA really that unreliable? The study also makes some interesting claims about the limits of R5 ELISA testing procedures. Specifically, it claims that “The R5 antibody is unable to accurately detect and quantify barley gluten (hordeins) in beer.” This is a slightly misleading statement. It is true that the sandwich R5 ELISA can be inaccurate when detecting hordein levels, but it actually overestimates them, so long as they are not hydrolyzed. Furthermore, that is the sandwich ELISA; there is much evidence to suggest that the competitive R5 ELISA provides an accurate measurement of hordein peptides (6) (7) (12). Conversely, this study employed multiple reaction monitoring mass spectrometry, a testing procedure that has not been validated for gluten testing of foods or fermented alcoholic beverages. I would say that the competitive R5 ELISA has a more proven track record when it comes to testing for hydrolyzed gluten in beer. What does it all mean then? Should I drink gluten-removed beer or not? Well, that's up to you, of course. As I said before, this is a hotly debated and highly contentious issue in the gluten-free world right now, so I'm hesitant to take one side or the other. If you suffer from refractory sprue, or some other severe form of gluten intolerance, I would advise you to stay away, as the risk simply isn't worth it for you. For more mild sufferers of celiac disease or wheat sensitivity though, if you really miss the taste of beer and gluten-free beers just aren't doing it for you, there is no solid evidence to discredit the results of competitive R5 ELISA testing. Find a beer that is batch tested to under 20 ppm using this test (not sandwich R5 ELISA, though it wouldn't hurt if it was tested by both), try a few sips, and see if you react. I've tried to provide all the key information so you can make an informed decision about these beers for yourself, but it never hurts to do your own research! Just know that there are a lot of biased and outdated sources out there; the more recent and scientific the study, the better! References: (1) Thompson, Tricia, MS, RD. “Wine Aged in Oak Barrels Sealed with Wheat Paste: Test Results for Gluten Contamination.” GlutenFreeDietitian.com, 10 Oct. 2012. Web. 20 Dec. 2012. (2) Tichy, Megan, PhD. “Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free?” Celiac.com, 26 Aug. 2009. Web. 20 Dec. 2012. (3) Adams, Scott. “Unsafe Gluten-Free Food List (Unsafe Ingredients).” Celiac.com, 27 Nov. 2007. Web. 20 Dec. 2012. (4) Thompson, Tricia, MS, RD. “Standards for testing food for gluten: Issues that need addressing.” GlutenFreeDietitian.com, 6 Aug. 2012. Web. 20 Dec. 2012. (5) Thompson, Tricia, MS, RD. “Beer: Why it is so hard to assess fermented and hydrolyzed products for gluten.” GlutenFreeDietitian.com, 24 Jul. 2012. Web. 20 Dec. 2012. (6) Gessendorfer, Benedict, et al. “Preparation and characterization of enzymatically hydrolyzed prolamins from wheat, rye, and barley as references for the immunochemical quantitation of partially hydrolyzed gluten.” Analytical and Bioanalytical Chemistry 395.6 (Nov. 2009): 1721-1728. Web. 20 Dec. 2012. (7) Haas-Lauterbach, S, et al.”Gluten fragment detection with a competitive ELISA.” Journal of AOAC International 95.2 (2012): 377-381. Web. 20 Dec. 2012. (8) Thompson, Tricia, MS, RD. “How much gluten is 20 parts per million?” GlutenFreeDietitian.com, n.d. Web. 20 Dec. 2012. (9) Colgrave, Michelle, et al. “What is in a Beer? Proteomic Characterization and Relative Quantification of Hordein (Gluten) in Beer.” Journal of Proteome Research 11.1 (2012): 386-396. Web. 20 Dec. 2012. (10) Cane, Sue. “Gluten-free beer 2011. How is it made? How is its gluten content tested? And is it really safe for coeliacs?” FoodsMatter.com, 2011. Web. 20 Dec. 2012. (11) Thompson, Tricia, MS, RD. “Barley enzymes in gluten-free products.” GlutenFreeDietitian.com, Jun. 2009 (updated 3 Feb. 2011). Web. 20 Dec. 2012. (12) Guerdrum, Lindsay, Bamforth, Charles. “Levels of gliadin in commercial beers.” Food Chemistry 129.4 (2011): 1783-1784. Web. 20 Dec. 2012.
  16. Celiac.com 04/22/2010 - Restless leg syndrome (RLS) is a common neurological condition, with generally unknown causes, that is sometimes associated with specific disorders such as iron deficiency. Even though celiac disease is an autoimmune condition, people with celiac disease often suffer from associated malabsorption-related iron deficiency anemia and peripheral neuropathy. A team of researchers recently set out to assess rates of restless leg syndrome in adults with celiac disease. The team included Marcello Moccia, MS, Maria Teresa Pellecchia, MD, PhD, Roberto Erro, MD, Fabiana Zingone, MD, Sara Marelli, MD, Damiano Giuseppe Barone, MD, Carolina Ciacci, MD, Luigi Ferini Strambi, MD, and Paolo Barone, MD, PhD. They are variously associated with the Department of Systematic Pathology, the Department of Neurological Sciences at University Federico II and IDC Hermitage Capodimonte, Naples, Italy, and the Sleep Disorders Center, University Vita-Salute San Raffaele, Milan, Italy. For their study, the team enrolled 100 adult patients for features of celiac disease, iron metabolism, clinical and neurological conditions, and enrolled another 100 people from the general population as control subjects. These subjects were matched for age and sex. To determine the presence of restless leg syndrome in celiac disease patients and controls, the team applied the four essential diagnostic criteria of the International restless leg syndrome Study Group, in addition to conducting a neurological examination. They gauged restless leg syndrome severity using the International restless leg syndrome Study Group rating scale. The results showed a 31% prevalence of restless leg syndrome among subjects with celiac disease, which was much higher than the 4% prevalence in the control population (P < 0.001). The average restless leg syndrome severity among celiac disease patients was moderate (17 ± 6.5). In the subjects with celiac disease, the team saw no significant correlation between restless leg syndrome and either gluten-free diet or iron metabolism; even though the celiac patients with restless leg syndrome showed significantly lower hemoglobin levels than celiac patients without restless leg syndrome (P = 0.003). They also found no connection between restless leg syndrome and other possible causes of secondary restless leg syndrome, including signs of peripheral neuropathy, pregnancy, end-stage renal disease, and pharmacological treatments. Their study increases the number of neurological disorders associated with celiac disease, and supports screening all celiac disease patients for restless leg syndrome. SOURCE: Movement Disorders; 13 Apr 2010 DOI 10.1002/mds.22903
  17. Celiac.com 12/26/2014 - Celiac disease can have such a wide-ranging number of symptoms, ranging over so many parts of the body, that it can be hard for doctors seeking to make a diagnosis to even suspect celiac disease as an underlying cause in the first place. A team of researchers set out to better understand the characteristics of celiac disease by looking at the findings in a large number of celiacs diagnosed in a single referral center, and to using clear definitions of the clinical, serological and histopathological aspects of celiac disease to get a better picture of how the disease presents itself. The research team included Umberto Volta, Giacomo Caio, Vincenzo Stanghellini and Roberto De Giorgio of the Department of Medical and Surgical Sciences at the University of Bologna’s S. Orsola-Malpighi Hospital, in Bologna, Italy. For their study, their team looked at data on celiac patients admitted to S. Orsola-Malpighi Hospital from January 1998 to December 2012. They found a total of 770 patients ranging from 18 to 78 years, averaging 36 years old. A total of 599 patients were female. The team broke celiac disease down into three types: The first type, classical, in which patients present with malabsorption syndrome. The second type, non-classical, in which patients experience extraintestinal and/or gastrointestinal symptoms other than diarrhea. The third type, subclinical, with no visible symptoms. The team evaluated patient serology, duodenal histology, comorbidities, response to gluten-free diet and complications. A total of 610 patients (79%) showed clear physical symptoms when they were diagnosed, while 160 celiacs showed a subclinical phenotype. In the symptomatic group 66% of celiacs were non-classical, that is, they experienced extraintestinal and/or gastrointestinal symptoms other than diarrhea. Only 34% of patients in the symptomatic group showed classical malabsorption syndrome. The team found that just 27% of the non-classically symptomatic group complained of diarrhea, while other gastrointestinal manifestations included bloating (20%), aphthous stomatitis (18%), alternating bowel habit (15%), constipation (13%) and gastroesophageal reflux disease (12%). Extraintestinal manifestations included osteopenia/osteoporosis (52%), anemia (34%), cryptogenic hypertransaminasemia (29%) and recurrent miscarriages (12%). Positivity for IgA tissue transglutaminase antibodies was detected in 97%. Th steam found villous atrophy in 87%, while 13% had minor lesions consistent with potential celiac disease. A large proportion of patients showed autoimmune disorders, such as autoimmune thyroiditis (26.3%), dermatitis herpetiformis (4%) and diabetes mellitus type 1 (3%). Complicated celiac disease was very rare. This study demonstrates that the clinical profile of celiac disease has changed over time, and now features much more non-classical and subclinical phenotypes. Source: BMC Gastroenterology 2014, 14:194. doi:10.1186/s12876-014-0194-x
  18. 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.
  19. Celiac.com 08/19/2012 - In an effort to assess rising rates of celiac disease, and an increasing popularity of gluten-free food products, a team of researchers recently conducted a survey. The research team included Alberto Rubio-Tapia, Jonas F. Ludvigsson, Tricia L Brantner, Joseph A. Murray and James E. Everhart. Their data indicate that about 1.8 million Americans have celiac disease, while another 1.4 million remain undiagnosed. Surprisingly, their results show that around 1.6 million people have adopted a gluten-free diet despite having no official diagnosis. Some of these people likely have celiac disease, while others likely belong to a large group of people who don't actually have celiac disease, but who suffer bloating and other celiac symptoms and seem to be helped by avoiding gluten; people many doctors are now officially describing as 'gluten sensitive.' Once a controversial term, the existence of gluten sensitivity has been supported by several studies, among them, a very small but often-cited Australian study. In that study, volunteers with gluten reaction symptoms received a gluten-free diet or a regular diet for six weeks, without knowing which one. At the end of the period, those who ate gluten-free had fewer problems with bloating, tiredness and irregular bowel movements. Clearly, the current data tell us that "there are patients who are gluten-sensitive," said Dr. Sheila Crowe, a San Diego-based physician on the board of the American Gastroenterological Association. The debate is now shifting to the question of how many people suffer from gluten sensitivity, she added. Because gluten sensitivity lacks the clinical markers of celiac disease, that question may not be answered anytime soon. Certainly, more and more people without any official diagnosis are turning to gluten-free diets as a way to lose weight, or as part of low carb and/or 'paleo' diets. Those people, together with celiacs and those with gluten intolerance are helping to drive the estimated $7 billion that will be spent on gluten-free. There has also been increasing concern among researchers that that many or most people have some kind of gluten sensitivity. Stay tuned for more news on this and other gluten and celiac-related topics. Source: The American Journal of Gastroenterology
  20. Celiac.com 06/09/2014 - Anemia is extremely common in patients with celiac disease. In some cases, anemia may be the sole manifestation of celiac disease, but there is no good data on rates of celiac disease in Indian patients with nutritional anemia. A research team recently examined rates of celiac disease among nutritional anemia patients at a care center in India. The team included A. Kavimandan, M. Sharma, A.K. Verma, P. Das, P. Mishra, S. Sinha, A. Mohan, V. Sreenivas, S. Datta Gupta, and G.K. Makharia. For their study, the team conducted positive celiac disease screens on adolescent and adult patients presenting with nutritional anemia. They also prospectively screened for celiac disease using IgA anti-tissue transglutaminase antibody (anti-tTG Ab). Subjects with positive antibody screens received upper gastrointestinal endoscopy and duodenal biopsy. In all, the team screened ninety-six patients. Of these patients, 80 had iron deficiency anemia, 11 had megaloblastic anemia, and 5 had dimorphic anemia. Seventy-three patients were receiving hematinics and 36.4 % had received blood transfusions. Nineteen patients had histories of chronic diarrhea persisting for an average of about ten years. Of those, the team found 13 patients with positive IgA anti-tTG Ab screens, 12 of whom agreed to duodenal biopsy. Ten patients showed villous atrophy (Marsh grade 3a in three, 3b in one, and 3c in six), while two patients showed no villous atrophy. In all, ten patients with nutritional anemia, defined as iron deficiency 9, vitamin B12 deficiency 1, were also diagnosed with celiac disease. Multivariate logistic regression showed age, duration of symptoms, and presence of diarrhea to be the main predictors of celiac disease. The team put all patients with celiac disease on gluten-free diet, supplemented with iron and vitamin B. All patients showed significant improvement in hemoglobin concentration. The team recommends celiac disease screening, and appropriate follow-up in all cases of unexplained nutritional anemia. Source: Indian J Gastroenterol. 2014 Mar;33(2):114-8. doi: 10.1007/s12664-013-0366-6. Epub 2013 Sep 1.
  21. Celiac.com 01/13/2014 - Researchers have documented stress in patients with various immune-mediated diseases but little is known about stressful life events and the onset of celiac disease from a patient's perspective. Using the standardized interview of Paykel, a team of researchers set out to examine the relationship of stressful events in patients diagnosed with celiac disease, and to compare them with a control group of gastroesophageal reflux patients. The research team included C. Ciacci, M. Siniscalchi, C. Bucci, F. Zingone, I. Morra, and P. Iovino, of the Department of Medicine and Surgery at the University of Salerno in Italy. They found that 186 adults (67.2%) with celiac disease reported more frequent and more severe life events in the years prior to the diagnosis, compared with 96 control patients (37.5%, p < 0.001, mean Paykel score 11.5 vs. 13.4, p = 0.001, respectively). Overall, the time lapse between the event and the diagnosis was about the same for celiac patients (5.5 months) as it was for control patients for (5.7 months). A total of 20.3% of celiac women considered pregnancy a negative event , but no control women defined pregnancy as a negative event.. Repeat analyses subgroup of patients of both groups with diagnosis made within one year of onset of symptoms confirmed these findings. Data indicate that, before diagnosis, people with celiac disease faced stressful events that were more frequent, but less severe than in the control group suggesting that life events may impact the clinical appearance of celiac disease or accelerate its diagnosis. Source: Nutrients. 2013 Aug 28;5(9):3388-98. doi: 10.3390/nu5093388.
  22. Celiac.com 12/16/2013 - Numerous popular herbal products may be contaminated or may contain unlabeled substitute ingredients and fillers, meaning that they are not what their labels claim. According to the World Health Organization, adulterated herbal products are a potential threat to consumer safety. These revelations came to light after a group of Canadian researchers conducted an investigation into herbal product integrity and authenticity, with hopes of protecting consumers from health risks associated with product substitution and contamination. Using a test called DNA barcoding, a kind of genetic fingerprinting that been effective in uncovering labeling fraud in other commercial industries, the researchers found that nearly 60% of herbal products tested were not what their label claimed them to be, and that pills labeled as popular herbs were often diluted or replaced entirely, sometimes with cheap fillers that could be dangerous to consumers. In all, the researchers tested 44 herbal products from 12 companies, along with 30 different species of herbs, and 50 leaf samples collected from 42 herbal species. The researchers were Steven G. Newmaster, Meghan Grguric, Dhivya Shanmughanandhan, Sathishkumar Ramalingam and Subramanyam Ragupathy. They are variously affiliated with the Centre for Biodiversity Genomics, Biodiversity Institute of Ontario (BIO) at the University of Guelph, the Bachelor of Arts and Science Program at the University of Guelph in Guelph, Ontario, Canada, and with the Plant Genetic Engineering Laboratory, Department of Biotechnology, Bharathiar University in Tamil Nadu, India. Their laboratory also assembled the first standard reference material (SRM) herbal barcode library from 100 herbal species of known provenance that were used to identify the unknown herbal products and leaf samples. The team recovered DNA barcodes from most herbal products (91%) and all leaf samples (100%), with 95% species resolution using a tiered approach (rbcL + ITS2). Nearly 60% of the products tested contained DNA barcodes from plant species not listed on the labels. That means they were not what the label said they were. Furthermore, even though 48% of the products contained authentic ingredients, one-third of those also contained contaminants and/or fillers not listed on the label. The air data showed clearly that most herbal products tested were not what their labels claim, while most of the rest were poor quality, and often contained unlabeled, possibly dangerous, product substitute, contamination and fillers. They note that selling weak, ineffective, or mislabeled herbal supplements reduces the perceived value of otherwise helpful products by eroding consumer confidence. The study team recommends that the herbal industry embrace DNA barcoding to ensure authentic herbal products by effectively documenting raw manufacturing materials. They suggest that the use of an SRM DNA herbal barcode library for testing bulk materials could provide a method for 'best practices' in the manufacturing of herbal products, and note that this would provide consumers with safe, high quality herbal products. What do you think? Should herbal products and supplements be tested, authenticated and verified? Share your thoughts below. Source: BMC Medicine 2013, 11:222. doi:10.1186/1741-7015-11-222
  23. Celiac.com 12/23/2013 - Symptoms of celiac disease negatively impact the social activities and emotional states of some patients. A team of researchers recently set out to assess rates of altered eating behavior in celiac patients. The research team included V. Passananti, M. Siniscalchi, F. Zingone, C. Bucci, R. Tortora, P. Iovino, and C. Ciacci. They are variously affiliated with the Department of Clinical and Experimental Medicine at University Federico II of Naples, Italy, and with the Department of Medicine and Surgery, University of Salerno, Baronissi Campus, in Salerno, Italy. The researchers evaluated 100 celiac adults and 100 control subjects of statistically similar gender, age, and physical activity. The researchers had both celiac patients and control subjects complete a dietary interview and the Binge Eating Staircases, Eating Disorder Inventory (EDI-2), Eating Attitudes Test, Zung Self-Rating Depression Scale, State Trait Anxiety Inventory Forma Y (STAI-Y1 and STAI-Y2), and Symptom Check List (SCL-90). The results showed that, compared with the control group, celiac patients had higher STAI-Y1 and STAI-Y2, Somatization, Interpersonal, Sensitivity, and Anxiety scores of the SLC-90. EDI-2 differed in pulse thinness, social insecurity, perfectionism, inadequacy, aceticisms, and interpersonal diffidences between celiac disease patients and healthy female controls, whilst only in interceptive awareness between celiac disease patients and healthy male controls. Celiac patients with gastrointestinal symptoms showed dependently higher EAT-26 scores. The EAT26 showed a connection between indices of diet-related disorders in both celiac disease, and the feminine gender after controlling for anxiety and depression. Eating disorders appear to be more frequent in young celiac women than in celiac men and in healthy control subjects. Overall, these results indicate that pathological eating behavior in celiac adults may be due to celiac disease itself, rather than the gastrointestinal related symptoms or psychological factors. Source: Gastroenterology Research and Practice Volume 2013 (2013), Article ID 491657
  24. Celiac.com 12/09/2013 - People with celiac disease commonly suffer malabsorption, weight loss and vitamin/mineral-deficiencies. A team of researchers recently set out to assess the nutritional and vitamin/mineral status of current “early diagnosed” untreated adult celiac disease patients in the Netherlands. The research team included Nicolette J. Wierdsma, Marian A. E. van Bokhorst-de van der Schueren, Marijke Berkenpas, Chris J. J. Mulder, and Ad A. van Bodegraven. They are affiliated with the Department of Nutrition and Dietetics and the Department of Gastroenterology at Celiac Centre Amsterdam in VU University Medical Centre in Amsterdam, The Netherlands. Researchers assessed 80 newly diagnosed adult celiac patients, averaging 42.8 years old, ± 15.1 years. They compared vitamin concentrations for those patients against a sample of 24 healthy Dutch subjects. Before prescribing gluten-free diets to the patients, the researchers assessed nutritional status and serum concentrations of folic acid, vitamin A, B6, B12, and (25-hydroxy) D, zinc, haemoglobin (Hb) and ferritin. Almost nine out of ten celiac patients (87%) measured at least one value below the lowest normal reference levels. Specifically, for vitamin A, 7.5% of patients showed deficient levels, for vitamin B6 14.5%, folic acid 20%, and vitamin B12 19%. Likewise, 67% of celiac patients showed zinc deficiency, 46% showed decreased iron storage, and 32% had anaemia. Overall, 17% of celiac patients were malnourished, with more than 10% experiencing undesired weight loss, 22% of the women underweight (Body Mass Index (BMI) < 18.5), and 29% of the patients overweight (BMI > 25). Vitamin deficiencies were nearly non-existent in healthy control subjects, though they did show some vitamin B12 deficiency. Interestingly, vitamin and or mineral deficiencies were not associated with greater histological intestinal damage or with adverse nutritional status. This study shows that vitamin and/or mineral deficiencies are still common in newly “early diagnosed” celiac patients, even as rates of obesity upon initial celiac diagnosis continue to rise. Thorough nutritional monitoring is likely warranted for establishing a dietary baseline and maintaining nutritional levels during the course of celiac disease treatment. Source: Nutrients 2013, 5(10), 3975-3992; doi:10.3390/nu5103975
  25. Celiac.com 11/14/2013 - Until now, rates of non-celiac gluten sensitivity were largely a matter of clinical speculation, basically, educated guesswork among doctors. Some thought that rates of non-celiac gluten-sensitivity might by much higher than rates of celiac disease in the USA. But there was just no actual clinical data supporting these claims. A team of researchers recently set out to get some good clinical data that would tell them how common non-celiac gluten sensitivity actually is. The research team included Daniel V. DiGiacomo, Christina A. Tennyson, Peter H. Green, and Ryan T. Demmer. They are variously affiliated with the Department of Medicine, Celiac Disease Center at Columbia University, and the Department of Epidemiology at the Mailman School of Public Health at Columbia University in New York. The authors used the Continuous National Health and Nutrition Examination Survey (NHANES) 2009–2010 to enroll 7762 people from the civilian, non-institutionalized, US population free of celiac disease. They then analyzed the data to estimate rates of adherence to a gluten-free diet among participants without celiac disease as a surrogate marker for non-celiac gluten sensitivity in the US. They also used the data to characterize the demographics and general health status of the study participants. Overall, forty-nine participants reported adherence to a gluten-free diet. With a weighted national prevalence of 0.548%, this represents 1.3 million individuals between 6 and 80 years old in the US. The prevalence of a gluten-free diet was higher in females (0.58%) than males (0.37%), although this was not statistically significant (p = 0.34). Participants reporting a gluten-free diet were older (46.6 vs. 40.5 years, p = 0.005), had higher high-density lipoprotein, lower iron and lower body mass index. These numbers put the estimated national prevalence of non-celiac gluten sensitivity at 0.548%, about half the rate of celiac disease. However, the team calls for further studies in order to better understand the population burden of non-celiac gluten sensitivity. Source: Rev Esp Enferm Dig. 2013 Apr;105(4):187-193. doi:10.3109/00365521.2013.809598