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Celiac.com 01/15/2025 - Celiac disease is a complex autoimmune disorder that requires strict lifelong adherence to a gluten-free diet for effective management. This diet, while essential for recovery and symptom relief, poses several nutritional and psychological challenges. A deeper understanding of these challenges helps highlight the need for a comprehensive approach to supporting individuals with celiac disease. The Importance of a Gluten-Free Diet The gluten-free diet is the cornerstone of treatment for individuals with celiac disease. When people with celiac disease consume gluten, their immune system attacks the lining of the small intestine, causing damage to the villi, which are essential for nutrient absorption. Over time, this leads to significant health problems, including malabsorption of nutrients such as calcium, vitamin D, iron, and folic acid. Left untreated, this can result in conditions such as osteoporosis, anemia, and neurological issues. Adopting a gluten-free diet is highly effective in reducing symptoms, healing the intestinal lining, and preventing long-term complications. Many patients report significant improvements in gastrointestinal symptoms such as diarrhea, abdominal pain, and bloating after transitioning to the diet. However, even strict adherence to the diet does not guarantee complete recovery for all individuals, with older adults often experiencing slower or incomplete healing. Nutritional Deficiencies in a Gluten-Free Diet Although the gluten-free diet resolves many symptoms of celiac disease, it is associated with a range of nutritional deficiencies due to the exclusion of common grains like wheat, barley, and rye. Macronutrient Imbalances Fats: Gluten-free processed foods are often higher in total fats and saturated fats than their gluten-containing counterparts. This imbalance increases the risk of cardiovascular disease and metabolic disorders in celiac patients. Carbohydrates: Many gluten-free products rely on high-glycemic-index ingredients, leading to an overconsumption of simple sugars and a reduction in complex carbohydrates. This dietary pattern is linked to insulin resistance and an increased risk of diabetes. Fiber: Low fiber intake is a common issue among those on a gluten-free diet, as many gluten-free products lack whole grains. Insufficient fiber can lead to gastrointestinal discomfort, constipation, and long-term digestive issues. Proteins: While most individuals on a gluten-free diet consume adequate protein, the primary sources are often animal-based, which may not provide the balance of nutrients found in plant-based alternatives. Micronutrient Deficiencies Iron: Iron deficiency is prevalent in untreated and newly diagnosed celiac patients. Although levels improve with intestinal healing, iron-rich foods or supplements are often necessary to prevent anemia, especially in women. Calcium and Vitamin D: These nutrients are critical for bone health but are often deficient in individuals with celiac disease. Supplementation and dietary planning are essential to prevent osteoporosis. B Vitamins: Low levels of folate and vitamin B12 are common and can contribute to elevated homocysteine levels, which increase the risk of cardiovascular complications. Supplementation can help address these deficiencies. Other Minerals: Zinc, magnesium, and selenium deficiencies are frequently observed. Gluten-free processed foods often lack these essential minerals, making supplementation or diet adjustments necessary. Psychological and Social Challenges Maintaining a gluten-free diet significantly impacts social and psychological well-being. The need for strict dietary adherence can lead to feelings of isolation, anxiety, and depression. Individuals often experience difficulties dining out or participating in social gatherings due to concerns about cross-contamination or the unavailability of gluten-free options. This can result in avoidance of social activities and a sense of exclusion. In some cases, these challenges affect adherence to the diet, as individuals may intentionally consume gluten-containing foods to feel socially included. However, this behavior risks worsening symptoms and increasing the likelihood of severe complications. Support systems, education, and counseling can play a crucial role in helping individuals navigate these challenges and maintain their quality of life. The Role of Monitoring and Supplements Managing celiac disease goes beyond eliminating gluten from the diet. Regular monitoring of nutritional status is vital to identify and address deficiencies early. Blood tests can help track levels of critical nutrients, such as iron, calcium, vitamin D, and folate, enabling timely interventions. Nutritional counseling and education are essential components of care for celiac patients. Healthcare providers can guide patients in incorporating naturally gluten-free, nutrient-rich foods like fruits, vegetables, lean proteins, and pseudo-cereals such as quinoa and amaranth. Supplements may also be recommended, particularly during the initial years of dietary transition, to ensure adequate intake of critical nutrients. Why This Study Matters for Celiac Disease Patients This research underscores the multifaceted challenges faced by individuals with celiac disease in managing their condition. While the gluten-free diet is an effective treatment, it is not without its limitations. Nutritional deficiencies and psychological struggles are common, highlighting the need for a more comprehensive approach to care. For individuals with celiac disease, this study emphasizes the importance of regular nutritional assessments, balanced meal planning, and support systems to maintain both physical and mental health. By addressing these challenges, healthcare providers and patients can work together to improve quality of life and long-term outcomes for those living with this condition. Read more at: cureus.com Watch the video version of this article:
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Celiac.com 01/21/2023 - Celiac disease is a chronic autoimmune disorder that occurs in genetically predisposed individuals, causing damage to the small intestine when gluten is consumed. The only treatment option currently available is a strict, long-term gluten-free diet, which can be restrictive, socially limiting, and costly. In a recent study, researchers aimed to identify the factors associated with a better quality of life in a large group of French celiac disease patients. The study, conducted between January and March 2016, surveyed celiac disease patients who were 15 years or older and self-reported as having an official diagnosis of celiac disease. Information about the study along with a link to an online questionnaire were sent via email to the members of the French Association of Gluten Intolerant People (AFDIAG). The online questionnaire included both demographic and clinical data, the French version of the “Celiac Disease Questionnaire” (F-celiac diseaseQ), along with information on gluten-free purchasing and consumption habits. The results of the study showed that out of the 4,000 patients who were contacted, 907 (23%) or them responded to the questionnaire, and 787 (20%) of them were included in the final analysis. The population included was predominantly female (81%) with a median age of 49 years old. The median age at the time of celiac disease diagnosis was 38 years, and the median duration of those who were on a gluten-free diet was 10 years. Seventy-one percent of the patients had a self-assessed dietary compliance rating of more than 8/10 over the prior six months. The dimensions with the best results on the F-celiac diseaseQ questionnaire were “Social” and “Gastrointestinal Symptoms”, while the dimensions with the worst results were “Emotions” and “Worries”. The study found that the duration of and compliance with a gluten-free diet are major factors that influence the quality of life of patients with celiac disease. These findings have important implications for healthcare providers as they suggest that by taking into consideration the restrictive aspects of the gluten-free diet and working to improve adherence, the management of celiac disease can be improved. Additionally, the study also found that the frequency of follow-up visits was not associated with better compliance or better quality of life, which could be useful for healthcare providers in terms of resource allocation. Overall, this study highlights the importance of considering quality of life in the management of celiac disease and the need for further research in this area. Read more at mdpi.com
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Celiac.com 07/02/2020 - Lack of long-term follow-up after pediatric-adult transition in celiac disease is not associated with complications, ongoing symptoms or dietary adherence, but researchers are calling for more personally tailored follow-ups that can help celiacs who don't follow a gluten-free diet. People with celiac disease need to follow a life-long gluten-free diet. To make sure that celiac treatment is successful, and that celiacs are properly following a gluten-free diet, doctors recommend regular follow-up for celiac patients. A team of researchers recently set out to evaluate the implementation and significance of long-term follow-up. The research team included Laura Kivelä, Sointu Hekkala, Heini Huhtala, Katri Kaukinen, and Kalle Kurppa. The team collected medical data from 585 patients, and sent follow-up questionnaires to 559 current adult celiac disease patients, who were diagnosed as children. The team then compared the diagnostic factors and health outcomes between those adults who got follow-up and those who did not. The data showed that 92% of pediatric celiac patients received follow up 6–24 months after diagnosis. A total of 235 adults responded to the questionnaires a median of 18 years after diagnosis, only one in four reported regular celiac follow-ups. Among patients with similar features at diagnosis, those reporting regular follow-ups were diagnosed more recently than those reporting no follow-up. Those reporting follow-ups were less likely to smoke, or to be related to celiac patients, and more likely to be students and/or to have type 1 diabetes. Patients who did not receive regular follow-ups did not have more complications, ongoing symptoms, poorer general health or dietary adherence. Most celiac disease patients diagnosed as children do not receive recommended follow-up checks as adults. Lack of follow-up was not tied to poorer long-term treatment outcomes in general, but no patients avoiding a gluten-free diet were receiving follow-up checks, so we don't have data on this group. Based on these results, the study team recommends a more personally tailored follow-up of celiac disease treatment. Do you receive regular medial follow-up checks for your celiac disease? Do you feel that your follow-up treatment is adequate? Share your comments below. Read more at United European Gastroenterol J. 2020 Mar; 8(2): 157–166 The researchers are variously affiliated with the University Consortium of Seinäjoki, Seinäjoki, Finland; Tampere Center for Child Health Research, Tampere University and Department of Paediatrics, Tampere University Hospital, Tampere, Finland; the Department of Internal Medicine at Tampere University Hospital in Tampere, Finland; the University of Helsinki and Helsinki University Hospital, Children's Hospital, and Pediatric Research Center, Helsinki, Finland; and the Faculty of Medicine and Health Technology, the Faculty of Social Sciences, and the Celiac Disease Research Center at Tampere University in Tampere, Finland.
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Celiac.com 08/08/2018 - A number of studies have cataloged the numerous challenges faced by adolescents with celiac disease attempting to comply with a gluten-free diet. A team of researchers recently set out to reevaluate gluten-free dietary compliance and the current clinical condition of 123 now teenage celiac patients, who were diagnosed in the first three years of life and were followed up for at least 10 years to determine whether a less strict approach to a gluten-free diet can actually increase gluten-free dietary compliance. The research team included M Mayer, L Greco, R Troncone, S Auricchio, and M N Marsh. They are variously affiliated with the University Department of Medicine, Hope Hospital, Salford, Manchester, UK. The team used computerized image analysis to assess mucosal structure and lymphocytes in small intestinal biopsy specimens obtained from 36 subjects. Of these adolescents with celiac disease, 65% were adhering to a strict gluten free diet, 11.4% followed a gluten-free diet with occasional gluten intake, while nearly 25% ate a gluten containing diet. Patients on a gluten containing diet had more frequent clinical gluten-related symptoms, while patients on a semi-strict diet did not. Occasional intake of small amounts (0-06-2 g/day) of gluten did not produce increased concentrations of anti-gliadin antibodies, but did result in a substantially greater crypt epithelial volume and expanded crypt intraepithelial lymphocyte numbers. So, could a semi-strict gluten-free diet benefit celiac teenagers who eat a gluten containing diet? These numbers suggest that a semi-strict gluten-free diet may be better than no gluten-free diet at all. Of course, the best choice would always be a 100% gluten-free diet. Source: Gut
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Celiac.com 11/01/2017 - Recent product testing by the FDA shows overwhelming compliance with FDA's requirement that foods labeled "gluten-free" have less than 20 parts per million detectable gluten. According to the FDA, more than 99.5 percent of "gluten-free" food products met the agency's gluten-free standard, according to Carol D'Lima, a food technologist in FDA's Office of Nutrition and Food Labeling. The FDA collected and analyzed 702 samples from more than 250 products labeled "gluten free." So far, D'Lima noted, only one product labeled as gluten-free tested positive for gluten levels above 20 ppm. The FDA does not name the products that were tested, but does note that the failed product was "recalled and subsequent sampling by the FDA did not find levels of gluten that violated the regulation." Also, the FDA testing very likely includes products by major manufacturers. That's likely good news for manufacturers like General Mills, which made news recently when they announced that they will voluntarily remove the "Gluten-Free" label from their Cheerios products in Canada. The company says that it did not make the move due to any concerns about gluten levels, but due to a technicality over oat testing protocols under which oat products can be labeled "Gluten-Free." A statement from the company's website reads in part: "Each serving of Cheerios products in Canada are gluten free, as defined by the current regulatory standard of containing less than 20 ppm of gluten. General Mills Canada has made the decision to voluntarily remove the gluten-free label from our Cheerios products in Canada until Health Canada and The Canadian Food Inspection Agency (CFIA) publish a consistent testing protocol for products containing oats. At this time the product is not changing, just the label on the box." Absent any product recalls in the face of the FDA product testing, it's safe to assume that the consumers can take General Mills and other companies at their word, and trust that products labeled gluten-free meet FDA gluten-free standards, and are safe for people with celiac disease. Such high compliance levels by food manufacturers mean that the FDA may now put more of their resources into other enforcement measure, including ensuring that the supply chain remains free from cross-contamination. Even in the face of such encouraging test results, look for the FDA to remain diligent in validating "Gluten-Free" and other labeling claims. The FDA maintains "an ongoing compliance program," says D'Lima. Under that program, field staff in FDA district offices conduct inspections that include products labeled as gluten-free. If any products are found to be out of compliance for gluten standards, the FDA notifies the company to make appropriate corrections, and works with the company to recall any mislabeled products on the market. Source: foodnavigator-usa.com
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Celiac.com 06/28/2017 - Tests to measure serum endomysial antibodies (EMA) and antibodies to tissue transglutaminase (tTG) were developed to screen for celiac disease in patients who are actively eating gluten. However, doctors often use them to monitor patients on a gluten-free diet. Now, making sure celiac patients are successfully following a gluten-free diet is important, as unconscious gluten ingestion can lead to complications over time. But how accurate are these tests for assessing gluten-free compliance in celiac patients? A team of researchers recently set out to assess the sensitivity and specificity of tTG IgA and EMA IgA assays in identifying patients with celiac disease who have persistent villous atrophy despite a gluten-free diet. The research team included Jocelyn A. Silvester, Satya Kurada, Andrea Szwajcer, Ciarán P. Kelly, Daniel A. Leffler, and Donald R. Duerksen. They are variously affiliated with the Farncombe Family Digestive Health Research Institute and Division of Gastroenterology, and the Department of Pathology and Molecular Medicine and Department of Medicine, McMaster University, Hamilton, Ontario. To begin their meta-analysis, the team searched PUBMED, EMBASE, BIOSIS, SCOPUS, clinicaltrials.gov, Science Citation Index, and Cochrane Library databases through November 2016. They included studies of subjects with biopsy-confirmed celiac disease, follow-up biopsies and measurement of serum antibodies on a gluten-free diet, biopsy performed on subjects regardless of symptoms or antibody test results. Their analysis excluded patients with refractory celiac disease, undergoing gluten challenge, or consuming a prescribed oats-containing gluten-free diet. They determined positive or negative findings based on manufacturer cut-off values. They defined villous atrophy a Marsh 3 lesion or villous height:crypt depth ratio below 3.0. They constructed forest plots to determine the sensitivity and specificity of detection for individual studies. For their meta-analysis, they used a bivariate random effects model to determine both sensitivity and specificity. Their search of abstracts revealed 5,408 unique citations, which yielded 442 articles for detailed review. Those reviewed articles yielded just 26 studies that met the team’s inclusion criteria (6 of tTG assays, 15 of EMA assays, and 5 of tTG and EMA assays). Inability to cross-tabulate histologic and serologic findings was the most common reason the team excluded a given study from analysis. They found that serum assays identified patients with persistent villous atrophy with high levels of specificity: 0.83 for the tTG IgA assay (95% CI, 0.79–0.87) and 0.91 for the EMA IgA assay (95% CI, 0.87–0.94). However, the tests showed low sensitivity for detecting villous atrophy: 0.50 for the tTG IgA assay (95% CI, 0.41–0.60) and 0.45 for the EMA IgA assay (95% CI, 0.34-0.57). Results were similar in both pediatric and adult patients. A meta-analysis of biopsy-confirmed celiac patients who received follow-up biopsy while on a gluten-free diet, showed that tests for serum tTG IgA and EMA IgA had low sensitivity, detecting persistent villous atrophy less than 50 percent of the time. The team supports the search for more accurate, non-invasive, markers of mucosal damage in celiac patients who follow a gluten-free diet. Source: Gastroenterology. DOI: http://dx.doi.org/10.1053/j.gastro.2017.05.015
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Celiac.com 12/08/2016 - People with celiac disease are supposed to follow a strict lifelong gluten-free diet. Celiac patients should receive regular follow-up dietary interviews and blood tests to make sure that they are successfully following the diet. However, none of these methods offer an accurate measure of dietary compliance. The only way to know for sure, is to test. A team of researchers recently set out to evaluate the measurement of gluten immunogenic peptides (GIP) in stools as a marker of gluten-free diet adherence in celiac patients and compare it with traditional methods of gluten-free diet monitoring. The team conducted a prospective, nonrandomized, multi-center study including 188 celiac patients on gluten-free diet and 84 healthy controls. Subjects were given a dietary questionnaire and fecal GIP quantified by enzyme-linked immunosorbent assay (ELISA). They simultaneously measured serological anti-tissue transglutaminase (anti-tTG) IgA and anti-deamidated gliadin peptide (anti-DGP) IgA antibodies. A total of 56 of the 188 celiac patients, about 30 percent, had detectable GIP levels in stools. There was significant association between age and GIP in stools that revealed increasing dietary transgressions with advancing age. Nearly forty percent occurred in in subjects 13 years of age or older, with 60% occurring in men 13 years of age or older. The team found no connection between fecal GIP and dietary questionnaire or anti-tTG antibodies. However, they did spot a connection between GIP and anti-DGP antibodies, with seven of the 53 GIP stool-positive patients testing positive for anti-DGP. The detection of gluten peptides in stool samples shows the limits of traditional methods for monitoring a gluten-free diet in celiac patients. The GIP ELISA provides direct and quantitative assessment of gluten exposure soon after consumption, and might improve diagnosis and clinical management of non-responsive celiac disease and refractory celiac disease. Basically, doctors need to take a much more hands on role in monitoring celiac patients who are following gluten-free diets. Source: Am J Gastroenterol 2016; 111:1456–1465; doi:10.1038/ajg.2016.439; published online 20 September 2016 The research team included Isabel Comino PhD1, Fernando Fernández-Bañares MD, PhD2, María Esteve MD, PhD2, Luís Ortigosa MD, PhD3, Gemma Castillejo MD, PhD4, Blanca Fambuena MS5, Carmen Ribes-Koninckx MD, PhD6, Carlos Sierra MD, PhD7, Alfonso Rodríguez-Herrera MD, PhD8, José Carlos Salazar MD9, Ángel Caunedo MD10, J M Marugán-Miguelsanz MD, PhD11, José Antonio Garrote MD, PhD12, Santiago Vivas MD, PhD13, Oreste lo Iacono MD, PhD14, Alejandro Nuñez BSc13, Luis Vaquero MD, PhD13, Ana María Vegas MD12, Laura Crespo MD12, Luis Fernández-Salazar MD, PhD11, Eduardo Arranz MD, PhD11, Victoria Alejandra Jiménez-García MD10, Marco Antonio Montes-Cano MD, PhD15, Beatriz Espín MD, PhD9, Ana Galera MD8, Justo Valverde MD8, Francisco José Girón MD7, Miguel Bolonio MSc6, Antonio Millán MD, PhD5, Francesc Martínez Cerezo 4, César Guajardo MD3, José Ramón Alberto MD3, Mercé Rosinach MD, PhD2, Verónica Segura BSc1, Francisco León MD, PhD16, Jorge Marinich PhD17, Alba Muñoz-Suano PhD17, Manuel Romero-Gómez MD, PhD5, Ángel Cebolla PhD17 and Carolina Sousa PhD1 They are variously affiliated with the Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Seville, Spain; the Department of Gastroenterology, Hospital Universitari Mutua Terrassa, and CIBERehd, Terrassa, Barcelona, Spain; the Pediatric Gastroenterology, Hospital Universitario Nuestra Señora de La Candelaria, Tenerife, Spain; Pediatric Gastroenterology, Hospital Universitari de Sant Joan de Reus, IISPV, URV, Reus, Spain; the Unit for the Clinical Management of Digestive Diseases and CIBERehd and Gastroenterology and Nutrition Unit, Hospital Universitario Virgen de Valme, Seville, Spain; the Pediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario y Politécnico La Fe, Celiac Disease and Digestive Inmunopatology Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; the Pediatric Gastroenterology and Nutrition Unit, Hospital Materno-Infantil, Malaga, Spain; the Gastroenterology and Nutrition Unit, Instituto Hispalense de Pediatría, Seville, Spain; the Servicio de Gastroenterología Pediátrica, Hospital Universitario Virgen del Rocío, Seville, Spain; the Hospital Universitario Virgen Macarena, Seville, Spain; the Mucosal Immunology Laboratory, Instituto de Biología y Genética Molecular (IBGM), University of Valladolid, CSIC and Gastroenterology Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; the Clinical Analysis and Pediatrics, Hospital Universitario Río Hortega, Valladolid, Spain; the Servicio de Aparato Digestivo, Hospital Universitario de Leon, Leon, Spain; the Sección de Aparato Digestivo, Hospital del Tajo, Madrid, Spain; the Servicio de Inmunología, CIBER de Epidemiología y Salud Pública, Hospital Universitario Virgen del Rocío/IBiS/CSIC/Universidad de Sevilla, Seville, Spain; with Celimmune, Bethesda, Maryland, USA, and with Biomedal SL, Seville, Spain
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Celiac.com 02/24/2012 - Currently, testing for anti tissue-transglutaminase antibodies is the standard of celiac disease blood testing. The test has a high sensitivity in patients who are eating a diet that contains gluten, but poor sensitivity for people on a gluten-free diet. So, it's not much use for measuring gluten-free diet success in people with celiac disease. A research team set out to determine if a new test might be more useful than current standard in assessing long-term gluten exposure in celiac disease patients attempting to follow a gluten-free diet. The new test measures Immunoglobulin-A antibodies to catalytically active open conformation tissue-transglutaminase. The study team included K. Pallav, D. A. Leffler, M. Bennett, S. Tariq, H. Xu, T. Kabbani, A. C. Moss, M. Dennis, C. P. Kelly, D. Schuppan. They are affiliated with the Celiac Center of the Beth Israel Deaconess Medical Center at Harvard Medical School in Boston. The team made a preliminary dietary assessment of 147 patients with celiac disease, and grouped them according to good or poor compliance to a gluten-free diet. The team used 50 patients with inflammatory bowel disease as a control group. The team then measured both open (new test) and closed (conventional) tissue-transglutaminase levels using standard enzyme linked immunosorbent assay. The team's initial dietary review indicated that 128 of the celiac patients had followed a gluten free diet for more than six months. They found 19 to have poor compliance to a gluten-free diet. Of the 19 who had poor adherence to a gluten-free diet, the team found 13 patients (68.4%) who tested positive using open conformation assay (p=0.51), while ten of the 19 patients (52.6%) tested positive using conventional assay (p=0.51). In the control group, just two patients tested positive using closed assay, while one tested positive using open assay. The team concluded that, compared to conventional testing, open conformation tissue-transglutaminase may offer greater sensitivity in the poor gluten-free diet adherence group and higher specificity in the control population. The team suggests studies on larger populations to determine whether open conformation tissue-transglutaminase assay may be superior to the conventional assay in measuring compliance with a gluten-free diet. Source: Dig Liver Dis. 2012 Jan 17.
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Celiac.com 11/23/2011 - Osteopenia and osteoporosis, both conditions in which bone density is less than optimal, are often seen in people with celiac disease at the time of their diagnosis. There have been conflicting data as to whether a gluten free diet can improve bone density. Researchers in Argentina set out to determine if celiac patients suffer more peripheral fractures than a control population, and to assess the effects of a gluten free diet on fracture risk. Their results are reported in the July 7, 2011 issue of the World Journal of Gastroenterology. They recruited 256 people who had been diagnosed with celiac at least five years before the study began in March, 2007, asked them if they had ever broken any bones and, if so, which. They then compared their answers to answers obtained from 530 age- and sex- matched controls with functional gastrointestinal disorders. People with other disorders that could reduce bone health – like thyroid dysfunction, rheumatoid arthritis, inflammatory bowel disease, and diabetes – as well as those taking vitamin D, steroids, calcium supplements or other medications that could affect bone metabolism were excluded. They found that celiacs had a higher rate and risk of first peripheral fracture before diagnosis – but this effect only achieved statistical significance for men. This increased risk was also associated with a classical clinical presentation; those with atypical or silent forms of celiac did not exhibit the same risk. Although the finding that being male increases a celiac’s risk of peripheral fractures is intriguing, it must be borne out by larger studies – only 42 of the 256 celiacs included in this study were male. After maintaining a gluten free diet for five years, the elevated risk of fractures was gone. The authors speculate that eliminating gluten may reduce the risk of fractures in celiac patients not necessarily by increasing bone mass and mineral density, but by improving body mass and fat/ muscle composition, nutritional status, and bone architecture. Despite its limited scope, the take home message of this study is clear; if you have celiac disease, strictly adhering to a gluten free diet is good not just for your intestines, immune system, and skin; it is also good for your bones. Source: Sanchez et al. Risk of fracture in celiac disease: Gender, dietary compliance, or both? World J. Gastroenterol 2011 July 7; 17(25).
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Celiac.com 10/13/2009 - The standard method of measuring successful observance of a gluten-free diet in patients with celiac disease is through a dietary interview performed by health professional. However, there is currently have no simple, objective method for conducting such a dietary interview. To address this discrepancy, a team of researchers recently designed an easy, quick questionnaire based on four simple questions which yield a five-level score (0–IV). The score provides the test individual with an indication of their compliance level. The research team was made up of Federico Biagi, Alida Andrealli, Paola Ilaria Bianchi, Alessandra Marchese, Catherine Klersy, and Gino Roberto Corazza. The team recently set out to assess the accuracy of the questionnaire. They ran the questions past 168 celiac patients, 126 females and 42 males, with a median age of 42·4 (SD 12·9) years. All subjects were allegedly following a gluten-free diet (median 82, 25th–75th percentile 50–108, range 15–389 months). They compared the resulting scores with the persistence of both villous atrophy and endomysial antibodies while on a gluten-free diet. They also compared patient survival rates. Non-expert personnel interviewed patients by telephone. The questionnaire took less than one minute to complete. The lowest results were markedly more common among the patients with a persistence of both villous atrophy and positive endomysial antibodies. Those patients also had significantly higher rates of death overall. From these results, the researchers conclude that the questionnaire offers a simple, accurate way to verify compliance with a gluten-free diet for patients with celiac disease. Source: British Journal of Nutrition (2009), 102, 882–887
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Celiac.com 07/20/2010 - Anyone who's tried to maintain a gluten-free diet for celiac disease or other reasons can likely tell stories about the difficulties and challenges they face on a regular basis. Still, very little research has been done regarding the psychological and social challenges faced by people with celiac disease who are attempting to follow a gluten-free diet. Scientists in India recently conducted just such a study. A research team set out to assess psychological and social challenges faced by Indian children with celiac disease who are attempting to follow a gluten-free diet. The research team included Srikanta Basu, J. C. Chauhan, A. K. Dutta, Praveen Kumar, and Arun Kumar from the Division of Gastroenterology, Department of Pediatrics at Lady Hardinge Medical College and Associated Kalawati Saran Children Hospital in New Delhi, India. Their goal was to assess dietary compliance to gluten-free diet, to identify barriers to compliance, and to study the impact of diet on the psychosocial behavior of children with celiac disease. For the study, the team looked at children with clinically proven celiac disease, who had been observed for at least 6 months. They then evaluated the children for gluten-free diet compliance. Researchers who were blinded to initial results then interviewed patients using a self-administered questionnaire. The team measured psychosocial parameters using the standard 35-item Pediatric Symptom Checklist (PSC). To determine what factors might affect dietary compliance, the team compared the results of children who were compliant with their gluten-free diets to those who were not-compliant. They then compared the psychosocial parameters of both groups to those of healthy control subjects. The team measured a total of 70 patients for dietary compliance. They found 53 children to be compliant with a gluten-free diet (75%). They found 13 were non-compliant with a gluten-free diet (18%), while 4 children were likely non-compliant. A total of 64 children completed the full assessment. Final analysis showed that 4 of those children were likely non-compliant. Data for 2 patients with incomplete assessments was dropped. Younger kids showed higher compliance with a gluten-free diet than did teens. 80% of younger kids showed compliance with a gluten-free diet, compared with just 44% of teens. Gluten-free diet compliance was also higher in children with higher maternal education, and in parents with better knowledge and understanding of celiac disease, and in nuclear families. Higher family income raised compliance levels. Children with 2 or fewer siblings did better, with compliance rates of 68.3% and just 23% non-compliance. 72% of kids who were compliant with a gluten-free diet had presented classic symptoms of celiac disease, while only 15% of this group was non-compliant. Adjustment-related challenges, such as difficulty in maintaining diet at school, restaurants, trips, etc. are among the most common problems faced by celiac children. Nearly half (45%) of the children complained that teachers did not adequately understand the challenges of their condition. Researchers established a PSC cutoff point of 4 for children in the dietary non-compliant group. Generally, kids with celiac disease did not show higher levels of symptoms, such as complaints of aches and pains; being irritable/angry; not listening to rules, blaming other for mistakes; teasing others; refusing to share. The study findings show that about 1 in 5 (18%) people with celiac disease fail to comply with their gluten free diet, and that kids who comply with a gluten-free diet have better psychosocial parameters, as measured by PSC score. Also, adolescents, kids in joint families, and kids in larger families tend to have greater non-compliance levels. Successful treatment of celiac disease requires full compliance with a gluten-free diet. Non-compliance increases risk factors for numerous celiac-associated conditions. Knowing which factors are most likely to present challenges for maintaining compliance can provide celiac suffers and clinicians with useful tools for reducing those challenges and increasing compliance. Source: Indian Journal of Pediatrics 2010 Jun;77(6):649-54. DOI 10.1007/s12098-010-0092-3
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Aliment Pharmacol Ther. 2005;22(4):317-324. Celiac.com 09/14/2005 - In an effort to determine whether general screening for celiac disease should be conducted in high-risk groups, Finnish researchers conducted a 14 year follow-up study which focused on dietary compliance, quality of life, and bone mineral density in 53 consecutive screen-detected celiac disease patients who were diagnosed and treated around 14 years ago. The researchers assessed dietary compliance via an interview, a 4-day food record, and a blood antibody screening. Quality of life was measured via the Psychological General Well-Being and SF-36 questionnaires, while gastrointestinal symptoms were evaluated using the Gastrointestinal Symptom Rating Scale, and bone mineral density was measured using dual-energy x-ray absorptiometry. The researchers compared the results of these evaluations with those of 44 symptom-detected and treated celiac disease patients, 110 non-celiac disease subjects, and the general population. The researchers found that 96% of screen-detected and 93% of symptom-detected celiac disease patients adhered to a strict or fairly strict gluten-free diet. In the screen-detected group quality of life and gastrointestinal symptoms were similar to that of the symptom-detected patients and non-celiac disease controls, and their bone mineral densities were similar to that of the general population. The researchers conclude that dietary compliance in long-term screen-detected patients was good, and quality of life and bone mineral densities were comparable to that of the non-celiac disease subjects and the general population. Based on these results active screening for celiac disease in risk groups is beneficial and in no way harmful.
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