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Celiac.com 05/10/2024 - Celiac disease is an autoimmune condition triggered by gluten consumption, that can manifest in people across a wide spectrum of body weights, including obesity. Despite the common perception that celiac disease is associated with weight loss, recent studies suggest otherwise, revealing a complex interplay between this condition and obesity. Here's a rundown of the basics. Understanding Celiac Disease Celiac disease, also known as sprue or gluten-sensitive enteropathy, occurs when the body mounts an abnormal immune response to gluten, a protein found in wheat, barley, and rye. When individuals with celiac disease ingest gluten, it damages the lining of the small intestine, leading to various symptoms such as diarrhea, bloating, fatigue, and weight loss. However, some individuals, including those with obesity, may exhibit different symptoms or even gain weight after starting a gluten-free diet. Triggers of Celiac Disease Celiac disease can emerge at any stage of life, with triggers ranging from physiological events like pregnancy and surgery to emotional stress and infections. Although the exact mechanisms underlying the onset of celiac disease later in life remain unclear, factors affecting the immune system may play a role in triggering the condition. Obesity and Celiac Disease: Risk Factors While the exact relationship between obesity and celiac disease remains under-explored, emerging research suggests that obesity can coexist with celiac disease, with some studies reporting obesity rates of up to 44% among individuals with celiac disease. Moreover, individuals with celiac disease may develop obesity, particularly if they consume a gluten-free diet high in processed foods and low in whole foods. However, it's challenging to determine whether obesity increases the risk of celiac disease or vice versa. Celiac disease can often go undiagnosed, complicating efforts to understand the temporal relationship between these conditions. Nonetheless, both celiac disease and obesity independently pose risks for various health complications, including metabolic syndrome, fatty liver disease, high blood pressure, diabetes, and heart disease. The relationship between celiac disease and obesity is multifaceted and warrants further investigation. While individuals with celiac disease may present with a range of body weights, including obesity, understanding the mechanisms underlying this association is crucial for improving diagnosis, management, and treatment strategies for both conditions. As research in this field continues to evolve, healthcare providers can offer more tailored interventions to individuals affected by celiac disease and obesity alike. Read more at healthline.com

Celiac.com 04/17/2024 - Maintaining optimal health involves ensuring that our bodies receive essential nutrients, including magnesium, a vital mineral crucial for various bodily functions. Magnesium deficiency can arise from various factors, including medical conditions like celiac disease, poor absorption, increased need, or excessive elimination. Understanding the signs, causes, and remedies for magnesium deficiency is essential for overall well-being. Identifying Magnesium Deficiency Symptoms Magnesium deficiency symptoms may initially manifest subtly, including muscle spasms, fatigue, decreased appetite, and nausea. However, if left unaddressed, more severe effects such as abnormal heart rhythm, seizures, anxiety, and personality changes may occur. As these symptoms overlap with those of other health conditions, a blood test from a medical provider is crucial to confirm magnesium deficiency accurately. Causes of Magnesium Deficiency Malabsorption due to gastrointestinal conditions like celiac disease or inflammatory bowel disease can hinder magnesium absorption. Additionally, certain medications and increased magnesium needs, such as during pregnancy or in athletes, can contribute to deficiency. Factors that affect magnesium elimination, like alcohol consumption or medical conditions such as kidney disease, also play a role. The Role of Magnesium in the Body Magnesium plays a vital role in numerous bodily processes, including muscle and nerve function, heart rhythm maintenance, blood sugar control, bone health, and blood pressure regulation. Furthermore, magnesium influences hormone balance related to sleep, circadian rhythm, and mood regulation, and can alleviate conditions like migraine headaches. Sources of Magnesium To address magnesium deficiency, both oral supplements and magnesium-rich foods can be beneficial. Supplements, such as magnesium glycinate or magnesium citrate, offer an easily accessible solution, although they may cause mild gastrointestinal side effects. Alternatively, incorporating magnesium-rich foods like pumpkin seeds, almonds, spinach, soy, and black beans into one's diet can help meet daily magnesium requirements. Frequently Asked Questions About Magnesium What is the best magnesium supplement? Magnesium glycinate and magnesium citrate are generally well-tolerated forms of magnesium supplements. Are there supplements best avoided when taking magnesium? Calcium supplements should be taken separately from magnesium to prevent competition for absorption. What medications interfere with magnesium: Certain medications, including proton pump inhibitors, antibiotics, diuretics, and chemotherapy drugs, can hinder magnesium absorption and should be managed accordingly. In conclusion, recognizing the signs of magnesium deficiency, understanding its causes, and knowing how to address it through supplementation or dietary adjustments are essential for maintaining optimal health. Consulting healthcare providers for accurate diagnosis and personalized treatment plans is vital in managing magnesium deficiency effectively. This article is not intended to offer medical advice, and is for informational purposes only. Please consult a medical professional for personal advice on celiac disease, magnesium deficiency, and/or any other medical concern.

Celiac.com 03/21/2024 - For people with celiac disease, managing symptoms and maintaining a gluten-free lifestyle are essential for overall health. However, recent research has uncovered another potential cause of enteropathy that presents a diagnostic challenge for both patients and healthcare providers: olmesartan-induced enteropathy. Olmesartan, an angiotensin II receptor antagonist commonly prescribed for hypertension, has been linked to enteropathy in rare cases, and another brand name for it is Benicar. This side effect, while uncommon, can manifest as chronic diarrhea, weight loss, and signs of malabsorption, mirroring the symptoms of celiac disease. A team of researchers set out to study the diagnostic challenges related to non-celiac enteropathy, specifically focusing on olmesartan-induced enteropathy. Here's what they found. The research team included Doukas S G, Doukas P G, and Velpari S. They are variously affiliated with the Department of Medicine, Saint Peter's University Hospital in New Brunswick, NJ, USA; the Department of Forensic Sciences and Laboratory of Toxicology, University of Crete, Medical School in Heraklion, GRC; and the department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School/Saint Peter's University Hospital in New Brunswick, USA. Their recent study focused on a 73-year-old woman who presented to the emergency department with watery diarrhea, weight loss, and electrolyte imbalances. Despite extensive testing, including celiac disease panels and imaging studies, the cause of her symptoms remained elusive until duodenal biopsies revealed moderate to severe villi blunting and intraepithelial lymphocytosis—a hallmark of olmesartan-induced enteropathy. History of Taking Olmesartan The patient's history of olmesartan use prompted the discontinuation of the medication, leading to a remarkable improvement in her symptoms and duodenal biopsy results within one month. This case underscores the importance of considering medication history and ruling out other potential causes of enteropathy in patients with symptoms suggestive of malabsorption. Olmesartan-induced enteropathy can mimic celiac disease both clinically and histopathologically, often leading to unnecessary diagnostic investigations and delays in appropriate treatment. Greater awareness of medication-related diarrheal syndromes, such as olmesartan-induced enteropathy, is crucial for prompt diagnosis and management. Healthcare providers should be vigilant in recognizing the potential link between olmesartan use and enteropathy, as simple discontinuation of the medication can lead to significant clinical improvement. For people with celiac disease and other gastrointestinal conditions, understanding the potential causes of enteropathy beyond gluten exposure is essential for effectively managing symptoms, and optimizing health outcomes. By staying informed and working closely with healthcare providers, patients can navigate the complexities of non-celiac enteropathy, and advocate for their well-being. Read more at Cureus 16(2): e54373. doi:10.7759/cureus.54373

Celiac.com 03/13/2024 - Trichobezoar may sound like a term from a medical textbook, but for some individuals, it's a real and challenging condition. Imagine a solid mass forming in your stomach, composed of hair and food debris. This unusual condition, known as trichobezoar, is exceptionally rare, particularly in children. However, a recent case study has shed light on a unique connection between trichobezoar and celiac disease, emphasizing the importance of understanding these conditions and their treatment. A team of researchers present an unusual case involving the discovery of gastric trichobezoar in a 15-year-old girl who had undiagnosed celiac disease. The condition manifested after she experienced abdominal pain and pallor. Trichobezoar typically occurs in less than 1% of children, with most cases observed in young girls with psychiatric disorders. The condition arises from a compulsion to pull out hair (trichotillomania) and ingest it (trichophagia), leading to the accumulation of hair within the stomach lining. While trichobezoar is often associated with psychiatric conditions, its link to celiac disease is less common but noteworthy. In a recent case study, a 15-year-old girl presented with symptoms of trichobezoar, including abdominal pain, vomiting, and unexplained weight loss. Upon examination, doctors discovered a firm mass in her abdomen, along with signs of hair loss on her scalp. What made this case unique was the subsequent diagnosis of celiac disease, a condition characterized by an adverse reaction to gluten. Celiac disease is a chronic autoimmune disorder triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. While the association between trichobezoar and celiac disease is unusual, researchers suggest two possible explanations. Firstly, deficiencies in iron and folic acid, common in individuals with celiac disease, may lead to behavioral disorders such as trichophagia. Secondly, celiac disease itself may directly contribute to the development of trichobezoar. Treatment for trichobezoar typically involves surgical removal of the mass, followed by psychological support to prevent recurrence. In cases associated with celiac disease, adopting a gluten-free diet is essential to manage symptoms and promote healing. This comprehensive approach addresses both the physical and psychological aspects of the condition, offering patients a chance at improved health and well-being. While trichobezoar and celiac disease are relatively rare on their own, their coexistence presents a unique challenge for patients and healthcare providers alike. By raising awareness of this uncommon association and emphasizing the importance of early detection and treatment, we can better support individuals living with these conditions. As medical research continues to advance, we hope to gain further insights into the complex relationship between trichobezoar, celiac disease, and other related disorders, ultimately improving outcomes for those affected. Read more at cureus.com The research team included Hassnae Tkak, Amal Hamami, Aziza Elouali, Nadir Miry, Amal Bennani, Houssain Benhaddou, Abdeladim Babakhouya, and Maria Rkain. They are variously affiliated with the Department of Pediatrics, University Hospital Mohamed V, Faculty of Medecine and Pharmacy, University Mohamed first, Oujda, MAR; the Department of Pediatrics, Mohammed VI University Hospital, Oujda, MAR; the Faculty of medicine and pharmacy of Oujda, Mohammed I University of Oujda, Morocco; Oujda, MAR; the Pathology department, Mohammed VI University Hospital; Oujda, MAR; the Histopathology department, Faculty of Medicine and Pharmacy, Oujda, MAR; the Department of Pediatric Surgery, Mohammed VI University Hospital, Oujda, MAR; the Service de Pédiatrie, CHU Mohammed VI, Oujda, Maroc. , Faculté de médecine et de pharmacie d'Oujda, Université Mohammed I d'Oujda, Maroc., CHU Mohammed Vi Oujda Morocco, Oujda, MAR; the Department of Pediatrics, Mohammed VI university hospital, Oujda, Morocco., Faculty of medicine and pharmacy of Oujda, Mohammed I University of Oujda, Morocco, Oujda, MAR; and the Pediatric Gastroenterology, CHU Mohammed Vi Oujda Morocco, Oujda, MAR.

Celiac.com 02/26/2024 - A recent study, conducted by researchers Bodil Roth and Bodil Ohlsson, sheds light on the association between celiac disease and microscopic colitis, providing valuable insights into the clinical course, and subtypes of the disease in a female population. Microscopic colitis is characterized by chronic inflammation of the colon, and has long been linked to autoimmune conditions, smoking, and certain medications. Their study aimed to investigate this connection, considering various subtypes of microscopic colitis and their clinical presentations. The research, which involved 240 women aged 73 years or older diagnosed with microscopic colitis, revealed intriguing findings. Out of the 158 women who agreed to participate, half experienced the simultaneous onset of microscopic colitis and celiac disease. Notably, celiac disease was most prevalent in patients with lymphocytic colitis, with a significantly higher incidence compared to other subtypes of microscopic colitis. Analysis of blood samples also revealed the presence of anti-transglutaminase antibodies, a marker for celiac disease, in some participants with one episode of microscopic colitis. Moreover, corticosteroid use was more common in patients with collagenous colitis and refractory microscopic colitis, highlighting the diverse clinical manifestations of the disease. The study also explored the impact of smoking habits on the prevalence of microscopic colitis and associated symptoms. Past smokers showed a higher prevalence of one-episode microscopic colitis, while current smoking was associated with an increased likelihood of experiencing irritable bowel syndrome (IBS)-like symptoms. Significant Association Found Between Celiac Disease and Lymphocytic Colitis Upon adjusting for smoking habits, the researchers found a significant association between celiac disease and lymphocytic colitis, suggesting a potential link between these conditions. However, further research is needed to elucidate the nature of this relationship and whether lymphocytic colitis in conjunction with celiac disease should be classified as a distinct entity or a variant of celiac disease. These findings underscore the complex interplay between autoimmune conditions and gastrointestinal disorders, emphasizing the importance of comprehensive clinical evaluation and tailored management approaches. As researchers continue to unravel the intricacies of these diseases, advancements in diagnosis and treatment hold promise for improving the lives of individuals affected by celiac disease and microscopic colitis. Read more in BMC Gastroenterology volume 24, Article number: 70 (2024)

Celiac.com 12/27/2023 - Researchers Aljoharah Al Saud and Ziad F. Rayes deliver a case study report on the uncommon but impactful coexistence of celiac disease and antiphospholipid syndrome, two conditions with links to infertility. Respectively, they are associated with the Family Medicine and Polyclinics, Alfaisal University College of Medicine, and Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Centre, in Riyadh, SAU. The journey began for a 23-year-old woman with seemingly unrelated symptoms—urticaria and vitamin D deficiency. Initially diagnosed with idiopathic urticaria, her health story unfolded over 13 years. Recurrent miscarriages became a recurring theme, casting shadows on her dream of motherhood. The puzzle pieces started to fit together when antiphospholipid syndrome was identified after multiple pregnancy losses. Symptoms of Osteoporosis The patient's persistence paid off as she successfully underwent in vitro fertilization, leading to a diamniotic dichorionic pregnancy. However, post-delivery brought an unexpected twist—severe back pain unveiling acute wedge fractures, a sign of osteoporosis. Diving deeper into investigations, elevated antigliadin and anti-tissue transglutaminase antibodies emerged, revealing the presence of celiac disease. A gluten-free diet became the transformative key, bringing not only relief from symptoms but also notable improvements in bone mass density. This case serves as a poignant reminder of the intricate links between seemingly unrelated health issues. The intersection of celiac disease and antiphospholipid syndrome highlights the importance of thorough investigations in cases of unexplained infertility and unexpected osteoporosis. Beyond its diagnostic implications, this case underscores the critical need for early identification of celiac disease. Swift action can mitigate its potentially detrimental effects on fertility and bone health. As healthcare continues to unveil the complex interplay of various conditions, stories like these emphasize the significance of holistic and timely approaches to diagnosis and treatment, ensuring a healthier and more informed future for individuals navigating the intricate landscape of their well-being. Read more in cureus.com

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

Celiac.com 07/10/2023 - Previous observational studies have suggested links between migraine, inflammatory bowel disease (IBD), and celiac disease. However, it remained unclear whether these associations were due to shared genetic factors or if there was a causal relationship. Understanding these connections could have implications for treatment and symptom management. A research team recently aimed to investigate the possible genetic and causal connections between migraine, inflammatory bowel disease, and celiac disease. To do this, they conducted a Mendelian randomization study using data from various genome-wide association studies. The Research Team The research team included Nike Zoe Welander MSc, Gull Rukh PhD, Mathias Rask-Andersen PhD, Aster V. E. Harder MSc, MD, The International Headache Genetics Consortium, Arn M. J. M. van den Maagdenberg PhD, Helgi Birgir Schiöth PhD, and Jessica Mwinyi MD, PhD. They are variously affiliated with theDepartment of Surgical Sciences, Uppsala University, Uppsala, Sweden; the Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden; the Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands; and the Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands. The Study - Statistical Analyses to Assess Genetic Correlation and Causality Their study analyzed data from over 60,000 migraine cases, 25,000 inflammatory bowel disease cases, and 12,000 celiac disease cases, along with their respective control groups. Different subtypes of migraine and inflammatory bowel disease were also considered separately. The researchers used specific statistical analyses to assess genetic correlation and causality. The Findings - No Genetic Correlation The findings showed no genetic correlation between migraine and inflammatory bowel disease or celiac disease when all participants with migraine were analyzed together. There was also no evidence of inflammatory bowel disease or celiac disease causing migraine, or migraine causing inflammatory bowel disease or celiac disease. Causal Associations Between Celiac Disease and Migraine However, the study did indicate some potential causal associations between celiac disease and migraine with or without aura, as well as between migraine without aura and ulcerative colitis. It is important to note that these associations did not reach statistical significance after adjusting for multiple testing. In conclusion, this study did not find evidence of a shared genetic basis or a causal relationship between migraine and either inflammatory bowel disease or celiac disease. Although there were indications of potential causal associations with specific subtypes of migraine, further research is needed to confirm these findings and explore the underlying mechanisms. Read more in headachejournal.onlinelibrary.wiley.com

Celiac.com 06/05/2023 - Gluten-related disorders involve immune responses triggered by gluten ingestion, and they affect millions of individuals worldwide. With an overall prevalence of about 5%, gluten-related disorders represent a potentially significant health concern. The most prominent gluten-related disorder is celiac disease, a T-cell-mediated autoimmune disease with a wide range of symptoms, including diarrhea, malabsorption, and even lymphoma. Despite extensive research on gluten-related disorders, the environmental factors that contribute to the diverse reactions in susceptible individuals have remained elusive. However, recent studies have shed light on a potential link between pathogens and the development of celiac disease, transcending the traditional notion of molecular mimicry. Scientists have long speculated that pathogens might act as environmental triggers for celiac disease by exploiting molecular mimicry mechanisms. Molecular mimicry happens when foreign molecules resemble self-antigens, leading to immune system confusion and subsequent attacks on host tissues. In this context, it is plausible that pathogens may exhibit molecular, structural, and physical similarities to gluten, thereby inducing immune responses in susceptible individuals. Analysis of the 33-mer and p31-43 Gliadin Peptides To investigate this hypothesis further, researchers conducted a comprehensive analysis of the two most significant gluten peptides involved in celiac disease: the 33-mer and p31-43 gliadin peptides. The research team included Diego S. Vazquez, Hanna M. Schilbert, and Veronica I. Dodero, Francesco Asnicar, Academic Editor and Serena Manara. They are variously affiliated with the Grupo de Biología Estructural y Biotecnología (GBEyB-IMBICE), Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Buenos Aires, Argentina; the Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) in Buenos Aires, Argentina. Streptococcus Pneumoniae and Granulicatella sp. Show Strong Similarity to the Gliadin Peptides Employing advanced bioinformatics techniques, the team performed a stringent BLASTp search, and identified high sequence similarity regions between these gliadin peptides and proteins derived from bacterial pathogens. Notably, extracellular proteins from Streptococcus pneumoniae and Granulicatella sp. displayed a strong similarity to the gliadin peptides. Further examinations involved molecular dynamics calculations and the construction of updated α-2-gliadin models. These investigations revealed close spatial localization and solvent-exposure of the 33-mer and p31-43 peptides. By comparing these structures with the homology models and localization predictors of pathogen-related proteins, the researchers identified putative functions of the pathogen-derived sequences, such as T-cell epitopes and SH3/WW-binding domains. Moreover, shape and size parallels between the pathogenic agents and the superstructures of gliadin peptides led to the formulation of novel hypotheses concerning the activation of innate immunity and dysbiosis. The researchers propose that these pathologically relevant gluten-derived peptides may behave as non-replicating pathogens, introducing exciting avenues for further exploration at the intersection of innate immunity, microbiome research, and the field of food science. Conclusions These findings suggest that the relationship between gluten and pathogens is more intricate than previously understood. The sequence, structural, and physical similarities between gluten peptides and pathogen-derived proteins raise intriguing questions about the role of pathogens in the development of gluten-related disorders. While the molecular mimicry hypothesis remains relevant, this research expands the scope of investigation, highlighting the need to consider a broader range of factors that may contribute to the activation of the immune system in individuals susceptible to celiac disease. By unraveling the mechanisms behind the immune responses triggered by gluten ingestion, researchers are helping to improve diagnosis, treatment, and prevention strategies for celiac disease and other gluten-related disorders. Read more in the Int J Mol Sci. 2021 Sep; 22(17): 9278

Celiac.com 06/12/2023 - Celiac disease is an autoimmune disorder characterized by gastrointestinal symptoms and nutrient deficiencies. While genetic factors, particularly HLA association, play a significant role in its development, the exact environmental triggers remain unclear. Recent studies have proposed infections as potential contributing factors. With the Covid-19 pandemic causing a systemic inflammatory response and affecting the gastrointestinal tract, researchers in southern Sweden set out to investigate whether Covid-19 infection could increase the risk of developing celiac disease. The research team included Jesper Lexner, Ylva Lindroth and Klas Sjöberg. They are variously affiliated with the Department of Gastroenterology and Nutrition, Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden; and the Division of Medical Microbiology, Department of Laboratory Medicine, Skåne University Hospital, Lund University, Lund, Sweden. The Covid-19 and Celiac Disease Connection To explore the potential association between Covid-19 infection and celiac disease, the researchers identified all patients, including children and adults, in the county of Skåne with newly diagnosed biopsy- or serology-verified celiac disease or positive tissue transglutaminase antibody tests (tTG-ab) from 2016 to 2021. They also identified individuals who tested positive for Covid-19 using PCR or antigen tests in 2020 and 2021. The Findings During the period from March 2020 to December 2021, there were 201,050 cases of Covid-19 in Skåne, and among them, 568 patients were diagnosed with celiac disease or had positive tTG-ab tests. Interestingly, only 35 of these patients had previously been infected with Covid-19. Contrary to initial expectations, the incidence of verified celiac disease and tTG-ab positivity was lower during the Covid-19 pandemic compared to before. The incidence rates of celiac disease were 21.1 and 22.4 cases per 100,000 person-years for patients with and without prior Covid-19 infection, respectively. Implications of the Study The findings of this study suggest that Covid-19 infection is not a significant risk factor for the development of celiac disease. While previous research has indicated that gastrointestinal infections may play a role in the pathogenesis of celiac disease, respiratory infections, such as those caused by the SARS-CoV-2 virus, appear to have less relevance in this regard. Study Limitations It is important to note that this study focused on a specific region in southern Sweden and the findings may not be generalizable to other populations or geographic areas. Further research involving larger and more diverse populations is warranted to validate these findings. Additionally, the study did not explore potential mechanisms underlying the connection between gastrointestinal infections and celiac disease pathogenesis, highlighting the need for future investigations in this area. Understanding the environmental triggers and risk factors associated with celiac disease is crucial for improving diagnosis, treatment, and prevention strategies. While the Covid-19 pandemic has posed significant challenges worldwide, this study suggests that Covid-19 infection does not increase the risk of developing celiac disease. Read more in BMC Gastroenterology volume 23, Article number: 174 (2023)

Celiac.com 06/06/2023 - Celiac disease, osteopenia and osteoporosis are conditions that have been found to be connected. A research team recently described celiac disease-induced osteoporosis in an attempt to enlighten new and lesser-known aspects, including the influence of the intestinal microbiome and sex-related differences, on bone health. The team included Lisa Lungaro, Francesca Manza, Anna Costanzini, Marianna Barbalinardo, Denis Gentili, Fabio Caputo, Matteo Guarino, Giorgio Zoli, Umberto Volta, Roberto De Giorgio, and Giacomo Caio. They are variously affiliated with the Department of Translational Medicine, University of Ferrara in Ferrara, Italy; the National Research Council, Institute for the Study of Nanostructured Materials (CNR-ISMN) in Bologna, Italy; the Department of Medical and Surgical Sciences, University of Bologna, in Bologna, Italy; the Mucosal Immunology and Biology Research Center, Massachusetts General Hospital—Harvard Medical School in Boston, MA, USA. Their review describes the role of celiac disease in the development of skeletal alterations, in order to provide physicians with an updated overview on this debated topic, and to improve the management of osteoporosis in celiac disease. It is important to note that not all individuals with celiac disease will develop osteoporosis. The risk varies depending on factors such as the duration and severity of the disease, adherence to a gluten-free diet, and individual variations in bone health and genetics. However, individuals with celiac disease should be aware of the increased risk of osteoporosis and take steps to manage their bone health, including ensuring adequate calcium and vitamin D intake, monitoring bone density through regular screenings, and maintaining strict adherence to a gluten-free diet. Several important connections between the conditions highlighted by the researchers include: Malabsorption Celiac disease is characterized by damage to the small intestine, leading to impaired absorption of nutrients, including calcium and vitamin D, which are essential for maintaining healthy bones. Malabsorption of these nutrients can result in reduced bone mineral density and increased risk of osteoporosis. Inflammatory Response Celiac disease triggers an immune response in the presence of gluten. This immune response involves the production of pro-inflammatory molecules, which can contribute to bone loss and increased bone turnover, leading to osteoporosis. Calcium Imbalance The malabsorption of calcium in individuals with celiac disease can disrupt the balance of calcium in the body. When there is insufficient calcium intake or absorption, the body may draw calcium from the bones, weakening them and increasing the risk of osteoporosis. Calcium intake in the young age is an essential determinant of the bone mass peak. Calcium metabolism defects are common in untreated children with celiac disease, and they return to normal with a gluten-free diet. Vitamin D Deficiency Vitamin D plays a crucial role in calcium absorption and bone health. Celiac disease can lead to reduced vitamin D absorption due to intestinal damage. Vitamin D deficiency further exacerbates the risk of osteoporosis. Gluten-Induced Autoimmunity Celiac disease is an autoimmune disorder, and individuals with autoimmune diseases, including celiac disease, have a higher risk of developing additional autoimmune conditions such as autoimmune osteoporosis. Autoimmune mechanisms may contribute to bone loss and the development of osteoporosis in individuals with celiac disease. Hormonal Imbalance Celiac disease can disrupt the endocrine system, leading to hormonal imbalances. Hormones such as estrogen and testosterone play a crucial role in maintaining bone health. Imbalances in these hormones can accelerate bone loss and increase the risk of osteoporosis. Sex Differences Women with celiac disease are at a higher risk of osteoporosis due to both indirect and direct effects. The indirect effects include factors such as early menopause and amenorrhea (absence of menstruation), which can have a negative impact on bone health. Early menopause refers to the cessation of menstruation before the age of 45, which can occur in women with celiac disease due to various factors, including hormonal imbalances and inflammation. Early menopause is concerning for bone health because estrogen, a hormone that helps maintain bone density, decreases significantly during menopause. Lower estrogen levels can accelerate bone loss and increase the risk of osteoporosis. Therefore, women with celiac disease who experience early menopause should be particularly vigilant about managing their bone health. Physicians should be aware of bone conditions linked to celiac disease that might contribute to the worsening of BMD, and should treat them promptly. There is little evidence regarding osteopenia and pharmacological osteoporosis treatment, specifically in celiac disease. Probiotic supplementation might become a novel strategy in preventing bone alterations, although the role of gut microbiota is still uncertain and not well-established yet. In the full report, the researchers offer a comprehensive dive into each of the areas mentioned above. Read more in Nutrients. 2023 Mar; 15(5): 1089 doi: 10.3390/nu15051089

Celiac.com 05/29/2023 - Celiac disease is an autoimmune disorder triggered by gluten consumption. While genes and gluten play a significant role in the development of the disease, researchers have started to explore additional factors that contribute to its onset. One intriguing area of study is the gut microbiota, the vast community of microorganisms that reside in our digestive tract. Recent research has suggested that alterations in the gut microbiota may act as an additional risk factor for celiac disease. To shed light on this complex relationship, scientists have embarked on a journey to explore the biogeographic variation and functional pathways of the gut microbiota in individuals with celiac disease. One challenge researchers face is the variability in sampling sites within the digestive system. Celiac disease primarily affects the small intestine, specifically the duodenum. Therefore, understanding the microbiota along different sections of the duodenum and comparing it to fecal samples is crucial for interpreting the findings accurately and gaining mechanistic insight. Comprehensive Study Using 16S rRNA Gene Sequencing To tackle this issue, a team of scientists conducted a comprehensive study using 16S rRNA gene sequencing, a method that allows for the identification and characterization of microbial communities, and predicted gene function using advanced bioinformatics tools. The research team included Marco Constante; Josie Libertucci; Heather J. Galipeau; Jake C. Szamosi; Gaston Rueda; Pedro M. Miranda; Maria Ines Pinto-Sanchez; Carolyn M. Southward; Laura Rossi; Michelle E. Fontes; Fernando G. Chirdo; Michael G. Surette; Premysl Bercik; Alberto Caminero; and Elena F. Verdu. They are variously affiliated with the Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; and the Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Instituto de Estudios Inmunológicos y Fisiopatológicos, Universidad Nacional de La Plata-National Scientific and Technical Research Council, La Plata, Argentina. Their team collected duodenal biopsies from sections D1, D2, and D3, aspirates, and stool samples from individuals with active celiac disease, as well as healthy controls. They also assessed participants' celiac disease risk genotypes. To delve deeper into the functional impact of the microbiota, the team selected a subset of duodenal samples with similar celiac disease risk genotypes for further analysis, and used to colonize germ-free mice, enabling the study of gluten metabolism. Study Results - Certain Microbes Present in Celiacs The results of the study were intriguing. The composition and predicted function of the gut microbiota in celiac disease were found to be largely determined by the location within the intestine. In the duodenum, but not in stool samples, specific bacterial species, such as Escherichia coli (D1), Prevotella salivae (D2), and Neisseria (D3), were found to be more abundant in individuals with celiac disease compared to healthy controls. Furthermore, the researchers discovered alterations in bacterial protease and peptidase genes, indicating changes in gluten degradation pathways specific to celiac disease. Interestingly, impaired gluten degradation was observed only in mice colonized with microbiota from individuals with celiac disease, further highlighting the role of the microbiota in gluten metabolism. These findings suggest that celiac disease influences the microbial communities in distinct niches within the gut. The researchers also identified novel microbial proteolytic pathways involved in gluten detoxification, which were impaired in individuals with celiac disease but not in healthy controls carrying the celiac disease risk genotype DQ2. This suggests a potential association between these pathways and active inflammation in the duodenum. It is important to note that the study highlights the significance of sampling site as a confounding factor in microbiome research related to celiac disease. Understanding the nuances of the gut microbiota at different locations within the intestine is crucial for accurate interpretation and meaningful conclusions. Conclusions This groundbreaking research opens up new avenues for exploring the complex interplay between the gut microbiota and celiac disease. By identifying specific microbial species and functional pathways associated with the disease, scientists are gaining valuable insights into its mechanisms. Furthermore, these findings provide potential targets for future therapeutic interventions and diagnostic approaches, ultimately improving the lives of individuals living with celiac disease. As our understanding of the intricate relationship between the gut microbiota and celiac disease deepens, we move one step closer to understanding the parameters of the disease, and possibly to develop better approaches to treatment. Stay tuned for more on this and related stories. Read more at Gastroenterology

Celiac.com 03/30/2023 - A study recently published in the Journal of the American Academy of Dermatology shows that people with psoriasis have twice the odds of having celiac disease compared to those without psoriasis. The study is the work of a research team that included Marina Z. Joel, BS; Ryan Fan, BA; and Jeffrey M. Cohen, MD. They are variously affiliated with the Johns Hopkins University School of Medicine, Baltimore, Maryland; the Yale School of Medicine, and the Department of Dermatology at Yale School of Medicine, New Haven, Connecticut. The Psoriasis & Celiac Disease Study For their study, the Ms. Joel and her colleagues examined the association between psoriasis and celiac disease. They used data from 316,166 adults, and found that of the 6,476 patients with psoriasis, 1.65% had celiac disease compared to nearly 0.5% of 309,690 patients without psoriasis. The study controlled for various factors such as age, sex, race and ethnicity, smoking status, autoimmune diseases linked to psoriasis and celiac disease, and body mass index (BMI), and found that psoriasis remained significantly associated with celiac disease. Study Findings The authors note that while the exact mechanism behind this association is unclear, genome-wide association studies have found that many susceptibility loci for psoriasis overlap with those for celiac disease: “While the pathophysiologic mechanism behind the association between psoriasis and celiac disease is unclear, several explanations have been proposed. Genome-wide association studies have found that many susceptibility loci for psoriasis overlap with those for celiac disease," they write. They add that "both psoriasis and celiac disease are T-cell driven disorders, there could be shared immunogenic mechanisms between the two conditions." Although more research is needed to fully understand the link between psoriasis and celiac disease, studies that help to document connections between celiac disease and other disorders are very helpful in clarifying the overall celiac disease puzzle. Read more in Journal of the American Academy of Dermatology

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

Celiac.com 03/06/2023 - We get a lot of questions about celiac disease and gluten-free-related issues. One question we've seen lately is: Is there a connection between the human gut microbiome and celiac disease? The short answer is yes. The longer answer is that research has show a number of connections between the two conditions, but we still have far more questions than answers. Here's a rundown of what we do know. Celiac disease is an autoimmune disorder that affects the small intestine. When individuals with celiac disease consume gluten, a protein found in wheat, barley, and rye, it triggers an immune response that damages the lining of the small intestine and interferes with the absorption of nutrients. One of the key components of the gut environment is the microbiome, a complex community of microorganisms that live in the gut. Recent research has shown that the gut microbiome plays a crucial role in the development and progression of celiac disease. Studies have shown that celiac disease is associated with changes in the composition and diversity of the gut microbiome. In individuals with celiac disease, there is a decrease in beneficial bacteria, such as Lactobacillus and Bifidobacterium, and an increase in pathogenic bacteria, such as Clostridium. This disruption of the gut microbiome, also known as dysbiosis, can lead to an imbalance in the gut environment, which can trigger an immune response and further damage to the small intestine. Celiac Disease Disrupts the Gut Microbiome Recent studies have shown that celiac disease not only affects the gut lining but also disrupts the balance of the gut microbiome. The gut microbiome is made up of trillions of microorganisms that reside in the gut and play a crucial role in maintaining overall health. In healthy individuals, the gut microbiome is diverse and balanced, but in celiac patients, the gut microbiome is often imbalanced, known as dysbiosis. Gluten-Free Diet Affects Gut Microbiome Dysbiosis in celiac patients can lead to a reduction in beneficial bacteria and an increase in harmful bacteria. This can cause a number of issues such as inflammation, changes in gut motility and nutrient malabsorption. Additionally, research has shown that the gut microbiome in celiac patients also changes after starting a gluten-free diet. For instance, the levels of certain beneficial bacteria such as Lactobacillus and Bifidobacterium increase, which can help to restore balance in the gut microbiome. Gut-Brain Axis It is not entirely clear yet how the gut microbiome is affected in celiac disease, but researchers believe that the gut-brain axis, which connects the gut and the brain, plays a key role. Studies have shown that the gut microbiome can influence the brain-gut axis and may impact nociceptive behavior and brain function. There's also a connection between gut-brain axis and migraines in people with celiac disease. Connections Between Microbiome and Celiac Research We also know that Genetic Risk for Autoimmune Disease Tied to Gut Microbiome We know that Celiac Disease Onset Changes Gut Microbiota in Children Recent research shows that Gluten Does Not Change Gut Microbiome in Patients with Celiac Disease and Non-Celiac Gluten Sensitivity We just recently learned that Altered Gut Bacteria Linked With Long COVID-19 Symptoms We also know that, in some cases, Fecal Microbiota Transplant Restores Gut Microbiome New research tells us that interaction between the gut microbiome and micronutrients are a key to the availability of minerals and vitamins. Gut Microbiome Affects Bioavailability of Micronutrients The gut microbiome can variously influence the bioavailability of micronutrients, as well as be influenced by micronutrient supplementation, with potential implications for health, even in the long term. Although several mechanisms have been advanced, a thorough characterization of the microbiome–micronutrient bidirectional axis is of utmost importance, as it can guide the design of microbiome‐based precision intervention strategies, aimed at improving micronutrient status and overall health. Studies have shown that celiac disease is associated with changes in the composition and diversity of the gut microbiome, which can lead to an imbalance in the gut environment, known as dysbiosis. Gut microbiome imbalance can lead to a number of issues such as inflammation, changes in gut motility and nutrient malabsorption. Research has shown that the gut microbiome in celiac patients also changes in some worrisome ways after starting a gluten-free diet. Much Unknown About "Healthy" Gut Microbiome Additionally, we need a clear understanding of what constitutes a "healthy" gut microbiome in people with or without celiac disease to fully understand the implications of gut health on celiac disease. When it comes to the connection between the human gut microbiome and celiac disease, we're learning that the two conditions are connected. Some evidence suggests that the health of the gut microbiome can influence certain symptoms of celiac disease, especially headaches. However, much more research is needed before we can make any hard conclusions about the exact nature of the connections, and the implications for people with celiac disease and other auto-immune conditions.

Celiac.com 02/20/2023 - Celiac disease is a condition that is caused by the immune system's response to gluten, a protein found in wheat, rye and barely. In celiac patients, an immune response triggers a pro-inflammatory environment in the small intestine, causing damage to the tissue. A major role in the pathogenesis of celiac disease is played by the HLA-restricted gliadin-specific intestinal T-cell response generated in a pro-inflammatory environment. A recent review article highlights the growing body of research that supports the central role of inflammation in the development of celiac disease, and how it is influenced by factors such as sensitivity to gluten and other pro-inflammatory agents. The review is authored by researchers Maria Vittoria Barone, Renata Auricchio, Merlin Nanayakkara, Luigi Greco, Riccardo Troncone, and Salvatore Auricchio. The are variously affiliated with the Department of Translational Medical Science, University Federico II in Naples, Italy; and the European Laboratory for the Investigation of Food Induced Disease (ELFID), University Federico II in Naples, Italy. Live studies on a population at risk have explored the mechanisms behind this inflammation. These studies show cellular and metabolic alterations in the absence of a T cell-mediated response, before the onset of the disease and before the introduction of gluten in the diet. Gluten exacerbates these constitutive alterations, both live and in the lab. The role of inflammation in celiac disease has led researchers to consider it as a chronic inflammatory disease, similar to other autoimmune disorders. The review also explores the crucial role played by the intestine in controlling inflammation both locally and systemically, and the impact of nutrients and gut bacteria on inflammation. Reduction of Early Inflammation Could Delay Onset of Celiac Disease Celiac disease is characterized by inflammation, which plays a critical role in the onset of the disease. It begins with a pre-clinical phase where the body is set up for inflammation, making it susceptible to various pro-inflammatory agents, including gluten. Historically, research has focused on the T-cell response in celiac disease, but there is growing recognition of the importance of the pre-inflammatory state. Modulating this state with a Mediterranean-type diet or preventing intestinal viral infections could have a significant impact on the onset of celiac disease, and could be easier to manage than the more complex autoimmune response. The implications of this research extend to additional chronic inflammatory diseases including inflammatory bowel diseases and diabetes, where early intervention with the state of inflammation in at-risk subjects could have a lasting impact on their health. Read more in mdpi.com

Celiac.com 02/06/2023 - Typically, doctors diagnose celiac disease using serological markers, like anti-tissue transglutaminase antibodies (t-TGA), along with a biopsy of the small bowel (SBB) to spot mucosal damage in the gut. To get a better understanding of the connection between serological markers and changes to gut mucosa in children with celiac disease, a team of researchers recently examined the connection between serological markers, and changes of the intestinal mucosa in children with celiac disease. To do so, they used data from a national Spanish registry, called REPAC-2, that included children under 15 years old. The wanted to determine the potential connection between t-TGA levels and other factors, such as mucosal damage and clinical findings, based on gender, age, symptoms. The study included nearly 5,000 patients with celiac disease, nearly 3,000 of whom underwent both t-TGA and a SBB for diagnosis. The results showed that more than two-thirds of the patients with normal IgA values had a Marsh 3b-c lesion, which is a severe form of mucosal damage, and nearly as many had t-TGA IgA levels at or above 10 times the upper limit of normal (ULN). The study found a statistically significant association between t-TGA IgA levels and the degree of mucosal damage. The higher the t-TGA IgA levels, the more severe the mucosal damage. Among other things, the study found that patients who reported symptoms had more severe mucosal damage compared to those who did not. They also found a negative association between age and changes of the intestinal mucosa, which suggests that younger patients are more likely to suffer severe mucosal damage. But, the team found no connection between gender and changes to gut mucosa. The study included a subgroup of 18 IgA-deficient patients. The results showed that nearly half of these patients had t-TGA IgA levels at or above 10 times ULN, while nearly seventy percent had Marsh 3b-c lesions. The team found no significant connection between t-TGA IgG levels and changes to gut mucosa, including for factors like age, gender, or symptom type. The results of this study suggest a positive association between t-TGA IgA levels and the degree of gut mucosal changes in children with celiac disease. However, they found no association in IgA-deficient patients with positive t-TGA IgG results. These findings echo the recommendations of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN), which advises SBB in IgA-deficient patients, even with high t-TGA IgG readings. The study reinforces the practice of factoring in both t-TGA IgA and IgG levels, as well as conducting a small bowel biopsy, when diagnosing celiac disease in children, especially in those with IgA deficiency, regardless of t-TGA IgG levels. Studies like this are helpful for getting clinicians and primary care physicians on the same page about best practices for celiac diagnosis in children. However, there is still much to be discovered about the relationship between serological markers and changes to gut mucosa in celiac patients. Stay tuned for more on this and related topics. Read more in the Journal of Pediatric Gastroenterology & Nutrition

Celiac.com 02/03/2023 - Multiple sclerosis is a chronic autoimmune disease of the central nervous system that affects individuals worldwide. People with multiple sclerosis often have other autoimmune diseases such as hypothyroidism, inflammatory bowel disease, rheumatoid arthritis, and diabetes, which suggests that there may be common genetic or environmental exposures between multiple sclerosis and other autoimmune diseases. Epidemiological studies have also shown that individuals with one autoimmune disease have an increased susceptibility to developing another autoimmune disease. Celiac disease is an autoimmune gluten-sensitive enteropathy that results in small intestinal lesions and malabsorption in affected individuals. Celiac disease develops based on genetic factors and mucosal immune response. Almost all individuals with celiac disease have HLA DR3-DQ2 and/or the DR4-DQ8. These HLA class II haplotypes have a strong association with multiple sclerosis. celiac disease is also associated with neurological manifestations and diseases such as ataxia, epilepsy, neuropathy, and multiple sclerosis. However, the exact relationship between celiac disease and multiple sclerosis is not well understood. In order to evaluate the prevalence of celiac disease in multiple sclerosis cases, two researchers conducted a systematic review and meta-analysis using PubMed, Scopus, EMBASE, Web of Science, and Google Scholar. The search included all relevant studies published up to October 2022. The researchers independently searched all databases and also references of included studies. They included cross-sectional studies/case, articles which had been published in the English language, and studies in which the diagnostic criteria were biopsy of the duodenum. They excluded letters to editors, case reports, and RCT studies. They found a total of 1,113 articles by literature search, and after deleting duplicates, 519 remained. Sixteen articles remained for meta-analysis. A total of 31,418 patients were evaluated and the total number of possible/confirmed cases was 124. Studies were published between 2004 and 2020, and the most published studies were from Italy. Five studies provided information regarding controls. The pooled rates of this systematic review showed that celiac disease is not common in multiple sclerosis cases. However, the study did have some limitations. There were studies that used serologic evaluation for celiac disease diagnosis which were excluded. Additionally, there were no reports from some countries, and the control groups were different; as in some studies, the control group was healthy subjects, and in others, the control group was patients with other diseases except multiple sclerosis. The study authors suggest that larger multicenter studies from numerous countries are needed to fully understand the relationship between celiac disease and multiple sclerosis. It is important to note that while the rates of celiac disease in multiple sclerosis patients may be low, patients with multiple sclerosis still suffer from a wide range of gastrointestinal manifestations such as dysphagia, constipation, and/or fecal incontinence. Dyspeptic symptoms and associated pain are also common in multiple sclerosis cases, which can negatively affect quality of life and interfere with daily activities. Because of this, it's important for doctors to be aware of the potential for these symptoms in multiple sclerosis patients, and to consider a range of possible causes. Read more in the American Journal of Gastroenterology

Celiac.com 01/09/2023 - Psoriasis is one of several skin conditions long associated with celiac disease. Several studies have found connections between psoriasis and celiac disease, but so far no study has shown a causal connection between these two autoimmune conditions. A new study shows that celiac disease patients face a higher risk of psoriasis, but not vice versa. Here's what they found. Genetic Study A team of researchers recently set out to explore the causal link between psoriasis and celiac disease with bidirectional 2-sample Mendelian Randomization (MR) study. The research team included Lin Li, Lixin Fu, Liwen Zhang & Yanyan Feng. They are affiliated with theDepartment of Dermatology, Chengdu Second People’s Hospital, Chengdu, Sichuan, China. The Psoriasis-Celiac Disease Connection The team set out to extract eligible instrument variables with genome-wide significance. To do so, the team used data from the published genome-wide association studies (GWAS) of the European population. They then performed sensitivity, post-MR, and inverse variance weighted (IVW) analyses. The MR analyses showed that genetically doubling the odds of celiac disease would increase the risk for psoriasis. Subsequent sensitivity analyses reinforced those results. Higher Psoriasis Risk for Celiac Patients However, the team's data showed that genetically determined psoriasis was not connected with the risk for celiac disease. This study offers new genetic evidence that celiac patients face an increased risk of psoriasis, while psoriasis patients face no higher celiac risk. For this reason, the team advises clinicians to be aware of the connections, and to closely watch for any psoriasis-associated skin symptoms in celiac patients, or in patients with celiac symptoms. This study offers another valuable insight into the many connections between celiac disease and the risk of other auto-immune conditions, and perhaps supports the idea that all non-genetically determined psoriasis patients should be screened for celiac disease. Read more at Scientific Reports volume 12, Article number: 21508 (2022)

Celiac.com 10/17/2022 - Headache is one of the main clinical symptoms and complaints of people with celiac disease, and often it manifests as migraine. The roots and origins of migraine as it relates to celiac disease are complex, and still poorly understood. The term 'dysbiosis' refers to a disruption of the microbiome that triggers an imbalance in the gut microbiota, which leads to changes in their functional composition and metabolic activities, or changes to their distribution within the gut microbiome. A team of researchers recently set out to give a narrative summary of the literature on celiac disease's neurological symptoms, particularly migraines, and to assess potential connections with dysbiosis. The research team included Hodan Qasim, Mohamed Nasr, Amad Mohammad, Mosab Hor, and Ahmed M. Baradeiya. They are variously affiliated with theDepartment of Internal Medicine, Alfaisal University, Riyadh, SAU; the Ophthalmology, Palestinian Medical Council, Ramallah, PSE; the Department of Ophthalmology, Children Retina Institute, Los Angeles, USA; the department of General Internal Medicine, Mansoura general hospital in Mansoura, Egypt; and the Research center, Fresno clinical research center, Fresno, USA. In an effort to explain the connection, researchers have proposed various mechanisms involving the gut-brain axis, including: the interaction of chronic inflammation with inflammatory and vasoactive mediators; the modulation of the intestinal immune environment of the microbiota; and a malfunction of the autonomic nervous system. The research article refers to a known gut-brain pathway that can influence neurological illnesses such as migraines. Some data suggests that gut microbiota can influence the brain-gut axis, and may impact nociceptive behavior and brain function A layer of columnar intestinal epithelial cells separates the 100 trillion bacteria present on the gut surface from the host. The key pathophysiological processes connected to migraine are thought to work partly due to the gut microbiota composition, which also plays a significant role in the gut-brain axis. Potential pathways include neurotransmitters, hormones, and inflammatory chemicals originating from the microbiome. However, further research is required to fully understand the basic specific factors which influence the process. The team's review aims to give a narrative summary of the literature on celiac disease's neurological symptoms, particularly migraines, and to assess any potential associations to dysbiosis, an imbalance in the microbiome that may be related to celiac disease. Read more at Cureus.com

Celiac.com 07/25/2022 - Celiac disease and inflammatory bowel disease share a number of factors, including some co-occurrence, independent of temporal sequence, which suggests a shared etiology. To better understand the picture, a team of researchers recently set out to determine the risk of inflammatory bowel disease (IBD) in patients with celiac disease (and vice versa) compared to matched subjects from the general-population. The research team included Karl Mårild MD PhD; Jonas Söderling PhD; Lebwohl, Benjamin MD; Green, Peter HR MD; Pinto-Sanchez, Maria Ines MD MSc; Halfvarson, Jonas MD PhD; Bjorn Roelstraete PhD; Ola Olén MD PhD; and Jonas F. Ludvigsson MD PhD. The researchers used the Swedish histopathology and healthcare register data to identify nearly 50,000 patients with celiac disease, along with nearly 85,000 with IBD diagnosed in 1969-2016. The team compared each patient to age- and 336 sex-matched general-population subjects with celiac disease, and 503 with IBD. They used Cox regression to estimated hazard ratios (HRs) for IBD in celiac patients and vice versa. To reduce potential surveillance bias, the team limited their main analyses to events beyond the first year of follow-up. Nearly eight-hundred patients were diagnosed with IBD during follow-up, compared to 1015 in the matched group. Te HR for IBD was 3.91 in celiac patients, which is similar to HRs for Crohn’s disease and ulcerative colitis. During follow-up, 644 IBD patients and nearly six-hundred in the matched group were diagnosed with celiac disease. The HR for celiac disease in IBD patients was 5.49, with the highest risk estimates seen in ulcerative colitis, the HR for Crohn’s disease was 3.31. Even though most patients with celiac disease and IBD are diagnosed in under a year, many experienced HRs of 3-4 even ten years later. Over a twenty year follow-up period, 2.5% of celiac patients developed IBD, while 1.3% of IBD patients developed celiac disease. The team is advising physicians to keep in mind the two-way connection between celiac diagnosis and IBD in the initial assessment and follow-up of both conditions. Because of their common co-occurrence, which is independent of the order in which the diseases are contracted, the researchers suggest the potential for a shared etiology between the two conditions. Read more in the American Journal of Gastroenterology The researchers are variously affiliated with the Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden; the Department of Pediatric Gastroenterology, Queen Silvia Children's Hospital, Gothenburg, Sweden; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; the Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; the Celiac Disease Center Department of Medicine Columbia University College of Physicians and Surgeons New York NY USA; the Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; the Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; the Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden; the Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; and the Department of Pediatrics, Orebro University Hospital, Orebro, Sweden.

Celiac.com 04/11/2022 - Researchers and clinicians are just beginning to understand the many connections between celiac disease and diabetes. We've done a number of articles on links between celiac disease and diabetes. We've talked about how a gluten-free diet might help lower diabetes risk. We've looked at the potential role of gluten in Type 1 Diabetes. We've even asked if having type 1 diabetes mellitus and celiac disease automatically mean worse health and quality of life? We know that rates of diabetes are much higher in celiacs than in the general population, and vice versa. We also know that non-diabetic patients often show celiac-specific humoral immunoreactivity at the time of their celiac disease diagnosis. What about diabetic patients? Do they show type 1 diabetes celiac-specific humoral immunoreactivity? To find out, a research team recently looked at celiac-associated humoral autoimmunity in child, adolescent, and adult patients at the onset of type 1 diabetes (DM1) to see if those patients exhibit DM1 celiac-specific humoral immunoreactivity, as do non-diabetic celiac patients at first diagnosis. The research team included Claudio Tiberti Aceliac disease, Francesca Panimolle BS, Margherita Bonamico MD, Blegina Shashaj MD, Tiziana Filardi MD, Federica Lucantoni BS, Raffaella Nenna MD, Francesco Costantino MD, Andrea Lenzi MD, and Susanna Morano MD. They are variously affiliated with the Department of Internal Medicine, University of Rome “Sapienza,” Rome, Italy; the Department of Pediatrics, University of Rome “Sapienza,” Rome, Italy; and the Department of Physiopathology, University of Rome “Sapienza,” Rome, Italy. The team found IgA anti-transglutaminase autoantibodies (IgA-tTGAb) in more than 650 new-onset DM1 serum samples. They then analyzed IgA-tTGAb-positive DM1 samples for IgG-tTG, deamidated gliadin (DGP), and actin antibodies, and compared the results against those from more than 80 screen-detected non-diabetic patients at the time of their celiac diagnosis. In all, nearly thirteen percent of DM1 samples were positive for IgA-tTGAb, with patients 18 years or over showing lower autoantibody frequency, that's about 2.2 times more than in adult patients. Meanwhile, compared with non-diabetic celiacs, IgA-tTGAb+ DM1 patients showed substantially lower IgA-tTGAb titers, IgG-tTGAb, and DGPAb frequency/titers, along with sharply lower average number of celiac-autoantibody positive results per patient. These results show that the age of diabetes onset is negatively associated with risk of celiac disease, that is, the lower age of DM1 onset, the higher the risk of developing celiac disease. Compared with the activity of non-diabetic patients at the time of celiac diagnosis, celiac-specific humoral immunoreactivity is sharply lower at the onset of DM1. The team suggests that a general lower celiac-specific humoral immune response reflects a slower process of celiac disease development in DM1 patients, which is marked by nearly imperceptible gastrointestinal symptoms. This hypothesis is supported by an autoimmune diabetes study that shows a direct correlation between intensity of the humoral immune response and more prominent characteristics of insulin deficiency.* Stay tuned for more stories on connections between celiac disease and diabetes. Read more in Diabetes Care. 2012 Oct; 35(10): 2083–2085 *Buzzetti R, Di Pietro S, Giaccari A, et al. Non Insulin Requiring Autoimmune Diabetes Study Group High titer of autoantibodies to GAD identifies a specific phenotype of adult-onset autoimmune diabetes. Diabetes Care 2007;30:932–938