Search the Community

Celiac.com 01/04/2025 - Navigating dietary restrictions during family meals can be challenging, especially when emotions, traditions, and communication gaps come into play. This recent story about a sister-in-law who added flour to a dish meant to be gluten-free highlights just how delicate these situations can be for people with gluten intolerance, celiac disease, or other dietary sensitivities. It also raises important questions about respect, trust, and the lengths individuals must go to protect their health while maintaining family relationships. Understanding Gluten Intolerance and Celiac Disease For those with gluten intolerance or celiac disease, eating gluten is not just a matter of personal preference—it is a serious health issue. Gluten, a protein found in wheat, barley, and rye, can trigger a range of symptoms in sensitive individuals. For those with celiac disease, consuming gluten damages the small intestine, leading to nutrient deficiencies, gastrointestinal distress, and long-term health complications. Even small amounts of gluten, such as those added to a dish during cooking, can cause harm. In this story, the husband’s dietary restrictions were made clear in advance. His wife repeatedly reminded the sister-in-law about his gluten intolerance, and he took proactive measures, such as bringing his own gluten-free dishes. Despite these efforts, the addition of flour to a sweet potato casserole turned a safe dish into a harmful one, creating not only physical risk but also emotional tension. Miscommunication or Malice? One of the most striking aspects of this situation is the tone and intent behind the sister-in-law’s actions. According to the account, her response to being asked about the presence of flour seemed "smug," which only deepened the sense of betrayal. However, it is also possible that the tone was misinterpreted, especially given the significant stress she faces as the primary caregiver for a family member with serious health conditions. Stress, fatigue, and caregiving responsibilities can sometimes cause people to act thoughtlessly or defensively. While this doesn’t excuse actions that put others at risk, understanding the context may help to approach the situation with more compassion. What This Means for People with Gluten Sensitivity or Celiac Disease This story illustrates a common challenge faced by people with dietary restrictions: navigating social situations where food is central. Here are some key takeaways for individuals with gluten intolerance or celiac disease: Clear Communication is Essential Openly communicating dietary needs is vital, but as this situation shows, even clear instructions can sometimes be ignored or misunderstood. When attending meals prepared by others, it is often safest to bring your own dishes or to confirm ingredients with the host directly. Advocating for Your Health Situations like this underscore the importance of being your own advocate. If you suspect that a dish is unsafe, it’s okay to ask direct questions—even if it feels awkward. Your health and well-being should always come first. The Emotional Toll of Non-Compliance Beyond the physical risks, experiences like this can leave people feeling invalidated or disrespected. For individuals with celiac disease or gluten sensitivity, it’s not just about avoiding discomfort—it’s about protecting their health and feeling supported by loved ones. Balancing Boundaries and Relationships While it’s tempting to draw a hard line and refuse future dinner invitations, the couple in this story is grappling with the complexity of family dynamics. The sister-in-law’s role as a caregiver for an aging family member adds another layer of difficulty. Forging a path forward will require a balance of firm boundaries and understanding. Here are some strategies to navigate similar situations: Set Clear Boundaries Politely but firmly communicate your intentions, whether that means declining future invitations or setting specific expectations for shared meals. For example, you might offer to prepare and bring your own dishes or suggest a potluck-style gathering to reduce the burden on the host. Focus on Education Sometimes, misunderstandings about dietary restrictions stem from a lack of knowledge. If the sister-in-law didn’t fully grasp the seriousness of gluten intolerance, taking the time to explain its impact may help prevent future issues. Consider Stress Factors While caregiving stress doesn’t excuse actions that jeopardize someone’s health, acknowledging the pressures the sister-in-law faces may open the door for a more constructive conversation. Offering support or finding ways to ease her burden could help improve the relationship. Trust Your Instincts If you feel that a situation is unsafe or unsalvageable, it’s okay to prioritize your well-being. Declining future invitations or suggesting alternative ways to connect with family—such as meeting for coffee or attending events that don’t center around food—may be the best solution. Building a Path Forward For people with celiac disease or gluten sensitivity, navigating family gatherings can be fraught with challenges. Stories like this one highlight the importance of both setting boundaries and fostering understanding. While the sister-in-law’s actions were concerning, the couple may benefit from approaching the situation with empathy, while still standing firm in their commitment to health and safety. Ultimately, this story serves as a reminder that dietary restrictions are not just personal quirks—they are medical necessities. For friends and family members, respecting these needs is a fundamental way to show care and support. For those with celiac disease or gluten intolerance, advocating for yourself while maintaining relationships can be a delicate balance, but it’s one worth striving for. Read more at: twistedsifter.com

Celiac.com 08/15/2023 - Researchers from the University of Otago in New Zealand recently studied the effects of dietary wheat gluten on the hypothalamus of male mice. The researchers include Mohammed Z. Rizwan, Romy Kerbus, Kaj Kamstra, Pramuk Keerthisinghe, and Alexander Tups. Their findings are intriguing. The researchers are variously affiliated with the Centre for Neuroendocrinology and Department of Physiology at the University of Otago School of Biomedical Sciences in Dunedin, New Zealand; the Centre for Neuroendocrinology and Department of Anatomy at the University of Otago School of Biomedical Sciences in Dunedin, New Zealand, and the Maurice Wilkins Centre for Molecular Biodiscovery in Auckland, New Zealand. Gluten is commonly found in wheat, rye, and barley, and is a major dietary component in many western countries. Gluten has been linked to weight gain and peripheral inflammation in mice. This research aimed to understand its impact on central inflammation, particularly in relation to diet-induced obesity. Low-fat Diet vs. High-fat Diet with Gluten The study observed that adding gluten to a low-fat diet had no discernible effect, but male mice fed a high-fat diet enriched with gluten exhibited increased body mass and adiposity compared to those on an high-fat diet without gluten. Additionally, when gluten was introduced to the low-fat diet, it led to higher levels of circulating C-reactive protein. Interestingly, it made no difference whether gluten was added to a low-fat or a high-fat diet. Either way, it triggered a significant increase in the number of microglia and astrocytes in the arcuate nucleus of the hypothalamus. These changes were identified using specific markers through immunohistochemistry. Even on an low-fat diet, gluten appeared to replicate the immunogenic effects seen with an high-fat diet, and its inclusion in the latter led to a further rise in the number of reactive immune cells. Gluten Triggers an Obesity and Injury to the Hypothalamus Overall, the findings suggested that gluten had a moderate obeso-genic effect, when given to mice exposed to an high-fat diet. Moreover, the study reported that gluten triggered the presence of astrocytes and microglia in the hypothalamus, indicating a potential injury to the hypothalamus in rodents. Mice are used in studies to model human disease risk due to genetic similarities, allowing researchers to investigate potential factors and develop treatments in controlled, ethically manageable settings. This research contributes to our understanding the complex relationship between dietary components, like gluten, and obesity-related inflammation in the brain. It also offers up some exciting areas of further research inquiry into the brain's response to gluten in both mice and humans. Read more in the Journal of Neuroendocrinology

Celiac.com 08/31/2012 - I have always been a little unsure what to think of probiotics. My mother raised me to take acidophilus supplements religiously, but I could never find any evidence to suggest that the pills actually improved my health. After two weeks taking Vidazorb Super C Chewable Probiotics, I think I have my first substantial evidence that probiotics actually do something. At first, I didn't notice much change, but about a week after I started taking the chewable tablets, I realized that it had been a while since I had suffered indigestion. Prior to this, at least a meal or two a week just wouldn't sit right in my stomach. I have no known allergies or sensitivities, and it didn't seem like I was responding to any particular ingredients, just every now and then, my stomach would seem to not like something I ate. I don't know what was going on, but in the two weeks (and counting) I've been taking Vidazorb Super C Chewable Probiotics, I haven't had indigestion problems once. Additionally, I seem to be getting acid reflux less as well (I usually get that at least a few times a week). I am very happy with the results I've gotten from Vidazorb Super C Chewable Probiotics. The fact that they're chewable (and actually taste pretty decent), calorie-free and non-refrigerated makes them fit easily into my daily routine. I highly recommend them to anyone hoping to improve their digestive health.

Celiac.com 10/30/2019 - More and more, doctors are noticing cases of both celiac disease and eosinophilic esophagitis (EoE) in children. A team of researchers recently set out to examine the results of therapeutic dietary treatment in a group of children with celiac disease and eosinophilic esophagitis. The research team included Tiffany Patton; Ankurt Chugh; Leena Padhye; Catherine DeGeeter; and Stefano Guandalini. They are variously affiliated with the Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Comer Children's Hospital, University of Chicago Medical Center, Chicago, IL; the Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI; the Division of Allergy and Immunology, Rush University Medical Center, Chicago, IL; and the Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Stead Family Children's Hospital, University of Iowa, Iowa City, IA. For their assessment, the team reviewed patient records obtained from the University of Chicago Celiac Center Database from August 2008 to July 2013. The researchers collected information on children with both celiac disease and eosinophilic esophagitis including age, sex, dates of diagnoses, presenting symptoms, length of symptoms before diagnosis, family and personal history, dietary therapy, and esophageal response to dietary treatment. The team reviewed records of 350 pediatric celiac disease patients. Twenty-two children, or 6.3% had confirmed celiac disease and eosinophilic esophagitis, 17 of those children had repeat biopsies. In four cases, the esophageal eosinophilia cleared up on a strict gluten-free diet, 10 of 17 (59%) needed to eliminate other foods before the problem resolved, 1 of 17 failed to reached histological remission, while there was no follow-up information for 2 of those 17 patients. After symptom improvement, five out of five patients could tolerate soy, three of five could tolerate eggs, three of seven could eat dairy, two out of four could tolerate nuts 2 of 4, and two of four can tolerate fish. This is perhaps the largest pediatric study to examine the histologic aspects of EoE-associated esophageal eosinophilia in response to dietary treatment of pediatric patients with both celiac disease and eosinophilic esophagitis. The results show that most of these patients can tolerate soy, and suggest that making it the first food to be reintroduced, or testing out a soy-inclusive elimination diet could be helpful for those patients. Read more in the Journal of Pediatric Gastroenterology and Nutrition: August 2019.

Celiac.com 01/26/2017 - The only currently effective therapy for celiac disease is for patients to follow a gluten-free diet. However, no serum marker for gluten intake has yet been found, so it's not always easy for doctors to tell if patients are following their diets properly. A team of researchers recently set out to evaluate the use of alkylresorcinol concentrations for detecting dietary gluten intake in humans and mice. The research team included R. S. Choung, J. A. Murray, E. V. Marietta, C. T. Van Dyke, and A. B. Ross. They are variously affiliated with the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA, and with the Department of Biology and Biological Engineering, Chalmers University of Technology in Gothenburg, Sweden. For their study, they compared alkylresorcinol concentrations among 34 treated patients with celiac disease, 36 untreated celiac disease patients and 33 control subjects. They also evaluated seven additional celiac disease patients whose serum samples were available at diagnosis and after gluten-free diet. In mice, they compared alkylresorcinol concentrations in the serum of five mice fed a regular chow, and 10 mice fed lifelong with a gluten-free chow. In addition, They also assessed the effect of added gluten on alkylresorcinol concentrations. Their study indicates that serum alkylresorcinol concentrations could be a useful marker for dietary gluten in celiac disease. Certainly, having an easy, reliable way for doctors to spot dietary gluten will be useful in helping people with celiac disease maintain their required gluten-free diets. Source: Alimentary Pharmacology & Therapeutics. DOI: 10.1111/apt.13917

Celiac.com 07/05/2016 - Principal Investigator: Amrit P.S. Narula M.D, F.A.C.P, F.A.C.G, F.A.C.N., A.G.A.F Study Coordinator: Alicia Mercuri, PA-C Background Research estimates that approximately 18 million Americans have gluten sensitivity. That is six times more than patients confirmed with celiac disease. Non-celiac gluten sensitivity is defined as those individuals who cannot tolerate gluten in the diet and experience the same symptoms attributed to celiac disease, but lack antibodies and intestinal damage as seen in celiac disease. A dietary supplement called ZyGluten was developed from in vitro studies, not in vivo. The primary aim in its development was a supplement which, if taken at the beginning of a meal, would hydrolyze gluten concentration in ingested food. Foods tested included McDonald's hamburger, white sliced bread, a plain bagel, macaroni and cheese, spaghetti, a muffin, and frozen pizza. The amount of gluten was measured at 0, 30 and 60 minutes after the introduction of ZyGluten. In all samples, gluten measured at the end of 60 minutes was less than 20 ppm. ZyGluten is a compound of amylases, proteases, and lipase enzymes with probiotics, specifically Lactococcus lactis and Lactococcus cremoris. It is derived from plant and microbial sources. Inclusion Criteria Ages 18-80 years Physician diagnosed gluten sensitivity by history and experienced symptoms of gluten sensitivity for at least 1 month prior to involvement Willing to take supplement twice daily for 2 weeks Sign informed consent Exclusion criteria Active Inflammatory Disease Celiac disease confirmed by antibodies and duodenal biopsy Peptic ulcer disease Lactose intolerance Pregnant or lactating women Received any experimental drug within 30 days of enrollment Methods 27 patients, all of whom met the inclusion criteria, were selected to take 2 capsules of ZyGlutens before 2 major meals of the day for 2 weeks. 23 patients were female and 4 were male, with ages ranging from 25-77. The following symptoms were assessed at baseline, week 1, and week 2 which was the conclusion of the study: Abdominal pain Diarrhea Constipation Headaches Joint pain Fatigue The severity of symptoms was measured as mild, moderate, or severe, and none if symptoms were absent. All patients were contacted by phone within 48 hours of start of the trial to assess for any adverse effects. Following parameters were checked at baseline, week 1, and week 2: Weight Height Blood pressure Pulse rate Respiration rate Patients were not charged or reimbursed for their participation in the study. Results The following number of patients (27) had these symptoms at baseline: None Mild Moderate Severe Abdominal Pain/Cramping 1 1 16 9 Bloating/Distention 0 3 9 15 Diarrhea 10 4 2 11 Constipation 16 2 3 6 Headaches 11 5 7 4 Joint Pains 12 2 9 4 Fatigue 3 4 5 15 The following number of patients (23) had these symptoms at week 1: None Mild Moderate Severe Abdominal pain/Cramping 10 7 4 2 Bloating/Distention 9 10 1 3 Diarrhea 16 5 2 0 Constipation 20 1 1 1 Headaches 17 2 3 1 Joint Pains 14 2 4 3 Fatigue 7 8 3 5 The following number of patients (23) had these symptoms at week 2: None Mild Moderate Severe Abdominal Pain/Cramping 15 4 2 2 Bloating/Distention 14 6 1 2 Diarrhea 21 1 1 0 Constipation 21 1 0 1 Headaches 16 5 1 1 Joint Pains 17 3 2 1 Fatigue 10 7 1 5 The following number of patients rated their symptom improvement as: No improvement: 0 Improved: 4 Markedly improved: 19 Adverse Effects No patients reported any adverse effects. Participants Twenty-seven participants were enrolled in the study. Two patients withdrew from the study; one of which had a scheduling conflict with follow-up visits and one stopped taking the medication due to increased sleepiness after two pills. Two patients were lost to follow-up. These four patients were excluded from analysis. Conclusion In conclusion, ZyGluten study is a 2 week open labeled trial. Our outcome so far has shown to be extremely efficacious with no significant side effects. There was no significant difference found in patients who complained of headaches or joint pain. The majority of the patients found significant improvement in their symptoms of abdominal pain, bloating, changes in bowel habits, and fatigue. In fact, 83% of patients rated that their symptoms markedly improved, and 17% rated an improvement in their symptoms. Patient Testimonials *The medication was known by patients as ‘Gluten Buster' during the clinical trial. "Medication has given me more freedom. I am no longer afraid to eat, especially away from home. I am very pleased with the medication".-MF "My symptoms have improved. I would like to keep taking this if I can, especially since it's natural, to see how long I can go without an endoscopy".-MH "I feel that this pill has made a tremendous improvement in my condition". –BW "Bloating is gone. Stools seem to be more formed. Feeling good". –PS "It's wonderful to not be limited in what I can eat. It's great not to have the symptoms of pain, etc. when eating gluten foods". –JH "Great for bloating".-JF "Very little of passing gas. I feel good". -PW "Bloating is a lot better". -LW "I have not had any cramping or urgency to have a BM after a meal. My bowel movements are now normal. I have had no GI distress since on the meds". –KY "Gluten Buster has been a miracle pill. After so many years of having bowel problems, I never knew what it was like to have a regular bowel movement. I have had no problems with digestive system since I starting taking these pills". -JM "Medication was very helpful". –KO "My experience with the Gluten Buster that Dr. Narula has given me to take has been simply amazing. It has made my quality of life so much better. He is an amazing doctor to help those that otherwise thought there was no hope! I feel great"!-CM "Seems a little bit better. Still have IBS. Still have a lot of gas and bloating."-AM "It has been helping to go to the bathroom. The weight is going up and the stomach is going down a little bit".-SH "Before taking the medicine, mornings were hard because of bloating and diarrhea. Now I feel great in the morning".-GK "Gluten Buster is a life changer. Will definitely go on it when available in market." -MC "It is helping with bloating and gas. Has improved all of my GI symptoms. Overall, I can eat anything, including French fries and food I could not eat before (Super Pill)". -MK "I feel it has improved. Still have bloating, but eating regular food. Diarrhea has improved, no pain in stomach or abdomen". -BS "I feel 10x better than I did before starting the medication. No stomach cramps of bloating, I only have a BM twice/day. Feel great!" -JB "I am doing 100% better now since I have been taking the Gluten Buster meds". - JZ "Passing more gas, feeling better". -ML "I'm feeling better. I'm eating anything I want, not sticking with gluten free food. If it's due to taking the Gluten Buster, then I would still take it". -BS "It has made a big difference in bloating and abdominal pain. I would like to continue taking it". -JP "My stomach feels fantastic when I take the product. This should be available for all people with gluten sensitivity. This would be a great idea for Shark Tank. It needs to be available to the masses! I don't know how my stomach will survive without it, especially at the holidays". -LT References Am J Gastroenterol. 2011 Mar;106(3):508-14; quiz 515. doi: 10.1038/ajg.2010.487. Epub 2011 Jan 11. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Biesiekierski JR1, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, Shepherd SJ, Muir JG, Gibson PR. The Oslo definitions for celiac disease and related terms. Jonas F Ludvigsson,1,2 Daniel A Leffler,3 Julio C Bai,4 Federico Biagi,5 Alessio Fasano,6 Peter H R Green,7 Marios Hadjivassiliou,8 Katri Kaukinen,9 Ciaran P Kelly,3 Jonathan N Leonard,10 Knut Erik Aslaksen Lundin,11 Joseph A Murray,12 David S Sanders,13,14 Marjorie M Walker,14 Fabiana Zingone,15 Carolina Ciacci16 Food Allergy - An Overview (PDF|1 MB). DHHS. NIH. National Institute of Allergy and Infectious Diseases. Gastroenterol Hepatol. 2014 Jun-Jul;37(6):362-71. doi: 10.1016/j.gastrohep.2014.01.005. Epub 2014 Mar 22. [Non-celiac gluten sensitivity: a critical review of current evidence]. [Article in Spanish] Molina-Infante J1, Santolaria S2, Montoro M2, Esteve M3, Fernández-Bañares F3. Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial. Jessica R Biesiekierski, Evan D Newnham, Peter M Irving, Jacqueline S Barrett, Melissa Haines, James D Doecke, Susan J Shepherd, Jane G Muir and Peter R Gibson. Nutrients. 2013 Sep 26;5(10):3839-53. doi: 10.3390/nu5103839. Non-Celiac Gluten sensitivity: the new frontier of gluten related disorders. Catassi C1, Bai JC, Bonaz B, Bouma G, Calabrò A, Carroccio A, Castillejo G, Ciacci C, Cristofori F, Dolinsek J, Francavilla R, Elli L, Green P, Holtmeier W, Koehler P, Koletzko S, Meinhold C, Sanders D, Schumann M, Schuppan D, Ullrich R, Vécsei A, Volta U, Zevallos V, Sapone A, Fasano A. BMC Med. 2014 May 23;12:86. doi: 10.1186/1741-7015-12-86. Non-celiac gluten sensitivity - why worry? Lundin KE. BMC Med. 2014 May 23;12:85. doi: 10.1186/1741-7015-12-85. An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. Volta U1, Bardella MT, Calabrò Neurogastroenterol Motil. 2013 Nov;25(11):864-71. doi: 10.1111/nmo.12216. Epub 2013 Aug 12. Non-celiac gluten sensitivity: clinical relevance and recommendations for future research. Mooney PD1, Aziz I, Sanders DS. World J Gastroenterol. 2014 Jul 21;20(27):8837-45. doi: 10.3748/wjg.v20.i27.8837. Irritable bowel syndrome and food interaction. Cuomo R, Andreozzi P, Zito FP, Passananti V, De Carlo G, Sarnelli G. Expert Rev Gastroenterol Hepatol. 2012;6(1):43-55. Problems of an Emerging Condition Separate From Celiac Disease. Amy C Brown Dig Dis Sci. 1999 Jul;44(7):1317-21. Pancreatic supplements reduce symptomatic response of healthy subjects to a high fat meal. Suarez F1, Levitt MD, Adshead J, Barkin JS.

Celiac.com 09/12/2013 - Good news for consumers of gluten-free foods and other products: The FDA's new standards for the labeling of gluten-free food and other products apply to all foods and products labeled gluten-free, including dietary supplements and vitamins. The FDA rules state that any product declaring the contents to be "gluten-free," "no gluten," "free of gluten" or "without gluten," must meet all parts of FDA's gluten-free definition, including the requirement that the food contains less than 20 parts per million of gluten. People with celiac disease who consume gluten from wheat, rye, or barley risk gradual damage to the intestines, leading to poor absorption of vitamins and minerals and leading to a host of other health problems, including nutritional deficiencies, osteoporosis, miscarriages, and cancer," according to Virginia Cox, Associate Commissioner of FDA's Office of External Affairs. Creating uniform rules and conditions for the use of the term 'gluten-free' in the labeling of foods and other products is "necessary to ensure that individuals with celiac disease are not misled and are provided with truthful and accurate information with respect to foods so labeled, " according to the text of the final rule, which was published last week in the Federal Register. FDA projects the new requirements will yield annual health benefits of roughly $110 million, compared to estimated annual costs (related to testing and relabeling) of $7 million. Manufacturers of gluten-free foods and products will have one year to comply with the FDA's labeling requirements. Source: http://www.naturalproductsinsider.com/news/2013/08/fda-gluten-free-definition-applies-to-dietary-sup.aspx

Wellesse’s Digestive 3-In-1 Health liquid dietary supplement provides prebiotics and soluble fiber, (which are both key to maintaining healthy gut microbiotia) as well as aloe vera to balance stomach acidity. These are all important supplements for maintaining a healthy digestive system and Wellesse brings them all together in a form that the body can easily absorb. Taken with juice, the supplement is very easy to fit into your morning routine (perhaps easier than pills, for those who have trouble swallowing them). After a week or two, I was noticing more digestive regularity, I was feeling full from meals quicker and I had dramatically reduced acid reflux. Overall, my digestive system feels… well, healthier. Wellesse’s Digestive 3-in-1 Health Liquid Dietary Supplement makes a great digestive health ‘cocktail’. Just be sure to take some kind of probiotic supplement as well. Visit their site for more info: www.wellesse.com. Note: Articles that appear in the "Gluten-Free Food Reviews" section of this site are paid advertisements. For more information about this see our Advertising Page.

Celiac.com 02/24/2012 - Currently, testing for anti tissue-transglutaminase antibodies is the standard of celiac disease blood testing. The test has a high sensitivity in patients who are eating a diet that contains gluten, but poor sensitivity for people on a gluten-free diet. So, it's not much use for measuring gluten-free diet success in people with celiac disease. A research team set out to determine if a new test might be more useful than current standard in assessing long-term gluten exposure in celiac disease patients attempting to follow a gluten-free diet. The new test measures Immunoglobulin-A antibodies to catalytically active open conformation tissue-transglutaminase. The study team included K. Pallav, D. A. Leffler, M. Bennett, S. Tariq, H. Xu, T. Kabbani, A. C. Moss, M. Dennis, C. P. Kelly, D. Schuppan. They are affiliated with the Celiac Center of the Beth Israel Deaconess Medical Center at Harvard Medical School in Boston. The team made a preliminary dietary assessment of 147 patients with celiac disease, and grouped them according to good or poor compliance to a gluten-free diet. The team used 50 patients with inflammatory bowel disease as a control group. The team then measured both open (new test) and closed (conventional) tissue-transglutaminase levels using standard enzyme linked immunosorbent assay. The team's initial dietary review indicated that 128 of the celiac patients had followed a gluten free diet for more than six months. They found 19 to have poor compliance to a gluten-free diet. Of the 19 who had poor adherence to a gluten-free diet, the team found 13 patients (68.4%) who tested positive using open conformation assay (p=0.51), while ten of the 19 patients (52.6%) tested positive using conventional assay (p=0.51). In the control group, just two patients tested positive using closed assay, while one tested positive using open assay. The team concluded that, compared to conventional testing, open conformation tissue-transglutaminase may offer greater sensitivity in the poor gluten-free diet adherence group and higher specificity in the control population. The team suggests studies on larger populations to determine whether open conformation tissue-transglutaminase assay may be superior to the conventional assay in measuring compliance with a gluten-free diet. Source: Dig Liver Dis. 2012 Jan 17.

Celiac.com 11/23/2011 - Osteopenia and osteoporosis, both conditions in which bone density is less than optimal, are often seen in people with celiac disease at the time of their diagnosis. There have been conflicting data as to whether a gluten free diet can improve bone density. Researchers in Argentina set out to determine if celiac patients suffer more peripheral fractures than a control population, and to assess the effects of a gluten free diet on fracture risk. Their results are reported in the July 7, 2011 issue of the World Journal of Gastroenterology. They recruited 256 people who had been diagnosed with celiac at least five years before the study began in March, 2007, asked them if they had ever broken any bones and, if so, which. They then compared their answers to answers obtained from 530 age- and sex- matched controls with functional gastrointestinal disorders. People with other disorders that could reduce bone health – like thyroid dysfunction, rheumatoid arthritis, inflammatory bowel disease, and diabetes – as well as those taking vitamin D, steroids, calcium supplements or other medications that could affect bone metabolism were excluded. They found that celiacs had a higher rate and risk of first peripheral fracture before diagnosis – but this effect only achieved statistical significance for men. This increased risk was also associated with a classical clinical presentation; those with atypical or silent forms of celiac did not exhibit the same risk. Although the finding that being male increases a celiac’s risk of peripheral fractures is intriguing, it must be borne out by larger studies – only 42 of the 256 celiacs included in this study were male. After maintaining a gluten free diet for five years, the elevated risk of fractures was gone. The authors speculate that eliminating gluten may reduce the risk of fractures in celiac patients not necessarily by increasing bone mass and mineral density, but by improving body mass and fat/ muscle composition, nutritional status, and bone architecture. Despite its limited scope, the take home message of this study is clear; if you have celiac disease, strictly adhering to a gluten free diet is good not just for your intestines, immune system, and skin; it is also good for your bones. Source: Sanchez et al. Risk of fracture in celiac disease: Gender, dietary compliance, or both? World J. Gastroenterol 2011 July 7; 17(25).

Celiac.com 07/20/2010 - Anyone who's tried to maintain a gluten-free diet for celiac disease or other reasons can likely tell stories about the difficulties and challenges they face on a regular basis. Still, very little research has been done regarding the psychological and social challenges faced by people with celiac disease who are attempting to follow a gluten-free diet. Scientists in India recently conducted just such a study. A research team set out to assess psychological and social challenges faced by Indian children with celiac disease who are attempting to follow a gluten-free diet. The research team included Srikanta Basu, J. C. Chauhan, A. K. Dutta, Praveen Kumar, and Arun Kumar from the Division of Gastroenterology, Department of Pediatrics at Lady Hardinge Medical College and Associated Kalawati Saran Children Hospital in New Delhi, India. Their goal was to assess dietary compliance to gluten-free diet, to identify barriers to compliance, and to study the impact of diet on the psychosocial behavior of children with celiac disease. For the study, the team looked at children with clinically proven celiac disease, who had been observed for at least 6 months. They then evaluated the children for gluten-free diet compliance. Researchers who were blinded to initial results then interviewed patients using a self-administered questionnaire. The team measured psychosocial parameters using the standard 35-item Pediatric Symptom Checklist (PSC). To determine what factors might affect dietary compliance, the team compared the results of children who were compliant with their gluten-free diets to those who were not-compliant. They then compared the psychosocial parameters of both groups to those of healthy control subjects. The team measured a total of 70 patients for dietary compliance. They found 53 children to be compliant with a gluten-free diet (75%). They found 13 were non-compliant with a gluten-free diet (18%), while 4 children were likely non-compliant. A total of 64 children completed the full assessment. Final analysis showed that 4 of those children were likely non-compliant. Data for 2 patients with incomplete assessments was dropped. Younger kids showed higher compliance with a gluten-free diet than did teens. 80% of younger kids showed compliance with a gluten-free diet, compared with just 44% of teens. Gluten-free diet compliance was also higher in children with higher maternal education, and in parents with better knowledge and understanding of celiac disease, and in nuclear families. Higher family income raised compliance levels. Children with 2 or fewer siblings did better, with compliance rates of 68.3% and just 23% non-compliance. 72% of kids who were compliant with a gluten-free diet had presented classic symptoms of celiac disease, while only 15% of this group was non-compliant. Adjustment-related challenges, such as difficulty in maintaining diet at school, restaurants, trips, etc. are among the most common problems faced by celiac children. Nearly half (45%) of the children complained that teachers did not adequately understand the challenges of their condition. Researchers established a PSC cutoff point of 4 for children in the dietary non-compliant group. Generally, kids with celiac disease did not show higher levels of symptoms, such as complaints of aches and pains; being irritable/angry; not listening to rules, blaming other for mistakes; teasing others; refusing to share. The study findings show that about 1 in 5 (18%) people with celiac disease fail to comply with their gluten free diet, and that kids who comply with a gluten-free diet have better psychosocial parameters, as measured by PSC score. Also, adolescents, kids in joint families, and kids in larger families tend to have greater non-compliance levels. Successful treatment of celiac disease requires full compliance with a gluten-free diet. Non-compliance increases risk factors for numerous celiac-associated conditions. Knowing which factors are most likely to present challenges for maintaining compliance can provide celiac suffers and clinicians with useful tools for reducing those challenges and increasing compliance. Source: Indian Journal of Pediatrics 2010 Jun;77(6):649-54. DOI 10.1007/s12098-010-0092-3