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      Frequently Asked Questions About Celiac Disease   04/24/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What is Celiac Disease and the Gluten-Free Diet? What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes

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Found 1,233 results

  1. Celiac.com 02/01/2018 - To make a clinical diagnosis of celiac disease, doctors use serological testing for IgA antibodies to human tissue transglutaminase (anti-tTG) which indicate celiac disease autoimmunity. However, some tests are more highly sensitive for anti-tTG, while other tests are highly specific. So, is combining two tests a reliable strategy for screening for celiac disease in clinical practice? A team of researchers recently compared the performance of three kits used to diagnose celiac disease, and evaluated the point prevalence of celiac disease autoimmunity in a South Indian urban population. The research team included G Venugopal, J Mechenro, G Makharia, A Singh, S Pugazhendhi, R Balamurugan, and BS Ramakrishna. They are variously associated with the SRM Institutes for Medical Science, Jawaharlal Nehru Salai, Vadapalani in Chennai, India, the SRM Medical College Hospital and Research Centre, Kattankulathur, India, the All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, the Kansas University Medical Center, Kansas City KS, USA, the Indian Institute of Technology, Samantapuri, Bhubaneswar, India, the SRM Institutes for Medical Science, Jawaharlal Nehru Salai, Vadapalani, Chennai, India, and with the SRM Medical College Hospital and Research Centre, Kattankulathur, India. For the first part of their study, the team performed anti-tTG testing on sera from 90 patients with documented celiac disease and 92 healthy controls using three different kits. They then tested one thousand nine hundred and seventeen healthy adults residents of the Vellore and Kancheepuram districts for celiac disease autoimmunity using a sequential two-test strategy. Based on these results, the team suggests that using first a highly sensitive test for anti-tTG followed by a highly specific test is a reliable strategy for screening for celiac disease in clinical practice. Source: Indian J Gastroenterol. 2017 Dec 22. doi: 10.1007/s12664-017-0803-z.
  2. METHYLATION AND CELIAC DISEASE

    Celiac.com 01/31/2018 - Methylation is a biochemical reaction in the human body that requires a variety of nutrients to perform indispensable roles in neurological health, detoxification, amino acid metabolism, gene regulation and vitamin assimilation. Every person with celiac disease needs to have their methylation variants tested by their physician so they can achieve good health. How well your body can "methylate" is important to your overall health. Methylation pathways in the body are important in cardiovascular health, neuroprotection from dementia and Alzheimer's disease, cognition skills in the young and old, along with emotional wellness and cellular function. A simple blood test- MTHFR- which is available at all major laboratories can determine if common genetic variants require additional supplementation of B vitamins. The MTHFR (Methylene Tetrahydrofolate Reductase) converts folate (vitamin B9) and riboflavin (vitamin B2) into an active part of the energy production cycle. In addition, it can indicate if higher levels of Vitamin B12 are needed. Since it is a genetic factor, some clinics do not test it but every celiac needs to know what variants they have in order to optimize their nutritional needs. (Author's note: I wish I had done this testing when I first learned about it 20 years ago. It has made all the difference in the world in my health these past 8 years!) The role of methylation is to help enzymes in our body work efficiently. Enzymes are like switches for chemical reactions in cells and tissues. Inadequate methylation nutrients- folate (NOT folic acid), methylcobalamin - the active form of B12 (NOT cyanocobalamin- the cheap cyanide form), and vitamin B6 as pyridoxal-5-phosphate can improve anemia, sleep, energy production and detoxification of chemicals from gasoline fumes to ammonia odors and personal care fragrances. Research over the past twenty years has provided a wealth of knowledge about methylation. It is the responsibility of each person to know their MTHFR variants which were inherited from mom and dad. Here is a brief list of the medical conditions affected by variants in MTHFR. Neurological Disorders: Parkinson's, Alzheimer's, Dementia, Multiple Sclerosis, Autism Cardiovascular Disorders: Atherosclerosis, Pulmonary Embolisms, General Clotting Disorders Mental Dysfunction: Depression, Anxiety, Insomnia, ADD/ADHD, Bipolar, Addictive Behaviors, Schizophrenia Conception: Infertility, Recurrent Miscarriages Immune Function: Allergies, Chronic Viral Infection Diabetes: Retinopathy, Neuropathy, Nephropathy Increased Sensitivity: Chemicals, Drugs, Supplements Birth Defects: Congenital Heart Defects, Cleft Palette, Spinal Bifida, Down's Syndrome Cancer Thyroid Dysfunction Chronis Conditions: Pain, Fibromyalgia, Chronic Fatigue Syndrome These MTHFR variants are NOT uncommon but unfortunately few in the medical arena are educated to address dietary concerns related to them. A book MTHFR- Methylation Diet is available on my website www.betty-wedman-stlouis.com for those who need assistance understanding their profile and designing dietary plans. The Methylation Diet is a high protein diet with lots of folate rich vegetables. Thos individuals with MTHFR variants should avoid folic acid as a dietary supplement and foods enriched with it like cereals, breads, flour, etc.
  3. Celiac.com 01/29/2018 - Researchers suspect that certain environmental factors, including infectious agents, might play a role in making celiac disease more prevalent and more widespread. Researchers in the USA and Sweden studying regional variation in the frequency of celiac disease have found similarities in the geographic distribution of Lyme disease, an emerging multisystemic infection caused by Borrelia burgdorferi spirochete, which invites questions about a possible connection with celiac disease. One research team recently set out to determine if infection with Borrelia contributes to an increased risk of celiac disease. The research team included Armin Alaedini, Benjamin Lebwohl, Gary P. Wormser, Peter H. Green, and Jonas F. Ludvigsson. They are variously affiliated with the Department of Medicine, Columbia University Medical Center, New York, NY USA; the Celiac Disease Center, Columbia University Medical Center, New York, NY USA; the Institute of Human Nutrition, Columbia University Medical Center, New York, NY USA; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, NY USA; the Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; and with the Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK. Using biopsy reports, the team identified 15,769 individuals with celiac disease. By linking to the nationwide Patient Register, they were able to compare the rate of earlier occurrence of Lyme disease in the patients with celiac disease to that in 78,331 matched controls. To further assess the temporal relationship between Borrelia infection and celiac disease, they also examined the risk of subsequent Lyme disease in patients with a diagnosis of celiac disease. The team found that twenty-five patients with celiac disease had a prior diagnosis of Lyme disease (0.16%), whereas 79 had a subsequent diagnosis of Lyme disease (0.5%). This showed a modest association between Lyme disease and celiac disease was seen both before and after celiac diagnosis, with celiac risk being highest in the first year of follow-up. So, only a small portion of the celiac disease patients had a prior diagnosis for Lyme disease. The research team asserts that the supposed association between Lyme disease and celiac disease, both before and after the diagnosis of celiac disease, is likely driven by surveillance bias, at least in part. These data show that patients with Borrelia infection do not face a substantially higher risk for developing celiac disease. Source: BMC Med. 2017; 15: 169. doi: 10.1186/s12916-017-0926-1. PMCID: PMC5599869
  4. Celiac.com 01/22/2018 - Celiac disease is marked by HLA-DQ2/8-restricted responses of CD4+ T cells to gluten from wheat, barley or rye. Currently, in order to properly diagnose celiac disease based on serology and duodenal histology doctors need patients to be on gluten-containing diets. This is a problem for many people, who prefer not to begin ingesting wheat again once they have adopted a gluten-free diet. This can present challenges for doctors attempting to diagnose celiac disease. It is known that HLA-DQ–gluten tetramers can be used to detect gluten-specific T cells in the blood of patients with celiac disease, even if they are on a gluten-free diet. The team set out to determine if an HLA-DQ–gluten tetramer-based assay can accurately identify patients with celiac disease. The research team included Vikas K. Sarna, Knut E.A. Lundin, Lars Mørkrid, Shuo-Wang Qiao, Ludvig M. Sollid, and Asbjørn Christophersen. They are variously affiliated with the Department of Immunology, Oslo University Hospital – Rikshospitalet, Norway; the KG Jebsen Coeliac Disease Research Centre, University of Oslo, Norway; the Department of Gastroenterology, Oslo University Hospital – Rikshospitalet, Norway; the Department of Medical Biochemistry, Oslo University Hospital – Rikshospitalet, Norway; and with the Centre for Immune Regulation, Oslo University Hospital – Rikshospitalet and University of Oslo, Norway. For their study, the team produced HLA-DQ–gluten tetramers and added them to peripheral blood mononuclear cells isolated from 143 HLA-DQ2.5+ subjects. There were a total of 62 subjects with celiac disease on a gluten-free diet, 19 subjects without celiac disease on a gluten-free diet due to perceived sensitivity, 10 subjects with celiac disease on a non-gluten-free diet, and 52 seemingly healthy individuals as control subjects. The team used flow cytometry to measure T cells that bound HLA-DQ–gluten tetramers. They then used researchers blinded to sample type, except for samples from subjects with celiac disease on a gluten-containing diet, to conduct laboratory tests and flow cytometry gating analyses. They also conducted analysis on test precision using samples from 10 subjects. They found that an HLA-DQ–gluten tetramer-based test that detects gluten-reactive T cells identifies patients with and without celiac disease with a high level of accuracy, regardless of whether patients are on a gluten-free diet. This test could conceivably allow celiac diagnosis while suspected patients are still on a gluten-free diet. The team notes that their results require a larger study for validation. Could reliable celiac diagnosis be done without making patients consume gluten? Will that become common? Stay tuned for more developments. Source: Gastrojournal.org
  5. Celiac.com 01/19/2018 - Did you know that there are so many issues and questions surrounding celiac disease that even doctors who specialize in it find that the scientific data changes every six months, and this includes research data, new diagnostic and testing recommendations, and its connections to other diseases and conditions. In fact, many of us who think we have "arrived" and know it all might actually need a refresher course on the disease. There is always something new to learn about this disease. For example, did you know that the primary proteins in wheat gluten are gluten and gliadin, and gliadin contains repeating patterns of amino acids that many humans' digestive systems cannot break down, and gluten is the only substance that contains these proteins? People with celiac disease have one or two genetic mutations that somehow cause the immune system to attack the walls of their intestines when gliadin is present. That in turn causes finger-like structures called villi that absorb nutrients on the inside of the intestines to atrophy and the intestines can become leaky, wreaking havoc. Symptoms which vary widely among people with the disease, can include vomiting, chronic diarrhea, or constipation and diminished growth rates in children. The vast majority of people who have celiac disease don't know it, and not everyone who has the genetic markers will develop it. What worries doctors is that the problem seems to be increasing. Studies on blood collected in the 1950's show that the rate of celiac disease appears to be increasing. Some blame changes in wheat for this increase, as some varieties now grown contain higher levels of gluten. Did you know that the tTg-IgA - Tissue Transglutaminase Antibodies will be positive in about 98% of patients with celiac disease who are on a gluten-containing diet. That same test will come back negative in about 95% of healthy people without celiac disease. Though it is rare this means patients with celiac disease could have a negative antibody test result. "There is also a slight risk of a false positive test results, especially for people with associated autoimmune disorders like Type I diabetes, autoimmune liver disease, Hashimoto's thyroiditis, psoriatic or rheumatoid arthritis and heart failure, who do not have celiac disease. There are other antibody tests available to double-check for potential false positives or false negatives, but because of the potential for false antibody tests results, a biopsy of the small intestine is the only way to diagnose celiac disease. If your tests were negative, but you continue to experience symptoms, please don't give up. Consult your physician and undergo further medical evaluation. Ask to be referred to the closest hospital research department that deals with celiac disease. Did you know that there is something called "silent celiac disease," also known as asymptomatic celiac disease, where patients do not have any noticeable symptoms, but still experience villus atrophy damage to their small intestine? The number of ways that celiac disease can affect patients, combined with a lack of training in medical schools and primary care residency programs contributes to poor diagnosis rates in the United States. Some estimate that 80% of celiacs remain undiagnosed. Did you know that some people with wheat/gluten sensitivity still experience symptoms such as "brain fog", depression, ADHD - like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue, yet they do not test positive for celiac disease? Terms like NCGS (non-celiac gluten sensitivity), and NCWS (non-celiac wheat sensitivity) are used to refer to this condition, but only after the removal of gluten from the diet resolves their symptoms. Did you know that celiac disease research funding has been neglected in the United States, and, as I have often said, where the United States goes, Canadians soon follow. A five-year review ending in 2017 shows the NIH gave less money to celiac disease than other gastro-intestinal conditions. Additionally, the National Institute for Digestive and Kidney Diseases awarded the fewest number of grants to celiac disease research over the same period from 2011 to 2015. The review, published as commentary in the Journal of Gastroenterology (http://www.gastrojournal.org/article/S0016-5085(17)36084-5/pdf) found that NIH funding, which is the major source of research support for inflammatory gastrointestinal diseases, showed no association between the estimated prevalence or mortality rates of a disease. In general, NIH support is seen as essential for improving the understanding of health and disease. The review included celiac disease, irritable bowel syndrome (IBS), Crohn's disease, eosinophilic esophagitis (EoE), Barrett's esophagus and non-alcoholic fatty liver disease (NAFLD). In fact, both IBS and NALFD, neither of which is associated with increased mortality, still receive more funding than celiac disease. According to the report: "Although there is no global metric for disease importance, it is difficult to justify on medical and scientific bases as a reason for such large and persistent funding differences . Although Crohn's disease has many available and emerging treatment options, celiac disease, for example, is more prevalent and has no current treatment to patients beyond the burdensome gluten-free diet." However, we cannot complain that celiac disease is not getting the same exposure that Irritable Bowel Disease has if we do not get involved directly and help spread the news about celiac disease, which will help others get diagnosed and treated. We also need to report erroneously labeled "gluten-free" products. Sometimes we pass the buck and hope that someone else will report an error on product label, for example I have been sold something that indicates it is gluten free when it was actually just "wheat free", which is a common error among fast food companies. What do they know about malt? Unfortunately there is no EPI-PEN for the celiac, so you must learn to be your own advocate and check whatever goes into your mouth.
  6. Celiac.com 01/15/2018 - Cerebellar ataxia with sensory ganglionopathy is a disabling combination of neurological dysfunction that usually occurs as part of certain hereditary ataxias. However, some patients present this combination with no apparent genetic cause. A team of researchers recently set out to if autoimmunity might have a role to play in SG. The research team included Panagiotis Zis, Ptolemaios Georgios Sarrigiannis, Dasappaiah Ganesh Rao, Nigel Hoggard, David Surendran Sanders, and Marios Hadjivassiliou. They are variously affiliated with the Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; the University of Sheffield, Sheffield, UK; the Department of Neuroradiology, Sheffield Teaching Hospitals NHS Foundaiton Trust, Sheffield, UK; the University of Sheffield, Sheffield, UK; and the Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. The team reviewed records of all patients that have been referred to the Sheffield Ataxia Centre who had neurophysiological and imaging data suggestive of SG and cerebellar ataxia respectively. We excluded patients with Friedreich's ataxia, a common cause of this combination. All patients were screened for genetic causes and underwent extensive investigations. They found 40 patients with combined cerebellar ataxia and sensory ganglionopathy. The majority of patients were initially diagnosed with cerebellar dysfunction, and about one-third were initially diagnosed with sensory ganglionopathy. For that one-third, the two diagnoses were made together. The average time between the two diagnoses was 6.5 ± 8.9 years, ranging from 0 up to 44 years. The most common initial symptom was unsteadiness, in 77.5% of patients, followed by patchy sensory loss in 17.5%, and peripheral neuropathic pain in 5%. Nineteen patients had gluten sensitivity, of whom 3 patients had biopsy proven celiac disease. Other abnormal immunological tests were present in another 15 patients. Six patients had malignancy, which was diagnosed within 5 years of the neurological symptoms. Only 3 patients were classified as having a truly idiopathic combination of cerebellar ataxia with sensory ganglionopathy. This study shows that immune pathogenesis plays a significant role in patients with the unusual combination of cerebellar ataxia and sensory ganglionopathy. Source: Cerebellum & Ataxias 20174:20
  7. Celiac.com 01/03/2018 - A recent study indicates that symptoms for some autoimmune disease can vary depending on the time of day. A substance called transcription factor BMAL1 plays a crucial role in the human molecular clock, regulating biological pathways that drive 24 hour circadian rhythms in behavior and physiology. The molecular clock has a major influence on innate immune function, and disturbances in circadian rhythms are associated with increases in multiple sclerosis (MS), for example. But, researchers just don't have much good information on the factors that influence this association. A team of researchers recently set out to better understand the factors that influence this association. The research team included Caroline E. Sutton, Conor M. Finlay, Mathilde Raverdeau, James O. Early, Joseph DeCourcey, Zbigniew Zaslona, Luke A. J. O'Neill, Kingston H. G. Mills, and Annie M. Curtis. They are variously affiliated with the Immune Regulation Research Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland; the Inflammatory Research Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland; and with the Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland. In a recent study, the research team found that BMAL1 and time-of-day regulate the accumulation and activation of various immune cells in a CNS autoimmune disease model, experimental autoimmune encephalomyelitis (EAE). In myeloid cells, BMAL1 maintains anti-inflammatory responses and reduces T cell polarization. Loss of myeloid BMAL1 or midday immunizations to induce EAE create an inflammatory environment in the CNS through expansion and infiltration of IL-1β-secreting CD11b+Ly6Chi monocytes, resulting in increased pathogenic IL-17+/IFN-γ+ T cells. These findings show the important role played by the molecular clock in processing innate and adaptive immune crosstalk under autoimmune conditions. Understanding the exact ways in which the human molecular clock influences innate immune function, and by extension, autoimmune diseases, will help doctors to better understand these disease, and to develop better approaches to treatment, among other things. Source: Nature.com
  8. Celiac.com 12/25/2017 - In the very near future, your personal microbiome may be the key to creating a customized treatment for celiac disease. That's because new advances in genome studies are promising to help create a customized, individual approach for treating numerous disorders, including celiac disease. Such individualized treatments may also help to reduce adverse events, and decrease health care costs. So far, a similar approach for optimizing preventive and therapeutic approaches in cancer using human genome sequencing has proven successful. Writing in the Mayo Clinic Proceedings, ad team of researches expounded on this approach. The research team included Purna C. Kashyap, Nicholas Chia, PhD, Heidi Nelson, MD, Eran Segal, PhD, and Eran Elinav, MD, PhD. They are variously affiliated with the Enteric Neuroscience Program, Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN; the Department of Surgery, Mayo Clinic, Rochester, MN; the Department of Computer Science at the Weizmann Institute of Science in Rehovot, Israel and with the Department of Immunology, at the Weizmann Institute of Science in Rehovot, Israel. Your personal microbiome is the sum total of all the microbes that reside within and upon you, along with all their genetic elements. Using genome sequencing allows doctors to design highly personal, highly focused treatments and therapeutic strategies. In their review for the Mayo Clinic Proceedings, the team highlights the importance of the microbiome in all aspects of human disease, including pathogenesis, phenotype, prognosis, and treatment response. The microbiome also plays a crucial role as a diagnostic and therapeutic biomarker. The team's report describes the role to be played by next-generation sequencing in helping to provide precision microbial identification of infectious diseases, and helping to elucidate the nature and function of microbial communities. Basically, as we further unlock the human genome, we can begin to better understand the role played by the myriad microbes that make up the human microbiome. As we unlock the role of various parts of the microbiome, look for major advances and refinements to diagnosing, treating, and even conquering conditions like celiac disease, and many others. And, with advances coming at breakneck speed, look for this to happen sooner, rather than later. Source: PlumX Metrics - mayoclinicproceedings.org
  9. Celiac.com 12/22/2017 - Venture capital firms Arch Venture, and Vatera are betting big on biotech startup ImmusanT, the makers of potential celiac disease vaccine Nexvax2. Arch and Vatera have funded a $40 million B round that will support ImmusanT's development of their celiac treatment through Phase II testing. Full data are expected in mid-2019. As part of it's efforts, Arch Venture partner and former head of research at Celgene, Tom Daniel, will join the board at ImmusanT. Additionally, renowned immunologist and Arch managing director Steven Gillis will also join the board at ImmusanT. Nexvax2 is the first prong in ImmusanT's efforts to develop a treatment that creates immune system tolerance to thwart autoimmune diseases. If they are successful in tackling celiac disease, the company is looking to expand the technology to include treatments for type 1 diabetes and other ailments. Celiac disease is a great place to start, says ImmusanT CEO Leslie Williams, because scientists already know the antigen that triggers the disease. Williams says that her company has scoured 17,000 peptides to "create a hierarchy of the key components that trigger the T cell response" in celiac disease. Nexvax2 is designed to work by slowly coaxing the immune system to ignore the trigger. Patients exposed to Nexvax2 react as if they have eaten gluten, says Williams. The goal is to harness that immune reactions and to modulate it. Williams is looking to double the size of the company's tiny 7-person staff as the ImmusanT journeys through a mid-stage trial. She will then look to an expanded set of programs as well as the data to determine the best direction for the company. Williams says that all options are currently open, including another funding round, an IPO or even a strategic deal. Read more at: endpts.com
  10. Celiac.com 12/21/2017 - After a lot of trial and error we celiacs learn, often the hard way, to eliminate foods that are poisonous to our bodies. Sadly, we often forget about what "goes onto" our skin. Since the skin is the living outer layer of our bodies it absorbs not only water and oils, it also absorbs cosmetics that can be poisonous to our celiac bodies, most specifically those of us afflicted with dermatitis herpetiformis (often called celiac disease of the Skin). Men, before you set this article aside, thinking it's only for women and you are exempt, please read on. One of 133 Americans has a wheat-related allergy according to CNN.com. We have a tendency not to group toothpaste and lip-glosses with cosmetics, and we usually ignore vitamins and medications when researching celiac disease and dermatitis herpetiformis. We forget to ask our hairdresser what products they are using and whether they contain wheat or gluten, and glibly apply night creams (to absorb into our skin as we sleep) and mud packs that promise similar benefits. Inquiring into the gluten content of cosmetics, I contacted more than twenty leading companies, then I waited. I was discouraged, particularly by the blatant rudeness of some of the responses I received. Meanwhile, I had to learn whether gluten could be absorbed through the skin. Some websites answered that question with a direct "no". Even some physicians responded saying "no". However, since the skin is the largest living organ in the body and it does absorb various oils and emollients, listing gluten-containing components of medicinal and non-medicinal ingredients allows consumers with celiac disease (celiac disease) or wheat allergies to make informed choices when purchasing and/or consuming natural health products. It enables them to avoid gluten in quantities that may trigger adverse reactions. There are numerous articles on dermatitis herpetiformis and celiac disease making claims so contradictory that it is no wonder we are confused. And I'm not talking about accidental ingestion of gluten. Some such articles claim that trace amounts of gluten One article insists that the skin is not going to absorb gluten, even though our skin is a living organism that can absorb suntan lotions, trans-dermal drugs, etc. It is so susceptible to absorption that when you place a slice of onion in your sock you will taste it in your mouth the following day. How can these websites make such contrary claims? The skin absorbs flavors as well as creams containing gluten. On the other hand, "Glutino" had an article on record, written on September 14, 2010, regarding "Hidden Gluten in Health and Beauty Products". It states that if you apply hand lotion that contains gluten and then prepare food you are exposing yourself to accidental ingestion and your food to cross contamination. They suggest a site called: naturallydahling.com, a site that lists gluten-containing ingredients commonly used in cosmetics. Research proving the full extent of how much your skin absorbs is still unavailable, but to those who believe that "what goes on, goes in", the cosmetic industry is full of unknowns. The size of gluten molecules suggests that they may not be able to pass through the skin, but chemicals and technology designed to enhance skin absorption are already present, if not prevalent, in the cosmetic industry. These chemicals are potentially dangerous and often go untested for negative health effects, yet are widespread in lotions, antiperspirants, perfumes and the "Great Mother Market" anti-wrinkle cosmetics. Since the cosmetic industry is self-regulated it is more important than ever to carefully read labels and use natural or organic products whenever possible. If you find yourself reacting to a particular cosmetic, it is possible that you may have an increased sensitivity to gluten, an allergy or even dermatitis herpetiformis. But wait a minute! Aren't we told that gluten cannot pass through the skin? I suffered terribly from the use of an "Anti-Frizz" product for my hair that caused a massive outbreak of dermatitis herpetiformis. I should have read the label all the way down to the end. I would have found, in very small print, "wheat germ oil". When researching for this article, I wrote to the company and mentioned my problems with their product. I received an apology and a sample of their "new and improved" "Frizz-Ease" product. They obviously do not know their own products and the fancy names they use are as confusing to them as they are to me. The "new and improved" product contained Avena Sativa, the Latin name for OAT. I was also told that I likely just had "hives" on the back of my scalp, as oats are still somewhat controversial. Some research suggests that oats in themselves are gluten free, but that they are virtually always contaminated with other grains during cultivation, harvest, distribution or processing. Recent research indicates that a protein naturally found in oats (avenin) contains peptide sequences closely resembling some peptides from wheat gluten. The oat peptides caused mucosal inflammation in significant numbers of celiac disease sufferers. Some examination results show that even oats that are not contaminated with wheat particles may be dangerous. Again, I was told not to introduce oats into my diet, or use oatmeal as a facial mask until I had been free of a dermatitis herpetaformis outbreak for at least a year. Thus far I have not been able to get relief for that long. It seems the celiac or those who suffer from dermatitis herpetiformis {and let's face it, most people suffering from dermatitis herpetaformis have celiac disease} have to apply the rule of "caveat emptor" - Let the buyer beware. Tolerance to gluten varies among individuals with celiac disease and there are limited clinical scientific data on a threshold for the amount of gluten required to initiate or maintain an immunological reaction in celiac disease patients. "Therefore there is no clear consensus on a safe gluten threshold level." The Dermatologist I see at The University of British Columbia Hospital has told me to tell people in restaurants that gluten is poison to my system and I can become very ill from ingesting gluten. They are a little more careful before telling me a dish is gluten free, and hopefully through education the cosmetic industry is going to improve its testing and cease glibly stating things as "fact" when they simply do not know. Industries that produce over-the-counter medications and vitamin supplement, especially those that may contain gluten as a binding agent, should also be scrutinized. We have come a long way, but large challenges are still ahead. One of our biggest challenges is reading the labels on these products. One almost needs to carry a magnifying glass when shopping. Cosmetics, which include hair products, soaps, perfumes and toothpastes also run us into problems, often big, "itchy" problems. The male celiac/dermatitis herpetaformis experience can also include outbreaks from any product that comes into contact with the skin and particularly those that "stay" on the hair or skin. Who would have known that sun tan lotions could contain wheat germ oil? It is difficult enough to eliminate words such as "triticum vulgare" the Latin name of wheat or "wheat germ" containing ingredients! In preparation for this article, I contacted the following companies: Avon, Clairol, Clarins, Clinique, Coty, Covergirl, Estee Lauder, Garnier, John Frieda, John Paul Mitchell, L'Oreal, Mabelline, Marcelle, Neutrogena, Olay, Pantene, Revlon, and companies that go under general all-encompassing headings such as "Life Brand". This can be a daunting task, and "gluten free" and "wheat free" are not the same thing. Some of the things that I learned in this rather massive undertaking include the rule of "Pac Man". Companies are sometimes taken over by bigger companies and when this occurs their rules change. A company that at one time did not test on animals or use machines that were cleaned prior to using products claiming to be gluten free are now glibly adopting the "new bigger and better". I was shocked to find out that some of the containers from the smaller company were still being used after these PAC MAN take-overs, to save on manufacturing costs. And, remember, once several ingredients are combined the "organic" ingredient probably ceases to be "organic". Some women (and men, you are not exempt here) expect to pay a higher price for a luxury brand assuming that the gorgeous bottle of eye cream sold at Saks for $60.00 is going to work better than the $1.99 tube on the clearance rack of a local store. Just ensure the product has not reached its "sell by" date because it may all be psychological. What you have to concern yourself about, as a celiac patient or a person with dermatitis herpetiformis, is whether there is gluten or wheat in that product. Before you splurge on an expensive product take the time to compare it to a similar product from one of their sister brands. Usually an online store (like Drugstore.com) will list the ingredients. Or you can check on a site like "Makeup Alley" which is a great resource, offering numerous reviews and you can ask questions of the extremely knowledgeable posters on this message board. Another great resource is a large paperback book, titled "Do not go to the Drugstore Without Me" written by Paula Begoin. When I purchased the books in 2001 it was in its 5th Edition. NB: This is not a book specifically for celiac disease or dermatitis herpetiformis, but it was in this book that I found out about "Glutamic Acid". It is derived from wheat gluten and is an amino acid that can have water binding properties for the skin. It also explains glycerylesters that form a vast group of ingredients that are a mixture of fatty acids, sugars, and non-volatile alcohols. These fats and oils are used in cosmetics as emollients and lubricants as well as binding and thickening agents. At the back of this book is a list of the companies that do not test on animals and those that do, but again, the PAC MAN Rule applies. I purchased the book for myself, my daughter, and daughter-in-law, specifically because when my daughter was in her twenties she seemed to think she simply must buy her shampoo from the hairdresser because only $45.00 shampoo was good enough for her hair. It was a big eye opener when she moved out of home and had to purchase it herself! I believe that the more we know about beauty products and the beauty industry the wiser our purchases will be. Consider, for instance, the cost of research and development for say, L'Oreal who develop formulas that can be used in Garnier Shampoos ($3.99) and Kerastase shampoo ($29.99) It doesn't take long to realize that it is a good idea to compare products at different ends of the price scale. Sometimes, two products from two different brands will have the same patent number. The difference is in the non-active ingredients, which give it a unique texture, scent and/or color. Also, it is wise to photo-copy, and even apply plastic covering to lists of "safe" beauty products, just as it is wise to keep a copy of "safe" and "unsafe" foods on hand when you go shopping. When you cannot even pronounce some of the words used in foods and beauty products how can you be expected to remember what is safe to apply to your hair and skin? I received a very nice letter from Teresa Menna, Manager at L'Oreal in Quebec who told me that L'Oreal has abolished gluten in the composition of L'Oreal products. However, on reading more literature I find that Garnier is a mass market cosmetic brand of L'Oreal, and L'Oreal is part of the Group P&G. P&G stands for Proctor and Gamble and P&G Beauty brands can be found on the site:_ http://pgbeautygroomingscience.com/product.php {The Company Garnier Laboratories was started in 1906 and acquired by L'Oreal in the 1970's}. I was unaware prior to researching this article that L'Oreal owned Kerastase, or that L'Oreal had purchased the MAC Cosmetic line, or that the KAO Brands Company owns Ban, Biore, Jergens and John Frieda. Here are some of the ingredients you might find in cosmetics that could indicate wheat or gluten: Avena Sativa {Latin name of oat, or "oat" term containing ingredients Hordeum distichon {Latin name of barley, or "barley" term containing ingredients} Hydrolyzed malt extract Hydrolyzed wheat protein Hydrolyzed vegetable protein Wheat germ Vitamin E Cyclodextrin Barley extract Fermented grain extract Oat (Avena sativa) Samino peptide complex Secale Cereale (Latin name of rye, or "rye" term containing ingredients) Stearyldimoniumhydroxypropyl Phytosphingosine extract Triticum vulgare {Latin name of wheat, or "wheat" term containing ingredients} Dextrin Dextrin palmitate Maltodextrin Sodium C8-16 Isoalkylsuccinyl Wheat Protein Sulfonate Yeast extract Anything with wheat in the name Thoughts: Some cute person gave the warning to ensure your lipstick is gluten free even if you don't have any skin issues. You could swallow some lipstick and get gluten in your system! Another person adds at the bottom of their e-mail to be sure to check guidelines regularly because company policies can change yearly and the list is only to be considered as "guidelines" and make-up ingredients can change each time a company changes or the scientists within that company decide to add to or delete certain products. {Makes you feel very safe as a celiac/dermatitis herpetaformis person doesn't it?} Another e-mailer suggested that mascara labeled as a "thickening agent" should be fearfully evaluated by the celiac/dermatitis herpetaformis person because the thickening agent is often "flour" and can sometimes cause eyelashes to fall out! Who knew? Noted on one e-mail, ‘So-called luxury brands can be laden with synthetic ingredients that do not cost more than their not so luxurious counterparts. True natural products that do perform, and there are a few such brands on the market, are authentic natural products that actually deliver what they promise and they truly do cost more to make because raw ingredients are much higher in cost. In fact, the cost is significantly higher when pure high grade ingredients are used. Letter received: " We have compiled a list of gluten free beauty products available on sephora.com. These products do not contain any wheat, rye or barley derivatives, and they were made in gluten-free laboratories so there is no chance of cross-contamination. But since you cannot be too careful, discontinue use of any product that triggers an attack." Letter received from Clairol:- "Gluten is a protein found in wheat, rye and barley. Although it is not added directly to our product, it may be present in fragrances. Due to the difficulty of tracing the source ingredients for the variety of fragrances used in manufacturing our products, we cannot provide specific levels of gluten content for any of our fragrance blends. Be aware that even products labeled "unscented" will still contain masking scent, therefore they may potentially contain gluten." Advertisement: World's Top Ten Cosmetic Companies : "Beauty begins on the inside, check out our post on ‘The Top Five Foods for Amazing Skin'" - Posted by The Greenster Team "I finally got up the nerve to go through my own (their) personal care products and look them up on "SKIN DEEP" and was very disappointed. The Company that makes my mascara (L'Oreal) tests on animals as does the company that makes my eyeliner (Covergirl) and my under eye concealer (Made by Physician's Formula) contains parabens" THE GREENSTER TEAM creates great articles, list the top ten cosmetic companies, what portion of the world's market they share and their hazard range. Letter received from Mabelline:- "Please find below most ingredients containing gluten (wheat and other grains). We invite you to take this list and compare it to our ingredient listings every time you buy a new product. When in doubt, do not hesitate to do your own research or contact your doctor." {Caveat Emptor} REMEMBER:- The truth is that there is no such thing as gluten free. The FDA has proposed a less than 20 ppm gluten -free standard in 2006. That was its first attempt to define the term gluten free, but the agency has yet to finalize it. The USDA is awaiting the FDA's decision before moving ahead. STILL WAITING. With the number of products making unregulated gluten free claims on the rise, the marketplace can be scary for consumers with gluten sensitivity and wheat allergies. Why hasn't the FDA finalized its 2006 definition of gluten free? As part of sweeping legislation known s FALCPA the Food Allergen Labelling and Consumer Protection Act of 2004, Congress ordered the FDA to define and permit the voluntary use of the term gluten free on the labeling of foods by August 2008. As directed, the FDA issued proposed gluten-free regulations on schedule but seems to have failed to follow through with a final ruling. There has been no explanation for the delay. Since the Cosmetic Industry is a self-regulating body it seems {appears, is assumed} that we the consumers are on our own as far as researching what goes on our skin and in our hair, because some of the letters I have received leave it to the celiac or dermatitis herpetiformis sufferer to research their own products. Even a letter from Avon states:- "Although Avon sells quality products, there is always possibility of contamination during manufacturing or changes/substitutions of ingredients. As with everything related to celiac disease, dermatitis herpetiformis and gluten Intolerance, products, ingredients and preparation may change over time. Your reactions to a specific product, ingredient may be different from the reactions of others. Like eating at a restaurant, you have to make a choice whether to consume/use a product. The list is meant to be a "guide" and does not guarantee that a product is 100% free of gluten. Dacia Lehman, Avon and GIG assume no responsibility for its use and any resulting liability or consequential damages is denied." LETTER: - Proctor and Gamble "The WHMIS rating is designed to rate raw materials and not formulated products such as ours. Nor are our consumer products required to be labeled under the Occupational Safety and Health Administration (OSHA) Hazard Communication Standard. Thus labelling of our products with WHMIS ratings or any other hazard rating should not be required by any state health and safety regulatory agencies." That letter is signed by Asela for the Pantene Team. LETTER:- May 2, 2012 - xyz@ca.loreal.com - "We have received your message and we will get back to you as soon as possible. Web Sites: Gluten-free Lifestyle: glutenfree-lifestyle.com (Gives gluten free products by type and by company) i.e.: deodorants, face & body wash, make-up, suntan lotion, toothpaste, moisturizer, lotion, shampoo & conditioner, shave cream, gels, after shave, laundry products, cleaners, soap, etc. Beauty Industry: Who Owns What? Glutino - Hidden Gluten in Health Products - Glutino & Gluten Free Pantry Blogs: www.gluten-free-cosmetic-counter.org Beauty Blogging Junkie Ebates Shopping Blog In The Makeup Lipstick Powder n'Paint Shop With a Vengeance Smarter Beauty Blog The Beauty Brains Sephora Sephora's iGoogle Beauty Portal References: Codex Standard for Foods for Special Dietary Use for Persons Intolerant to Gluten. Codex STAN 118 - 1979 ROME Government of Canada 2008 - Regulations Amending the Food and Drug Regulations (1220- Enhanced Labeling for Food Allergen and Gluten Sources and Added Sulphites) Health Canada 2007 - celiac disease and the Safety of Oats Labeling of Natural Health Products Containing Gluten - Health Canada Notice 2010
  11. Celiac.com 12/14/2017 - Can enzyme supplements help people with gluten sensitivity, including those with celiac disease? An Australian company is touting the results of a recent randomized, double blind study that supports enzyme supplements might be helpful for celiac patients in certain circumstances. The enzyme supplement was designed for people with celiac disease to use when facing likely or possible exposure to gluten, such as when traveling or eating food prepared outside their direct control. The company is careful to state that "enzyme supplementation won't cure celiac disease, and sufferers still need to avoid gluten." But the evidence from the two most recent studies does suggest that the product does help digest dietary gluten and could make life much easier for many people with celiac disease. The product, called GluteGuard, is based on a papaya fruit enzyme called caricain. This enzyme is shown to be helpful for celiac patients. A 2015 study showed adding caricain to bread dough reduced gluten toxicity to gluten by 90% for celiac patients. GluteGuard was recently evaluated in two clinical studies in Poland. The first study looked at 20 patients with celiac disease who were in clinical remission on a gluten-free diet. In that study, all patients ate one gram of gluten, equal to about one slice of bread, each day for 42 days, with 14 patients also taking GluteGuard and six taking a placebo tablet. Patients noted their symptoms and well-being each day, and received biopsies both before and after the study. Thirteen of the 14 celiac patients (93%) taking GluteGuard showed no adverse changes in clinical symptoms, biopsy results or well-being throughout the 42 day trial. Only one GluteGuard patient withdrew due to celiac-associated symptoms, while 4 of 6 taking placebo withdrew after 14 days due to adverse celiac symptoms. The second Polish study looked at the effectiveness of GluteGuard in patients with dermatitis herpetiformis, a gluten-triggered skin condition common in celiac patients. As with the first study, all patients in these study were in clinical remission. Patients consumed around six grams of gluten daily for seven days, with ten patients also receiving GluteGuard tablets and ten getting a placebo. The GluteGuard showed better results compared with the placebo group, with 81% showing no increase in areas of skin lesions and 71% showing a reduction in the appearance of skin lesions. The GluteGuard group also showed a 38% reduction in skin itchiness. Of the seven patients who withdrew from the study due to gluten symptoms, six were taking placebo. Both clinical trials met high scientific standards. In both studies, participants were randomly allocated to receive the treatment or placebo, and neither the participants nor the researchers knew owhich patient was receiving which intervention. So, yes, enzyme supplements may provide some help for people with celiac disease, especially as a hedge against minor or occasional gluten ingestion. So far though, they are not a magic bullet, and cannot replace a gluten-free diet. Read more at Medicalexpress.com.
  12. Celiac.com 12/07/2017 - Amaranth is naturally gluten-free and usually safe for people with celiac disease or gluten sensitivity. Amaranth is not actually a grain, but is considered a pseudo-cereal like it's cousin, quinoa. Both are part of the same large family that includes beets, chard and spinach. Amaranth is highly nutritious, and contains about one-third more protein than rice, sorghum, or rye. It also contains high levels of calcium, iron, potassium, magnesium, and fiber, together with a nearly perfect amino acid profile. So, amaranth is good to include in just about any diet, but especially for gluten-free folks looking for more nutritious options. Cooked amaranth is very similar to cooked quinoa, with similar nutty taste and chewy texture, although cooke amaranth is not quite as fluffy as quinoa. Like quinoa, it's important to soak amaranth thoroughly before cooking. As with buckwheat and quinoa, you can also bake with amaranth flour. If you're looking for something more nutritious than brown rice and other flours, then amaranth flour may be a good fit. Here are some recipes that use amaranth flour. Also, amaranth is more comparable to wheat in terms of the chewy, sticky characters needed for baking, so it's a good addition to many gluten-free breads. You'll likely still need xanthin gum, but probably less of it. Like rice, or quinoa, amaranth goes great in soup. Here's a recipe for stuffed chicken breasts with oatmeal and amaranth.
  13. Will a new treatment enable people with celiac disease to ditch a gluten-free diet? About one in a hundred people in the United States is affected by celiac disease. If you're one of them, you know how hard it can be to maintain a strict gluten-free diet. Everyone's got their horror stories about trying to simply eat a meal, only to have a tiny amount of gluten wreck havoc on their digestive system. There are currently no therapeutics on the market to treat celiac disease, says Sydney Gordon, a scientist at Ab Initio Biotherapeutics. Sure, there are other over-the-counter enzyme treatments, Gordon adds, but most are slow to act, or don't break down enough gluten to prevent a reaction. "There are no other enzymes on the market for celiac disease," said Justin Siegel, the co-founder of PvP Biologics and an assistant professor of chemistry, biochemistry and molecular medicine at UC Davis. "There is nothing that is approved by the FDA for celiac disease. Nothing has made it through clinical trials. There are pills on the market that cause degradation of gluten, but there is no clinical evidence that they are effective." "We wanted to design an enzyme […] a protein that would act as a therapeutic for celiac disease. We came up with a design using a protein modeling tool called FoldIt," said Ingrid Pultz, a co-founder of PvP Biologics. PvP Biologics enzyme therapy works by targeting the exact triggering molecule, the immunogenic epitope, before it gets to the intestine and causes an immune reaction. To do this, PvP Biologics uses kumamolisin, a naturally occurring enzyme that, unlike some other enzymes, can survive the acidity of the stomach. By modifying the amino acid sequence in the original kumamolisin enzyme, researchers were able to specifically target the epitope causing the reaction. If the therapy proves successful, many celiac patients won't have to worry about minute amounts of cross-contamination when eating outside. Those are pretty strong claims. Many people with celiac disease might likely say that it sounds too good to be true. Still, the company is moving in a direction that few others have gone. No word on if or when we might expect to see a finished treatment come to market. For all the company's claims, there is much to work out, and a long, winding road to get FDA approval. Stay tuned to see if the evidence from trials and from potential consumer use supports those claims. Read more at TheAggie.org. Editor's note: We've received a correction on this story from PvP Biologics, makers of KumaMax, which states that their product is designed for accidental gluten ingestion, and not as a replacement for a gluten-free diet in people with celiac disease. Their enzyme could lessen the effects of accidental consumption of small amounts of gluten.
  14. Celiac.com 12/05/2017 - It's not uncommon for people with celiac disease to have other medical conditions, including liver disease, glossitis, pancreatitis, Down syndrome, and autism. By the same token, people with one or more of these associated disorders can be at greater risk for having or developing celiac disease. Until recently, though researchers didn't have much good data on the numbers behind those risk levels. A new database study of more than 35 million people changes that. The study found that, for example, people with autism have celiac disease at rates that are 20 times higher than those without autism. You read that right. People with autism are 20 times more likely to have celiac disease than people from the general population. Reporting on his team's findings at the World Congress of Gastroenterology 2017, lead investigator Daniel Karb, MD, a second-year resident at University Hospitals Case Medical Center in Cleveland, says that doctors who treat autistic patients may want to keep an eye out for celiac-like symptoms. "If you have a patient who is autistic and they have all these unusual symptoms, you might want to screen them for celiac disease," said Karb. Researchers have long known that people with celiac disease can present with unusual symptoms that fall outside the classic celiac symptoms of malabsorption, steatorrhea, malnutrition, abdominal pain, and cramping after eating, "but this is putting numbers to it," said Dr Karb. For their study, Dr. Karb and his colleagues searched the Explorys database, which aggregates electronic health record data from 26 major integrated healthcare systems in the United States. Combing through the records of 35,854,260 people in the database from 2012 to 2017, they found 83,090 celiac disease diagnoses. The investigators uncovered significant connections between celiac disease and 13 other autoimmune disorders, such as type 1 diabetes, Crohn's disease, and ulcerative colitis. In fact, the team found that, except for a condition called primary biliary cholangitis, "[e]very autoimmune disease [they] looked at is associated with celiac disease," Dr. Karb reported. The study indicates that "there is a large undiagnosed burden of celiac disease," he explained. "And a lot of it is probably because of these atypical presentations." As research continues, look for more connections between celiac disease and other inflammatory conditions to be more fully detailed. For more on the World Congress of Gastroenterology 2017. Source: Medscape.com
  15. Celiac.com 11/30/2017 - Talk about handling a celiac disease diagnosis in style. This past summer, "Us" star Mandy Moore showed us how its done, when she documented the process of working with her doctor to determine if she had celiac disease. She even posted a photo of her endoscopy visit for her Instagram followers. Moore captioned the post: "Grog city. Just had an upper endoscopy to officially see whether or not I have celiac (only way to officially diagnose)…things are looking 👌)." Later, and also on Instagram, she revealed that she had been diagnosed with celiac disease. "Well, this definitely takes the (now gluten free cake) for bummer news," she wrote on her Instagram story at the time. "Any celiac sufferers out there with any helpful tips??" Maybe consider looking at Celic.com for helpful tips and information on living with celiac disease and eating gluten-free? Later, she posted another message, thanking her fans for sharing their knowledge with her, adding that there were "so many lovely humans out there. My heart is full." Moore seems to be embracing the realities of a gluten-free diet. Later, in an Instagram post celebrating her engagement to Taylor Goldsmith, Moore thanked her friends and family for their support, and noted that she planned to "enjoy some delightful gluten-free tea sandwiches (and 🥂) like ladies do." Best of luck to Mandy Moore in dealing with her new found celiac disease diagnosis.
  16. Celiac.com 11/27/2017 - For centuries, physicians have used cannabis to treat numerous disorders. Modern research shows that various cannabis compounds can alleviate symptoms from numerous conditions, including neurological disorders, cancer, rheumatism, epilepsy, sexual disorders, pain, among others. Many people with celiac disease suffer from neuropathy, which causes nerve pain, among other symptoms. Neuropathy can be difficult to treat. Nerve pain is a debilitating symptom that can significantly impair a patient's quality of life. Could a new cannabis patch change that? Some researchers think so. One California-based company, Cannabis Science, is developing an innovative new medicinal patch specifically designed to treat nerve pain. In addition to celiac related neuropathy, the patch could be helpful in treating nerve pain from many illnesses including fibromyalgia, diabetes, and multiple sclerosis. The National Institute of Health estimates that over 5 million Americans suffer from fibromyalgia, which has no known cure, and is difficult to treat. With diabetes on the rise in the U.S., diabetic nerve pain is also on the rise. When placed on the patient's skin, the patch developed by Cannabis Science delivers a measured dose of high potency cannabidiol (CBD) extract. CBD is the second major cannabinoid in marijuana after THC, but CBD has no psychoactive effects, so it won't get people high. When the patch is applied, the CBD is first absorbed into the blood, then moves to the central nervous system, where it delivers pain relief. Numerous studies have documented CBD's “anti-inflammatory and pain-relieving properties. More recent studies have shown that CBD provides relief from many kinds of pain. In addition to nerve pain, CBD has been shown to relieve inflammatory pain. Some studies have shown CBD to be more effective than current medication in treating inflammatory pain, such as pain from arthritis. As researchers home in on the pain-relieving properties of cannabis, look for more treatments to be developed, including treatments that may helpful for peopl with celiac disease. Read more: cannatech.news
  17. Celiac.com 11/22/2017 - A team of physicians recently reported on the case of a 3-year-old Albanian girl who presented at their clinic with carpal spasms and hand paresthesia. The physicians include Atifete Ramosaj-Morina; A. Keka-Sylaj; V. Hasbahta; A. Baloku-Zejnullahu; M. Azemi; and R. Zunec. A physical exam showed the girl to be in good physical condition, with a body weight of 10.5 kg (10 percentile). She was suffering from carpal spasms and paresthesias of her extremities. Positive Chvostek and Trousseau signs indicated neuromuscular irritability. Blood tests showed severe hypocalcemia with a total serum calcium of 1.2 mmol/L (normal range 2.12 to 2.55 mmol/L), ionized calcium of 0.87 (normal range 1.11 to 1.30 mmol/L), and 24-hour urine calcium excretion of 9.16 mmol (normal range female The team screened the girl for celiac disease with antigliadin immunoglobulin A, anti-tissue transglutaminase, and anti-endomysial immunoglobulin A antibodies. All tests were positive. The girl underwent a duodenal biopsy, which showed lymphocyte infiltration, crypt hyperplasia, and villous atrophy compatible with celiac disease grade IIIb according to the Marsh classification. Following her celiac diagnosis, the team conducted human leukocyte antigen typing, which provided a definite diagnosis of celiac disease. She was started on a gluten-free diet. Apparently, the girl did not follow a gluten-free diet, which caused a recurrence of carpal spasms. At 7 years of age, the girl showed signs of delayed psychophysical development. Although hypocalcemia is not uncommon in people with celiac disease, it is rare for hypocalcemic carpal spasm to be the first manifestation of the disease. Because of this, the doctors urge other physicians to consider the possibility of celiac disease in patients with repeated carpal spasms that seem to resist easy treatment. They indicate that celiac disease should be considered even in the absence of gastrointestinal symptoms, since hypocalcemia and carpal spasm may appear as the first symptoms of celiac disease, even in young children. Source: J Med Case Reports. 2017;11(252)
  18. Celiac.com 11/20/2017 - People who do not have celiac disease, but who have celiac-like symptoms that improve on a gluten-free diet are prime candidates for a condition called non-celiac gluten sensitivity (NCGS). Researchers don't know much about the condition. There are no biomarkers, so they can't just do a blood test. People with this condition often experience celiac-like symptoms. Many of people with non-celiac gluten sensitivity see their symptoms improve on a gluten-free diet. However, these people may also have puzzling sensitivities to other foods that just don't seem to add up. Interestingly, foods with gluten often contain fructans, a type of fermentable oligo-, di-, monosaccharides and polyols (FODMAPs). Fructan is one such compound. Could fructan be the culprit? A team of researchers recently set out to investigate the effect of gluten and fructans separately in individuals with self-reported gluten sensitivity. The research team includes Gry I. Skodje, Vikas K. Sarna, Ingunn H. Minelle, Kjersti L. Rolfsen, Jane G. Muir, Peter R. Gibson, Marit B. Veierød, Christine Henriksen, Knut E.A. Lundin. They are variously affiliated with the Division of Cancer Medicine, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway; the K. G. Jebsen Celiac Disease Research Centre, University of Oslo, Norway; the Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway; the Department of Gastroenterology, Monash University and Alfred Hospital, Melbourne, Victoria, Australia; the Department of Immunology and Transfusion Medicine, Oslo University Hospital, 0424 Oslo, Norway; and the Centre for Immune Regulation, University of Oslo, 0424 Oslo, Norway. For their double-blind crossover challenge, the team enrolled 59 individuals without celiac disease, but who followed a self-driven gluten-free diet. The team conducted the study at Oslo University Hospital in Norway from October 2014 through May 2016. The team randomly assigned study subjects to groups. For 7 days, each group ate muesli bars containing either 5.7 grams of gluten, 2.1 grams fructans, or a placebo. Subjects then underwent a washout period that lasted until the symptoms caused by the previous challenge were resolved. Washout period was a minimum of 7 days. After the washout period, participants crossed over into a different group, until they completed all 3 challenges. To measure symptoms, the team used the gastrointestinal symptom rating scale irritable bowel syndrome (GSRS-IBS) version. They used a linear mixed model for analysis. In this study of individuals with self-reported non-celiac gluten sensitivity, researchers found that fructans induced symptoms of irritable bowel syndrome, as measured by the gastrointestinal symptom rating scale. Clinicaltrials.gov no: NCT02464150 See the article below for more information, including study results. Source: Gastrojournal.org DOI: http://dx.doi.org/10.1053/j.gastro.2017.10.040
  19. Celiac.com 11/16/2017 - If people with celiac disease hope to avoid complications, then it's important for their gut mucosa to heal. However, besides biopsy, there is currently no good way for doctors to assess that a patient has healed enough to experience full remission. A team of researchers recently set out to assess the role of a point-of-care test (POCT) based on IgA/IgG-deamidated gliadin peptide, in detecting persistent villous atrophy in celiac disease. The research team included Michelle S Lau, Peter D Mooney, William L White, Michael A Rees, Simon H Wong, Matthew Kurien, Nick Trott, Daniel A Leffler, Marios Hadjivassiliou and David S Sanders. They are affiliated with the Academic Department of Gastroenterology at Royal Hallamshire Hospital, Sheffield Teaching Hospitals, in Sheffield, UK, and with the Celiac Center and Division of Gastroenterology at Beth Israel Deaconess Medical Center in Boston, Massachusetts, USA. The research team recruited celiac disease patients undergoing endoscopy for the assessment of histological remission. All patients had IgA-endomysial (EMA) antibodies, IgA-tissue transglutaminase (TTG) antibodies, received a POCT, and completed a validated dietary questionnaire. All patients received a gastroscopy, with four biopsies taken from the second part of the duodenum and one from the duodenal bulb. The research team then compared the diagnostic performance of the surrogate markers against duodenal histology as the reference standard. From 2013 to 2017, the team evaluated a total of 217 celiac disease patients. 70% of patients were female, ranging in age from 16–83 years, with an average age of 53 years. Patients had been on a gluten-free diet for an average of 6 years when recruited. Eighty-five (39.2%) patients had persistent villous atrophy. The sensitivities of the POCT, TTG, EMA, and the adherence score in detecting villous atrophy were 67.1%, 44.7%, 37.7%, and 24.7% respectively (P=0.0005). The combination of the POCT and adherence score only marginally increased the sensitivity to 70.6% (59.7–80.0%). The POCT showed a higher sensitivity than the other markers in predicting villous atrophy. A POCT may help doctors get a quick, accurate assessment of mucosal healing levels during simple follow-up office visits. Source: The American Journal of Gastroenterology , (10 October 2017). doi:10.1038/ajg.2017.357
  20. Celiac.com 11/13/2017 - ImmusanT, Inc., the company working to develop a therapeutic vaccine to protect HLADQ2.5+ patients with celiac disease against the effects of gluten, presented data that shows a way to tell the difference between celiac disease and non-celiac gluten-sensitive (NCGS) based on cytokine levels. Professor Knut Lundin, University of Oslo, presented the data at United European Gastroenterology (UEG) Week 2017. The results are important, in part because many people go on a gluten-free diet before they ever get diagnosed with celiac disease. It's hard for doctors to ask these people to start eating gluten again so that they can be properly diagnosed. But that's how it currently works. If there are no anti-gliadin antibodies in your blood, current tests are not accurate. These data suggest that it is possible to spot celiac disease through plasma or blood test. Along with easier, more accurate celiac diagnoses, a blood test would be a major breakthrough because "patients would only be required to consume gluten on one occasion and would still achieve accurate results," said Robert Anderson, MBChB, Ph.D., Chief Scientific Officer of ImmusanT. The test may also help people who do not have celiac disease, but find symptom relief on a gluten-free diet. For these people, gluten may not be the cause of their symptoms and a gluten-free diet may be totally unnecessary. The latest data support the company's approach to "developing a simple blood test for diagnosing celiac disease without the discomfort and inconvenience of current testing methods. This would be the first biomarker for measuring systemic T-cell immunity to gluten," said Leslie Williams, Chief Executive Officer of ImmusanT. As development is ongoing, further tests are expected to flesh out the details. Source: Immusant
  21. Celiac.com 11/07/2017 - Researchers still don't have much good data on the consequences of antibiotic use in early life and how that relates to the risk of certain autoimmune diseases. A team of researchers recently set out to test the association between early-life antibiotic use and islet or celiac disease autoimmunity in genetically at-risk children prospectively followed up for type 1 diabetes (T1D) or celiac disease. Their study is part of a larger study called The Environmental Determinants of Diabetes in the Young, or TEDDY, for short. The reasearch team enrolled HLA-genotyped newborns from Finland, Germany, Sweden, and the United States between November 20, 2004, and July 8, 2010, and analyzed data from November 20, 2004, to August 31, 2014. They also enrolled individuals from the general population, and those having a first-degree relative with T1D, with any 1 of 9 HLA genotypes associated with a risk for T1D. The team charted parental reports of the most common antibiotics, such as cephalosporins, penicillins, and macrolides, used between age 3 months and age 4 years. Islet autoimmunity and celiac disease autoimmunity were defined as being positive for islet or tissue transglutaminase autoantibodies at 2 consecutive clinic visits at least 3 months apart. The team used Cox proportional hazards regression models to assess the relationship between antibiotic use in early life before seroconversion and the development of autoimmunity, and to calculate hazard ratios and 95% CIs. The team conducted tests for islet and tissue transglutaminase autoantibodies on 8,495 children (49.0% female), and 6,558 children (48.7% female) who were enrolled in the TEDDY study, and they found that antibiotic exposure and frequency of use in early life or before seroconversion did not influence the risk of developing islet autoimmunity or celiac disease autoimmunity. Additionally, cumulative use of any antibiotic during the first 4 years of life was not tied to the appearance of any autoantibody (hazard ratio , 0.98; 95% CI, 0.95-1.01), multiple islet autoantibodies (HR, 0.99; 95% CI, 0.95-1.03), or the transglutaminase autoantibody (HR, 1.00; 95% CI, 0.98-1.02). Using any of the most common antibiotics during the first 4 years of life, in any geographic region, did not influence the later development of autoimmunity for T1D or celiac disease. Based on these results, the team concluded that doctors recommending antibiotics for young children at risk for T1D or celiac disease need not be concerned that the use will lead to islet or tissue transglutaminase autoimmunity. Source: JAMA Pediatr. Published online October 9, 2017. doi:10.1001/jamapediatrics.2017.2905 The research team included Kaisa M. Kemppainen, PhD; Kendra Vehik, PhD; Kristian F. Lynch, PhD; Helena Elding Larsson, MD, PhD; Ronald J. Canepa, BSc; Ville Simell, MSc; Sibylle Koletzko, MD, PhD; Edwin Liu, MD; Olli G. Simell, MD, PhD; Jorma Toppari, MD, PhD; Anette G. Ziegler, MD, PhD; Marian J. Rewers, MD, PhD; Åke Lernmark, PhD; William A. Hagopian, MD, PhD; Jin-Xiong She, PhD; Beena Akolkar, PhD; Desmond A. Schatz, MD; Mark A. Atkinson, PhD; Martin J. Blaser, MD; Jeffrey P. Krischer, PhD; Heikki Hyöty, MD, PhD; Daniel Agardh, MD, PhD; and Eric W. Triplett, PhD; for The Environmental Determinants of Diabetes in the Young (TEDDY) Study Group. They are variously affiliated with the Department of Microbiology and Cell Science, Institute of Food and Agricultural Sciences, University of Florida, Gainesville; the Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa; the Department of Clinical Sciences, Lund University Clinical Research Center, Skåne University Hospital, Malmö, Sweden; the MediCity Laboratory, University of Turku, Turku, Finland; the Division of Paediatric Gastroenterology and Hepatology, Dr von Hauner Children's Hospital, Ludwig Maximilian University, München, Germany; the Digestive Health Institute, Children's Hospital Colorado, Anschutz Medical Campus, University of Colorado Denver, Aurora; the Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; the Department of Pediatrics, University of Turku, Turku University Hospital, Turku, Finland; the Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland Institute of Diabetes Research, Helmholtz Zentrum München, München, Germany; the Klinikum Rechts der Isar, Technische Universität München, München, Germany; the Forschergruppe Diabetes e.V., Neuherberg, Germany; the Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora; the Pacific Northwest Diabetes Research Institute, Seattle, Washington; the Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland; the Department of Pediatrics, College of Medicine, University of Florida, Gainesville; the Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville; the Department of Medicine and Microbiology, New York School of Medicine, New York; the Department of Virology, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; and with Fimlab Laboratories, Pirkanmaa Hospital District, Tampere, Finland.
  22. Celiac.com 11/02/2017 - What is the link between the autoimmune diseases Sjögren's syndrome and celiac disease? In a study, 14.7% of Sjögren's syndrome patients were found to have celiac disease and 11.8% of non-celiac Sjögren's syndrome patients were found to have inflamed mucosa in the small intestine. With this knowledge, people who suffer from Sjögren's syndrome may be able to find relief for their symptoms with the gluten-free diet. Four million Americans are suffering from a disease they don't even know they have and their doctors don't even know to test for. Sound familiar? If you're familiar with my work as a gluten-free advocate, you have probably guessed that what I'm describing is celiac disease, an autoimmune reaction triggered by gluten, a protein component in wheat, barley, and rye. If that was your guess, you would actually be wrong: there is another underdiagnosed and common autoimmune disease that we and our doctors need to be aware of—Sjögren's syndrome, which affects the exocrine, or moisture-producing, glands. Unlike celiac disease, Sjögren's syndrome doesn't have a standardized effective treatment, but fortunately, research is demonstrating a link between these two autoimmune diseases, bringing good news for Sjögren's patients who may see relief of their symptoms by eliminating gluten from their diet. Chances are, many haven't heard of Sjögren's syndrome. This relatively unknown and underdiagnosed disease is an autoimmune disease in which the immune system attacks the tear and saliva glands of the body, reducing their production and resulting in dry mouth and eyes and other symptoms. Complications of Sjögren's include tooth decay, corneal ulcers, and non-Hodgkin's lymphoma. In women, vaginal dryness can also be a symptom. According to the UK's National Health Service, 9 out of 10 people who suffer from this condition are women, and the average age onset is between the ages of 40 and 60 years old. In a study by the Institute of Medical Technology, University of Tampere, Finland, 34 Sjögren's syndrome patients and a control group of 28 people were given a small bowel biopsy; five (14.7%) of the Sjögren's patients tested positive for celiac disease and four (11.8%) of the non-celiac patients were found to have inflammation in the mucous membrane of the small intestine. According to the study's conclusions, "The findings show a close association between Sjögren's syndrome and celiac disease." Currently, there are two classifications of Sjögren's syndrome as either primary, meaning that it has developed on its own, or secondary, which means that it has developed as the result of another autoimmune disease, such as rheumatoid arthritis or lupus. There is no "cure" for Sjögren's; researchers have identified a combination of factors—environmental, genetic, and hormonal, according to the National Health Service. There are a variety of treatments which can vary in effectiveness, including saliva-stimulating medication and eye drops. The good news is that Sjögren's patients who are found to be celiac may see the relief of their symptoms through a gluten-free diet, currently the effective and only treatment used for celiac disease. Just as with celiac disease, Sjögren's syndrome is under diagnosed relative to its frequency. As a diagnosed celiac American, I consider myself very lucky that I've been correctly diagnosed with celiac disease. With the help of advocate groups all over the country, gluten-free awareness and celiac diagnosis is on the rise. By spreading the word about the association between Sjögren's syndrome and celiac disease, we can help those with Sjögren's achieve better health and quality of life. Resources: National Health Service (UK): Sjögren's syndrome http://www.nhs.uk/conditions/Sjogrens-syndrome/Pages/Introduction.aspx National Institutes of Health: Celiac disease and markers of celiac disease latency in patients with primary Sjögren's syndrome http://www.ncbi.nlm.nih.gov/pubmed/10201480 Nutritional Healing: Articles. Sjögren's World: Links http://www.sjogrensworld.org/links.htm
  23. Celiac.com 10/26/2017 - Making an accurate count of intraepithelial lymphocytes (IEL) is important to making an accurate diagnosis of celiac disease, but so far, researchers have not been able to establish a definitive 'normal' IEL range. In a recent multi-center study, a team of researchers set out to do just that. The research team included Kamran Rostami, Michael N Marsh, Matt W Johnson, Hamid Mohaghegh, Calvin Heal, Geoffrey Holmes, Arzu Ensari, David Aldulaimi, Brigitte Bancel, Gabrio Bassotti, Adrian Bateman, Gabriel Becheanu, Anna Bozzola, Antonio Carroccio, Carlo Catassi, Carolina Ciacci, Alexandra Ciobanu, Mihai Danciu, Mohammad H Derakhshan, Luca Elli, Stefano Ferrero, Michelangelo Fiorentino, Marilena Fiorino, Azita Ganji, Kamran Ghaffarzadehgan, James J Going, Sauid Ishaq, Alessandra Mandolesi, Sherly Mathews, Roxana Maxim, Chris J Mulde, Andra Neefjes-Borst, Marie Robert, Ilaria Russo, Mohammad Rostami-Nejad, Angelo Sidoni, Masoud Sotoudeh, Vincenzo Villanacci, Umberto Volta, Mohammad R Zali, Amitabh Srivastava. They are variously affiliated with the twenty-eight institutions listed below. The study was designed at the International Meeting on Digestive Pathology, Bucharest 2015. Investigators from 19 centers in eight countries on three continents, recruited 198 patients with Marsh III histology, and another 203 control subjects. They used a single agreed upon protocol to count IEL/100 enterocytes in well-oriented duodenal biopsies. They also collected demographic and serological data. The research team used receiver operating characteristic (ROC) curve analysis to determine the optimal cut-off between normal and celiac disease (Marsh III lesion) duodenal mucosa, based on IEL counts on >400 mucosal biopsy specimens. The average ages of celiac and control groups were 45.5 and 38.3 years, respectively. They found that mean IEL count was 54±18/100 enterocytes in celiac disease and 13±8 in normal controls (p=0.0001). ROC analysis indicated an optimal cut-off point of 25 IEL/100 enterocytes, with 99% sensitivity, 92% specificity and 99.5% area under the curve. Other cut-offs between 20 and 40 IEL were less discriminatory. Additionally, there was a sufficiently high number of biopsies to explore IEL counts across the sub-classification of the Marsh III lesion. Their ROC curve analyses show that a cut-off of 25 IEL/100 enterocytes for Marsh III lesions provides the best way to distinguish between normal control and celiac disease biopsies. They saw no differences in IEL counts between Marsh III a, b and c lesions. There was an indication of a continuously graded dose–response by IEL to environmental gluten antigenic influence. Source: GUT Affiliations: The team members for this study are affiliated with the Department of Gastroenterology and Pathology, Milton Keynes University Hospital, Milton Keynes, UK; the Department of Gastroenterology, Luton and Dunstable University Hospital, Luton, UK; the Wolfson College, University of Oxford, Oxford, UK; the Gastroenterology and Liver Diseases Research Centre, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, The Islamic Republic of Iran; the Centre for Biostatistics, Faculty of Biology, Academic Health Science Centre, University of Manchester, Manchester, UK; the Department of Gastroenterology, Royal Derby Hospital, Derby, UK; the Department of Pathology, Ankara University Medical School, Ankara, Turkey; the Department of Gastroenterology, Warwick Hospital, Warwick, UK; the Service de Pathologie, Centre de Biologie et Pathologie Groupe Hospitalier du Nord, Hospices Civils de Lyon, Lyon, France; University of Perugia Medical School, Perugia, Italy; the Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Department of Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Institute of Pathology Spedali Civili, Brescia, Italy; Internal Medicine and Pathology Unit, University of Palermo, Giovanni Paolo II Hospital, Sciacca, Italy; Department of Pediatrics and Surgical Pathology, Università Politecnica delle Marche, Ancona, Italy; Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Salerno, Italy; Departments of Gastroenterology and Pathology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania; College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK; Digestive Disease Research Center, Tehran University Medical Science, Tehran, Iran; Center for Prevention and Diagnosis of Coeliac Disease and Pathology Unit, Fondazione IRCCS Ca' granda Ospedale Maggiore Policlinico, Milano, Italy; Department of Medical and Surgical Sciences, University of Bologna and Diagnostic and Experimental, University of Bologna, Bologna, Italy; Gastroenterology and Hepatology, Faculty of Medicine, Mashhad University 0f Medical Sciences, Mashhad, Iran; Pathology department, Razavi hospital, Mashhad, Iran; Department of Pathology, Southern General Hospital, Lanarkshire, UK; Department of Hepatogastroenterology and Pathology, Free University Medical Centre, Amsterdam, The Netherlands; Department of Pathology and Medicine, Yale University School of Medicine, New Haven, USA; Digestive Disease Research Center, Tehran University Medical Science, Tehran, Iran; Department of Pathology, Brigham & Women's Hospital, Boston, USA.
  24. Celiac.com 10/20/2017 - Are doctors even getting close to diagnosing the actual number of cases of celiac disease? Or are they missing the vast majority? Researchers have said for some time that there are far more people with celiac disease than are being diagnosed, and that the vast majority of cases go undiagnosed. So, just how far are we from the actual number? Well, if a new study by Canadian nutrition researchers is any indication, doctors are very far from diagnosing most cases. The team studied the blood work of nearly 3,000 people, and their conclusions are stunning. They say that ninety percent of celiac cases go undiagnosed. How could this be? One reason is that even classic celiac disease symptom, such as abdominal pain, bloating, gas, diarrhea, anemia and weight loss can mimic other conditions. Less classic symptoms such as fatigue, low vitamin C, D and calcium levels can be misleading. Ahmed El-Sohemy, a professor of nutritional science at the University of Toronto, wanted to see whether celiac disease results in subpar nutrition because of poorer absorption of vitamins and minerals. But to find out, he needed Canadian data on the frequency of undiagnosed celiac disease. To that end, El-Sohemy and his colleagues checked blood samples from more than 2,800 individuals in Toronto. One group had an average age of 23, and the other 45. Among their findings is likely ~1%, with 87% of cases being undiagnosed. These findings suggest the need for better screening in high genetic risk groups. Source: BMJOPEN.com
  25. Celiac.com 10/18/2017 - Celiac disease is a chronic inflammatory disease of the small intestine mucosa due to permanent intolerance to dietary gluten. A team of researchers recently set out to clarify the role of small intestinal epithelial cells in the immunopathology of celiac disease, especially the influence of celiac disease-associated bacteria. The research team included G Pietz, R De, M Hedberg, V Sjöberg, O Sandström, O Hernell, S Hammarström, and ML Hammarström. They are variously affiliated with the Department of Clinical Microbiology, Immunology, and the Department of Clinical Sciences and Pediatrics at Umeå University, in Umeå, Sweden. The team collected duodenal biopsies from children with active celiac disease, treated celiac disease, and a group of clinical control subjects. They then purified intestinal epithelial cells, and analyzed them for gene expression changes at the mRNA and protein levels. To assess how interferon-γ, interleukin-17A, celiac disease-associated bacteria and gluten influence intestinal epithelial cells, they used two in vitro models for human intestinal epithelium, small intestinal enteroids and polarized tight monolayers. In patients with active celiac disease, intestinal epithelial cells significantly upregulated more than 25 defense-related genes, including IRF1, SPINK4, ITLN1, OAS2, CIITA, HLA-DMB, HLA-DOB, PSMB9, TAP1, BTN3A1, and CX3CL1. Of these genes, 70 percent were upregulated by interferon-γ via the IRF1 pathway. Notably, IRF1 was also upregulated by bacteria associated with celiac disease. Intestinal epithelial cells also expressed the NLRP6/8 inflammasome yielding CASP1 and biologically active interleukin-18, which induces interferon-γ in intraepithelial lymphocytes. Over-expression of IRF1 appears to be a key factor in the epithelial reaction in celiac disease. This may be inherent, but may also be due to presence of undesirable microbes that trigger or influence IRF1. From this study, the researchers conclude that activation of IRF1 and IRF1-regulated genes together, both directly and via the interleukin-18 dependent inflammasome, would greatly increase the severity of the inflammatory response, and trigger the pathological gut response that is common in active celiac disease. Could this provide a key to unlocking the mysteries of celiac disease and its associated symptoms? Source: PLoS One. 2017 Sep 21;12(9):e0185025. doi: 10.1371/journal.pone.0185025.