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Celiac.com 10/21/2015 - Celiac disease has been traditionally recognized among Caucasians, with an estimated prevalence of about 1%. Latin America features a the population with European ancestry, along with native communities sharing a diverse degree of mix with European colonizers. The population of native Toba people comprises more than 60,000 individuals living with a clusters of villages in a forest called 'The Impenetrable' in Northeastern Argentina. In recent years, as a consequence of governmental food aid programs aimed at improving nutritional conditions in the community, the Toba people have undergone a drastic change in dietary habits, with wheat replacing their ancestral food sources. In general celiac disease can only occur in individuals with certain class II human leukocyte antigen (HLA) molecules – namely, HLA DQ2 and/or DQ8, but little information exists about the prevalence of HLA DQ2 and DQ8, and of celiac disease in native South Americans. The research team included Horacio Vázquez MD, María de la Paz Temprano RD, Emilia Sugai MS, Stella M Scacchi MS, Cecilia Souza MD,Daniel Cisterna MS, Edgardo Smecuol MD, María Laura Moreno MD, Gabriela Longarini MD, Roberto Mazure MD, María A Bartellini MS, Elena F Verdú MD2, Andrea González RD, Eduardo Mauriño MD, and Julio C Bai MD. They are variously affiliated with the Small Bowel Section, Department of Medicine, Hospital de Gastroenterología C Bonorino Udaondo. Buenos Aires, Argentina and the Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario. For their study, the research team set out to prospectively assess environmental, genetic and serological conditions associated with celiac disease among members of the Toba native population attending a multidisciplinary sanitary mission. Using an established questionnaire, an expert nutritionist determined daily gluten intake. The team then conducted gene typing for the human leuko-cyte antigen (HLA) class II alleles using DNA extracted from peripheral blood (HLA DQ2/DQ8 haplotype). The team then measured serum antibodies were immunoglobulin (Ig) A tissue transglutaminase (tTG) and the composite deamidated gliadin peptides/tTG Screen test. They tested positive cases for IgA endomysial antibodies. The team screened a total of 144 subjects, 55% of those female. Estimated average gluten consumption was 43 grams per day, ranging from 3 grams per day up to 185 grams per day. Genetic typing showed that 73 of 144 subjects had alleles associated with celiac disease; 69 of these subjects had alleles for HLA DQ8, while four had DQ2. Four and six subjects had antibody concentrations above the cut-off established by the authors' laboratory (>3 times the upper limit of normal) for IgA tTG and deamidated gliadin peptides/tTG screen, respectively. Four of these had concomitant positivity for both assays and endomysial anti-bodies were positive in three subjects who also presented a predispos-ing haplotype. The present study was the first to detect celiac disease in Native Americans. The native Toba ethnic population has very high daily gluten consumption, and a predisposing genetic background. This study found subjects with persistent celiac disease autoimmunity and, at least, three of them met serological criteria for celiac disease diagnosis. This study invites some questions about gluten and celiac disease in the tribe. For example, does the amount of gluten in the diet of people with genetic predisposition have an impact on the likelihood of celiac disease? Given that many of these people likely had DQ2/DQ8 positivity for many generations, did the introduction of wheat into their diets trigger their celiac disease? Much remains to be understood about celiac disease, and studies like this can be important and insightful. Source: Can J Gastroenterol Hepatol Vol 29 No X Month 2015 1

Appl Environ Microbiol. 2004 Feb;70(2):1088-1096 Celiac.com 02/26/2004 - Please note that the sourdough bread used in this study is not your garden-variety sourdough bread, and as far as I know it is not commercially available. Even though this study had very promising results, it was conducted on a relatively small number of people, and larger studies need to be carried out before reaching any conclusions about the long-term safety of celiacs consuming this type of sourdough bread. -Scott Adams Researchers in Europe conducted a novel study which utilized a highly specialized sourdough lactobacilli containing peptidases that have the ability to hydrolyze Pro-rich peptides, including the 33-mer peptide, which is the main culprit in the immune response associated with celiac disease. The sourdough bread in the study was made from a dough mixture that contained 30% wheat flour and other nontoxic flours including oat, millet, and buckwheat, which was then started with the specialized lactobacilli. After 24 hours of fermentation all 33-mer peptides and low-molecular-mass, alcohol-soluble polypeptides were almost totally hydrolyzed. For the next step in the study the researchers extracted proteins fro the sourdough and used them to produce a "peptic-tryptic digest" for in vitro agglutination tests on human K 562 subclone cell. The agglutinating activity of the sourdough proteins was found to be 250 times higher that that of normal bakers-yeast or lactobacilli started breads. A double blind test was then conducted in which 17 celiac disease patients were given 2 grams of gluten-containing bread started with bakers yeast or lactobacilli. Thirteen of them showed distinct, negative changes in their intestinal permeability after eating the bread, and 4 of them did not show any negative effects. The specially prepared sourdough bread was then given to all 17 patients and none of them had intestinal permeability reactions that differed from their normal baseline values. The researchers conclude: "These results showed that a bread biotechnology that uses selected lactobacilli, nontoxic flours, and a long fermentation time is a novel tool for decreasing the level of gluten intolerance in humans."

GUT 2002;50:332-5 Celiac.com 03/19/2002 - According to a long term study conducted by Dr Matti Uusitupa and colleagues from the University of Kuopio, Kuopio, Finland, long-term ingestion of a moderate amount of oats in an otherwise gluten-free diet is safe for adult patients with celiac disease. In a previous study Dr. Uusitupa found no harmful effects from oats after patients ate them for 12 months, which was reflected by the patents symptoms, nutritional status, duodenal villous architecture, and mucosal mononuclear cell infiltrate, as seen in celiac patients who are in remission. The earlier study also showed that ingestion of oats did not delay recovery of mucosal damage in newly diagnosed celiacs. Dr. Uusitupas first study compared the effects of a gluten-free diet and a gluten-free diet that included oats with a randomized trial involving 92 adult celiac patients: 45 in the oats group whose intake averaged approximately 34 grams per day, and 47 patients in the control group. Patients in the oats group were allowed to eat oats freely in conjunction with an otherwise gluten free diet. After five years 35 patients in the original oats group, 23 of whom were still eating oats at least twice a week, and 28 in the control group that was on a conventional gluten free diet were examined. The results confirmed that eating oats did not cause ANY duodenal mucosal damage to the adult celiac patients in the study. Further, the patients were also examined using histological, histomorphometric, and immunological methods, and AGA, ARA, and EMA serological test results of those in the oat group showed no negative effects that could be linked to eating oats. According to Dr. Uusitupa, the high antibody levels that appeared in some of the patients that were in both groups are most likely explained by poor compliance to a gluten free diet, and the reason why celiac patients can tolerate oats must be based on structural differences between the proteins of oats, wheat, barley, and rye. The toxic portion of the harmful gluten protein lies in the ethanol soluble fraction called gliadins, whose toxicity remains after digestion. With oats, however, it is possible that the absence of specific amino acid sequences that are found in wheat gliadin but are not found in oat avenin allow oats to be tolerated by celiacs. Last, the researchers note that taking oats off of the list of forbidden cereals might improve patient compliance to the gluten-free diet by giving them more food choices.

Gut. 2004 May;53(5):649-654 A multi-center Swedish study involving eight separate pediatric clinics looked at 116 children with newly diagnosed celiac disease. The group was randomized into two groups, and one group was given a standard gluten-free diet, while the other was given a standard gluten-free diet that also included oats. The study period was one year, small bowel biopsies were performed at the beginning and end of the study, and serum IgA antigliadin, antiendomysium, and antitissue transglutaminase antibodies were monitored at 0, 3, 6, and 12 months. The median intake of oats for the oat-eating group was 15g per day. By the end of the study all patients were in clinical remission for celiac disease. Neither group differed significantly from one another with regard to serology markers or small bowel mucosal architecture (including numbers of intraepithelial lymphocytes). Out of the original 116 children 93 finished the study, and significantly more younger patients withdrew from it than older patients. The researchers conclude: "This is the first randomized double blind study showing that the addition of moderate amounts of oats to a gluten-free diet does not prevent clinical or small bowel mucosal healing, or humoral immunological downregulation in coeliac children. This is in accordance with the findings of studies in adult coeliacs and indicates that oats, added to the otherwise gluten-free diet, can be accepted and tolerated by the majority of children with celiac disease."