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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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  1. Celiac.com 05/16/2018 - Galectins are a family of animal lectins marked by their affinity for N-acetyllactosamine-enriched glycoconjugates. Galectins control several immune cell processes and influence both innate and adaptive immune responses. A team of researchers recently set out to assess the role of galectins, particularly galectin-1 (Gal-1), in the treatment of celiac disease. The research team included Victoria Sundblad, Amado A. Quintar, Luciano G. Morosi, Sonia I. Niveloni, Ana Cabanne, Edgardo Smecuol, Eduardo Mauriño, Karina V. Mariño, Julio C. Bai, Cristina A. Maldonado, and Gabriel A. Rabinovich. The researchers examined the role of galectins in intestinal inflammation, particularly in Crohn’s disease, ulcerative colitis, and celiac disease patients, as well as in murine models resembling these inflammatory conditions. Maintaining the fine balance between host immunity and tolerance promotes gut homeostasis, and helps to prevent inflammation. To gain insight into the role of Gal-1 in celiac patients, the team demonstrated an increase in Gal-1 expression following a gluten-free diet along with an increase in the frequency of Foxp3+ cells. The resolution of the inflammatory response may promote the recovery process, leading to a reversal of gut damage and a regeneration of villi. Among other things, the team’s findings support the use of Gal-1 agonists to treat severe mucosal inflammation. In addition, Gal-1 may serve as a potential biomarker to follow the progression of celiac disease treatment. Gut inflammation may be governed by a coordinated network of galectins and their glycosylated ligands, triggering either anti-inflammatory or pro-inflammatory responses. That network may influence the interplay between intestinal epithelial cells and the highly specialized gut immune system in physiologic and pathologic settings. The team’s results demonstrate that the anti-inflammatory and tolerogenic response associated with gluten-free diet in celiac patients is matched by a substantial up-regulation of Gal-1. This suggests a major role of this lectin in favoring resolution of inflammation and restoration of mucosal homeostasis. This data highlights the regulated expression of galectin-1 (Gal-1), a proto-type member of the galectin family, during intestinal inflammation in untreated and treated celiac patients. Further study of this area could lead to better understanding of the mechanisms behind celiac disease, and potentially to a treatment of the disease. Source: Front. Immunol., 01 March 2018. The researchers in this study are variously affiliated with the Laboratorio de Inmunopatología, Instituto de Biología y Medicina Experimental (IBYME), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; the Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina; the Instituto de Investigaciones en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina; the Laboratorio de Glicómica Funcional y Molecular, Instituto de Biología y Medicina Experimental (IBYME), Consejo de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; the Sección Intestino Delgado, Departamento de Medicina, Hospital de Gastroenterología Dr. C. Bonorino Udaondo, Buenos Aires, Argentina; the Unidad de Patología, Hospital de Gastroenterología, Bonorino Udaondo, Buenos Aires, Argentina; the Instituto de Investigaciones, Universidad del Salvador, Buenos Aires, Argentina; and the Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina.
  2. Celiac.com 05/07/2018 - Pursuing a hypothesis that Gilles de la Tourette syndrome (GTS) and Non-Celiac Gluten Sensitivity (NCGS) may be related, a team of researchers recently set out to assess the efficacy of a gluten-free diet in 29 patients with Gilles de la Tourette Syndrome GTS in a prospective pilot study. The research team then evaluated patient progress after one year on a gluten-free diet. The research team included Luis Rodrigo, Nuria Álvarez, Enrique Fernández-Bustillo, Javier Salas-Puig, Marcos Huerta, and Carlos Hernández-Lahoz. To establish a baseline of conditions, the team used a series of questionnaires, including YGTSS, Y-BOCS/CY-BOCS and GTS-QOL, which they then compared before and after the gluten-free diet. The YGTSS questionnaires measured tics, while the Y-BOCS/CY-BOCS questionnaires measured the intensity and frequency of OCD. The study group included 23 children and 6 adults. In all, 74% of children and 50% of adults were male. When the study began, nearly 70% of children and 100% of adults showed OCD (NS). Both groups showed frequent symptoms of NCGS, with nearly half of the children and 83.6% of adults reporting headaches. After one year of gluten-free diet, both child and adult patients showed a substantial reduction in tics (YGTSS), a reduction in the intensity and frequency of OCD, along with improved QOL measurements. This study showed that both children and adults with Tourette syndrome and non-celiac gluten sensitivity who followed a gluten-free diet for one year showed a significant reduction in tics and OCD. A gluten-free diet seems to reduce tics and OCD both in both children and adults with Tourette syndrome and gluten sensitivity. Clearly larger studies are needed to confirm these finding, but this is exciting news for those with Tourette syndrome and the doctors who treat them. Meantime, the number of conditions that seem to improve with gluten-free diet treatment continues to grow. Stay tuned for more developments. Source: Preprints 2018, 2018040332. doi: 10.20944/preprints201804.0332.v1
  3. Celiac.com 05/02/2018 - Celiac disease is an autoimmune disorder, not an allergy. Celiac disease affects abut 1 in 100 people, and requires professional diagnosis and treatment with a gluten-free diet. There is a good deal of confusion and inaccurate information about celiac disease and a gluten-free diet. Here are some important things to know about celiac disease: 1) Celiac Disease Doesn’t Always Have Obvious Symptoms People with celiac disease may have few or no symptoms. In fact, these days, most people diagnosed with celiac disease, report few or no symptoms. Classic gastrointestinal symptoms include bloating, diarrhea, gas, constipation, and gut pain after consuming wheat, barley or rye. Other prominent symptoms can include fatigue, headache, poor weight gain, and depression. Less classic, but still common celiac symptoms include one or more of the following: anemia, anxiety, skin rashes, infertility, irritability, joint pain, pale mouth sores, thin bones, tingling and/or numbness in hands and feet. 2) No Symptoms Doesn't Mean No Damage The level of celiac-related symptoms or complaints a person has does not equate to the level of gut damage. Few or no symptoms does not mean little or no gut damage. People can have severe celiac symptoms, yet relatively light gut damage on biopsy, or conversely, they can have light symptoms and still have serious gut damage on biopsy. 3) A Simple Antibody Test Can Point the Way If you suspect celiac disease, be sure to talk with your doctor. A simple antibody test or two is usually sufficient to rule celiac disease in or out. If the test is positive, then a doctor will likely recommend a biopsy for confirmation. Recent studies show that a combination of two antibody tests may be better than biopsy. Usually, patients need to be eating wheat when they are tested for celiac disease, but that is changing. There are also some promising new approaches to blood testing for celiac disease. 4) Early Diagnosis is Key The longer you go without treatment, the higher the risk of gut damage, and the greater the likelihood of developing associated conditions. Early diagnosis is especially important in the elderly, as they have a greater risk of developing associated conditions and complications from untreated celiac disease. Still diagnosing celiac disease can be tricky and can take time, partly because the symptoms can be vague, seem unrelated, and can mimic other conditions. 5) No Cure Currently, there is no cure for celiac disease. Several companies are working to develop a vaccine, or other immune therapy for celiac disease, but until we see a major scientific breakthrough, there is no cure for celiac disease. 6) Gluten-Free Diet is Mandatory A gluten-free diet is the only treatment for celiac disease. For people with celiac disease, a gluten-free diet is mandatory, not optional. If people with celiac disease consume wheat, rye or barley proteins they risk causing serious damage to their health, including gut damage and potential cancer, especially in the long term. 7) Full Gut Healing Can Take Time Recent studies show that most people with celiac disease begin to see gut healing in the first year or year and a half. The vast majority of celiacs on a gluten-free diet heal within two to three years. Gut healing usually corresponds to healing in other affected parts of the body, such as improvements in bone microarchitecture, neuropathy, and other areas of celiac-associated damage. 8) Gluten Sensitivity Can Increase The longer you go without gluten, the more sensitive you may become to accidental gluten ingestion. It’s not uncommon for people with celiac disease to see their sensitivity to gluten increase in the weeks and even years after they give up gluten. That can mean that accidental gluten ingestion can bring on symptoms that are more severe than their original complaints. For many people, this sensitivity may slowly taper off and decrease over time. For others, sensitivity remains high and requires extra vigilance about to make sure food is gluten-free. Remember, increased gluten sensitivity does not equal increased gut damage. For some, a fully healed gut may be more sensitive to gluten than a damaged one, and vice versa. Among people on a gluten-free diet due to celiac disease, sensitivity can vary. 9) Non-Celiac Gluten Sensitivity (NCGS) is a Thing You can be sensitive to gluten and not have celiac disease. Researchers have recently confirmed a condition called non-gluten sensitivity. People with this condition experience celiac-like symptoms when they consume gluten. However, they typically do not test positive for antibodies to gliadin, and they typically have a clean biopsy, so no gut damage. Some studies have cast doubt on the existence of non-gluten-celiac sensitivity. Other studies have shown that many people with NCGS react to gluten. Still other studies show that Fructan has emerged as one possible culprit. 10) You Can Still Live a Healthy Life and Eat Delicious Food Having celiac disease means making some important adjustments to your diet, but it’s still possible to live a healthy life and eat tasty food. Read more about the best gluten-free breads, burgers, pizzas, and all your favorite gluten-free treats. Here is a list of SAFE and UNSAFE foods for people with celiac disease. Here is a list of easy, list of easy, delicious gluten-free recipes. Here is a list of great gluten-free sandwich breads. Here is a list of great gluten-free Mexican Fast Food Chains. Here's a recipe for a delicious gluten-free No-Bake Cheesecake. Knowledge is Power Use Celiac.com, and the Celiac.com Forums to get important information and to share your experience with others like you. Other great celiac disease resources include: The Mayo Clinic Celiac Disease Center at Columbia University Gluten Intolerance Group of North America
  4. Celiac.com 04/27/2018 - The latest market research shows that the gluten-free food boom is being driven by people looking to improve their diets with healthier, more nutritious food, rather than concerns about gluten intolerance or celiac disease. A recent survey showed that gluten-free items were the top bakery choice for consumers. That news led DuPont Nutrition & Health to begin trials in its bakery center in an effort to improve their product offerings. The company said in a news release that the trend was driven by people looking to improve their diets with healthier food, rather than concerns about gluten intolerance or celiac disease. Additionally, consumers are looking for better quality and wider availability in their favorite specialty foods. Even though just under 1% of the population avoids gluten due to celiac disease, more than 10% of people in Italy and the U.K. choose gluten-free products, while in France and Spain, about 8% of consumers choose gluten-free. Obviously, these numbers greatly exceed the number of people with celiac disease, and that is part of the power driving the rapid expansion of gluten-free products. According to DuPont’s reading of the Mintel study data shows “untapped potential for bakers to develop more and better-quality products with extra nutritional benefits,” including products that are high in fiber, devoid of added preservatives, and low in saturated fats, carbohydrates and calories. These numbers help to dispel the idea that the gluten-free food explosion is simply a passing fad. In any case, building an association between good nutrition and gluten-free bakery products can only help food makers with global consumers who are actively seeking one. Read more at: fooddive.com
  5. Celiac.com 04/26/2018 - Emily Dickson is one of Canada’s top athletes. As a world-class competitor in the biathlon, the event that combines cross-country skiing with shooting marksmanship, Emily Dickson was familiar with a demanding routine of training and competition. After discovering she had celiac disease, Dickson is using her diagnosis and gluten-free diet a fuel to help her get her mojo back. Just a few years ago, Dickson dominated her peers nationally and won a gold medal at Canada Games for both pursuit and team relay. She also won silver in the sprint and bronze in the individual race. But just as she was set to reach her peak, Dickson found herself in an agonizing battle. She was suffering a mysterious loss of strength and endurance, which itself caused huge anxiety for Dickson. As a result of these physical and mental pressures, Dickson slipped from her perch as one of Canada's most promising young biathletes. Eventually, in September 2016, she was diagnosed with celiac disease. Before the diagnosis, Dickson said, she had “a lot of fatigue, I just felt tired in training all the time and I wasn't responding to my training and I wasn't recovering well and I had a few things going on, but nothing that pointed to celiac.” It took a little over a year for Dickson to eliminate gluten, and begin to heal her body. She still hasn’t fully recovered, which makes competing more of a challenge, but, she says improving steadily, and expects to be fully recovered in the next few months. Dickson’s diagnosis was prompted when her older sister Kate tested positive for celiac, which carries a hereditary component. "Once we figured out it was celiac and we looked at all the symptoms it all made sense,” said Dickson. Dickson’s own positive test proved to be both a revelation and a catalyst for her own goals as an athlete. Armed with there new diagnosis, a gluten-free diet, and a body that is steadily healing, Dickson is looking to reap the benefits of improved strength, recovery and endurance to ramp up her training and competition results. Keep your eyes open for the 20-year-old native of Burns Lake, British Columbia. Next season, she will be competing internationally, making a big jump to the senior ranks, and hopefully a regular next on the IBU Cup tour. Read more at princegeorgecitizen.com
  6. WHAT IS CELIAC DISEASE? Celiac disease is an autoimmune condition that affects around 1% of the population. People with celiac disease suffer an autoimmune reaction when they consume wheat, rye or barley. The immune reaction is triggered by certain proteins in the wheat, rye, or barley, and, left untreated, causes damage to the small, finger-like structures, called villi, that line the gut. The damage occurs as shortening and villous flattening in the lamina propria and crypt regions of the intestines. The damage to these villi then leads to numerous other issues that commonly plague people with untreated celiac disease, including poor nutritional uptake, fatigue, and myriad other problems. Celiac disease mostly affects people of Northern European descent, but recent studies show that it also affects large numbers of people in Italy, China, Iran, India, and numerous other places thought to have few or no cases. Celiac disease is most often uncovered because people experience symptoms that lead them to get tests for antibodies to gluten. If these tests are positive, then the people usually get biopsy confirmation of their celiac disease. Once they adopt a gluten-free diet, they usually see gut healing, and major improvements in their symptoms. CLASSIC CELIAC DISEASE SYMPTOMS Symptoms of celiac disease can range from the classic features, such as diarrhea, upset stomach, bloating, gas, weight loss, and malnutrition, among others. LESS OBVIOUS SYMPTOMS Celiac disease can often less obvious symptoms, such fatigue, vitamin and nutrient deficiencies, anemia, to name a few. Often, these symptoms are regarded as less obvious because they are not gastrointestinal in nature. You got that right, it is not uncommon for people with celiac disease to have few or no gastrointestinal symptoms. That makes spotting and connecting these seemingly unrelated and unclear celiac symptoms so important. NO SYMPTOMS Currently, most people diagnosed with celiac disease do not show symptoms, but are diagnosed on the basis of referral for elevated risk factors. CELIAC DISEASE VS. GLUTEN INTOLERANCE Gluten intolerance is a generic term for people who have some sort of sensitivity to gluten. These people may or may not have celiac disease. Researchers generally agree that there is a condition called non-celiac gluten sensitivity. That term has largely replaced the term gluten-intolerance. What’s the difference between celiac disease and non-celiac gluten-sensitivity? CELIAC DISEASE VS. NON-CELIAC GLUTEN SENSITIVITY (NCGS) Gluten triggers symptoms and immune reactions in people with celiac disease. Gluten can also trigger symptoms in some people with NCGS, but the similarities largely end there. There are four main differences between celiac disease and non-celiac gluten sensitivity: No Hereditary Link in NCGS Researchers know for certain that genetic heredity plays a major role in celiac disease. If a first-degree relative has celiac disease, then you have a statistically higher risk of carrying genetic markers DQ2 and/or DQ8, and of developing celiac disease yourself. NCGS is not known to be hereditary. Some research has shown certain genetic associations, such as some NCGS patients, but there is no proof that NCGS is hereditary. No Connection with Celiac-related Disorders Unlike celiac disease, NCGS is so far not associated with malabsorption, nutritional deficiencies, or a higher risk of autoimmune disorders or intestinal malignancies. No Immunological or Serological Markers People with celiac disease nearly always test positive for antibodies to gluten proteins. Researchers have, as yet, identified no such antobodies or serologic markers for NCGS. That means that, unlike with celiac disease, there are no telltale screening tests that can point to NCGS. Absence of Celiac Disease or Wheat Allergy Doctors diagnose NCGS only by excluding both celiac disease, an IgE-mediated allergy to wheat, and by the noting ongoing adverse symptoms associated with gluten consumption. WHAT ABOUT IRRITABLE BOWEL SYNDROME (IBS) AND IRRITABLE BOWEL DISEASE (IBD)? IBS and IBD are usually diagnosed in part by ruling out celiac disease. Many patients with irritable bowel syndrome are sensitive to gluten. Many experience celiac disease-like symptoms in reaction to wheat. However, patients with IBS generally show no gut damage, and do not test positive for antibodies to gliadin and other proteins as do people with celiac disease. Some IBS patients also suffer from NCGS. To add more confusion, many cases of IBS are, in fact, celiac disease in disguise. That said, people with IBS generally react to more than just wheat. People with NCGS generally react to wheat and not to other things, but that’s not always the case. Doctors generally try to rule out celiac disease before making a diagnosis of IBS or NCGS. Crohn’s Disease and celiac disease share many common symptoms, though causes are different. In Crohn’s disease, the immune system can cause disruption anywhere along the gastrointestinal tract, and a diagnosis of Crohn’s disease typically requires more diagnostic testing than does a celiac diagnosis. Crohn’s treatment consists of changes to diet and possible surgery. Up to 10% of Crohn's patients can have both of conditions, which suggests a genetic connection, and researchers continue to examine that connection. Is There a Connection Between Celiac Disease, Non-Celiac Gluten Sensitivity and Irritable Bowel Syndrome? Large Number of Irritable Bowel Syndrome Patients Sensitive To Gluten Some IBD Patients also Suffer from Non-Celiac Gluten Sensitivity Many Cases of IBS and Fibromyalgia Actually Celiac Disease in Disguise CELIAC DISEASE DIAGNOSIS Diagnosis of celiac disease can be difficult. Perhaps because celiac disease presents clinically in such a variety of ways, proper diagnosis often takes years. A positive serological test for antibodies against tissue transglutaminase is considered a very strong diagnostic indicator, and a duodenal biopsy revealing villous atrophy is still considered by many to be the diagnostic gold standard. But this idea is being questioned; some think the biopsy is unnecessary in the face of clear serological tests and obvious symptoms. Also, researchers are developing accurate and reliable ways to test for celiac disease even when patients are already avoiding wheat. In the past, patients needed to be consuming wheat to get an accurate test result. Celiac disease can have numerous vague, or confusing symptoms that can make diagnosis difficult. Celiac disease is commonly misdiagnosed by doctors. Read a Personal Story About Celiac Disease Diagnosis from the Founder of Celiac.com Currently, testing and biopsy still form the cornerstone of celiac diagnosis. TESTING There are several serologic (blood) tests available that screen for celiac disease antibodies, but the most commonly used is called a tTG-IgA test. If blood test results suggest celiac disease, your physician will recommend a biopsy of your small intestine to confirm the diagnosis. Testing is fairly simple and involves screening the patients blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis. Also, it is now possible to test people for celiac disease without making them concume wheat products. BIOPSY Until recently, biopsy confirmation of a positive gluten antibody test was the gold standard for celiac diagnosis. It still is, but things are changing fairly quickly. Children can now be accurately diagnosed for celiac disease without biopsy. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide. WHY A GLUTEN-FREE DIET? Currently the only effective, medically approved treatment for celiac disease is a strict gluten-free diet. Following a gluten-free diet relieves symptoms, promotes gut healing, and prevents nearly all celiac-related complications. A gluten-free diet means avoiding all products that contain wheat, rye and barley, or any of their derivatives. This is a difficult task as there are many hidden sources of gluten found in the ingredients of many processed foods. Still, with effort, most people with celiac disease manage to make the transition. The vast majority of celiac disease patients who follow a gluten-free diet see symptom relief and experience gut healing within two years. For these reasons, a gluten-free diet remains the only effective, medically proven treatment for celiac disease. WHAT ABOUT ENZYMES, VACCINES, ETC.? There is currently no enzyme or vaccine that can replace a gluten-free diet for people with celiac disease. There are enzyme supplements currently available, such as AN-PEP, Latiglutetenase, GluteGuard, and KumaMax, which may help to mitigate accidental gluten ingestion by celiacs. KumaMax, has been shown to survive the stomach, and to break down gluten in the small intestine. Latiglutenase, formerly known as ALV003, is an enzyme therapy designed to be taken with meals. GluteGuard has been shown to significantly protect celiac patients from the serious symptoms they would normally experience after gluten ingestion. There are other enzymes, including those based on papaya enzymes. Additionally, there are many celiac disease drugs, enzymes, and therapies in various stages of development by pharmaceutical companies, including at least one vaccine that has received financial backing. At some point in the not too distant future there will likely be new treatments available for those who seek an alternative to a lifelong gluten-free diet. For now though, there are no products on the market that can take the place of a gluten-free diet. Any enzyme or other treatment for celiac disease is intended to be used in conjunction with a gluten-free diet, not as a replacement. ASSOCIATED DISEASES The most common disorders associated with celiac disease are thyroid disease and Type 1 Diabetes, however, celiac disease is associated with many other conditions, including but not limited to the following autoimmune conditions: Type 1 Diabetes Mellitus: 2.4-16.4% Multiple Sclerosis (MS): 11% Hashimoto’s thyroiditis: 4-6% Autoimmune hepatitis: 6-15% Addison disease: 6% Arthritis: 1.5-7.5% Sjögren’s syndrome: 2-15% Idiopathic dilated cardiomyopathy: 5.7% IgA Nephropathy (Berger’s Disease): 3.6% Other celiac co-morditities include: Crohn’s Disease; Inflammatory Bowel Disease Chronic Pancreatitis Down Syndrome Irritable Bowel Syndrome (IBS) Lupus Multiple Sclerosis Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Psoriasis Rheumatoid Arthritis Scleroderma Turner Syndrome Ulcerative Colitis; Inflammatory Bowel Disease Williams Syndrome Cancers: Non-Hodgkin lymphoma (intestinal and extra-intestinal, T- and B-cell types) Small intestinal adenocarcinoma Esophageal carcinoma Papillary thyroid cancer Melanoma CELIAC DISEASE REFERENCES: Celiac Disease Center, Columbia University Gluten Intolerance Group National Institutes of Health U.S. National Library of Medicine Mayo Clinic University of Chicago Celiac Disease Center
  7. Celiac.com 04/03/2018 - A gluten-free diet is crucial to avoiding problems associated with celiac disease. However, many gluten-free foods come with drawbacks that are important to understand. Also, not all gluten-free food is created equal, not all gluten-free foods are healthy, and simply going gluten-free may not resolve all of your issues. Here are some things to keep in mind about a gluten-free diet: Gluten-Free food is more expensive than food made with wheat flour. In fact, gluten-free substitutes are about twice as expensive as standard foods. They are more costly to make, and they sell in lower volume, which pushes up retail prices. Like many of their non-gluten-free counterparts, gluten-free foods can be highly processed. Processed foods can promote inflammation, which is one of the things that people with celiac disease are trying to avoid. Gluten-Free does not automatically mean nutritious. In fact, gluten-free food is generally less nutritious than similarly processed foods made with wheat flour. Foods that are naturally gluten-free will generally be healthier than gluten-free substitutes. That may seem obvious, but if you look at the gluten-free food aisle in your local store, you will see many highly processed foods that are not any better than their gluten-containing counterparts in terms of general nutrition. Gluten-free foods are often higher in carbohydrates and calories than their non-gluten-free counterparts. Gluten-Free food is higher in salt than its non-gluten-free counterparts. Recent products tests show that most gluten-free snacks tested are far saltier than their non-gluten-free alternatives. Of 106 products surveyed, researchers found that many gluten-free snacks have up to five times more salt than non-gluten-free counterparts. Gluten-Free food is higher in fat than its non-gluten-free counterparts. Gluten-Free food is higher in sugar than its non-gluten-free counterparts. Gluten-Free ingredients don’t always mean gluten-free food. The news is riddled with stories about gluten contamination in restaurants, pizza joints, etc., that claim to use gluten-free ingredients. Examples of companies that rolled out gluten-free pizza only to be met with complaints by people with celiac disease include: California Pizza Kitchen, Domino’s pizza, and Papa John’s, among others. The longer you avoid gluten, the more sensitive you may become. For many people with celiac disease, the longer they avoid gluten, the more sensitive they become. This can mean stronger, more lengthy reactions to seemingly minor gluten ingestion, so be careful. A gluten-free diet will not reverse osteoporosis, or iron and calcium deficiency. If your celiac disease progressed for a long time before your diagnosis, then the odds are much more likely that you have suffered from osteoporosis, iron and calcium deficiency. A gluten-free diet alone will not reverse osteoporosis, or calcium deficiency. In such cases, you will need to consult your doctor for proper treatment. Osteoporosis is especially problematic in women with celiac disease.
  8. Celiac.com 03/28/2018 - Compliance with a gluten-free diet is difficult at all ages, but particularly for teenagers due to social, cultural, economic, and practical pressures. A team of researchers recently set out to assess the rates and determining factors of non-adherence to a gluten-free diet, along with the nutritional status of children and adolescents with celiac disease in a tertiary Brazilian referral center. The research team included Maraci Rodrigues, Glauce Hiromi Yonaminez, and Carla Aline Satiro. They are variously affiliated with the Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of Sao Paulo (SMUSP), Av. Dr Eneas de Carvalho Aguiar, 255, 05403-000, Sao Paulo, Brazil, and the Department of Pediatric, Instituto da Criança, Division of Nutrition, Hospital das Clínicas, School of Medicine, University of Sao Paulo in Sao Paulo, Brazil. The team’s cross-sectional and retrospective study included patients under 20 years of age, with biopsy-confirmed celiac disease, followed regularly at the Department of Pediatrics, Division of Gastroenterology, Hospital das Clínicas, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil, were surveyed using a questionnaire and serologic test applied between November 2011 and February 2012. The team reviewed patient charts to collect the anthropometric data along with the results of the serologic test performed both at the time of diagnosis, and after at least 1 year of a gluten-free diet. They assessed 35 patients aged between 2.4 and 19.9 years. Average patient age at diagnosis was 5.4 years. Nearly 70% of the patients were women, nearly 90% had classical celiac disease, while just over 50% had other celiac-associated conditions. Despite dietary guidance, one in five patients reported deviating from the gluten-free diet. After five years of gluten-free diet, most children achieved normal height and weight, while some of the children gained an excessive amount of weight, especially in the first two years of gluten-free eating. Most deviation from gluten-free eating was intentional, and occurred at parties and other social gatherings. In addition to teaching self-management skills, factors that promote knowledge and tools to manage celiac disease among independent children and adolescents include more choices and easier access of low cost gluten-free foods, and increased family discussions about the benefits of eating gluten-free diet. Helping kids and adolescents with celiac disease to effectively manage their condition by closely following a gluten-free diet is crucial, and parents have an important role to play in reinforcing information from doctors and health care professionals. Source: BMC Gastroenterol. 2018; 18: 15. doi: 10.1186/s12876-018-0740-z
  9. Celiac.com 03/16/2018 - Celiac awareness has increased exponentially over the last decade among physicians and the general public alike. Increasing numbers of research publications and very active support groups and individuals have contributed to this growing awareness. Knowledge of the many and varied manifestations is also growing rapidly although some individuals continue to cling to the notion that celiac disease is characterized by malabsorption and that nutrient deficiency is the dominant feature of this ailment. This misses the broader understanding of the many ways in which gluten grains negatively impact on human health. From toes to head, any and all of our human body systems may be harmed by ingesting gluten under some circumstances. Although the wide range of signs and symptoms of celiac disease is impressive, a similar, even broader range of impacts may be attributed to gluten in the context of non-celiac gluten sensitivity. Those with celiac disease only comprise a small portion of the population of people who are afflicted by non celiac gluten sensitivity. Dr. Rodney Ford has offered the all encompassing term of 'gluten syndrome' to identify everyone whose health is compromised by gluten consumption (1). From Dr. Fasano's most conservative estimate that 6% of the population is afflicted by non-celiac gluten sensitivity (2), to Dr. Rodney Ford's estimate that 10% is afflicted (3), to Dr. Kenneth Fine's finding that IgG class anti-gliadin antibodies are found in about 11% of the population (4), to this writer's assertion that non-celiac gluten sensitivity includes well more than 20% of the population, the paucity of research in this area offers a wide range of estimates without a solid basis for refuting any of them. Nonetheless, it is clear that those with non-celiac gluten sensitivity outnumber those with celiac disease by a ratio of somewhere between 6 to 1 and more than 20 to 1. The gluten syndrome may therefore include from seven percent to more than twenty percent of the population. The importance of these percentages and ratios is that we are seeing growth in the diagnosis of celiac disease, and in the number of people who have celiac disease (4). It has been argued that a similar trend may be seen across the spectrum of the gluten syndrome, attributing that trend to the genetic modifications that have been made to grains, and the increased consumption of these foods (5). But this is just the tip of the iceberg. Dr. Fasano bases his estimate of non-celiac gluten sensitivity on those who mount an innate immune reaction to gluten grains. While there is likely some overlap between innate immune reactions and selective antibody reactions, most estimates of non-celiac gluten sensitivity are based on IgG class antibodies against one of the proteins of several protein families found in gluten. It makes eminent sense to me that when our bodies are mounting a measurable immune response against the most common food in our diets, whether the reaction is by the innate immune system or by creating selective antibodies, that food might be harmful to our health. I do not quarrel with the basis on which these sensitivities are identified. I simply argue that they are only identifying a sub-fraction of many more possible cases of non-celiac gluten sensitivity. To put this issue into sharper focus, there are several protein families to be found in each of the gluten grains. In wheat, for instance, each family, glutelin, gliadin, and glutenin contains a number of individual proteins. The antibody test for gliadin ignores possible reactions to proteins in either of the other two families. Further, IgG class antibodies are the most common and widespread class of selective antibody we produce. But they form only one of five types of selective antibodies (known as immunoglobulins). Further, as is obvious from Dr. Fasano's conservative approach to identifying non-celiac gluten sensitivity, there are other facets of the immune system that do not involve selective antibodies, and can also be enlisted in a reaction against gluten grains. Thus, when we test for IgG anti-gliadin antibodies, the most common test for non-celiac gluten sensitivity, positive results are identifying reactions against only one of the several protein families found in gluten, and only one of the five possible selective antibody reactions against this single protein family. It therefore seems wholly improbable that testing for reactions against a single protein family in only a single class of selective antibody would identify all or even most cases of gluten sensitivity. Admittedly, some researchers test for IgA antibodies but those investigators usually do not test for IgG antibodies. However, even with testing for both classes of selective antibodies, which most published reports on this issue have not done, it is clear that many possible immune reactions to any other protein fractions of gluten might well be overlooked, either in the form of other selective antibodies or as other immune reactions and various innate reactions against gluten grains. I'm sure that, by now, the reader will see that there are many possible immune reactions against this most common food, and that most of these reactions will go undetected, both in the context of standard medical testing and in most research conducted in this venue. On a more practical plane, when Dr. Curtis Dohan identified significant improvements among patients with schizophrenia patients eating a gluten-free, dairy-free diet (6), and Singh and Kay replicated their findings (7), many looked for celiac disease among patients with schizophrenia and found only a small increase. Dohan and Singh's publications were followed by several sloppy studies that ignored the guiding principles expressed in this pioneering work. These weak studies further undermined acceptance of the connection between gluten and schizophrenia. The net result was a growing belief that Dohan had erred and his heroic work was widely dismissed. Yet, more than twenty years after his death, one of Dohan's most vigorous critics is listed among the authors of a paper that reports an immune reaction against gluten that, while different from the reaction seen in celiac disease, is common among people with schizophrenia (8). Similarly, I think that we can expect, sometime in the future, to see research that identifies immune reactions and damaging dynamics caused by gluten consumption among people with learning disabilities. There is, for instance, one newspaper report of an informal study conducted at the Nunnykirk School in Northumberland, a school that serves only children with dyslexia, a condition that is reported to afflict about 10% of children in the United Kingdom. After six months of eating a gluten free diet, more than 80% of these children improved their reading at a rate of at least twice that of normal children. Some leaped ahead, in their reading skills, by as much as 2.5 years over this six month period (9). Relatedly, I had the privilege of working with Dr. Rodney Ford on a retrospective analysis of indicators of school readiness among children who had celiac disease, non-celiac gluten sensitivity (as measured by selective antibody testing) and children who showed no signs of either reaction to gluten. A large majority of those who reacted to gluten improved dramatically. There was a small but significant sub-group whose school readiness improved following a gluten free diet, and these improvements happened within 6 months of avoiding gluten (unpublished data). Autism, especially where normal development was curtailed after one or several years, is another condition in which excluding gluten seems to provide substantial improvements even in the absence of celiac disease. Some research in this area suggests that toxins (generated by bacteria resident in the intestines) are allowed access to the bloodstream and the brain (10). Perhaps exclusion of dietary gluten is the factor that limits access to the bloodstream through reducing zonulin production. Similarly, although not as well supported, there is some evidence to suggest that gluten contributes to bi-polar disorder. Just how frequent and significant the contribution may be is still open to debate, but I have observed some evidence to support this hypothesis in my own family. A range of types of epilepsy have been found in association with celiac disease, many of which are mitigated by the gluten free diet (11). The manifestations of undetected non-celiac gluten sensitivity are not limited to brain function. We know that celiac disease is much more frequent in the context of other autoimmune diseases. We also know that antibody tests show even higher rates of non-celiac gluten sensitivity. Since we are only identifying a fraction of those who may be reacting to gluten, it seems reasonable to suggest that everyone with an autoimmune disease, or antibodies suggesting that an autoimmune disease is imminent, should begin a strict gluten free diet and follow it for at least one year. If there is any reduction of auto-antibodies or symptoms of autoimmunity, the diet should be continued. Although difficult in the early stages, it is an entirely benign intervention/treatment. There are no unwanted side effects or hazards. There are more than 200 autoimmune and other medical conditions reported in association with gluten and are listed in Appendix D of Dangerous Grains (12). In each case, a lengthy trial of a gluten free diet would be well advised. Again, there are no negative side effects of the gluten free diet. It is an entirely benign intervention. A significant proportion of those who suffer from IBS, Crohn's or any of the various types of colitis have also been reported to benefit from a gluten free diet on various websites. Similarly, many people with MS and a host of other neurological diseases have been shown to benefit from a gluten free diet (13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23). Even many AIDS patients are helped by a gluten free diet. It reduces their diarrhea and improves nutrient absorption (24). This is an important discovery that can be harnessed in conjunction with the improved treatments now available for this very serious illness. Overweight, obesity, and weight loss are contentious issues with regard to the gluten free diet. Until quite recently, there were two reports of small studies of changes in body mass index in the USA and one report from Ireland, following institution of a gluten free diet. The two American studies showed weight loss among overweight subjects on a gluten free diet. The study from Ireland showed only weight gain among overweight subjects after following a gluten free diet. In November of 2011, another small study was published. Their conclusion states "The GFD (gluten free diet) has a beneficial effect upon the BMI (body mass index) of overweight children with celiac disease" (25), which is congruent with the earlier two American studies. I have previously suggested that the discrepancy between the findings may be due to the acceptance of wheat starch as part of the gluten free diet in the United Kingdom. However, regardless of the cause, the preponderance of evidence supports the notion that a gluten free diet can be used as an effective weight loss strategy in some cases of celiac disease. Other evidence suggests it may be a more broadly effective weight loss tool. Thus, my estimate of the prevalence of non-celiac gluten sensitivity includes the 6% who show signs of innate immune reactions to gluten, in addition to those who show IgG antibodies against gluten, at about 11% of the population (although there may be some overlap between these 6% and 11% groups). My estimate also includes many of those with schizophrenia who number about 1% of the general population, and a portion of those with autism who are quickly approaching 1% of the population. I am also including 80% of the approximately 10% of the population with some degree of dyslexia. Because of overlaps between groups, and because gluten's impact is often only demonstrable through a gluten free diet, I only assert that non-celiac gluten sensitivity is a factor in more than 20% of the general population. However, I remain open to findings that will show a much greater negative impact from eating foods derived from gluten grains. The portion of the human population that may be negatively impacted by gluten consumption can range as high as the 80% portion that produce haptaglobin 2, for which zonulin is the precursor. The take away point here is that the gluten free diet may aid overall health for up to as much as 80% of the general population. In that context, my estimate that 20+% of the population is showing signs that they are variously mounting immune reactions against gluten or are otherwise harmed by gluten appears modest. The overlapping symptoms make it extremely difficult to narrow my estimate further. Nonetheless, gluten is one of the most harmful substances in our diet. Yet it is the most ubiquitous factor in our diets. Sources: 1. www.doctorgluten.com 2. Sapone A, Lammers KM, Casolaro V, Cammarota M, Giuliano MT, De Rosa M, Stefanile R, Mazzarella G, Tolone C, Russo MI, Esposito P, Ferraraccio F, Cartenì M, Riegler G, de Magistris L, Fasano A. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med. 2011 Mar 9;9:23. 3. personal communication 4. personal communication 5. Wheat Belly 6. Dohan FC, Grasberger JC. Relapsed schizophrenics: earlier discharge from the hospital after cereal-free, milk-free diet. Am J Psychiatry. 1973 Jun;130(6):685-8. 7. Singh & Kay 8. Samaroo D, Dickerson F, Kasarda DD, Green PH, Briani C, Yolken RH, Alaedini A. Novel immune response to gluten in individuals with schizophrenia. Schizophr Res. 2010 May;118(1-3):248-55. 9. Blair, Alexandra. Wheat-free diet gives food for thought. http://www.timesonline.co.uk/tol/news/uk/article444290.ece 10. Sandler RH, Finegold SM, Bolte ER, Buchanan CP, Maxwell AP, Väisänen ML, Nelson MN, Wexler HM. Short-term benefit from oral vancomycin treatment of regressive-onset autism. J Child Neurol. 2000 Jul;15(7):429-35. 11. Ribaldone DG, Astegiano M, Fagoonee S, Rizzetto M, Pellicano R. Epilepsy and celiac disease: review of literature. Panminerva Med. 2011 Dec;53(4):213-6. 12. Braly J, Hoggan R, Dangerous Grains. Avery, New York, 2002. 13. Hadjivassiliou M, Sanders DS, Grünewald RA, Woodroofe N, Boscolo S, Aeschlimann D. Gluten sensitivity: from gut to brain. Lancet Neurol. 2010 Mar;9(3):318-30. 14. Turner MR, Chohan G, Quaghebeur G, Greenhall RC, Hadjivassiliou M, Talbot K. A case of celiac disease mimicking amyotrophic lateral scl Nat Clin Pract Neurol. 2007 Oct;3(10):581-4. 15. Hadjivassiliou M, Chattopadhyay AK, Grünewald RA, Jarratt JA, Kandler RH, Rao DG, Sanders DS, Wharton SB, Davies-Jones GA. Myopathy associated with gluten sensitivity. Muscle Nerve. 2007 Apr;35(4):443-50. 16. Hadjivassiliou M, Grünewald RA, Kandler RH, Chattopadhyay AK, Jarratt JA, Sanders DS, Sharrack B, Wharton SB, Davies-Jones GA. Neuropathy associated with gluten sensitivity. J Neurol Neurosurg Psychiatry. 2006 Nov;77(11):1262-6. Epub 2006 Jul 11. 17. Hadjivassiliou M, Sanders DS, Grünewald RA. Multiple sclerosis and occult gluten sensitivity. Neurology. 2005 Mar 8;64(5):933-4; author reply 933-4. 18. Hadjivassiliou M, Williamson CA, Woodroofe N. The immunology of gluten sensitivity: beyond the gut. Trends Immunol. 2004 Nov;25(11):578-82. Review. 19. Hadjivassiliou M, Sanders DS, Grünewald RA, Akil M. Gluten sensitivity masquerading as systemic lupus erythematosus. Ann Rheum Dis. 2004 Nov;63(11):1501-3. 20. Hadjivassiliou M, Grünewald RA, Davies-Jones GA. Gluten sensitivity as a neurological illness. J Neurol Neurosurg Psychiatry. 2002 May;72(5):560-3. 21. Hadjivassiliou M, Grünewald RA, Lawden M, Davies-Jones GA, Powell T, Smith CM. Headache and CNS white matter abnormalities associated with gluten sensitivity. Neurology. 2001 Feb 13;56(3):385-8. 22. Hadjivassiliou M, Grünewald RA, Davies-Jones GA. Gluten sensitivity: a many headed hydra. BMJ. 1999 Jun 26;318(7200):1710-1. 23. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71. 24. Quiñones-Galvan A, Lifshitz-Guinzberg A, Ruíz-Arguelles GJ. Gluten-free diet for AIDS-associated enteropathy. Ann Intern Med. 1990 Nov 15;113(10):806-7. 25. Reilly NR, Aguilar K, Hassid BG, Cheng J, Defelice AR, Kazlow P, Bhagat G, Green PH. Celiac disease in normal-weight and overweight children: clinical features and growth outcomes following a gluten-free diet. J Pediatr Gastroenterol Nutr. 2011 Nov;53(5):528-31. 26. Cheng J, Brar PS, Lee AR, Green PH. Body mass index in celiac disease: beneficial effect of a gluten-free diet. J Clin Gastroenterol. 2010 Apr;44(4):267-71. 27. Murray JA, Watson T, Clearman B, Mitros F. Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease. Am J Clin Nutr. 2004 Apr;79(4):669-73.
  10. I need to make a post because I am starting to really trust my gut. (*IT is a SUPER LONG POST). I am very curious if anyone else in this world has experienced or is experiencing something similar to this. I don't know where to go where anyone will believe me. I have had 3 separate passing out/ still conscious incidents where I end up having muscle convulsions. The first one happened New Year's Day 2017, I wasn't eating gluten free at this time. I keep being told I am negative for celiac disease. I was drinking and eating a s$#& ton of gluten. I went to the bathroom and my heart was beating too fast. I felt like I was dizzy, lightheaded, and I was going to faint. I eventually had convulsions on the toilet. Then they stopped I was able to wash my hands then go to the couch. My head dropped losing muscle tone in my body and falling to the floor. On the floor I had were 20-30 different muscle contractions/convulsions. I kept crying and I couldn't talk when they were happening. Eventually, they stopped. April 2017 I had another one in the waiting area of a new GI doctors waiting area. I had just started a high blood pressure medication. I went to pee before my appointment. I sat down. I started sweating on my palms, getting really hot, my heart palpitating, and I got really dizzy again. I told the nurse I am going to faint. My head dropped, and lose muscle tone before convulsing. Of course, my blood pressure dropped too low but was also not gluten free at this point. I was 100% alert and hearing everyone freaking out. I want everyone to understand from August 2017 until end-January 2018 I was on a gluten-free diet. The reason I got off of it at the end of January was for a food sensitivity/allergy test in February. My GI doctor said celiac disease was negative (again) but it seemed that a gluten-free diet would be best. The third time was February 18, 2018. I was at a wedding. I was drinking (and when I was on a gluten-free diet, of course, I made sure what I was eating, and drinking was gluten-free). I am drinking, and I have no care if it's made with gluten. I was eating food too. I sat down for the dinner and the hot sweaty feeling happened, my heart is racing, I feel sick. I feel worried. I know I am going to faint. In the women's bathroom, on this fancy couch with my fiancé. She and I are sitting there and my head drops… I lose all muscle tone. And I have multiple muscle convulsions on the ground… until the ambulance came. I have been to two neurologists who refuse to believe me that the ONE thing these 3 incidents have in common is the fact I was not eating gluten-free. They said to stop drinking.. but I was in Mexico for 1-week January 6th to 13th. Drinking every day and eating gluten-free with no incident like this. They refuse to take a head scan or believe this can be caused by gluten. The people who see it believe they are seizures, but I am 100% alert. It cannot be a seizure. Doctors think it can be trauma, anxiety, convulsion disorder or some other mental illness. I need to know I am not crazy and I know I am not. I believe it is gluten related. My body is telling me it is. Also, I have passed out other times in my life without convulsions that I alreadys related to some kind of food but I didn't know which kind. Thank you for reading.
  11. Celiac.com 02/21/2018 - There's more than a bit of talk in the sports world these days about the potential benefits of a gluten-free diet, even for athletes with no known gluten-sensitivities. More recent questions have been proposed whether the gluten free diet should be recommended for endurance athletes. Swimmers are endurance athletes, so should swimmers go gluten free? Obviously athletes with celiac disease or gluten-sensitivity will see major health and performance benefits by avoiding gluten. Athletes with known gluten-sensitivities include tennis champion Novak Djokovic, who claims to have been diagnosed with a gluten sensitivity in 2010, and Swimmer Dana Vollmer, who is known to suffer from gluten intolerance as well as other allergies. However, a number of high profile athletes with no known sensitivity to gluten have also adopted gluten-free diets, including NFL quarterback Tom Brady, baseball players Justin Morneau and Raúl Ibañez, and football player Cedric Benson, among many others. Athletes claim benefits like speedier recovery times to better stamina and energy levels, despite any solid science to support such claims. A US National Library of Medicine study done with non-celiac athletes found no benefits in athletic performance, gastro-intestinal symptoms, or well-being by following a gluten-free diet compared with a non-gluten-free diet. So, the short answer is no, swimmers and other athletes who are not sensitive to gluten should not adopt a gluten-free diet. That said, if you are not celiac and decide to adopt a gluten-free diet, do take extra measures to make sure you are getting proper nutrition and proper fiber in your diet. Read more at: Swimmingworldmagazine.com
  12. Celiac.com 02/19/2018 - It's very important that people with celiac disease maintain a gluten-free diet. Still, there has been some data to suggest that some people with celiac disease may be "hyper vigilant" in their approach to a gluten-free diet, and that such extreme vigilance can cause them stress and reduce their overall quality of life. Can a more relaxed approach improve quality of life for some people with the disease? A team of researchers recently set out to determine whether "extreme vigilance" to a strict gluten-free diet may increase symptoms such as anxiety and fatigue, and therefore, lower quality of life (QOL). The research team included Randi L. Wolf, Benjamin Lebwohl, Anne R. Lee, Patricia Zybert, Norelle R. Reilly, Jennifer Cadenhead, Chelsea Amengual, and Peter H. R. Green. They are variously affiliated with the Department of Health and Behavior Studies, Program in Nutrition, Teachers College Columbia University New York USA, the Department of Medicine, Celiac Disease Center Columbia University Medical Center, Harkness Pavilion New York, USA. The team assessed the influence of QOL with energy levels and adherence to, and knowledge about, a gluten-free diet. For their cross-sectional prospective study, the team looked at 80 teenagers and adults, all with biopsy-confirmed celiac disease, living in a major metropolitan area. They assessed QOL using celiac disease-specific metrics. The team based dietary vigilance on 24-hour recalls and an interview. They based knowledge on a food label quiz. They used open-ended questions to describe facilitators and barriers to following a gluten-free diet. Overall, extremely vigilant adults had greater knowledge, but significantly lower QOL scores than their more relaxed counterparts. Both teens and adults who reported lower energy levels had much lower overall QOL scores than those with higher energy levels. To maintain a strict gluten-free diet, hyper-vigilant celiacs were more likely to avoid eating out, to cook at home, and to use internet sites and apps. For hyper vigilant eaters, eating out was especially challenging. Being hyper-vigilant about maintaining a strict gluten-free diet can cause stress and adverse effects in both teens and adults with celiac disease. Doctors may want to look toward balancing advocacy of a gluten-free diet with promoting social and emotional well-being for celiac patients. In some cases, allowing a more relaxed approach may increase well-being and, thus, make dietary adherence easier. Obviously, people would need to tailor any relaxation in their gluten-free vigilance to make sure they weren't suffering preventable symptoms or doing themselves any harm. Source: Dig Dis Sci (2018)
  13. Celiac.com 02/02/2018 - An opinion article by Dr. Di Sabatino and Dr. Corazza in the February 2012 issue of Annals of Internal Medicine (1) has unleashed a storm of opinion articles in the popular media that decry the gluten-free diet. The article by these two physicians is mostly reasonable and thoughtful but there are a couple of problems with it. The authors devalue patients' participation in their own health care and implicitly assert that gluten is a healthy food for most people. They do so through a protocol they have devised and by stating that they wish to prevent "a gluten preoccupation from evolving into the conviction that gluten is toxic for most of the population" (1). This statement, and the media claims that followed, reflect several deeply flawed assumptions and perspectives that are not only unscientific, they elevate the physician's observations over the individual's insights into her/his own health. The first assumption, of course, is that gluten is a healthy food for all those without celiac disease. Yet in the very same article, Di Sabatino and Corazza offer a list of afflictions that, in the absence of celiac disease, improve or completely disappear when gluten is withdrawn. Thus, while they acknowledge the existence of these illnesses, they simultaneously assert that a condition of gluten preoccupation exists and that gluten is not toxic for most of the population. They go on to bemoan the absence of clear diagnostic criteria for these non-celiac, gluten-induced illnesses, calling for an individualized approach to diagnosis that would involve patients following a single-blinded gluten challenge test for subjective symptoms and an open test for objective signs and symptoms. In a nutshell, they want patients to undergo a gluten challenge, without knowing (the patient is the one who is blinded) when they are or are not gluten-free, to confirm, for the physician, the patient's claim that her/his symptoms are legitimately linked to gluten ingestion. The gluten challenge is for the sole benefit of the physician. If she/he observes that the signs and/or symptoms worsen with gluten exposure and/or improve after excluding gluten then the physician will be reassured that the patient's self-report is accurate. Does that strike anyone else as a trifle offensive? Of course, this assumes that the physician's tests and observations are somehow more valid than the patient's complaints. I don't want to be too cranky about this. After all, I'm a pretty skeptical person and I think it is important to resist random claims, especially about dietary restrictions, without supporting evidence. But honestly, when an individual is seeking medical advice and reports on their signs and symptoms, there seems little cause to doubt that patient's word. After all, if they misrepresent the facts they are only hurting themselves. Patients can, of course, be mistaken. And those who are interested in a physician's diagnosis might want to subject themselves to such a paternalistic gluten challenge. I have no quarrel with patients making that informed choice. Perhaps some patients will have conditions imposed by their insurance company. Or maybe they will have some other reason to accept this protocol. However, it should not be overlooked that, at its root, this protocol is the antithesis of encouraging patients to take responsibility for their own health care. Further, despite their implied disdain for patients, Doctors Di Sabatino and Corazza don't seem to have considered some of the risks involved in their newly hatched diagnostic protocol which is aimed at pushing back against what they seem to believe is a growing idea that "gluten is toxic for most of the population". In brief, they advocate patients resuming gluten consumption, thus incurring several serious risks to the health and welfare of the patient so physicians may stem the growing tide of gluten-free patients who have undertaken the diet without the blessing of a gastroenterologist or physician. Please take a moment to consider this proposition. The gluten-free diet is restrictive, inconvenient, and expensive. Why would anyone choose to follow such a diet without being convinced that it was valuable to them? Di Sabatino and Corazzo freely acknowledge that there is a dearth of diagnostic tests and protocols for diagnosing or excluding non-celiac gluten sensitivity (although they do overlook some basic tests that I'll discuss shortly). The inconvenience of a gluten-free diet should disabuse critics and skeptics of much of their doubt. However, even if this huge factor is ignored, there are issues of opioid addiction, appetite manipulation, and the risks of triggering allergies, chronic inflammation, autoimmune disease, and psychiatric illness, any or all of which can accompany ingestion of gluten in some individuals. All of these costs and risks are ignored by these two innovators in their Brave New World of non-celiac gluten sensitivity. Addiction to Gluten-derived Opioids Most of the people I know who follow a gluten-free diet are well aware of how addictive gluten can be. Once a person has broken away from an addictive substance, it seems very questionable, to say the least, to persuade them, ostensibly in the interests of their health, to ingest that addictive substance again. Since 1979, we have had solid evidence of the morphine-like peptides of gluten grains (2). Many subsequent reports have replicated the findings first reported by Christine Zioudrou and her colleagues (3, 4, 5, 6) so there is little cause to question the addictive potential of gluten grains and the foods derived from them. How wise would it be to ask a former smoker to do a trial of smoking cigarettes for a few weeks? Or to ask an alcoholic to return to alcohol to reassure his physician of the correctness of the patient's choice to quit? Appetite Manipulation Relatedly, an opioid blocker, Naloxone, was given to a group of binge eaters who experienced reduced "duration and magnitude of binge eating episodes" (7). Another group, of healthy volunteers, showed 28% reductions in food intake on days when they were given the same opioid blocker (8). Although gluten opioids were not the intended target of the Naloxone, it may be that this was exactly what this drug was doing in both of these studies. As the obesity epidemic spreads, it is increasingly important to exercise care with respect to foods that cause abnormal and unwarranted increases in appetite. Other researchers have also reported reductions in food intake after administration of opioid blocking medications (9, 10). Autoimmunity Although obesity is an important health concern, autoimmune disease may be of at least equal concern. The loss of integrity of the mucosal barrier of the small intestine is now considered an important factor in the development of many cases of autoimmunity (11, 12). This group of ailments currently plagues the western world with their serious, sometimes lethal consequences. Especially among those who report symptoms in association with gluten consumption, it seems only prudent to proceed with an abundance of caution. When there may be an increased risk of developing one or more autoimmune diseases, a return to gluten consumption seems a very poor choice. In susceptible individuals, gluten consumption triggers zonulin production. Zonulin mediates the tight junctions between the epithelial cells that form the protective barrier between the digesting food in our intestines, and our bloodstreams (11). Thus, ingesting gluten , for those at risk, invites leakage of undigested and partly digested proteins into the bloodstream. The immune system sees these foreign substances as invaders and attacks them in the same manner it would attack a viral or bacterial invader. These same antibodies sometimes attack self tissues with similar protein structures. Because gluten is ingested each day, several times a day, this leaky gut and flood of antibodies can quickly become chronic. Why would a caring health-care professional advise someone who is reporting symptoms associated with gluten consumption to return to eating this substance when the patient may well be reporting early signs and symptoms of a developing autoimmune disease? Allergies and Inflammation Similarly, a compromised intestinal mucosa has been connected to allergies and chronic inflammation. It seems irresponsible to bring one's professional authority to bear on the patient, encouraging them to return to eating gluten so the physician may be persuaded that the patient is accurately reporting their responses to gluten. At the Department of Neurology at the Royal Hallamshire Hospital in Sheffield, U.K., a group of researchers have been reporting, since the mid 1990s, the identification of elevated serum IgG antibodies against one of the proteins in gluten among a majority of patients with a variety of neurological diseases of unknown origins (13). They also report that the prognosis is quite poor for these people. I attended a presentation by the lead researcher of this group, Dr. Marios Hadjivassiliou, in 2005. He repeatedly stated that these individuals require an exceedingly strict gluten-free diet to have any chance of improving their prognosis. Yet doctors Di Sabatino and Corazza's approach would further compromise these patients' chances of recovery to satisfy the doubts held by physicians. The research group at the Royal Hallamshire Hospital, and many other researchers, continue to use testing for IgG and IgA class antibodies against gliadin, a sub-group of gluten proteins, as an indicator of gluten sensitivity (13). It may be imperfect, but any time a particular food protein is triggering an abnormal immune response in our bodies, it seems reasonable to assert that this individual is sensitive to that food protein. When celiac disease has been ruled out, positive IgG and/or IgA anti-gliadin antibodies clearly indicate a condition of non-celiac gluten sensitivity. There are other forms of non-celiac gluten sensitivity that may be missed by these tests, but it is clear that IgG and IgA testing for anti-gliadin antibodies is identifying some, perhaps most, cases of non-celiac gluten sensitivity. About 12% of the general population shows elevated levels of IgG antibodies against gluten (13, 14). Notwithstanding Di Sabatino and Corazza's assertion that there are no tests for non-celiac gluten sensitivity, IgG and IgA anti-gliadin antibody tests are certainly one means of identifying gluten sensitivity, whether in the blood or in fecal matter. Additional markers may well arise from current and future research. Psychiatric Illnesses Some forty years ago, Dr. Curtis Dohan and his colleagues established a clear connection between gluten and dairy proteins and schizophrenia (15). Doctors Singh and Kay replicated those findings (16). The issue was hotly debated on the basis of several other studies of sloppy design that followed. For a long time, the connection with gluten was dismissed because of the contradictory reports in the medical literature. In the last fifteen years, another spate of research has emerged showing that Dr. Dohan, Dr. Singh, and both of their research groups had unearthed a compelling connection with serious implications for the effective treatment of a sub-group of patients with schizophrenia and other mental illnesses. Some of these findings were capricious, as in the case of a long-term schizophrenic who was placed on a ketogenic diet. After 53 years of battling her symptoms she experienced complete relief from her schizophrenia (17). Genetic studies and investigations of schizophrenic patients and bi-polar patients have also shown that gluten may be an important factor in these conditions (18, 19, 20, 21, 22, 23, 24, 25 ) which are both common and debilitating. A subset of autistic patients have also experienced symptom improvement on a gluten-free diet (25, 26, 27). Thus, there is compelling evidence across a number of specialty areas of human illness in which gluten plays a role as an important contributor to symptoms and/or it lies at the root of these conditions. I must therefore question how Dr. Di Sabatino and Dr. Corazza can assert that gluten is not toxic to most people? Their implicit claim to that effect is questionable given the wide range illnesses that it contributes to or causes. We now know that increased production of zonulin, the mediator of intestinal barrier integrity, discovered at the University of Maryland in 2000 (28), is triggered, in some people, by gluten ingestion (29). Subsequent research has revealed that zonulin is the precursor of haptoglobin 2 which is found in about 80% of the human population (11). In the absence of further research, there may well be cause to suspect that gluten grains are a healthy food for only about 20% of the population. So these two physicians would have us continue to consume gluten until such time as we develop full-blown illness or signs and symptoms acceptable to our physicians. Surely that has put the cart before the horse. Their patients do not visit them for the sole benefit of the physician. Nonetheless that is the central thrust of this protocol. This published opinion has spawned a number of articles online and in the popular press, all of which (that I've seen) seem to ignore all of the concessions to non-celiac gluten sensitivity mentioned in the article by doctors Di Sabatino and Corazza . Some of these spin-off commentaries even use the original article to support their suggestions that a gluten-free diet is inappropriate even for those with symptoms that are relieved by the diet. This blatantly contravenes the opinions expressed by Di Sabatino and Corazza but these journalists don't let the facts get in the way of their over-simplified, august opinions. While I take exception to their implied distrust of patients, at least Di Sabatino and Corazza concede that the gluten-free diet is appropriate for those who experience symptom mitigation or remission when avoiding gluten. These reporters make no such concession. One article from the LA Times, states: "That hasn't stopped many people from declaring they are gluten sensitive, even though they may not be" (30). This journalist seems to imagine that he/she is in a better position to judge whether there is benefit in a gluten-free diet than the people who choose to follow it. Given Di Sabatino and Corazza's flagrant disrespect for patients, I suppose similar disparagement by the journalists who mindlessly follow should not surprise us. They, too, dispense medical advice that could prove very harmful. The quality of that advice is about what one might expect under the circumstances. Doctors Di Sabatino and Corazza not only acknowledge non-celiac gluten sensitivity as a cause for symptoms very similar to those of celiac disease, they call for further research to develop and codify diagnostic protocols that will help clinicians better recognize and treat this newly recognized ailment. They go on to acknowledge that conditions including "headache, lethargy, attention-deficit/hyperactivity disorder, ataxia, or recurrent oral ulceration" in the absence of celiac disease often improve or resolve on a gluten-free diet. Their unfortunate denial of gluten as toxic seems to have invited much of the spin-off, journalistic conjecture under such titles as "Gluten-free diets not always necessary, study suggests" (31). Even the characterization of this opinion article as a study is misleading in the extreme. These journalists and medical opinion authors also seem oblivious to the strong connection between learning disabilities and gluten consumption (32, 33). My own professional experience echoes Blair's report in which 70% to 90% of children with dyslexia accelerated their reading and writing skills more rapidly than mainstream children not afflicted with dyslexia during a six month trial of the gluten-free diet (33). This is startling! In most cases, children with dyslexia work very hard to reduce the gap by which they are falling behind in their studies. In my work it is often difficult to persuade parents of a child who struggles with learning disabilities to undertake a six month trial of a gluten-free diet. Yet the positive results are often quite astounding. The medical opinion expressed by Di Sabatino and Corazza and the subsequent spin-off in the popular press have just made this task substantially more difficult. Who wants to be characterized as a radical nut case? Who wants to risk their child's learning and welfare on a fad diet? These are the accusations implicit in the Di Sabatino and Corazza characterization of "gluten preoccupation" and the journalistic frenzy that followed. One article in The Toronto Star claims that the gluten-free diet is dangerous. Anyone who has followed it knows that claim to be pure nonsense. The article is based on an interview with Dr. Corazza so it is difficult to tell whether the journalist got it wrong or Dr. Corazza actually made this silly claim. The dangers that Dr. Corazza is quoted about are that it will be more difficult to get a diagnosis of celiac disease and that the diet will cost more money (34). Yet the title says " Gluten-free diets could be dangerous, doctors say" (34). What these journalists and physicians missed is the rapidly growing body of evidence showing that increasing numbers of ailments among escalating numbers of people are driven by this ubiquitous food (2-35) . Gluten may or may not be toxic for most of the population. We don't know. We can't know that without more research. Neither can Di Sabatino and Corazza or any of the journalistic lemmings who leaped off that same cliff, asserting that those who take up a gluten-free lifestyle are the ones who are misguided. Regardless of whether gluten is toxic to most of us, a gluten-free diet certainly is not. Just how do Dr. Corazza and/or these journalists imagine that humans survived and thrived before gluten grains were first cultivated about 10,000 years ago? And most of the world's populations survived and thrived without gluten for many more millennia without gluten grains. The growing numbers of people who are willing to accept the inconvenience and expense of a gluten-free diet because of the benefits they experience should incite curiosity and discourse - not contempt and dismissal. Gluten may be toxic to many more people than are currently identifiable by limited available testing. Asserting one side or the other of this argument is at least premature. At most it could prove very harmful to those individuals who listen and obey the voices of experts and journalistic hucksters using devious methods to promote their own pet ideas. Sources: 1. Di Sabatino A, Corazza G. Nonceliac Gluten Sensitivity: Sense or Sensibility? Ann Intern Med. 2012;156:309-311. 2. Zioudrou C, Streaty RA, Klee WA. Opioid peptides derived from food proteins. The exorphins. J Biol Chem. 1979 Apr 10;254(7):2446-9. 3. Fukudome S, Jinsmaa Y, Matsukawa T, Sasaki R, Yoshikawa M. Release of opioid peptides, gluten exorphins by the action of pancreatic elastase. FEBS Lett. 1997 Aug 4;412(3):475-9. 4. Fukudome S, Yoshikawa M. Gluten exorphin C. A novel opioid peptide derived 5. from wheat gluten. FEBS Lett. 1993 Jan 18;316(1):17-9. Fukudome S, Yoshikawa M. Opioid peptides derived from wheat gluten: their isolation and characterization. FEBS Lett. 1992 Jan 13;296(1):107-11. 6. Huebner FR, Lieberman KW, Rubino RP, Wall JS. Demonstration of high opioid-like activity in isolated peptides from wheat gluten hydrolysates. Peptides. 1984 Nov-Dec;5(6):1139-47. 7. Drewnowski A, Krahn DD, Demitrack MA, Nairn K, Gosnell BA. Naloxone, an opiate blocker, reduces the consumption of sweet high-fat foods in obese and lean female binge eaters. Am J Clin Nutr. 1995 Jun;61(6):1206-12. 8. Cohen MR, Cohen RM, Pickar D, Murphy DL. Naloxone reduces food intake in humans. Psychosom Med. 1985 Mar-Apr;47(2):132-8. 9. Wolkowitz OM, Doran AR, Cohen MR, Cohen RM, Wise TN, Pickar D. Single-dose naloxone acutely reduces eating in obese humans: behavioral and biochemical effects. Biol Psychiatry. 1988 Aug;24(4):483-7. 10. Trenchard E, Silverstone T. Naloxone reduces the food intake of normal human volunteers. Appetite. 1983 Mar;4(1):43-50. 11. Tripathi A, Lammers KM, Goldblum S, Shea-Donohue T, Netzel-Arnett S, Buzza MS,Antalis TM, Vogel SN, Zhao A, Yang S, Arrietta MC, Meddings JB, Fasano A. Identification of human zonulin, a physiological modulator of tight junctions, as prehaptoglobin-2. Proc Natl Acad Sci U S A. 2009 Sep 29;106(39):16799-804. Epub 2009 Sep 15. 12. Fasano A. Leaky gut and autoimmune diseases. Clin Rev Allergy Immunol. 2012 Feb;42(1):71-8. 13. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71. 14. Fine K. Enterolabs. Private communication. 15. Dohan FC, Grasberger JC, Lowell FM, Johnston HT Jr, Arbegast AW. Relapsed schizophrenics: more rapid improvement on a milk- and cereal-free diet. Br J Psychiatry. 1969 May;115(522):595-6. 16. Singh MM, Kay SR. Wheat gluten as a pathogenic factor in schizophrenia. Science. 1976 Jan 30;191(4225):401-2. 17. Kraft BD, Westman EC. Schizophrenia, gluten, and low-carbohydrate, ketogenic diets: a case report and review of the literature. Nutr Metab (Lond). 2009 Feb 26;6:10. 18. Dickerson F, Stallings C, Origoni A, Vaughan C, Khushalani S, Leister F, Yang S, Krivogorsky B, Alaedini A, Yolken R. Markers of gluten sensitivity and celiac disease in recent-onset psychosis and multi-episode schizophrenia. Biol Psychiatry. 2010 Jul 1;68(1):100-4. Epub 2010 May 14. 19. Samaroo D, Dickerson F, Kasarda DD, Green PH, Briani C, Yolken RH, Alaedini A. Novel immune response to gluten in individuals with schizophrenia. Schizophr Res. 2010 May;118(1-3):248-55. Epub 2009 Sep 11. 20. Cascella NG, Kryszak D, Bhatti B, Gregory P, Kelly DL, Mc Evoy JP, Fasano A, Eaton WW. Prevalence of celiac disease and gluten sensitivity in the United States clinical antipsychotic trials of intervention effectiveness study population. Schizophr Bull. 2011 Jan;37(1):94-100. 21. Kalaydjian AE, Eaton W, Cascella N, Fasano A. The gluten connection: the association between schizophrenia and celiac disease. Acta Psychiatr Scand. 2006 Feb;113(2):82-90. 22. Wei J, Hemmings GP. Gene, gut and schizophrenia: the meeting point for the gene-environment interaction in developing schizophrenia. Med Hypotheses. 2005;64(3):547-52. 23. De Santis A, Addolorato G, Romito A, Caputo S, Giordano A, Gambassi G, Taranto C, Manna R, Gasbarrini G. Schizophrenic symptoms and SPECT abnormalities in a coeliac patient: regression after a gluten-free diet. J Intern Med. 1997 Nov;242(5):421-3. 24. Dickerson F, Stallings C, Origoni A, Vaughan C, Khushalani S, Yolken R. Markers of gluten sensitivity in acute mania: A longitudinal study. Psychiatry Res. 2012 Mar 2. 25. Millward C, Ferriter M, Calver S, Connell-Jones G. Gluten- and casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev. 2004;(2):CD003498. 26. Shattock P, Whiteley P. Biochemical aspects in autism spectrum disorders: updating the opioid-excess theory and presenting new opportunities for biomedical intervention. Expert Opin Ther Targets. 2002 Apr;6(2):175-83. 27. Knivsberg AM, Reichelt KL, Høien T, Nødland M. A randomised, controlled study of dietary intervention in autistic syndromes. Nutr Neurosci. 2002 Sep;5(4):251-61. 28. Fasano A, Not T, Wang W, Uzzau S, Berti I, Tommasini A, Goldblum SE. Zonulin, a newly discovered modulator of intestinal permeability, and its expression in coeliac disease. Lancet. 2000 Apr 29;355(9214):1518-9. 29. Clemente MG, De Virgiliis S, Kang JS, Macatagney R, Musu MP, Di Pierro MR, Drago S, Congia M, Fasano A. Early effects of gliadin on enterocyte intracellular signalling involved in intestinal barrier function. Gut. 2003 Feb;52(2):218-23. 30. http://www.latimes.com/health/boostershots/la-heb-gluten-sensitivity-20120221,0,4517592.story 31. http://www.cbsnews.com/8301-504763_162-57381966-10391704/gluten-free-diets-not-always-necessary-study-suggests/ 32. Knivsberg AM. Urine patterns, peptide levels and IgA/IgG antibodies to food proteins in children with dyslexia. Pediatr Rehabil. 1997 Jan-Mar;1(1):25-33. 33. http://www.timesonline.co.uk/tol/news/uk/article444290.ece 34. http://www.thestar.com/living/article/1146787--gluten-free-diets-could-be-dangerous-doctors-say#article 35. Hoggan R. Considering wheat, rye, and barley proteins as aids to carcinogens. Med Hypotheses. 1997 Sep;49(3):285-8.
  14. Celiac.com 01/11/2018 - Gluten-free, food allergies and celiac disease have reached the media in the form of jokes and ridicule. This is a serious development because the media influences viewer's day-today reactions to various social situations. In many ways, TV becomes a role model for social interactions. DeVault (1991) says that "an enormous body of science, literature and even humor tells us how a middle-class man and woman might 'do' family life" (p. 16). This is the fundamental reason why the media jabs about gluten-free and food allergies are so impactful. What we see on TV, we emulate in life. If 'doing gluten free' is something to be ridiculed, as with the examples below, then those of us with food allergies need to unite our voices to be heard in public forums to change this practice. An example of food-allergy ridicule is found in a scene in The Smurfs 2 when the unctuous "Corndog King" presents every child at a birthday party with a corn-dog. A concerned parent asks if the corn-dogs contain peanuts, and he says, "No, I would never use peanuts." Meanwhile, a little boy is shown eating the corn-dog just as the Corndog King recalls that they are fried in peanut oil. The parents rush to the little boy urging him to spit it out. Here is the snippet: . I think the producers thought this incident was funny. Newsflash: It isn't. This scene has been criticized on various blog sites as making light of allergies, but one criticism from a parent of a child who recently died from inadvertently eating peanuts is especially poignant. The parent said scenes like this are not funny, nor entertaining. Scenes of this nature on TV undermine the consequences of food allergies.As much as I love Frankie and Grace, the game that the siblings played in Season 3, Episode 1, called "Bud's Super Needy Girlfriend Game" is offensive. It shows them eavesdropping as Allison, Bud's girlfriend, talks about her allergies to a stranger at the art show. With each statement Allison makes, such as, "it is easier to tell you what I am not allergic to," the group takes a shot of liquor. Allison says, "and that's when I realized I have celiac disease" and the siblings laugh and take another shot. This goes on for several rounds. The siblings ridicule Allison's allergies and maladies in a very uncompassionate way, setting an example for viewers on how to respond when there is a person in the crowd who has allergies. In another episode, when Allison faints, the reaction from the siblings is, "…she always has to be the center of attention. She conjures up some kind of illness. But there's a name for it, 'Fictitious disorder.'" (For a transcript of this and similar scenes, please check out: http://thewalkingallergy.com/2017/08/grace-and-frankie-i-bet-allison-has-mcas/). These responses to Allison's physical malaise are callous and may encourage copycat behavior in real life situations. Humans are easily influenced, starting from infancy when they imitate their parents (McCall, Parke & Kavanaugh, 1977) and continue to be guided by what they view in the media, especially on TV. Ramasubramanian (2010) conducted a study to discover how stereotypes of laziness and criminality changed as a result of reflecting on TV depictions of racial/ethnic groups by white viewers (p. 109) and concludes that the ways these scenes influence opinions and attitudes is worrisome (p. 106), perpetuating stereotypes and prejudice. A study conducted by Tan and Kinner (1982) found that interracial children who watched a TV program showing cooperative, positive behavior, yielded "pro-social" (p. 654) social interactions, when compared with a control group. The impact of what is viewed on TV and how it translates to social (or anti-social behavior) has been validated. Humans imitate what they see. Similar to how racial stereotyping is reinforced by the media, so are people with food allergies who become the butt of jokes. The media is teaching unacceptable social norms disguised as humor. Disney's episode of Quitting Cold Koala (edited out after parents complained, but still on YouTube in a home-video snippet) shows the character named Stuart (who has a "five page list of dietary problems" according to his nanny) sitting at the breakfast table with other children. He is a cute little boy who wears glasses cocked awkwardly on his nose. He told the cook that he couldn't eat pancakes that contained gluten only to be attacked by other children throwing gluten-containing pancakes in his face! Here it is on: . Stuart reacts the way anyone would who has celiac disease. He says, "That's gluten!" and frantically tries to wipe it off his face. I agree with the person who put the video of it on YouTube. This is not "remotely funny. Depending on how sensitive Stuart is, he may have had to suffer through a reaction because of those mean kids. And though this segment was deleted from the final cut of the episode, several people captured videos of it so it remains on the Internet for anyone to see. It sets a sad, and arguably violent standard for how to treat the child that has special dietary needs. Huesmann and Taylor (2006) found that violent behavior on TV poses "a threat to public health inasmuch as it leads to an increase in real-world violence and aggression" (p. 393). Violence toward someone with food allergies, such as throwing pancakes at the person who has just declared they are sensitive to gluten is an example of how behavior seen on TV could be re-enacted in real-life.How do scenes like the three examples above translate into our everyday social interactions? Does the waiter who watches a scene on a sit-com ridiculing someone with food allergies doubt the customer the next day as she orders a gluten-free meal? Does the waiter play a derivation of the "Needy Game" seen on Frankie and Grace and have a shot of liquor in the back room with his waiter-buddies for every customer that orders a special meal? Ridicule in the media completely undermines the severity of celiac disease, and other food-related illnesses. I experienced a situation the may have been influenced by commercial programming recently while ordering at a restaurant. I special-ordered my salad, deliberately sitting on the end of the table and explaining to the waiter that I needed to ensure it was gluten and dairy free. I spoke quietly, but since there were only two others at the table, unfortunately the conversation stopped during ordering and the others heard me. The waiter rolled his eyes when I gave him my order, and moved on to the next person who said, "I'll take the salad 'regular' with all the fixings" in a kind of a sarcastic way that belittled my order. My dinner was spoiled because I was irked with my dinner companion, and because I was skeptical of the food I was served. This kind of slight happens all the time, and is likely because of the role models depicted on TV and other media that portrays that it is it socially acceptable to mock the person with special needs. It is hard to understand why food sensitivities trigger so much negativity. If someone says they have heart disease, they are taken seriously. Other autoimmune diseases such as rheumatoid arthritis, lupus, Hashimotos, and diabetes are met with seriousness, but gluten-sensitivities seem to be a charged 'trigger' reaction, that I believe has been perpetuated by the media. People ordering in a restaurant seem to be challenged by the waiter – scrutinized whether it is an 'allergy,' 'autoimmune response' or 'fad diet.' When did waiters have the prerogative to make that kind of decision? Where did this 'right' come from? I believe the media has perpetuated these attitudes. Nobody with special needs should endure scrutiny or ridicule. I'm frankly glad for the publicity gluten has received because it has enhanced awareness, but I am discouraged about how the media seems to think celiac disease, gluten intolerance and food allergies are a joke. Here is our call to action: When we see something offensive in the media ridiculing food allergies, we need to say something in a public forum to bring attention to this unacceptable portrayal of people with food sensitivities. Please post on social media, or on Celiac.com to create a buzz that this type of ridicule/humor is unacceptable. Perhaps by doing this, we can influence positive changes. And on another subject… the winners from the survey. A couple of months ago, a survey studying the impact of food sensitivities on adults living together offered a $25 gift card to Amazon to four lucky winners. Those are: Morgan, Angela, David and Tricia. (Winners have been notified and gift cards were sent via email.) Congratulations! And thank you for your participation in the study. References DeVault, M. L. (1991). Feeding the family: The social organization of caring as gendered work. Chicago, IL: University of Chicago Press. Huesmann, L. R., & Taylor, L. D. (2006). The role of media violence in violent behavior. Annual Rev. of Public Health (27), 393-415. McCall, R. B., Parke, R. D., Kavanaugh, R. D., Engstrom, R., Russell, J, and Wycoff, E. (1977). Imitation of live and televised models by children one to three years of age. Monographs of the Society for Research in Child Development 42(5), 1-94. Tan, A. S., Kinner, D. (1982). TV role models and anticipated social interaction. Journalism Quarterly 59(4), 654-656.
  15. Celiac.com 12/12/2017 - Does a gluten-free diet have any effect on cardiovascular risk in people with celiac disease? Does it effect people without celiac disease? So far, both questions have remained unanswered. Recently, a team of researchers set out to conduct a systematic review to shed some light on the matter. The team was led by Michael D.E. Potter, MBBS (Hons), from the University of New Castle, Australia. The team focused their review on the "potential of the gluten-free diet to affect modifiable cardiovascular risk factors including weight, blood pressure, cholesterol and blood sugars," and to do this they searched for "studies which measured these risk factors in individuals before and after the institution of a gluten-free diet." In all, Potter and colleagues reviewed 27 studies that evaluated the effect of a gluten-free diet, as followed for a minimum of 6 months, on cardiovascular risk factors such as BMI, waist circumference, blood pressure, fasting glycemia, hemoglobin A1c and serum lipids. Despite their efforts, they found no clear evidence that a gluten-free diet increases cardiovascular risk in celiac patients. They found no evidence that it increases heart disease risk in people without celiac disease. They really found nothing much at all. While the results varied across studies, and researchers did see changes in some cardiovascular risk factors, they say the data do not support a gluten-free diet for cardiovascular health in individuals without celiac disease. True, perhaps. But it's also true that the data neither support nor condemn a gluten-free diet in people without celiac disease. Unless and until researchers get some solid data from large groups and can make accurate, informative comparisons between those groups, it seems foolish for them to advocate or discourage a gluten-free diet in people without celiac disease. Source: Healio.com
  16. 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.
  17. Celiac.com 11/23/2017 - Many theories have been fielded about autism. Some research careers have been made by investigating autism, while other careers have been seriously damaged when that research threatened some sacred cows of allopathic medicine. Yet despite all of this active research exploring the world of autism, we continue to experience exponential increases in rates at which autism is diagnosed. And debate continues unabated regarding the causes and appropriate treatments. Part of this increasing trend is, doubtless, because we have gotten better at recognizing the various manifestations of this debilitating condition. However, the evidence indicates that there is a dramatic increase in the absolute incidence of autism. Although frightening, this trend may offer some insight into several of the factors that contribute to this condition. That is the crux of my argument here. Since most prior theories have been tested in isolation, as is the norm in medical investigations, measurement of changes induced by individual contributing factors may either be so mild as to escape notice, or may not have been sufficient to induce symptom mitigation. Similarly, if preconceived notions shape resistance to some of these hypotheses, we may miss the most salient characteristics of autism. I have therefore chosen to combine several findings to form a testable hypothesis. I'll let posterity and the reader be the judges of whether this speculation is worthy of further investigation. We begin with Dr. Kalle Reichelt, who sought to understand autism and other psychiatric illnesses through the prism suggested by Dr. Curtis Dohan's work investigating schizophrenic patients. While Dohan et al reported positive results among schizophrenics from a gluten free, dairy free diet, Reichelt and his colleagues identified unique peptides in the urinary excretions from patients on the autistic spectrum and explored their possible connections with gluten and dairy proteins(1). A leaky gut appeared to be a precondition for autism. In 1996, D'Eufemia and others reported increased intestinal permeability in almost half of their autistic patients, using synthetic sugars that can be measured in the urine (2). Gardner has reported disturbed gastrointestinal function in autism. Reichelt and Knivsberg have also published reports of improved social interaction and communication among some children with autism following institution of a gluten-free, casein-free diet (4). However, their investigations reveal that the diet must be consistent, strict, and long-lasting to allow the gradual dissipation of the psychoactive peptides from these foods. Others have reported that this dissipation process can take up to 12 months (5). It is important to note that, while the work indicating that the symptoms of autism can often be mitigated by the strict, long-term avoidance of gluten and dairy, none of these investigators claimed that this diet can cure autism or even eliminates all of its symptoms. The diet simply helped children improve to the point where they could function better in school and society by mitigating their most severe and limiting symptoms (4). Many of these researchers postulate that improved integrity of the intestinal barrier and reduced ingestion of psychoactive peptides in the diet are a likely root of these improvements. Against this backdrop of widespread recognition of gastrointestinal dysfunction, excessive intestinal permeability, and symptom mitigation through dietary restriction in many autistic children, Dr. Andrew Wakefield, along with 12 other researchers, published their discovery of a pattern of intestinal inflammation and compromised barrier function in 11 of 12 subjects with pervasive developmental disorders, including 9 children with autism. Based on histories provided by parents, health visitors, and general practitioners, a pattern of behavioral/autistic symptom onset was seen within 14 days of combined vaccination for measles, mumps, and rubella. The average time to symptom onset was about 6 days. In the same report, Wakefield et al state "We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described." Later on the same page, they state "If there is a causal link between measles, mumps, and rubella vaccine and this syndrome, a rising incidence might be anticipated after the introduction of this vaccine in the UK, in 1988." [my emphasis] Wakefield et al identify several reports connecting vaccine-strain measles virus with Crohn's disease and autoimmune hepatitis. They also hearken to earlier work that implicates inflamed or dysfunctional intestines in the behavior changes seen in some children. They point to other factors that suggest a genetic predisposition may also be a precondition of developing autism, along with markers of vitamin B12 deficiency (which many readers will recognize as a common finding in celiac disease and non-celiac gluten sensitivity). Clearly this group was not attacking the MMR vaccine or its importance to public health. Nonetheless, in the same issue of The Lancet, no less than six letters, written by a combined total of 21 authors, attacked Wakefield et al because of the impact that their findings might have on public health. Over the ensuing months and years, Wakefield's methods were criticized and denigrated. One of the more emotional attacks alleged academic fraud on Wakefield's part (7). He has been vilified in the public and professional media as a brigand. Yet he and his research group were careful to avoid making any claims beyond having found a form of bowel disease (lymphoid hyperplasia) in 9 of their subjects, and non-specific colitis in 11 of their subjects, along with reporting the close temporal association of onset of behavioral symptoms and MMR vaccines as reported by parents, health visitors, and general practitioners. They would have been remiss had they failed to report this association. Further, there were 12 other researchers who put their names to this research. Surely we cannot suspect that all 13 of these professionals would risk their careers to perpetrate a fraud! Meanwhile, as these attacks were ginning up, a research group at the University of Maryland reported that, in genetically susceptible individuals, a protein they dubbed "zonulin" can, when gluten is ingested, induce changes to intestinal permeability (8, 9). Does the gluten free, dairy free diet reduce excessive intestinal permeability? We know it does in people with celiac disease (8), but what impact would or could it have on children with the lymphoid hyperplasia and/or non-specific colitis identified by Wakefield et al? And does reduced zonulin production due to restriction of these foods explain the benefit experienced by many children with autism? Perhaps these questions are also relevant to another area of autism research reflected by identification of specific strains of clostridium infection in autism, first postulated by Bolte (10). Dr. S. Finegold and his colleagues demonstrated that 8 of 10 children with late onset autism showed transient reductions of symptoms of autism in response to oral vancomycin which returned when vancomycin was withdrawn (11). This is an antibiotic that is usually used in cases of antibiotic-resistant infections. Because this group identified an unusually large number and variety of strains of clostridium in their autistic subjects, as compared with controls, and because many clostridium variants excrete neurotoxic substances, their use of vancomycin was given to target clostridium. However, elements of Finegold's work and Wakefield's work may be taken to suggest some overlap. For instance, could the added clostridium load in autistic children contribute to the intestinal inflammation and permeability seen in Wakefield's report? Or could the MMR vaccinations produce conditions that are more hospitable to antibiotic resistant, neurotoxic strains of clostridia? Or could symptoms induced by MMR lead to administration of antibiotics that provide favorable conditions in the gut for proliferation of clostridium? To further complicate this issue, Dr. Stephanie Seneff has identified vitamin D deficiency, and popular use of statin drugs, in combination with reduced dietary consumption of cholesterol and fats as possible factors in autism. She implicates these deficiencies as arising either in utero or in infancy and she specifically cites work demonstrating that cholesterol, fats, and vitamin D are important components of healthy immune function (14). Putting it all together The hypothesis embodied herein asserts that at some stage the autistic child has: some predisposition to autism; a multi-dimensionally compromised immune system; been exposed to multiple and uncommon strains of clostridium which lead to the colonization of the gut by these antibiotic-resistant bacteria; are suffering from some degree of vitamin D deficiency and are eating a diet that is deficient in fats and cholesterol. Further, as the child develops one or more of the symptoms or sequelae of clostridium colonization or other infection, antibiotics are administered to provide relief from these or other symptoms of infection, sometimes including chronic ear infections. Thus, the competing gut bacteria that might otherwise keep these strains of clostridia in check are wiped out, permitting broader proliferation of multiple strains of clostridia. Similarly, the MMR vaccine, which, by design, engages and taxes the immune system. In the immune system's weakened state resulting from vaccination and dietary opioids (13), increased numbers of unusual strains of clostridium, abnormal gut biome, cholesterol deficiency, vitamin D deficiency, and perhaps, other nutrient deficiencies, also reduces systemic surveillance for, and antibody combat with, the clostridia and/or remnants of MMR vaccine. The neurotoxic excreta from clostridia and MMR are released into the intestinal lumen and by zonulin's action to widen the junctions between epithelial cells, these toxins are thus given access to the bloodstream. By the same pathway, opioids, other psychoactive peptides from gluten and dairy, along with other undigested and partly digested proteins, which may be harmful, also reach the bloodstream. From there, they travel to the BBB where zonulin again opens gaps in this barrier and allows the clostridium-derived toxins, opioids, and other impurities access to the brain where they alter blood-flow patterns, damage neurological tissues, and perhaps do other damage that has not yet been recognized. Ultimately, this damage and dynamics lead to impeded social performance, intellectual performance, and sometimes, induce startlingly abnormal behaviors. Although this picture appears bleak, and much of it simply reflects the several dietary miscues of the last and our current century, there are corrective steps that can sometimes improve these children's lives. Vitamin D, vitamin B12, and other supplements can be administered to address deficiencies. Because of the associated gut problems, sub-lingual vitamins, and exposure to sunlight without sun screen may both be good starting points. A strict, long-term gluten free, dairy free diet should also be on the menu, even if the whole family has to follow it to ensure that the autistic child does not rebel due to feeling deprived. High levels of cholesterol, saturated and mono-unsaturated fats should also comprise a large part of the diet. One or more courses of vancomycin may also be worth trying. In isolation, the benefits of antibiotics alone will likely be short-lived, as reported by Finegold, but in combination with these other strategies, may extend the benefits of this drug. New developments in antibiotics research may lead to isolation of protective substances from hens' egg shells that may provide more appropriate antibiotic relief and therefore benefit these children even more (15). Most of the research, to date, has focused on one of these factors in isolation. However, if an immune system is compromised by any or all of cholesterol deficiency, vitamin D deficiency, vitamin B12 deficiency, dietary shortages of cholesterol and fats, lingering, chronic sequelae of MMR vaccination, opioids from gluten and/or dairy, and an unusual and wide variety of clostridia, then it seems unreasonable to expect to reverse this condition through implementing only one of the interventions suggested by the above. Each and all of these other components should be addressed when attempting to remediate autism. In the context of these dietary and lifestyle changes, appropriate antibiotics may lead to more permanent improvements for the autistic child. This would be the greatest gift that a physician, parent, or caretaker could give to these children. One may hope. References: Reichelt KL, Hole K, Hamberger A, Saelid G, Edminson PD, Braestrup CB, Lingjaerde O, Ledaal P, Orbeck H. Biologically active peptide-containing fractions in schizophrenia and childhood autism. Adv Biochem Psychopharmacol. 1981;28:627-43. D'Eufemia P, Celli M, Finocchiaro R, Pacifico L, Viozzi L, Zaccagnini M, Cardi E, Giardini O. Abnormal intestinal permeability in children with autism. Acta Paediatr. 1996 Sep;85(9):1076-9. Gardner MLG (1994) in Physiology of the gastrointestinal tract (Johnson LR : edit) Rave Press, NY pp 1795-1820 Knivsberg AM, Reichelt KL, Høien T, Nødland M. A randomised, controlled study of dietary intervention in autistic syndromes. Nutr Neurosci. 2002 Sep;5(4):251-61. Paul, K., Henker, J., Todt, A., Eysold, R. (1985) Zoeliaki- Kranken Kindern in Abhaengigkeit von der Ernaehrung Seitschrift der Klinische Medizin 40; 707-709. as reported in Reichelt K (1990). The Effect of Gluten-Free Diet on Urinary Peptide Excretion and Clinical State in Schizophrenia. Journal of Orthomolecular Medicine. 5(4): 223-239. Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P, Valentine A, Davies SE, Walker-Smith JA. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 2004 Mar 6;363(9411):750. Flaherty DK. The vaccine-autism connection: a public health crisis caused by unethical medical practices and fraudulent science. Ann Pharmacother. 2011 Oct;45(10):1302-4. Epub 2011 Sep 13. Fasano A, Not T, Wang W, Uzzau S, Berti I, Tommasini A, Goldblum SE. Zonulin, a newly discovered modulator of intestinal permeability, and its expression in coeliac disease. Lancet. 2000 Apr 29;355(9214):1518-9. Clemente MG, De Virgiliis S, Kang JS, Macatagney R, Musu MP, Di Pierro MR, Drago S, Congia M, Fasano A. Early effects of gliadin on enterocyte intracellular signalling involved in intestinal barrier function. Gut. 2003 Feb;52(2):218-23. Bolte ER. Autism and Clostridium tetani. Med Hypotheses. 1998 Aug;51(2):133-44. Finegold SM, Molitoris D, Song Y, Liu C, Vaisanen ML, Bolte E, McTeague M, Sandler R, Wexler H, Marlowe EM, Collins MD, Lawson PA, Summanen P, Baysallar M, Tomzynski TJ, Read E, Johnson E, Rolfe R, Nasir P, Shah H, Haake DA, Manning P, Kaul A. Gastrointestinal microflora studies in late-onset autism. Clin Infect Dis. 2002 Sep 1;35(Suppl 1):S6-S16. http://stephanie-on-health.blogspot.ca/2008/11/sunscreen-and-low-fat-diet-recipe-for.html Hoggan R. Considering wheat, rye, and barley proteins as aids to carcinogens. Med Hypotheses. 1997 Sep;49(3):285-8 Seneff S, Davidson R, Mascitelli L. Might cholesterol sulfate deficiency contribute to the development of autistic spectrum disorder? Med Hypotheses. 2012 Feb;78(2):213-7. Epub 2011 Nov 17. Wellman-Labadie O, Lakshminarayanan R, Hinckeemail MT Antimicrobial properties of avian eggshell-specific C-type lectin-like proteins. FEBS Letters Volume 582, Issue 5 , Pages 699-704, 5 March 2008
  18. Celiac.com 10/27/2017 - It has long been understood that two autoimmune diseases, celiac disease and type 1 diabetes are related. They share common genes and the incidence of celiac disease is higher among type 1 diabetics. There have been some anecdotal reports regarding children diagnosed with type 1 diabetes who were put on a gluten-free diet soon after their diagnosis and for a period of two years or more didn't require any insulin. The thought was that the gluten-free diet effectively halted the progression of the diabetes, at least for the duration of the study. Studies of mice have shown that despite utilizing a genetic strain of mice that were strongly in-bred to increase the risk of type 1 diabetes, 2/3 of them did not do so when a drug was administered to prevent leaky gut. This study was performed by Dr. Alessio Fasano at the University of Maryland Celiac Research Center. Dr. Fasano is one of the world's acclaimed researchers in the area of celiac disease and gluten sensitivity. Leaky gut is associated with the initiation and continuation of autoimmune disease and Dr. Fasano's work with these genetically predisposed mice shed a great deal of light on the power of an undamaged gut lining to effectively forestall development of a genetic condition, in this case type 1 diabetes. A recent study out of Immunology, dated August 22, 2012, is titled "Dietary gluten alters the balance of proinflammatory and anti-inflammatory cytokines in T cells of BALB/c mice". The title is a mouthful but here is what the researchers out of Denmark found: Their initial premise was based on the idea, as I mentioned above, that dietary modifications, specifically a gluten-free diet, could reduce the risk of developing type 1 diabetes. The question they posed was, "How did this occur?" They discovered that wheat gluten induced the production of pro-inflammatory chemicals called cytokines that would damage the intestinal lining and immune tissues of the small intestine. More importantly, a gluten-free diet didn't just neutralize the negative effects just mentioned, but it actually caused the production of anti-inflammatory chemicals that would provide protection for the immune system and gut. So, while gluten is a known bad guy, a gluten-free diet doesn't just take the negative away, it actually induces a positive, healing response. Clinically we frequently see this with patients. As soon as we meet a patient with any history of autoimmune disease, we quickly test them for celiac disease and gluten sensitivity via lab tests and a 30 day elimination diet. If we discover any negative immune reaction to gluten, we begin a strict gluten-free diet. Happily, we often see stabilization, if not reversal, of their autoimmune disease. We support the gluten-free diet with our other protocols for normalizing gut permeability (healing a leaky gut) and strengthening the immune system. Taken together this program yields excellent results. If you know anyone suffering from an autoimmune disease, please show them this article. Gluten could be a component in furthering their disease and a gluten-free diet could be a positive influence in their journey to improved health. I hope this was helpful. Please feel free to contact me should you have any questions. And if your health is not at the level you would like, I can also offer you a free health analysis. Call us at 408-761-3900. Our destination clinic treats patients from across the country and internationally and we would be delighted to help you. To your good health.
  19. Celiac.com 09/27/2017 - Patients who have clinical, genetic and histological signs of celiac disease, but no serological markers, present a challenge when it comes to making a diagnosis. If the patient doesn't have elevated antibodies, what signs do doctors look for? What's the best way to evaluate the patient's natural history and response to a gluten-free diet? A team of researchers recently set out to outline a specific profile, and to evaluate the natural history and response to a gluten-free diet of patients with seronegative celiac disease. The research team included Maria Pina Dore; Giovanni Mario Pes; Ivana Dettori; Vincenzo Villanacci; Alessandra Manca and Giuseppe Realdi. They are variously affiliated with the Internal Medicine Section, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy, with the Baylor College of Medicine, Michael E. DeBakey VAMC, Houston, TX, USA, the Pathology Section, Department of Molecular and Translational Medicine, Spedali Civili and University of Brescia, Brescia, Italy, and with the Pathology Section, Department of Clinical and Experimental Medicine, University of Sassari in Sassari, Italy. Patients with duodenal mucosa damage Marsh I, II and III stages, HLA DQ2/DQ8 haplotype and clinical features suggestive of celiac disease, but with negative celiac serology, were defined as seronegative celiac patients. The team excluded other common causes of duodenal mucosa damage. They the compared HLA–DR and DQ genotype/haplotype between all Marsh stages of patients with seronegative and seropositive celiac disease. They then assessed clinical features, lab tests and histological findings after a gluten-free diet and a gluten re-challenge. The group provided the team with a long follow-up period to gather data. The researchers enrolled a total of 48 patients who fulfilled diagnostic criteria over a 4-year period. Patients with seronegative and seropositive celiac disease showed similar clinical phenotype and HLA−DR and DQ frequencies. However, Marsh I stage was seen in 42% of seronegative patients (42% vs 22%; p<0.05). After a 1-year gluten-free diet trial, clinical symptoms, histological features and laboratory testing improved in 40 patients and worsened in those who underwent a 6-months gluten challenge. Five patients with seronegative celiac disease (25%) experienced the occurrence of autoimmune diseases during an average follow-up of about 11 years. Patients with seronegative celiac disease did not show any specific profile, but they did see benefits from a gluten-free diet similar to seropositive patients. In the absence of more sensitive serological markers, diagnosing seronegative celiac disease remains an often confusing and challenging process of excluding various other possibilities. Source: BMJ Open Gastro. 2017;4(1):e000159
  20. Celiac.com 09/22/2017 - I run into many parents who are in quite a quandary about instituting a gluten-free diet for their child. A typical scenario is that one of the parents is gluten intolerant and is highly suspicious that their child is as well. Due to the child being 'relatively healthy' the non-gluten intolerant spouse suggests that the child be able to 'live a little' and enjoy the cake and pizza that is so prevalent during children's parties and sporting events. In my opinion, there is no question about whether a gluten-free diet should be implemented, after confirmation that gluten intolerance exists that is. I know that gluten intolerance vastly increases your risk of developing diseases that can affect almost any system and/or organ in the human body. The evidence shows that it vastly increases your risk for autoimmune disease. I also know that it can be rather silent in a younger body, but if a positive test exists, then it IS doing damage, regardless of whether it is felt or not. To add a little more strength to my argument is the result of a recent study published by the Journal of Human Nutrition and Dietetics wherein researchers aimed to evaluate the influence of celiac disease on the social aspects of life in those living in the U.S. Not surprisingly celiac disease did have a negative impact on the quality of life in social settings, specifically in the area of travel and dining out. However, and this is where I find that most people make their mistake with their children, the researchers found that 'those diagnosed in childhood and maintained on the diet experienced a reduced impact on their quality of life as an adult'. So it turns out that you aren't doing any favors to your at-risk child by putting off the implementation of a gluten-free diet. You're not only creating negative impacts health-wise, as mentioned above, but by delaying a gluten-free diet you are also condemning them to the perception of a lower quality of life. If you think about it, if gluten-free is pretty much all you've ever known, you would be less likely to miss it. You haven't built up the memories of gluten-containing cakes and pizzas and pancakes. Please do not put off testing your child because you think you're doing him or her a favor by putting it off. The truth is quite the contrary. Waiting could allow an autoimmune or other illness to develop that could have been avoided. There is absolutely NO benefit to one's health to continue eating gluten when one is gluten intolerant, and it turns out that there is no benefit psychologically either. Have you run into this argument from friends or family? Have you put off diagnosing a child because you were made to feel guilty? Please write to me and let me know your experiences and thoughts. To your good health. Reference: Journal of Human Nutrition and Dietetics. 2012 Feb 25. Living with coeliac disease: survey results from the USA. Volume 25, Issue 3, pages 233–238, June 2012
  21. Celiac.com 09/08/2017 - For for the overwhelming majority of our time here on this planet we've all followed a paleo, or hunter-gatherer, diet. This is not a way of eating invented by the latest Hollywood guru – though truth be told there are now plenty of stars who eat this way. It's common sense, really, if you're able to unlearn a good portion of the dietary wisdom we've been force-fed over the last generation or two. Paleo means little more than, in the words of Ray Audette, what you could find to eat if you were "naked with a sharp stick.” And the foods you'd find would have to be, at least in theory (though usually not in practice), edible raw. So what foods would have been available to our ancestors? Meat, for sure. There are no known hunter gatherer populations who were vegetarian/vegan. Animal protein is vital to human health. Why then do we hear about healthy vegetarian diets? Because they are healthy as compared to the modern Western diet, with its ubiquitous high fructose corn syrup, artificial fats and sweeteners, and high-glycemic carbohydrates. Ok, so animal protein. What else could have been found by our ancestral hunter-gatherers? Fruit and true vegetables, in season. That's basically it: meat, fruit, vegetables. And of course, plenty of good, cold water. What did we not eat then? Grains in any form, gluten-free or not. Legumes, which are extremely toxic raw and have to be soaked and cooked in order to be edible. (Hint: peanuts are legumes!) New world foods like chocolate, coffee. The list goes on and you should have the hang of it by now. Again, the standard: foods edible raw that would have been available to our ancestors. Question: Would dairy have been available to our ancestors? The answer is clearly no, other than in the form of human breastmilk for the first few months or years of life. Bovine milk, meant for calf populations, is not a natural human food. Sound overly restrictive? Let me tell you today's menu: For breakfast, three eggs over easy with bacon and a glass of fresh-squeezed orange juice. Lunch was tuna on romaine lettuce with sliced almonds and a vinaigrette with iced green tea to drink. And dinner, a mere five minutes away, is grassfed flank steak lettuce-wrap tacos with roasted hatch green chile guacamole. And a nice glass of New Zealand Sauvignon Blanc. Give paleo a try. It's the ultimate gluten-free way of eating.
  22. Celiac.com 06/24/2017 - A long-time pasta lover with celiac disease is desperately fundraising for surgery after losing half his body weight on a gluten-free diet. Years of eating lots of pasta and high calorie meals had left Christopher DeLorenzo weighing over 400 pounds. "My grandparents were Italian so I grew up eating lots of pasta…all I would do was eat, eat, eat always pasta and pizza, my stomach was like an endless pit," said the Phillipsburg, New Jersey, native. DeLorenzo's battle with portions and weight began early. At just 12 years old, he already tipped the scales at 250 pounds. His struggles with food led to years of dieting, and numerous attempts to lose weight. "My digestive system was terrible before weight loss surgery. I was forever complaining to doctors that there was something wrong but I was told that I was eating too much," says DeLorenzo. DeLorenzo found some improvement with weight loss surgery, but it wasn't until he was diagnosed with celiac disease and gave up gluten that he saw his health return. "Now I believe I can attribute a lot of the problems I was having to my body reacting badly to gluten." Still, the experience has left DeLorenzo with a mass of excess skin that looks, he says, like a 'deflated airbag.' He is currently seeking donations to fund surgery to remove the excess skin. Read more at Entertainmentdaily.co.uk
  23. Celiac.com 06/12/2017 - Previously, Transcranial Magnetic Stimulation in de novo celiac disease patients has signaled an imbalance in the excitability of cortical facilitatory and inhibitory circuits. Researchers have reported that, after about of 16 months on a gluten-free diet, patients experience a global increase of cortical excitability, which suggests some kind of compensation for disease progression, likely mediated by glutamate. To better assess these finding, a team of researchers recently conducted cross-sectional evaluation of the changes in cortical excitability to TMS after a much longer gluten-free diet. The research team included M. Pennisi, G. Lanza, M. Cantone, R. Ricceri, R. Ferri, C.C. D’Agate, G. Pennisi, V. Di Lazzaro, and R. Bella. They are variously affiliated with the Spinal Unit, Emergency Hospital "Cannizzaro", Catania, Italy, the Department of Neurology IC, I.R.C.C.S. "Oasi Maria SS.", Troina, Enna, Italy, the Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy, the Gastroenterology and Endoscopy Unit, University of Catania, Catania, Italy, the Department "Specialità Medico-Chirurgiche,” University of Catania, Catania, Italy, and the Institute of Neurology, Campus Bio-Medico University, Rome, Italy. For their study, the team enrolled twenty patients who had followed an adequate gluten-free diet for about 8.35 years, on average. They then compared the results with twenty de novo patients, and twenty more healthy controls. The team measured Transcranial Magnetic Stimulation, recorded from the first dorsal interosseous muscle of the dominant hand, as follows: resting motor threshold, cortical silent period, motor evoked potentials, central motor conduction time, mean short-latency intracortical inhibition and intracortical facilitation. De novo patients showed a shorter cortical silent period, while responses for gluten-free diet participants were similar to controls. Regardless of diet, all celiac patients showed a significantly smaller amplitude of motor response than did control subjects, Again, without regard to diet, all celiac patients showed a statistically significant decrease of mean short-latency intracortical inhibition and enhancement of intracortical facilitation with respect to controls. The team also observed that gluten-free celiac patients showed more intracortical facilitation compared to non-gluten-free patients. Neurological examination and celiac disease-related antibodies were both negative. This study showed that a gluten-free diet helps to mitigate the electrocortical changes associated with celiac disease. Even so, in many patients, an intracortical synaptic dysfunction, mostly involving excitatory and inhibitory interneurons within the motor cortex, may persist. The calls for further investigation into the clinical significance of subtle neurophysiological changes in celiac disease. Source: PLoS One. 2017 May 10;12(5):e0177560. doi: 10.1371/journal.pone.0177560. eCollection 2017.
  24. Celiac.com 06/08/2017 - After thirty three years of a self indulgent relationship with food, my life hit rock bottom and took an unexpected turn, for what momentarily seems to be the worst. As spontaneous and adventurous as I am, I decided to challenge myself and make my already horrid situation, even worse. Or, as you will come to see, surprisingly better. To start, when I say self indulgent, I mean I allowed myself to have whatever delicious and comforting food I wanted, whenever I wanted. This was never anywhere close to an eating disorder, but I most certainly had a seductive sweet tooth and I definitely experienced emotional eating. A bowl of ice cream always made a bad day turn good, despite my lactose intolerance issue. When I was forced into this drastic change in my life and my world was flipped upside-down, it challenged me emotionally, physically, and spiritually. My health was crashing. I couldn't regulate my blood sugar. I was diagnosed with a stress induced hiatal hernia. I had constant and burning indigestion. My emotions were all over the place and my faith in who I was and what I believed in was tested. Courage I never knew I had slowly came out of the depths of my soul and spilled over into all the areas of my life. I wanted to press on, conquer, and show how strong I am. I decided to challenge myself even further. I decided for the fun of it, to go refined sugar and gluten-free. I wanted to see if I had it in me to exhibit extreme self control under my extreme circumstances. I ultimately wanted to stretch my faith in God and the power residing within me; that which sustains me. Now to some that may sound silly or easy to eliminate a few ingredients, but to my fellow sweet tooth and carb lovers, you know the kind of uphill battle I was committed to taking on. My way of eliminating these things was very simple. I just stopped eating them. I didn't wean myself off of them. To me that would be a tease. I can have a crumb but not the cake? Silly, right? To make matters worse, both sugar and gluten are challenging in themselves to eliminate, as they are in EVERYTHING, but putting them together to eliminate and trying to find something to eat seemed nearly impossible. I had to get creative. I already knew all about eating healthy and the gluten-free diet because my six year old has been gluten-free for the past five years. I know what products to avoid. However, going gluten-free after eating gluten filled food for thirty three years was tough, and even though I knew better by raising my daughter gluten-free, I always found excuses for my own eating habits. I do believe taste buds get accustomed to unhealthy food. But I reasoned in my eye opening feat, that if taste buds can get accustomed to unhealthy food, then I guess taste buds can get accustomed to healthy food. I have to say that the first and fourth weeks were the most difficult. Week one, I had to keep telling myself no! No one wants to hear the word "no" all day long. Weeks two and three were pretty easy. I was into my routine of making healthy meals, trying new recipes, and baking yummy things without sugar or gluten! I have to say, the cake I made the other day was seriously the best cake I ever ate! Week four was the true test of my willpower. I had rampant cravings. For some reason it seemed like everyone kept forgetting that I was now gluten and sugar free and kept offering me bad things! Smells drove me crazy. I couldn't really be around anyone who was eating things I couldn't. Since then, I have to admit, it's been pretty smooth sailing. Despite the difficulty and temptations of week four, I began to notice something amazing. My hair and nails were longer than I can ever remember. For thirty three years I've been trying to grow my hair long and it was always thin and would never grow past my shoulders. Looking in the mirror at this long beautiful hair gave me some kind of warm smile inside and urgency to share my good news. I noticed other changes too. My bloating and stomach aches were gone. This was another chronic condition of mine that has been with me for so long that I actually came to accept it as "normal." Horray! I no longer feel like I'm ten pounds heavier than my scale says! Now mind you, I'm a very tiny and petite girl, and with the realization that gluten must have been stunting my hair and nails growth, I can only imagine what other things might have been stunted? You get the picture. Going gluten and refined sugar free was one of the best decisions I have ever made. It changed me in ways I could never have imagined and it opened my eyes to a whole new way of living and optimizing my health. Experiencing firsthand the kind of care and dedication that I give to my daughter and her health makes me feel like a whole new woman!
  25. Celiac.com 05/26/2017 - Can a gluten-free diet help improve symptoms in people suffering from IBS? A new study says yes, some of them, at least. More than 60% of patients with IBS suffer from bloating and abdominal pain after eating certain foods. In some patients, who do not have celiac disease or wheat allergy, these symptoms may be due to an adverse reaction to wheat and gluten. Several studies have suggested that anti-gliadin antibodies can be a useful benchmark for predicting which patients with irritable bowel syndrome will benefit from a gluten-free diet. However, the idea remained untested until recently, when researchers conducted a prospective study in IBS patients. An update on their research was presented at Digestive Disease Week. The research was conducted by María Inés Pinto Sanchez, MD, and colleagues at the department of medicine at McMaster University and the Farncombe Institute in Ontario, Canada. To better understand the usefulness of these predictors, the research team looked at 44 patients with IBS and 23 healthy volunteers, both before and after 1 month of adhering to a gluten-free diet. They assessed GI transit, GI symptoms, anxiety, depression, somatization and dietary habits. The team tested each subject for anti-gliadin antibodies, then stratified the patients based on the results. Patients with celiac disease were not included in the study. The investigators found that just over half (53%) of the IBS patients, and 25% of the healthy volunteers, tested positive for IgA or IgC anti-gliadin antibodies. Additionally, HLA DQ2/DQ8 genetic predisposition was comparable for both groups. IBS patients who tested positive for antigliadin antibodies, and who followed a gluten-free diet, showed overall improvement in symptoms, especially constipation (P = 0.01), diarrhea (P = 0.001) and abdominal pain (P < 0.001) while IBS patients who tested negative only experienced improvements in abdominal pain (P = 0.01). Compared with patients who tested negative, gluten-free IBS patients who tested positive saw more normalization in GI transit (OR = 1.75 95% CI, 1.06 - 3.06). Regardless of antibody status, all IBS patients saw comparable improvements in anxiety, somatization and well-being, but only patients who tested positive saw reduced depression scores. A gluten-free diet in patients who tested positive for anti-gliadin antibodies was associated with symptomatic improvement (OR = 8.54; 95% CI, 1.41-48.21), while other factors like changes in motility, dietary adherence or genetic risk were not. Their data led the team to conclude that anti-gliadin antibodies can be used to determine which IBS patients are more likely to see an improvement in symptoms, and in functionality. Interestingly, strict compliance with the gluten-free diet did not predict improvement, which indicates that gluten restriction, rather than gluten avoidance, may help to manage symptoms in these IBS patients. That means that patients might be able to get better by cutting back on gluten, instead of cutting it out of their diet entirely. Read more at Healio.com.