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Celiac.com 05/07/2015 - Are chefs are improving their awareness of gluten-related disorders? That's one of the questions addressed in a new 10-year follow-up study in the UK. The study was conducted by a team of researchers headed by I. Aziz of the Department of Gastroenterology in Royal Hallamshire Hospital at Sheffield Teaching Hospitals in Sheffield, UK. The team also included M.A. Karajeh, J. Zilkha, E. Tubman, C. Fowles, and D.S. Sanders. The team set out to measure any changes in awareness of gluten-related disorders among the general public, and among chefs. To do so, they compared results from face-to-face questionnaires on celiac disease and gluten sensitivity on the general public and chefs based in Sheffield, UK. The survey was conducted in 2003, and repeated in 2013. They compared the results from the 265 chefs in 2013 against results from the 322 chefs in 2003. Whereas in 2003 the public were significantly more aware of gluten-related disorders than chefs, by 2013, rates of awareness in the groups were about equal. The 2003 group was 85% male, with a mean age 37.6 years old. The second group was younger at 27.1 years, on average, and more evenly mixed, with 38% women. Overall, the results showed a significant increase in chefs' awareness of gluten-related disorders from the years 2003 to 2013. Awareness of celiac disease had risen from a dismal 17.1% in 2003 to a respectable 78.1% in 2013 (adjusted odds ratio (AOR) of 12.5; 95% CI 7.9-19.6). For Gluten Sensitivity, awareness had climbed from a mere 9.3% in 2003 to 87.5% in 2013 (AOR 65.7; 95% CI 35.4-122; P<0.001). The survey also showed that 44% of the public and 40% of chefs (P=0.28) properly recognized the official gluten-free symbol. There has been a marked increase in both the public's and chefs' awareness of gluten-related disorders. Hopefully, this awareness will translate into better, safer gluten free offerings for people with celiac disease and gluten-sensitivity. Find further reading, including hard numbers from the survey, in the European Journal of Gastroenterology and Hepatology. Source: Eur J Gastroenterol Hepatol. 2014 Nov;26(11):1228-33. doi: 10.1097/MEG.0000000000000166.

Celiac.com 11/03/2009 - Many infants, toddlers and young children are either born with or develop a variety of protein allergies with symptoms including anaphylaxis, intolerance or sensitivity to milk, egg, shellfish, crustacean, peanuts, nuts, sesame seeds, soy and gluten. These symptoms can manifest themselves in a variety of ways including coeliac (celiac) disease (gut damage), eczema, shock, migraines, headaches, crankiness, aggression, depression, listlessness, chronic fatigue, irritable bowel, wind, flatulence, diarrhea, bloating, fluid retention, poor growth patterns, feeling vaguely and sometimes seriously unwell: a general failure to thrive.Unfortunately, we do not understand all the reasons. There are nutritional, neurological and hormonal implications, which often go unconsidered, to many of the foods we eat. In some instances, with babies, the problems are transmitted via the mother’s breast milk and there are many instances of babies, for example plainly uncomfortable at being entirely covered in a painful rash due to their reactions to gluten and other foods in their mother’s diets. Such problems are more common where there is a history of asthma, colic, gluten sensitivity and other immune system issues in the family. In other instances, the problems may be caused by too early an introduction of solid foods and food types and in some cases by simple over exposure to particular food categories. These issues require awareness and careful observation on the part of the mother to try and relate/identify the problem foods to the problems in the child. In some instances, these problems may also overlap with lactose intolerance, fructose malabsorption and other fermentable sugar issues. There can also be cumulative issues with preservatives and the histamines in chocolate/cocoa and orange juice. Histamines and gluten, either singly or in combination, can both contribute to headache, migraine and behavioral problems. I recall one young mother, the wife of a colleague, who found that her normally happy and contented baby son reacted negatively to the coffee, cabbage, curry, chocolate, pasta and occasional alcohol in her diet – all foods his mother enjoyed, particularly the chocolate - by becoming red in the face, grizzly, plainly uncomfortable and often with diarrhea. Fortunately, she was perceptive enough to relate these incidents to her diet and chose to abstain from consuming the offending foods for the duration of the breast-feeding period. We had spent some time discussing and theorizing about the underlying reasons.With the coffee we suspected the caffeine. With the cabbage we suspected the nitrogenous (high protein) fertilizers used in growing the vegetable and the sugar content. With the pasta we suspected the gluten and possibly the fructose content of the garlic and perhaps the garlic as an irritant. The curry and chili plainly had an irritant effect and we suspected the histamines in the chocolate. Michael, now in his late teens, eats all these foods sparingly but is pleased to avoid them where possible. He thrives on plain, simple meals with careful food combinations. Although not a celiac he is not fond of bread, biscuits and cakes etc and appears to instinctively avoid them. He likes his fruit and, particularly, his vegetables. He prefers to avoid spicy foods, deep fried foods, meat pies and the like where he struggles to digest the combination of meat and pastry: of protein and carbohydrate. He also prefers to avoid consuming orange juice in combination with toast and breakfast cereals: the combination of acid and carbohydrate. He deliberately avoids cucumber, garlic, onion, soft drinks, coffee and alcohol due to sugar fermentation and acidity issues. An intelligent, fun loving and well adjusted young man who towers over both his parents and enjoys robust good health, he has learned, with his mother’s support, to select and develop a diet which suits him and upon which he obviously thrives. He is living proof of the adage “that one man’s meat is another man’s poison”: that a single diet does not suit everyone. A lesson many people have yet to learn. Recently, via my blogs and Youtube videos I have made “friends” with three young men in their early twenties: one of Hispanic background from California and two from Melbourne. All are coeliacs (celiacs) with diabetes and thyroid complications overlapping with their gluten induced gut damage. All I suspect the result of long term poor food choices exacerbated by having to fend for themselves in early adulthood without the parental support, awareness and perception enjoyed by Michael. Interestingly, one of these young men from Melbourne has come to the conclusion that, unless he urgently does something to help himself, he will seriously compromise both his longevity and quality of life if he continues going down the path he has pursued to date. He has come back several times for reassurance, to seek further information and to express his determination to reach 80 years of age in good health. He is slowly, painfully and somewhat belatedly trying to go down the path pursued by Michael and his mother since Michael was a baby: that of finding the diet that suits his individual nutritional and health needs. He is making solid progress with the occasional setback like a recent bout of Ataxia (poor co-ordination, a classic symptom of gluten sensitivity, in addition to his severe gut damage) resulting from the eating of potato chips deep fried in gluten contaminated oil: an all too frequent occurrence. In some instances the child may outgrow the problem but in many others the problems or tendencies may be lifelong, for example, in the case of coeliac disease and many forms of gluten sensitivity and as in the case of Michael, recounted above, where many of the food sensitivities of early childhood remain into adulthood. In some other health problems, the degree of exposure to a particular food or food additive may be the issue. A small amount is OK but too much may lead to eczema, mucus, arthritis or headache problems etc. The consumption of such a food needs to be managed carefully. It is my belief that it is often better to eat a small amount of as many foods as possible – to build some tolerance to them - rather than to go down the road of the total exclusion of every offending food. Often, this approach is not only socially desirable but sometimes a necessity where there is limited opportunity to organize the food. In these circumstances, it is important for the dietary challenged individual to be selective and to know and understand their dietary limits and the consequences of exceeding those limits. I am a firm believer in the old adage of moderation and diversity in the diet and of gentle shifts in dietary regimes if making any changes. It is possible, for example, and often desirable to reduce the intake of sugar, salt, coffee, milk etc., in the diet and these changes are all best done gradually over a few weeks to enable the body, digestive system and the taste buds to acclimatise to the new regime. The same applies to the introduction of a new food. A gradual introduction of any new food is often more beneficial and pleasant than a sudden change in diet as this allows the body to adjust without adverse and off-putting reactions.

Celiac.com 05/08/2007 - For people with celiac disease, accurate and comprehensive information on maintaining a healthy, high-level quality of life can be difficult to find. Research is particularly sketchy with respect to factors that have a negative impact on health and quality of life for adults with celiac disease. Factors that have a negative impact on health and quality of life are often modifiable through changes in diet, or adjustments in treatment. Thus researchers are motivated to identify which celiac patient groups are at risk of being impacted in a negative way, and to determine which adjustments might bring positive results. In an effort to refine treatment approaches and improve the lives of patients with celiac disease, clinical researchers in Gastroenterology have become increasingly interested in health-related quality of life issues as primary or secondary endpoints in their studies. A recent study published online in Medscape Today suggests that, in addition to physical and mental co-morbidities, a failure to sustain a gluten-free diet and disappointment with doctor-patient communication are also important factors associated with health-related quality of life concerns in people with celiac disease. Motivated by inconsistencies in available data, a team of German researchers made up of Drs. W. Häuser, A. Stallmach, W. F. Caspary, and J. Stein, set out to evaluate the various predictors for reduced health-related quality of life in adult patients with celiac disease. Using logistic regression analysis, the researchers catalogued responses to medical and socio-demographic questionnaires by 1000 adult celiac disease patients who were members of the German Coeliac Society. The subjects responded to the following three survey questionnaires, which were administered by post: 1) the Short-Form Health Survey (SF-36); 2) the Celiac Disease Questionnaire; 3) the Hospital Anxiety and Depression Scale. The results showed that physical co-morbidities (ß = -0.41; OR = 0.66, P < 0.001) and mental disorder (ß = 0.88; OR = 2.4, P = 0.03) were associated with a reduced physical summary score of the SF-36 Scale. Mental disorder (ß = 2.5; OR = 11.9, P < 0.001), physical co-morbidities (ß = -0.26; OR = 0.77, P = 0.004) and younger age at diagnosis (ß = -0.10; OR = 0.91, P = 0.05) predicted a reduced mental summary score of the SF-36 Scale. Mental disorder (ß = 0.90; OR = 2.5, P = 0.03), non-compliance with gluten-free diet (ß = 0.44; OR = 1.6, P = 0.009), active medical co-morbidities (ß = -0.28; OR = 0.76, P = 0.007) and dissatisfaction with doctor–patient communication (ß = 0.55; OR = 1.7, P = 0.03) were associated with reduced Celiac Disease Questionnaire scores. In adult patients with celiac disease, the following factors were associated with reduced health-related quality of life: female gender, younger age at diagnosis, newly diagnosed patients, latency of diagnosis, failure to follow a gluten-free diet, anxiety and somatic and psychiatric co-morbidity. Until this study, attempts to measure health status in patients with celiac disease relied on generic health-related quality of life methods, rather than validated, disease specific instruments, and thus the relative predictive value of these variables had not been fully assessed. Aliment Pharmacol Ther. 2007;25(5):569-578.