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Celiac.com 09/04/2024 - Researchers conducted a retrospective, observational cohort study with the aim of determining whether iron deficiency at the time of celiac disease diagnosis affects the tissue transglutaminase antibody (TTG) normalization rate among pediatric patients on a gluten-free diet. Celiac disease is an immune-mediated disorder triggered by gluten consumption in genetically predisposed individuals, often diagnosed using specific serological tests. A gluten-free diet is the only effective treatment, and the study investigates whether iron deficiency affects the rate of antibody normalization in pediatric patients adhering to this diet. Methods The researchers conducted a retrospective, observational cohort study involving children aged 2-18 years diagnosed with celiac disease between January 2016 and December 2020. Data on demographics, hemoglobin, ferritin, and antibody levels were collected at diagnosis and one year after starting a gluten-free diet. Iron deficiency was defined by specific hemoglobin and ferritin levels. The primary focus was to compare tissue transglutaminase antibody normalization rates between children with and without iron deficiency at diagnosis. Results The study included 118 pediatric patients. At diagnosis, 51.7% had iron deficiency, with a higher prevalence among females in the non-iron deficient group. The median age at diagnosis was slightly lower for those with iron deficiency. After one year on a gluten-free diet, 65.5% of children with iron deficiency achieved antibody normalization, compared to 53.8% of those without iron deficiency, though this difference was not statistically significant. Notably, male children had a significantly higher rate of antibody normalization than females. Discussion The study's findings indicate that iron deficiency at the time of celiac disease diagnosis does not significantly impact the rate of antibody normalization after one year on a gluten-free diet. However, male children showed a higher likelihood of achieving normalization compared to females. This gender disparity suggests that other factors might influence antibody normalization rates, warranting further research. The study's results align with previous research showing no significant difference in serological response between children with and without anemia at diagnosis. Conclusion The study concludes that iron deficiency at diagnosis does not hinder tissue transglutaminase antibody normalization in pediatric celiac disease patients adhering to a gluten-free diet. The observed higher normalization rates among males suggest that gender-specific factors may influence the immune response to a gluten-free diet. Future research should focus on understanding these factors and their implications for managing celiac disease in children. Significance for Celiac Disease Patients For individuals with celiac disease, this study provides valuable insights into the role of iron deficiency in disease management. It reassures parents and healthcare providers that iron deficiency at diagnosis does not delay antibody normalization, highlighting the importance of maintaining a gluten-free diet. Additionally, the gender-specific findings may guide personalized treatment approaches, improving outcomes for children with celiac disease. This study underscores the need for ongoing research to optimize care for pediatric celiac disease patients. Read more at: cureus.com -
Tests: (1) TISSUE TRANSGLUTAMINASE ANTIBODY, IGG,IGA (11073) TISSUE TRANSGLUTAMINASE AB, IGG <1.0 U/mL TISSUE TRANSGLUTAMINASE AB, IGA <1.0 U/mL Tests: (2) IMMUNOGLOBULIN A (539) IMMUNOGLOBULIN A 281 mg/dL Tests: (3) ENDOMYSIAL ANTIBODY SCR (IGA) W/REFL TO TITER (15064) ENDOMYSIAL ANTIBODY SCR (IGA) W/REFL TO TITER NEGATIVE NEGATIVE I understand it’s a negative test and it’s not diagnostic with just this test alone but I was wondering if anyone could give me any insight into the numbers and what they mean? I have had all of the symptoms of celiac for several years now including DH. -
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Rain Changes Gluten Levels in Wheat More than Breeding
Scott Adams posted an article in Latest Research
08/26/2020 - A new study on old and new wheat varieties shows no evidence for higher immunoreactivity in hybridized wheat strains. In fact, they found that rain changes immunoreactivity of wheat proteins even more than breeding. In recent years, the number of people affected by celiac disease, wheat allergy or gluten or wheat sensitivity has risen sharply. Many people who study celiac disease, and many who suffer from it, have wondered whether "modern wheat varieties contain more immunoreactive proteins than in the past," and if "this is the cause of the increased incidence of wheat-related disorders," says Darina Pronin, a doctoral student from the Leibniz-Institute for Food Systems Biology, and contributor to the study. A single wheat kernel contains about seventy-percent starch, and about ten to twelve-percent protein. Up to eighty-percent of the protein is gluten, a mixture of two different protein molecules, "gliadins" and "glutenins." Gliadins, especially, are suspected of causing undesired immune reactions in people with celiac disease. Could it be that modern wheat varieties contain more immunoreactive protein than in the past? We know from recent studies, that ancient Einkorn wheat is easier to digest and less toxic than modern Durum strains. What about other old, but less ancient wheat hybrids? To assess the differences between old and new wheat varieties, Katharina Scherf, and her team at the Leibniz-Institute for Food Systems Biology, analyzed sixty wheat varieties originated between 1891 and 2010. The team chose five popular wheat strains for each decade of the 120 year study period. To create comparable samples, they cultivated each strain in 2015, 2016 and 2017 under identical conditions. Their analysis showed that modern wheat varieties contain slightly less protein than older strains, while overall gluten content has remained steady, with minor changes in composition. Over the period studied, the ratio of suspect gliadins fell by nearly twenty-percent, while the glutenins content rose about 25 percent. Environment Changed Gluten Proteins More than Breeding Interestingly, the team found that environmental conditions, such as rain, changed protein composition more than breeding. At least in terms of the proteins they studied, the team saw no evidence that the "immunoreactive potential of wheat has changed as a result of the cultivation factors," explains professor Scherf, now at the Karlsruhe Institute of Technology (KIT). However, Scherf notes that the immunoreactivity of numerous protein types contained in wheat remain unstudied, so much remains to be explored. Better understanding the composition and immunoreactivity of wheat could help researchers to better understand how celiac disease develops and is triggered, which could prove helpful in diagnosing and managing the condition. Several groups are working on non-toxic strains of wheat that may one day be suitable for those with celiac disease. Read more at Sciencedaily.com -
Hey I was diagnosed celiac in November 2017 with ttg levels above 200 and started on a strict gluten free diet. After 6 months it came down to 100 and I got it checked 3 months back and it was down to 25 but I checked again this week and they were rocket high to 100. What could be the cause of this ? I don’t understand why my levels won’t go down I’m on the most strict gluten free diet I think anybody could be on. I don’t even eat chicken unless it says gluten free on it -
Celiac.com 10/15/2018 - If you’re on a gluten-free diet for medical reasons, then you’re probably already cautious about eating out. A new study tells us exactly why people with celiac disease and other gluten-sensitive conditions have reason to be very careful about eating out. According to the latest research, one in three foods sold as "gluten-free" in U.S. restaurants actually contain trace levels of gluten. This is partly due to the fact that the gluten-free diet has become popular with many non-celiacs and others who have no medical need for the diet. That has led many restaurants to offer gluten-free foods to their customers, says study author Dr. Benjamin Lebwohl, of Columbia University's Celiac Disease Center. But, if this research is any indication, too many restaurants don’t do a good job with gluten-free. For the study, more than 800 investigators set out to assess the true gluten content of dishes listed as "gluten-free" on menus. Armed with portable gluten sensors, they tested for gluten levels that met or exceeded 20 parts per million, the standard cutoff for any gluten-free claim. Based on more than 5,600 gluten tests over 18 months, the investigators determined that 27 percent of gluten-free breakfast meals actually contained gluten. At dinner time, this figure hit 34 percent. The rise could reflect a steady increase in gluten contamination risk as the day unfolds, the researchers said. Off course, the risk is not all equal. Some restaurants are riskier than others. Unsurprisingly, the biggest culprit seems to be restaurants that offer gluten-free pastas and pizzas. Nearly half of the pizza and pasta dishes from those establishments contained gluten, according to the study. Why is that? Well, as most folks with celiac disease know all too well, kitchens aren’t really set up to segregate gluten, and "sharing an oven with gluten-containing pizza is a prime setting for cross-contamination," says Lebwohl. Also, too many restaurants use the same water to cook gluten-free pasta as they do for regular pasta, which contaminates the gluten-free pasta and defeats the purpose. Moreover, although the U.S. Food and Drug Administration regulates gluten-free labels on packaged food products, there is currently no federal oversight of gluten-free claims in restaurants. The results of the study will be presented today at a meeting of the American College of Gastroenterology, in Philadelphia. Research presented at meetings is usually considered preliminary until published in a peer-reviewed medical journal. In the absence of federal enforcement at the restaurant level, the burden for making sure food is gluten-free falls to the person doing the ordering. So, gluten-free eaters beware! These results are probably not surprising to many of you. Do you have celiac disease? Do you eat in restaurants? Do you avoid restaurants? Do you have special tactics? Feel free to share your thoughts below. Read more at UPI.com -
Celiac.com 07/17/2018 - What can fat soluble vitamin levels in newly diagnosed children tell us about celiac disease? A team of researchers recently assessed fat soluble vitamin levels in children diagnosed with newly celiac disease to determine whether vitamin levels needed to be assessed routinely in these patients during diagnosis. The researchers evaluated the symptoms of celiac patients in a newly diagnosed pediatric group and evaluated their fat soluble vitamin levels and intestinal biopsies, and then compared their vitamin levels with those of a healthy control group. The research team included Yavuz Tokgöz, Semiha Terlemez and Aslıhan Karul. They are variously affiliated with the Department of Pediatric Gastroenterology, Hepatology and Nutrition, the Department of Pediatrics, and the Department of Biochemistry at Adnan Menderes University Medical Faculty in Aydın, Turkey. The team evaluated 27 female, 25 male celiac patients, and an evenly divided group of 50 healthy control subjects. Patients averaged 9 years, and weighed 16.2 kg. The most common symptom in celiac patients was growth retardation, which was seen in 61.5%, with abdominal pain next at 51.9%, and diarrhea, seen in 11.5%. Histological examination showed nearly half of the patients at grade Marsh 3B. Vitamin A and vitamin D levels for celiac patients were significantly lower than the control group. Vitamin A and vitamin D deficiencies were significantly more common compared to healthy subjects. Nearly all of the celiac patients showed vitamin D insufficiency, while nearly 62% showed vitamin D deficiency. Nearly 33% of celiac patients showed vitamin A deficiency. The team saw no deficiencies in vitamin E or vitamin K1 among celiac patients. In the healthy control group, vitamin D deficiency was seen in 2 (4%) patients, vitamin D insufficiency was determined in 9 (18%) patients. The team found normal levels of all other vitamins in the healthy group. Children with newly diagnosed celiac disease showed significantly reduced levels of vitamin D and A. The team recommends screening of vitamin A and D levels during diagnosis of these patients. Source: BMC Pediatrics -
Celiac.com 11/13/2017 - ImmusanT, Inc., the company working to develop a therapeutic vaccine to protect HLADQ2.5+ patients with celiac disease against the effects of gluten, presented data that shows a way to tell the difference between celiac disease and non-celiac gluten-sensitive (NCGS) based on cytokine levels. Professor Knut Lundin, University of Oslo, presented the data at United European Gastroenterology (UEG) Week 2017. The results are important, in part because many people go on a gluten-free diet before they ever get diagnosed with celiac disease. It's hard for doctors to ask these people to start eating gluten again so that they can be properly diagnosed. But that's how it currently works. If there are no anti-gliadin antibodies in your blood, current tests are not accurate. These data suggest that it is possible to spot celiac disease through plasma or blood test. Along with easier, more accurate celiac diagnoses, a blood test would be a major breakthrough because "patients would only be required to consume gluten on one occasion and would still achieve accurate results," said Robert Anderson, MBChB, Ph.D., Chief Scientific Officer of ImmusanT. The test may also help people who do not have celiac disease, but find symptom relief on a gluten-free diet. For these people, gluten may not be the cause of their symptoms and a gluten-free diet may be totally unnecessary. The latest data support the company's approach to "developing a simple blood test for diagnosing celiac disease without the discomfort and inconvenience of current testing methods. This would be the first biomarker for measuring systemic T-cell immunity to gluten," said Leslie Williams, Chief Executive Officer of ImmusanT. As development is ongoing, further tests are expected to flesh out the details. -
I recently took a blood test and went over the results with my GI doctor who will be performing and endoscopy and colonoscopy on me soon. I can't remember exactly what she said, but I believe she was talking about my IGA-TTG levels. She said the normal range was under 10 but mine was 639. I think she was talking about IGA-TTG but I'm not sure. For people who have done this test what were your high levels? Thanks! Female, 16 -
Celiac.com 03/01/2017 - Do people who eat a gluten-free diet face an increased exposure to toxic metals like arsenic and mercury, and thus possibly higher rates of cardiovascular disease, cancer and neurological effects? That's a very possible scenario, according to a report published in the journal Epidemiology. Maria Argos, assistant professor of epidemiology in the UIC School of Public Health, and her colleagues searched data from the National Health and Nutrition Examination Survey for a link between gluten-free diet and biomarkers of toxic metals in blood and urine. Of the 7,471 people they surveyed between 2009 and 2014, they found 73 participants who reported eating a gluten-free diet. People on a gluten-free diet higher concentrations of arsenic in their urine, and mercury in their blood, than those who ate a non-gluten-free diet. In fact, arsenic levels for gluten-free eaters were nearly twice as high, and mercury levels were 70 percent higher. So, does a gluten-free diet pose an actual health risk? Do people need to make any immediate dietary changes? While noteworthy, Argos says the findings indicate the need for more studies, "to determine if there are corresponding health consequences that could be related to higher levels of exposure to arsenic and mercury by eating gluten-free." Argos points out that the EU has in place regulations for food-based arsenic exposure, while the United States does not. The question that needs to be answered if whether rice flour consumption increases the risk for exposure to arsenic. An answer to that requires further study. Source: University of Illinois at Chicago -
Celiac.com 09/19/2016 - At the time of diagnosis, some celiac patients suffer also from what is called celiac hepatitis, which is liver damage in patients with celiac disease that resolves after a gluten-free diet. A team of researchers recently set out to evaluate predictive factors of celiac hepatitis at the celiac disease diagnosis stage. To do so, they conducted a retrospective study that included 46 adult patients with clinically diagnosed celiac disease. The research team included Andreia Albuquerque, Susana Rodriguesa, and Guilherme Macedoa of the Department of Gastroenterology at Centro Hospitalar São João, in Porto, Portugal. Of the 46 patients, eighty-seven percent were women, with an average age of 33 ± 11 years, 87% showed Marsh 3, and 21 patients (46%) had celiac hepatitis. At the time of diagnosis, these patients had average Immunoglobulin A anti-tissue transglutaminase antibody (TTG-IgA) levels of 208.0 U/ml (p25–p75: 89–1316 U/ml), a mean aspartate aminotransferase of 42 ± 24 U/L, alanine aminotransferase 50 ± 28 U/L, alkaline phosphatase 111 ± 64 U/L. One year after diagnosis, the median average TTG-IgA was 9U/ml (p25–p75: 4.5–30.5 U/ml) and one-third of the patients had normal values. At diagnosis, patients without celiac hepatitis had an average TTG-IgA of 77U/ml (p25–p75: 24–288 U/ml), average aspartate aminotransferase of 23 ± 4 U/L, alanine aminotransferase 20 ± 6 U/L, alkaline phosphatase 69 ± 17 U/L. One year after diagnosis, median TTG-IgA was 6 U/ml (p25–p75: 3–19 U/ml) and nearly half of the patients showed normal values. At diagnosis, patients with celiac hepatitis had higher values of TTG-IgA (p = 0.007). Also, at diagnosis, there was a statistically significant positive correlation between TTG-IgA and alanine aminotransferase (r = 0.324, p = 0.028). For patients with a TTG-IgA level higher than 310 U/ml (OR = 4.8, 95%CI = 1.213–18.781, p = 0.025), the risk of having celiac hepatitis was nearly 5-times higher. From this, the team concludes that higher TTG-IgA levels can help predict celiac hepatitis in adult patients with celiac disease at diagnosis. Source: Scandinavian Journal of Gastroenterology. DOI:10.1080/00365521.2016.1203017 -
Celiac.com 06/06/2014 - Celiac disease guidelines suggest that some patients with high anti-tTG ab levels might be diagnosed without biopsy. A team of Indian researchers recently reviewed their celiac disease database to determine if anti-tissue transglutaminase (tTG) antibody (ab) titers correlate with severity of villous abnormalities in Indian patients, and to find out a cutoff value of anti-tTG ab fold-rise that might best predict celiac disease. The researchers included P. Singh, L. Kurray, A. Agnihotri, P. Das, A.K. Verma, V. Sreenivas, S. Datta Gupta, and G.K. Makharia. The are affiliated with the Departments of Gastroenterology and Human Nutrition, Pathology, and Biostatistics at the All India Institute of Medical Sciences in New Delhi, India. The team reviewed data on 366 anti-tTG ab-positive individuals who received duodenal biopsies. The team conducted anti-tTG ab screens before patients began a gluten-free diet, and they expressed anti-tTG ab results in terms of fold-rise by calculating ratio of observed values with cutoff value. Celiac disease was diagnosed only in patients with positive serology, villous atrophy greater than Marsh grade 2, and clear response to gluten-free diet. Average anti-tTG fold-rise in groups with Marsh grade ≤2 was 2.6 (±2.5), grade 3a was 4.0 (±3.9), 3b was 5.7 (±5.1), and 3c was 11.8 (±8.0). Overall positive likelihood ratio for diagnosing celiac disease was 15.4 and 27.4 at 12- and 14-fold-rise of anti-tTG ab titer, respectively. The positive predictive value of diagnosis of celiac disease was 100% when anti-tTG ab titer was 14-fold higher over the cutoff value. Fifty-seven (43.9%) patients with anti-tTG titer rise less than 2-fold also had celiac disease. Levels of anti-tTG rise directly with severity of villous abnormality. High anti-tTG ab titers indicate likely villous atrophy. Contrary to emerging wisdom, even patients with anti-tTG ab levels less than 2-times baseline should receive mucosal biopsies, because many patients with celiac disease have such low levels. Source: J Clin Gastroenterol. 2014 Feb 27. -
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Celiac.com 06/12/2013 - Pregnant women with higher levels of issue transglutaminase (anti-tTG), an antibody common in people with celiac disease, at risk for low fetal and birth weight in their babies, according to a new study in Gastroenterology. A number of studies before this one have confirmed an association between celiac disease and poor growth fetus growth, but very little study had been done as to how the level of celiac disease might affect fetal growth, birth weight or birth outcome. In an effort to better understand how the level of celiac disease affects fetal growth, birth weight, and birth outcome, a team of researchers set out to assess the associations between levels of antibodies against tissue transglutaminase (anti-tTG, a celiac disease marker) and fetal growth and birth outcomes for pregnant women. The research team included J.C. Kiefte-de Jong, V.W. Jaddoe, A.G. Uitterlinden, E. A. Steegers, S.P. Willemsen, A. Hofman, H.Hooijkaas, and H.A. Moll of the Generation R Study Group at Erasmus University Medical Center in Rotterdam, The Netherlands. They conducted a population-based prospective birth cohort study of 7046 pregnant women. Serum samples were collected during the second trimester of pregnancy and analyzed for levels of anti-tTG. Based on these levels, they grouped each woman into groups of negative anti-tTG (≤0.79 U/mL; n = 6702), intermediate anti-tTG (0.8 to ≤6 U/mL; n = 308), or high anti-tTG individuals (over 6 U/mL; n = 36). They then collected data for fetal growth and birth outcomes from ultrasound measurements and medical records. The fetal growth data showed that, on average, fetuses of women in the positive anti-tTG group were 16 g lighter than those of women in the negative anti-tTG group (95% confidence interval [CI], -32 to -1 g) during the second trimester and weighed 74 g less (95% CI, -140 to -8 g) during the third trimester. The birth outcome data revealed that newborns of women in the intermediate and positive anti-tTG groups weighed 53 g (95% CI, -106 to -1 g) and 159 g (95% CI, -316 to -1 g) less at birth, respectively, than those of women in the negative anti-tTG group. Of mothers in the intermediate anti-tTG group, those with HLA-DQ2 or -DQ8 had reduced birth weights that were double those of mothers without HLA-DQ2 or -DQ8. This study led the researchers to conclude that levels of anti-tTG in pregnant women are inversely associated with fetal growth. The higher the anti-tTG in women, the lower the birth weights of their babies. So, women with the highest levels of anti-tTG (over 6 U/mL) saw the greatest reduction in birth weight of their babies. Also, women with intermediate levels of anti-tTG (0.8 to ≤6 U/mL) saw lower birth weights that were even further reduced if they carried the HLA-DQ2 and -DQ8 gene markers. Source: Gastroenterology. 2013 Apr;144(4):726-735.e2. doi: 10.1053/j.gastro.2013.01.003. -
Celiac.com 05/13/2013 - Intestinal absorption capacity is currently regarded as the best way to assess overall digestive intestinal function. Earlier reference values for intestinal function in healthy Dutch adults were based on a study that was conducted in an inpatient metabolic unit setting in a relatively small series. A team of researchers recently used bomb calorimetry to measure normative values of intestinal absorption in healthy ambulant adults. The research team included N. J. Wierdsma, J. H. C. Peters, M. A. E. van Bokhorst-de van der Schueren, C. J. J. Mulder, I. Metgod & A. A. van Bodegraven They are variously affiliated with the Department of Nutrition and Dietetics, the Department of Gastroenterology, Small Bowel Unit, and the Department of Clinical Chemical Laboratory at VU University Medical Centre in Amsterdam, and the Department of Gastroenterology and Hepatology of Red Cross Hospital in Beverwijk, The Netherlands. The present study aimed to readdress and describe the intestinal absorption capacity of healthy adults, who were consuming their usual (Western European) food and beverage diet, in a standard ambulatory setting. The researchers evaluated twenty-three healthy subjects, ranging form 22–60 years old, using a 4-day nutritional diary to determine levels of nutritional intake (energy and macronutrients). They then collected fecal samples over three days to measure mean fecal losses of energy (by bomb calorimetry), fat, protein and carbohydrate. Finally, they calculated intestinal absorption capacity by determining the differences between intake and losses. They found that average (SD) daily feces production was 141 grams, of which, 49 grams (29%) was dry weight, Overall, the samples contained 891 (276) kJ [10.7 (1.3) kJ g1 wet feces; 22.6 (2.5) kJ g1 dry feces], 5.2 (2.2) g fat, 10.0 (3.8) g protein and 29.7 (11.7) g carbohydrates. Mean (SD) intestinal absorption capacity of healthy subjects was 89.4% (3.8%) for energy, 92.5% (3.7%) for fat, 86.9% (6.4%) for protein and 87.3% (6.6%) for carbohydrates. They found that average intestinal energy absorption was approximately 90%. These data serve as normative values for both stool nutrient composition and intestinal energy and macronutrient absorption in healthy adults on a regular Dutch diet in an ambulatory setting. Source: J Hum Nutr Diet. doi:10.1111/jhn.12113
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Celiac.com 02/13/2013 - A team of researchers wanted to determine whether levels of immunoglobulin G (IgG) were associated with a later diagnosis of a non-affective psychotic disorder. The researchers included H. Karlsson, Å. Blomström, S. Wicks, S. Yang, R.H. Yolken, and C. Dalman. They are affiliated with the Department of Neuroscience at the Karolinska Institute in Stockholm, Sweden. To accomplish their goal, the team analyzed archival dried blood spots taken from newborns in Sweden between 1975 and 1985 with verified register-based diagnoses of non-affective psychoses made between 1987 and 2003 and comparison subjects matched on sex, date of birth, birth hospital, and municipality. The team reviewed samples from a total of 211 case subjects and 553 comparison subjects who agreed to take part in the study. They pulled data for factors associated with maternal status, pregnancy, and delivery from the Swedish Medical Birth Register. They used enzyme-linked immunosorbent assay to analyze the results for levels of IgG directed at gliadin (a component of gluten) and casein (a milk protein) in eluates from dried blood spots. They then calculated odds ratios for levels of IgG directed at gliadin or casein for non-affective psychosis. Comparison subjects associated with non-affective psychosis showed levels of anti-gliadin IgG (but not anti-casein IgG) above the 90th percentile of levels observed (odds ratio=1.7, 95% CI=1.1-2.8). This connections was not affected by differences in maternal age, immigrant status, or mode of delivery. They also found that gestational age at birth, ponderal index, and birth weight were not associated with maternal levels of anti-gliadin IgG. From their study, they concluded that high levels of anti-gliadin IgG in the maternal circulation are associated with an elevated risk for the development of a non-affective psychosis in offspring. They point out that more research is needed to identify the mechanisms underlying this association in order to develop preventive strategies. Source: Am J Psychiatry. 2012 Jun;169(6):625-32. doi: 10.1176/appi.ajp.2012.11081197.
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Celiac.com 11/07/2011 - Fat-soluble vitamin malabsorption, inflammation and/or under-nutrition put children with celiac disease at risk for decreased bone mineral density. A research team recently set out to determine how vitamin D and K might influence bone mineral density and bone growth in children and adolescents with celiac disease. The study team included D. R. Mager, J. Qiao, and J. Turner. The team's goal was to examine the interrelationships between vitamin K/D levels and lifestyle factors on bone mass density in children and adolescents with celiac disease at diagnosis and after 1 year on the gluten-free diet. The team studied children and adolescents aged 3–17 years with biopsy proven celiac disease at diagnosis and after 1 year on the gluten-free diet. To measure bone mineral density the researchers used dual-energy X-ray absorptiometry, factoring in relevant variables including anthropometrics, vitamin D/K status, diet, physical activity and sun exposure. The children saw their lowest BMD-z scores for whole-body and lumbar-spine (−1) at diagnosis (10–20%) and after 1 year (30–32%), independent of symptoms. Older children (>10 years) showed substantially lower BMD-z scores for whole-body (−0.55±0.7 versus 0.72±1.5) and serum levels of 25(OH) vitamin D (90.3±24.8 versus 70.5±19.8 nmol/l) as compared with younger children (10 years) (P<0.001). Overall, forty-three percent showed suboptimal vitamin D status (25(OH)-vitamin D <75 nmol/l) at diagnosis. Nearly half of these vitamin D deficiencies corrected after 1 year on the gluten-free diet. Also, twenty-five percent of the children showed suboptimal vitamin K status at diagnosis. All vitamin K deficiencies resolved after 1 year. Both children and adolescents with celiac disease face a substantial risk for suboptimal bone health at time of diagnosis and up to 1 year after adopting a gluten-free diet. This higher risk is likely due in part to suboptimal vitamin D/K levels. Children and teens with celiac disease may benefit from treatment regimens that promote optimal vitamin K/D intake. Source: European Journal of Clinical Nutrition, (5 October 2011) | doi:10.1038/ejcn.2011.176
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Celiac.com 07/13/2011 - Some people who follow a gluten-free diet due to celiac disease may develop unusually elevated levels of liver enzymes, according to researchers from Finland. The results are reported online in the American Journal of Gastroenterology. Contrary to some earlier studies, the results show that only a small minority of these celiac disease patients showed elevated transaminase levels. Dr. Markku Maki from University of Tampere points out that doctors don't routinely test transaminase levels in newly diagnosed celiac disease patients. With this in mind, the research team examined the prevalence and gluten dependency of hypertransaminasemia in 313 untreated and 339 treated adult celiac disease patients and in 237 nonceliac control subjects. They checked transaminase levels in 130 celiac disease patients at diagnosis and after one year on a gluten-free diet. They also conducted a before and after gluten challenge in 25 treated celiac patients who showed clinical remission. Their cross-sectional study showed elevated aspartate transaminase (AST) levels in a similar proportion of untreated celiac patients (11%), treated celiac patients (8%), and healthy controls (9%). Earlier studies showed that up to half of celiac disease patients may have elevated serum liver enzyme levels at diagnosis. The celiac patients showed significantly higher rates of hypertransaminasemia when their celiac symptoms were severe or moderate than when their symptoms were mild or nonexistent (23% vs 9%; P=0.03). The team suggests that routine investigation of liver enzymes in celiac disease patients would likely provide the same yield as in the general population--"at least in populations with high clinical prevalence of celiac disease," they say. They further suggest that clinicians reevaluate strategies for routine investigation of liver enzymes in celiac disease patients. After one year, results of the gluten-free diet trial showed that serum AST levels dropped significantly, even to normal levels, in conjunction with the disappearance of clinical symptoms. In the gluten-challenge study, gluten antibodies reappeared in the blood samples of nine of the 25 celiac patients who had previously been in clinical remission. 18 of the 25 developed gastrointestinal symptoms. AST and 11 patients showed elevated levels of alanine transaminase (ALT). When the patients resumed their gluten-free diets, their symptoms resolved, serum endomysial antibodies became undetectable, and serum transaminase levels returned to normal levels. Dr. Maki says that "gluten may induce liver disease in celiac disease patients. Even if the liver manifestation is infrequent and mostly mild." This is a potentially important discovery, because as Dr. Maki points out, when people with celiac disease regularly consume wheat, rye, and barley gluten, "the environmental insult in celiac disease, seem to trigger an autoimmune loop in genetically susceptible persons where formed autoantibodies target the autoantigen, transglutaminase 2, also in the liver." Dr. Maki adds that the biological implications of this can be studied further. In the meantime, he stops short of recommending routine screening with liver function tests when celiac patients are first diagnosed, saying that there is simply no evidence to support that practice. However, he does say that if a case finding for celiac includes elevated liver enzymes, patients should be checked for normalization of liver values once on a gluten-free diet. Source: Am J Gastroenterol 2011. -
Do Income Levels Influence Celiac Disease Diagnosis?
Jefferson Adams posted an article in Additional Concerns
Celiac.com 05/30/2011 - Income plays a major role in whether patients with uncommon symptoms of celiac disease are accurately diagnosed, according to a new study from the Beth Israel Deaconess Medical Center in Boston. A team of researchers led by Daniel Leffler, MD, compared data of nearly 800 adult patients with celiac disease based on presenting symptoms and household and per capita earnings. Some patients had complained of acute gastrointestinal distress, while others complained of classic celiac disease signs like weight loss and anemia, and others of less typical issues. Regardless of patient symptoms upon complaint, the research team found "a very striking linear correlation" between levels of diagnosis and in higher versus lower income groups. Basically, people with better socioeconomic status, had better chances of being diagnosed, according to Dr. Leffler, director of clinical research at the hospital's celiac center. The income disparity may reflect differences in both health awareness and access to health information between higher and lower income groups. The difference serves as a "marker for patients having the resources to educate themselves as to what might be the underlying cause of their disorder," Dr. Leffler said. "Celiac testing is often prompted by patient request rather than physician suspicion, which almost certainly contributes to the diagnostic disparity seen in this study." He believes the study shows a need for greater awareness among both physicians and the public. "Although we need physicians to be more proactive in celiac testing, we can't just focus on physician training if we want to make a difference," he said. "There are likely significant gains to also be made in patient education." Dr. Leffler's findings were included as part of presentations for Digestive Disease Week (DDW), the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. DDW is sponsored jointly by the American Association for the Study of Liver Diseases, the AGA Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract. -
Celiac.com 09/20/2010 - People with celiac disease face increased risk of cancer and a large amount of circumstantial evidence suggests that oxidatively damaged DNA may be used to help predict future cancer development in celiac patients. To evaluate that hypothesis, a research team set out to assess and describe oxidative stress and oxidative DNA damage in celiac disease patients. Anna Szaflarska-PopÅ‚awska, Agnieszka Siomek, MieczysÅ‚awa Czerwionka-Szaflarska, Daniel Gackowski, RafaÅ‚ Różalski, Jolanta Guz, Anna Szpila, Ewelina Zarakowska and Ryszard OliÅ„ski comprised the research team. They are associated with the college of medicine at Nicolaus Copernicus University, in Bydgoszcz, Poland. They found that children with celiac disease have higher than normal levels of the oxidative DNA damage biomarkers urinary 8-oxodG and 8-oxoGua, regardless of following a gluten-free diet. To measure urinary excretion of 8-oxodG and 8-oxoGua, and levels of oxidative DNA damage in the leukocytes, as well as the level of antioxidant vitamins, the team used high-performance liquid chromatography (HPLC) and HPLC/gas chromatography with isotope dilution mass detection. They observed parameters for DNA damage in a group of children with untreated celiac disease, in a group of children with celiac disease following a strict gluten-free diet, and in a control group of healthy children. They found that the two groups of celiacs showed significantly higher overall levels of 8-oxodG in DNA isolated from the leukocytes and from the urine samples than did the control subjects, without regard to diet. There was no significant difference between treated and untreated celiacs. That means being on a gluten-free diet offered no protection from oxidative DNA damage for all children with celiac disease. One key difference was that the untreated celiac children showed significantly lower levels of retinol and α-tocopherol, vitamin A and E, compared to the treated celiac children. Between group difference of 0.31 and 3.76 µmol/l, respectively, suggests that a gluten-free diet offers some protection against oxidative damage in treated celiacs. From the results indicate that oxidative stress and/or oxidatively damaged DNA in celiac patients cannot be explained by diet alone, and that factors independent of diet play an important role. Supplemental vitamin A and E in celiac disease patients may help minimize the risk of cancer development. Source: Cancer Epidemiol Biomarkers Prev 2010; 19: 1960–1965 -
Celiac.com 03/05/2010 - A team of researchers recently studied therelationship between increased levels of antigliadin antibodies andintestinal barrier gene variants. The research team included V.M. Wolters, B. Z. Alizadeh, M. E. Weijerman, A. Zhernakova, I. M. vanHoogstraten, M. L. Mearin, M. C. Wapenaar, C.Wijmenga, M. W. Schreurs.They are affiliated with the Department of Pediatric Gastroenterology,UMC Utrecht, Utrecht, The Netherlands. Numerous genes may affectintestinal barrier function, including MAGI2, MYO9B, and PARD3, whichhave a close association with celiac disease. Gauging intestinalpermeability is tough to do, so researchers can test indirectly byusing antibodies against gliadin and Baker's yeast (anti-Saccharomycescerevisiae antibodies). The goal of the study was to determinewhether intestinal permeability, represented by antibodies againstgliadin, was connected to MAGI2, MYO9B, and PARD3. The teamanalyzed patients with Down syndrome, a population with suspectedincreased intestinal permeability. The team examined connectionsbetween AGA and ASCA. The team genotyped 126 Down syndromepatients for six single-nucleotide polymorphisms in MAGI2 (rs1496770,rs6962966, rs9640699), MYO9B (rs1457092, rs2305764), and PARD3(rs10763976). They then performed an allele dosage associationof these risk genes and AGA levels. They also found a strongcorrelation between AGA and ASCA (p < 0.01). Subjects withone or more risk genotypes showed lower average AGA levels (trend testp = 0.007) and made up a larger number of patients with normal AGAlevels (p = 9.3 x 10(-5)). Celiac-associated risk genotypesare associated with lower AGA values rather than higher AGA values.This all means that, regarding the increased prevalence of elevated AGAin patients with Down syndrome, there are other immunologic factors atplay. These may involve altered induction and/or maintenance oftolerance. Source: Hum Immunol. 2010 Feb 3.
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Celiac.com 10/02/2009 - A team of researchers led by Michelle M. Pietzak, M.D., of the University of Southern California Keck School of Medicine in Los Angeles, recently conducted a large-scale study to identify HLA-DQ haplotypes most connected with increased risk of celiac disease. Their results show that for people with elevated risk factors for celiac disease, it is in fact possible to stratify risk based on HLA-DQ genotype, according to results of the study published in the September issue of Clinical Gastroenterology and Hepatology. The research team analyzed blood samples from 10,191 subjects with elevated risk for celiac disease due to clear clinical symptoms, an affected family member, or the presence of other conditions associated with celiac disease. They found that eight major genotype groups commonly tested positive for anti-endomysial immunoglobulin A. They also noted a steady progression of elevated risk rising from 2.11 percent for DQ8 heterozygotes up to 28.28 percent for DQ2.2+DQ7.5 homozygotes. Additionally, they discovered that the relative risk for anti-endomysial immunoglobulin A positivity of DQ8 homozygous:heterozygous was about the same as DQ2 homozygous:DQ2.5 heterozygous samples, with an odds ratio of about 4.0 for each. Based on the results, the team concludes that the information might "further quantify the relationship between the expression of celiac disease-associated heterodimers and the occurrence of celiac disease, aid in characterizing previously indeterminate cases, and potentially avoid intestinal biopsies when used in combination with highly sensitive and specific serology." The add that "targeting these high-risk alleles might aid the design of peptide immuno-therapeutic strategies to augment the gluten-free diet." Prometheus Laboratories underwrote the study, and all study authors work or consult for the company. Source: Clinical Gastroenterology and Hepatology - September, 2009.
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Am J Gastroenterol 2000;95:1742-1748. Celiac.com 09/20/2000 - A new study published in the July issue of the American Journal of Gastroenterology by Dr. Vincenzo Toscano and colleagues at the Universita La Sapienza in Rome indicates that adolescent patients with celiac disease have elevated levels of anti-thyroid and anti-pancreatic autoantibodies. The results indicate that gluten plays a key role in the observed autoimmunity, and may in some cases result in organ dysfunction. Previous studies have shown that antibodies directed against endocrine glands develop in a high proportion of patients who have celiac disease. In many cases a gluten-free diet is abandoned by many patients in adolescence, and the researchers studied such a group to determine whether anti-endocrine antibodies and endocrine function were affected by the presence or absence of gluten. Their study indicates that 9 of 44 celiac disease patients tested positive for at least one anti-thyroid autoantibody. The same numbers of patients tested positive for anti-pancreatic autoantibodies. Additionally, one patient was diabetic, two others exhibited preclinical hypothyroidism, and one had clinical hypothyroidism. Further, 10 of 19 patients on a diet containing gluten were positive for at least one antibody, in comparison with five of 25 patients on the gluten-free diet, and the distribution of autoantibodies was significantly different between the two groups. Dr. Toscanos team concludes that gluten consumption is associated with a high prevalence of anti-endocrine autoantibodies.
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Celiac.com 07/10/2007 - Studies have shown children with Type 1 diabetes to have a greater risk of developing celiac disease. A study published recently in Diabetes Care shows that people with celiac disease who follow a strict gluten-free diet frequently have inferior body composition and nutritional uptake compared to healthy people without celiac disease. Faced with a shortage of solid data on the exact nature of the levels at which children with type 1 diabetes are at risk for developing celiac disease, a Swedish research team set out to review the Swedish national inpatient registry for the years 1964 to 2003. The research team was made up of Anders Ekbom, Michael Fored, Jonas F. Ludvigsson, Johnny Ludvigsson, Nders Ekbom, Ola Ole, & Scott M. Montgomery. They looked at data for patients with celiac disease who are following a strict gluten-free diet, and who were in full clinical, biochemical, and histological remission. They looked at data from 45,680 patients. Children with a one year follow-up after entering the study were added to the final results. Celiac Disease in Children Linked to Type-1 Diabetes The results showed that children with celiac disease face an increased risk of developing type 1 diabetes before the age of 20 (hazard ratio 2.4 [95% CI 1.9 –3.0], P 0.001). Children with celiac disease also faced an increased risk of ketaocidosis or diabetic coma before the age of 20 (2.3 [1.4 –3.9], P 0.001). This increase showed up without regard to the age at diagnosis [those diagnosed between 0 and 2 (2.2 [1.7–2.9], P 0.001) or 3 and 20 (3.4 [1.9 – 6.1], P 0.001) years of age.] Given that 95% of individuals with celiac disease are HLA-DQ2 positive, these increased risk levels were comparatively low, though still significant. Diabetes Care. 2006 Nov;29(11):2483-8. health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
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J Tropical Pediatrics 2004, 50:37-40 Celiac.com 03/30/2004 – Researchers in India have discovered that serum prolactin levels in those with celiac disease are elevated in direct proportion to the severity of the disease. Dr. Gaurav Kapur and colleagues from the Lady Hardinge Medical College, New Delhi screened serum prolactin levels in 41 children who were diagnosed with celiac disease, 21 of which were on a gluten-free diet for more than a year. The results were compared to 41 healthy controls. The researchers found that serum prolactin levels were highly elevated in those with active celiac disease (average of 48.3 ng/mL), and present at lower levels in those on a gluten-free diet (average of 18.3 ng/mL). The healthy controls had an average level of 9.3 ng/mL. The longer the disease was left untreated along with the increase in severity of villous atrophy, the higher the levels of serum prolactin that were detected. The researchers conclude that serum prolactin levels can be used to determine the severity of celiac disease in patients, and this option is more economically viable than the use of other options.
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Diabetes Care 25: 1111-1116 Celiac.com 08/08/2002 - Dr. Anette-G. Ziegler, of the Academic Teaching Hospital Muenchen-Schwabing in Munich, Germany, and colleagues looked at seven first-degree relatives of patients who had type 1 diabetes and were under seven years of age and found that their titers of type 1 diabetes-associated autoantibodies did not improve after one year on a gluten-free diet. At the same time the subjects IgG antibody titers to gliadin were reduced. The researchers conclude that even though studies have shown that a gluten-free diet protects against autoimmune diabetes in animal models, it does not appear to do so in humans, although there is research that shows that it can reduce the frequency of type 1 diabetes in patients with celiac disease. According to the researchers, gluten is not the driving antigen for type 1 diabetes-associated islet autoimmunity.
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