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What Causes Villous Atrophy Besides Celiac Disease?
Scott Adams posted an article in Additional Concerns
Celiac.com 06/01/2021 - Villous atrophy not caused by celiac disease is called "non-celiac enteropathy." In many cases, the symptoms mirror the classic symptoms of celiac disease: diarrhea, weight loss, abdominal pain, and fatigue. Spotting the difference between celiac disease and non-celiac enteropathy can be challenging. That's why physicians recommend celiac disease blood tests, which are used to find adverse immune reactions to the gluten protein in the foods you eat. Just as it's possible to have damaged villi without celiac disease, it's possible to have celiac disease, and villi damage, even with negative blood antibody tests. People with celiac disease usually improve on a gluten-free diet. While some may not, many folks with non-celiac enteropathy do not respond to a gluten-free diet. People who do not see symptom improvement on a gluten-free diet may need to consider alternative causes for their symptoms and villous atrophy. Non-Celiac Causes of Villous Atrophy Non-celiac causes of villous atrophy include: Benicar (olmesartan) In some patients, taking this blood pressure medication leads to villous atrophy combined with diarrhea and weight loss. The U.S. Food and Drug Administration issued a warning about this in 2013. Common Variable Immune Deficiency, or CVID CVID is a condition that leaves people vulnerable to recurrent infections. Crohn's disease Villous atrophy is unusual in Crohn's disease, but can happen. Lymphoma One study found two different types of lymphoma could cause villous atrophy: small intestinal T-cell lymphoma, and enteropathy-associated T-cell lymphoma. Enteropathy-associated T-cell lymphoma is closely linked to celiac disease. Casein/Cow's Milk Intolerance Research has shown that flattened villi can also be caused by casein intolerance. For more info see "Mucosal reactivity to cow's milk protein in C(o)eliac disease," which states "A mucosal inflammatory response similar to that elicited by gluten was produced by CM (Cows Milk) protein in about 50% of the patients with coeliac disease. Casein, in particular, seems to be involved in this reaction." Certain Drugs Drugs that suppress your immune system (such as Imuran and CellCept), the antibiotic neomycin, and the anti-inflammatory medication Colcrys, also have been linked to reports of medication-induced villous atrophy. Small intestine Bacterial Overgrowth, or SIBO Symptoms of SIBO can mimic those of celiac disease. Other possible causes of villous atrophy, including infection with parasites or with the ulcer-causing bacteria Helicobacter pylori, also have been reported. Thiamine Deficiency and/or Beri Beri Both can cause thinning of the villi, leading to both casein/lactose intolerance and in time possibly a celiac disease or non-celiac gluten sensitivity (NCGS) diagnosis. Not all Villous Atrophy is From Celiac Disease Most, but not all, cases of villous atrophy are caused by celiac disease. Patients with negative blood test, who do not see symptoms improve on a gluten-free diet, should consult with a doctor about other possible causes of villous atrophy.- 13 comments
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Celiac.com 03/21/2024 - For people with celiac disease, managing symptoms and maintaining a gluten-free lifestyle are essential for overall health. However, recent research has uncovered another potential cause of enteropathy that presents a diagnostic challenge for both patients and healthcare providers: olmesartan-induced enteropathy. Olmesartan, an angiotensin II receptor antagonist commonly prescribed for hypertension, has been linked to enteropathy in rare cases, and another brand name for it is Benicar. This side effect, while uncommon, can manifest as chronic diarrhea, weight loss, and signs of malabsorption, mirroring the symptoms of celiac disease. A team of researchers set out to study the diagnostic challenges related to non-celiac enteropathy, specifically focusing on olmesartan-induced enteropathy. Here's what they found. The research team included Doukas S G, Doukas P G, and Velpari S. They are variously affiliated with the Department of Medicine, Saint Peter's University Hospital in New Brunswick, NJ, USA; the Department of Forensic Sciences and Laboratory of Toxicology, University of Crete, Medical School in Heraklion, GRC; and the department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School/Saint Peter's University Hospital in New Brunswick, USA. Their recent study focused on a 73-year-old woman who presented to the emergency department with watery diarrhea, weight loss, and electrolyte imbalances. Despite extensive testing, including celiac disease panels and imaging studies, the cause of her symptoms remained elusive until duodenal biopsies revealed moderate to severe villi blunting and intraepithelial lymphocytosis—a hallmark of olmesartan-induced enteropathy. History of Taking Olmesartan The patient's history of olmesartan use prompted the discontinuation of the medication, leading to a remarkable improvement in her symptoms and duodenal biopsy results within one month. This case underscores the importance of considering medication history and ruling out other potential causes of enteropathy in patients with symptoms suggestive of malabsorption. Olmesartan-induced enteropathy can mimic celiac disease both clinically and histopathologically, often leading to unnecessary diagnostic investigations and delays in appropriate treatment. Greater awareness of medication-related diarrheal syndromes, such as olmesartan-induced enteropathy, is crucial for prompt diagnosis and management. Healthcare providers should be vigilant in recognizing the potential link between olmesartan use and enteropathy, as simple discontinuation of the medication can lead to significant clinical improvement. For people with celiac disease and other gastrointestinal conditions, understanding the potential causes of enteropathy beyond gluten exposure is essential for effectively managing symptoms, and optimizing health outcomes. By staying informed and working closely with healthcare providers, patients can navigate the complexities of non-celiac enteropathy, and advocate for their well-being. Read more at Cureus 16(2): e54373. doi:10.7759/cureus.54373
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Celiac.com 01/01/2024 - A recent review by researcher Evan D. Newnham delves into the evidence concerning the effects of gluten ingestion on gastrointestinal symptoms and small intestinal injury indices in individuals without celiac disease, but who may be gluten intolerant. Newnham, affiliated with the Eastern Health Clinical School in Australia, conducted a literature review focusing on interventional studies to address this issue. The findings highlighted a lack of comprehensive exclusion of celiac disease in some studies. In particular, an unblinded study that identified symptomatic responses to gluten didn't effectively exclude celiac patients, as many exhibited intraepithelial lymphocytosis. However, a more robust double-blinded, randomized, placebo-controlled re-challenge trial was reported. This trial included patients where celiac disease had been ruled out based on either normal duodenal histology on a gluten-containing diet or the absence of the HLA DQ2 or DQ8 haplotype. During the trial, participants were randomly assigned to receive 16 grams per day of either gluten or a placebo for six weeks. All participants experienced improved gastrointestinal symptoms on a gluten-free diet (GFD) for at least six weeks before enrollment. The study, comprising 19 participants receiving gluten and 15 receiving a placebo, revealed that the change in overall symptom severity from baseline to the final weeks was more significant for those receiving gluten. Within one week, symptoms like pain, bloating, satisfaction with stool consistency, and tiredness were worse for the gluten group compared to the placebo group. However, the mechanisms behind symptom induction were not identified. The study underscores the existence of non-celiac gluten intolerance and emphasizes the need for future research to address critical issues like determining the required gluten dose and understanding the mechanisms of action in non-celiac individuals. Read more in the Journal of Gastroenterology and Hepatology
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Celiac.com 08/22/2022 - Researchers present a case series of patients with chronic low-back pain and spondyloarthritis related features, who respond well to the gluten-free diet, despite celiac disease being ruled out. Currently, people who suffer from chronic low-back pain, with spondyloarthritis related features, are treated with immunosupresive drugs for both diseases. Prior studies have shown that gut involvement is a well-known association of spondyloarthritis, but limited to a few disorders, such as inflammatory bowel disease. A team of researchers recently set out to test the hypothesis that non-celiac gluten sensitivity is associated with chronic low-back pain related to spondyloarthritis, and that treatment with a gluten-free diet would be beneficial in certain patients. Researchers Carlos Isasi, Alexander Stadnitsky, Fernando Casco, Eva Tejerina, Ana Royuela, Blanca Esteban, and Natalia Fernandez Puga present results from a case series of patients with chronic low-back pain, spondyloarthritis related features, and positive response to a gluten-free diet, despite celiac disease being ruled out. The team's retrospective case report covers 110 patients from a tertiary hospital rheumatology clinic, which specializes in treating chronic pain and gluten sensitivity. All patients suffered from refractory low-back pain and spondyloarthritis features, and all patients followed a gluten-free diet despite celiac disease being ruled out. The team sought a measure of improvement called, "demanding improvement," which they defined based on the achievement of at least one of the following improvements: Asymptomatic status, remission of chronic low-back pain, returning to normal life, returning to work, changing from confinement to bed/wheelchair to being able to walk, returning to self-sufficiency for hygiene and personal care, discontinuation of opioids. Average patient age at low-back onset pain was 30 years old, while the average disease duration was 15 years. Nearly eighty percent of the patients experienced improvement, while nearly seventy percent achieved demanding improvement. Average duration of a gluten-free diet in patients with demanding improvement was five years. A total of 56 out of 69 patients with demanding improvement ingested gluten, with 54 of those experiencing clinically worse symptoms, considered to have non-celiac gluten sensitivity. Two main factors for making demanding improvement were oral aphthae and having a relative with celiac disease. Nearly four out of five patients retrospectively classified with axial spondyloarthritis showed demanding improvement. Nearly all patients with uveitis showed demanding improvement. Meanwhile, well over half of patients with fibromyalgia showed demanding improvement. The team's data support the hypothesis that non-celiac gluten sensitivity is associated with chronic low-back pain related to spondyloarthritis, and a gluten free diet has a therapeutic benefit for some patients. These results are important, because the could point the way to using a positive response to a gluten-free diet in people with non-gluten sensitivity to help improve chronic low-back pain related to spondyloarthritis in those patients. Read more in Med Hypotheses. 2020 Feb 28;140:109646 The researchers in this study are variously affiliated with the Rheumatology Department of Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Family Medicine at Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; the Pathological Anatomy Department of Unilabs, Madrid, Spain; the Pathological Anatomy Department of Hospital Universitario Puerta de Hierro, Majadahonda Madrid, Spain; the Biostatistics Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, Spain; the Asociación de celíacos y sensibles al gluten de Madrid (Association of Celiacs and Gluten-Sensitives of Madrid, Spain; and the Digestive Medicine Department of Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
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Celiac.com 04/18/2022 - Several observational studies have indicated that celiac disease patients do not have higher susceptibility of COVID-19 and the risk of severe COVID-19. However, the the conclusions of such studies can be distorted by reverse causation and confounding, especially for newly-emerged diseases, such as COVID-19. A team of researchers recently set out to further clarify the picture using both observational and Mendelian Randomization analysis. The research team included Jiuling Li, Aowen Tian, Dandan Yang, Miaoran Zhang, Lanlan Chen, Jianping Wen, and Peng Chen. For their observational study, the team used data from the UK Biobank cohort. They conducted both univariate and multivariate logistic regression analysis to identify the risk factors for both COVID-19 susceptibility and severe COVID-19. They also conducted a two-sample Mendelian Randomization analysis to delineate causality between celiac disease and COVID-19 susceptibility and severe COVID-19. The good news is that the team's UK Biobank data revealed that celiac disease patients had a slightly lower overall susceptibility to COVID-19, and that celiac patients did not have higher rates of severe COVID-19. Meanwhile, the Mendelian Randomization study showed that celiac patients had lower susceptibility to both COVID-19 and fewer cases of severe COVID-19, although the lower COVID-19 susceptibility is seen in only in the UK Biobank cohort. These results indicate that people with celiac disease do not face higher risk of getting COVID-19, or of developing severe COVID, than the non-celiac population, and they likely do not need to take any extra COVID-19 precautions. Read more in Clin Transl Gastroenterology The researchers in this study are variously affiliated with the Department of Pathology, College of Basic Medical Sciences, Jilin University in Changchun, Jilin, China; the Experimental Center of Pathogenobiology, Immunology, Cytobiology and Genetics, College of Basic Medical Sciences, Jilin University in Changchun, Jilin, China; the Clinical Medicine of Jilin University in Changchun, Jilin, China; and the Department of Genetics, College of Basic Medical Sciences, Jilin University in Changchun, Jilin, China.
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Celiac.com 03/08/2022 - There's been some evidence to connect celiac disease with an imbalance in gut microflora. However, researchers still don't know much about how gluten exposure in people with well-controlled celiac disease might influence microbial balance in the gut. A better understanding of this connection could help to improve our knowledge of celiac disease activity and its symptoms. To get a better idea of such a possible connection, a team of researchers recently set out to evaluate the impact of gluten exposure on the gut microbiome in patients with celiac disease and non-celiac gluten sensitivity (NCGS). The research team included Nobel, Yael R. MD; Rozenberg, Felix BA; Park, Heekuk PhD; Freedberg, Daniel E. MD, MS; Blaser, Martin J. MD; Green, Peter H.R. MD; Uhlemann, Anne-Catrin MD, PhD; and Lebwohl, Benjamin MD, MS. They are variously affiliated with the Celiac Disease Center, Columbia University Irving Medical Center, New York, New York, USA; the Microbiome and Pathogen Genomics Collaborative Center, Columbia University Irving Medical Center, New York, New York, USA; the Center for Advanced Biotechnology and Medicine, Rutgers University, New Brunswick, New Jersey, USA; the Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA; the Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA. The team conducted a 14-day gluten challenge of 5 grams of gluten per day on nine patients with celiac disease and eight with NCGS, all of whom had been on a gluten-free diet. They then compared the results from the two groups against results from eight control subjects on a standard gluten-containing diet. The team used 16S rRNA gene and metagenomic sequencing before, during, and after the gluten challenge, to conduct fecal microbiome analysis on patient stool samples. They assessed symptoms using two 2 validated clinical scales. The results showed that patients with celiac disease and NCGS showed no significant fecal microbial changes in response to the gluten challenge. Interestingly, gut microbiome composition differed between all thee groups at baseline, and these differences continued regardless of gluten exposure. Celiac and NCGS subjects reported worse symptoms and general health in the middle of gluten challenge, and slightly better by the end. However, the symptoms and general health issues showed no consistent connections with the composition of the gut microbiome. In this study, fecal microbiome diversity remained unchanged by gluten challenge in adult subjects with celiac disease and NCGS. These results indicate that celiac disease and NCGS activity and severity may be unrelated to gut microbiome status. Since the gut microbiome is crucial to good health, it may be some comfort to people with celiac disease and NCGS that gluten exposure doesn't seem to damage the microbiome balance, and so is unlikely to worsen disease symptoms, at least in the short term. Read more in Clinical and Translational Gastroenterology: December 2021
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Celiac.com 01/31/2022 - As intestinal permeability and innate immune system activation emerge as possible pathophysiological mechanisms in non-celiac gluten sensitivity (NCGS), a number of researchers have become interested in markers for gut integrity and inflammation. The idea being that thesis markers might help to reveal pathological changes that occur with non-celiac gluten sensitivity. A team of researchers recently set out to assess relevant biomarkers in non-celiac gluten sensitivity by analyzing serum levels of gut integrity and permeability markers, pro-inflammatory cytokines and antigliadin IgG in patients with suspected non-celiac gluten sensitivity on a gluten-free diet, and compare them to serum levels in patients with irritable bowel syndrome (IBS) and healthy controls (HC). The research team included Hanna Fjeldheim Dale, Julianne CH Johannessen, Ingeborg Brønstad, and Gülen Arslan Lied. They are variously affiliated with the Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway; the Division of Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway; and the National Centre of Functional Gastrointestinal Disorders, Haukeland University Hospital, Bergen, Norway. Their team analyzed serum samples collected from twenty patients with suspected non-celiac gluten sensitivity patients on a gluten-free diet, twenty with IBS, and twenty healthy sex and age matched control subjects. The team used IBS severity scoring system (IBS-SSS) to assess gastrointestinal symptom severity. Compared to heathy control subjects, suspected non-celiac gluten sensitivity and IBS patients had higher IBS-SSS scores. Their analysis showed no significant differences in serum levels of any of the gut integrity and permeability markers, cytokines or antigliadin IgG antibodies between the three groups. However, they did see positive correlations between claudin-1 and i-FABP, and between claudin-1 and antigliadin IgG antibodies. The team's assessment showed no differences in serum levels of gut integrity and permeability markers, pro-inflammatory cytokines or antigliadin IgG antibodies among patients with suspected non-celiac gluten sensitivity patients on a gluten-free diet, IBS and healthy control subjects. The findings suggest that these biomarkers do not offer a way to spot possible pathophysiological mechanisms in non-celiac gluten sensitivity. Stay tuned for more on this and related stories. Read more at DovePress.com.
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Celiac.com 12/22/2021 - In people with celiac disease, gluten sparks an immune reaction that causes damage to the small intestine, likely increasing their long-term risk of a number of gastrointestinal cancers. What about cancer risk when people without celiac disease eat gluten? The general assumption has been that gluten is basically healthy for those without gluten sensitivity. But researchers just don't know that much about the health impacts of gluten in the general population. A team of researchers recently set out to examine the association between gluten intake and risk of digestive system cancers among individuals without celiac disease. The research team included Yiqing Wang, Yin Cao, Benjamin Lebwohl, Mingyang Song, Qi Sun, Peter H.R. Green, Edward L. Giovannucci, Walter C. Willett, and Andrew T. Chan. For their study, the team used longitudinal data from three prospective cohorts, the Nurses’ Health Study, Nurses’ Health Study II, and Health Professionals Follow-Up Study. They estimated hazard ratios using Cox proportional regression, along with 95% confidence intervals of digestive system cancers, based on levels of gluten intake as determined by food frequency questionnaires. Over 4,801,513 person-years of follow-up, they found 6,231 incident digestive system cancer cases among three groups, and that gluten intake was not connected with an increased risk of digestive system cancer, even after adjusting for numerous risk factors, including body mass index, physical activity, diet quality. Similarly they found no connection for individual digestive system cancers, including oral cavity and oropharyngeal cancer, esophageal cancer, stomach cancer, small intestine cancer, colorectal cancer, pancreatic cancer, gallbladder cancer, and liver cancer. Gluten intake was not associated with any elevated risk of digestive system cancers in non-celiac adults. Avoiding or reducing dietary gluten is unlikely to help prevent digestive system cancers in non-celiacs. So, if you don't have celiac disease, avoiding gluten won't protect you from the kinds of digestive system cancers that are more common in people with celiac disease. Read more in Clinical Gastroenterology and Hepatology The researchers are variously affiliated with the Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; the Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; the Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri ; the Division of Gastroenterology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri; the Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, Missouri; the Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; the Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; the Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; the Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and the Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
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Celiac.com 01/14/2021 - It's no secret that most gluten-free food sales are for snack foods. It's also no secret that most gluten-free snacks are nutritionally inferior to comparable non-gluten-free snacks. It's also true that the majority of people who eat gluten-free diet are doing so for dietary, rather than medical reasons. But does that mean we need to be worried about the nutritional well-being of people who adopt a gluten-free diet for non-medical reasons? The folks who grow, market and sell wheat and wheat products want us to think so. The wheat industry gave some money to some food scientists and a behavioral economist from the University of Nebraska–Lincoln to try to figure out "why gluten-free foods have become so popular among those who aren't medically required to avoid gluten." Their reasons for doing so are, of course, wholly altruistic, and their concern lies in the dietary health of people who might suffer poor nutrition by ditching wheat and eating gluten-free. "The gluten-free diet is a medical diet that's being adopted by people who don't really need it," said Kristina Arslain, who authored the paper as part of her master's thesis with the Department of Food Science and Technology at Nebraska. The researchers note that 20% of non-celiacs surveyed said that they had tried a gluten-free diet. They also note that an estimated 25% of Americans follow a gluten-free diet. As fewer than one percent of Americans have celiac disease, and ~12% may have gluten sensitivity and/or gluten intolerance, the vast majority who give up wheat do so for non-medical reasons. They claim they are looking to shed light on what attracts people to "fad diets," and they do present a few data points to suggest that, say, acne is a bigger motivator than weight loss. But, they give up the game early by making assumptions, and by feigning health concerns about people eating gluten-free for non-medical reasons. The sentiment is echoed by Christopher Gustafson, an associate professor of agricultural economics who studies behavioral economics, who says that "One of the implications of going gluten-free is that you are probably going to end up with a diet that is less rich in whole grains. There's real public health and personal health reasons to be concerned about people voluntarily choosing the gluten-free diet when they don't have a diagnosed reason to do so." Most Americans Self-diagnose to Adopt Gluten-Free Diets So what? Most Americans do not follow a prescribed diet. They choose their diet based on myriad personal, cultural and economic factors, some solid and well reasoned, some capricious, some learned. This so called scientific paper looks a lot like concern trolling mixed with assumption and innuendo. People are eating less wheat, with many avoiding it all together. This is a problem for the people who grow and sell wheat, not necessarily for people avoiding it. Absent a medical reason to avoid gluten, anyone on a gluten-free diet is self diagnosing. Most people on a gluten-free diet self diagnose. So what? We reject the idea that there are any extra health concerns associated with a nutritious, well-balanced gluten-free diet. This goes as much for people without celiac disease as for celiacs. Many processed gluten-free foods are less nutritious than their non-gluten-free counterparts, which are still not very nutritious themselves. No question, processed foods are not particularly nutritious, and processed gluten-free foods are slightly worse, maybe. However, there's no good science to support the idea that a gluten-free diet is necessarily any less nutritious than a diet that contains gluten. It depends on the diet. It depends on the individual. It depends on the choices. A Gluten-Free Diet Can be Perfectly Nutritious and Healthy, Whether You Need it or Not A diet rich in fresh fruits and vegetables, fiber, protein, and a moderate amount of fat is going to be healthier than a diet rich in processed foods. That's true for both a gluten-free diet, and a non-gluten-free diet. The key is not the presence or absence of gluten. The key is the nutritional profile of the food choices. If the goal of the paper is to encourage non-celiacs eating gluten-free to pay close attention to making sure they are eating a well-balanced diet, then that's laudable. However, beyond that, it's impossible to claim the a gluten-free diet is risky for non-celiacs without claiming that it's risky for celiacs, which has not been proven. And, conversely, you can't argue that it's possible for people with celiac disease to eat a nutritious, well-balanced gluten-free diet, without also admitting that it's possible for non-celiacs to do the same. There are myriad reasons why non-celiacs choose a gluten-free diet, and as many versions of what that diet can be as there are people. There are just no good solid studies that support any "real public health and personal health reasons" to be concerned about people choosing the gluten-free diet, whether for medical or for non-medical reasons. I'm pretty sure any number of nutritionists, or even a fairly educated layperson, can design a nutritious, well-balanced gluten-free diet, and also a non-gluten-free diet. It may be a bit easier to eat unwholesome food of questionable nutritional value on a gluten-free diet, but it's not that much harder on a non-gluten-free diet. The researchers pull back a bit by concluding that gluten-free bread-related products have improved in quality, and that people whose gluten-free and non-gluten-free diet includes more fruits and vegetables will very likely have better health outcomes than those who gravitate to cakes and cookies. Sure, a nutritious, well-balanced diet is important, gluten-free, or not. People are eating less wheat, with many avoiding it all together. Some people mistakenly assume that avoiding wheat and gluten will automatically make their diet more nutritious than eating wheat and gluten, which is not true. But it's also not true that eating gluten-free is automatically less nutritious than eating wheat and gluten. It really depends on the choices of each dieter, on how much of which foods they eat and many other factors. Absent real data on actual effects of a gluten-free diet, any concern "about people voluntarily choosing the gluten-free diet when they don't have a diagnosed reason to do so," is likely misplaced. That's especially true if the concern is funded by the wheat industry in the guise of thin, and largely empty studies, with equally empty conclusions, such as this one. There are legitimate reasons for some people eating gluten-free for non-medical reasons to take a look at their choice, and their reasons for making it. There are good reasons to check with a doctor or a nutritionist. But, this study isn't especially helpful. Let's translate: Cakes and cookies and processed foods are not especially nutritious, gluten-free or not. People who adopt a gluten-free diet, whether for medical or non-medical reasons, need to pay particular attention to nutrition, but so should people who don't eat gluten-free. If you eat a gluten-free diet, for any reason, or if you eat a non-gluten-diet, you will do well to focus on eating nutritious, well-balanced diet, that provides suitable amounts of fiber, along with fresh, whole fruits and vegetables. But certainly don't let a questionable study by the wheat industry scare you away from a gluten-free diet, if you decide that's the right diet for you. Read more at Medicalexpress.com, and at news.unl.edu.
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Celiac.com 08/21/2013 - It is becoming much more common for people with celiac disease to receive a diagnosis late in life, the implications of which are largely unknown. Although short stature is a common trait of childhood celiac disease, there has been no clear data on the height of adult celiac disease patients. A team of researchers recently set out to determine if men with celiac disease are shorter than their peers in the general population. The research team included R. Sonti, B. Lebwohl, S.K. Lewis, H. Abu Daya, H. Klavan, K. Aguilar, and P.H. Green. They are affiliated with the Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, New York, USA. Their cross-sectional study assessed the final height of men and women diagnosed with celiac disease in adulthood. The team looked at 585 adults at the Celiac Disease Center at Columbia University, comparing their height against that of a control population (NHANES). The study included only patients who were over 18 years of age at diagnosis, and with available baseline height and weight data. The team also looked for differences in demographic and physical features, mode of presentation, and concomitant illnesses in shorter versus taller celiac patients. The 162 men with celiac disease diagnosed in adulthood were shorter than men in the general population. Overall, the men with celiac disease were 169.3±10.5 cm compared to 177.3±7.0 cm (P Interestingly, this was not the case with women. The 423 women with celiac disease averaged 166.3±9.4 cm compared with 163.2±6.7 cm for the general population. There were no significant differences in age at diagnosis, BMI, concomitant autoimmune illnesses (hypothyroidism, type I diabetes, dermatitis herpetiformis), or mode of presentation in shorter versus taller celiac disease patients of either sex. Hemoglobin was associated with short stature in men with celiac disease (short: 13.9 g/dl, tall: 14.6 g/dl; P=0.01), but not in women with celiac disease (short: 12.9 g/dl, tall: 13.0 g/dl, P=0.41). Short stature is a a common and well documented feature of childhood celiac disease. Many celiac children who suffer low BMD experience 'catch-up growth' once they adopt a gluten-free diet. However, men with celiac disease who reach their final height before diagnosis are shorter relative to the general population. This is not true for adult women with celiac disease. Source: Eur J Gastroenterol Hepatol. 2013 Jun 5.
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Celiac.com 05/29/2014 - Many people with celiac disease report symptoms of depression, which usually subside upon treatment with a gluten-free diet. But a new study out of Australia suggests that gluten can cause depression in people with non-celiac gluten-sensitivity. Current evidence shows that many patients with self-reported non-celiac gluten sensitivity (NCGS) continue to have gastrointestinal symptoms on a gluten-free diet, but say that avoiding gluten makes them feel ‘better'. So, why do people with non-celiac gluten sensitivity seem to feel better on a gluten-free diet, even if they still have gastrointestinal symptoms? A team of researchers wanted to know if this might be due to gluten’s effects on the mental state of those with NCGS, and not necessarily because of gastrointestinal symptoms. The research team included S. L. Peters, J. R. Biesiekierski, G. W. Yelland, J. G. Muir, and P. R. Gibson. They are affiliated with the Department of Gastroenterology, Central Clinical School of Monash University at The Alfred Hospital in Melbourne, the Department of Gastroenterology at the Eastern Health Clinical School of Monash University in Box Hill, and the School of Health Sciences at RMIT University in Bundoora, Victoria, Australia. For their double-blind cross-over study, they looked at 17 women and five men, aged 24–62 years. All participants suffered from irritable bowel syndrome, but not from celiac disease, and their symptoms were controlled on a gluten-free diet. The team gave the participants one of three random dietary challenges over 3 days, followed by a minimum 3-day washout before moving to the next diet. All participants got all three diets over the course of the study. For each phase, the team supplemented the challenge gluten-free food with gluten, (16 g/day), whey (16 g/day) or nothing at all (placebo). The team assessed mental state as determined by the Spielberger State Trait Personality Inventory (STPI), cortisol secretion and gastrointestinal symptoms. They found that gluten ingestion was associated with higher overall STPI state depression scores compared to placebo [M = 2.03, 95% CI (0.55–3.51), P = 0.010], but not whey [M = 1.48, 95% CI (−0.14 to 3.10), P = 0.07]. They found no differences for other STPI state indices or for any STPI trait measures, and they saw no difference in cortisol secretion between challenges. Gastrointestinal symptoms were similar for each dietary challenge. Short-term exposure to gluten specifically induced current feelings of depression with no effect on other indices or on emotional disposition. Moreover, the team saw no gluten-specific trigger of gastrointestinal symptoms. Such findings might explain why patients with non-coeliac gluten sensitivity feel better on a gluten-free diet despite the continuation of gastrointestinal symptoms. Source: Aliment Pharmacol Ther. 2014;39(10):1104-1112.
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Celiac.com 11/14/2013 - Until now, rates of non-celiac gluten sensitivity were largely a matter of clinical speculation, basically, educated guesswork among doctors. Some thought that rates of non-celiac gluten-sensitivity might by much higher than rates of celiac disease in the USA. But there was just no actual clinical data supporting these claims. A team of researchers recently set out to get some good clinical data that would tell them how common non-celiac gluten sensitivity actually is. The research team included Daniel V. DiGiacomo, Christina A. Tennyson, Peter H. Green, and Ryan T. Demmer. They are variously affiliated with the Department of Medicine, Celiac Disease Center at Columbia University, and the Department of Epidemiology at the Mailman School of Public Health at Columbia University in New York. The authors used the Continuous National Health and Nutrition Examination Survey (NHANES) 2009–2010 to enroll 7762 people from the civilian, non-institutionalized, US population free of celiac disease. They then analyzed the data to estimate rates of adherence to a gluten-free diet among participants without celiac disease as a surrogate marker for non-celiac gluten sensitivity in the US. They also used the data to characterize the demographics and general health status of the study participants. Overall, forty-nine participants reported adherence to a gluten-free diet. With a weighted national prevalence of 0.548%, this represents 1.3 million individuals between 6 and 80 years old in the US. The prevalence of a gluten-free diet was higher in females (0.58%) than males (0.37%), although this was not statistically significant (p = 0.34). Participants reporting a gluten-free diet were older (46.6 vs. 40.5 years, p = 0.005), had higher high-density lipoprotein, lower iron and lower body mass index. These numbers put the estimated national prevalence of non-celiac gluten sensitivity at 0.548%, about half the rate of celiac disease. However, the team calls for further studies in order to better understand the population burden of non-celiac gluten sensitivity. Source: Rev Esp Enferm Dig. 2013 Apr;105(4):187-193. doi:10.3109/00365521.2013.809598
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Celiac.com 01/20/2020 - Researchers have only recently begun to acknowledge that some people without celiac disease nonetheless suffer celiac-like symptoms after eating wheat/gluten, a condition known as non-celiac wheat sensitivity (NCWS), or non-celiac gluten sensitivity (NCGS). A recent study found the first miRNA signatures for the diagnosis of non-celiac wheat sensitivity. Imagine how hard it is for some people to get diagnosed with celiac disease, even with the relatively simple antibody tests available. Now imagine having exactly the same symptoms, and not having celiac disease at all. Now, because there are no biomarkers to point the way, doctors must totally exclude celiac disease before settling on a diagnosis of non-celiac wheat sensitivity. A team of researchers recently set out to conduct an explorative study to identify miRNA signatures that might be helpful in diagnosing non-celiac wheat sensitivity. The research team included Emanuela Clemente, Konstantinos Efthymakis, Erminia Carletti, Vanessa Capone, Samantha Sperduti, Giuseppina Bologna, Marco Marchisio, Marta Di Nicola, Matteo Neri, and Michele Sallese, and Louise Emilsson. They are variously affiliated with the Department of Medical, Oral and Biotechnological Sciences, “G. d'Annunzio” University of Chieti–Pescara, Chieti, Italy; the Centre for Advanced Studies and Technology (CAST), “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy; and the Department of Medicine and Ageing Sciences, “G. d'Annunzio” University of Chieti–Pescara in Chieti, Italy. As with celiac disease, people with non-celiac wheat or gluten-sensitivity can experience a wide range of symptoms including diarrhea, intestinal discomfort, and fatigue. So far, the only clear clinical feature for non-celiac wheat sensitivity patients is a slight increase of intraepithelial lymphocytes. They don't have any antibodies to tissue transglutaminase (tTG) and show no villous atrophy, or any other diagnostic features of celiac disease. Because there are no known biomarkers for non-celiac wheat sensitivity, diagnosis is currently made by excluding celiac disease in patients who otherwise show persistent celiac-like symptoms triggered by wheat/gluten consumption. Here, the expression levels of selected miRNAs were examined in duodenal biopsies and peripheral blood leukocytes collected from newly diagnosed patients with non-celiac wheat sensitivity and, as controls, from patients with celiac disease and gluten-independent gastrointestinal problems. The team found several miRNAs to be elevated in the intestinal mucosa of patients affected by non-celiac wheat sensitivity in comparison to control subjects with by gluten-independent dyspeptic symptoms (Helicobacter pylori-negative) and celiac disease. This is the first study to show any type of clear miRNA expression patterns in non-celiac wheat sensitivity patients. This development could lead to a helpful way to diagnose non-celiac wheat sensitivity using a simple biomarker. Stay tuned for more on this and related stories. Read more at PloS One
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Celiac.com Article: Study Shows First Clear Biomarker for Non-Celiac Wheat Sensitivity
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Celiac.com 07/24/2017 - Are many non-celiac gluten-free eaters actually treating undiagnosed medical conditions? Is the gluten-free movement less a fad than we imagine? Currently, about 3 million Americans follow a gluten-free diet, even though they do not have celiac disease. Known colloquially as "PWAGs," people without celiac disease avoiding gluten. These folks are often painted as fad dieters, or hypochondriacs, or both. Call them what you will, their ranks are growing. According to a study in the journal Mayo Clinic Proceedings, the number of PWAGs tripled from 2009 to 2014, while the number of celiac cases stayed flat. A new study from the Mayo Clinic supports these conclusions. The study derived from data gathered in the National Health and Nutrition Examination Survey, as well as serological tests. There is also a growing body of data that support the existence of non-celiac gluten sensitivities, though the evidence is not conclusive. Moreover, researchers really don't have any idea how many non-celiacs on a gluten-free diet may have legitimate reactions to gluten. The phenomenon has emerged in the past five years in medical literature. For a long time, researchers just assumed that only people with celiac disease would eat a gluten-free diet. About a decade ago, when research into celiac disease and gluten-free dieting began in earnest, says Joseph Murray, a celiac researcher at the Mayo Clinic and an author of the new research, researchers "didn't think to ask why people avoid gluten. When we designed this study 10 years ago, no one avoided gluten without a celiac diagnosis." The latest research by Murray and his colleagues showed that the total number of celiac cases leveled off in the last few years, while more non-celiacs began to avoid gluten for different reasons. Researchers still aren't sure what's driving the trend, and whether it will continue. Part of the increase is doubtless to growing awareness of gluten sensitivity. However, Benjamin Lebwohl, the director of clinical research at Columbia University's Celiac Disease Center, estimates that more than half of the 3.1 million PWAGs noted in this latest study have legitimate gluten sensitivity. "An increasing number of people say that gluten makes them sick, and we don't have a good sense why that is yet," Lebwohl said. "There is a large placebo effect — but this is over and above that." Non-celiac patients with gluten sensitivity often complain of symptoms similar to those of celiacs, such as intestinal problems, fatigue, stomachaches and mental fogginess. And while researchers don't know the reason, clinical studies have shown that these symptoms are often relieved by eliminating dietary gluten. One theory that is gaining some credence is that these people may be sensitive to other irritants, such as FODMAPS, a class of carbohydrates shown to cause gastrointestinal symptoms found in wheat, milk, onions and cheese. Look for more studies into this topic, as researchers seek to nail down answers about celiac disease and gluten-sensitivity, and similar symptoms in non-celiacs. Meantime, the number of people who suspect they have non-celiac gluten sensitivity, and who seek improvement in their symptoms by eliminating gluten from their diets, continues to grow. Source: DailyTribune.com
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Celiac.com 06/13/2012 - In general, doctors and researchers know a good deal about how celiac disease works, and they are finding out more all the time. However, they know very little about non-celiac gluten sensitivity (NCGS). In an effort to learn more about non-celiac gluten sensitivity, a team of researchers recently carried out a study to measure the presence of somatization, personality traits, anxiety, depression, and health-related quality of life in NCGS individuals, and to compare the results with celiac disease patients and healthy control subjects. They also compared the response to gluten challenge between patients with non-celiac gluten sensitivity and those with celiac disease. The research team included M. Brottveit, P.O. Vandvik, S. Wojniusz, A. Løvik, K.E. Lundin, and B. Boye, of the Department of Gastroenterology at Oslo University Hospital, Ullevål in Oslo, Norway. In all, the team looked at 22 patients with celiac disease and 31 HLA-DQ2+ NCGS patients without celiac disease. All patients were following a gluten-free diet. Over a three day period, the team challenged 17 of the celiac disease patients with orally ingested gluten. They then recorded the symptoms reported by those patients. They did the same with a group of 40 healthy control subjects. The team then had both patients and healthy control subjects complete questionnaires regarding anxiety, depression, neuroticism and lie, hostility and aggression, alexithymia and health locus of control, physical complaints, and health-related quality of life. Interestingly, patients with non-celiac gluten sensitivity reported more abdominal (p = 0.01) and non-abdominal (p < 0.01) symptoms after the gluten challenge than patients with celiac disease. The increase in symptoms in non-celiac gluten sensitivity patients was not related to personality. However, the two groups both reported similar responses regarding personality traits, level of somatization, quality of life, anxiety, and depressive symptoms. Responses for both groups were about the same as for healthy controls. The results showed that patients with non-celiac gluten sensitivity did not show any tendencies toward general somatization, as both celiac disease patients and those with non-celiac gluten sensitivity showed low somatization levels. Source: Scand J Gastroenterol. 2012 Apr 23.
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Celiac.com 09/26/2018 - Non-celiac gluten sensitivity (NCGS) is a clinical syndrome marked by both intestinal and extra-intestinal symptoms that respond to the elimination of gluten-containing food and the adoption of a gluten-free diet. A team of researchers recently set out to review the diagnostic challenges surrounding non-celiac gluten sensitivity, and to summarize recent advances in research and provide a brief overview of the history of the condition for the benefit of professionals working in gastroenterology. The research team included Giovanni Casella, Vincenzo Villanacci, Camillo Di Bella, Gabrio Bassotti, Justine Bold, and Kamran Rostami. They are variously affiliated with General Practioner National Health Italy; the Institute of Pathology Spedali Civili Brescia Italy; the Pathology Department, Carate Brianza Hospital, ASST-Vimercate (Monza Brianza), Italy; the Gastroenterology and Hepatology Section of the Department of Medicine at the University of Perugia School of Medicine in Perugia, Italy; the Department of Gastroenterology Milton Keynes University Hospital, Milton Keynes, UK; and with Allied Health and Social Sciences, University of Worcester, UK. The researchers searched academic databases such as PubMed and Google Scholar using key words like ”non-celiac gluten sensitivity,” “gluten related disorders,” and the studies outlined in reference page were selected and analyzed. Clinical opinion generally holds that NCGS is best diagnosed by ruling out celiac disease and wheat allergy. Currently there is no blood test that can pinpoint NCGS. The underlying causes of symptoms in NCGS patients is poorly understood. However, there have been a few recent insights. Professional estimates of NCGS rates currently vary between 0.6 and 6%. Gastrointestinal symptoms of NCGS overlap slightly with those of irritable bowel syndrome. Researchers are currently investigating the histologic characteristics of NCGS, which range from normal histology to slightly elevated rates of T lymphocytes in the superficial epithelium of villi. Positive response to gluten free diet for up to 6 weeks, followed by a recurrence of symptoms after a gluten challenge, is still the best confirmation of NCGS. The Salerno expert criteria may help to accurately diagnose NCGS, especially in research settings, but isn’t particularly useful for diagnosis in clinical practice. Source: Gastroenterol Hepatol Bed Bench 2018;11(3):197-202).
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Celiac.com 01/16/2018 - More and more, people are adopting a gluten-free diet due to perceived health and weight-loss benefits. A team of researchers recently set out to ask people with celiac disease and non-celiac gluten sensitivity about their views on the health effects of gluten, and safety of vaccines and gluten-free food products. The research team included Loren G. Rabinowitz, Haley M. Zylberberg, Alan Levinovitz, Melissa S. Stockwell, Peter H. R. Green, and Benjamin Lebwohl. They are variously affiliated with the Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons New York USA; the Department of Philosophy and Religion James Madison University Harrisonburg USA, the Department of Pediatrics Columbia University College of Physicians and Surgeons New York USA, the Department of Population and Family Health, Mailman School of Public Health, Columbia University New York USA, the Department of Epidemiology, Mailman School of Public Health, Columbia University New York USA, and the Celiac Disease Center at Columbia University New York USA. Their team conducted an online survey of celiac and non-celiac gluten sensitivity patients from a celiac disease center e-mail list. They used univariate and multivariate analysis to compare responses from the two groups. The overall response rate was 27%, with 217 non-celiac gluten sensitivity responses, and 1,291 celiac disease responses. Subjects with non-celiac gluten sensitivity were more likely than those with celiac disease to disagree with the statement that "vaccines are safe for people with celiac disease." In all, 41.3% of respondents with non-celiac gluten sensitivity said vaccines are safe for celiacs, while just 26.4% of celiac patients said so. Celiac patients were slightly more likely to decline vaccination when offered, at about 31%, compared with just over 24% of gluten-sensitive respondents. After adjusting for age and gender, non-celiac gluten sensitivity subjects were more likely than celiac disease subjects to avoid genetically modified (GMO) foods, eat only organic products, believe that the FDA is not a reliable source of information, and believe a gluten-free diet will improve energy and concentration. People with non-celiac gluten sensitivity were more likely than those with celiac disease to have doubts about vaccine safety and to believe in the value of non-GMO and organic foods. The team's findings suggest that there might not be enough easily accessible information on gluten and its inclusion in food and drugs, and that may reinforce incorrect beliefs that are contrary to good public health. Source: Springer.com.
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Celiac.com 12/31/2012 - In people with celiac disease, eating wheat, barley, or rye triggers inflammation in the small intestine. Left unchecked, this inflammation causes the gut damage that is associated with untreated celiac disease. Specifically, the storage proteins in these grains (gluten) trigger an adaptive Th1-mediated immune response in individuals carrying HLA-DQ2 or HLA-DQ8 as major genetic predisposition. Researchers actually have a pretty good understanding of this aspect of celiac disease, part of a process called adaptive immunity. However, there has been some research that suggests that gluten proteins might trigger an immune response in people who do not have celiac disease, and who do not carry the HLA-DQ2 or HLA-DQ8 genetic markers that predispose them to developing celiac disease. Such a response is part of a process called innate immunity, and is far less understood than the adaptive immunity process. The innate immune system provides an early response to many microbial and chemical stimuli and is critical for successful priming of adaptive immunity. To better understand the relationship between adaptive immunity and innate immunity in celiac disease, a research team recently set out to determine if gliadin digests might induce innate immune responses in celiac and non-celiac individuals. Specifically, they wanted to know if wheat amylase trypsin inhibitors drive intestinal inflammation, and if so, by what receptor mechanism. The research team included Yvonne Junker, Sebastian Zeissig, Seong-Jun Kim, Donatella Barisani, Herbert Wieser, Daniel A. Leffler, Victor Zevallos, Towia A. Libermann, Simon Dillon, Tobias L. Freitag, Ciaran P. Kelly, and Detlef Schuppan. They are affiliated variously with the Division of Gastroenterology and the Proteomics and Genomics Center at Beth Israel Deaconess Medical Center at Harvard Medical School in Boston, with the Department of General Pediatrics and the Department of Internal Medicine I at the University Medical Center Schleswig-Holstein Kiel in Kiel, Germany, the Department of Experimental Medicine at the University of Milano-Bicocca in Milan, Italy, the German Research Center for Food Chemistry in Garching, Germany, the Hans-Dieter-Belitz-Institute for Cereal Grain Research in Freising, Germany, the Division of Molecular and Translational Medicine in the Department of Medicine I at Johannes Gutenberg University in Mainz, Germany, and with the Department of Bacteriology and Immunology at the Haartman Institute at the University of Helsinki in Finland. A number of earlier studies (Molberg et al., 1998; Anderson et al., 2000; Shan et al., 2002) have found HLA-DQ2– and HLA-DQ8–restricted gluten peptides that trigger the adaptive immune response in people with celiac disease. However, only 2–5% of individuals who show these HLAs develop celiac disease, which means that other factors, especially innate immune activation, are at play in the generation of celiac disease. Responsive innate cells are primarily macrophages, monocytes, DCs, and polymorphonuclear leukocytes that by means of their pattern-recognition receptors, such as TLRs, trigger the release of proinflammatory cytokines and chemokines, resulting in recruitment and activation of additional inflammatory cells (Medzhitov, 2007). Earlier studies (Maiuri et al., 2003) showed that peptides p31-43 or p31-49 from α-gliadin, that lack adaptive stimulatory capacity, triggered innate immune reactions by inducing IL-15 and Cox-2 expression in patient biopsies, and MHC class I polypeptide–related sequence A (MICA) on intestinal epithelial cells (Hüe et al., 2004). However, these studies have proven difficult to reproduce in cell culture, and researchers could not identify any specific receptor responsible for the observed effects. In a subsequent study, gliadin, in cell culture, reportedly triggered increased expression of co-stimulatory molecules and the production of proinflammatory cytokines in monocytes and DCs (Nikulina et al., 2004; Cinova et al., 2007). Two other studies (Thomas et al., 2006; Lammers et al., 2008) implicated the chemokine receptor CXCR3 in increased intestinal epithelial permeability upon gliadin challenge in a MyD88-dependent manner. However, those studies failed to reproducibly identify a specific gliadin peptide as the trigger. So far, no clear picture of the role of the innate immune system in celiac disease has emerged. In this study, the researchers show that members of the non-gluten α-amylase/trypsin inhibitors (ATIs), CM3 and 0.19, pest resistance molecules in wheat and related cereals, are strong triggers of innate immune responses in human and murine macrophages, monocytes, and dendritic cells. Their results show that ATIs activate the TLR4–MD2–CD14 complex and lead to up-regulation of maturation markers and elicit release of proinflammatory cytokines in cells from celiac and nonceliac patients and in celiac patients’ biopsies. They also show that mice deficient in TLR4 or TLR4 signaling are protected from intestinal and systemic immune responses upon oral challenge with ATIs. These findings define cereal ATIs as novel contributors to celiac disease. Moreover, ATIs may fuel inflammation and immune reactions in other intestinal and nonintestinal immune disorders. The findings of this study mean that the proteins in wheat may trigger immune reactions not just in people with celiac disease, but in people without celiac disease, and that these reactions may be actively contributing to the development of numerous other intestinal and non-intestinal immune disorders. That's a pretty big deal. Stay tuned to see how future studies elaborate these findings. Read the entire study in the Journal of Experimental Medicine. Source: J Exp Med. 2012 Dec 17;209(13):2395-408. doi: 10.1084/jem.20102660
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