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      Frequently Asked Questions About Celiac Disease   04/24/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What is Celiac Disease and the Gluten-Free Diet? What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes

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Found 8 results

  1. Celiac.com 08/23/2017 - A team of researchers recently set out to assess how many patients with a diagnosis of non-celiac wheat sensitivity (NCWS) still experienced symptoms of wheat sensitivity after an average follow-up time of 99 months. The research team included Antonio Carroccio, Alberto D’Alcamo, Giuseppe Iacono, Maurizio Soresi, Rosario Iacobucci, Andrea Arini, Girolamo Geraci, Francesca Fayer, Francesca Cavataio, Francesco La Blasca, Ada M. Florena, and Pasquale Mansueto. Using data collected from 200 participants from a previous study of non-celiac wheat sensitivity, performed between July and December 2016 in Italy, the team found that 148 of these individuals still followed a strict wheat-free diet. In total, 175 patients (88%) said that they had fewer symptoms after a diagnosis of non-celiac wheat sensitivity and general improvement. Of the 148 patients who adhered strictly to a gluten-free diet, 145 (98%) had reduced symptoms, compared with 30 of 52 patients who did not adhere to a gluten-free diet (58%) (P < .0001). Of the 22 patients who repeated the double-blind, placebo-controlled challenge, 20 reacted to wheat. The numbers and percentages of the 148 non-celiac wheat sensitivity patients on a strict wheat-free diet who reported that the following symptoms recurred after occasional and accidental wheat consumption: Lack of well-being 135 (91%); Tiredness 102 (69%); Foggy mind 68 (46%); Menstrual alterations 54 (36%); Anemia 46 (31%); Weight increase 45 (30%); Joint/muscle pain 35 (24%); Headache 31 (21%); Weight loss 30 (20%); Anxiety 18 (12%); Skin rash 16 (11%); Recurrent cystitis 12 (8%); Depression 10 (7%). From these numbers, the team concludes that non-celiac wheat sensitivity is a persistent condition. Clinicaltrials.gov registration number: NCT02823522. Source: Gastroenterology. DOI: http://dx.doi.org/10.1053/j.gastro.2017.03.034
  2. Celiac.com 03/13/2015 - People who suffer from celiac disease with persistent villous atrophy do not face any higher risk of ischemic heart disease or atrial fibrillation, according to a recent study by a research team in Sweden. This is important, because patients with celiac disease do face an increased risk of death from cardiovascular causes, so it is mildly encouraging that persistent villous atrophy resulting from gluten exposure does not appear to affect overall or cardiovascular mortality. The research team, led by Dr. Jonas F. Ludvigsson from Karolinska University Hospital in Stockholm, studied 7,440 celiac disease patients, 43% with persistent villous atrophy, who had follow-up biopsies, along with up to five controls each, matched for age, gender, county, and calendar year. Overall risk of ischemic heart disease was not significantly higher in the patients with celiac disease. After adjusting for age at follow-up biopsy, gender, duration of celiac disease, and other factors, they found no significant difference in the risk of ischemic heart disease risk between patients with villous atrophy and those with mucosal healing. Similarly, patients with villous atrophy had no higher risk of atrial fibrillation than those with mucosal healing. Factors associated with ischemic heart disease risk included being male, older, and having lower educational levels. Factors associated with atrial fibrillation risk included being male and being older. Source: Medscape
  3. Celiac.com 02/09/2015 - Do you suffer from persistent celiac symptoms in spite of following a strict gluten-free diet and having normal small bowel mucosa? Many celiac patients do. Moreover, typical explanations, such as accidental gluten-intake or the presence of other gastrointestinal disease, do not account for all of the symptoms in these patients. Recent studies have suggested that changes in intestinal microbiota are associated with autoimmune disorders, including celiac disease. A team of researchers recently set out to determine if abnormal intestinal microbiota may in fact be associated with persistent gastrointestinal symptoms in gluten-free celiac disease patients. The research team included Pirjo Wacklin PhD, Pilvi Laurikka, Katri Lindfors PhD, Pekka Collin MD, Teea Salmi MD, Marja-Leena Lähdeaho MD, Päivi Saavalainen PhD, Markku Mäki MD, Jaana Mättö PhD, Kalle Kurppa MD, and Katri Kaukinen MD. They are variously associated with the Finnish Red Cross Blood Service, Helsinki, Finland; School of Medicine, University of Tampere, Tampere, Finland; the Tampere Centre for Child Health Research at the University of Tampere and Tampere University Hospital in Tampere, Finland; the Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, in Tampere, Finland; the Department of Dermatology at Tampere University Hospital in Tampere, Finland; the Research Programs Unit of the Immunobiology, and Department of Medical Genetics at the Haartman Institute of the University of Helsinki in Helsinki, Finland; the Department of Internal Medicine at Tampere University Hospital in Tampere, and with Seinäjoki Central Hospital in Seinäjoki, Finland, The team used 16S rRNA gene pyrosequencing to analyze duodenal microbiota in 18 gluten-free celiac patients suffering from persistent symptoms, and 18 gluten-free celiac patients without symptoms. All celiac patients had been following a strict gluten-free diet for several years, and had restored small bowel mucosa and tested negative for celiac autoantibodies. The team rated symptoms using the Gastrointestinal Symptom Rating Scale, and found that gluten-free celiac disease patients with persistent symptoms had different duodenal bacteria than celiac patients without symptoms. Gluten-free celiac patients with persistent symptoms had a higher relative abundance of Proteobacteria (P=0.04) and a lower abundance of Bacteroidetes (P=0.01) and Firmicutes (P=0.05). Moreover, they had a much narrower range of bacteria types in their guts. The discovery that dysbiosis of microbiota is associated with persistent gastrointestinal symptoms in gluten-free celiac patients offers a new avenue of treatment for such patients. Source: Am J Gastroenterol. 2014;109(12):1933-1941.
  4. Celiac.com 05/26/2014 - Villous atrophy with intraepithelial lymphocytosis is the classic confirmation of of celiac disease. However, data show varying rates of mucosal recovery among individuals. A research team recently sought gauge the impact of age and other demographic variables on the likelihood of persistent villous atrophy in celiac disease with follow-up biopsy. The research team included B. Lebwohl, J. A. Murray, A. Rubio-Tapia, P. H. R. Green, and J. F. Ludvigsson. They are variously affiliated with the Celiac Disease Center of the Department of Medicine at Columbia University College of Physicians and Surgeons in New York, NY., the Clinical Epidemiology Unit of the Department of Medicine at Karolinska University Hospital and Karolinska Institutet in Stockholm, Sweden, the Division of Gastroenterology and Hepatology of the Department of Medicine at the Mayo Clinic College of Medicine in Rochester, Minnesota, and the Department of Pediatrics of Örebro University Hospital in Örebro, Sweden. For their study, the team reviewed data on patients with villous atrophy on duodenal histology from all 28 Swedish pathology departments from 1969–2008. They looked at age, gender, calendar period, duration of disease and educational attainment to determine predictors of persistent villous atrophy. They found that, of 7,648 celiac disease patients who received follow-up biopsy, 3,317 patients showed clear persistent villous atrophy (43%; 95% CI 42–44%). Persistent villous atrophy rise with patient age, with 56% of those 70 years of age or older, compared to 17% among those younger than 2 years. In contrast, persistent villous atrophy did not vary widely by age in earlier years. Multivariate analysis showed that, 2–5 years after celiac disease diagnosis, persistent villous atrophy was more common among males (OR 1.43; 95% CI 1.07–1.90), and less common in more highly educated patients (OR for college degree vs. Overall, rates of persistent villous atrophy have changed over time, with greater rates of healing in recent years. Social differences in persistent villous atrophy suggest that levels of education regarding the importance of a gluten-free diet can influence mucosal healing. Source: Alimentary Pharmacology & Therapeutics 2014;39(5):488-495.
  5. Celiac.com 02/06/2013 - Villous atrophy (VA) in the small intestine is one of the prime features of celiac disease, and has been associated with increased mortality, but it is unknown if mortality is influenced by mucosal recovery. To better understand the relationship between mucosal healing and mortality in celiac disease, a research team set out to determine whether persistent villous atrophy is associated with mortality in celiac disease patients. The research team included B. Lebwohl, F. Granath, A. Ekbom, S.M. Montgomery, J.A. Murray, A. Rubio-Tapia, P.H. Green, and J.F. Ludvigsson. They are variously affiliated with the Celiac Disease Center at the Department of Medicine of Columbia University College of Physicians and Surgeons in New York, NY, the Clinical Epidemiology Unit at the Department of Medicine of Karolinska University Hospital and Karolinska Institutet in Stockholm, Sweden. The team used biopsy reports from every pathology department (n = 28) in Sweden to identified 7,648 individuals with celiac disease, which they defined as the presence of villous atrophy, and who had undergone a follow-up biopsy within 5 years of diagnosis. They used Cox regression to assess mortality according to follow-up biopsy. Celiac patients were 28.4 years of age, on average, and 63% were female. The average follow-up after diagnosis was 11.5 years. Overall, patients who underwent follow-up biopsy had lower mortality rates than those who did not undergo follow-up biopsy (Hazard Ratio 0.88, 95% CI: 0.80-0.96). Of the 7648 patients who underwent follow-up biopsy, 3317 (43%) showed persistent villous atrophy. In all, 606 (8%) patients died. However, patients with persistent villous atrophy died at about the same rates as those with mucosal healing (HR: 1.01; 95% CI: 0.86-1.19). Also, children with persistent villous atrophy showed no increase in mortality (HR: 1.09 95% CI: 0.37-3.16) or adults (HR 1.00 95% CI: 0.85-1.18), including adults older than age 50 years (HR: 0.96 95% CI: 0.80-1.14). Mortality rates for celiac patients with persistent villous atrophy are about the same as for celiac patients with healthy guts. So, persistent villous atrophy is not tied to higher mortality for celiac disease patients. That means that even though a follow-up biopsy will help doctors to spot refractory disease in symptomatic patients, persistent villous atrophy is not useful in predicting future mortality. Source: Aliment Pharmacol Ther. 2013 Feb;37(3):332-9. doi: 10.1111/apt.12164.
  6. Celiac.com 12/27/2011 - Non-controlled studies suggest that Rifaximin may improve celiacdisease symptoms in such cases. However, up to now, no controlledtrials have been conducted. A team of researchers used a double-blind clinical trial to assess the effectiveness of rifaximin in relieving gastrointestinal symptoms in patients with poorly responsive celiac disease. They also assessed the effects of rifaximin on lactulose-hydrogen breath tests in those patients. The research team included Matthew S. Chang, Maria T. Minaya, Jianfeng Cheng, Bradley A. Connor, Suzanne K. Lewis, and Peter H. R. Green. Small intestinal bacterial overgrowth (SIBO) is one of the main reasons that certain people with celiac disease fail to respond well to a gluten-free diet, and why they often suffer persistent symptoms. To make their assessment, the team designed a single-center, double-blind, randomized, controlled trial of patients with biopsy-proven celiac disease and persistent gastrointestinal symptoms despite following a gluten-free diet. For the trial, the team 25 randomly assigned patients received a placebo, while the other 25 received rifaximin (n = 25) 1,200 mg daily for 10 days. For each patient, the team then used the Gastrointestinal Symptom Rating Scale (GSRS) and administered lactulose-hydrogen breath tests at weeks 0, 2, and 12. The team defined an abnormal breath test as showing either: (1) a rise in hydrogen of C20 parts per million (ppm) within 100 min, or (2) two peaks C20 ppm over baseline. They found that rifaximin had no effect on GSRS scores, regardless of baseline breath tests. Using a multivariable regression model, they found that the length of a patient's gastrointestinal symptoms significantly predicted overall GSRS scores (estimate 0.029, p.006). According to criteria 1 and 2, respectively, SIBO was present in 55 and 8% of patients at baseline, intermittently present in 28 and 20% given placebo, and 28 and 12% given rifaximin. Results showed no difference SIBO rates between placebo and treatment groups at weeks 2 and 12. From their study, the team concludes that rifaximin does not improve gastrointestinal symptoms, and that hydrogen breath tests do not reliably show which patients will respond favorably to antibiotic therapy. Source: Dig Dis Sci (2011) 56:2939–2946
  7. Celiac.com 03/02/2009 - Many people suffer symptoms of fatigue prior to being diagnosed with celiac disease or gluten intolerance. For some, fatigue is a major reason for initially seeking medical attention. In both Celiac disease and gluten intolerance, malabsorption of nutrients can result in weakness, lack of energy, and even iron-deficiency anemia. Iron-deficiency anemia can be compounded by gynecological conditions, especially in peri-menopause. A thorough physician will test for and sometimes treat underlying vitamin and mineral deficiencies common in malabsorption disorders such as celiac disease and gluten intolerance, and after three-to-six months, many symptoms related to such deficiencies will resolve. Some alternative practitioners even offer injectables such as B-Vitamins and Magnesium. Oral supplements range from plant-based liquid concentrates, to sublingual drops, to tablets and capsules, allowing a range of options for sensitive individuals. Recently I spoke to a gluten intolerance group where a woman raised an important question. She described her symptoms, which included profound fatigue and asked, “What can you do if extreme fatigue persists on a strict gluten free diet and supplements, even after a year or two?” At the time, I wasn’t sure how to answer her, other than to suggest, off the top of my head, that she ask her Naturopath to do a saliva-based adrenal function panel. I guess my reasons for doing so were based on fifteen years of nursing experience and the fact that she was probably about my age, and possibly in peri-menopause, which I knew places an additional strain on the adrenals. In women the sex hormones are produced in varying amounts in both the ovaries and adrenal glands. A smooth transition through menopause would involve a gradual transition that decreased production of sex hormones by the ovaries, and increased production of sex hormones by the adrenal glands. But, what happens if there are other factors in a woman’s life that prevent the adrenals from assuming this additional burden? Coupled with the added strain that menopause places on the body and indirectly on the adrenals, a triggering event like a significant accidental gluten exposure, an increase in food allergies, or infection with a virus or bacterial illness, could simply tax the adrenals beyond their ability to meet this increased demand. The Gluten Connection Although relatively tiny, the adrenals have a very big job. Adequate levels of the adrenal hormone cortisol are required by the body to help prevent inflammation and tissue destruction, keep blood sugars level, moderate nervous system responses, and attempt to maintain homeostasis, or the steady-state of balance in the body. Periodically experiencing incredibly painful episodes of inflammation and tissue destruction from an accidental exposure to gluten, the protein found in wheat, barley, and rye, places a huge strain on the adrenals, including a sudden demand for high cortisol levels to help moderate the inflammatory response. Each time, the body is able to cope, but with each experience it may take longer for the adrenals to recover. When stress is prolonged, these high levels of cortisol must be maintained. And if there is no significant recovery period during which the adrenals can rest and replenish themselves, adrenal fatigue results. After doing some research for a new book I’m working on, I found another possible connection, especially for those with celiac disease. Many of us are aware of the strong, well-documented association between celiac disease and autoimmune thyroid disorders like Hashimoto’s thyroiditis. We also know there is a relationship between celiac disease and another endocrine gland, the pancreas. (Diabetes has a strong correlation with celiac disease.) Autoimmune hepatitis affects the liver – the body’s largest internal organ. Nephropathy, which affects the kidneys, is a very serious, less familiar disorder linked to celiac disease. But, we rarely hear about the adrenals, especially in relation to celiac disease. Could there be a connection? In fact, there are several important connections that are often over-looked. In researching autoimmune disorders, I learned about a disorder called “Autoimmune Adrenal Hypofunction” or “Autoimmune Hypo-Adrenalism”, which sometimes occurs together with other autoimmune disorders. As in other autoimmune disorders, the body produces antibodies targeted against its own tissues, in this case, the two walnut-sized adrenal glands that sit atop the kidneys. While thought to be relatively uncommon, Autoimmune Hypo-Adrenalism is most closely associated with celiac disease. In fact, I was quite surprised by the wealth of information on this association, based on many studies done in Italy and Ireland, both countries where celiac disease is common. While the connection between other autoimmune disorders and celiac disease is generally accepted in the U.S., the case for adrenal insufficiency in relation to celiac disease has not appeared to have received as much attention. So, it can’t hurt to mention this link here, since it has the potential to affect those with persistent fatigue and/or chronic inflammatory disorders such as interstitial cystitis, in which low cortisol levels may play an important role. Stress, Food Allergies, and Nutrition As anyone who has studied stress and the allergenic response knows, diet does matter. One of the least recognized forms of stress is untreated or unidentified food allergies and sensitivities. In Dr. Wilson’s book, “Adrenal Fatigue – the 21st Century Stress Syndrome”, he writes, “It has long been observed that people suffering from adrenal fatigue have a definite increase in allergic responses or become allergic to things that did not previously bother them.” This is because levels of the adrenal hormone cortisol, the most powerful anti-inflammatory substance in the body drop, making it “more likely that the body will have severe allergic (inflammatory) reactions and that these reactions will be more severe.” Another factor in adrenal function through is nutritional status. As we know, many people with Celiac disease or gluten intolerance do have some underlying nutritional deficiencies, and these become more difficult to address as we age. Certain vitamins and minerals are essential to replenishing and nourishing the adrenal glands. Ideally, we’d obtain these essential nutritional components through our diet. In cases of adrenal fatigue, it is important to discuss with your physician what you can do to help your adrenals recover, both by eating an ideal diet, and taking recommended supplements, including B-Vitamins, Vitamin C, Magnesium, and specific herbs and amino acids. Symptoms of Adrenal Fatigue Ten relatively common symptoms of adrenal fatigue are listed below: Fatigue Depression and memory difficulties Sleep Disturbances Migraine Headache An increase in allergies or the development of new allergies Alcohol Intolerance Low Blood Pressure and Low Body Temperature Blood Sugar Regulation Problems (Hypoglycemia) Low Libido & Hormonal Imbalances Inflammation Adrenal TestingTesting for adrenal insufficiency isn’t rocket-science, but an established and useful diagnostic tool that might have important implications for poor regulation of inflammation as well as for general health. The first step is to check for a low cortisol level, in combination with other hormones, including DHEA, Progesterone, Estrogen, and Testosterone. This is easily done with a safe, reliable, and cost-effective serial saliva test, with four samples taken at specified time periods throughout the day. Your physician often stocks these kits in the office, and can provide one for you to use and then mail to the laboratory. The laboratory will perform the tests, and send the results to your physician, who will discuss them with you. The whole process takes a week or two, and can be repeated every few months to track your recovery. It is not expensive, and may even be covered by your insurance. In fact, you do not need a doctor to order the test, but the results will be of little value without a physician to interpret them, make a plan to address any abnormal findings, and support and monitor you in your treatment. Blood tests, including and ACTH challenge, may be indicated, but a serial saliva test is a good first step. Adrenal Recovery Any program of adrenal recovery must incorporate lifestyle changes that include avoiding stress or dealing with stress in healthy ways, such as exercise, relaxation, and meditation. Eating an anti-inflammatory diet, free of sugars and alcohol, is essential, as continuing to follow a strict gluten-free diet. This article is partially excerpted from “The Better Bladder Book – a Holistic Approach to Healing Interstitial Cystitis & Chronic Pelvic Pain through Diet, Lifestyle, & Self-Treatment”, available soon through my website. The book provides documentation for all research and factual content, including the information in this article.
  8. Scand J Gastroenterol 1999 Sep;34(9):909-14 AW Morrow Gastroenterology and Liver Centre, Dept of Histopathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. SPECIAL NOTE: European Codex Alimentarius quality wheat starch was used in this study. (Celiac.com 06/25/2000) BACKGROUND: It is expected that in patients with coeliac disease the small bowel mucosal mucosa will return to normal if they adhere to a gluten-free diet (GFD). However, in many this is not the case. This study aims to determine whether this persistent villous atrophy (VA) could be due to continued ingestion of the trace amounts of gluten in gluten-free foods, as defined by the WHO/FAO Codex Alimentarius. METHODS: Duodenal biopsy specimens from 89 adults with long-standing coeliac disease were examined, and the findings correlated with their form of gluten-free diet. RESULTS: In 51 subjects the duodenal specimen was normal, whereas in 38 there was villous atrophy (partial, 28; subtotal, 8; total, 2). There was no relationship between the presence or absence of VA and ingestion of either a GFD as defined by the Codex Alimentarius (Codex-GFD; 39 patients) or a GFD that contained no detectable gluten (NDG diet: 50 patients). Intraepithelial lymphocyte counts were higher, and lactase levels lower, in subjects with an abnormal biopsy specimen than in those in whom it was normal. However, within each of these biopsy groups there was no difference in these variables between patients on a Codex-GFD and those on an NDG-GFD. IgA antigliadin antibody was detected in 4 of 29 patients on a Codex-GFD and in 3 of 13 on a NDG-GFD (NS). CONCLUSION: The persistent mucosal abnormalities seen in patients with coeliac disease on a GFD are not due to the ingestion of trace amounts of gluten. The consequences of these abnormalities have yet to be determined.