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  1. Celiac.com 12/01/2017 - Celiac disease is a genetically determined disorder in which affected individuals show an intolerance to ingested gluten (Food Safety Authority of Ireland [FSAI]). It is an inheritable, life-long disease and is characterized by an inflammatory reaction to dietary gluten in the human small intestine. The special feature of the disease is a flattening of intestinal villi along with crypt hypertrophy. As a result, it leads to significant loss of absorptive surface area and resulting malabsorption of nutrients, vitamins and minerals. Untreated celiac disease may be found in the context of symptoms like: anemia, bone diseases, infertility, neurological problems, cancer and other complications due to persistent inflammation and micronutrient deficiencies. Approximately 1% of the United States population has the disease, which is similar to its frequency in the United Kingdom. Only about 10% of affected individuals have been diagnosed thus far [Kagnoff MF (2007) Celiac disease: pathogenesis of a model immunogenetic disease. J Clin Invest 117: 41–49]. At present, the only suitable treatment is strict, life-long exclusion of gluten from the patient's diet. Although a large fraction of patients who attempt to follow such a diet still exhibit signs or symptoms of active disease, there is no available supplementary therapy for such conditions [Ehren J, Morón B, Martin E, Bethune MT, Gray GM, et al. (2009) A Food-Grade Enzyme Preparation with Modest Gluten Detoxification Properties. PLoS ONE 4(7): e6313. doi:10.1371/journal.pone.0006313]. Gluten is defined as a protein fraction from wheat, rye, barley, oats or crossbred varieties and derivatives thereof. Some persons are intolerant to this group of proteins that are insoluble in water and 0,5 M sodium chloride solution [Commission Regulation (EC) No 41/2009 concerning the composition and labeling of foodstuffs suitable for people intolerant to gluten. Official Journal L 16/09 21 January 2009]. To address this problem, the food industry is developing new products for people affected by celiac disease. These new foods are very helpful in diversifying the celiac diet. More available products will increase nutrient consumption, including fiber and minerals, which are often lacking in restrictive diets. Production of gluten free products involves the fulfillment of specific requirements. These products must be free of gluten, which is present in most components of confectionery production. Labeling of the final product is subject to the European Community Commission Regulation No 41/2009 of 20 January 2009, which sets conditions that must be fulfilled by manufacturers. The composition and labeling of foodstuffs suitable for people who are intolerant to gluten is divided into two categories of products according to the nutritional purpose: Gluten free for people intolerant to gluten, and very low gluten content [Wojtasik. A, Daniewski W., Kunachowicz H., 2010. Ocena wybranych produktów spożywczych w aspekcie możliwoÅ›ci ich stosowania w diecie bezglutenowej. Bromat. Chem. Toksykol., XLIII, 2010, 3, str. 362-371]. Selected paragraphs of these labeling rules are quoted below: Foodstuffs for people intolerant to gluten, consisting of or containing one or more ingredients made from wheat, rye, barley, oats or their crossbred varieties which have been especially processed to reduce gluten, shall not contain a level of gluten exceeding 100 mg/kg in the food as sold to the final consumer. The labeling, advertising and presentation of the products referred to in paragraph 1 shall bear the term ‘very low gluten'. They may bear the term ‘gluten-free' if the gluten content does not exceed 20 mg/kg in the food as sold to the final consumer. Oats contained in foodstuffs for people intolerant to gluten must have been specially produced, prepared and/or processed in a way to avoid contamination by wheat, rye, barley, or their crossbred varieties and the gluten content of such oats must not exceed 20 mg/kg. Foodstuffs for people intolerant to gluten, consisting of or containing one or more ingredients which substitute wheat, rye, barley, oats or their crossbred varieties shall not contain a level of gluten exceeding 20 mg/kg in the food as sold to the final consumer. The labeling, presentation and advertising of those products shall bear the term ‘gluten-free'. Where foodstuffs for people intolerant to gluten contain both ingredients which substitute wheat, rye, barley, oats or their crossbred varieties and ingredients made from wheat, rye, barley, oats or their crossbred varieties which have been especially processed to reduce gluten, paragraphs 1, 2, and 3 shall apply and paragraph 4 shall not apply. The terms ‘very low gluten' or ‘gluten-free' referred to in paragraphs 2 and 4 shall appear in proximity to the name under which the food is sold. To achieve gluten content as described above, special conditions in work environment must be instituted. Preparation of high quality products that are safe for people affected by celiac disease, the production process must be controlled not only at the production plant. Origin, breeding, harvesting, storage and transport of ingredients must be also taken into account. The best way to ensure the customer about the safety of a given product is to implement a specially designed quality management plan from the very first step of production. In order for products to be gluten-free or reduced in gluten when they reach the consumer, the gluten-free quality of the product must prevail at every stage of production. Cross contamination is the process by which a reduced-gluten or gluten-free product loses that status. It has come into contact with something that is not gluten-free. Cross contamination may happen during primary production, harvesting and storage of grain, during the manufacture of gluten-free or reduced gluten food in the same plant where gluten-containing food is produced. Cross contamination may also occur as a result of poor re-work, incorrect formulation, product carry-over due to use of common equipment, clean-up or sanitation, poor equipment design, human error or the presence of gluten products near exposed product lines. Potential risks, preventative measures and critical control points need to be identified in the handling of ‘gluten-free' or ‘very low gluten' products. (Deibel, Kurt, Tom Trautman, Tom DeBoom, William H. Sveum, George Dunaif, Virginia N. Scott, and Dane T. Bernard. 1997. A Comprehensive Approach to Reducing the Risk of Allergens in Food. Journal of Food Protection. Vol. 60, No. 4: 436-441) Raw Materials Origin To minimize risk, producers of raw ingredients have to implement appropriate control practices during crop production, harvesting and storage. Plants should originate from certified seeds which guarantees a high level of species purity. Cleaning of sowing machines is also important because seeds from the previous planting can contaminate new crops. The same rule applies to equipment used for harvesting and transportation. Storage areas should be thoroughly cleaned before filling with new crops. Every magazine should be identifiable and people responsible for crop delivery must be informed and instructed to maintain a gluten free workplace. Producers should produce representative samples for laboratory analysis to verify their product's "gluten free" status. Even on the first level of food production, which is plant growing, training and supervision of employees and producers is critical for maintaining the non gluten status of raw materials. Good training of all staff working at these first stages will help to avoid potential sources of food allergens. This type of training should increase awareness about food allergens and the consequences of unintentional consumption by allergic persons. Workers should be encouraged to report any suspected breaches of protocol to their supervisors and suggest possible improvements [Australian Food and Grocery Council, Food Industry Guide to Allergen Management and Labelling - 2007 Revised Edition]. Transport Suppliers of raw materials are obligated to have good allergen management practices to minimize the risk of cross contact between raw materials. Suppliers should provide information identifying any products that contain allergens, the origins of allergenic materials, or those that are likely to cross contamination with allergens. Vendor audits are recommended to verify and explore potential contact with allergenic substances [Australian Food and Grocery Council, Food Industry Guide to Allergen Management and Labelling - 2007 Revised Edition]. Storage Manufacturing plants should be designed to accommodate all aspects of the quality control and allergen management plan,. Storage of raw materials should prevent mixing allergens with non allergenic ingredients. To meet this condition, allergenic materials should be kept at separate facilities, or when this is impossible, all raw materials should be covered to avoid allergenic dust contamination. Clear and visible labeling of containers and all equipment should also be implemented. Tools and equipment used for different materials must also be kept separate [Guidance Note No. 24 Legislation on ‘Gluten-free' Foods and Avoidance of Cross-contamination during Manufacture of ‘Gluten-free' or ‘Very Low Gluten' Products Published by: Food Safety Authority of Ireland 2010, ISBN 1-904465-71-4]. Production To minimize the risk of unintentional contamination of products good manufacturing practices – the Good Manufacturing Practice (GMP) and Hazard Analysis and Critical Control Points (HACCP) plan must note all specific conditions. The production plan should be designed to avoid production of allergenic and non allergenic foods during the same shift. If this is impossible, non allergenic products should be produced first to avoid contamination from dust. Ingredients containing gluten should be identified by color-coded containers or stickers. Ingredients containing gluten must be added at the end of the shift after gluten free products are completed and removed. Rework containing gluten should be reused into the same products. Appropriate employee training and labeling for rework can also help to minimize the risk of cross contamination through human error. The possibility of contamination can easily be minimized by using dedicated equipment for the gluten free products. When it is impossible to have a separate building, the use of special barriers is necessary. The use of separate space and separate containers for all materials (as above) is recommended for gluten free production. In such conditions ventilation and dust flow must be well controlled. Dust flow in the plant has a potential to carry over allergens from separate spaces of facilities. [Guidance Note No. 24 Legislation on ‘Gluten-free' Foods and Avoidance of Cross-contamination during Manufacture of ‘Gluten-free' or ‘Very Low Gluten' Products Published by: Food Safety Authority of Ireland 2010, ISBN 1-904465-71-4]. Packing and labeling are also important elements in preventing cross contamination. Packing equipment may also be a source of contamination. The packaging machines and material should be checked for any allergens, e.g. foil coated with releasing agents derived from wheat flour. Appropriate labeling should be use to inform customers who are affected by coeliac disease. Correct labeling should reflect actual and real composition of the product. Labels must also fulfill legislative requirements. To facilitate recognition of gluten free products, labeling must be clear and readable. EU legislation regarding food labeling imposes an obligation to provide true and clear information about ingredients. Alerts to all allergenic ingredients, starch source (plant from witch starch originates) and gluten content are required. The manufacturer is obligated to ensure readability of the above information. Directive 2003/13/EC of 10 February 2003 posted in the Official Journal of the European Union requires that food manufacturers should place notification on labels of any of the fourteen groups of potential allergens responsible for more than 90% of allergic reactions if they have been used as food ingredients (including alcoholic drinks), regardless of the allergen content. The list of allergenic ingredients is constantly being updated. Also, the components derived from allergenic substances must be listed as potential allergens [ Czarniecka-Skubina E., Janicki A. 2009. Znakowani produktów żywnoÅ›ciowych. Informacje żywieniowe i zdrowotne. PrzemysÅ‚ Spożywczy, StyczeÅ„, 34-36; Commission Directive 2003/13/EC of 10 February 2003 amending Directive 96/5/EC on processed cereal-based foods and baby foods for infants and young children. Official Journal of the European Union L 41/33, 14.2.2003] Codex Alimentarius has proposed the introduction of the following descriptions in the vicinity of the product name. If the product comes from natural raw materials that do not contain gluten, it is described as "gluten free by nature," or "product may be used in gluten-free diet" [Hoffmann M., JÄ™drzejczyk H. 2007. Å»ywność bezglutenowa – legislacja i aspekty technologiczne jej produkcji. PostÄ™py Techniki Przetwórstwa Spożywczego, 1, 67-69]. Products low in gluten, are marked with the inscription: "very low gluten foods", "low gluten foods", or gluten-reduced foods [Wojtasik. A, Kunachowicz H., Daniewski W. 2008. Aktualne wymagania dla produktów bezglutenowych w Å›wietle ustaleÅ„ kodeksu żywnoÅ›ciowego. Bromat. Chem. Toksykol., XLI, 2008, 3, str. 229-233; Darewicz M., Jaszczak L.; „Oznakowanie produktów stosowanych w diecie osób chorych na celiakiÄ™", PrzeglÄ…d Piekarski i Cukierniczy, march, 2012.]. Training Employee awareness at all levels of production, beginning with plant growing to finished preparation of proper labels is necessary throughout the gluten free production chain. Everybody must be informed about the consequences of gluten consumption by coeliac patients. Staff who are employed from time to time must be also well trained. Implementation of control procedures and proper documentation will be very helpful in maintaining control. Documentation of the training of every new employee needs to be prepared and maintained. All working stuff and implemented methods must be supervised all the time [Guidance Note No. 24 Legislation on ‘Gluten-free' Foods and Avoidance of Cross-contamination during Manufacture of ‘Gluten-free' or ‘Very Low Gluten' Products Published by: Food Safety Authority of Ireland 2010, ISBN 1-904465-71-4]. By taking into account all aspects mentioned above and striving to make continuous improvements, manufactures are able to produce safe, high quality gluten free products. The human factor is one of the most important elements in this process because only human mistakes can lead to contamination and only good training and awareness at every stage of production stage can produce the best possible product. Implementation of quality management systems like HACCP or GMP assures customers of food quality and safety, while also allowing the producer to lower production costs related to potential human mistakes. However, nothing will really change the fact that all of the factors described above must be implemented in everyday production, ensuring that they are not simply ideas on the piece of paper. Implementation is the key.
  2. Celiac.com 04/18/2013 - Does the way the dough is mixed have any effect on the quality of gluten-free bread? A team of researchers recently set out to answer just that question. The research team included Manuel Gómez, María Talegón, and Esther de la Hera. They are affiliated with the Food Technology Area of E.T.S. Ingenierías Agrarias at Valladolid University in Palencia, Spain. In the past few years, a great deal of research has gone into making better gluten-free bakery products, but there is still very little data on what impact mixing might have on gluten-free bread quality. In their study, the team focused on the way dough mixing effects two different gluten-free bread formulas; one with an 80% water formula, and another with 110% water formula. The team found that less hydrated breads showed no significant differences depending on the mixing arm (flat beater or dough hook). However, longer mixing time produced bread with higher specific volume. In the dough that contained more water, both mixer arm and mixing speed had a significant effect on bread volume and texture, with the wire whip, combined with lower mixing speeds and longer mixing time, producing softer bread with higher specific volume, compared with the flat beater. In more hydrated breads, proofing time improved bread specific volume, but in less hydrated breads, volume was decreased. The same pattern was seen when longer mixing times were used. The study shows the importance of mixing time and the type of mixer device in gluten-free bread making, something not well-studied. It also shows that mixing produces different effects than does kneading gluten-free bread dough. Based on the results of this study, corresponding changes to the mixing process of the gluten-free bread doughs can produce higher quality breads with higher volume and lower hardness. Source: Journal of Food Quality doi/10.1111/jfq.12014/abstract
  3. There have been several studies of celiac disease sufferers and health-related quality of life (HRQoL), but few of these studies have focused on children. Since diseases that develop through childhood (as celiac disease often does) usually negatively impact physical, social and psychological development, it is important to determine the extent to which celiac children suffer as a result of the disease. In the present study, 160 celiac children (55 males and 105 females) were given questionnaires to assess mental health, social health and physical health over the four weeks prior to when the test was taken. Children were divided into three age groups: 8-11 years, 12-15 years and 16-18 years. Parents were given a proxy version of the questionnaire to assess their children. Questions came from the short version of the DISABKIDS questionnaire (a well-validated research method used for different chronic disease diagnostic groups). Age and severity of disease at onset were examined to determine if these factors influenced self-valuation later in life. Children rated their HRQoL surprisingly high, with a median score of 92/100 (85 points for mental health, 95 for social health and 100 for physical health). Sex and age did not show any significant correlation, though years since diagnosis showed slight correlation (children rated themselves higher the longer it had been since disease onset). Children who were younger at diagnosis also rated themselves higher, which is likely because young children have not grown accustomed to gluten-containing foods, and thus miss them less. It is also likely that children closer to adolescent age have a harder time accepting their 'otherness' due to their psychological development. Children with more severe symptoms at onset rated their HRQoL higher than children who had more mild symptoms, or were asymptomatic at onset. This is likely because more symptomatic children are able to perceive more of a dramatic change in their overall health after starting on gluten-free diet. They feel relatively better, so they rate themselves higher. Parents tended to rate their children's HRQoL lower than then the children themselves did. This underestimation is probably a result of parental worrying, guilt and/or sense of responsibility. Parents whose children were younger at onset of disease, or had lived with the disease longer tended to judge their children's HRQoL more accurately. This study suggests that children adapt well to celiac disease, and that parents tend to overestimate the negative impact the disease has on their children. At risk of overtreatment of the psychological, social and physical impacts of the disease, it is important that parents of celiac children let their children be heard about their perceived quality of life. Source: http://www.hindawi.com/journals/grp/2012/986475/
  4. Celiac.com 03/04/2011 - Celiac disease is similar to the inflammatory bowel diseases, ulcerative colitis and Crohn’s disease, in the obvious sense that all are chronic inflammatory disorders of the gastrointestinal tract. But more than that, they all also present daily psychological and social challenges to patients’ lifestyles. In a recent study reported in the European Journal of Gastroenterology and Hepatology, researchers in the United Kingdom examined the prevalence of GI symptoms in patients with these diseases and correlated the incidence of these symptoms with quality of life (QoL). Not surprisingly, they found that increased severity of reflux and irritable bowel syndrome were associated with a diminished QoL. Patients with celiac disease had worse symptoms and QoL than those with ulcerative colitis, but they were better off than people with Crohn’s disease. This cross-sectional study was performed by sending patients surveys through the mail. One thousand and thirty-one people were included; 225 patients with celiac, 228 with ulcerative colitis, 230 with Crohn’s disease, and 348 healthy age- and sex-matched controls. As this was a postal survey, there is a potential inclusion bias – it is possible that those patients faring the worst would be most likely to send back the questionnaires. Seventy one percent of the celiac patients reported adhering to a gluten-free diet, but this was not corroborated endoscopically. One of the surveys assessed physical and mental QoL and another considered depression and anxiety. Participants were also asked to report and rate GI symptoms they had experienced over the past month, including reflux, heartburn, regurgitation, belching, dysphagia (difficulty swallowing), and retrosternal pain. Barrat et al. found that the celiac patients had higher rates of belching and dysphagia than inflammatory bowel diseases sufferers in this study and also than reported previously. They highlight that despite the high (71%) degree of adherence to the gluten-free diet, 22% of celiac patients still reported severe enough IBS symptoms to affect their QoL. They infer from this finding a couple of noteworthy things. First, that the gluten-free diet may not adequately control IBS symptoms in celiac patients. But also, that doctors are perhaps not inquiring about reflux and IBS during consultations, or patients are under-reporting their prevalence. The authors thus suggest that QoL might be improved for these patients if doctors were more diligent in assessing them for reflux and irritable bowel syndrome. Source: European Journal of Gastroenterology & Hepatology: February 2011 - Volume 23 - Issue 2 - p 159–165
  5. This article originally appeared in the Spring 2010 edition of Celiac.com's Journal of Gluten-Sensitivity. Celiac.com 07/19/2010 - Thinking about sending your youth to a gluten-free camp, but not sure if the benefits outweigh the cost? A new study was conducted to determine the quality of life among young celiac campers and it is indicating that camp may not only be fun for younger celiacs, but also improve their general well-being, self-perception and emotional outlook. The Department of Pediatrics, University of California San Francisco, recently published the results of a study they administered which indicates strong evidence that gluten-free camp is important to the physical and emotional well-being of young celiac patients. The study surveyed 104 celiac youth, 7-17 years old who attended a gluten-free camp. Before, and after attending the camp, each camper was given a 14-question survey, using a Likert scale, to evaluate their emotional outlook, overall well-being and self-perception. Of the 77 campers that completed the survey before and after attending the camp, all of them showed marked improvement in all three categories and were found to greatly benefit from attending a gluten-free camp. The reasons for the health benefits can be attributed to providing strictly gluten-free food for the campers, so no food was off limits to them. Also cited for the improvement of the campers was that all campers shared similar food sensitivities and they therefore felt safe and included among the other campers, decreasing the social anxiety that many celiacs feel when dining with non-celiacs. Interestingly, campers who had been on a gluten-free diet for less than four years were more positively impacted by the gluten-free camps than were the campers who had been on a gluten-free diet for more than four years. The difference in results between the newer gluten-free campers and the more experienced gluten-free campers suggests that, over time, adaption to celiac disease can decrease the social anxieties that are often associated with the disease. To accurately test the endurance of these findings, once a young celiac has returned to normal daily activities, more tests will be needed. For now, it is safe to assume that not only is camp a great break for you and your kids, it is also important for their overall health and general well-being. Source: http://pediatrics.aappublications.org/cgi/content/abstract/125/3/e525
  6. Celiac.com 05/08/2007 - For people with celiac disease, accurate and comprehensive information on maintaining a healthy, high-level quality of life can be difficult to find. Research is particularly sketchy with respect to factors that have a negative impact on health and quality of life for adults with celiac disease. Factors that have a negative impact on health and quality of life are often modifiable through changes in diet, or adjustments in treatment. Thus researchers are motivated to identify which celiac patient groups are at risk of being impacted in a negative way, and to determine which adjustments might bring positive results. In an effort to refine treatment approaches and improve the lives of patients with celiac disease, clinical researchers in Gastroenterology have become increasingly interested in health-related quality of life issues as primary or secondary endpoints in their studies. A recent study published online in Medscape Today suggests that, in addition to physical and mental co-morbidities, a failure to sustain a gluten-free diet and disappointment with doctor-patient communication are also important factors associated with health-related quality of life concerns in people with celiac disease. Motivated by inconsistencies in available data, a team of German researchers made up of Drs. W. Häuser, A. Stallmach, W. F. Caspary, and J. Stein, set out to evaluate the various predictors for reduced health-related quality of life in adult patients with celiac disease. Using logistic regression analysis, the researchers catalogued responses to medical and socio-demographic questionnaires by 1000 adult celiac disease patients who were members of the German Coeliac Society. The subjects responded to the following three survey questionnaires, which were administered by post: 1) the Short-Form Health Survey (SF-36); 2) the Celiac Disease Questionnaire; 3) the Hospital Anxiety and Depression Scale. The results showed that physical co-morbidities (ß = -0.41; OR = 0.66, P < 0.001) and mental disorder (ß = 0.88; OR = 2.4, P = 0.03) were associated with a reduced physical summary score of the SF-36 Scale. Mental disorder (ß = 2.5; OR = 11.9, P < 0.001), physical co-morbidities (ß = -0.26; OR = 0.77, P = 0.004) and younger age at diagnosis (ß = -0.10; OR = 0.91, P = 0.05) predicted a reduced mental summary score of the SF-36 Scale. Mental disorder (ß = 0.90; OR = 2.5, P = 0.03), non-compliance with gluten-free diet (ß = 0.44; OR = 1.6, P = 0.009), active medical co-morbidities (ß = -0.28; OR = 0.76, P = 0.007) and dissatisfaction with doctor–patient communication (ß = 0.55; OR = 1.7, P = 0.03) were associated with reduced Celiac Disease Questionnaire scores. In adult patients with celiac disease, the following factors were associated with reduced health-related quality of life: female gender, younger age at diagnosis, newly diagnosed patients, latency of diagnosis, failure to follow a gluten-free diet, anxiety and somatic and psychiatric co-morbidity. Until this study, attempts to measure health status in patients with celiac disease relied on generic health-related quality of life methods, rather than validated, disease specific instruments, and thus the relative predictive value of these variables had not been fully assessed. Aliment Pharmacol Ther. 2007;25(5):569-578.
  7. Aliment Pharmacol Ther. 2005;22(4):317-324. Celiac.com 09/14/2005 - In an effort to determine whether general screening for celiac disease should be conducted in high-risk groups, Finnish researchers conducted a 14 year follow-up study which focused on dietary compliance, quality of life, and bone mineral density in 53 consecutive screen-detected celiac disease patients who were diagnosed and treated around 14 years ago. The researchers assessed dietary compliance via an interview, a 4-day food record, and a blood antibody screening. Quality of life was measured via the Psychological General Well-Being and SF-36 questionnaires, while gastrointestinal symptoms were evaluated using the Gastrointestinal Symptom Rating Scale, and bone mineral density was measured using dual-energy x-ray absorptiometry. The researchers compared the results of these evaluations with those of 44 symptom-detected and treated celiac disease patients, 110 non-celiac disease subjects, and the general population. The researchers found that 96% of screen-detected and 93% of symptom-detected celiac disease patients adhered to a strict or fairly strict gluten-free diet. In the screen-detected group quality of life and gastrointestinal symptoms were similar to that of the symptom-detected patients and non-celiac disease controls, and their bone mineral densities were similar to that of the general population. The researchers conclude that dietary compliance in long-term screen-detected patients was good, and quality of life and bone mineral densities were comparable to that of the non-celiac disease subjects and the general population. Based on these results active screening for celiac disease in risk groups is beneficial and in no way harmful.
  8. Gastroenterology. 2005 Feb;128(2):393-401. Celiac.com 02/09/2005 – Norwegian scientists have been mapping gluten T-cell epitopes in various wheat ancestors and have found several varieties that may be suitable for those with celiac disease. The trigger for celiac disease has been identified as the epitopes that cluster within a stable 33mer fragment of wheat chromosome 6D. The scientists extracted and screened gluten from a variety of modern wheat ancestors to look for any T-cell stimulatory gluten peptides. They found that the 33mer fragment is encoded by alpha-gliadin genes on wheat chromosome 6D, which does not exist in the gluten of diploid einkorn or in certain types of tetraploid pasta wheat. These findings indicate that there may be grains that have long since been considered unsafe for those with celiac disease, but which may actually be safe and not contain any harmful gluten proteins. The most encouraging thing about this research is that baking and pasta-quality wheat ancestors could one day be added to our Safe List, which would greatly increase the quality of gluten-free products. Note: We strongly advise against celiacs including these grains in their diet until more testing and research is done to verify their safety.
  9. Scand J Caring Sci. 2003 Sep;17(3):301-7 Celiac.com 09/03/2003 - A recent study published in the Scandinavian Journal of Caring Sciences looked at the differences in how men and women cope with celiac disease. The study concludes that gender should be taken into account in the treatment of celiac disease to improve its outcome. The biggest flaw in this study is with the number of people in it—only 10. I think that it is difficult to draw such conclusions using such a small sample of people, and that a larger study of this type needs to be done to draw more solid conclusions. Additionally, the poorer outcome for women in this study may be due to the fact that they experienced more bowel-related symptoms than did the men, which may not be due at all to their "emotionally oriented strategy" of coping. It could just be a fact that women with celiac disease experience more real health problems than men, which is also in need of further study. - Scott Adams Here is the abstract: "Perceptions of health-related quality of life of men and women living with coeliac disease." Hallert C, Sandlund O, Broqvist M. Coeliac Centre, Faculty of Health Sciences, Linkoping University, Linkoping, Sweden. "Women with long-standing coeliac disease express poorer health-related quality of life (HRQoL) than men do for unclear reasons. This led us to explore differences in their understanding of HRQoL using a phenomenographic approach. We interviewed 10 coeliac subjects (mean age 57 years, range 35-73) who had been on a gluten-free diet for 10 years and had scored either high or low in the Short Form 36 Health Survey (SF-36) General Health and Vitality scales. Three dimensions were revealed that pertained to their perception of HRQoL: bodily sensations, social consequences and coping strategies. Within these, the women experienced more bowel symptoms than men did, despite keeping to a strict diet. This item was the only one predicting the SF-36 scores. The women also described more distress caused by the restrictions in daily life, closely related to their controlling of food contents. The coeliac men took advantage of using a problem-oriented coping approach while the women seeking an emotionally oriented strategy showed less satisfaction with the outcome. We conclude that the intriguing difference in HRQoL between coeliac men and women may have some of its origin in the way living with the disorder is conceptualized and coped with. The results imply that in the management of coeliac patients, gender-related aspects need to be taken into account to improve treatment outcome."
  10. The following Medline abstract describes a unique study that was done on the quality of life of two groups of people with celiac disease: One that was diagnosed as the result of having symptoms, and the other which had little or no symptoms and whose diagnosis was reached via screen-detection. Both groups were treated for one year with a gluten-free diet, and were then studied to determine their overall response, including their psychological response. Here is the abstract: Eff Clin Pract 2002 May-Jun;5(3):105-13 Mustalahti K, Lohiniemi S, Collin P, Vuolteenaho N, Laippala P, Maki M. Department of Pediatrics, Tampere University Hospital, Finland. CONTEXT: Since the advent of serologic testing for celiac disease, most persons who receive a diagnosis of celiac disease have few or no symptoms. Although pathologic changes of celiac disease resolve on a gluten-free diet, how a gluten-free diet affects the quality of life for patients with screen-detected celiac disease is unclear. OBJECTIVE: To evaluate the effect of a gluten-free diet on the quality of life of patients with screen-detected celiac disease. DESIGN: Prospective study of patients before and 1 year after initiating a gluten-free diet. PARTICIPANTS: 19 patients with screen-detected celiac disease (found by serologically testing first-degree relatives of celiac patients) and 21 consecutive patients with symptom-detected disease. In all cases, celiac diagnosis was confirmed by finding villous atrophy and crypt hyperplasia on small-bowel biopsy. INTERVENTION: Gluten-free diet (explained during a single physician visit). MAIN OUTCOME MEASURES: Gastrointestinal Symptoms Rating Scale (GSRS), in which scores range from 0 to 6 (higher scores represent worse symptoms); and quality of life measured with the Psychological General Well-Being Questionnaire (PGWB). Scores range from 22 to 132 (higher scores mean greater well-being). RESULTS: At baseline, patients with symptom-detected celiac disease had poorer quality of life and more gastrointestinal symptoms than those with screen-detected celiac disease. Reported compliance with the gluten-free diet was good. All mucosal lesions of the small bowel had resolved at the follow-up biopsy. After 1 year of following the diet, quality of life for patients with screen-detected disease significantly improved (mean PGWB score increased from 108 to 114; P CONCLUSIONS: Gluten-free diet was associated with improved quality of life for patients with symptom-detected celiac disease and patients with screen-detected celiac disease. Concerns about the burden of a gluten-free diet, at least over the short term, may be unfounded. PMID: 12088289
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