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Celiac.com 06/21/2016 - Transitioning from childhood to adulthood is hard, but doing it with celiac disease can be harder. Beginning in adolescence, people with celiac disease should assume full responsibility for their care. So how can a parent best help teens transition to full control over their celiac disease and gluten-free diet? According to the Prague Consensus Report, a few simple measures can help children to successfully manage caring for their conditions as they transition into teenagers and young adults. One of the study's authors is Dr. Steffen Husby of Hans Christian Andersen Children's Hospital, Odense University Hospital in Denmark. Get a Formal Diagnosis "We think it most important to stress that celiac disease is a definite disorder," Husby told Reuters Health. "We should make a regular diagnosis of celiac disease before putting kids on a gluten free diet." Consult a Doctor About Transition "We recommend close communication with the doctor when transitioning to adult care," said Dr. Husby. Ideally, teens with celiac disease should visit a clinic with pediatric and adult services that handles such transitions, the study authors write. Talk About the Transition Talk with a doctor about dietary adherence and consequences of non-adherence during transition. Consider asking your child's pediatrician to include a "transition document," which includes written information on the patient's diagnosis, follow-up, body composition data, other health conditions and dietary compliance. Know the Importance of Biopsy The authors also conclude that most teens and young adults do not need routine small intestine biopsies to reconfirm a childhood diagnosis of celiac disease, unless pediatric diagnostic criteria, like a blood test for gluten antibodies, were never fulfilled, according to the recommendations published online April 18 in the journal Gut. In most adolescents and young adults, routine small intestinal biopsy is not needed to reconfirm a childhood diagnosis of celiac disease, based on criteria set by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) or North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). However, biopsy may be advisable in patients who did not have biopsy at diagnosis, or when other pediatric diagnostic criteria are incomplete, if additional endomysium antibody test have not been performed to confirm 10-fold positivity of tissue transglutaminase antibodies, or in cases of asymptomatic children who may have been followed a no biopsy strategy to that point. Young people tend not to register risk for future health consequences, whether the risk is lung cancer as a result of smoking or osteoporosis as a result of eating gluten, says Dr. Patience White, co-director of Got Transition, the Center for Health Care Transition Improvement at the National Alliance to Advance Adolescent Health in Washington, D.C. "All youth…need a better transition," she added. These simple steps can help teens to manage their own celiac disease as they progress into adulthood. Source: Gut 2016. -
Celiac.com 02/15/2010 - Just five simple questions can help you determine if your child needs a gluten-free diet, according to the a recent Danish study that aims to improve celiac disease diagnosis in children. Celiac disease is a disorder in which people suffer intestinal damage when they eat foods made with wheat, rye, or barley. Over the last five or six decades, rates of celiac disease have increased 400%. Worse still, at least half of kids with celiac disease never get diagnosed. That means they will continue to eat foods made with wheat, rye, or barley; and that they will suffer persistent symptoms such as diarrhea, abdominal pain, and behavior problems, along with intestinal damage, that are perfectly avoidable with a gluten-free diet. A simple blood test can tell doctors which kids most likely have celiac disease. But doing a blood test on every child is simply not practical. Would it be better to test just the kids who show one or more symptoms common to celiac disease? To answer that question, doctor Peter Toftedal, MD, of Denmark's Odense University Hospital, created a simple, five item questionnaire to help parents provide information on recurrent abdominal pain, chronic diarrhea, constipation, and lack of height and weight gain: Has your child ever suffered from abdominal pain more than twice during the last three months? Has your child ever had diarrhea lasting more than two weeks? Does your child have a tendency to firm and hard stools? Does your child gain enough weight? Does your child gain enough height? Toftedal's study team conducted a trial of the questionnaire in Denmark's County of Funen. They mailed it to the parents of 9,880 8- and 9-year-olds. Prior to mailing the questionnaire, just 13 children in Funen were known to have celiac disease. A total of 7,029 parents returned the completed questionnaire, with 2,835 reporting at least one symptom. The research team invited these children for a celiac blood screen. A total of 1,720 children submitted to screening, with 24 showing positive antibodies common with celiac disease. Additional testing confirmed 14 case of celiac disease among the children of Funen, meaning that only half of the kids with celiac disease had been diagnosed. When you factor in the additional 1,115 parents who did not report for screening, the result might be slightly higher. Toftedal and colleagues conclude that a number of "preclinical and low-grade symptomatic patients with celiac disease may be identified by their responses to a mailed questionnaire." Pediatrics, March 2010
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Celiac.com 10/06/2017 - Gluten-free doesn't have to be complicated or confusing. It can be easy and delicious without thinking twice about the processed foods in the food stores. Simply eat Clean. What's Clean, you say? It's about eating real, wholesome, naturally gluten-free foods and steering clear of processed, packaged foods. My Clean eating philosophy is about fresh and simple ingredients. That's right, how about starting with some avocado, roasted turkey, fresh raspberries and balsamic vinegar that you can easily whip up in a food processor for a tasty turkey pate to use throughout the week with crudités or corn tortillas? It takes five minutes to make and you can store it in the fridge for a quick dose of protein any time of the day whether it be a meal or snack. How about adding some to your morning omelet, spread it atop your afternoon sandwich with lettuce and tomato or added to your burritos for dinner? See how easy it can be? And guess what? It's naturally gluten-free and delicious. You don't have to think twice or worry about eating anything out of a box when you can visit your local farmers' market for fresh produce and your butcher for lean proteins such as turkey, chicken, bison and eggs. If you're a vegetarian or vegan, simply use tofu and you're all set. It's as easy as 1,2,3 and you've got a week's worth of eats to enjoy when your stomach starts rumbling. So, next time you are yearning for a processed food, think again and slice up some veggies to serve with your new pate recipe. Believe me I know first-hand about eating Clean as my whole approach to Clean eating started a few years ago when my body started reacting negatively to packaged foods. What helped me heal? Food. That's right. Real, Clean food; I have real food to thank. Because gluten-free is not about the gluten-free cookies and packaged, over-processed foods. It's about eating Clean. Eating fresh fruits and vegetables, lean proteins and healthy fats. That's exactly what I eat. I love it and I know you will to! Bon Appetite.
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Quite Simple, Food Allergies vs. Food Intolerance
Paul Smith posted an article in Allergy vs. Intolerance
Celiac.com 06/29/2009 - Hypersensitive reactions to food are becoming increasingly problematic in society. Allergy experts report that the prevalence of food allergies appears to be rising and while there are no exact figures for this in Australia, some studies have shown marked increases overseas. For example, a study from the Isle of Wight in the U.K. has shown a tripling in the rate of peanut allergies over the past 10 years. However, the reason for this is not yet clear. Auckland allergy expert Dr. Vincent Crump has three theories regarding the increase in peanut allergies. More people are eating peanuts and, up until recently, many eczema creams contained peanut oil, possibly exposing an allergy prone person to the food. There’s also the 'hygiene theory' of disease, which suggests that children are not exposed to enough dirt and bacteria these days, and therefore do not build up a normal immunity to harmless substances. So when they are exposed, their immune system overreacts and they develop an allergy. Despite the overall increase in food allergies, the rate in adults is still pretty low – around one per cent. However, the rate is higher in children, where up to five per cent are believed to have a food allergy. Allergy vs. intoleranceThe most common and best understood type of allergy is a reaction in which the body's immune system overreacts to a food and mistakenly produces antibodies (called IgE) to the food. This can cause reactions, sometimes severe, that affect the skin, breathing, gut and heart. An intolerance is an adverse reaction to a food that does not involve the immune system. Symptoms are generally less severe, and can include headaches, gut problems and worsening of skin conditions such as eczema. Intolerance is much less likely to be life-threatening than a true allergy. What is an allergy?According to the Australian Society of Clinical Immunology and allergy (ASCIA) education resources website, the word “allergy” is frequently overused and misused to include any irritating or uncomfortable symptoms after eating. Strictly speaking the term should only be used for the symptoms which develop after eating certain foods as part of the immune response.In an allergic reaction, the body’s immune system mistakenly believes the food is harmful and tries to protect itself. In doing so it overreacts and produces, for example, harmful antibodies to fight the food “allergens”. In turn, these special antibodies (called IgE) make the body produce histamines and other chemicals, causing reactions that affect the skin, breathing, gut and heart. IgE antibodies can also “cross react “with other allergens. For example, someone with a latex allergy may also react after eating a banana, kiwi fruit or avocado. According to allergy specialist Professor Rohan Ameratunga, up to 50 per cent of people who react to one tree nut (including almonds, brazil nuts, Cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios and walnuts) will react to other tree nuts. A recently recognized form of food allergy is the “oral allergy syndrome”, where a person experiences a cross reaction between pollens and fresh fruit and vegetables. This “cross-reactivity” is also the reason why some adults with a predisposition to other allergies suddenly develop a food allergy. For example, a person with a birch pollen allergy can suddenly became allergic to apple or kiwi fruit allergens. Dr Crump says more and more adults prone to allergies are developing cross reactions after they are overexposed to certain foods (such as acquiring wheat allergies after working in a bakery). What are the most common food allergies?Allergies are mostly triggered by nuts, shellfish, fish, milk, eggs, wheat and soybeans.Adults are more likely to be allergic to fish, shellfish and nuts, with children suffering more from allergies to milk, eggs and peanuts. Reactions to seeds and fruits are also becoming more common. There are cultural differences in allergy patterns, according to professor Ameratunga. In Japan, rice allergy is common. In the Middle East and Australia, sesame allergy is on the rise. We know the treatment for coeliac disease is a gluten-free diet for life. Although people with coeliac disease produce antibodies the allergic process is different from that seen in most other allergic reactions. In coeliac disease, gluten reacts with the small intestine, and activates the immune system to attack the delicate lining of the bowel. The normally rippled lining of the intestine becomes damaged and inflamed, and forms the characteristic flat appearance of celiac disease. The surface area, which enables the absorption of nutrients and minerals from food, is seriously depleted, leading to gastrointestinal and malabsorptive symptoms. Common IntolerancesAlmost any food can cause an intolerance, but the repeat offenders are;OFFENDER: Lactose FOUND IN: Milk and milk products. Yoghurts have little lactose and hard cheeses have none. OFFENDER: Salicylates FOUND IN: Natural food chemicals found in a wide variety of fruits and vegetables such as cauliflower, eggplant, broccoli, tomato, apple, orange, and pineapple. Also found in nuts, spices and aspirin. OFFENDER: Amines FOUND IN: Histamines and histamine-like chemicals produced during fermentation, and the ageing and ripening of foods. Found in wine, processed meats, hard cheese, tomato paste, chocolate, and many fruits and vegetables. OFFENDER: Glutamate FOUND IN: An amino acid found naturally in all protein foods such as cheese, processed meats and milk. MSG (additive621) is a type of glutamate, and natural glutamates are also found in soy sauce, broccoli, mushrooms, spinach, tomatoes, grapes, plums and many others foods. Anything else you'd like to add? Leave a comment -
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Celiac.com 05/06/2013 - After a diagnosis of celiac disease, it is unlikely a gluten-free diet alone will provide expeditious relief from its various associated symptoms and health problems. Additional steps and remedies to restore the integrity of the damaged intestinal mucosal barrier are often needed, at least, to hasten the process. The first step all patients should take after a celiac disease diagnosis is to establish a "baseline" measurement of the intestinal damage which can be used to assess how well the gut is healing over time. Assessing the status of the gut via multiple endoscopic biopsy procedures is not a very practical choice of method. It is expensive, invasive, uncomfortable, subject to possible risks and complications, and only assesses the intestinal mucosa at the sites biopsied.[1] The downsides of biopsies can be avoided by using a low-cost, non-invasive leaky gut or intestinal permeability test to provide a useful baseline measurement and following up with future periodical testing for comparison. A new, simple and easy-to-use home Carbon-13 or 13C-Sucrose Breath Test to assess for leaky gut is now available. The 13C-Sucrose Breath Test takes only 90 minutes, requiring drinking a sucrose (20 grams) solution and collecting 4 breath samples 30 minutes apart following an 8 hour fast. 13C-Sucrose Breath Test samples, collected in 4 small screw-capped glass tubes, are simply mailed to the laboratory within 14 days in the original shipping box that also serves as a pre-paid U.S. Postal Service First Class Mailer. 13C-Sucrose Breath Test results are emailed back within 24 hours after the breath test samples are received.[2] In comparison, the better known and established Lactulose/Mannitol Intestinal Permeability Test requires an 8 hour overnight fast, collecting a pretest urine specimen, drinking a Lactulose(5 grams)/Mannitol(1 gram) solution, drinking water every 2 hours, and sampling and collecting all the urine excreted over a 6 hour period. The Lactulose/Mannitol Test urine specimens must be kept refrigerated and shipped to and received by the laboratory within 24 hours in a special frozen gel pack shipper via FedEx overnight delivery. Lactulose/Mannitol Test results are emailed around 7 days after the specimens are received.[3] The 13C-Sucrose Breath Test is based on the level of sucrase activity in cells of the intestinal mucosa. Sucrase enzymes break down sucrose into its constituent components, fructose and glucose, which, when metabolized in the liver, produce carbon dioxide (CO2) exhaled in the breath. Sucrase enzymes are synthesized and embedded in the "brush border" of cells comprising the villi of the intestinal mucosa. The brush border is composed of numerous microvilli which extend into the intestinal lumen from the face of the villus cells.[1,4,5] Natural sucrose from cane sugar contains 2 forms of carbon atoms, carbon-12 (12C) and the stable, non-radioactive isotope, carbon-13 (13C). 12C and 13C carbon dioxide can be detected and measured using an isotope ratio mass spectrometer (IRMS). By using natural 13C-enriched sucrose in which the ratio of 13C to 12C has been previously measured, measurement and analysis of the relative amounts of 13C and 12C in the carbon dioxide exhaled by an individual after ingesting a known quantity of the 13C-enriched sucrose provides an indicator of the sucrase activity in the brush border. Damage to villus cells and the brush border results in both a decrease in sucrase activity and an increase intestinal permeability. This forms the basis for a leaky gut test where low carbon-13 measured in the breath means the intestinal villi are damaged.[1,4] The Metabolic Solutions, Inc. 13C-Sucrose Breath Test is taken after a minimum 8 hour fast. No sleep or exercise is allowed during the test. A baseline breath sample is first collected. Then a 20 gram packet of 13C-enriched sucrose is stirred into an 8 ounce glass of water and ingested. Breath samples are then collected at 30, 60, and 90 minutes after sucrose ingestion. Breath samples are collected into 4 small labeled 10 ml glass tubes with color-coded screw caps by simply unscrewing the cap, taking a full breath, and blowing into the tube through an ordinary straw. Breath will be felt escaping out of the tube as it is blown through the straw. That is normal. All that is required is to screw the cap back on the tube, finger-tight, within 5 seconds. If screwing the cap back on takes more than 5 seconds, one can simply take another breath and blow again. After the test, the 4 tubes and the instruction sheet, filled-in with the test taker's name, email address, date of birth, sex, height and weight, are repacked into the original shipping box and dropped into any U.S. mail box within 14 days. A prepaid U.S. Postal Service First Class mailing label is printed on the box. Test results are emailed back within 24 hours after receipt by Metabolic Solutions, Inc. If the percentage cumulative dose of 13C recovered from the sucrose at 90 minutes is less than 5.10% 13C for females or less than 3.91% 13C for males, the test is considered positive for intestinal damage.[2,4] The percentage cumulative dose of 13C recovered from sucrose over 90 minutes is calculated from the area under the curve formed by plotting the amount 13C carbon dioxide measured in each 10 ml breath sample against time, the ratio of 13C to 12C in the 20 grams of sucrose ingested, and a formula where age, sex, height and weight are used in a to compute the total amount of carbon dioxide (both 12C and 13C) that would be expirated by the test subject during the test time period. Together, these considerations yield the desired test result expressing how much of the 20 grams of sucrose ingested has been metabolized by brush border sucrase enzymes and the liver and expelled in the breath within 90 minutes.[6,7] The 13C-Sucrose Breath Test was invented and developed by scientists at The Centre for Paediatric and Adolescent Gastroenterology, Children, Youth and Women’s Health Service, University of Adelaide, North Adelaide, SA Australia. U.S. Patent 7338454 (March 4, 2008) and U.S. Patent Application 20080160504 (July 3, 2008) are assigned to Children, Youth and Women's Health Service Incorporated, North Adelaide, AU.[7,8] Development of the 13C-Sucrose Breath Test began prior to 2002, the year an international patent application for the test was filed.[9] Only recently has the test become available in the United States. Because of limited published clinical studies, the 13C-Sucrose Breath Test has not yet become fully established as a standard for intestinal permeability testing, but has advantages over other tests and appears to be reliable. Except in cases of intestinal damage, sucrase levels generally remain consistent thoughout life and across differing ethnicities. Only 0.2% of the population has a genetic sucrase deficiency.[1,4,7] In only one study concerning zinc absorption in children with celiac disease has the 13C-Sucrose Breath Test been compared against Marsh scores of celiac disease patients. That study recruited 51 children, aged 2 to 18 years, who underwent routine endoscopy for the diagnosis or exclusion of celiac disease. There were no significant differences in 13C-Sucrose Breath Test results between children with a Marsh score of 0 and Marsh scores of 3a, 3b, and 3c. All participants, including those with Marsh score 0, had a mean percentage cumulative dose of 13C recovered from sucrose at 90 minutes slightly below the 5.06% cut-off for a normal 13C-Sucrose Breath Test. In a prior study, the average test result for normal healthy children (aged 11.2 +/- 0.8 years) was 8.5%. Since all recruited children had bowel symptoms prompting an endoscopy, those children with March scores of 0, while not diagnosed with celiac disease, were not normal and healthy. The study shows the 13C-Sucrose Breath Test is potentially useful to monitor gut integrity in celiac disease children.[10] Lactulose/Mannitol and the similar Lactulose/Rhamnose dual-sugar permeability tests have been studied since 1979. Mannitol and rhamnose are small sugar molecules which normally cross the intestinal barrier via absorption through healthy intestinal cell membranes. Lactulose is a large sugar molecule that crosses the intestinal barrier by passing between intestinal cells through the "tight junctions". These sugars are non-metabolizable, and, therefore, the molecules which cross the intestinal barrier are excreted unchanged in the urine. Loss of tight junctions elevates lactulose urinary levels. Damage to intestinal cell membranes compromises absorption of mannitol or rhamnose molecules, and, thus, lowers mannitol or rhamnose urinary levels. A high urinary lactulose to mannitol or lactulose to rhamnose ratio, therefore, indicates intestinal damage.[1] Lactulose/Mannitol permeability tests have been studied in celiac disease patients with mixed results as to whether the test is suitable as a screening test for celiac disease.[11-15] Like the 13C-Sucrose Breath Test, the Lactulose/Mannitol test is probably best used to monitor the progress of gut healing by first testing intestinal permeability at the time of celiac disease diagnosis to establish a baseline for subsequent follow-up tests. The two tests are available online at competitive prices. Metabolic Solutions Inc. currently offers the 13C Sucrose Breath Test for $129 which includes shipping. The Genova Diagnostics Lactulose/Mannitol Intestinal Permeability Test is available at similar discounted prices from several online sellers. 13C-Sucrose Breath Leaky Gut Test Kits are available directly from: Metabolic Solutions, Inc. 460 Amherst Street Nashua, NH 03063 866-302-1998 For Health Professionals: http://www.metsol.com/leaky-gut-syndrome To Order Home Test Kits: http://www.breathtestingathome.com/leaky-gut/ Lactulose/Mannitol Intestinal Permeability Test Kits are available (through retail website sellers) from: GDX/Genova Diagnostics 63 Zillicoa Street Asheville, NC 28801 800-522-4762 http://www.gdx.net/product/10122 I have personally taken the Metabolic Solutions, Inc. 13C-Sucrose Breath Leaky Gut Test. A kit ordered online on a Monday was picked up from my post office box on Friday of the same week. The test was taken on the following Monday, and the prepaid shipping box was dropped off at the U.S. Post Office the next day, Tuesday. The test result was received in an email sent from Metabolic Solutions, Inc. Thursday evening, only 2 days later. The test result was normal, 6.97% cumulative dose of 13C recovered, well above the cut-off of 3.91% for males. Since no such simple and easy leaky gut test existed more than a dozen years ago when leaky gut was first suspected, no baseline was ever established for test result comparison. Following years of diet and supplements targeted to heal leaky gut and treat its symptoms, a general indication of current gut status was desired. Some symptoms still remain. A normal test result suggests the symptoms are likely due to other factors occurring before or during the leaky gut healing process, such as inflammation due to the continued presence of previously "leaked" environmental toxins accumulated in adipose tissue. Sources 1. Mucositis and non-invasive markers of small intestinal function. Tooley KL, Howarth GS, Butler RN. Cancer Biol Ther. 2009 May;8(9):753-8. http://www.landesbioscience.com/journals/cbt/article/8232/01-TooleyCBT8-9.pdf 2. Instructions for Leaky Gut Breath Test. Metabolic Solutions, Inc. http://www.breathtestingathome.com/leaky-gut/instructions-leaky-gut/ 3. GDX Lactulose/Mannitol Intestinal Permeability Test Kit Instructions. Genova Diagnostics. http://www.gdx.net/core/domestic-kit-instructions/Intestinal-Permeability-Instructions.pdf 4. 13C-Sucrose Breath Test for Leaky Gut Syndrome. Metabolic Solutions, Inc. http://www.metsol.com/leaky-gut-syndrome 5. Small Intestine: Brush Border Enzymes. R. Bowen. Pathophysiology of the Digestive System, Colorado State University. http://www.vivo.colostate.edu/hbooks/pathphys/digestion/smallgut/bbenzymes.html 6. Recent Results of the Development and Application of 13C–Breath Tests. Klaus Wetzel and Heinz Fischer. Fischer ANalysen Instrumente GmbH (FAN), Leipzig, December 1999, Page 33. http://www.fan-gmbh.de/docs/13c_recent_results.pdf 7. Breath Test. Butler RN, Tivey D, Davidson GP, Pelton N. U.S. Patent 7338454, March 4, 2008. http://www.google.com/patents/US7338454 8. Breath Test. Butler RN, Tivey D, Davidson GP, Pelton N. U.S. Patent Application 20080160504, July 3, 2008. http://www.google.com/patents/US20080160504 9. Breath test. Butler RN, Tivey D, Davidson GP, Pelton N. International Application No.: PCT/AU2002/001666, December 9, 2002. 10. Zinc homeostasis and gut function in children with celiac disease. Tran celiac disease, Katsikeros R, Manton N, Krebs NF, Hambidge KM, Butler RN, Davidson GP. Am J Clin Nutr. 2011 Oct;94(4):1026-32. http://ajcn.nutrition.org/content/94/4/1026.long 11. Follow-up of adult celiac patients: which noninvasive test reflects mucosal status most reliably? Vecsei AK, Graf UB, Vogelsang H. Endoscopy. 2009 Feb;41(2):123-8. http://www.ncbi.nlm.nih.gov/pubmed/19214890 12. Intestinal permeability in long-term follow-up of patients with celiac disease on a gluten-free diet. Duerksen DR, Wilhelm-Boyles C, Parry DM. Dig Dis Sci. 2005 Apr;50(4):785-90. http://www.ncbi.nlm.nih.gov/pubmed/15844719 13. Lactulose-mannitol intestinal permeability test: a useful screening test for adult coeliac disease. Johnston SD, Smye M, Watson RG, McMillan SA, Trimble ER, Love AH. Ann Clin Biochem. 2000 Jul;37 ( Pt 4):512-9. http://www.ncbi.nlm.nih.gov/pubmed/10902869 14. Lactulose-mannitol intestinal permeability test: a useful screening test for adult coeliac disease. Johnston SD, Smye M, Watson RG, McMillan SA, Trimble ER, Love AH. Ann Clin Biochem. 2000 Jul;37 ( Pt 4):512-9. http://www.ncbi.nlm.nih.gov/pubmed/10902869 15. Is the sugar intestinal permeability test a reliable investigation for coeliac disease screening? Catassi C, Fabiani E, Rätsch IM, Bonucci A, Dotti M, Coppa GV, Giorgi PL. Gut. 1997 Feb;40(2):215-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1027051/ -
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Celiac.com 04/06/2012 - The first step in diagnosing celiac is serological testing, looking for the presence of anti-tTg antibodies. But in adults at least a duodenal biopsy is still the gold standard of diagnosis, partially because of the risk of false positive anti-tTg results. Yet serum anti-tTg levels positively correlate with the severity of small intestinal histopathology. This prompted researchers in Italy to wonder if those patients with the highest ant-tTg levels could be spared an endoscopy, and if so, how high their anti-tTg levels had to be. They conclude, in their words, that "tissue-transglutaminase antibody level 5-folds the upper limit of normal is 100% specific for duodenal atrophy and using this cut-off biopsy could by avoided in 1/3 of patients. Diagnostic criteria of celiac disease in adults need revision." They retrospectively looked at 945 patients who came to their center because of suspected celiac disease. Three different commercially available methods were used to assess anti-tTg levels, which were then correlated with duodenal histology. By all serological methods used, anti-tTg levels increased in parallel with increasing severity of intestinal damage. As noted above, a cut off of five times the upper limit of normal ant-tTg included all of the patients with significant levels of villous atrophy. Celiac disease was confirmed in these patients by the presence of antiendomysial antibodies (EMS) and by their positive response to a gluten free diet. The use of serological results alone had previously been suggested as diagnostic guidelines for children, but these authors suggest that many adults could be spared an endoscopy as well. They also note this strategy is already being implemented in primary care, with people adopting a gluten free diet solely on the basis of blood work; this study is valuable in that it validates that approach. Source: Zanini B, Magni A, Caselani F, Lanzarotto F, Carabellese N, Villanacci V, Ricci C, Lanzini A. High tissue-transglutaminase antibody level predicts small intestinal villous atrophy in adult patients at high risk of celiac disease. Dig Liver Dis. 2012 Apr; 44(4):280-5. Epub 2011 Nov 25. -
So often I hear people asking how to make their own healthy, gluten-free snacks. The following nut cracker recipe is easy, inexpensive, and yes it's also healthy. Feel free to substitute the nuts and seeds listed below for other nuts or seeds of your preference. I always like to soak my nuts before using them; soaked nuts are much easier to digest. Crunchy Nut Crackers Serving Size: Makes around 30-40 (depending on how the size of cracker you make.) Ingredients: 2 cups mixed nuts of your choice: (cashew, almonds, pumpkin seeds and flax seeds work well) 1 egg 2 tbsp filtered water 1 1/8 tsp Himalayan salt Options: Top with sea salt, anise seeds, nigella seeds or some other seeds of your choice.To make: Preheat the oven at 360°F (180°C). Line two baking sheets with parchment papers. Grind nuts into a flour consistency in a blender or food processor (food processor usually works best). Add egg, water and sea salt and stir around with a wooden spoon until the mixture comes together in a quite stiff dough. Divide the dough into two and place them directly on the parchment papers. Roll them out to two rectangles, about 0-1 inches thick. If the dough sticks to the rolling pin you could roll it with parchment paper covering the dough. Use a knife to cut them in slices or squares. Spray some water on them and top with the seeds. Bake for about 10 minutes. Tip: Stay close and keep an eye on the oven, these crackers burn easily. Store them in jars or out in the open if you eat them within the first couple of days. -
I recently took my wife out for dinner at one of our favorite little French restaurants. Among the many delicious foods we ate was a butter lettuce salad. It was one of the simplest, most delicious salads I've ever had, so I took some notes and then set out to recreate it at home. Salad ingredients: Butter leaf lettuce Apple, thinly sliced Goat cheese, crumbled Candied walnuts Mandarin orange slices Salt and pepper to taste Dressing ingredients: 2 tablespoons Dijon mustard 2 tablespoons fresh lemon juice 2 tablespoons honey 1 garlic clove, finely chopped ½ cup extra virgin olive oil ¼ cup champagne vinegar ½ teaspoon salt ½ teaspoon freshly ground black pepper Dressing directions: Whisk together the garlic, mustard, vinegar, lemon juice, honey, salt, and pepper In a large bowl, whisk together all of the ingredients except the olive oil. Once the ingredients are well-mixed, slowly whisk in the olive oil until the dressing is emulsified. In place of a whisk, I sometimes like to use a blender or a food processor and simply pureé all of the ingredients until smooth. Either way makes a good dressing. Salad directions: Thoroughly wash and dry the lettuce leaves. If the leaves are large, tear them into large pieces and place into a bowl. If the leaves are small enough, you may use them whole. Toss the leaves with a bit of the dressing. Cut slices from a nice, sweet, crisp apple, such as a Braeburn or a Fuji apple, and add four slices to each bowl. Crumble goat cheese over the lettuce and apples. Add a few candied walnuts and a few skies of mandarin orange. Serve.
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This fast and delightfully fresh salad is a staple in my kitchen throughout the year, but particularly during the summer months I know affectionately as "tomato-heaven." You can mix it up by using cherry or plum tomatoes, or whatever tomatoes rate handy. The dressing offers a nice balance of tart and sweet; it’s a good one to keep on hand. Feel free to omit the chili flakes if you’re not a fan, or even substitute with a little dill. Ingredients: 3 large tomatoes 1 large cucumber 2 bell peppers, red or yellow 1 red onion 1 cup crumbled feta cheese ½ cup red whine vinegar 1 tablespoon Dijon mustard 1 tablespoon honey ½ cup olive oil 1 teaspoon red chili flakes Salt and pepper to taste Directions: Dice all vegetables into similar size and mix together in a large bowl. For the dressing, combine vinegar, mustard and honey. Slowly whisk in olive oil. Pour over vegetables and sprinkle with chili flakes. Top with cheese, taste and season with salt and pepper if desired.
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American Journal of Clinical Pathology, April 2000 - A New Method of Quantitative Fecal Fat Microscopy and its Correlation with Chemically Measured Fecal Fat Output, by Kenneth Fine, M.D. and Frederick Ogunji Ph.D (Celiac.com 07/09/2000) Patients with gluten sensitivity should be evaluated for nutrient malabsorption because if present, this means there is small intestinal damage and institution of a gluten-free diet is imperative to prevent osteoporosis and other nutrient deficiency syndromes. Furthermore, a test at the time of diagnosis serves as a baseline to be compared to later if needed. For more than 50 years, the primary method used to assess for the presence of small intestinal damage and nutrient malabsorption in patients with celiac disease has been a 72-hour quantitative stool collection. However, because this method requires that patients accurately collect all the stools they pass for 3 days (missed stools lead to falsely low results), the test is logistically difficult for medical centers unaccustomed to the procedure, and the voluminous specimens usually are abhorred by patients and laboratory technicians. It poses obvious problems for children who cannot or will not collect all their stools, as well as for patients with chronic diarrhea, who may have bowel movement frequencies reaching 15 or more per day and/or fecal volumes as high as 2 or 3 liters per day. For these reasons, physicians evaluating patients with suspected or proven gluten sensitivity often avoid tests for intestinal malabsorption altogether. Recently, researchers at the Intestinal Health Institute in Dallas, Texas have developed a new method for quantitating fecal fat excretion that requires collection of only a single stool specimen. Development of this method was based on the fact that as more fat is malabsorbed, the fat globules in stool become more numerous and larger. In a study published in the April 2000 issue of the American Journal of Clinical Pathology entitled A New Method of Quantitative Fecal Fat Microscopy and its Correlation with Chemically Measured Fecal Fat Output, Kenneth Fine, M.D. and Frederick Ogunji Ph.D. tested 180 patients and found a highly statistically significant linear correlation between quantitative fecal fat microscopy (the new method) and chemically measured fecal fat output (the old method). They also showed that their microscopic analysis of just one stool gives comparable results to analysis of an entire 3-day collection. These researchers have, thus, shown that a dedicated quantitative analysis of one stool under a microscope can detect the rise in fecal fat due to intestinal malabsorption (or pancreatic maldigestion) as accurately as 3-day stool collections, making this latter test a thing of the past for most patients. This new stool test for intestinal malabsorption and other celiac-testing is available for order online from a laboratory set up by Drs. Fine and Ogunji to serve the needs of celiac patients. It is called EnteroLab and can be accessed at http://www.enterolab.com/. -
Celiac.com 10/13/2009 - The standard method of measuring successful observance of a gluten-free diet in patients with celiac disease is through a dietary interview performed by health professional. However, there is currently have no simple, objective method for conducting such a dietary interview. To address this discrepancy, a team of researchers recently designed an easy, quick questionnaire based on four simple questions which yield a five-level score (0–IV). The score provides the test individual with an indication of their compliance level. The research team was made up of Federico Biagi, Alida Andrealli, Paola Ilaria Bianchi, Alessandra Marchese, Catherine Klersy, and Gino Roberto Corazza. The team recently set out to assess the accuracy of the questionnaire. They ran the questions past 168 celiac patients, 126 females and 42 males, with a median age of 42·4 (SD 12·9) years. All subjects were allegedly following a gluten-free diet (median 82, 25th–75th percentile 50–108, range 15–389 months). They compared the resulting scores with the persistence of both villous atrophy and endomysial antibodies while on a gluten-free diet. They also compared patient survival rates. Non-expert personnel interviewed patients by telephone. The questionnaire took less than one minute to complete. The lowest results were markedly more common among the patients with a persistence of both villous atrophy and positive endomysial antibodies. Those patients also had significantly higher rates of death overall. From these results, the researchers conclude that the questionnaire offers a simple, accurate way to verify compliance with a gluten-free diet for patients with celiac disease. Source: British Journal of Nutrition (2009), 102, 882–887
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Celiac.com 01/04/2010 - The practice of using antibody testing to diagnose celiac disease has led to an explosion in the number of cases detected among children, coupled with a rise in median age at diagnosis, a new study suggests. European studies have shown that celiac disease is a multi-system disorder, affecting 0.3% to 1.0% of all children. A team of researchers recently set out to examine the impact of serological testing on childhood celiac disease in North America The research team consisted of Kelly E. McGowan, BHSc, Derek A. Castiglione and J. Decker Butzner, MD with the Department of Pediatrics, University of Calgary, Calgary, Canada. Serological testing makes it easier to spot children with atypical or extra-intestinal symptoms or with conditions associated with celiac disease. Serological testing has resulted in a huge increase in celiac disease cases; it has tripled incidence levels, quadrupled diagnosis age, and brought about a greater understanding of the wide variety of presentations of celiac disease in North America. Younger children are more likely to develop classic celiac disease, whereas older children seem more likely to show atypical presentations. The goal of the study was to determine the effects of immunoglobulin A endomysial antibody testing on the incidence and clinical presentation of childhood celiac disease. Researchers compared the incidence and clinical presentation of celiac disease in two groups of patients. Both groups were under a pretesting group of patients under 18 years of age in 1990–1996 and compared with a testing group of patients under 18 years of age in 2000–2006. Average age at diagnosis was 2 years (95% confidence interval: 2–4 years) in the pretest group (N = 36), compared with 9 years (95% confidence interval: 8–10 years) in the test group (N = 199; P < .001); female/male ratios (1.6:1) were similar (P = .982). Incidence of celiac disease increased from 2.0 cases per 100,000 children in the pretest group to 7.3 cases per 100,000 children in the test group (P = .0256). Frequency of classic celiac disease decreased from 67% in the pretest group to 19% (test group; P < .001), but the incidence of classic celiac disease did not change (0.8 vs 1.6 cases per 100000; P = .154). In the test group, researchers uncovered 13 previously unnoticed clinical presentations in 98 children, including 35 with family history, 18 with abdominal pain, and 14 with type 1 diabetes mellitus. The frequency of Marsh IIIc lesions decreased from 64% in the pretest group to 44% in the test group (P = .0403). In the test group, classic celiac disease was most common, making up 67% of cases in young children under 3 years, whereas atypical gastrointestinal and silent presentations were more common in older children. Overall, the contribution of serological testing to the diagnosis of celiac disease has been enormous. Antibody testing for celiac disease has tripled the incidence of celiac disease and quadrupled the average age at diagnosis, thus offering millions of children a higher quality of health. Source: Pediatrics, December 2009.
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Celiac.com 11/03/2008 - Blood testing for radioimmunoassay (RIA) tissue transglutaminase auto-antibodies (tTG-Abs) has proven to be a sensitive test for celiac disease follow-up. Recent studies have shown that RIA can accurately detect tTG-Abs in human saliva. However, not much is known about reliability of this method for monitoring the progress of celiac disease over time in patients who are attempting to follow a gluten-free diet. A team of researchers recently set out to assess salivary RIA tTG-Abs in celiac children on gluten-free diet. The research team included doctors M. Bonamico, R. Nenna, R.P.L. Luparia, C. Perricone, M. Montuori, F. Lucantoni, A. Castronovo, S. Mura; A. Turchetti, P. Strappini, and C. Tiberti. The team evaluated blood and saliva samples taken from 109 children at the time of their diagnosis for celiac disease. The first group included 71 females, with an average age of 9.4 years. A second group included 58 people who were following a gluten-free diet. The second group was broken into two subgroups: group 2a with 36 patients assessed at 3-6 months; and group 2b with 34 patients at 9 months or more (group 2b). The research team also included two control groups matched for age and sex. Group 3 included 89 gastroenterological patients, while group 4 included 49 healthy subjects. The team used RIA to detect tTG-Abs in saliva and blood, and compared the results against two other established tests: serum tTG-Abs ELISA and IgA anti-endomysium antibodies (EMA). The team detected salivary RIA tTG-Abs in 94.5% of patients from group 1, 66.7% of celiac patients from group 2a, and 50.0% from 2b. They detected blood RIA tTG-Abs in 98.2% of patients from group 1, 72.2% of celiac patients from group 2a, and 50.0% from 2b. The longer patients were on a gluten-free diet, the more the tTG-Abs decreased. The research team also found a correlation between saliva and serum levels (r = 0.75, P = 0.0001). A celiac disease follow-up showed comparable salivary and serum RIA sensitivities, and higher levels for EMA and ELISA methods. The research team concluded that it is possible to measure salivary tTG-Abs with a high level of accuracy; both at initial diagnosis for celiac disease, and also while patients are following a gluten-free diet. This discovery means that doctors treating people with celiac disease might soon be able to use a simple saliva test to monitor the progress of their patients’ gluten-free diets. Such a development might take remove much of the guesswork for celiacs who are trying to follow a gluten-free diet, and would be particularly useful for patients who might be asymptomatic, or who are at risk for celiac-associated conditions. Aliment Pharmacol Ther. 2008; 28(3): 364-370.
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