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Celiac.com 11/11/2015 - If you ask me, it doesn't seem that far-fetched that some people who do not have celiac disease could still have adverse reactions to gluten. However, actually proving that scientifically continues to be challenging. Take the case of the research team that recently conducted a double-blind, placebo-controlled, cross-over, gluten-challenge trial of patients with suspected non-celiac gluten sensitivity. The team wanted to try to get an idea of the number of self-diagnosed patients with non-celiac gluten sensitivity. The team enrolled 53 women and 8 men referred to two Italian centers between October 2012 and November 2013 for suspected non-celiac gluten sensitivity. The subjects were randomly assigned to receive 4.375-g gluten or rice starch per day via gastro-soluble capsules for 1 week after a 1-week run-in period, and followed by a 1-week washout period and cross-over to the other group. The team chose rice starch as the placebo because it is "the most readily absorbable of the complex carbohydrates, and thus less fermentable, in the intestinal tract." They used a daily questionnaire to chart any changes in overall symptom scores, and conducted analysis with a per-protocol approach. A total of 59 patients completed the trial, while two withdrew due to "intolerable symptoms." Overall, one week of gluten consumption increased overall symptom severity compared with one week of placebo (P = .034), including abdominal bloating (P = .04), abdominal pain (P = .047), foggy mind (P = .019), depression (P = .02) and aphthous stomatitis (P = .025). Perplexingly, the team found that "most patients showed approximately equal degrees of overall symptoms with either gluten or placebo, although overall symptoms were worsened significantly by gluten in comparison with placebo." Got that? Significant numbers of the subjects reacted to the placebo. The short conclusion is that these results "do not represent crucial evidence in favor of the existence of this new syndrome." However, and it's a big however, the results aren't quite as clear as they might appear. In an accompanying editorial, Benjamin Lebwohl, MD, from the Celiac Disease Center at Columbia University, and Daniel A. Leffler, MD, MS, from Beth Israel Deaconess Medical Center write: The "overall positive result was driven by a minority of patients, whereas the rest had no (or at most a modest) worsening compared with placebo." They add that: "These findings can be a Rorschach test of sorts, in which the viewer draws interpretations that are based on his or her prior beliefs about NCGS. … It is therefore not surprising that this trial, like its predecessors, seems only to contribute to the uncertainty about NCGS." So, basically, there's no clear word on the existence or non-existence of non-celiac gluten sensitivity, or on the number of people who might suffer from it. Stay tuned for more studies, and more information as researchers attempt to sort it all out. Source: CGHJournal.org

Celiac.com 11/13/2015 - Celiac disease sufferers, and others in the UK, are unhappy with a government proposal to cut financial support for gluten-free food. UK celiac patients are currently allowed up to 18 lots of gluten-free bread, pasta and flour a month on the NHS. One unit is equal to a 400g loaf of bread, 250g of pasta or 250g flour or bread mix. Under the proposal the NHS budget of 209,000 pounds a year for gluten-free food prescriptions for gluten free food will face substantial cuts. But Alison Smith, of the Clinical Commissioning Groups (CCGs), says the current system is out of date and unfair. NHS organizations set up by the Health and Social Care Act 2012 to organize the delivery of NHS services. According to Smith, the wide variety of gluten-free foods available in supermarkets and even corner shops these days invites the creation of a new way of alloying gluten-free benefits that will be "fairer for everyone, not just people with celiac disease, so that we can actually share out NHS resources as fairly as possible." The range of foods currently allowed includes bread, rolls and baguettes, bread mixes, flour, pasta, crackers, pizza bases and breakfast cereals. The CCGs are proposing to change the allowance to eight units per month of bread, pasta and/or flour/bread mixes for everyone eligible for prescription gluten-free food. The change is needed, says Smith, because gluten-free food is vital for people with celiac disease and gluten-sensitivity. Source: mix96.co.uk

Celiac.com 05/18/2009 - People with clinical irritable bowel syndrome (IBS) suffer from biopsy-proven celiac disease at rates that are more than four times higher than in non-IBS control subjects, according to the results of a recent systematic review and meta-analysis conducted by Alexander C. Ford, MBChB, MD, MRCP, from Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada, and colleagues. Prior studies have indicated that people with IBS had higher rates of celiac disease, but evidence has not been clear, and medical guidelines do not always call for celiac screening in these individuals. To determine rates of celiac disease in random adults meeting clinical criteria for IBS, the research team reviewed MEDLINE from 1950 to May 31, 2008, and EMBASE from 1980 to May 31, 2008. They isolated case series and case-control studies that contained data for celiac disease blood screens. They found 14 such studies. From each study, they isolated and aggregated positive serologic test results for celiac disease and biopsy-proved celiac disease. They then compared the data to that for patients with IBS and control individuals, using an odds ratio (OR) and 95% confidence interval (CI). The team isolated 4204 suitable cases from the identified studies. Of those, 2278 met clinical criteria for IBS (54%). The overall rate of positive immunoglobulin A (IgA)–class antigliadin antibodies (AGA) was 4.0% (95% CI, 1.7% – 7.2%), the rate of positive endomysial antibodies (EMA) was 1.63% (95% CI, 0.7% – 3.0%), and the rate of tissue transglutaminase (tTGA) was 4.1% (95% CI, 1.9% – 7.0%). For biopsy-proven celiac disease, the overall rate was 4.1% (95% CI, 1.9% – 7.0%). In patients who met the clinical criteria for IBS compared with non-IBS control subjects, aggregate OR for positive IgA-class antigliadin antibodies was 3.40 (95% CI, 1.62 – 7.13), aggregate OR for either positive EMA or tTGA was 2.94 (95% CI, 1.36 – 6.35), and aggregate OR for biopsy-proved celiac disease was 4.34 (95% CI, 1.78 – 10.6). The study did have some weaknesses, including issues with the methodology governing study selection, possible spectrum bias in case-control studies, possible selection bias in studies based in secondary care, and, in some cases, results too limited to allow meaningful aggregation of data. Still the research team concludes that rates of biopsy-proven celiac disease are more than four times higher for IBS patients than for non-IBS controls. The team recommends that, if screening is undertaken, EMA or tTGA testing be used in lieu of IgA-AGA testing due to their higher positive predictive value, though they admitted that results will depend on celiac rates in the population being screened. The study was supported by the American College of Gastroenterology. Arch Intern Med. 2009;169:651–658.

Celiac.com 07/01/2006 - Scientists have discovered what may be a successful non-dietary therapy for celiac sprue, an inherited inflammatory disorder of the small intestine that impacts an estimated 1 in 200 people around the world. Two research studies, published in the June issue of Chemistry and Biology, pave the way for clinical testing with an oral enzyme therapy that may prevent the many symptoms and complications of this widespread disease. People with celiac sprue, also called celiac disease, cannot tolerate the protein gluten in their diet. Gluten is present in grains like wheat, barley, and rye. When gluten is ingested by a celiac patient, it sets off an inflammatory reaction that damages the small intestine, leading to malabsorption, an autoimmune-like response, and many other complications. The only effective therapy for celiac disease is complete dietary exclusion of gluten. However, the ubiquitous nature of gluten poses a constant threat to celiacs, and a majority of celiac patients who adopt a restrictive diet still exhibit structural and functional gut abnormalities. "Non-dietary therapies that allow celiac patients to safely incorporate low-to-moderate levels of gluten into their daily diet would be of considerable benefit," explains study leader Dr. Chaitan Khosla, from Stanford University and Celiac Sprue Research Foundation. "Having demonstrated earlier that certain types of enzymes can detoxify gluten, our laboratory set out to devise an optimal oral enzyme therapy for celiac sprue by borrowing from nature. In germinating barley seed, gluten serves as a nutritious storage protein that is efficiently digested by enzymes. One enzyme, EP-B2, plays a crucial role in this process by breaking gluten proteins after glutamine residues, which comprise one-third of all amino acid residues in gluten." Dr. Khoslas group used recombinant bacteria to produce a form of EP-B2 that only activates under acidic conditions similar to the conditions found in the human stomach. The researchers demonstrated that EP-B2 efficiently digested gluten protein under gastric conditions and, importantly, EP-B2 was most specific for those parts of gluten that are known to trigger celiac pathogenesis. In a second study, the researchers went on to devise an even more potent double enzyme therapy for detoxifying gluten. EP-B2 was tested in combination with another well-characterized enzyme called PEP that breaks gluten protein after proline residues. Like glutamine, proline is also abundant in inflammatory gluten peptides. At very high gluten loads, where neither PEP nor EP-B2 alone could detoxify gluten quickly enough to prevent inflammation, a PEP and EP-B2 combination completely abolished gluten immunotoxicity within ten minutes under simulated gastric and duodenal conditions. In this tag-team therapy, EP-B2 first cleaved gluten into small pieces under gastric conditions that were then easier for PEP to fully detoxify under duodenal conditions. "Our results suggest that recombinant EP-B2 should be effective as supportive therapy to help celiacs cope with the hidden gluten in everyday life, and that a two-enzyme cocktail containing PEP and EP-B2 may even allow celiacs to resume a more normal diet in the future," offers Dr. Khosla. References: Seigel et al. The researchers include Matthew Siegel, Michael T. Bethune, Jiang Xia, Alexandre Johannsen, Tor B. Stuge, and Peter P. Lee of Stanford University in Stanford, CA; Jonathan Gass, Jennifer Ehren, Gary M. Gray, and Chaitan Khosla of Stanford University in Stanford, CA and Celiac Sprue Research Foundation in Palo Alto, CA. This research was supported by a grant from the National Institutes of Health (R01 DK63158 to C.K. and Mary Hewitt Loveless, MD Pilot-Project Grant to P.P.L.). Siegel et al.: "Rational Design of Combination Enzyme Therapy for Celiac Sprue." Publishing in Chemistry & Biology 13, 649–658, June 2006 DOI 10.1016/j.chembiol.2006.04.009 www.chembiol.com Bethune et al. The researchers include Michael T. Bethune, Yinyan Tang, and Chaitan Khosla of Stanford University in Stanford, CA; Pavel Strop of Howard Hughes Medical Institute and Stanford University in Stanford, CA; Ludvig M. Sollid of University of Oslo and Rikshospitalet University Hospital in Oslo, Norway. This research was supported by R01 DK063158 to C.K. M.T.B. is a recipient of a National Institutes of Health Cellular and Molecular Biology Training Grant through Stanford University. Bethune et al.: "Heterologous Expression, Purification, Refolding, and Structural-Functional Characterization of EP-B2, a Self-Activating Barley Cysteine Endoprotease." Publishing in Chemistry & Biology 13, 637–647, June 2006 DOI 10.1016/j.chembiol.2006.04.008 www.chembiol.com. Contact: Heidi Hardman Tel: (617) 397-2879

Celiac.com 06/15/2008 - Many people with celiac disease have stories to tell about the about how difficult it can be to get a getting a proper diagnosis. Celiac disease can mimic so many other conditions. Irritable Bowel Syndrome (IBS) is one of those conditions. The symptoms for Irritable Bowel Syndrome and for celiac disease are often similar as a result the diagnosis of celiac disease can be delayed or missed and misdiagnosed as irritable bowel syndrome. In an effort to reduce the misdiagnosis of celiac disease as Irritable Bowel Syndrome, Britain’s National Institute for Health and Clinical Excellence has drawn up new guidelines covering the diagnosis of Irritable Bowel Syndrome. The guidelines call for all diagnosis of Irritable Bowel Syndrome to be preceded by a screen for celiac disease. Keeping this in mind, anyone suffering from Irritable Bowel Syndrome, and who has not been tested for celiac disease, might want to take the initiative and check with their doctor to see if further testing might be in order. Studies show that a minimum of 1 out of every 100 people in Britain suffers from celiac disease, but that only 1 out of 8 is properly diagnosed. More worrisome still is the fact that new research shows that it takes an incredible 13 years on average before the diagnosis are made. That means 13 years of unnecessary pain and discomfort, to say nothing of potential systemic damage for those awaiting a proper diagnosis of celiac disease, including osteoporosis, bowel cancer and increased risk of other autoimmune diseases. Since similar numbers likely prevail in America, it's good to keep an eye on clinical changes like the one recently made in Britain. Again, for people diagnosed with IBS, but who have not been evaluated for celiac disease, it might be good to consider getting checked for celiac disease, even if these changes are not officially implemented in America anytime soon. Changes in diagnostic and treatment practices that benefit people with celiac disease are long overdue and highly welcomed by the celiac community. As our abilities to evaluate diagnostic and treatment practices continue to expand, look for important changes in the clinical approach to celiac disease, greater awareness among the general population, and improvements in the quality of life among celiacs. References: 1. The Economic Burden of Coeliac Disease in the UK research paper 2. Recent advances in Coeliac Disease by D.A. van Heel and J. West, published in Gut 2006 55, pp 1037-1046 3. Coeliac Society of the UK

This approach has great promise for improving the quality of future gluten-free products--here is a related article. Celiac.com 10/11/2005 - Arcadia Biosciences, an agricultural biotechnology company focused on products that benefit the environment and human health, today announced that it has received a Small Business Technology Transfer Program (STTR) grant from the National Institutes of Health in partnership with Washington State University (WSU) to research novel lines of wheat with reduced celiac disease-causing proteins. The grant will be split equally between Arcadia and its academic collaborator at WSU, Dr. Diter von Wettstein, the R.A. Nilan Distinguished Professor in the Department of Crop and Soil Science. Nearly 1 percent of American people and 4 percent of European people are estimated to suffer from celiac disease, or gluten intolerance. This genetic disorder can create symptoms that range from chronic diarrhea to malnutrition. Studies also indicate that celiac disease sufferers who continue to eat gluten are between 40 and 100 times more likely to develop gastrointestinal cancer than non-celiac disease sufferers. The only known treatment for celiac disease is adherence to a gluten-free diet, which includes complete abstinence from wheat, rye, barley, and their derivatives. "New diagnostic tests continue to identify people who suffer from celiac disease and who need to make extreme dietary adjustments," said Eric Rey, president of Arcadia Biosciences. "This grant is the first step in our effort to identify and develop wheat varieties that can significantly expand the dietary options for people on gluten-free diets. Our goal is to help enable people who suffer from celiac disease to enjoy wheat-based products, like bread and cookies, and not experience an adverse reaction." Working with Dr. von Wettstein and his colleagues at WSU, Arcadia will use its proprietary TILLING® technology to identify wheat plants in which harmful gluten proteins are minimized. Arcadias current product pipeline includes six technologies that either protect the environment or improve human health. The company expects to launch its first product, GLA-enriched safflower oil, to the nutritional supplement market in 2008. Other technologies include higher-yielding plants that use less nitrogen fertilizer, salt-tolerant plants, and fresh produce with high levels of antioxidants such as lycopene. These products are being developed using both genetic engineering and advanced breeding technologies.