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Found 31 results

  1. Celiac.com 11/02/2017 - What is the link between the autoimmune diseases Sjögren's syndrome and celiac disease? In a study, 14.7% of Sjögren's syndrome patients were found to have celiac disease and 11.8% of non-celiac Sjögren's syndrome patients were found to have inflamed mucosa in the small intestine. With this knowledge, people who suffer from Sjögren's syndrome may be able to find relief for their symptoms with the gluten-free diet. Four million Americans are suffering from a disease they don't even know they have and their doctors don't even know to test for. Sound familiar? If you're familiar with my work as a gluten-free advocate, you have probably guessed that what I'm describing is celiac disease, an autoimmune reaction triggered by gluten, a protein component in wheat, barley, and rye. If that was your guess, you would actually be wrong: there is another underdiagnosed and common autoimmune disease that we and our doctors need to be aware of—Sjögren's syndrome, which affects the exocrine, or moisture-producing, glands. Unlike celiac disease, Sjögren's syndrome doesn't have a standardized effective treatment, but fortunately, research is demonstrating a link between these two autoimmune diseases, bringing good news for Sjögren's patients who may see relief of their symptoms by eliminating gluten from their diet. Chances are, many haven't heard of Sjögren's syndrome. This relatively unknown and underdiagnosed disease is an autoimmune disease in which the immune system attacks the tear and saliva glands of the body, reducing their production and resulting in dry mouth and eyes and other symptoms. Complications of Sjögren's include tooth decay, corneal ulcers, and non-Hodgkin's lymphoma. In women, vaginal dryness can also be a symptom. According to the UK's National Health Service, 9 out of 10 people who suffer from this condition are women, and the average age onset is between the ages of 40 and 60 years old. In a study by the Institute of Medical Technology, University of Tampere, Finland, 34 Sjögren's syndrome patients and a control group of 28 people were given a small bowel biopsy; five (14.7%) of the Sjögren's patients tested positive for celiac disease and four (11.8%) of the non-celiac patients were found to have inflammation in the mucous membrane of the small intestine. According to the study's conclusions, "The findings show a close association between Sjögren's syndrome and celiac disease." Currently, there are two classifications of Sjögren's syndrome as either primary, meaning that it has developed on its own, or secondary, which means that it has developed as the result of another autoimmune disease, such as rheumatoid arthritis or lupus. There is no "cure" for Sjögren's; researchers have identified a combination of factors—environmental, genetic, and hormonal, according to the National Health Service. There are a variety of treatments which can vary in effectiveness, including saliva-stimulating medication and eye drops. The good news is that Sjögren's patients who are found to be celiac may see the relief of their symptoms through a gluten-free diet, currently the effective and only treatment used for celiac disease. Just as with celiac disease, Sjögren's syndrome is under diagnosed relative to its frequency. As a diagnosed celiac American, I consider myself very lucky that I've been correctly diagnosed with celiac disease. With the help of advocate groups all over the country, gluten-free awareness and celiac diagnosis is on the rise. By spreading the word about the association between Sjögren's syndrome and celiac disease, we can help those with Sjögren's achieve better health and quality of life. Resources: National Health Service (UK): Sjögren's syndrome http://www.nhs.uk/conditions/Sjogrens-syndrome/Pages/Introduction.aspx National Institutes of Health: Celiac disease and markers of celiac disease latency in patients with primary Sjögren's syndrome http://www.ncbi.nlm.nih.gov/pubmed/10201480 Nutritional Healing: Articles. Sjögren's World: Links http://www.sjogrensworld.org/links.htm
  2. Celiac.com 08/05/2017 - I was told that I had irritable bowel disease about thirty years before being diagnosed with celiac disease. I avoided hard to digest foods such as corn, broccoli, beef and other foods difficult to digest, and instead I would, for instance, eat the bun of a hamburger, avoid steaks but eat the buttered buns and the gravy with a main meal and wondered why I was still having the gut and bowel reactions! Did you know that even in the absence of fully developed celiac disease, gluten can induce symptoms similar to FBD (Functional Bowel Disorder)? Doctors such as Elena F. Verdu, David Armstrong and Joseph Murray describe celiac disease and irritable bowel syndrome (IBS) as the "no man's land of gluten sensitivity.” Celiac disease is a condition traditionally characterized by chronic inflammation of the proximal small intestine resulting in villus atrophy and malabsorption. Irritable bowel disease is a clinical syndrome defined in the most recent Rome III consensus by the presence of abdominal pain or discomfort, at least three days per month in the last three months, and two or more other symptom features: 1) Improvement in defecation, 2) Association with a change in stool frequency, and 3) Association with a change in stool form or appearance. Other GI symptoms, such as bloating and distension are also considered to be consistent with a diagnosis of FBD (Functional Bowel Disorder) such as IBS. Did you know IBS has a prevalence of about 10% and is the most common GI disorder in our society, imposing a very high economic burden in North America? Did you know that there is an overlap between IBS and celiac disease? It has been reported that testing for celiac disease in patients with diarrhea-predominant IBS is cost effective if the prevalence of celiac disease is above 1%. Not only do the symptoms of IBS and celiac disease overlap, but epidemiological studies also suggest a greater than by chance association (4 - 5 fold increased risk). By convention, a patient with confirmed celiac disease is no longer considered to have IBS. It has never been determined whether celiac disease and IBS cannot co-exist, and there is no reason to think that a diagnosis of celiac disease necessarily precludes a diagnosis of IBS. Dr. Fasano has concluded that about 3% of patients with a "clinical" presentation of IBS were subsequently diagnosed with celiac disease. I would wager that many of you with confirmed celiac disease may also have the symptoms of irritable bowel disease. I cannot be alone in this! I can check off the symptoms of IBS on many occasions and yet I have diagnosed celiac disease and dermatitis herpetiformis. In Dr. Fasano's report: "they have concluded that gluten induced Patho-physiology may constitute an underlying factor in symptom generation in a proportion of patients with IBS like symptoms." A lot of this wording may seem like Greek or a "little over ones head" so to speak, but I believe what they are saying is though we define gluten sensitivity as a condition of some morphological, immunological, or functional disorder that responds to gluten exclusion and NOT a true disease. Gluten sensitivity changes that occur with IBS because of exposure to gluten are eventually going to show up positive for celiac disease. Why would a person who has been diagnosed and KNOWS that they have irritable bowel disease continue to ingest gluten when Fasano et. al., have concluded that about 3% of patients with a "clinical" presentation of IBS were subsequently diagnosed with celiac disease? Did you know that in July of 2016 teams of researchers at Columbia University published a study confirming that wheat exposure response is, in fact triggering a systemic immune reaction and accompanying intestinal cell damage. "It is estimated that the impacted population is equal to or even exceeds the number of individuals with celiac disease, the vast majority of whom remain undiagnosed" Dr. Armin Alaedin confirmed. Finally they are reporting that a person with irritable bowel disease may have gotten that way from ingesting gluten. Celiac Disease and Dermatitis Herpetiformis – Did You Know? 15 - 25% of individuals with celiac disease experience dermatitis herpetiformis? Dermatitis herpetiformis is a skin manifestation of celiac disease and is part of the abnormal immune response to gluten; Affects more men than women? Dermatitis herpetiformis generally starts in adulthood. It is not common to see dermatitis herpetiformis in children, but it can occur; Only about 20 percent of people with dermatitis herpetiformis have intestinal symptoms of celiac disease, however, biopsies show that 80 percent have some degree of damage to the small intestine, especially if a high gluten diet is maintained; If you suspect dermatitis herpetiformis you may have celiac disease; Iodine is something that a person with dermatitis herpetiformis should definitely avoid; One of the oldest checks for dermatitis herpetiformis was putting some iodine on ones thigh; Dermatitis herpetiformis sores tend to run in a line, or stay in a cluster; Dermatitis herpetiformis treatment consists of a gluten-free diet for life, just like in celiac disease? The skin's response to the gluten-free diet is much slower compared to the healing of the intestines in those with celiac disease. It may take about six months to achieve improvement, though with my own dermatitis herpetiformis spots daily dapsone was miraculous. It did take up to a year for the sores in my scalp to heal. Dr. John Zone, M.D. Professor and Dermatology Chair at the University of Utah and CDF Medical Advisory Board member states "There is little question that ingestion of large amounts of iodine dramatically worsens dermatitis herpetiformis," he continues, "iodine does not cause dermatitis herpetiformis. It worsens dermatitis herpetiformis. Gluten causes dermatitis herpetiformis." Dr. Zone explains that through seeing hundreds of celiac disease patients over the years, he has found that some react to highly concentrated solutions of iodine in cough medicines, shellfish, and kelp, which is often found in Sushi. He also cautions that dietary supplements may contain large amounts of kelp or iodine (usually in the form of potassium iodide or sodium iodide) which can worsen dermatitis herpetiformis. I can share with you that I was incorrectly told over 25 years ago by an internist that I could take up to five dapsone, going 5- 4 - 3- 2 -1, and if the spots had not totally disappeared I could repeat the process. Taking too much cased a blood disorder called Methemaglobinemia, a rare but dangerous response to taking too much dapsone. It is a blood disorder in which an abnormal amount of methemoglobin is produced. Hemoglobin is the protein in red blood cells (RBCH's) that carries and distributes oxygen to the body. Methemoglobin is a form of hemoglobin, with it the hemoglobin can carry oxygen, but is not able to release it effectively to body tissues. It can either be passed down through families (inherited or congenital) or be caused by exposure to certain drugs, chemicals, or foods (acquired). My nephew was on dapsone, which is, according to the Head of Dermatology at the University of British Columbia, the true test of dermatitis herpetiformis. By taking Dapsone for three or four days the lesions (itchy/sore blisters that beg to be itched, and when you do you break open a lesion that appears to contain liquid...they burn, then they crust, and if you continue to pick off that crust they scar your skin.) almost disappear like magic. My nephew thought it was permissible to cheat once in a while and thought that he could get away with it. He used to eat hamburgers every time the craving for a "Big Mac" overcame him! He ate one, or maybe two, until he found out he had dermatitis herpetiformis sores on the soles of his feet and was limping from the pain. Who knows what damage he was doing to the villi in his bowel! It is a vast no man's land out there, but if you are a celiac and have dermatitis herpetiformis or are gluten sensitive you need to step into that “land” and learn more about the diseases and what is going on in your body!
  3. Celiac.com 09/23/2015 - Wheat products are a key component of human diets worldwide. Despite the many beneficial aspects of consuming wheat products, it is also a trigger for several diseases such as celiac disease, wheat allergy, and non-celiac gluten sensitivity (NCGS). A team of researchers recently set out to examine the relationship between celiac disease, non-celiac gluten sensitivity and irritable bowel syndrome. The research team included M El-Salhy, JG Hatlebakk, OH Gilja, and T. Hausken. They are variously affiliated with the Section for Gastroenterology, Department of Medicine, Stord Hospital, Stord, Norway, the Section for Neuroendocrine Gastroenterology, Division of Gastroenterology, Department of Clinical Medicine, University of Bergen, Bergen, Norway, the National Centre for Functional Gastrointestinal Disorders, Department of Medicine, and the National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway. Celiac disease and irritable bowel syndrome (IBS) patients have similar gastrointestinal symptoms, which can result in celiac disease patients being misdiagnosed as having IBS. Therefore, celiac disease should be excluded in IBS patients. A considerable proportion of celiac disease patients suffer from IBS symptoms despite adherence to a gluten-free diet (GFD). The inflammation caused by gluten intake may not completely subside in some celiac disease patients. It is not clear that gluten triggers symptoms in NCGS, but there is compelling evidence that carbohydrates in wheat such as fructans and galactans do. Based on their results, the team feels that it is likely that NCGS patients are a group of self-diagnosed IBS patients who self-treat using a gluten-free diet. Source: Nutr J. 2015 Sep 7;14(1):92. doi: 10.1186/s12937-015-0080-6.
  4. Celiac.com 10/31/2016 - Responding to observations and reports that many patients with postural tachycardia syndrome (PoTS) adopt a gluten-free diet without medical consultation, a team of researchers recently set out to evaluate the prevalence of celiac disease and self-reported gluten sensitivity in patients with PoTS, and to compare the results against data from the local population. The research team included HA Penny, I Aziz, M Ferrar, J Atkinson, N Hoggard, M Hadjivassiliou, JN West, and DS Sanders. They are variously affiliated with the Academic Department of Gastroenterology Departments of Cardiology, Radiology, and Neurology at Royal Hallamshire Hospital, and Upperthorpe Medical Centre in Sheffield, UK. For their study, the team recruited 100 patients with PoTS to complete a questionnaire that screened for gluten sensitivity, related symptoms and dietary habits. They also screened patients for celiac disease. For comparison, they calculated local celiac prevalence from a total of 1,200 control subjects (group 1) and another 400 control subjects (group 2), frequency matched for age and sex, who completed the same questionnaire. Overall, 4/100 (4%) patients with PoTS had serology and biopsy-proven coeliac disease. This was significantly higher than the local population prevalence of celiac disease (12/1200, 1%; odds ratio: 4.1, 95% confidence interval: 1.3-13.0; P=0.03). PoTS patients also had a higher prevalence of self-reported gluten sensitivity (42 vs. 19%, respectively; odds ratio: 3.1, 95% confidence interval: 2.0-5.0; P<0.0001). This is the first study to show a possible connection between gluten-related disorders and PoTS. They note that a prospective study which examines this relationship further might promote better understanding and treatment of these conditions. Source: Eur J Gastroenterol Hepatol. 2016 Sep 7.
  5. Celiac.com 02/15/2016 - Gluten sensitivities have been documented in some dogs, but now researchers have the first solid evidence that gluten is the culprit behind a movement disorder in Border Terriers known as Epileptoid Cramping Syndrome (CECS). There have been anecdotal reports that these dogs might respond to a gluten-free diet, but no clinical studies. This changed recently, when a team of researchers set out to assess the clinical and serological benefits of a gluten-free diet in Bornder Terriers with CECS. The research team included M. Lowrie, O. A. Garden, M. Hadjivassiliou, R.J. Harvey, D.S. Sanders, R. Powell, and L. Garosi. They are variously associated with the Davies Veterinary Specialists in Hitchin, UK, the Department of Clinical Sciences and Services of Royal Veterinary College in Hatfield, UK., the Department of Neurology at Royal Hallamshire Hospital in Sheffield, UK., the Department of Pharmacology, UCL School of Pharmacy in London, UK., the Department of Gastroenterology at Royal Hallamshire Hospital, Sheffield, UK., and with Powell Torrance Diagnostic Services in Higham Gobion, UK. The team evaluated a group of six client-owned Bornder Terriers with clinically confirmed CECS. The dogs all had at least a 6-month history of CECS, with their symptoms observed and confirmed using video, and each had exhibited at least 2 separate episodes on different days. The team tested the dogs for anti-transglutaminase 2 (TG2 IgA) and anti-gliadin (AGA IgG) antibodies at presentation, and 3, 6, and 9 months after the introduction of a gluten-free diet. They performed duodenal biopsy on 1 dog. Their results showed that, upon presentation, 6 of 6 dogs had increased serum TG2 IgA levels (P = .006), and 5 of 6 dogs had increased AGA IgG levels, compared to those of controls (P = .018). After 9 months on a strict gluten-free diet, 5 of the 6 dogs showed clinical and serological improvement with CECS. The one dog that had persistently high antibody levels apparently scavenged local horse manure, which contained gluten. However, this dog, too improved after the introduction of a strict gluten-free diet. So, all of the affected dogs eventually responded favorably to a gluten-free diet. To further demonstrate the connection, two dogs suffered relapses after gluten was reintroduced into their diets. In Border Terriers, canine epileptoid cramping syndrome is caused, and perpetuated by, an adverse reaction to gluten, and thus responds well to a gluten-free diet. The takeaway for owners of Border Terriers is to keep an eye on their dogs, and work with their vets if they suspect canine epileptoid cramping syndrome; which can be effectively treated with a gluten-free diet. Source: J Vet Intern Med. 2015 Nov;29(6):1564-8. doi: 10.1111/jvim.13643. Epub 2015 Oct 25.
  6. Celiac.com 01/29/2016 - Women and girls who have Turner syndrome are significantly more likely to have celiac disease than those without the sex chromosome anomaly, according to a new study by Scandinavian researchers. Previous reports have suggested a connection between Turner syndrome, which is the partial or complete loss of an X chromosome in females, and celiac disease, but those reports were based mainly on case reports from specialty centers. Estimates of celiac disease rates in this population have varied widely, from 2% to 9%, the researchers note. To get a better picture of the association between celiac disease and Turner syndrome, they queried Sweden's comprehensive computerized registries for data from 28 pathology departments to construct a cohort of women and girls with celiac disease, and then matched each with up to five control patients selected from the Swedish Total Population Register. The research team led by Karl Mårild, MD, PhD, from the Norwegian Institute of Public Health in Oslo, recently conducted a review of pathology records on 7,548 females with biopsy-confirmed celiac disease in Sweden. Their results showed that 20 of the patients (0.26%) also had a diagnosis of Turner syndrome. By contrast, of 34,492 age- and sex-matched controls in the general Swedish population, only 21 (0.06%) were diagnosed with Turner syndrome. This translated into an odds ratio (OR) of 3.29 for celiac disease, with a 95% confidence interval [CI], 1.94 - 5.56. These results are consistent with earlier findings of a positive association between celiac disease and Turner syndrome. They are important because they provide "population-based risk estimates from a population consisting of both in- and outpatients with celiac disease," according to the team. Their data supports the current recommendation of active case-finding for celiac disease in patients with Turner Syndrome. In addition to establishing an overall odds ratio (OR) for celiac disease in females with Turner Syndrome, the investigators found that the risk ranged from an OR of 2.16 (95% confidence interval [CI], 0.91 - 5.11) from birth to age 5 years to an OR of 5.50 (95% CI, 1.53 - 19.78) for females diagnosed with celiac disease after age 10 years. Although women with Turner Syndrome are more prone to type 1 diabetes than women in the general population, the association between Turner Syndrome and celiac disease remained essentially unchanged when the researchers excluded cases and control patients with a diagnosis of type 1 diabetes from the analysis (OR, 3.32; 95% CI, 1.96 - 5.62). One shortfall of the study is that the researchers were not able to establish "…whether patients with celiac disease were symptomatic or asymptomatic. In addition, in Sweden, the threshold for testing individuals with Turner Syndrome for celiac disease is low." Because of this, the team acknowledges that their estimates may have been "somewhat influenced by surveillance bias." The full article appears in January 8 online issue of Pediatrics. Source: Pediatrics
  7. Celiac.com 07/29/2015 - Numerous studies have shown that a high percentage of patients with irritable bowel syndrome (IBS) are also sensitive to gluten. A team of researchers recently set out to evaluate the effect of a gluten-free diet on gastrointestinal symptoms in patients with IBS. The research team included B. Shahbazkhani, A. Sadeghi, R. Malekzadeh, F. Khatavi, M. Etemadi, E. Kalantri, M. Rostami-Nejad, and K. Rostami. They are variously affiliated with the Gastroenterology Unit of Imam Khomeini Hospital at the Tehran University of Medical Sciences, Tehran, Iran, the Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran, the Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Clinic, Tehran, Iran, the Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran, the Gholhak Medical Laboratory, Tehran, Iran, the Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran, and with the Department of Gastroenterology, Alexandra Hospital, Worcestershire, UK. For their double-blind randomized, placebo-controlled trial, the team enrolled 148 IBS patients who fulfilled Rome III criteria between 2011 and 2013. Unfortunately, only 72 out of the 148 remained on a gluten-free diet for the six weeks needed to complete the study. The team recorded clinical symptoms biweekly using a standard visual analogue scale (VAS). In the second stage after six weeks, patients whose symptoms improved to an acceptable level were randomly divided into two groups; The first group of 35 patients received packages containing powdered gluten, while 37 patients received a gluten-free placebo powder. Nearly 84% of the gluten-free placebo group showed a significant improvement in symptoms compared to just under 26% for the gluten consuming group (p < 0.001). This study confirms that a large number of patients diagnosed with irritable bowel syndrome are sensitive to gluten. The team suggests that the term of IBS might be misleading and may change or delay an "effective and well-targeted treatment strategy in gluten sensitive patients." Source: Nutrients. 2015 Jun 5;7(6):4542-54. doi: 10.3390/nu7064542.
  8. Celiac.com 04/06/2015 - Several studies have shown that many patients with celiac disease experience changes in body weight after starting a gluten-free diet, but researchers still don't have much data on rates of metabolic syndrome in this population. A team of researchers recently set out to assess rates of metabolic syndrome in patients with celiac at diagnosis, and at one year after starting gluten-free diet. The research team included R. Tortora, P. Capone, G. De Stefano, N. Imperatore, N. Gerbino, S. Donetto, V. Monaco, N. Caporaso, and A. Rispo. They are affiliated with the Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy, or with the Department of Education and Professional Studies, King's College London, London, UK. For their study, the team enrolled all consecutive patients with newly diagnosed celiac disease who were referred to their third-level celiac disease unit. For all patients the team collected data on waist circumference, BMI, blood pressure, HDL cholesterol, triglycerides, and blood sugar levels. The team diagnosed metabolic syndrome according to the International Diabetes Federation (IDF) criteria for European countries. They reassessed rates of metabolic syndrome in patients after 12 months of gluten-free diet. The team assessed ninety-eight patients with celiac disease, two (2%) who fulfilled the diagnostic criteria for metabolic syndrome at diagnosis, and 29 patients (29.5%) after 12 months of gluten-free diet (P < 0.01; OR: 20). After 1 year on a gluten-free diet, the team compared the patient data to baseline, with respect to metabolic syndrome sub-categories. They found 72 vs. 48 patients exceeded waist circumference cut-off (P < 0.01; OR: 2.8); 18 vs. 4 patients had high blood pressure (P < 0.01; OR: 5.2); 25 vs. 7 patients exceeded glycemic threshold (P = 0.01; OR: 4.4); 34 vs. 32 patients with celiac disease had reduced levels of HDL cholesterol (P = 0.7); and 16 vs. 7 patients had high levels of triglycerides (P = 0.05). The results of this study show that celiac disease patients have a high risk of developing metabolic syndrome 1 year after starting a gluten-free diet. To address this, the research team recommends an in-depth nutritional assessment for all patients with celiac disease. Source: Aliment Pharmacol Ther. 2015;41(4):352-359.
  9. Celiac.com 04/22/2010 - Restless leg syndrome (RLS) is a common neurological condition, with generally unknown causes, that is sometimes associated with specific disorders such as iron deficiency. Even though celiac disease is an autoimmune condition, people with celiac disease often suffer from associated malabsorption-related iron deficiency anemia and peripheral neuropathy. A team of researchers recently set out to assess rates of restless leg syndrome in adults with celiac disease. The team included Marcello Moccia, MS, Maria Teresa Pellecchia, MD, PhD, Roberto Erro, MD, Fabiana Zingone, MD, Sara Marelli, MD, Damiano Giuseppe Barone, MD, Carolina Ciacci, MD, Luigi Ferini Strambi, MD, and Paolo Barone, MD, PhD. They are variously associated with the Department of Systematic Pathology, the Department of Neurological Sciences at University Federico II and IDC Hermitage Capodimonte, Naples, Italy, and the Sleep Disorders Center, University Vita-Salute San Raffaele, Milan, Italy. For their study, the team enrolled 100 adult patients for features of celiac disease, iron metabolism, clinical and neurological conditions, and enrolled another 100 people from the general population as control subjects. These subjects were matched for age and sex. To determine the presence of restless leg syndrome in celiac disease patients and controls, the team applied the four essential diagnostic criteria of the International restless leg syndrome Study Group, in addition to conducting a neurological examination. They gauged restless leg syndrome severity using the International restless leg syndrome Study Group rating scale. The results showed a 31% prevalence of restless leg syndrome among subjects with celiac disease, which was much higher than the 4% prevalence in the control population (P < 0.001). The average restless leg syndrome severity among celiac disease patients was moderate (17 ± 6.5). In the subjects with celiac disease, the team saw no significant correlation between restless leg syndrome and either gluten-free diet or iron metabolism; even though the celiac patients with restless leg syndrome showed significantly lower hemoglobin levels than celiac patients without restless leg syndrome (P = 0.003). They also found no connection between restless leg syndrome and other possible causes of secondary restless leg syndrome, including signs of peripheral neuropathy, pregnancy, end-stage renal disease, and pharmacological treatments. Their study increases the number of neurological disorders associated with celiac disease, and supports screening all celiac disease patients for restless leg syndrome. SOURCE: Movement Disorders; 13 Apr 2010 DOI 10.1002/mds.22903
  10. Celiac.com 09/03/2009 - Every night thousands of people lose sleep because of a gnawing, tingling urge to move their legs, disturbing their sleep and are often causing chronic pain. These people wake feeling unrested, with aching muscles. In addition to lost sleep and discomfort, these people often suffer chronic pain. Often, these symptoms baffle both patients and primary care doctors. Little do these people and their doctors know that the pain and restlessness is due to Restless Legs Syndrome (RLS) and is likely caused by a problem with the digestive tract. RLS affects 7% to 15% of the population, especially older adults and pregnant women. RLS symptoms can have a major impact on quality of life, and the syndrome often stymies the medical community. In recent years a number of drugs have been introduced to help the symptoms of RLS, but until now the cause has remained unknown. Small intestinal bacterial overgrowth (SIBO) is a condition where abnormally large numbers of bacteria exist in the small intestine. Symptoms often include diarrhea, bloating, excess gas and abdominal pain. SIBO has strong ties to IBS, diabetes, celiac disease and Crohn’s disease. St. Louis-based Gastroenterologist Dr. Leonard Weinstock has led research that has recently established a link between RLS and SIBO. Dr. Weinstock's clinical trials have shown that treating SIBO often sends the RLS into remission. “When a patient was diagnosed with SIBO, given a course of treatment that included rifaximin, an antibiotic that is not absorbed by the bloodstream, we found that the patient showed quick, dramatic and continuing relief of RLS symptoms,” explains Weinstock. This discovery promises a new lease on life for many RLS sufferers. Weinstock discovered the association while treating a patient for Irritable Bowel Syndrome (IBS) who also suffered from RLS. Treatment of the IBS, also seemed to send the patient’s RLS into remission. This discovery led to a number of trials, all of which produced the same overall result. “While many new drugs help treat the symptoms of RLS. This research shows us the cause of the disease and in turn allows us to treat the RLS rather than just helping the symptoms,” says Weinstock. Based on a standard RLS severity scale, all Weinstock’s patients have shown substantial improvement. In the most recent trial, severity scores for 9 of 14 patients dropped an average of 65% after one course of antibiotics. After an initial lack of response, two patients received a second round of antibiotics and no longer had any symptoms. A third patient was cured after discovering that she had celiac disease and beginning on a gluten-free diet. The link between non-responsive celiac disease and SIBO has also been documented. The fact that such a link exists between SIBO and RLS, and other conditions such as celiac disease, IBS and Crohn’s disease clearly warrants further study, and should give anyone suffering from RLS some information to share with their clinician in approaching the issue. Source: http://www.pitchengine.com/specialistsingastroenterologyadvancedendoscopycenter/sending-restless-legs-syndrome-rls-into-remission/21146/
  11. Celiac.com 05/14/2012 - Should gluten sensitivity be thought of as “celiac light,” as just one of the milder manifestations within the wider spectrum of celiac disease? Some doctors and researchers think so. Over the past several years, there has been increasing discussion concerning gluten sensitivity as a possible cause of irritable bowel syndrome (IBS) symptoms in patients for whom celiac disease has been excluded. This is undoubtedly because gluten sensitivity, like IBS, is a symptom-based condition of diverse pathogenesis. As discussed, some have argued that gluten sensitivity might be best thought of as “celiac light,” representing the milder domains of the celiac disease spectrum. However, there are some data to suggest that a subset of patients with gluten sensitivity may actually belong to the spectrum of celiac disease. In a recent letter to the editors of the American Journal of Gastroenterology, doctors Courtney C. Ferch and William D. Chey of the Division of Gastroenterology at the University of Michigan Health System in Ann Arbor, Michigan, comment at length on the latest findings regarding Irritable Bowel Syndrome and gluten sensitivity without celiac disease. Ferch and Chey note that gluten sensitivity is one of the most rapidly growing sectors in the food industry, with gluten-free products accounting for $1.31 billion in U.S. sales alone in 2011. Those sales are expected to exceed $1.6 billion by 2015. Major food manufacturers such as General Mills and Betty Crocker, along with popular restaurant chains like PF Chang's and Subway are busy introducing new gluten-free options, or retooling original products into gluten-free versions. People with gluten sensitivity typically show symptoms after eating gluten, but show no evidence of celiac disease or food allergy. Unlike celiac disease, there are no accepted biomarkers for gluten-sensitivity. Doctors diagnose the condition mainly by looking at the connection between eating gluten and the presence adverse symptoms. Numerous studies on gluten sensitivity suffer have included small sample size, a lack of adequate controls, a lack of blinding, and the use of non-validated outcome measures. Even with these limitations, Ferch and Chey say there are several studies worthy of further consideration. One of the studies discussed in the Ferch and Chey was a double-blind, placebo-controlled, dietary re-challenge trial performed by Biesiekierski et al. The study sought to better understand the role of gluten ingestion in the development of gastrointestinal (GI) and non-GI symptoms in patients diagnosed with IBS. The Biesiekierski study included a sample of 34 patients diagnosed with IBS by the Rome III criteria who had experienced symptom improvement with a gluten-free diet for 6 weeks before study enrollment. Celiac disease had been excluded in all study participants by either a negative HLADQ2/HLA-DQ8 haplotype or a normal duodenal biopsy. The study excluded patients with conditions such as cirrhosis, inflammatory bowel disease, non-steroidal anti-inflammatory drug ingestion, or excessive alcohol. Over a six week double-blind randomization phase, study participants followed either a gluten-free or gluten-containing diet that was assigned at random. Nineteen of the 34 patients ate food containing 16 g of gluten per day. The other 15 patients ate gluten-free bread and mufï¬ns. Gluten used in the study was free of fermentable oligo-, di-, monosaccharides and polyols, and its protein distribution included 2.3% nongluten, 45.7% glutenin, and 52% gliadin. The primary outcome of the study was the proportion of patients answering “no” on over half of the occasions at the end of each week to this question: “Over the past week, were your symptoms adequately controlled?” The study team also assessed secondary outcomes including bloating, abdominal pain, satisfaction with stool consistency, nausea, and tiredness using a 100-mm visual analog scale. Once the study period ended, the results showed that many more patients in the gluten group compared with the gluten-free group answered “no” to the primary outcome question (68% vs 40%; P .001). Compared with the gluten-ingesting group, those who remained gluten-free also reported signiï¬cant improvements in pain (P .016), bloating (P .031), satisfaction with stool consistency (P .024), and tiredness (P .001), although they showed similar levels of wind (P .053) or nausea (P .69). The results of celiac antibodies at baseline and after the dietary intervention were similar. The team also found that diet had no effect on intestinal permeability as measured by urine lactuloseto-rhamnose ratio. Additionally, they found detectable fecal lactoferrin levels in just one patient during the treatment period. Meanwhile, high-sensitivity C-reactive protein levels remained normal before and after the dietary intervention. There was no difference in the level of symptoms experienced by those with and without HLA-DQ2 and HLA-DQ8 alleles. The authors felt that these data support the existence of non–celiac-associated gluten sensitivity. They concluded that gluten is in fact tied to overall IBS symptoms, bloating, dissatisfaction with stool consistency, abdominal pain, and fatigue in some patients. In their letter, Ferch and Chey also comment on several side issues. First, they note that a recent global meta-analyses of studies showed that patients with IBS symptoms had signiï¬cantly higher rates of celiac disease than controls. As such, they point out that the American College of Gastroenterology Task Force now recommends routine celiac blood screens for patients with diarrhea-predominant IBS and IBS with a mixed bowel pattern (grade 1B recommendation). Secondly, they note that there has been much recent discussion around the potential role of food in IBS symptoms that has focused on celiac disease. However, they point out that much has been made over the possible role of food, and possibly celiac disease, in IBS symptoms. However, they note that data from US studies show no higher risk for celiac disease among patients with IBS symptoms and no warning signs. Although these results are certainly intriguing and hypothesis generating, they require validation in larger, randomized, controlled trials in other parts of the world. What is clear and important for providers to understand is that gluten sensitivity is here to stay and signiï¬cantly more likely for them to encounter in day-to-day practice than celiac disease. Read the full letter by Ferch and Chey at the website for the American Journal of Gastroenterology. Source: Am J Gastroenterol 2011;106:508 –514
  12. In the Friday, February 9, 1996 edition of the Independent newspaper (UK), there was a short article reporting research into ME (myalgic encephalomyelitis) by doctors at the Royal Hallamshire Hospital in Sheffield. Their research was published that same weeks Lancet. Mysterious symptoms, including muscle weakness, wasting, and poor coordination and balance may be due to an undiagnosed allergy to wheat, barley, oats or rye, according to new research which may have implications for some people with ME...A study of 53 patients with these and other unexplained neurological symptoms, found that nearly three-fifths of them had antibodies to gluten in their blood...none of the patients in the Sheffield group had been diagnosed with celiac disease but when samples of tissue were removed from their gut, more than a third showed evidence of the disease or inflammation of the middle and lower gut.
  13. Celiac.com 06/14/2013 - A team of researchers recently conducted a controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea to gauge the effects on bowel frequency and intestinal function. Their goal was to determine whether a gluten-free diet might benefit patients with diarrhea-predominant irritable bowel syndrome (IBS-D). The team included M.I. Vazquez-Roque, M. Camilleri, T. Smyrk, J.A. Murray, E. Marietta, J. O'Neill, P. Carlson, J. Lamsam, D. Janzow, D. Eckert, D. Burton, A.R. Zinsmeister. They are variously affiliated with the Clinical Enteric Neuroscience Translational and Epidemiological Research at the Mayo Clinic in Rochester, Minnesota, and the Division of Gastroenterology and Hepatology at the Mayo Clinic in Jacksonville, Florida. The team designed a randomized controlled 4-week trial comparing the effects of a gluten-containing diet against gluten-free diet in 45 patients with IBS-D. They conducted genotype analysis for HLA-DQ2 and HLA-DQ8, and randomly placed twenty-two patients on the gluten-containing diet (11 HLA-DQ2/8 negative and 11 HLA-DQ2/8 positive) and 23 patients on the gluten-free diet (12 HLA-DQ2/8 negative and 11 HLA-DQ2/8 positive). They measured daily bowel function, small-bowel and colonic transit. They used lactulose and mannitol excretion to measure mucosal permeability, and peripheral blood mononuclear cells after exposure to gluten and rice to gauge cytokine production. The team collected rectosigmoid biopsy specimens from 28 patients, analyzed levels of messenger RNAs encoding tight junction proteins, and performed H&E staining and immunohistochemical analyses. They analyzed covariance models to compare data from the gluten-containing and gluten-free diet groups. They found that subjects on the gluten-containing diet had more bowel movements per day (P = .04); the gluten-containing diet had a greater effect on bowel movements per day of HLA-DQ2/8-positive than HLA-DQ2/8-negative patients (P = .019). They also found that the gluten-containing diet was associated with higher SB permeability, based on 0-2 h levels of mannitol and the ratio of lactulose to mannitol. They found that SB permeability to be greater in HLA-DQ2/8-positive than HLA-DQ2/8-negative patients (P = .018), and saw no significant differences in colonic permeability. Patients on the gluten-containing diet had a small decrease in expression of zonula occludens 1 in SB mucosa and significant decreases in expression of zonula occludens 1, claudin-1, and occludin in rectosigmoid mucosa. The effects of the gluten-containing diet on expression were substantially greater in HLA-DQ2/8-positive patients. Neither diet had any significant effects on transit or histology. Peripheral blood mononuclear cells produced higher levels of interleukin-10, granulocyte colony-stimulating factor, and transforming growth factor-α in response to gluten than rice, regardless of HLA genotype. The team's findings show that gluten alters bowel barrier functions in patients with IBS-D, especially in HLA-DQ2/8-positive patients, and that these aspects of IBS can be reversed with a gluten-free diet. Source: Gastroenterology. 2013 May;144(5):903-911.e3. doi: 10.1053/j.gastro.2013.01.049. Epub 2013 Jan 25.
  14. Celiac.com 05/27/2013 - A team of researchers recently investigated whether celiac disease influences risk for non–insulin-dependent diabetes mellitus (NIDDM) and metabolic syndrome. To do so, they examined the prevalence of NIDDM and metabolic syndrome among adults with celiac disease, compared with healthy matched control subjects. The research team included Toufic A. Kabbani, Ciaran P. Kelly, Rebecca A. Betensky, Joshua Hansen, Kumar Pallav, Javier A. Villafuerte–Gálvez, Rohini Vanga, Rupa Mukherjee, Aileen Novero, Melinda Dennis, and Daniel A. Leffler. They are variously affiliated with the Celiac Center, Department of Medicine, Division of Gastroenterology at Beth Israel Deaconess Medical Center, and the Harvard School of Public Health in Boston, Massachusetts. For their study, the team assessed medical records of 840 patients with biopsy-proven celiac disease for diagnoses of NIDDM, hypertension, or hyperlipidemia; body mass index (BMI); lipid profile; and levels of glucose or glycosylated hemoglobin, to identify those with metabolic syndrome. They matched 840 healthy control subjects for age, sex, and ethnicity. They then compared rates of NIDDM and metabolic syndrome in the celiac disease cohort with that of the controls and subjects included in the National Health and Nutrition Examination Survey. The team found that 26 patients with celiac disease (3.1%) had NIDDM compared with 81 controls (9.6%) (P less than .0001). Similarly, patients with celiac disease had lower rates of metabolic syndrome compared with the control group (3.5% vs 12.7%; P less than .0001). The average BMI of patients with celiac disease was substantially lower than the BMI of control subjects (24.7 vs 27.5; P less than .0001). However, even after controlling for BMI, celiac disease patients still had a lower risk of developing NIDDM, compared with non-celiac patients. From this study, the team concludes that rates of NIDDM and metabolic syndrome are lower among patients with celiac disease than in matched controls and the general population. These differences are not explained by differences in BMI. Further study is important so that researchers can determine exactly how celiac disease affects the risk for NIDDM and metabolic syndrome. Source: Gastroenterology, Volume 144, Issue 5, Pages 912-917.e1, May 2013
  15. Celiac.com 05/18/2011 - Irritable Bowel Syndrome (IBS) is based on a clinical description only; there are no pathophysiological pathways definitively associated with it. It is characterized as gastrointestinal symptoms with no discernable cause. A diagnosis of IBS depends on recurrent abdominal pain or discomfort for at least three days per month in the last three months, with the onset of the discomfort either associated with a change in frequency or appearance of stool or alleviated by defecation. A number of different mechanisms have been suggested as potential causes of IBS. These range from psychological origins, to increased visceral hyperalgesia (sensitivity to pain), to the low grade gut inflammation and altered gastrointestinal permeability and motility observed in IBS patients. Complicating matters is that most patients exhibit only a subset of symptoms. Since gluten has been demonstrated to negatively affect even people without celiac disease by an unknown mechanism (see Study Shows Gluten Intolerance Without Celiac Disease), and the underlying causes of IBS remain unclear, Dr. Elena Verdu wondered if gluten might contribute to IBS. Like those with IBS, patients with gluten sensitivity lack the antibodies against tissue transglutaminase that are the hallmark of celiac disease but nonetheless suffer immune mediated inflammation in their gut. Interestingly, when IBS patients without celiac eliminated gluten from their diet, 68% of them reported more severe pain, bloating, and tiredness upon gluten rechallenge. But how – by what mechanism? No changes were detected in intestinal permeability or fecal lactoferrin, a marker of intestinal inflammation. However, it is possible that these phenomena persisted, just at below the level of detection. Based on these data, and other evidence that is rapidly accruing suggesting that gluten can negatively affect those without celiac disease, Dr. Verdu suggests that IBS patients might be screened for anti-gliadin antibodies even if they lack antibodies against tissue transglutaminase. These nonspecific antibodies can indicate an immunological response to gluten, and thus their presence could used to determine if their symptoms might be alleviated by adherence to a gluten free diet. She makes sure to point out, though, that this is probably not the case for all IBS patients. Source: Am J Gastroenterol 2011; 106:516–518
  16. Celiac.com 10/09/2009 - The causes and mechanisms that fuel the development of gastrointestinal symptoms, along with the individual perceptions of those symptoms are varied and, in many cases, not well understood. A team of researchers recently set out to explore the clinical and experimental evidence regarding the possible association between gluten sensitivity, celiac disease, irritable bowel syndrome, and the development of gastrointestinal symptoms. The research team was made up of Elena F. Verdu, MD, PhD, David Armstrong, MA, MB, BChir, and Joseph A. Murray, MD. The team's hypothesis is that, even in the absence of fully developed celiac disease, gluten exposure can trigger symptoms that mirror FBD. To test that hypothesis, the team set out to see how many people with gluten sensitivity are likely to suffer from symptoms similar to functional bowel disorder (FBD). The team proposes model for the exploring and assessing factors influencing the development of gastrointestinal symptoms and dysfunction by gluten in FBD and organic disease. They elaborate on their hypothesis that gluten sensitivity and post-infectious irritable bowel syndrome (IBS) represent two triggers that can explain at least part of the wide range of IBS symptoms and dysfunction. Better understanding this relationship offers researchers a better understanding of the role of mucosal responses to luminal factors in FBDs. The team proposes that the animal model of gluten sensitivity in human leukocyte antigen (HLA)- DQ8 mice permits exploration of mucosal pathophysiological changes that develop before the onset of advanced inflammation in gluten sensitive individuals. A clearer picture of the means by which gluten triggers symptoms in sensitive individuals will help to shed light on the interactions between host genotype, diet, and intestinal microbiota in triggering gluten sensitivity. The goal of the review is to shed light on the connections between celiac disease, IBS, and gluten sensitivity, as well as to emphasize several important facts. First, 'gluten sensitivity' is marked by one or more various immunological, morphological, or symptomatic problems that may also be common to celiac disease and IBS. Second, gluten sensitivity and classic celiac disease may have common roots, but people with gluten sensitivity do not meet the clinical threshold for celiac disease. Third, while gluten sensitivity and IBS may share common symptomatology, gluten sensitivity by definition is not IBS. Successful treatments for IBS have are few, due to the lack of pharmacological targets and even a conceptualized framework for the basic pathogenetic mechanisms. In some patients with symptoms of post-infectious IBS, doctors have been able to associate the role of subtle persistent inflammation in as a likely trigger for gut immune responses. They conclude that recent clinical evidence supports the view of gluten sensitivity as the likely cause of gastrointestinal symptoms that would otherwise point to of IBS. This information dovetails with other recent information regarding the prevalence of gluten sensitivity. The idea that gluten sensitivity is far more widespread than believed , and that gluten sensitivity lies at the heart of numerous gastrointestinal and other systemic disorders is rapidly gaining support from data, and drawing new believers within the scientific community. Source: Am J Gastroenterol 19 May 2009; doi: 10.1038/ajg.2009.188
  17. November 1993. European Journal of Pediatrics. Authors Hilhorst MI. Brink M. Wauters EA. Houwen RH. Institution: Department of gastro-enterology, Wilhelmina Childrens Hospital, Utrecht, The Netherlands. The frequency of celiac condition is 43 times greater in children with Down syndrome than in children without Down syndrome. It should be strongly considered in all children with Down syndrome who have either persistent diarrhea or failure to thrive. Leyden University Medical School just finished a large scale investigation. 198 families with a child with DS aged between 1 and 9 years were approached. 115 decided to have their child participate. The first researcher, Elvira George, made home visits and collected blood and urine for testing. A. o. values of anti-endomysium (EmA) were determined. Only if one of the investigated blood or urine values was significantly different from the norm the child was referred to the hospital to take a biopsy. That was the case with 43 of the 115 children. In 9 cases no biopsy was taken, in six because the parents refused it and in 3 because the childs condition didnt allow for it. Of the 34 children that had a biopsy taken eight, or rather 7 % (!) of the original 115, had the intestinal appearance typical for celiac disease (according to international standards). Retrospectively, five of these eight children had complaints that were compatible with celiac disease, that were considered to be caused by DS as such until then. Three children were free of complaints. Their diagnosis was a complete surprise. In addition, it was proven that the value for EmA was the strongest indicator of a positive biopsy. If EmA was positive there always was celiac disease upon biopsy. Needless to say that all (so far but one) concerned children were put on a totally gluten free diet. It was reported that their complaints decreased rapidly. Celiac disease is considered to put people involved at risk for particular intestinal cancers, if they do not keep their diet. Therefore, the diet has to be maintained lifelong. This aspect makes testing for celiac disease so important in an at risk population as children with DS are. Even without complaints one in fourteen of our children might have it! It is postulated that the children who had different blood values, but no positive biopsy still can develop celiac disease in the future. Presently, the complete study is in the process of being published in the international literature. So, Im afraid Im only able to give a you a reference to a pre-publication: Reference: George, E. et al. The high frequency of celiac disease in DS: screening methods. Gastroenterology 1995; 108 (Supp 4): A 16.iv
  18. 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
  19. Celiac.com 05/28/2010 - Celiac disease research is linking Irritable Bowel Syndrome with gluten intolerance and doctors are recommending IBS sufferers, especially those with diarrhea-predominant IBS, to get tested for gluten issues or celiac disease. Celiac disease is an autoimmune disease. The source of this being gluten, a protein found in wheat, barley, and rye, often affecting the entire body and manifesting various physical and mental symptoms, and a gluten-free diet is the simple treatment for this disease. New research published in the Archives of Internal Medicine has shown that people with IBS are four times more likely to have celiac disease than those without IBS. Doctors, often uneducated about celiac disease or improperly taught that its symptoms are dramatic, don’t associate the common symptoms of IBS, stomachaches, bloating, fatigue, and diarrhea, with celiac disease or gluten intolerance. In the January 2009 issue of the American Journal of Gastroenterology, the American College of Gastroenterology began recommending that doctors screen patients who manifest symptoms of IBS for celiac disease as well. The diagnosis is easy to test for. Simple blood tests detect the disease over ninety percent of the time. The diagnosis is then confirmed by an upper endoscopy. A small, flexible tube is slipped into the mouth of the sedated patient, down his esophagus and stomach and into the first part of the small intestine, where biopsies are taken and then examined for changes seen in celiac disease. After a correct diagnosis is made, people with IBS who are also celiac can begin the rapid road to recovery with a gluten-free diet. As people become more aware of celiac disease and gluten intolerance, gluten-free foods and gluten-free cooking become more and more available. There are now many delicious gluten-free recipes available for favorite foods and desserts such as gluten-free pizza, gluten-free muffins, and gluten-free cupcakes. Adults and children alike who are gluten intolerant can still enjoy a gluten-free balanced diet with a variety of gluten-free choices. In the U.S., a slightly increased rate of celiac diagnosis among adults has already lead to increased support. Gluten-free foods and gluten-free recipes are more readily available than ever. The Gluten-Free Restaurant Awareness Program (GFRAP) assists in the mutually beneficial relationship between people diagnosed with celiac disease or gluten intolerance and restaurants, resulting in an increase in the number of restaurants which can provide service to people following a gluten-free diet while increasing their patronage. Participating restaurants are able to provide gluten-free meals. As more and more people are diagnosed with gluten intolerance, their list of participating restaurants will surely grow. However, the U.S. remains behind in celiac awareness. This probably has something to do with the fact that celiac disease is the only autoimmune disease that the government doesn’t support with research grants. Centers such as Dr. Green’s Celiac Disease Research Center are one-hundred percent dependent on charitable donations or university funds. Even though diagnosis is slightly up for celiac adults, this isn’t enough to raise awareness and bring relief for the three million people who suffer from celiac disease, nearly ninety-seven percent of whom don’t even know the cause of their painful symptoms. With increased diagnosis, we will surely see increased support, and soon the celiac community will be able to enjoy the same quality of life and food and cooking options which is enjoyed by, for instance, the lactose-intolerant community. If you have been diagnosed with IBS or have similar symptoms, make an appointment with your doctor today to get tested for celiac disease or gluten intolerance. It may just bring you the relief you’ve been looking for all these years.
  20. Celiac.com 01/19/2010 - A new study says that migraines and carpal tunnel syndrome may point to celiac disease. Moreover, 35% of people with celiac disease report a history of depression, personality changes, or psychosis. Others commonly suffer from neurological issues that are not improved with a gluten-free diet. Researchers recently screened a cohort of 72 patients with biopsy-proven celiac disease, recruited through advertisements and interviewed using a standard questionnaire. Nearly one in three celiac patients (28%) reported a history of migraine, though numerous patients showed a decrease in frequency and intensity of migraine attacks after adopting of a gluten-free diet. While about 20% of patients suffered from carpal tunnel syndrome, epilepsy was, surprisingly, less common than expected," report the researchers. "Only 4 individuals presented with a history of generalized or focal seizures." In general, doctors believe about 6% to 10% of celiac patients show typical neurological presentations, the study authors note. Prior studies have shown cerebellar ataxia to be the most common celiac disease-associated neurological symptom. This new study found cerebellar ataxia in 6% of patients, and vestibular dysfunction in another 6%. In all, 26% of patients showed afferent ataxia. About a third of patients had problems with stance and gait, with numerous cases of deep sensory loss and reduced ankle reflexes. "Gait disturbances in celiac disease do not only result from cerebellar ataxia but also from proprioceptive or vestibular impairment," report investigators led by Katrin Bürk, MD, from the University of Marburg in Germany. The bad news is that such neurological problems may develop "despite strict adherence to a gluten-free diet," says Burke. "Most studies in this field are focused on patients under primary neurological care," the researchers note. "To exclude such an observation bias, patients with biopsy-proven celiac disease were screened for neurological disease." Motor problems, such as basal ganglia symptoms, pyramidal tract signs, tics, and myoclonus, were not common. A total of 14% of patients reported problems with bladder function. The underlying causes for neurological problems in celiac disease are not yet understood. There has been some evidence to implicate deficiencies in folic acid, vitamin E, and biopterin in the pathogenesis. However, the investigators note that, in most patients, replacement therapy does not resolve clinical symptoms. They note also that hypo-vitaminosis rarely causes obvious abnormalities in celiac patients, and most with neurological symptoms show no evidence of any nutritional deficiencies. "The prevalence of neurological manifestations in celiac disease is striking and must be considered more than accidental," they say. "The patients' gluten-free diet had resolved intestinal symptoms but had not prevented the development of neurological deficits." The investigators suggest that, because of the considerable clinical variability, neurological and psychiatric dysfunction in celiac disease is likely the result of numerous pathogenic mechanisms. Source: Mov Disord. 2009;24:2358-2362.
  21. Celiac.com 02/09/2009 - Doctors are recommending simple, low-cost blood tests to screen for celiac disease in patients who have Restless Leg Syndrome (RLS) with low serum ferritin, but who otherwise show no clear cause for iron deficiency. Low iron reserves are a known risk factor Restless Leg Syndrome, as blood iron levels below 45-50ng/mL have been tied to more severe expressions of RLS. In fact, iron levels are so important to assessing RLS, that it is now common for doctors to test blood ferritin levels when first assessing Restless Leg Syndrome. Celiac disease is a common genetic disorder of the immune system that can cause iron deficiency. Doctors S. Manchanda, C.R. Davies, and D. Picchietti of the College of Medicine at the University of Illinois at Urbana-Champaign recently set out to determine if celiac disease might play a role in iron deficiency in patients with Restless Leg Syndrome. The doctors evaluated a series of four patients with Restless Leg Syndrome and blood ferritin below 25ng/mL, who had shown positive blood tests for celiac disease. Doctors confirmed celiac disease for all four patients via duodenal biopsy and positive reaction to a gluten-free diet. In each case, Restless Leg Syndrome symptoms improved, with two patients discontinuing Restless Leg Syndrome medication and two responding positively without medication. The doctors are recommending simple, low-cost blood tests to screen for celiac disease in patients who have Restless Leg Syndrome with low serum ferritin, but who otherwise show no clear cause for iron deficiency. They also note that diagnosis and treatment of celiac disease is likely to improve the outcome for those patients with Restless Leg Syndrome, as well as to better identify people at risk for the significant long-term complications associated with celiac disease. Restless Leg Syndrome is just the latest neurological disorder to show a connection to celiac disease. Stay tuned as more information becomes available. Source: Sleep Med. 2009 Jan 10. PMID: 19138881
  22. 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.
  23. Aliment Pharmacol Ther 19(11):1199-1210, 2004. Celiac.com 06/08/2004 - Researchers at the University of California, San Francisco have determined that everyone with Irritable Bowel Syndrome (IBS) should also be screened for celiac disease. The researchers used decision analysis to estimate the number of celiac disease cases detected, quality-adjusted life-years gained, and costs resulting from screening suspected IBS patients for tissue transglutaminase antibody and antibody panel. Positive tests were followed up with an endoscopic biopsy. A gluten-free diet was initiated to improve the quality of life in those with celiac disease. The results of this study indicate that 3% of the 1,000 patients with suspected IBS have celiac disease. Based on these results the researchers analyzed the costs of several celiac disease screening methods used a decision analysis formula to determine whether or not the screening is cost effective. The researchers conclude that celiac disease screening in patients with suspected irritable bowel syndrome is likely to be cost-effective even at a relatively low celiac disease prevalence. Perhaps the researchers should have taken their analysis one step further and concluded that it would make good economic sense to screen the entire population of the USA (as well as that of other countries) for celiac disease, rather than just those with IBS, given the fact that it affects approximately 1% of the population--which is the only conclusion that I could reach after my review of their good work. -Scott Adams
  24. Celiac.com 03/13/2009 - A recent study confirms that celiac disease affects adults with Turner Syndrome at rates of up to 5%, compared to 1% for the general population. A team of researchers recently set out to assess rates of celiac disease in adults with Turner Syndrome. Led by doctor A. Frost of the Department of Endocrinology at University College Hospital in London, UK, the research team included doctors M. Band, G. Conway. The researchers enlisted 256 adults with clinically proven Turner Syndrome. Five turned out to have existing diagnosis of celiac disease. The team conducted IgA endomysium antibody (EMA) screening for celiac disease on the remaining 251 Turner Syndrome patients. Eight patients (3.2%) showed positive EMA screens. Doctors offered those eight patients endoscopy with duodenal biopsy. Seven patients committed to duodenal biopsy, and all seven (2.8%) showed positive histological confirmation for celiac disease. Thus, the doctors reasonably estimate the rate of sub-clinical celiac disease to be between 2.8% and 3.2%. When the existing cases are factored in, the total population shows rates between 4.7% and 5.1%. The team conducted human leukocyte antigen (HLA) typing in the existing celiac disease cases and new EMA-positive cases. Ten of those 13 patients submitted to HLA typing. Eight showed positive results for HLA-DQ2, one for HLA-DQ8, while one showed negative results for both HLA-DQ2 and HLA-DQ8. The study demonstrates that celiac disease affects adults with Turner Syndrome at rates of up to 5 times those of the general population, and the results are consistent with previous data published in pediatric populations. European Journal of Endocrinology. 2009 Feb 10
  25. 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