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Celiac.com 06/13/2022 - In 1992 Dr. Michael Marsh developed his "Marsh Classification" system to describe the various stages of microscopic damage to the small intestine (histological changes) seen in those with celiac disease. The original system ranged from 0 - 4, and 3 or higher meant celiac disease, but his system was modified for consistency and reproducibility between pathologists. Today, anyone who has been diagnosed with celiac disease has likely heard about the Marsh classification system. Using the Marsh Classification allows clinicians to accurately measure the full extent of the damage to the villi that line the small intestine, to determine the extent of celiac disease progress and damage. Modified Marsh Classification of histologic findings in celiac disease (Oberhuber) are measured in units of IEL/100 enterocytes, intraepithelial lymphocytes per 100 enterocytes. Current Marsh Classification Marsh Type 0 - Normal; celiac disease highly unlikely. IEL / 100 enterocytes – jejunum <40 IEL / 100 enterocytes - duodenum <30 Normal crypt hyperplasia Normal villi Marsh Type 1 - Seen in patients on gluten free diet (suggesting minimal amounts of gluten or gliadin are being ingested); patients with dermatitis herpetiformis; family members of celiac disease patients, not specific, may be seen in infections. IEL / 100 enterocytes – jejunum >40 IEL / 100 enterocytes - duodenum >30 Normal crypt hyperplasia Normal villi Marsh Type 2 - Very rare, seen occasionally in dermatitis herpetiformis. IEL / 100 enterocytes – jejunum >40 IEL / 100 enterocytes - duodenum >30 Increased crypt hyperplasia Normal villi Marsh Type 3 - Spectrum of changes seen in symptomatic celiac disease. Marsh Type 3a IEL / 100 enterocytes – jejunum >40 IEL / 100 enterocytes - duodenum >30 Increased crypt hyperplasia Mild villous atrophy Marsh Type 3b IEL / 100 enterocytes – jejunum >40 IEL / 100 enterocytes - duodenum >30 Increased crypt hyperplasia Marked villous atrophy Marsh Type 3c IEL / 100 enterocytes – jejunum >40 IEL / 100 enterocytes - duodenum >30 Increased crypt hyperplasia Complete villous atrophy In an effort to simply the Marsh Classification system, the following Simplified Celiac Classification System has been proposed by researchers Corazza, Roberts, and Ensari, which may be much easier and more reproducible. Simplified Celiac Classification System Grade A/Type 1: increased intraepithelial lymphocytes but no villous atrophy. This occurs in those on a gluten-free diet and is likely caused by patients who consume small amounts of gluten due to cross-contamination or in those who cheat on their diets, and in patients with dermatitis herpetiformis, family members of celiacs, and can also be seen in certain infections. Grade B1/Type 2: villi still present but shortened. This level of damage is accompanied by many symptoms associated with celiac disease. Grade B2/Type 3: complete villous atrophy. This level of damage is accompanied by many symptoms associated with celiac disease. To date, there has been no good study data comparing the two systems. Certainly, a simpler, more reproducible Marsh system would make the job of measuring the progress of celiac disease and the gluten-free diet in celiac patients much easier. Stay tuned for more on this and related stories. Read more at stanford.edu.
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Celiac.com 11/03/2017 - Talk about finding needles in a haystack. Imagine, if you will, sifting through rail cars full of oats and plucking out nearly every stray grain of wheat, barley or rye so that the final product tests at under 20 ppm, instead of the original 200 ppm to 1,000 ppm. Quite a challenge, yes? It's a challenge General Mills take on every day as it produces Gluten Free Cheerios from raw oats into the final product. According to their website, General Mills ships 500,000 cases of Cheerios each week. To do this, General Mills uses a proprietary optical sorting process, for which it has filed a patent with the US Patent Office. That process sifts through those rail cars of oats, with stray gluten ranging from 200 ppm to 1,000 ppm, and "takes it down to less than 20" ppm, said Paul Wehling, principal scientist for General Mills. Mr. Wehling told audience members at the annual meeting of AACC International at Cereals 17 in San Diego on Oct. 9, that the General Mills sorting process achieves a "2- to 3-log reduction of the gluten." To verify their oat sorting results, General Mills uses enzyme-linked immunosorbent assay (ELISA) testing and visual inspection to spot and eliminate gluten-containing grains such as wheat. The company uses hand inspection in place of lateral flow testing, as they find that "hand inspection is much more efficient because we can look at quite a few more seeds," Mr. Wehling said. That process would seem to be validated by Laura K. Allred, regulatory and standards manager for the Gluten Intolerance Group, Auburn, Wash., which recommends companies use a combination of visual testing and ELISA testing. However, the General Mills process is not without critics. One of the more prominent voices in opposition to General Mills has been the Canadian Celiac Association (CCA). The CCA has made numerous statements questioning the process General Mills uses to create their Gluten-Free Cheerios, and other oat products. CCA statements, or statements attributed to the CCA include comments in an article published in October 26, 2017, in which Globalnews.ca writes "[CCA] expressed doubt in the company's mechanical sorting system and claim of 100 per cent removal of cross-contaminants." Candiangrocer.com reported in August 2016 that the CCA was, to paraphrase, "awaiting evidence showing the new line [of Gluten Free Cheerios] is 100% free of gluten." It is unclear what the CCA means by such terms as "100% gluten-free," "100 percent removal," and "100 percent safe for people with celiac disease." Is the CCA hinting that the standard for gluten-free products should be 0 ppm? Besides voicing fear and concerns, and citing alleged complaints by members, the CCA never actually provided any evidence that Cheerios failed to meet the US and Canadian standard of 20 ppm allowable gluten, and were, thus, not gluten-free. The CBC reported on August 31 2016, that the "Canadian Celiac Association is warning against gluten-free Cheerios products over concerns the cereal is not 100 per cent safe for people with celiac disease." Again, the CCA made this recommendation based not on independent product testing, or on any confirmed accounts of gluten-exposure in people with celiac disease who had consumed Cheerios, but on "fear" and "concerns" driven by anecdotal evidence. Moreover, they seemingly disregarded overwhelming anecdotal evidence provided by people with celiac disease who say they eat Cheerios safely. The CCA has yet to provide a satisfactory response for their warnings, or to provide any clarification of their position regarding the safety of products that test under 20 ppm gluten for people with celiac disease. The FDA recently announced that 99.5% of products tested came in under the 20 ppm standard set by the FDA for labeling a product "gluten-free." In fact, only one of 750 samples taken from 250 products tested above 20 ppm. That product was recalled and the manufacturer corrected the problem. There has been no indication the Cheerios tested outside the FDA's gluten-free standard. That means that even an ambitious sorting process like the one developed by General Mills seems to be working as designed. It means that consumers can trust the FDA, and American gluten-free labels, and that consumers of gluten-free foods can buy with confidence.
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Is Your Gut Creating Nervous System Trauma?
Dr. Vikki Petersen D.C, C.C.N posted an article in Summer 2012 Issue
Celiac.com 11/25/2017 - We have long known that gluten intolerance, both celiac disease and gluten sensitivity, are highly associated with neurological symptoms. Migraines, ataxia (unstable gait), seizures, schizophrenia – the list is long. But a recent research study just published last month sheds some new light on exactly what the mechanism may be. Understanding why these debilitating symptoms occur as a result of a gluten intolerance will, hopefully, go a long way toward increased awareness among the lay public and clinicians alike. It is certainly true that too many millions of Americans suffer the effects of a gluten intolerance unknowingly. They only know that they feel unhealthy but have no idea that gluten is the culprit. The digestive tract is sometimes called the second brain. Some say that is because it is second in importance to the brain. After all, if the food that is consumed doesn't turn into fuel that can effectively feed the 10 trillion cells in the body, those cells will be unable to perform their job and keep the body healthy. In fact, poor digestion is absolutely linked to poor health and increased onset of degenerative disease. This article in Current Pain and Headache Reports looks at another possibility for naming the digestive tract the second brain, and it simply stems from anatomy. The digestive tract actually has a ‘mind of its own'; more correctly, it has a nervous system of its own, called the enteric nervous system. ‘Enteric' simply means having to do with the intestine. This nervous system, according to research, is very similar to the brain housed in the head in that it is bathed in similar chemicals (called neurotransmitters – which, interestingly enough, are mostly produced in the gut!). It sends and receives impulses and records experiences and is influenced by emotions. Some proof of the latter: Have you ever been nervous and had diarrhea? This particular study stated that experiencing ‘adverse events' created a state of hypervigilance (a state of being overly responsive - not a good thing) in the nervous system which was associated with migraines and IBS. Such ‘hypervigilance' was previously only associated with the central nervous system – the one attached to the brain in the head. This group of researchers suggests that the initiation of hypervigilance may very likely lie in the enteric nervous system also. What this means is that if the small intestine is genetically sensitive to gluten and gluten is ingested, it could set off a nervous system response that could create disabling diseases, such as migraines and IBS, but likely others as well. The take-away message is that it is truly critical to diagnose gluten intolerance as soon as possible. Once that hurdle is surmounted it then needs to be followed with a program of nutrition, lifestyle and diet that will ensure healing of the small intestine and a ‘calming' of the hypervigilant nervous system. You may sometimes hear this referred to as healing a leaky gut. Here at HealthNOW we often see this clinically in patients who seem intolerant to many different foods and can't seem to enjoy stable improvement of their symptoms, even after they eliminate gluten from their diet. The reason for this insufficient improvement is that a comprehensive follow-up program is missing – a program that addresses what we call the Secondary Effects of Gluten. This entails evaluating for any other food sensitivities, cross reactive foods, a tendency towards autoimmune disease, the presence of any infectious organisms, healing the leaky gut, balancing the probiotic population, and more. While increasing awareness of the presence of gluten intolerance is absolutely critical, neglecting the secondary effects, as mentioned above, can result in long-term ill health that is truly preventable. Have you experienced such symptoms? Have you removed gluten but are only partially healthier? I'd love to hear from you. To your good health.- 1 comment
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I have been taking probiotic supplements for a long time, but nothing has worked as well for me as Shaklee Optiflora Two-Product System with Prebiotic & Probiotic. Every since I started Shaklee's gluten-free prebiotics and probiotics I feel so much different--I feel like I have more energy. This is a high quality system that is designed to provide needed support for our digestive tracts. According to Shaklee the Optiflora Probiotic Complex uses a "patented triple layer encapsulation technology to protect live probiotics and guarantee their delivery into the intestine," which can enhance energy levels and provide excellent support for our bodies. Shaklee Optiflora Probiotic Complex contains bifidus and acidophilus, which support long-term intestinal and colon health. For those with celiac disease or other digestive issues high quality probiotics like these are a must. Shaklee Optiflora Prebiotic Complex is intended to provide a welcome environment for the friendly, beneficial bacteria that live and work in the colon. Due to the positive response my body has had to these products I plan to continue taking them long term. Visit their site for more info: http://insideout.myshaklee.com/us/en/products.php?sku=80638 Note: Articles that appearin the "Gluten-Free Product Reviews" section of this site are paid advertisements. For more information about this seeour Advertising Page.
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Celiac.com 01/30/2009 - Doctors from the Mayo clinic are proposing a new staging system for patients with Refractory Celiac Disease (RCD) after results of a recent study showed that their system offered greater accuracy and improved survival rates over the existing staging system. The new system will rely on the cumulative effect of 5 prognostic factors evaluated at the time of the refractory state diagnosis. Refractory Celiac Disease occurs when both the symptoms and intestinal damage continue or recur, regardless of strict adherence to a gluten-free diet. In Refractory Celiac Disease, the immunophenotype of intraepithelial lymphocytes may be normal and polyclonal (RCD I) or abnormal and monoclonal (RCD II). The goal of this study was describe the clinical characteristics, treatment, and long-term outcome in a large single-center cohort of patients with RCD. The study was conducted by doctors Alberto Rubio–Tapia, Darlene G. Kelly, Brian D. Lahr, Ahmet Dogan, Tsung–Teh Wu, and Joseph A. Murray, all with the Mayo Clinic in Rochester, MN. The research teams assessed and compared clinical characteristics and outcomes in 57 patients with RCD: 42 with RCD I and 15 with RCD II. The team developed a scale that served as the basis for the new staging system. Using Cox regression, they assigned a point score to each of the various prognostic factors. They assigned a score of 0 to patients who showed no Refractory Celiac Disease factors. A score of 1 or 2 was assigned for presence of prognostic factors by rounding each score and taking the sum of all 5 factors for a total score. The team then applied the system to survival rates within the study: Stage I combined patients with a point score of 0 or 1 (n = 27), stage II patients with a point score of 2 or 3 (n = 16), and stage III patients with a point score of 4 (n = 14). Patients with total point scores of 0 (n = 15) or 1 (n = 12), showed overall 5-year survival rates of 93% and 100%, respectively. Patients with a score of 2 (n = 7) or 3 (n = 9) showed 5-year overall survival rates of 80% and 65%, respectively. Patients with a score of 4 (n = 10) or 5 (n = 4), the 5-year cumulative survival rates of 25% and 0%, respectively. For patients in stages I, II, and III, the 5-year cumulative survival rate was 96%, 71%, and 19%, respectively (P < .0001). Fifteen of the 57 patients died within 2 years of being diagnosed with RCD (8 with RCD I and 7 with RCD II). Over the five-year course of the follow-up, the overall survival was 70% for the entire cohort, 80% for RCD I, and 45% for RCD II. Most deaths were a result of refractory celiac disease, or to enteropathy-associated T-cell lymphoma (EATL). Refractory Celiac Disease generally carries a high rate of mortality, and the outcomes for RCD II have been especially poor because of the tendency for EATL to develop. Citing the results, the team is proposing a new staging system based on the cumulative effect of 5 prognostic factors investigated at the time of the refractory state diagnosis Gastroenterology 2009; 136:000–000
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Nature Immunology 2, 353 - 360 (April 2001) Celiac.com 04/12/2001 - According to an article published in the April issue of Nature Immunology, Dr. Marc Rothenberg and colleagues at the Childrens Hospital Medical Center in Cincinnati, Ohio performed a series of experiments on mice which led them to the conclusion that white blood cells called eosinophils could be the cause of many food allergies and gastrointestinal inflammation. The researchers believe that the eosinophil cells, which are present throughout the body, mistakenly identify food proteins as germs in individuals with food allergies. When the intestinal lining of an allergic person is exposed to an allergen, a substance called eotaxin is released by the cells lining the intestine, which causes the eosinophil cells and other immune cells to attack them and release powerful proteins that destroy the surrounding tissues and cause eosinophilic inflammation. The results of this study are unique because this is the first time eosinophils cells have been implicated in causing allergies, even though scientists have known for some time that they were present in great numbers at the sites of inflammation caused by reactions to food. The implication of this study is the possible development of drugs that stop this reaction from occurring, and thus prevent digestive inflammation and destruction that occurs when people with food allergies eat foods to which they are allergic. These results put scientists one step further in understanding how and why the digestive system is attacked in certain individuals, and a possible means of one day controlling the process.
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New Improved Confocal Laser Endomicroscopy System
Roy Jamron posted an article in Diagnosis, Testing & Treatment
Celiac.com 11/24/2007 - A new confocal laser microscopic probe has been developed by Mauna Kea Technologies which works in conjunction with conventional endoscopes providing real-time video sequences of the intestinal mucosa magnified 500-1000 times greater than the conventional endoscopic view. Both normal endoscopic images and confocal images are available simultaneously, allowing the confocal probe to be visually positioned with the endoscope. This system allows for an immediate diagnosis and eliminates the need to take and prepare intrusive biopsy samples. The new system is an improvement over previously available confocal laser endomicroscopy systems, being easier and more intuitive to use. Studies have shown the system to be effective in diagnosing celiac disease. The Mauna Kea technologies website provides a detailed description of the device. New clinical studies confirm Mauna Kea Technologies’ endomicroscopy system in a range of procedures 23 November 2007 http://www.mtbeurope.info/news/2007/711022.htm . Mauna Kea Technologies - Cellvizio® GI: first ever confocal miniprobes for GI endoscopy (See "System Description") http://www.maunakeatech.com/products/cellvizio_GI/docs/faq . * * *- 1 comment
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