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Celiac.com 02/23/2015 - There's an interesting article over at Mother Jones regarding the possible role that shorter rising times in most commercial bakeries might play in celiac disease and gluten-intolerance. In the article, author Tom Philpott interviews Stephen Jones, a wheat breeder at Washington State University, who points out that bread rising times in commercial bakeries has been cut from hours or even days down to just minutes, through the use of fast-acting yeasts and additives. What's more, Jones points out, commercial bakers add a lot of extra gluten to their products. Many supermarket sliced breads, especially whole-wheat breads include something called "vital wheat gluten" among the top four ingredients. Because whole-wheat flour has a lower gluten density than white flour, and to make the bread more soft and chewy, like white bread, commercial bakeries add extra gluten in the form of vital wheat gluten. So bakers are using more gluten and fermenting very rapidly, compared with traditional fermentation techniques that take up to 12 hours and more. By contrast, the team in Jones' laboratory, located in a rural stretch along Puget Sound has found that the longer the bread rises, the more the gluten proteins are broken down in the finished bread. It's certainly true that long fermentation reduces the amount of gluten in bread, and that long fermentation using strains of lactobacillus, as in many sourdough breads, breaks down even more of the gluten; in some cases, enough to be tolerated by people with celiac disease. Celiac.com has written about this in several articles on the future of long-fermentation sourdough, its tolerability and gut healing potential in people with celiac disease. However, Jones' notion that modern baking techniques, rather than modern wheat breeding techniques, are responsible for rising rates of celiac disease, and gluten-sensitivity remains unproven.

Celiac.com 07/16/2014 - Information about the number of cases and and overall rates of celiac disease and dermatitis herpetiformis in the UK have not been well studied over time, either by region or by age. Yet, this type of information is essential for determining potential causes and quantifying the impact of these diseases. To provide this information, a team of researchers recently conducted a population-based study to assess incidence and prevalence of celiac disease and dermatitis herpetiformis in the UK over two decades. The researchers included J. West, K.M. Fleming, L.J. Tata, T.R. Card, and C.J. Crooks. They are variously affiliated with the Division of Epidemiology and Public Health, City Hospital Campus, The University of Nottingham, the NIHR Biomedical Research Unit in Gastrointestinal and Liver Disease at Nottingham University Hospitals NHS Trust, and the Division of Epidemiology and Public Health at the City Hospital Campus of The University of Nottingham in Nottingham, UK. They used the Clinical Practice Research Datalink to identify patients with celiac disease or dermatitis herpetiformis between 1990 and 2011, and calculated incidence rates and prevalence by age, sex, year, and region of residence. They found a total of 9,087 incident cases of celiac disease and 809 incident cases of dermititis herpetiformis. From 1990 to 2011, the incidence rate of celiac disease rose from 5.2 per 100,000 (95% confidence interval (CI), 3.8-6.8) to 19.1 per 100,000 person-years (95% CI, 17.8-20.5; IRR, 3.6; 95% CI, 2.7-4.8). During that same period, incidence of dermatitis herpetiformis decreased from 1.8 per 100,000 to 0.8 per 100,000 person-years (average annual IRR, 0.96; 95% CI, 0.94-0.97). The absolute incidence of celiac disease per 100,000 person-years ranged from 22.3 in Northern Ireland to 10 in London. Celiac disease showed large regional variations in prevalence, while dermatitis herpetiformis did not. The team found a fourfold increase in the incidence of celiac disease in the United Kingdom over 22 years, with large regional variations in prevalence. This contrasted with a 4% annual decrease in the incidence of dermatitis herpetiformis, with minimal regional variations in prevalence. These contrasts could reflect differences in diagnosis between celiac disease (serological diagnosis and case finding) and dermatitis herpetiformis (symptomatic presentation) or the possibility that diagnosing and treating celiac disease prevents the development of dermatitis herpetiformis. Source: Am J Gastroenterol. 2014 May;109(5):757-68. doi: 10.1038/ajg.2014.55. Epub 2014 Mar 25.

Celiac.com 02/09/2009 - An extensive recent survey of the Swedish cancer registry reveals that people with celiac disease face a 5-fold increased risk of developing non-Hodgkin lymphoma, but that the risk has decreased by more than 50% over the last 40 years. Researchers at the National Cancer Institute (NCI) in Bethesda, Maryland, and Sweden's Karolinska Institute recently undertook a review of more than 60,000 lymphoma cases diagnosed in Sweden between 1965 and 2004. They matched those cases to individual lymphoma-free controls with similar characteristics. Dr. Ying Gao of the NCI and colleagues found 37,869 cases of non-Hodgkin's lymphoma, 8,323 cases of Hodgkin's lymphoma, 13,842 cases of chronic lymphocytic leukemia. The researchers also enrolled 236,408 matched controls and 613,961 first-degree relatives. The team used hospital discharge information to identify people with a history of celiac disease. The data revealed that people with a hospital discharge diagnosis of celiac disease faced a 5.35-fold increased risk of developing non-Hodgkin's lymphoma. The data also showed that risk of Hodgkin's lymphoma was mildly elevated, and thst celiac patients showed no elevated risk of developing chronic lymphocytic leukemia. The data showed that from 1975-1984, patients with celiac disease faced a 13.2-fold greater risk of non-Hodgkin's lymphoma; from 1985-1994, that level fell to a 7.90-fold increased risk, and from 1995-2004 that risk fell again to 3.84-fold increased risk. Siblings of those affected with celiac disease also faced a 2.03-fold greater risk of non-Hodgkin's lymphoma. At present, doctors do not clearly understand the causal link between the two. Earlier studies have indicated that the inflammation common to celiac disease leads drives lymphoma development. According to the research team, the study carries two basic messages: The first is that earlier detection of celiac disease is helping to lower the risk of developing lymphoma over time, so today, fewer people are detected in the late stages, when the risk of lymphoma is much greater. The second message is that people with a family history of celiac disease have a greater chance of developing lymphoma. This family connection was shown to be separate from the personal celiac disease history of the individual. Together, these revelations suggest that shared mechanisms might contribute to both celiac disease and lymphoma. The full report appears in the medical journal Gastroenterology, January 2009.

I wrote this response below to address a recent New York Times article: Confirming a Diagnosis of Celiac Disease. Celiac.com 01/13/2010 - The problem with current diagnosis criteria for celiac disease is that it takes a certain degree of damage to intestinal villi in order to get a formal diagnosis. Since celiac disease with villi damage are just one manifestation of a much broader and more widespread problem--gluten sensitivity--many people who could still develop serious health problems if they continue to eat gluten, will go undiagnosed under the current definition of celiac disease. The reality of gluten sensitivity is that around 7 to 12% of the US population test positive for antibodies which are an indicator that their immune system is mounting a response to gliadin, the part of gluten that causes the reaction in those who are sensitive. Many of these people may never get flattened villi, however, many may end up with other conditions that are triggered by gluten exposure in sensitive individuals, for example nerve damage (ataxia), liver problems, diabetes, thyroid issues, etc.. In the past 10 years the diagnostic criteria for celiac disease have been changed significantly to include various degrees of villi damage (Marsh Criteria), and as a result, more people are now being properly diagnosed. In the next 10 years I predict that blood tests alone will replace the use of all biopsy results to diagnose celiac disease, as they are a far more sensitive indicator of gluten sensitivity. Once this happens we will finally reach a point where those affected can be properly treated and avoid the risk of the many disorders that have been associated with sensitive individuals who eat gluten, some of which are described here.

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

Celiac.com 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

Celiac.com 10/10/2008 - A team of Finnish researchers announced that they have found high rates of undetected celiac disease in elderly populations. They have also noted that a significant number of those older people diagnosed with celiac disease showed only minor symptoms. The study team was made up of doctors A. Vilppula, P. Collin, M. M¨aki, R. Valve, M. Luostarinen, I. Krekel¨a, H. Patrikainen, K. Kaukinen, and L. Luostarinen. Even with a wealth of new information on celiac disease from numerous recent studies, along with better testing methods, we still don’t know very much about rates of celiac disease in older people. Motivated by that fact, the team recently set out to study the prevalence of celiac disease in elderly populations. In theory, celiac disease should occur in the elderly at rates similar to, or lower than, those of the general population. Since current research indicates that about 1 person in a hundred has celiac disease, it seems logical to figure that rates of celiac disease among the elderly would be the same or even lower than rates for the general population. The researchers figured that clinically silent or undiagnosed celiac disease would be rare in elderly populations, as they would be likely to develop obvious symptoms. But the team was surprised to find that rates of celiac disease among the elderly are more than double those of the general population. They looked at 2,815 individuals between the ages of 52–74. They took blood samples from everyone and isolated people who showed signs of clinical celiac disease. They then screened the samples for IgA tissue transglutaminase antibodies. Subjects with positive antibody tests were given a small bowel biopsy. The doctors found celiac disease in 60 individuals, 25 (0.89%) through positive blood tests, and 35 (1.24%) through biopsy, for a total prevalence of in elderly subjects of 2.13% with 95% confidence intervals (1.60–2.67%). Of the screen-detected cases, only 15 had symptoms, and those were mostly mild. Driving home the dangers of late diagnosis, two out of the 60 had small bowel T-cell lymphoma and two had gastric cancer. Altogether, celiac disease was diagnosed through biopsy, and by blood test without a post-gluten-free diet follow-up test at a rate of 2.45% (1.88–3.02%). This study shows that celiac disease is far more prevalent in elderly people than in the general population. To better detect and treat celiac disease in elderly populations, the doctors are encouraging the use of active case finding using blood tests, since undetected celiac disease can lead to serious complications and even early death. 2008 Editrice Gastroenterologica Italiana S.r.l.

Celiac.com 09/16/2008 - A team of researchers recently set out to examine the connection between celiac disease and primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis. The research team was made up of Alberto Rubio-Tapia, Ahmad S. Abdulkarim, Patricia K. Krause, S. Breanndan Moore, Joseph A. Murray, and Russell H. Wiesner. The team measured the rates of occurrence for tissue transglutaminase antibodies (tTGAs) and endomysial antibodies (EMAs) in end-stage autoimmune liver disease (ESALD). They then correlated autoantibodies and the human leucocyte antigen (HLA) haplotype. Finally, they assessed the effect of liver transplantation on antibody kinetics. The team tested tTGA levels on blood samples from 488 prior to transplant. 310 of these had ESALD, and 178 had non-autoimmune disease. The team tested positive samples for EMAs, and retested at 6-12 and =24 months after transplant. They then correlated their results with the HLA type of the recipient. The results showed that 3% of ESALD patients showed evidence of celiac disease compared to 0.6% of those with non-autoimmune disease. This represents a five-fold greater risk for those with ESALD. The prevalence of tTGAs was 14.2 for ESALD patients compared to 5.4% for those with non-autoimmune disease (P = 0.0001). The prevalence of EMAs was 4.3 for ESALD patients compared to 0.78% for those with non-autoimmune disease (P = 0.01)—significantly higher for those with HLA-DQ2 or HLA-DQ8 haplotypes. After transplant, tTGAs and EMAs normalized in 94% and 100%, respectively, without gluten elimination. Also, three out of five patients with classical symptoms of celiac disease improved. The research team found two cases of intestinal lymphoma in two cases that showed no clinical signs of celiac disease. Patients with ESALD, particularly those with HLA-DQ2 or HLA-DQ8 gene haplotypes, showed greater occurrances of celiac disease-associated antibodies. Following liver transplants, both tTGA and EMA levels decreased without gluten withdrawal. The team also concluded that symptoms of celiac disease might be improved through immune suppression, but those improvements may not prevent the disease from progressing to intestinal lymphoma. The study doesn’t tell what effect, if any, early detection and treatment of celiac disease might have on rates of ESALD. It would be helpful to know if celiac disease contributes to liver disease, if liver disease contributes to celiac disease, or if some third connection links the two. Until then, we’ll just have to keep a tight eye on developments concerning celiac disease and liver disease. Liver Int. 2008; 28(4): 467-476.

Celiac.com 02/25/2005 - Move over low-carb and sugar-free! New research shows that the need for a gluten-free diet is 10 times higher than experts originally predicted. Retailers should prepare to meet the needs of this growing niche, say two experts on the gluten-free diet. This is the message that Shelley Case, RD and Carol Fenster, Ph.D. will bring to retailers at the Natural Products Expo West trade show on March 17 at the Anaheim Convention Center. Case is a dietitian who counsels gluten-free patients and is the author of Gluten-Free Diet, www.glutenfreediet.ca. Fenster is a chef who develops gluten-free products for manufacturers and is the author of Gluten-Free 101, www.glutenfree101.com. This diet is not a fad, they explain, but a medically prescribed avoidance of gluten which is a protein in wheat that is toxic for some people. The two experts will help retailers understand the medical necessity of the gluten-free diet and how stores can stock their shelves and market effectively to gluten-free consumers. "Food manufacturers are responding to the need for gluten-free products. According to the Natural Foods Merchandiser, the number of gluten-free products jumped 88% between 2002 and 2003," says Fenster, who has been gluten-free for 15 years. Total food dollars spent on allergies and intolerances––gluten-free products are a part of this––will rise to nearly $4 billion by 2008, she adds. People who need gluten-free diets are those with allergies or intolerances to wheat or related grains such as barley, rye, spelt, and possibly oats. Nearly 3 million Americans have celiac disease, an autoimmune form of gluten intolerance in which gluten damages the ability to absorb nutrients. The condition can be fatal if not treated with a gluten-free diet. "There is no magic pill or surgery for gluten intolerance," says Case, who has been counseling gluten-free patients for 20 years. "The only treatment is total avoidance of gluten for the rest of ones life. This makes the gluten-free consumer a repeat buyer––and very attractive to retailers."

Pediatrics 2002;109:833-838. Celiac.com 06/06/2002 - The results of a study conducted by Dr. Graziano Barera and colleagues from the Scientific Institute H San Raffaele, Milan, Italy and published in the May issue of Pediatrics indicate that those with type 1 diabetes are 20 times more likely to also have celiac disease. The researchers collected data on 274 consecutive newly diagnosed type 1 diabetes patients with a mean age of 8.28 years. These patients were studied for the following 6 years. At the time of their diagnosis 10 of them (3.6%) already had celiac disease, and over the next 4 years an additional 12 children tested positive for antiendomysial antibodies, and 7 underwent biopsies and were confirmed to have celiac disease. The overall prevalence of biopsy confirmed celiac disease in the group was 6.2%, and most of the cases were asymptomatic and the children showed no obvious signs of the disease. The researchers conclude that greater than 10% of children with newly-diagnosed type 1 diabetes had developed serological markers for celiac disease within the first 6 years of diagnosis, and they recommend that children in this category be screened annually for celiac disease for several years following their type 1 diabetes diagnosis.

JAMA 2002;287:1413-1419. Celiac.com 04/12/2002 - According to a report published in the March 20th issue of the Journal of the American Medical Association, people with celiac disease are three times more likely to develop non-Hodgkin lymphoma (NHL) than the normal population. Dr. Carlo Catassi and colleagues from the University of Maryland in Baltimore compared the prevalence of celiac disease in 653 NHL patients with more than 5,000 healthy control subjects to determine the NHL-celiac disease occurrence rate. The results indicate that 1% of NHL patients also have celiac disease, in comparison with 0.42% of the healthy controls. Adjustments were made for age and sex, and the final results indicate that the odds ratios for a patient with celiac disease of developing NHL are: 3.1 for all types of NHL, 16.9 for gut NHL, and 19.2 for T-cell NHL. The overall risk, however, for someone with celiac disease developing NHL is only 0.63%. The researchers do not feel that their findings support mass screening for celiac disease, but they do feel that selected NHL patients should be screened for celiac disease. We would also like to add that these findings support the screening of people with celiac disease for NHL, which was not directly addressed by the report.