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Celiac.com 01/10/2001 - According to the Food Standards Agency (FSA) of the UK, British health experts are exploring ways to eliminate a bacterium that has been linked to Crohns disease from the food chain. As reported by Reuters Health, scientists have warned of a widespread bacterium called Mycobacterium paratuberculosis that is the likely cause of the bowel disorder. This bacterium can survive the milks normal, or even prolonged pasteurization process. Crohns disease, like ulcerative colitis, is a chronic inflammatory bowel disease with a number of symptoms, including severe abdominal pain, diarrhea, nausea and loss of weight. The scientists do not believe, however, that ulcerative colitis is caused by Mycobacterium paratuberculosis. According to the FSA test results on UK samples, the bacterium is present in 1.9% of raw milk samples and 2.1% of pasteurized milk samples. According to the Advisory Committee on the Microbiological Safety of Food, there is no direct scientific proof of a link between the bacterium and Crohns disease, but they nevertheless believe that there is evidence of a link. The committee has not given any advice on the consumption of milk, but believe that people need to reduce their exposure to the bacterium, and they intent to convene a conference to review ideas to create controls at all stages of the food chain to prevent the bacterium from contaminating the milk. Mycobacterium paratuberculosis is known to cause Johnes Disease in cud-chewing animals, so they will first look at ways to control this disease in animals, which will hopefully lead to a way to prevent it from entering the human food chain

California Marvin Ament, M.D. - Pediatrician UCLA Medical Center 200 UCLA Medical Plaza 10833 La Conte Avenue Los Angeles, CA 90024 Tel: (310) 206-6134 Fax: (310) 206-0203 Jeffrey M. Aron, M.D., Gastroenterologist 2330 Post Street, Suite 460 San Francisco, CA 94115 Tel: (415) 563-3534 Micheal Bender, M.D. - Gastroenterologist 1828 El Camino Real Burlingame, CA Tel: (415) 692-1373 Amy Burkhart, MD, RD 1100 Lincoln Ave. Suite 200 Napa, CA 94558 Tel: (707) 927-5622 Internet: www.TheCeliacMD.com Dr. Anders Dahlstrom, MD, PhD Pediatric Gastroenterology 2505 Samaritan Drive, Suite 504 San Jose, CA 95124 Tel: (408) 358-3573 Fax: (408) 356-2888 Jesse Dohemann, M.D. California Pacific Medical Center San Francisco, CA Tel: (415) 923-3673 Richard W. Fisher,M.D. - Gastroenterologist Gould Medical Foundation 600 Coffee Rd. Modesto, CA Tel: (209) 524-1211 Gary Gray, MD Professor of Medicine, Emeritus (Gastroenterology) 269 Campus Dr., CCSR 3115; MC: 5187 Stanford University Med. Ctr. Stanford, CA 94305 Tel: (650) 725-6467 Paul Harmatz, M.D. Children's Hospital Oakland, CA Dolores Kent CNC, CPT (Not an M.D.) Clinical Nutrition Designs For Health Specializing In Celiac Desase Morgan Hill, CA 95037 Tel: (408) 710-5277 E-mail: dolores.kent@gmail.com John Kerner, M.D. - Pediatrician Stnaford Medical center Stanford, CA Tel: (650) 723-5070 Fax: (650) 723-2137 John La Puma MD FACP 123 West Padre Street, Suite B Santa Barbara CA 93101 Tel: (805) 284-2238 Dr Charles Menz Gastroenterologist 168 Brent St Suite 404 Ventura, California 93003 Tel: (805) 641-6525 Dr Carrie Mousseau HealthNOW Medical Center 1309 S. Mary Ave, Suite 100 Sunnyvale, CA 94087 Tel (408) 733-0400 Dr. Olusola A. Oyemade Pediatrics and Ped. Nephrology 77 Milliken, Ste. 360 Rancho Cucamonga, CA 91730 Tel: (909) 944-7099 Michelle Pietzak, M.D. 4650 Sunset Blvd. MS #78-Division of Gastroenterology Los Angeles, CA 90027 Tel: (323) 669-2181 http://chla.org/gastroenterology.cfm Samuel Marcus, M.D. 2485 Hospital Drive, Suite 240 Mountain View, CA 94040 Tel: (650) 988 7488 Frank Sinatra, M.D. - Pediatrician Children's Hospital and USC Medical Center Los Angeles, CA Tel: (213) 226-3801 Dan Thomas, M.D. - Pediatrician Children's Hospital LA Tel: (213) 669-2181 Dr. Joel M. Wittles 36243 Inland Valley Drive #40 Wildomar, CA 92595 909-600-0288 Colorado Lawrence (Jack) Adams Colorado Springs Neurological Associates, P.C. 175 S Union Blvd # 310 Colorado Springs, CO 80910 Tel: (719) 473-3272 Pete H. Baker, M.D.,FACP Swedish Medical Plaza 499 E. Hampden Ave., Suite 420 Englewood, CO 80110 Tel: (303)-788-8888 Fax: (303)-788-6452 Scot M. Lewey, D.O., FACP, FAAP Certified American Board Internal Medicine, Gastroenterology, Pediatrics Gastroenterology Associates of Colorado Springs 1699 Medical Center Point Colorado Springs, CO 80907 Tel: (719) 632-7101 or (719) 632-4468 Dr. Ted. Stathos Rocky Mountain Pediatric Gastroneterologists 1601 East Ninteenth Ave. Suite 3700 Denver, CO 80218 Tel: (303) 869-2121 District of Columbia Parvathi Mohan, M.D. - Gastroneterologist Children's Hopital 1111 Michigan Ave. N.W. Washington D.C. 20010 Florida Dr. Juan Carrere 4790 Barkley Circle Fort Myers, FL 33907 Georgia Dr. Agnes Han 960 Johnson Ferry Rd., Suite 515 Atlanta, GA 30342 Tel: (404) 252-8803 Cynthia Rudert, M.D. 5555 Peachtree Dunwoody Rd., Suite 312 Atlanta, GA 30342 Tel: (404) 943-9820 Idaho Angela House, DO FP/Nutritional Medicine 450 W. State St., Ste 250 Eagle, ID 83616 Tel: (208) 947-0925 Illinois Dr. Alan F. Bain Chicago Health and Wellness Alliance 55 E. Washington Street #3305 Chicago, IL 60602 Tel: (312) 236-7010 www.docintheloop.com Stefano Guandalini, MD University of Chicago Comer Children's Hospital 5841 S. Maryland Ave MC 4065 Chicago, IL 60637 Tel: (773) 702-3051 Barbara S. Kirschner, M.D. University of Chicago Comer Children's Hospital 5841 S. Maryland Ave MC 4065 Chicago, IL 60637 Tel: (773)702-6152 Indiana Arthur R. Baluyut, M.D., PhD Northside Gastroenterology 8424 Naab Rd., 3-J Indianapolis, IN 46260 Tel: (317) 872-7396 Mark Bruns, M.D. Internist IU Medical Group 1095 Broadripple Ave. Indianapolis, IN Tel: (317) 251-6121 Dr. Joseph Fitzgerald Dr. Sonny Chong Dr. Joseph Croffie Dr. Sandeep Gupta Indiana University School of Medicine, Division of Gastroenterogy James Whitcomb Riley Hospital for Children Dept. of Pediatrics 702 Barnhill Drive, Room 2728 Indianapolis, IN 46202-5120 Tel: (317) 274-3774 Iowa David E. Elliott, MD, PhD Director, Celiac Disease Clinic University of Iowa Health Care 200 Hawkins Road Iowa City, Iowa 52242 Tel: (319)-356-4901 John Kelly, M.D. Des Moines, IA Leon Qiao, M.D., Gastroenterologist 931 8th Ave S.E. Cedar Rapids, IA 52401 Tel: (319) 366-8695 Kentucky M.K. Younoszai, M.D Pediatric Gastroenterologist Medical Towers North Suite 513 Louisville, KY 40202 Tel: (502) 629 5796 Louisiana Firooz Jalili, MD Pedatric Gastroenterologist 1211 Coolidge Blvd., Ste. 203 Lafayette, LA 70503 Tel: (337) 233-2535 Maine Dr. John Bancroft (3 responses) Pediatric Gastroenterologist Maine Pediatrics Specialty Group 887 Congress Street, Suite 420 Portland, ME 04104 Tel: (207) 772-2827 Dr. Benjamin B. Potter Portland Gastroenterology Center 1200 Congress Street, Suite 300 Portland, ME 04102 Tel: (207) 773-7964 Dr. Igor Prokopiw 1250 Forest Ave. Portland, ME 04103 Tel: (207) 878-5100 Dr. Michael A. Roy Portland Gastroenterology Center 1200 Congress Street, Suite 300 Portland, ME 04102 Tel: (207) 773-7964 Dr. Gilbert M Wilcox 131 Chadwick Street, Suite 2 Portland, ME 04102 Tel: (207) 774-3461 Maryland George Fantry, M.D. - Gastroenterologist University of Maryland in Baltimore Medical System 22 S. Greene St. Baltimore, M.D. 21201 Tel: (410) 328-5196 Alessio Fassano, M.D. - Gastroenterologist/Pediatrician University of Maryland in Baltimore Medical System 22 S. Greene St. Baltimore, M.D. 21201 Tel: (410) 328-0812 Karoly Horvath, M.D., Ph.D. - Gastroenterologist/Pediatrician Associate Professor of Pediatrics University of Maryland in Baltimore Medical System 22 S. Greene St. Baltimore, M.D. 21201 Tel: (410) 328-0812 Fax: (410) 328-1072 E-mail: khorvath@umabnet.ab.uM.D..edu David L. Hutcheon, M.D. 10755 Falls Rd. Timonium, M.D. 21093 Tel: (410) 583-2630 Dr. Mark D. Noar, M.D., M.P.H, F.R.C.T.M.&H Therapeutic Endoscopy & Gastroenterology 7402 York Road, Suite 100 Towson, Maryland 21204 Tel: (410) 494-1846 Dr. Alan N. Schulman Digestive Disease Consultants 15001 Shady Grove Road Rockville, MD 20850 Tel: (301) 340-3252 Fax: (301) 340-1423 Massachusetts Catherine Petruff Cheney, M.D. - Gastroenterologist Beth Israel Deaconess Medical Center Divison of Gastroenterology and Hepatology 330 Brookline Avenue Boston, MA 02215 Phone: (617) 667-1846 Myron Falchuck, M.D. - Gastroenterologist GI Associates Suite 8E 110 Francis Street Boston, MA 02215 Tel: (617) 734-5552 Richard J. Grand, M.D. - Pediatrician New England Medical Center Ciaran Kelly, M.D. - Gastroenterologist Beth Isreal Hospital Boston, Massachusetts Tel: (617) 667-1272 Gary J. Russell, M.D. - Pediatrician Massachusetts General Hospital Jerry S. Trier, M.D. Brigham & Women's Hosp 75 Francis Street Boston, MA 02215 Tel: (617) 732-5824 Michigan Thomas J. Alexander, M.D., F.A.C.P., F.A.C.G Gastrointestinal Specialists, P.C. 264 W. Maple Road, Suite 200 Troy, MI 48084. Tel: (248) 273-9930 Ann Silverman, MD Chief, Gastroenterology, Henry Ford Hospital West Bloomfield (Detroit) Minnesota Joseph Murray, M.D. - Gastroenterologist Mayo Clinic 200 First St. S.W. Rochester, MN 55905 Tel: (507) 284-2511 E-mail: murray.joseph@mayo.edu Robert Wyllie, MD. - Pediatrician Mayo Clinic 200 First St. S.W. Rochester, MN 55905 Tel: (216) 444-2237 Missouri Dr. Leonard Weinstock 10287 Clayton Rd. St. Louis, MO Tel: (314) 997-0554 Chandra Prakash, M.D., M.R.C.P. Assistant Professor of Medicine Washington University in St. Louis School of Medicine Campus Box 8124 660 South Euclid Avenue St. Louis, MO. 63110-1093 Tel: (314)747-2066 Charlene Prather, M.D. St. Louis University Medical School Medical Group Building 3660 Vista Avenue. St. Louis, MO 63110 Tel: (314) 577-6150 Nebraska Ed Schafer, M.D. Department Head at UNMC University of Nebraska Ddepartment of Gastroenterology Tel: (402) 552-2600 David Watts, M.D., Dermatologist 2808 S. 80th Ave. Omaha, NE Tel: (402) 390-0333 Nevada Dr. Carl Dezenberg Pediatric Gastroenterology & Nutrition Associates 3196 S. Maryland Pkwy, Suite #309 Las Vegas, NV Tel: (702) 791-0477 Dr. Dennis Yamamoto - Gastro. Digestive Health and Assoc. 655 Sierra Rose Dr Reno, NV 89511 Tel: (775) 829-7600 New Hampshire David Golden, M.D. - GI Hitchock Clinic Nashua, NH 03060 Tel: (603) 883-0326 New Jersey Dr. Amy DeFelice Celiac Disease Center at Columbia/Presbyterian Tel: (212) 305-8802 Debra Goldstein, MD The Middlesex Medical Group 225 May Street, Suite E Edison, New Jersey 08837 Tel: (732) 661-2020 Dr. Peter Green Columbia Presbyterian Hospital Phone: 212-305-5590 Fax: 212-305-3525 Pamela Hoffley MD (Pediatric Gastroenterologist) Dartmouth, NH 279 3rd Ave. Medical Center this month. Long Branch, NJ 07740 Tel: (732) 222-4474 Lawrence Pickover, M.D. - Gastroenterologist East Brunswick and New Brunswick, NJ Tel: E. Brunswick (908) 390-9200 Tel: N. Brunswick (908) 846-2777 Jack Rubin, M.D. - Gastroenterologist East Brunswick and New Brunswick, NJ Tel: E. Brunswick (908) 390-9200 Tel: N. Brunswick (908) 846-2777 Zalman R. Schrader, M.D. - Gastroenterologist 101 Old Short Hills Road West Orange, NJ 07052 Dr. Lawrence Stein 1) Morristown (973) 455-0404; 2) Denville (973) 625-5985 New Mexico James E. Baum, D.O. Orthopedic, Functional & Anti-Aging Medicine Prolotherapy, Sclerotherapy & Neural Therapy AST Chelation Therapy Gluten Free Diet Specialist 1850 Old Pecos Trail, Ste. L Santa Fe, NM 87505 Tel: (505) 989-8647 New York Dr. Keith Benkov Mt. Sinai Hospital (212) 241-5415 Stuart Berezin, M.D. - Pediactric Gastroenterologist Westchester County Medical Center Valhalla, NY Tel: (914) 594-4610 Thomas Bolte, M.D. (board certified, Internal Medicine) 141 East 55th Street, Suite 8-H New York, NY 10022 Tel: (212) 588-9314 E-mail: TJBolte@juno.com Dr. Amy DeFelice Celiac Disease Center at Columbia/Presbyterian Tel: (212) 305-8802 Peter Green, M.D. Columbia Presbyterian Medical Center 161 Ft. Washington Ave. New York, NY 10032 Tel: (212) 305-5590 Phillip Kaslow - Pediactric Gastroenterologist Babies' Hospital Columbia, NY Tel: (212) 305-5903 Vijay Kumar, Ph.D. IMMCO Diagnostics 963 Kenmore Ave. Buffalo, NY 14223 USA Tel: (716) 876-5672 Jack A. Pasquale, M.D. Physician Nutrition Specialist Board-Certified in Internal Medicine 73-03 198th Street Fresh Meadows, NY 11366-1818 Tel: (718) 465-0041 Fax (718) 465-4224 Dr. Nanci Pittman Mt. Sinai Hospital Tel: (212) 241-5415 Dr. Lesley Smith, M.D. - Pediatrician GI Celiac Disease Center at Columbia/Presbyterian Tel: (212) 342-2914 North Carolina John Baille, M.D. - Gastroenterologist Division of Gastroenterology Duke Medical Center Durham, NC 27710 Ivor Dennis Hill, M.D. Clinical Pediatric Gastroenterology Chief of the Division of Pediatric Gastroenterology and Nutrition Bowman Gray School of Medicine Winston-Salem, NC Tel: (336) 716 4431 Martin Ulshen, M.D. - Pediactric Gastroenterologist North Carolina School of Medicine CB # 7220 UNC Chapel Hill, NC 27599 Tel: (919)-966-1343 Ohio Ahmad Ascha,M.D. - Gastroenterologist 9500 Mentor Ave #380 Mentor, OH 44060 Tel: (440) 352-9400 E-mail: mail1@ascha.net Amy Jones, M.S., R.D., L.D. Logan County Celiac Support Group 205 Palmer Ave. Bellefontaine, OH 43311 Tel: (937) 651-6428 Internet: http://www.logancountyceliac.org Dr. David Corrallo Beloit, OH Tel: (330) 938-3333 Kirk Elliott, M.D. - Gastroenterologist Canton, OH Tel: (216) 492-4441 Dr. Li - pediatric gastroenterologist Children's Hospital Columbus, Ohio Edward Schirack, M.D. - Gastroenterologist Canton, OH Tel: (216) 492-4441 Dr. Arjun Venkat, M.D. - Gastroenterologist Akron Digestive Disease Consultants, Inc. 570 White Pond Dr., Ste. 100 Akron, OH 44320 Tel: 330-869-0124 Oklahoma Dr. Robert C. Brown Northwest Internal Medicine Division of Medical Group, PC 3433 N.W. 56 Street, Suite 800 Oklahoma City, OK 73112 Tel: (405) 946-9831 Dr. Debra Riggs Family Practice Mercy Health Center Bethany, Oklahoma Tel: (405) 789-4150 Oregon Sarah Brendler, M.D. Lane Gastroenterology Associates 960 N. 16th, Suite 203 Springfield, OR Tel: (541) 726-4686 Pennsylvania William Battle, M.D. Jeanes Physicians Office Building, Suite 209 7600 Central Avenue Philadelphia, PA 19111 Tel: (215) 728-6688 Anthony Colatrella, M.D. David Limauro, M.D. David Glorioso, M.D. Pittsburgh Gastroenterology Associates Pittsburgh, PA 15219 Tel: (412) 232-8104 Keith Laskin, M.D. Main Line Gastroenterology Paoli Memorial Medical Building 3 Suite 333 255 West Lancaster Ave Paoli, PA 19301 Tel: (610) 644-6755 Thomas Pineo, DO Greenville Medical Center 90 Shenango Street Greenville, PA 16125 724-588-4240 Marc A. Zitin, M.D. Main Line Gastroenterology Associates, P.C. 252 Lankenau Med. Bldg. East Lancaster Ave & City Line Wynnewood, PA 19096 Tel: (610) 896-7360, or (610) 896-8335 Dr. Andrew Schwartz Fern Hill Medical Campus, Building B, Suite 300 915 Old Fern Hill Road West Chester, PA 19380 Tel: (610) 431-3122 E-mail: info@westchestergi.com Rhode Island Pamela J. Connors, MD Gastroenterology Specialists, Inc. 45 Wells Street, Suite 103 Westerly, RI 02891 Tel: (401) 596-6330 James J. Murdocco, M.D. 360 Kingstown Road Narragansett, RI 02882 Tel: (401) 789-0226 Tennessee Maurace Barnes, M.D. 5651 Frist Blvd. Suite 214 Hermitage, TN. 37076 Tel: (615) 885-7788 E-mail: summit@usit.net Dr. Lind, M.D. - Gastroenterologist Vanderbilt University Medical Center Tennessee Tel: (615) 322-5000 Texas Alberto O. Barroso, M.D. 6560 Fannin, Suite 1660 Houston, TX 77030 Tel: (713) 797-9595 Dr. Kenneth Fine Finer Health Institute/Entero Labs 10851 Ferguson Rd., Suite B Dallas, TX 75228 Tel: (972) 686-6869 E-mail: kdfine@finerhealth.com Craig Lubin - Gastroenterologist 1910 W. 35th Austin, TX 78703 Tel: (512) 454-4588 John F. Pohl, M.D. Pediatric Gastroenterologist Scott & White Hospital Temple, Texas Tel: (254) 724-2491 Tel: (877) 724-KIDS William Santangelo, M.D. Baylor University Medical Center Suite 809 3600 Gaston Avenue Dallas, TX 75246 Tel: (214) 818-0948 John Secor, M.D. Presbyterian Professional Building 8221 Walnut Hill Lane Dallas, TX Tel: (214) 368-6707 Mesquite, TX Tel: (214) 289-0636 John R. Stroehlein, M.D. Professor of Medicine Univ. of TX Health Science Center & Medical School 6431 Fannin Houston, TX 77030 Tel: (713) 500-6677 Ray A. Verm, M.D. 6560 Fannin, Suite 1625 Houston, TX 77030 Tel: (713) 791-1800 Utah Linda S. Book, M.D. Primary Childrens Hospital Tel:(801) 588-3370 Janet Harnsberger, M.D. - Pediatric Gastroenterologist Cottonwood Medical Tower 250 E 5770 S #330 Salt Lake City, UT 84107 Dr. Michael J. Sossenheimer Utah Gastroenterology 6360 S 3000 E #310 Salt Lake City, UT 84121 Tel: (801) 944-3144 E-mail: msossenheimer@utahgastro.com Virginia Michael Hart, MS, M.D. Director, Pediatric Gastroenterology & Nutrition 102 Highland Avenue, S.E. Suite 305 Roanoke, VA 24013 Tel: (540) 985-9832 Fax: (540) 224-4421 email: mhart@carilion.com website: www.michaelhart.yourmd.com Christopher N. Sheap, M.D. 1741-B Erickson Avenue Harrisonburg, VA 22801 Tel: (540) 442-6619 Washington Patricia Elliott ND 1155 N State St #610 Bellingham, WA 98226 Tel: (360) 647-0228 Dr. Jean McFadden Layton, ND Natural Health Bellingham 1329 Lincoln St Suite 3 Bellingham, WA 98229 Tel: (360) 734-1659 Kasra Pournadeali, ND, Director Northwest Center for Optimal Health Clinical & Academic Faculty, Bastyr University President, Washington Association of Naturopathic Physicians 316 State Avenue, Suite A; Marysville, WA 98270 Tel: (360) 651-9355 Stephen O. Wangen, ND IBS Treatment Center Nordstrom Medical Tower 1229 Madison St., Suite 1220 Seattle, WA 98104 Wisconsin Drew M Elgin, MD Board Certified in Gastroenterology Madison Medical Affiliates 13133 N. Port Washington Road Seton Professional Building, Suite G16 Mequon, WI 53097 Tel: (262) 243-5000

Thompson T. NEJM. 2004;351:2021-2022 (Nov. 4, 2004, Number 19) Celiac.com 11/09/2004 - While oats do not appear to naturally contain gluten, like other grains they can become contaminated during harvesting, transporting, milling and processing. Many studies have shown that moderate amounts of uncontaminated oats are safe for most adults with celiac disease. There may, however, also exist a sub-set of celiacs who also have avenin-reactive mucosal T-cells, avenin being the oat counterpart to wheats gliadin. To summarize the study—12 containers of oats representing 4 different lots of 3 brands (Quaker, Country Choice, and McCanns) were tested for gluten contamination using the R5 ELISA developed by Mendez. Contamination levels ranged from below the limit of detection (3 ppm gluten) to 1807 ppm gluten. Three of the 12 oat samples contained gluten levels of less than 20 ppm, and the other nine had levels that ranged from 23 to 1,807 ppm. All brands of oats tested had at least 1 container of oats that tested above 200 ppm gluten. It is interesting to note that Country Choice oats ranged from below the limit of detection to 210 ppm—an amount that is nearly at the level allowed by the Codex Alimentarius for products that normally contain gluten but have had their gluten removed—and of the three brands had the least amount of cross-contamination. We must caution, however, that the sampling done in the study was much to small to make any firm conclusions about the average level of gluten-contamination of each of these brands. This study shows that cross-contamination is indeed a concern for celiacs who want to try oats. Celiac patients should contact oat millers directly and talk to them about their clean-out procedures, and whether they have done any testing of their own for gluten cross-contamination.

The following was written by Donald D. Kasarda who is a research chemist in the Crop Improvement and Utilization Research Unit of the United States Department of Agriculture. If you have any questions or comments regarding the piece, you can address them to Don at: kasarda@pw.usda.gov. The connection with wheat (and rye and barley) wasnt recognized until the 1950s - (a)nd it wasnt until the 1960s that intestinal biopsies began to become commonly used in the diagnosis of celiac disease. With regard to the harmfulness of barley malt, the situation is complicated. I will give you my best shot with the qualification that the ideal experiments have not been done and a definitive statement is not possible at this time. Because barley malt is made from barley grain that has been germinated it is reasonably certain to be less toxic than barley itself. The hordein proteins and starch in the endosperm of barley grains, like the equivalent gluten proteins and starch in wheat, are there for storage purposes. In a sense, they provide food for the new plant upon germination. In order to use the hordein proteins, the grain releases and generates enzymes upon germination that break down the storage proteins into their constituent amino acids. The problem is that the process is not complete during a short germination, so some peptides (short pieces of the proteins) remain intact in malted barley. There is experimental evidence for this. The resulting mix of peptides is highly complex. We know from work described in the scientific literature that relatively small polypeptide chains can still retain activity in celiac disease and we know something about a few sequences that seem to be harmful. But we probably dont know all the sequences that are harmful and we havent put our fingers on the common theme that gives rise to the activity in celiac disease. So the question arises as to whether or not the remaining sequences in malted barley are harmful. The possibilities that come to my mind are: There are sufficient remaining harmful peptides (with sizes including approximately 12 or more amino acid residues) to give a significant activity in celiac disease to barley malt (remember though that barley malt is usually a minor component of most foods in which it is used and processing might decrease the amount of harmful peptides in a malt product); There are traces of these peptides, but they are sufficiently minimal so as to cause no discernible harm; or The key harmful amino acid sequences are completely destroyed by the enzymes during germination (I can speculate that there might be an important enzyme, very active, in germination that clips a key bond in active sequences, thus reducing the concentration of those active sequences to almost nil while still allowing non-harmful peptides to exist; no evidence exists for this speculation, but it could be used as a working hypothesis for experimentation). There is no completely solid evidence for or against there being a threshold of gluten consumption below which no harm, or at least no lasting harm, occurs and above which definite harm occurs (but see my previous post to the list on starch/malt question). This is a difficult area to study where zero consumption is being approached and the arguments that come up are at least similar to those that have arisen in regard to the question of whether or not there is a minimal level of radiation exposure below which no harm is caused, but above which there is harm that increases with dosage. Accordingly, celiac patients must choose arbitrarily the path they feel comfortable with. Here are some references that deal with the question of peptide toxicity. It is not a simple situation: Shewry, P. R., Tatham, A. S., Kasarda, D. D. Cereal proteins and coeliac disease. In Coeliac Disease, Ed. M. N. Marsh. Blackwell Scientific, London 1992;pp. 305-348. Kasarda, D. D. Toxic cereal grains in coeliac disease. In: Gastrointestinal Immunology and Gluten Sensitive Disease: Proc. 6th International Symp. On Coeliac Disease, C. Feighery and C. OFarrelly, eds., Oak Tree Press, Dublin 1994;pp. 203-220. Wieser, H., Belitz, H.-D., Idar, D., Ashkenazi, A. Coeliac activity of the gliadin peptides CT-1 and CT-2. Zeitschrift fur Lebensmittel-Untersuchung und-Forschung 1986;182:115-117. De Ritis, G., Auricchio, S., Jones, H. W., Lew, E. J.-L., Bernardin, J. E., Kasarda, D. D. In vitro (organ culture) studies of the toxicity of specific A-gliadin peptides in celiac disease Gastroenterology 1988;94:41-49. Fluge, 0, K. Sletten, G. Fluge, Aksnes, L., S. Elsayed. In vitro toxicity of purified gluten peptides tested by organ culture. Journal of Pediatric Gastroenterology and Nutrition 1994;18:186-192. Sturgess, R., Day, P., Ellis, H. J., Lundin, K. A., Gjertsen, H. A, Kontakou, M., Ciclitira, P. J. Wheat peptide challenge in coeliac disease. Lancet 1994;343:758-761. Marsh, M. N., Morgan, S., Ensari, A., Wardle, T., Lobley, R., Mills, C., Auricchio, S. In vivo activity of peptides 31-43, 44-55, 56-68 of a-gliadin in gluten sensitive enteropathy (GSE). Supplement to Gastroenterology 1995;108:A871.

The following was written by Donald D. Kasarda who is a research chemist in the Crop Improvement and Utilization Research Unit of the United States Department of Agriculture. If you have any questions or comments regarding the piece, you can address them to Don at: kasarda@pw.usda.gov. Most sprouted wheat still has gluten or gluten peptides remaining. Although the sprouting begins enzymatic action that starts to break down the gluten (a storage protein for the plant) into peptides and even amino acids. Generally this is not a complete process for sprouts used in foods so some active peptides (active in celiac disease) remain.

Celiac.com 03/16/2004 - The U.S. Senate has unanimously passed S. 741, which includes the Food Allergen Labeling and Protection Act. The key labeling provisions are: Require that food ingredient statements identify in everyday terminology that an ingredient is itself, or derived from, the top eight food allergens -- peanuts, tree nuts, fish, Crustacean shellfish, eggs, milk, soy, and wheat; Require food ingredient statements to identify food allergens used in spices, natural or artificial flavorings, additives, and colorings; Require all foods to be re-labeled by January 1, 2006; Require the Secretary of Health and Human Services to issue a rule defining the term gluten-free and permitting use of the term on food labeling, and; Require a final rule regarding the voluntary use of gluten-free on food labels be issued not later than four years after this bill becomes law. This historic, bipartisan vote, sends a LOUD and clear message to the House of Representatives -- its time to fix food labels. Thank you for all your work to bring the celiac community to this point. Scream and shout today, tomorrow we tackle the House of Representatives. -American Celiac Task Force

Celiac.com 2/13/2003 - According to a recently published large-scale multi-year and multi-center study, 1 in 133, or a total of 2,131,019 Americans have celiac disease. Alessio Fasano, MD, et. al., and colleagues screened 13,145 subjects using serum antigliadin antibodies and anti–endomysial antibodies (EMA). Those who had positive EMA results were screened again for human tissue transglutaminase IgA antibodies and celiac disease-associated human leukocyte antigen DQ2/DQ8 haplotypes, and when possible, intestinal biopsies were also given. Additionally, for those with biopsy-proven celiac disease, 4,508 first-degree relatives and 1,275 second-degree relatives were also screened for the disease. A total of 3,236 symptomatic patients and 4,126 not-at-risk individuals were screened. The study determined the following: Group Prevalence First degree relatives 1 in 22 Second-degree relatives 1 in 39 Symptomatic patients 1 in 56 Not-at-risk individuals (overall prevalence) 1 in 133 These results are much higher than previous studies have found, and they indicate that celiac disease is perhaps the most common genetic disorder in the United States, as well as one of the most poorly diagnosed diseases. February 10, 2003 edition of Archives of Internal Medicine

Celiac.com - 07/24/2001 Study: Holmes, Prior, Lane, et. al. Malignancy in Coeliac Disease - Effect of a Gluten-Free Diet Gut 1989; 30: 333-338 Comments Regarding the Study to the List (January 8, 1997): I would like to suggest that you check out some of the information on malignancy and celiac disease, especially lymphoma. One of the studies established three categories: One for those who adhere to the diet strictly; one for those who follow the diet, but not very strictly; and one for those who do not follow the diet. The first group, after 5 years, shows a significant reduction in risk. In fact, it is quite close to the risk experienced by members of the general population. The second group does experience some reduction in risk, but it remains closer to the rate of malignancy in untreated celiac disease. The third group has a very high risk of malignancy. Response by Donald D. Kasarda (January 9, 1997 - Donald D. Kasarda is a research chemist in the Crop Improvement and Utilization Research Unit of the United States Department of Agriculture): I point out that the people in the first group, which supposedly was adhering to a strict gluten-free diet, were likely to have been including foods made with wheat starch in their diet because that was, and is, common in England where the study was carried out. I have asked several celiac researchers in England if I am correct in this assumption. They agreed that I am. Therefore these people in the strictly gluten-free group were likely to be eating a small amount of gluten each day. The amount is unknown because we dont know the amount of gluten in the starch (this varies according to the manufacturer and possibly according to lot) nor which subjects ingested how much starch. The apparent small increase in cancer risk for the first group was not statistically significant for those who had been on the diet more than 5 years. In the group with a normal diet, the relative risk of lymphoma was increased 78 fold, but it should be pointed out that the incidence of lymphoma of the gastrointestinal tract in the normal population is rather low. For the 210 patients in the study, the cancer morbidity was expected to be 0.21. For the 46 patients in the normal diet group, 7 cases of lymphoma were observed. For the 108 patients on the strict gluten-free diet, 3 cases of lymphoma were observed. The statistical significance of the numbers is weak because of the relatively small numbers of patients involved. These are extremely valuable and well-done studies. No criticism is intended. To arrange a study with larger numbers will be extremely difficult although a group in Leiden (The Netherlands) is trying to arrange such a study. I have no quarrel with those who wish to play it safe, but I dont think we can say for sure that small amounts of gluten in the range of a milligram to a few milligrams per day are harmful on the basis of any scientific study of which I am aware. They may be, or they may not be. I offer these comments only with the intent of providing as much information to celiac patients as possible so that they can make informed decisions. If anything I have said is incorrect, I hope someone will point out my errors on the net. Don Kasarda, Albany, CA FYI: According to the calculations made with Don Kasarda in Nov 1995, 0.1 grams = 100 milligrams is about one-50th of a slice. Therefore, 10 milligrams is about one-500th of a slice of bread.

The following contributions can be made to the United Way to support celiac sprue research: Celiac Sprue Flourtown, PA; Agency Code 030289 Celiac Sprue Association of United Omaha, NE; Agency Code 026760

The University Of Maryland Center For Celiac Research (CFCR) was established as an impartial, non-profit organization to improve the lifestyle of Celiacs through scientific research. As many of you know, we are presently conducting a nationwide six center serological study to determine the prevalence of Celiac Disease in the United States. Scott Adams’ call for "... a conference among the different Celiac organizations to reach an agreement on what is safe and what is not?" sound like a reasonable approach to at least beginning the discussions essential to resolving this very difficult problem. Ann Whelan, in her May-June issue of "Gluten-free Living" enclosed an insert entitled "Time to Act...Unite Now". Maybe this single issue is a good place to start. We at the CFCR would like to offer our impartial auspices in putting together such a "Celiac Food Forum". Inviting food scientists, dieticians, nutritionists, support group leaders and interested Celiacs from the United States, Canada and other countries to discuss in open forum these very important issues. Please let us know if you think we may be of service by responding to Bob Levy, CFCR Volunteer, via his e-mail address "bobolevy@erols.com" or by calling him at 410-486-0292. Dr. Alessio Fasano and Dr. Karoly Horvath, Co-Medical Directors - University Of Maryland Center For Celiac Research.

The following was written by Donald D. Kasarda who is a research chemist in the Crop Improvement and Utilization Research Unit of the United States Department of Agriculture. If you have any questions or comments regarding the piece, please address them to Don at: kasarda@pw.usda.gov The work from Prof. Auricchios laboratory (Troncone et al.) in Naples is certainly of interest and I shall look forward to seeing the details, but I will just point out for the sake of balance that studies with patients who ingest, or have instilled into their intestines, the substance to be tested represent the gold standard and in vitro testing (that is, in glass, or in the test-tube), while valuable, does not carry as much weight. The results from the Finnish group and from Dr. Feigherys group (not yet published), Dublin, Ireland, are very impressive. The results based on in vitro testing would have to be truly exceptional to undermine the excellent work that has been done on the safety of oats. So, we shall have to wait and see, but I doubt there is reason to be overly concerned just yet.

The following was written by Donald D. Kasarda who is a research chemist in the Crop Improvement and Utilization Research Unit of the United States Department of Agriculture. If you have any questions or comments regarding the piece, please address them to Don at: kasarda@pw.usda.gov I have not seen the NEJM article from the Finnish group although I had heard second hand about a meeting presentation of the work. I have no reason to doubt the results. I am co-author of a paper from an independent study carried out by the laboratory of Dr. Conleth Feighery, Trinity College, Dublin, Ireland, and this study (paper submitted) also supports the lack of toxicity for a PURE oats sample. I will remind people that it is EASY for oats to be contaminated with wheat both in the field and in processing. I have no reason to think that oats must be limited to small amounts, but, of course, it isnt good to focus ones diet too much on a single food, so moderation of the normal sort is probably good. There are bound to be some people who are sensitive to oats, possibly through an allergic reaction to one component or another (just as there are people allergic to rice), but this sensitivity, on the basis of current results, seems unlikely to be celiac disease in its strict sense. The term gluten in celiac disease is not used in a proper sense (in that sense it is present only in wheat), but rather as a shorthand term for peptides derived from prolamins (proteins) that include the harmful amino acid sequences found in wheat. These peptides set off (in an unknown way) a series of reactions that ultimately may lead to flattening of the mucosa, malabsorption, and possibly other effects as well. Wheat, rye, and barley have prolamins that contain the toxic sequence(s). The finding that oats is (are?) not toxic indicates that the key sequences are NOT found in the avenins, the prolamins of oats. Comparison of the amino acid sequences of avenins and gliadins yields clues to possibly important differences and I am pursuing the significance of these differences. I am currently trying to find sources of pure, uncontaminated oats, and will post them here as soon as they are available. -Scott The oats used in the Irish study (see Doctor #2 below) came from a company called Peter Kölln in Germany. The oats from this company were tested and found to be safe. Their address is: Peter Kölln Postfach 609 D-25306 Elmshorn Germany

The abstract below will be published in the April, 1996 issue of Gastroenterology. It was accepted for poster presentation for the Annual meeting of the American Gastroenterological Association. The poster section will be on May 22, 1996 (12-2:30 PM) in Hall D, at the Moscone Center, San Francisco, CA. ENDOMYSIUM ANTIBODIES IN BLOOD DONORS PREDICTS A HIGH PREVALENCE OF CELIAC DISEASE IN THE USA. T. Not, K. Horvath, *I.D. Hill, A. Fasano, A. Hammed, +G. Magazz=F9. Division of Pediatric Gastroenterology & Nutrition,= University of Maryland School of Medicine, *The Bowman Gray School of Medicine, Winston-Salem, & The University of Messina, Italy. Several epidemiological studies in Europe using antigliadin (AGA) and endomysium antibodies (EmA) for initial screening report the prevalence of celiac disease (celiac disease) to be about 1 out of 300 in the general population. The EmA is most reliable for screening with greater than 99% positive predictive-value in subsequent biopsy-proven cases. There are no comparable scientific data for the USA yet, and celiac disease is considered rare in this country. Lack of awareness could result in significant under-diagnosis of celiac disease in the USA. Aim: To determine the prevalence of positive serological tests for celiac disease in healthy blood donors in USA. Methods: Sera from 2000 healthy blood donors were screened for IgG and IgA AGA using ELISA test. All those with elevated AGA levels (IgA >18 units or IgG >25 units) and those with high normal levels (IgA 10-18 units or IgG 15-25 units) were tested for EmA by indirect immunofluorescence using both monkey esophagus (ME) and human umbilical cord (HUC). Results: The mean age of blood donors was 39 years, with 52% being men, 87% being Caucasian, 11.5% African American, and 1.5% Asian. 95 (4.75%) of the subjects had elevated AGA levels (IgG and/or IgA). A total of 44 (2.2%) had an elevated IgA AGA. Of these, 7 were also positive for EmA. No patient with only raised levels of IgG AGA was positive for EmA. Of the subjects with high normal AGA levels, one (IgA 12 units, IgG 1.8 units) was positive for EmA. Among the total of 8 subjects with elevated EmA levels, seven were Caucasian and one was African American. There was a 100% correlation between ME and HUC for positivity (8 samples) and negativity (288 samples). Conclusions: The prevalence of elevated EmA levels in healthy blood donors in USA is 1:250 (8/2000). This is similar to that reported from countries in Europe where subsequent small intestinal biopsies have confirmed celiac disease in all those with EmA positivity. Based on a positive predictive value of >99% for celiac disease in patients with elevated EmA levels, it is likely that the 8 blood donors identified in this study have celiac disease. These data suggest that celiac disease is not rare in the USA and may be greatly under-diagnosed. There is need for a large scale epidemiological study to determine the precise prevalence of the disease in the USA.