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HeatherAdministrator

Reged: 12/09/02
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Celiac / Gluten Intolerance
      #13957 - 07/14/03 01:59 PM

All articles related to Celiac or gluten intolerance should be posted here.

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HeatherAdministrator

Reged: 12/09/02
Posts: 7353
Loc: Seattle, WA
High prevalence of small intestinal bacterial overgrowth in celiac patients new
      #13973 - 07/14/03 03:04 PM

American Journal of Gastroenterology Volume 98 , Issue 4 , Pages 839-843

High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal

Antonio Tursi M.D. * a , Giovanni Brandimarte M.D. b and GianMarco Giorgetti M.D. c

Received: 12/21/2001. Accepted: 4/12/2002.

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Abstract Objective

Celiac disease is a gluten-sensitive enteropathy with a broad spectrum of clinical manifestation, and most celiac patients respond to a gluten-free diet (GFD). However, in some rare cases celiacs continue to experience GI symptoms after GFD, despite optimal adherence to diet. The aim of our study was to evaluate the causes of persistence of GI symptoms in a series of consecutive celiac patients fully compliant to GFD.


Methods

We studied 15 celiac patients (five men, 10 women, mean age 36.5 yr, range 24–59 yr) who continued to experience GI symptoms after at least 6–8 months of GFD (even if of less severity). Antigliadin antibody (AGA) test, antiendomysial antibody (EMA) test, and sorbitol H2-breath test (H2-BT), as well as esophagogastroduodenoscopy (EGD) with histological evaluation, were performed before starting GFD. Bioptic samples were obtained from the second duodenal portion during EGD, and histopathology was expressed according to the Marsh classification. To investigate the causes of persistence of GI symptoms in these patients, we performed AGA and EMA tests, stool examination, EGD with histological examination of small bowel mucosa, and sorbitol-, lactose-, and lactulose H2-breath tests.


Results

Histology improved in all patients after 6–8 months of GFD; therefore, refractory celiac disease could be excluded. One patient with Marsh II lesions was fully compliant to his diet but had mistakenly taken an antibiotic containing gluten. Two patients showed lactose malabsorption, one patient showed Giardia lamblia and one patient Ascaris lumbricoides infestation, and 10 patients showed small intestinal bacterial overgrowth (SIBO) by lactulose H2-BT. We prescribed a diet without milk or fresh milk–derived foods to the patient with lactose malabsorption; we treated the patients with parasite infestation with mebendazole 500 mg/day for 3 days for 2 consecutive wk; and we treated the patients with SIBO with rifaximin 800 mg/day for 1 wk. The patients were re-evaluated 1 month after the end of drug treatment (or after starting lactose-free diet); at this visit all patients were symptom-free.


Conclusions

This study showed that SIBO affects most celiacs with persistence of GI symptoms after gluten withdrawal.

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Affiliations:
a Department of Emergency, “L. Bonomo” Hospital, Andria (BA), Italy. b Department of Internal Medicine, Digestive Endoscopy Unit, “Cristo Re” Hospital, Rome, Italy. c Department of Internal Medicine, Artificial Nutrition Unit, “S. Eugenio” Hospital, Rome, Italy.


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Copyright
© 2003 Am. Coll. of Gastroenterology

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Celiac Disease: More Common Than You Think new
      #13996 - 07/14/03 04:15 PM

American Family Physician - December 15, 2002

Gluten-Sensitive Enteropathy (Celiac Disease): More Common Than You Think

DAVID A. NELSEN, JR., M.D., M.S., University of Arkansas for Medical Sciences, Little Rock, Arkansas

Gluten-sensitive enteropathy or, as it is more commonly called, celiac disease, is an autoimmune inflammatory disease of the small intestine that is precipitated by the ingestion of gluten, a component of wheat protein, in genetically susceptible persons. Exclusion of dietary gluten results in healing of the mucosa, resolution of the malabsorptive state, and reversal of most, if not all, effects of celiac disease. Recent studies in the United States suggest that the prevalence of celiac disease is approximately one case per 250 persons. Gluten-sensitive enteropathy commonly manifests as "silent" celiac disease (i.e., minimal or no symptoms). Serologic tests for antibodies against endomysium, transglutaminase, and gliadin identify most patients with the disease. Serologic testing should be considered in patients who are at increased genetic risk for gluten-sensitive enteropathy (i.e., family history of celiac disease or personal history of type I diabetes) and in patients who have chronic diarrhea, unexplained anemia, chronic fatigue, or unexplained weight loss. Early diagnosis and management are important to forestall serious consequences of malabsorption, such as osteoporosis and anemia. (Am Fam Physician 2002;66:2259-66,2269-70. Copyright© 2002 American Academy of Family Physicians.)

Although celiac disease was formally described late in the 19th century, treatment remained empiric until the middle of the 20th century when patients were noted to improve dramatically after wheat was removed from their diet. With the development of small-bowel biopsy techniques, the small intestine was identified as the target organ. Disease causality was established when the characteristic features of villous flat tening, crypt hyperplasia, and increased intraepithelial lymphocytes (Figure 1) were shown to normalize after the institution of a gluten-free diet.1

In the mid-1960s, an enteropathy strikingly similar to celiac disease was identified in patients with dermatitis herpetiformis. Subsequently, this skin disorder was shown to be a manifestation of gluten-sensitive enteropathy. In the mid-1960s, adult celiac disease was also noted to be associated with numerous neuro logic disorders, including epilepsy, cerebral calcifications, and peripheral neuropathy.1

Recent population studies indicate that celiac disease is more common than was previously thought. Some patients with gluten-sensitive enteropathy have minimal or no symptoms and are unlikely to be referred to a gastroenterologist unless the disease is considered. Hence, family physicians need to be familiar with the diagnosis and management of gluten-sensitive enteropathy.

Pathophysiology

Ingested protein does not normally provoke an immune response. This phenomenon is termed "oral tolerance." Patients who exhibit true allergy to an ingested protein (e.g., milk or soy protein) have a typical IgE-mediated response consisting of urticaria, angioedema, and bronchoreactivity.

The autoimmunity in gluten-sensitive enteropathy involves plasma cells that produce IgA and IgG; there is little or no IgE involvement. Current theory suggests that ingested alpha-gliadin (a component of the gluten protein) and related peptides bind with tissue transglutaminase (a ubiquitous intracellular enzyme) in enterocytes. The alpha-gliadin is rich in glutamine; transglutaminase deamidates glutamine residues, forming glutamic acid. Deamidation enhances the immunogenicity of alpha-gliadin by creating epitopes that are recognized as foreign by host cell­mediated immunity.2

Plasma cells produce IgA and IgG that are directed against a variety of antigens, including transglutaminase, endomysium, gliadin, and reticulin. Locally elaborated lymphokines attract inflammatory cells.3 This intense local inflammatory reaction produces the villous flattening characteristic of gluten-sensitive enteropathy. Malabsorption of micronutrients (e.g., vitamins and minerals) and macronutrients (e.g., protein, carbohydrate, fat) follows. Small-bowel involvement is most prominent proximally and may be "patchy," especially in patients with "silent" celiac disease (i.e., minimal or no symptoms) and those with dermatitis herpetiformis.

Approximately 95 percent of patients with celiac disease exhibit specific Human Leukocyte Antigen (HLA) class II alleles DQA1*0501 and DQB1*0201.4 Patients with type 1 diabetes, autoimmune thyroid disease,5 Sjögren's syndrome, primary biliary cirrhosis, Addison's disease, systemic lupus erythematosus, selective IgA deficiency, and alopecia areata may also exhibit similar genotypes and are at risk for gluten-sensitive enteropathy (Table 1). Because many persons have these genotypes and only a few develop gluten-sensitive enteropathy, investigators have hypothesized that other genes or cofactors may be involved.1

Epidemiology

Until recently, celiac disease was considered to be relatively uncommon. Previous U.S. figures suggested that it affected one in 6,000 persons.6 However, population studies published in the past four years suggest a much higher prevalence, particularly in persons of European ancestry.7 Studies conducted in Europe estimate the seroprevalence of celiac disease to be one case per 130 to 300 persons.8-10




FIGURE 2. Dermatitis herpetiformis, sometimes termed "celiac disease of the skin." Vesicular, crusted, intensely pruritic lesions develop on the back (top left and right), buttocks (lower left), and elbows (lower right). Secondary infection of the lesions is common.
In a recent U.S. study,11 investigators tested sera from 2,000 healthy Red Cross blood donors and found eight samples that were positive for antibodies associated with gluten-sensitive enteropathy (seven samples from white persons, one sample from a black person). The seroprevalence rate in this study (one case per 250 persons tested) is consistent with the rates in European studies.

The likelihood of having gluten-sensitive enteropathy increases to 10 to 20 percent in persons who have a first-degree relative with celiac disease.1 In addition, celiac disease is associated with other autoimmune syndromes. For example, as many as 7 percent of patients with type I diabetes also have gluten-sensitive enteropathy.12

Clinical Presentation

Untreated gluten-sensitive enteropathy is associated with a range of symptoms13,14 (Table 2). The "classic" form typically presents in infancy and manifests as failure to thrive, diarrhea, abdominal distention, developmental delay, and, occasionally, severe malnutrition. Failure to diagnose the disorder may lead to a true medical emergency.

Beyond infancy, the symptoms of celiac disease tend to be less dramatic. Older children may present with constitutional short stature or dental enamel defects.

Women comprise approximately 75 percent of newly diagnosed adult celiac disease cases. Women also tend to have more clinically conspicuous disease.15 In adults of both sexes, gastrointestinal tract involvement may manifest as diarrhea, constipation, or other symptoms of malabsorption, such as bloating, flatus, or belching. Fatigue, depression, fibromyalgia-like symptoms, aphthous stomatitis, bone pain, dyspepsia, gastroesophageal reflux, and other nonspecific symptoms may be present and can make the diagnosis quite challenging.14 A number of other autoimmune syndromes have been associated with celiac disease (Table 1).

DERMATITIS HERPETIFORMIS

Fewer than 10 percent of adults with gluten-sensitive enteropathy present with dermatitis herpetiformis.16 This skin condition may be misdiagnosed as atypical psoriasis or nonspecific dermatitis.

The rash of dermatitis herpetiformis is intensely pruritic and typically occurs on the back, buttocks, knees, and elbows (Figure 2). Unexcoriated lesions (Figure 3) are remarkably like those of herpes simplex (thus, the term "herpetiformis"). Granular IgA deposition on immunofluorescence of a skin biopsy specimen is diagnostic (Figure 4).

ANEMIA

Anemia is the most common laboratory manifestation of celiac disease13,14 (Table 3). One half of patients with newly diagnosed gluten-sensitive enteropathy are anemic. Iron is absorbed in the proximal small intestine, where celiac manifestations are most prominent; hence, iron malabsorption is common. In addition, occult blood loss related to intense small-bowel inflammation may occur in 50 percent of patients with gluten-sensitive enteropathy.17 Less commonly, vitamin B12 deficiency, folate deficiency, or both may be present.

SILENT CELIAC DISEASE

A number of investigators believe that clinically apparent gluten-sensitive enteropathy represents the "tip of the iceberg" of the overall disease burden.7 Patients who were detected in the seroprevalence studies8-11 were asymptomatic or oligosymptomatic (so-called "silent" celiac disease).

Family physicians should consider serologic testing in patients with the following: family history of celiac disease, personal history of thyroid disease or type I diabetes, irritable bowel syndrome, anemia (especially iron deficiency), chronic diarrhea, chronic fatigue, unexplained weight loss, short stature, epilepsy, infertility,18 or unexplained elevation of transaminase levels. Asymptomatic or oligosymptomatic patients are still at risk for complications of celiac disease.

Diagnosis

SEROLOGIC TESTS

When the diagnosis of gluten-sensitive enteropathy is suspected, serologic tests can identify many affected patients.19 (Figure 5). IgA antiendomysial antibody has been shown to be 85 to 100 percent sensitive and 96 to 100 percent specific for celiac disease. IgA antiendomysial antibody is measured using direct immunofluorescence of monkey esophagus or umbilical cord tissue processed with suspect serum.

IgG and IgA antigliadin antibodies are also useful in diagnosing celiac disease. The antibody directed against endomysium has recently been identified as identical to the antibody directed against (tissue) transglutaminase. An enzyme-linked immunosorbent assay has been developed to measure IgA antitransglutaminase; this test will generally replace the more tedious direct fluorescent antibody test for IgA antiendomysial antibody.20-22 In diagnosing celiac disease, antitransglutaminase antibody is considered to be approximately as sensitive and specific as antiendomysial antibody (Table 4).21,23-25

The presence of IgA antiendomysial and antitransglutaminase antibodies correlates with intestinal damage. Tests for these antibodies are highly sensitive in patients with total and subtotal villous atrophy. IgA antiendomysial antibody testing has been reported to be 100 percent sensitive in patients with total villous atrophy. The combination of IgA antiendomysial antibody and IgG and IgA antigliadin antibodies detects 76 percent of patients with mucosal damage.

It is important to note that 2 to 3 percent of patients with gluten-sensitive enteropathy also have selective IgA deficiency. Because these patients may not produce the diagnostic IgA antibodies, a positive IgG antigliadin antibody test may be the only serologic evidence of the disease. If clinical suspicion is high, quantitative IgA measurements should be obtained in these patients.26 Endoscopy and biopsy should be strongly considered in patients with selective IgA deficiency.

Declining autoantibody titers correlate with resolution of the gastrointestinal lesion and may be used to document clinical improvement. In equivocal cases or when a patient has been on a gluten-free diet, a gluten challenge test may be used to provoke the gastrointestinal lesion and serologic response.

DISTAL DUODENAL BIOPSY

Distal duodenal biopsy is the gold standard for the diagnosis of celiac disease. Biopsy should be performed in most patients with suspected gluten-sensitive enteropathy. In determining the need for biopsy, family physicians should consult a gastroenterologist who is experienced in the diagnosis and management of celiac disease.1

Complications

OSTEOPOROSIS

Calcium and vitamin D malabsorption dramatically increases the risk of osteoporosis and osteomalacia in patients with gluten-sensitive enteropathy. Most patients with celiac disease have some degree of osteopenia or osteoporosis. Fortunately, calcium and vitamin D supplementation, coupled with a strict gluten-free diet, usually results in remineralization of the skeleton.27,28

Bone density should be assessed in all patients with newly diagnosed celiac disease. Postmenopausal women should be advised about the benefits of estrogen replacement. The use of antiresorptive agents (e.g., alendronate [Fosamax]) has not been extensively studied, but these drugs may be of benefit.

NEUROLOGIC MANIFESTATION

Cerebral calcifications and epilepsy have been associated with celiac disease29,30 and do not always resolve with the institution of a gluten-free diet. Peripheral neuropathy, postural instability, "gluten ataxia," and other vague neurologic complaints may be the sole manifestation of gluten-sensitive enteropathy.31 Autoantibodies associated with celiac disease have demonstrated a strong affinity for brain vasculature.32

REFRACTORY SPRUE

In patients with refractory sprue, gastrointestinal tract inflammation continues despite maintenance of a gluten-free diet. Dietary noncompliance is the most common reason for persistent inflammation; however, coexistent conditions such as hyperthyroidism and collagenous colitis should also be considered.

Patients who are truly refractory to dietary measures may have cryptic lymphoma of (bowel) intraepithelial lymphocytes. All diet-refractory patients should be evaluated by a gastroenterologist with expertise in the management of celiac disease. Corticosteroids and immunosuppressant drugs have been used to treat refractory sprue, but data on their effectiveness are sparse.


IgA antiendomysial antibody has been shown to be 85 to 100 percent sensitive and 96 to 100 specific for celiac disease.


Intestinal strictures and bowel obstruction may develop in patients with refractory sprue or celiac disease that has been untreated over a long period.

LYMPHOMA AND BOWEL ADENOCARCINOMA

Enteropathy-associated T-cell lymphoma has been associated with untreated gluten-sensitive enteropathy and refractory sprue.33 Lymphoma may develop in patients with celiac disease who also have dermatitis herpetiformis.

Studies34,35 have shown that maintenance of a long-term gluten-free state reduces the risk of lymphoma to the level in the general population. Thus, it is imperative that patients with celiac disease (and dermatitis herpetiformis) maintain a gluten-free diet for the rest of their lives.

Patients with celiac disease are also at risk for the development of bowel adenocarcinoma in all sites. The risk is especially high in patients with a long period of disease preceding institution of a gluten-free diet.

Management

Once the diagnosis of celiac disease has been made, patients should be evaluated for known manifestations and complications (Table 5). Iron deficiency should be treated with supplemental iron. Osteoporosis should be treated with calcium and vitamin D replacement. Depending on individual factors, patients with gluten-sensitive enteropathy may need to take a multivitamin, iron, calcium, magnesium, zinc, selenium, vitamin D, or other nutrients.

The primary treatment for celiac disease is the removal of gluten and related proteins from the diet. Complete exclusion of dietary gluten generally results in rapid and complete healing of small-bowel inflammation. Advice from a registered dietitian is essential to outline an appropriate diet.

Gluten, a prolamine, is the primary protein in wheat. Hence, wheat and products containing wheat must be avoided. Barley and rye contain similar proteins and must also be avoided. Oats are a subject of controversy.36,37 Although oats themselves may be nontoxic in limited quantities, commercial oat products are measurably contaminated with wheat. Rice, corn, maize, flax, quinoa, tapioca, potato, amaranth, and other grain substitutes, such as nuts and beans, are safe.

There are many commercial gluten-free products, including breads, cookies, chips, and cereals, that can be used to fashion a rich and interesting diet. Meats, vegetables, fruit, and most dairy products are free of gluten, as long as they have not been contaminated during production.

A number of food manufacturers maintain lists of gluten-free products. These lists can be obtained from the manufacturers' Web sites or by telephone request. Information on gluten-free foods is also available from local or national support groups such as the Celiac Sprue Association. Selected resources are provided in Table 6.

The author indicates that he does not have any conflicts of interest. Sources of funding: none reported.

Figure 1 provided by Laura Lamps, M.D., assistant professor of pathology, University of Arkansas for Medical Sciences (UAMS), Little Rock. Figure 4 provided by Bruce Smoller, M.D., professor of pathology and dermatology, UAMS.


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The Author

DAVID A. NELSEN, JR., M.D., M.S., is associate professor in the Department of Family and Community Medicine at the University of Arkansas for Medical Sciences, Little Rock, where he earned his medical degree and completed a family medicine residency. He completed a faculty development and clinical investigation fellowship at the University of Minnesota Medical School, Minneapolis, where he also earned a master's degree in family and community medicine. Dr. Nelsen has published and presented in the area of medical informatics and speech recognition. He serves on the technical panel of the American Academy of Family Physicians.

Address correspondence to David A. Nelsen Jr., M.D., M.S., University of Arkansas for Medical Sciences, Department of Family and Community Medicine, Mail Slot #530, 4301 W. Markham, Little Rock, AR 72205 (e-mail: nelsendavida@uams.edu). Reprints are not available from the author.

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Van De Wal Y, Kooy Y, Van Veelen P, Vader W, Koning F, Pena S. Coeliac disease: it takes three to tango! Gut 2000;46:734-7.
Marsh MN. The natural history of gluten sensitivity: defining, refining and re-defining. QJM 1995;88:9-13.
Sollid LM, Markussen G, Ek J, Gjerde H, Vartdal F, Thorsby E. Evidence for a primary association of celiac disease to a particular HLA-DQ alpha/beta heterodimer. J Exp Med 1989;169:345-50
Collin P, Salmi J, Hallstrom O, Reunala T, Pasternack A. Autoimmune thyroid disorders and coeliac disease. Eur J Endocrinol 1994; 130:137-40.
American Gastroenterological Association medical position statement: celiac sprue. Gastroenterology 2001;120:1522-25.
Catassi C, Ratsch IM, Fabiani E, Rossini M, Bordicchia F, Candela F, et al. Coeliac disease in the year 2000: exploring the iceberg. Lancet 1994;343:200-3.
Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. Gastroenterology 2001;120:636-51.
Hin H, Bird G, Fisher P, Mahy N, Jewell D. Coeliac disease in primary care: case finding study. BMJ 1999;318:164-7.
Branski D, Troncone R. Celiac disease: a reappraisal. J Pediatr 1998;133:181-7.
Not T, Horvath K, Hill ID, Partanen J, Hammed A, Magazzu G, et al. Celiac disease risk in the USA: high prevalence of antiendomysium antibodies in healthy blood donors. Scand J Gastroenterol 1998;33:494-8.
Cronin CC, Shanahan F. Insulin-dependent diabetes mellitus and coeliac disease. Lancet 1997;349:1096-7.
Iovino P, Ciacci C, Sabbatini F, Acioli DM, D'Argenio G, Mazzacca G. Esophageal impairment in adult celiac disease with steatorrhea. Am J Gastroenterol 1998;93:1243-9.
Clemens, PC. Coeliac disease in adults with atypical symptoms [Letter]. Lancet 1996;347:1050.
Ciacci C, Cirillo M, Sollazzo R, Savino G, Sabbatini F, Mazzacca G. Gender and clinical presentation in adult celiac disease. Scand J Gastroenterol 1995;30:1077-81.
Trier JS. Celiac sprue and refractory sprue. In: Feldman M, Fordtran JS, Sleisenger MH, Scharschmidt BF, eds. Sleisenger & Fordtran's Gastrointestinal and liver disease: pathophysiology, diagnosis, management. 6th ed. Philadelphia: Saunders, 1998:1557-73.
Fine KD. The prevalence of occult gastrointestinal bleeding in celiac sprue. N Engl J Med 1996;334:1163-7.
Sher KS, Mayberry JF. Female fertility, obstetric and gynaecological history in coeliac disease. A case control study. Digestion 1994; 55:243-6.
Fotoulaki M, Nousia-Arvanitakis S, Augoustidou-Savvopoulou P, Kanakoudi-Tsakalides F, Zaramboukas T, Vlachonikolis J. Clinical application of immunological markers as monitoring tests in celiac disease. Dig Dis Sci 1999;44:2133-8.
Troncone R, Maurano F, Rossi M, Micillo M, Greco L, Auricchio R, et al. IgA antibodies to tissue transglutaminase: an effective diagnostic test for celiac disease. J Pediatr 1999;134:166-71.
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Hadjivassiliou M, Chattopadhyay AK, Davies-Jones GA, Gibson A, Grunewald RA, Lobo AJ. Neuromuscular disorder as a presenting feature of coeliac disease. J Neurol Neurosurg Psychiatry 1997;63: 770-5.
Hadjivassiliou M, Grunewald RA, Chattopadhyay AK, Davies-Jones GA, Gibson A, Jarratt JA, et al. Clinical, radiological, neurophysiological, and neuropathological characteristics of gluten ataxia. Lancet 1998;352:1582-5.
Pratesi R, Gandolfi L, Friedman H, Farage L, de Castro CA, Catassi C. Serum IgA antibodies from patients with coeliac disease react strongly with human brain blood-vessel structures. Scand J Gastroenterol 1998;33:817-21.
Pricolo VE, Mangi AA, Aswad B, Bland KI. Gastrointestinal malignancies in patients with celiac sprue. Am J Surg 1998;176:344-7.
Lewis HM, Renaula TL, Garioch JJ, Leonard JN, Fry JS, Collin P, et al. Protective effect of gluten-free diet against development of lymphoma in dermatitis herpetiformis. Br J Dermatol 1996; 135:363-7.
Holmes GK, Prior P, Lane MR, Pope D, Allan RN. Malignancy in coeliac disease--effect of a gluten free diet. Gut 1989;30:333-8.
Hoffenberg EJ, Haas J, Drescher A, Barnhurst R, Osberg I, Bao F, et al. A trial of oats in children with newly diagnosed celiac disease. J Pediatr 2000;137:361-6.
Janatuinen EK, Pikkarainen PH, Kemppainen TA, Kosma VM, Jarvinen RM, Uusitupa MI, et al. A comparison of diets with and without oats in adults with celiac disease. N Engl J Med 1995;333: 1033-7.

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Copyright © 2002 by the American Academy of Family Physicians.

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Heather is the Administrator of the IBS Message Boards. She’s the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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HeatherAdministrator

Reged: 12/09/02
Posts: 7353
Loc: Seattle, WA
Is it necessary to screen for celiac disease in postmenopausal osteoporotic women? new
      #14119 - 07/15/03 06:09 PM

Calcif Tissue Int. 2002 Aug;71(2):141-4. Epub 2002 Jul 24.

Is it necessary to screen for celiac disease in postmenopausal osteoporotic women?

Gonzalez D, Sugai E, Gomez JC, Oliveri MB, Gomez Acotto C, Vega E, Bagur A, Mazure R, Maurino E, Bai JC, Mautalen C.

Seccion Osteopatias, Hospital de Clinicas, University of Buenos Aires, (1114) Buenos Aires, Argentina. diana@bertini.com

Decreased bone mass is a frequent finding in celiac patients, and subclinical celiac disease (CD) appears to be unusually overrepresented among patients with idiopathic osteoporosis. Since silent CD may be more common than previously believed, it has been suggested that all osteoporotic patients should be checked for occult CD. The aim of this study was to explore the prevalence of CD in a well-defined population of postmenopausal osteoporotic women. We evaluated 127 consecutive postmenopausal patients (mean age: 68 years; range: 50-82 years) with verified osteoporosis. The observed prevalence of CD in this group was compared to that observed in a group of 747 women recruited for a population-based study. The screening algorithm used to diagnose CD was based on a 3-level screening using type IgA and IgG antigliadin antibodies (AGA) in all the patients (1st level) followed by antiendomysial antibodies (EmA) and total IgA (2nd level) of samples testing positive, and intestinal biopsy of positive cases (3rd level). At the end of the serological screening, only 1 of 127 osteoporotic women was eligible for jejunal biopsy showing a characteristic celiac flat mucosa (prevalence 7.9 x 1,000; 95% CI 0.2-43.1). In addition, CD was diagnosed in 6 of 747 women of the population-based study (prevalence: 8.0 x 1,000; 95% CI 3.3-18.3). There was no significant difference between the two groups. Therefore, our study showed that the prevalence of CD in postmenopausal osteoporotic women was lower than that reported in previous studies and similar to that of the general population. In conclusion, although the relatively small size of the group tested does not allow us to be conclusive, the results suggest that a case finding policy in postmenopausal osteoporosis would have a high cost/benefit ratio except for patients not responding to conventional therapies, or presenting borderline laboratory results.

PMID: 12200648 [PubMed - indexed for MEDLINE]
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Heather is the Administrator of the IBS Message Boards. She’s the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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HeatherAdministrator

Reged: 12/09/02
Posts: 7353
Loc: Seattle, WA
Celiac disease and spontaneous abortion new
      #14121 - 07/15/03 06:12 PM

Minerva Ginecol. 2002 Apr;54(2):151-9.

Celiac disease and spontaneous abortion

[Full Article in Italian]

Foschi F, Diani F, Zardini E, Zanoni G, Caramaschi P.

Istituto di Clinica Ginecologica e Ostetrica A, Universita degli Studi, Verona, Italy.

BACKGROUND: Over the last ten years it has become clear that the clinical expression of celiac disease is more heterogeneous than was thought in the past. Although celiac disease is a relatively frequent disease (1/170-200), it is only diagnosed in a small percentage of adult cases compared to the real situation because it is manifested with few symptoms or in an atypical form, or occasionally is completely silent. Gynecological problems have been reported in women with celiac disease, in particular delayed menarche, early menopause, sterility, recurrent abortion and fetal intrauterine growth retardation. The main aim of this study was to investigate the association between celiac disease and abortion, and in particular to evaluate whether patients suffering from recurrent spontaneous abortion might present an atypical or subclinical form of the disease. METHODS: During the period 1997-1998 a series of laboratory tests were carried out at the Department of Obstetrics and Gynecology and at the Institute of Medicine B of Verona University, in a sample of 184 women (149 from the Obstetrics Clinic and 35 from Internal Medicine B ). These tests included circulating anti-gliadin (AGA) and anti-endomysium (EMA) antibodies and total serum immunoglobulins. In positive cases, further diagnostic tests were performed using small bowel biopsy specimens. RESULTS: In our selected sample of cases, 5 women (2.7%) were positive for immunological screening against IgA-EMA and for bowel biopsy (confirmed diagnosis of celiac disease). Four of these women (2.1%) formed part of a group of patients with a positive history of spontaneous abortion and one (0.5%) was from the control group. CONCLUSIONS: An analysis of the cases that emerged from this study and those reported in the literature shows that tests to identify the celiac disease should be extended to the population with a risk of developing this disease. These subjects should include those with a family history or clinical symptoms, in particular women with a history of multiple abortions. In these cases, there are grounds for suspecting an atypical form of celiac disease.

PMID: 12032453 [PubMed - indexed for MEDLINE]
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Celiac disease: fertility and pregnancy. new
      #14122 - 07/15/03 06:14 PM

Gynecol Obstet Invest. 2001;51(1):3-7.

Celiac disease: fertility and pregnancy.

Eliakim R, Sherer DM.

Division of Gastroenterology, Rambam Medical Center, Technion School of Medicine, Haifa, Israel.

Celiac disease (gluten-sensitive enteropathy) may manifest clinically with an array of nongastrointestinal symptoms among which are: dermatitis herpetiformis; dementia; depression; various neurological symptoms; osteoporosis; osteomalacia; dental enamel defects, and anemia of various types. Important data have accumulated in recent years regarding the association between celiac disease, fertility and pregnancy. Many primary care obstetricians and gynecologists and perinatologists are not aware of these important relationships. The aim of this review, utilizing a MEDLINE search from 1966 through March 2000 of the English language, is to describe the possible effects of celiac disease and its treatment upon the reproductive cycle, fertility, pregnancy, and menopause. Review of the literature reveals that patients with untreated celiac disease sustain a significantly delayed menarche, earlier menopause, and an increased prevalence of secondary amenorrhea. Patients with untreated celiac disease incur higher miscarriage rates, increased fetal growth restriction, and lower birth weights. It appears that improvement of celiac disease, as reflected by restoration of small bowel mucosa associated with implementation of a gluten-free diet, may decrease miscarriage rates, improve fetal nutritional support and overall perinatal outcome. Copyright 2001 S. Karger AG, Basel.

Publication Types:
Review
Review, Tutorial

PMID: 11150866 [PubMed - indexed for MEDLINE]
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Against the grain: The growing awareness of celiac sprue new
      #17060 - 08/12/03 12:12 PM

Against the grain: The growing awareness of celiac sprue

The wide-ranging symptoms of the disease can disguise the intestinal disorder, but new tests are helping to make diagnosis easier.

By Susan J. Landers, AMNews staff. Aug. 18, 2003.


--------------------------------------------------------------------------------

True or false: Celiac disease is rarely seen in the United States. When Alessio Fasano, MD, born, raised and medically trained in Italy, first arrived on American shores, he would have said "true" without hesitation.

The intestinal disorder was common in his native country. One of his medical school mentors was an expert in the condition. And he already had treated celiac patients of all ages with a wide variety of symptoms ranging from diarrhea and abdominal pain to constipation, osteoporosis, anemia and even behavior changes.

But it also was widely accepted that Americans almost never harbor this illness, which is triggered in genetically susceptible people by gluten-containing foods. Dr. Fasano looked forward to the different experiences he thought would accompany his new position as professor of medicine, pediatrics and physiology at the University of Maryland School of Medicine in Baltimore.

Instead, he almost immediately began seeing patients who had the very familiar range of complaints.

Now, Dr. Fasano co-directs the University of Maryland's Center for Celiac Research and focuses on spreading a different truth among primary care physicians. Celiac disease actually is one of the most common lifelong disorders in the United States -- American doctors just had not been trained to look for it.

This task -- making physicians more aware about celiac disease -- runs counter to much of American conventional wisdom about the disorder's incidence. Thus, Dr. Fasano and colleagues decided that mounting a large-scale study was necessary to gather the evidence that celiac disease affected many patients.

One in 133 Americans is at risk for celiac disease.
They hypothesized that because the necessary components for the disease almost certainly were present in the United States -- both the genetic background and the gluten trigger -- there either was a third element at work that prevented the interplay of the components or the disorder was being overlooked.

After screening more than 13,000 people in 32 states, they found that the latter assertion proved true. One in 133 Americans is at risk for celiac disease.

Those figures, published in the Feb. 10 Archives of Internal Medicine, demonstrated a tremendous increase from the one in 4,700 Americans who had been diagnosed up until that point. Estimates of the prevalence of celiac disease, also called celiac sprue, now range from one in 100 to one in 300.

"Whichever way you look at it, it's a very large number of people," said Chaitan Khosla, PhD, a professor of chemistry at Stanford (Calif.) University, who started the Celiac Sprue Research Foundation after his son and wife were diagnosed with the disease.

The disorder also can be found in many of the world's populations, he said, "pretty much all the way from the Indian subcontinent to Eastern and Western Europe as well as Northern Africa."

The fact that it is not always recognized in the United States doesn't surprise Joseph Murray, MD, professor of medicine at the Mayo Clinic in Rochester, Minn. Originally from Ireland, where celiac disorder is considered a very common ailment, and trained in medicine at the University of Galway, he never expected to confront the disease again once he arrived in the New World. "I came to study another part of the digestive system, and celiac disease kind of came along and bit me on the leg."

Celiac disease is often overlooked in the U.S.
He attributes celiac's lack of American celebrity to the fact that there are a lot of diseases, and places in the medical school curriculum are reserved for those that are either very big, such as cancer or heart disease, or very noticeable.

"It has to be a classic something," he said. Celiac disease doesn't fit this description -- it often presents atypically, "so it's not what you're expecting."

Others would agree. "It falls into that category of squirrelly disorders that show themselves in many different ways," Dr. Khosla said. Dr. Fasano described it in the June 19 New England Journal of Medicine as a "clinical chameleon."

Despite this shifty nature, celiac disease can be suspected if a patient complains of chronic diarrhea that's been going on for several weeks; has other autoimmune diseases such as type 1 diabetes, thyroid disorders, some types of arthritis or lupus, or if they have a family history of those disorders; or is anemic and the condition cannot be easily explained, Dr. Murray said.

Dr. Fasano defined the disease even more broadly. "You can have vomiting, bloating or constipation, or you can have symptoms that have nothing to do with the gastrointestinal system, such as chronic fatigue syndrome, joint pain, osteoporosis, depression or miscarriage."

Many people with the disorder go undiagnosed for years. The typical time between the onset and diagnosis in the United States is 11 to 13 years. Sometimes the disease is triggered by severe emotional stress, surgery, pregnancy or viral infections.

The disease is split about 50/50 between being a disease of children and a disease of adults, Dr. Fasano said. In textbooks, it is likely to be described as a pediatric condition with the typical symptoms of diarrhea and big belly developing a few weeks after grains are introduced into a child's diet. If there is anything like a classic form of this condition, it is the one diagnosed in very young children.

"During the past two decades, however, the clinical picture of the disease has changed to include milder forms, thus resulting in an upward shift of the age at diagnosis," writes Maki Markku, MD, PhD, of the Pediatric Research Center in Tampere, Finland, also in the June 19 NEJM.

Testing one, two, three
The disease can be detected in patients via blood tests. And these readily available screens put the power to consider the disorder in the hands of the primary care physician.

That's a good thing, according to the experts. After all, it's the primary care physicians who are seeing most of the patients with celiac disorder, although they might not know it. "If a primary care doctor has 2,000 to 3,000 patients, then he or she is likely to have 10 or 15 patients with celiac disease. That's not a small number for a chronic disease," Dr. Murray said.

Celiac's only treatment is to avoid foods with gluten.
Negative blood test results can rule out the disease, while a positive finding indicates there's a good chance a patient has it.

But these outcomes are not entirely clear cut.

One problem with the blood test is that it will result in a negative finding if patients already have eliminated gluten from their diets.

A way to circumvent this problem is to order a DNA test, which doesn't require the presence of antibodies to gluten to confirm the presence of the disease. The diagnostic gold standard, however, is a biopsy of the intestine performed when a patient has eaten gluten-containing food and the resulting damage to the villi lining the intestine can be verified.

Dr. Khosla urges primary care physicians to consider sending patients for a blood test the day they present with symptoms and before they make dietary changes.

He would also like to see an even simpler pin-prick blood test developed as a diagnostic tool that could be on hand in every primary care physician's office. "But it is just not on the radar screen, because primary care physicians aren't saying they have a need for it."

Changes for life
Once diagnosed, the effective, albeit difficult, treatment is to avoid eating anything containing gluten. Foods that contain wheat, rye, oats and barley must be eliminated from the diet. There are also hidden sources of gluten in many foods and even in prescription medications. Labels sometimes identify them as "vegetable" or "plant" protein.

The good news is that avoiding gluten allows damaged intestinal villi to heal and an individual to fully recover. Advocates are lobbying Congress for passage of food labeling legislation that clearly indicates which foods are off limits. Europe has adopted a universal sign of wheat with a line through it to indicate safe products.

Dr. Khosla is very familiar with the implications of diet and the changes celiac disease has made necessary in his life. "We've learned to keep a gluten-free kitchen. I would say on average, if someone asked me the difference between my kitchen now and my kitchen seven years ago [before his son was born], the primary difference is higher grocery bills."

But these costs are nothing compared with the high price patients can pay if the disorder is not adequately diagnosed and treated. Quality of life is one thing. Stomachaches and gas make it hard for individuals to socialize. Additional consequences include short-term memory loss and depression.

Miscarriages and osteoporosis also are among the complications. Dr. Fasano recently spoke with a woman who was diagnosed with celiac disease at age 46. She had experienced nine miscarriages, and her diagnosis came too late to allow her to have children.

"I can't do anything for her now because she is in menopause and has lost the opportunity to have a baby," he said.

Lymphoma is the scariest complication of undiagnosed celiac disease, although it is extremely rare, Dr. Fasano said. "But the chances of developing other autoimmune diseases as a consequence of celiac disease, like type 1 diabetes, are well described," he said. "And that is a travesty."

There are efforts under way to find a cure other than dietary restrictions, and Dr. Khosla hopes to hasten its discovery through the work of his foundation. "If this was like GERD [gastroesophageal reflux disease] or any other gastrointestinal disorder for which there are good treatments, there wouldn't be any room for a nonprofit organization to do what is typically done by the pharmaceutical industry."

Others agree that an alternate treatment or even a cure is not impossible in the next five or 10 years. After all, celiac disorder is unique in that it is the only autoimmune disease for which all elements are known, Dr. Fasano said. The trigger, gluten, is well understood. And the genes involved, though there may be more, also are known, as is the part of the body that is attacked.

"For scientists, that is the blessing. I believe we will come up with a cure," he said.

That's what Dr. Khosla hopes is in store for his young son.

"I have a dream that when he goes to college in the fall of 2014, he takes with him a refillable prescription for a pill he can take whenever he finds himself in a situation where he cannot avoid, or does not wish to avoid, a gluten-containing meal."


--------------------------------------------------------------------------------


Symptoms:
Behavior change
Bone pain
Chronic diarrhea
Dermatitis herpetiformis
Joint pain
Muscle cramps
Pale sores inside mouth
Recurring abdominal bloating and pain
Seizures
Tooth discoloration
Unexplained anemia
Weight loss
Source: National Institute of Diabetes & Digestive & Kidney Diseases

--------------------------------------------------------------------------------

Diagnosis
Blood tests are available to measure levels of antibodies to gluten, which is found in wheat, rye and barley, as well as other foods and some pharmaceutical products.
If the blood tests suggest celiac disease, a biopsy of the intestine would confirm the disease.
Blood tests and biopsy should be completed before an individual begins a gluten-free diet.
Source: National Institute of Diabetes & Digestive & Kidney Diseases

--------------------------------------------------------------------------------

Weblink
Celiac Disease Foundation (www.celiac.org)

Celiac Sprue Assn. (www.csaceliacs.org)

University of Maryland Center for Celiac Research (www.celiaccenter.org)

Celiac Sprue Research Foundation (www.celiacsprue.org)

--------------------------------------------------------------------------------

Copyright 2003 American Medical Association. All rights reserved.

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Celiac disease is a risk factor for schizophrenia new
      #46425 - 02/24/04 02:13 PM

Celiac disease is a risk factor for schizophrenia

Public release date: 19-Feb-2004

Contact: Tim Parsons
paffairs@jhsph.edu
410-955-6878
Johns Hopkins University Bloomberg School of Public Health

People with a history of the digestive disorder celiac disease are three times more likely to develop schizophrenia than those without the disease, according to a report by Danish researchers and a researcher at the Johns Hopkins Bloomberg School of Public Health. The report is published in the February 21, 2004, edition of the British Medical Journal.

Celiac disease is an autoimmune disorder that impairs the body's ability to digest the protein gluten, which is found in grains and many other foods. The condition can lead to diarrhea, weight loss and malnutrition. William W. Eaton, PhD, lead author of the report and interim chair of the Department of Mental Health at the School of Public Health, said, "For years, scientists have suspected a link between celiac disease and schizophrenia. Our research shows that the link is moderately strong."

Dr. Eaton and his colleagues examined the records of 7,997 schizophrenic patients admitted to a Danish psychiatric facility for the first time between 1981 and 1998. Those records were compared to Denmark's national patient register to determine if the schizophrenic patients or their parents were previously treated for celiac disease. The researchers also looked for diagnosis of similar digestive disorders not previously associated with schizophrenia, which included dermatitis herpetiformis, Crohn's disease and ulcerative colitis. The researchers found a small number of schizophrenic patients were previously treated for celiac disease or had a parent treated for celiac disease. Both conditions are rare. The prevalence of celiac disease among schizophrenics was 1.5 cases per 1,000 compared to 0.5 cases per 1,000 in the larger control group.

After adjusting for other factors associated with schizophrenia, the researchers determined that the risk of schizophrenia was three times greater with a history of celiac disease. Crohn's disease and ulcerative colitis were not associated with an increased risk of schizophrenia.

"More research is needed to understand the link between celiac disease and schizophrenia. The most important question is whether treatment for celiac disease, in the form of a gluten-free diet, would benefit the small proportion of individuals with schizophrenia who are genetically prone to celiac disease but have not been diagnosed with it," said Dr. Eaton.


"Coeliac disease and schizophrenia: population based case control study with linkage of Danish national registers" was written by William W. Eaton, Preben Bo Mortensen, Esben Agerbo, Majella Byrne, Ole Mors and Henrik Ewald. Mortensen, Agerbo and Byrne are with the National Centre for Register-Based Research, Aarhus University, Denmark. Mors and Ewald are with the Institute of Basic Psychiatric Research, Aarhus, Denmark.

The research was funded by the Danish National Research Foundation, Stanley Medical Research Institute and the National Institute for Mental Health.

http://www.eurekalert.org/pub_releases/2004-02/jhub-cdi021804.php

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Oats Safe for Celiac in Children new
      #64835 - 04/26/04 01:08 PM

Oats to children with newly diagnosed coeliac disease: a randomised double blind study

L Högberg1, P Laurin2, K Fälth-Magnusson2, C Grant3, E Grodzinsky4, G Jansson5, H Ascher6, L Browaldh7, J-Å Hammersjö8, E Lindberg9, U Myrdal10 and L Stenhammar1

1 Department of Paediatrics, Norrköping Hospital, Sweden, and Department of Paediatrics, Linköping University Hospital, Sweden

2 Department of Paediatrics, Linköping University Hospital, Sweden

3 Laboratory Medicine Östergötland, Pathology, Norrköping Hospital, Sweden

4 Development Unit for Primary Care and Psychiatry, County Council in Östergötland, Sweden

5 Department of Paediatrics, Motala Hospital, Sweden

6 Department of Paediatrics, The Sahlgrenska Academy, Göteborg University, Göteborg, Sweden

7 Department of Paediatrics, Sachsska Hospital, Stockholm, Sweden

8 Department of Paediatrics, Västervik Hospital, Sweden

9 Department of Paediatrics, Örebro University Hospital, Sweden

10 Department of Paediatrics, Västerås Hospital, Sweden


Correspondence to:
Dr L Högberg

Department of Paediatrics, Linköping University, Norrköping Hospital, SE-601 82 Norrköping, Sweden; lotta.hogberg@lio.se

Background: Treatment of coeliac disease (CD) requires lifelong adherence to a strict gluten free diet (GFD) which hitherto has consisted of a diet free of wheat, rye, barley, and oats. Recent studies, mainly in adults, have shown that oats are non-toxic to CD patients. In children, only open studies comprising a small number of patients have been performed.

Aim: To determine if children with CD tolerate oats in their GFD.

Patients and methods: In this double blind multicentre study involving eight paediatric clinics, 116 children with newly diagnosed CD were randomised to one of two groups: one group was given a standard GFD (GFD-std) and one group was given a GFD with additional wheat free oat products (GFD-oats). The study period was one year. Small bowel biopsy was performed at the beginning and end of the study. Serum IgA antigliadin, antiendomysium, and antitissue transglutaminase antibodies were monitored at 0, 3, 6, and 12 months.

Results: Ninety three patients completed the study. Median (range) daily oat intake in the GFD-oats group (n = 42) was 15 (5–40) g at the six month control and 15 (0–43) g at the end of the study. All patients were in clinical remission after the study period. The GFD-oats and GFD-std groups did not differ significantly at the end of the study regarding coeliac serology markers or small bowel mucosal architecture, including numbers of intraepithelial lymphocytes. Significantly more children in the youngest age group withdrew.

Conclusions: This is the first randomised double blind study showing that the addition of moderate amounts of oats to a GFD does not prevent clinical or small bowel mucosal healing, or humoral immunological downregulation in coeliac children. This is in accordance with the findings of studies in adult coeliacs and indicates that oats, added to the otherwise GFD, can be accepted and tolerated by the majority of children with CD.

http://gut.bmjjournals.com/cgi/content/abstract/53/5/649

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No Link Apparent Between IBS and Celiac Disease new
      #65454 - 04/27/04 09:01 PM

No Link Apparent Between IBS and Celiac Disease

NEW YORK (Reuters Health) Apr 13 - The results of a study of local residents by researchers at the Mayo Clinic College of Medicine, Rochester, Minnesota, show no association between irritable bowel syndrome (IBS) and celiac disease.

There have been reports of a particularly high prevalence of celiac disease in patients with IBS, Dr. G. Richard Locke III and colleagues note in the April issue of the Mayo Clinical Proceedings. They also point out that serological testing offers a sensitive and specific means of identifying celiac disease.

Ten percent of the population has symptoms consistent with IBS, Dr. Locke told Reuters Health. Since the symptoms of celiac disease and IBS are similar, it has been suggested that these patients may have undiagnosed celiac disease.

To investigate, the researchers conducted a case-control study, based on the results of a bowel disease questionnaire sent to a random sample of Olmsted County residents between the ages of 20 and 50 years.

One hundred fifty subjects were evaluated. These included 72 respondents who reported symptoms of IBS and dyspepsia and 78 controls who reported no notable gastrointestinal symptoms. Overall, 50 had IBS, 24 had dyspepsia and 15 had both conditions.

However, serological testing showed no significant difference in celiac disease distribution among groups. In all, two controls tested positive for celiac disease (2.6%), as did two subjects with IBS (4.0%) and two with dyspepsia (5.9%). Celiac disease, the team concludes, "did not explain the presence of either IBS or dyspepsia in these subjects."

"Our study," Dr. Locke added, "shows that celiac disease is an uncommon cause of IBS symptoms in the community."

He and his colleagues suggest that "selection bias possibly explains in part the increased prevalence of celiac disease reported in outpatients with IBS and dyspepsia."

Mayo Clin Proc 2004;79:476-482.
http://www.medscape.com/viewarticle/473449?src=mp


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Celiac Disease: Where We Are and Where We Are Going new
      #83754 - 06/27/04 01:58 PM

Celiac Disease: Where We Are and Where We Are Going

Alessio Fasano, MD

New Orleans, Tuesday, May 18, 2004 --

Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten-containing grains (including wheat, rye, and barley) in genetically susceptible individuals. CD is associated with HLA molecules DQ2 (90%-95%) and DQ8 (5%-10%), and in the continued presence of gluten the disease is self-perpetuating. CD is one of the most common lifelong disorders worldwide. This condition can manifest with a previously unsuspected range of clinical presentations. These include the typical malabsorption syndrome (chronic diarrhea, weight loss, bloating) and a spectrum of symptoms potentially affecting any organ or body system. Because CD is often atypical or even silent on clinical grounds, many cases remain undiagnosed and become exposed to the risk of long-term complications, such as osteoporosis, infertility, or cancer. There is also a growing interest in the social dimension of CD, because the burden of illness related to this condition is doubtless higher than previously thought.

Many aspects of CD were discussed during this year's Digestive Disease Week (DDW) meeting that may help pave the way for future breakthroughs concerning the pathogenesis, diagnosis, and, most important, alternative treatment options.

The Genetics
The major component of the genetic predisposition to CD resides in the HLA region of chromosome 6. CD is strongly associated with HLA class II antigens, and approximately 90% of cases show a particular DQ2 alpha/beta heterodimer, with the remaining cases being HLA DQ8-positive. Therefore, the presence of HLA DQ2 and/or DQ8 is considered absolutely essential and their absence essentially rules out CD. The latter already has applications in clinical practice, particularly in those cases in which the diagnosis has not been validated by the currently recommended diagnostic algorithm. However, the HLA alleles explain only part of the genetic susceptibility to CD. In most European and North American populations, the frequency of DQ2 is high (15%-30%), but only a minority of DQ2-positive subjects develop CD. In the absence of strong functional candidate genes, several genome-wide scans in families with affected sib-pairs have been conducted. Although no additional susceptibility loci have been clearly identified thus far, there is some evidence of a genetic risk factor on chromosomes 5q and 11p11.[1]

The Immunopathology
The celiac enteropathy is the result of immune-mediated damage to the small intestinal mucosa. The cascade of pathophysiologic events most likely starts with an alteration in the barrier function and/or increased transcellular passage of gluten through the small intestinal mucosa. In the lamina propria, the tissue transglutaminase (tTG), a ubiquitous enzyme that catalyzes the cross-linking of proteins, deamidates gliadin peptides, strongly increasing their affinity for the HLA molecules located on the membrane of antigen-presenting cells (APC; eg, the macrophages). The HLA molecule forms a "groove" where short peptides (eg, a product of gliadin digestion) can be specifically linked. Among these fragments, the recently described 33-mer seems to be the most intriguing gliadin fragment, given its exceptional resistance to intraluminal as well as surface digestion and its immunodominant motifs particularly suited to bind to T lymphocytes either directly or following manipulation by APC.[2] Ultimately, the interaction between gliadin peptides and HLA molecules activates intestinal T cells. The release of proinflammatory cytokines (eg, interferon-gamma) by activated T cells could determine the damage to the enterocyte, increased proliferation in the intestinal crypts, and, finally, severe damage to the intestinal mucosa architecture.

The Epidemiology
Traditionally, CD was perceived as a rare disorder typical of infancy, with wide incidence fluctuation in space and time, and confined to the European population. Both evolutionary and epidemiologic observations suggested an inverse relationship between CD frequency and the introduction of wheat with agriculture. However, this theory is now challenged by recent epidemiologic studies showing that, beside being frequently found in countries where individuals are mostly of European origin, CD is a common disorder in many areas of the developing world where agriculture started 10,000 years ago.

It is interesting to note that the highest frequency of CD in the world has actually been reported among the Saharawi refugees, an inbred population of Berber-Arabic origin. These results raise an interesting question: Why is a disease that is associated with a high rate of morbidity and increased mortality, if left untreated, not segregated out by genetic evolution? The disease has remained one of the most frequent genetically based disorders of humankind. One possible explanation is that gluten, a protein introduced in large quantities in the human diet only after the advent of agriculture, activates "by mistake of evolution" mechanisms of innate immunity that are too important for human survival to be eliminated.

Treatment
One of the most innovative aspects of today's session on CD was discussion of the possible alternatives to the gluten-free diet that can be developed based on the new pathophysiologic findings discussed above. Inhibition of the gliadin-induced increased permeability of the intestinal barrier is a strategy already applied in the setting of type-1 diabetes, a disease that shares a leaky gut pathology with CD.[3] The digestion of the proteolytic-resistant gliadin peptides (33-mer) using bacterial-derived prolyl endopeptidase is another attractive therapeutic strategy. This enzyme has already been used to predigest gliadin with interesting preliminary results in human trials that need to be confirmed on a larger scale.[4] The inhibition of the tTG deamidating activity is another theoretical strategy for treatment; however, the caveat of affecting other important functions of the enzyme, such as wound repair, requires further scrutiny. Finally, the recently reported crystallographic data on gliadin binding on the T-lymphocyte groove offer the possibility to block the receptor using synthetic peptide inhibitors.

Concluding Remarks
CD is a common disorder in children as well as adults. At any age, the spectrum of clinical presentations is wide, and at present, extraintestinal manifestations (eg, anemia or short stature) are more common than the classical malabsorption symptoms. A high degree of awareness among healthcare professionals and a "liberal" use of serologic CD tests (case findings) can help to identify many of the atypical cases. Although the gluten-free diet currently remains the cornerstone of treatment for CD, new perspectives are on the horizon that may help disclose a better future for all individuals affected with this condition.

References
Fasano A. Prevalence and genetics. In: AGA Clinical Symposium -- Celiac Disease Clinical Symposium. Program and abstracts of Digestive Disease Week 2004; May 15-20, 2004; New Orleans, Louisiana. [Sp418]
Sollid LM. Immunology. In: AGA Clinical Symposium -- Celiac Disease Clinical Symposium. Program and abstracts of Digestive Disease Week 2004; May 15-20, 2004; New Orleans, Louisiana. [Sp 419]
Sapone A, Warrs T, Counts D, et al. Inhibition of the zonulin-dependent increased intestinal permeability prevents the onset of type 1 diabetes in BB/Wor rats. Gastroenterology. 2004;126(suppl 2):A-518. [T1820]
Gray GM. Treatment. In: AGA Clinical Symposium -- Celiac Disease Clinical Symposium. Program and abstracts of Digestive Disease Week 2004; May 15-20, 2004; New Orleans, Louisiana. [Sp 419]




Copyright © 2004 Medscape.

http://www.medscape.com/viewarticle/478293


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Gastrointestinal Motility Disturbances in Celiac Disease. new
      #105354 - 09/12/04 03:27 PM

Gastrointestinal Motility Disturbances in Celiac Disease.

Journal of Clinical Gastroenterology. 38(8):642-645, September 2004.
Tursi, Antonio MD

Abstract:
It is quite frequent to recognize celiac patients who show gastrointestinal motor abnormalities in clinical practice. In fact, in 30 to 60% of patients, physical examination and dyspeptic symptoms (epigastric discomfort, early satiety) suggest a gastrointestinal motility disorder. Consistent data are now available on the presence of a disturbed motility of the esophagus, stomach, small intestine, gallbladder, and colon of untreated celiac patients. Gastrointestinal abnormalities differ in different gastrointestinal districts. In fact, esophageal transit, gastric and gallbladder emptying, and orocecal transit time are delayed, while colonic transit is faster. These findings are related to the complex interactions among reduced absorption of food constituent (in particular, fat), neurologic alteration, and hormonal derangement. Motility disorders of the gut are also a predisposing factor in the development of small intestinal bacterial overgrowth and may contribute both to development of symptoms in some untreated celiacs and to the persistence of symptoms after gluten-free diet in some of them. All these alterations fortunately disappear after gluten-free diet, and patients return to well being status.

Whatever the initial event in the pathogenesis of the celiac lesions may be, we know for certain at this time that gastrointestinal disturbances play an important role in the genesis of gastrointestinal symptoms in celiac disease and that surveillance for celiac disease in patients complaining of dysmotility-like dyspeptic symptoms should be increased.

(C) 2004 Lippincott Williams & Wilkins, Inc.

http://www.mdlinx.com/GILinx/thearts.cfm?artid=1041735&specid=13&ok=yes

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Relief for celiac patients new
      #183764 - 06/05/05 05:48 PM

Relief for coeliac patients

An easy-to-use tool for the detection of gluten in foods will be developed in an EU-funded project designed to help people with coeliac disease avoid problem foods.

Gluten, which causes the symptoms of the disease, is common in many foodstuffs, even if the product itself is not a cereal product, and due to its increasing use as a food additive its presence in many products is not immediately obvious.

Scientists in the project will use new knowledge on the development of reliable and easy to handle test systems for the detection of gluten in food products.

Coeliac disease affects approximately 1million Europeans. The intolerance to gluten causes damage to the small intestine mucosa which is reversible with avoidance of dietary gluten. The damaged mucosa disturbs the absorption of water and nutrients. This can cause malnutrition, which can be severe, especially for small children and adolescents. Coeliac disease is different from allergy: some people with wheat allergies are not gluten intolerant and can eat rye and barley. According to present knowledge, oats can be consumed by coeliac patients.

The symptoms of coeliac disease can vary with each individual and they do not always involve the digestive system. They can range from no symptoms at all, to severe ones, such as gas, bloating, diarrhoea, abdominal pain, irritability, muscle cramps or fatigue. Because of the broad range of symptoms that coeliac disease presents, it can be difficult to diagnose.

http://www.nutraingredients.com/news/ng.asp?id=37123

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Babies at Celiac Disease Risk Should Wait for Wheat new
      #187582 - 06/20/05 04:24 PM

Babies at Celiac Disease Risk Should Wait for Wheat

Timing of first gluten in diet could help ward off the illness, study suggests.

By Serena Gordon
HealthDay Reporter

WEDNESDAY, May 18 (HealthDay News) -- New parents with a family history of either celiac disease or type 1 diabetes should be very careful about when they introduce wheat into their baby's diet, a new study suggests.

Researchers found that if wheat was introduced before 3 months of age or after 7 months, the risk of developing celiac disease was increased compared to babies who had their first taste of wheat when they were between 4 and 6 months old.

"Children fed wheat, barley or rye cereals in the first three months had a fivefold increased risk [for developing celiac disease] compared to children who didn't have those cereals until they were 4 to 6 months old," said study co-author Jill Norris, head of the section of epidemiology and community health at the University of Colorado at Denver and Health Sciences Center.

"Children who had cereals after 6 months had a small increase -- about a twofold increased risk," Norris said.

Norris and her colleagues published their findings in the May 18 issue of the Journal of the American Medical Association.

Celiac disease is an autoimmune disorder that causes the body to perceive gluten, a protein substance found in wheat, rye and barley, as harmful. As a result, the small intestine becomes damaged from the immune system's ongoing assault on gluten. Eventually, the small intestine becomes so damaged it can no longer process nutrients from other foods, and serious nutritional deficits can occur.

The disease is inherited and researchers have identified several genes associated with celiac disease autoimmunity. Not everyone with the gene defects, however, develops celiac disease.

All of the children in the study had known genetic defects that put them at greater risk of developing the disease, and Norris was quick to point out that because all of the children in her study were at increased risk to begin with, these findings do not apply to the general population of newborns.

Another important issue this study wasn't able to address is whether the early -- or late -- introduction of gluten into the diet contributed to the development of celiac disease, or simply accelerated the appearance of the illness, Norris said.

Between 1994 and 2004, Norris and her colleagues identified 1,560 newborns from the Denver area at increased risk of celiac disease, either because they carried a genetic mutation associated with celiac disease or had a first-degree relative with type 1 diabetes. The genetic defects associated with celiac disease are the same as those for type 1 diabetes, so a family history of type 1 diabetes is also a risk factor for celiac disease, Norris explained.

The investigators tracked health outcomes in each of the babies for an average of five years, interviewing parents, checking each child's blood for signs of celiac disease, and monitoring the youngsters' diets.

Fifty-one children developed celiac disease during the study, the researchers report. Children fed products containing gluten before they were 3 months old faced more than a fivefold increase in risk for the illness, while children first fed gluten products during their seventh month or later were at a slightly less than twofold increased risk of the disease, compared to babies fed gluten between 4 and 6 months.

Norris said the researchers weren't able to learn exactly why early and late wheat introduction was associated with the development of celiac disease, but she suspects that young babies' digestive systems are too immature to process gluten, a complex protein. This may cause some gluten to cross into the bloodstream, where the immune system would start to attack it.

And, in the case of those introduced to wheat later, Norris said they may simply be getting exposed to more gluten at once because older babies take in much larger amounts of food per meal than newborns.

While calling the trial a "welcome study, and the first to suggest that timing [of first wheat ingestion] may be a risk factor," Dr. Richard Farrell, an assistant professor of medicine at Harvard Medical School, said these findings must also be interpreted with caution.

"Only three infants actually exposed to gluten before four months developed celiac disease," noted Farrell, who wrote an accompanying editorial in the same issue of the journal. He said a much larger study needs to be done to corroborate the findings.

"As the editorial author said, this study leaves 'too many questions' unanswered," added Angela Kurtz, a pediatric nutritionist from New York University Medical Center.

Kurtz said previous research has shown a protective effect from breast milk, and she pointed out that this study did not address the potential effects breast-feeding might have on the development of celiac disease.

She recommends breast-feeding children exclusively until they reach 6 months of age. Then, when babies start eating solid food, Kurtz recommends starting with rice cereals, or fruits or vegetables.

"Hold off on wheat, rye and barley, and when you do introduce them, only give small amounts once a day," she said.

Both Norris and Farrell said the results of this study are far too preliminary to recommend any changes to the current feeding guidelines, which suggest beginning solid foods at 4 to 6 months of age.

More information

To learn more about celiac disease, visit the Celiac Disease Foundation.


SOURCES: Jill Norris, Ph.D., M.P.H., professor and head, epidemiology and community health, University of Colorado at Denver and Health Sciences Center, Denver; Richard Farrell, M.D., assistant professor, medicine, division of gasteroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; Angela Kurtz, M.S., R.D., pediatric nutritionist, New York University Medical Center, New York City; May 18, 2005, Journal of the American Medical Association

http://www.principalhealthnews.com/article/hscoutn/104095771

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Non-Toxic Wheat May Be an Answer to Celiac Disease new
      #221832 - 10/28/05 11:57 AM

Non-Toxic Wheat May Be an Answer to Celiac Disease

NEW YORK (Reuters Health) Oct 14 - It may be possible to produce varieties of wheat that can be safely consumed by patients with celiac disease, according to Dutch researchers.

"Our work," lead investigator Dr. Liesbeth Spaenij-Dekking told Reuters Health "indicates that not all wheat varieties appear to be equally harmful for patients. This suggests that through breeding programs new varieties may be generated that will be acceptable for consumption by celiac disease patients. Moreover, such varieties may be used to prevent disease in individuals at risk."

In the September issue of Gastroenterology, Dr. Spaenij-Dekking of Leiden University Medical Center and colleagues note that it unknown whether all wheat types are of equivalent toxicity for patients with celiac disease.

To investigate, the researchers examined wheat gluten protein information contained in public databases. The aim was to find varieties low in the T-cell stimulatory sequences that prompt celiac disease.

The team found that ancient grass-like wheat varieties had less gluten, but subsequent breeding led not only to an increase in yield, but an increase in gluten and potential toxicity.

Eventually the researchers assayed samples of 16 wheat varieties, only 2 of which are commercially available, and found that there were considerable differences in the levels of T-cell- stimulatory epitopes.

Thus they conclude that through breeding and screening, "varieties may be identified with a reduced or even absent toxicity profile for celiac disease patients."

In an accompanying editorial, Dr. Marco Londei and colleagues at University College London characterize the study as providing important information, but among caveats, point out that the commercially viability of growing "less toxic" wheat varieties is open to question.

Gastroenterology 2005;129:797-806,1111-1113.

http://www.medscape.com/viewarticle/514562?src=mp

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Gluten-Free Diet in Patients Diagnosed With Diarrhea-Predominant Irritable Bowel Syndrome new
      #311397 - 07/17/07 11:18 AM

Predictors of Clinical Response to Gluten-Free Diet in Patients Diagnosed With Diarrhea-Predominant Irritable Bowel Syndrome

Ulrich Wahnschaffe, , , Jörg–Dieter Schulzke‡, Martin Zeitz‡ and Reiner Ullrich‡
‡Medical Clinic I (Gastroenterology/Infectious diseases/Rheumatology), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
Medical Clinic A, Department of Gastroenterology, Endocrinology and Nutritrion, University Hospital Ernst Moritz Arndt Universität Greifswald, Greifswald, Germany


Refers to: Exam 2: Predictors of Clinical Response to Gluten-Free Diet in Patients Diagnosed With Diarrhea-Dominant Irritable Bowel Syndrome
Clinical Gastroenterology and Hepatology, Volume 5, Issue 7, July 2007, Page 769
U. Wahnschaffe

Background & Aims: Gluten sensitivity might cause abdominal symptoms in the absence of villous atrophy. We examined the prevalence of celiac disease–associated serum antibodies in diarrhea-dominant irritable bowel syndrome (d-IBS) patients and their efficacy in combination with HLA-DQ2 expression to predict the response to gluten-free diet.

Methods: HLA-DQA1*0501/DQB1*0201 expression and celiac disease–associated IgA and IgG serum antibodies against gliadin and tissue-transglutaminase were measured in 145 patients with d-IBS, 74 patients with untreated and treated celiac disease, and 57 patients with active IBD. Follow-up antibody levels, stool frequency, and gastrointestinal symptom scores were determined in 41 d-IBS patients (26 women, 15 men; median age, 46 years, range, 30–67 years) who participated in a nonrandomized evaluation of 6 months of gluten-free diet.

Results: Increased celiac disease–associated serum IgG, but not IgA, was found in the majority of patients with treated (55%) as in most patients with untreated celiac disease (97%). In d-IBS patients, celiac disease–associated serum IgG antibodies (37%) and HLA-DQ2 expression (39%) were more frequent than in IBD patients (18% and 23%, respectively). After 6 months of gluten-free diet, stool frequency and gastrointestinal symptom score returned to normal values in 60% of d-IBS patients who were positive and in 12% who were negative for HLA-DQ2 and celiac disease–associated serum IgG; both parameters combined yielded positive and negative predictive values of 56% (95% confidence interval, 30%–80%) and 88% (69%–97%), respectively.

Conclusions: Celiac disease–associated serum IgG and HLA-DQ2 expression can identify likely responders to gluten-free diet in d-IBS patients.

Clinical Gastroenterology and Hepatology
Volume 5, Issue 7, July 2007, Pages 844-850


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Effect of gluten-free diet and co-morbidity of irritable bowel syndrome-type symptoms on celiac patients new
      #343424 - 03/18/09 05:46 PM

Dig Liver Dis. 2007 Sep;39(9):824-8.


Effect of gluten-free diet and co-morbidity of irritable bowel syndrome-type symptoms on health-related quality of life in adult coeliac patients.

Usai P, Manca R, Cuomo R, Lai MA, Boi MF.
Gastroenterology Unit, University of Cagliari, S.S. 554 Bivio per Sestu, 09042 Monserrato (CA), Italy.

BACKGROUND: Both coeliac disease and irritable bowel syndrome show impaired health-related quality of life, however, the impact of irritable bowel syndrome-type symptoms on health-related quality of life in coeliac disease is unclear.

AIM: To evaluate the effect of gluten-free diet adherence and irritable bowel syndrome-type symptoms co-morbidity on health-related quality of life in adult coeliac disease patients.

PATIENTS AND METHODS: A total of 1130 adults were enrolled in the study comprising 1001 controls from the general population and 129 diagnosed coeliac disease patients from the University Clinic in Cagliari. Irritable bowel syndrome-type symptoms and health-related quality of life were assessed using the Rome II and the SF-36 questionnaires, respectively.

RESULTS: Irritable bowel syndrome-type symptoms prevalence in controls was 10.1% (102/1001) and 55% (71/129) in the coeliac disease patients. Irritable bowel syndrome-type symptom controls and coeliac disease patients both presented significantly lower health-related quality of life (p<or=0.05) compared to healthy controls. Strict diet coeliac disease patients, compared to partial diet patients, showed significantly (p<or=0.05) better scores in all domains, except physical functioning, physical-role and bodily pain. The lowest scores were found in partial diet coeliac disease patients with irritable bowel syndrome-type symptoms.

CONCLUSIONS: The present results confirm the burden of irritable bowel syndrome-type symptoms and coeliac disease on health-related quality of life. Moreover, these data show that health-related quality of life in coeliac disease is impaired by poor compliance and by co-morbidity with irritable bowel syndrome-type symptoms.

PMID: 17644056 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/17644056?ordinalpos=18&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

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Study confirms four-fold increase in wheat gluten disorder new
      #348308 - 07/22/09 01:15 PM

Study confirms increase in wheat gluten disorder

Blood samples from '50s show it isn't just improved diagnosis, and researchers wonder if diet is a factor.

By JOSEPHINE MARCOTTY, Star Tribune

A Minnesota study using frozen blood samples taken from Air Force recruits 50 years ago has found that intolerance of wheat gluten, a debilitating digestive condition, is four times more common today than it was in the 1950s.

The findings contradict the prevailing belief that a sharp increase in diagnoses of wheat gluten intolerance has come about because of greater awareness and detection, and raises questions about whether dramatic changes in the American diet have played a role.

"It's become much more common," said Dr. Joseph Murray, the Mayo Clinic gastroenterologist who led the study. No one knows why, he said, but one reason might be rapid changes in eating habits and food processing over the last half century.

"Fifty years is way too fast for human genetics to have changed," Murray said. "Which tells us it has to be a pervasive environmental influence."

Researchers at the Mayo Clinic and the University of Minnesota who conducted the study also found that the recruits who had the undiagnosed digestive disorder, called celiac disease, also had a four-fold increase in the risk of death.

Today an estimated one of 100 people suffer from the inherited disorder, though most of the time people don't know they have it.

The disease occurs in people whose bodies cannot digest gluten, a protein found in wheat, rye and barley. The undigested protein triggers the body's immune system to attack the lining of the small intestine, causing diarrhea, nausea and abdominal pain. Though people live with it for many years, over time it destroys the lining of the small intestine, leading to an inability to absorb nutrients such as iron and calcium. That, in turn, causes serious problems, including anemia, osteoporosis and even infertility.

The only treatment is a gluten-free diet -- no wheat, rye or barley.

Murray said he initiated the study to find out whether the disease is on the rise, and whether it had long-term health consequences if undiagnosed and untreated.

He turned to medical archaeology to find the answers - a treasure-trove of blood samples taken from recruits at the Warren Air Force base in Cheyenne, Wyo., between 1948 and 1954. At the time, strep infections were raging among the recruits, mostly young men on their way to fight in the Korean war. Doctors there drew the samples as part of a study that proved treating the infections with antibiotics would prevent rheumatic fever, a serious heart ailment that can follow strep throat.

One of the doctors in that study took some of the samples with him when he moved to the Cleveland Clinic in Ohio. When he decided to retire two decades ago, he asked Dr. Edward Kaplan, a strep specialist at the University of Minnesota, to become their guardian. The vials were transported in frozen-pizza delivery trucks to Minneapolis, where they reside today.

"Nobody has anything like it," said Kaplan. "There are other collections, but none go back this far."

In 2000 they were used to help resolve an intense debate among researchers over whether hepatitis C infection meant certain death, or whether many people could live with it for years.

Murray used a similar design for the study on celiac disease, published today in the journal Gastroenterology. He tested more than 9,133 samples for the antibodies that proved the recruits had celiac disease; 43, or about one out of 652, had the disease. He then tested blood samples from groups of men from Olmsted County, more than 12,000 in all. In an older group of men, one in 121 tested positive, and in the younger group one in 106 tested positive, an increase of four to four-and-a-half times.

His findings raise questions about why the number of people with the disease has grown so fast. But rates of other immune diseases have also increased a lot. One theory is that modern, clean living, which has resulted in fewer infections, parasites and microbes in our bodies, causes the immune system to turn on healthy tissue instead. Or it might be the modern diet, Murray said.

"The types of food we eat now are different," he said.


http://www.startribune.com/lifestyle/health/49558522.html?elr=KArks:DCiUo3PD:3D_V_qD3L:c7cQKUiD3aPc:_Yyc:aUU

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Between Celiac Disease and Irritable Bowel Syndrome new
      #356358 - 03/05/10 11:49 AM

Review

Am J Gastroenterol 2009; 104:1587–1594;

doi:10.1038/ajg.2009.188;

Between Celiac Disease and Irritable Bowel Syndrome: The "No Man's Land" of Gluten Sensitivity

Elena F Verdu MD, PhD1, David Armstrong MA, MB, BChir1 and Joseph A Murray MD2

1. 1Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada

2. 2Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA

Correspondence: Joseph A. Murray, MD, Division of Gastroenterology and Hepatology, McMaster University, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, Hamilton, Canada.

The repertoire of gastrointestinal (GI) symptoms is finite; however, the etiologies and mechanisms underlying symptom generation and perception are diverse and, in many cases, unknown. This review examines the clinical and experimental evidence exploring the putative relationship between gluten sensitivity (GS) and the generation of GI symptoms. It explores the hypothesis that, in a proportion of patients, GS causes functional bowel disorder (FBD)-like symptoms. We propose a model for investigating and understanding the induction of GI symptoms and dysfunction by gluten in FBD and organic disease. We hypothesize that, even in the absence of fully developed celiac disease, gluten can induce symptoms similar to FBD. We discuss the hypothesis that GS and post-infectious irritable bowel syndrome (IBS) provide two triggers that can explain at least part of the spectrum that constitutes IBS, further advancing an understanding of the role of mucosal responses to luminal factors in FBDs. We propose that the animal model of GS in human leukocyte antigen (HLA)-DQ8 mice allows investigation of mucosal pathophysiological changes that occur before the onset of full-blown inflammation in a GS host. A better understanding of how gluten can cause symptoms in sensitive individuals will illuminate the interaction between host genotype, diet, and intestinal microbiota in generating one of the most common GI conditions.

http://www.nature.com/ajg/journal/v104/n6/abs/ajg2009188a.html

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People on gluten-free diets benefit from oats new
      #356364 - 03/05/10 12:23 PM

Oats may boost nutritional profile of gluten-free diets

By Stephen Daniells, 08-Jan-2010

Adding oats to a gluten-free diet may enhance the nutritional values of the diets, particularly for vitamins and minerals, as well as increasing antioxidant levels, say two studies from Scandinavia.

Kilned or unkilned oats were found to increase levels of vitamin B1, magnesium and zinc during six months of an oat-enriched gluten-free diet, according to results published in the European Journal of Clinical Nutrition.

According to scientists led by Tarja Kemppainen from the University of Kuopio in Finland, gluten-free diets have been shown to be deficient in nutrients in some of the patients. Results from their new study indicate that 100 grams of oats a day may increased intakes of various nutrients in adult celiac patients in remission.

The gluten-free market is growing rapidly. According to a recent report from Packaged Facts, the market has grown at an average annual rate of 28 per cent since 2004, when it was valued at $580m, to reach $1.56bn last year. Packaged Facts estimates that sales will be worth $2.6bn by 2012.

The market researcher said it expected to see a much wider range of gluten-free products on shelves by 2012, and said that this will be driven by companies reformulating existing products for gluten-free acceptability, as well as by releasing new ones.

Care with oats

It should be noted that, although oats do not actually contain gluten there is some concern over their presence in foods since they are commonly contaminated during processing with gluten from wheat, rye or barley, according to Coeliac UK.

Study details

Kemppainen and co-workers recruited 13 men and 18 women with celiac disease in remission and assigned them to receive a gluten-free diet with kilned or unkilned oats. At the end of the study, addition of kilned oats to the diet increased intake of vitamin B1 and magnesium, while the unkilned oats increased intakes of magnesium and zinc, said the researchers.

Antioxidant boost

The results were supported by another study from Scandinavia. Writing in the e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism, Astrid Lovik and her co-workers from Oslo University Hospital report that gluten-free oats allowed people on gluten-free diets to achieve their recommended daily intakes of fibre, as well as increasing levels of the antioxidant bilirubin in coeliac disease patients.

“So far there are no documented clear nutritional advantages of oats in gluten-free diet, except for increased dietary fibre intake,” wrote Lovik. “Results from our pilot study of nineteen patients and supportive evidence from a large cohort of patients, suggest increased levels of bilirubin after oats intake.

“To confirm this finding, controlled and randomised studies in oats consuming and oats non-consuming coeliac disease patients have to be performed,” they concluded.

The researchers gave 19 people with coeliac disease 50 grams per day of gluten-free rolled oats for 12 weeks. At the end of the study, the gluten levels of only three people were outside of the proposed safe levels. Bilirubin levels were significantly higher following oat consumption.

In a separate experiment with 136 coeliacs and 141 healthy controls in the general population, the researchers noted that bilirubin blood levels were higher amongst oat consumers..

“In healthy subjects, lower serum bilirubin levels are associated with endothelial dysfunction and increased carotid intima-media thickness, while moderately increased serum bilirubin levels are connected to reduced risk for atherosclerosis,” wrote the researchers. “Whether serum bilirubin in oats consuming coeliac disease patients is an independent and inversely related predictor of atherosclerosis has yet to be studied,” they added.

Source: European Journal of Clinical Nutrition
2010, Volume 64, Pages 62-67, doi:10.1038/ejcn.2009.113
“Nutrient intakes during diets including unkilned and large amounts of oats in celiac disease”
Authors: T.A. Kemppainen, M.T. Heikkinen, M.K. Ristikankare, V-M. Kosma, R.J. Julkunen

e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism
Pages e315-e320
“Oats in a strictly gluten-free diet is associated with decreased gluten intake and increased serum bilirubin”
Authors: A. Lovik, A.U. Gjoen, L. Morkrid, V. Guttormsen, T. Ueland, K.E.A. Lundin

http://www.foodnavigator.com/Science-Nutrition/Oats-may-boost-nutritional-profile-of-gluten-free-diets

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Genetic links to celiac disease identified new
      #356371 - 03/05/10 02:36 PM

Gene links to celiac disease may help drug search

LONDON
Sun Feb 28, 2010 1:02pm EST
Related News

LONDON (Reuters) - Scientists have identified new genetic links to celiac disease and say their findings could speed the search for better ways to diagnose and treat the gluten-intolerance disorder.

Health

British researchers scanned the genetic maps of more than 9,400 celiac patients and found areas of immune system disturbance which lead to the development of the auto-immune disease, which affects around one percent of people.

The researchers also found "substantial evidence" that genes associated with celiac disease may also be linked to many other common chronic immune diseases, such as type 1 diabetes and rheumatoid arthritis.

"We can now shed light on some of the precise immune disturbances leading to celiac disease," said David van Heel, a professor of gastrointestinal genetics at Barts and The London School of Medicine and Dentistry, who led an international team of researchers in conducting the study.

Celiac disease is a digestive disorder caused by an abnormal immune response to gluten, a protein found in wheat, rye and barley and many other everyday items like medicines and vitamins. The disease damages structures in the lining of the small intestine called villi, impairing the body's absorption of nutrients.

It can lead to severe health problems including anemia, poor bone health, fatigue and weight loss. There is no cure, and the only treatment is a life-long gluten-free diet.

Van Heel said his findings meant scientists could now see that many of the genetic risk factors for celiac disease work by altering the amount of immune system genes made by cells.

"The data also suggests that celiac disease is made up of hundreds of genetic risk factors, we can have a good guess at nearly half of the genetic risk at present," he wrote in the study published in the Nature Genetics journal on Sunday.

(Reporting by Kate Kelland)

http://www.reuters.com/article/idUSTRE61R27P20100228

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Gene links to celiac disease may help drug search new
      #356590 - 03/11/10 12:57 PM

Gene links to celiac disease may help drug search

Sun Feb 28, 2010

LONDON (Reuters) - Scientists have identified new genetic links to celiac disease and say their findings could speed the search for better ways to diagnose and treat the gluten-intolerance disorder.

Health

British researchers scanned the genetic maps of more than 9,400 celiac patients and found areas of immune system disturbance which lead to the development of the auto-immune disease, which affects around one percent of people.

The researchers also found "substantial evidence" that genes associated with celiac disease may also be linked to many other common chronic immune diseases, such as type 1 diabetes and rheumatoid arthritis.

"We can now shed light on some of the precise immune disturbances leading to celiac disease," said David van Heel, a professor of gastrointestinal genetics at Barts and The London School of Medicine and Dentistry, who led an international team of researchers in conducting the study.

Celiac disease is a digestive disorder caused by an abnormal immune response to gluten, a protein found in wheat, rye and barley and many other everyday items like medicines and vitamins. The disease damages structures in the lining of the small intestine called villi, impairing the body's absorption of nutrients.

It can lead to severe health problems including anemia, poor bone health, fatigue and weight loss. There is no cure, and the only treatment is a life-long gluten-free diet.

Van Heel said his findings meant scientists could now see that many of the genetic risk factors for celiac disease work by altering the amount of immune system genes made by cells.

"The data also suggests that celiac disease is made up of hundreds of genetic risk factors, we can have a good guess at nearly half of the genetic risk at present," he wrote in the study published in the Nature Genetics journal on Sunday.

(Reporting by Kate Kelland)

http://www.reuters.com/article/idUSTRE61R27P20100228

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Celiac disease may strike elderly, too new
      #356593 - 03/11/10 01:19 PM

Celiac disease may strike elderly, too

Fri Jul 24, 2009

NEW YORK (Reuters Health) - Celiac disease doesn't only affect the young, new research from Finland confirms, but can strike a person for the first time in later life.

Health

In people with celiac disease, eating gluten-a protein found in many types of grain-causes the immune system to launch an attack on the small intestine. This can eventually damage the organ and lead to poor absorption of nutrients, especially fat. But people with celiac disease who cut gluten out of their diet can avoid symptoms and complications.

It's now possible to use blood tests to determine whether or not a person has celiac disease, which affects over 1% of Western populations, Dr. Anitta Vilppula of Päijät-Häme Central Hospital in Lahti and her colleagues note. In the United States, celiac disease is four times more common now than it was in the 1950s. (See Reuters Health eLine report, July 10, 2009.)

While people may think of the condition as a problem for children and young adults, they add, Vilppula and her team recently identified cases of celiac disease in elderly people. In some individuals, the condition had not been detected.

In the current study, the researchers investigated whether some older people had actually developed celiac disease later in their lives, or the disease had simply gone undetected. They looked at 2,815 people over 55 who had undergone blood tests for celiac disease in 2002, 2,216 of whom were screened again in 2005. The researchers also did biopsies of patients' small intestines to confirm the blood test findings.

In 2002, 2.13% of the study participants had biopsy-confirmed celiac disease, while 2.34% did in 2005. There were five new cases among people whose blood tests had initially been negative for the disease, and only two of these individuals had symptoms. That led the researchers to conclude that the elderly could develop the disease late in life.

Past research has shown that undetected celiac disease can lead to significant health problems in older people, the researchers note; in one study including 35 people 60 and older, 15 had been seeing their doctor for 28 years, on average, with symptoms without being diagnosed.

Doctors should be aware of the possibility that their older patients may have or develop celiac disease, Vilppula and colleagues say, and they should use blood tests to confirm the diagnosis-even though a negative test doesn't mean a person won't develop the condition later on.

SOURCE: BMC Gastroenterology, online June 29, 2009.

http://www.reuters.com/article/idUSTRE56N6BZ20090724

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Gluten intolerance versus celiac disease new
      #357798 - 04/14/10 10:27 AM

April 8, 2010
Can You Be Intolerant to Foods Like Pasta?
By THE NEW YORK TIMES

Hundreds of readers had comments and questions for the New York Times Consults blog when the topic turned to celiac disease, an often overlooked digestive disorder that causes a range of problems, from infertility and anemia to digestive upset, when susceptible people eat gluten-rich foods like bread or pasta containing wheat, barley or rye.

Here, Dr. Sheila Crowe, a professor in the division of gastroenterology and hepatology in the department of medicine at the University of Virginia, responds to readers who asked whether you can be intolerant to gluten, the way some people might be intolerant to milk, without having full-blown celiac disease.

Intolerant to Gluten Without Having Celiac Disease?
Q.

What is your take on non-celiac gluten intolerance? There are some medical professionals who say that without the definitive markers of celiac disease (blunt villi, positive blood work), there is no reason to ever change to a gluten-free diet.

Could it be that the markers only become evident after a certain degree of damage and ill heath has been attained, and that celiac is really part of a spectrum of disease relating to the body’s reaction to gluten? Thank you.
N Whittemore
Q.

Can Dr. Crowe address briefly gluten intolerance? Although the symptoms are not as severe as those that celiacs experience, they are serious.

Does intolerance lead inevitably to celiac disease, and does the intolerance ever disappear over time, with healing? Many thanks.
Katalin
A.

Dr. Sheila Crowe responds:

Your comments and queries introduce a very important and somewhat controversial topic: gluten sensitivity, sometimes referred to as gluten intolerance. In fact, as testimony to how difficult it is to discuss the issue of gluten sensitivity, my co-author Ian Blumer and I decided not to include this topic in our recently published book “Celiac Disease for Dummies” (John Wiley and Sons, Canada). Relatively little high quality research has been conducted on the topic, and much more needs to be learned.

To start, even trying to define gluten sensitivity is difficult. Some experts reserve this term for cases in which symptoms of celiac disease are present but the intestinal biopsy remains normal. This definition separates celiac disease from gluten sensitivity based on the biopsy results. Other experts use the term gluten sensitivity to take into account the various gluten-dependent symptoms that can occur outside the digestive tract, even in patients with apparently normal intestinal biopsies.

Another view of gluten sensitivity encompasses a spectrum of conditions that range from classical celiac disease, with its intestinal abnormalities, to a syndrome in which avoidance of gluten in the diet leads to resolution of symptoms that resemble those of irritable bowel syndrome.

Between these extremes are individuals who have abnormal immune system (antibody) responses to gluten but who do not have abnormal intestinal findings on biopsies. (See my earlier post, “Confirming a Diagnosis of Celiac Disease,” for more on antibody findings.) By this definition of gluten sensitivity, as long as someone has abnormal biopsies or antibody tests, or clinical symptoms that respond to excluding gluten from the diet, one can consider the disorder as a case of gluten sensitivity. Most specialists, however, exclude those with celiac disease — that is, those who have intestinal biopsy abnormalities — from the rest of the gluten-sensitive patients.

It is unknown how gluten causes symptoms in some of the gluten sensitive syndromes other than celiac disease. Most cases do not involve abnormal T-cell responses, as in celiac disease. Damage to neurological tissue may be because of other types of immune responses to gluten, and some scientists have postulated that the components of gluten may be toxic for some. Gluten has also been thought to cause a condition known as “leaky gut.” These putative mechanisms, however, are only theories without solid scientific backing at this time.

To add confusion to an already complex problem, studies show that some gluten-sensitive patients who do not have abnormal biopsies have abnormal celiac disease antibodies, while others do not. Very often, the antibody type that is abnormal is the antigliadin antibody, particularly the IgG class of antibody, while the TTG antibody is often negative or normal. (Again, see my earlier post, “Confirming a Diagnosis of Celiac Disease.”)

Genetic testing, which I discussed previously in “Genetic Testing for Celiac Disease,” is also variable in patients with gluten sensitivity. Some individuals who are gluten sensitive with normal biopsies have the H.L.A. DQ2 or DQ8 genes that place them at risk of celiac disease, while others do not have these genes. These findings further suggest that being gluten sensitive is not one condition but most likely several different disorders that probably have different long-term outcomes and that may respond to different kinds of treatments.

Celiac Disease or Gluten Intolerance?
Q.

I would like to know how the diagnosis is made between having celiac disease and just being “intolerant” to gluten. Intolerant is the diagnosis my friend got, so she eats low doses. Further, can you ever “recover” to the point of being able to eat some gluten, i.e., just being “intolerant”?
Holly
Q.

Is there evidence for a “mild gluten intolerance,” similar to mild lactose intolerance?

I was trained as a dietitian many years ago, and like other health care professionals, I was taught that celiac disease was a severe reaction/intolerance to any small amount of gluten. I now realize that I have celiac. I’ve done an elimination diet, and my symptoms — bloating and mild cramping — receded. I do not have more extreme symptoms, like diarrhea, vomiting, eczema, anemia, etc. Occasionally, I can eat a small amount of wheat without symptoms. But I can’t figure out why.

There is also a rumor that “older varieties of wheat” do not cause symptoms. Has anyone tested/studied this assertion?
Rose
Q.

Is it possible to be wheat or gluten intolerant, but not have celiac disease?

After having the stomach biopsy, my daughter tested negative for celiac, but she feels better if she doesn’t eat wheat. If she is wheat/gluten “intolerant,” can this cause organ damage, etc., in the same way as celiac disease?

Should she be as careful as someone who has tested positive for celiac? Many thanks.
Jane
A.

Dr. Sheila Crowe responds:

Holly, Rose and Jane all touch upon the important issue of how to best treat people with gluten sensitivity or gluten intolerance. Should they all be totally gluten-free or partly gluten-free? And does gluten actually harm them in the long run?

The bottom line is that no one really knows. Part of the problem is that it depends on what type of gluten sensitivity we are dealing with. Another concern is that there are no long-term, rigorously conducted scientific studies to tell us whether a specific diet or another treatment is helpful, harmful or makes no difference to gluten sensitive patients.

We know from many other studies that patients with digestive disorders like irritable bowel syndrome, or I.B.S., often feel better when taking placebos. This makes it difficult to show that a test drug or treatment, such as a gluten-free diet, has a real effect. My clinical experience suggests that quite a few patients with I.B.S. get better on a gluten-free diet, but this can be because of factors other than the harmful effects of gluten.

Gluten can be harder to digest than some other proteins in grains. Going gluten-free, as anyone who has tried this diet knows, eliminates lots of other factors from the diet. Most individuals on a gluten-free diet give up fast-food, prepared foods and packaged foods and instead eat more natural, fresh foods that are often prepared in the home. Feeling better may not necessarily be a result of excluding gluten in this setting. However, gluten may be causing problems in some people.

So how do we know who really needs to be gluten-free?

It depends on the type of patient. Some patients have symptoms of celiac disease but do not have an abnormal intestinal biopsy that is taken before starting a gluten-free diet (by definition, they are not categorized as having celiac disease). If blood tests show that such patients also have antibodies to tissue transglutaminase (TTG) or deamidated gliadin peptide (DGP), I would suggest that these individuals consider going on a truly gluten-free diet, since they are most likely on their way to celiac disease. The same advice could apply to those who have H.L.A. DQ2 or DQ8 genes without elevated antibodies, though in this case the recommendation is more ambiguous, since there are no immune abnormalities or intestinal damage.

Another scenario is the patient without an abnormal intestinal biopsy but who has neurological symptoms and an elevated antigliadin antibody (AGA). These individuals may not ever get celiac disease, but removing gluten from the diet may benefit their neurological problems.

For my patients without intestinal biopsy abnormalities, without celiac disease antibodies (including AGA IgG) and without H.L.A. celiac disease susceptibility (DQ2 or DQ8 genes), I advise a gluten-free diet only to control symptoms. Often these individuals can return to including gluten in their diets. This scenario likely applies to Holly’s friend and to Rose. I would need more information, including antibody test results and genetic test results, to answer Jane’s questions about her daughter.

I hope that, with time, we will understand gluten sensitivity better. It is likely that better defined subgroups of gluten sensitivity will emerge, which will allow us to make clearer recommendations for diagnosis and treatment.

http://consults.blogs.nytimes.com/2010/04/08/can-you-be-intolerant-to-foods-like-pasta/

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Celiac Disease Is Increasing Worldwide new
      #360106 - 08/04/10 11:57 AM

From Medscape Medical News

Celiac Disease Diagnosis Up 4-Fold Worldwide

Megan Brooks

July 30, 2010 — Studies from the United States, Europe, and elsewhere indicate that the prevalence of celiac disease (CD) has increased significantly in the last 3 decades — possibly by as much as a factor of 4.

"More and more studies indicate a prevalence of CD of more than 1% in both adults and children. This should be compared with lower prevalence figures [from] 20 to 30 years ago," Jonas Ludvigsson, MD, from the Department of Medicine, Epidemiology Unit, at the Karolinska Institute and Orebro University Hospital, Sweden, and an expert in CD, noted in an email to Medscape Medical News.

"The reason for this increase is mutlifactorial, but there is probably a true underlying increase. This has been shown when old sera have been analyzed with modern techniques, (eg, in Finland)," Dr. Ludvigsson pointed out.

Mayo Clinic Research Confirms Rise in CD

Researchers at the Mayo Clinic also report an increase in CD, according to an article in the summer issue of the Mayo Clinic's research magazine Discovery's Edge. Joseph Murray, MD, and colleagues analyzed stored blood samples, taken from Air Force recruits in the early 1950s, for gluten antibodies. They assumed that 1% would be positive, mirroring today's rate. That assumption was wrong — the number of positive results was far smaller, indicating that CD was "rare," Dr. Murray noted in the article.

This led him and his colleagues to compare those results with 2 more recently collected sets from Olmsted County, Minnesota. Their findings suggest that CD is roughly 4 times more common now than in the 1950s.

"This tells us that whatever has happened with CD has happened since 1950," Dr. Murray said. "This increase has affected young and old people. It suggests something has happened in a pervasive fashion from the environmental perspective," he added.

Excess Mortality Seen With CD and Latent CD

Recent research by Dr. Ludvigsson's team (JAMA. 2009;302:1171-1178) and others supports the concept of "latent CD" or "gluten sensitivity." Latent CD, defined in the Journal of the American Medical Association study by Dr. Ludvigsson's team as having normal small intestinal mucosa but positive CD serology, is something that is estimated to occur in at least 1 in 1000 individuals.

Dr. Ludvigsson's team has also reported evidence that in 1 year, 10 of 1000 individuals with CD will die compared with an expected 7 in 1000 without the disease.

"Not only is the mortality raised in patients with [CD] but also in those individuals with latent [CD]," Dr. Ludvigsson noted in a statement from the United European Gastroenterology Federation.

However, in comments to Medscape Medical News, he emphasized that "although patients with CD are at increased risk of a number of disorders, and at increased risk of death, the absolute risk increase is very small."

A Tricky Disease

CD remains a "tricky disease," Dr. Ludvigsson said. "It can be asymptomatic; have so-called traditional symptoms such as diarrhea, weight loss, failure to grow (in children), fatigue, and malnutrition; and have nontraditional symptoms such as osteoporosis, depression, adverse pregnancy outcome; and increased risks of both malignancy and death."

The onset of certain autoimmune disorders including autoimmune liver disease, thyroid disease, type 1 diabetes, and Addison's disease can actually signal CD, he noted. "This means that clinicians should consider CD in a number of symptoms and disorders."

CD Often Undetected; Cause Unknown

CD often goes undetected, although the percentage of undetected cases varies between countries, Dr. Ludvigsson noted. "In most countries, at least two thirds of individuals with CD have not received a diagnosis by a doctor." The reason for the high percentage of undetected disease is that the disease can be difficult to diagnose, and "it is sometimes almost asymptomatic," he added.

Detection Methods Are Improving

Over the years, Dr. Ludvigsson told Medscape Medical News, "we have improved existing means to diagnose CD. Antibody tests are becoming better and better, although a positive antibody test should be confirmed with a small intestinal biopsy before the diagnosis is certain. Transient increases in CD antibody levels occur. In the future, I expect microscopy in the very small intestine to become a tool for diagnosis."

Alternatives to the Gluten-Free Diet?

At this time, Dr. Ludvigsson said, the gluten-free diet remains the cornerstone of treatment for CD. However, "in the future, alternative treatment strategies may be available. The recent discovery of the structure of transglutaminase 2 may help in designing inhibitors of transglutaminase 2 to treat CD," he said. "Another potential treatment strategy is to ingest enzymes that digest gluten, thereby increasing the safe threshold for gluten intake.

"There is also ongoing research on the topic of decreasing the bowel's permeability to gluten, Dr. Ludvigsson told Medscape Medical News. He added, however, that the safety of this approach is unclear, as "a decreased permeability here might mean that the body cannot absorb other needed substances.

"Finally, agricultural research may mean that we can modify the gluten structure in wheat produce a kind of wheat that will not illicit an immune response in patients with CD," the researcher noted.

Counseling CD Patients Is Important

Although evidence is scarce, said Dr. Ludvigsson, "most researchers believe that a gluten-free diet will reduce the risk of complications/comorbidity in CD, and it is important for the doctor to underline this for the patients. In patients with CD who do not become better on a gluten-free diet, the most common reason is probably that the patients do not eat a strictly gluten-free diet," he said.

Dr. Murray advocates greater vigilance in CD patients. "It's not enough to say, 'You've got CD, be gluten-free, goodbye,' " he said. "CD requires medical follow-up."

This October, at the United European Gastroenterology Week in Barcelona, Spain, Dr. Ludvigsson will be 1 of 8 researchers to receive the Association of National European and Mediterranean Societies of Gastroenterology and United European Gastroenterology Federation Rising Stars award.

http://www.medscape.com/viewarticle/726127


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Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease new
      #362891 - 01/13/11 01:01 PM

Am J Gastroenterol. 2011 Jan 11. [Epub ahead of print]

Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial.

Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, Shepherd SJ, Muir JG, Gibson PR.

Monash University Department of Medicine and Gastroenterology, Box Hill Hospital, Box Hill, Victoria, Australia.
Abstract

OBJECTIVES: Despite increased prescription of a gluten-free diet for gastrointestinal symptoms in individuals who do not have celiac disease, there is minimal evidence that suggests that gluten is a trigger. The aims of this study were to determine whether gluten ingestion can induce symptoms in non-celiac individuals and to examine the mechanism.

METHODS: A double-blind, randomized, placebo-controlled rechallenge trial was undertaken in patients with irritable bowel syndrome in whom celiac disease was excluded and who were symptomatically controlled on a gluten-free diet. Participants received either gluten or placebo in the form of two bread slices plus one muffin per day with a gluten-free diet for up to 6 weeks. Symptoms were evaluated using a visual analog scale and markers of intestinal inflammation, injury, and immune activation were monitored.

RESULTS: A total of 34 patients (aged 29-59 years, 4 men) completed the study as per protocol. Overall, 56% had human leukocyte antigen (HLA)-DQ2 and/or HLA-DQ8. Adherence to diet and supplements was very high. Of 19 patients (68%) in the gluten group, 13 reported that symptoms were not adequately controlled compared with 6 of 15 (40%) on placebo (P=0.0001; generalized estimating equation). On a visual analog scale, patients were significantly worse with gluten within 1 week for overall symptoms (P=0.047), pain (P=0.016), bloating (P=0.031), satisfaction with stool consistency (P=0.024), and tiredness (P=0.001). Anti-gliadin antibodies were not induced. There were no significant changes in fecal lactoferrin, levels of celiac antibodies, highly sensitive C-reactive protein, or intestinal permeability. There were no differences in any end point in individuals with or without DQ2/DQ8.

CONCLUSIONS: "Non-celiac gluten intolerance" may exist, but no clues to the mechanism were elucidated.Am J Gastroenterol advance online publication, 11 January 2011; doi:10.1038/ajg.2010.487.

PMID: 21224837 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/21224837?dopt=Abstract

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More People May Benefit From Going Gluten-Free new
      #364666 - 05/09/11 11:44 AM

More People May Benefit From Going Gluten-Free
Related Health News

SUNDAY, May 8 (HealthDay News) -- People at risk for celiac disease ought to be screened for the disorder, even if they show no symptoms, a new study suggests.

Celiac disease is a disorder that causes digestive problems in the small intestine when the person consumes gluten, a protein found in wheat, rye and barley. The number of U.S. residents with the disease has grown rapidly in recent decades, but, according to the study authors, an estimated 2 million people have the disease but do not know it.

For the study, researchers screened 3,031 healthy people who were related to someone with celiac disease, but had no symptoms themselves, and selected 40 people who tested positive for antibodies specific to celiac disease. By random selection, members of that group were either put on a gluten-free diet or told to continue with their normal diet, containing gluten.

People on a gluten-free diet reported improved gastrointestinal health as well as an overall improvement in their health-related quality of life, compared with the others, according to the study.

"We found that regardless of the clinical presence of celiac disease, most screen-detected patients benefitted from early treatment of a gluten-free diet," Dr. Katri Kaukinen, from the gastroenterology department at Tampere University Hospital and School of Medicine in Finland, said in a news release from the American Gastroenterological Association.

"In addition, the results showed that endomysial-antibody positive patients had an evident gluten-dependent disorder and, therefore, it could be argued that detection of antibody positivity could be sufficient for the diagnosis of celiac disease," she explained.

After the study, 85 percent of the participants were willing to maintain a gluten-free diet, and 58 percent viewed their screening for celiac disease in a positive light, the researchers said.

"Based on our results, an intensified serological screening of at-risk populations of celiac disease is encouraged," Kaukinen said. "However, more research needs to be done before expanding screening to the general population."

Kaukinen was scheduled to present the findings Monday in Chicago at the Digestive Disease Week conference. Experts note that research presented at meetings should be considered preliminary because it has not been subjected to the rigorous scrutiny given to research published in medical journals.

More information

The U.S. National Digestive Diseases Information Clearinghouse has more on celiac disease.
SOURCE: American Gastroenterological Association, news release, May 8, 2011
Copyright © 2011 HealthDay. All rights reserved.
This is a story from HealthDay, a service of ScoutNews, LLC.

http://generic.e-healthsource.com/index.php?p=news1&id=652637

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Birth Month Seems to Be Linked to Celiac Disease new
      #364668 - 05/09/11 11:50 AM

Kids' Birth Month Seems to Be Linked to Celiac Disease: Study

Related Health News

SUNDAY, May 8 (HealthDay News) -- Celiac disease is more common among children born in the spring and summer months, according to a new study from the Massachusetts General Hospital for Children.

The findings suggest that the higher incidence of this autoimmune disease may be related to a combination of seasonal and environmental factors.

Celiac disease is a digestive disorder triggered by consuming the protein gluten, which is primarily found in bread and other foods containing wheat, barley or rye. It can damage the small intestine and make it difficult to absorb certain nutrients, causing problems ranging from abdominal pain to nerve damage.

Examining data on 382 Massachusetts children diagnosed with celiac disease at between 11 months and 19 years of age, researchers found that in the 15- to 19-year-old set, birth season appeared to make no difference. But among 317 children younger than 15 years of age, 57 percent were born in the "light" season of March through August, compared with 43 percent who were born in the "dark" season of September through February.

Even though the exact cause of celiac disease is unknown, potential triggers include the timing of infants' introduction to gluten, and viral infections contracted during the first year of life. The study's findings suggest the season of a child's birth is another potential risk factor for the disease.

The researchers pointed out that infants are generally introduced to solid foods containing gluten at around 6 months of age, which for spring and summer babies would coincide with cold and flu season.

Based on the findings, the study's lead researcher, Dr. Pornthep Tanpowpong, said that the age at which gluten is first offered to some babies may need to be altered.

"If you're born in the spring or the summer, it might not be appropriate to introduce gluten at the same point as someone born in the fall or winter," said Tanpowpong. "Although we need to further develop and test our hypothesis, we think it provides a helpful clue for ongoing efforts to prevent celiac disease."

The study also noted that exposure to sunlight may also play a role in celiac disease, since vitamin D deficiency has been associated with the disease.

The study is slated for presentation Sunday in Chicago during Digestive Disease Week, an international gathering sponsored by the American Gastroenterological Association and other organizations.

Because the study was presented at a medical meeting and is small, its findings should be considered preliminary until published in a peer-reviewed journal and confirmed in other research.

More information

The American Academy of Pediatrics provides detailed information on celiac disease in children.
SOURCE: American Gastroenterological Association, news release, May 8, 2011
Copyright © 2011 HealthDay. All rights reserved.
This is a story from HealthDay, a service of ScoutNews, LLC.

http://generic.e-healthsource.com/index.php?p=news1&id=652636

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Celiac Disease on the Rise in U.S. - from sanitation and hygiene? new
      #365901 - 08/24/11 02:41 PM

Celiac Disease on the Rise in U.S.

Speculation on increase in digestive disorder centers on improvements in sanitation and hygiene

By Dennis Thompson
HealthDay Reporter

FRIDAY, Aug. 19 (HealthDay News) -- Complaints of celiac disease are on the rise in the United States, with more and more people growing ill from exposure to products containing gluten.

Nearly five times as many people have celiac disease today than did during the 1950s, according to one recent study. Another report found that the rate of celiac disease has doubled every 15 years since 1974 and is now believed to affect one in every 133 U.S. residents.

"It's quite widespread," said Dr. Alessio Fasano, director of the Center for Celiac Research and the Mucosal Biology Research Center at the University of Maryland School of Medicine. "We thought there were regional differences in the past, but now we know it's everywhere."

That increased incidence rate has left researchers scrambling to figure out why more people are developing the chronic digestive disorder. Doctors still can't explain the trend, but they are making some headway testing a number of hypotheses.

"There are many theories out there, not all independent of each other and not all of them true," Fasano said.

Celiac disease is an inherited autoimmune disorder that causes the body's immune system to attack the small intestine, according to the U.S. National Institutes of Health and the University of Chicago Celiac Disease Center. The attack is prompted by exposure to gluten, a protein found in such grains as wheat, rye and barley.

The disease interferes with proper digestion and, in children, prompts symptoms that include bloating, vomiting, diarrhea or constipation. Adults with celiac disease are less likely to show digestive symptoms but will develop problems such as anemia, fatigue, osteoporosis or arthritis as the disorder robs their bodies of vital nutrients.

Awareness of celiac disease has grown in recent years, evidenced by the growing number of gluten-free foods on the market. However, medical experts don't believe that the increase in celiac disease incidence can be chalked up simply to folks becoming more aware of the chronic digestive disorder or to improvements in diagnostic techniques.

Rather, the most popular potential explanations for the increase in celiac disease rates involve improvements in sanitation and hygiene in civilization overall, said Fasano and Carol McCarthy Shilson, executive director of the University of Chicago Celiac Disease Center.

According to the "hygiene hypothesis," Shilson said, people in industrialized countries are more at risk for celiac disease because their bodies have not had to fight off as many diseases.

"We're just too clean a society, so our immune systems aren't as developed as they should be," she said.

Another version of the hypothesis holds that the cleanliness of industrialized society has caused a fundamental change in the composition of the digestive bacteria contained within the gut, Fasano said.

"It's because this increase occurs primarily in industrialized countries, where things are cleaner," Fasano said. "We abuse antibiotics, we wash our hands too often, we are vaccinated more often."

Other potential explanations for the rise in celiac disease rates, according to Fasano, include:

An increase in the amount of gluten found in grains. "We eat grains that are much more rich in glutens than they were 70 or 80 years ago," he said.
Children being exposed to gluten from an early age. "We know for sure if we introduce grains too early, people at risk for developing celiac disease are more likely to contract it," he said.
Too few women breast-feeding their children. "There are theories out there that say breast-feeding will protect you, or prevent celiac disease," Fasano said.

It's possible, experts say, that each of these theories is correct to a degree and that a combination of factors will ultimately be found to contribute to celiac disease. "It may well be in one person, one plays a stronger role than another," Fasano said.

But while experts try to find a cause -- and then, they hope, a cure -- advocates urge people who are at risk for developing celiac disease to undergo screening for the disorder.

Researchers have shown a genetic predisposition for celiac disease, with about 30 percent of the population carrying genes that make them vulnerable, Shilson said.

But because adults with celiac disease often don't suffer the digestive symptoms associated with gluten intolerance, many people are unaware they have it or could pass it on. "About two-thirds of people with the active disease have no symptoms at all," Shilson said.

Studies also have found that the earlier people find out they have celiac disease, the better able they are to head off the disorder's more debilitating effects.

"There's not much you can do to prevent it, but you can be aware of it and catch it," Shilson said. "Early intervention is key."

However, people who suspect they have celiac disease should not go gluten-free before being tested. Doing that can interfere with the accuracy of the screening.

"It's very important that you don't change your diet before you are screened for celiac disease," Shilson said.

More information

To learn more about celiac disease, visit the Celiac Sprue Association.

SOURCES: Alessio Fasano, m.d., director of the Center for Celiac Research and the Mucosal Biology Research Center at the University of Maryland School of Medicine; Carol McCarthy Shilson, executive director, University of Chicago Celiac Disease Center

Last Updated: Aug. 19, 2011

Copyright © 2011 HealthDay. All rights reserved.

http://consumer.healthday.com/Article.asp?AID=651247

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Celiac disease is more common in older adults new
      #367293 - 04/23/12 01:40 PM

By Anne-Marie Botek, AgingCare.com

Though more commonly thought of as a disease that manifests in youth and young-adulthood, celiac disease is being diagnosed in the elderly with increasing frequency.

Celiac disease is the name given to a specific type of autoimmune response that occurs when a person ingests gluten, a protein found in foods such as pasta and bread.

Recent research, conducted by scientists from the University of Maryland School of Medicine Center for Celiac Research, has discovered that celiac disease is about two and a half times more common among elderly people than it is in the population as a whole.

One of the lead researchers of this study, Dr. Alessio Fasano, M.D., Director of the University of Maryland Center for Celiac Research, discusses celiac disease in an interview for the University of Maryland.

According to Dr. Fasano, people with a genetic predisposition for celiac disease may develop it at any time, even if they have been eating gluten for years without any problems. He says this of the disease, “You cannot grow out of it, but you may grow into it.”

If a person with celiac disease eats food containing gluten, their immune system will go on the defensive, injuring and sometimes destroying the hair-like villi that line the inside of the small intestine. Without villi, an elderly person will not be able to soak up essential vitamins and minerals from their food. A variety of different health problems can arise from the malnutrition caused by untreated celiac disease. When left untreated, celiac disease can pose serious health risks for the elderly that include osteoporosis (reduced bone density caused by thinning bones) and neuropathy (nerve damage).

The common symptoms associated with celiac disease are diarrhea and abdominal pain and cramping.

Other symptoms can include:

Joint pain
Irritability
Muscle cramps
Tingling in the lower extremities
Depression
Anemia
Fatigue

Celiac Disease in the Elderly originally appeared on AgingCare.com.

Read more: http://www.care2.com/greenliving/celiac-disease-in-the-elderly.html#ixzz1stlTiTwt


http://www.care2.com/greenliving/celiac-disease-in-the-elderly.html?page=1

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Irritable Bowel Syndrome and Gluten Sensitivity Without Celiac Disease new
      #367471 - 05/17/12 12:13 PM

Celiac.com 05/14/2012 - Should gluten sensitivity be thought of as “celiac light,” as just one of the milder manifestation within the wider spectrum of celiac disease? Some doctors and researchers think so.

Photo: CC--Joe MabelOver 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, in&#64258;ammatory bowel disease, non-steroidal anti-in&#64258;ammatory 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 muf&#64257;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 signi&#64257;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 signi&#64257;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 signi&#64257;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

http://www.celiac.com/articles/22889/1/Irritable-Bowel-Syndrome-and-Gluten-Sensitivity-Without-Celiac-Disease-Notes-from-the-Front-Lines/Page1.html

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Weird!! Patients with Non-celiac Gluten Sensitivity Report More Symptoms than Those with Celiac Disease new
      #367610 - 06/15/12 01:12 PM

Celiac.com 06/13/2012 - By Jefferson Adams

In general, doctors and researchers know a good deal about how celiac disease works, and they are finding out more all the time. However, they know very little about non-celiac gluten sensitivity (NCGS).

Photo: CC -- EmeraldimpIn an effort to learn more about non-celiac gluten sensitivity, a team of researchers recently carried out a study to measure the presence of somatization, personality traits, anxiety, depression, and health-related quality of life in NCGS individuals, and to compare the results with celiac disease patients and healthy control subjects. They also compared the response to gluten challenge between patients with non-celiac gluten sensitivity and those with celiac disease.

The research team included M. Brottveit, P.O. Vandvik, S. Wojniusz, A. Løvik, K.E. Lundin, and B. Boye, of the Department of Gastroenterology at Oslo University Hospital, Ullevål in Oslo, Norway.

In all, the team looked at 22 patients with celiac disease and 31 HLA-DQ2+ NCGS patients without celiac disease. All patients were following a gluten-free diet.

Over a three day period, the team challenged 17 of the celiac disease patients with orally ingested gluten. They then recorded the symptoms reported by those patients. They did the same with a group of 40 healthy control subjects.

The team then had both patients and healthy control subjects complete questionnaires regarding anxiety, depression, neuroticism and lie, hostility and aggression, alexithymia and health locus of control, physical complaints, and health-related quality of life.

Interestingly, patients with non-celiac gluten sensitivity reported more abdominal (p = 0.01) and non-abdominal (p < 0.01) symptoms after the gluten challenge than patients with celiac disease. The increase in symptoms in non-celiac gluten sensitivity patients was not related to personality.

However, the two groups both reported similar responses regarding personality traits, level of somatization, quality of life, anxiety, and depressive symptoms. Responses for both groups were about the same as for healthy controls.

The results showed that patients with non-celiac gluten sensitivity did not show any tendencies toward general somatization, as both celiac disease patients and those with non-celiac gluten sensitivity showed low somatization levels.

Source:

Scand J Gastroenterol. 2012 Apr 23.


http://www.celiac.com/articles/22940/1/Gluten-Challenge-Patients-with-Non-celiac-Gluten-Sensitivity-Report-More-Symptoms-than-Those-with-Celiac-Disease/Page1.html

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The good and the bad of going gluten free new
      #367611 - 06/15/12 01:18 PM

Monday - 6/11/2012, 5:04am ET (WTOP/Paula Wolfson)

Read the labels to see how much sugar, fat and sodium are in gluten-free products. (


WASHINGTON - Being on a gluten-free diet used to mean essentially going on a "white foods" diet and eliminating processed and packaged foods.

Not anymore.

"Now we have a bit of a trap. Now it is easy to buy a lot of gluten-free junk food," says nutritionist Monica Reinagel, who hosts the "Nutrition Diva" podcast.

It seems the gluten-free diet has gone mainstream, with a lot of otherwise healthy people signing on. As a result, manufacturers are producing gluten-free cookies, cakes, pastas and other products high in sugar, fat or sodium.

Reinagel recommends checking labels closely and shopping carefully.

"You can't assume a food or a product is nutritious simply because it is gluten free," Reinagel says.

Millions of Americans are sensitive to gluten, a protein found in wheat and certain other grains. Most suffer from a condition called celiac disease. When they eat gluten, it triggers an immune reaction that can ultimately damage the lining of the small intestine.

Celiac disease is not the same as a wheat allergy or gluten intolerance. But for all three the treatment is identical: a gluten-free diet.

Reinagel says a lot of people who can handle wheat go gluten-free anyway because they think it might help them lose a few pounds.

"If you are looking at a gluten-free diet as an easy solution for weight loss, I have to disappoint you, there is no guarantee that a gluten-free diet is going to lead to weight loss."

In April, teen actress Miley Cyrus took some heat for encouraging everyone to go gluten free for a week, saying "The change in your skin, phyisical (sic) and mental health is amazing! U won't go back!"

There is no evidence of significant health benefits from going gluten-free other than treating celiac disease or related gluten intolerance.

Reinagel says it is certainly possible to have a healthy diet that doesn't include wheat.

"You can't just assume 'Oh, it is gluten free, it must be good for me,'" she says.

Another problem is that gluten-free products are often lower in fiber than those made with wheat. Reinagel suggests looking for products that include whole grains, and supplement with other sources of fiber, such as fruits and vegetables.

Reinagel offers helpful tips and links in her Nutrition Diva column on the Quick and Dirty Tips blog.

Follow WTOP on Twitter.

(Copyright 2012 by WTOP. All Rights Reserved.)

http://www.wtop.com/1055/2897829/The-good-and-the-bad-of-gluten-free

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Most Cases of Non-Responsive Celiac Disease Due to Ongoing Gluten Consumption new
      #367617 - 06/15/12 03:08 PM

Most Cases of Non-Responsive Celiac Disease Due to Ongoing Gluten Consumption

By Jefferson Adams
Published 06/4/2012

Celiac.com 06/04/2012 - Non-responsive celiac disease is very much what it sounds like: celiac disease where symptoms seem to resist treatment and continue even in the face of a gluten-free diet.

Photo: CC--return the sunA team of researchers recently set out to look for the most likely causes of persistent symptoms in celiac disease patients on a gluten-free diet.

The research team included David H. Dewar, Suzanne C. Donnelly, Simon D. McLaughlin, Matthew W. Johnson, H. Julia Ellis, and Paul J. Ciclitira. They are variously affiliated with King's College London, Division of diabetes and Nutritional Sciences, Department of Gastroenterology, and The Rayne Institute at St. Thomas' Hospital in London.

Their goal for the study was to investigate all patients referred to our center with non-responsive celiac disease (NRCD), to establish a cause for their continued symptoms.

For their study, the research team assessed all non-responsive celiac disease who were referred to their gastroenterology center over an 18-mo period.

They then established the etiology of ongoing symptoms for these patients. For all patients, the team established a thorough case history and conducted a complete examination with routine blood work including tissue transglutaminase antibody measurement.

Additionally, each patient was examined by a specialist gastroenterology dietician to try to spot any gaps in their diets, or any hidden sources of gluten consumption.

When possible, the team conducted a follow-up small intestinal biopsy, and compared the results against the biopsies from the referring hospital.

Patients with persistent symptoms received colonoscopy, lactulose hydrogen breath testing, pancreolauryl testing and a computed tomography scan of the abdomen.

The team monitored patient progress over a minimum of two year period. Overall, the team looked at 112 patients with non-responsive celiac disease. They determined that twelve of those did not actually have celiac disease. Of the remaining 100 patients, nearly half, 45%, were not adequately following a strict gluten-free diet. Of these, 24 (53%) were found to be accidentally consuming gluten, while 21 (47%) admitted to not faithfully following a gluten-free diet.

Microscopic colitis was found in 12% and small bowel bacterial overgrowth in 9%. refractory celiac disease was found in 9%. Three of these were diagnosed with intestinal lymphoma. After 2 years, 78 patients remained well, eight had continuing symptoms, and four had died.

In most cases of non-responsive celiac disease, the team found a reversible cause can be found in 90%. In the vast number of those cases, continued consumption of gluten was the main cause.

The team is proposing the use of an algorithm for further investigation of the matter.

Source:

World J Gastroenterol. 2012 Mar 28;18(12):1348-56.

http://www.celiac.com/articles/22914/1/Most-Cases-of-Non-Responsive-Celiac-Disease-Due-to-Ongoing-Gluten-Consumption/Page1.html

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Non-celiac gluten sensitivity less common than celiac disease new
      #368375 - 10/31/12 11:32 AM

Non-celiac gluten sensitivity less common than celiac disease

October 24, 2012

LAS VEGAS — Incidence of non-celiac gluten sensitivity is approximately half that of celiac disease, according to data presented at the 2012 American College of Gastroenterology Annual Scientific Meeting.

“A growing number of patients are being found to have non-celiac gluten sensitivity,” Daniel V. DiGiacomo, MPH, research assistant at Columbia University, told Healio.com. “Unfortunately, there is not much clinical data, nor published studies, on non-celiac gluten sensitivity. We thought this would be the perfect opportunity to take an epidemiologic approach and study non-celiac gluten sensitivity on a national level.”

Researchers evaluated data from the Continuous National Health and Nutrition Survey between 2009 and 2010, which included 7,762 participants aged 6 years and older. The prevalence of non-celiac gluten sensitivity (NCGS), defined as undertaking a gluten-free diet following the exclusion of celiac disease, was determined within this cohort, along with demographics and health status for those with the condition.

Forty-nine participants were diagnosed with NCGS. Investigators calculated a weighted national prevalence of 0.55% (95% CI, 0.21-0.89) for the condition — about half that of celiac disease. Patients with NCGS were older than those without (46.6 years compared with 40.5 years, P=.005), had lower BMI (25.8 vs. 27.5, P=.049) and smaller waist circumference (88.2 cm vs. 93.9 cm, P=.028)and trended toward higher HDL (63.5 mg/dL vs. 52.9 mg/dL, P=.054) and lower iron levels (77.2 mcg/dL vs. 87.5 mcg/dL, P=.136). Females had NCGS more frequently than males (0.58% vs. 0.37%; P=.336). Researchers noted, however, that this difference was closer to significance among patients aged 65 years or older (P=.153).

“Our study, albeit preliminary in its nature, depicts non-celiac gluten sensitivity as a disorder that is less common than celiac disease,” DiGiacomo said, adding that the results are preliminary due to sample size. “This is in contrast to prior expectations, that gluten sensitivity is several times more common than celiac disease. Overall, caution should be used, whether it is in the home or the doctor’s office, when deciding to partake in the gluten-free diet. Unless one is afflicted with a gluten-related disorder, this diet is most likely unnecessary, and may present with some potential long-term health risks if not followed properly.”

For more information:

DiGiacomo DV. P149: Prevalence and Characteristics of Non-Celiac Gluten Sensitivity in the United States: Results from the Continuous National Health and Nutrition Examination Survey 2009-2010. Presented at: the 2012 American College of Gastroenterology Annual Scientific Meeting; Oct. 19-24, Las Vegas.


http://www.healio.com/gastroenterology/inflammatory-bowel-disease/news/online/%7B7D8B2D5F-13CC-4C46-BEC8-36760252A5F7%7D/Non-celiac-gluten-sensitivity-less-common-than-celiac-disease

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Gluten-Free, Whether You Need It or Not new
      #369174 - 02/08/13 11:27 AM

Eat no wheat.

That is the core, draconian commandment of a gluten-free diet, a prohibition that excises wide swaths of American cuisine — cupcakes, pizza, bread and macaroni and cheese, to name a few things.

For the approximately one-in-a-hundred Americans who have a serious condition called celiac disease, that is an indisputably wise medical directive.

Now medical experts largely agree that there is a condition related to gluten other than celiac. In 2011 a panel of celiac experts convened in Oslo and settled on a medical term for this malady: non-celiac gluten sensitivity.

What they still do not know: how many people have gluten sensitivity, what its long-term effects are, or even how to reliably identify it. Indeed, they do not really know what the illness is.

The definition is less a diagnosis than a description — someone who does not have celiac, but whose health improves on a gluten-free diet and worsens again if gluten is eaten. It could even be more than one illness.

“We have absolutely no clue at this point,” said Dr. Stefano Guandalini, medical director of the University of Chicago’s Celiac Disease Center.

Kristen Golden Testa could be one of the gluten-sensitive. Although she does not have celiac, she adopted a gluten-free diet last year. She says she has lost weight and her allergies have gone away. “It’s just so marked,” said Ms. Golden Testa, who is health program director in California for the Children’s Partnership, a national nonprofit advocacy group.

She did not consult a doctor before making the change, and she also does not know whether avoiding gluten has helped at all. “This is my speculation,” she said. She also gave up sugar at the same time and made an effort to eat more vegetables and nuts.

Many advocates of gluten-free diets warn that non-celiac gluten sensitivity is a wide, unseen epidemic undermining the health of millions of people. They believe that avoiding gluten — a composite of starch and proteins found in certain grassy grains like wheat, barley and rye — gives them added energy and alleviates chronic ills. Oats, while gluten-free, are also avoided, because they are often contaminated with gluten-containing grains.

Others see the popularity of gluten-free foods as just the latest fad, destined to fade like the Atkins diet and avoidance of carbohydrates a decade ago.

Indeed, Americans are buying billions of dollars of food labeled gluten-free each year. And celebrities like Miley Cyrus, the actress and singer, have urged fans to give up gluten. “The change in your skin, physical and mental health is amazing!” she posted on Twitter in April.

For celiac experts, the anti-gluten zeal is a dramatic turnaround; not many years ago, they were struggling to raise awareness among doctors that bread and pasta can make some people very sick. Now they are voicing caution, tamping down the wilder claims about gluten-free diets.

“It is not a healthier diet for those who don’t need it,” Dr. Guandalini said. These people “are following a fad, essentially.” He added, “And that’s my biased opinion.”

Nonetheless, Dr. Guandalini agrees that some people who do not have celiac receive a genuine health boost from a gluten-free diet. He just cannot say how many.

Continue reading here http://well.blogs.nytimes.com/2013/02/04/gluten-free-whether-you-need-it-or-not/?hpw

February 4, 2013, 6:00 pm
Gluten-Free, Whether You Need It or Not
By KENNETH CHANG

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The Gluten-Free Vegetarian — Not to Worry, the Food Options Are Plentiful new
      #369441 - 04/17/13 12:01 PM

The Gluten-Free Vegetarian — Not to Worry, the Food Options Are Plentiful

By Cheryl Harris, MPH, RD

Today’s Dietitian
Vol. 15 No. 4 P. 20

When Nancy became a vegetarian as a teenager, she found it easy to balance her diet with an active lifestyle. After she was diagnosed with celiac disease in her 40s, however, suddenly she couldn’t eat the variety of foods she once enjoyed. Whole wheat bread, granola, and many of her beloved high-protein meals and snacks, including seitan, veggie burgers, falafel, and barley-based miso, now were off limits.

Like all people with celiac disease, Nancy must avoid foods containing gluten, a protein found in wheat, barley, rye, and in oats that aren’t specifically grown and processed without gluten. Individuals who don’t have celiac disease but have been diagnosed with gluten sensitivity, a condition that causes similar gastrointestinal (GI) symptoms, such as diarrhea, constipation, bloating, and gas, in response to gluten, also are unable to eat gluten-containing foods.1

The different types of vegetarians, from people who avoid all meat, fish, and poultry to vegans who avoid all foods of animal origin, including eggs and dairy products, especially find it difficult to eat healthfully and obtain the nutrients they need while following a gluten-free diet.

This article will discuss the types of vegetarian foods containing hidden gluten and the nutrient deficiencies common in vegetarian clients with celiac disease and provide meal and snack options RDs can share with clients.

Gluten’s Hiding Place
It’s no secret that gluten is ubiquitous in the typical American diet, yet vegetarian dishes tend to rely more heavily on wheat, barley, rye, and oats, either as a source of protein or as a binder or filler. Many commercially available veggie burgers, veggie sausage links, or textured vegetable protein crumbles contain gluten. Seitan, also known as “wheat meat,” often is used in vegetarian Asian fare. Tempeh may be made with wheat or barley, and tofu may be breaded or flavored with wheat-derived soy sauce. In addition, gluten frequently appears in processed foods, including sauces, candy, beer, soups, and supplements.

Cross-contamination also is a concern, both at home and restaurants. Even though foods such as French fries are made from only potatoes, restaurants often fry them in the same oil used for other breaded products, making them unsafe for anyone with celiac disease.

A Balanced Diet
The first step RDs should take when counseling vegetarian clients with celiac disease or gluten sensitivity is to teach them basic label-reading skills to identify hidden sources of gluten, ways to avoid cross-contamination when preparing foods at home, and strategies for dining out. They also should provide support to balance nutritional needs, which is critical.

“A combined gluten-free and vegetarian diet should be very well planned,” says Tricia Thompson, MS, RD, founder of Gluten-Free Watchdog, a subscriber service that independently tests products for the presence of gluten. “Gluten-free diets, as typically followed, may be high in fat and low in carbohydrates, fiber, calcium, iron, phosphate, zinc, folate, niacin, and B12, and some of these nutrients are especially concerning for vegetarians.”

For example, getting enough iron can be tricky on a gluten-free vegetarian diet. Approximately one-half of the people newly diagnosed with celiac disease have iron-deficiency anemia. Many gluten-free cereal products lack the iron fortification of their standard counterparts, and vegetarians don’t consume heme iron found in animal sources, which is more bioavailable. Nonheme iron is found in beans, lentils, seeds, quinoa, and nuts, but pairing these foods with vitamin C can significantly increase iron absorption. In many cases, iron supplements are necessary to replenish iron stores.2

Research indicates that fewer than one-third of women with celiac disease consume the recommended amount of calcium daily, and this is presumably lower among people who avoid dairy.3 The intestinal damage resulting from celiac disease temporarily can hinder the digestion of lactose in some individuals shortly after diagnosis. This lactose intolerance causes GI symptoms, such as bloating, gas, and diarrhea, after eating dairy foods. Subsequently, clients may avoid all dairy products, not realizing they can choose foods low in lactose, such as hard cheeses, or lactose-free milk and yogurts to obtain the calcium they need without experiencing GI symptoms.

Supplemental lactase drops can help clients digest lactose, enabling them to enjoy a wider range of dairy products. However, dietitians also should recommend other nutrient-dense calcium sources, such as firm tofu, leafy greens, nuts, seeds, a range of fortified nondairy milks, or calcium supplements, for clients struggling to meet calcium requirements.4

Moreover, many gluten-free diets are low in B vitamins, and B12 is of particular concern for vegans. “Many fortified foods may not be gluten free, and many gluten-free foods are not fortified,” Thompson says. Fortunately, whole grains contain a range of B vitamins (except B12) and some protein. While quinoa has long enjoyed elite status in the vegetarian world as a complete protein, other options include buckwheat, millet, amaranth, sorghum, and teff in addition to the more familiar whole grains, such as gluten-free oats, wild rice, brown rice, and corn.

Zinc is a nutrient of concern for vegetarians with celiac disease, since it’s mostly absorbed from animal sources. Pumpkin seeds, navy beans, wild rice, and teff are the best vegetarian sources of zinc. A variety of legumes, nuts, and grains have smaller amounts.4

Educating Clients
Vegetarian clients with celiac disease or gluten sensitivity may miss their favorite foods initially, but once RDs identify all the gluten-free vegetarian options available, clients can enjoy a wide variety of nutritious foods once again. There are many gluten-free recipes that include protein sources, such as beans, lentils, soy, whole grains, seeds, nuts, dairy, and eggs.

According to Rachel Begun, MS, RD, a spokesperson for the Academy of Nutrition and Dietetics, “Egg dishes such as omelets, frittatas, and Spanish tortillas pair well with greens and salads. Eggs and greens are one of my personal favorites.”
Begun also recommends bean dishes, such as bean chili, lentil soup, black bean soup, or split pea soup. Beans are nutrient-dense sources of protein, iron, and calcium, and a great source of fiber.

Gluten-free whole grains lend themselves well to quick and easy meals. Clients can microwave quinoa in minutes to make a pilaf; they can pair 100% buckwheat soba noodles, which cook in fewer than 10 minutes, with veggies and peanut sauce; and they can top whole grain gluten-free pasta with sauce and serve with steamed veggies. Precooked wild rice tossed with feta, cucumbers, tomatoes, and olive oil is another simple but tasty meal. For customer convenience, precooked brown rice, wild rice, and quinoa are sold frozen or in pouches, but urge clients to read labels, as these ready-to-heat processed foods may contain gluten.

Naturally gluten-free snack options include fruits and vegetables that clients can serve with hummus, salsa, guacamole, or another type of dip. Clients can eat a variety of nuts, seeds, popcorn, yogurt, cheese, hard-boiled eggs, edamame, roasted garbanzo beans, or soynuts, or they can make their own trail mix. Fruit or vegetable smoothies with yogurt or tofu for protein are a quick and easy snack or light meal.

For many vegetarians with celiac disease, following a gluten-free diet can be a challenging transition. But with careful planning and by focusing on the available nutritious food options they can eat, RDs can help make their journey a smooth one.

— Cheryl Harris, MPH, RD, is a dietitian in private practice in Alexandria and Fairfax, Virginia, specializing in helping people follow a gluten-free diet. She’s also a nutrition advisor for the DC Metro Area Celiac Support Group and speaks locally and nationally on celiac disease.

http://www.todaysdietitian.com/newarchives/040113p20.shtml

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Tooth damage may be a sign of celiac disease new
      #369602 - 06/11/13 03:47 PM

Dental problems are common in people with celiac disease, studies have shown. But “if you talk to most dentists, they would not know this connection,” said Dr. Mohsin Rashid, a gastroenterologist at the IWK Health Centre in Halifax.

Awareness of the link is crucial, since in some patients, tooth enamel defects and recurrent canker sores are the only manifestations of celiac disease, Rashid said. If a dentist notices abnormalities in tooth enamel in a routine check-up, “this is a relatively easy way of suspecting or identifying this condition,” he explained.

Celiac disease is a severe form of gluten intolerance. In patients with the disease, the surface of the small intestine is damaged by gluten protein found in such grains as wheat, rye and barley. The disease interferes with the body’s ability to absorb essential nutrients, including vitamins and minerals. Symptoms can include anemia, diarrhea, weight loss and depression. Left untreated, the disease can lead to osteoporosis, serious vitamin and mineral deficiencies and an increased risk for lymphoma and other cancers.

Celiac disease affects about 1 in 100 Canadians, but according to Rashid, up to 90 per cent are undiagnosed. Screening for celiac disease involves a blood test – which is covered by medicare in every province except Ontario – and an intestinal biopsy to confirm results.

Although celiac disease affects the small intestine, more than half of celiac patients have no gastrointestinal symptoms, Rashid said. Dental enamel defects, however, are found in the majority of celiac patients, according to a study published in April in the European Journal of Internal Medicine. Researchers from the University of Pavia, Italy, detected enamel defects in 46 out of 54 patients with celiac disease – or 85 per cent.

The prevalence of enamel defects in the study is consistent with findings from previous studies, said Anthony Iacopino, a spokesman for the Canadian Dental Association and dean of dentistry at the University of Manitoba. “Anywhere between 70 and 80 per cent of celiac patients do have some type of tooth abnormality.”

In patients with celiac disease, dental enamel may be rough and discoloured, with spots of yellow or brown. There may be structural defects, include deep horizontal grooves and large pits, or the entire tooth may be irregular in shape.

Researchers have presented two possible explanations for the defects. Autoimmune responses triggered by celiac disease may affect tooth development. Another theory is that malabsorption of nutrients such as calcium and vitamin D may prevent patients from building healthy tooth enamel.

Iacopino noted that patients may have dental enamel defects for other reasons, including a genetic predisposition or exposure to tetracycline antibiotics. “Just because you see [enamel defects] doesn’t mean it’s celiac disease,” he said. But if the patient has tooth abnormalities as well as frequent canker sores, celiac disease is a likely culprit, he added.

In patients with no other symptoms, dentists and dental hygienists can play an important role in recommending screening for celiac disease, noted a 2011 report in the Journal of the Canadian Dental Association.

Early diagnosis is especially important for children. Although celiac disease can strike at any age, dental-enamel defects “can only occur when teeth are forming,” Iacopino said. Children diagnosed with celiac disease before their adult teeth are fully formed, at about age 7, have a good chance of developing healthy tooth enamel if the disease is treated with a gluten-free diet, he said.

A diagnosis in adulthood is too late to reverse the damage to a patient’s teeth, however. Treatment options for dental enamel defects include sanding the teeth into more regular shapes and adding veneers and crowns, Iacopino said.

In DeMone’s case, her teeth were so weak that one dentist recommended extracting them all. DeMone refused, opting instead to wear upper dentures and live with gaps in the bottom row. The teeth that were lost, she said, “weren’t even worth fixing.”

http://www.theglobeandmail.com/life/health-and-fitness/health/conditions/tooth-damage-may-be-a-sign-of-celiac-disease-dentists-told/article12346685/?cmpid=rss1

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FDA Defines ‘Gluten-free’ for Food Labels new
      #369940 - 08/07/13 10:49 AM

Aug 02, 2013

The U.S. Food and Drug Administration (FDA) has published a new regulation defining the term “gluten-free” for voluntary food labeling, with the goal of providing a uniform standard definition to help the up to 3 million Americans with celiac disease, an autoimmune digestive condition that can be effectively controlled only by following a gluten-free diet.

“Adherence to a gluten-free diet is the key to treating celiac disease, which can be very disruptive to everyday life,” noted FDA commissioner Margaret A. Hamburg. “The FDA’s new ‘gluten-free’ definition will help people with this condition make food choices with confidence and allow them to better manage their health.”

The new federal definition standardizes the meaning of “gluten-free” claims across the food industry. It requires that, to use the term “gluten-free” on its label, a food product must meet all requirements of the definition, including that the item must contain fewer than 20 parts per million of gluten. The rule also applies to foods marketed with the claims “no gluten,” “free of gluten” and “without gluten.”

Food manufacturers will have a year after the rule's publication to bring their labels into compliance with the new requirements. “We encourage the food industry to come into compliance with the new definition as soon as possible and help us make it as easy as possible for people with celiac disease to identify foods that meet the federal definition of ‘gluten-free,’” said Michael R. Taylor, the FDA’s deputy commissioner for foods and veterinary medicine.

The agency was directed to issue the new regulation by the Food Allergen Labeling and Consumer Protection Act (FALCPA). The rule was published in the Federal Register.

http://www.progressivegrocer.com/top-stories/headlines/cpgs-trading-partners/id39662/fda-defines-gluten-free-for-food-labels/

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Is a Gluten-Free Diet Right for You? new
      #370001 - 08/16/13 02:15 PM

Is a Gluten-Free Diet Right for You?
Candidates include people with celiac disease, gluten sensitivity or those with a wheat allergy

By Serena Gordon
HealthDay Reporter

FRIDAY, July 19 (HealthDay News) -- Chances are you know at least one person who's given up eating gluten. Maybe you've even given it up yourself. But who can really benefit from a gluten-free diet?

"Gluten is one of the main proteins found in wheat, barley and rye," said Dr. Joseph Levy, division director of pediatric gastroenterology at NYU Langone Medical Center in New York City. "It's actually a group of proteins and not a single component, but gluten is the general term."

In baking, it plays a key role. "Gluten is responsible for the way dough is able to rise when you put yeast in it," Levy explained. "It's the structure of gluten that makes baked goods light and crispy. If you try to cook with gluten-free flour it won't have the same airiness. The dough is heavier, and the finished product will be flat and heavy."

But though gluten might make for a flaky croissant, it can cause a number of problems for certain people.

Registered dietician Rachel Begun, a spokeswoman for the Academy of Nutrition and Dietetics, said that three types of people may not be able to eat products containing gluten: people with celiac disease, people with gluten sensitivity or intolerance, and people with a wheat allergy.

"Celiac disease is an autoimmune disorder, and when gluten is eaten, the body triggers an attack on the intestines," Begun said. "Damage occurs over time, and nutrients can't be absorbed."

Levy said that "even tiny amounts of gluten trigger an immune-mediated attack on the lining of the bowel." For someone with celiac disease, "it's important that you don't have any exposure to gluten," he said.

One problem, though, is that people aren't always aware that they have celiac disease. In fact, a study published last year in the American Journal of Gastroenterology found that almost 80 percent of people with celiac disease don't know they have it.

Celiac disease often has no symptoms for years, Begun said, and is often discovered because of the problems it creates, such as anemia or osteoporosis.

Another group of people who might benefit from forgoing gluten are those who have what's called gluten sensitivity. "We're just starting to recognize this non-celiac-related sensitivity to gluten," Levy said.

"When they eat gluten," he said, "they can have diarrhea or they may get bloated, nauseous, tired and achy." Begun added that people who are gluten-sensitive may also experience migraines and feel like they have a "foggy brain."

"Something is going on in the body that triggers these symptoms, but you don't see damage to the intestine," she said. "There's a lot of research going on now in this area, but we don't yet know if there are any long-term consequences of gluten sensitivity."

Others who might want to avoid gluten are those who are allergic to wheat. Begun said while there's no specific allergy to gluten, some people with a wheat allergy choose to avoid gluten-containing products altogether due to the risk of cross-contamination with wheat.

Though it might seem logical to stop eating gluten to see if it's at the root of your problems, both Levy and Begun noted that that's an extremely bad idea. First, they said, you should see a gastroenterologist to be evaluated for celiac disease. Otherwise, stopping consumption of gluten can mask the true cause of your symptoms.

Once those results are in, dietary adjustments can follow. Begun said the best gluten-free diet is one that contains foods that are naturally gluten-free, such as fruits, vegetables, low-fat dairy, beans, nuts, seeds, fish and lean meats.

"A healthy diet really doesn't need to change much when you give up gluten," she said. But people with celiac disease need to carefully watch for hidden sources of gluten. For example, she said, bottled salad dressings may contain gluten, as might soy sauce, medications, vitamins and even lip balm.

"For people with celiac disease, it's not just a matter of trying to avoid gluten," Begun said. "They must avoid even tiny amounts of gluten."

Eating out gluten-free can be a challenge because restaurants don't always understand that cross-contamination can be a problem, too. "If a gluten-free food touches something with gluten, someone with celiac can't eat it," Begun said. "The restaurant industry as a whole is trying hard and has come a long way."

Friends and family can sometimes be more of an issue for someone with celiac disease. "There's a lack of understanding about the need to avoid gluten 100 percent of the time," she said.

But if you don't have celiac disease -- which affects about 2 million people in the United States, according to the U.S. National Institutes of Health -- there should be no harm in trying a gluten-free diet, Levy said, assuming that you've seen a doctor if you suspect celiac.

He said you can get all the nutrition you need from a gluten-free diet. But, he added a note of caution for those who eat gluten-free with the hope of losing weight.

"People who go on gluten-free diets tend to gain weight," Levy said. "People often substitute gluten-free flours and alternative baked goods, and too much of these foods can increase weight."

More information

The American Gastroenterological Association has more about celiac disease and a gluten-free diet.

SOURCES: Rachel Begun, M.S., R.D., spokeswoman, Academy of Nutrition and Dietetics; Joseph Levy, M.D., division director, pediatric gastroenterology, NYU Langone Medical Center, New York City; July 31, 2012, American Journal of Gastroenterology

Last Updated: July 19, 2013

Copyright © 2013 HealthDay. All rights reserved.

http://consumer.healthday.com/vitamins-and-nutritional-information-27/food-and-nutrition-news-316/is-a-gluten-free-diet-right-for-you-674855.html

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New approach to celiac testing identifies more at risk new
      #370107 - 08/30/13 12:11 PM


New approach to celiac testing identifies more at risk

Full Text
ScienceDaily, 08/30/2013

Australian researchers have developed a new approach to detecting coeliac disease, revealing this immune disorder is far more common than previously recognised. In a study of more than 2500 Victorians the researchers combined traditional antibody testing (measuring the immune response to gluten) with an assessment of specific genetic risk markers. They found more than half of Australians had genetic risk factors for developing coeliac disease. The research is published online today in the journal BMC Medicine. Dr Jason Tye–Din from the Immunology division at the Walter and Eliza Hall Institute and Dr Bob Anderson, chief scientific officer at US biotechnology company ImmusanT, worked with Barwon Health, Deakin University, Healthscope Pathology and the University of Queensland Diamantina Institute to develop and trial the new diagnostic approach. Dr Tye–Din said the new approach of combining the genetic test with a panel of antibody tests would increase the accuracy of testing, decrease overall medical costs by reducing invasive diagnostic tests, and avoid medically unnecessary use of a gluten–free diet.

http://www.mdlinx.com/gastroenterology/newsl-article.cfm/4799402/ZZ956160859472514387259/?news_id=522&newsdt=083013&subspec_id=155&utm_source=Newsletter&utm_medium=DailyNL&utm_content=General-Article&utm_campaign=Article-Section

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Evidence points to Monsanto Roundup as culprit in rise of gluten intolerance & IBS new
      #370918 - 02/19/14 01:30 PM

Nancy Swanson
Seattle GMO Examiner

February 18, 2014

New evidence points to glyphosate, the active ingredient in Roundup, as the culprit in the rise of gluten intolerance, celiac disease and irritable bowel syndrome. A study just published in the Journal of Interdisciplinary Toxicology (Vol. 6(4): 159–184 ) by Anthony Samsel and Stephanie Seneff explains how the nearly ubiquitous use of glyphosate as a crop desiccant is entering our food chain and making us ill.


Pre-harvest application of glyphosate to wheat and barley as a desiccant was suggested as early as 1980 and its use as a drying agent 7-10 days before harvest has since become routine. It is now used on all grain crops, rice, seeds, dried beans and peas, sugar cane, sweet potatoes, and sugar beets. According to the Pulse Growers Association in Canada (legume growers), “Desiccants are used worldwide by growers who are producing crops that require 'drying down' to create uniformity of plant material at harvest. These products may also assist in pre-harvest weed control. In Canada, products such as diquat (Reglone) and glyphosate (Roundup) have been used as desiccants in pulse crops in the past, and there are new products on the way. ”

The percentage of the total acreage of wheat in the US treated with glyphosate in 1998 and 2012 is shown in Table 1 (slide show).

Samsel & Seneff state that in 2004 glyphosate was used to treat 13% of the wheat in the UK and by 2006, 94% of UK growers used glyphosate on 40% of cereal and 80% of oilseed crops for weed control or harvest management. According to a 2012 report on glyphosate residues in food in the UK, residues as high as 1.1 parts per million [ppm] were detected in whole wheat flour. Lesser residues were detected in a wide range of breads. Residues of 0.6 ppm were found in dried lentils and peas, 2.7 ppm in dried beans, and 11 ppm in dried chickpeas.

Despite multiple letters and documents submitted in protest, just last July the EPA raised the maximum allowable residues of glyphosate in our food, most likely to accommodate levels already present. Allowed levels for various crops where desiccants are routinely used are shown in Table 2 (slide show).

In 2009 Gasnier et al. published an article in the journal Toxicology citing evidence that glyphosate-based herbicides are endocrine disruptors in human cells. They reported toxic effects to liver cells “at 5 ppm, and the first endocrine disrupting actions at 0.5 ppm.”

Samsel & Seneff have meticulously researched the known (published) effects of glyphosate along with the known (published) pathologies associated with celiac disease, gluten intolerance and irritable bowel syndrome. They have identified chemical and biological pathways where glyphosate can be the cause. These are: disruption of the gut bacteria; breakdown in the junctions of the intestinal wall; depletion of vital minerals, vitamins and nutrients; and impairment of cytochrome enzymes that aid the liver in detoxifying environmental toxins, thus multiplying the deleterious effect of other environmental toxins to which we are exposed in increasing amounts.

The increase in the amount of glyphosate applied to wheat correlates with the rise of celiac disease, peritonitis, and deaths due to intestinal infection (see slide show). Samsel and Seneff argue that

the increases in these diseases not only have an environmental factor, but not all patient's symptoms are alleviated by eliminating gluten from the diet, which points to another cause.

http://www.examiner.com/article/is-it-the-gluten-or-is-it-the-glyphosate

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