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

Reged: 12/09/02
Posts: 7799
Loc: Seattle, WA 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, inflammatory bowel disease, non-steroidal anti-inflammatory drug ingestion, or excessive alcohol.

Over a six week double-blind randomization phase, study participants followed either a gluten-free or gluten-containing diet that was assigned at random. Nineteen of the 34 patients ate food containing 16 g of gluten per day. The other 15 patients ate gluten-free bread and muffins. 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 significant 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 significantly 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 significantly 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.


Am J Gastroenterol 2011;106:508 –514

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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

Reged: 12/09/02
Posts: 7799
Loc: Seattle, WA 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.


Scand J Gastroenterol. 2012 Apr 23.

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

Reged: 12/09/02
Posts: 7799
Loc: Seattle, WA

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.)

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

Reged: 12/09/02
Posts: 7799
Loc: Seattle, WA

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

By Jefferson Adams
Published 06/4/2012 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.


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

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

Reged: 12/09/02
Posts: 7799
Loc: Seattle, WA

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 "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.

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

Reged: 12/09/02
Posts: 7799
Loc: Seattle, WA

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

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

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

Reged: 12/09/02
Posts: 7799
Loc: Seattle, WA

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.

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

Reged: 12/09/02
Posts: 7799
Loc: Seattle, WA

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."

Heather is the Administrator of the IBS Message Boards. She is 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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FDA Defines ‘Gluten-free’ for Food Labels new
      #369940 - 08/07/13 10:49 AM

Reged: 12/09/02
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Loc: Seattle, WA

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.

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

Reged: 12/09/02
Posts: 7799
Loc: Seattle, WA

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.

Heather is the Administrator of the IBS Message Boards. She is 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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