Psyllium improves the quality and shelf life of gluten-free bread
A Brazilian research team studied the impacts of adding different percentages of psyllium husk in the making of gluten-free bread. The results showed that the addition of approximately 17% psyllium husk yielded gluten-free bread with structure, appearance, texture, and acceptability like wheat bread, with delayed bread staling during 72 hours of storage. The research team suggests that this approach might yield softer, chewier, better tasting gluten-free breads that stay soft longer.
For more information: Foods 2021, 10(5), 954
Salivary inflammatory biomarkers for the screening of CD
A team of Spanish researchers used the gene expression analysis of celiac inflammatory cytokines to determine if inflammatory gene expression in saliva mirrors the gene expression in intestinal epithelia. They found that the gene expressions between the two areas were highly correlated, and this non-invasive method might be used for the diagnosis of celiac disease.
For more information: https://www.sciencedirect.com/science/article/pii/S2352345X21001107
Monoclonal antibody being investigated as a potential celiac disease treatment
T-cells are triggered by gluten in those who have celiac disease. Monoclonal antibodies, man-made proteins, are being researched by a group of international researchers to see if they can turn off this autoimmune response and halt the development of celiac disease. A biologic, monoclonal antibodies are used in immunotherapy to treat other autoimmune diseases such as rheumatoid arthritis. Nextera, an Oslo-based company is involved in the study. Several monoclonal antibodies have received emergency use in fighting COVID 19. “To be able to treat disease with a drug which only affect the diseased tissue is rarely seen, though of course, it would be optimal outcome of any treatment said Geir Age Loset, PhD CEO of Nextera. The study needs to determine the precise mechanism the antibody uses to stop the t-cell activation.
For more information: https://www.science.org/doi/10.1126/sciimmunol.abg4925
Latiglutenase – CeliacShield Study
ImmunogenX, Inc. acquired the drug in 2016 and recently concluded a Phase 2 gluten-challenge study. The trial showed significant reductions in symptoms versus the placebo group: abdominal pain, bloating, and fatigue. Latiglutenase is a combination of two enzymes that break down gluten in the stomach, rendering it inactive. It is to be used with a gluten-free diet and is a simple flavor package in a drink consumed with meals. Other Phase 2 trials will continue trying to mimic accidental gluten consumption in a normal gluten free diet.
For more information: https://www.beyondceliac.org/research-news/immunogenx-latiglutenase-2021
Larazotide Phase 3 trial is recruiting participants Larazotide is meant for patients with symptoms despite being on a gluten-free diet. It is called the CeDLara Study (CeDLara (CeD-LA-3001). It has been fond to be safe and effective in trials to date.
For more information: www.innovatebiopharma.com/inn-202.html
Medical students and professionals lack knowledge regarding nutritional deficiencies and CD
A Polish study found that over ½ of the 430 professionals and students surveyed were not aware that CD could lead to nutritional deficiencies. They also were not aware of the risk of being obese or over-weight.
For more information: Nutrients 2021, 13(6), 1771
Fungal dysbiosis in children with CD
Mucosal and fecal samples were collected from children with CD and controls. Fungal microbiota communities were analyzed. Although fungal dysbiosis was found in children with CD, more study is needed to determine the role fungi has in CD.
For more information: https://pubmed.ncbi.nlm.nih.gov/33723701/
Atherosclerotic cardiovascular disease (ASCVD) prevalence in CD Patients in the US
A Mayo Clinic study looked at CD patients from 2005 to 2014. Prevalence of ASCVD was calculated in both CD patients and controls and compared by sex and age. Common cardiovascular risk factors were adjusted for. Of 371M patients, 227K adults with CD were matched to 1,133K controls. ASCVD was highest in young celiac disease women compared to controls and had significant risks of mortality, 7.31 times higher in women under 40 than the general population.
For more information: https://pubmed.ncbi.nlm.nih.gov/33673917/
Beyond Celiac – Top 5 Research articles of 2021, December 15 2021
1. Can you trust a negative celiac disease blood test? https://www.beyondceliac.org/research-news/can-you-trust-negative-blood-test Although there is no issue with a positive blood test due to biopsy follow-up, as negative results of the tTG (anti-tissue transglutaminase IgA test) blood tests are never followed up with a biopsy, celiac disease may go undiagnosed in those who have a false negative test. Therefore, if a person has negative blood test but still has symptoms further investigation needs to be tried.
Journal of Clinical Gastroenterology: April 2021 - Volume 55 - Issue 4 - p 327-334 doi: 10.1097/MCG.0000000000001361
2. Monoclonal antibodies are used to treat COVID-19 and other illnesses. Monoclonal antibodies (often called biologics) need to be investigated for celiac disease treatment. PRV-015, from prevention Bio and Amgen, is in Phase 2b clinical trials and an example. Monoclonal antibodies block cytokines which are produced by the immune system. These cytokines create inflammation. Recruitment is still going on for these studies.
3. Celiac disease drug targeting the immune system, Phase 2 trial of TAK-101 shows promise. https://www.beyondceliac.org/research-news/drug-targets-immune-system-shows-promise/ This drug retrains the immune system to tolerate gluten.
4. Neurological and psychological symptoms of celiac disease – Study had 1,500 registrants and used an online survey. They found that 86% of participants experience brain fog. Additionally, over 71% reported migraines and 47% said they experienced peripheral neuropathy. This survey further adds to the growing evidence that celiac disease should also be considered more than just a GI-related disease. https://www.beyondceliac.org/research-news/neuro-symptoms-gobeyondceliac/
5. KAN-101, Phase 1 clinical trial – this drug creates immune tolerance to gluten by targeting liver receptor to “re-educate” the immune system. https://www.beyondceliac.org/research-news/kan101/
Oral spray Budesonide in newly diagnosed CD
A small trial showed no significant effect on mucosal healing in patients treated with Budesonide and concurrently on a gluten-free diet. Healings at 8 weeks in one in four patients was attributed to having less severe villous atrophy at diagnosis.
For more information: https://www.medscape.com/viewarticle/956466
Cancer risk in patients with CD
A Swedish research team reviewed records of 50K celiac patients. 64% were diagnosed with some type of cancer since 2000. The risk rose overall but was most sharply elevated in the first year after diagnosis. The risk of blood, lymph, liver and pancreatic cancers were seen later. Risk levels were highest in ages greater than 60, while those diagnosed before age 40 showed no such increase.
For more information: https://www.celiac.com/articles.html/major-cohort-study-assesses-cancer-risk-in-celiac-disease-r5654
Nutritional deficiencies in adults following a gluten-free diet
A Spanish research team looked at nutritional deficiency of adults following a gluten-free diet. Deficiencies at diagnosis should improve on a gluten-free diet as the gut heals, however, the gluten-free diet itself may lead to deficiencies if it is not correctly balanced. High fat, high sugar intake and low complex carbohydrate and fiber in the diet can cause micronutrient deficiencies include iron, calcium, magnesium and vitamin D and E as well as certain B vitamins. Seeing a registered dietitian and ensuring a balanced diet is important.
For more information: Nutrients 2021, 13(8), 2877
Urinary gluten immunogenic peptides (GIP) use to detect GFD adherence
GIP in the urine proved to be not a reliable indicator of gluten in the diet as it was difficult to standardize the test and the research showed common false negative results.
For more information: Clinical and Translational Gastroenterology: October 2021 - Volume 12 - Issue 10 - p e00411 doi: 10.14309/ctg.0000000000000411
Gaps and opportunities in celiac disease
A position paper created by The Society for the Study of Celiac Disease indicated there is “potential to greatly improve clinical care in coeliac disease and facilitate innovations across autoimmunity. However, if funding opportunities do not increase for coeliac disease in the coming years, the breakthroughs need to continue advance and possibly cure this morbid condition will be delayed or lost?”
For more information: https://www.nature.com/articles/s41575-021-00511-8
Burden of the gluten-free diet
A poster presentation showed a multi-national survey of celiac patients with most adhering to a GFD. Many have difficulty adhering and experience frequent accidental exposure to gluten. The conclusion of the study was the GFD was suboptimal to manage CD. Average number of years on the GFD was 9.
For more information: https://celiac.org/main/wp-content/uploads/2021/10/TKVC103-Multi-national-burden-of-CD-UEGW-21-poster_8.00_for-upload_23-Sep-21.pdf
New European guidelines for Dermatitis Herpetiformis
For more information: https://onlinelibrary.wiley.com/doi/abs/10.1111/jdv.17183
Iron deficient anemia in celiac disease
This is the most common type of anemia associated frequently with celiac disease. “Folate and vitamin B12 malabsorption, nutritional deficiencies, inflammation, blood loss, development of refractory CD, and concomitant Heliobacter pylori infection are other causes of anemia in such patients.”
For more information: https://www.mdpi.com/2072-6643/13/10/3437
Intestinal cancers and celiac disease
Compared with the general population, CD patients had a high total risk of small intestinal bowel cancer and T-cell lymphoma (EATL), but not colorectal cancer. The protective effect of GFD on CD-related malignancies is controversial. Further studies are needed to confirm whether GFD treatment can reduce the risk of intestinal neoplasms in CD.
For more information: https://www.wjgnet.com/1948-5204/full/v13/i9/1017.htm
Genetic overlap between type 1 diabetes and other autoimmune diseases
This study shows the importance of genetic links of these diseases to identify key molecular pathways that are exhibited in multiple disorders. This may help in therapeutic approaches and improving usage of existing drugs.
For more information: https://link.springer.com/article/10.1007%2Fs00281-021-00885-6
Inflammatory and microbiota regulation of the intestinal epithelial barrier
The intestinal epithelial barrier limits harmful antigens and microorganisms and assures the absorption of vitamins, minerals and water. This is critical for human life. Tight junctions in the small intestine are important for regulating these activities and they can be affected by cytokines, gut microbiota, and diet. Gut microbiota also regulated the immune system through the release of metabolites. Growing evidence indicates that the wrong mix of good and bad bacteria, dysbiosis, immune activation and the epithelial barrier play roles in several diseases including celiac disease.
For more information: https://www.frontiersin.org/articles/10.3389/fnut.2021.718356/full
Mucosal reactivity to cow's milk protein in celiac disease
This is a 2007 study, however, it helps to explain why patients with coeliac disease (CD) on a gluten-free diet may still have gastrointestinal symptoms. Cow's milk (CM) protein sensitivity may be suspected. Six of the patients who reacted to CM were also challenged with α-lactalbumin and casein (found in CM). 18 of 20 patients showed a strong reaction to a gluten-challenge. Ten of these 20 patients also showed a similarly strong inflammatory reaction to CM challenge. Six of the CM sensitive patients were challenged with specific CM proteins: casein and α-lactalbumin. Casein, in contrast to α-lactalbumin, induced an inflammatory response like that produced by CM. A mucosal inflammatory response like that of gluten was produced by CM protein in about 50% of the patients with coeliac disease. Casein seems to be involved in this reaction.
For more information: Clin Exp Immunol. 2007 Mar; 147(3): 449–455. doi: 10.1111/j.1365-2249.2007.03298.x
Number of children with celiac disease has double in the past 25 years
A study in Italy presented at the World Congress of Paediatric Gastroenterology, Hepatology and Nutrition this year found that “At the moment 70 per cent of celiac disease patients are going undiagnosed and this study shows that significantly more could be identified, and at an earlier stage, if screening were carried out in childhood with non-invasive screening tests,” says Lionetti one of the researchers. “Diagnosis and avoiding gluten could potentially prevent damage to the villi, finger-like projections that line the gut, which can lead to malabsorption of nutrients and long-term conditions such as growth problems, fatigue and osteoporosis.”
For more information: https://www.studyfinds.org/gluten-free-children-celiac-disaese-doubled
Gluten neuropathy: electrophysiological progression and HLA associationsDQA1*02-positive patients were more likely to suffer with gluten sensitivity compared to the DQA1*02 negative patients (60% versus 13.8%). DQB1*06 allele and the DQA1*01/DQB1*06 haplotype were found more frequently in patients with gluten neuropathy than in healthy controls.
For more information: Zis, P., Sarrigiannis, P., Artemiadis, A. et al. Gluten neuropathy: lectrophysiological progression and HLA associations. J Neurol 268, 199–205 (2021). https://doi.org/10.1007/s00415-020-10137-6
COVID-19 pandemic may increase diabetes, celiac cases in Turkey
Professor Tufan Tükek, head of the Faculty of Medicine at Istanbul University warned that COVID 19 could increase the rates of autoimmune diseases like Type 1 diabetes and celiac disease. “Viruses serve as a mechanism that pull the trigger for autoimmune diseases”, he stated.
For more information: https://www.dailysabah.com/turkey/covid-19-pandemic-may-increase-diabetes-celiac-cases-in-turkey/news
Can serum anti-tissue transglutaminase (tTG) and anti-endomysium antibodies (EMA) be helpful in differentiating giardiasis from celiac disease?
Intestinal inflammation or autoimmune disease can increase markers for celiac disease. A team of researchers in Norway, found elevated serological markers after Giardia infection.
For more information: https://www.celiac.com/articles.html/a-look-at-giradia-related-elevation-of-anti-transglutaminase-and-anti-endomysium-antibodies-r5522/
Gluten induced neurocognitive impairment
A 9-question online survey was accessed by 1396 individuals (1143 with CD; 253 with NCGS). The timing of the most common symptoms of difficulty concentrating, forgetfulness, and grogginess was similar between celiacs and those with non celiac gluten sensitivity.
For more information: https://journals.lww.com/jcge/Abstract/9000/Gluten_induced_Neurocognitive_Impairment__Results.97407.aspx
Concerns raised over interpretation of a negative tTG test
Researchers from the Division of Gastroenterology and Hepatology at the Mayo Clinic, in conjunction with others, conducted a study to investigate the accuracy of the immunoglobulin A tissue transglutaminase, or tTG-IgA, blood screen for CD. The researchers found verification bias due to people with positive tTG-IgA result being more likely to have an endoscopy and biopsy of the small intestine than people with a negative tTG-IgA result. Researchers concluded that there is no concern about positive tTG-IgA results, but that caution should be exercised when interpreting a negative tTG-IgA result when screening for CD.
For more information: Estimating the Impact of Verification Bias on Celiac Disease... : Journal of Clinical Gastroenterology (lww.com)
Young adults with celiac disease have greater social anxiety and hesitation regarding dating
Lower quality of life and higher anxiety was seen in celiac disease patients aged 23 to 39 in a study done at Columbia University. 68% reported moderate to major impacts on their dating life. Explaining to waiters about their disease increased their discomfort and in 30% increase riskier eating behaviors while on a date. 39% hesitated to kiss their partner due to celiac disease.
For more information: https://www.healio.com/news/gastroenterology/20210522/hesitation-with-dating-greater-social-anxiety-among-individuals-with-celiac-disease
Composition of breast milk not affected by mothers with controlled celiac disease
A study out of Mass General Hospital found no difference in the breast milk of those with controlled celiac disease to a control group. The study did find differences in the amount of several bacterial strains in the breast milk of the mothers with celiac disease compared to mothers who don’t have celiac disease. Three bacterial strains were more abundant in the breast milk from the mothers with celiac disease.
Additionally, four strains of bacteria and two strains of virus were higher in breast milk from mothers without celiac disease.
The differences may represent variations in maternal health and diet between the two groups. Researchers called for additional studies to be done.
For more information: https://www.beyondceliac.org/research-news/celiac-disease-doesnt-affect-mothers-breast-milk
Promotion of alternative medicine testing of celiac disease
Over 500 complementary and alternative medicine clinic websites were reviewed for marketing practices. Many claims are either false or unproven, thus warranting a need for increased regulation of CAM advertising to protect the public.
For more information: Promotion of Testing for Celiac Disease and the Gluten-Free... : Official journal of the American College of Gastroenterology | ACG (lww.com)
A randomized Phase 2 trial of transglutaminase 2 inhibitor
Small intestinal transglutaminase 2 causes deamidation of glutamine residues in gluten peptides, which enhances stimulation of T cells and leads to mucosal injury in the small intestine. Inhibition of transglutaminase 2 is a potential treatment for celiac disease. The preliminary study found that treatment with ZED1227 reduced gluten-induced duodenal mucosal damage in patients with celiac disease.
For further information: https://www.nejm.org/doi/full/10.1056
Persistently tTG results above normal (low positive) should be investigated
Repeated low positive tTG results in children with symptoms were found to be indicators of celiac disease. These children should undergo endoscopy regardless of their EMA results.
For more information: https://journals.lww.com/jpgn/Abstract/2021/05000/Diagnostic_Value_of_Persistently_Low_Positive.16.aspx
Pancreatitis and celiac disease
A review of 72M medical records in the US looked at those having both acute pancreatitis (AP) and chronic pancreatitis (CP) as well as celiac disease (CD). CD patients were at increased risk of both AP and CP and had more medical issues compared to non-CD patients. More study is needed to investigate CD as a potential cause of pancreatic disease.
For more information: https://pubmed.ncbi.nlm.nih.gov/32809104/
Vitamin D deficiency negatively affects both the intestinal epithelial integrity and bone metabolism in children with celiac disease
Vitamin D deficiency was common in children diagnosed with celiac disease. Cellular pathway structures responsible for calcium absorption are disturbed in CD and this is aggravated by vitamin D deficiency.
For more information: https://pubmed.ncbi.nlm.nih.gov/32952100/
Celiac Disease and the thyroid: highlighting the roles of vitamin D and iron
Vitamin D is assumed to be involved in the onset and progression of CD, presumably plays a substantial protective role for intestinal mucosa and affects the thyroid via its immunomodulatory effects. Iron is an essential micronutrient for the thyroid gland needed for effective iodine utilization by the iron-dependent enzyme thyroid iodine peroxidase (TPO). Despite being crucial for thyroid hormone synthesis, iron deficiency (ID) is a common finding in patients with hypothyroidism like HT and is frequently found in patients with CD.
For more information: https://pubmed.ncbi.nlm.nih.gov/34064075/
Mass Screening of all Children Recommended to Identify Children with Celiac Disease
A large-scale pediatric study in Colorado looking at Celiac Disease and Type 1 Diabetes, tested blood of nearly 10K children and found 2.4% had positive tTG blood tests. 70% had no symptoms, 90% did not have a family history and were mainly female of white ancestry.
The study concluded that there are many undetected celiac disease children and the only way to detect is to use mass screening to reduce diagnostic delay and associated morbidity.
For more information: Am J Gastroenterol. 2021 Jan 1;116(1):180-187.
Seronegative Celiac Disease
Seronegative Celiac Disease is where no antibodies are found in the blood of a patient, yet there is villous atrophy. It is rare, but research teams in Italy and Sheffield UK worked together to define this situation which makes diagnosis difficult. A study in 2017 had looked at the use of proton pump inhibitors and nonsteroidal anti-inflammatory drug (NSAID) usage by celiac patients and found that of 148 patients with newly diagnosed CD, current users of ASA/NSAIDs were older than non-users (47 vs 39 years, p=0.003) and users of PPI/H2RAs were older than non-users (48 vs 39 years, p=0.004). PPI/H2RA users comprised 12% of seropositive patients, compared to 55% of seronegative patients. More study is required in this area.
For more information: Curr Opin Gastroenterol. 2018 May;34(3):154-158. and The impact of acid suppression medications and non-steroidal anti-inflammatory drugs on clinical and histologic features in celiac disease - PubMed (nih.gov)
Risk of psychiatric disorders among patients with celiac disease: A population‐based national study
A study of data of Celiac Disease patients compared to patients who did not have Celiac Disease, it was found that CD are at increased risk of having multiple psychiatric diseases including anxiety, depression, bipolar, attention‐deficit hyperactivity disorder, eating disorder, and childhood autism. Individual care and referral to psychiatry when appropriate are warranted while taking care of this group of patients.
For more information: https://doi.org/10.1111/jgh.15437 Unfortunately full text article is paid only.
Use of Micro-Needle Patches May Assist in Identifying Biomarkers for Celiac Disease and Non-Celiac Gluten Sensitivity
IL-15 and IL-8 could be proposed as potential markers in their optimal cut-off points for distinguishing CD from the NCGS and the healthy control. Evaluation of cytokine levels can be recommended as a useful tool for the diagnosis of CD and NCGS in a clinical practice.
“Cytokines are challenging in blood to begin with, actually,” says Singamaneni. “We need an extremely sensitive method to be able to detect these biomarkers in the interstitial fluid.”
So how did they collect tiny volumes of mouse interstitial fluid for analysis? They did not. Singamaneni put aside the notion that testing a bodily fluid requires removing it. They tested the cytokine levels just below the surface of the skin using a micro-needle patch. Cytokine levels are higher in patients with Celiac Disease and Non-Celiac Gluten Sensitivity.
For more information: https://www.wired.com/story/forget-blood-your-skin-might-know-if-youre-sick/ and
https://pubmed.ncbi.nlm.nih.gov/32660201/
Lack of Medical Inertia Results in Delayed or Missed Diagnosis of Celiac Disease
A UK study looked at diagnostic delay as a key issue facing modern management of celiac disease (CD) while only one in four cases are estimated to be diagnosed. Delayed diagnosis of CD is associated with an increased risk of complications from the disease and a worse quality of life.
Physicians viewed IBD or Crohn’s Disease as higher priorities for diagnosis. The majority of endoscopists do not follow guidelines for diagnostic endoscopy for CD. The study recommended lower thresholds for investigation of CD, greater adherence to biopsy guidelines and increased referral urgency to reduce overall diagnostic delay of the disease.
For more information: https://bmjopengastro.bmj.com/content/bmjgast/8/1/e000544.full.pdf BMJ Open Gastro 2021;8:e000544. doi:10.1136/ bmjgast-2020-000544
Low Level Mucosal Inflammation Predicts Response to a 14-day Gluten Challenge
A new test may be able to determine if a patient has Celiac Disease, without doing a gluten-free challenge. Researchers used a strategy called proteome analysis, which is a large-scale analysis of proteins in a patient’s tissue. Using tissue from patients who were subjected to a 2-week gluten challenge, they were able to identify subtle differences in protein expression that had not been observed before. When gluten is eliminated from patient’s diets, there may still be ongoing low-level anti-gluten immunity that might explain the variations in responses to gluten challenges.
Their study also raised the question whether the gluten free diet is an adequate treatment for everyone. “This also raises the question of whether the ‘normal’ gluten-free diet is sufficient to completely curb the immune response in all patients,” added Stamnæs. “We are currently investigating whether well-treated celiac patients can have gluten-specific T-cells that show sign of activation – i.e. signs of recently having encountered gluten. If we find such activated cells, it will reinforce the suspicion that a ‘normal’ gluten free diet does not curb the disease in all celiac patients.”
For more information: Jorunn Stamnaes, et al., In Well‐Treated Celiac Patients Low‐Level Mucosal Inflammation Predicts Response to 14‐day Gluten Challenge, Advanced Science (2021). DOI: 10.1002/advs.202003526 and https://www.advancedsciencenews.com/some-gluten-free-celiac-patients-still-experience-tissue-inflammation/
European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders
This is a good review of gluten disorders and the follow up care that is required. The guidelines, published recently in the United European Gastroenterology Journal, were based on a revision of existing recommendations and a review of evidence from celiac disease studies done over 30 years, though emphasis was given to research done since 2000. A series of recommendations, classified as “strong” or “conditional,” were made based on the quality of the scientific evidence.
For more information: Umberto Volta et al. First Published April 13, 2019. Review Article
https://doi.org/10.1177/2050640619844125
Gluten-Free Foods Cooked in Shared Fryers with Wheat: A Pilot Study Assessing Gluten Cross Contact
In a study, Tricia Thompson et al, tested 20 orders of fries from 10 different restaurants that stated they used their fryers for both gluten and non-gluten frying. The study found that 25% of the fries would not be considered gluten-free and were unsafe for those with celiac disease.
For more information: https://www.frontiersin.org/articles/10.3389/fnut.2021.652039/full
Interleukin-2 Marks Variation in Celiac Disease Symptoms
An Australian study of 295 CD patients who underwent a gluten challenge found that 1/3 of them had severe symptoms, 1/3 had moderate symptoms and 1/3 had mild symptoms (8 had no symptoms). An immune signal protein, IL-2 released by t cells (white blood cells). T-cells primed to respond to gluten, secrete large amounts of IL-2 to signal an immune reaction. The larger the number of t-cells circulating in their blood, have stronger reactions. Nausea corresponded most closely with the peak IL-2.
For more information: Tye-Din, J.A., Daveson, A.J.M., Goldstein, K.E. et al. Patient factors influencing acute gluten reactions and cytokine release in treated coeliac disease. BMC Med 18, 362 (2020). https://doi.org/10.1186/s12916-020-01828-y
IgA tTG Blood Test Not as Sensitive as We Thought
The reason for this is verification bias: individuals who screen positive are more likely to have their disease confirmed by a follow-up small-bowel biopsy while those who screen negative are unlikely to have a follow-up biopsy that could reveal missed celiac disease. The researchers reviewed a separate set of nine retrospective and prospective studies to determine the frequency of referral for both IgA tTG–positive patients (positive referral rate) and IgA tTG–negative patients (negative referral rate), which were 79.2% and 3.6%, respectively. The new overall values were 57.1% sensitivity (95% confidence interval, 35.4%-76.4%) and 99.6% specificity (95% CI, 98.4%-99.9%) versus previously estimated rates of sensitivity at 92.6% and specificity at 97.6%.
For more information: https://www.medscape.com/viewarticle/949143
Gluten Neuropathy and Genetic Associations
Researchers from Sheffield, UK and the University of Cyprus investigated the genetic linkages to gluten neuropathy. They followed 45 patients who had gluten neuropathy over approximately 8 years. 60% of patients with positive DQA1*02 suffered from sensory ganglionopathy compared to just under 14% of DQA1*02-negative patients. Also, statistically significant was the DQB1*06 allele and the DQA1*01/DQB1*06 haplotype, which were found more frequently in patients with gluten neuropathy than in healthy control subjects.
For more information: Zis, P., Sarrigiannis, P., Artemiadis, A. et al. Gluten neuropathy: electrophysiological progression and HLA associations. J Neurol 268, 199–205 (2021). https://doi.org/10.1007/s00415-020-10137-6
Microbiome Connections with Host Metabolism and Diet
The research studied the microbiome of 1,098 individuals and found many significant associations between microbes and specific nutrients, foods, food groups and general dietary indices, which were driven especially by the presence and diversity of healthy and plant-based foods.
For more information: https://pubmed.ncbi.nlm.nih.gov/33432175/
Can Zonulin Levels Help Diagnose Non-Celiac Gluten Sensitivity?
This Italian study looked at zonulin levels in celiac patients, patients without celiac disease and those with IBS. Zonulin (haptoglobin 2 precursor) is a protein that modulates the permeability of tight junctions between cells of the wall of the digestive tract. This study found that six-month wheat avoidance significantly reduced zonulin levels only in non-celiac gluten sensitivity patients with positive HLA-DQ2/8. Wheat withdrawal was associated with reduced zonulin levels only in non-celiac gluten sensitivity with the HLA genotype.
Zonulin levels were 81% accurate in distinguishing non-celiac gluten sensitivity from IBS-D. By excluding celiac disease, a diagnostic algorithm combining zonulin levels, symptoms and gender increased that accuracy to 89%.
For more information: Gut, 2020 Nov;69(11):1966-1974.
Exposure Sources, Amounts and Time Course of Gluten Ingestion and Excretion in Patients with Celiac Disease on a Gluten-free Diet
Twenty one adults (18 had CD and 3 ate a gluten containing diet) with biopsy confirmed celiac disease, kept a diary of what they ate, and had urine and stool samples collected over a 10-day period. 'Doggie bags' containing ¼ portions of foods consumed were saved during the first 7 days. Gluten in food, stool and urine was quantified using A1/G12 ELISA. 12 of the 18 celiacs had gluten exposure and most were asymptomatic and unsuspecting they had been exposed. A strict gluten free diet is difficult to attain.
For more information: www.medscape.com/viewarticle/939322
University of Chicago, Dr. Chervonsky, MD, PhD Research Looks at Gut Bacteria and CD and Diabetes
Chervonsky and his colleagues hypothesized that some microbes process gluten into biologically active substances that contribute to inflammation. But which microbes do that—and how? The researchers delved into the question using the microbe Enterococcus faecalis, which digests gluten by secreting protease, an enzyme. They fed two versions of E. faecalis to microbiome-free mice: one version that secreted protease and a mutant version that did not. Of the mice fed the conventional E. faecalis that secreted protease, more than half developed diabetes. Of the mice fed the mutant version that did not secrete protease, none got diabetes. With that, the lab had done what had initially seemed impossible: it went from hoping to figure out what gluten does to the microbiota, to identifying one protein produced by one strain of bacteria that enables gluten to trigger diabetes.
For more information: http://www.cureceliacdisease.org/wp-content/uploads/CdC_Newsletter_IssueThree_FINAL-1.pdf
New Study Looking at Ways to Diagnose CD with Less Burden on the Patient
After a gluten challenge, IL-2 increases rapidly in patients with celiac disease, but not in controls, according to the study, which found a response in four hours. “The increase is associated with symptom severity and is one of the earliest and most dynamic soluble blood biomarkers of gluten exposure to date,” the authors wrote. They noted that use of IL-2 is feasible for large studies, reducing the burden on patients because only a single-dose gluten challenge and minimal amounts of blood for testing are needed. Dr. Daniel Leffler at Takeda is the lead researcher on this study. “Different research focuses on different aspects of celiac disease,” Leffler said. “Some [studies] look at intestinal damage, some at symptoms, some at white blood cells. This provides data to guide how to most efficiently study these issues so that we are asking patients who participate in research to have the minimal amount of gluten necessary for the study to be successful and help us better understand celiac disease.”
For more information: https://www.beyondceliac.org/research-news/research-tools-improve-ways-diagnose-celiac-disease
GF Watchdog, Tricia Thompson, RD, Video detailing Testing of GF Foods
Did you know that 96% of labeled gluten-free foods tested through Gluten Free Watchdog test below 20 ppm of gluten? When foods do test out of compliance, the vast majority are grain foods. Of these grain foods, about half are oat products.
For more information: Lessons Learned from 16 Years of Testing Food for Gluten | (glutenfreewatchdog.org)
Tryptophan and Targeted Probiotics may Help Heal the Gut
A study led by researchers at McMaster University in Canada looked at targeting tryptophan metabolism in the gut of those who have celiac disease to better control symptoms that persist despite a gluten-free diet and speed up intestinal healing, according to a press release from the university. Tryptophan is an essential amino acid, which cannot be produced by the body and needs to be consumed through foods such as poultry, chocolate, bananas and cruciferous vegetables such as broccoli, cabbage and cauliflower.
For more information: https://stm.sciencemag.org/content/12/566/eaba0624
Alterations in Intestinal Microbiota of Children with Celiac Disease at the Time of Diagnosis and on a Gluten-free Diet
A study in Glasgow Scotland looked at the microbiota diversity of children with Celiac Disease when they were newly diagnosed and again at 6 and 12 months after being on a gluten-free diet compared to siblings who did not have CD. They concluded that microbiota diversity decreased on a gluten-free diet and compared to the control group without CD, specific bacteria were distinct markers of CD. However, it could not be determined whether these bacteria contributed to the children having CD. More study is required.
For more information: Alterations in Intestinal Microbiota of Children with Celiac Disease at the Time of Diagnosis and on a Gluten-free Diet - Gastroenterology (gastrojournal.org) Published August 10 DOI: https://doi.org/10.1053/j.gastro.2020.08.007
Celiac Disease Patients have no Higher Risk of Contracting COVID-19 than General Population
An international team of researchers including Dr. Elena Verdu and Dr. Maria Ines Pinto Sanchez of McMaster University, had volunteers from celiac associations, electronic newsletters and social media, answer forty-one questions in a web-based survey that was available in English, Spanish and Italian. People with celiac disease tend to have more comorbidities including respiratory, cardiac, and diabetes, compared with control subjects. Patients with celiac disease were significantly less likely to have been tested for, and to have been exposed to, COVID-19, compared with control subjects. Just under 9% of 940 participants tested positive for COVID-19. Celiac patients do not face any higher risk of contracting Covid-19 than control subjects. Unfortunately, this study did not look at whether celiac patients have worse outcomes if they do contact COVID-19.
For more information: https://www.celiac.com/articles.html/no-higher-covid-19-risk-for-celiac-disease-patients-r5368/
The Hidden Dangers of Protein Powders
An updated article by the Harvard Health Letter warned of the problems with protein powders on the market today. Many are high in sugar and calories and as they are supplements, there is no oversight on what is contained in the products. They may cause digestive distress especially if you have a sensitivity to dairy products. Some have been found to have high levels of toxins. Check out Clean Label Project's website (www.cleanlabelproject.org) to ensure the safety of products that you may use. The article recommends getting protein from healthy food sources.
For more information: https://www.health.harvard.edu/staying-healthy/the-hidden-dangers-of-protein-powders
Infant Antibiotic Exposure Tied to Celiac Disease and Many Other Childhood Health Disorders
A group of researchers mainly from the Mayo clinic, set out to see what they could learn about potential connections between antibiotic exposure in the first two years of life, and the risk of childhood immunological, metabolic, and neurobehavioral health conditions.
Of the 14,572 children in the study, over half were boys. 70% of the children had received at least 1 antibiotic prescription during the first 2 years of life. They found that early antibiotic exposure was tied to an increased risk of childhood-onset asthma, allergic rhinitis, atopic dermatitis, celiac disease, overweight, obesity, and attention deficit hyperactivity disorder. The number, type, and timing of antibiotic exposure all influenced the connections. Further study is required to maximize the benefits and minimize the risks of antibiotics in the first two years of childhood.
For more information: https://www.mayoclinicproceedings.org/article/S0025-6196(20)30785-0/fulltext
Brain Scans May Provide Clues for Those Suffering from Gluten Sensitivity
A study out of England finds that those with gluten sensitivity have celiac disease like neurological issues. “Feelings of brain fog and headache each worsened in a consistent manner and by an overall significant magnitude after eating gluten,” the study says, reinforcing the importance of a gluten-free diet for those with gluten sensitivity.
“Overall, our conclusions are that this is evidence that [gluten sensitive] patients potentially have slightly “unwell” brains in terms of our baseline measurements in ways which mirror what we see in celiac disease,” Croall said. “And eating gluten appeared to lead to worse neurological symptoms.”
For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454984/
Gut Microbiota in Celiac Disease: Microbes, Metabolites, Pathways and Therapeutics
Researchers including Dr. Maureen Leonard and Dr. Alessio Fasano review the role of the intestinal microbiota on the development of chronic autoimmune disease including Celiac Disease. While research to date provides a solid foundation, most studies have been case-control and thus do not have capacity to explore the mechanistic role of the microbiota in CD onset. Further longitudinal studies and integrated multi-omics are necessary for investigating CD pathogenesis.
For more information: https://www.tandfonline.com/doi/abs/10.1080/1744666X.2021.1840354
Screening Only Way to Find All Children with Celiac Disease
The study by researchers at University of Colorado found that symptoms were not reliable predictors of which children would have celiac disease. And most children who had positive antibody screening did not have a family history of celiac disease. Screening is testing for health conditions and diseases when there are no risk factor, signs or symptoms. More than half of those with Celiac Disease may have no symptoms and not be identified by current recommendations for screening through blood tests for celiac disease. In addition to consequences for patients, diagnosis of CD through screening has implications for the healthcare system. Costs of unrecognized CD can include prescription drugs, primary healthcare visits and missed days of school.
For more information: https://pubmed.ncbi.nlm.nih.gov/32701732/
Celiac Disease Researchers Link Early-Life Environmental Triggers with Changes in the Developing Gut Microbiome
Dr. Maureen Leonard, a celiac herself and associated with the Centre for Celiac Research and Treatment at MassGeneral Hospital, was the lead researcher in a study that looked at the impact of three early-life environmental triggers on the microbiome during the first six months of life: birth delivery mode, antibiotic exposure and infant feeding type. Infants exposed to at least one of the three environmental triggers had alterations in the microbiome associated with immune dysfunction and inflammatory conditions. Those not exposed to any of these environmental triggers developed strong immune systems and anti-inflammatory effects. Based on these early results, researchers cannot yet link the microbiome alterations seen in this study directly to celiac disease onset, but “the results lay a solid and promising foundation for future studies,” said Leonard. They plan to follow the 31 infants studied in a longitudinal study to provide more insight.
For more information: https://mgriblog.org/2020/12/22/celiac-disease/
Exposure to Microbes and Risk of Celiac Disease
A review of 135 studies in Oslo, Norway found that childhood infections correlated with an increased risk of subsequent celiac disease in nine studies, whereas maternal infections during pregnancy did not show a clear association. Microbes were linked to CD: Helicobacter pylori in four out of 16 studies, adenovirus in two out of nine studies, and enterovirus in two out of six studies. Rotovirus infections have also been linked to the development of CD.
For more information: https://www.medscape.com/viewarticle/943274
Biopsy May Not be Needed in the Diagnosis of Celiac Disease
The study found that when participants’ anti-tissue transglutaminase immunoglobulin A (TTG) tests were highly positive, ten times the upper limit of normal, they almost always also had the level of damage to the intestine that is the hallmark sign of celiac disease. This is consistent to changes in the diagnosis guidelines for children. The role of the biopsy in celiac disease diagnosis is a controversial topic and the subject of ongoing research.
For more information: https://www.beyondceliac.org/research-news/biopsy-not-always-needed/
Go Beyond Celiac Conducted Research on Celiac Disease and Headaches
A UK study found that celiac disease patients were 2.7 times more likely to have headaches than those who did not have celiac disease. 71% of Go Beyond Celiac participants report getting headaches or migraines with gluten exposure, and 28% say their headaches are severe or very severe. The study concludes that patients with unexplained headaches and abnormal brain scans should be tested for celiac disease.
For more information: https://www.beyondceliac.org/research-news/the-headache-of-celiac-disease
Comments on Study “Preparation of Gluten-Free Foods Alongside Gluten-Containing Food May Not Always Be as Risky for Celiac Patients as Diet Guides Suggest”
The Gluten-Free Watchdog, Tricia Thompson, RD, reviewed the above study and concluded more information is necessary before celiacs changes their habits with regards to avoiding cross-contamination. The study can be found at https://www.gastrojournal.org/article/S0016-5085(19)41340-1/pdf . Tricia concluded that Cross contact must continue to be addressed and assessed. One study should not change recommendations. As a result, please do not use a shared toaster oven or pop up toaster without cleaning the grill or using toaster bags. And please do not use a shared rolling toaster when eating away from home. Please do not use shared utensils that have not been washed between uses. More study in the area is needed before we change our habits to avoid cross contamination.
For more information: https://www.glutenfreewatchdog.org/news/gluten-free-watchdog-comment-on-the-recent-gluten-cross-contact-study-preparation-of-gluten-free-foods-alongside-gluten-containing-food-may-not-always-be-as-risky-for-celiac-patients-as-diet/
Celiac Disease Changes the Gut Microbiota in Children
“Duodenal microbiota of celiac patients showed a dominance of Enterobacteriaceae and sub dominance of Bacteroidetes/Streptococcus, while stool microbiota showed a lower abundance of Bacteroides-Prevotella (p=0.013), Akkermansia (p=0.002) and Staphylococcaceae (p=0.001) in celiac patients compared to healthy controls.
Patients with abdominal pain showed an increased mean relative abundance of Bacillaceae and Enterobaeriaceae, while celiac patients with diarrhea had reduced mean relative abundance of Clostridium cl. XIVa, Akkermansia, with an increase in Bacillaceae, and Fusobacterium.”
For more information: J Gastroenterol Hepatol. 2020 Jul 14
Gut Microbiota in Celiac Disease: Is There Any Role for Probiotics?
A study in Italy looked at the role of probiotics in CD therapy. They reviewed published English articles that provided evidence-based data. “Literature analysis showed that the gut microbiota has a well-established role in gluten metabolism, in modulating the immune response and in regulating the permeability of the intestinal barrier. Promising studies suggest a possible role of probiotics in treating and/or preventing CD. Nevertheless, human trials on the subject are still scarce and lack homogeneity.” Which probiotics are more effective, at what dose and how long they should be administered are yet to be determined. Further study is required. For more information: Front Immunol. 2020; 11: 957. Published online 2020 May 15. doi: 10.3389/fimmu.2020.00957
Study Reveals that Vitamin D supplementation Changes a Baby’s Microbiome
A study of 1,157 infants found that those supplemented with Vitamin D may give some protection to respiratory illnesses and lung infection among infants. The study found that nearly 30% of the infants carried C. Difficile, but there was a lower incidence of the bacterium among exclusively breastfed infants. ‘Interestingly, maternal consumption of vitamin D fortified milk was the only factor that reduced the likelihood of C. Difficile colonization in infants.” More study is required.
For more information: https://www.tandfonline.com/doi/full/10.1080/19490976.2020.1799734
Gluten Response Biomarkers in Celiac Disease
A recent study out of Boston, Massachusetts looked at changes in “villi height, gluten-specific cluster of differentiation (CD)4 T-cell analysis with human leukocyte antigen (HLA)-DQ2-gluten tetramers and enzyme-linked immune absorbent spot (ELISpot), gut-homing CD8 T cells, interleukin (IL)-2, symptoms, video capsule endoscopy (VCE), intraepithelial leukocytes (IELs), and tissue multiplex immunofluorescence.” A portion of the study participants were given 3 gm of gluten per day, while another group were given 12 gm of gluten per day. The gluten challenge showed changes in all factors, however, the time taken to see changes varied. IL2 showed the earliest changes and was most sensitive to the gluten exposure. Differences in reaction were seen between those with the HLA DQ2 and HLA DQ8 genes. This study will assist in defining the gluten challenge and the testing required.
For more information: https://doi.org/10.1053/j.gastro.2020.10.040
Introduction of Gluten to Infants
A recent study in JAMA Pediatrics results indicate that there is no harm to introduce children between 4 – 6 months of age to gluten. In fact, the study found that the introduction of gluten at this age may very well decrease the risk of developing celiac disease at a later date.
For more information: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2770801
Larazotide Acetate Phase 3 Trial Shows Promise to Reduce Symptoms of Those with CD
“The CeDLara Study is testing larazotide acetate in people with celiac disease who continue to have symptoms even while following the gluten-free diet. Larazotide acetate is designed to tighten the adhesions between cells lining the small intestine, called tight junctions. In people with celiac disease, gluten causes these tight junctions to break down, which allows gliadin (a component of gluten) to enter this space between and underneath the intestinal cells. Once in the “wrong” place, the gliadin prompts an inflammatory response from the immune system. This “leaky gut” is thought to be the gateway to many autoimmune diseases, including celiac disease. Larazotide acetate makes the tight junctions more secure, keeping gliadin from passing through.”
For more information: https://www.beyondceliac.org/research-news/larazotide-phase3/
Multi-omics analysis reveals the influence of genetic and environmental risk factors on developing gut microbiota in infants at risk of celiac diseaseThis article looks at the microbiota and the gut bacteria and metabolites that may put infants at risk for celiac disease. More study in this area is required.
For more information:https://microbiomejournal.biomedcentral.com/articles/10.1186/s40168-020-00906-w
Assessment of KAN-101 in Celiac Disease Study (ACeD Study)
A Phase I trial will study KAN-101 which acts by re-educating T cells, or tolerizing them, so they do not respond to gluten antigens. KAN-101 may help patients with celiac disease without interfering with the natural protective functions of the immune system.
For more information: https://clinicaltrials.gov/ct2/show/NCT04248855
Dermatitis Herpetiformis (DH) Patients Unlikely to Gluten-free Diet Counselling
A University of Pennsylvania study DH patients were less likely to get gluten-free diet counselling as most dermatologists lack appreciation for the need to offer this information. The result is those who failed to adopt a strict gluten-free diet within the first 5 years of diagnosis had an increased risk of mortality from lymphoma. Further prospective studies are needed to better understand the DH population, specifically if comorbidities and prognosis mirror those in patients with CD but without DH.
For more information: https://jamanetwork.com/journals/jamadermatology/article-abstract/2771178
Celiac Disease is Associated with Risk of Osteoporotic Fractures
693 people with celiac disease in Manitoba BMD Registry were followed for a mean 7 years and compared to 68K of the general population who were followed a mean 7.1 years. Those with celiac disease had a higher risk of a major osteoporotic fracture compared to the general population.
For more information: https://www.docwirenews.com/condition-center/celiac-disease-is-associated-with-risk-of-osteoporotic-fractures/
Gluten Exposure in Patients with Celiac Disease on a Gluten-Free Diet
By studying gluten immunogenic peptides in urine and fecal samples over a 4-week period from 53 adults in Argentina diagnosed with celiac disease the study determined that even patients on a long-term gluten-free diet are frequently exposed to gluten. They also concluded that stool and urine samples might be used to assist dietitians in determining gluten-free compliance. “Patients with symptoms had more weeks in which GIP was detected in stool than patients without symptoms.” 37.9% of the samples were positive for GIP and 88.7% of patients had at least 1 positive sample.
For more information: https://pubmed.ncbi.nlm.nih.gov/32217152/ and https://www.beyondceliac.org/research-news/new-evidence-gluten-in-gluten-free-diet
Organic Pollutant Exposure and Celiac Disease
Researchers affiliated with New York University School of Medicine found a high correlation to organic pollutant exposure and the development of inflammatory autoimmune conditions. Although more research is required, the study looked at levels of DDE, PFOS, PFOA and BCE153 in patients and found a greater incidence of celiac disease in: both males and females with higher levels of DDE; females with increased concentrations of perfluoroalkyl substances (PFASs); and, males associated with BCE153. Persistent organic pollutants (POPs) are know endocrine disruptors that interplay with the immune system.
To reduce exposure, open windows and recirculate air as well as use a wet mop to reduce household dust that includes pollutants. When cooking use cast-iron or stainless-steel pans to reduce PFAS.
Comments by Dr. Fasano regarding this study: “Common sense is advisable not just because of celiac disease. Any child will get sick if they are exposed to chemicals beyond normal levels,” Fasano said. “Try to have a lifestyle that minimizes the risk that your child and your family in general are exposed to chemicals that can be offensive to you.”
For more information: https://www.sciencedirect.com/science/article/abs/pii/S0013935120303327
Increased IBD Risks for Celiac Patients and Celiac Risk for IBD Patients
Researchers from the Francombe Family Digestive Research Institute, McMaster University, Hamilton reviewed medical databases and found nearly 10K studies, using 65 in their assessment. They found higher risk of ant-Saccharomyces antibodies, a serologic marker of IBD, in celiac patients and IBD patients had an increased risk of anti-tissue transglutaminase (tTG) antibodies. Further study is required.
For more information: https://www.gastrojournal.org/article/S0016-5085(20)30609-0/fulltext
Gluten Contamination in Labelled and Naturally Gluten-free Grain Products in Southern India
I know travel is limited at this time, but in BC there is a large population from India who have higher than normal incidences of Celiac Disease. A study of gluten-free grain product in India found that Among “35.9% of the flour samples and 85% of the oat samples (11.67–1830 mg/kg) were contaminated with gluten. In the case of flours, unbranded samples collected from local markets (70%) and directly from local mills (30%) showed gluten content above Codex safety levels (20–400 mg/kg). “ The problem seems to be on products source from local retailers and directly from millers. Be aware of the risks if you are travelling in India.
For more information: Nagaraju Raju, Apurva Kumar R Joshi, Raidu Vahini, Thappatla Deepika, Kandlakunta Bhaskarachari & S. Devindra (2020) Gluten contamination in labelled and naturally gluten-free grain products in southern India, Food Additives & Contaminants: Part A, 37:4, 531-538, DOI: 10.1080/19440049.2020.1711970
High Prevalence of Celiac Disease in First Degree Relatives
A Mayo Clinic study found that of 360 first degree relatives of diagnosed celiacs (FDR) screened 44.4% were diagnosed with CD. 62% of those diagnosed were female. 6% had classical symptoms, 66% had non-classical symptoms and 28% had no symptoms. tTG levels were high even with no symptoms.
For more information: https://www.mayoclinicproceedings.org/article/S0025-6196(19)30353-2/fulltext
Recurrent Aphthous Stomatitis Points to Anemia and Celiac Disease
A Turkish study of children between 6 months and 18 years. Medical records of patients diagnosed with recurrent aphthous stomatitis (RAS) were reviewed. RAS is one of the most common diseases of the oral mucosa and may be related to vitamin deficiencies or systemic diseases such as celiac disease (CD). Iron deficiency anemia, hematological abnormalities and malnutrition was much more prevalent in the patients diagnosed with RAS.
For more information: https://pubmed.ncbi.nlm.nih.gov/31957941/
Digestion of Intact Gluten Proteins by Bifidobacterium Species: Reduction of Cytotoxicity and Proinflammatory Responses
A Brazilian study showed that Bifidobacterium species reduced the destruction of living cells and the inflammatory response in the body. These results indicate that Bifidobacterium may be beneficial in the treatment of celiac disease.
For more information: J. Agric. Food Chem. 2020, 68, 15, 4485–4492, Publication Date: March 20, 2020, https://doi.org/10.1021/acs.jafc.0c01421 , Copyright © 2020 American Chemical Society
Celiac Disease and Children’s Mental Health
34% of children within the study published in the Journal of Pediatric Gastroenterology Nutrition were found to have at least 1 mental disorder compared to 13% of the general population. “The significant psychological and psychosocial impact of celiac disease in children and adolescents has gone unrecognized for too long. This lack of recognition can leave children on their own to deal with anxiety, anger, depression, ADHD and more,” said Salvo Alesci, MD, Beyond Celiac chief scientist and strategy officer. “As this study suggests, mental health should be routinely assessed and monitored in children with celiac disease to provide help that can make a big difference in their lives and the lives of their families. Overall, we need to pay more attention to extraintestinal symptoms of celiac disease.”
For more information: https://www.beyondceliac.org/research-news/children-mental-issues-risk
Possible Role of Vitamin D in Celiac Disease Onset
Italian researchers call for further research into the role Vitamin D has in celiac disease. Researchers have noted that the Vitamin D receptor sites (VDR) expresses itself as antigen-presenting cells and lymphocytes, which indicates that vitamin D is a key modulator of immune and inflammation mechanisms, and suggests that VDR gene polymorphisms function as markers of either resistance or susceptibility to autoimmune diseases.
For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231074/
Nausea and Vomiting, but not IBS-like Symptoms are Common for Gluten-Free Celiacs
A study at the University of Queensland, Brisbane, Australia, School of Medicine, indicates that nausea and vomiting are common symptoms of being exposed to gluten if you are a gluten-free celiac. Levels of interleukin – 2 correlated highly with the severity of the symptoms. They also stated that FODMAP issues are common among celiacs.
For more information: https://onlinelibrary.wiley.com/doi/abs/10.1111/apt.15551
Tofacitinib Triggers Celiac Disease Remission in a Gluten-Eating Patient
A patient who started tofacitinib therapy for alopecia areata had complete histologic and serologic remission of his celiac disease (CD), despite being on a gluten-containing diet. This is only one instance. "The efficacy of tofacitinib in alopecia areata may also be related to inhibition of CD8+ T-cell reactions to follicle-associated autoantigens," Dr. Wauters and his team write. If the findings are confirmed, the researcher noted, the advantages of tofacitinib for patients with refractory CD could outweigh the potential risks. Further study is required.
For more information: https://bit.ly/2CRJxeM Annals of Internal Medicine, online July 27, 2020.
Supercharged Shellfish Could Aid in Vitamin Deficiency
Researchers at the University of Cambridge have fortified shellfish (oysters, clams and mussels) through a new microencapsulation technology. As we eat the whole organism when we eat these shellfish, so they are ideal to target for nutritional fortification.
For more information: https://www.newfoodmagazine.com/news/114597/supercharged-shellfish
Cytokines, IL-15 and IL-8 Can Aid in Differentiating Patients with NCGS versus Celiac Disease
Research in Iran found that IL-15 distinguished the celiac and NCGS groups from control groups 83% of the time. IL-8 was 75% sensitive. These cytokine levels can be useful in spotting the difference between the two conditions.
For more information: https://pubmed.ncbi.nlm.nih.gov/32660201/
Gut microbiome investigation in celiac disease: from methods to its pathogenetic role
This article details the microbiome and the differences in types of bacteria for celiacs compared to healthy individuals. It also details the microbiome organisms found in gut, oral, duodenum, and feces.
For more information: https://www.degruyter.com/view/journals/cclm/58/3/article-p340.xml
Association Between Celiac Disease and Mortality Risk in a Swedish Population
“In this population-based cohort study of 49 829 patients in Sweden with celiac disease followed up for a median of 12.5 years, the mortality rate compared with general population controls was 9.7 vs 8.6 deaths per 1000 person-years, a difference that was statistically significant.”
For more information: https://jamanetwork.com/journals/jama/article-abstract/2764182
Gut Microbiota in Celiac Disease: Is There Any Role for Probiotics?
“Currently published data suggest the efficacy and safety of probiotic supplementation in improving CD-related symptoms, as well as documenting the ability of some probiotics to alter the fecal microbiota and decrease pro-inflammatory parameters such as TNF-α levels or peripheral CD3+ T lymphocyte counts (which probiotics are more effective, at what dose and how long they should be administered are yet to be definitively clarified.”For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243837/Celiac Disease Patients have a Slightly Higher Mortality Risk
Over a ten-year period, 9.7 people out of 100 people with celiac disease died from all causes compared to 8.6 out of 100 people who did not have celiac disease, according to the study. The study was based on 50K Swedish celiacs between 1969 and 2017. However, no increase in mortality risk was seen when the 25 percent of celiac disease patients who had persistent damage to the villi were compared to those who had intestinal healing. Dr. Lebwohl emphasized that the absolute risk, which was about 1 more person in 100 over 10 years is more practical. “We know that the great majority of people with celiac disease live long and healthy lives,” he said.
Among the causes of death, patients with celiac disease were at slightly increased risk of cardiovascular disease death, cancer, and respiratory disease.
For more information: https://jamanetwork.com/journals/jama/article-abstract/2764182
IL 15, gluten and HLA-Dq8 drive tissue destruction in celiac disease
Using a mouse mode, this study found that overexpression of IL-15 in both the epithelium and the lamina propria (thin layer of connective tissue, which lies beneath the epithelium. Together they make up the mucosa) is required for the development of villous atrophy in the small intestine. This demonstrates the location-dependent central role of IL-15 in the development of celiac disease. In addition, CD4+ T cells and HLA-DQ8 have a crucial role in the causing cytotoxic (toxic to living cells) T cells to mediate intestinal epithelial cell disintegration. They also demonstrated a role for the cytokine interferon-γ (IFNγ) and the enzyme transglutaminase 2 (TG2) in tissue destruction.
For more information: https://www.nature.com/articles/s41586-020-2003-8 . February 12, 2020
Masked bolus gluten challenge low in FODMAPs implicates nausea and vomiting as key symptoms associated with immune activation in treated coeliac disease
After ingestion of gluten, nausea increased most in those with treated CD. Apart from tiredness and headache, changes in other symptoms were small or absent. Only nausea increased significantly in occurrence with gluten (11% vs 69%, P < .001). Without nausea, only tiredness and flatulence were common after gluten and vomiting were the only adverse events more common with gluten than the control group.
For more information: 26 November 2019 https://doi.org/10.1111/apt.15551
Researchers confirm celiac disease can damage the brain
People living with celiac disease (CD) have a higher risk of neurological damage according to a new study from the University of Sheffield. Dr. Iain Croall, a research fellow from the University of Sheffield's Department of Infection, Immunity and Cardiovascular Disease, said and Associate Member of Insigneo: "For the first time, the study offers some clarity on the fact that there does appear to be the risk of neurological damage for people living with CD, driven by their autoimmune response to gluten exposure.
"Our independent UK Biobank participants with CD showed meaningful neurological and psychological deficits when compared with control participants.
"The data from the CD group of participants showed a significant reaction time deficit, compared to the control participants; alongside signs of anxiety, health-related unhappiness and depression." Note: Dr. Croall was Guest Speaker at the recent CCA National On-line conference.
For more information: https://medicalxpress.com/news/2020-02-celiac-disease-brain.amp and I.D. Croall et al. Cognitive Deficit and White Matter Changes in Persons with Celiac Disease: a Population-Based Study, Gastroenterology (2020). DOI: 10.1053/j.gastro.2020.02.028
Cytokine release and gastrointestinal symptoms after gluten challenge in celiac disease
Rapid, coordinated elevation of circulating cytokines including IL-2 confirmed in vivo activation of CD4+ T cells in CD patients after injecting short antigenic gluten peptides or ingestion of gluten that was closely associated with the onset and severity of acute digestive symptoms. The systemic cytokine release observed provides definitive evidence of rapid immune activation within 2 hours after administering gluten peptides in almost all HLA-DQ2.5+ CD patients. Qualitative and quantitative assessments of cytokines elevated after injecting gluten peptides or gluten food challenge were complicated by individual cytokines having different profiles and by low baseline concentrations of key cytokines such as IL-2.
For more information: https://advances.sciencemag.org/content/5/8/eaaw7756
Cardiovascular outcomes in patients with Celiac Disease: an insight from the national inpatient sample
According to the results, in 2014 the proportion of patients with CD in AMI hospitalizations grew from 0.015% in 2005 to 0.076%. The results showed that CD+AMI patients were significantly older (70.3 vs. 67.4 years), and more likely female (51.9% vs. 39.5%). “We found that the number of acute myocardial infarction related admissions in the CD patients has risen more than five-fold from 2005-2014,” the authors concluded. “However, the odd of in-hospital mortality in these patients is lower than the patients without CD for unclear reasons or mechanisms. The results of our study show that though the CD-related systemic inflammation is associated with an increasing number of AMI hospitalizations, these patients have comparatively favorable outcomes than controls; though it definitely adds an extra cost to the hospitalization.”
For more information: https://www.docwirenews.com/conference-coverage/acc20/cardiovascular-celiac-disease/
Researchers investigate rogue cells that are the root cause of autoimmune diseases
"Current treatments for autoimmune disease address only the symptoms, but not the cause. To make more targeted treatments that address disease development and progression, we first need to understand the cause," says Professor Chris Goodnow, co-senior author of the published work, Executive Director of the Garvan Institute and Director of the UNSW Sydney Cellular Genomics Futures Institute.
By first separating individual cells, and then separating their genetic material, the researchers isolated immune cells that produced 'rheumatoid factors' - antibody proteins that target healthy tissues in the body and are associated with the most common autoimmune diseases, including rheumatoid arthritis. "We uncovered 'lymphoma driver mutations', including a variant of the CARD11 gene, which allowed the rogue immune cells to evade immune tolerance checkpoints and multiply unchecked," explains Professor Goodnow, who first hypothesised that disease-causing autoimmune cells employ this cancer tactic in 2007. The researchers are now planning follow-up studies to investigate mutations of autoimmune cells in a range of other diseases, including lupus, celiac disease and type 1 diabetes.
For more information: https://medicalxpress.com/news/2020-02-rogue-cells-root-autoimmune-disease.html
Gynecological symptoms in patients with non-celiac wheat sensitivity (NCWS)
The researchers in Palermo, Italy surveyed gynecological symptoms and recurrent cystitis in sixty-eight women with NCWS. Nearly sixty percent of NCWS patients had more frequent gynecological symptoms, than did healthy control subjects, IBS control subjects or controls with celiac disease. More than twenty-five percent of patients with NCWS experienced more frequent changes to the menstrual cycle, compared with just over eleven percent of healthy controls. Sixteen percent patients with NCWS suffered from recurrent vaginitis (16%) and dyspareunia (6%) significantly more frequently than healthy controls.
Over a one-year follow-up period, nearly half of patients with menstrual disorders and nearly forty percent with recurrent vaginitis reported that their symptoms had resolved on a wheat-free diet.
For more information: https://link.springer.com/article/10.1007/s10620-020-06184-8
Children who meet specific criteria do not require an endoscopy for diagnosis of Celiac Disease
The team analyzed 2016 medical records for celiac patients under 19 years old, who were diagnosed in five European countries. 653 children from Croatia, Hungary, Germany, Italy, and Slovenia data was analyzed. Ages of subjects were 7 months-18.5 years, average age of 7 years. 64% were female.
134 children were asymptomatic at diagnosis. Of 519 children who did show symptoms, 107, nearly 21%, were diagnosed without biopsy. Out of 412 children diagnosed via biopsy, 214, or nearly 52% had tTG levels of above 10 times upper level of normal (ULN) and thus could have been diagnosed without biopsy. The data showed no differences in diagnostic times with the no-biopsy approach. In this study, about 60% of celiac patients who show symptoms could have been diagnosed without duodenal biopsies. However, only 20% of eligible patients are getting a biopsy-free celiac diagnosis.
For more information: https://www.celiac.com/
Ocular Manifestations in Celiac Disease: An Overview
Several ocular symptoms and disorders have been associated with CD and are a result of defective intestinal absorption and immunological mechanisms. These include nyctalopia, dry eye, cataract, thyroid-associated orbitopathy, uveitis, central retinal vein occlusion and neuro-ophthalmic manifestations. In addition, CD-related ocular disease may represent the first manifestation of CD.
For more information: https://link.springer.com/article/10.1007/s10792-019-01254-x
Increased Prevalence of Celiac Disease in School-age Children in Italy
The incidence of celiac disease in school age children in Italy has increased to 1.5% which is significantly higher than 25 years ago. Causes for this increase need to be determined.
For more information: https://www.cghjournal.org/article/S1542-3565(19)30651-2/pdf
Celiac Disease and Its Role in the Development of Metabolic Bone Disease
CD and the effects of malabsorption on bone health. Imbalances in bone resorption and formation particularly in individuals with CD and persistent disease activity ultimately lead to a state of bone loss and impaired mineralization. Initiation of a gluten-free diet is critical in the management of CD-related metabolic bone disease, demonstrating improvements in bone mineral density within the first year of dietary adherence.
For more information: https://pubmed.ncbi.nlm.nih.gov/31320223
Atopic Dermatitis and Celiac Disease: A Cross-Sectional Study of 116,816 Patients
1909 adults had moderate to severe atopic dermatitis. Those with atopic dermatitis were associated with significantly higher prevalence of CD (1.6 times more likely to have CD). This association emphasizes the need for timely screening of gastrointestinal issues, especially CD.
For more information: https://www.ncbi.nlm.nih.gov/pubmed/31679111 American Journal of Clinical Dermatology Feb 2020 21(1):133-138. doi: 10.1007/s40257-019-00474-2.
Treatment of Neurological Manifestations of Gluten Sensitivity and Coeliac Disease
This paper outlines the neurological manifestations of CD and NCGS. Co-authored by expert Dr. Marios Hadjivassiliiou. The paper reviews gluten ataxia, gluten neuropathy, cognitive impairment and headaches including chronic migraines resulting from autoimmune responses to gluten.
For more information: https://link.springer.com/article/10.1007/s11940-019-0552-7
Infection, Antibiotic Exposure and the Risk of Celiac Disease
This study looked at published research in PubMed, Embase and Cochrane databases from their inception to April 2019. These results provide strong evidence that early infection and/or antibiotic exposure increase the odds of developing celiac disease and suggest that disruption of intestinal immune processes or gut microbiota may play a role in celiac disease development. Further study is required on other causal factors.
For more information: https://onlinelibrary.wiley.com/doi/epdf/10.1111
Latiglutenase Treatment for Celiac Disease: symptom and quality of life improvement for seropositive patients on a gluten‐free diet
Although this study was not powered to definitively establish the benefit of latiglutenase in seropositive CD patients, such patients appear to show symptomatic and QOL benefit from using latiglutenase with meals.
For more information: https://onlinelibrary.wiley.com/doi/abs/10.1002/ygh2.371
Significant Association Shown Between Psoriasis and Celiac Disease
A review of published studies of Celiac Disease and Psoriasis showed that patients with psoriasis with bowel complaints might benefit from screening for CD through questionnaires or interviews with subsequent gastroenterology consultation. Of 754 citations 18 were reviewed in detail. Odds were 2.16 times that psoriasis patients would have CD and 1.8 times more likely to find psoriasis in CD patients than the general population.
For more information: https://www.jaad.org/article/S0190-9622(19)33131-7/fulltext?rss=yes
Incidence of Celiac Disease is Increasing over Time
In the 21st century, of 11,189 citations, 86 eligible studies were identified and 50 were deemed suitable for analyses. Female incidence of CD was 17.4 per 100,000 person-years, compared with 7.8 in males. Child-specific incidence was 21.3 per 100,000 persons compared with 12.9 in adults. The average annual percent changes showed the incidence of CD to be increasing by 7.5% per year over the past several decades.
For more information: American Journal of Gastroenterology, Feb 4, 2020
https://journals.lww.com/ajg/Abstract/publishahead/Incidence_of_Celiac_Disease_Is_Increasing_Over.99422.aspx
IV-infused agent (TAK-101, Takeda Pharmaceutical) has Successful Phase 2 Trial
“If our findings are confirmed by subsequent studies, this treatment may represent a revolutionary change in how we manage celiac disease,” said Ciaran Kelly, MD, of Beth Israel Deaconess Medical Center, in Boston, who led the study (late-breaking abstract 18). Gliadin containing nanoparticles are infused through two IV infusions spaced one week apart and they are used to reduce the immune reaction to gluten. A gluten challenge followed for those taking the nanoparticles and a control group of patients with CD. The symptoms of the control group were significantly worse than those taking the nanoparticle infusions.
While more research is needed to demonstrate the agent’s efficacy, the study offers an “important proof of concept that tolerization to gluten is a path worth pursuing in celiac disease,” said Benjamin Lebwohl, MD, MS, the director of clinical research at the Celiac Disease Center at Columbia University, in New York City, who was not involved in the study. Continued study is required.
Biomarker for Non-Celiac Gluten Sensitivity Found
A research team in Italy investigated the expression levels of selected miRNAs in duodenal biopsies and peripheral blood leukocytes collected from newly diagnosed patients with non-celiac wheat sensitivity (NCWS) and, as controls, from patients with celiac disease and gluten-independent gastrointestinal problems. They found that several miRNAs in those with NCWS were elevated. More study is required to determine if this will be useful for a test to identify those with NCWS.
For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6910677/
Incidence of Undiagnosed Celiac Disease Presenting as Bone Stress Injuries to a Sport and Exercise Medicine Clinic
In a UK study, the incidence of positive blood testing for CD for 100 patients with bone stress injuries from sport was 6%. The incidence confirmed by biopsy was 5%, therefore CD screening should be considered for all those with bone stress injuries.
For more information: https://www.ncbi.nlm.nih.gov/pubmed/32032163
Headache in Children with Celiac Disease
At least one-third of children and adolescents with celiac disease have recurrent headaches at the time of diagnosis. A gluten-free diet led to improved headache symptomology in a significant number of these patients.
For more information: Journal of Child Neurology, 35 (1) 37 - 41Jan 2020
Processed Food Additive Microbial Transglutaminase and Its Cross-Linked Gliadin Complexes Are Potential Public Health Concerns in Celiac Disease
According to the manufacturers' claims, microbial transglutaminase and its cross-linked products are safe, i.e., nonallergenic, nonimmunogenic, and nonpathogenic. The regulatory authorities declare it as "generally recognized as safe" for public users. The enzyme imitates its family member tTG, the autoantigen of CD and may enhance intestinal permeability, suppress immunological protective barriers, increase bacterial growth and augment the uptake of the gliadin peptide. Scientific observations are accumulating concerning its undesirable effects on human health and more study is required to ensure its safety.
For more information: Int. J. Mol. Sci. 2020, 21(3), 1127; https://doi.org/10.3390/ijms21031127
Current Concepts of Dermatitis Herpetiformis
Dermatitis Herpetiformis (DH) is the skin manifestation of celiac disease. The article talks about TG3 autoantibody identification in the diagnosis of DH and covers the current diagnosis and treatment options.
For more information: https://www.medicaljournals.se/acta/content/html/10.2340/00015555-3401
Psychiatric Manifestations of Coeliac Disease, a Systematic Review and Meta-Analysis
This systematic review identified a significant increased risk for autistic spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), depression, anxiety, and eating disorders amongst patients with CD compared to healthy controls. No significant risk was identified for bipolar disorder or schizophrenia. The cerebellum has emerged as one of the key brain regions affected in non-motor disorders, including autism spectrum disorder and attention deficit-hyperactivity disorder. The cerebellum is the principle brain target in both CD and gluten sensitivity.
For more information: https://www.mdpi.com/2072-6643/12/1/142/htm
T-Cells Trigger Immediate Symptoms in Celiacs
Immune cells, CD4+ T cells, react to proteins in wheat, rye and barley in those with Celiac Disease (CD). This reaction is what leads to the damage in the villi of the small intestine. Cytokine activity, called interleukin-2 or IL-2, begins to climb immediately after the ingestion of gluten. As these chemicals increase, study participants felt nauseous or vomited. Doctors may be able to diagnose celiac disease by measuring IL-2 levels in the blood, sparing patients the need for tests in which they’re repeatedly given gluten. Future therapies may be able to block the gluten-reacting T cells to reduce symptoms from gluten exposure.
For more information: G. Goel et al. Cytokine release and gastrointestinal symptoms after gluten challenge in celiac disease. https://advances.sciencemag.org/content/5/8/eaaw7756 and https://www.medicalnewstoday.com/articles/326018.php#2
Early Childhood Stress and Trauma Linked to the Development of Celiac Disease
A McMaster University study highlights the need for psychosocial assessments in clinical gastroenterology practice, a step they say may improve understanding of the pathophysiology of celiac disease and care of patients with the condition. There were 44 adult participants in the study, including 25 people with celiac disease and 19 members of a control group with a similar balance of age and sex as the celiac group. Each participant completed a questionnaire on adverse events in early childhood, as well as one on current digestive symptoms.
The researchers found that people with celiac disease reported significantly more adverse events during childhood than those in the control group. The most commonly reported events were substance abuse in family members and neglectful parenting.
For more information: https://www.glutenfreeliving.com/blog/stress-in-early-life-linked-to-celiac-disease-in-adults/
Gluten Immunogenic Peptides to Monitor Children Diagnosed with Coeliac Disease During Transition to a Gluten-free Diet
97% of children have elevated gluten peptides (GIP) in their stools at CD diagnosis. GIP dropped to 13% after 6 months on the gluten-free diet. Non adherent patients had increased levels of GIP in their stools. The elevation of tTG antibody was more prolonged in patients with detectable gluten peptides in their feces after diagnosis. GIP readings in the stool may be a means to determine adherence to the GF diet and healing in the small intestine of CD patients.
For more information: https://www.medscape.com/viewarticle/914116
Risk Factors Associated with CD
An Internet-based survey based out of Columbia University in partnership with the Ontario Teachers Association was conducted among parents living in the US with at least one biological child between 3 and 12 years old. After exclusions, there remained 332 responses associated with children with CD (cases), and 241 responses associated with children who do not have CD (controls). This study is the first to find an association between skim milk consumption and CD and vitamin D drop use for greater than 3 months and CD. Further study is required in these 2 areas. It also adds to evidence that early life exposure to antibiotics and early life infection, specifically ear infection, are associated with CD.
For more information: https://www.dovepress.com/potential-risk-factors-for-celiac-disease-in-childhood-a-case-control--peer-reviewed-article-CEG
Children with a Genetic Predisposition Eating More Gluten have Higher Risk of Developing CD
A study posted in JAMA network found eating higher-than-normal levels of gluten during the first five years of life can increase a child's likelihood of developing CD. Higher gluten intake was associated with a 6.1% increased risk of CD autoimmunity, an immunological response to gluten, and a 7.2% increased risk of CD per each additional gram or gluten per day, according to the study.
Researchers evaluated more than 6,600 newborns in the United States, Finland, Germany and Sweden born between 2004 to 2010. All of the children carried a genotype associated with Type 1 diabetes and CD (HLA DQ2 and HLA DQ8 genes).
Over the course of the study, 1,216 of the children -- nearly 20% -- developed celiac disease autoimmunity, the first sign of the body's negative response to the protein, said study author Carin Andrén Aronsson, study manager at the Unit for Diabetes & Celiac Disease at Lund University in Sweden. Another 450 participants developed CD, about 7%. Most of the diagnoses occurred between the ages of 2 and 3, according to the study.
For more information: https://jamanetwork.com/journals/jama/article-abstract/2747670?resultClick=1 and https://www.sciencedaily.com/releases/2019/08/190814093858.htm
Burden of Depressive and Bipolar Disorders in CD
This study found that major depressive disorders had higher incidence in CD patients compared to the controls by 30% compared to 8.3%. Panic disorders were found in 18.3% of CD patients versus 5.4% of the control group. The comorbidity with these disorders is the key determinant of impaired quality of life in CD. A preventive action on mood and anxiety disorders in patients suffering from CD is required. Also screening for CD in people with affective disorders and showing key symptoms or family history of CD is recommended.
For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763959/ Clin Pract Epidemiol Ment Health. 2015; 11: 180–185.
Silent CD Common in Relatives Celiacs
Mayo Clinic researchers have found that first-degree relatives of patients with CD frequently have the condition, too - often without any symptoms. They found that 44% of close relatives who were given a blood test to test for CD, also had the disease. This study shows that testing asymptomatic close relatives of those with CD is important.
For more information: https://www.reuters.com/article/us-health-celiac-relatives-idUSKBN1W81RE
Neurologic Deficits in Patients with Newly Diagnosed Celiac Disease Are Frequent and Linked with Autoimmunity to Transglutaminase 6
In a study headed by Dr. Mario Hadjivassiliou, the following neurologic deficits were found in the study of 100 diagnosed patients of CD.
Gait instability 24%
Persisting sensory symptoms 12%
Frequent headaches 42%
Gait ataxia 29%
Involuntary eye movement 11%
Distal sensory loss 10%
Sixty percent of patients had abnormal results from magnetic resonance imaging, 47% had abnormal results from MR spectroscopy of the cerebellum, and 25% had brain white matter lesions beyond that expected for their age group. Antibodies against TG6 were detected in serum samples from 40% of patients.
For more information: https://www.cghjournal.org/article/S1542-3565(19)30278-2/fulltext
Genetic Risk for Autoimmunity is Associated with Changes in the Gut Microbiome
HLA gene alleles (CD they are HLA DQ2 and HLA DQ8) have significant effect on the bacterial composition of the infant gut based on a study of 17K newborns. For Type 1 diabetes this if the first time that HLA genetic risk of developing autoimmunity has been associated with changes in the microbiome. Certain species of gut bacteria have protective effects against autoimmunity and may be useful in future treatment to prevent autoimmune disease.
For more information: https://www.nature.com/articles/s41467-019-11460-x
Study Shows High Rates of CD Antibodies in Adult Rheumatology Patients
An international study screened 230 rheumatological patients for CD. 3% of patients showed elevated tTG IgA antibodies indicating screening for CD may be important in those with Rheumatoid Arthritis
For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040033/
Do Families Who Have a Celiac in the Family Require Toasters?
Gluten levels remained at less than 20 ppm when gluten-free bread was toasted in the same toaster as regular bread, across repeated tests and even when gluten-containing crumbs were present at the bottom of the toaster. The study was led by Jocelyn Silvester, M.D., Ph.D. FRCPC, director of Research for the Celiac Disease Program at Boston Children's Hospital who led the study's biostatistical analysis.
A video by Alessio Fasano indicates caution should still be used as a high percentage of patients are not healing. Potentially more study is needed in this area as study stated that “may” not always. The paper deserves follow-up however it may not translate into relaxing what celiacs have been doing to avoid cross-contamination.
For more information: https://www.sciencedaily.com/releases/2019/09/190930131557.htm and Dr. Alessio Fasano Video Cross Contamination Guidelines https://www.youtube.com/watch?v=IeFnq-xpn68 Oct 11, 2019
Risk of Other Autoimmune Diseases in Treated CD Patients
249 celiac patients following a gluten-free diet during the study period were matched with 498 control subjects. 85 celiac patients and 170 control subjects were boys.
After five years, 5.0% of patients with celiac disease and 1.3% of controls had a new autoimmune disorder diagnosis. Treated celiac patients face an elevated risk of developing autoimmune disorders. The risk of a new autoimmune disorder is higher in children, especially when more than one autoimmune disorder diagnosis exists.
For more information: https://journals.lww.com/jpgn/Abstract/2019/10000/The_Risk_of_Autoimmune_Disorders_in_Treated_Celiac.10.asp
Bone Health of Adults with Undiagnosed CD
Adults with probable undiagnosed celiac disease had lower bone density than those without celiac disease, even though they reported higher calcium intake and nutritional density of calcium and phosphorus.
For more information: https://www.ncbi.nlm.nih.gov/pubmed/31322483
Use of Fecal Gluten Immunogenic Peptides (GIP) to Monitor Children Diagnosed with Coeliac Disease During Transition to a Gluten-free Diet
97% of children had detectable gluten peptides at diagnosis. On a gluten-free diet at 6 months this dropped to 13% of children, however increased to 25% at 24 months. This suggests that gluten exposure was intentional. The elevation of tissue transglutaminase antibody was more prolonged in patients with detectable gluten peptides. Adolescence is a developmental phase characterized by rebellion and teenagers may be particularly susceptible to the burden of a GFD related to stigmatization and are more likely intentionally non-adherent in such settings. Teenagers are more likely to eat out and are therefore subject to more cross contamination. It is therefore important to diagnose CD as soon as possible to avoid the years when social issues become a problem. The introduction of GIP as an assessment tool of GFD adherence may help to ascertain dietary compliance and reduce the need for additional invasive investigations on follow-up.
For more information: Aliment Pharmacology and Therapeutics. 2019;49(12):1484-1492
Vitamin Deficiencies May Be the Only Sign of Celiac Disease
In a Mayo Clinic proceeding, June 2019, Dr. Joseph Murray, study coauthor and a professor of medicine at the Mayo Clinic in Rochester, Minnesota, indicated that "People have preconceived ideas of what celiac disease looks like. They expect to see patients who because of nutrient malabsorption and diarrhea will end up being skinny with lots of deficiencies. But now we have lots of patients who haven't lost weight - and many who are quite overweight - but still have micronutrient deficiencies. While they are not losing calories, they are not absorbing some vital nutrients."
Low levels of certain micronutrients, in particular iron, vitamin D and zinc can cause telltale fatigue, that may be the only symptoms of CD. In a study of 309 adults, zinc was deficient in 59.4% of those with celiac versus 33.2% of controls; copper was low in 6.4% of celiac patients versus 2.1% of controls, folate was low in 3.6% of celiac patients versus 0.3% of controls and vitamin B12 was low in 5.3% of celiac patients versus 1.8% of controls. Among celiac patients, iron was low in 30.8%, but there were no controls with iron measurements to compare to. And contrary to traditional assumptions about celiac and thinness, weight loss was seen in just 25.2% of patients diagnosed with the disease.
For more information: Article by Linda Carroll, June 26, 2019, Reuters Health http://bit.ly/2XCi8Wq
Early-Life Gluten Intake Linked to Increased Risk of Celiac Disease
"We found that 1-year-olds in the highest third of gluten intake had a two-fold increased relative risk of developing celiac disease autoimmunity (CDA), a potential prodromal stage of celiac disease," said Dr. Karl Marild from the Norwegian Institute of Public Health, in Oslo, Norway, and Queen Silvia Children's Hospital, in Gothenburg, Sweden. Compared with 1-year-olds in the lowest third of gluten intake, those in the highest third had a 96% increased risk of CD (P=0.09) and a significant 2.17-fold increased risk of CDA. The study was done on 1,875 children who were at risk of developing CD in the Denver area of the US.
For more information: American Journal of Gastroenterology, https://bit.ly/2x5ICRo
Association Between Antibiotics in the First Year of Life and Celiac Disease
The intestinal microbiota is believed to be involved in the pathogenesis of celiac disease, in addition to genetic variants and dietary gluten. The study collected information from 1.7 million children, including 3, 346 diagnosed with CD. Exposure to antibiotics was identified if the child took antibiotics in the first year of life. The study found that risk of CD increased for those exposed to antibiotics in their first year of life and it also increased more with each prescription for antibiotics in the first year. Further research is required in this area.
For more information: Gastroenterology, June 2019 Volume 156, Issue 8, Pages 2217–2229
Human Gut Derived-organoids Model to Study Gluten Response and Effects on Microbiome in Celiac Disease
Using intestinal organoids developed from duodenal biopsies from both non-celiac (NC) and celiac (CD) patients, the study explored the contribution of gut epithelium to CD pathogenesis and the role of microbiota-derived molecules in modulating the epithelium’s response to gluten. When compared to NC, RNA sequencing of CD organoids revealed significantly altered expression of genes associated with gut barrier, innate immune response, and stem cell functions. The study concluded that: (1) patient-derived organoids faithfully express established and newly identified molecular signatures characteristic of CD. (2) microbiota-derived bioproducts can be used to modulate the epithelial response to gluten. Finally, the study validated the use of patient-derived organoids monolayers as a novel tool for the study of CD (mini-gut models).
For more information: https://www.nature.com/articles/s41598-019-43426-w
Potential Risk Factors for Celiac Disease in Children
This study found a connection between skim milk consumption, and vitamin D drop use for more than 3 months, and later development of celiac disease. It also found evidence to support earlier data that early life exposure to antibiotics and early life infection, especially ear infection, are also associated with the development of celiac disease in children.
For more information: https://www.dovepress.com/potential-risk-factors-for-celiac-disease-in-childhood-a-case-control--peer-reviewed-article-CEG Published July 4, 2019
Gluten inequality? Report finds two thirds of coeliac sufferers in Italy are female
Women, who have more reactive immune systems than men, are more susceptible to coeliac disease, says the Italian Ministry of Health.
For more information: https://www.foodnavigator.com/News/Science/Gluten-inequality-Report-finds-two-thirds-of-coeliac-sufferers-in-Italy-are-female 25-Feb-2019 By Flora Southey
Anxiety Might be Alleviated by Regulating Gut Bacteria
People who experience anxiety symptoms might be helped by taking steps to regulate the microorganisms in their gut using probiotic and non-probiotic food and supplements.
The authors say one reason that non-probiotic interventions were significantly more effective than probiotic intervention was possible since changing diet (a diverse energy source) could have more of an impact on gut bacteria growth than introducing specific types of bacteria in a probiotic supplement.
For more information: https://www.sciencedaily.com/releases/2019/05/190520190110.htm
Adults over 50, Newly Diagnosed with CD Have Greater Risk of Some Cancers
A Dutch study of medical records between 1994 and 2014 correlated the diagnosis of CD and malignancies associated with lymphoma and GI tract cancers and found them to be higher in CD patients. T-cell lymphoma, small bowel carcinoma and esophageal carcinoma had elevated risks although the absolute risks of the diseases were low.
For more information: https://journals.sagepub.com/doi/full/10.1177/2050640618800540
United European Gastroenterology Journal
Advances in the Understanding of How Microbes Promote Food Sensitivity
New findings suggest that enzymes produced by opportunistic pathogens and certain bacteria within the gut can trigger host immune responses that could increase susceptibly to food sensitivities.
McMaster University have been completing research into gluten digestive processes. In a recent study published in Nature Communications and led by Dr. Elena Verdu of McMaster’s Farncombe Institute, Dr. Caminero identified additional pathways by which the opportunistic pathogen incites gluten sensitivity, but which are independent of gluten metabolism. “Biopsies from celiacs had more bacteria that were able to use gluten as an energy source,” said Verdu.
When “HLA-DQ8” mice were colonized with the protease-producing P. aeruginosa, the bacterial proteolytic activity synergized with gluten to induce more severe inflammation and intestinal damage.
For more information: https://www.gutmicrobiotaforhealth.com/en/advances-in-the-understanding-of-how-microbes-promote-food-sensitivity/ and Caminero A, McCarville JL, Galipeau HJ, et al. Duodenal bacterial proteolytic activity determines sensitivity to dietary antigen through protease-activated receptor-2. Nat Commun. 2019; 10:1198. doi: 10.1038/s41467-019-09037-9.
Family Screening for Relatives of Celiac Patients
Even patients without symptoms benefit from going gluten free because they have fewer digestive problems, less intestinal damage and less anxiety about the illness. Studies estimate the disease affects 10 percent of people who have a first-degree relative with celiac. To achieve earlier diagnosis, guidelines recommend screening parents, siblings and children of those with celiac.
For more information: https://www.glutenfreeliving.com/gluten-free/celiac-disease/family-screening-for-relatives-of-celiac-patients April 22, 2019
High Fiber During Pregnancy Reduces Risk of Celiac Disease in Children
“Experts from Norway found that the risk of pediatric coeliac disease was 8% lower per 10g increase in fiber intake during pregnancy. For those with the highest fiber intake (>45 grams per day), the risk was 34% lower in comparison to the lowest fiber intake (<19 grams per day). High fiber intake from fruits and vegetables, rather than from cereals, were associated with the lowest risk.”
For more information: https://www.eurekalert.org/pub_releases/2019-06/sh-hfd053019.php
Understanding Prebiotics and Fiber
For a great infographic on this topic see: https://www.gutmicrobiotaforhealth.com/en/the-different-ways-that-prebiotics-and-fiber-affect-the-gut-microbiota/
Study Supports Celiac Screening for Long-Term Health
A study in Bologna, Italy supported controversial testing of adults for CD due to an important long-term health benefit. Screened patients had a significantly lower rate of bone disease: 31.3 percent compared to 46 percent in other patients. They were also less affected by anemia. The authors advocate screening adults to help diagnose the large hidden population of celiac patients. Improved health and reduced medical costs later would balance costs of testing.
For more information: https://www.glutenfreeliving.com/gluten-free/celiac-disease/study-supports-celiac-screening-for-long-term-health/
Micronutrient Deficiencies: Researchers Discover Change in Celiac Disease Symptoms
Micronutrient deficiencies, including vitamins B12 and D, as well as folate, iron, zinc and copper, are common in adults with celiac disease and must be addressed at that time of diagnosis, according to a new study. July 2, 2019 by Nikki Cutler
For more information: https://www.nutraingredients.com/Article/2019/07/02/Micronutrient-deficiencies-Researchers-discover-change-in-celiac-disease-symptoms
Canadian Celiac Association Announce Changes to the Gluten Challenge
See new guidelines for health professionals for requirements for blood testing for CD and how to test for CD in those individuals who may have been following a gluten-free diet.
For more information: https://www.celiac.ca/healthcare-professionals/diagnosis/gluten-challenge/
Bipolar Disease and Celiac Disease
Those with CD are 17 times more likely to suffer from bipolar disease. Given the high frequency of mood disorders and anxiety disorders in celiac disease and the fact that celiac disease itself has a significant frequency in the general population, a screening of celiac disease is recommended to all the people with affective disorders.
For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763959/
A Study Links Enterovirus Infection and Celiac Disease
Norwegian researchers have found that genetically susceptible youngsters who contracted an enterovirus infection between the ages of three months and three years were significantly more likely to develop celiac disease. They examined stool samples to detect the viral infection. This is consistent with prior research findings.
Infections with adenovirus had no effect on the risk of celiac disease. The damaging enterovirus infections were those that occurred after the child was already eating foods containing gluten. If they occurred before gluten exposure, they did not seem to increase the risk. Babies who were still getting breast milk as an important part of their diets appeared to be protected. Most of the infections did not cause symptoms. The Norwegian scientists looked specifically for Enteroviruses A, B, C and D. Only A and B infections were common. This is where they found the link between infection and celiac disease developing later.
For more information: Kahrs et al, BMJ, Feb. 14, 2019 https://www.bmj.com/content/364/bmj.l231
Celiac Teens Twice as likely to Have Eating Disorders
“Researchers found that 19% of female teens and 7% of male teens with CD exhibited eating disorders, compared to 8% and 4% of adolescents who did not have CD.” by Tel Aviv University, medicalexpress.com 1 “These eating patterns can lead to a failure to meet nutritional and metabolic needs, which cause severe impairment to psychosocial functioning,” Dr. Tokatly-Latzer continues. “Primary care physicians and gastroenterologists who encounter adolescents with CD should increase their awareness to the possibility of this population having disordered eating behavior. Once the suspicion is raised, they can refer them for psychological and nutritional treatment.”
For more information: https://medicalxpress.com/news/2019-02-adolescents-celiac-disease-higher-disorders.html
Nexvax2 in Phase II Trials Look Promising
Nexvax2, a vaccine that will work like allergy shots, is being developed for Celiac treatment. ImmusanT is will develop tolerance levels in individuals with Celiac Disease so there is minimal immune reaction to gluten exposure. As this is like traditional vaccines, the path for testing and approval will be easier and therefore may get approval for the marketplace sooner.
For more information: https://www.celiac.com/articles.html/celiac-disease-diagnosis-testing-amp-treatment/celiac-vaccine-nexvax-2-could-be-a-big-deal-for-disease-sufferers-r4715/
Can IL17A and IL21 Gene Expression and Trx Levels in Celiac Patients Be Used as Diagnostic Biomarkers?
In the future, doctors might be able to check to see if you have certain genes, and maybe look at your levels of Thioredoxin (Trx), an extracellular regulator of TG2 activity, to determine whether you have celiac disease.
For more information: Genetic Testing and Molecular Biomarkers, Volume 22, Number 9, 2018, DOI: 10.1089/gtmb.2018.0128 https://www.ncbi.nlm.nih.gov/pubmed/30183349
Celiac Disease Can Cause Irreversible Changes to Immune Cells
A Cardiff University study found that immune cells in the bowel of those with Celiac Disease are permanently replaced by a subset of cells that promote inflammation. “Under normal circumstances, T cells have a protective role in the bowel and form a stable population.” In CD the T cells in the small intestine react to gluten and cause inflammation.
Dr. Bana Jabri, study author from the University of Chicago, explained: “Chronic inflammation caused by gluten causes an immunological scar that results in the loss of intestinal resident immune (gamma delta T cell) subset that has an important role in tumor surveillance and fighting against infection.” This means that the damage caused by gluten results in the permanent loss of these beneficial immune cells in celiac patients.
While a strict, gluten-free diet can alleviate many of the short-term symptoms of celiac disease, the diet alone is not enough to undo the permanent damage to the intestine.
Dr. Jabri noted, “This immune subset is partially preserved in children, suggesting that early intervention may rescue this cell subset.” Early diagnosis and treatment of celiac disease may be able to save some of these beneficial cells and prevent additional permanent damage to the bowel.
For more information: https://www.sciencedaily.com/releases/2019/02/190214100033.htm Cardiff University, February 14, 2019 and https://celiac.org/about-the-foundation/featured-news/2019/02/chronic-inflammation-permanently-alters-immune-cells-in-celiac-patients
Novel Breath Test Could Pave New Way to Measure Gut Health
Blowing into a glass tube may be able to replace the more invasive endoscopy currently used to diagnose Celiac Disease. Flinders University researchers will trial the new Dipeptidyl peptidase-4 (or 'DPP4') breath test in a pilot study to measure a digestive enzyme found in the small intestine and is associated with gastrointestinal damage and celiac disease. "Some research groups have suggested that DPP4 is involved in the breakdown of gluten, and that people with celiac disease have a reduced amount of the DPP4 enzyme along their small intestine. However, the tools to measure this in celiac disease have not been available," Dr Yazbek says.
For more information: https://www.news-medical.net/news/20190320/Novel-breath-test-could-pave-new-way-to-non-invasively-measure-gut-health.aspx
New Feeding Guidelines for Infants at Risk of Celiac Disease
The University of Chicago, Impact Magazine, provides the latest information on feeding infants at risk of CD. Key findings of recent research include: large amounts of gluten in the first two years favors the onset of CD, so during the first 2 years gluten should be less than 5 grams/day (about 1 slice of bread); follow a Mediterranean diet with vegetables and grains, but low consumption of refined cereals and sweet beverages.
For more information: http://www.cureceliacdisease.org/wp-content/uploads/CdC_Newsletter_IssueOne_032019_v7.pdf
The Effect of Depressive Symptoms on the Association between Gluten-Free Diet Adherence and Symptoms in Celiac Disease
A study out of Columbia University and The Celiac Disease Foundation found that of 519 biopsy-diagnosed patients found that 46% reported having depressive symptoms. The results indicate that the relationship between celiac disease symptoms and dietary adherence may be diminished by the presence of depressive symptoms. This finding was confirmed with a linear regression analysis, showing that depressive symptoms may modify the effect of a GFD on celiac symptoms. In those without depression, symptoms more strongly correlated with dietary adherence than in those with depressive symptoms. Depressive symptoms may therefore mask the relationship between inadvertent gluten exposure and symptoms. Additional longitudinal and prospective studies are needed to further explore this potentially important finding.
For more information: Nutrients 2018, 10(5), 538; https://doi.org/10.3390/nu10050538
Mental Health and Celiac Disease
There are over 200 symptoms of celiac disease that can affect the body physically and mentally. Depression can be a mental manifestation of celiac disease. The prevalence of depression among patients with celiac disease has been reported to be between 6% and 57%, with conflicting findings regarding whether depression is more common in celiac patients than in the general population.
As it is Mental Health Awareness Month, here at the Vancouver Chapter we encourage you to voice your concerns with trusted healthcare providers and recognize when you are feeling down.
Read more about Mental Health and Celiac at: https://celiac.org/about-the-foundation/featured-news/2019/04/how-depression-affects-the-relationship-between-celiac-symptoms-and-diet-adherence/Do Celiacs Suffer from Headaches More?
A UK study looked at scientific articles from 1987 to 2017 found that the prevalence of headaches in adults with celiac disease was 26 percent and in children with celiac disease, 18 percent. More than 42,000 patients with either celiac disease or headaches with an unknown cause were followed in the studies. Headaches associated with celiac disease are predominantly migraines, but lack of specific information on the type of headache found in some articles made interpretation of the results less clear.
Up to 75% of adults and 71% of children saw their headaches reduced on a gluten-free diet.
For more information: https://www.beyondceliac.org/research-news/View-Research-News/1394/postid--112419/
New Blood Test May Help Monitor Celiac Disease Activity
A study at the Mayo Clinic is very promising in identifying and managing Celiac Disease. "We identified immunogenic epitopes of the tTG-DGP (tissue transglutaminase-deamidated gliadin-derived peptide) complex and found that an assay to measure the immune response to epitopes accurately identified patients with celiac disease, as well as patients with mucosal healing," the authors write in Gastroenterology, online October 17, 2018. The study was broad and looked at 85 patients with celiac disease that was treated and healed, 81 patients with treated but unhealed celiac disease (who had villous atrophy despite maintaining a gluten-free diet), 82 patients with untreated celiac disease, as well as 27 disease controls (who had villous atrophy without celiac disease) and 217 healthy controls.
Dr. Joseph Murray, the senior author on the study, agreed with Dr. Choung that this assay may make diagnosis easier, improve management, and avoid the need for follow up biopsies. "Indeed," he said, "we could move to a strategy that avoids biopsy for both diagnosis and follow-up, although a lot more work is needed for that to happen." This is new work and more study is required.
For more information: https://www.mdlinx.com/internal-medicine/top-medical-news/article/2018/11/16/7549414
What is really behind gluten sensitivity?
This is a very interesting article that looks at two different theories as to the cause of gluten sensitivity.
First, Alaedini, contacted researchers at the University of Bologna in Italy and he studied 80 patients who had been identified as gluten sensitive based on a gluten challenge. He wished to study the immune response but did not expect to see one. He found that these individuals had high levels of a class of antibodies against gluten that was short lived. “For Alaedini, the beginnings of a mechanism emerged: Some still-unidentified wheat component prompts the intestinal lining to become more permeable. (An imbalance in gut microbes might be a predisposing factor.) Components of bacteria then seem to sneak past immune cells in the underlying intestinal tissue and make their way to the bloodstream and liver, prompting inflammation.”
The other competing theory is FODMAPs. Initially observed by Dr. Peter Monash, in Melbourne Australia. He showed that only FODMAP symptoms were statistically significant (but barely). Carbs in wheat called fructans can account for as much as half of a person's FODMAP intake.
Dr. Elena Verdù, President of the North American Society for the Study of Celiac Disease, believes careful research will ultimately break through to find answers. This year the organization awarded its first grant to study nonceliac wheat sensitivity. She's hopeful that the search for biomarkers like those Alaedini has proposed will show that inside the monolith of gluten avoidance lurk multiple, nuanced conditions. "It will be difficult," she says, "but we are getting closer."
For more information: https://www.sciencemag.org/news/2018/05/what-s-really-behind-gluten-sensitivity
FDA Gives Approval to Fast Track Nexvax2
Nexvax2 is a therapeutic vaccine being investigated in a Phase 2 study, which is currently recruiting 150 patients in the United States, Australia and New Zealand for participation in a clinical trial. Nexvax2 is being developed to be used in addition to the gluten-free diet to provide protection from inadvertent gluten exposure, for example from cross-contact when dining out.
“Celiac disease is a life-changing condition that causes significant health problems due to cumulative damage from chronic and repetitive bouts of gluten-triggered inflammation,” said Ken Truitt, M.D., chief medical officer for ImmusanT. “Using a novel panel of celiac disease-associated immunological markers, identified in early clinical studies, we can follow both acute symptoms and the underlying inflammatory response following gluten exposure. This helps monitor Nexvax2’s effectiveness in altering the disease process.”
For more information: https://www.beyondceliac.org/research-news/View-Research-News/1394/postid--112674/ Article by Amy Ratner.
New at Home Test for Celiac Disease
A new at-home celiac disease test is being launched Microdrop Health, a Houston company. It is only available in the US and could help patients get their doctors to more quickly take the steps needed for CD diagnosis.
Called imaware™, the test measures the same antibodies to gluten as the tests that doctors use in their offices as the first step to diagnose celiac disease -- anti-tissue transglutaminase (tTG) and deaminated gliadin peptide (DGP) tests.
For more information: https://www.beyondceliac.org/research-news/imaware-home-celiac-test-launches/ Article by Amy Ratner.
Larazotide Acetate Reduces Intestinal Permeability
Innovate Biopharmaceuticals, in a new preclinical study, assessed the effects of larazotide acetate on intestinal permeability and found it triggered a clear reduction in gut barrier permeability which could have implications for celiac disease.
For more information: https://www.celiac.com/articles.html/celiac-disease-diagnosis-testing-amp-treatment/larazotide-acetate-reduces-intestinal-permeability-in-a-nash-preclinical-study-r4653/
What’s the Relationship Between Celiac Disease and Endocrine Autoimmunity?
Between 10% and 30% of patients with celiac disease (CD) test positive for thyroid and/or Type 1 diabetes antibodies. 5% - 7% of patients with autoimmune thyroid disease and /or Type 1 diabetes for IgA anti-tissue transglutaminase antibodies, the antibodies associated with CD. CD and endocrine autoimmunity share common genetics, the HLA DQ2 and HLA DQ8 genes. Conclusions of the study were those with celiac disease should be tested for Type 1 diabetes and autoimmune thyroid disease.
For more information: https://www.sciencedirect.com/science/article/abs/pii/S1568997218302301?via%3Dihub
Incidence of Refractory Celiac Disease May be Higher than Previously Thought
Dr. Shailaja Jamma, MD and Dr. Daniel Leffler, MD, MS stated reasons for not responding favorably to the gluten-free diet. Recovery times vary from person to person and if the patient is improving continually non-responsive CD is usually an unnecessary label. The most common causes are gluten exposure, Irritable Bowel Syndrome, lactose intolerance, fructose malabsorption, microscopic colitis and small intestinal bacterial overgrowth. “Rare” is actual refractory CD, as is pancreatic exocrine insufficiency, motility disturbances where food moves too quickly or slowly through the intestine, food allergy and cancer which is very rare. Refractory CD responds favorably to a thiopurine medication versus steroids that used to be the main treatment.
For more information: https://www.celiac.com/articles.html/journal-of-gluten-sensitivity/journal-of-gluten-sensitivity-summer-2011-issue/incidence-of-refractory-celiac-disease-may-be-higher-than-previously-thought-r4657
Cystic Fibrosis Transmembrane Conductance Regulator Plays a Key Role in Celiac Disease
Exactly how gliadin causes problems with the intestinal mucosal defenses in CD is poorly understood. CFTR, cystic fibrosis transmembrane conductance regulator is an anion channel important for epithelial (gut cell wall) adaptation to cell-autonomous or environmental stress. The function of CFTR is reduced when energy production in the cell is reduced. CFTR plays a central role in gliadin (protein in wheat) activities and shows potential for new treatments for CD. Intestinal handling of dietary proteins usually prevents local inflammatory and immune responses and promotes oral tolerance. However, this is not the case for those with CD.
For more information: http://emboj.embopress.org/content/early/2018/11/28/embj.2018100101
Celiac Disease “Symptoms” May Not Accurately Determine Gluten Exposure
A presentation given at the American College of Gastroenterology Association, concluded the patients of celiac disease had difficulty determining if they had ingested gluten based on their symptoms. A study from the Mayo Clinic recruited 14 patients with celiac disease and 14 healthy controls for the trial. Each patient randomly received 6 grams of gluten suspension or a placebo. They received a questionnaire to understand their symptoms (if any) at the start of the study and then were asked to monitor symptoms every 30 minutes to 60 minutes for 6 hours and then daily for 3 days and were asked if they believed they had received gluten. Only 2 of the 7 patients who received the gluten suspension identified that they had received it. There was no statistical difference in symptoms in the gluten celiac disease group compared with the placebo celiac disease group. Most symptoms were nausea and abdominal pain.
Amanda K. Cartee, MD, stated that the symptoms were non-specific and based on this small sample seemed like an unreliable way to self-diagnose and identify gluten exposure.
For more information: Healio Gastroenterology, October, 17, 2018 https://www.healio.com/gastroenterology/malabsorption/news/online/%7B80aad70a-f6df-4e87-a348-ec3b523f312b%7D/patients-with-celiac-disease-have-trouble-determining-gluten-exposure-based-on-symptoms
Aging Celiac Patients and Osteoporosis
A systematic review of 54 CD patients revealed some interesting things about the correlation between aging with celiac and developing bone related conditions. The study found that out of 54 cases, 14.4% of patients developed osteoporosis and 39.6% developed osteopenia, which is the reduction of bone mass. While more tests are needed, this study brings up interesting areas to devote attention to, including our calcium intake, exercise, and balanced dieting, which can certainly be a challenge for many of us.
For more information: https://www.ncbi.nlm.nih.gov/pubmed/30732599
Effect of Celiac Disease in Pregnancies
In a recent Danish population-based survey that compared women with CD and women without it during their pregnancies revealed some interesting information. No significant difference was seen in the pregnancy outcomes between women with and without CD; however, women with CD were slightly more at risk of miscarriages or stillbirths, prior to being diagnosed with celiac disease. This shows the importance of early stage detection and diagnosis of CD, as it can have damaging effects during pregnancy.
For more information: https://www.medscape.com/viewarticle/900457
Gluten in our toothpaste!
The Journal of Pediatric Gastroenterology and Nutrition recently published a study that investigated the presence of gluten in our toiletry items, including toothpastes, lipsticks, mouthwashes and lip balms. In testing 66 different items, it was found that 94% of those advertised as gluten-free were actually gluten free, meaning <20 ppm gluten. This shows that there is not a major threat in gluten contaminated dental/cosmetic products, but you must exercise caution when purchasing gluten-free items.
For more information: https://journals.lww.com/jpgn/Abstract/2019/01000/Contribution_of_Oral_Hygiene_and_ Cosmetics_on.7.aspx
Vaccine Advancement in the resistance to gluten
Currently, there are no FDA-approved drugs for the treatment of celiac disease. While adhering to a strict gluten-free diet yields success, it can definitely be a challenge. A novel vaccine called Nexvax2 is entering the clinical trial phase in the U.S. The vaccine functions by stimulating the body’s own immune system with the HLA DQ2.5 gene in approximately 90% of celiac patients through signaling. Once this treatment is approved from clinical trials, you might be seeing it in doctors’ offices, and advertised everywhere, but only time can tell when, or if this will happen.
For more information: https://celiac.org/about-the-foundation/featured-news/2019/01/nexvax2-therapeutic-vacci ne-fast-tracked-by-fda/
Prevalence and Risk of Epilepsy in Celiac and Gluten-Sensitive Patients
Previous studies have found celiac disease to be associated with neurological complications. The article below concludes that out of 79 published articles of CD patient data and epileptic episodes, epilepsy occurred 1.8 times more in CD patients than the general populations. However, it was concluded that sticking to the strict gluten-free diet helped mitigate the neurological symptoms of epilepsy.
For more information: https://celiac.org/main/wp-content/uploads/2018/10/epilepsy-and-GS-2.pdf
Celiac disease and eosinophilic esophagitis linked
A large analysis of more than 35 million patients found an intriguing connection between celiac disease and eosinophilic esophagitis (EoE). Out of the 15,000 patients in a database pulled from 360 U.S. hospitals who had been diagnosed with EoE, 2 percent also had celiac disease. The numbers translate into a likelihood nine times larger of finding celiac disease in a patient with EoE compared to a patient in the normal population.
For more information: https://www.allergicliving.com/2018/06/07/whats-the-link-between-eoe-and-celiac-disease/
Prebiotics can help celiac symptoms
Research published in the Journal of Clinical Gastroenterology found that a 6-week probiotic treatment is effective in improving the severity of IBS-type symptoms in celiac disease patients on strict GFD, and is associated with a modification of gut microbiota, characterized by an increase of bifidobacteria.
For more information: https://www.ncbi.nlm.nih.gov/pubmed/29688915
Viruses can lead to activated celiac disease
A growing body of research suggests that viral DNA or proteins introduced into the body can contribute toward the development of serious diseases long after the initial viral infection has passed. And now, research by a team from the Cincinnati Children’s Hospital shows that exposure to the Epstein-Barr virus (EBV), best known for causing mononucleosis, appears to boost the risk of developing seven other diseases in individuals who inherited predisposing gene variants – including celiac disease.
For more information: http://www.iflscience.com/health-and-medicine/the-virus-that-causes-mono-linked-to-seven-autoimmune-diseases/
Questioning the link between antibiotics and celiac
In contrast with existing research, a recent study published in the journal Jama Pediatrics found that antibiotics taken during a child’s first four years of life were not associated with the development of celiac disease or type 1 diabetes, even if the child was genetically predisposed to the development of either condition.
For more information: https://mykidsfoodallergies.com/is-there-a-link-between-childhood-antibiotic-use-and-celiac-disease/
Celiac disease can indeed strike anytime in life
From childhood to late life, diagnosis of celiac disease is critical and should not be ignored. That’s the message for patients and healthcare providers from two recent studies. In the first, researchers from Italy concluded that the number of patients with celiac disease worldwide is increasing, “thanks to better environmental conditions that allow children with celiac disease to survive longer.” In the second, scientists from Finland and the United Kingdom found that one in four celiac disease diagnoses is made in people 60 years or older. Still, 60 percent of patients remain undiagnosed because their symptoms, including tiredness, indigestion and reduced appetite, are blamed on older age itself.
For more information: https://www.beyondceliac.org/research-news/View-Research-News/1394/postid--106300/?utm_content=69946060&utm_medium=social&utm_source=twitter
Gluten-free food not so gluten free in Melbourne
A first of its kind study led by Institute researchers and City of Melbourne environmental health officers has detected potentially harmful levels of gluten in foods sold and served as ‘gluten-free’ across Melbourne, Australia. The undercover study revealed one in 11 samples of ‘gluten-free’ food tested were contaminated with gluten at levels that could prove harmful to people with celiac disease.
For more information: https://www.wehi.edu.au/news/illuminate-newsletter/june-2018/melbourne-gluten-free-study
US study finds restaurant gluten-free food not always gluten-free
Based on more than 5,600 gluten tests over 18 months, the investigators determined that 27 percent of gluten-free breakfast meals contained gluten. At dinner time, this figure hit 34 percent. The rise could reflect a steady increase in gluten contamination risk as the day unfolds, the researchers said.
For more information: https://www.webmd.com/digestive-disorders/celiac-disease/news/20181008/study-some-gluten-free-restaurants-fall-short#1
New drug may keep celiacs gluten free
An experimental new drug may provide relief to celiacs who happen to ingest gluten. The AMG 714 antibody leads to fewer symptoms after gluten exposure by blocking interleukin 15. A randomized, double-blind, placebo-controlled, phase 2 study was conducted to test the drug's effectiveness. The study showed that the AMG 714 had an effect on the groups of participants who received the drug and the gluten challenge when compared to the placebo group who received no drug. Both a reduction in reported symptoms occurred as well as a decrease in injury to the intestinal lining. Further testing is underway.
For more information: https://www.acsh.org/news/2018/05/22/new-drug-may-keep-those-celiac-disease-gluten-free-12996
Current procedures may underreport celiac disease
Currently accepted indications for celiac disease testing fail to discriminate between patients with and without undiagnosed celiac, according to a case-control study in Alimentary Pharmacology and Therapeutics. Although almost 40% of a 400-patient cohort had at least one testing indication, the study found that fewer than 5% of the patients were tested for celiac disease -- suggesting, the authors said, a strong need for alternative methods of detecting symptomatic celiac disease.
For more information: https://www.medpagetoday.com/gastroenterology/generalgastroenterology/72979
Ensuring dietary compliance among children and teenagers
New research on children and adolescents with celiac disease examined their dietary habits to determine the factors responsible for non-adherence to a gluten-free diet. Compliance with the diet is difficult at all ages but particularly for teenagers due to social, cultural, economic, and practical pressures.
For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5775619/
Urine as a gluten indicator?
A research study presented at the 16th International Celiac Disease Symposium (ICDS) in Prague shows that gluten presence in urine correlates with mucosal damage. Researchers from Biomedal Life Science were able to identify whether a person has ingested gluten by detecting the presence of gluten immunogenic peptides in urine. This was the first time a urine test has been used to monitor compliance with the gluten-free diet.
For more information: https://www.celiac.com/articles.html/celiac-disease-gluten-intolerance-research/new-urine-test-can-spot-gluten-in-celiac-patients-r4475/
Can a gluten-free diet normalize Vitamin D levels for celiac patients?
A study in Salerno, Italy found that Vitamin D levels for celiac patients fell back to normal levels after following a gluten-free diet without any additional supplementation.
For more information: https://www.ncbi.nlm.nih.gov/pubmed/29773507
Gluten-free diet likely improves neuropathic pain in patients with gluten neuropathy
A study in the UK, including Dr. Hadjivassiliou, studied patients with gluten neuropathy. When the patients followed a strict gluten-free diet their odds of peripheral neuropathic pain were reduced by nearly 90%.
For more information: https://www.ncbi.nlm.nih.gov/pubmed/30032386
The real challenge: avoiding gluten
A presentation at Digestive Week provided information on a study looking at inadvertent exposure to gluten by persons with CD. Silvester and colleagues did a “doggie bag” analysis of samples of processed or cooked food consumed by study participants. 33% of the food samples had >20 ppm of gluten.
For more information: https://www.medscape.com/viewarticle/899861
Celiac patients have higher risk of non-alcoholic fatty liver disease (NAFLD)
More than one-third of CD patients adhering to a GFD had concurrent NAFLD, accounting for a three-fold increased risk compared to the general population. Dietary advice provided using a patient-tailored approach should assist CD patients with NAFLD in achieving an appropriate nutritional intake whilst reducing the risk of long-term liver-related events.
For more information: https://www.medscape.com/viewarticle/900972
Prevalence of celiac disease in patients with osteoporosis
About 1 in 62 individuals with osteoporosis, or 1.6%, have biopsy-verified CD. This prevalence is comparable to that in the general population. These findings argue against routinely screening patients with osteoporosis for CD, which is contrary to current guideline recommendations. Additional studies are needed to determine the true utility of such screening programs.
For further information: https://www.medscape.com/viewarticle/902433
Surprising number of conditions linked to celiac disease
The incidence of autism is 20 times higher in those with celiac disease than the normal population. Several other conditions also show higher incidences including; liver disease, glossitis, pancreatitis, Down syndrome, and autism, according to a database study of more than 35 million people.
For more information: https://www.medscape.com/viewarticle/889005 World Congress of Gastroenterology 2017
The distribution of HLA DQ2 and DQ8 haplotypes and their association with health indicators in a general Danish population
In this Danish study of 2,293 individuals, a total of 47.7% individuals were positive for HLA DQ2 and/or HLA DQ8 genes: 31.2% only DQ2, 11.9% only DQ8, 4.1% both DQ2 and DQ8. Among nine individuals diagnosed with CD, 89.9% had DQ2.5cis, 22.2% DQ8 and 22.2% DQ2.2 (two both DQ2 and DQ8). HLA DQ2.5 was associated with higher thyroid-stimulating hormone levels, while DQ2/DQ8-positive participants had significantly lower prevalence of irritable bowel syndrome (IBS). DQ2/DQ8 were strongly associated with CD, but no other registry-based diagnoses.
United European Gastroenterol J. 2018 Jul;6(6):866-878. doi: 10.1177/2050640618765506. Epub 2018 Mar 8.
Most people with osteoporosis do not need to be screened for celiac disease
This Columbia University study found that the prevalence of celiac disease was 1.6% said Dr. Benjamin Lebwohl. Reviewing medical databases of patients with osteoporosis, they found that 1.9% had CD. Based on this, they felt that most individuals with osteoporosis, do not need to be screened for CD. However, they did state that if a patient has osteoporosis as well as additional signs of celiac disease, they should be screened. As well, younger patients who have lower bone densities should also be screened.
https://www.mdlinx.com/family-medicine/top-medical-news/article/2018/07/30/7539771
Celiac Disease and Reproductive Issues
In a new Danish study, Grode and colleagues compared the medical records of 6,319 women identified as having celiac disease through the Danish National Patient Register to the records of 63,166 women who did not have the condition. The researchers from Horsens and Odense hospitals and Aarhus University looked at the chance and timing of pregnancy, live and stillbirths, molar and ectopic pregnancy and miscarriages.
“I think this study substantiates the majority of data suggesting that uncontrolled celiac disease has an adverse effect on childbearing,” he said. “While these are admittedly small effects requiring thousands of patients to assess, they are real and provide a very good reason to be proactive about testing for celiac disease in young women.” At the 2017 Beyond Celiac Research Symposium, Leffler called for routine celiac disease testing for all women who have unexplained infertility.
“The message to women in general is that it is worth discussing celiac disease with your doctor if you have experienced fertility problems and adverse pregnancy outcomes,” Grode said.
Human Reproduction, Volume 33, Issue 8, 1 August 2018, Pages 1538–1547, https://doi.org/10.1093/humrep/dey214
AMG714 – A drug to assist with inadvertent exposure to gluten
Francisco Leon MD presented about AMG 714 (also known as ANTI-IL-15 MAB). This project offers hope for celiac patients who are inadvertently exposed to gluten (i.e., NOT cheating and eating gluten outright). This reduces the effects of gluten consumption in celiac disease. He reported that they just finished a phase 2a, randomized, double-blind, placebo-controlled study evaluating AMG 714 in adult patients with celiac disease exposed to a high-dose gluten challenge. This drug reduced activation of the immune system, leading to fewer symptoms due to intestinal damage. It’s a subcutaneous injection of a biologic immune modulator that blocks Interlukin 15 (IL-15) that is a mediator of celiac disease.
“It’s important to note that this drug is being investigated for its potential to protect against modest contamination, not deliberately eating large amounts of gluten, like bread or pasta,” said Francisco Leon, MD, PhD, the study director and consultant for Amgen. “Contamination, which can happen during food processing or packaging, during cooking, or due to inadequate labelling, is known to occur very frequently, despite following a gluten-free diet. Our hope is that this drug may allow celiac patients on a gluten-free diet to experience fewer gluten-triggered events.” http://ddw.org
ZED 1227 Advances to Phase 2 Clinical Trial
“You can compare [gluten] to a dangerous bug. In celiac disease, the intestinal immune system does not recognize gluten as a harmless food, which it normally is, but as a dangerous bug, and the tTG makes it worse by causing a better fit of the bug to the immune system,” said Detlef Schuppan, M.D., a celiac disease expert investigating ZED 1227 and director of the Institute of Translational Immunology and Celiac and Small Intestinal Diseases at the University of Mainz in Germany. Research into ZED 1227 recently advanced to a Phase 2 clinical study, which will test how well the pill works and at what dose in blocking the immune response of the body to gluten. It is unlikely to eliminate the need for a gluten-free diet, however, it will make the lives of celiac disease patients easier. https://www.beyondceliac.org/research-news/View-Research-News/1394/postid--110642/
Natural history and clinical detection of undiagnosed coeliac disease in a North American community
"Gastroenterology symptoms are certainly common signs of celiac disease when it becomes obviously symptomatic. So, patients present with diarrhea, abdominal pain, bloating, and anemia with fatigue," Murray said. "What this study tells us is that many patients are out there in the community who likely have some measure of celiac disease and who have not developed any of these symptoms. This also indicates that, perhaps, celiac disease is being detected much more without those symptoms being present."
The study was based on screening of nearly 50,000 stored blood samples taken from patients from Olmsted County, Minnesota, treated at the Mayo Clinic from 1995 to 2009. Researchers tested the samples for a biomarker of celiac disease, tissue transglutaminase (tTg) IgA. Samples that were positive were further tested for endomysial antibodies, which are very specific for celiac disease. Ultimately, 400 cases of undiagnosed celiac disease were identified and matched with 400 controls without celiac disease. This study strongly suggests that current case finding of using symptoms is not effective in detecting undiagnosed celiac disease. Aliment Pharmacol Ther. 2018 May;47(10):1358-1366. doi: 10.1111/apt.14625. Epub 2018 Mar 25.
Doggie Bag Study – How Much Gluten are We Getting?
The Doggie Bag study is being done by researchers from Boston Children’s Hospital, the University of Manitoba, Beth Israel Deaconess Medical Center and Biomedal, the Spanish company that developed the stool and urine tests.
Preliminary results “confirm the general concern that a strictly gluten-free diet is difficult to achieve even by highly motivated and educated celiac disease patients,” Jocelyn Silvester, M.D., a study author and director of research of the Celiac Disease Program at Boston Children’s Hospital, said in a presentation at the recent Digestive Disease Week. Testing for gluten peptides found positive results in 6 percent of 519 urine samples, 11 percent of 72 stool samples and 8 percent of 318 food samples.
Nearly half of the 25 food samples that tested positive for gluten had more than 20 parts per million (ppm). Five samples had more than 100 ppm. Gluten-free food labeling regulations in the United States and Canada limit the amount of gluten in packaged food labeled gluten-free to less than 20 ppm. Gluten-free food served in restaurants is not bound by the 20 ppm cut off, but restaurants are encouraged to voluntarily meet the standard.
When food tested positive for gluten peptides, it was associated with a positive urine test in 40 percent of cases and with a positive stool test in 83 percent of cases. Stool tests are more sensitive, detecting smaller amounts of gluten. It takes more gluten to trigger a positive urine test result.
https://www.glutenfreewatchdog.org/news/significant-study-published-on-the-amount-of-gluten-eaten-by-folks-with-celiac-disease-on-a-gluten-free-diet/
IBD risk increases substantially in the presence of celiac disease
In an Australian study, it was found that the prevalence of inflammatory bowel disease (IBD) is 11 times higher in patients with celiac disease compared with the population at large. The meta-analysis of 27 studies was published in the Journal of Clinical Gastroenterology. Meanwhile, the prevalence of celiac disease is twice as high in patients with IBD as in those without IBD.
The authors reasoned that the link between celiac disease and IBD are due to common disease genetic risk factors. But, they stated, celiac disease is a specific risk factor for the manifestation of IBD.
“On the basis of animal studies, a combination of factors such as genetic susceptibility and environmental factors such as the microbiome (or GI microbiome) may define the risk to develop intestinal pathology,” they wrote. Other evidence suggests that IBD in the presence of celiac disease “may result in more severe disease manifestations.”
https://www.mdlinx.com/gastroenterology/article/1771
Mortality in celiac disease: a population-based cohort study from a single centre in Southern Derbyshire, UK
The study found that in celiacs between 1978 and 2014, mortality in the serology (blood testing for celiac disease) era declined overall. Mortality from cardiovascular disease, specifically, decreased significantly over time. Death from respiratory disease significantly increased in the post-diagnosis period. Survival in those who died after diagnosis increased by three times over the past three decades. Serological testing has impacted on the risk of mortality in celiac disease. There is an opportunity to improve survival by implementing vaccination programs for pneumonia and more prompt, aggressive treatments for liver disease.
https://bmjopengastro.bmj.com/content/5/1/e000201
Intestinal Microbiota Influences Non-intestinal Related Autoimmune Diseases
A team of researchers recently set out to examine the role played by gut microbiota in the pathogenesis of non-intestinal autoimmune diseases, such as Grave's diseases, multiple sclerosis, Type-1 diabetes, systemic lupus erythematosus, psoriasis, schizophrenia, and autism spectrum disorders. They wanted to see if microbiota can influence and determine the function of cells of the immune system.
"The current evidence supports the notion that changes or alterations of the microbial species that form part of the intestinal microbiota will affect the balance of Tregs and Th17 cells at the intestine, which could modify the immune response of non-intestinal autoimmune diseases. The experimental evidence suggesting that the cytokines secreted from Treg and Th17 will determine and influence non-intestinal autoimmune responses. It could also be possible that cells of the immune system located at the intestine could to move other organs to establish or modify an autoimmune response. The major message of this review is that the abundant data support the notion that the intestine is a critical organ the appropriate immune balance and for the prevention of non-intestinal autoimmune diseases. The key point is that by modifying the intestinal microbiota of a patient that suffers non-intestinal autoimmune disease it might be possible to improve the outcome of such illness."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857604/ Front Microbiol. 2018; 9: 432.
Published online 2018 Mar 12. doi: 10.3389/fmicb.2018.00432
MyHealthyGut: development of a theory-based self-regulatory app to effectively manage celiac disease
Health-related mobile applications make smartphones useful tools in providing point of care to the user. Participants reported a need for the MyHealthyGut app, listed desired content, features and functions and provided feedback to revise the content, features and functions of version 1.0 of the MyHealthyGut app. MyHealthyGut is the first evidence-based app that may be helpful in empowering users to effectively self-manage celiac disease and promote general gut health. Dowd AJ1, Jackson C2, Tang KTY3, Nielsen D4, Clarkin DH4, Culos-Reed SN1,5.
Mobile health. 2018 Jun 11;4:19. doi: 10.21037/mhealth.2018.05.05. eCollection 2018.
Autoimmune and Allergic Disorders are More Common in People with Celiac Disease or on a Gluten-free Diet in the United States.
This study analyzed demographics, lifestyle patterns, and clinical characteristics of people with celiac disease (CD) and people without CD avoiding gluten (PWAG) to better understand associations with medical conditions and consumer behavior. Their study confirms that CD and PWAG share comorbidities of autoimmune nature. PWAG had more autoimmune/allergy-related disorders that may be associated with non-celiac gluten sensitivity a self-justifiable reason to be on the diet.
Kim HS1,2, Unalp-Arida A3, Ruhl CE4, Choung RS5, Murray JA5 J Clin Gastroenterol. 2018 Jul 24. doi: 10.1097/MCG.0000000000001100.
Prevalence of celiac disease serological markers in a cohort of Italian rheumatological patients.
This study identified a high prevalence of CD antibodies in adult patients referred to a rheumatology outpatient clinic. These results highlight the importance of CD screening in subjects presenting with rheumatological features.
Caio G1,2, De Giorgio R3, Ursini F4,5, Fanaro S3, Volta U1. Gastroenterol Hepatol Bed Bench. 2018 Summer;11(3):244-249.
Delayed celiac disease diagnosis predisposes to reduced quality of life and incremental use of health care services and medicines: A prospective nationwide study.
A delay in celiac disease diagnosis predisposes to reduced well-being and incremental use of medicines and health care services, both before diagnosis and one year after diagnosis.
United European Gastroenterol J. 2018 May;6(4):567-575. doi: 10.1177/2050640617751253. Epub 2018 Jan 8
HLA-DQ–Gluten Tetramer Blood Test Accurately Identifies Patients With and Without Celiac Disease in Absence of Gluten Consumption
Researchers at the Oslo University Hospital in Norway have found a potential test for CD for those who have been gluten-free for a period of time. The growing number of individuals adhering to a gluten-free diet (GFD) without exclusion of celiac disease complicates its detection. An HLA-DQ–gluten tetramer-based assays that detects gluten-reactive T cells identifies patients with and without celiac disease with a high level of accuracy, regardless of whether the individuals are on a GFD. This test would allow individuals with suspected celiac disease to avoid a gluten challenge and duodenal biopsy. This test requires validation in a larger study. Neither available anti-tissue transglutaminase immunoglobulin a (tTG IgA) blood tests nor the biopsy are accurate when someone has eliminated gluten, the trigger for celiac disease, from the diet. Clinicaltrials.gov no: NCT02442219.
Gastroenterology - March 2018 Volume 154, Issue 4, Pages 886–896.e6
Infections in Early Life and Development of Celiac Disease
Medically attended gastrointestinal and respiratory infections were associated with CD development by age 8 years in a large, population-based sample. Particularly strong associations were observed for repeated gastrointestinal infections in the first year of life. Early gastrointestinal infections may therefore be relevant for CD development rather than for type 1 diabetes development, for which early respiratory infections have been found to be more relevant in the same data.
Andreas Beyerlein; Ewan Donnachie; Anette-Gabriele Ziegler – American Journal of Epidemiology 2017;186(11):1277-1280. https://www.medscape.com/viewarticle/889711_4
Natural history and clinical detection of undiagnosed coeliac disease in a North American community
CD remains substantially undiagnosed. Of the 400 cases of undiagnosed celiac disease identified in the study, 159 had indications to screen, including classic symptoms such as diarrhea, and non-classic symptoms, such as other auto immune diseases. The remaining 241 cases had no indication to screen and would be likely to remain undiagnosed. Meanwhile, medical records showed that ultimately 92 cases were diagnosed, usually taking more than five years.
Among the controls, 147 cases had an indication to screen, nearly as many as were found in the cases of undiagnosed celiac disease. None of these were ever found to have celiac disease. More than half of adults with CD have symptoms not related to the gastrointestinal system. Current methods of screening for CD are not adequate.
Solutions proposed in the study are: use of natural language software to process electronic medical records; systematic acquisition of symptoms and family history; testing of those with combinations of symptoms or indications to test; and identification of new indications to test based on additional research.
Aliment Pharmacol Ther. 2018 May;47(10):1358-1366. doi: 10.1111/apt.14625. Epub 2018 Mar 25 https://www.ncbi.nlm.nih.gov/pubmed/29577349
Hypervigilance to a Gluten-Free Diet and Decreased Quality of Life in Teenagers and Adults with Celiac Disease
This article talks about a Columbia University study where the concern is that “extreme vigilance” to a strict gluten-free diet may increase symptoms such as anxiety and fatigue, and therefore, lower quality of life. The researchers examined the associations of quality of life with energy levels and adherence to, and knowledge about, a gluten-free diet. Clinicians must consider the importance of concurrently promoting both dietary adherence and social and emotional well-being for individuals with CD.
Wolf, R.L., Lebwohl, B., Lee, A.R. et al. Dig Dis Sci (2018). https://doi.org/10.1007/s10620-018-4936-4
Scientists May Have Found an “Off” Switch for Celiac Disease
Gluten causes an immune response in the body when it is modified by the enzyme transglutaminase 2 or TG2. In the Feb 23 issue of the Journal of Biological Chemistry new research has found an enzyme that turns off TG2. Michael Yi from Stanford University led the study. TG2 is now also the first protein known to have a reversible disulfide bond on/off switch of this type. “This is a very different kind of on-and-off chemistry than the kind that medicinal chemists would (typically) use,” Chaitan Khosla, who is also on the research team, said. Because previous studies have suggested that lack of TG2 doesn’t seem to negatively affect the health of mice, blocking TG2 is a promising avenue for treating celiac disease patients without requiring lifelong changes to their diets. More research is required.
https://www.goodnewsnetwork.org/scientists-may-found-off-switch-celiacs-disease/ Feb 24, 2018
Cutting Out Gluten may Help Some Battle Nerve Pain
“These finding are exciting because it might mean that a relatively simple change in diet could help alleviate painful symptoms tied to gluten neuropathy,” study lead author Dr. Panagiotis Zis, of the University of Sheffield in the UK, said in a news release from the American Academy of Neurology (AAN). Still, Zis stressed that while the study “shows an association between a self-reported gluten-free diet and less pain, it does not show that one causes the other.” More study is required in this area.
https://consumer.healthday.com/vitamins-and-nutrition-information-27/gluten-975/cutting-out-gluten-may-help-some-battle-nerve-pain-731369.html
SOURCES: Sami Saba, M.D., neurologist, Lenox Hill Hospital, New York City; Anthony Geraci, M.D., director, Neuromuscular Center at Northwell Health’s Neuroscience Institute, Manhasset, N.Y.; American Academy of Neurology, news release, Feb. 28, 2018
Comments from the Columbia’s Celiac Disease Center International Symposium
“It’s not possible one drug will be able to treat all people with celiac disease,” said Francisco Leon, M.D., former chief medical officer and former chief executive officer of Celimmune, a clinical development stage immunotherapy company. “We are targeting every aspect of the disease. These are not ‘Me, too,’ drugs.”
Dr. Jocelyn Silvester, University of Manitoba, indicated that there is no good way to know if a person is getting gluten in their diet, gluten is found everywhere, and more studies are needed to clarify the role of urine and stool tests to indicate exposure to gluten in a patient.
“Zero gluten is an aspiration rather than a realistic goal,” Silvester said in describing adherence to the gluten-free diet.
Dr. Lebwohl indicated that there is a lot about CD that is not known. How to prevent celiac disease or how to stop it in its tracks topped his list. Also, the degree of precautions patients need to take to avoid cross-contact, who to screen for celiac disease, why patients’ symptoms are so variable and which drug holds the most promise for treatment. Participation in clinical trials was urged as one of the most important steps patients can take to help scientists answer outstanding questions. www.beyondceliac.com
Do doctors take longer to diagnose celiac disease in people without symptoms than they do for people with symptoms? Yes, much longer. That needs to change
697 patients with celiac disease were reviewed by a team of researchers at Loyola University Centre Medical Centre in Illinois. Those with gastrointestinal symptoms were compared with those who did not have gastrointestinal issues. Statistical analysis revealed an average diagnosis delay in diagnosis of 2.3 months for the group with gastrointestinal symptoms, while the group that showed no symptoms showed an average delay of 42 months. That’s a difference of nearly 3½ years. Nearly half of those with no GI symptoms showed abnormal thyroid stimulating hormone (TSH). 70% of those with no GI symptoms had anemia. www.celiac.org
Anti-transglutaminase 6 Antibody Development in Children with Celiac Disease Correlates with Duration of Gluten Exposure
Antibodies against transglutaminase 6 (anti-TG6) have been implicated in neurological manifestations in adult patients with genetic gluten intolerance. In this study, 274 CD children and of 121 controls were reviewed. In CD patients, a significant correlation between the gluten exposure before the CD diagnosis and anti-TG6 concentration was found. Autoimmunity against TG6 is gluten dependent and disappeared during GF diet.
J Pediatr Gastroenterol Nutr. 2018 Jan;66(1):64-68. doi: 10.1097/MPG.0000000000001642.
The Enemy Within: Gut Bacteria Drive Autoimmune Disease
A Yale study, published in Science, found that bacteria found in the small intestine can travel to other organs and trigger an autoimmune response. They also found that "Treatment with an antibiotic and other approaches such as vaccination are promising ways to improve the lives of patients with autoimmune disease." They could reverse the autoimmune response with antibiotics. More study will be required. https://www.eurekalert.org/pub_releases/2018-03/yu-tew030618.php
Even on a GF Diet, Harmful Exposures May be Common
"Individuals who are on a gluten free diet are consuming more gluten than we actually imagined. It's not uncommon for them to be consuming on average a couple of hundred milligrams a day," Dr. Jack A. Syage, CEO of ImmunogenX in Newport Beach, California, and the study's lead author, told Reuters Health in a telephone interview.
Up to 10 mg of gluten per day is generally considered safe for people with celiac disease, according to the University of Chicago Celiac Disease Center. Still, the authors conclude, the data suggest "that individuals on a gluten-free diet cannot avoid accidental gluten intrusions and these small amounts are sufficient to trigger severe symptomatic responses."
The American Journal of Clinical Nutrition https://academic.oup.com/ajcn/article-abstract/107/2/201/4911450?redirectedFrom=fulltext February, 2018
Celiac Disease in Later Life Must not be Missed
The presenting symptoms of celiac disease are often subtle and the diagnosis is frequently delayed or overlooked. Therefore, especially elderly patients may be denied the benefits conferred by gluten free diet which can be dramatically life-changing. Common symptoms include tiredness, indigestion and loss of appetite and can therefore be missed. The diagnosis may prevent severe complications such as low-energy bone fractures and enteropathy-associated T-cell lymphoma.
https://www.medscape.com/viewarticle/892578_6
Richmond resident receives national recognition for work on celiac disease
Following years of work raising awareness on celiac disease, a Richmond woman has been recognized for her efforts through Canada's Sovereign Medal for Volunteers.
http://www.richmond-news.com/news/richmond-resident-receives-national-recognition-for-work-on-celiac-disease-1.23290797
April 25, 2018
Fructan – Not Gluten- Could be Source of Stomach Woes
Reviews new research suggesting that gluten intolerance might actually be caused by fructan not gluten. This is commonly referred to as FODMAPS.
www.healthline.com/health-news/fructan-could-be-source-of-stomach-woes
Fischer, Kristen, Healthline, November 27, 2017.
Celiac Disease, Gluten Symptoms Linked to Eating Disorders, even Anorexia
Johnson explores the relation of eating disorders such as Anorexia with celiac patients as recent study in Sweden indicated that there is a higher incident of Anorexia Nervosa (AN) amongst celiacs compared to control group.
https://www.allergicliving.com/2017/12/14/celiac-disease-gluten-symptoms-linked-to-eating-disorders-even-anorexia/
Johnson, Kate, Published December 14, 2017.
New blood test better identifies those with celiac disease, researchers say
Delves into new research involving an experimental test that may be able to detect celiac disease even for individuals on a gluten free diet. ImmunsanT has developed a blood test that looks at elevated cytokine levels to determine if the individual has celiac disease. For the test, patients would only be required to eat gluten one time. This would be the “first biomarker for measuring systemic T-cell immunity to gluten," said Leslie Williams, Chief Executive Officer of ImmusanT.
http://www.cbc.ca/news/health/new-blood-testceliac-1.4466280
Reuters, Thomson, Published December 28, 2017.
Genetically Modified Wheat – Gluten-Free
Would you eat bread with wheat flour, if it was safe? Scientists in the UK are experimenting with genetically modified wheat that does not include the gluten that would trigger a reaction in a celiac. It's still very early in the game, and much gene work remains to be done, but wouldn't that be exciting? Some trials with the new wheat are taking place in Mexico and Spain. It'll be interesting to see the results? For more information about the GM wheat, please visit: https://www.newscientist.com/article/2148596-genetically-modified-wheat-used-to-make-coeliac-friendly-bread/
Celiac Disease Undiagnosed 90% of the Time
Researchers at the University of Toronto studied the blood work of nearly 3,000 people and found that celiac cases were undiagnosed approximately 90% of the time. Ahmed El-Sohemy, a professor of nutritional science at the University of Toronto, wanted to see whether celiac disease results in subpar nutrition because of poorer absorption of vitamins and minerals. To find out, he needed data on the frequency of undiagnosed celiac disease. The findings reinforced that celiac disease occurs in around 1% of the population, but the vast majority who have it do not know they have it. To read more, please visit: http://www.cbc.ca/news/health/celiac-disease-1.4343691
Celiacs – Issues with Oats
A lot of celiacs feel that cannot tolerate oats. But the science shows only about 4% of us actually have problems with oats. You may feel "glutened" after eating oats but remember that oats are very high in fibre and can cause gastrointestinal issues if you have too much too quickly. Ease back into oats slowly, to allow your system to adapt. And of course stick to safe, clean, uncontaminated oats like those from Only Oats and Cream Hill Estates. Oats are a healthy and delicious option for us - enjoy!
Research – Autoimmune Disease in Family Impacts
Researchers at the University of Surrey in the UK are looking to gain an understanding of how people who have one sibling with an autoimmune disease feel about and manage their own health. This is an area of psychology which has not been studied very much before. If you know someone who would like to participate, please direct them to https://surreyfahs.eu.qualtrics.com/jfe/form/SV_8dI0Vbrvoo1iENn
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Reovirus May Trigger Immune Response To Gluten
According to a study conducted by the University of Chicago and the University of Pittsburgh School of Medicine, infection with reovirus, a common but harmless virus, may trigger the immune system response to gluten that leads to celiac disease. The study was published in the journal Science and it suggests that certain viruses play a role in the development of autoimmune disorders such as celiac disease and type 1 diabetes. This raises a possibility that a vaccine could developed in future to treat celiac disease! For more information, please visit: https://www.ndtv.com/food/scientists-discover-another-reason-for-celiac-disease-besides-genetics-1787157
Research – Celiac Disease
Harvard Medical School and Massachusetts General Hospital are currently recruiting 500 infants (250 in the US and 250 elsewhere) to participate in their new study that plans to look at the various factors that affect celiac disease's development. A skilled group of doctors and scientists will conduct a study called Celiac Disease Genomic Environmental Microbiome and Metabolic (CDGEMM), in order to understand and identify the various factors that are associated with the development of celiac disease. The study is led by Dr. Alessio Fasano and they'll be hoping to find a pattern, which would lead the team to creating treatment and predicting the disease's development. For more information, please visit www.cdgemm.org
Link of Oral Symptoms to Gastrointestinal Symptoms
Research published recently showed that concludes that oral symptoms can precede gastrointestinal symptoms in celiac disease, and be useful in diagnosis. In addition to celiac, oral problems can show up in the presence of Crohn's disease, ulcerative colitis, and gastroesophageal reflux disease. These symptoms may be key to identifying celiac earlier on, to reduce the current average delay of 11 years between the onset of symptoms and a firm diagnosis. To read more about this research, please visit https://www.ncbi.nlm.nih.gov/pubmed/29167716
Celiac Disease and the Gluten-Free Diet Found Unlikely to Impact IVF Outcomes or Fertility
Here's yet another reason why those without celiac disease or gluten sensitivity do not need to follow the gluten-free diet. Research presented in October by the Reproductive Medicine Associates of New Jersey (RMANJ) indicates that the gluten-free diet is not effective as a treatment for infertility. The findings are combined from 30 different scientific studies.
While healthy eating, including a low-carb diet, is part of a holistic, evidence-based approach to treating patients with infertility at RMANJ, adhering to a gluten-free diet has been shown to have no impact on increasing fertility for those trying to conceive.
The studies are the first large research projects to investigate IVF outcomes in gluten-free patients and the frequency of celiac disease in infertile patients. One study found that patients on a gluten-free diet had equivalent IVF success rates to those whose diet included gluten, proving that maintaining a gluten-free diet to improve IVF outcomes is a major misconception. The other study revealed that IVF success rates were equivalent between those with celiac disease (a disease with proven gluten intolerance) and those without.
More info: https://www.prnewswire.com/news-releases/gluten-free-ivf-new-research-from-reproductive-medicine-associates-of-new-jersey-reveals-gluten-free-diets-and-celiac-disease-are-unlikely-to-impact-ivf-outcomes-or-fertility-for-those-trying-to-conceive-300545215.html
Childhood Respiratory Infections Linked with Celiac Disease
Findings published recently in the journal Pediatrics reported that the number of at-risk children - or those with relatives who have celiac disease - who go on to develop celiac disease seems to be increasing. And recently, Dr. Renata Auricchio, from the University of Naples Federico II in Italy, set out to understand why this might be the case.
Studies have pointed toward infections in childhood as a potential trigger of celiac disease in those who are genetically susceptible. For instance, a 2013 study found that the presence of rotavirus antibodies could predict the onset of celiac disease.
Similarly, in the Norwegian Mother and Child Cohort Study, children who had experienced 10 or more infections before reaching the age of 18 months had a significantly increased risk of developing celiac disease than children who had had four or fewer.
Many earlier investigations into infections and celiac disease relied on parental recall of infections and have included a general cross-section of the population. However, to gather more detailed information, the new study used a prospective cohort. In other words, the team studied a group of infants known to be at risk of developing celiac disease and followed them for 6 years.
As the authors explain, the study's aim was "to explore the relationship between early clinical events (including infections) and the development of CD [celiac disease] in a prospective cohort of genetically predisposed infants.
Across the study, 6 percent of the children were diagnosed with celiac disease at the age of 3, 13.5 percent at age 5, and 14 percent by age 6. They also found that "[c]compared with gastroenteritis, respiratory infections during the first 2 years of life conferred a twofold increase in the risk of developing CD [celiac disease]."
When discussing how early infections might impact the later development of celiac disease, the authors write:
"It is possible that [...] early infection stimulates a genetically predisposed immune profile, which contributes to the switch from tolerance to intolerance to gluten."
More info: https://www.medicalnewstoday.com/articles/319702.php
Study Confirms that a Majority of Torontonians with Celiac Disease Don’t Know They Have It
Research at the University of Toronto, which focused specifically on Canada's largest city, found that around 87 of people living with celiac in the city are not aware that they have the disease.
Ahmed El-Sohemy, a professor of nutritional science at the University of Toronto and senior author of the paper that presented the findings, said researchers compared blood tests of about 3,000 Canadians with their responses to a health questionnaire. 90% of those who tested positive to the celiac blood test reported that they had not been diagnosed as celiac.
While the biopsy remains the gold standard, this study is a good indicator of how those who are diagnosed may be just the "tip of the iceberg"!
El-Sohemy also suspects (and we agree) that the vast majority of people eating gluten-free by choice don’t actually have celiac disease.
More info: https://www.thestar.com/news/gta/2017/10/07/majority-of-torontonians-with-celiac-disease-dont-know-they-have-it-study-shows.html
Danish Research Finds Huge Increase in Celiac Disease Prevalence
According to research published in October in the European Journal of Gastroenterology and Hepatology, the prevalence of diagnosed CD has doubled every decade in Denmark from 1986 to 2016, and in the same period the female/male ratio has increased and the median age at diagnosis has decreased. The prevalence of autoimmune comorbidity (having more than one) in 2016 was three times higher among celiac patients compared with the general Danish population.
The study included over 11,000 Danes. The prevalence of CD in 1986 and 2016 was 14 and 180 per 100,000 persons, respectively, with a female/male ratio changing from 1.3 to 2.0. Incidence rates (per 100,000 person-years) changed from 1.6 in 1980-1984 to 15.2 in 2015-2016, with the largest increase among females aged 0-9 years. In 2016, prevalence of autoimmune comorbidities was 16.4% among the CD patients compared with 5.3% in the general population.
More info: https://www.ncbi.nlm.nih.gov/pubmed/29076940
More Americans Eating Gluten-Free
The number of Americans who avoid gluten even though they do not have celiac disease more than tripled from 2009-2014, increasing to an estimated 3.1 million people, according to a study in the January issue of Mayo Clinic Proceedings.
Researchers at the Mayo Clinic in Rochester used a sample comprised of 22,227 people age 6 or older in the National Health and Nutrition Examination Surveys for their study. The prevalence of Americans without celiac disease who avoid gluten increased to 1.7% in 2013-14 from 1% in 2011-12 and 0.5% in 2009-10.
The study concluded long-term health consequences of a gluten-free diet warrant further investigation.
“The benefits of following a G.F.D. (gluten-free) diet in people without C.D. (celiac disease) have not been tested rigorously, and indeed nutritional concerns have been raised about deficient iron, calcium and fiber consumption,” the study said. “In contrast to public interest in following a G.F.D., it remains uncertain whether there is any benefit of following a G.F.D. for people without gluten-related conditions.”
More info: http://www.foodbusinessnews.net/articles/news_home/Consumer_Trends/2017/01/More_people_without_celiac_dis.aspx?ID={579BCDF6-7468-4761-A991-7F3AEF178C84}&cck=1
Type 1 Diabetes Continues to be Linked to Celiac Disease
Parents of young children with type 1 diabetes need to be on the lookout for symptoms of celiac, new research has confirmed.
The study found these youngsters appear to face a nearly tripled risk of developing celiac disease autoantibodies, which eventually can lead to the disorder.
"Type 1 diabetes and celiac disease are closely related genetically," explained study author Dr. William Hagopian.
"People with one disease tend to get the other. People who have type 1 diabetes autoantibodies should get screened for celiac autoantibodies," Hagopian said. He directs the diabetes program at the Pacific Northwest Research Institute in Seattle.
According to Hagopian, "Celiac is about three times more common in the general population than type 1 diabetes."
Previous research has pegged the co-occurrence of type 1 diabetes and celiac disease at around 5 percent to 8 percent, the study authors said.
More info: https://www.medcircle.com/articles/14252-where-theres-type-1-diabetes-celiac-disease-may-follow
Reduced Bone Mineral Density in Children With Screening-Detected Celiac Disease
New research published in the Journal of Pediatric Gastroenterology & Nutrition has found that children with screening-detected celiac disease have reduced bone mineral density (BMD), lower levels of vitamin D3, higher levels of parathyroid hormone (PTH), and signs of systemic inflammation compared with controls.
These differences were not found in celiac disease children on a gluten-free diet, indicating that children with screening-detected celiac disease benefit from an early diagnosis and treatment.
More info: http://journals.lww.com/jpgn/Abstract/2017/11000/Reduced_Bone_Mineral_Density_in_Children_With.11.aspx
Gluten Sensitivity
Want to know more about the causes of gluten sensitivity: view www.cbc.ca/quirks Saturday, December 2, 2017 show “Your ‘gluten sensitivity’ may have nothing to do with gluten.” Thanks to Kaye Hipper for letting me know about this segment.
Fracture Risk Increases with Type 1 Diabetes, Celiac Disease
In an Australian study, researchers assessed previous fractures (verified by radiologic reports and medical records), duration of type 1 diabetes, glycemic control, hypoglycemia incidence (assessed via glucose monitoring devices or logbooks), daily insulin dose, microvascular complications and celiac disease status. Patients with Type 1 diabetes and celiac disease had significantly more fractures than those with only diabetes. Patients with type 1 diabetes and celiac disease also had a higher prevalence of frequent hypoglycemia, defined as at least two episodes per week, compared with those who had type 1 diabetes alone. This is important as hypoglycemia increases the risk of falls and therefore fractures. www.helio.com Oct 5, 2017
Non-Celiac Wheat Sensitivity is a Persistent Condition
An Italian study following 200 participants who had a diagnosis of non-celiac wheat sensitivity and checking after a median follow-up time of 99 months found 88% had fewer symptoms and 98% of those who adhered to a gluten-free diet had reduced symptoms. 20 of 22 who were in the double blind group reacted to wheat. From this data, they concluded that Non-Celiac Wheat Sensitivity is a persistent condition. http://www.gastrojournal.org/article/S0016-5085(17)30343-8/fulltext More research needs to be done in this area as other studies have indicated non-celiac gluten sensitivity may be transient in nature. What is clear that Celiac Disease must be ruled out prior to diagnosing non-celiac gluten sensitivity to ensure that the proper treatment of the disease is provided.
Fish May Provide Hints to Treating Celiac Disease
Fish are carnivores and although often fed fishmeal, this is an expensive source of food. Plant soy based feeding has been used, but most fish have problems with a plant based diet and develop enteritis and gastrointestinal problems. One exception is the Rainbow Trout. For some thought to be genetic reason, these fish thrive on the plant soy based diet. Researchers identified 63 genes that help Rainbow Trout except the plant-based diet. This discovery has the potential for a biomedical model for the development of treatments for ulcerative colitis and celiac disease. http://researchnews.plos.org/2017/07/19/rainbow-trout-strains-tolerance-of-a-soy-based-diet-is-linked-to-63-genes/
Biopsy Sampling of Greater Than 4 Samples Increase Probability of Diagnosing Celiac Disease
The diagnostic rate of CD increased from 3.5% to 7.6% when more than 4 samples of the small intestine were taken at time of biopsy. Complying with the guidelines and taking greater than 4 samples will ensure better diagnosis of Celiac Disease. https://www.medscape.com/viewarticle/884268?src=wnl_edit_tpal
99.5% of Labels Found to be Accurate Regarding Gluten-Free Claims by FDA
According to the FDA, more than 99.5 percent of "gluten-free" food products met the agency's gluten-free standard, according to Carol D'Lima, a food technologist in FDA's Office of Nutrition and Food Labeling. If any products are found to be out of compliance for gluten standards, the FDA notifies the company to make appropriate corrections, and works with the company to recall any mislabeled products on the market. https://www.foodnavigator-usa.com/Article/2017/10/18/FDA-could-zero-in-on-cross-contamination-of-gluten
Patients with Sjogren’s Syndrome Have High Potential to Have Celiac Disease
A small study published in the American Journal of Gastroenterology showed 14.7%of patients with Sjogren’s syndrome also had Celiac Disease. Even non-celiac Sjogren’s patients showed inflammation in the small bowel mucosa. The findings show a close association between the diseases. https://www.ncbi.nlm.nih.gov/pubmed/10201480
At-home urine and stool tests that detect gluten now available
Gluten Detective tests detect fragments of the immunogenic gluten protein, called GIP, harmful to those who have celiac disease. They are being sold online by Glutenostics, the distributor of the tests in the United States and Canada. The urine test is sensitive for 500 milligrams of gluten, while the stool test, although less convenient test to 50 milligrams of gluten. The kits cost $45 plus shipping, and the company is currently offered a 25 percent off coupon on its website for first-time customers. Results are ready in 10 to 15 minutes. The sensitivity of the tests will only pick up a significant amount of gluten consumed and will not determine if there has been cross-contamination.
Gluten Detective is not approved under the Food and Drug Administration’s Food Drug and Cosmetic Act and cannot make a medical claim related to the treatment of celiac disease or any other condition. The tests can only claim to detect gluten consumed, fragments of which are found in the stool or urine of everyone, but only trigger an autoimmune response in those who have celiac disease.
www.beyondceliac.org Nov 7, 2017 Article by Amy Ratner
Celiac Disease Research Neglected in Federal Funding
Review of 2011 – 2015 funding of research shows NIH gives less money to celiac disease than other gastro-intestinal conditions. Dr. Daniel Leffler and Dr. Sonia Kupper stated that “These data suggest that a few diseases, including celiac disease and IBS, are underfunded in comparison with other diseases, especially when prevalence, burden and available treatment options are considered,” Celiac disease, with a prevalence of about 1 percent and mortality rate of 1.3, the highest among the diseases reviewed, received about $3 million per year. Meanwhile, Crohn’s disease, which had the second lowest prevalence at .25 percent and a mortality rate of 1.1, received about $16 million per year, the highest amount of funding. www.beyondceliac.org Article by Amy Ratner Oct 4, 2017
Research: Antibiotics Don't Increase Chances a Child Will Develop Celiac Disease
Antibiotics commonly prescribed for children do not increase the chance of celiac disease or type 1 diabetes developing in kids who are already at risk for either of the conditions, according to a new study.
Researchers found that antibiotics, including penicillin, amoxicillin and cephalosporin, prescribed during a child’s first four years were not associated with the development of autoimmunity for celiac disease or type 1 diabetes.
A lack of evidence regarding the consequences of using antibiotics early in a child’s life in relationship to celiac disease and type 1 diabetes prompted the study. The increased use of antibiotics worldwide has been proposed as a cause for an increase in autoimmune diseases in industrialized countries, the study authors wrote. These results suggest that the use of the most common antibiotics in early life does not increase the risk of autoimmunity in children at increased genetic risk. https://jamanetwork.com/journals/jamapediatrics/article-abstract/2656303?appId=scweb&appId=scweb
JAMA Pediatr. Published online October 9, 2017. doi:10.1001/jamapediatrics.2017.2905
Scientists at the University of Toronto Determine Celiac Disease Still Under-Diagnosed
by Utkarshna Sinha, 22 October 2017, THE VARSITY, The University of Toronto’s Student Newspaper
3,000 adult participants of diverse backgrounds were given the tTG blood test for Celiac Disease and they found that 90% of those studied were going undiagnosed. Consistent with US findings, 1% of the study group had celiac disease antibodies. Prior studies have indicated that only 15% of those with Celiac Disease in Canada are actually diagnosed.
https://theceliacscene.com/celiac-disease-still-under-diagnosed/ ; http://bmjopen.bmj.com/content/7/10/bmjopen-2017-017678
Commercially Available Glutenases: A Potential Hazard in Celiac Disease
14 glutenase products were tested and it was found that there was no scientific basis for their claims that they would break down the gluten. Although the products included disclaimers of not being evaluated by the US food and Drug Administration, the products should be avoided by those with Celiac Disease.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424869/
Do in Range tTG Levels Indicate Intestinal Healing?
A team of researchers from the Mayo Clinic, including Dr. J. A. Murray reviewed the results of 402 treated celiac patients who had had a blood draw, within 1 month of having a duodenal biopsy (2009- 2015). They found that patients who had undetectable tTG levels were more likely to have normal duodenal histology. Asymptomatic patients more often showed normal duodenal histology compared with patients who still had symptoms.
http://onlinelibrary.wiley.com/doi/10.1111/apt.14250/full
Can Specific Strains of Probiotics Delay the Onset of Gluten Sensitivity in Children
A trial at the Lund University was presented at the International Celiac Disease Symposium in New Delhi that indicated that new trial data suggests that the probiotic strains Lactobacillus plantarum Heal 9 and Lactobacillus paracasei 8700:2 may provide support for the immune system and delay the onset of gluten intolerance in children. 78 children with a genetic pre-disposition to celiac disease were included in the multinational and multiyear autoimmunity study.
www.celiac.com
Intraepithelial Lymphocyte (IEL) Count Distinguishes Celiac Disease from Normal Mucosa
IEL count in duodenal mucosa can be used to distinguish celiac disease from normal mucosa. A cutoff of 25 IEL/100 enterocytes. 198 patients with celiac disease and 203 controls without celiac disease were used in the study. This yielded 99.0% sensitivity, 93.1% specificity, and an overall accuracy of 99.5%. Use of this type of diagnostic process of Celiac Disease would make diagnosis easier and less expensive.
https://www.medscape.com/viewarticle/886127?src=wnl_edit_tpal Factors Associated with Villus Atrophy in Symptomatic Celiac Disease Patients on a Gluten-free Diet
1,395 celiac disease patients who had celiac disease and despite being on a gluten-free diet had on-going symptoms were reviewed. A majority of symptomatic celiac disease patients did not have active disease on follow-up histology. Symptoms were poorly predictive of persistent mucosal injury. Villous atrophy was most often seen in patients who used non-steroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), and selective serotonin reuptake inhibitors (SSRIs). Use of these drugs warrants further study.
S. Mahadev; J. A. Murray; T.-T. Wu; V. S. Chandan; M. S. Torbenson; C. P. Kelly; M. Maki; P. H. R. Green; D. Adelman; B. Lebwohl, Aliment Pharmacol Ther. 2017;45(8):1084-1093. http://www.medscape.com/viewarticle/878189?src=wnl_edit_tpal
A Unique Enzyme Could be a Game-Changer for Gluten-Sensitive Patients
A Press Release from Digestive Week May 7, 2017 – “Researchers have found that taking an enzyme tablet while consuming foods containing gluten prevents a significant amount of it from entering the small intestine. This could enable gluten-sensitive patients to ingest small quantities of gluten without experiencing symptoms, such as bloating, diarrhea and abdominal pain.
The encouraging results from the enzyme known as aspergillus niger-derived prolyl endoprotease (AN-PEP) were presented at Digestive Disease Week® (DDW) 2017, the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.” Note: this enzyme was not used on celiac disease patients as it does not adequately protect them. http://www.ddw.org/blogs/aimee-frank/2017/05/07/a-unique-enzyme-could-be-a-game-changer-for-gluten-sensitive-patients?CommunityKey=e1a95ab4-c2da-436d-be33-59f0c867cdcf&tab=
Mast Cells Tied to Onset and Progression of Celiac Disease
A team of researchers at the University of Udine, Italy investigated the roll mast cells have in the development of celiac disease. “The team found that infiltrating mast cells reflected the severity of mucosal damage, and their numbers were increased in patients with higher Marsh scores. They noted that mast cells responded directly to non-immunodominant gliadin fragments by releasing pro-inflammatory mediators.” The study found that mast cells were prominent in the inflammatory process. This could be important in finding therapeutic solutions for CD.
https://www.celiac.com/ and https://www.ncbi.nlm.nih.gov/pubmed/27619824
Psychiatric Disorders in Children Linked to Celiac Disease
Children with celiac disease are at a 1.4-fold increased risk for psychiatric disorders, according to a new Swedish study. Lower body mass and malnutrition in children with celiac disease is one possible pathogenic mechanism, and immune-mediated systemic reaction in celiac disease may be associated with the increased risk for depression and autism, they suggest. The increased risk of neurodevelopmental disorders also suggests a “biological etiology of psychiatric comorbidity in celiac disease.” In addition, psychological aspects of celiac disease and chronic symptoms may contribute to the effect. http://www.psychiatryadvisor.com/childadolescent-psychiatry/psychiatric-disorders-may-precede-celiac-disease-diagnosis-in-children/article/656070/
Have You Been Glutened?
An at home pregnancy-like test may be soon be available to tell you if you have been glutened. GlutenDetect will be available by the end of the year, but the test stick would have to be sent to a laboratory for evaluation. The test will give a “current picture of gluten exposure compared to the tTG test and biopsy, which show what has happened in the past few months. You are looking at what’s happening today, and patients can review their diets. This is a tool to help manage a gluten-free diet.”
https://www.beyondceliac.org/
Long Term Gluten Consumption in Adults Without Celiac Disease and Risk of Coronary Heart Disease
Long term dietary intake of gluten was not associated with risk of coronary heart disease. However, the avoidance of gluten may result in reduced consumption of beneficial whole grains, which may affect cardiovascular risk. The promotion of gluten-free diets among people without celiac disease should not be encouraged.
http://www.medscape.com/viewarticle/879702?src=wnl_edit_tpal
Antigliadin Antibodies May Indicate Gluten-free Diet Will Help in IBS
“There is growing interest in the role of food as a trigger of symptoms in functional bowel disorders, including IBS. More than 60% of patients with IBS [experience] bloating and abdominal pain after ingestion of certain foods, and within these foods, wheat and gluten may cause symptoms in a subset — not all — IBS patients in whom celiac disease and wheat allergy have been excluded,” said María Inés Pinto Sanchez, MD, of the department of medicine at McMaster University and the Farncombe Institute in Ontario, Canada. Patients with IBS, regardless of antibody status, experienced comparable improvements in anxiety, somatization and wellbeing, but only patients who were antigliadin positive had reduced depression scores, Sanchez said. This may “suggest that gluten restriction rather that strict gluten avoidance may be sufficient for symptom management in this subgroup of IBS patients,” Sanchez concluded.
https://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7B3bff7cd6-e277-42e9-b0a4-a982e8de96fe%7D/antigliadin-antibodies-may-indicate-gluten-free-diet-will-help-in-ibs Reference: Sanchez MIP, et al. Abstract #162. Presented at: Digestive Disease Week; May 6-9, 2017; Chicago.
Celiac Disease Tests Do Not Reflect Ongoing Mucosal Damage
Dr. Donald R. Duerksen, from the University of Manitoba looked 1,088 patients and found that the “estimated sensitivity of the tTG IgA was 50% and its specificity was 83% for detecting persistent villous atrophy on a gluten-free diet.” “Although widely available, and relatively non-invasive, serum tTG IgA and EMA IgA antibodies are poorly correlated with mucosal outcomes,” they conclude. “Most patients with celiac disease have negative antibody tests on a gluten-free diet, even those with persistent mucosal damage.” A positive test result is useful as it suggests that dietary assessment is required. A negative test however, does not indicate that there is mucosal recovery. Original article in Reuters Health.
http://www.medscape.com/viewarticle/881043?src=wnl_edit_tpal
Drug Development Pipeline – Beyond Celiac
Beyond Celiac has a page on their website that is tracking the stages of development of Celiac Disease drugs and research under development. They also have an infographic that provides what each of the stages of development of a drug trial are.
https://www.beyondceliac.org/drug-development-pipeline/
US Gluten-Free Labelling
The Celiac Disease Foundation June, 2017 newsletter indicated that as of August 2013, the Food and Drug Administration issued a rule mandating that packaged food labeled “gluten-free” (or similar claims such as “free of gluten”) cannot contain more than 20 parts per million of gluten (ppm). CDF is pleased to announce that the FDA has found extensive compliance with products labeled “gluten-free.” Of 702 samples from more than 250 products labeled “gluten-free,” over 99.5% are in compliance with the FDA’s requirement and contain less than 20 ppm of gluten.
https://celiac.org/blog/2017/06/new-sampling-data-compliance-fda-gluten-free-labeling-rule/?bblinkid=50860850&bbemailid=4230262&bbejrid=307504556
Is there a relationship between gluten sensitivity and postural tachycardia syndrome (PoTS)?
In a study in the European Journal of Gastroenterology & Hepatology, it was found that 4% of those diagnosed with PoTS also had celiac disease. Self-reporting by those with PoTS indicated that 42% were gluten-sensitive. Further study is required to understand the relationship between PoTS and gluten related disorders. PoTS is a condition that causes an abnormal increase in the heart rate when you go from a lying position to a standing condition.
http://journals.lww.com/eurojgh/Citation/2016/12000/Is_there_a_relationship_between_gluten_sensitivity.5.aspx
Are Gluten-Free Foods Misleading Consumers?
For those of you who are new to Celiac Disease, another study has confirmed that gluten-free foods do not have the same nutritional value as their gluten containing comparisons. “In all, the study assessed 654 gluten-free products, and compared them against 655 gluten-containing products. Among the group's key findings were that gluten-free breads had significantly higher content of lipids and saturated fatty acids; gluten-free pasta had significantly lower content of sugar and protein; and gluten-free biscuits had significantly lower content of protein and significantly higher content of lipids.” ESPGHAN expert and lead researcher, Dr Joaquim Calvo Lerma, adds that "…it is imperative that foods marketed as substitutes are reformulated to ensure that they truly do have similar nutritional values. This is especially important for children, as a well-balanced diet is essential to healthy growth and development."
www.celiac.com and the http://www.espghancongress.org Media Release
Infections in Early Life Associated with Increased Risk for Celiac Disease
“Infections during infancy are associated with increased risk for gluten intolerance (celiac disease) later on. Apparently the risk is particularly high in the case of repeated gastrointestinal infections in the first year of life. This conclusion was drawn by scientists of the Institute for Diabetes Research at Helmholtz Zentrum München, a partner in the German Center for Diabetes Research (DZD), after analyzing data provided by the Bavarian Association of Statutory Health Insurance Physicians. Results from this study have now been published in the current issue of the ‘American Journal of Epidemiology’.” There was also found to be an increased risk of celiac disease with upper respiratory infections early in life. “However, it seems that the increased risk of celiac disease is associated with a permanent inflammation of the gastrointestinal tract in early childhood and is not caused by a specific viral or bacterial pathogen.”
https://www.helmholtz-muenchen.de/en/press-media/press-releases/all-press-releases/press-release/article/40647/index.html German Research Center for Environmental Health
Assessing the Claims of Dietary Enzymes to Eliminate Gluten
“Researchers from the Celiac Disease Center at Columbia University set out to identify products with either overt or implied claims to aid in the digestion of gluten and to evaluate their ingredients, claims, and disclaimers. A thorough Google search was conducted to identify enzyme supplements commercially available in the United States that claimed to degrade gluten. This search ultimately identified 14 products, many of which had names like Gluten Cutter, GlutenEase, and Gluten Defense, implying relief for the celiac disease and non-celiac gluten/wheat sensitive communities.” Unfortunately, this study found little evidence that these substances met their claims.
Read more at https://celiac.org/blog/2017/07/assessing-claims-dietary-supplements/#e4V4KgZeL3RB6t4c.99 and original article http://journals.sagepub.com/doi/full/10.1177/1756283X17690991
High Incidence of Celiac Disease in Adolescents
A study published in Gastroenterology in May 2017 of children at St. Joseph’s Hospital in Denver, Colorado, looked at 1,339 children with genetic risk factors for celiac disease over up to a 20 year period. Celiac Disease Autoimmunity was defined as those who developed tissue transglutaminase autoantibodies for at least 3 months. They found that more than 5% developed celiac disease autoimmunity, CDA over the ten year period and at ages 5, 10 and 15 years respectively those who actually developed celiac disease were 1/6%, 2.8% and 3.1% respectively. Although more than 5% of children may experience a period of CDA, not all children develop celiac disease or required gluten-free diets. This study also reconfirmed that 40% of the population carry the genes for Celiac Disease.
https://www.ncbi.nlm.nih.gov/pubmed/28188747
Seemingly Innocuous Virus can Trigger Celiac Disease
The University of Chicago and the University of Pittsburgh School of Medicine, found that a common, thought to be harmless virus, the reovirus, can trigger an immune response to gluten. Dr. Bana Jabri, the senior author of the study, indicated that the virus sets the stage “for an autoimmune disorder, and for celiac disease in particular.” He also stated the specific virus and its genes and the interaction between the microbe and the host, as well as the health status of the host are all important. Dr. Jabri reported that IL-15, a cytokine upregulated in the intestinal lining of celiac disease patients, can break oral tolerance to gluten. They found that genetic differences between reovirus strains could either protect against or cause celiac disease. They found that celiac disease patients had much higher levels of antibodies against reoviruses than those without the disease. This could lead to a vaccination in the future that targets viruses infecting the intestine in order to protect children at risk for celiac and other autoimmune disorders.
https://news.uchicago.edu/article/2017/04/06/seemingly-innocuous-virus-can-trigger-celiac-disease
Anorexia Nervosa Diagnosis More Common in Women with Celiac Disease
Anorexia nervosa is an emotional disorder that involves an obsessive desire to lose weight by refusing to eat. Data from 1987 to 2009 on 18,000 Swedish women diagnosed with celiac disease and about 89,000 women around the same age who did not have the autoimmune disorder. Those with celiac disease were found to be 46% more likely to be diagnosed with anorexia nervosa. The study was not a controlled experiment designed to prove that celiac disease causes anorexia or the reverse. There may have been bias as those diagnosed with one condition were probably more closely monitored which could lead to a higher level of diagnosis of other disorders. This is something that should be monitored by healthcare providers.
http://www.reuters.com/article/us-health-celiac-anorexia-idUSKBN1752EG
Factors Associated with Villus Atrophy in Symptomatic Celiac Disease Patients on a Gluten-Free Diet
Despite sticking to a gluten-free diet, some celiac patients endure persistent duodenal damage, a condition associated with adverse outcomes. The researchers from Columbia University and the Mayo Clinic found that of 1,345 symptomatic diagnosed celiac patients in the study, 38% were found to have villous atrophy. People with villus atrophy were more likely to use proton-pump inhibitors, non-steroidal anti-inflammatory drugs (NSAID), and selective serotonin re-uptake inhibitors (SSRI). Adjusting for covariates showed that the symptoms alone were not tied to villus atrophy. Further research into the impacts of proton-pump inhibitors, NSAIDs and SSRI’s is indicated.
Alimentary Pharmacology and Histology Volume 45, Issue 8 April 2017 Pages 1084–1093, http://onlinelibrary.wiley.com/doi/10.1111/apt.13988/abstract;jsessionid=ED15F5C51D5E343FE71B5F0F6E850347.f04t04
Nexvax2 Moves to Next Stage of Research
Nexvax2 is a dose to protect against gluten exposure being developed by ImmusanT. The first stage of study investigating safety and tolerability is completed. The vaccine is initially designed to be used along with the gluten-free diet, with long range plans that would eliminate the need for the diet. Previous studies have shown that the first dose of the vaccine prompted the immune reaction to gluten, with patients who received Nexvax2 showing activation of T-cells as well as typical celiac disease symptoms. But when the treatment ended after twice weekly doses of Nexvax2 for eight weeks, the T-cells were no longer active. Additionally, when patients who had received Nexvax2 ate gluten for three days, the immune reaction was not triggered.
https://www.beyondceliac.org/research-news/
Gluten: ZERO Global
This is the name of a new book written by Dr. Rodney Ford, a respected pediatrician and expert in Celiac Disease from the UK. Dr. Ford’s contention is that 20 ppm is not OK. There must be “zero” gluten ingested. Dr. Ford states that you must get your tTG antibodies down as they are causing an immune effect in the gut, as well as doing neurological harm as shown by Dr. Hadjivassiliou (2002).
Dewar and co-workers investigated 100 patients who had non-responsive celiac disease (refractory celiac disease). They found the following: 45 (45%) of these patients were not adequately adhering to a strict gluten-free diet, of whom 24 (53%) were inadvertently ingesting gluten, and the remaining 21 (47%) admitted non-compliance. http://www.ncbi.nlm.nih.gov/pubmed/22493548.
Dr. Ford’s book is available at http://www.glutenZEROglobal.com
Clinical Trial Fails to Meet Its Objectives
ImmunogenX, the clinical stage biopharmaceutical company developing latiglutenase, an combination of two enzymes that are supposed to breakdown gluten, found that those receiving the drug did not do any better than those taking a placebo. ImmunogenX is continuing to look at data from the trial related to specific groups of patients. They are optimistic about the future of the drug and its ability to help these patients improve their quality of life and better manage celiac disease, according to the company. And plans are in place for the next Phase 2 clinical trial.
The recent CeliAction trial included nearly 500 celiac disease patients who had been on the gluten-free diet for a least one year and who had moderate to severe symptoms and intestinal damage. It was conducted from August 2013 to December 2014 throughout Europe and North America and had been widely publicized among celiac disease patients.
Among the 398 patients with a positive blood test, severity of abdominal pain improved for 57 percent and bloating for 44 percent. Tiredness and constipation were also shown to have decreased in these patients. “While the published study showed no overall benefit, we have since discovered that people with symptoms and elevated celiac disease antibodies did have a significant benefit,” said Peter Green, M.D., a study author and director of the Celiac Disease Center at Columbia University. “We are thrilled with that because it gives the medicine an ongoing opportunity to get out there to help patients.”
https://www.beyondceliac.org/research-news/View-Research-News/1394/postid--75508/
Biopsy-Defined Adult Celiac Disease and Selective Immunoglobulin A Deficiency
Dr. Hugh James Freeman, University of British Columbia, Department of Gastroenterology published results of 234 biopsy-defined celiacs from 1982 – 2011. 7 were found to be IgA deficient (immune-deficient), or about 3%. They also found that there is no apparent difference in the gluten-free dietary mucosal response from celiac disease with or without immunoglobulin deficiency. Immunoglobulin A deficiency is well recognized to be a cause of false-negative or falsely low determinations of IgA antibodies (i.e., either anti-endomysial or anti-tissue transglutaminase antibodies or both) used in screening or case-finding for celiac disease. In this setting, use of an alternative antibody, such as IgG, or even endoscopic biopsy may be considered, if there is a high suspicion for adult celiac disease. The present evaluation, however, also documented that IgA antibodies to tissue transglutaminase were present in all patients that could be tested here with selective IgA immunoglobulin deficiency. More study is required in this area.
Available online at http://pubs.sciepub.com/ijcd/5/1/1
Mucosal Recovery May Take Longer Than Previously Thought
Recently Dr. Hugh James Freeman of the Department of Medicine, Gastroenterology, University of British Columbia, Vancouver, BC, Canada, conducted a study to assess healing time in celiac patients. In this study, 182 patients (60 males, 122 females) referred for evaluation of symptoms, including diarrhea and weight loss, were selected only if initial biopsies showed characteristic inflammatory changes with severe architectural disturbance.
All patients were treated with a strict gluten-free diet, and diet compliance was regularly monitored. Up to 90% or more of patients showed a complete mucosal response or healing, many within 6 months. However, most patients required up to 2 years for full healing and recovery to take place in the gut.
http://pubs.sciepub.com/articleinpress/ijcd/ijcd-5-1-1.pdf
University of Washington Spinout PvP Biologics has won $35 M to Develop Celiac Disease Therapy
Takeda Pharmaceuticals is providing $35M in research and development funding for a Phase I trial for an enzyme, KumaMax that targets parts of gluten that cause the autoimmune reaction that leads to Celiac Disease. The hope is the enzyme will break down gliadin, the protein in gluten. Research will be done in Seattle.
http://www.bizjournals.com/seattle/blog/health-care-inc/2017/01/uw-spinout-wins-35m-deal-to-develop-therapy-for.html
Seeking a New Normality: Masculinity, Interaction and a Gluten Free Diet
A study from researchers in Sweden and the UK looked at the social experience of young men with screening-detected celiac disease and to highlight daily life situations five years after diagnosis.
The analysis also showed that the young men’s daily experiences of living with celiac disease largely depended on their use of characteristics known to be associated with masculinity: such as being self-assured, demanding, and behaving authoritatively. In food situations, where the young men had the ability to make use of such characteristics in their informal group, they experienced fewer negative aspects of the disease.
If the young men did not hold a strong position in their informal group, their situation was insecure and vulnerable and this could lead to avoidance of contacts and social meal situations.
So, basically, being relaxed and socially confident about eating gluten-free helps to ensure success with the diet.
International Journal of Celiac Disease Vol. 4, No. 4, 2016, pp 138-145. doi: 10.12691/ijcd-4-4-7 | Original Article http://pubs.sciepub.com/ijcd/4/4/7/index.html
Study Compared the Effects of Gluten Reduced Beers
A study conducted by the Gluten Intolerance Group in conjunction with the University of Chicago Celiac Disease Centre found that gluten removed beers caused a reaction in those who had been diagnosed with Celiac Disease.
Both gluten-free and gluten-removed beers have entered the marketplace recently. Gluten-free beer is made using grains that naturally do not contain gluten, such as sorghum or brown rice, in the fermentation process. Gluten-removed beer is made with wheat, barley or rye, and it then undergoes a process for the gluten to be removed.
The study used blood samples from individuals with celiac disease to see whether the proteins in gluten-free beer and gluten-removed beer were recognized by antibodies that were already present in the blood. It was found that no blood samples reacted to the gluten-free beer. However, a percentage of blood samples DID react to the gluten-removed beer. The study was done as a proof of concept of the methodology and further study will be required to understand better the possible risk of gluten-removed products.
https://www.gluten.org/branchnews/gigbeerstudy/
A Growing Trend: Diet Common Even Among Those Without Celiac Disease
William F. Balistreri, MD is professor of pediatric medicine at the University of Cincinnati and Cincinnati Children's Hospital. He and Dr. Alessio Fasano, Gastroenterologist Harvard Medical School and Dr. Ivor Hill, Gastroenterologist, Ohio State University College of Medicine, Columbus gave a panel discussion on Skype, November 2, 2016. Research indicates that 20% of individuals are following a gluten-free diet. This is significantly more than the approximately 1% who have medical needs to follow the diet as they have Celiac Disease. Those with gluten sensitivity also have issues with gluten, but research in this area is limited. The doctors agreed that if someone decides to be gluten-free, you should first make sure you have excluded celiac disease; that they are aware of the downsides, in terms of both cost and micronutrient deficiency; and that they are truly responding to gluten removal and not something else, like FODMAPS or other food sensitivities. http://www.medscape.com/viewarticle/870954?src=wnl_edit_tpal
Celiac Disease More Common in Patients With IBS Symptoms, Study Confirms
Researchers looked at 36 studies including more than 15,000 people, 61% of whom met IBS criteria. Twenty-two of the studies were new. All of the studies had recruited patients based on IBS symptoms, and tested them for CD using IgA-class antigliadin antibodies (AGA), endomysial antibodies (EMA), tissue transglutaminase antibodies (tTG) or duodenal biopsies performed after positive serology.
The odds ratio for a positive CD test among people with IBS were 3.21 based on IgA AGAs; 2.75 for EMA and/or tTG; and 4.48 for duodenal biopsy. The findings were consistent for patients with constipation, diarrhea, and mixed-stool pattern IBS.
The pooled prevalence of biopsy-proven CD among the patients with IBS-type symptoms was 3.3%.
Overall, prevalence of positive celiac serology and biopsy-proven CD was significantly higher in subjects with symptoms suggestive of IBS vs. healthy controls. However, the utility of screening for CD in individuals with suspected IBS in North America or in the community is less clear. American Journal of Gastroenterology 2016 http://www.nature.com/ajg/journal/vaop/ncurrent/full/ajg2016466a.html
Elderly Onset Celiac Disease
Symptoms of Celiac Disease in the elderly, such as diarrhea and weight loss, may be scarce, however, CD has been increasingly recognized in the elderly. Other symptoms in the elderly age group include iron deficiency anemia (often refractory to oral iron), autoimmune disorders, bone disease due to osteopenia, including fractures, malignant intestinal disease, especially lymphoma, and finally idiopathic dilated cardiomyopathy. Diagnosis may be delayed due to limited symptoms, a low clinical suspicion, or diagnostic difficulties related to important cognitive impairment that often affects elderly people. Although for these patients, the GFD is the key of clinical management, elderly patients may not adhere to diet.
Patients should be referred to specialists to ensure the better management of the disease and related complications. Micronutrients, such as iron, calcium, vitamin D supplementation, and vitamins, should be part of a modified GFD for the elderly patients. All other therapeutic interventions that limit malabsorption and avoid complications should be considered part of a management strategy. Clinical Medical Insights Gastroenterology, published online July 25, 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4965017/
Could the amount of gluten matter more than breast-feeding or the timing of the introduction of gluten as a trigger for celiac disease?
A study at Sweden’s Lund University, indicated that Swedish children who reported consuming more than 5 grams of gluten per day up to the age of two years had twice the risk of developing celiac disease compared to children who consumed a smaller amount, while children with celiac disease reported eating more gluten during that period. The risk of developing the autoimmunity which gives rise to celiac disease was highest in Sweden compared to Finland, Germany and USA, which were also studied. There was no apparent connection between the duration of the period of breast-feeding and the risk of developing celiac disease. www.celiac.com
Common bacteria shows promise for treating celiac disease
A research team, led by researchers at Boston University's Henry M. Golden School of Dental Medicine, wrote, "The aim was to isolate and identify the enzymes and evaluate their potential as novel enzyme therapeutics for CD. We have found that exceptionally high gluten-degrading enzyme activities are naturally associated with bacteria that colonize the oral cavity."
Rothia bacteria, found in human saliva, can break down gluten compounds that cause an exaggerated immune response and that are typically resistant to the digestive enzymes that mammals produce. The team isolated a new class of enzymes -- gluten-degrading enzymes from Rothia mucilaginosa, an oral microbial colonizer -- from Rothia bacteria. The researchers felt that this should be studied further. https://www.sciencedaily.com/releases/2016/09/160906085840.htm
Why Childhood Celiac Disease Should Be Checked With Lab Tests
A group of experts in pediatric CD, including Dr. Butzner who is a member of the CCA Professional Advisory Board, performed a critical review of the available literature in 6 categories associated with CD to develop a set of best practices by using evidence-based data and expert opinion. The 6 categories included the following: bone health, hematologic issues, endocrine problems, liver disease, nutritional issues, and testing. Evidence was assessed by using standardized criteria for evaluating the quality of the data, grade of evidence, and strength of conclusions. Over 600 publications were reviewed, and 172 were chosen for inclusion. The thorough review of the results demonstrated that the quality of the data available was often insufficient to provide unequivocal best practices.
To effectively treat children with the disease, doctors and parents need to be sensitive to the unique problems young patients may face, such as difficulty understanding what’s in their food and drink, peer pressure to eat and drink what their friends do, and a fear of ridicule and being singled out, said study co-author Dr. J. Decker Butzner of the University of Calgary in Canada.
“One main take away is that children can learn to manage their diet,” Butzner said by email. “They need to be involved in grocery shopping, menu planning, restaurant assessment, food ordering and trip organization in regards to a gluten free diet.”
“Second, children need to be periodically assessed by a health care professional for the management of their celiac disease,” Butzner added.
“Celiac disease presentations are highly variable and should be at least considered with many different symptoms, including abdominal pain, failure to thrive/weight loss and diarrhea, constipation, anemia, canker sores, arthritis, tooth enamel defects, distinct rashes, behavioral issues, headaches, delayed puberty and infertility,” stated Dr. Tracy Ediger, who also took part in the study. American Journal of Gastroenterology 2016 http://www.nature.com/ajg/journal/v111/n10/full/ajg2016439a.html
New study links protein in wheat to the inflammation of chronic health conditions
A study conducted in Vienna and published October 17, 2016 identified a protein in wheat that causes inflammation in chronic health conditions such as Multiple Sclerosis, asthma and rheumatoid arthritis and also contributes to non-celiac gluten sensitivity. A family of proteins called amylase-trypsin inhibitors (ATIs). Further to inflaming chronic health conditions outside of the bowel, ATIs may contribute to the development on non-coeliac gluten sensitivity. Further study is required. https://www.eurekalert.org/pub_releases/2016-10/sh-nsl101016.php
Fecal Test Shows Gluten-Free Compliance in Celiac Disease
Almost a third of celiac disease patients purportedly on a gluten-free diet showed gluten immunogenic peptides (GIP) in their stools, according to Spanish and U.S. researchers. Gastroenterologist Dr. Peter S. Liang, who was not involved in the research, told Reuters Health by email, "This study suggests fecal gluten peptides are more sensitive than either serology or food questionnaires at detecting gluten consumption and therefore may be a valuable addition to our non-invasive diagnostic tests. In future studies, it would interesting to know how closely fecal gluten peptide measurement correlates with gold standard small bowel biopsies." 30% of patients had detectable GIP’s in their stool samples. This study indicates that celiac patients are either intentionally or unintentionally getting gluten in their diet. http://www.medscape.com/viewarticle/869914?src=wnl_edit_tpal
Factors that Increase Risk of Celiac Disease Autoimmunity Following a Gastrointestinal Infection in Early Life
A study of 6,327 children in the US and Europe with the HLA DQ2 and HLA DQ8 genes found the following associations between gastrointestinal infection and celiac disease. GI infection increased the risk of celiac disease autoimmunity within the following 3 months of the infection by 33%. This risk increased 2-fold among children born in winter and introduced to gluten before 6 months, and increased 10-fold among children without HLA-DQ2 alleles and breastfed for less than 4 months. Risk of celiac disease autoimmunity was reduced in children vaccinated against rotavirus and introduced to gluten before 6 months. Clinical Gastroenterology and Hepatology 2016 Nov 10 https://www.ncbi.nlm.nih.gov/pubmed/27840181
Plant enzymes could help celiacs digest gluten, says U of C researcher, CBC News by Tricia Lo, August 8, 2016
University of Calgary researchers, have made a breakthrough that could help celiac patients digest gluten with the help of an enzyme from bug-eating pitcher plants. These plants have "disposable stomachs" that are filled with an enzyme-rich liquid that helps them digest insect prey. The lead researcher is David Schriemer says that celiac patients may be able to take the extract like “beano”. Full study is included in Nature at http://www.nature.com/articles/srep30980
Non Celiac Gluten Sensitivity is Real
Researchers including Dr. Peter Green found that there is a state of systemic immune activation in conjunction with a compromised intestinal epithelium affecting a subset of individuals who experience sensitivity to wheat in the absence of coeliac disease. In other words, NCGS is not all in their head. Much more research is required in this area.
Non-Celiac Wheat Sensitivity is Official https://celiac.org/blog/2016/08/non-celiac-wheat-sensitivity-is-official
Jury Still Out on Celiac Disease Screening, U.S. Doctors Say
There is not enough evidence to propose widespread screening for Celiac Disease. Guidelines do recommend screening for those with a close relative with celiac disease stated Dr. Joseph Murray, Mayo Clinic, as they are at increased risk for the disease.
http://www.medscape.com/viewarticle/862838?src=wnl_edit_tpal
Neurological Dysfunction in Coeliac Disease and Non-coeliac Gluten Sensitivity
562 patients were studied: 228 or 41% had enteropathy (CD) and 59% did not (NCGS). The severity of ataxia did not differ between the two groups, although those with CD had more severe neuropathy. All patients responded to a GF diet. tTG antibodies were similar in the two groups. The researchers concluded that both groups had similar neurological issues and that there is currently a risk that if diagnosed with NCGS, the neurological issues will not be dealt with. American Journal of Gastroenteroly 2016;111(4):561-567.
Honeycomb app can be customized to user’s allergies, likes and dislikes
A Vancouver Sun article talks about a local business that has developed an application on honeycomb.ai that will enable you to find restaurant menu items that will meet your allergy or in our case gluten-free needs. It is currently in Beta testing and enables you to pick by price, location and your specific needs if you have registered. There is no cost to the user as money is made from the restaurants.
http://vancouversun.com/business/local-business/food-allergy-sensitivity-new-app-from-vancouver-developers-will-help-you-navigate-restaurant-menus
Early recognition of celiac disease through community pharmacies: a proof of concept study
Fifteen pharmacies in UK had pharmacists administer a test for celiac disease, when customers brought forward common celiac disease symptoms. Of 554 administered the test 9.4% had CD. The study concluded that pharmacies could effectively either refer patients for testing, or be a site for testing for CD. International Journal of Clinical Pharmacology, 2016 Aug 8.Duodenal Bacteria from Celiac Patients Has Distinct Impact on Gluten Breakdown and Immunogenicity
Duodenal Bacteria from Celiac Patients Has Distinct Impact on Gluten Breakdown and Immunogenicity
A research team from around the world, including Canada’s Farncombe Digestive Family Centre and McMaster University, studied gluten metabolism by opportunistic pathogens and commensal duodenal bacteria, and to characterize the ability of the resulting peptides to activate gluten-specific T-cells from celiac patients. They colonized germ-free mice with bacteria isolated from the small intestine of celiac patients or healthy controls. These mice were selected by their in vitro gluten-degrading capacity. They then measured gliadin levels and proteolytic action in intestinal contents after gluten feeding. They found that the bacterial colonizations created clear gluten degradation patterns in the small intestine of the mice.Pseudomonas aeruginosa (Psa), an opportunistic pathogen from celiac patients, exhibited elastase activity and produced peptides that better translocated the mouse intestinal barrier. Psa-modified gluten peptides activated gluten-specific T-cells from celiac patients. In contrast, Lactobacillus spp. from the duodenum of non-celiac controls degraded gluten peptides produced by human and Psa proteases, reducing their immunogenicity. In other words, the bacteria in the gut of celiac patients impacts their immune response. This microbe-gluten-host interaction may modulate autoimmune risk in genetically susceptible persons and may underlie any connection between celiac disease and microbial imbalance or maladaptation in the digestive tract. http://www.ncbi.nlm.nih.gov/pubmed/27373514
Beyond Celiac has developed some free Back to School Kits
Back to School Toolkit: School prep begins this month, and parents with children on a gluten-free diet have a few extra items on their back to school checklists.
Gluten-Free in College Toolkit: Prepping for college is stressful, but when you throw a gluten-free diet into the mix, things can get intimidating.
These free resources can be found at:
http://www.beyondceliac.org/community/Get-Social/Monthly-Social-Media-Happenings/1377/
Correlation of Type 1 Diabetes and Thyroid and Celiac Disease Autoantibodies in Patients
A study in Saudi Arabia found the prevalence of thyroid and celiac disease autoantibodies among Type 1 diabetic patients was high. There was no correlation between the age of Type 1 diabetes diagnosis and the level of autoantibodies. Saudi Medical Journal 16 Apr, 37 (4): pages 386 – 391.
Diagnosis of Celiac Disease
The authors of this study reviewed over 7,000 prior studies on PubMed, Embase, Cochrane Library and the web of science and found that the tTG IgA tests have excellent sensitivity and excellent specificity is found in the tTG IgA and EmA IgA tests. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Jan. Report No.: 15(16)-EHC032-EF. AHRQ Comparative Effectiveness Reviews.
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Presenting Pattern of Pediatric Celiac Disease
A review of 165 patient charts of children newly diagnosed as having CD in western New York, they found that patients presented most frequently with abdominal pain and constipation and were older at the time of diagnosis than those described in the classical presentation of CD (gastrointestinal issues, diarrhea, and fatigue). They speculate that these patients may have a different long-term natural history and risk factors than originally described for patients with CD. Journal of Pediatric Gastroenterology Nutrition. 2016 January Pages 60-3.
Pathogenic Role of Gut Microbiota in Gastrointestinal Diseases
The gut microbiota is responsible for immune and metabolic functions. When this microbiota is out of balance, a condition called dysbiosis, gastrointestinal issues result that can lead to irritable bowel syndrome, celiac disease, inflammatory bowel disease and other inflammatory gastrointestinal issues. This study is looking at how genetics, diet, stress and medications can influence the gut bacteria. PubMed Commons Intestinal Research, 2016 April 14(2):127-38.
The Decreasing Prevalence of Severe Villous Atrophy in Dermatitis Herpetiformis: A 45-Year Experience in 393 Patients
This study looked at patients with Dermatitis Herpetiformis (DH), which is a manifestation of celiac disease presenting with itchy blistering rash and pathognomonic IgA deposits in the skin, and the degree of mucousal damage that these patients had. Prominent gastrointestinal symptoms are rare, and small-bowel findings range from severe villous atrophy (SVA) and partial villous atrophy (PVA) to normal mucosa with inflammatory changes. http://www.ncbi.nlm.nih.gov/pubmed/27136959
Is it gluten-free? Relationship between self-reported gluten-free diet adherence and knowledge of gluten content of foods
Patients are often unable to identify what food is gluten-free and which is not. Therefore, self-report measures do not account for the possibility of unintentional gluten ingestion and overestimate gluten-free diet adherence. The role of patient advocacy groups and education to improve outcomes through improved adherence to a GFD requires further research. Nutrition February 13, 2016.
Development of a Risk Score for Extra-intestinal Manifestations of Celiac Disease
This Australian study reviewed 301 patients who had symptoms other than the classic symptoms of gastrointestinal issues. They identified other symptoms that increased the risk of having celiac disease. These include a family history of CD, the presence of another autoimmune disorder, anemia, lactose intolerance, and depression. A risk score was developed (Celiac Risk COMPARE) which scores individuals based on the presence or absence of these additional symptoms and provides an additional screening tool when assessing whether the patient requires follow-up testing for CD.
http://www.ncbi.nlm.nih.gov/pubmed/27082568
Study Links Early Childhood Infections to Celiac Disease
A study in Norway of 73,000 children found that those who had 10 or more respiratory or gastrointestinal infections in the first 18 months of life were 30% more likely to develop celiac disease than those with only 5 or few infections. The study however did not discuss a cause and effect however. It could be that those with more infections were more actively involved in the health care system and were therefore more likely to be diagnosed. More research is required in this area.
Features of children with positive celiac serology and type 1 diabetes mellitus
A study from the Japan Pediatric Society, identified 294 children who had celiac disease. Of these, 21 of had diagnosed type 1 diabetes mellitus. It was found that diabetic children were more likely to have absence of gastrointestinal symptoms and more likely to have reflux issues compared to children who had just celiac disease. Pediatrics International Journal 2015 Oct
Low bone mineral density in Brazilian patients at diagnosis of Celiac Disease
Low bone mineral density is considered an extra-intestinal manifestation of celiac disease with reduced bone mass, increased bone fragility, and risk of fractures. Celiac disease is considered a condition at high risk for secondary osteoporosis and the evaluation of bone density is very important in the clinical management of these patients. A study in Brazil found that 69% of Brazilian patients with celiac disease at diagnosis had low bone mineral density, being more frequent in women older than 50 years. Arq Gastroenterol 2015 Jul-Sep
Cesarean Section (CS) and Diseases associated with Immune Function
A total of 750,569 children aged 0 to 14 years were included in the study. Children delivered by both acute and elective CS had an increased risk of asthma, laryngitis, and gastroenteritis. Children delivered by acute CS had an increased risk of ulcerative colitis and celiac disease, whereas children delivered by elective CS had an increased risk of lower respiratory tract infection and juvenile idiopathic arthritis. The effect of elective CS was higher than the effect of acute CS on the risk of asthma. Journal of Clinical Immunology 2015 Sep 11
Exploring the Strange New World of Non-Celiac Gluten Sensitivity
Dr. Daniel Leffler, who will speak at the CCA National Conference and Dr. Benjamin Lebwohl completed a study regarding Non-Celiac Gluten Sensitivity (NCGS) that really did not provide any conclusive results.
It seems only to contribute to the uncertainty about NCGS. But from these results and those of previous trials, it is reasonable to draw several conclusions. First, NCGS is distinct from IBS in that extraintestinal symptoms are prominent and respond to dietary modification, unlike the extra intestinal symptoms that can be seen in IBS. Indeed, half of the individual clinical components that worsened with gluten compared with placebo (aphthous stomatitis, depression, and foggy mind) related to non-intestinal symptoms, and this is certainly compatible with symptoms reported by NCGS patients in clinical practice. Second, there are no proven biomarkers for NCGS at this time, and studies focused on these have had, at best, conflicting results. "If nothing else, NCGS is a complex entity and will not give up its secrets easily. As such, studies with more limited but focused aims are likely to be more effective in providing important incremental knowledge."
Asymptomatic Children Might Not Need Biopsy for Celiac Diagnosis
Doctors might not need a biopsy to accurately diagnose celiac disease in children with no symptoms who have elevated anti-tTG, according to the latest study out of Italy. Among 196 patients with anti-tTG antibodies at least 10 times the standards, 156 had symptoms and 40 were asymptomatic. More than 90% of the symptomatic children (142/156, 91%) showed severe lesion degree on biopsy, and an even higher percentage of asymptomatic patients (37/40, 92.5%) had severe lesions. Among the EMA positive children with lower titers of anti-tTG antibodies, 70% of symptomatic children and 81% of asymptomatic children showed severe lesions. This is current research and of course it will take some time for these to filter down to our Canadian standards for care.
Mommy, I have a tummy ache!
Dr. Rodney Ford is Pediatric Gastroenterologist in New Zealand and has written seven books about gluten related issues. He feels that children's tummy aches should never be ignored. These children need help and understanding for their symptoms. Some of these children have unrecognized gastric reflux symptoms; some have celiac disease; some have Helicobacter pylori infection; some have chronic constipation; some have food intolerances; and many have gluten sensitivity/ intolerance. "Please don't just ignore them-please test and treat them! Please do not dismiss what your child is telling you: you may be able to help them. They might have a gluten-related disorder. They are not "attention seeking" they are in actual pain." Journal of Gluten Sensitivity, Autumn 2015 Issue
Are Industrial Food Additives to Blame for Soaring Rates of Autoimmune Disease?
Numerous common industrial food additives increase tight junction leakage. These include glucose, salt, emulsifiers, organic solvents, gluten, microbial transglutaminase, and nanoparticles, widely and increasingly used in industrial food production.
Researchers from Israel and Germany are calling for additional research on the connections between food additives exposure, intestinal permeability, and autoimmunity interplay to expand our knowledge of the common mechanisms associated with autoimmune progression.
Have Researchers Finally Nailed Down Non-celiac Gluten Sensitivity?
The study, from Giovanni Barbara and his team at the University of Bologna, Italy, suggests that inflammation in gluten-sensitive individuals may result from high levels of a molecule called zonulin.
Zonulin has been linked to inflammation, and people with celiac disease have been shown to have high levels of zonulin when consuming wheat protein. Symptoms include abdominal pain, bloating, alternating diarrhea or constipation. And there can be other symptoms, including "brain fog," headache, fatigue and joint and muscle pain.
Iron deficiency anemia in newly diagnosed celiac disease in children
Of all patients diagnosed with Celiac Disease in the study, 30.1% had anemia. This significant relation existing between CD and iron deficiency should be considered by pediatricians at the diagnosis of CD in order to treat the patients. Minerva Pediatrics: 2016 Feb.
Neurological Dysfunction in Coeliac Disease and Non-Coeliac Gluten Sensitivity
In a study done in the UK, the most common neurological manifestations of patients with either CD or NCGS were cerebellar ataxia, peripheral neuropathy, and encephalopathy. The neurological manifestations of CD and NCGS are similar and equally responsive to a gluten-free diet suggestive of common pathophysiological mechanisms. American Journal of Gastroenterology: 2016 Feb
Neurological Symptoms of Celiac Disease, July 29, 2015
The 2015 International Celiac Disease Symposium (ICDS) in Prague, reported that those with neurological dysfunction have a greater problem ingesting gluten. A UK study of newly diagnosed celiac patients showed 61% had neurological problems including headaches, balance issues and sensory problems. Gluten ataxia is having significant problems with balance and 18% of all ataxias are thought to be caused by gluten. Dr. Hadjivassiliou said that ataxia improved within 1 year of going on a gluten-free diet. Poor adherence to the gluten-free diet increase the on-going chance of ataxia as well as vascular dementia.
Developing Childhood Celiac Disease - Dr. Daniel Leffler, Digestive Disease Week, Washington, DC
Celiac Disease, it was thought, should be preventable by modifying childhood behaviours: timing of gluten exposure and breastfeeding. In fact, this has been found not to be the case. The most important thing is the child’s genes. Double HLA DQ2 genes is the worst scenario and greatly increases the chances of developing CD. Dr. Leffler supports genetic testing of children in families that have Celiac Disease to better understand the risk of the child developing the disease.
How to Get Enough Grains in a Gluten-Free Diet – Dr. Michael Picco MD
Good gluten-free grains include brown or wild rice, quinoa, amaranth, pure buckwheat, flax, whole corn, millet, gluten-free oats, sorghum and teff. Grain products that are not gluten-free include any type of wheat (including farina, graham flour, semolina and durum), barley, rye, bulgur, Kamut, kasha, matzo meal, spelt, triticale, couscous, emmer and einkorn. Source: Mayo Clinic
Foods Most Likely to Cause You a Problem
It is extremely important to read labels and be aware when eating these foods as hidden gluten may be a problem: soy sauce, cream-based soups, ice cream, “wheat-free” products (does not mean they are gluten-free), beer, prescription medications, gourmet meats and deli meats especially when they are not prepackaged (cut meats may be contaminated by the cutting machine), restaurant meals (ensure hamburger patties do not have added gluten, cross-contamination issues, sauces), and meals with friends and families (although they may be as careful as possible, the kitchen is not gluten-free). Source: Mayo Clinic
Hidden Sources of Gluten – links provided by Dr. Tom O’Bryan
From Celiac.com:
From Today's Dietician:
From Web MD:
From UDIS:
From Everyday Health:
Celiac Disease Screening Important for Kids Presenting for Rheumatology Evaluation
A team of researchers at the Division of Pediatric Rheumatology, New York Mount Sinai Medical Centre, found that children presenting with rheumatology issues had double the risk of having celiac disease (2%) as the general population. This was a 6.5 year study of 2,125 children whose most common symptoms report with celiac disease were myalgias, arthralgias, and skin rash. Their symptoms were notably different than the “classic celiac disease” symptoms.
Tiny Particles a Big Breakthrough on Celiac Cure
Cour Pharmaceutical Development Company has announced "a significant breakthrough in celiac treatment [that] has the potential to cure celiac patients rather than relying on gluten avoidance, immune suppressive regimens or dietary supplements," according to a company press release. They use antigen specific nano-particles, Toleragenic Immune Modifying nanoParticles (TIMP) that is fed intravenously to the patient. Cour presented at the 2015 ICDS. While there have been other claims made about potential cures, this is the first animal model demonstration of a treatment that effectively cures celiac disease. If these results hold up to scrutiny, and if successful treatments can be developed, this approach has tremendous potential to benefit numerous people with celiac disease. Caution is these trials are costly and take significant time. Source: PRNewswire
Lymphocytic Gastritis Strongly Associated with Celiac Disease
Dr. Peter Green and a team of researchers from the Columbia University, Celiac Disease Centre, studied 287,503 patients and found that lymphocytic gastritis (deals with the immune system) is strongly associated with celiac disease, with increasing prevalence correlating with more advanced villous atrophy. Chronic active gastritis and chronic inactive gastritis are also significantly associated with celiac disease. Source: Alimentary Pharmacology & Therapeutics Volume 42, Issue 2, pages 180–187, July 2015. DOI: 10.1111/apt.13249
Diagnosing and Treating Exocrine Pancreatic Insufficiency (EPI) in Patients with Celiac
New research concludes that the association between EPI, Exocrine Pancreatic Insufficiency is strong enough that any celiac patient suffering from gastric distress despite adherence to a gluten-free diet should be tested for EPI. Source: HCPlive
Celiac Urine Test May Offer Way to Detect Being Glutened
A presentation at the ICDS Symposium in Prague indicated that gluten immunogenic peptides (GIP) in urine may indicate a person has being glutened. Noting that the intestinal health of the vast majority (80 percent) of those without detectable GIPs was far better than those with detectable levels, researchers say there is a strong correlation between GIP levels in urine and damage to the gut.
General Mills is Under Attack for their Methods of Producing Gluten-Free Cereals
General Mills is under attack regarding the potential of cross-contamination in their gluten-free cereals. Gluten Free Watchdog's concerns include the reliability of testing analysis done by General Mills. General Mills currently use a sampling method to test the cereal and check that gluten is 20 parts per million (ppm) or less, but Gluten Free Watchdog claims this method can result in uneven results, and that some batches of cereal may actually contain more than the allowed 20 ppm of gluten, although they haven't offered any solid examples that support their theory.
To their credit, General Mills seems to be honestly engaged in the discussion, and has signaled an openness to sourcing pure gluten-free oats, which would address the concerns of groups like Gluten Free Watchdog. Source: Celiac.com 09/07/2015
Specific Non-gluten Proteins of Wheat Are Antigens in Celiac Disease Humoral Response
While the immunologic reactivity to gluten in celiac disease have been extensively researched, the immune response to non-gluten proteins of wheat has not been reviewed. This study investigated the level and molecular specificity of antibody response to wheat non-gluten proteins in celiac disease. Serum samples from patients and controls were screened for IgG and IgA antibody reactivity to a non-gluten protein extract from the wheat cultivar Triticum aestivum Butte 86. Antibodies were further analyzed for reactivity to specific non-gluten proteins. Compared with healthy controls, patients exhibited significantly higher levels of antibody reactivity to non-gluten proteins. The main immune-reactive non-gluten antibody target proteins were identified: serpins, purinins, α-amylase/protease inhibitors, globulins, and farinins. The results demonstrate that, in addition to the well-recognized immune reaction to gluten, celiac disease is associated with a robust humoral response directed at a specific subset of the non-gluten proteins of wheat. http://pubs.acs.org/doi/abs/10.1021/pr500809b, Journal of Protiome Research, October 20, 2014, pg 503-511
Conditions Fennel Seeds Can Help Relieve
Daily doses of 5 to 7 grams of fennel seeds are packed with vitamins B and vitamin C. They can help alleviate pain from gastric indigestion, bloating and gas; given they are high fibre, they can help prevent against cancers; they are good for your skin and provide protection against bone loss. http://www.medicaldaily.com/what-fennel-good-6-conditions-it-can-help-relieve-330946
Mucosal Recovery and Mortality in Adults with Celiac Disease After Treatment With a Gluten-free Diet
Dr. Joseph Murray and a team of researchers in the American Journal of Gastroenterology reported that mucosal recovery was absent in a substantial portion of adults with Celiac Disease after treatment with a gluten-free diet. Mucosal recovery was measured by the depth of the villi in the small intestine. There was a borderline significant association between confirmed mucosal recovery (vs. persistent damage) and reduced mortality independent of age and gender. For those who achieved mucosal recovery, the number of patients with good, moderate, and poor compliance to gluten-free diet was 75%, 20%, and 4%, respectively. In comparison, patients with persistent mucosal damage at first follow-up biopsy were significantly less compliant to the gluten-free diet. With good, moderate, and poor compliance of 61%, 21%, and 18%, respectively.
A novel finding of this study is the fact that persons with mucosal recovery after treatment with a gluten-free diet may have a clinically relevant lower risk of all-cause mortality than do patients with persistent mucosal damage. As a result, compliance to the gluten-free diet is imperative and systematic follow-up with intestinal biopsies may be advisable in patients diagnosed with Celiac Disease as adults. For more information: http://www.medscape.com/viewarticle/734724
Molecular Mimicry as a Mechanism for Food Immune Reactivities and Autoimmunity By Dr. Aristo Vojdani
The mucosal immune system is constantly exposed to challenges from the foreign bodies (antigenic) found in food and released from the body's own microbial flora. The body's normal tolerance to friendly substances can be disrupted by a number of factors, such as disease, injury, shock, trauma, surgery, drugs, blood transfusion, environmental triggers, etc. When this disruption happens, the ingestion of foods containing antigenic substances that have compositions similar to those of the body's autoantigens can result in the production of antibodies that react not only against the food antigens but also the body's own tissues. This response is known as food autoimmune reactivity. Between 7% and 10% of the world's population suffers from some form of autoimmune disease. Each patient's antibodies, both immunoglobulin A (IgA) + immunoglobulin M (IgM) in the saliva and immunoglobulin G (IgG) and IgA in the blood must be examined to give a complete picture of food immune reactivity. A host of health problems and autoimmune disorders have increasingly become associated with some of the most commonly consumed foods in the world, such as wheat and milk. Many of these problems can be traced to molecular mimicry. The peptide sequences of foods such as milk and wheat are similar to those of human molecules, such as myelin oligodendrocyte glycoprotein, human islet cell tissue, and human aquaporin 4 (AQP4). This similarity can result in cross-reactivity that leads to food autoimmunity and even autoimmune disorders, such as multiple sclerosis (MS), celiac disease (CD), and neuromyelitis optica. Further research is needed to determine what other foods have dangerous sequence similarities to human tissues and what methods are available to test for the autoantibodies resulting from these molecular, mimicry-induced misfires of the immune system. The identification and removal of corresponding food triggers can then be used as the basis of therapy. Alternative Therapies Health and Medicine. 2015;21 Suppl 1:34-45
Microbiome – The Garden Within
For every cell in the human body, there are about 10 nonhuman cells. These microbial residents of our gut, skin, eyes and nasal passages collectively are referred to as the "microbiome" — and research of its role in human health has revealed enough surprising discoveries that the National Institutes of Health has launched an international Human Microbiome Project. What we eat, parasite, molds and dirt all impact the microbiota and whether we are born naturally or through C-section or whether we drink breast milk on baby formula also impact our gut, which is the largest part of our immune system.
A diet high in fruit, vegetables and perhaps whole grains allows beneficial bacteria to dominate and inhibits the growth of more harmful strains. While researchers haven't reached consensus about what constitutes an optimal microbiome, there is some general advice for tending our microbial gardens: eat plenty of fruits and vegetables; fermented foods; garden herbs including garlic and leeks; focus on fresh; and, take probiotic supplements. http://www.foodandnutrition.org/May-June-2015/Microbiome-The-Garden-Within/
Four Differences Between Celiac Disease and Non-Celiac Gluten Sensitivity (NCGS)
Celiac.com identifies the differences between Celiac Disease and Non-Celiac Gluten Sensitivity:
Dr. Alessio Fasano and a team of researchers, have discovered that the immune response for celiac disease is very different than the response of patients with gluten sensitivity. It is hoped that this breakthrough leads to better diagnosis of the gluten sensitivity which to date has no diagnostic test. The study included individuals with celiac disease, gluten sensitivity and healthy gluten-tolerant controls. Participants were placed on a 4-month gluten challenge, then underwent serological screening for celiac disease, HLA DQ2/DQ8 typing and an upper endoscopy including duodenal biopsy. According to the results, individuals with gluten sensitivity showed no signs of intestinal damage or increased permeability, but showed an increase in an immune marker that is different than the adaptive immune response seen in celiac disease. Further research is needed to get a better understanding of these differences and how they could affect diagnosis of the conditions. To learn more, read the study in BMC Medicine
Israeli Researchers Propose Link Between Gluten Sensitivity and ALS
The association of celiac disease and neurological disorder have been well documented, however, Israeli researchers are cautiously stating that there is a link between gluten sensitivity and ALS. Lou Gehrig’s disease is a progressive disease that attacks nerve pathways and the links of nerves in the brain and spinal cord, eventually causing paralysis. The team tested fifty patients and 20 controls for celiac disease-specific HLA antigen alleles; 59.1% of TG6 IgA positive individuals tested positive for celiac disease-related alleles compared with 28.6% of the 28 negative individuals. Nearly 46% of patients with CD product antibodies to TG6 (tissue transglutaminase) even when they have no neurological symptoms. They warned that is very early research and ALS patients should not undertake a gluten free diet unless a tTG indicates that there are antibodies. Further research is required, but this study did find a linkage. JAMA Neurol. 2015 Apr 13. doi: 10.1001/jamaneurol.2015.48.
Licensing of the Pocket Dictionary...
The CCA Board of Directors licensed the Pocket Dictionary to the developers of Glutenfree247. The application runs on iPhone, iPad and iPod Touch devices and is now available for purchase from the iTunes Store. For more details, visit www.glutenfree247.ca
Celiac and wheat allergy affect the body differently
"Celiac disease and wheat allergy both involve the immune system but the reaction within the body is different. Celiac disease is an autoimmune disease that causes damage to the lining of the intestine. It is a lifelong disorder. Symptoms of wheat allergy include a skin rash, wheezing, abdominal pain, or diarrhea. Wheat allergy is often outgrown." -- WebMD for a slide show on Celiac Disease.
Persistent symptoms in some celiac patients tied to altered microbiota
Celiac disease patients who followed a gluten-free diet long term but still had gastrointestinal symptoms showed abnormal intestinal microbiota, researchers from Finland reported in the American Journal of Gastroenterology. The study included celiac disease patients who had normalized small bowel mucosa and negative celiac autoantibodies, and had followed a gluten-free diet for several years. Healio (free registration)/Gastroenterology (11/19/2014)
Study: Many celiac disease patients have non-traditional symptoms
Patients less frequently exhibit the classical celiac disease symptom of diarrhea when newly diagnosed with the disease. In a 15 year study by an Italian research study, they found that traditional symptoms like diarrhea decreased from 47% in the first 10 years of a study to 13% in the final five years. The study found many patients reported non-traditional symptoms, such as bloating, osteoporosis and anemia. Reuters (11/26)
Some heartburn drugs may change gut bacteria, raise infection risk
Researchers said that proton pump inhibitors that treat heartburn may change the bacterial makeup of the digestive system. The study does not show cause and effect, but it does suggest that heartburn drugs may create a “gut microbial environment” that increases the risk of infection said the study co-author John DiBaise of the Mayo Clinic in Scottsdale, Ariz. HealthDay News (11/25)
In the USA Over 20% of Foods Labeled "Gluten-free" Could Contain Too Much Gluten
Breakfast cereal was found to be the main culprit in a USA study which tested products that were labelled “gluten-free”: five of eight breakfast cereal samples showing gluten contents above 20ppm (20 mg/kg). Celiac News 12/05/2014
Is Oat Flour Gluten Free
While this report is out of the USA where oats ARE allowed in the gluten free diet, Tricia Thompson who has recently been doing a study on all things oats has just put out this post specifically on Oat Fiber (aka Oat Hull Fiber): Gluten Free Watchdog Feb 20, 2015
Celiac Disease in Children
In this article, Dr. Ed Hoffenberg, MD talks about the differences seen in children with Celiac Disease at different ages. It is unknown why some children develop celiac disease early in life and others later in life. Symptoms also vary between children from within minutes of ingestion of gluten, to delayed symptoms lasting sometimes as long as two weeks. With severe symptoms children are most likely to be diagnosed: failure to thrive, weight loss and vomiting. Infants and toddlers can suffer from malnutrition which results in low growth in height and/or weight. The tTG test is not accurate in children under 3 years of age and any child with symptoms under this age should be seen by a pediatric gastroenterologist.
School age children usually do not vomit, but have other gastrointestinal issues like stomach aches, bloating, diarrhea or constipation. Inability to either gain or lose weight should signal a test for celiac disease.
Teens with celiac disease often exhibit “atypical” symptoms. Mood disorders, depression and panic attacks may arise. Lethargy, fatigue, headaches, skin conditions (DH), stunted growth and delayed puberty are some of the possible symptoms.
Children may also have no or mild symptoms and testing should be considered if they have other related conditions: Type 1 diabetes, a relative with the disease, juvenile arthritis, a thyroid condition, IgA deficiency to name a few. Anemia, weak dental enamel, elevated liver enzymes or osteopenia are all signals that celiac disease should be tested for.
https://celiac.org/live-gluten-free/lifestyle/for-parents-and-children/22783-2/?bblinkid=24443625&bbemailid=1910934&bbejrid=129664823
Is there gluten in your over the counter medications?
This is not new research, but I like to let people know of the only site I have found that provides a listing of over the counter gluten-free drugs. This is a US site. It is run by a pharmacist who is also developing a new list of drugs indicating whether there are corn, lactose, potato and soy in the drugs, in addition to their gluten-free status. The site is www.glutenfreedrugs.com
Gluten-Free Diet Does Not Repair Intestinal Damage in Some Children With Celiac Disease
Medical records of 102 children diagnosed with celiac disease were reviewed. After a year, despite excellent adherence to a gluten-free diet for most (91%) patients, 43% experienced persistent symptoms, 27% had new gastrointestinal symptoms, and 34% had persistently elevated serology at the time of repeat endoscopy and biopsy. Only 33% of the patients were asymptomatic at the time of repeat endoscopy. Overall, 19% of patients showed persistent enteropathy consistent with a Marsh 3 lesion at the repeat endoscopy. The findings demonstrate that neither the presence of symptoms nor a positive tTG result was a reliable measure of mucosal recovery in the study population. For example, tTG was elevated in 43% of patients with persistent enteropathy and in 32% of those with mucosal healing. In contrast, 84% of patients with mucosal recovery on repeat biopsy were symptomatic at the time of the repeat endoscopy, as were 55% with persistent enteropathy. Further research is required in this area. The study included Dr. Alessio Fasano, a well-known gastroenterologist and researcher and Dr. Jocelyn Silvester, who has been funded by the Canadian Celiac Association in the past. Published on line, November 3, 2016 Journal of Pediatric Gastroenterology and Nutrition, February 2017 - Volume 64 - Issue 2 - p 286–291.
New List Created by Experts May Help Prevent Food Gluten Cross-Contamination
The newly created food services checklist was compiled after an extensive literature review, input from 11 different experts with PhDs and experience with food services and/or gluten and celiac issues, along with documents from various organizations such as the Gluten-Free Certification Program from the Canadian Celiac Association.
The final checklist consists of 88 items divided into 12 sections, which cover everything from building and facilities maintenance, cleaning and ventilation, to employee clothing and hygiene, to food production and transport. The list was published in the journal Nutrients.
http://www.cantechletter.com/2017/01/new-tools-may-prevent-gluten-cross-contamination-food-services-industry/
Celiac Disease Patients Have a Higher Risk of Pneumonia
One study, conducted in the United Kingdom, provides the most comprehensive look at the issue. The study tracked 9,803 people with celiac disease, along with 101,755 people who didn't have the condition for comparison purposes.
The study, which spanned 15 years, included all age groups.
Overall, the researchers identified 179 cases of pneumonia among those who had celiac disease, compared to 1,864 cases in those people who didn't have celiac. That works out to similar odds for those with celiac to catch pneumonia, when compared with those who didn't have the condition.
However, the researchers also identified a 28 percent increased risk of pneumonia in people younger than age 65 who had celiac disease and who had not been vaccinated for pneumonia. This increased risk was highest around the time of diagnosis—at that time, the risk was twice as high for any type of infectious pneumonia and four times as high for pneumococcal pneumonia, the researchers said. However, the risk remained elevated for more than five years following that celiac disease diagnosis.
The study concludes: "Unvaccinated patients with coeliac disease under the age of 65 have an excess risk of community-acquired pneumonia that was not found in vaccinated patients with coeliac disease. As only a minority of patients with coeliac disease are being vaccinated, there is a missed opportunity to intervene to protect these patients from pneumonia." http://www.mdmag.com/medical-news/doctors-suggest-celiac-disease-patients-get-pneumonia-vaccine
Celiac Disease Patients Pay a Higher Economic Burden
“This study highlights the additional healthcare resource use and costs associated with celiac disease on top of gluten-free-diet costs,” said Stefano Guandalini, M.D., founder and medical director of the University of Chicago Celiac Disease Center. “It focuses on the costs borne by insurers, as well as the medical burden of celiac disease for patients.” The study looked at the medical records of 18M patients in the US. They identified 12,187 patients with Celiac Disease and matched them based on age, sex, region, company and employment status. Patients with celiac disease had $12,217 total all-cause direct costs compared with $4,935 in controls (P < .0001). Guandalini S, et al. Abstract 2. Presented at: Digestive Disease Week, May 16-19, 2015; Washington, D.C.
http://www.healio.com/gastroenterology/malabsorption/news/online/%7B46029097-bd42-49b7-8f2c-39bfbd46e18b%7D/celiac-disease-associated-with-significant-economic-burden
Gluten Free Stakeholder 2016 Report
The Session was led and facilitated by the Canadian Celiac Association, the Allergen Control Group Inc, and the Agriculture and Agri-Food Canada. You can read their final report regarding the September 2016 meeting.
http://gfstakeholdersession.com/assets/ALLERGEN_STAKEHOLDER_SESSIONS_REPORT_.pdf
25% of Ataxia Caused by Gluten
A study in the Journal of Neurology, Neurosurgery and Psychiatry found that 25% of ataxia was caused by gluten. A research paper lead by Dr. M Hajivassiliou published in December, 2016 concluded that immune-mediated ataxias are common. Diagnosis of the cause is key to potential therapeutic treatments. Ataxia is a neurological condition consisting of the loss of control of bodily movements. It includes gait abnormality. http://jnnp.bmj.com/content/early/2016/12/13/jnnp-2016-314863
US Labelling of Gluten-Free Foods
The U.S. Food and Drug Administration (FDA) has defined the term “gluten-free” for voluntary use in the labeling of foods. Any food product bearing a gluten-free claim labeled on or after August 5, 2014 must meet the requirements of the agency’s gluten-free labeling rule. With this uniform definition, consumers with celiac disease can choose foods with greater confidence. The standard is no greater than 20 ppm in products that are labelled gluten-free. This brings US labeling closer to Canada’s standards. For detailed information if you are traveling to the US. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Allergens/ucm362880.htm
Celiac Associated Pancreatic Disease
Dr. Hugh Freeman, a gastroenterologist affiliated with the Department of Medicine, University of British Columbia, Vancouver, BC set out to study the prevalence of Type 1 diabetes and Celiac Disease
Prospective studies using an initial screening IgA tissue transglutaminase antibody assay (tTG) were done at UBC and a total of 125 male and 108 female children and adolescents with type 1 diabetes mellitus were evaluated from an established pediatric diabetes clinic. Of these, 15 male and 11 female patients had elevated tTG titers, of whom 19 were also positive for endomysial antibodies. Among these cases, 1 was already known to have celiac disease. Small intestinal biopsies were done in the other 18 children positive for both antibodies.
In this study, over 40% of diabetic children were asymptomatic, yet blood testing facilitated selection for a small intestinal biopsy evaluation. 7.7% of this pediatric group had biopsy results common in celiac disease. Dr. Freeman says that further research in this area is required to determine if these observations can be verified by others. Annals of Gastroenterolgoy, July – September, 2016, published on-line May 20, 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923808/
Wheat Proteins Cause Inflammation Beyond the Gut
This is a study regarding ATI's (amylase-trypsin inhibitors), which are specific proteins found in wheat that has been shown to trigger an immune response in the gut that can spread to other tissues in the body. While ATI's only compromise 4% of the protein in wheat, they have been suggested to exacerbate rheumatoid arthritis, multiple sclerosis, asthma, lupus, non-alcoholic fatty liver disease, IBS and other conditions such as non-celiac gluten sensitivity (NCGS). http://www.medicalnewstoday.com/articles/313514.php
Rituximab Promising for Dermatitis Herpetiformis
Rituximab may be an effective treatment for recalcitrant dermatitis herpetiformis (DH), according to a recent case study.
"DH is an autoimmune blistering disease which is commonly associated with celiac disease and can present with debilitating pruritic blisters on extensor surfaces," explained Dr. Ron Feldman of Emory University School of Medicine.
"The most common treatments are a gluten-free diet along with the addition of dapsone," he told Reuters Health. "For patients who do not typically respond to these therapies, other immune-suppressing medications have been utilized with mixed results."
"This is the first successful case of rituximab therapy used for a recalcitrant case of DH," he said by email. "The patient had resolution of both his pruritus and skin rash. In addition, the levels of both anti-tissue and anti-epidermal transglutaminase antibodies normalized."
The link to this article is below, you do need a login to Medscape to view it. http://www.medscape.com/viewarticle/874098?src=wnl_edit_tpal
A Brazilian research team studied the impacts of adding different percentages of psyllium husk in the making of gluten-free bread. The results showed that the addition of approximately 17% psyllium husk yielded gluten-free bread with structure, appearance, texture, and acceptability like wheat bread, with delayed bread staling during 72 hours of storage. The research team suggests that this approach might yield softer, chewier, better tasting gluten-free breads that stay soft longer.
For more information: Foods 2021, 10(5), 954
Salivary inflammatory biomarkers for the screening of CD
A team of Spanish researchers used the gene expression analysis of celiac inflammatory cytokines to determine if inflammatory gene expression in saliva mirrors the gene expression in intestinal epithelia. They found that the gene expressions between the two areas were highly correlated, and this non-invasive method might be used for the diagnosis of celiac disease.
For more information: https://www.sciencedirect.com/science/article/pii/S2352345X21001107
Monoclonal antibody being investigated as a potential celiac disease treatment
T-cells are triggered by gluten in those who have celiac disease. Monoclonal antibodies, man-made proteins, are being researched by a group of international researchers to see if they can turn off this autoimmune response and halt the development of celiac disease. A biologic, monoclonal antibodies are used in immunotherapy to treat other autoimmune diseases such as rheumatoid arthritis. Nextera, an Oslo-based company is involved in the study. Several monoclonal antibodies have received emergency use in fighting COVID 19. “To be able to treat disease with a drug which only affect the diseased tissue is rarely seen, though of course, it would be optimal outcome of any treatment said Geir Age Loset, PhD CEO of Nextera. The study needs to determine the precise mechanism the antibody uses to stop the t-cell activation.
For more information: https://www.science.org/doi/10.1126/sciimmunol.abg4925
Latiglutenase – CeliacShield Study
ImmunogenX, Inc. acquired the drug in 2016 and recently concluded a Phase 2 gluten-challenge study. The trial showed significant reductions in symptoms versus the placebo group: abdominal pain, bloating, and fatigue. Latiglutenase is a combination of two enzymes that break down gluten in the stomach, rendering it inactive. It is to be used with a gluten-free diet and is a simple flavor package in a drink consumed with meals. Other Phase 2 trials will continue trying to mimic accidental gluten consumption in a normal gluten free diet.
For more information: https://www.beyondceliac.org/research-news/immunogenx-latiglutenase-2021
Larazotide Phase 3 trial is recruiting participants Larazotide is meant for patients with symptoms despite being on a gluten-free diet. It is called the CeDLara Study (CeDLara (CeD-LA-3001). It has been fond to be safe and effective in trials to date.
For more information: www.innovatebiopharma.com/inn-202.html
Medical students and professionals lack knowledge regarding nutritional deficiencies and CD
A Polish study found that over ½ of the 430 professionals and students surveyed were not aware that CD could lead to nutritional deficiencies. They also were not aware of the risk of being obese or over-weight.
For more information: Nutrients 2021, 13(6), 1771
Fungal dysbiosis in children with CD
Mucosal and fecal samples were collected from children with CD and controls. Fungal microbiota communities were analyzed. Although fungal dysbiosis was found in children with CD, more study is needed to determine the role fungi has in CD.
For more information: https://pubmed.ncbi.nlm.nih.gov/33723701/
Atherosclerotic cardiovascular disease (ASCVD) prevalence in CD Patients in the US
A Mayo Clinic study looked at CD patients from 2005 to 2014. Prevalence of ASCVD was calculated in both CD patients and controls and compared by sex and age. Common cardiovascular risk factors were adjusted for. Of 371M patients, 227K adults with CD were matched to 1,133K controls. ASCVD was highest in young celiac disease women compared to controls and had significant risks of mortality, 7.31 times higher in women under 40 than the general population.
For more information: https://pubmed.ncbi.nlm.nih.gov/33673917/
Beyond Celiac – Top 5 Research articles of 2021, December 15 2021
1. Can you trust a negative celiac disease blood test? https://www.beyondceliac.org/research-news/can-you-trust-negative-blood-test Although there is no issue with a positive blood test due to biopsy follow-up, as negative results of the tTG (anti-tissue transglutaminase IgA test) blood tests are never followed up with a biopsy, celiac disease may go undiagnosed in those who have a false negative test. Therefore, if a person has negative blood test but still has symptoms further investigation needs to be tried.
Journal of Clinical Gastroenterology: April 2021 - Volume 55 - Issue 4 - p 327-334 doi: 10.1097/MCG.0000000000001361
2. Monoclonal antibodies are used to treat COVID-19 and other illnesses. Monoclonal antibodies (often called biologics) need to be investigated for celiac disease treatment. PRV-015, from prevention Bio and Amgen, is in Phase 2b clinical trials and an example. Monoclonal antibodies block cytokines which are produced by the immune system. These cytokines create inflammation. Recruitment is still going on for these studies.
3. Celiac disease drug targeting the immune system, Phase 2 trial of TAK-101 shows promise. https://www.beyondceliac.org/research-news/drug-targets-immune-system-shows-promise/ This drug retrains the immune system to tolerate gluten.
4. Neurological and psychological symptoms of celiac disease – Study had 1,500 registrants and used an online survey. They found that 86% of participants experience brain fog. Additionally, over 71% reported migraines and 47% said they experienced peripheral neuropathy. This survey further adds to the growing evidence that celiac disease should also be considered more than just a GI-related disease. https://www.beyondceliac.org/research-news/neuro-symptoms-gobeyondceliac/
5. KAN-101, Phase 1 clinical trial – this drug creates immune tolerance to gluten by targeting liver receptor to “re-educate” the immune system. https://www.beyondceliac.org/research-news/kan101/
Oral spray Budesonide in newly diagnosed CD
A small trial showed no significant effect on mucosal healing in patients treated with Budesonide and concurrently on a gluten-free diet. Healings at 8 weeks in one in four patients was attributed to having less severe villous atrophy at diagnosis.
For more information: https://www.medscape.com/viewarticle/956466
Cancer risk in patients with CD
A Swedish research team reviewed records of 50K celiac patients. 64% were diagnosed with some type of cancer since 2000. The risk rose overall but was most sharply elevated in the first year after diagnosis. The risk of blood, lymph, liver and pancreatic cancers were seen later. Risk levels were highest in ages greater than 60, while those diagnosed before age 40 showed no such increase.
For more information: https://www.celiac.com/articles.html/major-cohort-study-assesses-cancer-risk-in-celiac-disease-r5654
Nutritional deficiencies in adults following a gluten-free diet
A Spanish research team looked at nutritional deficiency of adults following a gluten-free diet. Deficiencies at diagnosis should improve on a gluten-free diet as the gut heals, however, the gluten-free diet itself may lead to deficiencies if it is not correctly balanced. High fat, high sugar intake and low complex carbohydrate and fiber in the diet can cause micronutrient deficiencies include iron, calcium, magnesium and vitamin D and E as well as certain B vitamins. Seeing a registered dietitian and ensuring a balanced diet is important.
For more information: Nutrients 2021, 13(8), 2877
Urinary gluten immunogenic peptides (GIP) use to detect GFD adherence
GIP in the urine proved to be not a reliable indicator of gluten in the diet as it was difficult to standardize the test and the research showed common false negative results.
For more information: Clinical and Translational Gastroenterology: October 2021 - Volume 12 - Issue 10 - p e00411 doi: 10.14309/ctg.0000000000000411
Gaps and opportunities in celiac disease
A position paper created by The Society for the Study of Celiac Disease indicated there is “potential to greatly improve clinical care in coeliac disease and facilitate innovations across autoimmunity. However, if funding opportunities do not increase for coeliac disease in the coming years, the breakthroughs need to continue advance and possibly cure this morbid condition will be delayed or lost?”
For more information: https://www.nature.com/articles/s41575-021-00511-8
Burden of the gluten-free diet
A poster presentation showed a multi-national survey of celiac patients with most adhering to a GFD. Many have difficulty adhering and experience frequent accidental exposure to gluten. The conclusion of the study was the GFD was suboptimal to manage CD. Average number of years on the GFD was 9.
For more information: https://celiac.org/main/wp-content/uploads/2021/10/TKVC103-Multi-national-burden-of-CD-UEGW-21-poster_8.00_for-upload_23-Sep-21.pdf
New European guidelines for Dermatitis Herpetiformis
For more information: https://onlinelibrary.wiley.com/doi/abs/10.1111/jdv.17183
Iron deficient anemia in celiac disease
This is the most common type of anemia associated frequently with celiac disease. “Folate and vitamin B12 malabsorption, nutritional deficiencies, inflammation, blood loss, development of refractory CD, and concomitant Heliobacter pylori infection are other causes of anemia in such patients.”
For more information: https://www.mdpi.com/2072-6643/13/10/3437
Intestinal cancers and celiac disease
Compared with the general population, CD patients had a high total risk of small intestinal bowel cancer and T-cell lymphoma (EATL), but not colorectal cancer. The protective effect of GFD on CD-related malignancies is controversial. Further studies are needed to confirm whether GFD treatment can reduce the risk of intestinal neoplasms in CD.
For more information: https://www.wjgnet.com/1948-5204/full/v13/i9/1017.htm
Genetic overlap between type 1 diabetes and other autoimmune diseases
This study shows the importance of genetic links of these diseases to identify key molecular pathways that are exhibited in multiple disorders. This may help in therapeutic approaches and improving usage of existing drugs.
For more information: https://link.springer.com/article/10.1007%2Fs00281-021-00885-6
Inflammatory and microbiota regulation of the intestinal epithelial barrier
The intestinal epithelial barrier limits harmful antigens and microorganisms and assures the absorption of vitamins, minerals and water. This is critical for human life. Tight junctions in the small intestine are important for regulating these activities and they can be affected by cytokines, gut microbiota, and diet. Gut microbiota also regulated the immune system through the release of metabolites. Growing evidence indicates that the wrong mix of good and bad bacteria, dysbiosis, immune activation and the epithelial barrier play roles in several diseases including celiac disease.
For more information: https://www.frontiersin.org/articles/10.3389/fnut.2021.718356/full
Mucosal reactivity to cow's milk protein in celiac disease
This is a 2007 study, however, it helps to explain why patients with coeliac disease (CD) on a gluten-free diet may still have gastrointestinal symptoms. Cow's milk (CM) protein sensitivity may be suspected. Six of the patients who reacted to CM were also challenged with α-lactalbumin and casein (found in CM). 18 of 20 patients showed a strong reaction to a gluten-challenge. Ten of these 20 patients also showed a similarly strong inflammatory reaction to CM challenge. Six of the CM sensitive patients were challenged with specific CM proteins: casein and α-lactalbumin. Casein, in contrast to α-lactalbumin, induced an inflammatory response like that produced by CM. A mucosal inflammatory response like that of gluten was produced by CM protein in about 50% of the patients with coeliac disease. Casein seems to be involved in this reaction.
For more information: Clin Exp Immunol. 2007 Mar; 147(3): 449–455. doi: 10.1111/j.1365-2249.2007.03298.x
Number of children with celiac disease has double in the past 25 years
A study in Italy presented at the World Congress of Paediatric Gastroenterology, Hepatology and Nutrition this year found that “At the moment 70 per cent of celiac disease patients are going undiagnosed and this study shows that significantly more could be identified, and at an earlier stage, if screening were carried out in childhood with non-invasive screening tests,” says Lionetti one of the researchers. “Diagnosis and avoiding gluten could potentially prevent damage to the villi, finger-like projections that line the gut, which can lead to malabsorption of nutrients and long-term conditions such as growth problems, fatigue and osteoporosis.”
For more information: https://www.studyfinds.org/gluten-free-children-celiac-disaese-doubled
Gluten neuropathy: electrophysiological progression and HLA associationsDQA1*02-positive patients were more likely to suffer with gluten sensitivity compared to the DQA1*02 negative patients (60% versus 13.8%). DQB1*06 allele and the DQA1*01/DQB1*06 haplotype were found more frequently in patients with gluten neuropathy than in healthy controls.
For more information: Zis, P., Sarrigiannis, P., Artemiadis, A. et al. Gluten neuropathy: lectrophysiological progression and HLA associations. J Neurol 268, 199–205 (2021). https://doi.org/10.1007/s00415-020-10137-6
COVID-19 pandemic may increase diabetes, celiac cases in Turkey
Professor Tufan Tükek, head of the Faculty of Medicine at Istanbul University warned that COVID 19 could increase the rates of autoimmune diseases like Type 1 diabetes and celiac disease. “Viruses serve as a mechanism that pull the trigger for autoimmune diseases”, he stated.
For more information: https://www.dailysabah.com/turkey/covid-19-pandemic-may-increase-diabetes-celiac-cases-in-turkey/news
Can serum anti-tissue transglutaminase (tTG) and anti-endomysium antibodies (EMA) be helpful in differentiating giardiasis from celiac disease?
Intestinal inflammation or autoimmune disease can increase markers for celiac disease. A team of researchers in Norway, found elevated serological markers after Giardia infection.
For more information: https://www.celiac.com/articles.html/a-look-at-giradia-related-elevation-of-anti-transglutaminase-and-anti-endomysium-antibodies-r5522/
Gluten induced neurocognitive impairment
A 9-question online survey was accessed by 1396 individuals (1143 with CD; 253 with NCGS). The timing of the most common symptoms of difficulty concentrating, forgetfulness, and grogginess was similar between celiacs and those with non celiac gluten sensitivity.
For more information: https://journals.lww.com/jcge/Abstract/9000/Gluten_induced_Neurocognitive_Impairment__Results.97407.aspx
Concerns raised over interpretation of a negative tTG test
Researchers from the Division of Gastroenterology and Hepatology at the Mayo Clinic, in conjunction with others, conducted a study to investigate the accuracy of the immunoglobulin A tissue transglutaminase, or tTG-IgA, blood screen for CD. The researchers found verification bias due to people with positive tTG-IgA result being more likely to have an endoscopy and biopsy of the small intestine than people with a negative tTG-IgA result. Researchers concluded that there is no concern about positive tTG-IgA results, but that caution should be exercised when interpreting a negative tTG-IgA result when screening for CD.
For more information: Estimating the Impact of Verification Bias on Celiac Disease... : Journal of Clinical Gastroenterology (lww.com)
Young adults with celiac disease have greater social anxiety and hesitation regarding dating
Lower quality of life and higher anxiety was seen in celiac disease patients aged 23 to 39 in a study done at Columbia University. 68% reported moderate to major impacts on their dating life. Explaining to waiters about their disease increased their discomfort and in 30% increase riskier eating behaviors while on a date. 39% hesitated to kiss their partner due to celiac disease.
For more information: https://www.healio.com/news/gastroenterology/20210522/hesitation-with-dating-greater-social-anxiety-among-individuals-with-celiac-disease
Composition of breast milk not affected by mothers with controlled celiac disease
A study out of Mass General Hospital found no difference in the breast milk of those with controlled celiac disease to a control group. The study did find differences in the amount of several bacterial strains in the breast milk of the mothers with celiac disease compared to mothers who don’t have celiac disease. Three bacterial strains were more abundant in the breast milk from the mothers with celiac disease.
Additionally, four strains of bacteria and two strains of virus were higher in breast milk from mothers without celiac disease.
The differences may represent variations in maternal health and diet between the two groups. Researchers called for additional studies to be done.
For more information: https://www.beyondceliac.org/research-news/celiac-disease-doesnt-affect-mothers-breast-milk
Promotion of alternative medicine testing of celiac disease
Over 500 complementary and alternative medicine clinic websites were reviewed for marketing practices. Many claims are either false or unproven, thus warranting a need for increased regulation of CAM advertising to protect the public.
For more information: Promotion of Testing for Celiac Disease and the Gluten-Free... : Official journal of the American College of Gastroenterology | ACG (lww.com)
A randomized Phase 2 trial of transglutaminase 2 inhibitor
Small intestinal transglutaminase 2 causes deamidation of glutamine residues in gluten peptides, which enhances stimulation of T cells and leads to mucosal injury in the small intestine. Inhibition of transglutaminase 2 is a potential treatment for celiac disease. The preliminary study found that treatment with ZED1227 reduced gluten-induced duodenal mucosal damage in patients with celiac disease.
For further information: https://www.nejm.org/doi/full/10.1056
Persistently tTG results above normal (low positive) should be investigated
Repeated low positive tTG results in children with symptoms were found to be indicators of celiac disease. These children should undergo endoscopy regardless of their EMA results.
For more information: https://journals.lww.com/jpgn/Abstract/2021/05000/Diagnostic_Value_of_Persistently_Low_Positive.16.aspx
Pancreatitis and celiac disease
A review of 72M medical records in the US looked at those having both acute pancreatitis (AP) and chronic pancreatitis (CP) as well as celiac disease (CD). CD patients were at increased risk of both AP and CP and had more medical issues compared to non-CD patients. More study is needed to investigate CD as a potential cause of pancreatic disease.
For more information: https://pubmed.ncbi.nlm.nih.gov/32809104/
Vitamin D deficiency negatively affects both the intestinal epithelial integrity and bone metabolism in children with celiac disease
Vitamin D deficiency was common in children diagnosed with celiac disease. Cellular pathway structures responsible for calcium absorption are disturbed in CD and this is aggravated by vitamin D deficiency.
For more information: https://pubmed.ncbi.nlm.nih.gov/32952100/
Celiac Disease and the thyroid: highlighting the roles of vitamin D and iron
Vitamin D is assumed to be involved in the onset and progression of CD, presumably plays a substantial protective role for intestinal mucosa and affects the thyroid via its immunomodulatory effects. Iron is an essential micronutrient for the thyroid gland needed for effective iodine utilization by the iron-dependent enzyme thyroid iodine peroxidase (TPO). Despite being crucial for thyroid hormone synthesis, iron deficiency (ID) is a common finding in patients with hypothyroidism like HT and is frequently found in patients with CD.
For more information: https://pubmed.ncbi.nlm.nih.gov/34064075/
Mass Screening of all Children Recommended to Identify Children with Celiac Disease
A large-scale pediatric study in Colorado looking at Celiac Disease and Type 1 Diabetes, tested blood of nearly 10K children and found 2.4% had positive tTG blood tests. 70% had no symptoms, 90% did not have a family history and were mainly female of white ancestry.
The study concluded that there are many undetected celiac disease children and the only way to detect is to use mass screening to reduce diagnostic delay and associated morbidity.
For more information: Am J Gastroenterol. 2021 Jan 1;116(1):180-187.
Seronegative Celiac Disease
Seronegative Celiac Disease is where no antibodies are found in the blood of a patient, yet there is villous atrophy. It is rare, but research teams in Italy and Sheffield UK worked together to define this situation which makes diagnosis difficult. A study in 2017 had looked at the use of proton pump inhibitors and nonsteroidal anti-inflammatory drug (NSAID) usage by celiac patients and found that of 148 patients with newly diagnosed CD, current users of ASA/NSAIDs were older than non-users (47 vs 39 years, p=0.003) and users of PPI/H2RAs were older than non-users (48 vs 39 years, p=0.004). PPI/H2RA users comprised 12% of seropositive patients, compared to 55% of seronegative patients. More study is required in this area.
For more information: Curr Opin Gastroenterol. 2018 May;34(3):154-158. and The impact of acid suppression medications and non-steroidal anti-inflammatory drugs on clinical and histologic features in celiac disease - PubMed (nih.gov)
Risk of psychiatric disorders among patients with celiac disease: A population‐based national study
A study of data of Celiac Disease patients compared to patients who did not have Celiac Disease, it was found that CD are at increased risk of having multiple psychiatric diseases including anxiety, depression, bipolar, attention‐deficit hyperactivity disorder, eating disorder, and childhood autism. Individual care and referral to psychiatry when appropriate are warranted while taking care of this group of patients.
For more information: https://doi.org/10.1111/jgh.15437 Unfortunately full text article is paid only.
Use of Micro-Needle Patches May Assist in Identifying Biomarkers for Celiac Disease and Non-Celiac Gluten Sensitivity
IL-15 and IL-8 could be proposed as potential markers in their optimal cut-off points for distinguishing CD from the NCGS and the healthy control. Evaluation of cytokine levels can be recommended as a useful tool for the diagnosis of CD and NCGS in a clinical practice.
“Cytokines are challenging in blood to begin with, actually,” says Singamaneni. “We need an extremely sensitive method to be able to detect these biomarkers in the interstitial fluid.”
So how did they collect tiny volumes of mouse interstitial fluid for analysis? They did not. Singamaneni put aside the notion that testing a bodily fluid requires removing it. They tested the cytokine levels just below the surface of the skin using a micro-needle patch. Cytokine levels are higher in patients with Celiac Disease and Non-Celiac Gluten Sensitivity.
For more information: https://www.wired.com/story/forget-blood-your-skin-might-know-if-youre-sick/ and
https://pubmed.ncbi.nlm.nih.gov/32660201/
Lack of Medical Inertia Results in Delayed or Missed Diagnosis of Celiac Disease
A UK study looked at diagnostic delay as a key issue facing modern management of celiac disease (CD) while only one in four cases are estimated to be diagnosed. Delayed diagnosis of CD is associated with an increased risk of complications from the disease and a worse quality of life.
Physicians viewed IBD or Crohn’s Disease as higher priorities for diagnosis. The majority of endoscopists do not follow guidelines for diagnostic endoscopy for CD. The study recommended lower thresholds for investigation of CD, greater adherence to biopsy guidelines and increased referral urgency to reduce overall diagnostic delay of the disease.
For more information: https://bmjopengastro.bmj.com/content/bmjgast/8/1/e000544.full.pdf BMJ Open Gastro 2021;8:e000544. doi:10.1136/ bmjgast-2020-000544
Low Level Mucosal Inflammation Predicts Response to a 14-day Gluten Challenge
A new test may be able to determine if a patient has Celiac Disease, without doing a gluten-free challenge. Researchers used a strategy called proteome analysis, which is a large-scale analysis of proteins in a patient’s tissue. Using tissue from patients who were subjected to a 2-week gluten challenge, they were able to identify subtle differences in protein expression that had not been observed before. When gluten is eliminated from patient’s diets, there may still be ongoing low-level anti-gluten immunity that might explain the variations in responses to gluten challenges.
Their study also raised the question whether the gluten free diet is an adequate treatment for everyone. “This also raises the question of whether the ‘normal’ gluten-free diet is sufficient to completely curb the immune response in all patients,” added Stamnæs. “We are currently investigating whether well-treated celiac patients can have gluten-specific T-cells that show sign of activation – i.e. signs of recently having encountered gluten. If we find such activated cells, it will reinforce the suspicion that a ‘normal’ gluten free diet does not curb the disease in all celiac patients.”
For more information: Jorunn Stamnaes, et al., In Well‐Treated Celiac Patients Low‐Level Mucosal Inflammation Predicts Response to 14‐day Gluten Challenge, Advanced Science (2021). DOI: 10.1002/advs.202003526 and https://www.advancedsciencenews.com/some-gluten-free-celiac-patients-still-experience-tissue-inflammation/
European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders
This is a good review of gluten disorders and the follow up care that is required. The guidelines, published recently in the United European Gastroenterology Journal, were based on a revision of existing recommendations and a review of evidence from celiac disease studies done over 30 years, though emphasis was given to research done since 2000. A series of recommendations, classified as “strong” or “conditional,” were made based on the quality of the scientific evidence.
For more information: Umberto Volta et al. First Published April 13, 2019. Review Article
https://doi.org/10.1177/2050640619844125
Gluten-Free Foods Cooked in Shared Fryers with Wheat: A Pilot Study Assessing Gluten Cross Contact
In a study, Tricia Thompson et al, tested 20 orders of fries from 10 different restaurants that stated they used their fryers for both gluten and non-gluten frying. The study found that 25% of the fries would not be considered gluten-free and were unsafe for those with celiac disease.
For more information: https://www.frontiersin.org/articles/10.3389/fnut.2021.652039/full
Interleukin-2 Marks Variation in Celiac Disease Symptoms
An Australian study of 295 CD patients who underwent a gluten challenge found that 1/3 of them had severe symptoms, 1/3 had moderate symptoms and 1/3 had mild symptoms (8 had no symptoms). An immune signal protein, IL-2 released by t cells (white blood cells). T-cells primed to respond to gluten, secrete large amounts of IL-2 to signal an immune reaction. The larger the number of t-cells circulating in their blood, have stronger reactions. Nausea corresponded most closely with the peak IL-2.
For more information: Tye-Din, J.A., Daveson, A.J.M., Goldstein, K.E. et al. Patient factors influencing acute gluten reactions and cytokine release in treated coeliac disease. BMC Med 18, 362 (2020). https://doi.org/10.1186/s12916-020-01828-y
IgA tTG Blood Test Not as Sensitive as We Thought
The reason for this is verification bias: individuals who screen positive are more likely to have their disease confirmed by a follow-up small-bowel biopsy while those who screen negative are unlikely to have a follow-up biopsy that could reveal missed celiac disease. The researchers reviewed a separate set of nine retrospective and prospective studies to determine the frequency of referral for both IgA tTG–positive patients (positive referral rate) and IgA tTG–negative patients (negative referral rate), which were 79.2% and 3.6%, respectively. The new overall values were 57.1% sensitivity (95% confidence interval, 35.4%-76.4%) and 99.6% specificity (95% CI, 98.4%-99.9%) versus previously estimated rates of sensitivity at 92.6% and specificity at 97.6%.
For more information: https://www.medscape.com/viewarticle/949143
Gluten Neuropathy and Genetic Associations
Researchers from Sheffield, UK and the University of Cyprus investigated the genetic linkages to gluten neuropathy. They followed 45 patients who had gluten neuropathy over approximately 8 years. 60% of patients with positive DQA1*02 suffered from sensory ganglionopathy compared to just under 14% of DQA1*02-negative patients. Also, statistically significant was the DQB1*06 allele and the DQA1*01/DQB1*06 haplotype, which were found more frequently in patients with gluten neuropathy than in healthy control subjects.
For more information: Zis, P., Sarrigiannis, P., Artemiadis, A. et al. Gluten neuropathy: electrophysiological progression and HLA associations. J Neurol 268, 199–205 (2021). https://doi.org/10.1007/s00415-020-10137-6
Microbiome Connections with Host Metabolism and Diet
The research studied the microbiome of 1,098 individuals and found many significant associations between microbes and specific nutrients, foods, food groups and general dietary indices, which were driven especially by the presence and diversity of healthy and plant-based foods.
For more information: https://pubmed.ncbi.nlm.nih.gov/33432175/
Can Zonulin Levels Help Diagnose Non-Celiac Gluten Sensitivity?
This Italian study looked at zonulin levels in celiac patients, patients without celiac disease and those with IBS. Zonulin (haptoglobin 2 precursor) is a protein that modulates the permeability of tight junctions between cells of the wall of the digestive tract. This study found that six-month wheat avoidance significantly reduced zonulin levels only in non-celiac gluten sensitivity patients with positive HLA-DQ2/8. Wheat withdrawal was associated with reduced zonulin levels only in non-celiac gluten sensitivity with the HLA genotype.
Zonulin levels were 81% accurate in distinguishing non-celiac gluten sensitivity from IBS-D. By excluding celiac disease, a diagnostic algorithm combining zonulin levels, symptoms and gender increased that accuracy to 89%.
For more information: Gut, 2020 Nov;69(11):1966-1974.
Exposure Sources, Amounts and Time Course of Gluten Ingestion and Excretion in Patients with Celiac Disease on a Gluten-free Diet
Twenty one adults (18 had CD and 3 ate a gluten containing diet) with biopsy confirmed celiac disease, kept a diary of what they ate, and had urine and stool samples collected over a 10-day period. 'Doggie bags' containing ¼ portions of foods consumed were saved during the first 7 days. Gluten in food, stool and urine was quantified using A1/G12 ELISA. 12 of the 18 celiacs had gluten exposure and most were asymptomatic and unsuspecting they had been exposed. A strict gluten free diet is difficult to attain.
For more information: www.medscape.com/viewarticle/939322
University of Chicago, Dr. Chervonsky, MD, PhD Research Looks at Gut Bacteria and CD and Diabetes
Chervonsky and his colleagues hypothesized that some microbes process gluten into biologically active substances that contribute to inflammation. But which microbes do that—and how? The researchers delved into the question using the microbe Enterococcus faecalis, which digests gluten by secreting protease, an enzyme. They fed two versions of E. faecalis to microbiome-free mice: one version that secreted protease and a mutant version that did not. Of the mice fed the conventional E. faecalis that secreted protease, more than half developed diabetes. Of the mice fed the mutant version that did not secrete protease, none got diabetes. With that, the lab had done what had initially seemed impossible: it went from hoping to figure out what gluten does to the microbiota, to identifying one protein produced by one strain of bacteria that enables gluten to trigger diabetes.
For more information: http://www.cureceliacdisease.org/wp-content/uploads/CdC_Newsletter_IssueThree_FINAL-1.pdf
New Study Looking at Ways to Diagnose CD with Less Burden on the Patient
After a gluten challenge, IL-2 increases rapidly in patients with celiac disease, but not in controls, according to the study, which found a response in four hours. “The increase is associated with symptom severity and is one of the earliest and most dynamic soluble blood biomarkers of gluten exposure to date,” the authors wrote. They noted that use of IL-2 is feasible for large studies, reducing the burden on patients because only a single-dose gluten challenge and minimal amounts of blood for testing are needed. Dr. Daniel Leffler at Takeda is the lead researcher on this study. “Different research focuses on different aspects of celiac disease,” Leffler said. “Some [studies] look at intestinal damage, some at symptoms, some at white blood cells. This provides data to guide how to most efficiently study these issues so that we are asking patients who participate in research to have the minimal amount of gluten necessary for the study to be successful and help us better understand celiac disease.”
For more information: https://www.beyondceliac.org/research-news/research-tools-improve-ways-diagnose-celiac-disease
GF Watchdog, Tricia Thompson, RD, Video detailing Testing of GF Foods
Did you know that 96% of labeled gluten-free foods tested through Gluten Free Watchdog test below 20 ppm of gluten? When foods do test out of compliance, the vast majority are grain foods. Of these grain foods, about half are oat products.
For more information: Lessons Learned from 16 Years of Testing Food for Gluten | (glutenfreewatchdog.org)
Tryptophan and Targeted Probiotics may Help Heal the Gut
A study led by researchers at McMaster University in Canada looked at targeting tryptophan metabolism in the gut of those who have celiac disease to better control symptoms that persist despite a gluten-free diet and speed up intestinal healing, according to a press release from the university. Tryptophan is an essential amino acid, which cannot be produced by the body and needs to be consumed through foods such as poultry, chocolate, bananas and cruciferous vegetables such as broccoli, cabbage and cauliflower.
For more information: https://stm.sciencemag.org/content/12/566/eaba0624
Alterations in Intestinal Microbiota of Children with Celiac Disease at the Time of Diagnosis and on a Gluten-free Diet
A study in Glasgow Scotland looked at the microbiota diversity of children with Celiac Disease when they were newly diagnosed and again at 6 and 12 months after being on a gluten-free diet compared to siblings who did not have CD. They concluded that microbiota diversity decreased on a gluten-free diet and compared to the control group without CD, specific bacteria were distinct markers of CD. However, it could not be determined whether these bacteria contributed to the children having CD. More study is required.
For more information: Alterations in Intestinal Microbiota of Children with Celiac Disease at the Time of Diagnosis and on a Gluten-free Diet - Gastroenterology (gastrojournal.org) Published August 10 DOI: https://doi.org/10.1053/j.gastro.2020.08.007
Celiac Disease Patients have no Higher Risk of Contracting COVID-19 than General Population
An international team of researchers including Dr. Elena Verdu and Dr. Maria Ines Pinto Sanchez of McMaster University, had volunteers from celiac associations, electronic newsletters and social media, answer forty-one questions in a web-based survey that was available in English, Spanish and Italian. People with celiac disease tend to have more comorbidities including respiratory, cardiac, and diabetes, compared with control subjects. Patients with celiac disease were significantly less likely to have been tested for, and to have been exposed to, COVID-19, compared with control subjects. Just under 9% of 940 participants tested positive for COVID-19. Celiac patients do not face any higher risk of contracting Covid-19 than control subjects. Unfortunately, this study did not look at whether celiac patients have worse outcomes if they do contact COVID-19.
For more information: https://www.celiac.com/articles.html/no-higher-covid-19-risk-for-celiac-disease-patients-r5368/
The Hidden Dangers of Protein Powders
An updated article by the Harvard Health Letter warned of the problems with protein powders on the market today. Many are high in sugar and calories and as they are supplements, there is no oversight on what is contained in the products. They may cause digestive distress especially if you have a sensitivity to dairy products. Some have been found to have high levels of toxins. Check out Clean Label Project's website (www.cleanlabelproject.org) to ensure the safety of products that you may use. The article recommends getting protein from healthy food sources.
For more information: https://www.health.harvard.edu/staying-healthy/the-hidden-dangers-of-protein-powders
Infant Antibiotic Exposure Tied to Celiac Disease and Many Other Childhood Health Disorders
A group of researchers mainly from the Mayo clinic, set out to see what they could learn about potential connections between antibiotic exposure in the first two years of life, and the risk of childhood immunological, metabolic, and neurobehavioral health conditions.
Of the 14,572 children in the study, over half were boys. 70% of the children had received at least 1 antibiotic prescription during the first 2 years of life. They found that early antibiotic exposure was tied to an increased risk of childhood-onset asthma, allergic rhinitis, atopic dermatitis, celiac disease, overweight, obesity, and attention deficit hyperactivity disorder. The number, type, and timing of antibiotic exposure all influenced the connections. Further study is required to maximize the benefits and minimize the risks of antibiotics in the first two years of childhood.
For more information: https://www.mayoclinicproceedings.org/article/S0025-6196(20)30785-0/fulltext
Brain Scans May Provide Clues for Those Suffering from Gluten Sensitivity
A study out of England finds that those with gluten sensitivity have celiac disease like neurological issues. “Feelings of brain fog and headache each worsened in a consistent manner and by an overall significant magnitude after eating gluten,” the study says, reinforcing the importance of a gluten-free diet for those with gluten sensitivity.
“Overall, our conclusions are that this is evidence that [gluten sensitive] patients potentially have slightly “unwell” brains in terms of our baseline measurements in ways which mirror what we see in celiac disease,” Croall said. “And eating gluten appeared to lead to worse neurological symptoms.”
For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454984/
Gut Microbiota in Celiac Disease: Microbes, Metabolites, Pathways and Therapeutics
Researchers including Dr. Maureen Leonard and Dr. Alessio Fasano review the role of the intestinal microbiota on the development of chronic autoimmune disease including Celiac Disease. While research to date provides a solid foundation, most studies have been case-control and thus do not have capacity to explore the mechanistic role of the microbiota in CD onset. Further longitudinal studies and integrated multi-omics are necessary for investigating CD pathogenesis.
For more information: https://www.tandfonline.com/doi/abs/10.1080/1744666X.2021.1840354
Screening Only Way to Find All Children with Celiac Disease
The study by researchers at University of Colorado found that symptoms were not reliable predictors of which children would have celiac disease. And most children who had positive antibody screening did not have a family history of celiac disease. Screening is testing for health conditions and diseases when there are no risk factor, signs or symptoms. More than half of those with Celiac Disease may have no symptoms and not be identified by current recommendations for screening through blood tests for celiac disease. In addition to consequences for patients, diagnosis of CD through screening has implications for the healthcare system. Costs of unrecognized CD can include prescription drugs, primary healthcare visits and missed days of school.
For more information: https://pubmed.ncbi.nlm.nih.gov/32701732/
Celiac Disease Researchers Link Early-Life Environmental Triggers with Changes in the Developing Gut Microbiome
Dr. Maureen Leonard, a celiac herself and associated with the Centre for Celiac Research and Treatment at MassGeneral Hospital, was the lead researcher in a study that looked at the impact of three early-life environmental triggers on the microbiome during the first six months of life: birth delivery mode, antibiotic exposure and infant feeding type. Infants exposed to at least one of the three environmental triggers had alterations in the microbiome associated with immune dysfunction and inflammatory conditions. Those not exposed to any of these environmental triggers developed strong immune systems and anti-inflammatory effects. Based on these early results, researchers cannot yet link the microbiome alterations seen in this study directly to celiac disease onset, but “the results lay a solid and promising foundation for future studies,” said Leonard. They plan to follow the 31 infants studied in a longitudinal study to provide more insight.
For more information: https://mgriblog.org/2020/12/22/celiac-disease/
Exposure to Microbes and Risk of Celiac Disease
A review of 135 studies in Oslo, Norway found that childhood infections correlated with an increased risk of subsequent celiac disease in nine studies, whereas maternal infections during pregnancy did not show a clear association. Microbes were linked to CD: Helicobacter pylori in four out of 16 studies, adenovirus in two out of nine studies, and enterovirus in two out of six studies. Rotovirus infections have also been linked to the development of CD.
For more information: https://www.medscape.com/viewarticle/943274
Biopsy May Not be Needed in the Diagnosis of Celiac Disease
The study found that when participants’ anti-tissue transglutaminase immunoglobulin A (TTG) tests were highly positive, ten times the upper limit of normal, they almost always also had the level of damage to the intestine that is the hallmark sign of celiac disease. This is consistent to changes in the diagnosis guidelines for children. The role of the biopsy in celiac disease diagnosis is a controversial topic and the subject of ongoing research.
For more information: https://www.beyondceliac.org/research-news/biopsy-not-always-needed/
Go Beyond Celiac Conducted Research on Celiac Disease and Headaches
A UK study found that celiac disease patients were 2.7 times more likely to have headaches than those who did not have celiac disease. 71% of Go Beyond Celiac participants report getting headaches or migraines with gluten exposure, and 28% say their headaches are severe or very severe. The study concludes that patients with unexplained headaches and abnormal brain scans should be tested for celiac disease.
For more information: https://www.beyondceliac.org/research-news/the-headache-of-celiac-disease
Comments on Study “Preparation of Gluten-Free Foods Alongside Gluten-Containing Food May Not Always Be as Risky for Celiac Patients as Diet Guides Suggest”
The Gluten-Free Watchdog, Tricia Thompson, RD, reviewed the above study and concluded more information is necessary before celiacs changes their habits with regards to avoiding cross-contamination. The study can be found at https://www.gastrojournal.org/article/S0016-5085(19)41340-1/pdf . Tricia concluded that Cross contact must continue to be addressed and assessed. One study should not change recommendations. As a result, please do not use a shared toaster oven or pop up toaster without cleaning the grill or using toaster bags. And please do not use a shared rolling toaster when eating away from home. Please do not use shared utensils that have not been washed between uses. More study in the area is needed before we change our habits to avoid cross contamination.
For more information: https://www.glutenfreewatchdog.org/news/gluten-free-watchdog-comment-on-the-recent-gluten-cross-contact-study-preparation-of-gluten-free-foods-alongside-gluten-containing-food-may-not-always-be-as-risky-for-celiac-patients-as-diet/
Celiac Disease Changes the Gut Microbiota in Children
“Duodenal microbiota of celiac patients showed a dominance of Enterobacteriaceae and sub dominance of Bacteroidetes/Streptococcus, while stool microbiota showed a lower abundance of Bacteroides-Prevotella (p=0.013), Akkermansia (p=0.002) and Staphylococcaceae (p=0.001) in celiac patients compared to healthy controls.
Patients with abdominal pain showed an increased mean relative abundance of Bacillaceae and Enterobaeriaceae, while celiac patients with diarrhea had reduced mean relative abundance of Clostridium cl. XIVa, Akkermansia, with an increase in Bacillaceae, and Fusobacterium.”
For more information: J Gastroenterol Hepatol. 2020 Jul 14
Gut Microbiota in Celiac Disease: Is There Any Role for Probiotics?
A study in Italy looked at the role of probiotics in CD therapy. They reviewed published English articles that provided evidence-based data. “Literature analysis showed that the gut microbiota has a well-established role in gluten metabolism, in modulating the immune response and in regulating the permeability of the intestinal barrier. Promising studies suggest a possible role of probiotics in treating and/or preventing CD. Nevertheless, human trials on the subject are still scarce and lack homogeneity.” Which probiotics are more effective, at what dose and how long they should be administered are yet to be determined. Further study is required. For more information: Front Immunol. 2020; 11: 957. Published online 2020 May 15. doi: 10.3389/fimmu.2020.00957
Study Reveals that Vitamin D supplementation Changes a Baby’s Microbiome
A study of 1,157 infants found that those supplemented with Vitamin D may give some protection to respiratory illnesses and lung infection among infants. The study found that nearly 30% of the infants carried C. Difficile, but there was a lower incidence of the bacterium among exclusively breastfed infants. ‘Interestingly, maternal consumption of vitamin D fortified milk was the only factor that reduced the likelihood of C. Difficile colonization in infants.” More study is required.
For more information: https://www.tandfonline.com/doi/full/10.1080/19490976.2020.1799734
Gluten Response Biomarkers in Celiac Disease
A recent study out of Boston, Massachusetts looked at changes in “villi height, gluten-specific cluster of differentiation (CD)4 T-cell analysis with human leukocyte antigen (HLA)-DQ2-gluten tetramers and enzyme-linked immune absorbent spot (ELISpot), gut-homing CD8 T cells, interleukin (IL)-2, symptoms, video capsule endoscopy (VCE), intraepithelial leukocytes (IELs), and tissue multiplex immunofluorescence.” A portion of the study participants were given 3 gm of gluten per day, while another group were given 12 gm of gluten per day. The gluten challenge showed changes in all factors, however, the time taken to see changes varied. IL2 showed the earliest changes and was most sensitive to the gluten exposure. Differences in reaction were seen between those with the HLA DQ2 and HLA DQ8 genes. This study will assist in defining the gluten challenge and the testing required.
For more information: https://doi.org/10.1053/j.gastro.2020.10.040
Introduction of Gluten to Infants
A recent study in JAMA Pediatrics results indicate that there is no harm to introduce children between 4 – 6 months of age to gluten. In fact, the study found that the introduction of gluten at this age may very well decrease the risk of developing celiac disease at a later date.
For more information: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2770801
Larazotide Acetate Phase 3 Trial Shows Promise to Reduce Symptoms of Those with CD
“The CeDLara Study is testing larazotide acetate in people with celiac disease who continue to have symptoms even while following the gluten-free diet. Larazotide acetate is designed to tighten the adhesions between cells lining the small intestine, called tight junctions. In people with celiac disease, gluten causes these tight junctions to break down, which allows gliadin (a component of gluten) to enter this space between and underneath the intestinal cells. Once in the “wrong” place, the gliadin prompts an inflammatory response from the immune system. This “leaky gut” is thought to be the gateway to many autoimmune diseases, including celiac disease. Larazotide acetate makes the tight junctions more secure, keeping gliadin from passing through.”
For more information: https://www.beyondceliac.org/research-news/larazotide-phase3/
Multi-omics analysis reveals the influence of genetic and environmental risk factors on developing gut microbiota in infants at risk of celiac diseaseThis article looks at the microbiota and the gut bacteria and metabolites that may put infants at risk for celiac disease. More study in this area is required.
For more information:https://microbiomejournal.biomedcentral.com/articles/10.1186/s40168-020-00906-w
Assessment of KAN-101 in Celiac Disease Study (ACeD Study)
A Phase I trial will study KAN-101 which acts by re-educating T cells, or tolerizing them, so they do not respond to gluten antigens. KAN-101 may help patients with celiac disease without interfering with the natural protective functions of the immune system.
For more information: https://clinicaltrials.gov/ct2/show/NCT04248855
Dermatitis Herpetiformis (DH) Patients Unlikely to Gluten-free Diet Counselling
A University of Pennsylvania study DH patients were less likely to get gluten-free diet counselling as most dermatologists lack appreciation for the need to offer this information. The result is those who failed to adopt a strict gluten-free diet within the first 5 years of diagnosis had an increased risk of mortality from lymphoma. Further prospective studies are needed to better understand the DH population, specifically if comorbidities and prognosis mirror those in patients with CD but without DH.
For more information: https://jamanetwork.com/journals/jamadermatology/article-abstract/2771178
Celiac Disease is Associated with Risk of Osteoporotic Fractures
693 people with celiac disease in Manitoba BMD Registry were followed for a mean 7 years and compared to 68K of the general population who were followed a mean 7.1 years. Those with celiac disease had a higher risk of a major osteoporotic fracture compared to the general population.
For more information: https://www.docwirenews.com/condition-center/celiac-disease-is-associated-with-risk-of-osteoporotic-fractures/
Gluten Exposure in Patients with Celiac Disease on a Gluten-Free Diet
By studying gluten immunogenic peptides in urine and fecal samples over a 4-week period from 53 adults in Argentina diagnosed with celiac disease the study determined that even patients on a long-term gluten-free diet are frequently exposed to gluten. They also concluded that stool and urine samples might be used to assist dietitians in determining gluten-free compliance. “Patients with symptoms had more weeks in which GIP was detected in stool than patients without symptoms.” 37.9% of the samples were positive for GIP and 88.7% of patients had at least 1 positive sample.
For more information: https://pubmed.ncbi.nlm.nih.gov/32217152/ and https://www.beyondceliac.org/research-news/new-evidence-gluten-in-gluten-free-diet
Organic Pollutant Exposure and Celiac Disease
Researchers affiliated with New York University School of Medicine found a high correlation to organic pollutant exposure and the development of inflammatory autoimmune conditions. Although more research is required, the study looked at levels of DDE, PFOS, PFOA and BCE153 in patients and found a greater incidence of celiac disease in: both males and females with higher levels of DDE; females with increased concentrations of perfluoroalkyl substances (PFASs); and, males associated with BCE153. Persistent organic pollutants (POPs) are know endocrine disruptors that interplay with the immune system.
To reduce exposure, open windows and recirculate air as well as use a wet mop to reduce household dust that includes pollutants. When cooking use cast-iron or stainless-steel pans to reduce PFAS.
Comments by Dr. Fasano regarding this study: “Common sense is advisable not just because of celiac disease. Any child will get sick if they are exposed to chemicals beyond normal levels,” Fasano said. “Try to have a lifestyle that minimizes the risk that your child and your family in general are exposed to chemicals that can be offensive to you.”
For more information: https://www.sciencedirect.com/science/article/abs/pii/S0013935120303327
Increased IBD Risks for Celiac Patients and Celiac Risk for IBD Patients
Researchers from the Francombe Family Digestive Research Institute, McMaster University, Hamilton reviewed medical databases and found nearly 10K studies, using 65 in their assessment. They found higher risk of ant-Saccharomyces antibodies, a serologic marker of IBD, in celiac patients and IBD patients had an increased risk of anti-tissue transglutaminase (tTG) antibodies. Further study is required.
For more information: https://www.gastrojournal.org/article/S0016-5085(20)30609-0/fulltext
Gluten Contamination in Labelled and Naturally Gluten-free Grain Products in Southern India
I know travel is limited at this time, but in BC there is a large population from India who have higher than normal incidences of Celiac Disease. A study of gluten-free grain product in India found that Among “35.9% of the flour samples and 85% of the oat samples (11.67–1830 mg/kg) were contaminated with gluten. In the case of flours, unbranded samples collected from local markets (70%) and directly from local mills (30%) showed gluten content above Codex safety levels (20–400 mg/kg). “ The problem seems to be on products source from local retailers and directly from millers. Be aware of the risks if you are travelling in India.
For more information: Nagaraju Raju, Apurva Kumar R Joshi, Raidu Vahini, Thappatla Deepika, Kandlakunta Bhaskarachari & S. Devindra (2020) Gluten contamination in labelled and naturally gluten-free grain products in southern India, Food Additives & Contaminants: Part A, 37:4, 531-538, DOI: 10.1080/19440049.2020.1711970
High Prevalence of Celiac Disease in First Degree Relatives
A Mayo Clinic study found that of 360 first degree relatives of diagnosed celiacs (FDR) screened 44.4% were diagnosed with CD. 62% of those diagnosed were female. 6% had classical symptoms, 66% had non-classical symptoms and 28% had no symptoms. tTG levels were high even with no symptoms.
For more information: https://www.mayoclinicproceedings.org/article/S0025-6196(19)30353-2/fulltext
Recurrent Aphthous Stomatitis Points to Anemia and Celiac Disease
A Turkish study of children between 6 months and 18 years. Medical records of patients diagnosed with recurrent aphthous stomatitis (RAS) were reviewed. RAS is one of the most common diseases of the oral mucosa and may be related to vitamin deficiencies or systemic diseases such as celiac disease (CD). Iron deficiency anemia, hematological abnormalities and malnutrition was much more prevalent in the patients diagnosed with RAS.
For more information: https://pubmed.ncbi.nlm.nih.gov/31957941/
Digestion of Intact Gluten Proteins by Bifidobacterium Species: Reduction of Cytotoxicity and Proinflammatory Responses
A Brazilian study showed that Bifidobacterium species reduced the destruction of living cells and the inflammatory response in the body. These results indicate that Bifidobacterium may be beneficial in the treatment of celiac disease.
For more information: J. Agric. Food Chem. 2020, 68, 15, 4485–4492, Publication Date: March 20, 2020, https://doi.org/10.1021/acs.jafc.0c01421 , Copyright © 2020 American Chemical Society
Celiac Disease and Children’s Mental Health
34% of children within the study published in the Journal of Pediatric Gastroenterology Nutrition were found to have at least 1 mental disorder compared to 13% of the general population. “The significant psychological and psychosocial impact of celiac disease in children and adolescents has gone unrecognized for too long. This lack of recognition can leave children on their own to deal with anxiety, anger, depression, ADHD and more,” said Salvo Alesci, MD, Beyond Celiac chief scientist and strategy officer. “As this study suggests, mental health should be routinely assessed and monitored in children with celiac disease to provide help that can make a big difference in their lives and the lives of their families. Overall, we need to pay more attention to extraintestinal symptoms of celiac disease.”
For more information: https://www.beyondceliac.org/research-news/children-mental-issues-risk
Possible Role of Vitamin D in Celiac Disease Onset
Italian researchers call for further research into the role Vitamin D has in celiac disease. Researchers have noted that the Vitamin D receptor sites (VDR) expresses itself as antigen-presenting cells and lymphocytes, which indicates that vitamin D is a key modulator of immune and inflammation mechanisms, and suggests that VDR gene polymorphisms function as markers of either resistance or susceptibility to autoimmune diseases.
For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231074/
Nausea and Vomiting, but not IBS-like Symptoms are Common for Gluten-Free Celiacs
A study at the University of Queensland, Brisbane, Australia, School of Medicine, indicates that nausea and vomiting are common symptoms of being exposed to gluten if you are a gluten-free celiac. Levels of interleukin – 2 correlated highly with the severity of the symptoms. They also stated that FODMAP issues are common among celiacs.
For more information: https://onlinelibrary.wiley.com/doi/abs/10.1111/apt.15551
Tofacitinib Triggers Celiac Disease Remission in a Gluten-Eating Patient
A patient who started tofacitinib therapy for alopecia areata had complete histologic and serologic remission of his celiac disease (CD), despite being on a gluten-containing diet. This is only one instance. "The efficacy of tofacitinib in alopecia areata may also be related to inhibition of CD8+ T-cell reactions to follicle-associated autoantigens," Dr. Wauters and his team write. If the findings are confirmed, the researcher noted, the advantages of tofacitinib for patients with refractory CD could outweigh the potential risks. Further study is required.
For more information: https://bit.ly/2CRJxeM Annals of Internal Medicine, online July 27, 2020.
Supercharged Shellfish Could Aid in Vitamin Deficiency
Researchers at the University of Cambridge have fortified shellfish (oysters, clams and mussels) through a new microencapsulation technology. As we eat the whole organism when we eat these shellfish, so they are ideal to target for nutritional fortification.
For more information: https://www.newfoodmagazine.com/news/114597/supercharged-shellfish
Cytokines, IL-15 and IL-8 Can Aid in Differentiating Patients with NCGS versus Celiac Disease
Research in Iran found that IL-15 distinguished the celiac and NCGS groups from control groups 83% of the time. IL-8 was 75% sensitive. These cytokine levels can be useful in spotting the difference between the two conditions.
For more information: https://pubmed.ncbi.nlm.nih.gov/32660201/
Gut microbiome investigation in celiac disease: from methods to its pathogenetic role
This article details the microbiome and the differences in types of bacteria for celiacs compared to healthy individuals. It also details the microbiome organisms found in gut, oral, duodenum, and feces.
For more information: https://www.degruyter.com/view/journals/cclm/58/3/article-p340.xml
Association Between Celiac Disease and Mortality Risk in a Swedish Population
“In this population-based cohort study of 49 829 patients in Sweden with celiac disease followed up for a median of 12.5 years, the mortality rate compared with general population controls was 9.7 vs 8.6 deaths per 1000 person-years, a difference that was statistically significant.”
For more information: https://jamanetwork.com/journals/jama/article-abstract/2764182
Gut Microbiota in Celiac Disease: Is There Any Role for Probiotics?
“Currently published data suggest the efficacy and safety of probiotic supplementation in improving CD-related symptoms, as well as documenting the ability of some probiotics to alter the fecal microbiota and decrease pro-inflammatory parameters such as TNF-α levels or peripheral CD3+ T lymphocyte counts (which probiotics are more effective, at what dose and how long they should be administered are yet to be definitively clarified.”For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243837/Celiac Disease Patients have a Slightly Higher Mortality Risk
Over a ten-year period, 9.7 people out of 100 people with celiac disease died from all causes compared to 8.6 out of 100 people who did not have celiac disease, according to the study. The study was based on 50K Swedish celiacs between 1969 and 2017. However, no increase in mortality risk was seen when the 25 percent of celiac disease patients who had persistent damage to the villi were compared to those who had intestinal healing. Dr. Lebwohl emphasized that the absolute risk, which was about 1 more person in 100 over 10 years is more practical. “We know that the great majority of people with celiac disease live long and healthy lives,” he said.
Among the causes of death, patients with celiac disease were at slightly increased risk of cardiovascular disease death, cancer, and respiratory disease.
For more information: https://jamanetwork.com/journals/jama/article-abstract/2764182
IL 15, gluten and HLA-Dq8 drive tissue destruction in celiac disease
Using a mouse mode, this study found that overexpression of IL-15 in both the epithelium and the lamina propria (thin layer of connective tissue, which lies beneath the epithelium. Together they make up the mucosa) is required for the development of villous atrophy in the small intestine. This demonstrates the location-dependent central role of IL-15 in the development of celiac disease. In addition, CD4+ T cells and HLA-DQ8 have a crucial role in the causing cytotoxic (toxic to living cells) T cells to mediate intestinal epithelial cell disintegration. They also demonstrated a role for the cytokine interferon-γ (IFNγ) and the enzyme transglutaminase 2 (TG2) in tissue destruction.
For more information: https://www.nature.com/articles/s41586-020-2003-8 . February 12, 2020
Masked bolus gluten challenge low in FODMAPs implicates nausea and vomiting as key symptoms associated with immune activation in treated coeliac disease
After ingestion of gluten, nausea increased most in those with treated CD. Apart from tiredness and headache, changes in other symptoms were small or absent. Only nausea increased significantly in occurrence with gluten (11% vs 69%, P < .001). Without nausea, only tiredness and flatulence were common after gluten and vomiting were the only adverse events more common with gluten than the control group.
For more information: 26 November 2019 https://doi.org/10.1111/apt.15551
Researchers confirm celiac disease can damage the brain
People living with celiac disease (CD) have a higher risk of neurological damage according to a new study from the University of Sheffield. Dr. Iain Croall, a research fellow from the University of Sheffield's Department of Infection, Immunity and Cardiovascular Disease, said and Associate Member of Insigneo: "For the first time, the study offers some clarity on the fact that there does appear to be the risk of neurological damage for people living with CD, driven by their autoimmune response to gluten exposure.
"Our independent UK Biobank participants with CD showed meaningful neurological and psychological deficits when compared with control participants.
"The data from the CD group of participants showed a significant reaction time deficit, compared to the control participants; alongside signs of anxiety, health-related unhappiness and depression." Note: Dr. Croall was Guest Speaker at the recent CCA National On-line conference.
For more information: https://medicalxpress.com/news/2020-02-celiac-disease-brain.amp and I.D. Croall et al. Cognitive Deficit and White Matter Changes in Persons with Celiac Disease: a Population-Based Study, Gastroenterology (2020). DOI: 10.1053/j.gastro.2020.02.028
Cytokine release and gastrointestinal symptoms after gluten challenge in celiac disease
Rapid, coordinated elevation of circulating cytokines including IL-2 confirmed in vivo activation of CD4+ T cells in CD patients after injecting short antigenic gluten peptides or ingestion of gluten that was closely associated with the onset and severity of acute digestive symptoms. The systemic cytokine release observed provides definitive evidence of rapid immune activation within 2 hours after administering gluten peptides in almost all HLA-DQ2.5+ CD patients. Qualitative and quantitative assessments of cytokines elevated after injecting gluten peptides or gluten food challenge were complicated by individual cytokines having different profiles and by low baseline concentrations of key cytokines such as IL-2.
For more information: https://advances.sciencemag.org/content/5/8/eaaw7756
Cardiovascular outcomes in patients with Celiac Disease: an insight from the national inpatient sample
According to the results, in 2014 the proportion of patients with CD in AMI hospitalizations grew from 0.015% in 2005 to 0.076%. The results showed that CD+AMI patients were significantly older (70.3 vs. 67.4 years), and more likely female (51.9% vs. 39.5%). “We found that the number of acute myocardial infarction related admissions in the CD patients has risen more than five-fold from 2005-2014,” the authors concluded. “However, the odd of in-hospital mortality in these patients is lower than the patients without CD for unclear reasons or mechanisms. The results of our study show that though the CD-related systemic inflammation is associated with an increasing number of AMI hospitalizations, these patients have comparatively favorable outcomes than controls; though it definitely adds an extra cost to the hospitalization.”
For more information: https://www.docwirenews.com/conference-coverage/acc20/cardiovascular-celiac-disease/
Researchers investigate rogue cells that are the root cause of autoimmune diseases
"Current treatments for autoimmune disease address only the symptoms, but not the cause. To make more targeted treatments that address disease development and progression, we first need to understand the cause," says Professor Chris Goodnow, co-senior author of the published work, Executive Director of the Garvan Institute and Director of the UNSW Sydney Cellular Genomics Futures Institute.
By first separating individual cells, and then separating their genetic material, the researchers isolated immune cells that produced 'rheumatoid factors' - antibody proteins that target healthy tissues in the body and are associated with the most common autoimmune diseases, including rheumatoid arthritis. "We uncovered 'lymphoma driver mutations', including a variant of the CARD11 gene, which allowed the rogue immune cells to evade immune tolerance checkpoints and multiply unchecked," explains Professor Goodnow, who first hypothesised that disease-causing autoimmune cells employ this cancer tactic in 2007. The researchers are now planning follow-up studies to investigate mutations of autoimmune cells in a range of other diseases, including lupus, celiac disease and type 1 diabetes.
For more information: https://medicalxpress.com/news/2020-02-rogue-cells-root-autoimmune-disease.html
Gynecological symptoms in patients with non-celiac wheat sensitivity (NCWS)
The researchers in Palermo, Italy surveyed gynecological symptoms and recurrent cystitis in sixty-eight women with NCWS. Nearly sixty percent of NCWS patients had more frequent gynecological symptoms, than did healthy control subjects, IBS control subjects or controls with celiac disease. More than twenty-five percent of patients with NCWS experienced more frequent changes to the menstrual cycle, compared with just over eleven percent of healthy controls. Sixteen percent patients with NCWS suffered from recurrent vaginitis (16%) and dyspareunia (6%) significantly more frequently than healthy controls.
Over a one-year follow-up period, nearly half of patients with menstrual disorders and nearly forty percent with recurrent vaginitis reported that their symptoms had resolved on a wheat-free diet.
For more information: https://link.springer.com/article/10.1007/s10620-020-06184-8
Children who meet specific criteria do not require an endoscopy for diagnosis of Celiac Disease
The team analyzed 2016 medical records for celiac patients under 19 years old, who were diagnosed in five European countries. 653 children from Croatia, Hungary, Germany, Italy, and Slovenia data was analyzed. Ages of subjects were 7 months-18.5 years, average age of 7 years. 64% were female.
134 children were asymptomatic at diagnosis. Of 519 children who did show symptoms, 107, nearly 21%, were diagnosed without biopsy. Out of 412 children diagnosed via biopsy, 214, or nearly 52% had tTG levels of above 10 times upper level of normal (ULN) and thus could have been diagnosed without biopsy. The data showed no differences in diagnostic times with the no-biopsy approach. In this study, about 60% of celiac patients who show symptoms could have been diagnosed without duodenal biopsies. However, only 20% of eligible patients are getting a biopsy-free celiac diagnosis.
For more information: https://www.celiac.com/
Ocular Manifestations in Celiac Disease: An Overview
Several ocular symptoms and disorders have been associated with CD and are a result of defective intestinal absorption and immunological mechanisms. These include nyctalopia, dry eye, cataract, thyroid-associated orbitopathy, uveitis, central retinal vein occlusion and neuro-ophthalmic manifestations. In addition, CD-related ocular disease may represent the first manifestation of CD.
For more information: https://link.springer.com/article/10.1007/s10792-019-01254-x
Increased Prevalence of Celiac Disease in School-age Children in Italy
The incidence of celiac disease in school age children in Italy has increased to 1.5% which is significantly higher than 25 years ago. Causes for this increase need to be determined.
For more information: https://www.cghjournal.org/article/S1542-3565(19)30651-2/pdf
Celiac Disease and Its Role in the Development of Metabolic Bone Disease
CD and the effects of malabsorption on bone health. Imbalances in bone resorption and formation particularly in individuals with CD and persistent disease activity ultimately lead to a state of bone loss and impaired mineralization. Initiation of a gluten-free diet is critical in the management of CD-related metabolic bone disease, demonstrating improvements in bone mineral density within the first year of dietary adherence.
For more information: https://pubmed.ncbi.nlm.nih.gov/31320223
Atopic Dermatitis and Celiac Disease: A Cross-Sectional Study of 116,816 Patients
1909 adults had moderate to severe atopic dermatitis. Those with atopic dermatitis were associated with significantly higher prevalence of CD (1.6 times more likely to have CD). This association emphasizes the need for timely screening of gastrointestinal issues, especially CD.
For more information: https://www.ncbi.nlm.nih.gov/pubmed/31679111 American Journal of Clinical Dermatology Feb 2020 21(1):133-138. doi: 10.1007/s40257-019-00474-2.
Treatment of Neurological Manifestations of Gluten Sensitivity and Coeliac Disease
This paper outlines the neurological manifestations of CD and NCGS. Co-authored by expert Dr. Marios Hadjivassiliiou. The paper reviews gluten ataxia, gluten neuropathy, cognitive impairment and headaches including chronic migraines resulting from autoimmune responses to gluten.
For more information: https://link.springer.com/article/10.1007/s11940-019-0552-7
Infection, Antibiotic Exposure and the Risk of Celiac Disease
This study looked at published research in PubMed, Embase and Cochrane databases from their inception to April 2019. These results provide strong evidence that early infection and/or antibiotic exposure increase the odds of developing celiac disease and suggest that disruption of intestinal immune processes or gut microbiota may play a role in celiac disease development. Further study is required on other causal factors.
For more information: https://onlinelibrary.wiley.com/doi/epdf/10.1111
Latiglutenase Treatment for Celiac Disease: symptom and quality of life improvement for seropositive patients on a gluten‐free diet
Although this study was not powered to definitively establish the benefit of latiglutenase in seropositive CD patients, such patients appear to show symptomatic and QOL benefit from using latiglutenase with meals.
For more information: https://onlinelibrary.wiley.com/doi/abs/10.1002/ygh2.371
Significant Association Shown Between Psoriasis and Celiac Disease
A review of published studies of Celiac Disease and Psoriasis showed that patients with psoriasis with bowel complaints might benefit from screening for CD through questionnaires or interviews with subsequent gastroenterology consultation. Of 754 citations 18 were reviewed in detail. Odds were 2.16 times that psoriasis patients would have CD and 1.8 times more likely to find psoriasis in CD patients than the general population.
For more information: https://www.jaad.org/article/S0190-9622(19)33131-7/fulltext?rss=yes
Incidence of Celiac Disease is Increasing over Time
In the 21st century, of 11,189 citations, 86 eligible studies were identified and 50 were deemed suitable for analyses. Female incidence of CD was 17.4 per 100,000 person-years, compared with 7.8 in males. Child-specific incidence was 21.3 per 100,000 persons compared with 12.9 in adults. The average annual percent changes showed the incidence of CD to be increasing by 7.5% per year over the past several decades.
For more information: American Journal of Gastroenterology, Feb 4, 2020
https://journals.lww.com/ajg/Abstract/publishahead/Incidence_of_Celiac_Disease_Is_Increasing_Over.99422.aspx
IV-infused agent (TAK-101, Takeda Pharmaceutical) has Successful Phase 2 Trial
“If our findings are confirmed by subsequent studies, this treatment may represent a revolutionary change in how we manage celiac disease,” said Ciaran Kelly, MD, of Beth Israel Deaconess Medical Center, in Boston, who led the study (late-breaking abstract 18). Gliadin containing nanoparticles are infused through two IV infusions spaced one week apart and they are used to reduce the immune reaction to gluten. A gluten challenge followed for those taking the nanoparticles and a control group of patients with CD. The symptoms of the control group were significantly worse than those taking the nanoparticle infusions.
While more research is needed to demonstrate the agent’s efficacy, the study offers an “important proof of concept that tolerization to gluten is a path worth pursuing in celiac disease,” said Benjamin Lebwohl, MD, MS, the director of clinical research at the Celiac Disease Center at Columbia University, in New York City, who was not involved in the study. Continued study is required.
Biomarker for Non-Celiac Gluten Sensitivity Found
A research team in Italy investigated the expression levels of selected miRNAs in duodenal biopsies and peripheral blood leukocytes collected from newly diagnosed patients with non-celiac wheat sensitivity (NCWS) and, as controls, from patients with celiac disease and gluten-independent gastrointestinal problems. They found that several miRNAs in those with NCWS were elevated. More study is required to determine if this will be useful for a test to identify those with NCWS.
For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6910677/
Incidence of Undiagnosed Celiac Disease Presenting as Bone Stress Injuries to a Sport and Exercise Medicine Clinic
In a UK study, the incidence of positive blood testing for CD for 100 patients with bone stress injuries from sport was 6%. The incidence confirmed by biopsy was 5%, therefore CD screening should be considered for all those with bone stress injuries.
For more information: https://www.ncbi.nlm.nih.gov/pubmed/32032163
Headache in Children with Celiac Disease
At least one-third of children and adolescents with celiac disease have recurrent headaches at the time of diagnosis. A gluten-free diet led to improved headache symptomology in a significant number of these patients.
For more information: Journal of Child Neurology, 35 (1) 37 - 41Jan 2020
Processed Food Additive Microbial Transglutaminase and Its Cross-Linked Gliadin Complexes Are Potential Public Health Concerns in Celiac Disease
According to the manufacturers' claims, microbial transglutaminase and its cross-linked products are safe, i.e., nonallergenic, nonimmunogenic, and nonpathogenic. The regulatory authorities declare it as "generally recognized as safe" for public users. The enzyme imitates its family member tTG, the autoantigen of CD and may enhance intestinal permeability, suppress immunological protective barriers, increase bacterial growth and augment the uptake of the gliadin peptide. Scientific observations are accumulating concerning its undesirable effects on human health and more study is required to ensure its safety.
For more information: Int. J. Mol. Sci. 2020, 21(3), 1127; https://doi.org/10.3390/ijms21031127
Current Concepts of Dermatitis Herpetiformis
Dermatitis Herpetiformis (DH) is the skin manifestation of celiac disease. The article talks about TG3 autoantibody identification in the diagnosis of DH and covers the current diagnosis and treatment options.
For more information: https://www.medicaljournals.se/acta/content/html/10.2340/00015555-3401
Psychiatric Manifestations of Coeliac Disease, a Systematic Review and Meta-Analysis
This systematic review identified a significant increased risk for autistic spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), depression, anxiety, and eating disorders amongst patients with CD compared to healthy controls. No significant risk was identified for bipolar disorder or schizophrenia. The cerebellum has emerged as one of the key brain regions affected in non-motor disorders, including autism spectrum disorder and attention deficit-hyperactivity disorder. The cerebellum is the principle brain target in both CD and gluten sensitivity.
For more information: https://www.mdpi.com/2072-6643/12/1/142/htm
T-Cells Trigger Immediate Symptoms in Celiacs
Immune cells, CD4+ T cells, react to proteins in wheat, rye and barley in those with Celiac Disease (CD). This reaction is what leads to the damage in the villi of the small intestine. Cytokine activity, called interleukin-2 or IL-2, begins to climb immediately after the ingestion of gluten. As these chemicals increase, study participants felt nauseous or vomited. Doctors may be able to diagnose celiac disease by measuring IL-2 levels in the blood, sparing patients the need for tests in which they’re repeatedly given gluten. Future therapies may be able to block the gluten-reacting T cells to reduce symptoms from gluten exposure.
For more information: G. Goel et al. Cytokine release and gastrointestinal symptoms after gluten challenge in celiac disease. https://advances.sciencemag.org/content/5/8/eaaw7756 and https://www.medicalnewstoday.com/articles/326018.php#2
Early Childhood Stress and Trauma Linked to the Development of Celiac Disease
A McMaster University study highlights the need for psychosocial assessments in clinical gastroenterology practice, a step they say may improve understanding of the pathophysiology of celiac disease and care of patients with the condition. There were 44 adult participants in the study, including 25 people with celiac disease and 19 members of a control group with a similar balance of age and sex as the celiac group. Each participant completed a questionnaire on adverse events in early childhood, as well as one on current digestive symptoms.
The researchers found that people with celiac disease reported significantly more adverse events during childhood than those in the control group. The most commonly reported events were substance abuse in family members and neglectful parenting.
For more information: https://www.glutenfreeliving.com/blog/stress-in-early-life-linked-to-celiac-disease-in-adults/
Gluten Immunogenic Peptides to Monitor Children Diagnosed with Coeliac Disease During Transition to a Gluten-free Diet
97% of children have elevated gluten peptides (GIP) in their stools at CD diagnosis. GIP dropped to 13% after 6 months on the gluten-free diet. Non adherent patients had increased levels of GIP in their stools. The elevation of tTG antibody was more prolonged in patients with detectable gluten peptides in their feces after diagnosis. GIP readings in the stool may be a means to determine adherence to the GF diet and healing in the small intestine of CD patients.
For more information: https://www.medscape.com/viewarticle/914116
Risk Factors Associated with CD
An Internet-based survey based out of Columbia University in partnership with the Ontario Teachers Association was conducted among parents living in the US with at least one biological child between 3 and 12 years old. After exclusions, there remained 332 responses associated with children with CD (cases), and 241 responses associated with children who do not have CD (controls). This study is the first to find an association between skim milk consumption and CD and vitamin D drop use for greater than 3 months and CD. Further study is required in these 2 areas. It also adds to evidence that early life exposure to antibiotics and early life infection, specifically ear infection, are associated with CD.
For more information: https://www.dovepress.com/potential-risk-factors-for-celiac-disease-in-childhood-a-case-control--peer-reviewed-article-CEG
Children with a Genetic Predisposition Eating More Gluten have Higher Risk of Developing CD
A study posted in JAMA network found eating higher-than-normal levels of gluten during the first five years of life can increase a child's likelihood of developing CD. Higher gluten intake was associated with a 6.1% increased risk of CD autoimmunity, an immunological response to gluten, and a 7.2% increased risk of CD per each additional gram or gluten per day, according to the study.
Researchers evaluated more than 6,600 newborns in the United States, Finland, Germany and Sweden born between 2004 to 2010. All of the children carried a genotype associated with Type 1 diabetes and CD (HLA DQ2 and HLA DQ8 genes).
Over the course of the study, 1,216 of the children -- nearly 20% -- developed celiac disease autoimmunity, the first sign of the body's negative response to the protein, said study author Carin Andrén Aronsson, study manager at the Unit for Diabetes & Celiac Disease at Lund University in Sweden. Another 450 participants developed CD, about 7%. Most of the diagnoses occurred between the ages of 2 and 3, according to the study.
For more information: https://jamanetwork.com/journals/jama/article-abstract/2747670?resultClick=1 and https://www.sciencedaily.com/releases/2019/08/190814093858.htm
Burden of Depressive and Bipolar Disorders in CD
This study found that major depressive disorders had higher incidence in CD patients compared to the controls by 30% compared to 8.3%. Panic disorders were found in 18.3% of CD patients versus 5.4% of the control group. The comorbidity with these disorders is the key determinant of impaired quality of life in CD. A preventive action on mood and anxiety disorders in patients suffering from CD is required. Also screening for CD in people with affective disorders and showing key symptoms or family history of CD is recommended.
For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763959/ Clin Pract Epidemiol Ment Health. 2015; 11: 180–185.
Silent CD Common in Relatives Celiacs
Mayo Clinic researchers have found that first-degree relatives of patients with CD frequently have the condition, too - often without any symptoms. They found that 44% of close relatives who were given a blood test to test for CD, also had the disease. This study shows that testing asymptomatic close relatives of those with CD is important.
For more information: https://www.reuters.com/article/us-health-celiac-relatives-idUSKBN1W81RE
Neurologic Deficits in Patients with Newly Diagnosed Celiac Disease Are Frequent and Linked with Autoimmunity to Transglutaminase 6
In a study headed by Dr. Mario Hadjivassiliou, the following neurologic deficits were found in the study of 100 diagnosed patients of CD.
Gait instability 24%
Persisting sensory symptoms 12%
Frequent headaches 42%
Gait ataxia 29%
Involuntary eye movement 11%
Distal sensory loss 10%
Sixty percent of patients had abnormal results from magnetic resonance imaging, 47% had abnormal results from MR spectroscopy of the cerebellum, and 25% had brain white matter lesions beyond that expected for their age group. Antibodies against TG6 were detected in serum samples from 40% of patients.
For more information: https://www.cghjournal.org/article/S1542-3565(19)30278-2/fulltext
Genetic Risk for Autoimmunity is Associated with Changes in the Gut Microbiome
HLA gene alleles (CD they are HLA DQ2 and HLA DQ8) have significant effect on the bacterial composition of the infant gut based on a study of 17K newborns. For Type 1 diabetes this if the first time that HLA genetic risk of developing autoimmunity has been associated with changes in the microbiome. Certain species of gut bacteria have protective effects against autoimmunity and may be useful in future treatment to prevent autoimmune disease.
For more information: https://www.nature.com/articles/s41467-019-11460-x
Study Shows High Rates of CD Antibodies in Adult Rheumatology Patients
An international study screened 230 rheumatological patients for CD. 3% of patients showed elevated tTG IgA antibodies indicating screening for CD may be important in those with Rheumatoid Arthritis
For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040033/
Do Families Who Have a Celiac in the Family Require Toasters?
Gluten levels remained at less than 20 ppm when gluten-free bread was toasted in the same toaster as regular bread, across repeated tests and even when gluten-containing crumbs were present at the bottom of the toaster. The study was led by Jocelyn Silvester, M.D., Ph.D. FRCPC, director of Research for the Celiac Disease Program at Boston Children's Hospital who led the study's biostatistical analysis.
A video by Alessio Fasano indicates caution should still be used as a high percentage of patients are not healing. Potentially more study is needed in this area as study stated that “may” not always. The paper deserves follow-up however it may not translate into relaxing what celiacs have been doing to avoid cross-contamination.
For more information: https://www.sciencedaily.com/releases/2019/09/190930131557.htm and Dr. Alessio Fasano Video Cross Contamination Guidelines https://www.youtube.com/watch?v=IeFnq-xpn68 Oct 11, 2019
Risk of Other Autoimmune Diseases in Treated CD Patients
249 celiac patients following a gluten-free diet during the study period were matched with 498 control subjects. 85 celiac patients and 170 control subjects were boys.
After five years, 5.0% of patients with celiac disease and 1.3% of controls had a new autoimmune disorder diagnosis. Treated celiac patients face an elevated risk of developing autoimmune disorders. The risk of a new autoimmune disorder is higher in children, especially when more than one autoimmune disorder diagnosis exists.
For more information: https://journals.lww.com/jpgn/Abstract/2019/10000/The_Risk_of_Autoimmune_Disorders_in_Treated_Celiac.10.asp
Bone Health of Adults with Undiagnosed CD
Adults with probable undiagnosed celiac disease had lower bone density than those without celiac disease, even though they reported higher calcium intake and nutritional density of calcium and phosphorus.
For more information: https://www.ncbi.nlm.nih.gov/pubmed/31322483
Use of Fecal Gluten Immunogenic Peptides (GIP) to Monitor Children Diagnosed with Coeliac Disease During Transition to a Gluten-free Diet
97% of children had detectable gluten peptides at diagnosis. On a gluten-free diet at 6 months this dropped to 13% of children, however increased to 25% at 24 months. This suggests that gluten exposure was intentional. The elevation of tissue transglutaminase antibody was more prolonged in patients with detectable gluten peptides. Adolescence is a developmental phase characterized by rebellion and teenagers may be particularly susceptible to the burden of a GFD related to stigmatization and are more likely intentionally non-adherent in such settings. Teenagers are more likely to eat out and are therefore subject to more cross contamination. It is therefore important to diagnose CD as soon as possible to avoid the years when social issues become a problem. The introduction of GIP as an assessment tool of GFD adherence may help to ascertain dietary compliance and reduce the need for additional invasive investigations on follow-up.
For more information: Aliment Pharmacology and Therapeutics. 2019;49(12):1484-1492
Vitamin Deficiencies May Be the Only Sign of Celiac Disease
In a Mayo Clinic proceeding, June 2019, Dr. Joseph Murray, study coauthor and a professor of medicine at the Mayo Clinic in Rochester, Minnesota, indicated that "People have preconceived ideas of what celiac disease looks like. They expect to see patients who because of nutrient malabsorption and diarrhea will end up being skinny with lots of deficiencies. But now we have lots of patients who haven't lost weight - and many who are quite overweight - but still have micronutrient deficiencies. While they are not losing calories, they are not absorbing some vital nutrients."
Low levels of certain micronutrients, in particular iron, vitamin D and zinc can cause telltale fatigue, that may be the only symptoms of CD. In a study of 309 adults, zinc was deficient in 59.4% of those with celiac versus 33.2% of controls; copper was low in 6.4% of celiac patients versus 2.1% of controls, folate was low in 3.6% of celiac patients versus 0.3% of controls and vitamin B12 was low in 5.3% of celiac patients versus 1.8% of controls. Among celiac patients, iron was low in 30.8%, but there were no controls with iron measurements to compare to. And contrary to traditional assumptions about celiac and thinness, weight loss was seen in just 25.2% of patients diagnosed with the disease.
For more information: Article by Linda Carroll, June 26, 2019, Reuters Health http://bit.ly/2XCi8Wq
Early-Life Gluten Intake Linked to Increased Risk of Celiac Disease
"We found that 1-year-olds in the highest third of gluten intake had a two-fold increased relative risk of developing celiac disease autoimmunity (CDA), a potential prodromal stage of celiac disease," said Dr. Karl Marild from the Norwegian Institute of Public Health, in Oslo, Norway, and Queen Silvia Children's Hospital, in Gothenburg, Sweden. Compared with 1-year-olds in the lowest third of gluten intake, those in the highest third had a 96% increased risk of CD (P=0.09) and a significant 2.17-fold increased risk of CDA. The study was done on 1,875 children who were at risk of developing CD in the Denver area of the US.
For more information: American Journal of Gastroenterology, https://bit.ly/2x5ICRo
Association Between Antibiotics in the First Year of Life and Celiac Disease
The intestinal microbiota is believed to be involved in the pathogenesis of celiac disease, in addition to genetic variants and dietary gluten. The study collected information from 1.7 million children, including 3, 346 diagnosed with CD. Exposure to antibiotics was identified if the child took antibiotics in the first year of life. The study found that risk of CD increased for those exposed to antibiotics in their first year of life and it also increased more with each prescription for antibiotics in the first year. Further research is required in this area.
For more information: Gastroenterology, June 2019 Volume 156, Issue 8, Pages 2217–2229
Human Gut Derived-organoids Model to Study Gluten Response and Effects on Microbiome in Celiac Disease
Using intestinal organoids developed from duodenal biopsies from both non-celiac (NC) and celiac (CD) patients, the study explored the contribution of gut epithelium to CD pathogenesis and the role of microbiota-derived molecules in modulating the epithelium’s response to gluten. When compared to NC, RNA sequencing of CD organoids revealed significantly altered expression of genes associated with gut barrier, innate immune response, and stem cell functions. The study concluded that: (1) patient-derived organoids faithfully express established and newly identified molecular signatures characteristic of CD. (2) microbiota-derived bioproducts can be used to modulate the epithelial response to gluten. Finally, the study validated the use of patient-derived organoids monolayers as a novel tool for the study of CD (mini-gut models).
For more information: https://www.nature.com/articles/s41598-019-43426-w
Potential Risk Factors for Celiac Disease in Children
This study found a connection between skim milk consumption, and vitamin D drop use for more than 3 months, and later development of celiac disease. It also found evidence to support earlier data that early life exposure to antibiotics and early life infection, especially ear infection, are also associated with the development of celiac disease in children.
For more information: https://www.dovepress.com/potential-risk-factors-for-celiac-disease-in-childhood-a-case-control--peer-reviewed-article-CEG Published July 4, 2019
Gluten inequality? Report finds two thirds of coeliac sufferers in Italy are female
Women, who have more reactive immune systems than men, are more susceptible to coeliac disease, says the Italian Ministry of Health.
For more information: https://www.foodnavigator.com/News/Science/Gluten-inequality-Report-finds-two-thirds-of-coeliac-sufferers-in-Italy-are-female 25-Feb-2019 By Flora Southey
Anxiety Might be Alleviated by Regulating Gut Bacteria
People who experience anxiety symptoms might be helped by taking steps to regulate the microorganisms in their gut using probiotic and non-probiotic food and supplements.
The authors say one reason that non-probiotic interventions were significantly more effective than probiotic intervention was possible since changing diet (a diverse energy source) could have more of an impact on gut bacteria growth than introducing specific types of bacteria in a probiotic supplement.
For more information: https://www.sciencedaily.com/releases/2019/05/190520190110.htm
Adults over 50, Newly Diagnosed with CD Have Greater Risk of Some Cancers
A Dutch study of medical records between 1994 and 2014 correlated the diagnosis of CD and malignancies associated with lymphoma and GI tract cancers and found them to be higher in CD patients. T-cell lymphoma, small bowel carcinoma and esophageal carcinoma had elevated risks although the absolute risks of the diseases were low.
For more information: https://journals.sagepub.com/doi/full/10.1177/2050640618800540
United European Gastroenterology Journal
Advances in the Understanding of How Microbes Promote Food Sensitivity
New findings suggest that enzymes produced by opportunistic pathogens and certain bacteria within the gut can trigger host immune responses that could increase susceptibly to food sensitivities.
McMaster University have been completing research into gluten digestive processes. In a recent study published in Nature Communications and led by Dr. Elena Verdu of McMaster’s Farncombe Institute, Dr. Caminero identified additional pathways by which the opportunistic pathogen incites gluten sensitivity, but which are independent of gluten metabolism. “Biopsies from celiacs had more bacteria that were able to use gluten as an energy source,” said Verdu.
When “HLA-DQ8” mice were colonized with the protease-producing P. aeruginosa, the bacterial proteolytic activity synergized with gluten to induce more severe inflammation and intestinal damage.
For more information: https://www.gutmicrobiotaforhealth.com/en/advances-in-the-understanding-of-how-microbes-promote-food-sensitivity/ and Caminero A, McCarville JL, Galipeau HJ, et al. Duodenal bacterial proteolytic activity determines sensitivity to dietary antigen through protease-activated receptor-2. Nat Commun. 2019; 10:1198. doi: 10.1038/s41467-019-09037-9.
Family Screening for Relatives of Celiac Patients
Even patients without symptoms benefit from going gluten free because they have fewer digestive problems, less intestinal damage and less anxiety about the illness. Studies estimate the disease affects 10 percent of people who have a first-degree relative with celiac. To achieve earlier diagnosis, guidelines recommend screening parents, siblings and children of those with celiac.
For more information: https://www.glutenfreeliving.com/gluten-free/celiac-disease/family-screening-for-relatives-of-celiac-patients April 22, 2019
High Fiber During Pregnancy Reduces Risk of Celiac Disease in Children
“Experts from Norway found that the risk of pediatric coeliac disease was 8% lower per 10g increase in fiber intake during pregnancy. For those with the highest fiber intake (>45 grams per day), the risk was 34% lower in comparison to the lowest fiber intake (<19 grams per day). High fiber intake from fruits and vegetables, rather than from cereals, were associated with the lowest risk.”
For more information: https://www.eurekalert.org/pub_releases/2019-06/sh-hfd053019.php
Understanding Prebiotics and Fiber
For a great infographic on this topic see: https://www.gutmicrobiotaforhealth.com/en/the-different-ways-that-prebiotics-and-fiber-affect-the-gut-microbiota/
Study Supports Celiac Screening for Long-Term Health
A study in Bologna, Italy supported controversial testing of adults for CD due to an important long-term health benefit. Screened patients had a significantly lower rate of bone disease: 31.3 percent compared to 46 percent in other patients. They were also less affected by anemia. The authors advocate screening adults to help diagnose the large hidden population of celiac patients. Improved health and reduced medical costs later would balance costs of testing.
For more information: https://www.glutenfreeliving.com/gluten-free/celiac-disease/study-supports-celiac-screening-for-long-term-health/
Micronutrient Deficiencies: Researchers Discover Change in Celiac Disease Symptoms
Micronutrient deficiencies, including vitamins B12 and D, as well as folate, iron, zinc and copper, are common in adults with celiac disease and must be addressed at that time of diagnosis, according to a new study. July 2, 2019 by Nikki Cutler
For more information: https://www.nutraingredients.com/Article/2019/07/02/Micronutrient-deficiencies-Researchers-discover-change-in-celiac-disease-symptoms
Canadian Celiac Association Announce Changes to the Gluten Challenge
See new guidelines for health professionals for requirements for blood testing for CD and how to test for CD in those individuals who may have been following a gluten-free diet.
For more information: https://www.celiac.ca/healthcare-professionals/diagnosis/gluten-challenge/
Bipolar Disease and Celiac Disease
Those with CD are 17 times more likely to suffer from bipolar disease. Given the high frequency of mood disorders and anxiety disorders in celiac disease and the fact that celiac disease itself has a significant frequency in the general population, a screening of celiac disease is recommended to all the people with affective disorders.
For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763959/
A Study Links Enterovirus Infection and Celiac Disease
Norwegian researchers have found that genetically susceptible youngsters who contracted an enterovirus infection between the ages of three months and three years were significantly more likely to develop celiac disease. They examined stool samples to detect the viral infection. This is consistent with prior research findings.
Infections with adenovirus had no effect on the risk of celiac disease. The damaging enterovirus infections were those that occurred after the child was already eating foods containing gluten. If they occurred before gluten exposure, they did not seem to increase the risk. Babies who were still getting breast milk as an important part of their diets appeared to be protected. Most of the infections did not cause symptoms. The Norwegian scientists looked specifically for Enteroviruses A, B, C and D. Only A and B infections were common. This is where they found the link between infection and celiac disease developing later.
For more information: Kahrs et al, BMJ, Feb. 14, 2019 https://www.bmj.com/content/364/bmj.l231
Celiac Teens Twice as likely to Have Eating Disorders
“Researchers found that 19% of female teens and 7% of male teens with CD exhibited eating disorders, compared to 8% and 4% of adolescents who did not have CD.” by Tel Aviv University, medicalexpress.com 1 “These eating patterns can lead to a failure to meet nutritional and metabolic needs, which cause severe impairment to psychosocial functioning,” Dr. Tokatly-Latzer continues. “Primary care physicians and gastroenterologists who encounter adolescents with CD should increase their awareness to the possibility of this population having disordered eating behavior. Once the suspicion is raised, they can refer them for psychological and nutritional treatment.”
For more information: https://medicalxpress.com/news/2019-02-adolescents-celiac-disease-higher-disorders.html
Nexvax2 in Phase II Trials Look Promising
Nexvax2, a vaccine that will work like allergy shots, is being developed for Celiac treatment. ImmusanT is will develop tolerance levels in individuals with Celiac Disease so there is minimal immune reaction to gluten exposure. As this is like traditional vaccines, the path for testing and approval will be easier and therefore may get approval for the marketplace sooner.
For more information: https://www.celiac.com/articles.html/celiac-disease-diagnosis-testing-amp-treatment/celiac-vaccine-nexvax-2-could-be-a-big-deal-for-disease-sufferers-r4715/
Can IL17A and IL21 Gene Expression and Trx Levels in Celiac Patients Be Used as Diagnostic Biomarkers?
In the future, doctors might be able to check to see if you have certain genes, and maybe look at your levels of Thioredoxin (Trx), an extracellular regulator of TG2 activity, to determine whether you have celiac disease.
For more information: Genetic Testing and Molecular Biomarkers, Volume 22, Number 9, 2018, DOI: 10.1089/gtmb.2018.0128 https://www.ncbi.nlm.nih.gov/pubmed/30183349
Celiac Disease Can Cause Irreversible Changes to Immune Cells
A Cardiff University study found that immune cells in the bowel of those with Celiac Disease are permanently replaced by a subset of cells that promote inflammation. “Under normal circumstances, T cells have a protective role in the bowel and form a stable population.” In CD the T cells in the small intestine react to gluten and cause inflammation.
Dr. Bana Jabri, study author from the University of Chicago, explained: “Chronic inflammation caused by gluten causes an immunological scar that results in the loss of intestinal resident immune (gamma delta T cell) subset that has an important role in tumor surveillance and fighting against infection.” This means that the damage caused by gluten results in the permanent loss of these beneficial immune cells in celiac patients.
While a strict, gluten-free diet can alleviate many of the short-term symptoms of celiac disease, the diet alone is not enough to undo the permanent damage to the intestine.
Dr. Jabri noted, “This immune subset is partially preserved in children, suggesting that early intervention may rescue this cell subset.” Early diagnosis and treatment of celiac disease may be able to save some of these beneficial cells and prevent additional permanent damage to the bowel.
For more information: https://www.sciencedaily.com/releases/2019/02/190214100033.htm Cardiff University, February 14, 2019 and https://celiac.org/about-the-foundation/featured-news/2019/02/chronic-inflammation-permanently-alters-immune-cells-in-celiac-patients
Novel Breath Test Could Pave New Way to Measure Gut Health
Blowing into a glass tube may be able to replace the more invasive endoscopy currently used to diagnose Celiac Disease. Flinders University researchers will trial the new Dipeptidyl peptidase-4 (or 'DPP4') breath test in a pilot study to measure a digestive enzyme found in the small intestine and is associated with gastrointestinal damage and celiac disease. "Some research groups have suggested that DPP4 is involved in the breakdown of gluten, and that people with celiac disease have a reduced amount of the DPP4 enzyme along their small intestine. However, the tools to measure this in celiac disease have not been available," Dr Yazbek says.
For more information: https://www.news-medical.net/news/20190320/Novel-breath-test-could-pave-new-way-to-non-invasively-measure-gut-health.aspx
New Feeding Guidelines for Infants at Risk of Celiac Disease
The University of Chicago, Impact Magazine, provides the latest information on feeding infants at risk of CD. Key findings of recent research include: large amounts of gluten in the first two years favors the onset of CD, so during the first 2 years gluten should be less than 5 grams/day (about 1 slice of bread); follow a Mediterranean diet with vegetables and grains, but low consumption of refined cereals and sweet beverages.
For more information: http://www.cureceliacdisease.org/wp-content/uploads/CdC_Newsletter_IssueOne_032019_v7.pdf
The Effect of Depressive Symptoms on the Association between Gluten-Free Diet Adherence and Symptoms in Celiac Disease
A study out of Columbia University and The Celiac Disease Foundation found that of 519 biopsy-diagnosed patients found that 46% reported having depressive symptoms. The results indicate that the relationship between celiac disease symptoms and dietary adherence may be diminished by the presence of depressive symptoms. This finding was confirmed with a linear regression analysis, showing that depressive symptoms may modify the effect of a GFD on celiac symptoms. In those without depression, symptoms more strongly correlated with dietary adherence than in those with depressive symptoms. Depressive symptoms may therefore mask the relationship between inadvertent gluten exposure and symptoms. Additional longitudinal and prospective studies are needed to further explore this potentially important finding.
For more information: Nutrients 2018, 10(5), 538; https://doi.org/10.3390/nu10050538
Mental Health and Celiac Disease
There are over 200 symptoms of celiac disease that can affect the body physically and mentally. Depression can be a mental manifestation of celiac disease. The prevalence of depression among patients with celiac disease has been reported to be between 6% and 57%, with conflicting findings regarding whether depression is more common in celiac patients than in the general population.
As it is Mental Health Awareness Month, here at the Vancouver Chapter we encourage you to voice your concerns with trusted healthcare providers and recognize when you are feeling down.
Read more about Mental Health and Celiac at: https://celiac.org/about-the-foundation/featured-news/2019/04/how-depression-affects-the-relationship-between-celiac-symptoms-and-diet-adherence/Do Celiacs Suffer from Headaches More?
A UK study looked at scientific articles from 1987 to 2017 found that the prevalence of headaches in adults with celiac disease was 26 percent and in children with celiac disease, 18 percent. More than 42,000 patients with either celiac disease or headaches with an unknown cause were followed in the studies. Headaches associated with celiac disease are predominantly migraines, but lack of specific information on the type of headache found in some articles made interpretation of the results less clear.
Up to 75% of adults and 71% of children saw their headaches reduced on a gluten-free diet.
For more information: https://www.beyondceliac.org/research-news/View-Research-News/1394/postid--112419/
New Blood Test May Help Monitor Celiac Disease Activity
A study at the Mayo Clinic is very promising in identifying and managing Celiac Disease. "We identified immunogenic epitopes of the tTG-DGP (tissue transglutaminase-deamidated gliadin-derived peptide) complex and found that an assay to measure the immune response to epitopes accurately identified patients with celiac disease, as well as patients with mucosal healing," the authors write in Gastroenterology, online October 17, 2018. The study was broad and looked at 85 patients with celiac disease that was treated and healed, 81 patients with treated but unhealed celiac disease (who had villous atrophy despite maintaining a gluten-free diet), 82 patients with untreated celiac disease, as well as 27 disease controls (who had villous atrophy without celiac disease) and 217 healthy controls.
Dr. Joseph Murray, the senior author on the study, agreed with Dr. Choung that this assay may make diagnosis easier, improve management, and avoid the need for follow up biopsies. "Indeed," he said, "we could move to a strategy that avoids biopsy for both diagnosis and follow-up, although a lot more work is needed for that to happen." This is new work and more study is required.
For more information: https://www.mdlinx.com/internal-medicine/top-medical-news/article/2018/11/16/7549414
What is really behind gluten sensitivity?
This is a very interesting article that looks at two different theories as to the cause of gluten sensitivity.
First, Alaedini, contacted researchers at the University of Bologna in Italy and he studied 80 patients who had been identified as gluten sensitive based on a gluten challenge. He wished to study the immune response but did not expect to see one. He found that these individuals had high levels of a class of antibodies against gluten that was short lived. “For Alaedini, the beginnings of a mechanism emerged: Some still-unidentified wheat component prompts the intestinal lining to become more permeable. (An imbalance in gut microbes might be a predisposing factor.) Components of bacteria then seem to sneak past immune cells in the underlying intestinal tissue and make their way to the bloodstream and liver, prompting inflammation.”
The other competing theory is FODMAPs. Initially observed by Dr. Peter Monash, in Melbourne Australia. He showed that only FODMAP symptoms were statistically significant (but barely). Carbs in wheat called fructans can account for as much as half of a person's FODMAP intake.
Dr. Elena Verdù, President of the North American Society for the Study of Celiac Disease, believes careful research will ultimately break through to find answers. This year the organization awarded its first grant to study nonceliac wheat sensitivity. She's hopeful that the search for biomarkers like those Alaedini has proposed will show that inside the monolith of gluten avoidance lurk multiple, nuanced conditions. "It will be difficult," she says, "but we are getting closer."
For more information: https://www.sciencemag.org/news/2018/05/what-s-really-behind-gluten-sensitivity
FDA Gives Approval to Fast Track Nexvax2
Nexvax2 is a therapeutic vaccine being investigated in a Phase 2 study, which is currently recruiting 150 patients in the United States, Australia and New Zealand for participation in a clinical trial. Nexvax2 is being developed to be used in addition to the gluten-free diet to provide protection from inadvertent gluten exposure, for example from cross-contact when dining out.
“Celiac disease is a life-changing condition that causes significant health problems due to cumulative damage from chronic and repetitive bouts of gluten-triggered inflammation,” said Ken Truitt, M.D., chief medical officer for ImmusanT. “Using a novel panel of celiac disease-associated immunological markers, identified in early clinical studies, we can follow both acute symptoms and the underlying inflammatory response following gluten exposure. This helps monitor Nexvax2’s effectiveness in altering the disease process.”
For more information: https://www.beyondceliac.org/research-news/View-Research-News/1394/postid--112674/ Article by Amy Ratner.
New at Home Test for Celiac Disease
A new at-home celiac disease test is being launched Microdrop Health, a Houston company. It is only available in the US and could help patients get their doctors to more quickly take the steps needed for CD diagnosis.
Called imaware™, the test measures the same antibodies to gluten as the tests that doctors use in their offices as the first step to diagnose celiac disease -- anti-tissue transglutaminase (tTG) and deaminated gliadin peptide (DGP) tests.
For more information: https://www.beyondceliac.org/research-news/imaware-home-celiac-test-launches/ Article by Amy Ratner.
Larazotide Acetate Reduces Intestinal Permeability
Innovate Biopharmaceuticals, in a new preclinical study, assessed the effects of larazotide acetate on intestinal permeability and found it triggered a clear reduction in gut barrier permeability which could have implications for celiac disease.
For more information: https://www.celiac.com/articles.html/celiac-disease-diagnosis-testing-amp-treatment/larazotide-acetate-reduces-intestinal-permeability-in-a-nash-preclinical-study-r4653/
What’s the Relationship Between Celiac Disease and Endocrine Autoimmunity?
Between 10% and 30% of patients with celiac disease (CD) test positive for thyroid and/or Type 1 diabetes antibodies. 5% - 7% of patients with autoimmune thyroid disease and /or Type 1 diabetes for IgA anti-tissue transglutaminase antibodies, the antibodies associated with CD. CD and endocrine autoimmunity share common genetics, the HLA DQ2 and HLA DQ8 genes. Conclusions of the study were those with celiac disease should be tested for Type 1 diabetes and autoimmune thyroid disease.
For more information: https://www.sciencedirect.com/science/article/abs/pii/S1568997218302301?via%3Dihub
Incidence of Refractory Celiac Disease May be Higher than Previously Thought
Dr. Shailaja Jamma, MD and Dr. Daniel Leffler, MD, MS stated reasons for not responding favorably to the gluten-free diet. Recovery times vary from person to person and if the patient is improving continually non-responsive CD is usually an unnecessary label. The most common causes are gluten exposure, Irritable Bowel Syndrome, lactose intolerance, fructose malabsorption, microscopic colitis and small intestinal bacterial overgrowth. “Rare” is actual refractory CD, as is pancreatic exocrine insufficiency, motility disturbances where food moves too quickly or slowly through the intestine, food allergy and cancer which is very rare. Refractory CD responds favorably to a thiopurine medication versus steroids that used to be the main treatment.
For more information: https://www.celiac.com/articles.html/journal-of-gluten-sensitivity/journal-of-gluten-sensitivity-summer-2011-issue/incidence-of-refractory-celiac-disease-may-be-higher-than-previously-thought-r4657
Cystic Fibrosis Transmembrane Conductance Regulator Plays a Key Role in Celiac Disease
Exactly how gliadin causes problems with the intestinal mucosal defenses in CD is poorly understood. CFTR, cystic fibrosis transmembrane conductance regulator is an anion channel important for epithelial (gut cell wall) adaptation to cell-autonomous or environmental stress. The function of CFTR is reduced when energy production in the cell is reduced. CFTR plays a central role in gliadin (protein in wheat) activities and shows potential for new treatments for CD. Intestinal handling of dietary proteins usually prevents local inflammatory and immune responses and promotes oral tolerance. However, this is not the case for those with CD.
For more information: http://emboj.embopress.org/content/early/2018/11/28/embj.2018100101
Celiac Disease “Symptoms” May Not Accurately Determine Gluten Exposure
A presentation given at the American College of Gastroenterology Association, concluded the patients of celiac disease had difficulty determining if they had ingested gluten based on their symptoms. A study from the Mayo Clinic recruited 14 patients with celiac disease and 14 healthy controls for the trial. Each patient randomly received 6 grams of gluten suspension or a placebo. They received a questionnaire to understand their symptoms (if any) at the start of the study and then were asked to monitor symptoms every 30 minutes to 60 minutes for 6 hours and then daily for 3 days and were asked if they believed they had received gluten. Only 2 of the 7 patients who received the gluten suspension identified that they had received it. There was no statistical difference in symptoms in the gluten celiac disease group compared with the placebo celiac disease group. Most symptoms were nausea and abdominal pain.
Amanda K. Cartee, MD, stated that the symptoms were non-specific and based on this small sample seemed like an unreliable way to self-diagnose and identify gluten exposure.
For more information: Healio Gastroenterology, October, 17, 2018 https://www.healio.com/gastroenterology/malabsorption/news/online/%7B80aad70a-f6df-4e87-a348-ec3b523f312b%7D/patients-with-celiac-disease-have-trouble-determining-gluten-exposure-based-on-symptoms
Aging Celiac Patients and Osteoporosis
A systematic review of 54 CD patients revealed some interesting things about the correlation between aging with celiac and developing bone related conditions. The study found that out of 54 cases, 14.4% of patients developed osteoporosis and 39.6% developed osteopenia, which is the reduction of bone mass. While more tests are needed, this study brings up interesting areas to devote attention to, including our calcium intake, exercise, and balanced dieting, which can certainly be a challenge for many of us.
For more information: https://www.ncbi.nlm.nih.gov/pubmed/30732599
Effect of Celiac Disease in Pregnancies
In a recent Danish population-based survey that compared women with CD and women without it during their pregnancies revealed some interesting information. No significant difference was seen in the pregnancy outcomes between women with and without CD; however, women with CD were slightly more at risk of miscarriages or stillbirths, prior to being diagnosed with celiac disease. This shows the importance of early stage detection and diagnosis of CD, as it can have damaging effects during pregnancy.
For more information: https://www.medscape.com/viewarticle/900457
Gluten in our toothpaste!
The Journal of Pediatric Gastroenterology and Nutrition recently published a study that investigated the presence of gluten in our toiletry items, including toothpastes, lipsticks, mouthwashes and lip balms. In testing 66 different items, it was found that 94% of those advertised as gluten-free were actually gluten free, meaning <20 ppm gluten. This shows that there is not a major threat in gluten contaminated dental/cosmetic products, but you must exercise caution when purchasing gluten-free items.
For more information: https://journals.lww.com/jpgn/Abstract/2019/01000/Contribution_of_Oral_Hygiene_and_ Cosmetics_on.7.aspx
Vaccine Advancement in the resistance to gluten
Currently, there are no FDA-approved drugs for the treatment of celiac disease. While adhering to a strict gluten-free diet yields success, it can definitely be a challenge. A novel vaccine called Nexvax2 is entering the clinical trial phase in the U.S. The vaccine functions by stimulating the body’s own immune system with the HLA DQ2.5 gene in approximately 90% of celiac patients through signaling. Once this treatment is approved from clinical trials, you might be seeing it in doctors’ offices, and advertised everywhere, but only time can tell when, or if this will happen.
For more information: https://celiac.org/about-the-foundation/featured-news/2019/01/nexvax2-therapeutic-vacci ne-fast-tracked-by-fda/
Prevalence and Risk of Epilepsy in Celiac and Gluten-Sensitive Patients
Previous studies have found celiac disease to be associated with neurological complications. The article below concludes that out of 79 published articles of CD patient data and epileptic episodes, epilepsy occurred 1.8 times more in CD patients than the general populations. However, it was concluded that sticking to the strict gluten-free diet helped mitigate the neurological symptoms of epilepsy.
For more information: https://celiac.org/main/wp-content/uploads/2018/10/epilepsy-and-GS-2.pdf
Celiac disease and eosinophilic esophagitis linked
A large analysis of more than 35 million patients found an intriguing connection between celiac disease and eosinophilic esophagitis (EoE). Out of the 15,000 patients in a database pulled from 360 U.S. hospitals who had been diagnosed with EoE, 2 percent also had celiac disease. The numbers translate into a likelihood nine times larger of finding celiac disease in a patient with EoE compared to a patient in the normal population.
For more information: https://www.allergicliving.com/2018/06/07/whats-the-link-between-eoe-and-celiac-disease/
Prebiotics can help celiac symptoms
Research published in the Journal of Clinical Gastroenterology found that a 6-week probiotic treatment is effective in improving the severity of IBS-type symptoms in celiac disease patients on strict GFD, and is associated with a modification of gut microbiota, characterized by an increase of bifidobacteria.
For more information: https://www.ncbi.nlm.nih.gov/pubmed/29688915
Viruses can lead to activated celiac disease
A growing body of research suggests that viral DNA or proteins introduced into the body can contribute toward the development of serious diseases long after the initial viral infection has passed. And now, research by a team from the Cincinnati Children’s Hospital shows that exposure to the Epstein-Barr virus (EBV), best known for causing mononucleosis, appears to boost the risk of developing seven other diseases in individuals who inherited predisposing gene variants – including celiac disease.
For more information: http://www.iflscience.com/health-and-medicine/the-virus-that-causes-mono-linked-to-seven-autoimmune-diseases/
Questioning the link between antibiotics and celiac
In contrast with existing research, a recent study published in the journal Jama Pediatrics found that antibiotics taken during a child’s first four years of life were not associated with the development of celiac disease or type 1 diabetes, even if the child was genetically predisposed to the development of either condition.
For more information: https://mykidsfoodallergies.com/is-there-a-link-between-childhood-antibiotic-use-and-celiac-disease/
Celiac disease can indeed strike anytime in life
From childhood to late life, diagnosis of celiac disease is critical and should not be ignored. That’s the message for patients and healthcare providers from two recent studies. In the first, researchers from Italy concluded that the number of patients with celiac disease worldwide is increasing, “thanks to better environmental conditions that allow children with celiac disease to survive longer.” In the second, scientists from Finland and the United Kingdom found that one in four celiac disease diagnoses is made in people 60 years or older. Still, 60 percent of patients remain undiagnosed because their symptoms, including tiredness, indigestion and reduced appetite, are blamed on older age itself.
For more information: https://www.beyondceliac.org/research-news/View-Research-News/1394/postid--106300/?utm_content=69946060&utm_medium=social&utm_source=twitter
Gluten-free food not so gluten free in Melbourne
A first of its kind study led by Institute researchers and City of Melbourne environmental health officers has detected potentially harmful levels of gluten in foods sold and served as ‘gluten-free’ across Melbourne, Australia. The undercover study revealed one in 11 samples of ‘gluten-free’ food tested were contaminated with gluten at levels that could prove harmful to people with celiac disease.
For more information: https://www.wehi.edu.au/news/illuminate-newsletter/june-2018/melbourne-gluten-free-study
US study finds restaurant gluten-free food not always gluten-free
Based on more than 5,600 gluten tests over 18 months, the investigators determined that 27 percent of gluten-free breakfast meals contained gluten. At dinner time, this figure hit 34 percent. The rise could reflect a steady increase in gluten contamination risk as the day unfolds, the researchers said.
For more information: https://www.webmd.com/digestive-disorders/celiac-disease/news/20181008/study-some-gluten-free-restaurants-fall-short#1
New drug may keep celiacs gluten free
An experimental new drug may provide relief to celiacs who happen to ingest gluten. The AMG 714 antibody leads to fewer symptoms after gluten exposure by blocking interleukin 15. A randomized, double-blind, placebo-controlled, phase 2 study was conducted to test the drug's effectiveness. The study showed that the AMG 714 had an effect on the groups of participants who received the drug and the gluten challenge when compared to the placebo group who received no drug. Both a reduction in reported symptoms occurred as well as a decrease in injury to the intestinal lining. Further testing is underway.
For more information: https://www.acsh.org/news/2018/05/22/new-drug-may-keep-those-celiac-disease-gluten-free-12996
Current procedures may underreport celiac disease
Currently accepted indications for celiac disease testing fail to discriminate between patients with and without undiagnosed celiac, according to a case-control study in Alimentary Pharmacology and Therapeutics. Although almost 40% of a 400-patient cohort had at least one testing indication, the study found that fewer than 5% of the patients were tested for celiac disease -- suggesting, the authors said, a strong need for alternative methods of detecting symptomatic celiac disease.
For more information: https://www.medpagetoday.com/gastroenterology/generalgastroenterology/72979
Ensuring dietary compliance among children and teenagers
New research on children and adolescents with celiac disease examined their dietary habits to determine the factors responsible for non-adherence to a gluten-free diet. Compliance with the diet is difficult at all ages but particularly for teenagers due to social, cultural, economic, and practical pressures.
For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5775619/
Urine as a gluten indicator?
A research study presented at the 16th International Celiac Disease Symposium (ICDS) in Prague shows that gluten presence in urine correlates with mucosal damage. Researchers from Biomedal Life Science were able to identify whether a person has ingested gluten by detecting the presence of gluten immunogenic peptides in urine. This was the first time a urine test has been used to monitor compliance with the gluten-free diet.
For more information: https://www.celiac.com/articles.html/celiac-disease-gluten-intolerance-research/new-urine-test-can-spot-gluten-in-celiac-patients-r4475/
Can a gluten-free diet normalize Vitamin D levels for celiac patients?
A study in Salerno, Italy found that Vitamin D levels for celiac patients fell back to normal levels after following a gluten-free diet without any additional supplementation.
For more information: https://www.ncbi.nlm.nih.gov/pubmed/29773507
Gluten-free diet likely improves neuropathic pain in patients with gluten neuropathy
A study in the UK, including Dr. Hadjivassiliou, studied patients with gluten neuropathy. When the patients followed a strict gluten-free diet their odds of peripheral neuropathic pain were reduced by nearly 90%.
For more information: https://www.ncbi.nlm.nih.gov/pubmed/30032386
The real challenge: avoiding gluten
A presentation at Digestive Week provided information on a study looking at inadvertent exposure to gluten by persons with CD. Silvester and colleagues did a “doggie bag” analysis of samples of processed or cooked food consumed by study participants. 33% of the food samples had >20 ppm of gluten.
For more information: https://www.medscape.com/viewarticle/899861
Celiac patients have higher risk of non-alcoholic fatty liver disease (NAFLD)
More than one-third of CD patients adhering to a GFD had concurrent NAFLD, accounting for a three-fold increased risk compared to the general population. Dietary advice provided using a patient-tailored approach should assist CD patients with NAFLD in achieving an appropriate nutritional intake whilst reducing the risk of long-term liver-related events.
For more information: https://www.medscape.com/viewarticle/900972
Prevalence of celiac disease in patients with osteoporosis
About 1 in 62 individuals with osteoporosis, or 1.6%, have biopsy-verified CD. This prevalence is comparable to that in the general population. These findings argue against routinely screening patients with osteoporosis for CD, which is contrary to current guideline recommendations. Additional studies are needed to determine the true utility of such screening programs.
For further information: https://www.medscape.com/viewarticle/902433
Surprising number of conditions linked to celiac disease
The incidence of autism is 20 times higher in those with celiac disease than the normal population. Several other conditions also show higher incidences including; liver disease, glossitis, pancreatitis, Down syndrome, and autism, according to a database study of more than 35 million people.
For more information: https://www.medscape.com/viewarticle/889005 World Congress of Gastroenterology 2017
The distribution of HLA DQ2 and DQ8 haplotypes and their association with health indicators in a general Danish population
In this Danish study of 2,293 individuals, a total of 47.7% individuals were positive for HLA DQ2 and/or HLA DQ8 genes: 31.2% only DQ2, 11.9% only DQ8, 4.1% both DQ2 and DQ8. Among nine individuals diagnosed with CD, 89.9% had DQ2.5cis, 22.2% DQ8 and 22.2% DQ2.2 (two both DQ2 and DQ8). HLA DQ2.5 was associated with higher thyroid-stimulating hormone levels, while DQ2/DQ8-positive participants had significantly lower prevalence of irritable bowel syndrome (IBS). DQ2/DQ8 were strongly associated with CD, but no other registry-based diagnoses.
United European Gastroenterol J. 2018 Jul;6(6):866-878. doi: 10.1177/2050640618765506. Epub 2018 Mar 8.
Most people with osteoporosis do not need to be screened for celiac disease
This Columbia University study found that the prevalence of celiac disease was 1.6% said Dr. Benjamin Lebwohl. Reviewing medical databases of patients with osteoporosis, they found that 1.9% had CD. Based on this, they felt that most individuals with osteoporosis, do not need to be screened for CD. However, they did state that if a patient has osteoporosis as well as additional signs of celiac disease, they should be screened. As well, younger patients who have lower bone densities should also be screened.
https://www.mdlinx.com/family-medicine/top-medical-news/article/2018/07/30/7539771
Celiac Disease and Reproductive Issues
In a new Danish study, Grode and colleagues compared the medical records of 6,319 women identified as having celiac disease through the Danish National Patient Register to the records of 63,166 women who did not have the condition. The researchers from Horsens and Odense hospitals and Aarhus University looked at the chance and timing of pregnancy, live and stillbirths, molar and ectopic pregnancy and miscarriages.
“I think this study substantiates the majority of data suggesting that uncontrolled celiac disease has an adverse effect on childbearing,” he said. “While these are admittedly small effects requiring thousands of patients to assess, they are real and provide a very good reason to be proactive about testing for celiac disease in young women.” At the 2017 Beyond Celiac Research Symposium, Leffler called for routine celiac disease testing for all women who have unexplained infertility.
“The message to women in general is that it is worth discussing celiac disease with your doctor if you have experienced fertility problems and adverse pregnancy outcomes,” Grode said.
Human Reproduction, Volume 33, Issue 8, 1 August 2018, Pages 1538–1547, https://doi.org/10.1093/humrep/dey214
AMG714 – A drug to assist with inadvertent exposure to gluten
Francisco Leon MD presented about AMG 714 (also known as ANTI-IL-15 MAB). This project offers hope for celiac patients who are inadvertently exposed to gluten (i.e., NOT cheating and eating gluten outright). This reduces the effects of gluten consumption in celiac disease. He reported that they just finished a phase 2a, randomized, double-blind, placebo-controlled study evaluating AMG 714 in adult patients with celiac disease exposed to a high-dose gluten challenge. This drug reduced activation of the immune system, leading to fewer symptoms due to intestinal damage. It’s a subcutaneous injection of a biologic immune modulator that blocks Interlukin 15 (IL-15) that is a mediator of celiac disease.
“It’s important to note that this drug is being investigated for its potential to protect against modest contamination, not deliberately eating large amounts of gluten, like bread or pasta,” said Francisco Leon, MD, PhD, the study director and consultant for Amgen. “Contamination, which can happen during food processing or packaging, during cooking, or due to inadequate labelling, is known to occur very frequently, despite following a gluten-free diet. Our hope is that this drug may allow celiac patients on a gluten-free diet to experience fewer gluten-triggered events.” http://ddw.org
ZED 1227 Advances to Phase 2 Clinical Trial
“You can compare [gluten] to a dangerous bug. In celiac disease, the intestinal immune system does not recognize gluten as a harmless food, which it normally is, but as a dangerous bug, and the tTG makes it worse by causing a better fit of the bug to the immune system,” said Detlef Schuppan, M.D., a celiac disease expert investigating ZED 1227 and director of the Institute of Translational Immunology and Celiac and Small Intestinal Diseases at the University of Mainz in Germany. Research into ZED 1227 recently advanced to a Phase 2 clinical study, which will test how well the pill works and at what dose in blocking the immune response of the body to gluten. It is unlikely to eliminate the need for a gluten-free diet, however, it will make the lives of celiac disease patients easier. https://www.beyondceliac.org/research-news/View-Research-News/1394/postid--110642/
Natural history and clinical detection of undiagnosed coeliac disease in a North American community
"Gastroenterology symptoms are certainly common signs of celiac disease when it becomes obviously symptomatic. So, patients present with diarrhea, abdominal pain, bloating, and anemia with fatigue," Murray said. "What this study tells us is that many patients are out there in the community who likely have some measure of celiac disease and who have not developed any of these symptoms. This also indicates that, perhaps, celiac disease is being detected much more without those symptoms being present."
The study was based on screening of nearly 50,000 stored blood samples taken from patients from Olmsted County, Minnesota, treated at the Mayo Clinic from 1995 to 2009. Researchers tested the samples for a biomarker of celiac disease, tissue transglutaminase (tTg) IgA. Samples that were positive were further tested for endomysial antibodies, which are very specific for celiac disease. Ultimately, 400 cases of undiagnosed celiac disease were identified and matched with 400 controls without celiac disease. This study strongly suggests that current case finding of using symptoms is not effective in detecting undiagnosed celiac disease. Aliment Pharmacol Ther. 2018 May;47(10):1358-1366. doi: 10.1111/apt.14625. Epub 2018 Mar 25.
Doggie Bag Study – How Much Gluten are We Getting?
The Doggie Bag study is being done by researchers from Boston Children’s Hospital, the University of Manitoba, Beth Israel Deaconess Medical Center and Biomedal, the Spanish company that developed the stool and urine tests.
Preliminary results “confirm the general concern that a strictly gluten-free diet is difficult to achieve even by highly motivated and educated celiac disease patients,” Jocelyn Silvester, M.D., a study author and director of research of the Celiac Disease Program at Boston Children’s Hospital, said in a presentation at the recent Digestive Disease Week. Testing for gluten peptides found positive results in 6 percent of 519 urine samples, 11 percent of 72 stool samples and 8 percent of 318 food samples.
Nearly half of the 25 food samples that tested positive for gluten had more than 20 parts per million (ppm). Five samples had more than 100 ppm. Gluten-free food labeling regulations in the United States and Canada limit the amount of gluten in packaged food labeled gluten-free to less than 20 ppm. Gluten-free food served in restaurants is not bound by the 20 ppm cut off, but restaurants are encouraged to voluntarily meet the standard.
When food tested positive for gluten peptides, it was associated with a positive urine test in 40 percent of cases and with a positive stool test in 83 percent of cases. Stool tests are more sensitive, detecting smaller amounts of gluten. It takes more gluten to trigger a positive urine test result.
https://www.glutenfreewatchdog.org/news/significant-study-published-on-the-amount-of-gluten-eaten-by-folks-with-celiac-disease-on-a-gluten-free-diet/
IBD risk increases substantially in the presence of celiac disease
In an Australian study, it was found that the prevalence of inflammatory bowel disease (IBD) is 11 times higher in patients with celiac disease compared with the population at large. The meta-analysis of 27 studies was published in the Journal of Clinical Gastroenterology. Meanwhile, the prevalence of celiac disease is twice as high in patients with IBD as in those without IBD.
The authors reasoned that the link between celiac disease and IBD are due to common disease genetic risk factors. But, they stated, celiac disease is a specific risk factor for the manifestation of IBD.
“On the basis of animal studies, a combination of factors such as genetic susceptibility and environmental factors such as the microbiome (or GI microbiome) may define the risk to develop intestinal pathology,” they wrote. Other evidence suggests that IBD in the presence of celiac disease “may result in more severe disease manifestations.”
https://www.mdlinx.com/gastroenterology/article/1771
Mortality in celiac disease: a population-based cohort study from a single centre in Southern Derbyshire, UK
The study found that in celiacs between 1978 and 2014, mortality in the serology (blood testing for celiac disease) era declined overall. Mortality from cardiovascular disease, specifically, decreased significantly over time. Death from respiratory disease significantly increased in the post-diagnosis period. Survival in those who died after diagnosis increased by three times over the past three decades. Serological testing has impacted on the risk of mortality in celiac disease. There is an opportunity to improve survival by implementing vaccination programs for pneumonia and more prompt, aggressive treatments for liver disease.
https://bmjopengastro.bmj.com/content/5/1/e000201
Intestinal Microbiota Influences Non-intestinal Related Autoimmune Diseases
A team of researchers recently set out to examine the role played by gut microbiota in the pathogenesis of non-intestinal autoimmune diseases, such as Grave's diseases, multiple sclerosis, Type-1 diabetes, systemic lupus erythematosus, psoriasis, schizophrenia, and autism spectrum disorders. They wanted to see if microbiota can influence and determine the function of cells of the immune system.
"The current evidence supports the notion that changes or alterations of the microbial species that form part of the intestinal microbiota will affect the balance of Tregs and Th17 cells at the intestine, which could modify the immune response of non-intestinal autoimmune diseases. The experimental evidence suggesting that the cytokines secreted from Treg and Th17 will determine and influence non-intestinal autoimmune responses. It could also be possible that cells of the immune system located at the intestine could to move other organs to establish or modify an autoimmune response. The major message of this review is that the abundant data support the notion that the intestine is a critical organ the appropriate immune balance and for the prevention of non-intestinal autoimmune diseases. The key point is that by modifying the intestinal microbiota of a patient that suffers non-intestinal autoimmune disease it might be possible to improve the outcome of such illness."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857604/ Front Microbiol. 2018; 9: 432.
Published online 2018 Mar 12. doi: 10.3389/fmicb.2018.00432
MyHealthyGut: development of a theory-based self-regulatory app to effectively manage celiac disease
Health-related mobile applications make smartphones useful tools in providing point of care to the user. Participants reported a need for the MyHealthyGut app, listed desired content, features and functions and provided feedback to revise the content, features and functions of version 1.0 of the MyHealthyGut app. MyHealthyGut is the first evidence-based app that may be helpful in empowering users to effectively self-manage celiac disease and promote general gut health. Dowd AJ1, Jackson C2, Tang KTY3, Nielsen D4, Clarkin DH4, Culos-Reed SN1,5.
Mobile health. 2018 Jun 11;4:19. doi: 10.21037/mhealth.2018.05.05. eCollection 2018.
Autoimmune and Allergic Disorders are More Common in People with Celiac Disease or on a Gluten-free Diet in the United States.
This study analyzed demographics, lifestyle patterns, and clinical characteristics of people with celiac disease (CD) and people without CD avoiding gluten (PWAG) to better understand associations with medical conditions and consumer behavior. Their study confirms that CD and PWAG share comorbidities of autoimmune nature. PWAG had more autoimmune/allergy-related disorders that may be associated with non-celiac gluten sensitivity a self-justifiable reason to be on the diet.
Kim HS1,2, Unalp-Arida A3, Ruhl CE4, Choung RS5, Murray JA5 J Clin Gastroenterol. 2018 Jul 24. doi: 10.1097/MCG.0000000000001100.
Prevalence of celiac disease serological markers in a cohort of Italian rheumatological patients.
This study identified a high prevalence of CD antibodies in adult patients referred to a rheumatology outpatient clinic. These results highlight the importance of CD screening in subjects presenting with rheumatological features.
Caio G1,2, De Giorgio R3, Ursini F4,5, Fanaro S3, Volta U1. Gastroenterol Hepatol Bed Bench. 2018 Summer;11(3):244-249.
Delayed celiac disease diagnosis predisposes to reduced quality of life and incremental use of health care services and medicines: A prospective nationwide study.
A delay in celiac disease diagnosis predisposes to reduced well-being and incremental use of medicines and health care services, both before diagnosis and one year after diagnosis.
United European Gastroenterol J. 2018 May;6(4):567-575. doi: 10.1177/2050640617751253. Epub 2018 Jan 8
HLA-DQ–Gluten Tetramer Blood Test Accurately Identifies Patients With and Without Celiac Disease in Absence of Gluten Consumption
Researchers at the Oslo University Hospital in Norway have found a potential test for CD for those who have been gluten-free for a period of time. The growing number of individuals adhering to a gluten-free diet (GFD) without exclusion of celiac disease complicates its detection. An HLA-DQ–gluten tetramer-based assays that detects gluten-reactive T cells identifies patients with and without celiac disease with a high level of accuracy, regardless of whether the individuals are on a GFD. This test would allow individuals with suspected celiac disease to avoid a gluten challenge and duodenal biopsy. This test requires validation in a larger study. Neither available anti-tissue transglutaminase immunoglobulin a (tTG IgA) blood tests nor the biopsy are accurate when someone has eliminated gluten, the trigger for celiac disease, from the diet. Clinicaltrials.gov no: NCT02442219.
Gastroenterology - March 2018 Volume 154, Issue 4, Pages 886–896.e6
Infections in Early Life and Development of Celiac Disease
Medically attended gastrointestinal and respiratory infections were associated with CD development by age 8 years in a large, population-based sample. Particularly strong associations were observed for repeated gastrointestinal infections in the first year of life. Early gastrointestinal infections may therefore be relevant for CD development rather than for type 1 diabetes development, for which early respiratory infections have been found to be more relevant in the same data.
Andreas Beyerlein; Ewan Donnachie; Anette-Gabriele Ziegler – American Journal of Epidemiology 2017;186(11):1277-1280. https://www.medscape.com/viewarticle/889711_4
Natural history and clinical detection of undiagnosed coeliac disease in a North American community
CD remains substantially undiagnosed. Of the 400 cases of undiagnosed celiac disease identified in the study, 159 had indications to screen, including classic symptoms such as diarrhea, and non-classic symptoms, such as other auto immune diseases. The remaining 241 cases had no indication to screen and would be likely to remain undiagnosed. Meanwhile, medical records showed that ultimately 92 cases were diagnosed, usually taking more than five years.
Among the controls, 147 cases had an indication to screen, nearly as many as were found in the cases of undiagnosed celiac disease. None of these were ever found to have celiac disease. More than half of adults with CD have symptoms not related to the gastrointestinal system. Current methods of screening for CD are not adequate.
Solutions proposed in the study are: use of natural language software to process electronic medical records; systematic acquisition of symptoms and family history; testing of those with combinations of symptoms or indications to test; and identification of new indications to test based on additional research.
Aliment Pharmacol Ther. 2018 May;47(10):1358-1366. doi: 10.1111/apt.14625. Epub 2018 Mar 25 https://www.ncbi.nlm.nih.gov/pubmed/29577349
Hypervigilance to a Gluten-Free Diet and Decreased Quality of Life in Teenagers and Adults with Celiac Disease
This article talks about a Columbia University study where the concern is that “extreme vigilance” to a strict gluten-free diet may increase symptoms such as anxiety and fatigue, and therefore, lower quality of life. The researchers examined the associations of quality of life with energy levels and adherence to, and knowledge about, a gluten-free diet. Clinicians must consider the importance of concurrently promoting both dietary adherence and social and emotional well-being for individuals with CD.
Wolf, R.L., Lebwohl, B., Lee, A.R. et al. Dig Dis Sci (2018). https://doi.org/10.1007/s10620-018-4936-4
Scientists May Have Found an “Off” Switch for Celiac Disease
Gluten causes an immune response in the body when it is modified by the enzyme transglutaminase 2 or TG2. In the Feb 23 issue of the Journal of Biological Chemistry new research has found an enzyme that turns off TG2. Michael Yi from Stanford University led the study. TG2 is now also the first protein known to have a reversible disulfide bond on/off switch of this type. “This is a very different kind of on-and-off chemistry than the kind that medicinal chemists would (typically) use,” Chaitan Khosla, who is also on the research team, said. Because previous studies have suggested that lack of TG2 doesn’t seem to negatively affect the health of mice, blocking TG2 is a promising avenue for treating celiac disease patients without requiring lifelong changes to their diets. More research is required.
https://www.goodnewsnetwork.org/scientists-may-found-off-switch-celiacs-disease/ Feb 24, 2018
Cutting Out Gluten may Help Some Battle Nerve Pain
“These finding are exciting because it might mean that a relatively simple change in diet could help alleviate painful symptoms tied to gluten neuropathy,” study lead author Dr. Panagiotis Zis, of the University of Sheffield in the UK, said in a news release from the American Academy of Neurology (AAN). Still, Zis stressed that while the study “shows an association between a self-reported gluten-free diet and less pain, it does not show that one causes the other.” More study is required in this area.
https://consumer.healthday.com/vitamins-and-nutrition-information-27/gluten-975/cutting-out-gluten-may-help-some-battle-nerve-pain-731369.html
SOURCES: Sami Saba, M.D., neurologist, Lenox Hill Hospital, New York City; Anthony Geraci, M.D., director, Neuromuscular Center at Northwell Health’s Neuroscience Institute, Manhasset, N.Y.; American Academy of Neurology, news release, Feb. 28, 2018
Comments from the Columbia’s Celiac Disease Center International Symposium
“It’s not possible one drug will be able to treat all people with celiac disease,” said Francisco Leon, M.D., former chief medical officer and former chief executive officer of Celimmune, a clinical development stage immunotherapy company. “We are targeting every aspect of the disease. These are not ‘Me, too,’ drugs.”
Dr. Jocelyn Silvester, University of Manitoba, indicated that there is no good way to know if a person is getting gluten in their diet, gluten is found everywhere, and more studies are needed to clarify the role of urine and stool tests to indicate exposure to gluten in a patient.
“Zero gluten is an aspiration rather than a realistic goal,” Silvester said in describing adherence to the gluten-free diet.
Dr. Lebwohl indicated that there is a lot about CD that is not known. How to prevent celiac disease or how to stop it in its tracks topped his list. Also, the degree of precautions patients need to take to avoid cross-contact, who to screen for celiac disease, why patients’ symptoms are so variable and which drug holds the most promise for treatment. Participation in clinical trials was urged as one of the most important steps patients can take to help scientists answer outstanding questions. www.beyondceliac.com
Do doctors take longer to diagnose celiac disease in people without symptoms than they do for people with symptoms? Yes, much longer. That needs to change
697 patients with celiac disease were reviewed by a team of researchers at Loyola University Centre Medical Centre in Illinois. Those with gastrointestinal symptoms were compared with those who did not have gastrointestinal issues. Statistical analysis revealed an average diagnosis delay in diagnosis of 2.3 months for the group with gastrointestinal symptoms, while the group that showed no symptoms showed an average delay of 42 months. That’s a difference of nearly 3½ years. Nearly half of those with no GI symptoms showed abnormal thyroid stimulating hormone (TSH). 70% of those with no GI symptoms had anemia. www.celiac.org
Anti-transglutaminase 6 Antibody Development in Children with Celiac Disease Correlates with Duration of Gluten Exposure
Antibodies against transglutaminase 6 (anti-TG6) have been implicated in neurological manifestations in adult patients with genetic gluten intolerance. In this study, 274 CD children and of 121 controls were reviewed. In CD patients, a significant correlation between the gluten exposure before the CD diagnosis and anti-TG6 concentration was found. Autoimmunity against TG6 is gluten dependent and disappeared during GF diet.
J Pediatr Gastroenterol Nutr. 2018 Jan;66(1):64-68. doi: 10.1097/MPG.0000000000001642.
The Enemy Within: Gut Bacteria Drive Autoimmune Disease
A Yale study, published in Science, found that bacteria found in the small intestine can travel to other organs and trigger an autoimmune response. They also found that "Treatment with an antibiotic and other approaches such as vaccination are promising ways to improve the lives of patients with autoimmune disease." They could reverse the autoimmune response with antibiotics. More study will be required. https://www.eurekalert.org/pub_releases/2018-03/yu-tew030618.php
Even on a GF Diet, Harmful Exposures May be Common
"Individuals who are on a gluten free diet are consuming more gluten than we actually imagined. It's not uncommon for them to be consuming on average a couple of hundred milligrams a day," Dr. Jack A. Syage, CEO of ImmunogenX in Newport Beach, California, and the study's lead author, told Reuters Health in a telephone interview.
Up to 10 mg of gluten per day is generally considered safe for people with celiac disease, according to the University of Chicago Celiac Disease Center. Still, the authors conclude, the data suggest "that individuals on a gluten-free diet cannot avoid accidental gluten intrusions and these small amounts are sufficient to trigger severe symptomatic responses."
The American Journal of Clinical Nutrition https://academic.oup.com/ajcn/article-abstract/107/2/201/4911450?redirectedFrom=fulltext February, 2018
Celiac Disease in Later Life Must not be Missed
The presenting symptoms of celiac disease are often subtle and the diagnosis is frequently delayed or overlooked. Therefore, especially elderly patients may be denied the benefits conferred by gluten free diet which can be dramatically life-changing. Common symptoms include tiredness, indigestion and loss of appetite and can therefore be missed. The diagnosis may prevent severe complications such as low-energy bone fractures and enteropathy-associated T-cell lymphoma.
https://www.medscape.com/viewarticle/892578_6
Richmond resident receives national recognition for work on celiac disease
Following years of work raising awareness on celiac disease, a Richmond woman has been recognized for her efforts through Canada's Sovereign Medal for Volunteers.
http://www.richmond-news.com/news/richmond-resident-receives-national-recognition-for-work-on-celiac-disease-1.23290797
April 25, 2018
Fructan – Not Gluten- Could be Source of Stomach Woes
Reviews new research suggesting that gluten intolerance might actually be caused by fructan not gluten. This is commonly referred to as FODMAPS.
www.healthline.com/health-news/fructan-could-be-source-of-stomach-woes
Fischer, Kristen, Healthline, November 27, 2017.
Celiac Disease, Gluten Symptoms Linked to Eating Disorders, even Anorexia
Johnson explores the relation of eating disorders such as Anorexia with celiac patients as recent study in Sweden indicated that there is a higher incident of Anorexia Nervosa (AN) amongst celiacs compared to control group.
https://www.allergicliving.com/2017/12/14/celiac-disease-gluten-symptoms-linked-to-eating-disorders-even-anorexia/
Johnson, Kate, Published December 14, 2017.
New blood test better identifies those with celiac disease, researchers say
Delves into new research involving an experimental test that may be able to detect celiac disease even for individuals on a gluten free diet. ImmunsanT has developed a blood test that looks at elevated cytokine levels to determine if the individual has celiac disease. For the test, patients would only be required to eat gluten one time. This would be the “first biomarker for measuring systemic T-cell immunity to gluten," said Leslie Williams, Chief Executive Officer of ImmusanT.
http://www.cbc.ca/news/health/new-blood-testceliac-1.4466280
Reuters, Thomson, Published December 28, 2017.
Genetically Modified Wheat – Gluten-Free
Would you eat bread with wheat flour, if it was safe? Scientists in the UK are experimenting with genetically modified wheat that does not include the gluten that would trigger a reaction in a celiac. It's still very early in the game, and much gene work remains to be done, but wouldn't that be exciting? Some trials with the new wheat are taking place in Mexico and Spain. It'll be interesting to see the results? For more information about the GM wheat, please visit: https://www.newscientist.com/article/2148596-genetically-modified-wheat-used-to-make-coeliac-friendly-bread/
Celiac Disease Undiagnosed 90% of the Time
Researchers at the University of Toronto studied the blood work of nearly 3,000 people and found that celiac cases were undiagnosed approximately 90% of the time. Ahmed El-Sohemy, a professor of nutritional science at the University of Toronto, wanted to see whether celiac disease results in subpar nutrition because of poorer absorption of vitamins and minerals. To find out, he needed data on the frequency of undiagnosed celiac disease. The findings reinforced that celiac disease occurs in around 1% of the population, but the vast majority who have it do not know they have it. To read more, please visit: http://www.cbc.ca/news/health/celiac-disease-1.4343691
Celiacs – Issues with Oats
A lot of celiacs feel that cannot tolerate oats. But the science shows only about 4% of us actually have problems with oats. You may feel "glutened" after eating oats but remember that oats are very high in fibre and can cause gastrointestinal issues if you have too much too quickly. Ease back into oats slowly, to allow your system to adapt. And of course stick to safe, clean, uncontaminated oats like those from Only Oats and Cream Hill Estates. Oats are a healthy and delicious option for us - enjoy!
Research – Autoimmune Disease in Family Impacts
Researchers at the University of Surrey in the UK are looking to gain an understanding of how people who have one sibling with an autoimmune disease feel about and manage their own health. This is an area of psychology which has not been studied very much before. If you know someone who would like to participate, please direct them to https://surreyfahs.eu.qualtrics.com/jfe/form/SV_8dI0Vbrvoo1iENn
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Reovirus May Trigger Immune Response To Gluten
According to a study conducted by the University of Chicago and the University of Pittsburgh School of Medicine, infection with reovirus, a common but harmless virus, may trigger the immune system response to gluten that leads to celiac disease. The study was published in the journal Science and it suggests that certain viruses play a role in the development of autoimmune disorders such as celiac disease and type 1 diabetes. This raises a possibility that a vaccine could developed in future to treat celiac disease! For more information, please visit: https://www.ndtv.com/food/scientists-discover-another-reason-for-celiac-disease-besides-genetics-1787157
Research – Celiac Disease
Harvard Medical School and Massachusetts General Hospital are currently recruiting 500 infants (250 in the US and 250 elsewhere) to participate in their new study that plans to look at the various factors that affect celiac disease's development. A skilled group of doctors and scientists will conduct a study called Celiac Disease Genomic Environmental Microbiome and Metabolic (CDGEMM), in order to understand and identify the various factors that are associated with the development of celiac disease. The study is led by Dr. Alessio Fasano and they'll be hoping to find a pattern, which would lead the team to creating treatment and predicting the disease's development. For more information, please visit www.cdgemm.org
Link of Oral Symptoms to Gastrointestinal Symptoms
Research published recently showed that concludes that oral symptoms can precede gastrointestinal symptoms in celiac disease, and be useful in diagnosis. In addition to celiac, oral problems can show up in the presence of Crohn's disease, ulcerative colitis, and gastroesophageal reflux disease. These symptoms may be key to identifying celiac earlier on, to reduce the current average delay of 11 years between the onset of symptoms and a firm diagnosis. To read more about this research, please visit https://www.ncbi.nlm.nih.gov/pubmed/29167716
Celiac Disease and the Gluten-Free Diet Found Unlikely to Impact IVF Outcomes or Fertility
Here's yet another reason why those without celiac disease or gluten sensitivity do not need to follow the gluten-free diet. Research presented in October by the Reproductive Medicine Associates of New Jersey (RMANJ) indicates that the gluten-free diet is not effective as a treatment for infertility. The findings are combined from 30 different scientific studies.
While healthy eating, including a low-carb diet, is part of a holistic, evidence-based approach to treating patients with infertility at RMANJ, adhering to a gluten-free diet has been shown to have no impact on increasing fertility for those trying to conceive.
The studies are the first large research projects to investigate IVF outcomes in gluten-free patients and the frequency of celiac disease in infertile patients. One study found that patients on a gluten-free diet had equivalent IVF success rates to those whose diet included gluten, proving that maintaining a gluten-free diet to improve IVF outcomes is a major misconception. The other study revealed that IVF success rates were equivalent between those with celiac disease (a disease with proven gluten intolerance) and those without.
More info: https://www.prnewswire.com/news-releases/gluten-free-ivf-new-research-from-reproductive-medicine-associates-of-new-jersey-reveals-gluten-free-diets-and-celiac-disease-are-unlikely-to-impact-ivf-outcomes-or-fertility-for-those-trying-to-conceive-300545215.html
Childhood Respiratory Infections Linked with Celiac Disease
Findings published recently in the journal Pediatrics reported that the number of at-risk children - or those with relatives who have celiac disease - who go on to develop celiac disease seems to be increasing. And recently, Dr. Renata Auricchio, from the University of Naples Federico II in Italy, set out to understand why this might be the case.
Studies have pointed toward infections in childhood as a potential trigger of celiac disease in those who are genetically susceptible. For instance, a 2013 study found that the presence of rotavirus antibodies could predict the onset of celiac disease.
Similarly, in the Norwegian Mother and Child Cohort Study, children who had experienced 10 or more infections before reaching the age of 18 months had a significantly increased risk of developing celiac disease than children who had had four or fewer.
Many earlier investigations into infections and celiac disease relied on parental recall of infections and have included a general cross-section of the population. However, to gather more detailed information, the new study used a prospective cohort. In other words, the team studied a group of infants known to be at risk of developing celiac disease and followed them for 6 years.
As the authors explain, the study's aim was "to explore the relationship between early clinical events (including infections) and the development of CD [celiac disease] in a prospective cohort of genetically predisposed infants.
Across the study, 6 percent of the children were diagnosed with celiac disease at the age of 3, 13.5 percent at age 5, and 14 percent by age 6. They also found that "[c]compared with gastroenteritis, respiratory infections during the first 2 years of life conferred a twofold increase in the risk of developing CD [celiac disease]."
When discussing how early infections might impact the later development of celiac disease, the authors write:
"It is possible that [...] early infection stimulates a genetically predisposed immune profile, which contributes to the switch from tolerance to intolerance to gluten."
More info: https://www.medicalnewstoday.com/articles/319702.php
Study Confirms that a Majority of Torontonians with Celiac Disease Don’t Know They Have It
Research at the University of Toronto, which focused specifically on Canada's largest city, found that around 87 of people living with celiac in the city are not aware that they have the disease.
Ahmed El-Sohemy, a professor of nutritional science at the University of Toronto and senior author of the paper that presented the findings, said researchers compared blood tests of about 3,000 Canadians with their responses to a health questionnaire. 90% of those who tested positive to the celiac blood test reported that they had not been diagnosed as celiac.
While the biopsy remains the gold standard, this study is a good indicator of how those who are diagnosed may be just the "tip of the iceberg"!
El-Sohemy also suspects (and we agree) that the vast majority of people eating gluten-free by choice don’t actually have celiac disease.
More info: https://www.thestar.com/news/gta/2017/10/07/majority-of-torontonians-with-celiac-disease-dont-know-they-have-it-study-shows.html
Danish Research Finds Huge Increase in Celiac Disease Prevalence
According to research published in October in the European Journal of Gastroenterology and Hepatology, the prevalence of diagnosed CD has doubled every decade in Denmark from 1986 to 2016, and in the same period the female/male ratio has increased and the median age at diagnosis has decreased. The prevalence of autoimmune comorbidity (having more than one) in 2016 was three times higher among celiac patients compared with the general Danish population.
The study included over 11,000 Danes. The prevalence of CD in 1986 and 2016 was 14 and 180 per 100,000 persons, respectively, with a female/male ratio changing from 1.3 to 2.0. Incidence rates (per 100,000 person-years) changed from 1.6 in 1980-1984 to 15.2 in 2015-2016, with the largest increase among females aged 0-9 years. In 2016, prevalence of autoimmune comorbidities was 16.4% among the CD patients compared with 5.3% in the general population.
More info: https://www.ncbi.nlm.nih.gov/pubmed/29076940
More Americans Eating Gluten-Free
The number of Americans who avoid gluten even though they do not have celiac disease more than tripled from 2009-2014, increasing to an estimated 3.1 million people, according to a study in the January issue of Mayo Clinic Proceedings.
Researchers at the Mayo Clinic in Rochester used a sample comprised of 22,227 people age 6 or older in the National Health and Nutrition Examination Surveys for their study. The prevalence of Americans without celiac disease who avoid gluten increased to 1.7% in 2013-14 from 1% in 2011-12 and 0.5% in 2009-10.
The study concluded long-term health consequences of a gluten-free diet warrant further investigation.
“The benefits of following a G.F.D. (gluten-free) diet in people without C.D. (celiac disease) have not been tested rigorously, and indeed nutritional concerns have been raised about deficient iron, calcium and fiber consumption,” the study said. “In contrast to public interest in following a G.F.D., it remains uncertain whether there is any benefit of following a G.F.D. for people without gluten-related conditions.”
More info: http://www.foodbusinessnews.net/articles/news_home/Consumer_Trends/2017/01/More_people_without_celiac_dis.aspx?ID={579BCDF6-7468-4761-A991-7F3AEF178C84}&cck=1
Type 1 Diabetes Continues to be Linked to Celiac Disease
Parents of young children with type 1 diabetes need to be on the lookout for symptoms of celiac, new research has confirmed.
The study found these youngsters appear to face a nearly tripled risk of developing celiac disease autoantibodies, which eventually can lead to the disorder.
"Type 1 diabetes and celiac disease are closely related genetically," explained study author Dr. William Hagopian.
"People with one disease tend to get the other. People who have type 1 diabetes autoantibodies should get screened for celiac autoantibodies," Hagopian said. He directs the diabetes program at the Pacific Northwest Research Institute in Seattle.
According to Hagopian, "Celiac is about three times more common in the general population than type 1 diabetes."
Previous research has pegged the co-occurrence of type 1 diabetes and celiac disease at around 5 percent to 8 percent, the study authors said.
More info: https://www.medcircle.com/articles/14252-where-theres-type-1-diabetes-celiac-disease-may-follow
Reduced Bone Mineral Density in Children With Screening-Detected Celiac Disease
New research published in the Journal of Pediatric Gastroenterology & Nutrition has found that children with screening-detected celiac disease have reduced bone mineral density (BMD), lower levels of vitamin D3, higher levels of parathyroid hormone (PTH), and signs of systemic inflammation compared with controls.
These differences were not found in celiac disease children on a gluten-free diet, indicating that children with screening-detected celiac disease benefit from an early diagnosis and treatment.
More info: http://journals.lww.com/jpgn/Abstract/2017/11000/Reduced_Bone_Mineral_Density_in_Children_With.11.aspx
Gluten Sensitivity
Want to know more about the causes of gluten sensitivity: view www.cbc.ca/quirks Saturday, December 2, 2017 show “Your ‘gluten sensitivity’ may have nothing to do with gluten.” Thanks to Kaye Hipper for letting me know about this segment.
Fracture Risk Increases with Type 1 Diabetes, Celiac Disease
In an Australian study, researchers assessed previous fractures (verified by radiologic reports and medical records), duration of type 1 diabetes, glycemic control, hypoglycemia incidence (assessed via glucose monitoring devices or logbooks), daily insulin dose, microvascular complications and celiac disease status. Patients with Type 1 diabetes and celiac disease had significantly more fractures than those with only diabetes. Patients with type 1 diabetes and celiac disease also had a higher prevalence of frequent hypoglycemia, defined as at least two episodes per week, compared with those who had type 1 diabetes alone. This is important as hypoglycemia increases the risk of falls and therefore fractures. www.helio.com Oct 5, 2017
Non-Celiac Wheat Sensitivity is a Persistent Condition
An Italian study following 200 participants who had a diagnosis of non-celiac wheat sensitivity and checking after a median follow-up time of 99 months found 88% had fewer symptoms and 98% of those who adhered to a gluten-free diet had reduced symptoms. 20 of 22 who were in the double blind group reacted to wheat. From this data, they concluded that Non-Celiac Wheat Sensitivity is a persistent condition. http://www.gastrojournal.org/article/S0016-5085(17)30343-8/fulltext More research needs to be done in this area as other studies have indicated non-celiac gluten sensitivity may be transient in nature. What is clear that Celiac Disease must be ruled out prior to diagnosing non-celiac gluten sensitivity to ensure that the proper treatment of the disease is provided.
Fish May Provide Hints to Treating Celiac Disease
Fish are carnivores and although often fed fishmeal, this is an expensive source of food. Plant soy based feeding has been used, but most fish have problems with a plant based diet and develop enteritis and gastrointestinal problems. One exception is the Rainbow Trout. For some thought to be genetic reason, these fish thrive on the plant soy based diet. Researchers identified 63 genes that help Rainbow Trout except the plant-based diet. This discovery has the potential for a biomedical model for the development of treatments for ulcerative colitis and celiac disease. http://researchnews.plos.org/2017/07/19/rainbow-trout-strains-tolerance-of-a-soy-based-diet-is-linked-to-63-genes/
Biopsy Sampling of Greater Than 4 Samples Increase Probability of Diagnosing Celiac Disease
The diagnostic rate of CD increased from 3.5% to 7.6% when more than 4 samples of the small intestine were taken at time of biopsy. Complying with the guidelines and taking greater than 4 samples will ensure better diagnosis of Celiac Disease. https://www.medscape.com/viewarticle/884268?src=wnl_edit_tpal
99.5% of Labels Found to be Accurate Regarding Gluten-Free Claims by FDA
According to the FDA, more than 99.5 percent of "gluten-free" food products met the agency's gluten-free standard, according to Carol D'Lima, a food technologist in FDA's Office of Nutrition and Food Labeling. If any products are found to be out of compliance for gluten standards, the FDA notifies the company to make appropriate corrections, and works with the company to recall any mislabeled products on the market. https://www.foodnavigator-usa.com/Article/2017/10/18/FDA-could-zero-in-on-cross-contamination-of-gluten
Patients with Sjogren’s Syndrome Have High Potential to Have Celiac Disease
A small study published in the American Journal of Gastroenterology showed 14.7%of patients with Sjogren’s syndrome also had Celiac Disease. Even non-celiac Sjogren’s patients showed inflammation in the small bowel mucosa. The findings show a close association between the diseases. https://www.ncbi.nlm.nih.gov/pubmed/10201480
At-home urine and stool tests that detect gluten now available
Gluten Detective tests detect fragments of the immunogenic gluten protein, called GIP, harmful to those who have celiac disease. They are being sold online by Glutenostics, the distributor of the tests in the United States and Canada. The urine test is sensitive for 500 milligrams of gluten, while the stool test, although less convenient test to 50 milligrams of gluten. The kits cost $45 plus shipping, and the company is currently offered a 25 percent off coupon on its website for first-time customers. Results are ready in 10 to 15 minutes. The sensitivity of the tests will only pick up a significant amount of gluten consumed and will not determine if there has been cross-contamination.
Gluten Detective is not approved under the Food and Drug Administration’s Food Drug and Cosmetic Act and cannot make a medical claim related to the treatment of celiac disease or any other condition. The tests can only claim to detect gluten consumed, fragments of which are found in the stool or urine of everyone, but only trigger an autoimmune response in those who have celiac disease.
www.beyondceliac.org Nov 7, 2017 Article by Amy Ratner
Celiac Disease Research Neglected in Federal Funding
Review of 2011 – 2015 funding of research shows NIH gives less money to celiac disease than other gastro-intestinal conditions. Dr. Daniel Leffler and Dr. Sonia Kupper stated that “These data suggest that a few diseases, including celiac disease and IBS, are underfunded in comparison with other diseases, especially when prevalence, burden and available treatment options are considered,” Celiac disease, with a prevalence of about 1 percent and mortality rate of 1.3, the highest among the diseases reviewed, received about $3 million per year. Meanwhile, Crohn’s disease, which had the second lowest prevalence at .25 percent and a mortality rate of 1.1, received about $16 million per year, the highest amount of funding. www.beyondceliac.org Article by Amy Ratner Oct 4, 2017
Research: Antibiotics Don't Increase Chances a Child Will Develop Celiac Disease
Antibiotics commonly prescribed for children do not increase the chance of celiac disease or type 1 diabetes developing in kids who are already at risk for either of the conditions, according to a new study.
Researchers found that antibiotics, including penicillin, amoxicillin and cephalosporin, prescribed during a child’s first four years were not associated with the development of autoimmunity for celiac disease or type 1 diabetes.
A lack of evidence regarding the consequences of using antibiotics early in a child’s life in relationship to celiac disease and type 1 diabetes prompted the study. The increased use of antibiotics worldwide has been proposed as a cause for an increase in autoimmune diseases in industrialized countries, the study authors wrote. These results suggest that the use of the most common antibiotics in early life does not increase the risk of autoimmunity in children at increased genetic risk. https://jamanetwork.com/journals/jamapediatrics/article-abstract/2656303?appId=scweb&appId=scweb
JAMA Pediatr. Published online October 9, 2017. doi:10.1001/jamapediatrics.2017.2905
Scientists at the University of Toronto Determine Celiac Disease Still Under-Diagnosed
by Utkarshna Sinha, 22 October 2017, THE VARSITY, The University of Toronto’s Student Newspaper
3,000 adult participants of diverse backgrounds were given the tTG blood test for Celiac Disease and they found that 90% of those studied were going undiagnosed. Consistent with US findings, 1% of the study group had celiac disease antibodies. Prior studies have indicated that only 15% of those with Celiac Disease in Canada are actually diagnosed.
https://theceliacscene.com/celiac-disease-still-under-diagnosed/ ; http://bmjopen.bmj.com/content/7/10/bmjopen-2017-017678
Commercially Available Glutenases: A Potential Hazard in Celiac Disease
14 glutenase products were tested and it was found that there was no scientific basis for their claims that they would break down the gluten. Although the products included disclaimers of not being evaluated by the US food and Drug Administration, the products should be avoided by those with Celiac Disease.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424869/
Do in Range tTG Levels Indicate Intestinal Healing?
A team of researchers from the Mayo Clinic, including Dr. J. A. Murray reviewed the results of 402 treated celiac patients who had had a blood draw, within 1 month of having a duodenal biopsy (2009- 2015). They found that patients who had undetectable tTG levels were more likely to have normal duodenal histology. Asymptomatic patients more often showed normal duodenal histology compared with patients who still had symptoms.
http://onlinelibrary.wiley.com/doi/10.1111/apt.14250/full
Can Specific Strains of Probiotics Delay the Onset of Gluten Sensitivity in Children
A trial at the Lund University was presented at the International Celiac Disease Symposium in New Delhi that indicated that new trial data suggests that the probiotic strains Lactobacillus plantarum Heal 9 and Lactobacillus paracasei 8700:2 may provide support for the immune system and delay the onset of gluten intolerance in children. 78 children with a genetic pre-disposition to celiac disease were included in the multinational and multiyear autoimmunity study.
www.celiac.com
Intraepithelial Lymphocyte (IEL) Count Distinguishes Celiac Disease from Normal Mucosa
IEL count in duodenal mucosa can be used to distinguish celiac disease from normal mucosa. A cutoff of 25 IEL/100 enterocytes. 198 patients with celiac disease and 203 controls without celiac disease were used in the study. This yielded 99.0% sensitivity, 93.1% specificity, and an overall accuracy of 99.5%. Use of this type of diagnostic process of Celiac Disease would make diagnosis easier and less expensive.
https://www.medscape.com/viewarticle/886127?src=wnl_edit_tpal Factors Associated with Villus Atrophy in Symptomatic Celiac Disease Patients on a Gluten-free Diet
1,395 celiac disease patients who had celiac disease and despite being on a gluten-free diet had on-going symptoms were reviewed. A majority of symptomatic celiac disease patients did not have active disease on follow-up histology. Symptoms were poorly predictive of persistent mucosal injury. Villous atrophy was most often seen in patients who used non-steroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), and selective serotonin reuptake inhibitors (SSRIs). Use of these drugs warrants further study.
S. Mahadev; J. A. Murray; T.-T. Wu; V. S. Chandan; M. S. Torbenson; C. P. Kelly; M. Maki; P. H. R. Green; D. Adelman; B. Lebwohl, Aliment Pharmacol Ther. 2017;45(8):1084-1093. http://www.medscape.com/viewarticle/878189?src=wnl_edit_tpal
A Unique Enzyme Could be a Game-Changer for Gluten-Sensitive Patients
A Press Release from Digestive Week May 7, 2017 – “Researchers have found that taking an enzyme tablet while consuming foods containing gluten prevents a significant amount of it from entering the small intestine. This could enable gluten-sensitive patients to ingest small quantities of gluten without experiencing symptoms, such as bloating, diarrhea and abdominal pain.
The encouraging results from the enzyme known as aspergillus niger-derived prolyl endoprotease (AN-PEP) were presented at Digestive Disease Week® (DDW) 2017, the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.” Note: this enzyme was not used on celiac disease patients as it does not adequately protect them. http://www.ddw.org/blogs/aimee-frank/2017/05/07/a-unique-enzyme-could-be-a-game-changer-for-gluten-sensitive-patients?CommunityKey=e1a95ab4-c2da-436d-be33-59f0c867cdcf&tab=
Mast Cells Tied to Onset and Progression of Celiac Disease
A team of researchers at the University of Udine, Italy investigated the roll mast cells have in the development of celiac disease. “The team found that infiltrating mast cells reflected the severity of mucosal damage, and their numbers were increased in patients with higher Marsh scores. They noted that mast cells responded directly to non-immunodominant gliadin fragments by releasing pro-inflammatory mediators.” The study found that mast cells were prominent in the inflammatory process. This could be important in finding therapeutic solutions for CD.
https://www.celiac.com/ and https://www.ncbi.nlm.nih.gov/pubmed/27619824
Psychiatric Disorders in Children Linked to Celiac Disease
Children with celiac disease are at a 1.4-fold increased risk for psychiatric disorders, according to a new Swedish study. Lower body mass and malnutrition in children with celiac disease is one possible pathogenic mechanism, and immune-mediated systemic reaction in celiac disease may be associated with the increased risk for depression and autism, they suggest. The increased risk of neurodevelopmental disorders also suggests a “biological etiology of psychiatric comorbidity in celiac disease.” In addition, psychological aspects of celiac disease and chronic symptoms may contribute to the effect. http://www.psychiatryadvisor.com/childadolescent-psychiatry/psychiatric-disorders-may-precede-celiac-disease-diagnosis-in-children/article/656070/
Have You Been Glutened?
An at home pregnancy-like test may be soon be available to tell you if you have been glutened. GlutenDetect will be available by the end of the year, but the test stick would have to be sent to a laboratory for evaluation. The test will give a “current picture of gluten exposure compared to the tTG test and biopsy, which show what has happened in the past few months. You are looking at what’s happening today, and patients can review their diets. This is a tool to help manage a gluten-free diet.”
https://www.beyondceliac.org/
Long Term Gluten Consumption in Adults Without Celiac Disease and Risk of Coronary Heart Disease
Long term dietary intake of gluten was not associated with risk of coronary heart disease. However, the avoidance of gluten may result in reduced consumption of beneficial whole grains, which may affect cardiovascular risk. The promotion of gluten-free diets among people without celiac disease should not be encouraged.
http://www.medscape.com/viewarticle/879702?src=wnl_edit_tpal
Antigliadin Antibodies May Indicate Gluten-free Diet Will Help in IBS
“There is growing interest in the role of food as a trigger of symptoms in functional bowel disorders, including IBS. More than 60% of patients with IBS [experience] bloating and abdominal pain after ingestion of certain foods, and within these foods, wheat and gluten may cause symptoms in a subset — not all — IBS patients in whom celiac disease and wheat allergy have been excluded,” said María Inés Pinto Sanchez, MD, of the department of medicine at McMaster University and the Farncombe Institute in Ontario, Canada. Patients with IBS, regardless of antibody status, experienced comparable improvements in anxiety, somatization and wellbeing, but only patients who were antigliadin positive had reduced depression scores, Sanchez said. This may “suggest that gluten restriction rather that strict gluten avoidance may be sufficient for symptom management in this subgroup of IBS patients,” Sanchez concluded.
https://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7B3bff7cd6-e277-42e9-b0a4-a982e8de96fe%7D/antigliadin-antibodies-may-indicate-gluten-free-diet-will-help-in-ibs Reference: Sanchez MIP, et al. Abstract #162. Presented at: Digestive Disease Week; May 6-9, 2017; Chicago.
Celiac Disease Tests Do Not Reflect Ongoing Mucosal Damage
Dr. Donald R. Duerksen, from the University of Manitoba looked 1,088 patients and found that the “estimated sensitivity of the tTG IgA was 50% and its specificity was 83% for detecting persistent villous atrophy on a gluten-free diet.” “Although widely available, and relatively non-invasive, serum tTG IgA and EMA IgA antibodies are poorly correlated with mucosal outcomes,” they conclude. “Most patients with celiac disease have negative antibody tests on a gluten-free diet, even those with persistent mucosal damage.” A positive test result is useful as it suggests that dietary assessment is required. A negative test however, does not indicate that there is mucosal recovery. Original article in Reuters Health.
http://www.medscape.com/viewarticle/881043?src=wnl_edit_tpal
Drug Development Pipeline – Beyond Celiac
Beyond Celiac has a page on their website that is tracking the stages of development of Celiac Disease drugs and research under development. They also have an infographic that provides what each of the stages of development of a drug trial are.
https://www.beyondceliac.org/drug-development-pipeline/
US Gluten-Free Labelling
The Celiac Disease Foundation June, 2017 newsletter indicated that as of August 2013, the Food and Drug Administration issued a rule mandating that packaged food labeled “gluten-free” (or similar claims such as “free of gluten”) cannot contain more than 20 parts per million of gluten (ppm). CDF is pleased to announce that the FDA has found extensive compliance with products labeled “gluten-free.” Of 702 samples from more than 250 products labeled “gluten-free,” over 99.5% are in compliance with the FDA’s requirement and contain less than 20 ppm of gluten.
https://celiac.org/blog/2017/06/new-sampling-data-compliance-fda-gluten-free-labeling-rule/?bblinkid=50860850&bbemailid=4230262&bbejrid=307504556
Is there a relationship between gluten sensitivity and postural tachycardia syndrome (PoTS)?
In a study in the European Journal of Gastroenterology & Hepatology, it was found that 4% of those diagnosed with PoTS also had celiac disease. Self-reporting by those with PoTS indicated that 42% were gluten-sensitive. Further study is required to understand the relationship between PoTS and gluten related disorders. PoTS is a condition that causes an abnormal increase in the heart rate when you go from a lying position to a standing condition.
http://journals.lww.com/eurojgh/Citation/2016/12000/Is_there_a_relationship_between_gluten_sensitivity.5.aspx
Are Gluten-Free Foods Misleading Consumers?
For those of you who are new to Celiac Disease, another study has confirmed that gluten-free foods do not have the same nutritional value as their gluten containing comparisons. “In all, the study assessed 654 gluten-free products, and compared them against 655 gluten-containing products. Among the group's key findings were that gluten-free breads had significantly higher content of lipids and saturated fatty acids; gluten-free pasta had significantly lower content of sugar and protein; and gluten-free biscuits had significantly lower content of protein and significantly higher content of lipids.” ESPGHAN expert and lead researcher, Dr Joaquim Calvo Lerma, adds that "…it is imperative that foods marketed as substitutes are reformulated to ensure that they truly do have similar nutritional values. This is especially important for children, as a well-balanced diet is essential to healthy growth and development."
www.celiac.com and the http://www.espghancongress.org Media Release
Infections in Early Life Associated with Increased Risk for Celiac Disease
“Infections during infancy are associated with increased risk for gluten intolerance (celiac disease) later on. Apparently the risk is particularly high in the case of repeated gastrointestinal infections in the first year of life. This conclusion was drawn by scientists of the Institute for Diabetes Research at Helmholtz Zentrum München, a partner in the German Center for Diabetes Research (DZD), after analyzing data provided by the Bavarian Association of Statutory Health Insurance Physicians. Results from this study have now been published in the current issue of the ‘American Journal of Epidemiology’.” There was also found to be an increased risk of celiac disease with upper respiratory infections early in life. “However, it seems that the increased risk of celiac disease is associated with a permanent inflammation of the gastrointestinal tract in early childhood and is not caused by a specific viral or bacterial pathogen.”
https://www.helmholtz-muenchen.de/en/press-media/press-releases/all-press-releases/press-release/article/40647/index.html German Research Center for Environmental Health
Assessing the Claims of Dietary Enzymes to Eliminate Gluten
“Researchers from the Celiac Disease Center at Columbia University set out to identify products with either overt or implied claims to aid in the digestion of gluten and to evaluate their ingredients, claims, and disclaimers. A thorough Google search was conducted to identify enzyme supplements commercially available in the United States that claimed to degrade gluten. This search ultimately identified 14 products, many of which had names like Gluten Cutter, GlutenEase, and Gluten Defense, implying relief for the celiac disease and non-celiac gluten/wheat sensitive communities.” Unfortunately, this study found little evidence that these substances met their claims.
Read more at https://celiac.org/blog/2017/07/assessing-claims-dietary-supplements/#e4V4KgZeL3RB6t4c.99 and original article http://journals.sagepub.com/doi/full/10.1177/1756283X17690991
High Incidence of Celiac Disease in Adolescents
A study published in Gastroenterology in May 2017 of children at St. Joseph’s Hospital in Denver, Colorado, looked at 1,339 children with genetic risk factors for celiac disease over up to a 20 year period. Celiac Disease Autoimmunity was defined as those who developed tissue transglutaminase autoantibodies for at least 3 months. They found that more than 5% developed celiac disease autoimmunity, CDA over the ten year period and at ages 5, 10 and 15 years respectively those who actually developed celiac disease were 1/6%, 2.8% and 3.1% respectively. Although more than 5% of children may experience a period of CDA, not all children develop celiac disease or required gluten-free diets. This study also reconfirmed that 40% of the population carry the genes for Celiac Disease.
https://www.ncbi.nlm.nih.gov/pubmed/28188747
Seemingly Innocuous Virus can Trigger Celiac Disease
The University of Chicago and the University of Pittsburgh School of Medicine, found that a common, thought to be harmless virus, the reovirus, can trigger an immune response to gluten. Dr. Bana Jabri, the senior author of the study, indicated that the virus sets the stage “for an autoimmune disorder, and for celiac disease in particular.” He also stated the specific virus and its genes and the interaction between the microbe and the host, as well as the health status of the host are all important. Dr. Jabri reported that IL-15, a cytokine upregulated in the intestinal lining of celiac disease patients, can break oral tolerance to gluten. They found that genetic differences between reovirus strains could either protect against or cause celiac disease. They found that celiac disease patients had much higher levels of antibodies against reoviruses than those without the disease. This could lead to a vaccination in the future that targets viruses infecting the intestine in order to protect children at risk for celiac and other autoimmune disorders.
https://news.uchicago.edu/article/2017/04/06/seemingly-innocuous-virus-can-trigger-celiac-disease
Anorexia Nervosa Diagnosis More Common in Women with Celiac Disease
Anorexia nervosa is an emotional disorder that involves an obsessive desire to lose weight by refusing to eat. Data from 1987 to 2009 on 18,000 Swedish women diagnosed with celiac disease and about 89,000 women around the same age who did not have the autoimmune disorder. Those with celiac disease were found to be 46% more likely to be diagnosed with anorexia nervosa. The study was not a controlled experiment designed to prove that celiac disease causes anorexia or the reverse. There may have been bias as those diagnosed with one condition were probably more closely monitored which could lead to a higher level of diagnosis of other disorders. This is something that should be monitored by healthcare providers.
http://www.reuters.com/article/us-health-celiac-anorexia-idUSKBN1752EG
Factors Associated with Villus Atrophy in Symptomatic Celiac Disease Patients on a Gluten-Free Diet
Despite sticking to a gluten-free diet, some celiac patients endure persistent duodenal damage, a condition associated with adverse outcomes. The researchers from Columbia University and the Mayo Clinic found that of 1,345 symptomatic diagnosed celiac patients in the study, 38% were found to have villous atrophy. People with villus atrophy were more likely to use proton-pump inhibitors, non-steroidal anti-inflammatory drugs (NSAID), and selective serotonin re-uptake inhibitors (SSRI). Adjusting for covariates showed that the symptoms alone were not tied to villus atrophy. Further research into the impacts of proton-pump inhibitors, NSAIDs and SSRI’s is indicated.
Alimentary Pharmacology and Histology Volume 45, Issue 8 April 2017 Pages 1084–1093, http://onlinelibrary.wiley.com/doi/10.1111/apt.13988/abstract;jsessionid=ED15F5C51D5E343FE71B5F0F6E850347.f04t04
Nexvax2 Moves to Next Stage of Research
Nexvax2 is a dose to protect against gluten exposure being developed by ImmusanT. The first stage of study investigating safety and tolerability is completed. The vaccine is initially designed to be used along with the gluten-free diet, with long range plans that would eliminate the need for the diet. Previous studies have shown that the first dose of the vaccine prompted the immune reaction to gluten, with patients who received Nexvax2 showing activation of T-cells as well as typical celiac disease symptoms. But when the treatment ended after twice weekly doses of Nexvax2 for eight weeks, the T-cells were no longer active. Additionally, when patients who had received Nexvax2 ate gluten for three days, the immune reaction was not triggered.
https://www.beyondceliac.org/research-news/
Gluten: ZERO Global
This is the name of a new book written by Dr. Rodney Ford, a respected pediatrician and expert in Celiac Disease from the UK. Dr. Ford’s contention is that 20 ppm is not OK. There must be “zero” gluten ingested. Dr. Ford states that you must get your tTG antibodies down as they are causing an immune effect in the gut, as well as doing neurological harm as shown by Dr. Hadjivassiliou (2002).
Dewar and co-workers investigated 100 patients who had non-responsive celiac disease (refractory celiac disease). They found the following: 45 (45%) of these patients were not adequately adhering to a strict gluten-free diet, of whom 24 (53%) were inadvertently ingesting gluten, and the remaining 21 (47%) admitted non-compliance. http://www.ncbi.nlm.nih.gov/pubmed/22493548.
Dr. Ford’s book is available at http://www.glutenZEROglobal.com
Clinical Trial Fails to Meet Its Objectives
ImmunogenX, the clinical stage biopharmaceutical company developing latiglutenase, an combination of two enzymes that are supposed to breakdown gluten, found that those receiving the drug did not do any better than those taking a placebo. ImmunogenX is continuing to look at data from the trial related to specific groups of patients. They are optimistic about the future of the drug and its ability to help these patients improve their quality of life and better manage celiac disease, according to the company. And plans are in place for the next Phase 2 clinical trial.
The recent CeliAction trial included nearly 500 celiac disease patients who had been on the gluten-free diet for a least one year and who had moderate to severe symptoms and intestinal damage. It was conducted from August 2013 to December 2014 throughout Europe and North America and had been widely publicized among celiac disease patients.
Among the 398 patients with a positive blood test, severity of abdominal pain improved for 57 percent and bloating for 44 percent. Tiredness and constipation were also shown to have decreased in these patients. “While the published study showed no overall benefit, we have since discovered that people with symptoms and elevated celiac disease antibodies did have a significant benefit,” said Peter Green, M.D., a study author and director of the Celiac Disease Center at Columbia University. “We are thrilled with that because it gives the medicine an ongoing opportunity to get out there to help patients.”
https://www.beyondceliac.org/research-news/View-Research-News/1394/postid--75508/
Biopsy-Defined Adult Celiac Disease and Selective Immunoglobulin A Deficiency
Dr. Hugh James Freeman, University of British Columbia, Department of Gastroenterology published results of 234 biopsy-defined celiacs from 1982 – 2011. 7 were found to be IgA deficient (immune-deficient), or about 3%. They also found that there is no apparent difference in the gluten-free dietary mucosal response from celiac disease with or without immunoglobulin deficiency. Immunoglobulin A deficiency is well recognized to be a cause of false-negative or falsely low determinations of IgA antibodies (i.e., either anti-endomysial or anti-tissue transglutaminase antibodies or both) used in screening or case-finding for celiac disease. In this setting, use of an alternative antibody, such as IgG, or even endoscopic biopsy may be considered, if there is a high suspicion for adult celiac disease. The present evaluation, however, also documented that IgA antibodies to tissue transglutaminase were present in all patients that could be tested here with selective IgA immunoglobulin deficiency. More study is required in this area.
Available online at http://pubs.sciepub.com/ijcd/5/1/1
Mucosal Recovery May Take Longer Than Previously Thought
Recently Dr. Hugh James Freeman of the Department of Medicine, Gastroenterology, University of British Columbia, Vancouver, BC, Canada, conducted a study to assess healing time in celiac patients. In this study, 182 patients (60 males, 122 females) referred for evaluation of symptoms, including diarrhea and weight loss, were selected only if initial biopsies showed characteristic inflammatory changes with severe architectural disturbance.
All patients were treated with a strict gluten-free diet, and diet compliance was regularly monitored. Up to 90% or more of patients showed a complete mucosal response or healing, many within 6 months. However, most patients required up to 2 years for full healing and recovery to take place in the gut.
http://pubs.sciepub.com/articleinpress/ijcd/ijcd-5-1-1.pdf
University of Washington Spinout PvP Biologics has won $35 M to Develop Celiac Disease Therapy
Takeda Pharmaceuticals is providing $35M in research and development funding for a Phase I trial for an enzyme, KumaMax that targets parts of gluten that cause the autoimmune reaction that leads to Celiac Disease. The hope is the enzyme will break down gliadin, the protein in gluten. Research will be done in Seattle.
http://www.bizjournals.com/seattle/blog/health-care-inc/2017/01/uw-spinout-wins-35m-deal-to-develop-therapy-for.html
Seeking a New Normality: Masculinity, Interaction and a Gluten Free Diet
A study from researchers in Sweden and the UK looked at the social experience of young men with screening-detected celiac disease and to highlight daily life situations five years after diagnosis.
The analysis also showed that the young men’s daily experiences of living with celiac disease largely depended on their use of characteristics known to be associated with masculinity: such as being self-assured, demanding, and behaving authoritatively. In food situations, where the young men had the ability to make use of such characteristics in their informal group, they experienced fewer negative aspects of the disease.
If the young men did not hold a strong position in their informal group, their situation was insecure and vulnerable and this could lead to avoidance of contacts and social meal situations.
So, basically, being relaxed and socially confident about eating gluten-free helps to ensure success with the diet.
International Journal of Celiac Disease Vol. 4, No. 4, 2016, pp 138-145. doi: 10.12691/ijcd-4-4-7 | Original Article http://pubs.sciepub.com/ijcd/4/4/7/index.html
Study Compared the Effects of Gluten Reduced Beers
A study conducted by the Gluten Intolerance Group in conjunction with the University of Chicago Celiac Disease Centre found that gluten removed beers caused a reaction in those who had been diagnosed with Celiac Disease.
Both gluten-free and gluten-removed beers have entered the marketplace recently. Gluten-free beer is made using grains that naturally do not contain gluten, such as sorghum or brown rice, in the fermentation process. Gluten-removed beer is made with wheat, barley or rye, and it then undergoes a process for the gluten to be removed.
The study used blood samples from individuals with celiac disease to see whether the proteins in gluten-free beer and gluten-removed beer were recognized by antibodies that were already present in the blood. It was found that no blood samples reacted to the gluten-free beer. However, a percentage of blood samples DID react to the gluten-removed beer. The study was done as a proof of concept of the methodology and further study will be required to understand better the possible risk of gluten-removed products.
https://www.gluten.org/branchnews/gigbeerstudy/
A Growing Trend: Diet Common Even Among Those Without Celiac Disease
William F. Balistreri, MD is professor of pediatric medicine at the University of Cincinnati and Cincinnati Children's Hospital. He and Dr. Alessio Fasano, Gastroenterologist Harvard Medical School and Dr. Ivor Hill, Gastroenterologist, Ohio State University College of Medicine, Columbus gave a panel discussion on Skype, November 2, 2016. Research indicates that 20% of individuals are following a gluten-free diet. This is significantly more than the approximately 1% who have medical needs to follow the diet as they have Celiac Disease. Those with gluten sensitivity also have issues with gluten, but research in this area is limited. The doctors agreed that if someone decides to be gluten-free, you should first make sure you have excluded celiac disease; that they are aware of the downsides, in terms of both cost and micronutrient deficiency; and that they are truly responding to gluten removal and not something else, like FODMAPS or other food sensitivities. http://www.medscape.com/viewarticle/870954?src=wnl_edit_tpal
Celiac Disease More Common in Patients With IBS Symptoms, Study Confirms
Researchers looked at 36 studies including more than 15,000 people, 61% of whom met IBS criteria. Twenty-two of the studies were new. All of the studies had recruited patients based on IBS symptoms, and tested them for CD using IgA-class antigliadin antibodies (AGA), endomysial antibodies (EMA), tissue transglutaminase antibodies (tTG) or duodenal biopsies performed after positive serology.
The odds ratio for a positive CD test among people with IBS were 3.21 based on IgA AGAs; 2.75 for EMA and/or tTG; and 4.48 for duodenal biopsy. The findings were consistent for patients with constipation, diarrhea, and mixed-stool pattern IBS.
The pooled prevalence of biopsy-proven CD among the patients with IBS-type symptoms was 3.3%.
Overall, prevalence of positive celiac serology and biopsy-proven CD was significantly higher in subjects with symptoms suggestive of IBS vs. healthy controls. However, the utility of screening for CD in individuals with suspected IBS in North America or in the community is less clear. American Journal of Gastroenterology 2016 http://www.nature.com/ajg/journal/vaop/ncurrent/full/ajg2016466a.html
Elderly Onset Celiac Disease
Symptoms of Celiac Disease in the elderly, such as diarrhea and weight loss, may be scarce, however, CD has been increasingly recognized in the elderly. Other symptoms in the elderly age group include iron deficiency anemia (often refractory to oral iron), autoimmune disorders, bone disease due to osteopenia, including fractures, malignant intestinal disease, especially lymphoma, and finally idiopathic dilated cardiomyopathy. Diagnosis may be delayed due to limited symptoms, a low clinical suspicion, or diagnostic difficulties related to important cognitive impairment that often affects elderly people. Although for these patients, the GFD is the key of clinical management, elderly patients may not adhere to diet.
Patients should be referred to specialists to ensure the better management of the disease and related complications. Micronutrients, such as iron, calcium, vitamin D supplementation, and vitamins, should be part of a modified GFD for the elderly patients. All other therapeutic interventions that limit malabsorption and avoid complications should be considered part of a management strategy. Clinical Medical Insights Gastroenterology, published online July 25, 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4965017/
Could the amount of gluten matter more than breast-feeding or the timing of the introduction of gluten as a trigger for celiac disease?
A study at Sweden’s Lund University, indicated that Swedish children who reported consuming more than 5 grams of gluten per day up to the age of two years had twice the risk of developing celiac disease compared to children who consumed a smaller amount, while children with celiac disease reported eating more gluten during that period. The risk of developing the autoimmunity which gives rise to celiac disease was highest in Sweden compared to Finland, Germany and USA, which were also studied. There was no apparent connection between the duration of the period of breast-feeding and the risk of developing celiac disease. www.celiac.com
Common bacteria shows promise for treating celiac disease
A research team, led by researchers at Boston University's Henry M. Golden School of Dental Medicine, wrote, "The aim was to isolate and identify the enzymes and evaluate their potential as novel enzyme therapeutics for CD. We have found that exceptionally high gluten-degrading enzyme activities are naturally associated with bacteria that colonize the oral cavity."
Rothia bacteria, found in human saliva, can break down gluten compounds that cause an exaggerated immune response and that are typically resistant to the digestive enzymes that mammals produce. The team isolated a new class of enzymes -- gluten-degrading enzymes from Rothia mucilaginosa, an oral microbial colonizer -- from Rothia bacteria. The researchers felt that this should be studied further. https://www.sciencedaily.com/releases/2016/09/160906085840.htm
Why Childhood Celiac Disease Should Be Checked With Lab Tests
A group of experts in pediatric CD, including Dr. Butzner who is a member of the CCA Professional Advisory Board, performed a critical review of the available literature in 6 categories associated with CD to develop a set of best practices by using evidence-based data and expert opinion. The 6 categories included the following: bone health, hematologic issues, endocrine problems, liver disease, nutritional issues, and testing. Evidence was assessed by using standardized criteria for evaluating the quality of the data, grade of evidence, and strength of conclusions. Over 600 publications were reviewed, and 172 were chosen for inclusion. The thorough review of the results demonstrated that the quality of the data available was often insufficient to provide unequivocal best practices.
To effectively treat children with the disease, doctors and parents need to be sensitive to the unique problems young patients may face, such as difficulty understanding what’s in their food and drink, peer pressure to eat and drink what their friends do, and a fear of ridicule and being singled out, said study co-author Dr. J. Decker Butzner of the University of Calgary in Canada.
“One main take away is that children can learn to manage their diet,” Butzner said by email. “They need to be involved in grocery shopping, menu planning, restaurant assessment, food ordering and trip organization in regards to a gluten free diet.”
“Second, children need to be periodically assessed by a health care professional for the management of their celiac disease,” Butzner added.
“Celiac disease presentations are highly variable and should be at least considered with many different symptoms, including abdominal pain, failure to thrive/weight loss and diarrhea, constipation, anemia, canker sores, arthritis, tooth enamel defects, distinct rashes, behavioral issues, headaches, delayed puberty and infertility,” stated Dr. Tracy Ediger, who also took part in the study. American Journal of Gastroenterology 2016 http://www.nature.com/ajg/journal/v111/n10/full/ajg2016439a.html
New study links protein in wheat to the inflammation of chronic health conditions
A study conducted in Vienna and published October 17, 2016 identified a protein in wheat that causes inflammation in chronic health conditions such as Multiple Sclerosis, asthma and rheumatoid arthritis and also contributes to non-celiac gluten sensitivity. A family of proteins called amylase-trypsin inhibitors (ATIs). Further to inflaming chronic health conditions outside of the bowel, ATIs may contribute to the development on non-coeliac gluten sensitivity. Further study is required. https://www.eurekalert.org/pub_releases/2016-10/sh-nsl101016.php
Fecal Test Shows Gluten-Free Compliance in Celiac Disease
Almost a third of celiac disease patients purportedly on a gluten-free diet showed gluten immunogenic peptides (GIP) in their stools, according to Spanish and U.S. researchers. Gastroenterologist Dr. Peter S. Liang, who was not involved in the research, told Reuters Health by email, "This study suggests fecal gluten peptides are more sensitive than either serology or food questionnaires at detecting gluten consumption and therefore may be a valuable addition to our non-invasive diagnostic tests. In future studies, it would interesting to know how closely fecal gluten peptide measurement correlates with gold standard small bowel biopsies." 30% of patients had detectable GIP’s in their stool samples. This study indicates that celiac patients are either intentionally or unintentionally getting gluten in their diet. http://www.medscape.com/viewarticle/869914?src=wnl_edit_tpal
Factors that Increase Risk of Celiac Disease Autoimmunity Following a Gastrointestinal Infection in Early Life
A study of 6,327 children in the US and Europe with the HLA DQ2 and HLA DQ8 genes found the following associations between gastrointestinal infection and celiac disease. GI infection increased the risk of celiac disease autoimmunity within the following 3 months of the infection by 33%. This risk increased 2-fold among children born in winter and introduced to gluten before 6 months, and increased 10-fold among children without HLA-DQ2 alleles and breastfed for less than 4 months. Risk of celiac disease autoimmunity was reduced in children vaccinated against rotavirus and introduced to gluten before 6 months. Clinical Gastroenterology and Hepatology 2016 Nov 10 https://www.ncbi.nlm.nih.gov/pubmed/27840181
Plant enzymes could help celiacs digest gluten, says U of C researcher, CBC News by Tricia Lo, August 8, 2016
University of Calgary researchers, have made a breakthrough that could help celiac patients digest gluten with the help of an enzyme from bug-eating pitcher plants. These plants have "disposable stomachs" that are filled with an enzyme-rich liquid that helps them digest insect prey. The lead researcher is David Schriemer says that celiac patients may be able to take the extract like “beano”. Full study is included in Nature at http://www.nature.com/articles/srep30980
Non Celiac Gluten Sensitivity is Real
Researchers including Dr. Peter Green found that there is a state of systemic immune activation in conjunction with a compromised intestinal epithelium affecting a subset of individuals who experience sensitivity to wheat in the absence of coeliac disease. In other words, NCGS is not all in their head. Much more research is required in this area.
Non-Celiac Wheat Sensitivity is Official https://celiac.org/blog/2016/08/non-celiac-wheat-sensitivity-is-official
Jury Still Out on Celiac Disease Screening, U.S. Doctors Say
There is not enough evidence to propose widespread screening for Celiac Disease. Guidelines do recommend screening for those with a close relative with celiac disease stated Dr. Joseph Murray, Mayo Clinic, as they are at increased risk for the disease.
http://www.medscape.com/viewarticle/862838?src=wnl_edit_tpal
Neurological Dysfunction in Coeliac Disease and Non-coeliac Gluten Sensitivity
562 patients were studied: 228 or 41% had enteropathy (CD) and 59% did not (NCGS). The severity of ataxia did not differ between the two groups, although those with CD had more severe neuropathy. All patients responded to a GF diet. tTG antibodies were similar in the two groups. The researchers concluded that both groups had similar neurological issues and that there is currently a risk that if diagnosed with NCGS, the neurological issues will not be dealt with. American Journal of Gastroenteroly 2016;111(4):561-567.
Honeycomb app can be customized to user’s allergies, likes and dislikes
A Vancouver Sun article talks about a local business that has developed an application on honeycomb.ai that will enable you to find restaurant menu items that will meet your allergy or in our case gluten-free needs. It is currently in Beta testing and enables you to pick by price, location and your specific needs if you have registered. There is no cost to the user as money is made from the restaurants.
http://vancouversun.com/business/local-business/food-allergy-sensitivity-new-app-from-vancouver-developers-will-help-you-navigate-restaurant-menus
Early recognition of celiac disease through community pharmacies: a proof of concept study
Fifteen pharmacies in UK had pharmacists administer a test for celiac disease, when customers brought forward common celiac disease symptoms. Of 554 administered the test 9.4% had CD. The study concluded that pharmacies could effectively either refer patients for testing, or be a site for testing for CD. International Journal of Clinical Pharmacology, 2016 Aug 8.Duodenal Bacteria from Celiac Patients Has Distinct Impact on Gluten Breakdown and Immunogenicity
Duodenal Bacteria from Celiac Patients Has Distinct Impact on Gluten Breakdown and Immunogenicity
A research team from around the world, including Canada’s Farncombe Digestive Family Centre and McMaster University, studied gluten metabolism by opportunistic pathogens and commensal duodenal bacteria, and to characterize the ability of the resulting peptides to activate gluten-specific T-cells from celiac patients. They colonized germ-free mice with bacteria isolated from the small intestine of celiac patients or healthy controls. These mice were selected by their in vitro gluten-degrading capacity. They then measured gliadin levels and proteolytic action in intestinal contents after gluten feeding. They found that the bacterial colonizations created clear gluten degradation patterns in the small intestine of the mice.Pseudomonas aeruginosa (Psa), an opportunistic pathogen from celiac patients, exhibited elastase activity and produced peptides that better translocated the mouse intestinal barrier. Psa-modified gluten peptides activated gluten-specific T-cells from celiac patients. In contrast, Lactobacillus spp. from the duodenum of non-celiac controls degraded gluten peptides produced by human and Psa proteases, reducing their immunogenicity. In other words, the bacteria in the gut of celiac patients impacts their immune response. This microbe-gluten-host interaction may modulate autoimmune risk in genetically susceptible persons and may underlie any connection between celiac disease and microbial imbalance or maladaptation in the digestive tract. http://www.ncbi.nlm.nih.gov/pubmed/27373514
Beyond Celiac has developed some free Back to School Kits
Back to School Toolkit: School prep begins this month, and parents with children on a gluten-free diet have a few extra items on their back to school checklists.
Gluten-Free in College Toolkit: Prepping for college is stressful, but when you throw a gluten-free diet into the mix, things can get intimidating.
These free resources can be found at:
http://www.beyondceliac.org/community/Get-Social/Monthly-Social-Media-Happenings/1377/
Correlation of Type 1 Diabetes and Thyroid and Celiac Disease Autoantibodies in Patients
A study in Saudi Arabia found the prevalence of thyroid and celiac disease autoantibodies among Type 1 diabetic patients was high. There was no correlation between the age of Type 1 diabetes diagnosis and the level of autoantibodies. Saudi Medical Journal 16 Apr, 37 (4): pages 386 – 391.
Diagnosis of Celiac Disease
The authors of this study reviewed over 7,000 prior studies on PubMed, Embase, Cochrane Library and the web of science and found that the tTG IgA tests have excellent sensitivity and excellent specificity is found in the tTG IgA and EmA IgA tests. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Jan. Report No.: 15(16)-EHC032-EF. AHRQ Comparative Effectiveness Reviews.
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Presenting Pattern of Pediatric Celiac Disease
A review of 165 patient charts of children newly diagnosed as having CD in western New York, they found that patients presented most frequently with abdominal pain and constipation and were older at the time of diagnosis than those described in the classical presentation of CD (gastrointestinal issues, diarrhea, and fatigue). They speculate that these patients may have a different long-term natural history and risk factors than originally described for patients with CD. Journal of Pediatric Gastroenterology Nutrition. 2016 January Pages 60-3.
Pathogenic Role of Gut Microbiota in Gastrointestinal Diseases
The gut microbiota is responsible for immune and metabolic functions. When this microbiota is out of balance, a condition called dysbiosis, gastrointestinal issues result that can lead to irritable bowel syndrome, celiac disease, inflammatory bowel disease and other inflammatory gastrointestinal issues. This study is looking at how genetics, diet, stress and medications can influence the gut bacteria. PubMed Commons Intestinal Research, 2016 April 14(2):127-38.
The Decreasing Prevalence of Severe Villous Atrophy in Dermatitis Herpetiformis: A 45-Year Experience in 393 Patients
This study looked at patients with Dermatitis Herpetiformis (DH), which is a manifestation of celiac disease presenting with itchy blistering rash and pathognomonic IgA deposits in the skin, and the degree of mucousal damage that these patients had. Prominent gastrointestinal symptoms are rare, and small-bowel findings range from severe villous atrophy (SVA) and partial villous atrophy (PVA) to normal mucosa with inflammatory changes. http://www.ncbi.nlm.nih.gov/pubmed/27136959
Is it gluten-free? Relationship between self-reported gluten-free diet adherence and knowledge of gluten content of foods
Patients are often unable to identify what food is gluten-free and which is not. Therefore, self-report measures do not account for the possibility of unintentional gluten ingestion and overestimate gluten-free diet adherence. The role of patient advocacy groups and education to improve outcomes through improved adherence to a GFD requires further research. Nutrition February 13, 2016.
Development of a Risk Score for Extra-intestinal Manifestations of Celiac Disease
This Australian study reviewed 301 patients who had symptoms other than the classic symptoms of gastrointestinal issues. They identified other symptoms that increased the risk of having celiac disease. These include a family history of CD, the presence of another autoimmune disorder, anemia, lactose intolerance, and depression. A risk score was developed (Celiac Risk COMPARE) which scores individuals based on the presence or absence of these additional symptoms and provides an additional screening tool when assessing whether the patient requires follow-up testing for CD.
http://www.ncbi.nlm.nih.gov/pubmed/27082568
Study Links Early Childhood Infections to Celiac Disease
A study in Norway of 73,000 children found that those who had 10 or more respiratory or gastrointestinal infections in the first 18 months of life were 30% more likely to develop celiac disease than those with only 5 or few infections. The study however did not discuss a cause and effect however. It could be that those with more infections were more actively involved in the health care system and were therefore more likely to be diagnosed. More research is required in this area.
Features of children with positive celiac serology and type 1 diabetes mellitus
A study from the Japan Pediatric Society, identified 294 children who had celiac disease. Of these, 21 of had diagnosed type 1 diabetes mellitus. It was found that diabetic children were more likely to have absence of gastrointestinal symptoms and more likely to have reflux issues compared to children who had just celiac disease. Pediatrics International Journal 2015 Oct
Low bone mineral density in Brazilian patients at diagnosis of Celiac Disease
Low bone mineral density is considered an extra-intestinal manifestation of celiac disease with reduced bone mass, increased bone fragility, and risk of fractures. Celiac disease is considered a condition at high risk for secondary osteoporosis and the evaluation of bone density is very important in the clinical management of these patients. A study in Brazil found that 69% of Brazilian patients with celiac disease at diagnosis had low bone mineral density, being more frequent in women older than 50 years. Arq Gastroenterol 2015 Jul-Sep
Cesarean Section (CS) and Diseases associated with Immune Function
A total of 750,569 children aged 0 to 14 years were included in the study. Children delivered by both acute and elective CS had an increased risk of asthma, laryngitis, and gastroenteritis. Children delivered by acute CS had an increased risk of ulcerative colitis and celiac disease, whereas children delivered by elective CS had an increased risk of lower respiratory tract infection and juvenile idiopathic arthritis. The effect of elective CS was higher than the effect of acute CS on the risk of asthma. Journal of Clinical Immunology 2015 Sep 11
Exploring the Strange New World of Non-Celiac Gluten Sensitivity
Dr. Daniel Leffler, who will speak at the CCA National Conference and Dr. Benjamin Lebwohl completed a study regarding Non-Celiac Gluten Sensitivity (NCGS) that really did not provide any conclusive results.
It seems only to contribute to the uncertainty about NCGS. But from these results and those of previous trials, it is reasonable to draw several conclusions. First, NCGS is distinct from IBS in that extraintestinal symptoms are prominent and respond to dietary modification, unlike the extra intestinal symptoms that can be seen in IBS. Indeed, half of the individual clinical components that worsened with gluten compared with placebo (aphthous stomatitis, depression, and foggy mind) related to non-intestinal symptoms, and this is certainly compatible with symptoms reported by NCGS patients in clinical practice. Second, there are no proven biomarkers for NCGS at this time, and studies focused on these have had, at best, conflicting results. "If nothing else, NCGS is a complex entity and will not give up its secrets easily. As such, studies with more limited but focused aims are likely to be more effective in providing important incremental knowledge."
Asymptomatic Children Might Not Need Biopsy for Celiac Diagnosis
Doctors might not need a biopsy to accurately diagnose celiac disease in children with no symptoms who have elevated anti-tTG, according to the latest study out of Italy. Among 196 patients with anti-tTG antibodies at least 10 times the standards, 156 had symptoms and 40 were asymptomatic. More than 90% of the symptomatic children (142/156, 91%) showed severe lesion degree on biopsy, and an even higher percentage of asymptomatic patients (37/40, 92.5%) had severe lesions. Among the EMA positive children with lower titers of anti-tTG antibodies, 70% of symptomatic children and 81% of asymptomatic children showed severe lesions. This is current research and of course it will take some time for these to filter down to our Canadian standards for care.
Mommy, I have a tummy ache!
Dr. Rodney Ford is Pediatric Gastroenterologist in New Zealand and has written seven books about gluten related issues. He feels that children's tummy aches should never be ignored. These children need help and understanding for their symptoms. Some of these children have unrecognized gastric reflux symptoms; some have celiac disease; some have Helicobacter pylori infection; some have chronic constipation; some have food intolerances; and many have gluten sensitivity/ intolerance. "Please don't just ignore them-please test and treat them! Please do not dismiss what your child is telling you: you may be able to help them. They might have a gluten-related disorder. They are not "attention seeking" they are in actual pain." Journal of Gluten Sensitivity, Autumn 2015 Issue
Are Industrial Food Additives to Blame for Soaring Rates of Autoimmune Disease?
Numerous common industrial food additives increase tight junction leakage. These include glucose, salt, emulsifiers, organic solvents, gluten, microbial transglutaminase, and nanoparticles, widely and increasingly used in industrial food production.
Researchers from Israel and Germany are calling for additional research on the connections between food additives exposure, intestinal permeability, and autoimmunity interplay to expand our knowledge of the common mechanisms associated with autoimmune progression.
Have Researchers Finally Nailed Down Non-celiac Gluten Sensitivity?
The study, from Giovanni Barbara and his team at the University of Bologna, Italy, suggests that inflammation in gluten-sensitive individuals may result from high levels of a molecule called zonulin.
Zonulin has been linked to inflammation, and people with celiac disease have been shown to have high levels of zonulin when consuming wheat protein. Symptoms include abdominal pain, bloating, alternating diarrhea or constipation. And there can be other symptoms, including "brain fog," headache, fatigue and joint and muscle pain.
Iron deficiency anemia in newly diagnosed celiac disease in children
Of all patients diagnosed with Celiac Disease in the study, 30.1% had anemia. This significant relation existing between CD and iron deficiency should be considered by pediatricians at the diagnosis of CD in order to treat the patients. Minerva Pediatrics: 2016 Feb.
Neurological Dysfunction in Coeliac Disease and Non-Coeliac Gluten Sensitivity
In a study done in the UK, the most common neurological manifestations of patients with either CD or NCGS were cerebellar ataxia, peripheral neuropathy, and encephalopathy. The neurological manifestations of CD and NCGS are similar and equally responsive to a gluten-free diet suggestive of common pathophysiological mechanisms. American Journal of Gastroenterology: 2016 Feb
Neurological Symptoms of Celiac Disease, July 29, 2015
The 2015 International Celiac Disease Symposium (ICDS) in Prague, reported that those with neurological dysfunction have a greater problem ingesting gluten. A UK study of newly diagnosed celiac patients showed 61% had neurological problems including headaches, balance issues and sensory problems. Gluten ataxia is having significant problems with balance and 18% of all ataxias are thought to be caused by gluten. Dr. Hadjivassiliou said that ataxia improved within 1 year of going on a gluten-free diet. Poor adherence to the gluten-free diet increase the on-going chance of ataxia as well as vascular dementia.
Developing Childhood Celiac Disease - Dr. Daniel Leffler, Digestive Disease Week, Washington, DC
Celiac Disease, it was thought, should be preventable by modifying childhood behaviours: timing of gluten exposure and breastfeeding. In fact, this has been found not to be the case. The most important thing is the child’s genes. Double HLA DQ2 genes is the worst scenario and greatly increases the chances of developing CD. Dr. Leffler supports genetic testing of children in families that have Celiac Disease to better understand the risk of the child developing the disease.
How to Get Enough Grains in a Gluten-Free Diet – Dr. Michael Picco MD
Good gluten-free grains include brown or wild rice, quinoa, amaranth, pure buckwheat, flax, whole corn, millet, gluten-free oats, sorghum and teff. Grain products that are not gluten-free include any type of wheat (including farina, graham flour, semolina and durum), barley, rye, bulgur, Kamut, kasha, matzo meal, spelt, triticale, couscous, emmer and einkorn. Source: Mayo Clinic
Foods Most Likely to Cause You a Problem
It is extremely important to read labels and be aware when eating these foods as hidden gluten may be a problem: soy sauce, cream-based soups, ice cream, “wheat-free” products (does not mean they are gluten-free), beer, prescription medications, gourmet meats and deli meats especially when they are not prepackaged (cut meats may be contaminated by the cutting machine), restaurant meals (ensure hamburger patties do not have added gluten, cross-contamination issues, sauces), and meals with friends and families (although they may be as careful as possible, the kitchen is not gluten-free). Source: Mayo Clinic
Hidden Sources of Gluten – links provided by Dr. Tom O’Bryan
From Celiac.com:
From Today's Dietician:
From Web MD:
From UDIS:
From Everyday Health:
Celiac Disease Screening Important for Kids Presenting for Rheumatology Evaluation
A team of researchers at the Division of Pediatric Rheumatology, New York Mount Sinai Medical Centre, found that children presenting with rheumatology issues had double the risk of having celiac disease (2%) as the general population. This was a 6.5 year study of 2,125 children whose most common symptoms report with celiac disease were myalgias, arthralgias, and skin rash. Their symptoms were notably different than the “classic celiac disease” symptoms.
Tiny Particles a Big Breakthrough on Celiac Cure
Cour Pharmaceutical Development Company has announced "a significant breakthrough in celiac treatment [that] has the potential to cure celiac patients rather than relying on gluten avoidance, immune suppressive regimens or dietary supplements," according to a company press release. They use antigen specific nano-particles, Toleragenic Immune Modifying nanoParticles (TIMP) that is fed intravenously to the patient. Cour presented at the 2015 ICDS. While there have been other claims made about potential cures, this is the first animal model demonstration of a treatment that effectively cures celiac disease. If these results hold up to scrutiny, and if successful treatments can be developed, this approach has tremendous potential to benefit numerous people with celiac disease. Caution is these trials are costly and take significant time. Source: PRNewswire
Lymphocytic Gastritis Strongly Associated with Celiac Disease
Dr. Peter Green and a team of researchers from the Columbia University, Celiac Disease Centre, studied 287,503 patients and found that lymphocytic gastritis (deals with the immune system) is strongly associated with celiac disease, with increasing prevalence correlating with more advanced villous atrophy. Chronic active gastritis and chronic inactive gastritis are also significantly associated with celiac disease. Source: Alimentary Pharmacology & Therapeutics Volume 42, Issue 2, pages 180–187, July 2015. DOI: 10.1111/apt.13249
Diagnosing and Treating Exocrine Pancreatic Insufficiency (EPI) in Patients with Celiac
New research concludes that the association between EPI, Exocrine Pancreatic Insufficiency is strong enough that any celiac patient suffering from gastric distress despite adherence to a gluten-free diet should be tested for EPI. Source: HCPlive
Celiac Urine Test May Offer Way to Detect Being Glutened
A presentation at the ICDS Symposium in Prague indicated that gluten immunogenic peptides (GIP) in urine may indicate a person has being glutened. Noting that the intestinal health of the vast majority (80 percent) of those without detectable GIPs was far better than those with detectable levels, researchers say there is a strong correlation between GIP levels in urine and damage to the gut.
General Mills is Under Attack for their Methods of Producing Gluten-Free Cereals
General Mills is under attack regarding the potential of cross-contamination in their gluten-free cereals. Gluten Free Watchdog's concerns include the reliability of testing analysis done by General Mills. General Mills currently use a sampling method to test the cereal and check that gluten is 20 parts per million (ppm) or less, but Gluten Free Watchdog claims this method can result in uneven results, and that some batches of cereal may actually contain more than the allowed 20 ppm of gluten, although they haven't offered any solid examples that support their theory.
To their credit, General Mills seems to be honestly engaged in the discussion, and has signaled an openness to sourcing pure gluten-free oats, which would address the concerns of groups like Gluten Free Watchdog. Source: Celiac.com 09/07/2015
Specific Non-gluten Proteins of Wheat Are Antigens in Celiac Disease Humoral Response
While the immunologic reactivity to gluten in celiac disease have been extensively researched, the immune response to non-gluten proteins of wheat has not been reviewed. This study investigated the level and molecular specificity of antibody response to wheat non-gluten proteins in celiac disease. Serum samples from patients and controls were screened for IgG and IgA antibody reactivity to a non-gluten protein extract from the wheat cultivar Triticum aestivum Butte 86. Antibodies were further analyzed for reactivity to specific non-gluten proteins. Compared with healthy controls, patients exhibited significantly higher levels of antibody reactivity to non-gluten proteins. The main immune-reactive non-gluten antibody target proteins were identified: serpins, purinins, α-amylase/protease inhibitors, globulins, and farinins. The results demonstrate that, in addition to the well-recognized immune reaction to gluten, celiac disease is associated with a robust humoral response directed at a specific subset of the non-gluten proteins of wheat. http://pubs.acs.org/doi/abs/10.1021/pr500809b, Journal of Protiome Research, October 20, 2014, pg 503-511
Conditions Fennel Seeds Can Help Relieve
Daily doses of 5 to 7 grams of fennel seeds are packed with vitamins B and vitamin C. They can help alleviate pain from gastric indigestion, bloating and gas; given they are high fibre, they can help prevent against cancers; they are good for your skin and provide protection against bone loss. http://www.medicaldaily.com/what-fennel-good-6-conditions-it-can-help-relieve-330946
Mucosal Recovery and Mortality in Adults with Celiac Disease After Treatment With a Gluten-free Diet
Dr. Joseph Murray and a team of researchers in the American Journal of Gastroenterology reported that mucosal recovery was absent in a substantial portion of adults with Celiac Disease after treatment with a gluten-free diet. Mucosal recovery was measured by the depth of the villi in the small intestine. There was a borderline significant association between confirmed mucosal recovery (vs. persistent damage) and reduced mortality independent of age and gender. For those who achieved mucosal recovery, the number of patients with good, moderate, and poor compliance to gluten-free diet was 75%, 20%, and 4%, respectively. In comparison, patients with persistent mucosal damage at first follow-up biopsy were significantly less compliant to the gluten-free diet. With good, moderate, and poor compliance of 61%, 21%, and 18%, respectively.
A novel finding of this study is the fact that persons with mucosal recovery after treatment with a gluten-free diet may have a clinically relevant lower risk of all-cause mortality than do patients with persistent mucosal damage. As a result, compliance to the gluten-free diet is imperative and systematic follow-up with intestinal biopsies may be advisable in patients diagnosed with Celiac Disease as adults. For more information: http://www.medscape.com/viewarticle/734724
Molecular Mimicry as a Mechanism for Food Immune Reactivities and Autoimmunity By Dr. Aristo Vojdani
The mucosal immune system is constantly exposed to challenges from the foreign bodies (antigenic) found in food and released from the body's own microbial flora. The body's normal tolerance to friendly substances can be disrupted by a number of factors, such as disease, injury, shock, trauma, surgery, drugs, blood transfusion, environmental triggers, etc. When this disruption happens, the ingestion of foods containing antigenic substances that have compositions similar to those of the body's autoantigens can result in the production of antibodies that react not only against the food antigens but also the body's own tissues. This response is known as food autoimmune reactivity. Between 7% and 10% of the world's population suffers from some form of autoimmune disease. Each patient's antibodies, both immunoglobulin A (IgA) + immunoglobulin M (IgM) in the saliva and immunoglobulin G (IgG) and IgA in the blood must be examined to give a complete picture of food immune reactivity. A host of health problems and autoimmune disorders have increasingly become associated with some of the most commonly consumed foods in the world, such as wheat and milk. Many of these problems can be traced to molecular mimicry. The peptide sequences of foods such as milk and wheat are similar to those of human molecules, such as myelin oligodendrocyte glycoprotein, human islet cell tissue, and human aquaporin 4 (AQP4). This similarity can result in cross-reactivity that leads to food autoimmunity and even autoimmune disorders, such as multiple sclerosis (MS), celiac disease (CD), and neuromyelitis optica. Further research is needed to determine what other foods have dangerous sequence similarities to human tissues and what methods are available to test for the autoantibodies resulting from these molecular, mimicry-induced misfires of the immune system. The identification and removal of corresponding food triggers can then be used as the basis of therapy. Alternative Therapies Health and Medicine. 2015;21 Suppl 1:34-45
Microbiome – The Garden Within
For every cell in the human body, there are about 10 nonhuman cells. These microbial residents of our gut, skin, eyes and nasal passages collectively are referred to as the "microbiome" — and research of its role in human health has revealed enough surprising discoveries that the National Institutes of Health has launched an international Human Microbiome Project. What we eat, parasite, molds and dirt all impact the microbiota and whether we are born naturally or through C-section or whether we drink breast milk on baby formula also impact our gut, which is the largest part of our immune system.
A diet high in fruit, vegetables and perhaps whole grains allows beneficial bacteria to dominate and inhibits the growth of more harmful strains. While researchers haven't reached consensus about what constitutes an optimal microbiome, there is some general advice for tending our microbial gardens: eat plenty of fruits and vegetables; fermented foods; garden herbs including garlic and leeks; focus on fresh; and, take probiotic supplements. http://www.foodandnutrition.org/May-June-2015/Microbiome-The-Garden-Within/
Four Differences Between Celiac Disease and Non-Celiac Gluten Sensitivity (NCGS)
Celiac.com identifies the differences between Celiac Disease and Non-Celiac Gluten Sensitivity:
- NCGS is not genetic
- NCGS is so far not related to malabsorption, autoimmune diseases or intestinal malignancies.
- There are no screening tests that can identify NCGS.
- NCGS is a disease of exclusion, that is only identified after Celiac Disease and other gastrointestinal issues have been ruled out.
Dr. Alessio Fasano and a team of researchers, have discovered that the immune response for celiac disease is very different than the response of patients with gluten sensitivity. It is hoped that this breakthrough leads to better diagnosis of the gluten sensitivity which to date has no diagnostic test. The study included individuals with celiac disease, gluten sensitivity and healthy gluten-tolerant controls. Participants were placed on a 4-month gluten challenge, then underwent serological screening for celiac disease, HLA DQ2/DQ8 typing and an upper endoscopy including duodenal biopsy. According to the results, individuals with gluten sensitivity showed no signs of intestinal damage or increased permeability, but showed an increase in an immune marker that is different than the adaptive immune response seen in celiac disease. Further research is needed to get a better understanding of these differences and how they could affect diagnosis of the conditions. To learn more, read the study in BMC Medicine
Israeli Researchers Propose Link Between Gluten Sensitivity and ALS
The association of celiac disease and neurological disorder have been well documented, however, Israeli researchers are cautiously stating that there is a link between gluten sensitivity and ALS. Lou Gehrig’s disease is a progressive disease that attacks nerve pathways and the links of nerves in the brain and spinal cord, eventually causing paralysis. The team tested fifty patients and 20 controls for celiac disease-specific HLA antigen alleles; 59.1% of TG6 IgA positive individuals tested positive for celiac disease-related alleles compared with 28.6% of the 28 negative individuals. Nearly 46% of patients with CD product antibodies to TG6 (tissue transglutaminase) even when they have no neurological symptoms. They warned that is very early research and ALS patients should not undertake a gluten free diet unless a tTG indicates that there are antibodies. Further research is required, but this study did find a linkage. JAMA Neurol. 2015 Apr 13. doi: 10.1001/jamaneurol.2015.48.
Licensing of the Pocket Dictionary...
The CCA Board of Directors licensed the Pocket Dictionary to the developers of Glutenfree247. The application runs on iPhone, iPad and iPod Touch devices and is now available for purchase from the iTunes Store. For more details, visit www.glutenfree247.ca
Celiac and wheat allergy affect the body differently
"Celiac disease and wheat allergy both involve the immune system but the reaction within the body is different. Celiac disease is an autoimmune disease that causes damage to the lining of the intestine. It is a lifelong disorder. Symptoms of wheat allergy include a skin rash, wheezing, abdominal pain, or diarrhea. Wheat allergy is often outgrown." -- WebMD for a slide show on Celiac Disease.
Persistent symptoms in some celiac patients tied to altered microbiota
Celiac disease patients who followed a gluten-free diet long term but still had gastrointestinal symptoms showed abnormal intestinal microbiota, researchers from Finland reported in the American Journal of Gastroenterology. The study included celiac disease patients who had normalized small bowel mucosa and negative celiac autoantibodies, and had followed a gluten-free diet for several years. Healio (free registration)/Gastroenterology (11/19/2014)
Study: Many celiac disease patients have non-traditional symptoms
Patients less frequently exhibit the classical celiac disease symptom of diarrhea when newly diagnosed with the disease. In a 15 year study by an Italian research study, they found that traditional symptoms like diarrhea decreased from 47% in the first 10 years of a study to 13% in the final five years. The study found many patients reported non-traditional symptoms, such as bloating, osteoporosis and anemia. Reuters (11/26)
Some heartburn drugs may change gut bacteria, raise infection risk
Researchers said that proton pump inhibitors that treat heartburn may change the bacterial makeup of the digestive system. The study does not show cause and effect, but it does suggest that heartburn drugs may create a “gut microbial environment” that increases the risk of infection said the study co-author John DiBaise of the Mayo Clinic in Scottsdale, Ariz. HealthDay News (11/25)
In the USA Over 20% of Foods Labeled "Gluten-free" Could Contain Too Much Gluten
Breakfast cereal was found to be the main culprit in a USA study which tested products that were labelled “gluten-free”: five of eight breakfast cereal samples showing gluten contents above 20ppm (20 mg/kg). Celiac News 12/05/2014
Is Oat Flour Gluten Free
While this report is out of the USA where oats ARE allowed in the gluten free diet, Tricia Thompson who has recently been doing a study on all things oats has just put out this post specifically on Oat Fiber (aka Oat Hull Fiber): Gluten Free Watchdog Feb 20, 2015
Celiac Disease in Children
In this article, Dr. Ed Hoffenberg, MD talks about the differences seen in children with Celiac Disease at different ages. It is unknown why some children develop celiac disease early in life and others later in life. Symptoms also vary between children from within minutes of ingestion of gluten, to delayed symptoms lasting sometimes as long as two weeks. With severe symptoms children are most likely to be diagnosed: failure to thrive, weight loss and vomiting. Infants and toddlers can suffer from malnutrition which results in low growth in height and/or weight. The tTG test is not accurate in children under 3 years of age and any child with symptoms under this age should be seen by a pediatric gastroenterologist.
School age children usually do not vomit, but have other gastrointestinal issues like stomach aches, bloating, diarrhea or constipation. Inability to either gain or lose weight should signal a test for celiac disease.
Teens with celiac disease often exhibit “atypical” symptoms. Mood disorders, depression and panic attacks may arise. Lethargy, fatigue, headaches, skin conditions (DH), stunted growth and delayed puberty are some of the possible symptoms.
Children may also have no or mild symptoms and testing should be considered if they have other related conditions: Type 1 diabetes, a relative with the disease, juvenile arthritis, a thyroid condition, IgA deficiency to name a few. Anemia, weak dental enamel, elevated liver enzymes or osteopenia are all signals that celiac disease should be tested for.
https://celiac.org/live-gluten-free/lifestyle/for-parents-and-children/22783-2/?bblinkid=24443625&bbemailid=1910934&bbejrid=129664823
Is there gluten in your over the counter medications?
This is not new research, but I like to let people know of the only site I have found that provides a listing of over the counter gluten-free drugs. This is a US site. It is run by a pharmacist who is also developing a new list of drugs indicating whether there are corn, lactose, potato and soy in the drugs, in addition to their gluten-free status. The site is www.glutenfreedrugs.com
Gluten-Free Diet Does Not Repair Intestinal Damage in Some Children With Celiac Disease
Medical records of 102 children diagnosed with celiac disease were reviewed. After a year, despite excellent adherence to a gluten-free diet for most (91%) patients, 43% experienced persistent symptoms, 27% had new gastrointestinal symptoms, and 34% had persistently elevated serology at the time of repeat endoscopy and biopsy. Only 33% of the patients were asymptomatic at the time of repeat endoscopy. Overall, 19% of patients showed persistent enteropathy consistent with a Marsh 3 lesion at the repeat endoscopy. The findings demonstrate that neither the presence of symptoms nor a positive tTG result was a reliable measure of mucosal recovery in the study population. For example, tTG was elevated in 43% of patients with persistent enteropathy and in 32% of those with mucosal healing. In contrast, 84% of patients with mucosal recovery on repeat biopsy were symptomatic at the time of the repeat endoscopy, as were 55% with persistent enteropathy. Further research is required in this area. The study included Dr. Alessio Fasano, a well-known gastroenterologist and researcher and Dr. Jocelyn Silvester, who has been funded by the Canadian Celiac Association in the past. Published on line, November 3, 2016 Journal of Pediatric Gastroenterology and Nutrition, February 2017 - Volume 64 - Issue 2 - p 286–291.
New List Created by Experts May Help Prevent Food Gluten Cross-Contamination
The newly created food services checklist was compiled after an extensive literature review, input from 11 different experts with PhDs and experience with food services and/or gluten and celiac issues, along with documents from various organizations such as the Gluten-Free Certification Program from the Canadian Celiac Association.
The final checklist consists of 88 items divided into 12 sections, which cover everything from building and facilities maintenance, cleaning and ventilation, to employee clothing and hygiene, to food production and transport. The list was published in the journal Nutrients.
http://www.cantechletter.com/2017/01/new-tools-may-prevent-gluten-cross-contamination-food-services-industry/
Celiac Disease Patients Have a Higher Risk of Pneumonia
One study, conducted in the United Kingdom, provides the most comprehensive look at the issue. The study tracked 9,803 people with celiac disease, along with 101,755 people who didn't have the condition for comparison purposes.
The study, which spanned 15 years, included all age groups.
Overall, the researchers identified 179 cases of pneumonia among those who had celiac disease, compared to 1,864 cases in those people who didn't have celiac. That works out to similar odds for those with celiac to catch pneumonia, when compared with those who didn't have the condition.
However, the researchers also identified a 28 percent increased risk of pneumonia in people younger than age 65 who had celiac disease and who had not been vaccinated for pneumonia. This increased risk was highest around the time of diagnosis—at that time, the risk was twice as high for any type of infectious pneumonia and four times as high for pneumococcal pneumonia, the researchers said. However, the risk remained elevated for more than five years following that celiac disease diagnosis.
The study concludes: "Unvaccinated patients with coeliac disease under the age of 65 have an excess risk of community-acquired pneumonia that was not found in vaccinated patients with coeliac disease. As only a minority of patients with coeliac disease are being vaccinated, there is a missed opportunity to intervene to protect these patients from pneumonia." http://www.mdmag.com/medical-news/doctors-suggest-celiac-disease-patients-get-pneumonia-vaccine
Celiac Disease Patients Pay a Higher Economic Burden
“This study highlights the additional healthcare resource use and costs associated with celiac disease on top of gluten-free-diet costs,” said Stefano Guandalini, M.D., founder and medical director of the University of Chicago Celiac Disease Center. “It focuses on the costs borne by insurers, as well as the medical burden of celiac disease for patients.” The study looked at the medical records of 18M patients in the US. They identified 12,187 patients with Celiac Disease and matched them based on age, sex, region, company and employment status. Patients with celiac disease had $12,217 total all-cause direct costs compared with $4,935 in controls (P < .0001). Guandalini S, et al. Abstract 2. Presented at: Digestive Disease Week, May 16-19, 2015; Washington, D.C.
http://www.healio.com/gastroenterology/malabsorption/news/online/%7B46029097-bd42-49b7-8f2c-39bfbd46e18b%7D/celiac-disease-associated-with-significant-economic-burden
Gluten Free Stakeholder 2016 Report
The Session was led and facilitated by the Canadian Celiac Association, the Allergen Control Group Inc, and the Agriculture and Agri-Food Canada. You can read their final report regarding the September 2016 meeting.
http://gfstakeholdersession.com/assets/ALLERGEN_STAKEHOLDER_SESSIONS_REPORT_.pdf
25% of Ataxia Caused by Gluten
A study in the Journal of Neurology, Neurosurgery and Psychiatry found that 25% of ataxia was caused by gluten. A research paper lead by Dr. M Hajivassiliou published in December, 2016 concluded that immune-mediated ataxias are common. Diagnosis of the cause is key to potential therapeutic treatments. Ataxia is a neurological condition consisting of the loss of control of bodily movements. It includes gait abnormality. http://jnnp.bmj.com/content/early/2016/12/13/jnnp-2016-314863
US Labelling of Gluten-Free Foods
The U.S. Food and Drug Administration (FDA) has defined the term “gluten-free” for voluntary use in the labeling of foods. Any food product bearing a gluten-free claim labeled on or after August 5, 2014 must meet the requirements of the agency’s gluten-free labeling rule. With this uniform definition, consumers with celiac disease can choose foods with greater confidence. The standard is no greater than 20 ppm in products that are labelled gluten-free. This brings US labeling closer to Canada’s standards. For detailed information if you are traveling to the US. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Allergens/ucm362880.htm
Celiac Associated Pancreatic Disease
Dr. Hugh Freeman, a gastroenterologist affiliated with the Department of Medicine, University of British Columbia, Vancouver, BC set out to study the prevalence of Type 1 diabetes and Celiac Disease
Prospective studies using an initial screening IgA tissue transglutaminase antibody assay (tTG) were done at UBC and a total of 125 male and 108 female children and adolescents with type 1 diabetes mellitus were evaluated from an established pediatric diabetes clinic. Of these, 15 male and 11 female patients had elevated tTG titers, of whom 19 were also positive for endomysial antibodies. Among these cases, 1 was already known to have celiac disease. Small intestinal biopsies were done in the other 18 children positive for both antibodies.
In this study, over 40% of diabetic children were asymptomatic, yet blood testing facilitated selection for a small intestinal biopsy evaluation. 7.7% of this pediatric group had biopsy results common in celiac disease. Dr. Freeman says that further research in this area is required to determine if these observations can be verified by others. Annals of Gastroenterolgoy, July – September, 2016, published on-line May 20, 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923808/
Wheat Proteins Cause Inflammation Beyond the Gut
This is a study regarding ATI's (amylase-trypsin inhibitors), which are specific proteins found in wheat that has been shown to trigger an immune response in the gut that can spread to other tissues in the body. While ATI's only compromise 4% of the protein in wheat, they have been suggested to exacerbate rheumatoid arthritis, multiple sclerosis, asthma, lupus, non-alcoholic fatty liver disease, IBS and other conditions such as non-celiac gluten sensitivity (NCGS). http://www.medicalnewstoday.com/articles/313514.php
Rituximab Promising for Dermatitis Herpetiformis
Rituximab may be an effective treatment for recalcitrant dermatitis herpetiformis (DH), according to a recent case study.
"DH is an autoimmune blistering disease which is commonly associated with celiac disease and can present with debilitating pruritic blisters on extensor surfaces," explained Dr. Ron Feldman of Emory University School of Medicine.
"The most common treatments are a gluten-free diet along with the addition of dapsone," he told Reuters Health. "For patients who do not typically respond to these therapies, other immune-suppressing medications have been utilized with mixed results."
"This is the first successful case of rituximab therapy used for a recalcitrant case of DH," he said by email. "The patient had resolution of both his pruritus and skin rash. In addition, the levels of both anti-tissue and anti-epidermal transglutaminase antibodies normalized."
The link to this article is below, you do need a login to Medscape to view it. http://www.medscape.com/viewarticle/874098?src=wnl_edit_tpal