GlutenFree.com

Limited data is available on the safety of oats consumption over the long term in patients with celiac disease. This study evaluated the dietary intake, small bowel tissue and gastrointestinal symptoms of adults with celiac disease adhering to a gluten-free diet with or without oats. 

Key Points

• In this cross-sectional follow-up study conducted in Finland, 106 patients with confirmed celiac disease who adhered to a strict gluten-free diet underwent dietary and gastrointestinal symptom assessment as well as small bowel biopsy.
• Two-thirds of the patients preferred to consume oats, choosing a wide variety of commercially available oat products from local markets.
• The patients consuming oats had significantly higher fiber intakes than those who did not consume oats.
• Of those who did not consume oats, the majority were diagnosed with celiac disease before oat-containing gluten-free products were permissible for those with the condition. Fear of adverse effects was listed as a reason for continued avoidance. 
• Daily and long-term oats consumption did not result in small bowel tissue damage, inflammation or gastrointestinal symptoms. In fact, daily and long-term oat consumption was associated with better small-bowel tissue results and fewer complaints of indigestion.
• Of the 13 patients with dermatitis herpetiformis, nine chose to consume oats and none suffered from the hallmark skin rash.
• Results from this study confirm results from a previous five-year follow-up study of 23 celiac disease patients that showed long-term consumption of oats was safe.

Key Takeaways

Long-term consumption of oats was shown to be safe and to be associated with improved small bowel tissue and gastrointestinal symptoms while also enhancing the nutritional quality of a gluten-free diet through increased fiber intake. This study confirms results seen in previous studies demonstrating long-term oat consumption as safe.

Source:

Kaukinen K, Collin P, Huhtala H, Mäki M. Long-Term Consumption of Oats in Adult Celiac Disease Patients. Nutrients. 2013; 5(11):4380-4389.

As a dietitian, you most likely interact with patients who may have multiple health conditions, including celiac disease and other autoimmune diseases. While knowing how to connect one on one with your patients is important for behavior change, it’s scientific evidence that should provide the backbone for your recommendations. Although research promoting a gluten-free diet for various health conditions is relatively new, we can expect to see more data in the next few years. As research emerges, we can then incorporate these findings into our practice to help patients reap all of the potential health benefits of a gluten-free diet.

"Potential" celiac disease patients:
A 2010 study found that most patients classified as potentially having celiac disease based on immunological abnormalities that are similar to those found in celiac patients should also adhere to a gluten-free diet. Researchers concluded that these patients share the same “metabolic fingerprint” as diagnosed celiac patients and should follow the same avoidance of wheat, rye and barley.

Type 1 diabetes:
Researchers have established a connection between the gut and the body’s response to certain autoimmune diseases, and scientific data is now shedding light on the role gluten may be playing. One 2006 population-based study followed pediatric patients with type 1 diabetes to determine the prevalence of celiac disease as well as the effects on clinical outcomes of following a gluten-free diet. Results showed a high prevalence of celiac disease in children with type 1 diabetes and that they had lower scores for height and weight. After following a gluten-free diet for two years, participants experienced increases in height, weight, hemoglobin and serum ferritin, although HbA1c remained unchanged. These results led researchers to recommend screening for celiac disease in all children with type 1 diabetes. Additionally, a 2009 study found a potential association between wheat and the development of type 1 diabetes. Researchers tested 42 type 1 diabetic patients and found that almost half had an abnormal immune response to wheat proteins.

Rheumatoid arthritis:
As an inflammatory condition, rheumatoid arthritis is associated with a higher risk of heart diseases. A 2008 study found that a gluten-free vegan diet could help rheumatoid arthritis patients by decreasing their risk factors for heart attack and stroke. Researchers found that the gluten-free vegan diet decreased “bad” LDL cholesterol and increased antibodies associated with rheumatoid arthritis symptoms.

Autism:
The origins of autism remain unclear and, to date, autism is not officially considered an autoimmune disorder. However, researchers are finding evidence that may link autism to an immune reactivity to gluten that is unrelated to celiac disease. A 2013 study found that children with autism were more likely to have elevated antibodies to gluten protein when compared to children without autism. Researchers noted that this is an area that warrants additional research and attention to explore the use of biomarkers and disease pathophysiology.

Starting a gluten-free diet can be overwhelming and expensive. But it doesn’t have to break one’s budget. Many of the same nutritious foods are recommended for people following a gluten-free diet as are for the general population: fruits, vegetables, low-fat dairy, eggs, beans and legumes, nuts and lean protein. Here are some simple tips to keep a gluten-free shopping trip within budget:

• Plan your meals ahead of time, and stick to your list. Consult your grocery store’s weekly circular to see what coupons are available or what items are on sale.
• Find creative ways to use all of the ingredients you purchase to avoid waste.
• Purchase a combination of fresh seasonal produce, frozen and no sugar added/low sodium canned fruits and vegetables.
• Use plant-based proteins as an alternative to meat, which can be more costly. Items such as beans and lentils are packed with nutrition and budget-friendly.
• Eggs are another low-cost, high-quality protein.
• When purchasing fresh chicken, meat or fish, look for products that have not been pre-marinated or prepared in any way. This can cut back on cost and the likelihood of gluten appearing in other ingredients.
• Buy and cook in bulk. Saving and freezing leftovers for future meals can save time and money.
• Experiment with other whole grains like quinoa, millet, amaranth, buckwheat and wild rice. When you find some that you like, buy these in bulk too. Some “ancient grains” can be more costly when purchased in smaller quantities.
• Encourage everyone in your family to try gluten-free. Purchasing “regular” and gluten-free versions of foods and cooking separate meals can add up.
• When selecting your favorite gluten-free packaged goods, consider your meal plan. These packaged foods could serve as snacks or provide just one meal per day.
• Individuals with diagnosed celiac disease may be eligible to receive tax deductions for gluten-free food purchases. Speak with an accountant to learn more about this opportunity.

Sources:

Academy of Nutrition and Dietetics | Celiac.com | National Foundation for Celiac Awareness

2014 is here and, for many people, the New Year signifies new hope for positive lifestyle changes. With the increased prevalence and attention to gluten sensitivities and the desire for many to try a gluten free lifestyle, many patients are seeking advice on where to begin with their gluten-free resolution. There are many points to consider when making a gluten-free resolution, and as registered dietitians, we’re here to help our patients and clients with the transition. Luckily, going gluten free is easier today than it ever has been. It’s as simple as knowing the three “E’s.”

Educate. Education is a critical component to helping your patient’s live a gluten free lifestyle. Start with label reading basics and use example products or even a grocery store tour to demonstrate the essential factors that determine whether a product is truly 100% gluten free. Instruct your patients on how to identify statements that may indicate potential for cross contamination with gluten containing foods and provide handouts on processed foods that may be likely to contain gluten such as licorice, French fries and soy sauce. Finally, provide resources on tips for dining out and traveling.

Empower. While going gluten free may seem daunting at first, remind your patients that there is an entire world beyond wheat, rye and barley. In fact, there are more gluten-free grains that exist in nature than non-gluten-free grains. The world is their quinoa cake, so excite them about taking a bite!

Encourage them to eat gluten free now! Starting on January 1st is the norm with New Year’s resolutions, but starting as soon as possible is an even better plan. Going gluten free may be associated with a wide range of beneficial health outcomes that may be felt as early as a few days in. Further, the simple step of truly watching what you eat, including label reading and increased awareness to what certain ingredients will do to your body may have secondary dietary impacts, such as increased fruit and vegetable consumption, better portion control and increased water intake.

Finally, if you have a patient that desires their child to go gluten free, follow these same steps. Inspire mom and dad to lead by example by reading labels and educating themselves on gluten-free food options. Most importantly, encourage all family members to join the effort and make the entire household a gluten-free one.

The words “celiac disease,” “allergy,” “intolerance” and “sensitivity” are commonly interchanged when used to describe a person’s relationship and reaction to gluten and wheat. While there are a few similarities between the conditions, there also are important differences.

Celiac disease is a hereditary autoimmune disease in which a person’s immune system attacks the lining of the small intestine when gluten is eaten. This damages the cells that absorb nutrients from food and causes symptoms like gastrointestinal distress, fatigue, weight loss and slowed growth in children. Celiac disease can be diagnosed through blood tests and a biopsy of the small intestine to assess for damage. The only treatment currently available is to avoid eating gluten.  

A food allergy is defined as an abnormal response of a person’s immune system to a food. When a trigger food is ingested, a person’s immune system recognizes that food as a harmful substance instead of as nourishment, and an allergic reaction — such as hives, wheezing or even difficulty breathing — follows. Skin and blood tests can be used to diagnose it, and the only treatment is to avoid eating the trigger food.

There are eight main food allergy culprits. One of them is wheat. While gluten is a protein found in wheat, a wheat allergy is not the same thing as celiac disease or a gluten allergy. Experts say there may be other components in wheat, such as fructans, rather than gluten that are causing adverse reactions in people. In fact, some experts recently indicated there is no such thing as a “gluten allergy” at all. It may be an argument of semantics, however, experts do agree that celiac disease is a real and serious condition. It could be suggested that celiac disease is what people should think of when they hear “gluten allergy.”

A food sensitivity or intolerance is defined as causing an adverse reaction to a food or food group that does not involve the immune system. Experts and research studies agree that there is a condition known as non-celiac gluten intolerance (or gluten sensitivity). However, it is still not completely understood. What is known is that people with this condition experience neither an immune response indicative of an allergy nor do they show the small intestinal damage that is seen in celiac disease. In other words, sufferers may experience many of the same symptoms from food allergies or celiac disease, but diagnostic blood tests do not confirm either of the medical conditions. Following a gluten-free diet also is advised for those suffering from this condition.

Sources:

National Digestive Diseases Information Clearinghouse | Medline Plus | Gluten Intolerance Group

Key Points

• Results suggested symptoms of autism and attention-deficit hyperactivity improved in children on the diet after 12 months.
• After 24 months, there was evidence these positive results were sustained, although a leveling-off of the effects may have been seen.
• The authors concluded, “Our results suggest dietary intervention may positively affect developmental outcome for some children diagnosed with autism spectrum disorders.”

Key Takeaways

While these results are encouraging, further study is needed to help define which children might respond best to dietary intervention or a gluten-free diet.

Source:

Whiteley P, et al. The ScanBrit randomised, controlled, single-blind study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders. Nutritional Neuroscience, 2010; 13(2):87-100. http://www.ncbi.nlm.nih.gov/pubmed/20406576

According to the National Digestive Diseases Information Clearinghouse at the National Institutes of Health, celiac (or coeliac) disease (CD) is a chronic autoimmune intestinal disorder found in individuals who are genetically susceptible. Celiac disease also is known as celiac sprue, nontropical sprue and gluten-sensitive enteropathy.

When a person who has celiac disease consumes gluten, the individual’s immune system responds by attacking the small intestine, which then inhibits the absorption of important nutrients into the body. This response can result in the person experiencing any of more than 200 signs and symptoms.

As many as three million Americans may be living with celiac disease; however the University of Chicago Celiac Disease Center indicates 97% go undiagnosed.

Symptoms

Children tend to show more classic symptoms, including failure to thrive, chronic diarrhea/constipation, and recurring abdominal pain or bloating. Adults tend to have symptoms that are not entirely gastrointestinal in nature. Common symptoms of celiac disease may include one or more of the following:

• Frequent abdominal bloating and pain
• Chronic diarrhea or constipation
• Vomiting
• Weight loss
• Pale, foul-smelling stool
• Iron-deficiency anemia that does not respond to iron therapy
• Fatigue
• A skin rash, called dermatitis herpetiformis
• Tooth discoloration or loss of enamel
• Unexplained infertility or recurrent miscarriage

Diagnosis

There are a number of steps in the process of diagnosing celiac disease. Physicians first run a blood test to detect if levels of certain antibodies are higher than normal in people with celiac disease who eat gluten. These antibodies are the anti-tissue transglutaminase (tTG); the anti-endomysium (EMA); and the anti-deamidated gliadin peptides (DGP). A positive antibody test suggests a person might be celiac, but it is not conclusive. Therefore, the next step is to conduct a biopsy of the small intestine to check for damage to the villi. This is the only way to conclusively diagnose a person with celiac disease.

Treatment

The only known treatment for celiac disease is to follow a gluten-free diet. That is, for someone living with celiac disease to avoid all foods (and sometimes non-food products such as cosmetics) that contain gluten. The gluten-free diet is a lifetime requirement, but following it should stop symptoms, heal existing intestinal damage and prevent further damage to the body.

Source:

Maintaining a gluten-free diet when traveling may seem like a challenge. But, with a little planning ahead of time, eating gluten-free on the go can be easy and healthy.

On the Plane:

When flying, especially internationally, speak with a customer service representative ahead of time and request gluten-free in-flight meals for each leg of the journey. Most airlines will be able to comply, but for those that don’t, you will need to pack enough non‑perishable gluten-free snacks to tide you over.

In the Car:

When traveling by car, plan meals ahead of time and bring them along in a cooler, along with your favorite individual-sized gluten-free snacks. Try to bring more than you think you need, as you never know how difficult it may be to find gluten-free options at your destination.

Overnight Stays:

Try to stay in a place where you’ll have a kitchenette or access to kitchen facilities. If you’re staying in a hotel, ask in advance if there will be a microwave and refrigerator in your room. If you’re staying in someone’s house, ask if you can have some fridge or freezer space. This way, you will always be able to prepare something delicious and gluten-free for yourself.

In general, do as much research as possible beforehand. Doing so not only helps you feel safer about your options, but also helps those who will be accommodating you to prepare. If all else fails, naturally gluten-free foods like fruits, vegetables, and lean meats are always safe and nutritious options. 

Sources:

Gluten Intolerance Group | Gluten Free Cooking on About.com | Celiac Disease on About.com

Rule #1: Check the label! Anything containing “wheat,” “rye,” or “barley” is not gluten-free. Other, seemingly innocent additives, like food starch, caramel coloring, malt vinegar and hydrolyzed plant or vegetable protein also are not likely to be gluten-free.

Rule #2: If you’re not sure, find out! Most food manufacturers have customer service numbers and will answer any questions about products or ingredients. Until you’re sure a product is gluten-free, it’s safer not to use it. Accidentally ingesting gluten can be very harmful to people with celiac disease or gluten intolerance. 

Rule #3: Shop the perimeter of the store. Fortunately, many nutritious foods that are naturally gluten-free are found on the perimeter of the store. Fruits and vegetables, lean meats, fish and chicken, nuts and seeds, low-fat unflavored dairy products are all safe bets.

Rule #4: Look for the Gluten-Free Certification Organization (GFCO) Certified Gluten-Free seal. Many food manufacturers are now making healthy and delicious gluten-free products. This seal indicates that the manufacturing facility was inspected and the product contains less than 10 ppm of gluten.

Sources:

Gluten Intolerance Group Toolkit

Adjusting to a gluten-free diet can be tricky, so it’s important to ensure you are getting all the nutrients you need to stay healthy. Fortunately, many of the healthiest foods, such as vegetables, fruits, beans/lentils, nuts and seeds, low-fat unflavored dairy products, lean meats, fish, and chicken are naturally gluten-free.

On the other hand, some gluten-free products increase the sugar or fat content to compensate for texture and flavor changes that can result from the removal of gluten. Look for products that do not have sugar, syrups, or fat listed high on the ingredient list.

While it may seem like a safe choice, don’t cut out grains altogether. Choose products with significant amounts of gluten-free whole grains, and flours made from these grains, instead of refined grains like white rice flour. Whole grains provide essential fiber, vitamins and minerals necessary for a balanced diet.

When first starting a gluten-free diet, it also can be beneficial to meet with a dietitian or nutrition specialist who will help you get started and stay healthy.

Sources:

Gluten Intolerance Group

Gluten is the common name for proteins in specific grains, like wheat, rye, barley and triticale. Other related grains, including durum, einkorn, Kamut® khorasan wheat, semolina, spelt/spelta, faro and emmer, also contain gluten. And, while oats themselves do not contain gluten, they are often cross-pollinated with other grains and contain a protein (avenin) structurally similar to gluten’s protein (gliadin) when processed. As a result, some gluten-sensitive people cannot tolerate oats.

• Beer
• Breads
• Cakes and pies
• Candies
• Cereals
• Cookies and crackers
• Croutons
• French fries
• Gravies
• Imitation meat or seafood
• Matzo
• Pastas
• Processed luncheon meats
• Salad dressings
• Sauces, including soy sauce
• Seasoned rice mixes
• Seasoned snack foods, such as potato and tortilla chips
• Self-basting poultry
• Soups and soup bases
• Vegetables in sauce

Additionally, gluten is found in a number of other products, including cosmetics, vitamins and some pharmaceutical medications. It is important for people who are looking to avoid gluten to read product labels and educate themselves about ingredients.

During digestion, gluten’s two main protein groups, gliadins and glutenins, break down into smaller units. In people with celiac disease or gluten sensitivity, the body’s natural defense system reacts to these proteins by attacking the lining of the small intestine. Without a healthy intestinal lining, the body cannot absorb the nutrients it needs. This can lead to delayed growth, nutrient deficiencies, anemia or osteoporosis and, in more serious cases, result in diabetes, other autoimmune diseases, and intestinal cancers. 

However, there are more and more sources of food products without gluten. Following a gluten-free diet and avoiding the above-listed grains is very important for people with conditions like celiac disease and gluten sensitivity. 

Sources:

Food and Drug Administration | Mayo Clinic

For expecting women who have been diagnosed with celiac disease, one of the most important contributing factors to a healthy pregnancy is also maintaining a gluten-free diet. This keeps mom healthy while providing nutrients and calories her baby needs.

While it is possible to become pregnant and maintain a pregnancy with undiagnosed celiac disease, or while eating a wheat-containing diet despite known celiac disease, some studies have shown an increased risk for poor pregnancy outcomes compared to the normal population.

Key Points

• An Italian study found that of 845 pregnant women screened for anti-endomysial antibody (EMA), 12 had biopsy-proven celiac disease.
• Seven of these pregnancies resulted in adverse outcomes, two miscarried and five delivered low birth-weight babies.
• Of the five multiparous women with celiac disease, four had previously miscarried, which was significantly higher than in the study control population.
• The study also concluded unfavorable events associated with celiac disease may be prevented by a gluten-free diet.1
• Additionally, numerous studies have shown that improvement of celiac disease, with implementation of a gluten-free diet, may decrease miscarriage rates, improve fetal nutritional support and overall pregnancy outcome. 2 When a gluten-free diet is maintained, the statistics related to pregnancy outcomes become equal to that of the normal population.

Sources:

Martinelli P, Troncone R, Paparo F, et al. Coeliac disease and unfavourable outcome of pregnancy. Gut. 2000;46:332–335

Celiac disease: fertility and pregnancy. Eliakim, R Sherer DM. Gynecol Obstet Invest. 2001: 51(1):3-7

The U.S. Food and Drug Administration recently established the official “gluten-free” label, which holds packaged food products to a set of standards that establish them as safe to consume for anyone following a gluten-free diet. Among those standards, the food product must contain less than 20 ppm (parts per million) of gluten, a level considered by experts to be safe for those with celiac disease and gluten sensitivity. For people with gluten-related disorders or gluten intolerance, strictly avoiding gluten is critical to maintaining good health.

Consumers can also look for the following gluten-free seals on the food product:

• Gluten-Free Certification Organization (GFCO) Certified Gluten-Free seal
• NSF’s Certified Gluten-Free seal
• Gluten-Free Certification Program (GFCP) Certified Gluten-Free seal, endorsed by the National Foundation for Celiac Awareness (NFCA    

Each of the seals indicates that the company’s manufacturing facility was inspected and the product meets FDA standards of containing less than 20 ppm of gluten (and in some cases containing less than 10 ppm of gluten).

Many foods are naturally gluten-free, including milk, fresh fruits and vegetables, butter, eggs, lentils, nuts, seeds and corn. However, some other common ingredients are not. Check the “contains” line under the ingredient list on the product’s nutrition panel.

If the product contains any of these ingredients, it is not gluten-free:

• Wheat
• Barley
• Rye
• Oats (unless GF certified)
• Malt
• Brewer’s yeast
• Triticale
• Durum
• Einkorn
• Semolina
• Spelt/spelta
• Faro
• Emmer
• Kamut® khorasan wheat.

Sources:

Gluten Intolerance Group | Food and Drug Administration

Humans have been eating foods that contain gluten for thousands of years, but the amount and type of gluten in food products has greatly changed. Although the cultivation of grains for consumption evolved and spread across the globe, it was not until the processing innovations of the Industrial Revolution in the 19th century that grains became widely available and affordable. In the 1990s, the USDA created the food pyramid, further solidifying grains into the diets of Americans.

Research suggests the genetic predisposition for celiac disease and gluten intolerance is tied to the emergence of grain as a primary element in a normal diet. It has been suggested that the inability to process gluten is linked to the relatively short evolutionary period over which humans have become so exposed to it. In addition, due to modern methods of mass production, today’s grains are more glutinous than the grains of past generations.

Today, people are eating more grains and, therefore, more gluten than ever. The symptoms of gluten intolerance or gluten sensitivity may vary from person to person, so diagnosing it can be difficult. However, recent developments in testing and a better understanding of these conditions have led to an increased rate of diagnosis. For example, only 3.3 per 100,000 people were diagnosed with celiac disease in the 1990s, but 20.6 per 100,000 were diagnosed in the early 2000s. That’s why an increasing number of people have found it necessary to follow a gluten-free diet.

Sources:

Celiac.com | Mayo Clinic

Clin Gastroenterol Hepatol. Trends in the identification and clinical features of celiac disease in a North American community, 1950-2001. 2003 Jan;1(1):19-27.

Beyond the digestive complications associated with celiac disease, unexplained infertility has also been reported in this population since the 1970s.1 Since this time, numerous studies have found undiagnosed celiac disease to create fertility challenges for women, both in becoming pregnant and maintaining pregnancy.

An Italian study found the prevalence of celiac disease among women with unexplained infertility is 2.5-3.5% higher than the study control population.1 Other studies have found this prevalence to be as high as 6% as compared to almost 1% in the general population.2

Many women experience resolution of the infertility issues once celiac disease is diagnosed and a gluten-free diet is adopted. Numerous studies have shown that improvement of celiac disease, with implementation of a gluten-free diet, may decrease miscarriage rates, improve fetal nutritional support and overall pregnancy outcome. 3 However, it’s important for women to give themselves time after diagnosis and changing the diet, as they must be healthy and in good nutritional state before trying to become pregnant. In one U.S. study, all four patients diagnosed with celiac disease conceived within a year of their diagnosis and gluten free diet changes. 2 Ultimately, a normal pregnancy and healthy baby are possible for women diagnosed with celiac disease.

If a woman suspects undiagnosed celiac disease might be causing fertility issues, especially if she is experiencing other symptoms of the disease, she should consider consulting her doctor about being tested for celiac disease.

Sources:

1Women and celiac disease: association with unexplained infertility. Pellicano R et al. Minerva Med. 2007 Jun: 98(3):217-9.

2Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States. Arch Intern Med. 2003;163:286–292.

Many women may wonder if they can live a gluten-free lifestyle while pregnant, especially if they have been diagnosed with celiac disease or gluten sensitivity. It is possible to maintain a balanced, gluten-free diet while pregnant; however they should be sure to keep their doctor informed of their meal plans throughout their pregnancy. Also, there are essential vitamins and nutrients that women should pay special attention to if they have removed gluten from their daily meal plans.

1. Eat plenty of healthy, naturally gluten-free foods! On the list:

• All fruit, salads, vegetables. Green leafy vegetables are a good choice due to their high folate content (the natural form of folic acid)
• Potatoes
• Rice and corn
• Nuts
• Bean and lentils
• Red meat, chicken, fish, eggs and dairy products

2. There are many gluten-free products on the market that can serve as substitutes in traditional recipes. If sandwiches, pizza or snacks are on the menu, many supermarkets now carry an assortment of gluten-free breads, pizza crusts, crackers and pretzels that can serve as a trustworthy substitute.

3. Take a daily gluten-free prenatal supplement that includes 400mg of folic acid. It can sometimes be hard to get enough folate, iron and B vitamins from a gluten-free diet. A prenatal vitamin is essential to giving baby the vitamins and minerals he/she needs.

4. It is also recommended that gluten-free women take 10 mcgs of vitamin D each day along with an increased intake of calcium throughout pregnancy and while breastfeeding. This will help protect mineral loss in their bones.

Source:

Coeliac UK

As of August 2, 2013, the U.S. Food and Drug Administration has issued a definition of the term “gluten-free” to mean a food labeled with this claim would not contain any of the following:

• An ingredient that is a prohibited grain. Prohibited grains are defined as:
• Wheat, meaning any species belonging to the genus Triticum
• Rye
• Barley
• Crossbred hybrids of wheat, rye or barley (e.g., triticale, which is a cross between wheat and rye)
• An ingredient that is derived from a prohibited grain and has not been processed to remove gluten
• An ingredient derived from a prohibited grain and that has been processed to remove gluten, if the use of that ingredient results in the presence of 20 parts per million (ppm) or more gluten in the food
• 20 ppm or more gluten

 The agency would deem a product as misbranded after reviewing labels, an on-site inspection of the food manufacturer or an analysis of food samples.

 Read the full guidance: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm363069.htm

Key Points

• Researchers looked at a large sample size of Swedish patients (nearly 30,000 patients with confirmed celiac disease) to determine if summer births were more likely to develop celiac disease.
• Results suggested there is a very small, but definite increase in risk of celiac disease if born during the summer and diagnosed before the age of 2.
• The authors concluded, “In this study, summer birth was associated with an increased risk of later celiac disease, but the excess risk was small, and general infectious disease exposure early in life is unlikely to be a major cause of celiac disease.”

Key Takeaways

Since the seasonal time of birth is not a major factor in risk of developing celiac disease, other factors need to be examined, as well as any implications for interventions.

Source:

Lebwohl B, et al. Season of birth in a nationwide cohort of coeliac disease patients. Arch Dis Child, 2013; 98(1):48-51. http://www.ncbi.nlm.nih.gov/pubmed/23172784

Key Points

• The majority of published studies suggest positive benefits from dietary interventions.
• The data show improvement in communication, attention and hyperactivity after the new diet began.

Key Takeaways

Though the authors indicate more information is being gathered in clinical studies and that there are other studies seeking to understand the possible reasons for improvement, there may be specific autism spectrum cases where dietary interventions may be beneficial.

Source:

Whiteley P, et al. Gluten-and casein-free dietary intervention for autism spectrum conditions. Frontiers in Human Neuroscience, 2013; 6: doi: 10.3389/fnhum.2012.00344.

http://www.ncbi.nlm.nih.gov/pubmed/23316152

As is the case with non-celiac gluten sensitivity/intolerance, wheat allergy is not yet fully understood by researchers, but is also recognized as a distinct clinical condition.

Symptoms

Similar to gluten sensitivity/intolerance, wheat allergies generally present as one of two forms: symptoms with characteristics of celiac disease and the other with symptoms of a food allergy. Some of the common symptoms of a wheat allergy are:

• Swelling, itching or irritation of the mouth or throat
• Hives, itchy rash or swelling of the skin
• Nasal congestion
• Itchy, watery eyes
• Difficulty breathing
• Cramps, nausea or vomiting
• Diarrhea
• Anaphylaxis

Diagnosis

A physician may use a combination of tests to diagnose a wheat allergy, including:

• Skin test
• Blood test
• Food diary tracking
• Elimination diet
• Food challenge testing

Treatment

Research has suggested people with a wheat allergy may benefit from a gluten-free diet. However, there is much disagreement among experts about whether patients are suffering symptoms due to gluten or other components of wheat, like fructans. In some cases, antihistamines may relieve the symptoms of a wheat allergy. Evidence also has shown following a gluten-free diet is an acceptable and potentially beneficial treatment for a wheat allergy.

Sources:

American Journal Gastroenterology, December 2012 | Mayo Clinic

Packaged Facts. Gluten-Free Foods and Beverages in the U.S., 4th Edition. October 2012

Although non-celiac gluten intolerance or sensitivity is still not completely understood by researchers, it is generally accepted among healthcare professionals as a distinct clinical condition. Typically, gluten intolerance or sensitivity generally takes one of two forms: one with characteristics more similar to celiac disease and the other with characteristics more similar to a food allergy.

Given the varying degrees of severity and symptoms of gluten sensitivity, researchers believe the prevalence of non-celiac gluten sensitivity to be much higher than that of celiac disease. It is estimated 6% of the U.S. population, or as many as 18 million people, suffers from gluten sensitivity.

Symptoms and Diagnosis

This group reacts with some of the same symptoms as people with celiac disease (gastrointestinal pain or bloating, diarrhea, fatigue) but gluten-sensitive individuals typically test negative for celiac disease in diagnostic blood tests and show no signs of the damage to the small intestine that defines celiac disease. Because of the lack of clarity around symptoms, no accurate or conclusive test for gluten intolerance has been found.

Treatment

As such, it is generally advised that people who may suffer from gluten sensitivity speak with a dietitian and follow a gluten-free diet to relieve symptoms. If following a gluten-free diet does not alleviate symptoms, it is advised patients speak with their doctors, as they may be suffering from something other than gluten intolerance.

Sources:

Division of Internal Medicine, Hospital of Sciacca, ASP, Agrigento, Italy; Centro per lo Studio e la Curia della Mallatia Celiaca, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy.

Packaged Facts. Gluten-Free Foods and Beverages in the U.S., 4th Edition. October 2012

Key Points

• Blood samples were collected from 78 patients with gluten sensitivity and 80 patients with celiac disease and were tested for a variety of immune and antibody markers.
• Results suggested certain key markers known to be associated with celiac disease are not found in patients with gluten sensitivity.
• Other immune markers were noted in some patients with gluten sensitivity, but not in proportions of patients large enough to be considered both sensitive and specific.

Key Takeaways

Further research is needed to establish definitive markers for gluten sensitivity. Absence of known markers for celiac disease can assist in diagnosis of gluten sensitivity, along with presence of clinical symptoms that may include both intestinal and extra-intestinal symptoms.

Source:

Volta U, et al. Serological tests in gluten sensitivity (nonceliac gluten intolerance). J Clin Gastroenterol, 2012; 46(8):680-685.

Key Points

• Researchers reviewed the clinical charts of 276 patients who presented with irritable bowel syndrome (IBS)-like symptoms and had been diagnosed with wheat sensitivity.
• Control patients included 100 with celiac disease and fifty with IBS.
• The results showed two distinct groups of clinical characteristics could be identified:
• Group 1 having wheat sensitivity alone (with characteristics similar to celiac disease), and Group 2 showing wheat sensitivity associated with multiple food hypersensitivities and/or food allergies.
• Data from Group 1 included higher frequencies of anemia, weight loss, self‑reported wheat intolerance, a genetic tendency to develop allergic diseases and food allergies in infancy. Researchers characterized Group 1 patients by clinical features very similar to those found in celiac disease patients.
• Data from Group 2 patients with multiple food sensitivities showed they had clinical features similar to those found in patients who had broader food allergies.
• The authors concluded, “Our data confirm the existence of non-celiac wheat sensitivity as a distinct clinical condition. We also suggest the existence of two distinct populations of subjects with wheat sensitivity: one with characteristics more similar to celiac disease and the other with characteristics pointing to food allergy.”

Key Takeaways

Wheat sensitive patients may present with symptoms similar to celiac disease or similar to patients with broader food allergies. More research on the phenomenon of wheat sensitivity may lead to more complete clinical characterization and result in implications for effective interventions.

 Source:

Carroccio A, et al. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol, 2012; 107(12):1898-1906.

It is estimated celiac disease affects approximately 1% of the Canadian population, or 340,000 Canadians. As a result, Health Canada indicates it is continually monitoring the latest scientific evidence on celiac disease and gluten detection methodologies, and will update its guidance around gluten-free foods as new information becomes available.

Currently, the guidance around labeling on gluten-free foods in Canada is as follows:

“Only those foods that have been specially processed or formulated to meet the needs of individuals, including individuals with celiac disease, who need to follow a gluten-free diet in order to protect their health, are considered foods for special dietary purposes and are allowed to carry a gluten-free claim… If a food is determined to be protective of the health of people with celiac disease, and meets the other requirements of Division 24 (specially processed and formulated), it follows such a food should be able to use the claim "gluten‑free", as long as it is being done in a manner that is truthful and not misleading.

“Based on the available scientific evidence, Health Canada considers that gluten-free foods, prepared under good manufacturing practices, which contain levels of gluten not exceeding 20 ppm as a result of cross-contamination, meet the health and safety intent of (subsection) B.24.018 when a gluten-free claim is made.”

Read the full health claim: http://www.hc-sc.gc.ca/fn-an/securit/allerg/cel-coe/gluten-position-eng.php

Key Points

The review organized a panel of 15 industry experts who proposed new nomenclature and classifications for three categories representing the collective spectrum of gluten-related disorders.

The categories are:

• Allergic reactions (with onset of symptoms within minutes to hours after gluten exposure), such as wheat allergy
• Autoimmune reactions (with onset of symptoms from weeks to years after gluten exposure), including celiac disease, dermatitis herpetiformis and gluten ataxia
• Immune-mediated reactions (with onset of symptoms from hours to day after gluten exposure), such as distressful symptoms often similar to celiac disease, but not accompanied by the distinctive autoimmune markers of celiac disease

Key Takeaways

A broader spectrum of gluten-related disorders is now recognized, including a category characterized by not being consistent with the well-documented autoimmune or allergic markers associated with celiac disease or wheat allergy. Improved diagnosis and intervention based on these categories and their nuances may improve diagnosis and intervention.

Source:

Sapone A, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Medicine, 2012; 10:13

Key Points

• The study authors evaluated data from more than 11,000 newborns and their mothers between 1973 and 2008.
• From children born by elective C-sections, results found a 15% greater risk of later development of celiac disease.
• There was no association between emergency C-sections and risk of celiac disease.
• Additionally, infants born smaller than expected (based on their gestational age) had a 21% greater risk of developing celiac disease.
• The authors concluded, “The positive association with elective, but not emergency, cesarean delivery is consistent with the hypothesis that the bacterial flora of the newborn plays a role in the development of celiac disease.”

Key Takeaways

Even though there was an association between elective C-sections and a small increased risk of developing celiac disease, the direct cause and effect is not established. The study authors were careful to point out that these results should not alter delivery guidelines.

Source:

Key Points

• A survey including questions about overall health, well-being and quality of life was administered before and after initiating a gluten-free diet.
• Results suggested that a gluten-free diet resulted in significant improvements in self‑perceptions of health in both patients with classic symptoms, as well as those identified through screening.
• All patients were equally concerned about their health before receiving the diagnosis, and anxiety was alleviated by the gluten-free diet.
• At diagnosis, the quality of life was reduced among all patients, but then improved on the gluten-free diet. However, among a group of asymptomatic patients, perception of health worsened and concern about health increased while they were on the diet.

The authors concluded, “Self-perceived health and well-being were low among patients at the time they were diagnosed with celiac disease. Most patients benefited from a gluten-free diet, so it is important to identify patients with celiac disease. Perception of health decreased among asymptomatic cases, which discourages population-based screening.”

Key Takeaways

It may be counter-productive to institute large-scale screening for celiac disease because of the negative effects on perceptions of health and well-being among asymptomatic patients diagnosed with celiac disease. Other clinical outcomes from celiac disease, such as bone fractures and nutritional deficiencies, may play an important role in case-by-case screening strategies and self-perceived impact on quality of life. 

Source:

Some foods are naturally free of gluten. Here is a handy checklist of examples for your next trip to the supermarket:

• Milk, not flavored with ingredients that contain gluten, such as malt
• 100% fruit or vegetable juices
• Fresh fruits and vegetables
• Butter
• Eggs
• Lentils
• Beans, in their natural, unprocessed form
• Peanuts
• Seeds, such as flax
• Tree nuts, such as almonds
• Quinoa
• Rice
• Fresh fish (cod, salmon)
• Fresh shellfish (clams, oysters)
• Fresh poultry (unbreaded)
• Fresh meats
• Honey
• Water, including bottled, distilled, spring

Sources:

US Food and Drug Administration | Mayo Clinic

Key Points

• The study included 15 adults with biopsy-confirmed celiac disease of ≥1 year duration.
• Patients received pure oats, 350 grams weekly, for 12 weeks and evaluated outcomes included symptom scores, weight and blood chemistries.
• Additionally, biopsies from the small intestine were obtained before and after the 12‑week study.
• Results from the study found there were no significant changes in symptoms, in weight or blood chemistries.
• Additionally, biopsy results showed no changes. The authors concluded, “The findings support the safety of pure, uncontaminated oats manufactured under Canadian Celiac Association guidelines for patients with celiac disease.”

Key Takeaways

Pure oats are safe for consumption by patients with celiac disease, but must be free of contamination from wheat, barley, and rye or other gluten-containing grains. Availability of pure, uncontaminated oats manufactured under guidelines, such as those established by the Canadian Celiac Association, can improve consumer confidence for including these products in their gluten-free diets. Additional research within larger numbers of patients can improve confidence and extend these results.

Source:

Sey MSL, Parfitt J and Gregor J. Prospective Study of Clinical and Histological Safety of Pure and Uncontaminated Canadian Oats in the Management of Celiac Disease. JPEN J Parenter Enteral Nutr, 2011; 35: 459-464, DOI: 10.1177/0148607110387800. http://pen.sagepub.com/content/35/4/459.abstract

Key Points

• Nearly 200 patients with fertility problems were screened for celiac disease, and the rate of occurrence was compared to that of a general population of women in the same age range.
• Results suggested that overall, there was no increase in the occurrence of celiac disease between the women in the study and a general population; the rate of occurrence in this study was 2.1% compared to 1.3% in the general population.
• In a sub-group of 51 women with unexplained infertility, the rate of celiac disease was found to be 5.9%. Based on this finding, the study authors concluded, “Our findings suggest the importance of screening infertile female patients, particularly those with unexplained infertility, for celiac disease.”

Key Takeaways

Celiac disease may be an important risk factor in women with unexplained infertility. Because it can be managed with gluten-free diets, broader screening may allow interventions to improve fertility issues. More research is needed to confirm this association and assess the effects of dietary intervention on fertility and pregnancy outcomes.

Source:

Choi JM, et al. Increased Prevalence of Celiac Disease in Patients with Unexplained Infertility in the United States: A Prospective Study. J Reprod Med, 2011; 56(5-6): 199–203 http://www.ncbi.nlm.nih.gov/pubmed/21682114

Key Points

• 145 Swedish adolescents with celiac disease (detected upon screening) and their parents were invited to share their experiences in a follow-up study focusing on qualitative information gained through focus groups and written narratives.
• 81% of those screened participated; the insights were gained either from the adolescents themselves or from their parents.
• Results demonstrated the screening-based diagnosis of celiac disease had varying impact on quality of life. This impact related both to changes in perceived health and to social sacrifices associated with living with celiac disease.
• The range of changes in perceived health varied from “healthy as anyone else with no positive change” to “something was wrong and then changed to the better.”
• In terms of relating experiences of living with celiac disease, responses ranged from “not a big deal” to “treatment not worth the price.”
• The authors concluded, “Screening-detected celiac disease has varying impact on adolescents’ quality of life, where their perceived change in health has to be balanced against the social sacrifices the diagnosis may cause. This needs to be taken into account in any future suggestion of celiac disease mass screening and in the management of these patients.”

Key Takeaways

When assessing the overall value of mass screening for detection of celiac disease as a public health intervention, more evaluation is needed. Particularly among adolescents, there is a trade-off between the potential positive health benefits and the possible negative social and self-perception consequences.

Source:

Rosen A, et al. Balancing health benefits and social sacrifices: A qualitative study of how screening-detected celiac disease impacts adolescents’ quality of life. BMC Pediatrics, 2011; 11:32 http://www.biomedcentral.com/1471-2431/11/32

Key Points

• More than 38,000 Swedish men with and without presence of celiac disease were compared in terms of the number of children they produced.
• Results demonstrated there were no differences in the rate of offspring produced by men with celiac disease compared to those without.
• The authors concluded, “This study found a normal fertility in men with diagnosed CD.”

Key Takeaways

These results suggest that having celiac disease does not affect sperm quality or fertility in men.

Sources:

Zugna D, et al. Celiac disease is not a risk factor for infertility in men. Fertil Steril, 2011 95(5):1709-13.e1-3. http://www.ncbi.nlm.nih.gov/pubmed/21333987

Key Points

• Data showed that certain blood markers of celiac disease were present at rates 4-7 times higher than a control group of women who did not have a history of reproductive problems.
• The authors concluded there was a presence of subclinical evidence of celiac disease in women who have poor reproductive performance, and it may affect their ability to conceive and bear healthy children.

Key Takeaways

Women with a history of unexplained fertility or other reproductive problems may need to be tested for blood markers of celiac disease, even if disease symptoms are not present.

Source:

Kumar A, et al. Latent celiac disease in reproductive performance of women. Fertil Steril, 2011; 95(3):922-7. http://www.ncbi.nlm.nih.gov/pubmed/21106194

Key Points

• 34 patients with irritable bowel syndrome, but without celiac disease, participated in the study.
• Study researchers used a randomized, double-blind placebo-controlled “rechallenge” design, in which patients received either gluten or placebo (two bread slices plus one muffin per day) with a gluten-free diet for up to six weeks.
• Symptoms were evaluated by patients using a visual analog scale along with laboratory markers of intestinal inflammation, injury, and immune activation.
• Of 19 patients (68%) who received the gluten bread and muffin, 13 reported symptoms were not adequately controlled.
• This was significantly more than 6 of 15 (40%) who reported inadequate control on placebo.
• Within one week, patients taking gluten reported significantly worse symptoms, including pain, bloating and tiredness.
• However, laboratory markers did not suggest a reason for these increased symptoms. The authors concluded, “’Non-celiac gluten intolerance may exist, but no clues to the mechanism were elucidated.”

Key Takeaways

While gluten may indeed increase gastrointestinal symptoms in some people with irritable bowel syndrome who do not have celiac disease, the mechanisms by which this occurs are not clear. More research is needed to uncover mechanisms and further inform patients and doctors on use of gluten-free diets in non-celiac patients.

Source:

Biesiekierski JR, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol, 2011; 106(3):508-514.

Key Points

• Abnormal fertility in men may include testicular dysfunction, alterations in sperm appearance or motility and overall reductions in sexual satisfaction or frequency of sexual intercourse.
• In women, the scope of the impaired fertility can include problems with both fertility and pregnancy. 
• Fertility can be affected by delayed first periods, missed or absent periods and early menopause.
• Pregnancy issues can include reduced ability to become pregnant, spontaneous abortions, repeated miscarriages, premature deliveries, abnormal placental functioning and low birth weights. 
• Authors indicate there are numerous studies focusing on possible alterations in the immune system or nutrition deficiencies that are correlated to celiac disease, which also may lead to fertility issues.
  

Key Takeaways

More research is needed to confirm how celiac disease adversely affects fertility and pregnancy and what might be done to improve outcomes.

Source:

Freeman HJ. Reproductive changes associated with celiac disease. World J Gastroenterology, 2010; 16(46):5810-5814. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001971/

Key Points

• Celiac disease is now known to cause a variety of symptoms broader than just gastrointestinal upset. Specifically relevant to women are infertility, adverse pregnancy outcomes and osteoporosis.
• Missing the diagnosis is common, so healthcare practitioners need to improve their recognition of risk factors for celiac disease and test appropriate patients, so that earlier treatment intervention can potentially prevent complications. More research is needed to confirm the cost effectiveness of this approach.
• The article recommends all women with unexplained infertility, low birth-weight babies and spontaneous abortion be tested for celiac disease. This screening recommendation is also recommended for both pre- and post-menopausal women with low bone mineral density having symptoms of celiac disease.

Key Takeaways

Healthcare practitioners, particularly those focusing on women’s health, should be aware of the clinical impact of celiac disease beyond gastrointestinal signs and symptoms. Early testing and interventions that include gluten-free diets and possible pharmacologic approaches may improve outcomes.

Source:

Shah S and Leffler D. Celiac disease: an underappreciated issue in women’s health. Womens Health (Lond Engl), 2010; 6(5): 753–766. doi:10.2217/whe.10.57.

http://www.futuremedicine.com/doi/abs/10.2217/whe.10.57?journalCode=whe&

Key Points

• The study included 241 patients who had intestinal biopsies at diagnosis and after initiating a gluten-free diet.
• Results indicated mucosal recovery occurred in 34% of patients after two years and in 66% after five years on a gluten-free diet.
• While most patients (82%) experienced improvement in symptoms on the diet, symptom improvement did not predict mucosal recovery.
• Factors associated with lack of improvement of mucosal damage included poor adherence to the gluten-free diet; severe symptoms of celiac disease, including diarrhea and weight loss; and severe mucosal damage at diagnosis. There was strong trend toward reduced mortality in patients who experienced mucosal recovery on the gluten-free diet.
• The authors concluded, “Mucosal recovery was absent in a substantial portion of adults with celiac disease after treatment with a gluten-free diet. There was a borderline significant association between confirmed mucosal recovery (vs. persistent damage) and reduced mortality independent of age and gender.”

Key Takeaways

Follow-up with intestinal biopsies may be advisable in patients diagnosed with celiac disease as adults. Patients who adhere to the gluten-free diet have a greater chance of healing their intestinal lining in addition to improved symptoms.

Source:

Rubio-Tapia A, et al. Mucosal Recovery and Mortality in Adults with Celiac Disease after Treatment with a Gluten-Free Diet. Am J Gastroenterol 2010; 105(6):1412–1420. doi:10.1038/ajg.2010.10 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881171/

Key Points

• Patients with celiac disease were evaluated at diagnosis and an average of 2.8 years later, and results were compared against a national database.
• Results suggested celiac disease and gluten-free diets did not increase risk of being overweight.
• Additionally, a gluten-free diet tended to have a correcting effect on BMI; 66% of people who were underweight gained weight on the gluten-free diet, and 54% of those who were overweight and 47% who were obese lost weight on the gluten-free diet.
• The authors concluded, “A gluten-free diet had a beneficial impact on BMI, underweight patients gained weight and overweight/obese patients lost weight.”

Key Takeaways

An improvement in BMI increases the need to diagnose celiac disease as quickly as possible and institution of a gluten-free diet under expert dietary counseling may provide an additional level of support for achieving optimum weight in addition to symptom improvement.

Sources:

Cheng J, et al. Body mass index in celiac disease: beneficial effect of a gluten-free diet. J Clin Gastroenterol 2010; 44(4):267-71. http://www.ncbi.nlm.nih.gov/pubmed/19779362

Key Points

• 77 campers completed surveys before and after attending a seven-day gluten-free camp
• The age of the campers was 7-17, and 70% of the campers had been on gluten-free diets for four or fewer years.
• The surveys focused on general well-being, emotional outlook and self-perception.
• Results suggested all participants benefited from the camp experience, particularly in terms of no longer feeling different from other children or being frustrated by their diet restrictions.
• For campers who had been on a gluten-free diet for shorter periods (less than four years), an even greater beneficial impact was observed compared to those on the diet for longer periods.
• The general improvements occurred in each of the three categories of well-being, emotional outlook and self-perception.
• The authors concluded, “Children who had celiac disease and attended a week-long gluten-free camp demonstrated improvement in well-being, self-perception and emotional outlook. The positive effects of camp were more apparent among campers who had been on a GFD for less than four years compared with those who had been on a gluten-free diet for more than four years, suggesting an adaptation to celiac disease with time.”

Key Takeaways

A gluten-free camp experience can at least temporarily alleviate stress and anxiety around food and social interactions. Additional studies can determine whether these benefits persist as children return to their normal lives.

Source:

Bongiovanni TRS, et al. Impact of Gluten-free Camp on Quality of Life of Children and Adolescents with Celiac Disease. Pediatrics, 2010; 125(3);e525-e529. http://pediatrics.aappublications.org/content/125/3/e525.full

Key Points

Scientists studied 204 teenage patients living with celiac disease in southern Italy. The study examined a variety of clinical and blood chemistry tests; the patients were interviewed about school performance, social relationships, family integration, smoking habits and compliance with a gluten-free diet.

• Study results found that 73.5% of the teenagers reported complete compliance with their gluten-free diets, while 26.5% reported occasional or frequent non-compliance.
• Among those who were compliant with their diets over the last month, 74% were asymptomatic while 57.4% of non-compliant patients were asymptomatic.
• Additionally, the diet did not appear to have an impact on family relationships: 88.7% reported good family relationships.
• However, as many as 54% of patients reported some limitations in their social lives.
• The authors concluded, “Optimal school integration significantly contributes to the likelihood of good compliance. A better understanding within the school environment about CD-related issues could improve motivation to adhere to a gluten-free diet.”

Key Takeaways

Teenage celiac disease patients who feel limited in their social expression, and particularly as it relates to poor school integration, may be less likely to comply with a gluten-free diet. Better communication between doctors, caregivers and school officials, as part of a patient-tailored intervention, may lead to increased compliance with a gluten-free diet.

Source:

Errichiello S, et al. Celiac Disease: Predictors of Compliance With a Gluten-free Diet in Adolescents and Young Adults. J Ped Gastroenterol Nutr, 2010; 50:54–60. http://www.ncbi.nlm.nih.gov/pubmed/19644397

Key Points

• Researchers investigated two new markers available through blood tests, referred to as phosphorylated signal transducers and activators of transcription (pSTAT1) and T-bet, a key transcription factor for the development of T-helper type cells, to determine whether they provide value in tracking the celiac disease and the effects of gluten-free diets.
• Based on results from the study, the authors concluded, “…pSTAT1 and T-bet protein expression in peripheral blood mononuclear cells could be useful and sensible markers in the follow-up of CD patients to evaluate disease activity and response to dietary treatment.”

Key Takeaways

Biomarkers such as T-bet and pSTAT1, which can be evaluated through blood tests, may provide a simpler way to track the clinical course of celiac disease and the effects of gluten-free diets. Further research can confirm the utility of these and other blood-based biomarkers.

Source:

Frisullo G, et al. T-bet and pSTAT-1 expression in PBMC from coeliac disease patients: new markers of disease activity. Clin Exper Immunol 2009; 158:106-114.

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2249.2009.03999.x/full    

Key Points

• Overall, the risk of other gastrointestinal cancers seems to be limited, and stomach cancer does not appear to be detected more frequently in patients with celiac disease, even though endoscopies are commonly performed.
• Colon cancer also appears to be limited in celiac disease, even in patients first diagnosed with celiac disease late in life. As a result, some have suggested untreated celiac disease may be protective against gastrointestinal cancers. This may be because celiac disease can inhibit absorption or promote faster excretion of fat or fat‑soluble agents, as well as certain other substances (carcinogens) that have been implicated in causing colon cancer.

Key Takeaways

Additional research is needed to determine what, if any, links may exist between treated and untreated celiac disease and certain types of cancer.

Sources:

Key Points

• Researchers included 269 Danish teenagers less than 16 years old with type 1 diabetes in the study. The diagnosis of celiac disease was confirmed by intestinal biopsy.
• They followed patients for two years while consuming a gluten-free diet.
• Celiac disease was found in 12.3% of the diabetic patients (33 patients).
• Patients with celiac disease were shorter and weighed less than patients without celiac disease. They were significantly younger at the time of their diabetes diagnosis.
• After two years of initiating a gluten-free diet, the weight and height of the majority of patients (31 out of 33) with celiac disease tended to catch up with the non-celiac disease patients.
• The authors concluded, “This population-based study showed the highest reported prevalence of celiac disease in type 1 diabetes in Europe. Patients with celiac disease showed clinical improvements with a gluten-free diet. We recommend screening for celiac disease in all children with type 1 diabetes.”

Key Takeaways

Children with diabetes may have a higher rate of co-existing celiac disease, so screening for celiac disease in children with diabetes may be warranted. Presence of celiac disease may be associated with an earlier age of onset of diabetes and may affect growth and other clinical signs and symptoms that can be positively affected by institution of a gluten-free diet.

Source:

Hansen D, et al. Clinical Benefit of a Gluten-Free Diet in Type 1 Diabetic Children With Screening- Detected Celiac Disease: A population-based screening study with 2 years’ follow-up. Diabetes Care, 2006; 29:2452–2456. http://www.ncbi.nlm.nih.gov/pubmed/17065683

Key Points

• The study included seven patients without celiac disease who were first-degree relatives of patients with type 1 diabetes and who demonstrated a specific antibody marker associated with diabetes, but were not yet clinically diabetic.
• These patients followed a gluten-free diet for 12 months, then had gluten reintroduced into their diets for an additional 12 months.
• Results found that the diabetes-specific antibodies did not change during the gluten‑free diet or after reintroducing gluten.
• The authors concluded, “The findings do not support the hypothesis that gluten is a driving antigen in type 1 diabetes.”

Key Takeaways

While removing gluten from the diet in patients with celiac disease can reduce the frequency of occurrence of type 1 diabetes in patients with celiac disease, gluten may not have a role in inducing diabetes in non-diabetic and non-celiac disease patients.

Sources: