scholarly journals Should the Glu Be Ten or Twenty? An Update on the Ongoing Debate on Gluten Safety Limits for Patients with Celiac Disease

2020 ◽  
Vol 2 (3) ◽  
pp. 202-211
Author(s):  
Inna Spector Cohen ◽  
Andrew Day ◽  
Ron Shaoul
Keyword(s):  
Celiac Disease ◽  
Free Product ◽  
Daily Intake ◽  
Gluten Free ◽  
Ongoing Debate ◽  
Strict Adherence ◽  
General Consensus ◽  
Adherence To Diet ◽  
Recommended Treatment ◽  
Upper Limit

The only currently accepted and recommended treatment for individuals diagnosed with celiac disease (CD) is a strict life-long gluten-free diet (GFD). While the use of the GFD is well-established, strict adherence to diet is not easy to accomplish. In addition, the administration of a GFD may be compromised by inadvertent exposure to small amounts of gluten. International guidelines define a gluten-free product as one containing less than 20 parts per million (ppm), (20 milligrams of gluten per 1 kg of food) gluten. A number of reports have assessed the safe upper limit for gluten exposure for patients with CD, with general consensus that patients with CD should limit their daily intake to less than 50 mg.

scholarly journals Rationale for Timing of Follow-Up Visits to Assess Gluten-Free Diet in Celiac Disease Patients Based on Data Mining

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 357
Author(s):  
Alfonso Rodríguez-Herrera ◽  
Joaquín Reyes-Andrade ◽  
Cristina Rubio-Escudero
Keyword(s):  
Data Mining ◽  
Celiac Disease ◽  
Cultural Context ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Adherence To Diet ◽  
And Gender ◽  
Few Data

The assessment of compliance of gluten-free diet (GFD) is a keystone in the supervision of celiac disease (CD) patients. Few data are available documenting evidence-based follow-up frequency for CD patients. In this work we aim at creating a criterion for timing of clinical follow-up for CD patients using data mining. We have applied data mining to a dataset with 188 CD patients on GFD (75% of them are children below 14 years old), evaluating the presence of gluten immunogenic peptides (GIP) in stools as an adherence to diet marker. The variables considered are gender, age, years following GFD and adherence to the GFD by fecal GIP. The results identify patients on GFD for more than two years (41.5% of the patients) as more prone to poor compliance and so needing more frequent follow-up than patients with less than 2 years on GFD. This is against the usual clinical practice of following less patients on long term GFD, as they are supposed to perform better. Our results support different timing follow-up frequency taking into consideration the number of years on GFD, age and gender. Patients on long term GFD should have a more frequent monitoring as they show a higher level of gluten exposure. A gender perspective should also be considered as non-compliance is partially linked to gender in our results: Males tend to get more gluten exposure, at least in the cultural context where our study was carried out. Children tend to perform better than teenagers or adults.

scholarly journals Hematologic manifestations of celiac disease

Blood ◽  
2006 ◽  
Vol 109 (2) ◽  
pp. 412-421 ◽  
Author(s):  
Thorvardur R. Halfdanarson ◽  
Mark R. Litzow ◽  
Joseph A. Murray
Keyword(s):  
Celiac Disease ◽  
T Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Iga Deficiency ◽  
Gluten Free ◽  
Strict Adherence ◽  
Increased Risk ◽  
Systemic Disorder ◽  
Iron Folic Acid

AbstractCeliac disease is a common systemic disorder that can have multiple hematologic manifestations. Patients with celiac disease may present to hematologists for evaluation of various hematologic problems prior to receiving a diagnosis of celiac disease. Anemia secondary to malabsorption of iron, folic acid, and/or vitamin B12 is a common complication of celiac disease and many patients have anemia at the time of diagnosis. Celiac disease may also be associated with thrombocytosis, thrombocytopenia, leukopenia, venous thromboembolism, hyposplenism, and IgA deficiency. Patients with celiac disease are at increased risk of being diagnosed with lymphoma, especially of the T-cell type. The risk is highest for enteropathy-type T-cell lymphoma (ETL) and B-cell lymphoma of the gut, but extraintestinal lymphomas can also be seen. ETL is an aggressive disease with poor prognosis, but strict adherence to a gluten-free diet may prevent its occurrence.

scholarly journals Non-Invasive Biomarkers for Celiac Disease

2019 ◽  
Vol 8 (6) ◽  
pp. 885 ◽  
Author(s):  
Alka Singh ◽  
Atreyi Pramanik ◽  
Pragyan Acharya ◽  
Govind K. Makharia
Keyword(s):  
Celiac Disease ◽  
Tissue Transglutaminase ◽  
High Titer ◽  
Invasive Procedure ◽  
Gluten Free Diet ◽  
New Drugs ◽  
Current Status ◽  
Common Disease ◽  
Gluten Free ◽  
Strict Adherence

Once thought to be uncommon, celiac disease has now become a common disease globally. While avoidance of the gluten-containing diet is the only effective treatment so far, many new targets are being explored for the development of new drugs for its treatment. The endpoints of therapy include not only reversal of symptoms, normalization of immunological abnormalities and healing of mucosa, but also maintenance of remission of the disease by strict adherence of the gluten-free diet (GFD). There is no single gold standard test for the diagnosis of celiac disease and the diagnosis is based on the presence of a combination of characteristics including the presence of a celiac-specific antibody (anti-tissue transglutaminase antibody, anti-endomysial antibody or anti-deamidated gliadin peptide antibody) and demonstration of villous abnormalities. While the demonstration of enteropathy is an important criterion for a definite diagnosis of celiac disease, it requires endoscopic examination which is perceived as an invasive procedure. The capability of prediction of enteropathy by the presence of the high titer of anti-tissue transglutaminase antibody led to an option of making a diagnosis even without obtaining mucosal biopsies. While present day diagnostic tests are great, they, however, have certain limitations. Therefore, there is a need for biomarkers for screening of patients, prediction of enteropathy, and monitoring of patients for adherence of the gluten-free diet. Efforts are now being made to explore various biomarkers which reflect different changes that occur in the intestinal mucosa using modern day tools including transcriptomics, proteomics, and metabolomics. In the present review, we have discussed comprehensively the pros and cons of available biomarkers and also summarized the current status of emerging biomarkers for the screening, diagnosis, and monitoring of celiac disease.

scholarly journals Social Aspects of Adherence to Gluten-Free Diet for Children and Adolescents with Celiac Disease

2021 ◽  
Vol 65 (6) ◽  
pp. 57-64
Author(s):  
I. N. Zakharova ◽  
L. Ja. Klimov ◽  
L. D. Kochneva ◽  
M. G. Gevandova ◽  
V. A. Kuryaninova ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Children And Adolescents ◽  
Social Problems ◽  
Dietary Habits ◽  
Social Issues ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Free Products ◽  
Strict Adherence ◽  
Factors Affecting

The purpose of the study: analysis of medical and social problems and factors affecting the availability and compliance of a gluten-free diet, based on a survey of parents of children with celiac disease living in southern Russia. Purpose of the Study: Analysis of the medical and social problems and factors affecting the availability and adherence to the gluten-free diet based on the results of the questioning survey of the parents of children with celiac disease that are residents of the south of Russia. Children Characteristics and Study Methods. The study include 200 families that bring up the children with the celiac disease at the ages from 10 months to 18 years. The patients included 116 (58%) girls and 84 (42%) boys. The medical and social issues were studied using the developed questionnaire consisting of the open questions and intended as self-administered by the patient parents. Results. 87% of the families noted the significant difficulties in adhering to the diet, 75% were forced to refuse to travel with children, 56% of the surveyed were unable to visit the public spaces, restaurants, and 90% indicated the impossibility and difficulties in purchase of the gluten-free products. The strict adherence to the diet at school age is much worse. The main reasons for the deliberate non- adherence to the gluten-free diet are the high cost of food, lack of funds to purchase it. The patient families spend RUB 8,000– 9,000 per month in average to purchase the gluten-free products. There is a great demand of patients for the imported products with the relevant quality marks. The psychological symptoms were noted in the patients with celiac disease in response to the introduction of the gluten-free diet, manifested by the depression, aggression, irritability, high level of the anxiety. Conclusion. The main difficulties faced by the families that bring up the children and adolescents with the celiac disease include the social and psychological maladjustment of the patients, reduced finances, search and purchase of the high-quality gluten-free products and the necessity to adapt the child and family members to the dietary habits.

scholarly journals Oxidative and Antioxidative Status of Children with Celiac Disease Treated with a Gluten Free-Diet

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Grażyna Rowicka ◽  
Grażyna Czaja-Bulsa ◽  
Magdalena Chełchowska ◽  
Agnieszka Riahi ◽  
Małgorzata Strucińska ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Celiac Disease ◽  
Density Lipoprotein ◽  
Gluten Free Diet ◽  
Stress Index ◽  
Healthy Children ◽  
Gluten Free ◽  
Strict Adherence ◽  
Antioxidative Status ◽  
Group I

Aims. Oxidative stress is a factor involved in the pathogenesis of celiac disease (CD), possibly affecting the course of the disease and celiac-related complications. We assessed the intensity of oxidative processes and the efficiency of antioxidant defense in children with celiac disease. Methods. Group I (n=32) consisted of children with CD treated with a gluten-free diet, and group II (n=24) consisted of healthy children on a traditional diet. Antioxidative and oxidative status was assessed by measurement of serum total antioxidant capacity (TAC), total oxidant capacity (TOC), and oxidized low-density lipoprotein (ox-LDL) and on the basis of oxidative stress index (OSI).Results. There were no significant differences in serum TAC, TOC, ox-LDL, and OSI between children with CD and healthy children. Cluster analysis showed that the group of children with CD is not homogeneous in terms of serum TAC and TOC levels. About 50% of these children had TAC levels < 1.3 mmol/L and TOC levels > 0.35 mmol/L.Conclusions. Strict adherence to a gluten-free diet by children with CD seems to be important for maintaining oxidative-antioxidant balance. However, further research is needed to identify factors potentially responsible for increased oxidative stress in some children with celiac disease despite adherence to a gluten-free diet.

scholarly journals Probiotic supplement and gluten withdrawal in gluten allergy Patients may lead to gluten tolerance: first case report

2021 ◽  
Vol 8 (7) ◽  
pp. 3603
Author(s):  
Moni Kumari ◽  
Renu Bansal ◽  
Ranjit Singh ◽  
Parveen Bansal ◽  
Malika Arora
Keyword(s):  
Celiac Disease ◽  
Case Report ◽  
Disease Patient ◽  
Celiac Disease Patient ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Probiotic Supplementation ◽  
Strict Adherence ◽  
First Case ◽  
The Subject

Probiotic species such as lactobacillus and bifidobacteria are known to have a major role in gluten digestion and regulation of proper functioning of gastrointestinal system however these are found to be missing in gluten allergy patients. So, here in this case we aimed to find the effect of probiotic supplementation along with gluten free diet in celiac disease patient. A case of an 8-year-old female child admitted to civil hospital, Faridkot with chief complaints of vomiting, diarrhea, weight loss, retarded growth, and malnutrition was studied. When she first visited the hospital, based on her symptoms, she was advised celiac disease workup and was found to be highly tTG IgA positive (10.62). The subject was shifted to a strict gluten free diet along with probiotic supplementation. The subject was regularly followed up for the period of four and half years in order to find improvement in her symptoms. After 4 years, gluten diet was gradually reintroduced in a phased manner; the patient remained well even on full gluten diet. This may be due to probiotic supplementation to the subject along with gluten free diet. Present case report describes the spontaneous recovery of celiac disease patient after strict adherence to gluten free diet and probiotic supplementation for a specified period. It is suggested that there should be a proper monitoring and detailed evaluation of clinical and histological markers of recovery in a patient after strict adherence to gluten free diet and probiotic supplementation in order to evaluate the possible role of probiotic supplements in the management of CD.

scholarly journals Flour-free Gluten-free Compositions Influence on Qualitative Indicators of Cookies from Biscuits Dough

2021 ◽  
Vol 4 (1) ◽  
pp. 122-136
Author(s):  
Karyna Svidlo ◽  
Tatiana Gavrish ◽  
Olga Danylenko ◽  
Serhii Krasovkyi
Keyword(s):  
Celiac Disease ◽  
Gluten Free Diet ◽  
Seed Meal ◽  
Gluten Free ◽  
Organoleptic Evaluation ◽  
Pumpkin Seed ◽  
Strict Adherence ◽  
Risk Of Death ◽  
Increased Risk

The topicality. According to the World Organization of Gastroenterologists (FOG-OMGE), patients with active (clinically severe) celiac disease have an increased risk of death compared to the general population; patients with celiac disease should definitely not eat wheat, rye or barley in any form. However, there is the increased risk of death resumes after three to five years of strict adherence to a gluten-free diet, so it becomes especially important to develop technologies for confectionery products based on gluten-free flour compositions and study their quality indicators. The purpose of the article is to determine the influence of gluten-free flour compositions based on flaxseed, rice, sesame, pumpkin seed meal, sugar substitute on the quality of cupcakes. Research methods. The dependence of stress on the shear rate of biscuit dough based on gluten-free flour compositions has been determined using a Brookfield viscometer. The adhesive stress of the dough masses from the effects of different concentrations of the model system based on gluten-free flour compositions has been performed on a bursting machine МТ-140/RV2. Results. The data of research of gluten-free flour compositions influence on qualitative properties of biscuit cake dough are resulted. An organoleptic evaluation of cupcakes for a gluten-free diet was carried out and the daily requirement for vitamins of people aged 18-59 when consuming this confectionery has been determined. Conclusions and discussions. Determining the effect of gluten-free compositions on the quality of biscuit dough and finished products makes it possible to offer for a gluten-free diet three recipes for cupcakes based on compositions of rice-flax flour, sesame-flax flour and flax flour with pumpkin seed meal, added bougainvillea, carrot and pumpkin. Developed cupcakes for a gluten-free diet can be used in the diet of people aged 18-59 years for both dietary nutrition and general disease prevention.

scholarly journals Sensory evaluation of gluten-free chicken pasty made with cassava (Manihot esculenta Crantz)

2017 ◽  
Vol 5 (9) ◽  
pp. 54-60
Author(s):  
INEZ HELENA VIEIRA DA SILVA SANTOS ◽  
Maiara Bruna Nunes da Silva ◽  
Gleyson Marques de Menezes ◽  
Thatiana Wanessa de Oliveira ◽  
Maurício Reginaldo Alves dos Santos ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Free Product ◽  
Free Food ◽  
Production Costs ◽  
Attractive Alternative ◽  
Gluten Free ◽  
Manihot Esculenta Crantz ◽  
Autoimmune Reaction ◽  
General Aspects ◽  
The Cost

Celiac disease is a condition in which genetically predisposed people have an autoimmune reaction to gluten proteins found mainly in wheat. Celiac disease patients have few and expensive options of gluten-free food products. The aim of this study was to produce a gluten-free alternative to the wheat chicken pasty, a food largely consumed in South American countries. The main ingredient used for the elaboration of gluten-free pasty was cassava, a cheap and quite available raw ingredient, which after cooked results in a soft mass. This product was compared to the traditional wheat version by means of a sensory analysis, considering general aspects, consistency, flavor and aroma, and also a comparison of the production costs of the two products. General aspects, flavor and aroma did not differ significantly between the two products. Consistency was the only characteristic that differed significantly between them, the evaluation being more favorable to the cassava pasty. These results validate the gluten-free product regarding its sensory acceptability. The cost of production of the gluten-free product was lower than that of the traditional one. This product can be a cheap and attractive alternative for celiac disease patients.

scholarly journals Gluten Degrading Enzymes for Treatment of Celiac Disease

Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 2095 ◽  
Author(s):  
Guoxian Wei ◽  
Eva J. Helmerhorst ◽  
Ghassan Darwish ◽  
Gabriel Blumenkranz ◽  
Detlef Schuppan
Keyword(s):  
Celiac Disease ◽  
Enzyme Stability ◽  
Clinical Manifestations ◽  
Cysteine Proteases ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Strict Adherence ◽  
Degrading Enzymes ◽  
Gluten Peptides ◽  
Promising Therapeutic Approach

Celiac disease (CeD) affects about 1% of most world populations. It presents a wide spectrum of clinical manifestations, ranging from minor symptoms to mild or severe malabsorption, and it may be associated with a wide variety of autoimmune diseases. CeD is triggered and maintained by the ingestion of gluten proteins from wheat and related grains. Gluten peptides that resist gastrointestinal digestion are antigenically presented to gluten specific T cells in the intestinal mucosa via HLA-DQ2 or HLA-DQ8, the necessary genetic predisposition for CeD. To date, there is no effective or approved treatment for CeD other than a strict adherence to a gluten-free diet, which is difficult to maintain in professional or social environments. Moreover, many patients with CeD have active disease despite diet adherence due to a high sensitivity to traces of gluten. Therefore, safe pharmacological treatments that complement the gluten-free diet are urgently needed. Oral enzyme therapy, employing gluten-degrading enzymes, is a promising therapeutic approach. A prerequisite is that such enzymes are active under gastro-duodenal conditions, quickly neutralize the T cell activating gluten peptides and are safe for human consumption. Several enzymes including prolyl endopeptidases, cysteine proteases and subtilisins can cleave the human digestion-resistant gluten peptides in vitro and in vivo. Examples are several prolyl endopeptidases from bacterial sources, subtilisins from Rothia bacteria that are natural oral colonizers and synthetic enzymes with optimized gluten-degrading activities. Without exception, these enzymes must cleave the otherwise unusual glutamine and proline-rich domains characteristic of antigenic gluten peptides. Moreover, they should be stable and active in both the acidic environment of the stomach and under near neutral pH in the duodenum. This review focuses on those enzymes that have been characterized and evaluated for the treatment of CeD, discussing their origin and activities, their clinical evaluation and challenges for therapeutic application. Novel developments include strategies like enteric coating and genetic modification to increase enzyme stability in the digestive tract.

scholarly journals Consumption of Pure Oats by Individuals with Celiac Disease: A Position Statement by the Canadian Celiac Association

2007 ◽  
Vol 21 (10) ◽  
pp. 649-651 ◽  
Author(s):  
Mohsin Rashid ◽  
Decker Butzner ◽  
Vernon Burrows ◽  
Marion Zarkadas ◽  
Shelley Case ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Position Statement ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Strict Adherence ◽  
Food Inspection ◽  
Inspection Agency ◽  
Purity Testing ◽  
Canadian Food Inspection Agency ◽  
Health Canada

The treatment of celiac disease is a strict adherence to a gluten-free diet for life. In the past, oats were considered to be toxic to individuals with celiac disease and were not allowed in a gluten-free diet. However, recent evidence suggests that oats that are pure and uncontaminated with other gluten-containing grains, if taken in limited quantities, are safe for most individuals with celiac disease. For adults, up to 70 g (1/2 to 3/4 cup) of oats per day and for children, up to 25 g (1/4 cup) per day are safe to consume. These oats and oat products must fulfill the standards for a gluten-free diet set by the Canadian Food Inspection Agency and Health Canada. The Canadian Celiac Association, in consultation with Health Canada, Agriculture & Agri-Food Canada and the Canadian Food Inspection Agency, has established requirements for growing, processing, and purity testing and labelling of pure oats. These strategies have led to the production of pure, uncontaminated oats for the first time in Canada. Oats and oat products that are safe for consumption by individuals with celiac disease and dermatitis herpetiformis are now commercially available in Canada.

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