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The Gluten-Free Diet: Testing Alternative Cereals Tolerated by Celiac Patients  [PDF]
Isabel Comino,María de Lourdes Moreno,Ana Real,Alfonso Rodríguez-Herrera,Francisco Barro,Carolina Sousa
Nutrients , 2013, DOI: 10.3390/nu5104250
Abstract: A strict gluten-free diet (GFD) is the only currently available therapeutic treatment for patients with celiac disease, an autoimmune disorder of the small intestine associated with a permanent intolerance to gluten proteins. The complete elimination of gluten proteins contained in cereals from the diet is the key to celiac disease management. However, this generates numerous social and economic repercussions due to the ubiquity of gluten in foods. The research presented in this review focuses on the current status of alternative cereals and pseudocereals and their derivatives obtained by natural selection, breeding programs and transgenic or enzymatic technology, potential tolerated by celiac people. Finally, we describe several strategies for detoxification of dietary gluten. These included enzymatic cleavage of gliadin fragment by Prolyl endopeptidases (PEPs) from different organisms, degradation of toxic peptides by germinating cereal enzymes and transamidation of cereal flours. This information can be used to search for and develop cereals with the baking and nutritional qualities of toxic cereals, but which do not exacerbate this condition.
Plasma Selenium Levels in Celiac Disease Patients on a Gluten -Free Diet  [cached]
Fatih ünal,Cevval Umman,Ay?egül Cebe Tok,Evren Semizel
Güncel Pediatri , 2012,
Abstract: In-tro-duc-ti-on: Celiac disease (CD) is a gluten-induced enteropathy that results in malabsorption of nutrients such as selenium. A high incidence of malignancy in CD has been previously reported. Selenium is known to have a protective role against cancer. This study aimed to investigate whether there is an effect on serum selenium levels in children with CD on a gluten-free diet. Materials and Methods: Serum levels of selenium were studied in 17 children (mean age 5.64±3.30 years) with CD and 20 age-and gender-matched healthy children. CD was diagnosed according to ESPGHAN criteria. All the patients were clinically well and had been on gluten-free diets for 11.11±1.98 (mean±SE) months. All patients were fully consistent with the diet. The concentration of selenium was determined by a periodically validated atomic absorption spectrometer (Perkin Elmer AAS 700 system). Wet ashing procedure was used for all samples and controls. Results: In CD group one child’s (5.8%), and in control group three children’s (%15) serum selenium levels were found under normal limits. There was no statistically significant difference between serum selenium levels and the duration of gluten free diet (p>0.05). There was no statistically significant difference in serum selenium levels between celiac patients (124.19±12.31 μg/L) and control group (92.47±12.06 μg/L), (p>0.05). Discussion: It can be concluded that, normal levels of serum selenium in children with CD can be achieved with fully compatible gluten-free diet and a balanced diet which supplies daily selenium requirement. (Jo-ur-nal of Cur-rent Pe-di-at-rics 2012; 10: 55-8)
Problems and Challenges to Adaptation of Gluten Free Diet by Indian Patients with Celiac Disease  [PDF]
Preeti Rajpoot,Govind K. Makharia
Nutrients , 2013, DOI: 10.3390/nu5124869
Abstract: Celiac disease is emerging in India and has become a public health problem. Almost 6–8 million Indians are estimated to have celiac disease. While there is a large pool of patients with celiac disease in India, until now, only a fraction of them have been diagnosed. With increasing awareness about celiac disease amongst health care providers and the general population, a massive increase in the number of patients with celiac disease is expected now and in the subsequent decade in India. While the number of patients with celiac disease is increasing, the country’s preparedness towards the emerging epidemic of this disease is minimal. There are a number of issues, which requires urgent attention. Some of the key issues include increased awareness amongst health care professionals and the general public about the disease and its management, team-based management of patients with celiac disease, proper counseling and supervision of patients, training of dietitians in the management of patients with celiac disease, industrial production of reliable and affordable gluten-free food, and food labeling for gluten contents.
A gluten-free diet effectively reduces symptoms and health care consumption in a Swedish celiac disease population  [cached]
Norstr?m Fredrik,Sandstr?m Olof,Lindholm Lars,Ivarsson Anneli
BMC Gastroenterology , 2012, DOI: 10.1186/1471-230x-12-125
Abstract: Background A gluten-free diet is the only available treatment for celiac disease. Our aim was to investigate the effect of a gluten-free diet on celiac disease related symptoms, health care consumption, and the risk of developing associated immune-mediated diseases. Methods A questionnaire was sent to 1,560 randomly selected members of the Swedish Society for Coeliacs, divided into equal-sized age- and sex strata; 1,031 (66%) responded. Self-reported symptoms, health care consumption (measured by health care visits and hospitalization days), and missed working days were reported both for the year prior to diagnosis (normal diet) and the year prior to receiving the questionnaire while undergoing treatment with a gluten-free diet. Associated immune-mediated diseases (diabetes mellitus type 1, rheumatic disease, thyroid disease, vitiligo, alopecia areata and inflammatory bowel disease) were self-reported including the year of diagnosis. Results All investigated symptoms except joint pain improved after diagnosis and initiated gluten-free diet. Both health care consumption and missed working days decreased. Associated immune-mediated diseases were diagnosed equally often before and after celiac disease diagnosis. Conclusions Initiated treatment with a gluten-free diet improves the situation for celiac disease patients in terms of reduced symptoms and health care consumption. An earlier celiac disease diagnosis is therefore of great importance.
Clinical benefit of gluten-free diet in screen-detected older celiac disease patients
Anitta Vilppula, Katri Kaukinen, Liisa Luostarinen, Ilkka Krekel?, Heikki Patrikainen, Raisa Valve, Markku Luostarinen, Kaija Laurila, Markku M?ki, Pekka Collin
BMC Gastroenterology , 2011, DOI: 10.1186/1471-230x-11-136
Abstract: Thirty-five biopsy-proven patients aged over 50 years had been detected by serologic mass screening. We examined the disease history, dietary compliance, symptoms, quality of life and bone mineral density at baseline and 1-2 years after the commencement of a gluten-free diet. Symptoms were evaluated by gastrointestinal symptom rating scale and quality of life by psychological general well-being questionnaires. Small bowel biopsy, serology, laboratory parameters assessing malabsorption, and bone mineral density were investigated.Dietary compliance was good. The patients had initially low mean serum ferritin values indicating subclinical iron deficiency, which was restored by a gluten-free diet. Vitamin B12, vitamin D and erythrocyte folic acid levels increased significantly on diet. Celiac patients had a history of low-energy fractures more often than the background population, and the diet had a beneficial effect on bone mineral density. Alleviation in gastrointestinal symptoms was observed, even though the patients reported no or only subtle symptoms at diagnosis. Quality of life remained unchanged. Of all the cases, two thirds would have been diagnosed even without screening if the family history, fractures or concomitant autoimmune diseases had been taken carefully into account.Screen-detected patients benefited from a gluten-free diet. We encourage a high index of suspicion and active case-finding in celiac disease as an alternative to mass screening in older patients.Evidence suggests that the incidence of celiac disease increases with age [1,2]. Physicians' lack of alertness in the older people may result in a significant delay in diagnosis, as celiac disease is widely deemed to be a condition affecting younger subjects. Indeed, the majority of older celiac disease patients have remained undetected, often due to the absence of symptoms [3,4]. It is reasonable to assume that, due to long gluten exposure, older patients with untreated celiac disease may be dispo
The Professional Medical Journal , 2006,
Abstract: Introduction: Celiac disease is an autoimmune inflammatory disorder ofsmall intestine precipitated by ingestion of gluten. Clinical and histological improvement occurs on withdrawal of glutenfrom the diet. Objectives: The present study were to identify the trace mineral deficiency in newly diagnosed celiacchildren and to assess how far these deficiencies are corrected after strict gluten free diet. The study also assessedthe nutritional status of celiac children compared to the healthy controls before and after Gluten Free Diet. Setting:Department of Pediatrics Punjab Medical College Faisalabad. Duration: January 2004 to March 2005. Study Design:Interventional case control study. Patients and Methods: 22 children aged 2 to 14 years diagnosed as Celiac diseaseon the basis of typical intestinal biopsy findings were included. 15 healthy children served as controls. Anthropometricmeasurements and serum Zinc Copper Magnesium and Iron along with albumin were done for both patients andcontrols initially and repeated after 6 months while patients were receiving strict GFD and controls receiving normaldiet. The general linear model was used for the analysis of variance using SPSS (2004). Results: Serum Zinc wasbelow the reference range in 68%. Serum copper and Magnesium in 31%, Iron in 95%and albumin in 59% of thepatients. There was a statistically significant increase in serum zinc, iron and magnesium levels (p value, < 0 05) whileserum copper and albumin did not show any significant rise after Gluten free diet. Control group did not show any significant change in their trace mineral levels .Celiac patients gained more weight (mean 4.47 versus 2.91 cm) andheight (3.34cm versus 1.022 cm) as compared to the control group. Conclusion: Celiac children receiving strict Glutenfree diet and showing good clinical response probably do not need mineral supplementation.
Resolution of metabolic syndrome after following a gluten free diet in an adult woman diagnosed with celiac disease  [cached]
álvaro García-Manzanares,Alfredo J Lucendo,Sonia González-Castillo,Jesús Moreno-Fernández
World Journal of Gastrointestinal Pathophysiology , 2011, DOI: 10.4291/wjgp.v2.i3.49
Abstract: Adult celiac disease (CD) presents with very diverse symptoms that are clearly different from those typically seen in pediatric patients, including ferropenic anemia, dyspepsia, endocrine alterations and elevated transaminase concentration. We present the case of a 51-year-old overweight woman with altered basal blood glucose, hypercholesterolemia, hypertriglyceridemia and persisting elevated transaminase levels, who showed all the symptoms for a diagnosis of metabolic syndrome. Because she presented iron deficiency anemia, she was referred to the gastroenterology department and subsequently diagnosed with celiac disease after duodenal biopsies and detection of a compatible HLA haplotype. Gluten-free diet (GFD) was prescribed and after 6 mo the patient showed resolution of laboratory abnormalities (including recovering anemia and iron reserves, normalization of altered lipid and liver function parameters and decrease of glucose blood levels). No changes in weight or waist circumference were observed and no significant changes in diet were documented apart from the GFD. The present case study is the first reported description of an association between CD and metabolic syndrome, and invites investigation of the metabolic changes induced by gluten in celiac patients.
Celiac disease: Management of persistent symptoms in patients on a gluten-free diet
David H Dewar,Suzanne C Donnelly,Simon D McLaughlin,Matthew W Johnson
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i12.1348
Abstract: AIM: To investigate all patients referred to our center with non-responsive celiac disease (NRCD), to establish a cause for their continued symptoms. METHODS: We assessed all patients referred to our center with non-responsive celiac disease over an 18-mo period. These individuals were investigated to establish the eitiology of their continued symptoms. The patients were first seen in clinic where a thorough history and examination were performed with routine blood work including tissue transglutaminase antibody measurement. They were also referred to a specialist gastroenterology dietician to try to identift any lapses in the diet and sources of hidden gluten ingestion. A repeat small intestinal biopsy was also performed and compared to biopsies from the referring hospital where possible. Colonoscopy, lactulose hydrogen breath testing, pancreolauryl testing and computed tomography scan of the abdomen were undertaken if the symptoms persisted. Their clinical progress was followed over a minimum of 2 years. RESULTS: One hundred and twelve consecutive patients were referred with NRCD. Twelve were found not to have celiac disease (CD). Of the remaining 100 patients, 45% were not adequately adhering to a strict gluten-free diet, with 24 (53%) found to be inadvertently ingesting gluten, and 21 (47%) admitting non-compliance. Microscopic colitis was diagnosed in 12% and small bowel bacterial overgrowth in 9%. Refractory CD was diagnosed in 9%. Three of these were diagnosed with intestinal lymphoma. After 2 years, 78 patients remained well, eight had continuing symptoms, and four had died. CONCLUSION: In individuals with NRCD, a remediable cause can be found in 90%: with continued gluten ingestion as the leading cause. We propose an algorithm for investigation.
Osteogenesis Imperfecta with Celiac Disease and Type II Diabetes Mellitus Associated: Improvement with a Gluten-Free Diet
Luis Rodrigo,Isabel Pérez-Martinez
Case Reports in Medicine , 2012, DOI: 10.1155/2012/813461
Abstract: Osteogenesis imperfecta (OI) is a genetic disease, with a connective tissue alteration, consisting in the presence of multiple spontaneous fractures or after minimal traumatism. Its association with other metabolic processes is rarely described. We present the clinical case of a female adult patient of 43 years. From her infancy, she has had multiple fractures, needing several surgical interventions, and she was diagnosed of OI type 2 at adolescence age. Due mainly to difficulties in walking remaining in wheel-chair in the last three years, she was overweight with morbid obesity (BMI=45.4) and had a type-II DM associated. She suffered from recurrent abdominal pain and chronic diarrhea and was diagnosed of celiac disease (CD) with increased intraepithelial duodenal infiltration, being classified as lymphocytic enteritis, Marsh I type. She was put on a gluten-free diet (GFD), having lost 6 kg of weight after 6 months, with a good control of DM-II and presenting a significant clinical improvement. It is rewarding to search the presence of two coincidental metabolic diseases associated to OI, specially CD, because of the dramatic clinical benefit in the general found after putting on a GFD.
Maize Prolamins Could Induce a Gluten-Like Cellular Immune Response in Some Celiac Disease Patients  [PDF]
Juan P. Ortiz-Sánchez,Francisco Cabrera-Chávez,Ana M. Calderón de la Barca
Nutrients , 2013, DOI: 10.3390/nu5104174
Abstract: Celiac disease (CD) is an autoimmune-mediated enteropathy triggered by dietary gluten in genetically prone individuals. The current treatment for CD is a strict lifelong gluten-free diet. However, in some CD patients following a strict gluten-free diet, the symptoms do not remit. These cases may be refractory CD or due to gluten contamination; however, the lack of response could be related to other dietary ingredients, such as maize, which is one of the most common alternatives to wheat used in the gluten-free diet. In some CD patients, as a rare event, peptides from maize prolamins could induce a celiac-like immune response by similar or alternative pathogenic mechanisms to those used by wheat gluten peptides. This is supported by several shared features between wheat and maize prolamins and by some experimental results. Given that gluten peptides induce an immune response of the intestinal mucosa both in vivo and in vitro, peptides from maize prolamins could also be tested to determine whether they also induce a cellular immune response. Hypothetically, maize prolamins could be harmful for a very limited subgroup of CD patients, especially those that are non-responsive, and if it is confirmed, they should follow, in addition to a gluten-free, a maize-free diet.
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