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  • Scott Adams
    Scott Adams

    A Gluten-Free Diet May Not Stop Gut Inflammation for all Celiac Disease Patients

    Reviewed and edited by a celiac disease expert.

    New study shows that a gluten‐free diet may not be enough to curb gut inflammation in all celiac disease patients.

    A Gluten-Free Diet May Not Stop Gut Inflammation for all Celiac Disease Patients - Image: CC BY 2.0--Güel - Centro de Wellness Murcia
    Caption: Image: CC BY 2.0--Güel - Centro de Wellness Murcia

    Celiac.com 03/08/2021 - When people with celiac disease eat gluten, it triggers adaptive immune cells, which cause damage to the lining of the small intestine. Doctors gauge the severity of celiac disease through histological assessment of the intestinal damage via intestinal biopsy. To confirm diagnosis and to test drug efficacy in clinical trials, doctors rely on a gluten challenge. However, patients respond with different magnitudes to the same gluten challenge. This is a problem that a group of researchers looked at recently, in a study of 19 well‐treated celiac patients.

    The research team included Jorunn Stamnaes; Daniel Stray; Maria Stensland; Vikas K. Sarna; Tuula A. Nyman; Knut E. A. Lundin; and Ludvig M. Sollid. They are variously affiliated with the K.G. Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway; the Department of Immunology, University of Oslo and Oslo University Hospital‐Rikshospitalet, Oslo, Norway; and the Department of Gastroenterology, Oslo University Hospital‐Ullevål, Oslo, Norway. 
     
    In the study patients, proteome analysis of total tissue, or isolated epithelial cell compartment from formalin‐fixed paraffin embedded biopsies, collected before and after 14‐day gluten challenge, shows that patients with strong mucosal response to gluten challenge have signs of ongoing tissue inflammation prior to the gluten challenge. 

    Celiac.com Sponsor (A12):
    This low‐level tissue inflammation at baseline is mirrored by increased gluten specific CD4+ T‐cells in the gut, and a low‐level blood inflammatory profile. 

    This study shows that even well‐treated celiac disease commonly features ongoing low‐grade inflammation and anti-gluten immunity in the gut mucosa, and that histology assessment alone is not a good measure of full recovery and gut mucosal healing in celiac patients. 

    The findings raise a concern that even a vigilant gluten‐free diet might not be enough to curb gut inflammation in all celiac disease patients.

    Read more at Wiley Online Library

    Edited by Scott Adams



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    Posterboy
    2 hours ago, Guest sarah said:

    I did have long term exposure to black mold at my mom's house for years. And I definitely fit into the hypermobility spectrum disorder. Of course all of this stuff is undiagnosed.

    Sarah,

    Here is some resources that might help you.

    This person believed his toxic mold exposure triggered his Celiac disease.

    https://well.blogs.nytimes.com/2010/07/20/for-a-celiac-sufferer-a-new-mystery-illness/

    Here is some resources on Mycotoxins IE Molds and how Thiaminases aka AntiThiamine Factors can be produced by molds and poison animals...

    This one entitled "Thiaminases poison animals by destroying an essential vitamin Thiamine"

    http://www.rosincerate.com/2015/10/thiaminases-poison-animals-by.html

    This one entitled "Mycotoxin: Its Impact on Gut Health and Microbiota"

    https://www.frontiersin.org/articles/10.3389/fcimb.2018.00060/full

    This one entitled "Mycotoxic origin of cardiac beriberi"

    https://www.sciencedirect.com/science/article/abs/pii/0022474X6990037X

    And this one where someone was treated with Antibiotics for a UTI and developed Beri Beri.

    Entitled "Beriberi Disease: Is It Still Present in the United States?"

    https://www.amjmed.com/article/S0002-9343(12)00164-7/fulltext

    Yes they concluded and in some patients, at least in part, antibiotics used to treat infections can trigger it.

    That is if she didn't  have it (Thiamine deficiency)  already from the Urinary Tract Infection due to high inflammation in the body etc.....which can trigger the utilization of B-Vitamins at a  high rate...

    See this research how B1, B2, and B3 in combination was used to treat Sepsis in mice.

    Entitled "Vitamin B combination reduces fluconazole toxicity in Wistar rats."

    https://pubmed.ncbi.nlm.nih.gov/30903555/

    Note: that Flucanazole is an antifugal that can can trigger us to be low in B-Vitamins and supplementation reversed it's toxicity.

    Ironically the medicine made the condition worse.....Flucanazole is often used to treat a Candida Infection aka Yeast Infection commonly called thrush if it happens in the mouth.

    Benfotiamine is a Fat Soluble B-1 that is a good form to take to supplement with  B-1.

    It is commonly available and high absorbing.

    Good luck on your continued journey!

    I hope this is helpful but it is not medical advice.

    Posterboy,

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    Blue-Sky
    17 hours ago, Guest sarah said:

    When my primary care doctor had tested me for celiac I had been grain free for 5 months and the test came back with a score of "20" for the wheat. The other numbers were normal. That score confused her. She asked one gastro about it and he said I had celiac. Then later she changed her mind and said I had NCGS

    Are you sure the test you took was the right test for celiac disease? If you get a copy of your tests results and post what the paper says on it, we may be able to check if you got the right test. 

    Since you had been grain free before the Celiac disease test that means that Celiac disease has not been ruled out. In order for the celiac test to be accurate you have to be eating wheat in the weeks leading up to the test. Unfortunately a lot of doctors don't know how to properly diagnose Celiac disease. 

    If you get sick when you eat wheat and Celiac disease has not been ruled out I would assume it is likely that you are Celiac. You could also be allergic to wheat, I don't know if you got a skin prick test for wheat allergies (IGE) yet. 

    You can post in the main forum section of this website if you want. That way you will get a lot more responses. 

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    Rafea
    On 3/16/2021 at 11:46 AM, sc'Que? said:

    I've been gluten-free since 2009 after being gluten-sick since 2007.  Around 2014 to 2016, I developed what I thought was ringworm on my neck and scalp.  After various OTC treatment regimens failed, I began to consider seeking a dermatologist in late 2019. Having not had a GP since high-school... well, I'm sure you know how that went. 

    Didn't get to see a GP until May or June 2020... who, of course, wanted to cover up symptoms and collect money rather than track down the problem.  The dermatologist I was then able to access--the entire medical system is so fraught with gateway nepotism, and I don't understand how it's legal--at least looked at what the GP was trying to prescribe and laughed at him.  But he, too, was merely addressing the symptoms as it turned out, not seeking to find the cause. 

    November 2020, I figured out that the strange narcoleptic symptoms I'd been having for nearly a year were definitely food-related. And by happenstance, I figured out that potatoes were part of the problem. After in-home testing and dietary elimination, it became clear that I'm now also allergic to nightshade vegetables: tomatoes, potatoes, eggplant, goji berries, peppers of all varieties and tobacco.  

    I'd always been sensative to cigarette smoke, though less so to pipes and cigars. So I always figured it was the chemicals.  But once I was off nightshades for a month or so, my narcoleptic strangeness disappeared, and the "7-year itch" on my neck, scalp and shoulders finally went away!

    My diet is now severely limited. I can no longer eat most prepared foods. Almost everything contains un-named "spices" and "natural flavors" which generally lead back to paprika (or other peppers) and/or tomatoes.  And potatoes are used quite a bit in gluten-free baking and as thickening agents in all sorts of mainstream and gluten-free foods.  Quite literally, nightshades were at least 90% of my diet.  The change is dramatic. No more Sichuan, no more Italian. Even seemingly bland Germanic foods aren't safe. Mayonnaise and prepared mustard. Boxed meat stock.  50% of the spices on my extensive spice rack. 

    So, now I'm wondering... what comes next?   Am I just now completely pre-disposed to immune-system overdrive?  What's the next thing I'm going to suddenly become allergic to?  

    Plzzzz sum 1 come up with the solution now... cannot accept this disease for life time...😢😢😢

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    Monica2222
    On 3/17/2021 at 12:33 AM, knitty kitty said:

    Yeah, well, I didn't think you'd like the studies done of fish, either.  

    An antigen is an antigen.  It causes an immune response in MS (also an autoimmune disease), in fish presented with a fish antigen, in Celiac Disease.  Thiamine helps down regulate the immune system so fewer t cells react.  

    Vitamin deficiencies can occur after years on the gluten free diet.  

    And, no, thiamine supplementation isn't the silver bullet solution, but it's a place to start.  All the B vitamins are needed because they all work together.  Supplementation may be beneficial because absorption of nutrients can be badly affected in Celiac Disease.  

    The doctors who did the study in Scott's article above didn't investigate the nutritional status of the patients in the study to see if the groups had deficiencies or not.  Vitamins just aren't on doctors' radar.  And that's a shame.

    Not everything is caused by gluten contamination either.  

     

    Hi Knitty Kitty,

    what’s the reason for vit deficiency after few years of gluten-free diet. My daughter is celiac. Till one year before, her all vit, micronutrients were under normal range despite her being not regular for her vitamins. In her latest blood work, zin & vit D are low. I am not very sure if it’s because of inflammation in the gut due to gluten exposure. If so, why are other vits & micronutrient & celiac markers r ok and same like last year report. And even if it’s because of intestinal inflammation due to cross contamination or accidental exposure of gluten, which she had in past too( she doesn’t have strong symptoms after exposure) why this time, only zinc & vit D is low. Or it could be due to diet low in zinc. She is having premature gray hair & hair fall issue. Would appreciate your understanding in this matter. Thanks. Monica 

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    knitty kitty
    3 hours ago, Monica2222 said:

    Hi Knitty Kitty,

    what’s the reason for vit deficiency after few years of gluten-free diet. My daughter is celiac. Till one year before, her all vit, micronutrients were under normal range despite her being not regular for her vitamins. In her latest blood work, zin & vit D are low. I am not very sure if it’s because of inflammation in the gut due to gluten exposure. If so, why are other vits & micronutrient & celiac markers r ok and same like last year report. And even if it’s because of intestinal inflammation due to cross contamination or accidental exposure of gluten, which she had in past too( she doesn’t have strong symptoms after exposure) why this time, only zinc & vit D is low. Or it could be due to diet low in zinc. She is having premature gray hair & hair fall issue. Would appreciate your understanding in this matter. Thanks. Monica 

    Blood tests for the B vitamins are not always accurate and don't reflect the amounts stored inside tissues.

    The eight B vitamins are water soluble.  Any excess is excreted.  Most can't be stored longer than a month.  Supplementing with a B Complex may be helpful.  

    Vitamin D can be stored in the liver for many months.  When a blood test shows a deficiency, the stores in the liver have become low.  Supplementing will help.

    Has your daughter's thyroid been checked?  Low zinc and hair loss can be connected to thyroid problems.  

    You may want to consult a nutritionist.  Remember that gluten free versions of wheat products are not fortified with vitamins and minerals like wheat products are required to be.  I follow the Autoimmune Paleo Diet, but I still supplement.  

    Hope this helps! 

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    Monica2222
    17 hours ago, knitty kitty said:

    Blood tests for the B vitamins are not always accurate and don't reflect the amounts stored inside tissues.

    The eight B vitamins are water soluble.  Any excess is excreted.  Most can't be stored longer than a month.  Supplementing with a B Complex may be helpful.  

    Vitamin D can be stored in the liver for many months.  When a blood test shows a deficiency, the stores in the liver have become low.  Supplementing will help.

    Has your daughter's thyroid been checked?  Low zinc and hair loss can be connected to thyroid problems.  

    You may want to consult a nutritionist.  Remember that gluten free versions of wheat products are not fortified with vitamins and minerals like wheat products are required to be.  I follow the Autoimmune Paleo Diet, but I still supplement.  

    Hope this helps! 

    Thx for your reply. Her thyroid levels r good. She sees the specialist once a year but I never get answers to my concerns. That’s why I posted on this chat. I am still not very sure why she is low in zinc esp since all other markers r ok. If it’s because of intestinal inflammation as per the research in this article where celiac people tend to have inflammation despite being on gluten-free diet, shouldn’t the other vit, micronutrient & iron should be low too?? 

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    knitty kitty

    Vitamins and minerals are absorbed at different sections of the intestinal tract.  

    Minerals can be stored longer than vitamins, so depletion might take longer to show up.  

    Zinc and copper compete in the body for absorption.  Does your daughter use a copper cup or take a supplement or nutritional shake with lots of copper in it? 

    Is your daughter vegetarian?  

    Keep a food journal to help track nutritional information might help.

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    Posterboy

    Monica,

    Here is a study that might help you.

    Entitled "Micronutrient deficiencies in children with Celiac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet" including Zinc.

    Open Original Shared Link

    I was doing research for something else and came across it recently.

    It is very current just this month actually.....

    quoting "In contrast, deficiencies for vitamins D, A and zinc did not change significantly post-diagnosis."

    I also recommend this nice blog post started by Blue Sky.....it covers Zinc deficiency issues well....

    What people don't know about Zinc is it is an "Essential Nutrient" which means your body has no good way to store it (despite it being a mineral) or produce it itself....so being low in it your diet will  show up pretty quickly.  Luckily Pumpkin seeds are a good source of Zinc.

    See this nice livestrong article about how our body stores our nutrients IE Vitamins and Minerals and for how long.....it will elaborate on what Knitty Kitty said...

    Open Original Shared Link

    quoting "Your body has no mechanism for storing zinc, so whatever isn't used is expelled from the body, and you'll need a steady dietary supply to keep your body functioning well."

    And what is also worth noting here.....Zinc can be a proxy for Low Stomach Acid as well.....because our Zinc levels in the body is controlled by Vitamin B-3 (Niacin).....which we need to make Stomach Acid.

    See this research entitled "Effect of nicotinic acid (Niacin) on zinc and iron metabolism"

    Open Original Shared Link

    It is why many Celiac's are low in Zinc at the time of their diagnosis...

    See this Mayoclinic article about it...

    Entitled "Study finds micronutrient deficiencies common at time of celiac disease diagnosis"

    Open Original Shared Link

    This is normal for Celiac's to be low in Zinc.....I had low Zinc too!  OCD was a problem for me and I had "White Spot's" in my nail bed among other things....etc.

    quoting from the Mayoclinic article...

    "Zinc deficiency was observed most frequently at diagnosis, the study says, with 59.4% of patients having a deficiency. Other deficiencies included iron, vitamin D, copper, vitamin B12 and folate."

    If your daughter's stomach acid is too low....then we/she will get low in her other Minerals.....like Iron and Magnesium....as well....not just Zinc like she is now...

    This happens when get we low in Vitamin B3 aka Niacin and we can no longer produce strong enough stomach acid to absorb our Minerals and other nutrients.

    (Stress is a common trigger) for heartburn because STRESS burns up our B-Vitamin's leading to Heartburn...

    See this research entitled "The effect of life stress on symptoms of heartburn"

    Open Original Shared Link

    Stress/trauma that causes heartburn is a sign you have developed low stomach acid from it...

    See this also article entitled "Is Vitamin B3 Dependency a Causal Factor in the Development of Hypochlorhydria and Achlorhydria?"  that is Low or NO Stomach Acid and they concluded it a (Niacin deficiency) was the trigger (Cause) of Low Stomach acid.

    Open Original Shared Link

    This research on Niacin treating low Stomach Acid is almost 20 years old and because Dr'.s don't study nutrition they don't know anything about Nutrition still 20 years later.....or else they would be called nutritionist....not Doctor's of Medicine.

    You see the "Left Hand doesn't Know What the Right Hand" is doing.....or you might say ignorance is bliss for them! (at least).....but it is torture for their patients sadly!

    If this doesn't answer your questions read one of my Posterboy blog posts....

    I have written several Posterboy blog posts to help people just like your daughter.  I have been her!

    I hope this is helpful but it is not medical advice.

    Posterboy,

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    Wheatwacked
    On 3/16/2021 at 12:33 PM, knitty kitty said:

    Vitamin deficiencies can occur after years on the gluten free diet. 

    Why doesn't anyone make a supplement of 100% RDA (the minimum required) of all of the vitamins and minerals? Babies have Nutramigen.

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    Monica2222
    On 3/24/2021 at 3:51 AM, knitty kitty said:

    Vitamins and minerals are absorbed at different sections of the intestinal tract.  

    Minerals can be stored longer than vitamins, so depletion might take longer to show up.  

    Zinc and copper compete in the body for absorption.  Does your daughter use a copper cup or take a supplement or nutritional shake with lots of copper in it? 

    Is your daughter vegetarian?  

    Keep a food journal to help track nutritional information might help.

    No, she doesn’t use copper cup and she is non-veg

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    Monica2222
    On 3/24/2021 at 5:51 AM, Posterboy said:

    Monica,

    Here is a study that might help you.

    Entitled "Micronutrient deficiencies in children with Celiac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet" including Zinc.

    Open Original Shared Link

    I was doing research for something else and came across it recently.

    It is very current just this month actually.....

    quoting "In contrast, deficiencies for vitamins D, A and zinc did not change significantly post-diagnosis."

    I also recommend this nice blog post started by Blue Sky.....it covers Zinc deficiency issues well....

    What people don't know about Zinc is it is an "Essential Nutrient" which means your body has no good way to store it (despite it being a mineral) or produce it itself....so being low in it your diet will  show up pretty quickly.  Luckily Pumpkin seeds are a good source of Zinc.

    See this nice livestrong article about how our body stores our nutrients IE Vitamins and Minerals and for how long.....it will elaborate on what Knitty Kitty said...

    Open Original Shared Link

    quoting "Your body has no mechanism for storing zinc, so whatever isn't used is expelled from the body, and you'll need a steady dietary supply to keep your body functioning well."

    And what is also worth noting here.....Zinc can be a proxy for Low Stomach Acid as well.....because our Zinc levels in the body is controlled by Vitamin B-3 (Niacin).....which we need to make Stomach Acid.

    See this research entitled "Effect of nicotinic acid (Niacin) on zinc and iron metabolism"

    Open Original Shared Link

    It is why many Celiac's are low in Zinc at the time of their diagnosis...

    See this Mayoclinic article about it...

    Entitled "Study finds micronutrient deficiencies common at time of celiac disease diagnosis"

    Open Original Shared Link

    This is normal for Celiac's to be low in Zinc.....I had low Zinc too!  OCD was a problem for me and I had "White Spot's" in my nail bed among other things....etc.

    quoting from the Mayoclinic article...

    "Zinc deficiency was observed most frequently at diagnosis, the study says, with 59.4% of patients having a deficiency. Other deficiencies included iron, vitamin D, copper, vitamin B12 and folate."

    If your daughter's stomach acid is too low....then we/she will get low in her other Minerals.....like Iron and Magnesium....as well....not just Zinc like she is now...

    This happens when get we low in Vitamin B3 aka Niacin and we can no longer produce strong enough stomach acid to absorb our Minerals and other nutrients.

    (Stress is a common trigger) for heartburn because STRESS burns up our B-Vitamin's leading to Heartburn...

    See this research entitled "The effect of life stress on symptoms of heartburn"

    Open Original Shared Link

    Stress/trauma that causes heartburn is a sign you have developed low stomach acid from it...

    See this also article entitled "Is Vitamin B3 Dependency a Causal Factor in the Development of Hypochlorhydria and Achlorhydria?"  that is Low or NO Stomach Acid and they concluded it a (Niacin deficiency) was the trigger (Cause) of Low Stomach acid.

    Open Original Shared Link

    This research on Niacin treating low Stomach Acid is almost 20 years old and because Dr'.s don't study nutrition they don't know anything about Nutrition still 20 years later.....or else they would be called nutritionist....not Doctor's of Medicine.

    You see the "Left Hand doesn't Know What the Right Hand" is doing.....or you might say ignorance is bliss for them! (at least).....but it is torture for their patients sadly!

    If this doesn't answer your questions read one of my Posterboy blog posts....

    I have written several Posterboy blog posts to help people just like your daughter.  I have been her!

    I hope this is helpful but it is not medical advice.

    Posterboy,

    And how did u correct ur zinc levels 

     

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    Monica2222
    On 3/24/2021 at 5:51 AM, Posterboy said:

    Monica,

    Here is a study that might help you.

    Entitled "Micronutrient deficiencies in children with Celiac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet" including Zinc.

    Open Original Shared Link

    I was doing research for something else and came across it recently.

    It is very current just this month actually.....

    quoting "In contrast, deficiencies for vitamins D, A and zinc did not change significantly post-diagnosis."

    I also recommend this nice blog post started by Blue Sky.....it covers Zinc deficiency issues well....

    What people don't know about Zinc is it is an "Essential Nutrient" which means your body has no good way to store it (despite it being a mineral) or produce it itself....so being low in it your diet will  show up pretty quickly.  Luckily Pumpkin seeds are a good source of Zinc.

    See this nice livestrong article about how our body stores our nutrients IE Vitamins and Minerals and for how long.....it will elaborate on what Knitty Kitty said...

    Open Original Shared Link

    quoting "Your body has no mechanism for storing zinc, so whatever isn't used is expelled from the body, and you'll need a steady dietary supply to keep your body functioning well."

    And what is also worth noting here.....Zinc can be a proxy for Low Stomach Acid as well.....because our Zinc levels in the body is controlled by Vitamin B-3 (Niacin).....which we need to make Stomach Acid.

    See this research entitled "Effect of nicotinic acid (Niacin) on zinc and iron metabolism"

    Open Original Shared Link

    It is why many Celiac's are low in Zinc at the time of their diagnosis...

    See this Mayoclinic article about it...

    Entitled "Study finds micronutrient deficiencies common at time of celiac disease diagnosis"

    Open Original Shared Link

    This is normal for Celiac's to be low in Zinc.....I had low Zinc too!  OCD was a problem for me and I had "White Spot's" in my nail bed among other things....etc.

    quoting from the Mayoclinic article...

    "Zinc deficiency was observed most frequently at diagnosis, the study says, with 59.4% of patients having a deficiency. Other deficiencies included iron, vitamin D, copper, vitamin B12 and folate."

    If your daughter's stomach acid is too low....then we/she will get low in her other Minerals.....like Iron and Magnesium....as well....not just Zinc like she is now...

    This happens when get we low in Vitamin B3 aka Niacin and we can no longer produce strong enough stomach acid to absorb our Minerals and other nutrients.

    (Stress is a common trigger) for heartburn because STRESS burns up our B-Vitamin's leading to Heartburn...

    See this research entitled "The effect of life stress on symptoms of heartburn"

    Open Original Shared Link

    Stress/trauma that causes heartburn is a sign you have developed low stomach acid from it...

    See this also article entitled "Is Vitamin B3 Dependency a Causal Factor in the Development of Hypochlorhydria and Achlorhydria?"  that is Low or NO Stomach Acid and they concluded it a (Niacin deficiency) was the trigger (Cause) of Low Stomach acid.

    Open Original Shared Link

    This research on Niacin treating low Stomach Acid is almost 20 years old and because Dr'.s don't study nutrition they don't know anything about Nutrition still 20 years later.....or else they would be called nutritionist....not Doctor's of Medicine.

    You see the "Left Hand doesn't Know What the Right Hand" is doing.....or you might say ignorance is bliss for them! (at least).....but it is torture for their patients sadly!

    If this doesn't answer your questions read one of my Posterboy blog posts....

    I have written several Posterboy blog posts to help people just like your daughter.  I have been her!

    I hope this is helpful but it is not medical advice.

    Posterboy,

    Her B3 level is good too

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  • About Me

    Scott Adams

    Scott Adams was diagnosed with celiac disease in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. In 1995 he launched the site that later became Celiac.com to help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives.  He is co-author of the book Cereal Killers, and founder and publisher of the (formerly paper) newsletter Journal of Gluten Sensitivity. In 1998 he founded The Gluten-Free Mall which he sold in 2014. Celiac.com does not sell any products, and is 100% advertiser supported.


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    Study Reveals That Even Careful Gluten-Free Dieters Are Eating Gluten Regularly
    Celiac.com 01/07/2020 - Everyone with celiac disease needs to follow a gluten-free diet. However, celiac patients on a gluten-free diet often suffer from villous atrophy, which might point to regular accidental gluten ingestion.
    A group of international researchers called the Doggie Bag Study group, has found that gluten ingestion is common even among those who make a concerted effort to avoid gluten. The study group included Jocelyn A. Silvester, Isabel Comino. Ciarán P. Kelly, Carolina Sousa, and Donald R. Duerksen.
    The group's analysis found that antibody tests on celiac patients who report good or excellent gluten-free dietary practices show that most patients had ingested measurable amounts of gluten in the 10-days before biopsy. These findings indicate that most people w...


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