Celiac Disease

Discussing the latest advances in celiac disease

Tips from Clinicians

January 30th, 2017

Does Celiac Disease Contribute to Other Autoimmune Diseases?

By Kanaaz kanaazpe

Dr. Joseph Murray, M.D., addresses a question posted by a member on Mayo Clinic Connect: Are there any proven links between mesenteric panniculitis and other autoimmune diseases I have, such as celiac disease or small fiber neuropathy?

Mesenteric Panniculitis is a rare inflammatory disease that affects the subcutaneous adipose tissue of the mesentery or the small bowel area that is characterized by blockage to the small intestine; it can be associated with other immune disorders, like celiac disease. However, celiac disease does not contribute to mesenteric panniculitis,  but rather that the inflammation in the intestine could affect inflammation in the mesentery, as they are so closely related.

With regard to neuropathy, celiac disease could be one of the leading factors for peripheral neuropathy, but its association with other neurological disorders is not clear, and requires more research.

For more information about celiac disease, please visit mayoclinic.org/celiac disease

For more information about Mayo Clinic Connect, please visit connect.mayoclinic.org

Dr. Murray is a gastroenterologist and celiac disease expert at Mayo Clinic.

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Tags: celiac disease, Joseph Murray, Mayo Clinic Connect, mesenteric panniculitis, peripheral neuropathy, small fiber neuropathy

December 20th, 2016

Tips for a Healthy Holiday Season

By Kanaaz kanaazpe

Jacalyn See and Madalynn Strong, registered dietitians from Mayo Clinic’s Celiac Clinic discuss valuable tips for maintaining a gluten-free diet during the holidays.

For more information about celiac disease, visit mayoclinic.org/celiac disease





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Tags: celiac disease, diet, dietitian, Gluten Free, holidays, Jacalyn See, Madalynn Strong

December 15th, 2016

When Your Diagnoses of Celiac Disease is in Question

By Kanaaz kanaazpe

Blood tests for celiac disease are usually accurate, but what does it mean when there is a discrepancy between biopsies suggesting celiac disease, but blood tests are negative?

In response to a question from a Mayo Clinic Connect member, Dr. Joseph Murray, M.D., explains that there may be other conditions that can cause changes in the intestinal biopsy that are characteristic of celiac disease. Tropical sprue, certain medications, or infections can cause damage to the intestinal wall.

Other reasons could be IgA deficiency; people with this disorder have absent levels of a blood protein called immunoglobulin A (IgA), which protects against infections of the mucous membranes lining the mouth, airways and digestive tract.

Why is it important to investigate and identify intestinal damage when test discrepancies occur? They may have alternate causes and subsequently alternate treatment, Dr. Murray emphasizes.

For more information about celiac disease, visit mayoclinic.org/celiac disease

Dr. Murray, M.D., is a gastroenterologist and celiac disease expert at Mayo Clinic.


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Tags: celiac disease, https://connectmayoclinicorg, IgA, intestinal damage, Joseph Murray, tropical sprue

May 11th, 2016

The Oats Conundrum

By Kanaaz kanaazpe

A plethora of questions surrounds patients with celiac disease, regarding the consumption of oats while following a gluten-free diet. Dr. Joseph Murray, M.D., and Jacalyn See, clinical dietitian, take an in-depth look and discuss some of the misconceptions about oats and the celiac patient.

Points to consider:

In response to numerous queries concerning the use of oats in various products, the North American Society for the Study of Celiac Disease (NASSCD) has developed this statement: "Based on the available scientific evidence, the use of oats uncontaminated by wheat, barley or rye by individuals with celiac disease and dermatitis herpetiformis in North America has been endorsed by most experts. Oats can add diversity and offer many nutritional benefits to the gluten-free diet."

Oats do not naturally contain gluten. The main problem with oats in gluten-free eating is contamination during harvest and storage. Many commercial oats are processed in facilities that also process wheat, barley, and rye. The gluten in these ingredients can contaminate oats, and with most gluten intolerances, even a trace amount of gluten can cause severe discomfort. Therefore,  it has been stressed that the oats be certified as pure.

Oats contain a protein called "avenin" that has the same properties as gluten. However, adverse reactions to this oat protein are very rare. More commonly, some patients may react to the fiber content or the fermentable carbohydrates in oats, both of which can cause gas, bloating and diarrhea.

There have been extensive studies done in adults and children, and clinical reports now provide strong evidence that pure oats very rarely cause damage to the gut mucosa in people with celiac disease.

Jacalyn See urges patients to check with their doctor and dietitian before introducing oats, and to start very slowly. It is important to ensure the oats are labelled gluten-free, but if there is suspicion of contamination, See advises patients to contact the FDA's MedWatch; save all packaging so that the source of contamination can be traced.

Oats are a great source of nutrients that are often lacking in the gluten-free diet, such as iron and fiber. Dr. Murray concludes that, "There is renewed hope and new opportunity for celiac disease patients to expand their diet to an area of the past where they felt uncomfortable doing so before."

Read more about the oats statement by NASSCD, here

For more information about celiac disease, visit mayoclinic.org/celiac disease

Dr. Murray is a gastroenterologist and celiac disease expert at Mayo Clinic.

Jacalyn See is a registered clinical dietitian at Mayo Clinic

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Tags: celiac disease, FDA, Gluten Free Diet, Jacalyn See, Joseph Murray, MedWatch, oats

May 5th, 2016

The Gluten-Free Diet: A Practical Look

By Kanaaz kanaazpe

Celiac disease is a global disease, and currently the only available treatment is a gluten-free diet. In the developed world there are a lot of resources for people with celiac disease who need to be on a gluten-free diet, but it is still a substantial challenge. As celiac disease is being diagnosed in other countries, social, financial, cultural differences come into play, and can impact the ability of the celiac patient to follow a gluten-free diet. Dr. Joseph Murray, M. D., co-author of a recent paper published in Nature Reviews, Gastroenetrology and Hepatology, reviews some of these challenges and suggests strategies to maximize successful treatment, achieve healing, and prevent complications.

Some important highlights from the article:

  • The goals of treatment are best achieved when patients are managed by a team approach, including expert physicians and dietitians and community support.
  • The grains to be avoided on a gluten-free diet are wheat, barley and rye.
  • Patients with celiac disease must become expert label readers, and, because product ingredients change, must re-check labels at each purchase.
  • Worldwide, the availability of gluten-free foods is limited, especially in less-developed areas. Patients with celiac disease might access standard gluten-free foods by prescription and, in developed countries, many supermarkets now provide gluten-free sections.
  • The requirement for a strict gluten-free diet often affects social interactions. The burgeoning interest in gluten-free foods has led restaurants to offer gluten-free options on their menus. Many travel websites and mobile apps identify gluten-friendly restaurants, hotels, cruises and grocers near one's travel destination.
  • Once the diagnosis of celiac disease has been made, patients should be taught about the gluten-free diet with appropriate follow-up according to the individual's needs until a good understanding is achieved.
  • Dietary adherence is essential to achieve small bowel mucosal healing and alleviation of gastrointestinal symptoms.

Dr. Murray concludes that, "Central to success is engagement of the public health system, of doctors and dietitians who can support celiac patients in achieving wellness through a gluten-free diet."

Read the full journal review online here.

For more information about celiac disease, visit mayoclinic.org/celiac disease.

Dr. Murray is a gastroenterologist and celiac disease expert at Mayo Clinic.

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Tags: celiac disease, Gluten Free Diet, Joseph Murray, mucosal healing, Nature Reviews

April 19th, 2016

The Gluten ELISA Test Kit

By Kanaaz kanaazpe

If you have celiac disease, you may rely on commercial test kits for detecting gluten in food. But how reliable are these test kits for gluten detection? Dr. Joseph Murray, M.D., evaluates the ELISA test kits, based upon a study published in Cereal Chemistry.

The team of researchers who set out to evaluate the accuracy of 14 ELISA kits for gluten detection found that none of the currently available ELISA methods can accurately detect and quantify gluten in all cases. In the face of these results, Dr. Murray has the following recommendations for individuals who use the kits:

  • The FDA allows food products containing less than 20 parts per million of gluten to be labeled as gluten-free.
  • Be very cautious, and repeat the test multiple times.
  • Pay attention to the quality of the test.
  • Make sure that the test is appropriate for the matrix of the food type.

The authors of this study conclude that further improvements are urgently needed, and recommend focusing on competitive formats, improving extraction methods, and the detection of relevant gluten peptides.

Read the full study online here.

For more information about celiac disease, visit mayoclinic.org/celiac disease.

Dr. Murray is a gastroenterologist and celiac disease expert at Mayo Clinic.



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Tags: celiac disease, Cereal Chemistry, ELISA test, FDA, gluten, Gluten Free, Joseph Murray

April 5th, 2016

Could Sourdough Bread be the Answer to the Gluten Sensitivity Epidemic?

By Kanaaz kanaazpe


“I would bet that if you took a dozen people who claimed gluten intolerance and you gave them Richard’s bread, they’d be fine,” says Michael Pollan in the third episode of his new Netflix food documentary, Cooked.

The bread he is referring to is a sourdough made the old fashioned way, with hours of fermentation and naturally occurring yeast found in the air by a baker named Richard Bourdon in rural Massachusetts. Bourdon and Pollan go on to explain the importance of proper fermentation of grains to aid in digestion. Pollan says a long fermentation process allows bacteria to fully break down the carbohydrates and gluten in bread, making it easier to digest and releasing the nutrients within it, allowing our bodies to more easily absorb them. Pollan hypothesizes that the speeding up of the bread-making process for mass consumption has so radically altered what we know as bread in the last century that it’s no longer as easily digested.

The idea of sourdough being easier to digest is an intriguing one, and has been making the rounds on blogs devoted to gluten-free eating. In 2011, a small study conducted in Italy tried giving volunteers with celiac disease a small amount of specially prepared sourdough bread. The subjects in the study seemed to react well to the sourdough, which had been fermented until the gluten within it was degraded. The study authors concluded it was not toxic to the celiac disease subjects.

So could bread prepared the slow old fashioned way, the way it was made before added gluten and fast-rising yeast became the norm, be a solution to the gluten intolerance epidemic? Maybe, is the short version of the complicated answer, according to leading celiac experts.

For those with true celiac disease, it is too soon to extrapolate the findings of a small study to changes in diet, cautions Joseph Murray, professor of medicine at the Mayo Clinic. “It may provide options for celiacs in the future,” says Murray, adding that he is not hopeful because of the safety margins needed. Just baking sourdough would not be enough. For the bread to be an option, there would have to be a way to work out the baking process so that the gluten is guaranteed to have uniformly degraded to the point where the bread could be tolerated in each batch.

For those with a less severe reaction, with what Pollan calls “gluten intolerance”, which is more commonly known as non-celiac gluten sensitivity, the sourdough process may increase tolerance for consuming the bread, says Alessio Fasano, director of the Center for Celiac Research at Massachusetts General Hospital. The long fermentation process to make sourdough bread the old fashioned way does reduce some of the toxic parts of gluten for those that react to it, says Peter Green, director of the Celiac Disease Center at Columbia University.

While sourdough’s degraded proteins are promising, gluten sensitivity remains mysterious. It’s a relatively new concept, and experts still aren’t sure what causes it. Celiac disease, on the other hand, has been thoroughly studied, says Murray, who refers to it as one of the best understood autoimmune disorders. Gluten sensitivity is another matter. People claiming gluten sensitivity started showing up at celiac centers within the last ten years or so, says Green. When patients first started coming into the clinic, saying they got sick from eating gluten and felt better when they stopped consuming it, with no evidence that they have celiac disease, doctors were skeptical.

Raising awareness of celiac disease has been a blessing and a curse, says Fasano. “We created this monster,” he says, referring to what happened when doctors tried to educate the public about celiac disease. While people now understand the autoimmune disease, and gluten-free products are readily available, the idea that gluten could be responsible for myriad health problems has grown out of control, says Fasano.

Celiac disease affects an estimated 1% of the population, though there is concern that the rate is rising. By comparison, an estimated 29% of people in the US are avoiding gluten in their diets. Gluten-free products are a huge business. Everywhere you go, everyone seems to know the name of a wheat protein no one outside the medical and science community could name twenty years ago.

Seizing on growing public awareness of celiac disease, books like Wheat Belly: Lose the Wheat, Lose the Weight, and Find Your Path Back to Health, and Grain Brain: The Surprising Truth About Wheat, Carbs, and Sugar – Your Brain’s Silent Killers further popularized the idea that gluten was the culprit in many ills. Popular books like these tend to generalize and skimp on the science, says Murray. When asked to comment on or review books like Wheat Belly, Murray simply says, “I am a scientist, it is not for me to make literary criticisms on works of fiction.”

Public awareness and self help are not the only culprits. Another reason the gluten-free movement has taken off has been the appeal of the idea of a simple fix to so many health issues, says Fasano. The appeal lies in the fact that no diagnosis or pill is needed, he explains. All a person needs to do is go on a diet, without even needing to see a doctor. At the same time, many alternative practitioners have started to prescribe gluten-free diets to their patients for a variety of ills, touting its health benefits, says Fasano, further popularizing the idea that someone could be sensitive to gluten without having celiac disease. The bulk of people on a gluten-free diet don’t have a reason to be on it, says Green, who points out that eating a lot of bread can make a person bloated without it being a “disease state”.

While a placebo effect seems to be at work for a lot of people, there are those that really do seem to be reacting to something in wheat without having celiac disease. Some people may experience bloating and flatulence in response to FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) instead of gluten. FODMAPs are a type of carbohydrates that are not well absorbed in the small intestine and are present in bread along with a number of other foods. For people with irritable bowel syndrome, which has some overlap in gastrointestinal symptoms with celiac disease, FODMAPs can exacerbate symptoms, says Murray.

The idea of FODMAPS as the possible culprit came from an Australian research group who accidentally helped popularize the idea of gluten sensitivity, adding fuel to the fire. In 2011, a study of people with irritable bowel syndrome found that subjects felt better when they ate a gluten-free diet. The same research group did a follow-up study, in which they put gluten sensitive subjects on a diet free of both gluten and FODMAPs until they felt better. They then gave some of the subjects gluten and found that they did not react to it, suggesting the problem was FODMAPs and not gluten.

But, says Murray, by that time “it was too late to stop this gluten sensitivity train: it had left the station”.

Fermentation during the sourdough process, intriguingly, also reduces FODMAP levels, according to Monash University, where the Australian studies of FODMAPs and gluten sensitivity took place. Breads made in the traditional sourdough process that are made with flours that are low in FODMAPs, like spelt – which does contain gluten – can be tolerated by people who have been shown to have FODMAP sensitivity. FODMAPs may not be the only explanation for the rise in people claiming gluten sensitivity. Wheat itself has not changed in the past 100 years, says Fasano, but there are a lot of vital gluten and enzymes being added to food, so it may be something else in bread or highly processed food that might be causing sensitivity to gluten. There are also theories that changes in our gut microbes could be causing increased reactions to wheat. Another theory is that people who claim gluten sensitivity are actually reacting to another protein in wheat – Murray points out that wheat is a “complicated food”, made up of many proteins.

In the meantime, rates of diagnosed celiac disease are on the rise, according to Murray. People continue to show up at celiac centers saying they are sensitive to gluten, while scientists try to figure out what they could be reacting to and narrow down what has changed in our environment or food. Processed foods are not tested for their impact on human health, so when new additives are introduced, their effect on human health is unknown.

The only decisive conclusion available about gluten sensitivity is that more research is needed.

This article was originally published in the US edition of  The Guardian

For more information about celiac disease, visit mayoclinic.org/celiac disease.

Dr. Murray is a gastroenterologist and celiac disease expert at Mayo Clinic.

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Tags: bread, celiac disease, FODMAPs, gluten, gluten intolerance, Joseph Murray, non-celiac gluten sensitivity

March 1st, 2016

Evaluating Health News: Dr. Joseph Murray on Mayo Clinic Radio

By Kanaaz kanaazpe

Are you wondering if eating bacon is as bad as tobacco? Should you be on a gluten-free diet? Do you have gluten-sensitivity, or celiac disease? Although health and medicine news reports provide useful information, there seems to be a "frenzy of misinformation," and it is not uncommon to hear conflicting reports or even exaggerated or hyped-up messages.

Recently on Mayo Clinic Radio, gastroenterologist Dr. Joseph Murray along with preventive medicine specialist Dr. Donald Hensrud offered some guidelines for separating hype from reality in health news reports.

Click here to listen to the program.

For more information on the radio show, visit Mayo Clinic News Network 

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Tags: celiac disease, Gluten Free, gluten sensitivity, Joseph Murray

March 1st, 2016

Know Your Lectins

By Kanaaz kanaazpe

Recent media have suggested that lectins, found in legumes and grains, can be toxic to one’s gut, and may even lead to autoimmune disorders such as Crohn's disease and celiac disease. Jacalyn See, clinical dietitian at Mayo Clinic debunks this myth and explains why we shouldn’t eliminate this nutritious carbohydrate-binding protein from our diet.

Lectins are found in all foods, but are most concentrated in legumes and grains. They can be toxic, but only if eaten raw! Cooking completely denatures lectins; in fact, boiling legumes in water eliminates almost all lectin activity, and canning beans is just as effective. Moreover, whole grains and legumes are a powerhouse of nutrients, rich in B vitamins, iron, and fiber which are often difficult to get in restrictive diets such as a gluten-free diet.

The lectin-rich foods we consume, like grains and legumes, are almost always cooked in some way beforehand and this leaves only a negligible amount of lectins, making these foods safe to eat for the majority of people. The benefits of these healthy nutrients far outweigh the negative effects of trace amounts of lectins.

Learn more about celiac disease at mayoclinic.org/celiacdisease.

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Tags: carbohydrates, celiac disease, diet, grains, Jacalyn See, lectins, legumes, protein

November 30th, 2015

Gluten in Makeup: Does it Matter?

By Kanaaz kanaazpe

Currently, the only treatment for celiac disease is lifelong adherence to a strict gluten-free diet. People living gluten-free must avoid foods with wheat, rye and barley. But many patients are questioning if there may be more to a gluten-free lifestyle than just making dietary changes. Gluten is sneaky; it may also be lurking in makeup and toiletries where it's used as a binder to help ingredients stick together, and to add moisture to products through gluten-derived oils. Tara M. Myles, registered  clinical dietitian at Mayo Clinic assures patients that there is no definite link between any gluten in beauty products and harmful effects for those who have celiac disease.

Typically, gluten must be ingested for it to cause a reaction. Unless you accidentally swallow them, gluten-containing skin care products and cosmetics aren't a problem. For this reason, avoid using such products on your lips or around your mouth, and also avoid gluten-containing dental products.

If you use a cosmetic or skin care product that contains gluten, and you develop a skin reaction, see your doctor or dermatologist to identify the cause. It is possible to have an allergy to wheat or another grain that causes a skin reaction. Since there's not any defined science on it yet, opting for gluten-free cosmetics is a very personal decision people need to make.

For more information about celiac disease, visit mayoclinic.org/celiac disease.

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Tags: celiac disease, cosmetics, gluten, Makeup, Tara Myles

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