The Vancouver Chapter of the Canadian Celiac Association is a non-profit charity that supports people who are adversely affected by gluten, dermatitis herpetiformis, and other gluten-related conditions.



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The gluten problem: Found. Treated. Cured.

Celiac Disease (CD) is a genetic, multi-system, autoimmune disorder where the body reacts to gluten and other prolamines in wheat (e.g. durum, kamut, spelt), rye and barley.  Gluten consumption causes damage to the absorptive surface of the small intestine and can result in malnutrition, anemia, nutritional deficiencies and an increased risk of other autoimmune diseases and some cancers of the gut. Every person is different and there may be no symptoms, but damage is still being done.  More information can be found at the Canadian Celiac Association website.
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Last Updated
Feb 20th 2017
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More news...

Submitted by Val Vaartnou

The following are precise of scientific articles and news articles regarding Celiac Disease related issues
reviewed since the last newsletter. Links and bibliography information is provided if wish to read the full
article.

Celiac Disease in Children
In this article, Dr. Ed Hoffenberg, MD talks about the differences seen in children with Celiac Disease at
different ages. It is unknown why some children develop celiac disease early in life and others later in life.
Symptoms also vary between children from within minutes of ingestion of gluten, to delayed symptoms
lasting sometimes as long as two weeks. With severe symptoms children are most likely to be
diagnosed: failure to thrive, weight loss and vomiting. Infants and toddlers can suffer from malnutrition
which results in low growth in height and/or weight. The tTG test is not accurate in children under 3 years
of age and any child with symptoms under this age should be seen by a pediatric gastroenterologist.
School age children usually do not vomit, but have other gastrointestinal issues like stomach aches,
bloating, diarrhea or constipation. Inability to either gain or lose weight should signal a test for celiac
disease.
Teens with celiac disease often exhibit "atypical" symptoms. Mood disorders, depression and panic
attacks may arise. Lethargy, fatigue, headaches, skin conditions (DH), stunted growth and delayed
puberty are some of the possible symptoms.
Children may also have no or mild symptoms and testing should be considered if they have other related
conditions: Type 1 diabetes, a relative with the disease, juvenile arthritis, a thyroid condition, IgA
deficiency to name a few. Anemia, weak dental enamel, elevated liver enzymes or osteopenia are all
signals that celiac disease should be tested for.
https://celiac.org/live-gluten-free/lifestyle/for-parents-and-children/22783-2/?
bblinkid=24443625&bbemailid=1910934&bbejrid=129664823

Is there gluten in your over the counter medications?
This is not new research, but I like to let people know of the only site I have found that provides a listing of
over the counter gluten-free drugs. This is a US site. It is run by a pharmacist who is also developing a
new list of drugs indicating whether there are corn, lactose, potato and soy in the drugs, in addition to
their gluten-free status. The site is
www.glutenfreedrugs.com

Gluten-Free Diet Does Not Repair Intestinal Damage in Some Children With Celiac Disease
Medical records of 102 children diagnosed with celiac disease were reviewed. After a year, despite
excellent adherence to a gluten-free diet for most (91%) patients, 43% experienced persistent symptoms,
27% had new gastrointestinal symptoms, and 34% had persistently elevated serology at the time of
repeat endoscopy and biopsy. Only 33% of the patients were asymptomatic at the time of repeat
endoscopy. Overall, 19% of patients showed persistent enteropathy consistent with a Marsh 3 lesion at
the repeat endoscopy. The findings demonstrate that neither the presence of symptoms nor a positive
tTG result was a reliable measure of mucosal recovery in the study population. For example, tTG was
elevated in 43% of patients with persistent enteropathy and in 32% of those with mucosal healing. In
contrast, 84% of patients with mucosal recovery on repeat biopsy were symptomatic at the time of the
repeat endoscopy, as were 55% with persistent enteropathy. Further research is required in this area.
The study included Dr. Alessio Fasano, a well-known gastroenterologist and researcher and Dr. Jocelyn
Silvester, who has been funded by the Canadian Celiac Association in the past. Published on line,
November 3, 2016 Journal of Pediatric Gastroenterology and Nutrition,
February 2017 - Volume 64 -
Issue 2 - p 286291
.

New List Created by Experts May Help Prevent Food Gluten Cross-Contamination
The newly created food services checklist was compiled after an extensive literature review, input from 11
different experts with PhDs and experience with food services and/or gluten and celiac issues, along with
documents from various organizations such as the Gluten-Free Certification Program from the Canadian
Celiac Association.
The final checklist consists of 88 items divided into 12 sections, which cover everything from building and
facilities maintenance, cleaning and ventilation, to employee clothing and hygiene, to food production and
transport. The list was published in the journal Nutrients.
http://www.cantechletter.com/2017/01/new-tools-may-prevent-gluten-cross-contamination-food-servicesindustry/

Celiac Disease Patients Have a Higher Risk of Pneumonia
One study, conducted in the United Kingdom, provides the most comprehensive look at the issue. The
study tracked 9,803 people with celiac disease, along with 101,755 people who didn't have the condition
for comparison purposes.
The study, which spanned 15 years, included all age groups.
Overall, the researchers identified 179 cases of pneumonia among those who had celiac disease,
compared to 1,864 cases in those people who didn't have celiac. That works out to similar odds for those
with celiac to catch pneumonia, when compared with those who didn't have the condition.
However, the researchers also identified a 28 percent increased risk of pneumonia in people younger
than age 65 who had celiac disease and who had not been vaccinated for pneumonia. This increased risk
was highest around the time of diagnosisóat that time, the risk was twice as high for any type of
infectious pneumonia and four times as high for pneumococcal pneumonia, the researchers said.
However, the risk remained elevated for more than five years following that celiac disease diagnosis.
The study concludes: "Unvaccinated patients with coeliac disease under the age of 65 have an excess
risk of community-acquired pneumonia that was not found in vaccinated patients with coeliac disease. As
only a minority of patients with coeliac disease are being vaccinated, there is a missed opportunity to
intervene to protect these patients from pneumonia."
http://www.mdmag.com/medical-news/doctorssuggest-
celiac-disease-patients-get-pneumonia-vaccine

Celiac Disease Patients Pay a Higher Economic Burden
"This study highlights the additional healthcare resource use and costs associated with celiac disease on
top of gluten-free-diet costs," said Stefano Guandalini, M.D., founder and medical director of the
University of Chicago Celiac Disease Center. "It focuses on the costs borne by insurers, as well as the
medical burden of celiac disease for patients." The study looked at the medical records of 18M patients in
the US. They identified 12,187 patients with Celiac Disease and matched them based on age, sex,
region, company and employment status. Patients with celiac disease had $12,217 total all-cause direct
costs compared with $4,935 in controls (P < .0001). Guandalini S, et al. Abstract 2. Presented
at: Digestive Disease Week, May 16-19, 2015; Washington, D.C.
http://www.healio.com/gastroenterology/malabsorption/news/online/%7B46029097-bd42-49b7-8f2c-
39bfbd46e18b%7D/celiac-disease-associated-with-significant-economic-burden

Gluten Free Stakeholder 2016 Report
The Session was led and facilitated by the Canadian Celiac Association, the Allergen Control Group Inc,
and the Agriculture and Agri-Food Canada. You can read their final report regarding the September 2016
meeting.
http://gfstakeholdersession.com/assets/ALLERGEN_STAKEHOLDER_SESSIONS_REPORT_.pdf

25% of Ataxia Caused by Gluten
A study in the Journal of Neurology, Neurosurgery and Psychiatry found that 25% of ataxia was caused
by gluten. A research paper lead by Dr. M Hajivassiliou published in December, 2016 concluded that
immune-mediated ataxias are common. Diagnosis of the cause is key to potential therapeutic treatments.
Ataxia is a neurological condition consisting of the loss of control of bodily movements. It includes gait
abnormality.
http://jnnp.bmj.com/content/early/2016/12/13/jnnp-2016-314863

US Labelling of Gluten-Free Foods
The U.S. Food and Drug Administration (FDA) has defined the term "gluten-free" for voluntary use in the
labeling of foods. Any food product bearing a gluten-free claim labeled on or after August 5, 2014 must
meet the requirements of the agency's gluten-free labeling rule. With this uniform definition, consumers
with celiac disease can choose foods with greater confidence. The standard is no greater than 20 ppm in
products that are labelled gluten-free. This brings US labeling closer to Canada's standards. For detailed
information if you are traveling to the US.
http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Allergens/ucm3
62880.htm

Celiac Associated Pancreatic Disease
Dr. Hugh Freeman, a gastroenterologist affiliated with the Department of Medicine, University of British
Columbia, Vancouver, BC set out to study the prevalence of Type 1 diabetes and Celiac Disease
Prospective studies using an initial screening IgA tissue transglutaminase antibody assay (tTG) were
done at UBC and a total of 125 male and 108 female children and adolescents with type 1 diabetes
mellitus were evaluated from an established pediatric diabetes clinic. Of these, 15 male and 11 female
patients had elevated tTG titers, of whom 19 were also positive for endomysial antibodies. Among these
cases, 1 was already known to have celiac disease. Small intestinal biopsies were done in the other 18
children positive for both antibodies.
In this study, over 40% of diabetic children were asymptomatic, yet blood testing facilitated selection for a
small intestinal biopsy evaluation. 7.7% of this pediatric group had biopsy results common in celiac
disease. Dr. Freeman says that further research in this area is required to determine if these
observations can be verified by others. Annals of Gastroenterolgoy, July September, 2016, published
on-line May 20, 2016.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923808/

Wheat Proteins Cause Inflammation Beyond the Gut
This is a study regarding ATI's (amylase-trypsin inhibitors), which are specific proteins found in wheat that
has been shown to trigger an immune response in the gut that can spread to other tissues in the body.
While ATI's only compromise 4% of the protein in wheat, they have been suggested to exacerbate
rheumatoid arthritis, multiple sclerosis, asthma, lupus, non-alcoholic fatty liver disease, IBS and other
conditions such as non-celiac gluten sensitivity (NCGS).
http://www.medicalnewstoday.com/articles/313514.php

Rituximab Promising for Dermatitis Herpetiformis
Rituximab may be an effective treatment for recalcitrant dermatitis herpetiformis (DH), according to a
recent case study.
"DH is an autoimmune blistering disease which is commonly associated with celiac disease and can
present with debilitating pruritic blisters on extensor surfaces," explained Dr. Ron Feldman of Emory
University School of Medicine.
"The most common treatments are a gluten-free diet along with the addition of dapsone," he told Reuters
Health. "For patients who do not typically respond to these therapies, other immune-suppressing
medications have been utilized with mixed results."
"This is the first successful case of rituximab therapy used for a recalcitrant case of DH," he said by email.
"The patient had resolution of both his pruritus and skin rash. In addition, the levels of both anti-tissue and
anti-epidermal transglutaminase antibodies normalized."
The link to this article is below, you do need a login to Medscape to view it.
http://www.medscape.com/viewarticle/874098?src=wnl_edit_tpal

Gluten-Free Certification Program -  The CCA has spent several years developing a voluntary certification program based on a preventative approach for managing the production of gluten-free products.  This symbol is the copyright of the Allergen Control Group who now manages the certification of gluten-free products.  To see vendors who have been certified check out their website or look for this symbol on products in your stores.