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Celiac Disease and Non-Celiac Gluten Sensitivty

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marco montagino

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Transcript of Celiac Disease and Non-Celiac Gluten Sensitivty

Celiac Disease and Non-Celiac Gluten Sensitivity
Epidemiology and Definition of Celiac Disease
1% of the US population has Celiac Disease (CD)

CD is “an autoimmune disease in genetically susceptible individuals caused by the immunological reaction to gluten.”
Environmental factors that increase risk of CD
Viral infections in infants
Shorter duration of breastfeeding
Earlier introduction to gluten

Reasons for the increased risk of CD by these factors are not completely understood or remain unknown.
Gliadin is the Prolamin found in wheat
Genetic Predisposition and Gluten
The Prolamin component of Gluten does not get digested.

In the small intestine, Prolamin induces an immune response in those who are genetically susceptible to developing CD.

A person’s genetic predisposition plays a major role in the development of CD.

Prolamin
More specifically, the cause of the immunological reaction is a certain peptide component of Gluten called Prolamin.

There are different Prolamins in different grains, for example:

Gliadin (found in wheat)
Secalin (found in rye)
Hordein (found in barley)

By Fayth Holbrook, Marco Montagino, Michaela Sossamon, and Valerie Wright
Pathophysiology and Etiology
Diagnostic Criteria and Signs/Symptoms
Nutritional Concerns and Treatments
The Immune Response to Gluten
HLA-DQ2 and HLA-DQ8 are proteins found on the macrophages located in the Gut-Associated Lymphoid Tissue (GALT) of the small intestine.

The Detection of the Prolamin from gluten by these proteins initiate an immune response by immune cells.
Villous Atrophy
Villous Atrophy is characterized by the flattened villi which, in this case, results from the damage done by cytokines and Natural killer T cells.

The flattened villi reduces the necessary surface area needed for nutrient absorption
Associations between CD and other diseases
Besides the HLA gene, forty other genes have been found to be associated with CD as well as other autoimmune diseases.

Because other autoimmune diseases have been shown to be genetically connected to CD, the position of the American Gastroenterological Association is that people who have at least one autoimmune disease should be tested for CD as well.
Prevalence of autoimmune diseases in those with CD
Pathophysiology and Etiology of Celiac Disease
1. Kagnoff MF, Murray JA, Rostom A. Medical Position Statement on Celiac Disease. Gastroenterology. 2006;131(6):1977-1980. doi:10.1053/j.gastro.2006.10.003.
2. Lacey K, Nelms MN, Sucher K. Diseases of the Lower Gastrointestinal Tract. In: Nutrition Therapy and Pathophysiology. Boston (Ma.): Cengage Learning; 2015: 168, 405-413.
3. Kupfer SS, Jabri B. Celiac Disease Pathophysiology. Gastrointestinal endoscopy clinics of North America. 2012;22(4):10.1016/j.giec.2012.07.003. doi:10.1016/j.giec.2012.07.003.
4. Freeman HJ, Gujral N, Thomson AB. Celiac disease: Prevalence, diagnosis, pathogenesis and treatment. World Journal of Gastroenterology: WJG. 2012;18(42):6036-6059. doi:10.3748/wjg.v18.i42.6036.
5. Gliadin + Glutenin = Gluten; 2015. Available at: http://www.elisilvernd.com/health-news/what-exactly-is-gluten..
6. Pisapia L, Camarca A, Picascia S, et al. HLA-DQ2.5 genes associated with celiac disease risk are preferentially expressed with respect to non-predisposing HLA genes: Implication for anti-gluten T cell response. J Autoimmun. 2016 Apr 12
7. Thomas KE, Sapone A, Fasano A, Vogel SN. Gliadin Stimulation of Murine Macrophage Inflammatory Gene Expression and Intestinal Permeability Are MyD88-Dependent: Role of the Innate Immune Response in Celiac Disease. The Journal of Immunology. 2006;176(4):2512-2521. doi:10.4049/jimmunol.176.4.2512.
8. Harvard Health Publications. 2014. http://www.health.harvard.edu/digestive-health/celiac-disease
9. Nutrient Deficiency from Damaged Villi Due to Celiac Disease; 2015. Available at: https://microbewiki.kenyon.edu/index.php/file:celiac_villi.jpeg.
10.
Fasano A. Zonulin and Its Regulation of Intestinal Barrier Function: The Biological Door to Inflammation, Autoimmunity, and Cancer. Physiological Reviews. 2011;91(1):151-175. doi:10.1152/physrev.00003.2008.
11.
Lammers KM, Lu R, Brownley J, et al. Gliadin Induces an Increase in Intestinal Permeability and Zonulin Release by Binding to the Chemokine Receptor CXCR3. Gastroenterology. 2008;135(1). doi:10.1053/j.gastro.2008.03.023.
12. Leaky Gut; 2014. Available at http://therealfoodguide.com/do-you-have-a-leaky-gut/.
13. What other autoimmune disorders are typically associated with those who have celiac disease. Cure Celiac Disease web site. Available at http://www.cureceliacdisease.org/faq/what-other-autoimmune-disorders-are-typically-associated-with-those-who-have-celiac-disease/

References
Non-Celiac Gluten Sensitivity (NCGS) & Signs/Symptoms of CD and NCGS

Definition of NCGS
condition in which gluten consumption causes intestinal and extra-intestinal symptoms with no confirmed relation to celiac disease (CD) or wheat allergy (WA)
Epidemiology
Frequency of NCGS is unknown due to majority of
patients self-diagnosing
themselves after an onset of symptoms. They begin a
gluten- free diet (GFD)
without first seeking medical advice to heal symptoms.

Signs and Symptoms of CD
Gastrointestinal symptoms:
steatorrhea (abnormal amounts of fat in the feces)
Weight loss
Bloating
Flatulence
Abdominal pain
Constipation
Diarrhea


Non-gastrointestinal symptoms:
Abnormal liver function
Numbness in the arms and legs
Joint pain
Peripheral neuropathy (damage to peripheral nervous system)
mouth ulcerations

Symptoms of NCGS
Abdominal pain
Abdominal bloating
Diarrhea
Eczema
Rash/skin conditions
Headache
Foggy mind
Fatigue
Depression
Numbness in the arms and legs
Joint pain

Other Symptoms:
Foggy mind
Depression
Headache
chronic fatigue
skin conditions (dermatitis herpetiormis)

NCGS
NCGS is usually a "stand alone" condition.
Because there isn't an atrophy of the villi in NCGS, they do not experience the same absorption problems, thus you will not see the same complications that are often seen in CD.
Blood panel diagnostic criteria for CD
IgA anti-tTG (preferred test)
Both of these levels will be elevated

Immunoglobulin A (IgA)
plays a role in the immune function of the mucous membranes.
Produced by the immune system in response to gluten because gluten is a "threat"

People with CD make antibodies called
anti-tissue transglutaminase (anti-tTG)
that attack tissue transglutaminase (tTG).
Tissue transglutaminase (tTG
)
repairs damage in the body

EMA test

This test detects the presence of EMA anti-endomysial antibodies
EMA's are a type of Immunoglobin A antibodies that attack the body's own tissues.
Used for patients who need further evaluation
Anti-gliadin test
Anti-gliadin is produced in response to ingestion of gliadin (in gluten) in those with CD
Treatment and Nutrition Concerns
Further diagnostic criteria
conclusive diagnosis of CD is done through an endoscopic biopsy
a Gastroenterologist takes a biopsy of the small intestine that is analyzed for damage
CD is classified by varying degrees of atrophy of the internal mucosa, with reduced height of the villi (a complete loss of the villi in extreme cases)
CD is further confirmed after improvement is seen on a GF diet
Diagnostic criteria for NCGS
Presence of clinical symptoms that overlap with CD
Negative skin prick (negative wheat allergy)
Skin prick determines the presence of IgE
IgE is released as an allergic response to eating gluten.
Gene tests to rule out CD
Negative CD blood panel
Presence of bio-markers (gliadin antibodies)
Resolution of symptoms after GF diet
Positive gluten challenge
Pathophysiology
Not an autoimmune response:
NCGS patients lack highly specific autoantibodies to tissue transglutaminase (tTG)

Innate immunity is suggested:
increased expression of toll like receptor-2 (TLR-2) on the lining of the macrophages due to

Those with NCGS do not experience a deformity in mucosal tight junctions:

no "leaky gut" due to normal expressions of claudin-1 and Zonula-1, and increase of claudin-4
CD vs NCGS Pathophysiology
Other ingredients in wheat might be causing sensitivity:

wheat amylase trypsin inhibitor (ATI)
small family of five or more low density proteins
RESISTANT to protein degradation
engage in the TLR4-MD2-CD14 complex to produce a release of pro-inflammatory cytokines to trigger innate immune responses

fermentable, oliogosaccharides, disaccharides, monosaccharides, and polyols (FODMAPS)

poor absorption of these short-chain carbohydrates cause GI symptoms such as gas
It is thought that gluten might be one of the many FODMAPS that cause sensitivity

Diagnostic Criteria
and
Nutritional Concerns

References
14. CatassiC, Bai JC , Bonaz B et al., “Non-celiac gluten sensitivity: the new frontier of gluten related disorders,”
Nutrients
, vol. 5, no. 10, pp. 3839–3853, 2013.
15. Elli L, Roncoroni L , and Bardella MT, “Non-celiac gluten sensitivity: time for sifting the grain,”
World Journal of Gastroenterology
, vol. 21, no. 27, pp. 8221–8226, 2015.
16. Tonutti E, Bizzaro N. Diagnosis and classification of celiac disease and gluten sensitivity.
Autoimmun
Rev. 2014;13:472–476. doi: 10.1016/j.autrev.2014.01.043.
17. Shahbazkhani B, Sadeghi A, Malekzadeh R, et al. Non-Celiac Gluten Sensitivity Has Narrowed the Spectrum of Irritable Bowel Syndrome: A Double-Blind Randomized Placebo-Controlled Trial. Nutrients. 2015;7(6):4542-4554. doi:10.3390/nu7064542.
18. Peña AS. Immunogenetics of non celiac gluten sensitivity. Gastroenterology and Hepatology From Bed to Bench. 2014;7(1):1-5.
19. Sapone A, Bai JC, Ciacci C et al., “Spectrum of gluten-related disorders: consensus on new nomenclature and classification,”
BMC Medicine
, vol. 10, article 13, 2012. doi: 10.1186/1741-7015-10-13
20. Freeman HJ, Gujral N, Thomson AB. Celiac disease: Prevalence, Diagnosis, pathogenesis and treatment.
World Journal of Gastroenterology: WJG.
2012;18(42):6036-6059
21. American Associate for Clinical Chemistry. Celiac Disease Antibody Tests. Lab Tests Online. https://labtestsonline.org/understanding/analytes/celiac-disease. Published 30 September 2014.
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Tonutti E Bizzaro N. Diagnosis and classification of Celiac Disease and GLuten Sensitivity.
Autoimmunity Reviews.
April 2014; 13(4-5):472-467
21,23
Treatments
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Currently there is no cure

No medications for treating Celiac or Non-Celiac Gluten Sensitivity.

Studies recommend eliminating all gluten from the diet, as the only true available treatment.

This means all breads and foods not labeled gluten free.

16,20, 21, 22
New Experimental Treatments

ALV003

A Glutenzyme, activated by an acidic environment.

Starts to break down and degrade the gluten protein Gliadin.

Stops absorption in the Small Intestine.

A powder, it would be mixed with water before meals.

Most useful in accidental gluten consumption, i.e. restaurants.


Zonulin

Experimental prescription drug

Helps with absorption of nutrients to prevent malnutrition.

Necessary if gluten wasn't eliminated and continued to be consumed.


References
16,23

22. Lacey K, Nelms MN, Sucher K. Diseases of the Lower Gastrointestinal Tract. In: Nutrition Therapy and Pathophysiology. Boston (Ma.): Cengage Learning; 2015: 405-413
23. Di Tola, Marino, Casale R, Di Battista V, Borghini R, Picarelli A. Extension of the celiac intestinal antibody (CIA) pattern through eight antibody assessments in fecal supernatants from patients with celiac disease.
Immunobiology
{Serial online} January 1, 2016;221:63-69. Available from Science Direct.
24. Kemppainen T, Kosma V, Janatuinen E, Julkunen R, Pikkarainen P, Uusitupa M. Nutritional status of newly diagnosed celiac disease patients before and after the institution of a celiac disease diet —association with the grade of mucosal villous atrophy.
American Journal of Clinical Nutrition
[serial online]. March 1998;67(3):482-487. Available from: CINAHL Complete, ipswich, MA. Accessed November 3, 2016
25.Malterre T. Digestive and nutritional considerations in celiac disease: could supplementation help?
Alternative Medicine Review
[serial online]. September 2009;14(3):247-257. Available from:CINAHL Complete, Ipswich, MA. Accessed November 3, 2016

Allergy Skin Test; 2016. Available at: http://medbroadcast.com/procedure/getprocedure/allergy-skin-test
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5. Photo credit: Gliadin + Glutenin = Gluten.; 2015. http://www.elisilvernd.com/health-news/what-exactly-is-gluten.
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2
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9. Photo Credit: Celiac Villi.; 2015. Available at: https://microbewiki.kenyon.edu/index.php/file:celiac_villi.jpeg. Nutrient Deficiency from Damaged Villi Due to Celiac Disease.
References
Study on Celiac and Non Celiac Gluten Sensitivity
A current study being conducted by Alvine Pharmaceuticals on a enzyme made up of two proteases, formally called ALV003.

The company was bought out by biomedical giant ImmunogenX.

Consisted of two studies, both Phase 1

Study 1 had N =28 and Study 2 N=53 celiac participants in single blind, cross over studies

Randomly given a meal consisting of gluten along with the ALV003 or a Placebo for 6 weeks.

Foods with Gluten
Dairy: malted milk and malted ice creams, blue cheese

Grains: Whole wheat Breads, rye bread, barley, flour, cookies, crackers, pancakes. Basically any bread or baked product not labeled GF.

Pastas made from wheat like orzo, couscous, semolina.

Most processed foods should be avoided or examined carefully for hidden gluten additives.

Deli Meats, Soy Sauce, Sauces made with Wheat or Flour

White vinegar and malt vinegar

For those Louisiana Catholics sorry but no communion wafers

All deep fried foods

Medications and supplements containing gluten additives


Gluten Free Foods
Dairy: milk, ice cream, cheese, processed cheese

Grains: Rice, Corn, Corn Gluten, non contaminated OATS, quinoa

Fresh meats, vegetables, and fruits

Modified food starch

Distilled Alcohols and Spirits like whiskey, scotch, vodka and tequila.

To Eat Oats or Not to Eat Oats, that is the Question...
Oats do not contain the gliadin protein.

Therefore it does not contain gluten.

Oats do however carry another protein linked to autoimmune conditions and abnormal changes to white blood cells but not gluten sensitivity.

Research does show a small amount of celiac patients may suffer from villous atrophy, an increase in intraepithelial lymphocytes or exacerbate dermatitis herpetiformis due to Oats.

50g/d of non-contaminated oats is considered safe

Cross Contamination of Oats

The cheap mass production and commercialization of the grain industry lead to oat contamination.

Oats are mixed in with wheat, rye and barley rubbing off their glatin proteins onto the oats.

Celiac patients can avoid this by only buying Oats labeled Gluten Free.

Certain manufactures have gone to great lengths to separate or build facilities just for Oats.

Oats labeled gluten free must be handled away from all other gluten products and separate machinery must be used to avoid being cross contaminated.

To avoid cross contamination at home use separate toasters, no wooden spoons, clean, label and separate everything.
http://notquiteamishliving.com/2015/02/oats-whats-difference/
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First-degree relatives (parent, child, or sibling) of those with CD are at higher risk of obtaining CD.

Associations between certain genetic disorders and CD have also been identified.

95% of those who are genetically susceptible to developing CD carry a specific version of the HLA gene that codes for the proteins HLA-DQ2 and HLA-DQ8.
Genetic Predisposition and Gluten Continued
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T cells - secrete inflammatory cytokines that damage the small intestinal cells

B cells - secrete antibodies

Natural killer T cells - stimulated by cytokines and cause further damage to intestinal cells
Michaela Sossamon
Michaela Sossamon
Michaela Sossamon
Michaela Sossamon
Michaela Sossamon
Michaela Sossamon
Michaela Sossamon
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Also termed:
gluten hypersensitivity
gluten intolerance

Hidden and Uncommon Gluten Foods in Products
Abyssinian hard Wheat
Barley grass
baking powder
blue cheese
brewer's yeast
bulgar
chilton
couscous
durum wheat triticum
Miso
Mononoccum
Mustard Powder
Seitan
Shoyu
soy sauce
spelt
stock cubes
Teriyaki Sauce
Triticum durum
wheat nuts
wheat triticum
wheat germ oil
wheat grass
Hidden Gluten Abbreviations

FU- Dried wheat gluten
HPP- Hydrolyzed plant protein
HVP- hydrolyzed vegetable protein
MSG- monosodium glutamate
TPP- textured plant protein
TVP- textured vegetable protein
Nutritional Concerns
Calcium and Vitamin D
Celiac patients who reduce gluten and increase calcium and Vitamin D intake see beneficial changes.
Helps reduce bone loss and increase bone density.
Some may not fully recover their bone density.
Other Blood Panel Tests
Treatments
Education of patient through Medical Nutritional Therapy

Teaching patient how to read a food label correctly is critical
Food Label Reading
Nutritional Concerns/Conditions with CD
Deficiencies:
Folic acid
Vitamins B 12 & 6
Iron (anemia)
Hemoglobin
Serum ferritin
Zinc
Vitamins A, D, E, K
Elevated Homocysine levels (commonly associated with Vitamins B-6, B-12 and folate deficiencies)
Bone and immune disorders
due to malabsorption and inflammatory responses

Dairy intolerance
Lactase is secreted by cells in the brush boarder, which is likely to be damaged
Accelerated bone loss (due to inflammatory responses
Nutritional Concerns Cont.
Where to find gluten free food?
Local

Whole Foods
Trader Joe's
Magpie
Our Daily Bread
Lucy's Health Store
Non Local


theglutenfreeshoppe.com
udisglutenfree.com
Amazon.com
katzglutenfree.com
freefromgluten.com
Nutritional Concerns

Recent study showed that 67% of patients had malnutrition at diagnosis
Iron
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http://glutenfreehomemaker.com/reading-labels-to-determine-if-a-food-contains-gluten/
http://www.thesavvyceliac.com/2011/08/18/reading-labels-finding-gluten-free-food/
Study on nutritional status in relation to degree of villous atrophy
Subjects: 40 newly diagnosed CD patients who suffered from abdominal symptoms of CD (duration of symptoms in patients ranged from 1-57 years)
Patients diagnosed as having normal, partial, subtotal, or total villous atrophy
Screening gastroscopy and endoscopic biopsy
Nutritional status determined based on anthropometric and biochemical assessment
Nutrients assessed by blood samples
Hemoglobin, serum total protein, serum albumin, iron, ferritin, transferrin, B-12, calcium, magnesium, alkaline phosphate, folic acid, serum zinc, Vitamin D, Vitamins A and E, antibodies


Nutritional Concerns with a Gluten Free Diet
GF diets tend to be lower in intakes of:
Fiber
Thiamine
Folate
B12, B6
These levels should be monitored and supplementation may be considered if needs are not being met
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http://fdlglutenfreesupportgroup.weebly.com/g-f-foods--restaurants.html

Iron Supplements may be necessary to achieve normal values of hematological parameters over time.
Gluten free diet helps achieve normal values of serum hemoglobin, iron, ferritin, mean corpuscular volume, mean corpuscular hemoglobin and red blood cell distribution width
Iron deficiency recovery takes about 6 months; Anemia a year or longer with diet change and supplementation

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http://abcnews.go.com/Health/low-gluten-communion-wafers-deemed-kosher-vatican-options/story?id=26020063
Treatments
C
onsultation with a skilled dietitian
E
ducation about the disease
L
ifelong adherence to a gluten-free diet
I
dentification and treatment of nutritional deficiencies
A
ccess to an advocacy group
C
ontinuous long-term follow-up by a multi-disciplinary team.
https://www.pinterest.com/pin/124200902200258318/
https://www.pinterest.com/pin/179369997639011451/
Foods with Gluten
Oats
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Methods
Results
Conclusion
Results showed that 30 min after a meal, 100-300mg ALV003 degraded 1gram of gluten in 8 participants
Single dose, single blind, placebo-controlled, cross over.

Doses of ALV003 given at increasing dosages by cohort method of 100, 300, 900 and 1800mg

Gastric samples aspirated by nasogastric tube
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ALV003 has promising effects for both celiac and non celiac gluten sensitive patients

If patient continues to feed on gluten diet, ALV003 can degrade the gluten protein
8. Harvard Health Publications. 2014. http://www.health.harvard.edu/digestive-health/celiac-disease
Michaela Sossamon
Leaky Gut
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Definition: increased intestinal permeability due to deformed tight junctions

Prolamin binds to the intestinal cell receptor CXCR3

This complex stimulates release of the protein Zonulin

Zonulin then causes disassembly of tight junctions, allowing Prolamin to go through intestinal cells
12. Leaky Gut; 2014. Available at http://therealfoodguide.com/do-you-have-a-leaky-gut/.
Leaky Gut
Michaela Sossamon
Picture References
1. Gliadin + Glutenin = Gluten; 2015. Available at: http://www.elisilvernd.com/health-news/what-exactly-is-gluten.
2. Harvard Health Publications. 2014. http://www.health.harvard.edu/digestive-health/celiac-disease
3. Nutrient Deficiency from Damaged Villi Due to Celiac Disease; 2015. Available at: https://microbewiki.kenyon.edu/index.php/file:celiac_villi.jpeg.
4. Leaky Gut; 2014. Available at http://therealfoodguide.com/do-you-have-a-leaky-gut/.
5.Tovoli F, Masi C, Guidetti E, Negrini G, Paterini P, Bolondi L. Clinical and diagnostic aspects of gluten related disorders. World J Clin Cases 2015; 3(3): 275-284
6.Shahbazkhani B, Sadeghi A, Malekzadeh R, et al. Non-Celiac Gluten Sensitivity Has Narrowed the Spectrum of Irritable Bowel Syndrome: A Double-Blind Randomized Placebo-Controlled Trial. Nutrients. 2015;7(6):4542-4554. doi:10.3390/nu7064542.
7. Allergy Skin Test; 2016. Available at: http://medbroadcast.com/procedure/getprocedure/allergy-skin-test
8. Tonutti E Bizzaro N. Diagnosis and classification of Celiac Disease and GLuten Sensitivity.
Autoimmunity Reviews.
April 2014; 13(4-5):472-467
9.Leger A. Reading Labels & Finding Gluten Free Food. 2011 http://www.thesavvyceliac.com/2011/08/18/reading-labels-finding-gluten-free-food/
10.http://glutenfreehomemaker.com/reading-labels-to-determine-if-a-food-contains-gluten/
11. http://abcnews.go.com/Health/low-gluten-communion-wafers-deemed-kosher-vatican-options/story?id=26020063
12.https://www.pinterest.com/pin/179369997639011451/
13.http://fdlglutenfreesupportgroup.weebly.com/g-f-foods--restaurants.html
14.http://notquiteamishliving.com/2015/02/oats-whats-difference/
15.https://www.pinterest.com/pin/124200902200258318/
Michaela Sossamon
Leaky Gut (continued)
10, 11
Movement of Prolamin through tight junctions into the GALT triggers the typical immune response seen in CD


Expression of CXCR3 and regulation of Zonulin increases in those with CD
Michaela Sossamon
Movement of Prolamin through tight junctions into the GALT triggers the typical immune response seen in CD


Expression of CXCR3 and regulation of Zonulin increases in those with CD
Michaela Sossamon
Harvard Health Publications. 2014. http://www.health.harvard.edu/digestive-health/celiac-disease
Valerie Wright
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Shahbazkhani B, Sadeghi A, Malekzadeh R, et al. Non-Celiac Gluten Sensitivity Has Narrowed the Spectrum of Irritable Bowel Syndrome: A Double-Blind Randomized Placebo-Controlled Trial. Nutrients. 2015;7(6):4542-4554. doi:10.3390/nu7064542.
Study on nutritional status Cont.


Results showed strongest correlations of degree of villous atrophy and deficiencies in serum ferritin and erythrocyte folate concentrations
Some correlation between degree of villous atrophy and folate and serum Vitamin B12.
Low correlation between villous atrophy and serum protein, Vitamin A, and Vitamin B-12
Determined that duration of symptoms was NOT dependent on degree of villous atrophy
Follow up showed villous atrophy improved in all patients within 12 months
Valerie Wright
Umbrella nomenclature of gluten related disorders
Tovoli F, Masi C, Guidetti E, Negrini G, Paterini P, Bolondi L. Clinical and diagnostic aspects of gluten related disorders. World J Clin Cases 2015; 3(3): 275-284
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Fayth Holbrook
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Fayth Holbrook
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NCGS Has Narrowed the Spectrum of IBS
72 patients met the study inclusion criteria for the double blind randomized placebo controlled study:
Patient's with IBS
negative testing for CD
follow a strict gluten free diet 6 weeks

35 of the 72 randomly selected to consume a gluten diet for 6 more weeks

37 of the 72 randomly selected as the placebo group to consume a gluten free diet for 6 more weeks

NCGS Has Narrowed the
Spectrum of IBS

Symptoms questionnaire was given to all participants to provide primary outcomes: bloating, abdominal pain, stool satisfaction, nausea and fatigue.
Results
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Results:
26/35 (74.3%) gluten containing were symptomatic after initial GFD

31/37 (83.8%) placebo (non gluten containing) were not symptomatic after initial GFD
What does this mean for IBS patients ?
Consider
testing for food sensitivities
, like gluten sensitivity because IBS symptoms could be controlled by GFD. If gluten sensitivity ruled out, check other carbohydrate sources like FODMAPS, and lactose.
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Is gluten the issue?
25. Crunkhorn S. Deal watch: AbbVie invests in pioneering celiac disease therapy. Nature Reviews Drug Discovery. July 2013;12(7):497
26. Academy of Nutrition and Dietetics Evidence Analysis Library. Celiac Disease Evidence-Based Nutrition Practice Guideline (2009). Accessed 3 November 2016. http://www.andeal.org/topic.cfm?menu=5279&cat=3677.
27. Bower S, Sharrett M. Celiac Disease: A Guide to Living with Gluten Intolerance. 2nd Ed. New York: Demos Medical; 2014.
28. Lacey K, Nelms MN, Sucher K. Diseases of the Lower Gastrointestinal Tract. In: Nutrition Therapy and Pathophysiology. Boston (Ma.): Cengage Learning; 2015: 168, 405-413.
29. Wangen S. Healthier without Wheat: A New Understanding of Wheat Allergies, Celiac Disease and Non-Celiac Gluten Intolerance. Seattle, WA: Innate Health; 2009
30. Siegel M, Garber M, Adelman D, et al. Safety, Tolerability, and Activity of ALV003: Results from Two Phase 1 Single, Escalating-Dose Clinical Trials. Digestive Diseases And Sciences;57(2):440-450.
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Marco Montagino
Marco Montagino
Marco Montagino
Marco Montagino
Marco Montagino
Marco Montagino
Marco Montagino
Marco Montagino
Marco Montagino
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