Wednesday, November 29, 2017

Welcome to Celiac Brain: 400% Increased Risk of Death if Undiagnosed

I have been studying Celiac disease and its other 
manifestation, gluten sensitivity since 1995. I have become aware of its hidden and virtually unknown consequences. And it is very common. I am a physician, practicing since 1977, and have seen the devastating effects of celiac/gluten sensitivity first hand. I have seen remarkable turnarounds of very seriously ill persons when they have been on a diet free of gluten.

This site is to spread the word of its serious and dangerous nature to those interested, whether you are a physician, other health care professional, or a person in need of more information.

I propose to bring to you the newest in scientific research, links to other reputable celiac disease/gluten sensitivity websites, and other helpful articles or news items.

The most important finding I would like to impress upon all people comes from Dr. Joseph Murray from the Mayo clinic and that is the 400% increased risk of death by age 65 in undiagnosed persons with celiac disease or gluten sensitivity. This information highlights the need to get a diagnosis as early as possible to allow you to reverse the damage, if possible.

And to relax, if you don't have genetics.

I push for ALL to get tested and as early in life as possible. With proper diet and treatment, one can "buy back your time!" and extend ones healthy life span by decades. See Dr. Murray's video.

400% increased risk of death by age 65 in undiagnosed celiacs
Dr.Joseph Murray and his team from the Mayo clinic reported on a small but significant study they published in 2009. Not only was there an astronomically elevated death rate, but they noticed that there has been a 400% increase in the incidence of celiac disease since 1948.

Listen to Dr. Murray::

So get tested and find out if you are one of the 40% of people that are susceptible. The best testing, in my opinion, is a genetic test found at www.enterolab.comI don't have any financial benefit from recommending the company. I have found this testing has revolutionized my practice and my ability to help people.

If you find yourself with gluten sensitivity, go on a gluten free diet, or better yet, the Gut and Psychology Syndrome diet. This diet includes healing foods and nutrients that positively affect the main problems: the damaged bowel and the wrong microbiota, "bugs living in the bowel", malnutrition, poor immune system. 

Untreated celiac or gluten sensitivity leads to increased infections, food allergies of all kinds, epilepsy, rashes, depression, 4 times the rate cancer, inflamed intestines, and 12 times risk of autoimmune diseases like type 1 Diabetes.

To Your Health
Dr. Barbara (TM)
CeliacBrain (TM) is the trademark and copyright of Dr. Barbara Powell. The right of Dr. Barbara Powell to be identified as the author of this work has been asserted by her in accordance with the Copyright, Patent and Designs Act 1988.
Note that all information on these pages is accurate to the best of our knowledge. Information from secondary sources should be double checked before being cited. Information is not meant to be medical advice. Please see your family doctor if you have concerns.

Do You Have a Gluten-Free Emergency Food Kit?

I have had an emergency "gluten free" small food kit for several years now which I keep in the car. I think if you are celiac or non-celiac gluten sensitive you should consider two types of kits:
One that has three or four meals in it, used for when you get stuck away from your home and your gluten free (GF) supplies, like if you are waiting in a hospital emergency department or admitted to hospital. It can take a few days after admission for the GF diet and meal plan to be arranged. Or if you find yourself suddenly changing plans or helping someone else and you need to eat. 

The second kit would be to supply meals for an extended period of time, a "survival" kit. Here where I live there have been severe floods,or ice storms and people want to stay in their houses. Making it difficult to go out to a store and there may or may not be services like phone or electricity. 

When making a GF emergency food kit, I do suggest:
- that there be a can opener in the kit. In the three or four meal kit, the small kit, I have cans that have pull tabs to allow me to open the can without a can opener. This keeps the portable kit that much lighter. My pantry has water and emergency food, with portable heavy duty can openers.

- Just in case buy or make provisions that can be eaten without the need for cooking. Peanut butter and crackers, or jerky or canned soups or canned vegetables. You may not have easy access to electricity. If you can, have a small camping stove available with enough fuel for a few days. 

- for severe or prolonged emergencies, you and your family need a good source of fat. One that does not go rancid quickly, such as coconut oil. Dark bottles of olive oil. If you have a freezer for storage, available to you, keep GF hot dogs and sausages. A freezer will stay cold for a few days without electricity, so the food will stay frozen for awhile. Yes, I have experienced a few black outs, and as long as you keep the lid closed, the food will stay frozen. Especially when the outdoor temperature is below freezing. 

- And do rotate out the food every 3 months or so replacing the older food with newer foods. 

- You can personalize the emergency kit to a GAPS protocol too. Grain free crackers may be pricey so you can make your favourite bread and slice it thinly and dehydrate the bread slices. They keep well in an air tight container or bag. Or make crackers. 

And don't forget "potted" bread which is bread in a vacuum sealed jar. You take your favourite GF bread recipe and a dry and sterilized pint jar used for preserving. Put enough bread dough in the jar to up to 2/3 the height of the jar and bake it as you would normally. It will be baked through much sooner than a full loaf of bread so watch for it to be done in about 20 minutes. When it is ready, it will have stopped rising and you can see dry bubbles through the glass. Remove from oven, and seal with sealing top. As it cools a vacuum will seal it air tight.  This will last at least half a year. ( I have put a jar of "potted" bread in my checked luggage when travelling, just in case I got stuck with out GF supplies and it works nicely.)

- I just found out about GlutenFreeEmergencyKit and I hope to try it out soon. It is not GAPS or Paleo friendly but there are bio-hacks available if one has to eat grains. This is a subject for a future blog entry. (hint: fermenting, specialized digestive enzymes and probiotics would be fundamental).

The following article from gives advice on how to prepare a  "survival" kit. 11/24/2

017 - Do you have an emergency survival kit at home should disaster strike? Does that include drinking water and gluten-free provisions for at least a few days?

The fallout from the latest string of disasters still looms over parts of America; over Houston, Florida and neighboring states devastated by Hurricanes and by resulting floods; and over northern California communities devastated by wildfires.

That got us thinking about emergency kits. Gluten-Free-free emergency kits, to be precise.

What's in Your Emergency Gluten-Free Food Kit? This list is by no means authoritative or final. In fact, we are inviting you to share any favorites or ideas you may have for your own emergency kit.

Your Gluten-free Emergency Kit should include the following:

Water: You'll need a minimum of 3 days worth of drinking water for ever person. This includes water for cooking and other non-drinking uses. When it comes to water, it never hurts to have more than you need, so consider stocking even more than a 3 day supply.

Food: When assembling a survival kit, you want to put together a kit that will feed each family member family 2 cups of prepared meals 3 times a day. Canned foods like black beans are essential.

To Your Health
Dr. Barbara (TM) (TM)

Monday, November 13, 2017

Celiac Disease Increases Cardiovascular Disease Risk- World Journal of Cardiology

A few years back I heard Dr. Houston, cardiologist say that 50% of heart 
attacks are from eating gluten in someone who is an untreated person with celiac disease, that is they are celiac (CD) and were not eating a gluten free diet either because they were undiagnosed or they were not serious about the treatment for CD which is a gluten free diet.

This figure shocked me at the time. Not now.

The August 2017 issue of World Journal of Cardiology published a review article worth reading, entitled Cardiovascular involvement in celiac disease. This review article delves into current research and knowledge about untreated celiac disease and its systemic effects on the heart and circulatory system. Read carefully: untreated celiac disease.   Gluten free diet did show in many studies to improve the condition. 

Celiac disease is a public health issue and more people need to be screened and diagnosed. If for every celiac diagnosed there are 13 to 31 people not diagnosed according to research on the incidence, then there are a lot of people with undiagnosed CD.

Here is an excerpt from a review of that paper by Linda J. Dobberstein, Chiropractor in the news letter Wellness Resources.   Bold is mine,

"Since 2000, increasing evidence points to several common cardiovascular diseases related to gluten intolerance and celiac disease. Celiac disease is an autoimmune disorder that affects millions of Americans, with many of whom are undiagnosed. There is, however, more to celiac disease than gastrointestinal symptoms.

Celiac disease is due to the immune system attacking the intestinal tract after gluten is consumed. Gluten is a protein found in wheat, rye, and barley. Classic celiac disease symptoms include diarrhea, bloating, gas, heartburn, indigestion, cramping, nausea, vomiting, fatigue, anemia, and weight loss.

Several cardiovascular disorders have been linked or found to be higher in individuals with untreated celiac disease. These disorders include cardiomyopathy, myocarditis, arrhythmias, atrial fibrillation, heart attacks, atherosclerosis, POTS, and several other cardiovascular disorders. Evidence shows that these cardiac disorders are more common in individuals with celiac disease than those without the disorder...........Here is a brief synopsis on this topic".

She goes onto summarizing the original review. Get the gist of the topic which demonstrates there are dozens of variations of cardiovascular and stroke risks associated with CD and eating gluten. And it affects all age groups including children.

Good news is that the gluten free diet has been shown to improve the conditions when it was studied. 
If you are not sure if you are celiac or gluten sensitive get tested. 
50% of people with celiac disease don't have GI or gastrointestinal problems, but have problems in other parts of the body including mental health issues. 
Be safe rather than sorry and get tested. 

To Your Health

Dr. Barbara (TM) (TM)

Monday, October 23, 2017

Are Doctors Missing 90% of Celiac Disease Cases?-From

by Jefferson Adams of

If a new study by Canadian nutrition researchers is any indication, most cases of celiac disease remain undiagnosed. 10/20/2017 - Are doctors even getting close to diagnosing the actual number of cases of celiac disease? Or are they missing the vast majority?

Researchers have said for some time that there are far more people with celiac disease than are being diagnosed, and that the vast majority of cases go undiagnosed.

So, just how far are we from the actual number? Well, if a new study by Canadian nutrition researchers is any indication, doctors are very far from diagnosing most cases.

The team studied the blood work of nearly 3,000 people, and their conclusions are stunning. They say that ninety percent of celiac cases go undiagnosed.

How could this be? One reason is that even classic celiac disease symptom, such as abdominal pain, bloating, gas, diarrhea, anemia and weight loss can mimic other conditions. Less classic symptoms such as fatigue, low vitamin C, D and calcium levels can be misleading.

Ahmed El-Sohemy, a professor of nutritional science at the University of Toronto, wanted to see whether celiac disease results in subpar nutrition because of poorer absorption of vitamins and minerals. But to find out, he needed Canadian data on the frequency of undiagnosed celiac disease.

To that end, El-Sohemy and his colleagues checked blood samples from more than 2,800 individuals in Toronto. One group had an average age of 23, and the other 45. Among their findings is likely ~1%, with 87% of cases being undiagnosed. These findings suggest the need for better screening in high genetic risk groups.


To Your Health
Dr. Barbara (TM) (TM)

Saturday, September 9, 2017

Complete Remission of Psychiatric Symptoms with Vitamin B12 -Case Study in Literature. Encore

Today I was asked by a 70 year old friend if there is anything he could do to feel better as he was being treated for depression and he is feeling unwell and tired on some of the medicine he is prescribed. 

I told him to talk to his doctor if he hasn't already done so, not to stop any medication until he has talked it over with his doctor and to learn more about B12. 

The subject is so important as we age that I thought that I would re-published this blog entry. Do take the time to open the link at the end with Dr. Prousky's award winning article on B12 and why it is important to at least try a few doses of B12 by injection as a trial to see if this makes a positive difference to your symptoms, especially mental health symptoms like fatigue, depression, or others. 

B12 deficiency rates are high in all people especially with gluten sensitivity. I list a number of mechanisms:

-low stomach acid ( achlorhydria) from an autoimmune process (Gluten sensitive people have 12 times the rate of autoimmune disorders) or from drugs like metformin and proton pump inhibitors.
-antibodies to intrinsic factor, disabling the protein that carries B12 from the GI system into the bloodstream.
- dietary restrictions.
- higher B12 needs because of methylation gene abnormalities called MTHFR.
- and brain fluid called cerebrospinal fluid (CSF) may have a much lower level of B12 because of an impaired blood brain barrier and so the brain function may be impaired.

All these factors also make it tricky to take oral B12 and expect it to increase the amount of B12 in the brain, where you want it.The blood level does not accurately reflect the level of B12 in the CSF. ( van Tiggelen CJM, Peperkamp JPC, Tertoolen JFW. Vitamin B12 levels of cerebrospinal fluid in patients with organic mental disorders. J Orthomolec Psych. 1983;12:305–311.)

I would like to report the case of a man in his early thirties who came into my practice a few months after he was admitted to a psychiatric facility for 6 weeks. He had refused all medication, and after being assess as a person with schizoaffective disorder he was discharged in much the same condition. I placed him on a gluten free diet while testing proceeded, but this was easy as he was living with his parents and his mother was on a gluten free diet already. It was difficult to get testing done but when it was done it was clear he was vitamin B12 deficient,( and his hospital notes revealed the same thing). And he had two genes for celiac disease.

He had suffered for years with mood swings, lethargy, and intermittent perceptual disturbances and had been prescribed psychotropic drugs on and off. He was never suicidal although this symptom is common in gluten sensitive individuals.

On the gluten free diet, he was having less negative symptoms, but there was a noticeable improvement when he self administered B12 shots. He has had periods of going off B12 shots, but his family members notice and remind him to give himself a shot. When taking shots regularly, he is alert, oriented, and has a stable romantic relationship. He is looking for work in his field.

In the literature we find a severe case of psychiatric symptoms where B12 was the only additional treatment that gave complete remission. I don't find B12 deficiency unusual as a cause of mental symptoms. For testing I use homocysteine and urinary methylmalonic acid measurements as I find serum B12 measurements unreliable and it can miss methylation polymorphisms ( which has an prevalence in my practice of 76% for at least one SNP of c677T or a1298c). I will also do a trial of IM or Subcutaneous B12, and see what happens. If people feel better after the B12 the next step is to find the frequency. Some people need a shot a day but this is unusual.( this indicates multiple methylation polymorphisms, and/or heavy metal intoxication and/or active autoimmune disorders blocking B12 from going easily through the blood brain barrier, leading to low brain levels of B12.And needing more help). I recommend folate with B12 shots to avoid folate deficiency, in the form of a good B complex, with or without NAC.

Here is what Dr. Kelly Brogan, a psychiatrist has to say about B12 and mental health:

"If this is not a wake up call to the average psychiatric prescriber, I’m not sure
what is. Much of what we attribute to serotonin and dopamine “deficiencies” melts away under the investigative eye of a more personalized style of medicine that seeks to identify hormonal, nutritional, and immune imbalances that can “look” psychiatric in nature.

How can B12 impact brain health?
B12 supports myelin (which allows nerve impulses to conduct) and when this vitamin is deficient, has been suspected to drive symptoms such as dementia, multiple sclerosis, impaired gait, and sensation. Clinically, B12 may be best-known for its role in red blood cell production. Deficiency states may result in pernicious anemia. But what about B12’s role in psychiatric symptoms such as depression, anxiety, fatigue, and even psychosis?

The one-carbon cycle refers to the body’s use of B vitamins as “methylators” in DNA synthesis and the management of gene expression. There are three concepts that relate to B12’s role in chronic, long-latency neuropsychiatric syndromes:
1. Methylation
This process of marking genes for expression, like little “read me!” signs, is also critical for detox and elimination of chemicals and hormones (estrogen), building and metabolizing neurotransmitters, and producing energy and cell membranes.

2. Homocysteine recycling
B12 is a primary player in the one-carbon cycle and a co-factor for the methylation, by activated folate, of homocysteine, to recycle it back to methionine. From there, SAMe is produced, the body’s busiest methyl donor.
3. Genetic override
Sufficient supply of an activated/bioavailable form of a vitamin (ie methylfolate vs folic acid) is even more necessary in the setting of gene variants such as transcobalamin II, MTHFR, and MTRR which may function less optimally in certain individuals and result in pathology under stress. An example of this is a report of death in a B12-deficient patient with genetic variants who underwent anesthesia with nitrous oxide (which causes stress to the system). Notably the B12 blood level was normal, so this fatal case was attributed to functional deficiency, suggesting that access to B vitamins may not always guarantee proper utilization. For this reason, supplementing with activated forms of B vitamins enhances their likelihood of effectively supporting cellular processes."

Read her take on testing and causes of vitamin B12 deficiencies.

If you are interested in the scientific studies, see Dr. Prousky's award winning article on the rational of using B12 therapeutically for psychiatric conditions, even in the absence of "classical" deficiency.

In conclusion: if you are not feeling 100%, it could be B12.

To Your Health
Dr. Barbara (TM)  (TM)

Tuesday, August 8, 2017

Gluten-free Products ‘Not as Healthy’ as Conventional, New Study

So you have found out your are gluten sensitive or celiac and you want to eat healthy but just don't have the time to cook or bake everything from scratch which is what is demanded by the Gut and psychology syndrome protocol (GAPS) or Paleo way of eating.

And you don't want to give up croissants, Pizza, battered fish or crispy cookies. So you eat advertised gluten free versions of these. I don't recommend them for many reasons that I have written about extensively but there is another reason: often lower nutritional value to conventional products.

A new study focuses on fat, sugar, salt and fiber contents and that is good to know. But we must also remember wheat flour in conventional products are fortified with folic acid. And many breakfast cereals and other grain products (non-gluten) are fortified with B vitamins and other nutrients that gluten free products are not.

Read more about the new study out of the Netherlands that looks at fat, sugar, salt and fiber content of gluten free packaged foods here:

Gluten-free products ‘not as healthy’ as conventional

By Katy Askew, 08-Aug-2017

A new study has found gluten-free products are often not as healthy as their conventional counterparts.

To Your Health

Dr. Barbara (TM) (TM)

Saturday, August 5, 2017

Infographic on Dementia Prevention, Intervention and Care by The Lancet

 See the original at    

The experts agree there are some things we could do to lower our risk of dementia: get as much education in our early years as possible, treat hypertension, diabetes, hearing loss, depression, increase our physical activity at any age, do what it takes to be in the healthy range of weight, and be social. 

What you eat plays an important part in most of these modifiable risk factors. Don't assume that eating grains is part of your healthy diet. 

Find out if you are gluten sensitive and go on  a true gluten free diet such as the Gut and Psychology Syndrome protocol (GAPS) or specific carbohydrate diet which has been around for over 80 years and studied extensively. 

Cut and paste the following links for more information and the original article.

<img src="" width="600px"/>
Read the full Lancet Dementia 2017 Commission:
<a href="" title="The Lancet: Dementia prevention, intervention, and care" style="color:#0000FF;text-align:left"> The Lancet: Dementia prevention, intervention, and care</a>

To Your Health
Dr. Barbara (TM) (TM)

Friday, July 21, 2017

Combat Autoimmune Illness and Low Immunity: Immune Defense Summit

I am very hesitant to recommend any "summit" especially one that I have not previewed. I am making an exception here as I believe there will be good information in it. Those people with celiac disease and gluten sensitivity are immunocompromised which means they are at higher risk of catching an infection with a virus, bacteria, parasite or fungus. And at a higher risk of not fighting it off. If you can help yourself improve your immunity or even forestall complications from such things as colds, flu's or risks of infections such as post antibiotic diarrhea, then you are ahead of the game. 

Immune Defense Summit
Your best defense against today’s (and tomorrow’s) global health threats is a strong immune system. Yet, too many still remain uninformed about the best protocols to prevent illness and defeat diseases like autoimmune disorders, cancer, heart disease and the looming threat of "super bugs," which are on pace to be MORE deadly than any other health condition. Once you have the infection, it's much harder to eradicate.
Learn how to build a strong immune system NOW! 
Register here for The Immune Defense Summit
36 of the world’s top experts in integrative medicine and science are here to discuss the strengthening of your immune system to help protect you from all types of diseases, including autoimmune disorders, cancer, heart disease, dementia and even common pathogens like the flu, measles and pneumonia.
 Own all of the expert talks to watch at your own pace (plus, your purchase helps to create more of these valuable health talks!): Click here
The Immune Defense Summit will teach you about:
  • Infectious disease solutions (without toxic drugs!)
  • Latest advances in immune protective protocols
  • How to stop the threat of colds, flu and pneumonia
  • Alarming vaccine news (and safe alternatives!)
  • Strategies to reverse disease symptoms at the root cause
And more!
The Immune Defense Summit is online and free from July 24-31, 2017!

To Your Health
Dr. Barbara (TM)
CeliacBrain (TM) (TM)

Monday, June 19, 2017

Is Coconut Oil Deadly? Dr. Wolfson Responds to Recent News Story

Many of you know that I recommend cooking and eating coconut oil, if you are not allergic to it. Always buy the highest quality you can find to avoid the processed versions. Poorly processed coconut oil is not beneficial and comes at a cheaper price. 

Many of you have heard the recent medical news story that coconut oil has saturated fat, more than butter and that it causes heart disease. Well hold on. 

Many studies have shown that saturated fat intake in the diet is not linked to coronary heart disease. In fact in 2010 a study in the American Journal of Clinical Nutrition, the biggest nutrition journal in the world, looked at over 500,00 people regarding saturated fat and concluded there was no link to coronary heart disease. 

I will have Dr. Wolfson DO, FACC, cardiologist, author of The Paleo Cardiologist, inform you about fats, LDL a test commonly used to assist doctors in prescribing medication, and the role of saturated fats. 

Here is an excerpt: 

Is saturated fat bad for us?

In 2010, a study in the American Journal of Clinical Nutrition (AJCN) was published. This is the biggest nutrition journal in the world. They looked at over 500,000 people regarding saturated fat. The conclusion: sat fat is not linked to coronary disease. (1)

Fast forward to 2016. Same journal, more evidence…. Turns out that saturated fat actually LOWERS cardiac risk. (2)

In 2015, the AJCN reported sat fat IS linked to heart disease, unless the sat fat came from fish, dairy, or plants. From those sources of food, sat fat is not an issue. (3)

Here is what the study authors concluded about their results. “It should be acknowledged that other dietary components in the food sources containing SFAs may have played a role in the observed associations, such as refined carbohydrates in pastries or salt in processed foods.” Essentially, it’s the other crap in the food, not the saturated fat, that causes heart disease.

A side note from this 2015 study: The more fat you ate, the lower your heart attack risk and the chance you had of dying. (So much for the low-fat gurus)

To Your Health
Dr. Barbara (TM) (TM)

Friday, May 5, 2017

2 Reasons Why Celiac Disease Impairs Drug Therapy in Those Who Take Drugs?

If you have celiac disease you may have poor absorption of any drug prescribed for you or you may have more adverse affects. Poor drug absorption and impaired liver metabolism are two conditions found to effect drug therapy. 

As a pharmacist he advises increased monitoring for efficacy and adverse effects when starting a new medication regimen in patients with celiac disease.

Celiac disease is an autoimmune disorder that renders those affected with an intolerance to gluten, a protein found in many common grains. It occurs in approximately 1% of the population of the United States and Europe.1

People with celiac disease that ingest gluten generally experience an inflammatory reaction, manifested as gastrointestinal upset, diarrhea, and abdominal distension. Celiac disease is also associated with other chronic conditions, such as anemias and malabsorption of some critical vitamins. Alterations of the gastrointestinal tract, rates of gastric emptying, and gastric pH are responsible for altered vitamin and mineral absorption.2, 3 Intestinal CYP3A4 levels may also be disrupted, which may have implications in first-pass metabolism for some drugs that are substrates for this drug metabolizing enzyme.4 This has led some to investigate the potential impact of celiac disease on drug absorption. This would be of interest to pharmacists since altered drug absorption can have pharmacokinetic consequences and has the potential to impact overall drug therapy.

A comprehensive review on this topic was published in 2013 by Tran et al.The review considered absorption studies in subjects with celiac disease, and the authors summarized the literature available on a handful of drugs, including acetaminophen, aspirin, propranolol, levothyroxine, methyldopa, and some antibiotics.They reported that many studies had conflicting results. Some reports show an altered gastrointestinal environment and a significant difference in drug absorption in patients with celiac disease. Other reports did not show any absorption differences between those with and without the disease. It was noted that many of the studies considered for their analysis had small sample sizes and were not well powered. The authors concluded that there is the potential for altered drug absorption and that healthcare professionals should be cautious when initiating drug therapy.5

Another review on the topic of celiac disease and the potential impact on cardiovascular drug absorption was published in 2014. This review considered many of the same medications previously explored by Tran et al, with a focus on cardiovascular agents. The authors also expressed concern that many cardiovascular drugs may have altered absorption in celiac disease, but there are few published studies that are convincing enough for concrete clinical decision making. The authors also stressed the need for more studies that consider patients with celiac disease, as well as caution when initiating cardiovascular pharmacotherapeutic regimens.6

Based on the research available, it is clear that patients with celiac disease can exhibit altered absorption of many different substrates. Unfortunately, altered drug absorption and disposition are not well studied in this population. It is likely that future studies will elucidate any impact celiac disease has on drug disposition, as this disorder has been getting more attention in recent years. There is some preliminary evidence suggesting that celiac disease may alter drug absorption, but the degree and prevalence of this has yet to be confirmed with large prospective studies. Pharmacists should be cautious when making therapeutic recommendations for patients with celiac disease and consult the available literature when possible.

Increased monitoring for efficacy and adverse effects is advisable when starting a new medication regimen in patients with celiac disease.

1. Catassi C, Gatti S, Fasano A. The new epidemiology of celiac disease. J Pediatr Gastro Nutrition. 2014;S7-S9.
2. Perri F, Pastore M, Zicolella A, Annese V, Quitadamo M, Andriulli A. Gastric emptying of solids is delayed in celiac disease and normalizes after gluten withdrawal. Acta Paediatrica. 2000;8:921-25.
3. Caruso R, Pallone F, Stasi E, Romeo S, Monteleone G. Appropriate nutrient supplementation in celiac disease. Ann Intern Medicine. 2013;8:522-31.
4. Lang CC, Brown RM, Kinirons MT, et al. Decreased intestinal CYP3A in celiac disease: Reversal after successful gluten?free diet: A potential source of interindividual variability in first?pass drug metabolism. Clin Pharm Ther. 1996;1:41-46.
5. Tran TH, Smith C, Mangione RA. Drug absorption in celiac disease. Amer J Health-System Pharm. 2013;24.
6. Wang I, Hopper I. Celiac Disease and Drug Absorption: Implications for Cardiovascular Therapeutics. Cardio Ther. 2014;6:253-56.

To Your Health

Dr. Barbara (TM) (TM)

Tuesday, March 21, 2017

Screening for Celiac Disease: the use of HLA First?

The arguments for a step wise genetic screening for celiac disease made by a group of rheumatologists who wrote the following article are solid. If the risk of getting or having celiac disease is virtually zero in someone without the genetics of HLA DQ 2.5 or HLA DQ8 then the person with a medical problem associated with celiac disease (like an autoimmune disease) without these genetic markers doesn't need a small bowel biopsy. 

As the genetics tests become more economical than celiac blood tests, and are more accurate than celiac blood tests, then it makes sense to start with genetic HLA testing.

Read the full article here from International Journal of Celiac Disease, 2017.

Here is an excerpt: My Bold

3. A Step Wise Serology/Genetic Approach

CD patients negative for any of these HLA alleles are very rare. Therefore, the absence of both HLA-DQ2 and HLA-DQ8 heterodimer makes diagnosis of celiac disease very unlikely (sensitivity >96 %). HLA typing of patients has been included as a useful test to exclude celiac disease in the ESPGHAN guidelines for CD diagnosis. [8, 9] HLA typing confers a high negative predictive value: patients with a negative HLA (i.e. neither DQ2 nor DQ8) will not develop CD; and a suggested strategy to avoid repeated CD screening would be to first perform an HLA test. [10]

Targeting the HLA risk first, rather than tracking positive serology, would be a reasonable step-up approach, probably cost effective and time saving: in the past, HLA typing has been expensive and time-consuming, but new single nucleotide polymorphisms techniques [11] and other combined home-made procedures [12] have recently been reported as very cost-effective and work-time saving for HLA-DQ2 and DQ8 genotyping in CD screening................

In general population, the preferred test to screen for CD is the measurement of IgA TTG [Link here to a critique of the IgA TTG test]along with total serum IgA to avoid false-negative results due to selective IgA deficiency. Positive serology would lead to endoscopic small intestinal biopsies [14]. These serological tests, based on TTG associated to endomysial and deamidated gliadin peptides antibodies are recognized as performant screening tools. [15]

However, in asymptomatic members of a high-risk group, like those presenting RA, it seems reasonable to test first for negative result of HLA-DQ2/DQ8 in order to exclude CD, so that further serologic testing would be unnecessary [16]. Performing HLA genetic typing seems cost effective and could avoid subsequent fiberoscopies and biopsies [17].................recent studies emerging from the South Hemisphere confer solid arguments to such strategies [18] as CD is reported to be strongly associated with HLA-DQ2 in these regions [19].

It is my opinion and the opinion of these authors that the genetic tests for HLA provides a flexible, cost-effective methodology that could be applied to protocols to diagnose celiac disease and to obtain accurate estimates of the prevalence of CD in large cohort studies. The ESPGHAN guidelines for CD diagnosis are worth a look if you are interested in clinical matters.

To Your Health
Dr. Barbara (TM)
CeliacBrain (TM)

Monday, January 30, 2017

Processed Foods Have Contaminants That Have Undesired Side Effects

Watch this informative video, which is less than four minutes, and which explains how some of the predictable contaminants get into processed foods, including gluten free foods. You want to avoid toxic products. One way is to avoid processed foods. Another is to not cook foods for a long period of time above 120 degrees Celsius (248 F). And to avoid regular eating of "burnt"food such as french fries or toast, charred meat, fish, or vegetables. This info is good for all persons, gluten sensitive or not.


To Your Health
Dr. Barbara (TM) (TM)