Glucose syrup is a liquid sweetener used in candy, desserts and that ice cream in the picture. It can made from any starch. In the United States, corn is used, but in Europe it is usually derived from wheat. One would assume that the wheat-based glucose contains gluten, but in fact, glucose syrup made from wheat starch is considered gluten-free.

I confirmed this with Shelley Case, the go-to gluten-free dietician and author of Gluten Free Diet: A Comprehensive Resource Guide. In an email to me she said:

Glucose syrup can be derived from a variety of starches including wheat. Corn is the most common however Europe uses wheat more frequently. The glucose syrups are highly processed and purified and R5 elisa tests have found the majority to contain very little residual gluten if any. The European Food Safety put out a report on the safety of glucose syrups. Here is the link for more info:

wheat-based glucose syrups

Based on the FDA proposed gluten-free labeling regulation a product can be derived from a gluten-containing grain such as wheat based glucose syrup and be labeled gluten-free yet the ingredients could say glucose syrup (wheat) provided it is under 20 parts per million (ppm). This will be very confusing for patients as we teach them to avoid wheat and yet a product like glucose syrup may have no or very little residual gluten and be labeled gluten free.”

And just this month, a new gluten-free study from Finland was released. In the study they determined that it was safe for celiac patients to consume glucose syrup and other starch hydrolysates derived from wheat. Here is the summary of the report:

Background: Wheat-based starch hydrolysates such as glucose syrups, dextrose and maltodextrins are found in more than 50% of European processed food. These products contain low amounts of residual gluten, and it has been questioned whether they are safe for coeliac disease patients.
Aim: Our aim was to investigate whether coeliac disease patients can safely consume wheat-based starch hydrolysate products.
Methods: This randomized, double-blind, placebo-controlled, prospective follow-up study involved 90 coeliac disease patients in remission randomized to consume glucose syrups, maltodextrins or placebo for 24 weeks. Small bowel mucosal morphology and inflammation, symptoms, coeliac serology and malabsorption laboratory data were evaluated at baseline and at the end of the study.
Results: Daily ingestion of wheat-based starch hydrolysates, glucose syrups and maltodextrins, had no deleterious effect on small-bowel mucosal villous architecture or inflammation in coeliac disease patients when compared to the placebo group. Neither were there any significant differences in gastrointestinal symptoms, serology or malabsorption parameters after 24 weeks.
Conclusions: Wheat-based starch hydrolysates, glucose syrups and maltodextrins did not have harmful effect on coeliac disease patients. Coeliac patients can thus safely continue to consume these products.

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Dr. Jeffrey Aron and his associates at the Center for Inflammatory Bowel Diseases at California Pacific Medical Center have been approved as the only site west of the Mississippi to conduct research studies of AT-1001, a molecule designed by Alba Therapeutics. This molecule is being studied in human trials to see if it is effective in preventing intestinal leakage (leaky gut) and improve symptoms, along with a gluten free diet, in patients with Celiac Disease.

How will this study be conducted?

People who volunteer for the study will be randomized into one of three groups: those who take a placebo, those who take 24 mg of AT-1001 per day, or those who take 48 mg of AT-1001 per day. This is a double-blind study, meaning that neither the volunteer patients nor the researchers evaluating the effects know which patients are in which group.

All patients will follow a gluten-free diet, and measurements of intestinal leakage will be done at the beginning, twice during treatment, and at the end of the study. A second biopsy will also be taken at the end of the study. In addition, a standardized questionnaire will be given to measure clinical response (report of symptoms). Safety follow-up visits and labs will also be done.

Study visits, counseling for the gluten-free diet, labs and biopsies are all paid for by the research project.

Who is eligible for this study?

You may be eligible for the study if:

• you are newly diagnosed, with positive anti-Tissue Transglutaminase (anti-tTG) antibodies and a biopsy that is Marsh grade II or more. (If the biopsy was taken at another hospital, it needs to be recent and will be reviewed to ensure it meets the study parameters. If Dr. Aron performs the biopsy it will be covered by the research project.)

• you are a diagnosed Celiac who hasn’t adhered to a gluten-free diet or has not gotten better on a gluten-free diet, and meet the requirements above.
• you are a family member of someone with celiac and you suspect that you may have celiac also. If you show symptoms of celiac disease and are interested in becoming a volunteer, your celiac testing may be covered by the research project.

How does someone volunteer for the study?

Please contact Robin Bishop, Dr. Aron’s Research Coordinator, for more details.
Phone: 415-600-1368
Email: BishopRK@cpmcri.org

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Peanut and tree nut allergies can cause severe reactions, even anaphylaxis. Parents would give anything to have their children outgrow the allergy, but how realistic is this wish? It is a possibility for some children, but not for most, according to a report put out by the Division of Allergy and Immunology at The Johns Hopkins University School of Medicine.

9% of children allergic to tree nuts (almonds, pecans, walnuts, cashews, Brazil nuts, hazelnuts, pine nuts, pistachios and macadamia nuts) passed an oral food challenge, meaning that they were able to eat the food without a reaction. This included children who had severe reactions in the past. 58% of children with low levels of IgE antibody to tree nuts (5 kilounits per liter or less) also passed the oral challenge. 20% of children allergic to peanuts will outgrow their allergy.

Another finding in the study was that children who are allergic to more than one type of tree nut are unlikely to outgrow their allergy.

The researchers from the study recommend that children with peanut or nut allergies should be regularly re-evaluated to see if they are still allergic, and they say that blood antibody levels (IgE) can be used as an accurate guideline in predicting the likelihood that a child has outgrown the allergy. If you would like to know if your child has outgrown a peanut or nut allergy, ask your allergist for repeat testing and discuss the possibility of an oral challenge under careful supervision.

Related reading:
Will your child outgrow egg allergy?
Peanut protector dogs are here!
Cashews cause more severe reactions than peanuts

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Would you believe that 30-50% of celiacs do not always adhere to the gluten-free diet? How about that 20% of adult celiac patients’ biopsies do not normalize after diagnosis? According to researchers presenting at Digestive Disease Week 2008, an annual conference in San Diego for physicians and researchers, there is a “need for something beyond a gluten-free diet” in the treatment of celiac disease.

Treatment of celiac disease

In a talk led by Peter Green (leader in celiac disease research and author of the book Celiac Disease: A Hidden Epidemic, which I highly recommend), 2 research groups presented their progress in developing a treatment for celiac disease — Alvine Pharmaceuticals and Alba Therapeutics. Their approaches are different and their outcomes and uses remain undetermined, but both are trying to find a treatment for celiac disease, other than the gluten-free diet. You can hear both presentations in the video clip below.

Screening for celiac disease

Also discussed at the conference: could the criteria for the diagnosis of celiac disease be too strict?

The “gold standard” diagnosis for celiac disease is a positive blood test, followed by a small intestinal biopsy via endoscopy. If the patient has villous atrophy, meaning that the villi of the intestine is damaged to a certain degree, then the person has the official diagnosis of celiac disease.

Dr. Markku Maki from Finland presented his findings about whether this criteria for diagnosis is good enough. His study included 23 people who had elevated antibodies but had normal or only slightly inflamed intestinal lining. They therefore did not meet the criteria for celiac disease. The researchers put one half of this group on a gluten-free diet and the other half continued to eat gluten. They followed both groups for one year — their symptoms, antibodies, and endoscopy. After one year, the gluten-eaters’ symptoms worsened and their small bowels had deteriorated. The gluten-free people’s antibodies disappeared and their bowels became better than before. The gluten-eaters all wanted to go on the gluten-free diet and a year later everyone in that group improved also.

Dr. Maki’s conclusion is that “we have disease before we have gluten-induced small intestinal mucosal lesion.” In other words, perhaps our gold standard needs to be reevaluated, because according to this study, many people already have the disease before it shows up on a biopsy.

You can hear it all for yourself in this video from the conference.

Related reading:
Is a biopsy always necessary to detect celiac disease?
Blood tests are not the final say

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Did you know?

• Celiac Disease is the most common genetic disorder in the world. It affects as many as 3 million Americans, or roughly 1% of the population.

• Type 1 Diabetes affects 1,177,500 people; 6% (70,650) of those diagnosed also have celiac disease.

• 610,000 women in the US experience unexplained infertility; 6% (36,600) of these women might never learn that celiac disease is the cause.

• 350,000 people in the United States are living with Down Syndrome; 12% (42,000) of them also have celiac disease.

• The number of people with celiac disease in the U.S. is roughly equal to the number of people living in the state of Nevada.

• The National Commission on Digestive Diseases (NCDD) recently noted that physicians and medical staff members are unaware of the how common celiac disease is or what symptoms to look for. One of the Commission’s goals is to “improve screening, diagnosis, prevention, and treatment of celiac disease.”

What can you do?

May has been designated National Celiac Awareness Month by the Celiac Disease Foundation, and a bill is up for a vote that asks Congress to support the goals and ideals of National Celiac Awareness Month.

The American Celiac Disease Alliance (the group responsible for getting Congress to require food labeling of allergens) has issued an action alert: share the facts above with the legislators in Congress. Raising awareness of celiac disease can lead to increased physician education and training. This goal and the bill are supported by the American Gastroenterology Association, American College of Gastroenterology, American Dietetic Association, and the American Osteopathic Association.

All you have to do is click this link, fill out the form and either email or mail the letter. Together we can really make a statement!

I am grateful to the American Celiac Disease Alliance for all their work!

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I have good bones. In fact, I have never broken a single one (knock knock knock on wood). Somehow my untreated celiac disease decided to take out its anger on other parts of me, but left my bones strong and healthy. Some people’s bones, however, are weakened by the effects of gluten, making them more susceptible to fracture.

Untreated celiac disease can greatly affect the bone health in children and adults. A new report from the Laboratory of Pediatric Endocrinology and BoNetwork in Milan, Italy says that bone mass measurements are greatly reduced in children with untreated celiac disease compared to other children. Lower bone mass can lead to bones breaking more easily. Osteoporosis in adults has been linked to celiac disease, believed to be caused by either the inability to absorb necessary nutrients (calcium) for optimal bone health, or by chronic inflammation present in the body due to celiac disease.

Anyone with poor bone health should look at gluten as a cause, even if they don’t have the gastrointestinal symptoms of celiac disease. One study published in early 2008 suggested that screening of osteoporosis patients for celiac disease is advisable, since it may be the only sign of undiagnosed celiac disease.

Luckily, removing gluten from the child’s diet can restore bone mass to normal levels. The bone density of adults can also be improved with a gluten-free diet, but they may not regain bone mass to normal levels. Anyone diagnosed with celiac disease should talk to their doctor about having a bone mineral density test and about nutritional supplements to help restore bone mass.

Related reading:
About celiac disease
Symptoms of celiac disease

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Performing an intestinal biopsy is still considered the “gold standard” for diagnosing celiac disease, meaning that one usually does not get an official diagnosis of celiac disease unless they have a tube put down their throats and bits of their intestines removed and analyzed. Actually, I didn’t think the endoscopy was that bad. It was painless — I was drugged of course, and in my foggy state I got to see inside my own intestines on the monitor! How cool is that?

But watching your child get prodded and poked is another story. I never had to make that decision since my kids have been gluten-free since the womb. I talk to many mothers whose children have had blood test after blood test as doctors try to figure out what is wrong. I feel for the mothers and fathers who don’t want another invasive procedure performed on their child, not to mention those who may not have adequate medical insurance to cover it. There are some who opt to not have the biopsy, who say “the blood test is good enough for me” and adopt a gluten-free diet. Unfortunately because they don’t get a diagnosis of “celiac disease”, they are considered just gluten intolerant and left out of any statistics that might help raise awareness.

Well, perhaps a positive blood test is good enough. According to a new study out of the UK, the immunoglobulin-A tissue transglutaminase (tTG) antibody test is 100% positive for predicting celiac disease at a certain level. In their research, all people who had a very high tTG blood antibody level (10 times the upper limit of normal) tested positive on the biopsy. What does this mean? That a biopsy is not always necessary!

The conclusion of the researchers was this: “…diagnostic guidelines could be modified so that small bowel biopsy is no longer regarded as mandatory in patients with such high transglutaminase antibody levels. This will avoid an invasive procedure and lead to a more rapid diagnosis and earlier treatment for over half of the new patients with coeliac disease.”

I hope that doctors are up on the latest research — it could save people from unnecessary medical procedures and parents from having to make such a difficult decision.

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Remember the slogan “the incredible edible egg”? Well, not so incredible or edible in my household since my child is allergic to them. I have hopes that she will outgrow her egg allergy, but really, in the back of my mind, I am doubtful.

Kids with egg allergy can become egg tolerant, but the rate that children are developing tolerance to eggs is slower than in the past when it was thought that most children outgrew egg allergy by age 5 or 6. An egg allergy study published in December 2007 concluded the following:

• 4% of children outgrew egg allergy by age 4
• 12% of children outgrew egg allergy by age 6
• 37% of children outgrew egg allergy by age 10
• 68% of children outgrew egg allergy by age 16

They found that a patient was less likely to outgrow the allergy if they had high IgE antibodies when blood tested for egg allergy, if they had other atopic disease (like eczema or asthma), or if they had other food allergies.

So I guess I will just keep on baking without eggs until things (hopefully) change.

Filed under: News & Research, Babies & Kids, Egg Allergy | 3 Comments »

There has been much research on the relationship between celiac disease and autoimmune thyroid disease, and a new study out of Italy confirms that indeed celiac disease “is significantly increased in patients with thyroid autoimmune disorders.”

People with either Hashimoto’s Disease (also known as hypothyroidism) or Grave’s disease (also known as hyperthyroidism) should be screened for celiac disease, according to doctors and researchers knowledgeable about the relationship between the two disorders.

A 2005 study found that the prevalence of celiac in patients with Graves’ disease was 4.5% as compared with 0.9% in matched healthy controls. A 2007 Dutch study found that 15% of people with Hashimoto’s disease has positive blood work for celiac disease, and 4.8% had villous atrophy (flattened villi in the intestines), a higher number as compared to the general population.

According to Dr. Peter Green, in his book Celiac Disease, A Hidden Epidemic, celiac disease may predispose a person to thyroid disease, meaning that celiac disease actually happens first, but that doctors will more often test for thyroid disease first. Therefore, celiac disease is being missed in people who are being treated for their thyroid problems. And to make it even more confusing, many of the symptoms of these thyroid diseases can also be symptoms of celiac disease or gluten intolerance — fatigue, feeling run down, feeling cold, constipation, weight gain, weight loss, just to name a few. Interestingly, many of the people with thyroid disease who test positive for celiac have “silent” celiac disease, meaning that they don’t have the obvious gastrointestinal symptoms.

Can a gluten-free diet improve thyroid conditions? If a person has celiac disease or gluten intolerance underlying a thyroid disease, then the person must be gluten-free to relieve other symptoms and to lower the risk of developing other autoimmune disorders. Whether or not it will reverse the thyroid disease just depends on the individual. According to one study, most patients with hypothyroidism normalized after a year of following a strict gluten-free diet and so, the researchers concluded, “gluten withdrawal may single-handedly reverse the abnormality.”

Related reading:
Symptoms of celiac disease
Testing for celiac disease

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For parents of food allergic children, especially those who could have an anaphylactic reaction, it is very scary to think about where the food allergen may be lurking. Even if parents are able to control what their child eats, they still have to worry about what other kids have on their hands, and what is left on desks, cafeteria tables, drinking fountains and playgrounds. I have wondered how much of the allergen is really left in these places — how dangerous is it? As long as everyone uses wipes, is it okay?

One 2004 study shed some light on these questions. The purpose of the study was “to detect peanut allergen under various environmental conditions and examine the effectiveness of cleaning agents for allergen removal.” Here’s what they did:

• They smeared peanut butter on tables and then used different cleaning methods and tested the peanut allergen remaining. The cleaning methods used were plain water, dishwashing liquid, Formula 409 cleaner, Lysol sanitizing wipes, and Target brand cleaner with bleach.
• They randomly tested other surfaces in schools, such as desktops, water fountains and food preparation areas for peanut allergen.
• They applied peanut butter to people’s hands and used different cleaning methods to see how much of the allergen remained. The cleaning methods used were plain water, antibacterial hand sanitizer, Tidy Tykes wipes, Wet Ones antibacterial wipes, liquid soap and bar soap.
• They had people wear personal air monitors to detect airborne peanut allergen during different simulations — people eating peanut butter sandwiches (school setting), people shelling and eating roasted peanuts and walking on the shells (a sporting event), opening and eating a little bag of unshelled peanuts (an airline flight).

Here were the results:

• Tables: All cleaning methods except the dishwashing liquid removed the peanut allergen. After cleaning with the dishwashing liquid, 4 of 12 tables still had peanut allergen of varying quantities on them.
• Other school surfaces: peanut allergen was found on 1 out of 13 drinking fountains, none of the 36 eating or food preparation areas, and none of the 22 desks sampled. Note that the schools had either peanut-free tables or food prep areas, or were entirely peanut-free.
• Hands: All cleaning methods except plain water and antibacterial hand sanitizer removed the peanut allergen. Water left residual peanut allergen in high concentrations on 3 of 12 hands. Antibacterial hand sanitizer left residual peanut allergen in high concentrations on 6 of 12 hands.
• Air: There was no detectable peanut allergen in any of the airborne simulations, leading the researchers to question whether there is a different peanut protein that becomes airborne, not the one that they tested for.

The researchers concluded overall that “there is a relatively low risk of exposure to significant concentrations of [peanut allergen] when table surfaces and hands are cleaned with common household cleaning agents and that school cafeteria tables and desks are not likely to be a source of significant exposure for most peanut allergic patients.”

Does that make parents feel better about the possibility of exposure to peanut allergen while at school? I’m not sure. On one hand, it’s great to know that normal cleaning of tables and hands pretty much takes care of things. On the other hand, parents of allergic children can’t be sure that other parents and school staff are cleaning tables properly and wiping kids’ hands after they eat.

Still, I think I feel better overall, knowing that peanut allergen, or any other allergen, isn’t some super-entity that can only be removed with special powers — thank goodness for wipes! (But stay away from the drinking fountain?)

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