John Libonati

Bell and Evans Gluten Free Items – Chicken

June 24th, 2008 by John Libonati


Below is a list of gluten-free items from Bell & Evans.  You can also find hundreds of recipes that can be converted to gluten-free at their website:

http://www.bellandevans.com/index.cfm?act=recipes

Thank you for contacting Bell & Evans.  In addition to our line of breaded, gluten free items, the following are also gluten free:
All fresh chicken

Fully cooked wings  – Honey BBQ and Buffalo Style

Fully cooked grilled breasts – Honey BBQ, Buffalo Style and Plain

Chicken Burgers
As we reprint packaging we are adding gluten free to all these packages.
If I can be of any other assistance, please do not hesitate to contact me.
Susan Ranck

Quality Assurance Manager

Bell & Evans Poultry

(717)865-6626

www.bellandevans.com


Cleo Libonati, RN, BSN

Making the Connection – in Celiac Disease

May 19th, 2008 by Cleo Libonati, RN, BSN

Advance For Nurses Magazine
Vol. 9 •Issue 11 • Page 21

Making the Connection

Underdiagnosed in the U.S., celiac disease can be identified and treated if the condition is understood

By Cleo Libonati, RN, BSN

Celiac disease is a common food sensitivity that can be the underlying source of hundreds of health problems mistakenly attributed to other causes. This insidious disorder has the potential to disfigure, disable and destroy lives at any age. Yet, of the 3 million affected Americans, only 3 percent are diagnosed and treated.1 Prevalence rates are higher in certain populations, such as blood relatives of a person with celiac disease and those with autoimmune disorders.

Unfortunately, people in the U.S. with this condition actively seeking help for their symptoms can go a lifetime without diagnosis and proper treatment. Typically, worldwide diagnosis is faster.
Genetic Susceptibility & Gluten

Celiac disease is also called celiac sprue, nontropical sprue, gluten-sensitive enteropathy or simply celiac by the public.

This immune-mediated disorder stems from an inherited lifelong intolerance to the gluten protein found in wheat, barley, rye and oats. When ingested, gluten resists the breakdown action of normal digestive enzymes into harmless amino acids. Undigested peptides precipitate hyperpermeability of the small intestinal lining (so-called “leaky gut”) to breach the intestinal barrier defense system. In this way, gluten unnaturally gains entrance to the lamina propria.

Within the lamina propria, gluten peptides encounter the enzyme transglutaminase and the local immune system. Transglutaminase deamidates, or breaks off, the rich glutamine residues in gluten. This deamidation creates the toxic molecular compounds, or epitopes, the immune system identifies as foreign.

These epitopes trigger autoimmune antibodies in genetically susceptible individuals. Ensuing inflammation swells affected portions of the small intestinal lining and damages its delicate structures, interfering with its function to finish digestion and absorb nutrients.

While gluten itself is the environmental cause for antibody development, some stressors that can trigger active disease include gluten overload, pregnancy, viral gastrointestinal infection, surgery and severe stress.
Recognizing Celiac Disease

Despite dramatic advancements in knowledge and testing procedures, recognition of this multifaceted disorder is lacking.1Celiac disease often is undiagnosed due to ignorance of the following:

Pathophysiology — The traditional description of celiac disease as an intestinal disorder with malabsorption as the primary defect is a shadow of the real condition.

Prevalence — In contrast to the historic belief celiac disease affected just one in 5,000 individuals, antibody testing demonstrated prevalence of one in 100.

Diagnostic tests — Healthcare providers are unfamiliar with new and improved testing methods.

Manifestations — Many patients do not have diarrhea and wasting symptoms of classic celiac disease. Extraintestinal symptoms predominate in people with atypical symptoms.
How It’s Diagnosed

Diagnosis of celiac disease is made by a positive serologic antibody study and confirmed by histological findings of small-bowel biopsy specimens obtained by endoscopy and improved clinical response following a gluten-free diet.

The single most important step in diagnosing celiac disease is to recognize its myriad clinical features. No single test can definitively diagnose or exclude celiac disease in every individual; there also is a continuum of laboratory and histopathologic results.1

Positive anti-endomysium antibodies and positive anti-tissue transglutaminase antibodies show celiac disease. Positive antigliadin antibodies demonstrate sensitivity to gliadin itself, the gluten in wheat.

Not all patients have positive antibodies at presentation. When symptoms are present but test results are negative, further testing is warranted, including selective immunoglobin A deficiency. In the event the patient started a gluten-free diet prior to testing, suggest a gluten challenge of 3 months or longer in the expectation of antibody development.

Positive small intestinal biopsy shows the degree of villous atrophy, yet this is not foolproof either. The gastroenterologist must be skilled in taking accurate specimens from multiple sites, and the pathologist must be skilled in examining them properly. In addition, damage may be submicroscopic, returning a level not yet detectable by histological examination.

Additional studies include sonogram and genetic testing. Sonogram shows edema and abnormal appearance of the bowel wall. This is especially helpful for children or those who cannot undergo an endoscopy.

More than 97 percent of people with celiac disease share the same genetic human leukocyte antigen (HLA) haplotype markers, HLA-DQ2 and HLA-DQ8. While HLA genotyping is not specific for celiac disease, it has a very high negative predictive value. If the markers are not present, genetic testing essentially rules out the disease.

Annual follow-up testing is warranted for patients with negative test results who continue to show symptoms.
Recognizing Symptoms

There are no typical symptoms of celiac disease, although the most common clinical presentation is unexplained iron-deficiency anemia with or without gastrointestinal symptoms.

Celiac disease, by way of malnutrition, immunity or the direct toxic effect of gluten on cellular structures, has the potential to produce a broad range of symptoms, associated disorders and complications that may affect any organ or body system. Manifestations vary and may appear at any age.

Nutrient deficits are responsible for many seemingly unrelated conditions, such as depression, inability to concentrate, anxiety, insomnia, defective tooth enamel, coagulopathies, hypertension, obesity, anorexia and excessive thirst.

Associated autoimmune disorders may affect any body tissue, including type I diabetes mellitus, hypothyroidism and Grave’s disease, to name a few. Further, severe complications include various cancers such as B-cell non-Hodgkin lymphoma, cryptic intestinal T cell lymphoma and enteropathy-associated T cell lymphoma.

Chronic diarrhea in childhood should provoke screening. Pediatric presentation for celiac disease could involve hypotonia, failure to thrive, growth retardation, short stature, convulsions, poor bone and tooth development, thymic atrophy and delayed puberty.
Treatment

Treatment is a gluten-free diet. Excluding gluten usually results in rapid healing of the small intestinal mucosa, resolution or improvement of nutritional deficiencies, and disappearance of many manifestations of celiac disease.

The gluten-free diet is challenging due to the plethora of gluten-containing foods in the standard American diet. To succeed, patients need detailed diet instruction, including how to read food labels and identify hidden sources of gluten, such as in medications and supplements. Refer patients to a qualified dietitian if possible; otherwise, nurses can teach appropriate information.

Inform patients about community help such as celiac support groups, which offer practical advice on how to shop and cook, and where to dine. Many support groups hold their meetings at local hospitals.
Prognosis

Clinical outcome depends on duration of exposure to gluten. The longer gluten is consumed, the more the body is damaged, and the greater the likelihood of health disorders and complications developing.

Intestinal permeability improves within 2 months of starting a gluten-free diet. Despite a good clinical response, abnormal endoscopic and histologic appearances persist in the majority of patients.2Patients who receive adequate education about celiac disease and treatment with the gluten-free diet are better able to prevent intestinal damage and improve their health by dietary self-management. Clearly, nursing intervention that uncovers hidden celiac disease, provides nutritional education and promotes regular follow-up will considerably improve prognosis. n
References for this article can be accessed at www.advanceweb.com/nurses. Click on Education, then References.
Cleo Libonati is author of Recognizing Celiac Disease, and co-founder, president and CEO of Gluten Free Works Inc., Ambler, PA.
This article copyrighted to Advance For Nurses and can be accessed online at their website at http://nursing.advanceweb.com/Editorial/Search/AViewer.aspx?AN=NW_08may12_n4p21.html&AD=05-12-2008

Everyone on a Gluten Free Diet?

May 15th, 2008 by John Libonati

The below article by Nadine Grzeskowiak is a good explanation of why the gluten-free diet can work for anyone and everyone and pitfalls of the celiac tests.  Medical experts speak of the gluten-free diet as if it is something strange, yet most unprocessed foods you cook yourself are naturally gluten free.  All meats, seafood, fruits, vegetables, nuts, legumes, dairy (unless gluten was added to them), corn, rice and other grains,(besides wheat, barley, rye or oats), naturally do not contain harmful gluten.  Wheat, barley, rye and oats don’t contain any nutrients you cannot get in other foods, so what is the big deal with not eating them?Nadine’s article is excellent.  The only thing I would add is if you do eliminate the gluten grains of wheat, barley, rye and oats and feel better within two weeks, get yourself tested for celiac disease.  A positive diagnosis makes dealing with healthcare providers much easier.  That said, if it comes back negative but you feel better being gluten-free then eliminate gluten from your diet and be healthy.You can find Nadine’s blog article at http://glutenfreern.com:80/everyone-on-a-gluten-free-diet/-John Libonati, Editor Glutenfreeworks.com
john.libonati@glutenfreeworks.com

Discussion | | Nadine Grzeskowiak | May 13, 2008

I have thought for a long time about this very question.  Who would suggest such a thing?  I would.  The main reason I would dare to make such a statement is because we have been so negligent in recognizing and treating people with celiac disease.  Not a day goes by that I don’t hear about or speak to someone directly who has suffered needlessly for years.  The other main point I want to make is that NONE of the currently available testing is 100%.  The blood tests and endoscopic biopsies are great tools if they are positive.  If they are negative, I have heard of too many people tell me ‘I don’t have celiac disease, my blood test/biopsy was negative’.  This is a major cause for concern to me.  Both of these tests do not confirm you don’t have, or will never develop celiac disease.  First, neither test is 100% reliable.  Second, both tests are simply a snapshot of right now.  I have also seen test results that are clearly positive for celiac disease, but read as negative by a medical provider that does not understand what the results mean.  The genetic testing is great and it is my first choice when testing people.  The test is a cheek swab, I get results in one week and it is covered by most insurances.  I utilize Kimball Genetics in Denver, Colorado,  www.kimballgenetics.com.  I have run into this scenerio in the past week: a 12 year old on a gluten free diet for several months, a remarkable recovery from many symptoms while on the gluten free diet, and yet, she tests negative for DQ2 and DQ8.  Is she at risk for celiac disease if she eats gluten?  Are there other genes that could be looked at?  I am gathering more data on this because nothing is black and white with gluten intolerance, there are many grey areas.  Other than, of course, the need to be on a strict gluten free diet for the rest of your life if you have celiac disease.  Not much grey there. 

So, this leads me back to the original question: everyone on a gluten free diet?  In my perfect world, the answer would be a resounding YES!  If people would simply try the gluten free diet for a month, most, if not all of those people will feel better.  It remains simply a diet change.  Change your diet and feel better, doesn’t that sound appealing.  To some yes, and to others, not really. Not without the proof that they need to change their long held diet and lifestyle habits.  It also sounds quite un-American to say ‘I can’t eat wheat, barley, rye and oats’, by extension, bread, pies, cakes, beer and pizza.  My most recent convert to a gluten free diet, said to me, “You know I don’t even miss the bread anymore, it doesn’t even appeal to me, I feel so much better on the gluten free food”.  This is a woman who has had symptoms for most of her 76 years and I had a hard time convincing her to try the gluten free diet for a month.  She is convinced now.  I can tell many stories with the same happy ending.  I can also tell you that most men have a harder time changing anything, let alone their diet, than women.  Trust me, I am a nurse and I have no reason to lie to you.  Try it.  Go gluten free for a month and contact me with your results.  GO!

We have some very important information to share with you today.

While we were at Columbia University’s Topics in Gastroenterology, Dr. Steven Lobritto talked about cirrhosis of the liver and how he has actually seen people who were on the liver transplant list heal enough to be taken off once they started a gluten-free diet.

According to our new book, “Recognizing Celiac Disease”, 3.4% of people with non-alcoholic fatty liver disease have SILENT Celiac Disease. Most patients DO NOT have gastrointestinal symptoms.

Non-alcoholic fatty liver is a non-inflammatory hepatic (liver) disorder characterized by degenerative changes in the liver secondary to excessive accumulation of lipid in hepatocytes.

The good news is that studies showed liver enzymes normalize after 6 months on a gluten-free diet.

If you have patients or family members with non-alcoholic fatty liver (cirrhosis), who are not diagnosed with celiac disease, give them this information so they can get tested.

Related medical studies are referenced in “Recognizing Celiac Disease.” www.recognizingceliacdisease.com.

Celiac disease is a multi-system, hereditary, chronic, auto-immune disease estimated to affect 1% of the human population (3 million in the US) that is caused by the ingestion of wheat, barley, rye and oats. It is treated by removing these items from the diet. Signs, symptoms, associated disorders and complications can affect any part of the body and removal of the offending foods can result in complete recovery.  

Below is a recent message we received from someone who bought “Recognizing Celiac Disease.”

Thank you. My husband and I both have Celiac Disease and your book is by far the best one we have found in print on Celiac Disease. We love the format with the concise, current overview in the beginning and the detailed charts that make up most of the book. We refer to it on a regular basis as we research questions for ourselves, friends, family and others.

We shared your book with the head of the pathology dept. at our local hospital, our Celiac Disease support group members at our last meeting (and encouraged them all to purchase their own copies) and even with our dentist.

I wish there were a way to get your book to all of our local doctors since none of them are informed about Celiac Disease and few people are diagnosed in our area. My doctor had never dx’d a case of Celiac Disease before mine (I was on my deathbed 6 years ago), and our pediatrician has never dx’d a case!

I have proposed that our support group purchase books for all of our local gastroenterologists, providing you are not planning to publish an updated version in the near future.

If there is any way you recommend that our support group, or we personally, can promote your book please let us know.

Thank you again!

Suzanne Ludlam
Fairfax, VT

You can read more reviews Here!

Health Alert - Microbes Matter - Probiotics a.k.a. Good Bacteria in Your Gut

Strange as it seems, our well-being is uniquely tied to the condition of our colon, which is commonly unhealthy at diagnosis of celiac disease. To keep our colon healthy, we need to understand what happens there on a microscopic level.  Hundreds of varieties of intestinal microbe populations called “flora” live there, numbering in the billions.  To put these numbers into focus, dead bacteria make up about a third of each bowel movement.  Our resident microbes, whether beneficial or harmful, play a decisive role in nourishing or damaging the cells that form the intestinal lining.  Probiotic and prebiotic foods and supplements restore and feed our friendly microbes.


Probiotic flora inhibit colonization of pathogens by physically preventing them from adhering to the gut lining.  Other important functions are:

  • Produce short chain fatty acids (SCFA)s.  SCFAs are important and necessary energy byproducts formed during fermentation of undigested carbohydrates in the colon by flora.  SCFAs nourish the colonocytes, the cells that line the colon. They also help absorb salts and water from stool.

  • Produce a form of vitamin K and appreciable amounts of biotin.
  • Reduce the presence of putrefactive enzymes.

  • Protect against toxic substances.

  • Contribute to normal bowel movements.

For these reasons, we need to use probiotics and prebiotics every day to improve our overall health and specifically our intestinal health.  This is especially important if fatigue, weakness, achiness, depression, foggy thinking and digestive problems continue while maintaining a gluten-free diet. 


(This Health Alert was taken from information found in
Issue #9 – Microbes Matter of the Gluten Free Gazette.)  Celiac disease is a hereditary, auto-immune disorder estimated to affect 1% of the human population (3 million in the

US). Less than 3 % are estimated to be medically diagnosed, but numbers are expected to rapidly increase as diagnosis improves. Celiac disease is caused by the ingestion of wheat, barley, rye and oats and treated by removing these items from the diet. Signs, symptoms, associated disorders and complications can affect any part of the body and removal of the offending foods can result in complete recovery.  Visit Glutenfreeworks.com for more information.

Psoriasis and Celiac Disease – Genetic Link

April 4th, 2008 by John Libonati

The research below further supports the links demonstrated between celiac disease and psoriasis as noted in the book “Recognizing Celiac Disease.” (www.recognizingceliacdisease.com) Although not the focus of this study, the link could be a genetic sensitivity to gluten itself, considering the resolution of symptoms seen by people with psoriasis who go on a gluten-free diet. In addition, the other disorders, diabetes type 1 and arthritis have been linked to celiac disease/gluten sensitivity reactions. – John Libonati, Glutenfreeworks.com

Psoriasis: 7 New Genetic Clues

Newly Discovered Genetic Variations May Make Psoriasis More Likely, Study Shows
By Miranda Hitti

WebMD Medical NewsReviewed by Louise Chang, MDApril 3, 2008 — Scientists have discovered seven genetic variations linked to psoriasis.

If confirmed in other studies, those gene variants may make good targets for new psoriasis drugs, note the researchers, who included Anne Bowcock, PhD, genetics professor at Washington University School of Medicine in St. Louis.

“Common diseases like psoriasis are incredibly complex at the genetic level,” Bowcock says in a news release. “Our research shows that small but common DNA differences are important in the development of psoriasis. Although each variation makes only a small contribution to the disease, patients usually have a number of different genetic variations that increases their risk of psoriasis and psoriatic arthritis.”

Bowcock’s team compared DNA from 223 psoriasis patients (including 91 with psoriatic arthritis) and 519 people without psoriasis, and also from two other large groups of people with and without psoriasis.

Through those comparisons, the researchers identified seven genetic variations linked to psoriasis and psoriatic arthritis and confirmed other variations already linked to psoriasis.

One of the newly discovered variants is in a genetic region tied to four other autoimmune diseases: celiac disease, type 1 diabetes, Grave’s disease, and rheumatoid arthritis.

Further studies are needed to confirm the findings, Bowcock and colleagues note in the April 4 online edition of Public Library of Science Genetics.

View Article Sources
SOURCES:

Liu, Y. Public Library of Science Genetics, April 4, 2008; online edition.

News release, Public Library of Science.

© 2008 WebMD, LLC. All rights reserved.
http://www.webmd.com:80/skin-problems-and-treatments/psoriasis/news/20080403/psoriasis-7-new-genetic-clues

John Libonati

Rice Chex is now gluten free!

April 1st, 2008 by John Libonati

This just in from the Cincinnati Celiac Support Group listserve:

Rice Chex is now gluten-free – click the link below and check out the label where it says gluten-free on the middle of the box…
 
http://www.generalmills.com/corporate/brands/product_image.aspx?catID=23344&itemID=131

This was the response someone received on the Delphi Celiac Disease Forum when they emailed General Mills about the cross contamination issue:
 
Thank you for contacting General Mills with your inquiry.  Rice Chex has been reformulated to insure that it does not include gluten-containing ingredients or have the possibility of cross contact with gluten containing ingredients or products.
We hope you find this information helpful.  Please let us know if we can help you again.
 
Sincerely,
 
Connie Sellers
Consumer Services

BE AWARE THAT OLDER, BARLEY MALT CONTAINING BOXES MAY STILL BE ON THE SHELVES!  MAKE SURE TO READ THE INGREDIENT LABEL.

Hyperthyroidism, also called Grave’s Disease, is an immunologically mediated thyroid disease.  That basically means it is brought on by the action of specific abnormal autoantibodies, called thyroid receptor antibodies (TRAb), that stimulate excessive release of normal thyroid hormones into the blood.  Thyroid hormones control body metabolism.

Features of hyperthyroidism are diffuse non-tender goiter (enlarged thyroid gland), elevated blood levels of thyroxine hormone, suppressed blood levels of thyrotropin hormone (TSH), and the presence of thyroid receptor antibodies in the blood.

Symptoms include various degrees of bulging eyeballs, staring, firm areas of edema or swellings of the lower legs in most patients, rapid pulse, increased blood pressure, palpitations, nervousness, depression, anxiety, heat intolerance, weight loss, thigh and upper arm weakness, brisk tendon reflexes, cardiac abnormalities and oligomenorrhea in females – infrequent or scanty menstruation. 

According to a recent medical study of 111 people with hyperthyroidism, 4.5% had positive celiac disease antibodies, 14% had anti-gliadin antibodies and 3% had IgA deficiency. Anti-gliadin antibodies demonstrate a normal reaction to the abnormal presence of gluten in the blood. The high presence of anti-gliadin antibodies in thyroid disorders is likely related to gluten entering the bloodstream through the small intestine via “leaky gut.”  Leaky gut can result from poorly digested gluten with or without celiac disease. 

An immune-linked reason for the co-existence of hyperthyroidism and celiac disease revolves around the fact that both disorders (and several other diseases) share the immune system genetic markers HLA B-8 and HLA DR3. Individuals having these genetic markers can develop one or more of a certain cluster of diseases associated with these genes.1

The good news is that a strict gluten free diet can successfully treat hyperthyroidism in celiac disease.

Thyroid function should be assessed in all celiac disease patients at diagnosis and follow-up if clinically indicated. Screening of high-risk groups such as those with autoimmune thyroid disease is a reasonable strategy.2

If you have hyperthyroidism, be sure your doctor tests you for celiac disease and gluten sensitivity. Anti-gliadin antibody (AGA-IgA and AGA-IgG) tests for gluten sensitivity while EMA-IgA and EMA-IgG or tTG-IgA and tTG-IgG  are specific tests for celiac disease.  Testing that is based on IgA only would give a false negative result for individuals who are unable to produce IgA antibodies, that is, in IgA deficiency.

If your physician refuses or dismisses the idea of testing for celiac disease, please get a second opinion from a medical provider who is knowledgeable about celiac disease.  The longer gluten is consumed, the greater will be its damaging effects on your body.

(This Health Alert was taken from information found in Issue #11 – “Gluten and the Thyroid” of the Gluten Free Gazette.)

Celiac disease is a hereditary, auto-immune disorder estimated to affect 1% of the human population (3 million in the US). Less than 3 % are estimated to be medically diagnosed, but numbers are expected to rapidly increase as diagnosis improves. Celiac disease is caused by the ingestion of wheat, barley, rye and oats and treated by removing these items from the diet. Signs, symptoms, associated disorders and complications can affect any part of the body and removal of the offending foods can result in complete recovery.  Visit Glutenfreeworks.com for more information.
Grave’s Disease and Gluten Sensitivity Enteropathy (GSE). Elaine Moore. http://www.suite101.com/article.cfm/graves_disease/54749
Ch’ng CL, Keston Jones M, Kingham JGC. Celiac disease and autoimmune thyroid disease. Clinical Medicine & Research. May 2007; 5(3)184-192.

Spelt Bread Recall by Food For Life Baking Company

March 20th, 2008 by John Libonati

Food For Life Baking Company of Corona, California is voluntarily recalling 2,241 cases of Spelt Bread (UPC# 07347200168) because they contain spelt grain which is known to be a hybrid of wheat. People who have allergies to wheat or those with Celiac Disease may run the risk of a serious or life threatening allergic reaction if they consume spelt products.
The recalled products were sold nationwide through health food distributors and natural food retailers.

Food For Life Spelt Bread is sold frozen in a 24 oz. (680g) light blue package and bears either of the two following descriptions

Food For LIfe, Wheat Alternative Spelt Bread
Food For Life, Fruit Juice Sweetened Spelt Bread
Affected lot numbers are: H1847, H2042, H2136, H2435, H2872, H2974, H3224, H3460, I0485.

No illnesses have been reported to date in connection with this problem.

The recall was initiated as a precautionary measure following an FDA investigation concluding that the product contained undeclared wheat.

This recall is being made with the knowledge and in cooperation with the Food and Drug Administration.

Consumers who have purchased any of these products are urged to return them unopened to the place of purchase for a refund.

Consumers with questions may contact us toll free at: (800) 797-5090.

http://www.fda.gov/oc/po/firmrecalls/foodforlife03_08.html