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Relationship of Celiac Disease to Other Autoimmune Diseases
-----------------------------------------------------------
Dr. Markku Maki, Professor, Institute of Medical Technology,
University of Tampere, Finland

Is CD an autoimmune disorder?  It has a trigger (gliadin), a target
(gut and other organs), an autoantigen (tissue transglutaminase),
autoantibodies (reticulin/endomysial antibodies), and genetic risk
markers (HLA, DQ2/DQ8), but, it is not self perpetuating (rather, the
gut regenerates).  So, CD does not fit all the criteria of an
autoimmune disorder.

Dr. Maki assessed the connection between CD and hundreds of other
diseases.  He found that these diseases can be promulgated by
untreated CD gut anomalies:  dermatitis herpetiformis (DH), enamel
defects, ataxia, osteopenia/osteoporosis, and epilepsy.  Diseases that
are considered associated with (not caused by) CD are thyroid disease,
insulin-dependent diabetes mellitus (IDDM), and Sjogren's syndrome.
Rheumatoid arthritis, interestingly, was not found to be associated
with CD.


What the 2lst Century Holds for Celiacs
---------------------------------------
Ann Whelan, Publisher, Gluten Free Living, Hastings-on-Hudson, New
York

Ms. Whelan expressed great optimism about our future.  She sees
landmark advances leading to significant and positive changes in our
lives, and in the lives of those who will be diagnosed more easily and
on a more timely basis.  It could go something like this within the
next 25 years:

Doctors will be able to diagnose CD without the endoscopy, which means
more people will be diagnosed more easily and on a more timely basis.
Simple, cost-efficient CD diagnosis will help revolutionize treatment
of problems such as osteoporosis and infertility.

The GF diet will be used routinely for problems other than gluten
sensitivity.

More vendors will enter the market, offering a wider variety of safe,
nutritious foods, hopefully at lower prices.  Restaurants, hospitals,
airlines, caterers, and our own families will have easier access to GF
foods they'll need to purchase for their clientele/relatives.

Research and expanding knowledge will bring changes to the lives of
non-celiacs.  For example, if the GF diet is determined to be helpful
with other autoimmune diseases, as limited research is currently
suggesting, we may have a simple way of reducing the impact of
devastating problems like Type I diabetes and multiple sclerosis.

Easier access to GF foods will curtail the anxiety we feel in certain
situations, and help quell fears about contamination--and starving!
(Imagine local grocery stores that carry only GF food and GF bakeries
in cities across North America.)  Right now there is a GF bakery in
Philadelphia called "Mr. Ritt's", run by Paul Kelty and Rick Gallo.
Mr. Kelty feels it's best to go all-or-nothing in the GF baked goods
business as the cost of cleaning up the contamination from
wheat-containing baked goods could be prohibitive.

We will use computers to see our doctor, attend virtual support group
meetings, and order all of our food, not just our GF supplies.

As researchers work on making diagnosis easier, determining
prevalence, and figuring out the serendipitous benefits of the GF
diet, we need to support research and get the word out by contacting
individuals and groups who need to know about CD (doctors, dietitians,
chefs, restaurateurs, and groups for those with osteoporosis,
infertility, or other problems to which undiagnosed CD can lead).

We can also work with vendors, talk to local supermarket managers, and
help restaurants, hospitals, and other institutions to learn how to
serve their GF clients with ease.  We need to get remaining chips off
our shoulders about our diagnosis; if we think we won't be
accommodated, we won't, if we think we will, we will.


Is Celiac Disease a Chronic Condition?
--------------------------------------
Valerie Fines, self proclaimed, ordinary person-with-a-twist (CD)

When Ms. Fines thinks of a chronic condition as a "lasting
circumstance", her answer to the question is "yes".  A chronic
condition affects us on three levels:  personal, social, and familial.

On a personal level, we may contend with managing our time, lack of a
support system, disruption to future plans (no such thing as a
spontaneous celiac!), loss of autonomy/control, an uncertain or
unpredictable future, and distressing emotion.  It is important to
remember, amidst all of this, that you are still you (an ordinary
person with a twist).

On a social level, there may be an array of adjustments.  Our changes
affect our entire families.  Friends and family initially have little
knowledge, many fears, and a need for education.  CD changes our lives
and the way we relate to other people.  We celiacs need to commit to
educating many others while maintaining a positive self image.

On a familial level, ability to adapt depends on a family's resources
(emotional, financial, time, etc.)  and support in the community.
When the celiac in the family is a child, the family has to focus on
both nurturing and providing guidance.  Three questions arise for
parents:  1) How does CD affect my relationship with my child?  2) How
does CD change his/her relationships with siblings?  3) How does my
child learn the skills to manage?

Ms. Fines recommends contact with a health care professional six
weeks after diagnosis because, by then, the euphoria of "having a
solution" is gone and the life-long perspective has entered.
Supportive follow-up that's focused on psychological well-being helps
you make necessary adjustments, and avoid emotional traps.

Ms. Fines left us laughing with a couple of classic CD behaviors.
She noted that when celiacs have symptoms, they ask three questions,
in this order:  1) Did I ingest gluten?  2) Am I having a reaction to
something else?  3) Do I have the Flu?  And when two celiacs meet,
they always ask the same two questions:  How long did it take you to
get diagnosed?  Where do you buy your bread?  So true.


Vitamin and Mineral Therapy for Celiacs
---------------------------------------
Aileen Buford-Mason, B.S., Ph.D., independent research analyst, health
care writer, lecturer, and educator

All vitamins and minerals are used in concert in our bodies, and all
of them are needed at all times, so an absence of, or deficiency in,
any one disrupts many different functions and may cause many diverse
symptoms.  Additionally, there are optimal amounts of each, and more
is not better.  The best source of vitamins and minerals is the food
in your diet.  If vitamins and minerals are not sufficient in your
diet, or you take medications that affect absorption or utilization of
vitamins and minerals, or you have a health condition that increases
your need for vitamins and minerals (like CD), then you could benefit
from supplements.

In general, there is debate in the medical and scientific community
about supplementation, which is confusing to the lay person.  There is
some evidence, though, that calcium and antioxidants may be especially
helpful for celiacs.  So, Dr. Buford-Mason's recommendation for
celiacs:  Even if you are on a nutritious GF diet, you could benefit
from a good, well-formulated multivitamin and mineral supplement.
Look for one that contains all the B vitamins, antioxidants (vitamins
A, C, E; minerals selenium and manganese), a full spectrum of trace
minerals, and minerals in an easily absorbed form.  As always, talk to
your physician or nutritionist for guidance.