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Gluten Free and Not Well

The following books, articles and websites can help give you an idea of what might be wrong if you are not doing well even though you are following the gluten-free diet 


A book, Real Life with Celiac Disease, does a very good job of explaining additional problems that may be experienced by those with Celiac Disease. Highly Recommended.


Beth Israel Celiac Center has a very good section on their CeliacNow website:  The Medical Management of Celiac Disease


Article: Additional recommendations to help you 
make a full recovery from Celiac Disease



"Why Symptoms Persist - I'm on the diet and not getting better" is Chapter 16 of 
Celiac Disease: A Hidden Epidemic (Revised and Updated Edition) 


Effect of a Gluten-Free Diet on Gastrointestinal 
Symptoms in Celiac Disease



Etiology of nonresponsive Celiac Disease: 
Results of a systematic approach 



Histologic Follow-up of People with Celiac Disease 
on the Gluten-Free Diet: slow and incomplete recovery



List of autoimmune diseases associated with Celiac Disease


Small intestinal release mesalamine for the treatment of refractory celiac disease type I.


Prevalence of small intestine bacterial overgrowth diagnosed by 
quantitative culture of intestinal aspirate in Celiac Disease


Small Intestinal Bacterial Overgrowth
from MedicineNet.com


Uninvited Guests: The Impact of Small Intestinal 
Bacterial Overgrowth on Nutritional Status


Rifaxamin Therapy for Patients with Irritable Bowel Syndrome without Constipation

Rifaximin treats Irritable Bowel Syndrome

Articles about Xifaxan (rifaximin): 1, 2
This is an antibiotic used for irritable bowel syndrome and small intestinal bacterial overgrowth


Articles about Probiotics (see charts): Wall Street Journal, Wikipedia

Fermented Foods as a source of probiotics


Effect of Elemental Diet on ... type 1 refractory Celiac Disease


Update on the Management of Refractory Coeliac Disease (March 2007)

Differential Diagnosis of Persisting Villous Atrophy


Protein Intolerance
From this article: dairy, soy and egg protein are the most common problems.
"The simplest type of elimination diet is elimination of suspected food antigens from the diet for 2-4 weeks or longer." 


Mucosal Reactivity to Cow's Milk Protein in Coeliac Disease 


AGA Technical Review on the Evaluation of Food Allergy in Gastrointestinal Disorders
See page 9 of the pdf for a discussion of elimination diets

Guidelines for the Diagnosis and Management of Food Allergy in the United States

 
Risk Assessment of Trace and Undeclared Allergens in Processed Foods

A good description of elimination diets

Evaluation of the patient with suspected eosinophilic gastrointestinal disease (other than eosinophilic esophagitis)
This article is available for purchase online and is also at Ruth Lilly Medical Library


AGA Medical Position Statement: Guidelines for the Evaluation of Food Allergies


Clinical Aspects of Gastrointestinal Food Allergy in Childhood


Effect of six-food elimination diet on clinical and histological outcomes in eosinophilic esophagitis


Cincinnati Center for Eosinophilic Disorders at Cincinnati Children's Hospital


Quote from Textbook of Gastroenterology (2003, emphasis mine):
"Small amounts of antigenic macromolecules normally penetrate the gastrointestinal mucosal barrier and reach the systemic circulation, occurring more in early life and in conditions causing disruption of the mucosal defenses".

Note: Exposure to gluten increases intestinal permeability in everyone, although there tends to be a greater increase in people with CD (References 1 2). Increased intestinal permeabilitly may make people with CD more likely to have developed other food intolerances and allergies


Role of the Intestinal Barrier in Inflammatory Bowel Disease
includes a discussion of probiotics

Probiotic VSL#3 protects the epithelial barrier...in a murine model


Vitamin D has been demonstrated to play an important role in
intestinal mucosal barrier maintenance:
Novel role of the Vitamin D receptor in maintaining the integrity of the intestinal mucosal barrier
Protective Effect of 1,25-Dihydroxy Vitamin D3 on Pepsin-Trypsin-Resistant Gliadin-Induced TightJunction Injuries.
​

Celiac Disease and Recurrent Pancreatitis
This article shows the connection between Celiac Disease, 
Sphincter of Oddi Dysfunction (aka papillary stenosis) and pancreatitis


Risk of Pancreatitis in 14,000 Individuals with Celiac Disease


Sphincter of Oddi Dysfunction: Diagnosis and Treatment
Treatment of Sphincter of Oddi Dysfunction by ERCP with manometry/sphincterotomy
is best done at a specialist such as Stuart Sherman at Indiana University




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