Expert Postings
Apr - Jun 1998

Copyright by Michael Jones, Bill Elkus, Jim Lyles, and Lisa Lewis 1998 - All rights reserved worldwide.
Disclaimer
 
This file contains postings made by the following professionals:
 
Karoly Horvath, M.D.--an associate professor of pediatrics at the
   University of Maryland at Baltimore.  Dr. Horvath set up the
   Pediatric Gastrointestinal and Nutrition Laboratory, and is now
   director of this lab.
 
Donald D. Kasarda, Ph.D.--a research chemist with the United States 
   Department of Agriculture.  Dr. Kasarda has worked on grain proteins 
   in relation to grain quality for 30 years.  He has colloborated with 
   medical groups working on celiac disease for about 25 years and has 
   often been used as an informal consultant by support groups. 
 
Joseph Murray, M.D.--a gastroenterologist at the University of Iowa,
   USA, where they have a mutidisciplinary service for the clinical care
   of people with celiac disease.  They are also involved with clinical
   research and medical education related to celiac disease.
 

Date: Fri, 3 Apr 1998 04:32:43 -0500 From: Karoly Horvath (khorvath@UMARYLAND.EDU) Subject: Re: Short stature and celiac Short stature is defined as height below the 5th percentile for age. There is a standard growth curve showing a scale from 1 to 100 for each age in childhood (a simple explanation: e.g 25th percentile means that this kid would be the the 25th in the line of 100 children starting from the shortest one). This curves provide the basis to determine whether a child is short or not. Of course there are much more parameters used during an evaluation. A few example why a child can have short stature: 1) growth hormone deficiency 2) chronic organic disease (kidney, liver etc 3) short only until the teenage age group when his/her height became normal 4) has familial short stature when one of the parents is short 5) has bone anomaly 6) Has celiac disease It is known that up ro 10% of short children may have celiac disease. If any child with known celiac disease does not grow and her/his height is below the fifth percentile while is on a strict gluten-free diet she/he should be referred to a pediatric endocrinologist for further evaluation. Karoly Horvath, M.D., Ph.D, Center for Celiac Research Baltimore ========================================================================= Date: Mon, 6 Apr 1998 08:49:00 -0500 From: Joseph Murray (Joseph-Murray@MAIL.INT-MED.UIOWA.EDU) Subject: serological blood testing for celiac disease Any information is for general medical education and should not be applied to a specific patient's problem without that patient discussing it with his/her physician. There have been a number of questions/postings on serologic blood tests for celiac disease. These tests listed below have been around for sometime. Endomysial antibodies ( IgA) Reticulin antibodies ( can be IgA and IgG) Gliaidin antibodies ( can be IgA and IgG) The first 2 are antibodies directed against tissue. The gliadin antibodies are directed against wheat proteins. These tests have been used for several purposes: screen large populations for hidden celiac disease. test individual patients for celiac disease in whom it is suspected by the doctor, follow up for healing/improvement of the disease. There is a lot of medical info published on these tests. Firstly, they are not perfect or even close to it. No test is perfect not even the biopsy. The levels of antibody drop with exclusion of gluten from the diet (both gliadin and the connective tissue antibodies). This point is really important!! If someone has excluded gluten from their diet for a while (weeks to months) and then goes to the doctor and asks for a test for celiac disease, the test may be negative. This negative test does not tell that the person does not have celiac disease. Most labs in the US do well in comparison but they are not the same in how they report the results. Think of the analogy of distance measurements: Miles kilometers light years Cubits hands these are all different ways of expressing distance. However that analogy is not quite accurate because while you can convert the distances from one measure to another, you cannot convert the measures used in the lab testing for celiac disease from one lab to another. Usually a positive in one lab is a positive in another. Joe Murray MD University of Iowa ========================================================================= Date: Mon, 27 Apr 1998 15:18:11 -0500 From: Chris Silker (silk@MEANS.NET) Subject: Summary: Wheat Starch Below are the responses I received on wheat starch. Bottom line - avoid it! Thanks to all who responded. -------- From Dr. Murray: I was intrigued by your post on wheat starch. I have practiced medicine in both Ireland and the US and looked after celiacs in both places. wheat starch has been considered of limits here but was permitted in Ireland( then). I have been impressed at how much better off patients are without it. There have been some studies done on wheat starch that suggest it is not safe for many celiacs and that is the reason I ask my patients to very much avoid it. ========================================================================= Date: Tue, 2 Jun 1998 07:21:15 -0400 From: Don Wiss (donwiss@panix.com) Subject: Re: wheat germ Russ Paden (cbc@GOODNET.COM) wrote: )I read recently that wheat germ is gluten-free. Anybody know anything about )this? Below is an e-mail that has not been posted to the list before. Note that the endosperm is where the gluten is. Don. Date: Mon, 26 Aug 96 10:00:55 PDT From: "Donald D. Kasarda" (kasarda@pw.usda.gov) I did attend a meeting in Kansas City last week and talked with a representative of ADM (Archer-Daniels-Midland) Co. They do a lot of grain milling and he said that the bran and germ fractions are mostly used for animal feed. The small amount they sell for human consumption is not specially processed by them. It might be washed slightly by the user, but the feeling of the person I talked with was that thorough washing would be unlikely. So, even though I can't come up with any quantitative information on the amount of endosperm remaining with the bran and germ fractions (it will probably vary according to the end user's processing), my feeling is that too much is present for a celiac patient to risk eating products that contain a significant proportion of either wheat bran or germ. The ADM executive was in agreement on that. As I said in my earlier post, white bits of endosperm attached to the bran are very noticeable in a freshly milled bran fraction from a Brabender Quadrumat Senior mill, which is a fairly sophisticated experimental mill that I have used occasionally. ========================================================================= Date: Sat, 6 Jun 1998 15:10:08 -0500 From: Joseph Murray (Joseph-Murray@MAIL.INT-MED.UIOWA.EDU) Subject: Colonoscopy as a test for celiac disease(not!) This is not Medical advice The biopsy determination of celiac disease requires demonstration of the abnormalities in the proximal small intestine. It is not possible to get such a biopsy going through the anus. The colonoscope does not reach that far. The biopsy instrument must go through the mouth. This is usually achieved with a upper endoscopy( AKA gastroscopy,EGD) A colonoscopy is frequently preformed for the investigation of diarrhea but does not and can not detect celiac disease. Joseph A. Murray MD Coordinator, Celiac Disease Clinic Associate Professor of Medicine, University of Iowa IA 52242 =========================================================================
| Return to the Table of Contents. | Return to the Basic Information page. | Return to the FAQ. |
| Return to the Celiac WWW page. |

Copyright

Permission is granted to copy this document, at no charge and in its entirety, provided that the copies are not used for commercial advantage, that the source is cited and that the present copyright notice is included in all copies, so that the recipients of such copies are equally bound to abide by the present conditions. Prior written permission is required for any commercial use of this document, in whole or in part, and for any partial reproduction of the contents of this document exceeding 50 lines of up to 80 characters, or equivalent. The title page, table of contents and index, if any, are not considered to be part of the document for the purposes of this copyright notice, and can be freely removed if present.

The purpose of this copyright is to protect your right to make free copies of this paper for your friends and colleagues, to prevent publishers from using it for commercial advantage, and to prevent ill-meaning people from altering the meaning of the document by changing or removing a few paragraphs.

Return to the Table of Contents

Disclaimer

This fact sheet has been designed to be a general information resource. However, it is not intended for use in diagnosis, treatment, or any other medical application. Questions should be directed to your personal physician. This information is not warranted and no liability is assumed by the author or any group for the recommendations, information, dietary suggestions, menus, and recipes promulgated. Based upon accepted practices in supplying the source documents, this fact sheet is accurate and complete. Products mentioned or omitted do not constitute endorsement.

Return to the Table of Contents