Celiac Support Association

Library Series Learning Center

This series is a collection of articles that pertain to celiac disease and gluten related conditions. Most of these articles have appeared in CSA’s quarterly newsletter, Lifeline, which all CSA members receive. Historic articles included in these resources may or may not include updated notes. Articles represent the work of the author.

The * symbol denotes a newly added section to the library series.

Tax Deduction with Celiac Disease

Gluten-Free Definition - Food and Drug Administration (FDA) 

What is the relationship between 20 parts per million (ppm) and 10 mg gluten per day? 20 ppm gluten (equivalent to 20 mg gluten in 1 kg [1 million  mg] food) is the gluten threshold below which food manufacturers must achieve for foods to be labelled ‘gluten free’ in Europe, Canada and from August 2014, USA. If a person eats 500 g of food per day, 20 ppm of 500 g is 10 mg. 10 mg is present in 1/250th of a slice of bread containing 2.5 g of gluten.  Read more from Dr. Forbes.

"Gluten-Free You!" Monthlies                                        

"Gluten-Free You!" A new issue each month.  *February Monthly 2016   

"Gluten-Free You!" Monthly - 2016 issues

"Gluten-Free You!" Monthly - 2015 issues

"Gluten-Free You!" Monthly - 2014 issues

"Gluten-Free You!" Monthly - 2013 issues

Celiac Disease and Gluten Related Disorders

  • Reviewing medical literature: a primer for those living with Celiac disease  2014 A Must Read

    The safety, toxicity or otherwise of gluten…
    View as a presentation

    Author: Dr Geoff Forbes (MBBS, MD, FRACP) is a Gastroenterologist at Royal Perth Hospital, Perth, Australia; and Clinical Professor with the University of Western Australia. He is a clinician with expertise in immune conditions of the gut and in clinical nutrition. He is a teacher and researcher, and as he has family members with Celiac disease, he has a first hand knowledge of living with the gluten-free diet.

    The author has no conflicts of interest

Interpreting medical literature is difficult, time consuming, and easy to get wrong, even for the most knowledgeable. However, when someone has a life-long, but readily treatable condition such as Celiac disease, being informed is important. And before I receive objections to this statement, you will notice I said readily treatable, not easily treatable! Understanding empowers the individual, makes living with a GF diet easier, and is likely to result in improved health. I would not like to think that my missive will lead to CD patients turning to the medical literature in droves, but I hope that it provides some basis from which to be more enquiring of published data and reports.

  • *Celiac Disease Symptoms Fact Sheet - NEW
    - A comprehensive list of celiac disease symptoms. 4 page fact sheet
  • CD: The Great Mimic - 2000
    -Celiac disease (CD) is one of the great mimics in gastroenterology in particular and medicine in general. About 10 percent are incorrectly diagnosed for some length of time, in some cases years.
  • Hows and Whys - 1999 - Historical Article
    From the basics to the diagnosis, all celiacs that have been diagnosed or not should read this article.
  • Neurological Complications -  1998 - Historical Article
    -Neurological complications can exhibit features including peripheral neuropathy, myelopathy, optic myopathy, epilepsy and dementia. Malabsorption of vitamins has been implicated and reaction to toxic or antigenic material because of increased mucosal permeability has been speculated in celiac disease.
  • Dermatitis Herpetiformis and Dietary Gluten - 2004
    - Dermatitis herpetiformis (DH) is an intensely pruritic, chronic blistering disease that often appears quite suddenly, mainly between the ages of 20 and 55, and is much more common in men than women. Overall prevalence—more frequent than the bullous pemphigoid group of blistering diseases—is estimated at somewhere between 10 to 39 cases/100,000 annually.

For Those Recently Diagnosed

Launching a Gluten-Free Lifestyle - 2014 
By the CSA; This guide walks you through the first week after being diagnosed, giving you ideas on how you can adjust more quickly to the gluten-free lifestyle

Celiac Disease Associated Disorders

  • Alzheimer’s Disease David N. Wolfgang - 2010
    - Celiac disease and Alzheimer’s, among others, involve early-life exposures to environmental agents. They also involve immune-inflammatory insult or dysfunction that is evident.
  • Hypothyroid - 1998 - Historical Article
    -Hypothyroidism is most commonly due to an autoimmune mechanism. Typically referred to as Hashimoto's disease, it is associated with circulating thyroid and parietal cell antibodies as well as autoantibodies to other organs of the endocrine system [which includes thyroid]. The autoantibodies are particularly common in insulin-dependent diabetics.
  • Osteoporosis - 1996 - Historical Article
    -Osteoporosis commonly means bones that have thinned from the inside due to mineral loss and have now become vulnerable to fracture. The bad news: celiacs need to see osteoporosis as a common disorder which may accompany the malabsorption syndrome. The good news, however, is that there are now several medications which can greatly assist in giving bones a boost.
  • Psoriasis - 1998 Historical Article
    -Psoriasis is a persistent skin disease that takes its name from the Greek word for "itch." In some cases, psoriasis is so mild that people don't even know that they have it. At the opposite extreme, severe psoriasis may cover large areas of the body and harbor a pustular form.
  • Why Thyroid - 1998 Historical Article
    -Thyroid disease and abnormal thyroid tests are more common in people with sprue than in the general population. At the same time celiac disease is more common in individuals who have thyroid disease. This association appears to be based on the tendency for people with autoimmune diseases to be predisposed to other autoimmune diseases. 

    *Vocabulary Evolution of Celiac Disease
  •  A Multidiscliplinary task force of 16 physicians from seven countries reviewed and evaluated current terminology during a meeting in Oslo, Norway. These definitions are the results.
  •  Abbreviations for digestive situations described at ICDS 
                                     -PWAWG             Patients Who Avoid Wheat and/or Gluten (in the Absence of Celiac
    Disease) coined by Peter Green, MD:
                                     -SIBO               Small Intestine Bacterial Overgrowth

                                     -FODMAP         Fermentable Oligosaccharides Disaccharides Monsaccharides Polyols

Nutrition and Your Wellness

  • Quick Start Diet Guide - 2013 - Collaborative Effort

    -The Quick Start Guide is designed to provide a basic understanding of the gluten-free diet. Not all areas of the diet are as clear-cut as portrayed by this Guide. This is intended to be used as a basic reference tool for people newly diagnosed with celiac disease, dermatitis herpetiformis and non-celiac gluten sensitivity. For more detailed information consult with a dietitian who is knowledgeable in the gluten-free diet and go to the websites listed at the end of this resource. Information Sheet about Collaboration effort.

  • Medical Foods - 1997 - Historical Article
    -The question is: Should there be a category of medical foods for patients with the conditions of nontropical sprue and dermatitis herpetiformis? The Food and Drug Administration (FDA) is soliciting comments to initiate a reevaluation of its approach to the regulation of the broad group of heterogeneous products that are marketed as medical foods. FDA's goal is to arrive at a regulatory regime that will ensure the following goals:
  • Nutritional Care - 1995 - Historical Article
    -The question is: Should there be a category of medical foods for patients with the conditions of nontropical sprue and dermatitis herpetiformis? The Food and Drug Administration (FDA) is soliciting comments to initiate a reevaluation of its approach to the regulation of the broad group of heterogeneous products that are marketed as medical foods. FDA's goal is to arrive at a regulatory regime that will ensure the following…
  • Rational GF Food - 1996 - Historical Article
    -The ingestion of small amounts of gluten by gluten intolerant individuals can lead to morphological changes in the gut that may increase the risk of lymphoma, other forms of cancer and reduced bone mineralization. Celiac disease and dermatitis herpetiformis, a skin condition closely related to celiac disease, are the primary diseases treated with a gluten-free diet.
  • Safe Amounts - 1995 - Historical Article
    -Most celiacs don't need to worry about getting enough nutrients once they are stabilized and on an appropriate clinical diet adjusted to their condition and appropriate for them at their particular age and stage in life. But should we be concerned about getting too much?
  • Searching - 1997 - Histocial Article
    -Those of us with chronic illnesses benefit greatly from simple, inexpensive screening tools that lead to diagnosis and, in some cases, help to monitor the progress of treatment.
  • Vinegar 
    -Some people with celiac disease maintain optimal health by choosing only naturally gluten-free products, others find a personal balance between a greater range of gluten-free labeled products that are not naturally gluten-free. The information provided gives aspects to consider when choosing vinegar. 

Social and Family Issues

  • Helping Our Family & Friends Understand - 2013
    I want you to know – I will be okay! BUT I need your support and understanding. I have “celiac disease” and I have to..
  • Communion - 2003
    -Many congregations include believers whose health is at risk by consuming any wheat, barley, rye and common oats. An estimated 1 in 100 Americans are affected by wheat sensitivities and celiac disease, a genetic autoimmune disease. In seeking an opportunity for full open communion, many churches inquire about a positive way to serve parishioners who cannot eat wheat. It is evident that the bread formulated without wheat and gluten is suitable for the entire congregatio
  • Coping - 1993 - Historical Article
    -One of the most supported forms of coping is the importance of sharing feelings in support groups. The insecurities, frustrations and adjustments related to the gluten-free diet and the illness should be aired with those who understand our situation. Such meetings can contribute greatly to easing denial, isolation and potential anger
  • Then and Now - 1998 - Historical Article
    -The challenge of living with celiac disease is not trivial. A lot of people say, "Well, what's the big deal. You just get on the gluten-free diet, and you are cured." But eating gluten-free is not simple, so that is the challenge. The good news, of course, is that the complications of celiac disease can be avoided by careful adherence to a self-managed gluten-free diet.
  • Spring Candy List2015
  • Fall Candy List and Halloween Treat Guide - 2015

Labeling Food and Drugs

  • Definition of Food Labeling - 1993 - Histocial Article
    -Before passage of the 1990 Nutrition Labeling and Education Act (NLEA), the former Food, Drug, and Cosmetic Act did not require flavorings, colorings or spices to be identified by their common or usual names. Instead, they could be declared collectively as…
  • Label Reading 101 
    -Label reading is an essential skill in following a gluten-free diet. When reading labels, search for ingredients containing Wheat, Barley, Rye and Oats (WBRO) or their crosses or derivatives. Your best defense for risk-free choices is. . .
  • Label Names - 1993 - Historical Article
    - The additives commonly found in ice cream and frozen alternatives have some strange names. The list below includes some of the most common. While some are considered natural, they may be processed with chemicals. Check out the list here!
  • Label Changes  - 1993 - Historical Article
    - A packager's life can be tough. You watch the regulatory scene, and you think you know what's going on. Then one day things get so complicated that you wonder if you have even a clue. For example, food labeling.
  • 2012 CSA Gluten in Medications Position Statement - 2012
    -CSA supports eliminating ALL ingredients derived from gluten sources, from ALL forms of human medications.
  • 2011 CSA Submission to FDA Docket on Gluten-Free Labeling - 2011
    - The Celiac Support Association (CSA) supports a definition for voluntary use of the term gluten-free validated substantially lower than the proposed 20 parts per million (ppm). A lower compliance safety standard would be suitable for more celiacs, according to FDA’s own reports. The current preference of the membership is a gluten detection assay sensitive to 5 ppm. This definition would make certification programs, including the CSA Recognition Seal, unnecessary.
  • Food Drugs and Cosmetics Additives - 1992 - Historical Article
    -Color additives for use in foods, drugs, and cosmetics are regulated by the Food and Drug Administration (FDA) under its authority derived from the 1960 Color Additive Amendments to the Federal Food, Drug, and Cosmetic Act (FFDCA). The amendments shifted the burden to industry to prove that the FD&C color additives are safe
  • *Labeling and Advertising of Wines, Distilled Spirits, and Malt Beverages - 2012
    - The Alcohol and Tobacco Tax and Trade Bureau (TTB) May 24, 2012 ruling reiterates the pre Food Allergen Act of 2004 and the gluten-free proposed labeling -- working definition of gluten-free based upon FDA compliance guidelines on the use of the term “free” under misbranding penalties. Thus until a US definition for gluten-free in labeling exists or is set by the FDA, the former (and current) use of “free” is affirmed as the regulation. Click here to view the press release  and complete ruling.
  • Guidance for Industry
    Contract Manufacturing Arrangements for Drugs
  • Guidance for Industry
    Quality Risk Management
  • Guidance for Industry
    Pharmaceutical Quality System
  • The IPEC Quality Agreement Guide and Template - 2009
    - IPEC is an international industry association formed in 1991 by manufacturers and end-users of excipients. It is an association comprising four regional and country pharmaceutical excipient industry associations covering the United States, Europe, China and Japan 

Celiac Disease and Your Diet

Which vitamins and nutrients are crucial for a healthy diet while remaining gluten-free?
  • *The Diet is the Prescription - 2013, rev. 2015
    Right now you probably feel that you are the only person in the world requiring the gluten-free diet. Actually, there are millions of “celiacs” and even more with non-celiac gluten sensitivity. So...
  • Antioxidants Fact Sheet - 2010
    -Balance your calories and watch what you’re eating. Which foods do you eat daily that already have the antioxidants you need for a healthy diet?
  • B-12 Fact Sheet - 2010
    - Should you consume B-12 each day? What are the benefits and how much is the right amount?
  • Calcium Fact Sheet - 2010
    -What amount of Calcium should you ingest daily? Are strong bones and teeth the only reason to consume calcium?
  • Carbohydrate Intolerance Fact Sheet - 2012
    - It is rare to read a health or diet article without seeing something about high carbohydrate, low carbohydrate, or specific carbohydrate diets. Common advice is to avoid foods containing certain carbohydrates. Carbohydrates are an essential source of nutrition…but why?
  • Iron Fact Sheet - 2010
    -How much iron should you consume a day? Did you know that iron can reduce the risk of anemia, weakness, and fatigue?
  • Vitamin D Fact Sheet - 2010
    - Vitamin D is an important nutrient for helping our bodies absorb calcium. How much Vitamin D is the recommended amount per day? Which foods do you already consume that contains Vitamin D?
  • *All-Purpose Gluten Free Flour Comparison Fact Sheet - 2014 - Contains nutritional information about a number of commercial brands of gluten-free all-purpose flours.
Beans and their hidden magic!
  • Beans' Role In Gluten Free Diet - 2012
    -Beans are one of nature’s hidden treasures. Being economical, having not only a long shelf-life but a good source of protein, complex carbohydrates, fiber, vitamins, minerals and antioxidants, no wonder beans-beans are good for your heart.
  • Beans - Saving Money - 2012
    - Why spend money on supplements when you can save money and buy beans?
  • Beans and Flatulence: Fact or Fiction - 2012
    - Beans give you gas, is it true or false? Learn how to prepare beans and reduce the risk for embarrassing flatulence.
  • Beans and Legumes Cooking Chart with Recipes! - 2012
    -Learn how to prepare all sorts of beans and view recipes from our CSA test kitchen experts! 

Did you know?

Helpful tips and truths that each Celiac should keep in mind while maintaining a gluten free lifestyle.
  • Define the term Gluten Free - 2012
    -The United States Food and Drug Administration (FDA) has proposed a definition for voluntary use of the term which was posted in the Federal Register on January 3, 2007.
  • *Gluten-sensitivity and Current Definitions
    If about 1% of the populatio nhas celiac disease, an estimated six times more people are in the ambiguous situation of negative or non-conclusive diagnostic test results. And most of the symptoms improve on a ...
  • Definitions Associated with Celiac Disease - 1996 - Historical Article
    -The following concepts and definitions are offered to relate to requests from celiacs and dietitians for "textbook definitions" related to celiac disease.
  • Current Terminology Fact Sheet - 2010
    - What is Celiac Disease? What else can be associated with Celiac Disease?
  • Folate/Folic Acid Fact Sheet - 2012
    -Folate and Folic Acid is needed to produce and maintain new cells. But what amount is pristine for children and adults?
  • Gluten Free Whole Grains Health Fact Sheet - 2011
    -Are gluten-free grains on your plate? Grains are a common topic for those who require the gluten-free diet. Often, however, the subject is how to avoid grains that contain gluten.
  • Potential Risk Exposure Fact Sheet - 2011
    - According to the FDA Hazard Assessment, “the tolerable daily intake level for gluten in individuals with celiac disease was determined to be 0.4 mg gluten/day for adverse morphological effects and 0.015 mg gluten/day for adverse clinical effects.” What is the potential for consuming gluten
  • Weight Management Fact Sheet - 2011
    - Living healthy for today and your future! Plan your portions and be introduced to smart lifestyle choices to optimize your health.
  • Digestive Disease National Coalition Fact Sheet -2012
    -Get tested today!
  • Classification of Cereals - 2010
    -All cereals are from the grain family Poaceae, but which sub-family is the cereal you’re eating from?
  • Gliadin in Foods - 1994 - Historical Article
    -Is Gliadin in your food? What is it, and how do I avoid it?
  • Adapt Traditional Recipes to Gluten-Free
    -Almost any food can be adapted to become gluten-free. Some of the guidelines for gluten-free cooking are…
  • Guide to Oats - 2009
    -Oats appear to be suitable for most people with celiac disease and gluten-related disorders, but not all. Medical experts advise waiting until symptoms have resolved before introducing pure, uncontaminated oats (labeled gluten-free). For some, this could mean delaying the introduction of oats for a year or longer…
  • Celiac Disease Defined - Oat Intolerance - 2004
    -Celiac disease is a small intestinal inflammatory disorder characterized by malabsorption, nutrient deficiency, and a range of clinical manifestations. It is caused by an inappropriate immune response to dietary gluten and is treated with a gluten-free diet. Recent feeding studies have indicated…
  • Celiac Disease Defined - “Spelt Is Wheat” - 2012
    -The two major wheat species used for food production are bread wheat and durum wheat. However, other types of wheat were cultivated and consumed historically, and are still marketed today.
  • Preparing for Disaster - 2012
    -Natural disasters and medical emergencies are sometimes an unfortunate occurrence in the life of a celiac. Preparing for a disaster can help reduce stress and maintain health.
  • Celiac Centers - 2013
    -Locate a Celiac Center closest to you.
  • 2012 Nebraska State Fair - Sorghum Recipes - 2012
    -The Celiac Support Association would like to share these Gluten-Free recipes originally published for the 2012 Nebraska State Fair. Click the name of the recipe to access the recipe in our database.
  • 2012 Q4 Lifeline Recipes - 2012
    -Our fourth Quarter edition of our publication, Lifeline. If you are a CSA member please click any of the links below to access the printable, digital copy of the recipe, in our CSA Recipe database.
  • The Breeder's Dilemma - 2004
    -Plant breeders, challenged to create more nutritious crops, face seemingly radical choices that constitute a "breeder's dilemma". In the search for higher yields and lower farming costs, have breeders inadvertently selected for crops with reduced nutritional quality? 

Tax Deduction with Celiac Disease

Featured in Lifeline  Issue 2014 Volume XXXIV No. 2:

Gluten-Free Forever




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