#30 - 🔍 90% of high-risk kids aren't tested

Hey readers! 👋 This week we're diving into some eye-opening screening gaps, the ongoing oats debate, and why your mental health matters just as much as your gut health. Plus, there's a new app for our friends down under and some important label-reading reminders heading into the holiday season.

Only 1 in 10 High-Risk Children Are Being Tested for Celiac Disease — A Beyond Celiac-funded study reveals that despite clear guidelines, only about 10% of children with conditions that should trigger celiac screening are actually being tested. – Beyond Celiac

The racial disparities here are particularly concerning: non-Hispanic Black children are screened at less than 7%, compared to over 12% of non-Hispanic White children. Older children (ages 11-20) are twice as likely to be tested as younger ones. These gaps likely contribute to the diagnostic delays we hear about so often. The study authors are calling for either universal screening or much stronger efforts to ensure doctors follow existing guidelines.

High-Quality Nutritional and Medical Care in Celiac Disease Follow-Up — A new narrative review emphasizes that successful long-term celiac management requires a coordinated, multidisciplinary team approach. – PubMed

The review highlights emerging tools like gluten-immunogenic-peptide testing, digital health platforms, and AI as promising additions to improve adherence and catch relapses early. It also acknowledges what many of us already know: the gluten-free diet brings nutritional, economic, and psychosocial challenges that need ongoing attention.

Oats on the Gluten-Free Diet — The National Celiac Association addresses the complex and evolving safety picture around gluten-free oats. – National Celiac Association

The bottom line: commercial oats frequently contain gluten due to cross-contact and inadequate testing. A small subset of celiac patients also react to avenin, the oat protein itself. There's no universal recommendation here. If you want to include oats, work with your specialist to create an individualized plan based on your symptoms, antibody levels, and overall diet.

Depressive and Anxiety Symptoms in Patients with Celiac Disease — A review confirms that depression and anxiety are common comorbidities in celiac disease, with severity linked to how long someone has had the condition. – PubMed

The good news: a strict gluten-free diet, and potentially probiotics, can help alleviate these psychological symptoms. Family emotional support also plays a significant role in disease progression. Caregivers and healthcare providers should be monitoring for anxiety and depression, which are often overlooked but can worsen outcomes.

Adolescent Mental Health Predicts College Health Perceptions — A five-year follow-up study found that higher depressive symptoms and lower quality of life during adolescence predicted poorer perceived physical health in college-age celiac patients. – PubMed

Interestingly, neither adolescent mental health nor college health perceptions reliably predicted gluten-free diet adherence. The takeaway: early mental health screening in adolescents with celiac disease may help smooth the transition to independent dietary management in adulthood.

New Antibody Test Improves Celiac Disease Diagnosis in T1D — Researchers identified an optimal TGA-IgA threshold of about 6.1 times the upper limit of normal for recommending biopsies in children with type 1 diabetes, achieving 90.3% sensitivity. – Medscape

Adding IgG against deamidated gliadin peptides to the panel further improved accuracy. Elevated TGA-IgA at T1D diagnosis can predict celiac disease development within two years.

Virus-Related Respiratory Infections Linked to Celiac Disease Onset — The MAVRiC study found that respiratory infections reported during August-October were consistently associated with elevated risk of progressing from celiac autoimmunity to clinically manifest celiac disease. – Scientific Reports

Female sex, HLA and non-HLA genetic variants, and higher gluten consumption also independently elevated risk. This longitudinal resource will enable detailed analysis of viral and bacterial contributions to celiac pathogenesis.

Celiac Disease Symptoms Differ by Age of Onset — Children whose symptoms began at or before 24 months had higher symptom burden, including vomiting, mood changes, poor weight gain, and growth delay, and were more likely to be hospitalized. – ESPGHAN

Those with later onset (after 24 months) more frequently reported abdominal pain with fewer extra-intestinal manifestations. Time to diagnosis remained similar across both groups.

Childhood vs. Adult Diagnosis: Long-Term Outcomes — Patients diagnosed in childhood experienced fewer miscarriages but higher rates of allergies, dermatologic conditions, asthma, and depression in adulthood compared to those diagnosed as adults. – S. Karger AG

How Do We Solve a Problem Like 'May Contain' — Celiac Canada highlights how voluntary 'May Contain' warnings create confusion and limit choices for people with celiac disease. – Canadian Celiac Association

Advocacy efforts have prompted the FAO/WHO to include gluten in their global food allergen risk assessments. Celiac Canada is pushing for clearer labeling and stricter manufacturing controls.

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