#32 - 🧠 Your brain on gluten antibodies

Hey readers! 👋 This week brings some fascinating research on brain health, a promising new drug study, and important updates on diagnosis and diet management. Plus, we've got practical insights on everything from gluten-free bread science to travel tips that could save your next vacation.

Poorer brain health in celiac disease linked to specific antibody — A UK study found that persistent antibodies against Transglutaminase 6 (TG6) are associated with accelerated brain atrophy, increased depression, and reduced physical functioning in people with gluten-related disorders. The encouraging news? Strict adherence to a gluten-free diet lowered TG6 levels, suggesting the antibody could serve as a valuable monitoring tool. Unfortunately, TG6 testing remains limited to specialized neurology centers for now. – Beyond Celiac

ZED1227 prevents gluten-induced intestinal damage in new study — Published in Nature Immunology, this research shows that ZED1227, which blocks the enzyme transglutaminase-2, effectively prevents the cascade of gene-expression changes that lead to inflammation and villous atrophy. The study also revealed that patients with two risk alleles may need higher doses, pointing toward more personalized treatment approaches. – Beyond Celiac

Specialized gut cells linked to celiac disease — Researchers discovered that human microfold (M) cells can act as antigen-presenting cells, taking up and presenting gluten peptides to T helper cells, a capability absent in mouse M cells. This finding opens new avenues for understanding how celiac disease initiates. – Technology Networks

IL-2 blood test outperforms standard methods — An optimized interleukin-2 whole-blood assay achieved 80% sensitivity before gluten challenge and 90% after, compared to just 20% and 40% for the conventional interferon-γ ELISpot test. This could mean identifying gluten-specific T cells without requiring an oral gluten challenge. – PubMed

No-biopsy diagnosis debate continues — While European guidelines increasingly support serology-only diagnosis for pediatric celiac disease, North American practice remains in transition. Evidence suggests high-titer TTG antibodies combined with HLA-typing can accurately diagnose most patients, but recent studies show children diagnosed without biopsy may experience poorer mucosal healing. – PubMed

Early antibiotics linked to celiac disease risk — A study of over 1.8 million Israeli children found antibiotic use in the first year of life was associated with increased celiac disease autoimmunity, with a clear dose-response relationship. The association was stronger in females and children from lower socioeconomic backgrounds. – PubMed

Most children with celiac disease have normal BMI at diagnosis — A meta-analysis of over 14,000 children found 70% presented with normal BMI, challenging the traditional view that celiac disease mainly causes undernutrition. Underweight prevalence was nearly four times higher in low and middle-income countries compared to high-income regions. – Springer Nature

Nutritional challenges in pediatric gluten-free diets — A narrative review warns that long-term gluten-free diets in children can lead to deficiencies in iron, folate, B12, vitamin D, calcium, zinc, and magnesium, along with reduced fiber intake and gut microbiota changes. Unmonitored diets may impair growth and neurodevelopment. – PubMed

Celiac disease as a model of intestinal malnutrition — Children on long-term gluten-free diets tend to consume more saturated fats and simple carbohydrates while falling short on fiber and micronutrients. Gluten-free products are often lower in protein and less fortified than their gluten-containing counterparts. – PubMed

New FAO/WHO guidance clarifies "may contain gluten" labeling — The new 4mg per serving reference dose will help regulators determine when precautionary allergen labels are truly warranted, potentially eliminating confusing warnings on foods that already meet the gluten-free standard. The 20ppm standard remains unchanged. – Celiac Disease Foundation

High-protein rice flour improves gluten-free bread — Adding just 0.1% alpha-amylase enzyme to high-protein rice flour significantly improved bread texture, reducing hardness and chewiness while boosting consumer appeal. – PubMed

Cross-contamination study offers nuanced perspective — Analysis of nearly 28,000 food samples across 28 countries found that while 20% contained gluten above 20mg/kg, only 0.9% exceeded clinically relevant levels. The authors suggest strict avoidance of all cross-contact may be unnecessary and could foster disordered eating. – PubMed

Gluten-free product compliance varies by region — A Lebanese study found 9.6% of gluten-free products exceeded the 20ppm threshold, with local products showing 18.5% non-compliance versus just 1.6% for imports. – PubMed

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