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References: Celiac Disease and Food Reactions

  1. Definition & Facts for Celiac Disease - National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) - The US government's plain-language overview of celiac disease, with linked pages on symptoms, causes (including the DQ2 and DQ8 gene figures), treatment, and eating. Source for the "about 2 million Americans" estimate and the difference between celiac disease, wheat allergy, and gluten sensitivity.

  2. Diagnosis of Celiac Disease - NIDDK - Explains the blood tests, small bowel biopsy, and genetic testing, and states that doctors don't recommend starting a gluten-free diet before testing. The best single page for Section 12.5.

  3. American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease - Rubio-Tapia A, et al., American Journal of Gastroenterology, 2023 - The current US clinical guideline for doctors. Its summary describes celiac disease as a permanent immune response to gluten, tTG antibodies as the first screening test, biopsy for most patients, and a strict gluten-free diet with lifelong follow-up as treatment.

  4. Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis - Singh P, et al., Clinical Gastroenterology and Hepatology, 2018 - Pooled 96 studies to estimate that 1.4% of people worldwide test positive on blood tests and 0.7% have biopsy-confirmed celiac disease. A good example of how "about 1 in 100" is calculated.

  5. Celiac Disease - MedlinePlus Genetics, US National Library of Medicine - Clear explanation of how celiac disease flattens the villi and how HLA-DQ gene variants raise the chance of an immune reaction to gluten, plus family risk figures.

  6. 23.5 The Small and Large Intestines - OpenStax, Anatomy and Physiology 2e (CC BY 4.0) - Free open textbook section on circular folds, villi, microvilli, and the brush border enzymes. Source for the villus sizes and the "more than 600-fold" surface increase in Section 12.2.

  7. Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity - Skodje GI, et al., Gastroenterology, 2018 - A double-blind, placebo-controlled crossover trial of 59 adults that tested gluten and fructan separately. The data in Your Gut Check question 5 come from this study.

  8. Long-term Intake of Gluten and Cognitive Function Among US Women - Wang Y, et al., JAMA Network Open, 2021 (free full text) - A cohort study of 13,494 women without celiac disease that found no link between gluten intake and thinking scores. The study analyzed in the chapter's claim box.

  9. Neurological Manifestations of Neuropathy and Ataxia in Celiac Disease: A Systematic Review - Mearns ES, et al., Nutrients, 2019 - Reviews 16 studies on peripheral neuropathy (reported in up to 39% of patients) and gluten ataxia (0% to 6%) in celiac disease. Useful for seeing how wide the range of estimates can be.

  10. Guidelines for the Diagnosis and Management of Food Allergy in the United States - NIAID-Sponsored Expert Panel (Boyce JA, et al.), Journal of Allergy and Clinical Immunology, 2010 (free full text) - The expert definitions of food allergy, IgE-mediated and non-IgE reactions, and food intolerance used in Section 12.9. Long and technical; the definitions are in Section 2.1.

  11. Definition & Facts for Lactose Intolerance - NIDDK - Explains lactose intolerance and lactose malabsorption, how common they are worldwide and in the US, and why lactose intolerance is different from a milk allergy.

  12. Re-challenge Studies in Non-celiac Gluten Sensitivity: A Systematic Review and Meta-Analysis - Lionetti E, et al. Frontiers in Physiology, 2017 (free full text) - Pools 11 gluten rechallenge studies: about 30% of people with suspected NCGS relapsed on gluten, overall no different from placebo, but under the Salerno method more relapsed on gluten than on placebo (40% vs 24%). Source for Section 12.8.