basic introduction to gluten related health issues

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Basic Introduction to Gluten-Basic Introduction to Gluten-Related Health Issues and Related Health Issues and

Celiac DiseaseCeliac Disease

By William T. Beverly, Ph.D., L.C.S.W.By William T. Beverly, Ph.D., L.C.S.W.

(November 2008)(November 2008)

(copyright 2008, William T. Beverly, Ph.D.)(copyright 2008, William T. Beverly, Ph.D.)

www.glutenfreesimplicity.wordpress.comwww.glutenfreesimplicity.wordpress.com

NoteNote

Many of the slides here contain citations Many of the slides here contain citations noting the sources being used. noting the sources being used. – If you are online and you click on the source If you are online and you click on the source

(typically at the bottom of the quote) you (typically at the bottom of the quote) you should be taken to the original source itself.should be taken to the original source itself.


BackgroundBackground

Of the Gluten-Related Illnesses Celiac Of the Gluten-Related Illnesses Celiac Disease is the most common.Disease is the most common.

– Celiac disease affects at least 3 million Americans.Celiac disease affects at least 3 million Americans.– About 1% of Americans.About 1% of Americans.

((UChicago Celiac Disease Center, 2008UChicago Celiac Disease Center, 2008))


Celiac DiseaseCeliac Disease

““Celiac disease (CD) is a genetic disorder. Celiac disease (CD) is a genetic disorder.

In people with CD, eating certain types of In people with CD, eating certain types of protein, called gluten, sets off an autoimmune protein, called gluten, sets off an autoimmune response that causes damage to the small response that causes damage to the small intestine. intestine.

This, in turn, causes the small intestine to lose This, in turn, causes the small intestine to lose its ability to absorb the nutrients found in food, its ability to absorb the nutrients found in food, leading to malnutrition and a variety of other leading to malnutrition and a variety of other complications.” complications.”

((CSACeliacs.org, 2008CSACeliacs.org, 2008).).


Celiac Disease HistoryCeliac Disease History

““Celiac sprue disease was first described in the Celiac sprue disease was first described in the second century, but it wasn't until the 20th second century, but it wasn't until the 20th century that rudimentary causative factors were century that rudimentary causative factors were identified. Terminology changed as research identified. Terminology changed as research confirmed that celiac disease diagnosed in confirmed that celiac disease diagnosed in children was the same disease as non-tropical children was the same disease as non-tropical sprue diagnosed in adults. The term "celiac sprue diagnosed in adults. The term "celiac disease" is now most commonly used. Another disease" is now most commonly used. Another term for the same condition includes "gluten term for the same condition includes "gluten sensitive enteropathy" (sensitive enteropathy" (CSACeliacs.org, 2008CSACeliacs.org, 2008).).


Symptoms of Celiac DiseaseSymptoms of Celiac Disease

Abdominal cramping/bloating Abdominal cramping/bloating Feet (Reduced fat padding) Feet (Reduced fat padding) Abdominal distention Abdominal distention Flatus (Passing gas) Flatus (Passing gas) Acidosis Acidosis Gluten ataxia Gluten ataxia Appetite (Increased to the point of craving) Appetite (Increased to the point of craving) Mouth sores or cracks in the corners Mouth sores or cracks in the corners Back pain (Such as a result of collapsed lumbar vertebrae) Back pain (Such as a result of collapsed lumbar vertebrae) Muscle cramping (Especially in the hands and legs) Muscle cramping (Especially in the hands and legs) Constipation Constipation Night blindness Night blindness Decreased ability to clot blood Decreased ability to clot blood

Continued on next slide.Continued on next slide.


Symptoms of Celiac Disease cont.Symptoms of Celiac Disease cont.

Skin (Very dry) Skin (Very dry)

Dehydration Stools (Loose? Hard? Small? Large? Foul smelling? Dehydration Stools (Loose? Hard? Small? Large? Foul smelling? Floating? Clay, Light tan or Gray-colored? Highly rancid? Frothy?) Floating? Clay, Light tan or Gray-colored? Highly rancid? Frothy?) Diarrhea (See Stools below) Diarrhea (See Stools below) Tongue (Smooth or geographic - looks like different continents) Tongue (Smooth or geographic - looks like different continents) Edema Edema Tooth enamel defects Tooth enamel defects Electrolyte depletion Electrolyte depletion Weakness Weakness Energy loss Energy loss Weight loss Weight loss FatigueFatigue


Emotion-Specific Symptoms of Emotion-Specific Symptoms of Celiac Disease include:Celiac Disease include:

Depression Depression

Disinterested in normal activities Disinterested in normal activities

Irritable Irritable

Mood changes Mood changes

Unable to concentrate Unable to concentrate

FatigueFatigue


Gluten, Adults & Mental IllnessGluten, Adults & Mental Illness

““Paulley wrote in 1959: many (adult celiacs):Paulley wrote in 1959: many (adult celiacs):– showed extreme obsessional neuroses, showed extreme obsessional neuroses, – suffering delusions, suffering delusions, – frequently believing they had cancer. frequently believing they had cancer. – Paranoid ideas were also frequent and Paranoid ideas were also frequent and – many were considered psychotic or near psychotic.”many were considered psychotic or near psychotic.”

(from Professor F. C. Dohan of the University of (from Professor F. C. Dohan of the University of Pennsylvania was the first researcher to use this concept, Pennsylvania was the first researcher to use this concept, beginning in the late 1960’s. He quoted from earlier beginning in the late 1960’s. He quoted from earlier researchers in his article published in The Biological Basis researchers in his article published in The Biological Basis of Schizophrenia (Hemmings, ed; MTP Press; London, of Schizophrenia (Hemmings, ed; MTP Press; London, 1980)).1980)).


Emotional Impact of Celiac Emotional Impact of Celiac Disease in AdulthoodDisease in Adulthood

““Psychic alterations have been reported in celiac disease. Psychic alterations have been reported in celiac disease. Our aim was to evaluate:Our aim was to evaluate:– the emotional impact of celiac disease diagnosis in adulthood, the emotional impact of celiac disease diagnosis in adulthood, – the patient/doctor relationship, and the patient/doctor relationship, and – the patients’ cooperation with disease treatment and diet. the patients’ cooperation with disease treatment and diet.

The patients were 114 adult celiac patients on a gluten-free diet, The patients were 114 adult celiac patients on a gluten-free diet, there were 25 untreated celiac patients. there were 25 untreated celiac patients. Self-administered questionnaires aimed to evaluate:Self-administered questionnaires aimed to evaluate:– the patients’ level of knowledge of disease, the patients’ level of knowledge of disease, – the emotional impact at diagnosis, and the emotional impact at diagnosis, and – feelings during follow-up.” feelings during follow-up.”

Continued on next slide:Continued on next slide:

(Igenta Connect, 2008)(Igenta Connect, 2008)


Emotional Impact on Adults cont.Emotional Impact on Adults cont.

““Celiac patients showed good knowledge of the disease, directly Celiac patients showed good knowledge of the disease, directly correlated to their socioeconomic level (P = 0.011). correlated to their socioeconomic level (P = 0.011). At diagnosis, relief was most intense feeling (Mean ± SD, 10.82 ± At diagnosis, relief was most intense feeling (Mean ± SD, 10.82 ± 7.63), demographics, time latency of diagnosis, and the duration of 7.63), demographics, time latency of diagnosis, and the duration of the disease had no effect on the intensity of all feelings. the disease had no effect on the intensity of all feelings. The scores of the self-rated emotions were entered into a principal The scores of the self-rated emotions were entered into a principal component analysis that generated three factors: component analysis that generated three factors: – 1 (fear, anger, anxiety and sadness),1 (fear, anger, anxiety and sadness),– 2 (reassurance and resignation), and 2 (reassurance and resignation), and – 3 (relief); patients judged the clinicians presenting the disease “in the 3 (relief); patients judged the clinicians presenting the disease “in the

right way” (F = 33.279; P < 0.0001). The right way correlated with relief right way” (F = 33.279; P < 0.0001). The right way correlated with relief and reassurance (P = 0.0009; P = 0.0008 respectively).“and reassurance (P = 0.0009; P = 0.0008 respectively).“

Continued on next slide.Continued on next slide.



Emotional Impact on Adults cont.Emotional Impact on Adults cont.

““At follow-up, anger was the predominant At follow-up, anger was the predominant emotion that induced patients to transgress. emotion that induced patients to transgress. A positive correlation was observed between A positive correlation was observed between feeling different and the sadness, anger, fear (P feeling different and the sadness, anger, fear (P < 0.0001 for all). Anger was inversely correlated < 0.0001 for all). Anger was inversely correlated with actual compliance to diet (P = 0.0005). with actual compliance to diet (P = 0.0005). In conclusion, in adult patients, adaptive and In conclusion, in adult patients, adaptive and psychological aspects must be taken into psychological aspects must be taken into account to understand the celiac patient and for account to understand the celiac patient and for better clinical management.”better clinical management.”



Children, Gluten and Mental IllnessChildren, Gluten and Mental Illness

““Celiac disease may present with psychiatric symptoms, which, in Celiac disease may present with psychiatric symptoms, which, in association with other symptoms, may be of diagnostic help... association with other symptoms, may be of diagnostic help... Kaser (1961) described celiac children as showing definite Kaser (1961) described celiac children as showing definite symptoms in all cases. The children are:symptoms in all cases. The children are:– conspicuously quiet, conspicuously quiet, – turned, turned, – inward, inward, – often weepy, often weepy, – often discontented or surly andoften discontented or surly and– apparently lack all joy in living.apparently lack all joy in living.

They can take on negativistic and schizoid characteristics and may They can take on negativistic and schizoid characteristics and may execute ceaseless stereotyped movements.”execute ceaseless stereotyped movements.”

(from Professor F. C. Dohan of the University of Pennsylvania was the first (from Professor F. C. Dohan of the University of Pennsylvania was the first researcher to use this concept, beginning in the late 1960’s. He quoted froresearcher to use this concept, beginning in the late 1960’s. He quoted from earlier researchers in his article published in The Biological Basis of Schim earlier researchers in his article published in The Biological Basis of Schizophrenia (Hemmings, ed; MTP Press; London, 1980)).zophrenia (Hemmings, ed; MTP Press; London, 1980)).


Illnesses Commonly Associated Illnesses Commonly Associated with Gluten-Sensitivitywith Gluten-Sensitivity

Celiac DiseaseCeliac DiseaseCrohn’s DiseaseCrohn’s DiseaseDermatitis HerpetiformisDermatitis HerpetiformisAutismAutismGluten Sensitive EnteropathyGluten Sensitive EnteropathyChronic Fatigue SyndromeChronic Fatigue SyndromeSchizophreniaSchizophreniaRheumatoid ArthritisRheumatoid ArthritisDepressionDepressionThyroid DiseaseThyroid DiseaseMigrainesMigrainesADDADD


Celiac Disease and WheatCeliac Disease and Wheat

““Dr. Willem Karel Dicke, a Dutch pediatrician, Dr. Willem Karel Dicke, a Dutch pediatrician, recognized in 1952 that the disease is caused recognized in 1952 that the disease is caused by the ingestion of wheat proteins. He wrote his by the ingestion of wheat proteins. He wrote his doctoral thesis on the subject for the University doctoral thesis on the subject for the University of Utrecht in 1950. By 1954, Dicke, Charlotte of Utrecht in 1950. By 1954, Dicke, Charlotte Anderson and a number of their colleagues, Anderson and a number of their colleagues, working in Birmingham, England confirmed the working in Birmingham, England confirmed the treatment and described the histologic damage treatment and described the histologic damage to the intestinal mucosa as being directly related to the intestinal mucosa as being directly related to celiac disease.” (to celiac disease.” (CSACeliacs.org, 2008CSACeliacs.org, 2008).).


Good Old WheatGood Old Wheat

““The offending protein, gluten, is found in The offending protein, gluten, is found in wheat, barley, rye, and to a lesser extent, wheat, barley, rye, and to a lesser extent, oats (WBRO). Related proteins are found oats (WBRO). Related proteins are found in triticale, spelt, kamut.” in triticale, spelt, kamut.”

((CSACeliacs.org, 2008CSACeliacs.org, 2008).).

With the historical prevalence of wheat in With the historical prevalence of wheat in Western foods and other products, Western foods and other products, avoiding hidden sources of Gluten is very avoiding hidden sources of Gluten is very difficult.difficult.


Primary Treatment for Celiac Primary Treatment for Celiac DiseaseDisease

Gluten-Free Diet, includes:Gluten-Free Diet, includes:– No WheatNo Wheat– No BarleyNo Barley– No OatsNo Oats– No RyeNo Rye– No products that have been cross-contaminated with No products that have been cross-contaminated with

the above. This can include:the above. This can include:Mayonnaise, Salad Dressings, Vinegar, Sauces, SoupsMayonnaise, Salad Dressings, Vinegar, Sauces, SoupsBeer, Liquors, Cakes, Cookies, CrackersBeer, Liquors, Cakes, Cookies, CrackersVinegar, Soy Sauce, Steak SaucesVinegar, Soy Sauce, Steak SaucesMake upsMake upsSome medicinesSome medicines


Prevalence of Celiac DiseasePrevalence of Celiac Disease

““In average healthy people: 1 in 133In average healthy people: 1 in 133In people with related symptoms: 1 in 56In people with related symptoms: 1 in 56In people with first-degree relatives (parent, child, sibling) who are In people with first-degree relatives (parent, child, sibling) who are celiac: 1 in 22celiac: 1 in 22In people with second-degree relatives (aunt, uncle, cousin) who are In people with second-degree relatives (aunt, uncle, cousin) who are celiac: 1 in 39celiac: 1 in 39Estimated prevalence for African-, Hispanic- and Asian-Americans: Estimated prevalence for African-, Hispanic- and Asian-Americans: 1 in 2361 in 236In the landmark prevalence study on celiac disease, investigators In the landmark prevalence study on celiac disease, investigators determined that 60% of children and 41% of adults diagnosed determined that 60% of children and 41% of adults diagnosed during the study were asymptomatic (without any symptoms).”during the study were asymptomatic (without any symptoms).”

Source: A multi-center study on the sero-prevalence of celiac disease in the Source: A multi-center study on the sero-prevalence of celiac disease in the United States among both at risk and not at risk groups. Fasano et. al., United States among both at risk and not at risk groups. Fasano et. al., Archives of Internal Medicine. February 2003.Archives of Internal Medicine. February 2003.((UChicago Celiac Disease Center, 2008UChicago Celiac Disease Center, 2008))


How Common is Celiac Disease?How Common is Celiac Disease?

““Nearly one out of every 133 Americans Nearly one out of every 133 Americans suffer from Celiac Disease, according to a suffer from Celiac Disease, according to a new study by the University of Maryland new study by the University of Maryland Center for Celiac Research in Baltimore. Center for Celiac Research in Baltimore. The research indicates that celiac is twice The research indicates that celiac is twice as common as Crohn's disease, ulceric as common as Crohn's disease, ulceric colitis and cystic fibrosis combined.” colitis and cystic fibrosis combined.”

(UM, Celiac Center.org, 2008) (UM, Celiac Center.org, 2008) . .


Celiac Disease and CultureCeliac Disease and Culture

““Celiac (see-lee-ack) disease appears to Celiac (see-lee-ack) disease appears to be most common among those of us with be most common among those of us with Scandinavian-Celtic roots.”Scandinavian-Celtic roots.”

““In Finland they have Gluten-Free burgers In Finland they have Gluten-Free burgers at their McDonald's” at their McDonald's”

(Ancestry.com, 2007).(Ancestry.com, 2007).


ComplicationsComplications

Early diagnosis of celiac disease is Early diagnosis of celiac disease is important, as it might prevent important, as it might prevent complications.complications.

““Untreated Celiac Disease has also been Untreated Celiac Disease has also been linked an increased risk of certain types of linked an increased risk of certain types of cancer, especially intestinal lymphoma.” cancer, especially intestinal lymphoma.”

(UM, Celiac Center.org, 2008) .(UM, Celiac Center.org, 2008) .


Long-Term Effects of Celiac Long-Term Effects of Celiac DiseaseDisease

““Untreated Celiac Disease can be life threatening. Untreated Celiac Disease can be life threatening. Celiacs are more likely to be afflicted with problems Celiacs are more likely to be afflicted with problems relating to malabsorption, including:relating to malabsorption, including:– osteoporosis, osteoporosis, – tooth enamel defects, tooth enamel defects, – central and peripheral nervous system disease, central and peripheral nervous system disease, – pancreatic disease, pancreatic disease, – internal hemorrhaging, internal hemorrhaging, – organ disorders (gall bladder, liver, and spleen), and organ disorders (gall bladder, liver, and spleen), and – gynecological disorders.” gynecological disorders.”

(UM, Celiac Center.org, 2008) (UM, Celiac Center.org, 2008) ..


Delay in DiagnosisDelay in Diagnosis

““The average length of time it takes for a The average length of time it takes for a symptomatic person to be diagnosed with celiac symptomatic person to be diagnosed with celiac disease in the US is four years; this type of delay disease in the US is four years; this type of delay dramatically increases an individual’s risk of dramatically increases an individual’s risk of developing autoimmune disorders, neurological developing autoimmune disorders, neurological problems, osteoporosis and even cancer.” problems, osteoporosis and even cancer.”

Source: Characteristics of adult celiac disease in the USA: Source: Characteristics of adult celiac disease in the USA: results of a national survey. Green, P.H. et.al. American results of a national survey. Green, P.H. et.al. American Journal of Gastroenterology, 2001, 2006.Journal of Gastroenterology, 2001, 2006.

(UChicago Celiac Disease Center, 2008)(UChicago Celiac Disease Center, 2008)


Awareness is KeyAwareness is Key

““A recent study in North America shows that an active A recent study in North America shows that an active case-finding strategy in the primary care setting is an case-finding strategy in the primary care setting is an effective means to improve the diagnostic rate of Celiac effective means to improve the diagnostic rate of Celiac Disease: Disease: by screening with the blood test all subjects by screening with the blood test all subjects belonging to known “at-risk” groups such as those belonging to known “at-risk” groups such as those listed above, the diagnosis rates increased more listed above, the diagnosis rates increased more than 40-folds.”than 40-folds.”

Source: Duration of exposure to gluten and risk for autoimmune Source: Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Ventura A, et.al. Autoimmune Disorders in Celiac Disease. Ventura A, et.al. Gastroenterology 1999 Aug;117(2):297-303. Rampertab SD et al. Gastroenterology 1999 Aug;117(2):297-303. Rampertab SD et al. Trends in the Presentation of Celiac Disease Am J Medicine 2006Trends in the Presentation of Celiac Disease Am J Medicine 2006Catassi C et al. Detection of Celiac disease in primary care: a Catassi C et al. Detection of Celiac disease in primary care: a multicenter case-finding study in North America. Am J multicenter case-finding study in North America. Am J Gastroenterol 2007Gastroenterol 2007


Blood Tests for Celiac DiseaseBlood Tests for Celiac Disease

““A number of tests, sometimes collectively A number of tests, sometimes collectively referred to as the referred to as the Celiac Blood PanelCeliac Blood Panel, will aid the , will aid the physician in diagnosis. The tests may include, physician in diagnosis. The tests may include, but are not limited to:but are not limited to:– Serologic Tests Serologic Tests

EMA (Immunoglobulin A anti-endomysium antibodies) EMA (Immunoglobulin A anti-endomysium antibodies) AGA (IgA anti-gliadin antibodies) AGA (IgA anti-gliadin antibodies) AGG (IgG anti-gliadin antibodies) AGG (IgG anti-gliadin antibodies) tTGA (IgA anti-tissue transglutaminase) tTGA (IgA anti-tissue transglutaminase) Tolerance or Measure of Digestion/Absorption Tests Tolerance or Measure of Digestion/Absorption Tests Lactose tolerance test. Lactose tolerance test. D-Xylose test.”D-Xylose test.”


Before and After results from an Before and After results from an informal survey of about 20 informal survey of about 20 people with gluten related people with gluten related

sensitivitysensitivity

After going gluten-free, more than 90% reported After going gluten-free, more than 90% reported improvement from the gluten-free diet. improvement from the gluten-free diet. All Participants spoke of delayed learning prior All Participants spoke of delayed learning prior to a gluten-free diet either in themselves or their to a gluten-free diet either in themselves or their children. children.

Please Go to then next slide.Please Go to then next slide.


Before going gluten-free, Participants had Before going gluten-free, Participants had the following difficulties/complaints:the following difficulties/complaints:

Daydreaming in school Daydreaming in school Difficulty in finishing sentences and finding words Difficulty in finishing sentences and finding words Speech delay Speech delay In and out of Special Education classes In and out of Special Education classes Delays in walking and talking Delays in walking and talking Delayed puberty including menarche Delayed puberty including menarche Vitamin deficiencies Vitamin deficiencies Non-epileptic seizures Non-epileptic seizures Arthritis and osteopenia Arthritis and osteopenia Short term and long term memory was not good Short term and long term memory was not good Many reports of struggles with school but score high in intelligence Many reports of struggles with school but score high in intelligence Misdiagnosis of fibromyalgia Misdiagnosis of fibromyalgia Visual and auditory delusions Visual and auditory delusions Anxiety problems, tummy aches Anxiety problems, tummy aches Temporary dyslexia Temporary dyslexia

(Gluten-Brain Connection, 2008)(Gluten-Brain Connection, 2008)


Some of the physiological, cognitive, and Some of the physiological, cognitive, and emotional symptoms they reported with emotional symptoms they reported with

dietary avoidance of gluten included:dietary avoidance of gluten included:

Improved ability to learn Improved ability to learn Improved interest in school Improved interest in school Improved concentration Improved concentration No more meds for depression problems No more meds for depression problems No more avoidance of meeting people No more avoidance of meeting people Expected full recovery of ataxia problems (inability to coordinate muscle movements) Expected full recovery of ataxia problems (inability to coordinate muscle movements) Improved gross motor skills (was delayed in some cases) Improved gross motor skills (was delayed in some cases) Improved physical growth (was smaller than expected) Improved physical growth (was smaller than expected) Went from bottom of class to the top of his class after 3 months on diet Went from bottom of class to the top of his class after 3 months on diet Found a "hunger" for learning after avoiding gluten Found a "hunger" for learning after avoiding gluten Improved mood with less “crossness” and “crankiness” Improved mood with less “crossness” and “crankiness” Improved development to catch up with peers Improved development to catch up with peers Improved intellect with definite increases in intelligence Improved intellect with definite increases in intelligence Grade point average went from 2.5 to 3.9 Grade point average went from 2.5 to 3.9 Many have acquired college degrees with high gpa after going gluten-free Many have acquired college degrees with high gpa after going gluten-free Came alive academically Came alive academically Improved ability to meet daily challenges Improved ability to meet daily challenges Improved speed of learning ("quicker" in her studies) Improved speed of learning ("quicker" in her studies) Absenteeism no longer a problem Absenteeism no longer a problem Lots of stories about coming out of withdrawn state socially to an outgoing one -- running for student council, more motivated in doing well and meeting Lots of stories about coming out of withdrawn state socially to an outgoing one -- running for student council, more motivated in doing well and meeting people people Increased well-being and better brain chemistry Increased well-being and better brain chemistry No more "brain fog" No more "brain fog" Improved in reading (“noticeable”) Improved in reading (“noticeable”) Improved temperaments in childrenImproved temperaments in children

((Gluten-Brain Connection, 2008Gluten-Brain Connection, 2008))


BasicallyBasically

Many experts are agreed that:Many experts are agreed that:– Gluten-Related problems are genetic and/or hereditary.Gluten-Related problems are genetic and/or hereditary.– Gluten-Related illnesses such as Celiac Disease are both Gluten-Related illnesses such as Celiac Disease are both

common and appear to be common and appear to be underunder-diagnosed at this time.-diagnosed at this time.– Gluten appears to significantly impact many people on physical, Gluten appears to significantly impact many people on physical,

psychological, intellectual, social and economic levels.psychological, intellectual, social and economic levels.– Avoidance of, and/or a reduction in Gluten intake can have Avoidance of, and/or a reduction in Gluten intake can have

positive effects on several very serious and common human positive effects on several very serious and common human diseases/disorders, most clearly Celiac Disease.diseases/disorders, most clearly Celiac Disease.

– Gluten-Avoidance can be very difficult today in the U.S.A.Gluten-Avoidance can be very difficult today in the U.S.A.– There is Much More to Learn about Gluten-Related problems.There is Much More to Learn about Gluten-Related problems.

(copyright 2008, William T. Beverly, Ph.D.)(copyright 2008, William T. Beverly, Ph.D.)


The EndThe End

Contact: Contact:

– Dr. William T. Beverly, L.C.S.W.Dr. William T. Beverly, [email protected]@hotmail.com

– Dr. Beverly is also available for related consultations, menu Dr. Beverly is also available for related consultations, menu development, workshops, and presentations.development, workshops, and presentations.

www.glutenfreesimplicity.wordpress.comwww.glutenfreesimplicity.wordpress.comnepeht@[email protected]

(C.2008, William T. Beverly)(C.2008, William T. Beverly)

basic introduction to gluten related health issues

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