Grandmother and granddaughter with celiac disease share a bond that cuts across generations
By Amy Ratner, Medical and Science News Analyst Ava Giglio’s connection to her grandmother, Ginny Aires, goes beyond baking gluten-free cookies and apple pies together this Christmas. Their bond stretches across the generations as the two are bound by being the only two people in their extended family who have been diagnosed with celiac disease. That connection may wind even further back on the family tree, much like the roots of the Pennsylvania apple orchard that has been in Aires’ family since 1870. Aires’ grandfather and Giglio’s great, great grandfather left behind a journal in which he described frequent, debilitating stomach pain. No one is sure if he had celiac disease before his premature death, but the family suspects that might be the case. For Giglio and Aires that story is part of a bigger picture in which the two find the challenges of dealing with celiac disease and the gluten-free diet easier because they have each other to lean on, confide in and bake gluten-free apple pies with. “My grandmother is my number one guide on this journey,” Giglio, 22, says. “It’s been a wonderful experience in the midst of the medical difficulty.” Aires, 83, was diagnosed in her early 60s, before Giglio was born. Giglio grew up knowing that her grandmother needed special food but never thought that would eventually apply to her too. When she was in high school, Giglio started to have stomach aches, and her grandmother was the first to suggest she be tested for celiac disease because it is a genetic autoimmune condition. When Giglio’s blood tests and biopsy were positive for celiac disease, her grandmother quickly sent homemade gluten-free cookies and a new toaster that had not been cross-contaminated by gluten-containing breadcrumbs. “For a long time, my grandmother was alone [in following the gluten-free diet], Giglio says. Now the two are a team, and the entire extended family is more aware of and understanding about making gluten-free accommodations when they get together. For example, at Giglio’s sister’s wedding shower, a gluten-free sushi station was set up for grandmother and granddaughter. “My grandmother said, ‘This table is just for us gluten-free girls,’” Giglio says. The two also share a laugh and nod when someone in the family expresses surprise that gluten-free food tastes “just like the real thing.” In the past, Aires adapted recipes to make them gluten-free, but Giglio has started to bake the apple pies central to her family history. “Apple pies are a big thing in our family,” Giglio says. Her grandmother and grandfather returned to Gardeners, PA, to run Peters Orchards after years of living in Washington, D.C.  While mastering a gluten-free crust is important, the family pays more attention to the apples themselves. “The focus is on the apples to let the flavor come out,” Giglio explains. This year, Giglio had to travel across the country to share Christmas with her family. Following her graduation from Dartmouth in the spring, she started working in Los Angeles. While distance makes it harder to spend as much time with her grandmother, the two continue their strong relationship. Aires follows Giglio’s Instagram account as a way of keeping up with her granddaughter’s gluten-free adventures. “I always loved my grandmother,” Giglio says. “But an unexpected benefit of celiac disease is that it made us closer in a way we weren’t before. Even though there are 61 years between us, my grandmother is my friend, too.”
S.3021: Gluten in Medicine Disclosure Act of 2019
On December 11, 2019, Senator Richard Blumenthal [D-CT] introduced S.3021, to the Senate floor. This bill is meant to amend the Federal Food, Drug, and Cosmetic Act to require the label of a drug that is intended for human use and contains an ingredient that is derived directly or indirectly from a gluten-containing grain to identify each such ingredient, and for other purposes. It will also be known as the Gluten in Medicine Disclosure Act of 2019 and uses the same language as H.R. 2074, the bill Representative Tim Ryan [D-OH] introduced to the House in April. If passed, the bill would amend the Federal Food, Drug, and Cosmetic Act to require gluten be labeled in all medications. Read the bill.

How You Can Help

Beyond Celiac encourages you to support the Gluten in Medicine Disclosure Act of 2019 by contacting your representatives and encouraging them to cosponsor this bill. A list of those currently cosponsoring this bill can be found here. 1. Call, write, email, or send a message to your Senators and Congressional reps urging them to cosponsor this and the corresponding House bill. Include a personal story. 2. Set up district meetings as Senators are back home during recesses. 3. Attend local events and talk to their your Senators and their staff at the events urging them to cosponsor.
Contact Your Representatives Download a sample letter for your congressperson written by the staff at Beyond Celiac:
Beyond Celiac CEO Shares Personal Celiac Disease Story
Alice Bast, CEO and founder of Beyond Celiac, shared her personal celiac disease diagnosis journey with The Philadelphia Inquirer in the story titled, "Patient voices should drive celiac disease treatments beyond the gluten-free diet."
We were going to name her Emily. I didn’t know that the constant migraines, extreme stomach pain, and diarrhea that I developed after my first daughter Elizabeth was born would impact my second pregnancy. In my ninth month, I noticed the baby was no longer moving. I was told I was worrying needlessly. I wasn’t. I had a full-term stillbirth...
Read the full story on Inquirer.com. Download a PDF of the print version.
Beyond Celiac Supports the Safe Step Act
On Wednesday, November 13th, 2019 the Digestive Disease National Coalition (DDNC) will coordinate a National Day of Advocacy to encourage federal legislators to address step therapy reform by supporting the Safe Step Act (HR 2279 / S. 2546). Otherwise known as a “fail first” protocol, step therapy is an insurance practice which mandates that patients try and fail medications preferred by their insurer before they can utilize treatments prescribed by their doctor. While the practice can sometimes be used to contain the costs of prescription drugs, it can also have serious negative impacts on patients, including delayed access to the most effective treatments, severe side effects, and irreversible disease progression. Step therapy protocols may ignore a patient’s unique circumstances and medical history. That means patients may have to use medications that previously failed to address their medical issue, or – due to their unique medical conditions – could have dangerous side effects. Throughout the National Day of Advocacy, advocates from around the country will urge their members of Congress to improve patient access by cosponsoring the Safe Step Act, which would establish important guardrails for patients facing step therapy and fail-first protocols. The Campaign 1. Virtual Advocacy: Working with its constituent members and other voluntary and professional health care organizations, DDNC will develop and disseminate a grassroots outreach campaign to encourage advocates from around the country to contact their legislators through calls, emails, and social media to request their support for the Safe Step Act. 2. Targeted Capitol Hill Meetings: DDNC will also arrange targeted meetings for advocates from the states below with key Senate and House offices: Pennsylvania | North Carolina | Tennessee | Connecticut | Michigan | Washington If you would like to be a patient advocate from any of these states to join us in Washington, DC on November 13th, please register here. Capitol Hill Itinerary 8:30 AM – 9:30 AM Eastern Advocacy Training & Breakfast: The Monocle Restaurant 10:00 AM – 2:30 PM Eastern Congressional Visits: Senate & House Office Buildings 3:00 PM – 5:00 PM Eastern Reception: 188 Russell Senate Office Building Target States We are encouraging partnering organizations to invite advocates from key states to join us on November 13th for strategic Capitol Hill meetings. Please see the key states below: Pennsylvania | North Carolina | Tennessee | Connecticut | Michigan | Washington If you would like to be a patient advocate from any of these states to join us in Washington, DC on November 13th, please register here. Virtual Itinerary Throughout the day, advocates from around the country will urge their members of Congress to improve patient access by co-sponsoring the Safe Step Act, which would establish important guardrails for patients facing step therapy and fail-first protocols. Working with its constituent members and other voluntary and professional health care organizations that support patient access issues, DDNC will develop and disseminate a grassroots outreach campaign to encourage advocates from around the country to contact their legislators over the phone or through email to request their support for the bill.
Participating Organizations American College of Gastroenterology | American College of Rheumatology | American Gastroenterological Association | Arthritis Foundation | Association of Gastrointestinal and Motility Disorders | Beyond Celiac | Crohn’s & Colitis Foundation | Digestive Disease National Coalition | Global Healthy Living Foundation | IBD Moms | International Foundation for Gastrointestinal Disorders | National Eczema Association | National Pancreas Foundation | National Psoriasis Foundation | The Oley Foundation | Pulmonary Hypertension Association | United Ostomy Associations of America
Simply Asia Withdrawing Three Products from Store Shelves
Three flavors of Simply Asia Street Noodles that have the Beyond Celiac gluten-free trademark are being voluntarily withdrawn from the market by the manufacturer because they contain an ingredient not allowed under the trademark rules. The products affected are: 
  1. Simply Asia Garlic Basil Singapore Street Noodles, 9.24 oz UPC: 5428501032
  2. Simply Asia Classic Curry Singapore Street Noodles, 9.24 oz UPC: 5428501030
  3. Simply Asia Sesame Ginger Singapore Street Noodles, 9.24 oz UPC: 900627290 5428501034
All three contain “amylase (barley),” which is included in the ingredients list. Beyond Celiac does not allow its trademark to appear on products that contain ingredients made from wheat, barley or rye. Independent tests of these products confirm there are non-detectable levels of gluten in both the amylase ingredient and in the Singapore Street Noodles that are made with this ingredient. Testing of the finished product using the Gluten Peptide (ELISA R7021) to capture hydrolyzed protein showed non-detectable levels of gluten with a limit of detection of less than 10 parts per million (ppm). Further, R-Biopharm RIDASCREEN® Gliadin R7001 testing indicated non-detectable levels of gluten using a method with a more sensitive limit of detection of less than 5 ppm. FDA labeling rules allow less than 20 parts per million (ppm) of gluten in a food labeled gluten-free.
While there is no indication that there is any risk to our community, Beyond Celiac is committed to all standards included as part of the certification program. This is a poorly understood and confusing area of interpretation of the FDA regulations. Beyond Celiac will continue to advocate for clear and consistent labeling to reduce confusion and concern among the celiac disease and gluten-sensitive community.  The safety and trust of the gluten-free community is our first priority, prompting us to look for the correction in the labeling error. We at Beyond Celiac appreciate the decision by McCormick, the parent company of Simply Asia, to remove the product from store shelves.
Beyond Celiac works with the Gluten-Free Certification Program (GFCP), a food safety-based gluten management system for manufacturers, which was created by the Allergen Control Group, recently acquired by London UK based BRC Global Standards. The Canadian Celiac Association also uses this standard. For further details and information on getting a refund for the affected products, contact the Simply Asia Consumer Affairs team at 1-800-967-8424 (M-F 9am-7pm EST) or visit them at www.mccormick.com/simply-asia/contact.
Download: Official Simply Asia Statement on Singapore Street Noodles
 
Simply Asia  Q&A
  1. This is confusing to me. Why is use of the barley amylase a problem?
Barley is the original source of the amylase, which has then been processed to remove the gluten protein. The Beyond Celiac certification trademark does not allow use of any of the gluten-containing grains, even when they are processed the way the amylase is. The problem is more a labeling issue than an issue of the ingredient posing a health threat to those who have celiac disease. Beyond Celiac chose to bar use of an ingredient made from a gluten-containing grain because testing of these kinds of ingredients is difficult, complicated and inconsistent. Food manufacturers often don’t understand these issues or the seriousness of improper use for celiac disease patients. In some cases, an ingredient made from wheat, barley or rye might pose a threat. Consequently, Beyond Celiac working with BRC Global Standards, and the Canadian Celiac Association chose not to allow these ingredients in products carrying the certification trademark. Here is what the FDA says about the labeling of food in relationship to barley and ingredients processed to remove gluten: "A food labeled gluten-free cannot be intentionally made with any amount of a gluten-containing grain (wheat, rye, barley, or their crossbred hybrids like triticale) or an ingredient derived from such grain that was not processed to remove gluten."
  1. Can I eat the products in question?
Each celiac disease patient has to decide for themselves what to include in their diet. The FDA standard allows ingredients made from wheat processed to remove gluten to be used in products labeled gluten-free so long as the food in which they are used contains less than 20 parts per million of gluten. In the case of wheat, information about processing to remove gluten also must be on the label, for example when wheat starch is used. But there is no similar labeling requirement for ingredients made from barley or rye. Beyond Celiac seeks to give an extra layer of assurance that foods with our certification trademark are safe by banning ingredients made from gluten-containing grains.  As a result, these particular products do not meet our standards as being gluten-free.
  1. What should I do next?
You can contact the Simply Asia Consumer Affairs team at 1-800-967-8424 (M-F 9am-7pm EST) or visit us at www.mccormick.com/simply-asia/contact to apply for a full refund.
  1. Are other Simply Asia products with the Beyond Celiac certification trademark safe?
These three products, Simply Asia Garlic Basil Singapore Street Noodles, Simply Asia Classic Curry Singapore Street Noodles, and Simply Asia Sesame Ginger Singapore Street Noodles are the only products affected.
  1. What is going to happen with these products in the future?
These products already in the marketplace are being voluntarily withdrawn. The Beyond Celiac certification trademark will not be on the package label when the products return to store shelves and other outlets.
  1. What did Beyond Celiac do to solve the problem with these Simply Asia products?
When Beyond Celiac became aware of the labeling issue, we and BRC Global Standards immediately began working with Simply Asia to have the affected products voluntarily withdrawn from sale. Simply Asia understood the problem and cooperated in informing its customers about the issue, the plan to correct it and initiated the requested product withdrawal. The company also understood that the Beyond Celiac certification trademark could not be used going forward on products containing the amylase and will use revised packaging going forward.
  1. How can I be sure other Beyond Celiac certified products are safe?
Beyond Celiac stands behind the GFCP certification system. This specific incident was a labeling issue, not a health issue. As always, we encourage consumers to add an extra layer of safety by reading ingredients on the label of all products.  
Headlines are a Hindrance For People Who Really Need The Gluten-Free Diet
By Jackson Buttery, Digital Content Coordinator at Beyond Celiac Celiac Disease since 2002, Type 1 Diabetes since 2001 Yesterday, a study was published in the journal Gastroenterology entitled “Gluten Does Not Induce Gastrointestinal Symptoms in Healthy Volunteers.” Already, the study has been picked up by multiple publications, including Medical Daily and The New York Post, who used the headline “New Science shows Gluten-Free Trend is Expensive BS.” The first line of the Post article reads as follows: “Gluten-free is a load of crock.” Yet these are instant reactions to a much more complicated issue in the history of celiac disease, non-celiac gluten sensitivity (“gluten sensitivity”) and celiac disease awareness. When Beyond Celiac (then named the National Foundation for Celiac Awareness) was founded in 2003, buying gluten-free food was much more difficult. You were lucky if a local health food store carried anything gluten-free, and if not, you often had to order from far away, from companies in Canada, buying large quantities and storing it in your freezer. There was only a limited selection, and the taste and texture of most products were vastly different (many would say inferior) than the options we have today. Regulations for gluten-free labeling also didn’t exist as they do now, so you couldn’t be sure exactly what was in the food, whether it was safe to eat, or how it had been tested, if at all. The science was limited, and bloggers, support groups, and large nonprofit organizations hadn’t established themselves as the resources they are now. For as much as the “trend dieters” and celebrities and athletes have introduced the gluten-free diet to the possibility of mainstream ridicule, they’ve also helped introduce a stunning breadth of gluten-free options into grocery stores, convenience stores, gas stations, and nearly everywhere else. When those of us with celiac disease and gluten sensitivity go out to eat at restaurants and say we need gluten-free food, almost all servers know what we’re talking about, even if we happen to get an occasional eye-roll before qualifying that we have celiac disease, a serious, genetic autoimmune disease. These “trend-dieters” helped give the gluten-free diet its ubiquity, with the good and bad that came with it.  Was it a net positive impact on the lives of people with celiac disease? That’s hard to say just yet, but it feels like the popularity of the diet helped us achieve higher levels of awareness more quickly than we could have done on our own. There’s no reason to shame these people who helped bring awareness of the gluten-free diet and celiac disease to mainstream America. For as many words as these articles focus on gluten-free trend dieters, the mentions of celiac disease and gluten sensitivity are rather limited. In the Medical Daily article, celiac disease is mentioned sparingly, with no mention of non-celiac gluten sensitivity. In the Post article, both are mentioned, but in a few short words, “both are uncommon.” The Post article closes with a quote from a young man who went on the gluten-free diet to try to solve his GI issues. After realizing that his issues weren’t solved, he looked forward to going back on a gluten-containing diet because he “just missed eating delicious foods.”  For people with celiac disease and gluten sensitivity, the gluten-free diet is not a choice. We can’t control that gluten-free food is 139% more expensive than gluten-containing food. If we want to eat bread at all, we have to buy it. We’re not eating $100 of “gluten-free flourless cakes” per week. We’re simply trying to survive, and we have to keep doing that every single day.
Beyond Celiac Awards Nearly $450,000 in Research Grants
Beyond Celiac has awarded close to $450,000 to two scientists conducting groundbreaking celiac disease studies. One study is aimed at killer cells that cause the actual intestinal tissue damage in celiac disease and the other is researching a more exact way to measure intestinal damage revealed in a biopsy. In addition, Beyond Celiac awarded an Early Career grant of $150,000 earlier this year, bringing the total invested in research to nearly $600,000 in 2019. Overall, Beyond Celiac gave top priority in awarding these two newest 2019 grants to research investigating the role of T-cells in driving the immune response in celiac disease. White blood cells that function as the body’s disease-fighting soldiers, T-Cells are improperly activated by gluten in those who have celiac disease. “The scientific world is looking at celiac disease as part of the broader autoimmune disease spectrum, and progress is being made as a result. At Beyond Celiac, we remain committed to our mission of advancing research with an international scope and supporting scientists who study immunological diseases,” said Alice Bast, CEO of Beyond Celiac. Established Career Award Paul Klenerman, PhD, a professor of gastroenterology at the University of Oxford, Oxford, England, and an immunologist who has done extensive work in Hepatitis C and HIV, has received the Established Investigator Award, a grant of up to $100,000 for each of three years. The award places emphasis on immunology and is designed to support novel approaches to understanding celiac disease. It also encourages scientists working in another related field, like Klenerman, to turn their attention to celiac disease. Klenerman’s research will focus on T-cells in the inner gut lining – killer CD8 T-cells. Currently, it’s known that a particular type of CD8 T-cell is abundant in the gut of celiac disease patients even when they are on the gluten-free diet. “These cells have features which suggest they are responding to a particular, unknown signal, and acting to cause inflammation, potentially driving celiac disease,” Klenerman explained. “We do not yet fully know what activates them, how they cause damage and how they can be regulated.” His work will attempt to answer these questions and look more closely at a new cell type that is driving inflammation and tissue damage in celiac disease. Klenerman plans to explore the cells’ role in celiac disease and what triggers them, which may directly lead to improved tests and treatments. Pilot and Feasibility Award The Pilot and Feasibility Award, which is given to help scientists collect the preliminary data needed to begin answering major questions about celiac disease, has been awarded to Jocelyn Silvester, MD, director of research at the Celiac Disease Program at Children’s Hospital, Boston. Silvester will receive a grant of up to $80,000 for each of two years. Preliminary data show that transcriptomics – the study of all ribonucleic acid (RNA) molecules within a cell - of intestinal biopsies can identify genes that correlate to inflammation caused by gluten. This type of early phase of study could lead to breakthroughs for larger scale research or clinical trials. “When Beyond Celiac formed its Scientific Advisory Council earlier this year, one goal was to give vigorous review to the grant applications we receive,” said Marie Robert, MD, chief scientific officer of Beyond Celiac and the only CSO of a celiac disease patient advocacy group in the United States. “We achieved that goal through the selection of top notch research by top notch scientists.”
Scientists Find Way to Detect Rye Gluten in Foods

By Jackson Buttery, Beyond Celiac Communications Assistant

At National Science Week in Melbourne, Australia, scientists from CSIRO, Australia’s national science agency, announced that they’ve found a way to detect the presence of rye in food.  Gluten is a protein found in rye, along with wheat and barley. A strict gluten-free diet is currently the only treatment for people with celiac disease. Previously, scientists from CSIRO have discovered methods to detect wheat, barley and oats in 2015, 2016 and 2018, respectively.

Using varieties of rye from twelve countries milled into flour, the researchers extracted the gluten proteins and used special mass spectronomy to identify six proteins unique to rye, but not apparent in other grains. The researchers then tested food with rye as a listed ingredient and “gluten-free” food without rye listed. From a range of commercial “gluten-free” foods tested, one breakfast cereal and one spelt flour were found to contain trace amounts of rye.

While commercially available sensors have been able to detect if gluten is in a particular food, none are yet available that can detect the presence of a particular gluten-containing grain, such as rye. Scientists from CSIRO are optimistic that this new technology may soon become available in at-home testing kits to provide security for those with celiac disease, and certainty for manufacturers.

According to Professor Michelle Colgrave, protein analytics expert with CSIRO, “being able to detect any protein in diverse foods and beverages will help food companies ensure that what’s in the pack is what’s on the pack, and help consumers trust pack labelling around gluten-free claims.”

The ability to detect specific grains is especially important in Australia, which has stricter gluten-free labelling standards than the FDA’s standard of 20ppm. For a product to be labeled gluten-free, not only can it not have any detectable level of gluten (lower than 3-5ppm), it also can not contain any of the four gluten-containing grains (wheat, barley, rye, and oats).

These stricter standards provide greater scrutiny for companies⁠—such as in one instance noted in the testing process, when a breakfast cereal labeled “gluten-free” contained trace amounts of rye⁠—but also better security for patients with celiac disease.


Read more about the gluten-free labeling standards here.

Beyond Celiac Launches New App
Beyond Celiac, the leading celiac disease organization working to drive diagnosis, advance research and accelerate the discovery of new treatments and a cure, has launched a first-of-its-kind mobile app to complement its online research database, Go Beyond Celiac, providing more convenience and opportunity for patient engagement. Go Beyond Celiac, which has enrolled thousands of members since its launch in 2017, is an online database created by people with celiac disease, for people with celiac disease. Users can participate in research by sharing their stories and experiences and learn how to become involved in celiac disease research studies. The new app now makes Go Beyond Celiac more interactive and engaging, and the mobile convenience encourages more people to visit and share their experience of living with and managing celiac disease. This is done through surveys that can be filled out at users’ convenience. The app also offers helpful insights about events, educational opportunities and more. Go Beyond Celiac members will be able to see how they compare to others as a more complete picture of celiac disease emerges from the data collected.

“Understanding how people have been impacted by celiac disease is some of the most important information researchers and doctors need in order to accelerate celiac disease research,” said Alice Bast, CEO of Beyond Celiac. “Go Beyond Celiac provides us with the ability to tell them what life is like before, during and after our diagnosis.”

In addition to driving research that leads to a better understanding of how celiac disease develops, the Go Beyond Celiac online tool provides opportunities to increase timely diagnosis and improve the diagnosis experience, inform research about the burden of living with celiac disease, accelerate the development of treatment alternatives to the gluten-free diet and ultimately help find a cure. “While awareness of celiac disease is higher than ever, people living with this genetic autoimmune condition struggle to be taken seriously. At Beyond Celiac, we are working to address this need. We are a bridge between the community and the researchers who are focused on finding answers to our challenges,” added Bast. The Go Beyond Celiac app is available for both iOS and Android devices.
Nexvax2 Setback Only One Aspect of Ongoing Scientific Discovery
Alice Bast, Beyond Celiac CEO Many people in the celiac disease community have asked me about the news that ImmusanT has discontinued its clinical trial investigating the Nexvax2 vaccine. My response to everyone is the same – don’t be discouraged. Don’t give up on the possibility we will eventually have better options than the gluten-free diet alone. Don’t give up on a cure. As much as we’d like research into new treatments for celiac disease to be a straight shot from start to finish in record time, it rarely happens. Scientific discovery is usually a slow, incremental process, with successes and failures both building on each other to create a complete picture of how a disease can be treated and hopefully cured. Most in the celiac disease research community, including scientists working on competing new treatments, were disappointed by news of the failure of Nexvax2 to suppress the immune response to gluten and consequently the effects of celiac disease. But they also quickly pointed out that a lot is learned from trials with negative outcomes, that the point of clinical trials is to thoroughly investigate what works and what doesn’t and that there are a number of promising different approaches in the celiac disease drug pipeline. One drug has  even beaten the odds and made it to Phase 3 of clinical trial. Additionally, the scientific world is looking at celiac disease as part of the broader autoimmune disease world, and progress is being made as a result. Those who study immunological diseases around the world have a growing interest in celiac disease. At Beyond Celiac, we remain committed to our mission of advancing research and supporting scientists even in the face of setbacks. We will soon announce the recipients of two new Beyond Celiac research grants. Perhaps most important to mention is the patients who volunteered for the Nexvax2 trial, as well as all those who have participated in any other celiac disease study. ImmusanT helped protect the wellbeing of the study participants by ending the trial early after results showed they were not getting any benefit from the drug compared to the placebo. I personally want to thank the Nexvax2 participants for stepping up.  And I want to encourage others to continue to volunteer and not let the outcome of this trial dissuade you. Be reassured that drug developers do take the steps needed to minimize risk and remember that research cannot progress without patient participation. I also want to thank ImmusanT for pursuing a treatment for celiac disease with such dedication and care. The investment the company has made through its scientific, regulatory and business knowledge, as well as funding, is hard to describe or comprehend. We don’t yet know what the future holds, but we can only praise all the work that has been done in the past. To keep this in perspective, think of the best way to respond to setbacks in your own life. If your child fails a test, if a project at work isn’t going well, if you try a difficult career change, if you have a fight with a friend, you most likely don’t throw your hands in the air and give up. You learn from your experience and move forward. That’s what happens in the research community, too. ImmusanT is looking at the trial results to better understand the outcome and will share what it learns. And we’ll all be a little closer to treatment choices beyond the gluten-free diet for celiac disease patients in the end.