As for most of the vegetable species there is a wide range with the same characteristics and/or different and well distinct properties from those of the other vegetable species, such as productive potential, adaptability, disease resistance and characteristics of quality.

From a nutritional point of view cereals are the best source of complex carbohydrates, predominantly starch, dietary fibre; as well as proteins, minerals and vitamins. Recent literature indicates that cereals make an important contribution in terms of phytocompounds such as phenolic acid, phenolic compounds (lignans, tannins), phytosterols (sterols, stenols), phytoestrogen and carotenoids (beta-carotene). (1, 2, 3, 4).

Historical overview……………..
Cereals have been cultivated for 10.000 years when man understood that their seeds could be easily stored for a long time. Moreover, cereals constituted an important food for humans because they are a good source of nutrients and they ready complement the scarcity of game.

The spontaneous collection of cereals was the first step towards cereal domestication, which spread during Neolithic helping with the first type of farming, the origin of Mediterranean civilisation in an area called the “Fertile Crescent”. There was also cereal domestication in the Middle East: Syria, Palestine e Kurdistan while its diffusion is linked to the migratory flow which reached the Mediterranean.

Why should we talk about cereals, minor cereals and pseudo-creals?

Cereals is a common term which indicates wide variety of plants cultivated by man in order to use seeds, seeds transformed in to flour and other products.
The pseudocereals are non-grass plants but very similar to cereals for cultivation, products and nutritional use. Buckwheat, quinoa and amaranth grain are some examples of them. Lastly there are the minor cereals. They are defined in this way because they are less common and they are only should cultivated in a few small regions of the world such as Eritrea, Ethiopia…..

Why celiac individuals be interested in all of these? Patients with celiac disease, as is well known don’t get along with cereals and therefor they are not allowed. Moreover celiac individuals have to remove all wheat-based cereal products from their diet. In fact it isn’t so only a few cereals have the storage proteins such as prolamins (gliadin in wheat, secalin in rye and hordein in barley), which at the time of re-hydration of flour and/or meal with water, will recombine to form the three-dimensional lattice of gluten. Gluten is an artifact!

The most important cereals used by man are durum, wheat, corn, rice, barley, sorghum, oats, millet and rye. Only corn, rice and sorghum are safe for celiacs. However if you want to increase your variety of food you can use pseudocereals. In fact buckwheat, quinoa and grain amaranth could be safely included in a gluten-free diet, because they are gluten-free. The variety increases greatly if you include the minor cereals. Panic, fonio (white and black), teff, teosine, leusine, coracana and lacrime di Giobbe are gluten-free and so recommended in the GF diet.

So “minor cereals and /or the neglected ones” are becoming the “cereals of the future”!
In particular fonio is an African cereal crop which has had a marginal importance. Its seeds are very small but are full of potential uses! How small are they? One gram of fonio conteins nearly 2000 seeds. They are only 1 mm long and 0.7 mm wide. We talked about fonio in a previous post and we presented as a super cereal.

Fonio has an interesting nutritional profile. It provides a good source of carbohydrates (55% wheat vs 60% fonio or tef) and proteins (12% wheat vs 10% fonio or tef). Moreover, it has a low concentration of lipids (2% wheat vs 1.9% fonio or tef). Another important consideration is that fonio has appreciable amounts of inorganic compounds such as iron (23-40mg in 100g vs 1.3mg wheat and 2.3mg corn) and copper (0.1-1.2mg vs 0.4mg wheat and 0.17mg corn).

Why did we decide to talk about fibre? Because recently the study findings showed that often the GF diet and gluten-free products are usually low in fibre and vitamin B, calcium, vitamin D, zinc and magnesium, too.

Let’s take a closer look at component!

First of all we will try to answer some frequently asked questions: what is fibre exactly? What are the best sources of it? And what are its health benefits? What is the recommendation of dietary fibre for people?
And then I will give you some healthly tips to increase the amount of fibre in your diet.

What is fibre? Most experts agree that a key defining characteristic of dietary fibre is that it’s derived from the edible parts of plants that are not broken down by human digestive enzymes. Infact it is broken down in the colon by anaerobic bacteria (the process is called fermentation).

The most recent fibre definition is a balance between nutrition knowledge and analytical method capabilities. Whereas the physiologically-based definitions are already widely accepted and are the result of several adjustments in response to advances in scientific research.

Historical Overview
Historically, there has been a consensus since the late 1970s that “Dietary Fibre consists of the remnants of edible plant cells, polysaccharides, lignin and associated substances which are not broken down by human digestive enzymes. It has traditionally been considered to be plant sourced.”

Since 1980 the dietary fibre definition was broadened to include all undigestible polysaccharides in the human small intestine such as cellulose, hemicellulose, lignin, pectins, gum and mucilages and associated minor substances such as waxes, cutin and suberin.

Since 1990 the scope has been extended and now includes undigestable oligosaccharides and aminosaccharides. They are usually found in food. Moreover the scientific community argues that may also be included syntetic oligo-carbohydrates and resistant starch.

Furthermore the definition of dietary fibre should be based on chemical and physiological perspectives. The fermentability and solubility of these components are two attributes of fibre. They allow the fibre to be classified into fermentable and unfermentable; soluble and insoluble.
Finally in 2001 the American Association of Cereal Chemists (AACC) and l’American Academy of Sciences produced a report to update the definition and more clearly to delineate the makeup of dietary fiber and its physiological functionality.

What are the best sources of fibre? The most natural sources of fibre are vegetables, fresh fruit (including peel or skin), wholemeal cereals, pulses (peas, beans), grains, nuts, potatoes. Moreover there are whole-grain bread, pasta, pizza, crackers, rusks, biscuits, breakfast cereals.

Now food industries have developed new food products (fibre-enriched foods) not of vegetal origin, but animal origin such as cheese, yogurt and meat. All of them carry healthy sounding food labels indicating that they contain fibre: “with fibre” or “high level fibre”

What does this mean exactly?
In Europe the directive 2008/100/CE of the European Commission, has anended the Directive 90/496/CEE. It clarifies the issue and helps us to understand the claims. The law about the nutritional information of these products reiterates the updated definition of dietary fibre……

“The charboidrates polymers of vegetal origin which correspond to the definition of dietary fibre can be strictly associated with lignin or other non charboidrate components such as phenolic components, wax, saponins, phytate, cutin and phytosterol. These substances, if strictly associated with charboidrates polymers of vegetal origin and extracted with charboidrates polymers for the analyses of dietary fibre can be considered dietary fibre too. If however they are separated from charboidrates polymers and added to food, these substances cannot be considered dietary fibre.”

When shopping, look for the terms “good source of” and “high in” and use them to identify foods that have significant amounts of dietary fibre.

In Europe you can find the health claim “good source of fibre” if the products have at least 3g/100g or 1.5g/100 kcal.
Whereas you can find the health claim “high levels of fibre” or similar, if the products have at least 6g/100g or 3g/100kcal.

The same directive emphasizes the healthy benefits of fibre…..
Traditionally fibre is considered an important nutritional and healthy component of the diet for people of all ages. Research over the past several decades has shown that increased consumption of dietary fibre produces a positive effect on levels of serum cholesterol, particularly LDL-cholesterol a biomarker related to the risk of coronary heart disease (CHD). Scientific consensus on the evidence for the role of dietary fibre in reducing the risk of CHD has long been acknowledged. Moreover an increased consumption of dietary fibre and high fibre products also produce a measurable reduction in the peak level of serum glucose after eating. Fibre also helps to regulate blood sugar (is why it plays a very important role in the diet of diabetics).

Since the fibre passes through the digestive tract it is helpful in preventing constipation. A diet rich in fibre improves body function and reduces your risk of gastrointestinal problems, like Irritable Bowel Syndrome (IBS), colon-rectal cancer and other intestinal inflammation. The effect results in an increase in faecal bulk, reduces transit time of faecal material through the intestine and improved the regularity of defecation.

Dietary fibre also plays an important role in the prevention of certain types cancer (oral cavity and pharynx, larynx, lung, esophagus, stomach and colon-rectum).

It has demonstrated that the same results are obtained from undigestible polymers and/or synthetic dietary fiber analogues, which are not naturally in food that we eat daily.

What’s more……
for those who like counting the calories, we must dispel the following myth: fibre does not contribute any calories! This is false ……

It’s very difficult to determine the calories for fibre because we must consider: the uncertainty of analytical methodology, the amount of fibre fermented by bacteria in the large intestine and the individual capacity of its absorption in the small intestine. At least we must consider the negative effect of dietary fibre i.e the reduction of absorption of some nutrients such as vitamins and its capacity to bind to certain minerals such as calcium, iron…..

The energetic value of dietary fiber is 8 kJ/g or 4 kcal/g.

Increasing the amount you eat each day isn’t difficult.
- increase your consumption of fresh fruit and vegetables (5-6 portions/day)
- increase your consumption of peas, beans and other pulses (1-2 /week)
- chose gluten-free wholemeal cereal-based products.

So it isn’t necessary buy commercial products enriched in fibre.These types of fibre are derived from industrial chemical processes which are patented by companies.

Lastly if this is true for the celiac consumers (it’s the same for all people) we must also say something to the gluten-free food manufactures.
It would be very useful to correctly indicate the amounts of fibre in the nutritional information on food labels. This information helps us to choose the product with the highest fibre levels and such awareness will enable us to make the right purchase.

Now we will talk about the salt and the sodium, two very important minerals for our health.

Salt – sodium chloride is the technical name- is an ingredient which has been known since the beginning of mankind. It used to preserve meat, fish and vegetables and to improve the taste of food. NaCl is the chemical formula: Na=sodium and Cl=chlorine, two minerals of crucial importance for our good health if used correctly. It’s very important to consume 6g of salt a day.

The World Action on Salt and Health (WASH) held its 2nd annual World Salt Awareness Week, from 2 to 8 February 2009 and focused on salt eaten outside the home. In Italy the Società Italiana di Nutrizione Umana (SINU) sponsored the same event and prepared some materials (i.e. leaflets, posters and brochures).

Now we will try to clarify somethings about salt. First of all… salt or sodium? Sodium is the most important part of salt but the two terms aren’t synonymous. The body needs a certain amount of sodium to function properly. Typically 0.4g of sodium is the concentration in 1g of salt.

Why is too much salt bad for you?
Many scientists, although not all, believe that when salt levels are too high there are:
- hypertension
- a greater risk of coronary heart disease and stroke
- a close relation with stomach cancer and H.Pylori
- a major cause of kidney stones
- a loss of hip bone density.
Moreover, epidemiological evidence suggests that the severity of asthma may be related to salt intake.

Which are the most important sources of salt?
Some foods that we consume every day (vegetables, meat, ham, water…) have a good concentration of salt and they are not necessarily high in salt. Surprisingly, three quarters of the salt we eat is hidden in processed foods: snacks, foods prepared in restaurants, takeaways, fast foods and canteen food. Only a quarter comes from salt added either at the table or during cooking.

Some years ago (2007, 2008) an analysis showed that children in many countries have a very high salt intake because a lot of babyfood and/or children’s food have higher salt concentrations.
For the past 10 years manufacturers have been increasing the amount of salt in food up from 540 mg/100g to 1050mg/100g. At the same time there has been an increase in consumption of these type of food.

It’s important to recive a correct information, especially for celiac persons, who consume products daily which are processed by multi-national food companies i.e. pasta, bread, crackers, snacks, pizza, breakfast cereals etc.

What you should know about salt and sodium?
1. The target levels of salt intake for babies, children (according to the age), adults and the elderly.
The current recommendations for children depends on their age. Babies need only a very small amount of salt – less than 1g/day up to 12 months, wheareas at 11 years and over the average intake is 6g salt/day (2.4g sodium). Adults and the elderly should consume 6g salt/day. However for Italians the average intake of salt is between 9g and 12g of salt/day.

2. How can I understand the amount of salt from the nutrional information on food labels?
Very few people know how to read the nutritional information on the labels, correctly. It’s very important to check labels to find out which foods are high in salt. You can find out the quantity of salt or sodium. For salt you must divide by 2.5 (Sodium = salt : 2.5) so you calculate the sodium concentration.

… and then how to interpret the values? As a general rule:
Foods high in salt have more than 1.5g salt/100g (or 0.6g sodium / 100g).
Foods low in salt have less than 0.3g salt / 100g (or 0.1g sodium / 100g).

Now…… Let’s consider some gluten-free products…… straightaway you can note that the salt is usually listed on some foods but not all, while the sodium is shown in the nutritional information on food labels. Only a few food manufactures indicate the correct values.

Some years ago I analysed some breakfast cereals, today we will try to observe: rusks.

I examined six Companies: Giusto, Bi-Aglut, Pandea, La Finestra sul Cielo, dr Schar e DS.
Only four of then listed salt on their labels. Giusto, Bi-Aglut e Pandea are high in salt because the values are 0.8g – 0.708g and 0.6g per 100g, respectively.
La Finestra sul Cielo, a biological of food company, is low in salt because the value is 0.124g/100g.

Now we look at another example: crackers.
This time I analysed nine Companies but Pandea, Pauly, DS e dr Schar do not list sodium or salt.
Glutafin, Cereal, Bi-Aglut, Galbusera and Giusto are high in salt: 1.4g/100g Glutafin – 0.8g/100g Cereal – 0.7g/100g Bi-Aglut and Galbusera – 0.36g/100g Giusto.
It is surprising how there is no cracker with a low concentration of salt, i.e 0.3g salt/100g

The last thing to consider is “what should we do?”

First of all, it’s necessary to eat more fresh foods (they contain potassium which balances the effect of salt on the organism). If you must eat these products you must those with a reduced salt content. For example when you’re buying gluten-free bread, compare the amount of salt in different types and choose the product with the lowest salt levels.

Home cooking? That’s easy……
To improve the flavour of foods, try not to add salt automatically while you’re cooking or about to eat, but try using some herbs (parsley, basil, rosemary, sage, bay leaves, star anise, capers, marjoram, fresh mint, oregano, thyme, chili pepper) or spices (aniseed, cinammon, cloves, coriander, wild fennel, juniper berries, nutmeg, saffron, ginger); or lemon or vinegar and balsamic vinegar (3-4 drops).

Limit the salt you use in cooking to 2 pinches/day when preparing sauces, meat, fish or vegetables. When cooking pasta or rice 1 dessertspoonful/5litres of water.

- Before closing your traveling bag …… a T-shirt for all members of the family! Obviously gluten-free. Good shopping!

- The cyber-hypocondriac suffer coeliac disease (CD), too.
The Italian dictionary acquires always new words and the CD it is more and more to the focus of the attentions not only of the doctors but also of the persons who are annoying on Internet.
From a telephone test survey from the Harris Interactive Institute it emerges that in the last two years the people who have frequently or occasionally looked for information on health has increased to 37% and in 2007 in USA they have reached 160 million.

They are the cyber-hypocondriac, that is hypocondriac online, and represent 66% of the population online. In this group we can find persons who use Internet only like a information source in order to prepare themselves for the talk with the doctor and/or for curiosity, and than persons who are annoying in compulsive and frequent behavior on the internet about health: these last ones are 26% of the Americans internauti.
Between the associations more searched: badly of head = cancer to the brain; digestion problems = CD and at last fatigue = AIDS

- Tastespotting and gluten-free food
The food webblog dedicate to the food, recipe, councils on quality products, restaurant, food design…. are more and more numerous. It is not equally easy to find something dedicated to the gluten-free
Jean Aw, author of Tastespotting – a tasty aggregator of food blogs – it has shown attention to the gluten-free and it proposes 4 recipes.
And also possible to insert own images and one short description contributing to the enrichment of the archives. Here the instructions.

- The pandemia of Saharawi.
The professor Carlo Catassi write an interesting report about the condition of Saharawi people. They have supplied and continue to supply interesting news about the interaction mechanisms between genes-environment from point of view both patogenetic both evolutionistic.
Some data …… according to data already the harvests, CD catches up 5.6%. The analyses will continue and esteem that on an infantile population of 43.000 subjects can be arrived to 2.400 diagnoses of this intolerance.
The Saharawi are people of refugee, with Berber origins, that the desert of the Sahara has always populate but that today, for political reasons, is forced living in canvas in Algeria.
The genetic order of this population, is not sufficient to explain the high incidence. Therefore which other factor is therefore determining? The alimentary habits.
For millenia their diet was lacking in gluten and breast-feeding of the children was extend until the two years of life. The weaning was much late one and began using date flours and others food gluten-free.
As a result of the Spanish colonization – in the turn of two generations – the diet has been modified and currently the children are weaning to one month of life with food rich in gluten like the bread.

From this observation the professor Catassi thinks that:
1. the ancient alimentary habits, in the individuals genetically to risk too, have determine one CD vanished, with modest degrees much of internal atrophy;
2. this situation could be a evolutionistic advantage. In fact a modest atrophy of the internal mucosa would lack molecules that act as from pathogenic receivers for the internal pathogens;
3. the cells that cover the lumen internal of the celiac person are more immature and therefore more inclined to the secretion of water and electrolytes, facilitating the removal of the colonizing microbes;
4. at last, modest infiltrated of lymphocite would be accompanied to immunological answers of defense against the internal pathogens frequent in that region of the Africa North.

- Italian market gluten-free offer some food from biological agriculture.
In the food label – in the “ingredients” – appear raw materials, marked from an asterisk (*), in order to indicate that they come from biological agriculture.
In Italy 8 on 80, the companies of gluten-free market that have made the choice to use raw materials from biological cultivations.
The 0,7% of the dietotherapic food and the free commerce are biological, diversify in three categories: pasta, cereals for breakfast and biscuits.
How are read the labels of the biological products? Three are the type of labels:
- Filler logo UE and the notice “from Biological Agriculture”: this means that the product introduces at least 95% of the biological ingredients; remaining 5% must be represented from products available or difficultly available in insufficient amounts in biological agriculture.
- Don’t filler logo UE but only the products come from biological agriculture are marked with an asterisk. In this product at least 70% of the ingredients come from biological agriculture. On these labels the indication of the origin from biological agriculture will be brought back alone in the “ingredients”. Moreover it is obligation to specify the exact percentage of biological ingredients.
- At last the notice “produced in conversion from biological agriculture” can be brought back this means that the company is in progress of conversion for that specific product; obviously in this case it cannot bring back no logo UE or other indication.

From the analysis of Italian gluten-free food’s labels it emerges that:
- 7 companies produce biologic pasta but three of them haven’t the UE logo, they should then indicate the percentage of raw biological material. True? Only in part… because only one (Orgran) indicate it correctly:“9% corn (maize) flour deriving by biological agricolture” .
Among 4 companies which have the UE logo a special metion is for Molino di Ferro – Le Asolane which use in all its refers 100% of maize flour coming from biological agricolture.

- Two over three the companies which produce cereals for breakfast having correct notice. Two companies have the notice “biological agricolture” in their labels without indicate the percentages.

- The same situation is for biscuits. Only notices and no percentages.

Be then carefull to the “BIO” sign on the new pakages, they are not all the same and cannot ensure a true biological product.

And what about their nutritional quality? In table have brought back a comparison between 5 boscuit frollini, 6 boscuit buckets and 7 boscuit with chocolate – the letters indicate the companies (equal color same companies but various the type of biscuit). It emerges from the reading of the ingredients that: 83% of the products contain saturated fatty acids or trans fatty acids of insufficient quality and little expensive acids.

And attention… between these the “frollino H*” door in label also the logo of the biological agricolture. Uhmmm something does not work.

La celiachia in cucina: mangiare bene senza glutine, a book written by Pietro Semino. 200 pages to explode a myth: the kitchen without gluten is necessarily colourless, flavourless and monotonous.
The author demonstrates in contrary giving fanciful indications for the prescription realization easy, plates and mixture base. Not only, it enriches its publication with a glossary, an allowed directory of alimony and at last does not add suggestions on like making the expense and where to find modernized information.

A suggestion for the summer: a nice trip to know new place.
Are you loving of the good kitchen, the traditional and local kitchen? ….. but you are celiac. Don’t worry…..
RiVivinatura, a co-operative society – between the several tourist activities it proposes also gluten-free course of kitchen, elastic for timetables and duration, with the possibility to make also the expense before the lesson and to visit the market of the fish of Rialto.

Coeliac disease (CD) can be associated with several extra-intestinal manifestations, including neurological disorders. The aim of the study was to investigate the prevalence of hearing loss in coeliac patients compared with that in healthy controls.
24 adult coeliac patients and 24 healthy subjects matched for gender, age, smoking and drinking habits were enrolled in the study. Among the coeliac patients, 6 were newly diagnosed and 18 patients were on a gluten-free diet for at least one year. A hearing loss was found in 47.1% coeliac patients and 9.1% healthy controls. All CD patients with hearing loss presented a sensorineural hearing loss. The prevalence of hearing loss was significantly higher in coeliac patients than in healthy controls but it was not significantly different between untreated and treated coeliac patients (33.3% vs 44.4% respectively).
Immunological processes such as ear-specific and non-specific autoantibodies and vasculitis could be the basis of this association. Further longitudinal investigations on a larger sample size will be necessary to confirm the results.

CD is one exciting history. The origin and the spread of this intolerance are sure an exciting history in fact for the experts are a true dilemma.
Its dark origin, its closely connected history with the agricultural revolution of Neolithic – period in which the man begin the cultivation of the several plants, between which the cereals, and the taming of animals, swines and ovines, to alimentary scope – and peculiar one put into effect them geographic distribution at the same time make of CD se an exciting dilemma and a model for the grips relations GENI-ENVIRONMENT and on that it can happen when these do not work correctly.
The paleopatology is not a lot of aid, does not exist, in fact, signs of CD in the parts of the body that constitute the archaeological rests: skeletons and teeth.
According to the anthropologist Laura Johnson-Kelly of Cornell University of New York it has assumed that the period of maximum spread of the CD could be the Medioevo. Which are the many frequent in fact skeletons of that period suspiciones cribra orbitalia and the porotica hyperostoses consequence of one chronic anemia iron-lacking and the hypoplasia in the enamel. With the exception of great part of the typical morbid states of the human species, it is however possible to date the appearance in scene of the CD: approximately 10.000 years ago when barley and spelt and durum (Triticum durum Desf) and tender wheat (Triticum aestivum L) subsequently, they began to having an emergent role in the feeding.
According to J.F. Simoons – studious of geography of the nutrition – the course puts into effect them of CD reflect the wave of practical distribution of the agricultural one from the East to Europe. Here the new data of the distribution of the CD in the world.

With the market for gluten-free products growing rapidly around the world, many opportunities are opening for industry.
According to a market research, the UK is the third biggest market for gluten-free foods after the USA and Italy.
The market amounting to €70 m while sales of lactose-free products reaching €34m.
According to an interview with a food and drinks advisor at Coeliac UK such items are currently available but remain limited to large storse.
The biggest problem posed in the food market for celiac sufferers remains breakfast cereals, with most large manufacturers such as Kelloggs and Weetabix.
Little various the situation of the American market. The free-from market was worth €90 million ($123 million) in 2005, and Mintel – market analyst – said that the gluten and wheat-free sector has benefited in particular from the nation’s increasing interest in healthy eating. Sales of products such as wheat-free breads and cakes have grown by almost 120% over the last three years alone, to reach €48 million ($65 million).
Jodi Engelson, a senior research scientist at Cargill said: “There is clearly a market opportunity for gluten-free foods. For the patients who suffer, the diagnosis rate is increasing. In response to this, we have witnessed over a 100 per cent increase in gluten-free products over the last seven years.”

Ranjit Kadan, a researcher with the U.S. Department of Agriculture, said the gluten-free market is projected to be €1.25 billion ($1.7 billion) by 2010.

Replacement of wheat in baked goods, like bread and cookies, poses technical problems since gluten impacts significantly on the texture and taste of the final product.

And in Italy? What’s new in the Italian market?

- opinion of EFSA on Dietetic Products for person with gluten intolerance, on a request related to a notification on wheat-based maltodextrins, syrup of glucose and the alcohol distilled from cereals. It’s stated that the components based on wheat starch are not likely to trigger adverse reactions. This statement is based on the description of the manufacturing process which includes protein removal by active carbon treatment. The evidence of non-allergenicity allows to include all products in the gluten-free diet.

- a new and useful guide of Unione dei Commercianti di Prato (Toscana). In these guide old people and tourists will can find a list of exercises that they will remain opened during the summery period. From this year has been inserted new activity – all restaurants or hotels or B&B or pizzerie that belong to the network of Associazione Italiana Celiachia. You can find it here.

- vodka, whisky, gin and other superalcoholic ones newly are admitted to the consumption. Alcoholic drinks added of aromas and other substances and the beer remain prohibited. All this comes justified supporting that the working process is such to guarantee the gluten absence also in the products not allowed to the celiac person.

- Bennet offers some products gluten free. At the moment in Italy, 15 products are available by Pauly and DS Food. You can find pasta, wafer with chocolate, cracker and bread while in deep freeze there are Lasagne, Rosette, Pizza Margherita and IceCream Cones.

- an articleon The New York Times speaks about celiac disease.

- a biopsy of the intestine (before beginning a gluten free diet) is needed to make a final diagnosis (1). Before the diagnostic protocol of the ESPGHAN previewed three internal biospy. Today the protocol advices a single endoscopy with biopsy that allows to exceed the limits of the serologic testing, concur a differential diagnosis them in the cases of minimal lesions of intestinal mucosa, develop internatinal criteria for the classification of mucosal damage and at last is useful in order to decide the dietetic and therapeutic iter and the follow up in the subjects genetically predisposed.