Celiac Disease

1. Celiac Disease

2. No! No! No! No! No! http://www.csaceliacs.org/

3. “Ce-what-ac”??? I SEE… • Pronounced “SEE-lee-AAK” • Can also be referred to as “Coeliac Disease” • Partly genetic, partly autoimmune disease • Sensitivity to gluten • Gluten: • A combination of two proteins, known as gliadin and glutenin • Food (Certain grains): wheat, barley, rye, oats. • Products: stamp, envelope adhesive, medicines and vitamins • During digestion, the nutrients from the food must be broken down into molecules to be absorbed into the bloodstream. • Microvillus – tiny fingerlike projections lining the small intestine – allow nutrients from food to be absorbed into the blood stream.

4. ……… Microvillus • Immune system responds by damaging the microvillus lining the small intestine. • Leads to malnourishment (malabsorption), regardless of quantity of the food consumed • Leads to the damage of the small intestine • Can also be defined as the autoimmune disorder (damage caused by the immune system) • Unabsorbed nutrients are instead eliminated in stool, known as fatty stools • Occurs in both children and adults • Serious problem for children who need an adequate amount of nutrition http://www.denniskunkel.com/DK/DK/Medical/30259A.html http://bigoo.ws/view_content.php?category=babies&type=506&pag=0

5. History “The allowance of farinaceous foods must be small, but if the patient can be cured at all, it must be by means of diet” - Dr. Samuel Gee

6. History • Discovered in the 250 AD • A Greek physician named Areteus from Cappadocia • Patients had suffering in the bowels • He defined this disorder as “koiliakos” (suffering in the bowels) • Francis Adams translated his writings from Greek to English during 1856 • It was for the Sydenham society in England • Francis Adams called it “Celiac” Disease. (CD) • In 1888, Dr. Samuel Gee stated that patients should control their diet (gluten) • Only way to be cured from CD, is by changing their diet

7. Signs and Symptoms?? • Tingling numbness in legs (nerve damage) • Muscle cramps • Seizures • Behavioural problems • Irritability (most common in children) • Missed menstrual periods often due to excessive weight loss (women) • Infertility (men & women)- unable to conceive a child • Recurrent miscarriage • Delayed growth http://www.mchcares.com/images/rural_psychology_02.jpg http://www.leeds.ac.uk/lsmp/ healthadvice/depression2/depressed.jpg

8. Unexplained Anemia a low number of red blood cells causing fatigue/tiredness and various other complications. http://www.danceage.com/images/v3/general/tired-baby.jpg http://www.seedmagazine.com/news/uploads/yawnopar.jpg

9. Dermatitis Herpetiformis (itchy skin rash) Arms http://www.aafp.org/afp/980301ap/ pruessn.html http://www.csaceliacs.org/DHonarmandlegs_000.jpeg

10. Apthous Ulcers Distention Bloating http://www.aafp.org/afp/980301ap/pruessn.html http://www.aafp.org/afp/20000701/149_f2.jpg http://www.nelh.nhs.uk/oralhealth/mouth_ulcers/index.3.jpg http://www.pigur.co.il/imgceliac/celiac.jpg

11. Most dramatic symptoms: weight loss, delayed growth • Symptoms of Malnutrition: Anemia, weight loss, delayed growth • Abdominal cramping • Intestinal gas • Chronic diarrhea/ constipation (can be both) • Pale, foul – smelling fatty stools • Tooth discoloration/ loss of enamel http://studentweb.tulane.edu/~djohnso6/poo.gif http://www.cent4dent.com/images/discolor_reshape/2.jpg

12. ……….. • Bone transformations; similar to the transformations that occur in a bone disease called Rickets • Osteoporosis/Osteopenia (bone disease) • - amount of bone is decreased • - making the bone weaker • - more likely to fracture • - leads to bone or joint pain http://www.connecticutcenterforhealth.com/images/Osteoporosis.jpg

13. Osteoporosis

14. ……… NOTE: • Affects people differently • Symptoms may occur in the digestive system or in the other parts of the body • Some people may not have symptoms at all but are still at risk • Untreated CD have increased the risk of certain cancers, and intestinal lymphoma

15. Diagnosis

16. Diagnosis • When CD is suspected: • Generally: involves blood tests and biopsy of the small intestine • Biopsy (microscopic) of the small intestine may be done which helps to identify the damaged villi lining the small intestine (abnormalities) • CD can usually be confused with disease similar to it: • Irritable bowel syndrome (iron-deficiency, anemia by menstrual blood loss) • Crohn’s disease • diverticulitis intestinal infections • chronic fatigue syndrome • Due to this confusion, celiac disease is commonly misdiagnosed

17. CD have higher than normal levels of certain autoantibodies in their blood • Antibodies: protective protein produced by the immune system that attacks substances considered threatening to the body ex: virus, bad bacteria. • Autoantibodies: Proteins that react against the body’s own molecules/ tissues • Physicians will usually take blood tests to measure levels of certain autoantibodies: • Immunoglobulin (IgA), anti-tissue trans glutaminase (t TGA), IgA anti-endomysium antibodies (AEA)

18. Observe the symptoms after the infant starts including cereals in their diet. • Measuring the level of certain antibodies which are produced when gluten-based diet is in consumption. • Diagnosing the improvement after following the gluten-free diet • Stools are examined for excessive amounts of fat; common sign of CD • Before testing, patients should continue to consume gluten-based foods ex: breads, pastas etc.

19. Effect of Celiac Disease on Eating Out, Shopping for Food, and Travel(in Americans)

20. T r e a t m e n t

21. Diet plan will stop symptoms • Usually within the days of starting the diet • Children, younger adults: Healing of the small intestine takes about 3-6 months • Older adults: usually within 2 years time • Must avoid gluten for the rest of their lives • Symptoms will improve, some might not (depends on age. • Best thing to do is getting advice from a professional (dietitian) • Must follow the gluten-free diet carefully • There might be some deficiencies • Vitamin and mineral supplements may be given for compensations

22. Research http://bigoo.ws/view_content.php?category=mouses&type=506&pag=0

23. Research • Researchers are studying why CD affects people differently • Examining things such as: (Why?) • Some people know their symptoms are from CD • While others may not have symptoms at all • Undamaged part of the small intestine may not be able to absorb enough nutrients to prevent symptoms • Why and how Celiac Disease appears: • Length of the time a person was breastfed during their childhood • Age a person started consuming foods containing gluten • Amount of food they consume containing gluten

24. Some researches have shown for ex: The longer a person had been breastfed during infantry, the later and more uncommon the symptoms appeared

25. Miscellaneous Interesting information

26. http://www.fotosearch.com/FDC105/923828/ Gluten…. Foods Containing: Oats Wheat Barley Rye http://www.acclaimimages.com/_gallery/_pages/0443-0611-1622-0915.html http://www.shutterstock.com/pic-1559354.html http://www.acclaimimages.com/_gallery/_pages/0173-0606-1015-5335.html

27. ……….. • Diets high in barley/oats have lower cholesterol levels • Reduce the risk of unhealthy weight gain • Cardiovascular disease : reduce high blood pressure • reduce low density of lipoprotein (LDL) – bad cholesterol • High density lipoprotein (HDL) increases or remains the same • Barley contains similar fibers as oats • Wheat – Thiamine: contains vitamin B, essential for good appetite, digestion and healthy nerves • Wheat – supplies about 20% of the energy http://bigoo.ws/view_content.php?category=foods&type=506&pag=9

28. ………. • Niacin: A B- vitamin essential which assists the body to make efficient use of protein by the body • Iron: Important to nutrition; prevents fatigue/tiredness gives energy etc • Zinc: Important for skin healing and growth • Riboflavin – Essential for good vision and growth • Main allergies to: milk, eggs, peanuts, wheat, tree nuts, fish, Crustacean shellfish, soybeans. http://bigoo.ws/view_content.php?category=foods&type=506&pag=17

29. Things to and not to consider when having Celiac Disease Visit: http://www.csaceliacs.org/gluten_grains.php

30. Works Cited • American Academy of Family Physicians. (1998). Detecting Celiac Disease in Your Parents. Retrieved by October 20, 2006 on the World Wide Web: < http://www.celiac.org/cd-main.php> • Braithwaite, Diane. (2006). Gluten-Free Diets. Retrieved by October 20. 2006 on the World Wide Web: <http://www.colostate.edu/Orgs/safefood/NEWSLTR/v10n3s05.html> • Bunch, Bryan (Ed.). (2003). Sprue. In Diseases (Vol. 8, pg 11-12). Dunbury: Grolier International. • Celiac Disease Foundation. Celiac Disease. Retrieved by October 20, 2006 on the World Wide Web: <http://celiac.org/cd-main.php> • Mayo Clinic Family Health Book. (1996). New York: William Morrow and Company, Inc. • National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. (October 2005). Celiac Disease. Retrieved by October 20.2006 on the World Wide Web: • <http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/index.html>

31. _______. (January 21, 2004) Osteoporosis. Retrieved by bOctober 20, 2006 on the World Wide Web: <http://courses.washington.edu/bonephys/opop/opop.html#def> • Bunch, Bryan (Ed.). (2003). Sprue. In Diseases (Vol. 8, pg 11-12). Dunbury: Grolier International. University of Maryland Medical Centre. (2005). Tropical Sprue. Retrieved by October 20, 2006 on the World Wide Web:< http://www.umm.edu/ency/article/000275.html> • Vegetarian Society. Vitamin B12. Retrieved by by October 20. 2006 on the World Wide Web: <http://www.vegsoc.org/info/b12.html>