Celiac Disease

1. Provided Courtesy of RD411.com Where dietitians go for information Celiac Disease Review Date 4/08 G-0605

2. This presentation provides general information about celiac disease. Consult with your health care professional if you have any questions or for additional information because each case is unique.

3. Symptoms and Side Effects • No classic profile for celiac disease, unlike hypertension, cancer, or other diseases that have biomarkers • Often mistaken for Crohn’s disease, parasites, skin disorders, etc • Often surfaces after trauma

4. Symptoms and Side Effects (cont’d) • Strong genetic disposition: • Pale • Irritable • Fails to grow • Potbelly • Flat tush • Stinky stools

5. Diarrhea Gas Bloating Irritability Depression Joint pain Muscle cramps Skin rash (elbows, knees, and buttocks) Mouth sores Anemia Bone disorders Neuropathy Symptoms and Side Effects (cont’d)

6. Testing • Antibody test/blood test • Biopsy

7. Villi • Think of stomach lining as a carpet/tile or mop/broom • Digestive enzymes • Foods pass through with nutrients not absorbed/digested

8. Associated Conditions • Iron deficiency anemia • Osteoporosis • Vitamin K deficiency associated with risk for hemorrhaging • Vitamin and mineral deficiencies • Central and peripheral nervous system disorders, usually because of unsuspected nutrient deficiencies

9. Associated Conditions (cont’d) • Pancreatic insufficiency • Intestinal lymphomas and other GI cancers • Lactose intolerance • Neurological manifestations

10. Malnutrition • Vitamins A, D, E, K • Vitamin B12 • Folate • Iron • Most severe for children–may result in failure to thrive

11. Calcium and Vitamin D • Osteomalacia, rickets, kidney stones • Secondary lactose intolerance (usually reversible)

12. Additional Medical Consequences • Intestinal lymphoma and bowel cancer, if gluten-free diet is not followed • Seizures and peripheral neuropathy often manifest

13. Treatment • Avoid gluten–arguable as to whether to limit all intake, regardless of symptoms • See a dietitian/physician for vitamin supplementation recommendations • Once gluten-free diet is implemented, absorption of all nutrients, vitamins, and minerals will return when GI tract is repaired

14. Ingredients to Avoid • Grains–barley, wheat, triticale, rye, farina, graham, semolina, durum, bulgur, kamut, kasha, matzo meal, and spelt • Oats? • Many people with celiac disease have celiac disease symptoms when they eat oats • Possibly because many oats are processed on equipment that processes wheat • Amaranth, buckwheat, and quinoa–take care because of cross contamination

15. Breads Cereals Crackers Pasta Cookies Cakes Pies Gravies Sauces Snack foods Medications Stamps/stickers Cosmetics Avoid

16. Choose • Corn • Potatoes • Arrowroot • Tapioca • Rice

17. What to Do • August 2008 new FDA “gluten-free” regulations come out • Sit with a registered dietitian at least annually • Be diligent about checking ingredients and preparation methods

18. What to Do (cont’d) • Vitamin and mineral supplementation • Still controversial • Not necessary for general wellness if celiac disease patient is eating a healthful diet • Supplementation of B vitamins, magnesium, and a few others still too questionable to make definitive recommendations

19. What to Do (cont’d) • Decide to become proactive!

20. References and Resources • Visit http://www.rd411.com/forms/68138_sheet_2.pdffor a listing of valuableresources: • Education and research • Articles and references • Books • Cookbooks • Pamphlets and brochures • Magazines and newsletters