1. CELIAC DISEASE Joanne Nugent M.S., R.D, L.D., CDE

2. Celiac Disease An inflammatory disease of the small bowel initiated by gluten. Leading to malabsorption of nutrients and effect all systems of the body

3. Celiac disease Autoimmune disease;intolerance to gluten Autoimmune disease;intolerance to gluten Gluten sensitive Gluten sensitive Wheat allergy Wheat allergy 1 in 100 is the estimated prevalence of celiac disease. 1 in 100 is the estimated prevalence of celiac disease. Takes an average 11yr to get diagnosis Takes an average 11yr to get diagnosis 35% exhibit chronic diarrhea 35% exhibit chronic diarrhea 2-3x more common in women 2-3x more common in women 97% of people with celiac have not been diagnosed 97% of people with celiac have not been diagnosed

4. Pathophysiology Villi are similar to shag carpet. Damage from gluten causes breakdown of villi. When villi atrophy, the shag carpet is more similar to a tile floor. similar to a tile floor. “LEAKY GUT” This results in the inability to absorb certain nutrients(iron,calcium,vit.- D,A,E,K,protein nutrients(iron,calcium,vit.- D,A,E,K,protein and folic acid). and folic acid).

5. SYMPTOMS GI symptoms GI symptoms Chronic diarrhea/constipation Chronic diarrhea/constipation Abd pain/distention Abd pain/distention Poor appetite/intake Poor appetite/intake Vomiting Vomiting Non GI symptoms Non GI symptoms Dermatitis herpetiformis Dermatitis herpetiformis Dental enamel hypoplasia Dental enamel hypoplasia Osteopenia/osteoporosis Osteopenia/osteoporosis Iron deficient anemia Iron deficient anemia Delayed puberty Delayed puberty Infertility Infertility Fatigue/irritability and failure to thrive Fatigue/irritability and failure to thrive

6. Complications Lymphoma Lymphoma Intestinal carcinoma Intestinal carcinoma Osteoporosis Osteoporosis Refractory Celiac disease Refractory Celiac disease

7. Immune Disorders Dermatitis herpetiformis Dermatitis herpetiformis T1DM T1DM Liver/Thyroid disease Liver/Thyroid disease Lupus Lupus Addison’s disease Addison’s disease Down’s/Sjogren’s syndromes Down’s/Sjogren’s syndromes Rheumatoid Arthritis Rheumatoid Arthritis

8. Treatment Lifelong diet that is gluten free Lifelong diet that is gluten free Total elimination of wheat, rye, and barley Total elimination of wheat, rye, and barley

9. Gluten??? Gluten is an elastic protein found in certain grains. Gluten is an elastic protein found in certain grains. Proteins that cause problems for celiac Proteins that cause problems for celiac disease 1. Gliadin/wheat 2. Secalin/rye disease 1. Gliadin/wheat 2. Secalin/rye 3. Hordein/barley. 3. Hordein/barley.

10. Common Sources of Gluten Pasta Pasta Cereal Cereal Bread, pizza crust, salad croutons Bread, pizza crust, salad croutons Crackers, pretzels Crackers, pretzels Cookies, cakes, pies, pastries Cookies, cakes, pies, pastries Beer Beer Cross contaminated oats/other food products Cross contaminated oats/other food products

11. Foods that MAY contain Gluten Candy Candy Soy sauce Soy sauce Lunch/processed meats Lunch/processed meats Rice mixes Rice mixes Seasoned chips Seasoned chips Canned soups/sauces Canned soups/sauces Imitation fish Imitation fish Communion wafers Communion wafers Matzo/matzo meal Matzo/matzo meal

12. Potential Sources Chewing gum Chewing gum Lipstich/balm Lipstich/balm Personal care products; shampoo, lotions Personal care products; shampoo, lotions Medications; prescription, OTC, herbal and vitamins and minerals Medications; prescription, OTC, herbal and vitamins and minerals

13. Flours containing gluten Bulgur Bulgur Couscous Couscous Kamut Kamut Semolina Semolina Spelt Spelt Graham flour Graham flour Triticale Triticale Wheat germ Wheat germ

14. Gluten-free flours Rice flours Rice flours Almond flour Almond flour Amaranth Amaranth Arrowroot Arrowroot Buckwheat Buckwheat Corn flour-corn starch Corn flour-corn starch Cornmeal Cornmeal Gram flour(chick peas) Gram flour(chick peas) Potato starch flour Potato starch flour Quinoa Quinoa Soy (soya flour) Soy (soya flour) Tapioca starch Tapioca starch Teff grain Teff grain Potato flour Potato flour Sorghum flour Sorghum flour

15. Gluten-Free Foods Fruits Fruits Vegetables Vegetables Milk, cream, most ice creams, cheese, cottage cheese, cream cheese Milk, cream, most ice creams, cheese, cottage cheese, cream cheese Potatoes, corn, rice, lentils, beans Potatoes, corn, rice, lentils, beans Butter, margarine, oil, salad dressing (allowed ingredients) Butter, margarine, oil, salad dressing (allowed ingredients) Fresh meat, fish, poultry, eggs Fresh meat, fish, poultry, eggs Plain nuts, seeds, popcorn Plain nuts, seeds, popcorn

16. MORE Gluten-free Tea, coffee, soda Tea, coffee, soda Distilled alcoholic beverages Distilled alcoholic beverages Plain pickles, olives, relish, ketchup, tomato paste, mustard (with distilled vinegar, herbs/spices, black pepper Plain pickles, olives, relish, ketchup, tomato paste, mustard (with distilled vinegar, herbs/spices, black pepper Honey, jam, jelly, corn/maple syrup, sugar Honey, jam, jelly, corn/maple syrup, sugar

17. Labels Food Allergen Labeling and Consumer Protection Act (FALCPA) Food Allergen Labeling and Consumer Protection Act (FALCPA) Food labels identify eight main food allergens (milk, eggs, panuts, tree nuts, fish, crustacean shellfish, soy and wheat Food labels identify eight main food allergens (milk, eggs, panuts, tree nuts, fish, crustacean shellfish, soy and wheat Gluten-free are wheat free, but wheat free Gluten-free are wheat free, but wheat free are not always gluten free are not always gluten free

18. Compliance barriers Cost Cost Availability Availability Taste/quality Taste/quality Patients lack of symptoms Patients lack of symptoms Difficulty with labeling of food/drugs Difficulty with labeling of food/drugs Poor education from healthcare providers Poor education from healthcare providers

19. Resources www.celiac.com www.celiac.com www.celiac.com www.celiacsprue.com www.celiacsprue.com www.celiacsprue.com www.niddk.nih.gov/h ealth/digest/pubs/celi ac/index.htm www.niddk.nih.gov/h ealth/digest/pubs/celi ac/index.htm www.niddk.nih.gov/h ealth/digest/pubs/celi ac/index.htm www.niddk.nih.gov/h ealth/digest/pubs/celi ac/index.htm www.glutenfree.com www.glutenfree.com Support group cinciceliac.com Support group cinciceliac.com

20. Bottom Line Celiac disease can be managed successfully with education, resources and support. Celiac disease can be managed successfully with education, resources and support.