1. Celiac Disease

2. Recent Prevalence of Celiac Disease 1 in 133 people have CD Prevalent, but under diagnosed – Those not diagnosed have a higher death rate Mayo Clinic – Raise awareness, improve screening – Why is Celiac Disease on the rise?

3. Celiac Disease… Aka Celiac Sprue An auto-immune disease that affects the small intestine No wheat, rye and barley Attack of the micro-villi! Malabsorption – Osteoporosis, iron-deficiency anemia, infertility, cancer, other auto-immune diseases, etc Go gluten-free, intestinal repair

5. Signs and Symptoms No classic signs Bloating, abdominal pain, diarrhea Less noticeable symptoms – Anemia, joint pain, stomach pain, irritability, dental or bone disorders, weight loss, stunted growth in kids Can imitate symptoms of other conditions such as irritable bowel Dermatitis herpetiformis Silent Celiac Disease – No symptoms, still damage

7. The Latest Fad A new diet trend Gluten only harmful to those with CD No current evidence to back up gluten-free diet health claims Wheat flour fortification: B 1, B 2, B 3 and Iron

8. Diagnosis 1 st : Physical exam and blood testing 2 nd : Duodenal biopsy 3 rd : Implement gluten-free diet http://www.csaceliacs.org/celiac_diagnosis.php

9. Gluten Gluten is a protein that gives dough elasticity which allows it to rise without collapsing while trapping the CO 2 Exists within wheat, rye and barley. Also in wheat derivatives: bulgar, couscous, mataza, seitan, semolina, triticale, spelt, kamut, einkorn, emmer and anything with ‘wheat’ in the title (except buckwheat).

11. FDA Gluten Free Labeling Currently, FDA has no current definition for “gluten-free” Proposed definition of gluten: – proteins that naturally occur in wheat, rye or barley or a hybrids of these. Voluntary labeling Proposed in 2007, as of 2009 - still in draft form Read label ingredients!

12. Gluten-Free Naturally gluten-free – Ex: Fresh fruits and vegetables Commercially gluten-free – Ex: Rice flour bread, Gluten-free cookies

13. Eating Out and Gluten Free Gluten-free menus: http://www.glutenfreetravelsite.com/restaurants/ – Menu must be requested Ask questions! – What’s in the dish, how is it prepared, can I see the label A severe allergy? Be skeptical, cross contamination happens

14. Gluten Free Cooking and Baking “Safe” grains: corn, rice, buckwheat, wild rice, amaranth, quinoa, teff, millet, sorghum Other ‘safe’ foods: All vegetables, legumes, fruits, natural meats (not deli meats), fish, shellfish, eggs, natural dairy products and nuts as well as potatoes, tapioca and arrowroot. Baking is the most difficult-trial and error method of finding tasty recipes Be aware of gluten-contamination!

15. Possible Culprits Hygiene Hypothesis 21 st Century Diet Modern wheat

16. Celiac Disease and Obesity Study states that malnutrition of adults and children is not seen often After gluten-free diet, percentage of overweight participants doubled Nutritional imbalance of gluten-free foods New morbidities, especially in children Nutritional follow-up needed

17. Is CD Genetic? A link between genes and Celiac Disease 1 in 22 with first degree relatives Often comes shows up after a bout of trauma such as an infection, injury, stress or pregnancy Relatives need regular screens for auto- immune disorders

18. Celiac Disease and Type 1 Diabetes A link between, T1DM and Celiac Disease 1 in 20 people with Celiac Disease have Type 1 Diabetes Mellitus T1DM: the pancreas doesn’t make insulin T1DM is also an autoimmune disease that is thought to reveal itself in the same manner – Genetic disposition plus an environmental factor

20. “A New Hope For CD Sufferers?” New study, no conclusions yet Pills that break down gluten Immunotherapy: training the immune system to tolerate gluten through injections +?

21. Take Home Message Be aware of Celiac Disease and the implications it has on those who have it See a doctor if you have unexplainable symptoms that may be caused by CD or if an immediate family member has CD or another auto-immune disease