1. Eat to Heal... the Cure is Food!

2. Overview  Celiac Disease Definition Symptoms and presentations Diagnosis Treatment  The Kogan Celiac Center at Barnabas Health History Support

3. What is Celiac Disease?  Celiac disease is a permanent, genetic disorder that is characterized by an autoimmune reaction to the ingestion of gluten (a protein found in wheat, rye and barley). This reaction causes damage to the absorptive structures in the small intestine (villi) and ultimately results in: Conditions of malnutrition Potential damage to any organ system  There is no cure, the only known treatment is the complete removal of gluten from the diet.

4. Epidemiology  Affects all cultures and nationalities  1 in 133 individuals in the U.S. are believed to have celiac disease.  Only a small percentage of individuals know that they have celiac disease and it has been reported to take up to 11 years to diagnose.

5. The “Celiac Iceberg” “ Classic Symptoms ”  Anorexia  Diarrhea  Bloating/Gas  Vomiting  Constipation  Lactose intolerance  Abdominal pain  Pale or Foul Smelling Stool  Weight Loss/Muscle Wasting

6. The “Celiac Iceberg” (cont’d) “Non-Classic Symptoms”  Failure to thrive in infants  Anemia resistant to oral iron therapy  Unexplained short stature or delayed puberty  Depression, irritability, learning or behavior disorders  Seizures/Neuropathy/Ataxia  Recurrent fetal loss (intrauterine growth retardation)  Delayed or missed periods, infertility  Osteoporosis/osteopenia  Oral sores  Loss of tooth enamel  Vitamin deficiencies

7. Associated Disorders/Risk Factors  Type 1 Diabetes  Thyroiditis  Addison’s Disease  Primary Biliary Cirrhosis  Autoimmune Hepatitis  Rheumatoid Arthritis  Sjogren’s Syndrome  Down Syndrome  Turner’s Syndrome  Williams Syndrome  Increased risk of celiac disease in relatives of celiacs: 7-10% primary relatives 3-5% secondary relatives

8. Diagnosis of Celiac Disease  Serology  Small Bowel Biopsy

9. Dermatitis Herpetiformis  Skin manifestation of celiac disease. Itchy, pustules, bilateral Dx by local skin biopsy Symptoms respond to gluten free diet

10. The Gluten Free Diet  Gluten is a storage protein found in certain grains and is harmful to celiacs  These grains, and any ingredient that comes from them, are eliminated in a gluten free diet Wheat Barley Rye

11. The Gluten Free Diet (cont’d)  Substitution Foods: bread, pasta, cookies, cakes, crackers  Naturally gluten free food: stir fry, omelettes, chili, risotto  Hidden ingredients  Cross Contamination: purchasing, storing, preparation, serving  Nutritionally Complete

12. The Kogan Celiac Center at Barnabas Health MISSION To provide expert services including early assessment, diagnosis, treatment, education and support to improve the health and well-being of those who live with Celiac Disease

13. Serving Barnabas Health ONGOING SUPPORT, EDUCATION, MANAGEMENT AND ADVOCACY GI Panel Pediatric/Adult LifestyleManagement On-site Lab GI Endoscopy Services Bone Densitometry Nutrition Counseling & Education Events Kickoff & Annual PharmacyServices Screening Programs

14. Significant initiatives and accomplishments Recognized by the American Dietetic Association as expert resource for healthcare professionals nationwide Quoted in major journals, other print media and radio Educated healthcare professionals, nurses and students in public and private institutions statewide Implemented gluten free protocol in all food service operations in BH – certified by the National Foundation for Celiac Awareness Now running adult and pediatric support groups in all 3 locations with total membership in excess of 150 patients Guest speaker in two webinars broadcasted nationally

15. Support  Remains the ONLY dedicated celiac center in the state of New Jersey to offer a comprehensive approach to the treatment and management of celiac disease for adults and children Early assessment and diagnosis Screening Services Education and awareness  Patients  Healthcare professionals  Community Support Groups

16. The Kogan Celiac Center  www.koganceliaccenter.com www.koganceliaccenter.com  973-322-7272  JOIN US EAT TO HEAL!