1. { Celiac Disease Presented By: Kasi Johnson

2.  An Inherited, Autoimmune Disorder  Permanent Intolerance to Gluten in Wheat, Rye, Barley - Gluten is made of several different proteins - Gluten is made of several different proteins (Ex: Gliadin and glutenin). In Celiac disease, gliadin is resistant to certain membrane proteases, and does not digest.  Damages the villi of the small intestine  Interferes with the nutrient absorption  When people eat food that contains gluten, their immune system attacks their small intestine.  Typically genetic: 1 in 10 chance What is Celiac Disease?

3. Celiac Disease Summary of Celiac Disease

4. The Portion of the protein in flour that forms the structure of dough. What is Gluten?

5. What Actually Happens with Digestion Process?? Normal Digestion vs. Abnormal

6. The villi allow food to be absorbed through the walls of small intestine to the blood through endocytosis Proteins enter the small intestine. Pancreatic In a healthy microvilli, there are 650 per cell The Normal Digestion of Gluten

7. The Process of Celiac Disease

9. What causes Celiac Disease? Abnormally permeable intestinal lining leaks gluten and initiates immune reaction in these will susceptible genes. The intestinal villi flatten out and the intestinal lining becomes inflamed. This is due to an autoimmune response to gliadin. Flattened villi cannot absorb nutrients, due to the decrease in surface area. This includes all nutrients, not just gluten related. This villi cannot produce digestive enzymes to breakdown food. The nuclei in diseased small intestinal cells show irregularity in size and position. Without healthy villi, a person becomes malnourished, despite food consumption because nutrients cannot cross the phospholipid bi-layer from the small intestine into the blood capillaries. The Effects

11. Microvilli on Duodenal Villi can completely disappear Digestive enzymes of the S.I. are embedded within plasma membrane of the microvilli. The red box represents aminopeptidase, the enzyme that cleaves amino acids from polypeptide chains Examples of effects from lost enzymes: Free amino acids cannot be made by brush border enzymes and hydrolyzed within epithelial cells. Carbohydrates like maltose cannot be hydrolyzed into monosaccharides by brush border enzymes. Celiac Disease Destroys This Brush Border and Eliminates its Functions

12. Goblet cells cannot secrete mucus. The capillaries cannot absorb monosaccharides and amino acids, nor house lymphocytes. The lacteal cannot absorb fat. Simple columnar epithelium lose microvilli. Microvilli loose enzymes that hydrolyze disaccharides and polypeptides. The Crypt cannot make new epithelial cells by mitosis Celiac Stops These Processes:

13.  Gas and bloating.  Changes in bowel movements.  Weight loss.  Feeling very tired.  Weakness.  Some may be asymptomatic  Diarrhea  Short Stature  Iron Deficiency Anemia  Lactose Intolerance  Irritability  Mood Swings  Abdominal Pain  Irritable Bowel  Osteoporosis  Skin rash-very itchy with blisters Symptoms

14.  See your doctor.  Initial Blood Tests  Avoid foods with gluten in it and see what happens. Sound Familiar? Get Checked out!

15. NOT CUREABLE: GLUTEN FREE DIET ELIMINATE ALL WHEAT, RYE, BARLEY 97% go undiagnosed; 6 months to 1 year if gluten is out of diet Treatment

16.  Learn how to watch what goes into body.  Read Labels!  Understand Cross Contamination  Research What Next?

17.   Words of Wisdom   Website to locate local restaurant that have gluten- free options.   Tips for reading labels   Copy of PowerPoint Folders

18. 1- GLUTEN CONTAINING GRAINS TO AVOID 2- OVERLOOKED GLUTEN SOURCES 3- GLUTEN FREE GRAINS AND STARCHES 4- GLUTEN FREE SHOPPING LIST Learn how to watch what goes into body.

19.  Barley  Barley malt/extract  Bran  Bulgur  Couscous  Bromated or Durum Flour  Einkorn  Emmer  Enriched or Self Rising Flour  Farina  Faro  Graham Flour  Kamut  Phosphated Flour  Rye  Seltan  Semolina  Spelt  Triticale (cross between wheat/rye)  Udon  Wheat GLUTEN CONTAINING GRAINS TO AVOID

20.  Ales  Beer and Lagers  Bouillon Cubes  Breading  Brown Rice Syrup  Coating Mix  Communion Wafers  Croutons  Candy  Some Chips/Potato chips  Luncheon Meats, hot dogs, salami, sausage  French Fries  Gravy  Pasta  Rice Mixes  Seasoned Tortilla Chips  Sauces  Soup Base  Stuffing  Self-basting Poultry  Imitation Bacon/Seafood  Soy Sauce  Marinades Thickeners Herbal  Supplements, Prescription Meds  Over the Counter Meds OVERLOOKED GLUTEN SOURCES

21.  Amaranth  Arrowroot  Buckwheat  Corn  Flax  Flours made from nuts, beans and seeds  Millet  Montina  Potato Starch  Potato Flour  Quinoa  Rice  Rice Bran  Sago  Sorghum  Soy (soya)  Tapioca  Teff GLUTEN FREE GRAINS AND STARCHES

22.  Sour Cream  Plain Frozen Fruits/Veggies  Most Ice Cream/Sherbet  Potato Chips (beware flavored ones)  Rice Crackers, Rice Cakes  Jello  Pudding  Plain Canned Fruits/Veggies  Canned Tuna or Chicken  Dried Beans, Lentils, Peas  Most Baked BeansFresh Fruits  Fresh Vegetables  Tofu  Fresh Beef  Fresh Pork  Fresh Poultry (self-basting)  Fresh Fish or Seafood  Eggs  Unflavored Milk  Most Yogurts  Butter, Margarine GLUTEN FREE SHOPPING LIST Cream of Rice Grits Puffed Rice Plain Brown or White Rice CORN Tacos/Tortillas Ketchup Mustard Distilled Vinegars Most Salad Dressings Vegetable, Canola and Olive Oil Jams/Jellies, Marmalade Honey Peanut Butter Corn or Potato Starch Corn and Maple Syrup Brown, White and Confectioner’s Sugar Spices and Herbs Salt, Pepper Relish, Pickles, Olives Cream Cheese Cottage Cheese Corn Chips Popcorn

23.  Watch for Wheat, Barley, or Rye  Not all food are obvious (watch for other words that mean wheat) - Bromated flour, farina, flour, plain flour, semolina  If in doubt, look for “Gluten-Free” - Look at Handout in Folder for tips Read Labels!

24. Time to Practice

26. Understand Cross Contamination 8 Tips For Avoiding Gluten Cross Contamination -Handout in Folder Cross contamination: Happens when bacteria from one food item are transferred to another food item, often by way of unwashed cutting boards or countertops, as well as knives and other kitchen tools, or even unwashed hands. Cross contamination can in turn lead to food poisoning.

27.  Make time to “DO the research”  Books, magazines, websites and more!  Book:  Book: The G-Free Diet: A Gluten-Free Survival Guide By: Elisabeth Hasselbeck Research

28. Contact Info: Name Phone Number Email Questions or Comments??

29.  http://www.ncbi.nlm.nih.gov/pubmed http://www.ncbi.nlm.nih.gov/pubmed  www.calgaryceliac.com/events/Celiac Disease in Children.ppt www.calgaryceliac.com/events/Celiac Disease in Children.ppt www.calgaryceliac.com/events/Celiac Disease in Children.ppt  http://bnljceliacdisease.wordpress.com http://bnljceliacdisease.wordpress.com  http://www.marshfieldclinic.org http://www.marshfieldclinic.org  http://highered.mcgraw-hill.com http://highered.mcgraw-hill.com  http://www.nature.com http://www.nature.com  http://www.scribd.com http://www.scribd.com  http://digestive.niddk.nih http://digestive.niddk.nih   http://glutenfreeregistry.com/gluten-free-state- search.do?state=MN&page=3 http://glutenfreeregistry.com/gluten-free-state- search.do?state=MN&page=3   http://nutritioncaremanual.org/vault/editor/Docs/Ce liacLabelReadingTips_FINAL.pdf http://nutritioncaremanual.org/vault/editor/Docs/Ce liacLabelReadingTips_FINAL.pdf   http://www.celiac.org/index.php?option=com_conte nt&view=article&id=3&Itemid=9 http://www.celiac.org/index.php?option=com_conte nt&view=article&id=3&Itemid=9Sources