1. Celiac Disease Provided Courtesy of Nutrition411.com Review Date 11/14 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. Characterized by four factors: – Genetic susceptibility – Exposure to gluten – Environmental “trigger” – Autoimmune response What Is Celiac Disease?

4. No classic profile for celiac disease exists, unlike hypertension, cancer, or other diseases that have biomarkers Often mistaken for Crohn’s disease, parasites, skin disorders, or other conditions Trauma or stress may serve as the trigger What Is Celiac Disease? (cont’d)

5. Intestinal villi (tiny “hairs” that help with nutrient absorption) are damaged by an inflammatory response to gluten Malabsorption of nutrients results Intestinal walls are more porous Result of Celiac Disease

6. Diarrhea Stools that float because they contain unabsorbed fat Weight loss Fatigue Anemia Symptoms

7. Vomiting Poor appetite Dermatitis herpetiformis (itchy skin rash) Symptoms (cont’d)

8. Serum antibody tests: – Dietary changes alter results, so schedule evaluation before gluten is eliminated from the diet Biopsy of lining of intestine to confirm diagnosis Diagnosis

9. 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 Associated Conditions

10. Pancreatic insufficiency Intestinal and other gastrointestinal (GI) cancers Lactose intolerance Neurological manifestations Associated Conditions (cont’d)

11. Vitamins A, D, E, and K Vitamin B 12 Folate Iron Most severe for children—may result in failure to thrive Malnutrition

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

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

14. Avoid ingesting gluten for a lifetime See a registered dietitian (RD), registered dietitian nutritionist (RDN), or physician for vitamin supplementation recommendations Once a gluten-free diet is implemented, absorption of all nutrients, vitamins, and minerals will return when GI tract is repaired Treatment

15. 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 Ingredients to Avoid

16. Reading labels and asking questions are the keys to successfully managing celiac disease Living With a Gluten Restriction

17. Bread Cake Cereal Cookies Crackers Gravy Medication Pasta Pie Sauce Snack food Read Labels Before Purchasing These Foods

18. Gluten-containing cosmetics and skin care products are OK to use Gluten-free toothpaste and mouthwash often are recommended, as are gluten-free lip products, because of ingestion Some experts ask children to use gluten-free hand lotions, if they put their fingers in their mouth as a habit Cosmetics

19. Amaranth Arrowroot Buckwheat Corn Nut flours Potatoes Quinoa Rice Tapioca Choose For a complete list of allowed foods, contact an RD or RDN. Call manufacturers if you have any questions about possible cross-contamination during processing or packaging.

20. Meet with an RD or RDN at least annually Remain diligent about checking ingredients and safe preparation methods Managing Celiac Disease

21. Vitamin and mineral supplementation? – Not necessary for general wellness if individual with celiac disease is eating a healthful diet – Supplementation of B vitamins, magnesium, and a few other vitamins and minerals still too questionable to make definitive recommendations Managing Celiac Disease (cont’d)

22. Seek reliable sources of information: – Nutrition411.com – Celiac Disease Foundation (www.celiac.org)www.celiac.org Managing Celiac Disease (cont’d)

23. Decher N, Krenitsky JS. Medical nutrition therapy for lower gastrointestinal tract disorders. In: Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012:618-624. Jonega JV. The Health Professional’s Guide to Food Allergies and Intolerances. Chicago IL: Academy of Nutrition and Dietetics; 2013. References and Resources