1. Celiac Disease Provided Courtesy of RD411.com Where dietitians go for information Review Date 9/10 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. Symptoms and Side Effects No classic profile for celiac disease, unlike hypertension, cancer, or other diseases that have biomarkers Often mistaken for Crohn’s disease, parasites, skin disorders, etc Often surfaces after trauma

4. Symptoms and Side Effects (cont’d) Strong genetic disposition: – Pale – Irritable – Fails to grow – Potbelly – Flat tush – Stinky stools

5. Symptoms and Side Effects (cont’d) Diarrhea Gas Bloating Irritability Depression Joint pain Muscle cramps Skin rash (elbows, knees, and buttocks) Mouth sores Anemia Bone disorders Neuropathy

6. Testing Antibody test/blood test Biopsy

7. Villi Think of stomach lining as a carpet/tile or mop/broom Digestive enzymes Foods pass through with nutrients not absorbed/digested

8. Associated Conditions 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

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

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

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

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

13. Treatment Avoid ingesting gluten See a dietitian/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

14. Ingredients to Avoid 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

15. Avoid Breads Cereals Crackers Pasta Cookies Cakes Pies Gravies Sauces Snack foods Medications

16. Cosmetics Gluten-containing cosmetics and skin care products are OK to use Gluten-free toothpastes and mouthwashes often are recommended, as are 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

17. Choose Corn Potatoes Arrowroot Tapioca Rice Amaranth Buckwheat Nut flours Quinoa For a complete list of allowed foods, contact a registered dietitian. Call manufacturers if you have any questions about possible cross-contamination.

18. What to Do Sit with a registered dietitian at least annually Be diligent about checking ingredients and preparation methods

19. What to Do (cont’d) Vitamin and mineral supplementation –Still controversial –Not necessary for general wellness if celiac disease patient is eating a healthful diet –Supplementation of B vitamins, magnesium, and a few others still too questionable to make definitive recommendations

20. What to Do (cont’d) Decide to become proactive!

21. References and Resources Visit http://www.rd411.com/forms/68138_sheet _2.pdf for a listing of valuable resources: –Education and research –Articles and references –Books –Cookbooks –Pamphlets and brochures –Magazines and newsletters