Medical Program Version
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The Nature of Celiac Disease
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Celiac Disease (CD) is an autoimmune disease.
It is one of the most common autoimmune diseases.
The autoimmune response occurs in the gut.
It is triggered by Gluten, a storage protein in wheat, barley and rye.
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The Nature of Celiac Disease
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The onset of CD can occur at any age.
All people diagnosed with CD will have intestinal damage.
The villi become inflamed, flattened and disappear.
Nutrients, including carbohydrates, proteins, fats, vitamins and minerals, can no longer be absorbed.
This leads to malnutrition and other serious health problems.
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The Nature of Celiac Disease
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CD was formerly thought to be a disease of childhood.
It is now recognized as a disease that can occur at any age.
CD can be triggered in otherwise healthy people when additional stresses are placed on the body, including: childbirth, severe infections, surgery, food poisoning and emotional stress.
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The Nature of Celiac Disease
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Abdominal cramping and pain
Nausea and/or vomiting
Intestinal gas and bloating
Diarrhea, including steatorrhea
Weight loss
Anemia and other vitamin deficiencies
– iron, folate, B12, A, D, E, K
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The Nature of Celiac Disease
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It is now recognized as a multi-system disease including such additional symptoms as:
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Bone and joint pain, including arthritis
Depression
Nervous system disorders – central and peripheral
Extreme weakness and fatigue
Easy bruising of the skin
Osteoporosis
Edema of the hands and ankles
Fertility problems, amenorrhea, impotence
Mouth ulcers – canker sores
Weight gain
Constipation
Lactose intolerance
Other digestive system symptoms
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The Nature of Celiac Disease
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Dental enamel defects
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Delayed puberty
Failure to thrive/delayed growth/short stature
Abdominal distension
Learning difficulties
Severe irritability/behavioural changes
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The Nature of Celiac Disease
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CD is often associated with some other diseases and conditions, including:
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Intestinal lymphoma
Type I diabetes
Autoimmune thyroid disease
Liver enzyme elevations
IgA deficiency
Autoimmune hepatitis
Addison’s disease
Epilepsy
Sarcoidosis
Sjogren’s disease
Systemic lupus erythematosus
Turner’s syndrome, Williams syndrome, Down syndrome
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The Nature of Celiac Disease
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When left untreated, CD can result in other disorders, including:
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Nervous system disorders
Internal hemorrhaging
Intestinal lymphoma (non-Hodgkin’s)
Anemia
Osteoporosis
Vitamin and mineral deficiencies
Pancreatitis
Tooth enamel defects
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

The Nature of Celiac Disease
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Celiac Disease is often misdiagnosed as other common ailments, including:
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Allergies
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Anemia
Crohn’s disease/colitis
Diverticulosis/spastic colon
Gall bladder disease
Irritable bowel syndrome
Chronic fatigue syndrome
Lactose intolerance
Stress/depression/emotional disturbances
Viral gastroenteritis
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The Nature of Celiac Disease
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Dermatitis Herpetiformis (DH) is an intensely itchy skin rash.
It is a form of celiac disease and is often referred to as CD of the skin.
People diagnosed with DH will also have intestinal damage, with or without symptoms.
It is often treated with dapsone in addition to the GF diet.
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

Genetic Properties
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Celiac Disease is a true autoimmune disease.
The genetic predisposition (HLA), the exogenous trigger (Gluten) and the autoantigen (tTG) are all known.
CD is currently the only autoimmune disease for which all three factors are known.
Unlike many other autoimmune diseases, the cause of the disease has been identified.
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

Frequency of Occurrence
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CD occurs in almost 1% of the population.
CD occurs in 1 in 22 first degree relatives.
Canadian Research 12-15 per cent
CD occurs in 1 in 39 second degree relatives.
Canadian Research 5-12 per cent
CD occurs in 1 in 56 people with gastrointestinal symptoms.
CD occurs in 1 in 133 of the ‘not at risk population.
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

Diagnosing Celiac Disease
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A series of serologic tests can assist in the preliminary screening for CD.
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Serum IgA-endomesial antibody testing (IgA-
EMA) OR
Serum IgA-tissue transglutaminase testing
(IgA-tTG) PLUS
Total serum IgA
An intestinal biopsy must be performed to confirm the diagnosis of CD.
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Treatment of CD
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What Happens When We’re
Glutened ?
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Even small amounts of gluten can be harmful to people with celiac disease and can cause continued small bowel damage.
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The accidental ingestion of gluten does not cause the profound anaphylactic response that is common with peanuts and other allergens.
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

What Happens When We’re
Glutened ?
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Many people with CD will have immediate intestinal symptoms.
Many will have headaches or other nonintestinal symptoms.
Many will have delayed symptoms.
Many will have no symptoms but will still have intestinal damage which can lead to other illnesses.
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

What Happens When We’re
Glutened ?
Avoiding Gluten and Cross Contamination
The progression of damage to the villi www.calgaryceliac.com

What Happens When We’re
Glutened ?
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

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DH on the abdomen
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What Happens When We’re
Glutened ?
DH on the elbow DH on the knee
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Major Concerns
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Increase Awareness
Safe Ingredients
Hidden Sources of Gluten
CROSS CONTAMINATION
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

What is Gluten ?
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Gluten Containing Grains &
Grain Products
Barley
Couscous
Emmer
Graham flour
Oats*
Semolina
Wheat
Bulgar
Durum
Filler
Kamut
Cereal Binding
Einkorn
Farro
Malt
Roux Rye
Spelt (Dinkel) Triticale
Oats are currently excluded from the gluten-free diet because of the high risk of contamination from gluten containing grains
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

Gluten-Free Grains &
Grain Substitutes
Amaranth
Cassava
Flax
Nuts
Potatoes
Sago
Tapioca
Arrowroot
Corn (Maize)
Legumes
Poi
Quinoa
Sorghum
Teff
Buckwheat
Dahl
Millet
Polenta
Rice
Soy
Wild Rice
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

Other Gluten-free Foods
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Fresh meat, poultry, fish and seafood
Fresh vegetables and fruits
Eggs
Cheese and other dairy
All products made with gluten-free ingredients
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The Questionable Products
Baking powder
Bouillon cubes
Condiments
Dry roasted nuts
Herbal teas
Ice cream and yogurt
Imitation seafood
Marinades and sauces
Pilaf mixes
Puddings
Salad dressing
Seasoned fries
Smarties*
Soy sauce
Avoiding Gluten and Cross Contamination
Beverage mixes
Cheese spreads
Dried fruit
Flavourings
HPP/HVP
Icing sugar products
Licorice and candies
Modified food starch
Processed meats
Rice and soy beverages
Seasonings
Self basting poultry
Soups and broths
Worcestershire sauce www.calgaryceliac.com

Preventing Contamination &
Cross-contamination
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When preparing a gluten-free meal, it is important to prevent contamination of the gluten-free foods with glutencontaining food particles and residues.
Even small amounts of gluten can result in continued intestinal damage for people with CD and DH
Care must be taken to ensure that gluten-free foods remain gluten-free.
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

Preventing Contamination &
Cross-contamination
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Select a preparation area that is separate from other food preparation areas.
Air-borne flour and other glutencontaining particles can contaminate gluten-free foods.
Ensure all preparation surfaces, cooking surfaces and cooking utensils have been thoroughly cleaned, including counter top, meat slicer, grill surface, cutting boards, bowls, knives, utensils, thermometers, cleaning cloths.
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

Preventing Contamination &
Cross-contamination
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Use dedicated pots, pans, utensils and cutting boards whenever possible.
Rolled edge pans are easier to clean.
Scrub with soap and water to ensure removal of gluten-containing particle. Disinfect according to current standards of practice.
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

Preventing Contamination &
Cross-contamination
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Follow impeccable hand washing practices.
Use sanitary gloves for food preparation and change them before handling GF foods.
Ensure the powder used is gluten-free.
Even powder-free gloves can have trace amounts of powder.
Become knowledgeable about special needs diets and menu selections.
Educational programs are offered through many of the local chapters of the Canadian Celiac
Association.
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

Preventing Contamination &
Cross-contamination
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Ensure all ingredients are gluten-free.
Check product ingredients
regularly. Manufacturers and suppliers can change ingredients without notice.
Ensure that anti-caking and flow agents are GF. These agents may not be identified in the ingredient lists.
Use boldly labeled, air tight containers for all products designated as GF.
Prepare GF meals before other menu selections
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Preventing Contamination &
Cross-contamination
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Clean utensils must be used for each condiment, butter, sauce and all other items.
Use individual portions and/or squeeze bottles.
Deep fryer oil previously used for glutencontaining foods is unsafe for gluten-free cooking.
Fresh water must always be used for boiling, poaching or steaming.
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

Preventing Contamination &
Cross-contamination
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Use the top oven racks.
Use caution with convection ovens.
Use toaster bags to prevent contamination of GF bread products.
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Arrange buffet tables with gluten-free selections first and separated from the gluten-containing selections. Label them.
Bulk bins can be a source for crosscontamination.
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

Using Safe Alternatives
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Many common food products have safe alternatives:
Eg. Soy sauce.
Safe thickening agents can be used in place of flour:
Eg. Potato starch, tapioca starch.
Select pure spice blends rather than seasoning blends that may contain gluten-containing fillers.
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

Using Safe Alternatives
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Many foods start out gluten-free and are glutened in menu preparation:
Eg. Salads
Many food items have gluten-free alternatives:
Eg. Pizza shells, pasta
Develop clearly identified gluten-free alternatives as part of a standard menu.
Avoiding Gluten and Cross Contamination www.calgaryceliac.com

For More Information
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Our website: www.calgaryceliac.com
National website: www.celiac.ca
Links to other chapter and resource websites
Email: Jo Anne Murray murray2@telusplanet.net
Avoiding Gluten and Cross Contamination www.calgaryceliac.com