Celiac Disease
Recent Prevalence of Celiac Disease
• 1 in 133 people have CD
• Prevalent, but under diagnosed
– Those not diagnosed have a higher
death rate
• Mayo Clinic
– Raise awareness, improve screening
– Why is Celiac Disease on the rise?
Celiac Disease…
• Aka Celiac Sprue
• An auto-immune disease that affects the small
intestine
• No wheat, rye and barley
• Attack of the micro-villi!
• Malabsorption
– Osteoporosis, iron-deficiency anemia, infertility,
cancer, other auto-immune diseases, etc
• Go gluten-free, intestinal repair
Signs and Symptoms
• No classic signs
• Bloating, abdominal pain, diarrhea
• Less noticeable symptoms
– Anemia, joint pain, stomach pain, irritability, dental or
bone disorders, weight loss, stunted growth in kids
• Can imitate symptoms of other
conditions such as irritable bowel
• Dermatitis herpetiformis
• Silent Celiac Disease
– No symptoms, still damage
The Latest Fad
• A new diet trend
• Gluten only harmful to those with CD
• No current evidence to back up gluten-free
diet health claims
• Wheat flour fortification: B1, B2, B3 and Iron
Diagnosis
• 1st: Physical exam and blood testing
• 2nd: Duodenal biopsy
• 3rd: Implement gluten-free diet
http://www.csaceliacs.org/celiac_diagnosis.php
Gluten
• Gluten is a protein that gives dough elasticity
which allows it to rise without collapsing while
trapping the CO2
• Exists within wheat , rye and barley.
• Also in wheat derivatives: bulgar, couscous,
mataza, seitan, semolina, triticale, spelt,
kamut, einkorn, emmer and anything with
‘wheat’ in the title (except buckwheat).
FDA Gluten Free Labeling
• Currently, FDA has no current definition for
“gluten-free”
• Proposed definition of gluten:
– proteins that naturally occur in wheat, rye or
barley or a hybrids of these.
• Voluntary labeling
• Proposed in 2007, as of 2009 - still in draft
form
• Read label ingredients!
Gluten-Free
• Naturally gluten-free
– Ex: Fresh fruits and vegetables
• Commercially gluten-free
– Ex: Rice flour bread,
Gluten-free cookies
Eating Out and Gluten Free
• Gluten-free menus:
http://www.glutenfreetravelsite.com/restaurants/
– Menu must be requested
• Ask questions!
– What’s in the dish, how is it prepared, can I see the label
• A severe allergy?
• Be skeptical, cross contamination happens
Gluten Free Cooking and Baking
• “Safe” grains: corn, rice, buckwheat, wild rice,
amaranth, quinoa, teff, millet, sorghum
• Other ‘safe’ foods: All vegetables, legumes,
fruits, natural meats (not deli meats), fish,
shellfish, eggs, natural dairy products and nuts
as well as potatoes, tapioca and arrowroot.
• Baking is the most difficult-trial and error
method of finding tasty recipes
• Be aware of gluten-contamination!
Possible Culprits
• Hygiene Hypothesis
• 21st Century Diet
• Modern wheat
Celiac Disease and Obesity
• Study states that malnutrition of adults and
children is not seen often
• After gluten-free diet, percentage of
overweight participants doubled
• Nutritional imbalance of gluten-free foods
• New morbidities, especially in children
• Nutritional follow-up needed
Is CD Genetic?
• A link between genes and Celiac Disease
• 1 in 22 with first degree relatives
• Often comes shows up after a bout of trauma
such as an infection, injury, stress or
pregnancy
• Relatives need regular screens for autoimmune disorders
Celiac Disease and Type 1 Diabetes
• A link between, T1DM and Celiac Disease
• 1 in 20 people with Celiac Disease have Type 1
Diabetes Mellitus
• T1DM: the pancreas doesn’t make insulin
• T1DM is also an autoimmune disease that is
thought to reveal itself in the same manner
– Genetic disposition plus an environmental factor
“A New Hope For CD Sufferers?”
• New study, no conclusions yet
• Pills that break down gluten
• Immunotherapy: training the immune system
to tolerate gluten through injections
+
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Take Home Message
• Be aware of Celiac Disease and the
implications it has on those who have it
• See a doctor if you have unexplainable
symptoms that may be caused by CD or if an
immediate family member has CD or another
auto-immune disease