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 auto-immune 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