CELIAC DISEASECELIAC DISEASE

Joanne Nugent M.S., R.D, L.D., Joanne Nugent M.S., R.D, L.D., CDECDE

Celiac DiseaseCeliac Disease

An inflammatory disease of the An inflammatory disease of the small bowel initiated by gluten.small bowel initiated by gluten.

Leading to malabsorption of Leading to malabsorption of nutrients and effect all systems of nutrients and effect all systems of

the bodythe body

Celiac diseaseCeliac disease

Autoimmune disease;intolerance to glutenAutoimmune disease;intolerance to gluten Gluten sensitiveGluten sensitive Wheat allergyWheat allergy

1 in 100 is the estimated prevalence of celiac 1 in 100 is the estimated prevalence of celiac disease.disease.

Takes an average 11yr to get diagnosisTakes an average 11yr to get diagnosis 35% exhibit chronic diarrhea35% exhibit chronic diarrhea 2-3x more common in women2-3x more common in women 97% of people with celiac have not been diagnosed97% of people with celiac have not been diagnosed

Pathophysiology Pathophysiology

Villi are similar to shag carpet. Damage Villi are similar to shag carpet. Damage from gluten causes breakdown of villi.from gluten causes breakdown of villi.

When villi atrophy, the shag carpet is moreWhen villi atrophy, the shag carpet is more

similar to a tile floor.similar to a tile floor.

““LEAKY GUTLEAKY GUT””This results in the inability to absorb certainThis results in the inability to absorb certain

nutrients(iron,calcium,vit.- D,A,E,K,proteinnutrients(iron,calcium,vit.- D,A,E,K,protein

and folic acid).and folic acid).

SYMPTOMSSYMPTOMS

GI symptomsGI symptoms

Chronic Chronic diarrhea/constipationdiarrhea/constipation

Abd pain/distentionAbd pain/distention Poor appetite/intakePoor appetite/intake VomitingVomiting

Non GI symptomsNon GI symptoms

Dermatitis herpetiformisDermatitis herpetiformis Dental enamel Dental enamel

hypoplasiahypoplasia Osteopenia/osteoporosisOsteopenia/osteoporosis Iron deficient anemiaIron deficient anemia Delayed pubertyDelayed puberty InfertilityInfertility Fatigue/irritability and Fatigue/irritability and

failure to thrivefailure to thrive

ComplicationsComplications

LymphomaLymphoma Intestinal carcinomaIntestinal carcinoma OsteoporosisOsteoporosis Refractory Celiac diseaseRefractory Celiac disease

Immune DisordersImmune Disorders

Dermatitis Dermatitis herpetiformisherpetiformis

T1DMT1DM Liver/Thyroid Liver/Thyroid

diseasedisease LupusLupus AddisonAddison’’s diseases disease

DownDown’’s/Sjogrens/Sjogren’’s s syndromessyndromes

Rheumatoid Rheumatoid ArthritisArthritis

Treatment Treatment

Lifelong diet that is gluten freeLifelong diet that is gluten free Total elimination of wheat, rye, and Total elimination of wheat, rye, and

barleybarley

Gluten???Gluten???

Gluten is an elastic protein found in Gluten is an elastic protein found in certain grains.certain grains.

Proteins that cause problems for Proteins that cause problems for celiacceliac

disease 1. Gliadin/wheat 2. disease 1. Gliadin/wheat 2. Secalin/ryeSecalin/rye

3. Hordein/barley.3. Hordein/barley.

Common Sources of GlutenCommon Sources of Gluten

PastaPasta CerealCereal Bread, pizza crust, salad croutonsBread, pizza crust, salad croutons Crackers, pretzelsCrackers, pretzels Cookies, cakes, pies, pastriesCookies, cakes, pies, pastries BeerBeer Cross contaminated oats/other food Cross contaminated oats/other food

productsproducts

Foods that MAY contain Foods that MAY contain GlutenGluten

CandyCandy Soy sauceSoy sauce Lunch/processed meatsLunch/processed meats Rice mixesRice mixes Seasoned chipsSeasoned chips Canned soups/saucesCanned soups/sauces Imitation fishImitation fish Communion wafersCommunion wafers Matzo/matzo mealMatzo/matzo meal

Potential SourcesPotential Sources

Chewing gumChewing gum Lipstich/balmLipstich/balm Personal care products; shampoo, Personal care products; shampoo,

lotionslotions Medications; prescription, OTC, Medications; prescription, OTC,

herbal and vitamins and mineralsherbal and vitamins and minerals

Flours containing glutenFlours containing gluten

BulgurBulgur CouscousCouscous KamutKamut SemolinaSemolina SpeltSpelt Graham flourGraham flour TriticaleTriticale Wheat germWheat germ

Gluten-free floursGluten-free flours

Rice floursRice flours Almond flourAlmond flour AmaranthAmaranth ArrowrootArrowroot BuckwheatBuckwheat Corn flour-corn starchCorn flour-corn starch CornmealCornmeal Gram flour(chick peas)Gram flour(chick peas) Potato starch flourPotato starch flour

QuinoaQuinoa Soy (soya flour)Soy (soya flour) Tapioca starchTapioca starch Teff grainTeff grain Potato flourPotato flour Sorghum flourSorghum flour

Gluten-Free FoodsGluten-Free Foods

FruitsFruits VegetablesVegetables Milk, cream, most ice creams, cheese, Milk, cream, most ice creams, cheese,

cottage cheese, cream cheesecottage cheese, cream cheese Potatoes, corn, rice, lentils, beansPotatoes, corn, rice, lentils, beans Butter, margarine, oil, salad dressing Butter, margarine, oil, salad dressing

(allowed ingredients)(allowed ingredients) Fresh meat, fish, poultry, eggsFresh meat, fish, poultry, eggs Plain nuts, seeds, popcornPlain nuts, seeds, popcorn

MORE Gluten-freeMORE Gluten-free

Tea, coffee, sodaTea, coffee, soda Distilled alcoholic beveragesDistilled alcoholic beverages Plain pickles, olives, relish, ketchup, Plain pickles, olives, relish, ketchup,

tomato paste, mustard (with distilled tomato paste, mustard (with distilled vinegar, herbs/spices, black peppervinegar, herbs/spices, black pepper

Honey, jam, jelly, corn/maple syrup, Honey, jam, jelly, corn/maple syrup, sugarsugar

LabelsLabels

Food Allergen Labeling and Consumer Food Allergen Labeling and Consumer Protection Act (FALCPA)Protection Act (FALCPA)

Food labels identify eight main food Food labels identify eight main food allergens (milk, eggs, panuts, tree nuts, allergens (milk, eggs, panuts, tree nuts, fish, crustacean shellfish, soy and wheatfish, crustacean shellfish, soy and wheat

Gluten-free are wheat free, but wheat Gluten-free are wheat free, but wheat freefree

are not always gluten freeare not always gluten free

Compliance barriersCompliance barriers

CostCost AvailabilityAvailability Taste/qualityTaste/quality Patients lack of symptomsPatients lack of symptoms Difficulty with labeling of food/drugsDifficulty with labeling of food/drugs Poor education from healthcare Poor education from healthcare

providersproviders

ResourcesResources

www.celiac.com www.celiacsprue.c

om www.niddk.nih.gov

/health/digest/pubs/celiac/index.htm

www.glutenfree.cowww.glutenfree.comm

Support group Support group cinciceliac.comcinciceliac.com

Bottom LineBottom Line

Celiac disease can be managed Celiac disease can be managed successfully with education, successfully with education, resources and support.resources and support.