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CELIAC DISEASE. WHAT WE WILL COVER. Development of the disease Types of Celiac disease Associated Conditions Symptoms Why is it so hard to diagnose Gluten-free diet Resources for you and your patients. Celiac Isn’t…. a food allergy. Celiac Is…. Curable.
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WHAT WE WILL COVER • Development of the disease • Types of Celiac disease • Associated Conditions • Symptoms • Why is it so hard to diagnose • Gluten-free diet • Resources for you and your patients
Celiac Isn’t… a food allergy Celiac Is…. Curable An autoimmune disorder that is characterized by consuming a protein called gluten Treatable
FAST FACTS • 1. One in 133 Americans have celiac disease. • 2. Three million Americans across all races, ages and genders suffer from celiac disease.
FAST FACTS 3. 17% of celiac patients have an immediate family member who also has celiac. 6. $5,000-$12,000 is the average cost of misdiagnosis per person per year, not including lost work time.
Details about Celiac Disease Sometimes called: • Celiac sprue • Non-tropical sprue • Gluten sensitivity • Gluten enteropathy
Celiac Disease • Autoimmune disorder • Often triggered by a stressful event • Damages the villi of the small intestine • Interferes with the absorption of nutrients
Risk Factors • It is a genetic disorder • 17% of celiac patients have an immediate family member with celiac disease • Was thought to be a disease of infants but now often presents between the ages of 10 and 40
How do we test for Celiac? • Serology • IgA anti tissue transglutaminase antibody (IgA tTg) • IgA endomysial antibody (IgA EMA) • IgA antigliadin antibody (IgA AGA) • IgG antigliadin antibody (IgG AGA)
Application of Serology Tests • Individuals with low pretest probability • Individuals with moderate or high probability • Monitoring adherence and response to gluten-free diet
Other Serology Tests • Genetic testing • HLA DQ2 • DQ8 • Those without these genetic markers are very unlikely to have celiac disease
Other Serology Tests • Testing for malabsorption problems • Iron Deficiency Anemia • Folic Acid Deficiency • Vitamin D Deficiency
Problems with Serology testing • Not 100% accurate • Can be falsely negative if patient has started a gluten-free diet
Pathology • Small Bowel Biopsy • Multiple biopsies from second and third portion of duodenum
Problems with Pathology • May not be accurate if patient has started a gluten-free diet • Other causes for Villious atrophy
Types of Celiac Disease • Classical Form • Villous Atrophy • Symptoms of malabsorption • Steatorrhea • Weight loss • Signs of vitamin and nutrient deficiencies • Resolution of mucosal lesions and symptoms when on gluten-free diet
Types of Celiac Disease • Classic Form • Latent Form • Positive serology but negative pathology • No or minor symptoms while on normal diet • Normal mucosa at one time but Celiac developed later
Types of Celiac Disease • Classic Form • Latent Form • Positive serology but negative pathology • No or minor symptoms while on normal diet • Normal mucosa at one time but Celiac developed later • Potential Celiac Disease • Negative pathology but positive serology including genetic predisposition and 1st degree relative
Types of Celiac Disease • Classic Form • Latent Form • Positive serology but negative pathology • No or minor symptoms while on normal diet • Normal mucosa at one time but Celiac developed later • Potential Celiac Disease • Negative pathology but positive serology including genetic predisposition and 1st degree relative • Subclinical Disease • Very mild form and goes widely undetected • Malignancy, nutritional deficiencies, low birth-weight infants, occurrence of autoimmune disorders
Associated Conditions • Celiac disease can lead to a number of other disorders including infertility, reduced bone density, neurological disorders, some cancers and other autoimmune diseases. • Frequently associated with Dermatitis Herpetiformis, Down Syndrome, Type 1 Diabetes, Thyroid Disease, Liver Disease, and Atopic Dermatitis
Bloating Gas Diarrhea Abdominal Pain Constipation Weight Loss
Headaches Irritability Depression Tingling/Numbness
Infertility Growth Thin Bones Joint Pain Dental
Pale Mouth Sores Fatigue Itchy Skin Rash
Why is this hard to Diagnose? • 97% of celiacs are undiagnosed or misdiagnosed with other conditions. • 10 years is the average time a person waits to be correctly diagnosed. • $5,000-$12,000 is the average cost of misdiagnosis per person per year, not including lost work time.
Increase Awareness • 500,000 new celiac diagnoses are expected to occur in the next 5 years thanks to efforts to raise public awareness of celiac disease.
Treatment • There are NO pharmaceutical cures for celiac disease. • A 100% gluten-free diet is the only existing treatment for celiac disease.
What is Gluten? • The group of proteins found in wheat, rye, and barley • It’s found in obvious foods like bread, pasta, and cereals • Also found in many “hidden” foods
Breads, Grains, Cereals • Rice • Corn • Potato • Tapioca • Soy • Millet • Beans
Vegetables and Fruits • Naturally gluten free • May add pure spices but be careful of spice blends as they often use gluten as a filler
Milk and Dairy • May need to avoid Lactose until intestines heal • Gluten-free, Dairy-free alternatives • Rice, soy, hemp, or nut (almond, hazelnut) • Gluten-free lactase enzyme supplement
Meats and other Proteins • Beef, Chicken, Pork, and Fish are naturally gluten-free unless they have been seasoned or basted (turkey, deli meat, etc.)
Fats, Oils, and Sweets • Olive and Canola oils • Nuts and Pure nut butters • Avoid candies not marked gluten free
Gluten-free Products • The gluten-free marketplace is growing by 28% each year • Find Gluten-free products in specialty health food stores • Now available in many grocery stores including Meijer, Kroger, Walmart, etc • Also available on-line
C • E • L • I • A • C onsultation with skilled dietitian ducation about the disease ifelong adherence to gluten-free diet dentify & treat nutritional deficiencies ccess to an advocacy group ontinuous long-term follow-up
Resources • Physician/Endoscopy office • Web • www.celiac.org • www.gluten.net • www.csaceliacs.org • www.americanceliac.org • www.celiacawareness.org • http://celiacdisease.about.com/forum
Resources • Friends • Library…Cookbooks, etc