Celiac Disease Rachel Kinzie, Dietetic Intern 2011

1. Celiac DiseaseRachel Kinzie, Dietetic Intern 2011

2. Outline • What is it? • Symptoms • Who Does it Affect? • What is going on in the body?

3. What is it? • People with celiac disease cannot tolerate a protein called GLUTEN, found in wheat, rye, and barley • A digestive disease that interferes with absorption of nutrients from food.

4. Who Does it Affect? • It affects 1 in 133 people in the U.S. • It is Genetic • Because of the genetic component, it is found in 5 to 15 % of siblings and offspring of celiacs. • It affects both children and adults

5. Who Does it Affect? Sometimes it is triggered for the first time after surgery, pregnancy, child birth, or severe emotional stress.

6. Where Celiac Disease Targets

7. Symptoms • Flatulence • Constipation • Bloating • Indigestion • Steatorrhea • Abdominal pain *note that many newly diagnosed persons with celiac disease report no gastrointestinal symptom

8. How Do Symptoms Differ With Age? • In the past, celiac disease was considered to be a disease primarily of infants and children. • It is now clear that the initial signs and symptoms of celiac disease can occur in adults and even in the elderly.

9. How Do Symptoms Differ With Age? • Infants/Children • Steatorrhea, abdominal cramps, abdominal distension, short stature (children), failure to thrive (infants) • Adults • May have classic symptoms, but many either have no symptoms or vague abdominal discomfort

10. What is Celiac Disease is Not It is NOTan allergy

11. Allergic Reaction A A aaa • Histamines Released • Allergy Symptoms… • Rash • Itchy/watery eyes • Difficulty breathing • Sometimes… • Abd. cramps • Vomitting • Diarrhea • Antihistamines can help with symptoms Allergen

12. What Causes Celiac Disease? Intolerance to Gluten an autoimmune disorder

13. Autoimmune Disorder (Celiac) • A • A • aaa • Body attacks itself • Antihistamines will NOT help Gluten

14. The Small Intestine

15. What Does the Small Intestine Do? Tiny fingerlike projections called “villi” allow nutrients from food to be absorbed into the bloodstream.

16. What Happens w/ Celiac Disease? • When people with Celiac disease eat Gluten, their body responds by damaging the small intestine. • The villi become damaged or destroyed.

17. Long Term Effects • Malabsorption resulting in deficiencies… • Calcium • Vitamin D • Iron • Folate • Anemia • Bone Disease • Nerve Damage • Muscle Weakness • Cancer

18. Long Term Effects • Joint Pain • Anxiety • Delayed Puberty • Miscarriage • Short Stature • Easy Bruising • Wt loss • Fluid Retention • Intestinal bloating or “potbelly”

19. Related Complications • Those with CD are more likely to have other autoimmune disorders • Rheumatoid arthritis • Type I Diabetes • Autoimmune Thyroid Disease

20. Related Complications • CD is often misdiagnosed as Irritable Bowel Syndrome • In a survey of CD respondents, 37% reported that they were initially diagnosed with IBS • Dermetitis Hepetiformis (DH) • Manifestation of gluten sensitivity involving the skin • Can lead to itchy, blistering skin rash

21. Related Complications • Lactose Intolerance • Some people with CD aren't able to tolerate milk sugar (lactose) found in dairy products. • Intestinal damage from consuming gluten • Follow lactose and gluten free diet • Once intestines have healed, you may be able to tolerate dairy products again.

22. What Should I Do if I Think I have Celiac Disease? • See your doctor • http://www.celiaccentral.org/ “Celiac Symptoms Checklist” • Symptoms of celiac disease are similar to many other conditions • Small intestine biopsy • Antibody test

23. What is the Treatment for Celiac Disease? • A 100% Gluten Free Diet • Speak with a dietitian about this as well as the possible need for a multivitamin (Iron, B-vitamins, Fiber) • There is currently no cure

24. Myth or Fact?

25. Myth or Fact? • People with celiac disease are allergic to wheat? • Myth Celiac disease is an autoimmune disorder, not an allergy. Celiac disease is often confused for an allergic illness because (like an allergy) it requires a foreign substance to trigger it.

26. Myth or Fact? • If I have a normal weight, I am well nourished • Myth It is very possible to be overweight and malnourished. Calories do not always = Nutrients.

27. Myth or Fact? • Untreated Celiac disease can be life threatening • Fact

28. Myth or Fact? • You can outgrow celiac disease • Myth • You can’t “outgrow” celiac disease-even though doctors once thought you could. If you’re an adult who “had celiac disease as a child” you still have it now, even if the obvious symptoms have gone away.

29. Is There Anything Else? • You are more likely to have celiac disease if a close relative has it. • Fact There is a genetic component to CD

30. Myth or Fact? • Celiac disease is the same thing as Gluten Intolerance • Myth: Gluten intolerance is a broad term which includes all kinds of sensitivity to Gluten. However, if you have celiac disease, you have gluten intolerance.

31. Myth or Fact? • Gluten can be absorbed through the skin • Myth • Gluten molecules are too large to be absorbed through the skin. • Skin care products are okay • Just don’t swallow • Toothpaste, lipsticks, lip balms, and any product that will be used on small children should be gluten-free

32. Myth or Fact • Celiac disease is linked to other autoimmune disorders, such as Type I Diabetes. • Fact: It is estimated between 1 in 20 people with type 1 diabetes also have CD.

33. Myth or Fact • If you think you have celiac disease, you should begin a gluten free diet • Myth: You should NOT begin the gluten-free diet before you are diagnosed. Starting the diet will affect testing for the disease.

34. Myth or Fact • You’ll feel better as soon as you stop eating gluten • Myth: The amount of time it takes to feel better after going gluten-free is different for every person. Some people feel the results right away, but other need weeks or months to feel results.

35. Questions? VIDEO - Celiac Disease: A Life of Misdiagnosis