Transcript Celiac Sprue Disease

Hot Topics in Nutrition
for School Lunch: Celiac
Carey O’Brien, MS RD LDN
Celiac Disease
What is it?
 An Auto-Immune
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 It
disease
There are many different auto-immune
diseases: type 1 DM, Rheumatoid Arthritis,
Lupus, Inflammatory Bowel Disease, etc.
is a result of an over-active immune
response to a protein in our foods (Gluten)
What is happening in the body?
 The
body see’s the protein (Gluten) and
thinks it is not supposed to be there.
 It “fights” against this protein with an
antibody (our white blood cells) called
Tissue Transglutaminase (tTG).
 This tTG sends a message to the intestine
to keep out the Gluten – which causes
damage to the lining of the intestine.
Endoscopy
Normal Duodenum
Duodenal Scalloping
Histology
Normal Duodenal Mucosa
Villous Atrophy
How do you get Celiac?
Three things have to happen together:

1.
2.
3.
You had to have eaten Gluten at some point
in your life.
You have to carry the gene.
The Gene has to be turned on (like a light
switch). But this light switch is broken and
once it is turned on – it is never turned off.
So you never out-grow Celiac.
What are some of the Symptoms?
Classic CD
 Abd pain, diarrhea,
constipation
 Gas, distention
 Anorexia
 Poor wt gain/FTT in
children.
Unintentional wt loss
in adults.
 Irritability/lethargy
2nd to MalNutrition
 Anemia, fatigue
 Vitamin def
 Osteopenia
 Apthous Ulcers
 Delayed puberty
 Infertility
 Dental enamel
hypoplasia
How is someone diagnosed?
 All
testing must be done while on Gluten
containing diet
 Bloodwork for antibodies (tTG)
 If abnormal, then referral to GI specialist
 GI specialist confirms with a scope
Management
C
E
L
I
A
C
Consultation with skilled dietitian
Education about disease
Lifelong adherence to GF diet
Identification of nutritional deficiencies
Access to a support group
Continuous long-term follow-up by
multidisciplinary team
Dietitians and Reimbursement
Issues
 There
is limited or no reimbursement for
nutrition counseling for CD by insurance
companies
 Many patients/families will seek alternative
sources (internet, support groups,
family/friends, other health
practitioners)…results in obtaining
questionable information.
Gluten Free Diet

Attitudes are contagious!!!
 Your perceptions of the
Gluten free diet are likely to
become your patients
perceptions. We want to
give our patients
confidence, independence,
and quality of life that will
ultimately result in better
compliance.
Label Reading – Eliminate
WHEAT, RYE, BARLEY
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Barley
Bran
Bulgur
Couscous
Durum
Emmer
Einkorn
Farro
Farina
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Graham
Kamut
Orzo
Rye
Semolina
Spelt (Dinkel)
Triticale
Wheat
Label Reading - Safe
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Amaranth
 Arrowroot
 Buckwheat
 Bean Flours
 Carageenan
 Cassava (Tapioca)
 Corn
 Flax
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Millet
Nut Flours
Potato
Quinoa
Rice
Seed Flours
Soy
Sorghum
Teff
Oats
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Currently the inclusion of oats in the GF diet
remains an area of controversy.
 Research regarding the safely of oats for
people with celiac disease is still evolving
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Gluten contamination of oat products
Oat prolamin (avenin) may trigger it’s own reaction
Food Allergen Labeling and
Consumer Protection Act of 2004
 Has
two parts
 Part 1 – Effective Jan 2006
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Manufacturers must say in plain English if one
of the 8 most common allergens is in the food.
The Top 8: WHEAT, milk, soy, egg, peanut,
treenut, fish, shellfish.
Wheat is on this list, but rye and barley are
not on this list. So if wheat is in that food as
an ingredient, it MUST be listed.
Label Reading –
Questionable Ingredients
Could be WHEAT
 Modified Food Starch
 Flour
 Cereal Products
 HVP
 Soy Sauce
 Flavoring
Could be BARLEY
 Malt, Malt Flavoring,
Malt Extract, Malt
Syrup, Malto-Dextrin,
Dextrin, Malt Vinegar
 Brown Rice Syrup
FALCPA
 Part
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2 – Effective Jan 2008
FDA has to come up with a definition for the
Term: Gluten Free
Manufacturer’s can choose to label their foods
as GF
GF Food Guide
Pyramid
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Fruits – fresh, frozen, canned
Vegetables – fresh, frozen, canned
Meats – fresh, read labels of processed
Nuts and Beans – fresh, canned, dried
Dairy – milk, cottage cheese, natural cheese,
sour cream, cream cheese. Read labels on
yogurts, ice creams, processed cheese, and
pudding.
Food Guide Pyramid
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Grains –
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Rice, Corn, Potato in various forms.
Specialty foods required for cereals, breads, pasta, crackers,
pizza, pancakes, waffles, cereal bars, communion hosts and
baked goods.
Fats/Misc – Oils/Butter, Herbs/Spices. Read labels on
salad dressings and marinades. GF gravies and cream
sauces.
 Sweets – Chocolates like M&M’s, sugar candies, jello,
popsicles, and fruit snacks. (NOT Twizzlers)
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Example of Meals
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Breakfast:
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GF cereal with milk, glass of juice
Eggs, GF Corn Tortilla, bacon, and milk
Lunch:
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Rice, unbreaded chicken, cheese, sautéed fajita
vegetables, fruit, milk
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Snack: Corn chips and salsa
 Dinner:
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Meat, Potato or Rice, veg, milk.
Mexican
Snack: Ice Cream
Cross-contamination
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Toaster
 Food item containers
 Clean counter tops, cooking
equipment, and good
handwashing technique
 Cooking process
How much gluten is too much??

Hischenhuber and colleagues
reviewed a number of studies
and concluded that the
maximum tolerated daily intake
of gluten is >10 mg and < 100
mg of gluten.
 This equates to 1/50th to
1/500th of a slice of bread.
Cooking
 Gluten:
our structural protein in foods
 Get to know your GF flours
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Cooking properties, complementary flours,
best product use.
 Experiment…the
kitchen can be a great
science laboratory!
Web Resources
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www.pittsburghceliacs.org
www.livingwithout.com
www.glutenfreeliving.com
www.glutenfreedrugs.com
Google: gluten+drugs+sholland
www.gluten.net
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GIG publications downloaded free of charge
www.clanthompson.com
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Drugs and gluten alerts/updates
Book Resources