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Celiac Disease Presented by: Nelda Mercer, MS, RD, FADA March 14, 2013.

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Presentation on theme: "Celiac Disease Presented by: Nelda Mercer, MS, RD, FADA March 14, 2013."— Presentation transcript:

1 Celiac Disease Presented by: Nelda Mercer, MS, RD, FADA March 14, 2013

2 Celiac Disease Also known as: – Celiac Sprue – Gluten-sensitive Enteropathy – Non-tropical Sprue

3 How Common is Celiac Disease? Celiac disease affects people in all parts of the world. Originally thought to be a rare childhood syndrome, celiac disease is now known to be a common genetic disorder. More than 2 million people in the United States have the disease, or about 1 in 133 people – approx. 1% of population Among people who have a first-degree relative—a parent, sibling, or child—diagnosed with celiac disease, as many as 1 in 22 people may have the disease. Celiac disease is also more common among people with other genetic disorders including Down syndrome and Turner syndrome, a condition that affects girls' development. Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States. Archives of Internal Medicine. 2003;163(3):268–292.

4 What is Celiac Disease? Non-IgE Mediated Food Allergy − National Institute of Allergy and Infectious Disease - Sponsored Expert Panel Boyce, J. et al. Guidelines for the diagnosis and management of food allergy in the United States: Report Journal of Allergy and Clinical Immunology. 2010; 126(6):S1-S58. A unique disorder that is both a food intolerance and autoimmune disorder − American Gastroenterological Association American Gastroenterological Association (AGA) Institute Technical Review on the Diagnosis and Management of Celiac Disease. Gastroenterology. 2006 Dec;131(6):1981–2002.

5 Autoimmune Disorder The immune system can't tell the difference between healthy body tissue and antigens. The result is an immune response that destroys normal body tissues. This response is a hypersensitivity reaction similar to the response in allergic conditions.  Precipitated by the ingestion of gluten (a protein in wheat, rye, and barley) Attack the micro-villi small intestine

6 A disease of malabsorption and an abnormal immune reaction to gluten The immune system responds by damaging or destroying the intestinal villi

7 Malabsorption –Results in malabsorption of key nutrients: iron, calcium, folate absorbed in the first part of the small intestine - –Damage further down the small intestinal tract results in malabsorption of: carbohydrates (lactose), fat and fat-soluble vitamins, protein and other nutrients.

8 Symptoms Common in Children WIC Nutrition Risk, Celiac Disease, pg. 5

9 Celiac Disease Symptoms – Common in Adults WIC Nutrition Risk, Celiac Disease, pg. 5

10 Diarrhea Failure to Thrive Fatigue Emotional Issues Stomach Pain Distended Belly Vomiting Constipation Anemia Other PREVALENCE OF SYMPTOMS

11 Celiac Disease Continuing to ingest gluten results in increased risk for developing other autoimmune disorders: –Thyroid disease –Type 1 diabetes –Addison’s disease

12 Risk for Celiac Disease Depends on: Genetic Immunological Environmental

13 Risk – Recent Studies* Introduction of small amounts of gluten while the infant is still breastfed may reduce the risk of CD. Both breastfeeding during the introduction of dietary gluten, and increasing the duration of breastfeeding were associated with reduced risk in the infant developing CD. Not clear from these studies whether breastfeeding delays the onset of symptoms or provides a permanent protection against the disease. Therefore prudent to avoid both early ( 7 months) introduction of gluten and to introduce gluten gradually while the infant is still breastfed; this may reduce the risk of CD. * ESPGHAN Committee on Nutrition: Agostoni, C. et al. Complementary feeding: A commentary by the ESPGHAN Committee on Nutrition, Medical Position Paper. Journal of Pediatric Gastroenterology and Nutrition, January 2008: 46:99-110.

14 Diagnosis 1 st Physical exam and blood testing 2 nd Duodenal biopsy 3 rd Implement gluten-free diet

15 Celiac Disease Treatment –Lifetime Gluten-Free Diet

16 Dangerous vs. Safe Grains Dangerous Grains Wheat Bran Rye Barley Barley malt Bulgur Couscous Spelt Kamut Semolina Triticale Safe Grains Rice, Brown Rice* Corn, whole grain* Millet * Teff, whole grain * Sorghum, whole grain * Wild rice* Buckwheat* Quinoa* Garbanzo Potato Soy Gluten-free Oats *

17 Implications for WIC Professionals Client-centered Counseling  Assist clients in making gluten-free food choices that improve quality of life and promote nutritional well-being.  Provide nutrition education/counseling on alternatives to gluten-containing food products as well as provide gluten-free grain selections available in the WIC food packages.

18 Implications for WIC Professionals Based on the needs and interests of the client, WIC staff may (as appropriate): Based on the needs and interests of the client, WIC staff may (as appropriate): –Promote breastfeeding throughout the first year of life, with exclusive breastfeeding until 4-6 months of age. –In consultation with the guidance of a medical provider, introduce gluten-containing foods between 4 and 6 months to infants at risk of CD, including infants with a parent or sibling with CD. –Tailor food packages to substitute or remove gluten- containing foods.

19 Implications for WIC Professionals (cont’d) –Educate clients on meeting nutritional needs in the absence of gluten-containing foods. Encourage high fiber, gluten-free grain selections. Planning gluten-free meals and snacks for outside the home. –Provide educational materials outlining allowed foods and foods to avoid. –Monitor client’s growth pattern and weight status. –Provide referrals as appropriate.

20 Pediatric Nutrition Care Manual




24 FDA Gluten Free Labeling Currently, FDA has no current definition for “gluten-free” In 2007, FDA proposed to allow manufacturers to label a food “gluten-free” if the food does not contain any of the following:

25 Must Not Contain Any of the Following: an ingredient that is any type of wheat, rye, barley, or crossbreeds of these grains an ingredient derived from these grains and that has not been processed to remove gluten an ingredient derived from these grains and that has been processed to remove gluten, if it results in the food containing 20 or more parts per million (ppm) gluten 20 ppm or more gluten

26 FDA Gluten-Free Labeling Federal Register Notice of Reopening of the Comment Period on the Proposed Rule (August 3, 2011) To date NO Final Rule has been issued Voluntary Labeling Read label ingredients!! 2011-08-03/pdf/2011-19620.pdf


28 Continue to read food labels!


30 Our premium gluten free oats starts as pedigreed seed planted in oats-only fields. At harvest, R5 Elisa testing verifies their purity. Our dedicated gluten free facility and additional R5 Elisa testing ensure their integrity.* Are Oats Allowed on a Gluten-Free Diet?



33 Eating Out Gluten Free Gluten-free menus: –Menu must be requested Ask questions? –What’s in the dish? How is it prepared? May I see the label? A severe allergy! Be skeptical, cross contamination happens.

34 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: B 1, B 2, B 3 and Iron

35 Thank You! Questions ???

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