ObjectivesWhat is Celiac Disease?The Diagnosis for CD – 3 StepsWhat is non-celiac gluten sensitivity?Celiac Disease and Non-Celiac Gluten SensitivityCD Prevalence in the U.S.Statistics…..celiac diseaseStatistics…..gluten sensitivityNational numbers adding up……..Omaha numbers adding up……..National numbers adding up……..Symptoms…..over 300Symptoms…..Slide 15Other associated conditions….Symptoms in ChildrenThe Diet is the Prescription!Slide 19Slide 20Slide 21Slide 22Slide 23Slide 24Slide 25Slide 26Slide 27Slide 28Slide 29Slide 30Slide 31Where is gluten found?...Additional sources of gluten….Gluten-free basic choicesPreparing for the grocery storeFDA’s Proposed Definition of Gluten-FreeHow to know if something is gluten-free?Regulatory AgenciesLabel reading know how….Slide 40Slide 41Label Reading Savvy Ex 1Label Reading Savvy Ex 2Navigating the grocery storeHidden Sources of Gluten The Three C’s – Content, Contact, ContaminationHidden Sources of Gluten The Three C’s – Content, Contact, ContaminationTips to avoiding cross-contactWhat are healthy and tasty gluten-free grains?Gluten-Free Sources of FiberGluten-Free Sources of FiberDiscover New FoodsSlide 52Slide 53Kitchen Pantry Smarts!Resources –Support GroupsWhat does a support group provide?ADA ResourcesSlide 58CSA ResourcesCSA Tools CSA Gluten-Free Product ListingOther resourcesGluten-free living!ActivityThank you!Living Gluten-free in a Gluten-filled WorldObjectivesOverview of celiac disease and gluten sensitivityDiscuss common nutrient deficiencies Identify foods to chooseDiscuss strategies for navigating the grocery storeRecognize food prep strategies to avoid cross contaminationCite tools available2What is Celiac Disease?Celiac disease (CD) is a genetically linked disease with an environmental trigger. Eating certain types of protein fractions, commonly called gluten, sets off an autoimmune response that causes damage to the small intestine. 3The Diagnosis for CD – 3 Steps1. Physical examine including blood tests for gluten antibodies (IgA based tests)–EMA anti-endomysial–TTG anti-tissue transglutaminase–DGP Deaminated Gliadin Peptide 2. A small bowel biopsy3. Implement the gluten-free diet (process complete when symptoms subside)4What is non-celiac gluten sensitivity?•Nonallergic and nonautoimmune response to gluten•Is thought not to cause damage to the small intestine•Individual tests negative for celiac disease and wheat allergy but has adverse response to gluten•Diagnosis remains one of exclusion5Celiac Disease and Non-Celiac Gluten SensitivityCeliac Disease– autoimmune– IgA, TTG (or others) positive – biopsy shows damage– associated with complicationsGluten Sensitivity– non-autoimmune (test negative)– non-allergic (test negative)– normal biopsy– complications not known– no consensus on diagnostic criteria– diagnosis remains one of exclusion6Both respond to the gluten-free diet!CD Prevalence in the U.S.1: 133 Average healthy peopleAt Risk Groups:1:56 Related symptoms1:39 2nd degree relatives (aunt, uncle, cousin)1:22 1st degree relatives (parent, child, sibling)Fasano A, et al. Arch Intern Med 2003 Feb 10;163(3):286-92.7Statistics…..celiac diseaseCeliac disease affects at least 3 million Americans– 97% are undiagnosedThe average rate of diagnosis is 4 yearsDelay causes risk for developing:–autoimmune disorders–neurological problems–osteoporosis –cancerCharacteristics of adult celiac disease in the USA: results of a national survey. Green, P.H. et.al. American Journal of Gastroenterology, 2001, 2006.8Statistics…..gluten sensitivity9Study from Naples, Italy estimates six percent of the U.S. population, or 18 million people, suffer from gluten sensitivity (gs)Journal of Internal Medicine Vol 269 No 6, June 2011 Review of May Symposium: Celiac DiseaseSapline A . Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med. 2011 Mar 9;9:23.National numbers adding up……..10. 3,128,450 1% Celiac Disease (CD)18,772,705 6% Gluten Sensitivities (GS)__________________________________________21,901,000 7% Total Estimate with CD or GSUS Census Bureau as of 8/22/11: 312,045,081Omaha numbers adding up……..11. 4,090 1% Celiac Disease (CD)24,540 6% Gluten Sensitivities (GS)_______________________________________28,630 7% Total Estimate in Omaha with CD or GSCensus Data 2010 for NE and Omaha, 1,826,341 and 408,958 respectively*Omaha CSA Chapter has 1700 names; assuming 50% contact CSA the diagnosis rates are likely higher in this areaNational numbers adding up……... 3,128,450 1% Celiac Disease (CS)18,772,705 6% Gluten Sensitivities (GS)__________________________________________21,901,000 7% Total Estimate with CS or GSUS Census Bureau as of 8/22/11: 312,045,08112Symptoms…..over 300GI–Diarrhea or constipation–Abdominal cramping and bloating–Flatus (Passing Gas)–Constipation–Fat in stool–Malabsorption resulting in nutrient deficienciesEmotional–Depression–Disinterest in normal activities–Irritability–Mood changes–Inability to concentratewww.csaceliacs.org13Symptoms…..Other–Anemia–Appetite changes–Decreased ability to clot blood–Decreased fat padding feet/buttocks/hands–Dehydration–Delayed puberty–Edema–Electrolyte imbalance–Fatigue–Gluten ataxia (failure of muscle coordination)–Infertility/miscarriages14Symptoms…..Other–Mouth sores or cracked lips–Smooth or geographic tongue–Tooth enamel defects–Muscle cramping (hands and legs)–Night blindness–Nutrient deficiencies–Osteopenia–Osteoporosis–Pain in bones and joints–Very dry skin–Weakness–Weight loss (unexplained)–Dermatitis Herpetiformis15Other associated conditions….Autoimmune Diseases–Type 1 Diabetes –Thyroid Disease–Addison’s Disease–Sjorgen’s Syndrome–Rheumatoid arthritis–Autoimmune hepatitis–Vitiligo–Raynaud’s Disease Malignancies Enteropathic-associated T-cell lymphomaSmall bowel adenocarcinomaEsophageal squamous carcinomaOropharyngeal squamous carcinomaDermatitis HerpetiformisHealth Hazard Assessment for Gluten Exposure in Individuals with Celiac Disease: Determination of Tolerable Daily Intake Levels and Levels of Concern for Gluten. May 2011.