Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download What is Celiac Disease - VCU Department of Pediatrics
Document related concepts
Transcript
9/29/2014 Eating the Gluten-Free Way Success with Celiac Disease Karen Schmidt, RD, CSP Division of Pediatric Gastroenterology and Nutrition What is Celiac Disease (CD)? • Celiac disease (CD) is an autoimmune disorder that can occur in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. • It is estimated to affect 1 in 100 people worldwide. 2.5 million Americans are undiagnosed and are at risk for long‐ term health complications. What is Celiac Disease ? • When people with celiac disease eat GLUTEN, their body mounts an immune response that attacks the small intestine. • These attacks lead to damage to the villi (small fingerlike projections that line the small intestine) that promote nutrient absorption. • When the villi get damaged, nutrients cannot be absorbed properly into the body. 1 9/29/2014 What is Celiac Disease ? • Celiac disease is hereditary, so it runs in families. • People with a first‐degree relative with celiac disease (parent, child, sibling) have a 1 in 10 risk of developing celiac disease. • Celiac disease can develop at any age after people start eating foods or medicines that contain GLUTEN. Long Term Health Effects of Celiac Disease • Left untreated, celiac disease can lead to additional serious health problems. These include the development of other autoimmune disorders like Type I diabetes and multiple sclerosis (MS), dermatitis herpetiformis (an itchy skin rash), anemia, osteoporosis, infertility and miscarriage, neurological conditions like epilepsy and migraines, short stature, and intestinal cancers. Autoimmune Conditions and Celiac Disease Diagnosis • In a 1999 study, Ventura, et al. found that for people with celiac disease, the later the age of diagnosis, the greater the chance of developing another autoimmune disorder. Age of Diagnosis Chance of Developing Another Autoimmune Condition 2‐4 4 – 12 16.7% 10.5% 12 – 20 Over 20 27% 34% 2 9/29/2014 CELIAC DISEASE SYMPTOMS • Celiac disease can be difficult to diagnose because it affects people differently. • There are about 300 known symptoms which may occur in the digestive system or other parts of the body. CELIAC DISEASE SYMPTOMS • Some people with celiac disease have no symptoms at all. • However, all people with celiac disease are still at risk for long‐term complications, whether or not they display any symptoms. CELIAC DISEASE SYMPTOMS IN CHILDREN • abdominal bloating and pain chronic diarrhea vomiting constipation pale, foul‐smelling or fatty stool weight loss failure to thrive fatigue irritability and behavioral issues dental enamel defects of the permanent teeth delayed growth and puberty short stature Attention Deficit Hyperactivity Disorder (ADHD) 3 9/29/2014 CELIAC DISEASE SYMPTOMS IN ADULTS • unexplained iron‐deficiency • anemia fatigue bone or joint pain arthritis bone loss or osteoporosis depression or anxiety seizures or migraines missed menstrual periods infertility or recurrent miscarriage canker sores inside the mouth an itchy skin rash called dermatitis herpetiformis tingling numbness in the hands and feet TREATMENT • Currently, the only treatment for celiac disease is lifelong adherence to a strict gluten‐free diet. • People living gluten‐free must avoid foods with wheat, rye and barley, such as bread or beer. • Even ingesting small amounts of gluten, like crumbs from a cutting board or toaster, can trigger small intestine damage. Malabsorption of Essential Nutrients • If left untreated, CD can lead to nutrient deficiencies and subsequent disease. • Iron deficiency anemia, decreased bone density from inadequate calcium absorption, folate and vitamin B 12 deficiency. • Unintentional weight loss, failure to thrive, short stature. 4 9/29/2014 Common sources of GLUTEN GLUTEN IN WHEAT, RYE, BARLEY • These grains are of course used in baked goods such as bread, cereal, pasta, pizza, cakes, pies, cookies. • They are also added as an ingredient in many processed foods and are often “hidden.” • “Hidden” food items include broth, candy, soy sauce, self‐basting turkeys all of which are not obvious to people at first. • Questionable sources of GLUTEN also exist such as modified food starch, caramel color, malt. GLUTEN‐FREE GRAINS AND STARCHES • • • • • Amaranth, Arrowroot, Buckwheat, Corn, Flax, Nut Bean and Seed Flour, Millet, Montana Potato Starch/Flour, Quinoa, Rice, Rice Bran, Sago, Sorghum; Soy, Tapioca, Teff TM, 5 9/29/2014 What about Oats ?? • Studies show that the protein in oats may not be harmful to most celiac patients. • There is a problem with contamination with wheat during milling and processing of the oats. • MUST use GLUTEN‐FREE (GF) oats. HIDDEN GLUTEN SOURCES • From broth to candy to soup/sauce bases to lipsticks and balms • Play Dough to Pasta to Imitation Seafood to Marinades • Communion Wafers to Self‐Basting turkeys to Luncheon meats to Beer, Lagers, Ales. • Prescription and OTC Meds, Vitamins and Minerals MUST be a Label Reader • Read all labels carefully • If an ingredient is questionable, avoid it and check with the manufacturer to confirm it is GF • Read labels every time because ingredients can change at any time 6 9/29/2014 Gluten‐Free and the Law • In August 2013, the Food and Drug Administration issued a final rule that defined what characteristics a food has to have to bear a label that proclaims it "gluten‐free." • Manufacturers had one year to bring their labels into compliance. As of August 5, 2014, any food product bearing a gluten‐ free claim labeled on or after this date must meet the rule’s requirements. Getting Started: The Wrong Way • Families should not stop on the way home from the MD office and search for all the GF products at the store that they can find. • This action can be very expensive and frustrating and stressful when their child refuses to eat most of what they buy. Getting Started: The Right Way • Look at foods already in the home. Many foods are naturally GF and even some favorite brands may also be GF. • These include: fresh fruits and vegetables, meat, fish, poultry, dairy, • Snacks such as plain potato chips, popcorn, corn chips, rice cakes, Jello, pudding are also GF 7 9/29/2014 Getting Started: The Right Way • Dried beans, Lentils, Peas • Rice products such as Cream of Rice, brown/white rice, Rice crackers • Corn tortillas, Grits, Corn chips • Condiments and Jelly, Honey,, Sugar, Molasses, Peanut Butter • Spices and Herbs Salt, Pepper • Pickles, Ketchup, Mustard, most Salad Dressing Grocery Shopping • Shop the perimeter of the store where the whole foods which are not processed are located. • Fresh produce section, meat, poultry and seafood sections • Egg and dairy section • Inner Isles: corn tortilla, plain rice, beans/legumes, spices, Peanut Butter Grocery Shopping • Most stores have a health food section where many Gluten‐free (GF) products can be found • Asian sections have rice noodles and crackers • Some GF items may be in the freezer section such as bagels or pizza crust • There are even GF frozen meals 8 9/29/2014 Food Preparation • Avoid cross‐contamination of foods with GLUTEN • Use separate condiment jars like jam/jelly, peanut butter and mayo so bread crumbs do not end up in the jar • Use toaster oven with tinfoil on the rack or a separate toaster for breads • Clean cutting boards, utensils, pans carefully after each use. • Consider separate colander for pasta Eating Away From Home • Inform school personnel and provide GF option for treats in the classroom • Check restaurant website for online menu to review ahead of time • Call ahead to speak with chef/manager about special products • Identify self/child as one who cannot eat wheat, rye, barley. • Ask questions‐many foods use flour or are cooked with GLUTEN foods GF Does Not Mean Feel Free to Eat It • Explosion of GF products available • Cookies and Cakes and Granola Bars and Pretzels and Chips may not be a healthy addition • Unintentional weight gain can occur once the GI tract heals and nutrients are absorbed • Low fiber unprocessed rice is used in place of wheat and may lead to constipation 9 9/29/2014 Vitamin Supplements • A vitamin/mineral supplement may be required initially after diagnosis. • Intestinal damage leads to decreased absorption of iron, calcium, folate and other B‐vitamins • Must be GF and meet 100 % DRI • Add nutrient rich GF foods to the diet to provide adequate amounts of these Registered Dietitian Consult • Important to provide contact information to a Registered Dietitian with expertise in Celiac Disease • May require several sessions before families are confident in following the GF diet. • Repeat serology positive for gluten ingestion require close diet scrutiny A Bright Future “Although a total gluten‐free diet seems overwhelming at first, families have been very successful with the diet. Dietitians and support groups can help families adjust to this life‐altering diet; yet it may take several months to get used to the gluten‐free diet.” www.celiachealth.org 10 9/29/2014 A Few Resources National Support Groups: www.gluten.net, www.celiac.org, www.eatright.org , www.celiac.com www.CeliacHealth.org, www.CDHNF.org, www.NASPGHAN.org Books: Gluten‐Free Friends‐an Activity Book for Kids By Nancy Palin Falini, MA,RD,LDN www.savorypalate.com Kids with Celiac Disease‐A Family Guide to Raising Happy, Healthy Gluten‐free Children by Danna Korn Wheat‐free, Gluten‐free Cookbook for Kids and Busy Adults, by Connie Sarros www.gfbooks.homestead.com Gluten‐Free Living National Newsletter for People with Gluten Sensitivity www.gluten‐freeliving.com References • • • • • • http://celiac.org Celiac Disease Foundation Biomed Res Int. 2013; 2013: 127589, Expert Rev Gastroenterol Hepatol. 2010; 4(6):767‐780, Rheumatology (Oxford).2013 May; 52(5):939‐43 http://www.gastro.org/patient‐center/diet‐medications/food‐ allergies‐fructose‐intolerance‐and‐lactose‐intolerance accessed 9/23/14 www.cdhnf.org Gluten Free Diet Guide for Families: Children’s Digestive Health and Nutrition Foundation and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, 2005. http://www.fda.gov/forconsumers/consumerupdates/ucm363069.ht m accessed 9/23/14 Any Questions??? 11
