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Celiac Disease
Review Date 3/14
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This presentation provides general
information about celiac disease.
Consult with your health care
professional if you have any questions
or for additional information, because
each case is unique.
What is Celiac Disease?
• Characterized by four factors:
– Genetic susceptibility
– Exposure to gluten
– Environmental “trigger”
– Autoimmune response
What is Celiac Disease?
(cont’d)
• No classic profile for celiac disease exists,
unlike hypertension, cancer, or other
diseases that have biomarkers
• Often mistaken for Crohn’s disease,
parasites, skin disorders, or other
conditions
• Trauma or stress may serve as the trigger
Result of Celiac Disease
• Intestinal villi (tiny “hairs” that help with
nutrient absorption) are damaged by an
inflammatory response to gluten
• Malabsorption of nutrients results
• Intestinal walls are more porous
Symptoms
• Diarrhea
• Stools that float because they contain
unabsorbed fat
• Weight loss
• Fatigue
• Anemia
Symptoms (cont’d)
• Vomiting
• Poor appetite
• Dermatitis herpetiformis (itchy skin rash)
Diagnosis
• Serum antibody test:
– Dietary changes alter results, so schedule
evaluation before gluten is eliminated from
the diet
• Biopsy of lining of intestine to confirm
diagnosis
Associated Conditions
• Iron deficiency anemia
• Osteoporosis
• Vitamin K deficiency associated with risk
for hemorrhaging
• Vitamin and mineral deficiencies
• Central and peripheral nervous system
disorders, usually because of unsuspected
nutrient deficiencies
Associated Conditions
(cont’d)
• Pancreatic insufficiency
• Intestinal lymphomas and other
gastrointestinal (GI) cancers
• Lactose intolerance
• Neurological manifestations
Malnutrition
• Vitamins A, D, E, and K
• Vitamin B12
• Folate
• Iron
• Most severe for children—may result in
failure to thrive
Calcium and Vitamin D
• Osteomalacia, rickets, and kidney stones
• Secondary lactose intolerance (usually
reversible)
Additional Medical
Consequences
• Intestinal lymphoma and bowel cancer, if
gluten-free diet is not followed
• Seizures and peripheral neuropathy often
manifest
Treatment
• Avoid ingesting gluten for a lifetime
• See a registered dietitian, registered
dietitian nutritionist, or physician for
vitamin supplementation recommendations
• Once a gluten-free diet is implemented,
absorption of all nutrients, vitamins, and
minerals will return when GI tract is
repaired
Ingredients to Avoid
• Grains—barley, wheat, triticale, rye, farina,
graham, semolina, durum, bulgur, Kamut®,
kasha, matzo meal, and spelt
• Oats?
– Many people with celiac disease have celiac
disease symptoms when they eat oats
– Possibly because many oats are processed on
equipment that processes wheat
Living With a Gluten
Restriction
• Reading labels and asking questions are
the keys to successfully managing celiac
disease
Read Labels Before
Purchasing These Foods
• Bread
• Cakes
• Cereals
• Cookies
• Crackers
• Gravies
• Medications
• Pasta
• Pies
• Sauces
• Snack foods
Cosmetics
• Gluten-containing cosmetics and skin care
products are OK to use
• Gluten-free toothpastes and mouthwashes
often are recommended, as are lip products,
because of ingestion
• Some experts ask children to use gluten-free
hand lotions, if they put their fingers in their
mouth as a habit
Choose
• Amaranth
• Arrowroot
• Buckwheat
• Corn
• Nut flours
• Quinoa
• Potatoes
• Rice
• Tapioca
For a complete list of allowed foods, contact a registered
dietitian or registered dietitian nutritionist. Call
manufacturers if you have any questions about possible
cross-contamination during processing or packaging.
Managing Celiac Disease
• Meet with a registered dietitian or
registered dietitian nutritionist at least
annually
• Remain diligent about checking ingredients
and safe preparation methods
Managing Celiac Disease
(cont’d)
• Vitamin and mineral
supplementation?
– Not necessary for general wellness if celiac
disease patient is eating a healthful diet
– Supplementation of B vitamins, magnesium,
and a few others still too questionable to make
definitive recommendations
Managing Celiac Disease
(cont’d)
• Seek reliable sources of information:
– Nutrition411.com
– Celiac Disease Foundation (www.celiac.org)
References and
Resources
Decher N, Krenitsky JS. Medical nutrition therapy for
lower gastrointestinal tract disorders. In: Mahan LK,
Escott-Stump S, Raymond JL. Krause’s Food and the
Nutrition Care Process. 13th ed. St Louis, MO: Elsevier
Saunders; 2012:618-624.
Jonega JV. The Health Professional’s Guide to Food
Allergies and Intolerances. Chicago IL: Academy of
Nutrition and Dietetics; 2013.