Celiac Disease

Etiology: Also referred to as celiac sprue, is an inflammatory condition of the small intestine precipitated by the ingestion of wheat in individuals with certain genetic makeups.

Signs/Symptoms: Occurs most commonly around the age of two after wheat has been introduced into the diet, and in early adult life (third and fourth decades). protein gluten triggers an inflammatory reaction in the small bowel which results in a decrease in the amount of surface area available for nutrient and fluid and electrolyte absorption. Signs that occur with but may not be limited to are (In Children) — abdominal bloating and pain, chronic diarrhea, vomiting, constipation, pale, foul-smelling, or fatty stool,weight loss, and (In Adults) — unexplained iron-deficiency anemia, fatigue, bone or joint pain, arthritis, bone loss or osteoporosis, depression or anxiety, tingling numbness in the hands and feet, seizures, missed menstrual periods, infertility or recurrent miscarriage, canker sores inside the mouth, andan itchy skin rash called dermatitis herpetiformis

Method of Diagnosis: Recognizing celiac disease can be difficult because some of its symptoms are similar to those of other diseases. Celiac disease can be confused with irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss, inflammatory bowel disease, diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, celiac disease has long been underdiagnosed or misdiagnosed. As doctors become more aware of the many varied symptoms of the disease and reliable blood tests become more available, diagnosis rates are increasing.

**Risk Factors: Common in those with autoimmune disorders such as type 1 diabetes, autoimmune thyroid disease, lupus, microscopic colitis, and rheumatoid arthritis. Genetics is another risk factor. Most common in Caucasians/European descent.

*Modifiable:** Decrease Gluten in the diet
*Non-Modifiable:** Genetic probability

Prevention: Reduce gluten and wheat products in the diet. Someone with celiac disease can learn from a dietitian how to read ingredient lists and identify foods that contain gluten. To stay well, people with celiac disease must avoid gluten for the rest of their lives. (Gluten-Free Diet)

Supplements Commonly Used: Vitamins, minerals, and protein supplements are commonly used at first and vitamin and mineral supplements may be continued if malabsorption continues. Iron, folate, or B12 may be needed if anemia is present due to the disease. Calcium and Vitamin D may be needed to due osteoperosis or osteomalcia due to malabsorption from the disease. Vitamin A and vitamin E may be needed from losses due to steatorrhea. If purpura or bleeding occurs, Vitamin K supplementation may be necessary.

Labs Appropriate to Disease: Since the symptoms are moderate to none at all the lab values are normally just the same as they would be if you were healthy, this is why it is so hard to detect.
*Normal Values Range:
Total cholesterol <200, Triglycerides <150, HDL >60, LDL <130, Albumin 3.5-5.2, Fasting blood glucose 70-110, and Sodium 135-145
*Values in the Disease:** Same as normal
*Nutritional Significance:** It is very hard to detect when you have this condition.

General Dietary Prescription:High fiber, Plenty of fluids, and Avoid nuts, seeds, and hulls

Specific Foods to Include: Trade out gluten products with a rice product, but always stick to a healthy diet. Found mainly in foods but may also be found in everyday products such as medicines, vitamins, and lip balms. Increase high fiber foods unless it is an acute attack, drink plenty of fluids because the loss of fluid and decrease of fluid absorbtion, watch nutrient level intakes.

Specific Foods to Avoid: Try to avoid gluten which is easier said than done it is in most substances we eat. Common food items that can not be eaten include breads, bagels, pastries,nuts, seeds, hulls, pasta and pizza. There are companies throughout the United States which produce gluten-free products made predominantly from rice flour.

Reccomended Prescription Drug Therapy: If removal of gluten is not enough then medications that suppress inflammatory and immunologic reactions such as steroids, azathioprine, and cyclosporine may be used.

Potential Food and Drug Interactions: Cyclosporine should not be taken with aliskiren, bosentan, coal tar, live vaccines, rosuvastatin, or tacrolimus. When on cyclosporine, avoid potassium supplements or salt subsitutes and avoid grapefruit. Vitamin E may increase the absorption of cyclosporine.

General Nutrition Education Objectives or Goals: High fiber, Plenty of fluids, and Avoid nuts, seeds, and hulls

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