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Celiac Disease & Gluten Intolerence

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Sarah V

on 25 March 2014

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Transcript of Celiac Disease & Gluten Intolerence

So Who Is Affected?
How Age Affects Celiac Disease
• Since Celiac Disease is a genetic disorder age does not play a role in who is born with the disorder
• However, for a long time people thought age played a role in the onset of the disorder
• It was believed that onset of the disorder only occurred in infants, and one you were a certain age it was no longer a worry
• This was proven wrong
• Age does not dictate onset of CD. Onset can occur in all age groups
1. Theory of evolution and history of celiac disease
2. Is Wheat Breeding Really Driving Higher Rates of Celiac Disease?
3. Breast Milk and Celiac Disease
All about gluten!
Pros & Cons
Celiac Disease & Gluten Intolerence
Those Most Affected By Celiac Disease
When looking at those affected by celiac disease we can discuss prevalence of the disease in a couple different categories:
Geographic Location
Geographic location plays a role in whom celiac disease affects.
- An autoimmune inflammatory condition of the small intestine
- Previously called Celiac Sprue (Dutch)
- Caused by the ingestion of Gluten (Gliadin)
- Wheat, rye, barley and oat flour contain gluten
- Common condition that may be diagnosed at any age
- Damages cells that line the intestinal tract
- Diagnosed with a blood test
- Asymptomatic
Sarah V, Emily B, Andrew G, Justin M, Mel M
FN 1021
Section 531
Prof Noelle Martin
March 25, 2014

"Wheat breeding for
higher gluten content does
not seem to be the basis"
Infants with low genetic risk showed greater colonization of B. ovatus, B. plebeius and B. uniformis, while those with high genetic risk showed a greater colonization of B. Vulgatus.
Among, formula-fed infants, the prevalence of B. ovatus and B. plebeius was increased in those with
low genetic risk, while the presence of B.
vulgatus was greater in those with high
genetic risk.
A particular of the skeleton of Cosa in the original site.
A: The original site- The ancient remains of Cosa in the original site where they were found.
B: The young girl- A particular of the skeleton of the young girl of Cosa.
Research on the skeleton of the young girl.
A: skull vault showing excessive porosity
B: A particular of the femur showing cortical atrophy and spongiosum bone hypertrophy, indirect sign of bone marrow hypertrophy, well preserved in 2000 years;
C: A detail of teeth, showi basal dental enamel hpoplasia
D: DNA extraction- A tooth and a sample of bone
CASE STUDY: Case Of Cosa
"Consumption of vital gluten has TRIPLED since 1977"
"It is in the time frame that fits with the predictions of an increase in celiac disease"
- No evidence that farmers have been breeding wheat to ensure higher protein and gluten content
- Numerous students have compared the protein contents of wheat varieties from the early part of the 20th century
- No difference in the protein contents
- Geographic location
- Age
- High risk groups
Here we see a map showing regions of the world most affected by the disease:
- USA and Russia - 0.5 - 0.9%
- Australia - 1 - 1.95%
- European Countries ranging from 0.50% - >2.00%
- Many countries have no data because there is still a newer disease and if often not dianosed in some countries. If there is no or little diagnosis, there is little medical records and therefore cannot be throughougly studied in those countries/regions.
So we know Celiac Disease is more prevalent in some countries but why is that?
There are two MAJOR reasons:
1. Genetic disposition
2. Environmental factors
relating to diet
Genetics and the prevalence
of Celiac Disease
- Population with higher density of celiac disease could be cause by genetics and genetic predisposition
- If the CD gene spreads through a population (e.g. a country) the prevalence of the disease will increase.
- In a country or population without the gene, there is no chance the gene will spread causing no cases of the disease even though the diet could be the same in both populations.
- Just because an individual has the gene doesn't mean they will get the disease, but they are at risk for it, whereas, someone without them have a very low chance of getting the disease unless other factors come into play.
- This genetic factor is why the disease is mostly found in Caucasians.
Geographic location of CD could also be due to diet.
- Although there is not necessarily
a known cause of celiac disease it is the presence of gluten that 'switches on' the disease.
- This could be why places like America, Russia and Europe and other places in the developed world have a higher percentage of CD
• Because the diets have a higher concentration
gluten rather than places southern Africa and South America which have very little known cases of CD.
• The higher presence of gluten in the diet again, doesn't cause the disease but triggers it, causing regions with a higher gluten diet to have more outbreak of the disease.
High Risk Groups
Although CD is a genetic disorder there are several situations in which CD could be triggered in a dormant individual. These situations account for the high risk individuals.
- Situations of high physical stress including:
• Pregnancy
• Child Birth
• Surgery
• viral Infections
- Type 1 Diabetes Mellitus
- Down Syndrome individuals
Researchers are not entirely sure why these groups of people are at a high risk of onset because they do not know in itself the actual cause of onset in any individual.
CD only affects those who have a genetic predisposition toward the disorder.

The onset of the disorder can occur at any time from birth onwards.

Although in Canada and the United States only about 1 in every 140 people are diagnosed with CD the numbers are starting to rise. Whether it be due to better diagnosis or due to growth of the disease, numbers are increasing.

With these increasing numbers people are asking, "how can I avoid CD and gluten intolerance?"
Avoiding Celiac Disease and Gluten Intolerance
- There is not way of avoiding CD because it is genetic
- There is not even a way to avoid the onset of the disease because we do not yet know what triggers the onset
- However, a way to reduce and even eliminate the effects of CD and to avoid gluten intolerance is the gluten free diet
The Gluten Free Diet
Even the smallest amount of gluten can cause damage to the small intestine so it must be avoided at all costs.
As we already know, gluten is a protein found in wheat, barley, and rye flour but following the gluten free diet is much more extensive than just avoid these.
There are often hidden sources of gluten in other foods, and naturally gluten free foods can sometimes be contaminated.
Foods to avoid (gluten containing foods/ products)
• Barley
• Beer
• Bleached flour
• Blue Cheese
• Bran
• Bread flour
• Bulgur
• Cake flour
• Communion wafers
• Couscous
• Cracker meal
• Croutons
• Durum
• Farina
• Farro

• Flour
• Gluten, glutenin
• Graham flour
• Groats
• Kamut
• Malt
• Malt beverages
• Matzo
• Oats and oat bran
• Orzo
• Pasta
• Rye
• Seitan
• Semolina
• Soy sauce
• Spelt
• Suet
• Tabbouleh
• Teriyaki sauce
• Triticale
• Triticum
• Unbleached flour
• Vital gluten
• Wheat
As you can see, it's not that easy to avoid gluten!
An interesting finding...
A prospective study on a large cohort of babies with genetic predisposition to CD has shown that children who were introduced to gluten during the first three months of life were at greater risk to subsequently develop CD.
Signs and Symptoms
The most common signs and symptoms of celiac disease include:
• Abdominal cramping and diarrhea
• Growth failure
• Anemia
• Signs of nutrient deficiencies
• Life threatening electrolyte losses
• Osetomalacia and bone pain in children
• Secondary hyperparathyroidism from decreased absorption of calcium and vitamin D
• Dermatitis herpetiformis - a pruritic pattern of recurrent blisters over elbows and knees (disappears with gluten-free diet)
Testing For Celiac Disease
- A blood test is not available to help diagnose celiac disease
- Of interest is the fact that celiac disease can be asymptomatic and therefore the blood test is recommended for family members of celiac patients.
- The blood test is highly sensitive (99%) and specific (>90%) for identifying the disease.
Other Health Conditions Associated With Celiac Disease
Even with a gluten-free diet celiac disease patients show a higher incidence of future development of:
1. Intestinal lymphoma and colon cancer
2. Rheumatoid arthritis
3. Diabetes
4. Thyroid disease
5. Ulcerative colitis
6. Schizophrenia
Common extra-intestinal manifestations of celiac disease
Iron deficiency anemia
Dermatitis herpetiformis
Dental enamel defects
Aphtous ulcers
Abnormal liver enzymes
Psychiatric disorders
Short stature
Delayed puberty
Vitamin D deficiency
Unexplained infertility
Cerebellar ataxia
- May decrease carbohydrate consumption and encourage increase in fruits and vegetables
- If you have a gluten intolerance or sensitivity, which can cause inflammation or damage to the intestinal tract. Eating gluten free can help reverse this damage and inflammation
- Encourages label reading and more awareness of food
- Leads to a healthier diet filled with less processed foods
- Introduces higher quality grains into your diet
- Many gluten-free foods are also not enriched with iron, fiber, or folate
- A gluten-free diet can be limiting and difficult to stick to
- Gluten free foods are often more expensive
- Reduced carbohydrate intake due to lack of education on nutrients (not all carbs have gluten)
- Possible weight gain from eating gluten-free products, which often contain higher levels of fat and sugar
- Possible weight gain as the intestinal track adjusts and begins to absorb nutrients properly
- Possible weight loss and a nutrient deficient diet from eliminating too many foods in fear of consuming gluten
Adams,J. (2013). How old are the genetic factors that leave us at risk for celiac disease?.p.1. Retrieved from: http://www.celiac.com/articles/23317/1/How-Old-Are-
the-Genetic-Factors-that-Leave-us-at-Risk-for-Celiac-Disease/PAge1.html [Accessed 11th Jan 2014].
Adams,J. (2011). Breastmilk, baby formula, and genetic factors likely influence celiac disease risk.p.1. Retrieved from: http://www.celiac.com/articles/22656/1/
Breastmilk-Baby-Formular-and-Genetic-Factors-Likely-Influence-Celiac-Disease-Risk/Page1.html [Accessed 11th Jan 2014]
Bauer, J. (n.d.). What affects Celiac Disease?. Retrieced March 20, 2014, from http://www.vegkitchen.com/nutrtion/
Vegan Vegetarian Recipes VegKitchencom.
Dube, C., et a. (2005). The prevalence of celiac disease in average-risk and at-risk western European populations: A systematic review. 57-67.
Green, P. H., & Cellier, C. (2007). Celiac disease. (17), 1731-1743. 1159. http:///www.nejm.org/doi/full/10.1056/NEJMra071600
New England Journal of Medicine, 357
Kang, J. Y., et al. (2013). Systematic Review: Worldwide Variation in the Frewuency of Coeliac Disease and Changes Over Time. :226-245.
Aliment Pharmacol Ther,
Kasarda, D. D. (2013). Can an increase in celiac disease be attributed to an increase in the gluten content of wheat as a consequence of wheat breeding?.
Journal of Agricultural and Food Chemistry
61 (6), pp. 1155
Meschino, Dr. James. (2013). Celiac Disease: A Commonly Under-Dianosed Condition of the Small Bowel.
Sakai, J. (2013). John hawks explores how celiac disease evolved. Retrieved from: http://www.news.wisc.edu/22157 [Accessed:
11th Jan 2014]
University of Wisconsin-Madison,
Doc Oz on Celiac Disease issue. (2011, July 5). Retrieved from htp://www.youtube.com/
Exos | Formerly Core Performance. (2011, October 17). Retreived March 12, 2014, from http://www.coreperformance.com/daily/
Core Performance Core Daily.
Gluten-Free Diet. (n.d.). Retrieved Match 10, 2014, from http://sphweb.bumc.bu.edu/otlt/MPH-Modules/PH/NutritionModules/Popular_Diets/
Gluten-Free Diet.
Medical and Weight Loss Benefit of Gluten Free Diet. (2010-2012). Retrieved March 12, 2014,
from http://www.glutenfree-diet.ord/benefits.html
Gluten-Free Diet Pros and Cons: Weight Loss and Medical Benefits.
10 Pros and Cons for Going Gluten Free ... (n.d.). Retrieved Match 12, 2014, from http://health.allwomenstalk.com/pros-and-cons-for-going-gluten-free
1. Class split up into two teams
2. Three volunteers needed
3. Each volunteer has to complete a task
4. The team with the most tasks won wins!
- Trivia
- Taste testing
- Multiple choice
Name one of the major reasons why celiac disease is more prevalent in certain countries?
Which cookie is gluten-free and which one is a regular cookie?
Which of these is NOT okay to consume if a person has celiac disease?
Fresh eggs
Corn and cornmeal
Full transcript