Vandna Jerath, MD, ob/gyn physician at Parker Adventist Hospital in Parker, CO, presents a community health seminar on gluten free diets sorting out the health vs hype. Topics include celiac disease, gluten sensitivity, gluten intolerance, gluten free diets, fads vs facts, research, and gastroenterology.
Vandna Jerath, MD discusses gluten: fads vs. facts and the impact on your health for the Women's Health & Wellness Expo for Parker Adventist Hospital at the Parker PACE Center. Learn about gluten, celiac disease, gluten sensitivity, a gluten free diet, and evolving gastroenterology (GI) research.
A discussion of hormones that affect women and how to stay balanced and optimize women's health through the stages of menopause. Treatment options including nutrition, lifestyle modification, hormone replacement therapy, herbal and botanical options, and bioidentical hormones discussed.
Preconception Counseling - A Critical Window for Health Promotion v2zq
Preconception Counseling - A Critical Window for Health Promotion - Resources for Healthy Children www.scribd.com/doc/254613619 - For more information, Please see Organic Edible Schoolyards & Gardening with Children www.scribd.com/doc/254613963 - Gardening with Volcanic Rock Dust www.scribd.com/doc/254613846 - Double Food Production from your School Garden with Organic Tech www.scribd.com/doc/254613765 - Free School Gardening Art Posters www.scribd.com/doc/254613694 - Increase Food Production with Companion Planting in your School Garden www.scribd.com/doc/254609890 - Healthy Foods Dramatically Improves Student Academic Success www.scribd.com/doc/254613619 - City Chickens for your Organic School Garden www.scribd.com/doc/254613553 - Huerto Ecológico, Tecnologías Sostenibles, Agricultura Organica www.scribd.com/doc/254613494 - Simple Square Foot Gardening for Schools - Teacher Guide www.scribd.com/doc/254613410 - Free Organic Gardening Publications www.scribd.com/doc/254609890 ~ healthandenvironment.org
Women and men have many of the same health problems, but they can affect women differently.Some diseases or conditions are more common in women, such as osteoarthritis, obesity and depression. And some conditions, such as menopause and pregnancy, are unique to women.
Women sometimes neglect their own health and focus instead on their partner's and their children's.
Take care of yourself first:
-- Plan for pregnancies and see your healthcare provider regularly while you are pregnant
-- Have regular mammograms
-- Get regular checkups and screenings. Early detection is important for treating breast, cervical, uterine and ovarian cancer.
Vandna Jerath, MD discusses gluten: fads vs. facts and the impact on your health for the Women's Health & Wellness Expo for Parker Adventist Hospital at the Parker PACE Center. Learn about gluten, celiac disease, gluten sensitivity, a gluten free diet, and evolving gastroenterology (GI) research.
A discussion of hormones that affect women and how to stay balanced and optimize women's health through the stages of menopause. Treatment options including nutrition, lifestyle modification, hormone replacement therapy, herbal and botanical options, and bioidentical hormones discussed.
Preconception Counseling - A Critical Window for Health Promotion v2zq
Preconception Counseling - A Critical Window for Health Promotion - Resources for Healthy Children www.scribd.com/doc/254613619 - For more information, Please see Organic Edible Schoolyards & Gardening with Children www.scribd.com/doc/254613963 - Gardening with Volcanic Rock Dust www.scribd.com/doc/254613846 - Double Food Production from your School Garden with Organic Tech www.scribd.com/doc/254613765 - Free School Gardening Art Posters www.scribd.com/doc/254613694 - Increase Food Production with Companion Planting in your School Garden www.scribd.com/doc/254609890 - Healthy Foods Dramatically Improves Student Academic Success www.scribd.com/doc/254613619 - City Chickens for your Organic School Garden www.scribd.com/doc/254613553 - Huerto Ecológico, Tecnologías Sostenibles, Agricultura Organica www.scribd.com/doc/254613494 - Simple Square Foot Gardening for Schools - Teacher Guide www.scribd.com/doc/254613410 - Free Organic Gardening Publications www.scribd.com/doc/254609890 ~ healthandenvironment.org
Women and men have many of the same health problems, but they can affect women differently.Some diseases or conditions are more common in women, such as osteoarthritis, obesity and depression. And some conditions, such as menopause and pregnancy, are unique to women.
Women sometimes neglect their own health and focus instead on their partner's and their children's.
Take care of yourself first:
-- Plan for pregnancies and see your healthcare provider regularly while you are pregnant
-- Have regular mammograms
-- Get regular checkups and screenings. Early detection is important for treating breast, cervical, uterine and ovarian cancer.
Health Services is committed to assisting women at UNH learn how to be and stay well physically and emotionally. This slide show contains information regarding women's reproductive health, contraceptive options and wellness.
“Preconception Care” and the Transformation of Women’s Health Care into Repro...ParentingCultureStudies
In this paper I examine the recent, vigorously touted “preconception” care movement in the United States. With the 2009 publication of What to Expect Before You Are Expecting, and the Center for Disease Control’s 2006 guidelines urging that all primary care for women of reproductive age be treated as “preconception” care, the time when women’s bodies are interpreted as maternal bodies is extended backwards to before conception even occurs – and indeed, often to before women are even planning to become pregnant. The new CDC guidelines explicitly warn that “the average woman of reproductive age encounters the medical system 3.8 times per year and any of these occasions may be a woman’s last before she becomes pregnant.”
It is important to take care of your health, and that starts with understanding your health risks and recommended screenings at each stage of your life. With the guidelines constantly changing and varying opinions, it can be tricky to keep track! Annual exams and testing can save your life whether you are 21 or 65.
Learn more about your risks and tests needed at each stage of your life to keep your health in check in one simple list.
The "Best" Diet for Irritable Bowel Syndromealbertsnow
IBS can be cured by rebuilding the GI tract's mucosal tissue. However, in the meantime, you can manage the symptoms of your condition by not eating foods that will aggravate it. As you think about your diet and what you eat, keep in mind these two rules for diet for Irritable Bowel Syndrome:
Nutritional assessment in chronic liver diseaseShaimaa Elkholy
Protein Energy Malnutrition (PEM) is highly prevalent among patients with chronic liver disease. One of the problems is how to assess these patients nutritionally. yet no standard golden rule for their nutritional assessment.
Health Services is committed to assisting women at UNH learn how to be and stay well physically and emotionally. This slide show contains information regarding women's reproductive health, contraceptive options and wellness.
“Preconception Care” and the Transformation of Women’s Health Care into Repro...ParentingCultureStudies
In this paper I examine the recent, vigorously touted “preconception” care movement in the United States. With the 2009 publication of What to Expect Before You Are Expecting, and the Center for Disease Control’s 2006 guidelines urging that all primary care for women of reproductive age be treated as “preconception” care, the time when women’s bodies are interpreted as maternal bodies is extended backwards to before conception even occurs – and indeed, often to before women are even planning to become pregnant. The new CDC guidelines explicitly warn that “the average woman of reproductive age encounters the medical system 3.8 times per year and any of these occasions may be a woman’s last before she becomes pregnant.”
It is important to take care of your health, and that starts with understanding your health risks and recommended screenings at each stage of your life. With the guidelines constantly changing and varying opinions, it can be tricky to keep track! Annual exams and testing can save your life whether you are 21 or 65.
Learn more about your risks and tests needed at each stage of your life to keep your health in check in one simple list.
The "Best" Diet for Irritable Bowel Syndromealbertsnow
IBS can be cured by rebuilding the GI tract's mucosal tissue. However, in the meantime, you can manage the symptoms of your condition by not eating foods that will aggravate it. As you think about your diet and what you eat, keep in mind these two rules for diet for Irritable Bowel Syndrome:
Nutritional assessment in chronic liver diseaseShaimaa Elkholy
Protein Energy Malnutrition (PEM) is highly prevalent among patients with chronic liver disease. One of the problems is how to assess these patients nutritionally. yet no standard golden rule for their nutritional assessment.
Dr. Alap Shah from La Grange Family Medicine Residency of Amita Health talks about the importance of plant-based nutrition and tips on billing for it at the 2019 Family Medicine Midwest educational meeting
In 2008, Lara Field founded FEED – Forming Early Eating Decisions (FEED KIDS, LLC), a nutrition counseling practice.
Field has always had a passion for kids’ nutrition. She has over a decade of experience in clinical practice at two of the top ranked pediatric hospitals in the country, Lurie Children’s Hospital of Chicago (formerly Children’s Memorial Hospital) and University of Chicago Comer Children’s Hospital. She has specialized in pediatric nutritional care including the pediatric intensive care unit and pediatric gastroenterology and hepatology clinics.
A Conversation with the Dean of the Tufts School of Human Nutrition. 9-17-15 Recording here: https://www.dropbox.com/s/8qly017hyhct6ut/Darius%20Tufts%20Nutrition%20Talk.m4a?dl=0
As part of the IFPRI Egypt Seminar in partnership with the National Nutrition Committee (ASRT affiliated): "100 million healthy lives: Scientific evidence on the double burden of malnutrition in Egypt"
Whole grains are important part of healthy eating. They contains wide range of beneficial nutrients. From this presentation your can learn the nutritional facts of whole grains.
Navigating Nutrition During Cancer and COVID-19bkling
Nutrition can be puzzling enough, but when you add a cancer diagnosis and a global pandemic, it’s even harder to make sense of it all. Julie Lanford, MPH, RD, CSO, LDN, "The Cancer Dietitian" for Cancer Services, will help put the pieces together so you’re equipped to navigate nutrition during cancer and COVID-19.
RD Azmina Govindji - Yogurt in practice: simple swaps to improve nutrition -...Yogurt in Nutrition #YINI
By establishing simple and effective habits in the short-term, we can improve our lives in the long-term. Simple, nutritious and pleasurable - yogurt can be an interesting and healthy option as a “swap food” in sweet and savory dishes, at any time of the day. Azmina Govindji, RD, shared her golden tips for a triple win with yogurt swaps.*
Best OncoRx Testing Company In Hyderabad - GenepoweRxGenepowerx
We are a specialized genome clinic of Hyderabad, providing personalized healthcare to individuals to lead healthy and effective lives. We understand how important it is for you to have appropriate advice about the medicines prescribed for you and for your benefit. Our experts will give you individualized, comprehensive health advice and consultation to meet your specific needs.
Visit: https://genepowerx.com/oncorx/
Microbiologist Michael Jacobson, PhD introduced the term “junk food” in 1972.
Junk food is a slang word for foods with limited nutritional value.
high in salt, sugar, fat or calories and low nutrient content can be termed junk food.
The Time Factor
They are easy to prepare and are very tasty. Junk foods such as potato wafers do not even need cooking or heating.
we prefer to eat them when we watch TV. We save our self a lot of hassles and time when we are in a hurry eating pizzas and burgers as they are served at our door step hot and ready to eat.
Mentorship for Medical and Healthcare Careers: obstetrics & gynecologyVandna Jerath, MD
Vandna Jerath, MD discusses how to obtain a mentor in medicine to optimize your chances of getting into medical or osteopathic school, physician assistant school, or nursing school.
Learning Objectives:
Learn why it is a privilege to be a physician and a general overview of obstetrics & gynecology.
Learn the pros and cons of a career in medicine and obstetrics & gynecology.
Learn the education and training required for a career in medicine.
Learn how to cultivate a passion and purpose that will begin a career path in medicine and healthcare.
Learn how to pick ideal mentors, shadowing experiences, develop essential skills, and maximize mentorships.
Learn the basic medical career options, appropriate healthcare questions to ask, current healthcare hot topics, benefits of research, how to engage with helpful medical mentors, and importance of building relationships.
Learn how to share your authentic selves in the application and interview process to optimize chances of acceptance to medical school, osteopathic school, physician assistant school, dental school, or nursing school.
Healthcare Social Media: how to make a positive impact on your practice and ...Vandna Jerath, MD
Vandna Jerath, MD, ob/gyn physician and medical director of Optima Women's Healthcare and Optima Vitality MD and Women and Children's Services Chair at Parker Adventist Hospital, discusses health care social media (#HCSM) and digital health at a Business of Medicine Seminar at Parker Adventist Hospital. She discusses the importance and relevance by sharing her expertise, experience, and positive exposure with other healthcare providers, medical staff, practices, and practice managers to help them effectively connect, communicate, and collaborate, market and grow a practice, promote healthcare objectives, educate, engage, and empower patients, and make an overall positive impact on healthcare.
Menopause: how to balance your hormones and live vibrantlyVandna Jerath, MD
Vandna Jerath, MD discusses menopause, hormonal imbalance, how to balance hormones, and living vibrantly for a health seminar at Parker Adventist Hospital in Parker, CO. She outlines a number of treatment modalities including hormone replacement therapy (HRT), bioidentical hormone replacement therapy (BHRT), and alternative therapy. She reviews the latest women's health updates related to menopause and vulvovaginal atrophy as well as her current practice usage of BioTE hormone pellet therapy and MonaLisa Touch vaginal laser revitalization treatment.
Healthcare Social Media and Digital Health: how to effectively connect, comm...Vandna Jerath, MD
Vandna Jerath, MD, ob/gyn physician and medical director of Optima Women's Healthcare and Optima Vitality MD, discusses health care social media (#HCSM) and digital health at the Greenway ENGAGE 2015 conference in Dallas, Texas (#GreenwayENGAGE). She discusses the importance and relevance by sharing her expertise, experience, and positive exposure with the ob/gyn and primary care providers and user groups (GOBUG & Green PC) to help them effectively connect, communicate, and collaborate, market and grow a practice, promote healthcare objectives, educate, engage, and empower patients, and make an overall positive impact on healthcare. #HCSM #GreenwayENGAGE #HIT #digitalhealth #EHR
Healthcare Social Media (#HCSM): Using word of mouse to market & manage your...Vandna Jerath, MD
Dr. Vandna Jerath discusses healthcare social media #HCSM at the Colorado ACOG Summer Educational Symposium. She demonstrates how to use word of mouse to market and manage your practice by educating, engaging, and empowering women. Learn about HCSM platforms and why networking is beneficial to promote healthcare objectives.
Social Networking: how to make a positive impact on your practice and healthcareVandna Jerath, MD
A seminar discussion on healthcare social media and the impact of social networking on a practice, patients, the community, and healthcare. Steps and instruction on how to make a positive impact by sharing my experience with healthcare social media.
A discussion of women's health issues over age 40 including fertility, infertility, family planning, contraception, PMS, menopause, hormones, urinary incontinence, and osteoporosis, and cancer for the Illuminate women's luncheon.
Healthcare Social Media: using word of mouse to build a practice by educatin...Vandna Jerath, MD
Healthcare Social Media: using word of mouse to build a practice by educating, engaging, and empowering patients. Sharing my insights and experience in this presentation at the 4 corners MGMA conference - 4/25/2012.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Gluten Free & Healthy Living: sort the fads from the facts
1. Vandna Jerath, MD, FACOG
Community Health Seminar | Parker Adventist Hospital
drjerath.com | optimawomenshealthcare.com | optimavitalitymd.com
February 23, 2016
#glutenfree #healthyliving #factsvsfads
@drjerath @optimawhc @optimavitality
2. FACOG – Board-Certified Ob/Gyn
Private practice – 17 years
Full scope obstetrics & gynecology
Enjoy education and community outreach
Disclosures – no financial affiliations
Healthcare social media expert
drjerath.com
Gluten free for 2 ½ years
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
3. General Ob/Gyn Services
Women’s health resource/expert
Female empowerment
◦ Be educated Be engaged Be empowered
Spa-like setting
Individualized, personalized, and compassionate care
optimawomenshealthcare.com
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
4. Center for Rejuvenation and Wellness
Alternative, holistic, functional, integrative, and
complementary medicine
BioTE® bioidentical hormone pellet therapy
◦ Treatmemt for both women and men
◦ Nutraceuticals
MonaLisa Touch™ vaginal laser revitalization
VitaMedMD™ vitamins and minerals
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
5. To understand what gluten is and the impact it has on health.
To learn about celiac disease including prevalence,
signs/symptoms, diagnosis, and management.
To understand the evolving spectrum of gastroenterological
conditions, particularly regarding gluten and gluten
sensitivity.
To understand the dietary restrictions of a gluten free diet.
To be able to sort out the health vs. hype regarding gluten.
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
8. Jimmy Kimmel video
◦ http://www.youtube.com/watch?v=AdJFE1sp4Fw
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
9. What is all the fuss?
◦ Less people eating gluten
◦ Revenue producing for the food industry - $15 billion in 2016
◦ Potentially life threatening for people with celiac disease
May cause GI symptoms
◦ Allergy vs. sensitivity vs. intolerance
Gluten free may be diet fad vs necessity
Why?
◦ GMO crops?
Possible overdiagnosis and overtreatment
Media stories
◦ NY Times blog article – 9/29/2014
◦ Celiac Disease, a Common, but Elusive, Diagnosis
◦ http://well.blogs.nytimes.com/2014/09/29/celiac-disease-diagnosis-
gluten/?_php=true&_type=blogs&_r=0
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
14. Source: Thompson T. Celiac Disease Nutrition Guide, 2nd ed. Chicago:American Dietetic Association;2006.
Allowed Foods
amaranth
arrowroot
buckwheat
cassava
corn
flax
Indian rice grass
Job's tears
legumes
millet
nuts
potatoes
quinoa
rice
sago
seeds
sorghum
soy
tapioca
teff
wild rice
yucca
Foods To Avoid
•wheat including einkorn, emmer, spelt, kamut
•wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein
barley
rye
triticale(a cross between wheat and rye)
Other Wheat Products
bromated flour
durum flour
enriched flour
farina
grahamflour
phosphatedflour
plain flour
self-risingflour
semolina
white flour
ProcessedFoods that May Contain Wheat, Barley, or Rye*
bouillon cubes
brown rice syrup
candy
chips/potatochips
cold cuts, hot dogs, salami, sausage
communion wafers
French fries
gravy
imitationfish
matzo
rice mixes
sauces
seasonedtortilla chips
self-bastingturkey
soups
soy sauce
vegetablesin sauce
The Gluten-free Diet: Some Examples
In 2006, the American Dietetic Association updated its recommendations for a gluten-free diet. The following chart is based on the 2006 recommendations. This list is not
complete, so people with celiac disease should discuss gluten-free food choices with a dietitian or physician who specializes in celiac disease. People with celiac disease
should always read food ingredient lists carefully to make sure the food does not contain gluten.
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
15. Challenges
◦ Cross-contamination
◦ Hidden ingredients
◦ Preservatives
Wheat free is not gluten free
Not necessarily low fat or for weight loss
Make sure adequate vitamins and minerals
Vitamin B
Vitamin D
Calcium
Fiber
Iron
Avoid
◦ Wheat
◦ Malt
◦ Modified food starch
◦ Dextrin
◦ Hydrolyzed wheat protein
DO NOT START w/o confirming or ruling out celiac disease
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
16. Digestive disease that damages small intestine
◦ Damaged villi of the small intestine
◦ Malabsorption of nutrients
◦ Celiac disease (CD), Celiac sprue, nontropical sprue, gluten-sensitive enteropathy
Autoimmune reaction
Intolerance to gluten
◦ How does it start?
◦ Surgery, infection, cereal < 3mo age, hereditary?
Prevalence 1 in 100
Women > Men
◦ 2/3 of current diagnosis are female
More common in Caucasians
Genetic (5-10% first degree relative)
May take 10 years or more for diagnosis
◦ Average age of diagnosis is 50
◦ Confusing symptoms
◦ Delayed diagnosis or under diagnosed
17% of Americans don’t know they have the disease
Lifelong gluten free diet is the only treatment
◦ Less than 20ppm
Source: AGA Institute MedicalPosition Statement on the Diagnosisand Managementof Celiac
Disease.Gastroenterology. 2006; 131:1977-1980.
Source: Celiac Disease. NIH Publication No. 08-4269. September 2008.
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
17. Husby, S. & Murray, J. A. (2014) Diagnosing coeliac disease and the potential for serologicalmarkers
Nat. Rev. Gastroenterol.Hepatol. doi:10.1038/nrgastro.2014.162
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
20. Must be on a gluten diet for testing
Blood tests
◦ IgA tissue trans-glutaminase antibodies (tTG)
Most efficient single serologic test
◦ IgA/IgG deaminated gliadin peptide antibodies (DGP)
Genetic testing
◦ Human leukocyte antigen (HLA) haplotypes
◦ DNA PCR
◦ HLA DQ2 (95%)/DQ8 (5%)
No celiac if these are negative
Intestinal biopsies
◦ Multiple biopsies
◦ Histological testing for villous atrophy
◦ Gold standard for diagnosis
Skin biopsies
Equivocal test results can occur
Source: AGA Institute MedicalPosition Statement on the Diagnosisand Managementof Celiac
Disease.Gastroenterology. 2006; 131:1977-1980
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
21. Consultation with a skilled dietitian
Education about the disease
Lifelong adherence to a gluten free diet
Identification and treatment of nutritional deficiencies
Access to an advocacy group
Continuous long-term follow-up by a multidisciplinary
team
Source: NIH Consensus DevelopmentConferenceon Celiac Disease.
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
23. Is there a spectrum of disease?
Non-celiac gluten sensitivity (NCGS)
◦ First described in 1980’s now “re-discovered”
GI symptoms responsive to a gluten free diet
◦ May be able to titrate their gluten exposure to avoid symptoms
Prevalence unclear
◦ Many people self-diagnose and start a gluten free diet without
medical consultation (not recommended)
◦ .5-6% based upon different studies
◦ More common in females
Transitory or permanent?
Source: Fasano A, et al. Non-celiacgluten sensitivity: the new frontier of gluten related disorders. Nutrients. Oct 2013; 5(10): 3839-3853
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
24. Diagnosis
◦ Difficult to distinguishfrom irritable bowel syndrome (IBS) or wheat allergy (WA)
◦ Lack of biomarkers for diagnosis
First generation IgG AGA – 7.7%
HLA DQ2/DQ8 – 50%
◦ Different histological changes on intestinal biopsy
Present
◦ Younger age (case reports in children)
◦ Lack autoimmune or family history
◦ Constipation
Less likely to be at risk
◦ Malabsorption
◦ Severe nutrient deficiencies
◦ Lymphoma
◦ No major complication if untreated
Evolving spectrum
◦ Some more like celiac disease
◦ Some more like food allergy
◦ Is GMO wheat contributing?
◦ Possible relationship to autism and schizophrenia
◦ May be related to wheat amylase-trypsininhibitors
◦ May be related to low-fermentable, poorly absorbed, short chain carbohydrates
Reduced FODMAPs (fermentableoligo-, di-, and mono-saccharidesand polyols) diet
Fructans, galactans, fructose, and polyols
Source: Fasano A, et al. Non-celiacgluten sensitivity: the new frontier of gluten related disorders. Nutrients. Oct 2013; 5(10): 3839-3853.
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
25. Nonceliac enteropathy (NCE)
◦ Can mimic celiac disease
◦ May cause villous atrophy
◦ Can respond to a gluten free diet
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
26. Gibson et al- Australian study in 2011
◦ Double blinded, randomized, placebo controlled
◦ Small study
◦ Gluten containing diet caused GI distress in people w/o Celiac
Disease (CD)
Biesiekierski/Gibson et al - repeat study in 2013
◦ Double blinded, placebo controlled, cross-over trial
◦ 37 patients gluten sensitivity (NCGS)
◦ FODMAPs reduction, low or high gluten, or whey (placebo)
challenge
◦ Improvement with FODMAPs reduction
◦ No specific response to gluten
◦ Nocebo effect – worsening of GI symptoms
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
Source: Biesiekierski/Gibson et al. “Is gluten a cause of gastrointestinalsymptoms in peoplewithout celiac
disease?” Curr Allergy Asthma Rep. 2013 Dec; 13(6):631-8.
Source: Biesiekierski/ Gibson et al. “No effects of gluten in patients with self-reported non-celiacgluten sensitivity
after dietary reduction of fermentable,poorlyabsorbed, short-chain carbohydrates.”Gastroenterology.2013 Aug;
145(2):320-8.e1-3.
27. More research needed
◦ FODMAPS
◦ IBS
◦ Wheat Sensitivity
◦ Autism
◦ Schizophrenia
◦ Larger trials – double blinded prospective randomized controlled
trials
◦ Nocebo effect
◦ Other autoimmune syndromes or allergies
Hashimoto’s, Sjogren’s, asthma
Diagnosis of gluten sensitivity (NCGS)
◦ Need biomarker
◦ Transitory or permanent?
◦ True prevalence/incidence
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016
30. Fads
◦ It is a good weight loss diet.
◦ Will make you “sick” or “fat”.
◦ GI symptoms will definitely occur.
◦ Healthy for you.
◦ Everyone is doing it.
◦ Ok to start a gluten free diet without a diagnosis.
Facts
◦ People with celiac disease have a permanent lifelong intolerance and cannot
eat gluten.
◦ May cause an autoimmune response with GI symptoms.
◦ Some people may have an allergy or sensitivity.
◦ Gluten free diet may improve sensitivity symptoms.
◦ Medical information and evidence is evolving.
◦ Do not start a gluten free diet without a medical diagnosis or consultation.
CommunityHealth Seminar | Parker Adventist Hospital | 2/23/2016