When we first walked in to the 26th Annual Celiac Conference room shortly after 8 am,
I was so excited to see that we would be sitting at actual tables, and not just
in rows of chairs. I intentionally brought my ASUS tablet with me so that I
could type all of my notes on Google Drive. Using a Bluetooth keyboard to take
notes is so much faster and easier, not to mention more legible, than trying to
write everything by hand.
The packet we received at registration had
a great outline of the day's agenda, as well as bios for all of the speakers for
the day. Promptly at 8:15 Registered Dietitian Mary Kay Sharrett started out
the conference with a brief introduction. She introduced our first speaker, Dr.
Ivor Hill, the director of the Celiac Disease Center at Nationwide Hospital.
Dr. Ivor Hill first discussed the Launching of the Celiac Disease
Center, including their past, where they are presently, and where they are
looking towards in the future.
Key points from this presentation
- They are hoping to increase the number of diagnosed patients by 25% by the end of the year, and to have frequent follow-ups to monitor risk of nutritional deficiencies that may be associated with celiac disease.
(Surprisingly, Dr. Hill said following up on nutritional deficiencies is
something that is not often done.) They are also looking at ways to
diagnose patients without having to do a biopsy, as well as researching the
natural history of celiac disease to better understand the disease and where
they may be going in the future. He mentioned that Dr. Prasad at Nationwide Hospital has developed new state of the art stains to further help in diagnosing Celiac Disease.
Dr. Hill's next presentation was about the Current and Future Guidelines for
- He compared and contrasted the 9 different sets of guidelines for diagnosing celiac disease around the world, and the history of diagnosis. It used to be rather complicated until Dr. Guandalini in the 90's that finally
showed that the subsequent reintroduction of gluten for definitive diagnosis was simply
not needed, and has since been done away with. The "gold
standard" for diagnosis continue to be a biopsy.
- Dr. Hill compared the different types of
antibody tests, stating the old-fashioned tried and true IgA is simply not
effective anymore, as a large percentage of the population tests positive for
IgA, even those who are not celiac. He said of the three others, tTg- EMA-
& DPG, he feels the EMA is the most sensitive and cost effective.
- He also talked about new research in
genetic testing. He stated that it is
possible to only have half of the HLA DQ2 or DQ8 gene and have celiac disease.
- He also discussed the topic of autoimmune
diseases in general. There
is also a stronger chance for someone to develop thyroid disease if they have
celiac disease. He did state though that adherence to the gluten free diet (or
lack of adherence) does not seem to play a factor in someone developing another
auto-immune disease. In other words, developing a second auto-immune disease is
a correlational fact, not causational.
Dr. Jolanda Denham presented on Non-Celiac Gluten Sensitvity.
- She defined the differences between celiac disease, wheat allergy, and
non-celiac gluten sensitivity, and research about NCGS. Much research still needs to be done on the issue. Some of the
potential causes of non-celiac disease are different compositions of gut flora which triggers an
inflammatory response, certain wheat proteins that cause an immune reactions,
and sensitivity to food additives and preservative.
- She also brought up a new area of study in
FODMAPs- Fermentable Oligo Di and Monosaccharides and Polyols. These are
short-chain carbohydrates that are poorly absorbed in some individuals. Their
small size can cause rapid fermentation and therefore lead to abdominal pain and
bloating, as well as diarrhea. These FODMAPs are found in dairy, beans, gluten
containing grains, and certain fruits, vegetables and sweeteners.
- Dr. Denham also raised concerns about
those who are following a gluten free diet unnecessarily. It is not necessarily
healthier, because there is a risk of nutritional deficiencies, loss of prebiotic
benefits, and can cause a diet low in fiber. There is also research that wheat
may help lower triglyceride and lipid levels.
The last presentation before lunch was by
Steve Plogsted, a pharmacist who has been on personal mission to divulge the
truth about Medications and
- The biggest thing I brought away was that on the whole, there are
very few cases of gluten being in medication and even less chance of cross-contamination. The main potential source of
gluten in medications is in the "excipients,” those things that provide
bulk, absorb water, and act as a lubricant for the powder. Of these, the
biggest culprit is pregelatinized starch. Steve stated that most excipients are
from corn, potato, or tapioca. Of over 4,000 package inserts only 3 were found
to have wheat starch in them. At this point there is no FDA requirement for
labeling gluten free risk. (although Representative Tim Ryan is trying to put this
back up for a vote in Congress.).
- The one drug that DOES have gluten in it
that Steve pointed out was Tricor, a drug to help combat high cholesterol. The
tablets are coated in wheat- although it seems that this drug is being phased
out by a "better performing" variety of the drug.
- He also mentioned the drug Benicar
(Olmesartan), which although it does not contain gluten, does seem to cause
people to have celiac symptoms.
- He suggested using the website DailyMed, and
taking that to your pharmacist. This is a reference site for prescription
sub-ingredients. You can also use his website, www.glutenfreedrugs.com.
- An interesting comment he made was to ask
your pharmacist to set aside a separate pill counter tray for your
prescriptions. He stated that they rarely get cleaned and that they may be the
biggest source of cross-contamination. Otherwise, the chances of
cross-contamination in the actual pharmaceutical processing plant are near
impossible, as they have very elaborate safety procedures.
That's a lot of information.....now off to
lunch! A pasta dinner with gluten free (and pork free!) meatballs, salad, and
gluten free tiramisu made with Schar ladyfingers! WOW!
Post Lunch Presentations