26th Annual Celiac Conference: Pre-lunch Presentations

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 Celiac Disease. 

• 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 Gluten. 

• 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
The Finale