What is celiac disease?
What is Dermatitis Herpetiformis?
What are HLA DQ2 and DQ8?
What are the symptoms?
How do you get tested?
What are the blood tests I should get?
Is testing the same for Dermatitis Herpetisformis?
What is the difference between Celiac Disease and Gluten Intolerance?
If I have some of the symptoms, should I try going on the gluten free diet?
I have just been diagnosed with celiac disease, should I get my family
What is gluten and the gluten free diet?
If I have celiac disease, do I have to follow the gluten free diet forever?
What is the Kogan Celiac Center?
Where is the Kogan Celiac Center located?
How does the program work?
Are there support groups for people with celiac disease?
How do the recent changes in labeling laws affect someone following the
gluten free diet?
What about alcohol?
Celiac disease is a lifelong, genetic intolerance to certain proteins found
in the grains wheat, barley and rye. When ingested by an individual with
celiac disease, these proteins trigger an autoimmune inflammatory response
in the small intestine, causing damage to the absorptive structures called
villi. When villi are damaged, their ability to absorb nutrients (fat,
carbohydrate, protein, vitamins and minerals) is greatly reduced, resulting
in compromised nutritional status and increased risk for diseases of almost
every organ system. In fact, the word “celiac” comes from
the Greek word “Koiliakos,” which means “abdomen”
or “hollow” and refers to the way an individual with celiac
disease can eat but remain malnourished when gluten is present in the diet.
Although most experts agree that individuals with certain genes can get
celiac disease at some point in their lives (see discussion about HLA
DQ2 and DQ8 below), it is not yet understood what triggers the onset of
the disease or when it actually happens. Some research suggests the following
may have an effect: early introduction of gluten-containing foods to a
baby’s diet, puberty, the stress of surgery, illness or pregnancy,
or a stressful occurrence in one’s life. Presently, there is
cure for the 1 in 133 individuals who are believed to have celiac disease in
the United States, and the only known
treatment is lifelong adherence to a gluten free diet.
At the Kogan Celiac Center, we are committed to early diagnosis and a comprehensive,
multidisciplinary approach to treating and managing this disease for our
adult and pediatric patients.
This is an itchy, blistering skin condition that is associated with celiac
disease. It is commonly found bilaterally on the buttocks, knees, elbows,
face and scalp. Individuals with the diagnosis of Dermatitis Herpetiformis
can also show similar damage to the small bowel and show positive response
to the gluten free diet.
HLA (Human Leukocyte Antigen) is a genetic marker or “flag”
that exists on the surface of each cell in our bodies. Its function is
to help the immune system distinguish between “self” cells
and “invader” cells. Individuals who have either HLA DQ2 or
HLA DQ8 markers are at risk for developing celiac disease and the presence
or absence of this genetic material can be useful information in diagnosing
Symptoms of celiac disease may include any of the following: diarrhea,
change in bowel habits, abdominal bloating, failure to thrive, delayed
weight gain and/or growth retardation, skin rash, discolored teeth, depression,
irritability, fatigue, anemia, missed menstrual periods or joint pain.
Some conditions associated with untreated celiac disease are osteoporosis,
Vitamin K deficiency, intestinal lymphoma, dental enamel defects, infertility
and/or miscarriage and general malnutrition.
Initially, a blood test is ordered to determine if antibodies against gluten
are being produced. High levels of antibodies show increased immune reaction
and a strong likelihood for celiac disease. This suspicion is confirmed
by examining the villi via a small bowel biopsy - a short, minimally invasive
procedure usually done on an out-patient basis.
The Kogan Celiac Center follows a strict protocol to measure the specific
antibodies that are markers for celiac disease. Of the most sensitive
and specific tests, IgA tissue transglutaminase (tTG) antibody testing
is ordered, or IgG tissue transglutaminase antibody testing when individuals
are deficient in IgA responses. Screenings that use these tests are hosted
frequently by the Kogan Celiac Center.
No, a skin biopsy is used to diagnose this skin condition.
Celiac disease is characterized by an autoimmune reaction to gluten in
genetically susceptible individuals that results in intestinal damage
and malnutrition that can affect any organ system in the body. The only
known treatment for celiac disease is a very strict, lifelong compliance
with a gluten free diet. Gluten intolerance, for the most part, results
in GI distress in individuals who consume gluten, without autoimmune or
malabsorption results. It is not known yet if there is any genetic marker
for this intolerance and, while treatment for this condition is also a
gluten free diet, small amounts of gluten may be tolerated without causing
damage to the small intestine.
No! When gluten is eliminated from the diet, the villi heal and the results
of a biopsy will not be accurate or reliable. Individuals are advised
to wait until they have been positively diagnosed with celiac disease
before going on a gluten free diet.
Yes. Evidence suggests that first-degree relatives (parents, siblings,
and children) have an elevated risk for celiac disease, as do second-degree
relatives (grandparents, grandchildren, aunts, uncles, cousins) to a lesser
extent. The Kogan Celiac Center recommends screening serology for these
Gluten is a general term for certain proteins that are found in wheat,
barley and rye and are responsible for triggering the autoimmune reaction
that is the hallmark of celiac disease. There is currently some controversy
about whether a similar protein found in oats causes a similar response.
Individuals who follow a gluten free diet eliminate gluten and all derivatives
of it from the food that they consume.
Grains that are NOT acceptable on the gluten free diet are: wheat (otherwise
known as enkorn, durum, faro, graham, kamut, semolina, spelt), rye, barley,
and triticale (a cross between wheat and rye). Obvious places for the
above grains are breads, pastas, and baked goods but processed foods can
also contain other hidden sources of gluten.
There are many grains and other sources of starch that are acceptable for
anyone following a gluten free diet. The most common are corn, potatoes,
rice and tapioca (sometimes called cassava). Other acceptable grains and
sources of starch are: amaranth, arrowroot, buckwheat, millet, quinoa,
sorghum (sometimes called jowar), sweet potato, taro, teff, and yam. Sometimes
flour is made from beans, legumes and nuts.
The Kogan Celiac Center is committed to providing expert nutritional education
to help individuals manage the gluten free diet and accompanying lifestyle changes.
At present, there is no treatment for celiac disease other than strict,
lifelong adherence to a gluten free diet. Exposure to even a small amount
of gluten will cause damage to the small intestine... you cannot “grow
out of” this disease! Over the course of time, intentional or non-intentional
ingestion of gluten increases risk for many diseases including but not
limited to lymphoma, osteoporosis and many other complications of malnutrition.
The Kogan Celiac Center offers comprehensive testing and treatment for
adults and children with celiac disease. The Center is dedicated to providing
expert early assessment, diagnosis, treatment, education and support to
improve the health and well being of those who have this disease.
The Center is located at the Barnabas Health Ambulatory Care Center, Suite
111, 200 South Orange Avenue, Livingston, New Jersey. For further information,
you may call us at (973) 322-7272.
The Center offers nutritional counseling, periodic screenings, and community-based
education events and provides comprehensive information regarding System
Our nutritional education program, Celiac Steps to Success, divides the
process of learning how to eat and live gluten free into easy, manageable
steps. Patients meet with a Registered Dietitian at regular intervals
and learn how to implement changes that meet dietary guidelines and address
lifestyle needs. This sequence typically runs over a 6 month period, after
which annual follow up visits are recommended.
Many national support organizations have local chapters which host regular
support group meetings. The Kogan Celiac Center also hosts monthly support
groups for adults, teens and children. Please call the Center for more details.
As of January 1, 2006, the Food Allergen Labeling and Consumer Protection
Act requires manufacturers to provide certain information about the ingredients
they use to make their products. They must specify in plain English any
ingredient that contains protein from any of the eight major food allergens:
milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, or
soybeans. Consequently, an individual with Celiac Disease can know very
quickly whether a product contains wheat; note, however, that there is
no current requirement for barley and rye to be mentioned on a product’s label.
This law also required the FDA to further examine gluten as an ingredient
of concern and to make a final ruling regarding the use of the term “gluten
free” on food labels by no later than August 2008. The final ruling
is expected to define “gluten free” as meaning that a product
must have less than a predetermined amount of gluten in it, usually measured
in parts-per-million. Check here for up-to-date information as this law
and the regulation of gluten labeling evolves.
It is currently believed that the gluten protein is too heavy to be transferred
to food or drink during the distillation process. So, distilled alcohol
is considered safe for those following a gluten free diet as long as no
additional colorings or flavorings are added. However, traditional beer
and other malt beverages are made with barley and are not gluten free
– explore online to find gluten free beer that has been developed
in past years.