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  1. Celiac.com 06/21/2016 - Transitioning from childhood to adulthood is hard, but doing it with celiac disease can be harder. Beginning in adolescence, people with celiac disease should assume full responsibility for their care. So how can a parent best help teens transition to full control over their celiac disease and gluten-free diet? According to the Prague Consensus Report, a few simple measures can help children to successfully manage caring for their conditions as they transition into teenagers and young adults. One of the study's authors is Dr. Steffen Husby of Hans Christian Andersen Children's Hospital, Odense University Hospital in Denmark. Get a Formal Diagnosis "We think it most important to stress that celiac disease is a definite disorder," Husby told Reuters Health. "We should make a regular diagnosis of celiac disease before putting kids on a gluten free diet." Consult a Doctor About Transition "We recommend close communication with the doctor when transitioning to adult care," said Dr. Husby. Ideally, teens with celiac disease should visit a clinic with pediatric and adult services that handles such transitions, the study authors write. Talk About the Transition Talk with a doctor about dietary adherence and consequences of non-adherence during transition. Consider asking your child's pediatrician to include a "transition document," which includes written information on the patient's diagnosis, follow-up, body composition data, other health conditions and dietary compliance. Know the Importance of Biopsy The authors also conclude that most teens and young adults do not need routine small intestine biopsies to reconfirm a childhood diagnosis of celiac disease, unless pediatric diagnostic criteria, like a blood test for gluten antibodies, were never fulfilled, according to the recommendations published online April 18 in the journal Gut. In most adolescents and young adults, routine small intestinal biopsy is not needed to reconfirm a childhood diagnosis of celiac disease, based on criteria set by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) or North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). However, biopsy may be advisable in patients who did not have biopsy at diagnosis, or when other pediatric diagnostic criteria are incomplete, if additional endomysium antibody test have not been performed to confirm 10-fold positivity of tissue transglutaminase antibodies, or in cases of asymptomatic children who may have been followed a no biopsy strategy to that point. Young people tend not to register risk for future health consequences, whether the risk is lung cancer as a result of smoking or osteoporosis as a result of eating gluten, says Dr. Patience White, co-director of Got Transition, the Center for Health Care Transition Improvement at the National Alliance to Advance Adolescent Health in Washington, D.C. "All youth…need a better transition," she added. These simple steps can help teens to manage their own celiac disease as they progress into adulthood. Source: Gut 2016.
  2. If you’ve been diagnosed with celiac disease, you probably know all about the painful and often uncomfortable physical and mental symptoms and are fortunate to be rid of them with a gluten-free diet. However, avoiding gluten doesn’t mean that your health and well-being are guaranteed, but fortunately you have taken a major step in preventing serious and potentially fatal complications of long-term, untreated celiac disease. There are a few side effects, you could say, associated with a gluten-free diet, but thankfully there are solutions to manage them as you adjust to your new lifestyle. First, it’s not uncommon to gain weight when you cut gluten out of your diet. Many celiac patients are thin and sickly-looking before their celiac diagnosis, as the damage caused to small intestine prevents the absorption of food. After being on a gluten-free diet for some time, when the intestines have begun to heal, the nutrients and calories in foods get absorbed better. Even though you may not be consuming any more calories now than in your gluten-eating days, it's likely that you're going to gain some weight. In fact, studies have shown an increased risk for obesity for gluten-free dieters. However, some people actually lose weight, as the changes to your diet may cause a decrease in caloric intake. Watching your caloric intake and regular exercise can help deal with any weight gain you may experience. Patients who are newly diagnosed with celiac disease often find that they have nutritional deficiencies, and what’s worse, gluten-free products are often low in B vitamins, calcium, vitamin D, iron, zinc, magnesium, and fiber and aren’t fortified in these nutrients. When Swedish researchers studied adult celiac patients who had been gluten-free for ten years, they found that half of them had vitamin deficiencies, including low levels of vitamin B-6 or folate, or both, and high levels of homocysteine, a risk factor for heart attacks, vascular disease, and strokes. Before the study, all the patients had biopsies to prove their intestines were in healthy condition, so these vitamin deficiencies could not be explained by malabsorption. Italian researchers have found similar deficiencies in gluten-free adolescents. I recommend that at your annual check-up, you should ask your doctor whether your vitamin status needs to be measured and whether you should be taking folic acid and vitamin supplements. Another thing to watch out for is increased cholesterol levels. For the first part of my life, when I was eating gluten-containing foods, doctors were amazed by my low cholesterol levels. The reason for this was that my intestines weren’t absorbing the cholesterol in my food. Now I need to pay attention to my cholesterol levels just like other people. This means checking food nutrition labels for not only gluten but also fat and cholesterol content, selecting low-fat, low- low-cholesterol foods. Watch out for packaged gluten-free products, which often have more fat than the gluten-containing foods they substitute, especially gluten-free cookies, crackers, and cakes. The American Heart Association recommends eating high-fiber foods to help lower cholesterol. Other side effects of a gluten-free diet include constipation, gassiness, and diarrhea. When you replace the bread and pasta in your diet with only processed white rice, you reduce the fiber in your diet, which may cause constipation. On the other hand, adding foods rich in fiber, such as quinoa, in large amounts and too quickly, can cause gassiness and diarrhea. I was diagnosed with celiac disease many years ago, and since then I have adopted a healthy, gluten-free lifestyle. This was initially quite a challenge, but now I’m reaping the benefits of this new way of life. As a celiac advocate I stay connected to the celiac community and keep abreast of the latest research. This is the first and fundamental step I recommend to celiac patients as they adjust to and manage their gluten-free diet—stay informed.
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