This was actually the one talk that I was able to listen to during the whole conference (aside from Fasano’s at the banquet). Dr. Pietzak’s talk was entitled “Life Lessons from Celiac Pediatrics” and followed along the lines of the book All I Really Need to Know I Learned in Kindergarten.
What was the first word you learned in kindergarten? Look. Look for Celiac Disease in its gastrointestinal forms (symptoms): diarrhea, nausea, vomiting, abdominal discomfort, gas, bloating, constipation, change in appetite; and extra-intestinal forms: short stature, osteoporosis, DH, delayed puberty, infertility (in both males and females), anemia, behavioral changes, seizures. Look for systemic complications like night blindness, low bone density, liver inflammation, skin rashes, kidney disease, infertility, and arthritis and joint pain. Iron deficiency anemia resistant to oral iron is the most common non-gi symptom in adults (according to some studies) and is often the first symptom. So look for the symptoms of iron deficiency anemia. She also said we should look for dental enamel defects, recurrent aphthous ulcers (in the mouth), other skin problems such as hair loss, and neurologic symptoms like ataxia, peripheral neuropathy, psychiatric symptoms (depression, schizophrenia), and seizures and intracranial calcifications.
Flush. Sometimes both kids and adults with Celiac Disease get constipated. Often this is because we get stuck eating mostly starches, and are foods are not enriched. Treatment of constipation can include nuts, seeds, legumes, gf whole grains, fresh fruits (eat the skins!), fresh veggies (raw is better), psyllium seed (like Metamucil). Remember to intake your fiber gradually, as a high fiber diet could cause GI upset. Also, popcorn and crunchy peanut butter are two good ways to get fiber, especially in reluctant children. Exercise and lots and lots of water are also very important to treat (and prevent) constipation.
Warm cookies and cold milk are good for you. Celiac patients should worry more about osteoporosis than things like cancer. 5% to 34% of celiac patients have low bone mass, and they have 3.5 times greater risk of fracture than people without celiac disease. Sometimes it can be hard to get enough calcium and vitamin D, especially since 20-40% of celiacs have lactose intolerance, but it is important to substitute and/or supplement to get enough calcium and vitamin D.