WEBVTT 00:00:00.000 --> 00:00:00.500 align:middle line:90% 00:00:00.500 --> 00:00:02.630 align:middle line:84% Celiac disease is an autoimmune disease 00:00:02.630 --> 00:00:04.820 align:middle line:84% that means people who have it and eat gluten 00:00:04.820 --> 00:00:06.800 align:middle line:84% will damage their small intestine. 00:00:06.800 --> 00:00:09.860 align:middle line:84% And when people eat things like wheat, rye, or barley, 00:00:09.860 --> 00:00:11.630 align:middle line:84% their body reacts, and that reaction 00:00:11.630 --> 00:00:13.610 align:middle line:84% is harmful to their small intestine. 00:00:13.610 --> 00:00:16.070 align:middle line:84% Millions of people are impacted by celiac disease. 00:00:16.070 --> 00:00:18.350 align:middle line:84% Do you or a loved one have celiac, 00:00:18.350 --> 00:00:19.820 align:middle line:90% and how can you deal with it? 00:00:19.820 --> 00:00:22.446 align:middle line:84% It's coming up right now on At the Forefront Live. 00:00:22.446 --> 00:00:26.910 align:middle line:10% [MUSIC PLAYING] 00:00:26.910 --> 00:00:36.850 align:middle line:90% 00:00:36.850 --> 00:00:39.220 align:middle line:10% Today on At the Forefront Live, physician Ritu Verma 00:00:39.220 --> 00:00:43.455 align:middle line:10% and dietitian Macy Mears joins us to discuss celiac. 00:00:43.455 --> 00:00:45.580 align:middle line:10% And remember, you can ask questions of our experts, 00:00:45.580 --> 00:00:48.280 align:middle line:10% so make sure you start typing in the comments section 00:00:48.280 --> 00:00:50.120 align:middle line:10% at the bottom of the screen. 00:00:50.120 --> 00:00:52.537 align:middle line:10% And our final reminder is the program 00:00:52.537 --> 00:00:54.370 align:middle line:10% is not designed to take the place of a visit 00:00:54.370 --> 00:00:55.660 align:middle line:10% with your physician. 00:00:55.660 --> 00:00:58.360 align:middle line:10% So for serious things, go see your doctor, 00:00:58.360 --> 00:01:00.970 align:middle line:10% but ask lots of questions today because we've 00:01:00.970 --> 00:01:02.320 align:middle line:10% got some great experts on. 00:01:02.320 --> 00:01:04.180 align:middle line:10% Thank you for being on the program. 00:01:04.180 --> 00:01:04.780 align:middle line:10% Thank you. 00:01:04.780 --> 00:01:05.620 align:middle line:10% Appreciate you being here, and we'll just 00:01:05.620 --> 00:01:08.410 align:middle line:10% start off with kind of the basics and if you can describe 00:01:08.410 --> 00:01:11.320 align:middle line:10% to us what celiac disease. 00:01:11.320 --> 00:01:14.500 align:middle line:10% So celiac disease is an autoimmune disease, 00:01:14.500 --> 00:01:16.960 align:middle line:10% contrary to what people think that it's an allergy, 00:01:16.960 --> 00:01:18.820 align:middle line:10% but it truly is an autoimmune disease, 00:01:18.820 --> 00:01:23.080 align:middle line:10% just like someone has multiple sclerosis or type one diabetes, 00:01:23.080 --> 00:01:25.930 align:middle line:10% and there's also a genetic component to that. 00:01:25.930 --> 00:01:28.450 align:middle line:10% So based on the genes, it's an autoimmune disease, 00:01:28.450 --> 00:01:30.520 align:middle line:10% and it occurs in people who then will 00:01:30.520 --> 00:01:34.960 align:middle line:10% eat gluten, which then causes damage to your small intestine. 00:01:34.960 --> 00:01:37.330 align:middle line:10% And when you say damage to the small intestine, what 00:01:37.330 --> 00:01:38.960 align:middle line:10% does it do? 00:01:38.960 --> 00:01:41.710 align:middle line:10% So the small intestine, even though it's 00:01:41.710 --> 00:01:44.050 align:middle line:10% called small intestine, is really a long organ, 00:01:44.050 --> 00:01:47.440 align:middle line:10% but it has these surfaces on the inside which 00:01:47.440 --> 00:01:49.640 align:middle line:10% have these things called villi. 00:01:49.640 --> 00:01:53.710 align:middle line:84% They're finger-like projections that help absorb nutrition. 00:01:53.710 --> 00:01:55.450 align:middle line:84% And what happens with celiac disease 00:01:55.450 --> 00:01:59.230 align:middle line:84% is the gluten then causes damage to the lining of these cells, 00:01:59.230 --> 00:02:02.110 align:middle line:84% to the villi, and the villi sort of shrivel up. 00:02:02.110 --> 00:02:04.180 align:middle line:84% Depending on how severe the disease is, 00:02:04.180 --> 00:02:07.390 align:middle line:84% this is mild shriveling to total flattening 00:02:07.390 --> 00:02:10.270 align:middle line:84% of the small intestine, and that hinders 00:02:10.270 --> 00:02:12.270 align:middle line:90% the absorption of nutrition. 00:02:12.270 --> 00:02:14.520 align:middle line:84% And then the second part that happens with the disease 00:02:14.520 --> 00:02:16.960 align:middle line:84% is there is the intestinal part, and then the second 00:02:16.960 --> 00:02:19.990 align:middle line:84% is it can cause other autoimmune diseases. 00:02:19.990 --> 00:02:22.940 align:middle line:84% And that's why it's more a genetic autoimmune disease. 00:02:22.940 --> 00:02:24.700 align:middle line:10% So it can be a pretty serious situation 00:02:24.700 --> 00:02:26.860 align:middle line:10% for people who suffer from it. 00:02:26.860 --> 00:02:27.580 align:middle line:10% Absolutely. 00:02:27.580 --> 00:02:30.970 align:middle line:10% If it's not treated, not recognized in time, 00:02:30.970 --> 00:02:33.710 align:middle line:10% yes, it can cause a lot of complications. 00:02:33.710 --> 00:02:35.230 align:middle line:10% Now it's interesting. 00:02:35.230 --> 00:02:36.700 align:middle line:10% When we talk about celiac disease, 00:02:36.700 --> 00:02:38.800 align:middle line:10% I think there's a lot of common misconceptions. 00:02:38.800 --> 00:02:41.800 align:middle line:10% And Macy, I'm glad you're here today because as a dietitian, 00:02:41.800 --> 00:02:44.620 align:middle line:10% you're a very important part of the team working 00:02:44.620 --> 00:02:46.510 align:middle line:10% with folks who have celiac. 00:02:46.510 --> 00:02:48.790 align:middle line:10% When do you come into the equation? 00:02:48.790 --> 00:02:52.090 align:middle line:10% So it's usually when there's a known diagnosis. 00:02:52.090 --> 00:02:54.670 align:middle line:10% And at least for our clinic it works 00:02:54.670 --> 00:02:56.170 align:middle line:10% when the diagnosis is known. 00:02:56.170 --> 00:02:58.870 align:middle line:10% Then you make an appointment with the physician 00:02:58.870 --> 00:03:02.230 align:middle line:10% and automatically also see me because it is so food based, 00:03:02.230 --> 00:03:04.810 align:middle line:10% and our treatment right now is a gluten-free diet. 00:03:04.810 --> 00:03:06.340 align:middle line:10% So yes, I am very involved. 00:03:06.340 --> 00:03:07.840 align:middle line:10% And it's really important for people 00:03:07.840 --> 00:03:10.210 align:middle line:10% to remember that part of the team here, 00:03:10.210 --> 00:03:11.860 align:middle line:10% a very important part of the team 00:03:11.860 --> 00:03:15.790 align:middle line:10% is the dietitian since it is a diet-related disease. 00:03:15.790 --> 00:03:17.710 align:middle line:10% Well, and that's interesting, and I 00:03:17.710 --> 00:03:19.750 align:middle line:10% think it certainly bears repeating 00:03:19.750 --> 00:03:22.450 align:middle line:10% because one of the things we do here at UChicago Medicine, 00:03:22.450 --> 00:03:25.210 align:middle line:10% we believe in the team-based approach, and you two 00:03:25.210 --> 00:03:27.460 align:middle line:10% are a perfect example of that. 00:03:27.460 --> 00:03:30.970 align:middle line:10% And that's really critical to the correct care 00:03:30.970 --> 00:03:33.190 align:middle line:10% of our patients. 00:03:33.190 --> 00:03:33.880 align:middle line:10% Absolutely. 00:03:33.880 --> 00:03:37.840 align:middle line:10% I think that one of the most important things that we can do 00:03:37.840 --> 00:03:42.550 align:middle line:10% is to have patients come in, see the physicians, 00:03:42.550 --> 00:03:43.960 align:middle line:10% see the dietitian. 00:03:43.960 --> 00:03:46.300 align:middle line:84% In some conditions we also need a psychologist. 00:03:46.300 --> 00:03:49.060 align:middle line:10% And the other beauty of being here at the University 00:03:49.060 --> 00:03:51.220 align:middle line:10% of Chicago is that as you get older, 00:03:51.220 --> 00:03:54.280 align:middle line:10% you have a transition that you can actually go and see 00:03:54.280 --> 00:03:58.330 align:middle line:10% an adult gastroenterologist as well and an adult dietitian. 00:03:58.330 --> 00:04:00.700 align:middle line:10% It goes across the continuum from pediatrics 00:04:00.700 --> 00:04:03.760 align:middle line:10% to adult being here at the University of Chicago. 00:04:03.760 --> 00:04:06.670 align:middle line:10% So as we talk about pediatrics, when 00:04:06.670 --> 00:04:11.410 align:middle line:10% do we commonly see children first diagnosed with celiac? 00:04:11.410 --> 00:04:13.180 align:middle line:10% Is it something that starts right away, 00:04:13.180 --> 00:04:16.180 align:middle line:10% or is it something that happens a little later in life? 00:04:16.180 --> 00:04:19.899 align:middle line:10% So usually a child has to start eating gluten, 00:04:19.899 --> 00:04:23.560 align:middle line:10% and so it usually occurs somewhere between 1 and 1/2, 2, 00:04:23.560 --> 00:04:27.040 align:middle line:10% depending on the eating habits in a particular family. 00:04:27.040 --> 00:04:28.630 align:middle line:10% You would say we probably see most 00:04:28.630 --> 00:04:31.660 align:middle line:10% of the children between two, three and older. 00:04:31.660 --> 00:04:34.180 align:middle line:10% And then it really can be at any age. 00:04:34.180 --> 00:04:38.020 align:middle line:10% You can have a teenager be diagnosed with celiac disease 00:04:38.020 --> 00:04:38.840 align:middle line:10% for the first time. 00:04:38.840 --> 00:04:41.290 align:middle line:10% You can have an adult diagnosed with the disease 00:04:41.290 --> 00:04:43.390 align:middle line:10% for the first time as well. 00:04:43.390 --> 00:04:45.460 align:middle line:10% And when you're dealing with these kids, Macy, 00:04:45.460 --> 00:04:47.620 align:middle line:10% I imagine it's probably challenging, particularly 00:04:47.620 --> 00:04:52.540 align:middle line:10% the younger children, to even have them understand that they 00:04:52.540 --> 00:04:54.640 align:middle line:10% have to change lifestyle. 00:04:54.640 --> 00:04:57.050 align:middle line:10% Of course mom and dad are a critical part of that, 00:04:57.050 --> 00:04:58.150 align:middle line:10% but how do you do that? 00:04:58.150 --> 00:05:01.870 align:middle line:10% Yeah, that is a really good point just working with peds 00:05:01.870 --> 00:05:04.150 align:middle line:10% because each patient is different anyway. 00:05:04.150 --> 00:05:06.370 align:middle line:84% But also-- I know this is something we do-- 00:05:06.370 --> 00:05:07.960 align:middle line:84% you have to kind of channel yourselves 00:05:07.960 --> 00:05:11.500 align:middle line:84% to be like, OK, what will make this child change 00:05:11.500 --> 00:05:13.690 align:middle line:84% or realize that it's important to be 00:05:13.690 --> 00:05:18.370 align:middle line:84% the different kid at school or have to have a different snack? 00:05:18.370 --> 00:05:19.930 align:middle line:10% So I think just talking through it 00:05:19.930 --> 00:05:22.000 align:middle line:10% and really getting the whole family involved-- 00:05:22.000 --> 00:05:25.480 align:middle line:10% so patient centered but very family focused 00:05:25.480 --> 00:05:28.100 align:middle line:10% helps because then it does go along that continuum 00:05:28.100 --> 00:05:31.240 align:middle line:10% as they keep growing and understanding more. 00:05:31.240 --> 00:05:33.220 align:middle line:10% It seems like we see a lot in the news 00:05:33.220 --> 00:05:36.150 align:middle line:10% and read a lot online about celiac disease, 00:05:36.150 --> 00:05:38.880 align:middle line:10% and we're hearing more and more about gluten-free diets. 00:05:38.880 --> 00:05:41.370 align:middle line:10% How common is this today? 00:05:41.370 --> 00:05:47.670 align:middle line:10% So celiac disease, it's about 1% of the population. 00:05:47.670 --> 00:05:50.130 align:middle line:10% In some populations you see 1 in 80. 00:05:50.130 --> 00:05:53.490 align:middle line:84% In some areas, it's a prevalence of 1 to 100. 00:05:53.490 --> 00:05:55.770 align:middle line:84% However, I think there's a lot of people 00:05:55.770 --> 00:05:58.680 align:middle line:84% who don't have celiac disease but are 00:05:58.680 --> 00:06:00.090 align:middle line:90% on the gluten-free diet. 00:06:00.090 --> 00:06:01.920 align:middle line:84% And the other things to think about 00:06:01.920 --> 00:06:06.180 align:middle line:84% is if you have an allergy to gluten, any part of the gluten. 00:06:06.180 --> 00:06:08.640 align:middle line:84% And gluten, of course, is wheat, rye, and barley, 00:06:08.640 --> 00:06:12.900 align:middle line:84% so you could have an allergy to one of these products. 00:06:12.900 --> 00:06:16.420 align:middle line:84% And then there is, of course, nonceliac gluten sensitivity. 00:06:16.420 --> 00:06:18.990 align:middle line:84% So it's very important for everyone 00:06:18.990 --> 00:06:21.930 align:middle line:84% to understand that each disease, each condition 00:06:21.930 --> 00:06:25.260 align:middle line:84% here needs to be diagnosed in a different way 00:06:25.260 --> 00:06:26.790 align:middle line:84% and dealt with in a different way. 00:06:26.790 --> 00:06:30.000 align:middle line:84% So for celiac disease, it's an autoimmune disease 00:06:30.000 --> 00:06:33.120 align:middle line:84% where you have a blood test that's abnormal. 00:06:33.120 --> 00:06:35.940 align:middle line:84% You have an endoscopy that's abnormal. 00:06:35.940 --> 00:06:38.010 align:middle line:84% You may or may not have all the symptoms, 00:06:38.010 --> 00:06:40.650 align:middle line:84% but it needs to be addressed in that way, 00:06:40.650 --> 00:06:45.030 align:middle line:84% and you have to be 120% gluten free, if I may say so. 00:06:45.030 --> 00:06:47.280 align:middle line:84% And then in nonceliac gluten sensitivity, 00:06:47.280 --> 00:06:50.040 align:middle line:84% those blood tests are usually normal. 00:06:50.040 --> 00:06:52.470 align:middle line:84% If you have an endoscopy with a biopsy done, 00:06:52.470 --> 00:06:55.080 align:middle line:84% those are usually normal, but you 00:06:55.080 --> 00:06:58.980 align:middle line:84% have a lot of symptoms that improve on a gluten-free diet. 00:06:58.980 --> 00:07:00.540 align:middle line:84% But it's really important for people 00:07:00.540 --> 00:07:03.330 align:middle line:84% to understand that is it really taking out 00:07:03.330 --> 00:07:06.030 align:middle line:84% the gluten that's helping or is it something else? 00:07:06.030 --> 00:07:08.460 align:middle line:84% So making that diagnosis, seeing someone 00:07:08.460 --> 00:07:10.980 align:middle line:84% who is a specialist in gluten-related disorders 00:07:10.980 --> 00:07:13.350 align:middle line:84% is extremely important before going off 00:07:13.350 --> 00:07:14.340 align:middle line:90% on a gluten-free diet. 00:07:14.340 --> 00:07:16.860 align:middle line:90% 00:07:16.860 --> 00:07:19.350 align:middle line:10% I think that's a fantastic point because, again, I 00:07:19.350 --> 00:07:21.480 align:middle line:10% think a lot of people try to self-diagnose. 00:07:21.480 --> 00:07:23.820 align:middle line:10% They want to read something online, 00:07:23.820 --> 00:07:26.370 align:middle line:10% or you mentioned even before the show, 00:07:26.370 --> 00:07:29.580 align:middle line:10% they may have a relative that has celiac, 00:07:29.580 --> 00:07:33.270 align:middle line:10% so they think that some of the symptoms match. 00:07:33.270 --> 00:07:36.750 align:middle line:10% If you have any inkling that you might have a situation, 00:07:36.750 --> 00:07:38.310 align:middle line:10% you really need to see a doctor. 00:07:38.310 --> 00:07:40.890 align:middle line:10% And again, that has to be followed up, 00:07:40.890 --> 00:07:45.420 align:middle line:10% with depending on the diagnosis, a visit with the dietitian 00:07:45.420 --> 00:07:49.830 align:middle line:10% because there is a whole treatment that 00:07:49.830 --> 00:07:53.610 align:middle line:10% can be put around that child or that person. 00:07:53.610 --> 00:07:54.990 align:middle line:10% So very important. 00:07:54.990 --> 00:07:57.190 align:middle line:10% We're getting some questions in online already. 00:07:57.190 --> 00:07:59.760 align:middle line:10% The first one is how are we going to get nationwide schools 00:07:59.760 --> 00:08:01.470 align:middle line:10% to take celiac more seriously? 00:08:01.470 --> 00:08:03.553 align:middle line:10% And even with the government's awareness, efforts, 00:08:03.553 --> 00:08:05.845 align:middle line:10% it still hasn't brought enough attention and awareness. 00:08:05.845 --> 00:08:08.400 align:middle line:10% And that's a difficult question for either one of you 00:08:08.400 --> 00:08:11.130 align:middle line:10% to answer, but I think it's a valid concern 00:08:11.130 --> 00:08:15.100 align:middle line:10% that parents might have if they have a child that has celiac. 00:08:15.100 --> 00:08:16.500 align:middle line:10% So I totally agree. 00:08:16.500 --> 00:08:20.850 align:middle line:10% It would be nice if the whole country would follow one rule, 00:08:20.850 --> 00:08:23.400 align:middle line:10% and it would be very nice. 00:08:23.400 --> 00:08:27.300 align:middle line:10% But I think the way to get to it is to start small, 00:08:27.300 --> 00:08:28.860 align:middle line:10% and it really has started. 00:08:28.860 --> 00:08:33.090 align:middle line:10% So each community, each group, work with us. 00:08:33.090 --> 00:08:35.100 align:middle line:10% We work with our schools, and Macy will go 00:08:35.100 --> 00:08:36.750 align:middle line:10% through a little bit with that. 00:08:36.750 --> 00:08:38.850 align:middle line:10% So we work with each individual, if you 00:08:38.850 --> 00:08:42.059 align:middle line:10% want to call, county or state and then spread it 00:08:42.059 --> 00:08:43.080 align:middle line:10% to the other states. 00:08:43.080 --> 00:08:47.430 align:middle line:84% There are groups that are in the process currently 00:08:47.430 --> 00:08:49.590 align:middle line:84% that are getting together and coming up 00:08:49.590 --> 00:08:54.450 align:middle line:84% with national guidelines for the 504 and for schools and so on. 00:08:54.450 --> 00:08:57.468 align:middle line:84% So that's something that you will hear this year, 00:08:57.468 --> 00:08:59.760 align:middle line:84% but there are groups that are working through together. 00:08:59.760 --> 00:09:01.230 align:middle line:90% So don't lose hope. 00:09:01.230 --> 00:09:03.900 align:middle line:84% But for right now, we do have our own little thing 00:09:03.900 --> 00:09:05.880 align:middle line:90% that we do in each state itself. 00:09:05.880 --> 00:09:08.340 align:middle line:10% And Macy, of course, you know we do that, 00:09:08.340 --> 00:09:10.020 align:middle line:10% so if you want to talk a little bit. 00:09:10.020 --> 00:09:13.560 align:middle line:10% So when a family does come in-- of course especially working 00:09:13.560 --> 00:09:17.610 align:middle line:10% with peds, the child spends most of their time at school. 00:09:17.610 --> 00:09:18.450 align:middle line:10% So what do we do? 00:09:18.450 --> 00:09:21.540 align:middle line:10% How do we trust others to keep them safe? 00:09:21.540 --> 00:09:23.910 align:middle line:10% So a lot of the times it's setting up a 504 plan 00:09:23.910 --> 00:09:26.340 align:middle line:10% right away or getting documentation 00:09:26.340 --> 00:09:29.310 align:middle line:10% from your physician to make it very credible 00:09:29.310 --> 00:09:32.490 align:middle line:10% and something that the school has to take very seriously. 00:09:32.490 --> 00:09:34.500 align:middle line:10% So a lot of the times families choose 00:09:34.500 --> 00:09:37.770 align:middle line:10% to pack their children's lunch; and then 00:09:37.770 --> 00:09:41.550 align:middle line:10% also being aware of where the child sits; 00:09:41.550 --> 00:09:43.440 align:middle line:10% and, depending on the age, making sure 00:09:43.440 --> 00:09:45.840 align:middle line:10% that that child always washes their hands before 00:09:45.840 --> 00:09:47.980 align:middle line:10% and after; and just being very aware, 00:09:47.980 --> 00:09:50.190 align:middle line:10% don't ever share drinks with other kids 00:09:50.190 --> 00:09:54.930 align:middle line:10% or don't trade food or trade for different snacks; 00:09:54.930 --> 00:09:57.180 align:middle line:10% making sure that teachers and staff 00:09:57.180 --> 00:09:59.940 align:middle line:10% are aware of birthday parties and different events 00:09:59.940 --> 00:10:01.680 align:middle line:10% like that that go on. 00:10:01.680 --> 00:10:03.700 align:middle line:84% The child can't have that same food. 00:10:03.700 --> 00:10:06.390 align:middle line:10% But then also making sure that the parents send 00:10:06.390 --> 00:10:08.580 align:middle line:10% kind of like an emergency meal kit 00:10:08.580 --> 00:10:12.330 align:middle line:10% or an emergency kind of like a frozen TV dinner, 00:10:12.330 --> 00:10:14.940 align:middle line:10% I guess, to have in the nurse's office 00:10:14.940 --> 00:10:17.050 align:middle line:10% so that if something ever happens or a lunch is 00:10:17.050 --> 00:10:21.450 align:middle line:10% lost that that child always has something as well as different 00:10:21.450 --> 00:10:24.600 align:middle line:10% treats that then the child can have during those birthday 00:10:24.600 --> 00:10:26.730 align:middle line:10% parties or special events. 00:10:26.730 --> 00:10:29.550 align:middle line:10% I am curious, Macy, how seriously 00:10:29.550 --> 00:10:32.730 align:middle line:10% are schools taking this? 00:10:32.730 --> 00:10:35.540 align:middle line:10% Are they reacting well, in your opinion? 00:10:35.540 --> 00:10:41.530 align:middle line:10% I would yes when the parents bring it to them. 00:10:41.530 --> 00:10:44.440 align:middle line:84% So really focusing on having that meeting 00:10:44.440 --> 00:10:49.060 align:middle line:84% with the school staff, that 504 plan in place, doing everything 00:10:49.060 --> 00:10:52.090 align:middle line:84% they can to make sure that it's done. 00:10:52.090 --> 00:10:54.030 align:middle line:84% Generally speaking, I'm not sure. 00:10:54.030 --> 00:10:56.480 align:middle line:10% If it was never brought to their attention, 00:10:56.480 --> 00:10:58.120 align:middle line:10% I'm not sure how great it would be. 00:10:58.120 --> 00:10:58.620 align:middle line:10% Sure. 00:10:58.620 --> 00:11:00.150 align:middle line:10% I mean, it's new. 00:11:00.150 --> 00:11:02.650 align:middle line:10% And I think it's important for families 00:11:02.650 --> 00:11:06.970 align:middle line:10% to understand that the medical team, the clinical team 00:11:06.970 --> 00:11:08.810 align:middle line:10% is there to help you. 00:11:08.810 --> 00:11:13.090 align:middle line:10% So if you are facing some issues and concerns with school, 00:11:13.090 --> 00:11:14.080 align:middle line:10% get in touch with us. 00:11:14.080 --> 00:11:18.070 align:middle line:84% Let us help you as well so that we work together as a unit 00:11:18.070 --> 00:11:20.110 align:middle line:84% because what are the needs for one child 00:11:20.110 --> 00:11:22.450 align:middle line:84% may not be the same needs for another child. 00:11:22.450 --> 00:11:25.060 align:middle line:84% So in the school's defense, I think 00:11:25.060 --> 00:11:27.220 align:middle line:84% that we can give them general guidelines of what 00:11:27.220 --> 00:11:29.080 align:middle line:84% needs to happen, but if there is a child who 00:11:29.080 --> 00:11:31.570 align:middle line:84% has a specific need, then reach out to us. 00:11:31.570 --> 00:11:33.940 align:middle line:10% Reach out to your clinical team-- not necessarily 00:11:33.940 --> 00:11:37.450 align:middle line:10% us, but your clinical team so that they can assist you 00:11:37.450 --> 00:11:41.048 align:middle line:10% in getting your child the best experience at school. 00:11:41.048 --> 00:11:42.340 align:middle line:10% Another question from a viewer. 00:11:42.340 --> 00:11:45.250 align:middle line:10% How long after a diagnosis and the start of a gluten-free diet 00:11:45.250 --> 00:11:48.980 align:middle line:10% do you recommend retesting? 00:11:48.980 --> 00:11:51.160 align:middle line:10% So retesting, there are a couple of things. 00:11:51.160 --> 00:11:53.710 align:middle line:10% So one retesting is the blood test. 00:11:53.710 --> 00:11:58.150 align:middle line:84% So you don't necessarily need to retest for at least about six 00:11:58.150 --> 00:11:58.810 align:middle line:90% months or so. 00:11:58.810 --> 00:12:01.690 align:middle line:84% However, being a parent, especially 00:12:01.690 --> 00:12:05.110 align:middle line:84% in a child who does not have the classic symptoms-- 00:12:05.110 --> 00:12:07.630 align:middle line:84% as a parent, you want to know how well are you 00:12:07.630 --> 00:12:08.560 align:middle line:90% doing with the diet? 00:12:08.560 --> 00:12:10.020 align:middle line:90% So often parents want to know. 00:12:10.020 --> 00:12:11.770 align:middle line:84% The children want to know in three months. 00:12:11.770 --> 00:12:15.340 align:middle line:84% So is it OK to do a blood test, the serology, as it's 00:12:15.340 --> 00:12:17.050 align:middle line:84% called, the antibodies, in three months? 00:12:17.050 --> 00:12:20.260 align:middle line:84% It's fine, but six months is a good enough time 00:12:20.260 --> 00:12:21.040 align:middle line:90% to get those done. 00:12:21.040 --> 00:12:22.810 align:middle line:84% But sometimes all of us want report cards. 00:12:22.810 --> 00:12:24.270 align:middle line:90% Am I doing well or not? 00:12:24.270 --> 00:12:25.810 align:middle line:84% Am I sticking to the diet or not? 00:12:25.810 --> 00:12:28.520 align:middle line:84% So you could do anywhere from three to six months, 00:12:28.520 --> 00:12:31.450 align:middle line:84% and it's a blood test that's done to look at the antibodies. 00:12:31.450 --> 00:12:33.940 align:middle line:84% And you compare those test results 00:12:33.940 --> 00:12:37.330 align:middle line:84% to the test result that was done before the endoscopy. 00:12:37.330 --> 00:12:41.320 align:middle line:84% And you may not have it normal in six months, so don't panic. 00:12:41.320 --> 00:12:44.710 align:middle line:84% What you want to do is you want to see the numbers going down. 00:12:44.710 --> 00:12:46.210 align:middle line:90% So talk with your clinicians. 00:12:46.210 --> 00:12:47.470 align:middle line:90% Talk with your team. 00:12:47.470 --> 00:12:51.370 align:middle line:84% Ask them to show you the numbers before the endoscopy and after, 00:12:51.370 --> 00:12:53.890 align:middle line:84% and the numbers should be going down. 00:12:53.890 --> 00:12:54.640 align:middle line:10% Here's a question. 00:12:54.640 --> 00:12:56.890 align:middle line:10% How do I help my child feel better 00:12:56.890 --> 00:13:00.760 align:middle line:10% after she has been either cross contaminated or accidentally 00:13:00.760 --> 00:13:01.900 align:middle line:10% glutened? 00:13:01.900 --> 00:13:05.430 align:middle line:10% I think new use of the word, but if you've been glutened. 00:13:05.430 --> 00:13:08.960 align:middle line:10% So how do you deal with it? 00:13:08.960 --> 00:13:12.040 align:middle line:10% So are no medicines per se that will 00:13:12.040 --> 00:13:13.780 align:middle line:10% block the gluten at this time. 00:13:13.780 --> 00:13:15.280 align:middle line:10% There are medicines in the pipeline. 00:13:15.280 --> 00:13:17.140 align:middle line:10% However, what can you do? 00:13:17.140 --> 00:13:20.200 align:middle line:84% So it really depends on if a child is having abdominal pain, 00:13:20.200 --> 00:13:21.340 align:middle line:90% you can do some antacids. 00:13:21.340 --> 00:13:23.860 align:middle line:90% 00:13:23.860 --> 00:13:26.500 align:middle line:84% Lots of fluids is what you want to give. 00:13:26.500 --> 00:13:28.180 align:middle line:84% And whatever symptom they're having, 00:13:28.180 --> 00:13:31.060 align:middle line:84% you want to talk to your clinicians and see what 00:13:31.060 --> 00:13:32.050 align:middle line:90% medicines, if any. 00:13:32.050 --> 00:13:35.905 align:middle line:84% But usually once you've been glutened, if that's the word-- 00:13:35.905 --> 00:13:38.500 align:middle line:84% it depends on how big that gluten load is. 00:13:38.500 --> 00:13:41.500 align:middle line:84% Your symptoms may not be that bad. 00:13:41.500 --> 00:13:44.130 align:middle line:84% But then just based on whatever symptom you have, 00:13:44.130 --> 00:13:45.880 align:middle line:84% it just needs to be addressed, but fluids. 00:13:45.880 --> 00:13:47.530 align:middle line:90% Take a lot of fluids. 00:13:47.530 --> 00:13:50.320 align:middle line:10% And I don't know if this was assumed in the question 00:13:50.320 --> 00:13:53.050 align:middle line:10% but also making sure you try to target what that 00:13:53.050 --> 00:13:55.450 align:middle line:10% was so it doesn't happen again. 00:13:55.450 --> 00:13:56.410 align:middle line:10% Oh, absolutely. 00:13:56.410 --> 00:13:57.490 align:middle line:10% Absolutely, yes. 00:13:57.490 --> 00:14:00.370 align:middle line:10% So before we started the show-- speaking of which, Macy. 00:14:00.370 --> 00:14:02.028 align:middle line:10% Before we started the show, you had, 00:14:02.028 --> 00:14:03.820 align:middle line:10% I thought, some really interesting comments 00:14:03.820 --> 00:14:06.880 align:middle line:10% as far as just kind of how do you set up 00:14:06.880 --> 00:14:08.530 align:middle line:10% for success with your child? 00:14:08.530 --> 00:14:11.103 align:middle line:10% You mentioned even maybe keeping snacks in different parts 00:14:11.103 --> 00:14:12.520 align:middle line:10% of the house or something like it. 00:14:12.520 --> 00:14:13.720 align:middle line:10% Can you share some of these tips with us? 00:14:13.720 --> 00:14:14.620 align:middle line:10% Yeah. 00:14:14.620 --> 00:14:18.220 align:middle line:10% So that kind of goes on how the family 00:14:18.220 --> 00:14:19.360 align:middle line:10% is going to adjust to this. 00:14:19.360 --> 00:14:23.110 align:middle line:10% So we see it differently among all families and patients. 00:14:23.110 --> 00:14:26.230 align:middle line:10% Some choose to be totally gluten free in the home, which 00:14:26.230 --> 00:14:30.340 align:middle line:10% we don't necessarily advocate for if others 00:14:30.340 --> 00:14:32.260 align:middle line:10% don't have celiac disease, but sometimes it's 00:14:32.260 --> 00:14:33.790 align:middle line:10% easier to adjust. 00:14:33.790 --> 00:14:35.620 align:middle line:10% But if there are other kids in the family, 00:14:35.620 --> 00:14:37.600 align:middle line:10% sometimes it's a lot easier to have still 00:14:37.600 --> 00:14:41.800 align:middle line:10% those gluten-containing snacks or normal foods 00:14:41.800 --> 00:14:43.210 align:middle line:10% and have them packaged. 00:14:43.210 --> 00:14:45.910 align:middle line:10% Some families, like to leave them in the garage 00:14:45.910 --> 00:14:48.550 align:middle line:10% or in the entryway as the kids are 00:14:48.550 --> 00:14:51.670 align:middle line:10% leaving so that the other children that 00:14:51.670 --> 00:14:55.060 align:middle line:10% don't have celiac disease grab those on the way out. 00:14:55.060 --> 00:14:57.430 align:middle line:84% A lot of families do also choose to set up 00:14:57.430 --> 00:15:00.910 align:middle line:84% dual kitchens, so gluten-containing 00:15:00.910 --> 00:15:02.440 align:middle line:90% and gluten-free foods. 00:15:02.440 --> 00:15:06.110 align:middle line:84% But we always would recommend condiments are never shared. 00:15:06.110 --> 00:15:09.880 align:middle line:84% They're labeled or some set up different shelves 00:15:09.880 --> 00:15:11.620 align:middle line:84% in the refrigerator that the gluten 00:15:11.620 --> 00:15:16.960 align:middle line:84% shelf and the gluten-free shelf and different specific area 00:15:16.960 --> 00:15:19.510 align:middle line:84% in the kitchen for those gluten-free foods 00:15:19.510 --> 00:15:21.670 align:middle line:84% or where you slice bread, et cetera, 00:15:21.670 --> 00:15:23.623 align:middle line:90% if that is a dual kitchen. 00:15:23.623 --> 00:15:24.790 align:middle line:10% More questions from viewers. 00:15:24.790 --> 00:15:27.207 align:middle line:10% And these are great questions, so I want to get to as many 00:15:27.207 --> 00:15:28.640 align:middle line:10% as we possibly can. 00:15:28.640 --> 00:15:31.450 align:middle line:10% My son has just been diagnosed with celiac disease on Monday. 00:15:31.450 --> 00:15:34.120 align:middle line:10% We've decided to wait three weeks, which 00:15:34.120 --> 00:15:36.430 align:middle line:10% is the end of the school year, because we're terrified 00:15:36.430 --> 00:15:37.540 align:middle line:10% of cross contamination. 00:15:37.540 --> 00:15:39.910 align:middle line:10% In your opinion, should we slowly get rid of gluten 00:15:39.910 --> 00:15:44.110 align:middle line:10% or just stop eating gluten altogether cold turkey. 00:15:44.110 --> 00:15:46.780 align:middle line:10% And I think they're talking as a family. 00:15:46.780 --> 00:15:49.300 align:middle line:10% 00:15:49.300 --> 00:15:51.550 align:middle line:10% So for the family, we don't recommend that they 00:15:51.550 --> 00:15:52.840 align:middle line:10% go on a gluten-free diet. 00:15:52.840 --> 00:15:55.120 align:middle line:10% The family should not go on a gluten-free diet 00:15:55.120 --> 00:15:59.800 align:middle line:10% unless there's someone who has some gluten-related disease. 00:15:59.800 --> 00:16:04.330 align:middle line:10% The child, himself or herself, I don't 00:16:04.330 --> 00:16:07.480 align:middle line:10% think that one should be waiting if the diagnosis is there. 00:16:07.480 --> 00:16:08.530 align:middle line:10% It's a disease. 00:16:08.530 --> 00:16:10.120 align:middle line:10% If someone has diabetes, you're not 00:16:10.120 --> 00:16:12.370 align:middle line:10% going to wait for three weeks to start your insulin 00:16:12.370 --> 00:16:13.720 align:middle line:10% or anything like that. 00:16:13.720 --> 00:16:16.330 align:middle line:10% So it is a condition that one should not 00:16:16.330 --> 00:16:19.090 align:middle line:10% be waiting for the right moment because there will never 00:16:19.090 --> 00:16:20.290 align:middle line:10% be a right moment. 00:16:20.290 --> 00:16:22.510 align:middle line:10% I think it's important to meet with the team 00:16:22.510 --> 00:16:26.200 align:middle line:10% and let the team help you figure this out and work with you, 00:16:26.200 --> 00:16:28.510 align:middle line:10% hold your hand through this process. 00:16:28.510 --> 00:16:31.540 align:middle line:10% And again, Macy, that's kind of where 00:16:31.540 --> 00:16:35.428 align:middle line:10% you play a large role in arming these parents with knowledge 00:16:35.428 --> 00:16:36.970 align:middle line:10% as they send the kids back to school, 00:16:36.970 --> 00:16:38.920 align:middle line:10% and that's really, really critical. 00:16:38.920 --> 00:16:42.190 align:middle line:10% Yeah, and a lot of times when they do come and meet with us, 00:16:42.190 --> 00:16:45.220 align:middle line:10% they have taken the gluten out, but we're 00:16:45.220 --> 00:16:50.380 align:middle line:10% able to provide more tips and oh, I didn't realize this, 00:16:50.380 --> 00:16:51.370 align:middle line:10% or I could do this. 00:16:51.370 --> 00:16:53.295 align:middle line:90% This would make it much easier. 00:16:53.295 --> 00:16:55.420 align:middle line:84% So just like that viewer's question, cutting it out 00:16:55.420 --> 00:16:57.970 align:middle line:84% now, but it will be easier after meeting with the dietitian 00:16:57.970 --> 00:16:58.580 align:middle line:90% and your team. 00:16:58.580 --> 00:17:00.790 align:middle line:10% Another interesting viewer question. 00:17:00.790 --> 00:17:03.550 align:middle line:10% If a parent has been diagnosed with celiac, 00:17:03.550 --> 00:17:05.680 align:middle line:10% how often should the child be tested, 00:17:05.680 --> 00:17:07.329 align:middle line:10% or should the child be tested even? 00:17:07.329 --> 00:17:09.819 align:middle line:10% So as we said earlier, it's a genetic condition. 00:17:09.819 --> 00:17:12.490 align:middle line:10% So it's really important that the rest of the family 00:17:12.490 --> 00:17:13.819 align:middle line:10% be screened. 00:17:13.819 --> 00:17:17.650 align:middle line:10% So if a parent has the disease, then all the children-- 00:17:17.650 --> 00:17:20.920 align:middle line:10% and why not the spouse as well, for good measure. 00:17:20.920 --> 00:17:23.710 align:middle line:10% Maybe the spouse will end up with celiac disease too. 00:17:23.710 --> 00:17:26.902 align:middle line:10% But I think that all the children need to be tested, 00:17:26.902 --> 00:17:28.569 align:middle line:10% and there are blood tests that are done. 00:17:28.569 --> 00:17:31.420 align:middle line:10% There are different antibodies, and the information 00:17:31.420 --> 00:17:35.470 align:middle line:10% is available on our celiac center website as well. 00:17:35.470 --> 00:17:37.330 align:middle line:10% So the blood test needs to be done 00:17:37.330 --> 00:17:39.430 align:middle line:10% at the time of the diagnosis. 00:17:39.430 --> 00:17:42.160 align:middle line:10% In terms of how often, there really 00:17:42.160 --> 00:17:45.940 align:middle line:10% are not any strict guidelines, but we do 00:17:45.940 --> 00:17:49.250 align:middle line:10% know that just one-time screening is not enough. 00:17:49.250 --> 00:17:52.150 align:middle line:10% So what I usually do-- and there is no science behind it, 00:17:52.150 --> 00:17:55.690 align:middle line:10% but it's easy to remember-- is that if your child is tested 00:17:55.690 --> 00:17:57.510 align:middle line:10% today and they are negative and they 00:17:57.510 --> 00:17:59.500 align:middle line:10% are going to be eating gluten, then 00:17:59.500 --> 00:18:02.630 align:middle line:10% they should be tested every year until they reach puberty. 00:18:02.630 --> 00:18:05.410 align:middle line:10% This is my bias because then I can remember 00:18:05.410 --> 00:18:07.430 align:middle line:10% and parents can remember, OK, it's once a year. 00:18:07.430 --> 00:18:09.100 align:middle line:10% It was this December. 00:18:09.100 --> 00:18:11.740 align:middle line:10% It's kind of hard to remember every two years or whatever. 00:18:11.740 --> 00:18:14.560 align:middle line:10% Until puberty I say because celiac disease 00:18:14.560 --> 00:18:16.480 align:middle line:10% does affect growth, so you'd want 00:18:16.480 --> 00:18:18.423 align:middle line:10% to be tested on a regular basis. 00:18:18.423 --> 00:18:19.840 align:middle line:10% Obviously you'll get tested sooner 00:18:19.840 --> 00:18:21.452 align:middle line:10% if you have any symptoms. 00:18:21.452 --> 00:18:22.660 align:middle line:10% Another interesting question. 00:18:22.660 --> 00:18:25.120 align:middle line:10% My child is a freshman at college living and eating 00:18:25.120 --> 00:18:28.180 align:middle line:10% on campus, which I would imagine would be a challenge. 00:18:28.180 --> 00:18:30.730 align:middle line:10% Should we retest at the end of the semester? 00:18:30.730 --> 00:18:33.580 align:middle line:10% 00:18:33.580 --> 00:18:35.680 align:middle line:10% It's like doing a drug test, right? 00:18:35.680 --> 00:18:40.150 align:middle line:10% So I think not just at the end of semester. 00:18:40.150 --> 00:18:42.670 align:middle line:84% Once you go on a gluten-free diet, 00:18:42.670 --> 00:18:44.860 align:middle line:84% you obviously get tested on a routine basis 00:18:44.860 --> 00:18:45.760 align:middle line:90% three to six months. 00:18:45.760 --> 00:18:48.580 align:middle line:84% And once your panel is negative, then you 00:18:48.580 --> 00:18:51.880 align:middle line:84% need to be tested once a year if you have the disease. 00:18:51.880 --> 00:18:55.400 align:middle line:84% I think definitely test at the end of the semester, 00:18:55.400 --> 00:18:58.750 align:middle line:84% but more important is that the young person needs 00:18:58.750 --> 00:19:02.470 align:middle line:84% to be educated in terms of what does he or she need 00:19:02.470 --> 00:19:03.610 align:middle line:90% to do in college? 00:19:03.610 --> 00:19:05.890 align:middle line:84% And I think it's really important for that age group 00:19:05.890 --> 00:19:08.410 align:middle line:84% to come back and meet with the dietitians 00:19:08.410 --> 00:19:10.542 align:middle line:84% so that they are learning for themselves, 00:19:10.542 --> 00:19:12.750 align:middle line:84% not their parents telling them what needs to be done. 00:19:12.750 --> 00:19:16.720 align:middle line:10% Yeah, and very college- or university-specific things-- 00:19:16.720 --> 00:19:18.370 align:middle line:10% who to talk to, who to get to know, 00:19:18.370 --> 00:19:19.885 align:middle line:10% what meetings to set up as well. 00:19:19.885 --> 00:19:21.760 align:middle line:10% And I imagine there are probably even support 00:19:21.760 --> 00:19:23.300 align:middle line:10% groups on a lot of campuses. 00:19:23.300 --> 00:19:24.270 align:middle line:10% For sure. 00:19:24.270 --> 00:19:24.860 align:middle line:10% Yeah. 00:19:24.860 --> 00:19:25.360 align:middle line:10% It's funny. 00:19:25.360 --> 00:19:28.282 align:middle line:10% Once one of my patients was going off to college, 00:19:28.282 --> 00:19:30.240 align:middle line:10% and I said to her-- and she was feeling lonely. 00:19:30.240 --> 00:19:31.900 align:middle line:10% So I said to her, well, you know what? 00:19:31.900 --> 00:19:33.940 align:middle line:10% You send one of those e-blasts saying 00:19:33.940 --> 00:19:36.430 align:middle line:10% gluten-free pizza, my dorm and this time 00:19:36.430 --> 00:19:38.365 align:middle line:10% and see how many people show up. 00:19:38.365 --> 00:19:39.990 align:middle line:10% Your support group will be right there. 00:19:39.990 --> 00:19:40.700 align:middle line:10% There you go. 00:19:40.700 --> 00:19:42.135 align:middle line:10% You've created one right there. 00:19:42.135 --> 00:19:43.290 align:middle line:10% That's great. 00:19:43.290 --> 00:19:45.790 align:middle line:10% So Macy, this is a question for you from one of our viewers. 00:19:45.790 --> 00:19:47.920 align:middle line:10% How significant is the difference between a shared 00:19:47.920 --> 00:19:51.850 align:middle line:10% facility versus shared-equipment production process 00:19:51.850 --> 00:19:53.890 align:middle line:10% note on packaging, and how concerned 00:19:53.890 --> 00:19:56.380 align:middle line:10% should someone be with celiac disease 00:19:56.380 --> 00:19:57.753 align:middle line:10% about either of these flags? 00:19:57.753 --> 00:19:59.920 align:middle line:10% Yeah, that's something we really haven't hit on yet, 00:19:59.920 --> 00:20:03.160 align:middle line:10% but obviously nutrition-label reading and ingredients-label 00:20:03.160 --> 00:20:05.128 align:middle line:10% reading is super important for celiac disease-- 00:20:05.128 --> 00:20:06.670 align:middle line:10% And a little tricky, I would imagine. 00:20:06.670 --> 00:20:11.530 align:middle line:10% --and so much of a gray area, especially with this question. 00:20:11.530 --> 00:20:14.380 align:middle line:10% So you kind of have to go with what 00:20:14.380 --> 00:20:17.260 align:middle line:10% you know is the foundation of what has gluten in it. 00:20:17.260 --> 00:20:20.470 align:middle line:10% So always be looking for wheat, barley, rye, 00:20:20.470 --> 00:20:28.000 align:middle line:10% contaminated or not, labeled nongluten oats or malt. 00:20:28.000 --> 00:20:32.920 align:middle line:10% So if it's something like broccoli, frozen broccoli, 00:20:32.920 --> 00:20:35.840 align:middle line:10% and it's manufactured in a facility that 00:20:35.840 --> 00:20:37.730 align:middle line:10% may contain wheat, we typically say 00:20:37.730 --> 00:20:41.390 align:middle line:10% that's OK because it's a voluntary label that they're 00:20:41.390 --> 00:20:45.020 align:middle line:10% putting on there, and broccoli naturally does not have gluten, 00:20:45.020 --> 00:20:48.830 align:middle line:10% and you know that from all of your great education. 00:20:48.830 --> 00:20:50.960 align:middle line:84% But if it specifically lists something 00:20:50.960 --> 00:20:55.010 align:middle line:84% that is manufactured on the same line as wheat or barley 00:20:55.010 --> 00:20:56.380 align:middle line:90% or rye-- 00:20:56.380 --> 00:20:58.400 align:middle line:84% they will typically only list wheat-- 00:20:58.400 --> 00:20:59.960 align:middle line:84% then we would say stay away from that 00:20:59.960 --> 00:21:02.990 align:middle line:84% or try to find a different substitute. 00:21:02.990 --> 00:21:06.680 align:middle line:10% I think just the initial diagnosis when it's made, 00:21:06.680 --> 00:21:08.870 align:middle line:10% most of the people stay away from everything. 00:21:08.870 --> 00:21:10.730 align:middle line:10% But I think we all have to realize 00:21:10.730 --> 00:21:13.800 align:middle line:10% that we need our children to grow in this world. 00:21:13.800 --> 00:21:18.050 align:middle line:10% We all have to live here, and you cannot have so much anxiety 00:21:18.050 --> 00:21:20.360 align:middle line:10% put on them that is our anxiety. 00:21:20.360 --> 00:21:23.210 align:middle line:10% So I think there's a huge disease burden 00:21:23.210 --> 00:21:25.250 align:middle line:10% here, and so that's where it becomes 00:21:25.250 --> 00:21:26.765 align:middle line:10% important to have those questions 00:21:26.765 --> 00:21:28.160 align:middle line:10% and discuss with your team. 00:21:28.160 --> 00:21:29.810 align:middle line:10% And you talk about the disease burden, 00:21:29.810 --> 00:21:32.030 align:middle line:10% and that's, to me, an interesting point 00:21:32.030 --> 00:21:34.340 align:middle line:10% because we spoke just a little bit before the program 00:21:34.340 --> 00:21:37.040 align:middle line:10% about the psychological and financial burden 00:21:37.040 --> 00:21:41.710 align:middle line:10% that a disease like this will place upon a family. 00:21:41.710 --> 00:21:44.690 align:middle line:10% You mentioned some families set up dual kitchens. 00:21:44.690 --> 00:21:47.180 align:middle line:10% Well, that's not inexpensive to do. 00:21:47.180 --> 00:21:48.680 align:middle line:10% The psychological burden-- obviously 00:21:48.680 --> 00:21:50.690 align:middle line:10% if you have a young child going to school 00:21:50.690 --> 00:21:54.108 align:middle line:10% and there's a party for another child, 00:21:54.108 --> 00:21:55.650 align:middle line:10% you don't want them to feel left out. 00:21:55.650 --> 00:21:56.720 align:middle line:10% So these are hard things. 00:21:56.720 --> 00:21:59.630 align:middle line:10% And again, that's the benefit of your team, I think. 00:21:59.630 --> 00:22:03.080 align:middle line:10% You really help parents and the children work through this 00:22:03.080 --> 00:22:05.210 align:middle line:10% and deal with this. 00:22:05.210 --> 00:22:08.250 align:middle line:10% Absolutely, and I think that Macy does an excellent job 00:22:08.250 --> 00:22:11.210 align:middle line:10% with sitting down and talking to each family 00:22:11.210 --> 00:22:14.600 align:middle line:10% that is based on what they are going through. 00:22:14.600 --> 00:22:16.280 align:middle line:10% And that might change from year to year. 00:22:16.280 --> 00:22:16.780 align:middle line:10% Absolutely. 00:22:16.780 --> 00:22:19.940 align:middle line:10% The next year we see you, it's totally different barriers 00:22:19.940 --> 00:22:20.690 align:middle line:10% to overcome. 00:22:20.690 --> 00:22:21.830 align:middle line:10% I need to stop talking because we're 00:22:21.830 --> 00:22:22.760 align:middle line:10% getting so many questions. 00:22:22.760 --> 00:22:24.625 align:middle line:10% We're not going to keep up with them if I-- 00:22:24.625 --> 00:22:25.750 align:middle line:10% they don't want to hear me. 00:22:25.750 --> 00:22:28.160 align:middle line:10% So let me get to more of these questions. 00:22:28.160 --> 00:22:31.370 align:middle line:10% Would cross contamination make a child's TTG number 00:22:31.370 --> 00:22:33.360 align:middle line:10% be very high? 00:22:33.360 --> 00:22:36.982 align:middle line:10% So TTG is Tissue Transglutaminase Antibody, 00:22:36.982 --> 00:22:39.440 align:middle line:10% which is one of the antibodies that is checked on the blood 00:22:39.440 --> 00:22:41.630 align:middle line:10% test before the diagnosis. 00:22:41.630 --> 00:22:46.130 align:middle line:10% So it depends on how much cross contamination and how often. 00:22:46.130 --> 00:22:49.160 align:middle line:10% So if you're sitting in a room and there's 00:22:49.160 --> 00:22:52.160 align:middle line:10% someone next to you has eaten a sandwich and a little crumb 00:22:52.160 --> 00:22:55.400 align:middle line:10% falls on yours and you don't realize it 00:22:55.400 --> 00:22:58.160 align:middle line:10% and then you get the blood test done, it's going to be normal. 00:22:58.160 --> 00:23:01.770 align:middle line:10% One time a little crumb, the blood test will be normal. 00:23:01.770 --> 00:23:05.420 align:middle line:10% So it all depends on how often, how much. 00:23:05.420 --> 00:23:06.440 align:middle line:10% Interesting. 00:23:06.440 --> 00:23:08.280 align:middle line:10% My son was a 3-- 00:23:08.280 --> 00:23:10.220 align:middle line:10% is it a 3B on the Marsh chart? 00:23:10.220 --> 00:23:12.560 align:middle line:10% How long to heal? 00:23:12.560 --> 00:23:15.080 align:middle line:10% There is no specific answer. 00:23:15.080 --> 00:23:16.850 align:middle line:10% All that I can tell you is it can 00:23:16.850 --> 00:23:19.670 align:middle line:10% take anywhere from six months to two, 00:23:19.670 --> 00:23:22.250 align:middle line:10% three years for it to heal totally. 00:23:22.250 --> 00:23:25.400 align:middle line:10% However, the good news is that if someone stays with 00:23:25.400 --> 00:23:28.900 align:middle line:10% a gluten-free diet, almost everyone-- 00:23:28.900 --> 00:23:30.110 align:middle line:10% in pediatrics. 00:23:30.110 --> 00:23:31.700 align:middle line:10% In adults, it doesn't heal as much, 00:23:31.700 --> 00:23:33.530 align:middle line:10% but in pediatrics, almost everyone 00:23:33.530 --> 00:23:37.205 align:middle line:10% heals if you are absolutely gluten free. 00:23:37.205 --> 00:23:39.350 align:middle line:10% Though again, there's a lot of research happening 00:23:39.350 --> 00:23:41.280 align:middle line:10% to look at healing process. 00:23:41.280 --> 00:23:44.983 align:middle line:10% But how long it takes, it's hard to determine. 00:23:44.983 --> 00:23:46.400 align:middle line:10% Next question-- what is considered 00:23:46.400 --> 00:23:50.090 align:middle line:10% to be a low iron level in an endurance celiac athlete? 00:23:50.090 --> 00:23:53.840 align:middle line:10% How long after iron infusions do you get blood levels rechecked? 00:23:53.840 --> 00:23:56.150 align:middle line:10% Kind of a specific question. 00:23:56.150 --> 00:23:57.650 align:middle line:10% So I think this is a question that's 00:23:57.650 --> 00:24:00.620 align:middle line:10% not just for celiac disease. 00:24:00.620 --> 00:24:03.170 align:middle line:10% Iron deficiency is seen in people with celiac disease, 00:24:03.170 --> 00:24:05.720 align:middle line:10% and that's because of the malabsorption. 00:24:05.720 --> 00:24:07.760 align:middle line:84% But again, it depends on if you're 00:24:07.760 --> 00:24:09.807 align:middle line:90% getting an iron infusion. 00:24:09.807 --> 00:24:11.390 align:middle line:84% So if you're getting an iron infusion, 00:24:11.390 --> 00:24:13.598 align:middle line:84% you wait for a few weeks to get your blood test done. 00:24:13.598 --> 00:24:15.680 align:middle line:84% So I think this you may want to address directly 00:24:15.680 --> 00:24:17.007 align:middle line:90% with your clinical provider. 00:24:17.007 --> 00:24:18.590 align:middle line:10% And Macy, are there things that people 00:24:18.590 --> 00:24:23.750 align:middle line:10% can do from a diet standpoint if they do have iron deficiencies? 00:24:23.750 --> 00:24:25.550 align:middle line:10% Yeah, well first of all, if it was celiac, 00:24:25.550 --> 00:24:27.740 align:middle line:10% we would definitely focus on a gluten-free diet 00:24:27.740 --> 00:24:29.870 align:middle line:10% first because then that helps with that healing. 00:24:29.870 --> 00:24:34.160 align:middle line:10% That then will help with your iron absorption. 00:24:34.160 --> 00:24:36.890 align:middle line:10% But yes, there are many different foods. 00:24:36.890 --> 00:24:42.410 align:middle line:10% We talk about our red meats, our also beans, our leafy greens, 00:24:42.410 --> 00:24:45.260 align:middle line:10% fortified cereals, which there are gluten-free options 00:24:45.260 --> 00:24:47.090 align:middle line:10% of that, fortified breads. 00:24:47.090 --> 00:24:49.190 align:middle line:10% So yes, there are options. 00:24:49.190 --> 00:24:51.208 align:middle line:10% Here's another viewer question. 00:24:51.208 --> 00:24:53.000 align:middle line:10% Trying to get away from eating lots of rice 00:24:53.000 --> 00:24:56.840 align:middle line:10% or rice-based gluten-free foods because of the link to arsenic. 00:24:56.840 --> 00:24:58.370 align:middle line:10% Looking for alternatives. 00:24:58.370 --> 00:25:00.470 align:middle line:10% Yeah, I just like this question because I 00:25:00.470 --> 00:25:04.550 align:middle line:10% think that a lot of the times we think that we can't eat grains 00:25:04.550 --> 00:25:06.830 align:middle line:10% altogether when we have to go gluten free. 00:25:06.830 --> 00:25:09.440 align:middle line:10% And then when we do, so many of the products 00:25:09.440 --> 00:25:11.300 align:middle line:10% are rice or corn based, which are 00:25:11.300 --> 00:25:18.110 align:middle line:10% fine but for multiple different reasons, like the viewer asked, 00:25:18.110 --> 00:25:21.890 align:middle line:10% I love talking about quinoa, chickpea-based items, 00:25:21.890 --> 00:25:26.870 align:middle line:10% different bean- or lentil-based things, sorghum, teff. 00:25:26.870 --> 00:25:30.590 align:middle line:10% There are many different naturally gluten-free grains 00:25:30.590 --> 00:25:34.430 align:middle line:10% and flowers that you can use, and a lot of products 00:25:34.430 --> 00:25:37.340 align:middle line:10% have really come a long way and taste really good 00:25:37.340 --> 00:25:40.550 align:middle line:10% and are easy to use, and there are tons of different recipes 00:25:40.550 --> 00:25:43.610 align:middle line:10% and resources that you can get different things besides rice 00:25:43.610 --> 00:25:45.020 align:middle line:10% or corn. 00:25:45.020 --> 00:25:49.767 align:middle line:10% Here's one though that I do want to ask you. 00:25:49.767 --> 00:25:51.350 align:middle line:10% How do I get restaurants to understand 00:25:51.350 --> 00:25:53.120 align:middle line:10% about cross contamination? 00:25:53.120 --> 00:25:54.510 align:middle line:10% This person also asked-- and this 00:25:54.510 --> 00:25:56.690 align:middle line:10% is interesting-- what about kisses on the cheek? 00:25:56.690 --> 00:25:58.970 align:middle line:10% My granddaughters are little and kiss me on the mouth 00:25:58.970 --> 00:26:00.550 align:middle line:10% after they eat pizza or bread. 00:26:00.550 --> 00:26:01.910 align:middle line:10% Should I worry about that? 00:26:01.910 --> 00:26:03.240 align:middle line:10% Do I just need to wash my face? 00:26:03.240 --> 00:26:05.450 align:middle line:10% And I chuckle a little bit, but I 00:26:05.450 --> 00:26:07.820 align:middle line:10% think people are really concerned, 00:26:07.820 --> 00:26:09.710 align:middle line:10% and they want to be safe. 00:26:09.710 --> 00:26:11.900 align:middle line:10% So it's a legitimate question. 00:26:11.900 --> 00:26:12.440 align:middle line:10% Definitely. 00:26:12.440 --> 00:26:14.390 align:middle line:10% I can take the restaurant one first. 00:26:14.390 --> 00:26:16.910 align:middle line:10% So that is something we really focus on, 00:26:16.910 --> 00:26:18.410 align:middle line:10% especially in our clinic, because it 00:26:18.410 --> 00:26:20.640 align:middle line:10% is such a part of our lives. 00:26:20.640 --> 00:26:23.660 align:middle line:84% So a lot of the times it's researching restaurants, 00:26:23.660 --> 00:26:26.000 align:middle line:84% especially if they're kind of chains or quicker lunch 00:26:26.000 --> 00:26:28.640 align:middle line:84% options, and seeing if they do have 00:26:28.640 --> 00:26:30.980 align:middle line:84% protocols in place for gluten free 00:26:30.980 --> 00:26:33.380 align:middle line:84% and avoiding cross contamination. 00:26:33.380 --> 00:26:35.810 align:middle line:84% But then if it's kind of your neighborhood restaurants 00:26:35.810 --> 00:26:39.710 align:middle line:84% that you see do accommodate, going in at a not very 00:26:39.710 --> 00:26:43.670 align:middle line:84% busy time and talking directly with the chef or the manager 00:26:43.670 --> 00:26:46.340 align:middle line:84% and seeing what protocols they can tell you about specifically 00:26:46.340 --> 00:26:49.130 align:middle line:84% how they make the dishes that you would possibly be eating 00:26:49.130 --> 00:26:52.520 align:middle line:84% or your child would be, to really kind of seek that 00:26:52.520 --> 00:26:54.978 align:middle line:84% out and then be making your own list. 00:26:54.978 --> 00:26:57.020 align:middle line:84% So it's really just knowing the questions to ask, 00:26:57.020 --> 00:26:58.770 align:middle line:84% which also you get more familiar with when 00:26:58.770 --> 00:27:00.500 align:middle line:90% we talk about kitchens at home. 00:27:00.500 --> 00:27:02.195 align:middle line:10% And then you can kind of. 00:27:02.195 --> 00:27:03.510 align:middle line:10% [LAUGHTER] 00:27:03.510 --> 00:27:06.057 align:middle line:10% We want to be able to give our grandchildren kisses, 00:27:06.057 --> 00:27:07.640 align:middle line:10% so you don't want to miss that, right? 00:27:07.640 --> 00:27:10.310 align:middle line:10% Absolutely, kisses and hugs, absolutely, yes. 00:27:10.310 --> 00:27:13.940 align:middle line:10% So if grandma has celiac disease and the grandchild 00:27:13.940 --> 00:27:16.340 align:middle line:10% has eaten pizza and kisses on the cheek, it's fine. 00:27:16.340 --> 00:27:21.080 align:middle line:10% Just go wash your face, and it's OK, not freaking out about it. 00:27:21.080 --> 00:27:23.480 align:middle line:10% If the grandchild has a mouthful of goldfish 00:27:23.480 --> 00:27:25.438 align:middle line:10% and kisses you on the mouth, then that's 00:27:25.438 --> 00:27:26.480 align:middle line:10% a little bit of an issue. 00:27:26.480 --> 00:27:29.640 align:middle line:10% So that, you just rinse out your mouth quickly. 00:27:29.640 --> 00:27:33.860 align:middle line:10% But yes, hugs and kisses are allowed between grandparents. 00:27:33.860 --> 00:27:34.640 align:middle line:10% That's fantastic. 00:27:34.640 --> 00:27:35.480 align:middle line:10% We are out of time. 00:27:35.480 --> 00:27:37.190 align:middle line:10% That was really, really interesting, 00:27:37.190 --> 00:27:38.565 align:middle line:10% and the questions were fantastic. 00:27:38.565 --> 00:27:40.732 align:middle line:10% We always have such good questions from our viewers. 00:27:40.732 --> 00:27:41.630 align:middle line:10% I love that. 00:27:41.630 --> 00:27:43.250 align:middle line:10% That's all the time we have for our program today. 00:27:43.250 --> 00:27:45.810 align:middle line:10% If you need more information or want to make an appointment, 00:27:45.810 --> 00:27:48.310 align:middle line:10% please check out our website at UChicagoMedicine.org, 00:27:48.310 --> 00:27:51.128 align:middle line:10% you can call 888-824-0200. 00:27:51.128 --> 00:27:53.420 align:middle line:10% Also make sure to keep checking up on our Facebook page 00:27:53.420 --> 00:27:56.637 align:middle line:10% for updates on future At the Forefront Live programs. 00:27:56.637 --> 00:27:57.470 align:middle line:10% Thanks for watching. 00:27:57.470 --> 00:28:00.320 align:middle line:10% Hope you have a great week. 00:28:00.320 --> 00:28:03.890 align:middle line:84% University of Chicago Medicine is advancing the forefront 00:28:03.890 --> 00:28:07.310 align:middle line:84% of health every day with innovations improving 00:28:07.310 --> 00:28:09.710 align:middle line:84% the lives of people with Crohn's disease, 00:28:09.710 --> 00:28:12.740 align:middle line:84% the most advanced care for complex pregnancies, 00:28:12.740 --> 00:28:14.960 align:middle line:84% and leading-edge cancer treatments that 00:28:14.960 --> 00:28:17.270 align:middle line:90% are shaping national standards. 00:28:17.270 --> 00:28:19.790 align:middle line:84% We're bringing research to reality 00:28:19.790 --> 00:28:22.760 align:middle line:84% and making the extraordinary possible 00:28:22.760 --> 00:28:28.140 align:middle line:84% so you can experience advanced care in everything we do. 00:28:28.140 --> 00:28:30.910 align:middle line:90% Welcome to the forefront.