Celiac Disease Assignment
Liberty University
Master of Exercise Science
HLTH 643
CASE STUDY: CELIAC DISEASE ASSIGNMENT
Kennedy Mills
ID: 27484490
November 17, 2023
Words: 2831
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Celiac Disease Assignment
1. Celiac disease involves damage to the intestinal mucosa caused by the small intestine
being exposed to the prolamin fraction (α-gliadin and other proteins in gluten).1 When the
small intestine detects the gliadin protein found in gluten, there is an immediate T-cell-
initiated inflammatory reaction.1 In this response, the intestinal mucosa is damaged which
leads to an increase in the white blood cells at the site.1 This response also leads to the
creation of IgA antitissue transglutamine (ant-tTG), antiendomy (EMA), and antigliadin
(AGA) antibodies which are the factors tested for in the diagnosis of celiac disease.1
Because of these factors, celiac disease is labeled as autoimmune in nature.1 There are
over 40 genes associated with celiac disease, but HLA-DQ2 and HLA-DQ8 are highly
associated with the disease and are found in 95% of people with this diagnosis.1 There is
an association between celiac disease and other autoimmune disorders.1 In Meghan’s
family history, it is noted that her aunt has T1D and her mother has thyroid disease. Both
of these diagnoses are autoimmune diseases. The literature suggests that gluten
introduced at a young age, shortened breastfeeding time, and viral infections at a young
age can increase the risk of autoimmune diseases.1 The increase in celiac disease
diagnoses is attributed partly to the increased testing and understanding of the disease.2
Additionally, environmental factors could be promoting less tolerance of gluten which
leads to an increase of the disease.2
2. Blood testing is the first step in diagnosing celiac disease.1 The test with the highest level
of accuracy, and therefore predominately used, is the tTG antibody test. This test is said
to have a sensitivity of 95-98%. This means that 95-98% of people who have celiac
disease will have an abnormal result on this test.3 The tTG test has a specificity of 94-
95%. This means that 94-95% of people who do not have celiac disease will have
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Celiac Disease Assignment
negative results. According to new European pediatric guidelines, it is possible to skip
the biopsy if the child has very highly elevated antibody counts and symptoms of celiac
disease.3 However, skipping the biopsy isn’t always a great idea since other diagnoses
could be found during an endoscopy procedure.3 Additionally, genetic testing can be used
to determine prevalence of the disease or help to rule the disease out completely.3 In
genetic testing, the DQ2 and DQ8 genes are searched for since these are found in 100%
of people with celiac disease.3
3. During a biopsy of the small intestine, the provider is noting villous atrophy, crypt
hyperplasia, and lymphocytic and plasma cell coming into the lamina propria.1 After
restricting gluten, these indicators will heal and the final evidence of celiac disease will
be noted.1 After the villi return to normal height and shape, digestion and absorption will
also return to normal functioning.1 The biopsy of the small intestine gives doctors a look
at the villi of the small intestine. These are finger-like projections that are responsible for
increasing surface area of the small intestine to increase absorption. In someone with
celiac disease, the villi found in their biopsy will be flattened, called villus atrophy.3 Its
flattening is caused by the white blood cells attacking it. The white blood cells are
triggered by the detection of gluten.3
4. Gluten can be found in wheat, rye, malt and barley.1 Gluten is the overarching name for
all of the proteins found in wheat, rye, malt, and barley.4 It is heat-stable and acts as a
binding agent for improved texture, moisture retention, and flavor.4 Common foods that
contain gluten are beer, bread, cake, cereal, cookies, baked goods, and pasta.
5. Yes, someone with celiac disease can also be lactose intolerant. The inability to digest or
absorb lactose is the most common example of carbohydrate malabsorption.1When there
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Celiac Disease Assignment
is a problem with absorbing lactose (as can be found in people with celiac due to their
damaged villi in small intestine), it will travel to the large intestine undigested.1 The
bacteria found in the large intestine will ferment the lactose and create gas and bloating
sensations.1 It is very common for an intolerance of lactose to be associated with other
gastrointestinal issues such as celiac disease.1 The damaged villi (and smaller surface
areas caused by atrophy) make it harder for lactose to be absorbed in the small intestine.1
6. Megan’s current weight of 14kg puts her in the 35th percentile for weight for girls her
age.5 Her height of 92cm puts her in the 10th percentile for height for girls her age.5 Her
heigh-to-weight is in the 78th percentile according to the chart.6 Meghan’s calculated BMI
is 16.5 which falls into the 78th percentile and is considered to be a healthy weight (z-
score 0.77).7 Meghan’s previous weight of 16kg put her in the 90th percentile for weight
for girls her age according to the CDC growth chart.5 Her height of 89cm put her in the
7th percentile for height for girls her age according to the same chart.5 Her height-to-
weight percentile was above the 97th according to the chart.6 Meghan’s calculated BMI
was 20.3 which falls in the 98.4th percentile according to the CDC and is considered
obese (z-score 2.49).7 Z-scores are a statistical measurement that tells how far a data point
is from the average. In the context of growth, z-scores are used to build growth charts. A
z-score of zero means that the data point lies on the average. A z-score of +1 indicates
that the data is one standard deviation above the mean while a z-score of -1 indicates that
the data is one standard deviation below the mean. On a growth chart, the average height
and weight is indicated as well as percentiles above and below the average. These
statistics are used by doctors to assess for possible disease, malnutrition, or other growth
concerns.7
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Celiac Disease Assignment
7. There are criteria for pediatricians to compare their patient to in order to determine if the
child does not have adequate nutrition. A BMI (based on age) that is less than the 5th
percentile, length (for age) less than the 5th percentile, weight greater than 75% of median
weight for age, or weight less than 75% median weight for length are all characteristics
that help indicate pediatric malnutrition.1 Pediatric malnutrition is most commonly caused
by inadequate caloric intake.1 Poverty, lack of nutritional knowledge, and mental health
disorders impact pediatric malnutrition.1 Medical conditions (such as celiac disease) can
also lead to pediatric malnutrition.1 Based on Meghan’s height and weight percentiles
found on the growth charts, she is not classified as failing to thrive according to the
criteria listed above. She is, however, at risk because of her celiac disease. She will need
to be careful to have proper caloric intake (of gluten free food) in order to not fall into
pediatric malnutrition.
8. Harris-Benedict (women):8
BMR= 655 + (9.6•weight in kg) + (1.85 • height in cm) – (4.7 • age)
BMR= 655 + (9.6•14) + (1.85•92) – (4.7•3)
BMR= 655 + 134.4 + 170.2 – 14
BMR= 946 kcal needed daily
Protein requirements (girl): 1.05g/kg.day1
1.05g • 14kg = 14.7g protein per day
9. Abnormal Laboratory Results:
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Celiac Disease Assignment
Lab Test Reference Range Result
tTG Antibody <4 U/mL 8 U/mL
IgA No antibody detected Antibody detected
DQ2 Negative Positive
DQ8 Negative Positive
Hemoglobin 11-16 9.5
Hematocrit 31-43 27
Vitamin D 30-100 16
The tTG antibody test has a 95-98% sensitivity and a 94-95% specificity.2 Meghan’s
laboratory testing showing a high level of tTG antibody count could be an indicator of
celiac disease. The presence of IgA antibody is a possible indicator of celiac disease.1 The
positive results for both DQ2 and DQ8 indicate that Meghan has celiac disease since
these are indicators that are present in 100% of people with this diagnosis.1,2 A low
hemoglobin count is indicative of anemia.1 A lot hematocrit level refers to a low red
blood cell count.1 The low hemoglobin and hematocrit might be signs of malnutrition and
are dangerous since the blood is crucial for oxygen and nutrient transportation in the body
and organ function. A low vitamin D score might be a sign of malnutrition.1
10. The positive DQ2 and DQ8 results and the presence of tTG antibodies are indicators of
celiac disease and aid in the diagnosis. The low hemoglobin, hematocrit, and vitamin D
found during bloodwork are related consequences of the celiac disease. As mentioned
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Celiac Disease Assignment
before, celiac disease involves damaging of the villi in the small intestine.1 Villi are
important for nutrient absorption into the blood. When these villi are damaged, nutrient
absorption is inefficient or ineffective. This can cause hemoglobin counts to be low as the
body does not absorb iron as well anymore.1 The vitamin D inadequacy may be caused
by Meghan’s recent refusals to eat food.
11. I would automatically prescribe a gluten free diet for Meghan. She has celiac disease
which is an autoimmune disease characterized by inflammation caused from gluten
intake. After restricting gluten, the villi are able to heal and return to their normal shape
and size.1 Then, nutrient absorption is able to return to normal. Once absorption levels are
able to increase, her hematocrit, hemoglobin, and vitamin D levels should also increase
once again. There should also be an alleviation of her chief complaints of abdominal
pain, diarrhea, lack of appetite, and weight loss. There are several gluten-free options to
replace her current diet that incorporates gluten. I would also suggest that Meghan avoid
dairy foods until her body can properly digest lactose to avoid negative side effects.
12. Intolerable foods:
BREAKFAST- cornflakes, milk
LUNCH- hot dog bun, chocolate milk
DINNER- chicken nuggets, soy sauce, pudding, milk
SNACK- cookie dough ice cream
Thankfully for Meghan, there are lots of delicious gluten free alternatives available. For
breakfast, her cornflakes should be replaced with a gluten free cereal option. Instead of
milk, Meghan should have a milk substitute or juice to drink. Appropriate milk
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Celiac Disease Assignment
substitutes include almond milk, oat milk, lactose free milk, or soy milk. For lunch, the
hot dog bun can be replaced with a gluten free bun, or she can eat the hot dog without a
bun. The chocolate milk should also be replaced with the options listed above or with
juice. For dinner, Meghan’s parents should check if the chicken nuggets have a breading
that includes gluten. If it does contain gluten, a gluten free chicken nugget option should
be selected instead. Additionally, the soy sauce should be checked for possible gluten
contents. If the soy sauce has gluten, it should be replaced with another type of sauce
without gluten (CFA sauce for example). The pudding cup should be checked for dairy
and replaced with a fruit cup or dairy-free pudding cup. The milk should be replaced with
a lactose-free option. Meghan’s cookie dough ice cream should be replaced with an ice
cream that does not have gluten since it is likely the cookie dough chunks contain gluten.
There are also dairy free ice cream alternatives such as oat milk ice cream. While the
gluten should be restricted permanently, the dairy can be added back to the diet after the
small intestine is healed.
13. A celiac nutrition therapy education should be focused on a gluten free diet.1 In order to
give a comprehensive understanding of the gluten free diet, the educator needs to teach
about which foods contain gluten, label reading, how to best prevent cross-contamination,
identifying gluten in items that are not food, and choosing gluten free options for a varied
and healthy diet.1 The educator should also mention that lactose and other nutrients are
unable to be absorbed well until a gluten free diet is achieved and should possibly be
avoided.1 This provides the attendees with a wide view of how celiac disease impacts
other processes in the body. The celiac nutrition therapy education should also emphasize
that gluten restriction should be a lifelong aspect of life.1
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Celiac Disease Assignment
14. To limit Meghan’s exposure to gluten in the home, Meghan’s mother and grandmother
should swap all gluten-containing foods for gluten-free alternatives. This would eliminate
the possibility of cross-contamination and Meghan’s contact with gluten. They should
read labels and be cautious when grocery shopping to buy only gluten free options. When
she visits her father’s house, only once or twice per month, her mother can pack her food
to send with her. This would make it easy for the father to feed Meghan properly without
having to change his usual lifestyle habits and routines. It would ensure than Meghan has
the types of foods that she needs and likes without expecting that the father would know
what to buy her. Her meals should be prepared separately and away from any food that
contains gluten. At daycare, Meghan’s teachers need to be made aware of her diagnosis
and needs to eat her own food only. She should be made to wash her hands often and
wipe down the lunch table with a disinfecting wipe before eating there. Her teachers
should also educate themselves on which classroom manipulatives and craft supplies
contain gluten in order to protect Meghan while she plays with them. Using gloves or
other supplies will help Meghan stay safe. Everyone in Meghan’s life should be educated
about what Meghan is allowed to eat and what she needs to avoid, how to help her be
healthy, and the impacts of her having even a little bit of gluten. Meghan also needs to
start being taught that she’s only allowed to eat her own food, how to check labels, how
to tell people “No” when they offer her food, and what kinds of foods she is allowed to
eat. Meghan’s family should create a list of non-food items that often contain gluten as a
reference for themselves for while shopping or to remind themselves of items to double
check before handing to Meghan to use.
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Celiac Disease Assignment
15. Yes, there are nutritional concerns for Meghan while she is following the gluten free diet.
To make sure that Meghan maintains optimal health, her bloodwork will be done every
few months to check in on her vitamin levels, hematocrit, and hemoglobin. Micronutrient
deficiencies are also a concern while being on the diet and can be monitored from blood
testing. She should take a multivitamin (gluten free) to encourage balanced micronutrient
levels. The food group that is mainly taken out on the gluten free diet is carbohydrates.
Carbohydrates, specifically whole grains, are a big source of dietary fiber. To
accommodate this loss of fiber-rich foods, Meghan’s family should make sure she is
getting fiber elsewhere. Other sources of fiber include a fiber. Supplement, leafy
vegetables, and beans.8 As Meghan’s RDN, I would be checking her food logs to assure
her caloric intake is sufficient and she has a balanced variety in her diet. I would be
checking her height and weight to calculate z-scores and watch her progress over time. I
would also check her height and weight measurements against the CDC growth charts to
ensure that she is developing appropriately compared to other kids her age. I would
monitor her blood levels for the possibility of T2D (based on her family history) and
record all laboratory results to watch their changes over time.
16. The Lord’s original diet for man was vegetarian. Genesis 1:29 says, “And God said,
‘Behold, I have given you every plant yielding seed that is on the face of all the earth, and
every tree with seed in its fruit. You shall have them for food.’”9 These foods include
plants, fruits, nuts, and grains. Anything that could come from a plant was given to Adam
and Eve to sustain them in the perfect Garden of Eden. Since God is perfect and His
creation in the Garden was perfect, we can conclude that a vegetarian diet is sufficient to
sustain us and maintain health. After the flood, the Lord gave Noah permission to eat
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Celiac Disease Assignment
meat. It was at this point in history when it became necessary to eat meat. The plants
were all destroyed in the flood and the stores of food in the ark were dwindling. In
Genesis 9:3, God says, “Every moving thing that lives shall be meat for you.”10 It was
only then that God gave humans the permission to kill animals as food. God intended us
to eat whole foods that were grown from the ground. Then, he allowed humans to eat
meat that they killed. Both of these types of foods are natural, homegrown, and clean.
Today’s processed foods, commercialized farming and ranching, and genetic
modifications of foods are not God’s intended way for us to consume His creation.
Processed foods are harsh on the body and hard to process. Added chemicals and
hormones are unnatural and impact the body in ways we can’t even understand yet. All of
these modifications to whole and natural foods are to blame for many of the
gastrointestinal issues, diseases, and intolerances. It is important to remember that whole
foods are good for the body. Even though processed and modified foods often taste better
and are more convenient, they are hurting our health.
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References
1. Nelms MN.PNutrition Therapy and Pathophysiology.;
2006.Phttp://lib.tums.ac.ir/site/catalogue/50707.
2. Lebwohl B, Rubio–Tapia A. Epidemiology, presentation, and diagnosis of Celiac
Disease.PGastroenterology. 2021;160(1):63-75. doi:10.1053/j.gastro.2020.06.098
3. Lebwohl B. Diagnosis and Management of Celiac Disease [Class
lecture]. Columbia University. n.d. Accessed November 17, 2023.
https://canvas.liberty.edu/courses/531641/pages/watch-diagnosis-and-
management-of-celiac-disease?module_item_id=59465809
4. Biesiekierski JR. What is gluten?PJournal of Gastroenterology and Hepatology.
2017;32(S1):78-81. doi:10.1111/jgh.13703
5. SOURCE: Developed by the National Center for Health Statistics in Collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
Http://Www.cdc.gov/Growthcharts 2 to 20 Years: Girls Stature Weight-For-Age
Percentiles -For-Age and NAME RECORD #.; 2000.
https://www.cdc.gov/growthcharts/data/set1clinical/cj41c022.pdf
6. 2 to 20 Years: Girls Body Mass Index-For-Age Percentiles.
https://www.cdc.gov/growthcharts/data/set2clinical/cj41c074.pdf
7. Center for Disease Control and Prevention. BMI calculator child and teen. Centers for
Disease Control and Prevention. Published May 9, 2019.
https://www.cdc.gov/healthyweight/bmi/calculator.html
8. C. Anna Kebles.POmega Z Diet for Weight Loss Workbook. Amazon; 2021.
9. Genesis 1:29 (ESV).
10. Genesis 9:3 (ESV).
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