INFORMATION ABOUT CELIAC DISEASE

Dear children and parents,
We are pleased to present you with an information sheet about celiac disease, which gives you information about diagnosis of and treatment for the disease, as well as guidelines for leading a healthy lifestyle and adopting suitable nutritional habits. We recommend that you read the attached special instructions issued by the Ministry of Education to ensure integration into the educational system while avoiding any health risks.
We are here to assist with any questions you may have.
Wishing you good health and a Refuah Shleima.
The Pediatric Gastroenterology Institute team


General Information:

Institute of Pediatric Gastroenterology - Hadassah Mount Scopus
Day care, entrance floor - phone: 02-5845039
Days and hours of office: Sunday-Thursday, 14:00 - 08.00

What is celiac disease?
Celiac disease affects the small intestine and is caused by sensitivity to a protein called gluten. It is a genetic autoimmune disease in which the body attacks itself, leading to damage in the small intestine and additional organs.

What are the causes of celiac disease?
The disease is caused by a combination of genetic factors, exposure to gluten and almost certainly, additional environmental factors. It should be noted that the causes of celiac disease are not absolutely clear.

What is the connection between celiac disease and gluten?
Celiac disease is seen in the body’s difficulty or inability to digest a protein called gluten which is mainly found in foods containing flour made from wheat, barley or rye – bread, pasta and cookies. People who have celiac disease and eat food containing gluten will have an autoimmune reaction, when the immune system attacks its own body and not a foreign invader. This reaction causes damage to the small intestine lining and mucous and an inability to absorb various food nutrients.

What are the symptoms and ramifications of celiac disease?
Symptoms include stomach aches, feeling bloated, diarrhea, malabsorption and nutritional deficiencies. In some cases, the symptoms are not at all connected to the digestive system. Over time, the malabsorption of various food groups may lead to vitamin deficiency that can harm various body systems, including the brain central nervous system, bones, liver and other vital organs.

What are the complications of celiac disease?
Without proper treatment, celiac disease may cause several complications:

• Malnutrition – faulty absorption of essential nutrients will cause malnutrition which can also be seen as weight loss and may cause delayed growth and development in children. Although children or adults with celiac disease seem to be eating sufficient amounts of food, vital nutrients, such as Vitamin D, folic acid and iron, are not being absorbed in the body and are excreted in the stools.
• Loss of calcium and low bone density – the faulty absorption of foods and minerals may lead to a lack of calcium and vitamin D, resulting in low bone density (osteoporosis), a condition in which the bones are brittle and break easily.
• Lactose intolerance – in some patients the ongoing damage to the small intestine caused by the immune reaction to gluten may also cause sensitivity to foods that do not contain gluten. Some patients may develop sensitivity to lactose (the sugar in milk and dairy products). In such a case, patients should follow a lactose free diet (in addition to a gluten free diet). The gut may recover after a gluten free diet is followed and then patients can once again eat dairy products containing lactose.
• Increased risk of cancer – people with celiac disease who do not maintain a gluten free diet have an increased risk of certain types of cancer, including small intestine cancer and lymphoma.
• Neurological complications – an association has been found between celiac disease and increased frequency of neurological disorders including seizures and damage to the nerves (neuropathy).
  

What is the standard treatment for celiac disease?
The reatment for celiac disease is prevention, meaning total avoidance of any foods containing gluten for the rest of your life. Strict adherence to a gluten free diet will enable the intestine to recover and a swift return to normal functioning.

Can celiac disease be cured?
There is no cure for celiac disease. However, being strict about eating the right nutrition may contribute to controlling the disease and enabling you to live a normal lifestyle.

What resources are recommended for people with celiac disease in Israel?

• The website of the Israel Celiac Association for up-to-date news and upcoming activities. www.celiac.org.il
• The Celiac Association operates a helpline offering immediate answers to questions, as well as emotional support for coping with celiac disease. Helpline number: 03-6781481.
• We recommend that any family who has a child with celiac disease should register with the Association through their helpline.
  

What are the Ministry of Education’s instructions for an educational institution in which a celiac patient studies?
The Ministry of Education circular (permanent circular no. 0112) determines that:

• Students who have celiac disease will not be limited in participating in any physical activity, and as they grow older, they develop personal responsibility, judgment and awareness of the appropriate behavior in light of their illness.
• In Routine
  A student with celiac disease can, in principle, participate in all educational and study activities in the educational institution, or in any activity arranged on behalf of the institution, according to his or her limitations.
  The educational institution is obliged to work in conjunction with the parents to ensure that during all educational activities in which there are materials or food with gluten, a suitable alternative will be provided for the student with celiac disease, to ensure that he/she will be able to participate fully in the activity, without any social exclusion or any danger to his/her health. This instruction also applies to arts and crafts lessons and for special activities, such as baking cakes or challa etc., in advance of the Festivals or special events.
   Educational institutions that serve food are obliged to ensure that students with celiac disease receive meals appropriate to their needs with varied menus and tastes. The institution will work in conjunction with the food supplier to ensure provision of such meals.
  
  What are the Ministry of Education’s instructions for an educational institution in which a celiac patient studies? Cont.
• Special activities – school trips and hikes
  The educational institution will ensure in advance that students with celiac disease will be given food appropriate to their needs during any special activity such as school trips and field hikes.
• Advocacy and education
  The principal of the educational institution is required to educate the school staff and raise awareness among them about students with chronic diseases, including celiac disease and to implement social values that help these students.
  
  
  For further details [in Hebrew] about Ministry of Education guidelines concerning students with celiac disease, click on the link: https://apps.education.gov.il/Mankal/Horaa.aspx?siduri=125&REFF_GUID={E6D4F2E9-4CA1-441A-A49D-63783646EA14}
  

What is a gluten free diet for treating celiac disease?

• Celiac disease is treated by following a gluten free diet. It is important to ensure that you eat food that does not contain gluten, and is unlikely to contain gluten.
• Adhering to a gluten free diet is for life, even after you no longer have symptoms of the disease.
• It is important to ensure that you follow a balanced gluten free diet that provides all the nutritional groups, according to your age.
  

What are the principles of a gluten free diet?

• Gluten is found in three grains – wheat, barley and rye.
• Oats do not contain gluten, but should not be eaten in the initial stages of a gluten free diet since oats contain a protein that is similar to gluten which could trigger a response in certain celiac disease patients.
  

What are the obvious foods that contain gluten in our diet?
Food containing wheat, barley and rye: baked goods, for example – bread, pasta, cakes etc.

What foods do not naturally contain gluten?
All foods that do not contain the four grains (wheat, barley, rye and oats), for example: meat and poultry, fish, cheese, eggs, milk, fruit, vegetables, all legumes, corn, rice, potato and sweet potato.

Important

• When any food is industrially processed, packaged and marketed, it is likely to become “contaminated” by gluten.
• Even if these food products are sold in “open” packaging, they are in danger of becoming cross-contaminated from products on display next to them.
  

Why is it essential to read the nutritional values of foods when you have celiac disease?

• In the food industry, wheat-based flour or starch is used for different purposes. In many cases, although the actual food product does not contain gluten, the machines in the production line are also used for foods containing gluten. It is very important to carefully read the nutritional information given on the packaging to see whether there is any hidden gluten in the food products.
• Although legally, any food containing gluten is required to be clearly marked, however the law is not always obeyed.
• For this reason, the Israel Celiac Association has published a pocket guide of gluten free products, as well as a list of food supplements and medications that are gluten free.
  We recommend that you purchase this guide and keep up to date with new products.
  
  
  Very Important: Whenever you are unsure if a food product contains gluten, do not eat it until you have fully investigated the matter.

Tips and Advice for following a gluten free diet:

• Make sure that most of the foods cooked at home are gluten free.
• Be careful about “cross-contamination” (secondary contamination) of gluten which can occur when the same item of silverware or cooking utensil is used for foods that are gluten free and for those that contain gluten.
• We recommend purchasing a separate toaster to be used for gluten free bread only.
  
  

Any other tips?

• When baking and cooking, make sure that all utensils and dishes are clean and washed and that all surfaces (counter tops and chopping boards) are clean and have no crumbs on them.
• Do not use the same wooden utensils (spoons, chopping boards etc.) both for foods that are gluten free and for those that contain gluten.
• Do not use the oven to bake foods with and without gluten at the same time.
• Store gluten free dried foods such as flours and pastas in separate containers, so that they do not get mixed up with products that contain gluten.
• We recommend that you avoid buying foods such as dried fruits, spices and nuts that are not pre-packaged.
• When you fry schnitzel or eggplant, when recommend you use ground rice, potato flour, corn flour or gluten free flour. When you make meatballs or fish balls, prepare them as usual but do not use flour. You can grind the meat or fish together with potato instead of bread.
• We recommend that you grind the meat at home or to buy freshly ground chopped meat.
• Vinegar made from grains may contain gluten. Wine vinegar is gluten free.
• We recommend that you freeze sliced gluten free bread and take out the number of slices you need each time. You can also make toast.
• When eating out at a restaurant, we recommend that you find out whether they have a gluten free menu. You should also be careful about gluten that is hidden in foods prepared with soup powder, soy sauce, grilled chicken spices.
• Do not buy creams and cosmetics containing gluten (wheat germ).
• If you have to take medications, check with the pharmacist whether they contain flour or starch.
• You can now buy some gluten free wheat flours. At present, we do not know whether they are safe for use, even if they do not trigger any symptoms.
• We recommend not to eat foods that come with the warning: “May contain gluten”.
• As a rule, only eat packaged food if you are absolutely certain that it is gluten free.
  

PERMITTED AND FORBIDDEN FOODS WHEN FOLLOWING A GLUTEN FREE DIET *

*The information in this chart is based on the Israel Celiac Association website: www.celiac.org.il

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