Ep41

[00:00:30] John Salak: Celiac disease is a tough go on a lot of fronts. It's a long term problem that can ravage a person's small intestines, effectively blocking the body's ability to take in nutrients. Yes, it's connected to gluten, but it's different from gluten sensitivity and intolerance.

Making things worse is that the disease is somewhat controllable, but not curable. Oh yeah, millions of Americans suffer from it, many of whom don't even realize they're walking around with celiac disease. If all this isn't bad enough, it's really hard to diagnose because the symptoms, weight loss, gas, diarrhea, cramps, joint pain, the list goes on, are similar to other digestive problems like Crohn's, IBS, intestinal infections, and more.

And here's another dollop of troubling news. Lots of people don't even experience any symptoms, which means they don't know that their intestines are on the fritz. Admittedly, this is a lot of bad news for those who suffer from celiac disease, worry they may have it, or are at high risk from the disease because of possible genetic links.

Thankfully, even though the disease can't be cured, there are ways to lessen its impact. There are also ways to help better diagnose those who may be struggling with the problem. Beyond this, additional advances may be coming soon too. So what are these tips, improvements, and promises? What the health has lined up is Celiac Authority to lay out what can be done and what the future may hold.

Listen up.

So now we're getting to the best part of every podcast is where we get to delve into these issues, in this case, celiac disease with an expert, and we certainly have an expert on hand to help us explore celiac disease, why it's happening, what it does to you, and maybe what people can do to deal with the risk. And we'd like to welcome, Megan Donnelly, Director of Health Communications from the Celiac Disease Foundation to our podcast. So, Megan, welcome.

[00:02:26] Meghan: Yeah, thank you so much for having me.

[00:02:28] John Salak: Okay. We had touched base a little bit earlier before it started. We discussed not just celiac, but there's a lot of issues out there where people are familiar with the name but they're not really familiar with what the issue is.

And I think that happens more and more, probably because of information getting out there, but certainly with celiac disease. So Megan, the first thing I want you to do is tell us what celiac disease is.

[00:02:51] Meghan: Yeah, so celiac disease is a genetic autoimmune disorder where the ingestion of gluten, which is just a protein that's found in wheat, barley and rye, gluten actually leads to an immune response that attacks the small intestine, and it actually damages the villi of the small intestine, which are these finger like little projections that line the inner part of the small intestine that actually absorb the nutrients from the food you consume. So the long term effects of that are really damaging. There's inflammation in the intestine, of course, which can lead to a number of digestive issues, but also there are significant nutrient deficiencies and all the associated problems with that.

[00:03:32] John Salak: Do you think people are aware of exactly what it is, not exactly, but largely what it is? Do people have a working definition for celiac or is it just sort of something we know is out there?

And this like feeds into how do people deal with it. But first, what about awareness? Is it the name or the issue?

[00:03:50] Meghan: I think people are familiar with the gluten free diet. I think people recognize that that is a diet that a lot of people follow, but they don't necessarily know why. There are people who follow the gluten free diet for different reasons, many of which have nothing to do with celiac disease and, you know, whether or not That's appropriate is certainly debatable, but I think for celiac disease, people tend to not really understand that it's an autoimmune disorder.

I think people have heard of the term. They don't know how significant it is. They tend to think of it like an allergy, but it's really not. It's an autoimmune condition. So yeah, I would say probably awareness of what actually the consequences of celiac disease are is something that we need to improve.

[00:04:35] John Salak: Okay. What are the short and long-term impacts for celiac?

[00:04:38] Meghan: So, I mean, see the when the villi are damaged, you're going to have nutrient deficiencies. The long term effects of those nutrient deficiencies can be significant. If you're not absorbing the nutrients that are important for bone health, you're going to have bone density issues. Sometimes, especially in children, we see poor growth because you're not absorbing nutrition appropriately.

Some people, have really bad symptoms that can lead to other issues. And symptoms can vary. They can range from things like neurological issues to digestive issues, to different, Like blood type issues like anemia, so there are a lot of different areas that celiac disease affects. And I think all of those issues over the long term can have increased risk for a number of other conditions that are difficult to treat people with celiac disease are at risk for death.

GI cancers, they are at increased risk for osteoporosis and osteopenia. There are a number of people who experience neurological changes and things like neuropathy, which is basically just People experience tingling in the extremities. People experience those things long term. And so I think the it kind of depends on the person.

Not every celiac patient presents with the same issues, but the prolonged effects of nutrient deficiencies are significant.

[00:06:06] John Salak: And we know a lot of people are going on a gluten free diet , or it's an awareness thing. Do we see the number of people facing celiac disease increasing? Is it a matter of diagnosis? Because we also find that an element too. So do you think more people are affected by this disease than previously?

And if so, why?

[00:06:26] Meghan: Yeah, I mean, I think it's a combination of things. I think we're getting better at diagnosing it. Awareness has certainly increased, but it's possible that there are also an increasing number of people developing celiac disease. It is a genetic condition. So, it tends to run in families. And I think as the population continues to grow they're going to see more cases.

I mean, it currently affects about one in a hundred people worldwide. And that prevalence has been pretty consistent for the last 20 years or so. But I think as we continue to recognize some of the non traditional symptoms and, possibly screening more people, possible that we're going to have more diagnosis.

[00:07:08] John Salak: Can you develop celiac disease outside of genetic factors?

[00:07:13] Meghan: So, you have to carry specific genes in order to be diagnosed with celiac, but there are a lot of people walking around with these genes that put them at risk that don't actually develop the disease. So, yes, we tend to see it run in families, but It's kind of a combination of factors that contribute to the disease.

So yes, you have to carry the genes, but your environment, there's often some sort of triggering event. We don't really know why the gene gets turned on in some people at this point.

[00:07:48] John Salak: Mm hmm. Is it 1 percent of the people who may, or 1 percent of the population of the base, may have the gene, or again, it may, it sounds like you might have a higher level of people with the celiac gene, if that's what I'm calling it, versus whether they actually develop the autoimmune disease.

[00:08:03] Meghan: Yeah, I've seen a number of different, well, a range, I guess you'll say. I've seen up to 30 percent of the global population carrying genes that would put them at risk for celiac disease. But yes, only 1 percent of the total population is estimated to develop the disease. So there's certainly a lot of people who don't develop it for whatever reason.

[00:08:27] John Salak: Yeah, I've read, and I think maybe you guys supplied it, that a great number of people don't realize they have celiac disease. They're running around without it. One, is it true? And I suspect you're nodding, so you're going to say, yes, it is true.

And two, then the follow up question, of course, is what would be some of the symptoms? I know there are multiple symptoms to it and then we can follow it up with how do you test for it. So are there a lot of people running around with celiacs who don't know?

[00:08:53] Meghan: Yes. We call this the celiac iceberg. There are a, there are a lot of people who are not diagnosed. And I think part of the reason for that is that there's not one picture of what this disease looks like. There's over 200 signs and symptoms of celiac disease.

Traditionally, we think of it as a digestive disease. People might present with symptoms like diarrhea or even constipation or possibly nausea and vomiting, difficulty tolerating food. That's common. But there's also a lot of people who present with very nondescript symptoms, things like brain fog, or headaches, or anemia, or, fertility issues, or difficulty growing.

We see so many different symptoms. things now. And I think at first, as celiac disease was becoming more well known, we really thought of the classic symptoms being the digestive symptoms. But more and more, we're realizing that a lot of people never get digestive issues and these non traditional symptoms are actually maybe more

[00:10:07] John Salak: more Wow So, short of, and we're going to go into how it would be identified medically or through a practitioner, but short of that, how would I worry about having, possibly having that? Is it a matter that I'm eating gluten products and all of a sudden I feel worse or there's something else that would trigger it?

Not that people shouldn't go for an exam, but just before an exam, how would I know that this is something I may need to look into?

[00:10:32] Meghan: Yeah. So I guess the first thing I would say, if there's other people in your family that have celiac disease or gluten intolerance, that would be my first red flag. Otherwise I think understanding what's in your food can be a really helpful exercise here. I'm a dietitian. I like to get into how food is affecting you and gluten is found in wheat, barley, and rye and all the products that contain wheat, barley, and rye.

So if you're feeling like something's not right, I always tell people, it's good to keep a food journal, write it down. If you always feel terrible after your lunch meal and you have a sandwich for lunch every day, like we should look at that sandwich and try to figure out if

that's causing issues.

Having that data can be really helpful when you go to your doctor or your dietician and they can help you work through what might be going on there. Even if you think maybe this is not related to what I'm eating, I do think it's helpful to whatever data you can supply your physician with that can help accelerate this diagnosis.

Studies show that people with celiac disease go like four to seven years undiagnosed from onset of symptoms. That's way too long and the effects of that can be significant. I mean, you're going to be much sicker than you would be if you were diagnosed early. So, yeah, that's where I would say to start.

[00:11:56] John Salak: And just as an aside, because I know we're talking about celiac disease and it relates to gluten. Is being gluten intolerant the same as celiac disease or is it something else? And I bring this up because my daughter, who's 31, has found out when she eats a lot of gluten products, she really doesn't feel as well, but she certainly hasn't tested for celiac disease.

So what's the relationship there? Or there may not be a relationship, but then to identify that, you may be gluten intolerant or not fond of gluten, but you may not have celiac.

[00:12:27] Meghan: Yeah, so there's kind of a, lot that could be going on there. So, there are three groups of people who follow a gluten free diet. The first is people with celiac disease, where the gluten free diet is the only treatment and it's medically necessary to follow that diet. Then there's, a condition called non celiac wheat sensitivity or non celiac gluten sensitivity, which these people look a lot like a celiac patient, but they don't test positive.

And so the reason for that is kind of unknown at this point. There is no biomarker for non celiac gluten sensitivity. And so the way it's diagnosed is based on removing it from your diet and seeing how you feel. And then there's this third group, which might overlap with the non celiac gluten sensitive group, but this group of people that has irritable bowel syndrome or IBS .Wheat, barley, and rye are, they are the gluten containing grains, but they also have a type of carbohydrates called FODMAPs, which can trigger digestive symptoms in people with IBS, and we see that there's a lot of overlap with the types of foods that need to be reduced in the diet.

So, yes, a lot of people feel better when they go on a gluten free diet. The reason might vary. vary. I always encourage people to get tested for celiac disease because the the degree of which you need to be vigilant about avoiding gluten is really different. But I think the best way to know if you don't to just gluten well is to Keep a food journal, keep track of it, and follow up with information that you gather with your doctor so that they can figure out the appropriate next steps.

[00:14:13] John Salak: Okay, people who don't have celiac disease are not necessarily, they're facing issues, but they're not necessarily facing, autoimmune issues, correct?

[00:14:22] Meghan: Yeah, exactly, which is why it's important that you know what's going on. People with celiac disease, because it's an autoimmune disease, are often at risk for other autoimmune diseases and it's important to get the right diagnosis so you can appropriately navigate

whatever else is going on in your health.

[00:14:43] John Salak: So, how do we test for it? If I go for a standard annual checkup, my doctor's not necessarily testing for celiac disease, unless I guess, I tell them something.

[00:14:54] Meghan: Exactly. So, the first step is a blood test. It is a simple blood test. Most doctors can order it with your annual blood work if you feel like there's a reason to be screened for it, but that blood test is only part of the story. You also need to go see a gastroenterologist who will do a biopsy of your small intestine and that's really important because you want to make sure that you actually have the damage to the villi.

That is the key factor for celiac disease diagnosis and so that is the identifying marker whether or not it's an autoimmune disease, like celiac disease or something else.

[00:15:33] John Salak: Right. Are there demographics, groups of people, ethnic, age, whatever, gender, that are more likely to have celiac disease?

[00:15:43] Meghan: Yeah, this is a really good question because I think more research needs to really be done here in order to understand it fully. Autoimmune diseases tend to occur more frequently in females. Reasons for that are a little bit but that is what we see in the data. As far as ethnic groups, It's estimated that global prevalence is similar worldwide, regardless of where they live, so 1%.

We do see it in every ethnic group. Age is an interesting one. Historically, people thought celiac disease was only a childhood disease, but we're seeing more and more that Elderly people are getting diagnosed, and so it can be turned on, the gene can be turned on, or you can develop the disease at any age, which is kind of interesting because, you know, when did gluten start to affect you negatively?

What was that triggering event that started the autoimmune reaction? And I think that piece. is important for understanding why autoimmune diseases develop in general. I mean, Celiac disease is the only autoimmune disease where we know the trigger of the reaction, which is gluten. But why gluten triggers the reaction, it's still a little bit not well understood.

[00:17:07] John Salak: Is there enough research and insight put into this disease? And it's all relative because when we talk to people who are specialized in a certain area, they all say, well, there's not enough money being put into our area.

How much research is being put in? How far have we advanced in the last five years? What's needed in the next 10 whatever?

[00:17:26] Meghan: Well, and I think many people with celiac disease will identify with what I'm about to say, but the gluten free diet is currently the only treatment for celiac disease. And it is not a good enough treatment. It is really hard to avoid gluten. It is easy to be accidentally exposed to gluten. And for a lot of people, this is a burdensome diet.

I mean, it is, It is one where it takes constant consideration for what your eating.

[00:17:57] John Salak: Mm hmm.

[00:17:58] Meghan: And because of that, there's a lot of focus right now in the celiac research world on finding other treatments or cures for celiac disease. The problem, though, is that there's not a lot of money being Funneled towards celiac disease research because you do have a treatment.

It's the gluten diet, but there are a lot of people who would love another option. And so I would say in the last five years, there have been significant efforts to get more funding for celiac disease and recruit more patients into clinical trials. It's kind of interesting because we have trouble getting people to enroll in clinical trials because You have to eat gluten in order to trigger a reaction, and a lot of patients don't want to do that.

Yeah, absolutely. So, it can be a challenge, but I would say the biggest barrier right now to getting a treatment or a cure for celiac disease is enrolling patients in clinical trials, and the Celiac Disease Foundation actually has a lot of options to help with that. We recruit a lot of people to clinical trials through our iRecruit platform on the Celiac Foundation website.

And that is really our biggest push because it's difficult to get more funding without willing to participate in trials. And we cannot get a drug for celiac disease without participation.

[00:19:29] John Salak: Got it. I suspect there's a couple reasons for that, for getting participation. One is obviously if you eat gluten, you're not going to feel well. But not everybody has that sort of intense reaction, right? It may be something they don't, and it's going to affect their bone density, it's going to affect something else, but it's not like, oh my God, I had a slice of pizza and I feel terrible.

[00:19:50] Meghan: Exactly. Not everyone has the same symptoms. I think something that. might be motivating to people is that you're being closely monitored by medical professionals throughout these trials. And so, they're not trying to make people sick because they participated in a trial. So yes, dealing with symptoms is absolutely part of it, but the long term effects side, reducing risk for those you are being closely monitored by a medical team to make sure that you're going to be healthy throughout the process.

[00:20:22] John Salak: Are there things that can be done to lessen the impact of the symptoms, or is it just removing gluten? You know, if you get seasick, I can take Dramamine or something like that. You know, is there anything that can be done in that fashion to lessen?

[00:20:36] Meghan: So avoidance of gluten is the only option, but we know exposures happen, and the treatment or way to reduce symptoms is really to treat the symptoms. So we tell people, if you get a lot of cramping, maybe use a heating pad. If you experience nausea, vomiting, sometimes there's things doctors can recommend medication wise to help reduce that.

Unfortunately, like until the gluten exposure is eliminated, you might continue to have symptoms, but we always recommend kind of palliative treatments to help people manage those symptoms. And ideally it doesn't happen often. But when it does, there are options, but there's nothing to kind of reduce the impact of gluten itself.

It's really just treating symptoms.

[00:21:27] John Salak: I suspect it varies from person to person, but if I'm having an adverse reaction to gluten because of celiac, how long does it take to that, for that to lessen if I eliminate? Gluten from my diet,

[00:21:41] Meghan: Yeah. It, it really does vary person to person. Some people really don't get significant symptoms and others that can take weeks. So it really depends.

[00:21:51] John Salak: You know, it just dawned me if you don't have significant symptoms You have other impacts which your body's just not telling you that's a really good Avenue to figure that I can cheat and then have Gluten because I don't feel the impact. I'm not rushing to the bathroom. I'm not getting cramps.

I don't feel awful I don't have headaches and I know I read that you guys said there possibly 200 different symptoms You can have to this but if it's not an overt symptom i'm thinking okay I can go have some pizza after the game or i'm in paris And those baguettes look wonderful.

I'm just going to dive into the baguettes or the croissants or the brioche or whatever

[00:22:28] Meghan: Yeah. Unfortunately that is. You are still potentially damaging the villi of your small intestine. And so even though you might not feel it, the damage is still being done. So unfortunately it is strict lifelong avoidance. We know gluten exposures happen accidentally, and you're not putting yourself at risk for long term illness by accidentally having something with gluten.

one time.

But the problem is when you tend to cheat,

[00:23:00] John Salak: Yeah,

[00:23:01] Meghan: it tends to cycle into something where maybe you're doing it more often. And that is not, um, that is not healthy for someone with celiac disease to be regularly doing. So yes, I could see where that would lead to a temptation, but really that is something we want to avoid because the long term effects can be really damaging.

[00:23:20] John Salak: What are some of the biggest myths or misconceptions people have when they're dealing with celiac disease or if it even spills over into, gluten intolerance or something else? I know we're focused on that, but I have a feeling these interchange a little bit, at least in terms of people's minds.

[00:23:37] Meghan: Yeah, there's actually so many here. I think people are really confused about two which degree they need to be worried about avoiding gluten in different settings. And I'll, I'll expand upon that a little bit. So there's something called gluten cross contact, and that is when a gluten containing item touches something that's gluten free, and then you consume it.

It's a problem because you contaminated it in a sense. We have a lot of research focus on this area, gluten cross contact at this point, because there's a lot of myths about cross contact as a whole. Most of what I'm gonna say is evidence based, but a lot of what we tell people as dietitians, as doctors, is not based on real evidence.

It's what we think we know. is best practice based on what we know about contamination as a whole and things like that. So, someone with celiac disease needs to basically think about using separate and clean items to prepare food. And I say that because, there are people who are really, really worried about this gluten cross contact thing and being exposed without their knowledge that they're so vigilant that it really affects quality of life.

You know, things like buying separate everything for their kitchen and only using that item for gluten free food preparation or never eating out at a restaurant because they're worried about cross contact. There's people who think they need to only purchase gluten free cosmetics. And we know that isn't true unless you're consuming it in your mouth.

You don't need to worry about a gluten, containing cosmetic. So there's a lot of things and I think my message would be

if you can clean it, you can use it to prepare gluten free food, and that applies to any kitchen settings. So, sometimes it takes a little bit of work. If you are at a restaurant, for example, you might need to ask a few more questions about how they separate and clean things in the back of the house.

But in a home setting, if you can wash it with soap and water, you can use it to prepare gluten free food. And that is really, it really alleviates the burden for families who might have only one person in their family with celiac disease. don't need to be worrying to the point of having a separate kitchen, essentially, for the person with celiac disease.

So, we see a lot, and I think finding reliable information is really important. I mean, your first go to should be your doctor or your dietician. The Celiac Disease Foundation has really great evidence based information on their website, and try to avoid asking Google or social media groups, because you might not be getting really accurate information, and we see misinformation in celiac disease all the time.

[00:26:33] John Salak: I'm not bashing restaurants, but certainly you go into a lot of restaurants and you see gluten free dishes or gluten free pizza or whatnot, and certainly they're appealing to a certain clientele, and, let's assume they're trying to do it for the right reason.

Do you think restaurants, are, cautious enough on that? Or do you think, yeah, they're trying to do a good job, but big kitchen, it's just really hard to prevent that cross contamination.

[00:26:57] Meghan: Many of them are. it requires a little bit of work. I always recommend that people call the restaurant ahead of time, let them know you're coming, ask them the questions you need to ask them, and make that decision on a case by case basis. I live in New York City, and I know there's a lot of focus on allergens and gluten free diets and specialized diets in general, so oftentimes, they have a really well thought out answer in how they prevent gluten cross contact, and I find that the best practice is to call ahead and figure out what your options are going to be.

That's not always appealing to people. Some people prefer to just eat at home. They don't want to worry about it. But eating is a really social thing and we don't want people to miss out just because they have celiac disease. So I think it can be done. There are some really great tools. There's an app called Find Me Gluten Free that helps it,

you really get a good idea of what restaurants do it well, and I recommend that all the time.

[00:27:58] John Salak: You mentioned information on the internet that, it may not be safe. Do you see a lot of herbal remedies or celiac related products on the market that, like, whoa, I'm not sure they're really good, they're just tapping into concerns,

[00:28:14] Meghan: Yeah, I've seen..

[00:28:15] John Salak: And I'm not asking you to identify the products for fear of libel or slander, but you know what I mean, you just see that, you know, in Yeah, I It's important to know that the gluten free diet is the only treatment available for celiac disease, and there are no medications or supplements that can reduce the impact of gluten and make something safe for someone with celiac disease. So I've seen different products claiming to break down gluten.

[00:28:42] Meghan: So that it's digestible and not inflammatory. There's no evidence to suggest that those products are appropriate. So, I would say, yeah, if you have a question about something and you're wondering if it's going to be helpful for you, bring it to your doctor. Let them tell you what the evidence is for it.

But at this point, we don't have anything.

[00:29:03] John Salak: I think we've covered a lot of great ground. Does it matter the amount of gluten? that you consume. Is a little bit of gluten just as bad as, watching the Mets lose and you're eating three slices or four slices of pizza?

Is that as bad as just a little bit or is it, the amount obviously has an impact?

[00:29:21] Meghan: So, any amount can trigger a reaction, but the amount may determine the severity of your symptoms. So, I would say it doesn't matter, but you might feel it more if you have more.

[00:29:34] John Salak: So it's a matter of triggering the reaction. And then, Maybe how inflamed the reaction is in layman's terms or something like that. Okay, what are the two or three things they should do right off the bat?

I'm worried, I've kept a food journal and I just should see my doctor or I think something's off, I should just go see my doctor or what it, and maybe it's something else.

[00:29:52] Meghan: Yeah, I mean, absolutely, the first step is to go see your doctor. A lot of people stop there, though. didn't know what to ask for and they never got the follow up appointment or maybe the doctor didn't run the right blood test and they didn't really get a clear answer, but they're still having symptoms.

You should always continue to follow up and advocate for yourself. I think the next step, I mean, I'm a dietitian. I'm a little bit biased, but I think Everybody with celiac disease or any digestive disorder should be working with a dietitian to try to find ways to make sure the diet is adequate and appropriate for what you have going on.

Dietitians don't just, give you a prescription and say, here, good luck. They work with you on integrating these benefits into your daily life. And there are a lot of people who maybe they have celiac disease and they've been on a gluten free diet, but they still have some sort of other digestive issue.

Maybe they have bloating or, or gas they can't get rid of. A dietitian can work with you on. combining the diets, if you will, and making sure it's nutritionally adequate because restrictive diets are limited in the nutrients they provide, regardless of what the restrictive diet is. And so we want to make sure you're getting all the nutrients you need and finding a diet plan that helps you meet those nutrition goals.

So absolutely a dietician should be part celiac disease or. Really any other, digestive disease because it can be really limiting.

[00:31:21] John Salak: I know that annual checkups are sometimes really brief.

We're hitting the top points and they may not delve in, but in general, do you think there's a enough awareness or growing awareness among physicians to check into this? Okay. Or to see warning signs.

[00:31:34] Meghan: Think in the United States, the primary care physicians have a general sense of what celiac disease is and what it looks like. However, there are over 200 signs and symptoms. and they might not be thinking about every single one. I think if you present with like a digestive issue, they might go to celiac disease a little bit faster than if you have something like brain fog, which is kind of nonspecific, right?

So think again, having the data to say like, this is how long the symptom has been going on. This is what it feels like. It might still take some time, but. You have to be an advocate your own health. And so, yeah, I think just keep pushing gastroenterologist is going to be the specialist for someone with celiac disease. but But usually you're not going to see a gastroenterologist unless you have something else going on that's related to the digestive system. So your primary care doctor or your pediatrician is often the first step.

[00:32:35] John Salak: Okay. Five, ten years from now, do we see great advances in dealing with celiac disease?

[00:32:41] Meghan: Yeah, I feel like we have never been in a better place as far as research for treatments and cures. So I really, really hope so. We have a lot of exciting Celiac Disease Symposium, and we're hopefully going to have a lot more updates coming out of that. But I think you'll start to see some new research coming out for sure.

[00:33:04] John Salak: Okay. And, I suspect you're going to say That the Celiac Disease Foundation is a great source for people who have some questions, at least want to get a little more knowledge and maybe jump off. I'd be shocked if you said it wasn't a great source of information.

[00:33:19] Meghan: Yeah, so the Celiac Disease Foundation is a great source for information. Just so everyone knows, we have kind of an interdisciplinary team working on the information that's on our website. So we have a clinical trials focused group called our Scientific Affairs Team. They have me, I'm the dietician on staff.

We have a number of doctors advising us and we have people who have years of experience working in hospitals. And so we are really. Always networking to make sure the information on the site is up to date and interesting and relevant.

[00:33:52] John Salak: And the website is.

[00:33:55] Meghan: www. celiac. org.

[00:33:58] John Salak: Okay, people can handle that. Okay. That's great. Megan, Donnelly director of health communications for the foundation. Thank you very much for your time. This has been great. Hopefully it'll flag people and encourage them to check out something that may be wrong, or at least get it a little more thoroughly checked out, I guess is what I'm saying.

Before we move on, we want to again encourage our listeners to take advantage of the hundreds of exclusive discounts WellWell offers on a range of health and wellness products and services. Now, these cover everything from fitness and athletic equipment to dietary supplements, personal care products, organic foods and beverages, and more.

Signing up is easy and free. Just visit us at WellWellUSA. com, go to Milton's Discounts in the top menu bar, and the sign up form will appear. Signing up will just take seconds, but the benefits can last for years. Okay, the bad news is that celiac disease can't be cured. The good news is that there is a growing body of knowledge that can help identify the disease and lessen its awful consequences.

And these are things you have to keep in mind. First off, gluten is out. No matter how hard this may be, there is no way around it. Thankfully, stores, restaurants, and virtually everyone else is becoming more accustomed to living in a gluten free environment. Secondly, learn your triggers. Beyond gluten, people experience individualized triggers that can ignite the disease and its symptoms.

These can include stress, pregnancy, childbirth, and viral infection, among others. Third, understand that if you're at high risk for the disease and you're experiencing potential symptoms, fatigue, weight loss, abdominal pain, nausea and constipation, visit your doctor. Get this checked out. Remember, celiac disease It can't be cured just yet, but it can be managed.

Well, that's a wrap for this episode of What the Health. We'd like to thank Megan Donnelly of the Celiac Disease Foundation for the great information and important insights she shared on how to deal with the disease. For those looking for more information, you should check out the foundation's website at celiac.

org. That's celiac. org. It's a great resource on all things celiac. Thanks again for listening, and we hope you'll join us again soon on What the Health.