Celiac Disease: The Latest Follow-up after Diagnosis

Size: px
Start display at page:

Download "Celiac Disease: The Latest Follow-up after Diagnosis"

Transcription

1 Celiac Disease: The Latest Follow-up after Diagnosis DR. CONNIE M SWITZER MD, FRCPC CLINICAL PROFESSOR OF MEDICINE UNIVERSITY OF ALBERTA CHAIR CCA PROFESSIONAL ADVISORY BOARD

2

3 Accreditation This event is an accredited (Section1) group learning activity as defined by the Maintenance of Certification program of the Royal College of Physicians and Surgeons of Canada (RCPSC). The program was produced under the RCPSC guidelines for the development of co-developed educational activities between the Canadian Association of Gastroenterology (CAG) and Vertex Pharmaceuticals

4 2013 CDDW/CASL Winter Meeting CanMEDS Roles Covered: Medical Expert (as Medical Experts, physicians integrate all of the CanMEDS Roles, applying medical knowledge, clinical skills, and professional attitudes in their provision of patient-centered care. Medical Expert is the central physician Role in the CanMEDS framework.) Communicator (as Communicators, physicians effectively facilitate the doctor-patient relationship and the dynamic exchanges that occur before, during, and after the medical encounter.) Collaborator (as Collaborators, physicians effectively work within a healthcare team to achieve optimal patient care.) Manager (as Managers, physicians are integral participants in healthcare organizations, organizing sustainable practices, making decisions about allocating resources, and contributing to the effectiveness of the healthcare system.) Health Advocate (as Health Advocates, physicians responsibly use their expertise and influence to advance the health and well-being of individual patients, communities, and populations.) Scholar (as Scholars, physicians demonstrate a lifelong commitment to reflective learning, as well as the creation, dissemination, application and translation of medical knowledge.) Professional (as Professionals, physicians are committed to the health and well-being of individuals and society through ethical practice, profession-led regulation, and high personal standards of behaviour.)

5 Financial Interest Disclosure (over the past 24 months) Name: Dr. Connie M Switzer Commercial Interest Ferring, Takeda Takeda Relationship advisory board speaker Related to this presentation: No relevant financial relationships with any commercial interests No Slides were prepared by an industry partner

6 Is dietary adherence assessment enough? No: But it is a start..

7 Celiac Follow-up Challenges Amongst the many guidelines for Celiac follow up there is a lack of clarity re: what, who and when Management of GFD is critical to successful Celiac Rx The role of serology in follow up is evolving Mucosal healing may be slow and lack of agreement on timing/need for repeat biopsy Micronutrient deficiencies may persist on GFD and require treatment Assessment of bone health is important especially in those at highest risk

8 Treatment of Celiac Disease GFD is the treatment for Celiac disease Aimed at treating and reversing the enteropathy Reduces systemic immune/inflammatory reactivity Improves patients GI/systemic symptoms Reverses micro and macro nutrient deficiencies Improves the QoL Improves bone density Prevents complications of Celiac

9 Status of Guidelines: F/U after Celiac diagnosis Practice guidelines are not consistent with regard to follow-up and timing * There is no consensus among recommendations on whether serology should be used (...to) assess compliance. *..incongruency of guidelines in defining the categories of follow up evaluation.. * Lack of clarity on need/timing of biopsy in follow up Follow up evaluation may suboptimal *Herman M et al; CGH, 2012: 10: 893

10 Guidelines for Celiac Follow-up AGA technical review 2001 AGA position statement 2001 NIH Consensus Conference 2004 Pietzak 2005 NASPGHAN 2005; 2012 WGO 2006 BSG 2006; 2010 PCSGI (UK) 2006 Systematic review long term management CD Canadian Position Statement: Bone health in CD 2012

11 Select summary: Guidelines for Laboratory F/U Measure AGA ( 01) NIH ( 04) BSG ( 10) PCSG ( 06) Haines (08) CBC Folate Ferritin B LFT s + Serology +? + + Ca, VitD, PTH? + + Dexa Adapted from: Silvester J, CJG, 2007;21(9):557; Haines et al APT;2008; 28:1042

12 Systematic review: The evidence for long-term management of Celiac Disease.Given the high number of complications associated with CD several risk factors and ways to assess risks.it appears intuitive that follow up is necessary. * *Haines M et al; APT; 2008; 28: 1042

13 Risk Factors for Complications of Celiac Genetic Gluten exposure Monitoring adherence to GFD Intestinal inflammation Assessing mucosal recovery Nutritional deficiency Monitoring for deficiencies and/or their complications Haines M et al; APT; 2008; 28: 1042

14 Risk Factors for Complications: Gluten Gluten exposure Antigenic drive to maintain intestinal inflammation Some evidence that GFD may alter some associated illnesses Evidence that GFD reduces the risk of developing complications or associated illness very difficult to obtain Malignancy risk higher: untreated or dx at older age Longer duration of untreated Celiac Mortality untreated/undiagnosed Celiac 4X higher GFD treats and prevents bone complications AI disease frequency may be reduced with earlier diagnosis Haines M et al; APT; 2008; 28: 1042

15 Monitoring Adherence to GFD Dietary history Skilled dietitian trained in GFD adherence/interview One of the best markers of adherence: low cost, non-invasive, correlation with intestinal damage Validated surveys/questionnaires Clinical assessment: Lack of strict adherence to GFD is the MOST common cause of persistent symptoms Resolution of symptoms is NOT an accurate assessment of GFD adherence or mucosal healing (as far back as 1982) Persistent symptoms may have causes other than gluten ingestion Haines M et al; APT; 2008; 28: 1042

16 Monitoring Adherence to GFD Celiac serology: Levels of attg and EMA fall with gluten restriction attg: 7/8 normalize within ONE year on strict GFD healing Rate of fall or normalization adherence to GFD EMA: 87% normalize at one year mucosal healing Serial serology may be useful in following on-going adherence to GFD Haines M et al; APT; 2008; 28: 1042

17 Monitoring Adherence to GFD Duodenal biopsy: Biopsy is the gold standard for assessing strict adherence to GFD This is a strong argument for performing a follow up bx after 12 months or so on strict GFD * Remember: <50mg gluten/day cause mucosal damage for some as little as 10 mg/day *Haines M et al; APT; 2008; 28: 1042

18 Assessing Mucosal Healing in Celiac disease Clinical assessment: Not a reliable method to determine healing Serology: normalization healing 50-66% pts normalized serology have persistent VA 66% pts who healed mucosa have a normalized serology Persistently +ve or raising titers MAY indicate development of RCD Markers of systemic inflammation Utility of ESR, CRP have not been reported Markers of absorptive surface area and function Intestinal permeability further study required Haines M et al; APT; 2008; 28: 1042; Rubio-Tapia et al, AJG, 2010; 105(6): 1412

19 Assessing Mucosal Healing in Celiac Histologic recovery may be slow even on strict GFD Many adult studies have demonstrated: slow or incomplete healing over time 10% persistent VA over 5 years (Wahab 02) 62% (of 57) persistent VA over 13 mo (Shepherd 08) 40% incomplete healing over 24 mo (Tursi 06) Complete mucosal healing may be slow: 34% complete mucosal recovery at TWO yrs; 66% complete recovery at FIVE yrs (Rubio-Tapia 10) 1/3 continue to have enteropathy 5 years on GFD Haines M et al; APT; 2008; 28: 1042; Rubio-Tapia et al, AJG, 2010; 105(6): 1412

20 What are the causes of delayed healing? Delayed diagnosis: Poor awareness and education about CD High rate of undetected CD; Late intervention Complexity and cost of GFD (242% more expensive) Access to GFF; texture, taste, availability North American lifestyle eating out & travel Hidden sources of gluten Cross contamination with gluten; Inadvertent gluten ingestion Intentional gluten ingestion Social issues: GFF: difference in appearance Food labelling issues

21 Canada s New Labelling Law Bill 1220 Effective August 4 th, 2012 In process for >20 yrs Collaboration by patient advocacy groups Allergen groups & CCA Exemption for the Beer industry All food/beverage are REQUIRED to label for: Almonds, peanuts, sesame seeds, wheat/gluten & triticale, eggs, milk, soybeans, crustasceans, fish, shellfish, mustard seed 2012: Acceptance of end product must have <20ppm of gluten to be GF

22 Risk Factors for Complications: Nutrients Nutritional deficiency: impact on likelihood of complications and can be readily treated Macronutrient deficiency: Celiac: peds developmental delay and growth retardation Micronutrient deficiency: Iron: anemia and cognitive impairment Folate: anemia B def: homocysteine levels ( s thrombosis, miscarriage, LBMD) Calcium, Vitamin D deficiency Vit E:?neurological esp cerebellar disease Selenium: impair thyroid hormone activity?evidence Haines M et al; APT; 2008; 28: 1042

23 Nutritional Deficiency Assessment At diagnosis: Many micronutrient deficiencies Iron, folate, B12, Ca, Zn, Se, Cu, etc Long term F/U on GFD (Sweden; Hallert 2002) 50% adult CD pts have continued abnormal vitamin status including: Low levels B6/12; homocysteine levels B replacement correct folate Calcium, vitamind Others of concern: copper (neurologic), selenium, zinc Causes:???multiple May include intake on strict GFD (GFF are not vitamin fortified) Haines M et al; APT; 2008; 28: 1042; Hallert et al APT; 2009: 811

24 What should be followed and when? Screening blood tests: CBC, Celiac serology, electrolytes, LFT`s, thyroid function, iron studies, calcium, phosphate, vitamin D, folate, B12, fasting glucose, ± zinc, Mg When: At diagnosis At 6 months At one year and annually Duodenal biopsy: At diagnosis At 1-2 yrs; then as indicated on clinical grounds Bone density see new Canadian recommendations At diagnosis At 3-5 years in high risk groups; yearly if osteoporosis on Rx Haines M et al; APT; 2008; 28: 1042

25 Recommendations for Celiac Follow Up (EB) Recommendations on frequency of follow up and who should do the follow up cannot be made based on evidence However: Initial consultation 1-2 weeks after endoscopy Review consultation 3-6 months Subsequent review annually* *Haines M et al; APT; 2008; 28: 1042

26 Recommendations for Celiac Follow Up (EB) Follow up should address: Compliance with the GFD Include assessment of dietary adherence Encouragement of self management strategies (include CCA) Symptoms Duodenal biopsy Appropriate timing has not been established Earlier bx is repeated the higher the likelihood that healing will be incomplete Repeat biopsy NO earlier than 1-2 years *Haines M et al; APT; 2008; 28: 1042

27 Recommendations for Celiac Follow Up (EB) Follow up should address: Nutritional assessment Micronutrient deficiency: CBC, iron studies, Vitamin D, Calcium, phosphate, folate, B12 Homocysteine levels (especial in pts with thromboembolic) PTH level: indicator of 2ndry hyperparathroidism Magnesium (reported low in 13% of pts)( Bode, 1996) Zinc (low in 30% Celiac pts) (Bode, 1996) Vit E & Selenium optional Screening for complications & associated disease Thyroid, glucose, LFT s, electrolytes, platelets Haines M et al; APT; 2008; 28: 1042

28 Canadian Position Statement on Bone Health in Celiac disease At Celiac diagnosis: Only 30% have normal bone mass 30% have osteoporosis;30% osteopenia Risk factors for LBMD Classical presentation, LBMI, postmenopausal, older age at diagnosis, men >age 50, non adherence to GFD, highly elevated attg, 2ndry hyperparathyroidism, RCD Increased fracture risk: adults and children Classical presentation OR 5.2 Overall fracture risk Many have their fractures before diagnosis Fouda MA et al; CJG, 2012; 26 (11): 819

29 Canadian Position Statement on Bone Health in Celiac disease - Adults Indications for BMD testing in Adult Celiac: Classic Celiac disease: BMD done at diagnosis (Level 1) Asymptomatic/silent Celiac disease: BMD should be evaluated after one year on GFD (Level 1) Fouda MA et al; CJG, 2012; 26 (11): 819

30 Canadian Position Statement on Bone Health in Adult Celiac disease Asymptomatic Celiac with other risk factors: BMD (<1 yr after dx): Peri or post menopausal women (Level 1) Men older than 50 (Level 1) History of fragility fracture (Level 1) Unexplained iron deficiency anemia (Level III) Vitamin D deficiency (Level II) High titers for CD serological markers (Level I) Repeat or 1 st time DEXA in all groups at menopause and men over 50 (Level II) The FRAX tool will be useful to estimate # risk (Level II) Fouda MA et al; CJG, 2012; 26 (11): 819

31 Canadian Position Statement on Bone Health in Celiac disease Indications for BMD follow up Osteoporosis & osteopenia at diagnosis: follow up BMD at one year GFD (Level I) Normal BMD at diagnosis Follow up BMD: after TWO years GFD (Level II) Fouda MA et al; CJG, 2012; 26 (11): 819

32 Canadian Position Statement on Bone Health in Celiac disease Treatment: Gluten free diet adherence is the treatment of choice for normalization of BMD in CD patients (Level I) Pharmacological intervention with antiresorptive medications can be used to treat osteoporosis in postmenopausal adult CD patients after ensuring adequate calcium and vit D supplementation (Level III) Fouda MA et al; CJG, 2012; 26 (11): 819

33 Canadian GI s and Celiac follow up Canada: Survey of 585 GI s (response rate: 43%) 76% GI s routinely provide Celiac f/u care 56% almost always order f/u serology Timing of f/u serology: 16% first 3 months 57% at 6 mo 26% at one yr Routine biopsy performed after GFD initiation 38% Always, 36% Never Most common indication for f/u biopsy 76% for on-going symptoms or concern re: GFD adherence 25% to confirm normal histology Silvester J & Rashid M; CJG, 2010;24(8):499

34 USA: What f/u do Celiac patients get? 122 biopsy proven Celiac patients Assessed: what follow up was done from 6mo-5 yrs after dx according to the health records 93% followed for 4 or more years ONLY 35% follow up met AGA recommendations % Clinic visit % GFD compliance Dietitian visit % % Biopsy % Serology 1 year year Herman M et al; CGH, 2012; 10: 893

35 Increasing BMI with GFD Concern regarding BMI following GFD therapy 679 pts with at least 2 BMI s recorded during 39.5 mo f/u Celiac cohort was less likely to be overweight or obese 32% vs 59% p BMI d significantly with introduction of GFD 24.0 to 24.6 p, % with normal or high BMI at start d BMI > 2 points 15.8% moved from a normal/low BMI into an overwt BMI 22% who were overwt at dx continued to gain weight Weight management should be an integral part of Celiac dietary education Kabbani T et al; APT 2012; 35:

36 What have we learned? Follow up strategy is essential for Celiac pts Clinical assessment Important in overall clinical care (includes BMI) Is not an effective measure of mucosal response GFD review essential for successful therapy Serology: indicates response but normalization healing Biopsy is the gold standard for healing Healing may be slow (biopsy recheck 1-2 yrs) Monitoring/treatment of nutritional deficiencies Fe, B6, B12, Vit D, Ca, Se, Cu, Zn Bone Density management important Encourage patient in their self-management

37

NICE guideline Published: 2 September 2015 nice.org.uk/guidance/ng20

NICE guideline Published: 2 September 2015 nice.org.uk/guidance/ng20 Coeliac disease: recognition, assessment and management NICE guideline Published: 2 September 2015 nice.org.uk/guidance/ng20 NICE 2015. All rights reserved. Contents Key priorities for implementation...

More information

GP Guidance: Management of nutrition following bariatric surgery

GP Guidance: Management of nutrition following bariatric surgery GP Guidance: Management of nutrition following bariatric surgery Introduction Patients who are morbidly obese will have struggled with their weight for many years before going forward for bariatric surgery.

More information

BONE DENSITY TEST. Why the Test is Performed BONE MINERAL DENSITY (BMD) TESTING - WHAT THE NUMBERS MEAN

BONE DENSITY TEST. Why the Test is Performed BONE MINERAL DENSITY (BMD) TESTING - WHAT THE NUMBERS MEAN BONE DENSITY TEST BONE MINERAL DENSITY (BMD) TESTING - WHAT THE NUMBERS MEAN People can have osteoporosis without any signs or symptoms. When you have osteoporosis, your bones become weak and are more

More information

CELIAC DISEASE. Conor G. Loftus M.D. and Joseph A. Murray M.D. Division of Gastroenterology and Hepatology Mayo Clinic, Rochester, MN

CELIAC DISEASE. Conor G. Loftus M.D. and Joseph A. Murray M.D. Division of Gastroenterology and Hepatology Mayo Clinic, Rochester, MN CELIAC DISEASE Conor G. Loftus M.D. and Joseph A. Murray M.D. Division of Gastroenterology and Hepatology Mayo Clinic, Rochester, MN 1. What is Celiac Disease (CD)? Celiac disease (CD) is a chronic (long-term)

More information

Nutrition Complications for Celiac Disease

Nutrition Complications for Celiac Disease Nutrition Complications for Celiac Disease Nutritional Iron Deficiency Anemia Iron deficiency anemia is common with celiac disease. In the 2007 Canadian Celiac Health Survey, 49% of respondents reported

More information

New study finds 1 in 7 young Canadian adults vitamin C deficient

New study finds 1 in 7 young Canadian adults vitamin C deficient New study finds 1 in 7 young Canadian adults vitamin C deficient The following is an excerpt by Ahmed El-Sohemy, PhD, a lead researcher in the newly published Canadian study examining ascorbic acid deficiency

More information

Celiac Disease. Donald Schoch, M.D. Ohio ACP Meeting October 17, 2014

Celiac Disease. Donald Schoch, M.D. Ohio ACP Meeting October 17, 2014 Celiac Disease Donald Schoch, M.D. Ohio ACP Meeting October 17, 2014 None to disclose Conflicts of Interest Format Present a case Do a pretest about the evaluation Review case Discuss the questions & answers

More information

Calcium. 1995-2013, The Patient Education Institute, Inc. www.x-plain.com nuf40101 Last reviewed: 02/19/2013 1

Calcium. 1995-2013, The Patient Education Institute, Inc. www.x-plain.com nuf40101 Last reviewed: 02/19/2013 1 Calcium Introduction Calcium is a mineral found in many foods. The body needs calcium to maintain strong bones and to carry out many important functions. Not having enough calcium can cause many health

More information

Calcium and Vitamin D Nutrition in the Elderly. Functions of Calcium. OCW: Geriatric Dentistry (E. Krall)

Calcium and Vitamin D Nutrition in the Elderly. Functions of Calcium. OCW: Geriatric Dentistry (E. Krall) 1. 2. Functions of Calcium Page - 1 3. Regulation of calcium: Hypocalcemia 4. Regulation of calcium: Hypercalcemia Page - 2 5. Calcium Homeostasis 6. Calcium absorption Page - 3 7. Some factors influencing

More information

Nutrition Management After Bariatric Surgery

Nutrition Management After Bariatric Surgery Nutrition Management After Bariatric Surgery Federal Bureau of Prisons Clinical Practice Guidelines October 2013 Clinical guidelines are made available to the public for informational purposes only. The

More information

At the completion of training, the resident will have acquired the following competencies and will function effectively as a:

At the completion of training, the resident will have acquired the following competencies and will function effectively as a: Objectives of Training in the Subspecialty of Endocrinology and Metabolism This document applies to those who begin training on or after July 1 st, 2013. DEFINITION 2013 VERSION 2.0 Endocrinology and Metabolism

More information

Position Statement Weight Loss Surgery (Bariatric Surgery) and its Use in Treating Obesity or Treating and Preventing Diabetes

Position Statement Weight Loss Surgery (Bariatric Surgery) and its Use in Treating Obesity or Treating and Preventing Diabetes Position Statement Weight Loss Surgery (Bariatric Surgery) and its Use in Treating Obesity or Treating and Preventing Diabetes People with diabetes Losing excess weight will assist in the management of

More information

What are Minerals. Lecture 13: Minerals. Trace versus Major Minerals. Minerals are elements, can be found on the periodic table

What are Minerals. Lecture 13: Minerals. Trace versus Major Minerals. Minerals are elements, can be found on the periodic table Lecture 13: Minerals What are Minerals Minerals are elements, can be found on the periodic table Inorganic (in chemical sense) Nutrition 150 Shallin Busch, Ph.D. Not broken down during digestion nor destroyed

More information

Functional Vitamin, Mineral and Antioxidant Assessment

Functional Vitamin, Mineral and Antioxidant Assessment Functional Vitamin, Mineral and Antioxidant Assessment Houston, Texas Micronutrient Test - Clinician Reference Guide Research proves that nutrients ork synergistically so that the status of one nutrient

More information

Background. 5. Where provider organisations are reviewing the provision of GF staple foods on

Background. 5. Where provider organisations are reviewing the provision of GF staple foods on Policy Statement Gluten Free Food on Prescription Statement Summary Coeliac disease is a lifelong autoimmune condition caused by an abnormal immune response to eating gluten. It is one of the most common

More information

Should we Screen for Celiac Disease in IBS?

Should we Screen for Celiac Disease in IBS? Should we Screen for Celiac Disease in? Brennan Spiegel, MD, MSHS Existential Question: What Is? Dietary factors High sorbitol diet High-fiber diet FODMAP Diet Caffeine Alcohol Infection SIBO C. diff Giardiasis

More information

Nutrient Reference Values for Australia and New Zealand

Nutrient Reference Values for Australia and New Zealand Nutrient Reference Values for Australia and New Zealand Questions and Answers 1. What are Nutrient Reference Values? The Nutrient Reference Values outline the levels of intake of essential nutrients considered,

More information

Osteoporosis (Low Bone Mass)

Osteoporosis (Low Bone Mass) Osteoporosis (Low Bone Mass) North American Spine Society Public Education Series What Is It? Osteoporosis is the most common bone disease in the United States and developed countries. It is a disease

More information

OBJECTIVES OF TRAINING IN ADULT AND PEDIATRIC NEPHROLOGY

OBJECTIVES OF TRAINING IN ADULT AND PEDIATRIC NEPHROLOGY The Royal College of Physicians and Surgeons of Canada Le Collège royal des médecins et chirurgiens du Canada 774 promenade Echo Drive, Ottawa, Canada K1S 5N8 Tel: (613) 730-8191 1-800-668-3740 Fax: (613)

More information

Bariatric Patients, Nutritional Intervention for

Bariatric Patients, Nutritional Intervention for SKILL COMPETENCY CHECKLIST Bariatric Patients, Nutritional Intervention for Link to Dietitian Practice and Skill Standard Met/Initials Prerequisite Skills Competency Areas Knowledge of how to conduct a

More information

OHTAC Recommendation Utilization of DXA Bone Mineral Densitometry in Ontario

OHTAC Recommendation Utilization of DXA Bone Mineral Densitometry in Ontario OHTAC Recommendation Utilization of DXA Bone Mineral Densitometry in Ontario November 2006 The Ontario Health Technology Advisory Committee (OHTAC) met on November 17, 2006, and reviewed the analyses of

More information

PREOPERATIVE MANAGEMENT FOR BARIATRIC PATIENTS. Adrienne R. Gomez, MD Bariatric Physician St. Vincent Bariatric Center of Excellence

PREOPERATIVE MANAGEMENT FOR BARIATRIC PATIENTS. Adrienne R. Gomez, MD Bariatric Physician St. Vincent Bariatric Center of Excellence PREOPERATIVE MANAGEMENT FOR BARIATRIC PATIENTS Adrienne R. Gomez, MD Bariatric Physician St. Vincent Bariatric Center of Excellence BARIATRIC SURGERY Over 200,000 bariatric surgical procedures are performed

More information

Ten top tips for the management of patients post bariatric surgery in primary care

Ten top tips for the management of patients post bariatric surgery in primary care Ten top tips for the management of patients post bariatric surgery in primary care Obesity is recognised as a major health and economic issue for the NHS. The rate of severe obesity with BMI >40 is increasing

More information

Calcium and Vitamin D: Important at Every Age

Calcium and Vitamin D: Important at Every Age Calcium and Vitamin D: Important at Every Age National Institutes of Health Osteoporosis and Related Bone Diseases ~ National Resource Center 2 AMS Circle Bethesda, MD 20892-3676 Tel: (800) 624-BONE or

More information

Weighing in on the Gluten-Free Diet

Weighing in on the Gluten-Free Diet Weighing in on the Gluten-Free Diet Melinda Dennis, MS, RDN Nutrition Coordinator, Celiac Center Beth Israel Deaconess Medical Center Boston MA, USA www.celiacnow.org Disclosures Co-author of Real Life

More information

AGS OSTEOPOROSIS WORK-UP. Joseph M. Lane, MD Hospital for Special Surgery New York, NY

AGS OSTEOPOROSIS WORK-UP. Joseph M. Lane, MD Hospital for Special Surgery New York, NY OSTEOPOROSIS WORK-UP AGS Joseph M. Lane, MD Hospital for Special Surgery New York, NY THE AMERICAN GERIATRICS SOCIETY Geriatrics Health Professionals. Leading change. Improving care for older adults. Types

More information

Osteoporosis has been identified by the US Surgeon General

Osteoporosis has been identified by the US Surgeon General New Guidelines for the Prevention and Treatment of Osteoporosis E. Michael Lewiecki, MD, and Nelson B. Watts, MD Abstract: The World Health Organization Fracture Risk Assessment Tool (FRAX ) and the National

More information

Treatment for Severely Obese Patients

Treatment for Severely Obese Patients Treatment for Severely Obese Patients Associate Professor Jimmy So Senior Consultant Surgeon Director, Centre for Obesity Management and Surgery (COMS) National University Hospital Obesity Shortens Lives

More information

Vitamin and Mineral Supplementation and Monitoring for Patients Having Bariatric Surgery. Dietitians

Vitamin and Mineral Supplementation and Monitoring for Patients Having Bariatric Surgery. Dietitians Vitamin and Mineral Supplementation and Monitoring for Patients Having Bariatric Surgery Dietitians We put our patients first by working as one team; leading and listening, and striving for the best. Together,

More information

Iron Supplementation: When

Iron Supplementation: When Iron Supplementation: When & When Not? Nancy F. Krebs, MD, MS Division of Nutrition Department t of Pediatrics i University of Colorado School of Medicine Clinical Nutrition Update 2012 Experimental Biology

More information

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) OSTEOPOROSIS GUIDELINE

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) OSTEOPOROSIS GUIDELINE DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) OSTEOPOROSIS GUIDELINE This is an updated guideline It incorporates the latest NICE guidance There are strong recommendations for calcium + vitamin D

More information

Southern Derbyshire Shared Care Pathology Guidelines. Vitamin D

Southern Derbyshire Shared Care Pathology Guidelines. Vitamin D Southern Derbyshire Shared Care Pathology Guidelines Vitamin D Purpose of guideline Provide clear advice on when to measure vitamin D and identify patients with insufficiency and deficiency. To provide

More information

When Food Goes Bad. Ashis Barad Pediatric Gastroenterology, Hepatology, and Nutrition BaylorScott&White

When Food Goes Bad. Ashis Barad Pediatric Gastroenterology, Hepatology, and Nutrition BaylorScott&White When Food Goes Bad Ashis Barad Pediatric Gastroenterology, Hepatology, and Nutrition BaylorScott&White Context Food allergies, intolerance and sensitivity is falsely used interchangeably Each are distinct

More information

Objectives of Training in the Subspecialty of Clinical Pharmacology and Toxicology

Objectives of Training in the Subspecialty of Clinical Pharmacology and Toxicology Objectives of Training in the Subspecialty of Clinical Pharmacology and Toxicology This document applies to those who begin training on or after July 1 st, 2007. (Please see also the Policies and Procedures.

More information

Bone Basics National Osteoporosis Foundation 2013

Bone Basics National Osteoporosis Foundation 2013 When you have osteoporosis, your bones become weak and are more likely to break (fracture). You can have osteoporosis without any symptoms. Because it can be prevented and treated, an early diagnosis is

More information

Osteoporosis Background and Screening Recommendations. Maria K Jorgensen. Concordia University

Osteoporosis Background and Screening Recommendations. Maria K Jorgensen. Concordia University Osteoporosis Background and Screening Recommendations Maria K Jorgensen Concordia University Master of Public Health Applied Epidemiology December 15, 2014 Osteoporosis Background and Screening Recommendations

More information

Medicare s Preventive Care Services. Manage Your Chronic Kidney Disease (CKD stages 3-4) with Diet

Medicare s Preventive Care Services. Manage Your Chronic Kidney Disease (CKD stages 3-4) with Diet s Preventive Care Services Manage Your Chronic Kidney Disease (CKD stages 3-4) with Diet What do the kidneys do? Your kidneys have important jobs to do in your body. Two of the kidneys most important jobs

More information

Frontier AIDS Education and Training Center

Frontier AIDS Education and Training Center Frontier AIDS Education and Training Center Vitamin D and HIV Subbulaxmi Trikudanathan, MD, MRCP, MMSc Division of Endocrinology, Metabolism and Nutrition University of Washington Medical Center Presentation

More information

Better Bone Health. Presented by: Rachel Ritchison, MS, RD, LD

Better Bone Health. Presented by: Rachel Ritchison, MS, RD, LD Better Bone Health Presented by: Rachel Ritchison, MS, RD, LD HealthSmart Wellness Program HealthSmart Care Management Solutions provides you with many tools and services to help you take a positive and

More information

NATIONAL OSTEOPOROSIS FOUNDATION OSTEOPOROSIS CLINICAL UPDATES Bariatric Surgery And Skeletal Health CE APPLICATION FORM

NATIONAL OSTEOPOROSIS FOUNDATION OSTEOPOROSIS CLINICAL UPDATES Bariatric Surgery And Skeletal Health CE APPLICATION FORM NATIONAL OSTEOPOROSIS FOUNDATION OSTEOPOROSIS CLINICAL UPDATES Bariatric Surgery And Skeletal Health CE APPLICATION FORM First Name: Last Name: Mailing Address: City: State: Zip/Postal Code: Country: Phone

More information

UCSF Kidney Transplant Symposium 2012

UCSF Kidney Transplant Symposium 2012 UCSF Kidney Transplant Symposium 2012 Nutrition Fitness in Kidney Transplant Mary Ellen DiPaola, RD, CDE UCSF Outpatient Dietitian Goal of Nutrition Fitness for Transplant Nutritional guidance of pre-

More information

OSTEOPOROSIS REHABILITATION PROGRAM

OSTEOPOROSIS REHABILITATION PROGRAM OSTEOPOROSIS REHABILITATION PROGRAM Tricia Orme, R.N. BSc(N) Mary Pack Arthritis Program Victoria i Arthritis i Centre Objectives Participants will gain an understanding of what Osteoporosis is and how

More information

Nutrition and Parkinson s Disease: Can food have an impact? Sarah Zangerle, RD, CD Registered Dietitian Froedtert Memorial Lutheran Hospital

Nutrition and Parkinson s Disease: Can food have an impact? Sarah Zangerle, RD, CD Registered Dietitian Froedtert Memorial Lutheran Hospital Nutrition and Parkinson s Disease: Can food have an impact? Sarah Zangerle, RD, CD Registered Dietitian Froedtert Memorial Lutheran Hospital Importance of Nutrition & Parkinson s Disease Good nutrition

More information

Clinical Practice Guideline for Osteoporosis Screening and Treatment

Clinical Practice Guideline for Osteoporosis Screening and Treatment Clinical Practice Guideline for Osteoporosis Screening and Treatment Osteoporosis is a condition of decreased bone mass, leading to bone fragility and an increased susceptibility to fractures. While osteoporosis

More information

Post-DDW OAG Course - Therapeutic Endoscopy

Post-DDW OAG Course - Therapeutic Endoscopy Post-DDW OAG Course - Therapeutic Endoscopy June 13, 2015 Jeffrey Mosko Division of Gastroenterology St. Michael's Hospital University of Toronto moskoj@smh.ca Program Name: Post-DDW OAG course CanMEDS

More information

1. If I go a couple of days without my vitamin D and calcium requirements, can I make up for them?

1. If I go a couple of days without my vitamin D and calcium requirements, can I make up for them? GOOD NUTRITION FOR BONE Calcium, Vitamin D and So Much More QUESTION & ANSWER Wednesday, March 23, 2011 (2:30 p.m. to 4:00 p.m. ET) 1. If I go a couple of days without my vitamin D and calcium requirements,

More information

Nutrition for Life! What starts here Lasts a Lifetime! Helen J. Binns, MD, MPH Professor of Pediatrics and Preventive Medicine

Nutrition for Life! What starts here Lasts a Lifetime! Helen J. Binns, MD, MPH Professor of Pediatrics and Preventive Medicine Nutrition & Children s Health Helen J. Binns, MD, MPH Professor of Pediatrics and Preventive Medicine Northwestern University Feinberg School of Medicine Ann & Robert H. Lurie Children s Hospital of Chicago

More information

Bone Mineral Density: Back to the Basics. Beth Chasen,, MD Assistant Professor MD Anderson Cancer Center

Bone Mineral Density: Back to the Basics. Beth Chasen,, MD Assistant Professor MD Anderson Cancer Center Bone Mineral Density: Back to the Basics Beth Chasen,, MD Assistant Professor MD Anderson Cancer Center Bone Densitometry (DXA)- who needs an evaluation? Women aged 65 and older. Postmenopausal women under

More information

Nephrology is that branch of medicine concerned with the care of patients with kidney disease and disorders of fluid and electrolyte metabolism.

Nephrology is that branch of medicine concerned with the care of patients with kidney disease and disorders of fluid and electrolyte metabolism. Objectives of Training in the Subspecialties of Adult and Pediatric Nephrology This document applies to those who begin training on or after July 1 st, 2012. (Please see also the Policies and Procedures.

More information

Nutrition for Family Living

Nutrition for Family Living Susan Nitzke, Nutrition Specialist; susan.nitzke@ces.uwex.edu Sherry Tanumihardjo, Nutrition Specialist; sherry.tan@ces.uwex.edu Amy Rettammel, Outreach Specialist; arettamm@facstaff.wisc.edu Betsy Kelley,

More information

Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D.

Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D. Vitamin D Deficiency and Thyroid Disease Theodore C. Friedman, M.D., Ph.D. Vitamin D deficiency and thyroid diseases Vitamin D is an important vitamin that not only regulates calcium, but also has many

More information

How can nutrition education contribute to competency-based resident evaluation? 1 4

How can nutrition education contribute to competency-based resident evaluation? 1 4 How can nutrition education contribute to competency-based resident evaluation? 1 4 Darwin Deen ABSTRACT The Curriculum Committee of the Nutrition Academic Award (NAA) has created a consensus document

More information

About Celiac Disease. A document providing answers and references to the most frequently asked questions about Celiac Disease

About Celiac Disease. A document providing answers and references to the most frequently asked questions about Celiac Disease About Celiac Disease A document providing answers and references to the most frequently asked questions about Celiac Disease FAQ AboutCeliacDisease rev1 Basics What is Celiac Disease? Celiac Disease is

More information

Osteoporosis. Dr Gordon MacDonald BSc MB BChir MRCP Consultant Rheumatologist. Rheumatology and Arthritis Seminar Tuesday 5 th February 2013

Osteoporosis. Dr Gordon MacDonald BSc MB BChir MRCP Consultant Rheumatologist. Rheumatology and Arthritis Seminar Tuesday 5 th February 2013 Osteoporosis Dr Gordon MacDonald BSc MB BChir MRCP Consultant Rheumatologist Rheumatology and Arthritis Seminar Tuesday 5 th February 2013 Plan What is osteoporosis? Consequences of osteoporosis Risk factors

More information

Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D.

Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D. Vitamin D Deficiency and Thyroid Disease Theodore C. Friedman, M.D., Ph.D. Vitamin D deficiency and thyroid diseases Vitamin D is an important vitamin that not only regulates calcium, but also has many

More information

ESPEN Congress Geneva 2014 LLL LIVE COURSE: NUTRITION IN OBESITY

ESPEN Congress Geneva 2014 LLL LIVE COURSE: NUTRITION IN OBESITY ESPEN Congress Geneva 2014 LLL LIVE COURSE: NUTRITION IN OBESITY Pre-operative medical assessment, post-operative follow-up and clinical outcome in bariatric surgery patients A. Thorell (SE) Nutrition

More information

Bone Appétit: New Information on Calcium & Vitamin D QUESTION & ANSWER

Bone Appétit: New Information on Calcium & Vitamin D QUESTION & ANSWER Bone Appétit: New Information on Calcium & Vitamin D QUESTION & ANSWER Wednesday, November 17, 2010 1:30 p.m. to 3:00 p.m. ET 1. I like to drink warm milk, but I have heard that heating some vitamins can

More information

Cystic fibrosis and bone health

Cystic fibrosis and bone health Cystic fibrosis and bone health Factsheet March 2013 Cystic fibrosis and bone health Introduction As we get older our bones become thinner and weaker, and may become more susceptible to fracture. However

More information

Lifestyle and Special Diet Guidance

Lifestyle and Special Diet Guidance Lifestyle and Special Diet Guidance Vegan A vegan diet consists of vegetables, grains, nuts, fruits and other foods made only from plants. We have a variety of recipes which are suitable for vegans on

More information

Metabolic Disorders , The Patient Education Institute, Inc. idg90101 Last reviewed: 08/14/2014 1

Metabolic Disorders , The Patient Education Institute, Inc.  idg90101 Last reviewed: 08/14/2014 1 Metabolic Disorders Introduction Metabolism is the process your body uses to make energy from the food you eat. Your body can use this fuel right away, or it can store the energy in your body tissues,

More information

Nutrition and Wellness in Cancer Survivorship. Kathy Hunt RD,CD,CSO Pediatric Oncology Dietitian Seattle Children s Hospital October 27, 2012

Nutrition and Wellness in Cancer Survivorship. Kathy Hunt RD,CD,CSO Pediatric Oncology Dietitian Seattle Children s Hospital October 27, 2012 Nutrition and Wellness in Cancer Survivorship Kathy Hunt RD,CD,CSO Pediatric Oncology Dietitian Seattle Children s Hospital October 27, 2012 Survivorship, quite simply, begins when you are told you have

More information

ICD-9-CM/ICD-10-CM Codes for MNT

ICD-9-CM/ICD-10-CM Codes for MNT / Codes for MNT ICD (International Classification of Diseases) codes are used by physicians and medical coders to assign medical diagnoses to individual patients. It is not within the scope of practice

More information

Daily Fuel: Hype, Hope or Truth?

Daily Fuel: Hype, Hope or Truth? 4/12/16 Disclosures Daily Fuel: Hype, Hope or Truth? I declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including

More information

Disability Evaluation Under Social Security

Disability Evaluation Under Social Security Disability Evaluation Under Social Security Revised Medical Criteria for Evaluating Endocrine Disorders Effective June 7, 2011 Why a Revision? Social Security revisions reflect: SSA s adjudicative experience.

More information

Fish in the diet a review. Sara Stanner British Nutrition Foundation

Fish in the diet a review. Sara Stanner British Nutrition Foundation Fish in the diet a review Sara Stanner British Nutrition Foundation www.nutrition.org.uk s.stanner@nutrition.org.uk BNF who we are, what we do? What the review covers Fish consumption Nutrient composition

More information

Fortunately, there are many things we can do at every age to keep our bones strong and healthy.

Fortunately, there are many things we can do at every age to keep our bones strong and healthy. Healthy Bones at Every Age Page ( 1 ) Bone health is important at every age and stage of life. The skeleton is our body s storage bank for calcium a mineral that is necessary for our bodies to function.

More information

Also attached are potential complications associated with each of the various procedures.

Also attached are potential complications associated with each of the various procedures. Dear Practitioner: You may encounter patients in your practice who come to you following recent bariatric surgery or have had bariatric surgery elsewhere at some time in the past and are coming to you

More information

GRADUATE PROGRAMS IN HUMAN NUTRITION COURSE DESCRIPTIONS 2014-2015

GRADUATE PROGRAMS IN HUMAN NUTRITION COURSE DESCRIPTIONS 2014-2015 GRADUATE PROGRAMS IN HUMAN NUTRITION COURSE DESCRIPTIONS 2014-2015 The following table shows the planned course offerings for the 2014-2015 academic year. Courses are subject to change. Summer 2014 Fall

More information

PROTOCOL FOR PATIENTS WITH ABNORMAL LAB AND X-RAY VALUES

PROTOCOL FOR PATIENTS WITH ABNORMAL LAB AND X-RAY VALUES PROTOCOL FOR PATIENTS WITH ABNORMAL LAB AND X-RAY VALUES Patients newly diagnosed as osteopenic or osteoporotic on a radiology report or patients receiving abnormal lab values on the following lab tests

More information

WIRRAL GUIDELINES FOR THE MANAGEMENT OF OSTEOPOROSIS

WIRRAL GUIDELINES FOR THE MANAGEMENT OF OSTEOPOROSIS Clinical Guideline WIRRAL GUIDELINES FOR THE MANAGEMENT OF OSTEOPOROSIS The scope of these guidelines covers:- Secondary prevention of osteoporotic fragility fractures Primary prevention of osteoporosis

More information

Anaemia Patient information

Anaemia Patient information Anaemia Patient information What is anaemia? Anaemia is the result of either not having enough red cells to take oxygen around the body, or having faulty red cells that are unable to carry enough oxygen.

More information

Rob Enns University of British Columbia, Vancouver. Grigorios Leontiadis McMaster University, Hamilton

Rob Enns University of British Columbia, Vancouver. Grigorios Leontiadis McMaster University, Hamilton Rob Enns University of British Columbia, Vancouver Grigorios Leontiadis McMaster University, Hamilton Accreditation This event has been approved as an accredited (Section1) group learning activity as defined

More information

Feeds and Feeding of Commercial Poultry. AgScience Poultry Science Curriculum Section 5

Feeds and Feeding of Commercial Poultry. AgScience Poultry Science Curriculum Section 5 Feeds and Feeding of Commercial Poultry AgScience Poultry Science Curriculum Section 5 Introduction Nutrition is one of the most important aspects of poultry production Comprises 60-70% of production cost

More information

Guidance on Prescribing of Gluten-Free Products within Primary Care on NHS Prescription (for Adults)

Guidance on Prescribing of Gluten-Free Products within Primary Care on NHS Prescription (for Adults) Guidance on Prescribing of Gluten-Free Products within Primary Care on NHS Prescription (for Adults) This guidance applies to all prescribers, both medical and non-medical. NHS Shropshire Clinical Commissioning

More information

Easy-to-Read Information for Patients and Families. U.S. Department of Health and Human Services National Institutes of Health

Easy-to-Read Information for Patients and Families. U.S. Department of Health and Human Services National Institutes of Health BONE HEALTH FOR LIFE Easy-to-Read Information for Patients and Families U.S. Department of Health and Human Services National Institutes of Health National Institute of Arthritis and Musculoskeletal and

More information

Wellness for People with MS: What do we know about Diet, Exercise and Mood And what do we still need to learn? March 2015

Wellness for People with MS: What do we know about Diet, Exercise and Mood And what do we still need to learn? March 2015 Wellness for People with MS: What do we know about Diet, Exercise and Mood And what do we still need to learn? March 2015 Introduction Wellness and the strategies needed to achieve it is a high priority

More information

Identifying Celiac Disease and Gluten Sensitivity with Minimally Invasive Testing

Identifying Celiac Disease and Gluten Sensitivity with Minimally Invasive Testing Identifying Celiac Disease and Gluten Sensitivity with Minimally Invasive Testing Enjoy this white paper by Jack A. Maggiore, PhD, MT(ASCP), Assistant Director, Chemistry Laboratory and R&D at Doctor s

More information

Osteoporosis in Women

Osteoporosis in Women What is osteoporosis? What is osteopenia? Osteoporosis is a problem in which bones are less dense and more fragile and thus at greater risk for fracture, even with a small amount of trauma. This disease

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: testing_serum_vitamin_d_levels 9/2015 2/2016 2/2017 2/2016 Description of Procedure or Service Vitamin D,

More information

Can You Be Vegan/Vegetarian after Bariatric Surgery?

Can You Be Vegan/Vegetarian after Bariatric Surgery? Can You Be Vegan/Vegetarian after Bariatric Surgery? By Laurie Shank, RD, LDN Bariatric Dietitian All Bariatric surgery patients know that we must be diligent with our nutrient intake after surgery. It

More information

Nutritional Challenges After Surgery

Nutritional Challenges After Surgery Nutritional Challenges After Surgery L I N D A P A T A K I M S R D C S O L D C N S C M D A N D E R S O N C A N C E R C E N T E R H O U S T O N, T E X A S Objectives Identify the reasons that GIST and its

More information

Alcoholic and Non-Alcoholic Fatty Liver Disease

Alcoholic and Non-Alcoholic Fatty Liver Disease Alcoholic and Non-Alcoholic Fatty Liver Disease Thomas W. Faust, M.D., M.B.E. Professor of Clinical Medicine Division of Gastroenterology The University of Pennsylvania Alcoholic Liver Disease Additional

More information

Recognizing the Signs of Gluten Intolerance

Recognizing the Signs of Gluten Intolerance Recognizing the Signs of Gluten Intolerance Schellenberg Chiropractic Inc. Dr. John Schellenberg 3445 Penrose Place Suite 260 Boulder, CO 80301 Introduction Gluten Intolerance (celiac disease) is a life-long

More information

Hair Thinning following Bariatric Surgery. June 2, 2016 Support Group

Hair Thinning following Bariatric Surgery. June 2, 2016 Support Group Hair Thinning following Bariatric Surgery June 2, 2016 Support Group How Hair Grows: At any given time, about 90% of hairs are in a growth stage 1 2 % are in the transition where growth stops The other

More information

Objectives of Training in Medical Oncology

Objectives of Training in Medical Oncology Objectives of Training in Medical Oncology 2009 EDITORIAL REVISIONS 2011 This document applies to those who begin training on or after July 1 st, 2011. (Please see also the Policies and Procedures. ) DEFINITION

More information

Nutrition and OI. Introduction. Nutrition Related Problems

Nutrition and OI. Introduction. Nutrition Related Problems Nutrition and OI 804 W. Diamond Ave., Ste. 210 Gaithersburg, MD 20878 (800) 981-2663 (301) 947-0083 Fax: (301) 947-0456 Internet: www.oif.org Email: bonelink@oif.org The Osteogenesis Imperfecta Foundation,

More information

Specific Standards of Accreditation for Residency Programs in Orthopedic Surgery

Specific Standards of Accreditation for Residency Programs in Orthopedic Surgery Specific Standards of Accreditation for Residency Programs in Orthopedic Surgery 2012 INTRODUCTION A university wishing to have an accredited program in Orthopedic Surgery must also sponsor an accredited

More information

Gluten-Free Market Trends

Gluten-Free Market Trends Gluten-Free Market Trends Our trend data shows the gluten-free target audience to be 44 million strong. In order to understand the dynamic growth trends taking place in the gluten- free market it is important

More information

Standing Up to Osteoporosis

Standing Up to Osteoporosis Virginia Commonwealth University VCU Scholars Compass Case Studies from Age in Action Virginia Center on Aging 1997 Standing Up to Osteoporosis Robert W. Downs Virginia Commonwealth University, rdowns@mcvh-vcu.edu

More information

Lakeside Family Physicians & Lakeside Primary Care Patient Centered Medical Home Program Bone Densitometry Disease Management Pathway

Lakeside Family Physicians & Lakeside Primary Care Patient Centered Medical Home Program Bone Densitometry Disease Management Pathway Lakeside Family Physicians & Lakeside Primary Care Patient Centered Medical Home Program Bone Densitometry Disease Management Pathway PROTOCOL FOR PATIENTS WITH ABNORMAL LAB AND X-RAY VALUES Patients newly

More information

Gastroenterology Celiac Disease Update

Gastroenterology Celiac Disease Update Celiac Disease Update A majority of patients go undiagnosed due to a lack of understanding By Catlin Nalley 24 MAY/JUNE 2015 NURSE PRACTITIONER PERSPECTIVE www.advanceweb.com/nppa May is Celiac Disease

More information

Blood Testing Protocols. Disclaimer

Blood Testing Protocols. Disclaimer Blood Testing Protocols / Page 2 Blood Testing Protocols Here are the specific test protocols recommend by Dr. J.E. Williams. You may request these from your doctor or visit www.readyourbloodtest.com to

More information

Overview. Nutritional Aspects of Primary Biliary Cirrhosis. How does the liver affect nutritional status?

Overview. Nutritional Aspects of Primary Biliary Cirrhosis. How does the liver affect nutritional status? Overview Nutritional Aspects of Primary Biliary Cirrhosis Tracy Burch, RD, CNSD Kovler Organ Transplant Center Northwestern Memorial Hospital Importance of nutrition therapy in PBC Incidence and pertinence

More information

GET THE GUTSY TRUTH ABOUT INFLAMMATORY BOWEL DISEASE EXPECT MORE FROM YOUR TREATMENT

GET THE GUTSY TRUTH ABOUT INFLAMMATORY BOWEL DISEASE EXPECT MORE FROM YOUR TREATMENT GET THE GUTSY TRUTH ABOUT INFLAMMATORY BOWEL DISEASE EXPECT MORE FROM YOUR TREATMENT Patient Education Forums - KOL Presentation What We Will Discuss Today Understanding Inflammatory Bowel Disease (IBD)

More information

Objectives of Training in Radiation Oncology

Objectives of Training in Radiation Oncology Objectives of Training in Radiation Oncology 2008 This document applies to those who begin training on or after July 1 st, 2009. (Please see also the Policies and Procedures. ) DEFINITION Radiation Oncologists

More information

ADVANCED SUBSIDIARY (AS) General Certificate of Education January Home Economics Assessment Unit AS 1. assessing. Nutrition for Optimal Health

ADVANCED SUBSIDIARY (AS) General Certificate of Education January Home Economics Assessment Unit AS 1. assessing. Nutrition for Optimal Health New Specification ADVANCED SUBSIDIARY (AS) General Certificate of Education January 2011 Home Economics Assessment Unit AS 1 assessing Nutrition for Optimal Health [AN111] MONDAY 10 JANUARY, AFTERNOON

More information

Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D.

Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D. Vitamin D Deficiency and Thyroid Disease Theodore C. Friedman, M.D., Ph.D. Vitamin D deficiency and thyroid diseases Vitamin D is an important vitamin that not only regulates calcium, but also has many

More information

NHRMC General Surgery Specialists. Minimally Invasive Gastrointestinal Surgery Phone: 910-662-9300 Fax: 910-662-9303

NHRMC General Surgery Specialists. Minimally Invasive Gastrointestinal Surgery Phone: 910-662-9300 Fax: 910-662-9303 Minimally Invasive Gastrointestinal Surgery Phone: 910-662-9300 Fax: 910-662-9303 W. Borden Hooks III, MD 1725 New Hanover Medical Park Drive Wilmington, NC 28403 Thank you for choosing NHRMC General Surgery

More information

Chapter 4 to supplement or not to supplement

Chapter 4 to supplement or not to supplement Chapter 4 to supplement or not to supplement What vitamins and minerals do I really need? What about other supplements herbal and botanical supplements, fibre and meal replacements, for example? CHAPTER

More information

Boning Up On Osteoporosis

Boning Up On Osteoporosis Boning Up On Osteoporosis Nicholas J. Avallone,, M.D. Orthopedic Surgeon Sports Medicine Specialist Conflicts of Interest I have no relationships with any company listed in this talk. Resources National

More information