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Gluten Free Diets Gluten Free Diets

Gluten Free Diets - PowerPoint Presentation

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Gluten Free Diets - PPT Presentation

Beverly Blough MSRD Director of Child Nutrition Wood County Schools What do you know about gluten Gluten is Food additive in bread Starch in potatoes Protein in wheat kernel Edible glue What do you know about gluten ID: 576807

amp gluten wheat free gluten amp free wheat food foods disease celiac symptoms intestinal rice diet protein tight wall

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Slide1

Gluten Free Diets

Beverly Blough MS,RD

Director of Child Nutrition

Wood County SchoolsSlide2

What do you know about gluten?

Gluten is

Food additive in bread

Starch in potatoes

Protein in wheat kernel

Edible glueSlide3

What do you know about gluten?

Gluten is

Food additive in bread

Starch

in potatoes

Protein in wheat kernel

Edible glueSlide4

Mixture of 2 proteins

found in wheat

Gliadin

+

Glutenin

What is gluten?Slide5

Wheat

Seed part of plant

Kernel

Joined with starch

Where is gluten found?Slide6

Other grass plants

(rye & barley)

proteins similar to gluten proteins

rye & barley proteins commonly referred to as gluten

Slide7

How is Gluten Formed?

Add water to wheat flour

strands

of proteins (

gliaden & glutenin) begin as

tangled

messSlide8

How is Gluten Formed?

During process of kneading dough proteins

begin to line up

& gluten gets

stronger Slide9

Gluten Strands

g

luten

strands are very stringySlide10

Gluten Structure

Takes shape into strong & elastic form when…..

w

ater in dough turns into vapor

or

yeast creates carbon dioxide (gas)Slide11

Developed Gluten has

….

Shape

Elasticity

Slide12

End Result

Heat changes gluten from "stringy " strands

to strong

support for

shape

& texture of

foodSlide13

Benefits of Gluten -

elasticity

F

orms

a "film" that can stretch

& hold

shape

Example:

Gluten is used in sausage casingSlide14

Benefits of Gluten

blends in

Bland

-

doesn't interfere with other flavorsComplements other vegetable proteins -

often

mixed with soy protein in TVP

(textured vegetable protein)Slide15

Benefits of Gluten -

binder

Helps meat &

pasta

products keep shape & resists food getting

mushy under heatSlide16

Benefits of Gluten -

absorbency

soaks

up twice its weight of

water

increases yield of food product increases

shelf life

Slide17

Gluten-related Disorders

Allergic reaction

Autoimmune reaction

Sensitivity

In the United States…

1.8 million people have celiac disease

1.4 million people not aware they have celiac disease1.6 million people not diagnosed with celiac disease & on gluten free dietMayo Clinic 7/31/2012Slide18

Allergic Reaction – wheat allergy

Onset – minutes to hours after eating

Affects skin, GI tract, respiratory tract

Two types of reactions to wheat

Wheat-dependent exercise induced anaphylaxis

Dermatitis,

uticaria & anaphylaxis Anaphylaxis – severe whole body allergic reaction Dermatitis – inflammation of skin Uticaria

- hivesSlide19

Autoimmune reactions- celiac disease

Onset –

weeks to years after exposure to gluten

Genetic predisposition

Wide range of symptoms

Autoimmune reaction –

abnormal response by body resulting in harm to healthy tissue in an attempt to destroy what is perceived as a foreign bodySlide20

Autoimmune reactions- celiac disease

Symptoms

Chronic diarrhea

Weight loss

Abdominal bloating & pain

Vomiting

Constipation

Pale, foul smelling, or fatty stoolSlide21

Autoimmune reactions – dermatitis

herpetiformis

Symptoms

Blistering rash

Intense itching of rash

Upper arm & elbow common site of rash

10% of patients have GI symptomsSlide22

Autoimmune reactions – gluten ataxia

Symptoms

Ataxia -

lack of voluntary coordinated muscle movements

Ataxia with

myoclonus

– lack of voluntary coordinated muscle movements & twitching of musclesLess than 10% have GI symptomsSlide23

Immune-mediated form –

gluten sensitivity

Negative test results for

autoimmune reaction to gluten

wheat allergy

Onset – hours to days Symptoms resemble those of Celiac DiseaseImmune-mediated – body reaction triggers inflammationSlide24

Immune-mediated form –

gluten sensitivity

Symptoms –

extraintestinal

Abdominal pain

Eczema and/or rashHeadache

Bone or joint pain

Chronic fatigue

Muscle cramps

Behavioral changes

Numbness in legs, arms or fingers

Weight loss

AnemiaSlide25

The Digestive Tract

Series

of hollow

organs

joined in a

long

twisting tube

Mouth

Esophagus

Stomach

Small Intestine

Large IntestineSlide26

Digesting & Absorbing Nutrients

Food is digested & broken down into

nutrients & absorbed by body in small intestine

Nutrient

Protein

Carbohydrates

Fat

Vitamins

Minerals

Surface of

intestinal wallSlide27

Inside the Small Intestine

Inside lining is called

mucosa

Surface is not flat but folded Slide28

Folds have

fingerlike

projections

called

villi

Mucosa

….up close

Mucosa contains folds

Villi

are covered

with tiny

projectionsSlide29

Tight Junctions

Links between

microvilli

act like glue to keep cells together

Slide30

Tight Junctions

In celiac disease tight junctions come apart & indigestible fragments of gluten seep into underlying tissue & trigger immune system to react

Slide31

Digestion process

Bloodstream

Indigestible food flows to rectum

Microvilli

Food from stomach

Enzyme

Tight Junction

NutrientsSlide32

Celiac Disease Impact

Normal intestinal

lining

Intestinal lining effected by celiac diseaseSlide33

Small Intestine

Normal Celiac Slide34

Leaky Gut & other disorders

T1D (type 1 diabetes )

onset of disease may be linked to malfunction of tight junctions in intestinal wall

Multiple Sclerosis

some evidence of pre-existing problem of presence of too much of protein that breaks down tight junctions

Rheumatoid Arthritis

clear link has been found with increased malfunction of tight junctionsSlide35

Leaky Gut & other disorders

IBS (inflammatory bowel disease)

abnormal intestinal wall may be genetic trait

Asthma

malfunction of intestinal wall may play a role in susceptibility to environmental allergens

Autism

emerging evidence of a subgroup of patients with autism (with or without GI symptoms) may have malfunction of intestinal wall & benefit from gluten free – casein free dietSlide36

Diagnosing Celiac Disease

Presence of typical symptoms

Positive blood test for gluten antibodies

Positive test for genes associated with celiac disease

Biopsy of small intestine reveals inflammation and thickening of intestinal wall

Improvement of symptoms on gluten free dietSlide37

Treatment of Celiac Disease

Gluten Free Diet –

currently only treatment

Stops symptoms within days

Prevents future damage to intestines

Healing of damaged intestinal wall

Children – 3-6 monthsAdults – up to several years

Slide38

The Gluten Free Diet

No wheat, rye or barley

Avoid foods & products with hidden sources of gluten

Slide39

Grains with Gluten

Wheat

Other members of wheat family:

Einkorn

Emmer

Spelt

KamutBarleyRye Triticale (cross between wheat & rye)Slide40

Other Sources of Wheat

Wheat starch

Wheat bran

Wheat germ

Cracked wheat

Hydrolyzed wheat protein

BulgarSlide41

Wheat Flours with Gluten

White & Wheat flour

White & Wheat Bleached flour

White & Wheat Enriched flour

Bromated flour

Durum flour

Graham flour

Phosphated

flour

Self-rising flour

SemolinaFarinaSlide42

Gluten Free Grains

Amaranth Buckwheat Kasha

Millet Quinoa

TeffSlide43

Gluten Free Grains/Flours

Sweet Rice Flour

White Rice Flour

Sorghum Flour

Potato Flour

Tapioca FlourSlide44

Processed Foods To Avoid

Cold cuts, hot dogs, salami, sausage

Self-basting turkey

Imitation Fish

Couscous

Orzo Pasta

Pasta

Pearl Barley

Tabbouleh

Matzo

Communion wafers

Seasoned tortilla chips

Rice Mixes

French fries

Vegetables in saucesSlide45

Processed Foods To Avoid

Barley Malt

Brown rice syrup

Malt

Rusk

TVP

(textured vegetable protein)

Wheat Nuts

Wheat Grass

Bouillon cubes

Gravy

Sauces

Soups

Soy Sauce/Teriyaki Sauce

Candy

Chips/potato chipsSlide46

Items May

Contain Gluten*

Artificial Color

Baking Powder

Caramel Color

Caramel Flavoring

Coloring

Dry Roasted Nuts

Emulsifiers

Flavoring

Food StarchFood Starch ModifiedGlucose Syrup

Ground Spices

Maltodextrin

Miso

Natural Flavoring

Natural Juices

Non-dairy Creamer

Smoke Flavoring

Soba Noodles

StarchVegetable GumVitaminsWheat Starch*Foods may or may not contain gluten depending on where & how they are madeSlide47

Gluten Free Diet at School

Student with gluten related disorder meets definition of “person with a disability”

Federal definition of disability broadened under Americans with Disabilities Act Amendments Act of 2008

“Major Life Activities” now includes “Major Bodily Functions” such as:

‘functions of immune system, normal cell growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, cardiovascular, endocrine and reproductive functions”Slide48

Gluten Free Diet at School

Special diet requires statement from licensed physician* & include:

Food-related disability (diagnosis)

Meal accommodation/food substitutions

School must provide special food/meal

*

diet order must be signed by physician Slide49

Preparing Gluten Free Meals

Follow Child Nutrition Program meal patterns

Well balanced meals are important for healing and preventing vitamin & mineral deficiencies

Ask student

(or parent)

about food likes & dislikes

Student will eat better if served foods they like and are used to eating at home Plan & serve "look like" meals Kids want to feel special but not different Slide50

Gluten Free School Meals

Which tray is Gluten Free?Slide51

Common Gluten Free Foods

Fruits

fresh fruits & plain canned fruit

Vegetables

fresh veggies & plain frozen/can veggies

Dairy

milk, aged cheese, most yogurt, margarine, cottage cheese, sour cream

Proteins

fresh beef, poultry, fish, shellfish, eggs, dried beans & peas, plain nuts, peanut butter, tofu, some hot dogs & luncheon meats

Fats & Oils

vegetable, canola & olive oils, shortenings,

pure mayonnaiseSlide52

Common Gluten Free Foods

Cereals & Grains

General Mills Rice

Chex

cereals, some Post cereals, Cream of Rice, grits, cornmeal, pure corn tortillas, pasta made from rice

Frozen Foods

most ice creams & sherbets

Snacks

most rice cakes, rice crackers, popcorn, plain potato & corn chips,

Jello

Condiments

vinegar, mustard, ketchup, horseradish, jams & jellies, sugar, honey, maple syrup, vanilla, salt & pepper, relish, pickles, olivesSlide53

Finding Gluten Free Foods

Local health food store

GF Bread

GF Breaded Meats

GF Baking Mixes

GF Grains

GF CerealsSlide54

Finding Gluten Free Foods

Local grocery store

www.Kroger.com

List of private label gluten free products

Click on Healthy Living

Click on Nutrition & Fitness Click on Gluten Free

Limited stock of GF foods (varies by store)

*

Find gluten free foods in Ethnic Food Sections such as rice based crackers & noodles Slide55

Finding Gluten Free Foods

Internet Distributors

www.dietspec.com

www.glutenfree.com

www.glutenfreemall.comSlide56

Finding Gluten Free Foods

Companies with “look

alikes

Ian’s Natural Foods – products & interactive fun activities for kids

Kinninnick

products & gluten free information & recipesSlide57

Gluten Free Food Products

Breakfast Foods

Bagels

Breads

Buns

Muffins

Baking MixesCookiesCrackersPastaSlide58

Gluten Free Food Products

Chicken Nuggets

Chicken Patties

Pizza

Lasagna

Soups

Fish SticksSlide59

Food Preparation

Gluten Free

#1 Rule –

"Clean"

kitchen

Wash hands

especially after handling foods with gluten

Wear gloves

- change often

Gluten particles are sticky and

can cling to most kitchen surfacesSlide60

Food Preparation

Gluten Free

#2 Rule – Remove hiding places

No porous equipment such as: Wooden cutting board

Wooden spoons

Worn out vinyl (rubber) spatulas

Blender with old rubber gasket (ring)Slide61

Food Preparation

Gluten Free

#3 Rule - Separate

Separate storage containers

store flour & baking mixes in labeled containers Separate colander (to drain foods)

Separate toaster

(or toast bread in

oven) Separate knives Separate baking pans/muffins tinsSlide62

Food Preparation Tips

Pureed Food –

use mashed potato flakes as thickener

Thickening Gravy/Sauces

– use cornstarch

Cornmeal

– good coating for meat, poultry & fishSlide63

Gluten Free Party Foods

Fresh

or Dried Fruit

String Cheese

Yogurt

Ice Cream

PopcornNuts or Pumpkin seeds

Homemade Trail Mix

Meat/Cheese Roll up in corn

tortillaSlide64

Future Treatments of Celiac Disease

Bioengineered gluten-free grains

Vaccine – restore body’s tolerance of gluten

Medication

Target gluten in intestinal tract – break down into small fragments that will get excreted instead of passing through intestinal wall and triggering an immune response

Blocking ability of protein to trigger breaking of

tight junctionsSlide65

THANK YOU!