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
Download Presentation The PPT/PDF document "Gluten Free Diets" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
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!