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Gluten Free Diets

Gluten Free Diets

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Gluten Free Diets

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  1. Gluten Free Diets Beverly Blough MS,RD Director of Child Nutrition Wood County Schools

  2. What do you know about gluten? Gluten is Food additive in bread Starch in potatoes Protein in wheat kernel Edible glue

  3. What do you know about gluten? Gluten is Food additive in bread Starch in potatoes Protein in wheat kernel Edible glue

  4. What is gluten? Mixture of 2 proteins found in wheat Gliadin + Glutenin

  5. Where is gluten found? WheatSeed part of plant KernelJoined with starch

  6. Other grass plants(rye & barley) • proteins similar to gluten proteins • rye & barley proteins commonly referred to as gluten

  7. How is Gluten Formed? Add water to wheat flour strands of proteins (gliaden & glutenin) begin as tangled mess

  8. How is Gluten Formed? During process of kneading dough proteins begin to line up & gluten gets stronger

  9. Gluten Strands gluten strands are very stringy

  10. Gluten Structure Takes shape into strong & elastic form when….. water in dough turns into vapor or yeast creates carbon dioxide (gas)

  11. Developed Gluten has…. Shape Elasticity

  12. End Result Heat changes gluten from "stringy " strands to strong support for shape & texture of food

  13. Benefits of Gluten - elasticity Forms a "film" that can stretch & hold shape Example: Gluten is used in sausage casing

  14. Benefits of Gluten –blends in Bland - doesn't interfere with other flavors Complements other vegetable proteins - often mixed with soy protein in TVP (textured vegetable protein)

  15. Benefits of Gluten - binder Helps meat & pasta products keep shape & resists food getting mushy under heat

  16. Benefits of Gluten - absorbency soaks up twice its weight of water increases yield of food product increases shelf life

  17. 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 disease 1.6 million people not diagnosed with celiac disease & on gluten free diet Mayo Clinic 7/31/2012

  18. 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 - hives

  19. 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 body

  20. Autoimmune reactions- celiac disease • Symptoms • Chronic diarrhea • Weight loss • Abdominal bloating & pain • Vomiting • Constipation • Pale, foul smelling, or fatty stool

  21. Autoimmune reactions – dermatitis herpetiformis • Symptoms • Blistering rash • Intense itching of rash • Upper arm & elbow common site of rash • 10% of patients have GI symptoms

  22. Autoimmune reactions – gluten ataxia • Symptoms • Ataxia - lack of voluntary coordinated muscle movements • Ataxia with myoclonus – lack of voluntary coordinated muscle movements & twitching of muscles • Less than 10% have GI symptoms

  23. Immune-mediated form –gluten sensitivity • Negative test results for • autoimmune reaction to gluten • wheat allergy • Onset – hours to days • Symptoms resemble those of Celiac Disease Immune-mediated – body reaction triggers inflammation

  24. Immune-mediated form –gluten sensitivity • Symptoms – extraintestinal • Abdominal pain • Eczema and/or rash • Headache • Bone or joint pain • Chronic fatigue • Muscle cramps • Behavioral changes • Numbness in legs, arms or fingers • Weight loss • Anemia

  25. The Digestive Tract Mouth Esophagus Series of hollow organs joined in a long twisting tube Stomach Small Intestine Large Intestine

  26. Digesting & Absorbing Nutrients Food is digested & broken down into nutrients & absorbed by body in small intestine Surface of intestinal wall Nutrient Protein Carbohydrates Fat Vitamins Minerals

  27. Inside the Small Intestine Inside lining is called mucosa Surface is not flat but folded

  28. Mucosa ….up close Folds have fingerlike projections called villi Villi are covered with tiny projections Mucosa contains folds

  29. Tight Junctions Links between microvilli act like glue to keep cells together

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

  31. Digestion process Enzyme Indigestible food flows to rectum Food from stomach Microvilli Tight Junction Nutrients Bloodstream

  32. Celiac Disease Impact Normal intestinal lining Intestinal lining effected by celiac disease

  33. Small Intestine Normal Celiac

  34. 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 junctions

  35. 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 diet

  36. 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 diet

  37. 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 months • Adults – up to several years

  38. The Gluten Free Diet No wheat, rye or barley Avoid foods & products with hidden sources of gluten

  39. Grains with Gluten • Wheat • Other members of wheat family: • Einkorn • Emmer • Spelt • Kamut • Barley • Rye • Triticale (cross between wheat & rye)

  40. Other Sources of Wheat • Wheat starch • Wheat bran • Wheat germ • Cracked wheat • Hydrolyzed wheat protein • Bulgar

  41. 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 • Semolina • Farina

  42. Gluten Free Grains Amaranth Buckwheat Kasha Millet Quinoa Teff

  43. Gluten Free Grains/Flours • Sweet Rice Flour • White Rice Flour • Sorghum Flour • Potato Flour • Tapioca Flour

  44. Processed Foods To Avoid Tabbouleh Matzo Communion wafers Seasoned tortilla chips Rice Mixes French fries Vegetables in sauces • Cold cuts, hot dogs, salami, sausage • Self-basting turkey • Imitation Fish • Couscous • Orzo Pasta • Pasta • Pearl Barley

  45. 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 chips

  46. Items May Contain Gluten* • Artificial Color • Baking Powder • Caramel Color • Caramel Flavoring • Coloring • Dry Roasted Nuts • Emulsifiers • Flavoring • Food Starch • Food Starch Modified • Glucose Syrup • Ground Spices • Maltodextrin • Miso • Natural Flavoring • Natural Juices • Non-dairy Creamer • Smoke Flavoring • Soba Noodles • Starch • Vegetable Gum • Vitamins • Wheat Starch *Foods may or may not contain gluten depending on where & how they are made

  47. 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”

  48. 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

  49. 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

  50. Gluten Free School Meals Which tray is Gluten Free?