gluten free diets
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Gluten Free Diets. Beverly Blough MS,RD 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?. Gluten is Food additive in bread - PowerPoint PPT PresentationTRANSCRIPT
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Gluten Free Diets
Beverly Blough MS,RDDirector of Child NutritionWood County Schools
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What do you know about gluten?
Gluten is (a) Food additive in bread(b) Starch in potatoes(c) Protein in wheat kernel(d) Edible glue
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What do you know about gluten?
Gluten is (a) Food additive in bread(b) Starch in potatoes(c) Protein in wheat kernel(d) Edible glue
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Mixture of 2 proteins found in wheat
Gliadin + Glutenin
What is gluten?
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Wheat Seed part of plant
Kernel Joined with starch
Where is gluten found?
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Other grass plants (rye & barley)
proteins similar to gluten proteins
rye & barley proteins commonly referred to as gluten
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How is Gluten Formed?
Add water to wheat flourstrands of proteins (gliaden & glutenin) begin as tangled mess
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How is Gluten Formed?
During process of kneading dough proteins begin to line up & gluten gets stronger
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Gluten Strands
gluten strands are very stringy
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Gluten StructureTakes shape into strong & elastic form when…..
water in dough turns into vapor or
yeast creates carbon dioxide (gas)
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Developed Gluten has….
• Shape
• Elasticity
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End Result Heat changes gluten from "stringy " strands to strong support for shape & texture of food
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Benefits of Gluten - elasticity
Forms a "film" that can stretch & hold shape
Example: Gluten is used in sausage casing
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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)
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Benefits of Gluten - binder
Helps meat & pasta products keep shape & resists food getting mushy under heat
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Benefits of Gluten - absorbency
• soaks up twice its weight of water
• increases yield of food product
• increases shelf life
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Gluten-related DisordersAllergic reaction
Autoimmune reaction
SensitivityIn the United States…1.8 million people have celiac disease1.4 million people not aware they have celiac disease1.6 million people not diagnosed with celiac disease & on gluten free diet
Mayo Clinic 7/31/2012
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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
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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
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Autoimmune reactions- celiac disease
Symptoms
• Chronic diarrhea
• Weight loss
• Abdominal bloating & pain
• Vomiting
• Constipation
• Pale, foul smelling, or fatty stool
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Autoimmune reactions – dermatitis herpetiformis
Symptoms
Blistering rash
Intense itching of rash
Upper arm & elbow common site of rash
10% of patients have GI symptoms
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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
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Immune-mediated form – gluten
sensitivityNegative test results for
autoimmune reaction to glutenwheat allergy
Onset – hours to days
Symptoms resemble those of Celiac Disease
Immune-mediated – body reaction triggers inflammation
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Immune-mediated form – gluten
sensitivitySymptoms – 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
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The Digestive Tract
Series of hollow organs joined in a long twisting tube
Mouth
Esophagus
Stomach
Small IntestineLarge
Intestine
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Digesting & Absorbing Nutrients Food is digested & broken down into nutrients & absorbed by body in small intestine
Nutrient
ProteinCarbohydratesFatVitaminsMinerals
Surface of intestinal wall
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Inside the Small Intestine
Inside lining is called mucosa
Surface is not flat but folded
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Folds have fingerlike
projections called villi
Mucosa ….up close
Mucosa contains folds
Villi are covered with tiny
projections
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Tight Junctions
Links between microvilli act like glue to keep cells together
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Tight Junctions
In celiac disease tight junctions come apart & indigestible fragments of gluten seep into underlying tissue & trigger immune system to react
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Digestion process
Bloodstream
Indigestible food flows to rectum
Microvilli
Food from stomach
Enzyme
Tight Junction
Nutrients
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Celiac Disease Impact
Normal intestinal lining
Intestinal lining effected by celiac disease
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Small Intestine
Normal Celiac
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Leaky Gut & other disordersT1D (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
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Leaky Gut & other disordersIBS (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
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Diagnosing Celiac DiseasePresence 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
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Treatment of Celiac Disease
Gluten Free Diet – currently only treatmentStops symptoms within days
Prevents future damage to intestines
Healing of damaged intestinal wall Children – 3-6 monthsAdults – up to several years
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The Gluten Free Diet
No wheat, rye or barley
Avoid foods & products with hidden sources of gluten
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Grains with Gluten
WheatOther members of wheat family:
EinkornEmmerSpeltKamut
BarleyRye Triticale (cross between wheat & rye)
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Other Sources of Wheat
Wheat starch
Wheat bran
Wheat germ
Cracked wheat
Hydrolyzed wheat protein
Bulgar
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Wheat Flours with GlutenWhite & Wheat flour White & Wheat Bleached flourWhite & Wheat Enriched flourBromated flourDurum flourGraham flourPhosphated flourSelf-rising flourSemolinaFarina
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Gluten Free Grains Amaranth Buckwheat Kasha
Millet Quinoa Teff
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Gluten Free Grains/Flours
Sweet Rice Flour
White Rice Flour
Sorghum Flour
Potato Flour
Tapioca Flour
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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 sauces
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Processed Foods To AvoidBarley 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
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Items May Contain Gluten*Artificial ColorBaking PowderCaramel ColorCaramel FlavoringColoringDry Roasted NutsEmulsifiersFlavoringFood StarchFood Starch ModifiedGlucose SyrupGround Spices
MaltodextrinMisoNatural FlavoringNatural JuicesNon-dairy CreamerSmoke FlavoringSoba NoodlesStarchVegetable GumVitaminsWheat Starch
*Foods may or may not contain gluten depending on where & how they are made
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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”
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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
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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 & dislikesStudent 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
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Gluten Free School Meals
Which tray is Gluten Free?
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Common Gluten Free FoodsFruits – 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 mayonnaise
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Common Gluten Free FoodsCereals & 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, olives
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Finding Gluten Free Foods
Local health food store
GF Bread
GF Breaded Meats
GF Baking Mixes
GF Grains
GF Cereals
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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
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Finding Gluten Free FoodsInternet Distributors
www.dietspec.com
www.glutenfree.com
www.glutenfreemall.com
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Finding Gluten Free FoodsCompanies with “look alikes”
Ian’s Natural Foods – products & interactive fun activities for kids
Kinninnick – products & gluten free information & recipes
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Gluten Free Food ProductsBreakfast FoodsBagelsBreadsBunsMuffinsBaking MixesCookiesCrackersPasta
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Gluten Free Food ProductsChicken NuggetsChicken PattiesPizzaLasagnaSoupsFish Sticks
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Food Preparation – Gluten Free#1 Rule –"Clean" kitchen
Wash hands – especially after handling foods with glutenWear gloves - change often
Gluten particles are sticky andcan cling to most kitchen surfaces
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Food Preparation – Gluten Free#2 Rule – Remove hiding places No porous equipment such as:
Wooden cutting boardWooden spoonsWorn out vinyl (rubber) spatulas Blender with old rubber gasket (ring)
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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 knivesSeparate baking pans/muffins tins
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Food Preparation TipsPureed Food – use mashed potato flakes as thickener
Thickening Gravy/Sauces – use cornstarch
Cornmeal – good coating for meat, poultry & fish
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Gluten Free Party Foods
Fresh or Dried FruitString CheeseYogurt Ice CreamPopcornNuts or Pumpkin seedsHomemade Trail MixMeat/Cheese Roll up in corn tortilla
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Future Treatments of Celiac Disease
Bioengineered gluten-free grainsVaccine – restore body’s tolerance of glutenMedication
Target gluten in intestinal tract – break down into small fragments that will get excreted instead of passing through intestinal wall and triggering an immune responseBlocking ability of protein to trigger breaking of tight junctions
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THANK YOU!