download the webinar slides - national foundation for celiac

Yes, You Can Eat!

When Gluten Isn’t the Only Ingredient to Avoid

with Melinda Dennis, MS, RD, LDN

Beth Israel Deaconess Medical Center

Brought to you by Lucy’s

www.CeliacCentral.org Restoring Health … Reclaiming Lives. National Foundation for Celiac Awareness 2012. All rights reserved.

www.CeliacCentral.org Restoring Health … Reclaiming Lives.

National Foundation for Celiac Awareness 2012. All rights reserved.



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after the live Webinar ends. To download recorded webinars and slides, visit the Archived

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participate in this live 60-minute webinar to obtain continuing education credits

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Three Important Reminders!

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③ In early July, NFCA community members can look for a review of the presentation in the form of

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Three Important Reminders!



A total of 3 webinar participants will each win a special prize pack from Lucy’s!

• Each prize pack includes a 5.5 oz. box of Lucy's newest flavors of gluten-free, vegan cookies

(made without milk, eggs, peanuts, or tree nuts!)

Ginger Snap: These snaps are made with real ginger, lemon and a tiny tad of chipotle spice.

Kids love them as much as grown-ups do.

Maple Bliss: These are crispy, crunchy, delicate, Maple Bliss. You'll think organic maple syrup

dripped right from the tree into our batter. Not too sweet. Just right!

Chocolate: These chocolate cookies have a delicate, crisp flavor. Eat them, crumble them

over frozen treats, make a pie crust with them. Have you had your chocolate today?

Also up for grabs!

Three more participants will win a copy of Melinda and Dr. Daniel A. Leffler's book:

Real Life with Celiac Disease: Troubleshooting and Thriving Gluten Free,

which was published by the AGA Press in May 2010.

Watch & Win!!

Welcome!

• Diagnosed with celiac more than 20 years ago

• Nutrition Coordinator and Research Investigator at

Celiac Center at BIDMC of Beth Israel Deaconess

Medical Center, Boston

• Former Task Group Member: Academy of Nutrition

and Dietetics’s Evidence Analysis Library for

Celiac Disease

•Coauthor: Real Life with Celiac Disease

www.RealLifewithCeliacDisease.com

•Founder and owner of www.DeleteTheWheat.com

•Founder of Healthy Villi Celiac Support Group, New

England’s largest support group

Melinda Dennis, MS, RD, LDN



•Differentiate between celiac disease, food allergies and food intolerances

•Review FDA and USDA food labeling laws

•Review key nutrients and recommended labs

•Discuss healthy alternative foods when gluten and other food groups are

removed

•Recognize conditions such as Fructose Malabsorption and Small

Intestinal Bacterial Overgrowth

•Gather tips and resources for dining out allergen-free



On Today’s Plate…



•A chronic small intestinal immune-mediated

enteropathy triggered by exposure to

dietary gluten in genetically predisposed

individuals.

•1% of the population

•3 million Americans

•Lifelong avoidance of gluten

•Genetic

What is Celiac Disease? (CD)

Ludvigsson, et al. 2012



•Adverse reaction(s) involving IgE antibodies to one or more

proteins found in the suspect food

•3-4% of adult population

•8% of the pediatric population

•Strict avoidance of the offending food(s)

•Runs in families

What is a Food Allergy?



•Symptoms related to exposure to a particular food without an immune response (enzyme deficiency, food effect)

•Unknown % of people with food intolerances

•Non-celiac gluten sensitivity

• 16 million Americans

• Suggested: 1 in every 4 people

What is a Food Intolerance?

New Kid

on the block

Ludvigsson, et al. 2012



•History of food intake

•Allergy skin tests and/or allergy blood

testing

•Removal of the allergen

•An oral challenge under direct supervision

of an allergist may be necessary.

Diagnosis of a Food Allergy

http://images.google.com/imgres?imgurl=http://www.isitallergy.co.uk/upload/IiaUk/IgE_drop.jpg&imgrefurl=http://www.isitallergy.co.uk/dia_templates/IiaUk/CompositePage.aspx?id=49236&usg=__95hG6dBfvIDscjM2_y4rBeCb0C8=&h=277&w=277&sz=31&hl=en&start=12&tbnid=AamGwS9uwl1rWM:&tbnh=114&tbnw=114&prev=/images?q=allergy+blood+testing&gbv=2&hl=en&sa=G

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http://images.google.com/imgres?imgurl=http://antonio.iies.es/Images/notepad.gif&imgrefurl=http://www.vaiw.org/vet/index.php?name=News&file=article&sid=3316&usg=__wNnbka-RISxSG9fIASmQnzh8TRQ=&h=365&w=317&sz=8&hl=en&start=19&tbnid=xVG0edsGIhCJPM:&tbnh=121&tbnw=105&prev=/images?q=clinical+notepad&gbv=2&hl=en&sa=G



•Rule out allergy.

•Do controlled food elimination trials or blood testing.

Diagnosis of a Food Intolerance



Why do late-onset food allergies and intolerances develop after

going gluten-free?

• Pre-existing problems

• Injured gut lining

• Injury to immune system

Developing Allergies/Intolerances



<1 mg of gluten (1/50th of a slice of bread) can cause significant,

sustained mucosal inflammation

Damage & Healing of Villi in Celiac Disease on

Strict Gluten-Free Diet

How do we educate our patients on how

to avoid gluten and other allergens?





Food Allergen Labeling Consumer Protection Act, 2004:http://www.fda.gov/Food/LabelingNutrition/FoodAllergensLabeling

GuidanceComplianceRegulatoryInformation/ucm106187.htm.

U.S. Food Allergen Labeling Consumer Protection Act

2004

Applies to FDA Regulated Foods • If a food or an ingredient in a food is or contains protein from 1 of the 8 major

allergens, it must be listed:

•Contains: Wheat, Soy, Egg, Peanut, Tree nuts, Milk, Fish, Shellfish

•OR in the ingredient list: Modified food starch (wheat)

• Includes packaged foods, prepackaged foods for retail sale, dietary supplements,

infant formula, and medical foods

Proposed FDA Ruling:

<20ppm = gluten-free



U.S. FDA Food Labeling

• The FDA does not mandate allergen labeling for oat, rye, barley,

malt, and brewer’s yeast.

• “Under the proposed FDA rule, labeling foods with the term

‘gluten-free’ continues to be voluntary.”

• Allergen advisory statements related to food processing are

voluntary and unregulated.

• i.e.: “processed in a facility that also processes wheat”

Applies to ingredients, NOT cross-contamination!

Recommendations Summary. Evidence Analysis Library. American Dietetic Association. http://www.adaevidencelibrary.com/template.cfm?template=guide_summary&key=2376. Accessed October 21, 2010.

United States Department of Agriculture (USDA)

Regulated Foods

• Allergen labeling of USDA-regulated foods (processed meat, poultry, eggs and mixed food products) is voluntary.

• USDA declares that all ingredients be listed in the ingredient list by their common or usual name which does not always indicate ingredient source.

• USDA will likely follow FDA labeling once final definition of “gluten free” is released.

Modified food

starch

Dextrin Maltodextrin

Caramel Glucose Starch

Durum flour Enriched

flour

Farina

Graham flour Plain flour Self-rising

flour

Bulgur Spelt Semolina

White flour Brewer’s

yeast (from

barley)

Triticale

Thompson. Food Labeling in the US and Canada. In Real Life with Celiac Disease. Dennis, Leffler, Eds. AGA Press, Bethesda, MD, 2010. :Labeling of USDA-

Regulated Foods. Available at http://www.glutenfreedietitian.com/articles/BLOGUSDALabelingBlog.30.pdf. Accessed October 21, 2010.

Common Names: AVOID





Checklist for Gluten Exposure and Cross-Contamination

Understand food labeling laws in their

country

Kitchen free of cross-contamination

Medications & Supplements Educated family, roommate, guests, friends,

schools, camps, nursing homes

Pets and Pet Food

Partner/Spouse/Kids: cross-contamination

Religious Practices/Holidays:

•Communion wafer/matzo

Bulk bins

Contaminated Grains:

• In the Field

• Transport

• Milling/Processing

• Repackaged Grains, Flours

Dining Out:

• Safe/Unsafe Ingredient Cards

• Detailed Questions

• Assertiveness

• Location Selection

Body Care Products: Nose & Mouth Salad bars

Newly introduced foods Bakeries, Pizza Parlors

Gum, mints, candy



Malt

Marinades

Matzo

Medications

Oats*

Panko

Pasta

Play-Doh

Processed

Luncheon meats

Croutons

Dressing

Flour or cereal products

Gravies

Imitation bacon

Imitation seafood

Beer/Ale/Lager

Breading

Broth/Bouillon

Candy

Coating/Drink

mixes

Communion wafers

Contaminated

Grains

Sauces

Seasonings

Self-basting poultry

Soup bases

Stuffing

Supplements

Thickeners (Roux)

Croutons

Dressing

Flour or cereal products

Gravies

Imitation bacon

Imitation seafood

Murray, Am J Clin Nutr, 1999;

Jamatiomem, et al N Engl J Med, 1995;

Miletic et al, J Pediatr Gastroenterol Nutr, 1994

Frequently Overlooked Sources of Gluten

“Wheat-free” does not necessarily mean “gluten-free.

• Medication ingredient lists are divided into:

• Active= Safe, no gluten

• Inactive= May contain gluten

• Medications are NOT required to declare

◦ “wheat” or other allergens.

• Supplement ingredient lists are divided into:

• Supplement facts

• Ingredients

• The starch source in medicine, vitamin/mineral and

herbal supplements can be made from any number

of starches, including WHEAT.

• Supplements are required to declare “wheat”

other allergens if an ingredient.

• Supplements are NOT required to list barley, etc.

Crowe JP, Falini NP. Gluten in pharmaceutical products. Am J Health Syst Pharm. 2001;58:396-401.



Gluten in Medications & Supplements



Drug/Supplement Ingredient *This list is not comprehensive

Possible Botanical Source

• Unspecified starch, modified starch

• Pregelatinized starch

• Dusting powder, Flour, Gluten

• Dextrin, cyclodextrin

• Dextrates

• Maltodextrin

• May be derived from wheat starch, etc.

• Dextri-maltose

• Caramel coloring

•Barley malt may be used in manufacturing

• Sodium starch glycolate

•Usually from potato starch; may be

derived from other starches.

Adapted from Kupper C. Dietary guidelines and implementation for celiac disease. Gastroenterology 2005;128:S121-S127.

Crowe JP, Falini NP. Gluten in pharmaceutical products. Am J Health-Syst Pharm; 2001;58:396-401.

US Pharmacopeia 28th, National Formulary 23rd ed, 2005.

Handbook of Pharmaceutical Excipients, 4th ed, 2003.

Questionable Inactive Ingredients in

Medications &Supplements

You need to clarify the

source of the ingredients.



What if our patients are avoiding more

than gluten?

How does that impact their nutrition?

Recommended Standard

Celiac Disease Labs

• CBC

• 25 OH Vitamin D

• B12

• Folate

• Osteoporosis occurs in >25% of all patients with celiac

disease

• High incidence of iron deficiency anemia in patients with

newly diagnosed celiac disease in the U.S.



• Iron and Ferritin

• Lipids

• TSH (thyroid)

• IgA-tTG



Iron Needed to deliver oxygen to blood and muscles. Deficiency can lead to

fatigue and decreased immunity. Produces many important

neurotransmitters.

Folate Works with Vitamin B12 to make and maintain cells, and to make DNA

and RNA, the genetic material of cells.

Vitamin B12 Needed to help make nerve cells, red blood cells, and DNA, the genetic

material of cells.

Vitamin B6 Needed to build and breakdown proteins, to build red blood cells,

maintain brain function, and for the immune system.

Vitamin D

Helps the body absorb calcium, which is needed for the normal

development and maintenance of healthy teeth and bones. It also helps

maintain proper blood levels of calcium and phosphorus. Offers anti-

cancer benefits, helps reduce inflammation, influences hormones.

Barton, et al. Gastroenterol Clin N Am 2007;36:93-108

Important Nutrients in Celiac Disease and General Health



Calcium

Needed for bone health and many other processes throughout the body. Aids

in blood clotting, nerve function, and muscle contraction. Maintains normal

levels of blood pressure and stomach acid.

Magnesium Needed for normal muscle and nerve function, to keep heart rhythm steady,

to support the immune system, and for bone health. Also used in the proper

functioning of over 300 enzymes in the body.

Zinc

Needed for immune function, improving of brain function (including memory),

in the synthesis of insulin, growth and development, and wound healing.

Vitamin K

Necessary for blood clotting. Some studies suggest that it helps promote

strong bones.

Vitamin A

Needed for vision, bone growth, cell division, reproduction, and the immune

system.

Vitamin E Necessary to protect cells from damaging effects of free radicals that can

contribute to cardiovascular disease and cancer; supports immune function.

Important Nutrients in Celiac Disease and General Health

Barton, et al. Gastroenterol Clin N Am 2007;36:93-108



Food Nutrients Alternatives

Peanut

• Protein, healthy fat (vitamin E), folate,

niacin, fiber, copper.

• Other tree nuts, sunflower seed

butter

Milk/Dairy

• Calcium, vitamin D, protein, phosphorus. • Soy milk, hemp milk, almond milk,

rice milk, potato milk, hazelnut, coconut,

flax milk, sunflower milk (all labeled

gluten-free)*

Wheat

• Protein, iron, B vitamins, fiber,

antioxidants, calcium, phosphorus, zinc.

• Amaranth, brown rice, buckwheat,

millet, quinoa, sorghum, wild rice, black

rice, oats (all labeled gluten free)

Soy

• Nutritionally complete protein, fiber, iron,

naturally-occurring ALA omega-3 fatty

acids.

• Gluten-free vegetarian burgers, dried

beans, peas, lentils, dairy products,

seeds (flax), nuts

* Low/no protein in most

Amaranth

• Annual herb/broad leafed plant

• “Super food” for warriors 8,000 years ago

• More iron than most grains

• Combine with other gluten-free flours to make pancakes, flatbreads

• Very good in dark colored baked products, such as:

• Dark bread, chocolate cake and with spices

• Toasted bran flour:

•Cookies, quick breads

• Blend with almond flour in light colored mild flavored baked goods

• Honorable Mention:

• Protein, fiber, calcium, iron, magnesium

• Phosphorus, potassium, zinc, lysine (amino acid), B vitamins



http://images.google.com/imgres?imgurl=http://www.fortunecity.com/littleitaly/roma/3/Amaranth.jpg&imgrefurl=http://www.fortunecity.com/littleitaly/roma/3/wes.madgarden.html&h=600&w=420&sz=53&hl=en&start=2&tbnid=Q3Z3-o7F3Zdk3M:&tbnh=135&tbnw=95&prev=/images?q=amaranth&svnum=10&hl=en&lr=&sa=G

• Is a fruit and is related to rhubarb

• Groats:

• Kernels stripped of outer coating, crushed

• Kasha:

• Roasted groats

• Unroasted:

• Poultry stuffing, cream of buckwheat

• Flour:

• Pancake mix, bread, muffins, “soba” noodles

• Cook with:

• Onions, chicken broth, maple syrup, egg, milk

• Use for:

• pie crusts, breakfast bars, side dish, pilaf, casseroles, thickener


• Protein, magnesium, zinc, phosphorus, potassium, niacin, riboflavin

• B6, fiber, iron, cholesterol and blood pressure lowering properties



www.birkettmills.com

Buckwheat

• Is a cereal grass

• Native to Ethiopia

• 100 grains = 1 wheat kernel

• Nutty, molasses-like flavor

• Combine 25-50% teff with other flours

• Use as:

• Hot cereal, scones, pancakes, pie crust

• Veggie burger (seeds, beans, tofu, garlic, herbs, onions)

• porridge, polenta, thickener, enjera


• Fiber, protein

• CALCIUM, IRON

• Magnesium, thiamin, zinc


www.teffco.com www.Bob’s Red Mill

Teff

whole green pea flour

chickpea flour

split green pea flour

whole yellow pea flour

pea bran meal

pea fiber

Slide courtesy of Shelley Case; www.glutenfreediet.ca


Pulse Flours, Brans and Fibre Milled in Portage la Prairie, MB, Canada



Chickpea

(Garbanzo

Bean) Flour

Yellow Pea

Flour

White Rice

Flour

Tapioca

Starch

Cornstarch Potato

Starch

Protein (g) 25.7 24.7 9.4 0 0.3 0.2

Fiber (g) 20.9 20.6 3.8 0 1.2 0

Carbohydrate (g) 73 71 127 119 117 158

Iron (mg) 6.8

5.4 0.6 0 0.6 2.9

Calcium (mg) 92 90 16 0 3 19

Zinc (mg) 3.5 3.9 1.3 0 0.1 N/A

Magnesium (mg) 169 144 55 0 4 N/A

Thiamin (mg) 0.70 0.73 0.22 0 0 0

Riboflavin (mg) 0.16 0.15 0.03 0 0 0

Folate (mcg) 334 15 55 0 0 N/A

Pulse Power (1cup)

* Chart excerpted from Gluten-Free Diet: A Comprehensive Resource Guide by Shelley Case, RD

** Pulse flours analyzed by Silliker Canada June 2010

• Naturally gluten-free grains, flours,

and products made from them may be

contaminated with wheat, barley or rye.

• Whenever possible it is best to choose

labeled gluten-free versions of these

products.



Celiac Disease Toolkit. American Dietetic Association. Chicago, IL, 2011; 7. Thompson T, Lee AR, Grace T. J Am Diet Assoc. 2010;110:937-940.

Important to remember…

Individuals with egg allergy should also avoid eggs from duck, turkey, goose, quail, etc., as

these are known to be cross-reactive with chicken egg.

Avoid foods that contain eggs or any of these ingredients:

•Albumin (also spelled albumen)

•Egg (dried, powdered, solids, white, yolk)

•Eggnog

•Lysozyme

•Mayonnaise

•Meringue (meringue powder)

•Ovalbumin

•Surimi

Egg is sometimes found in the following:

• Baked goods

• Egg substitutes

• Lecithin

• Macaroni

• Marzipan

• Marshmallows

• Nougat

• Pasta



http://www.foodallergy.org/page/egg1

In addition to FDA labeling, teach:

• 1 tsp. baking powder, 1 T. liquid, 1 T.

vinegar.

• 1 tsp. yeast dissolved in 1/4 cup warm

water.

• 1 1/2 T. water, 1 1/2 T. oil, 1 tsp.

baking powder.

• 1 packet gelatin, 2 T. warm water. Do

not mix until ready to use.

• 1 T. ground flax seed in 3 T. water;

whisk; wait 3 minutes.

These substitutes work well when baking

from scratch and substituting 1 to 3

eggs.



Substitutions

A Few Companies that Cater to Special Diets…



Tips for Safer Dining Out

• Know the gluten-free diet

• Know the restaurant

• Identify yourself to the wait staff

• Ask specific questions (and ask again!)

• When in doubt, go simple

• Do not accept mistakes

• Do your homework before you go

• Try to go early or late

• Say thank you!

• Tip well



Real Life with Celiac Disease, AGA Press, 2010.

• Cooler with milk & juice

• Picnic supplies for lunches:

• Gluten-free deli meat

• Cheese or rice cheese sticks

• Carrot sticks

• Plain chips

• Lunch in restaurants:

• Salads - question salad dressings or bring your own!

• Dinner in restaurants:

• Ask for manager

• Use restaurant cards

• Remember to use:

• GPS portable systems, AAA maps & itineraries

• Mapquest.com or Google maps

Rinehart, Janet Y. Traveling the World Gluten Free.

Traveling by Car



•Call ahead to check on nearby eateries

•Check with local support groups

•Book a room with a kitchenette

•Reserve a mini-fridge

•Ask the hotel to hold food for you

Staying In Hotels



• Less food available onboard or at pit stops

• Pre-order gluten-free meal in advance

• Check and double check

• Think airport security:

•No knives

•No liquids or peanut butter, yogurt

• Prepare for delays and layovers

• Pack non-smelly, easy to carry food:

•Alpine Aire: freeze dried

•Thai Kitchen

•Go Picnic

Traveling by Air, Bus or Train



Dried fruit/trail mix

Fresh fruit, veggies

Plain nuts

Dried cereal in bags

Tuna fish in pouch

Freeze-dried food

Energy bars

Oral supplements (Ensure®, Boost®)

Candy (in moderation)

Yogurt smoothies with ice

Pre-toasted bread

Pretzels

Chips

Cookies, muffins

Crackers, rice/corn cakes

Soups

Packaged entrees

Peanut butter

Dried pasta

Soy sauce, condiments

*Don’t forget: Can opener, extra baggies, ice packs, containers

Gluten-Free (and Allergy-Friendly) Food to Go:

Choose Labeled Gluten-Free Products



Print Resources



AAAAI.org



More Resources

FAAN.org

GREAT Kitchens Training: CeliacLearning.com

Indana-Allergynetwork.org

GIG Gluten Free Food Service: Gluten.net

http://www.foodallergy.org/

http://www.aaaai.org/home.aspx

http://www.indana-allergynetwork.org/

“My 3-year old has gluten and milk sensitivity.”

• Negative for celiac; negative for allergies

• Rash, vomiting, diarrhea with gluten

• Diarrhea, rectal sores with dairy

• Doctor says, despite tests, still allergic to gluten and milk

• Assuming the testing was reliable…what are the possibilities?



You ask, We answer.

① Intolerance with/without allergy

② Dermatitis Herpetiformis

③ Eosinophilic esophagitis



You ask, We answer.

Assuming the testing was reliable…what are the possibilities?

• No money for doctor’s visit

• Multiple loose bowels, painful gas, bloated and huge, bubbling stomach

• Tried over the counter gas relief

• What foods should I eliminate?

• Testing is needed.

“I have wheat/gluten/various food allergies.”



You ask, We answer.

Other Food

Intolerances



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http://images.google.com/imgres?imgurl=http://static.howstuffworks.com/gif/alcohol-drinks.jpg&imgrefurl=http://www.howstuffworks.com/alcohol.htm/printable&usg=__sJq2iPQXw15NIvW62BhbOW-zrUU=&h=489&w=400&sz=21&hl=en&start=4&tbnid=UKkJottXhIkH1M:&tbnh=130&tbnw=106&prev=/images?q=alcohol&gbv=2&hl=en&sa=G

http://images.google.com/imgres?imgurl=http://static.howstuffworks.com/gif/how-to-soothe-canker-sores-1.jpg&imgrefurl=http://health.howstuffworks.com/home-remedies-for-irritable-bowel-syndrome1.htm&usg=__HKFnctTWps1IzYPWAMwojhTadMQ=&h=320&w=400&sz=19&hl=en&start=1&tbnid=hTGOE7CA1XVv1M:&tbnh=99&tbnw=124&prev=/images?q=citrus+fruits&gbv=2&hl=en

• What is it?

• Poor digestion of a large sugar molecule found in some fruits, honey, high fructose corn syrup, etc.

• Fermented by bacteria in the colon

• What are the symptoms?

• Excess gas/bloating, cramping, diarrhea

• Who gets it?

• Common in IBS, increasingly seen in celiac disease

• Testing with the Hydrogen Breath Test:

• Tests ability to digest fructose

• Baseline breath (hydrogen and methane)

• Measurements every 30 mins x 2.5 hours

• Watch for strong rise in either gas

• Nothing by mouth midnight before test

Shepherd S, Gibson P. Fructose malabsorption and symptoms of IBS: guidelines for effective dietary management. J Am Diet Assoc. 2006;106:1631-1639



Fructose Malabsoprtion

Fermentable oligo-, di-, and monosaccharides & polyols

• Fructose: Honey, certain fruits, high fructose corn syrup

• Lactose: Milk products

• Fructans: Wheat, onion family, artichoke

• Galactans: Peas, soybeans, lentils, dried beans

• Sugar Alcohols: Artificial sweeteners, sorbitol, xylitol, isomalt, prunes, cherries



The Larger Picture: The Low FODMAP Diet

CHOOSE AVOID

• Pineapple, strawberry

• Blueberry, raspberry, lemon, lime

• Honeydew melon

• Banana, rhubarb, orange, kiwi,

grapes, grapefruit, cranberry, tangelo

•Prunes, pear, cherry, peach, plum

• Apple, applesauce, apple juice, pear juice

• Grapes, mango, date, figs, apricot

• Nectarine, dried fruit

Sugar Sources on the Low FODMAP Diet

CHOOSE AVOID

• Sucrose (table sugar), corn syrup

• Evaporated cane juice, jam or jelly

• Agave, honey

• High Fructose Corn Syrup

• Maple syrup, syrup, stevia • Sugar alcohols



• What is it?

• Abnormally high bacterial populations in the UPPER bowel

• What are the symptoms?

• Gas, bloating, cramps, weight loss, diarrhea, nausea

• Who gets it?

• Seen in celiac disease (in absence of obvious gluten exposure)

• Diabetes, Crohn’s, IBS, scleroderma, diverticula, gastroparesis or any intestinal dysmotility syndrome

• Fistulas, chronic pancreatitis, abdominal pain, diarrhea, weight loss, macrocytic anemia, etc.

• What are the implications?

• Can lead to carbohydrate, protein and fat malabsorption, inflammation and toxin production

• Can cause persistent damage to villi, vitamin deficiencies and increase in tTG levels



Small Intestinal Bacterial Overgrowth (SIBO)

Ghousal et al, 2004

Tursi et al, 2003

Leffler et al, 2007

•Get a clinical evaluation and testing!

•Treatment: Antibiotics

•Consult a dietitian:

•Balanced, healthy diet; limit FODMAPs

•Vitamins/minerals

•Probiotics

•Modest fiber and adequate fluid

•Spacing meals through the day

Diet for IBS and SIBO. Specialists in Gastroenterology. www.gidoctor.net/diet-ibs-sibo.php; Scarlata K. Today’s Dietitian, April 2011,13(4):46.



SIBO Diagnosis & Treatment

•Most people with Oral Allergy Syndrome are allergic to one or more

pollens

•What is it?

• Body mistakes one protein for another

• Local and mild reaction in general

• Heat destroys the proteins (except NUTS)

•What to do:

• See an allergist.

• Solution: Cook/Avoid/Get allergy shots.



Oral Allergy Syndrome

POLLENS CROSS- REACTIVE FRUITS/ VEGETABLES

Birch Pollen • Peach, Apple, Plum, Cherry, Apricot, Strawberry, Pear

• Almond, Hazelnut, Potato, Carrot, Celery

Grass Pollen •Tomato, Melon, Watermelon

Mugwort (weeds) •Apple, Celery, Carrot, Peanut, Kiwi

Ragweed Pollen • Banana, Melon, Honey, Cucumber, Zucchini

• Watermelon, Chamomile

*If allergic to one of the pollens, avoid the related fruits and vegetables IF

symptoms arise from eating them.



Cross-Reactivity



Plan Ahead! • Select some celiac-friendly restaurants in

advance of your trip:

• www.Allergyeats.com

• www.CeliacCentral.org/Kitchens

• www.glutenfreerestaurants.org

• [email protected] (archives)

• www.celiacchicks.com

• www.glutenfreepassport.com

• www.gluten.net

• www.glutenfreemenus.net

• www.gfregistry.com

• Copy restaurant cards in different

languages:

• www.celiactravel.com/restaurant-cards.html

• www.livingwithout.com

• www.csaceliacs.org

• www.triumphdining.com

• Pack foods that travel well.

• Carry a doctor’s note for

overseas trips

• Accept that travel is more

costly and not as healthy.

http://www.Allergyeats.com

http://www.CeliacCentral.org/Kitchens

http://www.glutenfreerestaurants.org

mailto:[email protected]

http://www.celiacchicks.com

http://www.glutenfreepassport.com

http://www.gluten.net

http://www.glutenfreemenus.net

http://www.gfregistry.com

http://www.celiactravel.com/restaurant-cards.html



http://www.livingwithout.com

http://www.csaceliacs.org

http://www.triumphdining.com

• American Celiac Disease Alliance: www.americanceliac.org

• Canadian Celiac Association: www.celiac.ca

• Celiac Disease Foundation: www.celiac.org

• Celiac Sprue Association: www.csaceliacs.org

• Evidence Analysis Library Celiac Toolkit (for dietitians): www.adaevidencelibrary.com

• Gluten Intolerance Group of North America: www.gluten.net

• IBS – Free at Last!: www.ibsfree.net

• National Foundation for Celiac Awareness:

• CeliacCentral.org

• CeliacCentral.org/Kids

• CeliacCentral.org/Gluten-Free-Food

• National Institutes of Health: http//:digestive.niddk.nih.gov/ddiseases/pubs/celiac

• Other websites:

• www.glutenfreedietitian.com

• www.celiac.com



Celiac Disease, Food Allergy & Food Intolerance Resources

http://www.celiac.ca

http://www.ibsfree.net

www.CeliacNow.org

Coming Summer 2012

From:



Healthy Focus on Food!

More organic food

More home grown food

Less processed food

Less label reading

Advocacy

Social events are also about people



Thanks to Lucy’s!



www.drlucys.com

http://www.youtube.com/user/drlucys

•Gluten Free

•Vegan

•No Peanuts, No Tree Nuts

•Dedicated Bakery

•Ingredients Tested

•Og Trans Fat

•Omg Cholesterol

•Non-GMO

•All Natural

Save The Date!

Thursday, July 26th at 8:30pm Eastern/5:30pm Pacific

"Setting the Record Straight:

Dispelling Gluten-Free Manufacturing and Production Myths”

Tricia Thompson, MS, RD; The Gluten-Free Dietitian, Nutrition Consultant

Celiac Disease, Founder Gluten Free Watchdog, LLC

CeliacCentral.org/webinars/schedule/



Thank you!

Questions? Comments? Feedback?

[email protected]



download the webinar slides - national foundation for celiac

Documents