Gluten Free Diet

Accommodating the Gluten Free Diet inThe PCH Setting

• One of the most common inherited diseases – 1:133• Chronic autoimmune intestinal disorder

• Presentation of celiac disease is related to genetic, environmental and immunological factors

• Can occur at any age• May be triggered by a gastrointestinal or viral

infection, severe stress, surgery or pregnancy• Immunologic reaction to gluten

• The absorptive surface of the small intestine becomes damaged

What is Celiac Disease

What Does the Intestinal Villi look like?

The progression of damage to the villi

Results in malabsorption:• Iron, calcium and folate• Carbohydrate – especially lactose• Vitamins – A, D, E, K• Protein

Vitamin and mineral deficiencies resulting in:•Anemia•Osteoporosis•Neurological disorders – ataxia, seizures and neuropathy

Increased risk of developing other autoimmune disorders•Thyroid disease•Type I diabetes•Gastrointestinal cancers

Effects of Celiac Disease

Symptoms

• Abdominal pain, bloating and gas

• Indigestion/reflux• Nausea and vomiting• Diarrhea, constipation • Lactose intolerance• Weight loss – note that

CD can also occur in obese individuals

• Chronic fatigue and weakness

• Bone and joint pain• Easy bruising of the skin• Edema of hands and feet• Migraine headaches• Depression• Mouth ulcers

• Is difficult• Misdiagnosis occurs:

• Allergies• Anemia• Crohn’s Diease• Diverticular Disease• Chronic fatigue syndrome• Irritable bowel syndrome• Lactose intolerance• Fibromyalgia• Stress/depression/emotional disturbances

Testing: Antibody test, Small Intestinal Biopsy

Diagnosis

Diet, diet, diet… for life:

Grain Group most affected•Dairy, fruits, vegetables and protein group food groups have minimal changes•Emphasis on whole foods, not processed or modified•Many naturally gluten-free foods

Treatment

Avoid wheat, barley and ryeAvoid oats

Hidden ingredients:•Sauces•Marinades•Gravies•Salad dressings•Soups•Prepared meats – hamburger patties, deli meats, hot dogs•Candy•Flavoured coffees and teas

Treatment – Strict Gluten Free Diet for

Life

Barriers and Solutions• Cross Contamination

» Guidelines to manage same• Cost and Variety

» “RDF Emergency Pack”» Supplier sources

• Staff Knowledge» Educational resources

• Diet adequacy» Individualized nutrition care

plan• Lack of preparation for residents

» Inform sites of potential residents on gluten free diets

Questions