Gluten Free Diets

Beverly Blough MS,RDDirector of Child NutritionWood County Schools

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

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

Mixture of 2 proteins found in wheat

Gliadin + Glutenin

What is gluten?

Wheat Seed part of plant

Kernel Joined with starch

Where is gluten found?

Other grass plants (rye & barley)

proteins similar to gluten proteins

rye & barley proteins commonly referred to as gluten

How is Gluten Formed?

Add water to wheat flourstrands of proteins (gliaden & glutenin) begin as tangled mess

How is Gluten Formed?

During process of kneading dough proteins begin to line up & gluten gets stronger

Gluten Strands

gluten strands are very stringy

Gluten StructureTakes shape into strong & elastic form when…..

water in dough turns into vapor or

yeast creates carbon dioxide (gas)

Developed Gluten has….

• Shape

• Elasticity

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

Benefits of Gluten - elasticity

Forms a "film" that can stretch & hold shape

Example: Gluten is used in sausage casing

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)

Benefits of Gluten - binder

Helps meat & pasta products keep shape & resists food getting mushy under heat

Benefits of Gluten - absorbency

• soaks up twice its weight of water

• increases yield of food product

• increases shelf life

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

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

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

Autoimmune reactions- celiac disease

Symptoms

• Chronic diarrhea

• Weight loss

• Abdominal bloating & pain

• Vomiting

• Constipation

• Pale, foul smelling, or fatty stool

Autoimmune reactions – dermatitis herpetiformis

Symptoms

Blistering rash

Intense itching of rash

Upper arm & elbow common site of rash

10% of patients have GI symptoms

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

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

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

The Digestive Tract

Series of hollow organs joined in a long twisting tube

Mouth

Esophagus

Stomach

Small IntestineLarge

Intestine

Digesting & Absorbing Nutrients Food is digested & broken down into nutrients & absorbed by body in small intestine

Nutrient

ProteinCarbohydratesFatVitaminsMinerals

Surface of intestinal wall

Inside the Small Intestine

Inside lining is called mucosa

Surface is not flat but folded

Folds have fingerlike

projections called villi

Mucosa ….up close

Mucosa contains folds

Villi are covered with tiny

projections

Tight Junctions

Links between microvilli act like glue to keep cells together

Tight Junctions

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

Digestion process

Bloodstream

Indigestible food flows to rectum

Microvilli

Food from stomach

Enzyme

Tight Junction

Nutrients

Celiac Disease Impact

Normal intestinal lining

Intestinal lining effected by celiac disease

Small Intestine

Normal Celiac

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

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

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

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

The Gluten Free Diet

No wheat, rye or barley

Avoid foods & products with hidden sources of gluten

Grains with Gluten

WheatOther members of wheat family:

EinkornEmmerSpeltKamut

BarleyRye Triticale (cross between wheat & rye)

Other Sources of Wheat

Wheat starch

Wheat bran

Wheat germ

Cracked wheat

Hydrolyzed wheat protein

Bulgar

Wheat Flours with GlutenWhite & Wheat flour White & Wheat Bleached flourWhite & Wheat Enriched flourBromated flourDurum flourGraham flourPhosphated flourSelf-rising flourSemolinaFarina

Gluten Free Grains Amaranth Buckwheat Kasha

Millet Quinoa Teff

Gluten Free Grains/Flours

Sweet Rice Flour

White Rice Flour

Sorghum Flour

Potato Flour

Tapioca Flour

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

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

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

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”

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

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

Gluten Free School Meals

Which tray is Gluten Free?

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

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

Finding Gluten Free Foods

Local health food store

GF Bread

GF Breaded Meats

GF Baking Mixes

GF Grains

GF Cereals

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

Finding Gluten Free FoodsInternet Distributors

www.dietspec.com

www.glutenfree.com

www.glutenfreemall.com

Finding Gluten Free FoodsCompanies with “look alikes”

Ian’s Natural Foods – products & interactive fun activities for kids

Kinninnick – products & gluten free information & recipes

Gluten Free Food ProductsBreakfast FoodsBagelsBreadsBunsMuffinsBaking MixesCookiesCrackersPasta

Gluten Free Food ProductsChicken NuggetsChicken PattiesPizzaLasagnaSoupsFish Sticks

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

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)

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

Food Preparation TipsPureed Food – use mashed potato flakes as thickener

Thickening Gravy/Sauces – use cornstarch

Cornmeal – good coating for meat, poultry & fish

Gluten Free Party Foods

Fresh or Dried FruitString CheeseYogurt Ice CreamPopcornNuts or Pumpkin seedsHomemade Trail MixMeat/Cheese Roll up in corn tortilla

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

THANK YOU!