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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 Presentation

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Gluten Free DietsBeverly Blough MS,RDDirector of Child NutritionWood County Schools6/17/2013 5:16 PM 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries.The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

1What do you know about gluten?Gluten is Food additive in breadStarch in potatoesProtein in wheat kernelEdible glue

2What do you know about gluten?Gluten is Food additive in breadStarch in potatoesProtein in wheat kernelEdible glue

3Mixture of 2 proteins found in wheat

Gliadin + GluteninWhat is gluten?4WheatSeed part of plantKernel 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? Addwater to wheat flourstrands of proteins (gliaden & glutenin) begin as tangled messHow is Gluten Formed? During process of kneading dough proteins begin to line up & gluten gets stronger

Gluten Strandsgluten 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 inBland - 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 States1.8 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 7/31/2012Allergic Reaction wheat allergyOnset minutes to hours after eating Affects skin, GI tract, respiratory tract Two types of reactions to wheatWheat-dependent exercise induced anaphylaxisDermatitis, uticaria & anaphylaxis

Anaphylaxis severe whole body allergic reaction Dermatitis inflammation of skin Uticaria - hivesAutoimmune reactions- celiac diseaseOnset 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 bodyAutoimmune reactions- celiac diseaseSymptomsChronic diarrheaWeight lossAbdominal bloating & painVomitingConstipationPale, foul smelling, or fatty stool

Autoimmune reactions dermatitis herpetiformis

SymptomsBlistering rashIntense itching of rashUpper arm & elbow common site of rash10% of patients have GI symptomsAutoimmune reactions gluten ataxiaSymptoms Ataxia - lack of voluntary coordinated muscle movementsAtaxia with myoclonus lack of voluntary coordinated muscle movements & twitching of musclesLess than 10% have GI symptomsImmune-mediated form gluten sensitivityNegative test results for autoimmune reaction to glutenwheat allergy

Onset hours to days

Symptoms resemble those of Celiac DiseaseImmune-mediated body reaction triggers inflammationImmune-mediated form gluten sensitivitySymptoms extraintestinalAbdominal painEczema and/or rashHeadacheBone or joint painChronic fatigueMuscle cramps Behavioral changesNumbness in legs, arms or fingersWeight lossAnemia

The Digestive TractSeries of hollow organs joined in a long twisting tube

MouthEsophagusStomachSmall IntestineLarge Intestine

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

NutrientProteinCarbohydratesFatVitaminsMineralsSurface of intestinal wallInside the Small IntestineInside lining is called mucosa

Surface is not flat but folded Folds have fingerlike projections called villi

Mucosa .up closeMucosa contains foldsVilli are covered with tiny projectionsTight 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

BloodstreamIndigestible food flows to rectumMicrovilliFood from stomachEnzymeTight JunctionNutrientsCeliac Disease Impact

Normal intestinal liningIntestinal lining effected by celiac diseaseSmall Intestine Normal Celiac

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

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 dietDiagnosing 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 DiseaseGluten 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 GlutenWheatOther members of wheat family:EinkornEmmerSpeltKamutBarleyRye Triticale (cross between wheat & rye)

Other Sources of WheatWheat starchWheat branWheat germCracked wheatHydrolyzed wheat proteinBulgarWheat Flours with GlutenWhite & Wheat flour White & Wheat Bleached flourWhite & Wheat Enriched flourBromated flourDurum flourGraham flourPhosphated flourSelf-rising flourSemolinaFarina

Gluten Free Grains AmaranthBuckwheat Kasha

Millet QuinoaTeff

Gluten Free Grains/FloursSweet Rice FlourWhite Rice FlourSorghum FlourPotato FlourTapioca Flour

Processed Foods To AvoidCold cuts, hot dogs, salami, sausageSelf-basting turkeyImitation FishCouscousOrzo PastaPastaPearl Barley

TabboulehMatzoCommunion wafersSeasoned tortilla chipsRice MixesFrench friesVegetables in sauces

Processed Foods To AvoidBarley MaltBrown rice syrupMaltRuskTVP (textured vegetable protein)Wheat NutsWheat GrassBouillon cubesGravy SaucesSoupsSoy Sauce/Teriyaki SauceCandy Chips/potato chipsItems May Contain Gluten*Artificial ColorBaking PowderCaramel ColorCaramel FlavoringColoringDry Roasted NutsEmulsifiersFlavoringFood StarchFood Starch ModifiedGlucose SyrupGround SpicesMaltodextrinMisoNatural FlavoringNatural JuicesNon-dairy CreamerSmoke FlavoringSoba NoodlesStarchVegetable GumVitaminsWheat Starch

*Foods may or may not contain gluten depending on where & how they are madeGluten Free Diet at SchoolStudent with gluten related disorder meets definition of person with a disabilityFederal definition of disability broadened under Americans with Disabilities Act Amendments Act of 2008Major 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 SchoolSpecial 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