Celiac Disease Hi! My name is April. I just finished my BS in Nutrition and I am currently an dietetic intern. Today, we will be discussing Celiac Disease. By the show of hands, is anyone familiar with this condition? Is anyone in this room have an allergy to any food?

Objectives Discuss government regulations that your school cafeteria follows. What causes Celiac Disease? What are the symptoms? What foods should be avoided? Safe Food Handling Practices Ingredient Labels Game time! -By a raise of hands, how many of you have a food allergy? Or know anyone with a food allergy? -Gluten-free foods are becoming very trendy now. However, in school there must be doctor’s note on file that proves the student has Celiac. -By a raise of hands, does has anyone heard of Celiac Disease? -What do you know about Celiac Disease?

Cafeteria regulations There are rules and regulations that are mandated by the government. Food is categorized into five components. A meal must contain these components. Vegetables are divided into group and must all be served throughout the week (1). -The five components are: meat, grain, fruit, vegetable, and dairy. -Even if you do not take every component, your café is still required to offer it to the student. -Every meal must at least come with 3 of the 5 items, and contain a fruit or vegetable (OVS). -Portions depend on grade level and must meet daily and weekly minimums. 1 cup minimum for F/V and dairy. -For example, pizza could count for 2 components: meat and grain. A serving a fruit or veg must be served with the pizza to count as a meal. -Vegetable categories are: red/orange, dark green, starchy, legumes/beans, and “other”

Cafeteria Regulations, continued… There are specific portions that need to be served with each meal. Half of all grains must be whole grain. Only natural flavors, herbs and spices can be used. No salt. The cafeteria will accommodate students with allergies and disabilities. -A lot of thought goes behind planning school meals to ensure that they are healthy and tasty.

What is causes Celiac Disease? It is damage to the intestinal tract from consuming gluten. The body’s immune system reacts to gluten and its response results in destruction of villi. The condition can develop at any point in life. Blood tests can detect antibodies, called antitissue transglutaminase antibodies (tTGA) (2). 1a. The small intestine has finger-like projections called villi that absorb the nutrients from food. In a celiac patient, when gluten is consumed, these villi are damaged and cannot absorb nutrients. 2a. Malnourishment is common no matter how much food is consumed. 3a. More women are affected than men. PICTURE. People may believe they have celiac disease because they have GI discomfort after eating certain foods. This condition must be diagnosed by a physician.

Gluten is located in the endosperm of the grain. Gluten is the protein part of the grain. In wheat bread, the endosperm is what gives wheat bread it chewiness.

What are the symptoms? Although there are no universal symptoms, some common symptoms include: Bad Breath Mouth Sores Headaches Itchy skin Diarrhea/constipation Weakness Anxiety/depression Malnourished appearance Abdominal bloating and pain

What foods should be avoided? Foods that contain gluten have ingredients that include: Wheat Bran Semolina Rye Barley Possibly oats This includes any food that is manufactured in the same facilities that process any of these products. This also includes pastries and baked goods that use any of the above mentioned: cakes, muffins, bagels, pizza crusts, beer, candy, gravies

Safe Food Handling Practices Remember to clean and sanitize storage containers and food surfaces that touch gluten products. Review the menu to choose “safe foods” Read labels (3) Wash your hands. Change your gloves. Sanitize work surfaces

Labels -Pay particular attention to ingredient label and look for wheat ingredients. -Wheat ingredients may not be as obvious. Other names for wheat products are: “malt flavoring” -Pay attention to labels that say it has been produced in the same facilities that handle wheat.

Game Time The objective of the game is to choose which food item is NOT ok to eat. I will give you 3 choices. On the raise of hands, which food is NOT ok to eat.

What is not ok to eat? Muffins. B Many baked products have gluten ingredients.

What is not ok to eat? Often nuts are processed in the same facilities as wheat products. A

What is not ok to eat? Often wheat derivatives are used as a stabilizer in candy. B

After answering questions, gather feedback from the class. -Was this information helpful? -Was the information easy to understand? -How can this presentation be improved? -What did they enjoy about this presentation?

References 1. USDA Final Meal Standards. MyCompass Website. Available at: https://mycompass.compass-usa.com/sectors/chartwellschools/menuindex/Pages/default.aspx. Accessed on October 01, 2013. 2. Understanding Celiac Disease. Academy of Nutrition and Dietetics Website. Available at: http://www.eatright.org/Public/content.aspx?id=5542. Reviewed on December 2012. Accessed on: November 13, 2013. 3. Gregoire M. Foodservice Organizations: A Managerial and Systems Approach. Upper Saddle River, NJ: Prentice Hall; 2010.