Beverly Blough MS,RD Director of Child Nutrition Wood County Schools

proteins similar to gluten proteins rye & barley proteins commonly referred to as gluten

Allergic reaction Autoimmune reaction Sensitivity In the United States… 1.8 million people have celiac disease 1.4 million people not aware they have celiac disease 1.6 million people not diagnosed with celiac disease & on gluten free diet Mayo Clinic 7/31/2012

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

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

Symptoms Chronic diarrhea Chronic diarrhea Weight loss Weight loss Abdominal bloating & pain Abdominal bloating & pain Vomiting Vomiting Constipation Constipation Pale, foul smelling, or fatty stool Pale, foul smelling, or fatty stool

Symptoms Blistering rash Intense itching of rash Upper arm & elbow common site of rash 10% of patients have GI symptoms

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

Negative test results for autoimmune reaction to gluten wheat allergy Onset – hours to days Symptoms resemble those of Celiac Disease Immune-mediated – body reaction triggers inflammation

Symptoms – extraintestinal Abdominal pain Abdominal pain Eczema and/or rash Eczema and/or rash Headache Headache Bone or joint pain Bone or joint pain Chronic fatigue Chronic fatigue Muscle cramps Muscle cramps Behavioral changes Behavioral changes Numbness in legs, arms or fingers Numbness in legs, arms or fingers Weight loss Weight loss Anemia Anemia

MouthMouth EsophagusEsophagus StomachStomach Small Intestine Large Intestine

NutrientNutrient Protein Carbohydrates Fat Vitamins Minerals Surface of intestinal wall

Links between microvilli act like glue to keep cells together

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

Bloodstream Indigestible food flows to rectum Microvilli Food from stomach Enzyme Tight Junction Nutrients

Normal intestinal lining Intestinal lining effected by celiac disease

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

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 diet

Presence 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

Gluten Free Diet – currently only treatment Stops symptoms within days Prevents future damage to intestines Healing of damaged intestinal wall Children – 3-6 months Adults – up to several years

Wheat Other members of wheat family: Einkorn Emmer Spelt Kamut Barley Rye Triticale (cross between wheat & rye)

Wheat starch Wheat bran Wheat germ Cracked wheat Hydrolyzed wheat protein Bulgar

White & Wheat flour White & Wheat Bleached flour White & Wheat Enriched flour Bromated flour Durum flour Graham flour Phosphated flour Self-rising flour SemolinaFarina

Sweet Rice Flour White Rice Flour Sorghum Flour Potato Flour Tapioca Flour

Cold cuts, hot dogs, salami, sausage Self-basting turkey Imitation Fish Couscous Orzo Pasta Pasta Pearl Barley TabboulehMatzo Communion wafers Seasoned tortilla chips Rice Mixes French fries Vegetables in sauces

Barley Malt Brown rice syrup MaltRusk TVP (textured vegetable protein) Wheat Nuts Wheat Grass Bouillon cubes GravySaucesSoups Soy Sauce/Teriyaki Sauce Candy Chips/potato chips

Artificial Color Baking Powder Caramel Color Caramel Flavoring Coloring Dry Roasted Nuts EmulsifiersFlavoring Food Starch Food Starch Modified Glucose Syrup Ground Spices MaltodextrinMiso Natural Flavoring Natural Juices Non-dairy Creamer Smoke Flavoring Soba Noodles Starch Vegetable Gum Vitamins Wheat Starch *Foods may or may not contain gluten depending on where & how they are made

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”

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

Which tray is Gluten Free?

Fruits – 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

Cereals & 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

GF Bread GF Breaded Meats GF Baking Mixes GF Grains GF Cereals

*Find gluten free foods in Ethnic Food Sections such as rice based crackers & noodles

Ian’s Natural Foods – products & interactive fun activities for kids Kinninnick – products & gluten free information & recipes

Breakfast Foods Bagels Breads Buns Muffins Baking Mixes Cookies Crackers Pasta

Chicken Nuggets Chicken Patties Pizza Lasagna Soups Fish Sticks

Gluten particles are sticky and can cling to most kitchen surfaces

Fresh or Dried Fruit String Cheese Yogurt Ice Cream Popcorn Nuts or Pumpkin seeds Homemade Trail Mix Meat/Cheese Roll up in corn tortilla

Bioengineered gluten-free grains Vaccine – restore body’s tolerance of gluten Medication Target gluten in intestinal tract – break down into small fragments that will get excreted instead of passing through intestinal wall and triggering an immune response Blocking ability of protein to trigger breaking of tight junctions