1. Actions to promote sustainable gluten free diet Eleftheria Roma Professor of Paediatric Gastroenterology University of Athens

2. COELIAC DISEASE IN GREEK CHILDREN Changing pattern in the presentation of paediatric CD Diagnosed more frequently in older children Often presents with atypical symptoms Increasingly detected through serological screening Roma et al. Digestion 2009;80:185–191

3. COELIAC DISEASE IN GREECE Incidence: Children 2-5y of Greek origin detected by serology 1: 154 Under-diagnosed National cover of the cost of GF products Need for: collaboration of health professionals registry of patients more dieticians Need for education about the disease of: Patients Food producers and restaurants Schools and other services Health care professionals with regard to the detection and management of C D

4. Dietary compliance and life style of children with coeliac disease in Greece Compliance to GFD was reported by 58% Adolescents 37% (unpublished data 2012) Avoidance of travelling and restaurants was stated by 17% and 46% of families, respectively. Reasons for noncompliance were: poor palatability (32%) dining outside home (17%) poor availability of products (11%) asymptomatic disease diagnosed by screening (11%) Most families experienced difficulties detecting gluten from the food label Roma et al. J Hum Nutr Diet,2010 23: 176–182

5. Dietary compliance and life style of children with coeliac disease in Greece Children with CD have low compliance with the GFD Proposed factors for improvement of quality of life were: Better education about the disease Better labelling of gluten-containing ingredients (76%) More GF foods in supermarkets (58%) and restaurants (42%). Roma et al. J Hum Nutr Diet,2010 23: 176–182

6. GLUTEN FREE PRODUCTS The whole cost is covered by the Government or insurances, obligatory prescribed by the specialist at National Hospitals ( permanent list with products completed by patients ) There are 6 companies with GF products (only one local company) GF products very expensive No service to detect gluten in samples of manufactured foods

7. PROBLEMS IN GREECE No available dietician for information on e-site or telephone Inadequate number of dieticians in hospitals No available GF products at schools No available GF at restaurants and restaurants of student residencies Absence of knowledge about CD in food producers (restaurants etc) Local food producers do not analyze products for possible presence of gluten, but for legal reasons they declare it may contain gluten

8. GREEK COELIAC SOCIETY Established in 1985 (council: patients, parents of CD, paed. GI, adult GI ) Members (children and adults): about 1200 Activities Annual meeting (600-700 participants) Annual participation of council members to AOECDS meeting Annually updated pamphlet with local and manufactured GF products Site for information Forum (chat between members) Support information by members Youth meetings (2-3/year, participants 16-30 years old) Summer camp

9. NEEDED ACTIONS IN EVERY COUNTRY FOR SUSTAINANCE OF GF DIET Education of children and families at diagnosis Regular follow up (6-12 months) by doctors, dieticians, serology Availability of GF products, restaurants, schools, supermarkets ….. Low cost of GF products Education of personnel working at restaurants, hotels, schools, hospitals Promotion of the local natural GF products

10. NATIONAL SUPPORT PLANS IN GREECE Collaboration with the: Ministry of Health Related doctors and health services Coeliac society Greek FDA Encouragement of local manufacturers to produce GF products Education of personnel related to food preparation Promotion of local natural GF products Effort to collect all the properly labeled GF products in supermarkets in separate place

11. PROGRESS IN NATIONAL SUPPORT PLANS IN GREECE Information by letter sent to medical societies: of GPs and subspecialties related to CD Information by letter of unions of restaurants and hotels and food manufacturers Meetings with the responsible persons at the ministry of Health and Greek FDA We are waiting the answer from the Greek FDA for the list of GF syrups and tablets TV show by a patient with CD and the president of the Hellenic Coeliac Society Internet TV show of gluten free cooking Publication in newspaper about CD Activities of Hellenic Coeliac Society

12. National support plans National cover of the cost for GF products Education of personnel of restaurants, hotels Obligatory list of gluten free menus in restaurants Inclusion of GF menus at schools and in restaurants of student residencies

13. ACTIVITIES OF HELLENIC COELIAC SOCIETY Renewal of annual catalogue of GF products of local food industries List of groups of natural food products containing or not gluten which will be distributed to the members and food producers (restaurants, hotels, food manufacturers ) Special letter for CD distributed during coeliac week to newspapers, journals and internet blogs Seminar at the business school for cook (80 students and teachers) given by Hel. Soc. CD, dietician and presentation of GF products New year celebration of the members and dinner with GF dishes Participation at the meeting with Greek FDA Plan for training the personnel at restaurants and hotels Natural gluten free recipes at the site of the society

14. Regulation for gluten free foods in Greece According to the regulation of European Union

15. Advertisements Local natural gluten free products Local natural gluten free recipes