1. Provided Courtesy of Nutrition411.com Planning For a Gluten- Free Hospital Stay Review Date 2/15 Contributed by Debbie Tindle, RD Area Clinical Nutrition Manager Fountain Valley Regional Hospital, CA

2. What is Gluten? Gluten is a specific protein component found in barley, rye, oats, and wheat grains. Barley (horedin) Rye (secalins) Oats (avenin) Wheat (gliadin) Rice and corn contain prolamins (non-toxic)

3. The most accurate means of diagnosis is a small intestine scraping to assess gluten enzyme levels. Approved home test now available on Amazon: http://www.amazon.com/Biocard-Celiac-Test-Kit- Brand/dp/B003AXYAE6 http://www.amazon.com/Biocard-Celiac-Test-Kit- Brand/dp/B003AXYAE6 How is Celiac Disease/ Sprue Diagnosed?

4. What are the Statistics? 1 in 133 people in the United States have been found to be positive for celiac/sprue Most often genetics influence the risk factor – European, Scandinavian Improved testing and identification have increased awareness and a greater need for gluten-free products

5. The Gluten-Free Market From 2009 to 2014, sales of gluten-free products posted a compound annual growth rate of 34%! In 2013, gluten-free food sales amounted to about $10.54 billion! The gluten-free products market is projected to reach $15.6 billion by 2016!

6. A Review of Safe Grains Many gluten-free grains are available Ancient grains like quinoa (“keen-wa”) are increasing in popularity — high fiber, whole grain, gluten free, high protein Other grains include amaranth, arrowroot, corn, potato, polenta, flax, nut and bean flours, Montina™ (Indian rice grass), all rice, soybean

7. Are Oats Safe to Eat? Pure oats do not contain gluten; they contain a non- toxic protein called avenins Most oats on the market have been cross-contaminated with wheat, barley and/or rye Safe oat brands to consider: Bob's Red Mill ®, GF Harvest, Glutenfreeda Foods, Holly's Oatmeal, Montana Gluten Free Research shows 10-15% of people with celiac disease react to oats Some findings conclude that people may react more to the fiber content of oats vs. gluten

8. Hidden Sources Remember to read labels carefully! Hidden gluten sources may include candies, communion wafers, packaged mixes for drinks, sauces, imitation seafood, gravy, cured products, self-basting turkeys, soy sauce, seasonings, and spice mixes.

9. Resource for Safe and Forbidden Foods www.celiac.comwww.celiac.com has a detailed resource for both safe and forbidden foods

10. Avoiding Deficiencies Choose gluten-free whole grains Rice, potato, and corn lack the B vitamins, protein, and iron that are found in whole grains Use nutrient-dense grains, nuts, and seeds Supplement with a high potency multiple vitamin/mineral tablet daily

11. Planning Ahead for a Hospital Stay Know your level of sensitivity! If admitting for elective surgery, you have time to plan ahead: contact the facility and speak with the food service director or registered dietitian Plan to bring specific foods from home Be sure the food service staff is well-informed of foods to limit for your meals/snacks — inquire about staff training and their knowledge of gluten-free diets

12. Unexpected Hospital Admission Again, know your level of sensitivity to gluten Be sure your family members are also informed of your sensitivity and needs since they may be required to complete admission information on your behalf If you are unable to speak with the food services director, RD, or department representative, have a family member manage this activity immediately. Request your physician to order a “gluten-free diet” Be aware that all oral liquid nutrition supplements and tube feedings are now made gluten and lactose-free

13. Patient Education Ask for the registered dietitian (RD) to provide food labels or recipes of questionable items on the menu and resources during your stay The Celiac Sprue Association (CSA.org) has many resources availableCeliac Sprue Association

14. Gluten-Free Cookbook Monika Sudakov’s Let’s Party! Gluten-Free Entertaining for Everyone Sponsored by community supported agriculture (CSA) No substitutions — uses all gluten-free ingredients RD “afterward” on page 187

15. Resources www.eatright.org — The Academy of Nutrition and Dietetics www.eatright.org www.ChooseMyPlate.gov — The USDA site for healthy American diets www.ChooseMyPlate.gov www.celiac.com — for safe/forbidden foods www.celiac.com www.csaceliacs.org — Celiac Sprue Association www.csaceliacs.org www.savorypalate.com — Gluten-Free Cookbook/Recipes www.savorypalate.com www.glutenfreeliving.com — Gluten-Free Magazine www.glutenfreeliving.com www.amazon.com/Biocard-Celiac-Test-Kit-Brand/dp/B003AXYAE6 — “Bio-Card” for home testing (blood test of IgA concentration) www.amazon.com/Biocard-Celiac-Test-Kit-Brand/dp/B003AXYAE6 Sudakov M. Gluten Free Entertaining for Everyone (Let's Party:). Princeton, IL: Hither Page Press; 2010. www.csaceliacs.org — Celiac Support Association www.csaceliacs.org www.cureceliacdisease.org — The University of Chicago Celiac Disease Center www.cureceliacdisease.org

16. Gluten-Free Foods in the U.S., 5th Edition. A packaged facts website. http://www.packagedfacts.com/Gluten-Free-Foods-8108350/. Published January 1, 2015. Accessed February 4, 2015. Gluten-free products market by type, sales channel and geography — global trends and forecasts to 2019. A Research and Markets website. http://www.researchandmarkets.com/research/ctg2gf/glutenfree. Published July, 2014. Accessed February 4, 2015. http://www.researchandmarkets.com/research/ctg2gf/glutenfree Retail dollar sales of gluten-free products in the United States from 2011 to 2016 (in million U.S. dollars). A Statista website. http://www.statista.com/statistics/301621/us-retail-dollar-sales-of-gluten-free- products/. Accessed February 4, 2015. http://www.statista.com/statistics/301621/us-retail-dollar-sales-of-gluten-free- products/ Watson E. What’s the size of the US gluten-free prize? $490m, $5bn, or $10bn? http://www.foodnavigator-usa.com/Markets/What-s-the-size-of-the-US-gluten- free-prize-490m-5bn-or-10bn. Updated February 27, 2014. Accessed February 4, 2015. http://www.foodnavigator-usa.com/Markets/What-s-the-size-of-the-US-gluten- free-prize-490m-5bn-or-10bn References and Recommended Readings