1. First Report on Cultural Attitudes to the Gluten Free Diet Aydan Kansu Ankara University Faculty of Medicine, Department of Pediatric Gastroenterology and Hepatology, Turkey Aydan Kansu Ankara University Faculty of Medicine, Department of Pediatric Gastroenterology and Hepatology, Turkey

2. Turkey Population: 72.561.312 Children: 18.859.334 CD prevalence (6-17 yr): 1:212 (Am J Gastroenterol 2011) Population: 72.561.312 Children: 18.859.334 CD prevalence (6-17 yr): 1:212 (Am J Gastroenterol 2011) Estimated childhood CD: 100.000 - 200.000 Diagnosed adult + childhood CD: ~12.000 Estimated childhood CD: 100.000 - 200.000 Diagnosed adult + childhood CD: ~12.000

3. Awareness about CD among doctors and among people and availability of testing is increasing in Turkey.

4. National Policy 0-5 y52.50 TL/month= 21 €/month 5-15 y80 TL/month= 32 €/month 15 y  72.50 TL/month= 29 €/month 0-5 y52.50 TL/month= 21 €/month 5-15 y80 TL/month= 32 €/month 15 y  72.50 TL/month= 29 €/month Flour: 10 €/kg Pasta: 5 €/kg Flour: 10 €/kg Pasta: 5 €/kg

5. Kinds of meals, ways of cooking and serving differ from nation to nation because of differences in climate, geographical setting, agriculture and economy. Turkish cuisine is extremely diverse and includes a nearly global mixture of spices, and recipes from northern, southern, eastern and western communities. In Turkey, nutrition is largely wheat-based. Wheat accounts for 60% of the daily caloric intake of a typical Turkish. Our food tend to be spicy, oily (olive oil) with much sauce (tomato and red pepper paste). Kinds of meals, ways of cooking and serving differ from nation to nation because of differences in climate, geographical setting, agriculture and economy. Turkish cuisine is extremely diverse and includes a nearly global mixture of spices, and recipes from northern, southern, eastern and western communities. In Turkey, nutrition is largely wheat-based. Wheat accounts for 60% of the daily caloric intake of a typical Turkish. Our food tend to be spicy, oily (olive oil) with much sauce (tomato and red pepper paste).

6. Turkish Food Grains-dough-based food Vegetables Meat-fish Fruits-dried food Legumes Desserts Dairy products Herbs-spices Grains-dough-based food Vegetables Meat-fish Fruits-dried food Legumes Desserts Dairy products Herbs-spices

7. Grains Wheat is the basic of bread which is an extremely important food in Turkey. In Turkish cooking, we use bread and other flour and dough-based foods. Bread holds an extremely important place at meals, some people eat bread even with pasta. Bread is a central element of Turkish culture and is considered sacred and paid more respect than others. It is used synonymously with both “food” and “work”. Wheat is the basic of bread which is an extremely important food in Turkey. In Turkish cooking, we use bread and other flour and dough-based foods. Bread holds an extremely important place at meals, some people eat bread even with pasta. Bread is a central element of Turkish culture and is considered sacred and paid more respect than others. It is used synonymously with both “food” and “work”.

8. We have various kinds of breads (wheat) In villages, bread is baked daily, weekly or even monthly at home Regular bread Pide (a thin flat bread) Yufka (paper thin bread) Bazlama (a thick, flat bread) Saç bread (cooked on a convex griddle) Tandır bread (cooked on the walls of an oven that opens from the top)

9. Wheat-Dough-Based Foods Bulgur is used to make pilaf, soup, köfte (wheat is washed and boiled, dried and beaten in a large mortar, or broken) Pide (an open faced pizza-like dish) Börek (pastry made from dough rolled to paper thinness, filled with vegetables, meat, cheese, potatoes or lentils) Mantı (like ravioli, mostly made at home) Erişte (home made noodles) Gözleme Bulgur is used to make pilaf, soup, köfte (wheat is washed and boiled, dried and beaten in a large mortar, or broken) Pide (an open faced pizza-like dish) Börek (pastry made from dough rolled to paper thinness, filled with vegetables, meat, cheese, potatoes or lentils) Mantı (like ravioli, mostly made at home) Erişte (home made noodles) Gözleme

10. Wheat-Dough-Based Foods On days where women get together, they prefer salty and sweet cookies and “börek”s prepared by the women of the house. Women like to display their skills as a cook. Women in Turkey generally learn to cook from their mothers and grandmothers, and not from books. Corn flour-corn bread is regularly consumed in only east Black-Sea region. In general, fresh whole corn is boiled and eaten salted in summer time. As income increases, the amount of bread and other wheat products decreases, and more rice is consumed. On days where women get together, they prefer salty and sweet cookies and “börek”s prepared by the women of the house. Women like to display their skills as a cook. Women in Turkey generally learn to cook from their mothers and grandmothers, and not from books. Corn flour-corn bread is regularly consumed in only east Black-Sea region. In general, fresh whole corn is boiled and eaten salted in summer time. As income increases, the amount of bread and other wheat products decreases, and more rice is consumed.

11. Vegetables Green beans Cabbage Leeks Okra Eggplant Grape leaves Peppers Cucumber Parsley Mint Green onion Onion Garlic Zucchini Spinach Lettuce Potatoes Cauliflower Pea Carrot Celery Tomatoes

12. We have various types of vegetable meals Soups Main dish (vegetable meal with chopped meat) Cold dish (vegetable meal with olive oil) Musakka Fried vegetables We have various types of vegetable meals Soups Main dish (vegetable meal with chopped meat) Cold dish (vegetable meal with olive oil) Musakka Fried vegetables

13. We have various types of vegetable meals Dolma (eggplant, zucchini, green pepper, tomatoes) (stuffed with rice/bulgur/meat) Sarma (wrapped from cabbage or grape leaves) Paste (tomatoes – red peppers) Dried vegetables We have various types of vegetable meals Dolma (eggplant, zucchini, green pepper, tomatoes) (stuffed with rice/bulgur/meat) Sarma (wrapped from cabbage or grape leaves) Paste (tomatoes – red peppers) Dried vegetables

14. Meat and Fish Meat and fish are not eaten very much frequently. Chopped meat is commonly used. Chicken is commonly consumed. Meat and fish are not eaten very much frequently. Chopped meat is commonly used. Chicken is commonly consumed. Köfte (chopped meat + bread/rice/bulgur + egg + spice) Sucuk: spiced sausage Pastırma: cured meat/pastrami Köfte (chopped meat + bread/rice/bulgur + egg + spice) Sucuk: spiced sausage Pastırma: cured meat/pastrami

15. Fruits Turkey is one of the richest countries in the world in terms of fruit production. Almond Apple Apricot Banana Blackberry Cherry Dates Fig Grapes Hazelnut Lemon Mandarin Orange Melon Pear Plum Pomegranate Quince Strawberry Watermelon

16. Fruits Hundreds of varieties of a single fruit (e.g. pear, apple, grape, watermelon) Eaten fresh / compotes / sherbets / jam Dried fruits and nuts (in some regions, staple food) Pekmez (sweet thick fluid made by boiling and concentrating fruit juice from grapes, plums, apples, pear, watermelon, pomegranates). It is the most important sweet food stuffs in our traditional diet. Pestil (fruit leather) Hundreds of varieties of a single fruit (e.g. pear, apple, grape, watermelon) Eaten fresh / compotes / sherbets / jam Dried fruits and nuts (in some regions, staple food) Pekmez (sweet thick fluid made by boiling and concentrating fruit juice from grapes, plums, apples, pear, watermelon, pomegranates). It is the most important sweet food stuffs in our traditional diet. Pestil (fruit leather)

17. Legumes Beans Chickpeas Fava beans Peas Red lentil Green lentil

19. Desserts Pastries (wheat flour + sugar + butter) Baklava Revani Helva Milk desserts (milk + flour + butter ± rice + sugar) Güllaç: made from wide thin starch wafers soaked in hot sweetened milk and layered with crushed nuts. Aşure (Noah’s pudding): wheat, beans, chick peas, dried grape, dried apricot, orange, hazelnut, almond, walnut, sugar

20. Dairy Products Milk Yoğurt: Fermented milk Functional food Holds an important place in our nutrition. Most people eat their own products. –Is used to top vegetable and grain based dishes (frequently garlic infused yoğurt) –Tarhana: Yoğurt + cracked wheat or flour + red pepper + onion + tomatoes –Is used with pekmez or honey as a dessert –Is used as a cold drink (yoğurt + water  ayran) –Like a salad (yoğurt + cucumber  cacık) Cheese –White cheese –Kaşar Butter Milk Yoğurt: Fermented milk Functional food Holds an important place in our nutrition. Most people eat their own products. –Is used to top vegetable and grain based dishes (frequently garlic infused yoğurt) –Tarhana: Yoğurt + cracked wheat or flour + red pepper + onion + tomatoes –Is used with pekmez or honey as a dessert –Is used as a cold drink (yoğurt + water  ayran) –Like a salad (yoğurt + cucumber  cacık) Cheese –White cheese –Kaşar Butter Tarhana

21. Breakfast Cheese Olives (green & black) Tomatoes Honey Pekmez Jam Tea Cheese Olives (green & black) Tomatoes Honey Pekmez Jam Tea Bread

22. Lunch – Dinner Soup (wheat/rice) –Vegetable soup –Tarhana soup –Lentil soup –Yoğurt soup –Flour soup Vegetable dish – beans/chickpeas Köfte Pilaf (bulgur or rice) / pasta / börek Salad / cacık / ayran Dessert (dough based pastry / milk based pastry) Soup (wheat/rice) –Vegetable soup –Tarhana soup –Lentil soup –Yoğurt soup –Flour soup Vegetable dish – beans/chickpeas Köfte Pilaf (bulgur or rice) / pasta / börek Salad / cacık / ayran Dessert (dough based pastry / milk based pastry) Bread One of the best summer food is bread + watermelon / grapes + white cheese

23. Problems about gluten free diet in Turkey Turkish cuisine is wheat based. Bread is very important in Turkish meals. Wheat is very commonly used in many soups and dishes. Gluten free products are mainly imported products, and they are expensive. Only gluten-free flour is produced in Turkey, other products are not produced. There are problems about food labeling. Turkish cuisine is wheat based. Bread is very important in Turkish meals. Wheat is very commonly used in many soups and dishes. Gluten free products are mainly imported products, and they are expensive. Only gluten-free flour is produced in Turkey, other products are not produced. There are problems about food labeling.

24. Problems about gluten free diet in Turkey There are no restaurants or cafes serving for Celiac patients. No arrangements at school for lunch. Social life of Celiac patients is a big problem in Turkey. Celiac societies are working hard but they have limited financial sources. Various kinds of vegetables, fruits and legumes are available and are consumed traditionally Alternatives for wheat flour is mainly corn flour There are no restaurants or cafes serving for Celiac patients. No arrangements at school for lunch. Social life of Celiac patients is a big problem in Turkey. Celiac societies are working hard but they have limited financial sources. Various kinds of vegetables, fruits and legumes are available and are consumed traditionally Alternatives for wheat flour is mainly corn flour

25. Thank you… Teşekkürler…