1. Gluten Free Information and recommendations for EH

2. Protein found in grains – Specifically found in Wheat, Barley, Rye – Spelt, triticale and kamut, other cultivated wheat varieties What qualities does gluten give foods? – The amount of gluten in a product affects the texture. – Elasticity (the sponginess of a muffin, chewiness of pasta) – Strength (the crustiness of a pizza crust) – Structure (the height of a yeast bread, the fluffiness of a waffle) What is Gluten?

3. What is used? – A variety of non wheat flours and gums are used in combinations to approximate the texture of different baked goods. – Examples of Gluten Free (GF) “flours” used include: rice, garbonzo bean, coconut, amaranth, buckwheat, corn, millet, quinoa, sorghum, teff, soy, almond, chestnut, potato, tapioca. What happens to the flavor and texture? – The flavor and texture varies depending on the flour combination and gums (guar gum, xanthan gum) used – Texture often described as ‘gummy”, “cardboard”, “stale”, “dry” – However, products are improving with increased demand and are increasingly described as “good”. WITHOUT GLUTEN…

4. Who needs gluten free food? People with … – Sensitivity to gluten With symptoms that vary from minor discomfort to acute distress – Celiac disease Genetic Autoimmune reaction to gluten Gluten damages the lining of the small intestine. – Reduces ability to absorb nutrients – Increases risk of malnutrition Up to 1 out of every 100 people in the US has celiac disease Because it is difficult to diagnose, it is often left to the patient to eliminate gluten and monitor their symptoms

5. WHY? WHAT HAPPENS IF THEY EAT GLUTEN? IS THERE A CURE? Symptoms Abdominal Pain Diarrhea Vitamin and mineral deficiencies Malnutrition due to malabsorption over time There is no cure for celiac disease Treatment Avoidance of gluten!!!!!

6. What foods are safe? What foods contain Gluten? Gluten Free in the Kitchen

7. Naturally Gluten Free Whole foods are less likely to have hidden Gluten Fruits, vegetables, meat, poultry, fish, nuts, seeds, lentils Naturally Gluten Free Grains Corn (including polenta), Millet, Quinoa, Rice, Tapioca, Teff, Aramanth, Buckwheat, Grits, Sorghum Gluten free grains can be served whole or ground to be used as flour in baked goods. Gluten Free Labeling: some examples

8. Check the Ingredients Carefully “Gluten” is rarely, if ever, listed in ingredients These ingredients contain gluten: wheat rye barley modified starch (some) bulgur couscous graham kamut seitan semolina, spelt, wheat germ, wheat germ oil, malt, maltose triticale oats (some) caramel color dextrin malt vinegar

9.  Baked goods  Beer  Bullion  Breading and coating mixes  Broth  Candy  Coated popcorn and chips  Cereal  Corn tortillas  Crackers  Energy Bars  Flavored or coated nuts and seeds  Flavored Teas  Gravies, marinades, sauces  Hoisin sauce  Licorice  Ice Cream  Multigrain rice and corn cakes  Pepperoni  Prepared icings and frostings  Prepared salsas  Processed meats (hot dogs, sausage)  Salad dressings  Seasoning Mixes  Soups  Spices (If there is no ingredient list on the label then it contains only the pure spice)  Teriyaki Sauce  Worcestershire Sauce  Yogurt (with granola) SURPRISE! FOODS WITH INGREDIENTS CONTAINING GLUTEN

10. Gluten “contamination”  Some people have symptoms when exposed to even a very small amount of gluten  At manufacturer: places that use shared equipment for grinding different flours  At the store: In the bulk section there is possitle that the bins containing gluten free flour or other product (rice or oats) have been contaminated by someone using the wrong scoop or by the “dust” from a gluten containing product that drifted into another bin  In the kitchen: shared equipment (like a toaster, waffle iron, pan, spatula, knife) that has been used with a gluten containing product must be thoroughly washed with soap and hot water before being used with gluten free foods. Ideally there would be no shared equipment, but separate equipment used ONLY for gluten free food.  Contamination can take place during preparation, cooking, storing, and serving of foods

11. Gluten Free in the Kitchen Best practices Know sources of gluten and check ingredients Prepare and store GF foods separately Label GF foods clearly Have dedicated equipment to avoid contamination

12. Serve breads and rolls warm. Don’t reheat more than once! Reheating makes starch go stale faster, so multiple reheating creates a tough and dry bread. Some gluten-free flours have a slightly gritty texture, especially brown rice flour, corn flour, teff flour, and quinoa flours. Balance these with a more fine flour like sweet rice flour or grind them in a food processor for a finer texture. Some gluten-free baked goods can be dense. To adjust to this fact, bake recipes that are naturally denser. In a dense ‘whole grain bread” this quality will not stand out as much as in a lighter white bread, for example. If the gluten free bread isn’t soft enough, serve them toasted. Freezing can help firm up the structure and can help keep products moist for a longer period. Some products, such as brownies and soft cookies can be frozen and served partially thawed. TIPS FOR IMPROVING TEXTURE AND ACCEPTANCE OF GLUTEN FREE FOODS

13.  What About? Are these foods ok for a gluten free patient? How can these be adjusted for a gluten free patient?

14.  THANK YOU THANK YOU FOR ALL YOU DO TO FEED OUR PATIENTS AND GUESTS HEALTHY, SAFE FOOD !!!

15. http://www.dummies.com/how- to/content/key-differences-between- wheat-and-glutenfree-baked.html http://www.dummies.com/how- to/content/key-differences-between- wheat-and-glutenfree-baked.html http://glutenfreecooking.about.com/od/g lutenfreeingredients/tp/20-Gluten-Free- Flours.02.htm http://glutenfreecooking.about.com/od/g lutenfreeingredients/tp/20-Gluten-Free- Flours.02.htm SOURCES