1. Gluten Free Diet Accommodating the Gluten Free Diet in The PCH Setting

2. One of the most common inherited diseases – 1:133 Chronic autoimmune intestinal disorder Presentation of celiac disease is related to genetic, environmental and immunological factors Can occur at any age May be triggered by a gastrointestinal or viral infection, severe stress, surgery or pregnancy Immunologic reaction to gluten The absorptive surface of the small intestine becomes damaged What is Celiac Disease

3. What Does the Intestinal Villi look like ? The progression of damage to the villi

4. Results in malabsorption: Iron, calcium and folate Carbohydrate – especially lactose Vitamins – A, D, E, K Protein Vitamin and mineral deficiencies resulting in: Anemia Osteoporosis Neurological disorders – ataxia, seizures and neuropathy Increased risk of developing other autoimmune disorders Thyroid disease Type I diabetes Gastrointestinal cancers Effects of Celiac Disease

5. Symptoms Abdominal pain, bloating and gas Indigestion/reflux Nausea and vomiting Diarrhea, constipation Lactose intolerance Weight loss – note that CD can also occur in obese individuals Chronic fatigue and weakness Bone and joint pain Easy bruising of the skin Edema of hands and feet Migraine headaches Depression Mouth ulcers

6. Is difficult Misdiagnosis occurs: Allergies Anemia Crohn’s Diease Diverticular Disease Chronic fatigue syndrome Irritable bowel syndrome Lactose intolerance Fibromyalgia Stress/depression/ emotional disturbances Testing: Antibody test, Small Intestinal Biopsy Diagnosis

7. Diet, diet, diet… for life: Grain Group most affected Dairy, fruits, vegetables and protein group food groups have minimal changes Emphasis on whole foods, not processed or modified Many naturally gluten-free foods Treatment

8. Avoid wheat, barley and rye Avoid oats Hidden ingredients: Sauces Marinades Gravies Salad dressings Soups Prepared meats – hamburger patties, deli meats, hot dogs Candy Flavoured coffees and teas Treatment – Strict Gluten Free Diet for Life

9. Barriers and Solutions Cross Contamination » Guidelines to manage same Cost and Variety » “RDF Emergency Pack” » Supplier sources Staff Knowledge » Educational resources Diet adequacy » Individualized nutrition care plan Lack of preparation for residents » Inform sites of potential residents on gluten free diets

10. Questions