Beverly Blough MS,RD
Director of Child Nutrition
Wood County Schools
proteins similar to gluten
proteins
rye & barley proteins
commonly referred to as
gluten
Allergic reaction
Autoimmune reaction
Sensitivity
In the United States…
1.8 million people have celiac disease
1.4 million people not aware they have celiac disease
1.6 million people not diagnosed with celiac disease & on gluten free diet
Mayo Clinic 7/31/2012
Onset – minutes to hours after eating
Affects skin, GI tract, respiratory tract
Two types of reactions to wheat
Wheat-dependent exercise induced anaphylaxis
Dermatitis, uticaria & anaphylaxis
Anaphylaxis – severe whole body allergic reaction
Dermatitis – inflammation of skin
Uticaria - hives
Onset – weeks to years after exposure to gluten
Genetic predisposition
Wide range of symptoms
Autoimmune reaction – abnormal response by body resulting in harm to healthy tissue in an
attempt to destroy what is perceived as a foreign body
Symptoms
• Chronic diarrhea
• Weight loss
• Abdominal bloating & pain
• Vomiting
• Constipation
• Pale, foul smelling, or fatty stool
Symptoms
Blistering rash
Intense itching of rash
Upper arm & elbow common site of rash
10% of patients have GI symptoms
Symptoms
Ataxia - lack of voluntary coordinated muscle movements
Ataxia with myoclonus – lack of voluntary coordinated
muscle movements & twitching of muscles
Less than 10% have GI symptoms
Negative test results for
autoimmune reaction to gluten
wheat allergy
Onset – hours to days
Symptoms resemble those of Celiac Disease
Immune-mediated – body reaction triggers inflammation
Symptoms – extraintestinal
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Abdominal pain
Eczema and/or rash
Headache
Bone or joint pain
Chronic fatigue
Muscle cramps
Behavioral changes
Numbness in legs, arms or fingers
Weight loss
Anemia
Mouth
Esophagus
Stomach
Small Intes
Large Intestine
Surface of intestinal wall
Nutrient
Protein
Carbohydrates
Fat
Vitamins
Minerals
Links between microvilli
act like glue to keep cells
together
In celiac disease tight
junctions come apart &
indigestible fragments of
gluten seep into underlying
tissue & trigger immune
system to react
Enzyme
Food
from
stomach
Indigestible food flows to rectum
Microvilli
Tight Junction
Nutrients
Bloodstream
Normal intestinal
lining
Intestinal lining effected
by celiac disease
T1D (type 1 diabetes )
onset of disease may be linked to malfunction of tight junctions in intestinal wall
Multiple Sclerosis
some evidence of pre-existing problem of presence of too much of protein that
breaks down tight junctions
Rheumatoid Arthritis
clear link has been found with increased malfunction of tight junctions
IBS (inflammatory bowel disease)
abnormal intestinal wall may be genetic trait
Asthma malfunction of intestinal wall may play a role in susceptibility to
environmental allergens
Autism emerging evidence of a subgroup of patients with autism (with or
without GI symptoms) may have malfunction of intestinal wall & benefit from
gluten free – casein free diet
Presence of typical symptoms
Positive blood test for gluten antibodies
Positive test for genes associated with celiac
disease
Biopsy of small intestine reveals inflammation
and thickening of intestinal wall
Improvement of symptoms on gluten free diet
Gluten Free Diet – currently only treatment
Stops symptoms within days
Prevents future damage to intestines
Healing of damaged intestinal wall
Children – 3-6 months
Adults – up to several years
Wheat
Other members of wheat family:
Einkorn
Emmer
Spelt
Kamut
Barley
Rye
Triticale (cross between wheat & rye)
Wheat starch
Wheat bran
Wheat germ
Cracked wheat
Hydrolyzed wheat protein
Bulgar
White & Wheat flour
White & Wheat Bleached flour
White & Wheat Enriched flour
Bromated flour
Durum flour
Graham flour
Phosphated flour
Self-rising flour
Semolina
Farina
Sweet Rice Flour
White Rice Flour
Sorghum Flour
Potato Flour
Tapioca Flour
Cold cuts, hot dogs, salami, sausage
Tabbouleh
Self-basting turkey
Matzo
Imitation Fish
Communion wafers
Couscous
Seasoned tortilla chips
Orzo Pasta
Rice Mixes
Pasta
French fries
Pearl Barley
Vegetables in sauces
Barley Malt
Bouillon cubes
Brown rice syrup
Gravy
Malt
Sauces
Rusk
Soups
TVP (textured vegetable protein)
Soy Sauce/Teriyaki Sauce
Wheat Nuts
Candy
Wheat Grass
Chips/potato chips
Artificial Color
Baking Powder
Caramel Color
Caramel Flavoring
Coloring
Dry Roasted Nuts
Emulsifiers
Flavoring
Food Starch
Food Starch Modified
Glucose Syrup
Ground Spices
Maltodextrin
Miso
Natural Flavoring
Natural Juices
Non-dairy Creamer
Smoke Flavoring
Soba Noodles
Starch
Vegetable Gum
Vitamins
Wheat Starch
*Foods may or may not contain gluten depending on where & how they are made
Student with gluten related disorder meets
definition of “person with a disability”
Federal definition of disability broadened
under Americans with Disabilities Act
Amendments Act of 2008
“Major Life Activities” now includes “Major Bodily
Functions” such as:
‘functions of immune system, normal cell growth,
digestive, bowel, bladder, neurological, brain,
respiratory, circulatory, cardiovascular, endocrine and
reproductive functions”
Special diet requires statement from licensed
physician* & include:
Food-related disability (diagnosis)
Meal accommodation/food substitutions
School must provide special food/meal
*diet order must be signed by physician
Which tray is Gluten Free?
Fruits – fresh fruits & plain canned fruit
Vegetables – fresh veggies & plain frozen/can veggies
Dairy – milk, aged cheese, most yogurt, margarine, cottage
cheese, sour cream
Proteins – fresh beef, poultry, fish, shellfish, eggs, dried
beans & peas, plain nuts, peanut butter, tofu, some hot dogs &
luncheon meats
Fats & Oils – vegetable, canola & olive oils, shortenings,
pure mayonnaise
Cereals & Grains – General Mills Rice Chex cereals, some
Post cereals, Cream of Rice, grits, cornmeal, pure corn tortillas,
pasta made from rice
Frozen Foods – most ice creams & sherbets
Snacks – most rice cakes, rice crackers, popcorn, plain
potato & corn chips, Jello
Condiments – vinegar, mustard, ketchup, horseradish,
jams & jellies, sugar, honey, maple syrup, vanilla, salt &
pepper, relish, pickles, olives
GF Cereals
*Find gluten free foods in Ethnic Food Sections such as rice based crackers & noodles
www.glutenfree.com
www.dietspec.com
www.glutenfreemall.com
Ian’s Natural Foods – products &
interactive fun activities for kids
Kinninnick – products & gluten
free information & recipes
Breakfast Foods
Bagels
Breads
Buns
Muffins
Baking Mixes
Cookies
Crackers
Pasta
Chicken Nuggets
Chicken Patties
Pizza
Lasagna
Soups
Fish Sticks
Gluten particles are sticky and
can cling to most kitchen surfaces
Fresh or Dried Fruit
String Cheese
Yogurt
Ice Cream
Popcorn
Nuts or Pumpkin seeds
Homemade Trail Mix
Meat/Cheese Roll up in corn tortilla
Bioengineered gluten-free grains
Vaccine – restore body’s tolerance of gluten
Medication
Target gluten in intestinal tract – break down into
small fragments that will get excreted instead of
passing through intestinal wall and triggering an
immune response
Blocking ability of protein to trigger breaking of
tight junctions