LIVING GLUTEN FREE Dawn Gray, RD CDE MPH - Pelican Bay Foundation

LIVING GLUTEN
     FREE
Dawn Gray, RD CDE MPH
       239.260.8999
  Pelican Bay Foundation

What is Gluten ?

• Gluten is one of the proteins naturally found in wheat,
  rye, and barley.
• Gives dough elasticity and strength and may be added to
  baked goods to increase workability.
• Gluten is often used as a filler or binder in processed
  foods
• Gluten damages the microvilli in the intestines of
  individuals with Celiac disease or Gluten Intolerance
• Gluten is also harmful to individuals with Non-celiac
  gluten sensitivity but in this case damage to
  microvilli does not occur.
• Gluten may be linked with a host of other illnesses

Celiac versus Non-Celiac Gluten Sensitivity
Celiac                                         Non-Celiac Gluten Sensitivity
• Genetic autoimmune disease where
    gluten causes damage to the microvilli     • Non-specific immune response,
    in small intestine                           no or minimal damage to
• Celiac affects 1 in 130 Americans(1%)          microvilli, not believed to be
• Incidence increases with other family
    history and other autoimmune                 genetically linked
    diseases                                   • May effect 18 million Americans
• Symptoms are highly varied and                 or more(6%)
    include GI distress, fatigue, OP,
    Dermatitis Herpetiformis, Nutritional      • Abdominal pain, fatigue,
    Deficiencies, and problems with
    conception.                                  headaches, “foggy brain”
• Blood test tTG IGA, IGG and intestinal       • No correct lab tests-important to
    biopsy confirm diagnosis
                                                 r/o celiac or wheat allergy before
• Test can be negative if following gluten
    free diet for anywhere from 2 weeks to       proceeding to gluten free diet.
    6 months
                                               • Unsure of long term
• Untreated Celiac increases risk for
    Autoimmune disease, cancer,                  complications
    infertility, dementia, and osteoporosis.

Damage to small intestine with Celiac

                      Treatment is 100% lifelong
                        adherence to a gluten
                              free diet.

Gluten has been researched in association
with…

• Diabetes( Increased risk for celiac with type 1 diabetes to 1 in 20)
• Autism and ADD
• Rheumatoid Arthritis
• Fibromyalgia
• Thyroid Disease
• Eczema
• IBS and IBD

Remember not all associations are causal although gluten restriction
may be helpful in some cases but not all.

Gluten Free Diet Principles
• Eliminate gluten containing foods and additives
• Gluten Free is defined as less then 20 ppm gluten
• Watch and safe guard against cross contamination even small
  quantities can be harmful.
• Beware of bulk bins, buffets, and eating out.
• Stick with fresh home-prepared meals, start with good gluten free
  ingredients and you will end up with good gluten free meals.
• Naturally gluten free foods include fresh and most frozen fruits and
  vegetables, most dairy (although you need to check labels), fresh
  cuts of meat, fish, poultry, herbs and spices, oils, distilled vinegars,
  and gluten free starches.
• Eating gluten free doesn’t necessarily mean better nutrition but is
  life changing and essential for many people.

Gluten Containing Grains
and Products
•   Barley                              •   Orzo
•   Barley malt/extract                 •   Panko
•   Bran                                •   Rye
•   Bulgur                              •   Seitan “wheat meat”
•   Couscous                            •   Semolina
•   Durum                               •   Spelt
•   Einkorn                             •   Triticale
•   Emmer or Faro                       •   Udon
•   Farina                              •   Ramen
•   Graham flour                        •   Wheat
•   Kamut                               •   Wheat Berries
•   Matzo flour/meal                    •   Wheat bran
•   Oats and Oat Bran if no specified   •   Wheat germ
    GF                                  •   Wheat starch

Gluten is Typically Found In
Obvious:                    Less Obvious Sources
• Most breads               •Beer
                            •Canned soups and broths
• Most cereals
                            •Some soy sauces
• Crackers                  •Dips/sour cream/dressings
• Pastas                    •Some yogurt and cheese products
• Cakes, cookies, donuts,   •Puddings
  pastries                  •Lunch meats or
• Granola or cereal bars      enhanced meats
                            • Communion wafers
                            • Premix seasonings
                              and sauces

Check the label for……
 Modified food starch, Dextrin, or Wheat Starch (unless a gluten-free grain
  in listed as starch source)
  Check for modified food starch on all labels including things like shredded
   cheese.
 Brewers Yeast or “Spent Yeast”
 Malt (unless a gluten-free grain in listed as malt source)
 Malt vinegar (distilled vinegars are generally gluten free)
 Natural Flavorings (wheat would be listed but barely and rye might not)

MSG, Caramel color, and maltodextrin are generally considered gluten free.

Call companies about questionable ingredients!

Gluten-Free Grains and Starches
• Amaranth         • Potato
• Arrowroot        • Sweet Potato or Yam
• Bean Flours      • Winter Squashes
• Buckwheat        • Yuca or Casava
• Corn             • Quinoa
• Polenta          • Rice
• Hominy (Grits)   • Soy
• Millet           • Sorghum
• Nut Flours       • Tapioca
• Oats*            • Teff
• Beans            • Wild Rice

What about Oats?
Cross contamination is an issue with Oats
 • during growth
 • harvesting
 • transport
 • milling and processing
Some manufactures have changed Oat production has
in recent years
 • Certified to be gluten free like Bob’s Red Mill

 Oats do contain a protein similar to gluten so some people with
 celiac can be symptomatic when consuming oats

Avoiding Cross Contamination at Home

• Use stickers or permanent marker to distinguish GF
  products
• Purchase separate condiments to avoid wheat/bread
  crumbs in the shared jars
• Purchase a separate toaster for gluten-free breads
• Use tinfoil on oven rack to avoid contamination
• Clean counter tops and cutting boards often to
  remove gluten-containing crumbs
• Cooking utensils, colanders, and pans need to be
  cleaned carefully after each use and before cooking
  gluten-free products

Cross Contamination…..
• Avoid bulk bins.
• Caution at buffets! Cross contamination is highly likely.
• Beware of fryers-French fries, chicken wings, or corn chips
  may have been cooked in the same oil where battered gluten
  containing foods have been fried-this happens often!
• Request to talk to chef and ask:
 • use clean utensils or a new crouton free salad bowl
 • clean the grill or pan before preparing food
 • keep the meal away from meals that contain gluten
• Always pack gluten free snacks for travel
• GIG certified restaurants in our area include Outback Steak
  House, Carrabba’s, The Melting Pot and Bonefish Grill

Don’t miss out on good nutrition..
• B vitamins -choose enriched and fortified products and gluten
  free nutritional yeast.
• Calcium -dairy, leafy greens, canned fish with bones.
• Vitamin D -get your levels checked! Food sources include
  salmon, enriched and fortified soy milk, milk, egg, some
  yogurts and mushrooms.
• Iron-fresh cuts of meat, beans, greens, blackstrap pair with
  citrus.
• Zinc-beans, nuts, seafood.
• Magnesium-nuts, seeds, dark leafy greens.
• Fiber-use beans and lentils as side starches, wild rice and
  quinoa are good choices, too. avoid excess processed gluten-
  free products.

If following a GF diet make sure to boost intake of
the above nutrients.

Gluten Free Meal Ideas
Breakfast:                                             Breakfast:
Gluten Free Cereal, Cooked Oats or Quinoa, 1 % Milk,
Fresh Berries, and Crushed Walnuts or Almonds
                                                       Scrambled eggs with corn tortillas, diced
                                                       tomato and avocado with fresh fruit.
Lunch:
Salmon tacos with GF corn tortillas and home made
                                                       Lunch:
coleslaw, Cooked pinto Beans and rice and salad.       Lentil Soup with gluten free crackers, 1 oz
Dinner:                                                cheese, and veggies.
Baked Chicken Breast with Honey Mustard, Cooked
Quinoa or Brown Rice and Steamed green beans
                                                       Dinner:
                                                       Herb rubbed pork tenderloin with pureed sweet
Snacks:                                                potato, and Steamed Broccoli
Any fresh fruit, Gluten Free crackers with peanut or
almond butter, Chobani yogurt, Veggies with Hummus,    Snacks:
rice cakes with PB.
                                                       Any fresh fruit, Gluten Free crackers with peanut or
Beverages:                                             almond butter, Chobani yogurt, Veggies with
Water, Loose leaf steeped teas, Coffee, Most Fruit     Hummus, rice cakes with PB.
Juices.
                                                       Beverages:
.                                                      Water, Loose leaf steeped teas, Coffee, Most Fruit
                                                       Juices.

Gluten Free Berry Tart(added per group discussion)
Crust Ingredients:                  Method:
• 1 cup finely ground almonds (or   • Preheat oven to 350 degrees.
  other nuts)                       • Spray pie plate or tart pan with cooking spray.
                                    •
• 1 cup GF flour mix                • Mix the ground almonds, GF flour mix, and xantham gum
                                      together in a medium bowl.
• ½ rounded tsp xantham gum
                                    • In a small bowl, mix the honey, tahini, and water
• approx ½ cup tahini or sesame       together to make a paste.
  butter                            • Add the paste to the flour/almond mixture and blend
                                      together with your hands, adding small amounts of
• approx ¼ cup honey                  water as needed, until you form a dough that starts to
                                      stick together.
• approx ¼ cup water                •
• 1 egg yolk, beaten well           • Pat the dough into the sprayed pie plate. Brush it with
                                      egg yolk and bake at 350 degrees for about 8 minutes or
                                      until the egg yolk has formed a dry seal over the crust.
                                    • While it is baking, toss the filling ingredients together.
Filling ingredients:                • Remove the crust from the oven, let it cool for a few
                                      minutes, then add the filling and return to the oven.
• 3 cups berries                      Cover any visible edges of crust with tin foil or crust
                                      protectors.
• ½ cup sugar                       • Continue to bake at 350 degrees for about 45-60 minutes
• ¼ cup corn starch                   or until the filling is thick and bubbly.
                                    • Remove and let cool for about 3 hours before serving.
• juice of ½ lemon                  • Serve the same day it is prepared.

Gluten is not just in food…..
• /Other Products that may be ingested
  • toothpaste (Crest and Colgate are gluten free)
  • lip products
  • shampoo
  • hand lotion
  • glue on envelopes
  • Wheat glue to seal tea bags
  • Play Dough(important for children with Celiac)
• Medications may use gluten in binders that hold pills
  together. Talk to your Pharmacist or call manufacturer.
  • Glutenfreedrugs.com

 See store specific lists for information on products.

Moving forward….
• Gluten awareness has increased resulting in more GF
  food options and better nutrition labeling!
• Most grocery stores have gluten free food lists
• The more you learn the easier it gets
• Keep food records and logs
• More resources are available
 • Gluten Intolerance Group
 • Celiac Disease Foundation
 • National Celiac Awareness Foundation
 • Center for Disease Control
 • National Institute of Health

FL Support Groups info from Celiac Disease
Foundation
•   www.cdfsouthflorida.org
•   Phyllis Kessler · 561-637-0396 · pkessler23@aol.com
•   GLUTEN FREE FOOD ASSISTANCE PROGRAM™ (GFFAP)
•   Celiac Disease Foundation Central Florida Chapter
•   www.cdfcentralflorida.org
•   Julie Kincart · 863-559-8025 · celiacsupport@tampabay.rr.com
•   Broward County
•   Anita Martinez · 954-366-3880 · transcript17@aol.com
•   Port Charlotte
•   Jessica Brimer · 941-815-2877 · jandjbrimer@centurylink.net
•   Port Richey
•   Margaret and Donald Bing · 727-844-5106 · mbing19@tampabay.com
•   Tampa Bay
•   Ryan Mitchell · 727-599-9071 · rm81dragon@yahoo.com
•   Vero Beach

Thank You!
It’s time for questions
     and discussion.