1. What is Celiac Disease? Celiac disease (CD) is a genetically linked disease with an environmental trigger. Eating certain types of protein fractions, commonly called gluten, sets off an autoimmune response that causes damage to the small intestine. http://www.youtube.com/watch?v=yGm Wf0et4hg http://www.youtube.com/watch?v=yGm Wf0et4hg Celiac Sprue Association 2011 1

2. By the numbers Research is telling us that 1 in every 133 people in the United States may have celiac disease Celiac Sprue Association 2011 2

3. What are the symptoms?…over 300 Abdominal cramping/bloating Feet (Reduced fat padding) Abdominal distention Flatus (Passing gas) Acidosis Gluten ataxia Mouth sores or cracks in the corners Back pain (Such as a result of collapsed lumbar vertebrae) Muscle cramping (Especially in the hands and legs) Constipation Night blindness Decreased ability to clot blood Celiac Sprue Association 2011 3

4. What are the Symptoms… Skin (Very dry) Dehydration Stools (Loose? Hard? Small? Large? Foul smelling? Floating? Clay, Light tan or Gray-colored? Highly rancid? Frothy?) Diarrhea (See Stools below) Nutrient Deficiencies Tooth enamel defects Electrolyte depletion Weakness Energy loss Weight loss Fatigue Celiac Sprue Association 2011 4

5. Symptoms in Children How is the child developing? – Slowly – Not gaining weight – Losing weight Under age three: – Growth failure – Diarrhea – Projectile vomiting – Abdominal bloating/distention Older children: – Crankiness – Difficulty concentrating – Irritability – Personality changes – Poor memory Celiac Sprue Association 2011 5

6. The Diet is the Prescription! Gluten-Free Diet Celiac Sprue Association 2011 6

7. Where is gluten found?... wheat barley rye oats (to a lesser extent) (WBRO) Celiac Sprue Association 2011 7

8. Hidden Sources of Gluten The Three C’s – Content, Contact, Contamination Content - Foods Breading Broths Caramel coloring Casseroles Croutons Flavors (artificial or natural Foods injected with broth Gravies Modified food starch Sauces Soy sauce Processed foods -Cold cuts, deli foods, pre-cooked foods, frozen foods Contact – Other Items Manufacturing Flour dust in air Flour in conveyor belts Flour on paper wrappers Glued container seams Business/Hobbies Envelopes Glue gun Stamps Play dough Personal Care Items Lipstick, make up Lotions Medications Mouthwash Shampoo’s/Soaps Toothpaste Celiac Sprue Association 2011 8

9. Cross contamination Common scenario’s…. – French toast? need gf bread, separate egg batter, utensils, pan and/or grill, FRESH GLOVES AND APRON – Grilled hamburger/hotdog/chicken? requires dedicated gf grill or gf pan, utensils, FRESH GLOVES AND APRON – Deli sandwich? requires gf condiments, bread, cheese and meat, utensils and prep surface, FRESH GLOVES AND APRON Celiac Sprue Association 2011 9

10. Common scenario’s….. – Toast? requires dedicated toaster, single serve condiments (butter, jelly, peanut butter)-can be portioned in back of house from fresh product into souffle cups – Prep area? Ideally have designated gf preparation area requires fresh/new bucket of sanitizer and fresh cloth wipe area from top to bottom – You? fresh apron, fresh gloves every time you assist a gf client Celiac Sprue Association 2011 10 Cross contamination

11. Label reading know how…. Celiac Sprue Association 2011 11 Food Allergy Labeling and Consumer Protection Act (FALCPA) requires only top 8 allergens to be identified. Barley, rye and oats and their derivatives are not required to be listed.

12. How to know if something is Gluten-free? 12 The CSA Recognition Seal < 5 parts per million of gluten Gluten –Free Certification Mark (Gluten Intolerance Group) < 10 parts per million of gluten

13. Label reading know how…. Wheat – (wheat flour, AP flour, wheat bran, wheat starch, wheat germ and other forms of wheat: -Durum-Emmer-Kamut-Semolina -Triticale-Spelt-Einkorn-Graham -Seitan- Couscous-Faro-Bulger Celiac Sprue Association 2011 13 A gluten-free diet means none of the following….

14. What are healthy and tasty gluten- free grains? 14 Brown rice Whole Corn Millet Teff Sorghum Wild Rice Buckwheat Amaranth Quinoa Gluten-Free Oats? Not recommended till after 1 year on gluten-free diet and then self-assessment and antibody testing recommended

15. Label reading know how…. Wheat Barley – Barley malt extract Rye Oats (non-contaminated okay after 1 year if approved by doctor) Celiac Sprue Association 2011 15 A gluten-free diet means none of the following….

16. Kitchen Smarts…. Wheat-free does not mean gluten-free A trace of wheat, barley, rye or oats can cause a reaction Watch out for “malt”….made from barley Celiac Sprue Association 2011 16

17. Kitchen Smarts Gluten-free foods include: – Fresh salad (no croutons) – Fruits and vegetables – Milk – Meats, fish or poultry (no breading, no marinade) – Pure spices and herbs – Pasta and breads labeled gluten-free Celiac Sprue Association 2011 17

18. Kitchen Smarts…GF foods to ?  Au jus  Canned soups  Malt flavorings  Pre-coated foods  Roux  Bouillon  French Fries  Pre-packaged foods  Sauces  Marinades Celiac Sprue Association 2011 18

19. Kitchen Smarts Request gluten-free listings from distributors Check out local grocery stores for gluten-free items – work with their dietitian Purchase only gf condiments! Celiac Sprue Association 2011 19

20. Kitchen Smarts for Preparation! Separate area and items needed to avoid cross- contamination: Strainers Utensils, Parchment Paper Toaster Oven Designated Prep Area or Station Celiac Sprue Association 2011 20

21. Kitchen Pantry Smarts! Keep gf items in separate container Keep gf items above other items Celiac Sprue Association 2011 21

22. Tools: a poster for food service employees 22

23. Kitchen Smarts When in doubt – leave it out! Questions? Celiac Sprue Association 2011 23

24. National & Local Support Celiac Sprue Association (CSA) PO Box 31700 Omaha, NE 68131-0700 Toll Free: 877-CSA-4CSA · Fax: 402-643-4108 · Email: celiacs@csaceliacs.org www.csaceliacs.orgwww.facebook.com/csaceliacs www.csaceliacs.orgwww.facebook.com/csaceliacs www.twitter.com/csaceliacs Celiac Sprue Association 2011 24