1. Gluten Free Eating Introduce OSU Extension and Educator.
Welcome to this Introduction to Gluten Free Eating.
Handouts for this lesson:
Gluten Free Eating: Important Considerations from OSU Extension
US FDA Gluten and Food Labeling fact sheet
Gluten-Free Baking from Colorado State University Extension
Optional handout: Gluten-Free Diet: Imprudent Dietary Advice for the General Population?
Optional food tasting:
Quinoa Mediterranean Salad from USDA What’s Cooking
COLLEGE OF FOOD, AGRICULTURAL, AND ENVIRONMENTAL SCIENCES
COLLEGE OF EDUCATION AND HUMAN ECOLOGY

2. Program overview: Gluten and related disorders
Considerations in eating gluten free
Gluten free shopping
Gluten free cooking & baking
These are the aspects of gluten free eating that we will cover today.

3. What is Gluten? A sticky protein found in Wheat Rye Barley
Gluten is a sticky protein found in wheat, rye and barley, and in oats that are not certified gluten free. Oats can easily become contaminated with gluten during harvest if they are not grown specifically to be gluten free.
Gluten helps foods maintain their shape, acting as a glue that holds food together. In fact, the word gluten comes from a Latin word meaning ‘glue.’

4. Why are some people concerned about gluten?
Wheat Allergy
Celiac Disease
Non-Celiac Gluten Sensitivity
These are the 3 medical reasons people must avoid gluten: wheat allergy, Celiac disease and non-Celiac gluten sensitivity.

5. Wheat Allergy Overreaction of immune system to protein in wheat
Range of symptoms from mild to severe or even fatal
Occurs in 0.4% of the US population
A food allergy is an overreaction of the immune system to a specific food protein. When the food protein is ingested, it can trigger an allergic reaction that may include a range of symptoms from mild symptoms (rashes, hives, itching, swelling, etc.) to severe symptoms (trouble breathing, wheezing, loss of consciousness, anaphylaxis). A food allergy can be potentially fatal. Note: People with wheat allergy must only avoid wheat. Rye and barley are safe for consumption by people with wheat allergy only.
Wheat allergy occurs in about 0.4% of the U.S. population.
Additional information:
“Although childhood allergies to milk, egg, wheat and soy generally resolve in childhood, they appear to be resolving more slowly than in previous decades, with many children still allergic beyond age 5 years.”

6. Celiac Disease Autoimmune disease
Triggered by the consumption of gluten
Causes damage to the villi in the small intestine
Over 200 possible symptoms
1 in 100 people worldwide
Celiac disease is a serious genetic autoimmune disease that is triggered by consumption of gluten. In fact, Celiac is the only auto-immune disease with a known trigger: gluten.
When a person with Celiac disease consumes gluten, it sets off a reaction where the body starts to attack the small intestine, blunting the finger-like projections, called villi, in the small intestines that help absorb nutrients.
There are over 200 symptoms associated with Celiac Disease affecting many body systems: Gastro-Intestinal, Muscular-skeletal, Neurological, Reproductive, skin and behavior. For a symptom checklist, see Celiac Disease Foundation website: celiac.org
It is estimated to affect 1 in 100 people worldwide.  Two and one-half million Americans are undiagnosed and are at risk for long-term health complications.
Celiac is usually diagnosed by a gastroenterologist through a blood test and endoscopy. If left untreated, can cause serious complications, including malnutrition and intestinal damage. Individuals with celiac disease must avoid gluten. People do not outgrow Celiac. It is a disease requiring strict lifelong adherence to a gluten free diet.
The good news is that once gluten is removed from the diet, the damage caused by Celiac will reverse, as the villi heal and re-grow.

7. Non-Celiac Gluten Sensitivity
Symptoms similar to Celiac
Negative Celiac tests
Estimated 18 million Americans have gluten sensitivity
A person who suffers from symptoms that seem related to gluten, it may be possible that he or she has non-celiac gluten sensitivity ('gluten sensitivity'). Research estimates that 18 million Americans have gluten sensitivity. That’s 6 times the amount of Americans who have celiac disease. More research is needed to understand non-Celiac gluten sensitivity. Recent studies say it may be a type of auto immune that affects a different part of the intestines.
Additional information:
“New research suggests that it gluten alone may not be responsible for the symptoms produced by the condition currently called gluten sensitivity. Instead, it is showing that perhaps FODMAPs, a group of poorly digested carbohydrates, may be the cause of the symptoms instead. It is also important to note that wheat, barley and rye — gluten-containing grains — are all high in FODMAPs.
Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols
FODMAPs are short chain carbohydrates that may be poorly absorbed in the small intestine.  This can cause more water to be pulled into the colon and can also rapidly ferment, or be broken down, by bacteria in the bowel. This can cause symptoms like increased gas, bloating, constipation/diarrhea and pain.  These symptoms are part of the diagnosis of Irritable Bowel Syndrome (IBS) and also overlap with celiac disease symptoms.”

8. What sparked your interest in gluten free eating?
Ask participants to share their reason for taking this series of classes, if they would like.
Educator can share his or her interest as well.
Possible reasons:
Medical Diagnosis (allergy, Celiac, sensitivity)
Family member with gluten issues
Doctor’s suggestion to avoid gluten
Other Health Reasons
Curiosity

9. Increased demand for gluten free foods
One of the most popular diet trends in US
1 in 5 people looking to reduce or eliminate gluten
In 2015, Americans spent $4 million on gluten free foods
There is an ever-increasing bounty of gluten free foods available in grocery stores and on restaurant menus. Both medical diagnoses and consumer demand are driving the surge in gluten free products. Recently, a gluten-free lifestyle has become an increasingly popular U.S. diet trend. According to a 2015 Gallup poll, approximately twenty percent of Americans are looking to reduce or eliminate gluten from their diet.
According to William F. Balistreri, MD, a doctor at Cincinnati Children's Hospital Medical Center, 100 million Americans say they ate gluten-free products in Americans spent an estimated $4 billion on gluten-free products in 2015.
Handout: The Gluten-Free Diet: What You Need to Know

10. Naturally gluten free foods
Fruits
Vegetables
Meat and poultry
Fish and seafood
Dairy
Beans, legumes, and nuts
The most cost-effective and healthy way to follow the gluten-free diet is to eat these naturally gluten-free food groups. Foods in the least processed state are more likely to be gluten free. Once meat is processed (even seasoning added), it must be scrutinized for gluten by reading labels or contacting manufacturer.
Read more at
Picture source: celiac.org*
*Note for reviewer: permission granted for photo use.
Alicia Carango
“Please feel free to use a photo from our site and cite us as a source. I appreciate you checking in!” 
Best,
Alicia 

11. Naturally gluten free grains and starch
Amaranth Arrowroot Beans Buckwheat groats Cassava Chia Corn Flax Gluten-free oats*
Millet
Nut flours
Potato
Quinoa
Rice
Sorghum
Soy
Tapioca
Teff
Yucca
These grains and other starches are naturally gluten-free.
*It is important to note that those with Celiac or gluten sensitivity should only consume oats that are labeled gluten-free as cross-contact may occur when oats are grown side-by-side with wheat, barley or rye, or harvested using the same equipment.
Optional discussion:
Gluten free diets tend to use a lot of rice and rice flour, which naturally absorbs arsenic from the soil.
Vary your grains to limit arsenic exposure
Optional handout: Arsenic in rice from FDA

12. Where is gluten found in food?
These are common sources:
Bread
Crackers
Cereal
Pasta
Baked Goods
Typically, these are the foods we think of as containing gluten, as they tend to have wheat as the main ingredient.
Note: These are NOT the only sources of gluten.
Picture source: Celiac.org

13. Which of the following sources may have gluten?
Processed meat
Seasonings
Salad Dressings
Soup stock
Granola bars
Chips
Candy
Soy sauce
Toothpaste
Medications
Supplements
Play dough
Ask: Which of the foods listed here may have gluten in them?
(on second click, the answer will appear: All of these must be verified as they may contain gluten).
Gluten can be found in many types of foods, even ones that would not be expected.
When unable to verify ingredients for a food item or if the ingredient list is unavailable DO NOT EAT IT. Adopting a strict gluten-free diet is the only known treatment for those with gluten-related disorders.
Note: There is more to come on finding gluten in food labels and ingredient lists in lesson #2.
Read more at
All of these must be verified by checking the label and/or manufacturer!

14. Sources of Cross Contact
Toasters
Colanders
Cutting boards
Flour sifters
Shared containers
Condiments
Airborne wheat flour
When preparing gluten-free foods, it is important to avoid cross-contact. Cross-contact happens when gluten free food or ingredients come into contact with gluten, generally through shared utensils or a shared cooking/storage environment. In order for food to be safe for someone with Celiac disease, it must not come into contact with food containing gluten.
*Note: if educator is preparing food for a tasting for this program, educator must control for cross-contact, especially if a participant is extremely sensitive to any gluten.
Read more at

15. Gluten Free does NOT always mean healthy
Depends on how you go gluten free
Gluten free substitutes may add more fat or sugar
Gluten free diets tend to be lower in fiber
The most popular reason consumers give for buying gluten free products is they believe the gluten free diet has health benefits, including weight loss. While there is evidence to show that a gluten free diet can help diminish symptoms associated with certain autoimmune diseases such as dermatitis herpetiformis, irritable bowel syndrome, rheumatoid arthritis, type 1 diabetes, thyroiditis, and psoriasis, there is no evidence to support gluten free health claims for the general population. Some people who are on a gluten free diet simply do not need to be.
The likelihood of weight loss on a gluten free diet depends on how a person goes gluten-free. Avoiding processed foods and refined carbohydrates like bread, crackers and pasta and replacing them with whole grains will reduce extra calories and increase fiber. Interchanging gluten-containing products with gluten free substitutes will likely lead to consumption of more fat, sugar and calories. Gluten free does not necessarily mean healthy. Gluten is found in foods that are part of a healthy diet and contribute nutrients and fiber.
Read more at

16. What you should know before gluten free
Talk with your doctor first
Consult a dietitian
Consider other family members
Consult a doctor. Be sure to consult a doctor before going gluten free, since diagnostic tests require active gluten consumption in order to be accurate. Consumers who decide to go gluten free without a diagnosis usually do not want to go back on gluten just to be tested. A gluten free diet cannot replace a formal consultation, diagnosis or recommendation from a physician.
Meet with a dietitian. Dietitians knowledgeable in celiac disease and the gluten-free diet play an important role in managing gluten-related disorders. Gluten free diets may need careful monitoring to ensure a healthy and adequate balance of nutrients and fiber.
Consider other family members. If you will be the only gluten free person in your household, will you prepare separate gluten-containing food for others? Will you have adequate space for storing and preparing gluten free food separate from gluten containing food?
Handout: Gluten Free Eating: Important Considerations from OSU Extension
Optional Handout (or use for reference): Gluten-Free Diet: Imprudent Dietary Advice for the General Population?

17. Where to find gluten free foods
Gluten free section
Specialty section
Throughout the store
Specialty stores
Online stores
If you are new to gluten free shopping, the first trip can be quite overwhelming and probably take longer than you planned. It does get easier over time, however.
Grocery Stores:
Some grocery stores have a clearly marked gluten free section. These tend to be the exclusively gluten free brands.
Some gluten free foods are with other specialty foods, such as organic or vegan.
Some gluten free products are amongst regular foods throughout the store in addition to the naturally gluten-free foods that are always accessible.
*Read carefully when… a gluten free product might be right next to a gluten item. Some brands make both gluten and gluten free, so double-check every item before it goes into your cart.
Specialty stores:
You will also find gluten free products in health food stores, whole food stores, those carrying foods for special diets. Check online for stores in your area.
Online stores:
Many companies offer free shipping on purchases over a certain amount and can send gluten free items right to your door. Once you have an item you know you like, check prices to see if an online order is more cost effective.

18. Gluten Free Shopping Always read list of ingredients
Look for ‘GLUTEN FREE’ on the package
Understand labeling laws
Smartphone apps may not be accurate or complete
Always read the list of ingredients in case manufacturers change ingredients. It’s possible that a food that used to be gluten free may no longer be.
While there is no standard logo, look for the words GLUTEN FREE somewhere on the package.
It helps to understand the labeling laws. “Gluten Free” is a voluntary claim, but if a package bears this claim, it must be gluten free.
There are smartphone apps where you can scan a food UPC label and the app will indicate if the item contains gluten. These are only as accurate as the app developer. You may find the app developer favors one store over another, so a store brand may be listed as gluten free in one store but not another. Use caution with apps. It’s better to read the ingredient list.

19. Which of the following terms fall under FDA regulation?
Gluten-free
Free of gluten
No gluten
Without gluten
Ask: Which of the following terms fall under the FDA regulation?
Answer: all of the above. The FDA regulation applies to these four terms.
Handout: US FDA Gluten and Food Labeling fact sheet
Defining “gluten free”:
Celiac disease experts deemed less than 20 parts per million a safe amount for most people with celiac disease. The FDA established a gluten limit of less than 20 parts per million for foods that carry the label with one of these four terms.

20. Gluten Free Labels
There is no standard logo for the gluten free label. These are just some of the many logos you may see on food packages. The FDA regulation doesn’t require manufacturers to place a food’s “gluten-free” claim in any specific location on the food label. So, manufacturers may choose where they place a “gluten-free” claim, as long as it doesn’t interfere with mandatory labeling information and meets the regulatory requirements.
Some manufacturers may choose to include the logo of a gluten-free certification program on their food labels; however, FDA does not endorse, accredit, or recommend any particular third-party gluten-free certification program.

21. Avoid Confusing Labels
For those with Celiac and those very concerned with potential hidden sources of gluten, clear labeling is important. Some manufacturers use confusing ambiguous labels like the ones pictured here. Terms such as “no gluten ingredients “and “made without gluten” are now frequently seen on products. The wary consumer must ask why the manufacturer wouldn’t use the standard language.  
These phrases are unfortunate loopholes in the labeling rule. These terms do not fall under the FDA labeling regulations so their meaning is vague. Contacting the manufacturer for products with these claims is recommended. It is reasonable to assume that there is a basic reason that these products are not labeled gluten free. It’s a valuable selling point if a product is labeled gluten-free, so it should raise suspicion if the company is deliberately using a similar-sounding term that evades regulation. Perhaps they are made in a shared facility or the ingredients are not sourced from gluten-free manufacturers. If the manufacturer cannot clarify the situation to your satisfaction, it would be prudent to avoid these products. The label pictured in the middle was from a package of sliced almonds. It says “Contains ingredients safe for a gluten-free diet”. Someone with Celiac had a strong symptomatic reaction after consuming these almonds. When the manufacturer was contacted, they declared the almonds were produced on lines where gluten was also present. The ‘may contain’ statement would have been helpful here for someone with Celiac, even though it was not required… but the manufacturer should not list it as gluten free unless it can be tested to less than 20 ppm.
Take home point: These products should be avoided if the manufacturer cannot adequately explain why they are not using a regular gluten-free label.
Note: if you find a product is mislabeled or misleading, use the information on the FDA labeling handout to contact appropriate authorities.

22. 8 Major Allergens Milk Eggs Fish Shellfish Tree nuts Peanuts Wheat
Soybeans
Those with Celiac and gluten sensitivity must also avoid rye and barley and their derivatives
Congress passed the Food Allergen Labeling and Consumer Protection Act of The law applies to all foods whose labeling is regulated by FDA, both domestic and imported. FDA regulates the labeling of all foods, except for poultry, most meats, certain egg products, and most alcoholic beverages.
The law requires that labels must clearly identify the food source names of all ingredients that are — or contain any protein derived from —the eight most common food allergens, which Act defines as “major food allergens.”
As a result, food labels help allergic consumers to identify offending foods or ingredients so they can more easily avoid them. The eight foods identified by the law are:
Milk
Eggs
Fish (e.g., bass, flounder, cod)
Crustacean shellfish (e.g. crab, lobster, shrimp)
Tree nuts (e.g., almonds, walnuts, pecans)
Peanuts
Wheat
Soybeans

23. Allergen & advisory statements
These notes taken verbatim from the Food Allergy Research & Education (FARE) website:
“The Food Allergen Labeling and Consumer Protection Act (FALCPA), which took effect January 1, 2006, requires that the labels of foods (including conventional foods, dietary supplements, infant formula, and medical foods) containing major food allergens (milk, eggs, fish, crustacean shellfish, peanuts, tree nuts, wheat and soy) note the allergen in plain language, either in the ingredient list or via:
the word “Contains” followed by the name of the major food allergen – for example, “Contains milk, wheat” – OR
in the ingredient list in parentheses – for example, “albumin (egg)”
Such ingredients must be listed if they are present in any amount, even in colors, flavors, or spice blends.
Although FALCPA has made label reading easier, FARE advises individuals and families who are managing food allergies to read all labels on all packages carefully every time. Ingredients can change without warning, so reading labels each time will ensure you avoid any ingredients that may cause a reaction.
“May Contain” Statements
The use of advisory labeling (i.e., precautionary statements such as “may contain,” “processed in a facility that also processes,” or “made on equipment with”) is voluntary and optional for manufacturers. There are no laws governing or requiring these statements, so they may or may not indicate if a product contains a specific allergen.  According to the FDA’s guidance to the food industry on this issue, advisory labels “should not be used as a substitute for adhering to current good manufacturing practices and must be truthful and not misleading.” If you are unsure whether or not a product could be contaminated, you should call the manufacturer to ask about their ingredients and manufacturing practices.”

24. Gluten free cooking tips
Thickening remains the same amount
Mix cornstarch first with cold water for thickening
Make breading out of dried sandwich bread
Cornflakes can be used as breading
Use same amount of gluten free flour for thickening.
Mix cornstarch first with cold water for thickening.
For breading, make from dried gluten free sandwich bread or use cornstarch.
You can also use gluten free unsweetened cornflakes as breading or casserole topping.

25. Baking gluten free Nutrition Moisture Flavor Structure Fat
Gluten free flours and starches work differently than wheat flour.
Note: Refer participants to these handouts for more information:
Gluten-Free Baking from Colorado State University Extension
Gluten-Free Sorghum Recipes Jenny Rees and Alice Henneman, UNL Extension Educators
These are some of the characteristics of baking gluten free that need adaptations to be successful with gluten free flours.
Nutrition
Substituting 1/4 cup ground flaxseed in 1/4 cup water for 1/4 cup flour will increase nutrition in any recipe.
Moisture
There are many ways to increase moisture in a recipe.  In general, recipes that call for pureed fruit, sour cream or yogurt are ones you can rely on for a moist product. In case your recipe does not call for these things, use brown sugar instead of white sugar to add moisture. Honey and agave as a sugar substitute can enhance moisture as well, but be aware that you should cut down slightly on the other liquids you are using in the recipe, as honey and agave are not solid ingredients. Adding an extra egg or oil can also help, but use caution.
Flavor
Gluten-free flours often have unique tastes, and adding additional flavoring to recipes will help cover up these unfamiliar flavors. New bakers should try adding extra vanilla and/or spices to recipes. Try adding chocolate chips, nuts or dried fruits.
Structure
Gluten is the ingredient most responsible for the structure of baked goods in traditional recipes. Using dry milk solids or cottage cheese in a recipe can help mimic glutenous structure. Sometimes using the moisture tricks listed above will also solve structure problems with products that come out too dense and crumbly.  Use combo of gluten free flours and mix together thoroughly before adding to other ingredients. Add dry milk or cottage cheese. Use evaporated milk in place of regular milk.
Fat
Use less butter and oil – gf flours don’t absorb as much fat as wheat flour… trim a few tablespoons off.

26. Gluten free flour blends
Commercial
Make your own
Use blend of different flours and starches (2:1 ratio)
Flour blends
There are many brands of all-purpose gluten-free flour blends available, each with different mixtures of various flours. They are convenient, since you can substitute them cup-for-cup in wheat flour recipes, but they can be quite expensive. Choose a brand based on the ingredients you prefer. Varieties with bean flour can have a “beany” flavor and with a large amount of cornstarch they can give baked goods a firm texture, and rice flour can give a gritty texture. Ingredients on the label are listed in descending order by predominance of weight, so you can tell which flour dominates in any flour blend. Follow the instructions and suggested uses for each brand, but don't hesitate to experiment!
One type of gluten-free flour alone cannot replace the all-purpose white or whole wheat flour used in regular baking. It is usually necessary to make a blend of the different weighted gluten-free flours and starches to replicate the flavor, texture and density of the gluten-filled flours.
The rule of thumb is a 2:1 ratio of flour to starch. A gluten-free flour blend could be as simple as 1 cup of rice flour for every ½ cup of tapioca starch. However, too much starch can lead to gummy results and not a lot of nutrition so it is best to use flours of different protein contents, weights and densities.
Gluten is what gives baked goods their structure. Without the gluten, foods are more likely to fall apart. Adding gums such as xanthan gum or guar gum replaces some of that structure.
For yeast products, add 1 teaspoon of xanthan gum or guar gum per cup of flour blend. For non-yeast products, add ½ teaspoon of xanthan gum or guar gum per cup of flour blend.
Finely ground rice flour yields better product

27. Gluten Free Dining Look for restaurants that offer gluten free options
Web search
Smartphone apps
Gluten free menus
You won’t have to give up eating out altogether, it just takes a little more planning.
Some websites and smartphone apps are helpful in finding restaurants with gluten free menu items. These sources sometimes have consumer reviews of how “Celiac-friendly” the restaurant is (for example, how knowledgeable and helpful staff were, consumer reactions to food, etc.).

28. Program summary: Wheat Allergy, Celiac, Gluten Sensitivity
Considerations in eating gluten free
Gluten free shopping & label reading
Gluten free cooking & baking
Gluten free dining

29. Please share one idea you learned today that will be helpful to you.
Wait for responses…
Optional food tasting:
Provide a taste of gluten free food:
1. A dish that is naturally gluten free (Quinoa Mediterranean Salad* from USDA What’s Cooking?) *Make sure chicken broth is gluten free.
2. A food that is an obvious gluten free substitute (Gluten free baguette with GF pesto, such as Schar bread that is ‘par-baked’ and you must finish baking 3-5 minutes before serving. A toaster oven is portable and works well for this during a presentation.)

30. Sources Academy of Nutrition and Dietetics eatright.org
Beyond Celiac beyondceliac.org
Celiac Disease Foundation celiac.org
Complete Food and Nutrition Guide, Fifth Edition by Roberta Larson Duyff, MS, RD, FADA, CFCS, and the Academy of Nutrition and Dietetics
US Food and Drug Administration “Gluten Free Labeling”. fda.gov/downloads/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Allergens/UCM pdf
Nutrition 411 nutrition411.com

31. This program was developed by: Shannon Carter, M.S.
Extension Educator, Family and Consumer Sciences,
Ohio State University Extension
Fairfield County
831 College Avenue, Suite D
Lancaster, OH 43130
CFAES provides research and related educational programs to clients on a nondiscriminatory basis. For more information: