Hot Topics in Nutrition for School Lunch: Celiac - PowerPoint PPT Presentation

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Hot Topics in Nutrition for School Lunch: Celiac

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Title: Hot Topics in Nutrition for School Lunch: Celiac


1
Hot Topics in Nutrition for School Lunch Celiac
  • Carey OBrien, MS RD LDN

2
Celiac Disease
3
What is it?
  • An Auto-Immune disease
  • There are many different auto-immune diseases
    type 1 DM, Rheumatoid Arthritis, Lupus,
    Inflammatory Bowel Disease, etc.
  • It is a result of an over-active immune response
    to a protein in our foods (Gluten)

4
What is happening in the body?
  • The body sees the protein (Gluten) and thinks it
    is not supposed to be there.
  • It fights against this protein with an antibody
    (our white blood cells) called Tissue
    Transglutaminase (tTG).
  • This tTG sends a message to the intestine to keep
    out the Gluten which causes damage to the
    lining of the intestine.

5
Endoscopy
Normal Duodenum
Duodenal Scalloping
6
Histology
Normal Duodenal Mucosa
Villous Atrophy
7
How do you get Celiac?
  • Three things have to happen together
  • You had to have eaten Gluten at some point in
    your life.
  • You have to carry the gene.
  • The Gene has to be turned on (like a light
    switch). But this light switch is broken and
    once it is turned on it is never turned off.
    So you never out-grow Celiac.

8
What are some of the Symptoms?
  • Classic CD
  • Abd pain, diarrhea, constipation
  • Gas, distention
  • Anorexia
  • Poor wt gain/FTT in children. Unintentional wt
    loss in adults.
  • Irritability/lethargy
  • 2nd to MalNutrition
  • Anemia, fatigue
  • Vitamin def
  • Osteopenia
  • Apthous Ulcers
  • Delayed puberty
  • Infertility
  • Dental enamel hypoplasia

9
How is someone diagnosed?
  • All testing must be done while on Gluten
    containing diet
  • Bloodwork for antibodies (tTG)
  • If abnormal, then referral to GI specialist
  • GI specialist confirms with a scope

10
Management
  • C Consultation with skilled dietitian
  • E Education about disease
  • L Lifelong adherence to GF diet
  • I Identification of nutritional deficiencies
  • A Access to a support group
  • C Continuous long-term follow-up by
    multidisciplinary team

11
Dietitians and Reimbursement Issues
  • There is limited or no reimbursement for
    nutrition counseling for CD by insurance
    companies
  • Many patients/families will seek alternative
    sources (internet, support groups,
    family/friends, other health practitioners)result
    s in obtaining questionable information.

12
Gluten Free Diet
  • Attitudes are contagious!!!
  • Your perceptions of the Gluten free diet are
    likely to become your patients perceptions. We
    want to give our patients confidence,
    independence, and quality of life that will
    ultimately result in better compliance.

13
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14
Label Reading EliminateWHEAT, RYE, BARLEY
  • Barley
  • Bran
  • Bulgur
  • Couscous
  • Durum
  • Emmer
  • Einkorn
  • Farro
  • Farina
  • Graham
  • Kamut
  • Orzo
  • Rye
  • Semolina
  • Spelt (Dinkel)
  • Triticale
  • Wheat

15
Label Reading - Safe
  • Amaranth
  • Arrowroot
  • Buckwheat
  • Bean Flours
  • Carageenan
  • Cassava (Tapioca)
  • Corn
  • Flax
  • Millet
  • Nut Flours
  • Potato
  • Quinoa
  • Rice
  • Seed Flours
  • Soy
  • Sorghum
  • Teff

16
Oats
  • Currently the inclusion of oats in the GF diet
    remains an area of controversy.
  • Research regarding the safely of oats for people
    with celiac disease is still evolving
  • Gluten contamination of oat products
  • Oat prolamin (avenin) may trigger its own
    reaction

17
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18
Food Allergen Labeling and Consumer Protection
Act of 2004
  • Has two parts
  • Part 1 Effective Jan 2006
  • Manufacturers must say in plain English if one of
    the 8 most common allergens is in the food.
  • The Top 8 WHEAT, milk, soy, egg, peanut,
    treenut, fish, shellfish.
  • Wheat is on this list, but rye and barley are not
    on this list. So if wheat is in that food as an
    ingredient, it MUST be listed.

19
Label Reading Questionable Ingredients
  • Could be WHEAT
  • Modified Food Starch
  • Flour
  • Cereal Products
  • HVP
  • Soy Sauce
  • Flavoring
  • Could be BARLEY
  • Malt, Malt Flavoring, Malt Extract, Malt Syrup,
    Malto-Dextrin, Dextrin, Malt Vinegar
  • Brown Rice Syrup

20
FALCPA
  • Part 2 Effective Jan 2008
  • FDA has to come up with a definition for the
    Term Gluten Free
  • Manufacturers can choose to label their foods as
    GF

21
GF Food Guide Pyramid
  • Fruits fresh, frozen, canned
  • Vegetables fresh, frozen, canned
  • Meats fresh, read labels of processed
  • Nuts and Beans fresh, canned, dried
  • Dairy milk, cottage cheese, natural cheese,
    sour cream, cream cheese. Read labels on
    yogurts, ice creams, processed cheese, and
    pudding.

22
Food Guide Pyramid
  • Grains
  • Rice, Corn, Potato in various forms.
  • Specialty foods required for cereals, breads,
    pasta, crackers, pizza, pancakes, waffles, cereal
    bars, communion hosts and baked goods.
  • Fats/Misc Oils/Butter, Herbs/Spices. Read
    labels on salad dressings and marinades. GF
    gravies and cream sauces.
  • Sweets Chocolates like MMs, sugar candies,
    jello, popsicles, and fruit snacks. (NOT
    Twizzlers)

23
Example of Meals
  • Breakfast
  • GF cereal with milk, glass of juice
  • Eggs, GF Corn Tortilla, bacon, and milk
  • Lunch
  • Rice, unbreaded chicken, cheese, sautéed fajita
    vegetables, fruit, milk
  • Snack Corn chips and salsa
  • Dinner
  • Meat, Potato or Rice, veg, milk.
  • Mexican
  • Snack Ice Cream

24
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25
Cross-contamination
  • Toaster
  • Food item containers
  • Clean counter tops, cooking equipment, and good
    handwashing technique
  • Cooking process

26
How much gluten is too much??
  • Hischenhuber and colleagues reviewed a number of
    studies and concluded that the maximum tolerated
    daily intake of gluten is gt10 mg and lt 100 mg of
    gluten.
  • This equates to 1/50th to 1/500th of a slice of
    bread.

27
Cooking
  • Gluten our structural protein in foods
  • Get to know your GF flours
  • Cooking properties, complementary flours, best
    product use.
  • Experimentthe kitchen can be a great science
    laboratory!

28
Web Resources
  • www.pittsburghceliacs.org
  • www.livingwithout.com
  • www.glutenfreeliving.com
  • www.glutenfreedrugs.com
  • Google glutendrugssholland
  • www.gluten.net
  • GIG publications downloaded free of charge
  • www.clanthompson.com
  • Drugs and gluten alerts/updates

29
Book Resources
30
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