Celiac Disease and the Gluten-Free Lifestyle

Transcription

1 Slide 1 Celiac Disease and the Gluten-Free Lifestyle Welcome to Celiac Disease and the Gluten-Free Lifestyle, a Texas A&M AgriLife Extension Service Professional Development Training Program. This course covers basic, relevant nutrition information about Celiac Disease, its diagnosis, and its treatment. This module is approximately 1 hour in length. This course will be presented in a voice-narrated format that allows you to follow along with a PowerPoint slide presentation. A high-speed Internet connection is required to complete the course. Content for this module is divided into multiple sections (see menu bar on the left for course outline), enabling you to complete and/or review content at your own pace. Printable handouts, if applicable, will be presented prior to the section in which they are referenced. In the next section, you will be directed to complete a brief, multiple-choice pre-learning assessment. Once you have completed the pre-learning assessment, you will be free to advance to the course content by checking the Next Section button at the bottom of the page. At the conclusion of this module, you will be directed to complete a post-learning assessment that will determine if you successfully pass the course. If at any time you wish to take a break from the module, simply log out and return to the course when you are ready to continue. When you sign back in to the module, you will be taken directly to the section where you left off. To review a section you have already completed, click on the desired section on the left menu bar. Learning Objectives The learning objectives for Celiac Disease and the Gluten-Free Lifestyle module are as listed below. At the conclusion of this module, participants will be able to: Discuss Celiac Disease, including its symptoms and how this condition differs from food allergies; Explain the diagnosis of Celiac Disease and its importance before treatment of the disease; Describe the lifelong treatment of Celiac Disease; Be aware of how to utilize the ingredients listing and nutrition facts labels, plus food allergen listings for gluten-containing foods on all manufacturers food labels and other identifiers on gluten-free products; Identify safe foods, unsafe foods, and foods that need special attention when reading food labels;

2 Be able to make wise gluten-free food selections, whether eating at home or away from home; and Explain why the gluten-free diet is not intended as a weight-loss plan or for any other purpose but to treat Celiac Disease. Introduction Slide 2 Celiac disease affects 1% of the U.S. population. Because people aren t aware of this disease, more than 97 % of those who have the disease don t know it. However, more recently, the public is being made more aware of Celiac Disease through media reports and by celebrities like Elizabeth Hasselback, who has the disease and has publicly spoken and written about it. Slide 3 So, is having Celiac Disease the same as having food allergies? A food allergy occurs when a food is eaten and the body s defense system mistakes the food, which is usually a protein, as harmful and develops antibodies to fight the offending food. Food Intolerance is a digestive system response, rather than an immune system response. The food irritates the digestive system so the person can t properly digest the food. Allergies to different foods can cause: aversions to certain foods, such as a child rejecting a food for no apparent reason; highly restrictive meal plans, which are boring; and forbidden foods that are used to manipulate parents or caregivers. Foods that can cause sensitivities or intolerances include gluten, lactose, and MSG, or monosodium glutamate. Slide 4 Celiac Disease is a digestive disorder that affects children and adults. When a person with Celiac Disease eats certain foods, it upsets the small intestine. A reaction then happens that damages the small intestine. Microvilli, or villi, are the small, hair-like cells where the absorption of nutrients occurs from the blood stream into the small intestine. When a person with Celiac Disease tries to digest gluten, the small intestine is damaged. The body begins reacting, and the villi are damaged. Normally, villi live up to 3 days before they die and are replaced by new cells. However, in the case of Celiac Disease, the villi die much earlier, before they ve had a chance to fully mature. Over time, if the damage continues, the villi will start to grow back, but they re smaller and flatter. When this happens, the villi can t work as well, and less nutrients are taken up.

3 Villi absorb the basic nutrients of all foods the proteins, carbohydrates, fats, vitamins, and minerals plus sometimes water and bile salts that are made in liver and transport fats from foods in the stomach to be used by the body. When the body doesn t absorb nutrients, it can become deficient, or lacking, in vital nutrients. This condition can be life-threatening if it s not treated. Foods with gluten in them can cause this reaction in those with Celiac Disease because gluten-containing foods aren t broken down properly in the body. Slide 5 Celiac Disease is a chronic disorder, which means it s a lifelong disease. The symptoms of Celiac Disease vary from person to person. The symptoms may occur in the digestive system or in other parts of the body. Digestive symptoms are more common in infants and young children and may include abdominal bloating and pain; chronic diarrhea; vomiting; constipation; pale, foul-smelling, or fatty stools; and weight loss. Some people who hear about the gastric symptoms of the disease are prone to make a selfdiagnosis of their problem. If they start following the gluten-free meal plan for treatment of the disease, they can cause the real symptoms of their disease to be masked so their real diagnosis is missed. To know if a person has Celiac Disease, they must consult their physician, who can conduct blood work. If the blood work results indicate that Celiac Disease is suspected, then an endoscopy of the small intestine, with several biopsy samples taken, can be performed to either confirm or prove that Celiac Disease is present. The only known treatment to prevent damage to the small intestine is to avoid foods with gluten and to follow the gluten-free meal plan. A registered dietitian, who is well-versed in the management of Celiac Disease and the gluten-free diet, should be consulted regularly. Once the person is no longer consuming gluten, the small intestine can begin to heal. However, the damage that s already been done from eating gluten in the past isn t always reversible. You can keep the damage from getting any worse, which can be enough to prevent the long-term conditions. In more extreme cases, some people need to have surgery to remove part or all of the small intestine, depending on the extent of damage. Usually, if Celiac Disease is diagnosed early enough, most or all function in the small intestine can return over time. Slide 6 The main treatment for Celiac Disease is to avoid gluten! Gluten is present in the proteins in wheat and grains. Examples of gluten products include: types of wheat, such as durum, semolina, spelt, kamut (kah-moot), einkorn (ein -corn), and faro; and rye, barley, and triticale.

4 These foods are harmful to people with Celiac Disease and must be removed from all foods they consume. Slide 7 There are other potentially harmful ingredients to watch for. All processed foods have a food label with a list of ingredients. This is normally the place you ll need to look to make sure you avoid foods with gluten ingredients. However, there are some hidden ingredients that food companies don t have to put on the food label. These hidden ingredients include: Slide 8 Unidentified starch, which must be identified by law as modified food starch ; Gluten binders, which are used in many baked and processed products to bind and thicken a product; Fillers that increase the volume of food without drastically changing its nutrition content are sometimes used in turkeys and other meats; Excipients are considered inactive ingredients but are often used by drug companies and may contain gluten; Extenders are, in many cases, used along with fillers and act as a sticky product to help bind different ingredients together; and finally, Malt, which most often refers to malted barley and is a gluten-containing grain. If you re diagnosed with Celiac Disease, your doctor will most likely want to perform a bone density test to check for signs of mineral loss, like calcium, and bone weakening. People with Celiac Disease are at a high risk of developing osteoporosis, which is the weakening of the bones. Drugs aren t usually prescribed. Sometimes a vitamin and mineral supplement is given, but since the issue is not usually the diet but the poor functioning of the digestive tract, supplements may not help. People with Celiac Disease may also benefit from vitamin and mineral supplements if the condition has caused a deficiency. Important nutrients that may need supplementing include iron, calcium, vitamin D, zinc, copper, folic acid, and other B vitamins. Be sure to check with your health care provider for the right amount. If supplements or drugs are prescribed, they can t contain gluten, which is common as a filler in pills. You should discuss this issue with your doctor and/or pharmacist. Review of Gluten-Free Diet Slide 9 Is a gluten-free meal plan a diet that can be used to treat many health problems? The answer is no, although it can be nutritious and delicious. This meal plan is only for those who have an intolerance to gluten, which is found in many foods.

5 Slide 10 We ve mentioned the gluten-free meal plan more than once in this presentation, but next, we ll talk about gluten-free meals and what foods fit into this meal plan. The gluten-free meal plan is a lifestyle of eating that includes only foods without gluten in them. Living by the gluten-free meal plan when you have Celiac Disease can increase your quality of life and decrease the risk of developing other conditions. To follow this meal plan, you must change your current lifestyle. It involves reading food and drug labels and identifying safe foods to eat. Slide 11 The foods shown on this slide are in question because they may contain gluten. However, many of these products are available in gluten-free versions. It s important to carefully read the ingredient list. Baked products made with buckwheat, which is sometimes blended with wheat flour in baking mixes, should state that they are gluten free or from a noncontaminated source. Slide 12 Reading food labels to make sure the food is safe to eat is very important. Proper food-labelreading education is very important for people with Celiac Disease. You must be able to identify harmful ingredients in processed and packaged foods. The best way to make sure you follow the gluten-free meal plan is to make your foods yourself, using gluten-free ingredients. But it s unrealistic to always abide by the meal plan, especially when gluten is a hidden ingredient in so many foods, such as packaged meats. If you have any questions about gluten-containing foods, you should consult with your doctor and dietitian. Slide 13 Ensure that you re eating well-balanced, nutritious meals. Following a gluten-free diet can be difficult to adjust to, especially if you ve been recently diagnosed with Celiac Disease and given a meal plan by your dietitian. Here s a suggestion for you to use, along with the gluten-free diet. The United States Department of Agriculture, or USDA, developed MyPlate, which provides guidelines for healthy eating and focuses on the major food groups Grains, Dairy, Vegetables, Fruits, and Protein Foods. While MyPlate is intended for the general population, here are some suggestions for eating gluten-free while following the USDA s food guidelines. The Grains food group has the most gluten sources. That makes sense because gluten is found in all wheat and other grain products. But the truth is that gluten may be hidden in many other food sources. Here s a list of some grains you can eat on a gluten-free diet or meal plan: Oats are naturally gluten-free, but they re often processed with wheat products. Some companies sell uncontaminated oats, so these foods should have a gluten-free symbol on the food product box.

6 Activity Flour made from bean, corn and cornmeal, potato, rice, soy can be eaten. You can also eat amaranth, cornmeal, flax, millet, and quinoa (ki-no-wa). Before proceeding, download and print the activity, What Foods in Each Food Group May Contain Gluten? Follow the directions provided. Reading Food Labels for Gluten, Wheat and Other Food Allergens? Slide 14 Do you know how to read food labels for gluten, wheat, and other food allergens? We re going to have a quick lesson on reading food labels to detect wheat gluten and other food allergens by looking at the packaging of products and food labels. Let s take a look at how gluten and food allergens are identified on food labels. Slide 15 When buying processed and packaged foods, look for the symbols you see on this slide. You ll see other symbols, too, but foods with these symbols should be gluten-free. Always use caution and review the food labels when you re shopping. It can take longer to grocery shop, especially at first, but it s worth it to ensure that you only buy and eat foods that are safe for you. Slide 16 Those with Celiac Disease must learn about food labels and how to use them when shopping for food and planning meals. Food labels give clues about the content of the food by the order in which the ingredients are listed. They also provide nutrition facts about the calories, carbohydrates, total and saturated fat, cholesterol, and sodium. What does a label tell you? Nutrition labels reflect how the foods we eat relate to health and what the food s role is in reducing the risks of some diseases, such as Celiac Disease, diabetes, heart disease, and osteoporosis. All food labels give us specific information about the product inside, such as the brand name, product name, manufacturer s address, and the amount of food in the package or the net weight of the ingredients. By looking at the Nutrition Facts label and the ingredients listing, the following information will help you to make a decision about whether or not this food choice will fit into your meal plan: Serving size; Calories; Total fat, saturated fat, and trans fat; Cholesterol; Sodium;

7 Slide 17 Total carbohydrates, fiber, sugars, and sugar alcohols; and Protein. Food allergy labeling for wheat, barley, rye and triticale is useful for those with Celiac Disease. The new food allergen labeling law requires food manufacturers to label food products that contain an ingredient that is or contains protein from a major food allergen or intolerance. This labeling can be done in one of two ways. With the first labeling option, the food source that is in parentheses follows the common or usual name of the major food allergen in the list of ingredients when the name of the food source of the major allergen doesn t appear elsewhere in the ingredient statement. The second labeling option uses the word Contains, followed by the name of the food source from which the major food allergen comes. It s just after or next to the list of ingredients, and it s in a type size that s no smaller than the type size used for the list of ingredients. Slide 18 Now let s take a look at how food allergens are identified on food labels by examining this example. Under this 2006 FDA ruling, a major food allergen is one of eight foods or food groups milk, eggs, fish, Crustacean shellfish, tree nuts, wheat, peanuts, and soybeans or an ingredient that contains protein that is derived from one of the eight. Major food allergen doesn t include a highly refined oil derived from one of the eight foods. Highly refined oil includes sunflower, rapeseed, soy oil, and many others. Additionally, major food allergen food groups don t include any ingredient found in highly refined oil, as well as any ingredient that doesn t have to follow this new labeling law. Remember, it s the protein portion of a food that has the food allergen. In highly refined oils or in other words, oil that is put in a hot solvent, extracted, refined, bleached, and deodorized the levels of protein present vary somewhat. Slide 19 Some food labels don t show common food allergens. Fresh meats can have gluten in them as a filler, but you won t see this on the food label. Be aware that meats may have some gluten, so don t eat large amounts in one meal. Limit your portion size to no more than 2-3 ounces. Fresh produce isn t required to have a food label, but you ll notice that some bags of produce do have one. Highly refined oils are oils that have been processed, purified, or chemically altered and may contain food allergens. Sometimes foods can be contaminated with a food allergen during the process of growing, harvesting, or processing and manufacturing. In these cases, the allergen won t be on the label.

8 In the case of processing and manufacturing, the label must say if the product was knowingly made in a factory that also processes foods with the allergen because there is always a risk of contamination. Be careful and alert when eating foods from this list, knowing that there s a chance they came into contact with allergens. Which Products Contain Wheat? Slide 20 Be careful when reading the ingredient list on foods. Look for this list of possible ingredients, including: whole, refined white, hard red, winter wheat, triticale, buckwheat, wheat flour, and gluten. Some products made with buckwheat may contain gluten because they blend it occasionally with wheat flour in baking mixes. More foods than you might expect could have one or more of these ingredients in them. Slide 21 Here are some ideas for what can you do at home to avoid gluten. Slide 22 Look for naturally gluten-free foods. Look for pre-packaged gluten-free foods. Plan menus each week using naturally gluten-free foods. Make a gluten-free grocery list. Read food labels when you shop. Don t let food with gluten come in contact with the food you eat. What else can you do to avoid gluten? Take time to plan gluten-free meals when you re eating out and traveling. Watch out for any other food intolerances, such as being lactose intolerant, that you may have. Have a good support system. Eat well-balanced, nutritious meals. Slide 23 Let s take a look at wheat products. Be careful when reading the ingredient listing on foods. Look for these ingredients: whole, refined white; hard red, winter wheat; triticale, which is a hybrid of wheat and rye; buckwheat; wheat flour; and gluten. Some products made with buckwheat may contain gluten because they blend it occasionally with wheat flour in baking mixes.

9 Slide 24 Read the ingredient listing on food labels to detect hidden sources of wheat or wheat products. They can be found in some surprising places, such as the following: Slide 25 Wheat flour may be flavored and shaped to look like beef, pork, or shrimp. This is especially found in Asian dishes. Wheat is an ingredient in certain brands of hot dogs. It can be an ingredient in some brands of ice cream. Surimi, or imitation crabmeat, may contain wheat. The use of wheat products to decorate wreaths and other home décor products is not uncommon. Why would eating foods like the ones shown on this slide be okay for someone on a gluten-free meal plan? The answer is that these foods don t contain wheat, barley, rye, or triticale. Additionally, the sauces, gravies, and other products aren t made with wheat or other gluten-containing foods. Slide 26 Why don t these foods fit within a gluten-free meal plan? Unless these delicious baked goods were purchased as gluten-free products, they probably contain gluten. Slide 27 Why can t you eat chicken nuggets or chicken-fried steak? It s because of their wheatcontaining coating and deep-fat fried. Unless they re designated as gluten-free on the food labels, they don t fit into a gluten-free diet. Food that is allowed includes the grilled beef or chicken kabobs with fresh vegetables added for color and flavor. Be sure to read the labels on the marinades that you select to ensure that they contain no gluten. Slide 28 Can you eat the candy jelly beans? Yes, you can eat them because candy is made of sugar, and it usually doesn t contain wheat. However, it s always recommended that you read the ingredients listing to ensure that no wheat, barley, rye, or triticale was used as an ingredient or in the processing of the sugar. What about the cakes, cookies, pies, muffins? Can you eat these foods? No, because they contain gluten unless they ve been prepared with gluten-free ingredients.

10 Slide 29 What about this homemade pizza? Does it contain gluten? The answer is yes, it contains gluten, so you can t eat it if you re following a gluten-free diet. The crust has flour in it, and the processed meat may have gluten filler as well. It may be available in a gluten-free version in the frozen foods section of the grocery store. Slide 30 What about cereals, in general? Do they contain gluten? At first, it can be tricky with these products. If a cereal is made with rice, there could still be gluten fillers in it so you ll always need to read the food labels. In this case, Rice Chex and Rice Krispies cereals are advertised as gluten-free foods. The variety package of instant oatmeal is also advertised as gluten-free. Although other cereals are gluten-free, it s still important to check the food label to be sure. Summary Slide 31 In summary, here are some important concepts to remember about Celiac Disease. Slide 32 Celiac Disease is an autoimmune disease, which means it acts like an allergy to gluten, except the body attacks itself as well as the gluten. If person with Celiac Disease eats gluten, the body damages the villi in the small intestine, which are needed to take in nutrients from your food. Avoiding gluten will stop the damage. A gluten-free meal plan is the only treatment for Celiac Disease. It s the best line of defense. The gluten-free meal plan requires that you change your lifestyle and read labels carefully. If you have other complications as a result of damage from Celiac Disease, such as early onset osteoporosis or other deficiencies, it s even more important to change your lifestyle and avoid gluten. To prevent the long-term conditions we ve discussed, you need to not only avoid gluten, but you also need to increase physical activity and reduce physical and emotional stress. The changes you make must be sustained for life so you can live a healthy and long life. If you ve been diagnosed with Celiac Disease, you will have it or the rest of your life. Celiac Disease affects people of all ages. It s an autoimmune disease, causing a food intolerance to gluten. It s diagnosed by a blood test and then a biopsy of the small intestine.

11 A gluten-free diet is the only treatment for this disease. It s a lifetime treatment, and you ll need to be under the care of a registered dietitian who is skilled in gluten-free dietary management. Never self-diagnose and start the gluten-free diet before being diagnosed with the disease by a physician. This diet isn t a weight control or diet of choice it s only intended to treat those who have Celiac Disease. Those on the gluten-free diet may need gluten-free daily supplements, such as B-vitamins, vitamin D, calcium, and fiber. Resources Celiac Disease & Gluten-Free Diet Information Since Accessed 13 June Celiac Disease Foundation. Accessed 13 June Dr. Scot Lewey. Celiac disease and gluten linked to brain disease by deposits in intestine and brain. Deposits-in-Intestine-and-Brain&id= Accessed 13 June ChooseMyPlate.gov United States Department of Agriculture (USDA), Accessed 13 June Canadian Celiac Association. Accessed 13 June Gluten-Free MyPlate, Tufts Medical Center, Boston, MA. Accessed 13 June Health Canada. Accessed 13 June Welcome to the National Institutes of Health (NIH) Celiac Disease Awareness Campaign. Accessed 13 June Author This module was developed by: Mary Claire Kinney Bielamowicz, PhD,MS,RD,LD,CFCS Regents Fellow Professor and Nutrition Specialist Texas A&M AgriLife Extension Service Texas A&M System 2012 Educational programs of the Texas A&M AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin. The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating