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Senior Passport Presentation

Kayleigh Hill, Molly Koch


May 11, 2017
Gluten-Free Living
Presentation Length: 90 minutes
Presentation Method: Powerpoint

Prompt: Learn more about how the differences between food allergies, sensitivities and intolerances and
how to adapt your eating habits to accommodate any level of severity. Keene State College dietetic
interns will discuss the nutritional impacts of gluten free living and what foods are naturally gluten free.
They will help you strategize how to incorporate more naturally gluten free foods into your diet so you can
leave empowered with a list of foods you CAN eat instead of a list of foods you CAN'T eat.

1) Introduction
a) Introduce self: KSC DI
b) Where we did our undergrad & why I chose to study the field of
nutrition
c) Today we will talk about the gluten-free diet
2) Icebreaker
a) Materials: 5-10 jars and bags of WGs (some w/gluten, some GF)
(CINDY!), pictures of grains on the slide
b) Backup plan: Print out grain pics
c) In partner pairs, participants will be given a bag or jar of grains
and have to identify if it is gluten free or not, and identify what grain it is.
We will: pass out real grains: most w/ gluten, some w/o gluten; ask pairs to
share their findings
d) Goals: to see if they can recognize what the grains are, and to get
them to use this skill when they go to the supermarket, or cooking.
e) Let them know we will go over these grains and whether or not
they can be options for you
f) Learning styles: Visuals- picture, kinesthetic- movement
g) Answer Key:

AMARANTH - Central america spread around the world, important


staple in India, Africa, Nepal - Light/nutty to lively/peppery - Popped
like corn, breakfast porridge, cereals, breads, pancakes

BARLEY - Egypt - Soup, pilaf, bread

BUCKWHEAT - Commonly used in a wide array of cultures (soba noodles,


buckwheat noodles, pizzoccheri, galettes)

MILLET - Leading staple in India - also popular in China, Russia, South


America, Himalayas - Mild flavor - pairs well with other foods - Flatbreads,
porridge, desserts, side dish

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QUINOA - Originates from Andes (Inca) - Red, purple, black; Rinse (saponins -
bitter), slightly nutty taste - Great side dish, can incorporate in oatmeal, many
different salads - flavor works well in a lot of different dishes.

OATS - US mainly rolled - steel but is another way to go (grain cut


up 1-2x) - Sweet flavor - Popular in breakfast cereal, desserts, oat
pilaf, granola

CORN - Originated in Americas - Naturally more of a sweet flavor -


often served salty - Fresh corn on the cob, popcorn (if corn meal, corn
flour look at the label!)

BROWN RICE - Classified by size, texture - Traced to south Asia & Africa
(today grown everywhere except Antarctica!) - Soups, salads, with beans

WILD RICE - Common to North America (Near Great Lakes - US & Canada) -
Can have smoky/nutty flavor - Side to meat/fish, salad, soup, quesadilla

3) Objectives: By the end of the lesson, participants will be able to


a) Identify naturally gluten-free foods to fit into their diet
b) Assemble a whole grain recipe that is gluten-free
c) Demonstrate how to adapt your eating habits to accommodate
any level of severity.
4) Background Info
a) Up until about 60 years ago, Celiac Disease was deemed an
untreatable and lethal disease. But then, scientists discovered the link between
Celiac Disease and gluten.
b) Now, the science of gluten has advanced, and we now know what
foods to choose or avoid for a gluten-free lifestyle.
c) Why is a GF diet important for people with an allergy, and
intolerance, or CD?
5) Content 1:
a) Distinguish between an allergy, an intolerance, and Celiac disease
b) Allergy: Cant have a gluten allergy because gluten is not an
allergen (IgE, the antibody responsible for life-threatening reaction)
You CAN have a wheat allergy though
A food allergy is an overreaction of the immune
system to a specific food protein. When the food protein is ingested, in
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, etc.). A
food allergy can be potentially fatal.
c) Intolerance: Some people experience symptoms found in celiac
disease, such as foggy mind, depression, ADHD-like behavior, abdominal pain,
bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic

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fatigue when they have gluten in their diet, yet do not test positive for celiac
disease. The terms non-celiac gluten sensitivity (NCGS) and non-celiac wheat
sensitivity (NCWS) are generally used to refer to this condition, when removing
gluten from the diet resolves symptoms
d) Celiac disease
When people with celiac disease eat gluten (a
protein found in wheat, rye and barley), their body mounts an immune
response that attacks the small intestine. These attacks lead to damage
on the villi, small fingerlike projections that line the small intestine, that
promote nutrient absorption. When the villi get damaged, nutrients cannot
be absorbed properly into the body.
Who is at risk: Celiac disease is hereditary,
meaning that it runs in families. People with a first-degree relative with
celiac disease (parent, child, sibling) have a 1 in 10 risk of developing
celiac disease.
What are the signs/symptoms: Adults are less likely
to have digestive symptoms, with only one-third experiencing diarrhea.
Adults are more likely to have;
unexplained iron-deficiency anemia
fatigue
bone or joint pain
Arthritis
osteoporosis or osteopenia (bone
loss)
liver and biliary tract disorders
(transaminitis, fatty liver, primary sclerosing cholangitis, etc.)
depression or anxiety
peripheral neuropathy ( tingling,
numbness or pain in the hands and feet)
seizures or migraines
missed menstrual periods
infertility or recurrent miscarriage
canker sores inside the mouth
dermatitis herpetiformis (itchy skin
rash)
What is the diet: A Gluten-Free diet is one which
denies eating any wheat, rye, or barley. Most patients report symptom
improvement within a few weeks, although intestinal healing may take
several years.
This means excluding the food items
like; bread products, pastas, flavorings, marinades or mixes
(made with wheat, rye, or barley), crackers, bulgur, croutons,
stuffing, imitation bacon and seafood, vegetarian meat substitutes,
processed meats, commercial potato and rice mixtures,
commercial soups, seasonings, sauces, thickeners,creamed
vegetables, and self-basting poultry. These items, for example,
may contain hidden sources of gluten.

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Be sure to read labels for products that contain
wheat, rye, or barley, and soy sauce, white or non-malt vinegars, and
wheat starch. On packaging, do not mistake wheat-free for gluten-free
because the product may still contain other grains with gluten.
Naturally Gluten Free Foods
what are the nutritional concerns for persons with
Celiac disease
(SHOW SHAG CARPET): Normal
digestion can be represented by a shag carpet. It has many villi
that increase the surface area of the intestine so we can get
maximum absorption of nutrients as foods is digested.
Now imagine if the carpet was just
flat.. There is not nearly as much surface area to be able to absorb
those nutrients. This change in cell structure is what happens in
persons with CD.
Damage done to the intestinal lining
can lead to decreased absorption of calcium, iron, folate, and
other B-vitamins.
Vitamin B-12 is a common nutrient
deficiency due to the absorption changes. Vitamin B-12 is an
important nutrient that maintains the myelination (the insulating
layer) around the nerves, allowing the nerves to effectively deliver
electrical impulses. This is why CD may initially manifest clinically
with neurological changes, such as sensory neuropathy usually in
the upper limbs, optic nerve dysfunction (blurring and blind spots),
and dementia.
Osteopenia and osteoporosis are
common in people with CD due to decreased calcium
Constipation/diarrhea: For those
who rely too heavily on processed white rice (which is common as
the GF grain in processed foods), the low fiber diet can result in
constipation.
(a) If high-fiber grains are
added to the diet in large amounts too quickly, diarrhea can
result.
Weight loss: Changes in the diet to
eliminate gluten-containing foods may lead to decreased caloric
intake, resulting in weight loss.
Weight gain: After the GI tract has
been able to heal on a GF diet, the GI tract can start to absorb all
the nutrients. Even though the calories have stayed the same, this
can cause unintentional weight gain.

6) Content 2:

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a) What are the nutritional benefits of a gluten-free diet for the
general population:
For those who are already eating a carbohydrate-
rich diet or who rely heavily on refined flour products, such as breads,
cereals, bagels, pasta, pretzels, baked goods, cookies, cakes, snacks
and convenience foods, and beer, the gluten-free diet can help to reduce
the caloric intake from those sources, thereby losing weight.
b) What are the nutritional concerns with a gluten-free diet for the
general population:
Many gluten-containing breads, cereals, and pasta
are fortified with iron and the B-vitamins, while many GF foods are not, so
this can also contribute to deficiencies in these vitamins and minerals for
the general public as well.
Fiber: Fiber is important for your digestive health
and keeping the digestive contents moving along efficiently. It is also
important for maintaining wt, lowering your LDLs, (your less healthy
cholesterol).
Typically GF living ends up being a low fiber
lifestyle, but not always.
Processed GF foods are usually not
whole grain, and many people avoid whole grain products since
they most likely wheat based. Instead of avoiding it, choose GF
whole grains for more fiber.
Iron and B-vitamins
Amaranth, oats, quinoa, oats,
buckwheat are all good sources of iron and the B-vitamins
Find sources that are fortified with
these, such as:
Kelloggs fortified GF cereal, namely
GF Special K
Energ-G Foods, which has many
bread products with added vitamins and minerals
Enjoy Life Foods which sells snack
bars
General Mills: fortified GF cereals
such as Rice Chex, Corn Chex, Honey Nut Chex, Chocolate
Chex, and Cinnamon Chex
Glutino: Bread and pasta products
Kinnikinnick: bread products
Maplegrove Gluten-Free Foods:
Potato-based pastas
Schar: bread products

Activity 1: Gluten-Free Menu Plan

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Have space for them to brainstorm different options in each
category, with 2 examples provided in each
Participants will create a days worth of meals based on the
options they chose

c) You have three opportunities to utilize GF whole grains. We will


take you through each of them:
1. Grocery store what are the gluten-free
whole grains
2. Kitchen How to prepare them and prevent
cross-contact
3. Restaurant Things to look for and ask
about

d) The grocery store:


What are the gluten-free grains, where can they purchase them (besides the co-
op), how do they prepare them.
Rice (brown, white, wild, basmati)
Rice bran
Potatoes, potato starch and flours
Arrowroot
Buckwheat
Flax
Corn
Legume (beans and peas) and seed flours
Quinoa
Millet
Sago
Soy
Tapioca (cassava, manioc)
Teff
d) Luckily, for those with concerns about gluten, many grocery stores
have their own aisles dedicated to GF-living.
e) These are some grain products that we found that have a great
nutrient profile.

Ancient Harvest - POW Green Lentil Protein Pasta


Made with green lentil flour and organic quinoa
flour - makes this a GF product
$2.99 per 8oz. box at Hannaford
Per 2 oz. Serving:
14g protein
7g fiber
Also a good source of iron
http://shop.ancientharvest.com/POW/c/AncientHarvest@Pow@Pasta

Chickpea Flour

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Also called gram flour, garbanzo bean flour
$3.19 per 16 oz. bag at Hannaford
High fiber (5g)
High Protein (6g)
Great for GF baking

http://www.bobsredmill.com/garbanzo-bean-flour.html
Other Bobs Red Mill GF products can be found at
Hannaford, Market Basket

Ronzoni Gluten Free Pasta


$1.89 per 12 oz. box at Hannaford ($2.52/lb)
Made with rice flour, brown rice flour, corn flour, and
quinoa flour.
Can be found at Hannaford, Market Basket, and
Aldi carries their own brand of GF pasta.
Nutrition: Per Serving (56g)
Fiber: 2g
Protein: 4g

Brown Rice: a simple switch from white rice to brown rice can
increase the nutrient density of your meal
Can be cooked then frozen for 6-8 months

f) Many GF grains can be found at stores such as Hannaford, Price


Chopper, and Aldi.
g) GF bread can often be found in the freezer section.

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h) Brown rice: simple switch to increase your nutrient density from
white rice
Can be cooked then frozen for up to 6 months

i) Millet
A light yellow grain, available as grits, hulled millet,
and flour
Source of folate, thiamin, niacin, fiber
Millet and wheat have similar protein levels
Nutrition: Per cup
Fiber: 1.2g
Protein: 3g

j) Quinoa is a commonly found GF whole grain.


Has anyone tried quinoa before? Do you like it?
Prepared like rice.
1:1 fluid:grain ratio. Bring to boil then simmer. Make
sure to rinse quinoa. Layer on outside makes it bitter. Use wire strainer.
Can cook in water, stock, broth, coconut milk, or even pineapple juice!
There are also different kinds: From least to most
bitter, they are white, red, black.
Done cooking when the white curls pop out.
$4.50/lb
Can be costly but beneficial due to high
nutritional value
Often called pseudocereal because it is used
like a grain in cooking
Available in seed, flour, and flake form
Source of iron, folate, thiamin, and fiber
Fiber: 4g per cup

https://www.csaceliacs.org/gluten_free_whole_grains_health_fact_sheet.jsp

k) The kitchen: How to prepare and prevent cross-contact


l) Food Preparation:
When you prepare your GF food, the possibility of
cross-contact with a gluten-containing food is something to be highly
aware of in order to prevent an exposure, particularly if youre living with
non-GF people..
Several tips to prevent cross-contact with gluten:
Buy separate jam, jelly, mayo, and
peanut butter so as to avoid bread crumbs in the jars that are
shared
Buy a separate toaster designated
for GF-breads and clearly label it. You can use a toaster oven and
clean it between uses, or use tin foil on the rack.

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Clean all countertops and cutting
boards often. Be weary of wooden cutting boards.
Carefully clean cooking utensils,
colanders, pots and pans before and after each use.

m) The restaurant:
n) Eating away from home:
Dining out is a big part of our culture and way of
life, and just because youre on a GF diet doesnt mean you cant
continue to enjoy that. Many restaurants, hotels, and more now have GF
menus to choose from, or they have a list of common food allergens that
they use in making their foods..
Several tips:
Find the restaurants website
through an Internet search. Review the menu for their GF
selections.
Things to be aware of if the
restaurant doesnt advertise its GF menu items:
(a) Mexican restaurants
and Asian restaurants are more likely to have GF options
even if theyre not explicitly advertised
Call ahead! The manager or the chef
should know about specially prepared menu items that are GF.
Try to visit the restaurant before
peak dining times. This will provide a reduced risk of cross-contact
in the kitchen.
When you order, always tell the
person taking your order that you are someone who cannot eat
wheat, rye, or barley. There are some restaurants that have flour
in their food items that you would have never guessed contain
flour. For instance IHOP adds pancake batter to their omelettes to
give them their signature fluff. Salads may not have croutons, but
sometimes they can come with breadsticks across the top.
Be proactive and dont be afraid to
ask detailed questions of how the food is prepared. Better yet,
their are some places where you can actually watch them prepare
the food in front of you (Subway for example). Meats may be
marinated in soy sauce, French fries may be cooked in the same
fryer as other breaded items, hamburgers and hamburger buns
may be cooked on the same space; all of which can lead to cross-
contact.
Bring your own GF bread or
crackers to an outing.
Many who suddenly go on the GF
diet can become overwhelmed or afraid of eating outside the
home. This can lead to social isolation or induce depression

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depression at varying degrees. These concerns must be
discussed with the RD and gastroenterologist, and sometimes a
referral to counseling or support groups may be necessary.

7) Conclusion: Food Activity! We are bringing in a Mediterranean Quinoa Salad


(replacing chicken with black beans). https://celiac.org/blog/recipe/mediterranean-
quinoa-salad/

8) Call to Action: Shorten So moving on from this class, we want you to use this
knowledge to be more understanding of the gluten-free diet and what it means to need
to follow one. If you have a gluten intolerance or have CD, we want you to use this
shopping list to help you purchase foods that will aid in the prevention of the nutrient
deficiencies we mentioned. Not loving this will probably change...

http://www.gikids.org/files/documents/resources/Gluten-FreeDietGuideWeb.pdf
https://www.glutenfreeliving.com/gluten-free/gluten-sensitivity/what-is-gluten-sensitivity/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661192/
https://celiac.org
https://www.eatbydate.com/grains/rice-shelf-life-expiration-date/
Thompson T. ADA Pocket Guide to Gluten-Free Strategies for Clients with Multiple Diet
Restrictions. Academy of Nutrition & Dietetics, 2016.

7-day
We need: Shag carpet sample, nutrient analysis of Quinoa/brown rice and Amaranth.
Know: ancient grains, new forms of GF pasta
Fix: not all GF diets are low in fiber
Handout: Hidden sources of gluten
Talk about some of the common controversies behind the GF diet for non-CD people
Handout: text box of tips for eating out
Recipe
Hidden sources of gluten

Supplies: gloves
10 copies of each: handout (2 sides), grocery list (1 side), menu (2 sides)
Plates & forks
Grains
Print Icebreaker list (2 copy)

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