Celiac Disease: The Gluten Free Diet - Pelican Bay

LIVING GLUTEN
FREE
Dawn Gray, RD CDE MPH
239.260.8999
Pelican Bay Foundation

What is Gluten ?
• Gluten is one of the proteins naturally found in wheat,
rye, and barley.
• Gives dough elasticity and strength and may be added to
baked goods to increase workability.
• Gluten is often used as a filler or binder in processed
foods
• Gluten damages the microvilli in the intestines of
individuals with Celiac disease or Gluten Intolerance
• Gluten is also harmful to individuals with Non-celiac
gluten sensitivity but in this case damage to
microvilli does not occur.
• Gluten may be linked with a host of other illnesses

Celiac versus Non-Celiac Gluten Sensitivity
Celiac
• Genetic autoimmune disease where
gluten causes damage to the microvilli
in small intestine
• Celiac affects 1 in 130 Americans(1%)
• Incidence increases with other family
history and other autoimmune
diseases
• Symptoms are highly varied and
include GI distress, fatigue, OP,
Dermatitis Herpetiformis, Nutritional
Deficiencies, and problems with
conception.
• Blood test tTG IGA, IGG and intestinal
biopsy confirm diagnosis
• Test can be negative if following gluten
free diet for anywhere from 2 weeks to
6 months
• Untreated Celiac increases risk for
Autoimmune disease, cancer,
infertility, dementia, and osteoporosis.
Non-Celiac Gluten Sensitivity
• Non-specific immune response,
no or minimal damage to
microvilli, not believed to be
genetically linked
• May effect 18 million Americans
or more(6%)
• Abdominal pain, fatigue,
headaches, “foggy brain”
• No correct lab tests-important to
r/o celiac or wheat allergy before
proceeding to gluten free diet.
• Unsure of long term
complications

Damage to small intestine with Celiac
Treatment is 100% lifelong
adherence to a gluten
free diet.

Gluten has been researched in association
with…
• Diabetes( Increased risk for celiac with type 1 diabetes to 1 in 20)
• Autism and ADD
• Rheumatoid Arthritis
• Fibromyalgia
• Thyroid Disease
• Eczema
• IBS and IBD
Remember not all associations are causal although gluten restriction
may be helpful in some cases but not all.

Gluten Free Diet Principles
• Eliminate gluten containing foods and additives
• Gluten Free is defined as less then 20 ppm gluten
• Watch and safe guard against cross contamination even small
quantities can be harmful.
• Beware of bulk bins, buffets, and eating out.
• Stick with fresh home-prepared meals, start with good gluten free
ingredients and you will end up with good gluten free meals.
• Naturally gluten free foods include fresh and most frozen fruits and
vegetables, most dairy (although you need to check labels), fresh
cuts of meat, fish, poultry, herbs and spices, oils, distilled vinegars,
and gluten free starches.
• Eating gluten free doesn’t necessarily mean better nutrition but is
life changing and essential for many people.

Gluten Containing Grains
and Products
• Barley
• Barley malt/extract
• Bran
• Bulgur
• Couscous
• Durum
• Einkorn
• Emmer or Faro
• Farina
• Graham flour
• Kamut
• Matzo flour/meal
• Oats and Oat Bran if no specified
GF
• Orzo
• Panko
• Rye
• Seitan “wheat meat”
• Semolina
• Spelt
• Triticale
• Udon
• Ramen
• Wheat
• Wheat Berries
• Wheat bran
• Wheat germ
• Wheat starch

Gluten is Typically Found In
Obvious:
• Most breads
• Most cereals
• Crackers
• Pastas
• Cakes, cookies, donuts,
pastries
• Granola or cereal bars
Less Obvious Sources
• Beer
• Canned soups and broths
• Some soy sauces
• Dips/sour cream/dressings
• Some yogurt and cheese products
• Puddings
• Lunch meats or
enhanced meats
• Communion wafers
• Premix seasonings
and sauces

Check the label for……
• Modified food starch, Dextrin, or Wheat Starch (unless a gluten-free grain
in listed as starch source)
• Check for modified food starch on all labels including things like shredded
cheese.
• Brewers Yeast or “Spent Yeast”
• Malt (unless a gluten-free grain in listed as malt source)
• Malt vinegar (distilled vinegars are generally gluten free)
• Natural Flavorings (wheat would be listed but barely and rye might not)
MSG, Caramel color, and maltodextrin are generally considered gluten free.
Call companies about questionable ingredients!

Gluten-Free Grains and Starches
• Amaranth
• Arrowroot
• Bean Flours
• Buckwheat
• Corn
• Polenta
• Hominy (Grits)
• Millet
• Nut Flours
• Oats*
• Beans
• Potato
• Sweet Potato or Yam
• Winter Squashes
• Yuca or Casava
• Quinoa
• Rice
• Soy
• Sorghum
• Tapioca
• Teff
• Wild Rice

What about Oats?
Cross contamination is an issue with Oats
• during growth
• harvesting
• transport
• milling and processing
Some manufactures have changed Oat production has
in recent years
• Certified to be gluten free like Bob’s Red Mill
Oats do contain a protein similar to gluten so some people with
celiac can be symptomatic when consuming oats

Avoiding Cross Contamination at Home
• Use stickers or permanent marker to distinguish GF
products
• Purchase separate condiments to avoid wheat/bread
crumbs in the shared jars
• Purchase a separate toaster for gluten-free breads
• Use tinfoil on oven rack to avoid contamination
• Clean counter tops and cutting boards often to
remove gluten-containing crumbs
• Cooking utensils, colanders, and pans need to be
cleaned carefully after each use and before cooking
gluten-free products

Cross Contamination…..
• Avoid bulk bins.
• Caution at buffets! Cross contamination is highly likely.
• Beware of fryers-French fries, chicken wings, or corn chips
may have been cooked in the same oil where battered gluten
containing foods have been fried-this happens often!
• Request to talk to chef and ask:
• use clean utensils or a new crouton free salad bowl
• clean the grill or pan before preparing food
• keep the meal away from meals that contain gluten
• Always pack gluten free snacks for travel
• GIG certified restaurants in our area include Outback Steak
House, Carrabba’s, The Melting Pot and Bonefish Grill

Don’t miss out on good nutrition..
• B vitamins -choose enriched and fortified products and gluten
free nutritional yeast.
• Calcium -dairy, leafy greens, canned fish with bones.
• Vitamin D -get your levels checked! Food sources include
salmon, enriched and fortified soy milk, milk, egg, some
yogurts and mushrooms.
• Iron-fresh cuts of meat, beans, greens, blackstrap pair with
citrus.
• Zinc-beans, nuts, seafood.
• Magnesium-nuts, seeds, dark leafy greens.
• Fiber-use beans and lentils as side starches, wild rice and
quinoa are good choices, too. avoid excess processed glutenfree
products.
If following a GF diet make sure to boost intake of
the above nutrients.

Gluten Free Meal Ideas
Breakfast:
Gluten Free Cereal, Cooked Oats or Quinoa, 1 % Milk,
Fresh Berries, and Crushed Walnuts or Almonds
Lunch:
Salmon tacos with GF corn tortillas and home made
coleslaw, Cooked pinto Beans and rice and salad.
Dinner:
Baked Chicken Breast with Honey Mustard, Cooked
Quinoa or Brown Rice and Steamed green beans
Snacks:
Any fresh fruit, Gluten Free crackers with peanut or
almond butter, Chobani yogurt, Veggies with Hummus,
rice cakes with PB.
Beverages:
Water, Loose leaf steeped teas, Coffee, Most Fruit
Juices.
.
Breakfast:
Scrambled eggs with corn tortillas, diced
tomato and avocado with fresh fruit.
Lunch:
Lentil Soup with gluten free crackers, 1 oz
cheese, and veggies.
Dinner:
Herb rubbed pork tenderloin with pureed sweet
potato, and Steamed Broccoli
Snacks:
Any fresh fruit, Gluten Free crackers with peanut or
almond butter, Chobani yogurt, Veggies with
Hummus, rice cakes with PB.
Beverages:
Water, Loose leaf steeped teas, Coffee, Most Fruit
Juices.

Gluten Free Berry Tart(added per group discussion)
Crust Ingredients:
• 1 cup finely ground almonds (or
other nuts)
• 1 cup GF flour mix
• ½ rounded tsp xantham gum
• approx ½ cup tahini or sesame
butter
• approx ¼ cup honey
• approx ¼ cup water
• 1 egg yolk, beaten well
Filling ingredients:
• 3 cups berries
• ½ cup sugar
• ¼ cup corn starch
• juice of ½ lemon
Method:
• Preheat oven to 350 degrees.
• Spray pie plate or tart pan with cooking spray.
•
• Mix the ground almonds, GF flour mix, and xantham gum
together in a medium bowl.
• In a small bowl, mix the honey, tahini, and water
together to make a paste.
• Add the paste to the flour/almond mixture and blend
together with your hands, adding small amounts of
water as needed, until you form a dough that starts to
stick together.
•
• Pat the dough into the sprayed pie plate. Brush it with
egg yolk and bake at 350 degrees for about 8 minutes or
until the egg yolk has formed a dry seal over the crust.
• While it is baking, toss the filling ingredients together.
• Remove the crust from the oven, let it cool for a few
minutes, then add the filling and return to the oven.
Cover any visible edges of crust with tin foil or crust
protectors.
• Continue to bake at 350 degrees for about 45-60 minutes
or until the filling is thick and bubbly.
• Remove and let cool for about 3 hours before serving.
• Serve the same day it is prepared.

Gluten is not just in food…..
• /Other Products that may be ingested
• toothpaste (Crest and Colgate are gluten free)
• lip products
• shampoo
• hand lotion
• glue on envelopes
• Wheat glue to seal tea bags
• Play Dough(important for children with Celiac)
• Medications may use gluten in binders that hold pills
together. Talk to your Pharmacist or call manufacturer.
• Glutenfreedrugs.com
See store specific lists for information on products.

Moving forward….
• Gluten awareness has increased resulting in more GF
food options and better nutrition labeling!
• Most grocery stores have gluten free food lists
• The more you learn the easier it gets
• Keep food records and logs
• More resources are available
• Gluten Intolerance Group
• Celiac Disease Foundation
• National Celiac Awareness Foundation
• Center for Disease Control
• National Institute of Health

FL Support Groups info from Celiac Disease
Foundation
• www.cdfsouthflorida.org
• Phyllis Kessler · 561-637-0396 · pkessler23@aol.com
• GLUTEN FREE FOOD ASSISTANCE PROGRAM (GFFAP)
• Celiac Disease Foundation Central Florida Chapter
• www.cdfcentralflorida.org
• Julie Kincart · 863-559-8025 · celiacsupport@tampabay.rr.com
• Broward County
• Anita Martinez · 954-366-3880 · transcript17@aol.com
• Port Charlotte
• Jessica Brimer · 941-815-2877 · jandjbrimer@centurylink.net
• Port Richey
• Margaret and Donald Bing · 727-844-5106 · mbing19@tampabay.com
• Tampa Bay
• Ryan Mitchell · 727-599-9071 · rm81dragon@yahoo.com
• Vero Beach

Thank You!
It’s time for questions
and discussion.