CELIAC DISEASE

1. CELIAC DISEASE A PRIMER FOR SCHOOL NUTRITION

2. What is Celiac Disease? • Inherited, Autoimmune Disorder • Permanent Intolerance to Gluten in WHEAT, RYE AND BARLEY • Also referred to as celiac sprue

3. SCOPE OF DISEASE • 2.2 million Americans afflicted-over 10,000 children diagnosed annually * • Affects 1 in 133 Americans • 97% go undiagnosed. Celiacs are at greater risk of GI cancer and particularly lymphoma *Dr. Alessio Fasano, University of Maryland-Baltimore Center for Celiac Research in A Gluten Free Solution, FoodService Director, September 15, 2008, p. 50-51.

4. DIAGNOSIS • Initial Blood Tests • If serology is positive, a biopsy of small intestine is the definitive test • NO CURE: person must strictly avoid food products, medicines, vitamins and even glue on envelopes that may have gluten

5. MECHANISM OF ACTION • Body attacks normal tissue resulting in damage to lining of small intestinal villi, the tiny hairlike projections that line inside of small intestine. • Villi contain blood vessels which absorb nutrients • Villi increase area for absorption of nutrients • Digested nutrients are carried away by circulating blood • If villi are damaged, vitamins, minerals, calcium, carbohydrates, protein, and fats are not absorbed well

6. Some may be asymptomatic Diarrhea Short Stature Iron Deficiency Anemia Lactose Intolerance Irritability (common in children) Mood Swings (common in children) Abdominal Pain Irritable Bowel Osteoporosis Skin rash-very itchy with blisters SYMPTOMS

7. TREATMENT • GLUTEN FREE DIET • ELIMINATE ALL WHEAT, RYE, BARLEY AND THEIR DERIVATIVES • MAY TAKE 6-12 MONTHS FOR INTESTINE TO HEAL

8. WHAT ABOUT OATS? • Oats may not be harmful to a celiac patient; however, oats may be cross-contaminated with wheat in the milling process

9. FOOD LABELING LAWS • Under the 2006 Food Allergen Labeling and Consumer Act, wheat protein or a derivative must be identified, even if used in small amounts • The law does not address the use of barley, rye or oats • Check with manufacturer if in doubt

10. USDA has given recent clarification on a specific case for an individual child: …if the physician, in the documentation for special dietary accommodations, identifies celiac as a disability, then the school must make the accommodations for a disabled student Supt. Reg. Memo #8. October 11, 2002

11. SCHOOL NUTRITION PROGRAMS SHOULD CONSIDER THE FOLLOWING PRACTICES • Determine if the student has an IEP or 504 plan • Discuss accommodations with the school division special education supervisor and/or nurse supervisor if necessary • Consult with a Registered Dietitian if family is working with one through their doctor

12. Meeting Meal Requirements • If following a physician’s orders, foods do not have to meet the same standard as a regular component-for example, bread doesn’t have to weigh 1 oz.

13. Rochester MN Public Schools • GF menu for 5 years-on web site • Found from surveys with kids/parents that sliced bread was least liked item • Buy locally • Modifications include: chicken nuggets (cornflake crumbs, GF chocolate chip cookie (school made)

14. AVOID CROSS CONTAMINATION-RECOMMENDATIONS • Separate Fryers or Clean Oil if Breaded Items are Fried in Same Vats as Non-Breaded • Use Separate Jars of Peanut Butter, Jelly, Mayonnaise to Avoid Wheat/Bread Crumbs in Jar • Clean and Sanitize Counters, Cutting Boards, Cooking Utensils, Pans after EACH use and BEFORE Cooking Gluten Free Products • Use Separate Colanders for gluten free products

15. Barley Barley malt/extract Bran Bulgur Couscous Bromated or Durum Flour Einkorn Emmer Enriched or Self Rising Flour Farina Faro Graham Flour Kamut Matzo Flour/meal Orzo Panko Phosphated Flour Rye Seltan Semolina Spelt Triticale (cross between wheat/rye) Udon Wheat Wheat Bran Wheat germ Wheat starch GLUTEN CONTAINING GRAINS TO AVOID

16. Ales Beer and Lagers Bouillon Cubes Breading Brown Rice Syrup Coating Mix Communion Wafers Croutons Candy Some Chips/Potato chips Luncheon Meats, hot dogs, salami, sausage French Fries Gravy Pasta Rice Mixes Seasoned Tortilla Chips Sauces Soup Base Stuffing Self-basting Poultry Imitation Bacon/Seafood Soy Sauce Marinades Thickeners Herbal Supplements, Prescription Meds Over the Counter Meds Vitamin and Mineral Supplements Lipstick Lip Gloss and Balms Play Dough* (hands must be properly washed after playing with) OVERLOOKED GLUTEN SOURCES

17. Amaranth Arrowroot Buckwheat Corn Flax Flours made from nuts, beans and seeds Millet Montina Potato Starch Potato Flour Quinoa Rice Rice Bran Sago Sorghum Soy (soya) Tapioca Teff GLUTEN FREE GRAINS AND STARCHES

18. TIME TO PRACTICE

19. MENU I Choose One: Whole Grain Chicken Corn Dog Bites Hamburger/Cheeseburger on Whole Wheat Bun PB&J Sandwich w/ String Cheese Yogurt w/ Graham Crackers Chef Salad/Tuna Salad (contains saltine crackers) Choose Two Steamed Whole Kernel Corn Fresh Orange Wedges Fresh Red Grapes Chilled Diced Pears Assorted Milk

20. MENU II Choose One: Chicken Drummie w/ Biscuit Grilled Cheese Sandwich on Whole Wheat Bread PB&J Sandwich w/ String Cheese Yogurt/Graham Crackers Spinach Chef (diced egg, mushrooms, onions, tomatoes) Choose Two Glazed Sweet Potatoes Chilled Applesauce Fresh Pear Dried Cranberries Assorted Milk

21. MENU III Pancakes w/Syrup OR Fat Free Yogurt OR Cereal w/ Graham Cracker OR Turkey Sausage w/ Biscuit OR PB&J Sandwich Fresh Orange Wedges or Orange Juice Assorted Milk