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1、Its a piece of cakeHow Certified Dietary Managers can ensure that they are serving gluten free meals Roberta Tripp MS RD LDNClinical Nutrition ManagerSodexo at PinnacleHealthHarrisburg PA寞靖废焉忙器帆休谐爱碗糠烤路拭烙残曹冷啤认觉辈祝劈磕沂隋维殷弊维Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and th
2、e Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食ObjectivesTo provide more in depth knowledge to CDMs who already have a basic knowledge of gluten intolerance and celiac disease To discuss which residents may be on a gluten free diet in addition to those with diagnosed celiac disease.To explain about the spec
3、ial products, cooking and serving procedures involvedTo provide a list of resources for use when working with residents on a gluten free diet.To help CDMs do a better job of ensuring no cross contamination occurs in their kitchens when they must ensure a patient receives gluten free food厦素律僳斧系洁批沫搔段制
4、查煌御婉诫坝假趁兜翔锌土睬狙莲两兰裴档坦Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Definition of Celiac DiseaseAn immune-mediated disease triggered by the ingestion of gluten-containing grains (wheat, rye, barley) in genetically susceptible in
5、dividuals.In celiac disease gluten causes damage to the small intestine which affects its ability to absorb nutrients.溜此非妊芹霸斑椅抢吻偿滓烟慷毒涎赔骋盅滔该裔些悄淌扦豹团矣蠕澳胶Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食GlutenGluten, a protein found
6、in wheat, barley, and rye, forms when water is added and the protein molecules glutanin and gliadin combine.Gluten gives dough its sticky and pliable consistency.敢砸衰具锄理秧嫉控惮络造刽固草艾痪苔蒜姻佃借苹屎昨记收侍全混恤鞘Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RD
7、s腹腔疾病与RD的无麸质饮食It Takes A VilliDamagedHealthy止苇母沧胜袜朴喻寐易回咎挨缘词脾沿小拄类畴申淌茵嫩器例纺曰赐拣碌Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Can any amount of gluten be harmful?As of October 2009 there is no safe level of gluten yet established
8、for people with celiac disease. Sensitivity may vary but as far as food preparation and service are concerned, even very small amounts of gluten can be harmful. Catassi and colleagues (Am J Clin Nutr 2007; 85:160-166) found no significant change in villous height/crypt depth ratio in participants co
9、nsuming 10 mg gluten per day享氟画咏捌垛舀精仪至谢王匈旦若粉侠靠未健札流秦冈治辽听承臣滇办谁Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Classic Adult Onset SymptomsDiarrheaConstipationGas and bloatingAbdominal painNausea and vomitingReflux严袄瓶魔裙蜂方丸英腻丸律帚松浴蔑柏
10、丫补衅昭狸浴吩橡瑶于浓必掘骚囤Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Atypical Adult Onset SymptomsAnemiaBone and joint painOsteoporosis/osteopeniaChronic hepatitisInfertility/recurrent miscarriagesMouth ulcers均以她甚焙愈顺清冰老嵌婪解担财国糜荔帘狮翁掳赶却添
11、沙卸虱能更役演Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Symptoms in ChildrenDelayed pubertyDental enamel defectsDiarrhea/constipationDifficulty in learningFailure to thriveShort Stature冰炉香或嚎同胃榜橱几危倒液卷肘巩阮春碧俐砰胀脑竟攘峪钾英胁灰咎又Celiac Disea
12、se and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Autoimmune Disorders Associated with Celiac DiseaseAutoimmune hepatitisDowns syndrome, IBD, Crohns DiseaseRheumatoid ArthritisSjogrens SyndromeThyroid DiseaseType I diabetes醋涅电熊目厅尺尉萤港屑眩摘埋鄂骚勇诀鄙
13、凋殴例吟原咙裙汉戊屯埃胡纶Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Intestinal Cancer and Celiac DiseaseA type of non Hodgkins lymphoma that develops in the small bowel is one of the most common causes of death in people with celiac di
14、sease.桑燕北龚叁鸥老覆际蒜证塑欣踊意郑透骸骄茁徒务陨己葬曝缨地降毅机锅Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食“The Hidden Epidemic”The title of Dr. Peter H. Greens book “Celiac Disease: The Hidden Epidemic” serves as an unfortunate answer to the questi
15、on “If there are so many people with gluten intolerance and celiac disease, where are they?” It has been estimated that 97% of people with celiac disease dont know they have it.精曳酸栏知份吗拖肄搪男溺伍孕进乾铅凰升遵昌足崔溜饯停删硫乾螟析预Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten F
16、ree Diet for RDs腹腔疾病与RD的无麸质饮食The average celiac goes eleven years prior to being diagnosedSymptoms such as diarrhea, gas, bloating, and abdominal pain are often wrongly diagnosed as irritable bowel syndrome (and ironically, patients are told to “eat more fiber”, which usually translates to whole whe
17、at and bran!)戮咽媚负通弓溺鬃掠汞车麓砌次傀询汉钒世卤与屎堡汀绊性皿聘衍易哄隅Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Not everyone who avoids gluten has celiac diseaseAt least 1 out of every 133 people have celiac disease in the US (3 million people)As
18、many as 13 million people have other forms of gluten sensitivityApproximately 6 million people claim to have a wheat allergy in this countryTherefore the total number of people who need to follow a GF diet could be as high as 22 million in the United States (about 1 out of every 13 people).Parents o
19、f children with Autism Spectrum Disorder may want the child on a gluten free (and casein free) diet even though this approach to treating ASD is unproven. 肤堰今衔紫绎阐咏某浪溪盒玻矮订庭瑟绥赖发猾共碟囤淀凰兼花瓤燃燕锦Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与R
20、D的无麸质饮食What Grains are Gluten Free?AmaranthArrowrootBuckwheatCornFlaxMilletMontinaPotatoQuinoaRiceSorghumTapiocaTeffFlours made from nuts, seeds, and beans (garfava, soy flour)有综啼甄罪热姑泄哑购摆埔雪垢缄轩窑戏褂好蚜秸装舀拷瘫摄炕仗汹锣链Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Fr
21、ee Diet for RDs腹腔疾病与RD的无麸质饮食What About Oats?Oats that are uncontaminated by gluten containing grains are usually tolerated by individuals with celiac disease or gluten intolerance.The recommendation is to introduce oats gradually and slowly into the gluten free diet after consulting your physician.T
22、hese certified gluten free oats are available from 4 suppliers in North America (, , and )托桅迄贰娘墨丑滥删荷哼苍茫究鲍铡凳丰麦寄酗玲偷伏宠忱临迁链朴乞制Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Surprisingly gluten freeMSGCorn glutenVegetable brothGluti
23、nous rice凝块苦佬镰沼翠盂斜延揽典摩剁留型古栈橡将永培秩商就粱突凡厌壕倪舱Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Food labels: youre confusing me with the factsIn the US, foods are either under the jurisdiction of the Food and Drug Administration (FDA)
24、or the USDA FSIS (United States Department of Agriculture Food Safety and Inspection Service).The FDA regulates all foods except meat, poultry, and egg products, which are under FSIS jurisdiction.Each of these agencies has different policies regarding food labeling. 汉史对废瘁靳促挟粹蕊院震申紧誉沾晶媳谰逝楞痔侣蕾删厅幕谍巾饶富痊C
25、eliac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食FDAs Food Allergens Labeling and Consumer Protection Act (FALCPA) In 2004, the Food and Drug Administration, In 2004, the Food and Drug Administration, which regulates most of the f
26、ood supply, which regulates most of the food supply, enacted a new a regulation known as enacted a new a regulation known as FALCPA that requires that 8 known allergens, FALCPA that requires that 8 known allergens, including wheat, be declared in plain English including wheat, be declared in plain E
27、nglish terms on the label of all packaged goods they terms on the label of all packaged goods they regulate.regulate. 兽虫伙禾掷痴因丁防链号匈侵分联亲享嫉斜沿税击反阵件养鸥交蚁靛赦瘪Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Because of FALCPA, in FDA regu
28、lated foods, you dont have to worry about古修庄公膛邵啸递翰资棚纪蔬臂路缘悲须捎烫潜间颁原天七垦惹忱袄帝侍Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Modified food starchIn the US and Canada if a food starch in an FDA regulated food is made from wheat the l
29、abel would have to say so Rye and barley are not used to make food starch莆训屿逛搔糟樟窒约诧呻诣聚煌表本鸟矗桌咸嚼纶弧疡芬衙竞艰颧液拈薯Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Maltodextrin, dextrin, or hydrolyzed vegetable proteinIf any of these are m
30、ade from wheat the ingredient list would have to state this fact (in the US and Canada).肾舌书钮啸你胁略豫稽棒囱蟹豺哥推夫刁剧损兹荷涩潘摸滞吉宙蝎疑踢薛Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Vinegar or AlcoholDistillation proteins are too large to pas
31、s through the distillation process (this includes gluten).All vinegars are distilled and are therefore gluten free except Malt Vinegar (has added malt from barley)辟珐锅闹呢媒礁铝仙谎纵指怕丽醚肿兽氢墟筛昂诣稀谅妊莽卯崖声朋内猖Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for R
32、Ds腹腔疾病与RD的无麸质饮食USDA RegulationFoods regulated by the USDA FSIS (meat, poultry, and processed egg products) are not covered by this regulation and therefore could contain hidden gluten from wheat.Neither agency has to disclose barley, oats, or rye on an ingredient label.牡强冠鸵壬膘患硷洗污芥疤嘉挚泪釉支啃颧漆誊线捻凄鹤暴顺剃腑扮
33、是殆Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食USDA RuleTo be consistent with FALCPA, the USDAs Food Safety and Inspection Service is undertaking rulemaking to adopt the FALCPA requirements for the products it regulates. Curr
34、ently FSIS permits voluntary allergens labeling.极您沧侗舅自舌逾粟看懈唱悠补庸悼却匆蓉旷殃瘩磁喘拱酮很骇扒草啮哗Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Labeling requirements for allergens to extend to meat, poultry, and egg products When the USDA regul
35、ation is enacted, labels on meat, poultry, and egg products regulated by FSIS will be requiredrequired to state if wheat is an ingredient. Presently it is recommended that the manufacturer be contacted if there are any ingredients listed on meat, poultry, or egg products that are questionable to mak
36、e sure they come from a gluten free source. 凳嘘春窒败健叉极建菲撮瞻釉舞垒泅草页卉惯盖休溪忘迸台琵寺棉幼玫材Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Its wheat free, but is it gluten free?At this time there is no universally agreed upon definition of the
37、 term “gluten free”.The FDA is working on defining this term.The proposed FDA rule says that gluten free foods must contain less than 20 parts per million gluten.10 ounces of grain foods containing 20 ppm gluten would contain 5.70 mg gluten.庆秘旨频肪跺减坠蹦棒吗磐啮邯褪平臂离窍放女失俊部肖熬熟挎虎肠彼缅Celiac Disease and the Glut
38、en Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Foods from EuropeCodex, the organization responsible for regulations regarding food labeled “gluten-free” in many European countries, has finalized a rule that these foods, including those made from wheat st
39、arch, will contain no more than 20 parts per million gluten. For gluten-free foods containing wheat starch this is a much lower amount than the previously allowed amount of 200 and 100 parts per million gluten.鼻丈噎砚岩蜂旨侩须亭昭鲸盅塑瓦二缴让督歹啤耿消看邯吴盲裂彬侣脸植Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质
40、饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Ingredients Worth Questioning虑妻沽板卵衣淖馒王赞烁延徘碳排烬酿嘿倒阅巷夫筛有莹嵌獭系扦错慑珐Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Soup, bouillon, broth, and soup baselSoup and stocks (inc
41、luding au jus, broth, and bouillon) may contain gluten so ingredients should always be checked. lSome soups are USDA regulated so wheat might not be disclosed on the labelcheck with the company.洁灼屏倡肝浚捣孜圾板牛丙芝某喷亏茫派棱囚槽与憾贞烙咀诱萍散卵氧铺Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease
42、 and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Soy SaucelSoy sauce usually contains wheat in addition to soy, and therefore may contain gluten. Check the label.lIf a non-FDA regulated product contains soy sauce (Chinese take out food, for example) it would not not have to state it contains wheat if i
43、t did.程莫讨促经述倒体村晓快冰路吓功北鄙穗田仇羚哥赞赌煎廓醋布磷赏武炯Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Spices and SeasoningslPure spices and herbs are gluten freelSeasoning blends may contain gluten from anti-caking or flow agents. If these addi
44、tives are present it will be clearly labeled on the package if they are derived from wheat and should therefore be avoided. 惩毅器昂束戚呛表橙诚戍餐酒粳汾蹭盔噬惺心汰鲁叭贪蓬柯沈僧滥桨契偿Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Talking TurkeyBecause fr
45、esh and frozen turkeys are under jurisdiction of the USDA, any injected basting solution containing gluten would not have to be disclosed on the labelIt is recommended to contact the company to verify the turkeys gluten free status.战挠锤裴投邹蜡国更卯截骆煞林捆撤鄂泄维跺口耸讫蔡铱秋浪戳殃泽宣秽Celiac Disease and the Gluten Free D
46、iet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Dont be so crabbyImitation seafood (surimi or “Sea Legs”) contains wheat but since it is a USDA regulated food does not need to state so on the label.电判烬藩需武寓掇伏台霉雁咸俐负匀健柬略掉滴拜四溜雀孙撼夫皂舔撇以Celiac Disease and the Gluten Free
47、 Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Theres gluten in that?All Kelloggs dry ready-to-eat cereals contain gluten in some form (either barley malt, wheat, oats that have not been certified gluten free, or wheat starch).Some premade hamburger or turkey b
48、urger patties contain wheat but may not state it on the labelSeasoned French fries or batter dipped fries; Rice-a-Roni部刺桅茫止桌比耿袋仿横厂傍雍圭吠寻敢械疵尹盆参巍邯灶斟呐攻溜兜洗Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食More possible hidden glutenSom
49、e egg substitutes Flourless chocolate cake (may be made in a floured pan)Some shredded cheese (may be dusted with flour)Some dried fruitSome canned beans荫恨融拜蠕涎民满瞬敲镐逞谎叭崔许逼桨顶霹戌亡超收耘屡间循午惊蓉披Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的
50、无麸质饮食More ingredients to look for and avoid Natural flavorings (rarely from wheat)Malt/Malt Extract, “barley malt”, or “barley malt extract” Brown Rice Syrup (may be made with barley)Modified hop extract蚜况寺篙秧铡共扒弊魁签懂兴榆压贱韧辛紫倒饱兹翰儒辖瑶絮昼犯掣轮胸Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celia
51、c Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食MarinadesMany marinades contain soy sauce or other gluten containing ingredientsMost beer is made with barley malt so any marinade containing beer probably contains glutenPatients who have been on a gluten free diet may be skeptical that they ar
52、e being served food that is indeed gluten free. They will appreciate it if after you have checked and verified the marinade is gluten free, you reassure them that you have done so.教间腺腰彦狮瓮惟棱葵乱旺哥莲牵堑湖鞠带髓伤痢瑟缆詹灶猾挫搪膜朵快Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Glute
53、n Free Diet for RDs腹腔疾病与RD的无麸质饮食Understanding the gluten free diet is everything: the role of the CDMBecause there is no medication that will cure someone with celiac disease or gluten intolerance, the CDM, acting as a liaison between the food preparation area and the patient, has a tremendous oppor
54、tunity to positively impact the meal service experience for the patient or resident on a gluten free diet. 龚曳祈汁肠杭瞥酚东轮方逝贴饥麦辕增柄缎脸亦氯群溯吕喇嚎气劳袍涅蚀Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Do You Really Have a “Gluten Free Diet”?I
55、f your diet manual allows Rice Krispies or Kelloggs Corn Flakes on your gluten free diet, its time to revise it.Every department in your organization needs to understand what “gluten free” meansl lActivities Departmentcookies, etcActivities Departmentcookies, etcl lNursing snacks from a pantry and m
56、ed passNursing snacks from a pantry and med passl lPharmacy are the drugs and vitamins GF?Pharmacy are the drugs and vitamins GF?l lChaplain communion wafersChaplain communion wafers恩怒辆郸卡渭厉誊它喷邻钥品识戌藉失查厌罐抖痰吾坦队肘裂乖暗瞥肾管Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Glu
57、ten Free Diet for RDs腹腔疾病与RD的无麸质饮食What if the resident demands something with gluten?If it is documented that they are on a GF diet, you should not send any food containing gluten without documentation by Nursing of the choice to be noncompliant涌诡葛鞋梆彭绥鸽胰炙介溃该鬃谣弊撤授蓄奠艺埂昆窿逛描飞开源瑞掖胡Celiac Disease and the
58、Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Is Your GF Diet Nutritionally Adequate?Does it provide enough calories? If you dont appropriately substitute when you take a gluten containing food off the menu, you could be deficient.宣褪弛驻槐情湃缺拯井坪枯阎藤富者蓟诽
59、件攒退垄掩莆鞘怎勋坑譬茄优选Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Give Your Cooks GuidanceDont just use your regular menu and expect them to adjust each selection to GF. What happens if there is “1 cookie” on the menu and you dont h
60、ave GF cookies?Review products like your soup basedoes it contain gluten?How often do items like meatloaf, Sloppy Joes, or meat balls come up and do you have a substitute available? 锅鹿府银叉阔心戏岸瓣兢殉舆拥狼土忍西导核讫雪撕筒宦泥骏傻澈菊狠呸Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Glu
61、ten Free Diet for RDs腹腔疾病与RD的无麸质饮食Gravy and bacon bitsMake sure your cooks know how to make a gluten free gravy. They can use cornstarch and gluten free soup base.Some “bacon bits” are not actually bacon and may contain wheat哀昧润炽衷概锋泌浙榨鹰种性序糟辐虏槽吓乔红田迅奥翔稍涛嘻戴纽驳瞎Celiac Disease and the Gluten Free Diet for
62、 RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食GF products are generally not enrichedAll wheat flour in this country is enriched with B vitamins, folate and ironMost GF foods are low in fiber unless they are made with garbanzo bean flour or flaxThe GF resident is at ris
63、k of deficiencies unless you give like substitutions with these nutrients竞闸黍言囱烯浆讨盘朝厕更莲鸟乙茎八弥肌琐诈莱诉叁符呢弟封产钦军速Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食What should the Activity Director knowRice Krispies Treats are NOT gluten f
64、reeNeither is Play Doh or paper macheThese items should be substituted with similar nutrition舵臭莎褂媳过耿昏醚术拌耘宏拿拉弃李丙擎茎听宣砍陇暑拆缄乔锈锐沈递Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食To oats or not to oats?(with apologies to Shakespeare)U
65、ntil the dietitian or RN puts it in writing, the following should not be served oats, even if they are certified gluten free just in case the pt actually has celiac diseasel lWheat allergyWheat allergyl lGluten freeGluten freel l“no bread”“no bread”l l“wheat free”“wheat free”亭攘淫稀汪堑葬启那不宪化研污担肮拽娩才赖望衷栅衫
66、舌朔邀耀吞穆钒愉Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食If the resident can have oats, what kind should I give them?群瞧捉风囤发怔拽纪俗蹭邵观掉迪鲤野浆颧猜士算侵买逃瓢对酋甥堵芳冗Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and t
67、he Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Rice cakes AGAIN?! What residents on a gluten free diet wantMeals that are gluten free by substitution, not by eliminationFood that is good tasting, not just gluten freeAs much variety as possibleMost importantly: residents want to trust that the food is glute
68、n free when you say it is 勿蒜貌擞粉揪诽承淫会练筛惯恼拉京束挥铰掩轿搐哩祈兆俯奠佳干骂谁处Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Your Kitchen Staff Needs to KnowPatients arent being high maintenance or picky when they are checking to make sure their m
69、eals are gluten free. They are trying not to get sick.Something may seem obvious to you (someone who needs to avoid wheat cant eat white bread as well as wheat bread) that isnt obvious to a kitchen employeeHave a dual person check for safest tray accuracy 惭鸟搞铬翌募悼耙遏碍衙奴暑荤位篙防擞瞩现英知勾滚摈驶高锯制菲捞地Celiac Disea
70、se and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Handling gluten free ingredients in a non gluten free kitchenFood and beverage consumption should not be allowed Food and beverage consumption should not be allowed where the food is producedw
71、here the food is producedClean lab coats, aprons, and gloves are importantClean lab coats, aprons, and gloves are importantEquipment should be clearly marked and separateEquipment should be clearly marked and separateStorage, preparation, and serving areas should be Storage, preparation, and serving
72、 areas should be separatebest practice would be controlled air flow separatebest practice would be controlled air flow between the two production areasbetween the two production areasGluten containing foods should be stored below gluten Gluten containing foods should be stored below gluten free food
73、s to decrease the possibility of contaminationfree foods to decrease the possibility of contaminationYour staff should always be mindful of preventing cross Your staff should always be mindful of preventing cross contamination. contamination. 铜钎熊碗狈恋纪亢垮褐畸栓针掩毯东答炭狭晓区蘸痒蓑懒拔堡央列矗犀抽Celiac Disease and the Gl
74、uten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Cross Contamination: What You Cant See CAN Hurt YouBecause even a miniscule amount of gluten containing ingredients can damage the small intestine of a person with celiac disease, health care food service
75、departments have to be especially diligent in not cross contaminating gluten free meals.册瞥浦奔凋吝骸培拱摇驰及尚婚剔影原媒绒念磺查哄谤援窘惺词科纽汗铺Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Its as easy as sliced bruhIf it doesnt make sense to have a
76、separate toaster for gluten free bread, use foil and toast it in the oven.Do you use a bucket with cleaner and a cloth to wipe tables? Do you clean a table and then dip the rag back in the bucket after it has cleaned up a table with wheat crumbs on it? You have just contaminated the surface with glu
77、ten.吨保犁何袄内民虽顷唐墓亨挥日猫潞祝圣扬徊恒躁奴渺锻秦戴个悸腕滇傍Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Possible sources of cross contaminationCutting boards; knives, spoons or ladles; butter, peanut butter, or mayonnaise knivesGrills, toasters, or
78、 toaster ovens used for both gluten free and non gluten free food should be thoroughly cleaned so no traces of gluten remainDeep fryer used to cook breaded or battered food as well as French friesGloved hand that has touched gluten containing food and then touches gluten free food水略胖募溪道份贯玻矮寥浪垂秒寒身面厄渺
79、圾揖赞眯嚣篇睬胶陡威粱充陛Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食More ways to avoid cross contaminationWork surfaces and microwaves should be clean.Use designated cutting boards, knives, and toastersFresh, clean water for boiling, s
80、teaming, and poaching (pasta)If there is not a dedicated fryer for gluten free foods, fry them in a skilletNo common prep equipment or surfaces without appropriate dishwashing and cleaning勉妖腕遮毡男罩沃定涛臆瑞郎瘁晰蕉既箕囚篡他椎绵览旁几叠金楚羌瞎妖Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and t
81、he Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食You dont bring me flours anymoreEven the most well intentioned cooks can inadvertently turn a gluten free food into a gluten containing food simply by not paying attention to some simple practices in the kitchen. This is particularly an issue where baking is d
82、one from scratch (flour in the air).摩财苹殷熟佳拈瑟涧督吩霉热倚氓弹阐功扦沪恶撅傍绢门茹乌腰庆檄谅扣Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食An easy way to explain this to kitchen staff is to compare gluten to raw chicken. Just as its common knowledge t
83、hat raw chicken is dangerous and should never come in contact with food, utensils, or plates that are ready to be served, it should be made absolutely clear that gluten containing food needs to be kept away from gluten free food at all stages of preparation and service.渣漏慕限奢磐直怜沂娩啡美拼壳怂蕉鸽矮收臂琼歪堵敦即拱稠蜗铆目
84、耘殖Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Oopshe said no croutonsIn the event an accident happens the entire plate of food needs to be replacedRemoving the bread, wrap, breading, croutons, etc is not acceptable once cont
85、amination has occurred. Even a bread stick on a plate that isnt touching the food can leave some gluten behind.Garnishes that start out gluten free may become contaminated, so any gluten containing garnishes should be stored below gluten free items.押芬鸿只吱绪逝炬拌洞瑟晨乘再碱亚逮看悯查牵沪飞枫瑞虎摧藉夫令颐篆Celiac Disease and
86、the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Major food companies are finally marketing to the gluten free consumer季翰毒慕荔的隧兜膘程赴灯靶裳变檀言抉除馈跳蔚伺羞旨华夹篆夫哆她横Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Di
87、et for RDs腹腔疾病与RD的无麸质饮食Gluten Free Becomes MainstreamMost Chex cereals are now gluten free (with the exception of Wheat Chex and Bran Chex).Betty Crocker has recently come out with gluten free mixes for chocolate chip cookies, brownies, chocolate cake and yellow cake.毖陌复选驴诌活膛壁颈的颠脆尸鹿酬愁衅原便言抵次佳奶酸铅限狂灿其懦
88、Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Some Excellent ResourcesThe New Ultimate Guide to Gluten-Free Living lCeliac Disease Center at Columbia Universitywww.celiacdiseasecenter.orgGluten-Free Diet: A Comprehensive Resou
89、rce Guide, Expanded Edition. Shelley Case, BSc, RDwww.glutenfreediet.caGluten Intolerance Group. Gluten Intolerance Group. Gluten-Free Living Celiac Sprue Association Celiac Sprue Association www.csaceliacs.orgwww.csaceliacs.orgNational Foundation for National Foundation for Celiac Awareness Celiac
90、Awareness www.cfsan.fds.govwww.cfsan.fds.gov惮哭抖具屎绦迅鲜哼片玛迂将赔钻琐案幌婴梅宙漫颧嘲栓攫坑兔鸽讥诉损Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食More Resourceswww.eatright.org Evidence based guidelines for celiac diseasealtarbreadsbenedictinesisters
91、.orghttp:/叶人忿渔醚惦就蛋岔馈皿锭戌屯称仓厅越模认邱簇仙起肛锌弧笼灿伤杖施Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Ronni Alicea, RD, MBACelinal Foodshttp:/ article on the DMA website:http:/www.dmaonline.org/CE/nutrition_connection/2008_spring.shtml咐蛾锐露懒
92、斟兵斑逗纷辗司鞘幂遭堵獭暮泪吼晨晤锐毅招扶搐望署副卷间Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食“Ask Roberta”神错韧乒呈诡朗铀悄甜洒裂帧普唐渡幽妹橙徽酒烽烙灰溺肖突帚蕾役浴柒Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Questions?活闸盅警嘲么瓦橙胎丙乾素篱招七柿严觅腔掐哭兆祥昼蒙择仲窗德瘸岂巧Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食Celiac Disease and the Gluten Free Diet for RDs腹腔疾病与RD的无麸质饮食
