University of MarylandCollege ParkDietetic Internship

INSERVICE EDUCATION LESSON PLANTopic:GlutenDate March 9, 2015

Audience: Dining Services Staff at Windsor Restaurant

Goal: Increase knowledge and understanding of gluten, what gluten is, what foods contain gluten (aka what is a gluten-free diet), who needs a gluten free diet and the difference between Celiac Disease vs. Gluten sensitivity.

Objective(s): Discuss gluten. Describe the properties and health implications of the protein. Review foods that contain gluten. Explain the difference between Celiac Disease and gluten sensitivity Discuss why it is important to see a doctor and a Registered Dietitian before eliminating gluten from the diet Discuss the preparation of gluten-free foods and the risk of cross contamination Discuss foods that are naturally gluten free

Audio-visual Aids:

Outline:A. Introduction to Gluten a) Hello! Our names are Megan Smith and Chandler Ray. Today we would like to discuss the protein gluten, foods that contain gluten, why gluten sometimes needs to be eliminated from the diet, and why it is important to see a Registered Dietitian before eliminating the protein from the diet.b) Grains such as wheat, barley, and rye grow from a seeds known as a kernel. A kernel contains three parts: the bran, endosperm, and the germ. (picture of a kernel of wheat)c) The endosperm portion of a kernel contains the greatest portion of gluten (protein), carbohydrates, iron, and B-vitamins. It is also a source of soluble fiber. d) Gluten protein can be found in these grains: wheat, barley, rye, and triticale. e) Foods that contain these gluten-containing grains include: breads, baked goods, soups, pasta, cereals, sauces, salad dressings, malt, food coloring, malt vinegar, beer, and rye bread. (picture of these foods)f) It is important to read food labels when looking for products that eliminate gluten. First check label for the following grains: wheat, rye, barley, triticale, malt, brewers yeast, and wheat starch. Also look for varieties and derivatives of wheat including: wheat berries, durum, emmer, semolina, spelt, farina, faro, graham, KAMUT, and einkorn. g) Products labeled wheat free are not necessarily gluten free.

B. Who needs to eliminate gluten from their diet? a) Celiac disease is an autoimmune disorder that can occur in genetically predisposed people. The bodies natural immune response attacks gluten like it is a foreign invader. These attacks lead to damage of the villi, the small fingerlike projections that line the intestine. Damage to the villi leads to improper absorption of nutrients. (picture of intestine)b) Common symptoms of Celiac disease include: foggy mind, depression, abdominal pain, diarrhea, bloating, chronic fatigue, headaches, and weight loss. c) Celiac Disease if left untreated can cause other health problems including other autoimmune disorders such as diabetes, as well as vitamin and mineral deficiencies, iron deficiency anemia, and osteoporosis. d) Currently the only treatment for celiac disease is lifelong adherence to a strict gluten-free diet. e) Gluten sensitivity is a condition with symptoms similar to those of celiac disease including bloating, abdominal pain, fatigue, and a foggy mind. These individuals do not experience the same damage to the intestinal lining as individuals with Celiac disease. f) It is never recommended to self-diagnose Celiac Disease or Gluten sensitivity. The individual should visit a doctor and a Registered Dietitian before eliminating gluten from the diet. g) A blood test can confirm the presence of Celiac disease. Individuals with gluten sensitivity will not test positive for Celiac disease but, an RD professional has strategies to help these individuals determine if gluten is truly the root of their symptoms.

C. Preparing Gluten free foods a) When preparing gluten-free foods for a resident with Celiac disease it is important to avoid cross-contamination with other ingredients, foods, or utensils that may contain gluten. b) Places where cross contact can occur include: toasters, flour sifters, shared and containers. Wheat flour can stay airborne for many hours after usage, it is important to thoroughly clean all exposed preparation surfaces and utensils. c) Mass produced foods that are most often cross-contaminated with gluten include: oats, pizza, French fries, and non-certified baked goodsd) Foods that are naturally gluten free include: Fruits, vegetables, meat, poultry, fish, seafood, dairy, beans, legumes, nutse) Grains and starches that do not contain gluten include: rice, cassava, corn, soy, potato, tapioca, beans, quinoa, millet, arrowroot, chia, buckwheat, amaranth, teff, flax, yucca, gluten-free oats, nut flours.

D. Conclusiona) Gluten is a protein that comes from the endosperm of a kernel of grain. Grains that contain gluten include: wheat, rye, barley and, triticale, b) People with Celiac Disease must eliminate gluten from the diet. Continued consumption of gluten in these individuals can lead to further damage of the small intestine and other long-term health problems. c) People with gluten sensitivities should see a Registered Dietitian to help them confirm if gluten is truly the cause of their symptoms.d) When preparing a gluten-free meal it is important to reduce cross-contamination in the kitchen.e) There are many naturally occurring gluten free foods and grains including quinoa, millet, and chia.

E. Resourcesa) http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/gluten-free-diet/art-20048530b) http://www.webmd.com/digestive-disorders/celiac-disease/features/gluten-intolerance-against-grain?page=2c) https://www.nutritioncaremanual.org/client_ed.cfm?ncm_client_ed_id=163d) http://celiac.org/live-gluten-free/glutenfreediet/food-options