Mary Schluckebier, BS, MA, Executive Director

Celiac Sprue Association20081

For life – eliminate All wheat, barley, rye and possibly oats

No known threshold Damage is cumulativeNo test for all amino acid fractionsNo test for all amino acid fractions Treatment - is strict adherence to

a 100% gluten-free diet for life gNational Institutes of Health (NIH)

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Accept Prescription

Eat and Be HealthyEat and Be Healthy

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Where do I find Gluten-Free Foods?

Supermarket and Super StoresNatural Food StoresEthnic Markets – Middle Eastern - OrientalMail Order and Food CooperativesLocal Bakeries and Restaurants Farmer’s MarketGardening

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g

CSA self-management approach

1 Foundation Restore health - stabilize– free of wheat, barley, rye,

oats, crosses and derivatives

2 Expansion

– Risk-Free choices

Experiment and evaluatep– Introduce items to test

personal tolerance levels

3 Maintenance

Experiment and evaluate diet choices

– Risk unclearHabits for optimal health3 Maintenance

– EvaluateHabits for optimal health

– What personally works

Jean Guest Ph Dc R D L M N T 2001

Celiac Sprue Association20085

Jean Guest, Ph.Dc.,R.D. L.M.N.T. 2001

CSA’s 3 – C’s

Contain ContactCross ContaminationCross Contamination

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Assimilate

Integrate InformationBalance

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Gold Standard Diet -- zero

completely eliminate toxic prolaminscompletely eliminate toxic prolamins Proline Glutamine Serine

Some ---- 0 ---- None

Celiac Sprue Association20088

Eat and be healthy Steps 1-2-3

Fruits, vegetables, nuts, leaves, flowers, stems, roots and tubers

BeveragesDairy, plain meat, fish, poultry and eggs eggs

Grains grasses sprouts

Sweeteners, fats, oils

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Grains, grasses, sprouts

What is important?

Celiac Sprue Association200810

Cross contamination issues

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Information to make decisions

M i f l•Meaningful

•Verifiable•Verifiable

•Consistent

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Difficult to predict risk?

• Barley malt syrup and extracts • 1800 ppm - 2024 ppm gluten

• Wheat starch modified, refined, pre-gelatinized• 13 to >5000 ppm glutenpp g

Food Allergy Research and Resource Program, UNL

RISK MANAGEMENT STRATEGY

Celiac Sprue Association200813

Information?

Gluten-Free

Wheat

Allergy Required labeling: or

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Parts per million (ppm) ratioParts per million (ppm) ratio 1 milligrams (mg) in 1 kilogram (kg)

What are we talking about?Wheat flour 10,000 ppm Wheat bread 8,000 ppmWheat starch 150 ppmWheat maltodextrin 20 ppmWheat glucose syrup less than 20 ppm 1 teaspoon vital wheat gluten 3,000 ppm

Food Allergy Research and Resource Program, UNL

Celiac Sprue Association200815

How much?

1 teaspoon salt = 5027 mg1 teaspoon sugar = 3992 mg

1 teaspoon vital wheat gluten = 3000 mg

10 – 50 milligrams per day Catassi 2007

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GF loaf weighs 2.2 pounds cuts mg ppm

1 kilogram = 1 million milligrams 1 slice about 3/8” thickweighs 100,000 milligrams

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Personalize filters to manage risk

Assume RISK managementAssume RISK management responsibility:

Ask the second question

Build on Healthy Habits

Celiac Sprue Association200818

Skilled shopper in action

Navigating the hidden dangers

Sin T.A.C.C.

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CSA Recognition Seal

FREE of Wheat, barley, rye, oats, crosses and , y, y , ,derivatives in:ProductProcessingPackagingg g

Testing for verification 5 ppmCeliac Sprue Association

200820

Testing for verification 5 ppm

Voluntary sharing is appreciated

Resource i f ti finformation from food companies and retailersand retailersList your store

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Mary Schluckebier, BS, MA, Executive Director

Celiac Sprue Association200822