Wheat and Gluten: We Hardly Know You
Transcription
Wheat and Gluten: We Hardly Know You
WheatandGluten:WeHardly KnowYou JulieMillerJones,PhD ProfessorEmerita St.CatherineUniversity St.Paul,MN Disclosures • ScienEficAdvisortotheInternaEonalLife SciencesInsEtute,WheatFoodsCouncil, HealthyGrainsInst.(Canada),HealthGrain Forum(EU) • Givespeechesandreceivehonoriaforsuch fromavarietyoffoodcompaniesand commodityboards WhatThisTalkWillCover • Alookatthecurrentenvironmentandpopulardiets • Alookattheclaimsthatwheathaschangedandis makingusfatandsick. • Ifwheathasnotchanged,whathas?Linktheroleof gutmicrofloraandgutdysbiosistohealthanddisease. • AddresslegiEmateandunfoundedclaimswithrespect towheat,gluten,carbohydratesandhealth. • OutlinedietarystrategiesandEpsforthosewith glutensensiEviEes,allergies,celiacdiseaseandother digesEvedisorders. TheLatestFadorHeretoStay? … mega-sellers like Grain Brain and Wheat Belly suggest that wheat may be the new asbestos CLAIM: HUMANSDIDNOT EVOLVETOEAT GRAINS Claim:HumansDidNotEvolvetoEat Grains • Humans-eaEnggrains>100,000yrs • Dentalrecordevidence – Hominidswereandareomnivores – CookedgrainDNAindentalcalculusofPaleolithic humans • Caveandcookingevidence* – Grains(sorghum,wildmaize,others)foundincaves • GrainDNAonstonetoolsandincookingpotsindicate processingandcookingofgrains. *CavesinIraqandtheLowCountries;theAmericas Henry,A.etal.EthologyandSociobiology15:219–35.;Unger,P.Theknown,theunknownandthe unknowableDOI:10.1016/0162-3095(94)90015-9. Claim:HumansDidNotEvolveto EatGrains • Withtheadventofagriculturehumansevolved tohave6copiesofamylase – otherprimates-2copies • Amylase&cookingofCHOenabledready supplyofglucosetothebrainincreasingthe brainsizeofhumans http://news.sciencemag.org/ evolution/2012/10/raw-food-notenough-feed-big-brains news.nationalgeographic.com/.../ 121026-human-cooking-e…- A surge in human brain size about 1.8 million years ago is linked to the innovation of cooking WhatWasLifeLikeinthePaleo Period • Averagelifespan~35years – 65-85%vegetarians;moremeatincolderclimates – Ourancestorsdideatgrainsandlegumes. – Earlyhumansateverymuchlikemodernpigsand bear-gegngcaloriestosurvive hhp://www.dailymail.co.uk/sciencetech/arEcle-2878166/ScienEsts-slam-cavemandiet-say-early-humans-just-ate-could.html#ixzz42Kv1U4Ur CLAIM:GRAINS/GLUTEN-CONTAINING CARBOHYDRATESTAPLESAREBADFOR THEHUMANDIET RecommendaEonsforCarbohydrates (CHO)andCHOStaples DietaryrecommendaEons-mostcountries/healthpromoEonorgs Foodguidelinesrecommendgrainsasafoodgroup CHO/grainstaples-Baseofpyramid/diet 45-65%ofE(upto75%ofE) • • • • – – – – – – – Australia/NewZealandDietaryGuidelines EuropeanFoodSafetyAuthority UKScienEficadvisoryCommiheeonNutriEon USDietaryGuidelines/USInsEtuteofMedicine SingaporeHealthPromoEonBoard IndianHealth HealthpromoEonbodiessuchasheart,canceranddiabetesassociaEons WorldHealthOrganizaEon/Food&AgricultureOrganizaEon(WHO/FAO) • “themacronutrientthathumansneedinthelargestquan3ty.” MontagneseCetalNutriEon.2015;31:908-915.RadhikaG,etalPublicHealthNutr.2011;14:591-8 hhp://www.hpb.gov.sg/HOPPortal/health-arEcle/2638 CLAIM:MODERNWHEATHASBEEN BRED(TRADITIONALANDGENETICALLY)TO BECOMETOXICANDFATTENING BreedingChangesEverythingEdible http://cdn.foodbeast.com.s3.amazonaws.com/content/wp-content/uploads/2013/09/ V8XnPeQ.jpg Claim:WheatChangesCreatedShort Straw“Frankenwheat” “Wheatweeatthesedaysisn'tthewheat yourgrandmahad…It’san18-inchtallplant createdbygene3cresearchinthe’60sand ’70s.”WilliamDavis • Nosignificantchanges Kasarda,USDAAlbany2013;Chibbar2015,HealthGrainEU So Jack, were these some seeds Norman Borlaug sold you? 13 FACT:Tri3cumaes3vumanditsparentsare12”-60”tall. – Heightgenesdonotcodeforglutensandgliadins 37 ancestral and modern varieties of wheat - From Red Fife dating (1860) to newest variety tested 2007;grown in 2013 and in 2014 Photo Credit: U Sask- Hucl et al 14 GlutenLevelsUnchanged ©Chibbar et al. 2015 over 150 yrs “Analysis of a variety of heritage and modern wheat starch shows very little difference ….varied from 56 % (Apex 1937) to 69% (Superb 2001) Claim:Gliadin–AnewproteinthatisaddicEve 1700-1893studies,namedanddescribedchemically Osborne&Voorhees TheProteidsoftheWheatKernelAm.Chem.J,392-471(1893) 2012–new,toxicproteinWilliamDavis “everybodyelseissuscep3bletothegliadinproteinthatisan opiate.Thisthingbindsintotheopiatereceptorsinyourbrain andinmostpeoples3mulatesappe3te,suchthatweconsume 440morecaloriesperday,365daysperyear.” Opioid receptor 46lbs/yr Hemmings WA, Antigen Absorption by the Gut. Springer Science & Business Media, 2012 16 Claim:OlderWheatsAreSuperior Emmer,einkorn,other‘ancient’vsotherwheats-sameregion “Thedatadonotsupportanoverallsuperiorityofprimi2veforms, butevidencedinteres3ng,poten3allyexploitable,between-and within-speciesvariability.” Einkorn/Emmervscommonwheat Higher-protein,riboflavinandB6,carotenoids Fructans(+prebioEcand–FODMAP) Lowerdietaryfiber8.7-9.1g/100gvs10.7-12.7g/100g Loweryield,Poorerbreadquality HidalgoA,BrandoliniA.JSciFoodAgric.2014;94:601-12;BenincasaP,etal.JSciFoodAgric.2015;95:1795-803; GiambanelliE,etal..JSciFoodAgric.2013;93:3490-501.GebruersK,etal.JAgricFoodChem.2008;56:9740-9. 1917 Claim:Ancientwheatglutenisless immunogenicandallergenic ‘Ancient’vsmodern wheats“…presentresultscannot Total gliadin and α-gliadin determination by indirect ELISA shows more in ancient.2 confirmthatancientdurumwheats wouldbelessCD-toxic.Inconclusion, westronglyadviseagainstceliac pa3entsfromconsumingancient wheatsincluding…”1 – notlessallergenicbyblot andpinpricktests3 ‘Ancient’ 2ŠuligojT,etal.EvaluaEonofthesafetyofancient strainsofwheatincoeliacdiseasereveals heterogeneoussmallintesEnalTcellresponses suggesEveofcoeliactoxicity.ClinNutr.2013; 32:1043-9;. 3SimonatoB.etal.AllergenicpotenEalofKamutwheat. Allergy.2002;57:653-4 1Colomba MS, Gregorini A. Are ancient durum wheats less toxic to celiac patients? A study of α-gliadin from Graziella Ra and Kamut. ScientificWorldJournal. 2012;2012:837416 CLAIM:WHEAT,GRAINSANDCARBS CAUSEOBESITYANDCHRONICDISEASE Obesity, CHO/Grains Alleged as Culprits 20 AvailableCaloriesHaveIncreased ~ 600 Kcal more overall, ~200 calories more each from fat and CHO; 50 cal more from sweeteners GrainIntakeIsFlatorDecreasingas ObesityClimbs http://www.fao.org/docrep/005/ac911e/ac911e05.htm 23 MixofWholeandRefinedGrains LowestVisceralAbdominalFat McKeown et al. Am J Clin Nutr 2010; 92:1165-71 Framingham Heart Study (n=2834) 24 O FTHE MICROBIOME,DIET, INFLAMMATION,DRUGSALLERGY ANDAUTOIMMUNEDISEASES DISEASES DigesEonandGutHealth: TheFirstPointofWellness "Diges3on,ofallthe bodilyfunc3ons,isthe onewhichexercisesthe greatestinfluenceon thementalstateofan individual.” Jean-AnthelmeBrillat-Savarin (1755-1826) FoodAllergies,Intolerances,and SensiEviEesDefined • FoodAllergy*:anIgEmediated reacEontoafoodproteincausing histaminerelease • FoodAutoimmune:reacEoncaused bytheacEvaEonofagene(celiac) • FoodIntolerance:reacEontoa metaboliteoringredientsuchas lactose,caffeine,ortyramine(aged cheesesandAsianfermented sauces) • FoodSensi^vity:reacEontofood componentthatisnotanallergic, chemicalorautoimmuneresponse *Celiacdiseaseisanautoimmunediseasenotanallergy Allergy • IgEImmunoglobulinresponsetoaprotein • Eczema&hives,swelling • Asthma&hayfever-likesymptoms,cough • Tiredness • GIsymptoms • Rare:anaphylacEcshock – Neurological – Joint/musclepainsèarthriEs – IBS,other Hollowayetal.PracEEoner.2011;255(1741):19-22 28 PerceivedandActualPrevalenceof FoodAllergy • Upto35%believethey havefoodallergy • ~3.5%confirmedbyoral foodchallenge Mastcellsrelease histamineazer proteinbindswithIgE • 10-foldlowerprevalence www.foodallergy.org/document.doc 2014 hhp://www.jacionline.org/arEcle/S0091-6749(07)00991-8/abstract; Rona RJ et al. Journal of Allergy and Clinical Immunology 2007, 120:638-646 IncidenceofFoodAllergy-US 90%ofAllergiesdueto8FoodGroups Children% • • • • • • • Milk Eggs Peanuts1.4/Nuts Wheat Soy Fish0.1&Shellfish Sesame 2.5* 1.5* 1.1 0.4* 0.4* 0.1 0.1 *80%outgrowbyteenyears • • • • • • • • Adults% Allseafood 2.8 Peanut 0.6 Treenuts 0.5 Wheat 0.5 Fish 0.4 Milk 0.3 Sesame 0.1 Wheatallergyinen^re popula^on~0.5% hhp://www.foodallergy.org/document.doc2014. WasermanS&WatsonW.AllergyAsthmaClinImmunol.2011;7Suppl1:S7;Sicherer& Sampson,2010;Chafenetal,JAMA.2010;303:1848-56. 30 WheatAllergy–IgEResponseto WheatProtein • 27wheatproteins – documentedasallergens • Gliadins:mostsevere – γ-gliadin – ω-5gliadin-Wheatdependent exerciseinducedanaphylaxis (WDEIA) • Glutenins • Wheatglutelin:mostfrequent allergens • Albumins • Someglobulins/enzymes α-amylase/trypsininhibitor non-specificlipidtransferprotein EllietalWorldJGastroenterol.2015;21:7110-9;Millsetal PlantFoodAllergens2007Blackwell Eaten any wheat lately? 31 MicrobiomeandHealth • Body - 10 trillion cells Microbes outnumber human cells 10:1 ~1 - 3 % of body 200 lb. adult 2- 6 lbs bacteria “Weshouldstartthinkingaboutdiets notonlyfromtheperspec3veof whatweshouldeat,butwhatwe shouldbefeedingouren2regut microbialsystems…. “thereisnotjustonewaytobehealthy, theredoesn’thavetobeoneortwo ‘justright’gutcommuni2es,but ratherarangeof‘justfine’ communi2es ~JeffLeach,founderoftheHumanFood Projectandco-founderofAmericanGut. MicrobiomeDiversity/Balance • Micorbiomeassoc.withtheImmuneSystemanddisorders – Allergies&Asthma – Crohn’sdisease&ColiEs – Obesity&Diabetes – Cancerrisk – Heartdisease • Pooptransplantsbychangingmicrobes – RatschangedsuscepEbilitytoheartahacks – Leanratsbecameobeseandviseversa • Assoc.withStress,PersonalityGerm-freemice&ratsaremore vulnerabletostress – Mice:Warmandfriendlyvs.aggressiveandstand-offishstrains • Assoc.withCogniEonandBehavior – Highfat/highproteindietsreducememoryacuity; execuEvefuncEoning – MarkersofinflammaEonèaffectenErebodyincl.brain GutBacteriaThroughtheLifecycle Source:Ohmanetal.FronEersCellularInfecEonMicro.2012;2:1-10 IntesEnalMicrobesandAllergy Clostridia, Enterobacteriaceae, Staphylococci Decreased risk prone Food allergy- Lactobacillus Bifidobacterium mice Increased Risk Source:NovalRivasMetal.JAllergyClinImmunol.2013Jan;131:201-12 LowAcid,BacterialOvergrowth DietaryDysbiosis&Disease Lowstomachacidallows: 1. Pathogenicbacteriato surviveandpopulate thegutèdysbiosis 2. Contributestoweak EghtjuncEonsèleaky gut 3. Proteinscrossthegut ètriggerimmune reacEons Dysbiosis: microbial imbalance in the GI tract AcidSuppression&Allergy AntacidsandanE-ulcerdrugs: • êstomachacid èêproteindigesEonèpotenEal allergicreacEonorinflammatorypotenEal • PromoteIgEformaEonbydietaryproteinfragments Ø Milk,potato, celery,carrots,apple,orange,wheat, rye Ø SensiEviEeslingered>3+mo.azerantaciduse Ø Alcohol,NSAIDs(aspirinetc),beta-blockersor antacidsmayaggravatetheseverityofafood allergicreacEon. Ballmer-WeberB.TherUmsch.2012;69:225-9.Untersmayretal.FASEBJ.2005; 19:656-8;DehlinkE,etal.ClinExpAllergy.2009;39:246-53;DiesneretalWienMed Wochenschr.2012;162:513-8;McCarthyDMCurrOpinGastroenterol. 2010;26:624-31 AcidSuppression&Allergy • AcidsuppressionwhileInuteroassociatedin offspring(Swedishcohort>29,000) – Allergy(OR1.43) – Childhoodasthma(OR1.51) Source:DehlinkEetal.ClinExpAllergy.2009;39:246-53;Diesneretal.WienMed Wochenschr.2012;162:513-8 C ELIAC,GLUTENSENSITIVITY,LEAKY GUTANDDYSBIOSIS CausalFactorsforCeliacSymptoms 1. Gluten 2. GeneEcs(>97%) – HLA-DQ-2 – HLA-DQ-8 3. Trigger-stress,trauma – Surgeries,pregnancy,etc. – InfecEons,childhooddiseases 4. IntesEnalPermeability – EmergingFactor – “LeakyGut” Scientific American • CeliacIncidence USAverage(healthypeople):1in133;only1:4700 diagnosed – HigherifScandinavian,Irish,partsofMiddleEast:1in50-60 – Est.African,Hispanic-andAsian-Americans:1in236 • Inpeoplewithrelatedgutsymptoms:1in56 – 1st-degreerelaEves:1in22 – 2nd-degreerelaEves(aunt,cousin):1in39 • Incidenceisincreasing:2to5xhigher – BasedonthepresenceofEssuetrans-glutaminaseanEbodies – NoconEnuousdatarelaEngtotheincidenceofceliacdiseasein theU.S.populaEononayear-by-yearbasis Sources:Fasano,www.uchospitals.edu/pdf/uch_007937.pdf AlbertoRubio-Tapia,AmerJGastro,2012;DOI:10.1038/ajg.2012.219;RiddleetalAmJ Gastroenterol.2012Aug;107(8):1248-55 • Abdominalpain (IBS) 68% • Eczema,rash 40% • Headache 35% • “Foggymind” 34% FaEgue Diarrhea Depression Numbnessin extremiEes • Jointpains • • • • 33% 33% 22% 20% 11% 4%haveglutensensiEvityEllietalWorldJGastroenterol.2015;21:7110-9 Novalidatedoragreedupontestfornon-celiacglutensensiEvity. 42 TopReasonsCitedforSeeking Gluten-FreeProducts 1. 2. 3. 4. 5. 6. DigesEveHealth(39%) NutriEonalValue(33%) HelpLoseWeight(25%) Other(21%)* HealthierSkin(20%) JointPain(18%) 7. ImproveConcentraEon(13%) 8. AlleviateStress(12%) 9. CleansingRegimen(10%) 10. AlleviateDepression(9%) 11. AlleviateAsthma(6%) 12. TreatCeliacDisease(5%) Source:HartmanGroupSurvey,1700USAdults,July2009 TheoriesaboutIncreasing PrevalenceofCeliac 1. 2. 3. 4. Increased awareness, better diagnostics Gluten sensitivity Bacterial overgrowth - medications, age, diet High Salt intake1 - modest increase increases proinflammatory molecules 5. Clean theory or hygiene hypothesis2 1Wu et al., Nature, doi:10.1038/nature11984, 2013; Kleinewietfeld M. Nature, doi:10.1038/nature11868, 2013; Yosef N et al., Nature, doi:10.1038/ nature11981, 2013. 2Fumagalli et al. J Exp Med. 2009;206(6):1395-408; Brooks et al Curr Opin Allergy Clin Immunol. 2013 Feb;13(1):70-7; Frei et al Allergy.2012;67(4):451-61;LaciandPenagos.NestleNutrWorkshopSer PediatrProgram.2011;68:169-83. TheoriesaboutIncreasing PrevalenceofCeliac 6. Infant&EarlyPracEces • • • • 33%ofbabiesintheUSAbornbyCaesarian Breastvs.bohlefeeding NoeffectofEmingforglutenintroducEon Wasaneffectofglutenintroazer6mo.Inanotherstudy 7. FoodborneinfecEonsandviruses:trigger autoimmunediseases hhp://www.cdc.gov/nchs/fastats/delivery.htm2015AronssonetalPediatrics. 2015;135: 239-45; ( US Germany Sweden Finland) Stordal et al Pediatrics. 2013 Nov; 132(5):e1202-9 – Norway;Silvaetal.ActaMédicaPortuguesa,2011December;24Suppl 4:1035-40.“DiversificaEoninthefirstyearoffoodlife.”;LaciandPenagos.NestleNutr WorkshopSerPediatrProgram.2011;68:169-83 45 TheoriesaboutIncreasing PrevalenceofCeliac 7. ShortfermentaEonsforbreadvssourdough: breakdowntheoffendingpepEdes,useofgluten 8. AgronomicpracEces:ferElizers,growing condiEons,specificvarieEes 9. Poordietsoverall:lowfiber,folate,vitamins, toomanycalories 10. Changeinthegutmicrobiome:mayincrease autoimmunediseases Sources:Millionetal.Int J Obes (Lond). 2013 Mar 5; SungetalNeurogastroenterol Motil. 2013 Mar 22. Ceseviciene2012;Grove2009;Katz2011,Rizzello2007;Belz2012 46 T HEMICROBIOME,FIBER, WHEAT,OBESITYANDCHRONIC DISEASE The US “Dietary Fiber Gap” US Intakes vs. Recommendations 14 25 AverageDailyIntake 18 38 Men 15 25 The filled in color for each category represents the actual intake, whereas the empty portion of the bar is what is lacking to reach the daily recommendations Women 0 5 10 15 20 25 Grams Dietary Fiber Clemens R et al. J Nutr. 2012; 142:1390S-401S. 30 35 40 * Data from the USDA and NHANES 48 Under 5% Meet Dietary Fiber Intake • US NHANES gender / age categories • < 4% meet the requirement • <<<<1% males 14-50 yrs • 13-15% women 51+yrs Marriott, et al. Crit Rev Food Sci Nutr. 2010;50:228-58. 49 FiberandFlatus • Flatusemissions:men,fiber28g+/-13g – mean – range 12.7 2-53 • Flatusemissions:women,fiber24g+/-3g – mean – range 7.1 1-32 • Correlatedwithfiberintake Source:BolinandStanton,EurJSurgSuppl1998582:115 GasMaybeDuetoFODMAP • "Fermentable,Oligo-,Di-,Mono-saccharidesand Polyols”DatafromMonaschUniversity,Australia • EliminaEondietpossiblyhelpswithIBS BarrehJS,GibsonPR.TherapAdvGastroenterol.20125:261-8. Gluten Avoidance “the reigning dietary restriction of our time” • 30% - decreasing / avoiding gluten completely • >100 million trying to cut down on gluten – 40% avoiding it because of gas/ bloating • >10 million households GF 2014 • Sales $973 million, 2014 è $2.3 billion by 2019 PkgFdFacts2/2014;SloanFdTech12/2014;* Gallupsurvey U.S.ConsumersIncreasinglysaytheyare, orwanttobe,Gluten-Free • ~One-thirdofU.S.adultssaytheywanttocutdownorbefree ofglutenin2013 Source:NPDGroup,hhps://www.npd.com/perspecEves/food-for-thought/gluten-free-2012.html SorEngOutWhoShouldBeGlutenFree • AskQuesEons – Whatistheirdiet&lifestylelikeNOW?Whyarethey(or dotheywanttogo)gluten-free? • EncouragetesEngFIRSTtoruleoutCeliac disease • MUSTBEINGESTINGGLUTEN:HavetheanEbodytests èthenproceedtoagutbiopsyandcheckforthe genes,ifwarranted • GlutenSensiEvity:notestavailable • GeneralGutHealthIssues(IBS,Crohns,etc): – LowFODMAPmaybewarranted IngredientstoAvoid • Wheatandits relaEves •Malt/beer •MaltExtract/vinegar – Wheatgerm,bran, •MaltFlavoring starch,bulgur,durum, • Soysauce semolina,pastas, farro,farina,cous • Hydrolyzedvegetable cous,triEcale,spelt, protein dinkel,einkorn, • Manyflavors emmer,Kamut® • Manyotherfoods • Rye,Barley • Oats–non-purity Gluten Free (GF) Does Not Help with Weight Loss • Many GF products are higher in carbs and calories “The increase in weight of already overweight patients after dietary gluten exclusion is a potential cause of morbidity, and the gluten-free diet as conventionally prescribed needs to be modified accordingly.” Source: Marcason W. J Am Diet Assoc. 2011, 111:1786; Dickey W, Kearney Am J Gastroenterol. 2006;101:2356-9. 56 NutriEonalImpactofaGFDiet • Highinfat,caloriesandmeat – Manygainweightonthisdiet • SomeincreaseBMI56% – Highglycemicindex:alternaEvegrainfoodshigherinstarch, sugarandfat • Ricecerealand/orrice-tapiocabread,muffins,chips,doughnuts, cookies • Fewergrainsandwholegrains, • Nearlyallrefinedlowfiber – Uselowerproteingrains Jenkins et al 1987 AJCN 45: 946-951; Berti 2004 EJN 43: 198-204 NutrientsinGluten-FreeProducts – Manygluten-freefoodsnotenrichedorforEfied – LowinBvitamins,nofolate=highhomocysteine – Lowiniron INGREDIENTS: White Rice Flour, Filtered Water, Honey, Safflower Oil, Vegetable Gum (xanthan, cellulose), Fresh Yeast, Sea Salt Kupper et al Gastroenterol 2005 128: S121-7; Thompson et al J Hum Nutr 18:163-169; JADA 2000 100: 1389-96 CostandEaEngQualityof Gluten-Free(GF)Foods • Ave 242% more – range 5-1000% • GF quality tends to be less than non-GFF “results to date have been notoriously off-putting.” Gluten-free bakery formulations have tended to be dry, bland, powdery, crumbly and/or oddly-textured, often with a reduced shelf life.” Case, S. All Things Baking. Chi, 2011; Zannini E. et al. AnnuRevFoodSciTechnol.2012;3:227-45. GutHealth:Much,MuchMore ThanJustGluten-Free • Guthealthhelpers: – PrebioEcs(inulin,oligosaccharides) – ProbioEcs(yogurt,kombucha,supplements) – AnEoxidant/anE-inflammatoryfoods(fruits, vegetables,wholewheatandotherwholegrains, nuts,fahyfishorfishoil,etc) – Smallermeals – Healthylifestyle:lowalcohol,notsmoking, exercise CONCLUSIONS • Paleo-anotherlowcarbdiet – Wedidevolvetoeatgrains • fewadvantages,manydisadvantages • Ancientwheatsarenotbeher;Wheat proteinshavenotchanged • GliadinisneithernewnoraddicEve • Ourmicrobiomeanddietshavechanged • 1%haveceliac;~6%neednogluten/wheat – Celiac/autoimmunediseasesareincreasing – Gluten-free-costlyandnonutriEonalbargain ResourcesforClientsWhoNeedto FollowGluten-FreeDiets • CenterforCeliacResearch&Treatmenthhp://www.celiaccenter.org/ • ShelleyCase,CanadiandieEEan:glutenfreediet.caverywell-informedRD aboutceliacdiseaseandnon-celiacglutensensiEvity – Twiher:@ShelleyCase • NaEonalFoundaEonForCeliacAwarenesshhp://www.celiaccentral.org/ • GlutenIntoleranceGroupofNorthAmerica:www.gluten.netTofind restaurantsthatofferglutenfree,campsandsupportgroups. • FoodAllergyNetwork-www.foodallergy.orgGeneralAllergyInformaEon andespeciallygoodforkidswithmulEplefoodissues. AddiEonalResources www.WheatFoods.org QuesEons? www.whea…oods.org Facebook.com/WheatFoods @Whea…oods