Celiac disease is an autoimmune disease associated with a persistent intolerance to gluten, involving the small intestine, which occurs with the ingestion of gluten-containing foods. As a result of the destruction of the villi in the small intestine by gluten intake, the absorption of macro (carbohydrate, protein, fat) and micronutrients (vitamins and minerals) cannot be performed adequately and deficiencies occur. In addition, the immune system is constantly stimulated and this can lead to some negative effects. Those with celiac disease should follow a gluten-free diet for life. All foods containing wheat, rye and barley should be avoided on a gluten-free diet. Corn, potatoes, rice, fruits and vegetables and meat group naturally do not contain gluten. Even if the gluten-free diet becomes normal in later ages in celiac patients and is more understandable by the person’s environment, it can bring with it certain social problems in childhood. The adaptation process is very important for children who are just starting school age. Activities such as feeding time at school, friends’ birthdays, special days, eating from the canteen, excursions and bazaars are all environments where children communicate with each other. Children with celiac may avoid eating in public and may experience difficulties in adaptation by staying away from socialization. In children, this situation may return with negative emotions such as the feeling of being excluded. At the same time, it can make it difficult to comply with the diet by causing the child to develop a prejudice against the gluten-free diet that he has to follow throughout his life. It is inevitable that the symptoms that disappear with dietary non-compliance will reappear and the severity of intestinal intestinal damage will increase.
In activities such as food sold in the school canteen, friend treats and bazaars, the celiac child is also affected by other children and consumes gluten products. Even if the products do not contain gluten, there is a risk of cross-contamination. Parents play a major role in providing the right nutrition for celiac disease. Providing nutrition education in a way that the child can understand is the first step in treatment. The child with celiac disease should be told which foods to avoid, not to take from his friends’ treats and why he should not consume gluten-free products. It is also very important that the teachers, school administrators, auxiliary staff and canteen staff working at the school are conscious. The guide published by the Ministry of Health for teachers on celiac disease in schools should be read thoroughly by school personnel and the necessary steps in the guide should be followed. Trainings should be organized periodically to raise awareness of parents and children about celiac disease and to provide nutrition education. Teachers’ knowledge about this disease will both help the child feel comfortable and protect him from possible risks. In addition, the teacher should explain the situation in detail when the parents are together and express that he expects sensitivity from other parents. Because gluten-free products may be desired to be prepared by the parents of classmates. However, even if the products prepared by the parents are gluten-free, the risk of cross-contamination is high. For this reason, parents should be informed about the risks of cross-contamination. For example, the mother of a close friend of your child with celiac disease may want to make a pastry made of gluten-free flour and offer it to your child, but in this case, the possibility of contamination is very high both during the preparation and during transportation. It is very important to speak clearly about such situations. Having a section where gluten-free products are sold in the canteen, which is one of the favorite environments of children, will both create an option for your child and make him/her feel good in that environment. It will be possible for the family to provide an environment where gluten-free products can be found by making preparations if the teachers inform the family about special events and bazaars a few days in advance.
Gluten Free Lunch Box
When preparing your child’s lunchbox, you should consider the foods that are frequently consumed at school. For example, if you keep fruit in the lunch box for a healthy diet, gluten-free fruit cake can be made, considering that the child will feel excluded while their friends are eating packaged products. The family may offer treats to other students from time to time, as the celiac child cannot eat the food offered by his friends, which may cause him to stay away from his friends. It would be more accurate for the family to make this treat or to hand it over to the teacher to avoid cross-contamination by contact. Foods that are easy to share and present, such as gluten-free chocolate balls, pastries or cookies, can be shared with students in the classroom from time to time. While the lunch box is being prepared, a bag that your child will love to use should be preferred in order to attract attention, and it should be found out what foods he likes to consume at school. If possible, a variety of food should be provided for the child by choosing dividing containers or several containers. In order for the child not to move away from the gluten-free diet, there must be foods that he likes and can consume at school while feeling more comfortable. In addition, they should be taught to wash their hands before and after feeding hours.
A Few Meal Ideas for a Lunch Box
There will be interesting foods in the lunch box, but its nutritiveness is also important, so variety must be provided.
Gluten-free bagel sandwich can be found in the bowl we prepared for breakfast. We can diversify it by adding cheese, lettuce and tomatoes. We can add grapes and a few walnuts next to it. Or we can prepare a sandwich for gluten-free bread with favorite products. We can also add freshly squeezed juice in a thermos for breakfast or snack. You can prepare a healthy and nutritious alternative for breakfast by adding tomato-cucumber-carrot slices to a homemade pastry prepared with gluten-free flour, buckwheat or chickpea flour.
Gluten-free cakes/cookies can be prepared as a snack. If possible, the content of the cake must be dried/fresh fruit; It should be enriched with oil seeds such as walnuts, hazelnuts, almonds. The flour used at this point may be gluten-free flour or rice flour. Care should be taken to ensure that cocoa is also gluten-free. As another option, cookies made from gluten-free flour such as almond flour, buckwheat flour, coconut flour can be preferred. Homemade cocoa milk can be preferred for a difference from time to time.
In this meal, which is nutritious, we can ensure that the child consumes vegetables in a form that will attract their attention. For example, we can make a vegetable burger using a small amount of cornmeal made with vegetable patties (vegetables such as broccoli, leeks, carrots, cauliflower, etc.) and gluten-free hamburger buns. We can add the french fries we made in the oven next to it. You can prepare a pasta salad by using gluten-free pasta and enriching it with vegetables, and you can create a healthy menu by adding buttermilk or yogurt to it. Another option can be gluten-free pizza, which is often available lately. You can prepare an oat-based pizza made with gluten-free oats using the ingredients your child likes.
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Alas, Celiac! What will happen now?
The only cure for celiac disease is a gluten-free diet. Patients need to maintain strict gluten-free meals for life. People diagnosed with celiac disease as a result of clinical symptoms, serological tests, and small bowel histology should immediately start a gluten-free diet. He should stay away from the consumption of wheat, barley, rye and oat foods and beverages that should eliminate gluten from his life. Gluten-containing and iced tea such as white bread, whole wheat bread, bran bread and pasta, bulgur are not consumed in the gluten-free diet. It should be used with gluten-containing foods, which we call cross contamination, which do not contain gluten, but in this utility, attention should be paid to gluten contaminated contents.
Serological, hematological and biochemical tests (complete blood count, iron profiles, thyroid tests, calcium, magnesium, zinc, B12, folic acid and vitamin D) density and dietary compliance should be monitored. It is also important in follow-up in children.
Transglutaminase needs to be measured in a certain way to observe the effect of gluten-free treatment. If there are serological findings that do not improve at the end of a year, it should be considered that there is contamination in the diet. Serological tests are considered as a symptom of reaching normal levels, and it is known that the fastest serological tests in celiac disease reach their normal values in the 6th month and the slowest at the end of the 1st year.
A gluten-free diet should be followed very strictly. Very low amounts of gluten can cause clinical symptoms to persist. Celiac patients and their relatives should be well aware of the free, unfavorable foods that are included in the gluten-free diet and which should be controlled.
Dietician Armoni Yılmaz
Guide to Diagnosis, Treatment and Follow-up for Family Physicians in Celiac Disease, 2019
KULOĞLU, Z. (2014). Celiac disease. Turkish Journal of Pediatrics, 8 (2), 105-111.
Öztürk, Y. E., Uyar, G. Ö., Serin, Y., & Gürkan, Ö. E. (2018). Gluten-Free Diet Treatment in Celiac Disease: A Case Report. Journal of Nutrition and Diet, 46 (3), 320-324