High-school seniors are choosing colleges based on whether or not they can safely eat there. For a student with special dietary needs — and his or her parents — food can cause fear and anxiety.
“Anytime you don't have control over the preparation of your food, that's scary,” says Beckee Moreland, a Gluten-Free Resource Education Awareness Training (GREAT) Guide, National Foundation for Celiac Awareness (NFCA), Lincoln, NE. “So you need to have trust and confidence in the people who are cooking and serving your food and in the ingredients being used.”
The dining staff at University of California-Berkeley builds that trust with food-sensitive students by regularly making efforts to show them new combinations and safe ingredients, says Ida Shen, assistant director/executive chef. So students end up with food that is fun and “better than home” (Just don't tell Mom!)
“I just met today with a student (we'll call him Steven) who transferred here from (we'll call it X University) specifically because of his diet concerns,” Shen says.
Management at X University, where Steven transferred from, had made an effort to provide a special celiac/diabetes diet for Steven.
But, in practice, the staff on the front lines sometimes wouldn't know what Steven was talking about when he had questions about menu items. That day-to-day communication and feeling “cared for” is a big deal for anyone who lives with food sensitivities.
Moreland teaches that same idea when training schools for celiac awareness. Recently, she helped the University of Nebraska put into place a strong gluten-free program.
“Management, staff, servers, and everyone in between should be trained on cross-contamination and the basics of gluten-free cooking,” Moreland says.
Shen meets students like Steven with special dietary needs at the beginning of the year, oftentimes with a chef on hand to explain the options.
UC Berkeley's dining website is key to helping students choose what they want to eat (one week out) at the four different dining halls on campus, each with a different menu.
But it doesn't end there. Shen told Steven that in addition to planning with the website, he could always ask for a custom-made stir-fry or special combination (maybe sloppy joe meat or spaghetti sauce over rice) at any time if he couldn't find anything he liked on the line that day.
“It takes a chef two minutes to stir fry some vegetables from the salad bar,” Shen says. “But it makes a world of difference to a food-sensitive student.”
The chef had already shown Steven and his parents around the kitchen while Shen was on vacation the week before, she added, proud that her staff knows what to do for special diets even when she isn't there.
Students walking into the dining halls at UC Berkeley will find extensive signage denoting “vegan,” “contains wheat,” “contains nuts,” etc.
“We try to cover all the bases,” Shen says, but also hands students a caveat: “We tell them to choose based on the signage and the website or to ask someone if they want to be 100% sure. Your health is still in your hands and you have to be your own advocate.”
Ryan McNulty, CEC, director of culinary development, Metz & Associates, Ltd., agrees that signage is key. “Whether it's a la carte or grab ‘n go on the service line, make sure there is a sign that says what the allergens are,” McNulty says.
Signage also works on another level: “People on a gluten-free diet are very brand-loyal,” Moreland says. “Especially kids. They are used to looking for certain brands and symbols that indicate gluten-free.”
Cancer Treatment Centers, Philadelphia, PA, does a good job with information: gluten-free items noted on both the cafe menu and the inpatient room menus, a staff educated through in-service days with the nutrition team and handouts available.
Before signage can be accurate, however, operators must read the labels on everything.
There are five words on the ingredient label that should ring alarm bells for those preparing a gluten-free menu, says Margaret Weiss Masiello, RD, clinical coordinator, Kogan Celiac Center, St. Barnabas Healthcare System, Livingston, NJ.
“Wheat, oats, barley, rye and malt are the words to look out for,” Masiello says.
New FDA labeling laws to make labels clearer about allergen content are reportedly on the way, but until then, thoroughly reading labels is the best way to keep your kitchen safe, experts agree.
“Operators and customers really need to look at labels and understand what words mean,” McNulty says.
Gluten can be ‘hiding’ in many products, such as soy sauce. “If you are making a stir fry, which can be a great option for a gluten-free diet, you need to use a gluten-free soy sauce,” Moreland says.
Shen has had great success with wheat-free tamari instead of soy sauce for stir fry. (Soy sauce can be made with wheat, but tamari is made only with soy beans and has a smoother taste than soy sauce).
Soy sauce is just one place where gluten can be hiding. Prepared ‘Teriyaki Sauce’ may not say ‘soy’ but it could be made with soy sauce. Broths can also contain gluten.
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One obstacle for the Pasadena Independent School District in Texas — and most other public K-12 districts — is that commodity beef often contains seasoning that may include gluten, says Mary R. Harryman, director of child nutrition services in Pasadena.
For students on a gluten-free diet, Harryman and her staff order 100% raw ground beef for burgers (using rice as the grain instead of a bun on the plate), and then the large quantity of beef must be portioned and frozen so it can be used again.
Gluten-free cuisine can go in many directions, but creating dishes that are naturally gluten-free, like an omelet, a rice bowl or a meaty salad can be a simple way to do it.
“It might be easier to accommodate the gluten-free diet than you think, with food that is already in existing inventories and on existing menus,” Masiello says.
Masiello works with the hospital cafeterias in several locations in the St. Barnabas system, and has found that a couple of ethnic cuisines make gluten-free fairly easy for the serving lines there.
“Oriental cuisine is great — rice and vegetables. Also, Mexican beans and rice is another great way to go gluten-free,” Masiello says, adding that a big pot of chili in the hospital café can go a long way, too.
UC Berkeley's student population is 48 percent Asian, Shen says, so rice dishes like juk (rice gruel) and stir fry with or without chicken and add-ins like ginger are natural favorites with gluten-sensitive students and their classmates alike.
Another fan of the ‘naturally gluten-free’ approach is Harryman at Pasadena ISD. Many menu items in the district are scratch-made, and so she has resisted bringing in specialty processed food for the gluten-free diets of the relatively small number of students with celiac disease in her district.
Using the existing foods, the staff in many K-12 settings create good options using such foods as beans, rice, cheese and eggs.
Speaking of eggs, the “breakfast all day” trend can work in favor of foodservice operatons accommodating special diets.
“We do a brunch every day, so eggs, bacon, and grits are always available, and we offer one gluten-free corn-based cereal,” Shen says.
Items like tuna salad, egg salad, chef salad with oil and apple cider vinegar, yogurt and fresh fruit plate, cubed cheese plate, vegetarian chili, and roast pork with gluten-free broth round out the naturally gluten-free choices on the café menu at Lehigh Valley Hospital, Allentown, PA. The menu also includes burgers and sandwiches on gluten-free English muffins and French toast made with gluten-free bread.
Recipes for baked goods using gluten-free substitutes for flour are becoming more common as demand increases, but, “Do they taste just like wheat products? The short answer is ‘no,’” says Chef Instructor James Sinopoli of culinary school Stratford University, Falls Church, VA. “Recipes that don't contain wheat products in the first place will work out much better.”
That doesn't mean that naturally gluten-free menu items should be a cop-out, either, says Nancy Baker, director of education, NFCA. “Some schools will just point to the salad bar, but there is a danger there for cross-contamination, with croutons and crackers,” she says.
Also, the salad bar can get boring if it's the only option day after day. Harryman keeps thinking of new ideas and encourages her staff to do the same. “The drawback of the gluten-free diet is that it can be pretty repetitive,” Harryman says. (See the naturally gluten-free recipes in this story for ideas).
Keeping flour contained in a bakery setting is very labor-intensive, since it gets into the air and settles onto virtually every surface in a way that can't always be seen by the naked eye.
That's one factor that leads many operators to consider bringing in at least a few pre-packaged, individually wrapped gluten-free products, baked goods in particular. Depending on your operation, getting individually wrapped gluten-free baked goods might be a good option to prevent cross-contamination, and there are many good companies out there, working to improve the taste and consistency of their gluten-free product lines.
Cancer Treatment Centers of America has had success with a finely tuned combination: a selection of pre-packaged gluten-free breads/breakfast items and gluten-free menu items made in-house for both patients and the café.
Shen has just made the decision to purchase pre-made gluten-free pizza dough, which comes on its own baking pan, not touching anything that may have flour on it, and then going right into the impinger oven.
For the most part, keeping ingredients that contain allergens separate should be sufficient for all but the most severe food sensitivities (where someone can't be in the same building with wheat). Having a dedicated gluten-free area in the kitchen would be ideal, but for many operations, that may not be realistic. That doesn't mean that you can't prepare gluten-free foods, though.
Color coding cooking equipment, plates and serving trays are also practices that can help prevent cross contamination.
In a school setting, it makes a lot of sense to work with your administration to ensure that food allergies could be included on registration forms with that information shared with the foodservice department. That way, at the beginning of the school year, you will have an idea of how many individuals you will need to accommodate with gluten-free choices.
“During new student enrollment, parents and students with special diets should make an appointment with the dietitian/foodservice director,” Moreland suggests. “This will help ease some fear and anxiety if the school can reassure the parents and students that gluten-free options are available.”
At the elementary school level, the issue of identifying customers with food allergies takes on special significance, especially with younger children. POS systems that automatically notify cashiers a student has diet restrictions offer one solution, though, as Harryman says, “After about three days into the school year, our staff know every single student anyway.”
Another good way to get the knowledge flowing in both directions is to post literature and information on bulletin boards that both staff and students can see. Find resources like these, plus information on the GREAT (Gluten-free Resource Education Awareness Training) program at www.celiaccentral.org.
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Celiac disease, an inherited autoimmune disease with more than 300 different symptoms (ranging from stomach issues to headaches, rashes and more), is difficult to diagnose. The diagnosis rate has doubled in the last five years, and the National Foundation for Celiac Awareness estimates that 1 in 133 Americans have the disease, and most may be undiagnosed.
An equation that Beckee Moreland, of the NFCA has developed over years of research, training foodservice professionals across the country, and living with celiac disease herself, is “Awareness + Education = Loyal Customers.”
“If people in the foodservice industry are aware of what celiac disease is and why gluten-free options are requested, they're more apt to train their staff to prepare food safely and gluten-free,” Moreland says. “In the celiac community, word travels fast when customers feel confident that a dining establisment ‘gets it’ and they'll back that trust with return visits and referrals.”