Gluten-Free Food Handling: What’s Your Plan? - …...Creating Substitutions Standard Menu Option...
Transcript of Gluten-Free Food Handling: What’s Your Plan? - …...Creating Substitutions Standard Menu Option...
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Gluten-Free Food Handling: What’s Your Plan?
Key Area 1 - Nutrition
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Learning Objectives
• Identify medical conditions associated with the gluten-free diet
• Recognize common and hidden sources of gluten
• Identify gluten-free substitutions for ingredients
• Describe menu substitutions and provide examples
• Identify potential areas in the cafeteria kitchen for gluten cross-contact and provide control solutions
• Illustrate product storage and equipment needs for special diet accommodations
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Beckee Moreland Director of GREAT Schools
Beyond Celiac Ambler, PA
Jessie Coffey, RDN, LMNT Nutrition Specialist
Lincoln Public Schools Lincoln, NE
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Definitions
• Food Allergy - A food allergy results when the immune system mistakenly targets a harmless food protein – an allergen – as a threat and attacks it. (IgE mediated)
• Food Intolerance – Can cause some of the same symptoms as a food allergy but not anaphylaxis, no immune reaction, e.g. lactose intolerance
• Food Sensitivity – Foods that cause reaction/discomfort, e.g. sulphite sensitivity
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
What is Gluten?
© 2016 Beyond Celiac
www.greatGFKitchens.org
• A protein; a tiny component of wheat, rye and barley.
• It gives baked goods their structure
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
What is Celiac Disease?
• Bloating, gas, abdominal pain • Diarrhea or constipation • Fatigue • Itchy skin rash (DH) • Tingling/numbness in hands or feet • Discolored teeth or loss of enamel • Canker sores • Joint pain • Irritability or behavior changes • Significant unexplained weight loss
• Poor weight gain • Delayed growth • Missed menstrual periods • Fractures or thin bones
Celiac disease is a genetic autoimmune disorder triggered by the protein gluten.
Symptoms before diagnosis and treatment
Treatment: 100% strict gluten-free diet
© 2016 Beyond Celiac
www.greatGFKitchens.org
Gluten Damage • Inflammation and immune
response in the small intestine that damages the villi
• Symptoms occur
• Body is unable to absorb nutrients into bloodstream
• Can lead to malabsorption
• Villi become healthy by removing gluten from diet
© 2016 Beyond Celiac
www.greatGFKitchens.org
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Non-Celiac Gluten Sensitivity (NCGS)
• Also known as gluten sensitivity
• Bodily reaction to gluten that causes symptoms similar to celiac disease
• Exact cause is unknown
• Blood tests for celiac disease cannot diagnose NCGS
• Does not involve damage to the small intestine
• Estimated 6% of the U.S. population or 18 million Americans
Treatment: Gluten-free diet
© 2016 Beyond Celiac
www.greatGFKitchens.org
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
“What happens when you get glutened?”
• Vast range of experiences – no two cases alike
• Reaction time – hours to days
• Severity – mild to debilitating
• Multitude of symptoms or none
• Internal damage and autoimmune reaction still occurs
• Vomiting, stomach cramps, brain fog, mood swings, rash, bloating, chills, depression, diarrhea, canker sores, tremors…
© 2016 Beyond Celiac
www.greatGFKitchens.org
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Who’s Eating Gluten-Free?
© 2016 Beyond Celiac
www.greatGFKitchens.org
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Most Difficult Lifestyle Situations
© 2016 Beyond Celiac
www.greatGFKitchens.org
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Impact on Relationships & Daily Life
• “Unwanted Visibility”
• Neglect and/or being “forgotten”
• Risk-taking/not wanting to disclose the gluten-free diet
• Constantly being “on call” and at-risk
• Changes in social life
© 2016 Beyond Celiac
www.greatGFKitchens.org
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Needs of the Gluten-Free Student
Food Safety • Safe food is first priority
• Health consequences to eating gluten
• Debilitating symptoms challenge students’ ability to learn and participate in activities
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Needs of the Gluten-Free Student
Variety • Offering tasty and
appealing menu options
• Mirror traditional menu options
• Substitute nutritious gluten-free alternatives
• Provide variety of options to support dietary compliance
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Needs of the Gluten-Free Student
Nutrition • Nutrition deficiencies are
common with celiac disease diagnosis
• Typical gluten-free diet lacking nutrients
• Gluten-free foods not required to be fortified
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Needs of the Gluten-Free Student
Emotional • Feel welcome and included
• Treated with respect
• Feel comfortable asking food questions about safety
• Build relationships in order to develop trust and confidence
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Section 504
Section 504 of the Rehabilitation Act of 1973
• Requires accommodating students with special dietary needs, including the gluten-free diet for medical reasons
• Dietary modifications documented within students Individual Education Plan (IEP)/504 plan
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Process to Identify Students
1. Parents get the necessary paperwork for school meal modifications completed by health professional.
2. Forms to Health Office or School Office - shared with the kitchen staff.
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Process to Identify Students
3. Collect additional information on child’s condition, severity of the diet provided through the nurses/parents.
(Follow up is done for diets that are unclear or not specific enough.)
4. If possible parents pre-select the foods from gluten- free menu for students.
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Communication & Team Work • Meet with parents and all school
personnel assisting with the student’s food choices (classroom and lunchroom).
• Parents share the level of dietary restriction needed for child • Often times what is on file at school is
more restrictive than what the parents are allowing at home- a new medical statement is needed if the diet has changed.
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Creating Gluten-Free Options
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Challenges to Conquer
• Identify ingredients with allergens and gluten
• Transparent communication with students and parents
• Education & commitment to training staff
• Eliminate & control allergen/gluten ‘hot spots’
• Create systems to execute controls precisely and consistently
© 2016 Beyond Celiac
www.greatGFKitchens.org
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
What is Gluten?
• Protein found in wheat, barley and rye and their derivatives:
• Wheat varieties include spelt, triticale, semolina, durum, farina, farro… (not a complete list)
• A sticky substance that gives many foods shape, texture and consistency
• Most commonly found in flours, breads, pastas, crackers, cake and cookies
Gluten-Free Grains
• Rice (all forms)
• Corn (corn bran, grits, hominy, hasa marina)
• Potato (starch & flour)
• Soy
• Tapioca
• Bean
• Amaranth
• Quinoa
• Buckwheat
• Millet
• Teff
• Nut flours
• Sorghum
• Arrowroot
• Wild rice
• Mesquite
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Overlooked Sources of Gluten • Soy sauce
• Licorice
• Imitation seafood
• Communion wafers
• Play-Doh©
• Gravies and Sauces
• Broth/Bouillon
• Deli Meats
• Veggie Burgers
• Refried Beans
• Seasoned Rice Mixes
• Self-basting poultry
• Pudding
• Taco Seasoning
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Food Allergy Labeling Consumer Protection Act - 2004 • Top 8 allergens – peanuts, tree nuts, egg, soy, fish,
shellfish, wheat, dairy
• All packaged foods sold in the U.S. - FDA regulated
• Must be clearly labeled in plan English if food contains the allergen
• Statements like “may contain” “made in facility” etc. not required & not regulated
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
FDA Gluten-Free Labeling - 2013
• Label “gluten-free”- the product must contain less than 20 parts per million of gluten
• Gluten = wheat, rye, barley and cross-bred hybrids (derivatives)
• Voluntary labeling claim - if labeled “gluten-free” you must follow the regulation
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
20 Parts Per Million
• 20 milligrams in one kilogram
• One wheat seed in 5,000 sorghum seeds
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Is it gluten-free?
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Research Ingredients
• Undeclared ingredients need to be researched (Colorings, seasonings and flavorings)
• Many companies will not make promises about their products
• Commodity foods are difficult to have verification of ingredient statements prior to the product arriving in your kitchen
• Create a policy of product usage based on best practices and FDA guidelines
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Modifying a Standard Menu
• Mirror standard menu if possible.
• Main entrées and side dishes may be easier to adapt
• Save extra portions of foods to use for gluten-free options (rice or ground beef)
• Similar meals for special diets students creates inclusion, confidence, pleasant experience
• Wheat/gluten substitutions: gluten-free bread, pasta, waffles, buns, rolls
Creating Substitutions Standard Menu Option
• Soft shell beef taco on flour tortilla
• Hot Dog on Bun
• Cheesy Taco
• Chef salad with roll
Gluten-Free Option
• GF Taco – no taco seasoning, plain ground beef or diced chicken on hard corn taco shell
• Hot Dog on gluten-free bun
• Cheesy Taco – NO OPTION
• Chef Salad with gluten-free muffin
Standard & Gluten-free: Refried Beans Shredded Lettuce Tomato
Plum & Grapes Peaches Low Fat Milk
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Gluten Free Breakfast Menu
Monday Tuesday Wednesday Thursday Friday
Cereal:
Cinnamon
Rice Chex
Cheerios (GF)
With Gluten free
toast (bread)-
302792 & jelly
Gluten Free
waffles- 302798
Syrup is gluten
free
Yogurt with
Gluten free
muffins
(order from your
central)
Gluten free
English Muffin-
(302779 with
jelly, order from
your central
kitchen
Cereal:
Cinnamon
Rice Chex
Cheerios
(GF)
With Gluten free
toast (bread)-
302792 & jelly
Lincoln Public Schools, Lincoln, NE
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Controlling Gluten Hot Spots
Courtesy of www.easyeats.com
Gluten or allergen-containing food transfers to gluten or allergen-free food - PROTEIN TRANSFER
Production
Transportation
Storage
Preparation
Unsafe for those with gluten-related disorders or food allergies
Cooking at high temperatures does not kill gluten/allergen
Cross-Contact
© 2016 Beyond Celiac
www.greatGFKitchens.org
Bacteria and some virus transfer to food- can lead to food-borne illnesses Production Transportation Storage Preparation Unsafe for EVERYONE Proper cooking can kill bacteria – some virus – limits food-borne illnesses
Cross-Contamination
© 2016 Beyond Celiac
www.greatGFKitchens.org
Communication is Key • Educate staff, train, again
• Focus on seriousness of conditions – medical necessity
• Cross-contact
• Make mistake; start over
• Assign staff to special diet duty
• Build relationship with student
• Identify student with correct meal - label
Keep it Simple and Separate
• Be aware of the crumb factor; airborne flour
• Wash hands; change gloves often
• Separate gluten & gluten-free foods, i.e. cold & dry storage, warmers, serving racks
• Identify best prep area for gluten-free
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
© 2016 Beyond Celiac
www.greatGFKitchens.org
Keep it Simple and Separate • Clean & sanitize surfaces before use
• Label – menus, products, menu items, meals
• Color-code – products, meals, equipment
• Use barriers in production and for meals
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Resources Beyond Celiac:
• Quick & Easy to Fix, Nutritious Gluten-Free Snacks
• Gluten-Free Menu Planning: Budget-Friendly Tips
• The Gluten-Free Diet
• Back-to-School Toolkit
• GREAT Schools, Colleges, & Camps program
Lincoln Public Schools:
• K-5 - Gluten-Free Menu – August 2016
© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS
Questions?
Beckee Moreland, Director of GREAT Schools
Beyond Celiac, Ambler, PA
Jessie Coffey, Nutrition Specialist
Lincoln Public Schools, Lincoln, NE