Gluten-Free Food Handling: What’s Your Plan? - …...Creating Substitutions Standard Menu Option...

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© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION #ANC16 SAN ANTONIO, TEXAS Gluten-Free Food Handling: What’s Your Plan? Key Area 1 - Nutrition

Transcript of Gluten-Free Food Handling: What’s Your Plan? - …...Creating Substitutions Standard Menu Option...

Page 1: Gluten-Free Food Handling: What’s Your Plan? - …...Creating Substitutions Standard Menu Option •Soft shell beef taco on flour tortilla •Hot Dog on Bun •Cheesy Taco •Chef

© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS

Gluten-Free Food Handling: What’s Your Plan?

Key Area 1 - Nutrition

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© 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

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© 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

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© 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

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© 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

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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

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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

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© 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

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“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

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© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS

Who’s Eating Gluten-Free?

© 2016 Beyond Celiac

www.greatGFKitchens.org

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Most Difficult Lifestyle Situations

© 2016 Beyond Celiac

www.greatGFKitchens.org

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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

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© 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

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© 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

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© 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

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© 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

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© 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

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© 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.

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© 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.

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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.

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© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS

Creating Gluten-Free Options

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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

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© 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

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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

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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

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© 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

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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

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20 Parts Per Million

• 20 milligrams in one kilogram

• One wheat seed in 5,000 sorghum seeds

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© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS

Is it gluten-free?

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© 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

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© 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

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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

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© 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

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Controlling Gluten Hot Spots

Courtesy of www.easyeats.com

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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

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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

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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

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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

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© 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

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© 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

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© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS

Questions?

Beckee Moreland, Director of GREAT Schools

Beyond Celiac, Ambler, PA

[email protected]

Jessie Coffey, Nutrition Specialist

Lincoln Public Schools, Lincoln, NE

[email protected]