Gluten-Free Basics & School Meals PDF Free Download

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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 glutencross-contact and provide control solutions Illustrate product storage and equipment needs for specialdiet accommodations COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Definitions Food Allergy - A food allergy results when the immune systemmistakenly targets a harmless food protein – an allergen – as athreat and attacks it. (IgE mediated) Food Intolerance – Can cause some of the same symptoms as afood allergy but not anaphylaxis, no immune reaction, e.g.lactose intolerance Food Sensitivity – Foods that cause reaction/discomfort, e.g.sulphite sensitivity COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

What is Celiac Disease?Celiac disease is a genetic autoimmune disorder triggered by the protein gluten.Symptoms before diagnosis and treatment Bloating, gas, abdominal pain Diarrhea or constipation Fatigue Itchy skin rash (DH) Tingling/numbness in hands orfeet Discolored teeth or loss ofenamel Canker sores Joint pain Irritability or behavior changes Significant unexplained weightloss Poor weight gain Delayed growth Missed menstrual periods Fractures or thin bonesTreatment: 100% strict gluten-free diet COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Gluten Damage Inflammation and immuneresponse in the smallintestine that damages thevilli Symptoms occur Body is unable to absorbnutrients into bloodstream Can lead to malabsorption Villi become healthy byremoving gluten from diet COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Non-Celiac Gluten Sensitivity Also known as gluten sensitivity Bodily reaction to gluten that causessymptoms similar to celiac disease Exact cause is unknown Blood tests for celiac disease cannotdiagnose NCGS Does not involve damage to the smallintestine Estimated 6% of the U.S. population or 18million AmericansTreatment: Gluten-free diet COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA 2016 Beyond Celiacwww.greatGFKitchens.org

“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 stilloccurs Vomiting, stomach cramps, brain fog, moodswings, rash, bloating, chills, depression,diarrhea, canker sores, tremors COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA 2016 Beyond Celiacwww.greatGFKitchens.org

Impact onRelationships & Daily Life “Unwanted Visibility” Neglect and/or being“forgotten” Risk-taking/not wanting todisclose the gluten-freediet Constantly being “on call”and at-risk Changes in social life COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA 2016 Beyond Celiacwww.greatGFKitchens.org

Needs of the Gluten-FreeStudentFood Safety Safe food is first priority Health consequences toeating gluten Debilitating symptomschallenge students’ ability tolearn and participate inactivities COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Needs of the Gluten-FreeStudentVariety Offering tasty and appealingmenu options Mirror traditional menu options Substitute nutritious gluten-freealternatives Provide variety of options tosupport dietary compliance COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Needs of the Gluten-FreeStudentNutrition Nutrition deficiencies are commonwith celiac disease diagnosis Typical gluten-free diet lackingnutrients Gluten-free foods not required to befortified COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Needs of the Gluten-Free StudentEmotional Feel welcome and included Treated with respect Feel comfortable asking foodquestions about safety Build relationships in order todevelop trust and confidence COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Section 504Section 504 of theRehabilitation Act of 1973 Requires accommodating studentswith special dietary needs,including the gluten-free diet formedical reasons Dietary modifications documentedwithin students IndividualEducation Plan (IEP)/504 plan COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Process to Identify Students1. Parents get the necessary paperworkfor school meal modificationscompleted by health professional.2. Forms to Health Office or SchoolOffice - shared with the kitchen staff. COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Process to Identify Students3. Collect additional information on child’scondition, severity of the diet providedthrough the nurses/parents.(Follow up is done for diets that areunclear or not specific enough.)4. If possible parents pre-select the foodsfrom gluten- free menu for students. COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Communication & Team Work Meet with parents and all schoolpersonnel assisting with thestudent’s food choices (classroomand lunchroom). Parents share the level of dietaryrestriction needed for child– Often times what is on file at school ismore restrictive than what the parentsare allowing at home- a new medicalstatement is needed if the diet haschanged. COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Challenges to Conquer Identify ingredients with allergens and gluten Transparent communication with students andparents Education & commitment to training staff Eliminate & control allergen/gluten ‘hot spots’ Create systems to execute controls precisely andconsistently COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA 2016 Beyond Celiacwww.greatGFKitchens.org

What is Gluten? Protein found in wheat, barley andrye and their derivatives:– Wheat varieties include spelt,triticale, semolina, durum, farina,farro (not a complete list)– A sticky substance that gives manyfoods shape, texture andconsistency Most commonly found in flours,breads, pastas, crackers, cake andcookies COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Gluten-Free Grains Rice (all forms) Buckwheat Corn (corn bran, grits,hominy, hasa marina) Millet Potato (starch & flour) Soy Tapioca Bean Amaranth Quinoa COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA Teff Nut Flours Sorghum Arrowroot Wild Rice Mesquite

Overlooked Sources of Gluten Soy sauce Licorice Imitationseafood Communionwafers Play-Doh Gravies andSauces Broth/Bouillon COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA Deli Meats VeggieBurgers Refried Beans Seasoned RiceMixes Self-bastingpoultry Pudding TacoSeasoning

Food AllergyLabeling ConsumerProtection 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 theallergen Statements like “may contain” “made in facility” etc. notrequired & not regulated COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

FDA Gluten-Free Labeling - 2013 Label “gluten-free”- the product mustcontain less than 20 parts per million ofgluten Gluten wheat, rye, barley and crossbred hybrids (derivatives) Voluntary labeling claim - if labeled“gluten-free” you must follow theregulation COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Research Ingredients Undeclared ingredients need to be researched (Colorings,seasonings and flavorings) Many companies will not make promises about theirproducts Commodity foods are difficult to have verification ofingredient statements prior to the product arriving in yourkitchen Create a policy of product usage based on best practicesand FDA guidelines COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

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 COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Creating SubstitutionsStandard Menu OptionGluten-Free Option Soft shell beef taco on flourtortilla GF Taco – no tacoseasoning, plain groundbeef or diced chicken onhard corn taco shell Hot Dog on Bun Cheesy Taco Chef salad with rollStandard &Gluten-FreeRefried BeansShredded LettuceTomato Hot Dog on gluten-freebun Cheesy Taco – NOOPTIONPlum & GrapesPeachesLow Fat Milk COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA Chef Salad with glutenfree muffin

Gluten-Free Breakfast MenuMondayTuesdayCereal: CinnamonGluten FreeRice Chexwaffles- 302798 Cheerios (GF)Syrup is glutenWith Gluten freefreetoast (bread)302792 & jellyWednesdayThursdayFridayCereal:Yogurt withGluten free English CinnamonMuffin-(302779 withRice ChexGluten free muffins jelly, order from Cheerios (GF)(order from youryour central kitchencentral)With Gluten freetoast (bread)302792 & jellyLincoln Public Schools, Lincoln, NE COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Cross-ContactGluten or allergen-containing foodtransfers to gluten or allergen-freefood - PROTEIN TRANSFER Production Transportation Storage PreparationUnsafe for those with gluten-relateddisorders or food allergiesCooking at high temperatures doesnot kill gluten/allergen COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA 2016 Beyond Celiacwww.greatGFKitchens.org

Cross-ContaminationBacteria and some virustransfer to food- can lead tofood-borne illnesses Production Transportation Storage PreparationUnsafe for EVERYONEProper cooking can killbacteria – some virus – limitsfood-borne illnesses 2016 Beyond Celiac COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GAwww.greatGFKitchens.org

Cross-Contact ExamplesDirect - Indirect Bread knife cutting a baked potato Salad dressing on a salad bar Peanut or sun butter sandwiches – gluten cross contact (multipleallergens) Tongs used for hot dogs on bun Gloved hands – Salad, roll – not changing gloves (picture or samples of purple gloves – kids see the gloves theyknow you have their backs) COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

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 Talk with student about what THEY like Attend 504 planning meeting COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Keep it Simple and Separate Be aware of the crumb factor; airborneflour Wash hands; change gloves often Separate gluten & gluten-free foods, i.e.cold & dry storage, warmers, servingracks Identify best prep area for gluten-free COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

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 2016 Beyond Celiacwww.greatGFKitchens.org COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

Ordering Channels forSpecial Diets Use foodservice website for purchasing and sourcing products Add slide of Rice Krispies Foodservice distributors can assist in sourcing and providingsmaller orders Caution using commodities (averaging used on labels, naturalfoods okay) Parents offering to provide certain products – Check with theHealth Dept. Work with local grocery stores – RD’s, Big Box online ordering COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

ResourcesBeyond 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 COPYRIGHT 2017 SCHOOL NUTRITION ASSOCIATION #ANC17 ATLANTA, GA

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 GREA