Working Around Wheat

For operators trying to create safe dining environments, wheat can be an area of concern for two different groups of customers. One group is allergic to wheat. Wheat is one of the top eight foods that account for all food-allergic reactions in the United States, according to The Food Allergy & Anaphylaxis Network. Another group has celiac disease, a digestive disease that interferers with the absorption of nutrients from foods. According to the National Digestive Diseases Information Clearinghouse (NDDIC), more than 2 million people in the United States, or about 1 in 133 people, have celiac disease. While celiac disease is not a food allergy—it is an autoimmune disorder—the affects of eating even small traces of gluten can cause damage to the small intestine. Both groups of customers must follow a gluten-free diet to prevent a reaction.

Gluten-free patient menus: “It’s becoming much more prolific,” Jacque Baker, patient service manager for 325-bed St. Clair Hospital in Pittsburgh, says about the number of patients who follow a gluten-free diet.

Because of the increase in the number of patients who cannot eat gluten, St. Clair’s foodservice department, which is managed by Cura Hospitality, developed a gluten-free menu last year. “We’ve seen an increase in the last few years so we decided to come up with a menu specific to [people who follow a gluten-free diet],” says Anne Berzinsky, lead dietitian, R.D., L.D.N. “The idea was to make sure that what we were providing to them was gluten free and also to give them variety.”

“We really wanted to make sure that the gluten-free people didn’t feel like they were singled out just because they have this allergy,” adds Chris Vitsas, general manager.

The gluten-free menu offers patients gluten-free versions of bread, cereal, yogurt and salad dressings. Entrée options include a gluten-free hamburger on a gluten-free bun, gluten-free pizzas and gluten-free baked cod with lemon. There are similarities between the gluten-free menu and the regular menu, such as fresh fruit and vegetables. Some of the gluten-free items are ordered from a manufacturer or specialty store, while others, like the pastas, are made in house.

Vitsas says to ensure there is no cross contamination in the kitchen, separate cutting boards and knives are used to produce items from the gluten-free menu. He adds that because it is a hospital, the staff is used to special diets and allergy concerns, which helps limit cross contamination.

Dining assistants do consultations with patients who follow a gluten-free diet after they are checked into the hospital. The dining assistant visits the patient’s room and goes over the menu with the patient to help him or her select meals that are gluten-free and also meet any other diet criteria the patient might need to follow.

Vitsas says patients are appreciative of having a separate gluten-free menu to select from. “We hade one patient on the gluten-free diet discharged the other day,” he says. “She was getting ready to leave the hospital and she still wanted to talk to me. Most people when they are getting ready to leave are like ‘get away from me, I don’t want to talk to you about food.’ She was so happy with our gluten-free menu that I was able to give her some contact information for a local provider that delivers to homes. I sent her packing with a couple of gluten-free cookies and a brownie to make her day.”

The gluten-free menu has also been beneficial to non-patients as well. “I had a patient whose wife followed a gluten-free diet and she asked me about guest trays,” Berzinsky says. “She was thrilled that we were able to offer her that gluten-free menu, which made it so much easier for her to be here and not have to go out and try to find appropriate meals for herself while her husband was in the hospital.”

Berzinsky says the most difficult part of developing and maintaining the gluten-free menu is ensuring that items are gluten free. “In general, manufacturers are labeling this better and have that information more at hand. It took some legwork to look at all the labeling and making some phone calls. Staying on top of it is important because manufacturers change how things are prepared, so just because it was gluten free yesterday doesn’t mean they won’t change the way they prepare things and it will continue to be gluten free.”

Right now the gluten-free menu is specific to patients, however, there are some items in the retail operations that are gluten free.

Education and outreach: At 244-bed Pocono Medical Center in East Stroudsburg, Pa., the Metz & Associates foodservice team is using the retail operations as a way to educate customers about gluten-free diets.

In May 2009, during National Celiac Awareness Month, a gluten-free day was held in the hospital’s cafeteria. BK Enterprises, a Philadelphia-based specialty food distributor, brought in several gluten-free items including cookies, muffins and pasta for diners to sample. One of the hospital’s dietitians was also on hand to provide educational materials and answer questions.

Heidi Franssen, foodservice director, says the event started because several of the hospital’s staff had celiac disease or followed a gluten-free diet. “Everyone seems to know someone who has celiac,” Franssen says. “We have a lot of patients with different dietary needs, mostly cardiac and diabetic, but more and more gluten free than in the past.” Franssen says the number of patients with celiac disease has increased because doctors are testing for the disease earlier. “We are stressing education to everyone. It is important for us to meet the needs of everyone in the community, whether they be a patient, visitor or a staff member, whether that is through good food that is diet appropriate or through nutritional education.”

Franssen says the department is working to get information about celiac disease and gluten-free diets in physicians’ offices. “It’s like diabetes. All of the sudden you get that diagnosis and then it’s like ‘what do I have to do differently?’ We want the doctors when they diagnose someone to have the information there and let them know that the cafeteria has stuff available.”

The hospital’s cafeteria offers several gluten-free items, including wraps and breads at the deli, pancake mixes and a gluten-free personal pizza. All of the soup bases are now gluten free. Gluten-free items are designated through signage at the point of sale. The gluten-free items are more expensive, so that cost is passed on to the customer. For example, the gluten-free pizza is $3.95 or $4.25, while the tradition pizza is $2.50.

The department also sells items, such as gluten-free dry pasta, for people to purchase for their personal use.

Cross contamination: For people with celiac disease, even the smallest amount of gluten causes a reaction. To avoid cross contamination, 12,450-student University of New Hampshire in Durham has separate gluten-free zones in each of the campus’s dining halls. The zone has a refrigeration unit, stocked with gluten-free breads, bagels, baguettes, spreads and dressings. On top of the refrigerator, there is counter space with a toaster, bagel cutter and microwave, which are only for use with the gluten-free products.

For gluten-free items that are not found in the gluten-free zone’s refrigerator, the students can use an online ordering system to notify the foodservice staff that they need a gluten-free entrée. Ralph Coughenour, director of culinary services, says they ask students to order using the system at least half an hour before they are coming in to eat. The university makes many items in house that are gluten free such as steak tips, herb-crusted chicken and rice crust pizzas, but the department also orders gluten-free items from manufacturers.

To avoid cross contamination in the kitchen, there is a separate area where gluten-free items are prepared. “We have one convection oven that we never put anything in to bake other than proteins,” Coughenour says. “The baking is done in a separate part of the kitchen. A lot of the gluten-free items are designed just to be sautéed so we don’t have to worry about them being in the oven. When the items go to the dining halls, everything is individually wrapped so nothing can contaminate it.”

America’s pastime: Aramark’s Sports, Entertainment and Conventions division launched a gluten-free line at five of Major League Baseball’s parks this season. The effort began last year at Coors Field in Denver, with what Aramark believes is the first dedicated gluten-free concessions stand in a baseball park. The stand sells gluten-free hot dogs, hamburgers, chicken sandwiches, potato chips, cookies, brownies and beer.

“We pride ourselves in designing menus that reflect the tastes and flavors of our guests, and the growing selection of gluten-free food on today’s menus is the result of fans with celiac disease suggesting we further diversity our menus,” says Marc Bruno, president, Aramark Sports, Entertainment and Conventions. “We understand that food is an integral part of the baseball experience, and we want to ensure that everyone who attends a game is able to enjoy this important feature of the ballpark experience.”