A Guide to Special Food and Nutrition Needs
A Closer Look at Overweight
Healthy children come in all shapes and sizes. Many health experts have a growing concern about some of America’s children. The concern centers on issues of size and shape. The Centers for Disease Control and Prevention (CDC) report that one in six American children is overweight. Our national health goals are to reduce overweight among children to one out of 20 children. Today’s children may not be as physically active as children were in years past. Many do not meet the current goal of at least 60 minutes of moderate or vigorous activity most days. Being physically active • helps develop fitness, or being ‘in shape’and • is a major step in helping overweight people achieve a healthy body weight.
How is overweight determined? One way to determine overweight is to use body mass index (BMI). BMI is a way to compare the ratio of weight to height. For assessing children and teens, BMI is combined with age and gender to get a percentile. Find a body mass calculator for children and teens at http://apps.nccd.cdc.gov/dnpabmi/ Find a body mass calculator for adults at http://www.cdc.gov/healthyweight/assessing/bmi/adult_BMI/english_bmi_calculator/ bmi_calculator.html
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A Guide to Special Food and Nutrition Needs
A Closer Look at Overweight, continued
Health Risks of Overweight
“Remember that the goal for overweight and obese children and teens is to reduce the rate of weight gain while allowing normal growth and development. Children and teens should NOT be placed on a weight reduction diet without the consultation of a health care provider.” Centers for Disease Control and Prevention, Tips for Parents – Ideas to Help Children Maintain a Healthy Weight, retrieved June 7, 2009 from http://www.cdc. gov/healthyweight/children/index. html
Being overweight in childhood increases the risk of being overweight as an adult. Overweight is a risk factor for many chronic diseases including • Heart disease • Diabetes • Asthma • High blood pressure Social problems resulting from teasing or bullying are more common among overweight children. The effects on self-esteem can lead to poor school performance and even depression.
Ways to help an overweight youth
An overweight youth should not be put on a diet. Rather, a lifestyle that focuses on healthy eating and physical activity is key. This lifestyle approach is good for the entire family. The Dietary Guidelines for Americans give tips for healthy eating. These guidelines are promoted in school meals. The tips below can help families balance food and activity.
Tips for Healthy Eating • • • • • • •
Follow the advice at MyPyramid Make half your grains whole Vary your veggies Focus on fruits Choose lowfat or fat-free milk Go lean with protein Limit foods rich in fats and sugars
Tips for Being Physically Active
• Aim for 30–60 minutes a day, in two or three segments • Limit computer and television time • Be active as a family • Walk or bike • Play games like tag • Shoot hoops • Dance or jump rope
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A Guide to Special Food and Nutrition Needs
A Closer Look at Overweight, continued
Resources and Organizations
Eat Smart. Play Hard.™ Healthy Lifestyle http://www.fns.usda.gov/eatsmartplayhardhealthy lifestyle/ Tips for Parents: Ideas to Help Children Maintain a Healthy Weight http://www.cdc.gov/ healthyweight/children/index.html MyPyramid www.mypyramid.gov We Can! Ways to Enhance Children’s Activity and Nutrition Families Finding the Balance A Parent Handbook http://www.nhlbi.nih.gov/health/public/ heart/obesity/wecan_mats/parent_hb_en.pdf American Academy of Pediatrics www.aap.org American Dietetic Association www.eatright.org
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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A Guide to Special Food and Nutrition Needs
What is Diabetes?
Diabetes is a medical condition where • the body does not make insulin; • the body does not make enough insulin; or • the insulin made does not work properly in the body.
How Does Insulin Work? The body makes insulin to use the energy in food. After food is eaten, it is digested and changed to sugar. All carbohydrates, which include sugar and starches, become sugar faster than protein or fats.
Insulin helps move sugar in the blood into the cells of the body to provide energy. When a person has diabetes, sugar is not transferred properly from the blood to the cells of the body. The result is high levels of blood sugar, also known as blood glucose.
Insulin helps move sugar from the blood into the cells of the body. Just as gas fuels a car, sugar fuels the cells.
A person with diabetes tracks their blood sugar levels. High blood sugar levels over time can damage kidneys, eyes, nerves, and increase the risk of heart disease. Diabetes is a serious condition. Two major types of diabetes are type 1 and type 2.
Without insulin, the sugar cannot enter the cells. The result is blood sugar levels stay too high.
People with type 1 diabetes need insulin shots because their bodies do not make insulin. Type 1 diabetes was called juvenile diabetes because it is more common in children. In type 1 diabetes, the amount of insulin injected is matched to the amount of food eaten and the level of physical activity.
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A Guide to Special Food and Nutrition Needs
What is Diabetes, continued
Type 2 diabetes is another form of diabetes. In type 2 diabetes, a person’s body makes insulin, but it either makes too little insulin or the insulin does not work as well as it should. Type 2 diabetes used to be most common among adults over the age of 40 and was called adult-onset diabetes. Being overweight and inactive raises the risk of having type 2 diabetes. Today, children are developing type 2 diabetes. Health experts think this is due, in part, to increased rates of overweight among children and teens. Some people with type 2 diabetes take pills that help their bodies make more insulin. Some also need insulin shots.
Did you know? Blood sugar and blood glucose are the same.
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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A Guide to Special Food and Nutrition Needs
Is Diabetes a Disability?
Several federal laws identify diabetes as a disability. School nutrition programs are required by law to make meal changes for students with diabetes after a signed physician’s statement is on file. A Registered Dietitian (RD) may help a school nutrition program plan meals to meet a student’s needs.
Common Changes The meal changes for diabetes will be specific to each student’s needs. Common changes may include: • Measuring food portions with extra care, especially for carbohydraterich foods • Serving foods in different portion sizes, as needed • Serving substitutions for foods rich in added sugars • Including foods containing protein in snacks
Students with diabetes need the nutrients school meals provide. School meals follow the Dietary Guidelines for Americans; these guidelines are similar to the nutrition goals for diabetes. Diabetic meal plans encourage: • Lean meats prepared in ways with little added fat • Lowfat and fat-free milk and milk products • Whole grains • Colorful fruits and vegetables • Legumes: dried beans and peas • Healthy fats from fish, nuts, seeds, and vegetable oils • Balanced meals and snacks at consistent times each day
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A Guide to Special Food and Nutrition Needs
Is Diabetes a Disability, continued
Resources and Organizations
American Diabetes Association www.diabetes.org 1-800-342-2383 Juvenile Diabetes Research Foundation www.jdrf.org 1-800-533-2873 American Dietetic Association www.eatright.org
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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For more information, contact NFSMI at 800-321-3054 or www.nfsmi.org
A Guide to Special Food and Nutrition Needs
A Closer Look at Type 1 Diabetes
What Is Type 1 Diabetes?
Type 1 diabetes is a medical condition in which a person’s body does not make insulin. Type 1 diabetes most often occurs between the ages of 8 and 12 years, but can happen at any age. Type 1 diabetes can be common in some families. Children who develop type 1 diabetes often have these symptoms: • Thirst • Hunger • Frequent urination • Unexplained weight loss Blood sugar tests are used to confirm type 1 diabetes. Did you know? • Insulin is a hormone made from protein. • Insulin cannot be taken as a pill because it would be digested like other proteins. • A person with type 1 diabetes must inject insulin several times a day.
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A Guide to Special Food and Nutrition Needs
A Closer Look at Type 1 Diabetes, continued
How Is Type 1 Diabetes Treated?
The treatment for type 1 diabetes balances insulin injections with diet and physical activity. A person with type 1 diabetes needs meals that provide foods from all energy sources– carbohydrate, protein, and fat–to match insulin levels. Menu planning for type 1 diabetes features meals and snacks that: • Are consistent from day to day in the amount and types of food served • Are served at regular times throughout the day. • Provide the same amount of carbohydrate for specific meals day to day; for example, 75 grams of carbohydrate for breakfast each day. • Carbohydrate and protein foods at each eating time • Provide ample amounts of fiber-rich foods • Are low in total fat with those fats consumed being healthy mono- and polyunsaturated fats.
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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For more information, contact NFSMI at 800-321-3054 or www.nfsmi.org
A Guide to Special Food and Nutrition Needs
A Closer Look at Type 2 Diabetes
What Is Type 2 Diabetes?
Type 2 diabetes is a medical condition in which a person’s body does not make enough insulin or the insulin does not work right. Type 2 diabetes most often occurs in adults. However today it is becoming more common in teens and children due to increased rates of obesity. Type 2 diabetes is more common in overweight or obese people of any age. Type 2 diabetes can be common in some families. Children who develop type 2 diabetes often have these risk factors: • Overweight or obese • Inactivity • Family history of type 2 diabetes Doctors use blood sugar tests to confirm type 2 diabetes.
How Is Type 2 Diabetes Treated?
The treatment for type 2 diabetes combines diet and exercise. Often the condition can be controlled in adults with weight loss. Some people take drugs to help produce more insulin. Insulin shots are not as common in type 2 diabetes treatment as in type 1. An adult with type 2 diabetes needs a meal plan with balanced energy sources (carbohydrate, protein, and fat) that promotes gradual weight loss. A child with type 2 diabetes needs a balanced meal plan, including important vitamins and minerals needed for growth, without too many calories.
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A Guide to Special Food and Nutrition Needs
A Closer Look at Type 2 Diabetes, continued
Menu planning for type 2 diabetes features meals and snacks with: • Controlled energy (calories) • Carbohydrate spread over the day • Ample amounts of fiber-rich foods • Routine eating times day to day Meal plans are based on healthy eating guidelines, such as MyPyramid, or diabetic exchange meal patterns. Exchange lists are similar to the food component groups used for food based menu planning in schools. A meal pattern is set and different foods are exchanged or used in the pattern to make meals.
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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A Guide to Special Food and Nutrition Needs
Meal Planning Methods for Diabetes
Each student’s meal plan for managing diabetes will be different. There are several ways to plan meals to meet a diabetes care plan. Two common approaches for meal planning are: • Carbohydrate counting, also called carb counting • Exchange lists for meal patterns Carbohydrate counting is a meal planning approach many people with diabetes use. In carbohydrate counting, a certain amount of carbohydrate is planned for each meal or snack. For example, a plan may allow 75 grams of carbohydrate at breakfast. All carbohydrate is counted together, both simple carbohydrates from fruit, milk, or added sugars, and complex carbohydrates from starches. Food label information, carb count charts, or exchange list portions are used to count carbohydrates. Some plans count the carbohydrate in each meal and adjust the insulin dose to match the meal.
To learn more about carb counting and school nutrition programs, see the diabetes lesson in the 2006 BLT, Meeting Children’s Special Nutrition Needs in School Nutrition Programs, available in the resource center at www.nfsmi.org.
Diabetic exchange lists are another way to plan meals. Exchange lists are similar to the food component groups used for food-based menu planning (FBMP). A meal pattern is used and different foods are exchanged or used in the pattern to make meals. The diabetic exchange lists vary from the food component groups in these ways: • Exchange list serving sizes provide the same amount of carbohydrate for all foods in that group • Starchy vegetables such as potatoes, corn, and dried beans are included with grains in the starch group • Fruit, milk, and starch exchange servings each provide 12-15 grams of carbohydrate per serving 1 National Food Service Management Institute The University of Mississippi
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Meal Planning Methods for Diabetes, continued
• Meat and meat substitute servings provide similar amounts of protein and are grouped by different levels of fat • Dried beans and peas are counted as both a starch and very lean meat substitute Each student’s meal pattern is individual. The meal pattern is planned to match the student’s insulin shots. Some students may have advanced skills to select foods and portions that meet their meal pattern. Other students may need foods pre-portioned in exchange amounts.
Diabetic Exchange List Groups Starches (starchy vegetables and grains) Non-starchy Vegetables Fruits Milk Meat and Meat Substitutes Fats
No matter which system is used, all foods can fit into a diabetic meal plan, including sugar in controlled amounts. When foods with added sugars are included, the meal has less of other carbohydrate-rich foods. This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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A Guide to Special Food and Nutrition Needs
How School Nutrition Staff Help Students with Diabetes
Students, parents, and school nurses need to know the carbohydrate content of each menu item. If nutrient standard menu planning (NSMP) is in place, the nutrient analysis of the menu will provide this information. When food based menu planning (FBMP) is used, schools can provide information about the serving sizes of menu items, which can be used to determine carbohydrate content. Be ready to adjust serving sizes, as needed. School nutrition staffs play an important role in meeting the special nutrition needs of students who have diabetes. These are ways your daily work meets these students’ needs: • Understand each student’s special needs diet order. • Use standardized recipes and measure ingredients carefully. • Serve correct portion sizes. • Know how to read labels on food products for carbohydrate content or Child Nutrition (CN) components. • Be able to make appropriate substitutions when the menu changes. • Take part in team meetings. • Work with other staff in the school. • Know your program’s plan in case a mistake happens during food preparation or service. • Keep special diet records private. This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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A Guide to Special Food and Nutrition Needs
Find Carbohydrates on Food Labels
Nutrition Facts
Labels must list the total amount of carbohydrate per serving.
Serving Size: 1 cup (228g) Servings Per Container: 2
Listed below the total are two types of carbohydrate: dietary fiber and sugars.
Amount Per Serving
Calories 260
Calories from Fat 120 % Daily Value*
Total Fat 13g Saturated Fat 5g Trans Fat 2g Cholesterol 30mg Sodium 660mg Total Carbohydrate 31g Dietary Fiber 0g Sugars 5g Protein 5g
20% 25%
Vitamin A Vitamin C Calcium Iron
4% 2% 15% 4%
Dietary fiber is a type of carbohydrate that is not digested. Sugars are simple carbohydrates that digest quickly.
10% 28% 10% 0%
To figure how much complex carbohydrate (starch) is in a food, subtract the grams of fiber and sugar from the total carbohydrate. The sample product has 31 grams of total carbohydrate with 5 grams sugar and 0 grams fiber. Complex carbohydrate is 26 grams. 31 – (5+0) = 26
*Percent Daily Values are based on a 2,000 calorie diet. Your Daily Values may be higher or lower depending on your calorie needs. Total Fat Sat Fat Cholesterol Sodium Total Carbohydrate Dietary Fiber
Calories: Less than Less than Less than Less than 2
Calories per gram: Fat 9 • Carbohydrate 4
2,000 65g 20g 300mg 2,400mg 300g 25g
•
2,500 80g 25g 300mg 2,400mg 375g 30g
Note: Total carbohydrate is used for carb counting.
Protein 4
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A Guide to Special Food and Nutrition Needs
Find Carbohydrates on Food Labels, continued
Nutrition Facts Serving Size: 1 cup (228g) Servings Per Container: 2 Amount Per Serving
Food labels list all sugars in a food together. There is no % Daily Value for sugar intake. The Dietary Guidelines for Americans suggest low intakes. Some foods have natural sugars, such as milk, yogurt, and fruits. Other foods have added sugars, such as candies and cookies. Other foods have both natural and added sugars, such as sweetened yogurt or fruit canned in light syrup.
Calories 260
Calories from Fat 120 % Daily Value*
Total Fat 13g Saturated Fat 5g Trans Fat 2g Cholesterol 30mg Sodium 660mg Total Carbohydrate 31g Dietary Fiber 0g Sugars 5g Protein 5g
20% 25%
Vitamin A Vitamin C Calcium Iron
4% 2% 15% 4%
10% 28% 10% 0%
Serving size is important. All information on the label is based on the serving size listed. It may be different from serving sizes used in school meals or listed on a student’s physician statement for special dietary needs. Fiber-rich foods such as whole grains, fruits, vegetables, and legumes are important foods in a healthy diet, including diabetic meal plans.
*Percent Daily Values are based on a 2,000 calorie diet. Your Daily Values may be higher or lower depending on your calorie needs. Total Fat Sat Fat Cholesterol Sodium Total Carbohydrate Dietary Fiber
Calories: Less than Less than Less than Less than 2
2,000 65g 20g 300mg 2,400mg 300g 25g
Calories per gram: Fat 9 • Carbohydrate 4
•
2,500 80g 25g 300mg 2,400mg 375g 30g
Protein 4
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A Guide to Special Food and Nutrition Needs
Find Carbohydrates on Food Labels, continued
Inspect Ingredients
Ingredients are listed in order of most to least amount in the food product. Look for the words whole grain, 100% whole wheat, brown rice, stone ground wheat, whole oats, or whole grain flour as the first ingredient on whole grain products. Read the ingredient list on the label to find added sugars in a food. Look for words that end in ‘-ose’, to find sugars. Examples are sucrose, glucose, dextrose, maltose, fructose, and lactose. Other sources of added sugar are honey, syrups, molasses, and fruit juice concentrates. See note in box below. Remember that foods with natural sugars, such as milk and fruit, list the amount of sugar in a serving on the food label. Foods with natural sugars are usually rich in vitamins and minerals. NOTE: The exception to the –ose ending is sucralose. It is a sweetener made from sugar, but is not digested so it does not raise blood sugar. The brand name for sucralose is Splenda®. Splenda® is a registered trademark of McNeil Nutritionals, LLC.
More Label Terms
Reduced sugar – Appears on a food label if the food has 25% less sugars than the standard food. Sugar free – Means the food has less than 0.5 gram of sugar per serving. If a sugar free food is not low in calories, it must also note this fact. No added sugar, Without added sugars, or No sugar added – No sugars were added during processing, including ingredients or foods that contain sugar, such as jam, fruit, or milk.
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A Guide to Special Food and Nutrition Needs
Find Carbohydrates on Food Labels, continued
Reduced calories – Appears on a food label if the food has 25% fewer calories than the standard food. Calorie free – Means the food has less than 5 calories per serving. Low calories – Means a serving has less than 40 calories unless it is an entrée or main dish, in which case it has 120 calories or less per serving.
CN
CN
000000*
This 5.00 oz. Pizza with Ground Beef and Vegetable Protein Product provides 2.00 oz. equivalent meat/meat alternate, 1/2 cup serving of vegetable, and 1 1/2 serving of bread alternate for the Child Nutrition Meal Pattern Requirements. (Use of this logo and statement authorized by the Food and Nutrition Service, USDA, 00/98**)
CN
CN
Child Nutrition Label
A Child Nutrition (CN) may appear on products for child nutrition programs. The CN label states how a serving of the food contributes to the meal pattern requirements.
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A Guide to Special Food and Nutrition Needs
Find Carbohydrates on Food Labels, continued
In the previous example of the CN label a 5.0 ounce serving of the pizza provides 2.0 equivalent of meat/meat alternate, ½ cup serving of vegetable, and 1 ½ servings of bread alternate. This information is useful. School nutrition staffs need to know this information in the event of a menu change. School nurses can use the serving information to determine how the portion of food fits a student’s diabetic meal plan. The ingredient panel will also be useful.
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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A Guide to Special Food and Nutrition Needs
A Closer Look at Food Allergy
Do you know the difference between food allergy and food intolerance? Both involve a reaction to a food, but are not the same. It is vital to know the differences. Food allergies are a reaction to protein in a food. The body’s immune system thinks the protein is harmful and tries to protect the body. Allergic reactions can happen within minutes or a few hours of eating a food. Allergic reactions can range from mild discomfort to severe, life-threatening anaphylaxis. Allergy symptoms include: • Itching in the mouth and throat • Skin rashes or eczema • Swelling of tongue or throat • Difficulty breathing • Cramps, nausea, diarrhea, and/or vomiting • Drops in blood pressure • Loss of consciousness • Anaphylactic shock (can cause death) Anaphylactic shock is the most severe food allergy reaction. A person with an allergy this severe keeps special medicines on hand in case an unexpected intake of the food occurs. The law protects anaphylaxis as a disability. Milder allergies that are not life threatening are not considered disabilities, but are a medical or dietary reason for special nutrition needs.
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A Guide to Special Food and Nutrition Needs
A Closer Look at Food Allergy, continued
The eight most common food allergens in the United States are: • Milk • Eggs • Peanuts • Tree nuts • Fish • Shellfish • Soy or soybeans • Wheat
How much of a food will produce an allergic reaction? It varies from one person to the next. Some people have severe reactions to very tiny amounts of an allergen. Sometimes allergen-free zones are created to minimize the risk of exposure. Examples include peanut-free tables in a cafeteria. Other people with less severe allergies must avoid the food themselves, but can sit at a table with someone drinking milk or eating wheat bread. Allergic reactions can change over time. Children can outgrow some allergies. In other cases, an allergic reaction can become more serious over time. The bottom line is a person with food allergies needs to avoid the food and seek medical care if they have an accidental exposure. A physician diagnoses food allergies. The physician uses skin tests, blood tests, a physical exam, and the patient’s history to diagnose an allergy. Medicines are prescribed to take in case the food is accidently eaten. Some people carry their medicine in a device that injects it into their bloodstream to counter the body’s allergic reaction. An EpiPen® or Twinject® are two types of injection devices. Medical care is vital after a reaction, even if symptoms go away. 2 National Food Service Management Institute The University of Mississippi
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A Guide to Special Food and Nutrition Needs
A Closer Look at Food Allergy, continued
A person with a food allergy needs to avoid eating that food or foods made from it. Food labels provide ingredient lists. It is important to check labels for possible allergens. For example, someone allergic to eggs needs to avoid albumen, an egg protein used in food processing. United States food label laws require that foods containing any of the eight most common allergens be clearly labeled.
Resources and Organizations
The American Academy of Allergy, Asthma and Immunology, www.aaaai.org 414-272-6071 The Asthma and Allergy Foundation of America, www.aafa.org 1-800-727-8462 The Food Allergy and Anaphylaxis Network, www.foodallergy.org 703-691-3179 EpiPen® is a registered trademark of Day, L.P. Twinject® is a registered trademark of Sciele Pharma, Inc.
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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For more information, contact NFSMI at 800-321-3054 or www.nfsmi.org
A Guide to Special Food and Nutrition Needs
A Closer Look at Food Intolerance
Do you know the difference between food allergy and food intolerance? Both involve a reaction to a food, but they are not the same. It is vital to know the differences. A food intolerance means there is difficulty digesting a food. A food allergy causes an immune system reaction.
Lactose Intolerance
One type of intolerance involves lactose, the natural sugar in milk. Lactase is an enzyme the body makes that digests lactose. Some people do not have enough lactase in their digestive tracts. They often experience symptoms after drinking milk. This condition is called lactose intolerance. It is not an allergic reaction. A person with lactose intolerance can have symptoms of digestive distress after eating dairy products. The type of symptoms can vary greatly from person to person. Symptoms include: • Bloating • Gas • Cramps, nausea, or diarrhea It is possible to reduce the symptoms of lactose intolerance and keep calcium-rich milk products in the diet. Strategies include: • Drinking smaller amounts of milk with a meal • Eating dairy foods lower in lactose, such as hard, aged cheeses • Eating yogurt with live, active cultures • Using lactase enzymes to pre-digest the lactose in milk In extreme cases, a person may have to avoid all sources of lactose and rely on non-dairy sources of calcium and other nutrients found in milk products. People very sensitive to lactose need to read ingredient lists on food packages carefully.
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A Guide to Special Food and Nutrition Needs
A Closer Look at Food Intolerance, continued
Gluten Intolerance
Gluten intolerance involves a sensitivity to the protein gluten. Gluten in found in wheat, rye, and barley and foods made from these foods. A person with gluten intolerance has distress after eating foods containing gluten. Symptoms may include: • Abdominal pain • Gas • Bloating • Diarrhea It is important to know gluten intolerance is not the same as an allergy to wheat. Gluten is found in foods with wheat, rye, and barley. Gluten intolerance is related to but not the same as celiac disease. Celiac disease also involves a sensitivity to gluten. In celiac disease, the intestine is damaged whenever gluten is eaten. The damage prevents nutrients from entering the body. People with celiac disease also avoid gluten.
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A Guide to Special Food and Nutrition Needs
A Closer Look at Food Intolerance, continued
Organizations and Resources
The Gluten Intolerance Group of North American, www.gluten.net 253-833-6655 The National Digestive Diseases Clearing House, http://digestive.niddk.nih.gov 1-800-891-5389 Lactose intolerance information link http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintolerance/index.htm
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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A Guide to Special Food and Nutrition Needs
A Closer Look at Celiac Disease
Celiac disease is a medical condition that shares common characteristics with wheat allergy and gluten intolerance. Celiac disease and wheat allergy both involve the immune system. A person with celiac disease must avoid the protein gluten, similar to someone with gluten intolerance. Celiac disease occurs when • A person has a gene for the disease • A trauma or event happens to make the gene active • A diet of foods containing gluten is eaten A person can have the potential for celiac disease because it can run in families. The disease may appear after something triggers the gene, such as surgery. Scientists are working to learn more about this disease.
The symptoms of celiac disease include: • Bloating • Chronic fatigue • Constipation • Diarrhea • Bone pain • Muscle cramps • Weakness Symptoms related to poor nutrition include: • Anemia • Growth failure in children • Premature osteoporosis
Other names for celiac disease include gluten sensitive enteropathy (GSE), nontropical sprue, and celiac sprue. When a person with celiac disease eats a food containing gluten, the result is damage to the intestines. The damage prevents the body from absorbing nutrients from food. The result is malnutrition. The damage occurs every time a food with gluten is eaten. There is no cure for celiac disease. The treatment is to avoid all sources of gluten. When gluten is removed from the diet, the intestines heal and absorb nutrients.
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A Guide to Special Food and Nutrition Needs
A Closer Look at Celiac Disease, continued
Gluten is found in all types of wheat, rye, and barley. Pure oats are allowed on most celiac disease approved lists if the oats do not contain even traces of gluten. Oats need to be grown and processed away from other grains that have gluten. A person with celiac disease follows a diet with a wide variety of allowed foods. Milk, fruits, vegetables, meat, fish and poultry, and legumes do not have gluten, unless added in processing. Grains such as buckwheat, quinoa, and corn do not contain gluten.
Organizations and Resources:
The American Celiac Society, www.americanceliacsociety.org 504-737-3293 The Celiac Disease Awareness Campaign, http://celiac.nih.gov 1-800-891-5389 The Celiac Disease Foundation, www.celiac.org 818-990-2354 The National Foundation for Celiac Awareness, www.celiaccentral.org The National Digestive Diseases Clearinghouse, http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/ 1-800-891-5389
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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A Guide to Special Food and Nutrition Needs
How School Nutrition Staff Help Students with Allergies or Intolerances
The school nutrition staff plays an important role in special needs diets for allergies. These are ways your daily work meets a student’s needs: • Understand each student’s special needs diet order. • Use standardized recipes. • Know how to read labels on food products for allergens and ingredients. • Be able to make appropriate substitutions when the menu changes. • Prepare foods with care to avoid cross-contact. • Take part in team meetings. • Work with other staff in the school. • Know your program’s plan in case a mistake happens during food preparation or service. • Keep special diet records private.
Food Safety for Allergies Needs Special Attention Food safety training includes preventing cross-contamination to reduce risk of food-borne illness. Preventing cross-contamination or cross-contact of food allergens is a critical food safety step in preparing meals for students with allergies and intolerances. Think about this situation: Croutons are mixed into a green salad just before meal service. The school nutrition staff realizes a student with an allergy to wheat needs a separate salad.
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A Guide to Special Food and Nutrition Needs
How School Nutrition Staff Help Students with Allergies or Intolerances, continued
The staff • uses proper food safety procedures, • prepares a salad for the student, and • covers the salad with plastic wrap to prevent any cross-contact. The staff knows that the student could have an allergic reaction if the mixed salad were eaten, even if the croutons were removed. The crouton crumbs left on the salad were a danger. Students, parents, and school nurses need to know the ingredients of each menu item. Be familiar with items and ready to share accurate information.
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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A Guide to Special Food and Nutrition Needs
How to Read a Food Label for Allergens and Ingredients
A food label tells many things about a food. The front panel of the label must show the product name. The product name may provide a clue that the food contains an allergen. The name Tasty Wheat Crackers is an example. When the name is not a clear description of the food, the label must describe the food in common terms. For example, a breakfast cereal made from wheat and oats has the product name Crunchy Bunch. The package would also need a statement “Oven baked wheat and oat cereal” near the Crunchy Bunch name to make it clear the product is a cereal. Product names and descriptions on the front of the package may provide clues that the product might contain allergens.
The Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that food labels list, in plain words, any foods or ingredients that come from any of the eight most common allergens: • milk • eggs • peanuts • tree nuts • fish • shellfish • soy or soybeans • wheat
The best place to look for an allergen is the ingredient label. Ingredients are listed in descending order by weight in the product. The ingredient list can note the potential allergen in one of two ways. The allergen can be listed in parentheses after the item in the list. A statement can appear near the ingredient list that states the food contains one of the major allergens. Examples of the two options for vanilla wafers appear in the box.
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A Guide to Special Food and Nutrition Needs
How to Read a Food Label for Allergens and Ingredients, continued
Option 1: Ingredients: Enriched flour (wheat flour, malted barley, niacin, reduced iron, thiamin mononitrate, riboflavin, folic acid), sugar, partially hydrogenated soybean oil, and/or cottonseed oil, high fructose corn syrup, whey (milk), eggs, vanilla, natural and artificial flavoring, salt, leavening (sodium acid pyrophosphate, monocalcium phosphate), lecithin (soy), mono- and diglycerides (emulsifier) Option 2: Contains Wheat, Milk, Eggs and Soy Source: Food Allergen Labeling And Consumer Protection Act of 2004 Questions and Answers, U. S. Food and Drug Administration retrieved June 8, 2009 from http://www.fda.gov/Food/LabelingNutrition/FoodAllergensLabeling/GuidanceComplianceRegulatoryInformation/ucm106890.htm#q22
Food companies often include a statement on the label to indicate if a food is processed in a plant that also processes a food that is a major food allergen. The FALCPA does not regulate these statements. The FDA rules apply to consumer food labels. Many food companies that produce food for school nutrition programs will use a similar format. Remember to check product labels often for a potential allergen. A food company may change their ingredients without changing the product name.
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A Guide to Special Food and Nutrition Needs
How to Read a Food Label for Allergens and Ingredients, continued
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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For more information, contact NFSMI at 800-321-3054 or www.nfsmi.org
A Guide to Special Food and Nutrition Needs
Food Labels and Milk Allergy
The Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that food labels list, in plain words, any foods or ingredients that contain milk. FALCPA applies to foods sold to consumers in the retail food market. Foods sold for use in commercial food service are not required to follow FALCPA. Contact the manufacturer for more information on any products of concern. Read labels carefully to find milk or items made from milk or other dairy foods. NOTE: The food label tips on this page provide an overview for milk allergies. The information is not intended to be a complete source for all aspects of food labels and milk allergies.
Milk and Dairy Foods Include Butter, butter fat, or butter oil or clarified butter, such as Ghee Buttermilk Cheese Cottage cheese Cream and half-and-half Curds Custard Ice cream and other frozen dairy desserts Milk in all forms: condensed, derivative, dry, evaporated, goat’s milk and milk from other animals, lowfat, malted, milkfat, nonfat, powder, protein, skimmed, solids, whole Pudding Sour cream, sour cream solids, or sour milk solids Yogurt
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A Guide to Special Food and Nutrition Needs
Food Labels and Milk Allergy, continued
Words for Milk Protein
Casein, casein hydrolysate, or caseinates Diacetyl Lactalbumin, lactalbumin phosphate Lactoferrin Milk protein hydrolysate Recaldent® (found in chewing gum) Rennet casein Tagatose (a low calorie sweetener made from whey) Whey or whey protein hydrolysate Milk protein may be present in Artificial butter flavor Baked goods Candy, including caramel, chocolate, and nougat Lactic acid starter culture and other bacterial cultures Luncheon meat, hot dogs, and sausages Nisin (a food preservative) Nondairy products, including creamers, margarines, and whipped toppings
Did you know? • An allergy to milk protein is very different from a sensitivity to milk sugar or lactose intolerance. It is important to know the difference. • Most individuals allergic to milk can safely consume soy milk and other soy products, such as soy cheese or soy yogurt. Be sure to know what is allowed for a special needs diet. • Many food producers will list a warning on the label if a product is made in a plant that also processes products that contain milk or milk by-products.
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A Guide to Special Food and Nutrition Needs
Food Labels and Milk Allergy, continued
Adapted with permission from How to Read a Label for a Milk-Free Diet, The Food Allergy and Anaphylaxis Network, retrieved March 21, 2009 from http://www.foodallergy.org/downloads/HTRLsheet.pdf
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
3 National Food Service Management Institute The University of Mississippi
For more information, contact NFSMI at 800-321-3054 or www.nfsmi.org
A Guide to Special Food and Nutrition Needs
Food Labels and Egg Allergy
The Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that food labels list, in plain words, any foods or ingredients that contain eggs. FALCPA applies to foods sold to consumers in the retail food market. Foods sold for use in commercial food service are not required to follow FALCPA. Contact the manufacturer for more information on any products of concern. NOTE: The food label tips on this page provide an overview for egg allergies. The information is not intended to be a complete source for all aspects of food labels and egg allergies.
Foods That Commonly Contain Eggs Baked goods and pastries Candies such as marshmallows, marzipan, or nougat Eggs in all forms: dried, fresh, frozen, powdered, solids, whites, yolks Eggnog Imitation egg products or egg substitutes Macaroni or pasta Mayonnaise and other salad dressings Meringue Pre-made potato or macaroni salads Surimi (imitation seafood)
Words for Egg Protein
Albumin, Globulin, Lysozyme, Ovalbumin, Ovoitellin
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A Guide to Special Food and Nutrition Needs
Food Labels and Egg Allergy, continued
Did you know? • The Nutrition Facts panel gives a clue that a food might contain eggs. If the amount of cholesterol is high, check the ingredients for eggs or foods made from eggs. Eggs are a rich source of cholesterol – an average large egg provides 215 milligrams of cholesterol. • Many food producers will list a warning on the label if a product is made in the same plant that also uses eggs in other products.
For more information on egg allergies, check with The American Academy of Allergy Asthma and Immunology, www.aaaai.org The Asthma and Allergy Foundation of America, www.aafa.org The Food Allergy and Anaphylaxis Network, www.foodallergy.org Adapted with permission from How to Read a Label for an Egg-Free Diet, The Food Allergy and Anaphylaxis Network, retrieved March 21, 2009 from: http://www.foodallergy.org/downloads/HTRLsheet.pdf
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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For more information, contact NFSMI at 800-321-3054 or www.nfsmi.org
A Guide to Special Food and Nutrition Needs
Food Labels and Peanut Allergy
The Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that food labels list, in plain words, any foods or ingredients that contain peanuts. FALCPA applies to foods sold to consumers in the retail food market. Foods sold for use in commercial food service are not required to follow FALCPA. Contact the manufacturer for more information on any products of concern. Read labels carefully to find peanuts or items made from peanuts. NOTE: The food label tips on this page provide an overview of peanuts and allergies. The information is not intended to be a complete source for all aspects of food labels and peanut allergies.
Words For Peanuts Artificial nuts Beer nuts Cold pressed, expeller pressed, or extruded peanut oil Goobers Ground nuts Mixed nuts Monkey nuts Nut pieces Nutmeat Peanut butter, peanut flour or peanut protein hydrolysate
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A Guide to Special Food and Nutrition Needs
Food Labels and Peanut Allergy, continued
Some foods or ethnic cooking styles often include peanuts. Read labels carefully to determine if peanuts may be included. Foods more likely to include peanuts are African, Asian (especially Chinese, Indian, Indonesian, Thai, and Vietnamese), and Mexican dishes Baked goods such as pastries or cookies Candy such as chocolate, nougat, or marzipan Chili Egg rolls Enchilada sauce Mole sauce
Did you know? • • • • •
Mandelonas are peanuts soaked in almond flavoring. Arachis oil is peanut oil. Many experts advise people allergic to peanuts to avoid tree nuts as well. Sunflower seeds are often produced on equipment shared with peanuts. Highly refined peanut oil does not have to be labeled as an allergen. Studies show that most people with peanut allergies can safely eat highly refined peanut oil (not cold pressed, expeller pressed, or extruded peanut oil). Be sure to know what is allowed for a special need diet. • Many food producers will list a warning on the label if a product is produced in a plant that also processes peanuts.
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A Guide to Special Food and Nutrition Needs
Food Labels and Peanut Allergy, continued
Adapted with permission from How to Read a Label for a Peanut-Free Diet, The Food Allergy and Anaphylaxis Network, retrieved March 21, 2009 from http://www.foodallergy.org/downloads/HTRLsheet.pdf
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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For more information, contact NFSMI at 800-321-3054 or www.nfsmi.org
A Guide to Special Food and Nutrition Needs
Food Labels and Tree Nut Allergies
The Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that food labels list, in plain words, any foods or ingredients that contain tree nuts. The specific nut must be listed, such as almond. FALCPA applies to foods sold to consumers in the retail food market. Foods sold for use in commercial food service are not required to follow FALCPA. Contact the manufacturer for more information on any products of concern. Read labels carefully to find tree nuts. NOTE: The food label tips on this page provide an overview of tree nuts and allergies. The information is not intended to be a complete source for all aspects of food labels and tree nut allergies.
Type of Tree Nuts Almonds Artificial nuts (may contain tree nuts) Beechnut Brazil nuts Butternut Cashews Chestnuts Chinquapin Coconut Filberts/hazelnuts Ginkgo nut Hickory nuts
Litchi/lichee/lychee nut Macadamia nuts Marzipan/almond paste Nangai nuts Natural nut butters, extracts, or pastes, such as walnut extract, cashew butter or almond paste Nut meal, pieces, or nutmeat Pecans Pesto (often contains pine nuts) Pili nut
Pine nuts (also referred to as Indian, pignoli, pigñolia, pignon, piñon, and pinyon nuts) Pistachios Praline Shea nut Walnuts
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A Guide to Special Food and Nutrition Needs
Food Labels and Tree Nut Allergies, continued
The following flavorings and oils may contain tree nuts Natural nut extract including black walnut hull extract (flavoring) Nut distillates/alcoholic extracts Nut oils such as walnut and almond oils
Did you know? • • • •
Mortadella may contain pistachios. There is no evidence that coconut oil and shea nut oil/butter are allergenic. Many experts advise people allergic to tree nuts to avoid peanuts as well. Many food producers will list a warning on the label if a product is produced in a plant that also processes tree nuts.
Adapted with permission from How to Read a Label for a Tree Nut-Free Diet, The Food Allergy and Anaphylaxis Network, retrieved March 21, 2009 from http://www.foodallergy.org/downloads/HTRLsheet.pdf
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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For more information, contact NFSMI at 800-321-3054 or www.nfsmi.org
A Guide to Special Food and Nutrition Needs
Food Labels and Fish and/or Shellfish Allergies
The Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that food labels list, in plain words, any foods or ingredients that contain shellfish or finfish. The term finfish is sometimes used to clearly identify fish from shellfish (crustacean). FALCPA applies to foods sold to consumers in the retail food market. Foods sold for use in commercial food service are not required to follow FALCPA. Contact the manufacturer for more information on any products of concern. Read labels carefully to find fish or shellfish. NOTE: The food label tips on this page provide an overview for fish and shellfish allergies. The information is not intended to be a complete source for all aspects of food labels and fish or seafood allergies.
Shellfish Types of shellfish: • Crab • Crawfish • Lobster • Prawn • Shrimp Foods that may contain shellfish: • Fish stock • Seafood flavoring (e.g., crab or clam extract) • Surimi (imitation seafood)
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A Guide to Special Food and Nutrition Needs
Food Labels and Fish and/or Shellfish Allergies, continued
Some people with shellfish allergies are advised not to eat mollusks. Mollusks are not required to be listed as an allergen on the food label. It is important to know special diet restrictions and to read labels carefully. Some types of mollusks: • Abalone • Clams • Mussels • Oysters Fish A person allergic to one type of fish usually avoids all types of fish. While fish is not a common ingredient in other foods, it can be found in • Foods that contain anchovies (Caesar salad dressing, steak or Worcestershire sauce, or Caponata, a traditional Sicilian relish) • Soups with seafood such as chowders or bisques • Surimi (imitation seafood)
Did you know? • Any food served in a seafood restaurant may contain fish or shellfish protein due to cross-contact. Restaurants that cook fish or seafood in the same oil as chicken nuggets or beef strips can also have cross-contact. • For some people, a reaction may occur from inhaling cooking vapors or from handling fish or shellfish. • Fish and shellfish allergies are often severe. They are common causes of food anaphylaxis. • Many food producers will list a warning on the label if a product is produced in a plant that also processes fish or shellfish.
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Food Labels and Fish and/or Shellfish Allergies, continued
Adapted with permission from How to Read a Label for a Shellfish-Free Diet, The Food Allergy and Anaphylaxis Network, retrieved March 21, 2009 from http://www.foodallergy.org/downloads/HTRLsheet.pdf and Tips for Managing a Fish and/or Shellfish Allergy, The Food Allergy and Anaphylaxis Network, retrieved June 3, 2009 from http://www.foodallergy.org/allergens/fish.html
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
3 National Food Service Management Institute The University of Mississippi
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A Guide to Special Food and Nutrition Needs
Food Labels for Soybean or Soy Allergy
The Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that food labels list, in plain words, any foods or ingredients that contain soy. FALCPA applies to foods sold to consumers in the retail food market. Foods sold for use in commercial food service are not required to follow FALCPA. Contact the manufacturer for more information on any products of concern. Read labels carefully to find soy or items made from soybeans. NOTE: The food label tips on this page provide an overview of soybeans and allergies. The information is not intended to be a complete source for all aspects of food labels and soy allergies.
Foods Made from Soybeans Edamame Miso Natto Shoyu Soy of all types: soy albumin, soy cheese, soy fiber, soy flour, soy grits, soy ice cream, soy milk, soy nuts, soy sprouts, soy yogurt Soya Soybean curd or granules Soy protein concentrate, hydrolyzed, or isolate
Soy sauce Tamari Tempeh Textured vegetable protein (TVP) Tofu
Some foods or ethnic cooking styles often include soy. Read labels carefully to determine if soy may be included. Foods more likely to include soy are: • Asian cuisine • Vegetarian cuisine, including meat analog products • Vegetable broth, gum, or starch 1 National Food Service Management Institute The University of Mississippi
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A Guide to Special Food and Nutrition Needs
Food Labels for Soybean or Soy Allergy, continued
Did you know? • Highly refined soybean oil does not have to be labeled as an allergen. Studies show that most people with soy allergies can safely eat highly refined soybean oil (not cold pressed, expeller pressed, or extruded soybean oil). Be sure to know what is allowed for a special needs diet. • Most people with allergies to soy can safely eat soy lecithin. Be sure to know what is allowed for a special needs diet. • Many food producers will list a warning on the label if a product is produced in a plant that also processes soy products. Adapted with permission from How to Read a Label for a Soy-Free Diet, The Food Allergy and Anaphylaxis Network, retrieved March 21, 2009 from http://www.foodallergy.org/downloads/HTRLsheet.pdf
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
2 National Food Service Management Institute The University of Mississippi
For more information, contact NFSMI at 800-321-3054 or www.nfsmi.org
A Guide to Special Food and Nutrition Needs
Food Labels and Wheat Allergy
The Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that food labels list, in plain words, any foods or ingredients that contain wheat. FALCPA applies to foods sold to consumers in the retail food market. Foods sold for use in commercial foodservice are not required to follow FALCPA. Contact the manufacturer for more information on any products of concern. Read labels carefully to find wheat or items made from wheat. NOTE: The food label tips on this page provide an overview of wheat and allergies. The information is not intended to be a complete source for all aspects of food labels and wheat allergies.
Foods Made from Wheat Pasta Semolina Soy sauce (may contain wheat) Spelt Sprouted wheat Starch (food starch, gelatinized starch, modified starch, modified food starch, or vegetable starch may contain wheat) Tabouleh Triticale (a grain that is a cross between wheat and rye) Vital wheat gluten Wheat (bran, durum, flakes, germ, gluten, grass, malt, sprouts, starch, or whole) Whole wheat berries
Breading or bread crumbs Bulgur Cereal extract Cracked wheat Cracker meal Couscous Durum Farina Flour (all purpose, bread, cake, durum, enriched, graham, high gluten, high protein, instant, pastry, self-rising, soft wheat, steel ground, stone ground, whole wheat) Hydrolyzed wheat protein Kamut Matzoh or matzoh meal
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A Guide to Special Food and Nutrition Needs
Food Labels and Wheat Allergy, continued
Did you know? • Buckwheat does not contain wheat or gluten. It is approved for wheat allergy and gluten-free diets. • Many food producers will list a warning on the label if a product is made in a plant that also processes products that contain wheat.
Adapted with permission from How to Read a Label for a Soy-Free Diet, The Food Allergy and Anaphylaxis Network, retrieved March 21, 2009 from http://www.foodallergy.org/downloads/HTRLsheet.pdf
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
2 National Food Service Management Institute The University of Mississippi
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A Guide to Special Food and Nutrition Needs
Food Labels and Lactose Intolerance
Read labels carefully for foods that may contain lactose or milk sugar. Dairy products and foods made from milk may contain varying amounts of lactose. Some people can digest foods with a small amount of lactose. Others may be more sensitive and need to avoid even trace amounts. NOTE: The food label tips on this page provide an overview of lactose in foods. The information is not intended to be a complete source for all aspects of food labels and lactose.
Dairy Foods Butter, butter fat, or butter oil or clarified butter, such as Ghee Buttermilk Cheese Cottage cheese Cream and half-and-half Curds Custard Ice cream and other frozen dairy desserts Milk in all forms: condensed, derivative, dry, evaporated, goat’s milk and milk from other animals, lowfat, malted, milk fat, nonfat, powder, protein, skimmed, solids, whole Pudding Sour cream, sour cream solids, or sour milk solids Yogurt
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A Guide to Special Food and Nutrition Needs
Food Labels and Lactose Intolerance, continued
Other words for milk compounds that may contain lactose: Acid, butter ester(s) Casein, casein hydrolysate, or caseinates Diacetyl Lactalbumin, lactalbumin phosphate Lactoferrin, lactose, or lactulose Milk protein hydrolysate Recaldent® Rennet casein Tagatose (a low calorie sweetener made from whey) Whey or whey protein hydrolysate
Foods that may have milk by-products and may contain lactose: Artificial butter flavor Baked goods Candy, including caramel, chocolate, and nougat Lactic acid starter culture and other bacterial cultures Luncheon meat, hot dogs, sausages Nisin (a food preservative) Nondairy products, including creamers, margarines, and whipped toppings
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A Guide to Special Food and Nutrition Needs
Food Labels and Lactose Intolerance, continued
Did you know? • Many individuals with lactose intolerance can safely eat some dairy foods such as natural, hard cheeses or live, active-culture yogurts. Be sure to know what is allowed for a special needs diet. • Milk products with the lactose pre-digested are available. It is also possible to pre-treat milk with the enzyme lactase to pre-digest the milk sugar lactose. • Some medications and cosmetics contain lactose. • Many food producers will list a warning on the label if a product is made in a plant that also processes products that contain milk or milk by-products. These foods may contain lactose.
Adapted with permission from How to Read a Label for a Milk-Free Diet, The Food Allergy and Anaphylaxis Network, retrieved March 21, 2009 from http://www.foodallergy.org/downloads/HTRLsheet.pdf
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
3 National Food Service Management Institute The University of Mississippi
For more information, contact NFSMI at 800-321-3054 or www.nfsmi.org
A Guide to Special Food and Nutrition Needs
Food Labels and Gluten-Containing Foods and Ingredients
The U.S. Food and Drug Administration is working on rules for the term ‘gluten-free’ on a food label as part of The Food Allergen Labeling and Consumer Protection Act (FALCPA). Use the terms below to find wheat, barley, or rye ingredients in foods that contain gluten and must be avoided on gluten-free diets. NOTE: The food label tips on this page provide an overview for foods that contain gluten. The information is not intended to be a complete source for all aspects of food labels and gluten.
Foods with Gluten
Barley (pearled, scotch, flaked, and barley-based cereals such as Grape-nuts) Batter or battered items Breading or bread crumbs Bulgur Cereal extract Cracked wheat Cracker meal Couscous Durum Farina Flour (all purpose, bread, cake, durum, enriched, graham, high gluten, high protein, instant, pastry, self-rising, soft wheat, steel ground, stone ground, whole wheat)
Granola bars and products, unless labeled gluten-free Hydrolyzed wheat protein Kamut Licorice Luncheon meats (may contain wheat by-products) Matzoh or matzoh meal Malt products, including malt vinegar Pasta Rye (flour, bread or products with rye) Seasonings (may contain wheat) Semolina Soy sauce (may contain wheat) Spelt
Sprouted wheat Starch (food starch, gelatinized starch, modified starch, modified food starch, or vegetable starch may contain wheat) Triticale Vital wheat gluten Wheat (bran, durum, flakes, germ, gluten, grass, malt, sprouts, starch, or whole) Whole wheat berries
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A Guide to Special Food and Nutrition Needs
Food Labels and Gluten-Containing Foods and Ingredients, continued
Substitutes for Wheat Flour The following are substitutes for wheat flour in recipes. Use tips from a gluten-free cookbook to produce quality products. As with any recipe modification, gluten-free cooking and baking requires testing recipes. Almond meal flour – SEE NOTE Amaranth Buckwheat Coconut flour – SEE NOTE Corn starch Guar gum Potato flour Sorghum flour White rice flour Xanthan gum NOTE: These flours are not appropriate for people with tree nut or some peanut allergies. Adapted with permission from How to Read a Label for a Wheat-free Diet, The Food Allergy and Anaphylaxis Network, retrieved March 21, 2009 from http://www.foodallergy.org/downloads/HTRLsheet.pdf and Getting Started Celiac Disease and The Gluten-Free Diet, The National Foundation for Celiac Awareness, retrieved May 15, 2009 from http://www.celiaccentral.org/SiteData/docs/CeliacSurvivalGuide%5b1%5d/347c76a38463ae75c6902a0528 caf498/CeliacSurvivalGuide%5b1%5d.pdf
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A Guide to Special Food and Nutrition Needs
Food Labels and Gluten-Containing Foods and Ingredients, continued
The Gluten-free Diet: Some Examples
In 2006, the American Dietetic Association updated its recommendations for a gluten-free diet. The following chart is based on the 2006 recommendations. This list is not complete, so people with celiac disease should discuss gluten-free food choices with a dietitian or physician who specializes in celiac disease. People with celiac disease should always read food ingredient lists carefully to make sure the food does not contain gluten. amaranth arrowroot buckwheat cassava corn flax
Allowed Foods quinoa Indian rice grass Job’s tears rice legumes sago millet seeds sorghum nuts potatoes soy Foods To Avoid
wheat • including einkorn, emmer, spelt, kamut • wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein bromated flour durum flour enriched flour
Other Wheat Products plain flour farina graham flour self-rising flour phosphated flour semolina
tapioca teff wild rice yucca
barley rye triticale (a cross between wheat and rye) white flour
Processed Foods that May Contain Wheat, Barley, or Rye* seasoned tortilla chips bouillon cubes cold cuts, hot dogs, gravy salami, sausage imitation fish self-basting turkey brown rice syrup communion wafers matzo soups candy rice mixes soy sauce French fries chips/potato chips vegetables in sauce sauces * Most of these foods can be found gluten-free. When in doubt, check with the food manufacturer.
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A Guide to Special Food and Nutrition Needs
Food Labels and Gluten-Containing Foods and Ingredients, continued
Source: Thompson T. Celiac Disease Nutrition Guide, 2nd ed. Chicago: American Dietetic Association; 2006. © American Dietetic Association. Adapted with permission. For a complete copy of the Celiac Disease Nutrition Guide, please visit www.eatright.org.
This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.
Source: The National Digestive Diseases Clearinghouse, Retrieved May 30, 2009 from http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/
This project has been funded at least in part by the Delta Health Alliance (DHA) through HRSA Grant Number U1FRH0741. The Delta Health Alliance is a non-profit organization based in Stoneville, Mississippi, that advocates, develops, and implements collaborative programs to improve the health of citizens in the Delta through the support of partnerships that increase access and availability of health care, conduct and apply health research, or offer health education programs that foster healthy lifestyles. For more information about the Delta Health Alliance visit www.deltahealthalliance.org. Permission to use DHA’s logo must be obtained through DHA’s single point of contact prior to use. This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service and through an agreement with The University of Mississippi. The contents of this program do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA Employer.
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