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Catering for special dietary requirements

Ask any foodservice professional who’s been around the block a few times and they’ll tell you that over the past decade, the growing public awareness around diet, food intolerances and allergic reactions has had a big impact on the market.

Statistics show more and more Australians are being medically diagnosed with food intolerances and allergies than ever before. These means more and more of your potential customers have special dietary requirements which they need to follow while eating out.

If your business doesn’t have food on the menu which meets their needs, they’ll obviously have to go elsewhere. But you might not only miss out on their order – suppose they’re dining with a party of four or five other people. Maybe only one of the five must adhere to a special diet – but they all want to eat together, so if your menu doesn’t offer a meal to suit that one person’s needs, you’ll miss out on all five orders.

Do the maths and it quickly becomes clear that over the course of a week, a month and a year, that’s an awful lot of potential business you could be missing out on.

So making a few modifications to the menu, either by changing the recipes of existing meals, or adding new ones suitable for those customers with dietary restrictions, is a sound business decision.

It means you are expanding your potential customer base and capturing more of the market, by offering a more inclusive menu.

In this report we look at some of the most common dietary requirements so you can be better informed about how to cater for customers who are either medically required or choose to eat within these categories.

That way you can be sure of maximising your customer base and not missing out on potential sales!

COELIAC DISEASE AND FOOD INTOLERANCES

Food intolerance is one of the major reasons for people following a restrictive diet. A food intolerance is a hypersensitivity to certain ingredients within food, leading to unpleasant reactions including upset stomach, irritable bowel, migraine headaches and skin complaints.

Food intolerances can often be medically diagnosed by health professionals and in extreme forms can be a form of autoimmune response.

The two most common food intolerances in Australia are to gluten (a protein found in wheat, rye, barley and oats, as well as ingredients made with these) and lactose (the sugar found in milk, cream, yoghurt and some soft cheeses). Other people have intolerances to fructose (the sugar found in fruit), wheat, histamines and others.

Gluten in particular has received widespread publicity in general times due to the growth of the gluten free food industry, which according to a recent report in London’s Daily Telegraph is currently estimated as being worth around $2.6 billion in the US and is predicted to double in size within the next two years.

The rise in availability of gluten free food comes in response to a growing demand from the many people being diagnosed with coeliac disease, a permanent intestinal intolerance to gluten.

“People often use the term ‘gluten intolerance’ to describe coeliac disease, but it’s more than just an intolerance,” points out Coeliac Society of Australia Chief Executive Officer David Sullivan.

“Coeliac disease is an immune-mediated condition whereby the body reacts to gluten during digestion. This causes inflammation of the small bowel and can cause significant damage in the long term if untreated, including fertility issues, osteoporosis and even some cancers.”

The latest figures show coeliac disease affects at least 1 in every 100 people in Australia, with 75 per cent of these currently undiagnosed. This means 160,000 Australians have the disease but don’t know it.

People with coeliac disease must avoid all gluten – including wheat-containing breads, cereals, pasta, pastries, biscuits and more.

When dining out, these people must choose gluten free meals at all times – so it’s essential that if you label a menu item as gluten free, you need to be able to be sure that’s the case.

It’s not just a question of replacing wheat flour with cornflour or rice flour – you need to check the ingredients of sauces, spreads, condiments and additives as these can often contain gluten. Standard soy sauce, for example, is made with wheat flour so contains gluten (but major manufacturers such as Kikkoman also offer a gluten free version).

You also need to be able to protect against the dangers of cross-contamination. People with coeliac disease often cannot tolerate even small amounts of gluten, so you must be able to ensure your gluten free meal is 100 per cent gluten free.

That means if you prepare it on the same benchtop or workspace where you’ve been preparing meals with gluten-containing ingredients – like flour – any residue which finds its way into your gluten free meal can in effect contaminate it with gluten.

The only way to ensure 100 per cent gluten free food in a commercial kitchen is to follow strict guidelines to minimise the risk of cross-contamination, and you’ll see examples of these on page XXX.

An inevitable consequence of the wider availability of gluten free food is that even people who haven’t been diagnosed with coeliac disease are experimenting with reducing or eliminating the amount of gluten in their diet.

This is part of a current trend among the public, fueled in part by widespread discussion about dietary issues on the internet, to adopt a gluten, wheat, lactose, fructose free or other kind of specialist food-intolerance-style diet, even in the absence of medical advice or diagnosis. Maybe a friend has recommended it to them, or they’ve read something online that’s convinced them it’s a healthier choice, or they believe that removing these ingredients makes them feel better.

Whatever the reasons, it means there are more and more potential customers out there who are looking for specific dietary choices on the menu, and the more of them you can cater to, the better.

 

ALLERGIES AND ANAPHYLAXIS

While food intolerances can make people ill, and cause a range of unpleasant symptoms similar to the effects of food poisoning, true food allergy is more dangerous and in severe cases can even be life-threatening.

Different people have different reactions depending on the severity of their allergy, but over time even those with an originally mild form of food allergy can become more sensitised.

Severe food allergy can trigger anaphylaxis, an allergic reaction which is treated as a medical emergency requiring immediate treatment and urgent attention.

The reaction usually occurs within 20 minutes of exposure to the allergen and can result in difficulty breathing, swelling of the tongue, swelling or tightness of throat, wheeze or persistent cough, loss of consciousness or collapse.

The most common food triggers for anaphylaxis, according to the Anaphylaxis Australia website, are milk, eggs, peanuts, tree nuts, sesame, fish, crustaceans and soy products. These cause 90 per cent of allergic reactions. However any food can trigger anaphylaxis and even trace elements can cause a life-threatening reaction. As with coeliac disease, this is why cross-contamination risk minimisation procedures are so important in your kitchen.

“It’s a generalised allergic reaction that often involves more than one body system – for example skin, respiratory, gastro-intestinal and cardiovascular,” explains Geraldine Batty of Allergies & Anaphylaxis Australia.

“When you look at the spectrum of allergic reactions, anaphylaxis is the most severe form. Milder allergic symptoms can be an itchy swelling on the mouth, sneezing and runny nose and eyes. But when a reaction progresses to breathing difficulty or involves the cardiovascular system, then there’s a real danger.”

For foodservice professionals, effective procedures to prevent cross-contamination in back of house are a must to minimise the risk of people suffering from these allergies being exposed to trigger foods.

While in most cases your customers will be well aware of what foods they have to avoid, they are nevertheless relying on you, as a professional, to ensure the food has been prepared in such a way that all possible precautions have been taken to prevent cross-contamination of their meal with a ‘trigger’ ingredient.

Australia’s Food Standards Code now includes a ‘nil tolerance’ on cross-contamination from food allergens, which has prompted food manufacturers to go to great lengths on their labelling. That’s why we see food labels stating ‘May contain traces of …’ or ‘This product has been manufactured on equipment also used for the manufacture of …’ typically followed by a food to which many people have an allergy.

 

RISK MANAGEMENT STRATEGIES TO PROTECT AGAINST CROSS-CONTAMINATION

Whenever you’re preparing special meals for customers with food intolerances or allergies, making sure the recipe is free of trigger ingredients is only the first step.

Cross-contamination of work surfaces and food preparation utensils can undo all your careful work. So here’s a few things to bear in mind:

  • Make sure all cooking and preparation utensils are thoroughly washed and cleaned before preparing a meal for someone with food intolerance or allergy. Be especially vigilant not to re-use pots and pans, microwave containers and mixing bowls previously used for general purpose meals when preparing food for someone with an intolerance or allergy. You can even cross-contaminate food by wearing the same gloves from one meal to the next.
  • Don’t overlook the risk of contamination through equipment like deep fryers, toasters, sandwich makers and grills, all of which can hold food residue from previous meals. Clean these regularly to remove buildups.
  • Use colour-coding systems to keep utensils and food preparation areas separate – eg separate colour coded food containers, stored in a separate fridge or designated area of your fridge. Take advantage of the colour-coded cleaning cloths on the market (such as CHUX Superwipes).
  • Make certain you know the ingredients of all pre-prepared and packaged products you use in meal preparation. Check the ingredients lists regularly to make sure the formulation hasn’t changed.
  • If any of your supplied food doesn’t come with a nutritional information statement, contact your distributor and request a list of ingredients. They are legally obligated to provide this under Australian law.
  • Make sure all food preparation areas and benches are clean and disinfected before you start to prepare and that all staff follow good hygiene procedures (like washing hands). This obviously applies to all foodservice businesses at all times!
  • Keep all ingredients clearly labelled so as to minimise risk of anyone using the wrong ingredient by mistake
  • Educate all kitchen and wait staff to be sure they are aware of and understand the reason behind all these procedures. Use wallcharts, internet printouts, emailed advice – it all helps.

 

DIABETES AND AUSTRALIA’S HEALTHY EATING GUIDELINES

One of the best-known health concerns requiring dietary modification, diabetes is currently the fastest growing chronic condition in Australia.

The current best estimate from Diabetes Australia is that 1.7 million Australians have some form of diabetes – this includes type 1, type 2 and gestational (i.e. during pregnancy) and those people at risk of type 2 but who have not yet been diagnosed.

At the moment about 280 Australians develop diabetes every day and some 2 million have pre-diabetes.

Like coeliac disease, type 1 diabetes is an autoimmune condition. Our pancreas produces insulin to regulate our blood sugar levels and in people with type 1, the body identifies the insulin producing cells as being foreign and attacks them via the immune system. This means people with type 1 can no longer produce insulin and must take regular injections of it to survive.

Type 2 diabetes is more related to lifestyle, tending to affect those who are obese or overweight. In type 2 the body still produces insulin but either it doesn’t produce enough, or the insulin it does produce isn’t effective in penetrating the body’s cells.

Some people with type 2 do not need to inject insulin but can regulate their condition by making healthier food choices and losing weight. But these people may eventually progress to needing insulin injections – currently about 50 per cent of type 2 diabetics will progress to injections within 10 years of diagnosis.

Unlike people with coeliac disease, the dietary recommendations for people with diabetes aren’t different from those for the general public. As Adele Mackie, an accredited practising dietitian with the Victorian branch of Diabetes Australia, points out, healthy eating is the same for everyone and we all need to maintain a good diet.

“The advice a dietitian would give is based on the current Australian Dietary Guidelines – increasing fruit and vegie intake, choosing wholegrain carbs like oats, barley, quinoa, brown rice and high fibre cereals, reducing full fat dairy products, choosing lean cuts of meat and so on.

“Really the biggest focus when we’re talking about type 2 is having a balanced diet across the core food groups and reducing non-core foods like processed, deep fried food and high fat foods.”

She emphasises that portion size is very important. “The majority of us eat too much anyway, but with diabetes portion size is particularly important when it comes to carbohydrate foods.

“Carbs is a broad term that covers sugars as well as starches like bread, cereal, rice, pasta and potatoes. When we eat these foods the body breaks them down and digests them into glucose, so all carbs, whether from sugar or starch, end up as glucose in our bloodstream. Our muscles and cells use this as energy and we need a certain amount to function. But with diabetes it’s about how much.

“People with type 2 diabetes will be watching portion sizes which differs from person to person. People with type 1 have a bit more flexibility and freedom in how much carbs to eat, but they need to estimate how much their meal contains so they can adjust the amount of insulin they inject to match.

“They are taught how to estimate amounts and when eating at home they can weigh carb foods, but obviously when eating out they have to estimate visually and this is where portion size is important. We teach that for example a bread roll is around 30g of carbs, a standard cup of pasta is 30g, and that helps guide them and give them a ballpark figure.”

Adele says that Diabetes Australia has developed catering guidelines which organisations use for function catering within the workplace, and these could be helpful to foodservice professionals in providing a guide to portion sizes and nutritional content. The association has also produced a fact sheet on the types of meals suitable when eating out.

“I do want to emphasise that as dietitians we are trying to move away from labelling food as ‘diabetic-friendly’ or ‘suitable for diabetics’,” Adele points out. “This is because the healthy eating guidelines are the same whether you have diabetes or not, so it’s not a question of people with diabetes having to order a special meal – it’s more about offering healthy balanced meals to everyone.

“Portion size is really a key concern. In some places you can order huge portions which are the equivalent of two or three regular meals. What we recommend is portions where half the plate is filled with vegetables or salads, a quarter of the plate with a meat, chicken or fish portion, and another quarter with the carb portion like pasta or rice – as opposed to things like chips which tend to come standard with meals.

“The option to be able to order half-serves would also be great. Some places offer entrée size meals but you can’t always order them as a full meal depending on the time of the day.

“Giving people the option to order smaller portions, as well as extra salad or vegies instead of chips, would also be helpful.”

 

WHERE TO FIND INFORMATION ONLINE

If you want more information about any of the information raised here, there are a number of websites which provide detailed advice, background sheets, posters etc which you can access and download for future reference or to use in back of house:

COELIAC DISEASE

Coeliac Society of Australia

www.coeliac.org.au

 

FOOD INTOLERANCES AND ALLERGIES

Allergy & Anaphylaxis Australia

www.allergyfacts.com.au

Information specific to the foodservice market can be found at

http://www.allergyfacts.org.au/caring-for-those-at-risk/food-industry/food-service

This website also features two helpful resources for foodservice professionals:

Be Prepared booklet available as downloadable PDF at http://www.allergyfacts.org.au/images/pdf/be%20prepared.pdf

A Food Allergen Kit for Foodservice (cost $40.91) which includes an interactive CD ROM, awareness posters and a comprehensive booklet covering anaphylaxis, coeliac disease, food labelling and how to develop an allergen management policy in your business to reduce the risk of cross contamination.

Available from the site’s online store at

http://www.allergyfacts.org.au/online-store?page=shop.product_details&flypage=flypage.tpl&product_id=35&category_id=5

 

DIABETES

Diabetes Australia

www.diabetesaustralia.com.au

Eating Out and Diabetes is a downloadable PDF outlining what sorts of foods people with diabetes are recommended to choose when dining out and the general advice they are given:

http://www.diabetesvic.org.au/images/stories/Eating_out__diabetes_2012.pdf

Catering Guidelines: a resource for making healthy food choices is a downloadable PDF brochure which provides a lot of advice that you may find useful and relevant:

http://www.diabetesvic.org.au/images/stories/Eating_out__diabetes_2012.pdf

 

AUSTRALIAN DIETARY GUIDELINES

The Australian Dietary Guidelines as well as lots of relevant background information on nutrition and recipes are available online at

http://www.eatforhealth.gov.au

 

HELLO FOODSERVICE

You can learn more about food allergies and intolerances, and the points raised in this article, by watching our special Hello Foodservice report on the subject.

Just visit wwww.foodservicegateway.com.au, click on the Videos tab, scroll down to Hello Foodservice and then look for Episode 6.

http://www.foodservicegateway.com.au

 

 

 

 

 

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