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Need Advice For How To Cater To Celiacs
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Hello, iv been a proffesional chef for around 5 years and have worked at some of the best hotels in England. Iv had to deal with alot of different alergies in the past celiac disease being probaly the most common, I recently started working In a old people's home and have 1 woman who is a celiac. I'm not sure if there's different levels of celiacs like with but allergies but the woman's daughter has kicked up a fuss to make us change many things for her mother. Her mother (the celiac I cook for) has been a resident here for 3 years and there was never a problem but because she has started to lose weight (due to Alzheimer's) the daughter is trying to associate that to the food. Getting to the point I just wanted to ask for tips on how to care for her mother the best way because being in a kitchen catering for 80 other residents its hard to use seperate cooking utensils and have a preparation area just for her, all of my spoons are metal as our my pans so I wondered are they a risk of cross-contamination? And if anyone has any other tips for me all help is very much appreciated.

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You know how I cater to the one celiac (me) in every dinner I host (up to 20 people, including toddlers)? I make the food naturally gluten free. After 10 years of doing this, I've had no complaints and rarely repeat what I'm serving. It's just easier, because there are a lot of healthy, easy to prepare foods that are gluten free.

But I realize that you aren't going to make the whole facility gluten free! Though having naturally gluten free meals a few times a week would make many things easier, you still are going to have times where you don't want to do that. So, yes, you need to deal with cross contamination.

You say "there have been no problems" and yet she's losing weight. You cannt know that the weight loss is from Alzheimer's, as it could be caused by her getting contaminated as well. Further, in the kitchen, you aren't likely to be privy to all the details of her physical complaints. She may well be having abdominal pain, bloating, or other symptoms (including a shift in her Alzheimer's symptoms faster than expected, which a non-Alzheimer's patient would describe as brain fog). Perhaps, in her state, she hasn't mentioned much - forgetting to or not waning to be a trouble. Perhaps she has mentioned it and it was ignored as insignificant or just old age. Perhaps she hasn't mentioned it and her daughter has had to figure it out. No matter, I encourage you to give her the grace to be as healthy as she can. This isn't being done to make your life harder, though it may well feel that way in the heat and stress of the pre-dinner rush. You would certainly do the same for any of your loved ones who were sick and couldn't advocate or care for themselves.

A "separate" preparation area is a must! I think the easiest way to think about it is a comparison to raw meats. You wouldn't share a cutting board for raw meats with fruits/veggies not being cooked. Not without thorough washing first. You wouldn't prepare food on the same counter that had chicken juice splattered on it without washing first. You wouldn't pass raw chicken over a salad about to be served.

Likewise, you need separate cutting boards for non-gluten and gluten foods. You need to make sure that counters that have had gluten containing ingredients on them are well cleaned before preparing gluten free foods. And you need to avoid passing gluten foods (particularly things like bread or breaded items) over gluten free foods.

Just like you wouldn't use the same spoon to stir a dish full of raw meat and then a cold soup, you need to use separate spoons for gluten containing and gluten free foods. In a busy kitchen, doing what many do here and having different colored tape or labels to note which is which may help, and it may be procedurally easier to keep them permanently separate, though a thorough washing on metal utensils should be sufficient. Same with pots and pans - you can mark dedicated ones, but a thorough cleaning is usually good for stainless cookware.

Some things, like collanders for pasta, scratched non-stick surfaces, toasters, and porous material like wood, simply can't be thoroughly cleaned and it really is vital to have separate, dedicated equipment in this case.

I'm sure others here will have more help. You might PM a user by the name of kenlove directly, as he's worked with a number of restaurants on the issue of serving gluten free food.

Good luck, and come back and let us know how it goes!!

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I wonder if the woman with celiac is getting regular bloodwork and what it says.

How have you been prepping food for her (and for the other residents) until now? How did your predecessor do it?

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You do realize that even the slightest bit of cross-contamination can cause damage? There are some of us who don't even get digestive symptoms, but if we eat something that was stirred with the wrong spoon, or something that was made in the same room where someone just made a cake (where the flour dust will remain in the air for hours), we will have damage to our small intestines. That damage makes is hard or even impossible to absorb nutrients from the food we eat. This will of course lead to weight loss, so the daughter's suspicion that her Mom is getting cross-contaminated is not unreasonable.

The bad thing is, weight loss is only one of the consequences of cross-contamination. There are a host of very nasty diseases that can come from continual low level exposure. Cancers, lupus, thyroid problems, and even dementia itself.

Cross-contamination is extremely serious and the extra precautions taken to avoid it are well worth it. If you learn how to do it in this setting you will be ahead of the game because I am sure you will have other celiac patients in the future.

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There is research to suggest that dementia and other related mental decline diseases are strongly linked to celiac. As already stated, the least bit of contamination could not only be causing her symptoms due simply to celiac, but could be making the condition she is there for worse. Either way, that would make her food responsible for what is happening to her. A lot of good points were brought up in how to make food safely for her. You wouldn't be blowing this off so simply if it were a life threatening allergy, and although it won't kill us immediately, gluten contamination can be equally deadly to us. It is very important that her food be prepared safely for her.

This will be good for you as well. As a chef you are already well familiar with cross contamination, now you just have to adjust to the idea that with gluten things can become permanently contaminated rather than having the option of a little hot water being able to clean up after everything. The idea mentioned of naturally gluten free meals is a good one also. This will almost certainly not work all of the time, but a few times a week no one will notice.

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    • I figured I would update those who were wondering.  I have gotten the appt. so far moved up to August 30. I am waiting to have gene testing done via swab for all 3 of my kiddos tomorrow. My daughters celiac antibodies came up negative but her IgA is low which the ped said could cause false negative antibodies for celiac so she will need to see a GI dr. also. The pediatrician is going to call the GI to try to get them in sooner. I am keeping them all on a gluten diet until the GI dr. decides what to do. I am on the cancellation list already for my son, however I am not going to be persistent with my phone calls to them until I have the results of the gene test. I really want that result in my hand before going to the GI dr if I can. Maybe if he is positive, along with his bloodwork and my history they can forgo the endoscopy. But he will eat gluten till then.  My husband and I have been very honest and upfront with him as to what is going on and the possibility of the endoscopy and what that entails and although scared in general he seems ok after assuring him that since I have it he has me to help him every step of the way.  Going through his current diet with him I realized that he is truly on such a low gluten diet that I am actually surprised his bloodwork shows antibodies at all!  So I told him to make a list of allllll the gluten he could possibly think of eating and he needs to pound it until the GI visit or endoscopy. Funny thing is everything he keeps thinking of to want to eat...is already gluten free!  The other night we were at a friends and he asked if he could be done with his hotdog. I made him finish just the bread 😂 Thanks for your help and advise and I will keep y'all posted on both kids!  My oldest is a ok as far as all his antibodies. Just actually had a follow up for other immune issues and all his levels are now normal!
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    • Well, you can probably get an apple or something.  You might be able to get someone to boil you some eggs.  But be careful of things like nuts that should be naturally gluten free.  They have almost always been soaked in a flavor solution that usually containes caramel coloring, "soy" (wheat) sauce and other aditives.  If I am really hungry and must eat in a Chinese restaurant, I order plain white rice and steamed vegetables.  But even so, you must monitor it carefully.  The rice sometimes has other substances added to give it a better texture, and very often the vegetables have in fact had "just a little bit" of soy sauce added.  To be fair, celiac disease is hardly ever found in East Asians, so understandably people are not tuned it to it.  Also, culturally, with the exception of fruits, it is generally thought that the flavor of foods needs to be enhanced, so it is had to find anything natural even in the "western" gorceries. Even in the western restaurants, be careful.  Fish and meat and often vegetables are usually pre-marinated. I will not even attempt to address the issue of cross-comtamination, since that is a whole higher order of things. I do know what I am talking about; I have celiac and have worked here for nearly 7 years.  
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