nutrition mattersAugust 2012

Circulation List Facility ManagerCatering Manager Catering Staff Clinical Manager Clinical and Care Staff

The number of requests for aged care facilities to prepare gluten free diets is increasing. Take a walk down the health-food isle of any supermarket and you will be bombarded with an array of glossy packaging that labels products as gluten free. If you were asked tomorrow to provide a nourishing gluten free menu for one or more residents at your facility, would you have the skills, knowledge, equipment and ingredients to do so? It’s not uncommon when presented with this situation to become overwhelmed and not really know where to start!

Key Points:

• Coeliacdiseasesisan autoimmuneconditionthatis medicallydiagnosed;treatment requiresalifelongglutenfreediet

• Glutenisaproteinfoundinwheat, rye,oats,barleyandallderivatives ofthesegrains

• Caremustbetakenincatering forresidentswithCoeliacdisease toavoidalltracesofgluten

• Beproficientinreadinglabelsfor allfoods,fluidsandmedicationsto identifyglutenfreeoptions

Where is gluten hiding in your kitchen? Catering for residents with Coeliac disease

Hello and welcome to Nutrition Matters produced by Leading Nutrition for Aged Care Facilities to support optimal nutrition practices. Leading Nutrition provides expert dietitian services to over 150 aged care facilities throughout Australia. The professional dietitians at Leading Nutrition compile the nutrition insights offered in this newsletter.

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Tip! Look out for the crossed grain symbol. This logo is the international symbol for gluten free. In Australia the logo is a registered trademark of Coeliac Australia and is only awarded to foods that have been independently tested within the last 12 months to contain no detectable gluten.

Coeliac disease is an autoimmune condition that results in damage to the small bowel and as yet there is no cure; diet is therefore key in managing the disease to enable people with the condition to optimise health and quality of life. As many as one in one hundred Australians are now being diagnosed with Coeliac disease and require a lifelong gluten free diet for treatment.

So what exactly is gluten? Gluten is the protein found in a number of grains, namely: wheat, rye, oats and barley. It is responsible for the elasticity of bread dough and many other food properties. Residents with Coeliac disease need to avoid all sources of these grains and we need to substitute with alternative starchy energy sources to create a nourishing menu. A list of gluten

containing and gluten free grain options can be found on the table on page 2.

Take a moment and think about where gluten features in your facility menu. Start by thinking about breakfast: gluten is found in many breakfast cereals, breads, some soy milks and the all-time Australian favourite VegemiteTM (contains malt). Move on to thinking about morning tea: it’s in the flour in biscuits, cakes and scones. At lunch: some soup stocks and boosters, crumbed or battered meats, pastries, some sauces and many desserts... and so forth. For a resident on a gluten free diet, alternatives need to be provided for all of these ingredients and others included within menus need to be checked. The good news is with Coeliac disease now more widely recognised, gluten free options

are readily available and the labelling laws in Australia are quite strict, meaning that any product claiming to be gluten free, is free of gluten.

Gluten containing breads, cereals, flours, stocks, sauces and spreads can be switched for those derived from gluten free grains or complete products can be purchased premade. Some recipes can be easily adjusted and made gluten free for all residents within your facility (e.g. a gluten free gravy on a roast meal) while other meals you will need to prepare separate components for those on a gluten free diet (e.g. for pasta, cook a small portion of gluten free pasta in a separate pot in addition to the wheat-based pasta for residents on a standard menu).

With all the obvious sources of gluten removed from the menu, you need to think about where else a resident will come into contact with gluten. Common places where gluten is overlooked are:

Ingredients in medications: Make sure residents on a gluten free diet also have this listed within medication charts as an alert to all medical professionals.

Toasters: These readily collect crumbs and the majority of these are likely to contain gluten. It is highly recommended that a separate toaster or grill is available for preparing gluten free toast.

Margarine, butter and other spreads: Like toasters, small crumbs of gluten containing breads act as a source of contamination for those on a gluten free diet. Separate spreads or portion control servings are recommended as part of a gluten free diet.

Kitchen workspaces and utensils: While it is not essential to have separate work stations to prepare gluten free foods, careful cleaning is required of all benches, utensils and equipment between preparing foods containing gluten and those that are gluten free.

Labelling of meals and ingredients: Be sure all staff within your facility (not only catering staff) can recognise gluten

free options. Consider clear labelling or colour coding of foods that can be used in gluten free meals.

Special occasions: It is common that provision of gluten free options can be overlooked at events such as birthdays, Christmas, lifestyle outings etc. All traces of gluten can cause gut damage for a resident with Coeliac disease, therefore gluten free options are required for special occasions also. Note that Beer, Ale, Lager, Stout and Guinness all contain gluten. Alternatives such as wine, spirits, cider, liqueurs, port, brandy, sherry or gluten free beers can be provided if alcohol is being served to residents.

With careful sourcing of ingredients, a gluten free diet can be prepared to be delicious and nourishing. If you are having trouble preparing a gluten free menu, speak to an Accredited Practising Dietitian. Leading Nutrition provides assistance in menu planning and staff education for preparing gluten free diets. Contact us for more details.

Gluten containing grains AVOID ON GLUTEN FREE DIETAtta Graham FlourBourghal/Burghal Kamat/KamutCouscous SemolinaDinkel SpeltDurum Triticale Farina BarleyGerman Wheat MaltOats RyePilcorn Pumpernickel

Gluten free grains and starches SUITABLE GLUTEN FREE OPTIONS

Amaranth Quinoa

Arrowroot RiceBuckwheat SagoChickpea Sorghum Coconut SoyLentil TapiocaMaize/CornMilletPotato

Table 1.0: Gluten and grains

The simple yet easy way to boost energy & sustain nutrition.

Formulated MealReplacement Cookies

17 Curzon St, Tennyson QLD 4105 T 07 3373 3000 www.flavourcreations.com.au

2 Cookies = 1 Complete Formulated Meal Replacement

Gluten Free12 g Protein

26 Vitamins & Minerals

Good Source of CalciumNo Artificial Colours or Flavours

Low Lactose

**Highly refined wheat in the forms of glucose syrup, caramel colour 150 and dextrose from wheat are suitable on a gluten free diet as no detectable gluten remains in these products.

Weight Management Do you have a foolproof system for identifying gradual as well as monthly weight loss/gain?

Texture Modified Meals and Thickened Drinks Do your staff consistently provide appealing meals and fluids of the correct consistency?

Menu Has your menu been comprehensively reviewed in the last 12 months by an aged-care specific dietitian?

Resident Feeding Are your staff providing optimal feeding techniques and dining environment to support resident eating?

Supplements Are you happy with the level of supplements your facility uses?

ACFI Are you getting the most out of ACFI for your residents with nutrition needs?

Special Diets Are you following Best Practice Guidelines for special diets including diabetes and coeliac disease?

Documentation

Are you 100% confident all of your resident’s nutrition needs are accurately documented throughout the facility and kitchen, including all dietary preferences and changes?

Education Are all of your staff adequately skilled and motivated with practical ways to improve nutrition for all residents?

If you answered NO to one or more of these questions, Leading Nutrition can help you!

Are You Providing Nutrition Excellence?

Contact our Customer Support Manager, Lynette Hogan on 0416 178 945 or lynette.hogan@leadingnutrition.com.au to speak to us about ways we can help you improve resident outcomes and quality of life.

1. Which of the following foods contain gluten?

a. Fruits, vegetables and legumesb. Rice, quinoa and cornc. Porridge, weetbix and brand. Yoghurt, milk and cheese

2. True or False? For a resident with Coeliac disease it is OK to have a small amount of gluten containing foods for special occasions as a ‘treat’?

3. Which of the following grain(s) is/are gluten free?

a. Speltb. Semolinac. Triticaled. Sorghum

Answers

1. c, 2. False, 3. d

Test your knowledge!

Why should I choose a Leading Nutrition dietitian for my facility?

• Aged care specialists

• Individualised care for each resident that we assess

• Values and experience of a cohesive team of 20 dietitians, not just a sole provider

• Flexibility to work with you according to your individual needs

• Always contactable (full-time reception and after hours emergency line)

• Better value for money through effective and efficient use of time and resources

• Access to a plethora of resources, associations, current research and best practice guidelines

• Strong focus on quality assurance and continuous improvement both internally and for your facility

• Your own Customer Partner, who keeps in regular contact with you to ensure optimum services are continually provided according to your needs

What Leading Nutrition Can Provide For Your Facility

• Staff education

• Food service workshops

• Nutrition and hydration auditing

• Menu reviews and menu planning

• Assistance for passing accreditation

• Quality Assurance activities and reports

• Nutrition screening for malnutrition risk

• Weight tracking system

• Comprehensive Diet Manual detailing modified diets & special meal plans

• Efficient regular or on-call clinical services

• Locum or leave cover for your regular dietitian

• Nutrition and hydration policy development

Contact UsLeading Nutrition www.leadingnutrition.com.au Phone 1300 722 712 Email: admin@leadingnutrition.com.au

About Leading NutritionLeading Nutrition is an aged-care nutrition leader in Australia, providing specialized aged-care services of an exceptionally high professional standard.

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Registration: Go to www.leadingnutrition.com.au/seminarFor further information please contact Leading Nutrition on (03) 9817 1544 or admin@leadingnutrition.com.au