More on Special Diets

“Special Delivery,” an article by Kim Schwabenbauer, RD, LDN, and Gabriela Pacheco, RD, LD, SNS, published in the September 2011 issue of School Nutrition, examines some solutions for turning the challenges of feeding special needs students into opportunities for innovation, growth and success. In specific, the article explored food allergies, diabetes, phenylketonuria (PKU) and mechanically altered meals as three common areas for special dietary accommodations. (Menu examples for PKU and puréed meals follow at the  end of this article .) But there are two other areas where special menus or menu items might be required or requested: gluten-free diets and vegetarian diets.

Gluten-Free Diets
Some individuals have conditions that make it difficult or downright dangerous for them to eat foods that contain gluten, a protein found in wheat, rye and barley, buckwheat and oats (as well as foods that include these grains as ingredients). Some might experience a temporary intestinal distress from a gluten sensitivity or intolerance. But those with celiac disease cannot tolerate gluten and can risk damage to the lining of the small intestine.

The only treatment for celiac disease is to eat a gluten-free diet. This can be a significant challenge, as gluten remains fairly ubiquitous within the food supply because it is a part of most grain-based foods, including pasta, cereals, breads and crackers. In addition, gluten hides in certain extracts, distilled grain vinegars (a component of condiments such as ketchup, mustard, relish, horseradish, etc.), alcohol flavorings and hydrolyzed wheat proteins.

School nutrition operators must become astute label readers and well-educated on this topic in order to provide menu items that are gluten-free. Key words to look for include: wheat starch, wheat bran, graham flour, Kamut and hydrolyzed wheat protein. In addition, operators must be diligent regarding cross contamination. To learn more about gluten intolerance, celiac disease and a list of grains/foods to avoid, see  “Grappling with Gluten-Free” (January 2011, School Nutrition).

Although feeding children a gluten-free diet can present some challenges, it’s not impossible! Seek out products that ensure there is no cross contamination in the manufacturing process. Plus, the list of recipes that support a gluten-free diet seems to grow longer every day. You can find these on the Internet and in specialized cookbooks. Check the “On the Market” section of the September 2011 issue of School Nutritionfor some initial resources. One district in the Chicago area, Indian Prairie School District 204, asserts success in offering such gluten-free items as chicken nuggets, BBQ chicken, cheese nachos and cheese pizza. These meals are packaged in individually labeled containers to avoid cross contamination. For more details about this district’s school meals program, see http://ipsdweb.ipsd.org/Subpage.aspx/SchoolLunches and  http://napervillesun.suntimes.com/1802425-417/district-free-gluten-malone-meals.html.

Vegetarian Diets
While we’re on the subject of special diets, you may have found that more and more kids consider themselves vegetarians and request special meals. While some make this choice for ethical or religious reasons, others are “going” vegetarian as a way to cut down on fat and cholesterol and potential weight gain. It’s important to communicate the risk of nutrient deficiencies, so that students understand they must seek out plant-based iron and protein sources. Indeed, vegetarian diets are not encouraged for growing children unless under the direction and supervision of a qualified health professional.

But if students and their parents ask about getting adequate nutrition from a vegetarian diet, you can tell them that the key is variety. The diet should include a wide range of fruits, vegetables, plenty of leafy greens, whole-grain products, nuts, seeds and legumes. Vegans (vegetarians avoiding dairy and eggs, in addition to meats/fish) should add vitamin B12 to their diet, as well. School nutrition operations that plan and offer a vegetarian entrée for students most days of the week can help ensure that these students get the nutrition they need.

Sample Menus
Following are some sample menus developed by one school district for students with specific dietary restrictions.

Phenylketonuria (PKU)
Julie Hedine, food and nutrition services supervisor at Pasco County (Fla.) Schools, developed the menu below for a high school student with PKU according to his particular likes and dislikes. This is a rare inherited metabolic disorder that results from a complete absence or large deficiency of a particular liver enzyme. The goals in implementing a PKU diet are to restrict phenylalanine (PHE) foods and supplement tyrosine, in order to maintain blood concentrations within a safe range to allow for proper growth and development. PHE can be found in large quantities in such high-protein foods as meats, fish, poultry, cheese, eggs, milk, nuts and legumes.

  Monday Tuesday Wednesday Thursday Friday
Week One Pasta with
Marinara Sauce
Baked Potato with
Ketchup & Margarine
Veggie Sandwich
(whole wheat bread, Miracle Whip, lettuce & tomato)
Potato Roasters with
Ketchup
Taco/Nacho
(lettuce, tomato, salsa in hard shell taco or chips)
Week Two Mashed Potatoes with
Ketchup
Pasta with
Marinara Sauce
Veggie Sandwich
(whole wheat bread, Miracle Whip, lettuce & tomato)
Breadsticks with
Marinara Sauce
Taco/Nacho
(lettuce, tomato, salsa in hard shell taco or chips)

*Student may have any potato product, including baked, roasters, smiles, mashed.
*Alternate meal if necessary is tomato soup with crackers.
*POSSIBLE SIDES: Fruit/vegetables/juice/juice bar/garden salad with Ranch or Italian dressing
*SNACKS: Rice Krispie Treat, Chips per MD

Puréed Diets
Also provided below by Pasco County’s Hedine is a puréed diet cycle menu developed for a specific student. The menu runs from September through December.

  Monday Tuesday Wednesday Thursday Friday
Week One Chicken, Diced
(3 ozs.)
Steamed Green Beans w/
*Margarine
**Fruit
Milk
Pasta (1 c.) with
Meatballs (5)
*sauce (1 c.)
Capri Vegetables w/
*Margarine
**Fruit 
Milk
Hamburger/Cheeseburger
(1 patty) with
Lettuce (1) & Tomato (2)
Oven Baked Beans (1/2 c.)
**Fruit
Milk
Turkey (3/4 c.) & 
*Gravy (1/4 c.) with
Mashed Potatoes (2/3 c.)
**Fruit
Hot Vegetable w/
*Margarine
Milk
Nacho Meat (1 c.) & 
Cheese Sauce
(1/2 c. or 2 PC cups)
*Salsa (1/4 c.)
**Fruit
Lowfat Pudding
Milk
Week Two Roast Beef with
Mashed Potatoes
(2/3 c.) & *Gravy (1/2 c.)
Broccoli Florets with
* Margarine
**Fruit
Milk
Chicken Griller (1) with
Macaroni & Cheese (1/2 c.)
** Fruit
Lowfat Pudding
Milk
Beef Nuggets (5) with
Mashed Potatoes (2/3 c.) & *Gravy (1/2 c.)
** Fruit
Hot Vegetable w/
*Margarine
Milk
Lasagna Rolls
(1 rollup, 3 meatballs) with
*Sauce (1/2 c.)
Spinach with
*Margarine
Lowfat Pudding
Milk
Nacho Meat (1 c.) & 
Cheese Sauce
(1/2 c. or 2 PC cups)
*Salsa (1/4 c.)
**Fruit
Hot Vegetable with
*Margarine
Milk
Week Three Asian Chicken (4.75 ozs.) with
Rice (1 c.) & *Sauce (1/4 c.)
Hot Vegetable w/
*Margarine
**Fruit
Milk
Tuna Salad (1 c.) with 
Tomato (6) & Crackers (2 pkg.)
Hot Vegetable with
*Margarine
**Fruit
Milk
Hamburger/Cheeseburger
(1 patty) with
Lettuce (1) & Tomato (2)
Oven Baked Beans (1/2 c.)
**Fruit
Milk
Ravioli (1 c.) 
Spinach w/
*Margarine
**Fruit
Milk
Nacho Meat (1 c.) & 
Cheese Sauce
(1/2 c. or 2 PC cups)
*Salsa (1/4 c.)
Hot Vegetable with
*Margarine
**Fruit
Milk
Week Four Baked Potato
with toppings (per teacher request)
*Margarine/Sour Cream
Green Beans
**Fruit
Milk
Tuna Salad (1 c.) with
Tomato (6) & Crackers (2 pkg.)
Capri Veggie Blend with
*Margarine
**Fruit
Milk
BBQ Beef (1c.-No Bun) with
Sweet Potato Puffs
(3 ozs./13 puffs) with
*Margarine
Oven Baked Beans (1/2 c.)
**Fruit
Milk
Penne (1 1/2 c.) with
Sun Dried Tomato
*Sauce (1/2 c.) & 
Chicken (2.5 ozs.)
Lowfat Pudding
**Fruit
Milk
Nacho Meat (1 c.) & 
Cheese Sauce
(1/2c. or 2 PC cups)
*Salsa (1/4 c.)
Hot Vegetable with
*Margarine
**Fruit
Milk
BREAKFAST MENU ^Yogurt Parfait
Juice
Milk
Omelet Sandwich
*Margarine
Juice
Milk
Breakfast Combo on
Biscuit
*Margarine
Juice 
Milk
Pancakes
*Margarine
Juice
Milk
^Yogurt Parfait
Juice
Milk

*Extra Condiment provided to help with blending; Margarine 4; sauces/gravies portion size is listed in the menu (these are for children on puréed/chopped meals).
**Fruit cup or flavored applesauce alternating. The ONLY fresh fruit allowed is bananas.
^Yogurt Parfait: layer fruit on bottom, top with yogurt, serve granola on side.
Note: Hot vegetables are to be served daily. No corn or granola/breakfast bars.

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