The New York State Dietetic Association Presents

1. The New York State Dietetic Association Presents The Danger Zone (Trans Fats/Celiac Disease/Food Allergies) With Marlisa Brown MS, RD, CDE, CDN Registered Dietitian, Certified Diabetes Educator and Chef www.TWellness.net

2. What’s Similar About Trans Fat,Celiac and Food Allergies? • All are hidden in food • Each may present a risk • More and more customers are asking about these items • Operators that aren’t able to answer questions and offer alternate choices may lose business

3. First introduced by Crisco through a process called partial hydrogenation First used to change a liquid shortening into a semi solid Can extend shelf life Provides a crispy texture Has been used in the development of many food products It is impossible to identify trans fat content by looking at a menu description or plated entree Trans Fats

4. Dangers of Trans Fats • Raises total cholesterol • Raises LDL (bad) cholesterol • Decreases HDL (good) cholesterol • Increases risk of heart disease (heart disease is the leading cause of death in new York city with 23,000 deaths in 2004 1/3 of these under 75 years old)

5. Trans Fat Rulings • January 2006 FDA made trans fats listing on food labels mandatory • July 2007 NYC Department of Health will require that all NYC restaurants only use oils and spreads that are trans fat free (except donuts until July 2008) • July 2008 all NYC restaurant food served must be trans fat free • Foods labeled trans fat free must have less than 0.5 gm trans fat per serving

6. What It Means Going Trans Free • Manufacturers will need to reformulate oils and ready to cook foods containing trans fats. • All natural vegetable oils are trans fat free but many don’t have the stability to hold as long as trans fat containing oils. Many oils are being formulated with lower linolenic content and higher oleic content that may be used as a successful substitute.

7. Arguments on the Mandate • Ethnic restaurants may have trouble converting or understanding the changes needed • There may not be enough time to provide suitable products for all uses • Will legislation change fast enough if the science changes? • Shouldn’t restaurants have the right to just post information and give customers the chance to choose?

8. Important Information on Trans Fat Ruling • For NYC Dial 311 and ask for the trans fat help line (for NYC calling outside of the city dial 718-254-8061) • Department of Health http://www.nyc.gov/html/doh/downloads/pdf/cardio/cardio-transfat-bro.pdf • Look for detailed information at www.notransfatnyc.org • General trans fat info www.bantransfat.com • Look for help if you need it. There will be substantial fines for lack of compliance issued by the DOH

9. Celiac Disease and Gluten Free • An intolerance to the gluten in food and other products • Gluten is a protein found, in wheat, rye, barley and possibly oats • Gluten is added to foods in many ways with sauces, gravies, breading, bouillon and thickening agents • It is estimated that 1 in 100 people in the US have celiac disease (currently only 1 in 1000 are being diagnosed)

10. Important to Know About Celiac • Unlike cardiac disease, diabetes and hypertension with celiac disease you can’t just cheat sometimes, it is a diet for life • It can take up to 3 years for adults on a gluten free diet to become free of symptoms and as little as a teaspoon of a gluten containing food can set back a persons recovery

11. Untreated Celiac Disease Is Linked to Many Health Problems • Type One Diabetes, Lymphomas, Dermatitis, Osteoporosis, Anemia, Reflux, Irritable Bowel Disease, Thyroid Disorders, Infertility, Depression, Mouth Ulcers, Rheumatoid Arthritis, Suppressed Auto immune Disorders, Tooth Enamel decay and Autoimmune Liver Disease are just some of the possible disorders • Prevalence of Celiac is rising due to better screening. Currently in Ireland it’s 1 in 50, in Italy 1 in 100 • The NIH and WHO are providing education to help increase the understanding and the diagnoses of celiac disease

12. Why Should Restaurants Know About Celiac? • A mistake in the kitchen or by your staff can make a customer sick • It is difficult to impossible to order gluten free food without knowledgeable help from the restaurant • Many restaurants and National chains offer gluten free options including: Outback, Legal Seafood, PF Chang’s, Texas Roadhouse, Bonefish Grill, Charlie Brown’s, Don Pablo’s, Houston’s, Mama’s in Oakdale and many more

13. Why Should Restaurants Know About Celiac? • People who have celiac disease and their families are very loyal to restaurants that accommodate them • Celiac support groups recommend restaurants at their meetings and people travel from all over to eat at these restaurants • With the help of a Registered Dietitian and a Celiac Support group it can be easy to coordinate gluten free choices for your menu

14. Celiac Support Groups • Celiac Disease Foundation www.celiac.org 1-818-990-2354 • Gluten Intolerance Group info@gluten.net 206-246-6652 • Celiac Disease Center at Columbia University www.celiacdiseasecenter.org 212-305-5590 • Celiac Sprue Association Omaha, NE www.csaceliacs.org • Canadian Celiac Association Mississauga, ON www.celiac.ca 905-507-6208 • American Celiac Disease Alliance www.americanceliac.org

15. The New York State Dietetic Association Presents The Danger Zone • Food Allergies Presented by Constance Brown-Riggs MSEd, RD, CDE, CDN Author – Eating Soulfully and Healthfully with Diabetes (iUniverse 2006) www.eatingsoulfully.com

16. Food Allergens • 90% of all allergic reactions to foods include: Milk, Eggs, Wheat, Peanut, Soy, Tree Nuts (Walnuts, Pecans, Chestnuts, Brazilian nuts, Hazelnuts, Pecans, Pine Nuts, Cashews), Fish and Shellfish • Many reactions in restaurants occur from cross contamination, through cooking utensils, grills, cooking oil, unclean surfaces and cookware. Also, incomplete information given by staff when questions are asked regarding allergens

17. Hidden Food Allergens • Some places milk could be hidden: deli slicing machines, processed meats and some tuna, on steaks topped with butter, in sauces, seafood soaked in milk or anything labeled with casein, and in desserts and toppings • Tree nuts could be hidden in barbeque sauce, crackers, breads, cereals, coatings and ice cream

18. Hidden Food Allergens • Fish could be hidden in Worcestershire, anchovies, and condiments. Imitation crabmeat could have wheat added and is a regular fish not a shellfish (take care with frying oil) • Wheat is used as a filler in many foods (other titles for wheat include; kamut and spelt) • Peanuts in toppings sauces, falling into muffins and baked goods, peanut oil, arachis is a peanut oil • Eggs could be in baked goods, sauces & foam toppings

19. Reactions to Food Allergies • Having a customer reacting to a food allergy is something to be avoided at all costs. If the reaction is severe and the person does not have an epi pen with them they may go into anaphylatic shock which could result in a fatality • Symptoms of an allergic reaction may include; skin symptoms or swollen lips, difficulty breathing, reduced blood pressure, headache and gastrointestinal symptoms

20. Resources for Food Allergies • American Academy of Allergy, Asthma, and Immunology www.aaaai.org • The Asthma and Allergy Foundation of America www.aafa.org • Food Allergy Anaphylaxis Network www.foodallergy.org 1-800-929-4040 • Food Allergies Database www.allergyadvisor.com • Find a Registered Dietitian through the American Dietetic Association www.eatright.org • © Marlisa Brown MS RD CDE CDN, 160 Howells Rd. Bay Shore, NY 11706 631-666-4297, Fax 631-666-5284 www.twellness.net call for information on reproducing

21. You may feel that some customers requests seem like they are not that important

23. Not providing for requests appropriately can lead to lost customers and a possible emergency situation

24. Marlisa Brown MS RD CDE CDNRegistered Dietitian, Certified Diabetes Educator and Chef 160 Howells Rd Bay Shore, NY 11706631-666-4297www.TWellness.net Constance Brown Riggs MSEd RD CDE CDN Registered Dietitian, Certified Diabetes Educator, Author 100 Veterans Blvd. Suite 15 Massapequa, NY 11758 516-795-4288 www.cbrnutritionenterprises.com