Food Allergy Counseling

Food Allergy Counseling
Sloane Miller, Food Allergy Counselor (Picture © Noel Malcolm 2013)

Tuesday, January 13, 2015

Recipe: Vegan Lentil Soup with Spinach and Avocado

Lentil soup January 13, 2015, 1:03pm



Lentil soup is one of my go-to recipes.
It’s vegan. (But you can add sausage to much delight!) 
It’s food allergy free. (Top 8 allergen free, but not for you legume allergic folks, natch)
It’s hearty. 
It’s incredibly healthy.
It only takes about an hour to cook.
And it has infinite varieties. 

This week, my lentil soup includes spinach, a squeeze of lemon and a half a perfectly ripe avocado. Here’s the recipe. Makes 4, 1 cup servings.

Lentil Soup with Spinach and Avocado

INGREDIENTS
1 cup of green lentils, rinsed 
1 T extra virgin olive oil
1 small onion, chopped
2-3 garlic cloves, minced
1 inch of fresh ginger, skinned and minced
2 carrots, scraped and chopped
1 large bay leaf (or two small ones)
Fresh baby spinach, one handful per serving of soup (broccoli, chard, kale, collards or escarole works beautifully here, too)
¼ fresh lemon to garnish (lime would be perfect, too!)
½ ripe avocado to garnish
Salt and pepper to taste
Water (you could use commercial chicken broth or veg broth if you like, just cut out the salt)

DIRECTIONS
In a large heavy bottomed pot on medium heat, sauté onions in olive oil until translucent and fragrant (5-7minutes). Add in garlic and ginger and sauté for 2 minutes, also until fragrant. Then add carrots and sauté the whole lot for another minute or two.  Add lentils and bay leaf, stir into veggie mixture until coated and mixed through. 

Add 8 -10 cups of water and one teaspoon of salt (you can add more salt and/or water as needed). Bring the whole mixture to a boil and then simmer for 45-minutes to an hour until lentils are tender. Adjust seasonings i.e. add more salt and freshly ground pepper.

When you’re ready to serve, add your favorite greens and warm through by stirring into the soup still simmering on the stove. It will only take a minute or two for the greens to cook and brighten; that's when they are at their best. This step is crucial: if you cook greens with this soup (which you can absolutely do) they tend to get soggy, overcooked and sad. You want bright green, happy greens like you see in this picture. 

A squeeze of lemon brightens the whole dish and lemon (any citrus) helps the body digest the nutrients in green veggies.

Avocado is perfect on top: a smooth, cool texture on top of hot and hearty. Also, because it’s a vegan, almost fat free soup, the healthy fat in avocado will help you feel full longer. 

Enjoy!

Wednesday, January 07, 2015

Food Allergy Counseling: Interview: Lily Roth of Food Allergy Survival Guide College Edition

During the 2014 FARE teen conference a few months back, I was following their twitter feed and discovered a new resource for teens entering into college: Food Allergy Survival Guide College Edition. Written by a teen Lily Roth, and her mom, Nancy Popkin, it offers excellent, first-person, real world advice about the whole college process, from choosing the right program for you through that first scary year on your own.  

*As with everything health and lifestyle related, please check with your medical health provider about your specific needs.*

I had a chance to ask Lily some questions about her excellent site. Read on!

***

Allergic Girl: What are your food allergies?
  
Lily Roth: I have anaphylactic allergies to milk, eggs, seafood, tree nuts, nightshade vegetables (potato, tomato, eggplant, pepper) and spices like cayenne and paprika, plus a few fruits and I don't eat wheat and soy because of another autoimmune condition. I also have asthma. 

AG: What was your motivation to create your Food Allergy Survival Guide College Edition website?

LR: I decided to make my Food Allergy Survival Guide College Edition website because I felt like teens with food allergies were kind of ignored. There is a lot of support for food allergy parents and young food allergic children, but after elementary school the support kind of ends.

For me, the whole college process was frustrating. During my sophomore and junior year of high school, my parents and I went and looked at six different schools within three hours of home. Some of the schools I did not like and the ones I liked, didn't seem to have the right program, were very competitive or were not in a desired location. The last school we visited was the University of Pittsburgh. I fell in love with it from the moment I toured; they had the academic program I wanted and they were in the perfect location. The only problem was that it was six hours from my house, and at the time my parents were a little nervous about me going far away.

At the beginning of my senior year of high school, I applied and accepted to the University of Pittsburgh before the end of September. I knew that I wanted to go to Pitt and my stubbornness was not going to let my food allergies stop me from going to my dream school.

After the frustration of getting accommodations for my food allergies and spending months trying to learn how to manage my food allergies and other medical conditions on my own, I realized I would have loved to have met someone who had done it before. I would have loved to have had a mentor who could tell me how they did it, and I know that my mom would have loved to have talked to a mom who had sent their child with food allergies off to college. And because of that Food Allergy Survival Guide College Edition (http://foodallergysurvivalguide.weebly.com) was born.

It covers college application to college graduation and everything in-between. It is also ever evolving and we are continuously adding to it so that we can keep it as up to date and as comprehensive as possible. 
  
AG: Who is the Food Allergy Survival Guide College Edition website for?

LR: While it is mostly geared toward food allergic high school and college students, there is also a parents only section and a section for college guidance counselors.
We also have a chapter of the guide that is geared towards newly diagnosed teens, and teens also managing other autoimmune conditions in addition to food allergies. 

AG: What tools and resources did you find most helpful in creating the Food Allergy Survival Guide College Edition website?

LR: I found my mom to be a very useful resource. She is an award-winning writer and she was very good at catching my spelling mistakes and writing content for the guide.

As I was writing this guide, I was simultaneously Co-Chairing a FARE committee of college students and parents that was writing a guide for FARE to put out for teens going to college with food allergies and their parents (the guide should be released soon).

The committee was helpful in coming up with tips for students going to college with food allergies, which I found useful. Most of the content though, has come from my own personal experience and things my family has found to be beneficial.

AG: What would you do differently now that you have been in college since the fall of 2014?

LR: I would worry less about what people thought about my allergies. I graduated from Abington Friends School in Jenkintown, PA. It is a small private Quaker school where everyone knows everyone and everyone is accepted for who they are. All the teachers and staff along with the students knew about my allergies, and it was just part of who I was--no one really cared ore judged me for them, but I was still the food allergy kid.

I went into college with the mindset that I didn't want to be the food allergy kid because I didn't want people to think I was weird or weak. I spent a lot of time the summer before my first semester worrying that I wouldn't find friends as amazing as my Abington Friends School Friends and that people were going to think that my food allergies made me weak and that they wouldn't want to be my friend because of them.

In the first hour of college, I learned that I was highly mistaken. No one really cares about my allergies, and I have found amazing friends who I love and trust to take care of me if I have anaphylactic reaction. 

AG: What are your three top tips for college-bound high schoolers?

LR:
1. Don't be worried about living in a single. When we went to the disabilities services for my apartment accommodation (because my allergies are too hard to accommodate in the dining hall) they told me they could only give me a single because they didn't think it would be safe to be using in mixed-use. For a while I was disappointed I couldn't have a roommate, but honestly I love having a quiet place to study when I need it, and the authority to invite over friends whenever I want without having to worry about bothering my roommate. 

2. Don't choose your college because of your allergies. If you don't go to the school that you love, you are not going to want to be there and college isn't going to be a fun experience. Choose a college and then figure out what accommodations you need to live there and study there safely. At one point, my parents wanted me to go to Temple, which is close to home and while it is a good school, I know I would have spend my entire time wishing I was at Pitt instead.


3. Carry your epinephrine autoinjector. Sure Epi-Pens or Auvi-Qs don't always fit discretely in your little black dress or in your jean pocket, but they can be life saving and the reason that food allergies are often fatal is because epinephrine isn't used fast enough. Even if you haven't had an anaphylactic reaction before, you can never be too safe. A really quick way to loose your parent's trust in your ability to go to college and be independent is to not have your epinephrine on you.

AG: Where can we find you?

LR:  You can find me volunteering as an EMT, doing community service, playing tennis or studying (you have to do a lot of that in college.) As far as social media goes, you can find our guide, Food Allergy Survival Guide-College Edition on Facebook (https://www.facebook.com/foodallergysurvivalguide) and Twitter (https://twitter.com/fasurvivalguide). You can also find me on Facebook (https://www.facebook.com/lily.roth.37) and Twitter (https://twitter.com/lilzforthrilz)


Thank you, Lily!

Lily Roth, used with permission.

Tuesday, December 23, 2014

Food Allergy Counseling: Food Allergy Chef Cards

Every chef I’ve spoken to, without exception, loves receiving a chef card (or restaurant card as they are sometimes called) from their restaurant patrons. It cuts out the game of telephone and gets the information in a clear way directly to where it needs to go: the chef. 

In the past few years, more companies have started to offer cards, many more than when I started this blog back in 2006. Here’s a list of a few options. If you know of more, put a link in the comments below

Chef cards in multiple languages:
Allergy Translation - http://allergytranslation.com/
Allergic Traveler - http://www.allergictraveler.net/
Select Wisely - http://www.selectwisely.com/

Free downloadable chef cards:
Allergy Free table - http://www.allergyfreetable.com/chef-card.php
Food Allergy Buddy –  http://www.supermarketguru.com/food-allergy-buddy.html
SafeFARE card - http://www.foodallergy.org/document.doc?id=219

My client made her own wonderful card on printed stationary: http://allergicgirl.blogspot.com/2014/06/food-allergy-counseling-custom-chef.html


Friday, December 19, 2014

Udi’s Gluten-free December 2014 Contest, #EatDrinkBeMerry

Udi's Gluten Free #EatDrinkBeMerry sent me some of my favorite tree nut-free gluten-free bread - white French rolls,  cinnamon raisin bread and bagels and their white bread and bagels -  in support of their contest where *you* can win some of their goodies. 

Here's one of my favorite weekend morning recipes using Udi's white bread: 7 Essential Ingredients for French Toast

Even simpler, yet equally delicious: cinnamon sugar toast. My bubby would make this for me as a snack when I was little and it never disappoints as a snack, breakfast or after dinner treat:

White bread toasted
Generous gobs of butter (or butter substitute)
A mix of cinnamon and sugar, sprinkled on top, in generous amounts.


What’s your favorite treat of any kind? You can submit your recipe entry on http://shop.udisglutenfree.com/eatdrinkbemerry or share a recipe using  #EatDrinkBeMerry on social media and be entered to win. 

More details, rules and regulations on the Udi’s website: http://shop.udisglutenfree.com/eatdrinkbemerry 

Contest runs through December 31, 2014 so get those recipes in and be entered to win!

Friday, December 12, 2014

Food Allergy Counseling: Study from Northwestern Medicine: Risk Taking Behavior Among Adolescents with Food Allergy

My colleague, Dr Ruchi Gupta sent me the following information about a study she is conducting for teens ages 14-22.  

"The goal of this study is to learn more about the risk taking behaviors of food allergic adolescents – both in regard to general risk taking and risk taking as it relates to food allergy."  

*Nota Bene: I am in no way involved in any aspect this study.*

More information is below from Dr Ruchi Gupta at Northwestern Feinberg School of Medicine, Northwestern University:

Study Overview: Researchers at Northwestern Medicine are conducting a research study entitled “Risk Taking Behavior among Adolescents with Food Allergy," which is currently enrolling participants.  The goal of this study is to learn more about the risk taking behaviors of food allergic adolescents – both in regard to general risk taking and risk taking as it relates to food allergy.  In order to participate in the study, adolescents between the ages of 14 and 22 years who currently have a food allergy are being asked to complete an entirely anonymous and confidential electronic survey. 

No protected health or identifying information is being collected.  No compensation is being offered in exchange for study participation. All aspects of this research study have been approved by the Northwestern Institutional Review Board, IRB STU00097291.

If you are between the ages of 18 and 22 and are interested in participating in this study, please click on this secure link to access the anonymous and confidential survey [https://redcap.nubic.northwestern.edu/redcap/surveys/?s=TcT8XLeZeA].

If you are a parent with a food allergic child between the ages of 14 and 17 and have no objections to your adolescent child participating in this study, please forward him/her this link [https://redcap.nubic.northwestern.edu/redcap/surveys/?s=TcT8XLeZeA].  The link will take him/her to the completely anonymous and confidential survey.

If you have any questions prior to making your decision, please feel free to contact Jacquie, jacqueline.pence@northwestern.edu, or Dr. Gupta, r-gupta@northwestern.edu.

Monday, December 08, 2014

Recipe: Pumpkin Spice Cake With Cinnamon Marshmallow Frosting

As my friend Chris said: my cupcake is wearing a "jaunty beret" of frosting

This is less of a recipe for more like semi-barely-not-really-homemade-but-I-did-use-my-mixer-and-bake-it homemade and all delicious.  I’ve always been severely allergic to tree nuts and seafood (and OAS to some fruits and veg) but since becoming intolerant to wheat, dairy and soy ten years ago, my baking from scratch has been curtailed. 

*Here a link to an explanation from AAAAI.org about the difference between allergy and intolerance.* 

Food allergy friendly mixes have saved the day and I have a few favorite go-tos, like Namaste Foods

CAKE: For this cupcake, I use the Namaste Foods Spice Cake mix and make the pumpkin variation on the box. Namaste is a lovely company that built their own facility in 2011 that is free from: "wheat, gluten, corn, soy, potato, dairy, casein, peanuts and tree nuts, are carefully manufactured in a dedicated allergen free facility and Kosher certified."

From a Namaste Foods 2011 press release: “Operating under the name of Taylor Gleason Enterprises, LLC, the new facility is virtually a one-of-a-kind allergen free facility. In addition to being free of the top eight allergens (dairy, 
egg, wheat/gluten, soy, peanuts, tree nuts, fish and shellfish) the facility is also free of corn and potato. It is estimated that 30 percent or more of the people with food allergies have multiple allergies. Being free of so many allergens demonstrates Namaste’s commitment to people with
food allergies above and beyond other manufacturers."

So yum!

FROSTING: And this is simply my new go-to frosting recipe. It's nut-free, dairy-free, gluten-free, soy-free and oh my goodness worthy.

Marshmallow Frosting

By Lori Karavolis and further adapted by me




1 C Domino’s confectioners’ sugar

1/2 C Spectrum organic palm shortening

1 C Durkee’s marshmallow fluff

1 t Nielsen-Massey vanilla extract

2 T hot water

Pinch of kosher salt


Mix well and try not to spoon directly into your mouth.

***

The reviews of this cupcake: 
“Do you have more?”
“You could sell these.”
"The frosting. The pumpkin cake. The frosting. YUM!!!!! So amazing!"

My uncle loved them so much that he created a thank you card featuring me and my mother atop the cupcake!



Friday, December 05, 2014

Food Allergy Counseling: Family, Holidays and Food Allergies



I read this New York Times opinion piece by Frank Bruni about his Italian American family - On Thanksgiving, an Abundance That's About Much More Than Food and his Thanksgiving which he likens to “…. a forced march, only a catered one, with prosciutto” and thought, even though my family is not Italian American, anyone with food allergies can relate to the sentiment, especially on Thanksgiving. 

Bruni goes on to say: “We Italian-Americans exalt food because we Italian-Americans exalt family. They’re intertwined. Indistinguishable.”

Many cultures express their love through feeding each other. Ahem, I’m looking at you my Jewish brethren. And when you have severe food allergies and cannot indulge in beloved family recipes, sometimes feathers get ruffled. Or worse, rifts can form.

So how do you initiate a loving conversation with extended family about the holiday season? 

Here’s a handy solution for only $1.50, the family e-chapter from my book Allergic Girl: Adventures in Living Well with Food Allergies.

You can download this chapter, Allergic Girl Family Guide to Food Allergies from Barnes & Noble or Amazon.com’s Kindle Store

If you want a more personalized approach, contact me about a short term counseling program today.

Monday, December 01, 2014

Interview: Chef Matt Abdoo, Del Posto

November centerpiece

Cool, marble floors. Low, romantic lighting. A dark wooden bar. A sweeping staircase headed to parts unknown. Even at 9:00am, Del Posto is stately; a Tuscan Castle dropped onto Tenth Avenue. Which is exactly what happened ten years ago when the B&B group transformed a former Nabisco factory into their New York Times four star rated restaurant Del Posto. (Read the glowing review here, written by Sam Sifton’s deft and poetic hand.) Against the cool floors and steep prices, there is a ton of warmth to be had. It’s emanating from the kitchen, in part from Chef De Cuisine, Matt Abdoo

Picture of Chef Matt Abdoo copyright Matt Abdoo
I interviewed Chef Matt for an Allergic Living Magazine article about the third annual Allergy Eats Conference. (You can read that interview in the Winter 2015 issue.) I was particularly struck by Chef Matt’s passion for food, for his guests, his attention to food allergy details and that he kept using the word love over and over again in his presentation: he loves food, he loves his job, he just wants his patrons to leave happy and feeling the love.

Recently, I had a chance to have a deeper conversation with Chef Matt about Del Posto’s food allergen and gluten-free programs, created with Executive Chef Mark Ladner. (Please note, I have not yet dined at Del Posto.)


***

Allergic Girl: In the last few years, Del Posto made a splash by creating the first high-end (that I know of) fresh gluten-free pasta menu/options in New York City. How did the gluten-free program start?

Chef Matt Abdoo: About four years ago, we were noticing that more and more guests with dietary restrictions or allergies, whether it was to wheat or gluten. As we encourage our guests to order the price fixed menu with the taste of two pastas, we always felt badly if a guest couldn’t partake in the most courses.

We had always dried, commercially made gluten-free pasta available, we used rusticella d’albruzzo rice penne and corn fusilli, and if someone came in, we’d put on a separate pot of water and we’d use the same sauce so they could have something similar to other diners. 

But we wanted to go a step further so these diners could have the same exact thing like the other diners. And that has been the driving force for a lot of our work to create a gluten-free pasta program: to mirror our Del Posto entire experience but gluten-free. 

(AG: Del Posto uses Cup4Cup as the basis for their gluten-free pasta. It involves egg and dairy. Here’s more about Cup4Cup.) 

AG: Were the chefs and staff always so aware of dietary restrictions? Or has something changed since Del Posto opened ten years ago?

MA: What’s changed, more so than anything, is that dietary restrictions and allergies have risen. More and more people are discovering they have some kind of restriction and we need to be able to accommodate those guests in one way or another.

What hasn’t changed at Del Posto is that whether a guest doesn’t have a single dietary restriction and they are just blown away by the food or if they are a guest who says ‘I’m really hard to accommodate”, we at Del Posto always find a way to accommodate them and give them an experience that is memorable and that blows them away. 

That’s what’s important to us. We want to be able to make our guests happy. We want to be able to fulfill an experience that is above and beyond anything that they thought was possible.

So, accommodating our guests with allergies and dietary restrictions is no different than how we have been and would accommodate any other guest.

AG: What is the procedure, generally, when a food allergy or gluten-free order comes into the kitchen at Del Posto? (NB: The process is more extensive and detailed than what is below, this is just a sample of some of the steps they stated that they take.)
MA: When guests make a reservation at Del Posto, our reservationists are trained to ask if there are any dietary restrictions in the party, and so the very first point of contact with guests is an attempt to get any pertinent information regarding allergies. 

The reservationist will then note the restriction on the reservation for the main dining room staff and the kitchen to be aware of from the get-go.

During dinner service, all tickets that include orders for food allergic guests or dietary restrictions of any kind include that guest’s seat number, as well as a special notation each time a ticket comes in.

Once the tickets are in the kitchen, they are marked with red dot stickers, which serve as a visual cue for everyone involved that there is a dietary restriction at the table.

Chef Matt and the red dot sticker for allergy plates 

Each plate for a food allergic guest is marked with a red dot sticker, and then hand delivered by a manager when the food walks for that table.

Finally, and most importantly, we do our very best to keep cross contamination at a minimum. Food is cooked in separate vessels that are free from the specific allergy in question- pans, pots, water, and special spoons are all used.

AG: That’s extensive. What about raw products?
MA: The food allergy process at Del Posto begins, in fact, with receiving products and inspecting products. An employee goes through all deliveries to ensure that the correct items have been delivered, and that those items have not been subjected to potential contaminants, for example: we don’t want to see a bag of almonds on top of a bag of wheat flour. 

To this end, our receiver also makes sure that all the ordered goods are in the appropriate condition. We do not accept dented items, or anything that looks tampered with. It’s a lot of work-- training your staff what to look for-- but it’s necessary.

The next step is processing ingredients. We make sure that all team members are aware of the top 8 allergens: shellfish, soy, milk, eggs, tree nuts, peanuts, fish and wheat.  When we are producing allergy friendly dishes they are prepared in a work environment free from the top 8 allergens, and all ingredients are treated with extra care and concern. 

For service and the service team, we provide extensive staff training, from meeting to pop quizzes, to testing, and a huge number training documents available to study from.

And then we wait for the reservation and enact those procedures I mentioned before.

AG: Incredibly extensive! So, in your opinion, generally speaking, what mistakes should a diner with food allergies watch out for when any restaurant is handling a food allergy or special diet order?
MA: There should be clear and continuous communication throughout the entirety of the meal with managerial staff. If there isn’t, that is a red flag.
Additionally, guests should watch out when the food is not delivered by either the manager or the person that took the order.
Make certain that the person you have been interacting with about your food allergies or their superior is the one that is looking out for you and understanding that your plate has a special request on it.
For example, at Del Posto, we require that a manager is the one point person who has contact with a guest with a food allergy request and sees it all the way through to delivery.
If when a manager delivers your meal to the table, if a discreet announcement is not made with eye contact about your special requests, it may not be your meal. Don’t eat if you are unsure.
AG: What are the top three things you need to hear from a guest to accommodate them when dining at Del Posto?

MA: 
1. What a guest can not have. 
2. What a guest can have. 
3. What they had last visit, if there was a last visit. 

If they have chef or restaurant card, use it. We love the card.

As chefs during a busy meal service, we’re processing a thousand things at once. When an allergy order comes in, we stop. And then our brains have to reprocess and go through every ingredient to every dish according to your needs, and we check and double check, because we get nervous and get scared. So, if you use a chef card or something like Sloane's word document and tell us what you can have, as well as what you can’t, it’s great!

AG: I know many people with severe dietary restrictions feel like chef cards or giving lists of can/cannot haves flags them as a difficult or undesirable guest. Do you agree? Basically, what’s the perception of special requests?
MA: Here at Del Posto every guest is welcomed like your Italian grandmother would; with a warm, welcoming hug. We love getting the information about you that will help us serve you better and safe and make you comfortable. 
AG: What’s the best way a diner should get in touch with Del Posto to start a dialog about dining with you, especially if they have severe food allergies or special dietary requests?

MA: Call (212.497.8090) or email us through opentable.com. The most important thing is that you reach someone and get a confirmation of your needs.
***
Thank you, Chef Matt and the Del Posto team for all that you do for guests with severe food allergies and dietary restrictions!
Del Posto
85 10th Avenue 
New York, NY 10011
(212) 497-8090