Food Allergy Counseling

Food Allergy Counseling
Sloane Miller, MFA, MSW, LMSW, Psychotherapist; Specialist in Food Allergy Management, Speaking At Mylan Specialty / EpiPen Event (© Noel Malcolm 2013)

Monday, June 29, 2009

Diet, Celiac Disease

At the Thought Leader’s Program, June 14, 2009 at the Celiac Disease Center at Columbia University, the center's preeminent leaders on celiac disease discussed the following topics (the event is up on shortly:

10:00 am, Peter Green, MD: Introduction to the Center and recent new information on celiac disease

10:30 am, Phil Kazlow, MD: Update in pediatric celiac disease

11:00 am, Suzanne Lewis, MD: Evaluation of poorly responsive patients

11:30 pm, Suzanne Simpson, RD: Why see an expert nutritionist for evaluation of celiac disease

12:00 Buffet Lunch Served (gluten-free, of course!)

12:30 pm, Christina Tennyson, MD: Nutrient and vitamin replacement

What I found of particular interest was the discussion of both "Evaluation of poorly responsive patients" by Dr. Lewis and Ms. Simpson's discussion about “Why you should see an expert nutritionist for evaluation of celiac disease.”

Sound familiar? Folks at the FAAN conference also talked about the vital importance of diet for the food allergic community.

According to Dr. Suzanne Lewis of Celiac Disease Center at Columbia University, thirty percent of people on a gluten-free diet fail to see improvement. Why? It’s mainly due to noncompliance.

Why do gluten-free folks not follow the diet? Because it’s difficult and they don’t know what to eat exactly.

As Dr. Peter Green stated: the gluten-free diet is what to avoid as well as what to eat. Many become educated on what to avoid but how many know what to add back in?

For those with diagnosed celiac disease, I urge you to make an appointment with a registered dietitian who understands celiac disease.

Some helpful sites. (NY ADA Chapter)

Tuesday, June 23, 2009

"Don't You Trust Me?"

My father and stepmother follow the raw diet religiously, so their kitchen is one tree-nut factory: nut milks, sweet nut balls, nutmeats and nut salads. They are nurtz for nuts. For this allergic girl, their kitchen is a potential minefield. When I visit their home, I do my best to further minimize risk by bringing my own food, keeping it segregated in the fridge, and generally washing and rewashing a lot of dishes and hands.

Of late, dad has been buying this organic raw honey. It’s crystallized, spreadable and beyond delicious. He buys it in bulk, in a carton of six big tubs and offered me some. This past Father’s Day weekend, I brought a quart jar to fill up with honey. (Always fun to “shop” at the parents’ house.)

On the counter top (next to lots of open packages of tree-nuts) there was an open tub with deep groves left by the bowl of the spoon scooping out luscious portions of honey for their morning green tea consumption.

I took out a fresh tub from the carton in the pantry and asked if I could open it to take a portion from there.

“Sure”, my dad said. “But why not use the open one?”

“Because you put your used spoons in there.”

“Yes, but just spoons for tea.”

“But what if you ate some nuts and then used a nutty spoon to dip into the tub?”

“But we don’t do that.”

“Never? Ever? You’re saying you never ate some nuts using a spoon and then used that nutty spoon and dipped it into the tub?”

It was an irrational question, I know, and not really probable but it was my deepest fear. I was thinking of the few occasions when he absentmindedly has offered to cut me some watermelon after popping a few Brazil nuts in his mouth without washing his hands. Not neglect per se, just not focusing.

“I don’t think we’ve ever done that”, he said. Then the T bomb: “Don’t you trust me?” He was teasing with a grain of truth.

“No,” I smiled. “Not with this. As it’s all the same to you I’m going to open the new honey and take some with a clean spoon.”

"OK," he said.

I did and it was delish.

But my dad’s question has lingered. Did I go a step too far in saying, “I don’t trust you with this”? Or was that a legitimate precaution? Especially given the lack of hand washing history and/or all the tree-nuts everywhere? At what point does risk management become global distrust? Can a person with food allergies ever let their guard down? Even with loved ones?

Big questions, I know.

I wonder readers: what would you have done? Would you have taken the honey from the already open but potentially contaminated container? Or would you have held your ground for a new fresh container? Is there a third option you can envision?

Friday, June 19, 2009

Big Night, NYC Food Film Festival

Real Timpano inspired by Big Night

Did something that felt New York-y last night: went to see an outdoor movie, at the South Street Seaport, in the fog and the rain, with a crowd of film goers, foodies and foreigners. It was the penultimate night of the third annual NYC Food Film Festival.

We all watched Big Night (sponsored by Buitoni). Remember that little jewel of an indie? Co-written and co-directed by Stanely Tucci, this poem about Italians and Italian food in the 1950s was the ideal treat after a long day at the office (er, where I write and think about food). The audience laughed more this time around than I remember when I saw it originally in theaters. It felt like a cozy drive-in or what I imagine that would be like. Here are some atmos shots of the new Water Taxi Beach at Pier 17.

Special drinks menu:

An "installation" at the end of Water Taxi Beach

Burgers for sale

Here’s the plot of Big night from Wikipedia. Here's Secundo trying to get 1950s patrons to understand the concept of risotto. Here the same scene translated into Italian. Brill! Here are some of the best lines in the movie by Pascal, the brothers’ perceived main rival for business.

“Bite your teeth into the ass of life”

“Give the people what they want, then give them what you want.”

“Secrets make the friendship stronger.”

The NYC Food Film Festival partnered with the NYC Food Bank to have a collection post for canned goods. I brought in over half a dozen cans that I discovered after starting a version of “eating down my fridge” (and pantry and freezer) last week through reading Kim O’Donnel’s tweets (@kimodonnel).

There’s one more night of the NYC Food Film Festival left, the movies are free and the last night movie is about Peeps, sweet Peeps.

Wednesday, June 17, 2009

Diet, Food Allergies

There is another aspect of food allergies that is often not discussed and I was glad to see FAAN address it at the FAAN Conference in Tarrytown.


How does one deal with the inevitable dietary restrictions, avoidances and eliminations that are an integral part of a diagnosis of food allergies?

With a lot of emotional, family and medical support. And dietary support from a well-trained, highly knowledgeable registered dietitian.

(Not all dietitians are created alike. Make certain yours is registered with the American Dietetic Association and has experience dealing with food allergies. How do you find out if your dietitian is registered? ASK before you go or look them up on the ADA site .)

I know many of you adults have been dealing with food allergies or intolerances your entire lives and have NEVER seen a registered dietitian, not even once, to go over what you’ve eliminated and what you need to replace. It’s never to late to learn more about your condition and new ways to stay healthy and happy!

According to Marion Groetch MS RD CDC of the Jaffe Food Allergy Institute, Mount Sinai School of Medicine a dietitian is needed:

If eliminating milk or wheat
If eliminating more than one food
If having a tough time with avoidance
If your growth faltering (for kids)
Evidence of nutritional inadequacies
Feeding difficulties or finicky eating (for kids)

Of any of that sounds like you, see a dietitian today. Some helpful sites. (NY ADA Chapter)

Tuesday, June 16, 2009

Enjoy Life’s Cookies for Everyone

One of my fave allergy-friendly companies, Enjoy Life (I can’t seem to get enough of the boom CHOCO boom™ crispy rice bar) has come out with a cookbook of 150 cookie recipes: Enjoy Life’s Cookies for Everyone!:150 Delicious Gluten-Free Treats That Are Safe for Most Anyone with Food Allergies, Intolerances, or Sensitivities by Leslie Hammond and Betsy Laakso.

From my scanning of the recipes, it looks like these easy bake cookies will be perfect for your little (or, ahem, bigger) cookie monsters. Please note: I haven’t yet tried a recipe yet but will soon and do part two of this post. Alias of has tried them out and it sounds like she loved, loved, loved.

The majority of the recipes are based on three allergen-friendly companies’ products and hinge upon these companies’ allergen statements and practices. The three companies are Enjoy Life, Bob’s Red Mill and Spectrum organic shortenings. Additionally, most recipes rely upon white sugar or superfine white sugar; however, there is a section for “healthier treats”.

Recipes are good for overseas market as all measurements are in both grams and cup measurements, Fahrenheit and Celsius (even gas marks for UK). Smart!

PLEASE NOTE: A rep from Enjoy Life recommends we use the volume measurements rather than weight as they had the better results this way.

I’m so excited to try them out. More soon.

Monday, June 15, 2009

Getting on the Ticket 2

You know how I love getting on the ticket-the food ticket that is.

Where have you all been lately that was safe, where you got on the ticket?

Friday, June 12, 2009

Greenmarket Bounty

Fifteen dollars American bought the above: eggs (your eyes aren't tricking you, they are blue/green shells), a pound of asparagus, a pound of broccoli, one bunch of mint and a pint of strawberries.

So far, I've made two lunches and dinners of the broccoli & asparagus, ate the strawberries for two snacks and none of the eggs in 48 hours.

So I ask you: expensive or worth it?

Wednesday, June 10, 2009

Cocoa Crispy Brown Rice Cereal

When was the last time you had cocoa crispies that make the milk (or dairy-free alternative) turn chocolaty? I know for me it’s been decades. As a child, my mother didn’t allow sugary cereals and then as an adult many of these morning treats became off limits because of my food intolerances (dairy and wheat).

Well, welcome back morning deliciousness.

Erewhon, who I’ve discussed in the past, has both organic and gluten-free cereals. What could be better?

This morning they had a cereal media tasting in Midtown where they displayed what they think could be better.

Erewhon is rolling out two new gluten-free cereals.

Cocoa Crispy Brown Rice whose product development included ensuring that the cereal would make the milk chocolaty (which it does, as you can see in the picture below).

And Strawberry Crisp, Erewhon’s version of Special K, with a light “frosting” and freeze dried strawberries.

I tried them both. (Erewhon/US Mills arranged for some Lactaid milk to be available so I could try the cereal in their correct state--Thank you, Amy!)

The Cocoa Cripsies tasted just right, a deep cocoa flavor but not overly sweet. The Strawberry Crisps flakes had a satisfying corn crunch; the frosting was light enough to suit an adult's palate (who has a low sugar diet, that would be me) and I think a child would still be thrilled with the product.

Overall: I think these new GF cereals are winners.

Thank you Erewhon for the breakfast and for the new products.

Monday, June 08, 2009

Worry-Free Dinners & B.R.Guest

I’m thrilled to announce a new Worry-Free Dinners partnership with a renowned NYC restaurant group: B.R.GUEST.

I've had many happy and allergen-friendly meals at various B.R.Guest restos over the years and have talked about several of them on Please Don't pass the Nuts. Remember my great date at Blue Water Grill? Or the business lunch at Dos Caminos Third Avenue?

Now you can experience some of the allergen-friendly love yourself. We will have our inaugural Worry-Free Dinners event for adult members on July 12th.

The excellent Mexican menu will be gluten free, peanut free, tree nut free, fish/shellfish free and still full of delicious flavor! Chef Young will be on hand to chat and walk us through how she specially prepared each dish just for us. Our table discussion theme will be: safe summer travel with food allergies/dietary restrictions. And as always I'll be there, chatting, coaching and eating with you!

Visit the WFD website for more details.

(Remember: Worry-Free Dinners® is a membership group and you MUST be a member to eat with us. It's super easy to join. Just send an email to to request an application. )

Friday, June 05, 2009

Lupine Allergies

Recently on I was asked about lupine allergies and how they may (or may not) relate to legume and/or peanut allergies.

Never heard of lupine? (Always makes me think of the Monty Python skit: “Dennis Moore”)

According to the online Encyclopedia Britannica, Lupine is in the pea family: Fabaceae (the plant family also called Leguminosae). So you can see why there might be some concern for you peanut and/or legume allergic peeps.

As of now, in the US, we don’t see a lot of lupine in food allergy free from foods. However, lupine is all over Europe and as more European free from foods are distributed and sold here (the FA food demand is high and getting higher) lupine may be something you'll see more and more. (Here’s a BBC story about this very concern.)

* Remember: it is vital to be reading food labels with vigilance. Please call food companies if you have any questions or concerns BEFORE eating.*

So peanut or legume allergic peeps: will a product made with lupine or lupine flour be safe for you? I turned to board certified allergist Dr. Matthew Greenhawt to have a look at the literature and this was his reply:

Within the legume family, the most notorious allergen is peanut. On blood tests and on skin tests, however, it is often observed that allergy to one legume results in cross reactivity to other legumes. This concept differs from multiple legume allergies, which most commonly involves allergy to lupine, chick pea, and lentil.

Given the rates of cross reactivity, the question becomes what level of concern should a peanut allergic individual have about reactivity to any given legume?

Clinical observations have shown that peanut allergic individuals generally have less than a 5% risk of having a reaction to another legume family member. There is one notable exception: lupine. Lupine is a bean that can be processed into flour, and it is generally used as either a supplement to wheat flour or a substitute for soy flour. There have been increasing reports of lupine allergy in both peanut and non-peanut allergic individuals.

In one small recent study, lupine was potent enough to elicit reactions beginning at just a 1mg dose in both peanut and non-peanut allergic individuals. Other studies, all involving lupine challenge in peanut allergic individuals, observed rates of cross-reactivity of 13%, 22%, and 35%. Therefore, clinically relevant-cross-reactivity with lupine in peanut allergic patients is a concern.

Peanut allergic individuals should exercise caution and consider avoiding foods containing lupine until testing (only available via ImmunoCAP in the US, outside of a research institution) and possibly controlled challenge with an allergist determines there is no risk of reactivity.

It should be noted that the presence of lupine is not always clearly labeled, and concerned individuals are reminded to carefully read all package labels before ingesting their food.

UPSHOT: There is a possibility of cross reactivity. Check with your allergist about how to proceed. Need to find an allergist check out

Thursday, June 04, 2009

Allergy-Friendly Restaurants, NYC

Welcome Allergic Living newsletter readers! Please, have a look around the Allergic Girl site, the Allergic Girl Recommends site; join us for a family Worry-free Dinners luncheon if you’re visiting NYC this summer (our next one is June 28th at 11:30am), join me on and please email me at if you have any questions.

Monday, June 01, 2009

Julie & Julia

Remember food blogger Julie Powell’s Julie/Julia Project? Over a year, Julie Powell cooked her way through Julia Child’s Mastering the Art of French Cooking and blogged about it. Then it became a book. Here’s the NYT review. And now, it’s a movie with Meryl Streep directed by the wonderful Nora Ephron. (I met Ms. Ephron at the movie screening and only gabbed with her for like 3 minutes but she seemed wonderful.)

I saw the movie screening (it comes out in August) with a BookExpo America audience, one well versed in this publishing story, Julia Child’s story and the story of Judith Jones, the American editrix that published Julia first.

Food was the star of the show, after the story of Julie & Julia (or was food first really?). Butter and sauces and meats and fowl and fish were gorgeously shot, luscious to look at and clearly enjoyed by the characters.

The movie also showcased a fictionalized version of Julia Child: her appetite for life, her joie de vivre and her innate sexiness (yes, sexiness). Meryl Streep was the embodiment of this larger than life food icon, and she seemed to be having a great time portraying Julia.

For me, the food, the cooking, Julia Child's story, the copper pots and pans, the whisking, the braising of beef in wine and the trussing of chicken legs were joyous reminders of our collective human affection and respect for food, culinary craft and technique and the wonder that is cooking and entertaining.

For someone that has food allergies, like this Allergic Girl, all the foodie elements of the movie deeply resonated with me.

Are you surprised? Perhaps you think that having food allergies means I dread mealtimes? Or that I should dread them? Or that I wouldn't like movies about food and other people's carefree abandon when eating anything they want, anytime?

I know for many of you, by many I mean millions, mealtimes are fraught with panic, anxiety, even fear and dread. Joy doesn’t enter that dining room; joy is for other people and food.

Let me say to you right now and I hope you listen closely: Joy and food and food allergies can co-exist.

I am proof: My love of food has not been diminished by food allergies. I think my foodie love has been heightened precisely because every safe morsel is savored and treasured and a reason for delight.

Sure, I wolf down a quick rice pasta dish every now on my couch in my jammies without much thought or pomp (like I did while writing this post). But for the most part give me some roasted asparagus in olive oil with sea salt and a fresh squeeze of lemon and watch as I consume each spear with relish.

I invite you to start thinking about this, for yourself. Food and joy and food allergies and then joy again. If you think about this "issue" all the time, then think a little deeper than you have before. Try to be kind to yourself and connect to what you love about sustenance i.e. food. And then maybe see the movie when it comes out. And have some butter.