A Mass General dietitian offers families with students who need to go gluten-free tips on how to prepare and what to pack for school or college.

mghfc-pngCeliac disease, an autoimmune disease triggered by gluten, and serious food allergies are now considered disabilities under the Americans with Disabilities Act. This is important for parents and college-bound teens to know, says Pamela Cureton, RD, LDN, a dietitian specializing in celiac disease at Massachusetts General Hospital’s Center for Celiac Research and Treatment. School systems and colleges are required to provide gluten-free options for those with physician-diagnosed celiac disease.

Celiac disease affects 1 percent of the population, which means that 1 in 133 children, teens and adults cannot consume products made with wheat, barley or rye. If they do, they might experience symptoms such as diarrhea, nausea, headaches and inability to concentrate, and can suffer long-term intestinal damage. The only treatment is to eat a gluten-free diet. Because even minute amounts can trigger a reaction, food preparation must be kept separate so food items containing gluten do not contaminate gluten-free food.

Ms. Cureton recommends that the parents of school-age children with celiac disease or a food allergy meet with the principal, school nurse and the child’s teacher before school begins.

More Gluten-free Menus

Ms. Cureton recommends that the parents of school-age children with celiac disease or a food allergy meet with the principal, school nurse and the child’s teacher before school begins. “Bring a letter from the diagnosing physician that indicates the diagnosis and explains the disease and what happens if the child ingests gluten,” she recommends.

This is essential if parents want, or financially need, their children to buy lunches through the school lunch program. It is becoming more common for schools to have gluten-free menus, Ms. Cureton says. Cafeteria staff also need training, however, to understand the necessity of wearing separate gloves and using separate areas to store and prepare gluten-free food.

In meeting with school officials, parents should also discuss circumstances like field trips or classroom parties. The best approach is to make sure that parents are notified ahead of time so they can provide food alternatives. Also, certain art supplies that contain gluten, like Play-Doh, are fine to touch, but children with celiac disease need to wash their hands thoroughly afterward. Another tip from Ms. Cureton: “Give the teacher a goody stash, like gluten-free candy bars or even small toys, to keep on hand for times when another parent brings in cupcakes that your child can’t eat.”

Packing a Healthy Lunch

Dr. Allessio Fasano, the renowned director of Mass General's Center for Celiac Research and Treatment, checks in with Logan.
Alessio Fasano, MD, the renowned director of Mass General’s Center for Celiac Research and Treatment, checks in with patient Logan Dundas.

Parents of children with celiac disease are often more comfortable packing their child’s lunches. “It’s pretty easy, just look at what your child was eating before diagnosis,” Ms. Cureton advises. “Swap out what contains wheat with an equivalent that is gluten-free.” Gluten-free bread can be made or bought and many healthy foods are naturally gluten-free. These include fruits, vegetables, cheese sticks, pudding cups, nuts, popcorn and yogurt. Most chips are gluten-free, but be careful with flavored varieties.

Gluten-free cookies and other desserts are now plentiful, but Ms. Cureton advises to eat these sparingly as they can be higher in fat and sugar than their gluten-containing counterparts. The lunch of a child with celiac need not look different than any other child’s. But it probably will be healthier if the focus is on fresh, unprocessed foods, she says.

To ensure that children eat what is packed for them, Ms. Cureton suggests food shopping together so they have a choice. This is also an educational opportunity for children to read food labels to check for gluten-related ingredients. She also encourages parents to role-play scenarios at school so their children know what to say if someone offers them food that is unsafe for them to eat.

Navigating College Gluten-Free

As for college-bound students with celiac disease, Ms. Cureton advises meeting with food service managers as part of campus tours and the college selection process. Many colleges post information online about their gluten-free or food allergy programs and even have gluten-free food stations in their dining facilities.

Many colleges post information online about their gluten-free or food allergy programs and even have gluten-free food stations in their dining facilities.

“It’s a huge adjustment going off to college,” Ms. Cureton points out. A dietitian specializing in celiac disease can help college-bound teens make this transition. She or he can suggest what questions to ask school officials, what to bring and how to fit into the social scene without feeling different.

The federal health information privacy law means that parents can’t even talk to health center staff without their child’s permission after age 18. By college, students need to advocate for themselves, she emphasizes. There is still a role for parents, however. Care packages with gluten-free snacks are always welcome.

Ms. Cureton offers advice on following the gluten-free diet for people with celiac disease and other gluten-related disorders in “Gluten Freedom,” a book by Alessio Fasano, MD, director of the Mass General Center for Celiac Research and Treatment. To learn more about the center and how you can support it, please contact us.