EATING OUT WITH RESTRICTIONS Recently we organised a meal out for our patients who have Phenylketonuria (PKU) and who have to follow a very low-protein diet. Eating out for them is stressful, as most foods contain too much protein. Working out what to eat from a menu can be confusing and, if they were being strict, they would have to take along their kitchen scales and weigh out the foods which contain protein! So, to take that stress away, a set menu was prepared for them that was very low protein. We chose a vegan plant-based restaurant, where many of the meals could be tweaked. The menu included tropical jackfruit stew, penne palmero (using lowprotein pasta) and pear crumble (using low-protein flour), custard (using rice milk) and sorbet. The food was great and we ate and chatted freely. Recently, my niece was diagnosed with cow’s milk protein allergy (CMPA). This made me think about food labelling and how to work out which foods contain allergens, especially when eating out at a restaurant. Before the food allergen labelling laws were introduced in 2005, it must have been a nightmare trying to figure out which foods contained allergens. Now the ingredients that contain allergens have to be highlighted on the label by law. In my role as the dietitian to the Galactosaemia Support Group (GSG), I educate on how to spot milk in foods using the label (as people with galactosaemia have to avoid galactose/ lactose). Before the labelling laws were introduced, the GSG produced a booklet that contained a long list of all the lactose-containing ingredients that had to be avoided and ingredients that sounded like they contained lactose but didn't! Thank goodness for the revised labelling laws; we only need to look for the word ‘milk’ now!
Unfortunately, however, there are a couple of loopholes. Current EU regulations state that foods directly from dairy are products in their own right, eg, yoghurt, cream, cheese and butter. Therefore, they do not have to by law be declared as milk on the label, so caution needs to be followed when interpreting the labels. Prepackaged foods currently do not have to follow the labelling laws for allergens, but this is changing. Natasha's Law will be introduced in the summer of 2021. Natasha Ednan-Laperouse tragically died as a result of an allergic reaction to a baguette she had eaten, which did not display allergen information on the packaging. The new law will mean that all foods prepacked for direct sale (eg, a sandwich or salad made and sold in the same premises) will have to be labelled with full ingredients. As well as helping allergy sufferers, this will also help people with galactosaemia to identify which prepacked foods contain milk. Restaurants have to provide allergen information in writing, making it easier for the consumer to identify allergens. Eating out on a restrictive diet is hard, but with planning it is possible. It is now much easier than it has been in the past due to allergen laws. Whether it be checking the menu beforehand for allergens, or looking up the amount of protein, fat or carbohydrate in the meals, it can be done.
Louise Robertson Specialist Dietitian Louise is an experienced NHS dietitian who has been specialising in the fascinating area of Inherited Metabolic Disorders in adults for the last 10 years. In her spare time she enjoys running her blog Dietitian's Life with her colleague and good friend Sarah Howe, playing the cello and keeping up with her two little girls! www. dietitianslife.com
www.NHDmag.com October 2019 - Issue 148
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COW’S MILK ALLERGY
DOESN’T ALWAYS END AT ONE YEAR
TRUST NEOCATE JUNIOR TO SUPPORT HIS NEXT STEP
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Visit: nutriciaproducts.co.uk/samples This information is intended for Healthcare Professionals only. Neocate Junior is a Food for Special Medical Purposes for the dietary management of Cow’s Milk Allergy, Multiple Food Protein Allergies and other conditions requiring an Amino Acid-based Formula, and must be used under medical supervision after full consideration of all feeding options including breastfeeding. *Product can be provided to patients upon the request of a Healthcare Professional. They are intended for the purpose of professional evaluation only. † Data on file, May 2016 & January 2017 ‡ Clinical data on file, May 2016 Accurate at time of publication, October 2019. Nutricia Advanced Medical Nutrition, White Horse Business Park, Trowbridge, Wiltshire, BA14 0XQ