Episode 78: Back to School - Gluten-Free College

On this episode, Jules is joined by Gabrielle Adragna MS, RDN, LDN, a dietitian at Aramark. In my role as Regional Dietitian at Aramark, she specializes in nutrition, menu transparency, and student engagement, collaborating with teams to promote healthier lifestyles on campus. Her passion is making sure people who eat differently - like those with celiac disease or a gluten intolerance, or people with a food allergy - can dine safely and experience college just like everyone else. 

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Transcript

0:09

Hey, I'm Erica. And I'm Jules. Most people have at least one thing that they can't or won't eat. Yeah, we're definitely like that. We started this podcast to talk about the gluten-free food industry. Like new products and some of the stories behind your favorite brands. And living life with a specialty diet and also some important healthcare topics. Since we're basically both broken inside. You Had Me at Eat. So welcome everyone to another episode of You Had Me at Eat. I am Jules and I am here with a special guest today. I have Gabrielle Adrania. She is a registered dietitian nutritionist at Aramark for the Northeast, supporting that region and specializing in nutrition, menu transparency, and student engagement on campus. So I had asked her for this special episode to come on with me to discuss, at this time of year, all things college and university for students who are entering the college life, either for the first time or returning. Mm-hm. Maybe could do it a little better this year. and they have dietary restrictions, be it celiac disease or others, there are a lot of things that are available to them that they may or may not know about. And it's kind of, anymore it doesn't have to be at a particular university. There's a lot of things that are available across the board at most universities. And there are nuances at different places. But Gabrielle and I met and started talking about it, and I could tell immediately how passionate she was about, you know, the student piece and making sure that students understood everything that was available to them in terms of accommodations. So I thought this would be a great opportunity to get this information out there. So thank you so much for coming on with me today. Of course, Jules. I'm so happy to be here, and I'm grateful that you're giving me the platform to talk about this very important aspect of entering college students' life. There's been a lot of discussion around allergies most recently and how they're formed, and, you know, I think that they're more abundant than ever. So having this conversation is really important, especially when a college student may have had their allergy previously managed by a parent or somebody else. So they're coming to college completely on their own, and it's really important to know all of the different things that their university or college could offer them. Yeah, I mean, I think especially this transition to college is such an important one for so many reasons, right? I mean, as you just alluded to, they're, you know, maybe they've been taken care of by mom and dad for all of their lives, right? That's the way it's supposed to be. And all of a sudden, they're on their own, which is, again, what's supposed to happen. But when you layer on something like a dietary restriction, a food allergy, something that's life-threatening perhaps even, you know, you're layering that on, and that fear of entering the unknown and being completely responsible for themselves in a way that is a life or death situation or could make them just very, very, very ill, it adds a lot of anxiety. Totally. Yep. Yeah. And it's— well, and that's, that's what we're here to talk about is how to manage that anxiety because it is real. It's not like it's not important. It's not like it's not a real thing. How to manage that anxiety, how to use the tools that are available, and how to do it safely, but also how to, you embrace the opportunities that are given to you because college is such a fantastic time in their lives and they shouldn't be afraid to move forward and enjoy all that college has to offer. I completely agree with you. Awesome. Well, I know at this time of the year, most of these students, they've already decided what college they're going to and they're now getting ready to move and to go to college. But I bet you've actually met some students, I have, I'm sure, you have, who made their college choice based upon what college could best actually accommodate them and their dietary restrictions. Have you seen a lot more students doing that in terms of shopping for schools? Yes, I have actually. And 2 platforms or websites that I've seen students use most, and ones that I've actually been responsible for updating, are the Celiac College Guide and the FARE College Search. So that's Food Allergy Research and Education College Search. They have these great databases of colleges where you can actually go in and search any college that you might be interested in attending, and they list every single way that the dining provider on campus can accommodate a student with food allergies or dietary restrictions. And there's certain gradings that are associated with them, certain color grading like red, yellow, green. And it really just is a one-stop shop for incoming students to understand what their school can do and then offer contact information for each specific university as well, in case you want more information. That is so cool. I mean, what a fantastic resource. And you alluded to the fact that you helped to update them, so I assume that they're updated very frequently then by you and others in the field, which is fantastic because I'm sure these things change all the time. They do. I am required to go in at least twice a year and update the various different accounts that I oversee. And I work with the general managers and the actual staff on campus to associate— to get that information as well, because not all of it are dining questions specifically. Sometimes it's, do RAs have training in food allergies or how to help somebody in a food allergy emergency? And I can work with the campus directly, or the GM who's on site every day can work with the campus directly to answer those more specific questions. Wow, that's such a useful resource. I mean, I can imagine, for especially for people with life-threatening food allergies, what a relief that would be to have that research done for them in advance and just be able to narrow down their college search based upon that. That's really cool. Definitely. Cool. Well, okay, so let's say I'm a student who has done my homework and I've picked my university because I believe that this university is going to be able to accommodate me and have delicious gluten-free food, and I have celiac disease and school hasn't started yet. Should I do anything before I get to school, or should I just wait until I get to school? Is there anything I could be doing right now that would be helpful before I land on campus? Yeah, I think that beyond the websites that I just mentioned, trying to see if that university has a dining website specifically and getting to know the team that is available to you on campus when it comes to the people who are actually serving your food. Sometimes it is a general manager, a food service director, a registered dietitian like myself. Understand who those people are. Hopefully there's photos on the website, but also just sending a quick email to all of them. And just introduce yourself saying, I am an incoming freshman or transfer student, whatever it is. Explain your allergy, and if there's not a dietitian on campus, maybe the manager can forward your email to a regional dietitian or something like that. Because giving them the heads up is a great way to just understand what your options are too, because when you schedule a meeting with them, for example, They can walk you through verbally what your options are and explain all the different locations on campus that would have, for example, gluten-free food, or at a lot of universities we say made without gluten because there is that risk of cross-contact being in an open-air kitchen. But there are different resources like stations, for example, that maybe don't have the top 9 allergens and do take every single precaution possible to reduce that cross-contact when it comes to allergens. So— Definitely reach out to the dining managers. That's gonna be my biggest piece of advice. Yeah, that's a good piece of advice. And I think also it's good training too, right? For them to start that self-advocacy and to really start reaching out and maybe doing it by email first. It's a little bit easier than having to present themselves. One thing that I have noticed, dealing with a lot of these, you know, students of that certain age, it's not something that most students want to call attention to themselves about. Like, they don't, they don't want to talk about their dietary restrictions or that there's something different about them or that there's something that is weird or, you know, makes them you know, just different. Like, you know, teenagers especially, like, they, they don't want to be different, and they— and certainly not, this is not cool. So they don't want to be called out. Yeah. So a lot of them don't want to identify themselves, and no matter what you say to them and, and, you know, how often you tell them that this is better and this is, you know, you're gonna get even better food and, you know, whatever, they, they don't want to do it. So how would you encourage these students to take that first step, either by email or phone call or presenting themselves once they do get to campus? What do you do to really get them over that hurdle to convince them? Yeah, I think the messaging on websites is so important because if they don't necessarily understand who they can contact or even get to me, Right. The work has to be done before I'm even in the picture as the dietitian that they can talk to. So advocating for certain messaging on your website or working with the admissions team when they're doing college tours on campus to say that there is a resource like a registered dietitian on campus or a top 9 allergen-friendly station and making sure that those messages are shared. So that the student, you know, feels comfortable with maybe taking care of it themselves first, but then also understanding that there is somebody that they can meet on campus to dive in a little bit more. Because the last thing that I want is for a student to get on campus and it's not super clear to them what they can eat and what they can't eat. I mean, we do our best with digital signage boards or identifying cards, but sometimes it doesn't have all the information they need, especially if it's a Allergy that's outside of the top 9 allergens. Sure. So having that, um, contact person is just, is so important because then you come to campus and if you have an allergy and you don't know what to eat, then they just go towards safe foods. And maybe for gluten-free, for example, right? Like, I know that a lot of different animal proteins, all animal proteins are gluten-free generally. Um, and that's what I'm going to eat all the time is animal proteins. And, you know, that obviously omits so many other food groups, categories, and then nutrient deficiency, obviously something I'm always thinking of as a dietitian, comes into play too. And the lack of variety and what that can do to your gut microbiome and your focus and, you know, your energy. And you're in college, there's going to be a lot of things to do. And I don't want students to have to worry about their nutrition. It should be an easy thing that they can get together, especially since they're usually on a meal plan. They're first year, and there's all-you-care-to-eat access at a dining location, which is huge. So they don't have to worry about shopping, cooking, anything like that. Yeah, no, I think those are some really good points. Um, I am thinking back to, you know, my, my daughter's college age and a lot of her friends and just sort of, you know, even those kids that I, I know really, really well. I've known them since they were little. They, you know, they know me, they trust me, and some of them have food allergies, some of them have celiac. Statistically speaking, it was bound to happen, you know, and then, and me counseling them even, and I remember this one kid telling me like, I'm just sick of eating, you know, chicken and rice every day. I'm like, because you won't identify yourself on campus. Right, right, so problematic. You've just got to do it because once the dietitian knows you're there and knows what your needs are, then they can start to work for you. Yes. And they can help find other things. And if there truly isn't something that's already being prepared that is safe for you, then they will help work with the chefs and they will make something else. Exactly. And that's why this whole issue of accommodations is so important. And let's step back to that because, you know, yes, if I have celiac disease and I come to you and I say, you know, hi, I'm Jules and I have celiac disease and here's a letter from my doctor, you know, whatever, saying that I have celiac disease, that's fine and well because we know that under the Americans with Disabilities Act, it's recognized that celiac disease is covered under that. Yeah. And a food allergy, fine. But what if someone comes to you and says, I think I have celiac disease, but I don't know. Or, I don't have celiac, I have non-celiac gluten sensitivity. Something else where the lines are a little more gray. What happens? What do you do with a student like that? Yeah. So I'd like to think that 99% of the time a student doesn't even need what I like to call an extraordinary accommodation. So when I'm saying that, you don't necessarily need to have a chef privately cook you a meal because there's a chance for that cross-contact, and then the chef would prepare that meal for you completely separate from everything else. That's above and beyond an accommodation that a student might need, but it's rare because we'd like to think that our menu offerings at these universities are vast enough to satisfy the majority of dietary needs and restrictions. When it comes to students who think they may have a food allergy, it's not diagnosed, or a non-celiac gluten sensitivity, like you said, It can be a little bit more challenging. We want the documentation, but again, we only need the documentation if there is an expectation where they need a significant accommodation. Otherwise, it's just them talking to accessibility or disability services on campus, that office scheduling a meeting with the dietitian on campus and/or the manager of the dining services. and working with that student one-on-one to see what can be done for them versus needing specific documentation for an accommodation. Does that answer your question? Yeah, in other words, like, you know, if you're that student, don't shy away from still having that meeting and, um, and asking for assistance and guidance and asking for that dining hall tour With the nutritionist because the nutritionist or the dietitian there or even the chef there can show you what is accessible and available to everyone, but might actually be very much tailored to your diet. It just so happens that it works for you. Yeah. Yeah, and then for— I'm thinking of There's a couple schools I know of off the top of my head. I'm sure you know several as well where it— for people who have extreme food allergies or lots and lots of food allergies where it's just like they're just layered and you'd think, oh my gosh, there's just no way anyone could ever prepare a meal safe enough for this person because there's just so many different things. Mhm. There actually are schools that do that with the appropriate accommodation You know, proof that that is needed. And, and it's, it's out there, folks. So don't, you know, don't even think that, you know, you can't go to school. Yeah, of course. These are things that, that are available, and we want everybody to have that social college experience too. Totally. And I do want to say something about accommodations as well. Another thing about accommodations. Yeah, sometimes students with food allergies or significant restrictions will automatically think they need to register with accessibility resources for students or disability resources for students on campus. And it might be a lengthy process depending on the university that you're applying to, and it's not always necessary because, like I said, it's when you need a kind of extraordinary accommodation. And you might not need to go through the whole process, so you just reach out to dining first, see if what they offer satisfies your need, and then work with them to get referred to the accessibility office if needed, because you need an additional accommodation, like a housing situation where you want a single because you're severely allergic to something that you're afraid of having a roommate have in their dorm room type of situation, or if they do need a separately prepared meal from the chef. Yeah, I love that. I love that because, you know, like, like I said earlier, a lot of people are just really daunted by the whole idea of saying like, hey, look at me, look at all these problems I have or whatever, and maybe you don't need all of that, but start with the dining services so you know what they already have and then you know what else you might need. And then to the other point that you just made, one of the possible accommodations that's out there is actually in the housing realm, which is kind of cool. Yes. And I don't know, and you just mentioned one of them, but if you could speak to that just at least briefly that, you know, different possible types of accommodations in the realm of housing? Yeah, so I know that sometimes campuses have different apartment-style housing that have kitchens, so in-suite kitchens. You might not technically have access to that your freshman year, but if you have a significant food allergy and you need a specific access or kitchen access, maybe that's something that you could apply for. Or if it's not a private kitchen, it could be a shared kitchen. And all of these things are really limited and usually reserved for upperclassmen because they've suffered through, quote unquote, living in a dorm. They've done their time. Yeah, they've done their time freshman, sophomore year. Yeah, but that is part of the accommodation process. If you have, you know, that medical need or that need covered by the ADA, that's exactly what could be done is a single, a shared kitchen, a private kitchen, Um, a share— a single bathroom versus a shared bathroom depending if there's like GI stuff going on. So yeah, there's, there's lots of options depending on the school. That's awesome. Um, I think a lot of people don't even realize that that's part of the suite of possible things that are available, so I think that's really a good thing to mention. Um, and then of course once you have done your time and you move off campus there's always the apartment option where, you know, you can, you can do that as well. So just briefly, because I know, you know, you do love to talk about student services and working with students, and I know that's a passion of yours, but like, aside from the actual dining hall, how would you counsel these kids who are coming in with dietary restrictions to navigate other types of social events? where, I mean, honestly, a lot of them do involve food, right? I mean, food kind of permeates all social things in our, in our world. How do you counsel them in that so that, you know, they do get the rich experience of being on campus and being involved in clubs or doing other social activities, you know, be it Greek life or, you know, what have you, but like what types of interactions have you had with, with students about that where you've actually helped them to, you know, I guess bridge that gap and figure out how to handle those social situations? Yeah, I think there's a few things that students could do in social situations. I think that if it's out somewhere, say at a restaurant, and you can always look at a menu in advance and understand if there are options for you on the menu available. And speaking to a manager, as always, when you get there, just to make sure that they understand you have a food allergy. It doesn't have to be at the table in front of everyone, but maybe you scoot away and say you need to go to the bathroom and just find somebody that you can talk to and say like, hey, give, give them a heads up. I have a food allergy. It's severe. I'm with all of my friends, but I can't have X, Y, and Z. That could be one option. If you are going to a gathering, a party, you know, you know, there's going to be food. Maybe you could bring something that you know is safe for you, but you make it big enough for everybody. So you're not singling yourself out, but you are bringing something. You know, you're a good guest bringing something. Yeah. But also that's a safe option for yourself, which is great. If it's a school organized thing, usually catering on campus, the dining services provider is going to be serving that food. So it goes back to that, um, situation or process of working with the catering person or making sure you understand who's ordering the food so that the food allergy is relayed to the catering person manager, um, to make sure that there is a safe option for you when you get to that social event that was organized by the school. And then there's always the eat first. Yes. Eat first. Yes, of course. I know that that is a very good option too. Absolutely. Yeah, this is just practice for the rest of your life, kids. Sorry. It is. No, it's so true. This is kind of what happens. We're not done yet. Yep. And you can say, yeah, I already, I already had lunch. I just ate. Yeah. Or I got a bag of gluten-free pretzels in my backpack. That's kind of the way I roll. Yeah, you know. Yeah, absolutely. It's the way I still roll. So yeah, that's, uh, kind of the way— It's good practice, Jules. It is. It really is. So what about kids who, you know, not in the celiac world, but like the food allergy world, and those kids who have severe food allergies and their epinephrine preparedness? You know, do you have a lot of consultations with those kids and their parents before they come to campus or once they land? And where are campuses going now with having epinephrine stocked around campuses now. What are you seeing? Yeah, so whenever I meet with a student with a food allergy, one of my questions is, do you have epinephrine, yes or no? And if they answer yes, I am always sure to tell them that they should have it on their bodies at all times. And I know that pockets are small for, for female clothes, and, you know, you don't always carry a backpack, but This is a life-saving tool that is necessary for food allergic reactions. So having all of— having that on them is a non-negotiable for me. Whether they do it is their prerogative, but it's life or— it's a life-saving tool. So I'm going to highly, highly encourage them to always have it. And if they don't, Um, there is a process on campus, a lot of campuses where you recognize a student's having a food allergic reaction, you call campus police or you call 911. And usually they join forces together. If you call campus police, there's usually an automatic dial to 911 at the same time. Um, and then the ambulance would have the epinephrine needed, but that response time, I mean, it can vary depending on where you are in the world. So having it yourself is definitely the first line of defense. To answer your question about where universities are going for stock epinephrine, it varies so widely across the country. For example, Massachusetts, there's no initial law or bill in place right now for every school to have it. Um, and there's certain trainings that need to be done to even be considered to have it. So I think that it's, it's not widely accepted as something be on campuses right now. And there is a huge cost associated with it as well. And there's— we shouldn't have to put a price tag on potentially saving someone's life. But that is a factor, unfortunately, in the world right now. Yeah. Well, hopefully, you know, this segment will be dated and this time next year, it'll be like, oh, that's so outdated. I hope so. I hope so. When they were talking about that, there weren't very many that had stock epi, but now everybody's doing it. Yeah, if only, but we'll see. Hopefully that'll be a thing that moves very, very quickly. I hope so too. So how many, I mean, do you counsel them on how many epinephrine pens to be bringing with them at any given time when they come to campus? I mean, it usually depends on their specific protocol for themselves. I know that some doctors will say, 1, but other doctors will say 2. So I say whatever is your specific protocol, you should have. So if it's, if it's 1 required, if it's 2 required, absolutely have that. And it's not even just injection pens anymore. I mean, they have the nasal sprays now, which are less, um, invasive, I guess I would say. And that can vary too. So whatever is recommended by their doctor is what I recommend. And just like we're talking about notifying dining services and, you know, going that route with regard to food, is there a recommendation for notifying health services that you, when you're coming onto campus as a student, that you have a food allergy that requires epinephrine? Not necessarily, because most students coming to college are 18, and I would encourage it. just to be on somebody's radar. Usually campuses have nurses on staff that they can absolutely talk to and bring them up to speed, um, but it's not required like it is in like a K-12 setting. So I, yes, encourage the person to go to health services and disclose, but they are adults, so they might not. Yeah. And is there any advice that you give to students to Like, if I was coming on campus like that and I had a roommate who was unfamiliar with food allergies, is there anything that you tell these students about, like, hey, you should prep your roommate for this just in case of an emergency, or, you know, anything like that? Yeah, I will usually suggest that students just be fully transparent with their roommates about their food allergies and the severity of them, what reactions may happen if they are exposed to their specific food allergen, and their specific plan with what should be done if they do get exposed to that food allergen. So if there is initial signs of food allergic reaction, you know, swelling of the throat, hives, something serious, you know, epi first, epi fast. suggesting that the epinephrine should be admitted. If for some reason the student can't admit it, administer the epinephrine themselves, suggesting to their roommate that they might need that assistance in the short time of this food allergic reaction happening. So definitely bringing them through your emergency action plan is what I would say as well. I, um, I just heard a story anecdotally from a friend of mine She was telling me the story that her sister was traveling and studying abroad and had informed her roommate, thankfully, that she had been exposed to a nut in eating out, and she has a nut allergy. But she was just gonna go to bed and try to sleep it off, which is absolutely not what you do. Mm-hmm. But thankfully, She had told her roommate that she had had this exposure, and the roommate found her and she was not breathing, like, later on, and was able to call 911 overseas and say, this is what happened. Oh my gosh. And only because they had gone through that information, you know, that was very, very helpful. And if she had kept that from her roommate, like, had been, you know, too shy to tell her roommate that she had an allergy or didn't tell her roommate what had happened. Or, you know, so information, it's all about information. Absolutely. Yeah, this is— it's nothing to be ashamed of. I mean, if, if you had a broken arm, you'd go get it fixed, right? Immediately. You just— there's something that your body for some reason is telling a perfectly normal thing it's a threat, and it's Important to share this information because, yeah, yeah, you could have somebody else help you save your life, right? It's not your fault. Yeah, it's not your fault. No, no, it's not. Well, if, if you could create like a, a checklist for an incoming student with celiac disease or other food allergies or dietary restrictions, you know, what would be the top like 3 or 4 things you would say These are the things, if you can't do anything else, these are the things that I would say you do as soon as you land on campus. What would those things be? I would say definitely finding out who your contact person is on campus. So whether that's Dining Services or you connect with Accessibility or Disability Services first, find out who that person is and make sure that you have their phone number as well as their email. Send them an email first, maybe give them a call depending on your comfort level, but definitely find out who that is. And then finding that— for number 2, finding that dining website. Like I said, usually you can look at all the menus too. Sometimes during the summer there aren't visible menus, but as you get closer to the fall there will be. So you can actually go in and view what your options might be in advance, just like you would maybe look at a menu at a restaurant in advance. So finding that dining website. And then 3 is scheduling a dining tour before classes start. I know that the week before you get to campus, the week you are starting classes, can be extremely busy, but eating is something you need to do every day, so might as well get that dining tour on the books as soon as possible with the dietitian, with the dining manager, so that you can visually see what is available to you. at the dining locations on campus. And then carrying your epinephrine at all times, or whatever emergency toolkit you have, having that with you so that if there is ever an emergency, you have the tools that you need to take care of yourself. And then developing that confidence, that self-advocacy, practicing with your parents or with your friends, developing that confidence to talk about your food allergy and ask ingredient questions and recipe questions. That's gonna be so important for you throughout college, but also for the rest of your life. So definitely using that and creating that muscle to advocate for yourself and build that confidence before you get to campus. Yeah, and I think, you know, I'm excited by the fact that so many universities are working so hard to make the gluten-free and food allergy-free foods so much better. I mean, that's the conference where you and I met, is, you know, there were chefs and dietitians and nutritionists all there, like, trying to find the best gluten-free and food allergy-free ingredients to use to make better food. Because, you know, they're making these stations with all this— these creative You know, new recipes and things where, you know, it's not going to be just the food allergy kids who are going to want to eat that food because the stuff is going to be so good, right? Yeah. I know. And I've been to several of these universities and I've tasted, you know, a lot of the foods. And, you know, we're working with a lot of universities, my company GF Jules is, you know, to bring in really great ingredients for them so that that everyone's going to want to eat this food together. And so it's not going to be as stigmatized like it was before. And I think that's going to go a long way towards a lot of these kids also coming out of their shells and just, you know, like, okay, now I can eat this food with other people and I don't have to go to that section. And, you know, and there's other people coming with me. Yes. And I think all of these things are going to work together and really help these kids to feel more integrated and not as shy about what's going on, you know, with them on campus. Yes, so true. I think that we've come a long way with the options, products, recipes, and serving foods that are naturally allergen-friendly. But I do see a future where it's, it's just so much more obvious and available to everybody, and everybody gets excited just about eating all the different food. Especially on college campuses. We've come a long way. Yeah, we sure have. I mean, my goodness, just even a few short years ago. But, um, well, thank you so much for taking the time. Thank you for everything that you do on behalf of your students and for educating and helping to share all this information today. We really appreciate your time, and thank you again for sharing. Yeah, of course. Thank you for having me here. I'm so grateful to be a part of this conversation. And like you said, it's something I'm very passionate about, and I just want to encourage all incoming freshmen out there or transfer students to just communicate, communicate, communicate, because that's how you're going to have the best dining experience on campus. Absolutely. All right, well, everybody have a great new year coming up. So yeah, all right, well, thanks again for your time, and thanks for listening. Um, like and subscribe and tell everybody about You Had Me at Eat. Talk to you next time. Thanks for tuning in to You Had Me at Eat, the number one voted gluten-free podcast in the country. Remember to like and subscribe, tell all your friends, and we'll talk to you next time.