Eating Gluten-Free on Carnival Cruise Lines

Traveling with celiac disease is a never ending challenge. Spending a week or more in a domestic or international location is difficult. You have to locate grocery stores, pack your food for the plane and beyond and research restaurants that have gluten-free menus or are rumored to cater to the needs of the gluten free. It is a lot of work.

Instead of requesting a gluten-free meal on the plane, I bring my own.

So, when my sister informed me that the 2014 family vacation would be an Alaskan cruise I immediately started spinning all the potential food-related nightmare scenarios. This was my first cruise.

We sailed on the Carnival Miracle for seven days out of Seattle with stops in Skagway, Juneau and Victoria. I shared the least dramatic of my worries with my sister and she assured me that she had made the necessary arrangements for me. I was to meet with Guest Services and then the maitre d’ to discuss my requirements. The Carnival representative assured my sister that they could safely feed me. My sweet sister then researched gluten free eating on Carnival cruises and she found a blog post by the lovely G-Free Laura. I felt better. I knew I would be worried until I was on the boat and talking to someone but this information helped.

I arrived in Seattle and enjoyed lovely gluten-free meals at Tom Douglas’s Lola, Anthony’s and Elliot’sOddfellow’s in Capitol Hill (I also recommend Elliot Bay Book Company while you are there), and Local 360, which is super awesome spot where everything on the menu is local. All these meals were lovely and gluten-free.

Then it was time to board the ship. The embarkation process took less time than I expected (considering there were over 2000 people aboard). We headed for Guest Services to request the partition between our rooms be opened and to talk about my dietary needs. Unfortunately, my record did not reflect that I needed a gluten-free accommodation, it only noted a special need. I took this as – they aren’t ready for me and I have to be perfectly honest, I was scared. Guest Services confidently advised me that all I needed to do was talk with the maitre d’ and it would be fine. I had packed enough food to eat one or two meals a day out of my bag, but I knew I needed at least one good meal a day from the kitchen. So, scared doesn’t really describe it, I had a minor meltdown.

We made our way to the dining room for our first meal. I met the maitre d’, Ken, at the door and explained what I needed. He promptly dispatched the lovely Jana to my table. I explained to her that I have celiac disease and would need a gluten-free meal. I went on to explain that I am medically required to have a gluten-free meal and that I am extremely sensitive. She was unflappable. She assured me immediately that they could accommodate my needs. In fact, because of my concern she offered to personally order and deliver my food herself since my server would be responsible for multiple tables of people. I happily agreed. She got me. To ensure that the kitchen would have time to specially (separately) prepare my meals I would need to order my meals a day in advance. So, every night at dinner I ordered my meals for the next day. It seems like it might be inconvenient, but I did not mind and it gave my family a preview of the next day’s offerings.

Our server, Damir, was helpful and a pleasure to be around. He understood my need and worked hard with Jana and the kitchen to make sure my meals came out at the same time as the rest of the table. This was a struggle on some nights, but they were aware and working on it. The kitchen is stocked with gluten-free bread and flour. So, many traditional items (sandwiches, French toast, pancakes, etc.) are available. I avoid all grains but rice when I am traveling, so I was slightly more limited and declined to eat the bread and flour-based items. Despite my more restrictive diet Jana was able to work with the kitchen each day to find something for me to eat that was interesting. I did eat a lot of steamed vegetables and plain meat – salmon, mahi mahi, flank steak, filet mignon and ribs. But I was also to have the seafood Newberg revised to meet my needs. Instead of the Newberg sauce they made a lemon butter sauce and put it over rice.

They were willing to go the extra step to help me enjoy my meal. As for dessert, the cream brulee and chocolate melting cake were my go-to items. Although, they did have other gluten-free choices. While dining room service was very good and accommodating, the room service and buffet offerings were off limits. I was specifically instructed not to order room service and as a rule I do not eat off buffets (too many changes for cross-contamination). So, on the ship my meals were restricted to what I brought onboard and eating in the main dining room. Know this ahead of time – eating is not a whenever-you-want-it-option unless you have a large stash of food in your cabin.

Chocolate Melting Cake

I was pleased with the attention and consideration that I was given by the dining room staff. They were genuinely concerned for me and they went out of there way to try to make my meals fun and interesting. It was not a perfect situation but the service was great and the food was better than expected. Tip your servers, maitre d’ and Jana. They deserve it.

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Celiac Awareness Month: Ten Things Everyone Should Know

May is Celiac Awareness Month.

As you may have read, I have celiac disease and I talk (and write) about it a lot. It is a huge part of my life – it controls everything I eat, where I eat it, the medication I can take, and even what sunscreen I can wear. In my many discussions about celiac disease with friends, family, servers, colleagues, grocery store clerks, doctors, nurses, and others, I find that people are usually very interested in knowing more about celiac disease.

So, in the spirit of increasing awareness, I offer my list of ten things everyone should know about celiac disease.

  1. Celiac disease is an autoimmune disease. When people with celiac disease eat gluten it causes an immune response and their immune system attacks and damages their intestines. This damage stops the body from absorbing nutrients properly. Celiac disease is not an allergy or an intolerance to gluten.
  2. Celiac disease is genetic. In order to develop the disease you must have the HLA-DQA1 and HLA-DQB1 genes.
  3. One in every 133 people has celiac disease. Many have the disease and do not know it.
  4. Celiac disease has more than 300 symptoms, affecting many different parts of the body, these can include chronic diarrhea, skin disorders, and infertility. These symptoms often subside after a gluten-free diet is instituted.
  5. Celiac disease diagnoses requires a blood test and biopsy. In order to properly diagnose a person with celiac disease the person should be eating gluten, have a blood test, and a biopsy of the upper intestine. If the blood test and the biopsy are positive the person has celiac disease.
  6. The only treatment for celiac disease is a gluten-free diet. Gluten is a protein found in wheat, rye, and barley.
  7. The intestinal damage caused by celiac disease can heal over time if gluten is eliminated from the person’s life. A person with celiac disease can never safely reintroduce gluten into his or her diet.
  8. Gluten is found in many products other than breads, crackers, and cereal. It can also be found in soy sauce, condiments, juices/smoothies, candy bars, processed foods, ice cream, beauty products, and alcoholic beverages, to name a few.
  9. Food is not gluten-free if it has come in contact with a surface, utensil, or other ingredient that contains gluten. That is called cross contamination and it can make a person with celiac disease sick.
  10. Not everyone on a gluten-free diet has celiac disease. There are many reasons why people may be on a gluten-free diet.

 

Gluten-Free Labeling in the United States

Grocery shopping has become challenging for me, because large sections of the grocery are off-limits. I have celiac disease (CD). CD is a systemic autoimmune disorder caused by exposure to gluten in genetically-susceptible people. Gluten is a protein found in wheat, rye, and barley. The immune response activated in celiac disease causes the body to attack gluten as if it is an antigen. Symptoms and other health problems associated with CD include including abdominal pain, bloating, diarrhea, psychiatric disorders, infertility, birth defects, osteoporosis, and life-threatening conditions such as intestinal cancer. According to the University of Chicago Celiac Disease Center, there are approximately 300 recognized symptoms of Celiac Disease. CD affects 1 in 133 people in the U.S. — the number of people in the U.S. with CD could fill 4,400 Boeing 747 jets.

The only treatment for CD is adherence to a gluten-free diet. This means that I must avoid anything that contains or has come in contact with gluten (wheat, barley, or rye). The list of gluten-containing substances I must avoid is not limited to food. People with CD must find cosmetics, beauty products, cleaning supplies, and medications that are gluten-free. Exposure to gluten from these sources can also result in a CD immune response and its accompanying symptoms.

I learned quickly after my diagnosis that the easiest way to eat is to buy fresh food. You know, the food found on the perimeter of the grocery store. I have little use for the guts of the grocery store where all the tasty bagged, boxed, and canned foods live.

When I pick up an organic bunch of kale, I know what is in it. That is not true of food that comes in boxes, bags, and cans. Decoding the ingredients of processed products is tricky. In foods not labeled “gluten-free,” I avoid anything that includes the ingredients “natural flavors,” “artificial flavoring,” or anything else that is vague. Then, I have to spend time Googling or using my gluten-free phone app to see if I can determine the gluten-free status of any other ingredients.

I am that lady standing in the aisle, probably in your way, basket on the floor, can in one hand, and an iphone in the other. Even if the product I am looking at has the words “gluten-free” on the label, I still have to wonder if it is gluten-free. I cannot just sigh with relief and toss it in my basket.

Why?

In the United States, there is no legal definition for the phrase “gluten-free.” That is right; manufacturers can use that phrase as they choose without meeting any established, regulated standards. “Gluten-free” means whatever they say it means as long as, according to the U.S. Food and Drug Administration (FDA), it is not “misleading.” There are instances of food products being sold with “gluten-free” labeling, and some products contain varying amounts of gluten, include “wheat” in the ingredients, and are exposed to gluten in the manufacturing process.

How can this be?

The FDA has failed to accurately define the term “major food allergen,” establish safe gluten thresholds for food products, and meet its legal obligation under the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCP) to create and implement final rules for gluten-free food labeling.

The phrase “major food allergen” under FALCP means “(1) Milk, egg, fish (e.g., bass, flounder, or cod), Crustacean shellfish (e.g. crab, lobster, or shrimp), tree nuts (e.g. almonds, pecans, or walnuts), wheat, peanuts and soybeans. (2) A food ingredient that contains protein derived from a food specified in paragraph (1), except the following: (A) Any highly refined oil derived from a food specified in paragraph (1) and any ingredient derived form such highly refined oil. . . . .” 21 USC 321(qq) (2012). The FALCP requires that manufacturers identify these allergens by their common names (i.e. wheat, milk, or soy) on labeling for easy identification by consumers.

In order for a product to be gluten-free, it must be free of all gluten: wheat, barley, and rye. Unfortunately, the current law does not meet that standard. The definition of major food allergen includes only wheat. It does not include rye and barley, both of which contain gluten. The FDA’s definition of major food allergen must include the term “gluten” or the words “wheat, barley, and rye” to safely protect citizens with CD or other non-celiac gluten sensitivities.

Additionally, the FALCP charged the FDA to have final standards for gluten-free labeling in place by 2008, no later than four years after the enactment of FALCP. In 2007, following up on the mandate from FALCP, the FDA issued a proposed rule “Food Labeling: Gluten-Free Labeling of Foods.” The proposed rule states that a food is gluten-free if the food does not contain any of the following:

  1. an ingredient that is any type of wheat, rye, barley, or crossbreeds of these grains;
  2. an ingredient derived from these grains and that has not been processed to remove gluten;
  3. an ingredient derived from these grains and that has been processed to remove gluten, if it results in the food containing 20 or more parts per million (ppm) gluten; or
  4. 20 ppm or more gluten.

Food Labeling; Gluten-Free Labeling of Foods, 72 Fed. Reg. 2795 (proposed January 23, 2007) (to be codified at 21 CFR Part 101).

The FDA’s notice described the currently-adopted analytical methods for gluten detection as being able to reliably and consistently detect gluten at levels of 20 parts per million or more in a variety of foods. Participation by food manufacturers would be voluntary if they wish to market products as gluten-free. The comment period for these rules passed with no action. No final rules were issued by the FDA.

In 2011, the FDA reopened the comment period on the same proposed regulations for “Food Labeling; Gluten-Free Labeling of Foods.” That comment period closed and, again, no action was taken. No final rules were issued by the FDA regarding the labeling of gluten-free foods.

Over a year later, on Dec. 14, 2012, the FDA issued a notice titled “Request for Comments and Information on Initiating a Risk Assessment for Establishing Food Allergen Thresholds; Establishment of a Docket.” The comment period on the notice will close on Feb. 12, 2013, and an advisory committee meeting of the FDA is scheduled for March 7, 2013 from 8 a.m. to 5 p.m.

Have you ever shopped for a gluten-free cookbook for yourself or a friend? Do you know anyone with CD? It is likely that you do. Please consider supporting them by taking time to help prompt the FDA to do something with the power provided to it by Congress. Commenting on proposed government rules is a way for us to directly impact policy making. Your comments can directly impact and in some cases be included in the FDA’s final rules. Let your voice be heard.

It has been five years since the statutory deadline for final rules on gluten-free labeling, and the FDA has taken no final action. Five years. It is time for the FDA to do something.

This post is featured on The Huffington Post Blog.

Gluten-Free Dining in Fort Wayne

Gluten-free eating can be pretty easy and very tasty at home. Whole foods do not contain gluten, so eating gluten-free at home is a healthy and naturally low-calorie way to eat. Just whip up a meat and three and you are good to go.

Eating gluten-free outside of your own kitchen can be challenging. The challenges can include the type of cuisine (hello, Italian), the knowledge and understanding of the chef and staff about the dietary restrictions, or your (my) own fear of cross-contamination (you don’t know what happens to your food before you get it). So far in my gluten-free adventure I have encountered uninterested, cynical, and disbelieving servers and restaurant owners. You know, the ones that think you are asking for a gluten-free meal because you are a low-carb weight loss diet (which is fine if you are – just say it and stop claiming you have a disease, allergy, or legitimate intolerance). This is why I have started using the word Celiac as much as possible. I hope to bring at least some awareness to a handful of people.

Anyway, for every one of those people, I run into two or three people who are genuinely interested in making sure I have a positive dining experience. They ask questions, offer suggestions, and take recommendations happily. Below is a list of the places in Fort Wayne where I have enjoyed great gluten-free food and service so far. I plan to share as many as I can find that are worth a share. I hope this helps guide you to the happiest gluten-free places in town.

Acme Bar & Grill – I love the hamburgers at the Acme. So, when I went in recently and asked for one, sans the bun and fries, my server never missed a beat. I had a salad instead of fries and it was a great gluten-free meal. Remember if you are not sure the fries are prepared in a dedicated fryer then they may be contaminated. Booo.

BakerStreet Steak, Seafood, & Spirits – This spot is one of my favorites, it has a great gluten-free menu as well as attentive, caring, and knowledgeable servers. I had a perfectly prepared steak with asparagus, a spinach salad, and a to-die-for flourless chocolate cake. Top notch. Also, if you want to participate in their dining events (they do some farm to fork dinners) then let them know when you make the reservation that you are gluten-free and they will make sure you can participate.

Casa – This Italian eatery has a comprehensive gluten-free menu that will satisfy the biggest, baddest pasta craving! Other than the bread, you would never know that you were eating gluten-free.

Firefly Coffee House – You can get a gluten-free Oregon Chai latte (my favorite) amongst other tasty safe drinks. They serve gluten-free cookies and crustless quiche from their kitchen. The staff is also never too busy to answer a question, show you a product label, or listen to any helpful suggestions. The folks get it. They have also started carrying almond milk in addition to soy for those of us who can’t tolerate lactose.

Friends – They do not have a gluten-free menu but they do have an accommodating kitchen and a flexible menu. Enjoy the chicken souvlaki with potatoes and a great Greek salad (it has pineapple and beets on it – I love it).

Grabill Country Store – Call ahead to this lovely Amish store in the burg of Grabill and they will bake you a loaf of your favorite bread – gluten-free. The Grabill Store also has a large selection of gluten-free flour, mixes, and other fixins. The daily breakfast and lunch buffet has naturally gluten-free options also (eggs and bacon are beautiful things).

J.K. O’Donnell’s – JK’s has outstanding salads that are gluten-free. For those that enjoy a snort every now and again, JK’s offers a gluten-free beer as well as a selection of ciders that are naturally gluten-free.

Madeleine’s Bakehouse – During your next shopping trip to Jefferson Pointe stop into Madeleine’s and enjoy one of their many macaroons and a cup of tea. Both are gluten-free and lovely!

The Oyster Bar – There is no gluten-free menu at The Oyster Bar but the chef is knowledgeable about gluten-free cooking and can whip you up some great fish, gluten-free. There are many things on The Oyster Bar’s expansive menu to enjoy gluten-free, including oysters.

Spice & Herb – Asian food can be tricky in regards to gluten, it is hard to know exactly what thickeners are used and there is typically no gluten-free menu. This is not a concern at Spice & Herb, I had a great lunch of noodles made of mung beans, tea, and salad, all gluten-free. The server was attentive, helpful, and knew exactly what I needed.

There are fast-food joints that offer pretty solid gluten-free options . . . Red Robin has a good gluten-free menu, Chik-fil-a offers gluten-free fries and chicken options (no bun), Culver’s custard in a cup (I only eat vanilla) is gluten-free, Chipotle is accommodating and can make a super gluten-free salad, and in a pinch you can get a bun-less cheeseburger at McDonald’s (although I prefer to go inside as I feel it is harder to mess up my food if you have to look directly at my face).

This diagnosis has been very hard for me – my hobby and great pleasure in life is finding and enjoying good food. I love to eat adventurously and being gluten-free has certainly changed how I can do that now. The days of not thinking about food are over – I have to pre-plan all my meals and carry snacks everywhere I go. But there is hope, in fact, after writing this list I feel a renewed hope that not all of my going-out-to-eat options are lost. That sure is a pretty thought.

Be patient, friendly, kind, and smile a lot and more often than not you will find someone who truly wants to meet your food needs!