Tricia Thompson, MS, RD is a nutrition consultant, author and speaker specializing in celiac disease and the gluten-free diet. She is the author of The Gluten-Free Nutrition Guide and has a MS degree in nutrition from Tufts University in Boston, Massachusetts and a BA degree in English Literature from Middlebury College in Vermont.

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Living Gluten-Free

by Tricia Thompson, MS, RD, The Gluten-Free Dietitian

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If you have a child with celiac disease, one of your concerns may be school lunch and making sure it is gluten free.

The American Celiac Disease Alliance (ACDA) (www.americanceliac.org), a non-profit organization that advocates for the celiac disease community, conducted a survey of parents with children on gluten-free diets. About 1/3 of the parents responded yes when asked if they had ever approached their child’s school about providing gluten-free meals. Of these, approximately 38 percent stated that their child’s school refused to provide gluten-free meals.

Can your child’s school refuse to provide gluten-free meals?
Because the National School Lunch Program receives federal funding it can not discriminate on the basis of disability. According to the United States Department of Agriculture (USDA) “…substitutions must be made for children who are unable to eat school meals because of their disabilities when that need is certified by a licensed physician.”

A disability is defined as “a physical or mental impairment which substantially limits one or more major life activities.” Eating is considered a major life activity. Many diseases and conditions qualify as “disabilities.” Severe allergies that result in anaphylactic reactions are considered “disabilities” but other allergies and food intolerances such as lactose intolerance are not. According to The National Food Service Management Institute, celiac disease is considered a “disability.”

What you need to do
To help ensure that your child receives gluten-free meals at school you need a signed statement from your child’s doctor that includes information about celiac disease, why celiac disease prevents your child from eating the regular school breakfast/lunch/snack, the foods that must not be eaten on a gluten-free diet, and gluten-free foods that should be substituted.

If this doesn’t work
While it sounds like a request for gluten-free meals should be accommodated, this is not always the case, as is illustrated in the survey done by ACDA. If you find yourself in this situation, Andrea Levario, Executive Director of ACDA offers the following recommendations:

1. Turn to your local celiac disease support group to find out if there are other children in your area who have been successful in obtaining gluten-free lunches. Within the same district, schools are likely to handle requests in a similar manner. If you know of another school in your district providing gluten-free lunches, providing that information to your child’s school may help.

2. Find out if the Department of Education in your state has provided any guidance to schools on accommodating special diets. State by state information is available on the ACDA website. Feel free to provide this information to your school administrator.

3. Call or email the school principal and request a 504 evaluation for your child. Email is preferred so that you have documentation of the request. This triggers a formal process, which will determine whether your child’s medical condition meets the requirements to warrant special accommodations. Based on our survey, the majority of students with celiac disease receiving gluten-free meals at school have a 504 plan detailing the need for those meals. Additional information about 504 plans is available on the ACDA website.

For more information
If you would like more information, Andrea suggests the following resources:

1. State specific information as well as sample 504 plans available on the ACDA website at: https://www.americanceliac.org/studentsCD.htm

2. USDA guidance “Accommodating Children with Special Dietary Needs” available at: https://www.fns.usda.gov/cnd/Guidance/special_dietary_needs.pdf

3. National Food Service Management Institute available at: https://www.nfsmi.org

4. State Agencies administering Child Nutrition Programs. State by state information available at: Continue

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Coeliac disease (pronounced /ˈsiːli.k/; spelled celiac disease in North America) is an autoimmune disorder of the small intestine that occurs in genetically predisposed people of all ages from middle infancy on up. Symptoms include chronic diarrhoea, failure to thrive (in children), and fatigue, but these may be absent, and symptoms in other organ systems have been described. A growing portion of diagnoses are being made in asymptomatic persons as a result of increased screening.

Coeliac disease is caused by a reaction to gliadin, a gluten protein found in wheat (and similar proteins of the tribe Triticeae, which includes other cultivars such as barley and rye). Upon exposure to gliadin, the enzyme tissue transglutaminase modifies the protein, and the immune system cross-reacts with the small-bowel tissue, causing an inflammatory reaction. That leads to a truncating of the villi lining the small intestine (called villous atrophy). This interferes with the absorption of nutrients, because the intestinal villi are responsible for absorption. The only known effective treatment is a lifelong gluten-free diet. While the disease is caused by a reaction to wheat proteins, it is not the same as wheat allergy.

This condition has several other names, including: cliac disease (with ligature), c(o)eliac sprue, non-tropical sprue, endemic sprue, gluten enteropathy or gluten-sensitive enteropathy, and gluten intolerance. The term coeliac derives from the Greek κοιλιακός (koiliakόs, "abdominal"), and was introduced in the 19th century in a translation of what is generally regarded as an ancient Greek description of the disease by Aretaeus of Cappadocia.

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