As gluten intolerance becomes a more widespread medical condition, students affected by the disease hope Duke will make further efforts to accommodate their needs.
Celiac disease, the formal name for gluten intolerance, is a digestive condition that causes damage to the small intestine and interferes with the absorption of nutrients from food, according to the National Digestive Diseases Information Clearinghouse website. For those affected, gluten—a protein commonly found in food products such as wheat, barley and rye—provokes an immune response that damages the villi, or tiny, finger-like projections that line the small intestine.
Increasing numbers of students at Duke are affected with cases ranging from mild to severe.
“Until about the last five years, gluten-free needs were almost unheard of,” Franca Alphin, director of nutrition services at Student Health, wrote in an e-mail. “I can remember a few meal plan exemption requests here and there, but nothing major.” In light of greater scientific knowledge and more accurate diagnoses of the condition, however, specific gluten-free dietary requests have doubled, she added.
“Nationally the prevalence is estimated to be 0.5 to 1 percent of the population,” Alphin said. “However, many in the industry believe that this is a significant underestimate—I have seen estimates as high as 20 percent.”
Villi are responsible for absorbing nutrients from food through the walls of the small intestine and into the blood stream. When they become destroyed or unhealthy, a person becomes malnourished regardless of their diet, according to the NDDIC website.
“While most people’s [small-intestine linings] look like a shag rug with all the villi, mine was like a tile floor—it had none,” said sophomore Jena Neuscheler, who was diagnosed with celiac disease this summer.
Risk of Contamination
Unfortunately, a gluten-free diet is the only treatment for celiac disease, and finding options on campus is not always easy.
In addition to Rosie’s Plate, a store in Raleigh that supplies gluren-free food items to several campus dining spots, five campus eateries offer gluten-free options: the Marketplace, the Great Hall, The Loop, The Refectory and The Tower.
The majority of these venues are not always as “gluten-free” as they appear, however, Neuscheler said. She has concerns at most of these on-campus eateries—including the Great Hall, The Refectory and The Loop—and eats less because she has fewer options.
“[Contamination occurs] if the surface or means of cooking the item has touched something that contains gluten,” Neuscheler said. “So at The Refectory, they offer nothing that they can guarantee is gluten-free unless you want things like pure fruit. The only thing they think is gluten-free is the vegan chile, but [even then] they’re concerned about a soy ingredient.”
Trace amounts of gluten can damage the small intestine and lead to dangerous consequences for those with celiac disease, Neuscheler said. If they do not follow a gluten-free diet, they risk serious complications such as osteoporosis, anemia and cancer later in life.
“[The Loop] has a gluten-free menu online, but... their grill is not cleaned and there’s not a separate [gluten-free] grill at all,” she noted. Even the Great Hall stations that are supposed to be gluten-free—such the omelet station and salad bar—are often contaminated by glutenous foods, Neuscheler added.
“I had an omelet and got really sick because they had cooked pancakes on [the same grill],” she said, adding that the salad bar also becomes contaminated when pasta falls into vegetable bowls.
Alphin said that although the dining and nutrition services will continue to work on providing more gluten-free options, the possibility of airborne cross-contamination still exists given the size of the institution and number of meals served.
“Many eateries have gluten-free options and we continue to work with the vendors to help us identify those items so that they can be listed,” Alphin said. “Our biggest challenge is not wheat... but rather the condiments, cereals and sauces that contain gluten that are not labeled.”
Despite problems faced by Neuscheler and others, some students like sophomore Molly Forlines, who was diagnosed with celiac disease in April, believe that maintaining a gluten-free diet on campus is possible.
“If you know what you’re looking for, Duke really does have a lot of options,” Forlines said. “It hasn’t been a problem because I’m careful about it. I tell [the Great Hall kitchen staff] that they have to wipe [their grills] down with something and they’ll do it.”
Nevertheless, it is sometimes difficult for students to know what can be safely consumed because some dining employees are not certain about which items are gluten-free.
“In the Great Hall, the workers rarely know what [gluten-free] is, but they are always able to find me a manager who does,” Neuscheler said. “It’s just always a 10-minute ordeal to ask.”
Alphin acknowledged that although the Bon Appetit Management dining staff—employed at the Marketplace, Trinity Cafe, Devil’s Bistro, Freeman Center and the Great Hall—are trained on issues such as gluten-intolerance, the necessary precautions are not always followed by Bon Appetit venues or other eateries. These issues, however, continue to be addressed, Alphin said.
Living gluten-free on campus
Students who have a diagnosed medical problem can request to be released from their meal plan, but eating gluten-free can be costly and constraining.
Neuscheler and Forlines, who kept their meal plans, both said they rely heavily on fresh fruits and vegetables, which are often pricey.
“Eating gluten-free is ridiculously expensive if you’re trying to have a real, sizable meal,” said junior Ben Berman, a member of the Duke University Student Dining Advisory Committee who was diagnosed with celiac disease when he was in ninth grade.
Because students with celiac disease pay the same amount for their meal plan as those without the condition, Neuscheler feels there should be more gluten-free food options on campus.
“I have the same meal plan as other students on campus, yet I can eat less than 50 percent of what they can eat,” Neuscheler said.
Alphin, Neuscheler and Forlines agreed, however, that Rosie’s Plate is an excellent dining option for students with gluten intolerance on campus.
“[Rosie’s Plate] prepares all [its] meals in a gluten-free, allergy-free environment,” Alphin said, adding that it is an ideal option for students who are extremely sensitive to gluten.
The only problem is that these items often run out quickly on-campus because they are popular among gluten-tolerant students as well, Neuscheler said.
“I’ve kind of just resigned to myself that I’m not going to get [gluten] out of my system while I’m at Duke because it’s impossible,” Neuscheler said. “I have to eat something besides Rosie’s Plate.”
Berman and sophomore Matt Nemoy—who was diagnosed with celiac disease when he was 17—said that those with the condition generally find a few things they enjoy eating and stick to those options even though it may not bet the healthiest practice.
Nemoy added that the dining and nutrition staff have been very accommodating to his needs. At the beginning of his freshman year, Nemoy said he was shown around the Marketplace and presented the gluten-free food options. On West Campus, both Berman and Nemoy said the Armadillo Grill staff are particularly attentive to their needs.
“The school’s been really nice about going out of their way to make sure I feel like there are options for every meal—breakfast, lunch and dinner,” Nemoy said.
In response to the growing number of students with gluten-free needs, Alphin said dining and nutrition services is working hard to expand dining options and educate staff and students so that everyone can feel satisfied with their meal plan.
“I believe we are making great strides in that direction and will continue to improve upon this,” she said.
Berman agreed that in order to better accommodate students with gluten intolerance, administrative and student groups need to promote knowledge about celiac disease.
“The key is getting two-way awareness,” Berman said. “Awareness from the staff perspective on proper preparation and food practices and awareness from the students so they can appropriately advocate for themselves.”
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