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Dietarv Advice for Airline Travel
J
Peter Leggat and Madeleine Nowak
of the chemicals in the food, which may include preservatives, coloring agents, or other chemicals.’ Food intolerance is not an allergy; for example, lactose intolerance
is due to a lack of or reduction in the enzyme lactase.2
Dairy products which are safe for those who are lactose
intolerant include (1) yogurt in which the lactose has been
fermented; and (2) cheese in which the lactose remains
in the whey. New milk products which are low in lactose are also on the market, and these may be made
available on request to the airlines.
Travelers should inform the airlines of any food
allergy, sensitivity or intolerance. Prospective passengers
should be as specific as they can, since a number of
ingredients tend to be used in producing gourmet foods
served on aircraft nowadays,which may dsguise a potential allergen or chemical. Gluten-free meal options are
usually given. Common food allergies include seafood,
a variety of which is often served on board.
In addition to their regular meal service, most of the
major domestic and international airlines offer special
meals. I t should be noted that regular meal services on
international flights often give a choice of meals, even
in economy class, and often include a salad and or fruit
dish, which could be consumed by most people. More
airlines also seem to be moving towards having at least
one more culturally appropriate meal on the menu, particularly for relevant flight sectors. However, these meals
may be inappropriate for some passengers, and there is
a need for this special meals service. Meals services on
airlines have improved greatly in recent years, particularly with the employment of consultant dietitians to the
catering staff of airlines and advances in chef training.
Special meal services are designed to cater to the most
common variations of meals required by most passengers for medical, religious, or other reasons.The special
requirements for these meals are described elsewhere.’
It is important to realize that the meals are designed and
the ingredients interpreted by that airline, and may not
necessarily reflect what the traveler might eat at home.
So it is important to advise travelers not to have high
expectations of this special meal service.This paper aims
to provide some basic practical advice for selection of special diets for airline travelers.
Special Meals
Vegetarian Meals
There are two main types of vegetarian meals: vegan
and ovo-lacto vegetarian.Vegan meals contain no animal
products. In ovo-lacto vegetarian meals, eggs and dairy
products are the only animal products included.Table 1
gives possible user groups for each of these two main types
of vegetarian meals. Special vegetarian meals such as
Asiatic (Indian) vegetarian meals may also be available.
Food Allergies, Sensitivities, and Intolerances
True food allergies are immune reactions and can
be severe and life threatening.These reactions are to the
protein in the food.’ Food sensitivities are the direct effect
Kosher Meals
Kosher meals follow Jewish dietary 1aws.There is no
pork and no seafood without fins or scales. Meat and dairy
products are not served together, and meat requires ritual slaughter.These meals are appropriate for those who
normally eat kosher food, those who do not eat pork,
and those who do not eat shellfish due to allergy.
For 8 days over Passover (usually March o r April),
foods which ferment or rise are not permitted. This
includes any flour-based food except specially prepared
unleavened bread (matzos).During t h s time, utensils must
be ritually cleaned or special Passover utensils must be
used. Food acceptable for Passover will be marked “Kosher
for Passover.”
Peter Leggat, DipCINutr, FAFPHM: Senior Lecturer,
Department of Public Health and Tropical Medicine, James
Cook University of North Queensland, Townsville,
Queensland, Australia; Madeleine Nowak, DipNutrDiet:
Course Co-ordinator and Dietitian, Department of Public
Health and Tropical Medicine, James Cook University of
North Queensland, Townsville, Queensland, Australia.
Reprint requests: Peter Leggat, Department of Public Health
and Tropical Medicine, James Cook University of North
Queensland, Townsville, Queensland, 4811 Australia.
J Travel Med 1997; 4:14-16.
14
Leggat and N o w a k , D i e t a r y Advice for Airline Travel
Table 1 Potential Applications of Main Vegetarian Meal
Options
Vegetarian Meal Options
Dietary Characteristics
Vegan
(no animal
pro ducts)
Vegans
Ovo-lacto vegetarians
Those on low-fat diets
Those on cholesterolreducing diets
Diabetics, since desserts
X
X
X
X
X
X
are usually fruit
Those who do not eat red
meat (or who eat only fish)
Those with religious
dietary laws (e.g.,Hindu,
Moslem,Jews)
Those who wish to avoid
bloating
And enjoy spicy food
Athletes who are carbohydrate loading (extra
carbohydrate should be
packed on board)
Ovo-Lacto Vegetarian
(egqs and dairy
products)
X
X
x
X
X
X
X
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delayed. In addition, airlines usually carry artificial sweeteners and a limited range of low calorie soft drinks on
both domestic and international flights. Caffeine-free
diet colas may also be offered. If in any doubt, the traveler can take on board convenient small dispenser packs
of artificial sweeteners.
In addition to being advised about diet, diabetics
should be advised about the amount of insulin required
for the trip, as well as appropriate storage methods. Protocols for insulin dosage can be found in a number of
travel medicine publications (e.g., Benson and Metz3).
Diabetics should also be advised to monitor blood
sugar levels (BSLs) more closely. Short-acting insulin
may be used if additional doses are required, or more frequent snacks may be necessary. Diabetics should be
counselled regarding long periods of inactivity on board
aircraft and the effect this may have on their BSLs.Those
travelers taking oral hypoglycemics may not require any
changes to their dosage schedule; however, they should
also be advised to monitor their BSLs more closely. Diabetic travelers should be given a doctor’s letter or a travel
health card with details of insulin or oral hypoglycemic
dosages and syringes being carried.
low-Cholesterol Meals
Moslem Meals
These meals follow Moslem dietary laws. There is
no pork. Other meat requires ritual (Halal) slaughter. No
wine or alcohol is permitted, even for cooking. These
meals are appropriate for Moslems who choose to eat traditionally,and for other passengers who do not eat pork.
Hindu Meals
Hindu meals follow Hindu dietary 1aws.There is no
beef, no pork, and no wine or alcohol, even in cooking.
These meals are usually curries. Hindus may or may not
be vegetarians.These meals are appropriate for Hindus,
and for other passengers who do not eat pork.
Diabetic Meals
These meals are normally low-sugar, low-fat meals.
They are appropriate for those with non-insulin-dependent diabetes, those with insulin-dependent diabetes,
those with impaired glucose tolerance, and those on
weight reduction diets.This type of diet may also be considered for travelers with chronic obstructive pulmonary
disease (COPD), who should avoid high carbohydrate
meals which may increase oxygen demand.
Diabetics should also be advised to carry a carbohydrate source in case of hypoglycemia, as well as appropriate diabetic identification.Travelers should be advised
to pack on board any snacks that they may routinely take,
particularly in the event that an inflight meal service is
These meals are low in saturated fat and low in
cholesterol. They are appropriate for those on low-fat
diets, those trying to lower blood lipids, and those on
weight loss diets. Athletes will need to add more high
carbohydrate foods or drinks.
Gluten-Free Meals
Gluten-fiee meals contain only gluten-fiee products.
They are appropriate for those with celiac disease, those
who have allergic reactions to gluten, and those who may
have allergic reactions to gluten.
low-Sodium Meals
In low-sodium meals, there is no added salt or
sodium. No foods with sodium are added in processing
(e.g., corned beef, ham, cheese), and meals include lowsodium bread and unsalted butter.These meals are appropriate for those currently on a low-sodium diet for
hypertension, those currently on a low-sodium diet for
chronic renal failure, those currently on a low-sodium
diet for congestive cardiac failure, and those who do not
like salt.
High-Protein Meals
The requirements for these meals need to be specified.Almost all cases can be dealt with by carrying on
board convenient packs of high-protein drinks. They
are unlikely to be needed during a 24-hour flight for a
walk-on traveler.
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low-Protein Meals
These meals are appropriate for those in chronic renal
failure, and those with diabetes who are on a low-protein
diet at home to reduce the risk of future renal failure.
Other Meal Options
Each airline usually has its own menu of special
meals. Other meal options which may be available include
high-fiber meals, raw fruit vegetable meals, bland meals,
seafood meals, a special menu for children, and baby food.
Ordering Special Meals
Special meal requests should be made at the time of
booking and be reconfirmed at check-in. Note that if
travelers have a late check-in, it may be difficult to obtain
a special meal.Trave1 agents may be able to assist travelers with establishing the range of special meals available
and these can be discussed with their travel health advisor
or physician. Many “frequent flyer” programs and airline
lounge clubs offer to put these special meal requests
onto travelers’computer profiles, so that they are “automatically” requested at the time of booking. It is still wise
to double-check at check-in to avoid disappointment.
Special meals often cannot be guaranteed if last-minute
flight reservation changes are made.
Role of Dietary Supplements
Most travelers will eat more food than they do at
home and include more variety in their diet, therefore
they do not usually require supplements.Those who
take supplements at home, and feel uncomfortable if
they do not continue to take them, should take their own
supply of supplements and should not attempt to buy
something sirmlar in another country.They may find problems in communicating their needs, and the quality and
composition of the supplements may vary.
Stanton’ and Burke and McCoy4 give information
on possible nutritional requirements for athletes.
Reducing Jet lag
Most airlines use meals as a means of circadian
retraining. Meals are too frequent, taking into account
J o u r n a l o f T r a v e l M e d i c i n e , V o l u m e 4, N u m b e r 1
circadian rhythm adjustments and colonic needs. To
avoid over-eating and its consequences (e.g., poor digestion, bloating, and nausea) only half the food offered
should be consumed. Alcohol is freely available and
hangovers form an important part of the jet lag suffered
by many over-indulgent passengers,discussed el~ewhere.~
Coffee, tea, cola soft drinks, and other beverages often
contain caffeine and, in addition to alcohol, may aggravate the dehydrating effects of the aircraft environment.
Passengers also need to be encouraged to drink su5cient
water. This is particularly important for travelers with
COPD, since alcohol can reduce respiratory drive, and
dehydration may lead to thickening of secretions.
Conclusion
I t is important that travelers be made aware of the
availability of special meals appropriate to travelers with
particular medical conditions. It is vital that travelers
understand the significance of food allergies and sensitivities, and that airlines are informed of these, since
triggers may not be readily identifiable in airline meals.
This information could also be incorporated into travelers’ handbooks and guides produced by the travel
industry and by travel health advisors, so that travelers can
make an informed choice regarding their selection ofspecia1 meals. If passengers order special meals, control
excessive consumption of food and of alcoholic and caffeinated beverages, and keep well hydrated, the stress of
travel can be reduced and control maintained over the
traveler’s lifestyle.
References
1. Stanton R. Different diets in Food for Health. 3rd Ed. London:WB Saunders/Bailliere Tindall, 1990:157-166.
2. Loblay RH, Swain AR. Food intolerance. Recent Adv Clin
Nutr 1986;1:169-177.
3. Benson 6 ,Metz R. Management of diabetes during intercontinental travel. Bull Mason Clinic 1984;38:145-151.
4. Burke L, McCoy M.The complete guide to food for sports
performance. Sydney:Allen and Unwin, 1992.
5. Leggat PA.“Jet lag”: surviving air travel. Safety Austral 1995;
18(1):10-12.