GI dietitians critical to celiac disease, gluten-sensitivity management
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At some clinics in Sweden, the dietitian — not the doctor — is the focal point of care for celiac disease.
During a conversation I had at the International Celiac Disease Symposium, doctors expressed support for this system, given that the dietitian is the one best-versed in the patients’ treatment of celiac disease and other gluten-related disorders.
Celiac disease is a genetically mediated autoimmune disease in which gluten triggers intestinal inflammation and subsequent damage. Non-celiac gluten sensitivity (NCGS) is currently defined as a condition in which individuals report improvement of symptoms following the elimination of gluten from their diet.
This diagnosis is only given after both celiac disease and wheat allergy are excluded.
Disease Management: Lifelong Adherence to the Gluten-Free Diet
Although there are several drugs in clinical trials, lifelong adherence to the gluten-free diet is the only viable treatment at this time. Gluten is the general term for proteins found in various cereals including wheat, barley and rye.
Exposure to gluten may trigger intestinal symptoms, such as diarrhea, constipation, abdominal pain and bloating, and/or extraintestinal symptoms like headaches, peripheral neuropathy, dermatitis herpetiformis and gluten ataxia. Celiac disease can result in malabsorption, leading to other consequences such as increased risk for osteopenia or osteoporosis and iron deficiency anemia.
Once a gluten-free diet is initiated, the intestines begin to heal and most individuals report resolution of symptoms. Despite symptom improvement, a strict gluten-free diet must be maintained to prevent ongoing damage to the intestine as well as the symptoms induced by gluten ingestion.
The Role of the Specialist Dietitian
Consultation and regular follow-up with an expert celiac disease dietitian is critical in the care of celiac disease/NCGS patients.
Without referral to an expert dietitian, patients are told to start a gluten-free diet on their own. Patients struggle with a lack of information or become exposed to misinformation that can be damaging to their health and quality of life, which could present as inadequate intestinal healing or hypervigilance.
Often, patients feel lost and overwhelmed without access to a provider who can proficiently advise on their treatment. As a celiac disease specialist dietitian, I ideally see patients as soon as possible after their celiac disease diagnosis. Our goal is to minimize gluten exposure while maximizing quality of life.
With every patient, I assess their acceptance of the diagnosis, their feelings toward the gluten-free diet and their readiness to make changes. Every session is individualized based on the specific challenges they are facing.
I explain to patients that nutritional management is a learning curve. Initially, they are figuring out what contains gluten and how to avoid it. Next, we move on to what foods they should include and how to optimize their health with a variety of safe foods. There are many naturally gluten-free foods, including dairy, seafood, meat, fruits, vegetables, legumes and gluten-free whole grains.
It is important to regularly check for nutritional deficiencies and other manifestations of the disease in the care of these patients.
Nutritional Guidance and Beyond
Dietitians ensure patients are maintaining a nutritionally adequate gluten-free diet, as there may be deficiencies due to malabsorption at diagnosis and deficiencies due to the inadequacies of the gluten-free diet in the longer term.
Counseling also addresses strategies to make dining out, social gatherings and travel not only manageable, but enjoyable too. In addition, dietitians provide updates on labeling, products and available resources.
Providers treating patients with celiac disease and gluten-related disorders need to understand that these are diet-driven conditions and the specialist dietitian plays an essential role in management.
A multidisciplinary team approach is vital to treat the physical, psychological and nutritional manifestations for those on a medically required, gluten-free diet.
- For more information:
- Jessica Lebovits, RD, CDN, is a clinical dietitian at the Celiac Disease Center at Columbia University.
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