By now, most of us know what celiac disease is and how it can affect one’s well-being and overall nutritional status. But often times the general public has no idea what it truly is or they have a definite misconception about the disease, which can lead to problematic and harmful consequences for a celiac patient.
Let’s explore the disease further and look at what we, as future dietitians, can do to help these patients, and the general public, have a better understanding of the disease as a whole.
Contrary to what many people believe, celiac disease is not a food allergy. Rather, it’s an inflammatory disease of the small intestine. When someone with celiac disease ingests gluten, a protein in wheat, barley and rye, an inappropriate autoimmune T cell-mediated response occurs.
This inflammatory response results in the destruction of the villi of the small intestine and, hence, a decrease in absorption of micro and macronutrients occurs. Furthermore, the small intestine can stop releasing hormones to signal the gallbladder and pancreases to release bile and digestive enzymes, resulting in further malabsorption.
Depending on when the disease is diagnosed, symptoms and damage to the small intestine vary. However, celiac disease can be misdiagnosed, leading to further damage of the villi and malnutrition.
But there is some good news coming out the medical community -- the awareness and diagnosis rate has significantly increased and more and more people are being treated completely though dietary changes to treat and reverse the disease.
Even better news for us as dietitians, we can help people with this life-changing diagnosis regain their health and get their lives back through medical nutrition therapy.
The dietary prescription is a “gluten free” diet, which can be quite intimidating. But as dietitians we must be advocates for our clients through education and awareness.
Gluten can be hidden in anything from medication to tea to condiments. It’s all about label reading and knowing what to look for in a product.
One of the biggest problems that celiac patients face is cross-contamination. Rachel Begun, MS, RDN, a spokesperson for the Academy of Nutrition and Dietetics states that, “… even just a microscopic amount of gluten can cause a reaction and damage to the intestines, such as a single bread crumb on a plate or speck of wheat flour on manufacturing equipment …”
Knowing this, the importance of keeping your food, utensils and cooking space gluten free is quite a challenge.
Ideally, the whole kitchen and house must be gluten free to ensure no cross contamination occurs.
This situation can be challenging for patients with children (and/or a spouse), who are not diagnosed with the disease and who might be resistant to the idea of a gluten-free diet.
As dietitians, we can try to put a positive spin on it and really encourage the family to try it together and perhaps learn to cook and eat as a family, which we all know has been shown to have an impact of preventing obesity.
Humans are social beings. We go out to eat and go to social gatherings with friends and family. So what happens then? This can be quite the challenge. How do you know the food you ordered is not only gluten free, but was not made in a bowl or with a knife that has been contaminated with gluten?
In some ways it’s a roll of the dice. You may never know -- until you get sick. Restaurant owners, chefs and servers have increased their awareness and precautions about gluten-free foods and cross contamination, but there is still a risk while dinning out.
The Academy of Nutrition and Dietetics gives some great tips on going to social gatherings, like talking to the host about your gluten-free needs and asking to serve yourself first to ensure no cross contamination. However, concern arises if and when the hosts’ kitchen is full of gluten products and he/she is cooking gluten-containing meals and gluten-free meals at the same time.
As you can see, celiac patients constantly need to be aware and advocate for themselves. Often, people do not realize the severity of the disease and the reality of cross contamination. But I believe this is where dietitians can really make a difference. Simply making people aware and educating patients can significantly decrease the incidence of cross contamination.
I urge all of us to be vigilant and advocates for celiac patients and their dietary restrictions, but also for all those who suffer from diseases that involve dietary constraints and cross contamination. People with celiac disease can suffer from just the slightest error in food handling, resulting in devastating consequences.
Here are some great resources for personal use or to recommend to future clients:
1. http://www.cureceliacdisease.org (University of Chicago Celiac Disease Center)
2. “Gluten free Daily” App
Brenna Lyons is a Human Nutrition-Dietetics student at Metropolitan State University of Denver and will be graduating in May of 2014. She is passionate about healthy eating and fitness and hopes to work with children and those who are struggling with food allergies and intolerances. She was diagnosed with celiac disease in 2010 and enjoys educating the public about this issue.