According to Celiac.com, at least one out of every 133 Americans has celiac disease, a condition that requires a meticulous avoidance of gluten. Gluten is composed of of the proteins gliadin and glutenin. These proteins are bound with starch in the endosperm of the grains wheat, rye and barley. Transitioning to a gluten-free diet can be difficult, as gluten is not only found in bread and pasta, but can also be hidden in such unusual places as salad dressing and ice cream.
While classic celiac symptoms are gastrointestinal, some of your patients may present with seemingly unrelated symptoms such as anemia or osteoporosis without any typical manifestation of gastrointestinal disease such as diarrhea or weight loss. Other patients may have allergies or intolerances that necessitate the avoidance of gluten-containing foods, and still others choose not to eat gluten because they feel better physically or mentally without it, or believe it to be a healthier dietary option.
Step 1
Instruct your patient to purchase or download a list of gluten-containing foods to take with her to the grocery store. While some foods should always be avoided and others are always safe, some foods fall into a "gray-area" category, because they sometimes contain gluten. For example, farina and semolina should always be avoided because they are variants of wheat, while fresh fruits and vegetables are all safe to eat. Foods such as salad dressings, sauces, spice blends and soups can contain gluten, so have the patient check ingredient labels carefully. The Mayo Clinic and Celiac.com recommend caution with oats and other grains, because even though they do not inherently contain gluten, they are sometimes contaminated before reaching the store shelves, so it is important to buy products such as oats and other grains from manufacturers who label them as "gluten-free."
Step 2
Counsel your patient to read all ingredient labels carefully. If a product is labeled as gluten-free, it is safe for consumption. If it is not specifically labeled by the manufacturer and she is unsure of the gluten content of a particular unfamiliar ingredient, she should wait until she has researched the ingredient or contacted the company to verify the gluten content of the food she is interested in. The FDA requires that the top eight allergens be listed on ingredient labels, and while wheat is considered one of the top eight, gluten is not specifically included in the requirements. While barley and rye are less common gluten sources in packaged foods, they can show up in unexpected places, such as malt flavoring and modified food starch.
Step 3
Caution the patient to keep gluten-free foods separate from gluten-containing foods at home. It is often safer to purchase a separate toaster since even crumbs of gluten-containing foods can cause uncomfortable symptoms. When preparing foods that contain gluten for others, the patient should wash her hands, surfaces, mixing bowls and pans to remove every trace of food. She also should use separate preparation areas, utensils, dishes and pans that are designated as gluten-free.
Step 4
Recommend appropriate supplements. Nutrient deficiencies may occur when certain grains are removed from the diet, and malabsorption is also a common problem with celiac disease, so even if dietary intake is adequate, the nutrients may not be well-used. Common deficiencies include calcium, iron, zinc and folate. Osteoporosis is one complication that may arise from celiac disease due to malabsorption of bone-building minerals such as calcium. In celiac disease, much of the damage from gluten occurs in the small intestine. Because this is where iron is normally absorbed, iron deficiency is often an issue for celiac patients. Vitamin C increases iron absorption, so include it when supplementing or eating iron-rich foods. Folate may also be poorly absorbed, which can also lead to an anemic state. Zinc is a component in gluten-containing cereals, so make sure patients are receiving it from another source when gluten is removed from the diet.
Tips and Warnings
- When eating out, choose restaurants that have gluten-free menus.
Member Comments