Review article: Dietary management of coeliac disease

Abstract

To begin a discussion on the dietary management of coeliac disease (CD), a review of the multifaceted negative impact of the gluten-free diet (GFD) on the individual with CD needs to be described. The impact of diet and disease ranges from the cost of GF products, [1][2][3][4] to the limitations on an individuals' social life, [5][6][7] the impact on quality of life (QOL) and the nutritional concerns of the diet. [10][11][12] This chapter will explore the various issues confronting an individual with CD and discuss the importance of ongoing dietary management. | G FD IMPLEMENTATI ONThe only treatment for CD is the GFD. Once CD is confirmed the individual should receive in-depth dietary counselling. Dietary counselling should include an in-depth assessment of the nutritional, social, cultural, environmental factors that will impact the individual's ability to adopt and adhere to the GFD. Indeed, the process has shifted from one that focuses on just foods to avoid to one that evaluates the multiple factors in the client's life (social, cultural, environmental, biologic) that affect the individuals' food choices and dietary behaviour. 13 This is especially important when counselling an individual with CD on a GFD. Initially, the individual may just be focused on what to eliminate rather than assuring their new dietary pattern is diverse and well-rounded.

Letter: dietitians are more than coaches

“…In assessing a gluten-free diet, this has been the gold standard. 7 Fourth, the optimal delivery of any diet requires good education, motivating technique and ongoing counselling together with access (email, telephone or personal) to the dietitian for queries.…”

Understanding the patient’s experience of coeliac disease diagnosis: a qualitative interview study

“…The only management currently recommended is lifetime adherence to a gluten-free diet, which improves symptom burden but brings about other challenges including impact on quality of life. 10 …”

“…Timely identification, diagnosis and management of CD is therefore key. The only current management is lifetime adherence to a gluten free diet (GFD) which improves symptom burden but brings about other challenges (10).…”

A dietitian‐led coeliac service helps to identify and reduce involuntary gluten ingestion with subsequent reduction in the frequency of repeat endoscopies

“…Dietitians have an important role in helping people achieve GFD adherence. This is because they are trained to assess patient knowledge, dietary adherence, nutritional status and psychosocial needs; monitor laboratory results; and provide individualised dietary advice 8 . However, a recent survey completed by 158 dietetic departments in England that provided dietetic gastroenterology services identified that specialist dietetic CD clinics were not provided in 49% of these services, 9 suggesting that adequate dietetic support for patients living with CD may be lacking.…”