Gluten-free diet compliance

  1. Gluten-free diet compliance

A gluten-free lifestyle may seem a bit daunting at first. The strict nature of the gluten-free diet can make it difficult for patients to comply. However, for long term health and avoidance of complication strict dietary compliance is a necessity.

In medical terminology, compliance is the cooperative behaviour of the patients with regard to the therapy. This is particularly important not only when taking medication, but also for adhering to certain diets, e.g. a gluten-free diet for celiac disease. As the gluten-free diet regime is very rigid and even traces of gluten must be avoided, compliance is lower than in the case of the less stringent restrictions for gluten/wheat sensitivity therapy. The ubiquitous use of wheat and gluten containing ingredients, the nature of current labelling laws often makes it difficult for newly diagnosed patient to comply with the stringent nature of the diet, especially since the symptoms are not always immediately associated with gluten intake [1]. There are also patients who have no symptoms despite eating foods containing gluten (although damage to the intestinal mucosa may still be caused). This can lead to either inadvertent or intentional gluten ingestion. In those individuals who are symptomatic approximately 30% - 50% do not strictly comply with a gluten-free diet [2]. To avoid future health complications, it is imperiative that patient education stress the importance of a strict lifelong gluten-free diet. The educational session should include practical tips on how to navigate shopping dining out and travel [3]. Additionally connection to a local support group and inclusion of family members in the educational session will increase compliance and reduce dietary mistakes, which can lead to secondary diseases.

References

  1. Leffler, D.A., Edwards-George, J., Dennis, M., Schuppan, D., Cook, F., Franko, D.L., Blom Hoffman, J., Kelly, C.P. (2008). Factors that influence adherence to a gluten free diet in adults with celiac disease. Dig Dis Sci. Jun;53(6):1573-81.
  2. Barratt, S.M., Leeds, J.S., Sanders, D.S. (2011). Quality of life in coeliac disease is determined    by perceived degree of difficulty adhering to a gluten free diet, not the level of dietary    adherence ultimately achieved. J Gastrointestin Liver Dis, 20;(3): 241-245.
  3. Lee, A.R., Diamond, B., Ng, D., Ciaccio, E., Green, PHR. (2012) . Quality of life of individuals    with celiac disease; Survey results from the United States. Journal of Human Nutrition    and Dietetics. 25, 233-238.