Gluten-free diet as therapy

  1. Dr. Schär Institute
  2. Gluten-free diet as therapy
Gluten Free Phone

The gluten-free dietary pattern is the only treatment for celiac disease, gluten sensitivity and wheat allergies.

To ensure accurate test results it is imperative that the patient does not initiate a gluten-free diet until a final diagnosis is obtained. Once the diagnosis is reached than the gluten-free diet should be implemented. The degree of rigidity will be determined by the diagnosis of celiac disease, gluten/wheat sensitivity or wheat allergy.
Currently the only treatment foe celiac disease is a lifelong strict adherence to a gluten-free diet. Strict adherence to the diet includes careful monitoring of ingredients, food preparation, and reading of labels will help avoid any potential cross contact and unintentional ingestion of gluten. In glute/wheat sensitivity the initial treatment is a gluten-free diet. After a period of time on the gluten-free diet individuals with gluten/wheat sensitivity may transition to a low gluten diet under the guidance of a healthcare professional. For the individual with wheat allergies an initial withdrawal of gluten may suffice for treatment. The transition off the gluten free diet should only be done with medical supervision for the individual with a wheat allergy.

Implementation of a gluten-free diet by diagnosis

Celiac diseaseGluten/wheat sensitivityWheat allergy
DurationLifelongPotentially limited time - at least one to two yearsPotentially limited time
Special featuresStrict gluten-freeWith medical supervision a low-gluten may then be sufficientAdjunctive medication may be necessary

Gluten-free diet in celiac disease

Currently the only therapy for celiac disease is a strict lifelong gluten-free dietary pattern. If celiac disease is not treated, it can lead to the development of other conditions, secondary symptoms, and increases the risk of long term complications. Non compliance to the gluten-free dietary pattern is associated with an increased risk of complications of celiac disease, such as osteoporosis, infertility, and/or malignancies. Regular follow-ups with a health care practitioner are recommended to assess any changes that would affect the overall health and quality of life of the patient and prevent any nutritional deficiencies and complications.

Consultation with a specialist dietitian is the key to health and compliance

The transition to a gluten-free diet at first, may seem daunting to your patients/clients. A consultation with a trained dietitian specialist is the key to health and compliance with the gluten-free dietary pattern. The dietitian will be able to guide your patient on the transition to a healthy gluten-free dietary pattern. The session should include an in-depth assessment of current intake patterns, food preferences, dining out and social eating patterns are crucial to individualize the diet pattern for the client and their family.  
For children the education session should include the family members.  Materials should be given to the family too use to educate the patients teachers, friends, and other care givers.
If possible the patient should see the dietitian specialist at least three time during the first year after diagnosis to ensure a smooth transition to the gluten-free dietary pattern.

Medical Nutrition Therapy Flowchart of Encounters

The medical nutrition therapy for an individual with celiac disease has been divided up into three sessions as outlined in the AND Evidence Based Nutrition Guidelines.

Referral/Consult Information (prior to encounter 1)

HCP to obtain pertinent clinical data from referral source or client medical record/information system to include:

  • Laboratory values (celiac antibodies, anemia profile, etc)
  • Other clinical data (EGD and biopsy reports
  • Physician treatment goals or medical plans
  • Past medical history
  • Presenting signs & symptoms
  • Medcations
  • Physical activity clearance or limitations

Encounter 1

Note initial education is split between encounter 1 & 2, however if it is unlikely subsequent visits will be possible, the educational goals should be combined into the first session.

  • Assessment

    • Evaluate height, weight, weight history, growth history, relationship to family stature, BMI, biochemical data
    • Review medical history
    • Review medical history of family – including other autoimmune diseases
    • Document clients food and nutrition history
    • Document clients food experiences – including any prescribed or self-imposed food restrictions
    • Assess medications, herbal supplements for gluten content and any potential food and drug interactions
    • Assess gastrointestinal symptoms
    • Assess clients’ knowledge base, motivation and readiness to change
    • Assess quality of life
  • Nutrition Intervention
    • Discuss nutrition prescription
    • Education on: labeling reading, cross contamination, gluten content of medications
    • Provide resources
    • Assist client in setting goals
  • Nutrition Monitoring and Evaluation
    • Check indicators to monitor each of the four categories of nutrition outcomes

Encouter 2

Two to four weeks after first encounter:

  • Assessment
    • Repasses weight, BMI
    • Review any new medical diagnosis and/ or changes in management of other diagnosis
    • Obtain brief diet history to evaluate compliance, nutritional adequacy, intolerances, availability of gluten free foods, dining out
    • Compare to expected goals
    • Reassess gastrointestinal symptoms
    • Reassess clients’ knowledge base
    • Reassess quality of life
  • Nutritional Intervention
    • Individualize nutrition prescription
    • Discuss intake and potential need for supplementation
    • Provide referral to resources and other health care providers as needed
    • Assist client in setting goals
  • Nutrition Monitoring and Evaluation
    • Check indicators to monitor each of the four categories of nutrition outcomes

Encounter 3

Six to 12 months from first encounter:

  • Assessment
    • Re-evaluate weight, BMI, changes in growth pattern, celiac antibodies and other biochemical data
    • Review any new medical diagnosis and/or changes in management of other diagnosis
    • Document clients food and nutrition history by obtaining comprehensive diet history including current diet intake, food intolerances, adherence to gluten-free dietary pattern, dining out practices, food availability, psychosocial or economic issues impacting nutrition therapy
    • Reassess gastrointestinal symptoms
    • Reassess medications, herbals, supplements
    • Reassess clients’ knowledge base
    • Reassess quality of life
    • Determine adherence to gluten-free dietary pattern and/or barriers to adherence
  • Nutrition Intervention
    • Reinforce and individualize the nutrition prescription
    • Reinforce behavioral goals
    • Provide referral to resources and other health care providers as needed
    • Assist client in setting goals
  • Nutrition Monitoring and Evaluation
    • Check indicators to monitor each of the four categories of nutrition outcomes

Dietary advice - Step 2: Tips and motivation for self-management

  • Approx. one to two weeks after initial consultation

  • Analysis of diary of diet and symptoms:
    • identify and compensate nutrient deficiency
    • Do symptoms still exist?
    • Are there any other food intolerances (e.g. fructose, lactose, fat)?
    • Dietary mistakes?
  • Shopping tips
    • Identify risky foods
    • Discuss allergen labelling, ingredient list exercise
    • View DZG lists with patient
  • Create a daily schedule

  • Recommend that the patient keeps a diary of diet and symptoms again

Dietary advice - Step 3: Tips for the kitchen and eating out

  • Approx. two to four weeks after the second consultation

  • Therapy for other food intolerances if necessary

  • Tips on how to keep your food gluten-free

  • Tips on gluten-free cooking and baking (with recipe recommendations)

  • Avoiding contamination

  • Tips on eating out in restaurants and travelling

  • Observe new findings

  • Evaluate and review diary of diet and symptoms (see second consultation)

  • Nutritional therapy recommendations for other diagnoses (after second consultation)

  • Continuation in fourth consultation depending on the scope of advice

Gluten-free diet in gluten/wheat sensitivity

Gluten/wheat sensitivity (GS/WS) is treated with a gluten-free diet similar to celiac disease. It is crucial for accurate results that patient do not start a gluten-free diet until the diagnostic process is complete. An important therapeutic difference in GS/WS is the management of the gluten-free diet. A strict gluten-free diet is usually only necessary for a limited period of time. For most patients a gluten-free diet should be maintained for at least one to two years after diagnosis. Then with medical guidance the transition to a low-gluten diet may begin. A low-gluten diet may then be sufficient to prevent reoccurrence of symptoms. There may be great variation in the individual gluten threshold in patients with GS/WS.

 

References

Academy of Nutrition and Dietetics – Evidence Analysis library – celiac disease