Dietitian's Gluten Free Resource

Inspired by the post earlier about being frustrated with most dietitian's general lack of knowledge about Celiac disease and the gluten free diet, I present to you a series written for and by knowledgeable dietitians. Enjoy!

THE CELIAC DIET: Introduction to a New Series from PRACTICAL GASTROENTEROLOGY • SEPTEMBER 2006
by Carol Rees Parrish, R.D., M.S., Series Editor

Quote:
As the number of patients diagnosed with celiac disease continues to grow, patients are clamoring for timely, reliable information that allows them to individualize their diet for their particular needs and lifestyle. Knowledgeable dietitians who are adept in the complexities of the gluten free diet and translating it to meet different lifestyles, budgets, and concomitant disease processes have contributed to this new mini-series. The series will run September 2006–May 2007


The Celiac Diet #1 - The Gluten-Free Diet: An Update for Health Professionals from PRACTICAL GASTROENTEROLOGY • SEPTEMBER 2006
by Nixie Raymond, MS, RD, LDN, CSP, Clinical Dietitian
Jenny Heap, MS, RD, LN, Clinical Dietitian
Shelley Case, B. Sc.,RD,Consulting Dietitian, Case Nutrition Consulting

Quote:
A strict, lifelong gluten-free (GF) diet is currently the only treatment for celiac disease. The diet requires the elimination of all forms of wheat, barley and rye and their derivatives. This article reviews the specifics of the diet, including recommendations regarding the use of pure, uncontaminated oats. The GF diet may be lacking in B vitamins, fiber, calcium and other nutrients, but these may be obtained from nutrient dense GF foods and supplements if needed. To successfully implement and adhere to the diet, individuals need to learn how to avoid gluten contamination and manage the diet while eating out. They must become skilled in label reading and should benefit from the new food allergen labeling laws. Gluten-free cookbooks and a wide variety of GF specialty foods make meal preparation easier. Comprehensive diet education and follow-up from an experienced registered dietitian is a key element in the successful management of celiac disease.


The Celiac Diet #2 - Whole Grains and the Gluten-Free Diet
Practical Gastroenterology October 2006
by Amy E. Pagano, M.S., R.D., Outpatient Nutritionist,
University of Virginia Health System, Charlottesville, VA.

Quote:
Recent attention to whole grains has increased with the Dietary Guidelines for Americans 2005 recommendation to eat at least three servings of whole grains daily. This new emphasis follows research linking whole grains to reduction of chronic disease risk. The American population in general is not meeting this recommendation. For a person diagnosed with celiac disease, a gluten-free diet and the elimination of one of the most common grains in the U.S. makes meeting those recommendations even more challenging. Many gluten-free whole grain options are available and several are exceptionally nutrient dense. Familiarity with these grains, however, is limited. Educating patients on gluten-free whole grains and helping them to incorporate these foods can improve the nutrient profile and add fiber to a gluten-free diet.


The Celiac Diet #3 - Gluten-Free Dining Out: Is it Safe?
Practical Gastroenterology October 2006
by Pam Cureton, RD, LDN, Center for Celiac Research,
Growth and Nutrition Clinic, Baltimore, MD.

Quote:
Dining out is one of life’s simple pleasures that most of us take for granted. However, for your patient with celiac disease, it can be an overwhelming task. The simple act of ordering off the menu becomes a complex challenge to achieve a safe, gluten-free meal. Some individuals on the gluten-free diet are fearful of dining occasions and worry that the outing may leave them ill with reoccurring celiac symptoms. Some dread the challenge of communicating their dietary restriction to the waiter, manager, or chef. Patients do not feel confident in their abilities to detect sources of gluten in restaurant food and sources of possible contamination. Given the right tools and educational support, their health care providers can turn dread into delight. Giving the patient confidence to eat away from home will increase his or her quality of life and improve compliance with the gluten-free diet.


The Celiac Diet #4 - Heart Health and Celiac Disease
Practical Gastroenterology Decemeber 2006
by Mark Dinga, MEd, RD, LDN, Outpatient Dietitian University of Pittsburgh Medical Center, and Andrea Dinga, MEd, RD, LDN, Clinical Studies Dietitian, University of Pittsburgh, both in Pittsburgh, PA.

Quote:
Following diagnosis of celiac disease, the focus of dietary modification is on gluten elimination. A person with celiac disease may feel entitled to eat anything gluten-free, even if high in fat, sugar, and calories, in an attempt to compensate for the restrictions of a gluten-free diet. Unfortunately, being gluten-free does not guarantee nutrition principles recommended to protect the heart. Prudent advice for individuals with celiac disease follows public policy initiatives and programs such as the National Cholesterol Education Program and the Dietary Guidelines for Healthy Americans. Considering the focus toward prevention and recognition of multiple risk conditions such as metabolic syndrome, early assessment and intervention is critical to cardiovascular health promotion. Individualized assessment of cardiovascular risk, maintenance of gluten-free diet principles and appropriate addition of heart healthy diet recommendations are critical to successful nutrition intervention, often requiring consultation with a registered dietitian.


The Celiac Diet #5 - Medications and Celiac Disease - Tips From a Pharmacist
Practical Gastroenterology January 2007
by Steven Plogsted, Pharm.D, BCNSP, Clinical Pharmacist, Nutrition Support Service, Columbus Children’s Hospital, Clinical Assistant Professor of Pharmacy, Raabe College of Pharmacy, Ohio Northern University, Columbus, OH

Quote:
Celiac disease is a chronic, generically linked, autoimmune disorder that is also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy. Although celiac disease primarily affects the small intestine, deleterious effects can occur throughout the entire body. Patients with celiac disease are unable to tolerate the ingestion of gluten. Gluten is an insoluble protein found in all cereal grains. The gluten that is found in wheat, rye, and barley is the offending culprit for celiac disease patients. The prevalence in the United States is estimated to effect 1% of the population. The following article is designed to help identify medications that may contain gluten.


The Celiac Diet #6 - Kids & the Gluten Free Diet
Practical Gastroenterology February 2007
by Mary K Sharrett, MS, RD, LD, CNSD, Nutrition Support Dietitian, Children’s Hospital, Columbus, OH.
Pam Cureton, RD, LDN, Center for Celiac Research,
Growth and Nutrition Clinic, Baltimore, MD.

Quote:
The gluten-free diet presents unique challenges for children with celiac disease and their families. Prior to diagnosis, children may be quite ill, suffering from poor growth and developmental delay. Upon accurate diagnosis and treatment, children usually improve quickly; however despite rapid improvement of symptoms, compliance with diet may be less than optimal, putting the child once again at risk for the complications of untreated celiac disease. Because children may feel uncomfortable being singled out as “different,” a diet that calls attention to their condition, and thus their differences, presents a unique challenge to parents and caregivers trying to meet the treatment guidelines. Frequent follow-up and monitoring, along with educational resources and support groups can aid families in maintaining a gluten-free diet and provide creative ways to deal with the challenges inherent in a gluten-free lifestyle.


The Celiac Diet #7 - Combining Diabetes and Gluten-Free Dietary Management Guidelines
Practical Gastroenterology March 2007
Cynthia Kupper, R.D., C.D., Executive Director, Gluten Intolerance Group of North America, Auburn WA.
Laurie A. Higgins, M.S., R.D., L.D.N., C.D.E., Pediatric Nutrition and Diabetes Educator, Pediatric Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA.

Quote:
The association of celiac disease and type 1 diabetes is well documented in the literature. Type 1 diabetes, celiac and thyroid diseases are a triad of autoimmune conditions with a significant co-morbidity. However, very little is written about the management of celiac disease and type 1 diabetes and clear guidelines are not available. This article reviews nutrition recommendations for diabetes management by the American Diabetes Association (ADA) for healthy meal planning, carbohydrate counting, and potential use of glycemic index/glycemic load, as well as practical tips and suggestions for transitioning to a gluten-free, diabetes meal plan.


The Celiac Diet #8 - The Gluten-free Diet: Can Your Patient Afford It?"
Practical Gastroenterology April 2007
Pam Cureton, RD, LDN, Center for Celiac Research,
Growth and Nutrition Clinic, Baltimore, MD.

Quote:
Currently, the only treatment for celiac disease (CD) is a strict gluten-free diet (GFD) for life. This means the elimination of products containing wheat, rye and barley. Following a GFD presents significant challenges and many barriers to compliance. One of the most significant challenges patients face is the cost of certain components of the diet. Great tasting gluten-free alternatives are essential to help patients comply with the diet, but come at a much higher cost than their gluten containing counterparts. Helping patients manage the cost of the diet is as important as understanding the basic concepts of the GFD.


The Celiac Diet #9 - The Gluten Free Vegetarian - Practical Gastroenterology May 2007
by Amy E. Pagano, M.S., R.D., Outpatient Nutritionist,
University of Virginia Health System, Charlottesville, VA.

Quote:
It is estimated that approximately 1% of the U.S. population has celiac disease. Currently the only treatment for celiac disease is a strict gluten-free diet, requiring the elimination of many staple grains. For a vegetarian, who has already eliminated meat, poultry, fish, seafood and possibly eggs and/or dairy products, further limitations may be particularly unwelcome. A plant-based vegetarian diet may rely more heavily on grains to provide both macro- and micronutrients, so the elimination of wheat and other gluten-containing foods may seem especially restrictive. However, with thought and planning, a vegetarian gluten-free diet can be a healthful way to meet one’s nutrient needs.


The Celiac Diet #10 - Management of Dialysis Patients with Celiac Disease
Practical Gastroenterology June 2007
by Thessa Obrero, RD, CSR, Outpatient Renal Dietitian, University of Virginia—Kidney Center, Charlottesville, Virginia.

Quote:
Although rare, celiac and kidney disease have been reported in the same individual. Because of its rare occurrence (or underdiagnosis), there are no written guidelines for managing these combined diseases. Celiac disease is characterized by inflammation of the small intestine, and in some, malabsorption, after the ingestion of gluten in susceptible individuals. It is managed by life-long avoidance of gluten in the diet. Kidney disease is manifested by fluid and electrolyte imbalance, which also involves life long dietary restrictions. This article reviews the renal dietary guidelines and provides suggestions on how to combine this with managing celiac disease.