Gluten-Free Diet
Dietary advice for celiac-related disorders
Beginning Your Gluten-Free Diet Plan & Getting Needed Nutrition
When you first learn that you have celiac disease, non-celiac gluten sensitivity (NCGS) or even a wheat allergy, it might seem overwhelming. It can be challenging to know what foods have gluten or wheat in them and what you should be eating. So can knowing if you're doing all you can to protect your health.
The National Institutes of Health (NIH) recommends the following for the treatment of celiac disease:
- Consultation with a skilled dietitian
- Education about the disease
- Lifelong adherence to a gluten-free diet
- Identification and treatment of nutritional deficiencies
- Access to a support group
- Continuous, long-term follow-up with a team of different specialists
Helpful information about a gluten-free diet is available here and from our gastroenterology team. As part of your care, you will be offered a referral to a registered dietitian at the Celiac Disease Center at Beth Israel Deaconess Medical Center (BIDMC).
Our dietitians are knowledgeable about all aspects of celiac disease and can help you eat to optimize your health. We also can help you with NCGS.
It is important not to diagnose yourself with NCGS or celiac disease or to start a gluten-free diet if you suspect NCGS. You must be tested while still eating gluten to get an accurate diagnosis.
Getting Healthy with Celiac Disease
A gluten-free diet is the only treatment for celiac disease. This means you can’t have foods that contain wheat, barley or rye. It’s also important to avoid gluten-free foods that may be contaminated with these grains. Staying gluten-free is likely to relieve your symptoms, heal your small intestine and prevent further damage.
NCGS causes symptoms similar to those of celiac disease, but blood tests and/or biopsy results for the condition are negative. Your intestines aren’t damaged like they are in celiac disease, either. However, a gluten-free diet may improve your symptoms and help you feel better.
Fruits and vegetables as well as plain meat, chicken and fish are naturally gluten-free. There are an increasing number of commercially produced gluten-free foods as well, so you have plenty of options.
Nutritional Consults at BIDMC
Unfortunately, there’s more to managing celiac disease or NCGS than avoiding gluten.
- Dining out and traveling on the gluten-free diet require planning and attention.
- Food labels can be difficult to understand.
- Shopping takes much longer when you’re first learning about celiac disease.
- Some people gain unwanted weight gain on the gluten-free diet; others have trouble regaining weight they’ve lost because of the disease.
A consultation with a registered dietitian who has special training in celiac disease can help by giving you expert advice on these and many other topics. And we can help you take these important steps:
- Find resources to manage your gluten-free lifestyle.
- Follow a healthy, gluten-free diet.
- Get all the nutrients you need in the required amounts.
- Learn which foods to avoid and which foods are safe to eat.
- Manage other conditions that also require a special diet such as lactose intolerance, kidney disease, diabetes and high cholesterol.
- Plan your meals at home, in restaurants and when traveling.
- Reach or maintain a healthy weight.
- Save money on your grocery bill.
It isn’t always possible for you to get a consult immediately after your diagnosis. But you can ask to see a dietitian when you’ve learned all you can about going gluten-free from reputable sources or if you have questions. Our knowledge of celiac disease is always growing. Connecting with a dietitian can help you stay current.
Before scheduling your consultation, check with your primary care provider and/or your insurance company to see if you need a referral. Feel free to bring a family member or friend for support.
At your first visit, the dietitian will have many questions for you. It’s helpful to be prepared for these questions ahead of time:
- Do you have your medical test results (biopsy report, gene testing or celiac blood work) available?
- Have you started a gluten-free diet? If so, for how long?
- How are you feeling? Are you having symptoms?
- How do you feel about your diagnosis and the gluten-free diet?
- How were you diagnosed with celiac disease?
- What is your main reason for requesting a nutrition visit?
- What symptoms or abnormal lab tests did you have before your diagnosis? How does that compare to now?
Information Your Dietitian May Request
Before or during your appointment, the dietitian may request specific information or records. Having them available will help your visit run smoothly.
- A three-day food record to show what you’ve been eating and drinking
- Copies of these medical test reports:
- Bone density report (recommended 12 months after starting a gluten-free diet)
- Celiac blood tests
- Fructose breath test
- Small intestine endoscopy with biopsy
- Current medications and their doses, including supplements, such as vitamins, minerals and herbal products (If you’ve researched whether these products contain gluten, make a note of it. You may learn about the gluten-free status of your medication by calling our pharmacist or the manufacturer.)
- Details about your height and weight
- Food allergies or food intolerances
- Your food and nutrition history and current diet (heart healthy, vegetarian, kosher, low lactose, etc.)
During your visit, the dietitian may:
- Advise you on dietary changes to relieve symptoms such as constipation, diarrhea, unwanted weight changes and conditions like lactose intolerance.
- Explain the gluten-free diet. This includes reading labels, identifying hidden gluten sources and shopping for groceries. You'll also learn about cross contamination and dining out safely.
- Recommend supplements to address vitamin and nutrient deficiencies.
- Suggest useful resources such as local and national support groups.
- Support you in adjusting to your new way of life.
Monitoring Your Condition
Several tests help monitor your nutritional status and health. If available, the dietitian may look at tests that measure these levels:
- B12
- Calcium
- Complete blood count (CBC)
- Ferritin
- Folate
- Magnesium
- Vitamin D
- Zinc
As needed, several other tests may be performed to check these levels:
- Other B vitamins
- Other fat-soluble vitamins (vitamins A, E and K)
- Parathyroid hormone
- Copper
During follow-up visits, you and the dietitian may review and discuss these issues:
- Your activity level
- Any ongoing or new symptoms such as gas, bloating, fatigue, nausea, loose stool or constipation
- Any weight changes and your goal weight
- Plans for future health goals
- Recent blood tests or procedures
- Medications and supplement use
- Your understanding of and willingness to follow the gluten-free diet
Follow-up appointments provide more chances for you to ask questions. If you continue to have symptoms after making diet changes, you should see your gastroenterologist in addition to your dietitian.
