Nothing scares a patient away faster than giving them a long sermon about things they should never ever eat again. For gluten-sensitive patients, it is not just about providing temporary relief using a badly-researched menu. The attending physician should also see to a tolerable lifestyle.
Changes in Diet
When a doctor or nutritionist is approached by a patient diagnosed with diseases such as hypertension, diabetes, renal failure, liver anomalies or intestinal problems such as gastric CA or celiac disease, the first advice is a lifestyle change. This lifestyle change involves the usual suggestion of living a more active lifestyle and lessening consumption of offending substances such as nicotine.
Mostly, though, this involves a lengthy lecture about what you shouldn’t eat. Some doctors even provide pamphlets or suggest books which contain a long list of items the patient should not eat. From a medical standpoint, this is helpful. From the viewpoint of the patient, however, having a long list of ‘FOODS YOU CANNOT EAT’ is depressing and discouraging. As far as the patient is concerned, the doctor might have done better by just prescribing a death sentence instead. Food is a wonderful thing which can easily uplift any mood, and hearing that you can’t eat most of your favourite foods might just lead to non-compliance.
Doctors and nutritionists should perhaps be more prudent when giving nutritional advice. It is important to inform the patient of the wonderful options that still remain open for him. It would be beneficial for any patient to hear that he/she doesn’t have to go hungry just because he is suffering from an illness such as gluten sensitivity or celiac disease. This will inspire patients to adhere to their diets, rather than craving for food they can’t have and then indulging on it. The important thing is to make sure that the patient doesn’t feel that they are condemned to a life of tasteless food fare, because celiac patients have lots of wonderful and tasty options which they can have every single day. It’s just a matter of educating the patient.
Gluten in Non-food Items
The gluten-sensitive community has become increasingly concerned about the gluten in shampoo, lotions, lip balm and other personal care products can cause their immune system to react adversely. The truth of the matter is, most doctors and nutritionists are unsure what to say.
On one hand, nutritionists claim that patients should be mindful of the contents of their personal care products. Modern technology had made it possible to reduce the sizes of wheat byproducts such that they can more readily be absorbed through the skin. Another route is inhaling aerosolized products by accident.1
However, most doctors agree that gluten-containing cosmetics and skin care products should not present a problem for gluten-sensitive individuals. This is unless they accidentally ingest these products. Gluten-sensitive individuals should avoid the use of beauty products meant for use on the lips or around the mouth: lip balm, lipstick and lip moisturizers. It is also advisable for patients to avoid the use of dental-care products which contain gluten. This includes mouthwashes and toothpaste. Absorption of minute carbohydrate particles start within the buccal mucosa or the lining of the mouth. Thus, patients and healthcare professionals should be wary and check if a product may contain residues of gluten.2
Dermatitis Herpetiformis is a form of skin problem which patients with celiac disease can develop. This blistering and itchy skin rash is closely linked to gluten intolerance. But this variant of dermatitis results not from superficial contact or application of gluten-bearing products, but as a skin reaction caused by the ingestion of gluten. Thus, it is not the avoidance of skin products, but the religious monitoring of dietary intake that can help avoid this skin problem.
In addition, a patient can still be allergic to a certain skin product regardless if it has gluten or not. Thus, one who is in doubt should consult with a qualified dermatologist and get a full-allergen screening test to identify the cause of the problem and avoid recurrence.
Transitioning to a Gluten-Free Lifestyle
The most important thing that a doctor and a patient should realise is that going gluten-free is a lifestyle change. It is not something temporary to alleviate symptoms. To keep symptom-free and healthy for life, the patient has to adhere to the diet for life as well. The first step is to communicate properly with the patient. Make sure that the patient knows what exactly gluten does to their body. One should know the dangerous changes the protein does to their gut, immune system, their brain, and other organ systems. These effects can easily be managed through adhering to a gluten-free lifestyle.
Doctors must remind patients to closely examine the contents of the food they eat. If necessary, a doctor must actively prescribe or suggest brands which are known to be gluten-free. This is to inform the patient that the physician trusts these brands; barring formulation changes, patients have a brand that they can trust for life.
If necessary, providing gluten-free recipes can facilitate transitioning to a gluten-free lifestyle. It is important to inform patients that even things as simple as their spice cabinet must also be gluten-free. This is because some spices have additional maltodextrin in them which the body could react to.
Good Gluten-Free Diet vs. Bad Gluten-Free Diet
Just because gluten has been eliminated from the diet doesn’t necessarily equate to a completely healthy lifestyle. Eliminating gluten is only one part of the solution. In going on a gluten-free diet, one must plan the food they ingest carefully to ensure that they are still able to achieve all their nutritional requirements. It is easy to drink nothing but soda all day and say it is a gluten-free diet. But what does the body have to gain from it? Empty calories.
A good gluten-free diet is composed of the appropriate amount of carbohydrates, proteins, fats, vitamins and minerals which are good for the body. Every component of the human diet is important. Research suggests that high fat low carbohydrate diet is the best way to reduce excess body fat, increase HDL which is the good cholesterol, and keep the bad cholesterol at its minimum.3 However, the kind of fat ingested needs to be monitored. This is because there are different types of fat. There’s saturated, unsaturated, PUFA, MUFA and many more different types and classifications. Around a decade ago, there was hype about trans-fats being bad for the human cardiovascular system. There is truth to this.4
Thus, it is important for doctors and patients to keep updated about keeping lifestyle healthy without making the patient suffer distasteful consequences. It is difficult to keep to the same diet without getting bored or destroying one’s general health. So each step must be carefully planned with the help of a doctor and a qualified nutritionist.
- Minich, D. (2013). Nutrition for the soul: moving beyond a gluten-free diet. Retrieved from http:theglutensummit.com ↩
- Farrell, R.J., et al. (2010). Celiac disease and refractory celiac disease. In: Feldman M, et al. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders Elsevier. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4160-6189-2..X0001-7–TOP&isbn=978-1-4160-6189-2&about=true&uniqId=229935664-2192. ↩
- Anneken, D. J. et al. (2006) “Fatty Acids” in Ullmann’s Encyclopedia of Industrial Chemistry, Wiley-VCH, Weinheim. ↩
- Beermann, C., Jelinek, J., Reinecker, T., Hauenschild, A., Boehm, G., & Klör, H. U. (2003). Lipids in Health and Disease 2: 10. ↩