Aramark Dietetic Internship

Erika Stahl

Title:Celiac Disease and the Gluten-Free

Diet: The Need for Registered Dietitians with Certified Expertise

Emerging Trends Research Project

Celiac Disease (CD)

autoimmune disease

affects the small intestine

1 to 3% of the general population has CD

ingestion of gluten inflammation

Introduction

Gluten protein found in wheat, barley, rye oats are contaminated with gluten the alcohol-soluble fraction is what causes

reactions gliadin=wheat hordein=barley secalin=rye

About Gluten

Gluten inflammation epithelium and

lamina propria of the small intestine become

infiltrated with lymphocytes crypt

hyperplasia and atrophy of the intestinal villi

What Gluten Does

Consequences decreased ability to absorb nutrients vitamin and mineral deficiencies malnutrition abdominal cramping distention and bloating of the stomach intestinal gas chronic diarrhea or constipation

(sometimes both) steatorrhea migraine headaches

Symptoms of Celiac Disease

Gluten-free diet Difficult because GLUTEN IS EVERYWHERE! Bread, crackers, pretzels, cereal, pasta,

soy sauce, beer, soup, etc… Cross contamination is a big issue

Rx: Gluten-Free Diet!

When first diagnosed celiac patients are often angry in denial frustrated have anxiety depressed overwhelmed and confused!

Emotions

Registered Dietitians (RD’s) Highly skilled trained nutrition professionals Celiac disease is managed by a strict gluten-

free diet alone thus making the dietitian ESSENTIAL!

Be prepared to have in-depth nutrition assessments, educational sessions and ready to answer multiple questions

Dietitians and Celiac Disease

Boston- 2007 prospective study

Assessed level of dietary adherence to a gluten free diet

Results: the presence of additional food intolerances greatly affected adherence

87.9% of participants who were declared to have “excellent” to “good” adherence to the gluten-free diet had additional food intolerances

Physicians should refer celiac patients to a registered dietitian, especially if newly diagnosed

Dietitians should give feedback to the physician 49% of physicians find feedback from the

dietitian useful Unfortunately 41% reported that they rarely

received any detailed feedback or recommendations from the dietitian

Team Approach

A 2001 study of celiac patients found that 54% who had seen a dietitian did not find the dietitian knowledgeable or helpful Celiac patients need definitive answers to

their questions Helpful if the RD knows which items taste

best

Nutrition Expert?

Commission on Dietetic Registration (CDR) offers various different specializations geriatrics, sports nutrition, pediatrics,

renal nutrition, oncology, etc require RD status for greater than 2 years

and approximately 2000 hours of practice experience

Future: Celiac Disease specialization???

Specializations

To determine: if registered dietitians have sufficient

knowledge of celiac disease in order to effectively work with this population

Is more education needed? Would a specialization in celiac disease be better suited to meet the needs of patients?

Objective

2 electronic surveys via survey monkey Survey 1 – Registered Dietitian Survey

Sent out via Aramark email Survey 2- Celiac and Gluten Intolerant

Survey Sent out using

LISTSERV@listserv.icors.org

Methodology

Celiac Survey- 586 surveys completed 91.3% (535 participants) were celiac

patients and the remaining 8.7% (51 participants) were gluten intolerant

Majority- female (86.3%, 506 women) 94.2% (552 participants) reported

following a gluten-free diet 100% of the time

Celiac & Gluten Intolerant Survey Results

The survey found that many of those in need of information about a gluten-free diet obtained the majority of their information from books, internet websites, and local or online support groups. Only 31.9% used information

provided by an RD.

Results Continued

187

173

186

417

384495

403

293

12170

Information Source

Information from a Registered Dietitian (RD)

Information from a Doctor

Information from family and/or friends

Celiac Disease Foundation Website (www.celiac.org)

Celiac.com (www.celiac.com)

Internet search/ alternate websites

Books

Magazines

Not Applicable

Other

Participants stated that they knew more about the gluten-free diet after doing research on their own than the RD did and/or that the RD provided them outdated or incorrect information.

When asked about the information provided by the RD: 69 out of 300 participants reported the information

was not useful (23%) 119 as somewhat useful (40%) 112 as very useful (37%)

Results Continued

Dietitian Survey- 140 surveys completed Primarily clinical dietitians (77.1%, 108

participants) Majority of respondents have 0 to 5

years of experience (55%) 19.3% with 6 to 10 years of experience

RD Survey Results

Dietitians were asked to rate their confidence level when working with celiac or gluten intolerant patients using a scale of 1 to 10. Mode and median= 7

Results Continued

Dietitians had difficulty: Identifying sources of gluten other than

the obvious- wheat, rye and barley Ex. Triticale- a hybrid grain made from

wheat and rye Identifying conditions which are

commonly associated with celiac disease Ex. Dermatitis herpetiformis

Results Continued

As dietitians are the experts in nutrition, a survey of dietitians regarding a disease that’s only treatment is medical nutrition therapy scores ideally should have been near perfect.

Additional education and/or specialization would be useful to provide better care to patients.

Discussion

Physicians are also in need of further education of the gluten-free diet ~30% of the gluten-free survey

participants stated that they felt their physician was not knowledgeable regarding the gluten-free diet

~ 20% reported that their physician didn’t explain as to why a gluten-free diet was necessary as a form of treatment

Discussion Continued

The majority of the dietitians polled worked with celiac patients ≤4 per month It would take a considerably long time for

dietitians to obtain enough practice hours for a specialization in CD

Would dietitians want to specialize in CD?

Conclusion

Better off increasing CD education undergraduate programs dietetic internships

Ensuring future dietitians are all equipped to work with celiac patients

Conclusion Continued

Questions?

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