The gluten free diet requires a lifestyle change that can seem overwhelming,
whether you are newly diagnosed or have been following the diet for
many years. At the Kogan Celiac Center, we understand that this kind
of change doesn’t happen overnight . . . it is a process that
includes many emotional, physical and practical adjustments.
Our diet education program, Celiac Steps to Success, divides the process
of learning how to eat and live gluten free into easy, manageable steps.
Patients meet with a Registered Dietitian at regular intervals and learn
how to implement changes that meet dietary guidelines and address lifestyle
needs. This sequence, listed below, typically runs over a 6 month period,
after which annual follow up visits are recommended.
Step 1 (Initial Consultation)
- Patient and family receive initial consultation which includes diet
education, label-reading instruction and resource guide. Current dietary
intake and lifestyle are assessed, appropriate substitutions and/or
strategies are discussed.
- Patient begins to eliminate obvious sources of gluten from diet,
including medications. Contact with manufacturers or pharmacist regarding
questionable ingredients is initiated.
- Patient establishes alliance with appropriate partners or resources
(school administrators, daycare staff, medical
team, psychologist), aided by Registered Dietitian
if desired.
Step 2
- Patient meets with Registered Dietitian 2 months after initial consultation.
Progress is reviewed, questions are answered,
adjustments are made as necessary.
- Patient and family learn skills for identifying sources of cross
contamination, both in and out of the home. Strategies are discussed,
self-advocacy is stressed.
- Patient develops skills for identifying hidden sources of gluten.
- Patient identifies avenues for support (utilizing online resources
and memberships, joining local support group
meetings).
- Patient continues to refine alliance with appropriate partners or
resources (school administrators, daycare staff,
medical team, psychologist), aided by Registered
Dietitian if desired.
Step 3
- Patient meets with Registered Dietitian 4 months after initial consultation.
Progress is reviewed, questions are answered, and adjustments are
made as necessary.
- Patient refines knowledge of hidden sources of gluten, issues of
cross contamination.
- Patient refines label reading skills.
- Patient begins introducing alternate grains, examines nutritional
adequacy of current gluten free diet (fiber,
fat, micronutrients) and begins to make adjustments accordingly (supplementation,
etc.).
- Patient refines self-advocating skills with manufacturers and when
dining out.
- Patient has attended at least one local support group meeting and
joined at least one national advocacy organization.
- Patient receives prescription for repeat serology, to be performed
1 week prior to Step 4 meeting.
Step 4
- Patient meets with Registered Dietitian 6 months after initial consultation.
Progress is reviewed, serology results are reviewed,
questions are answered, adjustments are made as necessary.
- If patient is asymptomatic and serology is improved, may add gluten
free oats back into the diet (monitor for symptoms).
- If serology is unchanged, diet and compliance are reviewed, follow
up visits to continue every two months or as
needed.
- Patient is now fully able to self-advocate with manufacturers and
while dining out of the home.
- Patient refines nutritional adequacy of current gluten free diet
(fiber, fat, micronutrients) and continues to
make adjustments accordingly (supplementation, etc.).
- Patient receives prescription for repeat serology, to be performed
1 week prior to Step 5 appointment.
Step 5 (one year from diagnosis)
- Repeat serology, compliance evaluated, questions answered.
- Patient keeps up-to-date regarding changes in labeling laws, ingredient
information, treatment options.
- Patient continues to examine the nutritional adequacy of current
gluten free diet and makes changes accordingly.
- Patient conducts periodic updates with allied partners, Registered
Dietitian to assist if desired.
- Patient receives prescription for repeat serology, to be performed
1 week prior to next annual appointment.
Step 6 (Annual Visit)
- Repeat serology, compliance evaluated, questions answered.
- Patient keeps up-to-date regarding changes in labeling laws, ingredient
information, treatment options.
- Patient continues to examine the nutritional adequacy of current
gluten free diet and makes changes accordingly.
- Patient conducts periodic updates with allied partners, Registered
Dietitian to assist if desired.
- Patient receives prescription for repeat serology, to be performed
1 week prior to next annual appointment.
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