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Dear Dietitian – Celiac Disease

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PICT Leanne McCrate Dear Dietitian
Leanne McCrate, RD, LD, CNSC

Dear Dietitian

My fourteen-year-old daughter was recently diagnosed with celiac disease.  We made an appointment with a dietitian, and she is doing her best to follow a gluten-free diet.  The problem is she still has stomach aches and diarrhea three to five times a week. What should we do? --Mandy

Dear Mandy,

Today as many as three million Americans suffer from celiac disease. As you have learned, gluten is a protein found in wheat, barley, and rye, and triticale (a hybrid of wheat and rye). Gluten intolerance, or celiac disease, is the body’s reaction to gliadin, a component of gluten. This reaction damages the small intestine, resulting in malabsorption of nutrients. Symptoms of gluten intolerance include abdominal cramping, bloating, and diarrhea. The definitive diagnosis for celiac disease is a biopsy of the intestine performed by a gastroenterologist, or GI doctor.

Gluten-free diets have become a bit of a fad in the US, but it seems to be past its peak.  Some claim that going gluten-free will help treat thyroid problems, but scientific evidence is lacking. Others eliminate gluten to cope with Irritable Bowel Syndrome (IBS), but little research has been conducted in this area.  A gluten-free diet is effective to treat celiac disease.

It is possible that your daughter is unknowingly consuming foods that contain gluten.  For instance, some candy, malt flavoring, and soy sauce contain gluten, but food manufacturers are not required to put this on the label. It takes a thorough investigation into food products to learn what foods contain gluten. 

Label reading is an integral part of following a gluten-free diet. Of course, you need to avoid any products that contain wheat, barley, or rye. Look for foods with “gluten-free” on the label. In order to be labeled “gluten-free”, the Food and Drug Administration (FDA) requires that a product contain less than 20 parts per million of gluten.  This type of labeling is voluntary.

Keeping a food log would be helpful to identify foods that cause problems.  A small note pad can fit in your daughter’s purse or backpack and serve as a valuable aid to record problem foods as she goes about her day.

Remember, it takes at least six weeks to get adjusted to a new way of eating. Try to be patient. You may consider making a follow-up appointment with the dietitian to gain more insight into the gluten-free diet.  Education is a process that takes time.

Sincerely, Dear Dietitian

Leanne McCrate, RD, LD, CNSC, is an award-winning dietitian with over fifteen years of experience. Have a question?  Email Leanne at