KEY POINTS:

Nutrition counseling appointments with dietitians vary by format, length of time, number of visits, and counseling style across the country. Here is a list of some commonly asked questions that a dietitian may ask you during a nutrition appointment for celiac disease.

1. How were you diagnosed with celiac disease?

2. Did you bring any medical test results with you?

See the Lab Work box and Medical Test Results box in Level 1 for suggested labs and medical testing.

3. How are you feeling? Do you have any symptoms?

Gas
Bloating
Fatigue
Constipation
Loose stool or diarrhea
Nausea
Skin rash
Headache/Migraine
Poor Concentration
Joint pain
Others?

4. What is your primary reason for coming to a nutrition visit?

To learn about label reading, hidden gluten, and safe, healthy food
To treat nutritional deficiencies through diet and/or supplements
To review my current supplements
To find out about celiac disease and gluten-free diet resources
To receive a nutrition assessment to help me achieve better health
To treat gastrointestinal or other symptoms, like fatigue
To manage my weight
Something else?

5. What additional questions do you bring with you today?

Following is a list of items that are often requested before or during a nutrition appointment. Having them available will help make your appointments run more smoothly and effectively.

Be prepared to answer the following questions as you are able:

  • Anthropometric Measurements
    • Age
    • Height
    • Current weight
    • Weight history (dieting history, etc)
    • Weight changes (before and/or after your diagnosis)
    • Your goal weight (if different from your current weight)
  • Food and Nutrition-Related History
    • Your food and beverage intake: It is helpful to provide a 3-day food record (also called a food log or diet recall) at your visit.

      One example of a standard food log: Record what you eat and drink for 3 consecutive days sometime prior to your appointment. Include 2 weekdays and 1 weekend day. Be sure to include brand names of products and estimated serving sizes. A dietitian will use this information to teach you about obvious and hidden sources of gluten as well as to assess your need for additional nutrients.

    • Specific diets you may be following (e.g. gluten-free, low lactose, heart-healthy, vegetarian, kosher, diabetes meal plan, etc.)
    • Your known food allergies and food intolerances
    • Where you gathered your information about the gluten-free diet (internet, other dietitians, your doctor, books, friends, support groups, etc)
    • Your beliefs and attitudes about food and the gluten-free diet
    • Where/How often you dine away from the home
    • You may be asked about steps you have taken to prevent cross-contamination of gluten-free food in a shared kitchen
    • Your perception about your quality of life: how does having celiac disease affect you? Do you have any issues with the cost of gluten-free foods?
    • You may be asked about your personal, professional and social life as it relates to your new diagnosis.
  • Patient History
    • Your personal health history
    • Your family health history
    • Your social history: socioeconomic factors, occupation/profession, social and medical support, daily stress level, access to safe food, etc.
    • Your level of exercise or physical activity
    • Tobacco and/or alcohol use
  • Lab Data, Medical Tests and Procedures, Medications and Supplements
    • If not already available to the dietitian, you may be asked to provide previous blood work, and results from medical testing and procedures.

      Other test results, when available: small intestinal endoscopy with biopsy reports, nutritional lab results, bone density reports, food allergy or food sensitivity testing results, and results from other relevant tests or studies. Click here to see an example biopsy report and click here to see an example bone density report.
    • Bring your updated list of medications and dosages (over-the-counter and prescription). Note on your list if the product(s) is/are gluten-free if you have already researched this information.
    • Bring your updated list of supplements and dosages. Examples include vitamins, minerals, specially formulated nutrition drinks or products, and herbal and complementary products. Note on your list if the product(s) is/are gluten-free if you have already researched this information. In some cases, it is quite helpful to bring the actual supplement bottle or label with you for your dietitian to review.
    • Don't forget to bring your questions for the dietitian.
    • You can bring your friend or family member for support and to be a "second pair of ears." It is a good idea to bring a notebook and a pen, too.
    • Make sure to check with your primary care doctor and/or your insurance company if a referral is needed for your appointments. Ask whether or not your visit will be covered by your insurance company.

By answering these questions to the best of your ability and by sharing any other relevant information with your dietitian, together you will be able to design an action plan to educate you fully about the gluten-free diet and lifestyle and maximize your nutrition and quality of life.

TAKE HOME MESSAGES:

  • It is most helpful to come prepared for your visit with the dietitian so that he/she will be equipped with all of the information necessary to assess your nutritional status.
  • The dietitian will use all of the information you provide to create a nutrition care plan that meets all of your nutritional needs and is gluten- free.

References

  1. Evidence Analysis Library. Executive Summary of Recommendations. American Dietetic Association. http://www.adaevidencelibrary.com/topic.cfm?cat=3726. Accessed 6/2011.
  2. Schuppan D, Dennis M, Kelly CP. Celiac disease: epidemiology, pathogenesis, diagnosis, and nutritional management. Nutr Clin Care, 2005:8(2);54-69.
  3. U.S. Department of Health and Human Services/National Institutes of Health. NIH Consensus Development Conference on Celiac Disease. http://consensus.nih.gov/2004/2004CeliacDisease118html.htm. Accessed August 16, 2011.
  4. What to expect and ask at the exam. Celiac Disease Center at Columbia University. http://www.celiacdiseasecenter.columbia.edu/A_Patients/A04-WhatTo.htm. Accessed 8/4/2011.

Revision Date: 8-30-12
Author: Melinda Dennis, MS, RD, LDN

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