Dr. Justine Dowd, PhD shares her research and own experience with Celiac disease.
Justine is currently a CIHR funded post-doctoral fellow working in the Faculty of Kinesiology at the University of Calgary. Her research is in the area of health behaviour change and she is specifically using evidence-based strategies, such as self-compassion and self-regulation, to improve quality of life and adherence to a gluten-free diet among people living with celiac disease. As an active health promoter, Justine has presented her work at conferences including the Canadian Celiac Association’s National and Regional Conferences and Big Brothers Big Sisters of Canada’s National Convention.
5 Strategies for Living Gluten-Free
My interests in following a gluten-free diet stem from when I was diagnosed with celiac disease 5.5 years ago and began to navigate the world of following a gluten-free diet. As a health psychology researcher, I became fascinated as I observed the experiences I was personally going through in changing my diet, as well as watching other people who were also trying to eliminate gluten from their diets.
When I was first diagnosed, my doctor actually said: “the results of the blood test suggest you have celiac disease. This means that you should follow a strict gluten-free diet for the rest of your life. Good luck with that. Gluten is in everything – even toothpaste.” Not exactly the caring, compassionate or even informative response one might hope to receive! Fortunately for me, my wonderful mother had been diagnosed with celiac disease a few months before me, so she was able to help me get started, and feel better about my new diet. Throughout the ups and downs involved in going gluten-free, I definitely ended up in tears in grocery stores and restaurants because I felt so frustrated, alone and often really hungry but unsure of what I could eat. Over time, following a gluten-free diet became easier as I learned what did and didn’t work for me. After following a gluten-free diet for about 8 months, my husband and I came across the ‘Paleo’ way of eating, and it changed my life. I loved that I could finally open up any Paleo cookbook or recipe blog and choose to make anything I wanted without modifying it! On top of that, by primarily avoiding grains, dairy and processed foods and focusing on a whole foods diet, I felt and looked the best I had in years as I lost the weight I had put on after initially going gluten-free (and indulging in a few too many processed gluten-free treats…) and my body just felt healthy again.
While I have found a way of eating gluten-free that works for me, I have also heard stories from many friends, family and even complete strangers about the struggles they have experienced in changing their diet. As a researcher, I wanted to understand why some people seem to be able to change their diet relatively easily, whereas others seem to struggle quite a bit.
Recent research suggests that despite the benefits of following a nutritious gluten-free diet for people with celiac disease1,2, adherence to a gluten-free diet ranges from 42% to 91%3. So you are not alone if you have been diagnosed with celiac disease but aren’t currently following a strict gluten-free diet. The good news is that research shows that people can learn how to follow a gluten-free diet4!
What strategies can I use to help me change my diet?
We know that one of the most important parts of changing behaviour is being able to self-regulate (that is – self-manage or self-control your behaviour)5,6. Self-regulation involves 5 parts; self-monitoring, goal-setting, developing coping strategies and action plans and giving yourself feedback. Read the information below, download and complete the Behaviour Change worksheet to help you get on track to successfully follow a nutritious gluten-free diet!
- Self-monitoring involves tracking your behaviours so you can become aware of what you are currently doing (or not doing!).
- Using the self-monitoring guide in the Behaviour Change worksheet you can track what you eat over the next week. This will help you become aware of if and/or when you eat gluten, and identify patterns about when you might eat gluten.
- Goal-setting is important because it gives you something to strive towards and a standard to measure your progress. Make sure to set goals that follow the SMARTI guide: Specific, Measurable, Action orientated, Realistic, Time frame, and Important to you.
- For example, your goal might be to: Consume a balanced, nutritious, strict gluten-free diet at every meal over the next week.
- Coping strategies help you overcome barriers to achieving your goals. Start with identifying barriers that are relevant to you and come up with strategies to overcome each barrier.
- For example, to overcome the barrier of not knowing if an ingredient is gluten-free, you might decide to purchase a resource, such as the pocket dictionary from the Canadian Celiac Association.
- Action plans helps you turn your goals (or your intentions) into reality. In order to change your diet, make sure to plan out meals and snacks for the next week, create reminder notes and a grocery shopping list to help you stay on track.
- Using the action planning guide in the Behaviour Change worksheet you can create a meal plan for the next week.
- Feedback – every week it is important to look over your plan and think about what worked and what could be improved. The goal is to create a plan that works for you and your family!
1 Norström, F., Sandström, O., Lindholm, L., & Ivarsson, A. (2012). A gluten-free diet reduces symptoms and health care consumption in a Swedish celiac disease population. BMC Gastroenterology, 12, 125.
2 Guandalini, S., & Assiri, A. (2014). Celiac disease: A review. Journal of the American Medical Association, Advanced online publication. doi:10.1001/jamapediatrics.2013.3858
3 Hall, N. J., Rubin, G., & Charnock, A. (2009). Systematic review: Adherence to a gluten-free diet in adult patients with coeliac disease. Alimentary Pharmacology & Therapeutics, 30(4), 315-335.
4 Sainsbury, K., Mullan, B., & Sharpe, L. (2013). A randomized controlled trial of an online intervention to improve gluten-free diet adherence in celiac disease. American Journal of Gastroenterology, 108, 811-817.
5 Bandura, A. (1991). Social cognitive theory and self-regulation. Organizational Behavior and Human Decision Processes, 50, 248-287.
6 Luszczynska A, Gibbons FX, Bettina F. (2004). Self-regulatory cognitions, social comparison, and perceived peers’ behaviors as predictors of nutrition and physical activity: A comparison among adolescents in Hungary, Poland, Turkey, and USA. Psychological Health, 19, 577- 593.