Appointments with a registered dietitian

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Melinda Dennis MS, RDN, LDN

Q: How frequently should I see a registered dietitian? And why?

Answer


If you are diagnosed with celiac disease, both the Academy of Nutrition and Dietetics and the National Institute of Health recommend consults with a registered dietitian nutritionist (RDN) skilled in celiac disease.1,2

The NIH recommends continuous long-term follow-up by a multidisciplinary team, including an RDN1  but does not offer a specific timeline. The Academy suggests an initial visit, and then follow-up visits 2-4 weeks later, 6 months post diagnosis, and annually thereafter.2  However, these general guidelines can differ by state, insurance plan, provider scheduling availability and, most importantly, by individual needs of the patient. At BIDMC’s Celiac Center, I try to see a patient newly diagnosed with celiac disease 3 times within the first year and then annually.

An RDN will assess your medical and social history, identify potential vitamin and mineral deficiencies or excesses, and develop an individualized, balanced nutrition treatment plan for you based on your current diet, labs, symptoms (such as gas, bloating, irregular bowels, etc.) and other conditions.3,4,5  You will learn about the foods to choose and avoid on the gluten-free diet, which supplements you need (if any) and how to find the correct resources for living gluten-free.6

Follow-up with an RDN is recommended to monitor your nutritional status and ensure you fully understand and carefully follow the gluten-free diet. Updates on new label reading information, sources of cross contamination, research, and resources to help you adjust socially and emotionally can be provided.4

Other Reasons to Visit a Dietitian Skilled in Celiac Disease: 7

  • Plan your meals at home, in restaurants and when traveling
  • Reach or maintain a healthy weight
  • Learn cost-saving tips
  • Manage your coexisting conditions like lactose intolerance, diabetes, high blood pressure, etc.

BOTTOM LINE: When you are first diagnosed with celiac disease, you can ask for a referral to see a dietitian skilled in celiac disease.7

If this is not possible, then you can ask for a referral:

  • When you have learned all you can from reputable sources
  • If you have questions about your gluten-free diet or supplements
  • If you are still having symptoms and/or your celiac antibody levels are not normalizing or are trending down toward normal too slowly; it is important to see your gastroenterologist and dietitian.

Insurance coverage may dictate how often and how many visits you can schedule.

There is still a shortage of RDNs skilled in celiac disease in the U.S. However, when possible, take advantage of the opportunity to learn as much as you can about the gluten-free diet and lifestyle by visiting with a celiac-skilled RDN. To read more about Nutrition Consults, see https://www.bidmc.org/centers-and-departments/digestive-disease-center/services-and-programs/celiac-center/celiacnow/nutrition-and-the-gluten-free-diet/nutritional-consults.

  1. Academy of Nutrition and Dietetics Evidence Analysis Library. Executive Summary of Recommendations.  Celiac Disease. andeal.org/topic.cfm?cat=3726. 2009. Accessed April 2, 2019.
  2. NIH Consensus Statement on Celiac Disease. www.consensus.nih.gov/2004/2004CeliacDisease118main.htm. Accessed April 2, 2019.
  3. Rubio-Tapia A, Hill ID, Kelly CP, et al. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol 2013;108(5):656–76.
  4. See J, Murray JA. Gluten-free diet: the medical and nutrition management of celiac disease. Nutr Clin Pract 2006;21(1):1–15.
  5. Dennis M, Lee AR, McCarthy T. Nutritional considerations of the gluten-free diet. Gastroenterol Clin N Am 48 (2019) 53–72.Dennis, M. Nutritional Consults for Celiac Disease. https://www.bidmc.org/centers-and-departments/digestive-disease-center/services-and-programs/celiac-center/celiacnow/nutrition-and-the-gluten-free-diet/nutritional-consults. Accessed March 30, 2019.

Note: This information is provided by NCA and Melinda Dennis, NCA's Senior Consulting Dietitian. This information is meant for educational purposes and is not intended to substitute for personalized medical advice or replace any medical advice provided directly to you by your health care provider. This information can be printed and used in consultation with your physician or dietitian. No liability is assumed by NCA, Ms. Dennis or her nutrition consulting service Delete the Wheat, LLC. by providing this information.

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About Melinda Dennis MS, RDN, LDN

Melinda Dennis, Senior Nutrition Consultant for NCA, is an expert celiac dietitian and and Nutrition Coordinator for the Celiac Center at Beth Israel Deaconess Medical Center in Boston, MA. Diagnosed with celiac disease in 1990, she specializes in the nutritional treatment of patients with celiac disease and gluten-related disorders.

Melinda lectures internationally and has written extensively on the nutritional management of celiac disease including the award-winning book Real Life with Celiac Disease. Melinda was the original founder of NCA in 1993 and so it is only fitting that she comes back to us in this capacity. We are truly honored to have her on our team.