In today’s Digestible Chat, I interview GI dietitian and celiac expert, Jessica Lebovits, RD, CDN, CNSC. Learn about the interesting study Jessica has been involved in that looks at the impact of having celiac disease and dating- as well as her top 3 books for celiac disease and gluten free living!
Kate: Can you share what type of work you do in the GI space as a dietitian?
Jessica: I am a registered dietitian who is passionate about helping those with gastrointestinal conditions. I specialize in celiac disease and other gluten-related disorders, IBS, SIBO, GERD, gastroparesis, lactose/fructose intolerances, etc. I love helping others meet their goals, live a healthy lifestyle, and enjoy food to the fullest!
I see patients at the Celiac Disease Center at Columbia University as well as through my own nutrition private practice, Jessica Nutrition. I am a total foodie and do not accept that a gluten free diet means bland, underwhelming food. You can find me on Instagram, Twitter, and TikTok as @gfree_rd, where I share tasty gluten free recipes, restaurants, travel, gluten free products, updates in research, and upcoming events related to nutrition, celiac disease, and the gluten free diet.
I recently collaborated with GI OnDemand, a new virtual support platform. Patients can now view the webinar I created, Celiac Disease 101 on their website. They can also view the 3-part course I created on Celiac Disease and the Gluten-Free Diet that offers a deeper dive into ‘Shopping, Planning, and Cooking,’ ‘Optimizing Nutrient Intake,’ and ‘Dining Out and Traveling’ on a gluten free diet. Additionally, the course offers helpful handouts and resources to anyone who registers.
I was lucky to work with Kate in co-authoring the chapter on Nutrition Therapy for Intestinal Disorders in Geriatric Gastroenterology. My section focused on Celiac Disease and Gluten Intolerance Disorders. Currently, I am co-leading the Academy of Nutrition and Dietetics’ Gluten-Related Disorders workgroup within Dietitians in Gluten and Gastrointestinal Disorders (DIGID) to further the evidence-based practice for gluten-related disorders. I am also co-leading a workgroup that is actively working on creating a GI nutritional credential to further establish and promote GI-specific registered dietitians.
I also co-authored two exciting articles on celiac disease, Factors Associated with Maladaptive Eating Behaviors, Social Anxiety, and Quality of Life in Adults with Celiac Disease and Patients’ Risk Tolerance for Non-Dietary Therapies in Celiac Disease. My personal research interests are in the social impact of celiac disease and I filmed a webinar for Epicured on the subject.
Kate: You recently published an interesting study about dating while having celiac disease. Can you share a link to this study and your key findings?
Jessica: We know that when seeking a new romantic partner, dating tends to revolve around food, especially dining out at restaurants. Based on what we have heard from our patients, we know that this may pose unique problems and cause elevated anxiety for those following a strict gluten free diet. Therefore, we expected that those with celiac disease may experience increased stress compared to the general population when engaging in dating behaviors.
Our study aimed to investigate the dating-related behaviors of adults with celiac disease and highlighted the interference celiac disease has on the dating experience. The majority of our respondents reported that celiac disease had a major/moderate impact on their dating life. This greater impact was more commonly reported among females, those in the 23-35 year age range, and those with an annual household income below $50K. This impact may result in hesitation towards dating and kissing, decreased quality of life, greater social anxiety, and less adaptive eating attitudes and behaviors. Dating poses a barrier to the gluten free diet as respondents admitted to feeling uncomfortable explaining precautions to waiters in front of their date, engaging in riskier eating behaviors on a date, and 7.5% [of those studied] intentionally consumed gluten on a date.
Our findings highlight the importance of continuous follow up with a registered dietitian for celiac disease management as these conversations about specific social barriers and quality of life take time. We hope that this study will increase awareness of our patients’ challenges as it relates to dating and relationships.
This study, the Impact of Celiac Disease on Dating, was presented at DDW 2021 and has been accepted for publication in the journal Digestive Diseases and Sciences.
Kate: Many individuals with GI conditions restrict gluten, what are your concerns about them doing this on their own?
Jessica: It is great when dietary changes can provide such significant relief in symptoms. But, it is really important to know why that relief occurs. Before committing to a restrictive diet, such as the gluten free diet, I recommend patients see a specialized gastroenterologist. Proper testing for celiac disease will only produce accurate results when gluten is still being consumed. Therefore, it will be difficult to determine the true diagnosis if a gluten free diet has already been started. If celiac disease is diagnosed, then the patient may need to be more aware of cross-contact and of proper follow up specific to celiac disease (i.e. lab work, bone density scans, vaccines).
If celiac disease is ruled out, it is possible that gluten is triggering symptoms due to non-celiac gluten sensitivity (NCGS). Although many people attribute their symptoms to gluten and may believe they have NCGS, they may actually have an alternate condition that has not been explored yet, but needs to be addressed (e.g. SIBO, IBS, IBD). This is another reason why it is so important to work with a trained gastroenterologist and dietitian to ensure a proper diagnosis is made and the appropriate therapeutic diet is followed.
It has become clear that other triggers within gluten-containing foods may be provoking symptoms, such as dietary fructans and amylase trypsin inhibitors (ATIs). Many gluten-containing foods are considered high FODMAP due to their high fructan content. In this case, patients may benefit most from exploring a low FODMAP protocol with the guidance of a trained dietitian. This will help to identify only select trigger foods that need to be limited as well as the quantities tolerated. This may allow for more flexibility in terms of restricting gluten and better control of symptoms.
Kate: What are 5 tips you often provide a person newly diagnosed with celiac disease?
- For those with celiac disease, gluten triggers inflammation in the body causing damage to the small intestine. The only way to allow the body to fully heal is to minimize the amount of gluten you are exposed to. Therefore, the recommendation is to follow the gluten free diet to the best of your ability. Nevertheless, everyone with celiac disease is slightly different. Everyone has different tolerances, sensitivities, and symptoms. And so, it is important to work with a specialized gastroenterologist and dietitian to figure out exactly how strict you need to be on your gluten free diet. Your goal is for your celiac disease antibodies to normalize and your intestines to heal, but it is also very important to maintain your quality of life while doing so.
- If you don’t notice any symptoms from gluten, you do still need to follow a gluten free diet. Although you may not feel any symptoms, it is possible gluten is still causing damage in your intestines, which can lead to other consequences. For example, gluten may be impairing your ability to absorb calcium and vitamin D, which can cause bone loss. You may not be acutely aware of these ‘symptoms,’ but you can prevent them by following a gluten free diet and preserving the integrity of your intestines. You may also be preventing any other conditions from developing later on in life.
- Although it may feel that ALL foods have gluten in them and you are left with nothing to eat, you will eventually realize that there are endless gluten free options. Aiming for naturally gluten free foods, such as fruits, vegetables, meats, fish, eggs, nuts, seeds, dairy, legumes, and gluten free whole grains (e.g. rice, quinoa, millet, buckwheat) will help you to achieve a varied, healthy gluten free diet. I encouraged my patients to aim for 1 new food or 1 new recipe per week!
- Although a gluten free menu is a great step towards helping you enjoy a gluten free meal, restaurant menus are not formally regulated. The foods on the menu should ideally be gluten free, but you will still need to ask about how the foods are being prepared to ensure measures are being taken to minimize gluten exposure and the items are actually safe for you.
- Utilize the resources available to you to make the best of your life on a gluten free diet! Find Me GF is a super valuable app and website that helps you find gluten free establishments. You can search by location and see different places and how celiac friendly they are. You can also filter by specific types of foods for when you are craving gluten free pizza or gluten free bakery goods!
Q5. What are your 3 favorite books you recommend for someone with celiac disease?
Celiac Disease: A Hidden Epidemic by Peter H.R. Green, MD and Rory Jones is really helpful to learn evidence-based information about celiac disease and the gluten free diet. However, it is difficult for books to keep up with all of the latest updates in research and practice as the science is constantly changing. So even if you feel you are managing your celiac disease well, it is valuable to follow up with your practitioners regularly to learn about updates within the field and with celiac disease management.
And given that the only treatment for celiac disease is a gluten free diet, I always recommend recipe resources and cookbooks for my patients to learn about gluten free ingredients and to learn that a gluten free diet can be fun, flavorful, and nutritious. For gluten free cookbooks, I recommend checking out America’s Test Kitchen’s How Can It Be Gluten Free and Aran Goyoaga’s Cannelle et Vanille for the more advanced cook.
Thank you, Jessica for sharing all this valuable information!