Is it the gluten-free diet that matters the most? : Food, gender and celiac disease

Background: The only treatment for celiac disease consists of excluding gluten. Gluten is a protein complex found in wheat, rye, and barley, which are cereals commonly used in bread, pasta, pizza, etc. The overall aims of this thesis were to study; what happens with food choices and nutrient intakes when individuals are prescribed a gluten-free diet and what consequences this has on the everyday lives of young women and young men dealing with this disease. Methods: A food frequency questionnaire (FFQ) was used to study nutrient intake and how food choices were affected after a change to a gluten-free diet. The FFQ was sent to 12-13 years-old adolescents who took part in a large Swedish celiac screening study. The following three groups were studied: previously diagnosed with celiac disease, screening-diagnosed and non-celiac controls. The first FFQ was sent out before the screening-diagnosed adolescents had been told they had celiac disease, and the second was sent 12-18 months after they had been prescribed the gluten-free treatment. Semi-structured interviews were performed five years later in order to study how everyday life was affected by celiac disease in seven young women and seven young men. The interviews were analyzed by content analysis. Results: The previously diagnosed celiac disease group reported a nutrient intake in line with the non-celiac control group. Most of the participants reported nutrient intakes above the estimated average requirements. A diagnosis of celiac disease altered the intake of some foods, and this was shown by comparing the results from the baseline FFQ before the diagnosis and the follow-up FFQ after. The young women and young men reported similar experiences of the gluten-free food, but the perceived consequences of living with celiac disease differed between genders. Conclusion: This thesis shows that after a diagnosis of celiac disease food changes are necessary in order to be compliant with the gluten-free diet. One common effect is that food options will be reduced. However, as long the food intake is gluten-free, varied, and in sufficient quantity there is no reason to worry more about the nutritional intake of adolescents diagnosed with celiac disease than there is for their non-celiac peers. The findings in this thesis also show that society’s gender order has a great impact on how young women and young men experience their everyday lives, with celiac disease, and with the gluten-free diet