Complete removal of gluten from the diet of those with coeliac disease has been shown to reduce the risk of developing many complications associated with coeliac disease, such as osteoporosis/osteopenia, anaemia, malignancy and gastrointestinal symptoms (Leffler, et al, 2007). It has also been documented that adults following a gluten-free diet have an improved quality of life (World Gastroenterology Organisation, 2007).

Despite this compliance rates can be poor among people with coeliac disease, with an estimated 45-80% of coeliacs adhering strictly to the gluten-free diet (Leffler, 2007). The highest rates of compliance are among those diagnosed as young children; while adolescents and those who were asymptomatic on diagnosis appear to have the most transgressions (Pietzak, 2005).

Causes of Poor Compliance

Gluten ingestion in coeliacs may be intentional or accidental and up to 72% of coeliacs report occasionally consuming gluten containing foods (Lamontagne, et al, 2001). The best method for measuring compliance in coeliac patients is an in-depth dietary assessment with a dietitian knowledgeable in coeliac disease. Causes of non-adherence to the gluten-free diet include:

As well as these practical difficulties a diagnosis of coeliac disease can have a profound impact on a person’s life. In a 2005 research paper entitled ‘Controlled by food’, Sverker at al. outlined experiences of clients living with coeliac disease. Areas where dilemmas were experienced included eating at work, purchasing gluten-free foods, travel, eating meals with other people inside and outside the home. Many felt shame associated with the diagnosis and were worried about being contaminated with gluten. Others did not want to be a burden or did not feel comfortable disclosing information about their disease and so chose eat foods containing gluten to avoid unwanted attention. These areas of dilemma may be just as influential in causing non-adherence to the gluten-free diet and should be addressed by the dietitian.