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I have been away from my computer for several weeks.  I was extremely upset
to come back to read about these horrible witches called dietitians.  I am
one of those witches and feel I need to put in my two cents into the
discussion.  When I was studying human nutrition at the University of
Guelph, the dietitian who was teaching about GI disorders knew alot about
Celiac Disease.  She knew what were the nutrients of concern, what were some
of the common problems like dumping syndrome, steatorrhea.  My class learned
about fecal fat tests, the value of reviewing food records with people with
CD or DH, observing for physical signs of malnutrition like clubbing of the
fingers, spooning of the nails and the need to refer the client to support
groups.  I wish all people with Celiac Disease could have a dietitian like
her.  The reality is that many dietitians see very few people with CD and
people with celiac disease do not always appreciate the nutritional
assessment skills of a registered dietitian.
 
In the five years that I have practised, I have had three people with Celiac
Disease referred to me.  I have seen over 8000 people in my practise.
Currently I am employed at a diabetes education center.  Although
epidemiological research indicated that there is a higher incidence of
Celiac Disease in people with Diabetes, I have no clients with CD.  I am not
trying to make any excuses for my profession but what I am trying to say is
that a dietitian who works regularly with CD would be the best dietitian to
see.  If a dietitian admits to you that she knows little about product
information for people with Celiac Disease, I would suggest that you
appreciate her/his honesty.  I would also suggest that you rely on your
dietitian for her/his nutritional assessment skills.
 
I spoke at the National Celiac Association Conference a few years ago about
this issue. The conference was attended by hundreds of people with CD but a
hand full of dietitians. I tried to encourage local dietitians to attend.
Many could not justify the expense for the handful of people they have been
in contact with.  The Canadian Celiac Association appreciated the problem
that dietitians were having in staying on top of the issues surrounding CD
by putting together a Dietitians Reference Manual.  It is excellent.  I lend
it to area dietitians all the time.
 
The Canadian Celiac Association published the results of a survey a few
years ago.  The survey was sent out to all the people registered with them.
The results indicated that dietitians were ranked third as a reliable source
of information for people with Celiac Disease (behind other people with CD
and the Canadian Celiac Association).  There definately is a problem.  I do
not know the solution.
 
In my area of expertise (diabetes education), I have to take a National
Certification Exam every five years to keep on top.  Would it not be nice if
dietitians who worked in GI units at hospitals had to be certified celiac
disease educators.  I suggest a letter writing to your National Celiac
Associations and National Dietitic Associations to initiate this process.
In my opinion this would be a much better use of your time.
 
I was in my third year of university before I was diagnosed with CD.  The
dietitian I saw had very little product information about CD.  She referred
me to several GF suppliers, many stores and a support group.  She made me
keep food records for three weeks.  We brainstormed together what were
nutrient of concern for me.  I was supplemented with appropriate minerals
and vitamins. I wish all people with CD would have this experience.  One
reference manual I have indicated that all people with CD should have a
NUTRITIONAL ASSESSMENT annually by a registered dietitian.
 
Well I have vented my feelings on the subject.  Thanks for the great recipes
and product information.  Sorry I was lonnng winded.  Teresa Taillefer,
BASC, RD, CDE