Coeliac Awareness Week – Lockdown as a Coeliac Dietitian

Cristian Costas, coeliac dietitian shares his experience supporting patients with coeliac disease during these challenging times.

What was your role before lockdown and COVID-19?

I was running the dietetic-led coeliac service at Bradford Teaching Hospitals Foundation Trust, where we take on the full coeliac care of patients, fully support them with the gluten free diet (the only treatment for coeliac disease) and order relevant bloods. It is relatively new service where we have been working closely with our gastroenterologists and been receiving some great feedback from patients.

How has the dietetic-led coeliac service changed?

As has happened to many dietitians, I have been asked to significantly reduce outpatient clinics so I can help inside the hospital on the Covid-19 wards as well as other wards. The service has therefore gone from having at least 3 clinics per week (plus group sessions for newly diagnosed patients) to just one telephone clinic per week, where we only attend to newly diagnosed patients. We decided to preserve this clinic as newly diagnosed patients are the ones that need our help the most.

What have the challenges been for your coeliac patients?

I really feel for the patients. It has been really challenging, with people panic buying all sorts of food including gluten free food because there was no regular pasta, bread, etc. This has had a huge knock on effect on people with coeliac disease and other medical conditions that require specific diets. For these people, diet is not a choice, it’s their medical treatment and they have had limited access to it. The gluten free diet is a restrictive and burdensome diet that has become even more challenging recently, especially for those from lower socio-economic backgrounds who don’t have access to prescribable gluten free food (as is the case in Bradford). Furthermore, the significant reduction of our appointments means there is even less support for patients to navigate through these challenges and learn to shop outside the gluten free isle with confidence. This can only be done by learning the skill of interpreting food labels- something which is crucial now more than ever so that patients understand they have more access to gluten free food than many think (as they don’t need to be restricted to just buying foods that say “gluten free” on them).

What have you done to help your coeliac patients?

For patients I can no longer see in clinic: I have made the decision to start creating video content in my own time so I can share practical knowledge about the gluten free diet for free. I will be releasing a video every day of this week to raise awareness for Coeliac Awareness Week and plan to continue creating videos answering “frequently asked questions” and sharing them with as many platforms as possible so I can help people with coeliac disease anywhere.  I will be working with IT to upload videos onto our Trust website and I have already been sharing some videos with Patient Webinars – an online platform with useful dietetic webinars and information for patients that can be accessed completely free.  The daily videos I will be sharing this week will mainly be shared on my twitter account.  I will be happy to share them with any Trust/organisation that wants them.

For the newly diagnosed patients I have been seeing in clinic: I now send extensive information in the post with a number of useful resources before their telephone appointment and encourage them to join Coeliac UK  and download their “gluten free food checker” app.  Coeliac UK really helps patients self-manage their condition and the app is amazing- it scans barcodes to identify gluten in supermarket food packaging instantly. We also encourage patients to access the Patient Webinars website and watch a webinar explaining the medical aspects of coeliac disease before they have their appointment- so we can mainly focus on trouble shooting problems and going through the practicalities of the gluten free diet.

Finally, I have also started to use Attend Anywhere as a video consultation platform so I can make consultations more interactive by going through presentations on my shared screen and using a video camera to go through food labels together with those patients  who have internet access.