title: Living gluten-free: adherence, knowledge, lifestyle adaptations and feelings towards a gluten-free diet.
abstract: BACKGROUND
  A gluten-free diet (GFD) requires tremendous dedication, involving substantive changes to diet and lifestyle that may have a significant impact upon quality of life. The present study aimed io assess dietary adherence, knowledge of a GFD, and the emotional and lifestyle impact of a GFD.
  
  
  METHODS
  Community dwelling adults following a GFD completed a questionnaire with items related to reasons for avoiding gluten, diagnostic testing, GFD adherence, knowledge and sources of information about a GFD, the Work and Social Adjustment Scale, and the effect of a GFD diet on lifestyle, feelings and behaviours.
  
  
  RESULTS
  Strict GFD adherence among the 222 coeliac disease (CD) patients was 56%. Non-CD individuals (n = 38) were more likely to intentionally ingest gluten (odds ratio = 3.7; 95% confidence interval = 1.4-9.4). The adverse impact of a GFD was modest but most pronounced in the social domain. Eating shifted from the public to the domestic sphere and there were feelings of social isolation. Affective responses reflected resilience because acceptance and relief were experienced more commonly than anxiety or anger. Non-CD respondents were less knowledgeable and less likely to consult health professionals. They experienced less anger and depression and greater pleasure in eating than CD respondents.
  
  
  CONCLUSIONS
  The findings obtained in the present suggest there is good potential for positive adaptation to the demands of a GFD; nevertheless, there is a measurable degree of social impairment that merits further study. The GFD may be a viable treatment option for conditions other than CD; however, education strategies regarding the need for diagnostic testing to exclude CD are required.
authors.affiliation: Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.|Harvard Medical School, Boston, MA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Silvester
authors.affiliation: Nutrition Services, Grace General Hospital, Winnipeg, MB, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Weiten
authors.affiliation: Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.|Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: L A
authors.initials: LA
authors.lastname: Graff
authors.affiliation: Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.|Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: J R
authors.initials: JR
authors.lastname: Walker
authors.affiliation: Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.|Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: D R
authors.initials: DR
authors.lastname: Duerksen
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000178:diet therapy*; D055050:Diet, Gluten-Free / Q000523:psychology; D004644:Emotions; D005260:Female; D005983:Glutens / Q000009:adverse effects; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011788:Quality of Life; D012934:Social Isolation / Q000523:psychology
chemical_list: D005983:Glutens
keywords: coeliac disease; dietary change; dietary intervention