SPAIN: 96% of Public Health Workers Want More Training in the Gluten-Free Diet

celiac disease researchAccording to a study by the University of the Basque Country in Spain (UPV/EHU), the Internet is the go-to source for most people with coeliac disease when tackling their dietary queries.

  • Edurne Simón, https://www.ehu.eus/en/web/campusa-magazine 1

Findings

  1. The Gluten: Health, Safety and Society Research Group detected a lack of time and training of public health staff to attend to coeliacs.
  2. Those suffering from the disease display good knowledge about the gluten-free diet, but they mainly turn to the Internet and specialized associations to clarify their dietary questions.
  3. The researchers are therefore calling for more nutritional education and better care in the public health system for people with coeliac disease.

Not consuming gluten is the only treatment available to prevent the consequences of coeliac disease, which can lead to serious complications such as intestinal cancer or infertility. Although adherence to the diet is vitally important, this is not always the case and, on many occasions, inappropriate food intake occurs because people with coeliac condition are unaware of a dietary transgression.

That is why the UPV/EHU’s Gluten: health, safety and society research team has analysed the knowledge of patients and healthcare professionals with respect to the gluten-free diet:

  • “We wanted to measure how much they know, to see where to place the emphasis when improving training, because the more knowledge there is, the better the health of people with coeliac disease.
  • Our work indicates that the greatest shortfalls are among medical staff. They lack preparation and time and this is directly detrimental to dietary compliance,”
    • Edurne Simón, leader of the research group that has been analysing issues relating to gluten and food for more than 25 years.

The conclusions of the research were drawn from the responses by public health professionals in the 17 autonomous communities (regions) of Spain. In the questionnaires,

  • 96% admit they need more training on the gluten-free diet 
  • 80% say they would like to be able to spend more time with their coeliac patients.

“Health workers are aware of the gaps they have. They miss more training because they are doing work that does not correspond to their area of expertise, and advising on issues they do not master. Moreover, surgery hours are limited. In the little time they have available, they focus on explaining the disease and do not have time to analyse whether the affected people are sticking to the diet.”

The UPV/EHU study detected specific aspects in which health professionals do not know very much. The revealed the following results:

  • One in five are wrong in thinking that quinoa contains gluten
  • 15% only know of three or fewer critical points in which contamination or cross-contact may occur.
  • 70% of medical staff mistakenly believe that the declaration of gluten traces is mandatory on food packaging. In other words, most of them do not know that products really do not have to display such information on their packaging.

The authors of the paper highlight the risks of this misconception: “If medical staff mislead their patients about labelling, there is a chance that the patients will eat gluten-containing food without a care in the world, which is harmful because the traces are also toxic.”

The Internet, the go-to source of information for people with coeliac disease

The research also managed to survey a broad sample of people with coeliac disease. Responses from more than 3,700 patients indicate the following:

  • Coeliacs have a good general knowledge about the gluten-free diet, especially those who have contacts with specialised patient associations.
  • Asked where they address their dietary queries: 51.4% responded that they use the Internet or social media. 
  • 31% turn to specialized patient associations to resolve their doubts
  • Only 15.2% go to the doctor’s surgery

The UPV/EHU researcher warned of the dangers of this reality, pointing out that there is a lot of unreliable content out there and that a certain amount of prior knowledge is needed to be able to discern between correct and erroneous information.

  • “The coeliac expert associations are doing a great job, but it is not acceptable for them to be taking over work that should really be done by social security.
  • We believe that setting up multidisciplinary clinical units comprising dieticians, doctors, nurses and psychologists to address coeliac disease would help to improve the health of people with coeliac disease.
  • It would also save money for the health care system, because it would prevent costs caused by late care or additional tests.”

Additional information

Edurne Simón is a member of the nutrition area in the Department of Pharmacy and Food Sciences. She leads the Gluten: health, safety and society research group, which has been analysing gluten and the gluten-free diet for over 25 years. Simón is a tenured lecturer on the Degree course in Human Nutrition & Dietetics and on the Degree Course in Pharmacy. She is also a lecturer on the Master’s courses in Nutrition and Health and in Healthy Ageing.

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