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Awareness
- May = Celiac Awareness Month (designated by multiple celiac organisations)
Psychosocial Impact of the GFD
Living on a GFD is demanding and touches every aspect of social life:
- Social isolation — cannot eat freely at restaurants, parties, friends' homes
- Anxiety about cross-contamination when eating out
- Disordered eating — restrictive nature of GFD can contribute
- Depression — particularly around food and social situations
- Stigma — a diagnosis of celiac disease may cause stigma; some patients hesitate to disclose their condition
- Relationship with food changes fundamentally — diagnosis can alter enjoyment of food, pressure to be vigilant at all times
Economic Burden
- GF food is significantly more expensive than conventional food
- Limited availability in many areas; variety is restricted
- Over the past decade costs have dropped but GF remains a premium category
- Increased popularity of GFD among those without celiac disease has improved availability, but also led to misunderstandings among food manufacturers about the importance of cross-contamination prevention
Nutritional Quality of GF Substitutes
Many commercial GF substitutes are nutritionally inferior:
- Lower in fibre, carbohydrates, and vitamins
- Higher in sugar and fat (rice/potato/corn starch bases)
- May contribute to deficiencies if diet is not carefully managed
- Dietitian guidance strongly recommended
Non-Food Products
- No federal regulations cover gluten in medications, cosmetics, and hygiene products
- Amount is usually minimal in non-food products
- Mislabelling can cause confusion and potentially affect health
Religious Practice
Christian Eucharist
- Communion wafers typically contain 2–5 mg of gliadin (not GF variety)
- Many people with celiac disease alter their religious practice due to symptoms from wafers
- Several Protestant denominations offer GF alternatives (rice crackers, GF bread)
- Roman Catholic doctrine: Mass bread must be made from wheat; low-gluten hosts are allowed but not gluten-free ones (the Vatican disapproved of GF bread for Holy Communion as of 2017)
- Catholics may receive from the chalice only, or ask for low-gluten hosts
Jewish Passover (Pesach)
- Matzah (obligatory unleavened bread) is made from wheat, barley, spelt, oats, or rye — all problematic for celiac disease
- Ashkenazi Jews avoid rice and many other GF grains entirely during Passover
- Potato starch is the primary gluten-free starch used during Passover, making many kosher-for-Passover products incidentally gluten-free