Life Management: Teenagers and Young Adults

Celiac.com 02/25/2022 - Developing independence from parents or guardians, forming long-term relationships, living at college, becoming financially self-reliant, going into full time employment, traveling for pleasure and on business and starting a family—each can be affected by celiac disease as children grow into teenagers and young adults.

Dietary compliance can be a challenge at this critical stage in life. There is no evidence that children with celiac disease can go back to a gluten containing diet in their teens—or ever. Occasionally this idea gets put forward because a teenager no longer has any obvious symptoms if they eat gluten-containing food. The medical position remains clear—celiac disease is a life long condition—ingestion of gluten will cause damage to the intestines, whether or not there are any obvious symptoms.

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During the teens and into the 20’s the body is going through significant growth and development, bone density is increasing, and any under-development of the bones before the late 20’s or early 30’s cannot be fully recovered afterwards. Teenage diets outside the home are likely to be based heavily on convenience foods, meaning that most of this food will likely be vitamin and mineral-deficient. School, college, socializing, sports and work can be very demanding—low energy levels due to iron-deficient anemia, (a common consequence of untreated celiac disease which creates poor absorption) will certainly not help. Maintaining a strict gluten-free diet will help their young bodies absorb more of the available nutrients like calcium, iron, vitamins and other minerals, which will help them develop properly, and aid with long-term health and energy levels. It also makes it easier for the primary care physician to correctly diagnose any other medical conditions which might otherwise be masked by the symptoms of malabsorption. Ideally annual follow up consultations with a physician and a dietitian are always recommended to help ensure that the gluten-free diet is understood and followed.

Eating At Home

Regular, balanced, sit down meals at home may become less practical as children grow into their teens and adopt more independent lifestyles. As this happens, convenience meals and snacks are bound to figure more highly in their diets. Parents of a celiacs who were diagnosed at a younger age will have had time to learn how to properly manage a gluten-free diet—including dealing with food shopping and cooking—before their children reach their teenage years. It is important to teach celiac children, including teenagers, to make their own decisions regarding the food they eat. Parents whose children are diagnosed as teenagers will face many new challenges—many food preferences will have to be changed—at a time when their teenagers are striving for independence. For many teenagers being different and having a medical condition that limits their freedom to eat and drink what they like are real problems, and denial is a common response. Parents have a key and difficult role to play—acknowledge the problems and don’t make to big of a deal out of them—but continue to stress the importance of a well managed gluten-free diet.

Eating Out

Eating out safely demands care and knowledge—even for the most experienced adult. Sometimes the appropriate choices on a menu can be very limited. Teenagers living at home might appreciate help from parents while ordering food out, or any time they have to request something special. Although there are extensive gluten-free beverage choices, beer must be avoided. All commercial beers contain gluten in varying amounts and are not suitable for the celiac diet.

School Trips

Many secondary schools offer trips involving overnight stays, and they are not likely to be familiar with celiac disease and its management. As a result, some schools may be reluctant to take a celiac child on a trip. They may not appreciate what is needed, have the facilities to prepare gluten-free meals, or want the responsibility. To help your child miss such trips you can provide the school with information on the gluten-free diet and/or prepare all of your child’s food beforehand, and have them take it with them.

College

Living away from home at college is going to involve self-catering, eating out and possibly cafeteria food in a dormitory. Having reliable access to gluten-free meals in a dorm might be a good way to begin life at college for a celiac student. Students might want to add this to the list of questions to be thought about when choosing a college. A meeting with the college dietitian is always helpful.

Employment

In the vast majority of cases, having celiac disease does not affect employment. However, several occupations—for example a baker or pastry chef—might pose a health risk because it would mean contact on a daily basis with airborne wheat flour— including skin contact—while baking or cooking with it. Special precautions may have to be taken to protect the celiac from contamination.

Starting a Family

There is good evidence that nutrition affects fertility and the success of pregnancy. Women on a well-managed gluten-free diet tend to have bigger, healthier babies. While miscarriage is not particularly common in women with celiac disease as a whole, it is more prevalent in those who are not on a gluten-free diet.

Hospitals

Food service in hospitals varies greatly, and some courses of treatment may involve dietary adjustments. If you are going into the hospital for a planned treatment, give them as much notice as possible, and ask the hospital to confirm in advance that they will be supplying you with a gluten-free diet. Also get permission to have gluten-free food brought in by a friend or family member.

A version of this article originally appeared in the Winter 2005 edition of the Celiac Disease Foundation Newsletter. The Celiac Disease Foundation is a national celiac disease support group that is based in Studio City, CA. For more information visit Celiac.org

Condensed from the Crossed Grain Magazine of Coeliac UK