Archive for tag: celiac

The Great Food Debate

I've been embroiled in a debate on different eating habits for a few weeks. It's been a heated debate. Information has been passed back and forth, but the science is a hard sell for those that don't know or understand it. I say, science, because it's not just the facts about Paleo, gluten-free, Mediterranean, or whatever eating patterns/diets, but about nutrition in general. It's about how our bodies handle food and what they need to be healthy.

There are a million and one (and probably more) "diets" out there. Right now, Paleo and gluten-free seem to be trending the most. Celebrities are using them to "get healthy." People are using them for weight loss or to control the symptoms of one disease or another. Some are using them to lower their inflammatory levels. But few seem to know the actual science behind any of it.

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Image source: www.towelmate.com

I'm admittedly biased. I've been a diagnosed Celiac, and gluten free for 16 years. The more information that I learn about grains, etc. -- the more I'm glad that I don't eat gluten. But the general public doesn't have the information that I have. In fact, it seems that most professionals don't either. But that's not the purpose of this posting.

When I started out writing this, I thought about my friend and how vehemently she adheres to her beliefs about "nutrition" and eating. She's a registered dietician. We've argued back and forth about grains, about how she thinks that Paleo/Mediterranean is bad for athletes, about how impossible it is to follow, and about how there's a lot of "false" science/claims about that particular eating pattern. The whole experience has been a major illustration on the adherence to beliefs that people have -- not just for her, but for me. It's also been an exercise in frustration.

I can only "recommend" what science (and anecdotal evidence -- but that's another story) shows to be true. For example, I can explain that zonulin destroys tight junctions in the gut, brain, and reproductive organs, and that the main sources of tight junction destroying proteins are grains and legumes. I can quote studies all day long (and all night long) -- and I have. I can distill the science down to very simple words that anyone could understand by using pictures, analogies, and more broad terms. I can do all of these things, but that doesn't mean it's going to change anyone's mind, and it also doesn't mean that they're going to be willing to put it into practice.

We're very steeped in our beliefs. Usually, those beliefs have absolutely nothing to do with evidence. My friend, for example, focuses on athletes and sports nutrition. The concept of carb-loading with pasta or the use of sports drinks is very much a part of her reality. She's concerned about having energy available for use. She's not concerned about inflammation, overall health and well-being, the prevention of disease, or whether or not someone might develop cancer or an autoimmune disorder. She wants to run marathons, or play 4-hour-long matches. Her reality and mine are very, very different. Chances are, that no matter what I say or provide her with, she will always adhere to her thoughts about nutrition. It will always be about the quick fix. My hope is that she'll come across a difficult case and be forced to broaden her concept of what healthy eating is.

Patients aren't any different. Some may have more or less information than my friend. They may be coming in with a copy of some new fad diet book, or a cookbook of recipes that their Aunt Sally said worked really great to help her lose weight. People may walk into the office carrying a well-worn copy of the all-carrot diet, asking what to do about their increasingly orange skin. They'll be emphatic about drinking their diet coke, eating their bowl of pasta, or consuming 3 Tablespoons of apple cider vinegar before every meal.

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Image source: msmomofosho.wordpress.com

It will be our job to walk them through their questions, hopefully bring some experience and education to the table, and talk them through ideas and possibilities that will help them find some form of healthy, sustainable ground. They may resist with everything that they have in them. As I write this, I'm thinking about how much I struggle with sugar or eating rice, and how hard it has been for me to give them up; I'm not there yet. It's our job to work with them, using their limitations (even if those are beliefs), and our education to help them get to someplace healthier.

My friend and I will probably continue to argue about what we should or shouldn't be eating. The only thing we've been able to agree on so far, I think, is that there's no one single "right" way. There's no perfect way that everyone should be eating. We're all human, and each body is different. The science may figure out that everything we "know" is wrong, and everything must be changed. I may never be able to fully give up sugar or rice. But whatever happens, we'll all hopefully be happier and healthier because of what we learn -- about food, about our relationship with it, and our relationships with each other.

Have a great week, everybody.

A LOOOOO–NG Weekend!

Did everybody enjoy the long weekend? Wow! What a weekend?!?

First, I need to say thank all the powers of the Universe for days off. I've been sneezing my fool head off ever since, but I spent most of the day cleaning. Having a clean house is Zen. I can now sit in the middle of my living room in the lotus position holding my fingers together. I won't (because I don't have time), but the important thing is -- I CAN.

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(Image source: http://blogs.studentlife.utoronto.ca/lifeatuoft/)

I spent some time out in the world this weekend, when I wasn't cleaning or studying. We get so sheltered, living in academia, that we forget how different it is. I came across a lot of stigma about chiropractic. Education helps fix that. Sometimes people just have to be exposed to what we're doing, what we're learning and practicing, and the basis for our practices in order to step beyond the conditioning they've received. Some won't. And that's OK. We'll love them anyway.

I received a big reminder about how difficult it is to practice "lifestyle medicine." We spend a lot of our time talking about changes that have to be made to the diet or lifestyle. I honestly don't know how many times a week that I tell someone something like, "Well, that could be fixed with removing XYZ from the diet." Here's the thing though: People don't want to remove XYZ from their diet. We're all familiar with people who continue to eat fast food or candy or soda and their effects on the body. We're also familiar with how many of those people end up injecting insulin or taking metformin. People do not respond well to change. The prevailing opinion is that it's easier to either accept the condition they have (and the symptom management) rather than to prevent or cure the issue by making change.

I'm honestly not sure where this mentality comes from. Perhaps it's the American adage that a pill fixes everything. I have a hard time believing that people are that *bad word alert* lazy (sorry). For some that I've talked to, they can't believe that making a change to their diet or activity levels will make them feel better, or that they've tried everything and nothing has worked. After all, they're dealing with complex health issues like autoimmune disorders, diabetes, and heart disease. Some will listen to reason and participate in education and others won't. Age doesn't seem to have a bearing on this -- people of all ages fall into this grouping. Perhaps I'd be the best physician ever, if I could figure out what would get through to people that have this block. But for right now, I'm struggling with the acceptance (which really sounds like defeat) that people have of their dysfunctions, and the lack of willingness to do anything about it. On compliance with lifestyle recommendations -- what do you think?

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Since stress management is a big part of lifestyle, here is a sunset picture I took on Monday. Remember. Zen.

As a self-reported "lifestyle change queen", I'm all too ready to make changes in my own life with the goal of feeling better. Dr S. tells us, as students, that we need to try things in order to be able to recommend them to our patients (speaking of dietary changes). Given that one of my own issues is Celiac disease, a change in lifestyle was the ONLY option for becoming healthy. I can't even begin to express how drastically my life changed in response to that.

Some changes are harder to make. Cutting down my rice consumption has been one of them. I'm down to only 2-3 servings per week at this point. But others are so much easier. For me, it comes down to the information, and hope. How will I feel once this change has been made? What are the possibilities? What information can I find that supports this decision?

Is there a change that you need to make? What's stopping you? What if you felt a million times better, increased the quality and quantity of your life, and it only took a short period of adjustment?

Maybe these are the questions we should be asking our (future) patients.

Have an amazing week, everyone.

Living Gluten Free

On Easter, this year, while everybody's eating their dark chocolate Paleo-friendly bunnies (I like to bite the ears off first), I'll be celebrating 15 years of being gluten-free. It's hard to believe. "Back in the day", things were a whole lot different than they are now. It seemed that few people had celiac (or were gluten-free) or knew anything about it--including the professionals. The testing was different--biopsy and IgG anti-gliadin or anti-endomysial blood tests. The pre-made food was a lot harder to find (and surprisingly less expensive) and the education of the medical community was nearly non-existent. My how things have changed! There are sensitive and specific blood tests now (tissue trans-glutaminase), everything seems to have a gluten-free label on it, and docs--especially those in our profession, seem to know more and more about the benefits of going gluten-free.

My household has been gluten-free--exclusively--for the last 5 years. It's so important that the whole house be in support of the diet. For me, it was a no-brainer. Both Grey and I are Celiac, and Forest has never purposely had gluten. All the support groups stress how important it is to avoid contamination (and NOT cheat!). In order for a product to be considered gluten-free, it has to have less than 200 ppm of gluten.

For Celiacs, even small/accidental exposures are dangerous. People might not have an overt reaction to contamination amounts, but they might still cause sub-clinical symptoms--flattened villi, malabsorption, deficiencies, and constant damage to the GALT--leading to lymphoma and GI cancers. Yikes, right?! These small amounts can remain in cooking utensils, porous cooking pans, and shared equipment. So, after a major move and shift within the family, we started over with new utensils, new pots and pans, and a completely clean house. Other than the occasional poison-carrying visitor and the cats (whose food smell reminds me of wheat bread toast), we don't even allow lickable envelopes (Did you know that glue contains wheat?).

I can't begin to say how much of a difference going gluten-free has made in my life. Besides feeling infinitely better, I've experienced a number of benefits--from clearer thinking to better skin and hair (and most importantly, a happier gut!). For Grey, the benefits were a lot more dramatic. He was born at the 95th percentile, and before being diagnosed, dropped to less than 5th percentile. Of course, that was a long time ago--and now he's bigger than I am! 

I've been asked if I'd endorse a gluten-free diet. I absolutely would. I'm not so sure that I'd endorse all the pre-packaged foods being sold on store shelves right now. Processing is pretty much always bad. But, with all the research that's coming out about lectins, gliadin, and grains, it's making more and more sense for pretty much everyone to be gluten-free. So, I'll leave all of you with this: Educate yourselves about what you CAN put into your body--and what effects it might have. If you're not doing it for yourselves, do so for your patients. Remember that not all cases are textbook (in fact most cases of Celiac aren't). If you need help, feel free to contact me. And for some other resources, check these out:

And one last thing: I'll leave you with some "crack" containing, non-Paleo, yet gluten-free yummies--just in case you're going gluten-free and missing something sweet. (Don't hate me, Dr. S.!) 

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These are gluten-free, can be made egg-free and dairy-free, are vegetarian (but not vegan) and are most definitely NOT sugar-free. 

Gluten-Free Chocolate Chip Cookies 

Preparation

  • Preheat oven to 350º F.

Ingredients

  • 1/2 cup butter
  • 1/2 cup cane sugar (not white - turbinado or dehydrated cane is best)
  • 1/4 cup brown sugar
  • 1 egg replacer (1 Tbsp. egg replacer powder with 3 Tbsp water - or sub 1 egg)
  • 1/2 tsp. vanilla (I make LIBERAL use of vanilla - DO NOT use imitation vanilla)

Instructions

  • Mix this stuff together with the mixer.
  • Add in the following:
    • 1-1/2 cups gluten-free flour mix (6 parts rice flour : 2 parts potato starch : 1 part tapioca starch) (Keep some extra just in case you need to stiffen up the dough.)
    • 1/2 tsp. baking powder
    • 1 cup (or more) chocolate chips (I like Ghirardelli mini semi-sweets mixed with their 60% cacao)
  • Bake for about 12 minutes per pan.

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No baking adventure is complete without flour all over the kitchen LOL. Please do your part to continue the tradition.

Next Food Adventure: Converting gluten-free to Paleo. I accept this challenge.

Have a GREAT week everybody!