Archive for Digestive Health

What Should You Top Your Cereal With?

September 13, 2012 A New You, Anti-Inflammatory Life, Digestive Health, Raising Healthy Kids, Recipes & Articles, Weigh Loss No comments

Should You Be Drinking Non-Dairy Milk?

More and more often soy milk, rice milk and almond milk are being recommended in place of cow’s milk. Are they healthier? Should you make a switch?

Do you have a dairy allergy or sensitivity?

Designed as dairy-alternatives non-dairy milk options created as an alternative to cow’s milk for those with a dairy allergy. Now these milks are going main stream. These are medically necessary for those with dairy allergies, and provide variety to the rest of us. While non-dairy milks do offer some nutritional benefit to you must be picky about the product you try.

Bloated with cow’s milk?

Many adults are lactose intolerant. Lactose is the naturally occurring sugar in cow’s milk; lactose intolerance is the result of inadequate lactase production in our body. Lactase is the digestive enzyme that breaks down lactose. If you don’t have enough lactase you don’t completely digest lactose and when you drink cow’s milk you may experience nausea, gas, bloating and diarrhea. Non-dairy milks serve as a nice option for those with lactose intolerance since these milks don’t contain lactose.

Are non-dairy milks healthier?

Think about where non-dairy milks come from…. They are plant-based, which makes them inherently healthier than cow’s milk.

Good carbs

Rice and oat milk are made from intact whole grains, brown rice and rolled oats. These milks are higher in carbohydrate than other milks and lack protein and fat. These milks are nutritionally more like fruit juice than cow’s milk. Because these are higher in carbs, they are great following hard workouts. Blend with frozen fruit and organic silken tofu and you’ve got a decent recovery drink.

*NOTE: oat milk is not gluten free

Better fats

Non-dairy varieties of milk made from soy beans, coconut, nuts and seeds contain healthy fats. These plant-based milks contain fats that gives them a nutritional edge compared to cow’s milk which contains unhealthy and inflammatory fats.

You may think, “Fats? That must be high calorie!” Not so! Unsweetened almond, hemp, sunflower seed, coconut and soy milk are 45-80 calories per cup, compared to 90-150 calories per cup cow’s milk.

Watch out for sugar

Be aware that added sugar is commonplace in non-dairy milk. Often “original” contains a tablespoon of added sugar per serving! Be sure to choose unsweetened varieties.

Tummy troubles

Despite the fact that non-dairy milks are often recommended for those with digestive health problems, the thickeners and stabilizers in these milks can cause much digestive distress. A common thickener found in non-dairy milk is, carrageenan. The Cornucopia Institute has identified specific products that don’t contain carageenan, you can find that list by clicking here. Of the products pictured above, these do not contain carageenan: Rice Dream Classic, Pacific Oat (not gluten free), and WestSoy Unsweetened Soy.

Choose organic

Definitely choose organic for soy and cow’s milk and preferably with all other milks.

Advocate for Yourself

July 2, 2012 Digestive Health, Nutrition Notes, Recipes & Articles One comment

A new study found that when doctors performed endoscopies on people complaining of diarrhea, weight loss, iron deficiency, or anemia, intestinal biopsies to test for celiac were performed only 40-50% of the time. This is shocking given that 1.) diarrhea, weight loss, iron deficiency and anemia are classic signs of celiac disease, 2.) an endoscopy is the procedure used to investigate the cause of these complaints, 3.) you have to do an endoscopy in order to a biopsy, and 4.) a biopsy is the only way to diagnose celiac disease. Why aren’t doctors doing biopsies?! This study doesn’t answer that question, but hopefully their next study will investigate that question.

Doctors are missing celiac disease

The researchers at the Celiac Disease Center at Columbia University Medical Center assert “under-performance of small bowel biopsy during endoscopy may be a major reason that celiac disease remains under-diagnosed in the United States”.

1 in 133 people are estimated to have celiac disease, but 95% of those people don’t know it.

The researchers also found that the rates of biopsy were even lower in men, older patients, African-Americans, and Hispanics.

This study is concerning, not only because those who obvious symptoms of celiac are being missed, but because I can only imagine that the rate of biopsy on people who present with constipation, irregular menses, depression, infertility, miscarriages or joint pain is even lower. These are symptoms of celiac that are widely accepted by celiac disease specialists, but they are not “classical symptoms” that all gastroenterology physicians seem to learn in their training.

The bottom line is:

Advocate for yourself. If you are experiencing symptoms of celiac disease, talk to your doctor. Ask about blood tests for celiac and intestinal biopsy. Bring this newly published study with you and share it with your doctor. A biopsy may not be what your doctor initially recommends, but it is likely the best way to diagnose or rule out celiac disease. Genetic tests for celiac are an option for ruling out celiac, but genetic tests do not diagnose celiac. Genetic tests are helpful when you are debating about whether or not you need a biopsy. If you do not have genes for celiac, a biopsy would not be indicated, however if you have symptoms of celiac AND you have genes for celiac, a biopsy would be indicated.

Resources:

Full text paper (pdf)

Media release summary

Who Can Eat Domino’s Gluten Free Pizza?

May 21, 2012 Digestive Health, Nutrition Notes, Recipes & Articles One comment

Domino’s released a gluten-free pizza crust earlier this month and it has created quite a stir in the world of celiac. Here are the facts as I understand them:

  • Domino’s wanted to create a gluten-free pizza and sought out partnership from the National Foundation for Celiac Awareness (NFCA).
  • I don’t know why Domino’s wanted to create a gluten-free crust.
  • NFCA is an advocacy group that, among other activities, certifies foodservice kitchens as gluten-free.
  • NFCA has two designations for kitchens:
    • Amber, which is a kitchen that provides gluten-free foods but does not have the capacity to prevent contamination from gluten, but DOES have the ability to understand and communicate this risk to people with celiac who order gluten-free foods.
    • Green, which is a kitchen that provides gluten-free foods AND is able to prevent gluten-contamination of these foods.
  • Domino’s was given an Amber designation because they are not able to prevent gluten from contaminating their gluten-free crusts. The gluten-free pizza is prepared on the same line, with the same toppings and in the same oven as a gluten-containing pizza, which means that the pizza is not appropriate for those with celiac disease.

From the NFCA website statement regarding Domino’s pizza:

“NFCA consulted with Domino’s on this launch and after reviewing operational procedures, we decided that we could not recommend this product for those with celiac disease. We urge those with non-celiac gluten sensitivity to exercise judgment in deciding whether to order this pizza.”

As a result of NFCA’s involvement and demand for transparency in the limitations of Domino’s operating procedures, Domino’s has trained its staff to warn anyone ordering the gluten-free pizza that it is not free of gluten from contamination and when you order online a disclaimer appears warning that the pizza is not appropriate for those with celiac. This is a heck of a lot more than you usually getting when ordering gluten-free foods.

Unfortunately, in response to the public’s confusion and frustration with the Amber designation, NFCA has suspended the use of the Amber designation.

What Does Gluten-Free Mean on a Menu?

In searching for the silver lining, I realize that there’s nothing like a bunch of media attention to get people moving in a different direction. I hope that restaurant owners all over the country are now reconsidering their gluten-free options. For example, there’s a local restaurant that identifies gluten-free options on their menu. One of the taco plates that is marked gluten-free contains, “drunken beans”. I ordered this taco plate with drunken beans and then asked, “How do you make that gluten-free?” The response from the server: “oh, those aren’t gluten-free; we make them with beer.” Hmmm, but it was marked as gluten-free and the server didn’t provide that information when I ordered. That’s not right.

I commend the NFCA for advocating for transparency in foodservice operating procedures. It is rare that a restaurant is able to alert it’s customers to the risks associated with eating gluten-free items. If you are going to identify something as gluten-free then it should always be gluten-free, from ingredients to contamination. Since this is not reality, I find the increased availability of gluten-free items on menus as a risk to those with celiac disease. Identification of gluten-free on a menu does not mean that the food is being prepared in a manner which prevents gluten-contamination, and sometimes doesn’t even mean that the item is free of gluten-containing ingredients!! Domino’s and NFCA were smart enough to realize the limits of their gluten-free pizza and worked dilligently to ensure that customer’s were informed about the risk of eating the gluten-free pizza. Not all restaurants do that.

What if NFCA hadn’t been involved?

I wonder what Domino’s would have done if they had not consulted with NFCA? Would they have released the gluten-free pizza crust without any warnings? Would those with celiac be congnizant enough to ask how the pizza was being prepared?

At least NFCA advocated for us so that we would know that the Domino’s gluten-free pizza is not right for us. I fully support transparency, it’s the only way the we can eat out. It’s infuriating to read a menu, see gluten-free, order it and then realize that it’s not really gluten-free. At least Domino’s will be up-front about it.

I hope that this brings NFCA more support to continue working in the foodservice industry to improve operations and make it easier to eat out.

So who can eat Domino’s gluten-free pizza?

Someone who has does not have celiac, yet chooses to eat gluten free. Why did Domino’s make a gluten-free pizza even though those with celiac can’t eat it? Probably because gluten-free is a fad. Which is annoying, but maybe the next big chain will do it right.

Celiac is Unique, Get Tested

May 14, 2012 Digestive Health, Nutrition Notes, Recipes & Articles One comment

There are many reasons for people to follow a gluten-free diet: The Paleo diet advocates for a gluten-free diet. Gluten-containing foods contain lectins, which may not be good for us. Gluten is in a lot of processed foods that aren’t good for us. Gluten is a difficult to digest protein, which may cause digestive upset and inflammation.

I acknowledge that celiac is not the only reason to follow a gluten-free diet. However, celiac disease is a very unique condition. If you feel that your overall health and well-being is improved on a gluten-free diet, you absolutely need to pursue celiac testing. Here’s why:

Celiac disease is the only gluten-related condition that:

  • Is genetic.
  • Causes damage to the small intestinal villi leading to absorption and nutrient deficiencies.
  • Carries a risk of intestinal cancer, lymphoma, osteoporosis, recurrent cavities related to dental enamel defects, central and peripheral nervous system damage, pancreatic disease, other autoimmune diseases or infertility.
  • Is associated with increased mortality, exceeding that of the general population by a factor of 1.9 to 3.8. The increased mortality is mainly due to malignancies. The excess mortality is reduced after 1 to 5 years on a gluten free diet.
  • Requires lifelong adherence to a strict gluten-free diet.

Unique, increased and life-long risks when you “cheat”

There are dramatic differences in the health effects of gluten on someone with celiac versus someone who does not have celiac. When someone with celiac “cheats” on their diet and exposes themselves to gluten, even minuscule, tiny, parts per million exposures will trigger inflammation and an autoimmune response that you may or may not feel. Continued exposure to gluten will increase your risk of developing other autoimmune conditions, intestinal cancer, osteoporosis, depression and infertility. The risks associated with not following a gluten-free diet are huge in someone with celiac disease, which is uniquely different from someone with a wheat or gluten allergy or sensitivity.

Genetic linkage

If you have celiac, your family members and children need to be screened for celiac disease, including blood tests and genetic markers. Celiac disease is unique because no other condition that is responsive to a gluten-free diet is genetically linked. If you feel improved health on a gluten-free diet, it is your responsibility to rule out or diagnose celiac disease so that you can inform your family members of this genetic condition.

Parts-per-million sensitivity

With celiac you are sensitive to teeny-tiny-miniscule amounts of gluten. This means that you must be cautious about eating in other peoples homes, eating out, sharing cutting boards, kissing, licking your fingers and so on. Even the smallest amount of gluten can make you sick, physically or mentally. Depending on how gluten exposure manifests in you, you may or may not leave a restaurant feeling ill, but your intestine and immune system always knows.

With celiac your intestine is uniquely sensitive. It means that you can’t just take the bread off a sandwich and eat the turkey inside, you must skip the sandwich entirely. You can’t kiss someone goodnight with passionate, reckless abandon, you have to first politely request a teeth brushing and mouth rinse…Or enjoy a close mouthed kiss. No other gluten-responsive condition, except possibly a severe wheat or gluten allergy, requires this level of diligence to a gluten-free diet.

Just ask for the test(s)

If you have celiac and you don’t follow a strict gluten free diet, you will continue to be not well, even really sick or plagued by health problems. If you respond well to a gluten-free diet, and ignore the possibility of celiac, you, and family members who have celiac have yet to be diagnosed, will continue to be at risk for chronic health conditions. If you have symptoms of celiac disease and you feel an improvement in these symptoms on a gluten-free diet, then you need to ask your doctor for more testing.

Advocate for yourself and work hard to rule out or diagnose celiac disease. Please contact me if you are unsure how to proceed at Hana@NourishingResults.com.

How to Pursue a Diagnosis of Celiac Disease

May 9, 2012 Digestive Health, Nutrition Notes, Recipes & Articles 2 comments

How do you know if gluten-free is medically necessary?

Celiac disease is hugely undiagnosed. I meet with at least one person per week who has multiple signs and symptoms of celiac disease who is searching for an answer. The answer may be gluten-free diet, but how do you know definitively if you have celiac disease? Here are the tests available to help to diagnose or rule out celiac disease.

Blood tests

There are multiple blood tests that should be done to screen for celiac disease. I say “screen” for celiac because blood tests cannot diagnose someone with celiac disease. If one of these tests is positive for celiac, further testing will be recommended to diagnose celiac. You must be eating gluten on a regular basis for these tests to be valid. From Celiac Central and the University of Chicago Celiac Disease Center, these are the tests to be ordered:

  • Total IgA
  • Anti-tissue transglutaminase (tTg)
  • Anti-endomysium (EMA)
  • Anti-deamidated gliadin peptides (IgG and IgA-DGP)
  • Possibly, IgG-AGA

Physicians don’t recognize when a person presents with celiac disease; that is the first problem contributing to celiac disease being under-diagnosed. The next problem is that most physicians only order tTg. This test has a high tendency towards falsely negative results, which means that the test comes back negative and you are told that you don’t have celiac, but you actually do have celiac. That is what happened with me. My physician ran the test 4 or 5 times over the 8 years that we were searching for the cause of my osteopenia, gut distress and elevated liver enzymes. My tTg level was always normal. My doctor also ran tests looking for nutrient deficiencies and those came back normal too, even though I had physical signs of a few nutrient deficiencies. Finally, I asked for an intestinal biopsy.

If one of the tests above comes back positive an intestinal biopsy will be recommended to confirm celiac disease. If the above tests all come back negative, but you still suspect celiac disease, you may consider genetic markers, a trial gluten-free diet or an intestinal biopsy.

Intestinal Biopsy

These finger-like projections, called villi, line the entire gastrointestinal tract. As celiac disease progresses, the villi flatten and the absorptive surface of the gastrointestinal tract is destroyed, resulting in nutrient deficiencies and multi-organ dysfunction.

You must be eating gluten on a regular basis to have an intestinal biopsy. An intestinal biopsy is used to diagnose celiac disease. Celiac is an autoimmune condition that results in flattening of villi in the small intestine. Villi are tiny, finger-like projections that cover the surface of your gastrointestinal tract and absorb nutrients from food. An intestinal biopsy is done to assess whether or not villi have been damaged.

Intestinal biopsy is considered the “gold-standard” for diagnosis of celiac. However, there is still a risk of false negative results with intestinal biopsy, particularly in people 18 years and younger or when the biopsy is done incorrectly. The risk of false negative is dramatically reduced when the gastroenterologist does the biopsy correctly by taking 3-4 or more biopsy samples from throughout the small intestine, including the duodenal bulb, and when a special stain is used to identify intraepithelial (between cell) inflammation.

One of the most frustrating cases I had last year was a young woman who had an intestinal biopsy done incorrectly. Only one sample was taken and she was told that she did not have celiac disease. She continued to eat gluten until her health had spiraled so out of control that she started a gluten-free diet on her own and immediately felt better. She had all the signs and symptoms of celiac and a cousin with celiac. In her case, her positive response to a gluten-free diet, signs and symptoms of celiac and family history (i.e. genetics) provided the diagnosis of celiac disease. Our work together centered primarily on working towards acceptance of her diagnosis and living well on a gluten-free diet.

Genetic Markers

Approximately 95% of people with celiac disease have one of these two genes, HLA-DQ2 or HLA-DQ8. Having one of these genes does not mean that you have celiac, and so genetic testing cannot diagnose you with celiac. However, if you do not have one of these genes, it is highly unlikely that you would ever develop celiac disease. Genetic tests for celiac are helpful in many situations. Here are a couple of examples of when genetic testing may be used:

  • When you have multiple signs and symptoms of celiac disease but the blood tests for celiac came back negative. You aren’t sure if you should pursue a biopsy or not. If you don’t have one of the genes, the biopsy would not be indicated, as it is highly unlikely that you have celiac.
  • When you have multiple signs and symptoms of celiac disease, but you have already initiated a gluten-free diet and have experienced an improvement in your health and well-being. You don’t want to start eating gluten again simply to have blood tests and/or a biopsy.
  • As a screening tool for family members of those who have celiac disease to identify those that would be at risk for celiac disease.

Trial Gluten-Free Diet

I do not recommend a trial of a gluten-free diet to be used as a part of the diagnostic process unless you are completely sure that you can use response to diet as your diagnosis. Once you go on a gluten-free diet and feel better, there’s often no turning back. Blood tests and biopsy depend on regular consumption of gluten for the three months prior to the test or biopsy. If you go on a gluten-free diet and feel better, you will need to start eating gluten again if you wish to pursue further celiac testing. This is an important consideration, as most people don’t want to start eating gluten again if they feel better on a gluten-free diet.

I fully support those who have already started a gluten-free diet and feel better and then come to me asking why. I have a client who started a gluten-free diet as a part of cleanse and felt immediate relief from a wide-range of non-specific complaints. She was too far into the gluten-free diet for diagnostic tests and she was struggling with the realization that she did not have a clear diagnosis of celiac and that no doctor would diagnose her without a positive blood test or biopsy. I recommended the genetic tests and she does have one of the celiac genes. Finally and fortunately, a local gastroenterologist did a complete assessment and diagnosed her with celiac based on the facts that she had a positive response to a gluten-free diet, signs and symptoms of celiac disease and a genetic marker for celiac.

Consult First, Gluten-Free Later

If you are suspicious of celiac disease, please consult with a knowledgeable medical practitioner before proceeding with any dietary changes. This is tricky and complicated stuff. There is not always a clear diagnosis of celiac disease and it’s not always a straightforward path. But, when possible, diagnosis of celiac is essential! More on that next time….

« Older Entries