Archive | October, 2012

Gluten Free Diet Making you Fat

30 Oct

News Roundup

Well, this was bound to happen: Mainstream media finally is starting to acknowledge one of the hurdles of a gluten free lifestyle–one that many CD patients have to experience and live with on a daily basis: some gluten free foods are heavy in calories and could cause that butt to get bigger! The challenge is, of course, to find gluten free foods that are low calorically but high in taste and satisfaction.

Whippet thin Victoria Beckham is said to maintain her trim figure by sticking to a strict gluten-free diet. Gwyneth Paltrow and Miley Cyrus are also fans of the wheat-free way which means no bread, pizza, pasta or cakes. But a new study shows that slimmers choosing gluten-free food could be filling up on fat instead.

Really? Celiac Disease Is Influenced by Season of Birth: One hypothesis is that the season in which a person is born may influence the development of this digestive disorder. Some researchers suspect that babies born in spring and summer are more susceptible to the disease, which is triggered by the gluten in wheat, barley and rye.

Babies usually begin eating foods containing gluten around 6 months of age, so those born in the warmer months would initially be exposed to gluten in the winter, when infections like cold and flu are common. Could early exposure to viral infections play a role in the autoimmune response to gluten?

For now that remains speculation. But at least three studies have backed the seasonal hypothesis. The most recent, published this month in The Journal of Pediatrics, looked at nearly 2,000 people with confirmed celiac disease. The researchers, at the Massachusetts General Hospital for Children, concluded that more patients were born in the spring than in any other season.

A new gluten free beer!

In the past few years, though, a new process has been described that would use a specific enzyme to “denature” the proteins that produce glutens, during the brewing process. Two Brothers of Warrenville has been using this process to make their Prairie Path Golden Ale gluten-free for the past year. Now Omission is rolling out nationally with a GF lager and a pale ale.

Omission was developed at Widmer Brothers brewery in Portland, Oregon, now a part of Craft Brew Alliance with Red Hook.** CBA’s Account manager, Paul Mott, told people at the FatPour event that their interest in a GF beer was more than professional, since their CEO had been diagnosed with celiac disease twelve years ago, and the wife of brewmaster Joe Casey learned she had it six years ago…Omission beer is certified to meet the standard of less than 20 parts per million of gluten peptides. Each bottle’s date code can be looked up at omissiontest.com to see the independent testing results for that particular batch.

The news items link out to external sources. And, like always, none of these are a substitute to your own health-care provider’s advice.

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Passport

26 Oct

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Urine Wheels

25 Oct

From Andrew Sullivan: Christina Agapakis is fascinated by this Urine Wheel from 1506:

The Urine Wheel was used for diagnosing diseases based on the color, smell, and taste of the patient’s urine in the early 16th century. Many diseases affect metabolism and many changes in metabolism can be detected in the urine. For example, diabetics will excrete sugar in their urine–sometimes enough sugar that it can be fermented into whisky. There are many other diseases that change the smell of a person’s urine, including the very descriptively named Maple Syrup Urine Disease or Sweaty Feet Syndrome, now much more likely to be diagnosed by electronic sensor arrays than actually tasting the urine.

 

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Ancient Urine Wheel

Non-celiac gluten sensitivity less common than celiac disease

25 Oct

Incidence of non-celiac gluten sensitivity is approximately half that of celiac disease, according to data presented at the 2012 American College of Gastroenterology Annual Scientific Meeting. “A growing number of patients are being found to have non-celiac gluten sensitivity,” Daniel V. DiGiacomo, MPH, research assistant at Columbia University, told Healio.com. “Unfortunately, there is not much clinical data, nor published studies, on non-celiac gluten sensitivity. We thought this would be the perfect opportunity to take an epidemiologic approach and study non-celiac gluten sensitivity on a national level.” From Healio GI

Prezzo and Pizza Hut add gluten-free options, is the industry doing enough? With Prezzo and Pizza Hut the latest branded national operators to up their gluten-free offerings, the rest of the industry needs to ‘get up to speed’ when it comes to catering for customers suffering with coeliac disease. From Big Hospitality

A link between gluten and the immune system has literally been visualized in new research published today in a leading scientific journal, Immunity. The discovery is the collaborative work of research groups in Australia, the Netherlands and ImmusanT Inc. based in Cambridge, Massachusetts, led by Professor Jamie Rossjohn and Dr. Hugh Reid at Monash University,Dr. Bob Anderson of ImmusanT and Professor Frits Koning at the University of Leiden. The use of x-ray crystallography enabled the researchers to visually determine how T cells interact with gluten that causes celiac disease in patients who have the DQ8 susceptibility gene, thereby providing insight into how celiac disease pathology is triggered. About half the population is genetically susceptible to celiac disease because they carry the immune response genes HLA-DQ2 or HLA-DQ8. At least one in 20 people who carry HLA-DQ2 and about one in 150 who have HLA-DQ8 develop celiac disease, but people with other versions of the HLA-DQ genes are protected.  This has led researchers to question how the immune system senses gluten. From ImmusanT.com

The news items link out to external sources. And, like always, none of these are a substitute to your own health-care provider’s advice.

Women with Celiac Disease and Fertility

25 Oct

Cruising with Celiac Disease: What to Know Before You GoRecently one of our readers, emailed us about a lackluster experience she had when she booked a Carnival Cruise to the Caribbean Islands in the fall.   Her sole apprehension upon reservation was whether they could accommodate her gluten-free diet due to her Celiac Disease.  Once assured that she would be satisfied with the service she happily booked her trip.  However, upon embarkation, she was surprised with the specific procedures that took place due to her dietary specifications, such as having to pre-order meals one day in advance.  Lack of communication between passengers and kitchen staff left her dissatisfied with the voyage. From Peter Greenberg. 10/23/2012

Women with celiac disease had significantly more problems related to fertility and pregnancy than a control group of women who did not have the condition, investigators reported here.Patients with celiac disease had increased difficulty conceiving compared with controls (41.2% versus 36.5%, P=0.03), as well as more consultations with fertility specialists and higher rates of spontaneous abortion, preterm delivery, and cesarean section. Women with celiac disease also tended to have a shorter duration of fertility, marked by later onset of menarche and younger age at menopause, Stephanie M. Moleski, MD, said at the American College of Gastroenterology meeting… From Medpage Today 10/23/2012

Who needs wheat anyway? The market for gluten-free foods and beverages is booming, with double digit growth over the last four years as more consumers find themselves diagnosed with celiac disease and food allergies. The market for products without the gluten protein is valued at $4.2 billion, according to a report from Packaged Facts. Since 2008, it has grown at a compound annual rate of 28% each year and is expected to exceed $6.6 billion by 2017.  From the LA Times 10/23/2012

I’ll be using this area to highlight news articles that I find of value. They will link out to external sources. And, like always, none of these are a substitute to your own health-care provider’s advice.

Gluten Free Tempura

19 Oct

So, since it’s Friday–and I’m on call for the night shift at the Hospital. Why not, a quick and easy, comfort snack!

Let’s make some gluten free tempura–in my case, potatoes only. (You can add pretty much anything).

The pics:

The Ingredients:

  • 3-4 small potatoes
  • Rice Flour  (to make sure it’s GF, the label MUST only have Rice Flour as the ingredient)
  • Water
  • Olive or Canola Oil (I prefer Olive)
  • A Knife 🙂

So, begin by finely slicing the potatoes. (I prefer to cut them in half by the length of the potatoes).  Then I begin the thin layer slicing–keeping the skin!

Next place the sliced potatoes in cold water for 5-10 minutes; after that, time for a thorough rinse. Then dry on paper towels.

Let’s prep the rice flour batter:

1 part flour with 2 parts H2O. Mix thoroughly; and let sit for 5-10 minutes.

Now let’s get cookin’:

After dipping the dry slices of the potatoes in the batter–i move 3-4 slices into the hot oil. Let it simmer for a bit–I like it a little brown.

Remove from the pan; and repeat the above ’till you’re done.

Garnish with sprinkle of salt and a dip of you’re choosing. Make sure, if you use soy sauce–it HAS to be GF. Natural soy sauce is not your friend.

Enjoy the snack with coffee or a hot sake.

Cheers

Hunting for Tiramisu

16 Oct

I am a professional young woman, highly educated, quite self-sufficient, and even cried at the end of “The Note-Book.”

On a daily basis, my job in the hospital gives me the opportunity to interact with people of varied ages, backgrounds, and socioeconomic groups. Yes, even Republicans.

Being a medical resident is like being at a cocktail party. You’re always meeting and interacting with new people, running into people you’ve known for years. And, then, there are those, few, that quickly after 2 seconds of reconnecting—you are quickly reminded of why the two of you are only Facebook friends. I’m finding that, like a cocktail party, there’s one other thing in common among all my interactions in the hospital. And, no it’s not Sick people.

Cakes are Nice Too

Everybody always makes the following statement to me: “…so, you’re single.” This comment is always said in a very nice and respectable way. Kind of in such a manner as not to offend me or others around me. I excitedly wait to hear: “…so, I know this young chap that I’d like you to meet.” This, of course, never happens! And, I’ve come to realize, alas, that such an interaction will never happen at the hospital.

The women’s liberation movement has, indeed made many great strides. And, at a workplace, where pride is taken in professionalism, such conversations would not end well, I suppose. So, I am not entirely sure where Grey’s Anatomy gets their weekly inspiration for their racey story lines. Since, I am a self-sufficient woman, I’ve read the works of Virginia Wolf and NY Times’ fiery redhead, Maureen Dowd. I’ve decided to act in a very proactive, self-sufficient manner. After all, my medical specialty of Family Medicine is all about being proactive. We try to prevent chronic diseases such as Type II Diabetes, High Blood Pressure, and Obesity by focusing on preventative measures that a patient can take to improve their health outcomes.

With a professional mindset, previously described, I boldly treaded forward to bring a proactively directed method to the matters of the heart. I can accomplish such a mission through the only one possible vehicle known to generation Y and Z—it’s online dating.

In theory, it is such a proactive and sound concept. There could be no flaws. You put up a picture of yourself, write a few paragraphs about yourself, what you like to do, and whom you’d like to meet. It seems analogous to a social “Resume” or a professional Curriculum Vitae. It makes so much logical sense, that I have high-fived myself.

As a physician, we are ingrained to look for patterns in most everything we observe. Diseases, people I meet, and even the clouds in the sky—all have patterns. My first few blind dates were rather nice and cordial. The men looked quite dapper in their corduroy pants. Yes, I like the preppy look. Most of my dates seem to be follow the following pattern:

I spoke about myself, the young gentleman spoke about himself. I usually ordered a Pinot, sometimes a dirty-martini depending on how big or late lunch I had earlier in the day. And, then we ordered dinner. Or, at least, “talked” about ordering dinner. It generally takes me 10 seconds to figure out what I wanted to order. Come on, I am a girl; I know what I want. Of course, I don’t tell the date that I already checked the dinner menu on-line before joining my date for dinner. And, it’s not because I hate spontaneity or am a control freak.

To my surprise, each gentleman would before ordering dinner spend a lot of time trying to “problem solve” my diet restrictions secondary to Celiac Disease. Some would go through the entire menu: naming each entrée and understanding why I could not eat it. I was always a little uncomfortable asking the managers and chefs; and, some of my dates preferred to do that on my behalf! Some chefs would come to our table and wanted to learn more about the specifics of my dietary restrictions. But, only after they found out I was a physician. Prior to knowing that I was a physician, I got the sense that I was viewed as “the high- maintenance ” date who was a rather picky eater

Once they realized I’m not snobby snot, I was made to feel special by the wait staff, my dates, and the general public around me. I was not made to feel apologetic for causing a disruption. In medicine, you decide how to get tasks done

Very Nice!

quickly and then, do not reinvent the wheel. Thus, my decision to pre call the restaurants. But, medicine also forces you to change in the face of new evidence.

I came to accept the attention as endearing. Most of my dates would ask questions about my life-style. They asked questions about Lipstick to toothpaste. After all, I couldn’t simply pluck off the bread accidentally placed on my meal, and, then call it a gluten free meal. So, no harm in not sharing this part of my life with my dates.

As time went on, though, I started to get a little annoyed. The spark wasn’t there for me. I kind of want to talk about me, my quirks and not just my disdain for bread. I was more than my disease process. I am not defined by having celiac disease. In my clinics, I usually tell my patients, that they are not defined by the disease. It could be, or share a part of your identity; but, never serve as the foundation of it.

But, my dates remained enthralled! Piercing eye-contact was maintained the entire time. Which slowly lead to the usual courtship ritual seen among the human “mating dance.” Men display certain patterns, here, too. Self grooming gestures were being thrown my direction—left and right, fixing of their hair, adjusting of ties, shoulder brushes, and eventually the gaze of “Come Hither” was flashed towards me. It was GAME-ON!

I would always get a little tired by dessert time. I caught myself numerous times politely, repeatedly having to say “No” to dessert. I forgot to read the dessert menu before hand. Thus, I was always blind sided by bready deliciousness.

Since, dessert is a must in our dating culture. I didn’t have time to completely prep for my entire meal. I have other obligations in my life–like the responsibilities of a resident at a hospital. Yes, this being-a-doctor thing is quite time consuming But, after a while, all hunting for the right desert started getting cute. I liked observing the hunter-gather instinct kicking in. My dates were hunting or at least trying to hunt and spear for some gluten free Tiramisu. So chivalrous!

As, I began to express my choice of foods to my blind dates, most were really excited to learn about the details of celiac disease and the gluten free lifestyle: from the diagnosis to the parts per million (ppm) guidelines the FDA has set on foods so that they can be classified as GF. Their interest wasn’t just about the current task at hand: dinner. I found myself talking about the non-GI symptoms of Celiac disease. No, not all of us “poop” a lot. Some of us can actually get cancer, infertility, anemia, and balance problems because of Celiac Disease.

My dates were finally turning into the cocktail parties I knew at the hospital. I felt like myself, and felt free to share myself. I could kid around, be goofy, and just talk about normal blind date things. They say you don’t find soul-mates, but you learn to become each other’s soul-mates. I even talked about some of my feelings and fears about having Celiac Disease, these dates were now full of emotion and feelings for me. Now, it was GAME-ON for me!

Then came John. And a few other non-corduroy wearing, non tiramisu-hunting men. John was a young physician as well. We never professionally worked together. He was an orthopedic surgeon, who personally thought that he was the grand-son of the first dude to have ever eaten an organic vegetable. And, probably—John also, owned a lot of stock in the Organic Food Stock Market. Okay, that maybe a bit of a little lie. There’s no such thing as the Organic Stock Market.

Things NOT always Equal

John was exceptionally Zealous of the Organics food lifestyle. He felt, I could immediately relate to his food habits because I’m GF. I, too, am a believer, though a cautious believer. I think it’s wise to know what goes into our bodies. As someone with Celiac Disease, you don’t always need to focus on what comes out of your body!

As a physician, and with the latest landmark Stanford meta-analysis study: I tell all my patients that Organic foods are not safer or healthier. They have not shown to reduce certain types of cancer. The only things that we can conclude about organic foods is: they have less pesticides, organic chicken and pork have less exposure to antibiotic resistant bacteria, they taste better, and they generally are kinder to the animals and help local farmers. This is what we know right now. That may change tomorrow.

Many years ago, we didn’t believe that Wheat, the staple of most of the entire world could cause disease. And, now we’re finding that dogs also have Celiac Disease! CD among humans was first described by Samuel Gee in 1888 in a report entitled “On the Coeliac Affection“, a similar description of a chronic, malabsorptive disorder by Aretaeus from Cappadocia (now Turkey) is traced as far back as 2nd century AD.

The specific cause of celiac disease was unexplained until the Dutch pediatrician Willem K Dicke recognized an association between the consumption of bread and cereals and relapsing diarrhea. This observation was corroborated, when, during periods of food shortage, during the Second World War, there would be a normalization of diarrhea symptoms. We are still learning about the specific genetic dance that must be orchestrated in order for a patient to develop such auto-immune diseases.

An essential tenant of clinical medicine, and the fundamental nature of science is that medical recommendations change in the face of new evidence. What’s constant is our analytical framework and the ability change in the face of new evidence.

After the Stanford study came out, I still saw many of my patients continue to eat Organic Foods. They saw it as a form of exercise in power, which transitioned from “it’s healthier” to “it’s environmentally friendlier, to, it is better for the farming community, and it just tastes better.” As, I sometime force my patients not to identify themselves with disease, I see many patients who form their identity with health.

Change Happens

It’s a choice. America is based on choice, given that one’s choice does not harm others. My patients that eat Organic Foods don’t harm anyone. Rather, they take great pride in their bodies. Their choice is a stark comparison to the majority of my patients who are morbidly obese and crippled with chronic life-style diseases such as high blood pressure, high cholesterol, and diabetes. As a family medicine physician, I am happy when someone CHOOSES to take an active role in their health. Specifically, in their eating choices.

My colleagues and I spend countless hours teaching patients about the perils of foods with a high glycemic index. Foods that are scientifically proven to cause heart attacks, liver disease, and
cancer. There are times that I imagine myself wearing amazing shoulder pads, as I punt my patents’ sprinkled doughnut into the ground, which obviously would then be followed by me doing a little victory dance at the goal post. That would be my super-bowl victory.

Speaking of football, my date, John played college football. That’s what he said, at least. If you ask me, his shoulders were kinda tiny. No, I did not see the size of his feet.

No, as a doctor, I do not have a medical opinion if a man’s shoe size accurately correlated to the size of his you know what. Our dinner progressed along. I enjoyed his company over hot sake and sushi rolls. The conversation drifted with a natural ebb and flow. I smiled, I laughed, and was totally captivated. I was having a great time. Then, John said something really stupid. “Don’t you think black pepper can replace a rescue inhaler when someone is having an asthma attack. You know, because black pepper naturally has amazing anti-inflammatory properties?”

For those of you not in the medical field: Orthopedic Surgeons are victims to a stereotype that precedes them. How do I say this nicely, they are known as the Jocks of our profession. Not the brightest, nor the most articulate. Shear brute strength which obviously is necessary to manually correct a dislocated bone. That’s a stereotype, kind of like a pattern.

Though to be fair: I have friends that are orthopods. I like orthopods. If an orthopedic surgeon ran for president, I would vote for him or her.

But poor John was just plain stupid. He took an amazing leap of faith with me. He whispered this correlation to me, knowing that if he raised this question in the hospital, or in a louder voice he might be ridiculed. I am surprised that I did not ridicule him. But, this did result in John not getting date #2. He, like millions of Americans was making an innumeric conclusion. John’s question is perfect in theory, similar to my acceptance and excitement of the theory of on-line dating. Both make perfect logical sense. Though, both fall apart because in real there are always exceptions. There are always Johns.

There’s a stereotype of people with Celiac Disease, too. A pattern that’s beginning to develop in mainstream America. I am not shy to call it out. It sort of goes like this: We inherently believe that a gluten free diet can cure many diseases: Multiple Sclerosis, Autism, and World Hunger. A gluten free can even cure the stupid out of Snookie and Kim Kardashian. Those are the imagined powers of a gluten free diet. Nothing more.

Some Disclaimers:

  1. Yes. In our present day society: hunting and gathering are not gender specific tasks. No, I do not know if females or males are the better hunter.
  2. No. No, animals were hurt in the process of hunting for tiramisu.

Free Gluten Free Starter Kit

15 Oct

I came across a great resource for those newly diagnosed with Celiac Disease and Gluten Sensitivity.

The Gluten-Free Care Package is a basket of helpful and essential resources, including a gluten-free food guide, support group information, and food samples to introduce people with celiac disease to a gluten-free diet. Since beginning the program in 2001, we have distributed thousands of Gluten-Free Care Packages to people newly biopsy-diagnosed with celiac disease all over the country.

Goodies!

This free starter kit from the University of Chicago is a great way to get a patient to start managing a complex disease.  It’s also a great idea if you have GF friends and are looking for ways to make them feel safe and welcome in your home.

Ancient Wheat Grains

13 Oct

Came across this nugget today via Andrew Sullivan:

There is a growing movement of farmers, scientists, and foodies working to bring back heritage grains—especially those ancient varietals of wheat that were around long before grains were widely hybridized to boost yield and resist disease. Among those who are growing and baking with these heirloom grains, there is a keen interest in einkorn, a nutty and nutritious species of ancient wheat that may be digestible by people with gluten allergies.

Gonna post more on this later…

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Rainbows at the Edges of Earth

13 Oct

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