Tag Archives: Celiac Disease

Ask Me Anything on Reddit

23 Jul

Recently, I did two AMAs on Reddit.

Click the links below to read the Ask Me Anything (AMA) segments on Reddit:

  1. Hi, I’m a Family Medicine Doctor. I find that patients that DON’T LIE to me make the best patients.
  2. Hi Reddit, I’m a Family Medicine Doctor. AMA about Celiac Disease and Gluten Intolerance.


How to do the Harlem Shake.

17 Feb

1. Canker sores are associated with Celiac Disease.

Ms. Lips.

Ms. Lips.

2. Canker sores are NOT contagious, while cold sores ARE. Typically, cold sores occur on the surface of your lips, while canker sores can occur on the inside of your mouth. Cold sores can cause viral meningitis.

Thinking of the word “viral,” my favorite viral video of the Harlem Shake comes to mind. Let’s talk about Canker & Cold Sores another day…

Three simple steps to do the Harlem Shake …

1. One person, stands in the center, with their head covered and dances for a few seconds

2. While that person is dancing and shaking, everyone around that person just goes about their normal business

3. Then, when the beat drops; everybody, in the frame joins in and starts dancing insanely and vigorously… That’s the Harlem Shake!

Below is my favorite version of the Harlem Shake:

Poop Cycle of Celiac Disease

21 Nov

Here is an interesting chart that shows the amount of time patients with Celiac Disease spend in the restroom.

A Graph about Poop

**Note: It’s Funny. 🙂

Some Facts about Autism

18 Nov

Autism Awarenss

So, here are some facts about Autism.

→ Vaccines do not cause autism.

→ Autism is a deficit in a kiddos language skills.   Specifically, autism manifests as a deficit in receptive language or expressive language. The term Autism Spectrum Disorder has replaced the term Autism.

→Autism spectrum disorder is defined by defects in impairment in socialization, restricted/repetitive behavior, and impairment in communication.

→Intervening  early and intensively is key to treatment. It should be done by trained applied behavioral analysts affiliated with a medical group. It should NOT be done by isolation, changing foods, and other fad diets.

→ A child with autism starts showing signs  around 12 months of age by showing impairment in communication.

→It is hard for parents and doctors to judge impairment in communication. Let’s be honest, we communicate better some days than others. Just remember the last time one of our spouses were exiled to “the couch.”

→A child’s brain develops by pruning. Similar to how we prune a hedge. It’s argued that “autistic” kids don’t prune early in life.

→The  inability to show “joint attention” is the core symptom of autism and is a more concrete way to identify  “communication” impairments.

→Joint attention is best explained by this analogy:  a kiddo points to a cloud. He really digs that cloud. He then, looks at you or dad–he signals,  makes a noise, or says a word to get your interest. AND, then, the child wants you to see that groovy cloud. That is joint attention is a nutshell.

→The inability to see, express interest, and share that interest is very telling of autism spectrum disorder.

→In the near future, head circumference might be one of the first screening tools for the  indication of autism.

→Autism’s incidence is growing because we now have screening tools to recognize and diagnose it.

→The Academy of Pediatrics now recommends autism screening for ALL children from between 18 and 24 months of age.

If  your doctor doesn’t screen your child, ask them nicely.  If your doctor still doesn’t, get another doctor.

→Kiddos should be screened earlier than 18 months if they have a sibling with autism, aren’t talking by age 1, have a family history of any auto-immune diseases, or, if, they have a family history of any psychiatric disease.

→Autism is a diagnosis that now forces Commercial and Medicaid Insurance to pay for treatment by specialists. It was recently passed and is rightfully called the “autism insurance bill.”

→Most Commercial insurances and Medicaid now reimburse doctors for this screening test, MCHAT. It is politically correct to educate your doctor from reputed academic sources, not necessarily from what ya may have  heard on da street.

→By, that I mean: Jenny McCarthy.

→If, Mr Rodgers were still around, he’d surely not like Jenny McCarthy. But, I’m sure, he’d have a classy way of describing his opinion of her. I have yet to gain that skill.

Please note: the above does not replace medical advice, diagnosis, and treatment of your doctor.

Some Facts about Hernias

11 Nov

Man, that hurts!

Here are some random facts about hernias:

-Men AND Women can and do develop hernias.

-Most men will describe a history of lifting a heavy object, turning/twisting abnormanlly; and, then, a sensation of having felt a “pop” and seeing a “bulge.”

-You may see a mass extrude through the hernia, which resembles a pouch.

-No, you’re not a kangaroo.

-Your surgeon may have to perform emergency surgery if your intestines get strangulated or incarcerated as they move through the abdominal defect.

-Most hernias can be surgically corrected via a laparoscopic approach–this is of value because you’re left with three tiny suture sites.

-The surgery to repair the defect is VERY routine and is done to strengthen your abdominal wall. Think of a tire patch on a flat tire.

-Blood in stools, bloating, numbness in the inner thighs, and intense pain, are, sometimes, symptoms that your hernia isn’t just an accessory of the year. It’s NOT something to show to your friends at parties–it might be time to have that pouch examined by your doctor.

Please note: the above does not replace medical advice, diagnosis, and treatment of your doctor.

Here are 6 things every Celiac patient must know

5 Nov

And 6 Facts you can share with your friends:

6: Celiac is also an artery in your stomach.

Celiac Artery

5:  Pooping and Shitting are NOT the only symptoms of Celiac Disease

Pooping and Shitting

Let’s Poop

4: Celiac Disease can and does affect your reproductive system. Man & Woman

Pregnant, Maybe?

3: Celiac Disease Patients, even at young age, have weaker bones than normal.

Broken Bones


2: The most common non gastroenterological symptom is: ANEMIA.

Fatigue Hurts

1: The most common symptom for Celiac Disease is: Fatigue.

Tired and Fatigued


Please note:  the above does not replace medical advice, diagnosis, and treatment of your doctor.

Soldiers Face a Tough Battle with Gluten

1 Nov
IDF Logo

Kicking Ass AND Gluten Free

I came across a rather fascinating article in the Israeli newspaper: Haaretz Daily. For those that may not know, Israel has a requirement that all able bodied men AND women be drafted and serve a set period of time as soldiers within the Israel Defence Forces (IDF). I’m not quite aware of all the issues that would or could defer a young man or woman from serving–but it would make sense that it would be for such things as severe asthma, severe chronic diseases, etc. As I was going through the article, I find that a rather peculiar problem is now being encountered.

Combat units refuse to take celiac patients who volunteer for the Israel Defense Forces due to “logistic” problems supplying appropriate, gluten-free food – in direct contradiction of army directives forbidding rejection of soldiers who have the disease. IDF sources admit the problem exists and explain that they cannot guarantee suitable food in field conditions. However, a celiac patient serving in such conditions told Haaretz: “There’s no problem getting along with battle rations.” In the past, all celiac patients were exempted from army service, until 2008, when an effort was made to draft them. After a number of soldiers complained of unsuitable food, the policy was again altered and at present, the IDF drafts only celiac patients who express a will to volunteer.  At first, celiac patients were allowed to serve in combat units that guaranteed a supply of gluten-free food, but soon after, all combat units were informed that they could not reject celiac patients because of logistical difficulties in supplying the right food. However, Haaretz has learned that various combat units still refuse to supply proper food, thus, in effect, rejecting celiac patients…

So the issue is:

  1. Soldiers with Celiac Disease can volunteer but they will not be automatically drafted.
  2. The IDF is not able to logistically supply–ie, feed CD soldiers that do volunteer.

So the brave soldiers that do end up volunteering are probably spending more time in the bathroom than on the gun range! (Yes, I know that Celiac Disease manifests beyond just GI issues). Joking aside, this is indeed a serious problem. If a large organization such as a Tier I army is unable to properly provide stable GF rations to their soldiers–what hope is there for us mere mortals that spend time walking up and down the aisles of Trader Joe’s or Better Health? What hope do we have that smaller organizations such as schools or offices be able to provide proper gluten free meals when required?

The answer, sadly, at the moment is still: NONE.

It is important that the CD community work as a whole, so that we could and should be able to expect that kids, loved ones, and ourselves are eating food without the risk of complications. The idea for a nutritionally sound untainted meal should not be a mirage.


HAARETZ.COM has a paywall. As such, I’ve posted the article below. All copyrights remain with the HAARETZ on the article below.

Contrary to orders, IDF combat units refuse to accept celiac patients
Celiac sufferers are exempt from service, but may volunteer. But combat units won’t take them.
By Gili Cohen | Oct.30, 2012 | 12:58 AM

Combat units refuse to take celiac patients who volunteer for the Israel Defense Forces due to “logistic” problems supplying appropriate, gluten-free food – in direct contradiction of army directives forbidding rejection of soldiers who have the disease.

IDF sources admit the problem exists and explain that they cannot guarantee suitable food in field conditions. However, a celiac patient serving in such conditions told Haaretz: “There’s no problem getting along with battle rations.”

In the past, all celiac patients were exempted from army service, until 2008, when an effort was made to draft them. After a number of soldiers complained of unsuitable food, the policy was again altered and at present, the IDF drafts only celiac patients who express a will to volunteer.

At first, celiac patients were allowed to serve in combat units that guaranteed a supply of gluten-free food, but soon after, all combat units were informed that they could not reject celiac patients because of logistical difficulties in supplying the right food.

However, Haaretz has learned that various combat units still refuse to supply proper food, thus, in effect, rejecting celiac patients.

One such soldier was told officially by the IDF that he cannot be accepted by the Givati Brigade due to logistical problems. The soldier insisted, and was then told that “the disease cannot be a reason for not being stationed in a particular unit. If they claim that it’s because you’re a celiac patient, it is in contradiction to proper conduct.”

IDF sources said a problem indeed exists, and that the soldier was refused because appropriate food could not be guaranteed. Still, another combat soldier suffering from the ailment told Haaretz: “I get along fine in field conditions. The battle rations include tuna and stuffed vine leaves, and I eat more of these, or concentrate on vegetables. Actually, It’s harder to find suitable food in the base than in field conditions.”

In September 2011, a celiac patient seeking to enroll in the Israel Air Force flight academy was refused, but after appealing the decision was accepted to the academy.

Celiac patients can choose between receiving a monthly allowance of NIS 500, or five gluten-free meals and two gluten-free loaves of bread per week. The IDF Spokesman said: “The issue is being examined and the problem does exist. Staff work is carried out at present with the intention of guaranteeing the supply of suitable food to all army units. Due to the partial details supplied by the journalist, we cannot comment on the specific case.”

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.

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.