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Eosinophilic Esophagitis and Celiac Disease EP069


Your gastrointestinal tract is approximately 30 feet long, and it runs from your mouth all the way to the anus! We know that celiac disease can impact any part of the digestive tract. But there is another disease that wreaks havoc on the GI tract as well, a condition called eosinophilic esophagitis or EoE.

The Gluten Free RN is explaining the fundamentals of eosinophilic esophagitis, from its characteristic inflammation of the esophagus and elevated eosinophils in the blood to the common symptoms of vomiting and upper abdominal pain. She walks us through the treatment for EoE, an elimination diet or steroid therapy.

Nadine speaks to the research exploring a possible connection between eosinophilic esophagitis and celiac disease, citing a paper that found a higher prevalence of EoE in children with celiac disease than the general population as well as the case study of a woman with both celiac disease and elevated eosinophils in her blood. Listen in for the Gluten Free RN’s insight on the best EoE clinics and physicians in the country and learn why further study is needed around EoE and celiac disease!

What’s Discussed:

The fundamentals of eosinophilic esophagitis

  • Allergic response to dietary antigens
  • Causes inflammation of esophagus, increased eosinophils in blood

The benefits of unsedated transnasal endoscopy for children with EoE

  • Monitors esophageal mucosa without sedation
  • Safer, faster and less costly

Some common symptoms of eosinophilic esophagitis

  • Vomiting, difficulty swallowing, food stuck in throat
  • Chest pain, heartburn, upper abdominal pain

The condition of achalasia

  • Muscles of esophagus don’t work appropriately
  • Causes spasms or constriction

The treatment for EoE

  • Elimination diet (remove wheat, eggs, milk, soy, shellfish and seafood, peanuts and tree nuts)
  • Topical or systemic steroids

The potential increased prevalence of EoE in children with celiac disease

  • 2015 paper found prevalence of 10.7% (much higher than general population)
  • Other research articles argue no increased prevalence of EoE in CD

The case study of a 30-year-old woman with celiac disease and elevated eosinophils

  • Presented with abdominal pain and distension, vomiting and frequent bowel movement
  • Treated with IV hydrocortisone, but developed steroid induced psychosis

Nadine’s insight on the best specialty clinics for EoE in the US

  • University of Colorado (Denver School of Medicine)
  • Pennsylvania

Dr. Glenn Furuta’s insight on the difficulty of diagnosing EoE

  • Relatively new disease, tendency to diagnose based on pathology report alone
  • Elevated eosinophils also found in GERD, inflammatory bowel disease and celiac disease

Special considerations for pediatric patients with EoE

  1. Consultation with dietician
  2. Limited exposure to corticosteroids
  3. Attention to development of feeding skills
  4. Potential psychosocial, behavioral problems

Resources:

‘Unsedated Transnasal Esophagoscopy for Monitoring Therapy in Pediatric Eosinophilic Esophagitis’ in Gastrointestinal Endoscopy

‘Eosinophilic Esophagitis Associated with Celiac Disease in Children’ in BMC Research Notes

‘Eosinophilic Gastrointestinal Disorder in Coeliac Disease: A Case Report and Review’ in Case Reports in Gastrointestinal Medicine

‘Eosinophilic Esophagitis in Children and Adults’ in Gastroenterology and Hepatology

‘The Association Between Celiac Disease and Eosinophilic Esophagitis in Children and Adults’ in BMC Gastroenterology

‘Eosinophils in Gastrointestinal Disorders’ in Immunology and Allergy Clinics of North America

‘2013 Update on Celiac Disease and Eosinophilic Esophagitis’ in Nutrients

‘Eosinophilic Esophagitis: New Insights in Pathogenesis and Therapy’  in the World Journal of Gastrointestinal Pharmacology and Therapeutics

‘Incidence and Prevalence of Eosinophilic Esophagitis in Children’ in the Journal of Pediatric Gastroenterology and Nutrition

‘Management of Eosinophilic Esophagitis and Celiac Disease’ in Current Opinion in Pharmacology

‘Increased Risk of Esophageal Eosinophilia and Eosinophilic Esophagitis in Patients with Active Celiac Disease on Biopsy’ in Clinical Gastroenterology and Hepatology

‘Individuals Affected by Eosinophilic Gastrointestinal Disorders Have Complex Unmet Needs and Frequently Experience Unique Barriers to Care’ in Clinics and Research in Hepatology and Gastroenterology

‘Eosinophilic Esophagitis and Celiac Disease: A True Association or Coincidence?’ in the Journal of Pediatric Gastroenterology and Nutrition

Connect with Nadine:

Instagram

Facebook

Contact via Email

‘Your Skin on Gluten’ on YouTube

Melodies of the Danube Gluten-Free Cruise with Nadine

Books by Nadine:

Dough Nation: A Nurse’s Memoir of Celiac Disease from Missed Diagnosis to Food and Heal

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Why No Dairy on a Gluten-Free Diet? EP068


If you’re just getting used to eliminating gluten from your diet, it may feel like a burden to remove dairy as well—especially if you’re a fan of comfort foods like cheese and ice cream. Why exactly do many practitioners recommend a gluten- AND dairy-free diet to patients diagnosed with celiac disease and non-celiac gluten sensitivity?

The Gluten Free RN is walking us through the similarities between gliadin and casein, explaining how the proteins found in gluten, milk and cheese impact our brains. She discusses how Marsh 1 damage from celiac disease leads to an inability to break down the sugar in milk and why we crave the very foods that are making us sick.

Nadine shares the story of a young man with autism whose health improved once his family went gluten-free, describing the well-documented gut-brain connection and how the right high-fat diet can repair the neurological system. Listen in for the Gluten Free RN’s insight around dairy replacement options and get empowered to reclaim your health with a gluten- and diary-free diet!

What’s Discussed: 

The similarities between the gluten and casein proteins

  • Molecularly very similar, bodies read as toxins
  • Both capable of crossing blood-brain barrier

How the casein protein impacts the brain

  • Causes inflammation, hypoxia (decrease flow of oxygen)
  • Brain fog, anxiety, depression, irritability and fatigue

The effect of Marsh 1 damage due to celiac disease

  • Microvilli damaged or destroyed
  • Can’t produce enzymes that break down sugar in milk

How gluten and casein proteins act as exorphins

  • Bind with opium receptors in brain
  • Crave foods that make us sick

Nadine’s recommendations for dairy replacements

How a gluten-free diet helped a young man with autism

  • More interaction with family, fewer GI issues
  • High-fat diet repairs neurological system

The story of Dr. Terry Wahls

  • Diagnosed with MS, healed on gluten-free diet

Resources:

Aroy’d Coconut Milk

Kite Hill

NuCulture Foods

Mary’s Gone Crackers

Jilz Crackers

Dr. Terry Wahls’ TED Talk

The Wahls Protocol  by Dr. Terry Wahls

Dr. Terry Wahls’ Website

Connect with Nadine:

Instagram

Facebook

Contact via Email

‘Your Skin on Gluten’ on YouTube

Melodies of the Danube Gluten-Free Cruise with Nadine

Books by Nadine:

Dough Nation: A Nurse’s Memoir of Celiac Disease from Missed Diagnosis to Food and Heal

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Indigenous Populations, Celiac Disease and NCGS EP067

‘Globally, indigenous peoples suffer from poorer health, are more likely to experience disability and reduced quality of life, and ultimately die younger than their non-indigenous counterparts.’

A UN Report on the health of indigenous peoples points to a significant problem, but the question is WHY? Why are native populations more prone to autoimmune disorders and type 1 diabetes? Why do they have a higher incidence of alcoholism and drug addiction? And why the lower life expectancy?

The Gluten Free RN is exploring the role of food in health outcomes for indigenous populations around the world. She begins with an explanation of the dietary differences between hunter-gatherer and agricultural societies, discussing how native populations were exposed to the gluten in grains only when European conquerors came to occupy their lands.

Nadine shares her challenge in finding information about indigenous populations and celiac disease, explaining why further study is necessary. She speaks to the highly processed nature of the commodity foods provided to Native Americans in the US and the shortcomings of Canada’s Food Guide when it comes to the health of First Nations people. Listen in and learn the significance of educating indigenous populations around celiac disease and non-celiac gluten sensitivity, empowering those groups to make choices that will improve their health and quality of life!

What’s Discussed:

The global indigenous population

  • 370M in 70-plus countries
  • Rich diversity of cultures

The health status of indigenous populations

  • Higher incidence of autoimmune disorders, T1D
  • Higher prevalence of addictive disorders, cardiovascular disease
  • Lower life expectancy, increased morbidity/mortality

Why indigenous populations have more health issues

  • Access to health care, isolation and lifestyle
  • Food (hunter-gatherer vs. agricultural society)

The lack of information around indigenous populations and celiac disease

  • Very few studies available

The impact of grains on the native population

  • Significant change in health care outcomes, quality of life

The prevalence of celiac disease in indigenous populations

  • At least 1%, likely 3% or higher
  • No way to know without mass screening

Why eating healthy is a challenge for the indigenous population

  • Food scarcity, desserts
  • Reliance on commodity foods provided by government

The conclusions of the Prairie Nymph blog on Canada’s Food Guide

  • Based on diet of European origins, doesn’t mention celiac disease
  • Ignores health benefits of traditional diet for First Nations people

Why it’s important to educate indigenous people around celiac disease

  • Empower to make food choices with better health outcomes

Resources:

Guns, Germs, and Steel: The Fates of Human Societies by Jaren M. Diamond

Dough Nation by Nadine Grzeskowiak

USDA Commodity Supplemental Food Program

‘Canada’s Food Guide and Native Women’ by Prairie Nymph

The Sioux Chef’s Indigenous Kitchen by Sean Sherman

American Indian and Alaska Native Health

‘Celiac Disease: A Disorder Emerging from Antiquity, Its Evolving Classification and Risk, and Potential New Treatment Paradigms’ in Gut Liver

‘Celiac Disease: A Life-Changing Diagnosis’ in Indian Country Today

‘Government Food Boxes? It’s Nothing New for Native Americans’ on WDET

UN Indigenous Peoples Fact Sheet

‘Many Native Americans Lack Access to Healthy Food, But There’s a Growing Movement to Change That’ in Grist

‘Characteristics and Factors Related to Quality of Life in Mexican Mestizo Patients with Celiac Disease’ in BMC Gastroenterology

Summary of Aboriginal and Torres Strait Islander Health

WHO Health of Indigenous Peoples

WHO Indigenous Peoples and Substance Abuse

Connect with Nadine:

Instagram

Facebook

Contact via Email

‘Your Skin on Gluten’ on YouTube

Melodies of the Danube Gluten-Free Cruise with Nadine

Books by Nadine:

Dough Nation: A Nurse’s Memoir of Celiac Disease from Missed Diagnosis to Food and Heal

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What & Where I Eat: A Q&A on Re-Find Health

I recently had the pleasure of answering a few questions on Re-Find Health about how I handle eating out at restaurants as well as what I eat at home. Here are a few of the questions (and answers) but be sure to click through to the original article on Re-Find Health to read them all.


CA: Do you put much thought into where you eat out? Or do you simply go anywhere and try to make do with what’s on the menu?

NG: I put a fair amount of thought into where we can safely eat out. Unfortunately, I learned quickly and completely that while many eateries say they can provide safe, gluten free food, often that is not the case. Pizzerias that offer gluten free pizzas but they toss the dough into the air are contaminating everything in that restaurant, even the salads. Unless a restaurant has a separate designated gluten free kitchen, the risk of contamination with gluten is enormous. Corporations, fast food joints and restaurants like to jump on the gluten free bandwagon because they understand that many people are interested in eating gluten free, not just the people diagnosed with celiac disease and this is impacting their profits. They offer gluten free options without realizing or taking into account how to prevent contamination and cross-contamination. Additionally, if I am going out to eat with my family, friends or for business, I look for a restaurant that is safe for me with good, quality food that we all can enjoy. I always look for and ideally choose restaurants that are designated gluten free, if that is an option.


CA: Most memorable restaurant meal in (or near) Salem?

NG: I have to confess, my most memorable gluten free restaurant meals have taken place at Eats and Treats Cafe in Philomath, Oregon. Several years ago, when Katy McHenry was employed at Gluten Free RN, we held a community meeting with the intention of having someone (but not us) open up a safe restaurant in our area. Katy’s Dad showed up to take notes for the meeting. It wasn’t long after that initial meeting that Katy’s Mom and Dad opened up Eats and Treats Cafe. The very first meal at Eats and Treats Cafe several years ago was extremely exciting and memorable, as has been every meal since. People, quite literally, travel great distances just to experience the incredible 100% gluten free barbecue, baked goods and other tasty foods on the extensive menu. Whenever Katy is back in town for a visit, we happily, proudly and safely eat out at Eats and Treats Cafe.


CA: Most memorable restaurant meal outside of Salem?

NG: My most favorite and memorable restaurant meal occurred in the Mission District of San Francisco, California at Pica Pica which serves 100% gluten free Venezuelan food. My mouth is salivating just thinking about their great food. The first time we ate there, we just kept ordering more and more food because we could not get enough of the incredible flavors. The arepa are handmade with either white or yellow corn fresh, every day. The meat options are spicy and tasty beyond belief. They also offer yuca fries on the menu. The food is fresh, tasty, gluten free, not expensive and amazingly fabulous. Thankfully, I find myself traveling to San Francisco frequently and always make sure at least one trip to Pica Pica is on the travel agenda.


CA: For people with special diets, how do you suggest they talk with restaurant staff in order to get what they need?

NG: I recommend that people do their homework first by asking people they trust for recommendations for safe restaurants. There are a few restaurants that I recommend that are not 100% gluten free but my criteria is pretty strict. People need to be very clear in communicating their needs to the restaurant staff. It might help to call ahead and ask the important questions before you show up. One app that we rely on when we are traveling is Find Me Gluten Free. We use that as a starting point but continue to ask questions until we are relatively certain the place is safe. Ask as many questions as you need to in order to get the information you need to eat safely. Whenever your food is delivered to your table, always ask the person presenting it to you, “Is this food gluten free?”. It is amazing how many times that simple question at the point of delivery has prompted that server to say that ‘well, no, it isn’t gluten free’. There are times restaurant staff have assured me that food is gluten free, but when I test to with my Nima Sensor or EZ Gluten test strips, it tests positive for gluten. If you really want to have another way to feel safer eating out, invest in either of these options and test the food at your table. You have to be prepared to not eat the food if it comes up positive for gluten.


Read the Rest of My Answers on Re-Find Health
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How to Easily Go Gluten-Free or Paleo EP066

‘It’s too hard.’ ‘It’s too expensive.’ ‘It’s time-consuming.’ ‘My family won’t support me.’

There are lots of excuses why you can’t go gluten-free or Paleo, but the Gluten Free RN argues that if it’s hard, you’re doing it wrong. And today, she’s prepared to explain how to easily go gluten-free or Paleo and either maintain or regain your health.

Nadine begins with a discussion of the connection between food and pain or discomfort. She explains how the processed, non-food that most people consume causes damage that prevents us from absorbing the nutrients our bodies need. She offers insight around where to go for gluten-free, organic food and how to jump-start a gluten-free or Paleo diet.

The Gluten Free RN provides tips on taking control of your food choices, trying new foods, and gluten-free cooking—minus the cheap fillers. She also outlines a shopping list for nutrient-dense foods that will heal your leaky gut and feed your neurologic system. Listen in and learn the easy way to go gluten-free or Paleo and optimize your health!

What’s Discussed: 

The value in recognizing how you feel

  • Shouldn’t have pain, discomfort daily
  • Underlying cause traced back to food

Nadine’s response to excuses for not going gluten-free

  • No more expensive, must buy food anyway
  • Food is medicine, good choices can improve health

How to avoid non-food with empty calories

  • Stay away from soda, sugary coffees
  • Pass up highly processed and fast non-food

The difference between organic and conventional food

  • Conventional food—herbicides, pesticides, genetically modified
  • Roundup causes leaky gut, even in absence of celiac disease

Nadine’s suggestions around where to go for gluten-free food

  • Grocery stores that cater to gluten-free population
  • Local food co-ops, farmers

Nadine’s advice for going gluten-free or Paleo

  • Try new foods in the produce section
  • Learn to pack simple breakfast, lunch and dinner
  • Consider putting in garden
  • Get re-educated, take control of food choices
  • Replace cutting boards, toasters, etc.

How to get started on a gluten-free or Paleo diet

Nadine’s shopping list for a gluten-free diet

  • Fruits and vegetables
  • Nuts and seeds
  • Meat, fish and eggs

Resources:

Whole Foods

Natural Grocers

Whole30

Midway Farms

Whole30 Cookbooks

Paleo Magazine

Connect with Nadine:

Instagram

Facebook

Contact via Email

‘Your Skin on Gluten’ on YouTube

Melodies of the Danube Gluten-Free Cruise with Nadine

Books by Nadine:

Dough Nation: A Nurse’s Memoir of Celiac Disease from Missed Diagnosis to Food and Heal