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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!
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)
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
- Consultation with dietician
- Limited exposure to corticosteroids
- Attention to development of feeding skills
- Potential psychosocial, behavioral problems
‘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
‘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
‘Eosinophilic Esophagitis and Celiac Disease: A True Association or Coincidence?’ in the Journal of Pediatric Gastroenterology and Nutrition
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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!
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
The Wahls Protocol by Dr. Terry Wahls
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‘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!
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
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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.
‘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!
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
- Whole30 Program (eliminate grains, sugar and dairy)
Nadine’s shopping list for a gluten-free diet
- Fruits and vegetables
- Nuts and seeds
- Meat, fish and eggs
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As stories about Russia continue to dominate the news cycle, you are probably familiar with the recent sanctions against the country, Vladimir Putin’s reelection, and even the expulsion of Russian diplomats from the EU and US. But what do you know about celiac disease in Russia?
The Gluten Free RN is taking a closer look at the limited information about celiac disease in Russia, giving us an overview of the country’s size and population and the likely number of celiac cases based on the global tendency. She discusses the thriving wheat production industry in Russia as well as the gluten-containing traditional Russian diet.
Nadine walks us through a presentation created by Dr. Elena Roslavtseva at the Scientific Center for Children’s Health in Moscow, sharing how the diagnoses of celiac disease changed from the 1970’s through the 2000’s, the inconsistencies with testing for celiac disease around the nation, and the challenges of maintaining a gluten-free diet in Russia. Listen in as the Gluten Free RN covers the Journal of Immunology Research’s overview of celiac disease in Russia, explaining why the reported frequency probably doesn’t reflect the true prevalence and the necessity of a mass screening.
General information about the country of Russia
- Population of 144.3M
- Dual nation state, 185 ethnic groups
- Largest country by land mass
Russia’s thriving wheat production industry
- Very high, exported to Middle East and Africa
- Ban on genetically modified wheat
The first diagnoses of celiac disease in Russia
- Late 1970’s—1980’s
- Cases of severe malabsorption
- No gluten-free foods available
How celiac diagnoses changed in the 2000’s
- Diagnosed more often, well-known in most regions
- Research done in many universities, med centers
The Eastern European countries that have done mass screenings
- Romania, Slovakia, Slovenia, Estonia
Why the data around celiac disease in Russia is unreliable
- Variation in how practitioners test for celiac disease
- Belarus—HLA-typing not available in most cases
- Latvia—mandatory screening for patients with IDDM and AIT
The problems associated with celiac disease in Russia
- Unreliable data in absence of mass screening
- Gluten-containing traditional Russian food
The overview presented in the Journal of Immunology Research
- Diagnostic tools for celiac disease in Russia vary significantly
- Reported frequency of 0.2-0.6%, but real rate unknown
‘Coeliac Disease and Gluten Related Disorders in Russia and Former Soviet Republics’ by Dr. Elena Roslavtseva
‘Overview of Celiac Disease in Russia: Regional Data and Estimated Prevalence’ in the Journal of Immunology Research
‘Russia’s Wheat Industry: Implications for Australia’ from the Australian Export Grains Innovation Centre
‘Growing Importance of Russian Milling Wheat Worldwide’ from Solaris Commodities
‘How an Oil Giant (Russia) Came to Dominate Wheat’ in Bloomberg
‘Celiac Disease in Russia and the Former Soviet Republics’ in The Celiac Scene
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When faced with new information, it’s important to consider the source. Stop for a moment and examine whether the material is coming from someone with YOUR best interests at heart. The Gluten Free RN has just returned from the Colombia University Celiac Disease Conference, and she is breaking down the information presented to determine what’s useful—and what might be tainted by the pharmaceutical or food industry agenda.
Nadine begins with a workshop led by General Mills that offered some questionable information about how grains are processed at their factories and a talk led by University of Chicago faculty on the topic of a gluten challenge. She also speaks to the differences between celiac management in the US and countries with universal healthcare like Italy and Australia.
Nadine covers new testing that detects gluten exposure in stool or urine and what that reveals about the systemic nature of gluten damage as well as her take on practitioners who perpetuate the myth that grains are necessary and nutritious. Listen in for the Gluten Free RN’s insight around pharmaceutical treatments for celiac disease and the danger in volunteering for studies backed by drug companies.
The two programs available at Colombia’s 2018 conference
- Clinical (nurses, RDs and laypeople)
- International (doctors, scientists, industry and VC)
How celiac disease is managed in Italy
- Presentation by Dr. Carolina Ciacci
- Law mandates gluten-free options
Nadine’s frustration with the General Mills presentation
- Major sponsor of conference
- Claim to separate grains at factory
Nadine’s take on gluten-free Cheerios
- Should be avoided, not truly gluten-free
Nadine’s confusion around Dr. Bana Jabri’s comments
- Wouldn’t put ‘potential celiac patient’ on gluten-containing diet
- Did not include patients with positive antibody test but negative biopsy
Why the biopsy for celiac disease is problematic
- Only tests one foot into duodenum
- GI tract is 30 feet in length
Nadine’s insight on a gluten-free challenge
- No possible benefit for patient
- Unnecessary, unethical
The systemic nature of gluten damage
- New tests detect gluten exposure in stool, urine
- Urine test indicates passage through every system
Nadine’s stance on pharmaceutical treatments for celiac disease
- No pill or vaccine will treat or cure CD
- Harmful to people in studies
The myth that grains are necessary and nutritious
- Practitioners who perpetuate are ‘toeing company line’
Why it’s important to understand the source of your information
- Should be untainted by pharmaceutical money, agenda
Australia’s requirements for gluten-free food
- Standard of less than 3 ppm