Photo by Mart Production

Addiction Issues, Celiac Disease and Gluten EP034

Few things are as painful as losing a loved one to an overdose. Addiction is such a powerful demon, and most of us have friends or family who are facing it right now. It is easy to feel helpless, believing that there is little you can do to ease their pain. But what if a diet change could resolve the physical and psychological pain at the root of the dependency? You might be surprised to learn that gluten binds with the opioid receptors in the brain, functioning as a ‘gateway drug’ to other addictions.

Today the Gluten Free RN shares her experiences with addiction and overdose during her 17-year career in the ER, explaining how she made the connection between undiagnosed celiac disease and addiction issues. She discusses the US opioid epidemic and how a mass screening for celiac disease could prevent such widespread substance abuse. Listen as she describes the morphine-like effects of gluten on your brain, the role of the microbiome in dictating cravings, and why gluten may be at the root of the pain that leads patients to self-medicate with dangerous recreational drugs.

The sad truth is that 91 Americans die every day from an opioid overdose. Because undiagnosed celiac disease goes hand in hand with addiction, is it past time to get our loved ones tested. Suggest it today — it could save a life.

What’s Discussed:

The recent flood of headlines regarding the US opioid epidemic

How exorphins affect the brain

  • Endorphins release chemical to make person feel good (i.e.: runner’s high)
  • Ingest exorphins, make feel differently (e.g.: good, tired, sedate)
  • Includes food, alcohol, pharmaceuticals and recreation medications (marijuana, cocaine, heroin, methamphetamines)

How Narcan reverses a heroin overdose

  • Binds with opioid receptors

The potential connection between gluten and opioid addiction

  • Gluten binds with same receptors in brain
  • Addiction to gluten, dairy may be precursor to other addictions
  • Many self-medicate with ‘comfort food’ containing wheat and dairy (i.e.: pizza, mac and cheese)

The morphine-like effects of gluten and dairy on your brain

  • Very similar to narcotics
  • Elimination diet causes uncomfortable detox process
  • Can take a few days, several weeks
  • May experience fatigue, depression, abdominal pain, headaches
  • Feel better once body clear of damaging proteins

The substances patients abuse to treat pain

  • Prescription drugs
  • Over-the-counter drugs
  • Alcohol
  • Cigarettes
  • Recreational drugs (e.g.: methamphetamine, marijuana)

The symptoms of pain patients may experience due to gluten

  • Autoimmune issues
  • Intractable headaches
  • Psychological, emotional anguish

The data around opioid overdose in the US

  • 91 Americans die every day
  • 32,000 people die annually
  • Numbers likely much higher

How gluten sensitivity may lead to pain med addiction

  • Opioid receptors may be damaged, destroyed by gluten
  • Patient cannot absorb pain meds due to villous atrophy
  • Need stronger meds, higher dose

Common prescription meds for pain

  • Vicodin
  • Percocet
  • Morphine
  • Dilaudid

Why patients turn to heroin for pain relief

  • Less expensive to acquire
  • Easily accessible

How food can act as a ‘gateway drug’ to other addictions

  • Celiac disease causes nutrient deficiencies
  • Magnesium
  • Folic acid
  • B vitamins
  • D3
  • Addictions to alcohol, cigarettes, shopping, etc. seek to fill void
  • Eliminate gluten and heal intestines, addictions resolve

Why Nadine advocates a mass screening for celiac disease

  • HLA-DQ2, HLA-DQ8 gene carriers more susceptible to addiction issues
  • Identification can prevent opioid addiction

How ER departments treat alcoholics

  • Banana bag (liter of saline + multivitamin, thiamin, folic acid and magnesium sulfate)
  • Addresses nutrient deficiencies
  • Prevent the shakes, help patient detox gradually
  • Celiac disease may be underlying issue

The power of the microbiome

  • Tiny bacteria live in intestine
  • Dictate what we eat, drink through cravings
  • Communicate with brain (e.g.: yeast signals need for sugar)

The mental health issues caused by untreated celiac disease that may lead patients to self-medicate

  • Depression
  • Anxiety
  • Hallucinations
  • Schizophrenia
  • Bipolar disorder


“Here’s How a Key Part of the Opioid Legislation is Not Working” in the Boston Globe

“Gluten Sensitivity May Be a Misnomer for Distinct Illnesses to Various Wheat Proteins” in Scientific American

“John F. Kennedy’s Pain Story: From Autoimmune Disease to Centralized Pain” in Practical Pain Management

“Malabsorption of Opioid Medications” in Practical Pain Management

“The Opioid Effects of Gluten Exorphins: Asymptomatic Celiac Disease” in the Journal of Health, Population and Nutrition

Connect with Nadine: 



Contact via Email

‘Your Skin on Gluten’ on YouTube

Books by Nadine:

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

missing piece

21 Important Facts About Celiac Disease EP033

There are a number of misconceptions about celiac disease, even within the medical community! Despite a growing body of research to the contrary, many practitioners still believe celiac disease to be strictly a gastrointestinal issue with a just a few tell-tale symptoms. It’s time to get the facts, and today the Gluten Free RN shares 21 important truths about celiac disease that you need to know.

Nadine shares her take on the list compiled by Gluten Free Works, covering the truth about who is at risk, the wide variety of neurological symptoms a celiac patient might present, and the components of an optimal treatment plan. As the most common genetic autoimmune disease in the world, it is incredibly important that we understand how gluten exposure can damage the intestines and cause debilitating nutrient deficiencies.

Nadine also explains why celiac disease often goes undiagnosed and how an astute practitioner is able to accurately interpret biopsies, antibody screenings and lab work. Get familiar with these 21 important facts about celiac disease, and become your own advocate!

 What’s Discussed:

  1. Celiac disease is the most common genetic autoimmune disease in the world
  • Powerful as consumer group, ‘vote with dollars’
  • Purchasing fewer grains
  • More and more gluten-free products available
  • Choose grass-fed, no antibiotic/hormone meat
  • Look for local, organic, non-GMO produce
  1. Celiac disease is the most commonly misdiagnosed disease in the world
  • Patients often diagnosed with other disorders
  • Gluten-free diet necessary for symptoms to resolve
  1. Celiac disease blood tests are not pass/fail
  • Measure antibody levels
  • Suggest how likely intestinal biopsy will discover damage
  • 70% false negative
  • Anti-TG2 or IgA EMA antibodies indicate gut damage
  1. Celiac disease can affect any genetically predisposed person of every race of gender and can first present symptoms at any age
  • No one can be ruled out
  • HLA-DQ2, HLA-DQ8 indicate genetic predisposition
  • 30% of those diagnosed over age 60
  1. Optimal treatment of celiac disease includes a 100% strict gluten-free diet, nutrient deficiency identification and replenishment, and education and support that meet the physical and emotional needs of the patient
  • May need to eliminate dairy, soy, grains and legumes as well (anything that causes inflammation)
  • ‘Find your people’
  1. Most cases of unresponsive celiac disease are due to inadvertent gluten exposure, where the person is consuming gluten without realizing it
  • May not exhibit symptoms when exposed to gluten (airborne, via cross-contamination)
  • Have expert examine home environment to ferret out potential sources
  1. The average person with celiac disease has a normal body mass index
  • Traditionally thought to be underweight
  • Roughly 33% of celiac patients are overweight
  • Obesity indicates malnourishment (body’s attempt to store cheap energy)
  1. Silent celiac disease refers to a person who tests positive on blood test and villous atrophy on intestinal biopsy, but exhibits no overt symptoms
  • Roughly 50% of those diagnosed on screening exam would claim to have no symptoms
  • Astute practitioner recognizes warning signs
  1. Celiac disease presents submicroscopic damage causing nutrient deficiencies before villous atrophy
  • Damage can occur before endoscopy finds it
  • Marsh 1 damage is first stage, caused by gluten
  • Don’t wait for total villous atrophy (Marsh 4 damage) to adopt gluten-free diet
  • Ask knowledgeable practitioner to review biopsies, antibody screenings and lab work
  1. 50% of people diagnosed with celiac disease exhibit neurological symptoms at the time of diagnosis
  • Neuropathy (numbness or tingling in hands and feet)
  • Seizure disorders
  • Ticks (especially facial)
  • Bell’s palsy
  • Fasciculation of muscles
  • ‘Pins and needles’ in feet
  • Gastroparesis
  • Constipation (paralysis of intestines)
  1. Doctors consider celiac disease to be a gastrointestinal disease
  • Symptoms can be neurological
  • Medical professionals must be astute, recognize all 300 symptoms
  1. Anxiety can be the only symptom of celiac disease
  • Due to nutrient deficiencies
  • Irritability can be sign of gluten sensitivity
  1. Celiac disease tests are not pass/fail
  • Follow up testing should be performed if symptoms don’t resolve
  • ‘Seroconversion’ means can test negative one day, then positive two weeks later
  1. Patient education is the most important predictor of good clinical outcome in celiac disease
  • Find a practitioner to help develop diet for health/lifestyle
  • Pursue body work to repair damage, strengthen body
  1. Celiac disease symptoms can be completely different among family members
  2. Celiac symptoms number over 300, affecting every system and any organ
  1. Symptoms in celiac disease are due to inflammation and/or nutrient deficiencies from chronic intestinal damage
  • Gluten-free diet will heal intestines, eliminate inflammation
  • Requires time, energy and investment in best possible food
  1. Celiac disease diagnosis can take ten years or more from the time symptoms first present
  • Frequently last disease considered by doctors (in for-profit healthcare systems)
  • Countries with universal health care diagnose much more quickly
  1. Celiac disease affects over three million people in the US, yet the vast majority are not diagnosed
  • Symptoms considered definitive diagnoses, treated superficially
  • Type 1 diabetes
  • MS
  • ALS
  • Lupus
  • Sjögren’s syndrome
  • Anemia
  • Osteoporosis
  • Failure to thrive
  • Eating disorders
  • Underlying cause (celiac disease) left untreated
  1. Exposure to gluten is the most important environmental factor in celiac disease
  • Sooner gluten is removed, more likely to achieve full remission
  • If gluten is never introduced, celiac disease will never develop
  1. Although celiac disease is now known to cause over 300 symptoms, the medical community has traditionally instructed doctors that celiac disease affects children, presenting symptoms of diarrhea, wasting muscles, anemia, and abdominal distention
  • Be your own advocate


Recognizing Celiac Disease: Signs, Symptoms, Associated Disorders and Complications by Cleo J. Libonati

21 Important Celiac Disease Facts You Need to Know…

Gluten Free Works

Connect with Nadine: 



Contact via Email

‘Your Skin on Gluten’ on YouTube

Books by Nadine:

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

bakery bread

Why a Gluten Challenge is NOT Recommended EP032

You don’t have to prove to anyone that you have celiac disease proper. Because food functions as both medicine and poison, it is important to have all the facts before you get talked into a gluten challenge … and the fact is, going back on gluten after you have adopted a gluten-free diet will cause organ damage.

The Gluten Free RN speaks to the motivation behind doing a gluten challenge, the consequences for celiac and gluten sensitive patients, and her work as a patient advocate to discourage people from being talked into a gluten challenge. She offers a detailed risk versus reward analysis of braving a gluten challenge, explaining how the maintenance of a gluten-free diet prevents the development of celiac disease and other autoimmune disorders.

Nadine also covers the unreliable nature of celiac testing in the US, where the medical community lacks savvy in interpreting results, and explains why biopsy results are no longer considered the gold standard of celiac testing. Listen in to understand the recommended diet for those who have adopted a gluten-free lifestyle and why it requires a long-term commitment. Get armed with information and protect yourself and your family from the dangerous, irreversible consequences of a gluten challenge!

What’s Discussed:

The gluten free lifestyle

  • Involves long-term change
  • Can’t take days off

Why you should be cautious of restaurants with a gluten-free menu

  • Very few actually deliver gluten-free meal
  • Employees may not understand contamination, cross-contamination

The advantages of living in the Northwest US

Nadine’s recommendations re: food options

  • Organic produce
  • Grass-fed meat
  • Whole foods produced locally

The misguided reason why people do a gluten challenge

  • Want to prove presence of celiac disease
  • You don’t have to prove to anyone, especially if HLA-DQ2 or HLA-DQ8 gene carrier
  • 30-50% of population has genetic predisposition to celiac disease

The value of a gluten-free diet in preventative medicine

  • Averts celiac disease and associated issues
  • Prevents other autoimmune disorders
  • Type 1 diabetes
  • Lupus
  • Sjögren’s
  • Rheumatoid arthritis
  • MS
  • ALS

What it means to do a gluten challenge

  • Targets patients who have adopted a gluten-free diet
  • Requires they consume gluten (2-6 slices of bread/day)

The consequences of a gluten challenge on celiac and gluten sensitive patients

  • Seizures
  • GI bleeds
  • Appearance of bowel cancer, bone cancer
  • Inability to get out of bed
  • Organ damage

The risks vs. rewards of enduring a gluten challenge

  • No benefit other than proving presence of celiac disease
  • Can be thrown into refractory celiac disease (permanent, irreversible damage to intestines)

Why Nadine would never do a gluten challenge

Why biopsy results are no longer considered the gold standard of celiac testing

  • Often misinterpreted, read incorrectly
  • Damage can be patchy

Why an antibody panel can be unreliable in identifying celiac disease

  • Takes time for body to mount autoimmune response
  • 70% false negative nationwide

How long it takes to obtain celiac diagnosis

  • Two to three weeks in countries where medical community is savvy about celiac disease
  • Nine to 15 years in US

Nadine’s advice around celiac testing

The enduring nature of celiac disease

  • Doesn’t go away
  • Children don’t grow out of it

Nadine’s nutrition guidelines for celiac patients

  • Gluten- and dairy-free
  • Ideally Paleo
  • Nutrient dense foods

Nadine’s work as a patient advocate

  • Seeks to help people stay healthy, avoid illness/disease
  • Patients get lives back, active and thriving


Whole Foods

Natural Grocers

First Alternative Co-op

LifeSource Co-op

Cyrex Laboratories



Connect with Nadine: 



Contact via Email

‘Your Skin on Gluten’ on YouTube

Books by Nadine:

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


Celiac Disease for Health Care Providers EP031

Celiac disease is grossly underdiagnosed in the United States in large part because the medical community is operating on outdated information about the condition. And despite the recommendations of the National Institute of Health back in 2004, we have yet to implement a mass screening for celiac disease, and health care providers remain alarmingly uninformed.

The Gluten Free RN is taking steps to remedy the situation by sharing the basics for medical professionals. Today she covers the WHO’s definition of celiac disease, how our understanding of the condition has change over time, and some common misconceptions about celiac disease. She also explains the top symptoms, recommended testing for celiac disease and gluten sensitivity, and the neurological nature of the disorder.

Listen in to learn what health care providers need to know about this undiagnosed epidemic, the complex web of health issues that may result from undiagnosed celiac disease, and why it is important to have a high index of suspicion and include celiac testing on every differential diagnosis. Help your patients go gluten-free and collect something other than autoimmune disorders!

What’s Discussed:

The standard of care in the US

  • Providers should have diagnosed at least 1% of patients with celiac disease
  • Undiagnosed for 70 years, must overcome to prevent further pain and suffering

The goals of Nadine’s consulting business

  • Works with facilities to protect celiac patients
  • Ensure compliance with ADA

How the media portrays the gluten-free lifestyle

  • Dissuades people from adopting diet (program sponsors influence messaging)
  • Negative headlines

How our understanding of celiac disease has changed over time

The recommendations of the 2004 NIH consensus meeting regarding celiac disease

  • Mass screening (meets WHO criteria)
  • Education for health care providers

The World Health Organization criteria for mass screening

  • Early clinical detection essential
  • Condition is common
  • Screening tests highly sensitive and specific
  • Effective treatment available
  • Untreated condition leads to complications

The autoimmune disorders associated with undiagnosed celiac disease

  • MS
  • Type 1 diabetes
  • Lupus
  • Rheumatoid arthritis
  • Sjögren’s
  • Vitiligo

The WHO definition of celiac disease

  • Characterized by hypersensitivity to gluten
  • Prevalence currently estimated at 1:1,000 worldwide
  • Screening trials suggest prevalence of 1:100
  • Results in weight loss, diarrhea, nutritional deficiencies
  • Caused by villous atrophy
  • May present as extraintestinal manifestations or remain clinically silent

Why celiac disease can’t be ruled out with a single test

  • Can be triggered at any point
  • HLA-DQ2 and HLA-DQ8 genes indicate genetic predisposition

Misconceptions about celiac disease in the US medical community

  • Thought to be digestive disorder, but really neurological
  • Can present with seizures, numbness, constipation, balance issues, celiac cerebellar ataxia

How skin issues are a reflection of what is going on internally

  • Epithelial skin is same tissue as inside

How damage to the small intestine leads to multiple health issues

  • Increased permeability of intestinal wall
  • Leaky blood brain barrier
  • Leaky blood vessels
  • Leaky lungs and skin

The classic symptoms of celiac disease

  • Chronic diarrhea
  • Malabsorption
  • Extreme weight loss
  • Malnutrition

What celiac disease looks like in children

  • Diarrhea, constipation
  • General abdominal pain
  • Failure to thrive
  • Falling off growth chart
  • Short stature
  • Learning disabilities
  • Autism
  • Skin issues (eczema, cirrhosis, acne)
  • Delayed puberty
  • Dental problems
  • Anorexia, obesity
  • Bed wetting

The prevalence of celiac disease in older adults

  • 30% of people diagnosed with celiac disease are over 60

Potential signs of celiac disease in the aging population

  • Dementia
  • Alzheimer’s
  • Vision, hearing loss
  • Urinary problems
  • Cancer diagnosis (especially bowel cancer)
  • Ataxia
  • Arthritis
  • Hair loss
  • Fatigue
  • Osteoporosis
  • Anemia

The elements that get into your blood stream as a result of villous atrophy

  • Toxins
  • Heavy metals
  • Undigested food particles
  • Yeast, fungus
  • Parasites, other harmful bacteria

Top symptoms of celiac disease

  • Chronic anemia
  • Fatigue
  • Muscle, joint pain
  • Depression, irritability
  • Thyroid disorders
  • Infertility issues
  • GI problems (from mouth to rectum)
  • Migraine headaches
  • Psychiatric disorders
  • Seizures
  • Dermatitis herpetiformis
  • Down, Turner or Williams syndrome
  • Cardiomyopathy

The effects of gluten on the brain

  • Anger
  • Depression, anxiety
  • Learning disabilities
  • Lethargy
  • Insomnia
  • Brain fog
  • Schizophrenia
  • Dyslexia

Populations affected by celiac disease

  • Any age, race, gender
  • 3 million people all over the world
  • Study of healthy blood donors in Mexico found unexpectedly high prevalence of tTGA positivity
  • Now recognized as common disease among Middle Eastern and North African populations
  • 1:7 Americans suffer from non-celiac gluten sensitivity (43 million people)

The findings of an economic study by Columbia University

  • Non-diarrheal presentations now most frequent
  • Celiac disease grossly underdiagnosed in US
  • Average delay in diagnosis is 4-11 years for adults in North America
  • Significant improvement in quality of life when patients diagnosed and treated appropriately

The importance of ensuring that medications are gluten-free

Nadine’s recommendations around nutrition for celiac patients

  • Gluten- and dairy-free
  • Ideally Paleo
  • Super-good high fat

Things to consider re: the results of a celiac panel

  • A positive test guarantees intestinal damage
  • Include total IgA and IgG
  • 70% produce a false negative

Additional tests that offer valuable information

  • Fecal fat score (ask for #, over 300 indicates malabsorption)
  • Complete blood count
  • Comprehensive metabolic panel
  • Vitamin D3 level (below 40 ng/ml is critically low)
  • Vitamins A, E & K levels
  • Vitamin B6 & B12 levels
  • MTHFR gene test
  • Magnesium RBC test
  • Zinc level
  • Iodine level
  • B9/Folate level
  • Ferritin level
  • Iron level
  • Thyroid panel
  • Bone density test
  • Lipid panel
  • ANA test (autoimmune issues)
  • ESR test
  • CRP test

Surprising facts around celiac disease contrary to conventional wisdom

  • Only 15% of celiac patients have chronic diarrhea
  • 39% of celiac patients are overweight
  • Shampoos, cosmetics and airborne gluten affect patients with gluten intolerance and celiac disease
  • Super-good high fat diet is essential for celiac patients


NIH Consensus Statement

“Where Have All the American Celiacs Gone?” in Acta Pediatrica

Montana Gluten Free

“Economic Benefits of Increased Diagnosis of Celiac Disease in a National Managed Care Population in the United States” in the Journal of Insurance Medicine

“Celiac Disease Could be a Frequent Disease in Mexico: Prevalence of Tissue Transglutaminase Antibody in Healthy Blood Donors” in the Journal of Clinical Gastroenterology

“Celiac Disease in Middle Eastern and North African Countries: A New Burden? in the World Journal of Gastroenterology

Recommended Labs

CDC 2013 Report Antibiotic Resistance Threats

Cyrex Laboratories




Primal Docs

Connect with Nadine: 



Contact via Email

‘Your Skin on Gluten’ on YouTube

Books by Nadine:

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

SIBO diagram

Small Intestinal Bacterial Overgrowth and Celiac Disease EP030

Nobody wants bad bacteria, parasites, yeast or food particles hanging around their small intestine! There are a number of causes of small intestinal bacterial overgrowth (SIBO), and undiagnosed celiac disease just happens to be one of them.

The Gluten Free RN is prepared to discuss the complexity of health issues celiac patients must resolve after going on a gluten free diet, one of which may be SIBO. She shares the symptoms of small intestinal bacterial overgrowth, how we test for SIBO, and potential treatments for the condition. Listen in to learn how foods and medication affect the microbiome and alter the environment of your intestines.

What’s Discussed:

The complexity of healing once a celiac patient goes gluten free

  • Very rarely does diet change heal all associated disorders
  • Other issues like SIBO must be treated once intestines heal

The causes of irritable bowel syndrome

  • Thought to be caused by stress
  • Studies now show food poisoning may be trigger

How food, drink and medication affect your intestines

  • Certain food/drink can move in bad bacteria, push out good
  • Antibiotics change pH of stomach acid
  • Bacteria, parasites, yeast and food particles get into small intestine

The consequences of damaged villi due to undiagnosed celiac disease

  • Compromised immune system
  • Inflammation
  • Body can’t absorb nutrients

The process of healing your intestines

  • Takes six months to a year
  • Must eliminate all foods that cause inflammation (gluten, dairy, soy, etc.)
  • After villi heal, deal with additional health issues (i.e.: SIBO)
  • Villi MUST grow back before good bacteria can return

The symptoms of SIBO

  • Gas, bloating
  • Abdominal pain
  • Diarrhea
  • Constipation

How to test for SIBO

  • Consume sugary drink, then breathe into tube
  • Hydrogen sulfate associated with diarrhea
  • Methane connected to constipation
  • Gives snapshot of what is happening in intestines

How SIBO is treated

  • Antibiotics (rifaximin)
  • Herbs (i.e.: oregano oil, berberine, neem)
  • Fecal microbial transplant

Risk factors for SIBO

  • Any course of antibiotics
  • Diabetes
  • Bowel surgery
  • Crohn’s disease
  • Undiagnosed celiac disease


Primal Docs

SIBO Info Website

“Small Intestinal Bacterial Overgrowth: A Comprehensive Review” in Gastroenterology and Hepatology

Connect with Nadine: 



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 Health Activism


spleen -

Celiac Disease and Your Spleen EP029

Did you know that the spleen plays a leading role in a properly functioning immune system? As the largest organ in your lymphatic system, the spleen spends its time fighting infection and keeping you healthy. Unfortunately, research points to a connection between disorders of the spleen and celiac disease. And if your immune system is already compromised because of gluten damage to your intestines, a spleen issue leaves you at heightened risk for a variety of infections and autoimmune diseases.

Today the Gluten Free RN shares her personal connection to genetic spherocytosis and how spleen damage affected her family. She also covers several studies that document the correlation between spleen issues and celiac disease. Listen in to understand how your spleen functions, the symptoms of spleen disorder, and the autoimmune diseases you may develop if your spleen is damaged or removed.

What’s Discussed:

How your spleen works to keep you healthy

  • Filters used/damaged red blood cells
  • Harvests iron to recycle
  • Produces antibodies, white blood cells
  • Fights infection
  • Vital to immune system

Conditions you may acquire if spleen is damaged (increased risk)

  • Pneumonia
  • UTI
  • Overwhelming sepsis

Instances in which spleen may be enlarged

  • Mononucleosis
  • Some bacterial infections, metabolic disorders
  • Liver diseases
  • Some blood cancers, lymphoma
  • Blood clots in veins of liver, spleen

Symptoms of spleen issues

  • Pain in upper left quadrant
  • Fatigue
  • Anemia
  • Bruise easily
  • Bloated

The correlation between genetic spherocytosis and celiac disease

  • As high as 88% in some studies

How the ratio of spleen diameter to RDW can indicate celiac disease

  • Two-thirds of celiac patients in study had elevated red blood cell distribution width
  • Small spleen in 80% of celiac patients
  • Spleen diameter to RDW ratio under 6 had 88.5% specificity in predicting celiac disease

Why patients with hyposplenism should get tested for celiac disease

  • 25-75% of celiac patients have hyposplenism
  • Look for red blood cell abnormality
  • HLA-DQ2 and HLA-DQ8 genes indicate predisposition for celiac disease
  • Antibody test available from EnteroLab or Cyrex Laboratories
  • Ask for total IgA, IgG

Other autoimmune diseases patients with hyposplenism may develop (increased risk)

  • Type 1 diabetes
  • Lupus
  • Sjögren’s syndrome
  • Vitiligo
  • Raynaud’s
  • Autoimmune thyroiditis
  • ALS, MS, any demyelination of nervous system
  • Idiopathic thrombocytopenia
  • Autoimmune hepatitis

Nadine’s recommendations around nutrition

  • Local, organic
  • Nutrient dense
  • Gluten-free, Paleo

The link between hyposplenism and autoimmune manifestations of celiac disease

  • Autoimmune disorders may cause splenic hypofunction or vice versa
  • Study hypothesizes that higher risk for splenic function in celiac patients may be related to celiac disease rather than autoimmunity
  • Prevalence of celiac disease-associated hyposplenism increased from 19% in uncomplicated patients to 59% in those with autoimmune disorders

Why celiac patients may not benefit from iron supplements, infusions

  • Damaged intestines cannot absorb iron
  • Damaged spleen destroys healthy red blood cells


“Ratio of Spleen Diameter to Red Blood Cell Distributions Width” in Medicine (Baltimore)


Cyrex Laboratories

“Is it Worth Investigating Splenic Function in Patients with Celiac Disease?” in the World Journal of Gastroenterology

“Hyposplenism in Gastrointestinal Disease” in Gut BMJ

“Hyposplenism, Adult Coeliac Disease, and Autoimmunity” in Gut BMJ

“Splenic Volume Differentiates Complicated and Non-Complicated Celiac Disease” in UEG Journal

Connect with Nadine: 



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 Health Activism

The Relationship Between the Respiratory System and Celiac Disease EP028

The average human takes between 14 and 20 breaths per minute. But if you are conscious of those breaths, that’s a problem. Perhaps you’re experiencing chest tightness, clogged sinuses or a nagging cough that make you very aware of every breath you take. If so, the ingestion of gluten may be a contributing factor to these respiratory issues.

Today Nadine explores the relationship between the lungs and celiac disease, offering anecdotal evidence as well as explaining the way that inflammation can lead to a number of respiratory problems. Because 70-90% of your immune system is housed in your intestines, it is no surprise that a leaky gut could make you more vulnerable to respiratory tract infections.

Despite the fact that current literature considers respiratory challenges to be an atypical presentation of celiac disease, the Gluten Free RN argues that there is enough anecdotal evidence to merit further study. Listen in to understand the vitamin deficiencies that likely contribute to respiratory issues, how those health concerns might be corrected by going gluten-free, and why your body heals more quickly on a high fat, whole food diet. It’s time to go gluten-free and breathe easy again!

What’s Discussed: 

How gluten ingestion likely affects the respiratory system

  • Body keeps fluids separate unless tissues leaky
  • Gluten alters epithelial tissue, including that of lungs

Nadine’s anecdotal evidence of a connection between gluten and respiratory issues

  • Fellow nurse had lung removed as child
  • Always needed inhalers
  • Went gluten-free with Nadine
  • Inflammation in lungs cleared, asthma gone
  • No longer needed inhalers

Respiratory issues that may be corrected on a gluten-free diet

  • Anemia (lack of red blood cells to carry oxygen causes shortness of breath with minimal exertion)
  • Recurrent respiratory infections
  • Cystic fibrosis
  • COPD
  • IPH (bleeding lung)
  • Pulmonary edema

Vitamin deficiencies caused by gluten ingestion that lead to respiratory problems

  • Vitamin K deficiencies initiate easy bruising, nose bleeds and bleeding lung

Why going gluten-free eliminates many respiratory issues

  • Gluten causes inflammation (-itis = inflammation)
  • Removing the cause heals intestines, repairs immune system
  • Patients operate on a higher level

Common symptoms of respiratory issues

  • Difficulty breathing
  • Chest tightness
  • Nagging cough
  • Clogged sinuses
  • Post-nasal drip

Nadine’s recommendations around diet and nutrition

  • Gluten- and dairy-free at a minimum
  • Ideally variation of Paleo diet
  • Whole foods (meat, fish, eggs, fruits, vegetables, nuts and seeds)
  • High fat (body needs to absorb fat-soluble nutrients – A, D, E & K)
  • Maintain Gluten Zero (takes six months to a year for intestinal villi to heal)

Why your body heals more quickly on a high fat, whole food diet

  • Body knows how to break down, utilize nutrients
  • Fat-soluble vitamins repair connective tissue, leaky gut

The genes that indicate a predisposition for celiac disease

  • HLA-DQ2
  • HLA-DQ8


“Hemoptysis in Patients of Celiac Disease with Disproportionately Severe Anemia” in Multidisciplinary Respiratory Medicine

“A Case of Cough, Lymphocytic Bronchoalveolitis and Coeliac Disease with Improvement Following a Gluten Free Diet” in Thorax

“Respiratory Symptoms as Atypical Manifestation of Celiac Disease” in the Pediatric Oncall Journal

“Recurrent Rhinitis and Pulmonary Infections Revealing Celiac Disease” in Revue de Pneumologie Clinique

“Pneumococcal Septic Shock in the Setting of Hyposplenic Celiac Disease” in Hospital Physician

Coeliac Australia: Associated Conditions

Connect with Nadine: 



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 Health Activism


Type 1 Diabetes and Celiac Disease EP027

Struggling to maintain control of your blood sugar? A gluten-free diet may be the answer! If you have one autoimmune disorder, you have a 30-50% greater risk of developing another, and both type 1 diabetes and celiac disease fall into that category.

As more and more research points to an enormous overlap between type 1 diabetes and celiac disease, it is in our best interests to mitigate additional risk by getting screened and/or adopting a gluten-free or Paleo diet to mitigate further risk. Today Nadine discusses the prevalence of diabetes, several research studies that explore the connection between type 1 diabetes and celiac disease, and the potential risks for type 1 diabetics who are undiagnosed celiac patients.

Listen and learn how your diet may be affecting your blood sugar and why going gluten-free could improve your health and quality of life!

What’s Discussed: 

The prevalence of diabetes

  • By 2050, half the population will have diabetes
  • According to CDC, 29.1 million have diabetes
  • One out of four don’t know they are diabetic
  • 18,000 young people diagnosed from 2008-2009

The difference between type 1 and type 2 diabetes

  • Minimize risk for type 2 through diet and exercise
  • Type 1 is autoimmune disorder, don’t produce enough insulin to break down sugar

Symptoms of type 1 diabetes

  • Extreme thirst
  • Urgency to urinate frequently
  • Fatigue
  • Weakness

The enormous genetic overlap between type 1 diabetes and celiac disease

  • Scottish study found 94% of type 1 diabetics were HLA-DQ2 or HLA-DQ8 gene carriers
  • 100% overlap if include HLA-DQ2.2
  • Prevalence of celiac disease among type 1 diabetics is 20% higher than general population

The importance of testing all type 1 diabetics for celiac disease annually

  • Can develop celiac disease at any age

The consequences of undiagnosed celiac disease in children with type 1 diabetes

  • Short stature
  • Failure to thrive
  • Early onset osteopenia, osteoporosis
  • Easily broken or rubbery bones
  • Difficulty maintaining glycemic control (low blood sugar, spikes)
  • Anemia

The decreased quality of life for type 1 diabetics who are undiagnosed celiac

  • Development of infections
  • Difficulty with blood sugar maintenance

Research studies re: the percentages of type 1 diabetics who also have celiac disease

  • Iraq – 11.2%
  • Mexican participants – 5.9%
  • Denmark – 12.3%

Nadine’s anecdotal evidence of the overlap

  • Volunteers at community outreach clinic
  • Young man struggling to control blood sugar
  • Nadine recommended gluten-free diet
  • Improved health and quality of life

Health risks associated with an inability to control blood sugar

  • Blindness
  • Kidney failure
  • Amputation of extremities
  • Difficulty healing wounds
  • Heart attacks
  • Strokes

Why carb counting doesn’t control blood sugar

  • Carbs with little/no nutrient value cause spikes in blood sugar

The diet Nadine recommends for type 1 diabetics

  • Variation of Paleo diet
  • Nutrient dense foods
  • Meat and fish
  • Eggs
  • Fruits and vegetables
  • Nuts and seeds

The benefits of a gluten-free diet for type 1 diabetics

  • Weight easier to control
  • Immune system works better
  • Tighter control on blood sugar

The lack of uniformity in screening guidelines

Additional autoimmune diseases that may be avoided with a gluten-free diet

  • Multiple sclerosis
  • Lupus
  • Sjögren’s
  • Scleroderma
  • Autoimmune thyroiditis
  • Graves’ disease
  • Hashimoto’s
  • Vitiligo
  • Raynaud’s

Potential triggers for autoimmune disorders

  • Gluten
  • Change in microbiome
  • Stress to body (i.e.: cold, food poisoning, travel)

 Treatments for small intestinal bacterial overgrowth

  • Low FODMAPs or specific carb diet
  • Rifaximin (antibiotic)

The dangers of maintaining high blood sugar

  • Damage to kidneys, eyes, capillaries, fingers and toes
  • Neuropathy
  • Gastroparesis

The long history of a connection between type 1 diabetes and celiac disease

The need for information re: the connection in diabetic education services


“Type 1 Diabetes and Celiac Disease: The Effects of Gluten Free Diet on Metabolic Control” in the World Journal of Diabetes

“Co-occurrence of Type 1 Diabetes Mellitus and Celiac Disease” in the World Journal of Diabetes

“Screening for Coeliac Disease in Adult Patients with Type 1 Diabetes Mellitus: Myths, Facts and Controversy in Diabetology & Metabolic Syndrome

“The Prevalence of Coeliac Disease in Libyan Children with Type 1 Diabetes Mellitus” in Diabetes Metabolism Research and Reviews

“Type 1 and Type 2 Diabetes in Celiac Disease: Prevalence and Effect on Clinical and Histological Presentation” in BMC Gastroenterology

“Coexistence of Coeliac Disease and Type 1 Diabetes” in Przeglad Gastroenterologiczny

“Screening for Celiac Disease in Type 1 Diabetes: A Systematic Review” in AAP News and Journals

Connect with Nadine: 



Contact via Email

‘Your Skin on Gluten’ on YouTube

Books by Nadine:

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

newspaper - Daria-Shevtsova

Celiac Disease and the Media EP026

The gluten-free movement is often dismissed in the media as a fad. Even so-called experts actively discredit the gluten-free diet and apply a negative connotation to terms like PWAG. Have you ever wondered why there is so much misinformation about celiac disease and non-celiac gluten sensitivity in the media? And who sponsors the coverage that dissuades people from going gluten-free?

Today, Nadine explains how the big business of wheat affects which voices we hear in media treatment of the gluten-free movement. In addition, she covers how the for-profit healthcare system in the US affects the timely diagnosis of celiac disease and non-celiac gluten sensitivity.

Celiac disease is a medical, social and economic issue with political implications. Listen and learn how to choose high quality, nutrient dense foods, and leverage your power as a gluten-free consumer!

What’s Discussed:

Misinformation in the media

  • Some coverage dissuades from adopting a gluten-free diet
  • Program/print sponsors may be corporations that depend on people eating wheat
  • Wheat/grain industry threatened by rise of gluten-free diet (33% of people in US and Canada on variation of gluten free diet)

The illusion of options in the area of food production

  • 8-10 corporations own nearly every food company
  • Nadine patronizes farmer’s markets, co-ops and local companies

Nadine’s rules for buying food products

  • Label must be clear, easy to read
  • Five or fewer ingredients
  • Must be able to picture each ingredient

The importance of reading labels

  • May be gluten in products that are typically gluten-free (i.e.: pesto, kombucha)
  • Companies are given six months to update labels after making changes
  • Barley and rye are not on list of allergens

Nadine’s story

  • Multi-system organ failure
  • Negative test for celiac disease despite being homozygous gene carrier
  • Healed quickly on a Paleo diet

Why countries with universal healthcare take celiac disease seriously

  • Early diagnosis saves money
  • Finland: 70% of people w/ celiac disease have been diagnosed
  • Italy, UK and Canada: 30-40% have been diagnosed
  • US: Less than 1% of those with celiac disease have been diagnosed

How long it takes to be diagnosed with celiac disease (for-profit vs. universal systems)

  • US: 9-15 years
  • Italy: 2-3 weeks

How doctors/experts discredit gluten-free as a fad

  • Use PWAG as derogatory term
  • Placebo effect
  • Nocebo effect (expect to feel poorly)

The inaccuracy of blood tests for celiac disease

  • 70% false negative

How companies profit from undiagnosed celiac patients

  • Products geared toward people with health issues (i.e.: compression socks, hypoallergenic sheets)

The prominence of wheat as a publicly traded commodity

  • Top export of US/Canada

The health risk associated with genetically modified wheat

The benefits of a gluten-free diet

  • Symptoms resolve
  • No longer need medicine, surgery

Nadine’s advice re: selecting gluten-free products

  • Avoid nutrient deficient gluten-free options (cheap fillers, empty carbs)
  • Focus on high quality, nutrient dense foods

How to leverage your power as a gluten-free consumer

  • Hold food producers accountable (standards, production methods)
  • ‘Vote carefully with your dollar’
  • Speak up when you see inaccurate media coverage

Why you cannot assume that gluten-free menu items are truly free of gluten

  • Uneducated restaurant staff
  • Possibility of contamination, cross-contamination

What a ‘gluten free’ designation means in labeling

  • GIG certification indicates less than ten parts per million
  • Standard in US/Europe is less than 20 parts per million

The Gluten Free RN mission

  • Educate people globally about celiac disease and non-celiac gluten sensitivity
  • Empower people to improve their health and quality of life with food


Food Company Infographic

Gluten Intolerance Group

Connect with Nadine: 



Contact via Email

‘Your Skin on Gluten’ on YouTube

Books by Nadine:

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