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

Baking Recommendation

Recently here at the Gluten Free RN, we purchased Annalise G. Roberts Gluten-Free Baking Classics. We have quite a collection of gluten free cookbooks so it remained on a shelf until a special occasion gave me cause to pull it down and take it home. The assignment- make a gluten free birthday cake for my younger sister that is so good, no one will be able to tell it apart from “normal” cake.

I settled on a yellow cake that would make a nice double round recipe and set to work. A nice brown flour mix Ms. Roberts uses yielded cake batter unlike any other gluten free batter I had yet tasted. Sweet, no aftertaste, delectable. Upon baking, it rose to a normal cake height and sprung back when pressed. Topped with a simple chocolate frosting, it was the hit of the party. Not a person at our birthday celebration could tell it was gluten free, and most were excited when they found out it was.

The next morning, inspired by the yellow cake, I set to work. The same brown rice blend was used for breakfast crepes. A person would be hard pressed to tell the difference from normal crepes. They folded easily without the least bit of crumply texture found in some gluten free products. I stuffed them with left over potatoes, cheese and salsa and wolfed them down before heading back to the kitchen.

Next was a bread recipe. I tried the simple white bread, putting it in my bread machine where I am sure it did not rise to its full potential. The taste however, was again marvelous with an actual crust surrounding the outside crispy and brown. I tried it one more time in the oven as the recipe actually suggests. The top was just beginning to peak the top of the bread pan when I pulled it out. It was to my horror that I discovered it was not yet done and watched it quickly delapitate before my very eyes. The bread can most certainly be done, unfortunately, someone much more experienced at bread making than myself is going to need to try it.

Without losing hope, I switched to a brownie recipe. An avid chocolate lover I could not resist adding in an extra cup of chocolate chips. The brownies were chewy, dense and a chocolate lovers heaven. Similar, if not better than my pre-celiac diagnosis brownie recipe. The brownies lasted a day in my household before being devoured.

Entrigued by the “captivating chocolate chip” comment on the front of the book, I set out to prove it. Opening the oven half way through baking showed what appeared to be a melted mess. However, five minutes later the goo had turned into real cookies. The result left me delighted as my previous chocolate chip cookie recipe had always been flat and chewy as well.

Last but not least was a cornbread recipe. My father, who does not eat gluten free, proclaimed it was the best cornbread he had ever eaten.

I have yet to find a recipe that does not work from this book. If you are new to gluten free, or even if you are just looking to perfect a gf baking recipe, I suggest you check out Annalise G. Roberts Gluten-Free Baking Classics.


The Best “Bang for Your Buck” Cookbook!

Tammy Credicott of Bend, Oregon recently released the cookbook The Healthy Gluten Free Life  – By far this is the best, biggest cookbook we have ever had in the office. It is chalk full of delicious recipes that are free of gluten, soy, dairy, and eggs. After hearing Nadine rave about Tammy’s cooking, I could not wait to get this cookbook home! The hardest decision was deciding what I wanted to make first… everything looked so good!

Flipping through the cookbook there were a few things that stood out to me…

  1. The photos! I love that every recipe is accompanied by a beautiful photo, really who wants to look at a bunch of words?!
  2. All of the recipes use nutrient dense flours! Tammy’s motto is to “make every bite count” and she does a wonderful job of using flours like; sorghum, millet, teff, and amaranth to make every recipe packed full of nutrients. This can unfortunately be rare with gluten free recipes, so I really appreciate the time and work Tammy put into making sure every recipe was not only delicious but also healthy.
  3. The index, oh the index! I think that every cookbook should be as well organized and accessible as this one. First everything is color coordinated which rocks… Then the index is organized by pictures, categories, and there is another index to find recipes by name. Instead of spending ten minutes finding a recipe I can spend more time deciding what to make!
  4. The recipes! There are over 200 recipes in this cookbook and to be honest I have yet to find one that doesn’t look amazing!

Last night I decided to give the blueberry muffin recipe a shot – To be honest I am not the best baker, and I often just hope that my baked goods will turn out. If I do crave gluten free baked goods I usually head over to Eats and Treats Cafe and buy some of their already made gluten free deliciousness. But…. I had faith in myself and gave this recipe a shot!

The recipe called for several different flours, I got the sorghum and millet from Big River Grains which is an awesome local gluten free grain company here in Corvallis, Oregon. If you haven’t tried them yet, I suggest you do. They are one of the very few grain companies that I trust and I have never been disappointed in their products.

The first thing I noticed about this recipe is how it was organized. The wet and dry ingredients were already separated for me, and all of the instructions were short concise and clear… maybe this was a muffin recipe I could accomplish! First I mixed all of my dry ingredients, then whisked my wet ingredients…

Next I whisked everything together and folded in my blueberries, which I got from the lovely Sunset Valley Organics Company. I popped them in the oven for about 25 minutes and out came these beautiful muffins! And… They were AMAZING! Not to mention my picky hubby absolutely loved them!

Thank you Tammy for all the hard work and time you put into this book – We can’t wait until your next cookbook!

– Sam


Paleo Indulgences Review

Tammy Credicott has done it again!

After months of eating our way through The Healthy Gluten Free Life, Tammy Credicott has come out with yet another extraordinary cookbook. Paleo Indulgences is filled with both savory and sweet Paleo recipes that are sure to satisfy the entire family.

Tammy and her husband Cain were actually the first ones to educate the Gluten Free RN office about the benefits of a Paleo diet. Over 18 months ago their words of wisdom helped us get started on our Paleo journey. We have not only had huge strides in our health, we have gone on to help others discover the benefits of eating whole real food. So, we were extremely delighted to receive our copy of Paleo Indulgences at the office.

We usually eat about 80-90% Paleo, eating as much grass fed beef and farmer’s market produce as we can. However, every once in awhile we do still enjoy our gluten free, dairy free baked goods. When we do decide to indulge it is always a bonus if those treats are not only dairy and gluten free but also grain, soy, and sugar free. This is where Paleo Indulgences comes in. It is chalked full with tons of Paleo friendly treats along with an abundance of savory recipes.

Paleo Indulgences is just as beautiful and remarkable as The Healthy GF Life:

  • The introduction gives a fantastic brief but thorough overview of what a Paleo diet entails and a run down on protein, fats, sweeteners, grains, etc.
  • The organization is amazing, from a picture table of contents to an ingredient index. Every recipe book needs to take note of Tammy’s genius organization techniques.
  • The photos are striking. I personally cannot stand when cookbooks do not have pictures. Paleo Indulgences includes a stunning photograph to go with every recipe… I have spent a good amount of time drooling over them.
  • This is not just another meat and broccoli Paleo cookbook. All of the recipes are unique and creative.

The recipes I have tried so far are the Slow-Cooker BBQ Beef, the Mandarin Chicken, and the Lemon Poppy Seed Muffins. Everything has turned out incredible and I can’t wait to enjoy the rest of the book.

If you are new to Paleo, a Paleo connoisseur, or even if you haven’t crossed the Paleo path, get this cookbook. You will NOT be disappointed.

Thanks Tammy once again, for keeping us happy, healthy, and full!


YOUR Gluten Free Story

Please share your story with us…

Our goal is to spread the word of the many faces of Celiac Disease/Gluten Intolerance. In order to do this we need the stories of those who have achieved a healthy life through a gluten free diet. Please be specific, but do not share anything that you would not be comfortable sharing with the world. We would like to use these stories on the Gluten Free RN’s website and possibly compile them into a book. By giving us your story you are acknowledging that we may publish it. Stories have the ability to remain anonymous, if you would prefer. Please include:

  • Your related symptoms and conditions
  • If you received any other health care treatment in the past (effective or not)
  • When you started a gluten free diet
  • Whether symptoms resolved

Remember, there are over 300 health conditions that have been associated with Celiac Disease. If you have been diagnosed with something in the past that you did not know was related, there is a good chance it might have been.

Please submit your story through the website or by mail to:

The Gluten Free RN
215 SW 4th Street
Corvallis, Oregon 97333

Thank you for your story. With your help, we can spread awareness of this common autoimmune condition not only within the healthcare community, but throughout the nation.


Chloe Marie: The Amazing Gluten Free Dog

Five years ago when I began looking for a dog I knew I had found the right one when I found Chloe.  She was adorable, energetic, and best of all cross-eyed.  Chloe seemed to be the perfect dog. However, I was unaware of the many vet trips we would take over the next few years.

Chloe’s first trip to the vet occurred only four months after her coming into my home.  To my surprise when I got home from school Chloe had several puke piles around the house, and her stomach was so bloated she looked like a doggy balloon.  Knowing something was definitely wrong I grabbed Chloe, lifted her into the car, and drove her straight to the emergency vet.  Although it was clear she was in pain, she laid on the vet office floor looked up at me with her beautiful eyes and wagged her tail.  It was that moment that I knew I would do whatever it takes to save her.  After a brief examination the vet informed me that Chloe had a gastric torsion.  Essentially she had gotten sick, and started puking so heavily that her stomach twisted.  Chloe had to have emergency surgery.

After Chloe recovered from her surgery she seemed to have little to no problems.  Over the next couple of years she was a really happy dog.  She loved running, swimming, and playing with other dogs. I did however have some small concerns about Chloe’s overall health.  She had occasional diarrhea, a stomach rash, and she always had trouble putting on weight.  Being the overprotective mom I am, I called the vet with questions at every slight chance of illness, and I brought Chloe in for all of her routine check ups. When I mentioned my concerns to the vet he had reasonable explanations for every problem. Her rash was from her surgery, her weight was her breed, and the diarrhea he felt could be worms. He gave me medication for the worms and told me to call with any other concerns.  Over the next few years Chloe’s health was about standard.  She occasionally had some joint pain but other than that she was fine.

It wasn’t until last year that I realized something was seriously wrong with Chloe.  Over the last year my husband and I had noticed her mood, and energy starting to rapidly decrease.  We just assumed it was her age.  We knew she was about 5, and that large breed dogs typically didn’t live long.  Then we noticed every morning Chloe’s dog bed would be soaking wet with urine.  We took her to the vet and without running any tests he let us know that she was going through a hormonal imbalance, and he gave us some medication to give her and sent us on our way.

For a while after the vet visit, everything seemed to be going fine. Chloe would still occasionally wet the bed, and her mood was still decreasing, but we just figured it was something we would have to deal with.  Then about two months ago my husband and I noticed a rapid change in Chloe’s physical appearance and mood.  She was extremely thin, she wouldn’t eat, and she was so fatigued she could barely get off the couch.  After watching her for a few days we took her back into the vet for some answers. The vet examined Chloe and expressed his extreme concerns for her health.  He said she seemed anemic.  She had developed small skin tumors, she was lethargic, and he was concerned about internal tumors.  He drew her blood, gave her a cortisone shot, and sent us home with steroids.  The next day he diagnosed Chloe with an autoimmune disease, and told us to prepare for the worst. He let us know that her mood might get better with the steroids, but we could be in for a long road ahead and that it was quite possible her time was up.

Now to most Celiac patients, Chloe’s symptoms probably sound familiar. She had diarrhea, a rash, she was skinny, lethargic, bladder problems, and now an autoimmune disease.  Not knowing any better I figured she was just a dog who had health issues, and I prayed that she would get better. I expressed my concerns for Chloe with Nadine and she recommended I put her on a gluten free diet. She pointed out the similarities between Chloe’s illnesses and celiac disease, and finally made a connection I couldn’t.

Chloe has been off of her steroids and gluten free for over one month now and she has more energy than she knows what to do with. We no longer have bed wetting problems, her energy is back, her coat is shinier, and for the first time in a year she wants to go for runs and play with other dogs.

Gluten free for your beloved pet
Gluten intolerance and celiac disease have been proven to be prevalent in canines. Unfortunately due to the wide variety in symptoms, it is not something that veterinarians often recognize.  Luckily there are great resources on the web for information involving pets and gluten intolerance.  Below we have attached some fantastic articles that will help you decide if a gluten free diet is right for your animal.

Cross contamination
When deciding to put your dog on a gluten free diet, please consider the cross contamination issues that come into play with keeping gluten filled dog food in your home. It only takes a single breadcrumb to trigger an autoimmune reaction in a celiac patient.  If you decide to keep your dog on a gluten diet consider wearing gloves, or washing your hands after feeding them.

Food Recommendations
Here at the office all of our dogs have gone gluten free.  We have tested several different “grain free” dog foods, and unfortunately most of them do not test 100% free of gluten.  The only food that has past the test is Natural Balance, LID. This is a great dog food that can be bought at most pet supply stores.  It has a limited amount of ingredients, and comes in several different varieties.  Remember when switching your pet to a different food to always slowly switch them over because their stomachs cannot handle a rapid change in foods.


Heidi’s Story: “A is for Anxiety”

Heidi lines her kitchen table with a virtual pharmacy of prescription pill bottles; celexa for sadness, ritalin for restlessness, ativan for anxiety, depakote for dark downs and hysterical highs, unisom for insomnia.   Each bottle tells a tale in Heidi’s life.

As an infant, Heidi was adopted by prestigious Southern Californians: a psychologist and his wife.  She knows just two things about her origins: 1) her birth mother was very young when she had her, and 2) there was a history of diabetes in her family.  That’s it – nothing more.  No explanation for why exactly she was given up, who her father was, or if she had any more biological siblings.  Very little information; lots of gaps and holes.

What she did have was a privileged upbringing- an estate with a view, the best schools, horse riding lessons, and…she was daddy’s girl.  Her father worked long hours counseling clients out of a home office but always made time for special little rituals with Heidi.  In the mornings they squeezed fresh orange juice together, sitting down at the table afterward with their matching glasses.  Afternoons they walked the same path of their property together until it seemed that their footprints were a part of the landscape.  At night he kissed her on the forehead and called her “butterfly”.

Heidi’s mother was more distant.  Hugs were rare and felt forced.  Approval was hard to come by.  Warmth seemed reserved for her brother Ronnie, who came by way of another adoption when Heidi was three.

“I hated Ronnie for showing up,  I bullied him.  I called him all kinds of names.  I would kick and punch him until he cried.  It makes me sick to think about it now.” The rivalry escalated over the years and created a rift between her parents.  “One day my mom actually looked at me and said, ‘Your dad and I used to be happy and life was easy.  Having children ruined our marriage’.”

Sadness.  The feeling of being unwanted: before her birth and also after.

So yes, Heidi was provided with opportunity.  She attended the best private schools in Santa Cruz, with children of the other local elite.  They had the freshest textbooks, the most ideal student-to-teacher ratios, artists in residence, and unique, challenging, courses.  Where the majority of her peers seized these opportunities and excelled – whether out of self-determination or pressure from parents – Heidi failed and fidgeted.  “Sitting in a classroom was the hardest thing.  Fifty minutes seemed like waaaay too long for anyone to sit in the same chair”.

Heidi’s classroom routine was: bounce knees nervously till someone asks, “where’s  the earthquake?”, drift off in space, doodle caricatures of her classmates, tap pen nervously and to the annoyance of others.  Eventually she just stopped showing up to classes at all.  “I skipped out with this angsty little group of rich kids, doing what kids do when they skip classes.  We smoked pot, we drank in our parents dens, we stole stuff we had more than enough money for”.

All this absenteeism and trouble making led to a string of “fails” on her report card, a ‘Minor In Possession of Alcohol’ charge, the discovery of pot in her locker, and a bust for shoplifting.  By the end of her freshman year in high school, she had been kicked out of one private school and two public ones.  The last resort was an alternative setting for behaviorally and emotionally challenged youth.  “Pretty much all the delinquents,” says Heidi, pulling out the year book from her sophomore year.  Pictured within is a motley crew of kids sporting mohawks, heavy makeup, multiple piercings, and expressions ranging from vacant to brazen.   “I felt more at home here- less weird.  These kids were more like me.  They had real reasons to be angry, real passions, and a real cause for rebellion.”

“The way I looked drove my father crazy.  I think that was even harder for him than the trouble I got into.  Like the trouble he could break down and rationalize as a psychologist.  But the dad in him couldn’t deal with what was right in front of his face”.  Their very last argument was, in fact, about eyeliner.  It was a loud and heated one with a lot of mean words.  It built slowly but ended abruptly, with Heidi slamming the door and driving away.  When she came back it was bedtime but no one was at home.  There was only a note on the kitchen counter.  She can’t remember exactly what it said, but what the words amounted to was: her father was dead.

What followed? “Guilt- for years.  Obviously.  I mean I’d give anything for a better goodbye.  Or wonder if he’d still be here if I had said goodbye.”  Heidi wrestled with those- and other questions- until something came along to help in letting go of them: motherhood.  “I realize as a parent that no matter how ugly things get, you love your kids and they love you back.  There’s just no doubt”.

All grown-up and pulled together, Heidi is now a hardworking mother of two. Mornings are for packing lunches, braiding hair, walking both children to their classroom doors.  Afternoons are for swimming lessons, Little Kickers classes, and playing at home.  Four days a week, Heidi works the swing shift at a psychiatric residential treatment center for youth.

“I see myself in these kids.  A lot of them are going through the same troubles that I was, the same emotions, the same confusion.”  Though the work can be stressful and sometimes dangerous, Heidi thrives on the moments when she gets through to a client, providing them with hope that the future can be brighter.  Underneath the happy veil however, there still lies a lot of worry.  “I always feel like something bad is about to happen.  Or, like something bad’s already happening, but I’ve forgotten what it is.  I’m convinced, always, that there’s something wrong with me.  Stomach cancer, brain tumor…something.”

Heidi has a close network of friends and they are always telling her that the only thing wrong with her is hypochondria.  “They don’t say it meanly-  they’re just honest, and they know better than to feed my paranoia”.  But in the fall of 2009, things really were starting to go wrong in her body.  “Working in residential, there are a lot of germs floating around. That fall and winter, I had strep throat three times and bronchitis twice.  I was almost constantly on antibiotics.  After that I started having a lot of stomach problems.  I would bloat to where it felt like I was pregnant, and always felt tired or nauseous.  My doctor ran all kinds of tests, looking for ovarian cysts and ulcers.”  Looking for an ulcer meant subjecting herself to a stomach scope- the fifteen minute swallowing of a long tube with a miniaturized color TV camera at the end of it, allowing for close examination of the esophagus, stomach, and duodenum.  The result: no ulcer.  More tests and x-rays did reveal something unrelated to Heidi’s digestive troubles.  She was found to have a benign tumor on her liver.

Dark Downs and Hysterical Highs
With surgery invasive, and the small tumor posing no imminent threat, her doctor advised a “wait and watch” approach.  He also prescribed one Zoloft for depression. Through all those appointments, her doctor had picked up on a certain level of sadness that was leading to a lack of sleep and motivation, and a whole lot of hopelessness.  “I went crazy with the first pill I took…literally.  I could go days without sleeping, I was paranoid out of my mind.  I’d always been anxious and nervous around people but now I couldn’t even leave my house”.  She discreetly met with Human Resources at work.  With her job protected through the Oregon Family Leave Act, she hunkered down at home for a six- week leave of absence.

“Those six weeks were a major roller coaster.  Some days I was exhausted, laying in bed, crying over nothing.  Other days I was filled with crazy energy – dancing around the house with my kids, talking hysterically and rapid fire, practically climbing the walls.  Every night my mind was racing.  I could NOT sleep…no matter HOW tired I was”.  Over the course of those weeks she was slowly weaned off of the Zoloft and popping Unisom to get some ZZZ’s.

In the ten months since then, Heidi has been through a cocktail of prescription drugs, and accrued a growing list of labels: Attention Deficit Hyperactive Disorder, Bipolar Disorder, Anxiety.  “I try not to take the labels on and let them define me.  I see that too much in the kids at work.  But I do know something is wrong with me, and I don’t want to feel like this forever.”

The Challenge
Convinced by a friend who has both Celiac disease and experience in the mental health field, Heidi has agreed to join the 6 week long gluten-free challenge.  “I’m willing to try anything.  I can’t deal with this anymore.  The insomnia, depression, and mania are mostly under control but the anxiety is definitely not.  That has always been a problem, and I feel like it always will be.  It makes me feel insane.  Truly.  It limits my life in so many ways.  So if changing my diet can help . . . yes, I will try that.”

Studies show a close link between celiac disease and mental illness, with three theories in explanation.  One idea is that antibodies generated in response to gluten proteins can attack the brain.  A second idea is that the gluten proteins themselves, or the peptides generated from them during digestion, are acting directly on the brain.  A third idea is that your brain is affected by immune responses in other parts of your body.  Celiac is an autoimmune disease; all immune activity sends signals to the brain to change behavior and to recruit a range of defensive responses.

Disturbances to brain function vary from routine effects such as sleepiness, fogginess, and brief episodes of confusion to symptoms of major mental or neurological illness. People with celiac disease may suffer for many years, and under varying labels, before the correct diagnosis is made.  Most will have reported along the way that they never feel well physically; this will typically be attributed to psychosomatic fears.  They will report periods of fatigue, difficulty concentrating, mental “fogginess”, extreme mood fluctuations, tearfulness, and irritability.  Common diagnoses include: Attention Deficit Hyperactive Disorder, Major Depression, Bipolar or Borderline Disorders, Anxiety, and Schizophrenia.  Fortunately, most patients will return to “normal” after fully transitioning toward a gluten-free diet.(1)

A family history of “psychiatric problems” is more common in patients with celiac disease.  While Heidi does not have this sort of information on her biological family, she knows there was a prevalence of diabetes.  She had her own brush with this during her first pregnancy, developing gestational diabetes.  Like most women, her blood glucose levels returned to normal after pregnancy.  She is, however, at greater risk for developing diabetes later in life and her son was, well . . . BIG.  “Noah weighed 10 lbs, 7 oz at birth.”

Celiac disease and diabetes often occur together, at a rate of 10 to 20% in people with type 1 diabetes.  By comparison, the rate of celiac disease in the general U.S. population is about 1 percent.  Diabetes and celiac disease are both autoimmune disorders.  Genetic links between the two diseases are becoming clearer, and it is thought that a malabsorptive disease such as celiac may create the opportunity for hypoglycemia. (2)

Taking a look at Heidi’s more recent health history, we pinpoint two things often related to celiac disease and gluten intolerance: 1) the overuse of antibiotics, and 2) unexplained abdominal pain and bloating, most often after the consumption of food containing gluten.

“My diet is pretty heavy in gluten, I guess.  I eat what my kids eat; lots of pasta, sandwiches, cereal.  At night when they’ve gone to bed I like to relax with a beer.  I never thought of beer having gluten until my friend pointed that out to me.  So, I think the food will be pretty easy to give up, but that nighttime ritual will be hard.”  We sit down and make a list of “food alternatives”.  Heidi agrees that it should be simple to switch the entire family to a gluten-free diet for the 6 weeks.  She’s not at all overwhelmed by the idea of using rice flour bread and quinoa pasta.  As for the beer, I show her a list of gluten-free varieties available at local grocery stores, and also present the option of drinking Hard Apple Cider instead.  She decides she can do this.

Weeks 1 through 3
At the end of the third week of her gluten-free trial, Heidi is happy to report a lot of positive changes.  “I’ve had more energy without a doubt.  And have been sleeping better!  It’s interesting.  Usually when I was falling asleep I’d have this very strange, almost drunken, confused feeling.  I’ve noticed in the last couple weeks that’s gone away.”  Another thing that’s starting to subside is the stomach pain and bloating.  “I do still have troubles on my work days.  I’ve been eating at the cafeteria with the kids at work.  I’m making sure to just go for the salad bar, skipping the croutons and sesame sticks.  But it’s weird-every time I eat there I feel awful afterward”.  We talk about the reality of cross-contamination.  That can be a hard one for people to buy into; tiny traces of gluten can spread through the shared use of cutting boards, utensils, serving trays, and cooking surfaces.  All it takes is one sesame size kernel of gluten to disrupt the system.  This is of great concern, especially in a residential setting such as the one where Heidi works.  “When we take a group of clients to the cafeteria, we mark attendance in a binder.  The first page lists which kids have food allergies, and that’s something we’re supposed to keep an eye on.  A lot of those kids are diagnosed with gluten and wheat allergies or full-on celiac disease!  I know if I’m not getting a good experience when I’m being so careful about it, they aren’t either”.  We talk about discrepancies in care.  A client with an allergy to bee stings will never set foot outdoors without an EpiPen in the hand of a staff.  Those with latex allergy will never come near it.  There is some progress in the recognition of food allergies, but this is mainly relegated to peanuts.

Client care is a larger issue than Heidi and I can tackle.  We can only take care of her.  She makes the decision to bring her own packaged meals to the cafeteria, utensils and all.

Weeks Three through Six
Heidi has made it through six weeks of eating gluten-free amidst the challenge of balancing work, motherhood, and her own emotions.  “Bringing meals to work was definitely the right choice.  I feel much more comfortable with my stomach.  Less self-conscious”.  As for drinking, she says this has actually decreased with the switch to gluten-free beer.  “I don’t know what it is, but I’m good at just one beer when it’s gluten-free.  Maybe part of it is sleeping better?  I don’t know.  But before I would average two or sometimes three drinks in a night.  Now it’s just one, or sometimes none”.

Heidi is not imagining things.  Wheat is one of the most addictive things in existence.  The wheat protein contains a number of opiod peptides which can be released during digestion.  These may affect the central and peripheral nervous system, creating the same addictive attachment to muffins and pasta as to drugs and alcohol.  This also explains why withdrawal symptoms are seen in individuals during their first days of going gluten-free – that “worse before it gets better” effect. (3)

Heidi is also greatly relieved to have lost about five pounds in the last six weeks.  Weight gain is one of the more common side effects of Depakote, and while the medication may have leveled her moods out a bit, she was not exactly pleased with going up a pant size or two.  On a less superficial note, Heidi has been able to decrease her daily use of Ativan.  “Before the gluten-free trial I was taking Ativan up to five times a day.  Pretty much first thing in the morning I would need it, then several times in the afternoon, and then definitely before bed.  I wasn’t really even paying attention to it at first, but all of a sudden I realized I was taking less.  Mostly only on really stressful workdays and sometimes still at night.”  She is enthused at the prospect of decreasing or discontinuing other medications; after her traumatic experience with Zoloft, she knows to work closely with her doctor before making any changes.

The End (and The Beginning)
The question for anyone at the end of a gluten-free trial is: will you stick with it?  The greater the results, the greater the chance that they will.  Heidi is one of those people who has experienced some very positive improvement in both health and mood.  She ends her six weeks with a commitment to carry forth with a gluten-free diet.  “I feel closer to being “normal”, less like this crazy person walking around with a bunch of labels.”

(1) Lewey, Scot MD; Gluten Free Diet Should be Considered for Everyone With Neurological and Psychiatric Symptoms

(2)  Vitoria JC, Castano L, Rica I, Bilbao JR, Arrieta A, Garcia-Masdevall MD: Association of insulin-dependent diabetes mellitus and celiac disease: a study based on serologic markers. 27:47–52

(3)  Sephen Levine, PhD; The Nutrition Notebook: Food Addiction, Food Allergy, and Overweight