Posts in category: Podcast

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

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African Americans & Celiac Disease EP072

June 8, 2018

by Nadine Grzeskowiak, RN with No Comment Podcast

Much existing propaganda claims that African Americans do not suffer from celiac disease. Even the Gluten Free RN was surprised to find out that her adopted daughter had a genetic predisposition to the disease back in 2006, as research available at the time regarded the HLA-DQ2 and HLA-DQ8 genes to be primarily Caucasian traits. And until we take steps to conduct a mass screening, we simply don’t know how common celiac disease is among people of African descent.

Today, the Gluten Free RN is exploring celiac disease in the African American population. She covers a 2006 study out of Columbia University that assessed African American celiac patients, discussing the variety of ways the subjects presented with celiac disease and the potential reasons for their poor compliance with the prescribed gluten-free diet.

Nadine also considers the prevalence of celiac disease on the continent of Africa, explaining why she believes the number of celiac patients will explode with the population’s growing exposure to wheat. Listen in for the Gluten Free RN’s insight on other health issues that may point to undiagnosed celiac disease and learn how we can prevent celiac disease among the African American population with access to testing, social support and gluten-free food!

What’s Discussed:

The 2006 Columbia University study of celiac disease in African Americans

Identified nine patients with biopsy-proven celiac disease
Presented with diarrhea, iron deficiency anemia and autoimmune disorders

Why patients in the Columbia study demonstrated poor dietary compliance

Expense, availability and palatability of gluten-free food
Lack of symptoms at diagnosis, inaccurate dietary information

Nadine’s prediction around the number of celiac patients in Africa

Increasing exposure to wheat will cause explosion

The statistics regarding the mortality burden of celiac disease

Science Daily reported estimates of 42K child deaths every year in 2011
Majority from Africa and Asia

The overlap between diabetes and celiac disease

Every type 1 diabetic is HLA-DQ2/8 gene carrier

The health issues that may indicate undiagnosed celiac disease

Type 1 diabetes, cardiac issues, stroke and heart attack
Obesity (stems from lack of nutrient absorption)

How to prevent celiac disease among the African American population

Access to testing, social support and gluten-free food

Resources:

Celiac Disease and How Gluten Affects Your Skin EP011

‘Celiac Disease in African-Americans’ in Digestive Diseases and Sciences

‘First Global Estimates of Coeliac Disease and Its Mortality Burden’ in Science Daily

Neurological Disorders Associated with Celiac Disease EP012

‘Celiac Disease in the Developing Countries: A New and Challenging Public Health Problem’ in the World Journal of Gastroenterology

‘Systematic Review: Worldwide Variation in the Frequency of Coeliac Disease and Changes Over Time’ in Alimentary Pharmacology and Therapeutics

‘HLA Typing and Celiac Disease in Moroccans’ in Medical Sciences

‘A Historical Assessment of Sources and Uses of Wheat Varietal Innovations in South Africa’ in the South African Journal of Science

University of Chicago: Celiac Disease Facts and Figures

‘Adult Coeliac Disease in South Africa: An Analysis of 20 Cases Emphasizing Atypical Presentations’ in the South African Medical Journal

‘Epidemiological and Clinical Features in Immigrant Children with Coeliac Disease: An Italian Multicentre Study’ in Digestive and Liver Disease

‘Prevalence of Positive Coeliac Serology in a Cohort of South African Children with Type 1 Diabetes Mellitus’ in the South African Journal of Child Health

ESPGHAN Goes Africa Course

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

Books by Nadine:

Celiac Disease & Why No One Should Have Belly Pain EP071

May 25, 2018

by Nadine Grzeskowiak, RN with No Comment Podcast

Approximately 50% of ER visits are associated with abdominal pain, and the vast majority of those patients are given a diagnosis of ‘abdominal pain of an unknown origin’ and directed to come back if the condition gets worse. This is little comfort to people suffering from severe discomfort who need answers around the cause of their belly pain, not just medication to mask it temporarily. Could undiagnosed celiac disease be the source of their suffering?

Today, the Gluten Free RN is diving into the issue of belly pain and undiagnosed celiac disease, discussing the expensive testing often conducted to determine the cause of abdominal discomfort—testing that rarely includes a celiac panel. She covers several of the common misdiagnoses of celiac patients as well as the incredibly high prevalence of abdominal pain in children.

Nadine shares the case study of a child-patient who was misdiagnosed with appendicitis and the research published in Digestive and Liver Disease outlining the unnecessary surgical interventions endured by undiagnosed celiac patients. Listen in for the Gluten Free RN’s advice to patients with idiopathic abdominal discomfort and learn why no one should suffer from belly pain!

What’s Discussed:

The statistics around ER visits and abdominal pain

50% of visits associated with belly pain

The most common abdominal pain diagnoses

Abdominal pain of unknown ideology, idiopathic abdominal pain

How patients are treated for idiopathic abdominal pain

Medication, directive to return if condition gets worse

The testing to find the cause of chronic abdominal pain

Expensive blood workups, rarely include celiac panel

How many children suffer from belly pain

30% report abdominal discomfort

Nadine’s patient who received a misdiagnosis of appendicitis

Mother of child-patient sought second opinion prior to surgery
Child didn’t have appendicitis, cause of pain still unknown

A research study around abdominal surgery and celiac disease

Patients with celiac disease at increased risk of abdominal surgery
Misdiagnosis leads to inappropriate interventions (i.e.: appendectomy)

Nadine’s advice for patients diagnosed with idiopathic abdominal pain

Initiate clinical trail of gluten-free or Paleo diet

Resources:

‘Increased Rate of Abdominal Surgery Both Before and After Diagnosis of Celiac Disease’ in Digestive and Liver Disease

‘Screening for Celiac Disease in Children with Recurrent Abdominal Pain’ in the Journal of Pediatric Gastroenterology and Nutrition

‘Effect of a Gluten-Free Diet on Gastrointestinal Symptoms in Celiac Disease’ in the American Journal of Clinical Nutrition

‘Clinical Features and Symptom Recovery on a Gluten-Free Diet in Canadian Adults with Celiac Disease’ in the Canadian Journal of Gastroenterology

‘Association of Adult Celiac Disease with Surgical Abdominal Pain’ in Annals of Surgery

‘A New Insight into Non-Specific Abdominal Pain’ in The Annals of The Royal College of Surgeons of England

Connect with Nadine:

Melodies of the Danube Gluten-Free Cruise with Nadine

Books by Nadine:

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

Blood Disorders and Celiac Disease EP070

May 4, 2018

by Nadine Grzeskowiak, RN with No Comment Podcast

If you are being treated for a blood disorder, it is time to look deeper and explore the underlying cause. Rather than simply addressing iron- or B12-deficiency anemia in isolation, ask WHY you have a deficiency in the first place. It is possible that damage to your intestines caused by gluten is preventing your body from absorbing the nutrients necessary to grow your red blood cells and keep your immune system healthy. And anemia is not the only blood disorder associated with celiac disease and non-celiac gluten sensitivity!

The Gluten Free RN is taking a closer look at the hematologic manifestations of celiac disease from anemia to hyposplenism. She explains the connection between disorders of the blood and bones, offering insight around why men with both anemia and osteoporosis are also likely to have celiac disease.

Nadine discusses the danger in taking H2 blockers or proton pump inhibitors for GERD long-term, describing how those medications decrease the gastric acid necessary for breaking down food. She also addresses what you can do to identify any nutritional deficiencies in your blood and reminds us why celiac patients have difficulty absorbing the nutrients necessary to form red blood cells. Listen in to understand how the skin reflects what’s happening internally and learn how to prevent a number of blood disorders with a gluten-free diet!

What’s Discussed:

The hematologic manifestations of celiac disease

Anemia secondary to malabsorption of iron, folate and vitamin B12
Thrombocytosis, thrombocytopenia, leukopenia, venous thromboembolism
Hyposplenism, IgA deficiency and increased risk of lymphoma

Why iron supplements didn’t solve Nadine’s anemia

Couldn’t absorb supplements due to undiagnosed celiac disease

The connection between anemia, osteoporosis and celiac disease

B12 forms red blood cells made in long bones

The danger of taking H2 blockers and PPIs long-term

Decreases levels of gastric acid necessary to liquify food
Leads to bacterial overgrowth, gastritis

How to uncover potential nutrient deficiencies in your blood

CBC with differential (breakdown of red blood cells)

The conclusions of the 2007 study in Blood

Anemia and hyposplenism are most common complications of celiac disease
Obtain small-bowel biopsy in all patients with iron-deficiency anemia

The fat-soluble vitamins

A, D, E and K
Deficiency in one indicates malabsorption, potential celiac disease

The connection between DH and celiac disease

Skin disorders begin in intestines

Resources:

‘Hematologic Manifestations of Celiac Disease’ in Blood

Celiac Disease and Your Spleen

Dr. Ben Lynch: Folic Acid vs. Folate

‘The Thrombophilic Network of Autoantibodies in Celiac Disease’ in BMC Medicine

‘Hematologic Manifestations of Celiac Disease’ in Celiac Disease— From Pathophysiology to Advanced Therapies

‘Sarcoidosis, Celiac Disease and Deep Venous Thrombosis: A Rare Association’ in Balkan Medical Journal

‘Celiac Disease Manifesting with Deep Venous Thrombosis: A Case Report’ in Govaresh

‘Deep Venous Thrombosis and Bilateral Pulmonary Embolism Revealing Silent Celiac Disease’ in Case Reports in Gastrointestinal Medicine

‘How Often Do Hematologists Consider Celiac Disease in Iron-Deficiency Anemia?’ in Clinical Advances in Hematology & Oncology

‘Deep Vein Thrombosis Associated with Celiac Disease’ in Bratislavske Lekarske Listy

‘Celiac Disease Presenting with Immune Thrombocytopenic Purpura’ in Case Reports in Hematology

‘Lower Extremity Deep Vein Thrombosis Associated with Gluten-Sensitivity Celiac Disease’ in Terapevticheskii Arkhiv

Connect with Nadine:

Melodies of the Danube Gluten-Free Cruise with Nadine

Books by Nadine:

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

Eosinophilic esophagitis - wikipedia.org

Eosinophilic Esophagitis and Celiac Disease EP069

April 27, 2018

by Nadine Grzeskowiak, RN with No Comment Podcast

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

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

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

What’s Discussed:

The fundamentals of eosinophilic esophagitis

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

The benefits of unsedated transnasal endoscopy for children with EoE

Monitors esophageal mucosa without sedation
Safer, faster and less costly

Some common symptoms of eosinophilic esophagitis

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

The condition of achalasia

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

The treatment for EoE

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

The potential increased prevalence of EoE in children with celiac disease

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

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

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

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

University of Colorado (Denver School of Medicine)
Pennsylvania

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

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

Special considerations for pediatric patients with EoE

Consultation with dietician
Limited exposure to corticosteroids
Attention to development of feeding skills
Potential psychosocial, behavioral problems

Resources:

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

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

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

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

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

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

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

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

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

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

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

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

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

Connect with Nadine:

Melodies of the Danube Gluten-Free Cruise with Nadine

Books by Nadine:

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

Why No Dairy on a Gluten-Free Diet? EP068

April 20, 2018

by Nadine Grzeskowiak, RN with 2 Comments Podcast

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

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

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

What’s Discussed:

The similarities between the gluten and casein proteins

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

How the casein protein impacts the brain

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

The effect of Marsh 1 damage due to celiac disease

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

How gluten and casein proteins act as exorphins

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

Nadine’s recommendations for dairy replacements

Coconut, hemp, almond or hazelnut milk
Kite Hill and NuCulture cheese options

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

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

The story of Dr. Terry Wahls

Diagnosed with MS, healed on gluten-free diet

Resources:

Dr. Terry Wahls’ TED Talk

The Wahls Protocol by Dr. Terry Wahls

Dr. Terry Wahls’ Website

Connect with Nadine:

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

Books by Nadine:

Indigenous Populations, Celiac Disease and NCGS EP067

April 13, 2018

by Nadine Grzeskowiak, RN with No Comment Podcast

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

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

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

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

What’s Discussed:

The global indigenous population

370M in 70-plus countries
Rich diversity of cultures

The health status of indigenous populations

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

Why indigenous populations have more health issues

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

The lack of information around indigenous populations and celiac disease

Very few studies available

The impact of grains on the native population

Significant change in health care outcomes, quality of life

The prevalence of celiac disease in indigenous populations

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

Why eating healthy is a challenge for the indigenous population

Food scarcity, desserts
Reliance on commodity foods provided by government

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

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

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

Empower to make food choices with better health outcomes

Resources:

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

Dough Nation by Nadine Grzeskowiak

USDA Commodity Supplemental Food Program

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

The Sioux Chef’s Indigenous Kitchen by Sean Sherman

American Indian and Alaska Native Health

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

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

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

UN Indigenous Peoples Fact Sheet

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

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

Summary of Aboriginal and Torres Strait Islander Health

WHO Health of Indigenous Peoples

WHO Indigenous Peoples and Substance Abuse

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