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The US Military and Celiac Disease EP061

It goes without saying that anyone who serves in the military needs to be healthy and strong—and that military leaders have an obligation to keep enlisted servicemen and women as safe and healthy as possible. So, it makes sense that people with food allergies (including celiac patients) are disqualified from military service, but it is less clear why celiac testing is not a part of the medical exam to qualify for enlistment.

Today, the Gluten Free RN addresses the issue of celiac disease in the military. She explains the challenges of preparing gluten-free food in a mess hall setting and describes the consequences for an active duty soldier who is found to have celiac disease.

Nadine shares a research study exploring celiac trends among active duty military as well as a case study around veterans and celiac disease. Listen in for insight on what’s behind the increased prevalence of celiac disease among military personnel and the confirmed association between celiac disease and other complex health issues.

What’s Discussed: 

Why celiac patients are disqualified from enlisting in any branch of service

  • Unable to provide safe food

What happens to military personnel who are found to have celiac disease

  • Will receive medical discharge

The US military policy around food allergies and intolerances

  • No accommodations made

Countries that allow celiac patients to serve

  • Israel, Finland and Scandinavia

The Mayo Clinic study of celiac trends among active duty military

  • Healthy worker population with medical diagnostic coding
  • Incidence of celiac disease increased five-fold from 1999-2008
  • Combination of increased suspicion and environmental factors

The challenge of preparing gluten-free food in a military setting

  • High risk of cross-contamination

A case study involving military veterans and celiac disease

  • Confirmed association between CD and other complex issues

The benefits of a gluten-free diet

  • Preventative for autoimmune disorders, nutritional deficiencies and cancer

Nadine’s argument for celiac testing prior to enlistment

  • Obligation to safety of servicemen/women

Resources:

Military Standards of Medical Fitness

‘The Incidence and Risk of Celiac Disease in a Healthy US Adult Population’ in the American Journal of Gastroenterology

‘Celiac Sprue Among US Military Veterans: Associated Disorders and Clinical Manifestations’  in Digestive Diseases and Sciences

‘Gluten-Free Soldier in Afghanistan’ in Gluten-Free Living

‘Medical Mix-Up Sidelines Army Sergeant’s Career’ in Military Times

Celiac Disease-Related Veterans Affairs Case

Connect with Nadine:

Instagram

Facebook

Contact via Email

‘Your Skin on Gluten’ on YouTube

Melodies of the Danube Gluten-Free Cruise with Nadine

Books by Nadine:

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

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Managing the Holidays with Celiac Disease EP050

With the approach of the holidays, you may be nervous about navigating family and workplace gatherings—especially if you are newly diagnosed with celiac disease. How do you explain your dietary restrictions and keep yourself safe, eating well without getting ‘glutened’?

Today the Gluten Free RN shares her best advice around managing the holidays with celiac disease. She offers ten key tenants to help you enjoy the holiday season and mitigate stress, without feeling like you’re missing out. She shares some things you need to avoid, including unsafe situations, people who make you miserable, and cheating on your gluten-free diet! But she also discusses strategies you can implement to make the season bright, such as creating new traditions, getting creative in the kitchen, and finding your tribe—the people who will support you in your gluten-free journey.

Nadine also gives tips around where to go for gluten-free ingredients and holiday recipes, and how to develop a backup plan so you won’t go hungry if the food you encounter is questionable. You are likely to encounter well-intentioned friends and family members who have no idea how to feed you safely at holiday parties. Listen in and learn how to be clear about your dietary needs and take control of your health without isolating yourself from loved ones during this most wonderful time of the year!

What’s Discussed: 

#1 Don’t eat anything contaminated with wheat

  • Cannot eat center of pie, any part of turkey with bread stuffing

#2 Beware of good-intentioned people

  • Don’t eat anything questionable
  • Bring a snack with you just in case

#3 Be prepared to establish new traditions

  • Get creative in kitchen

#4 Don’t isolate yourself

  • Find support group, create your own

#5 Gather recipes early

#6 Order ingredients in advance

  • Consider organic, free range turkey

#7 Don’t invite people who make you miserable

  • Set clear boundaries (no complaints, ridicule)

#8 Eat before you go or take your own plate

  • ‘Desperate people make desperate decisions’
  • Take a dish to share, take your portion first

#9 Don’t be a victim

  • Be clear about your needs

#10 Find your people

  • Those who truly love you don’t want you to be sick

Resources:

 

Nima Sensor

EZ Gluten Test Strips

Paleo Magazine

Paleo Principles: The Science Behind the Paleo Template, Step-by-Step Guides, Meal Plans, and 200+ Healthy & Delicious Recipes for Real Life by Sarah Ballantyne

Sarah Ballantyne on Instagram

Glutenpro

EnteroLab

Connect with Nadine:

Instagram

Facebook

Contact via Email

‘Your Skin on Gluten’ on YouTube

Melodies of the Danube Gluten-Free Cruise with Nadine

Books by Nadine:

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

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Eating Disorders and Celiac Disease EP043

Imagine being admitted to a psychiatric hospital and accused of being a pathological liar because no matter how carefully you follow the high-carb diet prescribed by your physicians, you continue to lose weight. In the introduction to his book, How Doctors Think, Dr. Jerome Groopman shares the story of a woman who was misdiagnosed with anorexia nervosa. The patient was ready to give up when one last doctor discovered villous atrophy and determined that it was celiac disease—not an eating disorder—that was causing her malnourishment.

Today the Gluten Free RN explores the reasons why celiac disease and gluten sensitivity are often mistaken for anorexia nervosa. She shares the limited research in the field, as well as the symptoms related to malnourishment that may be caused by gluten, including several mental health disorders.

Listen in as Nadine covers the use of PWAG (people who avoid gluten) as a derogatory term and shares her frustration with labels like ‘orthorexia nervosa’ which imply that gluten-sensitive patients are obsessed with healthy food: ‘I avoid gluten like the plague because it is, in fact, the plague for those of us who have celiac disease.’   

 What’s Discussed: 

The use of PWAG as a derogatory term

  • ‘People who avoid gluten’
  • Half of people in US
  • Implies food crazed/obsessed

 The new term orthorexia nervosa

  • Refers to obsessive behavior in pursuit of healthy diet
  • Not clinical term/official diagnosis

 The concept of food as medicine

 Anecdotal evidence of celiac disease misdiagnosed as anorexia

  • Introduction of Dr. Jerome Groopman’s book, How Doctors Think
  • Woman admitted to psychiatric hospital (thought to be pathological liar)
  • Continued to lose weight despite prescribed high-carb diet
  • Biopsy revealed Marsh 4 damage
  • Gluten-free diet resolved symptoms

 Why celiac disease and gluten sensitivity are misdiagnosed as eating disorders

  • Inability to absorb nutrients results in severe weight loss, malnutrition
  • Become picky eaters because food causes suffering
  • Practice food avoidance

 The prevalence of celiac disease

  • 3% of the US population
  • Millions undiagnosed

 How gluten affects a celiac patient

  • Gluten protein as neurotoxin
  • Damages intestines
  • Impairs immune system
  • Causes inflammation
  • Heart attack
  • Stroke
  • Joint, muscle pain
  • Any -itis

 Nadine’s recommended variation of a Paleo diet

  • Local, organic, whole foods
  • 100% grass-fed beef (no antibiotics/hormones)
  • Nutrient dense

 The study of celiac disease and eating disorders

  • Very few research studies in last 11 years
  • Handful of case studies in literature

 The issues associated with malnourishment

  • Little body fat
  • Cachectic
  • Hormonal disruption
  • Thyroid issues

 The anger and contempt Nadine has experienced as the Gluten Free RN

  • Gluten, dairy associated with comfort food
  • People resistant to give up

 The mental health issues associated with malnourishment

  • Significant cognitive impairment
  • Hypoxia
  • Brain atrophy (shrinking)

 The effect of gluten on epithelial tissue

  • Leaky skin, lungs, blood vessels, blood-brain barrier
  • Causes increased/decreased blood pressure, POTS

 The consequences of gluten getting through the blood-brain barrier

  • Causes hypoxia
  • Brain needs oxygen to work appropriately
  • Brain fog (irritability, anger)
  • Early onset dementia

 The shocking statistics around psychotropic medication in the US

  • Up to 50% of population on anti-depressants, mood-altering drugs
  • Gluten-free diet could help ‘get brain back’

 Nadine’s advice for parents of children who miss multiple days of school

  • Could be undiagnosed celiac disease
  • No downside to clinical trial of gluten-, dairy-free diet
  • Consider Whole30 Diet (eliminate sugar, grains, legumes)

 The process of a gluten detox

  • Gluten has narcotic-like effect on brain
  • May feel worse before you feel better
  • One day to two months

 The benefits of maintaining a gluten-free diet

  • Anxiety goes away
  • Mood improves
  • Able to sleep
  • Pain resolves
  • Heal intestines, epithelial tissue
  • Reduce inflammation
  • Heal immune system
  • Brain receives necessary oxygen

 The foods Nadine recommends as part of a super-good, high-fat diet

  • Avocados
  • Olive oil
  • Coconut oil
  • Coconut milk
  • Hemp milk

 Why Nadine chooses not to eat if there is any risk of gluten contamination in her food

 The places where gluten hides

  • Single bread crumb
  • Dusting of flour
  • Oil French fries cooked in
  • Personal care products

Resources:

 

How Doctors Think by Jerome Groopman, MD

Dr. Groopman’s NPR Interview

“The Interaction Between Eating Disorders and Celiac Disease: An Exploration of 10 Cases” in the European Journal of Gastroenterology & Hepatology

“Orthorexia and Anorexia Nervosa: Two Distinct Phenomena? A Cross-Cultural Comparison of Orthorexic Behaviours in BMC Psychiatry

“Predictors of Orthorexic Behaviours in Patients with Eating Disorders: A Preliminary Study” in BMC Psychiatry

“Eating Disorders and Celiac Disease: A Case Report” in The International Journal of Eating Disorders

Connect with Nadine: 

Instagram

Facebook

Contact via Email

‘Your Skin on Gluten’ on YouTube

Melodies of the Danube Gluten-Free Cruise with Nadine

Books by Nadine:

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

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Dental Issues and Celiac Disease EP039

Did you know that it is possible to diagnose celiac disease with a smile?

Damage from gluten starts in the mouth, and today the Gluten Free RN explores the important role dentists can play in identifying undiagnosed celiac disease. She outlines the symptoms of celiac disease that present in the mouth, the follow-up questions dentists should ask when they notice dental enamel defects or aphthous ulcers, and the nature of the tongue as an indicator of overall health.

This episode covers how the plastics in orthodontic retainers might contain gluten and what to do if you are accidentally exposed. Nadine also explains the relationship between fat-soluble vitamins and celiac disease, as well as the nutrient deficiencies a potential celiac patient should test for. You’re never fully dressed without a smile, so listen in to understand how to keep your mouth healthy—and prevent the accumulation of complications from celiac disease with a whole food, gluten-free diet!

What’s Discussed: 

How the GI tract functions

  • Starts at mouth, ends at rectum
  • Allows us to consume food, liquid
  • Only extract what body needs
  • Expel the rest

How damage from gluten presents

  • Malabsorption of nutrients
  • Inflammation
  • Autoimmune issues
  • Type 1 diabetes
  • ALS
  • Lupus
  • MS
  • Sjögren’s
  • Leaky gut

How dentists can play an important role in identifying undiagnosed celiac disease

The symptoms of celiac disease that present in the mouth

  • Dental enamel defects
  • Aphthous ulcers (canker sores)
  • Cheilosis (cracks, open sores where upper and lower lip join)
  • Dry, cracked lips
  • TMJ—temporal mandibular joint disorder
  • Pain where jaws meet
  • Inflammation of the jaw
  • Clicking
  • Lock jaw
  • Mouth pain, burning
  • Oral lesions
  • Tongue pain, tingling
  • Redness, swelling of the tongue
  • Tongue sores
  • Changes in taste, smell
  • Diminished sensory input
  • Dry mouth
  • Sore throat
  • Difficulty swallowing
  • Increased thirst
  • Bleeding gums
  • Delayed eruption of teeth
  • Pyrosis
  • Oral lichen planus
  • Glossitis (inflammation of tongue)
  • Clearing throat
  • Sinus infections
  • Redness, swelling of the uvula

How Nadine treats gluten exposure

  • Activated charcoal
  • Drink water

The grains to look for in personal care products (e.g.: lip balm)

  • Wheat
  • Barley
  • Rye
  • Oats

The relationship between fat soluble vitamins and celiac disease

  • Gluten causes malabsorption
  • Vitamins A, D, E and K are fat soluble
  • Under 40 in vitamin D may indicate deficiency in all

How we tested for celiac disease in children in the early 20th century

  • Fecal fat score
  • Pale stool that floats suggests malabsorption of A, D, E and K

Why parents should be tested for celiac disease prior to pregnancy

The fetal development issues that may present if an expectant mother is unable to absorb nutrients

  • Dental enamel defects
  • Smaller jaw formation
  • Smaller airway passages

Why Nadine advocates for a mass screening

How gluten in plastics, personal care products can prevent celiac patients from healing

The questions dentists should ask when they notice dental enamel defects, aphthous ulcers

  • Other clinical celiac symptoms (abdominal pain, diarrhea, weight loss, anemia, fatigue)
  • Associated disorders (type 1 diabetes, thyroiditis, etc.)
  • Family history of celiac disease

Why we need to get much better at recognizing celiac signs and symptoms

  • Even in Canada, diagnosis takes 11.7 years

Why Eastern medicine examines the tongue as an indicator of overall health

The genes that indicate a predisposition to celiac disease

  • HLA-DQ2
  • HLA-DQ8

Why it is acceptable to adopt a gluten-free diet if your antibody test is negative for celiac disease

The deficiencies a potential celiac patient should test for

  • Calcium
  • Magnesium RBC
  • Vitamin D
  • Zinc
  • Folic acid

Why thrush may be an indicator of celiac disease or gluten sensitivity

Why one negative test for celiac disease doesn’t rule anyone out

The importance of early diagnosis

  • Symptoms accumulate over the years

The Paleo diet Nadine suggests for celiac and gluten-sensitive patients

  • Whole food
  • Focus on local, fresh
  • 100% grass-fed meat (no antibiotic, no hormone)
  • Fish and eggs
  • Nuts and seeds
  • 100% organic fruits and vegetables

Resources:

 “An Orthodontic Retainer Preventing Remission in Celiac Disease”  in Clinical Pediatrics

“Oral Manifestations of Celiac Disease: A Clinical Guide for Dentists” in the Journal of the Canadian Dental Association

Gluten Free RN Podcast EP027: Type 1 Diabetes and Celiac Disease

“The Association Between Celiac Disease, Dental Enamel Defects, and Aphthous Ulcers in a United States Cohort” in the Journal of Clinical Gastroenterology

“Small-Bowel Changes in Recurrent Ulceration of the Mouth” in Hepatogastroenterology

“Oral Signs and HLA-DQB1*02 Haploytypes in the Celiac Paediatric Patient: A Preliminary Study” in Autoimmune Diseases

“The Oral Manifestations of Celiac Disease: Information for the Pediatric Dentist” in Pediatric Dentistry

“Oral Aphthous Ulcers and Dental Enamel Defects in Children with Coeliac Disease” in Acta Paediatrica

“Oral and Dental Manifestations of Celiac Disease” in the New York State Dental Journal

“Jejunal Mucosal Abnormalities in Patients with Recurrent Aphthous Ulceration” in The British Medical Journal

“Dental Enamel Defects in Adult Coeliac Disease” in the European Journal of Internal Medicine

“Screening for Celiac Disease in Children with Dental Enamel Defects”  in ISRN Pediatrics

“Celiac Disease Associated with Recurrent Aphthae” in Gut

“Importance of Oral Signs in the Diagnosis of Atypical Forms of Celiac Disease” in Recenti Progressi in Medicina

Connect with Nadine: 

Instagram

Facebook

Contact via Email

‘Your Skin on Gluten’ on YouTube

Melodies of the Danube Gluten-Free Cruise with Nadine

Books by Nadine:

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

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Celiac Disease for Nurses EP037

Nadine spent 17 years working as a nurse in the ER. She holds a membership in the Emergency Nurses Association, as well as a Certified Emergency Nurse certification. During the course of her career, Nadine obtained ACLS, PALS, NALS, ENPC and TNCC certifications, honing her skills in advanced cardiac life support, neonatal advanced life support, pediatric advanced life support, and trauma. Despite this impressive background and experience, she had never been educated about celiac disease, and didn’t know what to look for until she was diagnosed herself.

Nurses are in a unique position to recognize potential celiac patients and act appropriately. Though most nurses don’t have the authority to diagnose, they do have an obligation to act as patient advocates. Because celiac disease is the most underdiagnosed and misdiagnosed autoimmune disease in the world, it is important that nurses get educated about the fundamentals of celiac disease, the wide array of symptoms an undiagnosed patient may present, and how to keep celiac patients safe in and out of the hospital.

Today on the podcast, the Gluten Free RN addresses nurses, explaining how celiac disease damages the GI tract, the consequences of a ravaged immune system, and the neurological nature of the disease. She also reviews the genes that indicate a predisposition to celiac disease, the best available tests for gluten sensitivity, and the need for a worldwide mass screening. This is a must-listen for medical professionals, offering an overview of the most current celiac studies and an explanation of how to approach doing research on your own. Celiac disease is on the rise and it doesn’t discriminate, so it is crucial that the nursing community get educated – STAT.

What’s Discussed: 

Why nurses need to employ a high index of suspicion regarding celiac disease

  • Most undiagnosed and misdiagnosed autoimmune disease in world

 The lack of training around celiac disease in the medical community

  • Nadine was nurse for 17 years
  • Didn’t know symptoms of celiac disease
  • Diagnosed ‘by accident’

 The celiac symptoms Nadine thought to be ‘normal’

  • Canker sores
  • Intermittent constipation, diarrhea
  • Eczema on hands
  • Difficult time gaining weight
  • Whole family had gas

 What nurses need to know about celiac disease

  • What it is, what it entails
  • Symptoms may present with
  • How to keep patients safe (in and out of hospital)
  • How to request testing
  • How to interpret lab results

 How long it takes to receive celiac diagnosis in US

  • 9-15 years

 The restrictions of being a nurse

  • Can’t diagnose (can recognize, treat appropriately)
  • Can’t perform surgery
  • Can’t prescribe meds, take patient off medication

 Nadine’s experience leading up to her celiac diagnosis

 Nadine’s celiac diagnosis

  • Dermatologist diagnosed
  • Blood test, skin biopsy negative
  • HLA-DQ2.5 gene carrier (super-celiac category)

 Why a negative blood test, skin biopsy doesn’t rule out celiac disease

 Nadine’s current health

 Why Nadine stopped working as an ER nurse

  • Celiac diagnosis was life-changing
  • Started own businesses
  • RN On Call, Inc
  • The Gluten Free RN
  • Celiac Nurse Consulting

 The increased prevalence of mortality in undiagnosed celiac patients

  • Undiagnosed celiac disease associated with 4-fold increased risk of death (45 years of follow-up)
  • Prevalence of undiagnosed celiac disease has increased dramatically in US over last 50 years

 The grains that contain gluten

  • Wheat
  • Barley
  • Rye
  • Oats (cross-contamination)

 The products that may contain gluten

  • Medication
  • Food
  • Personal care products

 The search terms to use when doing celiac research

  • Gluten-related disorders
  • Both spellings (celiac, coeliac)

 Why celiac disease is primarily a neurological disorder

  • Involves enteric nervous system (in intestines)
  • Vagus nerve (superhighway of information from intestines to brain)

 Why celiac disease is not an allergy

  • Allergy is IgE-mediated antibody response
  • Celiac tends to be IgA, IgG-mediated antibody responses

 The genes that indicate a predisposition to celiac disease

  • HLA-DQ2
  • HLA-DQ8

 Why Nadine advocates for a world-wide mass celiac screening

 The relationship between celiac disease and infertility

  • People with infertility issues, difficulty maintaining pregnancy should be tested

 The chronic nature of celiac disease

  • Never goes away
  • Gluten is neurotoxin
  • Must be 100% gluten-free for life

 How gluten exposure presents for Nadine

  • Blisters in mouth within 10 minutes

 How gluten can cause damage along entire length of GI tract

  • 28 to 32 feet in length
  • Person-to-person variability

 How damage to GI tract presents

  • Canker sores
  • Difficulty swallowing, dysphasia
  • GERD
  • Eosinophilic esophagitis
  • Gas, bloating
  • Diarrhea constipation
  • Crohn’s disease
  • Atypical diseases
  • Idiopathic diseases
  • Ulcerative colitis
  • Diverticulitis
  • Diverticulosis
  • Rectal cancer
  • Bowel cancer
  • Hemorrhoids

 How constipation can be a neurological issue

  • Gluten as neurotoxin can paralyze nervous system, intestines
  • Stool cannot get pushed through
  • Can result in colon cancer, megacolon

 Disorders that may be caused by undiagnosed celiac disease

  • Diabetes
  • Heart problems
  • Sudden cardiac deaths
  • Strokes
  • Bowel, rectal cancer (recent increase in young people)

 Why a biopsy is no longer considered the gold standard of celiac testing

  • Positive anti-tissue transglutaminase and positive EMA indicates damage to intestines
  • Endoscopist should take six to 15 samples in duodenum, jejunum (damage can be patchy)

 The stages of intestinal damage caused by celiac disease

  • Marsh 1 – microvilli destroyed
  • Marsh 2, 3 – villi themselves fall over, blunt or atrophy
  • Marsh 4 – looks like hot, inflamed sponge and immune system compromised

 The consequences of a damaged immune system

  • Hypo-responsive (doesn’t respond)
  • Hyper-responsive (reacts to everything)

 The importance of including a total IgA and IgG in the celiac antibody panel

  • Ensure patient is not IgA deficient

 How the US has gone backwards in the last 70 years

  • Times article from 1950 declares ‘cures certain in 90% of cases’ and ‘deaths rare’
  • Celiac disease has gone unrecognized since then

 The testing for celiac disease

  • Celiac antibody test (baseline)
  • Small intestinal biopsy
  • Nutritional panel (D3, B6, B12, magnesium RBC, zinc, ferritin)
  • Follow-up to track healing, ability to absorb nutrients

 The difficulty with the celiac antibody test

  • 70% false negative

 The best available celiac testing

 Factors that might interfere with accurate celiac testing

  • IgA deficiency
  • Benicar (blood pressure med) known to cause villous atrophy in absence of celiac disease
  • Lab-to-lab variability
  • Only tests for anti-tissue transglutaminase 2

 How to carry out a clinical trial for celiac disease or gluten sensitivity

  • Adopt gluten-, dairy-free diet for at least three months
  • It takes six months to a year for intestines to heal
  • Recommended for patients with genetic predisposition, regardless of negative blood test

 The Paleo diet Nadine suggests for celiac and gluten-sensitive patients

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

 The findings of a celiac study published in the Journal of Insurance Medicine

  • Atypical, non-diarrheal presentations now most frequent
  • Celiac disease is grossly underdiagnosed in US
  • Average delay in diagnosis for adult patients ranges from four to 11 years
  • Diagnosis and treatment with gluten-free diet leads to improved quality of life
  • Medical costs in celiac cohort were 31% lower over three-year period

 Why celiac disease should be on every primary care physician’s differential diagnosis

 The rise of celiac disease

  • 1:501 in 1974
  • 1:219 in 1989
  • 1:100 is current estimate
  • Doubles every 15 years (according to Mayo Clinic)

 Why Celiac disease is a worldwide issue

  • Affects every ethnicity
  • Frequency of tTGA in Mexico City study was 1:37
  • Increasing diagnoses in North Africa, Middle East and Northern India

 How celiac disease can lead to obesity

  • Patient cannot absorb nutrients (malnourished)
  • Body responds by storing fat for cheap energy

 How the risk of cancer increases exponentially in undiagnosed celiac patients

 Why nurses must be patient advocates

 Nadine’s advice around research and celiac disease for nurses

  • Not taught in nursing programs
  • Do your own research to keep up with current info

Resources:

Snarky Nurses  on Instagram

National Nurses in Business Association

“Increased Prevalence and Mortality in Undiagnosed Celiac Disease” in Gastroenterology

PubMed

Cyrex Laboratories

EnteroLab

New York Times Article, May 1950

“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 African-Americans” in Digestive Diseases and Sciences

“Coeliac Disease” in The Lancet

Connect with Nadine: 

Instagram

Facebook

Contact via Email

‘Your Skin on Gluten’ on YouTube

Melodies of the Danube Gluten-Free Cruise with Nadine

Books by Nadine:

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