New Digs

Low section businesswoman crossing streetWhile I’ve enjoyed our brief time here at shellymalone.wordpress.com, it’s time for me to take up a new residence. To accommodate all the services I’d like to bring to you in the future, I’ve moved to a full website, shellymalone.com. 

You may notice that right now, the new site looks almost identical to what we have here. While that may not feel like a big change, it did take quite some time just to get it to this point, which is why you haven’t heard much from me lately. But I’ve been moving and shaking behind the scenes, and there will be some upgrades and updated content for you to enjoy soon.

If you’ve subscribed to this blog, you will be automatically transferred to the distribution list for the new site and you will continue to receive alerts of new blog posts and other content. If you haven’t subscribed, but want to, you can do so on the new sites’ homepage. You can also join me on Twitter, Instagram and Facebook for regular updates.

Of course, you can opt-out at any time. But I hope you’ll stick around.

We’re just getting started.

Gluten 3: What Was Your Name Again? Allergy vs. Intolerance vs. Sensitivity vs. Celiac Disease

Hello StickerI know. That’s a mouthful.

As if what does and doesn’t have wheat or gluten in it and how gluten can act within your body isn’t confusing enough, the frequently (yet inappropriately) interchanging terminology within the spectrum of gluten-induced conditions is sure to do the trick.

 

For many of you, this may be much further down the rabbit hole than you care to hop into. But because people are jumping on and off the gluten-free diet these days for so many different reasons, it is important to get us all speaking the same language, and to better understand the severity of the various conditions.

To simplify, we are going to break this into three commonly referred to groups. I’ll give you definitions, tell you what happens with each from onset to reaction, and then I’ll cover a general overview on how to test for them. I’ll also share with you a super fun exchange I had with my (ex-) doctor that had me screaming expletives the entire drive home. Lastly, we’ll take a look at why people get so testy about testing.

It’s juicy stuff.

As always, please use this as a basic guide to understanding. Any clinical decisions around diagnosis or treatment should be made with a qualified practitioner who is well educated on the spectrum of gluten sensitivity conditions.

Gluten/Wheat Allergy

Overview:

First off, I need to stress that true food allergies are not the focus of this site. However, it is still an important point to understand as it provides clarity on the overall gluten issue at hand, and because it is serious stuff.

We’re talking about the type of condition that has brought us into a world where packets of airplane peanuts are a thing of the past, the previously benign PB&J is being banned from lunch tables everywhere, and the EpiPen is locked and loaded for inadvertent ingestion. If you don’t live in this nightmare, it might seem easy to dismiss, but for parents who have to keep a constant, vigilant watch over what their child comes into contact with, it’s nothing short of horrific.

A food allergy results in an immediate hypersensitivity reaction, caused by histamines released after exposure. The severity of the reaction can range from hives to anaphylaxis – a potentially life threatening condition which can cause the airways to close.

A true food allergy is common in kids, but rare in adults. The most common foods that people are allergic to include: peanuts, tree nuts (such as walnuts, pecans and almonds), fish, and shellfish, milk, eggs, and soy products. A true wheat allergy is actually quite uncommon.

Onset:

Minutes to hours after wheat exposure.

Testing:

Blood tests looking for IgE (Immunoglobulin E) antibodies or a skin prick test (SPT) would be performed in the office of an allergist/immunologist.

Celiac Disease

Overview:

Celiac disease (CD) is an autoimmune disease, which is an illness that occurs when the body tissues are attacked by its own immune system. Think of joints being attacked in the case of rheumatoid arthritis, or your nerves being attacked due to multiple sclerosis, or the cells of the pancreas being attacked in the case of type 1 diabetes (previously known as juvenile diabetes or insulin-dependent diabetes mellitus).

With CD, antibodies produced in reaction to gluten consumption damage the intestinal villi (small, finger-like protrusions in the wall of your small intestine), whose job it is to absorb food and nutrients. With those important little villi down and out, the results can be malabsorption of food leading to GI distress (i.e. diarrhea), anemia, and sometimes, weight loss.

But, it’s important to note that CD symptoms are not isolated to GI symptoms as historically believed. It has been found that for every one patient with celiac disease who has GI symptoms, there are eight patients that present with completely different issues. That said, all people suffering from celiac disease run the risk of depriving their brain, bones and vital organs of essential nutrients if the disease is left untreated (i.e. if the person continues to consume gluten).

Autoimmune diseases are insidious, and their manifestations can be elusive. They can also create a domino effect within your body, as the presence of one autoimmune disease increases the chance for developing another, simultaneous autoimmune disease. Case in point: CD is associated with many other autoimmune disorders, including RA, type 1 diabetes, lupus, Hashimoto’s, alopecia areata (hair loss) and scleroderma, as well as non-autoimmune chronic diseases and disorders such as Down syndrome, fibromyalgia, and chronic fatigue syndrome. Left untreated (i.e. not committing to a 100% gluten free diet for life), CD can lead to certain cancers (primarily of the small bowel, esophagus and some non-Hodgkin lymphomas), iron-deficiency anemia, early onset of osteoporosis, pancreatic and gallbladder insufficiency, and neurologic issues. And most will go undiagnosed because the symptoms can be so elusive.

Onset:

Weeks to years after ingestion.

Testing:

There is no consensus regarding which symptoms, laboratory abnormalities and/or associated diseases require evaluation for CD. However, a generally accepted, conventional (which also means controversial, which we will discuss at the end of the post) approach is as follows:

  1. Patient has a set of defined symptoms (almost all dealing with poop, so buck up) – chronic diarrhea with weight loss, fat in the stool, abdominal pain after eating gluten.
  1. Patient has blood work to detect CD. The IgA anti-TTG (tissue transglutinamase) antibody is the preferred single blood test, but there are many others that may be used depending on the clinical scenario, including genetic testing due to CD’s strong genetic component. Diving deep into this topic goes beyond the scope of this big picture break-down, but if you’d like to indulge, comprehensive guidelines for diagnosis and management from The American College of Gastroenterology are available. Important to note: for accurate results, gluten cannot be removed from the diet prior to testing. Removing gluten for just weeks could result in a [falsely] negative test.
  1. If blood test(s) come back positive, patient undergoes an upper endoscopy with small-bowl biopsy to confirm the CD diagnosis (i.e. you are put under and a gastroenterologist inserts an endoscope through your mouth and shoots it all the way down to your bowels to look for that damage to your intestinal villi).

Gluten Intolerance/Gluten Sensitivity

These terms are probably the most commonly interchanged, and rightly so for the most part.

There is one school of thought that categorizes a gluten “intolerance” as a non-immune based reaction, and a gluten “sensitivity” as an immune-based and inflammatory reaction. The “intolerance” or non-immune based reaction means there is not a response strong enough to produce detectable antibodies on a blood test, but other “intolerances” could be felt – these could be from sources other than gluten – FODMAPS, salicylates, oxalates, etc. The “sensitivity” or immune-based and inflammatory reaction means an inflammatory response strong enough to produce antibodies that would be detected on a blood test, although not the same antibodies found in celiac disease. That said, the differentiations aren’t uniformly applied, and when the term “intolerance” is used, it is commonly in the context of a “sensitivity” meaning a significant, inflammatory reaction.

So for all intents and purposes, gluten intolerance and gluten sensitivity mean the same thing.

Are you dizzy yet? I know. Keep reading.

Recent literature is recommending using “sensitivity” as the appropriate term to keep some consistency in the discussions (amen!) and it seems to be holding. With this new insight, if you use the term “sensitivity” in the sexy world of gluten research, you’ll be an instant VIP. Congratulations.

To keep things simple here, we’ll use the term “sensitivity” or “sensitive.”

Overview:

When gluten sensitive, our immune system creates an overabundance of IgG (immunoglobulin G) antibodies to gluten, which bind directly to the food as it enters the bloodstream. This immune reaction can be delayed, which is why it is also commonly referred to as a delayed hypersensitivity. Reactions can appear anywhere from a couple of hours to several days after consumption. This is in contrast to a food allergy, when the response is immediate (and most likely more acutely life threatening).

An example of delayed hypersensitivity is migraine headaches, which commonly appear about two days after the problematic foods are consumed. For me, I notice joint pain several hours after consumption of gluten.

Like CD, gluten sensitivity has a genetic aspect. It is seen by some to also be an autoimmune disease; but there is some debate around that. However, with gluten sensitivity – in contrast to CD – damage to the intestinal villi usually does not take place and the comorbidities may be less. This is why you may also hear gluten sensitivity referred to as “non-celiac gluten sensitivity” to make that differentiation clear. However, as I have noted in my previous posts, even gluten sensitivity without celiac disease can lead to serious health concerns.

Symptoms for CD and gluten sensitivity commonly overlap, but in gluten sensitivity they are more likely to be outside of the traditional gastrointestinal symptoms, i.e. behavioral changes, bone or joint pain, muscle cramps, leg numbness, and/or fatigue.

Onset:

Hours to several days after exposure to gluten.

Testing:

Gluten sensitivities (as well as other food sensitivities) can be done via blood tests looking for IgG antibodies (most common), IgA or IgM antibodies. You may have heard of such tests performed by various labs like Cyrex or Metametrix (now Genova). Ironically, these tests are sometimes inappropriately called food allergy testing. No wonder there is so much confusion.

These tests can be helpful and provide a good piece to the overall individual’s health puzzle, but there are some limitations and a false negative (you do have a sensitivity, but your test reads negative) is usually the biggest issue. (Like with CD, if you do pursue this kind of testing, do so before removing gluten from your diet.)

  1. Some tests are not comprehensive enough – they only test one type of IgG or they don’t test IgA or IgM. Also, there is currently not one available that tests for all the 1000’s of wheat protein fractions that one could have a reaction to.
  1. You could react differently to the raw form of food (most commonly used to test for antigens) than you do cooked.
  1. They are expensive and usually not covered by insurance.

So, the best way to test for a sensitivity is to completely eliminate gluten from your diet (not even a single crumb of that red velvet cupcake!) for at least two weeks, ideally 4-6 weeks. This is commonly called an elimination diet. See if your symptoms improve. If they do, it is best not to reincorporate – just avoid consuming it. However, there are other schools of thought that dictate consuming in small amounts to see if the negative reaction occurs.

Based on the many paths that could be taken, and the lack of recognition by conventional medicine, it’s easy to see why it takes five physicians, and 10-11 years on average to diagnose a gluten sensitivity. But the fact is that there are six times as many people with a gluten sensitivity than there are people with CD. We’re talking about 18 million people, folks. So it’s important – if you feel this describes what’s happening in your body, acknowledge it, and explore your options.

Getting Testy

Celiac disease is often considered the more critical condition on the spectrum of sensitivities to gluten, which is understandable given the well-documented history of manifestations. However, it’s also commonly thought of – by conventional medicine and the uninformed/skeptical public – as the ONLY valid condition connected to any type of sensitivity (and morbidity) related to gluten. And the caboose on that train of thought is that without a confirmed celiac diagnosis there is no need to go on a gluten-free diet.

This really lights me up. It’s not only dismissive, it’s inaccurate. And studies published in some of the most beloved Western medical journals – The Journal of the American Medical Association (JAMA) and the New England Journal of Medicine – have shown that it’s blatantly incorrect.

There has been some progress made on this front. In response to recent research focused on the spectrum of gluten reactions, the testing for gluten sensitivity can now be integrated with testing/differentiation of celiac disease. However, according to the American College of Gastroenterology, “a diagnosis of non-celiac gluten sensitivity should be considered only after CD has been excluded with appropriate testing.”

And to either confirm the diagnosis or rule it out, it requires the upper endoscopy small bowel biopsy.

This is where it gets a little controversial.

Conventional medicine stands behind the requirement of confirming the CD diagnosis to mandate the need for a gluten-free diet. However, more progressive practitioners don’t believe the above approach is always necessary to start the gluten-free diet. A few reasons why:

  1. The primary methods to detect and confirm the diagnosis (the transglutaminase blood test and the small bowel biopsy) require significant villous atrophy (death of the tissue in your small intestine), meaning you are at a later stage in the disease. The majority of people on the celiac spectrum are at early stages, so this test is not helpful. Thinking logically – would you want to wait for serious damage to be done before finding out the issue at hand and the way to prevent and correct it?
  1. Recent studies have shown that blood tests alone showing elevations in various IgG & IgA antibodies are reason enough to go off of gluten because of the significant risks of non-celiac gluten sensitivity (and the increased risk in morbidities & mortalities in this condition alone).
  1. Going under anesthesia and having a large piece of hardware shoved down your throat and down into your bowels kind of bites. Many would feel that anything to avoid this invasive procedure, while still properly treating the condition, would be a good game plan.

And whether you have celiac disease, a gluten sensitivity or just don’t want your intestinal health disrupted – the only answer is to eliminate gluten from your diet.

However, on the other side of the coin, the CD testing and subsequent diagnosis should ensure that you are getting the proper follow-up care from a team focused on the condition, which hopefully keeps you compliant with the gluten-free diet and improves the inflammation in your gut. Getting a specific diagnosis could also enhance future research on the disease. And, because of the strong genetic link with CD, it could alert family members of possibly having the condition as well.

So, should you get tested? The short answer is, you have to decide for yourself. For comparison, here’s how my journey led me to where I am now:

I have had blood work done to detect CD, but with conflicting results. Soon after my RA diagnosis (and before I went gluten free), I had a tissue transglutaminase test come back with a “weak positive,” (indicative of CD) and a negative result for the wheat IgG on the same blood draw. At the time, all of this was quite confusing. Granted, it occurred at the height of my “Holy shit, I have a new debilitating autoimmune disease and a newborn baby, both of which are kicking my ass” fog. To be honest, at the time I was having a hard time staying awake in general, so seeking out a gastroenterologist and researching the pros and cons of small bowel biopsies was not something I had the mental, physical, or emotional capacity for. I was lucky if I could take a shower and throw a PB&J down my throat on a daily basis.

To make matters worse, I was having a less-than-fabulous experience with my very conventional-minded rheumatologist. Quick refresher on that story: He was the charmer who told me I should feel lucky I was not in a wheelchair on my first visit after learning of my RA diagnosis. So I simply couldn’t bring myself to pack up the diaper bag and haul ass – baby in tow – to another doctor’s appointment that would for sure end with me crying in public.

However, the silver lining was that his brutal comment was enough inspiration for me to find better solutions, and with the help of my naturopathic doctor, embrace an anti-inflammatory (or elimination) diet. And I saw amazing results.

On a subsequent appointment with Dr. Wheelchair, after I openly disclosed I had completely eliminated gluten from my diet for several weeks, he ordered CD blood work. He simultaneously dismissed my report that after eliminating gluten, dairy, corn and soy, my fatigue and joint pain virtually disappeared.

The conversation went something like this:

Dr.: So, how have you been feeling?

Me: So much better! I went on the anti-inflammatory diet a couple of months ago – taking out gluten, dairy, corn and soy – and now my joint pain and fatigue has almost completely resolved.

[awkward pause as I waited for him to show some reciprocal excitement]

Dr.: Yeah, some people make a big deal out of that diet stuff.

[second awkward pause while I swallowed rising venom so I could speak without snarling]

Me (seething): Well, previously I was barely able to get out of bed, and my joint pain was so bad I could barely hold my daughter, so yeah, I would say it IS a big deal [asshole].

Dr. (befuddled): What did you take out of your diet again?

Me: Gluten, dairy, corn & soy, primarily. Not eating much sugar. Trying to avoid peanuts. I’m still taking my omega-3 supplements [which, by the way, he hadn’t volunteered research on until I pressed for it].

Dr.: Okay, I’m going to test you for celiac.

I just nodded in silence, incensed that I was in the care of someone who was not only unwilling to take a holistic look at the situation, but who was also so dismissive about nutrition. I knew that because I had cut gluten out of my diet several weeks prior, his recommended test would likely be negative regardless, and not surprisingly, I was right. The test results were negative.

So whether that means I never had CD in the first place – or that my gluten-free diet was just effective in eliminating the gut inflammation within the several weeks prior to testing – I don’t know. And for me, that’s okay. I have no desire to add gluten back into my diet for an extended amount of time (what is called a “gluten challenge”) to be tested again. I know that consuming gluten will exacerbate my potentially debilitating autoimmune condition, sending me right back to pain and fatigue – regardless of whether I have CD or not – and that is enough motivation to continue with a gluten-free diet.

I have since found a lovely, new rheumatologist who is fully supportive of managing my symptoms with my diet. And I’ve also tested positive for other anti-bodies, and negative (again) for CD. So, I have a diagnostic confirmation that I have some type of sensitivity to gluten, but it doesn’t matter. Honestly, I’m happier about the fact that my new doctor hasn’t once mentioned a wheelchair.

That was my path…what will yours be? The journey and the result are up to you. Suffering through a progressively debilitating disease is way scarier than eating quinoa pasta, if you ask me. So either take steps towards eliminating gluten from your diet on your own, or get to the doctor. Because if you have chronic symptoms that could be consistent with CD, simply dabbling in this gluten-free thing will not help you. (Remember that chat we had earlier about cancer? Yeah. You simply can’t phone this one in.)

Bottom line: you have to take action. If a blood test or a diagnostic procedure lights the fire that you need in order to commit to life-long compliance with a gluten-free diet, get after it. Work alongside a qualified healthcare practitioner, one well informed on the complete spectrum of gluten sensitivity issues. And that might be hard to find, but don’t settle. A good option is to look for a physician trained in functional medicine.

Along the way, be open to what you might find out. Keep in mind that tests are sensitive, and parameters shift depending on which test is being done. Ask questions. Be your own tireless advocate. Remember that a negative test result could be false. If you continue having symptoms, don’t assume the test is right and you’re wrong. Listen to your body and respect what it’s telling you, even if it doesn’t sync up with popular commentary. Testing negative for CD does not necessarily mean you don’t have a sensitivity, or that continuing to consume gluten won’t otherwise wreak havoc on your system.

Putting the Pieces Together

This was a lot to take in. So that it sticks, here’s the quick review for you:

  • Wheat Allergy = Immediate, sometimes very severe reactions. Test for IgE antibodies. True wheat allergy is rare.
  • Celiac Disease = Autoimmune disease with damage to intestinal wall. Immediate OR latent/hidden/elusive symptoms. Test for IgA antibodies (and/or others, including genetic tests). Conventional medicine requires a biopsy of the small bowel for confirmation of the diagnosis.
  • Gluten Sensitivity = Immediate OR latent/hidden/elusive symptoms. Test for IgG antibodies (most common), also IgA or IgM. Can also be tested with an Elimination Diet.
  • “Gluten Sensitivity” = “Gluten Intolerance” = “Non-Celiac Gluten Sensitivity” (“sensitivities” now the more accurate term).
  • If you do get tested for Celiac Disease and it is negative, don’t discount that you could still have a Gluten Sensitivity (which comes with its own risk of increased morbidities and mortality, even without celiac disease).
  • Work with a qualified practitioner well versed in the spectrum of conditions of gluten sensitivity for diagnosis, and work with a qualified nutrition professional to adopt a gluten-free diet in a healthy manner.

Okay. You still with me? Let this information sit a while. Think about it, read it again, do some research. Keep in tune with your body – it’s going to tell you in lots of different ways how you’re doing. I know there are a lot of solutions, and a lot of information out there. Some answers will be definitive and some will leave you with more questions. But the most important thing you can do is this: Weigh how you feel against what you’re willing to do in order to feel better, and then choose from your available options from that point.

Personally, I don’t need a biopsy to tell me how I feel when I eat gluten at this point. My body tells me loud and clear. So I follow the gluten-free diet religiously. It’s not about skinny jeans, or fads, or being viewed as the difficult diner when we’re out to eat. For me, it’s about my health, personal wellness, and honestly – my sanity. If I don’t feel good, I’m not putting good into the world via my kids, my marriage, or my work. I avoid gluten because I can’t afford to lay in bed suffering, and I refuse a life of pharmaceuticals and/or pain. Besides, my kids are little and I want to see them get big. That’s what it boils down to for me. My little people are relying on me to be my best, and this is what it takes for me to be there for them. I owe it to them, but even more so, I owe it to myself to be healthy and happy.

Don’t you?


References:

  1. “Diagnosis & Testing – Food Allergy Research & Education.” Food Allergy Research & Education. N.p., n.d. Web. 18 May 2014.
  2. Rubio-Tapia, Ablerto, MD, Ivor D. Hill, MD, Ciarán P. Kelly, MD, Audrey H. Calderwood, MD, and Joseph A. Murray, MD. “ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease.” The American Journal of GASTROENTEROLOGY 108 (2013): 656-76. Web.
  3. Sapone, Anna, Julio Bai, Carolina Ciacci, Jernej Dolinsek, Peter HR Green, Marios Hadjivassiliou, Katri Kaukinen, Kamran Rostami, David S. Sander, Michael Schumann, Reiner Ullrich, Danilo Villalta, Umberto Volta, Carlo Catassi, and Allesio Fasano. “Spectrum of Gluten-related Disorders: Consensus on New Nomenclature and Classification – Springer.” BMC Medicine13 (2012): n. pag. Spectrum of Gluten-related Disorders: Consensus on New Nomenclature and Classification – Springer. BioMed Central, 01 Feb. 2012. Web. 12 Feb. 2012.
  4. Bizzaro, N., R. Tozzoli, D. Villalta, M. Fabris, and E. Tonutti. “Cutting-Edge Issues in Celiac Disease and in Gluten Intolerance.” Clinical Reviews in Allergy & Immunology3 (2012): 279-87. Web.
  5. “Celiac Disease: On the Rise.” Mayo Clinic’s Online Research Magazine. Mayo Clinic, July 2010. Web. 16 May 2014.
  6. “Screening – Celiac Disease Foundation.” Celiac Disease Foundation. N.p., n.d. Web. 15 June 2014.
  7. Matthews, Julie. “Food Allergies and Sensitivities and Gluten-Free/Casein-Free Diet.” Bioindividual Nutrition Advanced Training for Practitioners. 21 July 2014. Lecture.
  8. O’Bryan, Tom. “The Evolution of Autoimmune Disease.” The Evolution of Medicine. 14 Sept. 2014. Lecture.

 

 

Gluten 2: Gluten. What?

Dog. What.When everyone from your neighbor to your life coach is recommending a gluten-free diet, it’s easy to make light of the impact it can have. But just because we hear the term “gluten” 65 times a day doesn’t mean we know what it actually means or why we should consider living without it.

Now that we’re straight on how the gluten-free chatter has become so pervasive (whether derived from well-intended sources or those with not-so-altruistic motives), it’s time to move beyond the skewed and snarky headlines and get truthful answers on what really matters: What IS gluten, how do you avoid it, and why would you want to?

Let’s start at the beginning.

All foods are made up of 3 macronutrients – carbohydrate, protein and fat. Gluten is the protein complex that exists in grains, namely wheat, rye, spelt and barley.

Gluten is a very large protein and it is very difficult to digest. In fact, the human body doesn’t completely digest gluten at all. And there are many concerns (that were addressed in my last post) with the way our conventional, gluten-containing grains are processed and harvested today that make them especially harmful. To refresh, we’re talking about Category 2B carcinogens and glycophosphate herbicides to expedite the harvesting process and increase the yield.

Common sense would indicate (correctly) that this doesn’t sound beneficial to anyone, but for some, it creates a whole world of hurt.

This is the case for people with celiac disease, autoimmune and other inflammatory conditions and also for those with a disruption in their microbiome. As a quick refresher, this is when your intestinal lining is more tennis net than it is cheesecloth (due to a lack of enzymes and good bacteria), making it too permeable or “leaky.” As we’ve touched on in earlier posts, a “leaky gut” or “intestinal hyperpermeability” state often leads to disease. And unfortunately, medications to treat many of those diseases have a side effect of…you guessed it: even leakier guts. But, let’s say your microbiome is right as rain. You’re still not exempt, as consuming high amounts of gluten can lead to future problems. Because when you eat gluten, it causes the release of a protein called zonulin, which unzips the “tight junctions” that hold together a currently intact intestinal lining. 

Let’s face it: if your body was a stage, then gluten would be the character actor in every show. The act is sometimes subtle, sometimes brash, but gluten is always a major player, creating chaos in one way or another. Here are a few of gluten’s most popular personas. 

The Drunk Uncle

Gluten can become a sneaky annoyance once it’s inside of anyone’s body. In this role, gluten plays the drunk uncle you never invite to Thanksgiving but who always seems to show up anyway. He’s the guest who ends up stumbling around the house, bumping into guests and breaking things. When he’s in your home, you can minimize destruction by quietly taking his cocktail and guiding him into a cab with a smile and a wave. When he’s in your body, your brilliant internal system recognizes that drunk Uncle Gluten is where he shouldn’t be, and the attack is on (by way of inflammation).

Using my rheumatoid arthritis (RA) as an example – when I consume gluten, I have a hard time digesting it. It sits there bored in my intestine for a minute, then sneaks out through my tennis net gut lining before it has had enough time to marinate in the proper digestive juices and starts stumbling around. Eventually – and inappropriately – it gets into my bloodstream, and finally, sets itself up in my joints. My body recognizes it as a toxin, and attacks it. As a result, I develop hot, stiff, and achy phalanges. I generally lay there cursing whatever food, person or restaurant snuck that gluten into my meal and my system. I have since been able to make progress in healing my gut and closing up that tennis net, but gluten – with its ability to continue to cause more damage – is never going to make my dietary lineup.

Turns out, the fact that I have RA and a gluten sensitivity is not a coincidence. It has been shown that 48% of patients who have recently developed RA also have anti-gliadin antibodies (inflammation-causing antibodies produced by your body in response to consuming gluten). Researchers have also found celiac disease to be over five times more common among those with RA.

So for me – and for many of my RA brothers and sisters  – gluten is an unnecessary evil. And if you find yourself with achiness, digestive issues or other chronic symptoms you can’t explain, consider that gluten might be an unnecessary evil for you too.

The Nasty Best Friend

We’ve all heard the phrase “birds of a feather flock together.” Every bad guy always seems to have an equally toxic wingman. In the role of Nasty Best Friend, gluten plays that partner in crime. It’s not only linked with RA, it pals around with many other autoimmune diseases and chronic conditions as well. Here’s a sampling:

  • infertility
  • endometriosis
  • autism
  • skin conditions (e.g. psoriasis, eczema)
  • digestive disease
  • mood and cognitive issues including ADHD, anxiety and depression

And in the case of celiac disease, avoiding gluten is the ONLY treatment currently available. Continuing to consume gluten could have grave health consequences, including cancer and death. A recent study in the Journal of the American Medical Association (JAMA) found that people with celiac disease had a 39% increased risk of death. A 72% increased death rate was found in those with gut inflammation related to gluten, and there was a 35% increased risk of death in those with gluten sensitivity independent of celiac disease. The scariest part? It is estimated that 99% of people who have a sensitivity to gluten (wherever it may be on the spectrum) aren’t even aware of it.

Gluten is no joke. This is why I’m not letting you phone it in when it comes to looking into a possible sensitivity. And for those concerned with the conventional-minded headlines about the “dangers of the gluten-free diet,” I have a newsflash of my own: Wheat and gluten are not essential nutrients. We don’t have to consume either as part of a healthy diet. There are approximately zero nutrients exclusive to gluten-containing grains that can’t be found elsewhere.

The Sexy Bad Boy

Think about your favorite naughty, racy character. He’s beguiling and he’s everywhere you turn – especially in moments of weakness. The more you have, the more you want, until your appetite becomes insatiable. Why? In this case, it’s because gluten plays with your head. Literally.

If you are not completely breaking down the gluten, protein peptides can form and act on opiate receptors in the brain, mimicking the effects of opiate drugs (like heroin or morphine). Not only does this cause the obvious addiction to more of the gluten-containing food, it has been shown that these “neuropeptides” can affect cognitive function, and react with the temporal lobes involved in speech and auditory integration. This is one reason the gluten-free, casein-free diet has been so effective for autism in particular, as well as ADHD, depression and anxiety.

But gluten doesn’t just play mind games, it feeds our addiction for it by being positively insidious. It can be found in a really wide range of foods (not just grains), and it can also be found in processing plants, which can turn something without gluten, into something with gluten.

Here are a few examples of the trickery:

  • Buckwheat does NOT have gluten, but is likely contaminated with gluten during processing with other gluten-containing grains.
  • Spelt DOES have gluten in it, but it is NOT wheat.
  • Various prepared foods, beer and other alcohol, sauces, flavorings and condiments are often hidden land mines, because they use wheat or wheat derivatives as fillers. For example, soy sauce DOES have wheat in it – so it DOES have gluten. Wasabi may have wheat it in it. Sometimes balsamic vinegar has wheat. And unless “real” or “King” crab is specified, your California Roll is stuffed with artificial crab, which features – you guessed it – gluten. 

Confused? Don’t fret. A complete list of gluten sources – including hidden sources – is available here. And, I will be making other helpful tools available to you soon. In the meantime, here’s a sneak peek.

AVOID:

  • All products made with wheat (durum, farro, graham, kamut, semolina, spelt, triticale, einkorn, wheat berry, wheat germ, wheat germ oil, wheat grass or triga, wheat gluten, wheat nut and wheat starch)
  • Rye
  • Barley
  • Couscous
  • Bakery items used with grains from the first bullet (breads…I know, this one hurts…keep reading)
  • Soy sauce (not because of the soy itself, but because of the wheat)
  • Many food starches, e.g. modified food starch. (This will include most breads, muffins, cookies, pastas, beer, breaded/fried foods, and many packaged foods.)

ALLOWED:

  • Rice
  • Corn (maize)
  • Soy
  • Potatoes (all types!)
  • Tapioca
  • Beans
  • Garfava
  • Sorghum
  • Quinoa
  • Millet
  • Buckwheat*
  • Arrowroot
  • Amaranth
  • Teff
  • Flax
  • Nut flours
  • Certified Gluten Free Oats*
  • Wine and most distilled spirits (Hallelujah!)

*Often grown or processed with other gluten-containing grains, leading to cross-contamination with wheat, barley or rye. Be sure to look for the gluten-free certification.

A Peek Backstage

Gluten may be front and center in this conversation, but behind the curtain is where it all comes together. Let’s strip it down and see what gluten is really made of.

To understand gluten, you have to know the protein fractions it breaks down into – gliadins and glutenins. There are actually 10’s of 1000’s of protein fractions in wheat, but gliadin is thought to be the most harmful to the digestive tract for persons with gluten sensitivity or celiac disease because of its ability to illicit an immune reaction. So, in all honesty, gliadin is the primary troublemaker here. Gluten is just a more generalized and familiar term. This is why you will hear of gliadin, especially as it relates to food labeling. Gliadin is what is actually measured in meeting thresholds for “gluten-free” certification standards. For example, the World Health Organization (WHO), and now the FDA as of August 2013, require foods labeled “gluten-free” to be lab tested to assure gliadin levels are less than 20 parts per million (ppm). Don’t get too bogged down with these details now (or ever really, unless you want to). We will cover exactly what you need to know as far as food labels go in later posts.

That’s A Wrap

Have you noticed a theme? Gluten is never cast as America’s Sweetheart. It’s always the one who comes in rude and reckless. And yet, whether obvious or stealth, gluten is – for many of us – playing a starring role on our plates. I don’t suggest eliminating a mainstay of your diet as an intentional buzz kill. (I mean, it’s totally a buzz kill, but it’s for your own good.)

It may be hard to see now, but I promise you – I used to preach the food pyramid and love my bread. I was starch-obsessed, grain-heavy, and vegetable-averse, until I was also aching and crazy. Now I eat differently, and feel better, and once you make it through the change, you won’t ever look back.

So no matter what your pantry looks like today, I encourage you to take a ride with me on this gluten-free journey. It’s a tricky path at first, so do it slowly, and carefully – and ideally, work with a knowledgeable practitioner. Take the time to learn, try new things, and find out what works best for you.

Because whether you have a recognized sensitivity or a diagnosed disease – or you just don’t feel great and don’t know why – know this: If you take gluten out of your diet, you could literally be saving your own life…and that tastes better than any wheat-laden meal ever could.

And at this point, if you aren’t sure if you could have a sensitivity or celiac disease (or what the difference is between the two), don’t panic. My next post will demystify the diagnoses. Stay tuned.

 


References

  1. Challem, Jack. The Inflammation Syndrome: The Complete Nutritional Program to Prevent and Reverse Heart Disease, Arthritis, Diabetes, Allergies and Asthma. Hoboken, NJ: J. Wiley, 2003.
  2. Braly, James, and Ron Hoggan. Dangerous Grains: Why Gluten Cereal Grains May Be Hazardous to Your Health. New York: Avery, 2002. Print.
  3. Bizzaro, N., R. Tozzoli, D. Villalta, M. Fabris, and E. Tonutti. “Cutting-Edge Issues in Celiac Disease and in Gluten Intolerance.” Clinical Reviews in Allergy & Immunology3 (2012): 279-87.
  4. O’Bryan, Tom. “The Evolution of Autoimmune Disease.” The Evolution of Medicine. 14 Sept. 2014. Lecture.
  5.  Ludvigsson, J. F., S. M. Montgomery, A. Ekbom, L. Brandt, and F. Granath. “Small-Intestinal Histopathology and Mortality Risk in Celiac Disease.” JAMA: The Journal of the American Medical Association11 (2009): 1171-178. NCBI. Web. 15 June 2014.
  6. Potocki P, Hozyask K. Psychiatric symptoms and coeliac disease. Psychiatr Pol. 2002 Jul-Aug: 36(4):567-78
  7. Pynnonen PA, Erkki T, Isometsa ET, Verkasalo MA, Kahkonen SA, Sipila I, Savilah E and Aalberg VA. Gluten-free diet may alleviate depressive and behavioral symptoms in adolescents with coeliac disease.BMC psychiatry. 2005
  8. Fukudome, Shin-ichi, and Masaaki Yoshikawa. “Opioid peptides derived from wheat gluten: their isolation and characterization.” FEBS letters 296, no. 1 (1992):107-111.
  9. Kalaydijian AE, Easton W, Casella N, Fasano A. The gluten connection: the association between schizophrenia and celiac disease. Acta Psychiatr Scan. 2006 Feb;113(2):82-90.
  10. Matthews, Julie. “Food Allergies and Sensitivities and Gluten-Free/Casein-Free Diet.” Bioindividual Nutrition Advanced Training for Practioners. 21 July 2014. Lecture.

 

Gluten 1: Gluten is the New Black

Young attractive ladyGluten is the new black. It’s televised, evangelized, tweeted, and hashtagged as the cure-all to every weight, health, and cellulite problem anyone has ever had. Right? Well, not exactly.

“I’m gluten free!” is likely the most polarizing statement in the health community today. Progressive practitioners (and their clients) devoutly stand by the role gluten can play in inflammation and overall immunity, while conventional medicine dismisses its legitimacy and even condemns the “dangers” of a gluten-free diet.

Mainstream media has dutifully played its role by jumping on the topic and constantly feeding us the hype, and then rejoicing in the opportunity to run a follow up feature with the gluten-free tag as the villain. But as with most stories, there are three sides: His, hers, and the truth. And in this case, the truth lies somewhere in the middle.

For the most part, gluten’s overexposure – and the awareness it brings – is positive. When every news medium is covering it from CNN to US Weekly, it sheds a much needed spotlight on the physiology and benefits of the gluten-free diet. All press is good press – especially when it brings to light the fact that gluten is linked to over 50 different disease states. Along the way though, the attention from the media has given gluten-free a bit of a bad boy complex. It’s seductive and full of promises, but it doesn’t always deliver in the way one might hope. Depending on your intentions, the gluten-free road can be a convoluted one, and it can result in less-than-optimal eating.

There’s a TON of information out there – some of it skewed towards making sales numbers pop, and some of it downright conflicting. But, it’s essential that we get some clarity on the topic. Quite literally, if we don’t rise above the hype and misinformation, and get to a place of sound, actionable information, it’s an issue of life or death for some.

It is estimated that about 1% of Americans have celiac disease and that for every one person with celiac disease, there are an estimated six or seven people with non-celiac gluten sensitivity.
For this population, it has been shown that there is a 35-72% increased risk of death (primarily due to cancer, heart and respiratory disease, but other causes are at play here as well).

In a later post, we’ll discuss the complex differences between sensitivities to gluten and celiac disease, but for now I want to start a little broader. (It’s always easier for me to learn when I first get some context around the bigger issue at hand.) So before diving into the physiological weeds, let’s back up and look at why we’re talking about gluten in the first place.

Gluten’s Rise to Fame

How did this little protein fraction get itself on the map? And why are everyone and their dog on a gluten-free diet?

Well, there are multiple factors that have led to the awareness around, and increased prevalence of, gluten sensitivities.

1. Celiac Disease Gets its Day in the Sun. Kind of.
Celiac disease is four times more common now than 60 years ago, affecting an estimated 1 in 100 people (that’s three million Americans, people). The gluten-free message is getting more play because the only current treatment for the disease is eliminating gluten from your diet. The disturbing part is that despite this rise in recognition, 83% of people with celiac disease are unaware of their issue. Still work to do, indeed.

2. Progressive Practitioners Get It.
Increasingly, Americans are seeing progressive and functional medicine practitioners who take a more holistic approach to wellness. Overall, a progressive education has a more robust focus on nutrition than conventional medicine. For example, gluten has received a lot of attention in forward-thinking and effective treatments for conditions along the autism spectrum and ADHD. Also, progressive practitioners may more readily implement practice changes based on current research, where conventional medicine can be beholden to standard reimbursement rules and regulations. Case in point: It has been found that it takes seeing – on average – five physicians and 10-11 years to diagnose gluten sensitivity or intolerance when using conventional means.

3. Celebrity Evangelism.
This is where gluten really gets its time in the limelight. The progressive practitioners who impart accurate wisdom around the critical role gluten can play in our health don’t always take insurance. If they do, they can’t bill insurance for the services that can be most effective, like removing food sensitivities. So for the most part, they end up preaching to a pretty exclusive choir – namely the stars that can pay out of pocket each time, for every visit. Not only can celebrities afford these kinds of appointments – it’s their job to learn about anything that will make them look and feel their best, considering how they are scrutinized by the media, and the fact that their health, appearance and weight frequently determines whether they work or not. The more they are on screen, talking about their gluten-free lifestyle, the more they are talked about (and emulated). I am in no way condoning that we should receive health advice from celebrities (quite the contrary), but we can’t deny the buzz around how going gluten free has our favorite A-listers feeling amazing.

4. Big Food Getting into the Game.
This one is a two-sided coin. You can’t ignore the power that food manufacturers have on public awareness – whether their intentions are authentic or they are just trying to grab their piece of the ever-expanding gluten-free pie. Big food has been promoting their gluten-free lineups like it’s their job. Well, technically it is their job, I know – but it still doesn’t make it right to fool customers with their misleading marketing claims. The product might be gluten-free, but at what expense? Do you know what they use instead of wheat and other gluten-containing grains? Cornstarch, white rice, potato flour/starch, added sugars, and a whole bunch of other insulin-spiking, chemical-laden, inflammatory, and otherwise worthless ingredients. Nevertheless, it is still spreading the gluten-free word.

5. Thinking Paleo.
So why would what is promoted as one of the mainstays of our diet be the source of such digestive, immunological grief? To explain this point I need to go a little Paleo on you for a minute. Humans have been on earth for around 2 million years. Grains containing gluten were only introduced about 10,000 years ago. Add to that the fact that 30 percent of people of European descent carry the gene for celiac disease. Therefore, there are theories that this mismatch, or lack of genetic adaptation, has caused an “evolutionary challenge” that created adverse human reactions to gluten.

6. Body Burdened.
Another possibility as to why there is such an increase today in not only gluten sensitivities, but all sensitivities (including allergies) is a general toxic overload of our system or what is known as “body burden.”

There are now over 3000 chemicals added to our food supply, and more than 75,000 chemicals used for other purposes in North America. We are inundated with chemical-based products every day – pesticides on our non-organic foods, artificial fragrances in perfumes, lotions, hair products, room sprays, cleaning supplies, fabric softeners…the list goes on. Even if you are vigilant about insisting upon fragrance-, phthalate- and paraben-free cleaners and cosmetics, VOC-free paint, and organic produce, you are likely inadvertently exposed in the environment. Heavy metals, including lead, are in our water, and chlorine and other volatile organic compounds are used in many products that surround you.

As your body gets older and those exposures accumulate, the health of your digestive system is compromised (i.e. dysfunction within your microbiome – the cornerstone of your immune system) leading to decreased resistance to other foreign bodies (e.g. foods you don’t tolerate), which also helps explain the increase in sensitivities over the years.

I don’t say this to induce an OCD episode that has you searching for a bodysuit made of bubble wrap. These are things we simply can’t control most of the time. But you can control what you eat and make better choices to lower this burden.

And finally…

7. Frankenwheat.
Today, it’s not only the process that’s different, it’s the product.

Back in your granny’s day, dough was mixed in the KitchenAid and left to rise overnight on the counter. This rising process – part of the traditional method of baking – allowed a higher portion of the gluten to be assimilated by the yeast. So home-baked bread was not only delicious, it naturally had less gluten in it. The majority of bread is now made in commercial kitchens designed for maximized efficiency. The quick-producing, industrialized methods allow little time for the yeast to ferment, which means the dough retains more gluten.

Additionally, a powdered, concentrated form of gluten – vital wheat gluten – is commonly used as an additive in the U.S. in place of the naturally occurring gluten formed from kneading the dough to provide better baking properties (read: less waste, higher margins) – heat resistance, elasticity, malleability, longer shelf life.

Making matters [much] worse, instead of naturally allowing the dough to age in the open air, potassium bromate is used to expedite the process. (Of note, potassium bromate has been labeled as a Category 2B carcinogen by the International Agency for Research on Cancer (IARC) and it is banned throughout the European Union, Canada, Nigeria, Brazil, Peru and China.)

Farming methods are also a concern. Although genetically modified wheat is not on the market (yet!), conventional wheat is still doused in the glycophosphate herbicide (read: RoundUp, read: Monsanto) just prior to harvest to increase the yield.

Finally, once the bread is baked and packaged, it often has genetically modified ingredients added to it – namely corn and soy – which are hard for our internal systems to tolerate (we’ll school you on GMO’s and pesticides in later posts).

To sum it up, no matter what form the wheat ends up taking – we start with grain that is harvested and processed in a way that leaves it loaded with a toxic herbicide, and manufactured in a way that not only increases the gluten, but introduces a synthetic, concentrated gluten additive. And as consumers, we are supersaturated with this super gluten, as it’s tucked away inside product after product.

So if your body can’t tolerate gluten or wheat, you might feel like you’re sitting under a tree full of birds without an umbrella. The shit is just everywhere.

So. Now you know.

And really, it’s no wonder gluten is all the rage. The gluten-free sermon is being preached far and wide, with a lot of the mainstream messages being clouded with punchy sales pitches and mischievous marketing twists.

But I figure you came here for the truth, so I’m going to keep giving it to you.

You’re going to want to read the next post sitting down, because the ride on the way to learning what gluten actually is – and more importantly, what is does – gets a little bumpy.

See you next time.


References:

  1. Ludvigsson, J. F., S. M. Montgomery, A. Ekbom, L. Brandt, and F. Granath. “Small-Intestinal Histopathology and Mortality Risk in Celiac Disease.” JAMA: The Journal of the American Medical Association11 (2009): 1171-178.
  2. “Celiac Disease: Fast Facts.”Celiac Disease: Fast Facts. National Foundation for Celiac Awareness, n.d. Web. 03 Feb. 2015.
  3. Farrell, Richard J., and Ciarán P. Kelly. “Celiac Sprue.” New England Journal of Medicine3 (2002): 180-88.
  4. Matthews, Julie. “Food Allergies and Sensitivities and Gluten-Free/Casein-Free Diet.” Bioindividual Nutrition Advanced Training for Practioners. 21 July 2014. Lecture.
  5. Pietzak, M. “Celiac Disease, Wheat Allergy, and Gluten Sensitivity: When Gluten Free Is Not a Fad.” Journal of Parenteral and Enteral Nutrition1 Suppl (2012): 68S-75S.
  6. Bizzaro, N., R. Tozzoli, D. Villalta, M. Fabris, and E. Tonutti. “Cutting-Edge Issues in Celiac Disease and in Gluten Intolerance.” Clinical Reviews in Allergy & Immunology3 (2012): 279-87.
  7. Davis, Brenda, RD. “Cutting Edge Nutrition.” Interview by John Robbins. 2014 Food Revolution Summit. 30 Apr. 2014.
  8. “Trade Secrets: A Moyers Report.” Interview by Bill Moyer and Sherry Jones. PBS. N.d. Television. Transcript.
  9. Samsel, Anthony, and Stephanie Seneff. “Glyphosate, Pathways to Modern Diseases II: Celiac Sprue and Gluten Intolerance.” Interdisciplinary Toxicology4 (2013): 159-84.
  10. Kurokawa, Y., A. Maekawa, M. Takahashi, and Y. Hayashi. “Toxicity and Carcinogenicity of Potassium Bromate—a New Renal Carcinogen.” Environmental Health Perspectives 87 (1990): 309-35.
  11. Food Additives Linked to Health Concerns.” Environmental Working Group. Environmental Working Group, 12 Nov. 2014. Web. 04 Feb. 2015
  12. “Last Eval.: Potassium Bromate (IARC Summary & Evaluation, Volume 73, 1999).”INCHEM. International Programme on Chemical Safety, 1999. Web. 04 Feb. 2015.

A Blueprint: 10 Steps to a Clean, Anti-Inflammatory Diet

BlueprintI realize these first few posts have been a bit heavy on theory. Thank you for indulging me.

See, I felt the need to light a fire. To take you to school for a minute, if you will. I’m driven to teach why these clean eating, anti-inflammatory principles are so important. I am called to shift paradigms, even as I realize the challenge it will be, given the misguided mainstream messages we’re fed.

I have – and I will share – a lot more background on what to eat, what not to eat, and why. But I’m sensing many of you are ready for some more applicable insights. Something tangible for those of you who might be thinking, “Great info, now what the hell am I supposed to do with it?!”

So this week I’m channeling my inner architect, and giving you a blueprint that you can use to build your health from the inside out. Think of this as your guide to cleaning up your diet, reducing inflammation, and gaining momentum towards feeling a lot better.

Please note: these are VERY GENERAL recommendations. It’s important to keep in mind that this information – diet and supplementation – does not replace the individualized guidance you should seek out from a qualified practitioner.

1. Eat organic whenever possible.

This will significantly limit your consumption of genetically modified ingredients and  pesticides. Both have been shown to cause systemic damage to your body. At a minimum, use the “Dirty Dozen” and “Clean 15” guides from the Environmental Working Group to shop. Please see my resources page for printable, easy-to-use guides and links to more information.

2. Clean up your water and salt.

Water: Since you drink about eight glasses a day (right?), it makes sense to make sure it is from a good source. Drink filtered water (either purchase a quality water filter or buy outside filtered water). Avoid tap water that can contain arsenic, aluminum or traces of discarded medications. And avoid BPA plastic bottled water (it might just be tap water you’re paying for).

Salt: Switch out your chemical-laden, over-processed, aluminum-containing table salt for sea salt. Unlike table salt, sea salt retains many vital minerals, like magnesium and potassium, which balance the level of sodium. So, when you choose the better, unrefined source, salt is no longer the enemy to run from, it is actually a healthful, essential part of your diet. Make sure you are choosing a Himalayan or Celtic sea salt or choose an iodine-fortified brand if appropriate (iodine plays a big role in thyroid function), like Hain.

3. Eat more dark green veggies.

Steam them, smoothie them up, eat or drink them raw – but get these verdant vitals down the hatch.

This class of vegetables is a nutritional powerhouse, providing many essential vitamins and minerals, including Vitamin E (a potent inflammation-fighter), B-vitamins, disease-fighting phytonutrients, and calcium (a great source, especially if you are dairy-free).

If eating your greens doesn’t come easy for you – logistically or just out of pure distaste – I feel your pain. FULL DISCLOSURE: This self-diagnosed “super taster” had a previous aversion to any green vegetable and didn’t try a tomato until college.

Yeah, I know.

That said, here are a few tried and true ways to sneak the green into your diet:

  • Kale & fruit smoothies (you don’t taste the kale, really). Kids freaked out by the color? Buy some opaque cups, lids and straws.
  • Cold-pressed green juices. If you gag on the taste, try sucking it down with a straw. (I speak from experience.)
  • A supplement you can add to non-dairy milk like Amazing Grass Green Superfood Drink. They also make some kid-specific flavors. This is not an official endorsement, but I’ve tried many and this is one that, ironically (and thankfully), doesn’t taste like grass.

4. Choose wisely when eating off the farm.

If you consume meat and/or dairy, there are some guidelines you can follow to keep it clean. Labeling is a big can of worms (that I will open later), but in the name of simplicity, I’m going to usher everyone on the farm under this umbrella statement:

Choose “organic” and/or “grass-fed”, “pastured” or “pasture-raised” beef, bison, poultry, dairy and eggs.

“Organic” ensures no pesticide or genetically-modified feed is getting into the animal. “Grass-fed” or “pasture-raised” means the animals are eating high Omega-3, inflammation-fighting grass (instead of corn), have the most room to roam, and have higher levels of the important, fat-soluble Vitamins A & D in their system (which means you will, too).

5. Eat organic, cold-pressed, extra-virgin, unprocessed fats (and use them at their correct temperatures).

Yep, I said it. You should eat fat. Listen, you’re ready to give salt a chance…now it’s time to welcome another new friend into your life. You can do this. Here’s how.

Instead of using chemically processed, possibly genetically modified fats (think, canola, corn, soy or vegetable oil and partially hydrogenated margarines), opt for oils and fats that are pesticide- and GMO-free and minimally processed. This eliminates the use of toxic chemicals and helps them retain their vital nutrients and delicate flavors. And remember to pay attention to limits on smoke points (should be listed on the bottle) to avoid free-radical forming oxidation.

Some examples of good choices:

Liquid: Organic, Cold-Pressed Extra Virgin Olive, Macadamia, Flax, and Avocado Oils                   Solid: Coconut Oil, Organic/Grass-Fed Ghee or Butter (only if you can tolerate casein), and pastured sources of animal fats.

If you’re sticking to the above guidelines, you’re doing your body a huge favor. But the better news is that now you can stop freaking out about consuming too much fat.* Because guess what?

Eating the right kind of fat aids in brain and eye development, regulates blood sugar, promotes tissue healing, is critical for Vitamin D synthesis, promotes proper immune function, and carries and delivers to your body fat soluble vitamins (A,D,E,K) and nutrients like phytonutrients (believed to play a role in cancer prevention and serve as anti-inflammatories).

*fat may need to be limited with gallbladder issues or other concerns that would affect fat metabolism

6. Consume fish oil.

In addition to the above recommendations on fats, you also need to make sure you are getting the correct balance of Omega-6 and Omega-3 fats. Historically, American diets used to be close to a ratio of 1:1. But with our current Standard American Diet (SAD), the balance is way off, currently estimated at 15 (Omega 6): 1 (Omega-3).

And this skewed RATIO – not the TOTAL fat – is what is causing the inflammation that can lead to serious conditions such as cancer, heart disease, and autoimmune disease (to name just a few).

Because there is an overage of Omega-6 fats in our food supply (all those processed oils I mentioned in number 5 fall into the category, but they are also found in other, healthier choices like seeds and nuts), the best way to get back in balance is to get adequate amounts of Omega-3 via fish oil (or flax oil if you prefer a vegan option), or through consumption of wild fish (like salmon). Alternatively, and this is what I do, take a high-vitamin (both A & D), fermented, cod liver oil capsule (capsules = no gagging!).

7. Take a good probiotic and/or eat fermented foods.

In the last two posts I mentioned a couple of important things about your digestive system:

  • When your gut bacteria (aka microbiome) is out of balance, i.e. there is more bad bacteria than good (aka dysbiosis), fat storage is promoted.
  • This dysbiosis of your digestive tract can also make it all too easy for undigested food particles or harmful ingredients to enter your system (known as intestinal hyperpermeability, or more commonly, having a “leaky gut”). And this leads to – you guessed it – inflammation.

But here’s some good news. Consuming probiotics can help you re-balance. You can take a probiotic supplement, or eat whole, fermented foods (kimchi, kombucha, homemade fermented vegetables). A general recommendation for a probiotic supplement is to choose one that has at least 25 billion strains (containing at a minimum Lactobacillus and Bifidobacterium) and choose one that is refrigerated, unless purchasing a professional grade supplement specifically designed to maintain potency at room temperature.

8. Reduce your processed sugar intake.

I think we should all be “Fed Up” by now, so I won’t expand too much on this one. But just know that refined sugar is one of the most damaging ingredients you can consume, and that it has effects on your entire system.

Ideally, all forms of sugar should be reduced as much as possible – but natural forms are safer: stevia, Lakanto sugar (expensive, but magic), maple syrup and raw agave. Switch to these, then try to reduce the amount you need, gradually.

9. Address food sensitivities.

If you have autoimmune, skin, mood or digestive issues or have unresolved chronic symptoms, this is definitely worth looking into. See a qualified practitioner to healthfully remove gluten from your diet and assess other food sensitivities (and your entire diet plan, ideally). While gluten and dairy are often the biggest culprits, food sensitivities can be from many different food categories (e.g. phenols, oxalates, grains, specific types of carbohydrates) and be a big cause for inflammation.

If you’re ready to take this step, I happen to know a girl…

10. Cook more.

Obvious, I know. But when you are working, traveling, kid wrangling, or otherwise performing in your own personal circus, this can be tough. It takes a conscious effort to plan and make it happen consistently. This is something I am continually working on, because juggling while balancing on a tightrope isn’t always easy to do in front of a hot stove.

But if cooking is your Achilles heel too, let’s break it down into bites you can chew. Try to plan your meals for one week (or one day…I don’t judge). Swap out a couple of your packaged foods for fresh ingredients. Prepare one new recipe per week (and if it goes over well, double it next time and freeze half!).

That’s it, people. You are ready to build.

But before you do, let me acknowledge something: we are all actual humans. By no means would I expect you to incorporate all of the above suggestions in one fell swoop (unless you are extremely motivated, and then absolutely “lean in” my friend). So if you are just dabbling in clean eating, or the current mainstays of your diet are frozen pizza and Big Macs, then a slow start is probably a good idea. Maybe choose one new goal now. And in a couple of weeks, choose another (or two).

Baby steps will get you there.

And speaking of babies, you should know I’ve got a couple. One of them is a 2-year-old boy. I’m confident he has a successful career in the WWF ahead of him. I have about 30 seconds to prep before that guy scales the wall and jumps in the oven, so I get it. Life happens and when it does, sometimes a shortcut is the only way – and that’s okay too.

Don’t let yourself be overwhelmed by your detailed blueprint. (My inner architect is very thorough.) It’s true, developing better health from the inside out is more complicated than organizing your closet, but the rewards are epic.

And besides, I have a feeling you’re capable, driven, and you want to feel good. Sometimes having a plan is just what you need to spring into action. So give it a go, just one choice at a time, and get ready to thrive.


 

References:

  1. Morrell, Sally. “The Salt of the Earth.” Weston A Price. Weston A Price Foundation, 4 Jan. 2011. Web. 19 Jan. 2015.
  2. “Agricultural Marketing Service – Grass Fed Marketing Claim Standards.” Agricultural Marketing Service – Grass Fed Marketing Claim Standards. USDA, 29 Sept. 2008. Web. 20 Jan. 2015.
  3. Enig, Mary G. Know Your Fats: The Complete Primer for Understanding the Nutrition of Fats, Oils and Cholesterol. Silver Spring, MD: Bethesda, 2000. Print.
  4. Fallon, Sally, and Mary G. Enig, PhD. “Cod Liver Oil Basics and Recommendations.” Weston A Price. Weston A Price Foundation, 9 Feb. 2009. Web. 19 Jan. 2015.
  5. Simopoulos, A.p. “The Importance of the Ratio of Omega-6/omega-3 Essential Fatty Acids.” Biomedicine & Pharmacotherapy8 (2002): 365-79. Web.
  6. Challem, Jack. The Inflammation Syndrome: The Complete Nutritional Program to Prevent and Reverse Heart Disease, Arthritis, Diabetes, Allergies and Asthma. Hoboken, NJ: J. Wiley, 2003.

 

Hot and Bothered

Old iron kettle on the fire

Generally, feeling hot and bothered is a good thing – when we’re talking about love and certain areas of our anatomy. But when other parts of your body are going up in flames, it seems to have the opposite effect on us. Both situations can land you between the sheets, but that’s where the similarities end.

 

When your body is taken over by inflammation, it can not only be debilitating, it can raise your risk for heart disease, diabetes, some cancers, and is at the source of autoimmune disease and many other chronic conditions.

And when almost one-half of all Americans (and fully 50% of our children) live with some type of chronic health condition, it is time for us to take notice and put some energy towards addressing the root cause of the issue. 

The good news is that one of the most powerful attacks we have against inflammation is our diet. There is a growing understanding around the role food plays in chronic inflammation and I haven’t heard anyone sum up this relationship better than Dr. Andrew Weil, one of the leading authorities on Integrative Medicine:

“It is becoming increasingly clear that a host of illnesses – including heart disease, many cancers and Alzheimer’s disease – are influenced in large part by chronic inflammation. This is a process in which the immune system becomes off balance, and persists unnecessarily in its efforts to repair the body and repel pathogens. The prolonged process results in damage to healthy tissue as well. Stress, lack of exercise, genetic predisposition and other lifestyle factors can all promote inflammation, but poor diet is perhaps the main contributor, and the ideal place to begin addressing inflammation.”

Inflammation Exposed

Inflammation can play a positive role in our health as the primary defense mechanism against acute conditions – like when a fever fights off an infection, or when blood rushes to a sprained ankle to help heal the tissue. However, when your immune system is disrupted, it puts itself unnecessarily on constant defense, sending inflammation continually rippling throughout your body. In this state, it’s working against you instead of for you by launching a targeted attack on your own cells and tissues.

So what causes this disruption in your immune system and changes it from your internal watchdog to your worst enemy? Well, it could be a number of things…and those things can come together in any combination to create the perfect storm.

Maybe you don’t have any existing issues, consider yourself healthy, and aren’t aware of the cumulative effect of eating processed foods, more sugar than you think, a diet containing allergens, chemicals, and additives, and exposure to environmental toxins. Whether you realize it or not – these can become toxic to your system, and can trigger a shift from good health to poor.  Or maybe you have an existing autoimmune or other chronic disease (or simply a genetic predisposition to one). If that’s the case, new research confirms that you very likely have a disruption of your digestive tract that is making it all too easy for harmful ingredients to enter your system. This is known as intestinal hyperpermeability, or more commonly, having a “leaky gut”. (We will go into much more detail on this later.) I admit, it’s not a sexy topic, but it’s a necessary one.

The kicker is that if you are not [yet] in deep with a specific condition, you might blindly attribute your symptoms to life in general. Those mood swings, that steadfast muffin top, persistent headaches and our low energy level are all just accepted as a part of the insanity called life. Unless we make changes – and start to feel better as a result – we don’t realize how crappy we felt in the first place.

I was one of those people even before the onset of my rheumatoid arthritis (RA). Sure, I have migraines, and I get a lot of sinus infections. Yeah, I’ve taken a few courses of anti-depressants. Do I get gas? Well sometimes – but who doesn’t? And I just blame my husband anyway.  But what I found is that when I modified what I was putting into my body, I couldn’t believe the difference. It took me finally feeling better to realize I’d been painfully apathetic – literally and figuratively.

Working From the Outside In

The common thought process, especially with exclusive exposure to Western medicine ideals, is that management of this inflammation is through quick fix anti-inflammatory medications like NSAIDS (Non-Steroidal Anti-Inflammatory Drugs) – think ibuprofen or naproxen (Aleve) or more powerful anti-inflammatories and immune suppressants that come with serious side-effects. However, this plan of attack not only misses the true cause of the inflammation, but these drugs actually exacerbate the problem by making it easier for toxins and food you can’t tolerate to get into your system –  i.e., your gut becomes even leakier.

So, if you were wondering what the hell all of this has to do with what we eat…here’s the point: The path away from inflammation and towards your happy place is through your digestive system.

We’ll get into much more detail on this later, but for right now, just know this. There are many foods our bodies may react negatively to, and there are chemicals added to other foods that our bodies have no idea how to handle. So to keep the confusion and adverse reactions at bay, we need to tidy up what goes in.

Healing Through Diet

This clean way of eating, especially as it relates to avoiding food sensitivities, is commonly known as an anti-inflammatory diet or an elimination diet. There are other specialty diets that address very specific non-tolerated substances that can be very effective as well.

Eliminating substances/foods that are not tolerated is a recommended – and highly effective – treatment for many conditions involving chronic inflammation and/or autoimmune conditions including: RA, fibromyalgia, osteoarthritis, lupus and other autoimmune diseases; heart disease and diabetes as well as skin conditions such as acne, eczema and signs of aging (to name a few).

If you read last week’s blog, you’ll remember that eating clean to be lean not only decreases inflammation, it helps you avoid insulin resistance. To refresh, insulin resistance leads to fat storage and possibly obesity. If that’s not a reason to eliminate foods you can’t tolerate, I’m not sure what is.

In upcoming posts, we’ll discuss:

  • what the substances are that have the potential to cause so much harm
  • how and why they bring on the inflammation
  • how to avoid them and what satisfying substitutes to introduce so you don’t bitterly dive head first into a bag of Cheetos

and

  • what you can do to heal your underlying issues so that you can enjoy many of these items again

As a final note – in case you’re still not buying in to the importance of addressing the negative side of being hot and bothered – I’ll share this quote from Dr. Mark Hyman. He doesn’t sugar the donuts when he states in regard to inflammation:

“..this fire in your heart causes heart disease, in our fat cells causes obesity, in the whole body causes cancer, in the eyes causes blindness, and, when this fire spreads to your brain, it can cause depression, dementia, autism, ADHD, Alzheimer’s, forgetfulness and a host of other problems.”

Wow, right? No question – inflammation has the potential to light your whole damn body on fire! It can be destructive and for some, downright deadly…and there’s zero promise of a relaxing afterglow.

So how about you skip the pain and irritation and go right to bliss – every day. Keep reading to find out how.


References

  1. Chronic Diseases and Health Promotion.”Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 09 May 2014. Web. 13 Jan. 2015.
  2. Cleave, J. Van, S. L. Gortmaker, and J. M. Perrin. “Dynamics of Obesity and Chronic Health Conditions Among Children and Youth.”JAMA: The Journal of the American Medical Association 7 (2010): 623-30. Web. 12 Jan. 2015.
  3. Weil, Andrew. “Anti-Inflammatory Diet & Pyramid.” Anti-Inflammatory Diet. N.p., n.d. Web. 05 Nov. 2008.
  4. Challem, Jack. The Inflammation Syndrome: The Complete Nutritional Program to Prevent and Reverse Heart Disease, Arthritis, Diabetes, Allergies and Asthma. Hoboken, NJ: J. Wiley, 2003.
  5. Fasano, Alessio. “Leaky Gut and Autoimmune Diseases.”Clinical Reviews in Allergy & Immunology 1 (2012): 71-78. Web.
  6. Podas T, Nightingale JM, Oldham R, Roy S, Sheehan NJ, Mayberry JF. Is rheumatoid arthritis a disease that starts in the intestine? A pilot study comparing an elemental diet with oral prednisolone. Postgrad Med J. 2007 Feb;83(976):128-31.
  7. Rana, J. S., M. Nieuwdorp, J. W. Jukema, and J. J. P. Kastelein. “Cardiovascular Metabolic Syndrome: an Interplay Of, Obesity, Inflammation, Diabetes and Coronary Heart Disease.” Diabetes, Obesity and Metabolism 9.3 (2007): 218-32. Web. 2 Jan. 2015.
  8. Hyman, Mark. The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First: The Simple Way to Defeat Depression, Overcome Anxiety and Sharpen Your Mind. New York: Scribner, 2008.

 

Eat Clean And Be Lean.

Crash dieting conceptMany of you who have found this site are genuinely looking, some more desperately than others, for ways to heal your body. It is actually my sincerest hope that this site (and my services) will show you ways to help you do just that. However, I realize that for many others, a primary deciding factor for whether these clean eating principles are followed and maintained is:

Will they help me lose weight?

Let’s talk about this question, because it’s a big one.

I remember feeling the same way –  years ago –  prior to my rheumatoid arthritis (RA) diagnosis, when considering clean, wholesome eating in general. I knew I should have been eating organic, whole foods for general health reasons, but I also figured that wasn’t really going to make me look better on the outside,  so I wasn’t as compelled to take a closer look at the research (research outside of what you’re fed as a conventional practitioner).

I knew that Diet Coke and artificially sweetened products had a lot of crap in them, but hey, I was eating “healthy” and sticking to my 1500 to 1800-calories-a-day/low-glycemic diet plan.  I was fit, looked good in my jeans, so why change it up? I’m sure the strenuous workouts I did 5-6 days/week had nothing to do with it.

Even with my deep background in nutrition, I’m embarrassed to admit that I really just didn’t get it. I didn’t get how chemicals from pesticides, artificial sweeteners, and foods I didn’t tolerate were viewed as toxins to my body. And I certainly didn’t acknowledge that in response to such toxins – and the inflammation they cause – not only did my metabolism slow down, but my body held on to water and fat.

I also never regarded highly enough how our bodies vary when metabolizing different foods. Conventional, Western-based weight loss principles are focused solely on consuming fewer calories than are burned. A calorie is a calorie.

While calories obviously play a role in weight maintenance, gain or loss, this principle fails to acknowledge that, like the favorite child in the family, our bodies give preferential treatment to those nutrients it loves the most.

The good news is this: weight loss is inevitable when you eat a clean, anti-inflammatory diet.

A summary of how the magic happens:

  1. Lose Not Just the Bloat, but the Bulge.

If you are consuming foods you have sensitivities to, you likely have excess bloating in your belly as well as swelling in your hands, feet, ankles, chin or around the eyes. This is due to fluid retention caused by inflammation and the release of certain hormones. But, the bloating is only the frosting on the muffin top when it comes to inflammation and weight loss.

Inflammation (inevitable if you are consuming foods you don’t tolerate) has been found to increase insulin resistance, which in turn can lead to obesity (not to mention perpetuating diabetes, high blood pressure and other factors leading to heart disease).

  1. Prevent Fat Storage.

With repeat exposure to toxins from food, our bodies can be overloaded with chemicals. When the amount of toxins exceeds what your body can process, they are isolated from the body’s systems in additional adipose tissue (a.k.a. FAT) as a protection measure. In essence, your body holds on to excess weight to dilute the toxicity. 

In addition, when your gut bacteria (aka microbiome) is out of balance with more bad bacteria than good (aka dysbiosis), fat storage is promoted. This dysbiosis can be from many factors, but a diet high in processed foods, refined sugar and foods you don’t tolerate are key factors.

  1. Avoid Beefing Up (literally).

Here’s some food for thought. On its mothers’ milk alone, a calf doubles its weight in the first 6-8 weeks of life. A human baby takes 6-7 months to double its weight. The macronutrient makeup of cow’s milk, is designed for, you guessed it, cows. And unlike humans (thank goodness) cows weigh 1,600 pounds, give or take.

When you consume pasteurized dairy products that are not “organic” AND “grass-fed”, you are consuming the same synthetic hormones, steroids and genetically modified corn those animals were fed to drastically boost production — and profits. Cows are injected with bovine growth hormone, so you are consuming bovine growth hormone.  Is further explanation even required to see why conventional dairy is not your friend if you’re trying to be lean?

Dairy also contains a large, hard to digest protein called casein. This is a common sensitivity for many, which I’ll detail extensively in later posts, but for now just know that this could be causing inflammation (and leading to the bloat and bulge referenced in point #1).

  1. Ensure Optimal Thyroid (and Basal Metabolic Rate).

Your basal metabolic rate (BMR) is the rate energy is used (read: calories burned) while your body is at rest, (i.e., breathing, digestion, pumping blood…you get the picture).

And since this is a 24-hour function, the BMR is responsible for approximately 60-70% of the calories you burn in a day, making it much more important than the 45 minutes you spend draped over the Stair Climber.

The calorie-burning BMR is controlled by your thyroid gland, so a slowed metabolic rate – will result in weight gain. What causes hypothyroidism, you ask (besides inflammation)? One cause is exposure to environmental toxins, such as pesticides from non-organic foods.  Such toxins act as hormone disruptors and interfere with thyroid function.

I don’t know about you, but my life is dysfunctional enough. No additional environmental toxins for me, thank you.

  1. Keep Insulin Levels in Check.

When we eat refined sugar and other refined carbohydrates, they are absorbed very quickly which causes a surge in glucose levels (also referred to as having a high glycemic index). This requires your pancreas to release a responding level of insulin to combat the high levels of glucose.

When high levels of insulin are released your body is encouraged to store up calories as fat. Also, to add to our theme, prolonged levels of elevated insulin contribute to inflammation, and vice-versa.

Don’t despair – I am not here to say that you have to become a total carbohydrate-phobe to keep your weight in check. Eating a clean diet can include eating high-fiber, whole grain carbs to slow the absorption into the bloodstream and avoid spikes in that fat-storing insulin. I will show you how to choose and enjoy whole (gluten-free) grains, beans and legumes, nuts and lots of whole, organic fruits and veggies so that you are not feeling deprived.

  1. Avoid the Pitfalls of Refined Sugar.

Refined sugar won’t just pilot your insulin levels into skyrocket mode, it can steer your overall health into a nosedive. Sugar has been found to be as addictive as cocaine. And we build up a tolerance just like we would for any other drug.

So if you do the math, you will find that one Oreo leads to twenty.

A sugar habit won’t land you in the clink, but it can still conjure up a mighty long rap sheet. Calories from sugar are metabolized differently than other foods. Sugar metabolism, especially in the case of processed fructose, can result in the attack of nerve endings and a fatty liver – contributing to strokes, diabetes, hypertension and possibly dementia and cancer.  It disrupts mineral and enzyme function, which, not only can initiate new or worsen existing food sensitivities, but leads to toxicity and inflammation in various organs and tissues of the entire body.

  1. Don’t Just Avoid Inflammation, You Fight It.

Avoiding inflammation is the common denominator in all of the above points because it is a big contributor to weight gain. But we’re not just playing defense here. While there are many foods to avoid, there are also plenty of foods to consume as part of a clean diet to actually fight inflammation. The key players here are essential fatty acids (EFA’s), especially from fish oil (flaxseed is a vegan source).  Green leafy veggies, nuts and certain herbs and spices are also strong inflammation fighters and highly encouraged in a clean, anti-inflammatory diet.

  1. Fire Up Your Metabolism.

These aforementioned, rock star EFA’s are “good fats” that are needed by the body to make hormones and maintain the body’s metabolic rate.

In addition to fighting inflammation, they increase thermogenesis, also known as fat burning. A deficiency may do the opposite by causing cravings, particularly for fatty foods.

And if that isn’t enough good news, let me share with you that the calories from certain types of EFA’s – namely Omega-3 and Omega-9 fatty acids – are not as easily converted to body fat as other oils and fats (like Omega-6 fatty acids and some refined saturated fats). Much more on fat later.

  1. Get Full, Fast.

Whole foods that are high in nutrients, essential fatty acids and fiber and low in refined sugars will keep your appetite in check by triggering your feelings of satiety earlier than processed foods and artificial ingredients. And as mentioned above, your essential fatty acids will also keep cravings under control.

So when you recognize that you’re full sooner, you have a greater chance of not tripping over your sugar craving and falling head first into a vat of cookie dough.

  1. Cut the Crap.

I know this is an obvious one, but worth mentioning. When you choose whole, unprocessed foods, especially if you’re cutting out gluten and/or dairy, there aren’t going to be a lot of donuts and candy bars on the menu. So by making the whole foods choice, you’re sidestepping all the crap, and heading that much closer to your svelte self.

Throughout all of this, no calculators or food scales are required.

As living proof, I’m two kids deep but I feel better and look better now (with a lot less effort) than I did in my pre-baby life, which pretty much consisted of working out five days a week, restricting calories, and eating whole grains and low-fat foods (including low-fat dairy).

But most importantly, I was finally able to get off the calorie-counting crazy train. I realized that when I stopped working against my body, my body starting working for me, especially when fueled by clean nutrients. If you asked me how many calories I eat today, I couldn’t even tell you.And I exercise about one-third the amount of what I used to (this is not a recommendation, just my current situation – having almost every waking moment devoted to working, traveling and kid-wrangling).

My goal here (and going forward) is simple but impactful:  a paradigm shift.

I hope you end up focused on the quality of your food, and the effects they have on your health. I hope you are compelled to stop counting calories and fat grams, and instead, start consuming foods with ingredients you can pronounce.

Most of all, I hope you come back to read – because there is so much more to share. I aim to inspire, provide answers, and give you a reason – and a way – to get and stay healthy.

Your new found belief in the power of clean eating awaits.

Happy new year!


Note: there are some people with additional sensitivities and health conditions who would benefit from at least a short-term avoidance of all grains and other food categories, including certain beans, fruits and vegetables.

References

  1.  Rana, J. S., M. Nieuwdorp, J. W. Jukema, and J. J. P. Kastelein. “Cardiovascular Metabolic Syndrome: an Interplay Of, Obesity, Inflammation, Diabetes and Coronary Heart Disease.” Diabetes, Obesity and Metabolism 9.3 (2007): 218-32. Web. 2 Jan. 2015.
  2. Challem, Jack. The Inflammation Syndrome: The Complete Nutritional Program to Prevent and Reverse Heart Disease, Arthritis, Diabetes, Allergies and Asthma. Hoboken, NJ: J. Wiley, 2003.
  3. Braly, James, and Ron Hoggan. Dangerous Grains: Why Gluten Cereal Grains May Be Hazardous to Your Health. New York: Avery, 2002. Print.
  4. Snedeker, Suzanne M., and Anthony G. Hay. “Do Interactions Between Gut Ecology and Environmental Chemicals Contribute to Obesity and Diabetes?” Environmental Health Perspectives 120.3 (2011): 332-39. Web.
  5. Orban, J. E., J. S. Stanley, J. G. Schwemberger, and J. C. Remmers. “Dioxins and Dibenzofurans in Adipose Tissue of the General US Population and Selected Subpopulations.” American Journal of Public Health 84.3 (1994): 439-45. Web.
  6. Goldner, W. S., D. P. Sandler, F. Yu, J. A. Hoppin, F. Kamel, and T. D. Levan. “Pesticide Use and Thyroid Disease Among Women in the Agricultural Health Study.” American Journal of Epidemiology 171.4 (2010): 455-64. Web.
  7. Hyman, Mark. The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First: The Simple Way to Defeat Depression, Overcome Anxiety and Sharpen Your Mind. New York: Scribner, 2008.
  8. Lustwig, Robert, MD. “Sugar: The Sweet Killer.” Interview. 2014 Food Revolution Summit. 2 May 2014. Radio.