Category Archives: Autoimmune Conditions

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.

 

 

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.

 

There Has To Be a Better Way

I remember sitting on my couch Googling “rheumatoid arthritis” the day my blood work confirmed my diagnosis.  The first statistic that came racing to my eye was from a Johns Hopkins study, “sixty percent of people with rheumatoid arthritis will be unable to work 10 years after disease onset.” Come again? Not be able to work? I am glued to a chair in front of a computer screen or in meetings most of the day. In 10 years, I won’t be able to do that? The tears started to flow. I was just 32 years old with a 6-week old baby girl.

Prior to this, I would have been considered an extremely healthy gal – a dietitian by trade, a competitive athlete, an avid booty shaker. Now I was faced with a chronic, autoimmune disease without reliable indicators to predict how quickly it would progress. I was scared and devastated, with the countdown to debilitation ticking loudly in my head. I woke every morning with my body on fire, feeling like I had a never-ending flu, and I was so tired I couldn’t get out of bed. My knuckles were so swollen that I couldn’t get my wedding ring on and my wrists and hands were in so much pain that I couldn’t hold my daughter to breastfeed (forcing me to form a borderline inappropriate relationship with my breast pump).

I indulged in a pretty elaborate pity party while the words of my demoralizing Rheumatologist (“you should feel lucky you’re not in a wheelchair”) rang loudly in my head. But my baby girl and my off-the-charts Type-A personality quickly motivated me to find the answers I needed to beat this thing. Answers other than long-term steroids and immunosuppressant medications, I mean. Their laundry lists of side effects include glaucoma, osteoporosis, weight gain, mood swings and increased infection risk. Reading them almost made the rheumatoid arthritis (RA) sound pretty good. In what universe does RA + steroids = vibrant health? Was I really supposed to fill up on medication and feel like a puffer fish, or else be in debilitating pain? These were my only options??

After an underwhelming experience with Western medicine, I explored Eastern medicine options and in doing so, learned about the havoc food sensitivities can wreak on your system, as well as the principles of an anti-inflammatory diet. What should be concerning (for us all!) is that I’m a former registered dietitian with the American Dietetic Association, I have a bachelor’s degree in Nutrition and a master’s degree (also in Nutrition)…and this came as headline news to me.

Anti-inflammatory diet? Never heard of it.

Eliminate gluten if you don’t have Celiac Disease? Can’t be.

The function of your immune system is largely based on the effectiveness of your digestive system. Huh?

Eliminate toxins that can come from non-organic foods and artificial sweeteners, preservatives and additives? That’s a load of alternative health crap.

Isn’t it all about calories in/calories out? Counting your fat grams and carbs? We’re told to eat low-fat dairy and whole grains and we’ll all ride off into the optimal health, tight booty sunset. Right? Wrong. The apple cart was turned over and my REAL education was about to begin.

The first obstacle after fully educating myself was what the hell am I supposed to eat? I used my education (and desperation) to wade through all the questions, and nutritional guidelines, and how many different words companies are allowed to use in an ingredients list so that they don’t have to say “milk” (there are a lot). I’ve stood in that aisle at the grocery store thinking I’m making an easy, smart decision about a food item, only to read beyond the “Gluten-Free!” label to find it’s jam-packed with soy, sugar or corn – all three of which are also not good for my RA. Eventually, I found the short list of foods that did make me feel better, and I ate them in every possible combination to avoid boredom, while I researched what else I could add in. I even went so far as to start my own food company – Clean Cravings – and in the process developed a unique perspective on the allergy-free, gluten-free, natural food industry. I kept my mind and my eyes open, and I realized that the new foods I was putting into my body weren’t just good for kicking some rheumatoid arthritis ass, they were good for my ass (and my whole being).

Over 50 million Americans suffer from an autoimmune disease – with numbers on the rise – and over 30 million Americans suffer from some type of food sensitivity. However, our current health system is doing society a huge disservice. Eliminating inflammatory foods plays a huge role in managing autoimmune and other chronic conditions, and that fact is being largely ignored. Guidelines on treatment for RA from the CDC website, states “…there is no cure for RA, but new effective drugs are increasingly available to treat the disease and prevent deformed joints. In addition to medications and surgery, good self-management, including exercise, are known to reduce pain and disability.”

This is as good as it gets? Dulling the pain, going under the knife, and going for a walk (if I can even move by then) is my best approach? How are we missing the elephant in the room here? Not a single mention of nutrition. That’s why I’m here. That’s why this message is needed. People don’t know! They either aren’t being told about the power behind these progressive dietary changes, or they aren’t getting the fine print. There is so much to learn about the ramifications of food sensitivities and how the quality of our food can help. However, it is confusing and overwhelming.

My purpose is to teach ways to eat clean, feel great, and not hate it along the way. This site and my services are about demystifying clean eating. They are about helping people find a way to a night out with friends that doesn’t leave them feeling like a stuffed sausage. About helping people discover ways to recognize symptoms (whether obvious or obtuse), then alleviate them and crush cravings. Ultimately, it is about learning how to let go of the calorie counter and the fat gram obsession, and how to hold on tight to a fist full of delicious, whole, organic food.


 

  1. Ruffing, Victoria, and Clifton Bingham, III. “Rheumatoid Arthritis Signs and Symptoms.” Arthritis Information. Johns Hopkins Medicine, n.d. Web. 10 Oct. 2013.
  2. “Autoimmune Statistics.” AARDA. American Autoimmune Related Disease Association, n.d. Web. 11 Nov. 2013.
  3. “Rheumatoid Arthritis.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 19 Nov. 2012. Web. 12 Nov. 2013.