Thursday, October 10, 2013

The Science of Celiac: Your gut has a mind of its own

First, a short list of what celiac is not. Celiac is not an allergy to wheat. Celiac is not a food intolerance in which your body simply lacks the enzymes needed to digest a certain substance, such as a lactose intolerance. Celiac is not curable (at least, not yet). And it is not something that can be conclusively ruled out forever more by a test or food elimination experience - those are at best snapshots of your health at one point in time, but the picture is more of a head shot than a panorama of the whole terrain, and the circumstances that affect your health can change in time. 

This is a great time to remind you that I am not a doctor and I am not licensed to give medical advice (I am an attorney, and this isn't legal advice either, but this is a disclaimer)


I gleaned all the information on this blog post from science-based sources. To keep this post short and sweet I have cited and linked to each source just once, the first time I use info provided by any one particular source, and then put a list of those sources at the end of this post. Anything in quotes I copied wholesale. Everything else is my own rewording. All errors are my own, unless they're contained in quotes. And from now on, I promise to stick this disclaimer at the bottom of the posts, where it's less irritating. Because if you have celiac, Crohn's disease, or irritable bowl syndrome, the last thing you need is more irritation.  

What causes celiac? 
"Celiac disease is genetic, meaning it runs in families. Sometimes the disease becomes triggered -or becomes active for the first time- after surgery, pregnancy, childbirth, viral infection, or severe emotional stress." [1]

What is celiac? 
Celiac is "a permanent sensitivity to gluten in wheat and related proteins found in barley and rye."

Okay, but on a practical level, what is celiac?
Celiac is a disease in which your immune system attacks not only the foreign invader, wheat gluten, but goes haywire and attacks your own body - starting with the villi of your small intestine. [2] 

Villi are "the tiny, fingerlike protrusions lining the small intestine. Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream." 

Image used with permission from
the National Digestive Diseases Information Clearinghouse of Bethesda, Maryland, U.S.A.

  
The damage of celiac is three-fold:

1) Your immune system attacks your own body, your villi.

2) When your immune system damages your villi, it also impairs your ability to absorb nutrients, which leaves you susceptible to malnutrition, and to health problems that can result from malnutrition. How's that? Well...

3) Your small intestine is a manufacturing facility, and like many factory workers their expertise, diligence, and far reaching impact often go unnoticed until there is a factory shut down. In addition to producing digestive enzymes needed to break down food into component parts and then absorbing those parts as nutrients, your diligent villi also produce hormones. [3] Your gastrointestinal track, including your small intestines, even has a nervous system. Your gut has a mind of its own. So when you're tempted to reach for "just a little bit" of a food that contains wheat gluten, remember that what messes with your gut can truly mess with your mind.

Tomorrow: how to test for celiac, and why the tests will never tell you everything you need to know. 



A view of you.
Image used with permission from
the National Digestive Diseases Information Clearinghouse of Bethesda, Maryland, U.S.A. 
Sources:

[1]  Guideline for the Diagnosis and Treatment of Celiac Disease in Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, from the Journal of Pediatric Gastroenterology and Nutrition. 40(1):1-19, January 2005. Accessed: 10 October 2013. 

[2]  National Digestive Diseases Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthNIH Publication No. 08–4269. September 2008. Accessed: 10 October 2013. 

[3] The Enteric Endocrine System. R. Bowen, Vivo at Colorado State University. Accessed: 10 October 2013. 

 

Tuesday, October 8, 2013

A Theme Song For Celiac

http://flic.kr/p/8qFVNZ
Taro Chewing on a Roll of Toilet Paper. 


If celiac had a theme song, it would be "Who Let the Dogs Out".

Hear me out (I promise not to sing).

Celiac is an autoimmune disease, meaning the body's immune system attacks the body. Hu?

A healthy immune system is like a group of guard dogs that live in your home as part of the family. They know who belongs, and when someone comes in who does not belong, they may keep a wary eye on the foreign guest, sniff them to suss out more information, circle them to keep them contained (especially those herding dogs), or go ballistic to fight off an intruder (mailman! mailman! mailman!).

An autoimmune disease is a condition in which rather than attacking only foreign invaders, the immune system attacks the body. Imagine you leave the house and lock the door behind you. You know who has spare keys to the house, but otherwise the doors and windows are secure your well cared for dog safely inside the house. Then the mailman arrives and slips mail into the house through the mail slot as she does with all the houses on her route, which in most homes causes no problem. But having celiac is like having a guard dog who tweaks out.

The mailman puts your mail through the slot in your front door that is meant to receive mail. Your mail hits your foyer floor; so far everything is working as designed. But then your dog goes nuts. First he eats the mail, but he's so wound up that he chews the couch cushions, too. And when the cushions have been decimated, he chews the drywall in the laundry room clear through to the hallway, so that you can stand in one space and stick your hand clear through the new hole into the other space. And he keeps going, attacking parts of the house he would normally protect. Maybe from the outside of the house things look fine, but on the inside, in one room or another, havoc.

When you come home, it might be awhile before you have a reason to venture into the room where the damage has been done and discover the mess that had been your bedroom, den, living room. This whole time you were in the mudroom, kitchen, or dining room not knowing that elsewhere in the same house was destruction so sever that you cannot use that room properly until you take time and effort to repair the damage done by one well meaning but distraught dog.

Which brings us to the question: Who Let The Dogs Out? Tomorrow Next I'll talk about where celiac comes from: who gets it, how, and how to keep it in check.


Wednesday, October 2, 2013

31 Days of Going Gluten Free

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When going gluten free, it helps to share the kitchen with someone who is always happy to see food, no matter what.
For the month of October I am going to hijack my own blog. I've accepted The Nester's invitation to write about a topic for 31 days. If you find yourself swatting at the writing bug, I invite you to accept the open invitation and join the festivities.

About 13 years ago my spouse went on one of those old-school, calorie restricted, flavor depriving diets, and I did not. I made the mistake of getting into the car with her while eating fresh bacon, and she bit off my head. A year later she went on an elimination diet for two months, and in the spirit of marital harmony and self preservation I decided to go on that diet with her. And I noticed nothing, except how frustrated I was because every time I went to eat something, I was confronted with all the things I couldn't eat. Frustrated, cranky, and bitter about eating the same few foods repeatedly. And then the time passed, the two months were over, and one by one we reintroduced foods into our diet. I dove into the bread and pasta of my Italian heritage, and almost instantly was pummeled by the seasonal allergies, intestinal cramping, mental fog and energy issues that had all but disappeared over the past two months. I had been so busy being frustrated with the monumental challenge of avoiding wheat that I did not notice how much better my body felt while wheat free.

Avoiding wheat gluten is much harder than just avoiding wheat, and that the extra effort is entirely has paid off in increased physical health and endurance, mental clarity, a greater ability to focus, and enhanced emotional resilience.  As for that last part - I am not now an emotional monolith - I will still cry in the greeting card aisle. I'm just less likely to go from misty-eyed to melt down because birthdays and graduations and sympathy cards and it all goes by so quickly. There is a connection between gut health and mental health that I will cover in later posts, too. 

I do not have a medical degree or a medical background. I am not a doctor and nothing I write here should be interpreted as medical advice. My intention is to provide information you can use to inform your choices and your discussions with your doctor and other medical professionals.  

My go-to site for medical information is the University of Chicago Celiac Center. You can contact them for information about free screening in Chicago for celiac, or how to get tested closer to home. Going gluten free long before getting tested for celiac can reduce the ability to obtain an accurate antibody-test or biopsy result. This can put a gluten-intolerant person in the unenviable position of having to choose between going through the discomfort of ingesting gluten in order to get an accurate test result, or doing without the official diagnosis. There are tax deductions for celiacs who have obtained an official diagnosis, but doing what it takes to get the deductions could be more taxing than it’s worth.  There are over 300 symptoms associated with celiac, most of which do not involve intestinal distress. But I want to end on a sweeter note with a shorter list, so please check out this article on eight ways to snack gluten free healthfully.

Thursday, August 1, 2013

Five Things I Learned In July

  1. Wonderfully weird curtains make for wonderfully weird pillows. Especially when the tailor rocks his zipper skills.  
  2. Lemon Basil cookies are amazing.  Also, I actually like shortbread cookies, if they have lemon and basil.
  3. A scanner and a shredder are great household cleaning tools. I've been reading Getting Organized In The Google Era (see a synopsis here, especially points 8, 9, and 14), and it's wonderful organizing advice for someone like my right brained, creative, never going to think my way from point A to point B in a straight line self. Those handwritten notes you're supposed to take during important telephone calls with customer service reps? Scan them, email them to yourself or upload them to a free service such as Dropbox, and shred the originals. Brilliant. I have way more mental space and less anxiety now that I know where everything is, and that I can find it in a moment or two from anywhere in the world.
  4. In the "Not Fun" category, I learned that when a merchant runs my debit card, if he accidentally runs the charge through twice, if he doesn't cancel the second charge, the funds get pulled from my account for seven days. It will appear on my account as a hold, and I cannot use the funds until the hold is released. Which means that in the interim, if I am not made aware of the second (or in the case of this past week - all three - of the unauthorized, extra charges - I could unwittingly through no fault of my own overdraw my account and be left paying overdraft fees. I'm glad I looked into my account and found the three unauthorized holds, and talked extensively to the folks at the bank to learn this, without experiencing an overdraft. It was a relatively cheap lesson to learn. Now I need to think about using my debit card a lot less, and only when I'm prepared to follow up by frequently and regularly looking at my online account to see if there are unauthorized holds. 
  5. And I learned that watermelon fruit is a berry. I had no idea a berry could be so friggin' big. It is also my favorite fruit. I knew I loved it, but only as I was mowing my way through a watermelon earlier this month did I realize I have a favorite fruit. Also, those small seedless watermelons they sell at Trader Joe's? Those are single serving size. But if you happen to fill up before you're done, cut the remaining melon into cubes, freeze, and use later as ice cubes.

Tuesday, May 28, 2013

Looking, Leaping & Longing

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Emily Freeman at Chatting at the Sky has a beautiful post about the encouragement given to a young girl as she crouched at the edge of the high dive. She walked down off the board, returned later to take the leap, and propelled herself off the board into the cold water below. (But you should still read the blog post - the writing is wonderful and I promise I haven't ruined the story.)

My father in law grew up playing stickball on the streets of New York City. Someone hit the ball onto an apartment building rooftop, and he went after it. He got as close as he could - the rooftop of the neighboring building. As he stood there, looking across the chasm between the rooftop he could climb and the rooftop that held the small rubber ball, so close yet out of reach, his friends shouted - JUMP! JUMP! You can make it in TWO JUMPS!   

The little boy had climbed, surveyed, considered the advice, and reconsidered his original plan. He came empty handed to his friends who had counted on him to retrieve the ball and save the game. I don't know if they played another game that day, but the history of stickball in New York suggests that eventually they found a new ball and played more games.
I'm glad for the little girl who listened to her gut, respected herself enough to back away from the edge, reconsider, return, and leap into blue skies and cold water. I'm glad for the little boy who thought better of advice given by people who couldn't see the flaw in their plan, glad that he didn't feel compelled to sacrifice himself in order to save face with his friends. 

Kudos to the people that cheered on the little girl, who shouted encouragement when they could have shouted anything - could have soured the opportunity with taunts or jeers, or left her alone with her fears in deafening silence. I tip my hat to those long-ago children who gave their best advice and welcomed back the little boy who didn't take it and came back empty handed. 

How many times do I say "tell me what to do to get this to work out" when what I really need is: tell me that I can come back empty handed and still be okay with you, remind me that I can still play with you. Help me turn down the howling wind of this fear so I can better listen to my gut, sort out my own mind, consider feedback and the options and not feel rushed to step back from the best and scariest vantage point here at this edge. 

"Leap, and the net will appear."

Monday, May 27, 2013

Ruminating


I've had a Rumi quote taped first to my kitchen wall and then to my office wall for more years than I can remember: 


"Let the beauty we love be what we do. There are hundreds of ways to kneel and kiss the ground."

For years his words landed with me as a re-minder to have my prayers be my practices. I got the gratitude part, but I knew I was missing something. 

Tonight in a moment of otherwise unremarkable ceiling-gazing, the meaning of the quote slipped into focus. 

"Let the beauty we love be what we do. There are hundreds of ways to kneel and kiss the ground."
It has been easy for me to know what needs to be done - pay bills, fix squeaky wheels, answer emails, vote, feed the cats - but I have been dragging around this idea that there is Something Significant I am supposed to do with my life, to make my life worthwhile and to have my time on the planet amount to Something. Significant.

And I have been counting on some powerful feeling or sign from the Universe to tell me The Thing.

As if. As if there was only one big Something. And I would know what it is. And I have to do it, and when I do it my life will have Turned Out.

I've been trying to do The Right Thing for The Right Reasons in The Right Order and in Good Time.

Ridiculous.

There is so much love, so much that moves me, so much unruly potential. So much possible. 

I've just been worrying about getting it wrong, missing the window. Like that scene in I Love Lucy when Lucy and Ethel work at the chocolate factory. They set out to wrap individual pieces of chocolate candy in paper as they move down a conveyor belt, but the belt runs fast, their timing is off, they wind up shoving candy hand to mouth rather than let a piece slip by unwrapped - there's candy flying everywhere and it is mayhem.

Lucy says to Ethel, "I think we're fighting a losing game!"

Ethel can't say anything, because her mouth is full of chocolate. You couldn't hear her anyway, because the audience is laughing loudly at the spectacle of these women being overwhelmed by having so much chocolate in such a short span of time.

Sometimes life is like a box of chocolates, and those chocolates are flying past you faster than you can neatly wrap them for public consumption.

I want to work my best, side by side with people I am proud to call "friend," shove chocolates in my mouth, laugh with the glee of freedom, and marvel that there are so many opportunities that some slip by untouched. 

I am going to pursue what calls to me and watch the results shake out in their own good time, worry less about doing in the right order, the right time frame, or whether I get to do it all - because there are hundreds of ways to kneel and kiss the ground.

Monday, May 6, 2013

Food For Thought

I recently moved to the metro D.C. area to expand my career opportunities and work with people from all over the world. I have a home and a spouse in Pittsburgh. I am married to a massage therapist who moonlights as a professional space organizer. This is every bit as awesome as you might imagine. I live in a lovely, light filled efficiency apartment where the person who knows all my quirks and proclivities has helped me arrange all 500 square feet to meet my needs, and everything I need is only a few steps away. Which is why I was surprised this morning to see that I am still gravitating toward working on my dining room table, instead of at my desk in my home office all of twenty feet away. 

I sat down to the dining room table with my morning cup of coffee and put pen to a remnant of white packing paper that had been wrapped around some new purchase for the apartment. My day and week unfurled across one side of the sheet and then over to the other. People, places, tasks; part idea parking lot, part compilation of to-do lists. I took a couple of phone calls, scheduled a lunch date, and noticed that my desk was a repository for papers and a holder of pens, but the real work was getting done at the dining room table, the space in which so many endeavors - breakfast, lunch, and dinner - come to fruition to be savored sometimes alone, but more memorably with friends and family.

I think it is those memories that season the space of the dining room table. With memories of friends and family I feel fortified even after hours with my head bowed low and fingers flying or faltering over the keyboard. The jar of oatmeal bars and the bowl of fruit within arms' reach don't hurt either. Journeys of the mind are made solo, whether inward for writing or outward for job hunting, bill paying, or into the treacherous waters of requesting customer service. I take heart beginning and ending each journey at the place where memories of my kindred spirits will find me, in time for dinner.