IBS and the low-FODMAP diet

Irritable Bowel Syndrome is a common GI problem which troubles up to 15% of the

population and it is manifested primarily by abdominal pain associated with a change in bowel habits or change in stool frequency. It is a diagnosis of exclusion in that it can only be diagnosed after previous testing has failed to identify any underlying source of gastrointestinal pathology. Patients typically suffer from either chronic diarrhea or constipation; however, alternating between these two bowel patterns is also common. Other common complaints with this condition include nausea, excessive gas, bloating and chronic fatigue. The cause of this condition remains unexplained, but current theories from my research attribute the collection of symptoms to altered gut motility, visceral hypersensitivity involving the nervous system to the gut, and alteration of the normal intestinal bacteria. Current treatment strategies include the use of pharmaceuticals, psychological therapy, high fiber diet, probiotics, and certain dietary and lifestyle modifications.

FODMAP

The role of dietary factors contributing to distressful gastrointestinal symptoms has long been recognized, and certain dietary components including gluten, fat, dairy, caffeine, and alcohol have frequently been implicated. FODMAPs (Fermentable Oligo-, Di- and Mono-saccharides and Polyols) are short-chain carbohydrates.  These carbohydrates are poorly absorbed in the small intestine and are highly fermentable which subsequently leads to increased fluid in the intestinal tract, as well as increased gas production. 

A low FODMAP diet is eliminating fermentable oligo-,di- and mono-saccharides and polyols. The FODMAPs in the diet with some examples are fructose (large servings of fruit, fruit juice, honey, high fructose corn syrup), lactose (dairy), fructans (wheat, onion, garlic), galactans (beans, lentils, legumes), and polyols (sweeteners containing sorbitol, mannitol, xylitol, maltitol, stone fruits such as avocado, apricots, cherries, nectarines, peaches, plums.) The most common FODMAP is fructose; however, it will appear as allowed in low FODMAP foods where the glucose to fructose ratio is greater than one, as research has shown ingesting glucose at the same time as fructose eases fructose absorption. If you follow the low FODMAP diet nutrition plan you are still incorporating glucose and many other carbohydrates.

Trying the low-FODMAP diet

If you have IBS, the low FODMAP diet may be helpful for you. While I don’t personally have IBS, I hear about it from my friends all the time. I like to experiment with different diets (healthfully) so I followed the low FODMAP for about a month. It’s challenging to really dissect the foods you are eating. I constantly was referring to my food source charts. While it takes time to adjust to tolerance, you can reduce the FODMAP load of your meal or snack by choosing lower FODMAP alternatives or reduce the portion size of the FODMAP containing ingredient. I attached some helpful charts and links:

 http://stanfordhospital.org/digestivehealth/nutrition/DH-Low-FODMAP- Diet-Handout.pdf  http://www.webmd.com/ibs/features/finding-right-diet-ibs?page=2

Low FODMAP grocery list:

GRAINS

Oats, Oat bran, Polenta, Quinoa, Rice: Brown and White, Rice bran, Gluten-free pasta and corn

PROTEIN

Beef, Chicken, Fish, Egg, Pork, Tofu, Canned tuna, Turkey, Egg, Egg whites, Lamb, Cold cuts 

NUTS/SEEDS (allow one handful per sitting)

Almonds, Chia seeds, Flax seeds, Macadamias, Peanuts, Pine nuts, Pumpkin seeds, Sesame seeds, Walnuts

CHEESE

Cheddar, Swiss, Parmesan, Brie, Feta, Camembert, Mozzarella

MILK

Lactose free, Coconut milk, Rice milk, Almond milk

YOGURT/KEFIR

Green Valley lactose free yogurt, Lifeway kefir (plain only)

VEGETABLES:

Alfalfa sprouts, Arugula, Bamboo shoots, Bean sprouts, Beets (limit to 4 slices), Bok choy, Bell peppers, Broccoli (limit ½ cup), Brussel sprouts (limit ½ cup), Butternut squash (<1/4 cup), Carrots, Common cabbage, Corn (half a cob), Celery (1/4 stalk), Chives, Cucumber, Eggplant, Endive, Ginger, Green beans, Kale, Lettuce, Olives, Parsnips, Pears (<1/4 cup), White potato, Radish, Rutabaga, Scallions (green part only) , Spinach, Summer squash, Sweet potato (limit to ½ cup), Swiss chard, Turnips, Tomato, Water chestnuts, Zucchini

FRUIT (limit to one serving per meal)

Banana (small), Blueberries, Cantaloupe, Dragonfruit, Grapefruit (1/4 only), Grapes, Honeydew melon, Kiwifruit, Lemon, Lime, Orange, Papaya, Passion fruit, Pineapple, Raspberries, Rhubarb, Starfruit, Strawberries, Tangelo

My sources:  Horowitz BJ, Fisher RS. The irritable bowel syndrome. N Engl J Med 2001

Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc 2009
Shepard SJ, Gibson PR. Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management. J Am Diet Assoc. 2006. 
Mahan L, Escott-Stemp S, Raymond J. Krause's Food and the Nutrition Care Process. 2012 

Have you heard about GERD?

If you haven’t heard of GERD, you know about heartburn and acid reflux (which are sometimes used interchangeably). Heartburn is the symptom you feel when acid splashes up and out of the stomach. Acid reflux is when stomach acid splashes up from the stomach into the esophagus. Gastroesophageal reflux disease (GERD) is severe or chronic acid reflux that can lead to complications. Back in college at Ole Miss I was drinking about 64 ounces of diet soda and morning coffee every day. I was on a diet of salad with salsa as my dressing and snacking on pickles. My mom would ship me Prilosec in bulk in my care packages to help with my chronic acid reflux I had all day. 

GERD occurs when stomach acid, and sometimes bile, backs up (refluxes) into the esophagus (food pipe or the tube that connects your mouth and stomach.) Over time, the backwash of acid can irritate and inflame the lining of the esophagus and cause GERD signs and symptoms. Common symptoms include acid taste, increased belching, hoarseness, dry cough, burning sensation in upper middle chest, chest pressure or pain and difficulty swallowing. In children, vomiting, dysphagia, refusal to eat, or complaints of abdominal pain may be present. It’s important to get GERD under control as prolonged acid exposure can result in esophagitis (esophageal erosions, ulcerations) or stricturing resulting in chest discomfort or difficulty swallowing. Esophageal cancer may also form from chronic acid exposure.  

Most people can manage the discomfort of heartburn with lifestyle changes and over-the-counter medications such as Tums, Rolaids, Zantac, and Pepcid, or the stronger OTC medications such as Prilosec, Prevacid, Zegerid. It is important to note that the stronger OTC drugs are meant to be taken for chronic use to control acid throughout the day but are not as effective for immediate relief of acute reflux symptoms. If you are dependent on these medicines, you may need to consider a surgical procedure called a Laparoscopic Nissan Fundoplication. During this surgery, the surgeon wraps a portion of the stomach around the lower esophagus to basically tighten, reinforce the lower esophageal sphincter muscle. When these signs and symptoms occur at least twice each week or interfere with your daily life, you may want to contact your Doctor regarding further workup and treatment recommendations.

These are some tips to help reduce GERD with lifestyle changes:

• Avoid large, high-fat meals and going to bed shortly after. Avoid eating at least 3-4 hours before lying down. Stay upright and avoid vigorous activity after eating.
• Avoid acidic and spicy foods.
• Avoid garlic, onions, and tomato-based foods.
• Avoid smoking and alcoholic beverages.
• Avoid caffeine-containing foods and beverages, mints, and chocolate (it lowers the sphincter pressure).
• Avoid tightly fitted clothes, especially after a meal.
• Consume a healthy nutritionally complete diet and lose weight if overweight.
• It may help to keep a journal of foods that tend to trigger your symptoms to assist with avoidance.

Sources: http://www.webmd.com/heartburn-gerd/guide/heartburn-gerd-basic-information-causes and Dr. Patrick Saitta, Gastroenterologist at Concorde Medical Group, NYC.

Oh mama! Common GI problems during pregnancy

I’m a 29-year rare breed where I have two sisters-in-law with kids (many many miles away) and two girlfriends with children. Here comes friend #3 with a new bun in the oven talking to me about her body changes and GI issues, and I thought why not see what does go on during those 9 months. Detailed below are the most common GI problems associated with pregnancy including: constipation, hemorrhoids, heartburn, nausea/vomiting, and flatulence/belching.

Constipation

Constipation is a common complaint of pregnant women secondary to the physiologic changes and mechanical obstruction from an enlarging uterus. Increased progesterone levels result in smooth muscle relaxation and subsequent decrease in bowel transit time. Other causes include decreased maternal activity, decreased levels of motilin (hormone produced from endocrine cells to help regulate motility of the digestive tract), increased colonic sodium and water absorption and routine iron supplements (known to make stools dry and difficult to pass).

Tips:

• Are you getting your fiber in? The recommended dietary intake for fiber during pregnancy is 28 g/day. Please refer to my fiber blog for food lists and tips. Many benefit from meal supplementation with 4 to 6 tablespoons of bran.
• Drink lots of fluids as water and juices soften stools and keep digested waste passing through the bowel.
• Regular exercise keep your muscles in shape, it boosts blood circulation and brings more oxygen to all organs (including the bowels) to help them do their jobs more efficiently.
• Probiotics (supplements containing “healthy bacteria”) are being suggested more often in pregnant patients. These supplements can alter the flora of the colon and many patients notice an improvement in their bowel function.
• Don't take a laxative because its can excrete necessary nutrients out of your system, and might be harmful to your baby.

Hemorrhoids
Hemorrhoids are painful, swollen veins in the anus and rectum. Pressure from the enlarging uterus and increased blood flow to the pelvic area can cause the veins in the rectal wall to swell, bulge, and itch. Constipation and straining excessively during a bowel movement to pass hard stools can further aggravate them. They can also develop post-partum as a result of pushing during labor. If you see blood on your tissue when you wipe after a bowel movement or if you have pain or excessive itching at the opening of the rectum, ask your doctor to check for hemorrhoids. If you have hemorrhoids, they will accompany you through the pregnancy and will probably get worse during the pushing stage of delivery. If you take good care of them they might disappear after the birth. 

Prevention tips:

• Avoid constipation. Use all the tips mentioned earlier to keep your stools soft and moving easily through your bowel.
• Try not to strain during bowel movements.
• Put your feet up on a small stool during bowel movements to make the movement easier and don't read on the toilet. 
• Avoid standing still or sitting for very long periods of time.

Tips on managing hemorrhoids:

• Soak in warm water- several times a day. 
• Try applying witch hazel on cotton pads to your anal area.
• Try applying ice packs or cold compresses several times a day to help relieve swelling.
• Pre-moistened wipes may be more comfortable than dry toilet paper. 
• Avoid sitting for long periods of time, rather lie on your side or stand up. If you must sit, take frequent breaks.
• Try an over-the-counter hemorrhoid remedy. Ask your health care provider to recommend a hemorrhoid cream that's safe to use during pregnancy. 
• Consider having hemorrhoid banding procedure by a GI. 

Heartburn
Gastric esophageal reflux is more common during the latter part of your pregnancy and will often occur at night. It is caused by the effect of pressure of the uterus on the intestines and stomach with relaxation of the lower esophageal sphincter muscle. This may result in regurgitation of stomach contents into the esophagus. 

 Tips:

• Sip liquids rather than drinking big, full glasses. Try to get your fluid intake drinking beverages between rather than during meals. 
• Keep your head and upper chest elevated at approximately a 45 degree angle at night
• Eating smaller meals more frequently
• Stay upright for at least 3 hours after a meal before lying down
• Consider antacids (magnesium based are probably safest) but be more cautious with aluminum or calcium based antacids as these can cause constipation, and avoid sodium bicarbonate as it can cause swelling. Also, try to limit fatty foods, spicy foods, sweets/chocolate/peppermints as they can lower esophageal sphincter pressure.

Nausea and vomiting

According to the Mayo clinic, morning sickness affects a large proportion of pregnant women and is most common during the first trimester. Loud noises, motion, bright lights, adverse climates, and odors from hot foods can all trigger the symptoms. A more severe form characterized by excessive vomiting and weight loss, called hyperemesis gravidarum, can lead to fluid and electrolyte imbalance and may result in hospitalization. 

Tips:

• Small, frequent snacks of carbohydrate rich foods may help, while some women find protein meals help.
• Diets high in ginger may help, as well as smelling lemons.
• Wearing loose, comfortable clothing, get plenty of rest, and get appropriate physical activity
• Taking antacid medication before going to bed may help reduce stomach acid levels, and the subsequent morning vomiting.
• Consider that your iron supplements may be causing your nausea and consider switching to a lower dose or a liquid form which may be easier to tolerate. 

Flatulence/belching
Early in pregnancy, there is an increase of progesterone hormones that slows digestion, allowing more time for gas to be produced. The body responds by removing the gas with burps and farts, especially after a large meal. Then as the uterus enlarges, the shift in the crowded abdomen can slow digestion even more. In addition the muscle-relaxing effect of pregnancy hormones leaves less ability to hold the passing of gas.

Tips:

• Eat smaller, frequent meals.
• Exercise stimulates digestion
• Avoid foods that cause gas- onions, broccoli, cabbage, beans, brussel sprouts, cauliflower, fried, fatty foods.
• Try drinking milk icy cold and keep carbonated drinks to a minimum.

I hope my common GI problems either gave you new tips or helped prepare you for your pregnancy.

Resources:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2967327/
http://www.babyyourbaby.org/pregnancy/during-pregnancy/what-to-expect.php
http://www.mayoclinic.com/health/morning-sickness/DS01150

Are you getting enough fiber?

Nutrition therapy for constipation in healthy people is soluble and insoluble fiber, as well as fluids. (IBS patients consult with your physician or RD prior to initiating as it could lead to more discomfort) Fiber is also known as the roughage or bulk of the plant that your body can’t digest or absorb. Most Americans only consume half the recommended amount of fiber, which is about 14 g for every 1000 calories consumed. Adult women should consume 25 grams of fiber, and men 38 grams, children from 19-25 grams of fiber. 

Soluble (fermentable) fiber foods dissolve in water and sources include fruits, barley, legumes, oats, oat-bran, and vegetables such as cucumbers and carrots. Soluble fiber attracts water and forms a gel, which slows down digestion. This can slow down the absorption of sugar in your bloodstream to help maintain stable blood sugar levels and help prevent type 2 diabetes. Diets high in fiber can reduce cholesterol by 2-3% and LDL cholesterol by up to 7%. Fiber binds with bile acid, while not undesirable themselves, require the body to use up more cholesterol to replace them, hence improving blood lipids.  

Insoluble (nonfermentable) fiber foods do not dissolve in water and sources are from whole wheat products, wheat and corn bran, and vegetables such as cauliflower, green beans, and skins of root vegetables. Insoluble fibers help “keep you regular” because the food absorbs water and passes through the GI tract relatively intact, which speeds up the passage of food and waste through your gut. 

The other added benefit I like is that it makes me feel fuller in my meal, so it can help cut down overall caloric intake. If you currently don’t take in a lot of fiber, beware to jump right in, rather you should look to increase about 5 grams every 3 days. There are cases where an overload of fiber causes constipation, gas and bloating, and possibly diverticulosis, which are "weak spots or pockets" in the wall of the colon. Conversely, getting too much may cause loose stools or diarrhea. Excess fiber may bind to iron, zinc, calcium, and magnesium and decrease their absorption.

How to get more fiber in your diet:

Add bran or powdered fiber to your smoothies, or the fiber sprinkles that you can add to almost all foods because it dissolves in liquids and soft foods. There are also many fiber food sources, and the top rich ones include: beans, bran cereal, split peas, brown rice, lentils, artichoke, sweet potato, edamame, whole wheat bread, Asian pear, raspberries, prunes, oatmeal, corn, banana, and avocado.

Where I can get 2 grams of fiber:

Apple-1 small, Orange-1 small, Banana-1 small, Peach-1 medium, Strawberries- ½ cup, Pear ½ small, Cherries-10 large, Plums- 2 small, whole-what bread 1 slice, All Bran- 1 Tbsp., Rye bread 1 slice, Corn flakes 2/3 cup, oatmeal dry 3 Tbsp., Shredded wheat ½ biscuit, Wheat bran 1 tsp., Grape-nuts 3 Tbsp., Puffed wheat 1 1/3 cup, Broccoli ½ stalk, Lettuce 2 cups raw, Brussels sprouts 4, Green beans ½ cup, Carrots 2/3 cup, Potato 2-inch diameter, Celery 1 cup, Tomato 1 raw, Corn on the cob 2 inch, Baked beans canned 2 Tbsp.

Tips:

• Start your day with whole grains. Look for whole-grain cereal or oatmeal with 3 or more grams of fiber per serving. 
• Try whole-grain bread and crackers
• Include fruits like apples or pears (both leave skin on) with peanut butter as your afternoon snack, or add raspberries, blueberries, strawberries, or blackberries on top of your fluffy pancakes or in cereal. 
• Add flaxseed for fiber. The seed of the flax plant can be an excellent source of fiber, providing 2.8 grams per tablespoon of whole seeds. Flaxseed is often used as a laxative, but studies have shown that it also may help reduce cholesterol levels and decrease hot flashes. 
• Add high fiber veggies like artichoke hearts and corn in your pastas, or include beets, celery, raw broccoli to your mixed salads or soups.
• Adding beans to your tacos or rice dishes, eating veggie chili versus meat-based, or spread hummus (chickpea puree) on your sandwich instead of mayo.
• Drink plenty of water throughout the day.

You can read more on fiber at http://www.mayoclinic.com/health/fiber/NU00033  and see more fiber-rich recipes at on http://www.foodnetwork.com/recipe-collections/high-fiber/index.html. 

Screen this too!

October we recognize Breast Cancer Awareness month. I love seeing the husky NFL players with flashes of pink on their uniforms in support to raise awareness for women to get their mammograms and to support research cure funding. March is Colon Cancer Awareness month (blue is our color). I run the Colon Cancer Awareness 15k and support their charity awareness, but we can only do better to raise the awareness about colorectal cancer and getting colonoscopy screening. It’s not March, but since we are thinking about breasts, lets think about our bottoms. As the Colon Cancer Alliance says “Think Pink. Go Blue. Screen this too.” 

Colorectal cancer is cancer of the colon or rectum. In the US, it is the 3^rd most common cancer in adults and is also the 2^nd most common cause of cancer death. This year, over 142,000 people will be diagnosed with colorectal cancer and an estimated 50,800 will die of the disease.

Factors that increase the risk of colorectal cancer include family history, long-term presence of IBD, familial polyposis, adenomatous polyps, and several dietary components. Polyps are considered precursors of colon cancers. Patterns of dietary practices may be more predictive of the risk of developing colorectal cancer. These factors include increased meat, fat, and alcohol intake. Obesity is a major risk.

Protective:

Adequate intake of Vitamin D, folate, calcium, plant based foods, high fiber grains, omega-3 fatty acids can be beneficial in prevention as well as the use of aspirin. Nonsteroidal anti-inflammatory agents have also been shown to help prevent colon cancer, but benefit of long term use needs to be weighed against the increased risk of developing stomach or intestinal ulcers as well as major gastrointestinal bleeding. The use of prebiotics and probiotics reduces toxic and genotoxic compounds that may contribute to carcinogenesis, and regular use should be considered for digestive health. Regular exercise as well as limitation of alcohol is also a good preventative strategy.  

Colonoscopy screening:

This procedure involves the physician inserting a flexible tube with a camera (scope) on the end into the rectum and advancing the scope around the colon. The physician applies air to fully inflate the colon while withdrawing the scope back through and at same time looks at the video images from the scope searching for polyps (pre-cancerous growths) in the colon. If polyps are seen, they would also be removed at the same time by biopsy forceps or a cutting wire that is looped over the polyp. All samples are then sent to a pathologist determine potential cancer risk. The polyps will either be benign or pre-cancerous. These results will in turn determine the appropriate timing for a repeat exam. The timing can be 6 months-10 years (average is 5 years) for a repeat exam, and this can vary depending on personal and family risk factors, the size of the polyp, the pathology of the polyp and the quality of the cleaning preparation of the colon.

More than 90% of all colorectal cancers are found in people who are 50 and older. For this reason, the American Cancer Society recommends you start getting checked for this cancer when you are 50. People who are at a higher risk for colorectal cancer—such as those who have colon or rectal cancer in their families—may need to begin testing when they are younger. You should ask your primary doctor or your gastroenterologist the appropriate time to get started.

You can read up further on www.coloncancer.org or www.ccalliance.com

Runner’s GI distress

It’s almost time for THE marathon in NYC. If you lived here in the city, you can’t miss the hordes of runners in Central Park and West Side highway getting their training miles in these last few months, or the over 40,000 marathon runners who take over the boroughs the first weekend of November.

I want to discuss three uncomfortable and slightly embarrassing GI issues a long-distance runner may have or will face.

Runner’s trots

‘Runner’s trots’ is a friendlier name for runner’s diarrhea that affects distance runners by an urgent need for a bowel movement mid-run. The cause is controversial, one theory is the enzyme that is known to increase peristalsis (the food-pulsing of the large intestine). Another potential etiology is bowel ischemia, the process where the body shunts blood to running legs and away from the digestive organs, causing them to reject what they can’t digest. Diet is also a common cause. Runner’s diarrhea will clear up from several hours to a few days after running. As the case with diarrhea of any cause, electrolytes and fluids will need to be replaced. These tips might be useful for you: Cut down on eating the night before the race from 5pm on, except for something light (toast) or pretzels. Avoid fat,  high fiber foods (fruit, vegetables, legumes) and caffeine. I try to eat basic and bland (no Indian food, no seafood). I like quinoa and a few slices of turkey breast or homemade pasta with very little tomato sauce and French bread. Drink plenty of water (close to 64 ounces). Choose foods that are naturally constipating such as bananas, plain bagels, rice, oatmeal, and pasta. For the day of the race, get your breakfast in as soon as you wake up to allow at least 2 hours of digestion. I like small portions of either a slice of bread and peanut butter or 1/4 of a plain bagel with Gatorade to drink. Make sure you aren’t eating anything that’s “new” to your body, I had a friend who tried a new carbohydrate gel during our half marathon that didn’t agree with her. Make sure to sample out your gels, blocks, or sports drinks ahead of time to determine the best fit for you.

Hemorrhoids

Hemorrhoids or ‘roids are painful or swollen internal or external varicose veins in the rectum. The internal ones can bleed a lot, and the external are seen and extremely painful. It is common for runners to get hemorrhoids, just like the common patients who get them (obesity, pregnancy, older age). Dehydration and long exercise can lead to constipation, so it is important to drink plenty of water leading up to your running, and after to refuel. You may want to run with a Camelback or a water bottle during your run, especially on hot or humid days to assure hydration. Eat enough fiber (beans, fruits, broccoli, oat and wheat bran) or a fiber supplement (Metamucil). Also try to avoid straining or spending too much time on the toilet with bowel movements, as this increases your risk of hemorrhoids. If you are a toilet reader, stop now before it is too late! Hemorrhoids can be treated by surgery or by an outpatient banding procedure in a GI office. Trying over the counter meds such as Preparation H and soaking in a warm bathtub once or twice a day can also alleviate them.

Runner’s colitis

Runners colitis is associated with Ischemic colitis. This is a medical condition where inflammation and injury of the large intestine results from inadequate blood supply, usually due to dehydration and limited blood flow to the intestines during intense exercise. The symptoms may include mild to severe cramping, diarrhea, nausea, and bleeding. The bloody diarrhea is the intestine sloughing off its’ inflamed lining. Patients are usually treated with IV fluids, pain medicine and bowel rest, so no food or water by mouth until the symptoms resolve. Those with severe ischemia can develop complications such as sepsis, intestinal gangrene, or bowel perforation and may require more aggressive interventions such as surgery.

I personally have experienced runner’s colitis and it is very painful. I finished a half marathon in 1:37, and I’ve never been so sick. The amount of blood that came out of me was extreme and nothing made me feel better for 24 hours. I made a poor decision to compensate my late night party the prior evening by taking an Adderall before my race to wake me up. I found out later from my GI doc that I basically shut my lower organs down during the 90 minutes. I was surprised there are not more cases of this reported, but it could also be summed up as dehydration (which is effect of Adderall).

While running is a great exercise for our body and our minds, we should be mindful that long endurance running requires us to pay extra attention to nutritional preparation and hydration.

Happy running and good luck marathon runners.  





(That's me puffing through the finish of a half-marathon)




Further readings:
  http://www.mayoclinic.com/health/ischemic-colitis/DS00794
http://www.hindawi.com/crim/gastrointestinal.medicine/2012/356895/

On gluten and wheat

Celiac disease, gluten, gluten sensitivity, and wheat allergy

Last week at bookclub, the conversation turned to adopting a gluten free diet. My one girlfriend tried it out last year to see if it would help her then GI problem. (She actually ended up having a parasite from traveling to India). She told us she wanted to give it a try again to help with her fogginess and current GI issues. Of the group there were so many questions on gluten vs. wheat vs. Celiac disease vs. allergies. I broke this down in three segments:

Celiac disease

One out of every 133 people in the US has celiac disease. People with Celiac disease (CD) are food sensitive, not allergic, and these patients can’t consume the protein gluten because it causes their body to generate an autoimmune response that causes damage to the villi in the intestine. Over time the reaction wears down the villi that line the walls of your intestine called villous atrophy. Damage to the villi impairs absorption of nutrients from food. Digestive problems are more common in infants and young children, which may include chronic diarrhea, vomiting, constipation, weight loss, and addition symptoms of growth retardation, ADHD, headaches, and skin rashes. Adults may experience the same digestive symptoms and are more likely to experience different extra-intestinal manifestations of the disease including: unexplained iron-deficiency anemia, fatigue, bone or joint pain, arthritis, numbness or tingling sensations in the extremities, depression, bone loss, infertility, canker sores in the mouth. The diagnosis involves blood tests for gluten antibodies and a small bowel biopsy to access gut damage. The only treatment is a gluten free diet, so patients must avoid wheat, rye, barley, triticale (a cross between wheat and rye), and sometimes oats if cross-contaminated.

Fortunately, grocery stores and restaurants are becoming more accommodating to these patients. I've been to so many groceries that have half of an aisle dedicated to gluten-free products including gluten free beers, and on many restaurant menus, I now see several gluten free options including gluten free pasta and pizza.

 Celiac disease: condition that damages the lining of the SI and prevents it from absorbing nutrients from food that is a reaction from wheat, barley, rye.

Foods to avoid: wheat, barley, rye, triticale, sometimes oats.  

Foods to enjoy, all plain: meat, fish, rice, fruits, vegetables, beans, corn, white/brown/wild rice, nuts and seeds

Sub for wheat: potato, rice, soy, amaranth, quinoa, buckwheat, bean flour

Hidden: sharing the toaster, medications, chapstick, makeup, lotion, shampoo 

Gluten free drinks to order at the bar: Wine, Brandy, Champagne, Gin, Cognanc, Tequila. I read these drinks are safe according to their website, Bourbon Makers Mark, gluten free vodkas including Ciroc, Titos, and Chopin.  

Non-celiac gluten sensitivity

This is less of a diagnosis but more of a description of the patient who does not have the immune response and intestinal changes characteristic of CD but still experiences certain nonspecific symptoms oftentimes seen with CD. There is still research developing, but it hasn’t been established what causes gluten sensitivity. It has been confirmed that certain genetic mutations present in CD are not seen in these patients. Gluten sensitivity symptoms include: nausea, abdominal cramping, bloating, gas, or diarrhea after ingesting gluten, rashes, brain fog, headaches, depression, joint pain, and numbness in extremities. Patients visiting their GI doctors will be administered a celiac disease testing to first rule out CD.  They may choose to still follow a gluten-free diet to see if this helps with their complaints. Patients should be generally advised against following a gluten free diet without having a workup to exclude or confirm CD, because there may be an underlying medical condition where gluten free is not the treatment. 

Gluten sensitivity or gluten intolerance: a reaction to gluten but is not associated with the intestinal damage that characterizes celiac disease.

Patient may choose to follow a gluten-free diet after ruling out CD from GI doctor. 

Wheat allergy

Celiac disease or gluten sensitivity is not a wheat allergy. A wheat allergy generates an allergy-causing antibody to proteins found in wheat. Celiac disease is a reaction to one particular protein, the gluten, which causes an abnormal immune system response in the small intestine. A wheat allergy is common in children and tends to resolve by adulthood. Symptoms include swelling, itching, irritation of the mouth or throat, hives or rash on skin, cramps, nausea, vomiting, and difficult breathing. Blood testing can also be performed to screen for this particular allergy, however, a skin test is a more sensitive diagnostic tool used to confirm wheat allergies.

Wheat allergy: allergy-causing antibody to proteins found in wheat

Mostly found in children and grown out of by adult age.

Wheat free alternatives: Amaranth, barley, buckwheat, chickpea, corn, lentil, millet, oats, quinoa, rice, tapioca.

About 20% of children are also allergic to other grains. It is important to ask your doctor if foods containing barley, oats, and rye are safe to enjoy

Sources: Dr. Patrick Saitta, Gastroenterologist with Concorde Medical Group, NYC

http://www.celiac.com/categories/Allergy-vs.-Intolerance-%252d-What-is-the-Difference%3F/