Archive for May, 2014

May 25, 2014

Common Sense Trumps Gluten Intolerance vs. FODMAPs

Gluten intolerance may not even exist or how common sense trumps gluten Intolerance vs. FODMAPs argument…

Yesterday I was on the phone with a friend who asked, “By the way, did you see how the first doctor to study gluten has recanted and says he got it wrong? Gluten doesn’t bother very many people, so most people should keep eating it. The diet’s just a fad.”

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I had no idea what he was talking about. He emailed me a link to this article – http://gizmodo.com/your-gluten-intolerance-may-actually-be-from-somethin-1580781192 – that discusses a 2013 study by Dr. Peter Gibson of Monash University in Australia from which the doctor concluded that some gluten intolerance symptoms might be caused by a group of carbohydrates called fermentable oligo-di-monosaccharides and polyols or FODMAPs rather than gluten.

This short blip of information really didn’t give enough detail about the study to draw any conclusion, but it did contain another link to this article by Casey Chan posted May 15 on “Sploid” – http://sploid.gizmodo.com/being-gluten-free-is-dumb-because-gluten-insensitivity-1577178094. Here’s the title and first paragraph:

“Being gluten free is dumb—and gluten intolerance may not even exist

If you have Celiac, this obviously doesn’t apply to you. Don’t eat gluten. But if you don’t have Celiac—and that’s 99% of the human population, mind you—there’s no reason to be gluten free. You’re wasting your time. Even the scientist who started this gluten free craze thinks it’s useless to be gluten free. Seriously. People, the father of gluten free think it’s bullshit.”

It continues: “According to ‘Real Clear Science’, Gibson had subjects with ‘gluten intolerance’ but weren’t Celiac take part in an experiment that fed them a high gluten, normal gluten, low gluten and placebo diet for a week and found that there was ‘absolutely no specific response to gluten.’

What happened was that everybody reported pain, bloating, nausea and gas to similar degrees. No matter what they ate—gluten or placebo—they felt sick. The problem wasn’t with gluten, it was with their brains. Basically, it’s the nocebo effect. People psych themselves out and start believing they’re sick.”

Whenever someone attempts to communicate the results of a scientific study to me using words like “dumb and bullshit”, I have to wonder about their intent. Certainly, they cast a negative light on the term gluten intolerance, but to what purpose and to make what point?

Perhaps it’s just to stir things up – create controversy for the sake of controversy. Perhaps it’s to justify drinking better tasting beer. Perhaps it’s a way to tell us we’re all stupid and the writer is not. I have no idea.

What it told me was several things:
1)I needed to find the actual study so that I could better understand the methodology and the findings.
2)Mr. Chan fails to understand that Celiac is the end-stage phase of a disease process about which we are gaining more and more information. To refuse to recognize a disease until it reaches end stage seems a bit like saying you can’t have heart disease unless you’ve had a heart attack so that shortness of breath or chest pain you’re feeling must all be in your head.
3)Whether it is gluten that’s the culprit, FODMAPs, wheat germ agglutinin (WGA), bacterial overgrowth, yeast overgrowth, or something yet undiscovered causing bloating, gas, pain, motility problems and inflammation, it is a misrepresentation of the results of the study to say that wheat containing gluten had no real effect on the 37 subjects studied. Otherwise, why conclude that a low FODMAP diet, which by definition would not include wheat, was helpful? Which brings me to
4)If eliminating wheat from the diet is a recommendation resulting from this 2013 study (as indicated on the Monash University Gastroenterology Department’s Website), then isn’t that the important thing we need to know for patients to be healthy? In fact, a gluten-free diet would put these subjects closer to the suggested diet than a traditional one so whether or not you want to disparagingly label it a fad, a gluten-free regimen in these cases would be more helpful than harmful.

It is good for researchers to reexamine the issue. It is good to keep our minds open about the results. It will be normal for quite some time for scientists to present what appear to be conflicting results from studies. We are in an early phase of this research game. Eventually, the pieces of the puzzle will fall together and we can say more definitively what is causing certain symptoms for certain people. In the meantime, the preponderance of research indicates that eliminating at least wheat and rye from the diet is beneficial to those who suffer from gastrointestinal pain, bloating, nausea, and motility issues.

Why not use common sense and stay away from the foods while the experts sort out the specifics?

From Monash University’s website: http://www.med.monash.edu/cecs/gastro/fodmap/diet.html

Sample Low FODMAP meal ideas
Editor’s note: Notice that Dr. Gibson’s department recommends gluten-free items below.

Breakfast
Gluten-free or spelt toast with vegemite, strawberry jam (sweetened with sucrose)
Cereal (oats, porridge, cornflakes*, rice bubbles*)
Tea or coffee (lactose-free milk if you have lactose malabsorption)
Serve of suitable low FODMAP fruit
* add oat or rice bran for extra dietary fibre
Lunch
Gluten-free or spelt sandwich with fillings (ham/salad, tuna/ salad, cheese/salad, egg/ lettuce)
Soup homemade with low FODMAP vegetables
Fresh salads with dressing (olive oil, lemon juice) and plain meat
Gluten-free pizza with low FODMAP vegetable toppings
Dinner
Meat/fish/tofu plus low FODMAP vegetables/ salad plus potato/rice/gluten-free pasta/rice noodles
Snacks
One serve of suitable fruit (cantaloupe, banana, grapes, strawberries, orange)
Yoghurt (lactose-free if you have lactose malabsorption)
Gluten-free biscuits and cakes

And for you conspiracy theorists:
http://www.reddit.com/r/conspiracy/comments/26f88l/what_a_surprise_the_study_that_declared_gluten/

conspiracy

http://www.realclearscience.com/blog/2014/05/gluten_sensitivity_may_not_exist.html

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

May 17, 2014

The best way to start a gluten-free diet? Just jump in!

The best way to start a gluten-free diet? Just jump in!

Earlier this week, I went canoeing with Ben and James and his girlfriend. The threat of storms made everyone with good common sense stay off the river. I guess as a collective, we defy common sense more than we’d like to admit. Of course, sometimes we’re rewarded for our defiance and this float turned out to be one of those times.

The day was perfect. It was 80º; the water was warm enough to swim and just deep enough to avoid having to carry the canoes through the rapids. As always, the deep pools were a green that borders on blue. Turtles sunned themselves on rocks and logs skittering away as the boat neared them. Best of all, we had it all to ourselves.
canoe

I spent the first part of the trip in the driver’s seat. When you’re the driver, you must either go faster or slower than the water in order to have control of the canoe’s direction, otherwise, the current is in charge. Sometimes the current flows under trees and into rocks. At those times, control becomes important for keeping the canoe, its occupants, and its contents safe.

Down river we came to a short bluff. Ben decided he really needed to climb the bluff and jump in the river. First we scouted the depth of the water and the rock formations below to make sure he had plenty of clearance. Then we beached the canoe and yelled for James to beach his and bring the camera. Soon the jumping began.

Occasionally the countdown was, “One, two, three.” Other times, “One, two, scream!” Either way, the launch was quick and the destination predetermined. Sailing away from the rock required courage, surrender, and an uncertain landing.
jump in

I know it’s trite to use a river as a metaphor for life, but all day long I couldn’t help but see it that way – it feels best if you go with the flow but sometimes the flow will bash you against the rocks if you don’t use your will to change direction. If the water’s too cold or the bank too high, the best way in is to scream and jump. Once you’re in the water, you’ll figure out whether to let the water carry you downstream to a shallow spot or swim against the current to reach the nearest beach.

And so it is with adopting a gluten-free lifestyle. I get lots of questions about how to get started. I usually advise commitment for a year, supply a list of foods to avoid and a shopping list of items to purchase. I show clients how to read labels and order in a restaurant. All of these steps are helpful, but the truth is the best thing you can do is just jump in and follow the river. Float when you can, paddle when you have to, and be sure to see the beauty of the journey.

We’ll be here to hold your hand for the countdown – scream all you want to!

May 4, 2014

But, I’m Worried that I Won’t do it Perfectly!

Want to get started with a gluten-free regimen, but keep hearing a voice in your head say, “I’m worried that I won’t do it perfectly”? If so, then I am here to make you feel better.

I didn’t have that thought and I still didn’t do it perfectly. A few weeks after beginning a gluten-free lifestyle, I was cooking pasta for dinner. I carefully made sure I had corn pasta on hand for me and regular pasta for the boys. I cooked it in two separate pans. I had two colanders ready to drain the pasta separately.
pasta dinner

Everything was going according to plan until the timer told me it was about a minute until the boy’s regular pasta would be done. Without hesitation, I put a spoon in the pan, grabbed a pasta shell, drained away the water, and popped the pasta in my mouth to test the doneness. It was habit, pure and simple.

About the time I swallowed, I realized what I had done. I felt really stupid. I was worried that I would have to start all over again. A moment of *&@$$ing ensued. I told the boys what I’d done and how foolish I felt.

If I hadn’t fessed up right then, I probably would have kicked myself for a day, maybe weeks, and I might have been tempted to give up on my plan to remain gluten-free for a year before assessing the plan’s effectiveness. As it turned out, the boys gave me so much trouble I began to reflexively explain to them how what I had done wasn’t all that bad. I protested enough on my own behalf that I believed myself.

It never happened again. That incident scared me straight. Not only that, it was so early in the process, I didn’t even notice if it slowed down the healing. In retrospect, I’m glad I made that mistake when I made it. That was more than 10 years ago when I was suffering from an endless itchy rash, aching rotator cuff, overall weakness in my arms, horrible tummy aches, extreme tiredness, diarrhea and constipation, and my hair was falling out.

Within weeks of that mistake, my arm quit hurting, I started sleeping soundly again, and my tummy was starting to feel better. In a few more weeks, I could put my car in reverse with one hand again. My hair stopped falling out. Progress followed progress followed progress. There were some ups and downs during that first year as my body slowly rebuilt, but during each down period I felt better than I had in the previous down period.

Once I felt better, I began to have an aversion to the very thought of taking a bite of a fresh, yeasty roll or a crispy pizza crust. I felt too much association with my previous pain. Today, it’s second nature for me to pay close attention to what I’m eating and it’s habit to make sure it’s gluten-free. Of course, that can make it tortuous when I eat an extra scoop of ice cream because I’m very aware of what I’m doing.

My choices aren’t perfect – never have been, never will be. What I’ve learned is that it’s better to keep making steps forward than to punish myself for not being perfect or to give up because I made a mistake. If I had let my first mistake stop me, it is likely that I would have endured rotator cuff surgery; I would have continued to become weaker; my lack of sleep would have affected my work performance; and my mounting doctor bills would have adversely affected my finances.

Even now, ten years later, I sometimes get a little tummy ache and have a momentary remembrance of how bad I felt every day back then. When this happens, I always wonder how I could stand it? A tiny pain now is so distracting I simply can’t fathom how I could have focused enough to work through my pain when it was ten times worse. I feel so good now! I’m so glad that I made that first mistake and that I didn’t let it stop me from making my way down the gluten-free path!