Archive for ‘Education’

October 2, 2018

Looking Down the Road at Potential Celiac Disease Treatment, Will You be an Early Adopter?

Looking down the road at potential Celiac Disease treatment, will you be an early adopter? It may seem too soon to consider, but it’s possible that in 5 years there will be multiple pharmaceutical treatments or vaccines for Celiac Disease on the market. By the time they are FDA approved, they will have been through clinical trials involving human study participants that indicate the drugs are relatively safe and will most likely work. Once the drugs are approved, will you run to your doctor to request a new treatment, or will you take a wait and see approach?

Some of us love to be on the cutting edge of everything – fashion, interior design, automotive design, technology, everything. Some of us are even willing to pay dearly for the privilege. One of my graphic designer friends bought an Apple Lisa back in the day. He paid about $10,000 for it although he’ll tell you it was about $20,000. That’s $10,000 for a computer with 5MB (not GB) of hard drive space and a 5MHz processor. I regularly email photos that are 10MB.

This friend continued to buy a MAC immediately when a new model appeared. Then he’d scream often as he zapped the PRAM or held the shift key to disable extensions when he was trying to get the buggy system to boot. He’s followed the same pattern with iPhones. When it comes to technology, he understands he’ll pay more and experience less system stability as an early adopter and that’s okay with him.

I tend to wait a bit longer. I’m not on the tail end of adopting innovation, but I like to give companies a chance to work out a few of the bugs before I jump in with both feet. The internet has made it easy to monitor MAC computer system bug fixes. Armed with that information and knowledge of the nature of the bugs, I buy a bit later than my friend. I feel like I experience less downtime, less frustration, and less expense that way.
periodic
When it comes to pharmaceuticals, there’s a whole other level for early adopters to consider – long-term health effects. We often assume that the long-term effects of drugs have been studied before a drug goes to market. That’s not necessarily true. In fact, the more effective a drug is in clinical trials, the less true it may be.

If a drug or vaccine is extremely effective in producing a good outcome, a clinical trial may be ended early. This can mean some side-effects or long-term complications may not show up until after the drug receives approval and is prescribed to patients. There can be a lag in gathering and disseminating information regarding those complications to patients and physicians. The level of risk this presents for patients depends on the specific drug or vaccine.

The FDA website in describing the process of approving drugs states:
“Even though clinical trials provide important information on a drug’s efficacy and safety, it is impossible to have complete information about the safety of a drug at the time of approval. Despite the rigorous steps in the process of drug development, limitations exist. Therefore, the true picture of a product’s safety actually evolves over the months and even years that make up a product’s lifetime in the marketplace. FDA reviews reports of problems with prescription and over-the-counter drugs, and can decide to add cautions to the dosage or usage information, as well as other measures for more serious issues.”

If you’ve watched any network TV recently, you may have seen ads for lawyers representing patients who have received the shingles vaccine Zostavax. Various lawsuits allege the vaccine causes both loss of eyesight and, ironically, shingles. Class action lawsuits have also been filed on behalf of patients who allege they were harmed by drugs including Abilify, Ambien, Avandia, Baycol, Celebrex, Chantix, Crestor, Fosamax, Invokana, Januvia, Lamisil, Lexapro, Lipitor, Pradaxa, Prozac, Ritalin, Serevent, Tekturna, Xarelto, and Zyprexa.

Each of us has to weigh the potential risks and benefits of a recommended medication. If you have life-threatening bacterial pneumonia, the risk of refusing antibiotics most likely outweighs the benefits. If you have prediabetes, the possible risk to your long-term health from medication may not outweigh the benefit of reducing the possibility that you may develop a disease that you may not develop anyway.

With all of that in mind, let’s take a look at the drugs that are being explored for the treatment of Celiac Disease:

BL-7010
An Israeli company owns the rights to a non-absorbable polymer that binds gliadin in the gut and prevents the formation of peptides that trigger an autoimmune response. The drug is not absorbed into the blood and is excreted along with protein from the gut. BL-7010 drug has made it through a Phase 2 clinical trial.

Egg Yolk Therapy
The theory here is that antibodies in the yolk of chicken eggs neutralize gluten allowing people with Celiac Disease to include a little gluten in their diet without suffering symptoms. This therapy would be used alongside a gluten-free diet. It is not believed to be a potential cure.

Larazotide Acetate
Larazotide acetate is an oral peptide that reduces leakiness in the intestines so that gluten doesn’t cross the intestinal barrier and trigger an autoimmune response. It would not eliminate the need for a gluten-free diet, but could lessen the effects of accidental gluten ingestion. Phase 3 clinical trials are being conducted this year.

Latiglutenase
Latiglutenase is a combination of enzymes that was hoped to break down gluten so that damaged intestines could heal. In a Phase 2 clinical trial, participants receiving latiglutenase improved, but so did those receiving a placebo.

The data have now been re-analyzed and scientists believe that latiglutenase may help relieve the symptoms of Celiac patients who are following a gluten-free diet, but still experience discomfort and pain. Last year, the NIH extended a grant for a two-year blind study of latiglutenase. This research will focus on symptom reduction.

Saliva Rothia
There is an enzyme that pulverizes gluten found within a bacterium called Rothia in saliva. Using knowledge of Rothia’s enzyme, researchers found that another bacterium, B. subtilis, produces an enzyme similar to Rothia. Recent research proves that modified subtilisin enzymes adhere to and detoxify gluten in mice. A big plus is that B. subtilis is safely consumed in Japan in the fermented soybean dish natto, making food-based delivery a possibility.

TIMP-Gliadin
TIMP-Gliadin is a compound composed of the protein particle and Toleragenic Immune Modifying nanoParticles. It sounds like the nanoParticles may alter the body’s immune response to gluten, but I can’t be sure. It’s too early to know much about this research.

Nexvax2
This vaccine works much like allergy shots in that a patient develops gluten tolerance through a series of injections. $40 million in funding has been secured for future research and the vaccine will enter Phase 2 clinical trials. The goal of this vaccine is to eventually eliminate the need for a gluten-free diet.

As you can see, the goal of many of these drugs is to reduce or eliminate the effects of accidental gluten ingestion. They would not eliminate the need for a gluten-free diet. Nervax2, BL-7010, and TIMP-Gliadin could possibly achieve the loftier goal of allowing those with Celiac Disease to consume gluten without damaging their intestines.

With these treatments on the horizon, now is a great time to explore whether you are an early adopter, a wait and see type, or someone who is content following a gluten-free diet. The gluten-free diet remains an effective treatment for Celiac Disease as long as you are compliant, so there’s really no wrong answer here. It’s all up to you, your preferences, and your goals!

Waaait, does that make this decision easier or harder? Probably depends on whether you’re an early adopter. I think I’ll wait and see…

https://www.macstories.net/mac/the-lisa/

http://info.cmsri.org/the-driven-researcher-blog/merck-admits-shingles-vaccine-can-cause-eye-damage-and-shingles

https://www.thejusticelawyer.com/practice-areas/detail/dangerous-drugs-medical-devices-list/

http://www.immusant.com/clinical-development/celiac-disease-programs.php

https://www.allergicliving.com/2018/03/14/inside-the-race-for-a-celiac-disease-treatment/

https://www.fda.gov/ForPatients/Approvals/Drugs/ucm405579.htm

https://www.verywellhealth.com/celiac-disease-drugs-in-development-562289

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.”

July 3, 2018

Your Gut Has a Mind of Its Own

If you feel like your gut has a mind of its own, it’s because it does. The billions of neurotransmitters in your intestine are of the same type as those in your brain and house the Enteric Nervous System. The gut is capable of a level of independent intelligence equal to that of your dog.
diet
Does that mean our stomachs can be trained?

It’s kind of a funny idea, but it’s one that’s currently being explored. Some scientists hypothesize that we can treat stomach pain using hypnosis — essentially curing our tummies by talking to them.

The gut is host to 100,000 billion bacteria. When researchers mapped the DNA of one study participants’ microbiomes, they first reported that each of us falls into one of 3 enterotypes.

Subsequent research has called this limited number and the specific characteristics within each type into question. Things may be a bit more nuanced and complicated than originally indicated. Research continues and will bring a clearer picture over time.

We do know that the gut communicates with the brain via the vegas nerve and can affect our emotions. That could be why it feels like the gut has a mind of its own that sometimes controls us.

Ninety-five percent of the seratonin in our bodies is produced in the gut where it regulates the immune system and sets the pace for intestinal transit. Seratonin is also released into the bloodstream acting on the hypothalamus and registering in the upper brain as a sense of well-being.

With conditions like irritable bowel syndrome (IBS) in which there is no observable organic malfunction, it is theorized that there could be a problem between brain and gut communication. One of the brains may send the wrong message or a message may be misinterpreted resulting in the symptoms experienced.

Learning more about this possible process may lead to innovative treatments for the 1 in 10 of us who suffer from IBS. It also has potential benefit for those who have become hypervigilant as a result of trauma.

An examination of the microbiome can increasingly assist in diagnosis and treatment of disease. The microbiome can show a propensity for Type II diabetes, heart disease, and liver disease and may influence obesity. Patients with inflammatory bowel disease (IBD) show an increase in pro-inflammatory molecules and a decrease in inflammatory dampening bacteria. Altering microbial composition could possibly be used to reduce inflammation or calm down the immune system.

Researchers have successfully diagnosed Parkinson’s disease through intestinal biopsy paving the way for additional exploration of the possibility that the gut and brain share diseases. This could be key to a greater understanding of autism spectrum disorders and alzheimer’s disease.

Dr. Michael Gershon, Professor of Pathology and Cell Biology at Columbia University Irving Medical Center who is sometimes referred to as the father of neurogastroenterology has, along with Dr. Anne Gershon, demonstrated that shingles can occur in enteric neurons and may be the cause of several gastrointestinal disorders currently of unknown origin.

It’s a little unclear whether the DNA of a microbiome is a set entity that changes slowly over time or whether researchers were simply mapping a DNA moment in a constantly changing microbiota. Studies have shown that the microbiota can change within one day with a change in diet.

That sounds like great news to me! It’s possible that a change in diet could bring symptom relief fairly quickly once we better understand what in the diet needs to be altered.

The possibilities are huge and the research has just begun. Changing the microbiome through diet, prebiotics, and probiotics may have a much greater effect in preventing and reducing disease than we previously believed. Diet may not just be fuel to keep the body strong, it may be real medicine that can be used to reduce inflammation, revise autoimmune response, and change the messages transmitted from the gut to the brain.

Knowing that my gut has a mind of its own sounds like relief to my upper brain!

https://www.pathology.columbia.edu/profile/michael-d-gershon-md

http://sales.arte.tv/fiche/3707/VENTRE__NOTRE_DEUXIEME_CERVEAU__LE_

http://stm.sciencemag.org/content/1/6/6ra14.short

https://www.mdedge.com/jfponline/article/105514/gastroenterology/targeting-gut-flora-treat-and-prevent-disease

https://www.ncbi.nlm.nih.gov/pubmed/25786900

https://www.pathology.columbia.edu/profile/michael-d-gershon-md

February 20, 2018

Is Your Gluten-Free Tummy Tied in Knots?

Is your gluten-free tummy tied in knots? You’ve given up your favorite Hawaiian bread, yeast rolls, biscuits & gravy, cake, crackers and doughnuts, but your tummy still feels like it’s tied in knots. That doesn’t seem fair! What’s going on?
knots
Before you grab a doughnut while pondering this question, keep in mind that gluten is not the source of all abdominal pain – even for a person with Celiac Disease.

In December, I contracted rotavirus (don’t believe anyone who says adults don’t get it). After a couple of miserable rounds of it, I could finally get off the couch and eat! The problem was, my system could no longer break down many foods. Almost two months down the road, I still have to avoid nuts and seeds, raw greens, and beef unless it’s shredded. I am slowly improving, but still often one food choice away from significant pain.

I have a friend who spent the bulk of 3 months on the bathroom floor after gall bladder surgery. Removing the source of the problem did not mean an instant end to her tummy troubles. She followed her doctor’s dietary recommendations, but her system adjusted much more slowly than anticipated.

One of my former employees has Crohn’s Disease that caused significant pain before she began a monthly regimen of chemotherapy. Now she has few restrictions and little pain.

There are many other medical conditions that cause stomach and abdominal pain – Inflammatory bowel disease, irritable bowel syndrome, hiatal hernia, ulcer, kidney stone, endometriosis, pelvic inflammatory disease, appendicitis, bowel blockage, hepatitis, gastroesophageal reflux disease (GERD), parasitic infection, and urinary tract infection.

Sometimes the aftermath of another condition causes the stomach lining to become inflamed or swollen causing gastritis that results in abdominal pain.

The point is, you can be getting healthier after removing gluten from your diet and still experience tummy pain. I know, that sucks. And it makes things confusing. It’s one of those unfortunate, frustrating possibilities.

Another possibility is that you have learned through traumatic experiences to reroute emotions like terror, rage, horror, or helplessness to portions of your body where you then experience those emotions as physical pain. Most of us have experienced a sinking feeling in our gut as a result of fear or stress. Imagine if you multiplied that feeling in intensity, duration, and/or repetitiveness. The resulting feeling could be that your tummy is tied in knots.

The original response to a stress may have been emotional, but the resulting response to similar situation becomes physical pain. Untangling the messages of somatic experience can take time. Sometimes it is difficult to determine the origin of physical pain.

I’m aware that I’ve shared lots of words with you that are not definitive for determining why your tummy is tied in knots. Hopefully, something you read here will give you a starting point for describing your pain to your physician or therapist.

In the meantime, if you have Celiac Disease or gluten intolerance, I encourage you to stay the course with your gluten-free regimen. You may be getting better even if your tummy is tied in knots.

January 30, 2018

Back to Basics in the Kitchen

We often talk about cooking here as if you’ve been cooking all your life, but today we’re going to get back to basics. While my mom didn’t cook much when I was growing up, my grandmother did. I spent enough time cooking fresh food and baking from scratch to feel comfortable with the tools and the terms. That’s not true for everyone my age and certainly not for everyone my kids’ age.

In some circles cooking has come to mean popping a packaged meal in the microwave or heating precooked entrees or vegetables in the oven. I’ve seen posts in which a description of baking from “scratch” included a cake mix.

Reducing the amount of prepackaged, convenience foods you eat can help lessen your consumption of chemical additives, sodium, manufactured fats, and sugar. It also means you may have to perform a few additional “cooking” related tasks.
eggshells
If you’re not familiar with cooking terminology, translating a recipe into a dish may seem daunting. Removing some of the mystery can help you get past the feeling that you can’t cook because you don’t even know what the words in the instructions mean. Today, let’s explore some basic cooking terms and techniques so you can be on your way to becoming a great cook!

You don’t need a lot of fancy equipment to prepare a wide variety of foods for boiling, steaming, baking or broiling. Peeling, slicing, chopping, dicing, and mincing only require a knife. But what are they?
Definitions:
Peel – Remove the outside skin from vegetables or fruits.
Slice – Cut a thick or thin, flat piece of something like fruit, vegetable, bread, or meat.
Chop – Cut food into irregular pieces of similar size to each other. Chopped pieces are typically larger than diced or minced.
Dice – Cut food into cubes between 1/8″ and 1/2″ in size. If size is not specified, use 1/4″
Mince – Mincing is like dicing, but the pieces are smaller.

When preparing vegetables and fruits, you’ll use these techniques over and over again.

Sometimes you may not want a cooked or raw vegetable to retain its shape at all. You can then use a food chopper or processor to grind or purée it. Grinding reduces the food to tiny particles. Puréeing means the food is processed until it’s smooth. You don’t have to have an electronic appliance to do this. A cooked vegetable can be mashed, then put through a sieve to create a purée.

Once you’ve prepped vegetables and meats, you may want to add heat in order to boil, steam, sauté, bake, broil, roast, grill, or braise.
Definitions
Boil – To submerge in a boiling liquid at or above the boiling point of water.
Steam – To place food above boiling water in a pot or pan using some kind of rack or basket and a cover so that steam cooks the food.
Sauté – To cook a food quickly in oil and/or butter over high heat.
Bake – To cook using dry heat in an oven or on heated metal or stones.
Broil – To cook quickly using high heat from above the food.
Roast – To cook using dry heat with a temperature of at least 300 in an environment in which hot air from an open flame, oven or other heat source envelops the food, cooking it evenly on all sides.
Grill – To cook directly over live, high heat flames.
Braise – To cook slowly in a small amount of liquid in a covered container in the oven or on a burner.
Brown – To give a cooked surface to meat or flour. Also to turn a brown color in the oven.

Sometimes you’ll want to parboil, blanch, simmer, scald or blend.
Definitions
Parboil – To briefly boil in water until food begins to soften.
Blanch – To briefly place food in boiling water, then immediately move it into cold water. 
Simmer – To cook in liquid at a temperature just below a boil. 
Scald – Refers to both dipping into boiling water, and heating milk to just below the boiling point.
Blend – To mix ingredients together thoroughly often using a beater, mixer, or blender.

You may be instructed to dot a casserole with butter before baking it, or to baste a turkey while it roasts. If so, here’s what to do:
Definitions
Dot – Cover the top with small pieces of butter.
Baste – Spoon, brush or pour drippings or liquid over a food before or during cooking.

When you begin baking from scratch, you’ll commonly see instructions to sift, mix, cut in, whisk, flour, fold, and knead so let’s prepare for that:
Definitions
From Scratch – To make from the very beginning without using already prepared ingredients.
Sift – Use a device made of a metal cup with a screen at the bottom that contains a mechanism to force the flour through the mesh.
Mix – Combine items to form one mass.
Cut In – Work solid fat into dry ingredients with a pastry blender until evenly distributed.
Whisk – Beat or stir with a whisk.
Flour – To dust a pan the shortening in a prepared baking pan with flour.
Fold – To delicately incorporate one substance into another substance without releasing air bubbles.
Knead – To work a dough by mixing, stretching, and pulling with the fingers and mashing with the heel of the hand.
grate
Other common actions are grating, whipping, and garnishing. Let’s explore those terms:
Grate – To rub firm food on a tool with small, rough, sharp-edged holes grater to create small pieces.
Whip – To beat vigorously to incorporate air and cause expansion.
Garnish – To decorate a dish with something attractive and flavorful.

Now for the important question – Can we use these terms to make a great snack for the Super Bowl?

Of course we can! It’s winter. Let’s make chili!

Chili Sallie
Serves 8

1 large onion, chopped
2 tbsp olive oil
1 or 2 jalapeño peppers, seeds removed, finely chopped
2 fire roasted sweet peppers, seeds removed, diced
1 1/2 lbs lean ground beef
2 tbsp chili powder
1 1/2 cups cooked black beans
3 1/2 – 4 cups tomato juice
1/3 cup stewed tomatoes, roughly chopped
1 tbsp ground cumin
1/4 tsp red pepper flakes
1 tsp garlic powder
3/4 tsp salt
1/2 tsp fresh ground black pepper

Instructions
Sauté onion in olive oil in large pan until translucent – about 5-7 minutes. Add the jalapeño and cook for an additional 3 minutes. Add red peppers and ground beef to the pan and brown. Once beef is browned, sprinkle with chili powder and stir until all the meat turns red. Add beans, 3 1/2 cups tomato juice, stewed tomatoes, and the balance of the spices.  

Stir and simmer for at least 20 minutes. Add the balance of the tomato juice if needed as the chili cooks down.
Serve hot.
chili
Now that you have a guide to more than 30 common cooking terms and have had a chance to see them as they appear in a recipe, you can build on this knowledge as you gain experience and confidence.

Never feel bad about having to look something up. Many chefs have used books and kitchen experience to become successful. And remember, you don’t have to be a chef to be a great cook!