Archive for ‘Education’

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!

November 20, 2017

Celiac’s Relationship to Risk for Other Diseases

If you have Celiac Disease, it’s important to recognize Celiac’s relationship to risk for other diseases. It’s especially tempting at this time of year to ignore the signs of distress your body sends you when you eat bread stuffing, gravy on your turkey, flaky pie crust, gingerbread cookies, and Christmas cookies – after all, it’s the holidays! Before you grab another roll in spite of your physician’s advice to follow a gluten-free diet, it’s good to be informed about the other health effects this could have.
crust
Here is a list of health conditions related to Celiac Disease:

Cancers
Non-Hodgkin Lymphoma and Small Bowel Cancer are serious complications of Celiac Disease. The good news is that three to five years of adherence to a gluten-free diet reduces the risk of these cancers to the same risk found in the general population. The risk will remain the same as it is for the general population so long as the gluten-free diet continues.

In untreated Celiac Disease patients, Esophageal Cancer occurs at a rate as much as 8 times higher than in the general population. A gluten-free diet reduces this risk.

Those with Celiac Disease have a threefold higher risk of Papillary Thyroid Cancer. This is the most common type of thyroid cancer and is highly treatable.

Chronic Pancreatitis
Chronic Pancreatitis is an inflammation of the pancreas that worsens over time. Having Celiac Disease increases your risk of Chronic Pancreatitis threefold.

Scleroderma
Celiac Disease is a known trigger for Scleroderma – an autoimmune condition that causes a hardening and tightening of the skin and connective tissue. It is chronic and without cure.

Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease is the third leading cause of death in the US. A large Swedish study from 1987 – 2008 found that those with both diagnosed and undiagnosed Celiac Disease had a moderately increased risk of COPD.

Osteoporosis
Untreated Celiac Disease can lead to development of osteoporosis also known as brittle bones.

Infertility
Untreated Celiac Disease may be an underlying cause of unexplained infertility.

Type 1 Diabetes
The incidence of Celiac Disease in patients with Type 1 Diabetes is 4 – 6% (possibly as high as 10% according to the Diabetes Council). Untreated Celiac Disease with resulting malabsorption can cause hypoglycemia in these patients. If you have Type 1 Diabetes and Gluten-Sensitive Enteropathy, it will be easier to manage blood sugar levels when you adhere to a gluten-free diet.

In addition to these diseases, any condition that is exacerbated by inflammation can be affected because Celiac Disease is often associated with chronic inflammation. The inflammation from untreated Celiac Disease frequently causes joint pain.

With all the tempting treats of the holidays at hand, you may struggle to make the decision to remain gluten-free. While you are always free to choose that flaky pie crust, it’s only prudent to do so with the knowledge that if you have Celiac Disease, doing so can have a detrimental effect on your health. And now you know!

http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/learn-about-copd/how-serious-is-copd.html?referrer=https://www.google.com/

https://www.thediabetescouncil.com/balancing-diabetes-and-celiac-disease/

http://spectrum.diabetesjournals.org/content/15/3/197

https://celiac.org/celiac-disease/understanding-celiac-disease-2/celiac-disease-and-comorbid-conditions/22514-2/

http://www.cooking2thrive.com/blog/cut-bite-size-pieces/

September 26, 2017

Food or Feud

In my family, it can be food or feud. The simple solution is for us to eat on time. But what happens when things aren’t simple?food or fuedI am sitting in 3000 square feet of emptiness looking up at the ducts on the ceiling 22′ above me. My head is hurting. I planned to be here until 1pm. Now the heat & air installers say it may be 4pm. I am hungry for more than the cheese and crackers I brought to tide me over until 1. It may be fall, but it is hot!

Hot, hungry, and tired with a headache that won’t quit can be a recipe for a family feud or at least a lot of misunderstanding! When someone in my family starts to become easily annoyed, we immediately look for food. We know that we’re grumpy when we’re hungry. Because of this, we’re pretty good planners and we always have a snack handy, but the unexpected can still sometimes catch us unprepared.

If you’re one of those folks who can go all day without a meal, you’ll have no idea why this is significant. If, on the other hand, you begin to feel shaky, confused, sweaty, and sick if you don’t eat on time, you’ll understand why I’m writing this.It’s hard to count the number of times I’ve told a travel companion that I’m hungry only to have them stall me for 3 or 4 hours. Long before that time is up, I feel like I’m going to throw up my guts. I physically hurt. I cannot think straight enough to tell you what I want to eat.

What I’m describing has happened to me all of my life. It also happens to my son. It probably happened to my grandfather who could not tolerate sugar. He never ate cake, pie, cobbler, or cereal with added sugar. He would occasionally eat chocolate covered cherries. I don’t remember, but I’m guessing he ate those after a meal when they would have less effect.
I say this because that’s my experience with sugar. I can tolerate some after a meal, but feed me pancakes with syrup or a glazed doughnut for breakfast and I will be puking them up in 5 minutes. I will feel a horrible sinking sensation, then wretchedly nauseous.

My grandfather and his sisters who shared this sugar sensitivity were never diagnosed with a condition or disease. I have had blood work done just after two of these episodes. It is always in the normal range. My body may struggle to break down sugars because of celiac disease, but no one has been able to tell me that with any certainty.

That’s the thing sometimes. You know how you’re feeling isn’t normal, but whatever you have isn’t showing up, isn’t being tested for, or falls in the “normal” range. That can feel really frustrating. But life goes on. You learn to recognize when you’re approaching critical and do your best to stay ahead of the problem.

But when a plan suddenly changes, things run late, or there is an unexpected problem, what I most need is for you to believe me when I say I need to eat. I may say it matter-of-factly and without drama, but I need for you to understand that it will soon be more than I can do to remain calm if you ignore repeated requests to stop at the next place we come to.

I know that you may be trying to get to a better restaurant 10 miles down the road, but what I need for you to get is that once I hit a certain point, I do not care whether the food will taste good, I just need it in my tummy. Telling me to hang on because there’s a great restaurant in the next town is like telling me you’re going to break my arm. If I respond as though that’s what you’ve said, it is because that is how it feels to me.

When I am using my energy to stay calm, ask politely, and try not to puke or cry, it is overwhelming to ask me to choose a restaurant, name what I want, or really to communicate at all. Keep in mind that I will have attempted to address the oncoming problem I am sensing before I get to this point. If you did not recognize that those attempts were important, you may not recognize that I want to cooperate, but am feeling as though my situation is dire. Boom! Argument, misunderstanding, or meltdown may be imminent.

While I may get into a situation in which grabbing a handful of crackers from the table is tempting, since becoming gluten-free I have never made that choice. And that adds a second layer of distress when communication becomes difficult.
Today, when I began to feel vague hunger pangs, I ate some cheese and crackers. An hour later, I was getting seriously hungry. About that time, I received the news that my stay would be extended several hours past what I had planned for. I recognized that it was important to either stop the crew and go get food, or find a way to get some brought to me.

I did not wait until I could no longer think straight. I made a short list of people who could help, decided what I would request they do, and proceeded to call the list. Before the next hour was up, I had eaten lunch and no longer had a headache.
plate
Today, things worked out well. Other times, they have not. Most often those have been times that I was accommodating a group or an individual with little insight or empathy. Occasionally it has been at times that I was forced to deal with a person who simply can’t be reasoned with or does not value how I feel.

What’s the best plan in those instances?

Recognize that not everyone you come into contact with has your best interest at heart. If there are people in your life who are routinely difficult and make it hard to take care of yourself, avoid situations that make you dependent on dealing with them. Take a separate car. Choose a different work group. Volunteer for a different committee. Say no if you have to.
Know that you will never be able to make an unreasonable person be reasonable. They must come to a point where they choose to see their contribution to a situation that distresses you before you can reach them. How you feel can be communicated and cooperation can be requested, but it is helpful to know that you cannot force understanding.

You will never be able to make crazy behavior make sense. It is not necessarily important to understand why someone does something. If they exhibit a pattern of behavior that is detrimental to you, it is enough to know they do it and that it is not acceptable to you.

Once you determine that, you have many choices for what to do next:
Set and enforce better boundaries.
Minimize your exposure.
Leave behind friendships, romantic relationships, jobs, or distant relatives that hurt you.
Become realistic about your contribution to any friction in a relationship and apologize for your part in a misunderstanding.
Refuse to be lured into apologizing for taking care of yourself so long as you have managed to remain calm and kind and have tried your best not to inconvenience anyone else. You cannot control every circumstance.
pork roast
On the flip side, you also have choices about how you view another’s actions:
Extend the benefit of the doubt. Some people mean you no harm, but will inadvertently hurt you anyway.
Be present. We are all less likely to hurt each other when we are fully aware of the effect we’re having in the moment.
Allow yourself to see and feel the discomfort of someone else’s distress. Being attuned to subtle signs will change how you respond. Isn’t this what we want from others?

I wish for a partner who understands my physical limitation to the extent that in a pinch he is willing to voluntarily bring me something to eat that doesn’t take much energy to digest – a banana, a glass of milk, or some Greek yogurt. It sounds so simple. I’m sure any man who has failed to do so would read this and say, “I would do that.”

Of course you would if it seemed important at the time. But what if you got distracted by a work call or the kids throwing a fit or trying to figure out how we’re going to pay for replacing a heat & air system we haven’t budgeted for? What if you felt annoyed when I repeated a request for food when you’re planning to EVENTUALLY honor that request? What if you were in the mood for a really good meal and thought I’d be ruining my appetite by eating before our 9pm reservation? What if your mother believes I am trying to avoid eating the meal that’s taking extra time to prepare because she’s making it gluten-free for me? What if you simply don’t believe how sick I feel because you’ve never experienced it and my test results are normal?

We all like to see ourselves as reflected only by our best moments. In real life, we’re experienced by those around us as a sum of our level of presence, our tolerance for vulnerability, our priority in the moment, our insight, our ability to empathize, our reliability, our helpfulness, kindness, and thoughtfulness, our flexibility, stability, and mindfulness, our willingness to entertain different points of view, our truthfulness, genuineness, respect for others, and our courage to make the difficult choice. Other’s experience of us may not match up with what we believe about ourselves.

So what?

We are surrounded by evidence that many of us have difficulty taking care of ourselves. If we were consistently receiving the message that we matter, we are important, we are valued, others wish us well, and our loved ones are willing to help us, would we have a rapidly increasing number of pervasive, preventable, chronic health problems? Would we ignore simple lifestyle changes that can give us the ability to live longer, more productive, more comfortable, and more joyous lives? I don’t think so. I think part of the struggle to eat in a manner that maximizes our health comes from the messages we receive on a daily basis.

Why does that matter?

Only you know how significant, painful, overwhelming, exhausting, or stressful something is to you. You may communicate that clearly and still find yourself without assistance. That does not mean there is something wrong with you, that you should not take care of yourself, or that you do not deserve help. It could mean you need a better communication strategy, or it could mean that you are surrounded by relationships that need to be reexamined.

For my family, it’s food or feud, so there are repeated opportunities to observe, examine, and improve our interactions. Most of us accept each other’s limitations and work together to take care of each other. We also accept that some family members will choose to make things more difficult and that we have many options for dealing with this. Those options may not be easy choices and may require some self-sacrifice to maintain a relationship. We accept that at some point a relationship could become be too harmful to continue. At that point, we can choose to let it go.

Eating on time may not be a feuding issue for your family. Your point of contention could center around eating gluten-free or vegetarian It could be that a battle breaks out every time you try to convince your sister that your diabetic mother doesn’t need carbs. It could that no one but you lives near Grandma, but the rest of the family condemns you for wanting to put her in long-term care.

The specific issue may vary. The importance of expressions of empathy, kindness, helpfulness, thoughtfulness, care and concern, and acceptance for ourselves and each other cannot be overstated. These expressions are critical to our health, our families, our communities, and our nation. They make a difference. They can make THE difference, especially when things don’t go according to plan.

https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-activity

http://www.webmd.com/diabetes/tc/hypoglycemia-low-blood-sugar-in-people-without-diabetes-topic-overview#1