Add Foods Slooooowly

If you upset your system be sure to add foods slooooowly once you’re feeling better. The mistake I made eating smoked brisket in August, is still affecting me. No, it’s not my imagination. No, it’s not fun. It affects my everyday life, my work life, and my social life.

That’s what ingesting gluten, or triggering an IBS, or MCAS flare can do. It can disrupt everything! The results can make familiar situations so uncomfortable you have to change your routine. And, in the case of me yesterday, they can mean you have to lie down after a meal because if you don’t you feel dizzy or too tired to move.

For the next couple of days, I will eat primarily apples, eggs, potatoes, sweet potatoes, and limited amounts of chicken or turkey. These are things my system tolerates well even during a flare. As time goes on, I’ll add squash and English peas.  

The second mistake I made is, once I felt normal for a day, I rushed back to my regular diet and even tempted fate with restaurant food and a few Cheetos. The restaurant is local and uses fresh food, but still may have stretched the limits. Cheetos. I knew better.

long spread of food on wood table

Don’t worry, I won’t do that again any time soon. But I haven’t had a flare that lasted this long or put me in this much pain in a decade so I no longer remembered the effects viscerally.

If you try an elimination diet, make note of foods that you tolerate well when you begin adding foods back. This can become your go-to diet for recovering from an accidental ingestion of foods that irritate your system.

Using well-tolerated foods as your base, slooooowly add back foods that typically give you the least issues. For instance, I don’t usually have problems with beef until my system has already been triggered to overreact. In that circumstance, beef may cause a significant detrimental reaction.

It’s best if I don’t rush to eat beef once I feel better. If I do, I risk starting the healing process over to some degree. Not only will that bring physical discomfort, it will bring multiple levels of frustration.

Would I love to eat some chocolate today? Yes, it sounds yummy. But chocolate is an irritant I cannot tolerate in large quantities or often. Instead, I’ve gone back to the dietary basics I started with a month ago.

This is a great opportunity for me to practice patience. I will today and tomorrow, but as I begin to feel better, the temptation to eat something that tastes better will reappear. That’s when my resolve will be tested.

To entice myself to continue to eat safe foods, I can add small bites of relatively safe foods to jazz things up as I continue with the basics. Adding a little honey to my toast, a bit of goat cheese to my eggs, a bowl of rice with a dab of butter and raspberry jam to my breakfast, can introduce enough taste variety to reduce the temptation to eat chocolate or Cheetos.

There’s no set time frame for getting back to a more varied menu after a flare but learning from my mistake and not going back to a full diet immediately after you feel better for a day can prevent a lot of pain. After a flare, it’s better to add back slooooowly.

Setting the Stage

A question I asked myself daily when my children were growing up is what am I setting the stage for? That may seem like a less than emotional approach to parenting. It is. But based on my family of origin, thoughtfulness was always better than my initial emotional instinct.

I didn’t sit and study an issue for hours. I just quickly played out the lesson I was teaching to the extreme. Quick example: When my 2-year-old took a Happy Meal toy from another 2-year-old, I suggested he apologize. As I watched his fury and reluctance, I knew he wasn’t sorry. If I pursued pressuring him at that moment, I was teaching him to be disingenuous aka lie.

I’m not discounting that he needed to learn to be polite and kind and function well in society. But that required a more thoughtful and lengthy discussion repeated over time.  

If I teach a child to lie at a time in their development that I’m also attempting to teach him to tell the truth about throwing my ring in the trash, feeding the dog chocolate, or breaking his grandmother’s vase, can he differentiate or will he determine he should just ignore me because I make no sense?

You could argue I’m only teaching him to be emotionally disingenuous. Okay, well how will that play out in his adult relationships, especially intimate ones? Will he adopt polite appeasement over the truth? Maybe or maybe not, but the stage has certainly been set for it.

Each decision we make as a parent sets the stage for something. It is worth considering for what. This is also true as business owners or corporate citizens. And it is true of healthcare.

Young man with dark curly hair sitting at white table next to black chair pulling his hair with both hands.

The US healthcare system set the stage for people to seek answers elsewhere. Unfortunately, this has led to doubting science along with healthcare professionals. But dismissing people who run to Dr. Google first is to miss the point of the patient experience.

The aftermath of 2020 led many institutions away from the emphasis they were putting on patient-centered care. This is unfortunate. And even with a movement toward listening to the patient, the system in general needed hearing aids.

Many patients with GI problems suffer through years of no diagnosis, misdiagnosis, ineffective medication, being treated as though they’re crazy. And then years of paying off the invoices generated in getting them no relief. Why wouldn’t they mistrust a system that is not serving them?

A lot of those patients want to be treated by someone who cares to get to the root of the problem even if it means trying something besides medication. I’ve written before about the doctor I had coffee with who said he would never put someone on a gluten-free diet unless they had a positive biopsy. I understand the importance of best practices, but a gluten-free diet does no harm and might give him helpful information toward diagnosis.

Can we get past rigidity of thinking when we know our diagnostic tools are limited? Opting for surgery in an unclear diagnostic situation is considered acceptable. Is that because surgery gins more money through the system?

Why is a non-harmful approach rejected when a potentially dangerous procedure is considered acceptable within the standard of care? The answer may not be simple. Sometimes, it’s just that the physician you rely on is not well-informed on new research or developments. Sometimes, it’s fear of being sued. Often, it’s that huge systems are not nimble and move slowly.

But sometimes a complex answer gets simplified to – we’re following science – and presented to the patient. Great job! Now you’ve set the stage for that patient to distrust science.

And such incidents may come on top of setting the stage for patients to distrust the way medicine is practiced because they haven’t been provided a diagnosis or effective treatment. Further, they may have been treated as if they’re crazy (especially if they’re female).

Posters on Reddit and BlueSky last week asked people to post the most ridiculous thing a doctor had ever said to them with a straight face. These posts received hundreds of replies and thousands of replies and reposts.

We’re reaping the results of distrust in science in things like measles outbreaks. That is bad and dangerous. But until the healthcare system chooses some self-reflection, it will continue to set the stage for distrust.

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.”

Will A Gluten-Free Diet Help

Will a gluten-free diet help if you have Microscopic Colitis (MC)? https://my.clevelandclinic.org/health/diseases/17227-microscopic-colitis Possibly. About 50% of MC patients also have celiac disease.

older woman sitting on gray couch in front of bookshelves holding her stomach

Microscopic Colitis is so named because your colon may look normal until tissue is examined under a microscope. This can make it hard to diagnose. And while you’re trying to get a diagnosis, symptoms may be disrupting your life.

MC is an inflammatory bowel disease that causes frequent, watery diarrhea and abdominal pain. Many patients lose weight. Others gain. It’s easy to end up dehydrated. And forget eating meals out, or even leaving your home for an extended period of time until you get it under control.

Once diagnosed, your doctor may recommend changing some medications and adding others, adding supplements, and identifying food intolerances. There’s no standard list of trigger foods although the most common are alcohol, caffeine, gluten, dairy, and sugar.

It’s easy to identify alcohol, caffeine, dairy, and sugar, but eliminating gluten is sometimes confusing. To do so, you’ll need to avoid wheat, rye, barley, and malt and their derivatives. That means look for these problematic items on a label:

Barley Grass

Barley Malt

Beer (there are GF varieties)

Bleached Flour

Bran

Bread Flour

Brewer’s Yeast

Brown Flour

Bulgur Wheat

Cookie Crumbs

Cookie Dough

Couscous

Durum wheat

Edible Coatings

Edible Films

Edible Starch

Enriched Bleached Flour

Enriched Bleached Wheat Flour

Enriched Flour

Farina

Farina Graham

Farro

Filler

Flour

Fu

Germ

Graham Flour

Groats

Hard Wheat

Hydrolyzed Wheat Gluten

Hydrolyzed Wheat Protein

Hydrolyzed Wheat Starch

Kamut

Maida

Malt

Malted Barley Flour

Malted Milk

Malt Extract

Malt Flavoring

Malt Vinegar

Matza

Matzo

Matzo Semolina

Orzo Pasta

Pasta

Pearl Barley

Triticum

Roux

Rusk

Rye

Semolina

Semolina Triticum

Spelt

Sprouted Wheat or Barley

Tabbouleh

Unbleached Flour

Vital Wheat Gluten

Wheat

Wheat Bran Extract

Wheat Germ Extract

Wheat Nuts

Wheat Protein

Whole-Meal Flour

The following items sometimes contain gluten:

Artificial Color

Baking Powder

Boxed Cereals

Broth

Caramel Color

Caramel Flavoring

Clarifying Agents

Coloring

Dextrins

Dextrimaltose

Dry Roasted Nuts

Emulsifiers

Enzymes

Fat Replacer

Flavoring

Food Starch

Food Starch Modified

Glucose Syrup

HPP

HVP

Hydrolyzed Plant Protein

Hydrolyzed Protein

Hydrogenated Starch Hydrolysate

Hydroxypropylated Starch

Maltose

Miso

Modified Food Starch

Modified Starch

Natural Flavoring

Salad Dressing

Natural Flavors

Non-dairy Creamer

Oats

Seasonings

Soba noodles

Soy Sauce

Soup

Stabilizers

Starch

Tomato Paste

Vegetable Gum

Vegetable Starch

Vitamins

Wheat Starch

Beyond these common triggers, you may need to keep a food journal over a period of time in order to isolate other foods you cannot tolerate.

With the use of medication and dietary changes, it may be possible to resume most of your usual activities with confidence. For help dealing with lingering problems, MC support groups are available.

Medical Treatment of Celiac Disease

In 2018, I asked whether you’d be an early adopter of medical treatment of celiac disease.

When a friend recently assumed I’d give my kids a pill rather than restrict them to a gluten-free diet, I was surprised.

When there’s a way to address symptoms caused by a disease or condition through dietary changes without it resulting in life-threatening results, that is the choice I’ll make. Could that change? Perhaps. I’m always open to advancing science. If there were a vaccine for Celiac Disease that had been thoroughly tested, I would still be extra cautious when it comes to developing children because they can live a healthy life without medication.

assorted shapes and colors of pills

For me, the distinction is in automatically choosing convenience vs committing to a less convenient, but well-established healthy option. If we follow the line of reasoning that convenience rules, there should be no question that fast-food is the best choice for our children. Hopefully, we know better. And hopefully, we are more thoughtfully informed when choosing other options for our kids.

With that in mind, let’s review the status of previously explored treatments:

BL-7010 has not completed clinical trials evaluating safety. https://clinicaltrials.gov/study/NCT01990885?intr=BL-7010

Egg Yolk Therapy aka dietary supplement AGY-010 completed a study of 149 individuals. That’s too small a number of individuals to draw any conclusion other than further research is needed

https://clinicaltrials.gov/study/NCT03707730

Larazotide Acetate entered a Phase 3 clinical trial for safety in 2022. This study was terminated.

Latiglutenase entered Phase 2B clinical trials on an oral dissolvable powder in 2023.  A Phase 3 trial is planned.

https://adisinsight.springer.com/trials/700318623

Saliva Rothia was studied in 24 children in a clinical trial published in 2024.

https://www.nature.com/articles/s41598-024-67677-4

TIMP-Gliadin was studied in a trial published in 2024.

https://clinicaltrials.gov/study/NCT03409796

Nexvax2 trials were discontinued when the vaccine proved to be no more effective than placebo.

What we can see from a comparison of the previous list and this one is that it takes a very long time to bring new treatments to market even when early trials are promising. There are many complicating factors like funding, participant recruitment, and world events like pandemics.

This can be frustrating for anyone who has a disease that must be treated with medication! While you may not feel lucky to have celiac disease, at least there’s a dietary alternative.

Researchers continue to explore. For a quick view of the clinical development pipeline for treatment of celiac disease, visit:

https://www.sciencedirect.com/science/article/pii/S1359644624002381

Eventually, there may be a safe, effective, convenient choice. Until that time, we’re here to help you manage the diet.

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.”