Home for the Holidays

The holiday season can easily strike fear in the hearts of those on a gluten-free or restricted diet.As if it wasn’t hard enough to avoid gluten during the rest of the year, it can seem downright impossibleduring the holidays when cookies, pies, and bread are particularly prevalent.

But don’t fret! Dr. Vikki Petersen, DC, CCN, is here to help with her top tips for dealing with celiacdisease or gluten sensitivity during this gluten-rich time of year.

We know that celiac disease is a genetic disease.In fact, a full 40% of the population1 carries a gene for celiac disease.What most first degree family members (mother,father, sister, brother) of celiacs don’t appreciate is that their risk of the disease is five times that of the regular population.Many of my patients are perplexed and confused as to why some family members refuse to even be tested for celiac disease and gluten sensitivity.

Sometimes people simply don’t want to know. While it may be hard to understand, they feel that if they never find out for sure then they don’t need to worry about it. It’s foolhardy since we know that untreated celiac disease raises your risk of dying from all causes2, but ultimately all we can do is educate to the best of our ability and then let each adult decide for themselves.In other situations, a family member doesn’t get tested because they don’t share the same symptoms as the family member with the disease. As an example, if your sister has celiac disease and has suffered from anemia and been underweight her entire life,you may think those symptoms are unrelated to your depression and constipation. Part of the education process can include the fact that gluten intolerance is associated with over 300 symptoms, many of which are silent3. The vast difference in how gluten intolerance can present itself explains why over 95% of those suffering remain undiagnosed4.

Personally, in my family, gluten intolerance has manifested itself in the following diseases: pancreatic cancer, diabetes, rheumatoid arthritis, obesity, Parkinson’s, and osteoporosis. The various family members all had different diseases but gluten was the underlying root cause.

Gluten sensitivity is also genetic. It involves different genes than celiac disease but it is genetic nonetheless.
Research into gluten sensitivity is in its infancy, but the little that has been done estimates that the disease is minimally seven times more common than celiac disease. Other estimates are much higher5. Celiac disease is on the rise. While we typically consider its incidence to be 1%, making it the most common lifelong disorder in the United States and Europe6, research occurring in the past two years has demonstrated that incidence increases to 4% and 5% with increasing age7. This is a dramatic increase that begins to explain the clamoring for and popularity of everything gluten-free. The above statistics don’t even take into account gluten sensitivity, a serious condition in its own right. As mentioned previously, it conservatively affects 7% of the population, but I believe, based on clinical experience of my own as well as that of fellow clinicians around the world, that it more likely affectsa much larger percentage of the population. It might very well approach 30%, but only time and further research will tell.Nature’s Yolk Ad learn After working with patients for over two decades, I have developed some tips to help you navigate the dangerous gluten-laden “waters” of the holidays.
1. Eat before you go to a party. This is not only a good tip for avoiding those pesky extra pounds that so many gain over the holidays, but it prevents you from becoming overly hungry and giving into gluten temptation. It’s just a fact that if you’re really hungry, you’re more likely to cheat or make a mistake by not asking enough questions regarding food ingredients.

2. Bring something you CAN eat to a friend’s or family member’s party. Hostesses usually love it when they’re helped out with the food, so you can be helpful while keeping yourself safe. Also employ tip #1 above and don’t arrive starving.

3. Every year I hear about those pesky relatives who try to “guilt” you into trying their gluten-containing goodie. You know, the “Aunt Martha” who gives that sad face and explains how many hours she slaved over a hot oven to recreate your favorite childhood goodie? She pouts and asks you to just take a bite so that you can see how wonderful it is.

What do you do? I know what you’re thinking. Isn’t it easier to just take a bite and get her to stop bothering you? No, no, NO! Do not do that to yourself. Here’s what you do instead. You explain to Aunt Martha that you know that it’s delicious because everything she makes is so wonderful (yes, the use of flattery is a very good idea!) but unfortunately you have a terrible “allergy” (yes, that’s the wrong terminology but people understand “allergy” better than they understand “sensitivity” or “intolerance”) and you will get terribly, terribly ill. When she then begs you to take just a small bite (and she will), you then go into this explanation. “Aunt Martha, my doctors have explained to me that eating a little gluten, no matter how little, would be the same as eating a little rat poison. It is a poison for me and it doesn’t matter if I only eat a crumb, my body will still get very, very sick. And the last thing I want to do over the holidays is to be ill and not enjoy this special time with my wonderful family.” That should handle the toughest of relatives and friends. And the delightful result is that you will stick to your diet,remain healthy, and truly enjoy your holidays!

4. What about cravings and weight gain? Even following your gluten-free diet, you may notice that sometimes you crave sugar and desserts. While a small, occasional dessert is fine, making it a daily part of your life is not healthy for you or your waistline. If you’re someone who suffers from cravings, you understand that feeling where you just “can’t get enough” of something. Even when you should be “full,” you still want more. Those trigger foods,if you’re able to identify them, should be avoided. When you crave, it means that what you’ve been eating is a poor source of nutrition for you and your cells are crying out for “real,” nutritious food. Personally, I can enjoy a square or two of dark chocolate after dinner and be completely satisfied. I don’t want to eat the whole bar and I enjoy the treat. However, if that chocolate was replaced by a gooey brownie, even though gluten-free, it would be difficult for me to eat just one without truly craving more. Why? I have learned that refined flours go into my system very quickly, leaving me wanting more due to the roller coaster it creates for my blood sugar – a fast high followed by an equally fast low – and that’s when the cravings begin. Therefore, attempt to keep those trigger foods to a minimum and definitely only consume them after a satisfying and healthy meal. The good nutritious calories from the meal should, to some degree, lessen the impact of the trigger food on your blood sugar and reduce cravings.

5. Want a great gift idea? I find that many patients are pretty good diagnosticians when it comes to their family members. They identify, typically very accurately, those who suffer their same affliction of gluten intolerance.

A nice gift is a genetic test for a family member you suspect is intolerant. It’s painless as it only requires a swab of the inside of the cheek and it’s ordered online so the family member doesn’t need to go through their doctor. See the References box at right for the specifics of the lab8. Perhaps a positive test, whether for celiac disease or gluten sensitivity, will open up a discussion that will improve the health of a loved one. I hope this was informative and you find that these tips will help you enjoy your holidays in good health. Please feel free to contact me should you have any questions. I’m here to help. My destination clinic treats patients from across the country and internationally so you don’t need to live locally to receive treatment. To your good health,
Dr Vikki Petersen, DC, CCN

References:
1. https://www.enterolab.com/StaticPages/EarlyDiagnosis.aspx,
http://celiacdisease.about.com/od/glutenintolerance/f/Gluten-Sensitivity-Genes.htm
Fasano, A. 2009 International Celiac Disease Symposium held in Amsterdam in April 2009.
2. Ludvigsson JF et al., JAMA. 2009; 302:1171-1178.Green PH. JAMA 2009;302:1225-1226.
Alberto Rubio–Tapia*, Robert A. Kyle‡, Edward L. Kaplan#, Joseph A. Murray, et al.
Gastroenterology, Volume 137, Issue 1, July 2009, Pages 88–93 “Increased Prevalence and
Mortality in Undiagnosed Celiac Disease “
Anderson LA et al. World Journal of Gastroenterology 2007;13:146-151.
3. National Foundation of Celiac Awareness, http://www.celiaccentral.org/Celiac-Disease/21/,
http://www.celiaccentral.org/Celiac-Disease/Celiac-Symptoms/32/
C Catassi, et al, Acta Paediatrica, “The coeliac iceberg in Italy. A multicentre antigliadin
antibodies screening for coeliac disease in school-age subjects”, Volume 85, Issue Supplement
s412, pages 29–35, May 1996. DOI: 10.1111/j.1651-2227.1996.tb14244.x
4. Fasano A, et al. Archives of Internal Medicine. 2003;163:286-292.
Ravikumara, M; Nootigattu, VKT; Sandhu, BK, Journal of Pediatric Gastroenterology &
Nutrition, “Ninety Percent of Celiac Disease Is Being Missed”, October 2007 – Volume 45 – Issue
4 – p 497-499
5. C. Frangou, Gastroenterology & Endoscopy News. “Gluten Sensitivity Baffles Celiac Disease
Specialists” Issue: October 2010 | Vol: 61:10
6. The American Journal of Gastroenterology (2007) 102, 1454–1460; doi:10.1111/j.1572-
0241.2007.01173.x
Detection of Celiac Disease in Primary Care: A Multicenter Case-Finding Study in North
America
7. Murray, J. ‘Discovery’s Edge’ (Mayo Clinic).(2010)
“Natural history of celiac disease autoimmunity in a USA cohort followed since 1974”.
Posted online on September 27, 2010. (doi:10.3109/07853890.2010.514285)
Carlo Catassi, Debby Kryszak, Bushra Bhatti, Craig Sturgeon, Kathy Helzlsouer, Sandra L.
Clipp, Daniel Gelfond, Elaine Puppa, Anthony Sferruzza & Alessio Fasano
8. EnteroLab.com