Arthritis, Gout & Gluten; The Connection

Genetic and metabolic processes found in arthritis and gout are common in both Celiac Disease (CD) and Gluten Sensitivity (GS). I am a sufferer and was thrilled to see a recent article in Simply Gluten Free Magazine written by Dr Alexander Shikhman; it was all about arthritis, gout and gluten. These conditions definitely run in my family and I am lucky to have been cursed with this for most of my life.  I wanted to share this information with all of you because I meet so many customers with the same issues and I get so many questions about this. If you are like me and suffer from Celiac Disease, arthritis and/or gout; this is for you.  If you don’t, you will become aware of the symptoms and understand why arthritis/gout can be a problem for those with CD or GS. Below; I will not only tell you about each; but also the causes, prevention methods and treatments.

The most common forms of arthritis that are seen in people with CD/GS are Calcium Pyrophosphate Depositon Disease (CPPD also known as pseudogout), Gout, Psoriatic Arthritis and Rheumatoid Arthritis. I also will share with you how the above conditions have affected me.

I have had severe issues with most of the above for most of my life; suffering from uric acid stones (jagged crystal stones) and calcium stones (they look very different when you pass them). Often, I had jagged crystals which would get stuck in my ureter when I was trying to pass them.  Sometimes a calcium stone would follow and get stuck on the jagged crystal stone lodged in my ureter.  A few times the urologist or nephrologist would have to go in and remove all of them for me (blessed relief).  I also had arthritis so bad in my shoulder that it took a 5 hour plus surgery to clean/free up my shoulder joint! I had constant gall stones and “gravel” (sand like crystals) until they finally took my gall bladder out back in the early 90’s. While reading the article, it reminded me of the explanation of why I have kidney stones (see post on this). Thankfully, I am now on a combination of diuretics to help flush calcium and uric acid from my system; which reduces the amount of stones and crystals that I get.  If I miss a dose of my diuretics, I brace myself for the oncoming storm of stones and/or severe stabbing pain in my toe joints, knees and some finger joints!

So, lets examine each:

CPPD; Calcium Pyrophosphate Deposition Disease (pseudogout)– most common form associated with GS/CD; characterized by deposition of calcium pryrophosphate crystals in the joints that will trigger acute inflammation.  When untreated the crystals are like abrasive materials and can cause cartilage degeneration and joint and tendon ruptures as well as joint degeneration.

-Caused by: Malabsorption of Vit D and Magnesium, excessive use of proton pump inhibitors (acid reflux meds) and complications of bisphosphonate therapy (drugs to prevent loss of bone mass) in those with osteopenia/osteoporosis, excessive production of parathyroid hormone, advanced hypothyroidism and iron metabolism diseases.  Prevention: methods include Vit D and Magnesium supplementation, address and correct hormonal imbalances, avoidance of proton pump inhibitors & bisphosphonates, physical therapy, anti inflammatory probiotics, and bromelain consumption. Bromelain are enzymes found in pineapples that digest protein. *The trick here is to control flare ups by keeping blood levels of calcium, magnesium, viatmin D and parathyroid hormones consistently in normal limits.  Having a good internal medicine doc who helps manage all of your medical conditions is key..the internist looks at the big picture and how everything interacts! (I was able to get off my Proton Pump Inhibitor because I only get acid reflux if I consume gluten and that is not an issue for me any longer. My first symptom of ingesting gluten is acid reflux! I also went undiagnosed with Hashimoto’s Disease (advanced hypothyroidism) for a long time as well.)

Gout- Gout often shows up in joints; red, tender, hot and swollen, accompanied by pain. The body is overproducing uric acid that form crystals at high concentrations which forms crystals that are then deposited in the joints causing inflammation. It can affect any joint and is most often found in joints of of toes, elbows, knees, ankles and index finger. Often the attacks occur at night when the body temperature is lower. Uric acid forms when purines (natural substances found in foods and our body) are broken down. Foods that are high in purines should be avoided: meat and meat products, seafood, alcoholic beverages, asparagus, cauliflower, spinach, mushrooms, green peas, lentils and beans.

-Causes of Gout: unbalanced diet with high purine foods, disturbances in gastro-intestinal tract such as the gut microflora resulting in decreased breakdown of uric acid in the gut. This causes re-absorption into the bloodstream. Another cause is non-alcoholic fatty liver disease because the liver enzyme, xantine oxidase is not adequate and it is the main regulator of uric acid. Lastly, imbalances in our sex hormones (low estrogen & testosterone and elevated progesterone) that are frequently seen in people with CD/GS. –Prevention of Gout: Treatment Options: non-steroidal anti-inflammatory drugs (NSAIDS), bromelain, fish oil, alpha lipoic acid, folic acid, baking soda, probiotics, prebiotics, etc. (Vitamin C is not recommended because it increases intestinal permeability and can make leaky gut syndrome worse).  The goal is to keep the blood uric acid level below 5.0mg/dl and incorporate Allopurinol and Febuxostat. (I take probiotics daily, Hydrochlorothiazide and Allopurinol. When they finally added the Allopurinol into my regimine back in 2006; that combination finally worked for me… as long as I don’t miss any doses! I can’t take NSAIDS due to previous ulcer. PS: I got a lot better when I took spinach and red wine out of my diet too.)

Psoriatic Arthritis – This is just a type of arthritis that shows up in people who have a skin rash known as psoriasis. The symptoms vary and can affect any joint and the spine. If left untreated it can cause joint deformities and disability. Often those with psoriatic arthritis have increased prevalence of carrying gene HLA-DQ8 (gene associated with CD).      Prevention: GF Diet normalizes absorption of drugs and supplements used for psoriasis and psoriatic arthritis and normalizes our gut microflora that could halt the progression. Also, the GF diet reduces intestinal inflammation which can delay the systemic inflammation. (I don’t have this! My rash was Dermatitis Herpetiformis or DH which is the skin manifestation of Celiac Disease. It flares up when I am exposed to gluten.  When I was younger, I was sent to a dermatologist who perscribed steroids and I also used steroid creams for years to try to clear this up. After my Celiac diagnosis and consistent GF Diet; the rash cleared on it’s own. DH is most often mis-diagnosed as eczema.)

Rheumatoid Arthritis- an autoimmune and systemic disease in which the body’s immune system – which normally protects its health by attacking foreign substances like bacteria and viruses – mistakenly attacks the joints. This creates inflammation that causes the tissue (sinovium) that lines the inside of joints to thicken, resulting in swelling and pain in and around the joints. The synovium makes a fluid that lubricates joints and helps them move smoothly. RA can also affect the other body systems like the heart and lungs and that is why it is an autoimmune disease and a systemic disease and it is hereditary.

If inflammation goes unchecked, it can damage cartilage and the bones themselves. Over time, there is loss of cartilage, and the joint spacing between bones can become smaller. Joints can become loose, unstable, painful and lose their mobility. Joint deformity also can occur and joint damage cannot be reversed sometimes surgery can help. RA can occur at a young age and doctors recommend early diagnosis and aggressive treatment to control RA. Rheumatoid arthritis most commonly affects the joints of the hands, feet, wrists, elbows, knees and ankles. The joint effect is usually symmetrical. That means if one knee or hand if affected, usually the other one is, too.  Diagnosis is through x rays and blood tests and symptoms. There is not one test for it..it is a combination of tests, symptoms and family history.

My father’s aunt was crippled by RA when she was very young.  Many years ago, a Rheumatologist told me that he thought I had RA and I would have to come back for blood work when I was having a flare up. So, I tried that; I called but had to wait several weeks to get back in. By the time I got back in, the flare up had passed.  I decided that I would rather be a hypochondriac and did not attempt to go back the next time I had a flare up. So,  I don’t know..but I can say that once I had the Celiac diagnosis and adhered to my GF diet, the disabling joint pain subsided and my fingers and toes stopped curving.

The key is to know the signs and symptoms of these conditions and know your family history. I can’t stress enough the importance of a primary care physician who is also an internist. He or she manages and understands all of your conditions and how they affect other body systems and will actively work with your other doctors/specialists to keep you healthy. Many customers have asked me about this very issue. I will do a blog post very soon about my internist and why I am so glad I finally made the switch to an internist who also has Celiac Disease!

For more information on arthritis visit the arthritis foundation by clicking here!

As always, talk with your doctor before starting any treatment.

 

 

 

Nima Sensor, Sunflower Cafe to Close, New Day GF Hopes to Re-open

This week I tell you all about the new Nima Sensor and how it works.  Three weeks in a row I am having to tell you about gluten-free places closing; The Sunflower Cafe/Bakery in Williampsport, PA will close on October 30, 2016. Lastly, I will share some news about New Day GF hoping to open in a new location!

The Sunflower Cafe/Bakery in Williamsport, PA will close it’s doors. I was informed by one of my facebook followers last week and I immediately went to Sunflower Cafe’s facebook page. I  went to her page and read back about one year; I started crying.  She was very open about her struggles; talking about selling furniture to pay her business loan and trying to do it all by herself because she could not afford to pay help. Wow; she had 5 star ratings.  Let’s look at this situation by looking at the numbers:

Population of Williamsport, PA: 29,349 x 1.3% = 381 Celiacs

-This means every Celiac and their friends/family would need to eat there at least once a week. I know from experience that this did not happen.  Looking at this population statistic, I know it could not work because there are no large cities nearby. I am thankful to Sunflower Cafe & Bakery for being a safe haven for those with Celiac Disease.

Everyone is talking about the new Nima Sensor: Dining out in restaurants full of gluten is a calculated risk that many take way too often and pay the price later. Now you can test your food before you eat it! This is great news if you have Celiac Disease or a Wheat Allergy. Nima Sensor is a portable sensor that tests liquid and solid foods for the presence of gluten (wheat, rye and barley) in about two minutes. Nima hopes to be able to test for top 8 allergens in the future! My thoughts are:

  1. If you eat out a lot, you can make sure your food is safe before you eat it.
  2. If people detect gluten in their meals it will drive them back to the completely GF places who are doing it right!
  3. Cost for the device is $279.00
  4. Refill test capsules cost $60.00 for 12 capsules or $5.00 per test.
  5. Pretty pricey; add $5.00 to the price of your meal.
  6. Your meal is probably cheaper at the dedicated GF place; you don’t need to test it.
  7. If you must eat at a regular restaurant; a  $5 test is cheaper than taking days off work.
  8. If it detects gluten, the restaurant probably won’t refund your meal; especially if they have a disclaimer on their menu!
  9. Level of detection is to 20 ppm (parts per million).
  10. I won’t be getting one right now because I am always at One Dish Cuisine!

Click Here to learn more

Go Fund Me Page for New Day GF:  As I told you two weeks ago; this 5 star rated Gluten Free and Peanut Free cafe  was in a small town, too far out from St Louis, MO and had several competitors that had opened up in St Louis.  Last Friday they posted that they identified a new location just outside of St Louis and were awaiting “capital” or financing. It looks like they were not able to obtain financing. A “Go Fund Me” page was posted to their facebook page. They need to raise $300,000 in order to re-open. I hope that they can raise the funds, re-0pen and prosper in the new location.

 

 

Closed: Ali’s Marketplace; GF Store/Cafe Closes in Pittsburgh, PA

Two weeks in a row I find myself having to tell you about Gluten Free (GF)/Allergy Free or Friendly (AF) places closing. Here, at ODC, we just celebrated the 4th year of our Cafe, Deli and Bakery and 6.5 years for our frozen line of food and I feel so blessed and fortunate to be able to do what I love for the communities that I am a part of. It is so upsetting to have to share this news with you. Another one bit the dust on 9/30/16. What is even sadder to me is that I am the only one talking about it closing!

I wish there was a social media blitz when these places close so we could have a wake up call for the GF/AF community.  Occasionally, we may hear about a dedicated GF/AF place opening up; unfortunately, we mainly hear about mainstream places that get customers sick; that news travels around social media like a virus!  I wish this type of intense social media attention would be given when a place opens up so that our community would/could support them so they stay open.

Here is an example:  My Facebook/blog post on Sept 13, 2016 about “Cheeri-Oh-Nos” making people sick had 120 reactions, reached 24,441 people and had 117 shares. How many shares will this post about this closing have?  Whoever emails me by Sat 10/8/16 and guesses closest in the above categories, will win a ODC  t-shirt. I will wait a week to see what the response rate is!

Well, I am here to give it to you straight.  Ali’s Market Place by Gluten Free Zone, in Murrysville, PA (outside of Pittsburgh) closed after 4.5 years. This was a completely GF (gluten-free) cafe and the store carried all GF/AF products. I referred so many people there. What a shame; this store was awesome and they had a cafe too. Here is what they had to say:

Ali’s Marketplace by Gluten Free Zone

It is with great sadness that we announce the closing of Ali’s Marketplace by Gluten Free Zone. Your patronage of Ali’s Marketplace by Gluten Free Zone the past 4 ½ years has allowed us to provide to the gluten free community education, specialty products, a certified GF deli and an award winning gluten free bakery. We thank you for the many friendships gained and appreciate the support we provided each other dealing with the somewhat complex health conditions associated with gluten. As we prepare to close our doors, we will be offering 30% off your entire purchase (excluding bakery).
In good health,
Ali, Paul, Melanie

After lasts week’s bad news, many customers asked me to get more specific in my analysis by giving some hard numbers, so I will do this for you. Being a member of the Celiac/Food Allergy communities and owning a GF/AF Cafe, Deli and Bakery makes me qualified to explain the problem to you. It takes courage to say it and I believe that you all want to hear the truth. We hear of people complaining about lack of options while the ones offering the options complain about the lack of customers. Something is not adding up here!

Let’s take an educated guess about what might have caused Ali’s to close. From my research; their prices were higher and they could just not compete with lower prices in Wegman’s, Wal-Mart, Giant, 2 specialty food stores, 2 other dedicated GF Bakeries and all of the gluten filled restaurants that are offering “gf” meals (hopefully safe when you eat the food).

Again, the problem is too much competition and the supply/availability of GF goods outpaced the demand! How can this be?  Well, the population of Pittsburgh; 300k, Murrysville; 20k and Monroeville; 28k plus some more sparsely populated areas southeast of Pittsburgh .  Their you have it folks..350,000 people = 3,500 Celiacs. They just could not support and keep all of these specialty places afloat. (for ease of illustration I am only using Celiac numbers) Again, distance needed to drive, higher pricing, and not enough customers are probably all factors. If they experienced what we experience….only 3.5% of the Celiac, Food Allergy and Gluten Sensitive community actually supporting them on a regular basis, I can understand it.  I have no way to speculate as to what the numbers were for their grocery segment.

Specifics: Here, in Howard County (and Catonsville in Baltimore County), we have approximately 4,101 Celiacs (1.5%); 16,404 Gluten Sensitive (6%) and 32,809 with Food Allergies (12%).

*53,314 local people who need us; only 450 support us each week (this number will increase a bit in winter).

*The average family eats out between 4.2 and 5 times per week and that keeps the mainstream places busy.

*The average local person with Celiac/Food Allergies eats in our establishment less than 1 time per year! This is a dismal statistic for the communities that often complain there is no safe place to eat. I am sure that other specialty establishments have the same problem. Please keep this in mind the next time you have the choice of a completely GF/AF establishment or a mainstream establishment, wherever you are, and support them.

We see the average GF/AF customer about 1 time per year (actually the number works out to be under 1 time per year). In the past month a customer with Celiac told us 2 horror stories of being “glutened” at chains offering GF Meals. Dave and I thank God for our regulars every day, you keep us holding on and we can’t thank you enough for your ongoing support! We are not unique folks; we have the same problems as the others have. Sadly, many close and a few try to re-group and move to a more populated area.

The problem is that when completely GF businesses open, they over estimate the percentage of those who will support their business on a regular basis. I bet you all are shocked that only 3.5 % (of the 19.5%) of those that need us actually supports us on a regular basis.  The other 96.5% are not coming out. I must admit, I thought it would be a bit higher; at about 9% or worst case scenario 4.5%. However, the sad reality is that only 3.5% of the population “in need” shows up. I will use this percentage in my next business plan if/when we open up another location.

Now you know why businesses open up to serve the needs of our close knit community and end up closing their doors. Sadly, it will keep happening unless all of us who are “in need” of safe meals step up to the plate by showing up and spreading the word about the ones doing it right. Thanks Ali, Paul and Melanie for a job well done on behalf of the GF/FA community in Pittsburgh, PA!