New Info From the 2017 GF Education Day

On Sunday June 11,  I had the pleasure to attend and speak at the Washington DC Gluten Free Education Day again this year. Each year this great event is made possible by the Celiac Disease Program at Children’s National Medical Center. In addition, our bakers Emily and Jennifer did a cooking demonstration of our quick breads.  I spoke about the pitfalls of FALCPA (Food Allergen Labeling and Consumer Protection Act) and the GF Labeling Act and also gave some hints for easy weeknight meals.

This was a wonderful event for those who were newly diagnosed and those who are long time Celiacs got to learn what was new.  There were many activity sessions for children and so many well qualified speakers for adult sessions,  Unfortunately, I could not attend them all.  However, I was most impressed by the keynote presentation; The State of Celiac Disease- Current Research, Latest Advances and Mass Screening Protocols. Below are my notes from the session.

Dr Ivor Hill, Nationwide Celiac Disease Center Ohio; The Quintessential Autoimmune Disorder

-We know more about Celiac Disease than any other autoimmune disease! In 1888 Samuel Gee stated that diet would be the only cure. In 1950 William-Karel Dicke identified wheat, rye and barley as the problem.

-Factors in Celiac Disease are genetics, environmental factors, diet and other unknown triggers.

-Testing Recommendations are antibody blood testing, intestinal Biopsy and Genetic HLA Screening.

-Other grains that may be problematic for Celiacs are: Teff, Oats, Millet because they are in the same family! (Yup, they are a problem for me)

-Genetics; HLA and non HLA Genes found on chromosome 6, you can have DQ2 or DQ28 or both..they are necessary but not sufficient. There are many different versions of DQ2 and DQ8 genes with 40 different mutations associated. There is an autoimmune overlap.

-Trigger Factors; age, progression, prevalence, infections (rotovirus, adenovirus, stress, pregnancy and the Microbiome (lining of intestines) which is a trigger factor and is very different in those with Celiac.

-Research Treatments; Gluten Detox; grain modification is problematic due to the peptides in wheat. Glutenase; enzyme to relieve symptoms after gluten exposure is questionable because our stomach acid can destroy the enzyme.

-Peptide Transport Blockage; problematic…Lorazotide prevents opening of tight junctions in intestine that would let gluten in, but it only lasts about 90 minutes.

-Antibody Blockage or Nexvac 2 will only target those with gene HLA DQ 2.5.

-Future Research: He feels that the future will identify more genes involved in Celiac Disease. Right now half of all cases are cases of people who are asymptomatic.

Dr Edwin Lui, Colorado Children’s Hospital Celiac Disease Center; Is it Time for Mass Screening?

-Celiac Disease is not rare. Right now in the US the rate is 1.3%, Finland is 2% and Sweden is 3% (1984-1996 of all 12 year olds).

-Incidence of Celiac Disease is rising and more people are developing it.

-Who should we screen? Many have no symptoms. Those that are at risk are:

Those with: Type 1 Diabetes (3-12%), Autoimmune Thyroid Disease (7%), Liver Disease, Rheumatoid Arthritis, IgA Deficiency, Downs Syndrome, Turner Syndrome, Pancreatic Disease, Kidney Disease, Addison’s Disease, Parathyroid Disease, Growth Hormone Deficiency, Family History.

-40% of population is at risk of developing Celiac Disease because they have DQ2 or DQ8 genes.

-Following children in Denver study found that 3% developed Celiac by age 15 while 5% developed the antibodies.

Dr Benny Kerzner, Celiac Disease Program Children’s National Health, Wash, DC; Best Practices for Management of Celiac Disease

-Dr Snyder, Dr Liu, Dr Fasano, etc, got together to set guidance for physicians for the care of those with Celiac Disease. Here are a couple of interesting points that he made. Some of this is new information for many of us!

-Check newly diagnosed Celiac for Autoimmune Thyroid Disease, Liver (AST and ALT) and Hepatitis B. (30-70% of Celiacs are non responsive to the Hep B Vaccine if they got it before they started on GF Diet! So make sure you get this taken care of.)

-Vitamin Deficiencies usually correct on their own once following a strict GF Diet…so they don’t usually screen for them unless there are issues that warrant it.  The same for bone density, etc.

Children's National

 

 

 

 

 

St Pat’s Day; Safe GF Beers and Food!

How do you navigate Saint Patrick’s Day with Celiac, Wheat Allergy or Milk Allergies? Well, I am gonna give you some insight and talk about the food and the beer. Yup, where do you get some safe food and the Good, the Bad and the Ugly when it comes to Gluten Free (GF) and Gluten Removed Beers!

When I remember St Paddy’s day, I think of corned beef, Irish Stew, Colcannon (Irish Potato Salad) and beer.  I have great memories of my childhood and the parties my parents would throw with our friends, neighbors, parish priests and nuns all letting their hair down to celebrate Saint Patrick; the Patron Saint of Ireland.

Who was this Saint Patrick and why do we all want to party with this guy?  Why do we have this religious and cultural celebration each year on the anniversary of his Death; March 17th?  Well, it started off as Religious Holiday in the 1600’s; a Holy Day of Obligation for Catholics because it was he who brought Christianity and Catholicism to the Pagans of Ireland. It is said that he taught them about the Holy Trinity using a 3 leaf clover.

Shamrocks

I guess everyone caught onto all of the fun that the Irish were having and now this holiday is celebrated in more countries than any other national festival!  Ah, those were the days..not that I was around in AD 385-461, hanging out with St Pat, but passing on traditions is what the Irish do best. However, way back in once upon a time, time;  I could go to church, come home and celebrate and I could drink beer; real beer. Most Catholic Dioceses allow consumption of meat on Friday when the holiday falls on a Friday during Lent. The good news is that you have dispensation if you live in the Archdiocese in Baltimore or Washington, DC!  The Cardinal said…let them eat meat!

The Danger Foods on St Paddy’s Day: These memories get my mouth watering  for the real deal folks! Many don’t realize it but a whole lot of beer (Guinness) can be put into the stew and even the corned beef or something as innocent as a burger! (yes, a burger). Not to mention that the stew in mainstream places is thickened with flour too. Although, you don’t need to thicken with flour when you have potatoes in a stew.  Then there is the butter and milk in the mashed potatoes in a shepherd’s pie. Wow, talk about feeling left out. Not this year gang, you can have traditional Irish fare without sacrificing taste or getting sick! Here we go gang; first the food and then the Beer.

FOOD: We have you covered with safe food at the Cafe, Deli and Bakery; then you can pick up your safe beer on the way home!

-Traditional Irish Stew: Maureen’s recipe with Beef and Lamb and a soft roll to soak up the juice; Free of Gluten, Dairy and Top Allergens

-Traditional Reuben: Maureen’s recipe available free of all top allergens or choose real Swiss cheese.

-Irish “Cream” Whoopie Pies: Chocolate and mint “cream” filling!

irish stew 3

Beers: The Good, The Bad and The Ugly!

Taste Good GF Beers:  I have not had them all, so the other source is Gluten Dude!

-Pyro (Burning Brothers Brewing out of MN, co founder has Celiac)  Click Here

-Glutenberg (Quebec, Canada; owner gluten sensitive) Click Here

-Harvester Brewing (Ground Breaker Brewing out of Portland, OR) click here

Taste Bad GF Beers:

-Redbridge: I really, really, really tried to like this one back when it came out; it was my only choice and tasted like sorghum, bitter, yuck enough said! Turned m

Ugly Gluten “Removed” Beers that you should not drink if you have Celiac or Gluten Sensitivity or serious allergy to wheat or rye or barley!

-Omission

-Daura

-New Planet

I have had several gluten sensitive customers tell me that if they have 2 or more of these “Gluten Removed” beers, they get sick..so why would a person with Celiac. Gluten Sensitivity or a Food Allergy try them? It is like people knowing that “GF” Cheeri-oh-nos, as I call them, are not safe but are still eating them. Then they go to the doctor when they can’t understand why they don’t feel good and he says their celiac antibodies are high. Crazy. Here is the info you need to know about Gluten Reduced Beers and why they ARE NOT safe referencing a study done by GIG (Gluten Intolerance Group). Click Here

What does Gluten Dude have to say? Click Here

 

“No sex, age, tissue or organs are spared from effects of Celiac Disease”

This is the #1 thing you should listen to if you or someone you love has Celiac Disease or Gluten Sensitivity. If you have people in your life or even one of your doctors who doubt the serious nature of it, have them listen too! (link at bottom)

2/27/17: Dr Allessio Fasano from the Center for Celiac Research is interviewed by Dr Theresa Nacassio on her radio show.

He talks about Celiac Disease, Gluten Sensitivity, the Microbiome, Leaky Gut, neurological complications in the brain and Autism, ADHD, Dimentia, Depression, Skin (Dermatitis Herpeteformis), Probiotics, Fecal Transplants and more!  He even talks about the Non-hybridized wheat myth, GMO’s, pesticides and more.

“No sex, age, tissue or organs are spared from the effects of Celiac Disease….”

The interview starts at  4min and 55 seconds on the timer in the link. You can fast forward through commercials too.  Dr Nacassio also has lots of other links to Dr Fasano’s interviews and talks on Celiac Disease up on her site.

Click Here

Our Food Testing Results; How Labs Test Food for Allergens

As many of you know, periodically we send out some of our food to a lab for allergen testing.  Even though our facility is free of allergens, we also count on suppliers to provide us with some ingredients.  Periodically testing our products gives us that extra confidence. (you can see report at the bottom)

This time we tested our Chocolate Cupcakes, “Rye” Bread and a Blue Menu Cheese Pizza. We have the lab test for the following allergens:  Peanut, Almond, Egg, Hazelnut, Total Milk Protein, Casein Protein, Gliadin (Gluten) Walnut, Shellfish (Crustacea), Soy, Sesame, Cashew and Pistachio.

It is important to understand how testing works. The lab has a very specific way of testing food for the presence of allergens.  The results come back in ppm (parts per million).  I am going to make this as simple as possible to understand.   The first thing you need to understand is that zero ppm does not exist; below, I explain why.

When an item is being tested, they assume it is at  0 ppm of the allergen.  They take the sample and inject 2.5 ppm (or some quantity) of the allergen into it. Then they test it to see how many ppm of the allergen it contains.  If it comes back at 2.5ppm, then there is no allergen detected..because they put 2.5ppm of the allergen into the food item. If it comes back at 5ppm. they know it contained 2.5 ppm of the allergen before injecting the allergen into it.  For an item to be called GF it must test less than 20ppm of gluten.

Some companies are certified to 10ppm (GIG), we are certified to 5ppm by the Celiac Support Association.  These companies who give GF Certification require the company to test their products and they charge the company an annual fee to stay in compliance. Companies that do this are those that take it seriously! Remember, the federal law only encourages companies making a GF Claim to test their products..it is not required by the law and the type of testing is not mandated either.  Look for CSA seal or GIG seal to be sure it is GF!

So, when you hear people saying that they want 0 ppm test results; it is just not possible. The test results show what the Detection Limit is (as low as the lab can go at detection) and the Methods they used to test the product.  Usually it ranges between 2.0 and 2.5 ppm. For gluten the testing can only go as low as about 5ppm.

How do I visually understand a Part Per Million?

“If you divide a pie equally into 10 pieces, then each piece would be a part per ten; for example, one-tenth of the total pie. If, instead, you cut this pie into a million pieces, then each piece would be very small and would represent a millionth of the total pie or one part per million of the original pie. If you cut each of these million minute pieces into a thousand little pieces, then each of these new pieces would be one part per billion of the original pie. To give you an idea of how little this would be, a pinch of salt in ten tons of potato chips is also one part (salt) per billion parts (chips).” *SOURCE: Cornell click here for more

When gluten is being tested, it is a little bit different. If they are testing Gliadin; only 50% of gluten is available as gliadin…so to calculate the results you need to multiply the gliadin ppm by 2!  So, if it is 2.5 on gliadin, it would be 5 ppm for gluten.

Testing is not cheap, this round of testing cost several thousand dollars. Here is what our testing results looks like! 

pass-with-flying-colors

tests-feb-2017

My Doctor Has Celiac Disease Too!

Many of my customers ask me who my doctors are. The Gastroenterologist who diagnosed me with Celiac Disease is still practicing in Rockville, Md  and is retiring soon. I still see him for follow ups for Celiac and Barrett’s Esophagus.

However, my primary care physician and endocrinologist; whom I saw on a regular basis were not up to par when it came to Celiac Disease or it’s complications. One of my goals in 2016 was to find a primary care physician who truly understands Celiac Disease and who did not dismiss it as minimal or view it as not relevant to my overall health. To make it worse, I would wait for an hour or two to see the primary care doctor and then get 5 minutes of their time with no real understanding of Celiac Disease or how it affects other body organs. Neither doctor understood that Celiac Disease affected your whole body! I knew that I really needed to switch doctors. My goal was to not get the blank stare from my primary care physician and endocrinologist when I am dealing with other complications of Celiac Disease. We all know that look; kind of like this:

doctor-confused  The Clueless Look

At the same time, one  of our regular customers is a doctor, an Internist, who deals with the whole body system not just special parts of the body. She is practicing locally and has Celiac Disease; as does her young daughter. What was I waiting for or afraid of?

Finally, I made up my mind that I deserved a doctor who “gets it” and made the move to Dr. Polgar as my Primary Care Physician. This was by far the best decision that I made in 2016 when it comes to my health and well being.  She actually got all of my medical records from all of my specialists to understand the whole picture of my health! She was involved in pre-op for the other surgeries that I had to have last year. I decided to interview Dr Polgar and share her insight, perspective and information with all of you.

When did you know that you wanted to be a doctor?

My parents have been telling me stories about how as a young child I was hospitalized with asthma several times and, as soon as I felt better, I started nagging the nurses and doctors to let me help them. Since my father was also a physician, people always assumed that I was just simply following in his footsteps. However, my father was actually trying to talk me out of becoming a doctor, he thought it was too demanding. It was my experience as a patient that led me down this path.

Where did you go to medical school and where did you do your residency?

I was born and raised in Hungary and went to medical school there as well. After graduation, I finished a 5-year internal medicine residency program and worked as an internist for a few years, still in Hungary. I moved to the US about 15 years ago, initially to conduct cancer research at the National Institute of Health. As fascinating as cancer research is, I missed directly working with patients. So, in order to be able to practice here in the US, I did another 2 years of residency at Harbor Hospital in Baltimore.

What made you decide to specialize in internal medicine?

While I think that subspecialists play a very important role when it comes to patient care, I always wanted a field of medicine where I would deal with the whole person, not just a particular organ system. Being able to build a long term relationship with patients and get to really know them was also vital in my decision.

When and how were you diagnosed with Celiac Disease?

It was my then 7-year-old daughter who was first diagnosed. She had a very typical case with frequent abdominal pain, early satiety and eventually weight loss. It is recommended to screen the first degree relatives of anybody with confirmed celiac disease since there is an approximately 1:10 chance of having it. To be honest, I first had my husband tested because he was frequently complaining of gastrointestinal symptoms, while I was not. When his blood tests came back negative, I was tested and, lo and behold, very high antibody levels were found. Subsequently, a duodenum biopsy confirmed that I have had celiac disease for a long time, possibly my whole life.

Why do you think it is important for primary care physicians to understand Celiac Disease?

For a myriad of reasons. First of all, it is usually the primary care who first sees patients with any new symptom. Even when celiac disease presents itself with typical gastrointestinal symptoms, physicians still often do not think about testing for it.  Back in medical school, we were taught that it is a rare mostly childhood disease which, of course, now we know not to be the case. Another reason why it is very important for the primary care doctor to understand celiac disease is because it affects not only the GI system, but pretty much any organ you can you can think of, and seemingly unrelated symptoms could be due to either undiagnosed celiac disease, or gluten exposure in a previously diagnosed patient.

What have you learned about Celiac Disease that has surprised you?

The biggest surprise came through my own diagnosis, that a practically asymptomatic person can have “full-blown” celiac disease. This definitely led me down a path to learn as much as possible about this intriguing disease.

Why did you decide to leave Johns Hopkins and start your own practice?

I was growing more and more frustrated with what I call “assembly line medicine”. Decreasing insurance reimbursements force practices to compensate by seeing more patients. The only way to do that is to spend less time with one patient. I found myself not having time to do the things that I probably enjoy the most in medicine: educating patients and being able to thoroughly think through cases. As I mentioned previously, I like to look at the whole person not just concentrate on a single complaint. This cannot be done in 10-15 minutes.

How is your practice set up to give patients the individual attention that they need along with the best possible care?

My practice is based on a novel idea called Direct Primary Care (DPC). The name refers to the direct financial relationship between the patient and the doctor. By leaving the middle man (the insurance company) out, the distorted financial incentives disappear. This is the only model that I found where the interest of the patient is aligned with the interest of the physician. It allows for significantly longer visits (our new patient visits are scheduled in 90 minute slots), much more personalized care, better access to the doctor (we guarantee same or next day appointments, and my patients have my email and cell phone number in case they need to reach me outside of normal office hours). I could go on and on about the benefits of direct primary care.

How can patients reach you?

The practice is located at 8895 Centre Park Drive, Suite E, Columbia, MD 21045. Our main office number is (443) 864-5503. A lot more information about me and the practice can be found on our website: http://www.drpolgar.com Click Here

 

Gluten Free Watchdog

Many customers ask me how I learn about unsafe gluten free items so I decided to share this incredible site with you.  Gluten Free Watchdog randomly purchases and tests products for the presence of gluten.  Every week I get emails from them with test results of the products they have tested.  They test items based on what their subscribers want them to test and they test items randomly as well.

This is how I found out that GF Cheerios were not really GF. (see 2 previous blog posts)  I had heard this from many customers as well..telling me how sick they got when they tried them.  It all made sense when I read GF Watchdog’s report on them and how they are not using certified GF oats and they are not using solid testing methods to test the product.  I also learned about a Teff Flour today that is testing higher than 50ppm and it is Certified GF!

How does this happen?  How do you find out about it?

It is easy, just sign up on their website.  The cost is $5 per month and you get more than what you pay for from this invaluable service.

Click Here to Learn More

Non Hybridized Wheat and Spelt

Okay, the subject on “non hybridized wheat and spelt” comes up time and time again so I thought I would set the record straight for all of you.  I had a good laugh last week.  At first it was not funny..I was actually concerned. So here is the story and I am going to use this as a learning experience for you all.

A customer came in saying she had to eat gluten-free (GF). She went on to say that she eats healthy GF breads made with Spelt; also known as Farro or Dinkel.  She wanted to make sure my breads contained this “healthy” Spelt in them.  I think she wanted to educated me about healthy GF eating. I explained to her that we are a GF Facility and that Spelt is NOT Gluten-Free and not allowed in my facility!  She  was stunned.  We were very busy and I was going to try to talk with her further but she just walked out. Maybe she was embarrassed because her husband looked stunned when I said Spelt was not GF.

A person with Celiac Disease (CD) or Gluten Sensitivity (GS) or Wheat Allergy cannot eat Spelt and cannot eat Non Hybridized Wheat when they are traveling in Europe!  I hear so much garbage about this from customers and people on the internet.

Spelt/Farro/Dinkel is gluten. Non Hybridized ancient grains are just as toxic to a Celiac as the modern grains! PERIOD.

There are nuns in Europe producing “GF” Communion Wafers with non-hybridized wheat that they are saying is Celiac Safe.  Wrong. It is testing at 80 ppm….it is not safe folks! There is a safe GF Host out there gang. If your church won’t get it, you can choose to abstain! (I have done several posts on this)

No, I don’t take communion at church and I think GOD is okay with that decision. I could take communion and be sick for ten days and not be able to supply safe meals to those with CD and Food Allergies.  OR    I can skip communion and continue helping others suffering from CD and FA)  Mmmmm, this decision is “no brainer” for me and I don’t think there is a GOD who would hold this against me.

Eating Ancient Grains in Europe: I have heard gluten sensitive people say they went to Europe and ate “ancient non-hybridized wheat” and drank beer and they were fine. Really?  A Celiac would not do this.  So, to the GS folks who do this; maybe you just felt great because the food is so much fresher and not filled with junk and preservatives like it is here so it can sit on a shelf or a sidewalk and remain unchanged for a year!

food-festivals

Modern Wheat Breeding Does Not Contribute to Gluten Toxicity! (ie, the breeding of modern wheat is not what is causing CD or GS or allergies)

-Stay safe and don’t believe everything you read on the internet.

-Don’t believe that GF Cheerios are really GF.

-If you have CD, GS, Wheat, Rye or Barley Allergies, you should not eat Spelt,  Ancient Grains, or “GF Cheerios”. Period! (lots of posts about Cheerios on my blog)

http://naturalsciencenews.com/2016/12/13/modern-wheat-breeding-practices-do-not-contribute-to-gluten-toxicity/