Sunday, September 29, 2013

Gluten Intolerant? Don’t ‘Fall’ for Peer Pressure!

Is Peer Pressure 'Forcing' You to Cheat?

As adults I believe we would all like to think that peer pressure went the way of high school. While for many that may be true, unfortunately peer pressure seems to be alive and well in many of my patients who are gluten intolerant and their health is suffering as a result.

Here Are Some Real Life Examples

 Just this week I’ve run into the following patients:

  • A gentleman who had been suffering for years with severe IBS (Irritable bowel syndrome with diarrhea and discomfort multiple times per day) whom, after learning he was gluten intolerant and making the necessary dietary and nutritional changes, had been feeling great. His bowels had normalized and his pain had resolved entirely. I hadn’t seen him for several months but he contacted me and confessed that he had been eating some gluten and wasn’t feeling well again. Someone had offered him some a few months prior and, in a moment of weakness, he had given in. When he didn’t 'seem' to suffer terribly as a result, he started cheating more. Time passed and now he’s ill again.
  •  The second example is a young woman who had been off gluten for several months and doing well, who accepted a protein bar that her brother handed her before they went out to exercise – she was hungry and didn’t bother to read the gluten-containing ingredients. The result? She went into anaphylactic shock and had to be rushed to the emergency room.
  •  Lastly, a middle aged gentleman who had noticed great improvement in his health since removing gluten from his diet, called in to say he needed help. After initiating a gluten-free diet several months ago he’d lost weight from his prior bulging abdomen, his joint pain disappeared and his energy rose significantly. When he came into the clinic this week he was complaining of fatigue and insomnia. It turns out that he started sneaking in some gluten at a memorial dinner after a family member passed away and he was feeling ‘blue’ – someone offered him some and he said it was easier to eat it than explain why he couldn’t.The result? He felt terrible and it wasn't resolving.

What do all these patients have in common?

  1. They are all gluten intolerant and have experienced great health improvement as a result of a gluten-free diet, while also receiving treatment for the secondary effects of gluten as individualized for each patient. 
  2.  They have ‘cheated’ on their diet and experienced a variety of symptoms. In the case of the young lady, her anaphylactic shock could have killed her if she hadn’t gotten to the ER fast enough.
  3. Statistically they have increased their risk of developing autoimmune disease because they are again exposing their immune system to a known toxin – gluten.
  4. If they continue cheating they increase their risk of dying from all causes to 4 times over their non-gluten intolerant counterparts.

As I mentioned above, these were just stories from this week. I wish I could say this was an unusual week, but it wasn’t. 

Is it human nature to ‘cheat’?

 I like to have treats once in a while, but I’d NEVER cheat with gluten. Why? I know better.  I might have a couple of extra pieces of dark chocolate, but gluten doesn’t even tempt me. And the reason I'm not tempted is because I know the serious ramifications. I’d no sooner make that mistake than I would sign up for a game of Russian roulette – both can kill you.

If you’re gluten intolerant, please get educated. You’ll know when your education is adequately thorough when you wouldn’t ever consider cheating. Do you need help? That’s what I’m here for.

If your health is not at the level you'd like it to be, consider contacting us for a free health analysis - call 408-733-0400. Our destination clinic treats patients from across the country and internationally so you don't need to live locally to receive care. We are delighted to help!

To your good health,

Dr Vikki Petersen
Awarded Gluten-Free Doctor of the Year 2013

Monday, September 23, 2013

Can Your Skin Have Celiac Disease?

I Don't Like the Way We Treat Skin Conditions in this Country

One of my pet peeves is the way skin conditions are treated in this country. I cannot state what happens elsewhere, although I fear it’s similar, but here in the US dermatologists (skin doctors) tend to treat skin the way one would a stain on one’s shirt. In other words they direct all their attention to trying to make disappear, the rash, the dryness, the burning, etc. topically.

Why is that an error? The skin is an organ. In fact it’s our largest organ. It's also important to know that the skin is most closely related to the digestive tract, another very large and very important organ.

You Can Have 'Leaky Skin' in Addition to a 'Leaky Gut'

When we discuss celiac disease and gluten sensitivity, we often mention a leaky gut, a condition whereby the integrity and health of the small intestine is compromised. Interestingly, the skin can also be ‘leaky’ or too permeable. This problem actually explains why some people react to applying gluten topically while others do not – it depends on whether or not they have leaky skin.

There is a classic skin condition associated with gluten called dermatitis herpetiformis or DH. It is often knows as the celiac disease of the skin.

What is Dermatitis Herpetiformis (DH)?

DH appears as blisters in symmetrical areas of the body, including elbows, knees, buttocks, lower back and back of the head.  The blisters are usually inflamed and red with severe burning and itching.  The burning and itching can be present before a rash ever appears. I had one patient describe it as ‘lit kerosene beneath his skin’.

An immune substance called IgA, that is produced in the lining of the gut, is found as deposits in the skin of a DH patient. It is believed that gluten in the diet combines with IgA and together they enter the blood stream where they clog up small blood vessels in the skin. This manifestation creates an additional immune response by white blood cells and the result is the rash of DH. 

Despite DH’s relationship to celiac disease, only 20% of patients suffering from it have any digestive symptoms. However, villous atrophy, the hallmark destruction of the small intestine consistent with celiac disease, is present 80% of the time. This ‘silent’ destruction likely contributes to the very few who are correctly diagnosed with DH. Instead they are given creams, lotions and steroids, all focusing on the rash itself instead of addressing the root cause of the condition – in this case dietary gluten consumption.

We know that DH exists and we know that it is the skin’s expression of the disease celiac. One would think that having that knowledge would be enough to appreciate that gluten can causes manifestations in areas beyond the digestive tract. But unfortunately we continue to hear of case after case whereby the patient had to diagnose themselves with celiac disease or gluten sensitivity when their doctor refused to test them because they had no or minimal digestive complaints.

The incidence of DH is thought to be 10 in 100,000 typically beginning in the 2nd to 4th decade of life. It is two times more common in men and more so in Caucasians of northern European descent. DH affects about 15%-25% of patients with celiac disease.

Skin Conditions Reflect Gut Health

 In our practice we like to say that the skin is a reflection of gut health. Whether the condition is acne, eczema, dry skin, psoriasis or DH, when a skin condition is present we look to the gut. Researchers of DH agree with us. In fact they suggest that the tTG enzyme that is classically measured in the blood for celiac disease has a ‘skin derived’ version that indicates the presence of DH. They feel the underlying mechanism has to do with molecular mimicry between the gut’s tTG and the skin’s. By the way, Cyrex Labs is soon to release this particular skin-related tTG as a blood test for DH.

Treatment for DH is twofold:
1. Dapsone – a drug given for symptomatic relief that has a dangerous side effect of creating hemolytic anemia
2. Gluten-free diet

Why Are We Unsuccessful in Treating DH?

 What’s the success rate? Full remission is only seen in 10-20% of patients. Not very good, I think you’ll agree.

Why does this occur? The patient and their doctor tend to focus solely on the appearance of the skin, rather than the state of health of the small intestine and body as a whole. When the skin “looks” better, patients cheat on their diet. It sounds ill advised and it is, especially considering that DH increases one’s risk of developing other autoimmune disease (thyroid, diabetes, etc) as well as small intestinal cancer.

But is it the patient’s fault? No, in my opinion it’s their doctor’s. Although with much good information available to pretty much everyone on the internet, I guess we can hold patients somewhat accountable. In the main, I think the brunt of the responsibility lies with the doctors who do not themselves know enough about DH and misdiagnose it as another condition or correctly diagnose it but then put no emphasis on healing the body as a whole.

Find the 'REAL' Root Cause of Your Skin Condition

 If you or someone you know has a skin condition, regardless of whether it turns out to be DH, know this: The skin reflects the health of the digestive tract and with poor digestive health present, optimal health will be absent. Find a clinician who has the correct viewpoint of the body and who understands that skin conditions need to be treated by embracing the whole body , not topically.

If your health is not the way you desire it to be, consider calling us for a free health analysis – 408-733-0400. Our destination clinic treats patients from across the country and internationally. We are here to help.

To your good health,
Dr Vikki Petersen, DC, CCN
Awarded Gluten-Free Doctor of the Year 2013

Journal of European Academy of Dermatology and Venereology. 2009 Jun;23(6):633-8. Epub 2009 Mar 10.
“Guidelines for the diagnosis and treatment of dermatitis herpetiformis.”

World Journal of Gastroenterology  2007 April 14;13(14): 2138-2139
“Celiac disease and skin: Psoriasis association”

Journal of the American Academy of Dermatology. 2009 Jul;61(1):39-43.
“Autoantibodies against epidermal transglutaminase are sensitive dx marker in pts w/ DH on a normal or g-free diet.”

Clinical Gastroenterology and Hepatology. 2005 Apr;3(4):335-41.
“Permeability, zonulin production & enteropathy in DH.”

Saturday, September 21, 2013

Celiac Report: A Gluten Free Diet Can "Heal" Osteoporosis

What's the Risk of Osteoporosis with Celiac Disease?

For those who are well versed in celiac disease, we know that it's not only the most common lifelong illness in the U.S. and Europe, but it's also an autoimmune disease.

      What many people don't know is the following:

  •             Where there’s one autoimmune disease others tend to develop,
  •             Autoimmune diseases are the third leading cause of death in this country,
  •       Osteoporosis is one of over 100 different autoimmune diseases

Did you ever break a bone? If you did, you likely assumed that based on the trauma you suffered, anyone would have suffered the same fate… the broken bone. But we now realize that those with celiac disease are much more likely to suffer a fracture than their non-celiac counterparts. Plus, surprisingly, men may be at a particularly higher risk then we thought.

Can "Brittle Bones" Heal Themselves on a Gluten Free Diet?

 The above research comes to us from Argentina in a published study entitled “Risk of Fracture in Celiac Disease” dated July 7, 2011 in the World Journal of Gastroenterology..

It has been hotly contended that those suffering from celiac-induced osteoporosis or osteopenia (early osteoporosis) could see reversal of their bone density problems when placed on a gluten-free diet. Professionally I’ve definitely seen such a change in my patients, along with the reversal or improvement of other autoimmune diseases. But this study verified the beautiful ability of the human body to heal itself once the stressor (in the case of celiac disease – gluten) has been removed.

In a group of 256 people, all celiacs who had been diagnosed for over 5 years, information was gathered about prior fractures and to which bone they occurred. This data was compared to a control group of 530 individuals who had gastrointestinal problems as well, but none that were known to affect bone density. Similarly, any individuals diagnosed with any disease condition that could affect bone health in a negative fashion were excluded. Lastly, those who were taking any supplements or drugs that could affect bone health in a positive way were also removed from consideration.

Those celiacs who participated in the study strictly adhered to their gluten-free diet and the minimum amount of time they had been gluten-free was 5 years. 

The findings of the study were as follows:

Celiacs, prior to diagnosis, who demonstrated ‘classical celiac’ (vs the silent or atypical form) had a higher incidence of fracture in their extremities (not the spine) before diagnosis than after maintaining their gluten-free diet. This was statistically most significant in men.

The exciting news was that after maintaining a gluten-free diet for 5 years, the risk of fracture dropped to that of the control group. The gluten-free diet, when maintained, corrected any increased risk of fracture.

The take-home message is clear: Cheating on your gluten-free diet is always a bad idea. In addition to affecting so many facets of health, bone density can now be added to the list.

I hope you found this informative. If you health is not to the level you wish it to be or you suspect that gluten could be affecting you, consider contacting us for a free health analysis - call 408-733-0400. As a destination clinic, we treat patients from across the country and internationally. We are here to help!

To your good health,

Dr Vikki Petersen, DC, CCN
Author of the eBook: “Gluten Intolerance – What you don’t know may be killing you!”

Thursday, September 19, 2013

The ‘Gluten’ Found in Coffee and Chocolate

Why Do Some Celiacs Never Heal?

Research tells us that only eight percent of those adult patients suffering with celiac disease experience complete healing of their gut despite maintaining a strict gluten-free diet. Sixty five percent feel better, but only a fraction (8%) enjoy complete healing.

This is significant because too many patients suffering from celiac disease and gluten sensitivity do not enjoy the good health they deserve. Instead they suffer a variety of symptoms and many develop serious autoimmune diseases and other life threatening diseases such as cancer.

It is felt that many autoimmune diseases could potentially be prevented if the individuals’ gut lesions and leaky gut were fully addressed.

I want to discuss a tool that we use here at the clinic to help isolate any dietary components that could be ‘confusing’ the immune system of a gluten intolerant patient to react as if gluten was being consumed. I often have patients tell me that they feel ‘glutened’ despite the lack of gluten consumption.

What are "Cross Reactive" Foods and How Can They Make You Sick

How can this occur? Cross reactivity is a process whereby the body consumes a protein (e.g. milk) that has similarities to the protein gluten. Due to this similarity (known as molecular mimicry) the body’s immune system reacts to this food as if it were gluten, creating symptoms that the patient attributes to gluten consumption. The picture at the top of this post gives a good visual of how this occurs.

Is milk gluten? No. But if cross-reactivity is occurring, it may as well be as far as the patient’s immune system is concerned. In other words, ingestion of these cross-reactive foods can irritate and inflame the immune system in much the same way as if gluten was being ingested. The result? Poor healing and continued illness.

Therefore in patients who are not feeling optimal despite maintaining a gluten-free diet, or who continue to have a leaky gut or develop autoimmune disease, testing for cross-reactive foods can be a great diagnostic tool.

 The test is a blood test offered by Cyrex Labs and includes the following foods:

Cow’s milk
American cheese

Temporary Avoidance May Be All That's Needed

Once the test returns it will reveal what, if any, foods are causing a reaction. The protocol is to remove these foods from the diet for three months and then reintroduce them slowly, one at a time, to determine any negative reactions. Unfortunately, some foods, if found positive, are considered permanent sensitivities and are therefore not reintroduced. These are: dairy, rice, corn, yeast and millet.

For the rest of the foods, elimination for a period of three months should allow the body’s immune system to rebuild and repair and, along with other measures taken by a savvy clinician, will go far towards repairing any leaky gut issues.

I’m not trying to depress anyone regarding further dietary restrictions. Being gluten intolerant myself, I very much understand the discipline that is required. But if a cross-reactive food(s) is the culprit underlying a lack of healing and putting one at risk for other diseases, it certainly is important to find out.

Here at HealthNOW we have found it make a huge difference in some of our patient's health.

I hope this was helpful and please do let me know any questions that you have or if you would like assistance to improve your health. That’s why I’m here!

Our destination clinic treats patients from across the country and internationally. If you don’t live locally it’s not a problem. You can call for a free health analysis – 408-733-0400.

To your good health,

Dr Vikki Petersen, DC, CCN
Founder of HealthNOW Medical Center
Co-author of “The Gluten Effect”
Awarded Gluten Doctor of the Year 2013