the patient celiac

Celiac Disease "Journal Club" 2013 Part 1

0 comments September 04, 2013

As some of you may have figured out, I love to keep up to date with the latest research regarding celiac disease and non-celiac gluten sensitivity (NCGS). My interest in research stems from the countless Journal Clubs that I participated in during my decade of medical training. Journal Club gives medical students, residents, fellows, and other trainees the opportunity to learn how to read, interpret, and critically review research articles. Although there are many things which I do not miss about medical training (especially the sleep deprivation), I do miss Journal Club.

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Women with celiac disease, we are not alone...

0 comments August 21, 2013

I have spent a good portion of this summer enjoying my time with my family, traveling, and not obsessing about celiac disease (which has led me to not write about it either!) Overall, I am comfortable with my gluten free household and life and have accepted my diagnosis. But, the other day, in part due to fatigue and in part due to accidentally eating a KIND bar with soy protein (soy is one of my other food intolerances and I feel like total garbage after eating it), I totally lost my calm. I found my 4-year-old, Gabby, eating a bag of Goldfish crackers when I picked her up from day camp. Instead of hugging and kissing her, and asking her about her day, like I should have, I began to obsess about celiac disease. Thoughts like, “Now I have to clean all of the gluten off of her face and I don’t have any napkins or wet wipes,” and, “Why the heck is she getting Goldfish crackers as a ‘healthy’ snack’?” and, “I cannot afford to get ‘glutened’ this week because I have to be able to work and function as a mom!” went through my mind. The encounter of picking up Gabby from camp quickly became "all about me," which is one thing that I truly despise about this disease.

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Two Things

0 comments August 08, 2013

Thanks to another cancelled flight, I am apart from my family for one more night. I am desperate to see them and cannot put into words how much I miss them.

3 weeks ago we drove 1300+ miles to visit with family in Cape Cod and Boston. I flew back home to work a week ago and am flying back to meet them in Boston and then drive home with them (I would never make my husband do a 1350 mile road trip with 4 kids under 8 by himself!)  We are going to drive north into Montreal and then across northern Ontario to get home, which is going to be quite the 1350 mile adventure.

This quiet evening has given me the opportunity to run, read, and to reflect. I am grateful that I have been diagnosed with this disease, even though there are aspects of it that really stink.  If you haven’t read or heard, there was an article just published in the Annals of Internal Medicine which affirms that those with untreated Celiac Disease have a much higher risk of lymphoma (cancer) than the general population.  If you haven't read the article, I encourage you to read this summary. I am glad that I am being treated with the gluten free diet and that I have come to the realization that I needed to make my entire household gluten free in order for my intestines to heal and for my symptoms to resolve. I am thankful for all of you who I have “met” and connected with through this blog over the last 8 months.  I am thankful that this disease has caused me to prioritize the nutrition of my family. If learning that untreated Celiac Disease causes cancer does not lead my family members, and others, to get tested for Celiac Disease, then I do not think that anything will. I want you to get tested because I do not want any of you to get lymphoma, not because I want to make your life harder by having to give up bread!

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The Intestinal Villous Blunting (Flattening) in Celiac Disease is often "Patchy"

0 comments August 05, 2013

Villi are the fingerlike projections of the small intestine where nutrient absorption takes place and are the location of Celiac Disease’s assault on the digestive tract.

Untreated celiac disease leads to blunting (flattening) of the intestinal villi that can be seen when a gastroenterologist performs an endoscopy with biopsy. Despite current controversy over whether or not an endoscopy is necessary for all cases of celiac diagnosis, it is still considered by many experts to be the “gold standard” for officially diagnosing Celiac Disease. I look forward to learning more about this moving target at the International Celiac Disease Symposium being hosted by the University of Chicago in September 2013.

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Celiac Disease and Multiple Food Intolerances

0 comments July 05, 2013

There are many of us with celiac disease who develop additional food intolerances after going gluten free.  Despite maintaining control of my celiac symptoms by being strictly gluten free, I have become intolerant to soy (2011), sulfites (2012), and too much dairy (late 2012-early 2013).  My allergy skin prick tests for soy and milk were negative, which shows that my reactions are not IgE mediated, and, thus, not “typical” food allergies in which there would be a concern about anaphylaxis. I have no knowledge of getting sick from soy, dairy, or sulfites prior to my celiac diagnosis in 2010, however, I may not have realized that I was reacting to these foods because I felt so cruddy from chronic gluten ingestion.

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Celiac Disease and Endometriosis

0 comments June 25, 2013

As I was doing my weekly glance through the PubMed database (www.pubmed.gov) I came across an interesting letter to the editor in the Archives of Gynecology and Obstetrics entitled, “Celiac Disease and Endometriosis: What is the Nexus?" Endometriosis is a common gynecologic disorder, which effects approximately 10% of women of childbearing age. It involves the development of endometrium, which is the tissue which lines the uterus, in areas of the body outside of the uterus. Symptoms of endometriosis include heavy menstrual periods, abdominal and pelvic pain, abnormal menstrual cycles, and infertility. Although the exact cause of endometriosis is unknown, theories include retrograde menstruation (endometrial cells from the uterus flow backward into the fallopian tubes instead of out of the body during menstruation), an abnormal placement of embryonic stem cells in the pelvic cavity which produce endometrial tissue, and/or an immune system disorder.

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Eating Gluten Free During a 311 km Ragnar Relay

0 comments June 20, 2013

“I have Celiac Disease. I am very hungry and need to be able to eat without getting sick. Can you help me?”  These were my words as I stepped into a chain restaurant called “Crabby Joe’s” in the eastern Toronto area.  I was one third of the way through running a Ragnar Relay in which my team of eleven ran 311 km from Cobourg, Ontario to Niagara Falls over the course of 30+ hours. The entire experience is worthy of its own blog post, and I hope to post a link to some of my other team members’ blogs.  For the sake of brevity, I plan to discuss the logistics of traveling and running this race strictly gluten free. This race took me away from home (and out of my comfort zone of eating safely gluten free at home) for four days.

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Nonresponsive Celiac Disease

0 comments June 05, 2013

Nonresponders are the 5% of Celiac patients who have either persistent symptoms and/or abnormally high Celiac antibodies after two years on the gluten free diet.

According the most recent medical review in the “Up to Date” database, there are 5 main categories of nonresponders to the gluten free diet:

  1. Patient is continuing to eat gluten. This is the most common cause of persistent symptoms. This can be on purpose (i.e. taking a little bite of a gluten containing food every once in a while) or accidental (i.e. not realizing that a child is nibbling her wheat containing Playdough at school).
  2. Patient doesn’t actually have Celiac Disease.  For example, elevated serum antigliadin IgA antibodies may be a false positive. Small intestinal villous blunting may be caused by any of the following: hypogammaglobulinemia, acute infectious gastroenteritis, lymphoma, Crohn’s Disease, and/or a milk protein intolerance.

 

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Should Your Child be Screened for Celiac Disease?

0 comments June 05, 2013

I have four children, who are all at high risk for developing Celiac Disease. I was diagnosed with Celiac Disease 3 years ago, but have had symptoms since early childhood. My husband does not have Celiac Disease, but he carries one of the two main Celiac genes, DQ2. Due to my children’s risk, I have had their pediatrician screen them when they turn 4 years old with a Celiac panel (blood test with Celiac antibodies). My third child, Gabby, just turned 4 so she will have her first Celiac panel at her well-child visit in a few weeks, along with all of her four year old immunizations. I think I’ll try to get my husband to take her!

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"Up to Date" Management of Celiac Disease in Adults

0 comments May 30, 2013

\“Up to Date” is an online medical database for physicians and other practitioners.  I use it almost every day when I am at work to get a brief overview of the most recent evidence regarding the diagnosis and management of my patients’ problems.

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