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      Frequently Asked Questions About Celiac Disease   04/24/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What is Celiac Disease and the Gluten-Free Diet? What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes

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Posted (edited)

Hello!

I'm just wondering if anyone here can offer any advice on how to convince doctors that I'm gluten intolerant.

My history-

I've always been underweight no matter what I eat and prone to illness, and I've had severe pneumonia three times, one bout requiring a partial lobectomy. I never considered any sort of disease as the culprit for my poor health, but I accidentally stumbled onto celiac disease back in 2011.

I'd been running daily for several years, and was trying to bulk up on the cheap by eating a box of pasta a day, oatmeal, bags of cereal, and any other inexpensive high-calorie foods I could get my hands on. For about a year, I began dropping weight and developed painful swollen hands. I finally went to the E.R. after one of my eyes turned bright red and felt excruciatingly painful, where I was referred to a specialist and received an iritis diagnosis. A couple weeks later, I abruptly lost the enamel on one of my front teeth. I looked up the symptoms, and found that it was textbook celiac.

Without reading too much about celiac disease, I decided to cut out gluten just on a whim to see if my symptoms improved. Within a week, I started rapidly dropping weight and my face went white. At its worst, I passed easily-digestible gel cap vitamins whole. I did some more research, and found that a minority of patients actually get worse when they cut out gluten. Considering that I had no idea that this phenomenon even existed, yet still got much worse even though I was expecting to feel better, that clinched it for me - I likely had celiac disease.

Once the "withdrawal" period passed, I ended up gaining 20 pounds despite the fact that I was eating far less than before. Whenever my bowel habits suddenly changed for the worse, I'd scour my diet and find that I made a rookie mistake - eating soy sauce, cross-contaminated oats, etc.

I didn't have health insurance until several years ago, so I never sought care for my gastro issues. I ended up in the hospital in 2013 for a necrotizing strep infection, where I received a blood test that finally confirmed celiac disease.

Fast forward a few years, and I'm finally insured and want to do something about my symptoms. I went for my first appointment with a family doctor, who treated me like a wackjob fad dieter. I didn't have copies of my medical records yet, so I had no defense at the time. Every symptom I told him was met with the same condescending dismissal - "who TOLD you you had iritis?" etc., and he then proceeded to give me an impromptu blood test to check for celiac. When I asked "But don't you have to eat gluten first to test positive?" he smirked and gave a non-answer - "Oh, I wouldn't ask you to eat a Twinkie and get sick." The nurse was openly hostile after running the blood test, and sharply said "you're fine" before the doctor came back into the room and gave me a lecture about "assuming" that I have an illness. He then referred me to a gastro doctor.

The gastro doctor did an endoscopy and colonoscopy, and found iron deficient anemia and ulcers in my small intestine and duodenum. He had me eat gluten for two days leading up to the procedures, which he claimed was ample time to test positive for the disease. I'm aware that doctors tend to take it as a personal affront when patients disagree with them, so I played along and acted overjoyed to find out that I could eat wheat again. His diagnosis was Crohn's disease. But when I politely asked if my tooth enamel defects are a symptom of Crohn's, he confirmed that they aren't, but had actually never even heard of celiac disease causing tooth enamel loss. After gently pursuing this line of questioning further, he finally said "I'm not a dentist" and walked out in a huff without saying goodbye. No follow-up care was offered.

Ever since that initial GP visit, I've had nothing but overt dismissal from every doctor I visit, even when I bring copies of my medical records. I feel that the more doctors I see who make a snap judgment that I'm a hypochondriac, it just adds yet another doctor to the list of physicians who put down "hypochondria" or "anxiety" in my medical records, which makes it even more difficult to be taken seriously by future doctors.

My health has been failing me in recent years - no matter how immaculately I eat, I have to get up at least four hours before I need to leave the house so I can get repeated bouts of severe diarrhea. This entails literally getting up at 2 am to get to an 8 am appointment. I can't live like this much longer, but I've stayed away from doctors in recent years because I literally break down in tears from sheer frustration once I leave the office.

Can anyone offer any advice on how to handle doctors? I always make sure that I defer to their judgment and try not state anything in absolutes, and I'm naturally a very friendly and empathetic person, so my demeanor isn't confrontational. I'm dreading going to a new gastro doctor because I'm half expecting to be told that I'm imagining everything. I'd think that a Crohn's and iritis diagnosis, plus a positive blood test, would be enough to convince most reasonable doctors, but apparently not.

Thanks!

Edited by moleface

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I am sorry to hear about your frustrating experience with the physicians.

To me, the real question is: are you on a strict gluten free diet, and are you feeling better and healthier?

If you are, you don't need to "convince" any doctors, you don't need their blessing, certainly not their attitude.   It is your own body, if you know that gluten makes you feel bad, don't eat it.

My daughter was diagnosed 4 years ago.   We haven't seen our GI doctor in 3+ years.   Celiac disease does not require medication.   You self medicate through a gluten free lifestyle.

BUT...if you have been on a gluten free diet for years now, and still have issues, then you might want to be open to listen to the GI doctor about other possibility (perhaps in addition to celiac) that could be giving you health problems.

 

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You have Chrohns disease and the doctor isn't doing anything about it?  chrohn's  is a serious life threatening disease .  Celiac is serious, but not like  Crohn's.  

 

 

.  

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44 minutes ago, gluten-free-Cheetah Cub said:

I am sorry to hear about your frustrating experience with the physicians.

To me, the real question is: are you on a strict gluten free diet, and are you feeling better and healthier?

If you are, you don't need to "convince" any doctors, you don't need their blessing, certainly not their attitude.   It is your own body, if you know that gluten makes you feel bad, don't eat it.

My daughter was diagnosed 4 years ago.   We haven't seen our GI doctor in 3+ years.   Celiac disease does not require medication.   You self medicate through a gluten free lifestyle.

BUT...if you have been on a gluten free diet for years now, and still have issues, then you might want to be open to listen to the GI doctor about other possibility (perhaps in addition to celiac) that could be giving you health problems.

Oh, definitely. I'm not dismissive of the Crohn's diagnosis, but I'm just confused why gluten intolerance is so out of the question to doctors.

When I ate wheat for two days leading up to my gastro procedures, I developed itchy hands - a symptom I didn't even know existed. I also eat an extremely healthy but limited diet, and every time I get sick again, I look at anything different I ate during that period and inevitably find that I got contaminated.

The tooth enamel is another dead giveaway. As far as I know, no other disease causes the tops of the teeth to die off like that. When I asked one doctor about it, he made a comment about my "lifestyle." Meanwhile, I've always been an obsessive flosser and tooth brusher and have only had a couple cavities in my entire life.

Thanks for the advice!

44 minutes ago, gluten-free-Cheetah Cub said:

 

 

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13 minutes ago, kareng said:

You have Chrohns disease and the doctor isn't doing anything about it?  chrohn's  is a serious life threatening disease .  Celiac is serious, but not like  Crohn's.  

 

 

.  

Yeah, I'm surprised too. I wasn't even aware that it was such a serious disease - despite the fact that doctors apparently think I'm some WebMD-reading fad dieter, I almost never worry about my health. As long as I'm taking good care of myself, I consider everything else to be beyond my control. I assumed that it wasn't that big of a deal because I didn't think a doctor would just discharge me to my own devices after giving a serious diagnosis.

I spoke to a friend who's a nurse, and she thinks that the issue is that I currently live in a small town. Small communities tend to lag behind large cities socially, so I'd assume that the same applies to the medical field. There's actually a weird bias against health food here - at jobs, I get ridiculed by coworkers for being spotted eating fruit salad or whatever on my lunch break. I suspect that most doctors around here consider the gluten free diet to be a "liberal" health food fad.

Not only that, but I only recently got health insurance and I still go to the local sliding scale health clinic for care. I'm assuming that the quality of care provided at a public clinic must pale in comparison to a normal doctor.  I've been turned away a couple times because the doctors there tell me I have no record of iritis or Crohn's. Last time this happened, I asked them to check my charts, and they came back 10 minutes later saying there was no record of it. This same doctor ordered an impromptu blood test and then mailed me a passive-aggressive letter (they NEVER mail letters) telling me my blood tests were "fine". I'm assuming this is because I reported him to the front desk for refusing to treat my iritis, and he caught wind of it. I've gotten iritis once or twice a year since 2011, and the symptoms are impossible to mistake for something else, yet despite my history most doctors tell me I'm "self diagnosing" when I come to them during a flare-up. That same doctor changed the diagnosis from iritis to "red eye", and I ended up sustaining permanent vision damage after having iritis for several months. My eye on that side no longer dilates, for whatever reason. Weird stuff.

I think the issue is that somehow "hypochondria" got put on my charts. Once you get diagnosed with that, it's the kiss of death. Doctors seem to think that a hypochondria diagnosis trumps all other evidence. I hate to say it, but I'm really starting to hate doctors after going through this. I got sick 7 years ago and I've all but given up trying to get help after these frustrating experiences.

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I agree.   What you need is a good doctor.   You shouldn't have to worry about how to convince a doctor about feeling sick and helpless.

Crohn's  is indeed a very serious disease, and even more difficult to control than celiac.   People with Crohn's  tend to avoid a lot of food, including gluten.

Good luck to you!

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Hi moleface and welcome! :)

I found your posts a tough read because I felt like I could've written them myself. I was raised to think of the doctor as all knowing and it's only through painful experience that I've taken them down from that childish pedestal and look at them dispassionately as either good, (rare) bad, (less rare) or mediocre (most of them). To be fair this now matches up to the medical students I knew at University... 

Where celiac / gluten sensitivity is concerned however there's an additional ignorance factor to take in. Many of them have had little training. I saw one estimated they received half a day on celiac etc during their 7 year training period. I've had doctors assure me that one week on gluten is enough for the blood test to be accurate. Later finding out it was guess work on their part. There are so many bizarre ways that the condition can manifest and every case seems different.

I don't have any easy answers and my experience of US healthcare is limited but suggest.

Firstly, you need a fresh start with a good doctor and the Crohns is serious and needs treatment. Do the research, find a doctor that references celiac or intolerance issues, looks for online reviews, travel if necessary and write them a short letter detailing your previous experiences, the pain you are currently in and your need for help. You need and deserve good caring medical care and if you're upfront about past issues a good doctor will look to help. If they don't or refuse then you know they weren't any good in the first instance.  

Second, I wouldn't even bother opening up the celiac or gluten sensitive box. You've excluded gluten from your diet a long time ago and you're not going back to it? So, just say:

'For your reference, years ago following health problems I decided to exclude gluten from my diet and I noticed a very significant response from my body. I did pursue medical confirmation but unfortunately the advice I was given at the time turned out to be incorrect and my subsequent negative diagnosis may not be reliable although my endoscopy did reveal other issues which may be related. Given my positive response to the gluten free diet I continue to follow it to this day and given there's no treatment available other than the diet I already follow I'm not concerned about chasing a celiac diagnosis.'  

Document everything. Record visits, write brief notes. Before a consult have your notes in order and have any questions you have listed as concisely as possible.

Hi Dr I have noticed

Symptom 1, duration, Symptom 2, duration, Symptom 3, duration

Be concise, be organised, be polite, but do ask questions if you're not getting listened to and don't be fobbed off. Ask a closed question if you're not getting anywere. ie. Doctor given symptom 1,2 and 3 can you please explain to me how you have excluded Crohns as a potential diagnosis?

Finally you can take some advice from the ancient stoic philosophers and manage your own expectations to minimise the stress doctor visit causes. You won't get a whip smart diagnostician from 'House' although you may get one with his people skills :P I look at them now like mechanics. Some of them are better than others at different things and the small town guy who fixes every different type of car deserves respect but may not be the best person at recognising issues with an obscure Italian car from the late 70's. Just get what you can from them but this:

55 minutes ago, gluten-free-Cheetah Cub said:

I agree.   What you need is a good doctor.   You shouldn't have to worry about how to convince a doctor about feeling sick and helpless.

should be a bare minimum. If you're not getting that move on until you do.  

Wishing you the best of luck!

Matt

 

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11 hours ago, Jmg said:

Hi moleface and welcome! :)

I found your posts a tough read because I felt like I could've written them myself. I was raised to think of the doctor as all knowing and it's only through painful experience that I've taken them down from that childish pedestal and look at them dispassionately as either good, (rare) bad, (less rare) or mediocre (most of them). To be fair this now matches up to the medical students I knew at University... 

Where celiac / gluten sensitivity is concerned however there's an additional ignorance factor to take in. Many of them have had little training. I saw one estimated they received half a day on celiac etc during their 7 year training period. I've had doctors assure me that one week on gluten is enough for the blood test to be accurate. Later finding out it was guess work on their part. There are so many bizarre ways that the condition can manifest and every case seems different.

I don't have any easy answers and my experience of US healthcare is limited but suggest.

Firstly, you need a fresh start with a good doctor and the Crohns is serious and needs treatment. Do the research, find a doctor that references celiac or intolerance issues, looks for online reviews, travel if necessary and write them a short letter detailing your previous experiences, the pain you are currently in and your need for help. You need and deserve good caring medical care and if you're upfront about past issues a good doctor will look to help. If they don't or refuse then you know they weren't any good in the first instance.  

Second, I wouldn't even bother opening up the celiac or gluten sensitive box. You've excluded gluten from your diet a long time ago and you're not going back to it? So, just say:

'For your reference, years ago following health problems I decided to exclude gluten from my diet and I noticed a very significant response from my body. I did pursue medical confirmation but unfortunately the advice I was given at the time turned out to be incorrect and my subsequent negative diagnosis may not be reliable although my endoscopy did reveal other issues which may be related. Given my positive response to the gluten free diet I continue to follow it to this day and given there's no treatment available other than the diet I already follow I'm not concerned about chasing a celiac diagnosis.'  

Document everything. Record visits, write brief notes. Before a consult have your notes in order and have any questions you have listed as concisely as possible.

Hi Dr I have noticed

Symptom 1, duration, Symptom 2, duration, Symptom 3, duration

Be concise, be organised, be polite, but do ask questions if you're not getting listened to and don't be fobbed off. Ask a closed question if you're not getting anywere. ie. Doctor given symptom 1,2 and 3 can you please explain to me how you have excluded Crohns as a potential diagnosis?

Finally you can take some advice from the ancient stoic philosophers and manage your own expectations to minimise the stress doctor visit causes. You won't get a whip smart diagnostician from 'House' although you may get one with his people skills :P I look at them now like mechanics. Some of them are better than others at different things and the small town guy who fixes every different type of car deserves respect but may not be the best person at recognising issues with an obscure Italian car from the late 70's. Just get what you can from them but this:

should be a bare minimum. If you're not getting that move on until you do.  

Wishing you the best of luck!

Matt

 

Thanks for the advice and support!

I go out of my way to avoid saying anything that could be construed as "self diagnosis," but I end up being forced to gently suggest the possibility of gluten intolerance once the doctors seem baffled by my symptoms. Especially when I point to my teeth and get comments about my "lifestyle" - at that point, I'm just defending my honor in the face of people who seem to be suggesting that I don't brush my teeth and/or do meth. My teeth are actually my biggest issue. If I wasn't being blamed for my missing tooth enamel, I wouldn't bother trying to convince anyone that I have issues with gluten.

Re: Crohn's disease - as far as I know, the disease is idiopathic. From what I understand, Crohn's is just a name for systemic autoimmune inflammation that affects the gastro system. So considering that I react so strongly to gluten, I'd assume that my condition is essentially "end stage" inflammation caused by a lifetime of heavy gluten exposure. Or I may suffer from multiple food sensitivity, though I don't anticipate any doctors willing to explore this possibility. My symptoms eventually improved once I went gluten-free, at least in the sense that I have constant diarrhea instead of bloating and constipation. Whenever I eat gluten by mistake, the telltale symptom is that I get stopped up for a day or two.

I guess I shouldn't be surprised that doctors can be so irrational - I mean, this is the same group of people who tell themselves that free lobster dinners and medical symposiums held near golf courses aren't just transparent drug company bribes. It's still infuriating that these people literally hold my life in their hands though.

What about discretely recording audio of the visits on my phone? Most doctors I've seen play the hypochondria card, but one doctor who DID take me seriously instead told me I was delusional for thinking that other doctors were so dismissive. I'd like hard evidence that I'm not behaving irrationally during appointments. I feel that most physicians will bend the facts to make the patient the problem, if the alternative is to admit that a fellow doctor may have made a mistake. The medical field is shockingly cult-like.

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As a quick follow-up, I wanted to say that I'm trying once again to find a doctor who will take me seriously, and I'm hoping that hedging my wording during visits will yield better results. If not, I'm pretty much at a complete loss for what to do anymore. I'll post my results to this thread once I've gone to some appointments.

I developed painful iritis/uveitis again this week but I still haven't gone to a doctor. I'm not sure why it's considered "self diagnosing" to assume that I have iritis again, especially since I've had it yearly for the better part of a decade, plus the fact that the symptoms are always very distinct. In every one of these cases, I brought copies of my previous iritis diagnoses to the first visit, and my suspicion was always confirmed by a specialist during the subsequent appointment. Not sure why doctors are still so quick to think I'm imagining everything, even after repeatedly being proven wrong through medical tests.

I'm about as far from a hypochondriac as someone can get. I don't even like going to doctors - until I had medical insurance, I went twice in 20 years. Over the last decade, I broke several bones while out biking and running, yet always just wrapped up the injury and waited for it to heal without any professional medical treatment. Then the rare doctors who DO take me seriously say that it's my fault that I'm so sick because I "refuse" to go to doctors. I feel that it's lose-lose, no matter what I do.

 

If this final attempt to find a competent doctor falls flat, I'm considering dropping out of the medical system altogether. If I try to deal with it on my own, at least I wouldn't have to deal with wealthy "3 martini lunch" golfer types literally laughing at me,

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I have only been dismissed by one doctor re: celiac, but everything else you have written sounds like my experience with doctors in general. 

I don't know if it is necessarily your small town because I had terrible experiences in San Francisco and LA. It took me 4 years to diagnose a torn ligament in my hip (which occurred because I was hit by an SUV in a crosswalk) because no one would believe my symptoms. I had a pinched nerve under my piriformis muscle which was alleviated with botox injections AND bursitis which was alleviated with a few rounds of steroid injections, but two different docs told me I was both too flexible to have a pinched nerve and too young to have bursitis. One doctor even diagnosed me with fibromyalgia. And it's not like they didn't see my medical records from my accident that showed where I was hit, how far I flew in the air and where (and how) I landed on the pavement. X-rays and CTs showed clear injuries to my neck, lower back, and pelvis. 

"You still have pain in your lower back and hip, and you're tired all the time on the 5mg of Norco three times a day and would like to NOT take those meds anymore? Hmmm, let me see... Here's a referral to a psychiatrist." <--- that was my pain management doctor.

TL;DR -- I completely get how frustrating it is when doctors don't listen to you and treat you like your symptoms aren't real. The best advice I have is to keep going to these appointments and if they do not help, get a referral to someone else. It took me going through neuro, chiro, PT, and a host of other specialties until someone said, "Hey, let's stick a camera in her hip joint!" which finally showed the HUGE tear in my ligament and they approved me for surgery (which alleviated almost all of my pain by the way). It may take forever, but unfortunately, I haven't found a way to talk to doctors that makes them actually hear you. You kind of have to play dumb and just let them lead you. At some point, you will find a doctor who cares and who is willing to help you heal. 

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On 4/23/2018 at 1:30 PM, chrissy-b said:

I have only been dismissed by one doctor re: celiac, but everything else you have written sounds like my experience with doctors in general. 

I don't know if it is necessarily your small town because I had terrible experiences in San Francisco and LA. It took me 4 years to diagnose a torn ligament in my hip (which occurred because I was hit by an SUV in a crosswalk) because no one would believe my symptoms. I had a pinched nerve under my piriformis muscle which was alleviated with botox injections AND bursitis which was alleviated with a few rounds of steroid injections, but two different docs told me I was both too flexible to have a pinched nerve and too young to have bursitis. One doctor even diagnosed me with fibromyalgia. And it's not like they didn't see my medical records from my accident that showed where I was hit, how far I flew in the air and where (and how) I landed on the pavement. X-rays and CTs showed clear injuries to my neck, lower back, and pelvis. 

"You still have pain in your lower back and hip, and you're tired all the time on the 5mg of Norco three times a day and would like to NOT take those meds anymore? Hmmm, let me see... Here's a referral to a psychiatrist." <--- that was my pain management doctor.

TL;DR -- I completely get how frustrating it is when doctors don't listen to you and treat you like your symptoms aren't real. The best advice I have is to keep going to these appointments and if they do not help, get a referral to someone else. It took me going through neuro, chiro, PT, and a host of other specialties until someone said, "Hey, let's stick a camera in her hip joint!" which finally showed the HUGE tear in my ligament and they approved me for surgery (which alleviated almost all of my pain by the way). It may take forever, but unfortunately, I haven't found a way to talk to doctors that makes them actually hear you. You kind of have to play dumb and just let them lead you. At some point, you will find a doctor who cares and who is willing to help you heal. 

Thank you for the advice!

I'm so sorry that you had to deal with that. It makes me feel less alone to read peoples' medical horror stories online, but I hate to think of the potentially millions of people who are suffering because of the shortsighted egomania of doctors.

You're right that I need to play dumb - I realized years ago that doctors take it as a personal affront if a patient doesn't infantalize himself. Still, I get the distinct impression that these golfing yuppies are just offended by the idea that a lowly peasant could possibly know something that they don't. That attitude would be bad enough, but peoples' lives are literally being destroyed by it. Sometimes I get so frustrated and angry that I'd rather just continue rotting away from the inside out than subject myself to that smug condescension any longer.

Even before my issues with my gastro disease, I had similar experiences with other health problems. I had necrotizing strep I'd been carrying for more than half a year, and exactly two weeks before I ended up hospitalized with a collapsed lung, an ER doctor told me I was suffering from  "allergies." When I brought this up with the doctors in the hospital, they insisted that I must have developed pneumonia in the two weeks between the initial ER visit and my hospitalization. Yeah, sure - in two weeks my lungs abruptly developed abscesses and filled up with sacs of pus and blood.

After my lung surgery, I spent the next four months coughing up fluid until I gagged. My family literally begged me to return to the doctor, which I was hesitant to do because I still didn't have insurance. The E.R. doctor told me matter-of-factly that "strep can't cause pneumonia", and when I lifted up my shirt and showed him the scars from the lobectomy, he just stared, said nothing, and then changed the subject. Keep in mind, this is the exact same hospital where the surgery had been done several months prior. As I was leaving, I heard the doctor who'd seen me talking to the nurses - "Well, if he doesn't trust the staff's expertise, then I don't know what to TELL him...". I wasn't even being difficult or forceful - the issue seemed to be that I had the audacity to politely disagree with the all-knowing doctor.

I know I'm only hurting myself if I spend every day getting violent diarrhea with full-body inflammation, but part of me wants to bail altogether. The frustration of dealing with these doctors makes me feel like I'm losing my mind. I feel like I have to grit my teeth and politely agree when people are condescendingly lecturing me that the sky is green. At a certain point, when everyone around me is telling me to doubt my own perception, I can't help but let serious self-doubt seep into my psyche. It's so frustrating. I won't even hedge my words anymore - I legitimately hate doctors now. These are the same types who would've snickered at anyone who disagreed with lobotomies back in the 50s or 60s.

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    The team wanted to see if rye bread low in FODMAPs would cause reduced hydrogen excretion, lower intraluminal pressure, higher colonic pH, improved transit times, and fewer IBS symptoms than regular rye bread. 
    To do so, they conducted a randomized, double-blind, controlled cross-over meal study. For that study, seven female IBS patients ate study breads at three consecutive meals during one day. The diet was similar for both study periods except for the FODMAP content of the bread consumed during the study day.
    The team used SmartPill, an indigestible motility capsule, to measure intraluminal pH, transit time, and pressure. Their data showed that low-FODMAP rye bread reduced colonic fermentation compared with regular rye bread. They found no differences in pH, pressure, or transit times between the breads. They also found no difference between the two in terms of conditions in the gastrointestinal tract.
    They did note that the gastric residence of SmartPill was slower than expected. SmartPill left the stomach in less than 5 h only once in 14 measurements, and therefore did not follow on par with the rye bread bolus.
    There's been a great deal of interest in FODMAPs and their potential connection to celiac disease and gluten-intolerance. Stay tuned for more information on the role of FODMAPs in celiac disease and/or irritable bowel syndrome.
    Source:
    World J Gastroenterol. 2018 Mar 21; 24(11): 1259–1268.doi: &nbsp;10.3748/wjg.v24.i11.1259

    Jefferson Adams
    Celiac.com 05/22/2018 - Proteins are the building blocks of life. If scientists can figure out how to create and grow new proteins, they can create new treatments and cures to a multitude of medical, biological and even environmental conditions.
    For a couple of decades now, scientists have been searching for a biological Rosetta stone that would allow them to engineer proteins with precision, but the problem has remained dauntingly complex.  Researchers had a pretty good understanding of the very simple way that the linear chemical code carried by strands of DNA translates into strings of amino acids in proteins. 
    But, one of the main problems in protein engineering has to do with the way proteins fold into their various three-dimensional structures. Until recently, no one has been able to decipher the rules that will predict how proteins fold into those three-dimensional structures.  So even if researchers were somehow able to design a protein with the right shape for a given job, they wouldn’t know how to go about making it from protein’s building blocks, the amino acids.
    But now, scientists like William DeGrado, a chemist at the University of California, San Francisco, and David Baker, director for the Institute for Protein Design at the University of Washington, say that designing proteins will become at least as important as manipulating DNA has been in the past couple of decades.
    After making slow, but incremental progress over the years, scientists have improved their ability to decipher the complex language of protein shapes. Among other things, they’ve gained a better understanding of how then the laws of physics cause the proteins to snap into folded origami-like structures based on the ways amino acids are attracted or repelled by others many places down the chain.
    It is this new ability to decipher the complex language of protein shapes that has fueled their progress. UCSF’s DeGrado is using these new breakthroughs to search for new medicines that will be more stable, both on the shelf and in the body. He is also looking for new ways to treat Alzheimer’s disease and similar neurological conditions, which result when brain proteins fold incorrectly and create toxic deposits.
    Meanwhile, Baker’s is working on a single vaccine that would protect against all strains of the influenza virus, along with a method for breaking down the gluten proteins in wheat, which could help to generate new treatments for people with celiac disease. 
    With new computing power, look for progress on the understanding, design, and construction of brain proteins. As understanding, design and construction improve, look for brain proteins to play a major role in disease research and treatment. This is all great news for people looking to improve our understanding and treatment of celiac disease.
    Source:
    Bloomberg.com

    Jefferson Adams
    Celiac.com 05/21/2018 - Just a year ago, Starbucks debuted their Canadian bacon, egg and cheddar cheese gluten-free sandwich. During that year, the company basked in praise from customers with celiac disease and gluten-sensitivity for their commitment to delivering a safe gluten-free alternative to it’s standard breakfast offerings.
    But that commitment came to an ignoble end recently as Starbucks admitted that their gluten-free sandwich was plagued by  “low sales,” and was simply not sustainable from a company perspective. The sandwich may not have sold well, but it was much-loved by those who came to rely on it.
    With the end of that sandwich came the complaints. Customers on social media were anything but quiet, as seen in numerous posts, tweets and comments pointing out the callous and tone-deaf nature of the announcement which took place in the middle of national Celiac Disease Awareness Month. More than a few posts threatened to dump Starbucks altogether.
    A few of the choice tweets include the following:  
    “If I’m going to get coffee and can’t eat anything might as well be DD. #celiac so your eggbites won’t work for me,” tweeted @NotPerryMason. “They’re discontinuing my @Starbucks gluten-free sandwich which is super sad, but will save me money because I won’t have a reason to go to Starbucks and drop $50 a week,” tweeted @nwillard229. Starbucks is not giving up on gluten-free entirely, though. The company will still offer several items for customers who prefer gluten-free foods, including Sous Vide Egg Bites, a Marshmallow Dream Bar and Siggi’s yogurt.
    Stay tuned to learn more about Starbucks gluten-free foods going forward.

    Jefferson Adams
    Celiac.com 05/19/2018 - Looking for a nutritious, delicious meal that is both satisfying and gluten-free? This tasty quinoa salad is just the thing for you. Easy to make and easy to transport to work. This salad of quinoa and vegetables gets a rich depth from chicken broth, and a delicious tang from red wine vinegar. Just pop it in a container, seal and take it to work or school. Make the quinoa a day or two ahead as needed. Add or subtract veggies as you like.
    Ingredients:
    1 cup red quinoa, rinsed well ½ cup water ½ cup chicken broth 2 radishes, thinly sliced 1 small bunch fresh pea sprouts 1 small Persian cucumber, diced 1 small avocado, ripe, sliced into chunks Cherry or grape tomatoes Fresh sunflower seeds 2 tablespoons red wine vinegar  Kosher salt, freshly ground pepper Directions:
    Simmer quinoa in water and chicken broth until tender.
    Dish into bowls.
    Top with veggies, salt and pepper, and sunflower seeds. 
    Splash with red wine vinegar and enjoy!

    Jefferson Adams
    Celiac.com 05/18/2018 - Across the country, colleges and universities are rethinking the way they provide food services for students with food allergies and food intolerance. In some cases, that means major renovations. In other cases, it means creating completely new dining and food halls. To document both their commitment and execution of gluten-free and allergen-free dining, these new food halls are frequently turning to auditing and accreditation firms, such as Kitchens with Confidence.
    The latest major player to make the leap to allergen-free dining is Syracuse University. The university’s Food Services recently earned an official gluten-free certification from Kitchens with Confidence for four of the University’s dining centers, with the fifth soon to follow.
    To earn the gluten-free certification from Kitchens with Confidence, food services must pass a 41 point audit process that includes 200 control check points. The food service must also agree to get any new food item approved in advance, and to submit to monthly testing of prep surfaces, to furnish quarterly reports, and to provide information on any staffing changes, recalls or incident reports. Kitchens with Confidence representatives also conduct annual inspections of each dining center.
    Syracuse students and guests eating at Ernie Davis, Shaw, Graham and Sadler dining centers can now choose safe, reliable gluten-free food from a certified gluten-free food center. The fifth dining center, Brockway, is currently undergoing renovations scheduled for completion by fall, when Brockway will also receive its certification.
    Syracuse Food Services has offered a gluten-free foods in its dining centers for years. According to Jamie Cyr, director of Auxiliary Services, the university believes that the independent Gluten-Free Certification from Kitchens with Confidence will help ease the anxiety for parents and students.”
    Syracuse is understandably proud of their accomplishment. According to Mark Tewksbury, director of residence dining operations, “campus dining centers serve 11,000 meals per day and our food is made fresh daily. Making sure that it is nutritious, delicious and safe for all students is a top priority.”
    Look for more colleges and universities to follow in the footsteps of Syracuse and others that have made safe, reliable food available for their students with food allergies or sensitivities.
    Read more.