IBS Awareness Month–GF Newsletter

Declaration of Recognition - April is IBS Awareness Month in Virginia

April is IBS Awareness Month. And, for the 1st time, Virginia has officially recognized it as IBS Awareness Month! Many thanks to this administration for their support, and to Pam Emmer for starting this initiative across the country.

Now, you may already be more aware of IBS than you’d like. It’s very common—approximately affecting 45 million people in the U.S. It’s a condition of gut-brain interactions with chronic change in bowel habits and abdominal discomfort. Sometimes people have IBS solo; sometimes it tags along with other conditions, like Celiac, IBD, gastroparesis, MCAS, etc.

"Poop" chocolate pudding for IBS Awareness Month

The good news is that IBS does not lead to increased risk of cancer or death, but it does have a severe impact on quality of life for many people. Currently, there isn’t a cure, but there’s a lot that can be done to improve symptoms through diet, lifestyle changes, exercise, supplements, stress management, sleep, medications, and more.

Yes, for real, diet affects IBS, at least for many people. Most likely you already know this. ? Now the AGA recognizes it, too!

Great piece on IBS and stress on NPR

Low FODMAP, gluten-free bunny meringue cookies

Can gut microbiome predict long COVID? A new study suggests this may be a thing. (preliminary data, of course, and more study needed)

An article on diet and IBD in TIME

Dr. Mark Pimentel’s new book from Cedar Sinai on SIBO is out! And they are donating profits in April to World Central Kitchen.

Gluten-free, low FODMAP meringue bunnies—Kosher for Passover, too! (video recipe), with recipe written out here

GF Valentine’s and more!

Since it’s almost Valentine’s day, I’ll be sharing a few favorite recipes below–some that you can whip up last minute! But first, a quick research run-through.

Tuxedo strawberries
Tuxedo Strawberries

Here’s something I don’t love at all. There are concerns about gluten-free oats. Again. It’s harder to find gluten-free oats now, and there are recommendations for people who need gluten-free oats for medical reasons to choose oats certified gluten-free, preferably purity protocol. And even if you’ve checked the ones you eat, do check again, because some have change because of supply chain issues.

Interesting article on how many people who are diagnosed with IBS actually have other underlying issues, like Celiac, microscopic colitis, SIBO, carb malabsorption or pancreatic insufficiency.

Table 1: Summary of different diets in inflammatory bowel disease
IBD Diets that work

For those of you with IBD, and dietitians who read the newsletter, there’s a great article on diets for Crohn’s and UC, reviewing the ones that work…and the ones that don’t.
Along similar lines, I did a 5-minute journal review of a study out in Jan 2022 on a special diet for Crohn’s called the Crohn’s disease exclusion diet. It’s been used for children in the past, and was just studied for use in adults. Tricky to do, but can be effective, and interesting to read about.

Last but not least, I’ve got a CE course for nutrition professionals on histamine intolerance. I find it such a fascinating topic, and something I’ve been seeing so much more in clients and in research lately.

Onward to the food!

My favorite things to make for my Valentine (all gluten-free, of course)

Chocolate Frangelico mousse cake
Chocolate Frangelico Mousse Cake

What if you don’t like/can’t eat chocolate?

  1. I’m sorry
  2. I’d recommend toffee, or
  3. Crustless apple pie

Wintertime G-Free Newsletter

We are absolutely in the middle of eating season 2021!Christmas meringues with sprinkles

Here’s just a quick update of some gluten-free goodness:

I have a looong list of naturally gluten-free holiday desserts, because there’s no way to improve on the perfection of some classics.

The Washington post shared an article with 7 gluten-free cookies

Here’s a long list of low FODMAP desserts (all gluten and lactose free)

And because people often ask, what are we making this year? Well, thus far, gifts have been Toasted Sugar Almond and Hazelnut Meringues, above, (using this recipe and toasted sugar instead of regular), and dairy free hot cocoa mix, and crème brulee with the leftover yolks. Brownie cookies with Jules GF flour are on the line up, and toffee (minus the chocolate) ships well as a gift…

Research—

Oh, the irony. A study on mice shows that a high fat, high sugar diet can cause a partially reversible condition like Inflammatory Bowel Disease

A new study shows that many people with Celiac–up to 1-in-2 have ongoing GI problems despite being on a strict gluten-free diet. These digestive problems can lead  to both physical and emotional issues, so treating them is key. Hopefully this awareness leads to better treatment and taking concerns of patients more seriously. Graphic on GI disorders in Celiac

People who are food insecure with Celiac have trouble following a gluten-free diet. This is a no-brainer, but this is also the 1st study of its kind, so it IS a big deal. The authors estimated ~16% of people with Celiac were food insecure when the study was done, which was BEFORE the pandemic. The stats have likely changed for the worse. If this is an issue you are concerned with, the Gluten Intolerance Group just launched a non-profit to address food insecurity called GIG Cares.

Are you low FODMAP? Some of you know how I’ve always talked about how the fruit Strawberriesportions in the Monash app just don’t jive with what I’ve found with clients. Well…the Monash app is changing and revising their portions down for strawberries and grapes, to only 6(!!!) grapes and just 4 medium strawberries for the elimination. Which, to me, means that sometimes clients experience (when heard over and over and over) can be as valuable as the info that we get from the machines. But I’m assuming most of you already know that. ?

Wishing peace, happiness and health to you and those you love through this holiday season and beyond, and hoping next year is your best yet!

Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist and Certified Wellcoach in Fairfax, VA.  She helps people with a range of dietary issues, including Celiac Disease, digestive issues, preventing diseases and “whole foods” eating. Let’s get you on your way to achieving your goals and feeling great!  Email or call 571-271-8742.

 

G-Free Autumn Newsletter

Happy Autumn! Here’s a quick update of news, recipes, and more.

mini pumpkins

Some neat resources from FARE to keep candies safe for trick-or-treaters—and for nibblers—with food allergies or Celiac. Another list is from Jules GF here.

But what if you choose to opt out of candy?  Nope, I don’t have a vendetta against candy, I like being inclusive, and I’m a fan of rubber duckies. This year, we’re going for ninja rubber duckies and the regular Halloween ones, but go with what works for you!

Breakfasts:

As it’s darker in the morning and there’s more temptation to stay in bed until the last second, here are some quick make-ahead breakfast recipes:

Peanut Butter Banana Muffins

Overnight oats (scroll down)

egg bake

Easy Cheesy Egg Bake

Cinnamon Apple Millet

News:

I was delighted to see this article, How to maintain your social life with IBD in TIME on mental health and IBD

As part of the 2nd annual Digestive Disease Nutrition series the 2nd week in Nov, I’ll be presenting on Hypermobility and how it impacts digestion (including the overlap with Celiac). It’s aimed at nutrition professionals—info here.

Want to run for a cause? CDF has a Celiac Turkey Trot.

A new study showed that a low FODMAP diet can be helpful for people with Celiac who have symptoms despite staying strictly gluten-free and having healed intestines…support of an RD is key to make sure nutritional balance happens. ?

Planning ahead? Thanksgiving tips from years past here

Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist and Certified Wellcoach in Fairfax, VA.  She helps people with a range of dietary issues, including Celiac Disease, digestive issues, preventing diseases and “whole foods” eating. Let’s get you on your way to achieving your goals and feeling great!  Email or call 571-271-8742.

Big Gluten-free News! Summer ’21

picture of blueberries

Happy Summertime! Here is an updated gluten-free grab and go list for everyone who is finally traveling, and an update on gluten and digestive research below. And I’m loving all the seasonal fruit!

Starting with the biggest news:

Labeling for gluten may be on the horizon! There’s a new bill that was introduced which would require companies to label gluten (not just wheat!) on all packages. This would be huge….contact your representatives! And many thanks to Gluten-free Watchdog for the alert.

Oh, the neat new Celiac studies! This one suggests that there may be a new pill to help with cross contamination on the way—or to enable people to eat gluten…note that the study is relatively small, and short length. And for those of you thinking that a pill is not for you, I respect that! There are people with Celiac eating a gluten-free diet whose numbers have not returned to normal who will likely be hugely helped by technology like this, and same goes for people who travel for work. Here’s the same research covered in NEJM

Speaking of travel, this new dining app from Gluten dude makes gluten-free dining out easier. Restaurants are either 100% GF or actually take good precautions.

A study from the Center for Celiac Research suggests that there may be microbial changes before the development of Celiac—which hopefully may give new avenues for prevention down the line.

More about the microbiome in Celiac and RA

Ultra processed food is associated with risk of IBD–PURE study—this study links consumption of soft drinks, sweets, salty snacks, and processed meat with risk of UC and Crohn’s. Pros: it’s a big study, including people from different countries and regions, and it is a prospective study. Cons: correlation doesn’t mean causation. And nope, this still doesn’t mean the disease is your fault, but if you’ve got children at genetic risk, it’s something to consider. And as always, more study is needed.

This is a great overview of where the science is on the microbiome, which talks about everything from microbial diversity to busting many common myths.

For my fellow clinicians (or curious people) reading this, finally! IBS guidelines for pregnancy. All I can say is, it’s about time. Highlights—Low FODMAP should be adapted with an RD, soluble fiber is likely a plus, probiotics don’t have enough data.

A new randomized, controlled BMJ study shows that more dietary omega 3s may reduce migraines…

Enjoy the rest of your summer; it always goes by too fast!

Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist and Certified Wellcoach in Fairfax, VA.  She helps people with a range of dietary issues, including Celiac Disease, digestive issues, preventing diseases and “whole foods” eating. Let’s get you on your way to achieving your goals and feeling great!  Email or call 571-271-8742.

Something Yummy in Season

The Farmers’ Market season has begun! Some, like Burke are open now, and I got asparagus, apples, sweet potatoes and a bunch of plants.

I love gardening, and also buying from local farmers when possible. It was a rude awakening, moving from sunny California for grad school to Northern Virginia almost 18 years ago….there were farm stands everywhere, and I was totally accustomed to easy access to fresh, beautiful food. So I’ve been gardening since to fill some of the blanks.

Since we’ve moved to a more wooded area a few years ago, my garden has largely been a buffet for the deer and groundhogs. Sometimes I get a nice harvest; other times, I’m feeding the wildlife. So far, I’ve got kale, garlic, onions, herbs, strawberries, and green beans and I just put in potatoes, sweet potatoes, Thai peppers, basil and stevia, and more to come this weekend.  I’ll put them in soon anyway and hope for the best. We also have a blackberry and blueberry plant, and even grapevines. The blackberry has a ton of flowers this year (right), which hopefully means there’s lots of fruit coming my way!

Even if the critters get my veggies, there are a bunch of Farmers’ Markets and locally grown resources to give more options, and the number of markets has only grown for the last decade. We’ve got a bunch of markets nearby, and they’re about to open or just opened.

Why go to a Farmer’s Market?

  • They’re terrific for encouraging people to branch out and try new foods. There are generally a lot of samples, and everything looks so good. Works well for kids, too!
  • Fresh produce and meat. Most fruits and vegetables are picked that day. Seasonal food is generally going to be more nutritionally  dense than something shipped around the globe.
  • Support for local farmers and the local economy.
  • Few or fewer pesticides on fruits and vegetables. A plum shipped from Chile need a lot of pesticides to keep it lovely even after traveling thousands of miles.
  • Greater variety. While Whole Foods or Wegmans may have 5 kinds of apples, it’s common to have a choice of 10+ varieties and discover new flavors that you enjoy.
  • Better taste! There’s nothing that compares to the taste of a freshly picked tomato, peach, or apple.
  • The “manufacturer” is usually right in front of you, so if you have questions about how something is made or grown, just ask!

I’d be willing to bet there’s a market near you. Here’s a listing of Farmer’s Markets

Also, another great option are CSAs (Community Supported Agriculture). If that’s more your scene, there’s a nice list here.

Whether you have a nice big garden or even just an available window, it’s a great time to get growing. Even a sunny window should work for herbs like basil.

Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist and Certified Wellcoach in Fairfax VA (and currently, remotely). She helps people with a range of dietary issues, including Celiac Disease and all sorts of GI disorders. Let’s get you on your way to achieving your goals and feeling great! Email or call 571-271-8742.

Celiac Disease Awareness–May 2021

Happy Celiac disease Awareness Month! To celebrate, let’s talk about how to eat gluten-free and healthy.

Gluten-free and Healthy

Going gluten-free can be a big turning point to greater awareness and eating healthier.  All of a sudden, people need to start reading labels, and many begin to wonder why there are all of these ingredients they can’t pronounce and why high fructose corn syrup seems to be in everything.  Or maybe after years of eating anything and staying slim, the pounds have started creeping upward, or blood pressure, blood sugar or cholesterol numbers are moving in the wrong direction.

Here are some quick suggestions to make your diet healthier:

  • Go for healthy fats. Omega 3s are so important! Increase the amount you eat of fatty fish, like salmon, trout, flounder, sole, rockfish, sardines and more. Plant based options include flax, chia, walnuts, etc.
  • Calcium is key! This can be from Greek yogurt, cheese, or milk, or if you avoid dairy, choose sardines, collards or turnip greens, beans, nuts, etc.
  • Switch to a GF baking blend using sorghum, garbanzo beans, almond or coconut, brown rice or other whole grains.
  • Have fruit or vegetables with every meal—5-9 servings a day.  That can be as easy as an orange with breakfast, a veggie soup and a salad with lunch, dried fruit for snack and 2 servings of veggies along with dinner.
  • I’ve just updated the Farmers’ market list for 2021, too–a great place for veggie and fruit inspiration!
  • Include legumes (i.e., dried beans and peas) with your meals regularly; increase your intake of these foods gradually to limit gas.
  • Drink your water!  8 glasses a day are important to stay hydrated, especially when you increase the amount of fiber you eat.
  • Include nuts and seeds several times a week, which also contain monounsaturated fats and can help control blood cholesterol levels.
  • Find a way to reduce stress: acupuncture, meditation, deep breathing, talking to a friend, dancing, walking the dog, or whatever works for you. This under the umbrella of nutrition, because most people don’t reach for Brussels sprouts when they get stressed.
  • Use healthy oils, like olive, avocado, etc. and eliminate trans fats.
  • Limit sugar and high fructose corn syrup.
  • Take care of yourself. This includes sleeping well, reducing stress, and doing things you enjoy.  You’re worth it.

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May is also Ehlers-Danlos Awareness Month. If that’s a new term to you, it’s a connective tissue disorder that’s actually linked to Celiac and other digestive conditions. I recently did a presentation for the DC Metro EDS/HSD Support group on Digestive Disorders in EDS and HSD and How Nutrition Can Help.

  • Since many people are starting to travel again, I’ve updated my gluten-free “grab & go” list.
  • I’m excited about a new cookbook, Gluten-free Baking for Beginners by In Johnna’s Kitchen. It was just released on May 18th– I got to preview a copy and it looks fantastic, and delicious, especially for people with multiple food restrictions.
  • Gluten-free and kosher? There are upcoming (online) classes on baking GF breakfasts…and upcoming dates for picnics, BBQs & more.

———————–

Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist and Certified Wellcoach in Fairfax VA (currently, remotely!)  She helps people with a range of dietary issues, including Celiac Disease, GI digestive issues and more. Let’s get you on your way to achieving your goals and feeling great!  Email or call 571-271-8742.

 

Celiac disease & Ehlers-Danlos: What’s the Connection?

May is Celiac awareness month. It’s also Ehlers-Danlos awareness month. And if you’re really genetically blessed like me, you may be personally aware of the link between the two. If not, indulge me in a quick discussion of the research, because it’s too rarely discussed.

The Ehlers Danlos Society Logo

There was a 2011 paper which indicated that Celiac was much more common than expected in people with hypermobile EDS. [1] 19% had positive Celiac serology (bloodwork), and 16% agreed to a biopsy, and those 16% were confirmed to have Celiac disease. Notably, the sample size for this study was small—it was only 31 people—however, 16% is much higher than the expected prevalence of Celiac disease, which is ~1%.

2015 paper also indicated a potential link between Celiac disease and hypermobility, with found that 30% of people with Celiac met the criteria for Joint Hypermobility Syndrome (JHS), which is now known as Hypermobility Spectrum Disorder (HSD). [2]

Most recently, in 2021, a case control report looked at people with all types of EDS, and found that Celiac disease was one of the most common GI conditions associated with EDS, and the association was much stronger than in controls–with a 5.47 odds ratio. The study did not break out EDS subtypes, however. [3]

So, while the percentages and the details may still be a question, clearly there is some link between Celiac disease, EDS and Hypermobility Spectrum Disorders. And it is worth noting that while EDS is quite rare, HSD is common; 2-3% of the population.

Of course, testing is always essential before dietary changes because a proper diagnosis is critical. Other people may simply respond poorly to FODMAP content of wheat, so a much larger portion may feel better gluten free, even though they don’t have Celiac.

For more of the research on digestion and hypermobility and EDS, I do have more fun stuff on nutrition for GI issues and all things hypermobility here and for nutrition professionals, consider checking out the Digestive Disease Nutrition series, which includes a lecture from me on how hypermobility affects digestion.

Footnotes

  1. Danese C, Castori M, Celletti C, Amato S, Lo Russo C, Grammatico P, Camerota F. 2011. Screening for celiac disease in the joint hypermobility syndrome/Ehlers–Danlos syndrome hypermobility type. Am J Med Genet Part A 155:2314–2316.
  2. Fikree A, Aktar R, Grahame R, Hakim AJ, Morris JK, Knowles CH, Aziz Q. Functional gastrointestinal disorders are associated with the joint hypermobility syndrome in secondary care: a case-control study. Neurogastroenterol Motil. 2015
  3. Rachel S Brooks, James Grady, Thomas W Lowder, Svetlana Blitshteyn, Prevalence of gastrointestinal, cardiovascular, autonomic and allergic manifestations in hospitalized patients with Ehlers-Danlos syndrome: a case-control study, Rheumatology, 2021.

Gluten in Medications

Happy Springtime! My favorite season, hopefully yours, too.

Medications can contain hidden gluten!

Okay, if you only read one thing, read this!

Did you know companies don’t need to label for gluten in meds?

There’s finally some movement on gluten in medication….and hopefully finally goes somewhere. Congressman Tim Ryan D-OH and Rep. Steve Stivers R-OH have teamed up for the Gluten in Medications Act.

If you’ve been around for a while, you know this has been problem for quite some time, with no resolution in sight. I testified for the FDA in 2011, and they listened politely. Nothing changed.

I dearly hope that this time, there’s enough bipartisan momentum. And please nudge your Congressional reps to sponsor this bill. Because this isn’t the first time this bill has been proposed, but hopefully it’ll finally go somewhere this time! Handy dandy little form to nudge your rep right here.

Other news of interest:

  • Got fructose malabsorption? you’re in good company. Some of it is that in the US, we eat more fructose. This paper (from this month) has a good review
  • Kate Scarlata has a wonderful initiative for IBS month (April) to end hunger. To learn more, or to donate, check it out.

Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist and Certified Wellcoach in Fairfax, VA.  She helps people with a range of dietary issues, including Celiac Disease, digestive issues, preventing diseases and “whole foods” eating. Let’s get you on your way to achieving your goals and feeling great!  Email or call 571-271-8742.

Passover, G-Free Style

Passover isn’t here until March 27th but many of the products are already appearing in grocery stores. Not all Passover foods are gluten-free, but many are, and there’s a much wider selection than usual at the grocery store. This can be a good time to stock up on GF cakes and mixes, cookies, macaroons, some of the “bread” crumbs and supplies like potato starch. As an added bonus for people with multiple restrictions, most Kosher for Passover products contain no corn or soy products, either.

In a nutshell, the basic rule of foods for Passover is no leavened foods, which eliminates normal breads, cakes etc. Matzo is the main exception. Matzo is an unleavened bread usually made from wheat and is eaten regularly, and some products contain products with Matzo and matzo meal, which also potentially listed as cake meal or farfel. However, many products don’t contain gluten. Or, if you find products labeled “non-gebrok or gebroktz or grebrochts” (or another spelling variation) they’re non-grain containing and therefore have no gluten-containing ingredients. Often Kosher for Passover products and cakes are made of potato flour or nut meals rather than wheat or glutinous grains.

As always in the gluten-free world, read labels carefully. “Kosher” and “Kosher for Passover” are two different things entirely. Kosher for Passover foods will be labeled “May be used for Passover” or have a symbol that says OUP. I have often seen “regular” Kosher foods in the Passover section at grocery stores, so please do check the labels very carefully.

Keep in mind that many Passover foods are imported from other countries. Technically, imports must follow the FDA allergen labeling laws, but I can say I’ve seen many that aren’t labeled quite in the same way as the FALCPA U.S. labeling laws dictate So the label on an import may say matzo, but may not say “wheat” explicitly or have the disclaimer stating that it contains wheat.

Most Kosher for Passover products will have to adhere to strict standards for cross contamination from a religious perspective. Voluntary allergen labeling statements (AKA “Made in a factory” claims) are still not regulated.

From a gluten-free perspective, possibly the best part of Passover is AFTER Passover, when all of the great gluten-free goodies are on sale! Passover ends April 4th 2021, so mark your calendars, because the word has gotten out in gluten-free circles and the mad rush is on.

Back when you really couldn’t get GF prepared foods in the regular grocery store, this was a much bigger deal. But it’s still nicer to have an expanded selection, and nicest of all is AFTER Passover, when all of the products are on sale!

For people who DO celebrate the actual holiday of Passover, not just the gluten-free food, here are some great recipes and information:

Other favorite gluten-free recipe sites for Passover? Let me know in the comments section on my website.

Lately, Whole Foods has stocked a gluten-free Matzah, and the brand is Yehuda, so keep your eyes peeled! You can also get it on Amazon. It’s not technically matza because it’s not made of oats, but it’s “Matzo style squares”. There are also many more Kosher markets, such as Kosher Mart in Rockville. Some local grocery stores also have a great selection.

 

 

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