Gluten-free diets are on the rise. Why?
If you’ve been looking at menus or walking through the grocery store, you’ve likely noticed more and more items labelled “gluten-free”. Why? Who is avoiding gluten and why are they doing it? Why was there a three-fold increase in gluten-free diets when there has been no increase in the medical diagnosis of related diseases?
In honor of National Celiac Awareness Day, we’re talking about gluten. Gluten is a protein found in grains- wheat, rye and barley- and helps give an elasticity to these flours in cooking and baking. These grains are found in breads, pastas, soups, cereals and other baked goods. People can be affected by gluten in a few ways.
First, some people have an immediate allergic reaction to wheat and/or another grain. This is a more obvious reaction and easier to diagnose by blood tests looking for antibodies and skin testing looking for skin reactions. These must be treated by avoidance of the grain. There are no medications or allergy shots for food allergies- yet.
Second, people can be affected by the gluten found in wheat, rye, and barley. This can be found in a serious autoimmune form known as Celiac disease or in a milder form called gluten sensitivity. Certain individuals, about 1 in 100 people, have Celiac, a genetic condition where the body attacks the small intestine when gluten is ingested. This can cause lifelong effects and increases one’s chances of having other autoimmune diseases. The only treatment is avoidance of gluten. Blood tests can be performed to help diagnose this disease. Gluten sensitivity is something we don’t yet have conclusive testing for, but studies have shown that people without Celiac can still have damage to their small intestines if they are sensitive to gluten. Therefore, these individuals should still avoid gluten.
Are you avoiding gluten, or limiting your intake? Is it for health or weight loss? Did you have fatigue, digestive or other symptoms that have improved since you went off gluten? Or are you being encouraged by a friend or family member to eliminate it for a month? If you have a family member with confirmed celiac, or if you have an autoimmune disease you should get tested for celiac before you stop eating it. The blood tests are accurate only when you are actively eating (or drinking) gluten.
Going gluten-free is much easier now than it was 16 years ago when a member of my family was diagnosed with a wheat allergy. We are happy to discuss these issues with you, do any appropriate testing, and manage any diseases that are found.
Can exercise counteract alcohol?
If you exercise all week can you drink all weekend? Maybe. The quote in British outlet the Mail Online is “Adults who booze regularly but exercise for five hours a week are no more likely to die than teetotalers.” That’s a simplification of course. There’s a large 10 year study published in the peer-reviewed British Journal of Sports Medicine that shows physical activity can counteract some of the ills of alcohol consumption. It’s a strong study looking at data that was collected from adults aged 40+ from national surveys in the United Kingdom. The study shows that while alcohol intake increases death from cancer especially but also from all causes, people who followed the recommended level of physical activity were no more at risk than the non-drinkers. Alcohol has been shown to increase one’s likelihood of cancer, in particular mouth and throat, esophagus, liver, colon and rectum, and breast cancers, according to the journal Addiction. And it is imperative to note that the study was looking at death from cancer and other causes, not diagnosis rates.
The researchers, who hail from the UK, Canada, Australia and also Norway, used data from England and Scotland from 1994-2006. There were 36,370 people, both men and women, who answered questions about a multitude of health behaviors, and categorized their level of exercise and alcohol. These participants were followed over time to see how their health changed. The researchers controlled for the most obvious factors like body size, smoking status, and sex/gender. They used MET (metabolic equivalent of task) hours to categorize exercise, where 1 MET is sitting at rest, and the more intense the exercise, the higher the MET. For example jogging for 1 hour is equal to 7 MET hours while calisthenics at home for an hour would be 3.5 MET hours.
It’s important to understand what the categories were for both exercise and alcohol. Bottom line, you can’t drink too heavily no matter how much you exercise. In this study they defined hazardous levels as 14-15 drinks per week for women and 19-21 for men. At this level the exercise still seemed to counter the alcohol. But above that level the benefits of exercise did not outweigh the impacts of alcohol. What about exercise levels? They considered inactive as less than 7 MET hours per week, lower active as between 7.5-15 MET hours and higher active as >15 MET hours per week. In practical terms that’s jogging for 30 min 4 times per week. This level of exercise also offered a protective effect against cardiovascular disease, confirming results we already know from a multitude of other studies.
While we can’t be certain that exercise alone reduced the risks associated with alcohol consumption- it could be other lifestyle factors that were not measured- it seems like a good assumption for now. We know we should exercise for our heart health, to reduce cancer risks, and to maintain strong bones and muscles. But if you are someone who drinks alcohol consider this a very strong push to make physical activity a priority. Get moving!
Visit Kelly Goodman Group to learn more about our practice and schedule an appointment at any of our locations.
Do I really need a colonoscopy?
We all hear horror stories from our friends and families about colonoscopies and the dreaded “prep”. Why are we doing this to ourselves? How can we reduce the number of times we need to do this test in our lifetime? Is there a way to avoid it completely?
First let’s talk about prevention as this is what really saves lives. In the US, colorectal cancer is the second deadliest cancer. Men have a 4.7% chance and women a 4.4% chance of being diagnosed with it.
There are risk factors you can’t change, like living longer than 50 years, having a family member with colon cancer or other cancer syndromes, polyps, Crohn’s or ulcerative colitis, having diabetes, or being in certain racial or ethnic groups (African American and Ashkenazi Jewish).
But there are risk factors that we can control- like alcohol consumption, smoking, sedentary lifestyle, obesity, and poor diet. Make sure to talk with your primary care provider about when to start screening if you have a family history of polyps, colon cancer, or a high number of other cancers. Hint: you need to be screened earlier- up to 10 years earlier even without symptoms depending on the situation.
We now have genetic tests to identify familial disorders that link many types of cancers, such as Lynch syndrome (this causes ovarian, uterine, pancreatic, kidney, brain, ureter and bile duct cancers). So we can test people for a genetic predisposition and make sure they are vigilant about screenings. But what if you have no risk factors? What are the screening rules in that case? Our federal government, as the USPSTF (US Preventive Services Task Force- they will be a recurring character in this blog) recommends screening all Americans between 50 and 75 years old. How often during that 25 year span depends on what is found during the screening. If you are minimizing your risk factors and have a normal colonoscopy you can avoid one for up 10 years at a time. That means a lifetime total of 3 at ages 50, 60 and 70. The upside? It’s a day off from work and maybe you even lose a stubborn pound or two with the clear diet leading up to the procedure. But is it possible to avoid the colonoscopy completely? Well the USPSTF and the AAFP (American Academy of Family Physicians) agree that the only methods that we can count on are colonoscopy, sigmoidoscopy (similar to colonoscopy but not as thorough), and stool testing that looks for blood. There are other newer tests such as a stool test that looks for cancer DNA rather than blood (Cologuard) and CT scans specifically for the colon/rectum. But these newer tests have not had time to prove themselves effective in a way that outweighs the risks- like an incorrect result or exposure to radiation.
If you use one of the stool tests or sigmoidoscopy and there is any uncertainty about being cancer-free, then you’ll need to follow up with a colonoscopy. Honestly, other than our skin, we can’t look at an organ directly to look for changes in the cells. Colonoscopy allows us to use a camera, equipped with tools, to look for and take samples of cells to analyze under a microscope. If you want to use the stool tests, you should repeat them yearly. Otherwise follow up frequency for colonoscopy depends on what was seen inside and under the microscope-usually 3-10 years.
Bottom line (pun intended), the same rules for healthy living apply to colon health as for the rest of our body. Don’t smoke, get exercise, eat lots of veggies, fruits, and whole grains, keep alcohol to a max of 1 drink daily for women or 2 for men, and stay at a healthy weight (BMI/ body mass index <25). And make sure to see your primary care provider to discuss your personal and family health history and come up with an individualized plan for your health each year. Call us or visit us at any of our Kelly Goodman Group locations to set up a visit.