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.
In addition to its known benefits of improving bone and heart health, adding a natural supplement of Vitamin D may boost our immune system. So, we know that certain groups of people are deficient in D- like darker complexions, higher body fat, and indoorsy types. Fat cells absorb Vitamin D and keep it out of circulation so those of us who have any extra weight (and females have a higher body fat percentage anyways) are likely deficient. Also, if you have a darker complexion or use sunscreen outside it’s really difficult to absorb enough of the sunlight in our skin to make this vitamin. While we are still sorting out the ideal level of Vitamin D in our bodies, there is decades of evidence that this vitamin our bodies produce naturally is essential in achieving and keeping our optimum level of overall health. Our bodies make Vitamin D in our skin when we are exposed to sun. We’ve all been spending less time outside, and people who live in the northern half of the US (or similar latitudes around the world) don’t get enough sunlight.
You know how milk says “Vitamin D” on the label? Well, that’s because we can’t absorb calcium without Vitamin D so the milk producers add it to the milk. We have a tough time using that calcium to build bones without enough D. So while we all know calcium is essential to build and maintain bones and avoid osteoporosis in our later years, that calcium is not useful unless it has its helper- Vitamin D. This means people who follow a vegan diet are also at risk of low D (in addition to B12 and iron).
High blood pressure, heart attacks, strokes, and heart failure are all linked to low levels of Vitamin D as well. Huge clinical trials are being done right now so that we can determine how much of an impact supplementation has on improving heart health.
What we are also realizing is that we have Vitamin D receptors on our immune system cells. People with low D levels are more likely to have auto-immune disorders and increased risk of infection in general. Remember how people with Tuberculosis were sent to sanatoriums to go sit in the sun? And how cod liver oil has been used for centuries for general health? Well sitting in the sun and drinking cod liver oil both increase your Vitamin D level- they were on to something!
Come in and see us at any of our Kelly Goodman Group locations and we can check your Vitamin D level (our Nurse Practitioner draws your blood herself). Once we know your level we can advise you on how best to supplement this essential vitamin and prescribe a prescription strength Vitamin D if needed. Say no to colds and flu this fall and yes to bone and heart health!
Fatigue, muscle aches, rash, red eyes, mild fever. Is it Zika?
Now that the Zika virus has been transmitted by local mosquitos in Florida, we are all wondering when it will come to Washington DC. This city was built on a swamp and we have all experienced the mosquitos here. Our area has the right type of Aedes mosquito and we have lots of international travelers here, given that we are the nation’s capital. Two weeks ago we looked at risk factors for contracting Zika virus, as a resident of the District of Columbia. What happens if you have done your best to protect yourself but are starting to feel ill? How do you know if it’s Zika or just a run-of-the-mill virus? First, call us to schedule an appointment. We can test for Zika- we will draw your blood here and send it to a national laboratory for testing. Second, be on the safe side and only take Tylenol (acetaminophen) even if you’ve only been in the continental US. Given that Dengue has the same symptoms as Zika, and increases bleeding risk, don’t take Advil/Motrin (ibuprofen). If you have been out of the country recently we will discuss your risk factors, test for similar viruses such as Dengue fever and Chikungunya and determine the proper treatment for you. Above all, the treatment for Zika is supportive rather than curative- meaning lots of fluids, lots of rest, and time. The symptoms of the virus can last 2-7 days. Keep in mind that many, if not most, people who have Zika do not have any symptoms at all. That means that Zika can spread more easily, as infected people can remain active and exposed to mosquitos that will transmit the virus by biting an infected person and then an uninfected person and transferring the virus. Keep protecting yourself with insect repellent as needed and safe sex practices.
Whoever your Primary Care Provider is, they essentially have one central goal: to have your back and ensure you are always getting the best available care. Primary Care providers are the only ones who look out for total physical and mental health, coordinate care with specialists, and keep records of all your medications, labs, and imaging. Sure, you know you want a Primary Care Provider in your life, but here’s why you should see us here at Promenade.
We are highly accessible. With our convenient location in L’Enfant Plaza, we are served by 5 different metro lines. Little known fact: we are also the only primary care office in the entire Southwest quadrant of the city. But even if we had some competition, we are confident we would still be the clear choice for your primary care needs.
As a private independent practice, we take the time to get to know our patients. We are a local, family practice and we like to keep it friendly, personal, and simple. We don’t employ medical assistants or techs, so you will only ever deal with two people at our office: our front desk assistant and your provider. Upon checking in for an appointment, your provider (one of our lovely NP’s) will escort you to the exam room, measure your vital signs, discuss your symptoms or concerns, examine you, and if necessary, draw your blood themselves. You will see 1 room and 1 person per visit. And since we draw your labs ourselves, you will never need to go to an outside lab and sit in another waiting room to see another stranger.
We know how much continuity of care matters to our patients, and since we are a private, locally owned practice you can expect to see the same provider for most, if not all of your visits. Unlike a visit to any walk-in clinic or urgent care center, here at Promenade, each patient establishes a real relationship with his/her provider, and this helps us ensure that your health concerns are never forgotten or overlooked from one visit to the next.
Promenade Primary Care and our other location, Kelly Goodman NP & Associates in Bethesda, have streamlined your healthcare experience because we know your time is valuable. Check out our graphic and see how we have engineered our appointments to be as personalized and efficient as possible compared to other doctor’s offices.