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.
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.
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!
These days it’s hard to glance at a health magazine, flip past the cooking channel, or chat with your one vegan friend without hearing the word “superfood”. It seems like they just keep coming up with new ones. One week its kale, the next its acai, then before you know it you’re on amazon wondering if you should order some Maca powder from the Andes because apparently it’s a natural energy booster and you can sprinkle it in your smoothie. It’s hard to keep up without getting swept up. So, many people (rightfully so) regard superfoods with a healthy amount of skepticism. A superfood is “a nutrient-rich food considered to be especially beneficial for health and well-being.” That’s a pretty broad definition– it’s no wonder they keep announcing new ones! But please read on about walnuts.
This week I read two interesting articles about walnuts and their correlation to reduced cancer deaths. The British Journal of Cancer recently published an article written by a Harvard researcher reporting that his research had shown that tree nuts in general were found to reduce a man’s chances of dying from prostate cancer. Tree nuts include walnuts, almonds, cashews, macadamias and pine nuts. Now, prostate cancer is typically a slow-growing cancer that occurs later in men’s lives. Interestingly, most men who have it will not die from it, but will die from a completely unrelated cause as the disease is very often asymptomatic. However, after lung cancer, prostate is still the second leading cancer killer among men. It’s an extremely hit-or-miss cancer, to say the least, and so we have to ask: how can men reduce their chances of suffering prostate cancer’s fatal effects? The study looked back at 47,000+ men and found that those who ate tree nuts five times per week had a 34% lower chance of dying from prostate cancer than men who ate nuts less often. Let me be clear: both groups had the same rate of diagnosis of prostate cancer regardless of how many nuts they ate. The tree nuts don’t appear to keep men from developing prostate cancer, but they do seem to make them less likely to die from it.
If you think that sounds bizarre, researchers were pretty puzzled too. The research remains largely inconclusive as to exactly why tree nuts correlate to lower prostate cancer deaths, but several other studies have noticed and documented this relationship as well. The next study I read was published in Cancer Prevention Research and was actually performed on mice not humans, but it still offered some new insights on the topic. Some mice had walnuts added to their standard diet- either a diet of typical mouse kibbles or a Western diet. The mice who consumed walnuts were found to have fewer colon cancer tumors (2.3 fold fewer in the western diet group). The researchers then analyzed the stool of all the mice in the study and found that the mice that had eaten walnuts, especially the males, had more diverse gut biomes than the mice that had not been fed walnuts. More definitive research is needed to determine whether the change in the gut flora is behind the decrease in tumor development or whether it is just yet another benefit of the walnuts. Regardless, the walnuts seem to have had a surprisingly beneficial impact.
So what is it in the nuts that contribute to our health? Is it the B vitamins? The magnesium? Or a plant-specific type of chemical that offers protection against inflammation and cancer and encourages the growth of healthy gut bacteria? Nobody’s totally sure, but I’ll be sure to keep eating Waldorf salad, snacking on walnuts, and adding them to my baked goods any chance I get.
Nakanishi M, Chen Y, Qendro V, et al. Effects of walnut consumption on colon carcinogenesis and microbial community structure [published online May 23, 2016]. Cancer Prev Res (Phila). doi:10.1158/1940-6207.CAPR-16-0026
Wang W, Yang M, Kenfield SA, et al. Nut consumption and prostate cancer risk and mortality. Br J Cancer. 2016 Jun 9. doi:10.1038/bjc.2016.181. [Epub ahead of print]