What do you eat, Jeanne?

Although I eat healthy and am thin, my diet might not be the right one for you.  The way I eat won’t necessarily be the answer to a healthy body composition for you.  There are too many things to consider, before copying my diet.  Besides the fact that my cholesterol is about 120 mg/dl, my blood pressure hovers around 90/60 mm/Hg, and my body fat is about 17.4%, I have celiac disease (CD).  This column will explain what CD is and how it relates to me.  It was written not only to teach you about another aspect of health, but also to share with you my pursuit of a healthy lifestyle.
 
CD is a genetic condition in which damage to the lining (mucosal surface) of the small intestine is caused by an immunologically toxic reaction to gluten.  That is, after gluten is consumed, it makes its way to the small intestines where it attaches to abnormally formed antibodies.  Then, a number of reactions occur, leaving the intestinal lining damaged.  Usually, it is the first (duodenum) and/or second (jejunum) of three sections of the small intestines that is affected.  Gluten usually doesn’t make it any farther than that.
 
The fact that there are some abnormal antibodies makes CD an autoimmune disorder, too.  Normally antibodies are “good guys” that attack antigens or “bad guys.”  Those who have any autoimmune disease have some antibodies that bond with antigens instead of attacking them.  The result is damaged healthy tissue.
 
In CD, the tissue that is damaged is called villi (singular—villus).  They are finger-like projections that make up the lining of the small intestines.  Imagine each piece of grass in your lawn as being a villus.  Your lawn would look like a healthy mucosal surface.  Now imagine having each piece of grass gone so that only dirt is showing.  That is what my mucosal lining looked like when I was first diagnosed.  There was nothing sticking out anymore—no villi.  Villi are important because nutrients are absorbed through them to the blood stream and digestive substances pass through them to break down food in the small intestines.  Think of it as a two-way street.  Gluten is the bomb that takes out the street.
 
CD is similar to diabetes (mainly Type 1) in that there is a genetic predisposition to it and that it is not necessarily “activated” right from birth.  It “kicks in” later in life.  When?  It’s different for each person.  With CD, it’s usually a mentally or physically stressful event that starts it.  For me, I think the mononucleosis that I had in May 1993 started it.  Also like diabetes, there is no cure, but CD has a good prognosis.  One can be completely healthy, if gluten is 100% out of the diet for life.
 
After gluten is eliminated from the diet, it can take one to two years for the mucosa to heal.  If one does not stay gluten free for five years or more at a time, there is an increased chance for lymphoma (cancer).  Also, nutritional deficiencies and other complications can occur.
 
Gluten is a protein found in all forms of wheat (including durham, semolina and spelt), rye, barley, and related hybrids such as triticale and kamut.  Gluten is the antigen.  Or, I can say that I have an intolerance or sensitivity to a normally harmless protein.  Gluten is in everything.  It can be used to make “starch,” “natural flavors,” “hydrolyzed vegetable protein,” “malt flavoring,” “caramel coloring,” etc.  I can’t eat oats, either, because in the U. S. many oat products are contaminated by wheat.  You can imagine how hard it is to find gluten-free foods at a store or what it’s like to eat out.  Many times I have to call food manufacturers and talk to chefs.
 
After getting medical insurance in April 1994, I had a physical with a general practitioner.  I asked her to do two “routine” blood tests, fortunately, because she had not planned on it.  Two of the several values were abnormal, leading her to think I was deficient in vitamin B12 and folic acid (another B vitamin).  She confirmed her suspicion with another blood test.  After eight months (mostly spent with a gastroenterologist) of testing to figure out why I was deficient, CD was diagnosed.  A pan-endoscopy was the prevailing “winner” that led to the answer.  The scope allows the doctor to look at the mucosal lining and take a biopsy.  After the diagnosis, I was referred to a registered dietitian (R. D.) who not only didn’t know why I was there, but also didn’t know anything about gluten or CD.  That’s when I started my own research.  I read a book called “The Gluten-Free Gourmet” by Bette Hagman and joined several support groups.
 
What were my symptoms before being diagnosed?  Well, I did have symptoms, but didn’t know it.  I was ten pounds lighter than usual, but didn’t know it.  I always felt tired and thought a lot about sleep, had abdominal cramping, gas, and bloating (after eating fatty foods), diarrhea, irritability, and minor depression.  I thought all of these things were normal for me and I had a reason for why each occurred.  For example, the irritability was caused by something work-related.  It wasn’t until all of these symptoms went away that I realized how terrible I had felt.  Finally, I was able to feel like I was supposed to!
 
Six months after my diagnosis, I had a follow-up biopsy.  It showed that I had done quite well with my diet—the villi were back!  Since then, I have had at least three accidents, unfortunately.  First, I accidentally picked up the wrong box of cereal (made of wheat) at the store one time.  At home I ate a handful of it, then read the box.  Aaaaaahhhhhh!!!!  "Oh, my God!” I screamed aloud.  Second, I ate three other kinds of cereals for a few months after my follow-up biopsy.  Eventually, I started feeling poorly, again.  As it turned out, these cereals, which the R. D. said I could have, were not gluten-free.  Needless to say, I wanted to strangle her.  Third, I had a baked potato and steamed vegetables at a restaurant.  As it turned out, I unknowingly was eating a potato that had imitation butter on the skin.  Some products have gluten-type products for flavoring and/or consistency.  The reactions those of us get from having gluten vary greatly.  My first two “accidents” yielded no immediate reaction, but I felt the effects months later.  The third “accident” caused a reaction right after my last bite.  My stomach felt like it was bubbling and about to explode.  I barely had enough time to throw away my napkin, before racing to the restroom.  It was like the MonopolyTM game.  I drew a Chance card that told me to go right to jail.  The jail was the restroom, where I became one with the toilet.
 
As you can imagine, I have to be very careful with everything I put in or near my mouth.  This includes food, chapstick, lipstick, lotion, soap, shampoo/conditioner, medicine, and many more.  Also, I have to be careful before kissing my boyfriend.  I could have a reaction from kissing him, if he had just eaten something containing gluten.  Yes, I am that sensitive.  Fortunately, he is considerate enough to be careful.  Also, I have had to give up a lot of foods that I like.  I am the type who would reach for a piece of bread before a piece of cake.  Some of my favorite foods that I have given up are bagels, other breads, and cereals.  There are several gluten-free food manufacturers, but the products just aren’t the same.  Although, I am very grateful they even exist.
 
Oh, how depressing!  Not really.  I look at my diagnosis as a positive experience.  It was a relief to be diagnosed and get gluten out of my diet.  It enabled me to feel great!  That’s what has always been so important to me.  Since 1987, I have done whatever it takes to lead a healthy lifestyle, including exercising a lot (which I always had done) and eating well (which I hadn’t done).  A gluten-free diet was just one more piece of the puzzle in the pursuit of a healthy lifestyle.  I will always work on making that puzzle more complete.
 
“I need you to eat less chocolate,” Jeanne said to a client during a nutrition session.
 
“But it’s so hard.  I can’t do it,” said the client.
 
Believe me.  I know how hard it is.  Yes, you can do it.  Choose between a healthy diet and a lifestyle-related disease.  You decide.
 
For more information, you can call or write the Celiac Sprue Association/USA, P. O. Box 31700, Omaha, NE 68131-0700, 877-272-4272.
 
— Jeanne Murdoch owns BeanFit Health and Fitness Services. For more information, visit beanfit.com.