Gluten-free pizza and beer

As a doctor who treats many people with celiac disease and who is personally gluten sensitive, I am uniquely aware of the challenges of a gluten-free diet. I am also casein sensitive. So, pizza is something that has been missing from my diet for months. However, those of us on a gluten-free diet can enjoy Amy’s gluten free pizza. And if you are also avoiding casein, you can eat Amy’s gluten-free dairy-free Spinach Pizza.

The pizza is made with a rice crust and soy-based mozzarella and ricotta cheeses. Therefore, if you are sensitive or allergic to soy you will want to avoid this pizza. Also, not all of Amy's products are gluten-free so you need to pay attention to the pizza boxes to confirm that they are gluten-free. The Spinach Pizza also contains tomatoes, potatoes, sunflower seeds and rice. Spinach and organic sun-ripened tomatoes are combined with several herbs for a very tasty, yet gluten-free dairy-free pizza.

There are no trans fats, preservatives or MSG. However, more than half the calories are from fat. So, just add gluten-free Red Bridge beer and you can enjoy a classic American meal and be somewhat unhealthy without eating gluten (or casein). I did, at least on Super Bowl Sunday this year. I will tell you more about my thoughts on the new gluten-free beer, Red Bridge, in another post.

Copyright © 2007, The Food Doc, LLC, All Rights Reserved.
www.thefooddoc.com

Irritable bowel syndrome linked to increased intestinal mast cells and intraepithelial lymphocytosis as well as stress

Our digestive tract is the largest line of defense we have to maintain against outside attack. It is vulnerable to stress, foreign food proteins and bad bacteria. Irritable bowel syndrome is reported to be the most common gastrointestinal disorder. In this month’s issue of Gut, Guilarte et al. from Barcelona Spain report finding of mildly increased intra-epithelial lymphocytes (IELs) and marked increased mast cells patients with diarrhea predominant IBS who also had higher levels of psychological stress than normal volunteers.

A stress-mast cell axis has been proposed for possible cause of IBS. Mast cells typically release chemicals in response to allergens and parasites but have also been linked to stress. Increased mast cells have been found in the large and small bowel of patients with IBS especially when a stain for tryptase, an enzyme specific for mast cells, is performed.

Mast cells can increase intestinal permeability (cause leaky gut), increase visceral sensitivity (increased pain sensation and intensity) and increase motility (contractions of the intestine). This results in diarrhea and abdominal pain. The finding of increased lymphocytes or intraepithelial lymphocytosis in the patients of this most recent study was of particular interest to me. I am seeing this very commonly in my patients who do not meet criteria for celiac disease yet respond to a gluten-free diet who have previously been labeled IBS. Sometimes I find this in small intestine biopsies and sometimes in the colon of patients. Some have had a colonoscopy in the past but no biopsies were done because the colon “looked normal”. In a recent post I discussed a study that noted IBS defining symptoms in over 50% of patients with microscopic colitis.

If you are not experiencing optimal health, consider the proposition that our digestive tract is now under constant attack and is frequently failing as a defensive barrier. Our enemies increasingly appear to be genetically modified or prepared foods and bad bacteria. The bad bacteria have taken over due to excess hygiene practices and indiscriminant use of antibiotics. Our defense must include consideration of dietary changes such as reduction or elimination of gluten, eating organic foods, and the liberal use of probiotic supplements.

Copyright © 2007, The Food Doc, LLC, All Rights Reserved.
www.thefooddoc.com

Reference:
Diarrhoea-predominant IBS patients show mast cell activation and hyperplasia in the jejunum. Guilarte, M et al. Gut February 2007; 56:203-209.

Eat More Fish: Omega-3 Fatty Acids in Seafood and Fish Oil Capsules Prevent Colon Cancer

Eating fish may reduce colon cancer risk. A new study found that men not taking aspirin with high blood levels of omega-3 fatty acids had a 66% reduction of colorectal cancer compared with those with low levels. Omega-3 fatty acids aid brain function and protect against dementia and heart disease. Cold water fish or seafood are high in omega-3 fats. Fish oil capsules can be taken as a nutritional supplement. In addition to fish or seafood other sources of omega-3 fats are listed below.

• Fish and seafood
• Fish oil capsules
• Flaxseed oil
• Free-range chicken
• Game meat
• Leafy green vegetables
• Liver
• Nuts: Brazil, Cashews, Macadamia, Pistachios, walnuts
• Omega-3 enriched chicken eggs
• Pasture-fed beef or buffalo
• Walnuts

Omega-3 fatty acids may block the chemical pathway linked to cancer development and growth. Eating the equivalent of a U.S. standard sized meal of fish or seafood a twice week is linked to higher IQ babies. For those taking fish oil capsule, the typical preventive dose of omega-3 fatty acids is 1-2 grams a day while higher doses of 4-6 grams may be needed to treat various illnesses. Those with blood clotting problems or taking blood thinners should exercise caution and talk to their doctors before taking any fish oil capsule supplements. These supplements should be stopped before surgery.

Eating more fish or taking fish oil caps is an easy and effective strategy for improving your health. You may have a higher IQ children, less of a chance of Alzheimer’s disease and heart attack through a natural method that doesn't involve taking medications! There are much more health through food and the digestive system insights coming from the Food Doc. I am daily searching for the latest breaking medical discoveries on the link of food, altered gut microbes, and the digestive tract to share with you.

I have so much more but am limited in these short posts. Soon my website www.thefooddoc.com will be packed with this kind of rich information. Exciting features will include interactive online applications such as a diet symptom diary, a symptom assessment tool as well as multimedia resources such as streaming online videos and a virtual office, all provided to empower each of you to attain and maintain optimum health . Stay tuned!

Copyright © 2007, The Food Doc, LLC, All Rights Reserved.
www.thefooddoc.com

Reference:
Hall, M et al. “Blood levels of long-chain polyunsaturated fatty acids, aspirin and the risk of colorectal cancer” Cancer Epidemiology Biomarkers & Prevention. February 2007, 16:314-321.

The Food Doc Journal: New study supports fish as brain food for babies despite prior FDA warnings to limit intake during pregnancy.

The Food Doc Journal: New study supports fish as brain food for babies despite prior FDA warnings to limit intake during pregnancy.

New study supports fish as brain food for babies despite prior FDA warnings to limit intake during pregnancy.

According to a study published Friday February 16, 2007 in the British journal The Lancet, pregnant women who eat 12 or more ounces of fish per week have children with higher IQ’s. The study found that pregnant women who ate on average more than 340 grams of fish per week had children with IQ scores significantly higher than those who ate less fish during pregnancy.

In the U.S. more than 340 grams of fish per week is equivalent to eating 1 ½ to 2 servings of fish in the typical U.S. restaurant. A 3-ounce serving is about the size of the palm of your hand or a deck of playing cards and is equivalent to approximately 85 grams. The typical chain restaurant in the U.S. serve 8-10 ounces of fish as an entre whereas higher end restaurants typically serve 6 ounces. Six ounces of fish is 170 grams and eight ounces is 227 grams. A crab cake is about 70 grams and a single fish stick about 25 grams and typically most Americans would eat a couple of crab cakes or 4-6 fish sticks in a meal. Therefore, most Americans could easily eat the amount of fish found to be associated with higher IQ children if they eat the typical U.S. serving of fish twice a week.

Due to concerns about mercury exposure the U.S. Food and Drug Administration (USFDA) and U.S. Environmental Protection Agency (US EPA) had previously jointly issued the following fish consumption recommendations for women who are of childbearing age, pregnant or lactating and young children.

1. Do not eat shark, swordfish, King mackerel, or tilefish.
2. They may eat up to two 6-ounce (170 grams) portions per week of fish and shellfish that are lower in mercury.
3. If they chose two meals of fish and shellfish in a week,
they may eat one meal of (canned) albacore tuna per week.
4. When eating local sport fish, check local advisories. If no advice is available and they are eating up to 6 ounces (170 grams) a week of locally caught sport fish then they should not consume any other fish that week.

These recommendations may be in question. It is accepted that it is safe to eat up to 12 ounces of fish known to be low in mercury like shrimp, salmon, canned light tuna and catfish during pregnancy. However, it is generally advised that albacore tuna should be limited to no more than 6 ounces a week during pregnancy because of concerns about higher levels of mercury. Dr. Gary Meyers in an editorial in the same issue of the Lancet suggests that there is little science to support the FDA’s recommendation that seafood should be limited during pregnancy.

Since in the U.S., we have the government to thank for a food pyramid that promotes large amounts of grain in the diet that is clearly toxic to millions of people, it should be no surprise that their recommendation against eating fish during pregnancy may be contradictory to promoting healthy brains in babies. Eating a couple of servings of fish a week or taking daily fish oil capsules has numerous health advantages. We will explore this further in a future issue of the Food Doc Journal. However, for now, this new study indicates that the benefit to the IQ of babies from eating fish may outweigh any concerns about mercury poisoning. So eat some brain food. Eat fish and seafood several times a week. If you don't care for it then take fish oil capsules.

Copyright © 2007, The Food Doc, LLC, All Rights Reserved.
www.thefooddoc.com
Reference: Hibbeln, J. The Lancet, Feb. 17, 2007; vol 369: pp 578-585

Colitis and Irritable Bowel Syndrome Explained Based on Presence or Absence of Inflammation

In reflecting on how I can help empower people to understand what is going on in their bodies, make changes to achieve better health and be more effective advocates for themselves when dealing with doctors I realized I may need to define some terms more clearly. So, this post will briefly introduce the definition of inflammation and how its presence or absence separates colitis from irritable bowel syndrome (IBS. However, these distinctions may not be valid on the ultra structural level or in the role of food proteins and altered gut bacteria and yeast in causation.

Colitis defined: Colitis is inflammation of the colon, also known as the large bowel or large intestine. Colitis can be acute or chronic. There are known causes of colitis and some forms of chronic forms of colitis that are of unknown cause. Colitis can be visually recognizable during scope examination of the colon or may be only found under biopsy examination of the lining or microscopic colitis.

Inflammation defined: Inflammation is the body’s response to infection and or injury. At times the body suspects it is under attack and responds by triggering the movement of infection fighting white blood cells to release antibodies and chemicals. These are intended to fight infection but can result in irritation or self-injury of the body. Inflammation of a body area is labeled by adding the suffix “-itis” to the body part. Therefore appendicitis is an inflamed appendix. Recognized since ancient times, inflammation has been classically described by the presence of signs and symptoms of redness (rubor), pain (dolor), heat (calor), swelling (tumor) and impairment of the function of the involved organ or tissue. If you have arthritis, joint inflammation, the joint is red, swollen, painful, warm and doesn’t want to function.

The difference between Irritable bowel syndrome (IBS) and colitis explained: By definition IBS has no colon inflammation and therefore there is no redness, swelling or ulceration of the colon lining. As a result IBS does not result in bloody diarrhea, microscopic blood or white blood cells (pus cells) in the stool though mucus may appear in the stool. This is the origin of an old fashioned term for IBS, mucus colitis, that is an inaccurate label, and should be avoided. The presence of significant pain and abdominal cramps in IBS also is the origin of the old term spastic colitis that similarly is inaccurate and avoided. Biopsies of colon tissue in irritable bowel syndrome are normal and do not show signs of inflammation therefore it is not considered an inflammatory bowel disorder.

New studies indicating IBS may involve intestinal inflammation, leaky gut and altered gut microbes: There are newer studies however that indicate IBS may be linked to ultra structural defects in the tight junctions of the intestinal lining cells affecting permeability as well as altered bowel microorganisms or gut flora (bacteria and yeast). Hopefully, this information will help my readers. I encourage you to read more on my website www.theFoodDoc.com and my online articles as well review my earlier posts on the Food Doc Journal.

Copyright © 2007, The Food Doc, LLC, All Rights Reserved.
www.thefooddoc.com

Microscopic colitis may be misdiagnosed as diarrhea predominant irritable bowel syndrome if colonoscopy and intestinal biopsies are not done.

Just published from the Mayo Clinic is a study that indicates that there is a significant overlap of the symptoms of IBS and microscopic colitis. In a group of biopsy proven microscopic colitis patients, the authors noted that approximately half had symptoms that would have met diagnostic criteria for irritable bowel syndrome. Symptom-based criteria for diagnosing IBS are not specific enough to rule out microscopic colitis.

They state “patients with suspected diarrhea predominant irritable bowel syndrome should undergo biopsies of the colon to investigate further for possible microscopic colitis if symptoms are not well controlled by antidiarrheal therapy.” The diagnosis is made by intraepithelial lymphocytosis only seen under the microscope when the colon on the surface looks normal. Many doctors don't biopsy the colon when it looks normal despite the patient having a history of diarrhea. Microscopic colitis is a known treatable cause of such symptoms that can only be diagnosed by colon biopsies.

I suggest that the diagnosis of IBS based solely on symptoms without diagnostic testing is inadequate. Without blood tests and intestinal biopsies, Celiac disease, Crohn’s disease and various forms of colitis including microscopic colitis are frequently missed. I believe anyone undergoing colonoscopy or upper endoscopy with symptoms, especially diarrhea, bloating, gas or abdominal pain, should have multiple intestinal biopsies. Inflammation that is the cause of these symptoms is often only seen microscopically.

The earliest intestinal biopsy findings of Celiac disease and microscopic colitis is increased number of lymphocytes per 100 epithelial (intestinal lining) cells. In the colon intraepithelial lymphocytosis is considered diagnostic for microscopic colitis if 20 or more lymphocytes per 100 epithelial cells are found. Interestingly the criteria for abnormal intraepithelial lymphocytosis in Celiac disease has more recently been reduced from 40 IELs per 100 utilized for nearly thirty years to 30 per 100. Even more recent studies have indicated that this should be reduced further to 20-25 per 100 because it is noted that early gluten injury occurs with lower levels of lymphocytes in the intestinal lining and is associated with a favorable response to gluten free diet. Microscopic colitis frequently responds favorably to a gluten-free diet.

Numerous patients have come to me with a diagnosis of IBS for years who I have confirmed to have Celiac disease, microscopic colitis or non-celiac gluten sensitivity. These patients typically respond dramatically to a gluten free diet even in the absence of a diagnosis of Celiac disease. Several of my patients have both Celiac disease and a form of microscopic colitis such as lymphocytic or collagenous colitis.

These patients often have experienced years of unnecessary suffering and many have already developed preventable secondary complications such as osteoporosis, infertility, iron deficiency or autoimmune diseases. Most have lived for years under false conclusion that they had IBS. They are often frustrated that they had been told there was little to nothing that could be done besides taking antidiarrhea and antispasm medications along with a high fiber diet and fiber supplementation. Yet, most noted that they were worse with increase fiber and had complained to their doctors that such agents seem to cause more severe bloating, gas, diarrhea and abdominal pain. Little did they know that increase gluten was making them worse. Don't accept a diagnosis of IBS without adequate diagnostic testing or consideration of a trial of gluten free diet.

Reference:
Symptomatic overlap between irritable bowel syndrome and microscopic colitis. Limsui et al. Inflamm Bowel Dis Feb 2007;13(2)175-181.

Copyright © 2007, The Food Doc, LLC, All Rights Reserved.
www.thefooddoc.com

Gluten causes brain dysfunction and gluten free diet may be for everyone with neurological and psychiatric symptoms

Brain dysfunction may be only sign of gluten related disease. Dr. Mario Hadjivassiliou recently reported at the International Celiac Symposium that his neurology clinic has followed over 300 patients with gluten sensitivity presenting with various symptoms. The most common neurological sign is ataxia, a condition of impaired balance. It was present in almost half. About 60% of patients with gluten ataxia have shrinkage of the cerebellum portion of their brain. They also may have irreversible loss of brain Purkinje cells. MRI scans of the brain often reveal bright white spots in this area.

Gluten causes 34% of all unexplained sporadic axonal neuropathies. Gluten sensitive enteropathy is 10 times more common in these people. I recently treated a woman who had years of a known diagnosis of such a neuropathy though she had never been tested for celiac disease. She came to me after I diagnosed her daughter’s celiac disease. Though she does not meet strict criteria for celiac disease she has the major gene for celiac and has elevated gliadin antibodies in her stool and blood. Increased intraepithelial lymphocytes were seen on duodenal biopsy but not sufficient to confirm celiac disease. Yet she is improved on a gluten free diet. Dr. Hadjivassiliou has confirmed to me personally by b e-mail that these neuropathies will get worse with continued gluten ingestion but most improve with gluten free diet though it may take several years to do so. If long standing, the symptoms may never completely reverse.

This makes it very important not to delay considering gluten as a cause of neurological symptoms nor delay diagnostic testing or institution of a gluten free diet. In my opinion a gluten free diet trial should be offered or considered for all neurological and psychiatric symptoms. However, I encourage anyone considering such a diet to first undergo adequate testing for celiac disease because once a gluten-free diet is initiated the tests may be falsely negative, even within 2-3 weeks of the diet. Even if the tests are negative for celiac sprue a gluten free diet is suggested.

For those of you following the Food Doc Journal or have written me recently please accept my apology for the delay in a new post and answering e-mails. While seeing patients in my busy practice I was working on my annual presentation to the local Pikes Peak Chapter of the Celiac Sprue Association this week and a new booklet I am preparing to publish on Celiac and Gluten Sensitivity. I have also been working on the launch of the premier version of my educational website www.thefooddoc.com. Thank you for your continued interest as we journey together looking for the links between food, bacteria, yeast and the gut. Sincerely, Dr. Scot Lewey, the Food Doc.

References
J. Neurol. Neuropsychiatry 2006;77:1262-6
J. Neurol. Neuropsychiatry 2003;74:1121-4
Brain 2003;126:685-9
Muscle Nerve 2006;34:762-6

Copyright © 2007, The Food Doc, LLC, All Rights Reserved.
www.thefooddoc.com

Gluten associated SPECT brain imaging abnormalities in frontal area of brain reverse with gluten free diet

Though reports of functional brain scans or SPECT imaging in celiac disease are limited there are some very interesting findings. The most dramatic is the report in 1997 of a patient with established schizophrenia who was newly diagnosed with celiac disease as confirmed by a positive endomysial antibody blood test and villous atrophy on intestinal biopsy. Before starting a gluten-free diet he had an abnormal SPECT scan showing decreased blood flow to the frontal lobe of the brain. On a gluten-free diet his schizophrenia and celiac disease symptoms resolved and both the intestinal biopsy and brain scan normalized.

More recently in 2004, Usai et al., reported that 70% of 34 celiac disease patients had abnormal SPECT scans showing the most pronounced abnormalities in the frontal areas of the brain that are less severe on a gluten free diet. Disturbances of the frontal area of the brain are associated ADD, anxiety, depression, Bipolar disorder, drug and alcohol addiction, and schizophrenia, all of which have been associated with celiac disease.

SPECT, or single photon emission computerized tomography, is a combined nuclear medicine CAT scan of the head performed by injecting a radioisotope taken up by the brain according to blood flow and metabolism. The scan produced is a color-coded 3-D representation of functional brain activity. Daniel Amen MD, an expert on SPECT brain imaging, provides a free online brain system quiz that can partly predict what part of the brain may be affected (www.amenclinic.com). His very detailed and well-researched nutritional recommendations for brain health are also helpful. After recently corresponding with him I am hopeful that further research into the association of SPECT abnormalities gluten may result from our collaboration as we continue to explore the gut-brain connection.

References:
Schizophrenic symptoms and SPECT abnormalities in a coeliac patient: Regression after a gluten-free diet. De Santis A J Intern Med. 1997; 242(5): 421-3

Frontal cortical perfusion abnormalities related to gluten intake and associated autoimmune disease in adult coeliac disease: 99mTc-ECD brain SPECT study. Usai P et al. Dig Liver Dis. 2004; 36(8): 513-8

Images of Human Behavior: A Brain SPECT Atlas. Daniel G. Amen, MD 2004. Mindworks Press. Newport Beach, CA.

Making a Good Brain Great. Daniel G. Amen, MD
2005. Harmony Books. New York.

Copyright © 2007, The Food Doc, LLC, All Rights Reserved. www.thefooddoc.com

Probiotic VSL#3 breaks down toxic protein gliadin that causes celiac disease and non-celiac gluten sensitivity

The probiotic VSL#3 breaks down gliadin, the toxic protein produced from gluten. VSL#3 hydrolyzes gliadin peptides according to De Angelis et al. ("VSL#3 probiotic preparation has the capacity to hydrolyze gliadin polypeptides responsible for Celiac Sprue" in Biochim Biophys Acta. 2006; 1762(1): 80-93). They observed almost complete breakdown of gliadin during prolonged fermentation in bread dough. The ability to decrease the toxicity of wheat flour is a giant step forward.


VSL#3 (www.vsl3.com), a commercially available probiotic, has previously been shown effective in digestive conditions such as Crohn’s disease, IBS, antibiotic associated diarrhea. Probiotics are known to decrease gut permeability. This study confirmed proteins extracted from dough pre-treated with VSL#3 released less zonulin, the protein that controls tight junctions between intestinal lining cells. Zonulin is believed to be important in the development of celiac disease. It increases permeability of leaky gut that predisposes to celiac and non-celiac gluten toxicity. Less F-actin reorganization within the cells also was noted. F-actin controls intestinal permeability.

Exposure of protein products from dough pre-treated with VSL#3 did not show increased CD3+ intraepithelial lymphocytes (IELs) compared to non-treated dough. Increased IELs is a hallmark of celiac disease and the earliest sign of gluten toxicity to intestinal cells. The authors conclude that the ability of the probiotic VSL#3 to break down gliadin “may have an importance during food processing to produce pre-digested and tolerated gliadin for increasing the palatability of gluten-free products” Can this probiotic protect against the onset of celiac disease? Will taking it speed up the healing of celiac and reduce symptoms by reducing leaky gut? Theoretically, it seems it may be protective measure against inadvertent low levels of hidden gluten exposure.

Copyright © 2007, The Food Doc, LLC, All Rights Reserved.
www.thefooddoc.com