Celiac Disease and GF: What is it?

You may have noticed a new section cropping up on menus in restaurants these days- the gluten-free choices. What's up with that? Celiac disease. This disease is very common in the United States, affecting 1 in 133 people. In people with this disease, eating gluten (the wheat protein) causes an auto-immune reaction that damages the small intestine, causing poor absorption of food and nutrients.

What symptoms show up? Diarrhea is the classic symptom, but it turns out there are probably more cases of celiac disease without diarrhea. The symptoms are often rather nonspecific: fatigue, irritable bowel, anemia, vitamin deficiencies, and osteoporosis. There is, though, one symptom that is 85% specific for celiac disease-a rash called dermatitis herpetiformis, DH for short. This rash has nothing to do with herpes, however (nope, no STD talk in this topic!) This rash is intensely itchy, symmetrical eruption on the face, buttocks, elbows and knees.

The good news is that celiac disease can usually be treated with dietary changes alone-no medications required! The bad news is that gluten is found in many products beyond the obvious wheat breads and cereals, so to completely avoid gluten requires significant effort and education. Stay tuned this week for more about Celiac disease diagnosis and diet.

BOTTOM LINE: Problem: Celiac disease, a very common challenge. Answer: Gluten-free diet.

The Sunshine Vitamin

Do you remember which vitamin we get from the sun? It's Vitamin D, and it is front and center in the news these days. We used to think that Vitamin D deficiency only existed in the geographical areas where there was less sunshine- think Seattle or or the Northeastern states in the winter. I was taught that a mere fifteen minutes per day of sun exposure to your face and arms would do the trick to supply your daily needs of the sunshine vitamin.
Surprisingly, in the past several years, studies have consistently shown that Vitamin D deficiency is widespread in the United States, even in the Sun Belt! In fact, I have been screening my adult patients in sun-filled Austin, Texas, for the last year, and I have found that only one out of ten patients have NOT been deficient!
What are the symptoms of Vitamin D deficiency? Many people know that Vitamin D is linked to bone health, and deficiency puts you at greater risk of fractures. However, there are many other potential symptoms of Vitamin D deficiency that may be subtle, can including fatigue, low energy, decreased immunity, depression, muscle weakness, cramps or altered sensation.
If it's not enough incentive to know your Vitamin D level to avoid those symptoms, consider this: recent studies show that having good levels of Vitamin D correlates with lower levels of colon, breast and prostate levels.
If your level is super low, you will need a prescription dose of Vit D replacement for a few months (50,000IU tablet once per week), but many people simply need to take an over the counter dose of 2000 IU per day.
BOTTOM LINE: Talk with your doctor about checking your vitamin D level (ask for "25 OH Vitamin D" level) and get some sunshine in your life!

Too Tired to see the Doctor?

Should you bother going to the doctor when your only complaint is "I'm tired"? Well, truthfully, it depends. If there is an obvious explanation- having a newborn and getting no sleep, starting back to school while working two jobs (and getting no sleep), having a teenager learning to drive (and getting no sleep)- see the trend? However, if you have not changed your diet or sleep patterns significantly and you find yourself sleepy or fatigued all the time, then YES, DEFINITELY go see your doctor!
What could it be? Anemia (low red blood cell count), thyroid disease, diabetes, infections (especially chronic viral ones such as mono or hepatitis), fibromyalgia (and other rheumatic diseases) and vitamin deficiencies are the most common causes that I see. Certainly there are other more serious causes such as cancers, kidney or heart failure, or neurologic disease, to name a few, but my point here is that there are many causes of fatigue that can be improved or cured IF you are looking for them!
BOTTOM LINE: Don't be "TOO TIRED" to go to the doctor and find out what might be causing your fatigue!

Time to decaffeinate?

How much caffeine is too much? Most of my patients would laugh and tell you I think any caffeine is too much, because I have asked so many of them to give it up (and, for the record, had very positive feedback from those who have!) In reality, though, here is my standard answer. Do you have headaches, insomnia, heartburn or fatigue? If you have any of those, I would advise you to completely decaffeinate, because caffeine aggravates all these problems. Yes, I understand that you drink your coffee because you are tired and need the "pick-me-up", but all that you are doing is perpetuating the cycle. The more caffeine, the worse quality of sleep, and the more tired you get.
So how do you wean? Many people get intense headaches if they abruptly quit caffeine. (Here's a hint- if you do get caffeine withdrawal headaches, this should be a clue you're consuming "too much" for you!) Start mixing your coffee with roughly a third decaf, then several days later go to half decaf/half regular, and then several days after that drop down to 1/3 caffeinated. By day 10, you should be fully decaffeinated without getting a headache. I have found that after a couple weeks of NO caffeine, most people begin to have more energy.
BOTTOM LINE: If you have no trouble falling asleep, wake up rested and energetic, and never have heartburn- enjoy your Starbucks guilt-free! BUT...if you have any of those issues, it's time to DE-caffeinate!