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Weighty Matters: Physical and Psychological Impact: Celiac Disease and Gluten Intolerance

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In Part 1, I told you how I was a cheater when it came to implementing the gluten free diet. Today, we’ll go over some mechanisms behind why we see weight gain and weight loss with celiac disease.

Physical and psychological causes

There are 2 categories to take a look at-the physical, and the psychological. Both have impact on weight management-the psychological is just as powerful as the physiological. We’ll look at issues in both categories. In parts 3 and 4 we’ll cover steps you can take to positively impact your weight and health.

First, the physical.

Physical reasons behind weight loss and celiac disease/gluten intolerance:

  • With celiac disease (gluten sensitive enteropathy), there is damage done to the villi in the small intestine. The damage limits the ability of the intestine to absorb nutrients. With limited absorption, less overall calories and also less vitamins, minerals, etc. Many times a person may feel so sick that they just can’t eat enough to make up for the poor absorption. Worse, they may be eating more of the foods that are actually making them sick without realizing it.
  • People can feel so unwell when they eat they just eat less. Less often, and less in amount. Decreased calories.

Physical reasons behind weight gain and celiac disease/gluten intolerance:

  • Decreased absorption of nutrients can contribute to people never feeling “full.”
    They eat more, in frequency and/or amount. Eventually the calories get absorbed, and it catches up. After diagnosis, there may also be a small overcompensation effect of the gut to absorb nutrition.
  • When your gut begins to heal and absorb nutrients, you may find that you gain weight.
    The nutrition and calories that was just going thru you before in now being assimilated into your body. This is a good thing from a health standpoint. If you listened to part 3 of the podcast with Shelly Stuart she mentioned how she gained a bunch of weight after her gut began to heal. She had been accustomed to eating large amounts of food because it wasn’t being absorbed. When absorption increased, so did her weight. So she recognized that and scaled back on portions, focusing on quality and nutritionally dense foods. The upshot here-you may have been eating more food than you actually needed before, but some of it was going straight into the toilet. How’s that for a visual?
  • The damage and affects of celiac disease may impact the hormones in our gut that control appetite and satiety (the sense of being full.)
2 main hormones are leptin and ghrelin.

Quick definitions per Medical Dictionary.com:

Leptin:
hormone indicating degree of hunger: a hormone produced by fat cells that indicates the degree of hunger to the hypothalamus of the brain. (Tells you when you feel full and stop eating. Problems with leptin can lead to eating too much because “I’m full” doesn’t kick on.) Leptin resistance also appears to be a problem, as many obese indivduals have high levels of leptin, but are not recognizing the full sensation.

Ghrelin:
a gastrointestinal hormone produced by epithelial cells lining the fundus of the stomach; appears to be a stimulant for appetite and feeding.

A study done in 2005 in Italy using classic symptom female celiac patients (the underweight/malnourished classic) showed decreased ghrelin levels after 2 years of being on a gluten free diet, even though their body mass and fat mass had increased.

Another study completed on children with celiac disease showed leptin levels lower than non-celiac children, which then increased after one year on a gluten free diet.

A study in 2003 showed high levels of circulating ghrelin levels in adults with active untreated celiac disease, and normal levels of ghrelin in those who had been treated with a gluten free diet.

So why does this all matter?

We still don’t know, to be honest. This is an example of how our gut affects our hormones, and especially that as someone who has been newly diagnosed with celiac disease or gluten intolerance, you may feel especially hungry. There’s much more research to be done, and I’ve only begun to scratch the surface of what has already been done. But the take home is that our hormones dealing with hunger and the sense of fullness may be affected, and so may not be too accurate when it comes to saying we’ve had enough to eat.

The psychological

Which brings me to the psychological impact of celiac disease/gluten intolerance on weight:

  • After diagnosis there is an immediate reaction of “What can I eat?”
    The gluten free diet can feel overwhelming, with the huge lists of ingredients to avoid. First instinct may be to gravitate toward comfort foods labeled “gluten free,” and the attempt to replicate a “normal” carb based diet with their gluten free substitutes. Unfortunately, this can lead to weight gain. Many gluten free substitutes of ordinarily gluten foods have a higher number of calories. Many times this is due to the need to add additional fats to get a decent “mouth feel” in the product. With the proliferation of gluten free foods in the marketplace (a great thing for choice) also comes an increased need to be aware of the nutritional content and value of what we eat-to look “beyond the gluten free label.” Just because it’s gluten free doesn’t mean it’s good to eat in large quantities.
  • There is also a sense of Thank Goodness I can eat without feeling sick!
    This can lead to eating an increased volume of food as well-just being so happy that you don’t feel sick any more, and taking advantage of that.

Couple that with the fact that our innate mechanism of knowing when to stop eating because we feel full may be affected (we don’t know this for sure yet) because of some hormonal wackiness, and we’ve got some challenges.

In Parts 3 and 4 we’re going to look at steps you can take to impact your weight in a positive way, whether it’s a need to gain, or a need to lose.

If you have questions/comments/experiences, please leave them below. I like to hear from you-don’t be shy!

Probiotics and Gut Health: Say Hello to My Little Friend

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Probiotics. A popular word for sure right now. Looking around in the grocery store it seems like the healthy bacteria are being added to everything from yogurt to cottage cheese to coffee. (Kidding about that last one. Although given how much I love coffee, I’m not opposed to the idea.)

Probiotics by definition

Probiotic: A microbe that protects its host and prevents disease.

Probiotics are found naturally in the gut (stomach/intestines.) With antibiotic use, and sometimes with dysfunction of the gut (such as celiac disease) the balance of this “good bacteria” can be disrupted, and cause intestinal distress such as diarrhea. These little suckers can be a bit fragile, and not all of them can be ingested orally (eaten/swallowed) and survive into the digestive tract.

Different strains

There are many different strains of probiotics. If you think about antibiotics, there are lots of different prescriptions that we have seen or heard of over the years, right? Similarly, there are a number of different probiotics. Thousands, in fact.

However, there are only a handful of these thousand that have been researched upon and shown to be effective. Within the handful of effective ones, they may only be effective for certain conditions. So just ingesting a product with “probiotics” doesn’t necessarily give you any benefit. It depends on why you are taking them, and the strain of bacteria that is in the product. Unfortunately, the labeling for these products is often unclear.

Lactobacillus acidophilus

Lactobacillus acidophilus is a common probiotic. According to MayoClinic.com:

Lactobacillus acidophilus is generally considered to be beneficial because it produces vitamin K, lactase, and anti-microbial substances such as acidolin, acidolphilin, lactocidin, and bacteriocin. Multiple human trials report benefits of L. acidophilus for bacterial vaginosis. Other medicinal uses of L. acidophilus are not sufficiently studied to form clear conclusions.

It’s normally found in yogurt, and in lactose reduced milk. (Lactaid brand ’round these parts.)

Bifidobacteria

Another probiotic group known as Bifidobacteria (one of these strains is the one in the Activia yogurt-long live Jamie Curtis and her healthy bowels.) One of the methods of action is to slow the transit time of material through the intestines-again, reducing diarrhea.

The strain in Activia was produced specifically by Dannon and is known as Bifidus Regularis. As an aside, Dannon settled a class action lawsuit late in 2009 and has since altered the label claims.

Another strain of Bifidobacterium is bifidus infantis. This is the probiotic found in the product Align. Align is gluten free.

The Bifidobacterium probiotic strain appears to have real promise for those with intestinal disorders, including celiac disease and IBS.

Bifidobacterium appears to reduce the permeability of the intestinal walls in response to gliadin. This is especially of interest to those of us with celiac disease as the probiotic can help reduce gliadin’s (protein in gluten) damage to the intestines.

Recommendations were made at the Yale University Workshop in 2008 by a panel of 12 regarding the use of probiotics. Unfortunately, this paper is not available for free access (like so many I want to see,) but a summary from the NY Times stated:

A panel of 12 experts concluded that there was strong evidence that several probiotic strains could reduce diarrhea, including that associated with antibiotic use. Several studies have also suggested that certain probiotics may be useful for irritable bowel syndrome, with the strongest recommendation for Bifidobacterium infantis 35624, the probiotic in the Procter & Gamble supplement Align. (Two members of the panel had ties to Procter & Gamble; three others had ties to other companies that sell probiotics.)

Important to note that there is financial benefit there. That doesn’t mean their opinion should be discounted, it’s just something to be aware of.

Of course, if you have any questions, please contact your physician before starting probiotic use. They are GRAS (generally recognized as safe) by the FDA, but individuals with immunodeficiency or active bowel infection are not recommended to use probiotics.

Align was kind enough to send me samples to try, and a month’s supply for one lucky reader! I used Align for a month, and can say I did not notice a difference. However, I am not a fair subject as I was already taking another brand of probiotic. Align also offers a money back guarantee if you are dissatisfied after trying it. That’s pretty impressive.

Align can be found pretty much anywhere-I saw it at Target and Publix.

If you’d like to win a free month supply of Align, leave a comment below and tell me what your biggest obstacle is to eating healthfully (if you have one), and/or your experience with probiotics. Winner will be randomly selected.

You can get another chance in the virtual hat if you re-tweet this post for my Twitter buddies.


Additional references:

Gluten Free “Diet” vs. Gluten free Lifestyle

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Living gluten free has received quite a bit of mainstream press lately. The Dr. Oz feature of course comes to mind, and there was a 12 page special report in USA today in November, and numerous other articles in publications including the NY Times.

With the rising awareness of a gluten free “diet” comes increased numbers of people trying the “diet.” Here’s the reason I am adding quotations every time I use the word diet here. There’s a method to the madness, I promise.

“Diet” as per Dictionary.com has several different meanings and uses. It can be used as a noun, a verb, or an adjective:

  1. Food and drink considered in terms of its qualities, composition, and its effects on health
  2. A particular selection of food, esp. as designed or prescribed to improve a person’s physical condition or to prevent or treat a disease
  3. Such a selection or a limitation on the amount a person eats for reducing weight
  4. To select or limit the food one eats to improve one’s physical condition or to lose weight

This is only a small selection of the 10 potential meanings.

Gluten free and weight loss?

You can see how this one little word has multiple conotations associated with it. Most people associate the word “diet” with the 3rd definition, from my experience. A lifestyle approach to diet would be definition #1. With the media exposure of the gluten free diet, there are some who are associating the gluten free diet with a weight loss diet.

Not so fast, buttercup. This is not necessarily the case. Any method of eating can be a weight/fat loss diet. It depends on activity level, what you eat, but most importantly how much you eat. Can you gain weight on a gluten free diet? Hells yeah. You can lose it too. You can gain/lose weight eating anything. The laws of thermodynamics do not change.

Popular diets

Let’s take a very quick and admittedly non-complete look at some popular “diets.”

  • Atkins: Taken in it’s purest form, the idea of eating meats and vegetables, and fats only. Excludes a complete food group.
  • South Beach: A balanced diet including all food groups eventually, but in their whole forms.

At their inception, people by and large did quite well using these methods of eating, provided their daily caloric intake was less than their daily expenditure. Then, there was the advent of the Atkins bars, and pancakes, and the South Beach cereal, and more bars, etc and so on. These foods made it easier for people to consume more calories. It’s much easier and quicker to eat several to many hundred calories worth of a nutrition bar than of chicken and broccoli. The satiety (fullness) factor is less, so more is eaten. And guess what? No more fat/weight loss.

The gluten free “diet” in it’s purest form is a very healthful diet, and can certainly aid in controlling calorie intake.

Peter Bronski just did a blog post (here is his Gluten Free Athlete profile) on a brochure he found at his local market.

Check this out:

  • Eat more non-processed foods.
  • Eat an abundance of fresh vegetables and fruit.
  • Eat a serving of beans or legumes and nuts daily.
  • Eat fish twice a week, especially wild salmon.
  • Pay attention to your calcium and vitamin D intake to maintain healthy bones.
  • Choose lean poultry and meats as well as low-fat dairy products.
  • Balance the food that you eat with daily physical activity.

Sounds like an awfully nutritious way to live to me.

Getting into trouble

Where we can get into trouble is just like in any other “diet.” The gluten free cookies, candies, cereals-these are items where it is very easy to overeat calorie wise.

So when people ask me if they can lose weight on a gluten free diet, the answer is yes. It’s not rocket surgery. You can lose weight eating Burger King if you keep your calories where they need to be. (I DO NOT recommend that-it’s just an illustration.)

Does this mean that everyone should go on a gluten free diet?

Heck no. For those with celiac disease and gluten intolerance, living gluten free is not an option, it’s a necessity. And you can choose to eat gluten free in whatever manner you wish. For those with celiac disease and gluten intolerance, this is not just a “diet.”

It’s a lifestyle, and a medical necessity. It’s a way of life and a way of living. It’s extremely important that manufacturers and restaurants understand the medical implications of the gluten free distinction and follow good practices, not just jump on the gluten free bandwagon.

There are those have not been diagnosed with gluten intolerance or celiac disease who choose to live gluten free. They may be part of the many who are undiagnosed. It may be a personal decision. Honestly, the description provided by the brochure above would be a beneficial way for most people to eat.

Bottom line-there is no “magic” in a gluten free diet. If by going gluten free you cut out processed carbs, then by default your calorie intake may drop, which will cause weight loss if your activity stays the same. It’s not magic. It’s math.

What are your thoughts? Have you experienced people asking you about a gluten free diet? Speak your mind in the comments below!