Celiac simplified: the Gastroenteroligist’s perspective

In an effort to continue to provide you with rants, reviews, recipes and relevant information, I sat down with a physician to get their perspective on Celiac disease and the gluten-free diet.

Talia Zenlea, an Internist and Gastroenterologist, and I met on Twitter.

After reading her bio, I knew that she was the perfect person to chime in on the medical facts and feelings surrounding treating patients with Celiac.

Talia Zenlea, MD is the founder of bellyblog.ca. She completed her medical training at University of Vermont, residency in internal medicine at Yale-New Haven Hospital, and gastroenterology fellowship at Harvard/BIDMC. She currently practices gastroenterology in Toronto. She has her hands full as the mother of 3 rambunctious boys and a well-behaved Labradoodle. She is committed to empowering women to take charge of their own health and well being.

Talia Zenlea, MD is the founder of bellyblog.ca. She completed her medical training at University of Vermont, residency in internal medicine at Yale-New Haven Hospital, and gastroenterology fellowship at Harvard/BIDMC. She currently practices gastroenterology in Toronto. She is committed to empowering women to take charge of their own health and well being.

Q: What inspired you to become a doctor? Was there any moment or event that drew you to Gastro work?

A: When I was in high school and undergrad, I did a lot of volunteer work in the mental health and addictions fields, so I first went to medical school to become a psychiatrist.

Though I loved psychiatry, I also loved surgery and internal medicine. There wasn’t a specific “ah ha!” moment for me, but gastroenterology was a really good fit because I like the emphasis on preventative care (I do a lot of colon cancer screening and prevention), and I like helping people understand and appreciate the interplay between their symptoms, the foods they eat, and the world around them.

Q: That’s great! What’s your favorite thing about your job?

A: The best part of my job is getting to meet people from all walks of life, and understanding how their unique circumstances have shaped them. It’s my job to understand where they are coming from and how I can help them “make it work” in a way that’s in keeping with their beliefs and individual goals.

Q: I love that philosophy. So, of your patient base, how many have Celiac?

A: A lot! And a lot have non-Celiac gluten sensitivity.

Q: That’s actually what my doctor thinks I have, but I beg to differ. For those readers who are still unclear on what Celiac really means, will you break it down for us?

A: Sure! Unlike gluten-sensitivity, Celiac disease is an inherited, autoimmune disease characterized by inflammation of the small intestine, triggered by consumption of gluten.

By inherited, I mean that people do not get Celiac because of their lifestyle choices or health habits- they carry a gene that made them susceptible.

The autoimmune part means that in people with Celiac, consuming gluten triggers a response where their bodies “wage war” upon the small intestine. This attack damages the parts of the small bowel that are necessary for absorption of certain nutrients.

Q: It’s so fascinating to me that different people can have such different reactions when eating the same foods. My boyfriend eats bagels on the regular yet when I eat even a french fry (with a tiny bit of flour,) I definitely experience that wage war you’re referring to. 

A: Definitely! The autoimmune attack damages the parts of the small bowel that are necessary for absorption of certain nutrients. This is why people with celiac can sometimes have very low vitamin levels, or low blood counts. Because the autoimmune-mediated inflammation is triggered by gluten.

The good news is that for most people, stopping any exposure to gluten also stops the attack, and the bowel can usually heal itself.

Q: Yeah, my doctor says that my bowel has healed itself through years of strictly following the gluten-free diet.

A: Exactly.

Q: What does untreated Celiac (or breaking the gluten-free diet) do to our body? Can you explain the short and long-term impact?

A: Without treatment, there’s ongoing attack on the small bowel. This can lead to impaired absorption of certain important vitamins and nutrients, which can lead to deficiencies in those things.

So, for example, low calcium or vitamin D can lead to low bone density (osteoporosis or osteopenia,) low levels of certain B vitamins can lead to numbness and tingling… You can also have symptoms like belly pain, abnormal bowel habits, headaches, skin rashes, even infertility!

There’s a small risk of a very serious small bowel cancer in people with uncontrolled celiac disease.

Q: Wow. It’s terrifying actually – especially for young women hoping to one day have a child. So what’s one piece of advice that you would give someone who is just starting to follow the gluten-free diet?

A: My advice is – stick with it, and do the best you can.

One of the best parts of my job is when I see someone who was in tears at the idea of giving up pizza or bread, but then comes back a month later with a huge smile saying they didn’t even realize how bad they felt before, until they stopped eating gluten, and now they feel like a whole new person.

Q: It’s amazing, right? So do you have any advice for someone who is a bit more seasoned? Someone like myself who has been following the diet for years? Are there any specific foods I should steer clear of, or vitamins I should be taking, to stay healthy?

A: I think something that even “seasoned” individuals sometimes don’t realize is that gluten can be found in things that aren’t even food – like vitamin supplements or even medications, as well as cosmetics like toothpaste, lipstick, body creams…

So, always read labels, and when it doubt, call the manufacturer!

As for vitamins, I sometimes recommend a gluten-free multivitamin, and supplemental vitamin D if levels are low. This is something you should discuss with your doctor first.

While I was horrified to realize that there could be gluten in creams and toothpaste, I was glad to learn that now as I am trying to make a switch to more natural, organic products.

Talia’s advice is definitely helping me to make adjustments as a consumer.

Want to learn more? I encourage you to join the conversation on Talia’s blog!

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