The warm and inviting Toté Bakery & Store -- much better than that which preceded it.

I was first diagnosed with anemia when I was twenty. I was trying to donate blood and win tickets to a Heart concert in 1984 at the tender age of 20. I'd organized the blood drives in high school and had donated at least three times prior, so I didn't expect there to be any problem. The blood drive lady sent me away and I didn't have the nerve to ask for a chance to win the Heart tickets anyway. (No worries, I've seen them, like, four times all together.) On the way back to Stillwater from Oklahoma City, my back really started hurting. In true college student fashion, I decided to deal with it when I got home by splitting a pizza and drinking beer with my roommates. The pain increased, and long story short, I went to the hospital and it turns out I had a kidney stone. To make an even longer story shorter, I ended up being hospitalized for a week because they didn't want to remove the kidney stone which wouldn't pass without ruling out leukemia as the cause of my anemia. One good thing about the bone marrow biopsy was that it really took my mind off of the discomfort of the kidney stone, at least for the 42 seconds of excruciating pain it caused. Fortunately I didn't have cancer, they gave me an iron infusion, surgically removed the kidney stone and sent me home with instructions about all kinds of crazy things to not eat to avoid another stone. And oh yeah, take some iron.

The anemia never really went away. Every new doctor, every physical exam, the answer was, oh yeah, and take some iron. It was when I switched to a terrific young female doctor that something changed. She said, after I had taken my iron faithfully for months, "You know, something's not right here and we need to get it figured out." She sent me to a hematologist, who connected my anemia to a recent bout of GI distress. It was he who first suggested that I might have celiac disease. Blood tests and one endoscopy and biopsy later and the celiac suspicion was confirmed. I've been on the gluten free diet for more than 18 months and I feel better in many ways, but inexplicably my anemia persists.

In the 28 years I've gotten used to being blamed for my anemia. Of course I was anemic when I was 20 -- I was a college student eating junk and drinking too much alcohol. Of course I was anemic through the 1990's and 2000's because I'm a vegetarian and what can I expect if I choose to not eat meat? Of course I'm anemic -- I'm a woman of reproductive age and I carelessly throw away copious amounts of blood every month. When I got the celiac diagnosis, I was both relieved to have an answer and infuriated that no one had suggested looking for a real cause until my new fabulous doctor and hematologist came along.

The gf diet has been life-changing, but so far it hasn't fixed my anemia. I've been going monthly for IV iron infusions, a two-hour treatment in a chemo ward with a nice view of Washington Square Park. I decided that this cannot be the long-term solution and that I don't want to spend any more years with a big medical shrug for an anwer regarding the cause of my anemia. The hematologist and I are certain my diet is sufficiently iron rich. So at my last appointment with my GI doc at the Celiac Center at Thomas Jefferson University Hospital, we decided to do another endoscopy (to see if I still have villious atrophy despite a strict gf diet) and a colonoscopy to see if there is some issue with my colon (I'd had a bout of colitis in 1987 -- at least that's what was diagnosed). Those procedures happened this morning, and I'll be happy to not go through that again, especially the prep, for another 10 years. Things looked good. I will call for biopsy results in a couple of weeks. Hopefully everything will come back normal. Which will leave me to continue to sleuth out the cause of my anemia. Or just continue to deal with it until menopause and see if it resolves then.

There were a couple of highlights to the day. One is that it is an absolutely gorgeous day out, and while I can't operate heavy machinery, I did get to operate a rake and a pitchfork in the garden. Another was that, though the experience is generally unpleasant, I have a loving spouse who rearranged her schedule to look after me and drive me around. And the third, a biggy, was a post-procedure side trip to  Toté Bakery & Store in the Italiam Market section of Philadelphia. Everyone should console themselves with gluten-free raisin challah warm from the oven after half a dozen medical professionals have colluded to drive a camera and other assorted equipment through the entire length of their alimentary canal after a day of no eating and an evening and night of -- ahem -- cleansing.

I went a little crazy at Toté. In addition to the challah, I got two other kinds of gf bread (quinoa and teff), an onion roll, a piece of gf carrot cake, a couple of nutrition snack bars, and a jar of their special hot sauce. I got Jenn a thank you cannoli. The nice lady who helped me assured me that the bread freezes well, which is good, since I don't really need to eat a bunch of refined carbs non-stop -- it would be contrary to my weight management strategy -- but having them on hand for the occasional treat will be nice. I spent nearly $40, which is twice as much as my co-pay.  I ate at least a third of the warm challah in the car on the way home. Worth every penny.

The Wall Street Journal ran this article a few days ago. It reports on a recently published medical opinion paper that posits that the medical community should acknowledge three levels of gluten issues: 1) Allergy, 2) autoimmune disorders like celiac disease, and 3) gluten sensitivity in which neither an allergy or autoimmune disorder is detected, but in which individuals who go on a gf diet show an improvement in symptoms. Many doctors these days don't take the claim of gluten sensitivity from their patients very seriously. In my own case, the GI doc who did my upper endoscopy and biopsy was skeptical of my (and my hematologist's) suspicious that I had celiac, even in light of my positive antibody tests (frankly, he was a moron and I don't think he read my file, but that's another story. I have a much better GI doc now.) Needless to say, I think it's really important for more doctors to take diet and nutrition into account when addressing physical and mental challenges presented by their patients. I'd go so far as to say that they should look at diet and nutrition FIRST.  I recently blogged about and attached a link to a TEDx Talks by Dr. Terry Wahls in which through diet (a paleo diet, which is devoid of grains) she makes a remarkable recovery from debilitating symptoms of MS. I recently read an article about a possible connection between gluten and ALS (aka Lou Gehrig's disease.) In my own life, I know people who have tested negative for allergies or celiac or who haven't been tested at all, but who have shown a complete abatement of symptoms when going gluten free.

Here's my friend Betty's story. She discovered that gluten was behind her persistent cough. (Betty's the president of Guardian Nurses -- truly you want GN in your corner if you are dealing with complicated or long-term health issues for yourself or a loved one.) Other people I know personally are benefiting from a GF diet without the benefit of a celiac or allergy diagnosis. A friend and co-worker who has persistent debilitating GI distress who tested negative for celiac feels fine when she adheres to a GF diet. The asthma of child of another co-worker and friend is much improved from following a GF diet. A dear relative of mine whose doctor was ill-equipped to pursue a definitive diagnosis cleared up many significant GI issues AND supported his fitness regimin by going gluten-free. One friend had Dermatitis Herpetiformis (a classic sign of celiac) but tested negative when biopsied, who has resolved her issues on the GF diet. How many people do you know that suffer from canker sores or rheumatoid arthritis or lupus or teeth enamel problems or fertility issues or a host of other problems who have no idea what the cause is and can't seem to get better?

I don't believe that all of our ills are caused by gluten. I do believe that as a society we regularly eat things that are either not healthy or which have been so genetically engineered over time as to make them unrecognizable as food to our systems, confusing our natural defense mechanisms and setting off a chain reaction within our bodies from which we get sick.

I strongly believe that each of us needs to take responsibility for our own health and well-being. I try to avoid preaching. I do believe that if a person gets a diagnosis that confirms that damage is being done to the body by eating gluten that they are more likely to adhere to a strict GF diet and improve not only their quality of life NOW but decreasing the likelihood of related more serious health issues later. But for those who haven't tested positive, don't buy it if your doctor says that gluten isn't the issue. Trust your intuition. Listen to your body. Keep looking for the answer. It's your life and you should feel as good as you possibly can to make the most of it.

It's both wonderful and frustrating to have so many things to want to blog about and not having a good stretch of time to write them all up. We are getting a dog -- our first since we've had kids -- this weekend, so I'm taking a few minutes to get one thing down and I may have to let the others percolate. Just know that I HAVE to HAVE to HAVE to write up my experience at Philadelphia Chutney Co -- So good!

But in the meantime, I've been thinking a lot about how I came to the decision to do my detox, which I continue to follow. The path leads back to two TED Talks presentations I watched over the past months.
 
The first was this one with Matt Cutts: Try Something New for 30 Days. The big takeaway? If you want something badly enough, you can do anything for 30 Days. It's shorrt -- 3:27. Watch it here:
http://www.ted.com/talks/matt_cutts_try_something_new_for_30_days.html

The other was this video by Dr. Terry Wahls. Longer, but really powerful:
http://www.youtube.com/watch?v=KLjgBLwH3Wc&sns=fb

She has MS and went from wheelchair-bound to complete mobility in a very short period of time through diet. Her recommended diet is not one that most people would be willing to try, but when the stakes are high enough and the will strong enough, we can do anything.  After watching both videos, what other conclusion could I draw than to do a detox for 30 days?

Which brings me back to the top of the entry in which I bemoan lack of time to share my bloggy wisdom and to put into this site and my gluten-free coaching endeavor the things I've decided to pursue. If I want anything badly enough, I can do anything for 30 days. Now time for me to start my next 30 days. It's going to come to pass whether I rise to the challenge or not.

As a follow-up to my Nutritional Yeast Exposé, I want to report that I've been enjoying it on Beans and Greens. And scrambled eggs. And scrambled eggs with Beans and Greens. Very adventurous, I know. But it's good like this. Go easy on the salt though, the nutritional yeast adds its own sort of salty quality.

And as an aside, take 17 minutes to watch this TedX presentation: http://www.youtube.com/watch?v=KLjgBLwH3Wc&sns=fb

A physician with MS has made great strides in her recovery from eating very nutrient-dense foods. B-vitamins feature heavily as a desired dietary component. Nutritional yeast has loads of B vitamins. Nuff said.

I have anemia. My primary phsyician sent me to a hematologist after I religiously took iron supplements for months with no improvement. It was my hematologist who put the various pieces together and tested for celiac disease. Turns out he was right.

Enter the gf diet as of September 2010. I feel better. I have more energy.Improved GI quality of life. No more canker sores. And yet, my anemia persists. Maybe the vast quantities of dark green leafy veggies aren't enough to keep up with demand. Maybe my heavy periods are to blame. My celiac antibody tests have come back normal, and all signs indicate that my gut has healed. For the time being, I'm going in monthly for the two-hour iron transfusion process. I'd rather this not be the long-term solution. I see my celiac doc next week, so I plan to explore it more then.

In the meantime, I recall that I have tested low on B12 and folate, which is completely understandable given my vegetarian and enriched bread-free life. While my anemia is of the iron deficiency type, I don't really know how it is distinguished from B12 deficiency anemia or folate deficiency anemia. These are clearly questions for my doctor. But, in the meantime, I figure it can't hurt me to try to boost my dietary sources of B vitamins and folate. Which brings me to the topic of nutritional yeast, which is rich in both plus tons of other good stuff. Seems like a virtual treasure trove of health all in a weird flakey substance.

The only way I knew how to use it is to sprinkle it on popcorn. A serving of the stuff is 3 TABLESPOONS. Since I eat popcorn maybe once every 6 weeks and I would practically have to bury it in nutritional yeast, I tried adding it to my usual diet of soups and stews. I quickly learned that it has a distinct enough taste that it needs to be treated as a primary flavor, not as something I sneak into the pot.

So I googled it. The big take-away there was to use it as a replacement for parmesan cheese, which I eat even less than I do popcorn. More research and ideas were necessary.

The obvious place to turn was the celiac listserv, which is a huge list populated by real people with real experience. I got a number of replies, some with actual recipes, and some with links to most excellent websites by gluten-free folks who clearly spend a lot more time in the kitchen than I do.  Here are some of the suggestions, recipes and links.

Gravy: I got a couple of suggestions and links for gravy. I'm not much of a gravy eater, but we are in the holiday season when gravy seems to live large. Here's one recipe:

Start with a rice flour roux, add similar quantity of yeast as flour, then milk (or soy or coconut milk for the vegans.) Adding a bit of onion and garlic to the fat used in the roux is good, also a splash of GF tamari or amino acids enriches the flavor if you like those seasonings. Serve with steamed veggies and rice, or as gravy for
tempeh.

And here's a marinara sauce enhancement recipe: 1/2 cup marinara, 1 TBSP Almond Butter, 1 TBSP flax seed meal & 1 TBSP nutritional yeast.

Wendy Gregory Kaho of celiacsinthehouse.com suggested sprinkling it on kale chips and she recently reviewed Jules Shepard's cookbook, Free For All, which boasts a gf quiche that uses nutritional yeast as a primary ingredient.

And in addition to celiacsinthehouse.com, here are some additional recipes and great websites I'm glad I got introduced to:

http://beyondriceandtofu.com/2010/04/18/recipe-review-double-bean-pasta-with-tomatoes/

http://www.bookofyum.com/blog/gluten-free-vegan-breakfast-tofu-saute-with-nutritional-yeast-8192.html

Sage gravy, cauliflower gratin, dips, etc: http://toyourhealthnutrition.blogspot.com

In the end, I know I need to do some experimenting. Since my usual cooking M.O. is to make a big pot of something on the weekend and eat it for a number of dinners the coming week, I need to figure out which of these suggestions or which sites would accommodate that. And I can definitely sprinkle it on kale chips, popcorn, in scrambled eggs, incorporated into dips and added to gf pasta and sauce.

Over the past 10 weeks I had four transfusions of iron to bring my hemoglobin level up from paltry 9.4 to low-normal 12.3. Actually, the 4th transfusion happened on the day that my numbers came back in the 12's, so hopefully I'm holding at even better numbers. So my big question was: If I've been as strict on the GF diet as I think I have, why is my anemia still here? My hemotologist said I needed to talk to the GI people to explore it. So, between my first and second visit to the hemotologist, I talked to my care providers at Jefferson's Celiac Center and came up with a plan to do additional blood tests to see how my folate and B12 levels were doing, since I was deficient in both when I was first diagnosed and since they are absorbed in the same part of the small intestine as iron. We also decided to re-test for the antibodies that are present in active celiac disease.

I had a couple of theories about my anemia. The first was that I am extremely sensitve to gluten, and that the chance contact I get in my own home from crumbs on countertops or rinsing my veggies or beans in a clean colander that was set in a sink that had previously had pasta water in it was keeping my intestinal enteropathy going.  The second was a possible issue with lectins, which are proteins found in a lot of the foods I eat, and which from what I've read can set off all the same markers as Celiac disease. The third was that all of the doctors for the last 25 years were right, and that I am anemic because I bleed every month and my celiac is a weird coincidence and that the anemia is really a blessing because it brought about my diagnosis. The fourth is that there is something else going on.

My blood tests came back perfect, except for the iron. B12 and folate were normal, as were the celiac antibodies. So either something else is going on, or I'm anemic for some other reason. Sounds like a job for the hematologist. Or WebMD. Either way, I'm going to continue getting my iron levels monitored and get topped off with a transfusion before I get really low again. I've felt so much better since my iron levels have been boosted and I don't want to slip back again.

Some people with Celiac I've talked to have reported a life-altering boost of energy when they went gluten-free. I felt much better in many ways, but had no such elevation. In fact, my anemia is still here and I'm signed up for iron transfusions every two weeks until I get into the normal range. Which tells me that even though I have celiac and I live a strict GF lifestyle, my anemia has got a different cause. And I'd really like to get that boost in energy that other people have gotten.

On a hunch, I've started researching lectin intolerance. My sister-in-law texted me last week about a runner she had heard about who was anemic because of a bean allergy. I little research later, and I discovered lectin. From the descriptions I read, it sounds like lectin intolerance can set off all the same antibody tests and causes blunting of villi in the small intestine, just as gluten does. Lectin is in just about everything, but especially grains (from what I can tell, gluten is a type of lectin), legumes, nuts, seeds and veggies in the nightshade family -- tomatoes, peppers, eggplant, and potatoes. If lectin is part of my issue, I'm not sure how I would get enough protein and remain vegetarian. No one's got a book or a suggested diet plan for lectin intolerance, though one paper I read on it suggested borrowing heavily from the Specific Carbohydrate Diet. The SCD is used primarily by people with Crohn's Disease, and it's apparently VERY helpful for that crowd.  Another book to get and read in my quest for health and happiness.

I've been pretty darn strict with my gluten-free compliance. And yet, my anemia is alive and well. From my hematology appointment three months ago to the one a week and a half ago, my hemoglobin dropped from 11.4 to 9.6. I got my first transhfusion in over a year. I go back in a couple of weeks to see how things are going. In the meantime, I had THE WORST period ever. I've been feeling run down, I look pale, feeling light-headed, and I think I'll be getting another transfusion.

I asked my hematologist the obvious question: Shouldn't my small intestine be healed by now so that I can absorb the iron? He said I should take it up with my team at the Celiac Center. I spoke to them. I'll get more blood work to check the celiac antibodies to see if they have changed (for better or for worse) since they were last checked in January. In addition we'll test for folate and iron, both of which I've had a deficiency. Though if I'm getting iron transfusions, I don't know how illuminating that aspect of the test will be. And we'll take it from there. As I understand it, the only real way to know if my small intesting is healed is to do another biopsy. One thing at a time.

I also know that anemia can have many causes. It would just be weird if the symptom that lead to my celiac diagnosis turns out to be caused by something else.

I had a great visit to my hematologist. My iron levels are good, and we compared my celiac antibody tests from June to the ones from the Celiac Center, and my number dropped from 45 to 18!  Anything over an 8 means trouble, so the 18 by itself was looking kind of bad. But compared to the 45, I'm kicking ass on the gluten-free diet. We'll know more at my next check-up with the Celiac Center in a few months. What's more, my dexascan revealed that I don't have osteoporosis or osteopenia, which I was kind of worried about. Yay me!