Gluten-Free, Grain-Free Pumpkin Crisp Recipe
Every fall, the kids and I pick out small baking pumpkins from the market. Once home, I cut the pumpkins in half and my children happily scoop out the stringy pulp and seeds knowing that one of their favorite desserts is in progress. They use the seeds for various Halloween crafts at home and school. Sometimes we dye the seeds different colors with food dye to add interest to their crafts. Once all the pulp and seeds are removed, we put about 6 halves on each cookie sheet and roast them (cut side up) for 1 hour at 350 Fahrenheit. I love the smell of pumpkin that fills the house as we putter around doing other activities. Once baked, I sit the halves on the stove top to cool, then I scoop out the pumpkin pulp (minus the skin) and put it in in a food processor. The pumpkin is blended until smooth. Once the pumpkin is completely processed, I proceed with the recipe. I usually cook 3 pies at a time since we are huge pumpkin pie fans.
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Part 7 Of 12 Part Series: Urological Symptoms (Incontinence, Prostatitis, Interstitial Cystitis, Urethritis, IgA Nephropathy, Glomerulonephritis, Kidney Stones, Nephritis, Nephrotic Syndrome and Recurrent Bladder Infections) Associated With Undiagnosed Celiac Disease, A Gluten Sensitivity, Or A Food Allergy/Sensitivity
This is the seventh in a series of posts discussing the variety of symptoms that can be caused by undiagnosed Celiac Disease (CD). In this post, urological symptoms associated with undiagnosed CD, a gluten sensitivity, or food allergies/sensitivities will be discussed.
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Part 6 Of 12 Part Series: Reproductive (Delayed Puberty, Amenorrhea, Infertility, Impotence, Chronic Pelvic Pain, Fetal Complications, Premature Birth, Miscarriages, And Early Menopause) Symptoms In Undiagnosed Celiac Disease
This is the sixth in a series of posts discussing the variety of symptoms that can be caused by undiagnosed Celiac Disease (CD). In this post, reproductive symptoms associated with undiagnosed CD will be discussed.
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Part 5 Of 12 Part Series: Musculoskeletal (Rickets, Osteomalacia, Osteopenia, Osteoporosis, Arthritis, And Myopathies) Symptoms In Undiagnosed Celiac Disease
This is the fifth in a series of posts discussing the variety of symptoms that can be caused by undiagnosed Celiac Disease (CD). In this post, musculoskeletal symptoms will be discussed. In many with undiagnosed CD, the intestinal villi, responsible for absorbing nutrients, becomes damaged, creating a flattened mucosal surface (villous flattening) that is less able to absorb nutrients. Autoimmune reactions to ingested gluten cross-react with intestinal villi and create this damage. Various nutrient deficiencies can occur and this, along with inflammation and other autoimmune factors, can lead to various musculoskeletal symptoms (1,2,3,4).
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Part 4 Of 12 Part Series: Skin Rashes, Hair, And Nail Symptoms In Undiagnosed Celiac Disease
This is the fourth in a series of posts discussing the variety of symptoms that can be caused by undiagnosed Celiac Disease (CD). In this post, skin rashes, hair, and nail symptoms will be discussed. In many with undiagnosed CD, the intestinal villi, responsible for absorbing nutrients, becomes damaged, creating a flattened mucosal surface (villous flattening) that is less able to absorb nutrients. Autoimmune reactions to ingested gluten cross-react with intestinal villi and create this damage. Various nutrient deficiencies can occur and this, along with inflammation and other autoimmune factors, can lead to various skin rashes, hair, and nail symptoms (1,2,3,4).
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Part 3 Of 12 Part Series: Sensory Symptoms (Vision, Hearing, Taste, Smell, and Touch) In Undiagnosed Celiac Disease.
This is the third in a series of posts discussing the variety of symptoms that can be caused by undiagnosed Celiac Disease (CD). In this post, five sensory symptoms (vision, hearing, taste, smell, and touch) will be discussed. In many with undiagnosed CD, the intestinal villi, responsible for absorbing nutrients, becomes damaged, creating a flattened mucosal surface (villous flattening) that is less able to absorb nutrients. Autoimmune reactions to ingested gluten cross-react with intestinal villi and create this damage. Various nutrient deficiencies can occur and this, along with inflammation and other autoimmune factors, can lead to various sensory symptoms (8,71,72,74).
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Part 2 Of 12 Part Series: Fatigue, Anemia, and Abnormal Bleeding Or Bruising In Undiagnosed Celiac Disease
This is the second in a series of posts discussing the variety of symptoms that can be caused by undiagnosed Celiac Disease (CD). In this post, factors in CD that contribute to fatigue, anemia, and abnormal bleeding or bruising will be discussed. In many with undiagnosed CD, the intestinal villi, responsible for absorbing nutrients, becomes damaged, creating a flattened mucosal surface (villus flattening) that is less able to absorb nutrients. Autoimmune reactions to ingested gluten cross-react with intestinal villi and create this damage. Various nutrient deficiencies can occur and this, along with inflammation and other factors, can lead to fatigue, anemia, and abnormal bleeding in CD (6,7,8,15).
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Celiac and Crohn’s Disease: Recurrence Of Bowel Symptoms Despite The Maintenance Of A Gluten-Free Diet
The inspiration for this post came from a comment/question on my post “Gastrointestinal Symptoms In Undiagnosed Celiac Disease”. I decided to post my recommendations since many others could be dealing with this or a variation of this problem.
Question: I have been diagnosed with celiac and chrohn’s disease for one and a half years. My doctor put me on a gluten-free diet and it was instant relief; a miracle. However, it’s like my body is going back to the way it was. I don’t believe the diet is working anymore. Can this be possible? I am actually going back to my doctor to get another colon. exam done. I am thinking the diet is helping the celiac, but what about the crohn’s?
Celiac Nurse: There are many conditions that may cause similar symptoms. I’m not sure exactly what your symptoms are, but I will outline some possible causes that may lead to the recurrence of gastrointestinal symptoms. The presence of Crohn’s Disease can definitely complicate the puzzle. I’ll include some recommendations that you can discuss with your MD and Gastroenterologist.
Possible causes can include lactose intolerance, pancreatic insufficiency, bacterial or fungal overgrowth, parasites, accidental gluten consumption, small bowel lymphoma, ulcerative jejunitis, a new food intolerance/allergy, microscopic colitis, refractory sprue, liver or gallbladder dysfunction, side effect of a drug, and vitamin/mineral deficiency or toxicity if taking high supplement doses. The new presence of other autoimmune diseases, such as Sjögren’s Syndrome, Addison’s Disease, or Autoimmune Thyroid Disease may cause similar symptoms (1,2,3,4,5,8). Increased bowel permeability may pre-dispose someone with Crohn’s Disease or Celiac disease to develop additional allergies. The presence of new allergies/intolerances/sensitivities may also lead to the re-occurrence of bowel symptoms (3,4,6,7,8).
Recommendations
1. Upper endoscopy and colonoscopy (with inspection of the stomach, duodenum, jejunum, upper and lower ileum and colon) with biopsies. This will help rule out lymphoma, other cancers, refractory sprue, ulcerative jejunitis, microscopic colitis, or another disease process (1,3,4). There are many possible causes so try to keep that in mind emotionally when you read this first recommendation (avoid focusing on the cancer part).
2. Stool tests for parasites, fungal and bacterial infections (1,4). An overstressed intestinal immune system, maladaptive intestinal environment, and damaged mucosa may predispose individuals to develop bacterial or fungal bowel infections or provide an environment for parasites to thrive (12,13). A blood test, CBC with differential, can show how well your immune system is functioning and can be elevated with an infection.
3. Re-check ingredient lists on the foods/vitamins/supplements/medications you consume to ensure that all are gluten-free. Products that were once gluten-free may not be now due to a change in the ingredients. It’s worth viewing the label each time you buy a product. Also, check with companies to ensure that there is no cross contamination at their company due to packaging gluten and non-gluten foods on the same machine. It can be time consuming, but well worth the effort. Ask your MD/Gastroenterologist to do a Celiac Screen to see if you still have circulating antibodies. This can help you to see if you are still exposed to gluten. Keep in mind that the best test to check Celiac and Crohn’s related mucosal health is a scope with biopsies (1,4).
4. Tests to check pancreatic, liver, and gallbladder function. As discussed in the “Gastrointestinal Symptoms in Undiagnosed Celiac Disease” article, these organs aide in digestion and can be affected in Celiac Disease. Malabsorption can lead to flatulence, diarrhea, and bowel infections (1,5,9,10,11).
5. Testing for lactose intolerance. Lactose is found in dairy products. It is a disaccharide and requires lactase-phlorizin hydrolase (enzyme) produced within the intestines to digest it. Loss of this brush border enzyme results in hypolactasia (low lactase production), and can occur from the intestinal epithelial damage evident in CD. Once the lactose passes undigested into the colon, it is broken down by commensal bacteria. This process produces CO2 and hydrogen which cause abdominal discomfort, bloating, flatulence, and possibly diarrhea. This may be temporary, since lactase production may resume once the bowel has healed or the underlying cause is treated. In others, it is a permanent condition (1,2,5).
6. Blood tests to check for vitamin and mineral deficiencies or toxicities. Also ask about checking drug levels for any medications you are taking. Review side effects with a pharmacist to see if any of the medications you take cause gastrointestinal symptoms. Ask the MD about checking your BUN and creatinine levels to ensure your kidneys are functioning well. Dysfunction may lead to a drug or vitamin toxicity.
7. Consume nutritionally dense foods to help meet your nutritional needs. Avoid processed foods or foods high in processed refined sugar. Eat natural foods, hopefully, without additives if possible. Ensure the fats you consume are healthy (include omega 3). Adequate fat intake is necessary for absorption of vitamin A,D,E, and K. Since you have Crohn’s, you need to ensure you are getting enough B12 either through injections or food/vitamin intake. A periodic blood test can verify that your levels are normal. Overall, with Celiac and Crohn’s Disease you need to ensure an adequate intake of fat and water soluble vitamins, minerals, trace elements, electrolytes, proteins, fats, and carbohydrates (2). Ask your MD/Gastroenterologist about a multivitamin and probiotics. Ask for a referral to a Registered Dietitian (who is knowledgeable about Celiac and Crohn’s disease) to review your nutritional needs. Some find a Paleolithic Diet helpful to settle symptoms, but you need to ensure you are consuming all the nutrients your body requires, especially with 2 autoimmune diseases. Also, with diarrhea or vomiting, ask your MD about checking your electrolyte levels since electrolytes can be lost through both emesis and diarrhea. Your doctor may prescribe an electrolyte replacement drink and medications if you are having frequent vomiting or diarrhea.
8. Ensure adequate hydration is maintained. Usually, 8-10 glasses of fluids should be consumed every day. However, the recommended fluid intake can depend on your current hydration status and your health history. For example, an individual with a cardiac or kidney medical history may have fluid restrictions. Check with your MD. Remember caffeinated fluids do not do a great job of hydrating you since these fluids promote diuresis and may increase peristalsis leading possibly to more diarrhea. Flushed dry skin, poor skin turgor, dry mouth and lips, coated tongue, low concentrated urine output, decreased level of orientation, irritability, or confusion are some symptoms that may indicate you are getting dehydrated.
9. Ask your specialist/Gastroenterologist about the possible presence of other autoimmune diseases that may cause the symptoms you are having. Some possibilities that may cause bowel symptoms are Graves Disease (hyperthyroidism-diarrhea, weight loss), Hashimoto’s Disease (hypothyroidism-constipation), Sjögren’s Syndrome, Microscopic Colitis, or Addison’s Disease (1,2,4,14).
10. Check for other food intolerances/sensitivities or allergies. Ask about a referral to an allergist for blood tests and other allergy tests. If negative, a core or elimination diet can also help you to figure out the offending foods. Zonulin, a human protein, influences increased bowel permeability found in Celiac Disease and possibly Crohn’s Disease as well. Increased expression of zonulin in the intestinal tissues increases permeability allowing macromolecules (ex. food antigens, bacterial, and viral particles) exposure to the immune system. The immune systems exposure to gluten and the subsequent autoimmune reaction is thought to be responsible for the intestinal and other systemic damage seen in Celiac Disease. Unfortunately, the increased bowel permeability can also increase the risk of developing food allergies/intolerances/sensitivities (6,7,8,14).
Exposure to food allergens could potentially have the same effect in the development of other autoimmune diseases, such as Crohn’s Disease (14). I have a close family member with Crohn’s Disease. He has found that processed corn causes a flare up of abdominal discomfort, flatulence, and diarrhea. Corn is often processed with fungus and a bacteria that is used to break it down into different products. Since he can eat corn on the cob, he feels that it is either the bacteria or the fungus that he is reacting to. Aspergillus, a type of fungus that is used can cause skip lesions, therefore he is suspecting that it may be responsible. Processed corn is in about 80-90% of the grocery store foods we eat in developed countries (where Crohn’s is more prevalent). Google “corn allergy” and you will see the wide variety of foods that corn is in. For example, I have surprisingly found that 1%, 2%, and skim milk often has corn oil as a carrier for the fat soluble vitamin D, table salt can be coated with dextrose (dextrose is usually derived from corn) to stabilize the iodine, and also some of the IV fluids with dextrose used at our local hospital contain corn. Key words to look for on ingredient lists can be found at various corn allergy sites on the internet, such as www.corn-free.ca and www.corn-freefood.blogspot.com. Your allergist can probably supply a list for you as well. I found an independent movie called “King Corn” and a book I read called “Omnivores Dilemma” that was very informative about the corn industry. My family member with Crohn’s finds that he is intolerant to almonds and chocolate as well. He lives drug and surgery free. More research is needed to look at the association between diet and Crohn’s Disease.
Two of my children have the same corn sensitivity. They tested negative to a corn allergy at the allergist which leads me to believe they might be intolerant/allergic to an agent used to process corn. They both can eat corn on the cob, but have bowel symptoms and eczema with consumption of processed corn. Food allergies/intolerances/sensitivities can be difficult to identify. Patient detective work will often benefit those affected with a better quality of life.
I hope you found this helpful. Print it out and take it with you to your next appointment. Review my recommendations with your MD/Gastroenterologist before making any changes.
I wish you the best,
Shelly Stuart, RN
References
1. Excellent Book: Green PHR, Jones, R. Celiac Disease A Hidden Epidemic. Collins, Harper Collins Publishers, 2006.
2. Gibney MJ, Marinos E, Olle L, Dowsett J. Clinical Nutrition. Blackwell Publishing 2005.
3. Gislason SJ. Core Diet For Kids. Persona Audiovisual Production, 1989.
4. Feldman Mark, MD, Friedman Lawrence S, MD, Sleisenger, Marvin H, MD, Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management 7th Edition, Volume11, 2002,Saunders
5. Barrett KE. Gastrointestinal Physiology. Lange Medical Books/McGraw-Hill 2006.
6. Fasano A, Not T, Wang W, Uzzau S, Berti I, Tommasini A, Goldblum SE. Zonulin, a newly discovered modulator of intestinal permeability, and it’s expression in coeliac disease. Lancet, 2000 Apr 29;355(9214):1518-9.
7. Drago S, El Asmar R, Di Pierro M, Grazia Clemente M, Tripathi A, Sapone A, Thakar M, Iacono G, Carroccio A, D’Agate C, Not T, Zampini L, Catassi C, Fasano A. Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinal mucosa and intestinal cell lines. Scand J Gastroenterol. 2006 Apr;41(4):408-19.
8. University of Maryland Medical Center. Dr. Alessio Fasano MD. Researchers Find Increased Zonulin levels Among Celiac Disease Patients, Public Release 28-Apr 2000.
9. Rhodes RA, Tai HH, Chey WY. Impairment of Secretin Release in Celiac Sprue. Am J Dig Dis 23:833, 1978.
10. Maton PN, Seldon AC, Fitzpatrick ML, et al. Defective Gallbladder Emptying And Cholecystokinin Release In Celiac Disease. Reversal by Gluten-free Diet. Gastroenterology 88:391, 1985.
11. Vuoristo M, MiettinenTA. The Role Of Fat And Bile Acid Malabsorption in Diarrhoea Of Coeliac Disease. Scand J Gastroenterol 22:289, 1987.
12. Tursi A,Brandimarte G, Giorgetti G. High Prevalence of Small Intestinal Bacterial Overgrowth in Celiac Patients With Persistance of Gastrointestinal Symptoms After Gluten Withdrawl. Am J Gastroenterol 98(4):839-43
13. Bateson-Koch Carolee. How to Permanently Heal Your Allergic Condition Permanently and Naturally. Alive Books 1994.
14. Alessio Fasano, M.D. Physiological, Pathological, and Therapeutic Implications of Zonulin-Mediated Intestinal Barrier Modulation. American Journal of Pathology, 2008;173:1243-1252.
Part 1 of 12 Part Series: Gastrointestinal Symptoms in Undiagnosed Celiac Disease
This is the first in a series of posts discussing the variety of symptoms that can be caused by undiagnosed Celiac Disease (CD). While many gastrointestinal (GI) symptoms are well recognized by the medical community, there are many extraintestinal symptoms that are not as widely recognized. The elusive nature of this disease may lead some to provide an incomplete diagnosis by only diagnosing the symptoms, such as anemia, gastric reflux, lactose intolerance, infertility, or ataxia (2,3,24). As well, CD is often misdiagnosed as Irritable Bowel Syndrome (11). The list of possible incomplete diagnoses, misdiagnoses, and symptoms of CD is too extensive to include in just one post, which has led to the creation of this 12 part series. In this post, I’ll describe the various GI symptoms in undiagnosed CD.
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A 12 Part Series: The Elusive Symptoms of Celiac Disease/C(o)eliac Sprue/Gluten Sensitive Enteropathy/Non-Tropical Sprue
Celiac Disease (CD) is a permanent autoimmune condition. In response to gluten, the immune system’s effect on multiple systems of the body can lead to many typical, atypical, and silent or vague symptoms that can be confusing and sometimes lead medical professionals to mistakenly diagnose individuals with an incorrect or incomplete diagnosis. In this 12 part series, I’ll discuss the symptoms of undiagnosed CD, with the hope that this information will increase the rate of diagnosis for those suffering and lead to a better quality of life.
Outline of 12 Part Series
Each post will cover a variety of symptoms associated with each physiological system. The 11th post will outline associated diseases that increase one’s risk of having CD, and the final 12th post will be a simplified summary of all the symptoms.
Part 1: Gastrointestinal Symptoms
Part 2: Fatigue, Anemia And Bleeding Symptoms
Part 3: Sensory Symptoms
Part 4: Skin, Hair, and Nail Symptoms
Part 5: Musculoskeletal Symptoms
Part 6: Reproductive Symptoms
Part 7: Urological Symptoms
Part 8: Neurological Symptoms
Part 9: Psychological Symptoms
Part 10: Respiratory and Cardiac Symptoms
Part 11: Diseases Associated with Celiac Disease
Part 12: Simplified Summary of All Celiac Disease Symptoms.
The presence of any of the symptoms discussed in the posts indicates that you should talk to your MD about tests for CD and tests to rule out other possible causes of your symptoms. Testing for CD is important because undiagnosed CD increases the risk of developing other autoimmune diseases (1), cancers (2), allergies, complications from malabsorption issues, possible decreased immune response to other illnesses(3), and many other health complications that will be discussed in the posts about CD symptoms.
It is possible to have a gluten sensitivity even if you test negative for CD. It is also possible that your symptoms could be due to a food allergy or sensitivity. Allergy testing and an elimination diet may help you to identify the offending food. I encourage everyone to have their symptoms thoroughly investigated by their MD and specialists before implementing a therapeutic diet. Keep your MD informed about any dietary changes you are making and also the results. Of course, I would love to hear your story as well.
Diagnosed Celiacs and People With Food Allergies/Sensitivities-Please comment on your symptoms and experiences at the end of each post. This will help other readers to see how the sometimes elusive symptoms of CD or food sensitivities can affect each of us. We are all unique!
References
1. Ventura A. Coeliac Disease And Autoimmunity. In Lohiniemi S, Collin P, Maki M, eds. Changing features of Coeliac Disease. Tampere: The Finnish Coeliac Society. 1998:67-72
2. Corrao G, Corazza GR, Bagnardi V, Brusco G, Ciacci C, Cottone M et al. Mortality in Patients With Coeliac Disease And Their Relatives: A Cohort Study. Lancet 2001;358:356-61
3. Feldman Mark, MD, Friedman Lawrence S, MD, Sleisenger, Marvin H, MD, Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management 7th Edition, Volume11, 2002,Saunders
