Transcript

Lee Tetreault:

Welcome to frequently asked questions from the session "To Be or Not to Be Gluten Free: Food Elimination Diets for Allergies, Intolerances and Wellness." We are joined by Bethany Doerfler, registered dietician. Before we begin with these questions, Bethany, would you be able to reiterate a few key pointers from today's session to our audience?

Dr. Doerfler:  

Yes. Thank you very much. Often when people are looking to make behavior change related to their diet, it's natural for people to feel that they need to make a radical change. Often, the recommendation that people find in popular media books or on Instagram is to cut out massive food groups, not just wheat, but dairy, other potential allergens, or whole food groups. In short, what we really see in the literature to date is that while there are some patients who have true food allergy and autoimmune disorders like celiac disease that need to avoid gluten strictly, there are other GI disorders like IBS, or functional dyspepsia, or even other autoimmune disorders that likely benefit from us simply having less of this particular nutrient.

In the case of gluten specifically, Americans eat approximately 600 calories more a day than we did in the 1970s, and almost all of that comes in the form of refined carbohydrates. So while I do not think that gluten itself is necessarily the bad guy, there is room for that nutrient to be shaved down in small ways from the diet. When we do that, we always want to increase more fruits and vegetables in the diet because those have important antioxidant soluble fiber and have an inverse relationship with body mass index and diabetes risk that we've seen over the past several decades. In summary, also, when individuals go on restricted diets, they need to be mindful of avoiding key nutrients like calcium, vitamin D, B12, folic acid, and iron that are often found in fortified ways in carbohydrates such as wheat-containing products as well as in dairy products. A thoughtful look at dietary adequacy, as well as supplements, are important parameters of a wellness visit with your primary care or internal medicine provider.

Lee Tetreault:

Great. Thank you, Bethany. Now, we'll go on to the questions. Have you seen the link between autoimmune diseases and wheat intolerance? Have you seen a link between autoimmune diseases and wheat intolerance? For example, increased wheat intake exacerbates eczema.

Dr. Doerfler:  

Eczema specifically has been associated with several food allergies, particularly in kids. Food groups such as eggs, dairy, and possibly even wheat, have all been implicated in an eczema flare. And sometimes careful removal of those foods under the direction of an allergist is done in kids. We do see on a broader spectrum, though, foods such as gluten being implicated in causing or perpetuating flares in patients who have autoimmune diseases. There are several popular media diets, including autoimmune diet protocols, that remove wheat, dairy, sometimes eggs, and nuts like a Paleo-style diet. And those have been advocated in the popular media as ways to treat autoimmune diseases.

Likely, the reason why people feel better when they remove those foods is twofold: One, we eat... As Americans, we eat more carbohydrates and more wheat than we used to. So, usually reducing those foods and increasing healthy foods results in feeling well overall. The other additional thing is that people with one autoimmune disease are more likely to have another. There are published reports that people with one autoimmune disease, such as Hashimoto's or rheumatoid arthritis, have a likely increased incidents of having celiac. So, it could be that by putting people on a gluten-free diet, we are missing the fact that they could have a co-existing disease like celiac.

Lee Tetreault:

What is the best probiotic to use in IBS?

Dr. Doerfler:  

In IBS, we've come full circle on what we recommend with regard to probiotics. We generally do not see them as harmful, although the research is lacking to show their conclusive benefit. Strain, single-strain probiotics such as bifidus infantis, largely appears to be helpful in reducing abdominal pain and improving stool consistency among patients with IBS.

Lee Tetreault:

Interval fasting, how often and what is the minimal number of hours?

Dr. Doerfler:  

There are several different ways to do intermittent fasting. Some people will recommend that you fast. Some researchers are looking at fasting for two days, and then other researchers are looking at doing an interval-type fast where you would alternate between eight hours of eating and 16 hours of fasting. And you would do this over the course of, say, two days in a week. So the idea is that you would stop eating at 6:00 PM at night and then not eat your first meal until roughly 11 o'clock the next day. When you do start eating at 11 or 12 o'clock, your eating interval should last over eight hours. That work has been popularly studied by Kristina Varady at the University of Illinois, and I think she has a popular media book out right now called "The Every-Other-Day Diet" that dictates this. We don't see that one style of fasting is advantageous over the other, but rather that these are both techniques to reduce calories in the diet overall. Additionally, going longer periods of time without eating for some individuals with metabolic syndrome, might improve their insulin resistance.

Lee Tetreault:

Can you please comment on adrenal insufficiency and need for protein intake?

Dr. Doerfler:  

Adrenal insufficiency is a true condition that has also become popularly diagnosed by many complementary and alternative health care providers. It's a little difficult to know if some of our patients who have been diagnosed with "this," are in fact suffering from true adrenal insufficiency or true adrenal fatigue.

Lee Tetreault:

What's your opinion on eating late at night, or skipping breakfast or fasting?

Dr. Doerfler:  

The data to date demonstrates that whether or not you eat breakfast, likely does not substantially affect your weight gain. However, people who skip breakfast are more likely to overeat later in the today. So, eating breakfast doesn't necessarily set you up for a metabolic advantage, but it rather often serves as more of a behavioral advantage to prevent overeating at lunch or at dinner. Interestingly, the reverse has been studied as well, the idea that Americans should eat a larger breakfast, a larger lunch and then a smaller dinner, and this proves to not work for many Americans because while we eat the larger breakfast and lunch, we don't always compensate by eating the smaller dinner.

Lee Tetreault:

This is great information, Bethany. Thank you so much for your time

Dr. Doerfler:  

My pleasure. Thank you.




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