Thursday, May 26, 2011

How To Start A Gluten-Free Diet: Healing Through Foods

As food harms us, so can it heal us. 

In this seventh and final installment of the series, How to Start a Gluten-Free Diet, I turn my attention to healing through foods. Because gluten causes so much intestinal damage, just taking it out of your diet is often not enough. Yes, that is the first and most important step. But depending on the amount of damage that has been done, it may take time for your body to heal properly. Fortunately, there are things you can do to help speed up that process, and just as it was food that caused the damage in the first place, so food must be the answer for healing as well. There is an amazing amount you can do to help your body, and I've asked my good friend (and fellow Bastyr nutrition student), Gina Pagano, to help me sort out all of the research. Gina was diagnosed with Celiac Disease four years ago after six years of digestive and skin problems which progressed to malabsorption, anemia, and amenorrhea. Gina's own experience with healing her gut, as well as her research skills - did I mention she's the person I go to when I'm trying to answer questions for class - make her the perfect person to partner up with on this discussion. Together, we've gathered a number of ideas for you all, and Gina will be back later this week sharing one of her healing recipes with us as well.

And now, what you really want to know. Be forewarned that this is long, but it's worth it:
  • Goodbye Gluten: The first step, of course, is to eliminate gluten from your diet. This includes being careful with cross-contamination because even the smallest crumb can set off a reaction in your gut, whether you're aware of it or not. 
  • Rotate your Foods: Because your body is in a state of damage and inflammation, you're more likely to develop sensitivities to other foods. While I'm not suggesting you follow a complete rotation diet (although some people do suggest this), it is important to eat a variety of foods. Rather than eating the same meals every day, switch it up. For example, for breakfast try scrambled eggs with spinach and baked sweet potatoes one day, cooked amaranth with walnuts and raisins the next, and a green smoothie with a side of gluten-free toast the third day.
  • Take a Break from Dairy: Eliminate dairy from your diet until your gut has healed. Dairy can increase stress and inflammation in the body, thus impeding healing. Once you're feeling back to normal, you can try adding dairy back in to see if you can tolerate it. If you can, great! If not, there are a ton of wonderful gluten-free products on the market that you can replace your dairy with, such as coconut/almond/hemp/rice/soy milk, and some amazing dairy-free recipes that you can try:
  • Pay Attention to Bone Health: Individuals with Celiac Disease are more susceptible to osteoporosis, due to nutrient malabsorption. While it is important for everyone to pay attention to bone health, women may be at higher risk for developing osteoporosis due to estrogen balance. Calcium is not the only nutrient that matters here, though. Vitamin D is also required for the absorption of calcium from the gut. Sunlight is the best way for you to get your vitamin D, but when that's not an option (such as winter in Seattle), there are a few food sources that you can try to incorporate into your diet to help. In addition, weight bearing exercise helps strengthen bones, so getting that exercise in is critical! Every time you want to talk yourself out of working out, remind yourself that you're not just burning calories, you're also strengthening your bones! Here are a few of the many non-dairy food sources of calcium and vitamin D: 
    • Calcium: sardines (with bones), sesame seeds, spinach, blackstrap molasses
    • Vitamin D: wild salmon, sardines, shrimp, cod, shiitake mushrooms, whole eggs
  • Increase Nutrient Intake: As Gina knows only too well, malabsorption from years of eating gluten can cause a number of vitamin deficiencies. Some common nutrient deficiencies in the Celiac population are: iron, vitamin A, and zinc. In addition, a factor to keep in mind is that many wheat products are fortified with the B vitamins and folic acid, whereas many gluten-free products are not similarly fortified. So in addition to eating a variety of foods, look to include rich sources of these vitamins in your diet. If you're able to, ask your doctor to check your vitamin levels so you know which vitamins you should be targeting. Here are just a few of the many (non-dairy) food sources for these nutrients:
    • Iron: chard, spinach, romaine lettuce, blackstrap molasses, tofu, shiitake mushrooms, black beans, wild salmon, grass-fed beef
    • Vitamin A: carrots, spinach, kale, mango, cantaloupe, sweet potatoes (with skin on)
    • Zinc: calf's liver, crimini mushrooms, spinach, sea vegetables, grass-fed beef
    • Folic Acid: dark leafy greens, legumes, asparagus, broccoli, avocado, tomato juice,
    • Thiamin: legumes, salmon, jerusalem artichokes, orange juice, potatoes, carrot juice, nuts,
    • Riboflavin: liver, mushrooms, broccoli, dark green leafy vegetables, asparagus, eggs
    • Niacin: meat, fish, white rice, tomato products, peanuts, tofu, peas, eggs
    • Pantothenic Acid: cod, tuna, chicken, eggs, broccoli, lentils, split peas, avocado,
    • Biotin: chard, romaine lettuce, tomatoes, carrots, almonds, eggs, onions, cabbage
    • Vitamin B6: liver, fish, baked potato, chicken, garbanzo beans, bananas, sunflower seeds,
    • Vitamin B12: oysters, crab, beef liver, chicken, clams, nutritional yeast, fortified soy milk 
  • Improve Digestion with Fermented foods. Fermented foods are rich in probiotics, and will improve digestion, absorption, and assimilation of all of the amazing nutrients and phytonutrients in your meals. However, start slow and build up the amount of these foods in your diet, as a rapid increase in fiber might cause increased bloating.
  • Decrease Inflammation: Before you can even start the process of repairing the mucosal lining of your gut, you need to soothe your inflamed gut. There are a variety of ways you can do this: 
    • Decrease refined carbohydrates and sugars: High intake of refined carbohydrates or sugars can create insulin spikes, which increases inflammation. Luckily, there are a number of gluten-free grains that are healthy options, as well as many recipes using unrefined sugars. 
    • Increase Foods Containing Quercetin: Quercetin is an anti-inflammatory phytonutrient that is found in high amounts in: apples, onions, parsley, and green tea, as well as many other fruits and vegetables.
    • Increase Fruits, Vegetables, Herbs and Spices with Anti-Inflammatory Properties: Fruits and vegetables are just plain good for you. It's about as simple as that. However, there are a number of foods that are especially known for their anti-inflammatory properties, such as: turmeric, ginger, nettles, garlic, basil, rosemary, fennel, cloves, berries, purple grapes, and cruciferous vegetables (e.g. cabbage, broccoli).
    • Increase Omega 3 Fatty Acids: Omega 3 fatty acids are a key component to reducing inflammation. Some common sources in the diet are: wild salmon, flax and chia seeds (be cautious with increasing fiber too quickly though), sardines, tuna, walnuts, and grass-fed beef.
    • Try Soothing Foods: Due to the inflammation, your body may do better with mild, soothing foods for a little while. Strong spices, tomatoes, and/or citrus fruits may be too harsh for your gut right now. Instead, try:
        • Soft, well-cooked foods like quinoa soaked overnight, cooked until soft, or this apple pie recipe.
        • 1/2 cup unsweetened applesauce mixed with 2 teaspoons of marshmallow root or slippery elm powder. Gina's naturopathic doctor recommended slippery elm powder to her after she was diagnosed with Celiac Disease. She ate it in apple sauce faithfully for at least two weeks, and it not only improved her overall digestion, but alleviated lower GI and bowel pain and spasming. Marshmallow root and slippery elm powder are both powdered herbs that are demulcents (they soothe mucous membranes).
  • Heal Your Gut with Glutamine: Once you've taken gluten out of your diet and begun to work on decreasing inflammation, the final step is to repair the mucosal lining of your gut. Glutamine is the most abundant amino acid in the body, and is a key building block for protein. Glutamine can help to stimulate regeneration of the mucosa cells, as well as prevent further damage and decrease the amount of bacteria leaking across the mucosa. Cabbage is an excellent source of glutamine, as are most high-protein foods, such as chicken, fish, or beans.
  • Practice Stress Reduction Techniques: Stress is as much a culprit in inflammation as anything you're eating. High stress levels increase cortisol, which will in turn increase inflammation in the body. In addition, stress can decrease the flow of digestive juices, thus hampering all the hard work you're doing by working on your diet. Of course, in today's world, it's much easier said than done to reduce stress in your life. But there's one thing you can do every day that will only take a little extra time: 
    • Start by planning an extra fifteen minutes into your meal times. If you're like me, you're usually eating fast so you can rush out the door, or worse, eating standing up, walking, or driving. It took a conversation with Gina to make me realize how detrimental this was to my efforts to improve my digestion. Now, I plan enough time so that I can sit down and savor my meals at the kitchen table. You might feel like you don't have an extra fifteen minutes, but once you notice the difference in how you feel after eating, you'll want to make this a priority. 
    • Now that you have an extra fifteen minutes planned out, sit down to your lovely meal and quietly take a few deep breaths. Because food is often a source of stress for those of us with dietary restrictions, our minds may be primed to see food as the enemy. And if your mind thinks that way, your body is going to follow suit. So as you breathe, tell your body about all the healthy nutrients you're feeding it. Tell it that it's safe and has nothing to fear from the food you're about to eat. Ask your body to help you absorb all those nutrients and work with you to heal. (This may sound a bit out there - and it is - but incorporating this practice into my meals has helped reduce my food sensitivity symptoms more than I could imagine. Plus, you can do this all quietly and in your head, so if you're eating with other people, no one has to know you're doing it!) As you eat, take the time to chew your food and take some nice deep breaths in between bites. Once you're done eating, pause and take a few more deep breaths before you get up. Keeping your body relaxed in this way throughout your meal will help your digestion more than you would expect!
Now that you know what to do, I'll be focusing the last few days of this month on healing recipes that incorporate some of the anti-inflammatory foods we've talked about, such as my Anti-Inflammatory Cocktail, Cranberry Glazed Salmon, and Gina's Fresh Herb Salad.


Ricki said...

I love this post, Iris. Filled with so much great advice! I remember having long discussions with friends when I first went vegan about how I could possibly get my calcium from non-animal ingredients--and here you are with this great list! And how lovely to see someone mention things like slippery elm or marshmallow (the herb) in a blog post. They are also great for ulcers or pre-ulcers, as I know from my own experience--so much better than taking antacids, which wreak havoc in the gut!

Wendy @ Celiacs in the House said...

An important post, Iris. When we all had to go gluten free, I thought we would suddenly be well again with gluten out of our lives. That was the first step and you are so right about taking steps to then heal the damage. We went dairy free for about 18 months and found that we could all add some dairy back but in widely varying amounts for the three of us. So much good information packed into this post that is so important for my teens as well as me at midlife to recover from so many years of misdiagnosis.

gfe--gluten free easily said...

Iris, I love this post. Excellent job from Gogi Gina and Hazelnut Higgins ... thank you for this one. Interestingly enough, we watched Dr. Tom O'Bryan speak (via the 2010 Gluten Sensitivity and Celiac Forum video) at my support group meeting the other night and he peppered us, very persistently, with "Heal the gut! Heal the gut!" Seriously, he said that dozens of times. He shared the info that so many who go gluten free heal their villi, but do NOT remove the inflammation, which can be just as disastrous health wise. Inflammation is often not given its due for its role in illness and disease. Unfortunately, Dr. O'Bryan did not talk much at all about how to heal the gut and most folks do not know how to do so. At least he didn't address it much in that presentation. His focus was on getting everyone's attention that there's more to do than go gluten free, how important it is to stay 100% gluten free, etc. Your post does a wonderful job of highlighting just how much can be done to heal the gut and how--again, thank you both. I'll be sharing this with folks in my group and online.

Have a great weekend!

Iris said...

Thanks Ricki - I'm sure we could have gone more into herbs, but we wanted to stick with whole foods as much as possible and to not overwhelm our readers with too much!

Wendy, I've gone dairy free off and on since I stopped eating gluten, but never long enough and never when I was also working to calm the inflammation and heal my gut. So writing this has reminded me of its importance as well.

Shirley, thanks for sharing with your group. I think you're right that inflammation has a very strong role in many diseases, and if people realized it, they would be much more likely to take steps to keep their bodies cool and calm!

Maggie said...

Iris this is an information-packed post. I wish I had known more when Pete was first diagnosed, seven years ago. He went off gluten and that was about it. Sometimes I wonder if he healed his gut or if it's still in need of some repair. He's off dairy (it gives him excema) and we do eat really clean. Thanks for sharing all of this information. We are all benefiting from your degree :)

Anney E.J. Ryan said...

Thanks for explaining what glutamine is!!! Forever, I've been thinking of it as some distant cousin to gluten! Hilarious.

I love that you and Gina include soothing, comfort foods in your list. It is so important to pamper yourself when taking foods out of your diet. Knowing that I can eat a big bowl of warm oatmeal or rice makes giving up chewy sourdough no problem at all. :-)

Amy said...

This is an awesome post. I atually printed it out for me to reference. As you know I've had a blood test that showed all sorts of sensitivities, one being gluten, which I had wondered about given my strong craving for this food. I have made the decision to actually eliminate the foods that I believe I am sensitive to. You blog and the other blogs you follow are a definite referrence for me and a place to get reassurance that I can do this. Thanks for all the info that you provide!

Iris said...


I'm so glad it's been helpful! I hope you get symptom relief quickly, and yes, you can definitely do this! And you'll feel so much better!


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