Gluten – What is All the Buzz?

If it seems like everyone and their dog is avoiding gluten lately, rest assured, it is not all in your head. The food market is exploding with gluten-free alternatives from shampoo, body care, and cosmetics to gluten-free bread, cereal, and vodka. Even the Girl Scouts have joined in with the release of a gluten-free chocolate chip shortbread cookie! The food industry reports that the gluten free market is projected to balloon from about $7.28 billion in 2016 to over $16 billion in 2025.1

The exact reason for the increasing numbers of gluten intolerant people is unknown, but there are several theories as to why the prevalence has increased so much, including hypotheses like the so-called “old friends” theory where it is believed that the loss of contact with the very bacteria, fungi, parasites, and other microbes that humans evolved with has resulted in intolerance to natural compounds like gluten. Research with celiac patients found that those who were intentionally infected with hookworms could then tolerate digestive exposure to gluten without problems.2 Other hypotheses include the presence of too much wheat in the diet, overuse of antibiotics, treatment of conventionally grown wheat with pesticides, and of course misdiagnosis of the problem altogether.

To gain a more complete understanding of gluten and its potential impact on health, there are a few questions that must be answered.

What is gluten anyway?

Gluten is a general term for a large family of proteins found in several types of grains like wheat (all types including wheat berries, durum, semolina, spelt, faro, graham, etc.), rye, and barley. Gluten can also be found in derivatives of these grains like malt and brewer’s yeast. It is used by the plant as a source of nourishment during seed germination. Gluten acts as a glue, helping foods maintain their shape and elasticity, and also allows bread to rise during baking. Gluten is often found in unexpected places like soy sauce, pickles, cosmetics, medications, supplements, and even in naturally gluten-free products like rice, oats, or french fries via packaging or processing cross-contamination.

What does it mean to be “sensitive” or “intolerant” to gluten?

People that are sensitive or intolerant to gluten are those who develop any number of symptoms when they consume gluten or gluten containing products. Often termed, non-celiac gluten sensitivity, these people may experience many of the same symptoms such as brain fog, gas, bloating, constipation, headaches, joint pain, etc. as someone with celiac disease yet they do not test positive for the condition. Such individuals may see benefit including resolution of symptoms from adhering to a gluten-free diet.

What is the difference between a gluten “sensitivity” or “allergy” versus an “intolerance”?

An allergy to a particular food happens when the body produces an immune response upon exposure to that food. The resulting symptoms can be mild like a stuffy or runny nose and/or headache, to moderate symptoms like hives, itchy mouth, or a rash, to severe reactions like throat tightening, difficulty breathing and even life-threatening anaphylactic reactions. It is estimated that upwards of 32 million Americans have true food allergies, and the Center for Disease Control reports that food allergies have increased in children by 50% in recent years.3

Another type of food reaction is an intolerance (though people often mistakenly call these allergies). This type of reaction is not initiated by the immune system and does not result in anaphylactic reactions. Food intolerances are often related to the absence or decreased activity of specific chemicals or enzymes that are required to digest certain substances. A classic example of this is lactose intolerance. People who suffer from lactose intolerance lack sufficient amounts of the enzyme lactase which is needed to digest lactose resulting in digestive disturbance.

In conclusion, the difference between an allergy and an intolerance comes down to the type of biochemical reaction that drives them within the body. The treatment in many cases may be the same (avoidance) regardless of the type of reaction causing the symptoms.

What are the signs and symptoms of gluten sensitivity/intolerance?

The reactions an individual has to gluten consumption can vary. This is by no means an exhaustive list, and not every person will have every symptom, but typical symptoms include:

  • Bloating
  • Flatulence
  • Constipation
  • Diarrhea
  • Irritable Bowel Syndrome (IBS)
  • Iron deficiency anemia
  • Joint pain
  • Skin problems
  • Asthma
  • Mood imbalance
  • Fatigue
  • Weight loss
  • Delayed puberty (in children)
  • Slowed growth (in children)
  • Infertility
  • Osteoporosis

What is celiac disease?

The most well-known and serious type of gluten reactivity is an inflammatory gut disease known as celiac disease. Celiac disease is often thought of as a food allergy, but since celiac is a genetic autoimmune disease caused by activation of certain genes, this is an inaccurate representation. About 33% of people in the Western world, carry the gene for celiac disease.4 But since celiac disease has a prevalence of only about 0.5-1%, the cause is beyond simple genetics and disease manifestation in susceptible individuals likely must also include an environmental trigger.5

As in other autoimmune diseases, people with celiac disease may have periods of exacerbation of symptoms or remission, where they are asymptomatic.6 However, celiac disease is a chronic condition. If someone with celiac disease consumes gluten, an abnormal immune response is triggered that results in significant inflammation and damage to the lining of the small intestine, which then impairs the absorption of nutrients of the small intestine.5 The damage to the small intestinal wall  and inflammation of the intestinal lining can lead to malabsorption and malnutrition, which in turn, can lead to osteoporosis, anemia, and delayed growth.

Are celiac disease and gluten intolerance the same thing?

No. Although the symptoms can often be the same, celiac disease and gluten intolerance are driven by different biochemical processes within the body. Celiac disease is an autoimmune condition that results in an immunologic response to gluten in the intestines. An intolerance is not immune-mediated and may be related to lack of key enzymes or chemicals required for digestion of gluten.

Can a gluten free diet help?

Yes! In the case of celiac disease, a strict gluten-free diet is an absolute must. A gluten-free diet means that the protein gluten is excluded from all foods consumed. Label reading is very important when taking on a gluten-free diet. Some people are exquisitely sensitive to gluten and may not see improvement of symptoms with a gluten-free diet if they are exposed to even small trace amounts of gluten. For this reason, some people may need to be very conscientious of hidden sources of gluten, as well as cross contamination of typically non-gluten containing foods. Such individuals would need to consume gluten-free products from facilities and growers who are strictly dedicated to being gluten free.

Be sure to consult your naturopathic doctor if you are considering switching to a gluten-free diet. Click here to find an ND in the US and Canada.

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Dr. Tammy Ashney – NUNM

Tammy Ashney, ND is an associate professor at National University of Natural Medicine (NUNM), attending physician at NUNM Clinics, clinical supervisor for residents and student interns, and the medical editor for Women in Balance Institute monthly newsletter. She shares her path to naturopathic medicine that started with a baccalaureate degree in Anthropology and a minor in Women’s Studies. Her practice has come full circle, building on her undergraduate passions.

Why did you choose to become a naturopathic doctor?

“Naturopathic medicine beautifully combines my deep anthropological interest in people, my love of teaching embodied in the naturopathic principle of docere, and my deep belief in the healing power of nature. I became a vegetarian at the age of 12 and then subsequently became very interested in environmental health and herbal medicine. I found naturopathic medicine after a circuitous journey that included waiting tables, teaching kids, fine art and photography studio work, and cross-country travels.”

What topics in naturopathic medicine are you passionate about?

“I love being able to help women understand their bodies more deeply, discuss sensitive topics and utilize natural therapeutics to help support them.”

Dr. Ashney also has a special interest in environmental medicine. “In the fall of 2019, I petitioned the Portland mayor’s office and the Oregon governor’s office to create city and state proclamations to celebrate, in accordance with the Children’s Environmental Health Network (CEHN), the second Thursday in October as Children’s Environmental Health Day. October 10, 2019 marked the first Children’s Environmental Health Day in Portland and in the State of Oregon. Moving forward, I hope to work with others to create community events to invite parents, families, patients, and the community at large into fun educational opportunities about how to prevent and protect children from environmental exposure that can affect their health.”

Finding fulfillment as an ND and educator

Dr. Ashney has been teaching since her graduation from NUNM and the start of her residency. She is the course director for the Parenteral Therapy and Environmental Medicine, lectures in women’s health, and teaches the reproductive lab.

“I am humbled by student engagement and their ability to bring forth new information and collaboration with their peers.” Often times, Dr. Ashney learns from her students as well.

A note of gratitude

“I am a mother of two young children and have been married to my husband for 18 years. While this article is mostly meant to discuss my professional role, these are the people who constantly humble me, inform my humanity and keep me grounded in the here and now.  I am a better person because of them and a remarkably better teacher and physician because of the lessons they impart on me every single day.

Additionally, I am also the culmination of all the learning and mentoring of the teachers who have come before me. I would be remiss if I did not take a moment to honor some of them who believed in me. The saying, ‘I am standing on the shoulders of giants’ seems particularly relevant. Immense gratitude to: Kim Winstar, Tori Hudson, Walter Crinnion, Nancy Scarlett, Melanie Henriksen, Steven Sandberg-Lewis, Heather Zwickey, Rich Barrett, Sheryl Estlund, Wayne Centrone.”

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Daniella Remy – CCNM ND Student

Daniella Remy is a second-year naturopathic medical student at the Canadian College of Naturopathic Medicine (CCNM). She shares her unique path and why she fell in love with naturopathic medicine.

Why did you choose naturopathic medicine?

Following the completion of her master’s degree in Family Relations and Human Development in Ontario, Daniella moved to France to study at the University of Nice. While in France, she taught English in three elementary schools. Her goal was to engage in language development in five countries over five years to collect data for a PhD thesis on improving ESL programs. In this “whirlwind of experiences” in Europe and Australia, Daniella was involved in research, edited a book, prepared manuals and courses, established a clinic in Austria, helped with an herbal shop in Italy, learned how to make products in Switzerland, sat in on clinic sessions to translate for patients and became involved in the development of an app called ph360. The app uses a person’s anthropometry and health assessment questionnaire to estimate current health and disease trends. It then provides personalized, evidence-based, lifestyle recommendations.

After nearly a decade abroad, Daniella returned to Canada to be closer to family. She continued to work for ph360 but desired to have deeper understanding of medicine. When Daniella’s mother’s breast cancer was successfully treated with integrative cancer care, “the power of naturopathic medicine was truly brought to light,” and she fell in love with the profession.

“Though I wasn’t consciously aware of it, everything I had experienced had been leading to naturopathic medicine. While speaking to my partner about my frustrations of having a lack of medical knowledge and considering going back to school, his response was ‘Finally! It’s obvious to everyone that you should be a doctor, but it was important for you to decide this for yourself.'”

Daniella Remy practices taking blood pressure readings during class, pre-COVID-19.

How did you prepare for ND school?

“In my mind, there was no point in doing something so important unless I could do it well. Taking the time to prepare and make sure I could be fully engaged from the very first day was vital to me.” Daniella chose to begin naturopathic medical school in January instead of September so she could get her affairs in order, finish prerequisites, wrap up ongoing projects, make a financial plan, and speak with her employer about limiting her hours to support her academic goals.

What is your favorite thing about school? What surprised you?

“The CCNM community fosters learning and encourages excellence in the naturopathic profession. Students can create clubs and interest groups, engage in mentored research, provide feedback to the school that is truly taken to heart, and participate in many lectures and webinars for their professional and academic development. Students are offered an environment for collaboration and cohesiveness, and that is inspirational to me.

Daniella Remy and her classmates enjoy a CCNM event, pre-COVID-19.

Naturopathic medicine is like a start-up business – it needs highly motivated and driven people to establish it. Whether it’s through advocacy, quality research, evidence-based practice, interdisciplinary collaboration, or any number of engagements, there is a type of camaraderie in the profession that can be quite powerful. There is no shortage of opportunities for students and professionals to grow, be creative and explore their passion.”

How do you maintain a school/life balance?

Daniella is the student governor for the Naturopathic Student Association and the vice president of professional development for the Naturopathic Medical Student Association.  On top of that, she maintains good grades, participates in research, and works a part-time job with the unending support of her family and partner. She prioritizes self-care by finding time in nature, eating a nutritious diet, getting enough sleep, and taking care of her body and mind.​

What advice do you have for prospective ND students?

“You are responsible for your energy, so look on the bright side and make what you want from your experiences. Life can take many twists and turns but it always leads to a place that is right for you. Embrace it, make the most of the journey and stay positive – even with the challenges we are currently facing with COVID-19. Look for solutions and better outcomes rather than complaining or letting others bring you down. This is a time to focus on priorities. Learn something about yourself and the ones you love. Step up and take on challenges, engage in positive change and help foster a supportive community. Student life is not easy, but nothing that is worthwhile usually is. Studying for exams is much easier when you think about them as necessary stepping stones to your ultimate purpose.”

Click here to learn about other naturopathic doctors’ paths to naturopathic medicine.

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Dr. Zeynep Uraz – CCNM

Zeynep Uraz, BSc, ND is an associate professor at the Canadian College of Naturopathic Medicine (CCNM) – her alma mater. She teaches Sexual and Reproductive Health, and Integrative Fertility. She also leads the fertility-focused clinical program at the Robert Schad Naturopathic Clinic. Dr. Uraz shares her path to naturopathic medicine with a focus on fertility.

Why did you choose to become a naturopathic doctor?

“I often hear from students that their parents took them to a naturopathic doctor growing up, and they were raised in a very “naturopathic” household. That was not my story. I first heard about naturopathic medicine as an undergrad. When I learned about the principles of naturopathic medicine, I knew immediately that becoming an ND was the path for me!”

What topics in naturopathic medicine are you passionate about?

“I work at a large integrative fertility clinic in Toronto, where my practice is entirely focused on fertility care. There are so many ways in which naturopathic medicine can make a difference in fertility, starting with the principle of preventive medicine. Working with patients in the preconception period can have a profound impact on pregnancy outcomes and long-term health outcomes for the baby and even future generations.

In addition, working with patients who are trying to get pregnant is greatly rewarding, because they are often highly motivated to make recommended changes. While I definitely use the principles of motivational interviewing in my practice, I find most patients are ready for change, which makes my work so satisfying. I work with patients to optimize their diet, physical activity, weight, stress and sleep.  I provide acupuncture as well. Based on the evidence, we know that a specific preconception diet (the “pro-fertility diet”) is associated with significantly higher pregnancy rates in couples undergoing assisted reproductive technologies (ART). That, combined with various other changes really gives patients their best chance of pregnancy alongside ART (or of course, naturally!).

Dr. Uraz also dedicates her time to naturopathic research. “My husband and business partner Dr. Alan Vu and I conducted a pilot study involving group-based naturopathic fertility care. We presented our findings at the European Society of Human Reproduction and Embryology’s annual meeting in Vienna last year.  We are looking forward to future research opportunities to grow the body of evidence to support naturopathic management of fertility. I also speak regularly at conferences on the topic of integrative care and fertility. My goal is to help colleagues provide the best possible fertility patient care.”

Finding fulfillment as an ND and educator

“My absolute favorite thing about being an ND is the ability to spend a lot of time with my patients and get to know them. I am always humbled by what people will share with me, as well as their willingness to be open and let me walk alongside them on their fertility journey. It is such a privilege to be a part of this difficult time in their lives. Every day I am humbled by the strength and perseverance of my patients. And of course, getting baby pictures, or hearing that a patient is pregnant is one of the best things ever!”

As an educator, “I love the passion, excitement and optimism of naturopathic medical students. It’s heartening to see these future members of the profession be so dedicated to learning.” Dr. Uraz adds that curiosity, self-reflection, critical thinking, and empathy are some of the best qualities of future ND students.

Learn more about Dr. Uraz

Website

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Cooking Oils 101: The Naturopathic Kitchen

Cooking oil is a staple in every kitchen, and one that is not always given much thought. Did you know that what you don’t know CAN hurt you? Let’s dig deeper and learn more about seven of the most common kitchen oils. Discover how they are made, what they are best used for, and their pros and cons.

Oil
UseHow is it Made?ProsCons
CanolaCandles, soaps, lipsticks, lubricants, inks, biofuels, insecticides and foodProduced from a genetically modified rapeseed plant
Inexpensive cooking oil used for a wide range of industrial uses; improves cholesterol levels and insulin sensitivityOften GMO, hexane solvent extracted
VegetableDeep frying, stir frying, sautéing, baked goods
Can be any of rapeseed, cottonseed, safflower, sunflower, or other seed oils
Inexpensive and accessible
High amounts of omega-6 fatty acids may increase inflammation; contains trans fats when hydrogenated
AvocadoHigh-heat cooking, salads, frying

Pressed from the fleshy pulp surrounding the avocado pit
High smoke point, good raw or cooked; benefits skin health, arthritis and heart health
Expensive, not available in all stores or regions
GrapeseedDeep frying, stir frying, sautéing, baked goods
Pressed from the seeds of the grape plant
High smoke-point; neutral flavor; naturally occurring anti-oxidants; cardio-protective properties
High omega-6 content may contribute to inflammation
OliveSalad dressings, condiment, medium-high heat cooking
Pressed from raw olives
One of the healthiest oils, contains high amounts of antioxidants, as well as a high percentage of monounsaturated fats
Can be expensive, especially if organic and extra-virgin
CoconutHigh-heat cooking, baking, cosmetics, sunscreens, desserts
Pressed from the white pulp of the coconut often giving it a pearlescent look when solidified

Great for high-heat cooking due to high saturated fat content, widely available, antimicrobial and antifungal propertiesContains a high percentage of saturated fat, expensive, strong flavor that may not work with all foods
SesameCommon Asian and Indian food cooking oil; flavor-enhancer, as well as some industrial and cosmetic usesPressed or extracted from dehisced sesame seeds
Contains a moderate amount of vitamin K, inexpensive, nutty flavor/aroma, withstands high heat
Low quality products may be extracted with chemical or high heat extraction methods, may be allergenic for some

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Milk 101: The Naturopathic Kitchen

You’re probably familiar with famous tagline, “Got Milk?” along with images of celebrities sporting milk mustaches and espousing the health benefits of cow’s milk. Today, however, milk alternatives are increasing in popularity as cow’s milk has been linked to negative health effects in portions of the population.1 Many people develop a deficiency of the enzyme lactase that is needed to digest sugars found in cow’s dairy. Without the ability to properly digest cow dairy, they may experience uncomfortable digestive symptoms such as bloating, cramping, diarrhea and persistent abdominal pain. The pasteurization process further destroys important digestive enzymes needed to properly digest milk. For these reasons, cow dairy is a prominent food sensitivity for many people, even if they do not experience a true allergenic response.

As a result, a considerable number of non-dairy milk alternatives have emerged on the market. Milk alternatives are made from a variety of plant sources such as nuts, seeds and grains, and each variety has a unique nutritional profile, flavor, color, and texture as well as other properties such as its ability to combine with other liquids or be used in baking. People who wish to stop using dairy milk may substitute from a range of plant-based options as well as milk from other animals such as goats.

Milk
How is it Made?ProsCons
SoyProduced from soaking and grinding soybeans, boiling the mixture and filtering the remaining particlesBecoming widely available, thickest of the alternative milks, longer shelf-life than dairy milk, can be stored at room temperature for monthsCommon food allergen and can be difficult to digest; often contains gums, fillers, and added sugar. If not organic, it is likely a GMO and contains pesticides
AlmondProduced from blending almonds in water and passing through a filterGood alternative to dairy and soy milks, lower calorie (unless sweetened), high in vitamin EOften contains gums, fillers, and added sugars. Typically contains the non-active form of vitamin D (D2). Made from skinless almonds with most fiber and antioxidants removed
CowMilked and bottled directly from cowsMost versatile, can be processed into many different types of dairy products that have a long track record of use. Highest in natural micronutrient and good quality fats (when grass-fed)High incidence of allergy or lactose intolerance. May contain added hormones and other xenobiotics that the cow ingested
GoatMilked and bottled directly from goatsEasier to digest and less allergenic than cow dairy. Nutrients and minerals are more bioavailable than cow dairyHas a strong flavor and smell that may be unpleasant to some
CashewRaw cashews are soaked in water, blended, and filteredGood flavor and often thicker than other alternative milks. Contains significant amounts of tryptophan which may increase serotonin.Often contains gums, fillers, and often added sugars. Typically contains the non-active form of vitamin D (D2). Has a higher rate of intolerance or allergy than other alternative milks
CoconutGrated pulp is soaked in hot water, squeezed, and filteredHigh in healthy fats and medium chain triglycerides. Higher in vitamins and minerals than other alternative milks. Can improve digestion and aid in constipationOften contains gums, fillers, and often added sugars. Typically contains the non-active form of vitamin D (D2). Canned varieties may contain BPA (an industrial chemical used to make plastic)
RiceBlend cooked rice with water and strainedLess allergenic than cow dairy, easy and inexpensive to make at home, low in fat and cholesterol free, good source of B vitamins, manganese, and seleniumHigher in sugar and carbohydrates than other milk alternatives, may contain high levels of arsenic, may contain additives like gums, thickeners, as well as added sugar
HempHemp seeds are blended with water, salt, and sweetener, then strainedIs a complete protein and contains healthy fats including omega 3. It is also a good source of calcium, phosphorus, magnesium, Vitamin D, and B vitamins among others. Will not cause the “high” associated with marijuana (THC)Does not mix well and can separate in drinks like coffee; can be challenging to find
OatOats are soaked, drained, blended with water and salt, then strainedCreamy flavor, rich consistency, blends well with other beverages (i.e. coffee), Good source of iron, heart-healthy, may lower cholesterolCommercial varieties may be full of additives, preservatives, and sugar. Often cross-contaminated with gluten via processing facilities. Not as nutrient-dense as other milk alternatives

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