What the F&*! is Gluten?

I have battled digestive issues my entire life. I remember the panic inducing, cold sweats which would suddenly appear while browsing the mall with my grandmother when I was 9. As cold sweat would bead down my back, I remember looking desperately for a bathroom, while my grandmother ordered me to hold it. I still find myself avoiding anything spicy, exotic, greasy, or delicious when getting ready for a road trip or a date. There is nothing more embarrassing then having an attack happen while out with friends or in places where there is an audience in the bathroom when your bowels become explosive.

The  unexpected flare ups are the worst. Having a seemly harmless meal to find yourself running to the bathroom every hour the next day. You are experiencing so much abdominal pain, bloating, and cramping that you feel like you will be ripped in two. You are so sick, that you avoid food altogether. Toliet paper begins to feel like it is embedded with glass.

The digestive issues run in my family. And after dealing with severe digestive issues in Korea, I received an endoscopy of the stomach that indicated inflammation due to heart burn. The doctor attributed it to Irritable Bowel Syndrome, and told me to avoid stress and food triggers.

However, my life is unpredictable with IBS. I am never quite sure what will trigger my attacks, and even avoiding greasy foods, chocolate, cheese, and other known IBS triggers still does not diminish my attacks. I can go weeks feeling great, and then be leveled by an attack. My kidneys hurt, my intestines growl and twist, and I find that terrifying panic setting in.

As most people, with easy access to the internet, I have been doing research. Of course after reading symptoms on WebMD and being convinced I had everything from depression to colon cancer, I am beginning to rethink the IBS label.

According to WebMD and the Celiac Disease Center in California, approximately 6% of patients diagnosed with IBS may in fact have another relatively unknown and little understood condition called Non-Celiac Gluten Senstitivity (NCGS or gluten intolerance). What separates NCGS from celiac disease (which is a severe and life-threatening auto immune disease to gluten) is that individuals do have not damage to their intestines (diagnosed through colonoscopy) or the presence of antibodies in blood tests. There is presently no diagnostic test avaiable for NCGS. Even more frustrating is that the symptoms for IBS and NCGS are relatively the same, which makes it difficult for doctors to accurately and effectively diagnosis patients.

So, what the fuck is gluten?

Trust me, ask the average American, they can expound upon the virtues of a gluten-free diet or discuss this friend or that celebrity who has lost weight going gluten free. However, most people could not actually tell you what gluten is.

Luckily for me, as a biologist and science teacher, I just needed to look at one of my textbooks. Gluten is a protein, and actually it's a combination of two proteins: gliadin and glutenin. Gluten is present in the endosperm of grains such as wheat, barley, and rye. The endosperm is the part of the plant's seed (we refer to those seeds as grains) which provides nutrition to the developing embryo during germination. For us, gluten is what gives baked bread that elasticity and delicious chewiness that we love.

So why is gluten a problem now? Well some scientists have an answer for that: We don't prepare our grains the same way. Our ancestors hand ground the grains into a flour and then used a slow-leavening process to help bread to rise. That slow leavening process may have helped break up some of the gluten present in grains. Today processing techniques have rapidly shortened the leavening process and cross-breeds (think genetic modifying) of our grains have seen gluten in other varieties beyond just simple wheat, barley, and rye.

Okay.....so I am just going to make all my bread by hand. Problem solved!....

Actually, a new study by Drs. Biesiekierski, Peters, Newnhawm, Rosella, Muir, and Gibson just published in April indicate that it actually may not be gluten that people have a senstivity towards, as previously thought.

Bull shit!

Ok.....let me mention that Dr Biesikierski and his colleagues were the same people who published a large study in 2011 which indicated that people with no celiac disease may have reactions to gluten (aka NCGS). In fact, his study was the one that essentially spurred the neotrend of gluten free lifestyles and the gluten-free food industry (which makes approximately $6.2 billion/year). As most scientists, he wasn't satisfied with his results, so he refined his methodology and removed any additional confounding variables which may have influenced his results.

So what did he find?

Well, the culprit may not be gluten after all....rather FODMAPs.

What the fuck are FODMAPs?...

Well FODMAPs are fermentable, poorly-absorbed short chain carbohydrates, nitrites, sulfites, benzoates, etc. In other words artificial perservatives which are frequently found in processed foods that also happen to contain gluten. His study showed that patients who ingested low-FODMAPs diets had a reduction in digestive flare ups and symptoms in comparison to patients ingesting a high-FODMAP diet. Interestingly, patients reported having gluten flare ups in his study regardless of whether or not gluten was present indicating a nocebo effect (patients had no idea when they were receiving gluten in their diet). For those of you, who are not scientists, a nocebo effect is where patients report harmful symptoms even when harmless substances are present.

So what does this all mean? Gluten free or FODMAP free?

Well the answer, like most things in science, is that it needs additional studies and a lot more research into both NCGS and FODMAPs. The commonality is that both gluten and FODMAPs are frequently found in processed and refined foods. Which is also why people have also jumped on the Paleo Diet bandwagon (gluten-free and processed food free diet) in the past few years.

So what are patients like me, with a history of IBS symptoms who may suspect another culprit (gluten, FODMAPs, etc.), to do?

Doctors suggest patients who suspect NCGS should be tested first to rule out celiac disease, before going gluten free (or more importantly avoiding processed foods containing grains) to ensure an accurate diagnosis and assessment by your primary physician or a gastroenterologist.

As for me, as my intestines continue to rumble as I post this, and I am within jogging distance of the bathroom. After discussion with my primary physician, she has suggested going gluten free using a Paleo Diet for several weeks (the reduction in sodium from processed-free foods may also help my issues with blood pressure). I am supposed to write down everything that I eat each day, and to document any flare ups, symptoms, etc. which arise and how long after eating.

Going gluten free or adhering to a Paleo Diet is not easy. In other words, cutting out refined foods, grains, and processed foods requires time, effort, and more importantly money.

A bag of all-purpose flour costs $3 compared to a comparable sized bag of almond flour at $10. And sadly, the FDA has just begun to set stricter restrictions on companies regarding gluten-free. In other words, food labels may say gluten-free but actually the food may be processed in the same plant that makes gluten products or it may contain derivatives of grain which contain trace amounts of gluten.

The other problem is that fresh fruits and vegetables are harder to obtain and are more costly than the Ramen noodles, potato chips, canned soups, etc. that line the convenience store and grocery shelves located in most urban and economically depressed neighborhoods (also called "food deserts"). Avoidance of gluten and processed foods is not necessarily easy (look at what is vending machines and work place break rooms), and people who deal with serious allergies will describe the frustration of planning their social lives around places offering gluten free options.

In the meantime, while I wait for the research to continue concerning NCGS, FODMAPs, and digestive conditions, I am going to attempt to evaluate the effect of going gluten-free and processed food free for a few weeks. (I will have to wait till my workshop is done since everything from breakfast to lunch contains gluten and/or processed foods). When I went Paleo last year, I did feel better (less flare ups) but I did not truly eliminate all gluten, which is the only way to deal with NCGS (say goodbye to beer!). Not to mention, it was expensive to maintain and shop for (grass fed meat is twice the cost of grain fed meat).

However, the list of symptoms of NCGS is enough for me to warrant the experiment of trying out gluten-free and processed free food on a more permanent basis:

• cramping
• bloating
• gas
• abdominal pain
• irritability
• chronic fatigue
• rash 
• depression
• joint pain
• migraine headaches 
• diarrhea
• constipation 
• heart burn

Rise Above It

'Little minds are tamed and subdued by misfortune;

but great minds rise above them."

-Washington Irving

After reflecting on the negativity of my latest post, I have been trying this last week to embrace the motto "rise above it". Call it a mantra, I have been trying to remind myself that what I am facing now and what I have been struggling to overcome, is just another trial in the journey called life. And with most people, as I overcome this trial, I know that other (and harder) trials will always be ahead.

I have been working on writing science curriculum this week in a workshop, and it felt good working on something that I am good at. And while I may never know whether or not schools and teachers will actually use the curriculum I am writing, it makes me feel good to know that in some way I am helping to create positive change. That maybe someone will use my ideas to improve their teaching methods. 

On the other hand, I have also remained realistic. I am still applying, and still looking for jobs. I keep hoping that if I "rise above it", something will eventually fall into place. The universe has also reaffirmed that I work hard. While I did not get the job at my last interview due to my license, it impressed the principal enough to pass my name on to another school who called for an interview.

I have also been trying to "rise above" what has been my homeless situation, as my apartment and the 90 year old ceilings are finally being repaired after collapsing. And thankfully, no one was hurt when it came crashing down. It could have very likely been an entirely different situation, had I not remained so insistent. 

What mantras do you recite or adhere to? What sayings or thoughts get you through your rough patches? Are you also trying to "rise above it"?

$7.95

The minimum wage in Ohio is $7.95/hr. I have watched a lot of discussion in the news about the rate of inflation, the depressed economy, and the rising cost of healthcare indicating a need to raise the minimum wage for working Americans. We talk about the disappearing middle class, while we discuss the addition of jobs which mimic the feeling of changing tides.

What we don't talk about in greater detail is the underemployed. Today more Americans are underemployed, under appreciated, and over qualified for the jobs they work in. We cut salaries and benefits while raising insurance premiums and job responsibilities. In Korea, I paid approximately 3 dollars for a doctor's visit and about 5 dollars for prescriptions. There were no hidden fees, co-pays, coinsurance, or deductibles to be met. Today, I struggle to figure out the algorithms utilized to determine that I owe an additional $82.23 for an MRI reading after I have met both my deductible and coinsurance for the year.

What about the salaried workers, where we have no set minimum on the cost of full-time work? Most salaried workers are hired for 40 hours of work a week. Most of us work more than 40 hours. If I count the amount of time spent tutoring, grading papers, lesson planning, e-mailing students/parents, I work anywhere between a 10-12 hour day (I am excluding the time I put in during the weekends). If you factor in my salary of 10 months of paid work, I make approximately $6.80 an hour every day I work with my advanced degrees in Education. That is below the state's minimum wage. However, no one, including my employers believes that paying me that amount of money is unacceptable, and more importantly unlivable. I am being told it accept it for what it is, a job that someone else would be willing to work.

I try not to complain to my friends. Especially, the ones who are not necessarily struggling to make ends meet with their salaried jobs. I nod my head at their suggestions and agree to look at this website and that. But the truth is, I have looked everywhere. I apply everyday for jobs in education, in science, out of education, in sales, etc. No one responds. Or worse yet I go to an interview, and get told that I am qualified but my license prevents me from gaining employment or that I am overqualified. I struggle thinking that I made a mistake in my career choices, and that at 33 my doctorate will result in me making $6.80/hr for the rest of my life.

I try to repeat the mantra of positivity: "At least I have a job". But what is the work for and what is the hours I put in mean, when I can barely afford to put food in my mouth or gas in my car? Yes, I will die a person who is well-liked and well-respected but what about this life? I don't feel like I have much of a life these days. Because so much is wrapped around money, or the lack of. I don't buy new clothes. I don't go on vacations. I didn't even say anything about wanting to celebrate my birthday to any friends. I counted quarters this past week to put money in the bank to cover rent. I stress about dropping my health insurance because they are raising the premium by 20% with no change in my salary for next year.

And each week, I feel more beat down and more like a failure. I worked so hard, to be where, one step away from homeless? I see the people on the corner with their cardboard signs, and realize that I just a pay check away from their situation. I spend my free time coming job boards and social media sites for employment.

I talked with the business manager at work today about my salary, and was told, "We don't have the money to pay more". (He agreed that he would not be able to live on the salary I am paid.) But I am stuck. It is the only job I have managed to get, and God knows I have applied anywhere and everywhere else. I am even beginning to contemplate moving overseas again, just so I can take care of myself and my family. I feel like I live in a country that doesn't care what happens to me or others like me.

And it is so hard not to be bitter, and feel like life is so unfair. I work in a job that is often thankless and selfless, and I have nothing to show for it. I am so tired. I am so stressed. I sometimes feel like I am drowning. I am trying not to lose it some days.

Today is one of them. The difference between being paid $6.80/hr at my job and $7.95/hr comes out to approximately an additional $2000/yr. That would also be equal to approximately 3 months of rent, six months of groceries, or 500 gallons of gas. It makes a difference. A livable wage would make a difference. I am not talking about a wage that allows me vacations, I am talking about a wage that allows me to pay bills on time, every time.

And sadly, my story is one of many. I am the face of middle class America. I am college educated, articulate, goal oriented, and hard working. But I am also underpaid, underemployed, and in a dead end. My competition for jobs are thousands of others like me who are struggling to find a way out. We keep applying, and struggle to figure out our next choice.

This has nothing to do with political affiliation, gender, religion, etc. Rather it has to do with the fact that we are living in a country were we no longer are willing to talk things out together to solve problems. We rather point fingers, blame this party or that one, or pin our troubles on one specific demographic group.

$7.95/hr is a symbol of division that exists in our country. There are too many have and have nots walking around, there is no Goldilocks problems of "just enough" in our society. And to be honest, I have no idea myself where we begin to fix the problems. I just know that while people dream of the future, I am thinking about now. What am I supposed to do now? How do I make it through tomorrow?

How much longer can I keep going?