Mercury and Arsenic Exposures in the Gluten-Free Diet: Finally A Silver Bullet for Unnecessary Use?

February 17th, 2017

Wow.  So I am rusty with blog stuff.  It’s been literally YEARS since I wrote a blog post.  When I started blogging, I wasn’t sure where I’d go with it.  I never pushed myself to make it a huge aspect of my life or career.  I figured if it was something I loved and was motivated to do, then it would organically become a part of my life. Time and interest proved I wasn’t that motivated.  That’s OK.  Tweeting and blogging are truly things I ONLY do if I really want to.  I think that’s the way most of our activities should be–why do something unless you really enjoy it?

That being said, this article came across my email this morning and I felt compelled to respond.  (It helps it’s Friday, my administrative day, where I have dedicated time for research).  The gluten-free diet is so misused, and the downsides of it are rarely highlighted, so anything that brings real pause for concern is truly important.

First off, some statistics.  About 0.7% of the U.S. population, or 1.8 million people, have Celiac Disease.  Celiac Disease is the ONLY real reason to be on a gluten-free diet.  I fully expect rants in comments regarding how “toxic” it is, but the fact is, there is no proof that gluten ingestion in the absence of celiac disease causes measurable long term harm.  Quite the opposite, in fact, are the numerous studies showing the harms of low carb diets and the benefits of whole grains (see below).  Studies showing benefit of low carb diets are almost exclusively limited to short term studies of less than a year’s duration and look at intermediate markers of health (like weight changes or blood tests) not true markers of health (like whether you live longer and get fewer diseases).

I do believe there are people who are gluten sensitive, and for those people, avoiding gluten makes them feel much better and makes sense.  However, in the absence of a proven sensitivity to wheat, there is no reason to be “going gluten free”.

There are many misleading very popular books that talk about how “evil” gluten is, but they are wrong.  They are simply factually inaccurate and misleading.  However, as our current political environment shows, people seem to respond more to drama, exaggeration and propaganda than actual facts.  For a quick, thorough, factual and medically sound rebuttal of the mis-information behind the evils of wheat, read this quick commentary by Dr. John McDougall, a physician who has studied the effects of diet on human health his entire career.

Moving on and back to my point about the significant downsides of the gluten-free diet, I know from experience that people don’t really care that the gluten free diet contains more saturated fat and sugar and less vitamins, minerals, and phytonutrients (plant nutrients) than a wheat-containing diet when consumed in the way most Americans are eating.  However, people who ~love~ the gluten-free diet MAY care if it contains more “poisons”, which is why I was really intrigued by this study in the journal Epidemiology published online this month. Here is the link to a media summary of the article:

Contrary to popular myth, the gluten-free diet is more likely to cause weight gain, not the opposite, which is ironic because so many people are “going gluten free” to lose weight.  The caveat is that the ill effects are predominantly seen in people basing most of their diet on processed gluten-free foods that use wheat flour substitutes.  That is, if you eat a lot of gluten-free cereal, cookies, muffins, etc, then you will by necessity ingest a lot of alternative refined grains, and many of those alternative refined grains have less vitamins and minerals *and possibly more toxins* than wheat itself.  Gluten-free eaters fair substantially better if they eat a gluten-free diet full of healthy fruits, vegetables, nuts, WHOLE gluten free grains (the key is WHOLE), and limited meat and dairy.

The researchers in this article were wisely concerned that the reliance on rice flour as a substitute for wheat flour in many gluten-free processed foods could represent a source of inorganic arsenic (the bad kind) and mercury.  We have known for a while that rice, particularly from certain regions like the United States, can contain higher levels of inorganic arsenic.  There is even an FDA advisory out regarding arsenic in rice, particularly in infant rice cereal.

The study referenced in the news article is well done and was conducted by researchers at universities with high integrity in science.  It was not easy to do because of the complicated statistics necessary to make it a valid and reliable study.  It is also important, VERY IMPORTANT, to know this is an OBSERVATIONAL CROSS-SECTIONAL STUDY NOT DESIGNED TO DETERMINE CAUSE AND EFFECT.  Why is that important?  Studies like this can be very helpful in looking for potential problems that need further evaluation.  Cause and effect studies like randomized trials, are EXTREMELY time consuming and expensive, so we can’t just go planning these on a whim.  Observational studies can be done with less resources and usually in a larger group of people to see if the problem is even worth looking into before we commit a lot of time and money getting to the real truth behind the story.

The study results are very simple:  Those who self-identified as eating a gluten free diet had more arsenic of all kinds, including inorganic arsenic, in their blood and urine.  Almost TWICE as much.  They also had higher mercury and cadmium levels (cadmium only in the urine).

Important things this study CANNOT show:

1. It cannot show whether eating a gluten free diet is the CAUSE of the higher levels  (see explanation above for cause/effect).

2. If the diet is causing the levels to be higher, it cannot show which aspect of the diet is the culprit (the assumption is that rice is the exposure, but they can’t know that for sure).

3. It cannot show whether the higher levels are causing or will cause health problems.

To determine those three very crucial points, we need more studies (whah whah, the disappointing but appropriate conclusion of observational research).

What do I take from this?  What I’ve always taken from the gluten-free diet:  The gluten-free diet is NECESSARY for celiac patients and POINTLESS for most everyone else.  Why would anyone choose a diet that has no measurable health benefit but is likely to cause harm?  I also think it is very important for patients with celiac disease to be aware of these issues and try to limit gluten-free processed foods.  Processed foods of all kinds are bad for health (in everyone, not just celiac patients).  Stick to veggies, fruits, nuts, and select healthy gluten-free whole grains.

“The prep’s the worst part”- preparing for my own #colonoscopy

June 5th, 2013

I’m about to get a few hours of shut eye, but before I go, I’ll write a little about how I’m preparing for my own colonoscopy procedure, scheduled for 7 am tomorrow.

The back story of why I am getting a colonoscopy is a topic for another time. Suffice it to say I’ve had several mysterious, very short episodes of nausea and vomiting in the last few months, and I’ve had some rectal bleeding at times in the past. The rectal bleeding is almost certainly hemorrhoids, but with polyps in both my parents, it’s time to bite the bullet and get this over with.

The irony is that I perform this procedure for a living. I’m a gastroenterologist. When I started to have GI problems, I found myself in an interesting position. So here I am, sitting on a burning bum, trying to choke down MoviPrep and concerned I’ll miss my alarm.

A gastroenterologist cannot show up to her own colonoscopy with a poor prep. Ain’t no way I’m letting that happen. This is how I’m doing it:

I stopped eating anything with nuts, seeds, skins, fiber (essentially anything healthy) last Friday. That’s been incredibly tough. I’ve literally eaten crap like pizza and Mac & cheese for days. This is VASTLY different from my normal diet. Healthy foods full of good fiber cannot be removed from the colon during the procedure, and I didn’t want anything to obscure the view.

I started taking Miralax on Sunday night. Normally I recommend twice a day dosing for this, but I had to do my own scopes yesterday, so I didn’t take it in the morning.

I ate only puréed, liquid, or soft foods yesterday. I had a smoothie for breakfast, banana pudding and chocolate milk for lunch, tomato soup, Mac & cheese, yogurt, and chocolate mousse cake for dinner.

This morning around 6:30 am I had my last ‘full’ liquids (or creamy liquids)- almond milk with powdered peanut butter and chocolate, whey powder, and some ovaltine. The day before a colonoscopy one should ONLY have clear liquids. I figured I’d be OK because I generally have excellent bowel habits and it was 24 hours before the procedure. I’d also been ‘preparing’ for a few days already.

Since then I’ve had apple juice, two fresh juices from The Juice Joint in River Forest, IL, a liter of clear sparkling coconut pineapple drink, two big mugs of ‘doctored’ veggie and beef broth, and 3/4 of my colonoscopy prep: MoviPrep. That’s not what I prescribe, but it’s what my partner (who’s doing the test) ordered. One of the other docs in my group is doing it because my insurance is cheapest if I do things at my workplace. Therefore, when I needed a test that I do because it’s my specialty, that means one of my partners needed to do it. This person is the best endoscopist in the whole department, so I’m sure it’s going to be fine.

I’m going to sleep now, and I’m going to get up at 3 am to finish. I have to be done with liquids by 5 am. I’ll be fine. I’m already ‘clear’- meaning what’s coming out is a clear yellow liquid. I am so relieved because I was afraid it wouldn’t work!

Here’s what I’ve learned:

1. This stuff sucks. For real. It tastes horrible. It’s not the salty part, it’s the artificial flavoring. I’d rather it be unflavored. I truly didn’t understand that until now. Several other people have told me this, so now I know. I’ve only been successful by chasing it with non-prep drinks like sparkling water and broth. That has helped TREMENDOUSLY.

2. My bum is on FIRE!! I didn’t expect this but I should have. I know I have external hemorrhoids, and the prep is notorious for causing hemorrhoidal discomfort. I have cottonelle fresh wipes but they made it hurt way more, so back to plain TP, but only patting, no wiping. Wish I had some baby butt cream.

Last toilet trip then bed. We know from experience and from trials that splitting this up into two rounds is more effective, so I’ll sleep a little then get up again for round 2. I have to be done more than 2 hours prior to the start time.

Most people express great annoyance with the prep. Here’s my 2 cents, having been through it now:

it’s 24 hours out of my life and $5K out of my pocket. There’s NO WAY I’m screwing this up just because it tastes bad [it does] or I’m starving [I am] or I don’t want to get up early [I don't].

Suck it up and get it done. Your [my] gastroenterologist will thank you, and you will do the only thing you can to ensure a successful test.

#DDW13 Quick Update on Mega Meetings

May 20th, 2013

I’m flying back home (gotta love plane wifi) and here are my quick thoughts on this year’s mega meeting, DDW 2013.

1. It seemed quieter in general: not sure what the attendance stats were, but seemed like less people and the twitter stream was smaller.   BUT as Meenakshi Budhraja (@gastromom) pointed out it was a higher quality stream: less junk more usable tweets
2. I loved meeting a few other tweeters I know from the twitter universe. Social media is a powerful tool, but nothing competes with a “Howdy and a handshake.”   When we go back to our homes we can now connect those @ handles to a real human. Thanks @mathena123 @gastromom @RyanMadanickMD @meducate @alcoss (though I didn’t get to meet @alcoss in person ):
3. I dialed it down this year. I had some last minute personal conflicts that necessitated an abbreviated DDW, so I had no time to obsess over what I was doing when.   I made a decision NOT to go out guns blazing, and it was a less stressful DDW than some of my prior ones.   I went to the AGA post-grad course for most of Saturday and Sunday when I wasn’t in AGA committee meetings.   I saw a few extra sessions in which I was interested, and I talked to a lot of friends and acquaintances.   I sacrificed a valuable ASGE-sponsored session on Women in GI for some extra sleep and a wonderful conversation with @gastromom that I wouldn’t trade.   I went to the always inspiring AGA Women’s luncheon where I continue to feel like well-cared-for professional with an army of brilliant, successful women watching my back.   I spent a high-impact 30 minutes talking about the AGA Outcomes Registry and Bridges to Excellence program with Sam Walters, head of Quality at the AGA and Gail Hecht, my new division chief.   Both are excellent programs, and I’m excited we’ll be moving forward with them at Loyola.

I missed a great deal of the scientific programming, but I had a fulfilling professional meeting regardless.

4. After attending the major nutrition meeting earlier this year, ASPEN, I purchased a different iPad case that had a bluetooth keyboard.  I learned my hospital case (a Griffin Air Strap Med) and my stylus (Adonit Jot Flip) worked great for going room-to-room interviewing patients in the hospital, but they didn’t cut it for taking notes at conferences.  I decided the $90 investment for a conference case was worth it.  Literally a few hours before my flight out I went to our local Mac store and got a Targus Versavu Rotating Keyboard Case.


I had only 2 options at the store, no time to shop, and a flight to catch so I bought it.  Worked like a charm; it is stylish, so it was a good investment. I used the Notability App and kept only one running note document.  For the first time at a conference I felt like I ~might~ be able to ditch my HP mini and bring only the iPad.  I have been traveling with both because using Word office products is vastly easier on the HP mini, and it’s easier to access our medical record.  When I’m flying out and back, the HP mini is more useful.  At the conference, the iPad is more useful.  Ah the ongoing techy dilemmas.

Now I’m headed back.  Always a little sad.  I hope I can make one more improvement to my conference-going plan this time around, which is to capitalize on all the great ideas flowing around in my head and not let them fade away into “never finished land”.

Oh, and next time around, I’m getting better shoes.  Gotta go back to the twitter stream and poll the #DDW13 ladies about their favorites.  That’s it until next year, in Chicago!!


Guest Post: “A Real Cancer Story: Our Survival”

March 5th, 2013

Dear Readers,

I was honored to be contacted by Cameron whose wife Heather was able to beat a highly aggressive, usually fatal cancer called malignant pleural mesothelioma. He responded to a post I had written earlier that dealt with my personal health fears and taking care of my own health.

Often as physicians, we spend so much effort focusing on patients that we forget a critical component: caring for their caregivers.

Here is Cameron’s story about his experience. Since the position of caregiver is a role most of us will play at some time in our lives, I hope it serves as inspiration for you as it did for me.



A Real Cancer Story: Our Survival

I often think about the moment in my life when I changed completely. It was in November of 2005 as I sat with my wife in the doctor’s office that I knew everything was going to be different. That was the day that she was diagnosed with cancer, malignant pleural mesothelioma. It was terrifying, and it came out of nowhere. Only three months before we had been celebrating the birth of our daughter Lily, our only child. Our excitement about the future of our new little family was ripped away from us the instant we received the diagnosis.

I became a caregiver as soon as the diagnosis was delivered. There wasn’t any time to waste. The doctor made sure to tell us about treatment options, and laid out several different locations where we could seek treatment. He mentioned a specialist in Boston named Dr. David Sugarbaker who had an excellent recovery rate for mesothelioma. For my wife, I wasn’t going to let anything stop her from receiving the best treatment, and therefore we made the decision to travel to Boston. It was the first decision of many that I had to help make in the midst of doubts and fear after her diagnosis.

Everything is almost a blur after that. Months went by in chaos. Our lives had been turned upside down. I was still working as many hours as I could while I took care of Lily and Heather, and sometimes, I couldn’t help but let my fears get the best of me. I dreaded the thought of being widowed and alone with my daughter Lily. It was something that kept me up until the early hours of the morning, and more than once caused me to break down in tears under the pressure and fear. However, I never allowed Heather to see me in these weak moments, as I knew she needed me to be a rock for her through this difficult time.
Heather’s family was the first to reach out. They knew that we were going through rough times and came through for us in many ways. They provided help for treatment and other financial assistance that we desperately needed. They also helped with Lily’s care during our trips away from home for treatment. Friends were also there for us, offering support in any way that they could. It was the most amazing gift to receive after all of the heartache, and I can’t help but think of what would have happened if I didn’t have these people in my life. My strongest advice for anyone going through a similar situation is to always accept help whenever it is offered. There is no room for pride when a loved one’s life is on the line. Even the smallest bit of help can be a huge weight off your shoulders, and will remind you that you’re not alone in this fight.

After undergoing intense mesothelioma treatment, which included surgery, chemotherapy and radiation, Heather achieved the improbable and beat mesothelioma, a feat accomplished by far too few people. I learned to never give up hope through this whole ordeal. There were many times when I let fear get the best of me, but I always held on to hope and never gave in to despair. Now, seven years later, Heather is healthy and cancer free. We hope that our story of success over cancer can be a source of hope and inspiration to all those currently battling cancer today.

Cameron Von St. James

Mesothelioma Cancer Alliance


#lonelybfast #greensmoothie Sunday grab bag; finally used my Muscadine-Tomato gastrique

January 27th, 2013

It’s time to go to the grocery store. Since I don’t have time to go before breakfast, I’m just going to have to see what I have to make our green smoothie breakfast this morning.

Still have some kale. I also saved a little bit of red pepper from my dehydrated peppers yesterday. Have one sliver of a hot pepper left also.

We have a lot of kiwis that are ripening, and I just discovered yesterday that a less ripe Kiwi makes a nice peppery addition.

I also remembered an attempt this summer to make a Muscadine tomato gastrique. I took a container of muscadines, some fresh tomatoes, balsamic vinegar, brown sugar, and reduced them together for quite a while. It was only okay, so I froze it until I could figure out what to do with it. I realized that might make a fine addition to a green smoothie.

So, this morning’s lonely breakfast, green smoothie is:

(Recipe for two)
4 cups kale
One frozen banana
Half of a fresh red pepper
One slice of hot pepper
Two medium kiwis
4 tablespoons flax meal
One scoop lecithin granules (for my hubby; I’m not really sure if this is important, but he bought ‘em so I’m using ‘em).
1 cup frozen Muscadine- tomato gastrique

This was a risky one, but it was really good. I give it a solid four stars. I don’t think the hubby liked the fact that the muscadine skins didn’t get well puréed, and you had to chew. That didn’t bother me; I simply thought it was healthy fiber.

#lonelybfast #greensmoothie Kick A** Curry Smoothie *****

January 19th, 2013

Yay for the weekend! Have a little bit of extra time, and with what I have left in the fridge, I decided to make an awesome curry smoothie.

The hubs is home today studying hard for the GMAT, so I’m doubling my recipe to make us both one.

Unfortunately I have only one cup left of the flax milk, and only a little bit of cows milk. So I’m thinking hard, and realize that I really prefer to make this with the coconut milk beverage if I could.

And the proverbial lightbulb comes on over my head: I have a can of light coconut milk in the pantry. I looked at the label, and it’s 50 cal per 1/3 cup. That’s about how much is in one cup of coconut milk beverage. So I decided to make my own coconut milk beverage with one can of light coconut milk and two cans of water.

It looked a little thinner than what you can buy in the stores, but it tasted slightly more coconutty, which I liked. Particularly when you’re making a curry smoothie.

I also have a whole lot of tumeric root. I saw it at whole foods and thought I’d try it. I don’t really know exactly what to do with it, but I’ve blended up a piece with a few smoothies. It’s really bitter, and it definitely stains your hands orange, but tumeric is really good for you, and it’s suspected to decrease the rates of several cancers.

Here’s today’s Curry Smoothie (for two):

1 frozen banana
1 cup flax milk
1 cup coconut milk beverage (or diluted coconut milk from the can)
4 cups kale
1 1/3 cups frozen mango chunks
2 inch piece tumeric root
1/2teaspoon rosewater
1 teaspoon white/unroasted curry powder
2 tablespoons shredded coconut flakes
Six pods of cardamom ground

This was pretty awesome! At first the rosewater was overpowering, then I added the curry, and then the curry was overpowering the rosewater. So I adjusted the recipe above to cut back a little on the curry powder. Hopefully you’ll taste more of the rosewater that way.

Now for my coffee…

#lonelybfast #greensmoothie Acai Guarana Kiwi=grand slam! Plus eggplant chips results.

January 17th, 2013

If you were reading yesterday you might’ve noticed that I was more than a little bit disappointed with my new dehydrator. Really I was disappointed with myself.

This morning is total redemption! My eggplant chips and simple dehydrated red, orange and golden peppers are awesome! Today is going to be a great eating day!

My city is also excellent as well. I’ve learned that berries and Kiwi go great with kale, better than a lot of other fruits. So today:

2 cups kale
1 smoothie packet açai guarana
One kiwi
One cup flax milk

Five stars!

I also opened up the special holiday coffee that is really just too pretty to drink. It’s called hullabaloo from Metropolis coffee.

Adventures in dehydrating: okay, so green beans, yeah not that great

January 16th, 2013

Perhaps I was a little naïve. Perhaps I could’ve done a bit of extra research before I made this purchase. I mean, I had it all worked out in my head, but you know what they say about hindsight.

So experiment number two was green beans, right? I was so excited about green beans. Who wouldn’t want some crunchy spicy curry green beans to snack on? After my arugula fail, I was sure I had hit a homer with this one.

Oh the best laid plans of mice and men…

Problem #1: it took for-ev-uh to dry. It did say it would take 8 to 12 hours to dry, which was much longer than the other things. I didn’t really believe it, so I set it on 8 hours. Sure ’nuff they were right. Eight hours later they were maybe two-thirds there.

So I just cranked it up again and let it run for another three hours. This morning I took them out, expecting an improvement. Which leads us to:

Problem #2: They are really durn hard and chewy. There ain’t no crunch here.

I mean, duh Lena, have you had dehydrated soup before? Don’t you remember that that’s what happens when you dehydrate things?

I was seduced by the crunch of the kale chips, and naïvely believe that all fruits and vegetables would dehydrate in such a manner. Now I am more than a little concerned about my next experiments.

Ever the optimist though, I soldier on. Next up: orange cardamom eggplant chips. I really hope this one is going to be better, or I’m going to have to get really creative with my dehydrator fails.


#lonelybfast #greensmoothie Strawberry Mango Kale

January 15th, 2013

This Morning:
2 cups kale
1/2 cup fresh strawberries
2/3 cup frozen mango
1 cup flax milk
1/2 scoop lecithin granules just for the heck of it
After initial taste: 1/2 packet Truvia

Verdict? Good! 4 stars

I’m working in my scoring system:
1 star : not drinkable requires fixing
2 stars : drinkable but takes effort
3 stars: passable
4 stars: good, I enjoyed it
5 stars: awesome, I slurped it up!

#lonelybfast #greensmoothie Strawberry Mango Kale

January 15th, 2013

This Morning:
2 cups kale
1/2 cup fresh strawberries
2/3 cup frozen mango
1 cup flax milk
1/2 scoop lecithin granules just for the heck of it
After initial taste: 1/2 packet Truvia

Verdict? Good! 4 stars

I’m working in my scoring system:
1 star : not drinkable requires fixing
2 stars : drinkable but takes effort
3 stars: passable
4 stars: good, I enjoyed it
5 stars: awesome, I slurped it up!

    About Me

    Professional Gastroenterology Fellow

    Amateur Martha Stewart/Bob Villa/Julia Child/Collette Peters