Gluten Free RN Nadine Grzeskowiak, RN BSN CEN

What did we know about celiac disease in 1953?
The truth is, we knew quite a bit about sensitivity to gluten 65 years ago when Matilda Babbitz’s son Bobby was diagnosed with celiac disease. A nurse by profession, Matilda carefully observed her baby and kept detailed records of his reactions to foods, working with doctors to determine an appropriate diet for Bobby.
Today, the Gluten Free RN is sharing an article published in the March 1953 edition of the American Journal of Nursing written by Matilda herself. She covers how Bobby presented with celiac disease at six months of age and the dramatic change in his health and behavior after a diet change.
Nadine discusses the systematic approach Bobby’s healthcare team took in creating a custom diet, the relationship between the baby’s irritability and his inability to digest food, and his growth and development before and after treatment. She also addresses the misunderstanding that children will ‘grow out of’ celiac disease, explaining that we’ve since learned patients must adhere to a 100% gluten-free diet for life. Listen in for insight around what we can learn from past case studies of celiac disease and understand what we already knew about celiac disease back when Eisenhower was president and Gentlemen Prefer Blondes was on the big screen!
What’s Discussed: How Bobby presented with celiac disease at six months of age
Sudden attack of diarrhea, upper respiratory infection History of GI difficulty + distended abdomen, increased gas Marked irritability, weight loss, inability to move arms/legs The dramatic change in Bobby’s behavior after a diet change
Symptoms of diarrhea, vomiting and weakness disappeared Irritability subsided with shift to skim milk The new pediatrician’s approach when Bobby’s progress stalled
Shift to goat’s milk, added complete multivitamin supplement The relationship between irritable behavior and the inability to digest foods
Nurse/mom kept detailed records of foods eaten, reactions Bobby’s growth and development before and after diagnosis
Lost ability to perform gross motor activity prior to diagnosis Caught up with age group after diet change (walked at 18 months) How Bobby’s mother dealt with social pressure to eat with others
Replaced cookies and ice cream with sherbet and lollipops Kept away from parties so not conscious of being left out The chronic nature of celiac disease
No one ‘grows out of’ being celiac 100% gluten-free diet for life Nadine’s insight around what we knew about celiac disease in 1953
Many celiac patients unable to digest cow’s milk Need supplementation with vitamins, certain fats Recognized impairment of immune system Resources ‘Bobby Has Celiac Disease’ in the American Journal of Nursing
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Books by Nadine: Dough Nation: A Nurse's Memoir of Celiac Disease from Missed Diagnosis to Food and Heal
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‘Know your own truth and let that guide you.’
How do you cut through the noise and misinformation around gluten sensitivity and celiac disease in order to make the best choices for your health and happiness? By tapping into your intuition and asking WHY when the answers don’t feel right—and reaching out to the right people for support when you need it.
Today, the Gluten Free RN is sharing her Top 10 Musings and Truths for health and wellbeing, empowering you to be self-protective and surround yourself with the people who genuinely care enough to speak up for—and with you. She shares the value in setting goals for your physical and mental health and taking your power back from the people who may have victimized you in the past.
Nadine also encourages you to get educated and engage in critical thinking, questioning the information you are given and saying ‘no’ to anyone who suggests you eat gluten—even if they happen to be a doctor. Listen in to understand the idea that ‘you are your own experiment’ and learn to be the healthiest YOU you can be by committing to a 100% gluten-free diet!
What’s Discussed: Commit to being 100% gluten-free, dairy-free and ideally Paleo Focus on diet change for first year so intestines can heal Be self-protective Lose people who aren’t supportive Find your tribe People who speak up for/with you, willing to change diet Set goals for what you want your life to look like Write down objectives to make real, move in that direction Be powerful (even if you don’t feel it) Speak up and take power back, don’t be victim Get educated and educate others Go to conferences, read and do research Don’t believe everything you hear, read or say Get answers to questions, then question the answers (ask WHY) Don’t eat gluten for anyone Not for friends/family, doctors or research study Be the healthiest YOU, you can be Strive for MORE health, fun, good food and information You are your own experiment Reassess and apply new information as needs change, work with team Connect with Nadine: Instagram
Facebook
Contact via Email
‘Your Skin on Gluten’ on YouTube
Melodies of the Danube Gluten-Free Cruise with Nadine
Books by Nadine: Dough Nation: A Nurse's Memoir of Celiac Disease from Missed Diagnosis to Food and Heal

Much existing propaganda claims that African Americans do not suffer from celiac disease. Even the Gluten Free RN was surprised to find out that her adopted daughter had a genetic predisposition to the disease back in 2006, as research available at the time regarded the HLA-DQ2 and HLA-DQ8 genes to be primarily Caucasian traits. And until we take steps to conduct a mass screening, we simply don’t know how common celiac disease is among people of African descent.
Today, the Gluten Free RN is exploring celiac disease in the African American population. She covers a 2006 study out of Columbia University that assessed African American celiac patients, discussing the variety of ways the subjects presented with celiac disease and the potential reasons for their poor compliance with the prescribed gluten-free diet.
Nadine also considers the prevalence of celiac disease on the continent of Africa, explaining why she believes the number of celiac patients will explode with the population’s growing exposure to wheat. Listen in for the Gluten Free RN’s insight on other health issues that may point to undiagnosed celiac disease and learn how we can prevent celiac disease among the African American population with access to testing, social support and gluten-free food!
What’s Discussed: The 2006 Columbia University study of celiac disease in African Americans
Identified nine patients with biopsy-proven celiac disease Presented with diarrhea, iron deficiency anemia and autoimmune disorders Why patients in the Columbia study demonstrated poor dietary compliance
Expense, availability and palatability of gluten-free food Lack of symptoms at diagnosis, inaccurate dietary information Nadine’s prediction around the number of celiac patients in Africa
Increasing exposure to wheat will cause explosion The statistics regarding the mortality burden of celiac disease
Science Daily reported estimates of 42K child deaths every year in 2011 Majority from Africa and Asia The overlap between diabetes and celiac disease
Every type 1 diabetic is HLA-DQ2/8 gene carrier The health issues that may indicate undiagnosed celiac disease
Type 1 diabetes, cardiac issues, stroke and heart attack Obesity (stems from lack of nutrient absorption) How to prevent celiac disease among the African American population
Access to testing, social support and gluten-free food Resources: Celiac Disease and How Gluten Affects Your Skin EP011
‘Your Skin on Gluten’ on YouTube
‘Celiac Disease in African-Americans’ in Digestive Diseases and Sciences
‘First Global Estimates of Coeliac Disease and Its Mortality Burden’ in Science Daily
Neurological Disorders Associated with Celiac Disease EP012
‘Celiac Disease in the Developing Countries: A New and Challenging Public Health Problem’ in the World Journal of Gastroenterology
‘Systematic Review: Worldwide Variation in the Frequency of Coeliac Disease and Changes Over Time’ in Alimentary Pharmacology and Therapeutics
‘HLA Typing and Celiac Disease in Moroccans’ in Medical Sciences
‘A Historical Assessment of Sources and Uses of Wheat Varietal Innovations in South Africa’ in the South African Journal of Science
University of Chicago: Celiac Disease Facts and Figures
‘Adult Coeliac Disease in South Africa: An Analysis of 20 Cases Emphasizing Atypical Presentations’ in the South African Medical Journal  
‘Epidemiological and Clinical Features in Immigrant Children with Coeliac Disease: An Italian Multicentre Study’ in Digestive and Liver Disease
‘Prevalence of Positive Coeliac Serology in a Cohort of South African Children with Type 1 Diabetes Mellitus’ in the South African Journal of Child Health
ESPGHAN Goes Africa Course
Connect with Nadine: Instagram
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‘Your Skin on Gluten’ on YouTube
Melodies of the Danube Gluten-Free Cruise with Nadine
Books by Nadine: Dough Nation: A Nurse's Memoir of Celiac Disease from Missed

Approximately 50% of ER visits are associated with abdominal pain, and the vast majority of those patients are given a diagnosis of ‘abdominal pain of an unknown origin’ and directed to come back if the condition gets worse. This is little comfort to people suffering from severe discomfort who need answers around the cause of their belly pain, not just medication to mask it temporarily. Could undiagnosed celiac disease be the source of their suffering?
Today, the Gluten Free RN is diving into the issue of belly pain and undiagnosed celiac disease, discussing the expensive testing often conducted to determine the cause of abdominal discomfort—testing that rarely includes a celiac panel. She covers several of the common misdiagnoses of celiac patients as well as the incredibly high prevalence of abdominal pain in children. 
Nadine shares the case study of a child-patient who was misdiagnosed with appendicitis and the research published in Digestive and Liver Disease outlining the unnecessary surgical interventions endured by undiagnosed celiac patients. Listen in for the Gluten Free RN’s advice to patients with idiopathic abdominal discomfort and learn why no one should suffer from belly pain!
What’s Discussed: The statistics around ER visits and abdominal pain
50% of visits associated with belly pain The most common abdominal pain diagnoses
Abdominal pain of unknown ideology, idiopathic abdominal pain How patients are treated for idiopathic abdominal pain
Medication, directive to return if condition gets worse The testing to find the cause of chronic abdominal pain
Expensive blood workups, rarely include celiac panel How many children suffer from belly pain
30% report abdominal discomfort Nadine’s patient who received a misdiagnosis of appendicitis
Mother of child-patient sought second opinion prior to surgery Child didn’t have appendicitis, cause of pain still unknown A research study around abdominal surgery and celiac disease
Patients with celiac disease at increased risk of abdominal surgery Misdiagnosis leads to inappropriate interventions (i.e.: appendectomy) Nadine’s advice for patients diagnosed with idiopathic abdominal pain
Initiate clinical trail of gluten-free or Paleo diet Resources: ‘Increased Rate of Abdominal Surgery Both Before and After Diagnosis of Celiac Disease’ in Digestive and Liver Disease
‘Screening for Celiac Disease in Children with Recurrent Abdominal Pain’ in the Journal of Pediatric Gastroenterology and Nutrition
‘Effect of a Gluten-Free Diet on Gastrointestinal Symptoms in Celiac Disease’ in the American Journal of Clinical Nutrition
‘Clinical Features and Symptom Recovery on a Gluten-Free Diet in Canadian Adults with Celiac Disease’ in the Canadian Journal of Gastroenterology
‘Association of Adult Celiac Disease with Surgical Abdominal Pain’ in Annals of Surgery
‘A New Insight into Non-Specific Abdominal Pain’ in The Annals of The Royal College of Surgeons of England
Connect with Nadine: Instagram
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‘Your Skin on Gluten’ on YouTube
Melodies of the Danube Gluten-Free Cruise with Nadine
Books by Nadine: Dough Nation: A Nurse's Memoir of Celiac Disease from Missed Diagnosis to Food and Heal

If you are being treated for a blood disorder, it is time to look deeper and explore the underlying cause. Rather than simply addressing iron- or B12-deficiency anemia in isolation, ask WHY you have a deficiency in the first place. It is possible that damage to your intestines caused by gluten is preventing your body from absorbing the nutrients necessary to grow your red blood cells and keep your immune system healthy. And anemia is not the only blood disorder associated with celiac disease and non-celiac gluten sensitivity!
The Gluten Free RN is taking a closer look at the hematologic manifestations of celiac disease from anemia to hyposplenism. She explains the connection between disorders of the blood and bones, offering insight around why men with both anemia and osteoporosis are also likely to have celiac disease.
Nadine discusses the danger in taking H2 blockers or proton pump inhibitors for GERD long-term, describing how those medications decrease the gastric acid necessary for breaking down food. She also addresses what you can do to identify any nutritional deficiencies in your blood and reminds us why celiac patients have difficulty absorbing the nutrients necessary to form red blood cells. Listen in to understand how the skin reflects what’s happening internally and learn how to prevent a number of blood disorders with a gluten-free diet!
What’s Discussed:  The hematologic manifestations of celiac disease
Anemia secondary to malabsorption of iron, folate and vitamin B12 Thrombocytosis, thrombocytopenia, leukopenia, venous thromboembolism Hyposplenism, IgA deficiency and increased risk of lymphoma Why iron supplements didn’t solve Nadine’s anemia
Couldn’t absorb supplements due to undiagnosed celiac disease The connection between anemia, osteoporosis and celiac disease
B12 forms red blood cells made in long bones The danger of taking H2 blockers and PPIs long-term
Decreases levels of gastric acid necessary to liquify food Leads to bacterial overgrowth, gastritis How to uncover potential nutrient deficiencies in your blood
CBC with differential (breakdown of red blood cells) The conclusions of the 2007 study in Blood
Anemia and hyposplenism are most common complications of celiac disease Obtain small-bowel biopsy in all patients with iron-deficiency anemia The fat-soluble vitamins
A, D, E and K Deficiency in one indicates malabsorption, potential celiac disease The connection between DH and celiac disease
Skin disorders begin in intestines Resources: ‘Hematologic Manifestations of Celiac Disease’ in Blood
Celiac Disease and Your Spleen
Dr. Ben Lynch: Folic Acid vs. Folate
‘The Thrombophilic Network of Autoantibodies in Celiac Disease’ in BMC Medicine
‘Hematologic Manifestations of Celiac Disease’ in Celiac Disease— From Pathophysiology to Advanced Therapies
‘Sarcoidosis, Celiac Disease and Deep Venous Thrombosis: A Rare Association’ in Balkan Medical Journal
‘Celiac Disease Manifesting with Deep Venous Thrombosis: A Case Report’ in Govaresh
‘Deep Venous Thrombosis and Bilateral Pulmonary Embolism Revealing Silent Celiac Disease’ in Case Reports in Gastrointestinal Medicine
‘How Often Do Hematologists Consider Celiac Disease in Iron-Deficiency Anemia?’ in Clinical Advances in Hematology & Oncology
‘Deep Vein Thrombosis Associated with Celiac Disease’ in Bratislavske Lekarske Listy
‘Celiac Disease Presenting with Immune Thrombocytopenic Purpura’ in Case Reports in Hematology
‘Lower Extremity Deep Vein Thrombosis Associated with Gluten-Sensitivity Celiac Disease’ in Terapevticheskii Arkhiv
Connect with Nadine: Instagram
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‘Your Skin on Gluten’ on YouTube
Melodies of the Danube Gluten-Free Cruise with Nadine
Books by Nadine: Dough Nation: A Nurse's Memoir of Celiac Disease from Missed Diagnosis to Food and Heal

Your gastrointestinal tract is approximately 30 feet long, and it runs from your mouth all the way to the anus! We know that celiac disease can impact any part of the digestive tract. But there is another disease that wreaks havoc on the GI tract as well, a condition called eosinophilic esophagitis or EoE.
The Gluten Free RN is explaining the fundamentals of eosinophilic esophagitis, from its characteristic inflammation of the esophagus and elevated eosinophils in the blood to the common symptoms of vomiting and upper abdominal pain. She walks us through the treatment for EoE, an elimination diet or steroid therapy.
Nadine speaks to the research exploring a possible connection between eosinophilic esophagitis and celiac disease, citing a paper that found a higher prevalence of EoE in children with celiac disease than the general population as well as the case study of a woman with both celiac disease and elevated eosinophils in her blood. Listen in for the Gluten Free RN’s insight on the best EoE clinics and physicians in the country and learn why further study is needed around EoE and celiac disease!
What’s Discussed:  The fundamentals of eosinophilic esophagitis
Allergic response to dietary antigens Causes inflammation of esophagus, increased eosinophils in blood The benefits of unsedated transnasal endoscopy for children with EoE
Monitors esophageal mucosa without sedation Safer, faster and less costly Some common symptoms of eosinophilic esophagitis
Vomiting, difficulty swallowing, food stuck in throat Chest pain, heartburn, upper abdominal pain The condition of achalasia
Muscles of esophagus don’t work appropriately Causes spasms or constriction The treatment for EoE
Elimination diet (remove wheat, eggs, milk, soy, shellfish and seafood, peanuts and tree nuts) Topical or systemic steroids The potential increased prevalence of EoE in children with celiac disease
2015 paper found prevalence of 10.7% (much higher than general population) Other research articles argue no increased prevalence of EoE in CD The case study of a 30-year-old woman with celiac disease and elevated eosinophils
Presented with abdominal pain and distension, vomiting and frequent bowel movement Treated with IV hydrocortisone, but developed steroid induced psychosis Nadine’s insight on the best specialty clinics for EoE in the US
University of Colorado (Denver School of Medicine) Pennsylvania Dr. Glenn Furuta’s insight on the difficulty of diagnosing EoE
Relatively new disease, tendency to diagnose based on pathology report alone Elevated eosinophils also found in GERD, inflammatory bowel disease and celiac disease Special considerations for pediatric patients with EoE
Consultation with dietician Limited exposure to corticosteroids Attention to development of feeding skills Potential psychosocial, behavioral problems Resources: ‘Unsedated Transnasal Esophagoscopy for Monitoring Therapy in Pediatric Eosinophilic Esophagitis’ in Gastrointestinal Endoscopy
‘Eosinophilic Esophagitis Associated with Celiac Disease in Children’ in BMC Research Notes
‘Eosinophilic Gastrointestinal Disorder in Coeliac Disease: A Case Report and Review’ in Case Reports in Gastrointestinal Medicine
‘Eosinophilic Esophagitis in Children and Adults’ in Gastroenterology and Hepatology
‘The Association Between Celiac Disease and Eosinophilic Esophagitis in Children and Adults’ in BMC Gastroenterology
‘Eosinophils in Gastrointestinal Disorders’ in Immunology and Allergy Clinics of North America
‘2013 Update on Celiac Disease and Eosinophilic Esophagitis’ in Nutrients
‘Eosinophilic Esophagitis: New Insights in Pathogenesis and Therapy’  in the World Journal of Gastrointestinal Pharmacology and Therapeutics
‘Incidence and Prevalence of Eosinophilic Esophagitis in Children’ in the Journal of Pediatric Gastroenterology and Nutrition
‘Management of Eosinophilic Esophagitis and Celiac Dis