Yoga and Celiac Disease

This post is published on The Huffington Post Blog.

I was diagnosed with celiac disease (“celiac”) in 2012. As a result, my life changed dramatically. What I thought would be a diet change turned out to be a lifestyle change affecting every part of my life – family, social, travel, and work. My symptoms ranged from the traditional gastrointestinal symptoms to extreme fatigue, lactose intolerance, and vitamin D insufficiency. Four years later, planning and preparing meals and monitoring and managing symptoms are now a normal part of my daily life. The new normal.
Celiac is a genetic[i], systemic autoimmune disorder caused by exposure to gluten.[ii] Gluten is a protein found in wheat, rye, and barley. The immune response activated in celiac when gluten is ingested causes the body to attack gluten as if it is an antigen. This immune response causes damage to the villi within the small intestine. According to the University of Chicago Celiac Disease Center, there are approximately 200 hundred recognized symptoms of celiac,[iii] including cancer, infertility, and depression. Celiac affects 1 in 133 people in the U.S. Currently, the only available and medically accepted treatment for celiac disease is the strict adherence to a gluten-free diet.[iv]

Patients with celiac must avoid ingestion and in some cases physical contact with anything that contains or has come in contact with gluten (wheat, barley, or rye). This includes food, cosmetics, beauty products, cleaning supplies, and medications that contain gluten. Exposure to gluten from any of these sources can also result in a celiac-related immune response and accompanying symptoms.

Upon diagnosis, I immediately eliminated gluten from my diet after my diagnosis and over the following 10 months eliminated gluten from my beauty products and cleaning supplies. Only then did I receive a negative blood test and “no exposure” declaration from my gastroenterologist. In order to heal my gut completely I adopted a whole foods diet free from grain, alcohol, dairy, soy, and processed foods for six months. Studies show that the intestinal damage caused by celiac can be healed over time by adherence to a gluten-free diet, although it is less successful in adults than children.[v]

One of the primary challenges of living with celiac is avoiding unintentional exposure to gluten, typically due to cross-contamination of gluten-free food with gluten-containing food (e.g. via cutting boards, grills, utensils, or medications) in restaurants. An inadvertent exposure causes symptoms similar to those at diagnosis. The treatment of symptoms from an exposure to gluten may include rest for fatigue and brain fog, anti-diarrheal medications for gastrointestinal symptoms, and eating whole, easily digestible foods and drinking lots of water. However, this varies based on the needs of the individual.

Two years after my diagnosis I started a relationship with yoga, which as grown quickly and significantly. I practice Hatha and vinyasa flow yoga in the lineage of Krishnamacharya and Shiva Rea. I am now a registered yoga instructor (RYT200), trained at Pranayoga Institute of Yoga and Holistic Health. I was drawn to yoga for stress relief but have found it a great tool for gastrointestinal health and support for celiac symptoms.

However, there are no studies investigating a connection between yoga and celiac disease. Current medical research on yoga and gastrointestinal disorders is focused mainly on irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Similar to celiac, IBS and IBD symptoms include anxiety, depression, headaches,[vi] severe diarrhea, abdominal pain, cramping, weight loss, and fatigue.[vii]

In a study of patients with IBS practicing yoga once a week for 6 weeks improvement was found in the patients’ symptoms, including fatigue, physical functioning, and abdominal pain.[viii] Quality of life scores and functional abdominal pain improved in a study of 20 patients with IBS after practicing yoga for 12 weeks.[ix] Patients with IBS who practice one hour of yoga at home via a video-guided practice experienced improved gastrointestinal symptoms and decreased pain.[x] Additionally, the patients indicated that they would continue practicing yoga because it was beneficial to them. These studies demonstrate a pattern of improved symptoms and enhanced quality of life among those with gastrointestinal symptoms who practice yoga.

I have found that my yoga practice generally improves my health (mind and body) and specifically helps manage my digestive process. After two years of regular yoga practice with pranayama and inconsistent meditation I have found poses and techniques that help with specific symptoms. When I am experiencing constipation and other gastrointestinal symptoms I rely on balasana (child’s pose), apanasana (knees into chest or full gas release pose), viparita karani (legs up the wall), malasana (squat), and supta baddha konasana (reclining butterfly) to assist in elimination and relief. Apanasana or knees into the chest pose done with a micro-dynamic movement in and out with the breath (inhale and move the knees out as far as the arms will extend and exhale bring them back into the chest) provides immediate relief to bloating due to gas and constipation. And when I am experiencing extreme fatigue pranayama (alternate nostril breath and other deep breathing) and a balanced Hatha practice increase my energy level and help me to sleep better.

FullSizeRender 2Yoga certainly isn’t magic but the management of my digestive health and symptoms have improved since I began practicing yoga. Whether the improvement is a result of decreased stress and increased relaxation that comes from yoga or a direct physiological response to certain movements, I can’t be certain.

It is difficult to separate the whole body, wellness, and life experience into parts that isolate what activities affect certain conditions. However, for me it is clear that the holistic practice of yoga supports the healthy functioning of my body as a whole – mentally, emotionally, and physically.

Many of the same symptoms and body processes present across gastrointestinal diseases, including IBS, IBD, and celiac disease. Given the scientific evidence and my experience, it is an easy leap to suggest that a regular yoga practice can lead to positive outcomes for people with celiac and other gastrointestinal diseases or distress.

Ultimately, every body is different and each person must know how their body responds to their specific condition. That awareness will aid in finding the right physical yoga practice to feel whole and well again. Because, yoga is for everyone.

 

[i] Celiac Disease. U. S. National Library of Medicine website. https://ghr.nlm.nih.gov/condition/celiac-disease. Updated May 10, 2016. Accessed May 11, 2016.

[ii] Celiac Disease. National Institute of Diabetes and Digestive and Kidney Diseases website. http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/celiac-disease/Pages/facts.aspx#what. Updated June 2015. Accessed May 11, 2016.

[iii] Symptoms of Celiac Disease. The University of Chicago Medicine Celiac Disease Center website. http://www.cureceliacdisease.org/symptoms/. Accessed May 11, 2016.

[iv] Treatment of Celiac Disease. The University of Chicago Medicine Celiac Disease Center website. http://www.cureceliacdisease.org/treatment/. Accessed May 11, 2016.

[v] Celiac Disease – Sprue. U. S. Library of Medicine Medline Plus website. https://www.nlm.nih.gov/medlineplus/ency/article/000233.htm. Updated February 21, 2014. Accessed May 11, 2016.

[vi] Kavuri V, Raghuram N, Malamud A, Selvan SR. Irritable Bowel Syndrome: Yoga as Remedial Therapy. Evid based Complement Alternat Med : eCam. 2015;2015:398156. doi: 10.1155/2015/398156.

[vii] Mayo Clinic. Diease and Conditions: Inflammatory Bowel Disease. Available at: http://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/basics/symptoms/con-20034908. Updated: February 18, 2015. Accessed: March 14, 2016.

[viii] Evans S, Lung KC, Seidman LC, et al. Iyengar Yoga for Adolescents and Young Adults With Irritable Bowel Syndrome. J Pediatr Gastroenterol Nutr. 2014; 59(2):244-253. doi:10.1097/MPG.0000000000000366.

[ix] Brands M, Purperhart H, Deckers-Kocken J. A Pilot Study of Yoga Treatment in Children with Functional Abdominal Pain and Irritable Bowel Syndrome. Compliment Ther Med. 2011.19(3) 109-114.

[x] Kuttner L, Chambers CT, Hardial J, Israel DM, Jacobson K, Evans K. A randomized trial of yoga for adolescents with irritable bowel syndrome. Pain Res Manag : The Journal of the Canadian Pain Society. 2006; 11(4):217-224.

Advertisements

Fall in the Midwest Remembers Spring at the Four Seasons in Nevis

Last week while driving through rural Indiana I caught a glimpse of a soybean field at that special moment when it is green, yellow, and brown at the same time. I immediately stopped in the middle of the road. This is one of those moments, like the turning of the leaves, that change daily. You can’t wait until tomorrow to capture that view, because by tomorrow it will have changed.

It is pretty.

But, it is also a sign. A sign that fall is upon us and that winter is coming. The combines have started to churn up dust on the horizon. At night you can see the eerie glow of the combine lights as they work. Fresh apples are everywhere and the leaves will changes colors soon. This is all part of the opening act for the Midwestern winter – first comes harvest, then the leaves disappear, the wind quickly becomes unbearable, and then the snow. Maybe it will be an easy winter, maybe it will be another harsh one – it is impossible to predict. No one knows.

I looked at those soybean fields and my mind took me right back to my 5 days on the island of Nevis, West Indies in May. It is shocking how quickly a thought of winter will prompt my amygdala to paint scenes of sandy beaches and ocean sunsets in my mind.

I realized earlier this year that I was going to need a real break. I would need a vacation that was more than a stay-cation but less than an over-scheduled-experience-everything-possible vacation. A cousin and a dear friend both recommended Nevis after taking trips there (separately – they don’t know each other). So I signed up, with much less research than I normally do before committing to a trip.

I was a bit nervous about going alone. Traveling alone on a trip with a lot of activities is easy and I do that all the time, but I wondered if I would be happy being alone with nothing much to do for 5 days. But, I went anyway.

I am glad I did.

I spent five peaceful, refreshing, and fabulous days at the Four Seasons Resort on Nevis. It was so lovely that I did not leave the resort. Why would you – there are walking trails, 4 restaurants, 3 pools, watersports, and plenty of perfect beach right there.

It was the best solo trip I have ever taken – walks, reading, laying by the ocean, and making new friends. Dinners were amazing – the two fine dining restaurants Mango and the Coral Grill, were able to create celiac-friendly meals and legitimately seemed to enjoy doing it. The staff members were lovely. They learned my name and preferences quickly and made me feel right at home – so much so that I got goodbye hugs on my last night at Mango. It was an easy place to be.

I returned like new – calm, focused, and ready to get back to life until the next break. So, this winter when I am wondering when it is going to stop snowing I am going to remember Nevis to remind me that winter isn’t all that long. That should hold me over until Hawaii in January.

Mountaineers Are Always Free: My Introduction to Roger May

When I travel I always endeavor to find something interesting to do other than the usual tourist attraction. This is especially true in places I’ve visited before.

Sometimes this involves music, like the time I happened upon a Billy Joe Shaver concert at an art opening in Houston. It was such a small event we were able to have a good long visit with Billy Joe (a national treasure). Other times it’s a museum exhibit. That is how I got to see the history of dresses (or something like that) at the Fashion Institute of Technology in New York.

This week I was reminded of one of these experiences I had in Durham, North Carolina.

I was in Chapel Hill to see a friend and in a Google search prior to the trip I found an exhibit at a letterpress, graphic design, and print shop called Horse & Buggy Press. I had never heard of Horse & Buggy, and had no reason to, but was immediately drawn in by the name of the exhibit. It was called Testify: A Visual Love Letter to Appalachia by Roger May.

My childhood friend and I arrived at the print shop thinking this was as much an art gallery as a print shop. Not so much, but what we found was beautiful. While the majority of the first floor was a print shop there was a small lobby near the door that served as the gallery. Horse & Buggy printed Mr. May’s Testify, a limited edition, two-volume set of books featuring 50 photographs of Southern West Virginia and Eastern Kentucky. Some of the photographs from the books were displayed in frames on the shop’s walls near the front entrance.

Testify

Mr. May’s photographs were stunning and moving. Many of his photographs in Testify were taken less than an hour away from my childhood home. He captured with great care scenes from Central Appalachia as it is and has been for most of my life. I immediately bought the books and currently display them on my living room coffee table. I see them every day.

I recently showed the books to my father, a life-long resident of Central Appalachia, who was a bit flippant about looking at them. I imagine he was thinking that I was forcing him to appreciate some silly art or weird music (he knows his child). That changed when he realized what he was looking at and then he slowed down, his face softened and he looked with interest and more care. He saw something he knew. He said “I drove by this last month.” It is an amazing thing to see the things and places that you love captured in beautiful and respectful ways. That is what Mr. May did in Testify and does in his work. He displays the truth and beauty of Central Appalachia, including its idiosyncrasies and flaws, in a caring and respectful way.

Mr. May’s description of Testify and its meaning is as lovely as the photographs –

This is my testimony of how I came to see the importance of home and my connection to place. After moving away as a teenager, I’ve struggled to return, to latch on to something from my memory. These images are a vignette into my working through the problem of the construction of memory versus reality. My work embraces the raw beauty of the mountains while keeping at arms length the stereotypical images that have tried to define Appalachia for decades.

Mr. May’s first run of Testify went on to sell out. Currently, there are not plans for a second edition (although I bet if Horse & Buggy gets enough requests they might just do one).

I had never heard of Mr. May until I stumbled upon Horse & Buggy. He describes himself as an Appalachian American photographer and is most recently well-known for his work on the Looking at Appalachia project. You can read about it in National Geographic and the New York Times blog. He has a fun Instagram feed (@walkyourcamera) and a giant tattoo on his chest that reads Montani Semper Liberi – Mountaineers are always free, the West Virginia state motto. He is serious about Appalachian and I love that.

This week on Instagram Mr. May announced that he is selling his personal copies of Testify on a first come first serve basis. That post reminded me of what a treasure I found in an unlikely place on a random afternoon in Durham.

I am grateful for Mr. May and his work and love for Appalachia. I am also grateful for adventures that lead me to wonderful new people and things.

Fort Wayne Music: The B-Side

Have you ever wanted to hear your favorite band play in your living room? Just an evening with your closest friends and some live music.

You probably can’t make that happen, but seeing a show at One Lucky Guitar’s (OLG) B-Side is your next best option.

IMG_1769The B-Side space is located within the OLG design and marketing boutique. It is self-described as super intimate and urban, seating around 60 people. The mirrored fireplace and generous windows balance the exposed brick and open ceiling to give you the effect of being at home or in the coolest venue in the city.

My first B-Side experience was the most recent show – Rayland Baxter. The show was electric and the acoustics were great. The space, which is lovely, is set up to allow the artist to be as casual and comfortable as possible. There is no stage so the artist is amongst the crowd, which allows for an unusual visual perspective. This and the small size let’s the artist interact with the audience in personal and unusual ways – like a living room gathering of your closest friends.

The B-Side is a unique space featuring high quality acts, including Lloyd Cole later this month. Can you imagine, Lloyd Cole in your living room?

If you are a music lover in Northeast Indiana you should make seeing a show at the B-Side a priority.

What I’ve Learned from the Sun

I have always loved a sunset, but since moving to the Midwest I have fallen in love with the movements of the sky. I have try to watch as many sunsets and sunrises as possible; in four years I have seen hundreds. I make a special effort to watch them on certain days ­– my birthday, the new year, or when I need a reminder of just what a little speck that I am in this universe or how I am part of a large, unknowable plan.

The first thing I did on the first day of this year was get in my car and drive to my spot, a church parking lot at the edge of my subdivision, to watch the sun come up. In the silence I watched the light glow above the horizon and tree line. Then the sun slowly inched across the sky. As I did I made a list of the things I want to do and do better this year (no resolutions, just observations and promises to myself).

New Years Sunrise

When my list was long enough I stopped and put my phone down. I thought about how long I’ve been walking or driving to this spot to observe the sun. What have I learned from it? Is there anything to be taken from watching the two most physically beautiful parts of the day? It did not take long to realize the lessons and reminders that I can take from observing the sun.

The earth, the divine, speaks lessons and reminders, if we will listen. As I sat in the car, window down and seat heater on, a list of these lessons and reminders came quickly to mind.

Always look behind you.

RainbowsThe sun rises in the east and it does amazing things. But, that is not where all the action is. Look west. There is often something just as beautiful behind me. During a sunrise it is a pale pink glow on a clear day, other times the reflection of the sun’s glow on clouds, and if I am lucky, it’s a rainbow inspired by the morning dew. At sunset it’s the ombre of blue to purple to black layered from west to east. In the morning and night I look to the north and south and see more of that pink glow, carbon trails drawing pictures in sky reflecting the light in different ways, or long flat clouds that seem to go on forever.

I spend so much time looking in one direction – what I want, need, or where I am going down the road. If I’m not careful my laser focus causes me to miss things just as lovely, and important, that are happening in and around me. It is never just about what is in front of me. Situations look different depending on the point of view; sometimes I have to change my perspective to get to where I’m going.

Be patient.

Stalking sunsets and sunrises takes effort. It also takes practice. I can’t just show up at the exact time the weather channel says that the sun will set. I’ll miss it. This is especially true of ocean sunsets, if I look away for a second or stop watching for a moment to mess with my camera I’ll miss it. I have to find my spot and get there early. This might mean getting up early or staying late. It makes me work for it.

Pacific

Don’t all things worth having, seeing, or keeping take a little (or a lot) of work? The sun might be free, but it isn’t easy.

Embrace silence.

I like to talk. Frankly, I need to talk (my poor mother used to pray for 5 minutes of silence when I was a child).  If I am not talking I am playing music or running the television in the background. The sun, though, does all its work silently. Most of the year it does its work when the world is quiet – no traffic, little work, and before or after most people have gone inside.

The sun in some ways demands silence. I have watched sunsets with people and 100% of the time everyone becomes quiet as we watch. No one says, be quiet or shhhh. Your spirit just knows to quiet itself – to embrace the peace of it, to stand in awe and reverence of the divine.

It is a lovely time – a new day or the end of one – to think, pray, reflect, or whatever I need to do. A time to be quiet and still. A time to listen to that still small voice.

Summer Sunset

I can’t always see what is next, but I trust it will be good.

Recently a friend died unexpectedly. I found out on a Friday. As it goes with these things, I spent much of the day trying to understand and thinking about my life and its fragility. Understanding did not come, nor did I expect it. That understanding will only come, as Dolly would sing, “farther along.” But the lack of understanding hung there reminding me that I am not in control and I don’t know what will happen tomorrow.

LorinThe next morning I woke up, threw on my slippers and a jacket over my night-clothes. I drove to my spot to watch the sunrise. It was late fall and the sun had shifted behind a cluster of trees. I would not be able to see the sun itself until it was up and clear of the woods, a quarter of the way up. I waited and watched the light start to glow through and then above the trees. I knew what was coming but I couldn’t see it yet. As I waited I was reminded that just because I can’t see what’s next doesn’t mean it isn’t going to be wonderful. It is so easy to feel like things are not moving fast enough or going where I want them to go. But no matter how I feel, I believe there is something good ahead, just beyond what I can see. I believe it because I’ve seen it before.

Sometimes a memory is all I get to take with me.

My sister is great fun. Once when I was a teenager and she was living at home we had a particularly fun weekend. The following week I told her that I’d like to do it again. She told me it was fun but “those times are like bubbles, they last for a little while and then they pop. You can’t repeat them.” She was right.

Sunset and sunrises are beautiful, sometimes so much so that I can’t capture them in a picture. Even when I try the picture is so disappointing that I just delete it. There is a level of pretty that just doesn’t translate (at least not with an iPhone camera).

There are some things that so are beautiful that I can’t capture with anything but my mind, my memories. I get frustrated with the limits of my equipment and ability to share what I have seen, but that reminds me that some things, people, and experiences are meant just for me, not to be shared. The things that I keep for myself are the most precious.

Pink

I try to find something beautiful in every day. On days when I can’t accept beauty in myself, in others, or in the events of the day, I can find it in the sky. Even on a cloudy day. So, as the sun demands, I will stop and listen to what it has to say in its beautiful silence.

Summer Sunsets

I can’t deny it any longer.

Last week I turned off the air conditioning and haven’t turned on the heat. I do my very best to delay turning on the heat. I am not yet sure whether that is stubbornness, denial or both. But today there is a chill in the air inside the house.

Suddenly, every Saturday morning I regret my choice to not have cable. It is that one time a year when I miss ESPN, or maybe it’s just Kirk Herbstreit.

My white shoes, linen blazer and seersucker suits are dry cleaned and packed away, sadly, for months.

As I type, it is 42 degrees in Fort Wayne. Today’s high is 46 degrees.

It is fall.

In an effort to further my stubbornness and/or denial, I want so share my best of the summer sunsets.

There is not much better than a warm/hot/sweltering walk in the glow of the setting sun in bare legs and short sleeves. I am afraid that there won’t be any more of those until spring.

Indiana Sunsets:

Alaska, Arizona and Washington Sunsets:

Eating Gluten-Free on Carnival Cruise Lines

Traveling with celiac disease is a never ending challenge. Spending a week or more in a domestic or international location is difficult. You have to locate grocery stores, pack your food for the plane and beyond and research restaurants that have gluten-free menus or are rumored to cater to the needs of the gluten free. It is a lot of work.

Instead of requesting a gluten-free meal on the plane, I bring my own.

So, when my sister informed me that the 2014 family vacation would be an Alaskan cruise I immediately started spinning all the potential food-related nightmare scenarios. This was my first cruise.

We sailed on the Carnival Miracle for seven days out of Seattle with stops in Skagway, Juneau and Victoria. I shared the least dramatic of my worries with my sister and she assured me that she had made the necessary arrangements for me. I was to meet with Guest Services and then the maitre d’ to discuss my requirements. The Carnival representative assured my sister that they could safely feed me. My sweet sister then researched gluten free eating on Carnival cruises and she found a blog post by the lovely G-Free Laura. I felt better. I knew I would be worried until I was on the boat and talking to someone but this information helped.

I arrived in Seattle and enjoyed lovely gluten-free meals at Tom Douglas’s Lola, Anthony’s and Elliot’sOddfellow’s in Capitol Hill (I also recommend Elliot Bay Book Company while you are there), and Local 360, which is super awesome spot where everything on the menu is local. All these meals were lovely and gluten-free.

Then it was time to board the ship. The embarkation process took less time than I expected (considering there were over 2000 people aboard). We headed for Guest Services to request the partition between our rooms be opened and to talk about my dietary needs. Unfortunately, my record did not reflect that I needed a gluten-free accommodation, it only noted a special need. I took this as – they aren’t ready for me and I have to be perfectly honest, I was scared. Guest Services confidently advised me that all I needed to do was talk with the maitre d’ and it would be fine. I had packed enough food to eat one or two meals a day out of my bag, but I knew I needed at least one good meal a day from the kitchen. So, scared doesn’t really describe it, I had a minor meltdown.

We made our way to the dining room for our first meal. I met the maitre d’, Ken, at the door and explained what I needed. He promptly dispatched the lovely Jana to my table. I explained to her that I have celiac disease and would need a gluten-free meal. I went on to explain that I am medically required to have a gluten-free meal and that I am extremely sensitive. She was unflappable. She assured me immediately that they could accommodate my needs. In fact, because of my concern she offered to personally order and deliver my food herself since my server would be responsible for multiple tables of people. I happily agreed. She got me. To ensure that the kitchen would have time to specially (separately) prepare my meals I would need to order my meals a day in advance. So, every night at dinner I ordered my meals for the next day. It seems like it might be inconvenient, but I did not mind and it gave my family a preview of the next day’s offerings.

Our server, Damir, was helpful and a pleasure to be around. He understood my need and worked hard with Jana and the kitchen to make sure my meals came out at the same time as the rest of the table. This was a struggle on some nights, but they were aware and working on it. The kitchen is stocked with gluten-free bread and flour. So, many traditional items (sandwiches, French toast, pancakes, etc.) are available. I avoid all grains but rice when I am traveling, so I was slightly more limited and declined to eat the bread and flour-based items. Despite my more restrictive diet Jana was able to work with the kitchen each day to find something for me to eat that was interesting. I did eat a lot of steamed vegetables and plain meat – salmon, mahi mahi, flank steak, filet mignon and ribs. But I was also to have the seafood Newberg revised to meet my needs. Instead of the Newberg sauce they made a lemon butter sauce and put it over rice.

They were willing to go the extra step to help me enjoy my meal. As for dessert, the cream brulee and chocolate melting cake were my go-to items. Although, they did have other gluten-free choices. While dining room service was very good and accommodating, the room service and buffet offerings were off limits. I was specifically instructed not to order room service and as a rule I do not eat off buffets (too many changes for cross-contamination). So, on the ship my meals were restricted to what I brought onboard and eating in the main dining room. Know this ahead of time – eating is not a whenever-you-want-it-option unless you have a large stash of food in your cabin.

Chocolate Melting Cake

I was pleased with the attention and consideration that I was given by the dining room staff. They were genuinely concerned for me and they went out of there way to try to make my meals fun and interesting. It was not a perfect situation but the service was great and the food was better than expected. Tip your servers, maitre d’ and Jana. They deserve it.