Celiac Disease And Pregnancy Complications

I can think of few things more heartbreaking than infertility, repeated miscarriage and losing a child at birth.  Women in my family and in my close circle of friends have struggled with pregnancy complications and I know how difficult and painful it is.

There is a glimmer of hope that was just reported in the journal Human Reproduction recently.  Researchers in Denmark found that women who have undiagnosed celiac disease are at higher risk for infertility, miscarriage and stillbirth.

The good news is that if these women are diagnosed and treated with a gluten-free diet, their risk of pregnancy problems goes back to normal levels.  Knowing about this link between undiagnosed celiac disease and pregnancy complications may help women achieve the pregnancies and families they have always wanted.

So what is celiac disease?  Celiac disease is an autoimmune disorder triggered by eating the protein gluten, found in foods containing one or more of four grains.  The four gluten grains are wheat, barley, rye and spelt.

Eating gluten causes a reaction that harms the lining of the intestine and interferes with digestion and absorption of nutrients.  It increases the risk of cancer of the small intestine. Gluten intolerance also is associated with disorders in many other body symptoms, including the brain, skin, joints and cardiovascular system.  Turns out celiac disease also appears to affect the reproductive system.

Celiac disease is diagnosed by a combination of blood tests and endoscopy, and is treated with a strict gluten-free diet.  Even accidental intake of tiny amounts of gluten can trigger the disease.

I was diagnosed with gluten intolerance about 3 years ago and don’t know if I have celiac disease.  I might;  I’m not willing to eat gluten to confirm the diagnosis.  (Eating gluten-free can interfere with testing because antibody levels and changes in the intestine correct with avoiding gluten in the diet).

I probably have been gluten intolerant most of my life.  As I wrote before, major food intolerance (including gluten intolerance) is strongly associated with gallstone formation.  I had my gallbladder removed at age 19 because of gallstones.

Luckily I have not had any problems with fertility.  I was able to have my children when I wanted them and carried them without problems.  I want that for you and the women in your life!  If you or someone you love has been struggling with problems achieving and carrying a pregnancy please share this article with them.  Their doctor may not be aware of this newly reported link between celiac disease and pregnancy complications.

If you are considering getting pregnant please keep a few things in mind.  You need a prenatal vitamin BEFORE you are pregnant.  One that contains adequate amounts of folic acid, iron and iodine is crucial.  Don’t smoke, drink alcohol or use any recreational drugs while trying to conceive.  Also, you must manage your stress because too much stress can affect fertility.  (Heck it affects everything else, why not that, right?)

Please click this link for several articles about nutrition and pregnancy.

QUESTION: Do you know anyone struggling with infertility or pregnancy loss?  Would this information help them?


How To Talk To Your Doctor

Have you ever had the feeling that you just weren’t communicating with someone?  Have you felt like you were talking but the message wasn’t getting through?

Sometimes it feels like that with my patients, and I’m sure they sometimes feel like that with me.  Today I’d like to go over how to talk to your doctor.

First of all, it seems to go without saying, but you must be honest and forthright with your doctor.  We need to know what’s REALLY going on.  We need to know what, where, when, how long, what makes it worse, what makes it better, and what you’ve tried for whatever symptom you’re having.  The more information, the better, and if we ask specific, detailed questions, answer as completely and honestly as you can.

Believe me, we’re not being nosy.  (Well, I’m not.  I can’t really speak for EVERYONE, LOL.)  If I ask if you have pain in your vagina when having sex, or if you lose your erection during sex, there’s a reason for my question.  If I ask about your sexual history and past partners, it’s because it impacts your health in a big way.

When talking about a chronic condition, we need to know what you’re doing at home to take care of yourself.  Are you exercising, are you smoking (and WHAT are you smoking?), do you check your blood sugar or blood pressure and how often.  Please don’t tell me what you think I want to hear.  I want to know the truth, because it impacts the advice I will give you.

One more thing to be aware of when talking with your doctor is that if we ask you to do something you are NOT willing or able to do, you have to speak up.  I have had patients seem to agree with me, then just never come back.  There is always something we can do to move closer to your goals.  If you can’t do one thing, we can do something else.

For instance, if you have a medical condition that is not under control, and I want to change your medication to X and you’re not comfortable with that, that’s fine.  We can change it to Y instead.  Not doing ANYTHING isn’t really an option, but there are a variety of things we can do.  We need to decide together.  And if medication X causes a problem, I definitely need to hear about it ASAP!

You and your doctor are a team.  If you don’t think your doctor is listening to you, call them on it.  If they aren’t helping you, make sure they understand clearly what the problem is and what your expectation is.  Don’t lose a good doctor because of communication problems!

It all comes down to trust.  You need to trust that I hear you and have your best possible health as my goal.  I need to trust that you will tell me the truth, both when I ask for it and when I haven’t asked but need to hear it anyway.  Especially if you think I won’t like it.

QUESTION: Do you feel like you can talk to your doctor?  Why or why not?


CBD Oil – Is It Legal?

Lincoln is a young patient of mine who suffers with a number of medical problems.  He sees a host of physicians who haven’t had much success in controlling his symptoms.  Lincoln finds it very difficult to manage his life day-to-day.  He has a history of addiction problems and recently confided that smoking marijuana helps with his pain, his anxiety and with sleep.

I’ve advised him that, particularly as an asthmatic, smoking marijuana isn’t a smart idea.  At his last visit, he was proud to tell me that he had switched to using marijuana edibles rather than cigarettes, and was looking into CBD oil.  He assured me that CBD oil was legal to use in all 50 states and that it did not contain THC so there were no concerns about drug testing.

Is this true?

Well, in a word, no.  If it sounds too good to be true, it probably is, right?  Cannabidiol (CBD) oil from cannabis is legal over-the-counter only in states that have legalized recreational marijuana, and can be legally used by prescription in states that have legalized medical marijuana.  17 other states have CBD-specific laws, the list can be seen here on WebMD.

Hemp oil, which is legal, has only very small and inconsistent levels of CBD.  Most supplements don’t tell you what amounts of CBD are in them.  There’s a good reason for that.  According to the FDA, CBD oil cannot be sold as a dietary supplement.  Companies are hoping that by NOT labeling their products as containing CBD they will escape the FDA’s oversight.

I checked with Amazon and found a HUGE number of hemp oil supplements being marketed for reducing chronic pain, anxiety, insomnia and other symptoms.  THIS IS ILLEGAL.  As someone who markets supplements, I was cringing as I was reading the Amazon listings.  These companies are asking for HUGE fines from the FDA.

Another issue with CBD oil is that there is very little evidence that it works for anything.  The best evidence is for treating certain severe types of seizures, and in fact there is a formulation called Epidiolex which is working its way through the FDA approval process as a new drug.

There is only weak evidence for CBD oil helping anxiety, insomnia, chronic pain, inflammation or any other problem in humans.  Some animal trials have been done but they are of limited use.

Also, testing of CBD oils from cannabis showed over 60% of products didn’t have the amount of CBD shown on the label.  Some had more, some had less.  Worse, 20% of tested products were contaminated with THC, which is psychoactive (causing the “high”) and potentially causing positive drug tests.  Those who must take random drug tests as part of their employment should not use CBD oils.

CBD oils are not perfectly safe either.  It is fairly common to have increased liver enzymes, and the products can interact with medications too.

In Ohio, medical marijuana has been legalized but the infrastructure isn’t in place with dispensaries and training for medical personnel yet.  Everything is targeted to be in place later this year.  Presumably at that point those who are trained to prescribe medical marijuana will also be able to prescribe CBD oil for those who prefer a treatment with no risk of intoxication or dependence.

In the meantime it is important to remember these points:

  • CBD oil use without a prescription is against the law in states without legalized medical marijuana, recreational marijuana use, or special state provisions.
  • CBD oil cannot be sold as a nutritional supplement by FDA regulations
  • Hemp oil, which is legal, has very inconsistent levels of CBD and cannot be marketed with drug claims (such as reducing anxiety or pain or fighting cancer)
  • There is no consistent evidence that CBD is effective for anything other than intractable seizures
  • CBD has side effects of its own and can interfere with medications

QUESTION:  Have you or someone you love tried CBD oil?  What was your experience?


Injury Deaths Rise For Kids And Teens

What is the leading cause of death for children and teens?

If you said accidents, you’re right.  Injury is the leading cause of death for children over 1 year of age.  This includes accidents, homicide and suicide.  A recent troubling report from the CDC states that injury deaths are now on the rise among our kids and teens.

It used to be that kids mostly died from infections.  Pneumonia, measles, polio, influenza, strep throat, the list goes on.  As we got better at preventing and treating these illnesses, injury deaths became the leading killer of kids and teenagers.

We’ve been doing better with injury prevention.  Better automobile safety measures like seat belts and air bags have helped tremendously.  Injury deaths fell by 35% between 1999 and 2013.

Then they started to trend up again.  Injury deaths rose by over 15% from 2013 to 2016 (the last year for which data is available).

Why is this on the rise again?  All injury causes of death rose, including accidents, suicides and homicides.  Suicides are typically underreported and may be mistaken for accidental poisonings (especially opiate overdoses).

From reading this report, I have 3 takeaway points.


We have to help our kids cope with stress better.  I’ve written before about kids’ mental health issues.  Adolescence is hard no matter who you are or where you live, but some teens struggle more with it than others.

I’ve talked with more than one terrified parent desperate to protect their child and help them get and stay well.  I’ve wondered more than once if letting a teenager walk out of my office meant an unacceptable risk that I’d never see their face again except in an obituary photo.

It is critically important that we develop effective, easily accessed, and affordable mental health and substance abuse services that are designed for children and teenagers.  Our kids are killing themselves and each other, and we have to help them!


My son is learning to drive right now, so I KNOW just how hair-raising it is to have an impulse-control-challenged video game player with a serious social media addiction behind the wheel!  (Just kidding, my son doesn’t do social media accounts.  Texting, yes.  Instagram or Snapchat, no.)

The death rate from motor vehicle accidents for teens 15-19 is almost 6 times that of kids 10-14.  In Ohio teens learning to drive must not only participate in extensive driver training but they must also spend 50 hours behind the wheel driving with their parent or guardian.

We very sadly had a traffic accident locally within the last few years where a teen driver had her car overloaded such that not every passenger had access to a seatbelt.  She was driving unsafely, lost control of the car and a teenage passenger was killed.  More laws would not have prevented this needless death, but it serves to illustrate that teens don’t always make the best decisions when it comes to behavior behind the wheel.


Homicide and suicide by firearms are both on the rise.  Homicides of male children and teens increased by 25% from 2013 to 2016.  Homicides of female children and teens increased by a whopping 72%.  Suicides by firearms are overwhelmingly more common with boys, but rising in girls too.

Adults who own guns must keep them locked up and secure.  This is both a legal and moral responsibility and makes intuitive sense, but I think adults sometimes are as prone to impulse control problems and delusions of immortality as their teenage counterparts.

As a parent myself, and as a physician that cares for children and teens, the rise in injury deaths over the last few years is very concerning to me.  I will be keeping an eye on future reports and passing on recommendations to help keep my and your kids as safe as possible!

QUESTION:  Why do you think the injury deaths are on the rise for kids and teens over the last few years?


Tick Bites and Lyme Disease

It’s summertime!  Time to play outside, hike and swim and sail and kayak and camp and do all the fun things you love to do outdoors.

Say you and your family travel to Michigan to go camping and kayaking.  You’ve spent the day playing in a beautiful meadow with your kids and as you’re changing your 3-year-old into her pajamas you find this in her armpit:

Credit: www.co.ontario.ny.us

Credit: www.co.ontario.ny.us

What do you do?  (Aside from panicking and calling the doctor, LOL.)

This is an Ixodes tick, commonly called a deer tick.  It is this species that transmits Lyme disease.  Luckily this particular tick has NOT fed from your toddler, so she is safe from Lyme disease.

What if it HAD fed and completed a blood meal?  Well, then it would look like this, with a swollen, grayish-blue abdomen:

Credit: www.pbase.com

Credit: www.pbase.com

In this case, your child would need to see the doctor to be treated with antibiotics to prevent Lyme disease.  Luckily Lyme is preventable if treated early.

What if you hadn’t noticed your child had a tick, if it had fed and dropped off?  Lyme disease begins with a bullseye rash that can be easy to recognize.

Credit: www.webmd.com

Credit: www.webmd.com

Sometimes it doesn’t look exactly like this, so if you’ve been out in the woods and see a rash, it’s reasonable to see the doctor to be checked out.  Here are some other examples of how it might look.

Credit: www.bayarealyme.org

Credit: www.bayarealyme.org

Along with the rash (which happens 70-80% of the time), patients generally develop fever, chills, body aches and other flu-like symptoms.  This usually happens a few days to a few weeks after the tick bite.

If not treated, Lyme disease can go on to cause swollen, painful joints (especially large joints such as the knees), neurological problems such as headaches, heart problems, eye problems, and other less common symptoms.

Even though Lyme disease is treatable with antibiotics, it’s much better to avoid tick bites and being infected in the first place.  If you’re going to be in the woods or in grassy areas near the woods (where ticks are likely to be found), wear long sleeves and long pants.  Tuck your pants into your socks and your shirt into your pants so ticks will have a hard time getting to your skin.

After you’ve been outside where you might have been exposed to ticks, check your clothes carefully to remove any ticks.  Wash those clothes to get rid of ticks you might have missed.  Check your body carefully, especially the scalp and any skin folds (ticks like places that are warm, moist and dark).  Check every member of the family thoroughly, including four-legged ones.  Shampoo your hair to dislodge any hitchhikers.

Since a tick must take its blood meal before it can transmit Lyme disease, you have time to find and remove it.  If a tick doesn’t come off easily, put olive oil or another cooking oil on it.  They have pores in their shells that allow them to breathe.  They will let go before they suffocate.

Cleveland itself is not considered a high-risk area for Lyme disease, but we’re not far from areas that ARE considered high-risk.  This is projected to be a bad year for deer ticks and Lyme disease.

Credit: www.cdc.gov

Credit: www.cdc.gov

If you’re traveling it’s good to know how to stay safe!

QUESTION: Have you ever found a tick on yourself or a family member?