So, what is fact and what is fiction?

Gluten Intolerance Versus Gluten Sensitivity

Gluten intolerance is due to a condition called celiac disease. Celiac disease is a genetically predisposed autoimmune disorder in which the ingestion of gluten leads to damage in the small intestine. Common symptoms of celiac disease include brain fog, depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue after eating gluten.

It is estimated that celiac disease affects 1 in every 100 individuals worldwide, but millions are unaware that they have the condition. In the United States alone, 2.5 million men, women and children have undiagnosed celiac disease. 

People who suffer from symptoms that seem related to gluten may have a condition referred to as non-celiac gluten sensitivity. This means that they may experience similar symptoms of celiac disease, but ingesting gluten does not damage their small intestine in the same way. Studies estimate that 18 million Americans have non-celiac gluten sensitivity. That is six times the number of Americans who have celiac disease.

How is Celiac Disease Diagnosed?

Celiac disease can be detected by a simple blood test that screens for celiac disease antibodies. The most common test is called the tag-IgA test. For this test to be effective, the patient must be eating a diet including gluten at the time the test is administered. If the blood test results suggests celiac disease, the doctor will make a referral to a gastroenterologist.

The gastroenterologist will perform an outpatient procedure called an endoscopic biopsy of the small intestine to evaluate whether the patient has tissue damage related to gluten. A diagnosis of celiac disease can be confirmed when there is evidence of healing due to a gluten-free diet.

If you are experiencing symptoms related to celiac disease, call your gastroenterologist for an appointment. 

Gluten is what provides the elastic texture of bread, and it helps certain foods maintain their shape. Think of it as the “glue” that holds food together.  

Gluten can be harmful to those with Celiac disease because the protein causes inflammation and damage to the small intestine, the location in which the body absorbs vitamins and essential nutrients from food. Malabsorption can result in malnutrition, weight loss, anemia and stunted growth.

Gluten Intolerance Symptoms

There are over 200 identified symptoms of celiac disease, which means that every case is unique. An estimated 1 percent of the U.S. population is allergic to gluten, but 83 percent of those individuals are undiagnosed.

So how do you know if you may be allergic to gluten? Some of the most common symptoms include:

• Abdominal pain
• Gas
• Bloating
• Diarrhea
• Nausea
• Feeling tired or foggy
• Migraine headaches
• Dizziness and feeling off-balance
• Inflammation, pain or swelling in your joints
• Anxiety, depression and mood swings
• Hormone imbalances
• Diagnosis of chronic fatigue or fibromyalgia

How Gluten Allergy is Diagnosed

Many digestive conditions can present similar symptoms, so it is important to make an appointment with your doctor or gastroenterologist for proper testing. Celiac disease cannot be diagnosed by answering an online questionnaire or by eating a gluten free diet.  It must be diagnosed by a healthcare professional through a blood test.

There are several types of blood tests that screen for celiac disease antibodies, but the tTG-IgA test is the most common. For the test to be effective, you must be consuming gluten. If celiac disease antibodies are present in your blood, your doctor may order a biopsy of your small intestine to confirm whether you are allergic to gluten.

Non-Celiac Gluten Sensitivity

Some people experience symptoms of a gluten allergy but do not have celiac disease. This is often known as non-celiac gluten sensitivity. Although the two conditions share similar symptoms, non-celiac gluten sensitivity does not cause intestinal damage. Research estimates that 18 million Americans have gluten sensitivity, six times the number of Americans who have celiac disease.

Make an Appointment with Your Doctor

Remember that celiac disease is a serious medical condition. If you have symptoms, do not ignore them. Make an appointment with your doctor. Working with your primary care physician, a board-certified gastroenterologist and a registered dietician can help you obtain an accurate diagnosis and prompt treatment.

February is American Heart Month, and whether you are battling heart disease or not, it is the perfect time to evaluate your diet and make some healthy changes that are good for both your heart and your colon.

A sedentary lifestyle increases your risk of heart attack, stroke and colon cancer, but exercise gets your blood pumping and your digestive tract moving. Find an activity you enjoy and commit to exercising regularly. Aim for slow but consistent workouts. Avoid the weekend warrior mentality that often results in injury or burnout.

To Support Heart and Colon Health Through Exercise:

• Take a 20-minute walk
• Find a yoga class
• Go for a swim
• Take a hike
• Play tennis or racquetball with a friend
• Lift weights
• Find a dance class

Obesity is another risk factor for heart disease and colon cancer. In the U.S., 70 percent of adults are overweight or obese due to overconsumption, especially of foods that are high in saturated fats (American Heart Association). What you eat and how much you eat affects your risk of both heart disease and colon cancer.

• To Prevent Heart Disease and Colon Cancer Through Diet:
• Use an app like My Fitness Pal to track calories, fat and macronutrients
• Fill at least half of your plate with fruits and vegetables
• Limit red meat consumption to once a week as it may increase heart disease and colorectal cancer
• Load up the rest of your plate with whole grains, nuts and lean proteins
• Avoid processed foods like chips, cookies, ice cream, cake and doughnuts
• Read labels and watch sodium intake
• Monitor your portion sizes using a food scale or measuring cups
• Bulk up on fiber-rich foods (SCCN)

Why Eating Fruits and Vegetables is Good for Your Heart and Colon

We all know that fruits and veggies are good sources of vitamins and minerals, are high in fiber, and are low in calories, but did you know that they also contain nutrients that may actually prevent heart disease? Research shows that people who eat more than five servings of fruits and vegetables a day have about a 20 percent lower risk of heart disease and stroke than people who ate less than three servings a day (Time). Here are some ways to increase your veggie intake:

• Make fruits and vegetables the main course of your meals
• Try vegetable stir-fry, vegetarian fajitas, burrito bowls, roasted or grilled veggies, soups and salads
• Avoid canned fruits and vegetables and opt for fresh or frozen ones instead
• Prepare and refrigerate fruits and vegetables for convenient and healthy snacks
• Check out our Colon-Healthy Recipes board on Pinterest for heart-healthy fruit and veggie recipes

This month, work to prevent heart disease and colon cancer by boosting your activity level and improving your diet. Your heart (and your colon) will thank you!

Why is There a Disparity in the Risk for Colon Cancer?

Studies reveal that the higher incidence of colon cancer in African Americans is likely due to factors such as reduced access to healthcare and insurance and limited knowledge regarding the benefits of screening. African Americans are less likely to get a colonoscopy and to be treated for colon cancer than other racial groups. Because of this, colon cancer rates are 25 percent higher and mortality rates are 50 percent higher in African Americans compared with Caucasians.

When to get Screened for Colon Cancer

In 2005, The American College of Gastroenterology published new guidelines stating that colon cancer screening of African Americans should begin at age 45 due to statistics regarding incidence and survival. Most adults who are at average risk for colon cancer should get screened for colon cancer at age 50, but family history or personal history of polyps or colon cancer could also affect screening age.

Colonoscopy Offers the Best Protection Against Colon Cancer

Colonoscopy is the gold standard for colon cancer screening because it can detect and remove growths called polyps before they become cancerous. Other types of screenings such as fecal occult blood tests or double contrast barium enemas are designed only to detect cancer. A colonoscopy is the only screening that can both detect and prevent colon cancer.

You Can Affect Your Colon Cancer Risk

The most effective way to reduce your risk of colon cancer is to make colon-healthy choices every day like avoiding smoking, limiting alcohol, eating a high-fiber and low-fat diet, and being physically active. With routine screening, nutritious diet and regular exercise, colon cancer incidence and mortality can decrease significantly. So take steps to reduce your chance of colon cancer today.

That does not have to be true, however. Breakfast, lunch and dinner can be both enjoyable and heartburn-friendly if you know which foods to incorporate into your diet. 

Heartburn can flare when your stomach produces too much gastric acid, and your food choices can directly affect this. Here are three meals that incorporate heartburn-reducing foods that your stomach will appreciate.

Oatmeal and Wheat: Try Whole Grains for Breakfast

Oatmeal has been a whole-grain breakfast favorite for generations. It is a good source of fiber, so it keeps you feeling full and promotes regularity. Oats also absorb stomach acid and reduce symptoms of gastroesophageal reflux disease (GERD). For something sweet, top your oatmeal with bananas, apples or pears. The fructose in these fruits is less likely to trigger acid reflux than other sugars. Of course, eating oatmeal every day could get boring, so switch things up with a warm bowl of Cream of Wheat, or some whole grain toast with peanut butter.

Avoid coffee and most teas that contain caffeine, which can cause heartburn. Instead, brew a soothing cup of ginger tea. Ginger has natural anti-inflammatory properties that will help regulate acid production.

Vegetables: Add Some Color and Nutrients to Your Lunch

Vegetables are low in fat and sugar, which makes them stomach-friendly and healthy. Foods that are high in sugar or fat can be difficult to digest and can spike acid production. Some veggies that reduce heartburn include cucumbers, leafy greens, broccoli, green beans, potatoes, asparagus and cauliflower. 

Try these options for a light and tasty lunch:

• ​Baked potato with steamed broccoli 
• Mixed green salad with fresh-cut vegetables and a light oil and vinegar dressing (apple cider vinegar is known to help control heartburn)
• Veggie wrap or veggie quesadilla

Lean Proteins and Healthy Fats: Accents to a Delectable Dinner

​​Lean proteins like legumes, beans, chicken, turkey, fish and seafood are low in fat and help regulate stomach acid production. Instead of using oil to pan fry or deep fry foods, use healthier cooking methods like grilling, poaching, roasting and baking. Avoid making meat the main component of your dinner. Instead, see it as an accent or an accompaniment to a bed of greens, roasted vegetables, brown rice or fresh fruit.

​​Not all fats are unhealthy, so indulge in the good fats contained in nuts, seeds, avocados and olive oil. You can reduce your saturated and trans fat intake by substituting healthy monounsaturated fats (source: Health Line).

​​Remember that one of the best ways to control heartburn is to make thoughtful and healthy food choices. These options for reducing symptoms should provide some ideas and encouragement for your journey to find heartburn relief.

On the other hand, it could be something seemingly unrelated.

The thyroid gland is a small, butterfly-shaped gland located in the front of the neck. It is responsible for making and distributing thyroid hormones, which regulate metabolism and help the body use energy. When the thyroid gland is not functioning properly, it can cause a wide range of problems including digestive issues. Many people with chronic gastrointestinal problems cannot find relief because they have an undiagnosed thyroid condition.

Hyperthyroidism, or too much thyroid hormone in the body, causes bodily functions to speed up. Common symptoms of hyperthyroidism are a racing heart, nervousness, hand tremors, anxiety, difficulty sleeping and an enlarged neck. Digestive symptoms of an overactive thyroid can include difficulty swallowing, vomiting, diarrhea, lactose intolerance, liver problems, H. pylori bacterial infection and weight loss.

Hypothyroidism, or too little thyroid hormone in the body, can cause the body’s processes to slow down. This may cause symptoms such as fatigue, dry skin, depression, constipation, forgetfulness and weight gain. Digestive symptoms of an underactive thyroid can include dyspepsia (chest pain), low stomach acid, poor absorption, constipation, gallstones, anemia and bacterial overgrowth in the small intestine.

The thyroid gland can have a significant impact on the gastrointestinal system. A common misconception is that diet causes chronic digestive trouble and weight changes, but this may be an oversimplification. Thyroid conditions and their resultant symptoms are often complex and require ongoing treatment by an endocrinologist.

January is Thyroid Awareness Month, so make an appointment with an endocrinologist or gastroenterologist if you think you may have a thyroid condition. According to the American Association of Clinical Endocrinologists, an estimated 27 million Americans have thyroid disease, and about 13 million cases are undiagnosed. One appointment may provide the necessary insight to alleviate your digestive problems and put you on the road to better health.

Overexposure to gastric acid causes cellular changes in the esophageal lining, and this can be a precursor to esophageal adenocarcinoma.

If you have Barrett’s esophagus, it is important to manage your condition with the help of a board-certified gastroenterologist. Less than one percent of patients with Barrett’s esophagus develop esophageal cancer, but cancer of the esophagus is aggressive and difficult to treat. For this reason, researchers are committed to learning more about how Barrett’s esophagus develops so they can diagnose it earlier.

A team of researchers from Columbia University Medical Center (CUMC) recently made an exciting discovery: the “cell of origin” for Barrett’s esophagus. Jianwen Que, M.D., Ph.D., associate professor of medicine at CUMC, and Ming Jiang, Ph.D., associate research scientist in CUMC's Department of Medicine, led the study. Using genetically altered mice that were predisposed to Barrett’s esophagus, the research team examined the gastroesophageal junction tissue for changes. The gastroesophageal junction is a specific place where the esophagus and stomach join, and this area is especially susceptible to GERD inflammation and damage.

Dr. Que and the team discovered an area of the gastroesophageal junction that had a high concentration of unique basal progenitor cells. These cells are similar to stem cells and can specialize into various types of specific cells.

Now that the team knows where to find the Barrett’s esophagus cell of origin, this new knowledge could streamline Barrett’s esophagus diagnoses. In the past 40 years, esophageal adenocarcinoma has increased by 800 percent, making it the fastest growing form of cancer in the United States. Early diagnosis and immediate intervention is imperative because esophageal cancer advances rapidly. Currently, only 20 percent of patients survive longer than 5 years after diagnosis (Source: Medical News Today). Improving Barrett’s esophagus detection and treatment could impact esophageal adenocarcinoma rates.

Instead of contributing your hard-earned dollars toward a healthcare network account which pays for thousands of people of varying degrees of health, you can invest that same money, tax-free, into your HSA for your own medical costs and even earn interest.

What is an upper endoscopy?

Monthly contributions to your HSA can help pay for necessary tests and procedures like an upper endoscopy. Also known as esophagogastroduodenoscopy (EGD), this procedure is used to determine the cause of gastrointestinal disorders and symptoms including:

• Acid reflux
• Gastroesophageal reflux disease (GERD)
• Heartburn
• Swallowing difficulties
• Upper abdominal pain

Why might you need an endoscopy?

An upper endoscopy is used to diagnose or treat conditions of the upper digestive tract. This procedure is performed by a gastroenterologist – a doctor who specializes in digestive conditions. Gastroenterologists perform upper endoscopies to:

• Investigate the cause of symptoms – Upper endoscopy can help determine the cause of nausea, vomiting, upper gastrointestinal bleeding, upper abdominal pain or difficulty swallowing.
• Diagnose conditions – Upper endoscopy can be used to confirm or rule out conditions of the upper digestive tract. Tissue samples may be sent to a lab for biopsy.
• Treat symptoms – Your gastroenterologist can use tools to perform procedures during upper endoscopy. This may include esophageal dilation, removal of polyps, removal of foreign objects or cauterization of blood vessels.

How much does an upper endoscopy cost?

There are many factors that can influence the cost of an upper endoscopy, so it is imperative that you do your homework beforehand. These factors include:

• Medical code — The cost of an upper endoscopy will be influenced by how the procedure is coded. Medical codes are used to describe diagnoses and treatments and help determine costs and reimbursements. Request the Current Procedural Terminology (CPT) code from the doctor who is ordering the test. You will need it later.
• Your doctor and facility of choice — Choosing an in-network gastroenterologist and an in-network facility will save you money. Also, consider having your procedure done at an ambulatory surgery center (ASC) because it is often less expensive than a hospital.
• Timing of your procedure — If you have not met your deductible, you will be responsible for the charges for the upper endoscopy. If you have already met your annual deductible, your insurance may cover the procedure, but you may still be responsible for some cost-sharing.

Questions to ask your insurance company before you schedule an upper endoscopy

Before scheduling an upper endoscopy, you should make a list of questions to ask your insurance provider to determine your financial responsibility. These questions include, but are not limited to:

1. My doctor has ordered an upper endoscopy for me. The CPT code is _______. Would you please tell me how close I am to reaching my annual deductible?
2. My doctor suggests that I have Dr. __________ perform my procedure. Is Dr. ___________ in-network and covered under my policy? What other gastroenterologists in my local area are part of my network? I would like to call them and price compare using the CPT code.
3. Is ______________ [your preferred hospital or ambulatory surgery center] in-network and covered under my policy?
4. I know that if a biopsy is needed, this will be an additional cost to me. What cost should I anticipate if this is needed? What other out-of-pocket costs should I inquire about when calling these gastroenterologists?

Shop around for the best price for your upper endoscopy

Now that you have this information, you can begin comparing costs among gastroenterologists and facilities in your area. Cost for an upper endoscopy can vary widely, even within a small radius, so take your time and call several providers. Make sure to look at physician ratings and reviews and make them an equally important component in your decision-making process. You may have to call your insurance company back and ask them additional questions before making your final choice. 

Use your HSA funds

Before you call your doctor of choice to schedule the upper endoscopy, look carefully at your HSA and verify that you have enough funds in your account to pay for the procedure. If you do not, you can speak to the billing office about a payment plan.

With some careful budgeting and planning, you can schedule your endoscopy knowing that you are getting quality care at the most reasonable price. HDHPs with HSA gives you flexibility and choice so you can make informed decisions about your healthcare.