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Ask a dietitian - Gut health, celiac disease, and gluten intolerance.

In my practice, I work with people with digestive issues all day long. In the natural medicine world we often say that "health starts in the gut" and we often joke with each other that folks will come in for a skin rash or hormones, or something that seems totally unrelated to digestion, but we always find a way to connect it to their gut.

And that is for a good reason! Your digestion is really the foundation of your whole body's health. If you don't digest and absorb your food and nutrients, as well as detoxify and excrete the waste efficiently, then NOTHING in your body is going to work properly.

I have been lucky enough to work with some really amazing practitioners throughout my career, and one person who I lean on again and again for resources and clinical gems when it comes to gut health, is Registered Dietitian Jess Pirnak from Food Yourself.

1. Tell us a little about you and Food Yourself? What kind of work do you do as a Registered Dietitian? Hi I'm Jess! I'm a Registered Dietitian and Certified Wellness Coach based in Vancouver, where I grew up. My passions are prevention, education and creating a healthy community, so you'll find me consulting, writing and speaking on a variety of topics.

In addition to my nutritional consulting business (Food Yourself), I am the in-house dietitian advisor for the Canadian Celiac Association British Columbia, one of the Directors behind the app "MyHealthyGut" and a Clinical Instructor at UBC.

Before entering the dietetics world, I received my psychology degree from SFU and while at school for psychology my favourite book (that I still come back to for a laugh) is "All Families are Psychotic" by Douglas Copeland because all families are a little wacky.

2. What is your main focus in your clinical practice? Why do people seek you out? My clientele mostly consists of adults struggling with a range of health related issues but I'm one of the few dietitians with a practice focused on gut health and celiac disease. Celiac disease runs in my family and even though I don't have it now, I might in the future. My goal is that everyone I work with leaves feeling inspired and empowered to eat real food and have energy to enjoy life. I think people seek me out because of my background in retail as a supermarket dietitian. Where we met! Understanding the natural food sector and the importance of a sustainable food system is an amazing skill to have in this field. But I also integrate the coaching framework with nutrition counselling to support my clients reach their health goals, which makes me a little different from other dietitians. 3. I work with a lot of folks with gut health issues as well. What are your top 3 basic changes that you suggest to help people who suffer from digestive problems? Only 3? Haha Take a good probiotic! My favourite tool for selecting a probiotic, if you live in Canada or the US, is called Probiotic Chart. Each year, they independently review all of the probiotics on the market to assess the level of evidence and serve it up in a fairly easy to read chart. I recommend you take a peek at what is available and if you can, stick to the products with level I or II evidence. Add more fibre to your life! Getting fibre intake up is important…but can also cause some extra gas and bloating as your body gets used to it. Add in fibre slowly to allow your digestive system time to adjust AND ensure that you drink plenty of water so that it doesn’t constipate you. And last try to relax! Do not underestimate the deep connection between the brain and the gut. In addition to food and supplements, maintaining a commitment to stress relief and positive visualization of healing can be incredibly beneficial. 4. Talk to me a bit about celiac disease as I know this is a major focus in your practice. What kind of advice would you give to someone who is newly diagnosed with celiac disease? Great question! Celiac disease is serious! It is an autoimmune disease where the body reacts to gluten, meaning gluten consumption causes damage to the surface of the small intestine and can result in malnutrition, anemia, nutritional deficiencies and an increased risk of other autoimmune diseases and some cancers of the gut. This is why it is so so so important to follow a strict gluten-free diet. I know it can be overwhelming and frustrating, but the best thing you can do for yourself is to follow a strict gluten-free diet!

5. Can you touch briefly on the difference between celiac and non-celiac gluten intolerance? Do you believe that this is even a thing? Yes it's a thing! Non-celiac gluten sensitivity isn't celiac disease. It isn’t a fad either...but that doesn’t mean that the diagnosis is free of controversy. Non-celiac gluten sensitivity (NCGS) is an inability to tolerate gluten that does not produce damage to the gut lining or barrier function - although symptoms may be similar to celiac disease. One of the most controversial aspects of non-celiac gluten sensitivity is that no specific tests exist. Typically, NCGS is diagnosed following an exclusion of all other possible diagnoses, and a gluten elimination and blinded challenge. There is still so much to learn: Research is conflicting on the presence of low grade inflammation and gut barrier integrity in NCGS. Some studies suggest that non-celiac gluten sensitivity may be related to a low grade inflammatory response to partially digested gluten fragments. 6. Is there anything else we should know? I would love to see dietitians added to more extended health benefit packages because food, nutrition and health is so important! And I want you to have access to a dietitian! So, if you have a moment, call your insurance provider and ask them to add 'dietitian' to the list of health practitioners. Every phone call makes a difference!!

Thanks so much Jess, it is so great to have you as a resource. If people want to know more or follow you on social media, where can they find you?

This is me:

Check out Jess for amazing resources on gut health, celiac disease, and plant-based nutrition :)

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