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Celebrity Science PDF Print E-mail
Swift
Written by Harriet Hall   

tamyspeakerharhallThe current issue of Reader’s Digest has an article on “The Trouble with Celebrity Science.”  “What happens when stars weigh in on medical topics?...Celebrities may be perfectly qualified to evaluate sneakers, but that doesn’t mean you want to learn biochemistry from them.”

They mention Tom Cruise’s sweeping condemnation of modern psychiatry, then focus on…

 

Are you ready for this?....

  1. Woo-promoter extraordinaire Oprah Winfrey

  2. Anti-vaccine activist Jenny McCarthy (the one whose victims are listed on the Jenny McCarthy Body Count, and

  3. Gluten-free advocate Elisabeth Hasselbeck!!!

With regards to Oprah’s recommendations for bioidentical hormones, they point out that if you believe bioidenticals have all the benefits but none of the risks of pharmaceutical hormones, you believe in the tooth fairy. With regards to Jenny’s ravings, they clearly say vaccines save lives and do not cause autism and they stress that the science is not on Jenny’s side. Hasselbeck I wasn’t familiar with, but apparently she is famous from Survivor and The View and is gluten sensitive. She has written a book describing how she “discovered the myriad benefits that anyone can enjoy from a gluten-free diet: from weight loss and increased energy to even the alleviation of the conditions of autism.” Yeah, sure. Reader’s Digest says don’t bother with a gluten free diet unless you have been diagnosed with celiac disease or gluten sensitivity.

They even included a sidebar with 4 questions to ask before you buy into the latest health fad:

  1. Anecdote or evidence?

  2. How strong is the research?

  3. Who’s making the claim?

  4. Does it pass the smell test? (look for words like miracle and cure and conspiracy theories)

Reader’s Digest has published a lot of questionable medical information in the past. They might have written about “The Trouble with Celebrity Science and Reader’s Digest Science.” But they have partially redeemed themselves with this article. Finally, a popular mainstream publication that supports science and is not afraid to contradict Jenny – or Oprah!

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On the other hand...
written by HiEv, May 11, 2009
On the other hand, I've seen people dismiss perfectly legitimate claims simply because they were given by a celebrity. Brooke Shields spoke out quite accurately about postpartum depression (in spite of Tom Cruise's Scientology inspired attacks), Michael J. Fox on Parkinson's disease, and Christopher Reeve on stem cell research. And some people attacked their position on the issue primarily because it was a celebrity promoting it!

Celebrities do help bring more attention to things, so it can be a good or a bad thing. However, one shouldn't let the fact that it is a celebrity whom is promoting or attacking something be deciding the factor in whether you agree or disagree with that position. An argument should be judged on its own merits, not based on who is presenting it.
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written by Tonberry2k, May 11, 2009
I'm in college and my roommate is an art major. That major seems to attract all kinds of people who cling to fad diets (while smoking a pack a day, but that's another story). Can anyone tell me what a gluten-free diet is supposed to actually accomplish and why it's not worth pursuing? I'd like to let him know.
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written by janis1207, May 11, 2009
Don't you think its about time to question the "celebrity culture" itself?
How comes PR inflated actors, singers and talk show hosts (i.e. not exactly intellectuals) are the opinion makers of modern society? And is it any surprise then that we have ended up with masses on near-zombied people addicted to their TVs?
BTW, I can easily see the marks of celebrity culture in the skeptics society as well. What used to be a Skeptic newsletter now is some kind of Shermer show, for example.
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written by kenhamer, May 11, 2009
Don't you think its about time to question the "celebrity culture" itself?

You mean like "I'm not a doctor, but I play one on TV"?
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Celebrity Culture is the result of Evolution
written by Michael K Gray, May 12, 2009
The title says it all.
Humans have spent most of their eons in small tribes.
Where listening to those adults who garner the most studied attention pays dividends, in terms of survival.
Those who are famous and familiar on TV trigger the same innate tribal loyalty and respect mechanisms.
Thus the "Celebrity Culture" living off the back of the "Respect" Meme.
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written by MadScientist, May 12, 2009
@Tonberry2k: Maybe 'google' can help you - I'm sure there are myriad stooopid claims about what a gluten-free diet will do for you. People who are forced to stick to a gluten free diet have it pretty tough; there aren't many restaurants they can go to and they have to be so picky about what they eat when they go to a party - it's no fun. I've recently had sugar and other things whacked off my list of things to eat - that really sucks; I'm not allowed to have most of my favorite junk foods now and I can't make my chocolate cakes, hot sweet rolls, banana cakes and so on.

@Janis1207: I don't know why you'd say that; there are quite a few people who are all too happy to give Shermer a good kick now and then and they seem to just ignore the acolytes who hiss and spit back. The thing about being skeptical is that you've failed if you decide to simply believe what another alleged skeptic says; personally I see nothing wrong with Shermer even if I may disagree with him >60% of the time.

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written by CasaRojo, May 12, 2009
Hasselbeck's a gluten for punishment.
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Gluten free diets
written by Careyp74, May 12, 2009
Tom;
The Engineer I share my office with has celiac disease, so has to stick to a gluten free diet. I can tell you, the main reason why you would lose weight is because there isn't much processed food out there that does not contain some form of gluten, and the foods you can eat are not enjoyable. Basically, he eats out of necessity, and does not enjoy food the way everyone else gets to. Anyone that does not have to stick to a GF diet will surely not, even when trying to.

Readers Digest has printed some off the wall articles in the past, and probably will in the future. This particular article was surely the author's doing, and we can only hope to see more articles by that author in the future.
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written by LovleAnjel, May 12, 2009
@Tonberry2k

People with celiac disease cannot digest gluten, just like lactose-intolerant people cannot digest lactose in milk. Gluten is unfortunately in a lot of foods, since it's a natural part of many grains. People who can digest gluten suffer no ill effects from it. This to me falls under the same heading as people saying we should all eat low-GI foods because they work great for diabetics.
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In Hasselbeck's defense . . . .
written by Don Gwinn, May 12, 2009
. . . she apparently has real coeliac disease, so gluten really would cause symptoms for her. Where she falls down is in trying to apply it to everyone (do Cancer patients advocate that everyone get chemotherapy?)
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written by mazyloron, May 12, 2009
In Hasselbeck's defense...

...she's an idiot, so she doesn't realize how stupid the things that come out of her mouth really are. Where she falls down is in trying to tell everyone else to live their lives like she lives hers.

Seriously though, people with coeliac disease do have a rough time finding foods they can eat. Hasselbeck really does have it, so she does need to follow that diet. And, a side effect of it is that you'll lose weight, simply because you can't eat as much processed food. That doesn't mean everyone should eat that way. Like LovleAnjel said: we don't all eat like diabetics simply because diabetics are healthier when they eat that way. Same for lactose intolerance, or nut allergies, or any of that. Being on a narrow, restrictive diet of any kind does tend to make you lose weight. So does making healthy choices without banning entire food groups.

It would be nice if RD.com had this article. I'd like to read it, but I'm not super inclined to go out and buy the magazine just for the one article. Guess I'll be hanging out at the bookstore one night this week.
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written by NewCoaster, May 12, 2009
I have no idea if Elizabeth Hasselbach has gluten sensitivity, or Celiac disease. If she does, then a gluten free diet makes sense...though it is very difficult and expensive to do. If she is writing from the point of view of someone with a real disorder,offering advice that has been vetted by appropriate experts, fine. If she is promoting all sorts of other benefits such it cures autism, then she is firmly into pseudo-science/Jenny McCarthy land.
I find it difficult to put aside my dislike of her politics and religious beliefs and quasi-celebrity (she was annoying on Survivor, too) to take anything she says seriously.
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Gluten
written by Griz, May 12, 2009
Gluten occurs in wheat, barley, and rye. The list of foods that don't have gluten are myriad, and include corn, rice, all vegetables, all fruit, all meat, poultry, and seafood. I'm always puzzled when someone tells me that it's hard to eat well on a gluten free diet. Steak, mashed potatoes with butter, chives, and sourcream, and broccoli is a balanced, nutritious gluten free meal. If you're one of those people that's afraid of red meat, make it a piece of fish instead of a steak.

Is the world really that dependant on packaged food and restaurants? People nowadays seem so resistant to educating themselves about food, especially when it so directly imapcts their health.
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Where did Reader's Digest get the article?
written by wardenclyffe, May 12, 2009
Maybe I'm wrong, but doesn't Reader's Digest get all their articles from other publications? I thought that was their raison d'être. If so, where was the original article published?

Also, I assume that RD has promoted all of these pseudo-scientific ideas in the past. If we knew when and where, we could at least write a letter to them thanking them for this article, but then pointing out their past articles at the same time.

Ward
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written by The SkepDoc, May 12, 2009
No, Reader's Digest does not merely reprint articles from elsewhere. They have a lot of their own original material.
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It's ironic isn't it?
written by BillyJoe, May 12, 2009
This article is about incorrect infomation given by celebrities and here in the replies we have equally incorrect information given by sceptics.

So thank you, Griz, for this correct information:

Gluten occurs in wheat, barley, and rye. The list of foods that don't have gluten are myriad, and include corn, rice, all vegetables, all fruit, all meat, poultry, and seafood. I'm always puzzled when someone tells me that it's hard to eat well on a gluten free diet. Steak, mashed potatoes with butter, chives, and sourcream, and broccoli is a balanced, nutritious gluten free meal. If you're one of those people that's afraid of red meat, make it a piece of fish instead of a steak.


But, though she may be lovle as her name suggests, this is pure nonsense from this anjel:

People with celiac disease cannot digest gluten, just like lactose-intolerant people cannot digest lactose in milk.


Here is a link for those interested:
http://en.wikipedia.org/wiki/Coeliac_disease
(Wiki is not always correct, but it's pretty good on this one)

BillyJoe
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What a gluten-free...
written by DrMatt, May 12, 2009
Unless you are unable to digest gluten, the main benefit of a gluten-free diet is that if you are ever baked in a pie, your intestines won't puff up like baked bread.
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written by Diverted Chrome, May 12, 2009
@Tonberry2k

Many people have strange reactions to wheat. It's a food intolerance to the gluten. It's different than a food allergy. Those people can find their physical (and mental) health improved by a gluten-free diet. A wheat-free diet is damned hard to accomplish but is otherwise similar.
Gluten reactions can casue dark circles under the eyes, fatigue, continual headache episodes, failure to thrive, weight fluctuations, inability to concentrate, eroding of the immune system, increase in allergic reactions and more. An elimination diet can help pinpoint problems. Many people have this problem.

Then there's celiac disease, for which there's a test. It's anintentestinal disorder caused by the same food.

Both are very real and likely genetic. There are ways for specialists to find out if your roommate has one of these conditions but anyone can do elimination dieting on their own, if they're strict and organized about it. It can take a couple weeks.

@griz,
It may seem that way but try it. It's hard! Try enjoying a social life without going to restaurants, never eating cake, pizza, pastries, donuts, hamburgers, etc. Some can't drink beer, most have a cross-intolerance of eggs, milk or other foods in addition which means no ice cream, food sauces, and more on top of no restaurant or take-out food (because you can not be guaranteed of hidden ingredients; check the ingredrients of SYSCO products).

My autistic nephew reacts to grains, dairy and yeast. He gets so frustrated he just skips meals. It's getting easier only because society is learning/evolving.
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written by The SkepDoc, May 12, 2009
Tonberry said "anyone can do elimination dieting"
I'd just like to offer a caution. It would be better to have such a diet supervised by a professional. Double blind challenges would be even better, although they are difficult to do. It is very common for people to reach false conclusions when manipulating their own intake. For instance, patients who had a reaction every time they ingested aspartame failed to react when they didn't know they were getting it.
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written by MJG, May 12, 2009
Diverted Chrome wrote:
It may seem that way but try it. It's hard!


I second that. Several of my family members have coeliac disease and yes, it actually is quite a difficult diet to follow. Even aside from the obvious things like bread and other baked goods, you'd be surprised at how many foods use wheat in some way. Want a fish dinner? Better make sure it's not breaded. Want a meat dish? Better make sure it doesn't come in gravy that uses wheat flour as a thickening agent. Most beers are out. Simple things like a toast or bagel or muffin for breakfast are out. While going out to eat is the activity that requires the biggest adjustment, even home cooking requires some rethinking of how one prepares some pretty basic dishes. It's certainly not he worst thing in the world, but it does require some fairly major adjustments for the typical American diagnosed with coeliac disease, probably about on the same order as someone with diabetes must make.

On the other hand Careyp74 wrote:

The Engineer I share my office with has celiac disease, so has to stick to a gluten free diet. I can tell you, the main reason why you would lose weight is because there isn't much processed food out there that does not contain some form of gluten, and the foods you can eat are not enjoyable. Basically, he eats out of necessity, and does not enjoy food the way everyone else gets to.


Hmmm, while it can be a challenge at times, it's perfectly possible to thoroughly enjoy food and even dining out while observing a coeliac disease diet. There are now whole cookbooks and support groups and such dedicated to helping people with coeliac disease. Sure, you may not be able to eat the cake at the office party, but it's hardly as if one has to become some ascetic monk when it comes to enjoying food.

The first person in my family to be diagnosed actually put on weight after adjusting her diet. She had been wasting away due to the extreme digestive problems caused by the disease, and once she started on the proper diet she returned to a healthy weight. That was just her situation, others with genuine medical issues with gluten may have different reactions and situations. The point is, it's a medical condition that needs to be diagnosed, treated and monitored by a qualified medical doctor. Applying generalizations about gluten consumption outside of that context, as this Ms. Hasselbach seems to have done, is just an example of poor thinking.
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written by efedora, May 12, 2009
For those living in Chicago (or passing through) there is a good Italian restaurant with a gluten free menu. They even maintain a separate kitchen for gluten free dishes.
Da Luciano in Morton Grove.
http://tinyurl.com/oxtjsc
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Gluten free my ass
written by Richard Wolford, May 12, 2009
I have a condition called ankylosing spondylitis; a while back someone named Carolyn came to my blog and spat off a bunch of BS about how a gluten-free diet could cure me. Unfortunately, no amount of reasoning could show her otherwise, even when she failed to cite nothing more than anecdotes as evidence when I presented studies refuting her position. Why people believe stupid things is simply beyond me. For the record, I'm sticking with a well balanced diet and a regimen of indomethacin, my prescribed NSAID.
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@ Diverted Chrome: Still more misinformation!
written by BillyJoe, May 13, 2009
What the hell is going on in this thread?

Many people have strange reactions to wheat. It's a food intolerance to the gluten.

There are two distinct conditions involving reactions to wheat:
Coeliac Disease and Wheat Allergy.

Wheat Allergy is not an intolerance to gluten. It is an allergic reaction to one of the four proteins present in wheat. These proteins are albumin, globulin, gliaden and gluten. Most of the alergies actually involve either the albumin or globulin components and only rarely the gliaden or gluten components.

It's different than a food allergy. Those people can find their physical (and mental) health improved by a gluten-free diet. A wheat-free diet is damned hard to accomplish but is otherwise similar.

If you have Wheat Allergy, the treatment is a wheat free diet, though some need to avoid barley and rye as well.
If you have Coeliac Disease, the treatment is a gluten free diet which includes wheat, rye, barley and possibly oats.

Gluten reactions can casue dark circles under the eyes, fatigue, continual headache episodes, failure to thrive, weight fluctuations, inability to concentrate, eroding of the immune system, increase in allergic reactions and more.

Wheat Allergy can cause exercise induced anaphyaxis, rhinitis/sinusitis, asthma, urticaria, eczema, and migraine.
Coeliac Disease produces symptoms of due to malabsorption: cramps, bloating, diarrhoea, iron-deficinecy anaemia, Vitamin B12 deficiency anaemia, fatigue, and weight loss.

An elimination diet can help pinpoint problems. Then there's celiac disease, for which there's a test. It's anintentestinal disorder caused by the same food.

Wheat Allergy can be diagnosed by eliminating wheat (and gluten containing foods) from the diet.
Coeliac Disease can diagnosed with a blood test to detect antibodies or by genetic typing, but the definitive test is to find typical changes on biopsy of the duodenum. All these tests can become negative is gluten has already been removed from the diet.

Both are very real and likely genetic.

Coeliac diease is a genetic disorder and can be fairly reliably confirmed by means of genetic typing (98%)
There is no known genetic test for Wheat Allergy

There are ways for specialists to find out if your roommate has one of these conditions but anyone can do elimination dieting on their own, if they're strict and organized about it. It can take a couple weeks.

An self-applied Elimination Diet is an unreliable method for diagnosing both conditions. Even your specialist will not use an elinimation diet in order to diagnose Coeliac disease which, as I said previously, is diagnosed by antibody tests, genetic typing, or preferably by duodenal biopsy.

BillyJoe
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written by squonk, May 13, 2009
BillyJoe, I love you. You're clearing up a lot of confusion on this thread!! smilies/smiley.gif One error: genetic testing for celiac can confirm that you don't have celiac; about 30% of the population has the DQ2 and DQ8 genes connected with celiac, but just because you have that gene doesn't mean you'll get it. However, if you don't have the genes then it eliminates celiac as a possibility.

Another thing I have to argue with: food. For breakfast I had toast with peanut butter and jelly, lunch was thai chicken skewers with peanut noodles, a brownie cupcake, a salad, and dinner tonite will be lasagne. All Gluten Free. The number of GF products on the market now is amazing, and it isn't too hard to find decent substitutes for the common gluten-containing products out there, especially if you shop online. The problem is hidden amounts of gluten. One posted mentioned a simple meal, which sounds good..but did you know that some low fat sour creams have gluten-containing starches as thickeners? The problem we celiacs have is just finding normal products that don't contain hidden gluten, like in natural flavorings or food starches.

And yes, Hasselbeck does in fact have celiac disease, so she needs to follow the diet. I don't like her touting it as a 'cure all'!
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written by BillyJoe, May 14, 2009
squonk,

Thanks. smilies/smiley.gif

Regarding the DQ genes:
I think you are correct about the genetic test being used to eliminate the possibility of Coeliac disease. However, it is not quite true that the absence of these genes totally eliminates the possibility. About 2% of Coeliac Disease patients do not in fact have these genes.

regards,
BillyJoe
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written by Caller X, May 14, 2009
written by CasaRojo, May 12, 2009
Hasselbeck's a gluten for punishment.


I'd like to punish it.
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written by Caller X, May 14, 2009
Billy Joe...but the definitive test is to find typical changes on biopsy of the duodenum.


To paraphrase Dr. McCoy in Star Trek IV, drilling holes in his duodenum isn't the answer. That's 20th century technology, at least here in the civilized world. Maybe you roo-eaters do things differently.
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written by MJG, May 14, 2009
Another thing I have to argue with: food. For breakfast I had toast with peanut butter and jelly, lunch was thai chicken skewers with peanut noodles, a brownie cupcake, a salad, and dinner tonite will be lasagne. All Gluten Free.


Of course. When I said things like toast and muffins were "out", I meant the general, off the shelf wheat versions. There are substitute products out there, though they don't really have the same taste and texture, and are generally more expensive.
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written by Joreth, May 14, 2009
I was misdiagnosed with Celiac's several years ago. A woo-doctor put me on an elimination diet and decided, based on a very short testing period, that I had Celiac's, so I went on a wheat-free diet for 2 years. Eventually, I heard of the antibody test, got it done, learned I did NOT have Celiac's, and I went back to eating normally. I learned my lesson the hard way about blindly trusting authority figures.

The point here is to give a first hand anecdote as to just how hard a gluten-free diet is. It's not impossible, nor is it unappetizing. In fact, there are several products that I continue to eat simply because I like how they taste. But it's very, very difficult.

Salad dressings are out because they're all commercially made with vinegar. In the US, non-specified vinegar comes from wheat. This includes ranch and other types of dressing, because vinegar is an ingredient in mayonnaise and other products used to make the creamy-family of dressings.

All restaurant chefs have to be interrogated as to their cooking habits because oftentimes the same pans or grills will be used to cook breaded food and non-breaded food, so even if you order a steak, it might have been cooked on the same grill as a breaded chicken breast. Forget french fries in restaurants that also serve onion rings - they use the same pot of oil over and over again for both.

Plus, almost all meats in the US are covered with caramel food coloring to make it look more appetizing. Caramel food coloring uses wheat. So you actually have to look for "gluten-free meat", especially when eating anything with a sauce or gravy.

And, as someone said, sauces and gravies all use wheat flour to thicken them.

You can't lick envelopes (fortunately, it's much easier to find envelopes you don't have to lick nowadays) because the gum on the envelopes uses wheat in its formula.

Wheat and/or gluten is often used as a filler in medicine capsules.

Candy is often placed on conveyor belts and cooking surfaces that are dusted with flour to prevent sticking.

Now, all that being said, there are many products out there that are specifically gluten free, most often found in health food stores (so you have to put up with a fair amount of woo mixed in with your shopping). We found a gluten-free turkey for Thanksgiving. There are flour substitutes, and several cookbooks offer recipes for flour mixtures of multiple types of flour that can be substituted for wheat flour in most recipes with similar textures and properties.

Making food from scratch makes it a lot easier to watch your gluten intake, have good-tasting foods, and people are often healthier as a result simply because they're avoiding all the junk. For most people this translates to losing weight, but for a lot of Celiacs, it means adding weight because their conditions cause them to be underweight due to malnutrition. Plus, there is a high protein content in many gluten-free recipes, since eggs are used a lot to help imitate the texture of wheat flour. I dropped weight when I went on the diet (I was about 15 lbs overweight at the time) and my boyfriend gained about 10 lbs since he was underweight at the time and he went on the same elimination diet that I did.

Authentic Asian and Middle Eastern style foods use rice-based products, and the more expensive (often organic) pre-made foods will even forgo the usual caramel food coloring that is so popular in US products. Authentic South American food uses corn as its base instead of wheat. Many European-based foods, especially Eastern European, use potato as the base ingredient.

Basically, as long as you don't buy American, you can have a varied and tasty diet. The hard part is finding real non-American food. Restaurants and grocery products might claim to be an ethnic style or flavor, but they often use American ingredients, including that ever-popular caramel food coloring, so you really have to research where the ingredients come from and if they're using American packaging and preserving techniques.
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written by Joreth, May 14, 2009
I forgot to add 2 things.

1) Teriaki and soy sauce are also out unless you can read the ingredients and can verify the soy sauce used rice vinegar. Again, most American-made products use wheat vinegar and if they don't specify, it's wheat.

2) If you don't have Celiacs diease or a gluten allergy/sensitivity/whatever, then there's no good reason to be on a gluten-free diet. It won't do anything special and it's a royal PITA to have any kind of social life and try to eat out or visit friends' houses with this restriction. What it *will* do is simply make you pay more attention to what you're eating and make it much more complicated to get junk food, snacks and sweets, so you might be eating a healthier diet sort of by coincidence. But the absence of gluten itself isn't doing anything, it's the healthier diet that is doing something.
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written by BillyJoe, May 15, 2009
A definitive test is one which, if positive, is diagnostic of the disease being tested for. That does not imply that the test should be done in all cases.

BJ
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Celebrities, vaccines and gluten.....Oh my!
written by LuigiNovi, May 15, 2009
HiEv: Celebrities do help bring more attention to things, so it can be a good or a bad thing.
Luigi Novi: True. I think the the public tends to err on the side of being sympathetic, which is why they will be more likely to side with Fox, Shields and Reeve, not because the science is wrong, but because they don't want to feel unsympathetic to post-partum-suffering moms, the paralyzed, or people with Parkinson's, especially since many know people suffering from these things. I think it's for the same reason that some may sympathize with McCarthy. No one wants to appear unsympathetic to autistic kids, so unless they understand how to distinguish science from pseudoscience, it's not surprising that McCarthy will attract followers.

As for Hasselbeck, well, she's not the only idiot on The View who promotes crude, anti-intellectual ignorance in service of knee-jerk comments that garner audience reaction when they're spouted out in machine-gun fashion during one of their gabfests of overlapping voices. I can think of Joy Behar's condemnation of John Nash for his antisemitic comments, even though he made them while suffering from schizophrenia, Whoopi Goldberg's defense of Michael Vick due to her argument that dog fights are part of black culture, and my favorite, Sherri Shepherd's statement that she thought history began with the birth of Christ, and that the shape of the Earth is not something that was every important enough for her to consider. Apparently, that her son gets a proper education isn't important to her. Bottom line, no one on that show is particularly articulate or intelligent.
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There's no such thing as a definitive test
written by The SkepDoc, May 15, 2009
All tests have false positives and false negatives, not to speak of lab errors. Test results are not definitive and diagnostic in and of themselves, but are used in conjunction with many other factors to make a tentative diagnosis. One of the biggest considerations is the pre-test probability that the patient has the disease. My career in medicine taught me this lesson: never believe one lab test. Example: my mother was told she had diabetes based on one very high blood glucose reading. Subsequent tests were consistently normal.
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written by Caller X, May 15, 2009

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written by BillyJoe, May 15, 2009
A definitive test is one which, if positive, is diagnostic of the disease being tested for. That does not imply that the test should be done in all cases.

BJ


Okay, you prefer to cut a hole in someone's bowel, and I prefer to stick a tube up their butt. Who gets the results first, and whose patient has fewer complications?
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written by Caller X, May 15, 2009


written by Joreth, May 14, 2009
I was misdiagnosed with Celiac's several years ago. A woo-doctor put me on an elimination diet and decided, based on a very short testing period, that I had Celiac's, so I went on a wheat-free diet for 2 years. Eventually, I heard of the antibody test, got it done, learned I did NOT have Celiac's, and I went back to eating normally. I learned my lesson the hard way about blindly trusting authority figures.


Sometimes the slower students have to learn the hard way.



Plus, almost all meats in the US are covered with caramel food coloring to make it look more appetizing. Caramel food coloring uses wheat. So you actually have to look for "gluten-free meat", especially when eating anything with a sauce or gravy.


Not in any restaurant I've worked in nor any grocery store I've ever shopped in. If all your meat has caramel coloring, you're a fatso. Sorry about that.
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@ SkepDoc
written by BillyJoe, May 15, 2009
There's no such thing as a definitive test

Perhaps I meant "gold standard".
If the endoscopist finds the typical macroscopic changes and the pathologist comfirms the typical histological changes, that person surely has coeliac disease. Right?
If the clinical picture is unclear after clinical history and blood tests and there is still suspicion of coeliac disease, you would do a endoscopic duodenal biopsy right?

BillyJoe
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written by BillyJoe, May 15, 2009
Okay, you prefer to cut a hole in someone's bowel, and I prefer to stick a tube up their butt. Who gets the results first, and whose patient has fewer complications?

My doc will have the biopsy and your doc will have a dead patient.

BJ
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Even "gold standard" tests are not ideal
written by The SkepDoc, May 15, 2009
Yes, the "gold standard" test is the closest to a definitive test. But even they aren't perfect. Wikipedia puts it very well:
"A hypothetical ideal "gold standard" test has a sensitivity, or statistical power, of 100% (it identifies all individuals with a disease process; it does not have any false-negative results) and a specificity of 100% (it does not falsely identify someone with a condition that does not have the condition; it does not have any false-positive results). In practice, there are no ideal "gold standard" tests."

Pathologists must interpret biopsies and sometimes they read them wrong; or two pathologists will have a legitimate difference of opinion about what they are seeing on the slides. There are even cases where people were diagnosed with cancer and treated with surgery and chemotherapy, but a review of the original biopsy showed they never actually had cancer. The medical profession has to learn to live with a degree of uncertainty that laymen often can't appreciate.
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@ SkepDoc
written by BillyJoe, May 15, 2009
Yes, the "gold standard" test is the closest to a definitive test.

Okay, I am fine with that term then.

I don't disagree with anything you have said about uncertainty. As you say, there is no test that has a sensitivity and specificity of 100%. Medicine is science after all, and science, as we all know, is uncertain, and scepticism expresses this uncertainty.

However, with Coeliac Disease, the duodenal biopsy (macroscopic and microscopic changes) is as close as you're going to get, do you agree? Perhaps not necessary in all cases, but certainly the test to do if the diagnosis is in doubt or the clinical picture is confusing and Coeliac is in the differential. Do you agree?

Or would rely on the blood tests and the elimination diet?

BillyJoe
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written by The SkepDoc, May 16, 2009
Yes, the biopsy is the gold standard and I personally wouldn't want to commit to a lifetime of diet restrictions without it.
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written by Caller X, May 16, 2009
written by BillyJoe, May 15, 2009

Okay, you prefer to cut a hole in someone's bowel, and I prefer to stick a tube up their butt. Who gets the results first, and whose patient has fewer complications?


My doc will have the biopsy and your doc will have a dead patient.



In most cases, neither the endoscopy nor the celiac disease will result in death. Biopsy, on the other hand....

Once again you are talking ess through the back of your neck as you blow smoke through your hat.

'Roo-eater.
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written by Steel Rat, May 16, 2009
Hasselbeck's a gluten for punishment.


Oh no you di'en't!
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written by Steel Rat, May 16, 2009
People with celiac disease cannot digest gluten, just like lactose-intolerant people cannot digest lactose in milk. Gluten is unfortunately in a lot of foods, since it's a natural part of many grains. People who can digest gluten suffer no ill effects from it. This to me falls under the same heading as people saying we should all eat low-GI foods because they work great for diabetics.


Seems like more proof that humans are no longer evolving.
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written by BillyJoe, May 16, 2009
Let me just refer you to SkepDoc's answer, not that you should accept it uncritically just because she is a retired medic publishing widely and extensively in the area of medicine in which she keeps an ongoing keen and sceptical interest smilies/wink.gif:

Yes, the biopsy is the gold standard and I personally wouldn't want to commit to a lifetime of diet restrictions without it.

Also the perforation rate of duodenal biopsy is practically zero. But the differential diagnosis of Coeliac Disease includes conditions such as duodenal ulcer which can, not infrequently, result in haemorrhage or perforation.

BillyJoe
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Ah, please don't repeat that :(
written by BillyJoe, May 16, 2009
Steel Rat,

It has already been pointed out that the information contained in that quote is incorrect.

POSITED FACT: People with celiac disease cannot digest gluten.
STATUS: FALSE.
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written by Caller X, May 17, 2009
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written by BillyJoe, May 16, 2009
Let me just refer you to SkepDoc's answer, not that you should accept it uncritically just because she is a retired medic publishing widely and extensively in the area of medicine in which she keeps an ongoing keen and sceptical interest smilies/wink.gif:
To quote Tom Clancy: "You say so." I don't know her, I've never eaten her 'roo. How do I know she's not you? So nothing you say about her qualifications means anything.


Also the perforation rate of duodenal biopsy is practically zero.


I would say the rate is 100%, by definition.

How exactly do you do a biopsy without a perforation?

POSITED FACT: the perforation rate of duodenal biopsy is practically zero
STATUS: FALSE.
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written by BillyJoe, May 17, 2009
How exactly do you do a biopsy without a perforation?
By making sure you only do a biopsy and not a perforation smilies/wink.gif

BJ
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written by The SkepDoc, May 17, 2009
A biopsy removes a small piece of the inner bowel wall. It is not supposed to include the outer surface of the bowel. If it does, that constitutes a perforation, which is a rare complication of the biopsy procedure. A substantial percentage of these perforations will seal themselves without requiring surgery or resulting in any significant harm.
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written by BillyJoe, May 17, 2009
You're too generous SkepDoc.
I wanted him to look it up
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